脑出血继发损伤中沉默信息调节因子2的表达和炎症反应*

目的：探讨脑出血对酵母沉默信息调节因子2（Sirt2）和炎症的影响。方法：将胶原酶Ⅳ注入SD大鼠右侧 纹状体中建立脑出血模型，通过免疫印迹和ELISA 等方法测定大鼠脑出血后48 h 的Sirt2 的表达及炎症变化。利 用Hemin 诱导PC12 细胞损伤模拟体外脑出血模型，并检测Sirt2 及炎症变化；采用短发夹RNA（shRNA）-Sirt2 沉 默Sirt2 在PC12 细胞中的表达及对炎症的影响。结果：手术后48 h 脑出血行为学评分最低。脑出血组Sirt2 的表达 显著高于假手术组。脑出血组IL-6、IL-1β 表达显著升高。结论：脑出血可以促进Sirt2 的表达和炎症反应，降低 Sirt2 的表达可减缓炎症反应。 关键词 脑出血；沉默信息调节     

Effects of repeated doses of benzodiazepines on arterial blood gases and transcutaneous Po2

The effects of repeated doses of benzodiazepines, diazepam and midazolam in combination with meperidine on arterial blood gases and transcutaneous PO2 were studied in eight healthy volunteers. The study was designed to mimic a clinical situation. Initially two doses of either midazolam 0.05 mg/kg or diazepam in fat emulsion 0.15 mg/kg were given in a randomized crossover fashion with a 20-min interval, followed by meperidine 0.5 mg/kg another 20 min later. The opioid effects were then antagonized by naloxone 0.4 mg. The initial doses of benzodiazepines caused an increase in PaCO2 and a decrease in PaO2. The changes in PaO2 were of short duration and recovered to baseline levels between injections. However, they came sooner and were more pronounced after midazolam. The changes in PtcO2 paralleled those in PaO2. The PtcO2 index as a measure of cardiac output and peripheral blood flow adequacy was increased immediately after the first injection of midazolam but was otherwise not different from control. There were no differences between the drugs concerning PtcO2 index. PaCO2 increased after the first benzodiazepine injection and remained so throughout the study. Addition of meperidine caused only small changes in PaO2 and PaCO2. These changes were reversed by naloxone. In spite of different elimination kinetics there was no difference in the duration of respiratory depression between the two benzodiazepines.     

咪达唑仑在肠镜检查中的应用

目的　研究咪达唑仑在肠镜检查中的清醒镇静作用。方法　行肠镜检查的门诊或住院病人 10 0例 ,随机分为药物组与对照组 ,每组 5 0例 ;药物组肠镜检查前缓慢推注咪达唑仑 5 μg kg ,2min后开始检查 ,术中根据情况一次追加 1～ 2 μg kg ,但总量不超过 8μg kg ;对照组为常规检查。观察两组病人检查过程中心率、血氧饱和度、血压及呼吸的变化。治疗结束后询问病人对检查过程的记忆丧失程度、感受及满意情况 ;记录检查时间与是否完成检查 ,同时操作者及助手评价病人的配合情况。结果　药物组大部分病人 ( 90 % )肠镜置入及检查过程中听从医生的指令、无焦虑 ,配合肠镜检查 ,其他的病人略有不适但都能配合检查 ,无一例不能耐受检查 ;对照组只有 5 8%的病人能配合检查 ,且有 2例因无法耐受导致检查失败 ;药物组病人对检查过程 74%完全无记忆 ,部分记忆和完全记忆的 2 6% ;而对照组部分记忆和完全记忆为 10 0 % ;药物组 90 %以上的病人对检查过程满意 ,无不满意 ,对照组满意率不到 10 % ;药物组的HR、MAP、SpO2 基本平稳 ;对照组的病人在检查过程的血压明显上升但心率下降。结论　小剂量的咪达唑仑 ( <8μg kg)能很好地应用于肠镜检查 ,具有明显的记忆缺失、减少痛苦、提高满意率和检查率 ,稳定血液动力学的作     

Oral midazolam premedication for paediatric day case patients

Forty-nine children having day-stay surgical procedures were randomly assigned to receive oral midazolam 0.75 mg·kg^?1 or placebo in a double blind fashion. The child's level of anxiety was assessed before premedication using parental, child and observer scales. The child and observer anxiety scores were repeated in the anaesthetic room. Most children presented for anaesthesia in a calm state, irrespective of whether they had received midazolam. Parents tended to overestimate their child's level of anxiety. Observer anxiety scores reliably predicted behaviour during induction of anaesthesia in the absence of a sedative. Observer scores decreased in the midazolam group (P<0.02), but not in the placebo group, children below six years having the greatest decrease with midazolam. The median time to discharge from hospital was delayed by 30 min in the midazolam group (P<0.01). Children do not require routine sedative premedication for day case procedures, but oral midazolam is useful in producing calm behaviour in those children with high observer anxiety scores.     

A comparison of midazolam with trimeprazine as an oral premedicant for children

The effect of oral premedication was investigated in a double-blind, randomised trial in 85 children undergoing tonsillectomy and/or adenoidectomy. Orally administered midazolam 0.5 mg.kg⁻¹ given 30 min pre-operatively was compared with trimeprazine 2 mg.kg⁻¹ given 90 min pre-operatively and a placebo preparation. Compliance, sedation and ease of induction were assessed as were the duration and quality of recovery. Following premedication with midazolam none of the patients was anxious, crying or distressed on leaving the ward, compared with 2/28 in the trimeprazine group and 5/28 in the placebo group (p =0.0007). More patients were calm and quiet on arrival in the anaesthetic room following midazolam than following trimeprazine, with both premedicant agents comparing favourably with placebo. There was no significant difference between the three groups in the time to recovery or the sedation score on discharge to the ward. Midazolam is a safe and effective oral premedicant for children.     

Management of status dystonicus: our experience and review of the literature.

Status dystonicus (SD) is a life threatening disorder that develops in patients with both primary and secondary dystonia, characterized by acute worsening of symptoms with generalized and severe muscle contractions. To date, no information is available on the best way to treat this disorder. We review the previously described cases of SD and two new cases are reported, one of which occurring in a child with static encephalopathy, and the other one in a patient with pantothenate kinase-associated neurodegeneration. Both patients were admitted to an intensive care unit and treated with midazolam and propofol. This approach proved to be useful in the former while the progressive nature of the dystonia of the second patient required the combination of intrathecal baclofen infusion and bilateral pallidal deep brain stimulation. We believe that a rapid and aggressive approach is justified to avoid the great morbidity and mortality which characterize SD. Our experience, combined with the data available in the literature, might permit to establish the best strategies in managing this rare and severe condition.     

Comparison of propofol induction with thiopentone or methohexitone in short outpatient general anaesthesia

The per- and post-operative characteristics of three different i.v. anaesthetic induction agents were studied double-blindly in 75 patients admitted for outpatient gynaecological dilatation and curettage. All the patients were premedicated with midazolam 0.1 mg/kg i.m. Induction started with alfentanil 0.015 mg/kg i.v. 60 s before either: propofol 2.2 mg/kg i.v., or thiopentone 4.0 mg/kg i.v., or methohexitone 2.0 mg/kg i.v. All the patients received 66% nitrous oxide in oxygen. The propofol patients were significantly better relaxed and had a higher incidence of hypotension during the procedure. The methohexitone patients had higher pulse rates and a higher frequency of hiccups during the procedure. Propofol induction resulted in a faster awakening of the patients and a better recovery function compared with methohexitone for the first 15 min and compared with thiopentone for the first 240 min after the procedure. Postoperative side-effects were less frequent in the thiopentone group, and minor abdominal pain was significantly more frequent in the propofol group. There was no significant difference between the groups for any variable after 240 min postoperatively.     

咪唑安定对布比卡因蛛网膜下腔麻醉效果的影响

目的观察咪唑安定加入布比卡因对蛛网膜下腔麻醉维持时间和麻醉效果的影响。方法40例ASAⅠ级子宫切除病人随机分为咪唑安定组（试验组，11=20）和对照组（n=20）。咪唑安定组蛛网膜下腔注入0．5％重比重布比卡因2．5ml加咪唑安定1mg（0．2m1），对照组注入0．5％重比重布比卡因2．5ml加生理盐水0．2ml。观察运动神经阻滞（改良Bromage）、感觉神经阻滞（针刺法）、镇痛时间（VAS）、术者和患者对麻醉的满意率。结果咪唑安定组感觉和运动神经阻滞时间显著延长（P〈0．01），术者和患者对麻醉的满意率提高（P〈0．05）。咪唑安定组有效镇痛时间也显著延长（P〈0．001）。两组血流动力学、不良反应情况差别无显著性。结论咪哗安定加入布比卡因能显著延长麻醉作用时间，麻醉效应增强，而不良反应未见增加。