癫痫患者顺式阿曲库铵的剂量反应曲线测定

Objective To determine the dose-response curve and the ED95 of cisatracurium in epilepsy patients. Methods Forty ASA grade Ⅰ or Ⅱ epilepsy patients were randomly divided into four groups. The dose-response curve was determined by single bolus injection of cisatracurium under midazolam-fentanyl intravenous anesthesia. For each group, the dose of cisatracurium were 20,30, 40 and 50 μg/kg respectively. The neuromuscular block was measured by Neuromuscular Transmission Monitor, and the responses were defined in terms of the percentages of maximum suppression in T1 of TOF of the adductor pollicis muscle. After logprobit transformation of the data of dose and response, the dose-response curve of cisatracurium was then established by linear regression. The onset time of cisatracurium was also recorded. Results The ED50, ED75, ED90 and ED95 of cisatracurium in epilepsy patients were 36.3, 46.1, 57.4 and 65.4 μg/kg. There was no significant change in onset time among 4 groups. Conclusion The ED95 of cisatracurium in epilepsy patients is 65.4 μg/kg, which is about 30.8% higher than that in normal human.     

迷走神经电刺激后处理对大鼠心肌缺血/再灌注损伤的影响

Objective To evaluate the effect of postconditioning with electrical stimulation of vagus never on myocardial ischemia reperfusion injury in rats. Methods Forty male Sprague-Dawley rats aged 8 weeks and weighing 250 g-350 g were randomly allocated into four groups (n=10 in each group):sham group (S group), ischemia reperfusion group (IR group), ischemia preconditioning group( IPC group)and postconditioning with electrical stimulation of vagus never group( POES group). The myocardial ischemia reperfusion model was preparated by ligation of left anterior descending coronary artery (LAD) for 30 min followed by 120 min reperfusion. During process of ischemia and reperfusion, HR and MAP were recorded and the rate pressure product (RPP) at each measuring point was calculated as the index of myocardial oxygen consumption. Arrhythmia was recorded during ischemia and initial period of reperfusion. At the end of reperfusion, blood samples were collected to assay serum concentrations of CK-MB, and cTnI. At the end of experiment, the infarct sizes was assessed from excised hearts by Evans blue and triphenyltetrazolium chloride (TTC) staining. Results The infarct size (IS%) was (72±9)% in IR group, (36±13)% in IPC group and (47±12)% in POES group, respectively, and serum concentration of cTnI was(0.99±0.14) μg/L in IR group, (0.37±0.08) μg/L in IPC group and (0.40±0.08) μg/L in POES group. Serum concentration of CK-MB was(110±13) μg/L in IR group, (38±8) μg/L in IPC group and(42±7)μg/L in POES group. Compared to the IR group, the IS% and serum concentrations of cTnI and CK-MB in IPC and POES groups were significantly reduced, rate of ventricular arrhythmia during initial period of reperfusion in the IPC and POES groups were also significantly reduced. Compared to IPC group, the IS% was significantly increased in the POES group. Conclusion Postconditioning with electrical stimulation of vagus never can attenuate myocardial ischemia reperfusion injury in rats. However, cardioprotection provided by postconditioning with electrical stimulation of vagus never is weaker than that by ischemia preconditioning.     

维库溴铵预注复合麻黄素预处理对麻醉诱导时维库溴铵的起效时间的影响

Objective To evaluate the effect of vecuronium priming, ephedrine pretreatment, and vecuronium priming combined with ephedrine pretreatment on the onset time of neuromuscular blockade of vecuronium, intubation conditions and their hemodynamic effects during induction period. Methods Forty-eight adult patients with ASA grade Ⅰ or Ⅱ , scheduled for elective surgery were randomly allocated to four groups with 12 cases in each. Just 3 min before induction, the patients were injected with ephedrine 70 μg/kg and vecuronium priming 0.01 mg/kg in group Ⅰ , vecuronium 0.01 mg/kg in group Ⅱ , ephedrine 70 μg/kg in groupⅢ, and normal saline 0.5 ml in group Ⅳ. Followed by a four min priming or/and pretreatment interval, the intubation dose of vecuronium was injected (vecuronium 0.09 mg/kg in group Ⅰ and group Ⅱ , vecuronium 0.1 mg/kg in group Ⅲ and Ⅳ ). The neuromuscular block was monitor by acceleromyography (TOF Watch SX, Organon) using train of four stimulation (TOF) every 15 s.Endotracheal intubation was performed by a blinded investigator in 2 min. Time to maximal twitch depression was recorded, Intubation conditions were assessed, heart rate and mean blood pressure were observed and recorded as well right before the induction, 1 min after the induction and every minute after endotracheal intubation for 5 min. Results The onset times in group Ⅰ , Ⅱ , Ⅲ and Ⅳwere (99±13), (131±24), (143±20) and (185±26) s, respectively. The onset time of vecuronium in group Ⅰ , Ⅱ and Ⅲ was significantly shorter than that in group Ⅳ (P＜0.001). The onset time of vecuronium in group Ⅰ was faster than that in group Ⅱ and group Ⅲ (P＜0.005). The intubation conditions were better in group Ⅰ , Ⅱ and Ⅲ than those in groupⅣ.There were no significant change in mean blood pressure during the induction in all patients, but heart rates in group Ⅰ , Ⅲ (both with ephedrine pretreatment) were much higher( P＜0.05 ). Conclusion Either vecuronium priming or ephedrine pretreatment can shorten the onset time of vecuronium. The combination of vecuronium priming with ephedrine pretreatment accelerates the onset of vecuronium; In combination with ephedrine, it has no effect on hypotension induced by propofol injection.     

蛛网膜下腔注射Ro25-6981对切口痛大鼠的镇痛作用研究

Objective To investigate the analgesic effects of intrathecal administration of Ro 25-6981, a selective antagonist of the NR2B subunit of NMDA receptors (NR2B), in a rat model of incision pain. Methods Sixty SD rats were randomly divided into 4 groups: control group (C); incisional pain group (Ⅰ); intrathecal group of Ro 25-6981 at the dose of 50 μg/25 μl(R1);intrathecal group of Ro 25-6981 at the dose of 200 μg/25 μl(R2). Intrathecal injection of 5% DMSO solvent at the dose of 25 μl was administrated in group C and Ⅰ. Rat models of incisional pain on the right hind were prepared after intrathecal injection in group Ⅰ,R1 and R2. All rats were anesthetized with sevoflurane. The 50% paw withdrawal mechanical threshold (PWMT) and paw withdrawal thermal latency (PWTL) were tested to evaluate the behavioral changes and measured at 24 h before incision and at 2,6,24 h after incision. And the locomotor functions were also examined at the same time points. Results Compared with group C and baseline,the decreases of 50% PWMT (7.0±0.9), (6.7±0.7), (6.4±1.2) g and PWTL (10.3±1.4), ( 10. 1±1.0), (10.0±1.0) s were observed at each time point after incision in group Ⅰ (P＜0.05); Compared with group Ⅰ, significant changes of 50% PWMT and PWTL were not observed at each time point in group R1 (P＞0.05); Compared with group Ⅰ, increases of both 50% PWMT (9.0±0.8) g and PWTL (13.7±1.0) s were observed at 2 h after incision in group R2 (P＜0.05), while no significant changes of 50% PWMT and PWTL were observed at 6 h and 24 h after incision in group R2. No significant changes in locomotor functions were observed before and after intrathecal administration in rats (P＞0.05). Conclusion Intrathecal injection of Ro 25-6981 at the dose of 200.0 μg, the selective antagonist of the NR2B, exerts significant analgesic effects on incision pain in rats without affecting of locomotor functions.     

白藜芦醇对人胰腺癌PANC-1细胞增殖与侵袭的影响

Objective To investigate the effect of resveratrol on the proliferation and invasion of human pancreatic cancer PANC-1 cells. Methods Five groups including blank control group, 0. 1% dimethylsulfoxide (DMSO) group and resveratrol groups (50, 100, 200 μmol/L) were established. The proliferation of PANC-1 cells was detected by MTT assay. The apoptosis and cell cycle change were analyzed by flow cytometry. The invasive ability of PANC-1 cells was observed with a Transwell cell culture chamber. The expressions of Bax, Bcl-2,matrix metalloproteinases 2 (MMP-2) and 9 (MMP-9) of the PANC-1 cells were assayed by real-time quantitative PCR and Western blot. All data were analyzed using the analysis of variance. Results ( 1 ) The inhibition rate of resveratrol on the proliferation of PANC-1 cells was 0 in the blank control group, 3.25% ±0.42% in the 0. 1% DMSO group, 13.23% ± 1.68% in the 50 μmol/L of resveratrol group, 42.25% ± 3.20% in the 100 μmol/L of resveratrol group, and 56.94% ±5.31% in the 200 μmol/L of resveratrol group. There was a significant difference in the inhibition rate among the five groups (F=460. 10, P<0.05). (2) The apoptosis rate was 0.05% ±0.03% in the blank control group, 3.39% ± 1.77% in the 0. 1% DMSO group, 6.92% ± 1.85% in the 50 μmol/L of resveratrol group, 19.05% ± 2.01% in the 100 μmol/L of resveratrol group, and 27. 17% ±6.43% in the 200 μmol/L of resveratrol group. There was a significant difference in the apoptosis rate among the five groups (F = 38.84, P < 0.05). (3) There was no significant effect of 0. 1% DMSO on the cell cycle of PANC-1 cells. The number of PANC-1 cells in the G0/G1 and S phase was increased. (4) The average number of invading PANC-1 cells was 61 ± 13 in the blank control group, 54 ± 13 in the 0. 1% DMSO group, 48 ± 15 in the 50 μmol/L of resveratrol group, 23 ±6 in the 100 μ mol/L of resveratrol group and 18 ±7 in the 200 μmol/L of resveratrol group. There was a significant difference in the number of invading PANC-1 cells among the five groups (F = 69.08, P < 0.05 ). (5) There were up-regulated mRNA and protein expressions of Bax and down-regulated mRNA and protein expressions of Bcl-2, and the expressions of MMP-2 and MMP-9 of the PANC-1 cells were inhibited in the resveratrol groups. The changes of the protein expressions of Bax, Bcl-2, MMP-2, MMP-9 were consistent with the changes of the mRNA expressions of the four indexes. Conclusion Resveratrol can significantly inhibit the proliferation and invasion, as well as induce apoptosis of PANC-1 cells in vitro.     

神经生长因子对胆管癌细胞67-kDa层黏连蛋白受体表达的影响

Objective To investigate the effects of nerve growth factor (NGF) on the expression of 67-kDa laminin receptor (67LR) in human bile duct carcinoma QBC939 cells, and study the possible mechanism of perineural invasion and metastasis of bile duct carcinoma. Methods ( 1 ) The expression of a high-affinity receptor for NGF, TrkA, was detected by immunofluorescence staining. ( 2 ) QBC393 cells were pretreated by β-NGF at different concentrations ( 1, 10, 100,200 μg/L), and then the mRNA and protein expressions of 67LR were examined by Real-Time PCR and Western blot assay. QBC939 cells were divided into control group and β-NGF (1, 10, 100,200 μg/L) groups. (3) The ideal concentration of β-NGF was selected according to the results of previous tests, and then the mRNA and protein expressions of 67LR were re-examined by adding specific TrkA inhibitor K252a at different concentrations ( 100,200,300 nmol/L). QBC939 cells were divided into control group, β-NGF 100 μg/L group and K252a ( 100,200,300 nmol/L) groups. All data were analyzed by one-way analysis of variance or LSD-test. Results (1) A strong expression of TrkA was detected in the membrane of QBC939 cells. (2) The mRNA and protein expressions of 67LR in QBC939 cells were 0.35 ± 0.06 and 0. 32 ± 0.05 in the control group, 0.38 ±0.14 and 0.50 ±0.09 in the β-NGF 1 μg/L group, 0.62 ±0.14 and 0. 69 ±0. 13 in β-NGF 10 μg/L group, 0.90 ± 0.08 and 0.93 ± 0.07 in the β-NGF 100 μg/L group, and 0. 70 ± 0. 10 and 0. 76 ±0.07 in the β-NGF 200 μg/L group, there were significant differences among the five groups (F = 22. 4, 14. 6,P ＜0.05). The mRNA and protein expressions of 67LR in the β-NGF 100 μg/L group were significantly higher than those in the control group ( t = 19. 0, 21.0, P ＜ 0. 05 ). (3) The mRNA and protein expressions of 67LR in the QBC939 cells were 0.35 ±0.10 and 0.41 ±0.10 in the control group, 0. 88 ±0. 14 and 0.84 ±0.10 in the β-NGF 100 μg/L group, 0.80±0.08 and 0.76 ±0.04 in the K252a 100 nmol/L group, 0.67 ±0.12 and 0.61 ± 0.09 in the K252a 200 nmol/L group, and 0. 43 ± 0.07 and 0. 50 ± 0. 12 in the K252a 300 nmol/L group, there were significant differences among the five groups ( F = 14. 1, 8. 9, P ＜ 0.05 ). There were no significant differences in the mRNA and protein expressions of 67LR between the K252a 300 nmol/L group and the control group (t =1.02, 0. 85, P＞0.05). Conclusion In bile duct carcinoma cells, NGF enhances the expression of 67LR by combining with TrkA, which might be the mechanism of NGF mediating perineural invasion of bile duct carcinoma.     

老年非心脏手术患者术前高敏C反应蛋白与术后心脏不良事件相关性的研究

Objective To investigate the relevance between level of preoperative high-sensitivity C-reactive protein(hsCRP) and the occurrence of postoperative adverse cardiac events in elderly patients underwent noncardiac surgery. Methods 49 patients of more than 65 years that had undergone elective noncardiac surgery were enrolled in the study. And all patients were conformed to the standards of "classification of risk factors for clinical history", content of "Guidelines on Preoperative Cardiovascular Evaluation for Noncardiac Surgery" established by the ACC/AHA .The patients were divided into two groups based on the preoperative hsCRP level:A group:hsCRP ≤ 3mg/L group (n=21) and B group: hsCRP>3mg/L group (n=28). General clinical characteristics of patients were recorded before operation, and 24 hours dynamic ECG was monitored a week prior to and after the operation. All patients taken measures of analgesia after surgery. The incidence of postoperative adverse cardiac events and the hospitalized days was recorded. The distinctions between two groups were analyzed regarding the occurrence of adverse cardiac events and hospitalized days after operation. Results 19 patients had postoperative myocardial ischemia; 4 cases in A group and 15 cases in B group. 7 patients suffered other postoperative adverse cardiac events, including 1 case in A group and the others in B group. There was statistically significant difference considering morbidity of myocardial ischemia in postoperation between the two groups, but there was no statistically significant difference about incidence of other adverse cardiac events and the length of stay in postoperation. Indexes about serious degree of myocardial ischemia:total depression time is(43.5±5.82 )min in A group, is( 135.0±81.2)min in B group. The depression times is(5.2±2.5 )in A group, is( 8.8±3.0)in B group.The longest depression time is( 23.7±9.2)min in A group, is( 84.3±54.1 )min in B group.Total ischemia burden is( 170.1 ±88.8 )mm· min-1 ·24h-1 in A group, is (311.3± 118.8 )mm· min-1 ·24h-1 in B group.There was statistically significant difference between the two groups. Conclusion Level of preoperative hsCRP>3 mg/L was relevant to the incidence of the most common postoperative adverse cardiac events--myocardial ischemia in elderly patients and level of preoperative hsCRP >3 mg/L was one of the risk factors of postoperative myocardial ischemia;Determination of preoperative hsCRP level may improve cardiovascular risk scoring system.     

肠缺血再灌注损伤大鼠小肠运动功能的变化与细胞间黏附分子1表达的关系

Objective To evaluate the relationship between the intestinal motility alterations and intercellular adhesion molecule-1 ( ICAM-1 ) expression within the rat intestinal muscularis after ischemia reperfusion. Methods Thirty Wistar rats were divided randomly into IIR, monoclanal anti-ICAM-1 and sham group (n = 10), HR models were established by clamping-releasing the superior mesenteric artery. Gut transit was measured in vivo and intestinal circular muscle contractions were measured in an organ bath. The expression of ICAM-1 mRNA was detected by RT-PCR and immunohistochemisty. Leukocyte infiltration and myeloperoxidase (MPO) activity were quantified in sham and ischemia/reperfusion rats with and without monoclonal anti-ICAM-1 antibody treatment. Results The gut transit of monoclonal anti-ICAM-1 group was improved obviously as compared with IIR group. Circular smooth muscle contractility stimulated by ICAM-1 mRNA expression was 1.69 ± 0. 57 and 1.76 ± 0. 32 within the muscularis; Leukocyte infiltration into the muscularis was (5.6 ±2. 2) c/f and ( 18. 2 ±3. 1 ) c/f. MPO activity was (2. 03 ±0. 56) U/g and (6. 41 ± 1.25 ) U/g respectively. The differences were all statistically significant between IIR and treatment groups ( P ＜ 0. 05 ). The expression of ICAM-1 protein in IIR and anti-ICAM-1 groups was not significantly different (P ＞ 0. 05). Conclusions The up-regulated expression of ICAM-1 after ⅡR injury calls forth local infiltration of PMN within the intestinal muscularis, leading to intestinal motility dysfunction.     

急性胰腺炎胰腺腺泡细胞胀亡和巨噬细胞激活的关系

Objective To study the relationship between the oncosis of pancreatic acinar cells and activa-tion of macrophage in rat model of acute pancreatitis (AP). Methods The pancreatic acinar cells were isolated by two-step enzyme digestion, and then they were divided into control group, AP group and test group. Pancreatic acinar cells were cultured with caerulein in AP group, with caerulein and endothelin in test group, and with culture medium in control group. The oncesis rate of the pancreatic acinar cells was detected after acridine orange and ethidium bromide fluorescent staining. The supernatant was collected to detect the release of amylase and lactate dehydrogenase (LDH). The macrophages were cultured with 1 ml of supematant for 6 hours, and then the protein level of tumor necrosis factor-α (TNF-α) was measured by ELISA. Results Few oncotic pancreatic acinar cells were observed in the control group, and the levels of amylase and LDH secreted by pancreatic acinar cells and TNF-α secreted by macrophage were (1175±165)kU/L, (846±118)U/L and (36±5)μg/L, respectively. Oncotic pancreatic acinar cells were observed in AP group, and the levels of amylase, LDH and TNF-α were (7130±680) kU/L, (4262±626) U/L and (155±18) μg/L, respectively, which were significantly higher than those in control group (t = 5.184, 4.277, 3.665, P < 0.05). The levels of amylase, LDH and TNF-α were even higher in test group, and they were (9240±1177) kU/L, (6937±893)U/L and (268±35)μg/L, respectively, which were significantly higher than those in AP group (t = 2.251, 2.825, 2.843, P < 0.05). Conclusions The release of amylase was changed as the oncosis of pancreatic acinar cells occurred. The secretion of TNF-α was along with the degree of oncosis of pancreatic acinar cells. The results of the study indicate that a relationship exists among the inflammatory response of macrophage, the release of contents of pancreatic acinar cells and the oncosis of the pancreatic acinar cells.     

Significance of serum neuron-specific enolase in patients with acute traumatic brain iniurv

Objective: To study the association between serum neuron-specific enolase ( NSE) and the extent of brain damage and the outcome after acute traumatic brain injury (TBI).Methods: The release patterns of serum NSE in 78 patients after acute TBI were analyzed by using the enzyme linked immunosobent assay. The levels of NSE were compared with Glasgow coma scale, the category of brain injury and the outcome after 6 months of injury.Results: There were different NSE values in patients with minor ( 12.96 μg/L ±2.39 μg/L ), moderate ( 23.44 μg/L ±5.33 μg/L ) and severe brain injury ( 42.68 μg/L ±4.57 μg/L ). After severe TBI, the concentration of NSE in patients with epidural hematomas was 13.38 μg/L±4.01 μg/L, 24.03 μg/L±2.85 μg/L in brain contusion without surgical intervention group, 55.20 μg/L ±6.35 μg/L in brain contusion with surgical intervention group, and 83.85 μg/L ± 15.82 μg/L in diffuse brain swelling group. There were close correlations between NSE values and Glasgow coma scale     

不同剂量右美托咪定预注对利多卡因神经毒性的影响

目的 比较不同剂量右美托咪定(dexmedetomidine,Dex)预注对利多卡因致白兔中枢神经毒性的影响及可能机制. 方法 将40只新西兰白兔按随机数字表法分为4组(A、B、C、D组),每组10只:A组通过颈内静脉泵入含Dex 10 μg/kg的生理盐水8 ml,10 min后以4 mg· kg-1· min-1泵入利多卡因直到出现惊厥;B组泵入含Dex 5 μg/kg的生理盐水8 ml,同法泵入利多卡因;C组泵入等量生理盐水,同法泵入利多卡因;D组只泵入生理盐水8 ml.于白兔惊厥时抽血测利多卡因浓度,记录利多卡因剂量及发生惊厥时间,测脑组织天冬氨酸(aspartate,Asp)、谷氨酸(glutamic acid,Glu)、甘氨酸(glycine,Gly)、γ-氨基丁酸(γ-aminobutyric acid,GABA)的含量. 结果 产生中枢神经毒性所需利多卡因剂量、利多卡因血药浓度及发生惊厥时间,A组[分别为:(240±48) mg,(6.4±0.8)μg/kg,(822±122)s]、B组[分别为:(230±51) mg,(6.3±0.5)μg/kg,(802±114)s]较C组[分别为:(137±37) mg,(5.4±0.6) μg/kg,(510±76)s]明显增加,差异有统计学意义(P＜0.05);Asp、Glu、Gly、GABA的含量,A组[分别为:(3.5±1.0)、(4.0±1.9)、(10.1±1.9)、(16.5±2.2) μmol/g]、B组[分别为:(3.7±0.8)、(4.2±1.9)、(11.4±2.2)、(17.4±2.4) mol/g]、C组[分别为:(4.7±1.0)、(6.8±1.9)、(13.7±1.9)、(20.9±3.4) μmol/g]明显高于D组[分别为:(1.5±0.8)、(2.4±1.2)、(4.7±1.6)、(5.7±2.8) μmol/g],差异有统计学意义(P＜0.05),而C组又明显高于A、B组(P＜0.05). 结论 预注Dex可以延缓利多卡因致惊厥反应的发生,增加利多卡因神经毒性的阈值,对中枢神经有一定的保护作用.     

不同年龄患儿罗库溴铵药效学的比较

目的 比较新生儿、婴儿、幼儿和儿童罗库溴铵的药效学.方法 择期全麻手术患儿160例,ASAⅠ或Ⅱ级,根据年龄分为4组(n=40):新生儿组、婴儿组、幼儿组及儿童组.各组随机选取患儿20例,采用4次累积给药法静脉注射罗库溴铵,初始剂量:新生儿组40 μg/kg,婴儿组80 μg/kg,幼儿组及儿童组均为120 μg/kg,后3次均追加罗库溴铵40μg/kg.每次给药后.观察TOF反应.当T1连续3次稳定不变时,给予下一次剂量.采用概率单位法计算T1抑制50%、90%、95%的用药量(ED50、ED90、ED95).各组随机选取20例患儿,静脉注射2倍ED95剂量的罗库溴铵,记录肌松起效时间、高峰时间、临床肌松时间、体内作用时间和恢复指数.结果 与新生儿组比较,幼儿组和儿童组罗库溴铵ED50、ED90和ED95均升高(P<0.01),婴儿组上述指标差异无统计学意义(P>0.05).婴儿组、幼儿组和儿童组罗库溴铵起效时间、临床肌松时间和体内作用时间缩短,恢复指数降低(P<0.01);与幼儿组比较.儿童组罗库溴铵ED50、ED90和ED95升高(P<0.01).结论 不同年龄患儿对罗库溴铵的量效关系和时效关系存在明显的差别,新生儿对罗库溴铵的敏感性最强.     

急性高容量血液稀释对患者靶控输注异丙酚意识消失时EC50的影响

目的 探讨急性高容量血液稀释(AHHD)对患者靶控输注(TCI)异丙酚意识消失时EC50的影响.方法 择期行脊柱手术或全髋置换术患者60例,年龄18～64岁,ASA Ⅰ或Ⅱ级,随机分为4组(n=15):异丙酚血浆靶浓度输注组(Tp组)、异丙酚效应室靶浓度输注组(Te组)、AHHD+Tp组和AHHD+Te组.入室后经30 min外周静脉输注乳酸钠林格氏液0.7 nl·kg-1·h-1,AHHD+Tp组和AHHD+Te组同时经颈内静脉输注4%琥珀酰明胶15 ml/kg行AHHD.AHHD结束后TCI异丙酚,初始靶浓度为1.2μg/ml,到达该浓度30 S后,采用警觉/镇静评分(OAA/S)评价患者的意识状态,然后以0.3 μg/ml的浓度梯度增加靶浓度,直至患者意识消失(OAA/S=0分),记录此时异丙酚的血浆靶浓度和效应室靶浓度.采用概率单位法计算异丙酚意识消失时的EC50及其95%可信区间(CI).结果 Tp组、Te组、AHHD+Tp组和AHHD+Te组意识消失时异丙酚的EC50及其95%CI分别为3.74(3.46～4.16)、2.32(2.17～2.42)、4.12(3.81～4.32)、2.38(2.14～2.56)μg/ml.与Tp组比较,AHHD+Tp组意识消失时异丙酚的EC50升高(P<0.05);与Te组相比,AHHD+Te组意识消失时异丙酚的EC50差异无统计学意义(P>0.05).结论 AHHD可升高患者TCI异丙酚意识消失时血浆靶浓度的EC50,对效应室靶浓度的EC50无影响.     

癫痫患者罗库溴铵95％有效量的测定

目的 通过测定癫痫患者罗库溴铵95％有效量(95％ effective dose,ED95),为癫痫患者合理应用罗库溴铵提供依据. 方法 选取择期行癫痫病灶切除术患者40例,ASA分级Ⅰ、Ⅱ级.根据罗库溴铵不同剂量按随机数字表法分为4组(每组10例):120 μg/kg组、180 μg/kg组、240 μg/kg组和300 μg/kg组.采用单次剂量注射法测定患者ED95,记录拇指内收肌“四个成串刺激(train of four stimulation,TOF)”第1个肌颤搐反应(T1)最大抑制的百分比及药物的起效时间,将最大抑制百分比进行概率单位转换,罗库溴铵的首次剂量做对数转换,用直线回归方法建立维库溴铵的剂量-反应曲线,计算出癫痫患者的罗库溴铵ED95值. 结果 各组间一般情况比较,差异无统计学意义(P＞0.05);不同剂量组起效时间比较,差异无统计学意义(P＞0.05),T1最大抑制程度随剂量增加而增加(P＜0.05),但240 μg/kg组和300 μg/kg组间差异无统计学意义(P＞0.05);癫痫患者罗库溴铵ED95值为445.3 μg/kg,高于目前正常人群广泛应用的ED95值300 μg/kg(P＜0.05). 结论 癫痫患者罗库溴铵的ED95值高于正常人群,在该类患者中应增加罗库溴铵的剂量约50％以取得与正常人群相同的肌松水平.     

喷他佐辛对止血带致下肢缺血/再灌注后心肌肌钙蛋白Ⅰ的影响

目的 观察喷他佐辛对下肢缺血/再灌注(ischemia/reperfusion,I/R)后心肌肌钙蛋白Ⅰ(cardiac troponin Ⅰ,cTnⅠ)的影响及其与降钙紊基因相关肽(calcitonin gene-related peptide,CGRP)的关系. 方法 选取择期在蛛网膜下腔麻醉下行单侧下肢骨科手术使用止血带患者60例,按照随机数字表法分为对照组(C组)和喷他佐辛组(P组),每组30例.止血带充气前P组患者给予喷他佐辛0.5 mg/kg静脉滴注,C组在相同时刻给予等量生理盐水.在止血带充压前(To)及止血带释压后0.5 h(T0、24 h(T2)时采集输液对侧肘静脉血5 nl,采用ELISA法检测血清中cTnⅠ和CGRP的含量. 结果 两组患者一般资料比较,差异无统计学意义(P＞0.05).与To时cTnⅠ[(0.2 1±0.06)μg/L]比较,C组cTnⅠ在T1时无明显变化(P＞0.05),在T2[(0.28±0.10) μg/L]时明显升高(P＜0.05),P组cTnⅠ在T1、T2时无明显变化(P＞0.05);与To时CGRP[(16.9±2.2) ng/L]比较,C组CGRP在T1、T2时均无明显变化(P＞0.05),P组CGRP在T1[(17.9±2.7) ng/L]、T2[(18.8±2.8) ng/L]时均明显升高(P＜0.05).与C组在T1、T2时cTnⅠ[(0.23±0.12)、(0.28±0.10) μg/L] 、CGRP[(16.9±1.9)、(16.7±2.6) ng/L]比较,P组的cTnⅠ在T1时无明显变化(P＞0.05),T2[(0.22±0.06) μg/L]时明显降低(P＜0.05),P组的CGRP在T1、T2时均明显升高(P＜0.05). 结论 喷他佐辛可以减轻下肢使用止血带诱发I/R后的cTnⅠ升高,可能与内源保护性神经肽CGRP有关.     

瑞芬太尼引起全麻患者呼吸抑制的量效关系

目的 评价全麻患者靶控输注(TCI)或静脉注射瑞芬太尼引起呼吸抑制的量效关系.方法 择期全麻患者40例,ASA Ⅰ或Ⅱ级,年龄18～60岁,体重45～80 kg.随机分为TCI组和静脉注射组(V组)(n=20).按照序贯法进行试验,TCI组靶控输注瑞芬太尼7 min,相邻血浆靶浓度之间的梯度为70%,分别设为1.7、2.9、4.9和8.3 μg/L,初始靶浓度8.3 μg/L;V组静脉注射时间10 s,相邻靶剂量之间梯度为62%,分别设为0.8、1.3、2.1、3.3和5.3 μg/kg,初始靶剂量5.3 μg/kg.若上一例患者未发生呼吸抑制,则应用高一级的血浆靶浓度或剂量;若发生呼吸抑制,则应用低一级的血浆靶浓度或剂量.发生呼吸抑制的标准为脉搏血氧饱和度≤90%.结果 TCI瑞芬太尼引起呼吸抑制的半数血浆靶浓度为3.97 μg/L,95%可信区间为3.16～4.99 μ/L;静脉注射瑞芬太尼引起呼吸抑制的半数有效剂量为2.50 μg/kg,95%可信区间为1.93～3.24 μg/kg.结论 全麻患者TCI瑞芬太尼引起呼吸抑制的半数血浆靶浓度为3.97 μg/L;静脉注射瑞芬太尼引起呼吸抑制的半数有效剂量为2.50 μg/kg.     

右美托咪定复合左布比卡因用于剖宫产术后硬膜外镇痛的临床研究

目的 探索右美托咪定(dexmedetomidine,Dex)联合低浓度左布比卡因在剖宫产术后硬膜外自控镇痛治疗中的应用可行性及对舒芬太尼消耗量的影响. 方法 90例足月孕单胎择期行剖宫产术的孕妇,ASA分级Ⅰ、Ⅱ级,按随机数字表法分为3组(每组30例):对照组(C组),舒芬太尼1.5 μg/kg+0.1％左布比卡因;Dex 1组(D1组),舒芬太尼1.5μg/kg+0.1％左布比卡因+Dex 0.02 μg·kg-1·h-1;Dex 2组(D2组),舒芬太尼1.5 μ.g/kg+0.1％左布比卡因+Dex 0.05 μg·kg1·h-1,各组药物均用生理盐水稀释至150 ml.孕妇均采用L～L4硬膜外腔联合蛛网膜下腔阻滞麻醉,术毕均快速泵注镇痛液2ml,背景输注速度为2ml/h,患者自控镇痛(patient controlled analgesia,PCA)锁定时间15 min,每次2 ml.记录术前产妇的一般资料,手术与麻醉时间,副作用(皮肤瘙痒、恶心、呕吐)的发生率,舒适度(Bruggrmann comfort scale,BCS)评分以及术后4、8、12、24、48 h的VAS评分和Ramsay评分,统计PCA键有效按压次数和48 h舒芬太尼用量. 结果 术后4、8、12、24、48 h,C组Ramsay评分[(2.0±0.5)、(1.7±0.5)、(1.6±0.6)、(1.6±0.5)、(1.8±0.4)分]明显低于D1组[(2.3±0.5)、(2.3±0.6)、(2.1±0.5)、(2.3±0.5)、(2.2±0.5)分]和D2组[(2.3±0.5)、(2.4±0.5)、(2.3±0.5)、(2.4±0.5)、(2.3±0.5)分](P＜0.05或P＜0.01);D1组[(0.5±0.6)、(0.8±0.9)、(0.9±0.9)、(1.0±0.9)、(1.1±0.8)分]和D2组[(0.4±0.6)、(0.5±0.7)、(0.7±0.7)、(0.8±0.8)、(0.9±0.7)分]VAS评分明显低于C组[(1.3±1.0)、(1.5±1.1)、(1.8±1.0)、(1.9±0.7)、(1.9±0.7)分](P＜0.05或P＜0.01).D2组皮肤瘙痒发生率(3.33％)明显低于C组(26.67％)(P＜0.05).D2组BCS评分[(3.1±0.7)分]显著高于C组[(3.1±0.7)分]与D1组[(1.9±0.7)分](P＜0.05或P＜0.01).C组48 h舒芬太尼消耗量[(1.041±0.025) μg/kg]明显大于D1组[(1.020±0.021)μ.g/kg]和D2组[(1.003±0.019) μg/kg](P＜0.01),且D1组比D2组消耗量大(P＜0.05). 结论 小剂量Dex能明显提高左布比卡因和舒芬太尼剖宫产术后的镇痛效果和安全性,具有良好的应用前景.     

右美托咪定不同途径给药对罗哌卡因腰丛-坐骨神经联合阻滞效果的影响

目的 评价右美托咪定(dexmedetomidine,Dex)不同途径给药方式对0.375％罗哌卡因腰丛挫骨神经联合阻滞(combined lumber plexus and sciatic nerve block,CLPSNB)效果的影响. 方法 90例CLPSNB患者按随机数字表法分为3组(每组30例):罗哌卡因组(R组),0.375％罗哌卡因50 ml行CLPSNB;罗哌卡因+Dex静脉注射组(D+R组),静脉输注Dex 1 μg/kg(输注时间10 min)同时0.375％罗哌卡因50 ml行CLPSNB;罗哌卡因局部麻醉药液混合Dex组(DR组),局部麻醉药Dex 1 μg/kg+0.375％罗哌卡因至50 ml行CLPSNB.R组和DR组同时静脉输注与D+R组相同容量的生理盐水.记录感觉阻滞和运动阻滞的起效时间和维持时间、术者的满意情况及副作用发生情况. 结果 3组感觉阻滞和运动阻滞的起效时间差异无统计学意义(P＞0.05);运动阻滞持续时间和首次使用镇痛药的时间DR组[(768±246) min和(1 080±300) min]、D+R组[(732±204) min和(1 050±288) min]显著长于R组[(420±126) min和(840±306) min] (P＜0.05);感觉阻滞持续时间DR组[(1008±258) min]显著长于R组[(624±216) min]、D+R组[(672±144) min](P＜0.05),而R组与D+R组比较,差异无统计学意义(P＞0.05).术者满意率DR组(100％)高于R组(85％)(P＜0.05).3组患者均未出现恶心、呕吐、低血压、呼吸抑制等副作用. 结论 Dex混合于0.375％罗哌卡因行CLPSNB麻醉效果及术者满意度佳.     

回输外引流胆汁和胰液对胰十二指肠切除术疗效的影响

目的 探讨回输外引流的胆汁和胰液对胰十二指肠切除术疗效的影响.方法 回顾性分析2005年6月至2009年3月滨州医学院附属医院收治的51例行胰十二指肠切除术患者的临床资料.根据是否回输外引流的胆汁和胰液分为回输组(32例)和非回输组(19例).观察两组患者术后胆汁和胰液日均引流量,手术情况,肠内营养耐受性,肝脏功能及营养状态等指标.应用x2检验、Fisher确切概率法、两独立样本t检验、Mann-Whitney U检验、单因素方差分析等对数据进行统计分析.结果 术后回输组患者肺部感染率为3％ (1/32),低于非回输组患者的26％( 5/19),两组比较,差异有统计学意义(P＜0.05).回输组患者自术后4～10 d胰液日引流量显著低于非回输组(t=7.143,9.244,8.808,7.915,6.461,14.097,15.038,P＜0.05),而两组患者胆汁日均引流量比较,差异无统计学意义.营养支持治疗后,回输组患者腹泻发生率为9％(3/32),低于非回输组的37％(7/19),两组比较,差异有统计学意义(P＜0.05).回输组达到全量肠内营养支持的平均时间为3d,短于非回输组的4 d(U=145.000,P＜0.05).回输组和非回输组患者术前TBil、DBil、IBil分别为(261±108)、(132±55)、(129±55) μmol/L和(239±92)、(124±46)、(116 +46) μmol/L;营养支持治疗12 d后,两组患者的上述指标分别为(39±19)、(20±10)、(19±9) μmol/L和(55±22)、(29±12)、(26±11) μmoL/L,回输组患者上述指标下降程度高于非回输组(t=7.324,8.437,5.827,P＜0.05).回输组和非回输组患者术前血清前白蛋白、视黄醇结合蛋白、转铁蛋白分别为(0.261±0.021)g/L、(34.3±2.8) mg/L、(3.08±0.26) g/L和(0.263 ±0.021 )g/L、(33.8±3.5) mg/L、(3.10±0.27)g/L;术后两组患者的上述指标迅速下降,营养支持治疗3d后各项指标逐步回升,12 d后,两组患者的上述指标分别为(0.238±0.025)g/L、(30.7±2.0)mg/L、(2.78±0.19)g/L和(0.222±0.025) g/L、(29.3±2.1)mg/L、(2.63±0.21)g/L,并且回输组患者的上述指标明显高于非回输组(t=4.615,6.097,4.913,P＜0.05).结论 胰十二指肠切除术后回输外引流的胆汁和胰液可提高患者对肠内营养耐受性,降低肺部感染发生率,促进血清胆红素水平降低,改善患者营养状态,具有较高实用价值.     

癫痫患者顺式阿曲库铵的剂量反应曲线测定

目的 采用单次剂量注射法建立癫痫患者顺式阿曲库铵的剂量反应曲线,确定其量效关系及ED95,为癫痫患者合理应用顺式阿曲库铵提供依据.方法 选取择期癫痫手术患者40例,ASA Ⅰ～Ⅱ级,年龄16岁～42岁,病史3年～26年,均具有服用抗癫痫药物史,术前无酸碱平衡及水电解质紊乱,心肺、肝肾功能正常.患者按随机数字法分为20μ...