心率变异性频域分析在麻醉中应用探讨

目的利用惠普监护仪和现有计算机软件技术行麻醉期间心率变异性分析,扩展现有设备的功能.方法从惠普监护仪中采集麻醉插管期间病人的心电图数据,计算出R-R间期,利用MATLAB软件对其进行快速傅立叶变换,实现心率变异性分析.结果利用本方法可分析出与比麻醉前相比HRV明显降低.结论使用本方法,利用现有计算机软件技术,可扩展惠普监护仪功能实现心率变异性分析.     

LY354740对氯胺酮暴露致老年小鼠认知功能障碍的影响

【摘要】〓目的〓评价LY354740预先给药对氯胺酮暴露致老年小鼠认知功能障碍的影响。方法〓健康雄性SPF级C57BL/6小鼠36只,18月龄,体重20~30 g, 随机分成3组(n=12);氯胺酮组(K组),LY354740预处理组(L组),空白对照组(C组)。K组和L组均腹腔注射氯胺酮30 mg/kg,每隔30 min重复注射一次,每天注射氯胺酮3次,L组注射氯胺酮前30分钟注射LY354740 10 mg/kg,C组注射等量生理盐水。连续注射2周后进行认知功能测试,包括Morris水迷宫和旷场实验测试。结果〓与C组比较,K组逃避潜伏期延长,原平台停留时间和穿越平台次数减少,旷场中心区停留时间缩短;与K组比较,L组逃避潜伏期明显缩短,原平台停留时间和穿越原平台次数增多,旷场中心区停留时间延长。结论〓LY354740预先给药可以改善氯胺酮暴露所致老年鼠认知功能障碍。     

异丙酚和异氟醚对全麻手术病人脑干听觉诱发电位影响的比较

目的 比较异丙酚和异氟醚对全麻手术病人脑干听觉诱发电位(BAEP)的影响.方法 择期拟行全麻手术的病人30例,年龄20～50岁,体重44～75 kg,ASA分级Ⅰ或Ⅱ级,随机分为2组(n=15):异丙酚组(P组)和异氟醚组(I组).监测SpO2、PETCO2、BAEP和BIS.麻醉诱导:P组靶控输注异丙酚,血浆靶浓度6μg/kg,I组吸入3%异氟醚,两组静脉注射维库溴铵0.1 mg/kg,气管插管后行机械通气,维持PETCO235～40 mm Hg,SpO298%～100%.P组靶控输注异丙酚,I组吸入异氟醚维持麻醉.分别于麻醉诱导前(T0)、气管插管后BIS达70并维持5 min(T1)和BIS达50并维持5 min(T2)时,记录Ⅰ波、Ⅲ波、Ⅴ波的潜伏期、Ⅰ-Ⅲ、Ⅲ-Ⅴ、Ⅰ-Ⅴ的峰间期.结果 P组Ⅰ波、Ⅲ波、Ⅴ波的潜伏期和Ⅰ-Ⅲ、Ⅲ-Ⅴ、Ⅰ-Ⅴ的峰间期组内比较差异无统计学意义(P＞0.05);与T0时比较,I组T1时Ⅰ波、Ⅲ波、Ⅴ波的潜伏期和Ⅰ-Ⅲ、Ⅲ-Ⅴ、Ⅰ-Ⅴ的峰间期差异无统计学意义(P＞0.05),T2时Ⅲ波、Ⅴ波的潜伏期和Ⅰ-Ⅲ、Ⅲ-Ⅴ、Ⅰ-Ⅴ的峰间期延长(P＜0.05或0.01);与T1时比较,I组T2时Ⅲ波、Ⅴ波的潜伏期和Ⅰ-Ⅲ、Ⅰ-Ⅴ的峰间期延长(P＜0.05或0.01);与P组比较,I组T2时Ⅴ波潜伏期和Ⅰ-Ⅴ峰间期延长(P＜0.05).结论 与异氟醚相比,等效剂量的异丙酚对全麻手术病人BAEP的影响更小,提示其对脑干功能的抑制作用更小.

Abstract：

Objective To compare the effects of propofol versus isoflurane on brainstem auditory evoked potential (BAEP) and explore the difference in the effects of the two anesthetics on the brainstem. Methods Thirty ASA Ⅰ or Ⅱ patients aged 20-50 yr without heating disorder, scheduled for elective surgery performed under general anesthesia were randomly divided into 2 groups (n = 15 each): propofol group (group P) and isoflurane group (group Ⅰ). SpO2, PET CO2, BIS and BAEP were continuously monitored before and during anesthesia. Anesthesia was induced by propofol administered by TCI or isoflurane inhalation. Tracheal intubation was facilitated with vecuronium. The patients were mechanically ventilated. PET CO2 was maintained at 35-40 mm Hg and SpO2 at 98%-100%. After intubation BIS was maintained at 70 and 50 respectively ,the latency of the wave Ⅰ , Ⅱ and Ⅴ and the inter-peak latency (IPL) betwecn wave Ⅰ -Ⅲ , Ⅲ-Ⅴ and Ⅰ -Ⅴ were recorded.Results In group P there was no significant difference in the latency of the wave Ⅰ , Ⅲ and Ⅴ and the IPL between wave Ⅰ - Ⅲ , Ⅲ - Ⅴ and Ⅰ - Ⅴ between the baseline before anesthesia and at BIS 70 and 50. In group Ⅰ the latency of wave Ⅲ and Ⅴ and the IPL between wave Ⅰ - Ⅲ , Ⅲ - Ⅴ and Ⅰ - Ⅴ were significantly longer at BIS 50 than the baseline before anesthesia, while the latency of wave Ⅲ and Ⅴ and the IPL between wave Ⅰ -Ⅲ andⅠ -Ⅴ at BIS 50 were significantly longer than that at BIS 70. At BIS 50 the latency of wave Ⅴ and the IPL between wave Ⅰ -Ⅴ were significantly longer in group Ⅰ than in group P. Conclusion At comparable depth of anesthesia propofol exerts less depressant effects on BAEP indicating less depression of brainstem.     

不同感觉神经损伤对大鼠病理性疼痛的影响及其机制研究

目的 观察剪断大鼠的不同感觉神经分支引起的疼痛行为学表现及脑源性神经营养因子(BDNF)在其中的作用.方法 按随机数字表法将24只大鼠分为3组:SUR组,GS组和SHAM组,每组各8只,分别进行剪断Sural、GS神经和假手术.观察3组L5DRG和脊髓背角的BDNF表达情况及损伤的细胞类型.结果 GS组大鼠术后同侧后肢机械刺激50%缩足阈值较基础值和SHAM组显著下降(P＜0.01),热刺激撤足持续时间显著延长(P＜0.01),SUR组则无变化(P＞0.05).GS组L5DRG中BDNF阳性神经元比率[(37.87±4.23)%]和脊髓的BDNF阳性面积百分比[(21.9±3.1)%]较SHAM组增高[(分别为(17.31±2.12)%],(12.6±1.3)%],差异具有显著性(P＜0.01);而SUR组与SHAM组之间无统计学差异(P＞0.05).GS组表达BDNF的FG阳性神经元较SUR组明显增高(P＜0.01)[分别为(81.5%±3.8)%,(6.4±0.9)%];GS组中NF200与FG共染神经元占NF200阳性神经元的百分比较SUR组显著增高(P＜0.01)[分别为(47.7±1.8)%和(26.7±2.3)%].结论 切断骨骼肌的感觉神经会产生痛觉过敏,而切断皮肤的感觉神经则不会.不同类型神经元受损,以及DRG和脊髓背角的BDNF表达差异是导致这种痛觉差异的重要原因.

Abstract：

Objective To observe the pain behavioral performance of rats that different sensory nerve fibers were transected,and examine the expression of brain-derived neurotrophic factor(BDNF) in these models.Methods Twenty-four rats were divided into three groups according to random number table method:SUR group,GS group and SHAM group, which received sural nerve transection, gastrocnemius-soleus nerve transection or sham operation respectively.There were 8 rats in every group.The expression of BDNF in the lumbar 5 DRG and spinal dorsal horn were detected,and the types of damaged cells were also observed.Results In GS group, 50% paw-withdrawal thresholds were significantly decreased on the ipsilateral hind paw compared with baseline and with those in SHAM group,and the paw-withdrawal durations in response to the thermal stimulus increased significantly (P＜0.01 ＝.In contrast, no change was found in SUR group(P＞0.05 ).The expression of BDNF in the lumbar 5 DRG ( (37.87 ± 4.23 ) % ) and spinal dorsal horn ( (21.9 ± 3.1 ) % ) was significantly higher in GS group than in SHAM group( ( 17.31 ± 2.12 ) %, ( 12.6 ± 1.3 ) % ), and no significant difference was found between SUR and SHAM groups(P＞0.05 ).FG opposite cells which also expressed BDNF in GS group were more than those in SUR group ( (47.7 ± 1.8) % and (26.7 ± 2.3 ) % ) (P ＜ 0.01 ＝.The percentage in N200 and FG double positive cells to N200 positive cells in GS group was significantly increased in GS group than those in SUR group ( (47.7 ±1.8 ) %, (26.7 ± 2.3 ) % ) (P ＜ 0.01 ＝.Conclusion The data suggest that injury of the sensory nerve innervating skin does not produce hyperalgesia, but injury of the sensory nerve innervating muscle does.Different kinds of neuron were damaged and the differences of BDNF expression is essential for this difference.     

The use of continuous spinal anesthesia in high risk elderly patients undergoing lower abdominal or lower extremity surgery

The use of continuous spinal anesthesia in high risk elderly patients undergoing lower abdominal or lower extremity surgery@彭书崚$(Dept Anesthesiol,2nd Affil Hosp,Sun Yat-sen Univ,Guangzhou 510120     

麻醉前应用抗胆碱能药物的专家共识

该专家共识经多方多次征询意见,几经易稿,形成此稿。作者排名按拼音为序,徐世元教授执笔,供麻醉临床工作者参考。     

医院中层科室的组织文化模式探讨

现代社会的发展要求各医院科室建立相应的组织文化。主要讨论组织文化与其影响因素之间的相互作用 ,以及麻醉科应该建立何种组织文化模式 ,如何建立 ;认为组织文化无绝对的好坏之分 ,麻醉科在建立自己的组织文化中应因地制宜。     

异丙酚加小剂量芬太尼在小儿手术中的应用

目的 选30例小儿短小手术病人,观察异丙酚加小剂量芬太尼的麻醉效果及对呼吸、循环功能的影响。方法 诱导先静注芬太尼1μg/kg,接着静注异丙酚1mg/kg,继以0.2～0.4mg·kg~(-1)·min~(-1)的速率持续输入,直到手术结束。结果 麻醉效果满意,对循环功能影响轻,但对呼吸功能有一定抑制。结论 异丙酚加小剂量芬太尼用于小儿手术中,埘循环影响轻微,虽然对呼吸有一定的抑制,但经严密观察及时处理,是安全可行的。     

不同剂量瑞芬太尼复合异丙酚快速诱导的效果比较

目的：在不使用肌松药行气管插管的情况下,观察不同剂量的瑞芬太尼复合异丙酚快速诱导对患者心血管反应、插管条件的影响。方法：42例手术患者,ASAⅠ-Ⅱ级,将患者随机分为3组,每组14例。PR2组：异丙酚2mg／kg复合瑞芬太尼2ug／kg;PR4组：异丙酚2mg／kg复合瑞芬太尼4ug／kg;PR8组：异丙酚2mg／kg复合瑞芬太尼8ug／kg。记录各时点MBP、HR的变化、判断气管插管条件。结果：在3组患者中,PR8组气管插管条件最好,但部分患者在麻醉诱导完毕时出现心动减慢、血压下降;PR4组患者中,有1例患者出现呛咳反应;而PR2组患者中,有5例患者下颌不够松弛、出现呛咳反应。结论：在不使用肌松药的情况下,联合使用异丙酚2mg／kg、瑞芬太尼4-8μg／kg快速诱导的方法可以有效抑制气管插管时的心血管反应、取得较好的插管条件。