盐酸右美托咪定联合阿托品对老年患者心率变异性的影响

目的观察盐酸右美托咪定联合阿托品对老年患者心率变异性的影响。方法选择40例择期行单侧髋关节置换术的老年患者,年龄60岁-85岁,ASAⅡ-Ⅲ级,随机分为二组：静脉注射阿托品0.5mg组（AD组,n=20）;生理盐水对照组（D组,n=20）。3分钟后两组均给予盐酸右美托咪定（0.5μg/Kg.h）静脉泵入,维持至手术结束前30分钟。记录心率变异性指标：基础值（T0）、输注右美托咪定5分钟（T1）和10分钟后（T2）的HR、LF、HF及LF/HF。结果在给药后T1及T2时间点,D组的HR、LF、HF及LF/HF分别与T0时刻相比均下降,差异有统计学意义（P〈0.05）;AD组的HR、LF、HF及LF/HF分别与T0时刻相比无统计学差异（P〉0.05）;D组的HR、LF、HF及LF/HF与AD组相比较均明显降低（P〈0.05）。结论盐酸右美托咪定能降低老年患者心率变异性的相关指标,联合使用阿托品后对老年患者的心率变异性无明显影响,可预防心动过缓等不良反应的发生。     

右美托咪定对带状疱疹患者免疫功能的影响

目的探讨右美托咪定对带状疱疹免疫功能的影响。方法将40例带状疱疹后遗神经痛患者随机分为2组,每组20例。观察组给予右美托咪定联合局麻药皮内注射,对照组给予单纯局麻药皮内注射。比较2组不同时段CD4、CD8、CD4/CD8,以及视觉模拟评分(VAS)的变化。结果观察组治疗24、48 h时CD8水平显著低于对照组,CD4/CD8水平显著高于对照组。治疗后5、10、30 d观察组VAS显著低于对照组。结论右美托咪定联合局麻药组治疗带状疱疹后神经疼痛,能增加患者的免疫力,并延长局麻药的镇痛时间,减少治疗次数,缩短疗程,且后期疗效明显,优于单纯局麻药治疗,值得临床推广。     

右美托咪定麻醉镇静效果评价

目的 评价右美托咪定麻醉镇静的效果.方法 检索2000年1月-2012年1月PubMed、Cochrane Database of Systematic Reviews、EMbase、中国知网及万方数据库中右美托咪定用于麻醉镇静的随机对照试验(RCT)研究,同时检索纳入文献的参考文献,评价纳入研究的方法学.对符合纳入标准的文献采用Rev Man 5.0软件进行Meta分析.结果 共5篇文献284例纳入研究,其中使用右美托咪定干预的试验组150例,使用咪达唑仑和(或)丙泊酚干预的对照组134例.Meta分析结果表明试验组的镇静效果明显优于对照组,差异具有统计学意义[RR =2.04,95％CI(1.04,3.99)];谵妄及其他不良反应发生率明显低于对照组,差异亦具有统计学意义[RR =0.33,95％CI(0.13,0.85);RR=0.43,95％CI(0.20,0.93)].结论 与传统麻醉镇静药物相比,右美托咪定可显著提升麻醉镇静效果,且不良反应少,安全、可靠.     

右美托咪定对舌癌患者围术期免疫功能的影响

目的:探讨右美托咪定(Dex)对舌癌患者围术期免疫功能的影响.方法:将ASAⅠ~Ⅱ级拟行舌癌根治全麻择期手术患者30例随机分为右美托咪定组(Dex组)和对照组各15例.全麻诱导前,Dex组持续泵入右美托咪定0.5 μg/kg(溶于10 mL生理盐水),对照组静脉持续泵人生理盐水10 mL,均在10 min内完成.以相同药物快速诱导插管,插管后Dex组以Dex、七氟醚、瑞芬太尼维持;对照组以七氟醚、瑞芬太尼维持.分别于TO(诱导前)、T1(切皮前,诱导后20 min)、T2(切皮后,诱导后50min)测定CD3+、CD4+、CD8+、CD4+/CD8+及NK细胞比例.结果:两组在TO时间点CD3+、CD4+、CD8+、CD4+/CD8+以及NK细胞的分布差异无统计学意义(P>0.05).Dex组各个时间点CD3+、CD4+、CD8+、CD4+/CD8+及NK细胞变化不明显.相对于TO时间点,对照组T1、T2时间点CD3+、CD4+、C D4+/CD8+和NK细胞呈下降趋势,而CD8+升高.和对照组比较,Dex组在T1、T2时闻点CD4+/CD8+、NK细胞升高,而CD8+降低.结论:Dex作为麻醉辅助药物能减轻全麻药物对舌癌患者免疫功能的影响.     

观察右美托咪定治疗顽固性失眠的效果

目的:观察右美托咪定治疗顽固性失眠的效果.方法:选取2019年5月至2020年7月云南省昭通市第一人民医院收治的顽固性失眠患者80例作为研究对象,按照随机数字表法分为观察组和对照组,每组40例.对照组给予常规治疗,观察组给予微泵注射右美托咪定诱导睡眠.采用匹兹堡睡眠指数量表(Pittsburgh Sleep Quali...     

右美托咪定对体外循环患者体循环阻力的影响

目的观察体外循环期间右美托咪定对体循环阻力的影响。方法选择2012年1月-4月风湿性心脏病行二尖瓣置换术的患者31例,美国麻醉医师协会分级Ⅱ或Ⅲ级,心功能Ⅱ或Ⅲ级,年龄35～60岁,随机分为试验组（n=16）和对照组（n=15）,心脏停跳后保持灌注流量2.4 L/（min·m^2）,中度低温体外循环。试验组经贮血器静脉端泵入右美托咪定（1.0μg/kg）10 min,继以0.5μg/（kg·min）持续输注;对照组则泵入等容量生理盐水。分别记录两组给药前（T0,基础值）及给药后10 min（T1）、20 min（T2）时的平均动脉压（MAP）和外周循环阻力（SVR）,并测定对应时点血浆皮质醇、肾上腺素和去甲肾上腺素的浓度。结果与T0比较,试验组T1、T2时MAP、SVR下降,对照组MAP、SVR升高（P〈0.05）,两组T1、T2时点MAP、SVR比较,差异有统计学意义（P〈0.05）;试验组T1、T2时点血浆皮质醇、肾上腺素、去甲肾上腺素较术前下降,对照组则较术前上升,两组间T1、T2时点血浆皮质醇、肾上腺素、去甲肾上腺素差异有统计学意义（P〈0.05）。结论体外循环期间应用右美托咪定可以降低SVR,减轻应激反应。     

右美托咪定对婴儿体外循环心肌损伤的影响

目的探讨右美托咪定对婴儿体外循环心肌损伤的影响。方法年龄2月-1岁,行体外循环下室间隔缺损修补术的患儿60例,随机分为右美托咪定组(D组,n=30)和对照组(C组,n=30)。分别于麻醉诱导前、主动脉开放后1h、6h、24h检测患儿血清中cTnI、GP-BB、TNF-α、IL-6的浓度。结果两组患儿在麻醉诱导前cTnI、GP-BB、TNF-α、IL-6的浓度比较差异无统计学意义(P0.05),D组患儿在主动脉开放后1h、6h、24h,cTnI、GP-BB、TNF-α、IL-6的浓度均明显低于C组(P0.05)。结论右美托咪定可以减轻婴儿体外循环心内直视手术的心肌损伤,有良好的心肌保护作用,值得在临床广泛应用。     

右美托咪定在儿科中的应用

近年来,关于右美托咪定在儿科应用的报道逐渐增多。右美托咪定几乎不影响呼吸,具有镇静、镇痛、抗焦虑等作用。大量研究表明右美托咪定对缺血性和缺氧性损伤的组织有保护作用。右美托咪定不仅应用于小儿麻醉,而且用于小儿术后镇痛、辅助检查的镇静等,但其具有引起心动过缓及影响血液循环等副作用。本文对右美托咪定在儿科中的应用及其局限性进行综述。     

组织多普勒显像定量分析窦房结功能

目的 评价心动周期中窦房结内机械运动参数（如：加速度）的时空变化规律及其与心脏电兴奋之间的相关性。方法 制作5只犬开胸动物模型,用心内超声探头采集时间顺序窦房结组织多普勒图像,利用计算机图像处理与分析方法获取时间顺序窦房结内组织的加速度定量数据。结果 得到了窦房结兴奋过程中窦房结内心肌运动的加速度－时间曲线,其舒张末期初始加速度的起始时相与同步心电图特定时机（如：P波起始点）对照,二者具有很好的时相相关性。结论 由窦房结内组织多普勒顺序图像中得到的心肌兴奋的加速度－时间曲线及其与心电图时相之间的相关性,提示心内组织多普勒显像技术可用于定量评价窦房结内心肌机械兴奋及其与心肌电兴奋之间的关系。     

Effects of non-invasive ventilation on middle ear function in healthy volunteers

OBJECTIVES: To evaluate the effects of non-invasive ventilation (NIV) with facial mask or helmet on middle ear (ME). DESIGN. Prospective, randomised study. SETTING: University hospital. PARTICIPANTS: Ten healthy subjects randomly allocated in two groups of five subjects each. INTERVENTIONS: NIV for 1 h, with helmet (group H) or facial mask (group M). Flow-triggered pressure support was 10 cmH(2)O, PEEP 5 cmH(2)O, FiO(2) 0.21. MEASUREMENTS AND RESULTS: Impedenzometry was performed before NIV and 5 min after NIV ended; it was repeated 60 min later. In group H the acoustic compliance increased after NIV from 2.0+/-.6 ml to 2.3+/-.6 ml ( P<.01), suggesting that the tympanic membrane became less stiff; 1 h later the compliance returned to basal values (2.0+/-.7 ml); in group M the compliance was unaffected (from 2.0+/-.5 ml to 2.0+/-.4 ml; 1.9+/-.4 ml 1 h later). The acoustic reflex, i.e., the contraction of the stapedial muscle in response to an auditory stimulus, involving the acoustic and facial nerves, was also evaluated during impedenzometry at 250 Hz, 500 Hz, 1,000 Hz, and 4,000 Hz; no significant change of the threshold was observed. CONCLUSIONS: The tympanic membrane is tighten by the tensor tympani and a reversible loosening suggests muscle fatigue in response to the application of intermittent positive pressure applied to the external ear during NIV with helmet. The loss of tensor tympani protective action could theoretically predispose the middle and inner ear to mechanical damage during NIV with helmet, suggesting the use of protective devices (ear plugs) in selective cases requiring long-term, high-pressure treatment.     

Diagnosis and treatment of sinoatrial node dysfunction

Sick sinus syndrome is characterized by disturbance of its automatic function and (or) sinu-atrial conductivity caused by organic or vegetative defects. Diagnostic algorithm includes: clinical evidence, ECG, Holter monitoring, electrophysiological investigation, pharmacological test. Treatment is pharmacological and surgical.     

空吞咽与食团吞咽对健康人咽期吞咽功能的影响

摘要 目的：探讨通过使用高分辨率咽腔测压,分析空吞咽与不同黏度食团吞咽对健康人咽部和上食管括约肌功能的影响。 方法：使用高分辨率测压系统,分别测量34例健康志愿者[平均（24.29±5.926）岁]在空吞咽与进食三种不同黏度（5ml水,5ml浓流质,5ml糊状物）的食团情况下,咽部收缩压力峰值,咽部收缩持续时间,咽部压力上升速率,上食管括约肌（UES）松弛残余压,UES松弛持续时间,UES开放前峰值以及UES开放后峰值。使用重复测量的方差分析研究空吞咽与食团吞咽对这些参数的影响。 结果：食团吞咽与空吞咽时,咽部收缩压力峰值差异无显著性意义。而空吞咽时,UES松弛残余压、开放前压力峰值、咽部收缩持续时间和咽部压力上升速率明显高于食团吞咽,而UES松弛持续时间与UES开放后峰值明显低于食团吞咽。而不同黏度的食团吞咽之间的参数差异无显著性意义。 结论：不同的吞咽类型会影响健康人咽部与UES的压力和持续时间。明确空吞咽与不同黏度食团吞咽健康人的咽期吞咽生理学变化,为进一步探究吞咽障碍的生理与病理提供了研究基础。     

Muscle function testing and P-NMR spectroscopy in fasted healthy volunteers

The effects of a five-day fast on muscle function and ³¹P-NMR spectroscopy were examined in normal volunteers as a study preliminary to the application of these tests in assessing nutrient deprivation in critically ill patients. As a result of fasting, testing of the adductor pollicis muscle by ulnar nerve stimulation showed a decrease in the force of contraction at a stimulation frequency of 100 Hz and an increase in the ratio of the force of contraction at 10 Hz over that at 100 Hz, but no change in relaxation rate or fatiguability. ³¹P-NMR spectroscopy of the forearm muscles was performed at rest, immediately following four minutes of maximum voluntary exercise and during the recovery period. Fasting had no effect on the resting pH or the Pi/PCr ratio. There was also no significant change in Pi/PCr as a result of fasting in the immediate postexercise period. The pH was relatively higher immediately postexercise in the fasted state suggesting that less glycolysis had occurred. The alterations in muscle function and ³¹P-NMR spectroscopy seen after acute starvation in normals may serve as a basis for nutritional assessment in critically ill patients.     

心外膜窦房结电图指导窦房结细胞取材的价值

目的探索经心外膜窦房结电图指导窦房结细胞取材的准确性。方法长白山乳猪12只,行心外膜窦房结电图标测,A波前出现圆顶形或上斜形波形为窦房结电图,又称为"P前波",于"P前波"处取材行窦房结细胞培养及超极化激活环核苷酸门控阳离子通道(HCN4)免疫荧光定量测定。结果窦房结电图指导下窦房结细胞取材,培养的细胞有3种形态,即梭形、三角形与不规则形。培养梭形细胞较多,搏动频率较快;同时免疫荧光证实HCN4通道蛋白密度较高。结论窦房结电图提高窦房结细胞的取材的准确性。     

Effects of lorazepam on film-induced differentiated emotions in healthy volunteers

Summary— We studied the effects of lorazepam, a benzodiazepine, on differentiated emotions in healthy volunteers. In order to induce differentiated emotions, film excerpts were selected on the basis of the type of emotion they induced (fear, anger and for affective tone neutral film). For 6 days (D1 to D6), ten healthy volunteers received lorazepam (1 mg bid) or placebo in a randomized cross-over double-blind trial. During each treatment period, emotional induction occurred on D4, D5 and D6. One film excerpt (fear, anger or neutral) was presented each morning after relaxation. Evaluation was performed before and after each emotional induction and included questionnaires (Differential Emotions Scale and physical activation visual analog scales), and neurophysiological parameters (systolic and diastolic blood pressure, heart rate and norepinephrine levels). Globally, the film excerpts induced the predicted emotions. An analysis of variance was undertaken and revealed a significant effect of lorazepam versus placebo. On the Differential Emotions Scale and during fear induction, lorazepam induced a significantly higher increase in fear, anxiety and disgust emotions than placebo, whereas no effect was observed after anger induction. Lorazepam also induced a significantly higher increase in diastolic and systolic blood pressure with no change in heart rate, and physical activation items ("tears" and "faster breathing") without no significant change in norepinephrine. In conclusion, our results are consistent with an overall increase in emotional reactivity with lorazepam (1 mg bid) as compared to placebo. The pertinence of film-induced differentiated emotions has to be confirmed for clinical pharmacological use.     

Effects of naloxone on nitrous oxide actions in healthy volunteers

A number of studies have examined the effects of naloxone on nitrous oxide-induced analgesia with conflicting results. In the present study the effects of a relatively high dose of naloxone was examined to determine its effects on nitrous oxide-induced analgesia, as well as on the subjective and psychomotor effects of nitrous oxide. Fourteen subjects participated in a four-session crossover trial in which they received intravenous injections of either saline or 30mg/70kg naloxone 10min into a 35min period in which they were inhaling either 100% oxygen or 30% nitrous oxide in oxygen. Ten minutes after the naloxone administration, subjects were tested on the cold pressor test. Mood and psychomotor performance were also assessed before, during and after the inhalation period. Subjects reported higher pain ratings after the naloxone injection than the saline injection, but there was no evidence of naloxone reversing the analgesic effects of nitrous oxide. Similarly while naloxone also affected mood and impaired psychomotor performance, there was no evidence of naloxone reversing the effect of nitrous oxide on these measures. The results of this study call into question the role of the opioidergic system in mediating various effects of nitrous oxide in humans.     

Variation in non-invasive measurements of vascular function in healthy volunteers during daytime

Although it is often recommended to standardize the time of day when performing non-invasive measurements of vascular function, the exact influence of the time of day on the outcome of IMT (intima-media thickness), PWV (pulse wave velocity), AIX (augmentation index) and FMD (flow-mediated dilatation) measurements has not been reported before. Nineteen healthy volunteers visited our department on two different occasions: the first visit was at 09:00 hours after an overnight fast, and the second visit was at 14:00 hours after a standardized breakfast. Non-invasive measurements of atherosclerosis were performed twice at 09:00 hours and once on the second visit at 14:00 hours. Measurement of IMT, PWV, AIX and FMD was reproducible according to the method of Bland and Altman. The absolute difference between repeated measurements at 09:00 hours showed no significant difference compared with the absolute difference between 09:00 and 14:00 hours for IMT (0.029+/-0.014 compared with 0.021+/-0.014 mm; P = 0.27), PWV (0.63+/-0.50 compared with 0.75+/-0.74 m/s; P = 0.52), AIX (4.0+/-4.0 compared with 5.5+/-5.2%; P = 0.35) and FMD (3.8+/-3.7 compared with 4.2+/-2.9%; P = 0.70). In conclusion, our results show that, in healthy volunteers during the daytime, IMT, PWV, AIX and FMD outcomes are not confounded by variation in the exact time of the examination as long as other (exogenous) conditions, including food intake, smoking and intake of alcohol, are carefully controlled for.