Objective:To compare the anesthetic effects of sevoflurane and propofol in hepatectomy by using Meta-analysis.Methods:Randomized controlled trials (RCTs) regarding anesthetic effects of sevoflurane and propofol in hepatectomy were systematically searched from Cochrane Library, PubMed, Embase, CNKI, Chongqing VIP and Wanfang databases from the inception date to March 2022 by using the keywords of sevoflurane, propofol, hepatectomy and RCT in both English and Chinese. In the sevoflurane group, sevoflurane combined with fentanyl and other analgesics was given, and propofol in combination with fentanyl and other analgesics was delivered in the propofol group. Meta-analysis was conducted by RevMan 5.4 software. The anesthetic effects were compared between two groups.Results:13 RCTs consisting of 923 patients were enrolled. 460 patients were assigned in the sevoflurane group and 463 cases in the propofol group. Meta-analysis showed that the average arterial pressure after anesthesia and tracheal intubation in the sevoflurane group was significantly lower than that in the propofol group (MD=-5.17, P<0.05). Postoperative levels of ALT, AST and TB in the sevoflurane group were significantly lower than those in the propofol group (MD=-52.70, -41.18, -9.19; P<0.05). Postoperative levels of IL-6,IL-10 and TNF-α in the sevoflurane group were significantly lower compared with those in the propofol group (MD=-6.32, -10.98, -4.25; P<0.05). In the sevoflurane group, the recovery time of spontaneous breathing and the time of eye opening after operation were significantly shorter than those in the propofol group (MD=-5.54, -12.45; P<0.05). Postoperative visual analogue scale (VAS) score in the sevoflurane group was significantly lower than that in the propofol group (SMD=-1.19, P<0.05). There was no significant difference in extubation time between two groups (MD=-12.15, P=0.05).Conclusions:Compared with propofol, sevoflurane anesthesia in hepatectomy can suppress postoperative secretion of plasma inflammatory cytokines, accelerate the recovery of liver function, contribute to postoperative recovery of anesthesia, yield favorable analgesic effect and bring clinical benefits.

[目的]对比分析丙泊酚或七氟醚配合右美托咪定对老年腹腔镜下肿瘤切除手术患者血流动力学的影响.[方法]选择老年腹腔镜下肿瘤切除手术患者94例,按照随机数字表法分为A组(47例)与B组(47例).A组采用丙泊酚配合右美托咪定麻醉,B组采用七氟醚配合右美托咪定麻醉.比较2组手术时间、出血量和麻醉时间,术前、术后3 h和术后6 h简易精神状态评价量表(MMSE)评分,不同时刻血流动力学指标变化.[结果]A组与B组手术时间、出血量和麻醉时间比较差异无统计学意义(P＞0.05),术后3 h MMSE评分较术前降低(P＜0.05);A组术后6 h MMSE评分较术前无明显变化(P＞0.05),而B组术后MMSE评分较术前降低(P＜0.05);A组术后3 h、6 h MMSE评分均高于B组(P＜0.05),A组与B组T1时刻心率、舒张压和收缩压较T0时刻降低,而平均动脉压较T0时刻升高(P＜0.05);A组T1、T2和T3时刻舒张压和收缩压高于B组,而平均动脉压低于B组(P＜0.05).[结论]丙泊酚配合右美托咪定对老年腹腔镜下肿瘤切除手术患者血流动力学、术后认知功能影响小.

肝包虫病又称为肝棘球蚴病,这是一种主要由细粒棘球绦虫和多房棘球绦虫的幼虫累及于肝脏所引起的人兽共患性寄生虫疾病.青海省位于我国青藏高原东北部,是我国肝包虫病流行的严重区域,患者的生活因为该病而受到严重影响.随着医学的不断进步,近年来外科手术已经成为治疗肝包虫病的主要手段.由于肝脏血供十分丰富,为了更加有效提高肝包虫病手术的安全性,临床通过控制性低中心静脉压(CLCVP)技术以减少手术创面的出血量.但也有一些研究指出CLCVP技术在肝脏手术中存在一定滞后性.因此,探讨是否通过CLCVP技术以辅助外科手术从而有效控制肝包虫病的流行具有一定的现实意义.

Objective:Based on the etiological analysis of 105 patients with primary liver cancer,the influencing factors and risk of primary liver cancer in Qinghai were discussed.Methods:A case-control study was conducted on 105 patients with primary liver cancer and 124 patients with non-primary liver cancer who were hospitalized in the Department of Hepatobiliary and Pancreatic surgery,Affiliated Hospital of Qinghai University from March 2019 to September 2021.Results:There was no significant difference in address,history of hepatitis C,history of blood transfusion,fatty liver,cholecystitis,drinking history,liver echinococcosis and contact history of cattle,sheep and dogs between the two groups.Multivariate Logistic regression analysis showed that history of hepatitis B,liver cirrhosis and portal hypertension were independent risk factors for primary liver cancer.Conclusion:History of hepatitis B,liver cirrhosis and portal hypertension are independent risk elements of primary liver cancer,which should be prevented and controlled actively.

目的 探讨活血止痛胶囊联合舒芬太尼对老年全髋关节置换术后镇痛的疗效及对血流动力学、血液流变学及炎性因子影响.方法 选取医院收治的全髋关节置换术后患者125例,随机分为对照组(63例)和治疗组(62例).对照组术后给予舒芬太尼,治疗组在对照组基础上给予活血止痛胶囊,两组患者均持续治疗72 h.对比两组患者的临床疗效、术后镇痛前(T0)、术后镇痛12h(T1)、术后镇痛24h(T2)、术后镇痛48h(T3)、术后镇痛镇痛72 h(T4)的VAS和Ramsay镇静评分、血流动力学指标、血液流变学指标及血清炎性因子水平及不良反应情况.结果 治疗后,治疗组总有效率较高(P＜0.05);在T0和T1时刻两组VAS评分差异无统计学意义(P＞0.05);在T2、T3和T4时刻治疗组患者VAS评分明显低于对照组(P＜0.05);在T0和T1时刻两组Ramsay镇静评分差异无统计学意义(P＞0.05);在T2、T3和T4时刻治疗组患者Ramsay镇静评分明显低于对照组(P＜0.05);两组治疗前血清IL-6、TNF-α和CRP水平差异无统计学意义(P＞0.05);两组治疗后血清IL-6、TNF-α和CRP水平显著降低(P＜0.05);并且治疗组降低较明显(P＜0.05);两组治疗前SBP、DBP和HR值差异无统计学意义(P＞0.05);两组治疗后SBP、DBP和HR值显著降低(P＜0.05);并且治疗组降低较多(P＜0.05);两组治疗前血液流变学指标水平差异无统计学意义(P＞0.05);两组治疗后PV、WBV、HCT、FIB明显降低(P＜0.05);并且治疗组降低较多(P＜0.05).结论 老年全髋关节置换术后采用活血止痛胶囊联合舒芬太尼进行治疗,具有较好的镇痛效果,可降低VAS评分,安全性较高,值得在临床上推广应用.

目的 观察七氟烷吸入溶液剂用于高海拔地区藏族肝包虫手术患者的临床疗效及安全性.方法 将89例拟进行肝包虫手术的高海拔地区藏族患者随机分为对照组43例和试验组46例.对照组给予咪达唑仑2 mg+0.15 mg·kg-1顺式阿曲库铵+2 mg·kg-1丙泊酚+舒芬太尼20～30μg进行麻醉诱导,术中给予瑞芬太尼和丙泊酚分别以25～150μg·kg-1·min-1和0.01～0.10μg·kg-1·min-1的速度静脉麻醉维持,并视术中情况追加顺式阿曲库铵.试验组在麻醉诱导时联合吸入30％七氟烷30 min,其余治疗方法同对照组.比较2组患者的谷丙转氨酶(GPT)和谷草转氨酶(GOT)水平,以及药物不良反应的发生情况.结果 在阻断肝门后10 min、恢复肝血流20 min、恢复肝血流1 h和术后12 h时,试验组的GPT分别为(89.82±21.19),(120.01±30.02),(153.21±44.39)和(230.02±56.28)U·L-1,GOT分别为(78.82±19.20),(115.50±33.40),(162.20±50.03)和(204.03±60.38)U·L-1;对照组的GPT分别为(102.29±25.59),(167.28±29.89),(230.11±52.31)和(365.21±66.54)U·L-1,GOT分别为(101.10±23.30),(153.32±35.50),(210.15±49.82)和(290.88±59.82)U·L-1.2组患者相同时间点的上述指标比较,差异均有统计学意义(均P<0.05).试验组术后出现的药物不良反应有咳嗽和恶心呕吐,对照组术后出现的药物不良反应有恶心呕吐、咳嗽和头痛.试验组和对照组的总药物不良反应发生率分别为17.39％和16.28％,差异无统计学意义(P>0.05).结论 七氟烷吸入溶液剂用于高海拔地区藏族患者肝包虫手术患者具有肝保护作用,且不增加药物不良反应的发生率.

目的 基于Rho/Rho-kinase信号通路探讨丙泊酚减轻大鼠脑缺血再灌注损伤的效果.方法 SD大鼠100只分成:对照组、模型组、丙泊酚低、中、高剂量组(20.0、40.0、80.0 mg/kg),模型组、丙泊酚低、中、高剂量组建立脑缺血再灌注损伤模型,建模成功后,丙泊酚低、中、高剂量组给予相应剂量丙泊酚灌胃,对照组和模型组给予等体积生理盐水,持续给予4周,实验结束后,对每只大鼠进行神经功能缺损评分,行贴纸去除及平衡木行走实验,对大鼠海马区进行病理评分,同时测定大鼠脑组织中Rho、Rho-kinase mRNA和蛋白水平.结果 模型组神经功能缺损评分、双侧贴纸去除时间、平衡木过杆时间、海马组织病理评分、脑组织海马区Rho、Rho-kinase mRNA和蛋白表达水平明显高于对照组(P<0.05);丙泊酚各剂量组神经功能缺损评分、双侧贴纸去除时间、平衡木过杆时间、海马组织病理评分、脑组织海马区Rho、Rho-kinase mRNA和蛋白表达水平明显低于模型组(P<0.05);且随着丙泊酚给药剂量的增加,神经功能缺损评分、双侧贴纸去除时间、平衡木过杆时间、海马组织病理评分、脑组织海马区Rho、Rho-kinase mRNA和蛋白表达水平逐渐降低,剂量-效应关系明显(P<0.05).对照组海马区神经元细胞完整,排列紧密;模型组海马区神经元排列松散,细胞深染固缩,有片状坏死,神经细胞间质隔离;丙泊酚高剂组神经元细胞趋于正常;丙泊酚中、低剂量组较模型组而言,神经细胞疏松、固缩程度轻,神经元细胞核仁清楚可见.结论 丙泊酚能减轻大鼠脑缺血再灌注神经功能损伤;其机制与丙泊酚能抑制Rho、Rho-kinase mRNA和蛋白的表达进而抑制Rho/Rho-kinase信号通路的激活有关.

目的 探讨七氟醚预处理对藏区肝包虫手术患者肝缺血再灌注损伤(LIRI)和血浆中性粒细胞核转录因子κB(NF-κB)活性的影响.方法 选择就诊的80例肝包虫手术患者,采用随机数字表法将其随机分为藏族世居包虫患者对照组(ZC组)、藏族世居包虫患者七氟醚预处理组(ZS组)、汉族移居包虫患者对照组(HC组)和汉族移居包虫患者七氟醚预处理组(HS组)各20例.ZC组和HC组不用吸入性麻醉药,ZS组和HS组麻醉诱导插管采用七氟醚吸入麻醉.于麻醉诱导前(T0)、肝门阻断即刻(T1)、肝门开放即刻(T2)、缺血/再灌注1 h(T3)、6 h(T4)、24 h(T5),检测各时刻血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、乳酸脱氢酶(LDH)、乳酸、肿瘤坏死因子α(TNF-α)、白细胞介素(IL)-6水平和中性粒细胞NF-κB活性;于T3时刻,检测正常肝组织丙二醛(MDA)和超氧化物歧化酶(SOD)水平;HE染色光镜下观察肝组织病理学形态.结果 与ZC组比,ZS组患者在T1～L时间点的ALT、AST、LDH、乳酸、TNF-α、IL-6水平和NF-κB活性均降低(P＜0.05),在T3时间点肝组织的SOD活性升高(P＜0.05),肝组织的MDA水平降低(P＜0.05);与HC组比,HS组患者在T1～T5时间点的ALT、AST、LDH、乳酸、TNF-α、IL-6水平和NF-κB活性均降低(P＜0.05),在T3时间点肝组织的SOD活性升高(P＜0.05),肝组织的MDA水平降低(P＜0.05);HE染色显示ZS组和HS组肝组织病理变化减轻.结论 七氟醚可能通过抑制中性粒细胞NF-κB活性,抑制炎症因子的释放,减轻藏区肝包虫手术患者肝缺血再灌注损伤.

目的 探讨七氟醚预处理对减轻高原地区肝包虫患者缺血-再灌注损伤的作用,进而为肝包虫病手术中合理用药提供理论依据.方法 选取2017年9月至2018年7月本院收治的泡型肝包虫手术患者50例,男27例,女23例,年龄22 ～ 68岁,体重40～90 kg,ASA Ⅰ或Ⅱ级,Child-Pugh分级A级.随机分为七氟醚预处理组(SEV组)与对照组(TIVA组).SEV组持续性吸入2％的七氟醚,于手术结束前30 rmin停止.TIVA组给予全凭静脉麻醉,采用瑞芬太尼0.2μg·kg-1·min-1和丙泊酚1.5～2.5μg/ml靶控输注,间接追加顺式阿曲库铵.记录麻醉诱导前(T0)、肝门阻断(T1)、肝门开放(T2)、缺血-再灌注1 h(T3)、6 h(T4)、24 h(T5)两组患者ALT、AST、乳酸(Lac)、肿瘤坏死因子-α(TNF-α)、白细胞介素-1(IL-1)浓度,检测肝组织丙二醛(MDA)、超氧化物歧化酶(SOD)活性和NF-κB、ICAM-1蛋白相对含量,观察两组患者术中出血量、拔管时间、下床活动时间、术后住院时间、肝衰竭发生等情况.结果 T2-T5时,SEV组ALT、AST、Lac、MDA、TNF-α、IL-1明显低于TIVA组(P＜0.05),NF-κB和ICAM-1蛋白相对含量明显低于TIVA组(P＜0.05),SOD活性明显强于TIVA组(P＜0.05).SEV组患者术中出血量明显少于TIVA组(P＜0.05),术后住院时间、下床活动时间明显短于TIVA组(P＜0.05),肝衰竭发生率明显低于TIVA组(P＜0.05).结论 七氟醚预处理可减轻高原地区肝包虫手术肝缺血-再灌注损伤,可能与减少炎性因子生成、增强肝脏自由基清除能力有关.

目的:探讨高原地区危重患者术中乳酸水平与其术后病死率的相关性,为临床治疗提供参考.方法:回顾性分析100例需要进行手术的择期或急诊危重患者(ASA分级Ⅲ-Ⅳ级)为研究对象,根据患者术后疾病转归将其分为死亡组(n=24例)和存活组(n=76)两组,比较两组患者年龄、性别、急性生理学以及慢性健康状况评分(APACHEⅡ评分)、机械通气数量、机械通气时间、住ICU时间、乳酸、6 h乳酸清除率以及疾病构成的不同;观察不同乳酸水平、6 h乳酸清除率与患者病情和预后的关系;分析患者乳酸水平与预后相关参数的相关性.结果:死亡组患者在年龄、机械通气时间、机械通气数量、A-PACHEⅡ评分以及血乳酸含量明显高于存活组患者,血乳酸6 h乳酸清除率明显低于存活组患者(P<0.05);而在疾病构成方面,死亡组患者患有神经系统疾病以及心血管疾病的比例明显高于存活组(P<0.05);而两组患者患有消化系统疾病、呼吸系统疾病、复合伤以及其他疾病的比例无明显差异(P>0.05).乳酸酸中毒组患者的住院天数、术后送ICU病例以及A-PACHEⅡ评分明显高于高乳酸血症组,6 h乳酸清除率明显低于高乳酸血症组患者(P<0.05);而两组不同血乳酸水平患者的病死率差异无统计学意义(P>0.05).不同血乳酸清除率的两组患者的APACHEⅡ评分以及血乳酸水平差异无统计学意义(P>0.05);低清除率组患者的病死率为85.29％,明显高于高清除率患者的病死率(28.29％),差异有统计学意义(P<0.05).患者的血乳酸水平与其机械通气天数呈现负相关(r=-0.358,P<0.01),与APACHEⅡ评分呈现正相关(r=0.305,P<0.01),而与患者的住ICU时间和病死率无关(r=0.865,P=0.087;r=0.968,P=0.106).结论:高原地区危重患者的乳酸水平与其术后病死率无相关性,但与其病情危重程度呈正相关,而患者术中病死率与其血乳酸清除率密切相关.

OBJECTIVE To analyze the effects of different anesthetic methods on pulmonary infection in elderly patients with abdominal surgery ,so as to explore a relatively safe and effective anesthesia method to reduce the in‐cidence of lung infections .METHODS From Jun .2009 to Jun 2013 ,a total of 96 cases of elderly patients with up‐per abdominal surgery were chosen as study objects .They were randomly divided into general anesthesia combined with epidural block group (group A) ,inhalation anesthesia group (group B) and total intravenous anesthesia group (group C) with 32 cases each .The indexes among the groups were compared and analyzed by SPSS15 .0 software .RESULTS The pulmonary infection rate ,the recovery time and extubation time were 3% ,(6 .42 ± 3 .29) min ,and (12 .26 ± 6 .38) min respectively in group A ,and they were 21 .88% ,(15 .16 ± 8 .07) min ,(22 .45 ± 10 .23) min in group B ,while in C group ,the figures were 18 .75% ,(15 .75 ± 6 .67) min ,(22 .09 ± 10 .34) min .The postoperative pulmonary infection rate in group A was less than that in group B and C .The difference was significant (P<0 .05) .The level of interleukin ‐6 (IL‐6) ,interleukin‐8 (IL‐8) and T lymphocyte subsets CD4 + /CD8 + ratio were compared in the 6h ,1d and 3d after the surgery of the three groups .The results showed that IL‐6 and IL‐8 level were increased remarkably in the three groups compared with the level before anesthesia treatments (P<0 .05) .CONCLUSION Though the comparison and analysis we can know that epidural block com‐bined with general anesthesia is in favor of early extubation and has low pulmonary infection rate after the surgery . Hence it is useful to stabilize and recover the condition of elderly patients .

目的 探讨乌司他丁对高原地区老年前列腺增生症(BPH)经尿道前列腺电切术(TURP)的肺功能保护.方法 观察我院实施TURP术后联合应用鸟司他丁治疗老年BPH患者的效果.结果 与术前比较,A组术中和术后第1天动脉氧分压(PaO2)降低明显.肺泡压差(PA-aDO2)和呼吸指数(砌)升高(P＜0.05).A组和B组Na+的变化随手术时间呈现下降趋势,术中和术后第1天相比下降明显(P＜0.01).结论 乌司他丁用于高原地区老年患者TURP手术临床效果较好,值得推广应用.

目的观察七氟烷对大鼠缺血再灌注损伤肝脏的保护作用,并探讨其机制。方法雌性SD大鼠32只,随机分为A、B、C、D 4个组,各8只。A、B组采用腹腔注射1%戊巴比妥钠(PB)40 mg/kg麻醉,A组仅分离肝脏周围韧带不阻断入肝血流;B组麻醉后夹闭肝动脉和门静脉左支,造成约70%肝脏缺血60 min、再灌注3 h,建立肝脏缺血再灌注模型。C、D组采用七氟烷吸入麻醉,C组余操作同A组,D组麻醉后行部分肝脏缺血再灌注。采用化学发光法检测血清ALT、AST和乳酸脱氢酶(LDH);采用硫代巴比妥酸分光光度法方法检测肝组织内丙二醛(MDA)、超氧化物歧化酶(SOD)和谷胱甘肽(GSH);采用HE染色和Tunel染色进行组织学观察;Western blot法检测肝脏组织中的Caspase3、p53蛋白。结果 D组血清ALT、AST、LDH、MDA低于B组,SOD和GSH高于B组(P均<0.05)。D组缺血再灌注损伤肝脏组织形态学变化轻于B组,且肝脏组织中的Caspase3和p53蛋白表达水平亦较B组减少(P均<0.05)。B、D组肝细胞凋亡指数高于A、C组,且B组高于D组(P均<0.05)。结论七氟烷对大鼠缺血再灌注损伤肝脏具有保护作用,可能是通过抑制肝细胞凋亡来实现的。