目的 探讨负荷剂量右美托咪定对脑膜瘤切除术病人血清脑源性神经营养因子(BDNF)含量及血流动力学参数的影响.方法 将40例择期行脑膜瘤切除术病人采用随机数字表法随机分为对照组(C组)和右美托咪定组(D组),每组20例.D组病人于麻醉诱导前10 min静脉泵注右美托咪定1μg/kg,20 min注射完毕;C组病人静脉泵注等容量生理盐水.记录病人术前和术后24 h的简易精神状态量表(MMSE)评分;记录所有病人入手术室后(T0)、诱导前即刻(T1)、插管后1 min(T2)、手术开始时(T3)、打开硬脑膜时(T4)、术毕即刻(T5)、术后10 min(T6)的平均动脉压(MAP)及心率;分别于T0、T3、T4、T5、术后18 h(T7)采集静脉血,测定血清中的BDNF含量.结果 C组病人术后MMSE评分显著低于术前(t=2.33,P<0.05),而D组病人术前、术后MMSE评分比较差异无显著意义(P>0.05).D组病人T3～T6时的MAP和心率较T0时显著降低(F=5.93、7.72,P<0.01),且在T2时显著低于C组(t=2.60、4.26,P<0.05).D组病人T3、T5时的血清BDNF含量显著高于C组(t=2.22、2.34,P<0.05).结论 负荷剂量右美托咪定可以减小脑膜瘤切除术中血清BDNF的波动,有利于维持病人围手术期血流动力学参数平稳,具有一定的脑保护作用.

Objective To evaluate effect of dexmedetomidine on mitochondrion-dependent apoptosis during hypoxia-reoxygenation (H/R) injury to hippocampal neurons of rats.Methods The primarily cultured hippocampal neurons of Sprague-Dawley rats were divided into 4 groups (n =40 each) using a random number table method:control group (C group),vehicle group (V group),H/R group and dexmedetomidine group (D group).Hippocampal neurons were subjected to oxygen-glucose deprivation followed by restoration of oxygen supply to establish the model of H/R injury.Dexmedetomidine 1 μmol/L was added at 6 h of reoxygenation in D group.The viability of neurons was measured by methyl thiazolyl tetrazolium assay at 20 h of reoxygenation.The ultrastructure of mitochondria was observed by transmission electron microscopy.The expression of cytochrome c (Cyt c),caspase-3,Fis1 and Drp1 was detected by Western blot.The neuronal apoptosis was detected by flow cytometry,and apoptosis rate was calculated.Results Compared with C group,no significant change was found in the viability of neurons in group V (P＞0.05),and the viability of neurons was significantly decreased,the apoptosis rate was increased,the expression of Cyt c,caspase-3,Fis1 and Drp1 was up-regulated (P＜0.05),and the damage to mitochondrial ultrastructure was accentuated in H/R and D groups.Compared with H/R group,the viability of neurons was significantly increased,the apoptosis rate was decreased,the expression of Cyt c,caspase-3,Fis1 and Drp1 was down-regulated (P＜0.05),and the damage to mitochondrial ultrastructure was significantly attenuated in D group.Conclusion The nechanism by which dexmedetomidine reduces the H/R injury to hippocampal neurons is related to inhibiting mitochondrion-dependent apoptosis in rats.

目的 比较BIS监测下右美托咪定和丙泊酚用于小儿七氟醚全身麻醉苏醒期躁动的影响.方法选取于我院接受择期手术的病儿60例,年龄2~7岁,ASA分级 Ⅰ~Ⅱ 级,随机分为右美托咪定组(D组)及丙泊酚组(P组),每组各30例.两组病儿均应用七氟醚吸入诱导麻醉,芬太尼2μg/kg、苯磺顺阿曲库铵0.1 mg/kg静脉注射后气管插管,D组病儿首先静脉给予右美托咪定1μg/kg负荷量,随后以1μg·kg-1·h-1持续泵入;C组病儿静脉输注丙泊酚2 mg·kg-1·h-1持续泵入,术中BIS值维持在40~60,并根据心率 、血压及BIS值调整七氟醚的吸入浓度.记录两组手术时间 、麻醉时间 、手术结束时间 、术后苏醒时间 、拔管时间等指标,入麻醉恢复室后应用小儿麻醉苏醒期躁动量化评分表(PAED)进行躁动评分.结果两组病儿手术时间 、麻醉时间 、苏醒时间以及拔管时间比较差异无显著性(P>0.05);两组病儿术后恶心呕吐发生率差异无统计学意义(P>0.05).D组病儿麻醉苏醒期的躁动评分较P组降低,差异有显著性(t=2.10,P<0.05).结论与丙泊酚相比,右美托咪定可以更好地减轻小儿七氟醚全麻苏醒期的躁动.

目的:探究术中给予不同剂量右美托嘧啶对于预防痣切除术患者单次腰麻术后寒战的效果.方法:选取我院2016年1月至2016年8月收治的痔疮患者需行痔切除术者150例,随机数表法分为A、B、C3组.三组患者均使用0.75％罗哌卡因施行单次腰麻,A组患者麻醉同时静脉微泵注射0.9％生理盐水,B组患者采用0.3ug·kg-1右美托嘧啶微量泵注射,C组患者采用0.5ug·kg-1右美托嘧啶微量泵注射,三组患者注射时间均为10min.观察患者静脉泵用药前及用药后10min、30min、60min及90min后的生命体征变化,包括体温(T)、心率(HR)、呼吸频率(RR)、平均动脉压(MAP)、氧饱和度(SpO2)、寒战Wrench分级以及OAA/S评分变化.结果:三组患者静脉用药前后各时间点T、RR、SpO2比较无统计学意义(P>0.05);三组患者注药前HR和MAP比较无统计学意义(P>0.05),用药后B组及C组患者各时间点的HR及MAP均低于A组患者(P<0.05).三组患者中寒战发生率以A组最高,B组及C组患者寒战发生率低于A组患者(P<0.05);B组及C组患者间寒战发生率比较无统计学意义(P>0.05).B组及C组患者的镇静率高于A组患者(P<0.05),B组及C组患者间镇静率比较无统计学意义(P>0.05).结论:右美托咪定可降低痔疮手术接受单次腰麻的患者手术期间寒战的发生率,减轻术后焦虑程度,且无明显不良反应.

AIM:To evaluate the neuroprotective effect of load-dose dexmedetomidine (Dex) in patients undergoing meningioma operation.METHODS:Forty patients scheduled for meningioma operation were randomly divided into two groups:Dex group (group D,n =20) and control group (group C,n =20).Dex was intravenously infused 10 min before induction at the dose of 1 μg/kg and finished in 20 min in group D.Patients in group C were given the same bolus of saline.The Mini-Mental State Examination (MMSE) scores of all patients at 24 h were recorded before and after operation.The SBP,DBP and HR of all patients were monitored after entering operation room (T0),before induction (T1),1 min after intubation (T2),at the initiation of the surgery (T3),after opening the dura mater (T4),when the tumor was removed (T5),at the end of the operation (T6).Venous blood samples were taken for determination of neuron-specific enolase (NSE) and S100β protein at T0,T4,T6 and 24 hour after the operation (T7).RESULTS:The postoperative MMSE scores were lower than before in two groups (P ＜ 0.05).Compared with T0,the SBP,DBP and HR in group D were significantly decreased at T1-T6 (P ＜ 0.05),and were different with group C at T2 (P ＜0.05).The S100β3 protein levels were lower in group D than group C at T4 and T6 (P ＜ 0.05).At the point of T6,there was apparently difference between group D and group C.CONCLUSION:The postoperative MMSE scores were lower than before in two groups (P ＜ 0.05).Compared with T0,the SBP,DBP and HR in group D were significantly decreased at T1-T6 (P ＜ 0.05),and were different with group C at T2 (P ＜ 0.05).The S100β3 protein levels were lower in group D than group C at T4 and T6 (P ＜ 0.05).At the point of T6,there was apparently difference between group D and group C.

目的：比较喉罩麻醉与气管插管麻醉在胆囊手术患者中的应用效果。方法选取2014年11月-2015年10月收治的138例胆囊手术患者根据入院顺序分成甲组和乙组各69例。甲组采用喉罩麻醉，乙组采用气管插管麻醉。对比两组的麻醉效果及不良反应发生率。结果甲组麻醉优良率明显高于乙组（P<0.05）；甲组不良反应发生率低于乙组（P<0.05）。结论与气管插管麻醉相比较，喉罩麻醉在胆囊手术患者中应用具有麻醉效果好，不良反应少的优势。

目的：探讨靶控输注丙泊酚复合瑞芬太尼麻醉在呼吸功能不全行腹腔镜手术患者中的应用效果。方法：选取78例经腹腔镜手术治疗的呼吸功能不全患者按随机分为研究组和对照组各39例。对照组采用静脉泵入丙泊酚复合瑞芬太尼麻醉，研究组采用靶控输注丙泊酚复合瑞芬太尼麻醉。对比两组气腹前、后的心率（HR）、平均动脉压（MAP）及苏醒时间、不良反应发生率。结果：两组气腹前HR及MAP均无明显差异（P＞0.05），而气腹后则存在明显差异（P＜0.05）；研究组苏醒时间较对照组短（P＜0.05）；研究组不良反应发生率明显低于对照组（P＜0.05）。结论：靶控输注丙泊酚复合瑞芬太尼是呼吸功能不全经腹腔镜手术治疗患者更为安全的麻醉措施。

目的：探讨剖宫产术中应用小剂量舒芬太尼对术后牵拉痛和寒战的预防作用。方法：选择2015年1月～2015年6月期间我院收治的足月妊娠且行剖宫产的产妇130例，将其平均分为研究组与对照组。对照组进行常规椎管内麻醉，研究组在此基础上给予小剂量舒芬太尼。结果：研究组轻度疼痛发生率显著高于对照组（P＜0.05），中度疼痛发生率低于对照组（P＜0.05）。研究组患者寒战的发生率为12.31%，显著低于对照组的35.38%（P＜0.05）结论：小剂量舒芬太尼可以有效降低剖宫产术患者牵拉疼痛的阈值及寒战的发生率，预防效果显著。

<正>患者,男,20岁,体重85kg,诊断为右甲状腺肿,拟在气管插管全麻下行右甲状腺次全切除术。患者既往体健,对"青霉素、庆大霉素"过敏,术前一天静滴"氨曲南"时出现过敏性休克,经吸氧补液、应用肾上腺素和地塞米松等抗过敏治疗后生命体征平稳。否认哮喘史及食物过敏史,麻醉相关

患者男２２岁。反复水肿１年，伴腹胀、腹泻６个月，否认家族史。体检：消瘦、双下肢水肿，腹水，左侧少量胸腔积液。实验室检查：白细胞７３×１０９／Ｌ，淋巴细胞０．９５，血红蛋白１３２ｇ／Ｌ，血细胞压积０．３８。大便：脂滴阴性。肝功能：白蛋白１１～１４ｇ／Ｌ...