右美托咪定对低血红蛋白全麻患者脑氧饱和度及术后认知功能的影响*

目的:探讨右美托咪定对低血红蛋白全麻患者脑氧饱和度及术后认知功能的影响。方法:选取择期在全麻行开腹妇科手术、血红蛋白8～9 g/dl的患者30例,ASA分级Ⅰ～Ⅱ级,将其随机分成两组:生理盐水组(N组)和右美托咪啶组(D组),每组15例。两组麻醉诱导后,均行七氟醚复合瑞芬太尼静吸复合麻醉维持。D组在麻醉诱导前经15 min静脉输注右美托咪定0.5μg/kg,继之以0.3μg·kg~(-1)·h~(-1)的速率输注至术毕,N组给予等容量生理盐水。分别于入室时(T_0)、吸氧后3 min(T_1)、手术开始即刻(T_2)、手术开始后10 min(T_3)、20 min(T_4)、30 min (T_5)、手术结束即刻(T_6)以及患者苏醒拔管后5 min(T_7)记录平均动脉压(Mean Arterial Pressure,MAP)、心率(Heart Rate,HR)、血氧饱和度(Percutaneous Oxygen Saturation,SpO_2)、呼吸末二氧化碳分压(End-Tidal Carbon DioxidePartial Pressure,PETCO_2)、脑氧饱和度(Regional Cerebral Saturation Of Oxygenation,rSO_2)、脑电双频指数(Bispectral Index,BIS)以及腋温。并于术前1 d、术后1 d以及术后3 d,记录蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)数值以及术后认知功能障碍(Postoperative Cognitive Dysfunction,POCD)的发生率。结果:与N组比较,D组在T_2～T_6时的rSO_2升高,HR降低(P0.05),两组各时点MAP、SpO_2、PETCO_2、BIS以及腋温比较差异无统计学意义(P0.05)。与N组比较,D组术后1天、术后3天MoCA评分均显著升高,且术后认知功能障碍的发生率明显降低(P0.05)。结论:右美托咪定能够提高低血红蛋白患者的脑氧饱和度,改善患者脑氧供需平衡,降低术后认知功能障碍的发生率。     

经胸超声评价右美托咪定对麻醉插管前后循环功能影响

目的:探讨在诱导前给予预注射右美托咪定对于全麻患者麻醉诱导期插管前后循环影响。方法:选择拟行择期手术患者60例并将其随机分为3组,每组20例。D1组在入室后5 min内泵入0.2μg·kg~(-1)盐酸右美托咪定,D2组于入室后5 min内泵入0.4μg·kg~(-1)盐酸右美托咪定,C组于入室后5 min内泵入等容积量生理盐水。比较三组患者在给药前(T0)、给药15 min后(T1)以及插管成功后(T2)左室舒张末期容积(EDV)、左室收缩末期容积(ESV)、射血分数(EF%)、心输出量(CO)、每搏量(SV)以及同时期的平均动脉压、心率变化。结果:在T1时,D1、D2组患者EDV、ESV、EF%、CO、SV、平均动脉压、心率与对照组比较差异均无统计学意义(P0.05)。而在T2时,D1组心率、平均动脉压以及CO均较C组明显降低,D2组心率、平均动脉压、心输出量、每搏量、左室舒张末期容积较C组低,左室收缩末期容积较C组高(P0.05)。结论:麻醉诱导前给予0.4μg/kg盐酸右美托咪定可以更好的改善诱导期心脏负荷和心功能,并减轻插管引起的交感神经兴奋导致的循环波动。     

不同剂量右美托咪定对颅内动脉瘤夹闭术患者围术期血流动力学的影响

目的:观察单次给予不同剂量的右美托咪定对开颅行颅内动脉瘤夹闭手术的患者围术期血流动力学的影响,为右美托咪定在临床上的合理应用提供一定的理论基础。方法:选择拟行开颅颅内动脉瘤夹闭术的患者80例,年龄30-65岁,ASA I-III级,随机分为4组:Dl组、D2组、D3组和N组(生理盐水对照组),每组各20例。在麻醉诱导前20 min,四组患者分别经外周静脉泵注0.4μg·kg-1右美托咪定20 mL、0.8μg·kg-1右美托咪定20 mL、1.2μg·kg-1右美托咪定20 mL及生理盐水20 mL,每组的输注时间均为20 min。记录四组患者在麻醉和手术期间不同时点的平均动脉压(MAP)和心率(HR)的变化。结果:D2组的心率和血压与基础值相比波动较小,血流动力学更平稳。D1组和D3组的血压和心率较D2组波动明显。D3组的拔管时间明显较D1组、D2组和N组的时间延长(P0.05)。结论:0.8μg·kg-1右美托咪定用于颅内动脉瘤夹闭手术有利于维持患者麻醉和手术期间血流动力学的稳定,且不增加不良反应。     

右美托咪定联合氯胺酮的最佳麻醉浓度研究

目的:探寻患儿室间隔缺损封堵术中右美托咪定(dexmedetomidine,Dex)联合氯胺酮的最佳麻醉浓度。方法:选择4~11岁拟行VSDO的室间隔缺损患儿120例,随机分为A、B、C三组(n=40)。静脉注射阿托品及氯胺酮(1.0mg·kg-1)行麻醉诱导后,输注10min右美托咪定负荷量0.5μg·kg~(-1),然后对A、B、C三组分别静脉输注0.8、1.0、1.2μg·kg-1·h-1的右美托咪定。术中若麻醉变浅,单次追加氯胺酮0.5mg·kg-1。分别记录入室(T_0)、氯胺酮给药后1min(T_1)、5min(T_2)、输注完毕(T_3)、输注维持量15min(T_4)、术毕(T_5)、苏醒时(T_6)的BIS、BP、HR和SpO2,手术时间、苏醒时间,呼吸抑制和术后躁动等不良反应,氯胺酮总用量,氯胺酮和阿托品的追加情况。结果:与同组T_0时相比,三组在T_4和T_5的BIS值降低,三组的BP值、SpO2值在T_1~T_6无统计学差异。A组的HR在T_4、T_5无统计学差异(t=0.525,P=0.601)。三组手术时间和苏醒时间无统计学差异。B、C组的氯胺酮总用量和追加率、呼吸抑制发生率无统计学差异,均低于A组。B、C两组之间阿托品追加率有统计学差异,均高于A组。三组的苏醒期躁动发生率均为零。结论:4~11岁患儿室间隔缺损封堵术中,采用1.0mg·kg~(-1)氯胺酮行麻醉诱导,再以右美托咪定0.5μg·kg~(-1)的负荷量输注、1.0μg·kg~(-1)·h~(-1)的浓度维持,可使麻醉效果良好,且不良反应少,是最佳的联合麻醉浓度。     

右美托咪啶与咪达唑仑在重症破伤风患者镇静中效果比较

目的:比较右美托咪啶与咪达唑仑用于重症破伤风患者镇静中效果。方法:选取2012年1月~2015年12月间在我院治疗的重症破伤风患者72例,通过随机数表法分为右美托咪啶组与咪达唑仑组,各36例,给予右美托咪啶组静脉泵入右美托咪啶1μg/kg持续时间为10 min,之后以0.3~0.6μg/kg进行维持,咪达唑仑组静脉泵入咪达唑仑0.05 mg/kg,持续时间为1 min,之后以0.02~0.1/kg·h进行维持。监测两组患者用药前及用药12 h后平均动脉压(MAP)、呼吸频率(RR)、血氧饱和度(SpO_2)和心率(HR)深用Ramasy评分法评估镇静程度。结果:两组患者治疗后HR、RR、MAP水平明显降低而SpO_2明显上升且右美托咪啶组HR、RR、及SpO_2改善更显著差异均有统计学意义(P0.05);两组用药后4 h、8 h、12 h时Ramasy评分在组间、组内比较差异均无统计学意义(P0.05);右美托咪啶组不良反应发生率为5.56%,低于咪达唑仑组的16.67%,差异有统计学意义(P0.05)。结论右美托咪啶有助于维持患者血流动力学的稳定减少重症破伤风患者心动过速、心率增快、呼吸抑制等不良反应情况的发生。     

不同剂量右美托咪定治疗对大鼠术后神经功能及Keap1/Nrf2/ARE信号通路的影响

摘要 目的：探讨不同剂量右美托咪定治疗对大鼠术后神经功能及Keap1/Nrf2/ARE信号通路的影响。方法：60只SD大鼠随机分为假手术组（n=12）、脑缺血再灌注组（n=12）、低剂量右美托咪定组（n=12）、中剂量右美托咪定组（n=12）、高剂量右美托咪定组（n=12）,建立脑缺血模型,开展前瞻性研究。假手术组仅接受假手术而不造成脑缺血,术中持续静脉泵注生理盐水;脑缺血再灌注组维持脑缺血片刻,缺血即刻持续静脉泵注生理盐水;低、中、高剂量右美托咪定组脑缺血即刻静脉输注右美托咪定,首次剂量分别为6 μg/kg、60 μg/kg、600 μg/kg,剩余剂量分别以0.05 μg/kg/min、0.5 μg/kg/min、5 μg/kg/min持续静脉泵注。比较各组大鼠神经功能、炎症因子水平、氧化应激指标及Keap1/Nrf2/ARE表达。结果：与假手术组相比,低剂量右美托咪定组、中剂量右美托咪定组、高剂量右美托咪定组、脑缺血再灌注组Longa评分依次升高;与脑缺血再灌注组相比,低剂量右美托咪定组、中剂量右美托咪定组、高剂量右美托咪定组脑梗死体积、脑梗死体积所占百分比依次升高（P<0.05）。与假手术组相比,低剂量右美托咪定组、中剂量右美托咪定组、高剂量右美托咪定组、脑缺血再灌注组白介素6（IL-6）、白介素1β（IL-1β）、肿瘤坏死因子-α（TNF-α）水平依次升高（P<0.05）。与假手术组相比,低剂量右美托咪定组、中剂量右美托咪定组、高剂量右美托咪定组、脑缺血再灌注组神经元特异性烯醇化酶（NSE）、丙二醛（MDA）水平依次升高,超氧化物歧化酶（SOD）水平依次降低（P<0.05）。与假手术组相比,低剂量右美托咪定组、中剂量右美托咪定组、高剂量右美托咪定组、脑缺血再灌注组Keap1/Nrf2/ARE表达依次降低（P<0.05）。结论：低剂量右美托咪定能够保护脑缺血再灌注大鼠术后神经功能,主要通过减轻炎症反应和氧化应激来起作用,其作用机制可能与激活Keap1/Nrf2/ARE信号通路有关。     

右美托咪定对老年患者全麻肝叶切除术术后认知功能障碍的影响

目的探讨右美托咪定对老年患者全麻肝叶切除术术后认知功能障碍的影响。方法选择我院2018年8月～2019年8月择期全麻肝叶切除术的老年患者120例,年龄65～80岁,ASAⅡ～Ⅲ,随机分为右美托咪定组(DH组)和生理盐水组(HS组)。DH组在全麻诱导开始15 min内静脉泵入0.6μg/kg右美托咪定,术中以0.2～0.5μg/(kg·h)维持泵注;HS组静脉泵注等量的生理盐水。采用简易精神状态量表记录患者术前及术后第1、2天的MMSE评分,同时检测患者血浆IL-1、IL-6、TNF-α水平。结果与术前比较,术后第1、2天的MMSE评分明显降低(P0.05)。与HS组比较,DH组术后第1、2天的MMSE评分明显升高(P0.01),血清IL-1、IL-6、TNF-α水平明显降低(P0.05)。结论右美托咪定对老年肝叶切除术患者术后认知功能有一定的保护作用,可能与降低患者血浆IL-1、IL-6、TNF-α水平有关。     

不同剂量右美托咪定麻醉维持对老年全髋关节置换术患者血流动力学、细胞免疫和认知功能的影响

目的:探讨不同剂量右美托咪定麻醉维持对老年全髋关节置换术患者血流动力学、细胞免疫和认知功能的影响。方法:选取2017年3月~2019年8月期间我院收治的行全髋关节置换术的老年患者120例。采用随机数字表法分为对照组、低剂量组、高剂量组各40例。低剂量组和高剂量组麻醉维持分别持续泵入右美托咪定0.4μg/(kg·h)、0.8μg/(kg·h)维持麻醉,对照组给予0.9%氯化钠注射液持续泵入。比较三组患者围术期指标、血流动力学、细胞免疫、认知功能及不良反应。结果:高剂量组、低剂量组气管插管时(T2)、术毕5 min(T3)时间点心率(HR)、平均动脉压(MAP)均高于对照组,且低剂量组高于高剂量组(P<0.05)。高剂量组、低剂量组T2、T3时间点CD4⁺、CD4⁺/CD8⁺均高于对照组,且高剂量组高于低剂量组(P<0.05);高剂量组、低剂量组T2、T3时间点CD8⁺低于对照组,且高剂量组低于低剂量组(P<0.05)。术后1 d高剂量组、低剂量组简明精神状态量表(MMSE)评分较对照组高(P<0.05);低剂量组、高剂量组术后1 d的MMSE评分比较无差异(P>0.05)。低剂量组麻醉10 min后Ramsay镇静评分高于对照组、高剂量组(P<0.05);低剂量组术后苏醒时间、拔管时间较对照组、高剂量组短(P<0.05)。高剂量组的不良反应发生率高于对照组和低剂量组(P<0.05)。结论:老年全髋关节置换术患者术中采用右美托咪定麻醉维持,可维持血流动力学稳定,减轻免疫抑制及认知功能损害,安全性较好,其中以0.4μg/(kg·h)剂量的右美托咪定效果更佳。     

术中静脉不同剂量右美托咪啶对全髋置换术患者术后患者芬太尼静脉自控镇痛效果的影响

目的:观察气管内全身麻醉下行全髋置换术患者,术中静脉应用不同剂量右美托咪定对术后芬太尼静脉自控镇痛效果的影响及相关不良反应发生的情况。方法:选择择期在气管内全麻下行全髋置换术的患者60例,ASA I~Ⅱ级,年龄47~78岁,体重42~79 kg。患者随机分组法分为3组(n=20):C组(盐水对照组)、D1组(右美托咪定0.5μg/kg组)和D2组(右美托咪定1μg/kg组),在手术结束前约1小时按分组分别给予生理盐水和右美托咪啶,术后镇痛使用芬太尼静脉自控镇痛24 h。记录患者术后2h、2~6 h、6~12 h、12~24 h芬太尼的用量;VAS评分法评估患者术前、术后2 h、6 h、12 h、24 h时的疼痛程度;记录镇痛期间恶心呕吐、皮肤瘙痒及过度镇静等不良反应发生的情况。结果:术后2h和术后2~6 h芬太尼用量D1组和D2组较C组减少(P0.05),但D1组和D2组之间比较无差异(P0.05);而术后6~12和12~24 h三组患者芬太尼用量无差异(P0.05)。术后2 h、2~6 hVAS评分D1组和D2组较C组减少(P0.05),而D1组和D2组之间比较无差异(P0.05);术后6~12、12~24 h三组患者VAS评分无差异(P0.05)。与C组比较,D1组和D2组镇痛期间恶心呕吐发生率降低(P0.05),余不良反应各组之间比较无差异(P0.05)。结论:气管内全身麻醉下行全髋置换术的患者,术中静脉应用右美托咪啶可在术后6 h内增强芬太尼镇痛的效果减少芬太尼的用量,但增大剂量效果并不增加而作用时间也不延长。     

盐酸右旋美托咪定对脑膜瘤切除术患者围拔管期应激反应的影响

目的：观察不同剂量的盐酸右旋美托咪定对脑膜瘤切除术患者全麻围拔管期应激反应的影响。方法：60 例ASAI～Ⅱ级,年 龄25-65 岁脑膜瘤切除术患者,随机分为四组,NS、D1、D2 和D3 组,NS 组:静脉泵入等量的生理盐水,D1、D2 和D3组静脉泵注 负荷量均为0.6 滋g/kg 的盐酸右旋美托咪定,各组泵注时间均为10 分钟,输注结束后随之给予维持量,D1组：盐酸右旋美托咪定 维持量0.2 滋g·kg-1·hr-1;D2 组：盐酸右旋美托咪定维持量0.4 滋g·kg-1·hr-1;D3组：盐酸右旋美托咪定维持量0.6 滋g·kg-1·hr-1。观察 并记录拔管时的耐管评分、呛咳程度、警觉/ 镇静评分(OAA/S）、拔管时间及拔管即刻和拔管后3 min 的平均动脉压(MAP)、心率 (HR)及恶心、寒战等不良反应。结果：D3 组患者耐管评分高于D1 组、D2 组和NS 组,呛咳程度轻于D1 组、D2 组和NS 组（P<0. 05）;D2、D3 组患者拔管即刻和拔管后3 min 的MDP、HR 均明显低于D1 组（P<0.05）;D1、D2 和D3 组不良反应少于NS 组;四组 拔管时间无明显差异。结论：盐酸右旋美托咪定降低脑膜瘤切除术患者全麻围拔管期的应激反应,增强患者对气管导管的耐受 性。     

六种藓类植物茎的比较解剖学研究

通过对6种藓类植物,即褶叶青藓(Brachythecium salebrosum(Web.et Mohr.)B.S.G.)、湿地匐灯藓(Plagiomnium acutum(Lindb.)Kop.)、侧枝匐灯藓(Plagiomnium maximoviczii(Lindb.)Kop.)、大凤尾藓(Fissidensnobilis Griff.)、大羽藓(Thuidium cymbifolium(Doz.et Molk.)B.S.G.)和大灰藓(Hypnum plumaeforme Wils.)嫩茎和老茎的石蜡切片和显微观察发现,同一藓类植株的嫩茎和老茎,茎结构稳定,不同种藓类植物茎横切面具有不同特征.植物体茎横切面形状、表层细胞的层数、细胞大小和细胞壁厚薄、皮层细胞大小和形状、中轴的有无以及比例等特征可以作为藓类植物的分科分类依据之一.     

Photoregulation of seed germination of wild-type and of an aurea-mutant of tomato

Seed germination of an aurea mutant of tomato ( Lycopersicon esculentum Mill.) is promoted by continuous irradiation with red, far-red or long-wavelength far-red (758 nm) light as well as by cyclic irradiations (5 min red or 5 min far-red/25 min darkness). Far-red light applied immediately after each red does not change the germination behaviour. Seed germination of the isogenic wild-type, cv. UC-105, is promoted by continuous and cyclic red light while it is inhibited by continuous and cyclic far-red light and by continious 758 nm irradiation. Far-red irradiation reverses almost completely the promoting effect of red light. The promoting effect (in the aurea mutant) and the inhibitory effect (in the wild-type) of continuous far-red light do not show photon fluence rate dependency above 20 nmol m⁻² s⁻¹. It is concluded that phytochrome controls tomato seed germination throgh low energy responses in both the wild type and the au mutant. The promoting effect of continuous and cyclic far-red light in the au mutant can be attributed to a greater sensitivity to P_fr.     

Cause of Senescence of Nine Sorts of Flowers

The levels of endogenous phytohormones and respiratory rate in nine sorts of flowers such as Cymbidium faberi Rolfe, Nopalxochia ackermannii Kunth and others were investigated both at full bloom and senescence and meanwhile the effect of exogenous phytohormones on prolonging the blossoms and promoting ethylene production were tested. There is a high content of endogenous ethylene in all the long-lived flowere, about 3–16 folds higer than the short-lived ones. There is a high level of ABA at full blooming flowers of short-lived flowers, in which there is no or only some cytokinins in it, but the ratio of CTK (6BA+zeatin)/ABA is smaller(l.7). The endogenous ABA reached a much higher level at senescence in all nine sorts of flowers, so it is reasonable to consider that it is ABA which plays an important role of regulation in controlling flower's senescence. There is a much higher level of GA3 and zeatin in the long-lived flowers which is not demonstrated in the shortlived ones. The respiratory rate is one of the factors controtling the longevity of flowers, but it does not play a decided role. Application of 6BA and zeatin prolongs distinctly orchid’s longevity, however exogenous IAA through the promotive action on ethylene production, evidently extends the longevity of the flowers of the Nopalxochia ackermannii Kunth.     

龙胆科药用植物化学成分的研究现状

龙胆科植物在我国的分布范围很广,且多数为药用植物,其多数种属的药用植物,至今其化学成分尚未被系统研究。综述了目前龙胆科药用植物的化学成分的研究现状及一般提取方法,对近年来发现的环烯醚萜及裂环烯醚萜类化合物进行了总结,为本科药用植物的更深入研究提供了参考。     

Interconnection of parameters of regulation system of lipid peroxidation and of morphophysiological parameters of mouse liver

A complex analysis of seasonal fluctuations of the mean group parameters of the system of regulation of lipid peroxidation has been performed in liver of Balb/c mice. Association of lipid characteristics and morphophysiological parameters is studied in the Balb/c mouse liver. An inter-connection is revealed between the liver index and the amount of lysoforms of phospholipids, the scale and character of the interconnection differing essentially depending on proportion of phos-phatidylcholine in mouse liver phospholipids.     

真菌类遗传学分析的知识结构教学

本文以认知结构理论为指导,讨论了真菌类遗传分析与高等动植物遗传分析的内在联系,认为利用这种内在联系进行教学可收到好的效果并说明了作者的具体教学过程。 Abstract:In the paper, the relationship between genetic analysis of Fungi and genetic analysis of high animal and plant was discussed.A good results were obtained when we adopted this method in the teaching.     

Physiological characteristics of various species of strains of carboxydobacteria

Seven strains of aerobic carbon monoxide-oxidizing bacteria (carboxydebacteria) when growing on CO as sole source of carbon and energy had doubling times which ranged from 12–42 h. The activity profiles obtained after discontinuous sucrose density gradient centrifugation indicated that the CO-oxidizing enzymes are soluble and the hydrogenases are membrane-bound in all strains examined. The CO-oxidizing enzymes of Pseudomonas carboxydohydrogena, Pseudomonas carboxydoflava, Comamonas compransoris, and the so far unidentified strains OM2, OM3, and OM4 had a molecular weight of 230,000; that of Achromobacter carboxydus amounted to 170,000. The molecular weights of the CO-oxidizing and H₂-oxidizing enzymes turned out to be identical. The cell sonicates were shown to catalyze the oxidation of both CO and H₂ with methylene blue, thionine, phenazine methosulfate, toluylene blue, dichlorophenolindophenol, cytochrome c or ferricyanide as electron acceptors. Methyl viologen, benzyl viologen, FAD⁺, FMN⁺, and NAD(P)⁺ were not reduced. The spectrum of electron acceptors was identical for all strains tested. Neither free formate, hydrogen nor oxygen gas were involved in the CO-oxidation reaction. Methylene blue was reduced by CO at a 1:1 molar ratio. The results indicate that CO-oxidation by carboxydobacteria is catalyzed by identical or similar enzymes and that the reaction obeys the equation CO+H₂OCO₂+2H⁺+2e^- as previously shown for Pseudomonas carboxydovorans.Dedicated to Otto Kandler remembering almost three decades of enjoyable cooperation     

The effects of glutamine of the maintenance of embryogenic cultures of Cryptomeria japonica

Summary Embryogenic tissues of sugi (Cryptomeria japonica) were induced on a modified Campbell and Durzan (CD) medium containing 1 μM 2,4-dichlorophenoxyacetic acid (2,4-D) and 600 mg l⁻¹ glutamine, and subcultured in the medium of the same composition for over 1 yr. This resulted in a mixed culture of embryogenic and non-embryogenic cells. When embryogenic cells were isolated and cultured independently, their capacity to form embryogenic aggregates was lost. Thus, the non-embryogenic cells present within a mixed culture system were essential to the formation of embryogenic aggregates. When embryogenic tissues were isolated and cultured independently on a high glutamine-containing (2400 mg l⁻¹) medium, dry weights and endogenous levels of glutamine increased, and the tissue could generate a large number of embryogenic aggregates. Amino acid analysis of embryogenic and non-embryogenic cells from the maintenance culture indicated a higher level of glutamine was present in the latter. The high endogenous level of glutamine in the non-embryogenic portion of mixed cell masses may be the supplier of glutamine for maintaining the embryogenic property of the tissues.