芬太尼对先天性心脏病手术麻醉时心血管反应的影响

目的: 探讨芬太尼对先天性心脏病患儿心脏手术麻醉时心血管反应的影响。方法: 选3~13岁先天性心脏病手术患儿20例,随机分为2组:对照组给予0.9%生理盐水+维库溴铵+异氟烷吸入;芬太尼组给予芬太尼30 μg·kg-1·h-1+维库溴铵+异氟烷吸入。两组分别于切皮前(T)、体外循环后5 min (T₀)、主动脉开放前(T₁)、关胸后(T₂)各时点观察血液动力学、动脉血气、肺顺应性的变化。在T、T₁、T₂点测血糖、肿瘤坏死因子α(TNF-α)。结果: 对照组T₂平均动脉压(MAP)、心率(HR)、中心静脉压(CVP)较T、T₀显著增高(P<0.05和P<0.01);HR、CVP于T₂时对照组显著高于芬太尼组(P<0.01);对照组T₁、T₂点血糖显著高于T;芬太尼组T₁、T₂点血糖与对照组比较明显降低(P <0.01)。两组TNF-α在T₁、T₂点比T点明显增高(P<0.01),芬太尼组TNF-αT₂与T₁比较明显降低(P<0.01),两组肺顺应性在T₀后均降低,芬太尼组T₁肺顺应性高于对照组(P<0.05)。结论: 芬太尼能较好的调控术中的心血管反应在适度水平,从而更好调控小儿先天性心脏病的手术麻醉,但也有可能抑制术中的保护性心血管应激机制。

Effects of fentanyl on cardiovascular system of patients with congenital heart diseases in anesthesia for heart surgery

Objective: This study was designed to characterize the ultrastructure of the coccoid Helicobacter pylori(H. pylori) forms in the tissues of carcinoma.Methods: Transmission electron microscopy(TEM) technique was used to examine the structure of coccoid H. pylori in 4 cases of gastric carcinoma and 2 cases of esophageal carcinoma.Results: It was found that the coccoid H. pylori were scattered in cancer nest and cancer interspace,some of which enterded cancer cells,macrophages and other cells.The coccoid H. pylori appeared to be similar to the L-forms of other bacteria with varying cell shape and size,different cytoplasmic electron densities and defects in cell wall.Two types of coccoid H. pylori could be distinguished in the tissues of carcinoma by TEM.Type A was smaller with higher electron density in the cytoplasma,and flagellation on the cell membrane,suggesting that it could be viable.However,the type B was larger with lower electron density in the cytoplasma,and no flagellation on the cell membrane,suggesting that it could be a degenerative form.Conclusions: The coccoid forms of H.pulori still have certain degree of viability,thus they may play an important role in the transmission of H. pylori,the relapse of H. pylori related disease after treatment and the development of the related carcinoma.