七氟烷可替代丙泊酚用于成人麻醉诱导放置喉罩通气道

目的:比较七氟烷吸入诱导和丙泊酚静脉诱导用于插入喉罩通气道(LMA)的临床效能和安全性。方法:将80例ASAⅠ～Ⅱ级择期行下肢骨科手术患者随机分为2组。P组麻醉诱导采用静脉靶控输注丙泊酚,效应室浓度6mg/L;S组以肺活量法吸入七氟烷,目标呼气末浓度为4%。通过开口试验判断插入LMA适宜时机。观察麻醉诱导和放置LMA的过程,记录期间患者血流动力学的变化和不良反应的发生。结果:2种诱导方法都可以保证超过95%的患者一次顺利完成LMA的放置。S组患者意识消失时间较P组延长,但2组患者适宜LMA插入的麻醉诱导时间差异无统计学意义。P组患者诱导后平均动脉压(MAP)明显下降,S组患者试验期间血流动力学状态稳定,而且插入LMA后呼吸暂停的发生也明显低于P组(P<0.05)。结论:七氟烷吸入诱导可替代丙泊酚静脉诱导用于成年患者放置LMA。     

预防性处理骨水泥反应对血液动力学和血气参数的影响

目的观察预防性处理骨水泥反应对血液动力学和血气参数的影响。方法择期行全髋人工关节置换术成年患者160例,年龄52～83岁,ASAⅠ～Ⅲ级,随机分为4组：Ⅰ组（预防用药＋髓腔排气）,Ⅱ组（预防用药＋无髓腔排气）,Ⅲ组（无预防用药＋髓腔排气）,Ⅳ组（无预防用药＋无髓腔排气）,每组40例,4组均采用轻比重布比卡因施行单侧蛛网膜下腔麻醉（腰麻）。记录麻醉前、麻醉后5min、麻醉后10min、骨水泥灌注前、灌注即刻、灌注后3、5和10min的MAP、HR、CVP,并于骨水泥灌注前、灌注即刻、灌注后5min、灌注后10min测定血气参数。结果①与麻醉前比较,麻醉后5min 4组MAP均下降（P〈0.05）,麻醉后10min差异无显著性（P〉0.05）;与骨水泥灌注前及Ⅰ组和Ⅱ组相同时点的MAP比较,Ⅲ组和Ⅳ组在灌注即刻、灌注后3、5和10minMAP均显著下降（P〈0.01）。②与骨水泥灌注前比较,Ⅲ组和Ⅳ组在灌注即刻、灌注后3、5min HR均加快（P〈0.05）。③与骨水泥灌注前比较,在灌注即刻Ⅲ组和Ⅳ组CVP下降,Ⅳ组CVP比Ⅰ组和Ⅱ组下降（P〈0.05）。④与骨水泥灌注前比较,各组在灌注即刻PaO2均下降,在灌注后5minⅡ组和Ⅳ组PaO2仍下降;与Ⅰ、Ⅲ组比较,Ⅱ、Ⅳ组在灌注即刻、灌注后5min PaO2均下降（P〈0.05或P〈0.01）;与骨水泥灌注前比较,Ⅱ组和Ⅳ组在灌注即刻PaCO2均升高,但都在正常生理范围内（P〈0.05）。结论全髋人工关节置换术中采用轻比重布比卡因单侧腰麻,骨水泥灌注前预防性输注多巴胺和甲泼尼龙琥珀酸钠,并在骨水泥灌注时施行髓腔排气,可降低骨水泥反应对血液动力学和血气参数的影响。     

丙泊酚靶控输注和七氟烷吸入对顺式阿曲库铵药效学的影响

目的:比较丙泊酚靶控输注(TCI)复合瑞芬太尼全凭静脉麻醉和七氟烷复合瑞芬太尼麻醉对单次插管剂量顺式阿曲库铵肌松效应的影响.方法:ASA Ⅰ或Ⅱ级的择期全麻患者42例,随机均分为丙泊酚(P)组和七氟烷(S)组.麻醉诱导后给予0.2 mg/kg的顺式阿曲库铵后插管;P组和s组麻醉维持分别采用丙泊酚TCI-泵注瑞芬太尼和吸入1.3倍肺泡最小有效浓度(1.3 MAC)七氟烷-泵注瑞芬太尼.使用加速度肌松监测仪观察拇内收肌的收缩反应,记录顺式阿曲库铵的起效时间、无反应时间、肌松维持时间及恢复指数(RI)等指标.结果:2组之间肌松起效时间、无反应时间及单刺激肌颤搐强度(T1)25%时间差异无统计学意义(均P>0.05),S组25%四个成串刺激比(TOFr)及恢复指数较P组明显延长(P<0.05).结论:单次插管剂量的顺式阿曲库铵在丙泊酚TCI-泵注瑞芬太尼麻醉下肌松维持及恢复无明显变化,而在吸入1.3 MAC七氟烷-泵注瑞芬太尼麻醉下恢复时间明显延长,提示以七氟烷维持全麻,顺式阿曲库铵剂量应酌减,以免术后肌松残留.     

缺血后处理对大鼠脑缺血再灌注损伤的影响

目的探讨缺血后处理对大鼠脑缺血再灌注损伤的影响。方法成年雄性SD大鼠40只,体质量250～300g,随机分为5组,每组8只,①假手术组(sham组):不施加缺血及再灌注处理;②缺血再灌注1组(I/R1组):给予缺血30min,再灌注24h;③缺血再灌注2组(I/R2组):给予缺血30min,再灌注48h;④缺血后处理1组(Post1组):给予缺血30min,缺血后处理后再灌注24h;⑤缺血后处理2组(Post2组):给予缺血30min,缺血后处理后再灌注48h。用无创动脉夹夹闭双侧颈总动脉实现脑缺血,撤夹实现再灌注。在再灌注即刻给予双侧颈总动脉松夹15s/夹闭15s,如此3次,实现缺血后处理。实验结束制作脑组织匀浆,检测丙二醛(MDA)含量和超氧化物歧化酶(SOD)活性;作石蜡切片,用末端脱氧核苷酸转移酶介导的生物素脱氧尿嘧啶核苷酸缺口末端标记法(TUNEL)观察细胞凋亡情况。结果与sham组相比,I/R1、I/R2、Post1、Post2组MDA含量增高,SOD活性降低(P<0.05);与I/R1组相比,Post1组MDA含量降低,SOD活性升高(P<0.05);与I/R2组相比,Post2组MDA含量降低,SOD活性升高(P<0.05)。sham组可见少量凋亡细胞。与sham组相比,I/R1、I/R2、Post1、Post2组凋亡指数升高(P<0.05);与I/R1组比较,Post1组凋亡指数降低(P<0.05);与I/R2组比较,Post2组凋亡指数降低(P<0.05)。结论缺血后处理可以抑制脑缺血再灌注引起的脂质过氧化反应和细胞凋亡。     

合心爽抑制气管内插管期间心血管反应

目的：观察钙通道拮剂－－合心爽,对全麻气管内插管期间心血管反应的抑制作用。方法：４０例ＡＳＡⅠ级择期全麻手术成年患者,随机分为观察组和对照组,Ａｌｌｅｎ试验均生。诱导前用ＣＡＲＤＩＯ－ＣＡＰ监测仪监测有创模特 脉血压,同时显示心率（ＨＲ）Ｔ ＥＣＧ示波。常规诱导。观察组在静注琥珀胆碱前、静脉先给予合心爽０．１５ｍｇ／＝ｋｇ。于显露声门、气管插管期间观察有创桡动脉平均压（ＭＡＰ）、心率的变化。结果：     

健康志愿者6%羟乙基淀粉130/0.4的容量动力学

目的 探讨健康志愿者6%羟乙基淀粉130/0.4的容量动力学.方法健康志愿者7名,性别不限,年龄18～32岁,体重46～84 kg.经60 min静脉输注6%羟乙基淀粉130/0.4 30ml/kg.采用Matlab 6.0版软件包进行容量动力学分析,采用F检验选择房室模型.结果 一室模型参数:基础清除率(3.5±1.3)ml/min,清除率(19±11)ml/min,一室模型分布容积(5746±1371)ml;二室模型参数:清除率(63±29)ml/min,交换系数(11±4)ml/min,中央室目标容积(1551±995)ml,外周室目标容积(908±398)ml,二室模型分布容积(2460±1332)ml.6%羟乙基淀粉130/0.4扩张、转运、分布及消除等体内过程符合容量动力学一室模型(F值为3.81,P＞0.05).4 h清除率为(75±10)%.容量动力学一室模型分布容积与健康志愿者血容量比较差异无统计学意义(P＞0.05).结论 健康志愿者6%羟乙基淀粉130/0.4急性扩容符合容量动力学一室模型,提示羟乙基淀粉快速输注主要分布在血液,有效扩容时间4 h.

Abstract：

Objective To investigate the volume kinetics of 6% hydroxyethyl starch 130/0.4 in healthy volunteers.Methods Seven healthy volunteers aged 18-32 yr weighing 46-84 kg were selected in this study. 6% hydroxyethyl starch 130/0.4 30 ml/kg was infused over 60 min. Volume kinetics analysis of 6% hydroxyethyl starch 130/0.4 was performed with Matlab 6.0 software, compartment model was determined by F test.Results One-compartment model parameters: basic clearance, clearance and distribution volume of one-compartment model were (3.5 ± 1.3) ml/min,(19± 11) ml/min and (5746 ± 1371) ml respectively. Two-compartment model parameters: clearance, K1, the volume of central compartment, the volume of peripheral compartment, distribution volume of two-compartment model were (63 ±29) ml/min,(11 ±4) ml/min, (1551 ± 995) ml, (908 ±398) ml,(2460 ± 1332) ml respectively. There was no difference between the distribution volume of one-compartment model and blood volume of healthy volunteers ( P ＞ 0.05) .The distribution of infused 6% hydroxyethyl starch 130/0.4 was accordant with one-compartment model (F value was 3.81, P ＞ 0.05)and 4 h clearance was (75 ± 10)% .Conclusion The distribution of infused 6% hydroxyethyl starch 130/0.4 for volume expansion is accordant with one-compartment model, and the effective duration of plasma volume expansion is 4 h.     

右美托咪啶后处理对大鼠离体心脏缺血再灌注时线粒体损伤的影响

目的 探讨右美托咪啶后处理对大鼠离体心脏缺血再灌注时线粒体损伤的影响.方法 健康雌性Wistar大鼠,体重220～250 g,成功制备Langendorff离体灌注模型的40个心脏随机分为5组(n=8):缺血再灌注组(A组)、右美托咪啶10 nmol/L组(B组)、右美托咪啶100 nmol/L组(C组)、线粒体通透性转换孔开放剂苍术苷组(D组)及右美托咪啶联合苍术苷组(E组).离体心脏经K-H液平衡灌注20 min后,采用全心停灌40 min再灌注60 min的方法制备离体心脏缺血再灌注模型.于再灌注即刻B组、C组、D组和E组分别灌注含10 nmol/L右美托咪啶、100 nmol/L右美托咪啶、20μmol/L苍术苷、100 nmol/L右美托咪啶和20 μmol/L苍术苷的K-H液10 min.再灌注结束即刻取心尖组织,分离线粒体,测定SOD、Na+ -K+ -ATP酶、Ca2+-ATP酶活性和MDA和Ca2+含量.结果 与A组比较,B组和C组线粒体SOD、Na+ -K+ -ATP酶和Ca2+ -ATP酶活性升高,MDA和Ca2+含量降低(P＜0.05),D组和E组上述指标比较差异无统计学意义(P＞0.05);与C组比较,D组和E组线粒体SOD、Na+-K+-ATP酶和Ca2+ -ATP酶活性降低,MDA和Ca2+含量升高(P＜0.05),B组上述指标比较差异无统计学意义(P＞0.05).结论 右美托咪啶后处理可减轻大鼠离体心脏缺血再灌注时的线粒体损伤,其机制可能与抑制线粒体通透性转换孔开放有关.     

七氟醚预处理对局灶性脑缺血再灌注损伤大鼠皮质C/EBP同源蛋白表达的影响

目的 探讨七氟醚预处理对局灶性脑缺血再灌注损伤大鼠皮质C/EBP同源蛋白(CHOP)表达的影响.方法 健康雄性SD大鼠36只,体重250～280 g,采用随机数字表法,将大鼠随机分为3组(n=12):假手术组(S组)、局灶性脑缺血再灌注组(I/R组)和七氟醚预处理组(Sevo-pc 组).采用线栓法阻断右侧大脑中动脉1 h,再灌注24 h,制备局灶性脑缺血再灌注损伤模型.Sevo-pc 组于缺血前1 h吸入2.7%七氟醚.各组于再灌注24 h时行神经功能缺陷评分后断头取脑,TIC染色法测定脑梗死体积,免疫组化法测定缺血侧皮质CHOP表达,TUNEL法计数凋亡神经细胞.结果 与S组比较,I/R组和Sevo-pc组神经功能缺陷评分升高,脑梗死体积比升高,缺血侧皮质CHOP表达上调,凋亡细胞数增加(P＜0.01);与I/R组比较,Sevo-pc组神经功能缺陷评分降低,脑梗死体积比降低,缺血侧皮质CHOP表达下调,凋亡细胞数减少(P＜0.05或0.01).结论 七氟醚预处理可能通过下调皮质CHOP表达减轻大鼠局灶性脑缺血再灌注损伤.

Abstract：

Objective To investigate the effect of sevoflurane preconditioning on CCAAT/enhancer binding protein (C/EBP) homologous protein (CHOP) expression in the cerebral cortex after focal cerebral ischemiareperfusion (I/R) injury in rats and the mechanism. Methods Thirty-six male SD rats weighing 250-280 g were randomly divided into 3 groups ( n = 12 each) : sham operation group (group S) , focal cerebral I/R group (group I/R) and sevoflurane preconditioning group (group Sevo-pc). The animals were anesthetized with intraperitoneal chloral hydrate 300 mg/kg. In groups I/R and Sevo-pc, focal cerebral ischemia was induced by middle cerebral artery occlusion using a nylon thread with rounded tip inserted into the right internal carotid artery and advanced cranially until resistance was met. The occlusion was maintained for 1 h followed by 24 h reperfusion. Group Sevo-pc inhaled 2.7% sevoflurane for 1 h before ischemia. Neurological deficits were assessed and scored at the end of 24 h reperfusion and then the rats were decapitated. Their brains were immediately removed. The cerebral infarct size was determined by TTC staining. The CHOP expression in the ischemic cerebral cortex was determined by immunohistochemistry. The number of apoptotic neurons was counted using TUNEL. Results The neurological deficit scores were significantly higher, the cerebral infarct size was significantly larger, and the CHOP expression and the number of apoptotic neurons were significantly higher in groups I/R and Sevo-pc than in group S ( P ＜ 0.01) . The neurological deficit scores were significantly lower, the cerebral infarct size was significantly smaller, and the CHOP expression and the number of apoptosis neurons were significantly lower in group Sevo-pc than in group I/R ( P ＜ 0.05 or 0.01) . Conclusion Sevoflurane preconditioning may protect the brain against focal cerebral I/R injury by down-regulating CHOP expression in the cerebral cortex in rats.     

MR诊断颅脑海绵状静脉畸形23例分析

对我院MR诊断颅脑海绵状静脉畸形23例分析如下. 1 临床资料 1.1 一般资料本组男13例,女10例,年龄最小3岁,最大66岁,平均38岁.单发16例,其中幕上位于颞叶6例,额叶3例,白质区2例,枕叶、基底节区各1例.幕下位于小脑半球2例,桥脑1例.多发7例,共27处病灶.幕上位于颞叶9处,额叶7处,基底节4处,白质区3处.幕下位于桥脑、小脑半球各2处.有头痛症状者15例,有癫痫症状者14例,呕吐5例,发热伴抽搐2例,有血肿形成者1例.     

MRI检查对甲状腺腺瘤的诊断价值分析

分析甲状腺腺瘤的磁共振（MRI）表现特征，以提高诊断符合率。方法 对经手术、病理证实的22例甲状腺腺瘤患者的MRI影像资料进行全面的分析总结。结果 甲状腺腺瘤的MRI表现为：T1呈稍低信号，T2呈明显高信号，形状规则，多呈圆形或类圆形，边界清晰，增强可见完整强化环。结论 MRI检查对甲状腺腺瘤具有较高的诊断价值。