超声引导下QLB复合气管插管全麻对于老年患者TEP腹股沟疝无张力修补术影响因素分析

摘要 目的：探讨与分析超声引导下腰方肌阻滞(quadratus lumborum block,QLB)复合气管插管全麻对于老年患者腹腔镜下全腹膜外（totally extraperitoneal prosthetic,TEP）腹股沟疝无张力修补术的影响,以促进该方法的临床使用。方法：2014年9月到2020年6月选择在本院诊治的腹股沟疝老年患者180例,根据随机数字表法分为QLB组与对照组各90例。所有患者都给予腹腔镜下全腹膜外腹股沟疝无张力修补术,对照组给予气管插管全麻,QLB组在对照组麻醉的基础上给予超声引导下QLB,记录两组镇痛与麻醉效果。结果：两组的术中出血量、手术时间等对比差异无统计学意义(P>0.05),QLB组的术后住院时间、术后胃肠功能恢复时间、术后下床活动时间显著短于对照组(P<0.05)。与术后12 h对比,两组术后24 h与36 h的疼痛VAS评分均降低(P<0.05),且QLB组术后12 h、24 h与36 h的疼痛VAS评分都显著低于对照组(P<0.05)。QLB组术后7 d的血肿、呼吸抑制、脏器损伤、腹股沟区包块等并发症发生率为8.9 %,显著低于对照组的21.1 %(P<0.05)。QLB组的瑞芬太尼用量、术后48 h内有效按压自控静脉镇痛泵次数、自控静脉镇痛泵累计用量都显著少于对照组(P<0.05)。结论：超声引导下QLB复合气管插管全麻在老年患者腹腔镜下全腹膜外腹股沟疝无张力修补术中的应用能提高镇痛与麻醉效果,减少术后并发症的发生,有利于促进患者康复。     

非阿片类镇痛复合静脉全麻在鼾症手术患者中的疗效

目的:观察三重措施预防为基础,联合非阿片镇痛药复合静脉全麻在行鼾症手术患者术后恶心呕吐的应用效果。方法:选择择期行鼾症手术男性病人80例,随机分为两组:吸入麻醉组(inhalation group, IHLA组)和静脉麻醉组(intravenous group, TIVA组),每组40例,两组均采用三重措施预防恶心呕吐,IHLA组采用以舒芬太尼为基础复合七氟烷吸入麻醉,TIVA组以氯胺酮和右美托咪定镇痛基础上丙泊酚全凭静脉麻醉。评估两组病人恶心呕吐危险系数,采用李克特量表(Likert scale),记录并分析两组患者术后6~8 h在麻醉后监测治疗室(post anesthesia care unit, PACU)及病房24 h恶心呕吐发生情况及补救用药用量。结果:两组患者一般临床资料、恶心呕吐风险评分、手术时间、术后恢复期补救用药量人数无显著差异(P>0.05);IHLA组在PACU恶心呕吐发生率为39.5%,TIVA组发生率为18.9%,两者相比有显著性差异(P<0.05);IHLA组病房24 h恶心呕吐严重程度高于TIVA组,两组术后需要补救应用抗呕吐药物用量无显著差异(P>0.05)。结论:以三重措施预防为基础,与吸入麻醉相比,非阿片类镇痛药复合静脉麻醉可以减少肥胖病人鼾症手术术后恶心呕吐发生率和严重程度,降低围术期风险,有利于患者早期恢复。     

右美托咪定联合瑞芬太尼对全身麻醉下髋关节置换术患者脑氧代谢、血流动力学和认知功能的影响

摘要 目的：瑞芬太尼、右美托咪定对全身麻醉下髋关节置换术患者的脑氧代谢、血流动力学和认知功能的影响。方法：选取2016年6月~2019年10月期间我院收治的100例行髋关节置换术的患者。采用随机数字表法分为对照组和研究组,各50例。对照组患者麻醉中予以瑞芬太尼,研究组则在对照组的基础上复合右美托咪定,比较两组患者血流动力学、脑氧代谢和认知功能情况,记录两组患者围术期间不良反应发生率。结果：两组手术开始后30 min（T1）~手术结束时（T2）时间点平均动脉压（MAP）、心率（HR）均呈下降趋势,但研究组高于对照组（P<0.05）。两组T1~T2时间点动脉血氧含量（CaO₂）、颈内静脉血氧含量（CjvO₂）均呈下降趋势,且研究组低于对照组（P<0.05）;两组T1~T2时间点颈静脉球部血氧饱和度（SjvO₂）呈升高趋势,且研究组高于对照组（P<0.05）。两组术前~术后7 d简明精神状态量表（MMSE）评分均呈下降后升高趋势（P<0.05）;研究组术后3 d、术后7 d MMSE评分高于对照组（P<0.05）。研究组术后3 d、术后7 d的认知功能障碍（POCD）发生率低于对照组（P<0.05）。两组不良反应发生率比较无差异（P>0.05）。结论：全身麻醉下髋关节置换术患者麻醉方案选用右美托咪定联合瑞芬太尼,可减轻血流动力学波动,维持脑氧供需平衡,可减少POCD发生风险,且安全性较好。     

Early social contact alters the community structure and functions of the faecal microbiome in suckling-growing piglets

Social contact during suckling, in an enriched social environment, can reduce the aggressive behaviours of piglets during regrouping at weaning, and improve their production performance and welfare. The aim of this study was to determine the possible impact of suckling social contact on gut microbes. We performed 16S rRNA sequencing to measure the faecal microbial structure and function in piglets experiencing social contact. Eighteen-litter piglets were allocated to two treatments: an early continuous social contact (CSC) group where piglets from adjacent pens shared a mutual pen starting at 14 days postpartum and a control (CON) group where piglets had no contact with individuals from adjacent pens during the suckling period. The piglets were regrouped at 36 days of age. The litter weights at 35 and 63 days of age were measured. Faecal samples were randomly collected at 16, 35, 42, and 63 days of age and faecal DNA was determined. The results showed that the litter weight of piglets in the CSC group was significantly decreased at 63 days compared with the CON group. Continuous social contact also significantly decreased the microbial richness at 16 and 35 days of age (P < 0.05). Firmicutes was the most abundant bacterial phylum in both groups at all detected time-points and the abundance increased with social contact. At the genus level, Lactobacillus was the most abundant bacterium after weaning and the abundance increased in the piglets with social contact. Compared with the faecal microbiota of control piglets, a total of 22 genera at 16 days, 20 genera at 35 days, 12 genera at 42 days, and 27 genera at 63 days in the faeces of CSC piglets were observed to be significantly different in abundance (linear discriminant analysis score > 3, P < 0.05). Furthermore, functional analysis of the microbial composition showed that the changes induced by early CSC mainly altered the relative abundance of metabolic and related pathways. The social contact notably had an effect on the abundance of microbial pathways for amino acid and carbohydrate metabolism. In conclusion, CSC changed the microbial composition in the faeces of piglets, which might have a negative effect on nutrient metabolism for the suckling-growing piglets. Our study provided new insight into the influence of social contact on the suckling-growing piglets.     

Optimization of Lipase Purification by Rotating Annular Size-exclusion Chromatography

Crude porcine lipase was purified by continuous rotating annular size-exclusion chromatography. Sephadex G-75 was used as the size-exclusion packing material. Initial studies by this group on a similar unit have been reported [Genest et al. (1998) "Continuous purification of porcine lipase by rotating annular size-exclusion chromatography", Appl. Biochem. Biotechnol. 73, 215-230]. This article presents the results of optimization studies carried out on a modified unit. These modifications resulted in a better performance of the column and a higher throughput. Purification fold values of around 11 were achieved in most runs. The activity recovered was around 99% and the productivity was around 3 mg lipase/mg gel h.     

Continuous countercurrent salting-out extraction of 1,3-propanediol from fermentation broth in a packed column

The possibility of continuous extraction of 1,3-propanediol in a experimental packed column was investigated using a salting-out extraction system of dipotassium phosphate/ethanol. Mass transfer of 1,3-propanediol takes place from the dispersed phase (salt-rich solution) to the continuous phase (ethanol). The influences of flow rate of dispersed phase and size of packing material on partition coefficient and recovery of 1,3-propanediol were investigated and the results were compared with those obtained in spray column and test tube. Furthermore, the influences of various system compositions on hold up of dispersed phase, mass transfer coefficient, and system stability were also studied in the column packed by stainless steel Dixon 3 × 3 mm. It was found that the packed column showed a good extraction efficiency and stability. Besides, 1,3-propanediol recovery of 90.30% was obtained during a 11 h continuous operation when the real fermentation broth was used. At the same time, 94.4% of phosphate could be recovered when 0.2 volume of anhydrous ethanol was added into the raffinate phase at pH 4.0.     

Continuous production of selenomethionine-enriched Chlorella sorokiniana biomass in a photobioreactor

This article describes the enrichment of the fresh-water green microalga Chlorella sorokiniana in selenomethionine (SeMet). The microalga was cultivated in a 2.2 L glass-vessel photobioreactor, in a culture medium supplemented with selenate (SeO₄^2?) concentrations ranging from 5 to 50 mg L^?1. Although selenate exposure lowered culture viability, C. sorokiniana grew well at all tested selenate concentrations, however cultures supplemented with 50 mg L^?1 selenate did not remain stable at steady state. A suitable selenate concentration in fresh culture medium for continuous operation was determined, which allowed stable long-term cultivation at steady state and maximal SeMet productivity. In order to do that, the effect of dilution rate on biomass productivity, viability and SeMet content of C. sorokiniana at several selenate concentrations were determined in the photobioreactor. A maximal SeMet productivity of 21 μg L^?1 day^?1 was obtained with 40 mg L^?1 selenate in the culture medium. Then a continuous cultivation process at several dilution rates was performed at 40 mg L^?1 selenate obtaining a maximum of 246 μg L^?1 day^?1 SeMet at a low dilution rate of 0.49 day^?1, calculated on total daily effluent volume. This paper describes for the first time an efficient long-term continuous cultivation of C. sorokiniana for the production of biomass enriched in the high value amino acid SeMet, at laboratory scale.     

不同胰岛素给药方式救治糖尿病酮症酸中毒临床研究

目的：比较不同胰岛素给药方式治疗糖尿病酮症酸中毒（DKA）的临床疗效。方法：82例DKA患者随机分为胰岛素泵持续皮下输液胰岛素（CSⅡ）组和微量泵持续静脉泵入胰岛素（CXqI）组各41例,分别给予胰岛素泵持续皮下输注胰岛素和小剂量胰岛素持续微量泵静脉泵入不同胰岛素给药方式,观察两组治疗后血糖变化、血糖达标时间、尿酮体变化、pH值变化、胰岛素平均日用量、平均低血糖次数及平均住院时间。结果：两组治疗后空腹血糖、餐后血糖显著下降及血糖达标时间显著缩短差异无统计学意义（P〉0．05）;CSII组尿酮体转阴时间（22．3±7．4）h短于CVII组（32．1±12．1）h（P〈0．01）;CSII组PH值恢复时间（9．4±2．5）h短于CVII组（15．7±3．5）h（P〈0．01）;CSII组平均胰岛素日用量为（47±5）U比CVII组（58＋7）U少（P〈0．01）;CSII组人均低血糖次数为（0．6±O．5）次／人。少于CVII组（1．5±0．8）次／人（P〈O．01）;CSII组住院时间（9．8±1．2）天明显比CVII组（12．5±2．0）天短（P〈0．01）。结论：CSII相较于CVII能更快更有效的纠正代谢紊乱,减少胰岛素日用量,缩短住院时间,从而提高临床疗效。具有较高的安全性及患者依从性。     

蟾蜍皮下淋巴囊麻醉对心脏功能的影响

目的：研究一种对蟾蜍心脏功能影响较小的固定方式,适用于蛙心起搏点以及蛙心室舒缩与心电图同步记录观察期前收缩和代偿间歇实验的固定方式。方法：将一定数量的蟾蜍平均分为三组,分别为对照组捣毁大脑和脊髓组、乌拉坦皮下淋巴囊麻醉组。模拟Ⅱ导联分别将麻醉组、捣毁组蟾蜍连接RM6240,进入心电图实验模块,观察并记录两组组蟾蜍的处理前后心电图的变化情况,以及两组蟾蜍经过处理后痛觉、肌张力、呼吸的对比情况。快速游离三组蟾蜍的心脏,4%甲醛固定,30%蔗糖溶液脱水,修剪后冰冻固定,切片,苏木精-伊红（HE）染色,通过光学显微镜观查。结果：①乌拉坦皮下淋巴囊麻醉组蟾蜍的固定效果与捣毁大脑和脊髓组蟾蜍相当。②给药前后麻醉组蟾蜍的心电图变化幅度小于捣毁前后捣毁组蟾蜍的心电图。③与对照组蟾蜍的心肌细胞相比乌拉坦皮下淋巴囊麻醉组蟾蜍的心肌细胞破坏程度小于捣毁大脑和脊髓组蟾蜍。结论：在蛙心起搏点以及蛙心室舒缩与心电图同步记录观察期前收缩和代偿间歇实验中对蟾蜍进行乌拉坦皮下淋巴囊麻醉是一种优于捣毁蟾蜍大脑和脊髓的固定方法。     

结构方程混合模型在SNP分析中的应用

采用结构方程混合模型(SEMM)对实际SNP数据进行分析,为遗传统计学提供一种新的有效的分析方法。本研究的数据是由GAW17提供的,包含697个个体的22条常染色体的上万个SNP和根据这些SNP所模拟的697个个体的性状特点。随机挑选了1号染色体上的4个SNP和3个定量性状作为研究变量,分别进行潜在类别分析和结构方程混合模型分析。根据4个SNP数据,人群被分为3个潜在类别,概率分别为0.53,0.34,0.13。潜在类别1、2和3中的因子均值Q分别为-4.029、-2.052和0,潜在类别1、2的因子均值均低于3(<0.001)。研究表明:结构方程混合模型(SEMM)综合了结构方程模型和潜在类别模型的思想,形成了自己的优势,可用于处理同时包含分类潜变量和连续潜变量的数据。