硬膜外复合吸入全麻用于肝叶切除3 858例总结

目的：考察硬膜外复合吸入全麻用于肝叶切除手术的优缺点，以探讨较为理想的肝脏手术麻醉方法。方法：比较硬膜外复合吸入全身麻醉（n=3858)，单纯硬膜外麻醉（n=100)及单纯全麻（n=100)患者行肝叶切除术中生命体征，麻醉药用量及术后苏醒情况的差异。结果：硬膜外复合全麻组在诱导期对心率，血压影响较大，但一定量的麻黄素即可纠正，该法可明显减少阿曲库铵，芬太尼及吸入麻醉药的用量，硬膜外复合全麻组早期清醒拔管，很少发生烦躁，术后较长时间内无切口痛，结论：持续硬膜外复合吸入全麻用于肝吸切除手术优于单纯硬膜外麻醉及单 纯全麻，是肝脏手术麻醉比较理想的方法。     

氟烷、七氟醚肝毒性与肝细胞钙平衡

研究了3种配体（ConA、WGA、ZymosanA）引起的巨噬细胞溶酶体pH值动态变化情况。结果显示，在配体加入后溶酶体pH很快上升，5min左右达到峰值．提示受体介导内吞引起的溶酶体pH的上升，不是由于溶酶体体积增加引起的，而是由于内吞体酸化引起细胞内外离子变化所致。     

高渗氯化钠羟乙基淀粉40注射液高容量血液稀释对大鼠肝脏缺血再灌注损伤的影响

Objective To investigate the effects of hypervolemic hemodilution (HH) with hypertonic saline plus hetastarch solution 40 injectio on hepatic ischemia-reperfusion (I/R) injury in rats. Methods Thirty male Wistar rats weighing 300-350 g were randomly divided into 3 groups ( n = 10 each): group I sham operation (group S); group II I/R and group Ⅲ HH. Partial liver ischemia was produced by clamping hepatic portal vein and left arteria hepatica for 30 min with atraumatic mini-clamp, followed by 2 h of reperfusion in I/R group and HH group. In HH group the animals were infused hypertonic saline plus hetastarch solution 40 injectio 10 ml/kg through vena caudalis over 30 min and then hepatic I/R was performed IS min after the infusion.The animals were killed at 2 h of reperfusion. The left liver was removed and blood sample was taken from inferior caval vein for determination of (1) serum alanine amino transferase (ALT) and aspartate amino transferase (AST) activities; (2) superoxide dismutase ( SOD) activity and malondialdehyde ( MDA) content in the liver; ( 3 ) microscopic examination. Results The serum ALT and AST activities and MDA content in the liver were significantly higher, SOD activity in the liver significantly lower after hepatic I/R and pathological changes in the liver severer in group I/R and HH than in group S. The serum ALT and AST activities and MDA content in the liver were significantly lower, SOD activity in the liver significantly higher after hepatic I/R and pathological changes in the liver milder in group HH than in group I/R. Conclusion Hypervolemic hemodilution with hypertonic saline plus hetastarch solution 40 injectio can ameliorate hepatic I/R injury by decreasing oxygen free radical production in rats.     

6%羟乙基淀粉130/0.4对患者硬膜外复合全麻诱导期肺循环的影响

Objective To observe the effect of pulmonary circulation by 6% hydroxyethyl starch 130/0.4 during induction period from epidural block combined with general anesthesia. Methods Twenty-six hepatobiliary surgical patients with ASA Ⅰ-Ⅱ, aged 32 y-59 y, weighing 54 kg-73 kg, were randomized into 2 groups(n=13): hydroxyethyl starch 130/0.4 group(HS)and complex acetic acid Ringer's solution (RL). Above-mentioned solutions were infused 7 ml/kg respectively before induction. The pulmonary circulation hemodynamic parameters such as pulmonary arterial systolic pressure (PASP), pulmonary arterial diastolic pressure (PADP), mean pulmonary artery pressure(MPAP), pulmonary artery wedge pressure(PAWP), pulmonary vascular resistance(PVR) and right ventricular stroke work(RVSW) were recorded at base value(T0), 10 min after infusion(T1), 5 min after induction(T2), 5 rain after intubation(T3), 10 rain after intubation(T4)and 20 min after intubation(T5). Results PASP、PADP、MPAP、PAWP and CVP were significantly higher in group HS at T, than the values at T0 (P<0.05); PVR in group HS was obviously lower from T1 to T5 than the value at To (P<0.05 or P<0.01); RVSW was significantly higher in two groups at T1 than base value (P<0.05), but that in group HS was lower than base value (P<0.05 or P<0.01); HR obviously decreased in two groups from T2 to T5 as compared with the value at T0 (P<0.05); MAP was lower from T3 to T5 than the value at To (P<0.05 or P<0.01). PVR was obviously lower in group HS from T1 to T5 than that in group RL (P<0.05 or P<0.01); MAP obviously increased from T2 to T5 in group HS as compared with the value in group RL(P<0.05 or P<0.01). Conclusion 6% hydroxyethyl starch 130/0.4 can obviously reduce PVR during induction pe-riod from epidural block combined with general anesthesia. In all, there is no effect on pulmonary circulation by 6% hydroxyethyl starch 130/0.4.     

白介素-10在脓毒症中的作用

白介素-10(IL-10)是一种极具应用前景的抗炎及免疫调节细胞因子。它能够抑制局部组织及全身过度释放致炎细胞因子及趋化因子,抑制抗原特异性T细胞反应,同时还能上调部分抗炎细胞因子的表达,极有可能在炎症治疗中发挥重要作用。本文就其分子生物学特性、生物学活性及其在脓毒症中的作用作一综述。     

布比卡因和芬太尼浓度与容量匹配对肝脏术后硬膜外镇痛效应的影响

目的:研究布比卡因和芬太尼联合用药的浓度与容量匹配对肝脏术后硬膜外镇痛效应的影响.方法:对125例肝脏手术患者(ASA Ⅰ～Ⅱ)采用布比卡因(3.75 mg/h)和芬太尼(12 μg/h)联合用药行术后硬膜外镇痛,将该两药等剂量的浓度与容量的匹配关系随机分成5组(n=25),G1组为0.375％布比卡因和12 μg/ml芬太尼混合液以1 ml/h速率持续硬膜外输注;G2组为0.187 5％布比卡因和6 μg/ml芬太尼(2 ml/h);G3组为0.125％布比卡因和4 μg/ml芬太尼(3 ml/h);G4组为0.093 75％布比卡因和3 μg/ml芬太尼(4 ml/h);G5组为0.075％布比卡因和2.4 μg/ml芬太尼(5 ml/h).选择负荷量+持续输注量+PCA给药模式,计算术后48 h的用药总量,观察镇痛效果及相应的不良反应.结果:(1)药物用量:术后48 h各组的布比卡因和芬太尼用药总量、按压总数/按压实进数比值(D/D值)均无明显差异(P>0.05);但G4组的按压实进数明显低于G1和G5组(P<0.05).(2)镇痛效果:各组的有效镇痛率依次为G4>G3>G2>G5>G1.组间比较G3和G4组的静息痛视觉模拟评分(VAS)明显低于G1和G5组(P<0.05),但G3和G4组的咳嗽痛VAS评分仅低于G1组(P<0.05).(3)不良反应:G1组的恶心、呕吐和瘙痒发生率最高,分别为24％和32％,但组间比较未见明显差异.结论:肝脏术后联合应用等剂量布比卡因和芬太尼行硬膜外镇痛,其浓度与容量的匹配关系对镇痛效应有明显的影响.     

吸入麻醉药全麻敏感基因的研究现状

利用分子遗传学研究手段,在生物整体水平探索影响吸入麻醉药全麻敏感性的相关基因及其表达产物,是近年来开展的全麻机制研究的新方法和新策略.目前已在酵母类、线虫类、果蝇类、哺乳类等生物模型中筛选到许多吸入麻醉药的全麻敏感基因,并进行了初步的定位、克隆和功能鉴定,为进一步阐明特异性的全麻分子靶位作出了有益的探索.     

血小板及血小板源性5-羟色胺对早期肝癌切除术患者预后的影响:前瞻性队列研究

目的 探索血小板(platelet PLT)以及PLT源性5羟色胺(serotonin 5-HT)对早期肝癌切除患者术后肝功能、术后复发、远期生存率等预后因素的影响。资料与方法 本研究采用前瞻性队列研究。选取本院从2009年1月到2009年12月连续收治的符合Mlian标准的297例原发性肝细胞癌(hepatocellular carcinoma HCC)切除的患者。留取患者术前血清于-80℃保存,用购买的ELISA试剂盒检测患者血清5-HT浓度。术后定期对患者进行随访观察,收集患者临床资料。采用统计学软件SPSS19.0对数据进行统计分析,了解肝癌切除术后肝功能不全(liver dysfunction LD)、总生存(overall survival OS)时间、无瘤生存(recurrence-free survival RFS)时间的相关危险因素,以了解PLT及PLT源性5-HT对早期肝癌切除术后预后的影响。结果 LD患者术前术后PLT均较肝功能正常患者低(P<0.001)。血清5-HT浓度与PLT计数正相关(P<0.001,K=0.712)。术前PLT(P=0.018,OR2.952,95%CI：1.206-7.229)术前血清5-HT(P=0.001,OR4.989,95%CI：2.004-12.422)是早期肝癌切除术后LD的独立危险因素。术前PLT(P=0.022,OR=1.782,95%CI：1.086-2.924),5-HT(P=0.045,OR1.754,95%CI：1.014-3.034) 是OS期的独立危险因素。结论 术前低5-HT和PLT的早期肝癌切除患者术后围术期预后和远期预后均较差。     

慢性病理性疼痛的表观遗传学研究进展

病理性疼痛是指由创伤、感染、肿瘤等因素造成组织病理性改变后引起的疼痛.疼痛若持续1个月以上或在损伤组织愈合后持续存在则演变为慢性疼痛.慢性疼痛患者常伴有失眠、焦虑、抑郁等精神心理疾病,正常的生理功能和生活质量严重受损,带来许多社会经济问题.最新研究发现,表观遗传学调控可以在分子水平解释各种慢性病理性疼痛,包括炎性疼痛、神经病理性疼痛和精神源性疼痛的发病机制,进而引领其治疗手段的发展.本文围绕表观遗传学中DNA甲基化、组蛋白乙酰化和小干扰RNA(miRNA)调控这3种主要机制在慢性病理性疼痛领域的最新研究进展作一综述.