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中华麻醉学杂志

中华麻醉学杂志

北大核心

CSCD

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Chinese Journal of Anesthesiology
1981年3月创刊，中华医学会主办。本刊是反映了我国麻醉学临床、科研发展的水平，促进了国内外麻醉学科的学术交流，引导着我国麻醉学的发展方向；杂志发行世界104个国家，编委会中有美国、加拿大、新加坡、台湾地区、香港地区的国际知名专家加盟，被《化学文摘》等国际检索系统收录，且荣登《化学文摘》千刊表；首批获准加入WHO西太平洋地区医学索引。曾荣获 “百种中国杰出学术期刊”及“中国精品科技期刊”称号。
  • 发文量：8422
  • 被引量：3492
  • H指数：3
  • 开始收录时间：1989,9(1)
  • CNKI综合因子：0.688
  • 维普期刊影响因子： 1.56
  • 万方期刊影响因子：1.18
  • 创刊时间：1981
  • 国内刊号/CN：13-1073/R
    国际刊号/ISSN：0254-1416
  • 发行周期：月刊
    邮发代号：18-49
  • 主管单位：中国科学技术协会
    主办单位：中华医学会
中华麻醉学杂志-联系信息
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  • 电话：0311-85989621
  • 邮箱：cja@vip.163.com
  • 地址：石家庄市和平西路299号
  • 邮编：050071
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中华麻醉学杂志 >2021年第23期

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  • 摘要：带状疱疹是由潜伏于脊髓背根神经节（DRG）的水痘一带状疱疹病毒引起的一种疼痛性皮肤疾病，带状疱疹后神经痛（PHN）是其常见的后遗症。PHN与病毒侵犯脊髓DRG、引起神经组织炎性水肿、出血甚至坏死、神经纤维粘连及瘢痕形成等有关，为感受性疼痛。于外周感觉神经干内注射阿霉素，利用其逆行性轴突运输和对感觉神经元的破坏作用，毁损DRG可缓解PHN。本研究拟评价椎旁注射阿霉素毁损DGR对PHN患者的疗效，为临床提供参考。
  • 摘要：Objective To compare the efficacy of ropivacaine and bupivacaine for spinal anesthesia in patients undergoing unilateral lower limb surgery.Methods This was a prospective,muhicenter,randomized,double-blind clinical trial.Two hundred and eighteen patients of both sexes,ASA Ⅰ orⅡ,aged 18-64 yr,with body mags index 18-24 kg/m2,scheduled for unilateral lower limb surgery,were mdornly divided into 2 groups:group R(n=110)received intrathecaUy 3.5 ml of ropivacaine 5 mg/ml and group B(n=108)received intrathecally 2.5 ml of bupivacaine 5 mg/ml.The degree of motor block for the nonoperative lower limb was assessed by modified Bromage scale,and the onset time and duration were recorded.The degree of sensory block was assessed with pin prick test,and the onset time and duration were recorded.The quality of anesthesia and degree of muscle relaxation during operation were assessed and the adverse efrects were also recorded.Resets The onset time of motor block was significantly longer and the duration of motor and sensory block Wflfl significantly shorter in group R than in group B(P＜0.05 or 0.01),and there wag no significant difference in the onset time of sensory block(P＞0.05).There Wag no significant difference in the effective rate of motor and sensory block between both groups(P＞0.05).The quality of anesthesia and degree of muscle relaxation were good in both groups and there was no significant difference in the quality of anesthesia between both groups(P＞0.05),and the degree of muscle relaxation was significantly better in group R than in group B(P＜0.05).The incidence of adverse effects was lower in both groups without significant difference between them(P＞0.05).Conclusion The quality of anesthesia and degree of muscle relaxation are good during operation in patients undergoing.unilateral lower limb surgery when the spinal anesthesia is performed with ropivacaine.The duration of motor block of ropivacaine is shofler than that of bupivacaine,which is beneficial to post-operative recovery,so the clinical efficacy has more superiority.%目的 比较单侧下肢手术患者罗哌卡因和布比卡因蛛网膜下腔阻滞的效果.方法 本试验为前瞻性、多中心、随机、双盲的临床研究.拟行单侧下肢手术患者218例,ASA Ⅰ或Ⅱ级,年龄18～64岁,体重指数18～24 kg/m2,性别不限.随机分为2组,R组(n=110)蛛网膜下腔注射5 ms/ml罗哌卡因3.5 ml;B组(n=108)蛛网膜下腔注射5 mg/ml布比卡因2.5 ml.采用改良的Bromage评分法评估非术侧下肢的运动阻滞效果,记录起效时间和维持时间;采用针刺法评估感觉阻滞效果,记录起效时间和维持时间;评估术中麻醉质量与肌松效果;记录不良反应的发生情况.结果 与B组比较,R组运动阻滞起效时间延长,运动阻滞和感觉阻滞维持时间缩短(P＜0.05或0.01),感觉阻滞起效时间差异无统计学意义(P＞0.05);两组运动阻滞和感觉阻滞有效率差异无统计学意义(P＞0.05);两组麻醉质量和肌松效果均较好,麻醉质量比较差异无统计学意义(P＞0.05),R组肌松效果优于B组(P＜0.05);两组不良事件发生率均较低,且差异无统计学意义(P＞0.05).结论 下肢手术患者采用罗哌卡因蛛网膜下腔阻滞时,术中麻醉质量及肌松效果良好,且其运动阻滞维持时间较布比卡因短,有利于术后的恢复,其临床效果更具优越性.
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  • 摘要：患者，男性，58岁，身高165cm，体重75k，全身多发性肿块17年，面颊、枕部、颈部、胸部及双侧肩部、上臂、腋窝、腹股沟多发性巨大脂肪团块，质硬，活动度差；颈部大量脂肪块环状堆积致不能前屈及后仰；气管、甲状软骨无法扪及，甲颏间距、胸颏间距及下颌骨水平长度无法测量；上胸部、肩部、双上肢浅表静脉曲张，见图1；张口Ⅲ度，MalampaliⅣ级，AsAⅡ级，NYHAⅠ级，困难气道，诊断为Madelung病。EcG示左前分支传导阻滞；X光胸片示双侧中上纵隔增宽，侧位见胸廓及胸廓外软组织影，T2,3，平面可见气管狭窄，见图2；CT示脊柱生理弯曲消失，颈部及胸壁增多脂肪影、肌束萎缩，咽喉壁、气管周围、前中纵隔脂肪增多，气管中段受压致狭窄，最狭窄处左右径约7．8mm，狭窄长度约3．6cm，
  • 摘要：目的 探讨械牵张对肺泡上皮腺癌细胞A549(A549细胞)穿透素-3(PTX-3)表达的影响.方法 体外培养人A549细胞,将A549细胞接种于包被胶原基底膜的培养板上,待细胞贴壁并融合50%后,随机分为正常对照组(Ⅰ组)、假机械牵张组(Ⅱ组)、机械牵张组(Ⅲ组)、siRNA对照组(Ⅳ组)和siRNA+机械牵张组(V组).Ⅳ组仅转染PTX-3 siRNA;Ⅴ组转染PTX-3 siRNA后24 h,进行周期性机械牵张4 h.机械牵张结束后24 h时测定PTX-3 mRNA、PTX-3蛋白水平及细胞凋亡情况.结果 与Ⅰ组和Ⅱ组比较,Ⅲ组PTX-3 mRNA和PIX-3蛋白水平上调,Ⅳ组和Ⅴ组上述两指标下调(P＜0.05或0.01);与Ⅲ组比较,Ⅴ组上述两指标下调(P＜0.01).Ⅲ组和Ⅴ组细胞凋亡率高于Ⅱ组(P＜0.01);Ⅴ组细胞凋亡率低于Ⅲ组(P＜0.01).结论 机械牵张可上调A549细胞PTX-3 mRNA表达.%Objective To evaluate the effects of mechanical stretch on pentraxin-3(PTX-3)mRNA and protein expression in human alveolar epithelial cells (A549 cells).Methods The human lung epithelial adenocarcinoma cells A549(A549 cells)were purchased from cell biology laboratory,Tongji Medical College,Huazhong University of Science and Technology.The cultured A549 cells were inoculated on collagen Ⅰ BioFlex plates and divided into 5 groups(n=3 wells each):group Ⅰ normal control;groupⅡsham mechanical stretch;group Ⅲ mechanical stretch;groupⅣsiRNA and groupⅤ siRNA+mechanical stretch.In group Ⅲ the cells underwent square cyclic mechanical stretch for 4 h using the Flexercell Systcm.In group Ⅳ the cells were transfected with chemosynthetic PTX-3 specific siRNA by RNAi technique.In group Ⅴ at 24 h after being transfected with PTX-3 siRNA the cells underwent mechanical stretch for 4 h.In groupⅡ mechanical stretch of the cells were prevented by Flexstep.The expression of PTX-3 mRNA in the cells was detected by real-time PCR and the expression of PTX-3 protein in the culture media was determined by Western blotting.Apoptosis of the cells was measured bv flow cytometry(Beeten-Dickinson,USA).Results PTX-3 mRNA and protein expression was signlficantly up-regulated by mechanical stretch in groupⅢand decreased by transfection with siRNA in group Ⅳand Ⅴ as compared with group Ⅰ andⅡ(P＜0.05 or 0.01).The apoptosis ratio was significantly higher in group Ⅲ and Ⅴ than in groupⅡ and was significantly lower in group Ⅴ thanin group Ⅲ(P＜0.01).Conclusion Mechanical stretch can up-regulate PTX-3 mRNA expression in A549 cells.
  • 摘要：Objective To investigate the effects of hypercapnia preconditioning on anoxia/reoxygenation (A/R)-induced injury to endothelial cells of human umbilical vein.Methods Cuhured endothelial cells of human umbilical vein purchased from the cell bank of Central South University Xiangya Medical College were incubated in 16 well culture plates and randomly divided into 6 groups(n=16 each):group Ⅰ control(C);groupⅡA/R;group Ⅲ anoxia preconditioning(APC);groupⅣ,Ⅴ,Ⅵ 10,30 and 60 min 30%CO2 preconditioning (HCA1,2,3).In group MR the endothehal cells were exposed to 95%N2-5%CO2 in an air-tight incubator at 37℃for 4 h followed by 24 h reoxygenation(75%N2-20%02-5%CO2 at 37℃).In group APC the endothehal cells were exposed to 10 min anoxia twice at 10 rain interval before MR.In group HCA1,2,3 the endothelial cells were exposed to 30%CO2 for 10,30 and 60 min respectively before A/R.At the end of 24 h reoxygenation the cell vitality(by MTT)and the ICAM-1 expression(by immuno-histochemistry)were meagnred.Results The cell vitality of the endothelial ceils was significantly decreased while ICAM-1 expression was up-regulated in group A/R (Ⅱ),APC(Ⅲ)and HCA1-3(Ⅳ,Ⅴ,Ⅵ)compared with group C(P＜0.05).The cell vitality of endothelial cells was significandy increased in group APC(Ⅲ)and group HCA2(Ⅴ)and ICAM-1 expression was downregulated in group APC(Ⅲ)and group HCA1,2(Ⅳ,Ⅴ)compared with group A/R(Ⅱ).Conclusion Hypercapnia preconditioning can ameliorate the MR injury to endothelial cells of human umbilical vein.%目的 探讨高浓度二氧化碳(CO2)预处理对人脐静脉内皮细胞缺氧复氧损伤的影响.方法 人脐静脉内皮细胞接种于细胞培养板,随机分为6组,每组16孔,对照组(C组)常规培养;缺氧复氧组(MR组)缺氧4 h、复氧24 h;缺氧预处理组(APC组)缺氧10 min、复氧10 min,重复2次后缺氧4 h、复氧24 h;HCA.组、HCA2组和HCA3组分别于50%N-20%02-30%CO2培养箱中行30%CO2预处理10、30、60 min后常规培养10、20、30 min,缺氧4 h、复氧24 h.于复氧24 h时采用MTY法测定人脐静脉内皮细胞活力,采用免疫细胞化学法测定细胞间粘附分子-1(ICAM-1)表达水平.结果 与C组比较,MR组、APC组、HCA1～3组人脐静脉内皮细胞活力降低,ICAM-1表达上调(P＜0.05);与A/R组比较,APC组和HCA2组人脐静脉内皮细胞活力升高,APC组及HCA1,2组ICAM-1表达下调(P＜0.05).结论 高浓度CO2预处理可减轻人脐静脉内皮细胞缺氧复氧损伤.
  • 摘要：目的 探讨舒芬太尼、瑞芬太尼或芬太尼对食管癌根治术病人细胞免疫功能的影响.方法 择期行食管中、下段癌根治术病人45例,ASA Ⅰ或Ⅱ级,年龄45～64岁.随机分为3组(n=15):舒芬太尼组(SF组)、瑞芬太尼组(RF组)和芬太尼组(F组).麻醉诱导:靶控输注异丙酚,血浆靶浓度3μg/ml,三组分别靶控输注舒芬太尼(血浆靶浓度为0.5 ng/ml)、瑞芬太尼(血浆靶浓度为5 ng/ml)或芬太尼(血浆靶浓度为5 ng/ml),待BIS＜60时,静脉注射维库溴铵0.1 mg/kg,3 min后行双腔支气管插管,机械通气.麻醉维持:舒芬太尼、瑞芬太尼或芬太尼血浆靶浓度维持不变,停止输注异丙酚,持续吸入七氟醚0.7～1.5 MAC,按需间断静脉注射维库溴铵0.04 mg/kg.分别于麻醉诱导前(基础状态)、切皮后60min(T1)、术毕(T2)、术后24 h(T3)、72 h(T4)时采集肘静脉血样,检测CD3+、CD4+、CD8+及CD3- CD16+CD56+的百分率,计算CD4/CD8+,并检测血清白细胞介素-2(IL-2)和IL-10浓度.结果 与基础值比较,T2时三组CD4+百分率和CD4+/CD8+降低,CD3- CD16+CD56+百分率升高,SF组和RF组CD3+百分率降低,F组CD8+百分率升高,T3时三组CD3+和CIM+的百分率降低,RF组和F组血清IL-2浓度降低,T4时F组CD3+百分率和血清IL-2浓度降低,RF组和F组血清IL-10浓度升高(P＜0.05或0.01);与RF组比较,F组CD3+百分率升高,SF组血清IL-2浓度升高,血清IL-10浓度降低(P＜0.05).结论 舒芬太尼、瑞芬太尼或芬太尼均可抑制食管癌根治术病人的细胞免疫功能.%Objective To investigate the effects of sufentanil,remifentanil and fentanyl oH cellular immune function in patients undergoing radical resection of esophageal cancer.Methods Forty-five ASA Ⅰ or Ⅱpatients aged 45-64 yr undergoing radical resection of esophageal cancer were randomly divided into 3 groups(n=15 each):sufentanil group(SF);remifentanil group(RF)and fentanyl group(F).The patients were premedicated with iv atropine 0.5 mg.Anesthesia was induced with midazolam 0.04 mg/kg,propofol TCI(CT=3μg/ml)and TCI of sufentanil,remifentanil or fentanyl(CT=0.5,5 and 5 ng,ml respectively in the 3 groups).Endobronchial intubation was facilitated with vecuronium 0.1 mg/kg.The patients were mechanically ventilated.PETCO2 was maintained at 30-40 mm Hg.Anesthesia was maintained with inhalation of sevoflurane(0.7-1.5 MAC)and TCI of sufentanil,remifentanil or fentanyl(CT=0.5,5 and 5 ng/ml respectively).Venous blood samples were taken from peripheral vein before anesthesia(T0,baseline),60 min after skin incision(T1),immediately(T2),24 h(T3)and 72 h(T4)after the end of operation for determination of the expression of CD3+,CIM+,CD8+on T cells and CD3-CD16+CD56+on natural killer cells by flow cytometry,CD4+/CD8+ratio,serum concentrations of IL-2 and IL-10 by ELISA.Results Compared with the baseline values,the CD4+T-lymphocytes and CIM+/CD8+ratio were significantly decreased at T2,while the CD3-CD16+CD56+NK cells were significantly increased in all 3 groups.The CD3+T-lymphocytes were significantly decreased at T2 as compared to the baseline value at T0 in SF and RF groups.The CIM+and CD3+T-lymphocytes were significantly decreased at T3 as compared with the baseline value in all 3 groups.Serum IL-2 concentration was significantly higher at T3 in SF group than in RF group.Serum IL-10 concentration was sismficantly higher at T4 in RF group than in SF group.Conclusion Sufentanil,remifentanil and fentanyl can depress cenular immune function to some extent in patients undergoing radical resection of esophageal cancer.
  • 摘要：Objective To investigate the effects of different target plasma concentration(CT)of propofol adminislered by target controlled infusion(TCI)on mimmum alveolar concentration(MAC)of sevoflurane.Methods Adult patients aged 20-50 yr weighing 40-76 kg,classified as ASA Ⅰ or Ⅱ,undergoing elective abdominal surgery were randomly divided into 5 groups:P0,P1,P2,P3 and P4.Anesthesia was induced with 8% sevoflurane and intravenous remifentnil 1μg/kg and succinylcholine 1 mg/kg in all patients.After tracheal intubation the patients received propofol TCI.CT was set at 0,1,2,3,4 μg/ml in group P0,P1,P2,P3,P4 respectively.The first patient received sevofluranc at end-tidal concentration of3.0%,2.2%,2.0%,1.8%and 1.5%in group P0,P1,P2,P3 and P4 respectively.After at least 15 min of equilibration and when neuromuscular function returned to T4/T1≥0.7,skin incision was made.According to the patient's somatic responses,the end-tidal concentration of sevofhlrane was increased/decreased by 0.2%in the next patient.At least six independent crossover pairs were observed in each group.MAC of sevoflurane was determined.The interaction between sevoflurane and propofol was analyzed using linear regression and correlation analysis.Results The MAC of sevoflurane was 2.17%4-0.11%in group P0,1.90%±0.10%in group P1,1.47%4-0.19%in group P2,1.37%±0.13%in group P3 and 1.00%±0.10%in group P4 respectively.With increasing CT of propofol from group P1 to group P4,MAC of sevoflurane was decreasing.The linear regression equation of the interaction between sevoflurane and propofol was Y=2.17-0.212X,r=-0.946 9(P＜0.05).Conclusion With increasing CT of propofol from group P1 to group P4,the MAC of sevotlurane decreases by 12%,32%,37%and 54%respectively.Propofol and sevoflurane interact in an additive manner to produce immobility during skin incision.%目的 评价不同靶浓度异丙酚对七氟醚MAC的影响.方法 择期全麻下行腹部手术的病人,年龄20～50岁,ASA Ⅰ或Ⅱ级,随机分为5组,P0组、P2组、P3组、P4组和P4组均吸入8%七氟醚麻醉诱导,意识消失后静脉注射琥珀胆碱1 mg/kg和瑞芬太尼1 μg/kg.气管插管后行机械通气,P1组、P2组、P3组和P4组靶控输注异丙酚,血浆靶浓度分别为1、2、3、4 tμg/ml,P0组、P1组、P2组、P3组和P4组第1例病人七氟醚呼气末浓度分别为3.0%、2.2%、2.0%、1.8%和1.5%,当七氟醚呼气末浓度平衡15 min以上且神经肌肉功能恢复后开始切皮,根据是否发生切皮反应,采用up-down方法确定下一例病人的七氟醚呼气末浓度,每组出现6个交叉点后终止研究,以6个交叉点病人七氟醚呼气末浓度的均数为MAC.七氟醚MAC与异丙酚血浆靶浓度间分别进行直线回归和等级相关分析.结果 Pn组～P4组七氟醚MAC分别为2.17 4-0.11%、1.90%±0.10%、1.47%±0.19%、1.37%±0.13%和1.00%±0.10%;与P0组相比,P1组～P4组七氟醚MAC均降低,且呈浓度依赖性(P＜0.05).七氟醚MAC(Y)与异丙酚血浆靶浓度(X)间的直线回归方程为Y=2.17-0.212 X,相关系数为-0.946 9(P＜0.05).结论 异丙酚血浆靶浓度1～4 μg/ml可使七氟醚MAC分别降低12%、32%、37%和54%,两者以相加作用的方式抑制切皮反应.
  • 摘要：Objective To investigate the effects of multiple doses of propefol on long-term cognitive function in neonatal rats.Methods Twenty-four 7-day old SD rats weighing 12-16 g were randomly divided into 3 groups(n=8 each):group Ⅰ control(C)received intraperitoneal(IP)normal saline(NS)7.5 ml/kg once a day × 7 days:groupⅡ propofol 1(P1)received NS 7.5 ml/kg IP once a day×6 days+propofol 75 mg/kg IP on the 7 th day and group Ⅲ propofol 2(P2)received propefol 75 mg/kg IP once a day × 7 days.Learning and memory function were assessed using Morris water maze when the rats were 4 weeks old.The animals were decapitated immediately after the tests.The cortex and hippocampus were isolated for determination of aspartate (Asp),glutamic acid(Glu),glycine(Gly)and γ-aminobutyric acid(GABA)contents using high performance liquid chromatography(HPLC).Results Long-term learning and memory function significantly declined in group P2 as compared with group C and P1.The content of Asp in hippocampus and the Glu content and Glu/GABA ratio in cortex and hippocampus were significantly lower in group P2 than in group C and P1.There was no significant difference in Gly and GABA content in cortex and hippocampus among the 3 groups.Conclusion Multiple doses of propefol decreases long-term cognitive function by decreasing the levels of excitatory amino acid transmitters in the brain in neonatal rats.%目的 探讨反复注射异丙酚对新生大鼠认知功能的影响.方法 清洁级SD大鼠24只,7 d龄,12～16 g,雌雄各半,随机分为3组(n=8):对照组(C组)腹腔注射生理盐水7.5 ml/kg,1次/d,连续7 d;单次注射异丙酚组(P1组)腹腔注射生理盐水7.5 ml/kg,1次/d,连续6 d,第7天腹腔注射异丙酚75 mg/kg;反复注射异丙酚组(P2组)腹腔注射异丙酚75 mg/kg,1次/d,连续7 d.异丙酚给药结束后2周时采用水迷宫实验测试学习记忆功能,然后断头处死大鼠,取脑组织,采用高效液相色谱法测定皮层和海马谷氨酸、天冬氨酸、甘氨酸和7.氨基丁酸的含量.结果 与C组和P1组比较,P2组认知功能下降,海马天冬氨酸含量降低,皮层和海马谷氨酸含量降低,谷氨酸/γ-氨基丁酸比值下降(P＜0.05),皮层和海马甘氨酸和γ-氨基丁酸含量差异无统计学意义(P＞0.05).结论 反复注射异丙酚可导致新生大鼠远期认知功能减退,可能与脑内兴奋性氨基酸递质含量的降低有关.
  • 摘要：Objective To evaluate the accuracy of spectral entropy including response entropy(RE)and state entropy(SE)as a new electroencephalographic measure of depth of sedation during general anesthesia.Methods Twenty ASA Ⅰ or Ⅱ patients aged 20-55 yr undergoing elective abdominal surgery were studied.Anesthesia Was induced with intravenous propofol,fentanyl and vecuronium.After tracheal intubation anesthesia was maintained with sevoflurane inhalation and intermittent iv boluses of fentanyl and vecuronium.BP,HR,SpO2,spectral entropy(Datex-Ohmeda)and BIS(Aspect Medical)were monitored during anesthesia.Loss of eyelash reflex and unresponsiveness to verbal stimulus and mild prodding and shaking were considered to be signs of loss of consciousness(LOC).The time of regaining consciousness Was defined as the time when patients started responding to verbal commands.RE,SE and BIS were recorded before anesthesia(baseline),10 min before LOC,immediately after LOC,immediately after tracbeal intubation,1 h after skin incision,10 min before regaining consciousness immediately after consciousness was regained and 10 min after extubation.Results There were sisnificant changes in RE,SE and BIS during the transition from consciousness to LOC.The RE,SE and BIS values for LOC were 76,73 and 68 with sensitivity of 94%,95%and 92%and specificity of 92%,94%and 91%respectively.The accuracy of RE.SE and BIS in predicting LOC was 93%,95%and 94%respectively.The RE,SE and BIS values for regaining consciousness were 82,75 and 70 with sensitivity of 95%,95%and 91%and specificity of 93%,96%and 93%respectively.The accuracy in predicting regaining of consciousness was 98%,96%and 97%respectively.Conclusion Entropy index Can accurately monitor level of sedation during general anesthesia.%目的 评价反应熵和状态熵监测全麻患者镇静水平的准确性.方法 择期行腹部手术患者20例,ASAⅠ或Ⅱ级,入室后监测反应熵(RE)、状态熵(SE)及脑电双频谱指数(BIS),静脉注射异丙酚、维库溴铵和芬太尼麻醉诱导,气管插管后机械通气,吸入七氟烷、间断静脉注射维库溴铵和芬太尼维持麻醉.分别于入室时、意识消失前10min、意识消失即刻、气管插管时、手术1 h、意识恢复前10 min、意识恢复即刻、拔管后10 min时记录RE、SE和BIS.结果 RE、SE和BIS在意识改变前后差异均有统计学意义(P＜0.05),RE、SE和BIS判断意识消失的临界值分别为76、73和68,灵敏度分别为94%、95%和92%,特异度分别为92%、94%和9l%,临界值判断意识消失的准确度分别为93%、95%、94%;判断意识恢复的临界值分别为82、75和70,灵敏度分别为95%、95%和91%,特异度分别为93%、96%和93%,临界值判断意识恢复的准确度分别为98%、96%和97%.结论 熵指数能够准确地监测全麻患者镇静水平.
  • 摘要：小儿气道一食管双管喉罩（PLMA）在小儿麻醉中的应用范围日益广泛，尽管向套囊内注气应遵循以最少的气体获得有效密闭的原则，但在临床上如何决定充气量或套囊内压的问题有待进一步探讨。本研究按体重选择适宜型号的PLMA，通过观察小儿套囊不同时压力正压通气的效果，选择适宜的套囊压力。
  • 摘要：Objective To investigate the effects of transcutaneous electrical stimulation of acupuncture points(TEAS)on the target effect-site concentration(CT)of propofol and amount of fentanyl consumed in patients undergoing general anesthesia.Methods Forty ASA Ⅰor Ⅱ patients aged 38-64 yr weighing 50-90 kg undergoing upper abdominal surgery under general anesthesia were randomly divided into 2 groups(n=20 each):group Ⅰpropofol(P)and group Ⅱ TEAS+pmpofol(EP).The patients were predemicated with intramuscular phenobarbital 0.1 g and scopolamine 0.3 mg.Anesthesia was induced with midazolam 0.03 mg/kg.fentanyl 1.5 μg/kg and TCI of propofol(the initial CT=2.5 μg/ml).As soon as the patients lost consciousness,vecuronium 0.12 mg/kg was given iv.The patients were mechanically ventilated after tracheal intubation.PET CO2 was maintained at 30-35 mm Hg.Anesthesia was maintained with TCI of propofol and intermittent iv boluses of fentanyl and vecuronium.CT of propofol was adjusted to maintain BIS at 45-55 during operation.In EP group transcutaneons electrical stimulation of bilateral Neiguan and Zusardi points was performed at 30 min before induction of general anesthesia and maintained until the end of surgery with alternative stimulation at frequency of 2 Hz and 100 Hz and intensity of 8-12 mA.HR and MAP were recorded before induction of anesthesia(To,baseline),before(T1)and after tracheal intubation(T2),before(T3)and after skin incision(T4),during surgical exploration(T5)and at the end of operation(T6).The CT of propofol and amount of fontanyl consumed were also recorded at T1-6.Blood samples were taken at 30 min of TEAS before induction of anesthesia and at T4-6 for determination of serum concentrations of angiotensin Ⅱ and cortisol by radioimmuno assay.ResultsCT of propofol and the amount of fentanyl consumed were significantly lower in group EP than in group P(P＜0.01).There were no significant differences in the serum concentrations of angiotensinⅡand cortisol at all time points between the 2 groups.Compared with the baseline values the sernm concentrations of angiotensin Ⅱ and contisol were significantly decreased at 30 min of TEAS in group EP and were significantly increased at T5 in group P.Conclusion TEAS can reduce propofol CT and amou~of fentanyl consumed during general anesthesia.%目的 探讨经皮穴位电刺激对全麻患者异丙酚效应室靶浓度和芬太尼用量的影响.方法 择期全麻下行上腹部手术患者40例,随机分为2组(n=20),异丙酚复合全麻组(P组),穴位电刺激+异丙酚复合全麻组(EP组)从麻醉诱导前30 min至术毕行持续双侧内关穴、足三里穴电刺激,以刺激频率2 Hz和100 Hz的疏密波进行交替刺激,刺激强度8～12 mA.麻醉诱导:两组均静脉注射咪达唑仑0.03 mg/kg、芬太尼1.5μg/kg、维库溴铵0.12 mg/kg,靶控输注异丙酚(血浆靶浓度2.5 μg/ml);麻醉维持:以0.1μg/ml幅度增加或降低异丙酚效应室靶浓度,维持BIS 45～55,间断静脉注射维库溴铵2 mg和芬太尼0.05～0.1 mg.于气管插管前、气管插管后、切皮前、切皮后、术中探查、术毕时记录HR、MAP和异丙酚效应室靶浓度,记录芬太尼用量.于麻醉诱导前(基础状态)、电刺激30 min、切皮后、术中探查、术毕时采集外周静脉血样,测定血清血管紧张素Ⅱ和皮质醇的浓度.结果 EP组异丙酚效应室靶浓度和芬太尼用量低于P组(P＜0.01);两组MAP和HR均波动在正常范围;两组间各时点血清血管紧张素Ⅱ和皮质醇浓度差异无统计学意义(P＞0.05).与基础值比较,EP组电刺激30 min时血清血管紧张素Ⅱ和皮质醇浓度下降(P＜0.05),P组术中探查时血管紧张素Ⅱ和皮质醇浓度升高(P＜0.05或0.01).结论 经皮穴位电刺激可降低全麻患者异丙酚效应室靶浓度,减少芬太尼用量.
  • 摘要：Cookgas气管插管型喉罩（CILA）是一种新型的气管插管型喉罩，具有管壁柔软、引导气管插管操作简单和喉罩退出容易的优点。本课题组的前期研究表明，在引导气管插管过程中，CILA对咽喉部粘膜的损伤轻，可辅助盲探、纤支镜（FOB）和视可尼喉镜（SOS）进行气管插管。本研究拟对困难气道患者评价CILA引导气管插管的效果，为临床提供参考。
  • 摘要：阻塞性睡眠呼吸暂停综合征（OSAS）患者易发生困难气管插管，麻醉诱导时给予肌松药可导致上呼吸道进一步梗阻。七氟烷起效迅速，麻醉恢复快，适用于小儿吸入麻醉诱导，而小儿单纯吸入临床常用浓度七氟烷不能有效抑制气管插管心血管反应。瑞芬太尼作为选择性”阿片类受体激动剂，其强效镇痛作用可抑制气管插管心血管反应。本研究拟评价OSAS患儿高浓度七氟烷复合瑞芬太尼麻醉诱导的效果。
  • 摘要：目的 筛选老年患者发生术后认知功能障碍(POCD)的危险因素.方法 择期手术患者240例,ASA Ⅰ或Ⅱ级,年龄65～86岁,根据麻醉方法不同分为3组(n=80):全身麻醉组(G组)、硬膜外阻滞组(E组)和局部麻醉组(L组).分别于术前1 d、术后1、3、5 d记录MMSE评分,计算术前MMSE评分的标准差,每例患者术后MMSE评分与术前MMSE评分比较≥1个标准差时即发生POCD.将不同年龄、性别、文化程度、麻醉方法、手术时间和术前MMSE评分的老年患者POCD发生率进行比较,若差异有统计学意义,该因素进入非条件logistic回归模型,筛选老年患者发生POCD的危险因素.结果 性别、文化程度、麻醉类型、手术时间≥90 min及术前MMSE评分＜23分不是老年患者POCD发生的危险因素;年龄≥75岁与老年患者POCD的发生有关(P＜0.05).结论 年龄≥75岁是老年患者发生POCD的危险因素.%Objective To investigate the risk factors for postoperative cognitive dysfunction(POCD)in elderly patients.Methods Two hundred and forty ASA Ⅰ or Ⅱ patients without mental or neurological deficit,aged 65-86 yr undergoing elective surgery were divided into 3 groups(n=80 each):group Ⅰ general anesthesia (G);group Ⅱ epidural anesthesia(E)and group Ⅲ local anesthesia(L).The types of surgery included abdominal,orthopedic and ophthalmic operations.The cognitive function of the patients was assessed at day 1 before and days 1,3,or 5 after operation using Mini-Mental State examination(MMSE).Diagnostic criterion of POCD was defined as a decline in score more than or equal to the preoperative standard deviation in all patients.After the comparison of the influence of these factors,such as different ages,gender,educational levels,anesthesia methods,operation time and preoperative MMSE score,on incidence of POCD in elderly patients,if there was significant difference,the factors were analyzed using unconditional logistic regression to select the risk factors for incidence of POCD in elderly patients.Results The factors,such as gender,educational levels,anesthesia type,operation time≥90 min and preoperative MMSE score＜23,were not the risk ones for incidence of POCD in elderly patients.The factor of age≥75 yr was related to the incidence of POCD in elderly patients.Conclusion Age≥75 yr is the only significant independent risk factor for POCD in elderly patients.
  • 摘要：乳腺癌根治术要求镇痛完善，而对肌肉松弛程度要求较低。采用胸段硬膜外阻滞时，在保证感觉阻滞的前提下，应尽可能降低局麻药的浓度与剂量，以避免运动神经（膈神经和肋间神经）阻滞，抑制呼吸功能。低浓度罗．哌卡因具有感觉一运动阻滞分离的特点。有研究表明0．375％罗哌卡因胸段硬膜外阻滞明显抑制呼吸功能；而0．25％罗哌卡因胸段硬膜外阻滞对乳腺癌改良根治术患者血液动力学抑制较小且镇痛效果良好。本研究拟评价0．25％罗哌卡因胸段硬膜外阻滞对乳腺癌根治术患者呼吸功能的影响，为临床麻醉提供参考。
  • 摘要：@@ 异丙酚是麻醉诱导与维持常用的静脉麻醉药物之一.研究表明异丙酚可减轻肝脏缺血再灌注损伤.肝脏缺血再灌注时可诱发单核巨噬细胞释放肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)和一氧化氮(NO)等细胞因子,从而导致组织损伤.肝脏Kupffer细胞是位于肝窦内的巨噬细胞.本研究拟通过观察异丙酚对缺氧复氧诱导大鼠肝脏Kupffer细胞释放TNF-α、IL-1β和NO的影响,探讨其减轻肝脏缺血再灌注损伤的机制.
  • 摘要：目的 筛查中国人恶性高热(MH)家系的蓝尼定受体-1(RYR1)基因.方法 提取确诊为MH的先证者及家系其他成员外周血白细胞的基因组DNA,采用PCR扩增先证者RYR1基因的部分外显子,并进行直接测序,采用Fok Ⅰ限制酶分析验证先证者及家系其他成员基因突变情况.结果 先证者RYR1基因第6 724位碱基C突变为T(c.6724 C＞T),所编码第2 206位氨基酸由苏氨酸变为甲硫氨酸(p.T 2206 M),此突变在白种人已报道;先证者的4个子女中有2个为该错义突变携带者,为MH易感者.结论 中国人MH易感者携带与白种人MH易感者相同的RYR1基因突变.%Objective To screen the ryanodine receptor type 1(RYR1)gene in a Chinese pedigree with malignant hyperthermia(MH).Methods Total genome was extracted conventionally from peripheral leucocytes of the prohand and the other members of the family.In order to detect mutations in the RYR1 gene,part exons were amplified by polymerase chain reaction(PCR)and then subjected tO automatic DNA sequencing.The detected mumfion in the gene was confirmed in the preband and the other members of the family using Fok Ⅰ restriction analysis.Results DNA sequencing of PCR-amplified fragments of the pwband revealed c.6724C＞T (P.T2206M),a recurrent missense mutation which had been detected in Caucasian MH cages.Restriction analysis of all available family members showed that one daughter and one son of the 4 children of the proband were the missense mutation carriers,indicating that they were MH-susceptible individuals.Conclusion The Chinese susceptible to MH carries the simile RYR1 gene mutation to the Caucasians susceptible to MH.
  • 摘要：开胸手术患者单肺通气时多以观察非通气侧肺是否漏气及呼出气CO2曲线波形是否呈直线来判断双肺功能性隔离是否完全。本课题组经过临床研究对上述观点尚存疑义，开胸前单肺通气时非通气侧肺在双肺隔离完全的条件下究竟是否有气流及呼出气CO2曲线波形是否呈直线有待进一步探讨。本研究选择双腔支气管导管（DLT）定位准确（经纤维支气管镜定位）的开胸手术患者，对单肺通气时非通气侧肺和通气侧肺进行呼出气CO2监测，探讨呼出气CO2监测是否可正确判断开胸手术患者单肺通气时双肺功能性隔离情况。
  • 摘要：目的 评价瑞芬太尼和异丙酚对健康志愿者体外静脉血中性粒细胞(PMNs)呼吸爆发的影响.方法 健康志愿者12名,年龄20～40岁,体重55～65kg,取肘静脉血5 ml抗凝.采用正交实验设计确立实验因素为瑞芬太尼和异丙酚;实验水平数为5水平,即瑞芬太尼空白对照、溶媒(甘氨酸)对照、瑞芬太尼5、50、500 ng/ml和异丙酚空白对照、溶媒(脂肪乳)对照、异丙酚5、50、500μg/ml,用正交表L25(56),观察药物对静息状态和脂多糖(LPS)激活状态下PMNs呼吸爆发的影响,静息状态的PMNs不用LPS进行刺激,按实验设计方案加入相应药物孵育3 h;激活状态的PMNs根据用药时机分为预防性用药和治疗性用药,预防性用药加入相应药物孵育1 h,再加入LPS(终浓度1μg/ml)孵育2 h;治疗性用药首先加入LPS(终浓度1 μg/ml)孵育1 h,再加入相应药物孵育2 h.结果 瑞芬太尼50 ng/ml可增强静息状态下PMNs的呼吸爆发;各剂量瑞芬太尼治疗性用药均可增强LPS激活状态下PMNs的呼吸爆发(P＜0.05),预防性用药对PMNs的呼吸爆发无影响(P＞0.05).各剂量异丙酚及脂肪乳可降低静息和LPS激活状态下PMNs的呼吸爆发(P＜0.05),但各剂量异丙酚与脂肪乳比较差异无统计学意义(P＞0.05).瑞芬太尼和异丙酚对静息状态下和激活状态下PMNs呼吸爆发的影响没有交互作用.结论 瑞芬太尼对PMNs呼吸爆发的影响可能与PMNs所处的状态、用药剂量及用药时机有关;异丙酚的溶媒可抑制PMNs的呼吸爆发,而异丙酚本身无作用,且这种抑制作用与PMNs所处的状态及用药时机无关;瑞芬太尼和异丙酚对PMNs呼吸爆发的影响没有交互作用.%Objective To evaluate the effects of remifentanil and propofol on the respiratory burst of polymorphonuclear leukocytes(PMNs)in the venous blood of healthy adult volunteers in vitro.Methods The ulnar vein blood 5 ml was obtained from 12 healthy adult volunteers of both sexes,aged 20-40 yr,weighing 55-65 ks,and anticoagulated with EDTA.The experiment was divided in 2 parts:remifentanil and propofol.Each part was divided into 5 groups:LevdDrugⅠⅡⅢⅣⅤRemifentanil Blank control Solvent(glycine)control 5 ng/ml 50 ng/ml 500 ng/mlPropofol Blank control Solvent(intralipid)control 5μg/ml 50μg/ml 500μg/mlEach group was again divided into static group and LPS group and the latter was further divided into drug-pretreated group and drug-treat group.Blood samples were incubated with the drug for 3 h at 37℃in 95%air-5%CO2.Six G of rhodamine was added to 200μl of each sample which was incubated for 10 min,then phorbol ester was added and 200 μl of each sample was incubatcd for another 30 min.Then 4 ml of FACSlyse was added to each sample to break down RBC.The pellet was resuspended in 0.01 mol/L phosphate-buffered saline(PBS)500 μl containing 1%paraformaldehyde after centrifugation and the respiratory burst of PMNs was determined using flow cytometry.Results Remifentanil 50 ng/ml could enhance the respiratory burst of PMNs in the static state.Remifentanil at each dose could enhance the respiratory burst of LPS-activated PMNs in drug-treat group(P＜0.05),but it had no effect on the respiratory burst of PMNs in drug-pretreated group(P＞0.05).Propofol at each dose and intralipid could reduce the respiratory burst of PMNs in the static and LPS-activated state(P＜0.05),but there was no significant difference between propofol at each dose and intralipid(P＞0.05).The effects of remifentanil and propofol on the respiratory burst of PMNs had no interaction whether in the static state or in the LPS-activated state.Conclusion The effect of remifentanil on the respiratory burst of PMNs may be related to the state of PMNs(static or activated),dose of the drugs and the occasion when the drugs flxe used.It is the solvent of propofol that Can inhibit the respiratory burst of PMNs,but not propofol itself,and the inhibitory effect has no relationship with the state of PMNs or the occasion when the drugs axe used.The effects of remifentanil and prepofol on the respiratory burst of PMNs have no interaction.
  • 摘要：Objective To investigate the effects of intestinal ischemia-reperfusion(II/R)on the p-defensin-2 mRNA expression in the lung tissue in rats.Methods Seventy-two male SD rats weighing 250-300 g were randomly allocated to one of 2 groups(n=36 each):group Ⅰ sham operation(S)and group Ⅱ II/R.Intestinal I/R was produced by occlusion of superior mesenteric artery(SMA)for 60 min followed by reperfusion.Six animals were killed at each of the following time points:the onset of reperfusion(T0),15,30,60 min (T1,2,3)and 3,6 h(T4,5)of reperfusion in each group.Lung tissue specimens and broncho-alveolar lav~e fluid (BALF)were obtained for microscopic examination and determination of pulmonary permeability index(PPI),TNF-α content and BD-2 mRNA expression(by RT-PCR).ResultsMicroscopic examination showed edema and PMN infiltration in the lung in group II/R.The PPI and BD-2 mRNA expression were significantly higher in group II/R than in group S.The TNF-α content was significantly higher at T0-3 in group II/R than in group S(P＜0.05or 0.01).The BD-2 mRNA expression was positively correlated to the TNF-α content(r=0.823,P＜0.01)and negatively correlated to PPI(r=-0.615,P＜0.05).Conclusion BD-2 gene expression in the lung tissue is up-regulated after intestinal I/R in rats.%目的 观察大鼠肠缺血再灌注时肺组织β-防御素-2(BD-2)mRNA表达的变化.方法 72只雄性SD大鼠随机分为2组(n=36):假手术组(S组)和肠缺血再灌注组(II/R组).采用夹闭肠系膜上动脉(SMA)的方法制备肠缺血再灌注模型.II/R组阻断SMA 1 h后再灌注,S组仅分离SMA.分别于再灌注即刻(T0),再灌注15(T1)、30(T2)、60 min(T3)、3 h(T4)和6 h(T5)时处死6只大鼠,取肺组织,光镜下观察肺组织病理学结果,计算肺通透性指数(PPI),检测肺组织肿瘤坏死因子-α(TNF-α)含量和BD-2 mRNA表达水平.结果 S组肺组织结构未见异常,II/R组出现肺水肿和中性粒细胞浸润.与S组比较,II/R组再灌注各时点PPI升高,BD-2 mRNA表达上调,T0-3时TNF-a含量升高(P＜0.05或0.01).II/R组BD-2 mRNA表达水平与TNF-a含量及PPI的相关系数分别为0.823和-0.615(P＜0.01).结论 大鼠肠缺血再灌注时肺组织BD-2基因表达上调.
  • 摘要：舒芬太尼是目前效能最强的镇痛药，对心血管系统的影响较小，其代谢物去甲舒芬太尼也有镇痛作用，效价约为舒芬太尼的1，10，即与芬太尼相当；舒芬太尼比芬太尼能维持更长的术后镇痛效应，且呼吸抑制较轻，因此其药理特性更适合于静脉麻醉。本研究拟评价舒芬太尼复合静脉麻醉应用于小儿的效果。
  • 摘要：目的 评价异丙酚对腹腔镜胆囊切除术气腹患者肝功能的影响.方法 择期行腹腔镜胆囊切除术患者50例,ASA Ⅰ或Ⅱ级,年龄18～64岁,随机分为2组(n=25):异氟醚组(Ⅰ组)和异丙酚组(P组).麻醉诱导:静脉注射芬太尼3 gg/kg、依托咪酯0.3 mg/kg和琥珀胆碱1 mg/kg,气管插管后机械通气;麻醉维持:两组均静脉注射维库溴铵1～1.2 mg/kg,每30分钟静脉注射芬太尼1～2 μg/kg和维库溴铵0.5 mg/kg,Ⅰ组吸入异氟醚1.3 MAC,P组靶控输注异丙酚(血浆靶浓度2.0～2.3μg/ml).于麻醉诱导前(T0)和气腹解除后5 min(T1)时抽取肘静脉血样4 ml,检测血浆丙二醛(MDA)浓度、超氧化物歧化酶(SOD)、谷胱甘肽过氧化酶(GSH-PX)活性和总抗氧化能力(T-AOC).于T0及术后24 h(T2)时抽取肘静脉血样2 ml,检测血清谷丙转氨酶(ALT)、谷草转氨酶(AST)活性和总胆红素(T-BIL)浓度.结果 与T0时比较,两组T1时血浆MDA浓度升高,SOD、GSH-PX活性和T-AOC降低,T2时血清ALT、AST、T-BIL水平升高(P＜0.05或0.01);与Ⅰ组比较,P组血浆MDA浓度降低,SOD、GSH-PX活性和T-AOC升高,血清ALT、AST和T-BIL水平降低(P＜0.05).结论 腹腔镜胆囊切除术中靶控输注异丙酚(血浆靶浓度2.0～2.3μg/ml)可减轻CO2气腹诱发肝功能损害,有利于术后早期肝功能的恢复,其机制可能与减轻脂质过氧化反应有关.%Objective To investigate the effects of propofol on hepatic function in patients undergoing laparoscopic cholecystectomy(LC)with CO2 pneumoperitoneum.Methods Fifry ASA Ⅰ orⅡpatients aged 18-64 yr undergoing LC were randomly divided into isoflurane group(Ⅰ)and propofol group(P)(n=25 each).The patients were premedicated with intramuscular atropine 0.5 mg and midazolam 0.03 mg/kg.Anesthesia was induced with fentanyl,etomidate and succinylcholine and maintained with 1.3 MAC isoflurane in group Ⅰ or TCI of propofol(CT=2.0-2.3 μg/ml)in group P.Blood sample were obtained from peripheral vein immediately before induction of anesthesia(T0),at 5 min after induction of CO2 pneumoperitoneum(T1),and 24 h after operation (T2)for determination of plasma concentration of MDA,SOD activity,glutathione peroxidase(GSH-PX)activity and total antioxidant capacity(T-AOC)(at T0 and T1)and serum levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST)and total bilirubin(T-BIL)(at To and T2).Results The plasma concentration of MDA was significantly increased while the SOD and GSH-PX activities and T-AOC were significantly decreased at T1 as compared with the baseline vglues at T0 in both groups.The serum ALT,AST activities and T-BIL concentration were significantly increased at T2 as compared with the baseline values in both groups.The plasma MDA concentration was significantly lower,the SOD and GSH-PX activities and T-AOC were significantly higher and the serum ALT and AST activities and T-BIL concentration were significantly lower in group P than in group Ⅰ(P＜0.05).Conclusion Propofol administered by TCI(CT=2.0-2.3μg/ml)during LC can ameliorate hepatic dysfunction induced by CO2 pneumoperitoneum through decrease in lipid poroxidation.
  • 摘要：目的 通过观察体外循环(CPB)对先天性心脏病合并肺动脉高压患者血浆一氧化氮(NO)和不对称二甲基精氨酸(ADMA)浓度的影响,分析CPB加重肺动脉高压的原因.方法 拟在CPB下行心内修补术的先天性心脏病患者18例,年龄11～40岁,体重26～59 kg,ASAⅡ或Ⅲ级,心功能Ⅰ～Ⅲ级.根据术前肺动脉收缩压(PASP)分为3组(n=6),Ⅰ组肺动脉压正常(PASP<30 mm Hg);Ⅱ组肺动脉压轻度增高(PASP 30～50 mm Hg);Ⅲ组肺动脉压中重度增高(PASP>50 mm Hg).分别于麻醉诱导前(基础状态)、CPB开始即刻、CPB停机后即刻、3、6和24 h时采集桡动脉血样4 ml,测定血浆NO和ADMA浓度.结果 与基础值相比,Ⅱ组和Ⅲ组CPB停机后即刻、3和6 h时血浆ADMA浓度升高,NO浓度降低(P<0.05),Ⅰ组上述指标差异无统计学意义(P>0.05).与Ⅰ组比较,Ⅱ组和Ⅲ组血浆NO浓度降低,ADMA浓度升高(P<0.05).结论 CPB可引起先天性心脏病合并肺动脉高压患者血浆ADMA浓度升高,NO浓度降低.%Objective To investigate the effects of eardiopulmonary bypass(CPB)on plasma nitric oxide (NO)and asymmetric dimethyl arginine(ADMA)concentrations in patients with congenital heart disease complicated with pulmonary hypertension undergoing open heart surgery.Methods Eighteen ASA Ⅱ or Ⅲ patients aged 11-40 yr weighing 26-59 kg undergoing open heart surgery under CPB were divided into 3 groups according to pulmonary arterial systolic pressure(PASP)(n=6 each):group Ⅰ PASP<30 mm Hg;group Ⅱ PASP 30-50 mm Hg and group Ⅲ PASP>50 mm Hg.Arterial blood samples were taken before induction of anesthesia (To,baseline),at the start and termination of CPB(T1,2)and 3,6,24 h after CPB(T3-5)for determination of plasma NO and ADMA concentrations.Results The three groups were comparable with respect to M/F sex ratio,age,body weight and CPB time.The plasma ADMA concentrations were significantly increased while NO concentrations were significantly decreased at termination of CPB(T2)and 3 and 6 h after CPB(T3,4)as compared with the baseline at T0 in group Ⅱ and Ⅲ.The plasma ADMA concentration were significantly higher and No concentrations were significantly lower at all time points in groupⅡand Ⅲthan in group Ⅰ.Conclusion CPB can increase plasma ADMA concentration and decrease plasma NO concentration in patients with congenital heart disease complicated with pulmonary hypertension undergoing open heart surgery.
  • 摘要：Objective To investigate the reliability of bubbling method for delivering isoflurane during cell experiment in vitro.Methods A Petri dish 8.6 cm in diameter,which contained 3 small Petri dishes 3.5 cm in diameter used for cell culture.was placed in a 5%CO2 incubator at 37℃.Liquid culture medium 80 ml composed of DMEM and F12(ratio 1:1)and 10%fetal calf serum was infused into the big dish and overwhelmed the small dishes.A 21 G needle was inserted into the culture medium in the midge of big dish.A stream of gas mixture composed of 20%02,80%N2 and different concentrations of isoflurane was continuously bubbled into the culture media at 0.25 L/min.The liquid culture mesa were divided into 10 groups according to isoflurane concentration in the air stream:in groupⅠ-Ⅷ the concentrations of isoflurane in the air stream were 0.2%,0.4%,0.8%,1.6%,2.0%,2.4%,3.2%and 4.0%respectively;in group Ⅸ there Wfl8 no isoflurane in the air stream composed of only 20%02 and 80%N2 and in groupX no air stream bubbled in the culture medium.The culture media were collected after the air stream had bubbuled in it for 5,10,15,30,60,120 and 180 min for measurement of isoflurane concentration by double balanced headspace gas chromatography.Results The iseflurane concentration achieved balance between the bubbling air and culture medium after 15 min bubbling.Conclusion Bubbling method can provide stable and reliable concentration of isoflurane in the liquid culture medium during cell experiment in vitro.%目的 评价细胞实验时异氟醚鼓泡给药法的可靠性.方法 取直径8.6 cm的大培养皿100个,每个大培养皿内置3个直径3.5 cm用于细胞培养的小培养皿,大培养皿置于37℃、5%CO2培养箱中.使用ABV-A麻醉机给药,氧气:氮气比为1:4,混合异氟醚后(鼓泡气),经人工鼻过滤,接21 G针头置于大培养皿中央底部持续鼓泡,气体流量与培养液容积比例为0.25 1L/min:80 ml.按鼓泡气异氟醚浓度将大培养皿随机分为10组(n=10),Ⅰ组～Ⅷ组鼓泡气异氟醚浓度分别为0.2%、0.4%、0.8%、1.6%、2.0%、2.4%、3.2%和4.0%;Ⅸ组鼓泡气内未混合异氟醚;Ⅹ组未通人气体.Ⅰ组～Ⅷ组分别于鼓泡通气5、10、15、30、60和120 min时(T1～6)于小培养皿的底部取细胞培养液7 ml,采用气相色谱法测定异氟醚浓度.结果 与T3时比较,Ⅰ组～Ⅷ组T1,2时异氟醚浓度降低(P<0.05),T4～6时差异无统计学意义(P>0.05);异氟醚浓度(Y)与鼓泡气异氟醚浓度(X)直线回归方程为Y=1.5 652X-0.1 252.结论 细胞实验时鼓泡给药法可提供稳定、可靠的异氟醚浓度.
  • 摘要：全身麻醉下患者坐位实施后颅窝手术具有出血量少、手术野暴露清晰及手术时间短等优点，但全身麻醉抑制机体的正常反射，导致自我调节能力低下，患者体位由卧位变为坐位过程中，由于重力作用及心血管调节功能低下，可引起血液动力学剧烈波动，表现为动脉压下降、CI降低、HR加快。尤其是老年患者，坐位手术时还可诱发空气栓塞，心前区采用多普勒监测时，肺静脉空气栓塞发生率达40％，采用TEE监测时达76％。本院于2006—2007年在全身麻醉下患者坐位实施后颅窝手术30例，麻醉过程顺利，现总结如下。
  • 摘要：非体外循环冠状动脉旁路移植术（OPCABG）时，尽管消除了体外循环对机体的影响，但患者术后认知功能障碍（POCD）的发生率仍较高。麻醉药的合理配伍可减少POCD的发生，本研究通过比较不同麻醉下OPCABG患者术后认知功能，拟探讨OPCABG患者适宜的麻醉方法。
  • 摘要：剖宫产术后一般采用病人自控硬膜外镇痛（PCEA），但对于硬膜外麻醉失败或禁忌的病人则需采用病人自控静脉镇痛（PCIA）。而改用静脉镇痛会增加血药浓度，其是否会影响病人泌乳和新生儿吸允乳汁后的神经适应能力有待探讨。本研究通过与剖宫产术后传统的PCEA比较，拟探讨PCIA对剖宫产术后病人泌乳及新生儿神经适应能的影响。
  • 摘要：无

    中华麻醉学杂志的期刊信息

    • 创刊时间：1981
    • 地区：CN
    • 语言：中文
    • 热门主题：中华医学会
    • 学科分类： 外科学;

    中华麻醉学杂志的获奖情况

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    • • 北大核心期刊（1992版）
    • • 北大核心期刊（1996版）
    • • 北大核心期刊（2000版）
    • • 北大核心期刊（2004版）
    • • 北大核心期刊（2008版）
    • • 北大核心期刊（2011版）
    • • 北大核心期刊（2014版）
    • • 北大核心期刊（2017版）
    • • 化学文摘（网络版）
    • • 中国科学引文数据库（2011-2012）
    • • 中国科学引文数据库（2013-2014）
    • • 中国科学引文数据库（2015-2016）
    • • 中国科学引文数据库（2017-2018）
    • • 中国科学引文数据库（2019-2020）
    • • 日本科学技术振兴机构数据库
    • • 中国科技核心期刊

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