三种不同麻醉方式对产妇血流动力学及新生儿的影响

目的;探讨硬膜外麻醉、蛛网膜下腔-硬膜外麻、气管插管全麻三种不同麻醉方式对剖宫产产妇血流动力学及胎儿的影响。方法:纳入行择期剖宫产产妇152例,采用随机表法将其分为硬膜外组(48例)、腰硬联合麻醉组(52例)、气管内插管全麻组(52例)。观察麻醉前正常状态时(T1)、麻醉成功后5 min(T2)、胎儿娩出时(T3)三个时间点产妇SBP、DBP、HR、SV、CO、SVR及胎儿相关指标,包括出生后1 min、5 min Apgar评分、脐动脉血pH、PCO_2、PO_2。结果:硬膜外麻、腰麻-硬膜外联合麻醉、全麻三组间麻醉起效时间有明显统计学差异(P0.05),气管内插管全麻组起效时间最快。三组间在T1时间点SBP、DBP、HR、SV、CO、SVR差异无统计学意义(P0.05)。在T2时间点,硬膜外麻、联合麻醉、全麻三组SBP、DBP、HR、SVR水平均较T1时间点明显降低,差异有统计学意义(P0.05)。T2时间点,全麻组SBP、DBP、HR、SVR水平高于硬膜外、联合麻醉组(P0.05)。T3时间点三组SBP、DBP、HR、SV、CO水平均较T2时间相比差异有统计学意义(P0.05)。T3时间点,全麻组SBP、DBP、SVR高于其他两组,心率低于其他两组,差异有统计学意义(P0.05)。三组间新生儿出生后1 min Apagr、5 min Apgar评分、脐动脉血学pH、PCO_2无统计学差异(P0.05)。三组间脐动脉血PO_2有明显统计学差异(P0.05),气管内插管全麻组脐动脉血PO_2最高。结论:三种麻醉均可以用于剖宫产术,全麻剖宫产术对产妇血流动力学影响最小,起效快,但对胎儿脐动脉血氧浓度有一定的影响。     

电针内关对冠心病患者围术期细胞炎性因子的影响

目的:探讨电针刺激内关穴对冠心病患者围术期细胞炎性因子的影响。方法:选取择期行开腹全子宫及双附件切除术的冠心病患者60例,并将患者随机分为E组(电针组)、C组(对照组),E组用韩式电针刺激仪(HANS-B100B)在麻醉诱导前20 min开始针刺内关穴,并维持针刺至术毕,C组不做任何处理。两组患者分别记录插管前(T0)、插管后即刻(T1)、手术结束时(T2)、拔管后即刻(T3)、拔管后10 min(T4)时的血压(SBP)、平均动脉压(MAP)、心率(HR),并留T0~T4时刻的静脉血,采用酶联免疫吸附法(ELISA)检测血清IL-1β、IL-6、TNF-α的水平。结果:两组患者组内比较:E组各时点SBP、HR、MAP较同组T0时点比较差异无统计学意义(P0.05),C组T1-T4时点HR、SBP、MAP较同组T0时点明显升高(P0.05);组间比较:E组T1-T4时HR、SBP、MAP、明显低于C组(P0.05),E组患者T1~T4静脉血中的IL-1β、IL-6、TNF-α均明显低于C组(P0.05)。结论:电针刺激内关穴能抑制冠心病患者围术期的炎性反应改善心肌缺血,对心肌的保护作用显著。     

瑞芬太尼在全髋关节置换术中的麻醉效果观察

目的探讨瑞芬太尼在全髋关节置换术中的麻醉效果。方法将80例全髋关节置换术患者随机分为观察组和对照组各40例,观察组采用咪达唑仑、依托咪酯、舒芬太尼、罗库溴铵行全麻诱导,以丙泊酚、瑞芬太尼和阿曲库铵行麻醉维持;对照组采用咪达唑仑、依托咪酯、舒芬太尼、罗库溴铵行全麻诱导,以丙泊酚、芬太尼和阿曲库铵行麻醉维持。观察两组患者T0~T3各时点MAP和HR的变化情况以及手术时间、苏醒时间和语言恢复时间。结果观察组苏醒时间和语言恢复时间明显短于对照组,差异有统计学意义(P0.05)。结论瑞芬太尼用于全髋关节置换术中患者苏醒时间快,且手术过程血压、心率相对平稳,具有临床应用价值。     

不同剂量右美托嘧啶对胸腔镜下食管癌根治术患者心肌氧供及血流动力学的影响

目的:探讨不同剂量右美托嘧啶(DEX)对胸腔镜下食管癌根治术患者心肌氧供及血流动力学的影响。方法:选取66例我院拟行腔镜下食管癌根治术患者,随机分为三组,每组各22例:低剂量右美托嘧啶组(L组)(0.5μg/kg)、高剂量右美托嘧啶组(H组)(1.0μg/kg)、对照组(N组)(与L组和H组同等速率输注生理盐水),而后H组和L组均以0.5μg/kg/h维持输注DEX。记录各组输注前(T1)、输注后5 min(T2)、输注后10 min(T3)、输注后15 min(T4)、输注后30 min(T5)各组血流动力学指标:心率(HR)、收缩压(SBP)、平均动脉压(MAP)、每搏输出量(SV)、中心静脉压(CVP)、心排量(CO),计算HR与SBP的乘积RPP,抽取挠动脉和肺动脉血进行动脉血气分析,采用反向FICK法计算氧供(DO2)和氧耗(VO2)。结果:HR:H组和L组患者HR随时间的推移呈下降趋势,H组T3、T4、T5时间点HR较T1时间点显著降低(P0.05);与N组相比,H组和L组T3、T4、T5时间点HR显著降低(P0.05)。MAP:H组T3、T4、T5时间点MAP显著低于L组(P0.05);H组T3、T4时间点MAP显著低于N组(P0.05);H组T5时间点MAP显著低于同组T1、T2时间点(P0.05)。SBP:H组T3、T4、T5时间点SBP与L组和N组比较显著降低(P0.05);H组T5时间点SBP较同组T1、T2时间点显著降低(P0.05)。RPP:H组T3、T4、T5时间点RPP与同组T1、T2时间点和N组比较显著降低(P0.05)。DO2:H组T5时间点DO2与L组和N组比较显著降低(P0.05)。VO2:L组患者VO2T3、T4、T5时间点与组内T1、T2时间点和N组相比显著降低(P0.05);H组VO2T3、T4、T5时间点与组内T1、T2时间点和N组相比显著降低(P0.05)。结论:小剂量(0.5μg/kg)输注DEX能降低胸腔镜下食管癌患者心肌氧耗,维持血流动力学稳定,高剂量(1.0μg/kg)输注DEX降低心肌氧耗的同时会降低心肌氧供,存在一定风险,对于患有冠心病以及心肺功能低下的老年患者,建议给予小剂量输注DEX,并监测血流动力学指标,及时调整DEX用量。     

丙泊酚复合芬太尼静脉复合全麻在老年主动脉夹层介入手术中的麻醉效果研究

目的:探讨老年主动脉夹层介入手术采用丙泊酚复合芬太尼静脉复合全麻对患者麻醉效果的影响。方法:选取2015年6月到2018年3月四川省攀枝花市中心医院麻醉科接诊的老年胸、腹主动脉夹层行介入手术治疗的患者76例作为研究对象,采用随机数字表法将患者分为观察组(38例)及对照组(38例),观察组采用丙泊酚复合芬太尼静脉复合全麻,对照组采用丙泊酚静脉复合全麻,观察并比较两组患者循环功能指标[血压(DBP、SBP)、心率(HR)、平均动脉压(MAP)]、肺功能指标[呼吸频率(R)、呼气末二氧化碳(P~(ET)CO_2)、血氧饱和度(SpO_2)、气道压力(PAW)]及麻醉效果[脑电双频指数(BIS)值、苏醒时间(术后自主呼吸恢复时间、睁眼时间、定向力恢复时间)、拔管时间的组间差异。结果:观察组术后苏醒时间(自主呼吸恢复时间、睁眼时间、定向力恢复时间)及拔管时间低于对照组(P0.05)。观察组R在T1～T5时间点均低于对照组(P0.05),在T1时间点,观察组P~(ET)CO_2低于对照组,PAW高于对照组(P0.05),观察组SpO_2在T3、T4高于对照组(P0.05);观察组HR、SBP、DBP、MAP在T1～T3时间点均高于对照组(P0.01)。观察组患者的HR、MAP在不同时间点间比较无统计学意义(P0.05)。结论:采用丙泊酚复合芬太尼静脉复合全麻对于老年主动脉夹层介入手术患者,具有降低患者呼吸及循环功能影响的效果,具有更优的麻醉效果。     

右美托咪定对下肢手术使用止血带的血流动力学的影响

目的:观察右美托咪定(dexmedetomidine,Dex)对下肢手术使用止血带的血流动力学的影响.方法:选择择期在我院行下肢手术的患者60例,ASA Ⅰ～Ⅱ级,随机分为2组,即右美托咪定组(dexmedetomidine,D组)和对照组(control,C组),每组30例,两组均选择腰硬联合麻醉.麻醉成功后,D组于上止血带前15 min,用微量泵给予Dex负荷量0.8μg/g,10 min静脉泵入,之后输注速度设定为0.4 μg· kg-1·h-1,直至止血带放气;C组用生理盐水代替右美托咪定,用药方法同D组.记录两组药物给负荷量之前(T0)、止血带充气前(T1)、止血带充气后15 rain(T2)、止血带充气后30 min(T3)、止血带充气后45 min(T4)、止血带充气后60 min(T5)及止血带放气后5 min(T6)的平均动脉压(MAP)、心率(HR)及血氧饱和度(SPO2);记录两组高血流动力学的发生率及所用血管活性药物的量.结果:用药前,两组患者的MAP、HR及SPO2比较,差异均无统计学意义(P＞0.05).D组患者给予负荷量后,T2～T5各时点MAP均较T1显著升高(P＜0.05),而T6时MAP下降,与T1比较无明显差异(P＞0.05);T4～T6各时点HR均较T1显著升高(P＜0.05),各时点SPO2比较均无统计学意义(P＞0.05).C组在T2～T6各时点MAP和HR均较T1显著升高(P＜0.05),各时点SPO2比较均无统计学意义(P＞0.05).T2、T4和T6各时点D组患者的MAP具显著低于C组(P＜0.05),T1～T6各时点HR均显著低于C组(P＜0.05).D组T1时HR显著低于TO时(P＜0.05).C组和D组患者高血流动力学反应的发生率分别为66.7％和20％,C组明显高于D组(P＜0.01).两组患者尼卡地平和阿托品的用量差异均无统计学意义(P＞0.05),但D组麻黄碱的用量明显高于C组(P＜0.05),两组患者均未应用艾司洛尔处理.结论:Dex可减少下肢手术使用止血带时引起的血流动力学高反应的发生.     

右美托咪定对下肢手术患者止血带诱发肢体缺血-再灌注损伤的影响

目的:探讨右美托咪定对下肢手术患者因止血带诱发肢体缺血-再灌注损伤的影响。方法:选取2015年1月-2016年5月我院行下肢手术治疗的患者90例,按照数字随机法分为观察组及对照组,每组各45例。两组均给予蛛网膜下腔阻滞联合硬膜外麻醉,观察组在穿刺成功15 min内静脉输注1μg/kg的右美托咪定,维持剂量0.5μg/kg·h直至手术结束,对照组患者则给予同等剂量的生理盐水。对比两组止血带前(T0)、止血带充气30 min(T1)、止血带充气1 h(T2)、止血带释放后30 min(T3)、止血带释放后1 h(T4)时的超氧化物歧化酶(SOD)、丙二醛(MDA)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、平均动脉压(MAP)、心率(HR)水平以及不良反应发生情况。结果:T3、T4时点观察组SOD水平显著高于对照组,MDA水平显著低于对照组(P0.05)。T1、T2、T3、T4时点观察组TNF-α水平显著低于对照组,T4时点IL-6水平也显著低于对照组(P0.05)。T1、T2时点观察组MAP、HR水平均显著低于对照组(P0.05)。观察组术中止血带疼痛、高血压发生率均显著低于对照组(P0.05)。结论:右美托咪定可显著抑制下肢手术患者止血带诱发氧化应激反应以及炎症反应,进而降低肢体缺血-再灌注损伤,具有较好的安全性。     

超声引导下外周神经阻滞麻醉对老年单膝关节置换术患者血流动力学和认知功能的影响

目的:探究超声引导下外周神经阻滞麻醉对老年单膝关节置换术患者血流动力学和认知功能的影响。方法:选取2017年3月-2019年3月在我院进行单膝关节置换术的老年患者82例,根据麻醉方式不同分为研究组和对照组,每组各41例。研究组采用超声引导下外周神经阻滞麻醉,对照组采用全身麻醉,对比两组的麻醉诱导时间、麻醉维持时间、手术时间等指标,两组入室麻醉前(T0)、气管插管时(T1)、切皮(T2)、止血带60 min(T3)、松止血带5 min(T4)、拔除气管导管时(T5)、术后6 h(T6)、术后24 h(T7)的收缩压(Systolic blood pressure,SBP)、舒张压(Diastolic blood pressure,DBP)、心率(Heart rate,HR)等指标,两组术前、术后6 h、术后12 h、术后24 h的认知功能评分及术后镇痛药物的使用量。结果:研究组的麻醉诱导时间明显长于对照组(P0.05);两组的麻醉维持时间、手术时间比较均无明显差异(P0.05);研究组T1、T3、T5时点HR显著低于对照组(P0.05),T2、T3时点SBP、DBP水平明显高于对照组,T3、T4、T5、T6时点SBP、DBP水平显著低于对照组(P0.05)。两组术前、术后24 h的认知功能评分对比均无统计学差异(P0.05);但研究组术后6 h、术后12 h的认知功能评分均明显高于对照组(P0.05),术后24 h、术后48 h、术后72 h的镇痛药物使用量均明显低于对照组(P0.05)。结论:在老年单膝关节置换术中,超声引导下外周神经阻滞麻醉对患者血流动力学和认知功能的影响较小,且术后镇痛药物使用量更少。     

PICCO在老年髋关节手术麻醉及血流动力学优化中的应用

目的:探讨脉搏指示持续心输出量(pulse induced contour crdic output,PICCO)技术在老年髋关节手术麻醉及血流动力学优化中的临床应用。方法:将106例老年髋关节手术患者随机分成2组,每组各53例。常规组放置中心静脉导管和动脉导管,PICCO组放置PICCO,检测平均动脉压(mean arterial pressure,MAP)、中心静脉压(central venous pressure,CVP)、心率(heart rate,HR)、心指数(cardiac index,CI)、血管外肺水指数(extravascular lung water index,ELWI)、胸腔内血容量指数(intrathoracic blood volume index,ITBI)及肺血管通透性指数(pulmonary vascular permeability index,PVPI)等血流动力学参数。记录PICCO组术中各指标的变化,比较分析两组术后前3天液体输入量,术后并发症发生情况。结果:与T0时点比较,PICCO组T1时点的MAP、CVP、CI、ITBI明显降低,HR明显升高(P0.05);T2时点MAP、CVP、CI较T1明显升高,HR明显下降(P0.05);PICCO组T2时刻各血流动力学指标均明显优于常规组(P0.05)。PICCO组术后前3天的液体入量明显少于常规组(P0.05);ELWI与PVPI、ITBI、液体入量均呈高度正相关(P0.05)。且PICCO组术后肺部感染及心血管并发症的发生率也较常规组明显降低(P0.05)。结论:PICCO监测可准确反映血流动力学状态参数,指导临床麻醉和围术期液体管理,减少术中术后不良并发症,改善患者预后。     

喉上神经阻滞复合瑞芬太尼和右美托咪定用于经皮气管切开术的临床效果

目的:探讨喉上神经阻滞复合瑞芬太尼和右美托咪定应用于经皮气管切开术(PT)的临床效果。方法:将60例因呼吸困难行PT的患者随机分为两组。所有患者均喉上神经阻滞,对照组(30例)采用丙泊酚复合瑞芬太尼,实验组(30例)采用右美托咪定复合瑞芬太尼。观察并比较两组患者术前(T1)、麻醉药物注射结束后(T2)、气管切开置入套管时(T3)、手术结束时(T4)收缩压(SBP)、舒张压(DBP)、心率(HR)、血氧饱和度(SpO_2)及平均动脉压(MAP)、警觉/镇静(OAA/S)评分的变化及术中并发症的发生情况。结果:对照组T3、T4时刻SBP、DBP、HR、MAP均较T1时明显升高,且明显高于实验组同时点(P0.05),而实验组T2、T3、T4时SBP、DBP、HR、MAP与T1时刻比较差异无明显统计学意义(P0.05)。实验组术中呛咳、呼吸抑制的发生率显著低于对照组(P0.05)。两组T2～T4时刻OAA/S评分均明显低于T1时刻,且实验组OAA/S评分均明显低于对照组同时刻(P0.05)。结论:喉上神经阻滞复合右美托咪啶和瑞舒芬太尼应用于PT中可维持血流动力学的稳定,减少应激反应,降低术中并发症的发生率。     

Antibiotics in the treatment of wounds in the victims of the earthquake in the Armenian SSR

Purulent wounds in 88 victims of the Armenian earthquake with the syndrome of long-term squeezing were examined microbiologically and the experience with using antimicrobial drugs for their treatment was analyzed. In all the cases microbial associations were detected, coliform and nonfermenting gram-negative bacilli, enterococci, anaerobes and yeast-like fungi being isolated from 80, 20, 15 and 25 per cent of the patients respectively. 130 bacterial strains were studied in detail. 80 to 100 per cent of the bacterial isolates were resistant to the antibiotics routinely used in surgical practice, i.e. benzylpenicillin, tetracycline, levomycetin, kanamycin, cephalothin and cefazolin and highly sensitive to new antimicrobial drugs belonging to ureidopenicillins (mezlocillin), quinolones (ciprofloxacin) and cephalosporins of the 3rd generation (cefoperazone and ceftazidime). Retrospective estimation of the antibiotic therapy revealed its inadequacy in 55.7 per cent of the patients for the most part because of the isolates resistance. The 19 variants of the antibiotic use prescribed by the physicians mainly included penicillins, aminoglycosides and their combinations (in 67.2 per cent of the cases). The use of the highly efficient drugs of the groups of ureidopenicillins and quinolones was extremely rare which was likely due to lacking of information on the drugs.     

Histogenesis of the taste buds of the vallate papilla in the in the rat in the postnatal stages of development

The developing taste buds of vallate papillae were studied with electron microscope in rats during the first 7 days after birth. Two types of cells--light and dark--are identified in the taste buds of a one day old animal. The apical parts of dark cells are characterized by numerous dark granules. A distinguishing feature of light cells is the presence of synaptic contacts with afferent intragemmal nerves. On the 4th day of development on the top of the apical parts of the cell, a microvillar apparatus is seen to form, which does not yet communicate with the oral cavity. On the 7th day, basal cells appear in the taste buds. Some of these cells are seen mitotically dividing. The differentiated microvillar apparatus now communicates with oral cavity. The structure of the taste buds is getting similar to that in the adults. The structural and functional peculiarities of the developing taste buds are discussed in association with the period of ontogenesis under consideration.     

Changes in the size of the nucleoli of the Purkinje cells in the canine cerebellum in the postresuscitation period

The changes in the size of Purkinje cell (PC) nucleolus in the lateral and medial cerebellum zones were studied in dogs with different degree of neurologic status recovery after clinical death of various etiology and duration. PC always possess one nucleolus in the control and experimental groups. In the case of complete neurologic status recovery of animals the area of PC nucleolus increases in both zones studied, irrespective of the cause of clinical death. In the case of neurologic disorders the increase in PC nucleolus area is clearly expressed only in the medial zone of the cerebellum, being insignificant in the lateral zone. It is suggested that adaptive characteristics of PC are distinct in the two compared zones, which leads to greater PC vulnerability in the lateral zone during deep hypoxia.     

Frequency of the stages in the cycle of the seminiferous epithelium in the rat

This study determined the optimum number of tubules to be counted per testis cross section, and the number of animals per treatment group, when changes in stage frequencies in the cycle of the seminiferous epithelium are criteria for assessing effects of treatment on spermatogenesis. A data base of 9,672 observed and staged tubules was collected from testicular cross sections of 15 Sprague-Dawley rats. A significant variation between animals was found for the frequencies of Stages I, II, IV, VI, VIII, and XIII. Computer simulation was used to randomly select different combinations of animal and tubule numbers from the observed data. Stage frequency means from each simulation experiment were compared statistically to observed mean frequencies. A model that used data from all 14 stages was analyzed. The following conclusions were made: a) a minimum of 200 tubule cross sections/testis is recommended for estimating stage frequencies; b) for a fixed number of tubules scored, the number of animals sampled is more important than the number of tubules per animal in reducing variance; c) to detect a difference of 2 standard deviations from the mean with a 2% error rate and examining 200 tubules/testis, at least 12 animals must be used per group when assessing all 14 stages; d) when individual stages are examined using 10 animals per group, only Stage VII has 80% or greater power of test (alpha = 0.05) to detect a frequency difference; e) pooling stages into 3-4 groups is recommended to improve the power of detecting a treatment difference.     

Psychological Attributes of the Culture of the Ukrainians in the Modern Stage of the Development of Society and Trends in Changes in These Attributes in the Post-Soviet Period

The authors of the article focus on the transition of the former Soviet state of Ukraine to a market economy. One aspect of the analysis is the cultural values and attitudes of the citizens in a new situation. Market economy and entrepreneurship demand new types of motivation and individual values from people. A challenge for social psychology in the country is the further elaboration of methodological basis of research.     

Self-organization in the determination of the size of the axial structures in the embryogenesis of the clawed toad

Experiments were performed using X. laevis embryos during gastrulation and neurulation (stages 10, 11 1/2, 12 1/2, 13 1/2, 15 and 18). Part of presumptive epidermis and lateral plate mesoderm was removed, and embryos raised until stage 25. The size of axial structures (notochord, somite mesoderm, central nervous system) was determined using serial histological sections and compared with that of control embryos. In experimental embryos, the size of axial structures was decreased. Until a specific stage of development, close correlation was found between the volume of embryonic compartment corresponding to a particular, structure and the volume of presumptive epidermis and lateral plate mesoderm. This stage is individual for each axial organ: middle gastrula (stage 11 1/2) for notochord, late gastrula (stage 12 1/2) for somite mesoderm, and late neurula (stage 18) for central nervous system. This data suggest that differentiation pattern of ecto-mesodermal rudiment is subject to regulation during gastrulation-neurulation, and subdivision of ectoderm and mesoderm into axial and non-axial tissues is a self-organizing process.     

Immunohistochemistry of the cytoskeleton in the excurrent ducts of the testis in birds of the Galloanserae monophyly

The presence, location and degree of immunoexpression of various microfilament (MF) and intermediate filament (IF) systems (actin, cytokeratins, desmin, vimentin) were studied in the excurrent ducts of the testis in sexually mature and active galliform (Japanese quail, domestic fowl, turkey) and anseriform (duck) birds. These proteins were variably expressed between the epithelia and periductal tissue (periductal smooth muscle cell layer and interductal connective tissue) types and between species. Variable heterogeneous co-expression of filament systems was also found in the various duct epithelia and periductal tissue types: co-expression of filament systems was the rule rather than the exception. In the duck, neither vimentin nor cytokeratin was present in any of the tissues, whereas actin and desmin (absent in the rete testis) were co-expressed in the efferent ducts and epididymal duct unit (comprising the ductus conjugens, ductus epididymidis and ductus deferens). Actin, desmin and vimentin were generally co-expressed in the rete testis, efferent ducts and epididymal duct unit of the quail, domestic fowl and turkey, with vimentin being more strongly immunoreactive than actin and desmin in the epididymal duct unit, but more weakly immunoexpressed in the efferent ducts. Cytokeratin was present and co-expressed with actin, desmin and vimentin in the rete testis, efferent ducts and epididymal duct unit of the domestic fowl and turkey, but not in the quail and duck. The periductal smooth muscle cell layer and interductal tissue co-expressed actin, desmin and vimentin variably in all birds. Luminal spermatozoa of both the turkey and duck were immunonegative for all protein systems, whereas those of the quail and domestic fowl co-expressed actin, desmin and vimentin moderately or strongly. The tissues of the reproductive tract of male birds thus contain cytoskeletal protein systems that are variably but mostly co-expressed and whose contractile ability appears necessary and sufficient for transportation through the various excurrent ducts of the voluminous testicular fluid and its high sperm content, characteristic features of male avian reproduction.