静吸复合麻醉下吸入麻醉药物脑区分布和记忆变化的脑电非线性分析研究

目的研究围术期吸入麻醉药在脑区的作用分布和对记忆的影响。方法45例患者分为异氟醚组、七氟醚组、地氟醚组(n=15),三种吸入麻醉药的呼末浓度均为1．0MAC。记录围术期近似熵脑电地形图。术后调查患者围术期的记忆情况。结果与术前相比,三组患者术中外显记忆和内隐记忆成绩明显下降,差异有统计学意义,组间比较无差异。异氟醚脑区作用分布为：额叶区、颞叶区→枕叶区、顶叶区→全脑区抑制。七氟醚脑区作用分布为：颞叶区→顶叶区→额叶区→枕叶区→全脑区抑制。地氟醚脑区作用分布为：枕叶区、顶叶区→颞叶区、额叶区→全脑区抑制。吸入药脑区作用消除顺序异氟醚为：顶叶区→额叶区和颞叶区→枕叶区→全脑区兴奋,七氟醚与地氟醚为：额叶区和颞叶区→枕叶区与顶叶区→全脑区兴奋。结论静吸复合麻醉下,吸入麻醉药脑区分布不尽相同,但消除相似。静吸复合麻醉下,吸入麻醉药呼末浓度为1．0MAC时,可以消除患者术中的内隐记忆。     

脑电非线性分析用于静脉麻醉下异丙酚脑区作用的研究

目的　研究围术期静脉复合麻醉下异丙酚在脑区的作用。方法　20例患者随机均分为异丙酚8mg/(kg·h)组与 10mg/(kg·h)组,记录围术期近似熵与关联维数,常规监测BP、HR、SpO2。结果　与入室后相比,两组患者麻醉后均表现为额叶、顶 叶、颞叶脑区的脑电抑制程度较高。两组患者入室后与麻醉下相比较,关联维数、近似熵明显降低,差异有统计学意义(P<0.05),术 中与复苏、觉醒相比较,数值有明显的差异,差异有统计学意义(P<0.05)。患者在复苏与觉醒后各个脑区的脑电变化表现为额叶、顶 叶、颞叶的脑电活动度较高。结论　静脉异丙酚麻醉下,各个脑区的抑制程度是不同的,以额叶、顶叶、颞叶的抑制程度较高;额叶、顶 叶、颞叶区在复苏觉醒时兴奋程度较高。     

脑电非线性分析用于静吸复合麻醉下吸入麻醉药物脑区作用的研究

目的研究围术期吸入麻醉药对脑区的作用。方法45例患者随机均分为异氟醚组、七氟醚组、地氟醚组。记录围术期近似熵与关联维数。常规监测MAP，HR，SpO2。结果与入室后相比，3组患者在麻醉后表现为额叶与颞叶区的脑电抑制程度较高。3组患者入室后与麻醉后相比较，关联维数、近似熵明显降低，差异有统计学意义(P＜O．05)，术中与复苏、觉醒相比较，差异亦有统计学意义(p＜O．05)。在复苏与觉醒后，患者各个脑区的脑电变化表现为：额叶、枕叶、颞叶的脑电活动度较高。结论静吸复合麻醉下，吸人麻醉药对各个脑区的抑制程度不同，以额叶、颞叶的抑制程度较高，额叶、枕叶、颞叶区在复苏、觉醒时兴奋程度较高。     

健康人工作记忆脑电theta网络因果流研究

目的计算健康受试者工作记忆脑电(electroencephalogram,EEG)网络的因果流,为研究工作记忆大脑信息传递机制提供支持。方法实验数据为18名健康受试者在300次视觉工作记忆的32通道EEGs。应用快速傅里叶变换计算工作记忆时EEGs在各个频段的能量密度,选取能量密度最大的频段为工作记忆的特征频段。计算EEGs特征频段分量之间的因果连接强度DTF,构建因果网络,在计算网络每个节点的DTF加权因果流的基础上,计算额叶、顶叶、颞叶和枕叶4个脑区的(节点)平均因果流,研究工作记忆脑区之间的信息传递特征。结果工作记忆EEGs在theta频段的能量密度最大(911±15μV~2/Hz)。额叶、顶叶、颞叶和枕叶脑区的平均因果流:额叶为0.0033±0.0002,顶叶为0.0005±0.0003,枕叶为-0.0022±0.0004,颞叶为-0.0051±0.0003。结论 theta频段是工作记忆EEGs的特征频段。工作记忆EEGs的theta网络因果源在额叶,因果汇在颞叶和枕叶,提示工作记忆各个脑区的信息传递是从额叶流到颞叶和枕叶。     

孤立性侧脑室扩张胎儿脑的MRI弥散加权成像评估

目的:探讨ADC值对胎儿侧脑室扩张的诊断价值。方法:对50例轻度孤立性侧脑室扩张胎儿(轻度扩张组)及50例重度孤立性侧脑室扩张的胎儿(重度扩张组)行DWI扫描,分别测量胎脑双侧额叶、顶叶、颞叶、枕叶白质、基底核、丘脑及小脑ADC值,比较两组各脑区ADC值差异及各个侧脑室扩张胎儿左侧及右侧各脑区ADC值的差异。结果:与轻度扩张组比较,重度扩张组双侧额叶、顶叶,枕叶白质及基底核ADC值下降(P均<0.05)。侧脑室扩张胎儿左侧与右侧各脑区ADC值差异均无统计学意义(P均>0.05)。结论:重度侧脑室扩张胎儿额叶、顶叶,枕叶,基底节ADC值下降,ADC值对检测潜在脑部损伤较敏感,有助于评估胎儿孤立性侧脑室扩张神经系统改变。     

正常人工作记忆不同认知成分的fMRI研究

目的：采用事件相关功能磁共振成像（ER-fMRI）探讨工作记忆（working memory,WM）不同认知成分即编码、维持和提取的脑神经机制。方法：16名正常受试者接受了Sternberg项目认知任务（sternberg item recognition task,SIRT）的功能磁共振成像。采用低、高负荷任务。结果：编码期左侧PMA、左枕叶、左顶叶、双侧DLPFC及颞叶激活;维持期为双侧DLPFC、左侧VLPFC、双侧PMA、左顶叶、左枕叶及颞叶后部、左颞叶;提取期为辅助运动区/扣带、双PMA、左DLPFC、左VLPFC、左IPL及左颞叶。随负载增加编码期激活增加脑区为左侧PMA、枕叶及DLPFC;维持期为双侧PMA、左侧VLPFC、左IPL及左枕叶;提取期为SMA/CMA、左PMA及DLPFC。结论：不同的WM认知成分具有不同的功能脑区,同一脑区可具有不同认知功能。     

数字记忆广度与数字工作记忆的功能磁共振比较研究

目的比较数字记忆广度与数字工作记忆的脑区激活特点与差异。方法利用Siemens 1.5T MR机对12名右利手志愿者进行7位数数字记忆广度与2位数数字工作记忆实验,实验采用组块设计,2组任务均设相应对照任务,将记忆任务与对照任务比较,数据采用SPM99软件进行分析和脑功能区定位。结果进行2组任务时,志愿者额叶的Brodmann6区、9区和47区,顶叶的7区和40区,扣带回,海马结构,纹状体以及小脑均有激活。进行数字记忆广度测试时,双侧枕叶Brodmann18区、19区的激活尤其显著,无明显的半球优势,双侧颞叶Brodmann37区也有激活,而进行数字工作记忆时,则在额叶的激活最为显著,额叶和顶叶的激活都表现为左侧半球优势。结论脑区在进行不同要求的短时数字记忆任务时所参与的阶段和所起的作用不同,通过fMRI的研究对推断大脑进行数字信息的处理过程有一定的帮助。     

动脉自旋标记在评估甲状腺功能亢进患者脑血流灌注情况中的应用研究

目的探索动脉自旋标记(arterial spin labeling,ASL)在研究甲状腺功能亢进患者脑灌注情况的可行性并分析其与健康人群在脑灌注上的差异。方法收集年龄、性别、文化程度相匹配的17名甲亢患者(实验组)和16名健康志愿者(对照组)行常规颅脑磁共振检查及三维假连续式动脉自旋标记(three dimensional pseudocontinuous ASL,3D-p CASL)序列检查,测量实验组与对照组各脑区的脑血流量值(cerebral blood flow,CBF)。结果甲亢患者双侧额叶、颞叶、枕叶、基底节区及海马区的CBF较健康对照者减低(P均0.05,其中,双侧额叶、枕叶、左侧基底节区、右侧颞叶、右侧海马区P0.01)。右侧额叶CBF与促甲状腺激素(thyroid stimulating hormone,TSH)浓度呈正相关(r=0.7820,P0.05);诸脑区CBF与游离三碘甲状腺原氨酸(free triiodothyronine,FT3)及游离甲状腺素(free thyroxine,FT4)浓度无明显相关性;诸脑区CBF与促甲状腺素受体(thyrotropin receptor antibody,TRAb)浓度无明显相关性;右侧基底节区、右侧顶叶、左侧顶叶CBF与病程长短呈正相关(r=0.7576、r=0.7576、r=0.8257,P均0.05)。结论利用ASL评估甲亢患者脑灌注情况具有可行性。其双侧额叶、颞叶、枕叶、基底节区及海马区存在明显低灌注;右侧额叶灌注对血清TSH水平敏感;右侧基底节区、右侧顶叶、左侧顶叶灌注情况对病程时间长短敏感。     

全凭静脉麻醉在腹腔镜胆囊切除术中的应用价值

目的　探讨普鲁泊福和芬太尼全凭静脉麻醉在腹腔镜胆囊切除术 (LC)的应用及价值。方法　择期LC手术的患者 80例 ,随机等分成静吸复合麻醉组 (静吸组 ) 40例和全凭静脉麻醉组 (静脉组 ) 40例。两组均以咪达唑仑 0 .2 5mg/kg ,芬太尼 2 μg/kg和维库溴铵 0 .1mg/kg诱导后作气管插管。麻醉维持 :静吸组用异氟烷吸入 ,全凭静脉组将普鲁泊福 8mg/(kg·h)和芬太尼 4μg/(kg·h)混合液恒速输入。记录麻醉诱导前、气腹前、气腹后 10min、气腹毕和术毕的SBP ,DBP ,SpO2 ,停止麻醉至拔管的时间 ,拔管时的清醒程度和随访结果。结果　两组间的拔管时间、清醒程度无显著性差异。静吸组在气腹后 10min的HR ,SBP ,DBP及术毕HR明显高于术前基础值 (P <0 .0 5或P <0 .0 1) ,而全凭静脉组术中无明显变化 ,术后恶心呕吐发生率也明显低于静吸组。结论　普鲁泊福和芬太尼全凭静脉麻醉用于LC手术 ,具有麻醉效果满意、血液动力学稳定、苏醒快速、术后恶心呕吐率低等优点 ,且无吸入麻醉药的手术室空气污染     

正常人情景记忆编码和提取加工的fMRI研究

目的:研究正常人汉字情景记忆编码和提取加工时大脑皮层的激活情况。方法:利用血氧水平依赖性功能磁共振成像技术(blood oxygenlevel dependent functional MRI,BOLD-fMRI),采用组块设计和事件相关的刺激模式,检测20例正常青年人执行汉字情景记忆编码和提取任务时大脑皮层的激活脑区。结果:情景记忆编码加工的激活脑区主要有左侧前额叶背外侧(BA10)、右侧海马旁回、右侧颞叶梭状回(BA20)、两侧前运动区(BA6)、辅助运动区(BA8)、两侧枕叶(BA19)、右侧顶叶(BA7)和两侧小脑半球,提取加工的激活脑区主要有右侧前额叶背外侧(BA10,BA46/47)、左侧额中回(BA10)、左侧额下回(BA47)、辅助运动区(BA8)、两侧基底节区、左侧颞顶交界处、两侧枕叶(BA18/19)、两侧顶叶(BA40)和两侧小脑半球。结论:情景记忆的编码和提取加工尽管存在部分共同的激活脑区,但两者相应的神经机制有所差异。     

丙泊酚对大鼠的空间学习记忆和海马NMDA受体NR2A亚基表达的影响

目的观察丙泊酚单次麻醉对成年大鼠空间学习记忆能力的影响以及海马NMDA受体NR2A亚基的变化。方法 30只SD大鼠随机分成丙泊酚组(n=15)和对照组(n=15)。给予丙泊酚50mg/kg腹腔注射作为诱导剂量,待翻正反应消失后在腹腔追加50mg/kg丙泊酚加深麻醉。对照组不予任何处理。待翻正反应恢复12h后应用Morris水迷宫评价丙泊酚对于大鼠空间学习记忆的影响。同时通过免疫荧光技术检测海马NMDA受体NR2A亚基的表达变化。结果丙泊酚组平均学习潜伏期较对照组显著缩短(P<0.05),靶象限活动时间百分比明显延长(P<0.05),丙泊酚组NMDA受体NR2A亚基的表达增加。结论丙泊酚单次麻醉后成年大鼠的空间学习记忆能力提高,这种学习记忆能力的提高可能和NMDA受体NR2A亚基的表达上调相关。     

右美托咪定对丙泊酚靶控输注意识消失Cp50的影响

目的观察右美托咪定对丙泊酚靶控输注意识消失Cp50的影响。方法选择年龄18~65岁、ASA分级为Ⅰ~Ⅱ级、体质量指数(BMI)为18~30 kg/m2的择期全身麻醉患者,随机分为4组:空白组(C组)、瑞芬太尼组(Remif组)、右美托咪定(0.5μg/kg)组(Dex1组)、右美托咪定(1.0μg/kg)组(Dex2组)。4组患者均采用丙泊酚行麻醉诱导,待丙泊酚血药浓度与效应室浓度达到平衡时,应用镇静/警觉(OAA/S)评分判断患者的意识情况。根据改良的上下交叉点法增加或减少下一个患者0.5μg/ml丙泊酚血浆靶浓度,直至观察到6个连续上升波形出现,记录每次丙泊酚的靶控浓度值,以计算丙泊酚的Cp50值。结果 4组患者丙泊酚Cp50值分别为C组(3.50±0.27)μg/ml、Remif组(2.33±0.20)μg/ml、Dex1组(3.08±0.26)μg/ml、Dex2组(2.42±0.26)μg/ml。与C组比较,其他3组丙泊酚Cp50值均明显降低(P<0.05);Dex1组和Remif组比较,差异有统计学意义(P<0.05);Dex2与Remif组比较,差异无统计学意义(P>0.05)。结论右美托咪定能降低丙泊酚靶控输注意识消失的Cp50,且与剂量相关,1μg/kg的右美托咪定与靶浓度为2.0 ng/ml的瑞芬太尼作用相当。     

Death after excessive propofol abuse

Abuse of the anaesthetic agent propofol (2,6-diisopropylphenol) is rare, but we report a case of a 26-year-old male nurse in which the autopsy showed unspecific signs of intoxication and criminological evidence pointed towards propofol abuse and/or overdose. Intravenously administered propofol is a fast and short-acting narcotic agent, therefore it seemed questionable whether the deceased would have been able to self-administer a lethal overdose before losing consciousness. The blood and brain concentrations corresponded to those found 1–2 min after bolus administration of a narcotic standard dose of 2.5 mg propofol/kg body weight. Extremely high propofol concentrations were found in the urine indicating excessive abuse before death. However, due to the short half-life of propofol, the cumulative effects of repeated injections should not be relevant for toxicity, since this would result in a blood level increase of only 1–2 μg/ml. Furthermore, the detection and quantitation of propofol in three different hair segments indicated chronic propofol abuse by the deceased. The results of the investigation suggest that death was not caused by a propofol overdose but by respiratory depression resulting from overly rapid injection. Received: 1 July 1999 / Accepted: 25 November 1999     

再论普鲁泊福静脉麻醉人工流产

目的　再次研究普鲁泊福在人工流产术上的麻醉。　方法　 2 0 0例选择人工流产的早期妊娠女性 ,随机分为给予小剂量芬太尼的普鲁泊福组 (A组 ,n =10 0 )和单纯普鲁泊福组 (B组 ,n =10 0 )。A组在使用普鲁泊福前 1～ 2min静脉给予芬太尼 0 0 5mg。两组均在吸氧 ( 3L/min) 1～ 2min后静脉注射普鲁泊福 (预设速度 5mg/s)。 　结果　 ( 1)两组实际注药速度一致 ( 4 2mg/s) ,而A组进入麻醉状态的时间早于B组 (P >0 0 5 ) ,并因此普鲁泊福的初量少于B组 (P >0 0 5 )。两组手术时间相似 ,但B组所需普鲁泊福总量明显大于A组 (P <0 0 1) ,并因此B组苏醒时间明显滞后于A组 (P <0 0 1)。 ( 2 )两组均产生一过性 ( 1～ 2min)循环呼吸抑制 ,但其参数均值仍属正常。 ( 3)两组均有较高的睡眠质量 ,且无术中知晓 ,以及醒后多有欣快感。 ( 4 )AB两组分别有 32 %和 5 5 %的做梦率 ,且各有 6例和 9例回答梦幻与性有关。 ( 5 )普鲁泊福注射的局部疼痛发生率 ,AB两组分别为 2 2 %和 5 0 %。 ( 6 )术后下腹痛程度A组明显低于B组 (P <0 0 1)。　结论　单纯普鲁泊福静脉麻醉用于人工流产术并非十分完美 ,预给芬太尼 0 0 5mg辅助的普鲁泊福麻醉明显优越。     

Postoperative opisthotonus following the use of propofol

A case of opisthotonus following the use of the anaesthetic induction agent propofol is described. The patient was a woman with a known history of epilepsy. It is recommended that propofol should not be used in such patients.     

瑞芬太尼复合异丙酚全麻用于鼻内镜手术的观察

目的:比较瑞芬太尼复合异丙酚与芬太尼复合异丙酚应用于全身麻醉中的有效性可控性安全性.方法:60例鼻内镜手术患者,随机分为瑞芬太尼组(R)和芬太尼组(F),每组30例.观察麻醉诱导、气管插管、手术开始及麻醉维持时的血压变化、睁眼时间、术后疼痛等情况.结果:麻醉诱导时瑞芬太尼组低血压和心率减慢者多于F组(P＜0.05)插管反应率低于F组(P＜0.05),术中R组的心率、血压、低于F组(P＜0.05).睁眼时间、拔管时间R组明显少于F组(P＜0.05).结论:瑞芬太尼复合异丙酚应用于鼻内镜手术,与芬太尼复合异丙酚全麻相比较麻醉诱导及气管插管心血管反应发生率低、术中血流动力学稳定、术后苏醒快且无呼吸再抑制的优点.     

Propofol and propofol glucuronide concentrations in hair following medical propofol administration and in forensic death cases

Purpose

Propofol is the most preferred drug for general anesthesia as well as for analgosedation. However, the rate of abuse cases has increased in the past decade. Hair analysis is considered as the method of choice to determine chronic drug use, and propofol and propofol glucuronide have already been used to confirm previous propofol administration. However, given its frequent medical use, it is important that nonmedical propofol abuse can be distinguished from medical propofol application.

Methods

Nineteen hair samples collected from living subjects who received different doses of propofol in the setting of medical treatment and 31 hair samples from forensic death cases with indications of previous propofol administration were examined using our previously described method enabling the simultaneous extraction of propofol and propofol glucuronide from hair followed by validated liquid chromatography–tandem mass spectrometry analyses.

Results

Recent propofol administration was verified for eight of 19 living cases and 29 of 31 deceased cases. Of the living cases, propofol glucuronide could be detected in all eight cases, whereas propofol could only be detected in three of these cases. Propofol glucuronide could be detected more frequently and in higher concentrations than propofol following medical propofol administration and observed concentrations varied more widely.

Conclusions

Although further research is still required to clarify the mechanisms involved in propofol incorporation into hair and to establish reliable cutoff concentrations for the differentiation of medical from nonmedical propofol use, it seems likely that relatively high concentrations of propofol found across multiple hair segments strongly suggest a nonmedical propofol abuse.

     

异丙酚在人工流产术中52例观察

目的：观察异丙酚在人工流产术中对出血量的影响。方法：自2001年1--4月随机对52例早孕未产妇于术前缓慢静注异丙酚2mg／kg，使其进入睡眠状态，无痛觉时施行人工流产术。结果：镇痛效果达100%，不增加人流术的出血量及无人流综合症出现。结论：异丙酚用于人工流产术中镇痛效果快速、有效、不增加术中出血量、苏醒快、合并症少。     

Specific marker of feigned memory impairment: The activation of left superior frontal gyrus

Faking memory impairment means normal people complain lots of memory problems without organic damage in forensic assessments. Using alternative forced-choice paradigm, containing digital or autobiographical information, previous neuroimaging studies have indicated that faking memory impairment could cause the activation in the prefrontal and parietal regions, and might involve a fronto-parietal-subcortical circuit. However, it is still unclear whether different memory types have influence on faking or not. Since different memory types, such as long-term memory (LTM) and short-term memory (STM), were found supported by different brain areas, we hypothesized that feigned STM or LTM impairment had distinct neural activation mapping. Besides that, some common neural correlates may act as the general characteristic of feigned memory impairment. To verify this hypothesis, the functional magnetic resonance imaging (fMRI) combined with an alternative word forced-choice paradigm were used in this study. A total of 10 right-handed participants, in this study, had to perform both STW and LTM tasks respectively under answering correctly, answering randomly and feigned memory impairment conditions. Our results indicated that the activation of the left superior frontal gyrus and the left medial frontal gyrus was associated with feigned LTM impairment, whereas the left superior frontal gyrus, the left precuneus and the right anterior cingulate cortex (ACC) were highly activated while feigning STM impairment. Furthermore, an overlapping was found in the left superior frontal gyrus, and it suggested that the activity of the left superior frontal gyrus might be acting as a specific marker of feigned memory impairment.