姜黄素对2型糖尿病大鼠神经病理性痛及脊髓背角和背根神经节IRE1α表达的影响

目的 评价姜黄素对2型糖尿病大鼠神经病理性痛及脊髓背角和背根神经节肌醇需求激酶1α(IRE1α)表达的影响.方法 高脂高糖喂养雄性SD大鼠8周诱导胰岛素抵抗,以35 mg/kg链脲佐菌素(STZ)单次腹腔注射,3d后血糖≥16.7 mmol/L大鼠为2型糖尿病大鼠.注射STZ 14 d后机械缩足阈值(MWT)和热缩足潜伏期(TWL)低于基础值80％的大鼠为2型糖尿病神经病理性痛大鼠,采用随机数字表法,将其随机分为3组(n=27):2型糖尿病神经病理性痛组(DNP组)、姜黄素组(Cur组)和溶剂对照组(SC组).Cur组和SC组于注射STZ 14 d后腹腔注射姜黄素或玉米油100 mg/kg(25mg/ml),1次/d,连续14d,DNP组不做任何处理.另取27只正常大鼠为对照组(C组),给予普通饲料喂养.给予姜黄素后第3、7和14天时测定MWT和TWL,痛阈测定后用Western blot法检测大鼠脊髓背角和背根神经节IREIα的表达.结果 与C组比较、DNP组、Cur组和SC组MWT降低,TWL缩短,脊髓背角和背根神经节IRE1α表达上H调(P＜0.05);与DNP组比较,Cur组MWT升高,TWL延长,脊髓背角和背根神经节IREIα表达下调(p＜0.05).SC组和DNP组上述指标比较差异无统计学意义(P＞0.05).结论 姜黄素可减轻2型糖尿病大鼠神经病理性痛,其机制与抑制脊髓背角和背根神经节IRE1α表达有关.     

内质网应激蛋白BiP在姜黄素抗2型糖尿病神经病理性疼痛大鼠的作用

目的: 探讨姜黄素对2型糖尿病诱导的神经病理性疼痛(DNP)大鼠机械痛敏(MWT)、热痛敏(TWL)、脊髓背角和背根神经节(DRG)的保护作用及机制。方法: 高脂高糖饲料喂养8周诱导胰岛素抵抗后,继以单次小剂量链脲佐菌素(STZ)35 mg/kg腹腔注射,在注射STZ前和14 d后采用Electronic Von Fery触觉测痛仪和甩尾/足底测试仪测大鼠MWT和TWL,注射STZ 3 d后血糖≥16.7 mmol/L且在注射STZ 14 d后痛阈下降至基础值85%以下者入选为D组(81只)。将D组随机分为3组(n=27): DNP组、DNP+姜黄素100 mg·kg^-1·d^-1组(DCur组)和DNP+溶剂组(DSC组),另取27只为正常对照组(C组),给予普通饲料喂养。给姜黄素3、7、14 d后测血糖、MWT与TWL,并在同时点取大鼠L4~L6脊髓和DRG,用免疫组化和免疫印迹法测定脊髓背角和DRG中免疫球蛋白重链结合蛋白(BiP)的表达。结果: 与C组相比,DNP组各时点MWT降低,TWL缩短,血糖值升高,脊髓背角和DRG中BiP均出现表达上调(P<0.05)。与DNP组相比,DCur组在给姜黄素7 d后MWT升高,TWL延长;给姜黄素14 d后脊髓背角和DRG中BiP表达下调(P<0.05)。DSC组和DNP组相比差异无统计学意义。结论: BiP参与了2型糖尿病神经病理性疼痛的发病机制。姜黄素减轻2型糖尿病大鼠神经病理性疼痛的机制可能与抑制BiP表达有关。     

Ⅱ型糖尿病神经病理性痛大鼠模型的建立

目的:建立Ⅱ型糖尿病神经病理性痛大鼠模型。方法:60只SD大鼠随机分为:A组(对照组,即普通饲料组,n=10),B组(实验组,即高脂高糖组,n=50)。A组以普通饲料喂养,8周后单次空腹腹腔注射柠檬酸缓冲液。B组高脂高糖喂养8周诱发胰岛素抵抗,继以不同剂量链脲佐菌素(streptozotocin,STZ,30 mg/kg、35 mg/kg、40 mg/kg)腹腔注射1次,于不同时间点分别测体重、血糖、胰岛素,计算胰岛素敏感性、机械缩足阈值和热缩足潜伏期的变化。结果:高脂高糖饮食8周,模型组大鼠体重明显增加,空腹胰岛素浓度升高,胰岛素敏感性下降,机械缩足阈值和热缩足潜伏期无变化,血糖未升高。注射STZ后,30 mg/kg剂量组血糖升高但不能长期维持;40 mg/kg剂量组血糖较高,死亡率高;35 mg/kg剂量组血糖中度升高且相对稳定,胰岛素浓度和胰岛素敏感性均降低,其机械缩足阈值和热缩足潜伏期均低于基础值和对照组(P<0.05)。结论:高脂高糖饲料喂养8周后联合腹腔注射STZ 35 mg/kg可以建立理想的Ⅱ型糖尿病神经病理性痛大鼠模型。     

姜黄素对糖尿病神经病理性痛大鼠脊髓和背根神经节神经细胞凋亡的影响

目的 探讨姜黄素对糖尿病神经病理性痛(DNP)大鼠脊髓和背根神经节(DRG)神经细胞凋亡的影响.方法雄性SD大鼠108只,体重200～230 g,采用腹腔注射链唑霉素70 mg/kg的方法建立大鼠DNP模型.采用随机数字表法,将大鼠随机分为4组(n=27),正常对照组(C组):不制备DNP模型;DNP组;溶剂对照组(SC组)和姜黄素组(Cur组):于腹腔注射链唑霉素后14 d分别腹腔注射玉米油或姜黄素100 mg/kg(25 mg/ml),1次/d,连续2周.于链唑霉素给药前2 d、给药后14 d、姜黄素给药后3、7、14 d时测定机械缩足阈值(MWT)和热缩足潜伏期(TWL);于姜黄素给药后3、7、14 d时分别采用免疫组化法和Western blot法测定脊髓和DRG caspase-3和Bcl-2的表达水平,并测定神经细胞的凋亡率.结果 与C组比较,DNP组、SC组和Cur组MWT降低,TWL缩短,脊髓和DRG神经细胞凋亡率升高,caspase-3表达上调,Bcl-2表达下调(P＜0.05);与DNP组比较,Cur组MWT升高,TWL延长,脊髓和DBG神经细胞凋亡率降低,caspase-3表达下调,Bcl-2表达上调(P＜0.05),SC组差异无统计学意义(P＞0.05).结论 姜黄素可通过抑制脊髓和DRG神经细胞凋亡,从而减轻大鼠DNP,其机制与抑制caspase-3水平、增强Bcl-2水平有关.

Abstract：

Objective To investigate the effect of curcumin on the apoptosis in spinal cord and dorsal root ganglion neurons in a rat model of diabetic neuropathic pain (DNP) . Methods One hundred and eight male SD rats weighing 200-230 g were randomly divided into 4 groups ( n = 27 each): control group (group C), DNP group, solvent control group (group SC) and curcumin group (group Cur) . Diabetes was induced with intraperitoneal streptozocin 70 mg/kg. Successful induction of diabetes was defined as blood glucose ＞ 16.7 mmol/L. Curcumin and com oil 100 mg/kg (23 mg/ml) were given intraperitoneally once a day for 14 consecutive days starting from 14 days after administration of streptozocin in Cur and SC groups respectively. Mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured 2 d before and 14 d after streptozocin injection and 3, 7 and 14 d after curcumin injection. The pain threshold measured at 14 d after administration of streptozocin decreased by more than 15% of the baseline in all the rats. The expression of caspase-3 and Bcl-2 in spinal cord and dorsal root ganglion was determined at 3, 7 and 14 d after curcumin injection by immuno-histochemistry and Western blot, and the neuronal apoptosis rate was determined by TUNEL. Results Compared with group C, MWT and Bcl-2 expression were significantly decreased, TWL was significantly shortened, the neurona lapoptosis rate and caspase-3 expression were significantly increased in DNP, SC and Cur groups ( P ＜ 0.05).Compared with group DNP, MWT and Bcl-2 expression were significantly increased, TWL was significantly prolonged, the neuronal apoptosis rate and caspase-3 expression were significantly decreased in Cur group ( P ＜0.05) . There was no significant difference in the parameters mentioned above between DNP and SC groups ( P ＞0.05). Conclusion Curcumin can attenuate DNP by inhibiting the apoptosis in spinal dorsal hom and dorsal root ganglion neurons in rats, and the inhibition of caspase-3 expression and increase in Bcl-2 expression are involved in the mechanism.     

持续输注右美托咪定对行中上腹部开放性手术的中老年男性患者导尿管相关膀胱刺激征发生情况的影响

目的研究持续输注右美托咪定对行中上腹部开放性手术的中老年男性患者导尿管相关膀胱刺激征(CRBD)发生情况的影响。方法按随机数字表法将100例在全麻下择期行中上腹部开放性手术的患者分为观察组和对照组,各50例。观察组在麻醉诱导前泵注0.5μg/(kg·min)右美托咪定10 min后进行导尿,并持续泵注0.2μg/(kg·h)右美托咪定至手术结束前30 min。对照组泵注相同剂量生理盐水,麻醉诱导后进行导尿管导尿。比较两组的干预效果。结果观察组的MAP、HR变化较对照组更为平稳。T_(1~4)时,观察组的CRBD发生率均低于对照组,CRBD严重程度均轻于对照组(P<0.05)。T1~2时,观察组VAS评分低于对照组,Ramsay评分高于对照组(P<0.05)。观察组的心动过缓、低血压发生率高于对照组(P<0.05)。结论持续泵注右美托咪定可减少全麻下行开放性手术的中老年男性患者苏醒期CRBD发生率和严重程度,且镇痛、镇静效果好。     

STER术麻醉中皮下气肿一例

正患者,女,48岁,体重65kg。因"发现食管隆起性病变1月"入院,拟全麻下行经内镜粘膜下隧道肿瘤切除(STER)术。现病史及既往史无特殊,术前实验室及辅助检查未见明显异常,ASAⅠ级。患者入内窥镜室后开放外周静脉通路,心电监护,入室BP 110/70 mm Hg、HR 70次/分、SpO298%。常规给氧去氮3min,麻醉诱导:舒芬太尼20μg、丙泊