不同剂量罗库溴铵对甲状腺手术喉返神经功能监测的影响

目的观察不同剂量罗库溴铵对甲状腺手术喉返神经(RLN)功能监测的影响。方法择期甲状腺手术患者90例,ASAⅠ或Ⅱ级,随机均分为三组,采用静-吸复合全身麻醉。麻醉诱导:丙泊酚1.5~2.0mg/kg、芬太尼4μg/kg和罗库溴铵0.3mg/kg(A组)、罗库溴铵0.6mg/kg(B组)和罗库溴铵0.9mg/kg(C组),吸入2%~3%七氟醚维持麻醉。采用TOF监测肌松。观察并记录给药前60s、给药后60s及插管后60s的BP、HR及体动变化、TOF出现第一个、第二个肌颤搐的时间及RLN振幅。结果与给药前60s比较,给药后60sB组和C组HR明显减慢,三组SBP和DBP明显降低(P0.05),气管插管后60sA组HR明显增快,SBP和DBP明显升高(P0.05)。与给药后60s比较,气管插管后60s三组HR明显增快,SBP和DBP明显升高(P0.05)。与A组比较,气管插管后60sB组和C组HR明显减慢、SBP、DBP明显降低(P0.05),C组术中未监测到RLN例数明显增加、等待时间明显延长(P0.05),B组和C组术中体动例数明显减少、TOF出现第一个肌颤搐时的RLN振幅明显降低(P0.05),三组监测时间、TOF出现第二个肌颤搐时的RLN振幅差异无统计学意义。结论 2倍ED95的罗库溴铵(0.6mg/kg)诱导复合七氟醚麻醉适用于甲状腺手术喉返神经功能的监测。     

S100B蛋白与小儿七氟烷麻醉躁动的相关性研究

目的 探讨星形胶质细胞标志物S100B蛋白浓度变化与七氟烷麻醉躁动中的相关性.方法 选择在全麻下行择期白内障手术的患儿30例,美国麻醉医师协会麻醉风险评分(ASA)Ⅰ或Ⅱ级,年龄3～6岁.吸入麻醉诱导为8％七氟烷,待患儿睫毛反射消失后插入喉罩.术中采用3.0％～3.5％的七氟烷维持,调节氧流量2～3 L/min,保持患儿自主呼吸.术毕停止吸入七氟烷,拔除喉罩,记录躁动发生情况.分别于吸入七氟烷前,吸入七氟烷后15 min和术后10 min 3个时间点采集外周静脉血2～3 ml,静置离心后,检测血清S100B蛋白的浓度.结果 30例患儿术前、术中和术后血清S100B蛋白平均浓度分别为(62.76±32.51)、(47.90±22.20)、(48.05±23.53)ng/L,术中和术后浓度值较术前明显降低(P＜0.01),但术中和术后二者浓度值的差异无统计学意义(P＞0.05).其中,躁动患儿术中和术后平均血清S100B蛋白浓度均较术前明显下降[(49.71±25.20) ng/L vs.(68.26±39.40) ng/L,(55.59±30.54)ng/L vs.(68.26±39.40)ng/L,P均＜0.01],术中和术后的差异无统计学意义(P＞0.05);未发生躁动患儿术中和术后平均血清S100B蛋白浓度均较术前明显降低[(46.71±20.64)ng/Lvs.(59.1 1±27.62)ng/L,(43.18±16.95)ng/L vs.(59.11±27.62)ng/L,P均＜0.01],术中和术后的差异无统计学意义(P＞0.05).躁动患儿术前、术后S100B蛋白浓度差值与与躁动评分无相关性(r=0.045,P＞0.05).结论 S100B蛋白浓度在麻醉恢复期患儿躁动发生时明显下降,星形胶质细胞并未在躁动过程中表达增强,S100B蛋白浓度的变化与躁动的严重程度无相关性.     

MMP-9 and MMP-2 regulation in patients undergoing non-oncological and non-vascular elective surgery independent of the use of propofol or sevoflurane

BackgroundThere is debate regarding whether inhaled sevoflurane or intravenous propofol used during anesthesia achieves the best outcome. Propofol has been shown to affect expression of matrix metalloproteinases (MMPs). MMPs are enzymes that play a role in extracellular matrix remodeling, with activity balance disturbances during surgery. The goal of this study was to compare MMP-2/9 concentrations, activity, and tissue inhibitors of metalloproteinases (TIMPs) 1/2 concentrations in blood of who had undergone 2 types of anesthesia: based on volatile sevoflurane and intravenous propofol during non-oncological, non-vascular surgery.Methods39 patients were enrolled into analysis, 20 anesthetized with total intravenous anesthesia with propofol (P), 19 with volatile induction/maintenance of anesthesia with sevoflurane (S). Plasma samples collected before and 24 h after surgery were analyzed for MMP-2/9, and TIMP-1/2 concentrations using ELISAs. Additionally, MMP-2/9 activities were assessed by gelatin zymography.ResultsStudy revealed increased MMP-9 concentration (ELISA) (P:p = 0.011; S:p = 0.001) and activity (zymography) (P:p = 0.004; S:p = 0.008) in both groups 24 h after surgery. We noticed decreased (both groups) MMP-2 concentration (P:p = 0.044; S:p = 0.027) with MMP-2 activity increase (P:p = 0.002; S:p = 0.006) 24 h after surgery. We observed decreased TIMP-1 plasma concentrations (P:p = 0.002; S:p = 0.000) 24 h after procedures, while TIMP-2 plasma levels remain unchanged (P:p = 0.097; S:p = 0.172). There were no differences between concentration and activity of MMPs and TIMPs in regard to anesthetic used. Meperidine administration correlated with lower MMP-9 activity (R=-0.430; p = 0.006).ConclusionsConcluding, neither sevoflurane nor propofol used as anesthetics modulate MMP-2 and MMP-9 concentrations and activities during non-oncological, non-vascular elective surgery. Meperidine seems to decrease MMP-9 activity.     

反复吸入七氟醚对大鼠海马和血小板线粒体功能的影响

目的探讨反复吸入七氟醚对成年大鼠海马和血小板线粒体功能的影响方法选取体质量250～300 g的雄性SD大鼠60只,随机分成3组,每组20只:空白对照组(Ⅰ组);单次吸醚组(Ⅱ组)。单次吸入浓度为2.4%七氟醚;反复吸醚组(Ⅲ组),连续5 d吸入浓度为2.4%七氟醚。每组随机取10只,测定海马和血小板线粒体的ATP的含量和SOD活力,另外10只予八臂迷宫行为学检测。结果单次或反复吸入2.4%七氟醚5 d后,与空白组相比,海马和血小板线粒体的ATP的含量和SOD活力,差异无统计学意义(P>0.05)。结论成年大鼠反复吸入2.4%七氟醚,对海马组织和血小板线粒体的SOD、ATP无明显影响,提示短期反复吸入七氟醚不会引起大鼠近期学习记忆功能损害。     

七氟醚吸入镇静辅助儿童口腔治疗

目的 评价口腔门诊采用七氟醚吸入镇静镇痛技术辅助儿童口腔治疗的临床应用效果.方法 对广州市妇女儿童医疗中心口腔科收治的患有口腔疾病的不配合儿童170 例采用七氟醚吸入镇静镇痛技术辅助口腔治疗,随访并记录,资料统计分析.结果 170 例患儿镇静后均顺利完成手术,术中无挣扎、哭闹,血压、心率及呼吸指标均在正常范围,无严重缺氧、误吸、呕吐等并发症发生.患儿口腔治疗时间为15 ～ 60 min,术后5 ～ 10 min 苏醒.苏醒期58 例（34.12%）患儿发生烦躁哭闹;术后1 例患儿发生呕吐,立即置头部于低、侧位,及时吸清口内呕吐物及呼吸道分泌物,患儿恢复良好;2 例患儿手术当晚出现低热症状,给予物理降温并口服抗生素后好转.170 例患儿术后随访均无异常.结论 口腔门诊采用七氟醚吸入镇静镇痛技术辅助不配合儿童口腔治疗安全、不良反应少、临床效果显著.     

抗焦虑对胃癌根治术患者七氟烷用量及术后恢复的影响

目的:研究劳拉西泮联合咪达唑仑对择期胃癌根治术患者抗焦虑作用的有效性,及该方法对术中七氟烷用量和术后疼痛的影响.方法:观察组手术前1d服劳拉西泮,术前40min静注咪达唑仑,术中BIS监测控制麻醉深度,观察两组患者术前Spielberge状态—特质焦虑问卷(STAI)评分,术中七氟烷用量,麻醉恢复时间及术后2、6、24h疼痛VAS评分.结果:观察组状态-特质焦虑问卷评分低于对照组(S-AI:53.60±4.45vs62.70±3.98,P<0.05;T-AI:54.78±3.97vs65.65±4.21,P<0.05),七氟烷的使用量少于对照组(34.70±0.46vs36.20±0.44,P<0.05).两组术后苏醒及拔管时间无统计学差异.两组患者术后6、24hVAS评分,观察组低于对照组(6hVAS评分:3.45±1.60vs4.89±1.91,P<0.05;24hVAS评分:3.51±1.76vs5.17±1.71,P<0.05).结论:劳拉西泮联合咪达唑可以减轻术前患者的焦虑状态,减少术中七氟烷的使用,有利于减轻患者术后疼痛.     

Target-controlled induction with 2.5% sevoflurane does not avoid the risk of electroencephalographic abnormalities

Background

Epileptiform discharges (ED) can occur during sevoflurane induction, especially in young female patients and when high alveolar concentrations are used. The aim of this study was to evaluate whether low sevoflurane concentration reduces the occurrence of ED in female patients.

Methods

Thirty-four female patients scheduled for minor gynecological surgery were prospectively included and randomized in two groups. In group A, anesthesia was induced with sevoflurane inspired 8% manually set via the circuit of the Zeus^® (Dräger Medical, Lübeck, Germany) anesthesia workstation (fresh gas flow 8 L.min⁻¹) for 2 min and then 2.5%. In group B, induction was performed by target-controlled inhalation with a target end-tidal concentration of sevoflurane set at 2.5% (fresh gas flow in auto-control mode). Electroencephalogram (EEG) was recorded in the operating room throughout induction till two min after intubation and analyzed off-line by a neurophysiologist blinded to the randomization.

Results

ED occurred in five patients (15%): one in group A and four in group B (P > 0.05). ED occurred with a median delay of 303 s [25–75 interquartiles: 135–418] and the median duration of ED episode was 13 s [3–78]. Fifteen patients had abnormal movements without simultaneous EEG abnormality.

Conclusion

Induction of anesthesia with low target concentration of sevoflurane (2.5%) fails to totally prevent the occurrence of ED in young female patients and should be used carefully in this population.     

七氟醚对兔肝缺血/再灌注损伤后肝组织丙二醛、血浆丙氨酸转氨酶和谷草转氨酶活性及c-Fos蛋白的表达的影响

目的 探讨七氟醚麻醉对兔肝缺血/再灌注损伤(ischemia/reperfusion injury,Ⅰ/RI)的影响. 方法 健康成年新西兰大白兔21只,按照随机数字表法分为3组(每组7例):假手术组(S组)、肝Ⅰ/R组(Ⅰ/R组)、七氟醚麻醉组(Sev-Ⅰ/R组).结扎肝动脉建立兔肝脏Ⅰ/RI模型,分别于缺血前(Tl)、缺血45 min(T2)和再灌注60 min(T3)测定血浆丙氨酸转氨酶(aspartate a minotransferase,AST)及谷草转氨酶(alanine aminotransferase,ALT)水平,于T3测定肝组织丙二醛(malondialdehyde,MDA)含量;免疫组化染色检测c-Fos蛋白的表达情况. 结果 与S组比较,Ⅰ/R组血浆ALT和AST活性[T2:(48±6) U/L和(48±7) U/L,T3:(66±6) U/L和(70±6)U/L]及Sev-Ⅰ/R组血浆ALT和AST活性[T2:(43±7) U/L和(41±3) U/L,T3:(48±6) U/L和(50±6) U/L]、肝组织MDA含量和c-Fos蛋白表达水平均明显升高(P＜0.05或P＜0.01);Sev-Ⅰ/R组所有这些实验指标均明显低于Ⅰ/R组(P＜0.05或P＜0.01). 结论 七氟醚对Ⅰ/RI兔肝组织有保护作用,可与其降低活性氧产物有关.     

小儿七氟醚麻醉后躁动的研究进展

背景 七氟醚因其具有无刺激味、诱导迅速及对呼吸循环影响小等特点,目前广泛应用于小儿全身麻醉的诱导和维持.但小儿七氟醚麻醉后躁动发生率远高于成年人,对术后管理非常不利. 目的 提高小儿七氟醚全身麻醉苏醒的质量. 内容 系统回顾近年来小儿七氟醚麻醉后躁动的研究,综述其可能的发病机制及防治措施. 趋向 七氟醚麻醉后躁动的发生机制尚不清楚,特别是基础研究还需深入.     

海马内DNA甲基转移酶在七氟醚所致新生大鼠远期认知功能损伤中的作用

目的观察海马内DNA甲基转移酶(DNMTs)在七氟醚所致新生大鼠远期认知功能损伤中的作用。方法出生7d雄性SD大鼠64只,随机均分为四组(n=16):对照组(C组)、七氟醚组(S组)、七氟醚+生理盐水组(SN组)及七氟醚+5-杂氮胞苷组(5-AZA,DNMTs抑制剂,SA组)。C组吸入30%O22h,连续3d;S组、SN组和SA组吸入3%七氟醚+30%O22h,连续3d;SA组在七氟醚吸入前1h时侧脑室注入5-AZA 1mg/kg;SN组则注射等容量生理盐水。4周后,一部分大鼠行旷场实验和Morris水迷宫实验(n=8),另一部分取海马组织(n=8),采用实时荧光定量PCR和Western blot分别检测DNMT1、DNMT3a、DNMT3b的mRNA和蛋白含量。结果旷场实验中,四组大鼠探索路程和中央格停留时间差异无统计学意义。与C组比较,S组在Morris水迷宫实验中逃逸潜伏期明显延长,目标象限探索时间明显缩短,海马内DNMT3a及DNMT3b的mRNA和蛋白含量明显增加(P0.05);与SN组比较,SA组逃逸潜伏期明显缩短,目标象限探索时间明显延长,海马内DNMT3a及DNMT3b的mRNA和蛋白含量明显减少(P0.05);四组海马内DNMT1的mRNA和蛋白含量差异无统计学意义。结论七氟醚可致新生大鼠远期认知功能损伤伴海马内DNMT3a和DNMT3b表达增加;5-AZA可降低海马内DNMT3a及DNMT3b表达,减轻七氟醚所致新生大鼠远期认知功能损伤,表明DNMTs参与了七氟醚所致新生大鼠远期认知功能损伤的过程。