瑞芬太尼复合右美托咪定控制性降压在颅内动脉瘤栓塞术中的应用

目的探讨瑞芬太尼复合右美托咪定在颅内动脉瘤栓塞术中的的临床应用。方法 60例颅内动脉瘤患者,随机分为实验组(D组)和对照组(C组),每组30例。2组均静脉注射芬太尼5μg/kg、丙泊酚1.5mg/kg、咪达唑仑0.1mg/kg和维库溴铵0.1mg/kg进行全麻诱导;采用异氟醚吸入并微量泵注丙泊酚、瑞芬太尼,间断注射维库溴铵进行麻醉维持。放置弹簧圈前开始进行控制性降压,D组以右美托咪定0.4μg/(kgh)持续泵注辅助控制性降压,C组持续性泵注生理盐水0.1μg/(kgh)。记录患者麻醉诱导前(T0)、诱导后(T1)、颅内动脉瘤栓塞前(T2)、栓塞后(T3)和拔管时(T4)各时间点的HR和MAP;记录患者是否出现不良情况。结果 D组控制性降压诱导时间和血压恢复时间长于C组,血压较C组稳定(P0.05);D组丙泊酚、瑞芬太尼用量较C组明显减少,患者未见体动、寒战不良反应。结论瑞芬太尼复合右美托咪可有效用于颅内动脉瘤栓塞术中的控制性降压。     

右美托咪啶联用对老年缺血性脑血管病的作用对照研究

目的探讨联合应用右美托咪啶对老年缺血性脑血管病患者全麻术后认知功能的影响。方法选择2013-06—2016-06行全麻手术的老年缺血性脑血管病患者80例,根据随机数字表法分为异氟烷组(A组)、异氟烷+右美托咪啶组(B组)、七氟烷组(C组)、七氟烷+右美托咪啶组(D组),每组20例。麻醉前B组与D组静脉泵注右美托咪啶,A组与C组则以等量9g/L盐水替代右美托咪啶以相同方法静脉泵注。麻醉维持时A组与B组吸入异氟烷,C组与D组吸入七氟烷。观察术后认知功能,测定MMSE评分;并记录各组术前(T0)、插管后(T1)、手术关腹前(T2)、术后(T3)的HR、SBP、DBP、MAP、PetCO_2、SpO_2的变化。结果各组术后MMSE评分比较,4组术后1d、3d各组MMSE评分均较同组术前1d明显降低,差异均有统计学意义(P均0.05)。术后1d、3dB组较A组评分高,C组较D组评分高,差异均有统计学意义(P均0.05)。各组不同时间点生命体征指标比较,4组在插管后HR降低,与术前比较,B、D组HR值在插管后、关腹前、术后均明显下降(P均0.05);A、C组分别与B、D组比较,HR值在插管后、关腹前、术后均明显升高(P均0.05)。4组在插管后SBP、DBP均明显降低,直到手术后慢慢上升,术后A、C组明显升高,高于B、D组(P均0.05)。结论联合应用右美托咪啶,可减少麻醉性镇痛镇静药的用量,降低POCD的发生率,且有保护脑细胞的作用,可改善老年缺血性脑血管病患者术后的早期认知功能。     

右美托咪定滴鼻对颅内动脉瘤介入治疗全麻拔管期血流动力学的影响

目的 观察右美托咪定滴鼻对颅内动脉瘤介入治疗全麻拔管期血流动力学的影响。方法 选择择期行介入治疗的颅内动脉瘤80例，根据滴鼻药物分为4组（n=20），即对照组（C组）和低、中、高剂量右美托咪定组（D1组、D2组、D3组）。手术结束前30 min，D1、D2、D3组用右美托咪定0.6、1.0、1.4 μg/kg滴鼻，C组用生理盐水滴鼻。记录入室时（T0）、滴鼻前即刻（T1）、手术结束时（T2）、患者苏醒时（T3）、拔管时（T4）、拔管后1 min（T5）、5 min（T6）心率（HR）、平均动脉压（MAP）、收缩压与心率的乘积（RPP）；记录术后恢复指标（包括苏醒时间、拔管时间、拔管质量评分、Ramsay镇静评分）。结果 与C组比较，D1组T3~T5、D2和D3组T2~T6 MAP、RPP、HR均明显降低（P<0.05）；D2组和D3组拔管质量评分均明显降低（P<0.05）、Ramsay评分均明显增高（P<0.05），D3组苏醒时间及拔管时间均明显延长（P<0.05）。与D1组比较，D2和D3组T3~T6 MAP、RPP、HR均明显降低（P<0.05），D3组拔管质量评分明显降低（P<0.05）、RamaSay评分明显增高（P<0.05），苏醒时间及拔管时间均明显延长（P<0.05）。与D2组比较，D3组苏醒时间及拔管时间均明显延长（P<0.05）。D2和D3组HR、MAP、RPP、拔管质量评分、Ramsay镇静评分均无统计学差异（P>0.05）。结论 手术结束前30 min给予右美托咪定1.0 μg/kg滴鼻全麻拔管期血流动力学平稳，同时不影响术后恢复。     

两种剂量右美托咪定用于神经外科手术麻醉的临床比较

目的评价两种剂量右美托咪定用于神经外科手术麻醉的效果。方法选取择期全身麻醉下行神经外科手术患者90例,随机分为右美托咪定0.5μg·kg~(-1)·h~(-1)(D1组)、右美托咪定0.2μg·kg~(-1)·h~(-1)(D2组)和对照组(C组)每组各30例。D1组和D2组分别于麻醉诱导前10min静注右美托咪定负荷剂量0.7μg/kg,随后分别以0.5μg·kg~(-1)·h~(-1)和0.2μg·kg~(-1)·h~(-1)维持至硬膜关闭完全,C组给予等容量的生理盐水。记录入室(T_0)、气管插管时(T_1)、手术开始时(T_2)、钻颅骨时(T_3)、手术结束时(T_4)、拔管时(T_5)、拔管后5min(T_6)的平均动脉压(MAP)、心率(HR);记录异丙酚和瑞芬太尼用量;记录自主呼吸恢复时间、拔管时间和不良反应发生情况。结果 D1组的平均动脉压、心率与T0比较波动范围小,与D2组、C组比较血流动力学较平稳,差异有统计学意义(P0.05);与C组和D2组比较,D1组异丙酚和瑞芬太尼用量减少,苏醒期恶心呕吐、呛咳及躁动的发生率降低,差异有统计学意义(P0.05);3组间自主呼吸恢复时间和拔管时间比较差异无统计学意义(P0.05)。结论诱导前静注右美托咪定0.7μg/kg,继之以0.5μg·kg~(-1)·h~(-1)维持,血流动力学稳定,有效抑制插管和拔管时的应激反应且不影响拔管时间,减少异丙酚和瑞芬太尼用量,降低苏醒期不良反应的发生率。     

不同剂量右美托咪定减少全麻苏醒期躁动的效果观察

目的探讨不同剂量右美托咪定减少全麻苏醒期躁动的效果。方法将93例ASAⅠ~Ⅱ级全麻苏醒期躁动患者随机分为A、B、C 3组各31例,均给予右美托咪定+生理盐水至4μg/mL静脉恒速泵入,3mL/min,A、B、C3组右美托咪定总剂量分别为0.3、0.5、1.0μg/mL。对比3组全麻苏醒期躁动情况。结果 3组T1~T3时点SAS评分均显著低于T0(P0.05),尤以B、C组显著;拔管时,3组血压、心率均上升,B、C组低于A组,差异具有统计学意义(P0.05),B、C组无明显差异(P0.05)。结论 0.5μg/kg右美托咪定能够显著减少全麻苏醒期患者躁动,效果显著、安全性高。     

右美托咪定对急性颅脑损伤患者脑功能及血流动力学的影响

目的研究右美托咪定对急性颅脑损伤患者脑功能及血流动力学产生的影响。方法抽取2015-09―2017-01登封市人民医院收治的94例接受开颅血肿清除联合去骨瓣减压术急性颅脑损伤病例为研究对象,依据术后镇静药物差异,分为A组与B组各47例,A组予以右美托咪定,B组予以咪达唑仑,比较2组术前与术后24 h格拉斯哥昏迷评分(GCS)、格拉斯哥预后评分(GOS)、神经元特异烯醇化酶(NSE)浓度、术后各时刻心率(HR)、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)。结果术前2组GCS评分及血清NSE浓度对比无显著性差异(P0.05);术后24 h,A组GCS评分与GOS评分显著高于B组,NSE浓度明显低于B组(P0.05);T0时刻,2组HR、SBP、DBP及MAP对比无显著性差异(P0.05);T1、T2、T3时刻,A组HR、SBP、DBP及MAP均明显小于B组(P0.05)。结论右美托咪定治疗可保护急性颅脑损伤患者脑功能,并维持血流动力学指标的稳定,优化预后。     

右美托咪定用于脑膜瘤切除术患者的麻醉效果及安全性分析

目的观察右美托咪定用于脑膜瘤切除术患者中的麻醉效果,分析右美托咪定在脑膜瘤切除术中的应用价值及安全性。方法选取2015-01—2016-01郑州大学人民医院诊断治疗的脑膜瘤患者65例为研究对象,随机分为实验组和对照组,2组患者术前采取相同的常规麻醉诱导,实验组麻醉诱导前注射右美托咪定,对照组麻醉诱导前注射生理盐水,观察并对比2组患者入手术室时、切皮时及拔管时的收缩压(SBP)、舒张压(DBP)及心率(HR)等指标,同时对比2组患者麻醉时间、自主呼吸恢复时间、定向力恢复时间及苏醒期不良反应发生率等,分析右美托咪定在脑膜瘤切除术中的麻醉效果及安全性。结果 2组患者入手术室时的SBP、DBP及HR无明显差异(P0.05),切皮时和拔管时的SBP、DBP及HR比较差异有统计学意义(P0.05);2组患者的麻醉时间和定向力恢复时间无明显差异(P0.05),实验组患者的自主呼吸恢复时间明显小于对照组,差异具有统计学意义(P0.05);实验组患者苏醒期恶心呕吐、呛咳、躁动及呼吸抑制的发生率分别为17.1%、37.1%、22.9%及0,对照组分别为40.0%、66.7%、46.7%及16.7%,2组差异均具有统计学意义(P0.05)。结论右美托咪定用于脑膜瘤切除术患者中麻醉效果显著,不良反应发生率低,安全性高,具有一定的临床应用价值。     

右美托咪定对丙泊酚合并瑞芬太尼麻醉下脑功能区手术术中唤醒效果的影响

目的 探讨右美托咪定对丙泊酚合并瑞芬太尼麻醉下脑功能区手术术中唤醒效果的影响.方法 选择择期行大脑功能区手术的患者32例,美国麻醉师协会（American Association of anesthetists, ASA）Ⅰ～Ⅱ级,随机分为右美托咪定组（D组）和生理盐水对照组（C组）,两组均采用全凭静脉麻醉,静脉注射芬太尼、依托咪酯、顺阿曲库铵行麻醉诱导,1％丁卡因行喉头及气管内粘膜表面麻醉后气管插管.分别在麻醉诱导前给予1 μg/kg右美托咪定和等量生理盐水在10 min内静脉注入,术中D组持续泵入右美托咪定0.2 μg/（kg.h）,C组泵入等量的生理盐水.唤醒试验开始时两组停用麻醉维持药物（除右美托咪定和生理盐水外）,观察并记录麻醉诱导前10 min（T1）、诱导后即刻（T2）、停药即刻（T3）、唤醒即刻（T4）、加深麻醉5 min后（T5）的平均动脉压（Mean arterial pressure,MAP）、心率（heart rate,HR）;记录唤醒时间、唤醒成功率、每分钟呛咳次数和体动次数.结果 两组的唤醒成功率相同,D组唤醒时间比C组长但无统计学意义（P＞0.05）,D组的呛咳次数和体动次数明显少于C组（P＜0.05）,T1、T5时两组HR、MAP比较差异无统计学意义（P＞0.05）;两组间HR、MAP在T3、T4时比较有统计学意义（P＜0.05）,对照C组明显高于试验D组.结论 右美托咪定有助于脑功能区手术患者全麻诱导及术中唤醒时血流动力学的稳定,并不延长唤醒时间,能减轻患者应激反应,提高唤醒质量,减少了不良事件的发生.     

右美托咪定对神经外科手术患者围术期血清TNF-α和IL-6的影响

目的观察右美托咪定对神经外科手术患者围术期血清TNF?α和IL-6的影响。方法研究对象为我院2014-03—2015-11收治的102例颅内动脉瘤患者,按随机数字表法分成观察组(51例)与对照组(51例)。对照组术前和术后泵注生理盐水;观察组麻醉诱导前泵注右美托咪定1μg/kg,结束后以0.4μg/(kg·h)右美托咪定泵注,比较2组不同时刻血流动力学指标HR和MAP水平,对比2组不同时刻IL-6和TNF?α水平。结果诱导后,观察组IL-6、TNF?α及HR水平均较对照组明显降低,MAP水平较对照组显著升高,差异均有统计学意义(P0.05)。结论右美托咪定在神经外科手术中具有较高的应用价值,能够稳定患者的血流动力学,降低机体炎性介质的水平,减轻炎症反应,从而促进患者术后的康复预后。     

右美托咪定对颅内动脉瘤全麻下介入术后拔管期血流动力学的影响

目的 观察右美托咪定对全麻下颅内动脉瘤介入术后拔管期血流动力学的影响。方法 回顾性分析2016年1月至2018年12月全麻下介入治疗的66例颅内动脉瘤的临床资料,其中33例术后应用右美托咪定治疗（观察组）,33例未应用右美托咪定治疗（对照组）。记录拔除气管插管前（T1）、拔管时（T2）、拔管后5 min（T3）、拔管后30 min（T4）和拔管后1 h（T5）心率（HR）、平均动脉压（MAP）、脉搏血氧饱和度（SpO2）。采用Minogue评分评价拔管时呛咳反应;应用镇静和躁动量表（SAS）评分评估躁动情况;采用Ramsay镇静评分评估镇静情况。结果 T1,两组MAP、HR无统计学差异（P>0.05）;T2~T5,观察组HR、MAP明显低于对照组（P<0.05）。T1~T5,两组SpO2均无统计学差异（P>0.05）。观察组拔管时Minogue评分、SAS评分均明显低于对照组（P<0.05）,而拔管后30 min的Ramsay镇静评分明显高于对照组（P<0.05）。结论 颅内动脉瘤全麻下介入术后应用右美托咪定可维持拔管期血流动力学平稳,可有效抑制围手术期的应激反应,无呼吸抑制。     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.