肝功能对患者意识消失时咪达唑仑浓度和脑电双频谱指数的影响

目的探索肝功能对意识消失时咪达唑仑浓度和双频谱脑电指数的影响。方法选择无听力障碍且近期未服用精神类药物的患者45例。肝功能正常（A组,n=15）和中度脂肪肝（B组,n=15）行择期腹腔镜下胆囊切除术;终末期肝病（C组,n=15）行肝脏移植手术。3组患者均予靶控输注咪达唑仑,同时进行双频谱脑电图监测（BIS）,在患者意识消失时同时记录BIS值和抽取静脉血测量咪达唑仑血药浓度。用logistic回归分析咪达唑仑实测药物浓度与BIS的关系,计算50％患者意识消失时咪达唑仑的血药浓度（EC50）和BIS值（BIS50）。结果A、B组意识消失咪达唑仑EC50分别为310．4ng／ml和294.8ng／ml（P〉0．05）,BIS50分别为51和52（P〉0.05）;C组患者意识消失时咪达唑仑EC50低于A、B组而BIS50高于A、B组（P〈0．01）。结论轻度肝功能异常不影响患者意识消失时咪达唑仑的EC50和BIS50,而终末期肝病患者对咪达唑仑中枢抑制更敏感,其BIS预测意识消失概率发生情况发生的敏感性受到影响。     

异丙酚干预星形胶质细胞形态学变化及水通道蛋白-4的表达

Ammonia induces astrocyte swelling, which is strongly associated with overexpression of aquaporin-4. However, the mechanisms by which ammonia induces astrocyte swelling, and subsequently upregulating aquaporin-4 expression, remain unknown. In the present study, astrocytes were cultured in vitro and exposed to ammonium chloride (NH4Cl), followed by propofol, protein kinase C agonist, or antagonist, respectively. Astrocyte morphology was observed by light microscopy, and aquaporin-4 expression was detected by western blot analysis. Results showed that propofol or protein kinase C agonist significantly attenuated the degree of NH4Cl-induced astrocyte swelling and inhibited increased aquaporin-4 expression. Propofol treatment inhibited aquaporin-4 overexpression in cultured astrocyte induced by NH4Cl; protein kinase C pathway activation is potentially involved.     

气道异物淤积导致呼吸波形改变的临床模拟研究

目的 通过开展气道异物淤积导致呼吸波形改变的临床模拟研究,建立气道异物淤积量与呼吸波形改变程度之间的关系,验证气道实时可视化监测的可行性。方法 搭建一个气道异物淤积可控的呼吸过程模拟平台,采集气道不同阻塞面积下对应的呼吸波形。提取波形特征,计算变异系数、相关系数、均方根误差,并基于最小二乘法建立气道阻塞面积与呼吸波形特征之间的拟合关系曲线。结果 压控通气模式和容控通气模式下流速波形的上升峰值、上升梯度和下降峰值均与气道阻塞面积有强相关性,且其相关关系可用二次曲线来描述。结论 气道阻塞面积与呼吸波形特征之间关系的定量描述,验证了气道实时可视化监测的可行性,为人工气道管理提供一种新的思路。