氨溴索预先给药对单肺通气患者炎性反应及脂质过氧化反应的影响

Objective To investigate the effect of ambroxol pretreatment on the inflammatory response and lipid peroxidation during one-lung ventilation (OLV) .Methods Forty-five ASA I or II patients aged 37-64 yr weighing 53-65 kg undergoing thoracotomy under general anesthesia were randomly divided into 3 groups ( n = 15 each): group A two-lung ventilation (TLV); group B OLV and group C ambroxol 1 mg/kg + OLV. Anesthesia was induced with midazolam, fentanyl, propofol and atracurium and maintained with propofol infusion and intermittent iv boluses of fentanyl and atracurium. The patients were mechanically ventilated (VT8-10 ml/kg, RR 12 bpm during TLV, VT 6-7 ml/kg, RR 16 bpm during OLV, I: E 1:2, FiO2 100% ). In group C ambroxol 1 mg/kg in normal saline ( NS) 100 ml was infused at 25 min before OLV (infusion rate 4 ml/min) , while in group A and B equal volume of NS was infused instead of ambroxol. Blood samples were obtained from radial artery before induction of anesthesia and OLV (T0.1 ) and at 0.5, 1, 2 h of OLV (T2-4 ) and 1, 2 h of TLV (T5,6 ) and at 24 h after operation (T7) in group B and C for determination of serum SOD activity and TNF-α, IL-6 and IL-8 concentrations and WBC and neutrophil granulocyte counts. The same indexes were detected in group A at the corresponding time points.Results Serum SOD activity was significantly lower and serum TNF-α, IL-6 and IL-8 concentrations and WBC and neutrophil granulocyte counts were significantly higher in group B than in group A. Serum SOD activity was significantly higher and serum TNF-a, IL-6 and IL-8 concentrations and WBC and neutrophil granulocyte counts were significantly lower in group C than in group B. Conclusion Pretreatment with ambroxol 1 mg/kg can inhibit inflammatory response and lipid peroxidation during OLV.     

氨溴索预先给药对单肺通气患者炎性反应及脂质过氧化反应的影响

Objective To investigate the effect of ambroxol pretreatment on the inflammatory response and lipid peroxidation during one-lung ventilation (OLV) .Methods Forty-five ASA I or II patients aged 37-64 yr weighing 53-65 kg undergoing thoracotomy under general anesthesia were randomly divided into 3 groups ( n = 15 each): group A two-lung ventilation (TLV); group B OLV and group C ambroxol 1 mg/kg + OLV. Anesthesia was induced with midazolam, fentanyl, propofol and atracurium and maintained with propofol infusion and intermittent iv boluses of fentanyl and atracurium. The patients were mechanically ventilated (VT8-10 ml/kg, RR 12 bpm during TLV, VT 6-7 ml/kg, RR 16 bpm during OLV, I: E 1:2, FiO2 100% ). In group C ambroxol 1 mg/kg in normal saline ( NS) 100 ml was infused at 25 min before OLV (infusion rate 4 ml/min) , while in group A and B equal volume of NS was infused instead of ambroxol. Blood samples were obtained from radial artery before induction of anesthesia and OLV (T0.1 ) and at 0.5, 1, 2 h of OLV (T2-4 ) and 1, 2 h of TLV (T5,6 ) and at 24 h after operation (T7) in group B and C for determination of serum SOD activity and TNF-α, IL-6 and IL-8 concentrations and WBC and neutrophil granulocyte counts. The same indexes were detected in group A at the corresponding time points.Results Serum SOD activity was significantly lower and serum TNF-α, IL-6 and IL-8 concentrations and WBC and neutrophil granulocyte counts were significantly higher in group B than in group A. Serum SOD activity was significantly higher and serum TNF-a, IL-6 and IL-8 concentrations and WBC and neutrophil granulocyte counts were significantly lower in group C than in group B. Conclusion Pretreatment with ambroxol 1 mg/kg can inhibit inflammatory response and lipid peroxidation during OLV.     

乌司他丁对心脏瓣膜置换术患者体外循环期间全身炎性反应的影响

Objective To investigate the effects of ulinastatin on the systemic inflammatory response in the patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB). Methods Forty ASA Ⅱ or Ⅲ patients of both sexes, aged 27-44 yr, weighing 39-72 kg, scheduled for cardiac vavle replacement, were randomly divided into 2 groups (n = 20 each) : control group (group C) and ulinastatin group (group U). Ulinastatin 10 000 U/kg was injected iv 10 min before CPB, and ulinastatin 10 000 U/kg was added to the priming fluid in group U. The equal volume of normal saline was given in stead of ulinastatin in group C. Venous blood samples were taken at 15 min before CPB (T1), 10 min of CPB (T2), and 30 and 60 min after termination of CPB (T3,4)for determination of the plasma concentrations of IL-6, IL-8, IL-10 and TNF-α. Results The plasma concentrations of IL-6, IL-8 and TNF-α were significantly lower and plasma IL-10 concentration was significantly higher during and after CPB in group U than in group C (P <0.05 or 0.01). The plasma concentrations of IL-6,IL-8, IL-10 and TNF-α were significantly higher in beth groups at T2,3 than at T, (P < 0.01). Conclusion Ulinastatin can ameliorate the unbalance between pro- and anti-inflammatory responses during CPB and reduce the systemic inflammatory response in the patients undergoing cardiac valve replacement.     

异丙酚和七氟烷对全麻病人短时间吸入纯氧诱发氧化应激反应的影响

Objective To investigate the effects of propofol and sevoflurane on oxidative stess response induced by short period pure oxygen inhalation during general anesthesia.Methods Sixty ASA Ⅰ or Ⅱ patients aged 20-60 yr weighing 50-85 kg undergoing elective abdominal surgery under general anesthesia were randomly divided into 2 groups (n=30 each):group propofol (group P) and group sevoflurane (group S).Each group was further divided into 2 subgroups inhaling 40% O2 (P0.4,S0.4) and 100%O2(P1.0,S1.0) respectively during operation.Anesthesia was induced with propofol 1-2 mg/kg,midazolan 0.02 mg/kg and sufentanil 0.1-0.2 mg/kg.Tracheal intobation was facilitated with rocuronium 0.6-0.8 mg/kg.The patients were mechanically ventilated(VT 8 ml/kg,RR 12 bpm).PET CO2 was maintained at 35-40 mmHg.Anesthesia was maintained with in both groups.BIS was maintained at 40-60.Arterial blood samples were collected immediately before induction of anesthesia (baseline),at 2,4,6h after tracheal intubation(T1-3) and 24h after operation(T4) for determination of PaO2,serum 8-iso-PGF2α and MDA concentrations and SOD activity.PaO2/FiO2 was calculated.Results In subgroup S1.0 the serum 8-iso-PGF2α and MDA concentrations were significantly increased while serum SOD activity was significanfly decreased at T1-3 as compared with the baseline.Serum 8-iso-PGF2α and MDA concentrations were significantly higher while serum SOD activity and PaO2/FiO2 were significantly lower at T1-3 in subgroup S1.0 than in stress response induced by≤6h pure O2 inhalation but inhalation of 1.5%-3.0% sevoflurane can not.     

异丙酚和七氟烷对全麻病人短时间吸入纯氧诱发氧化应激反应的影响

Objective To investigate the effects of propofol and sevoflurane on oxidative stess response induced by short period pure oxygen inhalation during general anesthesia.Methods Sixty ASA Ⅰ or Ⅱ patients aged 20-60 yr weighing 50-85 kg undergoing elective abdominal surgery under general anesthesia were randomly divided into 2 groups (n=30 each):group propofol (group P) and group sevoflurane (group S).Each group was further divided into 2 subgroups inhaling 40% O2 (P0.4,S0.4) and 100%O2(P1.0,S1.0) respectively during operation.Anesthesia was induced with propofol 1-2 mg/kg,midazolan 0.02 mg/kg and sufentanil 0.1-0.2 mg/kg.Tracheal intobation was facilitated with rocuronium 0.6-0.8 mg/kg.The patients were mechanically ventilated(VT 8 ml/kg,RR 12 bpm).PET CO2 was maintained at 35-40 mmHg.Anesthesia was maintained with in both groups.BIS was maintained at 40-60.Arterial blood samples were collected immediately before induction of anesthesia (baseline),at 2,4,6h after tracheal intubation(T1-3) and 24h after operation(T4) for determination of PaO2,serum 8-iso-PGF2α and MDA concentrations and SOD activity.PaO2/FiO2 was calculated.Results In subgroup S1.0 the serum 8-iso-PGF2α and MDA concentrations were significantly increased while serum SOD activity was significanfly decreased at T1-3 as compared with the baseline.Serum 8-iso-PGF2α and MDA concentrations were significantly higher while serum SOD activity and PaO2/FiO2 were significantly lower at T1-3 in subgroup S1.0 than in stress response induced by≤6h pure O2 inhalation but inhalation of 1.5%-3.0% sevoflurane can not.     

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.     

雾化吸入小剂量氨溴索对开胸食道手术患者单肺通气时炎性反应的影响

目的 评价雾化吸入氨溴索对开胸食道手术患者单肺通气时炎性反应的影响.方法 择期行开胸食道手术患者60例,ASA分级Ⅰ或Ⅱ级,年龄39～64岁,体重50～85 kg,身高153～181cm.采用随机数字表法,将患者随机分为3组(n=20):对照组(C组)、静脉输注氨溴索组(IA组)和雾化吸入氨溴索组(AIA组).单肺通气前10 min,C组静脉输注生理盐水250 ml;IA组静脉输注氨溴索10mg/kg(用生理盐水稀释至250 ml);AIA组采用自制装置氧气驱动雾化吸入氨溴索4 ml(30 mg)+生理盐水2 ml,氧流量5～6 L/mim.于麻醉诱导后给药前1 min(T0)、单肺通气90 min(T,)和恢复双肺通气30 min(T2)时,采集桡动脉血样,采用双抗体夹心ELISA法测定血清TNF-α、IL-1β、IL-8和IL-10的浓度.结果 与T0时比较,各组T1和T2时血清TNF-α、IL-1β、IL-8的浓度升高,IL-10浓度降低(P＜0.05);与C组比较,LA组和AIA组T1和T2时血清TNF-α、IL-1β、IL-8的浓度降低,IL-10浓度升高(P＜0.05);IA组和AIA组各时点血清TNF-α、IL-1β、IL-8、IL-10的浓度差异无统计学意义(P＞0.05).结论 雾化吸入小剂量氨溴索可抑制开胸食道手术患者单肺通气导致的炎性反应,且与静脉注射大剂量氨溴索效果相似.

Abstract：

Objective To investigate the effects of inhaled aerosolized low dose ambroxol on the inflammatory response to one-lung ventilation ( OLV) in patients undergoing open-chest esophagus surgery. Methods Sixty patients with normal heart and lung function undergoing open-chest esophagus surgery were randomly divided into 3 groups ( n = 20 each): control group (group C) ; group IA received Ⅳ ambroxol 10 mg/kg after induction of anesthesia and group AIA inhaled aerosolized ambroxol 30 mg after induction of anesthesia. Arterial blood samples were taken after induction of anesthesia before ambroxol administration (T0, baseline) , at 90 min of OLV (T1 )and at 30 min after OLV (T2) for determination of plasma concentrations of TNF-α, IL-1β, IL-8 and IL-10 by ELBA.Results Plasma TNF-α, IL-1β, and IL-8 concentrations were significantly increased while plasma IL-10 concentration was significantly decreased at T1 and T2 as compared with the baseline at T0 in all 3 groups. Plasma TNF-α, IL-1β, and IL-8 concentrations were significantly lower and plasma IL-10 concentration was significantly higher at T1 and T2 in groups IA and AIA than in group C. Conclusion Both Ⅳ large dose ambroxol and inhaled aerosolized low dose ambroxol can inhibit the inflammatory response to OLV in patients undergoing open-chest esophagus surgery.     

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.     

异丙酚对腹腔镜胆囊切除术气腹患者肝功能的影响

目的 评价异丙酚对腹腔镜胆囊切除术气腹患者肝功能的影响.方法 择期行腹腔镜胆囊切除术患者50例,ASA Ⅰ或Ⅱ级,年龄18～64岁,随机分为2组(n=25):异氟醚组(Ⅰ组)和异丙酚组(P组).麻醉诱导:静脉注射芬太尼3 gg/kg、依托咪酯0.3 mg/kg和琥珀胆碱1 mg/kg,气管插管后机械通气;麻醉维持:两组均静脉注射维库溴铵1～1.2 mg/kg,每30分钟静脉注射芬太尼1～2 μg/kg和维库溴铵0.5 mg/kg,Ⅰ组吸入异氟醚1.3 MAC,P组靶控输注异丙酚(血浆靶浓度2.0～2.3μg/ml).于麻醉诱导前(T0)和气腹解除后5 min(T1)时抽取肘静脉血样4 ml,检测血浆丙二醛(MDA)浓度、超氧化物歧化酶(SOD)、谷胱甘肽过氧化酶(GSH-PX)活性和总抗氧化能力(T-AOC).于T0及术后24 h(T2)时抽取肘静脉血样2 ml,检测血清谷丙转氨酶(ALT)、谷草转氨酶(AST)活性和总胆红素(T-BIL)浓度.结果 与T0时比较,两组T1时血浆MDA浓度升高,SOD、GSH-PX活性和T-AOC降低,T2时血清ALT、AST、T-BIL水平升高(P＜0.05或0.01);与Ⅰ组比较,P组血浆MDA浓度降低,SOD、GSH-PX活性和T-AOC升高,血清ALT、AST和T-BIL水平降低(P＜0.05).结论 腹腔镜胆囊切除术中靶控输注异丙酚(血浆靶浓度2.0～2.3μg/ml)可减轻CO2气腹诱发肝功能损害,有利于术后早期肝功能的恢复,其机制可能与减轻脂质过氧化反应有关.     

异丙酚对肝叶切除术患者肝缺血再灌注损伤的影响

目的 探讨异丙酚对肝叶切除术患者肝缺血再灌注损伤的影响.方法 拟行肝叶切除术的肝癌患者60例,年龄28～64岁,体重50～77 kg,ASA Ⅰ～Ⅲ级,随机分为对照组(Ⅰ组)和异丙酚组(Ⅱ组),每组30例.Ⅱ组肝门开放后静脉输注异丙酚4～6 mg·kg-1·h-1至术毕.分别于麻醉前(T1)、肝门阻断前(T2)、肝门阻断后15 min(T3)、肝门开放后10 min(T4)和45 min(T5)时抽取中心静脉血测定血清谷草转氨酶(AST)、谷丙转氨酶(ALT)、超氧化物歧化酶(SOD)活性,丙二醛(MDA)浓度.结果 与T1时比较,两组T3-5时AST、ALT活性升高,Ⅰ组T4,5时SOD活性降低、MDA浓度升高,Ⅱ组T4,5时SOD活性升高、MDA浓度降低(P<0.05);与Ⅰ组比较,Ⅱ组T4,5时AST、ALT活性降低,SOD活性升高、MDA浓度降低(P<0.05).结论 肝门开放后至术毕静脉输注异丙酚4～6mg·kg-1·h-1可减轻肝叶切除术患者肝缺血再灌注损伤.     

犬气管插管全麻下吸入不同浓度氧时自由基及肺超微结构的变化

目的　观察犬气管插管全麻下吸入不同浓度氧时的自由基及肺超微结构变化。方法　健康杂种犬 2 0只 ,随机分为纯氧组 (1组 ,FIO2 =1,n =10 )及 4 0 %氧气组 (2组 ,FIO2 =0 4 ,n =10 )。两组麻醉方法相同 ,均行气管内插管 ,接呼吸机机械控制呼吸。监测SOD、MDA在气管插管后1、3、5、7h的变化 ,并在电镜下观察肺组织的超微结构变化。结果　 (1)与基础值比较 ,1组插管后 1、3、5、7hSOD活力明显下降、MDA值明显升高 (P <0 0 1) ;(2 )组间比较 ,1组SOD活力较 2组明显下降 (P <0 0 1)、MDA值明显上升 (P <0 0 1或P <0 0 5 ) ;(3)肺超微结构变化 ,1组观察到的肺损伤重于 2组。结论　纯氧通气氧自由基产生明显增多 ,纯氧通气 7h后观察到的肺超微结构损伤较多 ,推测氧自由基在高氧肺损伤中发挥重要作用     

乌司他丁对肺癌切除术患者的肺保护效应

目的 探讨乌司他丁对肺癌切除术患者的肺保护效应.方法 选择拟行肺叶切除术的Ⅲ期肺癌患者40例,年龄50～64岁,体重53～70 kg,ASA分级Ⅱ或Ⅲ级,随机分为2组(n=20):对照组(C组)和乌司他丁组(U组).均采用咪达唑仑-芬太尼-维库溴铵-异丙酚麻醉诱导,异丙酚-芬太尼-维库溴铵维持麻醉.麻醉诱导后单肺通气前,U组经30 min静脉注射乌司他丁10 000 U/kg(生理盐水稀释至20 ml),C组给予等容量生理盐水.于麻醉诱导前即刻(T0)、单肺通气0.5 h(T1)、1 h(T2)、术后4 h(T3)、24 h(T4)时采集动脉血样5 ml,行动脉血气分析,计算呼吸指数(RI),并测定血浆IL-6、IL-10和TNF-α浓度.结果 与T0时比较,C组T1～4时血浆TNF-α、IL-6浓度和RI升高,T1-3时血浆IL-10浓度升高(P＜0.05),U组T2,3时血浆TNF-α和IL-6浓度升高,T1～4时血浆IL-10浓度和RI升高(P＜0.05).与C组比较,U组血浆TNF-α、IL-6浓度和RI降低,血浆IL-10浓度升高(P＜0.05).结论 乌司他丁10 000 U/kg可通过减轻全身炎性反应从而对肺癌切除术患者产生肺保护效应.     

乌司他丁对肝脏肿瘤切除术患者肝脏缺血-再灌注损伤的保护作用

目的观察乌司他丁对肝脏肿瘤切除术患者肝脏缺血-再灌注损伤的保护作用。方法选择32例ASAⅠ～Ⅲ级拟行肝脏肿瘤切除术的患者,随机均分为乌司他丁组(U组)和对照组(C组)。U组:乌司他丁12000U/kg加在生理盐水50ml中,麻醉诱导后切皮前经颈内静脉泵入;C组:注入等量的生理盐水。在切皮时(T1)、缺血后10min(T2)、再灌注10min(T3)、30min(T4)、1h(T5)、术后1d(T6)、2d(T7)抽取静脉血测定血浆中谷草转氨酶(AST)、谷丙转氨酶(ALT)、超氧化物歧化酶(SOD)活性,丙二醛(MDA)水平、白细胞介素1β(IL-1β)、白细胞介素6(IL-6)、肿瘤坏死因子(TNF-α)浓度。结果与T1时比较,T3～T6时两组的AST、ALT活性、MDA水平、IL-1β、IL-6、TNF-α浓度均明显升高;SOD活性明显降低(P<0.05)。与C组比较,T2～T7时U组的AST和ALT活性明显降低;T3～T5时MDA水平、IL-1β、IL-6和TNF-α浓度均明显降低;T3～T5时SOD活性明显升高(P<0.05)。结论乌司他丁能抑制氧自由基生成和炎症因子的释放,对肝脏缺血-再灌注损伤具有保护作用。     

异丙酚和七氟烷对全麻病人短时间吸入纯氧诱发氧化应激反应的影响

目的 评价异丙酚和七氟烷对全麻病人短时间吸入纯氧诱发氧化应激反应的影响.方法 择期拟行开腹手术全麻病人60例,年龄20～60岁,体重50～85kg,ASAⅠ或Ⅱ级,随机分为4组(n=15),各组均依次静脉注射舒芬太尼0.1～0.2 mg/kg、咪达唑仑0.02 mg/kg、异丙酚1～2 mg/kg和罗库溴铵0.6～0.8 mg/kg麻醉诱导,气管插管后行机械通气.麻醉维持:Ⅰ组和Ⅱ组静脉输注异丙酚100～150μg·kg-1·min-1,FiO2分别为40%和100%,Ⅲ组和Ⅳ组吸入1.5%～3.0%七氟烷,FiO2分别为40%和100%,各组均静脉输注瑞芬太尼0.5～1.0μg·kg-1·min-1,间断静脉注射罗库溴铵0.15 mg/kg,维持BIS 40～60.于麻醉诱导前(基础状态)、气管插管后2、4、6h、术后24h时(T1-4)采集动脉血样,测定PaO2、血清8-异前列腺素F2α(8-iso-PGF2α)、MDA浓度和SOD活性,并计算PaO2/FiO2.结果 与基础值比较,T1-3时Ⅰ组、Ⅱ组和Ⅲ组PaO2/FiO2升高,Ⅳ组血清8-iso-PGF2α和MDA浓度升高,SOD活性降低(P<0.05或0.01).与Ⅱ组和Ⅲ组比较,Ⅳ组T1～3时PaO2/FiO2降低,血清8-iso-PGF2α和MDA浓度升高,SOD活性降低(P<0.05).Ⅰ组与Ⅱ组间上述指标比较差异无统计学意义(P>0.05).结论 静脉输注异丙酚100～150μg·kg-1·min-1维持麻醉可抑制全麻病人短时间(≤6 h)吸人纯氧诱发氧化应激反应,而吸入1.5%～3.0%七氟烷维持麻醉则不能.     

氨溴索预先给药对单肺通气患者炎性反应及脂质过氧化反应的影响

目的 评价氨溴索预先给药对单肺通气患者炎性反应及脂质过氧化反应的影响.方法 选择开胸手术患者45例,年龄37～64岁,体重53～65 kg,ASAⅠ或Ⅱ级,随机分为3组(n=15),双肺通气组(TLV组)、单肺通气组(OLV组),单肺通气+氨溴索组(OLV+AMB组)于单肺通气前25 min开始静脉输注氨溴索1 mg/kg(100 ml,4 ml/min),TLV组和OLV组静脉输注等容量生理盐水.OLV组和OLV+AMB组于麻醉诱导前(T0)、单肺通气前即刻(T1)、单肺通气0.5 h(T2)、1 h(T3)、2 h(T4)、恢复双肺通气后1 h(T5)、2 h(T6)和术后24 h(T7)时,TLV组于上述对应时点,采集桡动脉血样,测定血清TNF-α、IL-6、IL-8浓度和SOD活性,进行WBC和中性粒细胞(PMN)计数.结果 与TLV组比较,OLV组血清IL-6、IL-8、TNF-α浓度升高,SOD活性降低,WBC和PMN计数升高(P<0.05或0.01);与OLV组比较,OLV+AMB组血清IL-6、IL-8和TNF-α浓度降低,SOD活性升高,WBC和PMN计数降低(P<0.05或0.01).结论 氨溴索1 mg/kg预先给药可减轻单肺通气患者炎性反应及脂质过氧化反应.     

Preoperative Fasting Plasma C-Peptide Level May Help to Predict Diabetes Outcome After Gastric Bypass Surgery

Background

To evaluate whether preoperative measurement of fasting plasma C-peptide levels is useful to predict diabetes outcome after Roux-en-Y gastric bypass (RYGB) surgery.

Materials and Methods

Diabetes outcome after RYGB was evaluated in 126 obese patients: 41 non-diabetic controls (NDC), 29 with impaired glucose tolerance (IGT) and 56 had type 2 diabetes mellitus (T2DM). Body weight, fasting plasma glucose, fasting C-peptide levels, and HbA1c were measured at baseline and 3.6?±?0.16 years after GBS. Complete resolution of diabetes was defined as: fasting glucose <7.0 mmol/l, HbA1c <6.5 %, achieved without anti-diabetic medication.

Results

Patients with complete resolution of diabetes had a more recent diagnosis of T2DM, lower preoperative HbA1c levels and lower daily doses of metformin and insulin use. These parameters were related to postoperative HbA1c levels but they failed to mark the specific patients who had not reached complete resolution of T2DM. Fasting preoperative C-peptide levels had better predictive power: 90 % of T2DM patients with preoperative fasting C-peptide levels >1.0 nmol/l achieved a postoperative HbA1c <6.5 %, and 74 % achieved complete resolution of their diabetes. In contrast, none of the T2DM patients with a preoperative fasting C-peptide <1.0 nmol/l attained these goals.

Conclusions

A preoperative fasting plasma C-peptide level <1.0 nmol/l in severely obese T2DM patients indicates partial β-cell failure, and is associated with a markedly reduced chance of complete resolution of T2DM after RYGB. We therefore advocate measuring C-peptide levels in all diabetic patients up for bariatric surgery to improve the prediction of outcome.     

乌司他丁对老年肾移植围术期细胞因子的影响

目的：观察乌司他丁对老年肾移植患者围手术期细胞因子释放的影响,探讨其促进移植。肾功能早期恢复的机制。方法：选择30例慢性肾炎肾功能衰竭的老年患者（年龄≥60岁）,随机分为对照组（C组）和乌司他丁组（U组）,每组15例。U组于手术开始后至循环开放前静滴50万IU乌司他丁,术后5d继续每天静注30万IU两组分别在术前（T0）、术毕即时（T1）、术后第1天（T2）、术后第3天（T3）、术后第5天（T4）、术后第7天（T5）等时点测定血清超氧化物歧化酶（SOD）、丙二醛（MDA）、肿瘤坏死因子-α（TNF-α）、白介素（IL）-6、IL-8及IL-10的浓度。同时术后第1～30天每天查血肌酐,记录肌酐恢复正常所需天数,记录各组发生延迟肾功能恢复和急性排斥反应的例数。结果：乌司他丁治疗组于T1、T2、T3、T4、T5的SOD、IL-10值高于对照组（P〈0．05）,而MDA、TNF-α、IL-6、IL-8值低于对照组（P〈0．05）。血肌酐恢复正常水平时间,两组比较差异有统计学意义（P〈0．05）。结论：乌司他丁能够减轻移植。肾的缺血-再灌注损伤和排斥反应引起的组织损伤,促进移植肾功能早期恢复。