不同麻醉方法对腹腔镜子宫切除术患者血清皮质醇及儿茶酚胺的影响

目的：观察不同麻醉方法对腹腔镜子宫切除术患者血清皮质醇及儿茶酚胺的影响。方法：选择行腹腔镜子宫切除术患者42例,随机分为3组：硬膜外麻醉组（A组）、全麻组（B组）、全麻复合硬膜外阻滞组（C组）各14例,于麻醉前10min（T0）、气腹后10min（T1）、气腹后40min（T2）和术后10min（T3）四个时间点,采集静脉血测定皮质醇（COR）和儿茶酚胺（CA）浓度,并观察P旷c02、SP02及血流动力学变化。结果：与T0相比,A组T1时MAP、HR显著下降（P〈0．05）,B组T1、T2时MAP、HR、COR和CA明显升高（P〈0．05）,C组各时点MAP、HR、COR和CA差异无统计学意义;组间相比,C组各时点MAP、HR、COR和CA显著低于B组（P〈0．05）。结论：全麻复合硬膜外阻滞可以有效地调控腹腔镜子宫切除术患者的应激反应。     

Microglia modulate general anesthesia through P2Y12 receptor

1. Download : Download high-res image (131KB)
2. Download : Download full-size image

     

Evaluating the Association between Anesthesia Type and Postoperative Complications for Patients Receiving Total Ankle Arthroplasty

BackgroundTotal ankle arthroplasty (TAA) is performed for ankle arthritis and there has been interest investigating which anesthetic method is the best choice in order to optimize perioperative outcomes. In this study, we compared postoperative complications after TAA for patients receiving either 1) general anesthesia alone or 2) general anesthesia plus regional anesthesia.MethodsPatients undergoing primary TAA from 2007 to 2018 were identified in a national database. Patients were stratified into 2 cohorts: general anesthesia and general anesthesia combined with regional anesthesia. In this analysis, 30-day wound, cardiac, pulmonary, renal, thromboembolic, and sepsis complications, as well mortality, postoperative transfusion, urinary tract infection, extended length of stay, and reoperation were assessed. Bivariate analyses and multivariable logistical regression were performed.ResultsOf 1,084 total patients undergoing TAA, 878 patients (81.0%) had general anesthesia and 206 (19.0%) had general anesthesia combined with regional anesthesia. Following adjustment, there were no increased risk of postoperative complications in the combined general and regional anesthesia group compared to those who only underwent general anesthesia.ConclusionCompared to general anesthesia alone, the addition of regional anesthesia to general anesthesia for TAA is not associated with increased risk of complications in the perioperative period. Level of Evidence: III     

七氟烷与异氟烷对老年腹部全麻手术患者BIS和Narcotrend指数的影响

目的:比较七氟烷与异氟烷对老年腹部全麻手术患者BIS、Narcotrend指数的影响。方法:将80例择期行老年腹部全麻手术患者随机分为舒芬太尼组与地佐辛组,每组40例患者。两组均给予常规麻醉诱导,对照组患者采用面罩吸氧给予异氟烷和舒芬太尼麻醉,试验组给予七氟烷和舒芬太尼麻醉。治疗结束后,对比分析两组入室前(t1)、手术完毕后(t2)、拔管时(t3)、拔管后5min(t4)、拔管后10min(t5)、拔管后1h(t6)的血流动力学、术后认知功能、脑电双频指数(BIS)、伤害趋势指数(NI)及不良反应的发生情况。结果:与对照组相比,试验组于t3~t4时心率较高(P0.05),试验组t3~t4简易精神状态检查(MMSE)评分较低,t2、t5~t6MMSE评分无显著差异,试验组于t3~t4时心率、BIS、NI水平较低(P0.05)。对照组不良反应发生率为10.01%,试验组为17.50%,组间差异无统计学意义(P0.05)。试验组手术部位感染发生率为12.50%(5/40)显著低于对照组(35.00%)(P0.05)。结论:七氟烷联合舒芬太尼收缩压以及舒张压的波动较小,下调BIS、Narcotrend指数,并于拔管后迅速恢复,降低SSI发生,安全性高。     

Renal effects of general anesthesia from old to recent studies

Various types of anesthesia are being utilized to maintain physiologically secured surgical conditions. Nearly all categories of general anesthesia are characterized by various perioperative and postoperative complications. These shortcomings are important aspects that need to be considered by the anesthesiologist and surgeon before administration of these compounds. The renal effects of anesthesia play an important role in understanding possible systemic changes due to the fact that the kidney has a direct or indirect impact on nearly all the systems of the body. Various studies have been conducted to find out changes in renal parameters and its systemic effects upon administration of the anesthesia and its postoperative repercussions. Besides that, the impaired renal function might have an impact on the excretion of anesthetic metabolites, which can lead to long-term dysfunction. Patients with a previous history of disease ought to be brought under consideration because these chemicals can ameliorate pre-existent symptoms. This review is intended to discuss the early and latest studies based on the effects of general anesthesia on the renal system.     

外科动物实验中猪的麻醉问题

猪作为重要的实验动物,在外科实验中运用传统的麻醉方法时易引起呼吸道阻塞而死亡,我们使用全麻插管技术,并辅以术前术后各种对症处理,成功地解决了手术中猪因呼吸道阻塞而死亡的问题。     

脑电监测SD大鼠异氟醚全身麻醉模型的建立及脑电分析

目的:建立脑电监测SD大鼠异氟醚全身麻醉模型并分析脑电监测结果。方法:随机选取SD大鼠20只,先行脑电电极置入术,术后使用密闭吸入麻醉动物行为学观察圆筒,观察异氟醚引起的麻醉诱导、维持、觉醒状态并记录诱导、觉醒时间。将记录的行为学结果对照典型脑电图波形改变判断麻醉深度。结果:实验SD大鼠均检测出脑电图,通过对照行为学观察发现动态脑电监测结果同异氟醚麻醉过程进展一致。在麻醉过程中SD大鼠出现典型的全身麻醉脑电循环。结论:动态脑电监测和SD大鼠行为学观察可以准确反应全身麻醉深度。     

硬膜外阻滞复合全麻与全凭静脉麻醉在宫颈癌手术中的效果比较

目的:对比硬膜外阻滞复合全麻与全凭静脉麻醉在宫颈癌手术中的效果。方法:选择2016年1月～2018年12月我院收治的90例宫颈癌患者,均采取腹腔镜宫颈癌根治术治疗,将其随机分为两组。对照组采用全凭静脉麻醉方法,观察组采用硬膜外阻滞复合全麻方法。比较两组的术后感染率、拔管时间以及苏醒时间,术前、术后12 h和术后72 h的血清肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)水平、CD3~+、CD4~+/CD8~+、CD8~+、CD4~+的变化。结果:观察组术后感染率、拔管时间以及苏醒时间均明显低于对照组(P0.05);观察组患者术后12 h的血清TNF-α以及IL-6水平明显低于术前和对照组(P0.05),两组术后72 h的血清TNF-α和IL-6水平均恢复至术前水平;两组术后12 h的CD3~+、CD4~+/CD8~+、CD4~+均明显低于术前(P0.05),且观察组术后12 h的CD3~+、CD4~+/CD8~+、CD4~+明显高于对照组(P0.05),两组术后72 h的CD3~+、CD4~+/CD8~+、CD8~+、CD4~+均恢复至术前水平。结论:与全凭静脉麻醉相比,硬膜外阻滞复合全麻更有助于宫颈癌手术患者早期拔管和苏醒,其可明显减轻患者术后的免疫抑制,有效降低术后感染发生率。     

Behavioral and electrophysiological analysis of general anesthesia in 3 background strains of Drosophila melanogaster

General anesthetics achieve behavioral unresponsiveness via a mechanism that is incompletely understood. The study of genetic model systems such as the fruit fly Drosophila melanogaster is crucial to advancing our understanding of how anesthetic drugs render animals unresponsive. Previous studies have shown that wild-type control strains differ significantly in their sensitivity to general anesthetics, which potentially introduces confounding factors for comparing genetic mutations placed on these wild-type backgrounds. Here, we examined a variety of behavioral and electrophysiological endpoints in Drosophila, in both adult and larval animals. We characterized these endpoints in 3 commonly used fly strains: wild-type Canton Special (CS), and 2 commonly used white-eyed strains, isoCJ1 and w¹¹¹⁸. We found that CS and isoCJ1 show remarkably similar sensitivity to isoflurane across a variety of behavioral and electrophysiological endpoints. In contrast, w¹¹¹⁸ is resistant to isoflurane compared to the other 2 strains at both the adult and larval stages. This resistance is however not reflected at the level of neurotransmitter release at the larval neuromuscular junction (NMJ). This suggests that the w¹¹¹⁸ strain harbors another mutation that produces isoflurane resistance, by acting on an arousal pathway that is most likely preserved between larval and adult brains. This mutation probably also affects sleep, as marked differences between isoCJ1 and w¹¹¹⁸ have also recently been found for behavioral responsiveness and sleep intensity measures.     

Genetic effects on an anesthetic‐sensitive pathway in the brain of drosophila

General anesthetics are known to inhibit the electrically induced escape response of the fruitfly through action within the brain. We examined this response and its sensitivity to anesthetics in several mutants that cause significant disruption of the mushroom body and other structures of the central brain in adult flies. Because we show here that anesthesia sensitivity is influenced by genetic background, we have used a set of congenic mutant lines. Sensitivity to halothane is normal in most of these lines, indicating that the anesthetic target is unaffected by the gross status of the central brain. Thus, for the escape response, anesthetic sensitivity is not a global feature but reflects action at a localized target. Only the mushroom body defect (mud) line showed an increased sensitivity of the escape response to halothane. Sensitivity to two other anesthetics is also perturbed in this line, albeit less dramatically so. The behavior of mud/+ heterozygotes and the comparison of brain anatomy among all the mutant lines imply that the effect of the mud mutation on anesthesia is not via gross alteration of central brain structures. The possibility that an adventitious mutation in the mud line is responsible for the effects on anesthesia is disfavored by the behavior of a heterozygote between two mud alleles. Although we do not yet know whether the mud gene encodes an anesthetic target or influences the functioning of an anesthetic‐sensitive neuron in this pathway, our work indicates that this gene regulates the effects of halothane on a circumscribed pathway. © 2000 John Wiley & Sons, Inc. J Neurobiol 42: 69–78, 2000     

脑电监测SD大鼠异氟醚全身麻醉模型的建立及脑电分析

目的建立脑电监测SD大鼠异氟醚全身麻醉模型并分析脑电监测结果。方法：随机选取SD大鼠20只,先行脑电电极置入术,术后使用密闭吸入麻醉动物行为学观察圆筒,观察异氟醚引起的麻醉诱导、维持、觉醒状态并记录诱导、觉醒时间。将记录的行为学结果对照典型脑电图波形改变判断麻醉深度。结果：实验SD大鼠均检测出脑电图,通过对照行为学观察发现动态脑电监、}测结果同异氟醚麻醉过程进展一致。在麻醉过程中SD大鼠出现典型的全身麻醉脑电循环。结论：动态脑电监测和SD大鼠行为学观察可以准确反应全身麻醉深度。     

硬膜外复合全身麻醉对开胸手术患者麻醉苏醒期苏醒质量和应激状态的影响

目的:探讨硬膜外复合全身麻醉对开胸手术患者麻醉苏醒期苏醒质量和应激状态的影响。方法:选择2013年6月~2015年3月在我院行开胸手术患者80例作为研究对象,按照数字随机表法分为对照组和观察组,分别给予静吸复合全身麻醉和硬膜外复合全身麻醉,比较两组患者术后苏醒的时间和拔管的时间,采用运动活动评分(MAAS)评估镇静程度,电化学法测定去肾上腺素(NE)、肾上腺素(E)及多巴胺(DA)水平。结果:观察组的苏醒时间为(7.12±1.23)min,拔管时间为(11.38±1.86)min,均短于对照组的(15.34±2.82)min和(25.71±4.22)min,差异有统计学意义(P0.01)。术后0.5 h及术后6 h两组患者的MAAS均高于术前,且观察组优于对照组,差异均有统计学意义(P0.05)。两组患者术后NE、E及DA水平均高于术前,且对照组高于观察组,差异有统计学意义(P0.05)。结论:开胸手术患者采用硬膜外复合全身麻醉可缩短苏醒时间和拔管时间,提高患者的苏醒质量,降低应激反应,值得临床推广应用。     

非人灵长类个性化麻醉方案的探讨

目的 比较氯胺酮、舒泰、速眠新Ⅱ、戊巴比妥钠等4种全身麻醉药或其组合对非人灵长类的麻醉效果,探寻能替代或者减少氯胺酮使用的个性化麻醉方案。方法 以单独使用氯胺酮麻醉的方案作为对照,另设单独使用舒泰、氯胺酮复合速眠新Ⅱ、舒泰复合速眠新Ⅱ和戊巴比妥钠复合速眠新Ⅱ等麻醉4个实验组,每组选取5只食蟹猴进行实验,记录麻醉后的心率、体温、血氧饱和度、以及麻醉诱导时间和维持时间,以比较各方案的麻醉效果。结果 与单独使用氯胺酮麻醉比较,其他四种麻醉方案在心率、体温、血氧饱和度和麻醉诱导时间上均无显著性差异,不同方案麻醉维持时间分布在30~200min之间。在非人灵长类的全身麻醉中,舒泰可以很好地替代氯胺酮;氯胺酮复合速眠新Ⅱ麻醉可取得较长的麻醉维持时间,并减少氯胺酮的使用量;舒泰与速眠新Ⅱ联用、戊巴比妥钠与速眠新Ⅱ联用的方案也可替代氯胺酮,且麻醉维持时间较长。结论 在一定的麻醉时间内,联合用药可以降低氯胺酮的使用量,不同麻醉方案灵活运用可满足不同实验对麻醉维持时间的需求。     

Anesthetic management for instrumentation of the pregnant rhesus monkey

The anesthetic procedures used and the responses observed during maternal instrumentation on 38 pregnant rhesus monkeys (Macaca mulatta) during the second half of gestation are reported. A laparotomy with maternal instrumentation was performed in all animals. Anesthesia was induced with ketamine and maintained with halothane. Two animals delivered within five days of anesthesia and surgery and were unable to undergo experimentation. The remaining 36 animals underwent successful experimentation. Dysrhythmias, hypotension, and hypothermia were identified as complications of anesthesia.     

盐酸埃托啡在亚洲象全身麻醉中的应用

正盐酸埃托啡(etorphine hydrochloride)属于阿片受体激动剂,是人工合成的作用于中枢神经系统的化学保定剂,由英国人于1963年研发,其属强效镇痛类药,精神依赖多见,故一般不用于人体麻醉,而在动物尤其是食草动物的麻醉保定中被广泛使用(Nielsen,1999)。盐酸埃托啡可与马来酸乙酰丙嗪(acepromazine maleate)复合使用,乙酰丙嗪具有中枢镇静作用,能加强中枢抑制药的效应(刘焕奇等,2003;段俊堂,2015)。M99是以盐酸埃托啡为主要成分的动物麻醉剂。大动物保定灵是以盐酸埃托啡和马来酸乙酰丙嗪为主要成分的动物麻醉剂。盐酸     

经皮穴位电刺激对甲状腺手术后围拔管期应激反应的影响

目的:观察经皮穴位电刺激对行甲状腺手术的患者全麻围拔管期应激反应的影响。方法:选择择期行甲状腺手术的患者60例,随机分为经皮穴位电刺激(T)组和假电刺激(C)组,T组麻醉诱导前30分钟给予电刺激,C组患者仅将电极片贴附在相同穴位但不给予电刺激。记录两组在入室(T0)、手术结束时(T1),拔管后即刻(T2),拔管后5 min(T3),拔管后10 min(T4)的血压(NIBP)、平均动脉压(MAP)、心率(HR)以及静脉血中的肾上腺素(E)、去甲肾上腺素(NE)、皮质醇(Cor)的浓度;记录两组的拔管质量评分以及Ricker镇静-躁动评分。结果:T组在T2~T4时的NIBP、MAP、HR以及E、NE、Cor的浓度均较C组显著降低(P0.05);与C组比较,T组的拔管质量评分以及Ricker镇静-躁动评分降低(P0.05)。结论:经皮穴位电刺激能够减轻行甲状腺手术患者全麻围拔管期的应激反应,有利于维持血流动力学稳定。