己酮可可碱对术后痛模型大鼠脊髓胶质细胞激活的影响

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.     

术后疼痛管理的研究进展

术后疼痛（Postoperative pain）不仅给患者带来痛苦,还给其带来严重的心理及生理损伤,增加并发症的发生率。有效缓解术后疼痛,提高患者的生活质量,是众多临床学者当前面临的主要课题。     

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.     

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.     

瑞芬太尼预防全麻苏醒期呛咳的研究进展

正在全麻苏醒期,严重呛咳会导致高血压、心动过速、颅内高压和眼内压增高等各种不良并发症。尤其在神经外科手术和甲状腺手术等苏醒期,严重的呛咳及血流动力学变化会造成手术部位出血、再次手术等严重后果~([1])。瑞芬太尼作为一种超短效阿片类药物,能有效改善患者对气管导管的耐受性,预防严重呛咳反射,维持血流动力学稳定。但不同麻醉维持药物及性别可能影响瑞芬太尼用于预防苏醒期呛咳的剂量。本文就瑞芬太尼预防麻醉苏醒期呛咳抑制机     

脑氧饱和度监测在大型手术中的临床应用进展

近红外光谱技术能对脑氧饱和度进行连续、无创伤、灵敏的监测,其操作简易,能为临床诊疗提供重要诊疗依据。近年,利用反射性近红外光谱技术检测人脑组织氧饱和度(rSO2)在心脏手术、胸科手术、神经外科手术等非心脏手术、低温、低血压和重症监护等领域得到迅速发展。我们就近红外光谱技术监测脑氧饱和度在大型手术中的临床应用进展进行综述。1脑氧饱和度监测在心血管手术中的应用     

脑氧饱和度监测在大型手术中的临床应用进展

近红外光谱技术能对脑氧饱和度进行连续、无创伤、灵敏的监测,其操作简易,能为临床诊疗提供重要诊疗依据。近年,利用反射性近红外光谱技术检测人脑组织氧饱和度（rSO2）在心脏手术、胸科手术、神经外科手术等非心脏手术、低温、低血压和重症监护等领域得到迅速发展。我们就近红外光谱技术监测脑氧饱和度在大型手术中的临床应用进展进行综述。 1脑氧饱和度监测在心血管手术中的应用     

左双腔导管误插入右主支气管内1例

<正> 患者,男,50岁,因腰痛伴右下肢麻木、乏力2个月收住骨科。体查:T38.0C,P84bpm,R20次/分,BP15/10kPa(112/75mmHg)。胸片显示右肺巨大包块,考虑右肺包虫转入胸科,在全麻下行右肺包虫摘除术,静脉注射咪唑安定5mg,芬太尼0.2mg,2.5％硫喷妥钠12mL,琥珀胆碱10mg快速诱导,选用Robertshaw左双腔导管气管内插管后,听诊双肺尖均可闻及呼吸音。试行左侧导管单肺通气良好,但两侧肺部均可闻及呼吸音。右侧导管单肺通气时,气道压力峰值大于30cmH_2O,通气受阻,将导管推进1cm并适度向左侧旋转后,气道压力峰值减小到18cmH_2O,可以通气,听诊右肺可闻及较弱的呼吸音,SpO_299％,牢固固定导管后开始手术。术中见右     

罗哌卡因复合地塞米松双侧眶下神经阻滞对小儿唇裂修复术后疼痛与应激水平的影响

目的 观察罗哌卡因复合地塞米松双侧眶下神经阻滞对小儿唇裂修复术后疼痛与应激水平的影响. 方法 择期行先天性唇裂修复术患儿60例,按随机数字表法分为2组(每组30例):A组,0.25％罗哌卡因1 ml复合地塞米松1 mg配成2ml,于术前行双侧眶下神经阻滞;B组,手术结束后静脉给予地佐辛0.1 mg/kg.观察并记录苏醒期躁动发生率及躁动评分,记录术后2 h(T3)、4 h(T4)、6 h(T5)、8 h(T6)、12 h(T7)、24 h(T8) CRIES(crying,required O2 for SP02＞95％,increased vital signs, expression,sleeplessness)评分.评分≥4分时给予地佐辛0.1 mg/kg肌内注射,记录术后镇痛持续时间与24 h内注射地佐辛总剂量,记录术后副作用.于麻醉前(T1)、手术结束即刻(T2)、T6、T8时采集静脉血测定皮质醇(cortisol,COR)、去甲肾上腺素(norepinephrine,NE)、肾上腺素(epinephrine,E)水平.用放射免疫法测定血清COR浓度,用ELISA法测定血清E和NE的浓度. 结果 A组苏醒期躁动发生率、躁动评分明显低于B组,差异有统计学意义(P＜0.05).A组T4、T5、T6时CRIES评分低于B组,差异有统计学意义(P＜0.05),两组T7、T8时CRIES评分差异无统计学意义(P＞0.05).额外镇痛药需求总量、术后恶心呕吐发生率比较,A组明显低于B组,差异有统计学意义(P＜0.05).平均镇痛时间A组明显长于B组(P＜0.05).T6时A组血清NE、E、COR浓度均低于B组,差异有统计学意义(P＜0.05).T8时血清NE、E、COR浓度接近麻醉前水平. 结论 罗哌卡因复合地塞米松双侧眶下神经阻滞可为唇裂修复术患儿提供有效的术后镇痛,镇痛持续时间明显延长,抑制由于疼痛导致的应激水平的增强.