吸入一氧化碳对大鼠脑死亡致肺损伤的影响

Objective To investigate the effects of carbon monoxide (CO) inhalation on lung injury induced by brain death (BD) in rats. Methods Adult male Wistar rats weighing 250-300 g were used in this study. The animals were anesthetized with intraperitoneal pentobarbital sodium 60 mg/kg, tracheostomized and mechanically ventilated (VT 10 ml/kg, RR 50 bpm, PEEP 2 cm H2O). A balloon-tip catheter was placed in the cranium. Twenty-four rats in which Fogarty catheter was successfully placed in the cranium without complication were randomly divided into 3 groups ( n = 8 each) : group I sham operation (group S) ; group II BD and group Ⅲ BDCO. BD was induced by increase in intracranial pressure produced by inflating the balloon at the tip of the catheter. In group S the balloon of the catheter was not inflated. The animals inhaled 40% O2 for 150 min. In group BD, BD was induced and confirmed at 30 min after inflation of the balloon. Then 40% O2 was inhaled for 120 min. In group BDCO, 40% O2 and 0.025% CO were inhaled for 120 min after BD was confirmed at 30 min after balloon inflation. At the end of the experiment the animals were killed. Arterial blood samples were obtained for blood gas analysis before anesthesia (basline), immediately after confirmation of BD, and at 30, 60, 90 and 120 min of CO inhalation. Blood was collected for determination of plasma TNF-α, IL-6 and IL-10 concentrations at 120 min of CO inhalation. The lungs were obtained for determination of W/D lung weight ratio, and MPO activity in the lung tissue and microscopic examination. Lung injury scores were calculated. Results PaO2/FiO2 was stable during the 150 min in group S. Brain death significantly decreased PaO2/FiO2 at 30 min after balloon inflation. PaO2/FiO2 was gradually decreasing during the 120 min in group BD. CO inhalation prevented PaO2/FiO2 from decreasing further. W/D lung weight ratio and MPO activity were significantly higher in group BD than in group S and BDCO. The lung injury score (1 = normal, 4= severely injured) and plasma TNF-αα IL-6 and IL-10 concentrations were significantly higher in group BD than in group S. CO inhalation ameliorated the BD-induced lung injury and attenuated the increase in plasma TNF-a and IL-6 concentration. Plasma IL-10 concentration was significantly higher in group BDCO than in group BD. Conclusion CO inhalation can ameliorate acute lung injury induced by BD through decreasing the local and systemic inflammatory response.     

肝胆手术后胆漏的临床治疗分析

目的 探讨肝胆手术后胆漏的临床治疗方法及效果.方法 选取2008年3月至2020年3月我院收治的54例肝胆手术后胆漏患者,随机分为两组,对照组进行常规治疗,研究组进行针对性治疗.比较两组治疗结果、生活质量、炎性因子水平、总胆红素、谷氨酰转肽酶、白细胞计数.结果 与对照组比较,研究组手术、下床活动、住院天数、肛门排气时间...     

右美托咪定在胸外科手术麻醉中的应用进展

开胸、单肺通气及侧卧位,会导致一系列的病理生理改变,容易发生肺内分流、低氧血症;同时,由于吸入麻醉剂抑制了肺脏的缺氧性肺血管收缩机制,进一步增加了低氧血症的发生率;手术创伤导致肺的缺血再灌注损伤、术后疼痛继发肺不张等,都是胸外科麻醉面临的问题。目前,胸段硬膜外复合全凭静脉麻醉是胸外科较为理想的麻醉方式,并联合椎管内应用吗啡进行术后疼痛,但存在术中知晓和术后镇痛不全等不足。盐酸右美托咪定是一种新型α2 受体激动剂,对α2 ∶ α1 的选择性结合比为1 620 ∶ 1,能高选择性激动中枢及外周的α2 肾上腺素能受体,对肺脏具有保护作用,调节HPV,减少低氧血症的发生;稳定循环,避免血流动力学波动,有效地抑制应激;作为镇痛的一种新辅助用药完善术后镇痛;顺行性遗忘作用与丙泊酚协同麻醉,预防术中知晓;改善术后的认知功能。论文对右美托咪定在胸外科麻醉中的作用机制及优势进行综述。