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国际麻醉学与复苏杂志

国际麻醉学与复苏杂志

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International Journal of Anesthesiology and Resuscitation
1980年创刊，中华医学会、徐州医学院主办。本刊前身是《国外医学?麻醉学与复苏分册》，以提高为宗旨，竭诚为我国麻醉学科学术水平的提高和人才建设起到推动和导向作用。期刊内容涵盖临床麻醉、重症监测治疗、生命复苏、疼痛诊疗、药物依赖与戒断等领域。本刊以综述为特色，以创新性研究成果为核心，以临床前瞻性研究、应用基础和基础研究为重点。设置有论著、综述、述评、病例析评、学科建设等栏目。目前已被列为中国科技论文统计源期刊及中国学术期刊综合评价数据库来源期刊，已被《中国学术期刊》光盘版、《中国期刊全文数据库》、万方数据库、美国化学文摘全文收录。
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  • 发文量：4196
  • 被引量：1620
  • H指数：1
  • 开始收录时间：1982(3)
  • CNKI综合因子：0.683
  • 维普期刊影响因子： 0.966
  • 万方期刊影响因子：1.03
  • 创刊时间：1980
  • 国内刊号/CN：32-1761/R
    国际刊号/ISSN：1673-4378
  • 发行周期：月刊
    邮发代号：28-44
  • 主管单位：中华人民共和国卫生部
    主办单位：中华医学会；徐州医学院
国际麻醉学与复苏杂志-联系信息
  • 主编：-
  • 电话：0516-85708135
  • 邮箱：gjmzyfs@163.com
  • 地址：徐州市淮海西路99号
  • 邮编：221002
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国际麻醉学与复苏杂志 >2021年第11期

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  • 摘要：目的 观察帕瑞昔布钠预防上腹部手术苏醒期躁动的效果及安全性. 方法 美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级择期行上腹部手术患者120例按随机数字表法分为4组,每组30例.所有患者采用七氟醚、瑞芬太尼复合全麻,术中监测并维持脑电双频指数(bispectral index,BIS)值在40～50,A组于麻醉诱导前静脉注射帕瑞昔布钠0.8 mg/kg,B组于关腹前静脉注射帕瑞昔布钠0.8 mg/kg,C组于关腹前静脉注射静脉给予舒芬太尼0.08 μg/kg,D组于麻醉诱导前静脉注射生理盐水2ml.分别于麻醉诱导前(T1)、拔除气管导管前(停药10 min,T2)、拔管时(T3)、拔管后10 min (T4),观察两组平均动脉压(meanarterial pressure,MAP)、心率(heart rate,HR)、脉搏血氧饱和度(oxygen saturation,SpO2)及T4时躁动评分(restlessness score,RS)、视觉模拟评分法(visual analogue scales,VAS)、Ramsay镇静评分(ramsay sedation score,RSS)、瑞芬太尼用量、术后30 min恶心呕吐发生率. 结果 苏醒时间,A组、B组、D组分别为(7±3)、(8±4)、(7±3) min显著短于C组(10±4)min(P＜0.05);瑞芬太尼用量,A组为(0.8±0.3) mg,较D组(1.3±0.5)mg明显减少(P＜0.05),差异有统计学意义.D组在T3时间点MAP、HR分别为(126±25) mmHg(1 mmHg=0.133 kPa),(106±28)次/min,较A组[(106±25) mmHg,(96±25)次/min]、B组[(113±27) mmHg,(99±27)次/min]和C组[(111±27) mmHg,(86±19)次/min]升高,差异有统计学意义(P＜0.05),T4时间点也有相似变化.与对照组D组比较,A、B、C组患者术后躁动总发生率分别为6.7％,13.2％,10.0％,均低于对照组术后躁动总发生率33.3％,其中A组躁动总发生率低于B组(P＜0.05).A、B、C组患者VAS评分中位数分别为2、3、2均低于对照组评分5(P＜0.05);A、B、C组患者RSS评分中位数分别为3、3、3均显著低于C组4分(P＜0.05).与C组比较,A、B、D组副作用包括恶心,呕吐,嗜睡,呼吸抑制等发生率均显著低于C组(P＜0.05). 结论 帕瑞昔布钠用于上腹部手术中,可减少瑞芬太尼的用量,并可预防苏醒期躁动与术后恶心呕吐的发生.%Objective To observe the preventive effects of parecoxib sodium on occurring of emergence agitation during the recovery period of general anesthesia for the patients who underwent epigastric surgeries.Methods one hundred and twenty patients,ASA Ⅰ ～ Ⅱ,underwent elective epigastic surgeries were divided randomly into four groups,30 cases in each group.Anesthesia of all patients was maintained with sevoflurane and remifentanil,keeping the bispectral index (BIS) around 40-50.Parecocib 0.8 mg/kg was intravenously infused into the patients just before anesthesia induction in group A and just before the closure of peritoneum in group B,Sufentanil 0.08 μg/kg was injected just before the closure of peritoneum in group C,2 ml saline as placebo was administrated in group D.The level of agitation(RS),visual analogue scales(VAS) and ramsay sedation score(RSS) were evaluated during the recovery period of general anesthesia.Mean arterial pressure(MAP) and heart rate(HR)were monitored at preinduction (T1),10 min before tracheal extubation (T2),immediately after tracheal extubation (T3) and 10 min after tracheal extubation (T4).Results The recovery time of group A,B,D(7±3),(8±4),(7±3) min is significantly shorter than that of group C.Requirement of remifentanil in group A (0.8±0.3) mg is significantly lower than that of group D (1.3±0.5) mg (P＜0.05).At T3,the MAP and HR in group D(126±25) mmHg(1 mmHg=0.133 kPa)(106±28) beats/min were significantly higher than those in group A [(106±25) mmHg,(96±25) beats/min],group B [(113±27) mmHg,(99±27) beats/min],group C [(111±27) mmHg,(86± 19) beats/min](P＜0.05),which happened similarly at T4.Compared with group D,the incidence of agitation (33.3％) is significantly higher than that of group A (6.7％),group B (13.2％) and group C (10.0％) (P＜0.05),and the incidence of agitation group A is significantly lower than group B (P＜0.05).Compared with group D,the median of score of VAS is 5,which is significantly higher than that of group A (2),group B (3),and group C (2) (P＜0.05),Compared with group D,the median of score of RSS is 4,which is significantly higher than that of group A (3),group B (3) and group C (3) respectively (P＜0.05).The incidence of nausea and vomiting of group C is much higher than other groups significantly (P＜0.05).Conclusions Parecoxib sodium has an analgesic effect for the patients of epigastric surgeries,preventing the incidence of postoperative agitation and adverse reactions during the recovery period of general anesthesia.
  • 摘要：目的 评价股神经、胸腰椎旁神经联合阻滞在高龄患者髋关节手术的应用价值. 方法 将65例行髋关节术的70岁以上患者按抽签法随机分为全身麻醉(general anesthesia,GA)组、椎旁神经阻滞(paravertebral block,PVB)组,PVB组分别于股神经和T12、L3椎体行PVB,采用周围神经刺激器定位,局麻药为0.375％罗哌卡因与1％利多卡因混合液10 ml,并留置导管.GA组采用全凭静脉全身复合麻醉.比较两组患者手术开始30 min、手术结束时的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)和心肌氧耗指数以及术后送重症监护病房(intensive care unit,ICU)、留置导尿、视觉模拟评分(visual analogue scale,VAS)、复苏室评分、术后下呼吸道感染情况. 结果 两组患者术前一般情况、美国麻醉医师协会(ASA)分级、手术时间、MAP、HR和心肌氧耗指数差异无统计学意义.手术开始30 min HR和心肌氧耗指数GA组比PVB组低(P＜0.05),HR分别为(68±11)次/min和(80±11)次/min、心肌氧耗指数(8 807±1 883)和(10 362±2 433).与麻醉前比较,两组患者MAP、HR和心肌氧耗指数的变化均显著降低(P＜0.05).PVB组在手术后的MAP、HR和心肌氧耗指数均低于GA组(P＜0.05),MAP分别为(88±12) mmHg(1 mmHg=0.133 kPa)和(101±15) mmHg、HR(75±11)次/min和(84±19)次/min、心肌氧耗指数(9 706±2 009)和(12 687±4 119).与麻醉前比较PVB组MAP、HR及心肌氧耗指数低于术前(P＜0.05),GA组差异无统计学意义.PVB减少术后需送ICU、下呼吸道感染及留置导尿人数,与GA比较,差异有统计学意义(P＜0.05). 结论 股神经、胸腰椎旁神经联合阻滞可以安全有效地应用于高龄患者的髋关节手术,其生理干扰轻微,且术后需送ICU及留置导尿概率小,有效降低下呼吸道感染,有效降低心肌氧耗指数,提高了术后患者的安全性和舒适度.%Objective To evaluate the application value of combined femoral and thoracolumbar paravertebral nerve blocks in the hip joint operations of elderly patients.Methods Sixty five patients aged over 70 undergoing hip joint operation were randomly divided into general anesthesia group (GA) and paravertebral nerve block (PVB) group.In the PVB group,each patient received a combined femoral nerve-thoracolumbar paravertebral nerve block with the aid of a neurostimulator,and a 10 ml mixture of 0.75％ bupivacaine and 2％ lidocaine was used in each block.In the GA group,a total intravenous general combined anesthesia was applied to each patient.Mean arterial pressures (MAP),heart rates (HR) and myocardial oxygen consumption indexs were recorded 30 minites after the surgery started and when it finished.In addition,indwelling catheter management,visual analogue scale scores,resuscitation room indexes,and lower respiratory tract infections in the intensive care unit (ICU) were evaluated postoperatively.Results There were no differences in demographic data,ASA status,operation time,preoperative MAP,HR and myocardial oxygen consumption index of patients between the two groups.MAP,HR and myocardial oxygen consumption index of two groups 30 minites after the start of operations were lower than those of preoperative baseline values,respectively (P＜0.05),and the HR and myocardial oxygen consumption index of GA group were both lower than those of the PVB group (P＜0.05),the HR of GA group and PVB group were (68±11) beats/min and (80±11) beats/min,the myocardial oxygen consumption index of GA group and PVB group were (8 807±1 883) and (10 362±2 433).MAP,HR and myocardial oxygen consumption index in the PVB group was obviously lower than the GA group postoperatively (P＜0.05),MAP(88±12) mmHg(1 mmHg=0.133 kPa) vs (101±15) mmHg,HR(75±11) beats/min vs (84±19) beats/min,myocardial oxygen consumption index,(9 706±2 009) vs (12 687±4 119),respectively,and preoperatively (which was of no statistical significance).The length of ICU stay,infections of lower respiratory tracts,and the need for urinary catheters for patents in the PVB group were significant lower than those in Group GA (P＜0.05).Conclusions We conclude that the combined femoral-thoracolumbar parave rtebral nerve block can be safe and effective for the hip surgery,associated with minor physiological disturbance,lower myocardial oxygen consumption index,and higher postoperative comfort and safety.
  • 摘要：Background The transversus abdominis plane (TAP) block is a newly developed regional anesthetic technique over the past few decades,which can reduce postoperative opioid requirements and opioid related side effects,and finally improve the total satisfaction degree of patients.Objective To introduce TAP block technique and discuss the future perspectives on the use of TAP block for postoperative analgesia in abdominal surgery.Content Review of the TAP block technique,including the relevant anatomy,operation methods,clinical effects,complications,unsolved problems as well as the suggestions for future clinical research and application.Trend The TAP block technique has been confirmed to be safe,effective,and very promising for future use as part of a multimodal analgesic regimen for postoperative analgesia in abdominal surgery.%背景 腹横肌平面(transversus abdominis plane block,TAP)阻滞技术是一项近几十年发展起来的新型的局部神经阻滞技术,它可以减少术后镇痛阿片类药物的用量,继而减少其相关副作用,提高患者总的满意度. 目的 介绍TAP阻滞技术,探讨其在腹部手术术后镇痛中的应用. 内容 就TAP阻滞的解剖基础、操作方法、临床效果、并发症及尚待解决的问题等方面进行综述,为临床研究及应用提供参考. 趋向 TAP阻滞技术,被证实在很多手术的术后镇痛应用中是安全、有效的,有着广阔的应用前景.
  • 摘要：Objective To observe the therapeutic efficacy of dezocine on the treatment for the co-morbidity of pain-itch (CPI) which were induced by spared nerve injuries (SNI) and evoked by chloroquine intradermal injections.Methods Adult male Kun-Ming mice (SPF grade,22 g-26 g) were assigned randomly into six groups (n=8):group A (Sham+NS+NS),group B (SNI+ NS+NS),group C (SNI+Itch+NS),group D (Sham+Itch+NS),group E (SNI+Itch+Dezocine),and group F (Sham+Itch+Dezocine).Mechanical allodynia was assessed using electron-Von Frey.To test pain threshold,Paw withdrawal threshold (PWT,to assess mechanical allodynia) was measured by electro von Frey on-1 d (baseline),1,3 d,and 5 d (before and after dezocine and chloroquine intradermal injection).Scratching behaviors of animals were video-recorded to analysis chloroquine-evoked itching in each group.Results Compared with the area under curve (AUC) of PWT for mechanical allodynia or analgesic responses,group A-AUC＜group B-AUC (P＜0.05).Scratching latency (SL):group A (49± 11) s,group B (51 ± 10) s,group C (322± 127) s,group D (333±94) s,group E(571±67) s,group F(524±77) s,SL in group E or F of dezocine therapy were prolonged significantly compared to group C and D(P＜0.05).The number of scratching:group C(13.7±3.4),group D(25.8±5.2),group E(5.8±2.0),group F(6.3± 1.8),The number of scratching in group C (13.7±3.4) was significantly reduced compared to group D(13.7±3.4) vs (25.8±5.2)(P＜ 0.05).And the number of scratching in group E(5.8±2.0) or group F(13.7±3.4) was both reduced significantly compared to group C and D (P＜0.05).Conclusions These data suggest that dezocine is a highly efficacious analgesic and antipruritic treatment for the CPI in mice.%目的 观察地佐辛在小鼠坐骨神经分支高选择结扎切断(spared nerve injury,SNI)诱导的神经病理性疼痛与氯喹激发的急性疼痛-瘙痒共病(co-morbidity of pain-itch,CPI)中的治疗效果. 方法 成年雄性SPF级昆明小鼠,体重22 g～ 26 g,采用随机数字表法分为6组(每组8例):A组,假手术-非瘙痒-生理盐水治疗对照组(Sham+NS+NS组);B组,神经病理性疼痛-非瘙痒-生理盐水治疗对照组(SNI+NS+NS组);C组,神经病理性疼痛-瘙痒-生理盐水治疗对照组(SNI+Itch+NS组);D组,假手术-瘙痒-生理盐水治疗对照组(Sham+Itch+NS组);E组,神经病理性疼痛-瘙痒-地佐辛治疗组(SNI+Itch+Dezocine组);F组,假手术-瘙痒-地佐辛治疗组(Sham+Itch+Dezocine组).于SNI术前1d,术后1、3、5 d(地佐辛/氯喹注药前、后),采用电子VonFrey测定各时间点小鼠机械缩足阈值(pal withdrawal threshold,PWT)评估机械痛敏;采用视频记录并分析动物因氯喹激发的搔抓行为. 结果 各组机械痛敏/镇痛效应PWT曲线下面积(area under curve,AUC)比较:F-AUc＞E-AUC＞B-AUC;D-AUC＞C-AUC(P＜0.05).搔抓潜伏期(scratching latency,SL)比较:A组(49±11)s,B组(51±10)s,C组(322±127)s,D组(333±94)s,E组(571±67)s,F组(524±77)s;地佐辛治疗延长小鼠的SL(P＜0.05).搔抓次数比较:C组(13.7±3.4),D组(25.8±5.2),E组(5.8±2.0),F组(6.3±1.8),C组搔抓次数＜D组搔抓次数(P＜0.05),E组、F组搔抓次数＜C组、D组搔抓次数(P＜0.05). 结论 对于小鼠CPI的治疗,地佐辛具有显著的镇痛与抗瘙痒作用.
  • 摘要：目的 探讨线粒体钙单向转运体(mitochondrail calcium uniporter,MCU)在大鼠短暂性脑缺血/再灌注损伤(ischemia/reperfusion injury,I/RI)模型中对线粒体分裂的影响. 方法 将80只健康雄性Wistar大鼠采用完全随机分组法分成4组(每组20只):A组:假手术组;B组:脑缺血/再灌注(ischemia/reperfusion,I/R)+钌红(MCU抑制剂)处理组;C组,脑I/R+精胺(MCU激动剂)处理组;D组:脑I/R组.采用线栓法建立大鼠大脑中动脉栓塞(middle cerebral artery occlusion,MACO)模型,缺血2h再灌注24 h后对大鼠行神经行为学评分,取缺血侧脑组织测定其线粒体内钙含量、钙调神经磷酸酶(calcineurin,CN)活性、线粒体分裂相关蛋白Drp1的表达量,并观察线粒体形态. 结果 与D组比较,B组钌红预处理可以改善大鼠脑I/RI引起的神经功能学障碍(1.5±0.7)(P＜0.01),降低脑缺血侧大鼠线粒体自由钙含量(265±8) nmol/L(P＜0.01),降低CN活性(0.520±0.036) U/mgprot (P＜0.01)及Drp1的表达(1.24±0.11) (P＜0.01),并减轻线粒体损伤;与D组比较,C组精胺预处理得到与钌红预处理相反的结果. 结论 MCU的开放状态可能影响大鼠脑I/RI线粒体分裂,抑制MCU开放可以抑制线粒体分裂,从而减轻大鼠脑I/RI,保护脑组织.%Objective To investigate the effect of mitochondrial calcium uniporter (MCU) on mitochondrial fission in an in vivo model of cerebral ischemia/reperfusion injury (I/RI).Methods Eighty rats were randomly divided into 4 groups:group A:sham-operated; group B:Ruthenium red +ischemia/reperfusion (I/R),group C:spermine +I/R,group D:I/R.The middle cerebral artery occlusion (MCAO) was occluded for 2 h and reperfused for 24 h.The neuropsychological scores,mitochondrial free calcium contents,the calcineurin(CN) activities,Drp1 expression and mitochondrial ultrastructure were observed.Results Compared with group D,Ruthenium red preconditioning in group B improved neuropsychological score (1.5±0.7) (P＜0.01),decreased the mitochondrial free calcium content (265±8) nmol/L (P＜0.01),CN enzyme activities (0.520±0.036) U/mgprot (P＜0.01) and Drp1 expression (1.24±0.11)(P＜0.01),and improved the mitochondrial ultrastructure.While group C got the opposite results.Conclusions The activity of mitochondrial calcium uniporter has effects on mitochondrial fission this relationship between MCU and mitochondrial fission may possibly provide a protection against I/RI.
  • 摘要：目的 研究右美托咪定(dexmedetomidine,Dex)-氯胺酮复合麻醉用于日间手术的麻醉效果及安全性. 方法 100例日间乳腺手术的患者采用随机数字表法分为Dex-氯胺酮组(D组)和丙泊酚-芬太尼组(P组),每组50例.持续监测心率(heart rate,HR)、无创血压(noninvasive blood pressure,NIBP)、呼吸频率(respiratory rate,RR)、脉搏血氧饱和度(pulse oxygen saturation,SpO2)、呼气末二氧化碳分压(end-tidal carbon dioxide tension,PETTCO2)等指标,记录麻醉诱导及定向力恢复时间、副作用情况. 结果 D组患者麻醉前后RR、SpO2、PETTCO2无明显变化(P＞0.05).P组患者麻醉后RR(10±3)次/min、SpO2(92.1±5.6)％明显下降(P＜0.05),而PETCO2(38±6) mmHg(1 mmHg=0.133 kPa)升高(P＜0.05),且其中14例发生呼吸抑制,两组差异有统计学意义(P＜0.01).D组血流动力学也较P组更加稳定(P＜0.05),但麻醉诱导时间(640±102)s和定向力恢复时间(804±228)s长于P组(P＜0.01). 结论 Dex-氯胺酮复合用于日间乳腺手术的麻醉效果确切,无明显呼吸抑制,血流动力学稳定,是一种较理想的日间手术麻醉方法.%Objective To study the efficacy and safety of dexmedetomidine-ketamine combination for anesthesia in ambulatory surgeries.Methods One hundred patients undergoing day surgery of breast were randomly assigned to 2 groups,dexmedetomidine-ketamine group (group D) and propofol-fentanyl group (group P),with 50 patients in each group.For each case,heart rate (HR),noninvasive blood pressure (NIBP),respiratory rate (RR),pulse oxygen saturation (SpO2) and end-tidal carbondioxide (PETCO2) were dynamically recorded.The induction time,orientation recovery time and adverse reactions were also assessed.Results No significant changes in RR,SpO2 or PETCO2 were found during anesthesia in group D (P＞0.05).Compared with the baseline values before inductions of anesthesia,RR (10±3 vs 16±4) beats/min and SpO2 (92.1±5.6 vs 98.7±1.1)％ in group P were significantly decreased after anesthesia (P＜0.05).By contrast,PETCO2 (38±6 vs 31±4) mmHg(1 mmHg=0.133 kPa) was obviously increased (P＜0.05).Futhermore,respiratory depressions were abserved in 14 patients in group P,and 0 cases in group D.Compared with group P,the patients in group D had a more stable hemodynamic status (P＜0.05).Nevertheless,the anesthesia induction time (640±102 vs 170±62) s and orientation recovery time (804±228 vs 451t162) s were longer in group D than those in group P (P＜ 0.01).Conclusions The dexmedetomidine-ketamine combination for anesthesia is effective and safe for ambulatory surgery,via delivering a stable hemodynamic status without respiratory depression.
  • 摘要：Objective To investigate the effect of combination therapy of nerve block and acupuncture to phantom limb pain of upper extremity after amputation.Methods Eighty patients with phantom limb pain of upper limb were randomly divided into four groups (n=20):20 patients received basic treatment (A group),which included Medications and Psychotherapy,20 patients recieved acupuncture and basic treatment (B group),20 patients recieved nerve block and basic treatment (C group),20 patients recieved nerve block,acupuncture and basic treatment (D group).Scores of VAS,SR-36 and comprehensive comparison of efficacy were used to assess before and after treatment among the four groups.Results visual analogue scales (VAS) scores and SF-36 scores of four groups of patients were significant differences after treatment compared with before treatment (P＜0.05).VAS scores decreased after treatment,while SF-36 scores were significantly increased.When compared with A group (52±6),VAS scores of B group (42±8),C group (42±8) and D group (32±6) after treatment decreased significantly,and the differences were statistically significant(P＜0.05).Compared with A group(Mental:58±9,Physical:36±5),SF-36 scores of B group(Mental:67±9,Physical:43± 4),C group(Mental:66±6,Physical:43±5) and D group(Mental:77±10,Physical:50±6) after treatment increased significantly,and the differences were statistically significant (P＜0.05).When compared with B group and C group,VAS scores of D group decreased significantly after treatment,and SF-36 scores were significantly increased(P＜0.05).Comprehensive comparison of efficacy of four groups of patients:After treatment for 5 weeks,compared with A group (70％),there was significant difference in comprehensive comparison of efficacy of B group(85％),C group(85％) and D group(100％) (P＜0.05).The results suggest that the treatment effect of B group,C group and D group is better than A group,the treatment effect of D group is best among four groups.Conclusions The use of basic drug and psychology therapy combined with sympathetic blockade therapy and acupuncture treatment can significantly improve the treatment effect of phantom limb pain of upper limb after amputation,improve the patient 's quality of life.%目的 研究探讨针刺复合神经阻滞治疗上肢截肢术后幻肢痛(phantom limb pain,PLP)的疗效. 方法 80例上肢PLP患者采用随机数字表法分为4组(每组20例):基本治疗组(A组)、针刺+基本治疗组(B组)、神经阻滞+基本治疗组(C组)、神经阻滞+针刺+基本治疗组(D组).治疗前后分别采用视觉模拟评分法(visual analogue scales,VAS)、简明健康状况调查表(the MOS item short from health survy,SF-36)和综合疗效评估,并分别进行治疗前后和组间比较. 结果 4组患者治疗前后VAS评分及SF-36评分差异均有统计学意义(P＜0.05),治疗后VAS评分降低,SF-36评分明显升高;与A组(52±6)比较,B组(42±8)、C组(42±8)、D组(32±6)治疗后VAS评分明显降低,差异有统计学意义(P＜0.05);与A组[(精神评分(58±9),身体评分(36±5)]比较,B组[(精神评分(67±9),身体评分(43±4)]、C组[(精神评分(66±6),身体评分(43±5)]、D组[(精神评分(77±10),身体评分(50±6)]治疗后SF-36评分明显升高,差异有统计学意义(P＜0.05);与B组、C组比较,D组治疗后VAS评分明显降低,SF-36评分明显升高,差异有统计学意义(P＜0.05);4组患者综合疗效比较:治疗5周后,与A组(70％)比较,B组(85％)、C组(85％)、D组(100％)的综合疗效差异有统计学意义(P＜0.05),提示B组、C组、D组疗效优于A组,D组疗效优于B组和C组. 结论 采用基本药物和心理治疗联合交感神经阻滞治疗、针刺治疗的中西结合治疗方案能明显提高上肢截肢术后的PLP的疗效,改善患者的生活质量.
  • 摘要：Background The dangers of tobacco is one of the most serious public health problem in the world today.Some 69 million adults receive operations every year,and millions of them encounter perioperative respiratory and cardiovascular complications.Objective This article reviewed the effects of smoking on the surgical outcomes in patients and its mechanism.Content During perioperative period smoking patients encounter with pneumonia,non-expected endotracheal intubation,mechanical ventilation,cardiac arrest,myocardial infarction,stroke,superficial or deep cut infection,sepsis,organ cavity infection and septic shock,postoperative opioid requirements increase.Trend Study on the mechanisms of influence of smoking on perioperative complications and pain sensitivity provide theoretical basis for the rehabilitation of surgical patients.%背景 烟草危害是当今世界最严重的公共卫生问题之一.每年约有0.69亿吸烟患者接受手术治疗,其中数百万患者围术期出现呼吸和心血管并发症. 目的 就吸烟对手术患者围术期结局的影响及其发生机制作一综述. 内容 吸烟患者围术期发生肺炎、非预期气管插管、机械通气、心脏骤停、心肌梗死、中风、切口深部或浅部感染、败血症、器官腔隙感染和感染性休克的机率增加,术后阿片类药物需要量增加. 趋向 研究烟草危害对围术期患者并发症和疼痛敏感性影响的机制,为进一步采取干预措施,促进患者康复提供理论依据.
  • 摘要：Objective To investigate the effect of intrathecal bupivacaine on sensor motor function and on expression of caspase-9 and caspase-8 in dorsal root ganglion in pregnant or nonpregnant rats.Methods Eighteen female SD rats weighting 200 g220 g and eighteen late pregnant rats weighting 350 g-400 g were used in this study.All the pregnant rats in which PE-10 catheter were successfully placed without complication were divided into 3 groups randomly(n=6):normal pregnant control group (group PN),2％ bupivacaine group (group P2B) and 4％ bupivacaine group (group P4B).All the nonpregnant rats in which PE-10 catheter were successfully placed without complication were divided into 3 groups randomly(n=6),normal nonpregnant-control group (group N),2％ bupivacaine group (group 2B) and 4％ bupivacaine group(group 4B).The rats of group PN and group N received normal saline 30 μl intrathecal.The rats of group P2B and group 2B received 2％ bupivacaine 30 μl intrathecal.The rats of group P4B and group 4B received 4％ bupivacaine 30 μl intrathecal Tail-flick test and motor function were performed at 10,20,30 min,1,2,4 h,1,2,3 d and 4 d after intrathecal administration.TF latencies were converted to the percent of maximal possible effect (MPE).Four days later,the animals were sacrificed and the dorsal root ganglion were removed for determination of mRNA using reverse transcriptive polymerase chain reaction (RT-PCR).Results MPE were different among the groups according timepoints after intrathecal.Among in different groups have ainteraction.MPE in group P2B and P4B were significantly higher compared with those in group 2B and 4B after intrathecal 2,4 h and 1 d.MF scores were significantly different after intrathecal 10 min-4 h in rats,group 2B,4B,P2B and P4B motor block time was longer than group N and PN.Rats in group 2B,4B,P2B and P4B showed significantly increase the expression of caspase-9 mRNA in dorsal root ganglion compared with those in group N and PN.Conclusions Intrathecal injection of the same concentration and dosage of bupivacaine,pregnant rats sensory,motor nerve block lasted significantly longer than nonpregnant rats.The result indicated that the sensitivity of bupivacaine increased in pregnancy rats.Bupivacaine showed significantly increase the expression of caspase-9 mRNA in dorsal root ganglion cells.%目的 研究鞘内注入布比卡因对孕鼠神经功能的影响,脊神经细胞的凋亡及其信号转导机制. 方法 取鞘内置管成功孕鼠18只,按完全随机分组方法分成3组(每组6只),孕鼠对照组(PN组)、2％布比卡因组(P2B组)与4％布比卡因组(P4B组).另取鞘内置管成功非孕鼠18只,按完全随机方法分成3组(每组6只):非孕鼠对照组(N组)、2％布比卡因组(2B组)与4％布比卡因组(4B组).PN组与N组:鞘内注射生理盐水30μl,其余4组相应鞘内分别注入2％或4％布比卡因30μl.鞘内注药后不同时间点测定甩尾反应潜伏期(tail-flick latency,TFL),用最大效应百分比(maximal possible effect,MPE)表示,并进行下肢运动功能评分(motor function,MF).4d后各组大鼠行断颈处死,分离背根神经节,逆转录-聚合酶链反应(reverse transcriptive polymerase chain reaction,RT-PCR)检测天冬氨酸特异性半胱氨酸蛋白酶(cysteinyl aspartate specific protease,caspase)-8和caspase-9 mRNA的表达. 结果 注药后MPE随时间发生显著变化(P＜0.05),而且分组与时间之间存在交互作用(P＜0.05),10 min～2 h之间,2B组、4B组、P2B组和P4B组MPE均高于N组和PN组(P＜0.05),在1h时点,P2B组和P4B组MPE均高于N组、PN组、2B组和4B组(P＜0.05);在10 min～4 h之间2B组、4B组、P2B组和P4B组MF评分较N组与PN组均明显升高;与N组(851 ±201)和PN组(755±289)比较,2B组(3 852±1 247),4B组(4 273±1 513),P2B组(4 507±1 437)和P4B组(5 147±1 780) caspase-9 mRNA表达均上调(P＜0.05). 结论 妊娠期间孕鼠背根神经节细胞对布比卡因的阻滞效能敏感性增大.鞘内注入相同浓度和剂量布比卡因,孕鼠感觉、运动神经阻滞持续时间明显长于非孕鼠.鞘内注入布比卡因会导致大鼠背根神经节内caspase-9 mRNA表达上调.
  • 摘要：目的 观察股神经联合坐骨神经阻滞麻醉用于老年患者单侧下肢手术的麻醉效果. 方法 60例行下肢手术的老年患者,年龄60岁～80岁,美国麻醉医师协会(ASA)分级Ⅰ～Ⅲ级,按随机数字表法分为A、B两组,每组30例.A组采用外周神经刺激仪定位,分别于股神经、坐骨神经处注入0.5％罗哌卡因30 ml;B组于L2～3或L3～4.间隙穿刺,向蛛网膜下腔注入0.5％罗哌卡因2 ml,硬膜外向头端置管4 cm.观察并记录两组患者麻醉前(T0)和麻醉后15(T1)、30(T2)、45(T3)、60 min(T4)时的收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、平均动脉压(mean artery pressure,MAP)、心率(heartrate,HR)和口脉搏血氧饱和度(pulse oxygen saturation,SpO2),记录两组的麻醉效果和副作用发生情况. 结果 麻醉前两组患者的SBP、DBP、MAP、HR和SpO2的比较差异均无统计学意义(P＞0.05);与T0比较,A组T1时的MAP无明显变化(P＞0.05),而B组T1时的MAP从(96±8) mmHg(1 mmHg=0.133 kPa)降至(84±6) mmHg(P＜0.01);同一时刻比较,B组T1时的MAP为(84±6) mmHg,明显低于A组(98±7) mmHg(P＜0.01),两组麻醉前后HR和SpO2无明显变化(P＞0.05);两组的麻醉效果均满意,差异无统计学意义(P＞0.05);B组有12例尿潴留,5例恶心、呕吐,2例心动过缓,而A组只有1例患者发生心动过缓,两组差异有统计学意义(P＜0.05). 结论 股神经联合坐骨神经阻滞用于老年患者单侧下肢手术麻醉效果确切,血流动力学比较稳定,副作用少.%Objective To observe the efficacy of femoral and sciatic nerve block in unilateral lower limb surgery in elderly patients.Methods Sixty ASA Ⅰ-Ⅲ patients aged 60 to 80 years,undergoing unilateral lower limb surgery were randomly divided into two groups (n=30).In group A,the femoral and sciatic nerve was identified and blocked with 30 ml of 0.5％ ropivacaine respectively guided with peripheral nerve stimulator.In group B,subarachnoid anesthesia was performed with 2 ml of 0.5％ ropivacaine injected at spinal interspaces L2-3 or L3-4 before an epidural catheter was inserted for anesthesia maintenance.Blood pressure,heart rate and pulse oxygen saturation were monitored before anesthesia (T0) and 15 (T1),30 (T2),45 (Ta),60 min(T4) after anesthesia.The effectiveness of anesthesia and the incidence of adverse reactions were observed in both groups.Results There was no significant difference between the two groups in mean artery pressure (MAP) before anesthesia,while in group B,the MAP were decreased from (96±8) mmHg(1 mmHg=0.133 kPa) to (84±6) mmHg(P＜0.01) at 15 min after anesthesia compaired to preanesthesia.The MAP in group A were(98±7) mmHg while(84±6) mmHg in group B(P＜0.01) at 15 min after anesthesia and that at 30,45 min after induction was also decreased (P＜0.05).There was no significant difference in the analgesia effects between the two groups.The incidence of adverse events (urinary retention,nausea and vomiting,etc.) was higher in group B (P＜0.05).Conclusions Femoral and sciatic nerve block is a safe and efficient technique with more stable hemodynamic status and less adverse events in elderly patients undergoing unilateral lower limb surgery.
  • 摘要：背景 右美托咪定(dexmedetomidine,Dex)作为新型高效的α2肾上腺素受体(α2 adrenergic receptor,α2AR)激动剂,在椎管内麻醉中的镇静镇痛效果逐渐得到临床麻醉医师的认可. 目的 拟通过综述的方式探讨椎管内麻醉应用Dex的前景. 内容 对椎管内麻醉静脉辅助应用Dex镇静、椎管内麻醉Dex与局麻药的复合作用、Dex在椎管内麻醉中预防寒战及Dex的副作用进行综述. 趋向 Dex在椎管内麻醉中将有更广阔的应用价值.%Background Dexmedetomidine (Dex) is a highly selective α2 adrenergic agonist.It is an attempt to improve sedative/analgesic use and more and more applied in intravertebral anesthesia.Objective This article intends to review the study of the intravertebral anesthesia's application of Dex.The purpose is to inspire some new research ideas.Content This article is a review of Intravenous and intravertebral Dex in intravertebral anesthesia.In the mean time,this article is related to shiver prevention and the side effects of Dex being in intravertebral anesthesia.Trend Dex will have more broad application value in intravertebral anesthesia
  • 摘要：Objective To investigate the effect of general anesthesia combined with paravertebral block for thoracic surgery.Methods Retrospectively analyzed 30 patients (group P) under general anesthesia combined with paravertebral block for accepting radical resection of cardia carcinoma and 30 patients (group G) undergoing same surgery with only general anesthesia in the same period.Before general anesthesia,patients in group P received paravertebral nerve block in operating side with 20 ml 0.375％ ropivacaine injected into paravertebral space and catheters were left after injection.The consumption of anesthetic drugs,anesthetic management,anesthetic recovering,postoperative visual analog scale(VAS) at rest and when coughing in both groups were recorded.Satisfaction of anesthesia was recorded 24 h postoperatively.Results The process of anesthesia and operation went well in all groups.The mean consumption of sulfentanyl and sevoflurane in group P was less than that in group G [(5±4) μg vs (26±4) μg](P＜0.01).Recovery time in group P was shorter than that in group G [(45±18) min vs (100±20) min] (P＜0.01).Mean V AS scores when coughing were significantly decreased in group P (P＜0.01).The postoperative fentanyl consumption of patients in group P was significantly less than that in group G [(0.11±0.12) mg vs (0.42±0.11) mg](P＜0.01).Conclusions Using landmark technique in paravertebral block combined with general anesthesia for thoracic surgeries may simplify the anesthesia management and decrease anesthetics consumption in favor of anesthesia recovery and postoperative analgesia.%目的 回顾总结使用全身麻醉复合椎旁阻滞技术对普胸手术患者麻醉管理和恢复的影响. 方法 总结30例椎旁阻滞复合全身麻醉下完成贲门癌根治术患者(P组)的麻醉,与同时期30例在单纯全身麻醉下完成贲门癌根治术患者(G组)的麻醉过程进行对照研究总结.G组患者直接接受全身麻醉后接受手术治疗;P组患者首先清醒接受手术侧的椎旁间隙穿刺注入20 ml 0.375％罗哌卡因并留置导管后再接受全身麻醉开始手术治疗.比较患者麻醉中的用药量,麻醉管理情况.比较术后患者恢复情况,包括拔管清醒时间、静息和咳嗽疼痛视觉模拟评分(visual analogue scale,VAS)、术后镇痛药物的药量、术后24 h患者的整体满意程度进行比较. 结果 所有患者麻醉手术和恢复过程都顺利.P组患者术中舒芬太尼用量[(5±4)μg]显著低于G组[(26±4)μg](P＜0.01),维持麻醉七氟烷浓度P组[(1.41±0.12)％]也显著低于G组[(2.11±0.10)％](P＜0.01).术后P组麻醉恢复时间[(45±18) min]显著短于G组[(100±20) min](P＜0.01),术后P组患者的咳嗽VAS评分显著低于G组,P组追加芬太尼用量[(0.11±0.12) mg]也显著少于G组[(0.42±0.11)mg](P＜0.01). 结论 使用解剖标志定位实施椎旁阻滞与全身麻醉复合应用于食道等普胸手术中可以显著简化麻醉管理,减少麻醉药物使用,更有利于患者的苏醒和术后镇痛.
  • 摘要：目的 探讨依达拉奉(edaravone,EDA)对脂多糖(lipopolysaccharides,LPS)所致小鼠急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)肺纤维化的保护作用及其机制. 方法 72只雄性ICR小鼠按照完全随机分组法分为假致伤组(Sham组)、LPS组和EDA组,各组再分为1、3、7d和14d组,每组6只.LPS组和EDA组由气管内滴入LPS(5 mg/kg);Sham组气管内滴入等量生理盐水;EDA组气管内滴入LPS前1h和后12h,分别予以腹腔注射EDA(5 mg/kg).于各观察点(1、3、7d和14d)处死小鼠.苏木素-伊红(hematoxylin and eosin,HE)染色观察肺组织病理学改变,检测肺组织湿/干重比(wet/dry,W/D)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白介素(interleukin,IL)-1β、丙二醛(malondialdehyde,MDA)、髓过氧化酶(myeloperoxidase,MPO)、Ⅰ型胶原(collagen Ⅰ,Col Ⅰ)和羟脯氨酸(hydroxyproline,HYP)水平,免疫组化法检测肺组织内高迁移率族蛋白B1 (high mobility group box 1,HMGB1),Western Blot检测HMGB1和α-平滑肌收缩蛋白(α-smooth muscle contractile protein,α-SMA)的表达. 结果 LPS组与同时间点Sham组比较,肺组织肺泡间隔明显增宽,可见大量炎性细胞浸润,部分肺泡腔萎陷不张;EDA组较LPS组小鼠肺组织炎性细胞浸润、肺间质肿胀程度明显减轻,正常肺组织结构破坏少.LPS组及EDA组肺组织W/D比值、TNF-α、IL-1β、MDA含量和MPO活性在1d时明显升高,随后逐渐降低;EDA组TNF-α和IL-1β含量明显少于同时间点LPS组(P＜0.05);EDA-3、7、14 d组MDA含量分别为(6.94± 1.07)、(5.31±0.95) nmol/mg prot 和(3.16±0.37) nmol/mg prot,明显低于同时间点LPS组[(9.15±0.30)、(7.05±0.71) nmol/mg prot和(4.77±0.64) nmol/mg prot](P＜0.05);EDA-1、3、7d组MPO活性分别为(0.051 ±0.007)、(0.040±0.008) U/g和(0.032±0.005) U/g,显著低于同时间点LPS组[(0.066±0.011)、(0.050±0.014) U/g和(0.043±0.008) U/g] (P＜0.05).LPS诱导后,HMGB1的表达增多,主要定位在胞质;EDA组HMGB1表达明显低于与同时间点LPS组(P＜0.05).与同时间点Sham组比较,LPS组α-SMA和Col Ⅰ 、HYP显著增加(P＜0.05);EDA-1、3、7d组α-SMA显著低于同时间点LPS组(P＜0.05);EDA组Col Ⅰ、HYP显著低于同时间点LPS组(P＜0.05). 结论 EDA可能通过抑制氧化应激反应,减少体内炎症因子的产生和释放,减缓或阻断炎症反应和氧化应激损伤的恶性循环,减轻肺泡上皮的损伤和异常修复,阻止肺纤维化的进展,进而对LP所致ARDS肺纤维化起到防治作用.%Objective The aim of this study is to explore the protective effect of edaravone (EDA) on lipopolysaccharides (LPS)-induced acute respiratory distress syndrome (ARDS) with pulmonary fibrosis in mice and their potential mechanism.Methods Seventy-two male ICR mice were divided into Sham group,LPS group and EDA group by completely randomized method.Each group was further divided into 1,3,7 d and 14 d group (n=6).LPS(5 mg/kg) and equivalent saline was intratracheal instilled in LPS group and Sham group respectively.Intraperitoneal edaravone (5 mg/kg) was injected 1 h before and 12 h after intratracheal instillation of LPS in EDA group.At 1,3,7 d and 14 d,lungs were seized after animals were killed.Hematoxylin and eosin(HE) staining was used to observe of lung histopathology.Detection of lung wet/dry (W/D),tumor necrosis factor-α (TNF-α),interleukin (IL)-1 β,malondialdehyde (MDA),myeloperoxidase (MPO),collagen Ⅰ (Col Ⅰ) and hydroxyproline (HYP) levels was performed.Immunohistochemistry was used to detect high mobility group box 1 (HMGB1) in the lung tissue.The expression of HMGB1 and α-smooth muscle contractile protein (α-SMA) was detected by Western Blot.Results Compared with the same time point in Sham group,the lung tissue of LPS group showed significantly widened alveolar septa,a large number of inflammatory cell infiltration and partial alveolar collapse.Compared with the same time point in LPS group,the EDA group showed less inflammatory cell infiltration,interstitial lung exudates with significantly reduced damage of normal alveolar structure.Lung tissue W/D ratio,TNF-α,IL-1β,MDA content and MPO activity in LPS and EDA group was significantly elevated in 1 d,and then gradually decreased.EDA group TNF-α and IL-1β was significantly less than that in LPS group at the same time (P＜0.05).TNF-α and IL-1β levels in mice lung tissue of EDA group were significantly less than that in LPS group at the same time (P＜0.05).EDA-3,7,14 d group MDA levels of mice lung tissue was (6.94±1.07),(5.31±0.95) nmol/mg prot and (3.16±0.37) nmol/mg prot,significantly lower than that in the LPS group [(9.15±0.30),(7.05±0.71) nmol/mg prot and (4.77±0.64) nmol/mg prot] at the same time points (P＜0.05).EDA-1,3,7 d group MPO lung tissue in mice were (0.051±0.007),(0.040±0.008) U/g and (0.032±0.005) U/g,significantly lower than that in the LPS group [(0.066±0.011),(0.050±0.014) U/g and (0.043±0.008) U/g] at the same time point (P＜0.05).The expression of HMGB1 increased in LPS-induced mice,mainly located in the cytoplasm.HMGB1 expression was significantly lower in the the EDA group than that in LPS group at the same time point (P＜0.05).Col Ⅰ,HYP levels of LPS group increased significantly in EDA group(P＜0.05).α-SMA expression in EDA-1,3,7 d group was significantly lower than that in LPS group at the same time(P＜0.05).Col Ⅰ,HYP content in mice lung tissue of EDA group was significantly lower (P＜0.05).Conclusions EDA plays the vital role of prevention of LPS-induced ARDS with pulmonary fibrosis by reducing the abnormal alveolar epithelial injury and repair to prevent progression of lung fibrosis due to inhibition of oxidative stress,abatement of inflammatory cytokines and slowing down or breaking the vicious cycle of inflammatory response.
  • 摘要：Objective To observe the effect of acute normovolemic hemodilution (ANH) combine with low central venous pressure (LCVP) on regulatory T cells and natural killer (NK) cells in patients undergoing liver cancer resection.Methods The Sixty-six patients undergoing right liver cancer operation operated by the same surgeon were equally randomized into three groups ANH,LCVP,or ANH+LCVP,respectively.Peripheral venous blood was extracted on postoperative days 0(T0),1(T1),3(T2),5(T3) to determine immune function including regulatory T cells and NK cells.Results Compare with T0,the levels of CD4+CD25+[(9.0±1.4),(8.3±1.3)] and CD25+FOXP3+[(3.6±0.7),(3.3±0.7)] decreased,CD8+[(23.7±3.8),(26.9±2.8)] and CD4+CD25[(36.7±3.1),(38.0±1.9)] increased at T2 and T3,NK cells (12.8±2.8) decreased at T1 in the A+L group; the levels of CD4+CD25+[(12.1±2.9),(12.4±3.3) and (13.3±2.9),(13.0±3.8)] and CD25+FOXP3+[(5.4±1.5),(5.2±1.8) and (6.0±1.9),(5.5±2.0)] increased,CD8+ [(17.8±3.7) and (16.5±3.1)] decreased at T1,NK cells [(12.6±3.4),(11.4±4.2),(12.5±4.8) and (11.1±3.5),(11.2±4.7),(11.0±5.3)]decreased at T1,T2 and T3 in the L and A groups,in addition,CD4+CD25[(30.3±3.8),(31.2±6.5)] decreased at T1 and T2 in the A group (P＜0.05).Compare with the A+L group,the levels of C D4+CD25+[(12.1 ±2.9),(12.4±3.3),(10.8±3.9) and (13.3±2.9),(13.0±3.8),(12.6±4.3)] and CD25+FOXP3+ [(5.4± 1.5),(5.2± 1.8),(4.6± 1.9) and (6.0± 1.9),(5.5±2.0),(4.9± 1.7)] increased in the L and A groups,CD8+ [(16.5±3.1),(18.6±6.3),(19.2±6.9)] decreased in the A group at T1,T2 and T3,the levels of CD8+[(18.9±4.0),(20.5±5.0)] and CD4+CD25[(32.4±5.3),(34.6±6.2)] decreased in the L group,CD4+CD25[(31.2±6.5),(31.8±6.8)] decreased in the A group,NK cells [(11.4±4.2),(12.5±4.8) and (11.2±4.7),(11.0±5.3)] decreased in the L and A groups at T2 and T3(P＜0.05).In the patients of non-allogeneic transfusion:compare with T0,the levels of C D4+CD25+ [(9.0± 1.4),(8.3± 1.3) and (9.4± 1.8),(8.5±1.3)] and CD25+FOXP3+[(3.6±0.7),(3.4±0.7) and (3.7±0.8),(3.4±0.8)] decreased,CD8+[(23.7±3.8),(26.9±2.8) and (24.3±3.2),(25.61 ±3.0)] and CD4+CD25[(36.7±3.1),(38.0± 1.9) and (37.3 ±2.5),(38.2±2.4)] increased at T2 and T3,NK cells [(12.8±2.8) and(13.4±3.6)] decreased at T1 in the A+L group and A groups,the levels of CD4+CD25+(8.6±1.4) and CD25+FOXP3+ (3.7± 1.0) decreased,CD8+(23.3±2.5) and CD4+CD25(38.1±2.3) increased at T3,NK cells(13.8±3.2),(13.2±3.5)] decreased at T1 and T2 in the L group (P＜0.05).Compare with the A+L group,the levels of CD4+CD25+(10.9±2.5) and CD25+FOXP3+(4.3±1.0)increased,NK cells (13.2±3.5) decreased at T2,CD8+ [(20.7±3.0),(23.3±2.5)] decreased at T2 and T3 in the L group (P＜0.05).However,the alterations of T lymphocyte subsets and NK cells in the A group were not significant difference at each time points(P＞0.05).Conclusions In liver cancer operations,ANH combine with LCVP can rapidly improve postoperative immune functions and NK cells immune regulatory functions.%目的 探讨急性等容血液稀释(acute normovolemic hemodilution,ANH)联合低中心静脉压(low central venous pressure,LCVP)对肝癌患者调节性T细胞及自然杀伤(natural killer,NK)细胞的影响. 方法 同一手术医师实施择期右肝癌患者66例,采用随机数字表法将患者均分为3组(每组22例):ANH联合LCVP组(A+L组)、LCVP组(L组)和ANH组(A组).分别于麻醉前(T0)、术后第1天晨(T1)、术后第3天晨(T2)、术后第5天晨(T3)抽取外周静脉血测定调节性T细胞及NK细胞的情况. 结果 在所有患者中,与T0时比较:A+L组T2、T3时,CD4+CD25+[(9.0±1.4)、(8.3±1.3)]、CD25+FOXP3+[(3.6±0.7)、(3.3±0.7)]均降低,CD8+[(23.7±3.8)、(26.9±-2.8)] 、CD4+CD25[(36.7±3.1) 、(38.0±1.9)]均增加,T1时NK细胞(12.8±2.8)降低;L组和A组T1、T2时CD4+CD25+[(12.1±2.9)、(12.4±3.3)和(13.3±2.9)、(13.0±3.8)]、CD25+FOXP3+[(5.4±1.5)、(5.2±1.8)和(6.0±1.9)、(5.5±2.0)]均增加,T1时CD8+[(17.8±3.7)和(16.5±3.1)]降低,T1、T2、T3时NK细胞[(12.6±3.4)、(11.4±4.2)、(12.5±4.8)和(11.1±3.5)、(11.2±4.7)、(11.0±5.3)]均降低,A组T1、T2时CD4+CD25-[(30.3±3.8)、(31.2±6.5)]均降低,差异有统计学意义(P＜0.05).与A+L组比较,T1、T2、T3时L组和A组CD4+CD25+[(12.1±2.9)、(12.4±3.3)、(10.8±3.9)和(13.3±2.9)、(13.0±3.8)、(12.6±4.3)]、CD25+FOXP3+[(5.4±1.5)、(5.2±1.8)、(4.6±1.9)和(6.0±1.9)、(5.5±2.0)、(4.9±1.7)]均增加,A组CD8+[(16.5±3.1)、(18.6±6.3)、(19.2±6.9)]均降低;T2、T3时L组CD8+[(18.9±4.0)、(20.5±5.0)]、CD4+CD25-[(32.4±5.3)、(34.6±6.2)]降低,A组CD4+CD25[(31.2±6.5)、(31.8±6.8)]均降低,L组和A组NK细胞[(11.4±4.2)、(12.5±4.8)和(11.2±4.7)、(11.0±5.3)]均降低,差异有统计学意义(P＜0.05).在未输异体血患者中:与T0时比较,A+L组和A组于T2 、T3时CD4+CD25+[(9.0±1.4)、(8.3±1.3)和(9.4±1.8)、(8.5±1.3)]、CD25+FOXP3+[(3.6±0.7)、(3.4±0.7)和(3.7±0.8)、(3.4±0.8)]均减少,CD8+[(23.7±3.8)、(26.9±2.8)和(24.3±3.2) 、(25.61±3.0)] 、CD4+CD25[(36.7±3.1)、(38.0-±1.9)和(37.3±2.5)、(38.2±2.4)]增加,T1时NK细胞[(12.8±2.8)和(13.4±3.6)]减少;L组于T3时CD4+CD25+(8.6± 1.4)、CD25+FOXP3+(3.7± 1.0)减少,CD8+(23.3±2.5)、CD4+CD25(38.1±2.3)增加,T1、T2时NK细胞[(13.8±3.2)、(13.2±3.5)]均减少,差异有统计学意义(P＜0.05).与A+L组比较,L组T2时CD4+CD25+(10.9±2.5) 、CD25+FOXP3+(4.3±1.0)均增加,NK细胞(13.2±3.5)减少,T2 、T3时CD8+ (20.7±3.0)、(23.3±2.5)均减少,差异有统计学意义(P＜0.05);A组各时点差异均无统计学意义(P＞0.05). 结论 在肝癌手术中联合应用ANH和LCVP技术,可以较快的改善患者术后的免疫功能和NK细胞的免疫调节功能.
  • 摘要：Background Generally,patients should be examinated routinely before operation,but the value of operation risk assessment and the effect of spending is rarely reported,and the current doctor-patient relationship more aggravated the medical behavior to be blindness and non scientific nature.Therefore,thinking of he perspective of evidence-based medicine,seeking the clinical evidence seems to be the best solution to the problem.Objective This paper analysis and elaborate the correlation with anesthesia operation risk or outcome and the conventional inspection items before operation,and to investigate the relationship between the risk benefit and cost.Content The detection rate of occult disease by examined the three routine,electrocardiogram,blood biochemistry and organ function,and how these routine inspections affect on the anesthesia assessment and decision making.Trend Whether routinely medical behavior can bring real medical security,based on the tension doctor-patient relationship and ignored the waste of social resources,increase the cost for patients without corresponding benefit,are worthy of all of the official,the general anesthesia,and the operation doctors thinking critically.%背景 一般来说,患者术前均需常规检查,但其评估手术风险的价值及对花费的影响鲜有报道,且目前的医患关系更加剧了这种被认为是常规的医疗行为的盲目性和不科学性.因此,从循证医学的思维出发,寻求目前临床相关证据似乎是解决这一问题的最佳方法. 目的 通过分析阐述麻醉手术前常规的检查项目、麻醉手术风险与结局的相关性,了解这种风险得益与费用的关系. 内容 三大常规、心电图、血生化以及器官功能检查对隐匿性疾病的检出率;这些常规检查对改变麻醉手术评估结果和决策的影响. 趋向 所谓常规的医疗行为是否能带来真正的医疗安全,建立在紧张医患关系之上而忽视对社会资源的浪费以及徒增患者花费而并没有获得相应得益,这些问题值得官方及广大麻醉、手术医师进行思考.
  • 摘要：背景 半个多世纪来的研究证实丙酮酸盐具有多细胞/组织的保护功能. 目的 阐述丙酮酸盐对组织细胞的保护作用和可能的机制,提供深入研究的基础. 内容 丙酮酸是糖酵解的中间产物,是三大营养物质的代谢枢纽.外源性丙酮酸盐可在无氧和严重缺氧下保护多组织和器官功能,尤其是心肌、内皮和血细胞以及神经/视网膜和肠组织等;这可能和改善糖代谢紊乱,促进细胞能量代谢,抗氧化和硝基化,纠正细胞内酸中毒,抑制炎症反应等多途径修复细胞损伤有关. 趋向 丙酮酸可能在保护缺血/缺氧以及创伤和感染等所致组织细胞损伤和重症病例的治疗方面具有良好的应用前景.%Background Pyruvate has been demonstrated since over half a century ago that it has multi-histocyte protection function.Objective The present review illustrated the pyruvate's protection of multi-histocyte and its potential mechanisms for further studies.Context Pyruvate is metabolite of glycolysis,a center of three major nutrition's metabolisms in human beings.Exogenous pyruvate can preserve protection function on multiple tissue/organ under hypoxic,even anoxic conditions,especially cardiomyocytes,endothelial cells,blood cells,neurons and retina.The pyruvate protection may be closely associated with its correction of glucose metabolic disorders,enhancement of energy,anti-oxidative and-nitrosative stress,correction of intracellular acidosis,inhibition of inflammation,as well as anti-apoptosis.Trend Pyruvate may have great prospect in treating tissue damage and severe cases caused by ischemia,hypoxia,trauma and infection.
  • 摘要：Objective To compare the efficacy of different concentration of ropivacaine mesylate in cervical plexus nerve block.Methods Eighty ASA Ⅰ-Ⅱ thyroid adenoma patients were randomly divided into four groups:group A,group B,group C and group D (n=20),which were respectively performed cervical plexus nerve block with 0.55％,0.45％,0.35％,0.25％ Ropivacaine Mesylate.The analgesic effect and changes of breathing rate and heart rate (HR) were observed.Results Compared with group D(15),the mean rank of analgesic effect in group A,group B and group C(27,26,26) was significantly higher(P＜0.05).The mean rank of difficulty breathing in group B,group C and group D (38,39,67) were higher than that in group A(16) (P＜0.05).The mean rank of increased HR in group B,group C and group D(39,39,62) were higher than that in group A(20)(P＜0.05).Conclusions 0.35％-0.45％ ropivacaine mesylate is appropriate concentration in cervical plexus nerve block.%目的 比较不同浓度甲磺酸罗哌卡因实施颈丛神经阻滞的效果. 方法 选择美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级甲状腺腺瘤患者80例,采用随机数字表法将患者随机分成A、B、C、D4组,每组20例,依次采用0.55％、0.45％、0.35％、0.25％甲磺酸罗哌卡因实施颈丛神经阻滞,观察各组患者麻醉后的镇痛效果及呼吸和心率(heart rate,HR)的变化.结果 A、B、C、D组镇痛效果的平均秩次依次为27、26、26、15,A、B、C组的镇痛效果明显高于D组(P＜0.05),A、B、C组之间差异无统计学意义(P＞0.05).A、B、C、D组呼吸困难程度的平均秩次依次为16、38、39、67,A组呼吸困难程度明显高于B、C、D组(P＜0.05).A、B、C、D组HR增加的平均秩次依次为20、39、39、62,A组HR增加明显高于B、C、D组(P＜0.05). 结论 0.35％～0.45％甲磺酸罗哌卡因是颈丛神经阻滞较为合适的局麻药浓度.
  • 摘要：目的 观察侧卧折刀位对动脉血-呼气末二氧化碳分压差[difference of partial pressure of carbon dioxide in artery and end-tidal pressure of carbon dioxide,P(a-ET)CO2]的影响. 方法 36例择期手术患者分为两组(每组18例)∶对照组(C组)为择期行腹部手术患者,术中一直为仰卧位;实验组(L组)为择期行肾脏切除术、输尿管切开取石术或肾上腺囊肿切除术等患者,术中需要仰卧位变为侧卧折刀位.两组患者均采用全凭静脉麻醉,气管插管后机械通气,设置呼吸频率15次/min,吸呼比1∶1.5,维持呼气末二氧化碳分压(end-tidal pressure of carbon dioxide,PETCO2)在30 mmHg～35 mmHg(1 mmHg=0.133 kPa)之间.两组患者在PETCO2稳定(波动不超过1 mmHg)(T0)后15 min时(T1)和35 min时(T2)行动脉血气分析,期间不调整呼吸参数.L组于T1时仰卧位改为侧卧折刀位,而C组仰卧位不变.术中常规监测心电图、心率、脉搏血氧饱和度、有创血压、潮气量、气道峰压、分钟通气量、PETCO2等. 结果 L组T2时PETCO2、动脉血二氧化碳分压(partial pressure of carbon dioxide in artery,PaCO2)和p(a-ET)CO2分别为(28.4±2.3)、(35.7±3.3)、(7.2±3.0)mmHg,而L组T1时分别为(32.2±1.8)、(34.2±2.0)、(2.6±2.8) mmHg,差异有统计学意义(P＜0.05).C组T1和T2时P(a-ET)CO2分别为(2.6±2.5)、(3.1±1.5)mmHg,均低于L组T2时的P(a-ET)CO2(P＜0.05). 结论 侧卧折刀位体位显著增加P(a-ET)CO2,根据PETCO2指导调整呼吸参数时,应降低其数值.%Objective To observe the effects of lateral position plus jacknife position on difference of partial pressure of carbon dioxide in artery and end-tidal pressure of carbon dioxide[P(a-ET）CO2].Methods Thirty-six patients undergoing elective surgery under total intravenous anesthesia were involved.Patients were divided into two groups (n=18):control group (group C) and experimental group (group L).Patients undergoing abdominal surgery were at supine position in group C.Patients undergoing nephrectomy,ureterolithotomy surgery or adrenal cyst resection were at lateral position plus jacknife position.Patients were endotracheal intubation and mechanical ventilation,respiratory rate was 15 rpm,inspiratory/expiratory ratio was 1∶1.5.End-tidal pressure of carbon dioxide(PETCO2) was stable between 30 mmHg-35 mmHg (1 mm Hg=0.133 kPa).Blood gas analysis was done at 15 (T1),35 min (T2) and PETCO2 was stable (T0)(the fluctuation was less than 1 mmHg).The ventilator parameters were not been constant during T0-T2 At T1,patients' position were changed from supine position to lateral position plus jacknife position in group L,and patients' position remained supine position in group C.Intraoperative monitoring consisted of electrocardiogram,invasive arterial pressure,heart rate,pulse oxygen saturation,tidal volume,minute ventilation,peak of airway pressure,end-tidal pressure of carbon dioxide(PETCO2),and so on.Results PETCO2,partial pressure of carbon dioxide in artery(PaCO2) and P(a-ET)CO2 were respectively (28.4±2.3),(35.7±3.3),(7.2±3.0) mmHg at T2 in group L.In group L,those items were(32.2± 1.8),(34.2±2.0),(2.6±2.8) mmHg at T1 respectively(P＜O.05).P(a-ET)CO2 were(2.6±2.5) and (3.1 ±1.5) mmHg at T1 and T2 respectively in group C.Compared with group L,P (aET)CO2 were significantly lower (P＜0.05).Conclusions P (a-ET)CO2 was significantly increases at lateral position plus jacknife position.So the ventilator parameters should be adjusted according PETCO2.
  • 摘要：背景 术后认知功能障碍(postoperative cognitive dysfunction,POCD)是老年人大型手术后常见的并发症,严重影响了患者的预后及生活质量.局部脑氧饱和度(regional cerebral oxygen saturation,rSO2)可反映出脑组织的氧供需平衡.已有研究报道术中低脑氧饱和度与POCD的发生密切相关. 目的 评价rSO2与POCD的发生是否具有直接相关性. 内容 近红外光谱仪(near infrared spectroscopy,NIRS)可提供持续、无创的rSO2的监测,虽然这一监测手段很有前景,但是否能预防POCD的发生仍存在争议.此文就rSO2与POCD相关性进行综述. 趋向 术中监测rSO2对预防术后神经系统并发症提供了新的监测手段,但是否完全有效地预防POCD的发生,还需进一步研究.%Background Postoperative cognitive dysfunction (POCD) commonly develops after major surgery in elderly patients which may affect patients' outcome.Regional cerebral oxygen saturation (rSO2) serves as a tool to evaluate cerebral oxygen supply-demand balance.It has been reported that intraoperative cerebral desaturation closely associated with POCD.Objective The aim of this review is to evaluate the correlation between rSO2 values and postoperative cognitive dysfunction.Content Near infrared spectroscopy (NIRS) allows continuous,noninvasive monitoring.of rSO2.It is regarded as a promising,but not widely accepted technique to reduce POCD.This article reviewed the correlation between rSO2 values and postoperative cognitive dysfunction.Trend NIRS appears to be a new tool to predict central nervous system complications,however,futher study need to be conducted to evaluate the overall efficacy.
  • 摘要：背景 阿片类药物是临床上治疗慢性癌痛和非癌性疼痛最常用的药物之一.其副作用之一,阿片类药物诱导的痛觉过敏(opioid-induced hyperalgesia,OIH)正越来越受到研究者们的关注,然而其具体的发生机制和治疗方法尚不明确.目的 探讨OIH在动物和人体中的可能表现形式和发生机制,寻找有效的预防和治疗OIH的方法,提高对慢性疼痛患者治疗的临床疗效. 内容 已有大量动物和临床实验报道了OIH的可能表现形式并证实了OIH的存在.OIH的发生机制主要包括腺苷酸环化酶的活性增强、离子通道瞬时受体电位香草醛亚家族1(transient receptor potential vanilloid 1,TRPV1)基因转录的增加、内源性感觉神经肽的增多等.对于预防和治疗OIH学者们提出了多种方法,其中有些方法的疗效已在临床研究中得到证实. 趋向 我们还需进一步研究OIH的机制,探索更加有效和持久的治疗和护理方法,更好地为患者造福.%Background Opioid is one of the most common drugs being used in cancer pain or chronic non-cancer pain.Opioid-induced hyperalgesia (OIH),one of opioid side effects,is increasing nowadays.Objective Discussion on the possible patterns of manifestation and mechanism of OIH on animals or human.To find effective ways to preventing and treating OIH.To improve the outcomes of chromic pain management.Content A large amount of animal or clinical researches had demonstrated the possible manifestation of OIH.The mechanisms of OIH are related to increasing activity of adenylate cyclase,up-regulation of the transient receptor potential vanilloid 1 (TRPV1) channel's expression and increasing number of endogenous neuropeptides.Many researchers put forward different ways to preventing and treating OIH.Trend It is needed for further study of the mechanisms and treatments of OIH.
  • 摘要：Background Lacking of integrated and systematic pain assessment tools has been a serious obstacle of pain management in the intensive care unit (ICU) setting.Pain relief is of great importance not only for patients but also for their families.In order to provide the high quality of nursing service,a pain assessment and a timely pain relief have to be accomplished at first.However,no pain assessment equipment has been widely accepted or applied to patients with difficulty in communication.Objective This review analyzed and summarized the existent pain assessment tools for those critically ill patients with communication difficulty.Content Firstly we discussed the importance of pain assessment for critically ill patients.And then we introduced 6 different pain assessment tools including" behavior pain scale (BPS)","face,legs,activity,cry,consolability behavioural tool(FLACC)","nociception coma scale(NCS)","non-verbal pain scale(NVPS)","the critical-care pain observation tool (CPOT)"and "the pain assessment in advanced dementia scale (PAINAD)".Finally we discussed the limitations of those pain assessment tools.Trend In our country,the critically ill patients' pain assessment was just in the start-up phase.Regular use of pain assessment tools can be helpful to avoid the state of pain with lacking of analgesia caused by over sedation,and also to improve the compliance of the patients.%背景 缺乏一个完整的、系统的评估工具是当今重症监护室(ICU)疼痛评估的一大障碍.免于疼痛是病患的权力,是基本的人权,也是家属极为关心的事项之一.评估疼痛、管理疼痛和及时缓解疼痛是提供优质护理服务必需做到的,然而国际上目前尚无一种受到普遍认可的适用于存在交流障碍的患者的疼痛评估工具. 目的 分析总结目前能评估交流障碍的危重症患者疼痛的评估工具. 内容 危重症患者疼痛评估的重要性;危重症患者疼痛评估工具:疼痛行为量表(the behavior pain scale,BPS)、伤害性昏迷量表(nociception coma scale,NCS)、疼痛评估量表(face,legs,activity,cry,consolability behavioural tool,FLACC)、非语言的疼痛的量表(non-verbal pain scale,NVPS)、危重症患者疼痛观察工具(the critical-care pain observation tool,CPOT)、晚期老年痴呆症疼痛评估量表(the pain assessment In advanced dementia scale,PAINAD);危重症患者疼痛评估工具的局限性. 趋向 国内的重症患者疼痛评估尚处起步之中,规律地使用疼痛评估工具可避免患者处于镇静过度而镇痛不足的痛苦状态,提高患者的依从性,使其积极地配合治疗.
  • 摘要：Objective To investigate and analyse the status quo of discipline construction of anesthesiology departments in Guangxi.Methods Two hundred and ten hospitals were involved in questionnaire survey,which included manpower resource,working spectrum and anesthetic equipments.Results 133 questionnaires (63.3％) were retrieved.The survey data of 4 first-level hospitals was excluded.The ratio of operation table to anesthetist in 129 secondary and tertiary hospitals was 1∶1.2.In tertiary hospitals,88.9％ of anesthetists had bachelor degree or above.In secondary hospitals,39.8％ of anesthetists had college degree or below and only 2.3％ of anesthetists had senior professional title.Among the 129 hospitals,anesthesia for induced abortion,endoscopy and labor analgesia was carried out in 112 hospitals(86.7％),83 hospitals (63.5％) and 69 hospitals(53.4％)respectively.Postanesthetic care unit,pain branch and intensive care unit was set up in 42 hospitals (32.5％),34 hospitals (26.3％) and 60 hospital (46.5％) respectively.Anesthetic equipments in 27 hospitals (20.9％) were not considered qualified by anesthetic staff.Conclusions Scarcity of anesthesiologists is obvious in most of these hospitals with unreasonable academic credentials and professional titles structure.Comfort medicine was not extensively developed.Diagnosis and management of pain and Critical Care Medicine were hardly developed Anesthetic equipments allocation failed to reach the 'ideal state.Discipline construction of departments of anesthesiology in Guangxi should be modified.%目的 了解广西麻醉学科基本建设的现状. 方法 采用问卷调查法对我区210家医院麻醉科的人力资源、医疗业务开展情况、医疗设备等情况进行调查. 结果 回收问卷133份,回收率63.3％,其中4份一级医院的调查数据未纳入统计分析.129家三级医院和二级医院手术床与麻醉医师比为1∶1.2.三级医院麻醉医师大学本科及本科以上学历占88.9％.二级医院麻醉医师专科及专科以下学历仍有39.8％、高级职称者仅为2.3％.112家(86.7％)医院开展人工流产麻醉、82家(63.5％)医院开展内镜麻醉、69家(53.4％)医院开展分娩镇痛业务.42家(32.5％)医院设置麻醉恢复室、34家(26.3％)医院设置疼痛科、60家(46.5％)医院设置重症医学科.27家(20.9％)医院麻醉科认为设备配置不合格. 结论 我区绝大部分医院麻醉医师数量仍不足、学历和口职称结构欠合理;舒适化医疗未普及开展、疼痛诊疗和重症医学发展缓慢、设备配置情况未达理想状态.我区麻醉学科基本建设仍需进一步加强.
  • 摘要：Objective To investigate the role and mechanism of protein kinase B (Akt) in opioid-induced hyperalgesia (OIH) with an incisional pain model.Methods Sixty C57BL/6 male mice were randomly divided into 5 groups (n=12):incision pain+ dimethyl sulfoxide(DMSO) group(group Ⅰ),incision pain+remifentanil+DMSO group(group R),Akt inhibitor Ⅳ 0.08 μg/10 μl group(group A1),Akt inhibitor Ⅳ 0.16 μg/10 μl group(group A2) and Akt inhibitor Ⅳ 0.32 μg/10 μl group(group A3).DMSO was the solvent of Akt inhibitor Ⅳ.Incisional pain model was made in the right paw of all the mice.In group R and group A1,A2,A3,subcutaneous remifentanil(0.04 mg/kg) was infused for 30 min while the surgery was being performed and intrathecal 10 μl DMSO(10％) with corresponding concentration of the Akt inhibitor Ⅳ 10 μl was injected respectively.The paw mechanical withdrawal threshold (PMWT) and the paw withdrawal thermal latency(PWTL) was tested at 1 d(T0) before and 6 h(T1),1(T2),2(T3),3(T4),5(T5),7 d(T6) after surgery.Results Compared with group Ⅰ and the baseline value,PMWT and PWTL were significantly decreased after surgery except 7 d in group R and all group A(P＜0.05).Compared with group R,PMWT[(5.03±0.62),(6.10±0.86),(5.92±0.88),(6.01±1.02) g.(4.07±0.79),(4.73±0.48),(4.77±0.59),(4.86±0.56) g.(5.05±0.75),(5.99±0.63),(5.99±0.71),(6.00±0.81) g] and PWTL[(0.48±0.06),(0.60±0.08),(0.61±0.07),(0.58±0.04) s.(0.38±0.07),(0.50±0.08),(0.48±0.06),(0.45±0.08) s.(0.37±0.09),(0.52±0.09),(0.49±0.12),(0.58±0.21) s] were significantly increased after surgery except 7 d in groups A1,A2,A3 (P＜0.05).While there was no significant difference among group A1,A2 and A3 (P＞0.05).Conclusions Intrathecal injection of different doses of Akt inhibitor Ⅳ effectively alleviates hyperalgesia induced by remifentanil in non-dose-dependent way.%目的 通过观察鞘内注射不同浓度的蛋白激酶B(protein kinase B,Akt)抑制剂Ⅳ对切口痛瑞芬太尼痛觉过敏小鼠痛行为学的影响,初步探讨Akt在阿片诱导的痛觉过敏(opioid-induced hyperalgesia,OIH)中的作用及其机制. 方法 C57BI/6小鼠60只,采用随机数字表法分为5组(每组12只):切口痛+二甲基亚砜(dimethyl sulfoxide,DMSO)组(Ⅰ组)、瑞芬太尼+DMSO组(R组)、Akt抑制剂Ⅳ0.08 μg/10μl组(A1组)、Akt抑制剂Ⅳ0.16 μg/10μl组(A2组)、Akt抑制剂Ⅳ0.32 μg/10μl组(A3组),其中DMSO是Akt抑制剂Ⅳ的溶媒.所有分组均在右侧足做切口痛,R组、A1组、A2组及A3组造模同时腹部皮下泵注瑞芬太尼(0.04 mg/kg)30 min.R组及A1组、A2组及A3组术前30 min分别鞘内给予10％ DMSO 10μl和相应浓度的Akt抑制剂Ⅳ10μl.各组小鼠在术前1 d(T0)及术后6 h(T1)、1(T2)、2(T3)、3(T4)、5(T5)、7 d(T6)检测术侧后足热缩足潜伏期(paw withdrawal thermal latency,PWTL)及机械缩足阈值(paw mechanical withdrawal threshold,PMWT). 结果 与Ⅰ组和基础值比较,R组、A1组、A2组及A3组术后各时间除术后7d外PMWT和PWTL均降低(P＜0.05);与R组比较,A1组、A2组及A3组术后6h、1、2d的PMWT [(5.03±0.62)、(6.10±0.86)、(5.92±0.88)、(6.01±1.02) g;(4.07±0.79)、(4.73±0.48)、(4.77±0.59)、(4.86±0.56)g;(5.05±0.75)、(5.99±0.63)、(5.99±0.71)、(6.00±0.81)g]和术后1、2、3d的PWTL明显升高[(0.48±0.06)、(0.60±0.08)、(0.61±0.07)、(0.58±0.04)s;(0.38±0.07)、(0.50±0.08)、(0.48±0.06)、(0.45±0.08) s;(0.37±0.09)、(0.52±0.09)、(0.49±0.12)、(0.58±0.21)s](P＜0.05);A1组、A2组及A3组的各时间点的PWMT和PWTL差异无统计学意义(P＞0.05); 结论 预先鞘内注射Akt抑制剂Ⅳ能够有效缓解瑞芬太尼诱发的痛觉过敏,而且没有剂量依赖性.
  • 摘要：目的 观察青少年特发性脊柱侧凸矫形术后认知功能障碍(postoperative cognitive dysfunction,POCD)的发生,并探讨其发生与外周血白介素(interleukin,IL)-1β和IL-6水平变化的关系. 方法 拟选入择期行脊柱后路矫形术患者67例,根据是否发生POCD将患者分为POCD组和非POCD组.监测入院时(T0)、术前(T1)、术毕(T2)及术后第2天(T3)4个时刻的血清IL-1β及IL-6浓度并于术前1d、术后7d评估患者POCD的发生情况. 结果 共有66例患者完成所有测试,其中19例患者发生POCD,发生率为28.8％.统计结果表明:两组患者入院和术前血清IL-1β和IL-6浓度差异无统计学意义,而术毕及术后较基础水平均升高,但组间差异无统计学意义(P＞0.05);此外,组间比较术中及术后各记录指标发现,与非POCD组[(218±270) ml]比较,POCD组[(380±341) ml]患者自体血的输入量较多(P＜0.05). 结论 青少年特发性脊柱侧凸患者术后7d认知功能障碍发生率为28.8％,需要引起足够的重视,本试验发现外周血IL-1β及IL-6水平与POCD发生无关,但结果提示术中自体血回输量可能与POCD发生有关,需要进一步研究.%Objective To observe the occurrence of postoperative cognitive dysfunction (POCD) in adolescent scoliosis patients after orthopedic surgery and study its association with levels of serum interleukin (IL)-1β/IL-6 during perioperative period.Methods Sixty-seven adolescent scoliosis patients,who were scheduled for orthopedic surgery with general anesthesia were proposed to be enrolled.The levels of serum IL-1β and IL-6 were measured on the day for admission(T0),before surgery(T1),at the end of the surgery (T2) and the second day after surgery (T3) respectively and neurocognitive testing was performed at 1 d before surgery and 1 week after operation.Age,sex,years of education,past medical history,and visual analogue scale score after surgery,duration of surgery and other intraoperative indexes and also postoperative complications were recorded.According to the diagnostic criteria of POCD,patients were divided into two groups:POCD and NPOCD.All the data were put for statistical analysis.Results Sixty-six patients completed all these tests.Nineteen patients developed POCD,so the occurrence was 28.8％ at 7 d postoperatively.Statistical analysis showed that there were no differences in the levels of serum IL-1β and IL-6 at T0 and T1 in all the patients,while the concentrations increased at T2 and T3,but there were no differences between the two groups.In addition,comparisons between the two groups showed that the infusion of the volume of autologous blood in POCD group [(380±341) ml]was more than that in NPOCD group [(218±270) ml](P＜0.05).Conclusions The incidence of POCD is 28.8％ on the seventh day after scoliosis orthopedic surgery.It reminds us that we should cause enough attention on such surgeries.We did not found the relationship between the levels of serum IL-1beta/IL-6 and the occurrence of POCD,but the result sμggested that the volume of infused autologous blood might be associated with the occurrence of POCD,and further research was needed.
  • 摘要：Objective The aim of this study was to explore the role of heat shock protein A 12B (HSPA 12B) as a potential prognosis biomarker for multiple organ dysfunction syndrome (MODS).Methods The study involved 30 patients with MODS,including non-survivors (n=16) and survivors (n=14).Thirty patients with systemic inflammatory response syndrome (SIRS) and 15 healthy controls to evaluate the prognostic value of HSPA12B.The levels of plasma HSPA12B and interleukin (IL)-6 were measured by enzyme linked immunosorbent assay (ELISA).Results The level of plasma HSPA12B was significandy higher in patients with MODS than that in other two groups (P＜0.001).There is no differences in HSPA12B levels between SIRS patients and healthy volunteers (P=0.647).Level of HSPA12B in non-survivors was significantly higher than that in survivors (P＜0.05).Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ)score,MODS score,Sequential organ failure assessment(SOFA) score,and length of mechanical ventilation in non-survivors were significantly higher than surviors.For prognostic value of HSPA12B,it has a area under the cure(AUC)of0.826(95％ CI:0.663-0.989,P＜0.01),significantly higher than IL-6.Conclusions Increased plasma HSPA12B within 24 h after onset of MODS can be considered as a potential prognostic biomarker in patients.%目的 研究血浆热休克蛋白A12B(heat shock protein A12B,HSPA12B)对多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)患者预后的意义. 方法 采用前瞻性病例对照研究.纳入MODS患者30例,存活组14例,死亡组16例,并纳入全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)患者30例,健康志愿者15例.记录患者的人口统计学资料、临床信息、急性生理和慢性健康评分(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、MODS评分及序贯性器官衰竭评分(sequential organ failure assessment,SOFA).通过酶联免疫吸附试验(enzyme-linked immunosorbent assay,ELISA)测定诊断MODS后24 h内外周血中HSPA12B水平,探讨其与患者病情及预后的相关性. 结果 MODS患者外周血中HSPA 12B水平较SIRS患者、健康志愿者显著升高(P＜0.001),且死亡组患者外周血中HSPA 12B的水平较存活组显著升高(P＜0.05);MODS死亡组患者较存活组患者APACHEⅡ评分、SOFA评分、MODS评分、机械通气时间差异有统计学意义(P＜0.05),外周血中HSPA12B水平与APACHEⅡ评分、SOFA评分和MODS评分显著正相关.HSPA 12B预测患者死亡的曲线下面积(area under the cure,AUC)为0.826(95％ CI:0.663～0.989,P＜0.0),显著高于白介素(interleukin,IL)-6(P＜0.01).当HSPA 12B水平为1.577 μg/L时,HSPA 12B预测患者死亡的敏感度为72.2％,特异度为86.8％. 结论 血浆HSPA 12B水平可作为判断MODS患者预后的指标.
  • 摘要：目的 研究七氟烷后处理对大鼠局部脑缺血/再灌注损伤(ischemia/reperfusion injury,I/RI)的影响,初步探讨细胞外信号调节激酶(extracellular signaling-regulated kinase,ERK)1/2信号通路在其中的作用. 方法 建立大鼠大脑中动脉栓塞(middle cerebral artery occlusion,MCAO)模型.按随机数字表法将70只雄性Sprague-Dawley(SD)大鼠随机分为7组(每组10只):假手术组(Sham组)、I/RI组、七氟烷后处理组(Sevo组)、丝裂原活化蛋白激酶(mitogen-activated protein kinase,MAPK)/ERK1/2特异性阻断剂U0126组/PD98059组(U0126组/PD组)、七氟烷后处理+U0126组/PD98059组(Sevo+U0126组/Sevo+PD组).除Sham组外,其余各组大鼠均局部缺血90 min,再灌注24 h.Sevo组局部缺血90 min,再灌注开始即刻吸入2.5％七氟烷30 min行后处理,再灌注至24 h.特异性阻断剂U0126/PD98059分别于缺血前30 min显微镜下脑室内给予注射.再灌注24 h后行神经功能评分,测定脑梗死容积,Western blot法测定Total-ERK 1/2及磷酸化ERK1/2(ERK1/2 P42/P44)表达. 结果 与Sham组比较,I/RI组及Sevo组神经功能评分及脑梗死容积均增加(P＜0.05);Sevo组神经功能评分及脑梗死容积较I/RI组显著降低[分别为(2.2±0.4)vs(3.2±0.6)和(24.1±2.1)％vs(42.3±2.2)％](P＜0.05),磷酸化ERK1/2表达显著增高(P＜0.05),U0126组、PD组及Sevo+U0126组、Sevo+PD组各指标组间比较差异无统计学意义(P＞0.05). 结论 七氟烷后处理减轻大鼠局部脑I/RI,其作用机制可能与激活MAPK/ERK1/2信号通路有关.%Objective To investigate the effect of sevoflurane postconditioning on extracellular signaling-regulated kinase (ERK)1/2 after cerebral ischemia/reperfusion injury(I/RI) in rats.Methods Rat middle cerebral artery occlusion(MCAO) model was bulit.Seventy male Sprague-Dawley(SD) rats were randomly assigned to 7 groups (with 10 rats each):Sham group,I/RI group,sevoflurane postconditioning group (Sevo group),U0126/PD98059 [specific inhibitor of mitogen-activated protein kinase (MAPK)/ ERK1/2] group,Sevo+U0126 group and Sevo+PD group.All rats except the Sham group were subjected to 90 min of MCAO followed by 24 h reperfusion.Sevoflurane was administrated at the beginning of reperfusion for 30 min.U0126/PD98059 was given by intracerebroventricular injection 30 min before ischemia.The neurological deficit scores and infarct volume were evaluated at the end of reperfusion.Total ERK1/2 and Phosphrylated-ERK1/2 (ERK1/2 P42/P44) were measured by Western blot analysis.Results Compared with the Sham group,both of the neurological deficit scores and infarct volume increased in I/RI group and Sevo group (P＜0.05).Compared with I/RI group,significantly decreased neurological deficit scores and infarct volume[(3.2±0.6) vs (2.2±0.4)and (42.3±2.2)％ vs (24.1±2.1)％,respective](P＜0.05),significantly increased ERK1/2 P42/P44 expression were found in the Sevo group(P＜0.05).There was no significant difference in all variables among U0126 group,PD group,Sevo+U0126 group and Sevo+PD group (P＞0.05).Conclusions Sevoflurane postcondnioning may protect brain I/RI in rat perhaps contribute to activation of the ERK1/2 signaling pathway.
  • 摘要：背景 麻黄碱作为一种拟交感神经药,可通过增加心输出量加速非去极化肌松药到达神经肌肉接头的速度,进而缩短肌松药的起效时间. 目的 回顾麻黄碱在缩短非去极化肌松药起效时间方面的临床应用进展,为临床麻醉提供参考. 内容 主要对麻黄碱的作用机制、给药剂量、给药时机、副作用等方面予以阐述. 趋向 麻黄碱为临床麻醉中缩短非去极化肌松药的起效时间提供一种实用的方法.%Background Ephedrine,as a kind of sympathomimetic agent,can accelerate the delivery of non-depolarizing muscle relaxant to the neuromuscular junction by increasing cardiac output,thus shortening the onset time of muscle relaxant.Objective To review the advances of ephedrine use in shortening the onset time of non-depolarizing muscle relaxant and provide reference for clinical anesthesia.Content This article mainly elaborates the mechanism of ephedrine on shortening the onset time of non-depolarizing muscle relaxant,dosage,medication timing and adverse reactions.Trend Ephedrine has been proved to provide a practical way for shortening the onset time of non-depolarizing muscle relaxant in clinical anesthesia.
  • 摘要：背景 分娩疼痛程度剧烈,可对产妇及胎儿产生一系列不良影响.椎管内分娩镇痛是目前国内外应用最为普遍的分娩镇痛方法. 目的 回顾椎管内分娩镇痛对儿童影响的研究文献. 内容 椎管内分娩镇痛可以改善新生儿的状态(包括提高新生儿Apgar评分、改善新生儿酸碱平衡状态),这可能有利于儿童的远期发育,但还有待进一步的临床研究证实.椎管内分娩镇痛增加产妇发热的发生,这并不增加新生儿感染的发生,但会对新生儿产生不良的影响.已有的研究未能发现分娩镇痛药物对儿童脑发育有不良影响,也未发现剖宫产能改善儿童智力发育或器械助产能导致儿童远期神经发育迟缓. 趋向 目前的结果未发现椎管内分娩镇痛对儿童有不良的影响,这方面仍有待进一步研究.%Background Labor pain is one of the most severe pains that a woman encounters during her life time.And it produces a series of adverse effects on both mother and child.Neuraxial labor analgesia is the most commonly used method of labor analgesia.Objective To review the effects of neuraxial labor analgesia on children.Content Neuraxial analgesia improved the neonatal status (including higher Apgar score,ameliorated acid-base balance),which might be favorable for children's long-term neurodevelopment.The later effect,however,deserves further confirmation.Neuraxial analgesia increased the occurrence of maternal fever during delivery which might have adverse effects on the newborn.However,it did not increase the rate of neonatal infection.Current evidence had not find that drugs used during labor analgesia has any negative effects on children's brain development.Furthermore,studies had not find that cesarean section improved children's mental development,nor that instrumental delivery produced children's long-term neurodevelopmental retardation.Trend Current results have not find that neuraxial labor analgesia has adverse impacts on children.Further studies are needed to illuminate this problem.
  • 摘要：背景 大量研究表明各种疼痛模型和疼痛患者的神经元会产生自发性放电,并且近年来对这种自发性放电在疼痛过程中所发挥的重要作用有了较多的研究. 目的 总结分析神经元自发性放电在疼痛中的作用,为疼痛进一步研究提供新的思路. 内容 文章主要从神经元自发性放电、神经元自发性放电与疼痛的关系、神经元自发性放电与疼痛治疗三方面就与此有关的研究进展作一系统的综述. 趋向 疼痛中神经元的自发性放电将继续引起疼痛研究者的关注,因为它可能为疼痛的诊断、监测、管理提供新的方法.%Background Considerable studies have demonstrated that spontaneous discharge of neuron is a common phenomenon in various pain models and painful patients,which plays an important role in the process of pain.Objective This paper summarized the role of spontaneous discharge of neuron in pain and provided new ideas for advanced pain research.Content This paper reviewed related research on spontaneous discharge of neuron from three aspects,including spontaneous discharge of neuron,the correlation between spontaneous discharge of neuron and pain,spontaneous spiking of neuron and pain therapy.Trend Spontaneous discharge of neuron deserves further attractions as it may offer novel approaches for the diagnosis,monitoring and management of pain.
  • 摘要：Background Occludin,one of integral membrane proteins,extensively exists in epithelial cells and endothelial cells of brain,liver,lung,kidney and other important organs,constituting tight junctions(TJs) with Claudin,ZO-1,ZO-2 and ZO-3 together.Phosphorylation of Occludin plays an important role in the regulation of TJs function,structure and permeability.Objective This paper aims to introduce different kinds of phosphorylation as to promote our knowledge of TJs and its permeability.Content This paper introduced biological characteristics of occludin,different kinds of phosphorylation and clinical significance of phosphorylation.Trend Further investigation on phosphorylation of occluding and its mechanism should be done to come up with proper measurement to decrease the injury of organs and improve the quality of the patients.%背景 Occludin蛋白是一种跨膜连接蛋白,广泛地存在于脑、肝、肺、肾等重要器官的上皮细胞和内皮细胞中,与胞浆中的ZO-1、ZO-2、ZO-3,Claudin等蛋白共同参与细胞间的紧密连接(tight junctions,TJs).Occludin蛋白是组成TJs的最主要成分,其不同磷酸化状态直接影响TJs功能、结构及通透性. 目的 研究occludin蛋白不同磷酸化状态,提高对TJs的认识,深入了解通透性. 内容 介绍Occludin蛋白的生物学特性,Occludin蛋白不同磷酸化状态及Occludin蛋白磷酸化的临床意义. 趋向 对Occludin蛋白磷酸化状态及机制进行深入分析和研究,采取相应的防治措施,有助于减少脏器的损害,提高患者的生活质量.

    国际麻醉学与复苏杂志的期刊信息

    • 曾用名：国外医学.麻醉学与复苏分册;国外医学:麻醉学与复苏分册;国外医学：麻醉学与复苏分册;国外医学(麻醉学与复苏分册)
    • 创刊时间：1980
    • 地区：CN
    • 语言：中文
    • 热门主题：中华医学会;徐州医科大学
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