PET在全麻机制研究中的应用

正电子发射计算机断层扫描(PET)是一种功能性影像诊断新技术，能够在体反映机体内的物质代谢、局部血流量、受体密度等理化特性的变化。近年来PET技术已开始应用于全麻机制的研究，并在全麻药物的中枢区域定位、相关受体的功能分析等方面显示出独特的应用价值。     

高渗氯化钠羟乙基淀粉40注射液高容量血液稀释对大鼠肝脏缺血再灌注损伤的影响

Objective To investigate the effects of hypervolemic hemodilution (HH) with hypertonic saline plus hetastarch solution 40 injectio on hepatic ischemia-reperfusion (I/R) injury in rats. Methods Thirty male Wistar rats weighing 300-350 g were randomly divided into 3 groups ( n = 10 each): group I sham operation (group S); group II I/R and group Ⅲ HH. Partial liver ischemia was produced by clamping hepatic portal vein and left arteria hepatica for 30 min with atraumatic mini-clamp, followed by 2 h of reperfusion in I/R group and HH group. In HH group the animals were infused hypertonic saline plus hetastarch solution 40 injectio 10 ml/kg through vena caudalis over 30 min and then hepatic I/R was performed IS min after the infusion.The animals were killed at 2 h of reperfusion. The left liver was removed and blood sample was taken from inferior caval vein for determination of (1) serum alanine amino transferase (ALT) and aspartate amino transferase (AST) activities; (2) superoxide dismutase ( SOD) activity and malondialdehyde ( MDA) content in the liver; ( 3 ) microscopic examination. Results The serum ALT and AST activities and MDA content in the liver were significantly higher, SOD activity in the liver significantly lower after hepatic I/R and pathological changes in the liver severer in group I/R and HH than in group S. The serum ALT and AST activities and MDA content in the liver were significantly lower, SOD activity in the liver significantly higher after hepatic I/R and pathological changes in the liver milder in group HH than in group I/R. Conclusion Hypervolemic hemodilution with hypertonic saline plus hetastarch solution 40 injectio can ameliorate hepatic I/R injury by decreasing oxygen free radical production in rats.     

全麻复合硬膜外阻滞与单纯全麻的比较

比较全麻复合硬膜外阻滞和单纯全麻在围术期对机体应激、炎性、免疫等方面的影响。使用全麻加硬膜外麻醉能有效地抑制手术引起的应激反应，稳定循环状态，减少并发症，使病人在术中更为安全平稳，麻醉效果更为可靠，术毕清醒快，术后镇痛有利于术后病人咳嗽咯痰，并且能减轻围手术期对T细胞亚群的影响。     

6%羟乙基淀粉130/0.4对患者硬膜外复合全麻诱导期肺循环的影响

Objective To observe the effect of pulmonary circulation by 6% hydroxyethyl starch 130/0.4 during induction period from epidural block combined with general anesthesia. Methods Twenty-six hepatobiliary surgical patients with ASA Ⅰ-Ⅱ, aged 32 y-59 y, weighing 54 kg-73 kg, were randomized into 2 groups(n=13): hydroxyethyl starch 130/0.4 group(HS)and complex acetic acid Ringer's solution (RL). Above-mentioned solutions were infused 7 ml/kg respectively before induction. The pulmonary circulation hemodynamic parameters such as pulmonary arterial systolic pressure (PASP), pulmonary arterial diastolic pressure (PADP), mean pulmonary artery pressure(MPAP), pulmonary artery wedge pressure(PAWP), pulmonary vascular resistance(PVR) and right ventricular stroke work(RVSW) were recorded at base value(T0), 10 min after infusion(T1), 5 min after induction(T2), 5 rain after intubation(T3), 10 rain after intubation(T4)and 20 min after intubation(T5). Results PASP、PADP、MPAP、PAWP and CVP were significantly higher in group HS at T, than the values at T0 (P<0.05); PVR in group HS was obviously lower from T1 to T5 than the value at To (P<0.05 or P<0.01); RVSW was significantly higher in two groups at T1 than base value (P<0.05), but that in group HS was lower than base value (P<0.05 or P<0.01); HR obviously decreased in two groups from T2 to T5 as compared with the value at T0 (P<0.05); MAP was lower from T3 to T5 than the value at To (P<0.05 or P<0.01). PVR was obviously lower in group HS from T1 to T5 than that in group RL (P<0.05 or P<0.01); MAP obviously increased from T2 to T5 in group HS as compared with the value in group RL(P<0.05 or P<0.01). Conclusion 6% hydroxyethyl starch 130/0.4 can obviously reduce PVR during induction pe-riod from epidural block combined with general anesthesia. In all, there is no effect on pulmonary circulation by 6% hydroxyethyl starch 130/0.4.     

小儿肝移植无肝期丙泊酚的药代动力学特点

目的：研究小儿肝移植无肝期丙泊酚的药代动力学特征。方法：5例同种异体原位肝移植患,分别于麻醉诱导及无肝期开始时静脉注射丙泊酚2mg/kg,采用反相高效液相色谱法测定血浆中丙泊酚浓度,对比两之间的药代动力学差异。结果：丙泊酚的药-时曲线符合开放性三室模型,具有分布广,清除率高等特性。结论：无肝期与诱导期丙泊酚代谢无明显差异,推测该药可能存在明显的肝外代谢。     

器官保护与肿瘤治疗

恶性肿瘤是导致死亡的首要原因之一,手术切除、化疗及放疗是目前各种恶性肿瘤最主要的治疗方法.手术创伤,放疗、化疗药的毒副作用,肿瘤坏死等,这些损伤性因素不但会导致肿瘤部位器官损伤,还能诱发全身炎症反应综合征(SIRS),而导致其他器官的损伤.SIRS可诱发器官功能障碍综合征(MODS),因此部分患者在肿瘤治疗期间会使用器官功能保护措施,减少器官损伤和MODS的发生.而这些器官功能保护措施都是非特异性的,在保护患者体内正常的组织器官的同时可能也会保护患者体内的肿瘤细胞,导致患者术后肿瘤复发,或疗效下降,而术后肿瘤复发是肿瘤患者治疗后最主要的死亡原因,因此不能不考虑器官保护措施对肿瘤患者的远期治疗效果的影响.本文拟阐述围术期器官保护措施对患者肿瘤远期治疗效果的影响.     

家兔脑缺血与再灌注损害中的生化改变

本研究采用既无颅外脏器缺血缺氧,又易于控制实验条件的家兔脑缺血模型。用临床常用的生化监测手段,了解脑缺血及再灌注后脑代谢的改变。为临床进行脑复苏监测与治疗提供实验依据。材料与方法 (一)实验动物与分组健康雄性家兔18只,体重2.1～2.5kg。随机分为三组,每组6只。A组为对照组,行空气机械通气4h,B组为脑缺血20min组,C组为脑缺血20min再灌注4h组。     

背驮式原位肝移植术四例报告

目的 为了提高终末期肝病的存活率。方法 于１９９６年５月、８月、１９９７的上月和１９９８年２月先后成功地施行了４例背驮式原位肝移植术。结果 除例１忆 炎后肝硬变,受体术后２１４天突变死于乙肝复发并急生肝坏死和急性胰腺炎外。例２、例３和例４肝豆状核变性受体术后恢复顺利,效果良好,已分别健康生存５７５天、３９０天和１６２天。结论 肝移植是目前治疗大部分终末期肝移植的最有效手段。     

老年患者术后认知功能障碍与IL-1β、IL-6和TNF-α的表达

目的 探讨骨科手术患者术后认知功能障碍(POCD)与白细胞介素-1β(IL-1β)、白细胞介素6(IL-6)和肿瘤坏死因子α(TNF-α)表达的关系.方法 选择老年骨科全麻手术患者,年龄≥70岁,术前1 d和术后2 h采用简易智能状态检查量表(MMSE)评价患者认知功能,将术后2 h认知功能评分相对于术前1 d下降≥2分的患者归为POCD组(18例),无下降或上升的患者为对照组(21例).采血检测IL-1β、IL-6和TNF-α.结果 与对照组相比,POCD组术后2 h MMSE评分明显下降(P<0.05),POCD组麻醉诱导前10 min TNF-α和术后1 d IL-6明显高于对照组(P<0.05).与麻醉诱导前10 min相比,POCD组TNF-β于术中1 h、IL-6于术后2 h和术后1 d明显增高(P<0.05);对照组IL-6也于术后2 h明显增高(P<0.05).结论 老年骨科手术患者发生术后认知障碍者伴随血中IL-6和TNF-α表达增强.     

咪唑安定合用氯胺酮基础麻醉在小儿眼科手术中的应用

氯胺酮是小儿手术常用的麻醉药物之一,但氯胺酮能增加脑血流量,升高颅内压和眼压,术后还可出现精神症状,用于小儿眼科手术曾有所虑。我们应用咪唑安定、氯胺酮复合麻醉,观察这种复合麻醉方法是否更适合小儿眼科手术。资料与方法一般资料44例中男31例,女9例,年龄1~12岁,心、肺、