七氟醚对肾小管功能影响的研究进展

本氟醚与碱石灰可产生降解反应生成以化合物Ａ为主的５种产物，化合物Ａ具有潜在的肾毒性，可与鼠肾小管蛋白质结合，致肾髓质外层带和皮质与髓质交界处坏死。临床上通过对肾小管功能较敏感的尿ＮＡＧ酶学检测未发现明显肾损害。     

七氟醚对肾小管功能影响的研究进展

七氟醚与碱石灰可产生降解反应生成以化合物A为主的5种产物,化合物A具有潜在的肾毒性,可与鼠肾小管蛋白质结合,致肾髓质外层带和皮质与髓质交界处坏死。临床上通过对肾小管功能较敏感的尿NAG酶学检测未发现明显肾损害。     

酶诱导对七氟醚肝毒性的影响

目的:观察用异烟肼预处理后大鼠吸入七氟醚后血清谷丙转氨酶(SGPT)及肝病理学的变化,以研究酶诱导对七氟醚肝毒性的影响。方法:将40只月龄2～3月的SD大鼠随机分为对照组(C组),异烟肼组(Ⅰ组),酶诱导的七氟醚组(SI组),未有酶诱导的七氟醚组(S)组.Ⅰ组和SI组每天用异烟肼预处理25mg·kg~(-1)腹腔注射,持续三天。SI组和S组吸0.5MAC七氟醚3小时,C组和Ⅰ组吸O~2和空气混合气体。结果:SI组SGPT浓度(162.0±25.3)明显高于C组(115.8±41.8)、Ⅰ组(121.6±42.9)和S组(126.2±26.2)(P<0.05),且该组肝细胞疏松化程度较其它各组严重。结论:酶诱导有增加七氟醚肝毒性的可能。     

芬太尼对七氟醚麻醉诱导的影响

研究了２０例择期手术病人单吸七氟醚或七氟醚复合静注芬太尼麻醉诱导对呼吸、循环，量化脑电，肌 电活动及插管反应的影响。结论静注芬太尼复合七氟醚吸入明显协同诱导效率，在临床上优于单吸七氟醚诱导。     

比较七氟醚、异氟醚和安氟醚对颅内压的影响

目的：为了观察七氟醚对颅内压的影响。方法：选择２４例颅内肿胶病人,测定七氟醚麻醉的时颅内压变化并与异氟醚和安氟醚进行比较。术前用药、麻醉诱导及维持的静脉用药相同。于Ｌ３－４穿刺蛛网膜睛腔测脑脊液压（代表颅内压,ＩＣＰ）。依吸入药不同随机分为七的氟醚（Ｓ）组,异氟醚（１）组和安氟醚（Ｅ）组,监测ＢＰ、ＭＡＰ、ＥＣＧ、ＳｐＯ２、ＰＥＴ、ＣＯ２和ＭＡＣ,调整ＶＴ和ＲＲａＣＯ２维持在４～４．６６ＫＰＡ。三     

地氟醚、七氟醚和异氟醚对犬冠脉血流的影响

目的：采用超声血流量监测仪观察地氟醚、七氟醚和异氟醚对犬冠脉血流的影响。方法：犬１８只，腹腔注射１．５％硫喷妥钠２０ｍｇ／ｋｇ，静脉注射阿曲库铵０．８ｍｇ／ｋｇ麻醉诱导，气管插管后取正中开胸，分离冠状动脉左前降支，将３ｍｍ或３．５ｍｍ超声Ｄｏｐｐｌｅｒ血管探头置于分离血管处，连接超声多普勒冠脉血流量监测仪测定冠脉血流量，然后随机吸入地氟醚、七氟醚或异氟醚，ＭＡＣ分别为７．２％、２．３％和１．２８％     

七氟醚和地氟醚低流量麻醉对酶诱导大鼠的肝毒性作用

地氟醚被认为肝毒性小 ,但临床仍有报道与其有关的肝损害可能性。联合肝细胞凋亡、谷胱甘肽 Ｓ 转移酶 (ＧＳＴ)、丙二醛 (ＭＤＡ)、病理等指标全面、客观地研究地氟醚低流量麻醉对异烟肼酶诱导大鼠的肝毒性作用及其对脂质过氧化反应的影响 ,并与七氟醚相比较 ,现报道如下。材料与方法实验方法　成年雄性ＳＤ大鼠 40只 ,随机分成 4组 ,每组 10只。Ｃ :正常对照组 ;Ｉ :异烟肼酶诱导组 ;ＳＩ:酶诱导七氟醚组 ;ＤＩ:酶诱导地氟醚组。将后三组动物异烟肼酶诱导处理后置入与麻醉机 (使用标准、新鲜钠石灰 )回路相连的小室内 ;分别吸入氧气、1 1…     

七氟醚与恩氟醚在全麻诱导中的异同

本试验选择10例全麻手术病人,经自身对照,比较七氟醚与恩氟醚麻醉诱导的意识、痛觉消失及恢复情况,七氟醚均明显快于恩氟醚。对血压、心率的影响,两者无明显差别。     

地氟醚、七氟醚和异氟醚对内源性一氧化氮的影响

目的：观察犬吸入地氟醚、七氟醚和异氟醚后血浆ＮＯ含量的变化，以进一步探讨ＮＯ在囱族吸入麻醉药扩血管作用中的地位。方法：犬麻醉后３０分钟，随机吸入地氟醚、一氟醚或异氟醚（ＭＡＣ ７．２％￣２．３％和１．２８％）使呼气末浓度达１ＭＡＣ，持续３０分钟。分别于呼气末浓度达１ＭＡＣ后５分钟、１５分钟和３０分钟和停吸后３０分钟分钟和１２０分钟抽取静脉血，用硝酸盐还原酶法测定ＮＯ。结果：ＮＯ水平在三组药物吸入过     

小儿七氟醚和异氟醚快速吸入诱导的比较

目的:比较小儿使用高浓度七氟醚和异氟醚加氧化亚氮快速吸入诱导的区别。方法:38例4～11岁,未使用术前药小儿随机分为二组,七氟醚组(n=20),吸入5％七氟醚,60％氧化亚氮;异氟醚组(n=18)吸入3.5％异氟醚,60％氧化亚氮。观察两组小儿采用快速吸入诱导方法时,睫毛反射和疼痛反应消失时间,以及药物的刺激性和诱导平稳程度的区别;同时观察两种方法对小儿循环功能的影响。结果:七氟醚组的诱导效果较为满意,其睫毛反射时间,疼痛反应消失时间均明显快于异氟醚组,分别为63.45±16.27(秒),189.40±28.70(秒)和75.82±22.60(秒),231.62±77.74(秒)(P<0.01);异氟醚对气道的刺激性较大,小儿吸入时躲闪,咳嗽,喉痉挛,兴奋以及分泌物增加的发生率明显高于七氟醚组;两组吸入诱导对小儿的血压无明显的影响。结论:小儿使用高浓度七氟醚吸入诱导是较为理想的麻醉诱导方法之一,与异氟醚比较,其吸入诱导平稳,对气道的刺激性较小,诱导时间明显缩短。     

Side-to-side nerve bridges reduce muscle atrophy after peripheral nerve injury in a rodent model

Background

Peripheral nerve injury can result in muscle atrophy and long-term disability. We hypothesize that creating a side-to-side bridge to link an injured nerve with a healthy nerve will reduce muscle atrophy and improve muscle function.

Methods

Sprague-Dawley rats were divided into four groups (n = 7 per group). Group 1: transection only—a 10-mm gap was created in the proximal tibial nerve; group 2: transected plus repaired—the transected tibial nerve was repaired; group 3: transected plus repaired plus nerve bridge—transected nerve repaired with a distal nerve bridge between the tibial and peroneal nerves via epineurial windows; and group 4: transected plus nerve bridge—transected tibial nerve left unrepaired and distal bridge added. Gait was assessed every 2 wk. At 90 d the following measures were determined: gastrocnemius mass, muscle and nerve nuclear density, and axonal infiltration into the nerve bridge.

Results

Groups 3 and 4 had greater improvements in walking track recovery than groups 1 and 2. Group 3's gastrocnemius muscles exhibited the least amount of atrophy. Groups 1, 2, and 4 exhibited greater histologic appearance of muscle breakdown compared with group 3 and control muscle. Finally, most bridges in groups 3 and 4 had neuronal sprouting via the epineurial windows.

Conclusions

Our study demonstrated reduced muscle atrophy with a side-to-side nerve bridge in the setting of peripheral nerve injury. These results support the application of novel side-to-side bridges in combination with traditional end-to-end neurorrhaphy to preserve muscle viability after peripheral nerve injuries.     

腔镜甲状腺切除术中神经损伤的预防

目的 :总结腔镜甲状腺腺瘤切除术时预防神经损伤的经验。方法 :对 8例甲状腺腺瘤患者行腔镜甲状腺腺瘤切除术、甲状腺腺叶切除术、甲状腺腺叶次全切除术、双侧甲状腺次全切除术。结果 :本组手术均获成功 ,平均手术时间 10 3 6± 33 9min ,出血少 ,平均住院 9 7± 3 1d。患者对手术均表示满意。 1例术后出现声音嘶哑 ,术后 1月恢复正常。结论 :手术前合理选择病例 ,术中熟悉解剖、严密止血是减少神经损伤的关键     

白藜芦醇灌胃给药对大鼠脊髓损伤炎症反应中MPO和CCO的作用

目的探讨白藜芦醇灌胃(管饲)后对脊髓损伤后炎症反应中的髓过氧化物酶和细胞色素C氧化酶活性的影响。方法 2008年2月至2012年2月在武汉大学人民医院动物实验中心将96只Sprague-Dawley健康成年雄性大鼠随机分成4组,根据Allen’s法制成中度脊髓损伤模型,术后按照100 mg/kg立即管饲白藜芦醇或甲基强的松龙;通过比色法观察脊髓损伤8 h,1d,3 d及7 d后白藜芦醇组脊髓髓过氧化物酶和细胞色素C氧化酶活性的变化,并与甲基强的松龙组进行疗效对比。结果在脊髓损伤管饲后8 h,1 d,3 d及7 d白藜芦醇组髓过氧化物酶和细胞色素C氧化酶活性与损伤组统计学上具有显著性差异(P0.01),显示白藜芦醇管饲后对脊髓损伤具有明显神经细胞保护作用,而且损伤后1d白藜芦醇组与甲基强的松龙组间统计学上具有显著性差异(P0.01);结论在脊髓损伤后管饲白藜芦醇,能够有效降低髓过氧化物酶活性的升高幅度,并提高细胞色素C氧化酶活性,对损伤后脊髓起保护作用。     

七氟醚对在体大鼠肺缺血-再灌注损伤的影响

目的研究七氟醚对在体大鼠肺缺血-再灌注(I-R)损伤的影响。方法40只Wistar大鼠建立在体大鼠肺I-R模型,随机分为四组,每组10只:A组,假手术组,开胸后机械通气120 min;B组,I-R组,阻断左肺门60 min,开放再通气60 min;C组,七氟醚加I-R组,缺血前吸入1 MAC七氟醚30 min,开放再通气同时吸入1 MAC七氟醚60 min;D组,七氟醚组,持续吸入1 MAC七氟醚120min。观察各组实验结束时肺组织的湿/干重比(W/D)、肺丙二醛(MDA)、超氧化物歧化酶(SOD)和肺组织病理学的改变。结果B组及C组肺W/D较A组和D组显著升高(P<0.01,P<0.05),SOD含量显著低于A组和D组(P<0.05);B组肺MDA含量较A组和D组显著升高(P<0.01),C组肺MDA含量较B组低(P<0.05);C组肺W/D、肺MDA显著低于B组(P<0.05),SOD高于B组(P<0.05);病理切片见B组、C组部分肺泡结构破坏,肺泡间隔增宽,肺泡腔内水肿并有出血,以B组改变较为严重,炎症积分显著高于C组(P<0.01)。结论七氟醚对在体大鼠肺I-R损伤有一定的保护作用。     

Ulnar nerve injury with martin-gruber anastomosis

Summary A patient with a traumatic ulnar nerve interruption at the level of the elbow is presented; the motor function of the hand remained intact. Electromyographic studies demonstrated a functional median-to-ulnar motor nerve anastomosis in the forearm. The literature on this aberration of innervation is reviewed, and problems of diagnosis and the treatment are discussed.     

前列腺素E_1、人胎盘神经生长因子对周围神经损伤后运动恢复的作用

目的 探讨前列腺素Ｅ１（ＰＧＥ１）、人胎盘种经生长因子（ＨＮＧＦ）对周围神经损伤后运动功能恢复的影响。方法 取大鼠 ３５只,作坐骨神经夹毁模型,术侧分别注射 ＰＧＥ１、ＨＮＧＦ１４日,用三导记录肌肉收缩张力,术后每日测术侧和正常侧足趾伸张距离的比值（ＥＴＳ／ＮＴＳ）及足印长度的均值（ＥＰＬ／ＮＰＬ）,并分别与生理盐水组及无神经损伤组进行比较研究。结果ＰＧＥ１和ＨＮＧＦ能明显缩短足趾伸张距离和足印长度的恢复时间,明显增进肌肉收缩力、加快收缩峰值速度和减轻肌肉萎缩率,但ＰＧＥ１的作用效果低于 ＨＮＧＦ结论 ＨＮＧＦ可能通过某些间接作用途径促进神经损伤后运动功能恢复;ＰＧＥ１能部分模拟 ＮＧＦ促进运动功能恢复的作用。     

Eeffect of nerve growth factor on changes of myelin basic protein and functional repair of peripheral nerve following sciatic nerve injury in rats

OBJECTIVE: To investigate the therapeutic effect of nerve growth factor (NGF) on changes of myelin basic protein (MBP) and functional repair of sensory and motor nerve following sciatic nerve injury. METHODS: The sciatic nerves of rats were injured by sectioning with shaver,and divided into 3 groups: NGF group (Group A), group of normal saline solution (Group B), untreated group (Group C). The time point of observation was at the 4th week after operation. Sensory evoked potential (SEP) and motor evoked potential (MEP) were detected by Model WD-4000 nerve potential working diagnosis system. Immunohistochemical analysis was used for identification of MBP. RESULTS: The latency of SEP in the Group A at the 4th week after operation was shorter than that in the Group B (P<0.05). The MEP was elicited in 76% of the Group A and was higher than that in the Group B. Results of immunohistochemistry showed that there were less MBP-positive cells in the Group A than in the Group B in one and four weeks respectively. CONCLUSIONS: NGF can improve the conductive function of injured peripheral nerve and facilitate regeneration of nerve.     

Cold intolerance after nerve injury

Cold intolerance after nerve injury can be severe and has been associated with high levels of pain and disability. This article provides an overview of the assessment and nonoperative management of cold-induced symptoms after peripheral nerve injury. A comprehensive evaluation should include both objective measures such as skin temperatures and subjective tools to assess the patient's perspective and impact of the symptoms. Management of the patient with cold intolerance remains challenging and should include adaptive strategies, warming interventions, and desensitization conditioning programs to minimize cold-induced pain and hyperresponses.     

银杏酮酯对大鼠坐骨神经损伤后神经生长因子基因表达的影响

目的 观察银杏酮酯（EGb50）对大鼠坐骨神经损伤后神经生长因子（NGF）mRNA表达的影响。方法 取SD大鼠78只，其中72只切断右侧坐骨神经并缝合，随机分成损伤对照组与实验组，另6只为正常对照组。实验组给予EGb50200mg／kg／d溶于1．0ml生理盐水中灌胃，损伤对照组每天给予生理盐水1．0ml灌胃，正常对照组不作任何处理。分别于术后1、3、7、14、21及28d取吻合口远段的神经、相应节段的脊神经节及脊髓，采用逆转录-多聚酶链反应技术检测所取组织中NGFmRNA的表达水平。结果 实验组坐骨神经中NGFmRNA的表达在术后7、14和21d明显高于对照组（P〈0．05）。术后7d和14d，实验组脊神经节及脊髓中NGFmRNA的表达高于对照组（P〈0．05）。结论 大鼠坐骨神经损伤后用银杏酮酯治疗，在早期可促使坐骨神经及相应节段脊神经节和脊髓组织中的NGFmRNA的表达增加。