β-arrestin2抗基因RNA慢病毒表达载体的构建与鉴定

目的构建携带β-arrestin 2抗基因RNA的慢病毒表达载体并对其进行鉴定。方法将线性化的慢病毒载体pGC-FU与抗基因RNA在In-Fusion交换酶作用下构建目的质粒pGC-agRNA,转化感受态细胞,对长出的克隆应用菌落PCR鉴定,再对PCR鉴定阳性的克隆进行测序和比对分析。重组病毒质粒与另外两种辅助包装原件载体质粒通过LipofectamineTM2000共转染293T细胞,培养48 h后,收集细胞培养上清液,将病毒浓缩后在293T细胞中测定病毒滴度,并检测慢病毒载体在工具细胞NG108-15细胞的转染效率。结果抗基因RNA被成功构建入慢病毒表达载体pGC-FU,病毒滴度为2×109TU/mL。用该慢病毒感染NG108-15细胞,当感染复数(MOI)为100时,感染效率大于95%。结论成功构建了携带β-arrestin 2抗基因RNA的慢病毒表达载体,为研究β-arrestin 2在μ阿片受体调控机制中的作用提供了有效的研究工具,而且为抗基因RNA技术应用于体内外实验研究奠定了基础。     

颈部超声在预测困难气道中的研究进展北大核心CSCD

困难气道是指熟练掌握气道管理的医务工作者在使用如面罩、声门上气道通气或气管插管(严格来说,也包括拔管)时遇到困难的临床情况[1]。临床中困难气道的发生率根据不同的定义高达0.5%~10%[2,3]。美国麻醉学会分析显示困难气道事件相关的医疗事故索赔中患者死亡率高达73%[4]。遭遇非预料的困难气道极易增加患者的组织损伤,甚至导致气管切开等一系列后果,延长患者的住院时间,增加相关并发症,与近年来提倡的微创、精准、加速康复外科等理念不符[5],如何提高围术期气道评估的准确性一直是临床麻醉的热点问题。     

项目驱动式教学在纤维支气管镜培训体系中的构建和实践

目前麻醉专业的住院医师培训工作存在实训教学不足、理论与实践脱节等问题。纤维支气管镜引导下清醒插管是处理非紧急困难气道的金标准,但该技术学习曲线长,学习效率低,技能提升缓慢,是临床教学中的难点和痛点。本研究借助ORSIM模拟器开展项目式教学,以解决真实情境问题为任务,使住培医师在课堂即能体验到知识和技能的运用,学会探究并实践知识的建构和迁移,为临床住培医师的实训教学提供新思路和新方法。     

不同麻醉方法对髋部骨折老年患者术后转归的影响

目的：比较全身麻醉（general anesthesia, GA）和区域阻滞麻醉（regional anesthesia, RA）对接受手术治疗的髋部骨折老年患者术后心肺并发症和住院期间死亡率的影响。方法：回顾性分析我院骨科2005年1月至2014年12月间收治的572例髋部骨折老年患者的临床资料,分别记录患者性别、年龄、术前内科合并症、术前卧床时间、骨折原因、手术和麻醉方法、术后心肺并发症以及住院期间的死亡率。应用多重Logistic回归模型分析不同麻醉方法对髋部骨折老年患者术后住院死亡率的影响。结果：8例老年患者发生住院期间死亡（8/572,死亡率1.4%）,其中RA组5例（5/392,死亡率1.3%）,GA组3例（3/180,死亡率1.7%）,两组患者间住院死亡率的差异无统计学意义（P>0.05）,多重Logistic回归分析显示,性别（OR=0.18,95% CI：0.03~1.05,P=0.057）、年龄（OR=1.22,95% CI：1.07~1.38,P=0.002）、术前肺部合并症（OR=12.09,95% CI：2.28~64.12,P=0.003）和手术方式（OR=9.36,95% CI：1.34~64.26,P=0.024）是术后发生住院期间死亡的独立危险因素。36例患者术后发生心血管系统并发症（36/572,发生率6.3%）,其中RA组19例（19/392,发生率4.8%）,GA组17例（17/180,发生率9.4%）, 多重Logistic回归分析显示,年龄（OR=1.13,95% CI：1.07~1.19,P<0.001）、高血压（OR=2.72,95% CI：1.24~5.96,P=0.012）和术前脑血管合并症（OR=2.11,95% CI：0.99~4.52,P=0.054）是发生术后心血管系统并发症的独立危险因素。56例患者术后发生呼吸系统并发症（56/572,发生率9.8%）,其中RA组19例（19/392,发生率4.8%）,GA组37例（37/180,发生率20.6%）,多重Logistic回归分析显示,年龄（OR=1.13,95% CI：1.07~1.19,P<0.001）、术前肺部合并症（OR=2.89,95% CI：1.28~7.05,P=0.020）、术前卧床时间（OR=1.11,95% CI：1.04~1.18,P=0.003）和麻醉方法（OR=5.86,95% CI：2.98~11.53,P<0.001）是术后发生呼吸系统并发症的独立危险因素。结论：RA和GA对接受手术治疗的髋部骨折老年患者住院期间死亡率无显著影响,但RA组患者术后呼吸系统并发症的发生率低于GA组患者。     

颈椎脊素瘤行肿瘤切除术的麻醉管理1例

Chordoma is a slow-growing, locally invasive, low-grade malignant tumor with a prevalence of one in 100 000, accounting for 1%-4% of all malignant bone tumors. At present, it is considered that chordoma originates from ectopic embryonic chordal tissue and can occur in any part of the spine from the skull base to the sacrum. About 50% of chordoma occurs in the sacrococcygeal region, about 30% in the skull base, and the rest occurs in the active spinal region. Cervical chordoma is rare, but it may be accompanied by difficult airways. The tumors compress the pharynx and throat forward, which can cause upper airway obstruction. If the anesthesia is not properly handled, the patient may die of asphyxia. The core issues of airway management during the perioperative period of cervical chordoma surgery involve three main parts: preoperative airway evaluation, airway management and extubation management. Difficult airway assessment often relies on physical examination indicators, such as inter-incisor gap, thyromental distance, neck circumference, Mallampati test, etc. But the accuracy is insufficient. The application of imaging examination in the observation of different tissues can make up for the inaccurate evaluation of the internal structure of the airway. Because chordoma destroys cervical vertebral body and accessories, cervical stability is impaired. Excessive cervical vertebral extention should be avoided during tracheal intubation to prevent severe compression of the spinal cord. It is better to fix the head by an assistant and perform neutral tracheal intubation. Considering that the patient with a difficult airway that could be predicted before operation, the strategy of tracheal intubation under conscious sedation with topical anesthesia was selected. After sedation and topical anesthesia, the patient was successfully intubated with optical stylet. After operation, the patient returned to ICU with tracheal catheter. On the 4th day after operation, the tracheal tube was pulled out. On the 5th day after operation, the patient was transferred to the orthopaedic ward and discharged on the 7th day after operation. It is of great significance to establish specific strategies for such operations to reduce related complications, speed up post-operative rehabilitation and save medical resources. We reported the anesthetic management of cervical chordoma cured in Peking University Third Hospital.     

自媒体应用于麻醉专业住院医师医学教育的可行性及教学方法分析

本研究探讨自媒体应用于麻醉专业住院医师医学教育的可行性及教学方法分析,通过基础理论考核及问卷调查进行教学效果评价,结果发现考核成绩显著提高。麻醉专业医学自媒体内容形式灵活、不受时空限制,在带教老师的指导下,麻醉专业住院医师可以利用这一新的平台进行学习、发展,同时自媒体的应用也为我国麻醉专业住院医师培养提供了一种新的形式。     

双侧椎旁阻滞用于经皮椎体后凸成形术2例报告

2015年12月我院2例老年骨质疏松性椎体压缩骨折患者在双侧椎旁阻滞(paravertebral block,PVB)下接受经皮椎体后凸成形术(percutaneous kyphoplasty,PKP),2例在双侧PVB下顺利完成PKP,术中操作无疼痛不适,术后恢复良好,无麻醉相关并发症。我们认为双侧PVB临床操作简便,麻醉效果确切,对老年患者脆弱的心、脑、肺等重要脏器功能干扰轻微。