快通道心脏麻醉与术后早期拔管及术中知晓

目的　比较“快通道”心脏麻醉 ( fast- track cardiac anesthesia,FTCA)与传统的大剂量芬太尼麻醉对先天性心脏病病人术后清醒时间、拔除气管导管 (简称拔管 )时间和术中知晓的影响。方法　 FTCA组 ( 组 )麻醉维持以异氟醚为主 ,芬太尼组 ( 组 )麻醉维持以芬太尼为主 ,观察术后清醒时间、拔管时间和术中知晓情况。结果　清醒时间和拔管时间 组均比 组短 ,差异有非常显著性 ( P<0 .0 1) ,且 组病人无拔管后再插管 ,亦无术中知晓。结论　施行“快通道”心脏麻醉有利于术后早期拔管 ,减少术后呼吸系统并发症 ,对病人的心血管系统无明显的不良影响。同时减少了病人在重症监护室 ( ICU)的停留时间 ,降低了医疗成本     

异氟醚吸入或异丙酚复合芬太尼麻醉对血糖和血脂影响的观察

目的观察异氟醚吸入或异丙酚复合芬太尼长时间麻醉(≥6h)对血糖和血脂的影响。方法 30例口腔-颌面肿瘤外科手术病人随机分为异氟醚组和异丙酚组,每组15例。异氟醚组以咪唑安定诱导,异氟醚吸入维持;异丙酚组以异丙酚靶控输注复合芬太尼连续输注。于麻醉诱导前、手术开始后第3、6h测定血糖、血脂以及术后2h测定血糖,术后24h测定血脂。结果异氟醚吸入或异丙酚复合芬太尼长时间麻醉,术中第3h和6h的血糖水平较术前均有明显升高(P<0.05),但相同时间点的血糖水平,吸入组较静脉组有显著升高(P<0.05)。异氟醚吸入6h后,术中血脂水平较诱导前无明显改变,均在正常值范围之内。异丙酚连续靶控输注3、6h,其血脂水平达到临界高值,与同时间点的异氟醚组比较,均有显著升高,其血脂水平在术后24h恢复至诱导前水平。结论对于长时间麻醉,异丙酚复合芬太尼麻醉对术中高血糖反应的抑制作用较异氟醚吸入麻醉强。两种麻醉方法,手术6h后所有病例均未见低血糖。异氟醚吸入麻醉,手术应激对血脂代谢无明显影响。异丙酚连续靶控输注6h后,可增加病人血中甘油三脂水平,并引起脂类代谢异常。     

全凭静脉麻醉与静吸复合麻醉在颅脑手术中的临床观察

目的研究异丙酚和芬太尼全凭静脉麻醉在颅内肿瘤切除术的应用及效果评价.方法选择颅内肿瘤病人80例,随机分成静吸复合麻醉组(静吸组)和全凭静脉麻醉组(全静脉组),两组均以咪唑安定0.2mg/kg,芬太尼3μg/kg,阿曲库铵0.6mg/kg诱导后作气管插管.麻醉维持:静吸组用异氟醚为主吸入,全静脉组用微量泵注入异丙酚6mg.(kg.h)-1和芬太尼3 μ g.(kg.h)-1混合液,记录麻醉诱导前、切头皮、切开硬脑膜、缝合硬脑膜、术毕的SBP、DBP、HR和SPO2,停止麻醉至拔管时间,拔管时的清醒程度和随访结果.结果两组间的拔管时间、清醒程度无显著差异,静吸组在切开硬脑膜,缝合硬脑膜时的HR、SBP、DBP和术毕HR明显高于基础值(P＜0.05),而全静脉组术中无明显变化;此外,全静脉组的术后恶心、呕吐发生率明显低于静吸组.结论异丙酚和芬太尼全凭静脉麻醉用于颅脑手术具有效果满意、血液动力学稳定、苏醒快速、术后恶心、呕吐率低等优点,且无吸入麻醉药的手术室空气污染,可供临床应用.     

七氟醚吸入麻醉与异丙酚静脉麻醉的临床比较

目的比较七氟醚吸入麻醉与异丙酚静脉麻醉的临床效果。方法选择60例全麻腹部外科手术患者,随机分为Sev组和Pro组。Sev组采用循环回路诱导,在静脉注射2μg/㎏芬太尼1min后,再将准备好的呼吸回路上的面罩放在病人面前,保持密闭,让病人做深呼吸,吸入7%的七氟醚。Pro组则先静脉注射2μg/㎏芬太尼,1min后以30～40s速度静脉注射2.5㎎/㎏异丙酚。观察患者入室时的收缩压(SBP)、舒张压(DBP)、心率(HR)为基础值。记录从诱导开始至意识消失所需时间(T1)、插管即刻BPS、DBP、HR、停止麻醉用药至苏醒拔管所需时间(T2)和术后24h躁动、恶心、呕吐发生情况。结果Pro组患者的意识消失时间较Sev组显著缩短(P<001);2组患者插管即刻BPS、DBP、HR之间比较及与入室时比较无统计学差异(P>0.05),且停止麻醉用药至苏醒拔管所需时间、术后24h躁动、恶心、呕吐发生率二组之间均无统计学差异(P>0.05)。结论七氟醚具有麻醉诱导迅速、麻醉维持平稳、苏醒快速完全等临床特点,是一种较为安全和理想的吸入麻醉药物。     

七氟醚与异氟醚吸入用于腹腔镜胆囊切除术麻醉效果比较

目的比较七氟醚和异氟醚用于腹腔镜胆囊切除术麻醉效果。方法42例腹腔镜胆囊切除术患者随机分为七氟醚组（S组）和异氟醚组（Ⅰ组）,每组21例。快速诱导后麻醉维持两组分别吸入1MAC七氟醚和异氟醚,必要时追加芬太尼、罗库溴铵维持麻醉。记录诱导前（T0）、插管后5min（T1）、切皮（T2）、气腹开始（L）、缝皮（T4）、睁眼（T5）和拔管前（T6）,患者的HR、SP、DP和SpO2。计算从停止吸入麻醉药到睁眼和拔管的时间。结果1MAC七氟醚和异氟醚对病人血流动力学指标的影响均较轻,组间比较差异无统计学意义,S组患者的睁眼时间和拔管时间均比I组短,组间比较差异具有统计学意义。结论七氟醚和异氟醚吸入麻醉对腹腔镜胆囊切除术患者心血管功能的影响程度相似,但七氟醚全麻患者苏醒时间和拔管时间均明显短于异氟醚全麻患者。     

舒芬太尼复合异丙酚在妇科腹腔镜手术患者麻醉效果的研究

目的比较舒芬太尼、芬太尼在妇科腹腔镜手术麻醉中的优越性。方法60例行妇科腹腔镜手术的患者随机分成舒芬太尼+异丙酚组(Suf组),芬太尼+异丙酚组(Fen组)。记录患者麻醉诱导前,麻醉诱导时,气管插管后即刻,气腹前,气腹后1、15、60 min以及拔除气管导管后5 min的收缩压、舒张压、心率、检查呼气末二氧化碳分压;并观察记录患者术毕的清醒恢复时间及术后疼痛、恶心、呕吐的情况。结果Fen组在气管插管、气腹后1min以及拔除气管导管后5 min血流动力学变化较Suf组明显(P<0.05或0.01),Suf组术后意识恢复时间和拔管时间明显早于Fen组(P<0.05),且术后疼痛、恶心及呕吐的发生率明显少于Fen组(P<0.05)。结论舒芬太尼在妇科腹腔镜手术麻醉中具有更高的安全性,在麻醉过程中的平稳和术后恢复质量等方面明显优于芬太尼。     

七氟醚与异氟醚用于婴幼儿唇腭裂修复术的麻醉效果比较

目的 观察比较七氟醚或异氟醚用于婴幼儿唇腭裂修复术的麻醉效果.方法 选择ASA Ⅰ ～Ⅱ级的择期行唇腭裂修复术的婴幼儿100例,将其随机分为两组:S组(七氟醚组,50例)采用七氟醚维持全身麻醉；Ⅰ组(异氟醚组,50例)采用异氟醚维持全身麻醉.观察两组患儿停药至苏醒时间、气管拔管时间、完全清醒时间及苏醒期并发症的发生率；并记录两组患儿的Fa/Fi及术后24 h的肌酐与尿素氮水平.结果 S组苏醒、拔管及清醒时间较Ⅰ组明显缩短(P＜ 0.05),苏醒期并发症较Ⅰ组明显减少(P＜0.05).S组20 min内的Fa/Fi明显高于Ⅰ组(P＜0.05),术后24 h两组的肌酐及尿素氮水平无明显差异(P＞0.05).结论 婴幼儿唇腭裂修复术中采用七氟醚麻醉较异氟醚麻醉苏醒更快且更安全.     

非体外循环冠脉搭桥手术的"快通道"麻醉管理

目的 探讨非体外循环下冠脉搭桥手术病人实施"快通道"麻醉的管理及术后拔管时间.方法 择期非体外循环下冠状动脉旁路移植术患者78例,采用异丙酚、芬太尼、维库溴铵、异氟醚等静吸复合全麻.硝酸甘油、佩尔地平、艾司洛尔、去甲肾上腺素、多巴胺、多巴酚丁胺等用于调控血流动力学指标.观察术后清醒时间、拔管时间和住ICU时间.结果 所有病人的清醒时间、拔管时间和住ICU时间分别为(78±42)min、(6.5±2.0)h、(16.2±6.3)h.术后71例病人在6小时内拔管.76例预后良好,无麻醉并发症.结论 实施"快通道"麻醉有利于术后早期拔管,减少病人在ICU停留时间.     

瑞芬太尼复合异丙酚全凭静脉麻醉在腹腔镜胆囊切除术中的应用

目的研究瑞芬太尼复合异丙酚全凭静脉麻醉在腹腔镜胆囊切除术的应用及其效果评价。方法选择择期行腹腔镜胆囊切除手术患者100例,随机等分为静吸复合组(静吸组)和全凭静脉麻醉组(全静脉组),两组均以咪达唑仑0.1mg/kg、异丙酚2mg/kg、芬太尼2μg/kg和维库溴胺0.08~0.12mg/kg诱导后作气管插管。麻醉维持:静吸组用异氟醚吸入,间断辅以芬太尼静注;全静脉组将瑞芬太尼0.2μg/(kg.min)和异丙酚70μg/(kg.min)混合抽入50mL注射器中,用微量泵持续输注。记录麻醉诱导前、气腹前和气腹后10min、气腹毕和术毕的SBP、DBP、HR和SPO2及停止麻醉至拔管时间,拔管时的清醒程度和随访结果。结果两组间的拔管时间、清醒程度无显著性差异。静吸组在气腹后10min的HR、SBP、DBP、术毕HR明显高于基础值(P<0.05),而全静脉组术中无明显变化。全静脉组的术后恶心、呕吐发生率明显低于静吸组。结论瑞芬太尼复合异丙酚全凭静脉麻醉用于腹腔镜胆囊切除手术,具有麻醉效果满意、血流动力学稳定、苏醒快速、术后恶心呕吐率低、无空气污染等优点。     

异丙酚和异氟醚对老年患者术后认知功能的临床对比研究

目的探讨异丙酚和异氟醚对老年患者术后认知功能的影响,为老年患者安全麻醉用药提供参考。方法选取ASAⅠ~Ⅱ级择期全身麻醉行下腹手术的老年患者69例,随机分为异氟醚组(n=34)和异丙酚组(n=35),术中分别给予异氟醚和异丙酚维持麻醉。采用MMSE量表分别对麻醉前、术后12、24、48h进行评分,统计认知功能障碍的发生率。结果①与麻醉前比较,两组患者术后12、24、48hMMSE评分均显著下降(P<0.05);异丙酚组术后12、24h MMSE评分高于异氟醚组(P<0.05)。②异丙酚组患者术后12、24h认知功能障碍发生率明显少于异氟醚组(P<0.05)。结论异丙酚和异氟醚用于老年下腹部手术患者麻醉均可引起认知功能障碍,但异丙酚较异氟醚可显著减少认知功能障碍的发生率。     

异氟醚对缺氧心肌细胞的影响

目的 :探讨异氟醚对心肌细胞缺氧损伤的影响。方法 :将原代培养成活 48h的大鼠乳鼠心肌细胞分为 3组 :A组为对照组 (氰化钠造成心肌细胞细胞内缺氧模型 ) ,B组为 Iso1组 (缺氧 +0 .2 8mm ol/L异氟醚 ) ,C组为 Iso2组(缺氧 +2 .8m mol/L异氟醚 )。比较 3组心肌细胞细胞形态学 (倒置相差显微镜、透射电镜观察 )的变化及 A值的改变。结果 :缺氧 12 h后 ,对照组细胞搏动功能变化明显 ,呈散在细胞搏动 ,而实验组搏动频率减慢。随着时间的延长 ,细胞形态学变化逐渐明显 ,对照组较实验组变化更显著。结论 :异氟醚对培养心肌细胞缺氧损伤有一定的保护作用。     

Classification of beta-adrenoceptors in isolated bronchus of the pig.

1 (+/-)-Isoprenaline (Iso), (-)-adrenaline (Ad), (-)-noradrenaline (NA), the beta 2-selective adrenoceptor agonist (+/-)-fenoterol (Fen) and the beta 1-selective adrenoceptor agonist (+/-)-RO363 caused concentration-dependent relaxation of preparations of pig bronchus pre-contracted with carbachol 40-ng/ml (0.22 microM). Iso, Ad, NA and Fen caused complete relaxation of carbachol-induced tone, but RO363 caused relaxation equivalent to only 59% of the maximal response to Iso. 2 When relaxation responses to these amines were plotted as a % of their maximal effects, comparison of EC50 values showed that the order of potency was RO363 greater than Iso greater than NA greater than Fen greater than Ad (14.4:4.6:1:0.4:0.3). 3 pA2 values determined for the beta-adrenoceptor antagonists propranolol (non-selective) and atenolol (beta 1-selective), or the partial agonist salbutamol (beta 2-selective) using Iso as agonist were 8.3, 7.3 and 4.4 respectively. The pA2 value for atenolol using RO363 as the agonist was 7.6. 4 These results indicate that porcine bronchus contains a homogeneous population of beta 1-adrenoceptors.     

Classification of beta-adrenoceptors in human isolated bronchus.

(+/-)-Isoprenaline (Iso), (-)-adrenaline (Ad), (-)-noradrenaline (NA), (+/-)-phenylephrine (Phe) and the beta 2-selective adrenoceptor agonist (+/-)-fenoterol (Fen) caused a concentration-dependent relaxation of human isolated bronchial preparations. Iso, Ad and NA caused complete relaxation of both spontaneous and carbachol-induced bronchial tone. Fen, which was only tested in preparations where tone was induced with carbachol, also caused complete relaxation. However, Phe was a partial agonist in all preparations tested. When relaxation responses to these amines were calculated as a % of their maximal effects, comparison of EC50 values showed that the order of potency was Iso greater than Ad = Fen greater than NA greater than Phe (92:27:25:1:0.2) in preparations with carbachol-induced tone and Iso greater than Ad greater than NA greater than Phe (112:38:1:0.3) in preparations with spontaneous tone. pA2 values determined for the beta-adrenoceptor antagonists propranolol (non-selective), atenolol (beta-selective) and ICI-118, 551 (beta 2-selective), using Iso as an agonist were, 9.3, 5.3 and 9.1 respectively. These results indicate that beta 2-adrenoceptors mediate relaxation of human isolated bronchus to sympathomimetic amines in preparations obtained 4-14 h post-mortem from non-diseased lung. alpha-Adrenoceptors were apparently sparse or absent in this tissue.     

鞘内注射p-MPPF对异氟烷镇痛作用的影响

目的探讨异氟烷(isoflurane,Iso)镇痛作用与小鼠脊髓5-HT1A受体的关系。方法昆明种小鼠腹腔注射Iso建立镇痛模型。分别以甩尾法、热板法、醋酸扭体法(15min内)评估小鼠鞘内注射5-HT1A受体拮抗剂p-MPPF(6μg和3μg)对Iso镇痛作用的影响。结果单独鞘内注射p-MPPF对小鼠甩尾潜伏期、热板痛阈、扭体次数无影响(P>0.05)。与Iso镇痛组(Iso组)相比,合用药组(Iso+M6组,Iso+M3组)甩尾潜伏期与热板痛阈均缩短(P<0.01或P<0.05);Iso+M6组扭体次数较Iso组增多(P<0.05),Iso+M3组无变化(P>0.05)。结论 Iso体表镇痛作用与激动小鼠脊髓5-HT1A受体密切相关。     

Effect of steroids on beta-adrenoceptor-mediated relaxation of pig bronchus.

1--Progesterone, testosterone (40 microM), cortisol and cortisol hemisuccinate (80 microM) caused 6-8 fold potentiations of (+/-)-isoprenaline (Iso)-induced relaxations of pig bronchus while several other steroids caused smaller potentiations or had no effect. 2--17 beta-Oestradiol (40 microM) increased the potency of Iso, (-)-adrenaline (Adr) and (-)-noradrenaline (NA) by 10.6, 2.3 and 2.6 fold respectively but had no significant effect on the potency of fenoterol (Fen). 3--Inhibition of catechol-O-methyl transferase (COMT) with U-0521 (30 microM) caused a 6 fold increase in the potency of Iso but failed to alter the potency of Adr, NA or Fen. The extraneuronal uptake inhibitor normetanephrine (50 microM) caused significant 2 fold increases in the potency of Iso and Adr but did not potentiate the responses to NA or Fen. 4--In preparations where the potency of Iso had already been increased by U-0521 (30 microM) or by normetanephrine, 17 beta-oestradiol produced no significant further increase in potency. These results indicate that steroid-induced increases in the potency of catecholamines in pig bronchus can be explained in terms of inhibition of COMT or extraneuronal uptake or both.     

Alternative use of isoflurane and propofol confers superior cardioprotection than using one of them alone in a dog model of cardiopulmonary bypass

Our previous clinical study reported that isoflurane preconditioning and high-dose propofol posttreatment attenuated myocardial ischemia/reperfusion injury of patients in surgery with cardiopulmonary bypass (CPB). This study was designed to confirm this cardiac protection by use of a dog CPB model and to elucidate the related mechanism. Adult mongrel male dogs undergoing standard CPB were assigned into 4 groups: Sham group, Propofol group, Isoflurane (Iso) group and isoflurane in combination of propofol (pre-Iso+P) group. After induction, anesthesia was maintained with propofol (Propofol group), isoflurane (Iso group) or isoflurane preconditioning in combination with propofol posttreatment (pre-Iso+P group). After 2 h cardiac arrest and CPB, aortic cross-clamping was released to allow 2 h reperfusion. The results demonstrated that joint use of isoflurane and propofol facilitated cardiac functional recovery, improved myocardial oxygen utilization and decreased cardiac enzyme release. Also, the oxidative damage caused by ischemia/reperfusion injury was remarkably attenuated. Linear regression analysis showed that cardiac function performance and oxidative stress status were inversely correlated, indicating the improved cardiac function was in closed association with the attenuation of oxidative stress. In addition, the cardiac oxygen consumption (VO(2)) was found to be significantly associated with the above cardiac function and oxidative stress parameters, suggesting VO(2) was predictive for the levels of cardiac damage and oxidative stress. Therefore, we conclude that alternative use of isoflurane and propofol confers superior cardioprotection against postischemic myocardial injury and dysfunction, and this protection was probably mediated by attenuation of cardiac oxidative damage.     

抗氧化剂SS-31对异氟醚麻醉小鼠脑源性神经营养因子信号通路及认知功能的影响

目的 观察抗氧化剂SS-31对异氟醚麻醉小鼠脑源性神经营养因子(BDNF)信号通路及认知功能的影响。方法 老年雄性C57BL/6小鼠42只随机均分为3组(n=14)：氧气+生理盐水组(Con组)、异氟醚组+生理盐水组(Iso组)和异氟醚+SS-31组(SS-31组)。根据分组,于氧气或异氟醚吸入前30 min腹腔注射等容生理盐水或SS-31(5 mg/kg)。气体吸入2 h后各组取6只小鼠检测海马组织中活性氧自由基(ROS)及三磷酸腺苷(ATP)水平,以及BDNF、酪氨酸激酶B受体(TrkB)、磷酸化TrkB(p-TrkB)和磷酸化环磷酸腺苷反应元件结合蛋白(p-CREB)水平,24 h后各组余8只小鼠行旷场实验和条件恐惧性实验。结果 与Iso组比较,SS-31组ROS水平降低,ATP水平升高,BDNF、p-TrkB和p-CREB含量升高,24 h场景实验僵直时间增加(P<0.05)。结论 线粒体抗氧化肽SS-31可改善异氟醚麻醉所致小鼠认知功能障碍,其机制可能与清除线粒体内ROS,增加ATP的产生,调节BDNF信号通路有关。     

异氟烷对幼龄小鼠生长发育趋势的影响

目的研究异氟烷对幼龄小鼠生长发育趋势的影响。方法按随机分层方法,将64只幼龄小鼠分为2大组,再按完全随机分组方法,将每大组各分为4小组(n=8),即NS组(生理盐水组)、Iso1组、Iso2组和Iso3组,1～5d用跳台仪和避暗仪分别训练小鼠,并测得各组幼龄小鼠体质量。结果避暗训练和跳台训练中,各组幼龄小鼠生长发育趋势不同。在避暗和跳台训练中,NS组、Iso1组在2～3d间体质量出现了下降或增长缓慢的趋势,而Iso2组和Iso3组都按照原来的趋势递增。结论异氟烷在一定时期内可以影响幼龄小鼠的生长发育趋势。     

Isoflurane reduces the synthesis of surfactant-related protein a of alveolar type II cells injured by H2O2

The influence of isoflurane (Iso) on the synthesis of surfactant-related protein A (SP-A) of alveolar type II (AT II) cells in primary culture and after injury by H2O2 was investigated. AT II cells were isolated and purified from adult Sprague-Dawley rats and used for experiments after 32 h in primary culture. The cell cultures were randomized to six groups (n = 8 in each group): control group (no treatment), 0.28 mM Iso group, 2.8 mM Iso group, 75 microM H2O2 group, 75 microM H2O2 + 0.28 mM Iso group, and 75 microM H2O2 + 2.8 mM Iso group. Each group was continuously incubated for 3 h after administration of Iso and/or H2O2. The intracellular SP-A and the SP-A of the culture medium were measured with an enzyme-linked immunosorbent assay (ELISA). Iso significantly decreased the intracellular SP-A content and that of the culture medium, and aggravated the decrease of SP-A content induced by H2O2. These findings suggest that Iso itself may decrease SP-A synthesis of AT II cells in vitro, and aggravate the damage to AT II cells under peroxidation conditions.