肾上腺素对术后硬膜外吗啡镇痛效果影响的临床观察

本文对３１例硬膜外麻醉病人术后硬膜外腔注入吗啡（３ｍｇ）加肾上腺素用于术后镇痛，并与单用吗啡组进行了比较。结果表明：肾上腺素可使硬膜外吗啡的镇痛效果加强，作用时间延长。两者比较差异有显著性（Ｐ〈０．０５）。两者副作用发生率无统计学意义（Ｐ〉０．０５）。我们认为：１：２０万Ｕ肾上腺素加入小剂量的吗啡（２￣３ｍｇ）中，可应用于硬膜外麻醉的术后镇痛。     

红外线检测人体呼吸中的CO2：从Tyndall到目前使用的呼吸通路装置的突破性进展

成功检测患者呼吸过程中的二氧化碳（CO2）或描计二氧化碳曲线图，是现代医学中重要的技术进展之一。本文将根据历史记录和众多研发者的个人采访信息，记述关于红外检测呼吸中CO2的主流型二氧化碳描记图的发展和商业化进程。     

全凭静脉麻醉下罗库溴铵及顺式阿曲库铵起效和恢复时间的变异率的对比研究

目的 比较罗库溴铵及顺式阿曲库铵成年患者和老年患者起效和恢复时间上的变异率.方法 80例全凭静脉麻醉下择期手术的成年患者和老年患者,随机分为罗库溴铵成年组和老年组各20例,顺式阿曲库铵成年组和老年组各20例.TOF-Watch每12秒钟刺激尺神经并监测拇内收肌收缩力量.记录药物在每个患者的起效时间,作用时间及恢复指数.结果 两个年龄组的罗库溴铵的起效时间显著短于相应年龄组的顺式阿曲库铵,变异率小于相应年龄组的顺式阿曲库铵;与成年组相比,罗库溴铵老年组的作用时间显著延长,恢复指数及变异率显著增加,顺式阿曲库铵老年组的作用时间及其变异率差异无统计学意义(P>0.05).结论 丙泊酚和瑞芬太尼全凭静脉麻醉下,等效剂量的罗库溴铵的起效速度显著快于顺式阿曲库铵,而顺式阿曲库铵无论在老年患者成年患者,其作用时间及恢复指数都是相对恒定的.     

布托啡诺预先给药对大鼠心肌缺血再灌注损伤的影响

Objective To investigate the effects of butorphanol pretreatment on myocardial ischemia-reperfusion (IR) injury in rats. Methods Forty healthy male SD rats weighing 200-250 g were randomly divided into 5 groups (n = 8 each) : sham operation group (group S); IR group; butorphanol pretreatment group (group B); Nor-BNI group (group N) and glibenclamide group (group G) . In group IR, B, N and G, myocardial IR was produced by occlusion of left anterior descending artery (LAD) for 30 min followed by 120 min reperfusion. In group S and IR, normal saline S ml/kg was injected via femoral vein 10 min before ischemia and then continuously infused at a rate of 5 ml· kg -1· h-1 iv. In group B, butorphanol 25 μg/kg was injected via femoral vein 10 min before ischemia and the rest method was the same as that described in group IR. In group N, Nor-BNI 2 mg/kg (a selective κ-opioid receptor antagonist) was injected via femoral vein 20 min before ischemia and the rest method was the same as that described in group B. In group G, glibenclamide 1 mg/kg (a KATP channel blocker) was injected via femoral vein 10 min before ischemia and the rest method was the same as that described in group B. Blood samples were taken from femoral artery at 120 min of reperfusion for determination of the concentrations of serum TNF-α, IL-6 and IL-10 by ELISA. Myocardial infarct area and ischemic area were measured by TTC staining and myocardial infarct size was calculated. Results The concentrations of serum TNF-a, IL-6 and IL-10 were significantly higher in the other four groups than in group S (P < 0.05) . The concentrations of serum TNF-α andIL-6 were significantly decreased while IL-10 increased, and the myocardial infarct size was significantly decreased in group B, N and G as compared with group IR ( P < 0.05) . The concentrations of serum TNF-α and IL-6 were significantly increased while the concentration of IL-10 decreased) and the myocardial infarct size was significantly increased in group N and G as compared with group B ( P < 0.05). Conclusion Butorphanol pretreatment can protect the myocardium against IR injury in rate via activating κ receptor and KATP channel.     

三七总皂甙预处理对在体大鼠心肌缺血/再灌注的保护作用

本实验拟探讨不同时间段三七总皂甙（ＰＮＳ）预处理对大鼠心肌缺血／再灌注损伤的保护作用及其与热休克蛋白７０（ＨＳＰ７０）表达的关系。 材料与方法 模型制作及分组：经戊巴比妥钠麻醉，行气管插管，通气频率 ６０次／分，潮气量２ｍｌ／１００ｍｇ，开胸后用丝线穿过冠状动脉左前降支上 １／３处，建立模型。６０只ＳＤ大鼠，雌雄不分，随机分成４组，空白组６只，余每组１８只。空白组不行缺血／再灌注，余同实验组。对照组行缺血４０ｍｉｎ，再灌注后检测指标。ＰＮＳ１组，于缺血前 １ｈ腹腔注射ＰＮＳ １５０ｍｇ／ｋｇ，再灌前１…     

布托啡诺预先给药对大鼠心肌缺血再灌注损伤的影响

Objective To investigate the effects of butorphanol pretreatment on myocardial ischemia-reperfusion (IR) injury in rats. Methods Forty healthy male SD rats weighing 200-250 g were randomly divided into 5 groups (n = 8 each) : sham operation group (group S); IR group; butorphanol pretreatment group (group B); Nor-BNI group (group N) and glibenclamide group (group G) . In group IR, B, N and G, myocardial IR was produced by occlusion of left anterior descending artery (LAD) for 30 min followed by 120 min reperfusion. In group S and IR, normal saline S ml/kg was injected via femoral vein 10 min before ischemia and then continuously infused at a rate of 5 ml· kg -1· h-1 iv. In group B, butorphanol 25 μg/kg was injected via femoral vein 10 min before ischemia and the rest method was the same as that described in group IR. In group N, Nor-BNI 2 mg/kg (a selective κ-opioid receptor antagonist) was injected via femoral vein 20 min before ischemia and the rest method was the same as that described in group B. In group G, glibenclamide 1 mg/kg (a KATP channel blocker) was injected via femoral vein 10 min before ischemia and the rest method was the same as that described in group B. Blood samples were taken from femoral artery at 120 min of reperfusion for determination of the concentrations of serum TNF-α, IL-6 and IL-10 by ELISA. Myocardial infarct area and ischemic area were measured by TTC staining and myocardial infarct size was calculated. Results The concentrations of serum TNF-a, IL-6 and IL-10 were significantly higher in the other four groups than in group S (P < 0.05) . The concentrations of serum TNF-α andIL-6 were significantly decreased while IL-10 increased, and the myocardial infarct size was significantly decreased in group B, N and G as compared with group IR ( P < 0.05) . The concentrations of serum TNF-α and IL-6 were significantly increased while the concentration of IL-10 decreased) and the myocardial infarct size was significantly increased in group N and G as compared with group B ( P < 0.05). Conclusion Butorphanol pretreatment can protect the myocardium against IR injury in rate via activating κ receptor and KATP channel.     

预防性使用地塞米松可降低双腔气管导管拔管后咽痛及声嘶发生率

背景：手术后咽痛及声嘶是气管插管，特别是双腔气管导管插管后的主要并发症。我们开展此项前瞻、随机、双盲的安慰剂对照研究，来评价地塞米松用以降低手术后咽痛及声嘶发生率和严重程度的效能。方法本研究选择了166例（18～75岁）使用双腔气管导管插管的胸外科手术患者。在全麻诱导之前，以双盲、前瞻性的随机方法分为地塞米松（静脉给予）0．1mg／kg组（D1组）、0．2mg／kg组（D2组）和安慰剂组（P组）。分别记录Cormack—Lehane评分的声门暴露度、双腔管插管阻力、尝试插管次数、完成插管时间以及插管维持时间。在拔管后1及24小时，利用视觉模拟评分（VAS，0=没有疼痛；100=可以想象的最剧烈疼痛）来评价咽痛及声嘶程度。结果拔管1小时后，咽痛、声嘶发生率及咽痛程度与P组（53％，36％，VAS30．9）相比，D1组（31％，P=0．021；11％，P=0．003；VAS12．4，P〈0．001）与D2组（11％，P=0．001；4％，P=0．001；VAS6．6，P〈0．001）均低。拔管24小时后，D2组（27％，P=0．002；15％，P=0．001；VAS29．9，P〈0．002）咽痛、声嘶发生率及咽痛程度显著低于D1组（47％，31％，VAS43．9）及P组（57％，45％，VAS51．3）。同时未发现与注射地塞米松相关的并发症的发生。结论预防性使用0．2mg／kg地塞米松能显著降低双腔气管导管拔管后１及24小时咽痛、声嘶发生率及严重程度。