腹主动脉阻断合并脓毒症大鼠脊髓损伤的实验研究

目的 观察大鼠腹主动脉阻断术(AAC)后合并脓毒症时脊髓病理改变及肿瘤坏死因子(TNF)-α的表达.方法 Wistar大鼠32只,随机均分为四组:假手术组(A组),AAC组(B组),LPS组(C组),AAC+ LPS组(D组).所有动物均于再灌注后8h处死,处死前进行后肢神经功能评分,取脊髓行HE染色观察脊髓组织病理损害和免疫组化检测脊髓前角TNF-α的表达.结果 HE染色显示A组损伤较轻;B组可见炎性反应明显,较多神经元坏死;C组有炎性表现,较少神经元坏死,较多运动神经元凋亡;D组可见强烈炎性表现,大量神经元坏死.A组TNF-α少量表达,显著低于其它三组(P＜0.01).C组TNF-α显著高于其它三组(P＜0.01).A、C组后肢神经功能评分显著高于B、D组(P＜0.05或P＜0.01).结论 TNF-α在AAC后脓毒症急性脊髓损伤中发挥了重要作用,介导了运动神经元的坏死或凋亡.AAC后机体可存在免疫紊乱,如此时发生脓毒症,TNF-α表达增加可能不如单纯脓毒症明显.     

异氟醚麻醉引起大鼠空间记忆损伤的潜在分子机制

【摘要】目的 先前的研究表明异氟醚麻醉后的动物模型可出现学习和记忆能力的持续性降低,可达数周或数月。然而,其分子学的机制仍然不是很明确。已经明确的是海马PKA、PKC的表达与记忆的加工过程相关。本实验拟通过研究异氟醚麻醉对青、老年大鼠morris水迷宫训练成绩及海马CA1区脑神经元激酶系统的影响,探讨麻醉后脑神经元分子水平变化与行为学表现的相关性,为深入研究术后认知功能障碍的发生机制提供参考。方法 选择36只3月龄青年雄性SD大鼠和36只20月龄老年雄性SD大鼠,分别随机分为对照组（不麻醉）、训练组（不麻醉,行morris水迷宫训练）、异氟醚组（异氟醚1.2%;大鼠分别于2小时/4小时异氟醚麻醉后的2天/2周行Morris水迷宫训练）。Morris水迷宫连续进行5天,每天8次,记录逃避潜伏期变化,用以测试各组大鼠的空间学习记忆能力。行为学实验后立即杀鼠,取海马,应用免疫组化法和酶标法,半定量检测大鼠海马CA1区脑组织PKC、PKA的阳性表达和PKC、PKA的激酶活性。结果 行为学测试结果示：4小时异氟醚麻醉后,青、老年鼠的认知功能损害可持续至麻醉后2天至2周,且尤以老年鼠常见且程度严重,表现为学习速度和记忆质量均有所下降(P<0.05);与对照组相比,行Morris水迷宫训练后,大鼠海马CA1区PKA、PKC表达明显增加(P<0.05)。随麻醉时程的延长和年龄增加,麻醉引起大鼠海马脑区激酶系统的抑制作用也增加。结论 异氟醚麻醉后老年大鼠长期的空间记忆损伤与海马CA1区PKC、PKA的表达相关,蛋白激酶系统的抑制在麻醉后认知功能下降过程中起重要作用。     

内脏伤害性刺激在脊髓突触后背柱神经元的信号转导机制

内脏痛是急慢性胃肠道、盆腔、泌尿道和其它实体器官疾病的最常见症状之一。许多疾病伴发的内脏性疼痛十分顽固,如肠道激惹综合征、间质性膀胱炎、胰腺炎、子宫内膜异位症和癌性内脏痛等,给临床医师带来了极大的挑战。内脏疼痛机制十分复杂。近年来,一系列的临床和基础研究发现起源于     

国产舒芬太尼用于术后静脉自控镇痛的疗效和安全性——多中心、随机、双盲、平行对照临床研究

Objective To evaluate efficacy and safety of sulfentanyl (China) for PICA in surgical patients with general anes-thesia in a multiple-center, randomized, double-blind, parallel study. Methods 200 ASA grade Ⅰ -Ⅱ patients aged 18-55 undergo-ing surgery with general aneathesia enrolled from 3 hospitals were randomly and double-blindly divided into 2 groups: sulfentanyl (China, n=100) versus sulfentanyl(German, n=100). Sulfentanyl(China 0.1 μg/kg or German)was given before the end of surgery. VAS scores less than 3 after patient awake and PCA started after extubation(200 μg sulfentanyl was diluted with 50 ml saline solution, background dose 0.5 ml/h,bolus of 0.5 ml with lockout interval 15 min, continuous infusion 48 h). Vital signs including BP, HR, PR, SpO2 and side effects such as nausea, vomiting, urine retention, pruritus, breath depression, etc. And VAS scores with patients in quiet and cough were recorded at the beginning of infusion at 0, 1, 4, 12, 24, 48 h. The total number of PCA, the total effective number of PCA, and the ratio of both and other analgesics as well as the satisfactory degree of patients and the cumulative suffen-tanyl consumption were recorded at 24 h. Results There were no significant difference of BP, HR, PR, SpO2 and the adverse effect and VAS scores in quiet and cough between two groups at the beginning of infusion at 0, 1, 4, 12, 24, 48 h. There were no signifi-cant difference of the total number of PCA, the total effective number of PCA and other analgesics as well as the satisfactory degree of patients and the total dosage of sulfentanyl at 24 h. Conclusion The sulfentanyl (China) had satisfactory effects of postoperative analgesia and had no significant side effects compared with sulfentanyl (German). The efficacy and the side effects of both drugs had no significant difference.     

三甘氨酰基赖氨酸加压素对肝移植术病围术期肾功能的影响

目的 评价三甘氨酰基赖氨酸加压素对同种异体肝移植术病人围术期肾功能的影响.方法 择期静吸复合麻醉下行经典原位肝移植术的乙/丙肝后肝硬化病人40例,年龄35～55岁,未行静脉-静脉转流术,ASA Ⅲ或Ⅳ级,按术前肾功能正常与否分层随机分为2组(n=20):对照组和试验组.手术开始即刻静脉输注三甘氨酰基赖氨酸加压素(2 mg溶于50 ml生理盐水)10 ml/h,至新肝期前即刻,对照组以等容量生理盐水代替.测定麻醉前即刻(T0)、新肝期前即刻(T1)、术毕(T2)、术后1d(T3)和术后2 d(T4)尿N-乙酰β-D-氨基葡萄糖苷酶(NAG)和血浆血管紧张素Ⅱ(AT-Ⅱ)、血清β2微球蛋白(β2-MG)、尿素氮(BUN)、肌酐(Cr)浓度,并记录各时段尿量.结果 与T0比较,2组T1时尿NAG和血清β2-MG升高(P＜0.01);与无肝前期比较,2组无肝期尿量减少,新肝期、术后1 d和术后2 d尿量增加(P＜0.01);与对照组比较,试验组尿NAG、血浆AT-Ⅱ、血清β2-MG、BUN和Cr浓度及速尿用量降低,尿量增多(P＜0.05),其余指标差异无统计学意义(P＞0.05).结论 肝移植术中静脉输注三甘氨酰基赖氨酸加压素对病人围术期肾功能有保护作用.     

HTP102型无创鼓膜温度持续监测装置在不停跳冠状动脉旁路移植术中的应用

目的 通过对比行不停跳冠状动脉旁路移植术（off-pump coronary artery bypass grafting,OPCABG）患者全身麻醉（以下简称全麻）术中由HTP102型无创持续鼓膜温度监测装置测量的鼓膜温度和由SWAN-GANZ漂浮导管测量的肺血温度的相关性和一致性,从而评估无创持续鼓膜温度监测的临床应用价值。方法 观察并记录全麻术中不停跳冠状动脉移植术患者在不同时间点的鼓膜温度与肺血温度的数值,采用Bland-Altman一致性分析、组内相关系数（intraclass correlation coefficient,ICC）分析、Pearson相关性分析及重复测量方差分析,探讨HTP102鼓膜温度传感器用于全麻术中监测患者体温的准确性。采用Pearson相关性分析方法分析术中情况与预后之间的关系。结果 Bland-Altman显示偏倚为（0.125±0.176 4）℃,95%置信区间（confidence interval,CI）为（-0.073 9~0.278 9）℃。组内相关系数为0.968。Pearson相关系数r=0.938。重复测量方差分析可知：经非球多变量检验中的Roy's maximum root test检验时间变量F值为72.95,术中各时间点体温与初始体温对比可知术中各时间点的体温均低于初始体温。术后重症监护室（intensive care unit,ICU）天数与术中出血量明显相关（P=0.004）。术后住院天数与术后24 h纵隔引流量明显相关（P=0.032）。结论 HTP102型鼓膜温度传感器可准确反映患者术中的核心室温度,能够替代肺血温度监测,广泛应用于其他全麻手术。不停跳冠状动脉旁路移植术患者的术中均发生不同程度的低体温,尤以全麻维持期最为明显。不停跳冠状动脉旁路移植术患者预后情况与术中及术后出血量有明显相关。     

切口痛大鼠脊髓兴奋性和抑制性氨基酸类神经递质释放的动态变化

目的 探讨切口痛大鼠脊髓兴奋性和抑制性氨基酸类神经递质释放的动态变化.方法 雄性SD大鼠,麻醉后切开寰枕膜置人环形微透析导管至腰大池.恢复5 d后,选择12只无神经症状的大鼠,随机分为2组(n=6):对照组(C组)仅吸入1.2%异氟醚,切口痛组(Ⅰ组)吸入1.2%异氟醚后制备右后足底切口痛模型.于术前、术后3 h、1 d、2 d、3 d收集各组微透析液并观察大鼠痛行为学,测定微透析液内氨基酸类神经递质浓度.结果 与基础值比较,Ⅰ组天冬氨酸和谷氨酸水平于术后3 h升高(P＜0.01),术后1 d即恢复到基础值水平(P＞0.05),甘氨酸和γ-氨基丁酸的浓度于术后1 d升高(P＜0.01),术后2 d即恢复到基础值水平(P＞0.05),累积疼痛评分于术后3 h、1 d、2 d升高(P＜0.01);与C组比较,Ⅰ组术后3 h天冬氨酸和谷氨酸水平升高,术后1 d甘氨酸和γ-氨基丁酸水平升高,术后3 h、1 d、2 d累积疼痛评分升高(P＜0.01).结论 术后疼痛期脊髓氨基酸类神经递质释放的变化规律具有时间特异性,兴奋性氨基酸类神经递质在切口痛早期释放增加,介导术后早期脊髓敏化的发生;抑制性氨基酸类神经递质迟于兴奋性氨基酸类神经递质的释放,减轻术后疼痛.     

不同浓度异氟醚对大鼠海马乙酰胆碱释放的影响

麻醉药可影响颅内神经递质的水平,如多巴胺、去甲肾上腺素和乙酰胆碱(Ach)。异氟醚对颅内神经递质的影响尚未完全阐明。本研究拟观察不同浓度异氟醚对大鼠海马Ach释放的影响。 材料和方法 微透析导引管植入 选择6只成年雄性SD大鼠,体重300-350 g。将SD大鼠置入充有异氟醚的密封罐中,待其意     

自由活动大鼠微电极脑电和微透析模型的建立

中枢神经递质如乙酰胆碱、谷氨酸在调节中枢神经系统功能方面发挥重要作用,其变化可以导致脑电活动的改变。微透析技术能动态监测活体大鼠大脑皮层细胞外神经递质的变化,分析具有时间、空间分辨性,不经处理直接测定及易于自动化等优点,而自由活动大鼠的微透析模型还能避免麻醉药、手术操作创伤等因素的干扰,有利于进行麻醉药等对机体影响的对照研究。脑电双频指数(BIS)主要反应大脑皮层的功能状态,BIS用于大鼠脑电监测尚无定论。本研究拟建立自由活动大鼠微电极脑电和微透析模型,在监测中枢神经递质的同时,观察脑电活动的变化,为探讨麻醉机理的研究奠定基础。     

国产舒芬太尼用于术后静脉自控镇痛的疗效和安全性——多中心、随机、双盲、平行对照临床研究

Objective To evaluate efficacy and safety of sulfentanyl (China) for PICA in surgical patients with general anes-thesia in a multiple-center, randomized, double-blind, parallel study. Methods 200 ASA grade Ⅰ -Ⅱ patients aged 18-55 undergo-ing surgery with general aneathesia enrolled from 3 hospitals were randomly and double-blindly divided into 2 groups: sulfentanyl (China, n=100) versus sulfentanyl(German, n=100). Sulfentanyl(China 0.1 μg/kg or German)was given before the end of surgery. VAS scores less than 3 after patient awake and PCA started after extubation(200 μg sulfentanyl was diluted with 50 ml saline solution, background dose 0.5 ml/h,bolus of 0.5 ml with lockout interval 15 min, continuous infusion 48 h). Vital signs including BP, HR, PR, SpO2 and side effects such as nausea, vomiting, urine retention, pruritus, breath depression, etc. And VAS scores with patients in quiet and cough were recorded at the beginning of infusion at 0, 1, 4, 12, 24, 48 h. The total number of PCA, the total effective number of PCA, and the ratio of both and other analgesics as well as the satisfactory degree of patients and the cumulative suffen-tanyl consumption were recorded at 24 h. Results There were no significant difference of BP, HR, PR, SpO2 and the adverse effect and VAS scores in quiet and cough between two groups at the beginning of infusion at 0, 1, 4, 12, 24, 48 h. There were no signifi-cant difference of the total number of PCA, the total effective number of PCA and other analgesics as well as the satisfactory degree of patients and the total dosage of sulfentanyl at 24 h. Conclusion The sulfentanyl (China) had satisfactory effects of postoperative analgesia and had no significant side effects compared with sulfentanyl (German). The efficacy and the side effects of both drugs had no significant difference.