手术创伤对老龄大鼠海马CA3区突触结构的影响

目的 探讨手术创伤对老龄大鼠海马CA3区突触结构的影响.方法 健康SD大鼠56只,月龄18月,随机分为3组,对照组(C组,n=8)腹腔注射生理盐水0.8 ml/kg;麻醉组(A组,n=24)腹腔注射氯胺酮40 mg/kg;手术组(O组,n=24)腹腔注射氯胺酮40 mg/kg,翻正反射消失后行脾脏切除术.A组和O组于麻醉或术后1、3,7 d(T_(1～3))时取8只大鼠行Morris水迷宫实验测试认知功能,并测定海马CA3区突触结构各指标.结果 与C组和A组比较,O组T_(1,2)时通过原平台次数、突触数减少,突触间隙增宽,突触后膜致密物厚度变薄,突触活性带长度缩短,突触界面曲率减小(P<0.05或0.01).与C组比较,A组T_1时、O组T_(1,2)时潜伏期及游泳距离延长(P<0.01);与A组比较,O组T_(1,2)时潜伏期延长,T_2时游泳距离延长(P<0.05).结论 手术创伤导致老龄大鼠术后早期认知功能减退的机制与海马CA3区突触结构改变有关.     

雾化吸人利多卡因对哮喘大鼠肺组织热休克蛋白70、核因子κB表达的影响

Objective To observe the effect of aerosolized lidocaine inhalation on expression of HSP70 and NF-ΚB in lung of asthma rat model. Methods Thirty two Wistar rats were randomly assigned to four groups (n=8 each): control group( group A), asthma model group(group B),dexamethasone group(group C)and lidocaine group(group D). The rats in group B were sensitized by injection of ovalbumin(OA )together with aluminum hydroxide as adjuvants, followed by aerosolized OA challenge two weeks later. The rats in group C and D were sensitized with OA as group B, but exposed to 0.02% aerosol of dexamethasone and 0.04% aerosol of lidocaine 20 ml respectively. In group A saline was used instead of OA. In 24 hours after the last challenge, the lungs were removed for microscopic examination, determination of W/D lung weight radio, the expression of HSP70 and NF-ΚB was studied immunohistochemically.Results①The W/D lung weight radio were 4.08±0.16,3.54±0.10 and 3.66±0.12 respectively in group B,C,D,more than the group A with 3.30±0.12. ② The pulmonary expression of HSP70 were 0.210±0.018,0.138±0.010 and 0.154±0.012 respectively in group B,C,D, higher than the group A with 0.049±0.015. ③The pulmonary expression of NF -KB were 0.199±0.029,0.132±0.010 and 0.150±0.017respectively in group B, C, D, higher than the group A with 0.056±0.022. ④Compared with the group B, the W/D lung weight radio and pulmonary expression of HSP70 and NF -ΚB in group C and D were significantly down -regulated. In animals with asthma the bronchial walls were significantly thicker with inflammatory cell infiltration. Dexamethasone or lidocaine aerosolized inhalation significantly attenuated the pathologic changes induced by asthma. Conclusion Aerosolized lidocaine inhalation has a protective effect on airway inflammation and histology damages resulting from aeroallergen challenge in the asthma model of Wistar rats.     

己酮可可碱对术后痛模型大鼠脊髓胶质细胞激活的影响

目的 观察腹腔注射己酮可可碱(pentoxiflline,PTX)对术后痛模型大鼠的抗痛觉过敏及对脊髓胶质细胞激活的影响作用.方法 健康雄性SD大鼠60只,体重190 g～220 g,采用随机数字表法分为两组,每组30只:对照组(NS组),实验组(PTX组).本研究选择趾部切口术后痛大鼠模型.PTX组从术前15 min起至术后5 d,每日1次腹腔注射PTX 50 mg/kg,生理盐水治疗组在相同时间点给予等容量生理盐水.分别于术前1 d和术后1、2、3、5 h、1、2、3、5 d天腹腔注射药物后30 min～55 min后,随机取6只大鼠,进行累计疼痛评分和机械缩足反射时间(paw withdrawal threshold,PWT)的测定,并于术后1、2、3、5 d测定结束后处死,免疫组化观察脊髓星形胶质细胞标记物胶质纤维酸性蛋白(glial fibrillary acid protein,GFAP)和小胶质细胞标记物离子钙接头蛋白抗体(ionized calcium bindingadaptor molecule-1,Iba-1)的表达.结果 ①术后1、2、3、5 h、1、2、3 d累计疼痛评分,PTX组分别为2.9±0.4、3.9±0.8、6.6±0.5、8.6±0.7、10.2±0.4、7.0±0.6、5.6±0.5和NS组4.0±0.6、6.0±0.1、8.8±0.2、11.0±0.5、13.1±0.2、9.5±0.7、7.8±0.6相比下降(P＜0.05);②术后1、2、3、5 h、1、2、3 d PWT,PTX组分别为(5.8±1.6)、(5.2±1.1)、(4.4±0.6)、(4.9±0.4)、(5.2±1.1)、(7.6±1.8)、(10.4±1.6)g,和NS组(2.4±0.8)、(2.1±0.5)、(2.0±0.5)、(2.1±0.3)、(2.3±0.5)、(4.5±0.9)、(8.1±1.4)g相比增加(P＜0.05);③术后1、2、3 d脊髓背角GFAP表达,PTX组分别为181.2±4.1、205.6±4.2、230.2±3.2和NS组244.1±4.9、258.6±4.1、276.2±3.4相比表达下调(P＜0.05).④术后3、5 d脊髓背角Iba-1表达,PTX组分别为168±3、170±3和NS组230±3、205±4相比表达下调(P＜0.05).结论 腹腔注射PTX减轻术后痛模型大鼠的痛觉过敏机制可能与抑制脊髓胶质细胞的激活有关.

Abstract：

Objective To investigate the effect of intraperitoneal administration of pentoxifylline on the development of hyperalgesia and the activation of glial cells in a rat model of postoperative pain. Methods Sixty male SD rats weight 190 g-220 g were randomly divided into 2 groups: control group (NS group) and treatment group (PTX group), in which 50 mg/kg saline vehicle or pentoxifylline (n=30) was given intraperitoneally 15 min before surgery and continued once a day to the 5th day after the operation, respectively.The animal model of postoperative pain was established by incision hind paw. Cumulative pain score and paw withdrawal threshold were measured at 1 d before operation and then at 1, 2, 3, and 5 h and 1, 2, 3, and 5 d after operation.Spinal cord tissue samples from rats were taken for analysis of glial fibrillary acid protein (GFAP) and ionized calcium bindingadaptor molecule-1 (Iba-1) expression by means of immunohistochemistry at the following times after operation: 1, 2, 3, and 0.8, 6.6±0.5, 8.6±0.7, 10.2±0.4, 7.0±0.6 and 5.6±0.5 in the PTX group respectively, less than the NS group with 4.0±0.6, 6.0±and 3 d, the PWT were (5.8±1.6), (5.2±1.1), (4.4±0.6), (4.9±0.4), (5.2±1.1), (7.6±1.8) and (10.4±1.6) g in the PTX group respectively, more than the NS group with (2.4 ±0.8), (2.1±0.5), (2.0±0.5), (2.1±0.3), (2.3±0.5), (4.5±0.9)and(8.1±1.4) g 205.6±4.2 and 230.2±3.2 in the PTX group respectively, lower than the NS group with 244.1±4.9, 258.6±4.12 and 276.2±3.4 (P＜the PTX group respectively, lower than the NS group with 230±3 and 205±4 (P＜0.05). Conclusion Pentoxifylline can attenuate the process of mechanical allodynia in a rat model of postoperative pain, its main mechanism may be related to the inhibition of glial cells activation in the spinal cord.     

肾缺血再灌注损伤对大鼠肾脏CD44表达的影响

目的 观察大鼠肾缺血再灌注损伤(RIRI)对肾脏CD44表达的影响.方法 健康Wistar大鼠48只,体重300～350g,随机分为4组(n=12):假手术组(sham组)只分离肾动脉不夹闭;肾缺血60min再灌注1h组(I/R1h组),双肾缺血60min再灌注1h;肾缺血60min再灌注4h组(I/R4h组),双肾缺血60min再灌注4h;肾缺血60min再灌注24h组(I/R24h组),双肾缺血60min再灌注24h.实验结束处死大鼠,抽血检测血清CD44含量,光镜观察肾脏组织形态学改变,免疫组化检测肾脏CD44分子的表达.结果 光镜观察sham组肾组织肾小球较多,肾小管结构完整.I/R各组肾小球毛细血管扩张、淤血,部分肾小球纤维化,体积缩小,大量肾小管细胞水肿、变性,宫腔缩小,部分肾小管腔闭合.其中以I/R4h组形态学改变最明显.I/R各组血清CD44含量分别为(0.88±0.03)ng/ml、(10.22～3.01)ng/ml、(40.12±6.59)ng/ml、(8.12±1.59)ng/ml,肾组织表达分别为0.41±0.024、14.35±5.262、36.357±8.774、10.317±3.726.各组表达均较sham组升高,但是I/R4h组高于其他组(P<0.05).结论 大鼠肾脏缺血再灌注后CD44表达增加,再灌注4h达到峰值,24h开始回落.     

小剂量氯胺酮在术后静脉自控镇痛中的应用

N－甲基－D－天门冬氨酸（NMDA）受体是中枢神经系统中主要的兴奋性氨基酸受体，氯胺酮是NMDA受体非竞争性拮抗药，研究显示氯胺酮的镇痛作用与NMDA受体有密切的关系。动物实验已证明NMDA受体拮抗药可消除伤害性感受器的超敏反应，增强阿片药对神经损害性疼痛的镇痛作用。我科2008年1月至12月应用小剂量氯胺酮复合芬太尼与咪唑安定行术后静脉自控镇痛（PCIA），观察其安全性、有效性，取得了良好的临床镇痛效果，现报道如下。     

利多卡因复合氯胺酮对全脑缺血大鼠海马细胞凋亡的影响

Objective To investigate the effect of lidocaine combined ketamine to the cells necrosis and apoptosis in the CA1 region of rat hippoeampus following global cerebral ischemia-reperfusion. Methods Sixty adult Wistar rats were randomly divided into 6 groups:control group(Ⅰ, n=4),sham operation group (Ⅱ, n=4), model group (Ⅲ, n =4), lidoeaine group (Ⅳ, n =16), ke-tamine group(Ⅴ, n=16), lidocaine and ketamine group (Ⅵ, n=16). The global cerebral ischemia (10 min) was induced by the use of the four-vessel occlusion method. Group Ⅳ,Ⅴ,Ⅵ intraperitoneally injected the lidocaine 10mg/kg, ketamine 10 mg/kg or lidocaine combined ketamine 10 mg/kg. The effect of cells necrosis and apoptosis was detected by using HE staining and TUNEL methods. Results Compared with group Ⅱ the numbers of ischemia neuron of group Ⅳ, Ⅴ, Ⅵ had significant deviation (P<0.05) in 24 h, and group Wl had significant decreased than group Ⅳ, Ⅴ(P<0.05). The isehemia neurons peak presented in 24 h. Compared with group Ⅱ the numbers of apoptosis of group Ⅳ,Ⅴ,Ⅵ had significantly deviation (P<0.05)in 24 h, and group Ⅵ had significantly decreased than group Ⅳ,Ⅴ (P<0.05). The apoptosis peak presented in 24 h and 48 h, and decreased during reperfusion time. Conclusion Li-doeaine combined ketamine can reduce the cell necrosis and apoptosis after global erebral isehemia-reperfusion in rats hippocampus.     

利多卡因预处理对肾脏缺血再灌注大鼠心肌损伤的影响

目的:观察利多卡因对肾脏缺血再灌注大鼠心肌损伤的影响.方法:健康Wistar大鼠36只,体重300～350 g,随机分为3组(n=12),假手术组(sham组)只分离肾动脉不夹闭;肾缺血再灌注组(I/R组),双肾缺血60min、再灌注4 h;利多卡因组(L组)肾动脉阻断前静脉注射利多卡因5mg/kg,I/R组、sham组注射等量生理盐水,术中观察不同时间点的血压、心率.实验结束后处死大鼠,光镜观察心肌组织形态学改变,测定血浆心型脂肪酸结合蛋白(H-FABP)含量,心肌组织中性粒细胞弹性蛋白酶(NE)含量,肿瘤坏死因子-α(TNF-α)的表达.结果:光镜下可见I/R组呈明显心肌损伤的形态学变化,L组心肌组织损伤明显改善.I/R、L组血浆H-FABP,心肌组织NE、TNF-α较sham组升高,但是I/R组高于L组(P<0.05).结论:利多卡因预处理对肾脏缺血再灌注大鼠心肌损伤具有一定程度的保护作用,其机制可能与减轻肾缺血再灌注后心肌组织中性粒细胞浸润及下调TINF-α表达有关.     

右美托咪定对脑膜瘤患者胶质纤维酸性蛋白及肌酸激酶脑型同工酶的影响

目的 探讨盐酸右美托咪定（dexmedetomidine,Dex）对脑膜瘤患者胶质纤维酸性蛋白（glial fibrillary acidic protein,GFAP）及肌酸激酶脑型同工酶（brain typeisoenzyme of creatine phosphokinase,CK-BB）表达的影响,评估Dex对脑膜瘤患者术中脑保护的作用. 方法 选择择期行脑膜瘤切除术患者45例,年龄45岁～65岁,体重在55 kg～65 kg,美国麻醉医师协会（ASA）分级Ⅱ或Ⅲ级,采用随机数字表法将患者分为3组（每组15例）：对照组（C组）,Dex低剂量组（D1组）,Dex高剂量组（D2组）,D1组和D2组于常规诱导前10 min静脉输注Dex负荷量1μg/kg,继之分别以0.2 μg· kg-1·h-1和0.5 μg· kg-1·h-1持续输注至术毕前30 min,C组给与等容量的生理盐水.3组术中维持脑电双频指数（bispectral index,BIS）值在40～49之间,分别于麻醉诱导前（T1）、取出肿瘤时（T2）、拔管时（T3）、术后24 h（T4）采集静脉血样,测定血清中GFAP及CK-BB的浓度,且分别于T1、T2、T3时采集桡动脉及颈静脉球部的血样行血气分析,记录并计算动脉血氧含量（arterial oxygen content,CaO2）、脑动脉-静脉血氧含量差（cerebral arterial venous oxygen content difference,Da-jvO2）和脑氧摄取（cerebral extraction of oxygen,CEO2）. 结果 与T1时比较,3组T2～T4时血清GFAP、CK-BB浓度及CEO2升高（P＜0.05）;T2～T4时D2组血清GFAP[（0.72±0.05）、（0.80±0.05）、（0.90±0.05） μg/L]及CK-BB[（19.3±1.8） 、（21.1±2.4）、（23.5±2.8） U/L]浓度与C组血清GFAP[（0.78±0.06）、（0.88±0.07）、（1.17±0.19） μg/L]及CK-BB[（30.6±2.6）、（33.2±3.4）、（36.1±2.8） U/L]浓度比较差异有统计学意义（P＜0.05）;T2、T3时D1组CEO2[（0.33±0.04）％,（0.30±0.04）％]和D2组CEO2[（0.32±0.04）％,（0.26±0.04）％]与C组CEO2[（0.36±0.03）％,（0.34±0.03）％]比较,差异有统计学意义（P＜0.05）,但D2组降低更为显著（P＜0.01）. 结论 静脉输注Dex可对围术期     

内腔镜手术中冲洗液吸收量监测方法的研究进展

<正>在内腔镜手术,包括经尿道前列腺电切术(transurethral resection of the prostate,TURP)、经宫颈子宫内膜切除术(transcervical resection of the endometrium,TCRE)、经皮肾镜取石术(percutaneous nephrolithotripsy,PCNL)等手术中,为保持手术操作视野的清晰,及时冲洗掉手术中切除的组织、残渣或血液,需要使用大量的冲洗液以一定的速度及压力进行冲洗。冲洗液通过开放的血管、静脉窦进入循环系统,当进入血液循环的冲洗液较多时,将引起以血液稀释、电解质紊乱及循环超负荷为主要特征的前列腺电切综合征