吗啡联合有创呼吸机辅助通气治疗重症急性左心衰竭的疗效

目的:探讨吗啡联合有创呼吸机辅助通气治疗重症急性左心衰竭的临床疗效。方法:将2012年5月-2014年5月我院收治的82例重症急性左心衰竭患者随机分为观察组和对照组,各41例。两组患者均因常规药物治疗无效再行经口气管插管机械通气及对症治疗,观察组在此基础上加用吗啡静脉注射。对比两组患者的体征、症状、动血气指标及临床疗效。结果:两组治疗后血压、心率(HR)、呼吸频率(BR)、血气指标明显优于治疗前,比较差异有统计学意义(P0.05),且观察组各指标改善明显优于对照组,比较差异有统计学意义(P0.05);治疗后观察组总有效率为92.7%(38/41),高于对照组的82.9%(34/41),比较差异有统计学意义(P0.05)。结论:吗啡联合有创呼吸机辅助通气治疗重症急性左心衰竭可有效缓解患者症状,改善临床体征,临床疗效显著,值得推广。     

全凭静脉麻醉期间右美托咪定对靶控输注丙泊酚用量及血流动力学的影响

目的：探讨右关托咪定（dexmedetomidine,DEX）对行全凭静脉麻醉患者靶控输注（target controlled infusion,TCI）丙泊酚用量及拔管期间血流动力学的影响。方法：选择拟于全麻下行经鼻蝶窦垂体瘤切除术的患者30例（ASA I～II级）,随机分为两组,每组15例。试验组（D组）给予DEX负荷剂量0．5μg·kg-1,注药时间15rain,继以0．3μg·kg-1·h-1持续输注至修补硬膜时;对照纽（N组）在相同时间给予等容量生理盐水。两组麻醉诱导方法相同,术中以脑电双频指数（bispectral index,BIS）为麻醉深度监测指标,根据BIS值调节丙泊酚血浆靶浓度维持麻醉。记录拔管期间收缩压（SBP）、舒张压（DBP）和心率（HR）,并计算心肌氧耗指数（RPP）;记录丙泊酚平均用量、用药前后BIS值、呼吸恢复时间、睁眼时间、拔管时间及术中不良反应。结果：①D组给予负荷剂量后,BIS值由（95±3）降至（77±11）,差异有统计学意义（P〈0．01）。②与N组相比,D组丙泊酚用量减少28％,差异有统计学意义（P〈0．01）。⑧拔管期间SBP、DBP和HR与入室时比较,D组无明显变化,N组HR显著升高（P〈0．05）;D组拔管期间SBP、DBP、HR和RPP明显低于N组（P〈0．05）;④两组患者呼吸恢复时间、睁眼时间及拔管时间差异均无统计学意义;⑤两组不良反应（心动过缓、高血压、低血压）的发生率无显著性差异。结论：术中持续静脉输注DEX可减少TCI丙泊酚用量,能使BIS值进一步降低,产生良好镇静效应;同时可有效减轻拔管期间循环变化,降低RPP,减少心肌耗氧量,提高拔管质量。     

喉罩通气下七氟醚全凭吸入麻醉在小儿先天性心脏病介入手术的临床麻醉效果

目的:探讨喉罩通气下七氟醚全凭吸入麻醉在小儿先天性心脏病介入手术的临床麻醉效果。方法:选取2017年4月～2019年5月期间我院收治的行先天性心脏病介入手术患儿98例,根据随机数字表法将其分为对照组(n=49)和研究组(n=49)。对照组给予氯胺酮诱导,全凭丙泊酚维持,面罩吸氧;研究组给予全凭七氟醚诱导、维持,喉罩通气。比较两组患儿麻醉前(T0)、切皮前(T1)、切皮后1 min(T2)、切皮后30 min(T3)、术后(T4)的血流动力学指标[平均动脉压(MAP)、心率(HR)]及应激反应指标[血糖、皮质醇],记录两组患儿手术时间、麻醉诱导时间、术后苏醒时间等围术期指标情况。记录两组围术期不良反应发生情况。结果:研究组手术时间、麻醉诱导时间、术后苏醒时间均短于对照组(P0.05)。两组T0时间点血糖、MAP、皮质醇、HR比较差异无统计学意义(P0.05);对照组T1～T4时间点MAP、血糖、皮质醇、HR均较T0升高(P0.05);研究组T1～T4时间点血糖、MAP、皮质醇、HR与T0时间点比较无差异(P0.05);研究组T1～T4时间点血糖、MAP、皮质醇、HR低于对照组(P0.05)。两组不良反应发生率比较无差异(P0.05)。结论:小儿先天性心脏病介入手术中应用喉罩通气下七氟醚全凭吸入麻醉,诱导迅速且安全、术后苏醒快、手术时间短,可有效维持血流动力学稳定,减少应激反应。     

Responses of the teleost Hoplias malabaricus to hypoxia

Synopsis Oxygen uptake (VO₂) during graded hypoxia, rate of hypoxia acclimation, breathing frequency (f_R), breath volume (V_{S, R}) and gill ventilation (V_G) were measured in Hoplias malabaricus. Normoxia and hypoxia acclimated fish had similar and constant VO₂ and V_G in a range of water PO₂ from 150 to 25 mmHg. Hypoxia acclimated fish showed significantly higher VO₂ in severe hypoxia (PO₂ <15 mmHg). Normoxia acclimated fish showed symptoms similar to hypoxic coma after 1 h of exposure to water PO₂ of 10 mmHg whereas the same symptoms were observed only at PO₂ of 5 mmHg for fish acclimated to hypoxia. Fish required 14 days to achieve full acclimation to hypoxia (PO₂ ≥25 mmHg). Lowering of water PO₂ from 150 to 25 mmHg resulted in normoxic fish showing a 3–2 fold increase in V_G. The increase was the result of an elevation in V_{S, R} rather than f_R. Among normoxia acclimated specimens, small fish showed a higher V_G per unit weight than the large ones in both normoxia (PO₂ =150 mmHg) and hypoxia (PO₂ = 15 mmHg). A decrease in the ventilatory requirement (V_G/VO₂) with increased body weight was recorded in hypoxia (PO₂ = 15 mmHg).     

Heart rate and gill ventilation in ovigerous and non‐ovigerous edible crabs,Cancer pagurus: The effects of disturbance,substrate and starvation

This study compared the cardiac and ventilatory behaviour of disturbed and settled (48 h recovery) ovigerous Cancer pagurus with the behaviour of non‐ovigerous crabs. It also examined the effects of starvation and a sand substrate on ovigerous females. Ovigerous crabs had significantly lower heart rates than non‐ovigerous crabs. This implies that they have a reduced metabolic rate, confirmed by an earlier study which described lower rates of oxygen uptake in ovigerous crabs. Scaphognathite beat frequency was unaffected by either the presence of eggs, starvation or a sand substrate, but the amplitude of ventilatory pressure changes was higher in settled ovigerous females, implying greater force. The duration of periods of reversed ventilation was also substantially extended in ovigerous crabs, and disturbance caused a ten‐fold increase in the frequency of these reversals, resulting in ventilation being carried out in a predominantly reversed direction. It is suggested that these respiratory adaptations serve to ventilate the egg mass. Disturbance also led to a greater elevation of heart rate in ovigerous crabs, indicating that they are more prone to handling stress. Fed ovigerous crabs spent a higher percentage of time ventilating unilaterally; this response was lost following starvation. Starved ovigerous crabs had the lowest mean heart rate, highest mean ventilatory pressures and, when disturbed above a sand substrate, they showed the highest frequency of reversals of ventilation, possibly in association with their efforts to bury their abdomen bearing the egg mass.     

Functional morphology of the gills of the shortfin mako,Isurus oxyrinchus,a lamnid shark

This study examines the functional gill morphology of the shortfin mako, Isurus oxyrinchus, to determine the extent to which its gill structure is convergent with that of tunas for specializations required to increase gas exchange and withstand the forceful branchial flow induced by ram ventilation. Mako gill structure is also compared to that of the blue shark, Prionace glauca, an epipelagic species with lower metabolic requirements and a reduced dependence on fast, continuous swimming to ventilate the gills. The gill surface area of the mako is about one‐half that of a comparably sized tuna, but more than twice that of the blue shark and other nonlamnid shark species. Mako gills are also distinguished from those of other sharks by shorter diffusion distances and a more fully developed diagonal blood‐flow pattern through the gill lamellae, which is similar to that found in tunas. Although the mako lacks the filament and lamellar fusions of tunas and other ram‐ventilating teleosts, its gill filaments are stiffened by the elasmobranch interbranchial septum, and the lamellae appear to be stabilized by one to two vascular sacs that protrude from the lamellar surface and abut sacs of adjacent lamellae. Vasoactive agents and changes in vascular pressure potentially influence sac size, consequently effecting lamellar rigidity and both the volume and speed of water through the interlamellar channels. However, vascular sacs also occur in the blue shark, and no other structural elements of the mako gill appear specialized for ram ventilation. Rather, the basic elasmobranch gill design and pattern of branchial circulation are both conserved. Despite specializations that increase mako gill area and efficacy relative to other sharks, the basic features of the elasmobranch gill design appear to have limited selection for a larger gill surface area, and this may ultimately constrain mako aerobic performance in comparison to tunas. J. Morphol. 271:937–948, 2010. © 2010 Wiley‐Liss, Inc.     

One-lung ventilation patients: Clinical context of administration of different doses of dexmedetomidine

BackgroundOpen and endoscopic thoracic surgeries improve surgical exposure by One-lung ventilation (OLV). The aim of this study was to investigate the effects of different doses of dexmedetomidine on inflammatory response, oxidative stress, cerebral tissue oxygen saturation (SctO2) and intrapulmonary shunt in patients undergoing one-lung ventilation (OLV).MethodsSeventy-five patients undergoing open pulmonary lobectomy in our hospital from January 2016 to December 2017 were enrolled and randomly divided into high-dose dexmedetomidine group (group D1, 1 mg/kg, n=25), low-dose dexmedetomidine group (group D2, 0.5 mg/kg, n=25) and control group (group C, n=25). Then, arterial blood and internal jugular venous blood were taken before anesthesia induction (T0) and at 15 min after twolung ventilation (T1) and 5 min (T2) and 30 min (T3) after OLV for later use. Next, the changes in hemodynamic parameters [mean arterial pressure (MAP), heart rate (HR) and pulse oxygen saturation (SpO2)] of patients were observed in each group. Enzyme-linked immunosorbent assay (ELISA) was carried out to detect serum inflammatory factors such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) and oxidative stress indicators [superoxide dismutase (SOD) and malondialdehyde (MDA)]. The changes in SctO2, arterial partial pressure of oxygen (PaO2) and intrapulmonary shunt Qs/Qt (a measurement of pulmonary shunt: right-to-left shunt fraction) were observed. Additionally, the changes in lung function indicators like lung dynamic compliance (Cdyn) and airway peak pressure (P_peak) were determined.ResultsThere were no statistically significant differences in the MAP, HR and SpO2 among three groups at each observation time point (P>0.05). At T2 and T3, the levels of serum IL-6, TNF-α and IL-8 were obviously decreased in group D1 and D2 compared with those in group C (P<0.05), and the decreases in group D1 were overtly larger than those in group D2, and the decreases at T3 were markedly greater than those at T2 (P<0.05). In comparison with group C, group D1 and D2 had notably reduced levels of serum reactive oxygen species (ROS) and MDA (P<0.05) and remarkably increased SOD content (P<0.05) at T2 and T3, and the effects were markedly better in group D1 than those in group D2. Besides, they were significantly superior at T3 to those at T2 (P<0.05). The SctO2 in group D1 and D2 was evidently lowered at T2 and T3 compared with that at T0, and the decrease in group D1 was distinctly smaller than that in group D2 (P<0.05). The Qs/Qt was significantly lower in group D1 and D2 than that in group C at T2 and T3 (P<0.05), while the PaO2 content was notably raised (P<0.05), and the decrease and increase were significantly larger in group D1 than those in group D2, and they were obviously greater at T3 to those at T2 (P<0.05). At T0 and T1, no significant differences were detected in the Cdyn, Pplat and Ppeak among three groups. At T2 and T3, the Cdyn was significantly elevated, while the Pplat and Ppeak overtly declined (P<0.05), and group D1 had greater changes in comparison with group D2, and the changes were obviously more evident at T3 to those at T2 (P<0.05).ConclusionsDexmedetomidine effectively ameliorates inflammatory response and oxidative stress, lowers oxygenation, Qs/Qt and the decrease in SctO2 and improves lung function during OLV, with good efficacy.     

Dissociation of Intracellular Ca Release and Ca Entry Response to 5-Hydroxytryptamine in Cultured Canine Tracheal Smooth Muscle Cells

The relationship between the agonist-sensitive Ca²⁺ pool and those discharged by the Ca²⁺-ATPase inhibitor thapsigargin (TG) were investigated in canine tracheal smooth muscle cells (TSMCs). In fura-2-loaded TSMCs, 5-hydroxytryptamine (5-HT) stimulated a rapid increase in intracellular Ca²⁺ ([Ca²⁺]_i), followed by a sustained plateau phase that was dependent on extracellular Ca²⁺. In such cells, TG produced a concentration-dependent increase in [Ca²⁺]_i, which remained elevated over basal level for several minutes and was substantially attenuated in the absence of extracellular Ca²⁺. Application of 5-HT after TG demonstrated that the TG-sensitive compartment partly overlapped the 5-HT-sensitive stores. Pre-treatment of TSMCs with TG significantly inhibited the increase in [Ca²⁺]_i induced by 5-HT in a time-dependent manner. Similar results were obtained with two other Ca²⁺-ATPase inhibitors, cyclopiazonic acid and 2,5-di-t-butylhydroquinone. Although these inhibitors had no effect on phosphoinositide hydrolysis, Ca²⁺-influx was stimulated by these agents. These results suggest that depletion of the agonist-sensitive Ca²⁺ stores is sufficient for activation of Ca²⁺ influx. Some characteristics of the Ca²⁺-influx activated by depletion of internal Ca²⁺ stores were compared with those of the agonist-activated pathway. 5-HT-stimulated Ca²⁺ influx was inhibited by La³⁺, membrane depolarisation, and the novel Ca²⁺-influx blocker 1-{β-[3-(4-methoxyphenyl) propoxy]-4-methoxyphenethyl}-1H-imidazole hydrochloride (SKF96365). Likewise, activation of Ca²⁺ influx by TG also was blocked by La³⁺, membrane depolarisation, and SKF96365. These results suggest that (1) in the absence of PI hydrolysis, depletion of the agonist-sensitive internal Ca²⁺ stores in TSMCs is sufficient for activation of Ca²⁺ influx, and (2) the agonist-activated Ca²⁺ influx pathway and the influx pathway activated by depletion of the inositol 1,4,5-trisphosphate-sensitive Ca²⁺ pool are indistinguishable.     

Coupling of M3 Acetylcholine Receptor to Gq16 Activates a Natriuretic Peptide Receptor Guanylyl Cyclase

Muscarinic activation of tracheal smooth muscle (TSM) involves a M₃AChR/heterotrimeric-G protein/NPR-GC coupling mechanism. G protein activators Mastoparan (MAS) and Mastoparan-7 stimulated 4- and 10-fold the NPR-GC respectively, being insensitive to PTX and antibodies against Gα_i/o subfamily. Muscarinic and MAS stimulation of NPR-GC was blocked by antibodies against C-terminal of Gα_q16, whose expression was confirmed by RT-PCR. However, synthetic peptides from C-terminal of Gα_q15/16 stimulated the NPR-GC. Coupling of α_q16 to M₃AChR is supported by MAS decreased [³H]QNB binding, being abolished after M₃AChR-4-DAMP-alkylation. Anti-i₃M₃AChR antibodies blocked the muscarinic activation of NPR-GC, and synthetic peptide from i₃M₃AChR (M₃P) was more potent than MAS increasing GTPγ [³⁵S] and decreasing the [³H]QNB activities. Coupling between NPR-GC and Gα_q16 was evaluated by using trypsin-solubilized-fraction from TSM membranes, which displayed a MAS-sensitive-NPR-GC activity, being immunoprecipitated with anti-Gα_q16, also showing an immunoreactive heterotrimeric-G-β -subunit. These data support the existence of a novel transducing cascade, involving Gα_q16β γ coupling M₃AChR to NPR-GC.     

双歧杆菌四联活菌片联合肠内营养在机械通气患者中的应用

目的观察双歧杆菌四联活菌片联合肠内营养(EN)对机械通气患者营养状况及免疫调节的影响。方法选择我院98例行机械通气的患者为研究对象,随机分为治疗组和对照组,每组49例。对照组给予EN治疗,治疗组在EN治疗基础上加用双歧杆菌四联活菌片治疗,1.5 g/次,3次/d。比较两组患者治疗前后血红白蛋白(Hb)、白蛋白(Alb)、前白蛋白(PAB)、外周血T淋巴细胞数、免疫球蛋白水平及机械通气时间、ICU住院时间。结果治疗后,两组患者Hb、Alb、PAB、CD3~+、CD4~+、CD8~+、CD4~+/CD8~+、IgG、IgA、IgM水平均有所上升。与对照组相比,治疗组患者Hb、Alb、TP、CD3~+、CD4~+、CD4~+/CD8~+、IgG、IgA、IgM水平均显著升高,差异均有统计学意义(均P0.05)。治疗组患者机械通气时间[(4.6±1.2)d]、ICU住院时间[(11.3±4.8)d]均短于对照组,差异有统计学意义(均P0.05)。结论双歧杆菌四联活菌片能够改善机械通气患者的营养状况,同时改善患者免疫功能,缩短患者机械通气时间及ICU住院时间。