脑电双频指数联合控制性降压在髋关节置换手术中应用

目的：观察脑电双频指数联合控制性降压在髋关节置换手术中应用可行性。方法：择期手术80例,随机均分为2组,A组尼卡地平联合瑞芬太尼组监测脑电双频指数,B组对照组。记录麻醉过程血流动力学变化及控制性降压效果。结果：A组血流动力学较B组稳定,A组失血明显少于B组,差别均有统计学意义。结论：脑电双频指数监测联合控制性降压可安全在髋关节置换手术中应用。     

Transcutaneous Electrical Nerve Stimulation Regulates Organ Blood Flow and Apoptosis during Controlled Hypotension in Dogs

Transcutaneous electrical nerve stimulation (TENS) is commonly used in clinical practice for alleviating pains and physiological disorders. It has been reported that TENS could counteract the ischemic injury happened in some vital organs. To determine the protective effect of TENS on internal organs during CH in dogs, target hypotension was maintained for 60 min at 50% of the baseline mean arterial pressure (MAP). The perfusion to the brain, liver, stomach, and kidney was recorded and apoptosis within these organs was observed. Results showed that when arriving at the target MAP, and during the maintaining stage for 10 min, perfusion to the stomach and liver in the CH+TENS group was much higher than in the CH group (P<0.05). Perfusion to the cerebral cortex greatly declined in both the controlled pressure groups when compared with the general anesthesia (GA) group (P<0.05). After withdrawing CH, the hepatic blood flow in both the CH and CH+TENS groups, and the gastric and cerebral cortical blood flow in the CH+TENS group, were rapidly increased. By the end of MAP restoration, gastric blood flow in the CH group was still low. At 72 h after applying CH, terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL)-positive cells in stomach and kidney tissue from the CH group were significantly increased compared with those in the GA group (P<0.05). There was no significant difference in TUNEL-positive cells in the liver and hippocampus among the three groups. Our results demonstrated that CH with a 50% MAP level could cause lower perfusion to the liver, stomach, cerebral cortex, and kidney, with apoptosis subsequently occurring in the stomach and kidney. TENS combined GA is able to improve the blood flow to the liver, stomach, and reduce the apoptosis in the stomach and kidney.     

硝酸甘油复合艾司洛尔应用对推管减压术控制性降压的临床观察

目的:比较椎管减压椎弓根钉内固定手术中硝酸甘油(NTG)-艾司洛尔控制性降压与单纯NTG控制性降压对血流动力学的影响。方法:40例在持续异丙酚 瑞芬太尼、异氟醚静吸复合麻醉下实施椎管减压椎弓根钉内固定手术患者,随机分为两组,Ⅰ组采用NTG艾司洛尔,Ⅱ组单纯采用NTG控制性降压至平均压65-70mmHg,持续30min。监测降压前后及降压期间血氧饱和度及心率、血压、动脉氧分压变化。结果:在静吸复合麻醉下Ⅱ组患者的降压消耗时间和复压所需时间均高于Ⅰ组患者,同时维持剂量也大于Ⅰ组患者,且Ⅰ组的血压、心率在降压前后各个时期较Ⅱ组稳定。但两种控制性降压方案时手术病人的血气变化影响情况是基本一致的。结论:NTG-艾司洛尔用于异丙酚 瑞芬太尼、异氟醚复合麻醉在椎管减压椎弓根钉内固定术中的控制性降压比单纯NTG降压对心率、血压的影响小,且更迅速,更平稳,用量少,可控性好。艾司洛尔50μg·kg-1·min-1,可减慢心率,防止硝酸甘油NTG停药后反跳性高血压。所以联合使用NTG、艾司洛尔,优于单纯使用NTG。     

Hypotension Caused by L-Dopa

In 20 patients with idiopathic Parkinsonism maximum tolerated doses of L-dopa were found to induce a mean reduction in blood pressure (erect systolic) of 19·3 mm.Hg, without any significant change in pulse rate. This hypotension may be due to dopamine, acting on adrenergic nerve endings or on the central nervous system itself.     

右美托咪定联合尼卡地平用于老年骨科手术患者控制性降压时对炎症因子的影响

目的:探讨右美托咪定联合尼卡地平用于老年骨科手术患者控制性降压的临床疗效及其对炎症因子水平的影响。方法:选择2014年1月至2016年1月在我院行骨科手术的老年患者68例,随机分为两组,A组和B组,每组34例。A组患者接受尼卡地平控制性降压,B组患者在A组基础上静脉注射右美托咪定。比较两组患者的手术情况以及术中血流动力学指标,术中及术后血清IL-6(Interleukin-6)、TNF-α(Tumor necrosis factor-ɑ)以及CRP(C-reactive protein)的水平。结果:B组患者术中尼卡地平的使用剂量及术中出血量显著少于A组(P0.05),术后苏醒时间及拔管时间较A组显著缩短(P0.05),术中Fromme术野质量评分明显低于A组患者(P0.05)。降压后5 min,A组患者的HR显著加快(P0.05),B组患者HR相对稳定,且明显慢于A组(P0.05);两组患者的MAP以及CVP显著低于降压前(P0.05),且两组差异无统计学意义(P0.05),A组患者在降压后30 min的MAP和CVP较B组显著升高(P0.05)。两组患者术后不同时间点血清IL-6、TNF-α和CRP的水平显著上升(P0.05),其中B组患者血清IL-6、TNF-α和CRP的水平较A组明显较低(P0.05)。结论:右美托咪定联合尼卡地平用于老年患者行骨科手术时控制性降压的疗效显著,可有效降低尼卡地平的使用剂量,对患者血流动力学影响较小,并可减轻患者术后应激反应,利于患者术后恢复。