恩氟烷低流量循环麻醉

目的:观察低流量循环麻醉的临床效果。方法:选择择期胆囊摘除手术26例,每组13例,分别接受低流量(0.4～0.6L/min)或高流量(3.0L/min)恩氟烷循环麻醉,观察两组麻醉期间的SBP、HR、P_(ET)CO_2、S_pO_2、FiO_2、F_iE_nf、F_(ET)E_nf及新鲜气体流量;统计学处理采用t检验和X~2检验。结果:两组麻醉期间SBP、HR、P_(ET)CO_2、F_iEnf、F_(ET)Enf差异不显著(P>0.05);与高流量麻醉组相比,低流量麻醉组恩氟烷投入量小、利用率高(P<0.01),且FiO_2总高于0.6。结论:低流量循环麻醉与高流量麻醉同样安全、麻醉过程平稳,且具有节省麻醉药、提高麻醉气体利用率的优点。     

瑞芬太尼与丙泊酚诱导后补注对围插管期血流动力学的影响

目的观察瑞芬太尼或丙泊酚诱导后补注对插管期心血管的稳定作用.方法拟行气管插管全麻患者227例,ASA分级Ⅰ～Ⅱ级,麻醉诱导后SBP下降<30%者187例,随机分为A,B,C三组,A组63例,B,C组各62例.用瑞芬太尼1μg/kg、丙泊酚1.5 mg/kg、维库溴铵0.1 mg/kg静脉注射诱导,2 min后A组直接气管插管,B,C组分别补注瑞芬太尼0.2μg/kg和丙泊酚诱导剂量的1/5,随后行气管插管,观察并测量三组气管插管完成时即刻(T1)、3 min(T2)、5 min(T3)的HR,SBP,DBP,并计算RPP;比较3组插管后4项指标的变化,并与基础值(T0)比较.结果与T0时相比,A组插管后T1,T2时的HR,SBP,RPP均明显增加(P<0.05),而B,C两组插管后T1,T2时HR,SBP,RPP与T0时比较差异无统计学意义(P>0.05);与A组比较,B,C两组插管后T1时的HR,SBP,RPP均明显下降(P<0.05),而B组T1时的DBP与A组比较差异无统计学意义(P>0.05);B,C两组间各时点HR,SBP,RPP比较差异无统计学意义(P>0.05);T3时A,B,C三组的HR,SBP,DBP,RPP及与T0时比较差异无统计学意义(P>0.05).结论诱导后补注适量的瑞芬太尼或丙泊酚均可有效减轻气管插管时的心血管反应,对有高血压/缺血性心脏病的患者丙泊酚较瑞芬太尼更利于心肌灌注.     

Effect of tramadol on immune responses and nociceptive thresholds in a rat model of incisional pain

Objective： To evaluate the effects oftramadol on the proinflammatory responses in a rat model of incisional pain by investigating its effects on nociceptive thresholds and serum interleukin-6 （IL-6） and IL-2 levels. Methods： Forty-two male Sprague-Dawley （SD） rats scheduled for plantar incision were randomly divided into 7 groups 01=6 in each group）. Rats in Group 1 receiving general anesthesia with no incision were served as control; At 30 min before skin incision, Groups 2-5 were given 5 ml normal saline or 1, 10, and 20 mg/kg tramadol, respectively, intraperitoneally （i.p.）; Group 6 received 10 mg/kg tramadol after operation; Group 7 received 10 mg/kg tramadol before incision, followed by 200 μg/kg naloxone after operation. Mechanical allodynia was measured by electronic yon Frey filament to evaluate the nociceptive thresholds 1 h before incision, and 1 h and 2 h after operation. Serum IL-6 and IL-2 levels were measured by enzyme-linked immunosorbent assay （ELISA） 2 h after operation. Results： Mechanical thresholds decreased significantly and serum IL-6 level increased significantly after operation in Group 2 compared with control （P〈0.01）, and these changes were reversed respectively by tramadol in a dose-dependent manner （P〈0.05 and P〈0.01, respectively）. IL-2 level remained unchanged after operation in Group 2, but decreased in Group 3 （P〈0.05）, then gradually returned to the normal level in Groups 4 and 5. The intraperitoneally injected tramadol （10 and 20 mg/kg） produced a potent and dose-dependent antinocicptive effect on the lesioned paw. The antinocicptive effects of tramadol were partially an- tagonized by naloxone （200 μg/kg）, suggesting an additional non-opioid mechanism. Conclusion： The results suggest that tramadol could be a good choice for the treatment of pain under the conditions that immunosuppression may be particularly contraindicated.     

Cardiac protective role of a novel erythrocyte-derived depressing factor on rats and its Ca^2＋ mechanism

The cardiac protective role of a novel erythro-cyte-derived depressing factor (EDDF) on spontaneous hy-pertensive rats (SHR), calcium overload (CaO) rats and Wistar rats and its mechanism was evaluated. Mean artery pressure (MAP), heart rate (HR) and LVdp/dtmax were measured by physiological recorder. The effect of EDDF on the Ca2+-ATPase activity in myocardial sarcoplasmic reticu-lum (SR) of CaO rats was determined by inorganic phos-phate assay. Calcium transport in myocytes was measured by 45Ca2+ radioactive isotope measurement. The phosphoryla-tion levels of extracellular signal-regulated protein kinases (ERK1/2) in myocardial tissue of SHR and CaO rats were measured by Western blot method. And the ultrastructures of cardiac muscle cells were observed with the transmission electron microscope. The results indicated that EDDF could significantly decrease MAP, HR and LVdp/dtmax in a dose dependent manner (P < 0.05). It seems that the mechanism might relate with activating the Ca2+-APTase, enhancing the uptake and release of Ca2+ from SR (P < 0.05), decreasing the phosphorylation levels of ERK1/2 of myocytes (P < 0.01) and lightening the ultrastructural lesion of cardiac muscle cells. In CaO rats, the Ca2+-ATPase activity decreased clearly com-pared to control (64.99 7.16 vs 94.48 7.68 nmol·min-1 ·mg-1 protein, P < 0.01), while EDDF (100 mg/mL) could significantly increase the activity (87.93 ?9.54 vs 64.99 ?7.16, P < 0.05, n = 7). Both uptake and release rate of Ca2+ (祄ol 45Ca2+/g protein/min) from myocardial SR of CaO rats re-markably decreased compared to control (32.40 ?2.70 and 15.46 ?1.49 vs 61.09 ?10.89 and 25.47 ?4.29, P < 0.05); EDDF (100 mg/mL) could significantly stimulate their activi-ties (50.48 6.76 and 21.76 2.75 vs 32.40 2.70 and 15.46 1.49, P < 0.05). EDDF could evidently down-regulate the phosphorylation of ERK1/2 in myocardial tissue from SHR and CaO rats (P < 0.01), lighten the ultrastructural lesion of cardiac muscle cells of SHR as well. It is concluded that EDDF seems to play protective roles on both structure and function of heart, which closely related with amelioration of Ca2+ transport and inhibition of Ca2+-MAP kinase pathway.     

硬膜外注射吗啡用于下腹部手术后镇痛

目的 观察下腹部术后硬膜外注射吗啡镇痛的疗效。方法 择期下腹部手术病人５１例,待手术缝皮时,经硬膜外导管注射吗啡液（吗啡２ｍｇ加生理盐水１０ｍＬ）用于术后镇痛。结果 注药前后ＨＲ,ＭＡＰ,ＳＰＯ２无显著性并异（Ｐ〉０．０５）;术后２４ｈＶＡＳ显著高于术后４ｈ（Ｐ〈０．０５）,但无临床意义;术后并发恶心呕吐６例,尿潴留２例,瘙痒１例。结论 硬膜外注射吗啡用于腹部手术后镇育取得了良好的疗效,值得推广。     

不同麻醉药物在气道表面麻醉时对气管插管及拔管反应的影响分析

目的探讨不同麻醉药物行气道表面麻醉时对气管插管及拔管反应的影响.方法选取收治的80例择期行下腹部剖腹手术患者为研究对象,随机分为2%利多卡因组(L组,n=20)、0.75%丁卡因组(T组,n=20)、0.75%罗哌卡因组(R组,n=20)、对照组(C组,n=20),静脉诱导后分别用5 m L上述麻醉药物行气道表面麻醉,其中对照组用5 m L生理盐水.观察记录各组麻醉诱导前、插管即刻、插管后3 min、拔管即刻及拔管后3 min的平均动脉压(MAP)、收缩压(SBP)和心率(HR)情况;记录患者麻醉苏醒期呛咳评分及术后患者不良记忆情况.结果插管后4组患者HR,SBP及MAP较插管前显著升高(P0.05);与C组比较,插管后各组患者HR,SBP,MAP指标显著偏低(P0.05),其中R组插管后上述指标较L组、T组显著偏高(P0.05);拔管时C组HR,SBP,MAP较T组、R组显著偏高(P0.05),T组上述指标较L组低(P0.05);T组、R组呛咳评分及拔管时不良回忆评分较L组、C组低(P0.05).结论与2%利多卡因和7.5%罗哌卡因相比,0.75%丁卡因更能有效地抑制插管反应.     

氯诺昔康在神经外科术后静脉自控镇痛中的应用

目的:观察经额部、颞部入路的神经外科病人术后的疼痛情况以及氯诺昔康用于此类神经外科病人术后静脉自控镇痛的临床效果.方法:36例择期经额部、颞部入路的神经外科手术病人,随机分为二组:氯诺昔康组(L组)镇痛药物为氯诺昔康每mL0.8 mg;对照组(N组)术后当病人主诉疼痛明显,难以忍受时予口服颅痛定30mg.记录各组病人术前及术后4、16、24、48 h的心率、平均动脉压、呼吸频率、脉搏氧饱和度及瞳孔变化.记录各组病人术后4、16、24及48 h的疼痛模拟评分(VAS)、Ramsay镇静评分及术后的凝血指标和术后发生恶心呕吐的情况.结果:L组病人的心率、平均动脉压术前与术后各时段点比较无显著差异(P＞0.05);N组病人术后4 h的心率、平均动脉压较术前显著增加,差异有统计学意义(P＜0.05).两组病人均未出现明显的呼吸抑制,Ramsay镇静评分均不超过3分,在术后各时段点差异均无统计学意义(P＞0.05).术后4、16 h L组VAS评分均显著低于N组(P＜0.05),术后24、48 h二组VAS评分差异无显著性(P＞0.05).未镇痛组的病人在术后24 h内有10例需要使用颅痛定.两组病人术前术后血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)均在正常值范围内.L组和N组病人均有不同程度的恶心呕吐情况出现,各组的呕吐发生率均为33.33%.结论:经额、颞部入路的神经外科病人手术后存在术后疼痛,且大多发生在术后第1 d.氯诺昔康能为其提供良好的术后镇痛疗效,术后镇痛中无明显的呼吸抑制、镇静及凝血指标异常等不良反应.     

中草药保健剂“鸡食乐”对雏鸡红细胞免疫功能的影响研究

本研究将健康1日龄京白雏鸡100只随机均分为试验组和对照组.试验组饮水中添加“鸡食乐”煎汁,使饮水药液浓度为1%让鸡自由饮用;对照组饮水中不添加任何药物.饲养至7周龄,各组取15只采血测试红细胞免疫功能.结果,试验组、对照组红细胞C_(3b)受体花环形成率(E-C_(3b)R)分别为13.4±1.51%、10.6±1.25%,组间差异极显著(P<0.01),红细胞免疫复合物花环形成率(E—IC)分别为5.4±1.51%、4.7±1.34%,组间差异不显著(P>0.05),红细胞C_(3b)受体花环促进率(RFER)分别为55.5±10.8%、38.3±10.7%,组间差异极显著(P<0.01);红细胞C_(3b)受体花环抑制(RFIR)分别为17.4±3.4%、17.7±3.8%,组间差异不显著(P>0.05).     

宫腔镜手术围手术期患者生命体征、血糖及电解质的变化

目的:探讨宫腔镜下围手术期患者生命体征以及血糖、电解质的变化。方法:对158例择期宫腔镜手术患者分别于手术前、手术后10、20、40、60、80 m in观测并记录平均动脉压(MAP)、心率(HR)和中心静脉压(CVP)等指标,并观察血红蛋白(Hb)、红细胞压积(Hct)、血钾(K )、血钠(Na )、血氯(C l-)、血钙(Ca2 )和血糖(G lu)等参数变化。结果:在整个手术中过程中,MAP、HR、血糖和CVP等参数在手术开始40 m in后与术前比较明显增高,差异具有统计学意义(P<0.05)。Hb、Hct、Na 和C l-在手术开始40 m in后与术前比较明显下降,差异具有统计学意义(P<0.05)。结论:宫腔镜手术时间越长,出现过度水化综合征的机会越大,因此密切监测生命指标及血糖、血清Na 的变化是至关重要的。     

脑脊液稀释下布比卡因腰麻用于剖宫产术80例

目的：比较0.5％布比卡因用两种容积脑脊液稀释腰麻用于剖宫产的麻醉效果.方法：80例择期行剖宫产的产妇随机分成A、B两组,每组40例,A组见腰麻针脑脊液回流后接入抽有0.5％布比卡因1.5ml的注射器缓慢回抽至2ml后给药,B组药物用量同A组,回抽至2.5ml后给药.观察比较A组和B组麻醉效果、血压波动和恶心呕吐情况.结果：两组麻醉效果差异无统计学意义,但B组血压波动小于A组且恶心呕吐发生率低于A组.结论：0.5％布比卡因1.5ml（7.5mg）见脑脊液回抽至2.5ml能满足剖宫产麻醉要求,且不良反应少.