异丙酚对小鼠海马脑片细胞外信号调节激酶ERK1/2磷酸化水平的影响

目的 观察异丙酚对小鼠海马脑片细胞外信号调节激酶ERK1／2磷酸化水平的影响。方法BALB／C小鼠，体重18～22g，雌雄不拘，迅速断头取脑，取海马用震动切片机切成450μm厚的脑片。量效实验随机将脑片分为空白对照组（C组）及不同浓度异丙酚组[10^-4mmol／L（P1组）、10^-5mmol／L（P2组）、10^-6mmol／L（P3组）、10^-7mmol／L（P4组）、10^-8mmol／L（P5组）、10^-8mmol／L（P6组）]；分别以不同浓度的异丙酚36℃恒温孵育海马脑片1h。时效实验应用5μmol／L异丙酚孵育脑片，分别于孵育即刻、1、2、5、7、9、12、15、30、60min取出脑片；取5μmol／L异丙酚孵育5min后的部分脑片，以人工脑脊液洗出异丙酚，分别于洗出2、4、7、10、25min取出脑片。应用SDS-PAGE和Westem blot生化技术及Gel Doc凝胶成像系统半定量检测小鼠海马p-ERKI／2水平。结果 异丙酚能降低ERK1／2磷酸化水平，降低呈时间、浓度依赖性（P〈0．05）。随异丙酚孵育5min后洗出时间延长，ERK1／2的磷酸化水平逐渐恢复，但洗出25min时仍明显低于药物处理前水平（P〈0．01）。结论 异丙酚能显著地抑制小鼠海马脑片细胞外信号调节激酶ERK1／2磷酸化水平。     

吗啡预处理-后处理对大鼠离体心脏缺血再灌注损伤的影响

Objective To evaluate the effects of morphine preconditioning-postconditioning on ischemia-reperfusion (I/R) injury in isolated rat hearts. Methods Male SD rats weighing 180-200 g were killed after intraperitoneal injection of heparin 500 U/kg. The hearts were immediately removed and perfused in a Langendorff apparatus with K-H solution gassed with 95%O2-5%CO2 .HR and left ventricular systolic pressure (LVSP) were measured from a fluid-filled latex balloon in the left ventricle. Global myocardial ischemia was induced by interrupting perfusion for 45 min followed by 60 min reperfusion. Forty isolated rat hearts were randomly divided into 5 groups (n = 8 each): group 1 (I/R); group II morphine preconditioning (M1 ); group Ⅲ morphine postconditioning (M2); group IV M1 + M2; group V 5-hydroxydecanoate (5-HD) + M2. Group M1 was perfused with K-H solution containing morphine 3.0 μmol/L for 20 min 30 min before ischemia followed by 10 min normal K-H solution perfusion. Group M2 was perfused with K-H solution containing morphine 3.0 μmol/L for 10 min at the beginning of reperfusion followed by 50 min normal K-H solution perfusion. Group 5-HD + M2 was perfused with K-H solution containing morphine 3.0 μmol/L+ 5-HD 10-4 mmol/L for 10 min at the beginning of reperfusion followed by 50 min normal K-H solution perfusion. Myocardial CK-MB activity was measured and myocardial infarct size (IS/AAR) detennined (by 2,3,5-triphenyl tetrazolium staining) at the end of 60 min reperfusion. Results The preconditioning, postconditioning and combination of preconditioning and postconditioning with morphine 3.0 μmol/L perfusion for 10 min all provided cardio-protective effects in terms of IS/AAR and myocardial activation of CK-MB. Conclusion Although the combination of morphine preconditioning and postconditioning can protect the heart against I/R injury, the effects are similar to those of either of them alone, and the reason may be that either of them alone protects the heart against I/R injury via activating mitoKATP .     

吗啡预处理-后处理对大鼠离体心脏缺血再灌注损伤的影响

Objective To evaluate the effects of morphine preconditioning-postconditioning on ischemia-reperfusion (I/R) injury in isolated rat hearts. Methods Male SD rats weighing 180-200 g were killed after intraperitoneal injection of heparin 500 U/kg. The hearts were immediately removed and perfused in a Langendorff apparatus with K-H solution gassed with 95%O2-5%CO2 .HR and left ventricular systolic pressure (LVSP) were measured from a fluid-filled latex balloon in the left ventricle. Global myocardial ischemia was induced by interrupting perfusion for 45 min followed by 60 min reperfusion. Forty isolated rat hearts were randomly divided into 5 groups (n = 8 each): group 1 (I/R); group II morphine preconditioning (M1 ); group Ⅲ morphine postconditioning (M2); group IV M1 + M2; group V 5-hydroxydecanoate (5-HD) + M2. Group M1 was perfused with K-H solution containing morphine 3.0 μmol/L for 20 min 30 min before ischemia followed by 10 min normal K-H solution perfusion. Group M2 was perfused with K-H solution containing morphine 3.0 μmol/L for 10 min at the beginning of reperfusion followed by 50 min normal K-H solution perfusion. Group 5-HD + M2 was perfused with K-H solution containing morphine 3.0 μmol/L+ 5-HD 10-4 mmol/L for 10 min at the beginning of reperfusion followed by 50 min normal K-H solution perfusion. Myocardial CK-MB activity was measured and myocardial infarct size (IS/AAR) detennined (by 2,3,5-triphenyl tetrazolium staining) at the end of 60 min reperfusion. Results The preconditioning, postconditioning and combination of preconditioning and postconditioning with morphine 3.0 μmol/L perfusion for 10 min all provided cardio-protective effects in terms of IS/AAR and myocardial activation of CK-MB. Conclusion Although the combination of morphine preconditioning and postconditioning can protect the heart against I/R injury, the effects are similar to those of either of them alone, and the reason may be that either of them alone protects the heart against I/R injury via activating mitoKATP .     

靶控输注异丙酚意识消失时血浆和效应室浓度的EC50与脑电双频谱指数的关系多中心大样本临床研究

目的 研究择期手术患者靶控输注（TCI）异丙酚意识消失时血浆、效应室靶浓度的50%患者意识消失时的药物浓度（EC50）与脑电双频谱指数（BIS）的关系。方法 5家医疗中心405例择期手术患者（国人）,ASAⅠ或Ⅱ级。靶控输注异丙酚,以血浆靶浓度1．2μg/ml为起点,到达预期血浆靶浓度后每30秒递增0．3μg/ml,直至患者意识消失。采用概率单位回归分析计算患者意识消失时异丙酚血浆靶浓度、效应室靶浓度的EC05、EC50和EC95及其所对应的BIS。结果 择期手术患者TCI异丙酚意识消失时异丙酚血浆靶浓度EC05、EC50和EC95分别是2．9μg/ml、3．8μg/ml和4．8μg/ml,效应室靶浓度EC05、EC50和EC95分别是1．3μg/ml、2．2μg/ml和3．2μg/ml,50%患者意识消失的BIS是58,5%和95%患者意识消失的BIS分别是77和40。结论 择期手术患者TCI异丙酚意识消失时血浆靶浓度和效应室靶浓度EC50及95%置信区间分别是3．8μg/ml（3．8～3．9μg/ml）和2．2μg/ml（2．2～2．3μg/ml）, 50%患者意识消失的BIS用95%置信区间是58（58～59）。     

可乐定对悬雍垂腭咽成形术患者麻醉恢复期应激反应的影响

悬雍垂腭咽成形术是重症阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的主要治疗手段.麻醉恢复期是急性气道梗阻、出血及心脑血管意外等严重并发症的高发期[1-3],有必要采取有效的措施以降低术后并发症的发生.研究表明,肾上腺素能α2受体激动剂可乐定具有镇静和抗伤害性作用,与麻醉药物复合应用时可产生协同效应[4].     

音乐治疗对眼底手术病人焦虑的影响

目的：在于观察经听觉通道输入音乐对眼底手术病人焦虑状态的影响。方法：实验对象为39名择期进行眼底手术的男性病人，他们被随机地分为实验和对照两组，其中实验组19人，对照组20人，在手术过程中通过耳机给患者输入他们自己选定的音乐、观察焦虑（STAI），抑郁（SDS），视觉模拟焦虑（VAS）和脑电（BI）的变化。结果：实验组STAI，SDS，VAS值与对照组比明显降低，病人的焦虑、抑郁情绪有了明显改善，而脑电的变化没有显著性的差异。结论：音乐治疗可降低择期眼底手术男性病人的焦虑、抑郁与视觉模拟焦虑水平。     

法乐四联症儿童肥厚右心室细胞瞬间外向钾电流的研究

目的观察压力增高导致的人肥厚心室组织离子通道的特性.方法应用酶解分离技术从法乐四联症(F4)患儿的心脏右室得到单个细胞,应用膜片钳全细胞记录技术观察了细胞Ito1的特征.结果将钙电流阻断后,去极化至-20mV～+60mV时均可记录到Itn1,激活后电流衰减速度不随去极化程度的增强而改变,在0、20、40、60mV时分别为123ms±6ms、131ms±10ms、122ms±6ms、122ms±6ms,去极化至60mV时的电流密度为4.7pA/pF±0.8pA/pF,半数最大激活电位为4.1mV±2.8mV,半数最大失活电位出现在-41mV±4mV,失活后再激活的恢复时间常数为83ms±4ms.这种电流可被10mM4-AP基本抑制.结论肥厚的人右室细胞存在Itn1,通道动力学特征与成人心房肌细胞类似.     

赖氨匹林减轻阻塞性睡眠呼吸暂停低通气综合征术后吞咽痛

目的 观察围术期连续应用赖氨匹林(lysine acetyl salicylate,LAS)对阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者行悬雍垂腭咽成形术(uvul opalatopharyngoplasty,UPPP)后吞咽痛的影响.方法 中度OSAHS患者30例,美国麻醉医师协会(the American Society of Anesthesiologists,ASA)Ⅱ级,随机分为2组,Ⅰ组15例,诱导前30分钟静脉注射LAS10 mg/kg,术中以5 mg/kg·h泵入LAS至术毕;Ⅱ组15例,为对照组.分别记录术后即刻、2、4、6、12、24小时患者的疼痛、镇静、恶心和呕吐的评分,记录各时段镇痛液消耗量及有效按压次数/实际按压次数比值.结果 Ⅰ组术后各时段VAS普遍低于Ⅱ组,在前12小时有显著差异(P＜0.05),两组患者术后即刻～2小时自控静脉镇痛(patient controlled intravenous analgesia,PCIA)有效按压次数/实际按压次数比值Ⅰ组明显高于Ⅱ组(P＜0.05).术后24小时镇痛药消耗量Ⅱ组明显高于Ⅰ组,两组患者术后即刻～2小时、2～4小时、4～6小时镇痛药消耗量有显著性差异(P＜0.05).结论 围术期连续应用LAS可减轻OSAHS术后吞咽痛,有一定的超前镇痛作用.     

可乐定对低氧大鼠创伤后炎性反应及血流动力学的影响

目的 观察可乐定对缺氧大鼠创伤后炎性反应及血流动力学的影响.方法 40只成年雄性SD大鼠随机分为5组,缺氧对照组(A组)、创伤对照组(B组)、缺氧创伤组(C组)、缺氧创伤可乐定预处理组(D组)和缺氧创伤可乐定后处理组(E组),每组8只.除B组外,各组进行缺氧处理,建立缺氧大鼠模型.除A组外,各组大鼠在麻醉状态下进行咽部创伤操作;D组和E组分别在创伤前、后静脉注射可乐定30 μg/kg.记录各组大鼠创伤不同时点的平均动脉压(mean artery pressure,MAP)和心率(heart rate,HR),测定创伤后1小时血清肿瘤坏死因子α(tumor necrosis factor-alpha,TNF-α)和白细胞介素6(interleukin-6,IL-6)水平;光镜下观察各组大鼠肺脏和肾脏形态学变化.结果 除D组外各创伤组MAP和HR在创伤时明显上升(P＜0.05),各组之间没有显著差异;创伤后1小时D、E组MAP及HR明显低于B、C组(P＜0.05).创伤后1小时D、E组血清TNF-α、IL-6水平明显低于C组(P＜0.05).B、C组肺间质可见少量炎性细胞浸润,D、E组大鼠炎性细胞浸润较轻.结论 低氧大鼠对创伤所致的炎性反应更为敏感.30 μg/kg可乐定可以稳定低氧大鼠创伤后血流动力学,减轻创伤后炎性反应.     

6%贺斯及林格氏液对高凝患者凝血功能的影响

目的比较6%贺斯及林格氏液对高凝患者凝血功能的影响.方法择期行胃癌根治术、胃大部切除术、胆囊切除术、结肠癌根治术、直肠癌根治术等患者30例,年龄36～72岁,ASAI-Ⅲ级,符合下列条件:两周内未服用影响凝血的药物;术前经TEG检测MA＞68mm.术中出血＞500毫升的除外.随机分为A、B两组.采用静吸复合全麻,其中A组术中输液用林格氏液维持;B组入室后输入6%贺斯15ml/kg,其后用林格氏液维持.两组患者入室后及术毕拔管后分别取血做TEG检测及PT、APTT、FIB凝血分析,并记录两组出血量,术中的输液量.结果两组术中出血量及输液总量差异无统计学意义(P＞0.05).两组患者术前TEG参数及凝血分析指标差异无统计学意义(P＞0.05),A组术毕R、K、FIB值与术前比较减小,差异有统计学意义(P＜0.05),MA值与术前比较增大,差异有统计学意义(P＜0.05),PT、APTT与术前比较差异无统计学意义(P＞0.05);B组术毕R、K、PT、APTT与术前比较差异无统计学意义(P＞0.05),MA、FIB值与术前比较减小,差异有统计学意义(P＜0.05).结论高凝患者术中单纯输注林格氏液可能会加重患者的高凝状态,同时输入6%贺斯则对高凝状态有改善作用