老年病人术后认知功能障碍诊断与干预策略的研究进展

老年病人术后认知功能障碍(POCD)发生率高,会对病人术后产生众多不良影响。POCD延缓病人术后恢复,增加死亡风险,并可能导致认知功能的持续下降,严重影响老年人的生活质量。早期识别POCD和采取有效防治措施可降低POCD的发生,对老年病人尤为重要。本文主要阐述POCD诊断、预防和治疗的最新研究进展,为临床实践和未来研究提供参考。     

中枢5-HT系统和阿尔茨海默病的相关性

<正>阿尔茨海默病(AD)是一种神经退行性疾病,认知功能下降是其主要临床症状,当前抗AD药物只能短暂缓解症状,难以逆转病理过程而且长期使用会引起情绪异常等不良反应;作用于5-羟色胺(HT)系统信号转导为AD的药物研究带来新希望,不仅能改善认知和情绪,还能延缓β-淀粉样蛋白(Aβ)沉积;本文对5-HT系统与AD的相关性进行综述。1 ADAD主要表现为进行性的认知功能障碍,伴随着情绪、摄食、睡眠等其他生理功能失调。     

不同麻醉方法对老年高血压患者下肢关节置换术中高敏C反应蛋白的影响

目的探讨老年高血压患者在下肢关节置换术中,不同麻醉方法对血清高敏c反应蛋白（highsen—sitivity C．reactivityprotein,hs—CRP）的影响。方法根据病人体质状况和美国麻醉师协会（ASA）对手术危险性进行分类,选择Ⅱ～Ⅲ级择期下肢关节置换手术患者30例,随机分为2组,全身麻醉组（A组）和蛛网膜下腔阻滞组（B组）,每组15例。检测2组患者麻醉前（T0）、麻醉后5min（T1）、手术1h（T2）、手术结束缝皮时（T3）的血清hs—CRP水平。结果（1）与麻醉前比较,A、B组不同时点的hs—CRP水平差异均无统计学意义。（2）B组在T2时点hs—CRP显著高于A组（P〈0．05）;其余时点无明显差异。结论2种麻醉方法均可显著降低心肌耗氧量,有效改善心肌氧供需平衡,2组患者心血管事件发生危险性均无明显增加。     

CB2受体激动剂JWH015对大鼠神经病理性疼痛的治疗作用

Objective To test whether activation of CB2 receptor would induce antinociception and investigate the role of in-trathecal JWH015 in the modulation of Tyr-1472 phosphorylation of the spinal NR2B subunit in a model of neuropathic pain. Meth-otis 84 male SD rats with intrathecal catheter insertion were randomly divided into 3 groups: sham + 50% DMSO group (Sham group); CCD + 50%DMSO group(Vehicle group); CCD+JWH015 group(JWH015 group). Seven days after Sham or CCD(without in-trathecal injection), the lumbosacral spinal cords of 6 Sham rats and 6 CCD rats were collected for immunohistochemical study to de-termine the spinal expression of Tyr-1472 phosphorylated NR2B subunit(baseline). The rest were intrathcally injected with 50%DMSO 10 μl or JWH015 10 μg seven days after Sham or CCD. For behavioral studies, the data of paw withdrawal mechanical threshold (PWMT) and paw withdrawal thermal latency (PWTL) were measured in Sham group or CCD group, before intrathecal injection and 1, 2, 4, 8, 24, 72 h after intrathecal injection (n=6). For immunohistochemical study, the lumbosacral spinal cords were collected 4, 8, 24, 72 h after intrathecal injection(n=6). Results Compared with the baseline before operation, the PWMT and the PWTL of Vehicle group and JWHOI5 group began to decrease before intrathecal injection(P<0.01). Compared with Vehicle group, PWMT and PWTL of JWH015 group increased markedly 1, 2 and 4 h after intrathecal injection (P0.05). Tyr-1472 phosphorylated NR2B subunit expression in the superficial dorsal horn was weak in all sham groups, but increased significantly 7 days after CCD. While intrathecal 50%DMSO did not decrease the expres-sion of Tyr-1472 phosphorylated NR2B subunit in the superficial dorsal horn, the expression of Tyr-1472 phosphorylated NR2B sub-unit in the superficial dorsal horn decreased obviously 4 h and 8 h after intrathcal JWH015. However, the expression of Tyr-1472 phosphorylated NR2B subunit in the superficial dorsal horn increased again 24 h and 72 h after intrathcal JWH015. Conclusion In-trathecal administration of CB2 receptor agonist JWHOI5 may provide analgesic effect, which is probably attributed to the decrease in the spinal expression of Tyr-1472 phosphorylated NR2B subunit.     

CB2受体激动剂JWH015对大鼠神经病理性疼痛的治疗作用

Objective To test whether activation of CB2 receptor would induce antinociception and investigate the role of in-trathecal JWH015 in the modulation of Tyr-1472 phosphorylation of the spinal NR2B subunit in a model of neuropathic pain. Meth-otis 84 male SD rats with intrathecal catheter insertion were randomly divided into 3 groups: sham + 50% DMSO group (Sham group); CCD + 50%DMSO group(Vehicle group); CCD+JWH015 group(JWH015 group). Seven days after Sham or CCD(without in-trathecal injection), the lumbosacral spinal cords of 6 Sham rats and 6 CCD rats were collected for immunohistochemical study to de-termine the spinal expression of Tyr-1472 phosphorylated NR2B subunit(baseline). The rest were intrathcally injected with 50%DMSO 10 μl or JWH015 10 μg seven days after Sham or CCD. For behavioral studies, the data of paw withdrawal mechanical threshold (PWMT) and paw withdrawal thermal latency (PWTL) were measured in Sham group or CCD group, before intrathecal injection and 1, 2, 4, 8, 24, 72 h after intrathecal injection (n=6). For immunohistochemical study, the lumbosacral spinal cords were collected 4, 8, 24, 72 h after intrathecal injection(n=6). Results Compared with the baseline before operation, the PWMT and the PWTL of Vehicle group and JWHOI5 group began to decrease before intrathecal injection(P<0.01). Compared with Vehicle group, PWMT and PWTL of JWH015 group increased markedly 1, 2 and 4 h after intrathecal injection (P0.05). Tyr-1472 phosphorylated NR2B subunit expression in the superficial dorsal horn was weak in all sham groups, but increased significantly 7 days after CCD. While intrathecal 50%DMSO did not decrease the expres-sion of Tyr-1472 phosphorylated NR2B subunit in the superficial dorsal horn, the expression of Tyr-1472 phosphorylated NR2B sub-unit in the superficial dorsal horn decreased obviously 4 h and 8 h after intrathcal JWH015. However, the expression of Tyr-1472 phosphorylated NR2B subunit in the superficial dorsal horn increased again 24 h and 72 h after intrathcal JWH015. Conclusion In-trathecal administration of CB2 receptor agonist JWHOI5 may provide analgesic effect, which is probably attributed to the decrease in the spinal expression of Tyr-1472 phosphorylated NR2B subunit.     

妇科恶性肿瘤患者纤维蛋白溶解系统的研究

目的　研究妇科恶性肿瘤患者血浆纤维蛋白溶解系统的改变。方法　采用定量酶联免疫吸附试验和发色底物法 ,对 5 7例妇科恶性肿瘤患者 (肿瘤组 )、30例非恶性肿瘤者 (对照组 )血浆中组织型纤溶酶原激活物 (t PA)、纤溶酶原激活物抑止物 (PAI 1)和D 二聚体 (D D)含量及t PA和PAI 1活性进行测定。结果　肿瘤组血浆t PA含量与活性较对照组明显升高 ,PAI 1活性明显下降 ,差异有显著性 (P <0 .0 1) ;D D含量较对照组明显升高 (P <0 .0 5 )。结论　血浆纤溶系统在妇科恶性肿瘤中有明显改变 ,这种改变可能与妇科恶性肿瘤的发展相关 ,进一步研究纤溶系统与妇科恶性肿瘤转移的关系十分必要     

雷米芬太尼和芬太尼用于脊柱侧弯后路矫形手术的麻醉效果比较

目的:比较雷米芬太尼和芬太尼用于脊柱侧弯后路矫形手术的麻醉效果及其对术后疼痛的影响。方法:择期行脊柱侧弯后路矫形手术的患者40例,ASAⅠ～Ⅱ级,年龄11～18岁。随机分为两组:雷米芬太尼组(R组)和芬太尼组(F组)。以丙泊酚、维库溴铵和七氟醚维持麻醉。以R组(0.2μg·kg-1.min-1)和F组(1μg·kg-1.h-1)持续静脉输注维持术中镇痛。唤醒前半小时左右停用维库溴铵和镇痛药。唤醒时间为停用丙泊酚和七氟醚到患者双侧脚趾能动的时间。手术结束前R组停用雷米芬太尼后给予芬太尼2μg/kg,术后两组以芬太尼10μg·kg-1.min-1持续静脉镇痛,随访患者术后24h内的疼痛情况。结果:R组术中唤醒时间(12.3±5.7)min明显短于F组(21.6±6.5)min(P<0.01)。两组患者术后镇痛满意,术后疼痛评分(VAS评分)两组间比较差异无统计学意义。结论:在脊柱侧弯后路矫形手术中,R组患者术中唤醒明显快于F组。术中停用雷米芬太尼(0.2μg·kg-1.min-1)后及时追加芬太尼,术后未诱发明显的痛觉过敏。     

风湿性心脏病二尖瓣病变患者瓣膜替换术后肺功能的改变

目的：了解风湿性心脏病二尖瓣病变患者二尖瓣替换术（ＭＶＲ）后肺功能的改变。方法：观察２６例风湿性心脏病二尖瓣病变患者ＭＶＲ术前和术后３～１２个月的肺功能改变。结果：ＭＶＲ后３个月的肺功能与术前相比，无明显好转。术后６～１２个月，患者的各通气功能指标均有明显增加（Ｐ＜０．０５～Ｐ＜０．０１），但肺的一氧化碳弥散功能（ＤＬＣＯ）术后不但无增加，反而有下降的趋势。结论：ＭＶＲ术后３个月患者的肺功能与术前相比，无明显好转，可能与剖胸手术创伤有关。随着心功能的改善，术后６～１２个月，患者的通气功能逐渐改善，但ＤＬＣＯ并不增加，推测可能与患者术后肺泡毛细血管容量减少以及肺组织结构损害不可逆性改变有关。