布托啡诺预先给药对大鼠心肌缺血再灌注损伤的影响

Objective To investigate the effects of butorphanol pretreatment on myocardial ischemia-reperfusion (IR) injury in rats. Methods Forty healthy male SD rats weighing 200-250 g were randomly divided into 5 groups (n = 8 each) : sham operation group (group S); IR group; butorphanol pretreatment group (group B); Nor-BNI group (group N) and glibenclamide group (group G) . In group IR, B, N and G, myocardial IR was produced by occlusion of left anterior descending artery (LAD) for 30 min followed by 120 min reperfusion. In group S and IR, normal saline S ml/kg was injected via femoral vein 10 min before ischemia and then continuously infused at a rate of 5 ml· kg -1· h-1 iv. In group B, butorphanol 25 μg/kg was injected via femoral vein 10 min before ischemia and the rest method was the same as that described in group IR. In group N, Nor-BNI 2 mg/kg (a selective κ-opioid receptor antagonist) was injected via femoral vein 20 min before ischemia and the rest method was the same as that described in group B. In group G, glibenclamide 1 mg/kg (a KATP channel blocker) was injected via femoral vein 10 min before ischemia and the rest method was the same as that described in group B. Blood samples were taken from femoral artery at 120 min of reperfusion for determination of the concentrations of serum TNF-α, IL-6 and IL-10 by ELISA. Myocardial infarct area and ischemic area were measured by TTC staining and myocardial infarct size was calculated. Results The concentrations of serum TNF-a, IL-6 and IL-10 were significantly higher in the other four groups than in group S (P < 0.05) . The concentrations of serum TNF-α andIL-6 were significantly decreased while IL-10 increased, and the myocardial infarct size was significantly decreased in group B, N and G as compared with group IR ( P < 0.05) . The concentrations of serum TNF-α and IL-6 were significantly increased while the concentration of IL-10 decreased) and the myocardial infarct size was significantly increased in group N and G as compared with group B ( P < 0.05). Conclusion Butorphanol pretreatment can protect the myocardium against IR injury in rate via activating κ receptor and KATP channel.     

布托啡诺预先给药对大鼠心肌缺血再灌注损伤的影响

Objective To investigate the effects of butorphanol pretreatment on myocardial ischemia-reperfusion (IR) injury in rats. Methods Forty healthy male SD rats weighing 200-250 g were randomly divided into 5 groups (n = 8 each) : sham operation group (group S); IR group; butorphanol pretreatment group (group B); Nor-BNI group (group N) and glibenclamide group (group G) . In group IR, B, N and G, myocardial IR was produced by occlusion of left anterior descending artery (LAD) for 30 min followed by 120 min reperfusion. In group S and IR, normal saline S ml/kg was injected via femoral vein 10 min before ischemia and then continuously infused at a rate of 5 ml· kg -1· h-1 iv. In group B, butorphanol 25 μg/kg was injected via femoral vein 10 min before ischemia and the rest method was the same as that described in group IR. In group N, Nor-BNI 2 mg/kg (a selective κ-opioid receptor antagonist) was injected via femoral vein 20 min before ischemia and the rest method was the same as that described in group B. In group G, glibenclamide 1 mg/kg (a KATP channel blocker) was injected via femoral vein 10 min before ischemia and the rest method was the same as that described in group B. Blood samples were taken from femoral artery at 120 min of reperfusion for determination of the concentrations of serum TNF-α, IL-6 and IL-10 by ELISA. Myocardial infarct area and ischemic area were measured by TTC staining and myocardial infarct size was calculated. Results The concentrations of serum TNF-a, IL-6 and IL-10 were significantly higher in the other four groups than in group S (P < 0.05) . The concentrations of serum TNF-α andIL-6 were significantly decreased while IL-10 increased, and the myocardial infarct size was significantly decreased in group B, N and G as compared with group IR ( P < 0.05) . The concentrations of serum TNF-α and IL-6 were significantly increased while the concentration of IL-10 decreased) and the myocardial infarct size was significantly increased in group N and G as compared with group B ( P < 0.05). Conclusion Butorphanol pretreatment can protect the myocardium against IR injury in rate via activating κ receptor and KATP channel.     

参附注射液对体外缺氧复氧心肌细胞的影响

目的 观察参附注射液对体外缺氧复氧损伤乳鼠心肌细胞凋亡率及Bcl-2、Caspase-3蛋白的影响,探讨其对缺氧复氧损伤心肌细胞保护作用机制.方法 在协和医科大学阜外心血管病医院卫生部心血管疾病再生医学重点实验室进行以下实验:取出生1～2 d SD乳鼠,采用培养乳鼠心肌细胞建立缺氧复氧损伤模型.将培养的心肌细胞随机分为四组:(1)正常对照组(Con组)37℃、5%CO<,2>孵箱中持续孵育20 h,未经缺氧复氧处理;(2)缺氧复氧组(H/R组) 给予培养的心肌细胞单纯缺氧4 h,复氧16 h;(3)低剂量参附注射液组(L-SFI组)在缺氧前30min加入终质量浓度为50μL/mL的参附注射液,余同缺氧复氧组;(4)高剂量参附注射液组(H-SFI组)在缺氧前30 min加入终质量浓度为100μL/mL的参附注射液,余同缺氧复氧组.采用异硫氰酸荧光素(FTI℃)标记的Annexin V(Annexin V-FITC)及碘化丙锭(PI)双染流式细胞仪检测细胞凋亡率.采用增强化学发光免疫印记技术(ECZ-Western blot)检测心肌细胞Bcl-2,Caspase-3蛋白水平.采用SPSS11.5统计软件进行分析,均数计量资料以均数±标准差(x±s)表示,组间比较单因素方差分析,P<0.05为差异有统计学意义.结果 与Con组比较,H/R组细胞凋亡的各个阶段的凋亡率显著增加(P<0.01);与H/R组比较,L-SFI组和H-SFI组凋亡率明显下降(P<0.01).免疫印迹检测结果显示,与Con组比较,H/R组Bcl-2蛋白表达水平显著降低,出现Caspase-3相对分子质量17 000的裂解片断;与H/R组比较,不同浓度的参附注射液组Bcl-2蛋白的表达明显升高,伴随Caspase-3相对分子质量17 000片断的表达减少.结论 参附注射液可以减少缺氧复氧诱导的细胞凋亡,其机制可能通过上调Bcl-2蛋白表达,抑制Caspase-3蛋白的激活,发挥其抗凋亡的作用.     

疑似或确诊新型冠状病毒感染孕妇剖宫产术的围手术期管理建议

2019年年末,湖北省武汉市新型冠状病毒肺炎(COVID-19)疫情突发,鉴于COVID-19具有强烈的传染性,为了增强实施COVID-19孕妇剖宫产术医护人员防控工作的针对性和有效性,武汉大学中南医院作为本次抗击疫情的孕产妇保健定点一线医院,结合救治经验并结合文献,对于疑似或确诊COVID-19孕妇的剖宫产术围手术期管理提出有针对性的建议,内容涉及术前准备、手术和麻醉、术后管理以及需要注意的问题,供同道参考,希望能有所裨益。     

双氯芬酸钠栓对七氟醚复合瑞芬太尼麻醉恢复期患儿的镇痛效应

目的 评价双氯芬酸钠栓对七氟醚复合瑞芬太尼麻醉恢复期患儿的镇痛效应.方法 择期行扁桃体切除和(或)腺样体摘除手术患儿40例,年龄2～10岁,ASA Ⅰ或Ⅱ级,随机分为2组(n=20):对照组(C组)和双氯芬酸钠栓组(D组).吸入l%～3%七氟醚和静脉输注瑞芬太尼0.05～0.1 μg·kg-1·min-1维持麻醉,静脉输注罗库溴铵5～10μg·kg-1·min-1维持肌松.气管插管后,D组将双氯芬酸钠栓1 mg/kg塞至距患儿肛门2 cm处,C组不做任何处理.拔除气管导管即刻采用Ramsay镇静评分评价镇静程度,采用躁动评分评价躁动程度.结果 与C组比较,D组镇静效果好,躁动程度轻(P<0.01).结论 气管插管后经直肠给予双氯芬酸钠栓l mg/kg对七氟醚复合瑞芬太尼麻醉恢复期患儿产生显著的镇痛效应,有助于避免躁动的发生.     

不同剂量芬太尼对气管插管患者应激反应与脑电双频指数的影响

［摘要］目的在应用脑电双频指数(BIS)监测镇静深度的条件下观察靶控输注(TCI)不同剂量芬太尼对插管应激反应及BIS的影响，探讨BIS在45±3的镇静深度下气管插管芬太尼TCI的有效血浆目标浓度。方法90例全麻下行手术患者，随机分为Ⅰ～Ⅲ组，每组30例，麻醉诱导：咪唑安定0.1 mg·kg 1，丙泊酚TCI根据BIS变化调整目标浓度至BIS值稳定在 45±3，罗库溴铵 0.8 mg·kg 1，Ⅰ～Ⅲ组芬太尼 TCI血浆浓度分别设定为 2.5，3.0，3.5 ng·mL 1。分别记录诱导前、诱导后2 min、插管后1，3，5 min血压、心率和BIS值，并于诱导前、插管后1，3，5 min时点取血检测血浆去甲肾上腺素(NE)和血浆皮质醇（Cort）浓度。结果Ⅰ组患者插管后血浆NE浓度及血浆Cort浓度以及血压（SBP、DBP）和心率(HR)显著升高（P＜0.01），Ⅱ、Ⅲ两组患者的血浆NE浓度和血浆Cort浓度插管后虽升高但均在正常值范围内，与插管前比较差异无显著性（P＞0.05）；与诱导后2 min比较,Ⅰ、Ⅱ组插管后1 min BIS值均升高 (P＜0.05)，Ⅲ组BIS变化差异无显著性（P＞0.05）。结论在BIS值达到45±3的镇静深度下，芬太尼TCI血浆目标浓度达到3.0 ng·mL 1可有效预防气管插管应激反应,在血浆目标浓度达到3.5 ng·mL 1则可抑制插管引起的BIS升高且循环稳定。     

麻醉科七年制医学生临床教学改革初探

七年制医学生的培养目标就是造就掌握较高临床技能,具有较大发展潜能的临床医学人才。为了达到七年制麻醉学专业学生的培养要求,应该在七年制医学生硕士阶段注重培养学生的临床实践能力,树立以学生为中心的思想,鼓励学生早期深入临床,充分调动学生的主动性和积极性;还要加强麻醉学理论与临床技能培训,注重学生的思维能力培养,方法学训练和自学能力提高,加强科研能力培养和专业英语学习。通过改进临床教学方式和手段,使学生能够得到教师更细致的指点,并且不断提高教师的素质及临床带教医生的教学水平。只有不断地探索、总结,改进我国现有的临床医学教学模式,使其更加完善,才能培养出合格的高质量的医学毕业生。     

联合腰麻硬膜外麻醉用于妇科手术的临床研究

为研究联合腰麻硬膜外麻醉在临床上的应用 ,对联合腰麻硬膜外麻醉与单纯硬膜外麻醉用于妇科手术的效果及安全性进行了比较研究     

激活腺苷A2B受体对大鼠心肌缺血再灌注时自噬的影响：PI3K/Akt信号通路在其中的作用

目的:评价激活腺苷A2B受体对大鼠心肌缺血再灌注时自噬的影响及磷脂酰肌醇3-激酶/蛋白质丝氨酸苏氨酸激酶(PI3K/Akt)信号通路在其中的作用。方法:清洁级健康雄性SD大鼠48只,体重220～280 g,采用随机数字表法分为4组( n＝12)：假手术组(Sham组)、心肌缺血再灌注组(I/R组)、腺苷A2...     

聚明胶肽用于急性等容血液稀释对犬血流动力学及氧代谢的影响

为了研究聚明胶肽作为血浆代用品用于急性等容血液稀释对犬血流动力学、氧代谢和血液流变学的影响 ,为聚明胶肽的临床应用提供实验依据 ,选择 14例健康杂种犬 ,全身麻醉后接多功能呼吸机 ,股动脉、股静脉置管。经股动脉放血 ,同时以相同速率经股静脉输入同量聚明胶肽注射液。经左颈外静脉置入 5 FSwan-Ganz漂浮导管 ,监测心电图及各血流动力学指标。在血液稀释前、血液稀释即刻、稀释后 60 min、12 0 min抽取股动脉、股静脉和肺动脉血检测血液流变学指标 ,并进行血气分析。结果显示 ,实验动物在血液稀释后 HR、MAP、MPAP、PCWP、CVP均无明显变化 ,CO和 CI值在血液稀释后上升明显 ,TVRI和 PVRI在稀释后下降 ;红细胞压积、全血粘度、红细胞聚集指数均有所下降 (P<0 .0 5 ) ;动脉血 p H值、动脉氧分压 (Pa O2 )、动脉血氧饱和度 (Sa O2 )均无显著变化 (P>0 .0 5 )。