超声与周围神经刺激器引导技术用于上肢手术锁骨上阻滞效果研究

摘要 目的：探讨超声与周围神经刺激器引导技术用于上肢手术锁骨上阻滞的效果。方法：招募2019年5月~2021年4月在我院收治并接受上肢手术的100例患者为研究对象。所有患者均接受上臂丛神经阻滞。根据研究方案将患者随机均分为对照组和引导组。对照组采用神经刺激器辅助定位锁骨上臂丛神经阻滞,引导组采用超声与周围神经刺激器引导技术对上臂丛神经阻滞,统计分析临床麻醉完成时间等相关指标。结果：两组患者一般资料比较无差异（P>0.05）。引导组麻醉完成时间和神经阻滞起效时间较对照组缩短（P<0.05）,引导组神经阻滞持续时间较对照组延长（P<0.05）。引导组麻醉效果优良率较对照组升高（P<0.05）,引导组麻醉效果中差率较对照组低（P<0.05）。引导组总体并发症较对照组低（P<0.05）。引导组感觉评分、运动评分、应对评分和总评分较对照组升高（P<0.05）。引导组非常满意率和总满意率较对照组升高（P<0.05）,引导组不满意率较对照组降低（P<0.05）。结论：与单独使用神经刺激器相比,超声引导辅助定位锁骨上臂丛神经阻滞具有起效快、阻滞完全、持续时间长等优点,超声与周围神经刺激器引导技术可提高麻醉的有效性、准确性和安全性,值得临床推广。     

神经刺激仪经肌间沟定位臂丛神经分支行臂丛麻醉效果分析

目的：比较神经刺激仪经肌间沟定位臂丛神经分支行肌间沟臂丛神经阻滞麻醉的效果及安全性。方法：选择拟行肌间沟臂丛神经阻滞的上肢手术的患者80例,ASAI或II级,随机均分为A组和B组,每组40例患者。两组均给予1％的利多卡因＋0．375％耐乐品20mL。记录完成操作所需时间、感觉神经阻滞起效时间、感觉神经阻滞完善时间、运动神经阻滞起效时间、运动神经阻滞完善时间;评价手术区域麻醉效果（优、良、差、失败）;观察并记录并发症。结果：A组完成操作所需时间（5．01±1．40）min,明显长于B组（2．83＋O．87）min（P〈0．01）。A组感觉阻滞起效时间（4．48±1．36）min,明显短于B组（7．0±2．06）min（P〈0．01）;A组运动阻滞起效时间（4．88＋±1．18）min,明显短于B组（7．0±1．67）min（P〈0．01）。A组感觉阻滞完善时间（11．73±3．62）短于B组（13．33±3．02）min（P=0．033）。A组运动阻滞完善时间（11．18±2．73）短于B组（12．41±2．48）min（P=0．038）;麻醉效果优等率A组为87．5％,B组为67．5％,差异有统计学意义x^2=4．588,P=0．032;优良率A组为97．5％,B组为90．0％,差异无统计学意义x2=1．920,P=0．166;A组、B组均未出现严重麻醉并发症。结论：A组行肌间沟臂丛神经阻滞比B组阻滞操作时间长,但神经阻滞麻醉效果好,神经阻滞完善率高。     

超声定位与解剖定位对小儿臂丛神经阻滞麻醉效果的比较研究

目的:探讨超声定位对小儿臂丛神经阻滞麻醉的效果及优势。方法:选取我院收治的上肢手术患儿54例,随机分为两组。其中对照组在解剖定位下进行麻醉,实验组在超声定位下进行麻醉。比较两组麻醉完成时间、用药剂量、起效时间及不良反应等。结果:实验组麻醉完成时间及麻醉起效时间均较对照组短,用药剂量较对照组少,差异有统计学意义(P0.05);实验组VAS评分较对照组低,差异有统计学意义(P0.05);实验组血肿发生率低于对照组,差异具有统计学意义(P0.05);实验组Honer综合征、局麻药毒性反应以及气胸的发生率均低于对照组,但两组差异无统计学意义(P0.05)。结论:超声定位下行小儿臂丛神经阻滞麻醉能够明显改善麻醉效果,减少麻醉完成时间、麻醉药物用量及麻醉起效时间,降低麻醉相关不良反应的发生率,值得临床推广。     

B超声引导下肋锁间隙与喙突入路连续臂丛神经阻滞对Barton骨折术后镇痛效果比较

目的:比较超声引导下肋锁间隙与喙突两种入路连续臂丛神经阻滞对Barton骨折手术患者术后的镇痛效果。方法:选择择期行Barton骨折手术患者60例,随机分为肋锁间隙入路连续臂丛神经阻滞组(A组,n=30)和喙突入路连续锁骨下臂丛神经阻滞组(B组,n=30)。两组均在超声引导下进行臂丛神经阻滞,同时留置神经阻滞导管,麻醉后2小时经神经阻滞导管连接无线电子镇痛泵。记录手术过程中神经深度、麻醉操作时间,并评估麻醉效果;记录术后第一次追加药物时间;记录麻醉后6 h、12 h、18 h、24 h、36 h、48 h静息及运动状态VAS评分;记录术后第一天和第二天镇痛泵有效按压次数及补救镇痛情况;记录患者满意度及并发症发生情况。结果:与B组相比,A组神经深度明显减浅(P<0.05),麻醉操作时间显著缩短(P<0.05),术后第一次追加药物时间延长(P<0.05),麻醉后12 h、18 h、24 h、36 h静息及运动状态VAS评分较低(P<0.05),术后第一天有效按压次数明显减少(P<0.05),患者满意度评分高(P<0.05),误穿血管发生率明显减少(P<0.05)。结论:超声引导下肋锁间隙入路与喙突入路连续锁骨下臂丛神经阻滞均可安全有效用于Barton骨折手术术后镇痛;但肋锁间隙连续臂丛神经阻滞术后镇痛效果更好,且具有神经阻滞深度浅、操作时间更短、阻滞效果更好、患者满意度更高及并发症更少等优点。     

右美托咪定联合地佐辛在臂丛神经阻滞麻醉中的应用及对血清VEGF、IL-6、IL-10的影响

目的:右美托咪定联合地佐辛在臂丛神经阻滞麻醉中的应用及对血清VEGF(内皮细胞生长因子)、IL-6(白介素-6)、IL-10(白介素-10)的影响。方法:选择我院2016年10月至2017年12月94例上肢骨折内固定术患者作为本次研究对象,随机分为对照组和联合组,各47例。对照组于臂丛阻滞实施前10分钟持续泵注右美托咪定,联合组在此基础上辅助静脉推注地佐辛。随之在超声引导下行肌间沟臂丛神经阻滞对比分析两组患者臂丛神经麻醉前(T0),药物注射分钟后(T1),手术切皮(T2)、手术操作5分钟(T3)、手术操作30分钟(T4)和手术结束(T5)各时间点血流动力学、Ramsay镇静评分、VEGF、IL-6和IL-10水平。结果:联合组T1～T5时间MAP(血压)、HR(心率)均低于对照组(P0.05);两组SpO2(血氧饱和度)在各时间点比较差异无统计学意义(P0.05);联合组T1～T5时间点的Ramsay镇静评分明显优于观察组(P0.05);两组T1～T5时间点VEGF均上升,且联合组各时间点明显高于对照组(P0.05);术后24小时显示,联合组IL-6、IL-10水平显著低于对照组(P0.05);联合组麻醉起效时间明显短于对照组(P0.05),镇痛持续时间、感觉神经和运动神经阻滞的持续时间明显比对照组长(P0.05)。结论:在行上肢手术过程中,联合使用右美托咪定和地佐辛行臂丛神经阻滞麻醉镇痛效果明显,同时可有效刺激VEGF分泌,降低IL-6、IL-10炎症因子水平,加速患者术后恢复。     

B超引导下臂丛神经阻滞麻醉对老年桡骨远端粉碎性骨折患者的麻醉效果分析

摘要 目的：研究B超引导下臂丛神经阻滞麻醉对老年桡骨远端粉碎性骨折患者的麻醉效果。方法：选择2018年12月～2020年6月我院的80例老年桡骨远端粉碎性骨折患者,采用随机数字表法,将患者均分为两组。两组均实施臂丛神经阻滞麻醉,其中对照组使用传统的解剖定位法,观察组使用B超引导法。比较两组的麻醉效果、麻醉用药剂量、阻滞起效时间、麻醉完成时间、镇痛维持时间;不同时间的平均动脉压、心率;且记录两组的脊髓麻痹、气胸、呼吸困难、局麻药物中毒发生率。结果：观察组老年桡骨远端粉碎性骨折病人的麻醉效果优良率（95.00 %）明显高于对照组（77.50 %,P<0.05);观察组的麻醉用药剂量、阻滞起效时间、麻醉完成时间均显著低于对照组,镇痛维持时间长于对照组(P<0.05);两组T2和T3时间点的平均动脉压和心率明显高于T1(P<0.05),且观察组的平均动脉压和心率明显更低(P<0.05);观察组的脊髓麻痹、气胸、呼吸困难、局麻药物中毒发生率明显更低(P<0.05)。结论：B超引导臂丛神经阻滞麻醉能提高老年桡骨远端粉碎性骨折患者的麻醉效果。     

不同浓度罗派卡因用于老年患者臂丛神经阻滞麻醉的临床比较研究

目的：比较不同浓度的罗派卡因对老年患者臂丛神经感觉、运动神经阻滞起效和维持时间的影响。方法：选择60例行择期上肢手术老年患者。男38例,女21例,年龄65—78岁。ASAⅠ-Ⅲ级。随机分为两组。定时记录感觉、运动神经完全阻滞起效时间和维持时间,观察并记录术中生命体征的变化和有无并发症发生。结果：两组患者感觉和运动神经阻滞的起效时间和维持时间有极显著性差异（P〈0．05）,术中生命体征和并发症发生率无显著性差畀。结论：0．37％相较0．25％罗哌卡因用于老年患者臂丛神经阻滞麻醉起效更快,维持时间更长,副作用风险来见增加,可常规用于老年患者的上肢手术麻醉。     

不同浓度罗派卡因用于老年患者臂丛神经阻滞麻醉的临床比较研究

目的:比较不同浓度的罗派卡因对老年患者臂丛神经感觉、运动神经阻滞起效和维持时间的影响。方法:选择60例行择期上肢手术老年患者。男38例,女21例,年龄65-78岁。ASAⅠ-Ⅲ级。随机分为两组。定时记录感觉、运动神经完全阻滞起效时间和维持时间,观察并记录术中生命体征的变化和有无并发症发生。结果:两组患者感觉和运动神经阻滞的起效时间和维持时间有极显著性差异(P<0.05),术中生命体征和并发症发生率无显著性差异。结论:0.37%相较0.25%罗哌卡因用于老年患者臂丛神经阻滞麻醉起效更快,维持时间更长,副作用风险未见增加,可常规用于老年患者的上肢手术麻醉。     

小儿上肢骨折手术的快通道麻醉

目的:观察喉罩下丙泊酚复合雷米芬太尼加神经刺激器引导下臂丛阻滞的快通道麻醉在小儿上肢骨折术中的应用效果,并与传统的麻醉方法咪唑安定加氯胺酮作比较.方法:选择ASA Ⅰ级小儿上肢骨折手术40例.随机分为2组:试验组(喉罩下丙泊酚复合雷米芬太尼加神经刺激器引导下臂丛阻滞)20例和对照组(咪唑安定+氯胺酮)20例.试验组惠儿静脉注射丙泊酚和雷米芬太尼后置入喉罩,连接麻醉机控制通气,麻醉维持采用丙泊酚和雷米芬太尼持续输注.1%利多卡因8□/□在神经刺激器引导下臂丛阻滞,手术结束停麻醉药.对照组静脉给予咪唑安定和氯胺酮,术中微量泵入咪唑安定加氯胺酮,术中根据需要调整输注速度,手术结束前5min停药.记录两组患儿的镇静镇痛效果、术中SPO2、手术时间、苏醒时间.结果:两组惠儿术中镇静镇痛效果均能满足手术需要,差异无统计学意义;两组患儿术中SPO2差异有统计学意义,试验组对气道的控制优于对照组;两组患儿手术时间差异无统计学意义,苏醒时间差异有统计学意义,对照组显著长于试验组.结论:喉罩下丙泊酚复合雷米芬太尼加神经刺激器引导下臂丛阻滞是小儿上肢骨折手术一种很好的快通道麻醉技术.     

不同频率超声及作用时间对超声引导神经阻滞起效和完善的影响

为探讨超声引导联合神经刺激器阻滞技术的起效及完善时间与超声效应的相关性,为临床应用提供依据,将我院2014年1月至2015年12月收治的120例上肢手术患者随机分为4组,即UA组、CUA组、UB组和CUB组,UA组和CUA组在7.5 MHz超声探头引导下利用神经刺激器定位臂丛神经行阻滞,UB组和CUB组在10 MHz超声引导下阻滞,UA组和UB组局麻药注射完毕后即移开超声探头,CUA组和CUB组在各神经阻滞效果完善后移开超声探头;详细记录各组患者的探头接触皮肤时间、注药完毕时间、神经阻滞后的阻滞起效时间和完善时间。研究结果表明,UB组患者超声接触时间显著长于UA组(t=2.765,p=0.009),各组间患者注药时间、感觉阻滞完善时间和运动阻滞完善时间差异无统计学意义(p0.05);UA组患者腋神经、前壁外侧皮神经、前壁内侧皮神经、尺神经和桡神经支配起效时间显著低于UB组(t=2.492,p=0.018;t=3.017,p=0.005;t=2.072,p=0.045;t=3.249,p=0.003;t=4.444,p0.001),其余各组间诸神经支配起效时间无显著性差异(p0.05)。选用高频超声探头联合神经刺激仪引导定位穿刺具有较好的临床应用价值,且超声时间与神经阻滞并无显著相关性。     

Role for dopamine in malonate-induced damage in vivo in striatum and in vitro in mesencephalic cultures

Defects in mitochondrial energy metabolism have been implicated in the pathology of several neurodegenerative disorders. In addition, the reactive metabolites generated from the metabolism and oxidation of the neurotransmitter dopamine (DA) are thought to contribute to the damage to neurons of the basal ganglia. We have previously demonstrated that infusions of the metabolic inhibitor malonate into the striata of mice or rats produce degeneration of DA nerve terminals. In the present studies, we demonstrate that an intrastriatal infusion of malonate induces a substantial increase in DA efflux in awake, behaving mice as measured by in vivo microdialysis. Furthermore, pretreatment of mice with tetrabenazine (TBZ) or the TBZ analogue Ro 4-1284 (Ro-4), compounds that reversibly inhibit the vesicular storage of DA, attenuates the malonate-induced DA efflux as well as the damage to DA nerve terminals. Consistent with these findings, the damage to both DA and GABA neurons in mesencephalic cultures by malonate exposure was attenuated by pretreatment with TBZ or Ro-4. Treatment with these compounds did not affect the formation of free radicals or the inhibition of oxidative phosphorylation resulting from malonate exposure alone. Our data suggest that DA plays an important role in the neurotoxicity produced by malonate. These findings provide direct evidence that inhibition of succinate dehydrogenase causes an increase in extracellular DA levels and indicate that bioenergetic defects may contribute to the pathogenesis of chronic neurodegenerative diseases through a mechanism involving DA.     

2018年中国植物科学若干领域重要研究进展

2018年中国植物科学继续呈现快速发展的态势, 我国科学家在国际植物科学主流学术刊物发表论文数量大幅增加, 取得了多项具有重要影响的成果。调控植物生长-代谢平衡实现可持续农业发展入选2018年度中国科学十大进展; 中国被子植物区系进化历史研究入选2018年度中国生命科学十大进展。以水稻为代表的农作物和果蔬等经济作物研究在国际上已呈现出明显的优势, 若干领域已从“追赶”状态跨越到“领跑”地位。该文对2018年中国科学家在植物科学若干领域取得的重要研究成果进行了概括性评述, 旨在全面追踪和报道当前中国植物科学领域的发展前沿和热点, 展示中国科学家所取得的杰出成就。     

SSTR5 ablation in islet results in alterations in glucose homeostasis in mice

Somatostatin (SST) peptide is a potent inhibitor of insulin secretion and its effect is mediated via somatostatin receptor 5 (SSTR5) in the endocrine pancreas. To investigate the consequences of gene ablation of SSTR5 in the mouse pancreas, we have generated a mouse model in which the SSTR5 gene was specifically knocked down in the pancreatic beta cells (betaSSTR5Kd) using the Cre-lox system. Immunohistochemistry analysis showed that SSTR5 gene expression was absent in beta cells at three months of age. At the time of gene ablation, betaSSTR5Kd mice demonstrated glucose intolerance with lack of insulin response and significantly reduced serum insulin levels. Insulin tolerance test demonstrated a significant increase of insulin clearance in vivo at the same age. In vitro studies demonstrated an absence of response to SST-28 stimulation in the betaSSTR5Kd mouse islet, which was associated with a significantly reduced SST expression level in betaSSTR5Kd mice pancreata. In addition, betaSSTR5Kd mice had significantly reduced serum glucose levels and increased serum insulin levels at 12 months of age. Glucose tolerance test at an older age also indicated a persistently higher insulin level in betaSSTR5Kd mice. Further studies of betaSSTR5Kd mice had revealed elevated serum C-peptide levels at both 3 and 12 months of age, suggesting that these mice are capable of producing and releasing insulin to the periphery. These results support the hypothesis that SSTR5 plays a pivotal role in the regulation of insulin secretion in the mouse pancreas.     

2017年中国植物科学若干领域重要研究进展

2017年中国植物科学继续保持高速发展态势, 重大成果频出, 具体表现在中国植物学家在国际顶级学术期刊发表的文章数量平稳上升。中国植物科学领域的研究工作者成果精彩纷呈, 如新型广谱抗病机制的发现、水稻广谱抗病遗传基础及机制和疫霉菌诱发病害成灾机制研究等。2017年中国生命科学领域十大进展评选中, 有两项植物科学领域的研究成果入选。水稻生物学、进化与基因组学和激素生物学等领域学科发展突出。另外, 值得一提的是, 长期从事高等植物与代谢途径调控分子网络研究和水稻品种设计育种的李家洋院士的研究成果“水稻高产优质性状形成的分子机理及品种设计”荣获2017年国家自然科学一等奖。这一具有重大国际影响的开创性贡献标志着中国植物科学在该领域的国际科学前沿居于引领和卓越地位。该文对2017年中国本土科学家在植物科学若干领域取得的重要研究成果进行了系统梳理, 旨在全面追踪和报道当前中国植物科学领域发展的最新前沿动态, 与广大读者共同分享我国科学家所取得的辉煌成就。     

2018年中国植物科学若干领域重要研究进展

2018年中国植物科学继续呈现快速发展的态势, 我国科学家在国际植物科学主流学术刊物发表论文数量大幅增加, 取得了多项具有重要影响的成果。调控植物生长-代谢平衡实现可持续农业发展入选2018年度中国科学十大进展; 中国被子植物区系进化历史研究入选2018年度中国生命科学十大进展。以水稻为代表的农作物和果蔬等经济作物研究在国际上已呈现出明显的优势, 若干领域已从“追赶”状态跨越到“领跑”地位。该文对2018年中国科学家在植物科学若干领域取得的重要研究成果进行了概括性评述, 旨在全面追踪和报道当前中国植物科学领域的发展前沿和热点, 展示中国科学家所取得的杰出成就。     

我国葫芦科植物离体培养研究进展

葫芦科植物包括多种瓜类蔬菜,对其进行离体培养研究具有重要的理论和实践意义.综述了国内在葫芦科植物器官培养、体细胞胚胎发生、花药培养、原生质体培养和体细胞杂交及离体遗传转化等方面取得的研究进展,并对葫芦科植物离体培养、遗传转化与育种的前景作了展望.     

我国葫芦科植物离体培养研究进展

葫芦科植物包括多种瓜类蔬菜,对其进行离体培养研究具有重要的理论和实践意义。综述了国内在葫芦科植物器官培养、体细胞胚胎发生、花药培养、原生质体培养和体细胞杂交及离体遗传转化等方面取得的研究进展,并对葫芦科植物离体培养、遗传转化与育种的前景作了展望。     

Changes in aquatic vegetation in Rhine floodplain streams in Alsace in relation to disturbance

Abstract. Changes are described in aquatic vegetation in oligotrophic, groundwater-fed Rhine floodplain streams in Alsace (eastern France), resulting from disturbance. Disturbance factors include changes in nutrients, either permanent ones - effluent from a waste water treatment plant or trout hatcheries - or periodic ones: flooding. Regular inputs of high levels of phosphate and ammonia modified the macrophyte vegetation in these streams. The floristic composition, which was characteristic of oligotrophic waters upstream of the eutrophicated sector, changed to that of a eutrophic situation as originally found downstream. Periodic disturbance by floods which normally occur once a year, irregularly eutrophicates the small streams, causing the development of a mixture of eutrophic and oligotrophic species. Six macrophyte communities are distinguished, indicating different trophic levels. The aquatic vegetation is adapted to the variations of phosphate and ammonia levels. Hence, aquatic macrophytes can be used as bio-indicators of fluctuations in water nutrient levels in relation to the type of disturbance.     

Apoptosis in experimental myocardial infarction in situ and in the perfused heart in vitro

We report the appearance of apoptotic cells in experimental myocardial infarction (rabbit heart) in in situ and in vitro preparations. Apoptosis was recognized by intravital staining with Hoechst 33342 (Ho342), by nick-end labeling (TUNEL) and by DNA laddering. A steady rise in the relative number of apoptotic cardiomyocytes (apoptotic index) was noted in in situ preparations. Apoptosis was first noted 6 h after the onset of ischemia with its highest value occurring after 72 h. Apoptotic nuclei were absent in remote areas of the left and right ventricles. Apoptotic nuclei within the infarcted area showed diminished intensity of Ho342 fluorescence. Three days after ischemia, a border zone adjacent to the infarcted area consisting of apoptotic macrophages was recognized. A novel finding was the appearance of apoptotic cardiomyocytes in the isolated perfused ischemic heart. Occurring as early as 50 min after the onset of ischemia, a high apoptotic index was present adjacent to the ligature placed around the coronary artery. This observation provides the opportunity to selectively examine factors leading to apoptosis in the ischemic heart under controlled experimental conditions.     

Morphine-potentiated platelet aggregation in in vitro and platelet plug formation in in vivo experiments

The detailed mechanisms underlying morphine-signaling pathways in platelets remain obscure. Therefore, we systematically examined the influence of morphine on washed human platelets. In this study, washed human platelet suspensions were used for in vitro studies. Furthermore, platelet thrombus formation induced by irradiation of mesenteric venules with filtered light in mice pretreated with fluorescein sodium was used for an in vivo thrombotic study. Morphine concentration dependently (0.6, 1, and 5 microM) potentiated platelet aggregation and the ATP release reaction stimulated by agonists (i.e., collagen and U46619) in washed human platelets. Yohimbine (0.1 microM), a specific alpha(2)-adrenoceptor antagonist, markedly abolished the potentiation of morphine in platelet aggregation stimulated by agonists. Morphine also potentiated phosphoinositide breakdown and intracellular Ca(2+) mobilization in human platelets stimulated by collagen (1 microg/ml). Moreover, morphine (0.6-5 microM) markedly inhibited prostaglandin E(1) (10 microM)-induced cyclic AMP formation in human platelets, while yohimbine (0.1 microM) significantly reversed the inhibition of cyclic AMP by morphine (0.6 and 1 microM) in this study. The thrombin-evoked increase in pH(i) was markedly potentiated in the presence of morphine (1 and 5 microM). Morphine (2 and 5 mg/g) significantly shortened the time require to induce platelet plug formation in mesenteric venules. We concluded that morphine may exert its potentiation in platelet aggregation by binding to alpha(2)-adrenoceptors in human platelets, with a resulting inhibition of adenylate cyclase, thereby reducing intracellular cyclic AMP formation followed by increased activation of phospholipase C and the Na(+)/H(+) exchanger. This leads to increased intracellular Ca(2+) mobilization, and finally potentiation of platelet aggregation and of the ATP release reaction.