不同麻醉方式对老年冠心病患者围术期血流动力学及ECG的影响

目的：探讨对择期腹部手术的老年冠心病患者心脏血流动力学及心脏电活动影响较小的麻醉方式。方法：133例择期腹腔手术的老年冠心病患者随机分为硬膜外麻醉组（EA）,全麻组（GA）和腰-硬联合麻醉组（CSEA）。术中连续监测,分时段记录平均动脉压（MAP）、心率（HR）、血氧饱和度（SaO2）及异常心电图,比较3组组间及组内差异。结果：麻醉后15 min和麻醉后30 min,GA组的SaO2明显高于EA组（P〈0.05）。麻醉后15min、30 min和60 min CSEA组MAP值比EA组明显升高（P〈0.05）;麻醉后30 min,CSEA组的HR比EA组明显升高（P〈0.05）;麻醉后15 min和30 min,CSEA组的SaO2比EA组明显升高（P〈0.05）。组内比较,EA组麻醉后15min、30 min、60 min,MAP、HR、SaO2三个指标均比麻醉前明显降低（P〈0.05）,GA组和CSEA组前后比较差异不明显（P〉0.05）。异常ECG,组间比较,GA组和CSEA组ST-T改变发生率在麻醉后15 min、30 min、60 min、术毕时均明显低于EA组（P〈0.05,P〈0.01）,GA组和CSEA组心律失常发生率在麻醉后15 min、30 min、60 min均明显低于EA组（P〈0.05,P〈0.01）;组内比较,GA组和CSEA组的ST-T改变和心律失常发生率在麻醉后15 min、30min、60 min、术毕时均明显低于麻醉前（P〈0.05,P〈0.01）。结论：老年冠心病患者腹腔手术时全麻和腰-硬联合麻醉术中血流动力学较稳定,心电异常发生率较小。     

右美托嘧啶用于喉癌患者局麻下气管切开的临床效果分析

目的：探讨预注右关托嘧啶（dexmedetomindine,Dex）对喉癌患者局麻下行气管切开时的影响。方法：选择择期喉癌手术拟行气管切开的患者40例,随机分为Dex组（D组）和生理盐水组（c组）,D组在局麻前静脉注射Dex0．5μg／kg（10min泵注完毕）,c组以相同方式泵注等量生理盐水,观察5min后开始行局麻下气管切开。分别记录两组患者给药前（TO）、局麻开始时（T1）、切皮时（T2）、气管内麻醉时（T3）、气管切开造口时（T4）的平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2）和呼吸次数（RR）;观察并记录患者T1～T4各时间点的VAS评分、Ramsay镇静评分和手术耐受程度评分。结果：与T0相比,C组T1～T4各时点MAP和HR均升高,尤以T3～T4时明显（P〈0．05）,D组T1—4时MAP下降、HR明显减慢（P〈0．05）;与C组相比,D组T1～T4各时间点MAP均显著下降（P〈0．05）,HR均明显减慢（P〈0．01）,VAS评分显著降低（P〈0．05）,手术耐受程度评分和Ramsay镇静评分均显著升高（P〈0．05）。结论：喉癌患者行局麻气管切开前预先静注右关托嘧啶0．5μg／kg（10min泵注完毕）,可有效维持血液动力学稳定,并产生明显的镇静、镇痛作用。     

抑制瘢痕细胞中串珠素表达对Ⅰ型胶原蛋白生成量的影响

目的：硬膜外瘢痕,又叫硬膜外纤维化,是指在硬膜外腔的手术涉及范围内形成的瘢痕组织或纤维化,是机体对创伤的修复反应。瘢痕的粘连和收缩会牵拉硬膜和神经根,限制其活动,被瘢痕包绕的神经根受到非正常的牵拉和挤压,神经纤维的轴浆运输、动脉血供、静脉回流受阻,神经根和背侧神经节对机械压迫很敏感,会产生一系列症状,如疼痛、麻木及下肢肌力降低等。近年来,对硬膜外瘢痕防治的研究大多是椎板切除术后如何通过物理或化学屏障来减少术后因瘢痕粘连导致的并发症。但对通过瘢痕形成过程中抑制其主要构成成分的生成来减轻椎板切除术后硬膜外瘢痕形成的相关研究还较少。通过减少椎板切除术后硬膜外瘢痕主要成分Ⅰ型胶原蛋白的生成来实现抑制椎板切除术后硬膜外瘢痕的形成。方法：选用30只250克两月鼠龄的SD雄性大鼠随机按1、2、3、4、5、6周分为6组,行后路4、5腰椎全椎板切除术。术后1、2、3、4、5、6周时每周取一组大鼠全锥板切除术后硬膜后方瘢痕组织,分别行病理切片HE染色,组织块贴壁法细胞培养。筛选第三周瘢痕组织培养的成纤维细胞进行慢病毒干扰串珠素表达并设对照组,通过Western-blot、RT-PCR分析Ⅰ型胶原蛋白生成量与对照组的差别并进行统计学分析。结果：慢病毒干扰小组Ⅰ型胶原蛋白生成量较对照组及纯病毒组明显减少（RT-PCR F=509.331,q A,B=-43.371,P〈0.01,q A,C=-46.133,P〈0.01,Western-Blot F=337.578;q A,B=-112.433,P〈0.01,q A,C=-89.227,P〈0.01）。结论：干扰串珠素表达能有效减少术后硬膜外瘢痕成纤维细胞生成Ⅰ型胶原蛋白,对抑制椎板切除术后硬膜外瘢痕形成应有一定作用。通过慢病毒介导的shRNA干扰成纤维细胞中的串珠素后,其生成的Ⅰ型胶原蛋白量与对照组相比较差异有统计学意义（P〈0.05）,这说明通过抑制瘢痕成纤维细胞的串珠素表达能够有效减少Ⅰ型胶原蛋白的生成。这种方法不论从Ⅰ型胶原蛋白是瘢痕主要构成成分方面,还是Ⅰ型胶原蛋白在瘢痕生成过程中分泌胶原中占得比例增多导致机体由胎儿期的无瘢痕愈合转化至成体的瘢痕愈合这个方面来将,理论上都能够做到有效地抑制、减少硬膜外瘢痕的形成,因此通过干扰硬膜外成纤维细胞串珠素表达从而达到抑制硬膜外瘢痕的形成这一理论是可行的,为进一步进行椎板切除术后抑制硬膜外瘢痕形成的体内试验奠定了理论基础。     

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。     

针刺麻醉复合小剂量瑞芬太尼用于甲状腺良性结节消融术的临床疗效观察

目的:探讨小剂量瑞芬太尼复合针刺麻醉在甲状腺良性结节消融术中的麻醉镇痛效果。方法:选取2015年6月至2016年6月在我院进行甲状腺良性结节射频消融术的患者71例,并将其随机分为对照组(n=35)和复合麻醉组(n=36)。对照组患者接受单纯芬太尼麻醉,复合麻醉组患者接受小剂量瑞芬太尼复合针刺麻醉,观察和比较两组患者麻醉前(T0)、麻醉后(T1)、消融术中(T2)、手术结束(T3)时患者的平均动脉压(MAP)、心率(HR)、血氧饱和度(HPO_2)和VAS评分。结果:复合麻醉组患者T2和T3时间点MAP(95.00±6.09,90.86±3.23)(P0.05)、HR值(65.19±3.52,75.03±6.00)均显著低于对照组(P0.05),HPO_2水平(98.78±1.15,97.81±1.47)均显著高于对照组(P0.05),VAS评分(3.25±1.38,1.69±1.43)均显著低于对照组(P0.05)。结论:电针刺激结合小剂量瑞芬太尼复合麻醉用于甲状腺良性结节消融术可有效镇痛并维持较稳定的血压和心率,效果明显优于单纯芬太尼麻醉。     

Anesthesia of wild red howler monkeys (Alouatta seniculus) with medetomidine/ketamine and reversal by atipamezole

Wild red howler monkeys (Alouatta seniculus) were translocated during the flooding of the forest at a hydroelectric dam site in French Guiana. For a variety of minor clinical procedures, 96 monkeys were anesthetized with various intramuscular injections of combinations of medetomidine and ketamine. The howler population was composed of healthy animals (42 males and 54 females) of various ages. Medetomidine (150 μg/kg) associated with ketamine (4 mg/kg) gave the best results and was used on 63 animals. The injection rapidly resulted in complete immobilization with good to excellent myorelaxation. The induction stage was quiet, with absence of both corneal and pedal withdrawal reflexes in 57 animals after 2.9 ± 1.4 min. Six animals required an additional injection. Rectal temperature and respiratory and heart rates decreased during anesthesia, whereas relative oxyhemoglobin saturation increased. One death occurred during anesthesia. One abortion and one death also occurred the day following anesthesia but were more probably a result of capture stress. Atipamezole given i.m. at a dose of five times the medetomidine dose 38.4 ± 8.0 min after the anesthetic injection led to standing recovery in 7.1 ± 4.5 min. Spontaneous recovery occurred in 17 animals before the atipamezole injection after an average of 30.6 ± 9.6 min. Total recovery time was shorter in young animals. Medetomidine/ketamine induced good myorelaxation and provided considerably shortened immobilization duration, which are two notable advantages for field studies. We recommend this association for short procedures including minor surgery in red howler monkeys. Am. J. Primatol. 45:399–410, 1998. © 1998 Wiley-Liss, Inc.     

0.5%盐酸罗哌卡因复合芬太尼腰麻在剖宫产术中的临床应用效果

目的:探讨0.5%盐酸罗哌卡因复合芬太尼腰麻在剖宫产术中临床应用效果。方法:选取自2015年01月~2015年05月择期在我院行剖宫产的产妇70例,随机分为观察组和对照组,每组35例。对照组采用0.5%盐酸罗哌卡因进行腰麻,观察组采用0.5%盐酸罗哌卡因复合芬太尼进行腰麻。比较两组的麻醉效果及产妇麻醉指标,记录两组麻醉前后血压及心率变化,并对比两组新生儿出生后1、5、10 min的Apgar评分。结果:观察组麻醉优良率为97.14%,明显高于对照组的85.71%(P0.05)。两组麻醉后30 min血压、心率与麻醉前相比,差异具有统计学意义(P0.05),且两组间比较差异具有统计学意义(P0.05)。观察组痛觉阻滞起效时间、痛觉恢复时间、运动阻滞起效时间、运动恢复时间与对照组相比,差异具有统计学意义(P0.05);观察组新生儿出生后1、5、10min Apgar评分均明显高于对照组(P0.05)。结论:0.5%盐酸罗哌卡因复合芬太尼腰麻应用于剖宫产术,能有效提升麻醉效果,麻醉阻滞起效快,持续时间长,有利于改善新生儿结局,具有临床推广意义。     

限制性输液与充分液体复苏在感染性休克患者围手术期麻醉中的应用研究

目的:探究限制性输液与充分液体复苏在感染性休克患者围手术期麻醉中的应用,从而为患者治疗提供相关科学依据。方法:回顾性分析2007年2月至2015年6月期间因感染性休克入院接受治疗的82例患者的临床资料,按输液方式的不同分为研究组(限制性输液)与对照组(充分液体复苏)各41例,观察两组患者转归情况,记录患者心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、动脉血氧分压(PaO_2)、出血量、总输液量、尿量、术后机械通气时间及ICU住院时间。结果:术后研究组患者出现弥散性血管内凝血(DIC)5例、成人呼吸窘迫综合征(ARDS)3例,2例病情控制不佳者转为多器官功能障碍综合征(MODS),1例死亡,总发生率为26.83%;对照组患者出现DIC 8例,ARDS 7例,MODS 5例,最终出现3例死亡,总发生率为56.10%,两组患者术后转归状况比较,差异有统计学意义(P0.05);研究组患者MAP、CVP、HR、出血量、总输液量及尿量等指标低于对照组,差异有统计学意义(P0.05),研究组患者PaO_2显著高于对照组,差异有统计学意义(P0.05);研究组患者术后机械通气时间及ICU住院时间比对照组短,差异有统计学意义(P0.05)。结论:限制性输液较充分液体复苏能够显著改善感染性休克患者组织血流灌流状况,术中出血量少、术后并发症少,效果更显著,更适合在围手术期麻醉中使用。     

Computational verification of anesthesia effect on temperature variations in rabbit eyes exposed to 2.45 GHz microwave energy

This paper computationally verifies the effect of anesthesia on temperature variations in the rabbit eye due to microwave energy. The main reason for this investigation is that our previous paper suggested a reduction in blood flow due to the administration of anesthesia, resulting in an overestimated temperature increase. However, no quantitative investigation has yet been conducted. The finite-difference time-domain (FDTD) method is used for calculating power absorption and temperature variation in rabbits. For this purpose, we used a computational rabbit phantom, which is comprised of 12 tissues (including 6 eye tissues) with a resolution of 1 mm. Thermal constants of the rabbit were derived by comparing measured and calculated temperatures. For intense microwave exposure to the rabbit eye, time courses of calculated and measured temperatures were in good agreement for cases both with and without the administration of anesthesia. The point to be stressed is that under anesthesia the thermoregulatory response was inactivated and blood flow and basal metabolism was reduced.     

Solubility, adsorption, and the thermodynamics of the cutoff effect

For many years, the expression "cutoff effect of anesthesia," has been used to denote the failure of the higher alcohols or paraffins to produce anesthesia. As such, it is used to assess the plausibility of specific models, proposed for anesthesia. However, the uses were shown, in many respects, to be problematic. This article augments the notion of the cutoff to fit for all cases in which only some of the molecules in a homologous series are anesthetics. We find that the location of the cutoff points is affected by three free energy quantities: that of the adsorption of the agent to the anesthetic "site" (f(sl,site)), that of the perturbation of the site (f(ll,site)), and that of the evaporation of the agent from its pure condensed phase (Deltamu degrees (evaporation)). This outcome indicates that the cutoff cannot be attributed to a single parameter. In addition, the analyses that attribute the cutoff to the failure of compounds to obey the much-used Meyer-Overton correlation will have to be amended. This article shows that cutoff results can be used to elucidate the structure of a site.