缺血预处理-后处理对大鼠肠缺血再灌注损伤的影响

Objective To evaluate the effects of ischemic preconditioning-postconditioning on the intestinal ischemia-reperfusion (IR) injury in rats. Methods Forty healthy male SD weighing 225-275 g were randomly assigned into 5 groups ( n = 8 each): group I sham operation (group S) ; group II intestinal IR (group IIR); group Ⅲ ischemic preconditioning (group Ipr); group IV ischemic postconditioning (group Ipo); group V Ipr+ Ipo. The rats were anesthetized with intraperitonel 20% urethane 5 ml/kg. Superior mesenteric artery (SMA) was occluded for 60 min followed by 60 min reperfusion. In group S, SMA was isolated but not occluded. In group Ipr, SMA was occluded for 10 min followed by 10 min reperfusion, and the rest procedures were performed using the method described in group IIR. In group Ipo, 60 min ischemia was followed by three 30 s episodes of ischemia at 30 s intervals for reperfusion. In group Ipr+ Ipo, Ipr was performed followed by Ipo and the procedures were performed using the methods described in group Ipr and Ipo. The animals were killed at 60 min of reperfusion. The intestinal tissues were immediately removed for determination of MDA content, SOD and MPO activities and the degree of damage to intestinal mucous membrane was scored according to Chiu score. Arterial blood samples were taken for determination of plasma concentrations of TNF-α and 1L-6. Results Compared with group S, Chiu score, MDA content, MPO activity, and plasma concentrations of TNF-α and IL-6 were significantly increased, whereas SOD activity decreased in the other 4 groups ( P < 0.05). Chiu score, MDA content, MPO activity, and plasma concentrations of TNF-α and IL-6 were significantly decreased, whereas SOD activity increased in group Ipr, Ipo and Ipr + Ipo as compared with group IIR ( P < 0.05). Chiu score and MDA content were significantly lower, whereas SOD activity higher in group Ipr + Ipo than in group Ipr and Ipo ( P < 0.05). No significant differences were detected in the indices between group Ipr and group Ipo ( P > 0.05). Conclusion Ischemic preconditioning-postconditioning can attenuate the intestinal IR injury in rats, and the efficacy is better than that of either Ipr or Ipo alone.     

帕瑞昔布钠在腹腔镜胆囊切除术中预先性镇痛的效果

目的:研究帕瑞昔布钠预先镇痛对腹腔镜胆囊切除术患者术后镇痛的影响及安全性.方法:60例ASA Ⅰ～Ⅱ级择期行腹腔镜胆囊切除术的患者,随机分为3组,每组20例.对照组(C组)麻醉诱导前20 min静注生理盐水10 mL; 预先镇痛组 (P组) 麻醉诱导前20 min静注帕瑞昔布钠40 mg;常规镇痛组(R组)术毕前20 min静注帕瑞昔布钠40 mg.分别记录拔管后0、1、2、4、6、12、24 h的视觉模拟评分法(VAS)的评分及拔管后5、10、15、20 min的Rammesay镇静评分;记录24 h内追加镇痛药及不良反应的情况.结果:术后P组0、1、2、4、6、12 h的VAS评分显著低于C组同时点VAS评分(P<0.05);而P组1、2、4、6 h的VAS评分显著低于R组同时点VAS评分(P<0.05);同时,P组及R组在术后5、10、15、20 min时点的镇静评分显著高于C组同时点的评分(P<0.05).结论:帕瑞昔布钠预先镇痛用于腹腔镜胆囊切除术后镇痛效果确切,同时可减少术后患者躁动的发生,且不良反应少.     

麻醉诱导期不同预保温措施对胆道闭锁患儿术中体温的影响

目的 探讨麻醉诱导期预保温对胆道闭锁患儿术中体温的影响.方法 将46例行肝门空肠Roux-Y吻合手术的胆道闭锁患儿,随机分为试验组(n＝23)和对照组(n＝23).试验组患儿麻醉诱导期使用充气保温毯进行预保温30min;对照组患儿麻醉诱导期采用普通盖被覆盖保温30min.观察并记录两组患儿的体温变化情况.结果 试验组术中低体温发生率为47.6％ (10/21),2例因术中出血较多被剔除;对照组术中低体温发生率为78.3％(18/23).对照组术中低体温的发生率高于试验组,两组比较差异有统计学意义(p＜0.05).结论 胆道闭锁患儿麻醉诱导期应用充气保温毯预保温,有助于保持患儿术中体温相对稳定.     

JAK/STAT通路在大鼠肠缺血再灌注所致肠损伤中的作用

目的: 探讨Janus激酶/信号转导和转录激活子(JAK/STAT)通路在大鼠肠缺血再灌注(I/R)所致肠损伤中的作用。方法: 雄性健康SD大鼠40只,体重230~255 g,随机分为5组(n=8):假手术组(sham组),仅分离肠系膜上动脉(SMA)但不夹闭;肠缺血再灌注组(I/R组),采用阻断SMA 60 min后开放120 min的方法制备肠I/R损伤模型;AG490(JAK特异性抑制剂)组,于夹闭SMA前30 min在大鼠侧腹部皮下注射8 mg·kg^-1 AG490,余同I/R组;雷帕霉素(STAT特异性抑制剂)组(RPM组),于夹闭SMA前30 min在大鼠侧腹部皮下注射0.4 mg·kg^-1 RPM,余同I/R组;二甲基亚砜组(DMSO组),于夹闭SMA前30 min侧腹部皮下注射2 μmol·kg^-1 DMSO,余同I/R组,DMSO系AG490和RPM的溶剂。所有大鼠均于再灌注120 min后取小肠观察肠黏膜形态学变化并行Chiu's评分,同时取肠黏膜组织检测髓过氧化物酶(MPO)和超氧化物歧化酶(SOD)活性,以及丙二醛(MDA)和乳酸(LD)含量,采集动脉血检测血清二胺氧化酶(DAO)活性及15-F_2t-isoprostane、内皮素-1(ET-1)和血栓烷素B₂(TXB₂)浓度。TUNEL法检测肠上皮细胞凋亡情况并计算凋亡指数;采用Western blotting检测磷酸化的JAK2(p-JAK2)及STAT3(p-STAT3)的表达水平。结果: 与sham组比较,其余各组的Chiu's评分和肠黏膜细胞凋 亡指数均显著升高(P＜0.05);而I/R组和DMSO组的LD和MDA含量、DAO活性、MPO活性、15-F_2t-isoprostane浓度、ET-1浓度及TXB₂浓度均显著升高,p-JAK2及p-STAT3蛋白表达量也显著升高,SOD活性显著降低(P＜0.05)。与I/R组和DMSO组比较,AG490组和RPM组的DAO活性、MPO活性、肠黏膜上皮细胞凋亡指数、ET-1浓度、p-JAK2及p-STAT3蛋白表达均显著降低,SOD活性则显著升高(P＜0.05)。 结论: JAK/STAT信号通路的激活参与了肠I/R所致的肠损伤的发生,其作用与促进氧化应激损伤、中性粒细胞的聚集和肠黏膜细胞凋亡有关。     

缺血预处理-后处理对大鼠肠缺血再灌注损伤的影响

Objective To evaluate the effects of ischemic preconditioning-postconditioning on the intestinal ischemia-reperfusion (IR) injury in rats. Methods Forty healthy male SD weighing 225-275 g were randomly assigned into 5 groups ( n = 8 each): group I sham operation (group S) ; group II intestinal IR (group IIR); group Ⅲ ischemic preconditioning (group Ipr); group IV ischemic postconditioning (group Ipo); group V Ipr+ Ipo. The rats were anesthetized with intraperitonel 20% urethane 5 ml/kg. Superior mesenteric artery (SMA) was occluded for 60 min followed by 60 min reperfusion. In group S, SMA was isolated but not occluded. In group Ipr, SMA was occluded for 10 min followed by 10 min reperfusion, and the rest procedures were performed using the method described in group IIR. In group Ipo, 60 min ischemia was followed by three 30 s episodes of ischemia at 30 s intervals for reperfusion. In group Ipr+ Ipo, Ipr was performed followed by Ipo and the procedures were performed using the methods described in group Ipr and Ipo. The animals were killed at 60 min of reperfusion. The intestinal tissues were immediately removed for determination of MDA content, SOD and MPO activities and the degree of damage to intestinal mucous membrane was scored according to Chiu score. Arterial blood samples were taken for determination of plasma concentrations of TNF-α and 1L-6. Results Compared with group S, Chiu score, MDA content, MPO activity, and plasma concentrations of TNF-α and IL-6 were significantly increased, whereas SOD activity decreased in the other 4 groups ( P < 0.05). Chiu score, MDA content, MPO activity, and plasma concentrations of TNF-α and IL-6 were significantly decreased, whereas SOD activity increased in group Ipr, Ipo and Ipr + Ipo as compared with group IIR ( P < 0.05). Chiu score and MDA content were significantly lower, whereas SOD activity higher in group Ipr + Ipo than in group Ipr and Ipo ( P < 0.05). No significant differences were detected in the indices between group Ipr and group Ipo ( P > 0.05). Conclusion Ischemic preconditioning-postconditioning can attenuate the intestinal IR injury in rats, and the efficacy is better than that of either Ipr or Ipo alone.     

大鼠肠缺血再灌注损伤后肠黏膜差异表达蛋白质组的分离与鉴定

3、醛脱氢酶和醛糖还原酶,前3种酶与改善能量代谢相关,后3种酶与抗氧化应激、抑制凋亡相关.结论 建立了重复性较好的正常与II/R损伤后大鼠肠黏膜组织的双向凝胶电泳图谱.II/R的损伤机制可能与顺乌头酸酶、丙酮酸激酶、细胞色素C还原酶、蛋白二硫化物异构酶A3、醛脱氧酶和醛糖还原酶的下调有关.     

瑞芬太尼能够取代氧化亚氮用于地氟烷和芬太尼麻醉的门诊骨科手术吗？

背景手术中使用氧化亚氮（N2O）可能导致多种不良反应和毒性反应。瑞芬太尼与氧化亚氮有相似的特性,包括：降低挥发性麻醉药的MAC、镇痛以及停用后药效快速消失。我们比较了在门诊骨科手术采用地氟烷和芬太尼麻醉的患者中,添加临床等效剂量的氧化亚氮或瑞芬太尼对手术后转归的影响。方法70例行门诊骨科手术的患者入选。其中35例吸入66％的N2O,其余35例接受静脉注射0．085ug·kg^-1·min^-1的瑞芬太尼。所有患者均复合使用地氟烷并逐步增加剂量至脑电双频指数（BIS）为50,同时静脉注射芬太尼。测定的主要转归指标为患者在语言刺激下苏醒的时间,次要转归指标包括：神经心理测验、定向力恢复时间、血流动力学指标、疼痛和恶心的视觉模拟评分、出院时间以及满意度评分。此外还观察地氟烷的呼气末平均浓度和芬太尼效应室浓度。结果语言唤醒时间的中位数（四分位距）：瑞芬太尼组为3．0分钟（3．0—5．0分钟）,N2O组的为4．6分钟（3．0～8．1分钟）,两组间差异无统计学意义。瑞芬太尼组的定向力恢复时间为6．0分钟（5．0—8．5分钟）明显短于N2O组8．0分钟（5．0～12．8分钟）。两组患者地氟烷和芬太尼的使用剂量、神经心理测试以及其他测定的转归指标均无显著差异。结论本研究表明在地氟烷和芬太尼麻醉期间,0．085ug·kg^-1·min^-1的瑞芬太尼能够代替66％N2O,并且不改变患者的临床转归。     

三种5-HT3受体拮抗剂对妇科病人术后恶心呕吐的影响

【目的】对比观察5-HT3受体拮抗剂对妇科病人术后恶心呕吐(PONV)的影响。【方法】120例择期行妇科开腹手术的患者,ASAⅠ-Ⅱ级,年龄20～60岁,采用腰硬联合阻滞麻醉,术后采用吗啡行硬外镇痛。按双盲原则随机分为4组,每组30例:A组,生理盐水对照组;B组,恩丹西酮8mg;C组,托烷司琼5mg;D组,阿扎司琼10mg.于手术结束时静脉注射上述药物。观察术毕24h给止吐药至第1次出现恶心的时间,各组发生恶心、呕吐的病人数,采用补救药物的病例数,恶心的严重程度,病人对止吐药物的满意度,镇静程度,VAS疼痛程度评分及不良反应。【结果】B、C、D组恶心、呕吐的发生率、再次接受止吐药物的病人的百分率均小于A组(P<0.05),B、C、D组恶心、呕吐的发生率组间比较差异无统计学意义(P>0.05)。A组初次出现恶心呕吐的时间与其余各组相比有统计学意义(P<0.05),另外C、D组初次出现恶心呕吐的时间明显长于B组(P<0.05);A组恶心严重程度评分与其余各组相比有统计学意义(P<0.05),在A组中还发现有两例病人出现严重呕吐.c组恶心严重程度评分明显小于B、D组(P<0.05)。各组VAS疼痛程度评分无显著差异(P>0.05);B、C、D组镇静程度评分与A组比较差异具有统计学意义(P<0.05)。【结论】恩丹西酮8mg、托烷司琼5mg、阿扎司琼10mg在术后24h内预防妇科患者P     

髋关节置换术后胃肠道并发症的发生率和危险因素

目的探讨髋关节置换术后胃肠道并发症的发生率和危险因素。方法回顾2012年1月至2017年12月于本院行髋关节置换术的患者956例,男466例,女490例,年龄17~97岁,BMI 12.9~38.0kg/m~2,ASAⅠ—Ⅳ级。记录患者一般情况和术前情况,包括性别、年龄、BMI、ASA分级、伴随疾病(高血压、胃肠道手术史、胃肠道疾病史等)、心功能NYHA分级、AST、ALT和血清白蛋白(ALB)等;术中情况,包括手术方式、麻醉方式、手术时间、麻醉时间、液体入量、输血量、出血量、尿量;术后情况,包括使用镇痛泵、阿片类药物、糖皮质激素的情况、住院时间、ICU住院、术后住院时间、胃肠道并发症和其他并发症(急性心肌梗死、肺栓塞、假体脱位、假体周围感染等)。计算胃肠道并发症的发生率,探讨胃肠道并发症的危险因素。结果髋关节置换术后胃肠道并发症发生率为17.2%。单因素分析显示,与未发生胃肠道并发症患者比较,发生胃肠道并发症患者女性比例明显升高,年龄明显增大,高血压比例明显升高,术前AST、ALB浓度明显升高(P0.05);全麻比例明显升高,手术时间、麻醉时间明显延长,术中液体入量、尿量明显增多(P0.05);住院时间、术后住院时间明显延长(P0.05)。多因素Logistic回归分析显示,女性(OR=2.057,95%CI1.421~2.978)、高血压(OR=1.509,95%CI 1.012~2.250)、全麻(OR=1.739,95%CI 1.200~2.521)、手术时间1.5h(OR=2.208,95%CI 1.474~3.308)是髋关节置换术后胃肠道并发症的独立危险因素。结论髋关节置换术后胃肠道并发症的发生率较高,女性患者需要更多的临床关注;维持高血压患者围术期血压平稳、慎重选择全麻、合理缩短手术时间可以降低术后胃肠道并发症的发生率。     

硬膜外术后镇痛对食管癌根治术患者术后心肌酶的影响

目的 :观察硬膜外术后自控镇痛 (PCEA)时老年食道癌患者围手术期心肌酶水平的变化 ,探讨PCEA对该类患者术后心肌血供的影响。方法 :30例 5 6岁以上食道癌患者 ,分为A、B两组 ,每组 15例 ,A组为PCEA组 ,硬膜外置管后静吸复合全麻麻醉下行食道癌根治术 ;B组为对照组 ,术后镇痛均采用肌注哌替啶的方法。观察两组术前、术毕 ,术后 2 4h、48h的心肌酶水平和心血管反应并进行比较。结果 :两组术前、术毕的心肌酶各项差异无显著意义 (P >0 0 5 ) ,术后 2 4h、48hA组的心肌酶水平则较B组低 (P <0 0 5 )。结论 :硬膜外术后PCEA能减少食道癌患者术后心血管的应激反应 ,改善心肌供血