目的 探讨综合性护理干预对于肝豆状核变性合并癫痫患者的影响.方法 将58例肝豆状核变性合并癫痫患者随机分为观察组30例和对照组28例,对照组实施常规护理,观察组在常规护理基础上加以综合性护理干预.比较两组患者并发症的发生情况及出院时的护理满意度情况.结果 观察组患者的并发症发生率为6.7％,明显低于对照组32.1％,出院时观察组的护理满意度为100％,明显高于对照组的42.9％.两组比较差异均有统计学意义(P<0.05).结论 对肝豆状核变性合并癫痫患者实施综合性护理干预对于减少患者临床并发症,提高其生活质量及护理满意度具有重要意义.
Objective To investigate the effects of sevoflurane and fentanyl on long term cognitive function in aged rats. Methods 120 aged Wistar rats were randomly divided into four groups, rats received sham surgery group, myocardial ischemia reperfusion model group, myocardial ischemia reperfusion model plus sevoflurane group, and myocardial ischemia reperfusion model plus fentanyl group. Blood samples and brain tissue were collected. Hipp-ocampal neurons apoptosis index was calculated using TUNEL assay, and the rate of apoptosis was measured by flow cytometry and intracellular calcium levels in hippocampal neurons. Fluorescent probes were used to determine mitochondrial membrane potential in rat hippocampal neurons. ELISA assay was used to detect the inflammatory factors in the blood. Cognitive function was assessed by Morris water maze test. Results The results demonstrated that treatment of anesthetics shortened the periods of learning and memory incubation, suggesting a protective role in cognitive function. The expression of tumor necrosis factor-α (TNF-α ) and IL-1β decreased, whereas vascular endothelial growth factor(VEGF) expression increased when using anesthetics(P ＜0. 05). In addition, anesthetic treatment reduced neuronal apoptosis rate and apoptosis index, hut improved neuron cytoplasmic and mitochondrial membrane potential activity (P ＜ 0. 05 ). Conclusion Sevoflurane and fentanyl can increase the expression of VEGF and decrease the release of inflammatory factors such as IL-1β and TNF-α. The sevoflurane and fentanyl can also reduce the hippocampus cell apoptosis rate after ischemia-reperfusion in rats, reduce the incidence of cognitive dysfunction in aged rats. Among them, effect of sevoflurane is better.
目的观察并分析围术期应用脑电双频谱指数(BIS)及听觉诱发电位指数(AAI)监测来调整麻醉深度对七氟烷应用总量、苏醒时间和拔管时间的影响,并与以血流动力学指标来调整麻醉深度组做比较。方法择期七氟烷全麻下行腹腔镜胆囊切除手术患者45例,ASAⅠ～Ⅱ级,随机分为3组,每组15例。对照组:根据患者的血压来调节呼气末七氟烷浓度(ETsevo),保持血压和心率波动在基础值的±20%;AAI组:保持术中AAI值维持在15～20;BIS组:保持术中BIS值维持在45～55。于麻醉诱导前、气腹即刻、游离胆囊三角、游离胆囊、腹腔冲洗、缝皮和拔管前记录平均动脉压(MAP)、心率(HR)、脉搏氧饱和度(SPO2)、AAI、BIS和ETsevo,并记录苏醒时间和拔管时间,术毕1h内取3个时点行镇静/清醒(OAA/S)评分。结果麻醉维持期ETsevo对照组大于AAI组和BIS组(P<0.05);苏醒时间和拔管时间AAI组与BIS组均较对照组短(P<0.05);术后1h内各时点的OAA/S评分3组之间差异无统计学意义。AAI和BIS两组之间差异无统计学意义。结论将BIS、AAI监测运用于吸入麻醉能在很大程度上降低手术中吸入麻醉药的呼气末浓度,从而减少麻醉药需要量,缩短患者麻醉苏醒时间和拔管时间,更有预见性的使用吸入麻醉。
