腰硬联合蛛网膜下腔注射芬太尼用于分娩镇痛的半数有效剂量的临床研究

目的:确定腰硬联合蛛网膜下腔注射芬太尼用于分娩镇痛的半数有效剂量(ED50),观察蛛网膜下腔注射半数有效剂量芬太尼的效果和副作用,并与蛛网膜下腔注射半数有效剂量的布比卡因进行对比。方法:首先,确定芬太尼用于分娩镇痛的半数有效剂量,筛选50例符合的产妇行腰硬联合分娩镇痛,蛛网膜下腔注射芬太尼的剂量始于25μg,如果镇痛有效,下一病例减少2.5μg芬太尼;如果无效则下一病例增加2.5μg芬太尼。用Probit回归分析计算芬太尼蛛网膜下腔注射行分娩镇痛的半数有效剂量和95%可信区间(95%CI)。第二步,筛选100例需要进行分娩镇痛的产妇,随机分入ED50芬太尼组(F组)和ED50布比卡因组(B组),比较两组药物镇痛效果及起效时间、产妇下肢运动阻滞程度及血压心率变化、胎心变化和镇痛全程药物追加次数。结果:芬太尼蛛网膜下腔注射分娩镇痛的ED50为11.5μg,95%CI为3.5-15.4μg。F组镇痛的平均起效时间为(12.0±3.8)min,两组镇痛的成功率没有统计学差异(P=0.218),F组需要追加PCA的病例百分率明显少于B组(P=0.018)。F组下肢运动阻滞程度轻于B组(P=0.018)。两组镇痛方法对产妇的血压、心率均无明显影响。两组胎心下降的发生率没有明显差异(P0.05)。F组皮肤瘙痒的发生率明显增加(P=0.000)。结论:腰硬联合分娩镇痛蛛网膜下腔注射芬太尼的ED50为11.5μg,95%CI为3.5-15.4μg。蛛网膜下腔注射半数有效剂量的芬太尼可以提供简便、持久、满意和安全的镇痛效果,并且对下肢运动阻滞程度较小,但其所致皮肤瘙痒的发生率升高。     

腰麻硬膜外联合麻醉与硬膜外麻醉对剖宫产患者血流动力学的影响

目的:探讨腰麻硬膜外联合麻醉与硬膜外麻醉对剖宫产患者血流动力学的影响。方法:选择我院2013年12月至2014年12月收治的80例行剖宫产手术产妇,按随机数字表法平均分为A组及B组各40例,A组产妇使用腰麻硬膜外联合麻醉(CSEA),B组产妇使用硬膜外麻醉(EA),比较两组产妇麻醉效果,血流动力学变化、新生儿Apgar评分及产妇不良反应发生情况。结果:A组产妇麻醉效果Ⅲ级比率85.0%,明显高于B组的22.5%(P0.05)。A组产妇心率(HR)在胎儿娩出10 min(T3)及手术结束(T4)时刻明显高于B组,收缩压(SBP)和舒张压(DBP)在胎儿娩出即刻(T2)明显高于B组,平均动脉压(MAP)在麻醉前(T1)和麻醉后(T4)明显高于B组,每博输出量(SV)在T2时刻明显低于B组,比较差异具有统计学意义(P0.05);两组产妇心输出量(CO)各时刻比较差异无统计学意义(P0.05)。A组新生儿在娩出1 min时Apgar评分明显高于B组(P0.05)。A组不良反应发生率为5.0%,B组产妇不良反应发生率为10.0%,两组比较差异无统计学意义(P0.05)。结论:对剖宫产手术患者使用CSEA麻醉效果明显优于EA,且患者血流动力学更为稳定,麻醉效果较完善,安全性高,可应作为剖宫产手术首选的麻醉方式。     

Effect of midazolam and butorphanol premedication on inhalant isoflurane anesthesia in mice

Isoflurane is a representative inhalant anesthesia used in laboratory animals. However, isoflurane mediates respiratory depression and adverse clinical reactions during induction. In the present study, we established a novel balanced anesthesia method in mice that combined isoflurane anesthesia with midazolam and butorphanol (MB). Thirty-four male C57BL/6J mice received either isoflurane alone or isoflurane with an intra-peritoneal MB premedication (3 mg/kg midazolam and 4 mg/kg butorphanol). The minimum alveolar concentration (MAC) in each group was evaluated. Induction time and adverse clinical reactions were recorded in each group. Core body temperature, heart rate, respiratory rate, and oxygen saturation (SPO₂) were assessed before and for 1 h after induction. Premedication with MB achieved a significant reduction in MAC compared with isoflurane monoanesthesia (isoflurane, 1.38 ± 0.15%; isoflurane with MB, 0.78 ± 0.10%; P<0.05). Induction time was significantly shortened with MB premedication, and adverse reactions such as excitement or incontinence were observed less frequently. Furthermore, isoflurane anesthesia with MB premedication caused increase of respiratory rates compared to isoflurane monoanesthesia. No significant decrease of SPO₂ was observed in MBI anesthesia, while a decrease in SPO₂ was apparent with isoflurane monoanesthesia (baseline, 98.3% ± 1.1; 10 min after induction, 91.8 ± 6.4%; P<0.05). In conclusion, premedication with MB was effective for the mitigation of respiratory depression induced by isoflurane in mice, with rapid induction and fewer adverse clinical reactions.     

右美托咪定的临床麻醉应用进展

右美托咪定(dexmedetomidine,Dex)是高选择性α2-肾上腺素受体激动剂,具有镇静、镇痛、抑制交感神经活性、无呼吸抑制等药理性质。多项研究证实:围术期或ICUs住院期间给予患者右美托咪定,可以增加患者机械通气耐受力,减少机械通气时间,改善患者病情恢复,减少呼吸抑制,稳定血流动力学,减少麻醉剂用量及降低麻醉剂不良反应发生率,抑制应激反应,保护肺脏、神经功能、心脏功能,降低谵妄发生率,抗寒颤等作用特点。虽然右美托咪定存在心动过缓及低血压等不良反应,故应控制给药速度、剂量,合理用药在以便循环波动可控范围内。目前,右美托咪定可用于重症监护病房(ICUs)、全身麻醉、区域麻醉、小儿麻醉、日间手术及无痛检查等辅助用药。本文主要对右美托咪定的临床麻醉应用做以下介绍。     

Cholesterol level influences opioid signaling in cell models and analgesia in mice and humans

Cholesterol regulates the signaling of μ-opioid receptor in cell models, but it has not been demonstrated in mice or humans. Whether cholesterol regulates the signaling by mechanisms other than supporting the entirety of lipid raft microdomains is still unknown. By modulating cholesterol-enriched lipid raft microdomains and/or total cellular cholesterol contents in human embryonic kidney cells stably expressing μ-opioid receptor, we concluded that cholesterol stabilized opioid signaling both by supporting the lipid raft's entirety and by facilitating G protein coupling. Similar phenomena were observed in the primary rat hippocampal neurons. In addition, reducing the brain cholesterol level with simvastatin impaired the analgesic effect of opioids in mice, whereas the opioid analgesic effect was enhanced in mice fed a high-cholesterol diet. Furthermore, when the records of patients were analyzed, an inverse correlation between cholesterol levels and fentanyl doses used for anesthesia was identified, which suggested the mechanisms above could also be applicable to humans. Our results identified the interaction between opioids and cholesterol, which should be considered in clinics as a probable route for drug-drug interaction. Our studies also suggested that a low cholesterol level could lead to clinical issues, such as the observed impairment in opioid functions.     

呼气末正压通气在全麻下经皮肾镜碎石术中对患者呼吸功能的影响

目的探讨全麻下经皮肾镜碎石术（PcNL）灌注碎石期间应用呼气末正压通气（PEEP）对患者呼吸功能的影响。方法选择全身麻醉经皮肾镜碎石术的患者60例（ASAⅠ～Ⅱ级）,随机分成两组,每组30例,潮气量设定8ml／kg。对照组（A组）PEEP0cmH20,研究组（B组）PEEP5cmHzO。麻醉诱导后监测无创血压（BP）、平均动脉压（MAP）、心率（HR）、血氧饱和度（Sp02）、中心静脉压（CVP）、气道压力（Pmean）;患者俯卧位后,选灌注碎石术前（T1）、灌注碎石30min（T2）、灌注碎石60rain（T3）和灌注完毕即时（T4）为时间点,检测动脉血气（pH、PaCOz、Pa02、BE）。结果两组比较,B组的PaOz、CVP、Pmean值明显增加,差异有统计学意义（P〈0．05）;而HR、MAP值比较无统计学意义（P〉0．05）。两组组内与T1时点比较,T2～T4时点的pH、BE、Pa02值明显下降,PaCOz、CVP、Pmean值有所增高,差异有统计学意义（P〈0．05）。结论在全麻下经皮肾镜碎石术（PCNL）中应用PEEP辅助通气,动脉血氧分压升高,可有效改善动脉氧合,气道压力和CVP水平有相应升高,术中应加强CVP及动脉血气的监测。     

寰枢关节尾向置管建立上胸段硬膜外阻滞大鼠模型

目的为持续上胸段硬膜外阻滞的试验研究提供稳定可靠的动物模型。方法以大鼠为研究对象,经寰枢关节尾向于硬膜外腔置入PE-10导管,采用特殊的固定和管理措施。4周后,大鼠硬膜外腔注入美蓝100μL/kg,尸检鉴定模型成功和药液的分布范围。结果置管后4周的成功率为65%,硬膜外腔的感染率为2.5%。结论本研究证实了经寰枢关节尾向置管建立持续上胸段硬膜外模型和特殊管理的可行性,并具有成功率高,稳定性好的特点。     

Bispectral Index Analysis of Opioid Immobilization of Rocky Mountain Elk

Abstract: We immobilized elk with either isoflurane to produce general anesthesia (control), 0.01 mg/kg carfentanil plus 0.1 mg/kg xylazine, or 0.25 mg/kg butorphanol plus 0.4 mg/kg azaperone plus 0.15 mg/kg medetomidine (BAM) and measured the bispectral index (BIS). The carfentanil-xylazine BIS (70.4 + 1.4) and the BAM BIS (60.2 + 1.5) were higher than the control BIS (47.2 + 4.1; P ≤ 0.001). These data indicate that opioids produce neuroleptanalgesia and not general anesthesia or sedation, which explains observed elk responses to these drugs.     

EFFECTIVE, FIELD-BASED INHALATION ANESTHESIA FOR ICE SEALS

Thirty five adult crabeater seals ( Lobodon carcinophaga ) were anesthetized with combinations of the sedative midazolam and the gaseous anesthetic isoflurane during three research cruises to the Antarctic Peninsula (∼67°S, 67°W) in the austral winters of 2001 and 2002. Modifications were required to gas anesthetic equipment to achieve field portability and sufficient heating to allow operations in temperatures as low as -20°C. Seals were sedated with an average intramuscular dose of midazolam of 0.55 ± 0.14 mg/kg delivered via a pole syringe ( n = 32). One seal was not given midazolam and two seals were injected intravenously. Premedication with midazolam provided moderate sedation, making capture and masking practical and safe. Mean induction time with isoflurane was 8 ± 4.8 min. Mean maintenance concentration over the anesthetic period were 2.3%± 0.9% of isoflurane. Average recovery time was 18.2 ± 8.8 min. No substantial difficulties were experienced and anesthetics were easily managed. This drug combination and the use of modified, heated equipment provide an effective anesthetic procedure for crabeater seals.     

静脉全麻联合超声引导下前锯肌平面+肋间神经阻滞应用于胸腔镜肺楔形切除术效果分析

摘要 目的：探讨静脉全麻联合超声引导下前锯肌平面+肋间神经阻滞应用于胸腔镜肺楔形切除术效果。方法：选择2021年10月至2022年12月来我院诊治的60例行胸腔镜肺楔形切除术患者,根据随机数字表法,将60例患者分为对照组（30例）与观察组（30例）,对照组30例患者行全麻联合胸椎旁阻滞+肋间神经阻滞的麻醉方法,观察组30例患者行全麻联合前锯肌＋肋间神经阻滞的麻醉方法。对比两组患者监测入室时（T0）、插管即刻（T1）、手术切皮时（T2）、拔管即刻（T3 ）时的平均动脉压及心率,对比两组患者术后2 h、4 h、12 h、24 h、48 h的静息、咳嗽状态下的疼痛评分,对比两组患者T0-T3点的应激反应指标,对比两组患者术中血管活性药的使用剂量,对比两组患者围术期的不良反应发生率。结果：与T0点相比,观察组在T1、T2、T3时的平均动脉压、心率均有明显增加（P<0.05）,而在T1点时,两组比较无差异（P>0.05）;T2、T3点时观察组的平均动脉压、心率明显较对照组低（P<0.05）。随着术后时间延长,两组静息、咳嗽状态下的疼痛评分明显降低（P<0.05）,而同时间点组间对比无统计学意义（P>0.05）。与T0点相比,观察组在T1、T2、T3时的肿瘤坏死因子、白介素6、白介素10水平均有明显增加（P<0.05）,而同时间点观察组与对照组对比无统计学意义（P>0.05）。观察组术中血管活性药的使用剂量明显较对照组低（P<0.05）。观察组的不良反应发生率16.77%低于对照组23.33%,但组间对比无统计学意义（P>0.05）。结论：行静脉全麻联合超声引导下前锯肌平面+肋间神经阻滞的胸腔镜肺楔形切除术者血流动力学更加稳定,术中所需血管活性药物用量明显降低。