异氟醚对大鼠肝脏缺血-再灌注损伤期氧自由基及细胞间黏附分子-1表达的影响

目的探讨异氟醚通过抑制细胞间黏附分子（ICAM-1）表达参与减轻肝脏缺血-再灌注（IR）损伤的可能调节机制。方法 32只雌性SD大鼠分为4组。A组大鼠行腹腔注射1%戊巴比妥钠40 mg/kg麻醉,进行手术但不阻断入肝血流;B组1%戊巴比妥钠麻醉后行部分肝脏IR;C组大鼠仅接受1.0 MAC异氟醚吸入麻醉,不阻断血流;D组采用1.0 MAC异氟醚麻醉,建立肝脏IR模型。肝脏缺血60 min,再灌注3 h后取肝组织和血液标本,检测血清丙氨酸转氨酶（ALT）和天冬门氨酸转氨酶（AST）、肝组织ICAM-1和肝组织还原型谷胱甘肽（GSH）、脂质过氧化物丙二醛（MDA）和超氧化物歧化酶（SOD）含量。结果与戊巴比妥钠麻醉比较,采用异氟醚处理后明显降低血清ALT和AST的水平,再灌注肝组织内GSH、SOD含量明显高于而MDA含量降低,同时抑制肝组织ICAM-1的表达。结论异氟醚麻醉能够有效减轻肝脏IR损伤,抑制氧自由基的生成和释放,具体机制可能与抑制ICAM-1表达致使细胞内GSH含量增加密切相关。     

高渗盐水对缺血/再灌注损伤肝脏血红素加氧酶-1表达的影响

目的 探讨高渗盐水预处理对肝脏缺血／再灌注损伤的保护作用及其机制。方法 25只SD大鼠随机分为假手术组、血红素加氧酶-1（HO-1）抑制剂锌原卟啉（ZnPP）组、缺血／ig灌注组、高渗盐水预处理组及ZnPP干预组，每组5只。建立大鼠局部肝脏缺血／再灌注损伤模型，于缺血／再灌注后6h测定血清丙氨酸转氨酶（ALT）活性、肿瘤坏死因子-α（TNF-α）含量、肝组织髓过氧化物酶（MPO）活性及肝组织内皮素1（ET1）含量；采用逆转录-聚合酶链反应（RTPCR）和蛋白质免疫印迹法（Westernblot）检测肝组织HO-1mRNA和蛋白表达；光镜和电镜下观察肝脏病理学改变及肝窦情况。观察使用ZnPP后，高渗盐水预处理对肝脏缺血／再灌注损伤的保护作用。结果 肝脏缺血／再灌注后血清ALT活性、TNF-α含量及肝组织MPO活性、ET-1含量均明显升高（P均d0．01），HO-1mRNA和蛋白表达明显增强。高渗盐水预处理明显增强缺血／再灌注后肝脏HO-1mRNA及蛋白表达，降低血清ALT、TNF-α水平及肝组织MPO活性和ET-1含量，肝脏微循环明显改善；使用ZnPP以后，高渗盐水预处理的保护作用消失。结论 高渗盐水预处理通过增强HO-1表达，对肝脏缺血／再灌注损伤产生保护作用。     

肝区微波预照射对家兔肝脏缺血再灌注损伤的保护作用

目的观察20W、2450MHz微波照射肝区20min预处理后24h对肝门阻断造成缺血再灌注损伤的保护作用。方法20只成年健康家兔随机分为微波预处理组(n=4)、微波预处理加肝门阻断组(n=8)、单纯肝门阻断组(n=8)。所有动物麻醉后静脉采血。24h后前者再次采血。后两者则均将肝门阻断20min，开放血流后2h、4h分别采血查ALT、AST、LDH。最后一次采血后从肝右中方叶前缘取肝组织作切片．按Suzuki标准进行损伤评分。结果微波预处理组家兔肝脏Suzuki标准损伤评分结果与未进行微波预处理者无明显差别，但血中ALT、AST及LDH水平改变明显轻于后者。结论适宜照射条件的微波预处理可明显减轻肝脏的缺血再灌注损伤。     

齐墩果酸预处理对大鼠肝脏缺血再灌注损伤中细胞凋亡的影响

目的：观察齐墩果酸（OA）预处理对肝脏缺血再灌注损伤中细胞凋亡的影响,探讨齐墩果酸预处理对肝脏保护作用的机制。方法雄性 SD 大鼠40只,随机分为假手术组（SH 组）、缺血再灌注组（IR 组）、0．5％羧甲基纤维素钠组（CM 组）和齐墩果酸预处理组（齐墩果酸组）,齐墩果酸组以100 mg/kg 的齐墩果酸混悬液,SH 和 IR 组以相同容积的水,CM 组以相同容积的0．5％CMC-Na 分别每日灌胃1次,连续7 d。第8天建立70％肝脏缺血再灌注模型,肝脏缺血60 min 后行再灌注3 h。检测大鼠血清丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）和LDH 水平;检测肝组织内丙二醛（MDA）、超氧化物歧化酶（SOD）、谷胱甘肽（GSH）水平变化;通过 HE 染色观察肝组织形态,利用 Tunel 染色检测肝组织凋亡状态;Western blot 检测肝脏组织 caspase3和 p53蛋白表达水平。结果与 IR 组相比齐墩果酸组血清肝酶水平及肝组织中 MDA 水平显著降低,而 SOD 和 GSH 活性则显著升高;与 IR组相比齐墩果酸组肝组织病理形态学损伤明显减轻;缺血再灌注后可见明显的肝实质细胞凋亡现象,齐墩果酸组凋亡细胞较 IR 组显著下降,且 caspase3和 p53蛋白表达亦减少。结论齐墩果酸预处理可减轻肝脏缺血再灌注损伤,可能与抑制 caspase3和 p53蛋白表达从而抑制细胞凋亡有关。     

七氟醚预处理对大鼠肝缺血-再灌注后心肌损伤的影响

目的 探讨七氟醚预处理对大鼠肝缺血-再灌注后心肌损伤的影响及可能机制.方法 健康雄性SD大鼠30只,随机分为假手术组(Sham组,n=10)、肝缺血一再灌注组(IR组,n=10)和七氟醚预处理组(S组,n=10)三组.建立大鼠肝缺血-再灌注模型,S组大鼠在阻断入肝血流前吸入2.5%七氟醚30 min,IR组和s组大鼠肝缺血45 min再灌注120 min.分别测定各组大鼠血清谷丙转氨酶(ALT)、谷草转氨酶(AST)、心肌型肌酸激酶(CK-MB)、乳酸脱氢酶1(LDH1)浓度及心肌组织丙二醛(MDA)、超氧化物歧化酶(SOD)、肿瘤坏死因子(TNF-α)、白细胞介素6(IL-6)浓度,光镜观察心肌组织形态学.结果 与Sham组比较,S组和IR组血清ALT、AST、CK-MB、LDH1浓度均明显升高(P<0.05);心肌组织MDA、TNF-α和IL-6浓度明显升高(P<0.05),SOD活性明显降低(P<0.05).与IR组比较,S组血清ALT、AST、CK-MB、LDH1浓度明显降低(P<0.05);心肌组织MDA、TNF-α和IL-6浓度明显降低(P<0.05),SOD活性明显升高(P<0.05).Sham组心肌肌束及细胞形态正常,IR组和S组可见肌束断裂、细胞边界不清及炎症细胞浸润,S组改变较IR组轻微.结论 七氟醚预处理可减轻大鼠肝缺血-再灌注后心肌损伤,其作用机制可能与减少氧自由基的释放和抑制炎症反应有关.     

异氟醚预处理对缺血/再灌注复合内毒素大鼠肝脏损伤的影响

目的 观察再灌注期腹腔注射内毒素脂多糖(LPS)对大鼠肝脏缺血/再灌注(I/R)损伤的影响以及异氟醚(ISO)预处理的干预作用.方法 将32只SD大鼠随机均分为4组:假手术(Sham)组、单纯肝脏I/R组、肝脏I/R复合LPS损伤(I/R+LPS)组及ISO预处理组.I/R+LPS组吸氧预处理后间隔0.5 h进行肝脏缺血1 h、再灌注4 h,再灌注开始时腹腔内注入LPS;ISO预处理组以ISO吸入预处理0.5 h,间隔0.5 h后进行I/R损伤操作,再灌注开始时腹腔内注入LPS.再灌注4 h处死各组动物,留取肝脏及血液标本;观察各组肝组织病理学改变,血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、肿瘤坏死因子-α(TNF-α)的变化以及肝组织TNF-α、髓过氧化物酶(MPO)活性的改变.结果 与Sham组比较,损伤各组血清ALT、AST、TNF-α及肝组织TNF-α、MPO活性均显著升高(P均＜0.01);与I/R组比较,I/R+LPS组肝脏损伤和炎症细胞因子反应明显较重(P＜0.05或P＜0.01)l与I/R+LPS组比较,ISO预处理组肝脏的病理损伤明显较轻,血清ALT、AST、TNF-α水平及肝组织MPO活性和促炎细胞因子TNF-α的表达水平均显著降低(P均＜0.05).结论 再灌注期复合LPS腹腔注射明显加重了肝脏的损伤和炎症细胞因子反应,ISO预处理可明显减轻复合损伤介导的炎症反应,保护肝脏.     

七氟醚预处理对大鼠急性肾缺血-再灌注损伤保护作用的实验研究

目的：探索七氟醚对急性肾缺血-再灌注损伤肾功能的保护作用。方法选择健康 SD 大鼠90只,随机分为三组：伪手术组、对照组及七氟醚预处理组,建立肾缺血-再灌注模型,测定各组大鼠平均动脉压（MAP）、二氧化碳分压（PCO2）、血清尿素氮（BUN）、肌酐（Cr）及超氧化物歧化酶（SOD）的变化,HE 染色观察各组大鼠肾组织病理改变。结果随着七氟醚预处理浓度的增加,大鼠 MAP 呈下降趋势,但在七氟醚浓度2％-3％的临床常用剂量范围内,大鼠的 MAP 波动于92．1±6．0 mmHg。各组肾缺血前与再灌注后,PCO2浓度无明显变化。对照组及七氟醚预处理组 BUN 和 Cr 于再灌注后12 h、24 h 均明显高于伪手术组（P ＜0．05）,但七氟醚预处理组再灌注后12 h、24 h 的BUN、Cr 水平均较对照组明显下降（P ＜0．05）。七氟醚预处理组和对照组均较伪手术组血清 SOD 活力减低,但七氟醚预处理组 SOD 活力较对照组高,差异具有统计学意义（P ＜0．05）。肾脏病理观察发现伪手术组肾脏组织结构完整,对照组肾脏外髓部分组织结构严重破坏,而七氟醚预处理组肾脏组织破坏较小,肾小管组织相对完整。结论七氟醚吸入式麻醉能够有效降低 BUN、Cr 水平,保护 SOD 活力,对急性肾缺血-再灌注损伤肾功能具有一定的保护作用。     

重组腺病毒携带TNF—-α受体Ⅰ基因对肝脏缺血再灌注损伤的研究

目的探讨大鼠肝脏缺血再灌注损伤的过程和相关机制及可溶性TNF-α受体I（sTNFRI）基凼的保护作用。方法预先给予携带sTNFRI基因的重组腺病毒后建立大鼠缺血再灌注模型,阻断肝左、中叶入肝血流60rain后分别再灌注1h、3h、6h、12h。采用全自动生化分析仪测定血清中肝酶学指标（AST、ALT）,TBA法测定肝脏丙二醛（MDA）含量。大鼠肝脏组织切片HE染色后,行光镜检查,观察肝组织显微结构变化。结果AST、ALT和肝脏的组织形态学都显示模型组较假手术组大鼠有明显的肝脏损伤,其中以再灌注6h肝脏损伤最严重。肝组织MDA含量明显高于假手术组（P〈0．01）,于再灌注3h达到高峰。肝组织TNF-α的表达均明显高于假手术组（P〈0．01）,且于再灌注6h达到高峰。结论sTNFRI可增强抗氧化能力,降低MDA水平,抑制缺血再灌注大鼠体内氧化应激水平,对大鼠缺血再灌注有一定的治疗作用。     

三氯化钆对大鼠肝脏缺血再灌注损伤保护作用的实验研究

【目的】探讨枯否细胞抑制荆三氯化钆对大鼠肝脏热缺血再灌注损伤的影响，并分析其可能机制。【方法】将64只成年雄性SD大鼠随机分为3组：三氯化钆预处理＋缺血再灌柱组（GD组，n=24），生理盐水预处理＋缺血再灌注组（NS组，n=24），假手术组（Sham组，n=16）。按Pringle＇s法建立肝脏95％缺血模型：选择性阻断肝门静脉左支及肝动脉30min，再灌注120min。各组经下腔静脉取血测定血清谷丙转氨酶（ALT）、谷草转氨酶（AST）、肿瘤坏死因子（TNF-α）浓度；各组分别于再灌注120min后经尾静脉注射印度墨汁，断尾取血测量0D5 min and OD15 min值以计算枯否细胞吞噬系数；取左叶肝组织行病理切片检查。【结果】①缺血30min及再灌注120min后GD组ALT、AST、TNF-α浓度低于NS组（P〈0．05）。②再灌注120min后GD组枯否细胞吞噬系数较NS组及Sham组降低（P〈0.05）。③GD组再灌注120min后肝组织形态学改变均较NS组轻。【结论】三氯化钆能减少枯否细胞释放细胞因子（主要是肿瘤坏死因子）从而减轻肝脏热缺血再灌注损伤。     

Akt／GSK-3β信号通路和线粒体渗透性转换孔在吸入性麻醉药预处理对老年大鼠心肌缺血保护的研究

目的Akt／GSK．3β信号通路的激活参与了吸人麻醉药心肌保护预处理。在该研究中观察了老年和成年大鼠在异氟醚心肌保护预处理中的差异,包括Akt／GSK-3β信号通路和线粒体渗透性转换孔在异氟醚预处理中的差异。方法雄性Fisher344大鼠按照各自的年龄,成年（3—5月）、老年（20～24月）,随机分配到阴性对照组（sc）、缺血再灌注组（I／R）、异氟醚组（ISO）中。ISO组,大鼠接受30min1．0MAC的异氟醚预处理。I／R组,大鼠接受30min的心肌缺血。方案A中,大鼠接受2h再灌注,用来检测梗死面积。方案B中,大鼠接受10min再灌注,用Westcrn来检测P-Akt,Akt,P—GSK-3β,GSK．3β的表达;并且用分光光度法分析组织中烟酰胺腺嘌呤二核苷酸（NAD＋）水平,作为反映线粒体渗透性转换孔（mPTP）开放的指标。结果成年组大鼠,异氟醚预处理组（YISO＋I／R）心肌梗死面积为29．9％±1．9％,明显低于缺血再灌注组（YI／R,51．8％±2．1％,P〈0．001）。而老年组大鼠,异氟醚预处理失去心肌保护作用（OISO＋I／R--39．9％4-3．7％VSOI／R=46．9％±2．5％,P〉0．05）。比较成年阴性对照组（YSC组）和成年缺血再灌注组（YI／R组）,异氟醚预处理显著提高了成年异氟醚组（YISO组）和成年异氟醚＋缺血再灌注组（YISO＋I／R组）的Akt和GSK-3B的磷酸化水平（P〈0．05）。但是老年组大鼠,Akt和GSK-39磷酸化水平已经在阴性对照组（osc组）提高（对比YSC组）。异氟醚预处理没有进一步提高老年异氟醚组（OISO组）和老年异氟醚＋缺血再灌注组（OISO＋I／R组）的Akt和GSK-3B的磷酸化水平（P〈0．05）。同样,异氟醚预处理减少了成年组大鼠心肌组织中NAD’的减少,而异氟醚预处理失去了对老年组大鼠的NAD＋流失保护作用。结论老年大鼠失去异氟醚预处理心肌保护作用,失去进一步提高Akt、GSK．3β的磷酸化水平能力和失去关闭mPTP是其机理之一。     

地氟醚预处理对体外循环术后早期循环黏附分子和脂质过氧化影响

目的：研究地氟醚预处理对心肺旁路术后早期心肌缺血再灌注损伤的保护作用及可能机制。方法：30例行二尖瓣及主动脉瓣双瓣替换术的患者，随机分为对照组和实验组。对照组不用吸入麻醉药，地氟醚预处理组在气管插管后至体外循环转流前吸入地氟醚，使地氟醚呼气末浓度达到1MAC左右，累积维持时间不少于30min。分别于主动脉阻断前、开放后30min及1h抽取抗凝动脉血，测定PMN表面CD11b的表达、血浆sICAM-1浓度、MDA、SOD浓度。结果：（1）主动脉阻断前，组间比较血浆sICAM-1浓度无显著差异（P〉0．05），开放后30min、60min血浆sICAM-1浓度较主动脉阻断前明显降低（P〈0．05），组间比较各时间点无显著差异（P〉0．05）。（2）主动脉阻断前，组间比较PMN表面CD11b的表达无显著差异（P〉0．05），但地氟醚预处理组开放后30min、60minCD11b的表达较主动脉阻断前明显升高（P〈0．05），PMN表面CD11b的表达较对照组有降低趋势，主动脉开放后30min地氟醚预处理组CD11b的表达明显降低（P〈0．05）。（3）体外循环前，组间比较血浆SOD、MDA浓度无显著差异（P〉0．05），体外循环主动脉开放后30min、60min，MDA的血浆浓度较主动脉阻断前明显升高（P〈0．05），SOD较主动脉阻断前明显降低（P〈0．05）。地氟醚预处理组，体外循环主动脉开放后各时间点，SOD有升高趋势；MDA较对照组明显降低（P〈0．05）。结论：地氟醚预处理可降低心肺旁路术后早期MDA的释放，增加SOD活性的趋势，与再灌注早期地氟醚预处理可降低PMN表面CD11b有关，地氟醚预处理在心肺旁路术后早期对心肌细胞有保护作用，与内皮细胞粘附分子表达无关系。     

Effect of an anesthesia with propofol compared with desflurane on free radical production and liver function after partial hepatectomy

Propofol has shown antioxidant properties, but no study has focused on liver resection surgery. The aim of this study was to investigate the effect of an anesthesia with propofol compared with desflurane on oxidative stress and hepatic function during and after partial hepatectomy. This was a prospective randomized study performed on two parallel groups. The primary endpoint was malondialdehyde (MDA) plasma concentration 30 min after hepatic vascular unclamping. Hepatic damages were evaluated by plasma levels of alpha‐glutathione S‐transferase (α‐GST) 120 min after hepatic vascular unclamping and of aminotransferases at 120 min and on days 1, 2, 5, and 10. Liver function recovery was assessed by monoethylglycinexylidide (MEGX) formation 15 min after lidocaine injection on day 2 and by prothrombin time and plasma factor V at 120 min and on days 1, 2, 5, and 10. Thirty patients were analyzed (propofol group: 17; desflurane group: 13). There was no significant difference between groups for MDA plasma concentration 30 min after hepatic vascular unclamping (mean ± standard‐deviation: 1.28 ± 0.40 and 1.21 ± 0.29 in propofol and desflurane groups, respectively, P = 0.608). Plasma levels of α‐GST at 120 min were lower in propofol than in desflurane group (142.2 ± 75.4 vs. 205.7 ± 66.5, P = 0.023), and MEGX on day 2 was higher (0.092 ± 0.096 vs. 0.036 ± 0.020, P = 0.007). No differences between groups were observed with regard to plasma levels of aminotransferases, prothrombin time, and plasma factor V. Our study showed that in patients undergoing partial hepatectomy, propofol did not reduce MDA formation but seemed to display a protective effect on hepatic damages and liver function when compared to desflurane.     

Comparison of recovery characteristics, postoperative nausea and vomiting, and gastrointestinal motility with total intravenous anesthesia with propofol versus inhalation anesthesia with desflurane for laparoscopic cholecystectomy: A randomized controlled study

Background:Clinical effects, recovery characteristics, and costs of total intravenous anesthesia with different inhalational anesthetics have been investigated and compared; however, there are no reported clinical studies focusing on the effects of anesthesia with propofol and desflurane in patients undergoing laparoscopic cholecystectomy.Objective: The aim of this study was to determine the effects of total intravenous anesthesia with propofol and alfentanil compared with those of desflurane and alfentanil on recovery characteristics, postoperative nausea and vomiting (PONV), duration of hospitalization, and gastrointestinal motility.Methods: Patients classified as American Society of Anesthesiologists physical status I or II undergoing elective laparoscopic cholecystectomy due to benign gallbladder disease were enrolled in the study. Patients were randomly assigned at a 1:1 ratio to receive total intravenous anesthesia with propofol (2-2.5 mg/kg) and alfentanil (20 μg/kg) or desflurane (4%-6%) and alfentanil (20 μg/kg). Perioperative management during premedication, intraoperative analgesia, relaxation, ventilation, and postoperative analgesia were carried out identically in the 2 groups. Extubation time, recovery time, PONV, postoperative antiemetic requirement, time to gastrointestinal motility and flatus, duration of hospitalization, and adverse effects were recorded. Postoperative pain was assessed using a visual analogue scale.Results: Sixty-eight patients were assessed for inclusion in the study; 5 were excluded because they chose open surgery and 3 did not complete the study because they left the hospital. Sixty patients (33 women, 27 men) completed the study. Recovery time was significantly shorter in the propofol group (n = 30) compared with the desflurane group (n = 30) (8.0 [0.77] vs 9.2 [0.66] min, respectively; P < 0.005). Fifteen patients (50.0%) in the propofol group and 20 patients (66.7%) in the desflurane group experienced nausea during the first 24 hours after surgery. The difference was not considered significant. In the propofol group, significantly fewer patients had vomiting episodes compared with those in the desflurane group (2 [6.7%] vs 16 [53.3%]; P < 0.005). Significantly fewer patients in the propofol group required analgesic medication in the first 24 hours after surgery compared with those in the desflurane group (10 [33.3%] vs 15 [50.0%]; P < 0.005). Patients in the propofol group experienced bowel movements in a significantly shorter period of time compared with patients in the desflurane group (8.30 [1.67] vs 9.76 [1.88] hours; P = 0.02). The mean time to flatus occurred significantly sooner after surgery in the propofol group than in the desflurane group (8.70 [1.79] vs 9.46 [2.09] hours; P = 0.01). The duration of hospitalization after surgery was significantly shorter in the propofol group than in the desflurane group (40.60 [3.49] vs 43.60 [3.56] hours; P = 0.03).Conclusion: Total intravenous anesthesia with propofol and alfentanil was associated with a significantly reduced rate of PONV and analgesic consumption, shortened recovery time and duration of hospitalization, accelerated onset of bowel movements, and increased patient satisfaction compared with desflurane and alfentanil in these patients undergoing laparoscopic surgery who completed the study.     

Withdrawal of pioglitazone in patients with type 2 diabetes mellitus

Background and objective: The remodelling of the adipose tissue by pioglitazone may be associated with the sustained therapeutic effects. We studied the effects of withdrawal of pioglitazone after 3‐month treatment on glucose, lipid and high‐molecular weight (HMW) adiponectin levels as well as liver function in patients with type 2 diabetes mellitus. Methods: Forty‐nine Japanese patients with type 2 diabetes mellitus were randomly assigned into the withdrawal group after 3‐month treatment with pioglitazone (15 or 30 mg daily) and the non‐withdrawal group. Results and discussion: Three‐month treatment with pioglitazone improved glycaemic control, homeostasis model assessment for insulin resistance (HOMA), dyslipidaemia and liver function tests in association with a marked increase in serum HMW adiponectin level. Three months later after the withdrawal of pioglitazone, however, fasting plasma glucose and HOMA increased, whereas serum HMW adiponectin decreased to the pretreatment levels. Dyslipidaemia also returned to the pretreatment level. On the other hand, liver enzymes at 3 months after the withdrawal remained lower after a mild rebound. In addition, the bone formation marker, serum bone‐specific alkaline phosphatase, was significantly reduced by pioglitazone treatment in post‐menopausal women. Conclusions: The present study suggests that 3‐month treatment with pioglitazone has no sustained beneficial effects except in liver function tests in patients with type 2 diabetes mellitus.     

Effects of flow rate on hemodynamic parameters and agent consumption in low-flow desflurane anesthesia: An open-label, prospective study in 90 patients

Background:

In surgical patients, decreasing the fresh gas flow rate in anesthesia may minimize costs, reduce environmental pollution, and preserve heat and humidity in the respiratory system.

Objective:

The aim of this study was to investigate the effects of 3 low-flowdesflurane rates on perioperative hemodynamic stability, end-tidal desflurane concentration, emergence and recovery characteristics, and agent consumption.

Methods:

This open-label, prospective study was conducted at the Departmentof Anesthesiology and Reanimation, University of Gaziantep, Gaziantep, Turkey. Nonpremedicated adult patients scheduled to undergo surgery (ureterolithotomy, cholecystectomy, pyelolithotomy, or thyroidectomy) were enrolled. Patients were anesthetized with propofol and fentanyl and intubated after neuromuscular blockade with vecuronium. Patients were randomly allocated to 1 of 3 groups according to the fresh gas flow rate: medium flow (2 L/min), low flow (1 L/min), and minimal flow (0.5 L/min). Intraoperative fentanyl volume was recorded. Heart rate, mean arterial pressure, and end-tidal desflurane concentration were recorded before (baseline) and after anesthesia induction; immediately before incision; and 5, 10, 15, 30, 45, and 60 minutes after incision. Emergence time and desflurane consumption after extubation were recorded. Aldrete scores were recorded at 5, 15, and 30 minutes after extubation.

Results:

Ninety patients (46 women, 44 men; mean [SD] age, 39.74 [13.73] years; 30 patients per treatment group) participated in the study. Means of hemodynamic parameters, intraoperative volume of fentanyl, end-tidal desflurane concentration, emergence time, and Aldrete score were statistically similar between the 3 groups. Mean (SD) desflurane consumption was significantly higher in the medium-flow group compared with the low- and minimal-flow groups (110.43 [28.18] g vs 98.40 [23.62] g and 79.80 [17.54] g, respectively; both, P < 0.01). Mean (SD) desflurane consumption was also significantly higher in the low-flow group compared with the minimal-flow group (P < 0.01).

Conclusion:

The results of the present study in adult surgical patients suggestthat desflurane may be used in low-flow anesthesia, even with the minimal fresh gas flow rate.     

在地氟烷脑保护作用下颅内动脉瘤夹闭术中不同时间点血管紧张素Ⅱ和内皮素水平的变化

背景脑血管痉挛是颅内动脉瘤手术围术期主要并发症之一,颅内动脉瘤行开颅夹闭术的麻醉不仅应满足麻醉的基本要求而且要求尽可能预防脑血管痉挛、提供脑功能的保护.目的观察地氟烷麻醉下颅内动脉瘤患者行夹闭术中收缩脑血管物质血管紧张素Ⅱ、内皮素水平的变化,探讨地氟烷的脑保护作用.设计病例分析.单位首都医科大学附属北京天坛医院神经外科和麻醉科.对象选择2002-10/2004-06首都医科大学附属北京天坛医院神经外科64例拟行开颅动脉瘤夹闭术患者,男30例,女34例.方法麻醉诱导后气管插管控制呼吸,地氟烷维持麻醉.分别于麻醉诱导前、剪硬膜、夹闭动脉瘤和动脉瘤夹闭后30 min 4个时点采集动脉血4 mL,应用放免法检测血浆中血管紧张素Ⅱ、内皮素的水平.主要观察指标颅内动脉瘤患者麻醉诱导前、剪硬膜、夹闭动脉瘤和动脉瘤夹闭后30 min血浆中血管紧张素Ⅱ和内皮素的水平.结果2例患者手术中发生动脉瘤破裂,进入结果分析62例.①血管紧张素Ⅱ水平颅内动脉瘤患者术前血管紧张素Ⅱ水平在正常范围,地氟烷麻醉中3个时间点较麻醉诱导前无明显变化(P＞0.05).②内皮素水平剪硬膜、夹闭动脉瘤和动脉瘤夹闭后30 min时明显低于麻醉诱导前[(40.4±10.3),(40.0±9.6),(40.7±12.3),(49.3±12.7)ng/L,(P=0.002,0.001,0.009)].结论地氟烷麻醉下开颅动脉瘤夹闭术中收缩脑血管物质血管紧张素Ⅱ和内皮素在整个麻醉维持期间均无上升趋势,内皮素甚至明显低于麻醉诱导前水平,且不同手术阶段无明显差异,表明地氟烷麻醉能够避免由于血管紧张素Ⅱ和内皮素释放增加导致的急性脑血管痉挛,降低继发性脑缺血性损害,从而起到脑保护的作用.     

新型冠状病毒肺炎患者肝功能异常的相关临床分析

目的　探讨新型冠状病毒肺炎（COVID-19）患者肝功能异常的相关性因素。方法　回顾性分析湖南省岳阳市 第一人民医院2020 年1~3 月收治的新型冠状病毒（SARS-CoV-2）感染患者80 例，根据肝功能情况分为肝功能异常 组45 例，对照组35 例，对其进行病例对照研究，选择与肝损伤有关指标进行单因素及多因素分析，探讨COVID-19 患者肝功能异常的发生机制。结果　研究显示肺炎严重程度是COVID-19 患者发生肝损伤的主要危险因素（P=0.009， OR=3.826，95%CI 1.388~10.544），而基础疾病、炎症因子水平与COVID-19 患者出现肝损伤无统计学相关性（P>0.05）。 结论　COVID-19 患者发生肝功能损害与病情进展密切相关，临床医生诊治患者时，应当遵从早发现、早治疗的原则， 避免造成肝脏进一步损伤，改善患者预后。     

Remifentanil-propofol in vertebral disk operations: Hemodynamics and recovery versus desflurane-N<Subscript>2</Subscript>O inhalation anesthesia

The purpose of this study was to ascertain whether total intravenous anesthesia (TIVA) with propofol and remifentanil differs from inhalational anesthesia with desflurane and nitrous oxide in terms of hemodynamics, recovery profile, and postoperative analgesic demand in patients undergoing elective microsurgical vertebral disk resection. A total of 60 patients were randomly assigned to receive TIVA with propofol and remifentanil or inhalational anesthesia with desflurane and nitrous oxide. The TIVA group (n=30) then received 50%/50% N₂O/O₂. A constant infusion of remifentanil was provided at 0.125 μg/kg/min accompanied by propofol at 10 mg/kg/h in the first 10 min, 6 mg/kg/h in the second 10 min, then 4 mg/kg/h. The desflurane group (n=30) received 50%/ 50% N₂O/O₂, with 5% desflurane after intubation and 6% before incision; desflurane was administered in a minimum alveolar concentration 1 fashion during the operation. Hemodynamic, O₂ saturation, and end-tidal CO₂ data were recorded before induction, after intubation, after prone positioning, 5, 10, 15, 20, and 30 min into the operation, and at 15-min intervals thereafter until the end of the operation. Details on perioperative bradycardia, hypotension or hypertension, spontaneous breathing, extubation, eye opening, recovery time of ability to give name and date of birth, postoperative nausea and vomiting, shivering, agitation, and hypoxia were recorded. Patients anesthetized with desflurane responded to skin incision with increasing blood pressure and tachycardia; however, no other hemodynamic differences were noted between the 2 groups. In the TIVA group, recovery times were shorter for spontaneous ventilation (2.33–3.53 min), extubation (3.13–3.88 min), eye opening (4.06–6.23 min), and being able to give name and date of birth (5.4–7.9 min) compared with times in the desflurane group (P<.05). In theTIVA group, more postoperative shivering (16.7% of patients) and greater analgesic demand were seen than in the desflurane group. Although nausea and vomiting were more common in the desflurane group, no difference in bronchospasm was reported. In theTIVA group, a shorter recovery period and a greater demand for postoperative analgesia were seen. Because of the lack of residual analgesic effects, postoperative analgesic treatment should be initiated immediately in patients undergoing TIVA.