不同剂量左旋甲状腺素钠预处理对幼龄大鼠心肌缺血再灌注损伤的影响

目的 评价不同剂量左旋甲状腺素钠预处理对幼龄大鼠心肌缺血再灌注损伤的影响.方法 健康雌性 Wistar大鼠48只,日龄35 d,体重120～140 g,采用随机数字表法,将其随机分为6组(n=8):对照组(C组)、缺血再灌注组(I/R组)和不同剂量左旋甲状腺素钠预处理组(LS1-4组).C组和I/R组大鼠采用普通饲料喂养7 d;LS1-4组大鼠除了采用普通饲料喂养之外,每天胃内灌注左旋甲状腺素钠10、20、40和80 μg/100 g.第8天时,抽取外周静脉血样,测定血清甲状腺激素水平.采用Langendorff装置建立大鼠离体心脏缺血再灌注模型.C组K-H液持续灌注80 min;其余各组K-H液平衡灌注30 min,然后全心缺血20 min,恢复灌注30 min.于平衡灌注20 min和再灌注30 min时,记录HR、SP、左心室内压最大上升速率(+dp/dtmax)和左心室内压最大下降速率(-dp/dtmax),计算再灌注30min时HR、SP、+dp/dtmax和-dp/dtmax的恢复率.于平衡灌注10 min和再灌注15 min时,收集冠状动脉流出液2 ml,测定CK-MB的活性.再灌注30 min时,取心室肌组织,采用Western blot法检测心肌热休克蛋白70(HSPT0)的表达,采用RT-PCR法测定甲状腺激素受体(TR)亚型(TRα1、TRα2和TRβ1)mRNA以及肌球蛋白重链α和β(MHCα和MHCβ)mRNA的表达.结果 与C组相比,I/R组HR、SP和±dp/dtmax的恢复率降低,冠脉流出液CK-MB活性升高,心肌MHCα mRNA表达下调,LS1-4组SP和±dp/dtmax的恢复率降低,冠脉流出液CK-MB活性升高,心肌HSP70和MHCα mRNA表达上调,LS2-4组血清甲状腺激素水平升高,心肌TRα1 mRNA表达上调(P＜0.05).与I/R组相比,LS1-4组HR和±dp/dtmax的恢复率升高,心肌HSP70表达上调,MHCa mRNA表达上调,MHCβ mRNA表达下调,LS1-3组冠脉流出液CK-MB活性降低,LS2-4组血清甲状腺激素水平升高,心肌TRα1 mRNA表达上调(P＜0.05).LS1组、LS2组、LS3组和LS4组的甲状腺激素血清水平随左旋甲状腺素钠剂量的增加逐渐升高(P＜0.05).与LS1组和LS2组相比,LS3组和LS4组冠脉流出液CK-MB活性升高,心肌HSP70表达下调(P＜0.05).结论 10 μg/100 g左旋甲状腺素钠胃内灌注预处理可减轻大鼠心肌缺血再灌注损伤,且不会导致甲状腺激素水平升高,其机制可能与心肌HSP70和MHCα mRNA表达上调有关.

Abstract：

Objective To investigate the effects of preconditioning with different doses of levothyroxine sodium on myocardial ischemia-reperfusion (I/R) injury in immature rats. Methods Forty-eight female immature Wistar rats, aged 35 days, weighing 120-140 g, were randomly allocated into 6 groups ( n = 8 each): control group (group C), I/R group, and preconditioning with levothyroxine sodium 10, 20, 40 and 80 μg/100 g groups (groups LS1-4 ) . The rats received levothyroxine sodium 10, 20, 40 and 80 μg/100 g through a gastric tube every day for 7 days in groups LS1-4 , respectively. Venous blood samples were taken on 8th day for determination of serum thyroid hormone levels. The hearts were removed from the animals and perfused in a Langendorff apparatus with K-H solution saturated with 95% O2-5% CO2 at 37 ℃. The hearts were continuously perfused for 80 min in group C. After 30 min of equilibration, the isolated hearts were subjected to 20 min of ischemia followed by 30 min of reperfusion in I/R and LS1-4 groups. HR, SP and ± dp/dtmax were recorded at 20 min of perfusion and 30 min of reperfusion. The recovery rates of HR, SP and ± dp/dtmax were calculated at 30 min of reperfusion. The coronary effluent was collected at 10 min of perfusion and 15 min of reperfusion for determination of creatine kinase (CKMB) activity. The samples of ventricular myocardial tissues were taken at 30 min of reperfusion to detect the expression of heat shock protein 70 (HSP70), thyroid hormone receptor (TR) mRNA (TRa, , TRoj and TRft ) and myosin heavy chain (MHC) mRNA. Results Compared with group C, the recovery rates of HR, SP and. ± dp/dtmax were significantly decreased, the CK-MB activity was significantly increased, and MHCα mRNA expression was down-regulated in group I/R, the recovery rates of SP and ± dp/dtmax were significantly decreased, the CK-MB activity was significantly increased, and the expression of HSP70 and MHCα mRNA was up-regulated in groups LS1-4, and the serum thyroid hormone level was significantly increased and the expression of TRa, mRNA was up-regulated in groups LS2-4 ( P ＜ 0.05) . Compared with group I/R, the recovery rates of HR and ± dp/dtmax were significantly increased, the pression of HSP70 and MHCa mRNA was up-regulated, and the MHCJ3 mRNA expression was down-regulated in groups LS1-4 the CK-MB activity was significantly decreased in groups LS1-3, and the serum thyroid hormone level was significantly increased and the expression of TRα1, mRNA was up-regulated in groups LS2-4 ( P ＜ 0.05) . The serum thyroid hormone level increased gradually with the increase in the dose of levothyroxine sodium in groups LS1-4 ( P ＜ 0.05) . The CK-MB activity was significantly higher, while the HSP70 expression lower in groups LS3-4 than in groups LS1-2 (P ＜ 0.05). Conclusion Preconditioning with levothyroxine sodium 10 μg/100 g can alleviate the myocardial I/R injury in immature rats and does not lead to the increase in the level of thyroid hormone, and the up-regulation of HSP70 and MHCa mRNA expression may be involved in the mechanism.     

七氟醚和异丙酚复合麻醉下妇科腹腔镜手术患者脑血流量和颅内压的比较

Objective To compare the cerebral blood flow (CBF) and intracranial pressure (ICP) during laparoscopic gynecologic surgery performed under propofol and sevoflurane combined anesthesia.Methods Forty ASAⅠ orⅡ patients aged 20-59 yr weighing 44-69 kg were randomly divided into 2 groups(n=20 each):propofol group (group P) and sevoflurane group (group S).Anesthesia was induced with TCI of propofol (Ce 4μg/ml) in group P or 8% sevoflurane in group S combined with TCI of remifentanil (Ce 6 ng/ml).Tracheal intubation was facilitated with cis-atracurium 0.15 mg/kg.The patients were mechanically ventilated.PETCO2 was maintained at 35-40 mm Hg.Anesthesia was maintained with TCI of propofol or sevoflurane.inhalation combined with TCI of remifentanil.BIS value was maintained at 45-50 by adjusting Ce of propofol or concentration of sevoflurane.Intraabdominal pressure (IAP) was maintained at 12-14 mm Hg.Transcranial Doppler monitoring wag used.Cerebral blood flow velocity (CBFV) and pulsatility index (PI) were recorded at 5 min after supine position(T1)and 5 min after supine lithotomy position before induction(T2),while tracheal tube was being inserted(T3),5 min after tracheal intubation(T4),immediately and 15 min after abdominal CO2 iusnfflation in trendelenburglithotomy position (T5,T6) and at 10 min after deflation of abdomen(T7).Results CBFV was significandy decreased at T3,T4 and T7 in group P and at T4 and T7 in group S as compared with the baseline at T1.CBFV at T3 was significantly lower in group P than in group S.PI at T3,T4 was significantly decreased in group P as compared with the baseline at T1 and was significantly lower than in group S.PI at T5,6 was significantly increased as compared with the baseline in both groups but was not significantly different between the 2 groups.Conclusion When combined with remifentanil.propofol could decrease CBF and ICP while sevoflurane has no significant effect on CBF and ICP after induction.CBF and ICP are significantly increased in both groups after abdominal CO2 insufflation.     

七氟醚和异丙酚复合麻醉下妇科腹腔镜手术患者脑血流量和颅内压的比较

Objective To compare the cerebral blood flow (CBF) and intracranial pressure (ICP) during laparoscopic gynecologic surgery performed under propofol and sevoflurane combined anesthesia.Methods Forty ASAⅠ orⅡ patients aged 20-59 yr weighing 44-69 kg were randomly divided into 2 groups(n=20 each):propofol group (group P) and sevoflurane group (group S).Anesthesia was induced with TCI of propofol (Ce 4μg/ml) in group P or 8% sevoflurane in group S combined with TCI of remifentanil (Ce 6 ng/ml).Tracheal intubation was facilitated with cis-atracurium 0.15 mg/kg.The patients were mechanically ventilated.PETCO2 was maintained at 35-40 mm Hg.Anesthesia was maintained with TCI of propofol or sevoflurane.inhalation combined with TCI of remifentanil.BIS value was maintained at 45-50 by adjusting Ce of propofol or concentration of sevoflurane.Intraabdominal pressure (IAP) was maintained at 12-14 mm Hg.Transcranial Doppler monitoring wag used.Cerebral blood flow velocity (CBFV) and pulsatility index (PI) were recorded at 5 min after supine position(T1)and 5 min after supine lithotomy position before induction(T2),while tracheal tube was being inserted(T3),5 min after tracheal intubation(T4),immediately and 15 min after abdominal CO2 iusnfflation in trendelenburglithotomy position (T5,T6) and at 10 min after deflation of abdomen(T7).Results CBFV was significandy decreased at T3,T4 and T7 in group P and at T4 and T7 in group S as compared with the baseline at T1.CBFV at T3 was significantly lower in group P than in group S.PI at T3,T4 was significantly decreased in group P as compared with the baseline at T1 and was significantly lower than in group S.PI at T5,6 was significantly increased as compared with the baseline in both groups but was not significantly different between the 2 groups.Conclusion When combined with remifentanil.propofol could decrease CBF and ICP while sevoflurane has no significant effect on CBF and ICP after induction.CBF and ICP are significantly increased in both groups after abdominal CO2 insufflation.     

孤啡肽对大鼠离体心脏功能的调节作用及其对去甲肾上腺素诱发心脏功能变化的影响

Objective To investigate the effects of orphanin FQ (OFQ) on simple and norepinephrineactivated cardiac function in isolated rat heart.Methods Male SD rats aged 3-4 months weighing 250-280 g were anesthetized with intraperitoneal 25% urethane 1.4-1.8 ml.Their hearts were excised and passively perfused with K-H solutionin a Lanngendorff apparatus.A fluid-filled latex balloon was inserted into left ventricle for measurement of developed pressure.Left ventricular systolic pressure(LVSP),left ventricular end-diastofic pressure(LVEDP),left ventricular developed pressure(LVDP=LVSP-LVEDP),HR and±dp/dtmax were measured.Sixty isolated rat hearts were randomly divided into 10 groups(n=6 each):Ⅰ control group (group C);Ⅱ,Ⅲ,Ⅳ OFQ1,OFQ2,OFQ3 group--OFQ 10-6,10-7,10-8 mol/L were administered via perfusion system respectively;Ⅴ OFQ+UFP group--OFQ 10-6 mol/L+UFP-101 (all OFQ antagonist) 10-6 mol/L were administered;Ⅵ NE group--norepinephrine 10-5 mol/L;Ⅶ,Ⅷ,Ⅸ NE+OFQ groups--NE 10-5 mol/L+OFQ 10-6,10-7,10-8 mol/L were administered respectively;Ⅹ NE+OFQ+UFP group--NE 10-5 mol/L+OFQ 10-6mol/L+UFP-101 10-6mol/L.Results LVSP,LVDP and±dp/dtmax were significantly increased while HR was significantly decreased in the 3 OFQ groups as compared with control group.LVSP,LVDP±dp/dt max and HR were significantly increased in the 3 NE+OFQ groups as compared with NE group.Conclusion OFQ has positive inotropic action and negative chronotropic effect on the isolated rat heart.OFQ Can enhance the positive inotropic and chronotropic effect of NE on the heart.     

孤啡肽对大鼠离体心脏功能的调节作用及其对去甲肾上腺素诱发心脏功能变化的影响

Objective To investigate the effects of orphanin FQ (OFQ) on simple and norepinephrineactivated cardiac function in isolated rat heart.Methods Male SD rats aged 3-4 months weighing 250-280 g were anesthetized with intraperitoneal 25% urethane 1.4-1.8 ml.Their hearts were excised and passively perfused with K-H solutionin a Lanngendorff apparatus.A fluid-filled latex balloon was inserted into left ventricle for measurement of developed pressure.Left ventricular systolic pressure(LVSP),left ventricular end-diastofic pressure(LVEDP),left ventricular developed pressure(LVDP=LVSP-LVEDP),HR and±dp/dtmax were measured.Sixty isolated rat hearts were randomly divided into 10 groups(n=6 each):Ⅰ control group (group C);Ⅱ,Ⅲ,Ⅳ OFQ1,OFQ2,OFQ3 group--OFQ 10-6,10-7,10-8 mol/L were administered via perfusion system respectively;Ⅴ OFQ+UFP group--OFQ 10-6 mol/L+UFP-101 (all OFQ antagonist) 10-6 mol/L were administered;Ⅵ NE group--norepinephrine 10-5 mol/L;Ⅶ,Ⅷ,Ⅸ NE+OFQ groups--NE 10-5 mol/L+OFQ 10-6,10-7,10-8 mol/L were administered respectively;Ⅹ NE+OFQ+UFP group--NE 10-5 mol/L+OFQ 10-6mol/L+UFP-101 10-6mol/L.Results LVSP,LVDP and±dp/dtmax were significantly increased while HR was significantly decreased in the 3 OFQ groups as compared with control group.LVSP,LVDP±dp/dt max and HR were significantly increased in the 3 NE+OFQ groups as compared with NE group.Conclusion OFQ has positive inotropic action and negative chronotropic effect on the isolated rat heart.OFQ Can enhance the positive inotropic and chronotropic effect of NE on the heart.     

PI3K-Akt信号通路在七氟醚预处理减轻大鼠离体心脏缺血再灌注损伤中的作用

目的 评价磷脂酰肌醇-3-激酶-丝氨酸/苏氨酸激酶(PI3K-Akt)信号通路在七氟醚预处理减轻大鼠离体心脏缺血再灌注损伤中的作用.方法 健康成年雄性SD大鼠96只,体重220～280g,采用随机数字表法,将其随机分为6组(n=16):假手术组(S组)、缺血再灌注组(I/R组)、七氟醚预处理组(SP组)、渥曼青霉素组(W组)、二甲基亚砜组(D组)和七氟醚预处理+渥曼青霉素组(SW组).采用Langendorff装置建立大鼠离体心脏缺血再灌注模型.S组继续灌注180 min;I/R组平衡灌注30 min,缺血30 min,恢复灌注120 min;其余各组先平衡灌注15 min,SP组、W组、DMSO组和SW组分别用含2.4%七氟醚、100 nmol/L渥曼青霉察、20 μmol/L二甲基亚砜、2.4%七氟醚和100 nmol/L渥曼青霉素的K-H液灌注10 min,然后洗脱5 min,缺血30 min,恢复灌注120 min.各组随机取8个心脏,于平衡灌注末和再灌注15 min时,记录HR、左室舒张末压(LVEDP)、左室发展压(LVDP)、左心室内压最大上升速率(+dp/dtmax)和左心室内压最大下降速率(-dp/dtmax).再灌注15 min时取心肌组织,采用TUNEL法检测细胞凋亡,计算凋亡指数;采用Western blot法测定磷酸化Akt(p-Akt)表达.再灌注120 min时,取8个心脏,采用TIC染色法测定心肌梗死体积.结果 与S组比较,其余各组HR、LVDP和±dp/dtmax降低,LVEDP升高,I/R组、SP组和D组心肌p-Akt表达上调(P＜0.05);与I/R组比较,SP组LVDP和±dp/dtmax升高,LVEDP和凋亡指数降低,心肌p-Akt表达上调,心肌梗死体积减小(P＜0.05),SW组上述指标差异无统计学意义(P＞0.05).结论 七氟醚预处理可通过激活PI3K-Akt信号通路减轻大鼠离体心脏缺血再灌注损伤.

Abstract：

Objective To investigate the role of phosphatidyl-inositol 3-kinase-Akt (PI3k-Akt) signal pathway in the attenuation of ischemia-reperfusion (I/R) injury by sevoflurane preconditioning in isolated rat hearts. Methods Ninety-six adult male SD rats weighing 220-280 g were randomly divided into 6 groups ( n = 16 each): sham operation group (group S); I/R group; sevoflurane preconditioning group (group SP); wortmannin group (group W); dimethyl sulfoxide (DMSO) group (group D) and sevoflurane preconditioning + wortmannin group (group SW) . Their hearts were excised and perfused in a Langendorff apparatus with K-H solution saturated with 95%O2-5%C02 at 37 ℃ . The hearts were continuously perfused for 180 min in group S. After 15 min of equilibration, the isolated hearts were subjected to 30 min of ischemia followed by 120 min of reperfusion in SP, W, D and SW groups. Croups SP, W, D and SW received 10 min of perfusion with K-H solution containing 2. 4% sevoflurane, 100 nmol/L wortmannin, 20 μmol/L DMSO, and 2.4% sevoflurane + 100 nmol/L wortmannin, respectively, followed by 5 min washout before I/R. Eight hearts in each group were selected and HR, left ventricular end-diabetic pressure (LVEDP), left ventricular developed pressure (LVDP), and ± dp/dtmax were recorded at the end of equilibration and at 15 min of reperfusion, Myocardial tissues were obtained at 15 min of reperfusion for determination of apoptosis (by TUNEL) and phosphorylated Akt (p-Akt) expression (by Western blot) . Another 8 hearts were selected at 120 min of reperfusion for determination of myocardial infarct size by TTC staining. Result Compared with group S, LVDP and ± dp/dt,^ were significantly decreased and LVEDP was significantly increased in groups I/R, SP, W, D and SW, and myocardial p-Akt expression was up-regulated in groups I/R, SP and D ( P ＜ 0.05). Compared with group I/R, LVDP and ± dp/dtmax were significantly increased, LVEDP and apoptosis index were significantly decreased, myocardial p-Akt expression was up-regulated, and myocardial infarct size was significantly reduced in group SP (P ＜0.05) . Conclusion Activation of PI3K-Akt signal pathway is involved in the attenuation of I/R injury by sevoflurane reconditioning in isolated rat hearts.     

腹腔镜手术患儿压力控制通气和容量控制通气效果的比较

Objective To compare the efficacy of pressure-controlled ventilation and volume-controlled ventilation in children undergoing laparoscopic surgery. Methods Thirty ASA Ⅰ or Ⅱ children of both sexes,aged 12-36 months, weighing 9-15 kg, scheduled for laparoscopic surgery, were randomly divided into 2 groups (n = 15 each): pressure-controlled ventilation group (group P) and volume-controlled ventilation group (group V) . Anesthesia was induced with propofol 2-4 mg/kg, vecuronium 0.1 mg/kg and fentanyl 2 μg/kg. The children were tracheal intubated and mechanically ventilated. The maximum inspiratory pressure was adjusted to make the tidal volume (VT ) achieve 12 ml/kg in group P and the VT was set at 12 ml/kg in group V. PETCO2 was maintained at 35-45 mm Hg. MAP, HR, PETCO2 , minute ventilation and peak airway pressure were recorded immediately after intubation (T0 ) , immediately before skin incision (T1 ) , 30 min of pneumoperitoneum (T2 ) and 15 min after the end of pneumoperitoneum (T3 ) . Arterial blood samples were taken at the same time points mentioned above for blood gas analysis. Dynamic lung compliance and physiological dead space to tidal volume ratio were calculated.Results Compared with group V, PaCO2 and PETCO2 were significantly decreased and dynamic lung compliance was significantly increased at T1,2 , and minute ventilation and peak airway pressure were significantly decreased at T0-3 in group P ( P < 0.01) . There was no significant difference in MAP, HR and physiological dead space to tidal volume ratio between the two groups ( P > 0.05) . Conclusion Compared with volume-controlled ventilation, pressure-controlled ventilation can better improve the ventilatory efficacy, is more beneficial to gas exchange and reduces the influence of pneumoperitoneum on respiratory function in children undergoing laparoscopic surgery.     

腹腔镜手术患儿压力控制通气和容量控制通气效果的比较

Objective To compare the efficacy of pressure-controlled ventilation and volume-controlled ventilation in children undergoing laparoscopic surgery. Methods Thirty ASA Ⅰ or Ⅱ children of both sexes,aged 12-36 months, weighing 9-15 kg, scheduled for laparoscopic surgery, were randomly divided into 2 groups (n = 15 each): pressure-controlled ventilation group (group P) and volume-controlled ventilation group (group V) . Anesthesia was induced with propofol 2-4 mg/kg, vecuronium 0.1 mg/kg and fentanyl 2 μg/kg. The children were tracheal intubated and mechanically ventilated. The maximum inspiratory pressure was adjusted to make the tidal volume (VT ) achieve 12 ml/kg in group P and the VT was set at 12 ml/kg in group V. PETCO2 was maintained at 35-45 mm Hg. MAP, HR, PETCO2 , minute ventilation and peak airway pressure were recorded immediately after intubation (T0 ) , immediately before skin incision (T1 ) , 30 min of pneumoperitoneum (T2 ) and 15 min after the end of pneumoperitoneum (T3 ) . Arterial blood samples were taken at the same time points mentioned above for blood gas analysis. Dynamic lung compliance and physiological dead space to tidal volume ratio were calculated.Results Compared with group V, PaCO2 and PETCO2 were significantly decreased and dynamic lung compliance was significantly increased at T1,2 , and minute ventilation and peak airway pressure were significantly decreased at T0-3 in group P ( P < 0.01) . There was no significant difference in MAP, HR and physiological dead space to tidal volume ratio between the two groups ( P > 0.05) . Conclusion Compared with volume-controlled ventilation, pressure-controlled ventilation can better improve the ventilatory efficacy, is more beneficial to gas exchange and reduces the influence of pneumoperitoneum on respiratory function in children undergoing laparoscopic surgery.     

容量调控对腹腔镜活体肾移植术供肾者机体氧代谢的影响

Objective To investigate the effects of capacity control on oxygen metabolism of donors in living renal transplantation using laparoscopy.Methods Hypervolemic hemodilution (HHD) was performed with continuous infusion of 4% suceinylated.gelatin(SG) and lactated Ringer's solution(RL) from 15 min before anesthesia induction to renal artery interruption to decrease Hct to the level of 25% in 12 healthy donors for living renal transplantation.Meanwhile,micro-pump infusion of nitroglycerin was administered to maintain MAP change within the range of ± 25% of base value.Hct,CO,DO2,VO2,ERO2,Lac,SevO2,ipH,PgCO2,Pg-aCO2 were recorded or measured before anesthesia (T0),at the beginning of aeroperitonia (T1),15 min before renal artery interruption(T2),at the start of renal artery interruption(T3),30 min(T4) and 60 min(T5) after renal artery interruption.Results After hypervolemic hemodilution and control hypotension with nitroglycerin,Hct went down from (42.7± 1.9) % to (25.7 ±1.1) %,and CVP increased gradually(P＜0.05).DO2 and CO decreased at T1,and increased later,with significance between T3 and T1 (P＜0.05).There was no significant difference in VO2,ScvO2,ERO2 and Lac among time-points,ipH decreased slightly and PgCO2 increased after T1,reaching a significant level at T3 (P＜0.05).Conclusion Implementation of capacity control improves donor's renal perfusion,maintains a stable oxygen metabolism with more efficient organ oxygenation,without anaerobic metabolism.     

顺阿曲库铵的药效学及其对组胺释放的影响

Objective To evaluate and compare the histamine-releasing,potencies of cis-atracurium and atracurium during induction of general anesthesia.Methods Forty-five ASA Ⅰ or Ⅱ patients aged 16-71 yr undergoing elective surgery under general anesthesia were randomly divided into 3 groups (n=15 each):group Ⅰcis-atracurium (stored at 4-8℃)(group CIS1);groupⅡcis-atracurium (stored at room temperature)(group CIS2) and group Ⅲ atracurium (stored at 4-8℃)(group ATR).Anesthesia Was induced with TCI of propofol (Cp 3 μg/ml) and remifentanil (Ce 3-5 ng/ml).A bolus of cis-atracurium 0.15 mg/kg or atracurium 0.75 mg/kg Was given iv over 5-10 s as soon as the patients lost consciousness.Neuro-muscular block was monitored with TOF-Watch(R) SX(Organon,the Netherlands).Single stimulation (0.1 Hz) was apphed to the ulna nerve at wrist.The maximal degree of N-M block,onset time,duration of action and recovery index were recorded.The patients were intubated and mechanically ventilated when N-M block reached the maximal degree.The intubation condition Was evaluated.MAP and HR were continuously monitored.Changes in skin were scored (0=no change,Ⅰ=flushed>120 s,Ⅱ=erytbema,Ⅲ=urticaria).Blood samples were obtained before (T0,baseline),at 2 min after induction of anesthesia with TCI of propofol and remifentanil (T1) and 2 and 5 min after CIS/ATR administration (T2,T3) for determination of plasma histamine concentration using enzymatically amplified immunoassay.Results The onset time was significantly longer and the duration of action was significantly shorter in group CIS1 than in group ATR.The maximal degree of N-M block was 100%and the intubation condition was excellent in group CIS1 and ATR.There wag no significant difference in the recovery index between group CIS1 and ATR.The onset time was significantly longer and duration of action shorter in group CIS2 than in group CIS1.There was no significant difference in recovery index between group CIS1 and CIS2.There was no significant change in plasma histamine concentration at T1-3 as compared with the baseline at T0 in group CIS1 but plasma histamine concentration was significantly increased at T2,3 in group ATR.MAP was significantly decreased after induction of anesthesia with propofol and remifentanil,but CIS and ATR did not significantly change MAP.Conclusion The onset time is longer and duration of action is shorter after cis-atracurium than afar atracurium.The N-M block induced by cis-atracurium is significantly attenuated if stored at the room temperature.Cis-atracurium does not cause histamine release.     

顺阿曲库铵的药效学及其对组胺释放的影响

Objective To evaluate and compare the histamine-releasing,potencies of cis-atracurium and atracurium during induction of general anesthesia.Methods Forty-five ASA Ⅰ or Ⅱ patients aged 16-71 yr undergoing elective surgery under general anesthesia were randomly divided into 3 groups (n=15 each):group Ⅰcis-atracurium (stored at 4-8℃)(group CIS1);groupⅡcis-atracurium (stored at room temperature)(group CIS2) and group Ⅲ atracurium (stored at 4-8℃)(group ATR).Anesthesia Was induced with TCI of propofol (Cp 3 μg/ml) and remifentanil (Ce 3-5 ng/ml).A bolus of cis-atracurium 0.15 mg/kg or atracurium 0.75 mg/kg Was given iv over 5-10 s as soon as the patients lost consciousness.Neuro-muscular block was monitored with TOF-Watch(R) SX(Organon,the Netherlands).Single stimulation (0.1 Hz) was apphed to the ulna nerve at wrist.The maximal degree of N-M block,onset time,duration of action and recovery index were recorded.The patients were intubated and mechanically ventilated when N-M block reached the maximal degree.The intubation condition Was evaluated.MAP and HR were continuously monitored.Changes in skin were scored (0=no change,Ⅰ=flushed>120 s,Ⅱ=erytbema,Ⅲ=urticaria).Blood samples were obtained before (T0,baseline),at 2 min after induction of anesthesia with TCI of propofol and remifentanil (T1) and 2 and 5 min after CIS/ATR administration (T2,T3) for determination of plasma histamine concentration using enzymatically amplified immunoassay.Results The onset time was significantly longer and the duration of action was significantly shorter in group CIS1 than in group ATR.The maximal degree of N-M block was 100%and the intubation condition was excellent in group CIS1 and ATR.There wag no significant difference in the recovery index between group CIS1 and ATR.The onset time was significantly longer and duration of action shorter in group CIS2 than in group CIS1.There was no significant difference in recovery index between group CIS1 and CIS2.There was no significant change in plasma histamine concentration at T1-3 as compared with the baseline at T0 in group CIS1 but plasma histamine concentration was significantly increased at T2,3 in group ATR.MAP was significantly decreased after induction of anesthesia with propofol and remifentanil,but CIS and ATR did not significantly change MAP.Conclusion The onset time is longer and duration of action is shorter after cis-atracurium than afar atracurium.The N-M block induced by cis-atracurium is significantly attenuated if stored at the room temperature.Cis-atracurium does not cause histamine release.     

妇科腹腔镜手术患者气腹不同阶段伤害性刺激强度的变化

Objective To evaluate the changes in noxious stimulation intensity at different periods of pneumoperitoneum in gynecological laparoscopic surgery. Methods Forty-five ASA Ⅰ orⅡ patients, aged 25-36 yr, with body mass index 18-23 kg/m2 , undergoing elective gynecological laparoscopic surgery, were randomly divided into 3 groups ( n = 15 each) . In group Ⅰ , anesthesia was maintained with TCI of remifentanil (target plasma concentration 4-6 ng/ml) and propofol (target plasma concentration 2 μg/ml) , and the concentrations were ad-justed according to the changes in BP and HR to maintain hemodynamics stable. Ⅱ and Ⅲ groups received inhala-tion of isoflurane (end-tidal concentration 1%-2%) and TCI of remifentanil (target plasma concentration 2-4ng/ml) . TCI of remifentanil was then stopped at 5 min before pneumoperitoneum (group Ⅱ ) or at 5 min after theend of rapid inflation (group Ⅲ ) , and isoflurane was inhaled (end-tidal concentration 1%-2% ) to maintain anes-thesia until the end of operation in Ⅱ and Ⅲ group. Before anesthesia (T0 ), 5 min before pneumoperitoneum (T1), 5 and 15 min of pneumoperitoneum (T2,3), HR and MAP were monitored and venous blood samples were taken for determination of plasma cortisol (Cor) , norepinephrine ( NE) and epinephrine ( E) concentrations. Results HR, MAP and NE and E concentrations at T2,3 , and Cor concentrations at T3 were significantly higher than those at T0 ingroup Ⅱ , and in group Ⅱ than in group Ⅰ (P<0.05). HR, MAP and NE and E concentrations at T2,3 ,and Cur concentrations at T3 were significantly lower in group Ⅲ than in group Ⅱ ( P < 0.05). Conclusion The intensity of noxious stimulation is strongest during rapid inflation among the different periods of pneumoperitoneum in gynecological laparoscopic surgery and the depth of anesthesia should be regulated.     

犬烧伤休克延迟复苏的实验研究

目的探讨应用林格液进行烧伤休克延迟复苏的效果.方法12只犬随机分为对照组(S组,6只)和治疗组(LR组,6只).LR组采用35%TBSAⅢ度烧伤模型,伤后6h以乳酸林格液进行复苏,并以尿量为1.0ml@kg-1@h-1及心输出量为伤前值的70%～80%来调整输液速度及输入量,观察其在伤后第一个24h复苏中的容量负荷、平均动脉压(MAP)、左心室收缩压(LVSP)、左室内压最大上升/下降速率(±dp/dtmax)、心脏排血指数(CI)、氧供给(DO2)及氧消耗(VO2)等的变化.结果乳酸林格液在烧伤休克延迟复苏后第一个24h的复苏中,每1%烧伤面积的输液量为(887±1.02)ml/kg,比采用Parkland公式复苏多1.2倍,其中在复苏后4h内的输液量为(3.63±0.99)ml/kg,为总入量的41%;MAP、LVSP、±dp/dtmax、CI、DO2及VO2等指标在复苏后2h即达到或接近对照组水平.结论乳酸林格液在烧伤休克延迟复苏中,比早期复苏需要更多的液体量才能满足需求,而血流动力学、心肌功能及氧动力学等在复苏后2h即有明显改善.     

妇科腹腔镜手术患者气腹不同阶段伤害性刺激强度的变化

Objective To evaluate the changes in noxious stimulation intensity at different periods of pneumoperitoneum in gynecological laparoscopic surgery. Methods Forty-five ASA Ⅰ orⅡ patients, aged 25-36 yr, with body mass index 18-23 kg/m2 , undergoing elective gynecological laparoscopic surgery, were randomly divided into 3 groups ( n = 15 each) . In group Ⅰ , anesthesia was maintained with TCI of remifentanil (target plasma concentration 4-6 ng/ml) and propofol (target plasma concentration 2 μg/ml) , and the concentrations were ad-justed according to the changes in BP and HR to maintain hemodynamics stable. Ⅱ and Ⅲ groups received inhala-tion of isoflurane (end-tidal concentration 1%-2%) and TCI of remifentanil (target plasma concentration 2-4ng/ml) . TCI of remifentanil was then stopped at 5 min before pneumoperitoneum (group Ⅱ ) or at 5 min after theend of rapid inflation (group Ⅲ ) , and isoflurane was inhaled (end-tidal concentration 1%-2% ) to maintain anes-thesia until the end of operation in Ⅱ and Ⅲ group. Before anesthesia (T0 ), 5 min before pneumoperitoneum (T1), 5 and 15 min of pneumoperitoneum (T2,3), HR and MAP were monitored and venous blood samples were taken for determination of plasma cortisol (Cor) , norepinephrine ( NE) and epinephrine ( E) concentrations. Results HR, MAP and NE and E concentrations at T2,3 , and Cor concentrations at T3 were significantly higher than those at T0 ingroup Ⅱ , and in group Ⅱ than in group Ⅰ (P<0.05). HR, MAP and NE and E concentrations at T2,3 ,and Cur concentrations at T3 were significantly lower in group Ⅲ than in group Ⅱ ( P < 0.05). Conclusion The intensity of noxious stimulation is strongest during rapid inflation among the different periods of pneumoperitoneum in gynecological laparoscopic surgery and the depth of anesthesia should be regulated.     

肠癌根治术病人两种容量治疗方案效果的比较

Objective To compare the efficacy of two regimens of volume therapy in patients undergoing radical intestinal cancer operation. Methods Forty ASA Ⅰ or Ⅱ patients, aged 45-64 yr, weighing 42-65 kg,scheduled for radical intestinal cancer operation, were randomly divided into group Ⅰ and group Ⅱ (n = 20 each).In group Ⅰ , 6% hydroxyethyl starch 130/0.4 (HES) 15 ml/kg was infused iv over 30 min before anesthesia induction, and lactated Ringer's solution 15 ml/kg was infused iv over 30 min immediately after anesthesiainduction for hemodilution. In group Ⅱ , lactated Ringer's solution 15 ml/kg was infused iv over 30 min before anesthesia induction, and HES 15 ml/kg was infused iv over 30 min immediately after anesthesia induction for hemodilution. Intraoperative infusion of colloid and crystalloid, blood loss, urine output and allngeneic blood transfusion were recorded. MAP, CVP and HR were recorded after entering the operating room (T0 , baseline),and at 0, 15, 60 and 120 min after anesthesia induction (T<1-4>), and at the end of operation (T5). Blood samples were taken from radial artery at To , T0 , T3 and T5 for blood gas analysis and determination of Hb and Hct. Results Allogeneic blood was not transfused in beth groups. There were no significant differences in infusion of colloid and erystalloid, blood loss, and urine output between the two groups (P>0.05). Compared with the baseline value, no were significant changes in intraoperative MAP, HCO-3, concentrations of lactate, Na+ and K+ were detected (P> 0.05), while CVP was significantly increased, and HR, Het, Hb, and pH value at the end of operation were significantly decreased in group Ⅰ . Compared with the baseline value, intraoperative CVP was significantly increased, and MAP, HR, pH value, and HCO-3 at the end of operation were significantly decreased,while no significant changes in concentration lactate, Na+ and K+ were detected in group Ⅱ (P > 0.05).Intraoperative CVP was significantly higher and lactate concentration at the end of operation significantly lower in group Ⅱ than in group Ⅰ . Conclusion The efficacy of volume therapy with HES before anesthesia induction and lactated Ringer's solution after anesthesia induction for hemodilution is better.     

不同剂量6%HES 130/0.4容量治疗对失血性休克大鼠肺损伤的影响

Objective To evaluate the effects of volume therapy with different doses of 6% hydroxyethyl starch 130/0.4 (6% HES 130/0.4) on lung injury in a rat model of hemonhagic shock.Methods Twenty-four male SD rats weighing 220-300 g were randomly divided into 4 groups ( n = 6 each) : group I sham operation (group S); group II Ringer's solution (group RS); group HI and IV 2 HES groups (group H1, H2 ). The animals were anesthetized with intraperitoneal 1% sodium pentobarbital 45 ing/kg. Right common carotid artery (CCA) and left femoral vein were cannulated for blood letting, MAP monitoring, fluid administration and blood sampling. Hemonhagic shock was induced by withdrawing blood from right CCA in group II , III and IV . MAP was reduced to 35-45 mmHg which was maintained for 90 min. In group RS, hemorrhagic shock was resuscitated with Ringer's solution 3 times of the volume of blood withdrawn, while group H1 and H2 received HES 33 and 50 ml/kg respectively and Ringer' s solution (the total volume was equal to 3 times of the volume of blood removed) . Arterial blood samples were taken before blood letting (T0 , baseline), and at 2, 3 h after volume therapy (T1,2) for blood gas analysis and PaO2/FiO2 was calculated. The animals were then sacrificed by exsanguination and the lungs were immediately removed for microscopic examination and determination of protein concentration in broncho-alveolar lavage fuid (BALF), W/D lung weight ratio and TNF-α, IL-1 β and IL-10 contents in the lung.Results TNF-α, IL-1β and IL-10 content in the lung, protein concentration in BALF and W/D ratio were significantly higher in group RS, H1 and H2, while PaO2/FiO2 was significantly lower at T,2 in group RS and at T2 in group H2 than in group S (P < 0.05). TNF-α and IL-1β contents in the lung, protein concentration in BALF and W/D ratio were significantly lower in group H1 and H2 , while PaO2/FiO2 was significantly higher at T,i2 in group H1 and at T1 in group H2 than in group RS (P <0.05) . PaO2/FiO2 at T2 and IL-10 content in the lung were significantly lower in group H2 than in group H, ( P < 0.05) . The lung damage was significantly ameliorated in group H1 and H2 especially in group H, as compared with group RS. Conclusion Volume therapy with 6% HES 130/0.4 33 or 50 ml/kg can attenuate lung injury in a rat model of hemorrhagic shock and the efficacy of 33 ml/kg is better.     

联合腰-硬镇痛对分娩产妇IL-1β、IL-10及T细胞亚群的影响

Objective To investigate the effect of combined spinal-epidural analgesia(CSEA) on immunological function and Th1/Th2 balance by observing the levels of serum T-lymphocyte subsets,IL-1β and IL-10 during labor in maternity.Methods Fifty healthy primipara expecting spontaneous labor were randomly divided into two groups(n=25).CSEA was performed with 20 μg fentanyl for lumbar analgesia and with complex of ropivacaine(0.1%) and fentanyl(2 μg/ml) for epidural analgesia in group Ⅰ,and no labor analgesia was given in group Ⅱ.Serum cortisol,IL-1β,IL-10 and T lymphocyte subsets was detected at cervical dilation of 2 cm-3 cm (T1),fetal disengagement (T2) and 24 h after childbirth (T3).Labor progress,VAS and neonatal Apgar score were recorded.Results The active phase of the first labor stage significantly shortened in group Ⅰ compared to that in group Ⅱ (P＜0.05),without difference in neonatal Apgar score between two groups.Along with labor progress,the level of serum IL-1β markedly increased in two groups,and the levels of cortisol,IL-1β and IL-10 were obviously decreased at T2 in group Ⅰ compared to those in group Ⅱ(P＜0.05).The levels of serum CD3+,CD4+,and CD4+/CD8+ decreased in both groups,with significant reduction at T3 (P＜0.05) and more significant in group Ⅱ than in group Ⅰ (P＜0.05).Conclusion CSEA shortens the active delivery phase in the first stage of labor and alleviates pain stress-induced inhibition on immune function and may benefit the balance of Th1/Th2 in maternity.     

不同剂量6%HES 130/0.4容量治疗对失血性休克大鼠肺损伤的影响

Objective To evaluate the effects of volume therapy with different doses of 6% hydroxyethyl starch 130/0.4 (6% HES 130/0.4) on lung injury in a rat model of hemonhagic shock.Methods Twenty-four male SD rats weighing 220-300 g were randomly divided into 4 groups ( n = 6 each) : group I sham operation (group S); group II Ringer's solution (group RS); group HI and IV 2 HES groups (group H1, H2 ). The animals were anesthetized with intraperitoneal 1% sodium pentobarbital 45 ing/kg. Right common carotid artery (CCA) and left femoral vein were cannulated for blood letting, MAP monitoring, fluid administration and blood sampling. Hemonhagic shock was induced by withdrawing blood from right CCA in group II , III and IV . MAP was reduced to 35-45 mmHg which was maintained for 90 min. In group RS, hemorrhagic shock was resuscitated with Ringer's solution 3 times of the volume of blood withdrawn, while group H1 and H2 received HES 33 and 50 ml/kg respectively and Ringer' s solution (the total volume was equal to 3 times of the volume of blood removed) . Arterial blood samples were taken before blood letting (T0 , baseline), and at 2, 3 h after volume therapy (T1,2) for blood gas analysis and PaO2/FiO2 was calculated. The animals were then sacrificed by exsanguination and the lungs were immediately removed for microscopic examination and determination of protein concentration in broncho-alveolar lavage fuid (BALF), W/D lung weight ratio and TNF-α, IL-1 β and IL-10 contents in the lung.Results TNF-α, IL-1β and IL-10 content in the lung, protein concentration in BALF and W/D ratio were significantly higher in group RS, H1 and H2, while PaO2/FiO2 was significantly lower at T,2 in group RS and at T2 in group H2 than in group S (P < 0.05). TNF-α and IL-1β contents in the lung, protein concentration in BALF and W/D ratio were significantly lower in group H1 and H2 , while PaO2/FiO2 was significantly higher at T,i2 in group H1 and at T1 in group H2 than in group RS (P <0.05) . PaO2/FiO2 at T2 and IL-10 content in the lung were significantly lower in group H2 than in group H, ( P < 0.05) . The lung damage was significantly ameliorated in group H1 and H2 especially in group H, as compared with group RS. Conclusion Volume therapy with 6% HES 130/0.4 33 or 50 ml/kg can attenuate lung injury in a rat model of hemorrhagic shock and the efficacy of 33 ml/kg is better.     

腹腔镜手术患儿压力控制通气和容量控制通气效果的比较

目的 比较腹腔镜手术患儿压力控制通气和容量控制通气的效果.方法 择期行腹腔镜手术患儿30例,性别不限,年龄12～36月,ASA分级Ⅰ或Ⅱ级,体重9～15 kg,采用随机数字表法,将其随机分为2组(n=15):压力控制通气组(P组)和容量控制通气组(V组).麻醉诱导后气管插管行机械通气,P组调节麻醉机最大吸气压力使潮气量达到12 ml/kg,V组设置潮气量12 ml/kg,维持PETCO235～45mmHg.于气管插管后即刻(T0)、切皮前即刻(T1)、气腹30 min(T2)和气腹结束后15 min (T3)时,记录MAP、HR、PETCO2、分钟通气量和气道峰压,并采集动脉血样,进行血气分析,计算肺动态顺应性和生理死腔量/潮气量.结果 与V组比较,P组T1,2时PaCO2和PETCO2降低,肺动态顺应性升高,T0～3时分钟通气量和气道峰压降低(P<0.01),MAP、HR和生理死腔量/潮气量差异无统计学意义(P>0.05).结论 与容量控制通气相比,压力控制通气可更好地改善腹腔镜手术患儿肺通气效果,有利于气体交换,减少气腹对呼吸功能的影响.

Abstract：

Objective To compare the efficacy of pressure-controlled ventilation and volume-controlled ventilation in children undergoing laparoscopic surgery. Methods Thirty ASA Ⅰ or Ⅱ children of both sexes,aged 12-36 months, weighing 9-15 kg, scheduled for laparoscopic surgery, were randomly divided into 2 groups (n = 15 each): pressure-controlled ventilation group (group P) and volume-controlled ventilation group (group V) . Anesthesia was induced with propofol 2-4 mg/kg, vecuronium 0.1 mg/kg and fentanyl 2 μg/kg. The children were tracheal intubated and mechanically ventilated. The maximum inspiratory pressure was adjusted to make the tidal volume (VT ) achieve 12 ml/kg in group P and the VT was set at 12 ml/kg in group V. PETCO2 was maintained at 35-45 mm Hg. MAP, HR, PETCO2 , minute ventilation and peak airway pressure were recorded immediately after intubation (T0 ) , immediately before skin incision (T1 ) , 30 min of pneumoperitoneum (T2 ) and 15 min after the end of pneumoperitoneum (T3 ) . Arterial blood samples were taken at the same time points mentioned above for blood gas analysis. Dynamic lung compliance and physiological dead space to tidal volume ratio were calculated.Results Compared with group V, PaCO2 and PETCO2 were significantly decreased and dynamic lung compliance was significantly increased at T1,2 , and minute ventilation and peak airway pressure were significantly decreased at T0-3 in group P ( P < 0.01) . There was no significant difference in MAP, HR and physiological dead space to tidal volume ratio between the two groups ( P > 0.05) . Conclusion Compared with volume-controlled ventilation, pressure-controlled ventilation can better improve the ventilatory efficacy, is more beneficial to gas exchange and reduces the influence of pneumoperitoneum on respiratory function in children undergoing laparoscopic surgery.     

诱导型一氧化氮合酶在舒芬太尼预处理减轻大鼠心肌缺血再灌注损伤中的作用

目的 探讨诱导型一氧化氮合酶(iNOS)在舒芬太尼预处理减轻大鼠心肌缺血再灌注损伤中的作用.方法 成年雄性SD大鼠30只,体重250～330 g,采用随机数字表法,将大鼠随机分为5组(n=6):假手术组(S组)只穿线,不结扎;心肌缺血再灌注组(I/R组)采用结扎左冠状动脉前降支30min,再灌注120 min的方法制备大鼠心肌缺血再灌注损伤模型;舒芬太尼预处理组(SF组)缺血前24 h经尾静脉输注舒芬太尼120μg/kg,输注时间30 min;舒芬太尼预处理+iNOS特异性抑制剂S-甲硫脲组(SF+SMT组)缺血前24 h经尾静脉输注舒芬太尼120μg/kg,缺血前10 min静脉注射SMT 10 mg/kg;SMT组缺血前10 min静脉注射SMT 10 mg/kg.于缺血前30 min、缺血30 min、再灌注120 min时记录HR和MAP,计算RPP(SP× HR).于再灌注120 min时取颈动脉血样2 ml,测定血浆NO浓度,随后取心脏制病理切片,测定缺血危险区(AAR)和梗死区(IS)体积,计算心肌梗死体积(IS/AAR),测定心肌iNOS表达.结果 与S组比较,余4组再灌注120 min时MAP和RPP降低,IS/AAR升高,I/R组和SMT组缺血30 min时MAP和RPP降低(P＜0.05);与I/R组比较,SF组、SF+SMT组和SMT组HR、MAP和RPP差异无统计学意义,SF+SMT组和SMT组IS/AAR和血浆NO浓度差异无统计学意义(P＞0.05),SF组IS/AAR降低,血浆NO浓度和心肌iNOS表达升高(P＜0.05).结论 iNOS参与了舒芬太尼预处理减轻大鼠心肌缺血再灌注损伤的过程.

Abstract：

Objective To investigate the role of inducible nitric oxide synthase (iNOS) in reduction of myocardial ischemia-reperfusion (I/R) injury by sufentanil preconditioning in rats. Methods Thirty adult male SD rats, weighing 250-330 g, were randomly divided into 5 groups ( n =6 each): sham operation group (group S),I/R group, sufentanil preconditioning group (group SF), sufentanil preconditioning + a specific inhibitor of iNOS S-methyl thiourea (SMT) group (group SF+ SMT) and S-methyl thiourea group (group SMT). In I/R,SF,SF+SMT and SMT groups, myocardial I/R was produced by occlusion of left anterior descending coronary artery for 30 min followed by 120 min reperfusion. Group SF received 30 min infusion of sufentanil 120 μg/kg via caudal vein 24 h before ischemia. Group SF + SMT received infusion of sufentanil 120 μg/kg via caudal vein 24 h before ischemia and then SMT 10 mg/kg was injected 10 min before ischemia. In group SMT, SMT 10 mg/kg was injected 10min before ischemia. MAP and HR were recorded at 30 min before ischemia, at 30 min of ischemia and at the end of reperfusion. The rate-pressure product (RPP) was calculated. Arterial blood samples were obtained immediately at the end of reperfusion to determine the plasma concentration of NO. Then the animals were sacrificed and myo cardial tissues were obtained to determine the area at risk (AAR), infarct size (IS) and iNOS expression. IS/AAR was calculated. Results Compared with group S, MAP and RPP were significantly decreased, while IS/AAR was significantly increased at 120 min of reperfusion in the other four groups, and MAP and RPP were significantly decreased at 30 min of ischemia in I/R and SMT groups ( P ＜ 0.05). Compared with group I/R, no significant change was found in HR, MAP and RPP in SF, SF + SMT and SMT groups, and in IS/AAR and plasma NO concentrations in SF + SMT and SMT groups ( P ＞ 0.05), but IS/AAR was significantly decreased, and the plasma NO concentration and iNOS expression were significantly increased in group SF ( P ＜ 0. 05). Conclusion iNOS is involved in reduction of myocardial I/R injury by sufentanil preconditioning in rats.