克罗卡林预处理对脑缺血/再灌注大鼠水通道蛋白4表达及血脑屏障通透性的影响

Objective To investigate the effects of ATP-sensitive potassium channel openers (Cromakalim) on the expression of aquaporin-4 and permeability of blood-brain barrer (BBB) after cerebral ischemic/repeffusion. Methods Thirty healthy male Wistar rats were randomized into three groups for different conditioning, the sham-operated group(A,n=10), the cerebral I/R group(B,n=10),and the cerebral I/R+Cromakalim group (C,n=10). Intraluminal suture methods were applied to establish the middle cerebral artery occlusion(MCAO) model with occlusion 2 h and reperfusion 24 h. The neurobehavioral function was evaluated with Bederson's test, and the pathological changes were observed with hematoxylin-eosin(HE) staining. The water content of brain was evaluated by wet-dry weight method, and the expressions of IgG and AQP-4 in brain were observed by immunohistochemistry staining. Results In comparison with group A's water content(78.2±1.3 )% and expressions of IgG and AQP-4 (0.0±0.0,13.6±1.5) ,the expressions of IgG and AQP-4(2.4±0.4,19.8±1.9) and the water content (81.3±1.2)% in group B both were significantly higher (P<0.05). However,in group C,the water content (79.5±0.6)%was similar to group A( 78.2± 1.3 )%. Interestingly, the expressions of IgG and AQP-4( 1.1 ±0.2, 15.7± 1.2 ) of group C were higher than that of group A' s (P<0.05); compared with group B, The neurobehavioral deficit scores were obviously reduced, the expressions of IgG and AQP-4 (1.1 ±0.2,15.7±1.2) and the water content (79.5 ±0.6)% were significantly lower in group C (P<0.05).Conclusion Cromakalim maybe can alleviate cerebral edema via reducing permeability of blood-brain barrier and inhibit the expression of AQP-4 in cerebral ischemia/reperfusion mice.     

丙泊酚在胃镜治疗中的应用

本院近期应用丙泊酚镇静麻醉剂对36例患者施行胃镜下治疗,取得满意效果,报告如下. 1 临床资料 36例中男20例,女16例,年龄26～82岁,平均56岁.胃息肉高频电切除术21例,上消化道异物取出术6例,胃柿石碎石术5例,上消化道出血注射硬化剂治疗术4例.     

小剂量罗哌卡因复合舒芬太尼在剖宫产腰麻一硬膜外阻滞联合麻醉中的应用

目的 观察罗哌卡因复合舒芬太尼用于剖宫产腰麻一硬膜外阻滞联合麻醉（CSEA）的效果及安全性。方法 将择期行剖官产手术患者80例随机分为观察组和对照组各40例,分别予罗哌卡因＋舒芬太尼及罗哌卡因行CSEA。观察两组平均动脉压（MAP）、药物起效时间、运动恢复时间、痛觉恢复时间、肌松效果、牵拉反应、新生儿Apgar评分及麻醉并发症发生情况。结果 两组蛛网膜下腔给药后3、5min MAP均显著下降,尤以对照组为著（P均〈0．05）;两组药物起效时间、运动恢复时间、痛觉恢复时间和术中肌松效果比较无显著差异,且观察组无一例出现牵拉反应;两组不同时间点新生儿Apgar评分均无显著差异,术中均未发生呼吸抑制和心动过缓,术后均未出现腰背部穿刺点疼痛、双下肢异常感和头痛;两组仰卧位综合征、恶心及呕吐发生情况无明显差异,观察组4例出现轻度一过性皮肤瘙痒。结论 小剂量罗哌卡因复合舒芬太尼用于剖宫产CSEA麻醉效果确切、安全性高。     

腰麻和硬膜外联合麻醉用于妇科肿瘤患者的临床观察

妇科肿瘤患者手术时选用硬膜外腔阻滞麻醉常出现骶神经阻滞不全，内脏牵拉反应难以避免。作者旨在观察腰麻-硬膜外联合麻醉用于妇科肿瘤手术的麻醉效果及对血流动力学的影响，以了解其可行性及安全性。     

4000/预防性应用克罗卡林对大鼠脑缺血后AQP-4和血脑屏障通透性的影响

Cromakalim,an adenosine triphosphate-sensitive potassium channel opener,exhibits protective effects on cerebral ischemia/reperfusion injury.However,there is controversy as to whether this effect is associated with aquaporin-4 and blood-brain barrier permeability.Immunohistochemistry results show that preventive administration of cromakalim decreased aquaporin-4 and IgG protein expression in rats with ischemia/reperfusion injury;it also reduced blood-brain barrier permeability,and alleviated brain edema,ultimately providing neuroprotection.     

舒芬太尼和芬太尼对高血压病人气管插管应激反应的影响

目的评价舒芬太尼和芬太尼对高血压患者气管插管应激反应的影响,比较其气管插管期间血流动力学和血浆儿茶酚胺水平的变化。方法 60例择期全身麻醉手术的原发性高血压患者,随机分为舒芬太尼组(SF组)和芬太尼组(F组),分别于麻醉诱导前(T0)、气管插管前(T1)、气管插管即刻(T2)、气管插管后3 min(T3)记录收缩压(SBP)、舒张压(DBP)、心率(HR),并于各时点采静脉血检测血浆去甲肾上腺素(NE)和肾上腺素(E)水平。结果两组患者年龄、体重、性别比、血压比较差异无统计学意义(P(0.05);用药后两组患者SBP、DBP、HR均明显降低(P(0.05),气管插管时和气管插管后SF组DBP、HR变化幅度较小,明显低于F组,差异有统计学意义(P(0.05);两组患者各时点NE的变化差异无统计学意义(P(0.05),气管插管即刻和气管插管后F组E水平明显升高(P(0.05),并且与SF组比较差异有统计学意义(P(0.05)。结论舒芬太尼比芬太尼能更有效地抑制高血压病人气管插管的应激反应,维持血液动力学稳定,抑制血浆儿茶酚胺释放,对提高全麻诱导和气管插管期间的安全性有重要临床意义。     

丙泊酚在胃镜治疗中的应用

本院近期应用丙泊酚镇静麻醉剂对36例患者施行胃镜下治疗,取得满意效果,报告如下。1临床资料 36例中男20例,女16例,年龄26～82岁,平均56岁。胃息肉高频电切除术21例,上消化道异物取出术6例,胃柿石碎石术5例,上消化道出血注射硬化剂治疗术4例。     

不同剂量舒芬太尼对病人气管插管血流动力学的影响

目的比较不同剂量舒芬太尼复合异丙酚对病人气管插管血流动力学及脑电双频谱指数的影响,探讨舒芬太尼有效抑制气管插管应激反应的合适剂量。方法 60例择期全麻手术病人随机分为三组,每组20例,舒芬太尼剂量分别为0.2μg/kg（Ⅰ组）、0.3μg/kg（Ⅱ组）、0.4μg/kg（Ⅲ组）。3 min后三组均静脉注射异丙酚2 mg/kg和维库溴胺0.1 mg/kg麻醉诱导,经口气管内插管。记录麻醉诱导前（T0）、静脉注射舒芬太尼后（T1）、静脉注射异丙酚后（T2）、气管插管即刻（T3）、插管后3 min（T4）的收缩压（SBP）、舒张压（DBP）、心率（HR）、脑电双频谱指数（BIS）的变化。结果与T0比较,T1时三组SBP、DBP、BIS比较差异无统计学意义（P〉0.05）,T2时三组SBP、DBP、BIS明显下降（P（0.05或P（0.01）,T3时Ⅰ组SBP、DBP、BIS明显升高（P〈0.05）;与Ⅱ组比较,T3时Ⅰ组SBP、DBP、BIS明显升高（P〈0.05）;三组间各时点HR比较差异无统计学意义。结论应用舒芬太尼0.3μg/kg复合异丙酚2 mg/kg麻醉诱导能有效抑制气管插管应激反应,并维持插管期间血流动力学稳定,是临床使用的合理剂量。     

妊娠合并食管裂孔疝误诊

患者36岁,孕1产0,因停经7个月,持续性上腹部隐痛伴间歇性呕吐13天于1995年7月31日入院.既往体健,孕期经过良好.查体:T36.4℃,P81次/分,R19次/分,BP14/6kPa,心肺正常,腹软,肝脾未及,剑突下有压痛,无反跳痛,未触及包块,宫底耻上25cm,头先露,固定,胎心规律,140