目的 筛选肝细胞癌(HCC)组织表达下调蛋白,探索生物标志物.方法 采用在中国人民解放军某三甲医院8例住院患者HCC组织及癌旁组织标本,使用同位素标记相对和绝对定量(iTRAQ)蛋白标记技术和液相串联质谱分析对这些标本进行蛋白表达水平研究.结果 共筛选出下调蛋白71个,结合蛋白覆盖度、可信度及文献,发现蛋白谷胱甘肽转移酶(GSTM1)、B淋巴细胞瘤-2蛋白(Bcl-2)、细胞色素氧化酶(CYP)2C8、CYP2A6、氨基酰化酶1(ACY1)明显下调.结论 HCC组织下调蛋白对该病的诊断、预后判断有重要价值,下调蛋白迫切需要大样本进行验证,并开展关键蛋白机制研究,为HCC的防治提供新的信息.

目的 探讨原发性肝癌(PLC)患者外周血中环状RNAs(circRNAs)作为PLC分子标志物的临床诊断价值.方法 利用circRNAs微阵列芯片技术检测4例PLC患者(PLC组)和4例健康对照者(对照组)外周血circRNAs的表达谱,并进行组间差异分析,基因本体/基因功能(GO/KEGG)分析差异表达的circRNAs明显富集的潜在功能和信号通路.结果 与对照组比较,PLC组中共有26种circRNAs具有差异表达,包括上调的14种circRNAs和下调的12种circRNAs,亲本基因为:NFATC3、UBQLN1、SKA3、OAT、DENND4A、MGEA5、N4BP2L2、MKLN1、RANBP9、PICALM、SPECC1、LRP5、FAM64A、RPS8、FLI1、PCNXL2、RPL13、LINC00340、KIF26B、WBSCR17、NUP214、GPI、GRB10.GO/KEGG分析发现,亲本基因多涉及转录因子活性、RNA转运RT及通过内质网蛋白质加工、泛素介导的蛋白质水解和参与cGM P-PKG信号通路等功能.结论 PLC患者外周血存在明显差异表达的circRNAs,其亲本基因可能参与PLC复杂的发病机制.

目的 比较胸科手术单肺通气中七氟烷与丙泊酚对患者肺损伤的保护作用.方法 将200例胸科手术患者按随机数字表法分为丙泊酚组与七氟烷组,每组100例,术中均行单肺通气.2组患者麻醉诱导相同,麻醉维持时丙泊酚组静脉泵入丙泊酚,七氟烷组吸入七氟烷.比较2组麻醉诱导前(T0)、单肺通气前(T1)、单肺通气后0.5 h(T2)和手术结束时(T3)肺功能指标[包括潮气量(VT)、气道均压(Pmean)、气道峰压(Ppeak)、动态肺顺应性(Cydn)]、炎症因子[包括白细胞介素-6(IL-6)、白细胞介素-10(IL-10)]及氧化应激因子[包括丙二醛(MDA)、超氧化物歧化酶(SOD)]水平.结果 2组VT和Cydn均在T2时降低,T3时增高,但均显著低于T1时,差异均有统计学意义(P<0.05);2组Ppeak与Pmean均在T2时增高,T3时降低,但均显著高于T1时,差异均有统计学意义(P<0.05);2组肺功能指标各时点比较差异均无统计学意义(P>0.05).2组T1—T3时IL-6与IL-10水平均较T0时明显增高,其中T2、T3时水平与T0时比较差异均有统计学意义(P<0.05);T2、T3时丙泊酚组IL-6水平显著低于七氟烷组,IL-10水平显著高于七氟烷组,差异均有统计学意义(P<0.05).2组T1—T3时MDA水平较T0明显增高,SOD水平明显降低,其中T2、T3时水平与T0时比较差异均有统计学意义(P<0.05);T2、T3时丙泊酚组SDO水平显著高于七氟烷组,MDA水平显著低于七氟烷组,差异均有统计学意义(P<0.05).结论 丙泊酚对胸科手术单肺通气中炎症反应和氧化应激反应的抑制作用优于七氟烷,能够在一定程度上起到肺损伤保护作用.

目的 研究分析不同剂量右美托咪定用于心内直视手术麻醉的临床观察.方法 66例行心内直视手术的患者,随机分为A组、B组和C组,各22例.各组患者给予不同剂量的右美托咪定(浓度为4μg/ml)实施麻醉处理,A组患者给予0.5μg/kg,B组给予1μg/kg,C组给予1.5μg/kg的剂量进行缓慢注射.探讨分析三组患者的麻醉效果与安全性.结果 A组、B组、C组患者用药后15 min Ramsay镇静评分为(2.18±0.89)分、(3.73±1.02)分以及(4.58±0.77)分,三组组间比较差异具有统计学意义(P<0.05).C组患者平均动脉压(MAP)、心率(HR)水平均明显高于A组、B组,差异有统计学意义(P<0.05).A组、B组MAP、HR水平比较,差异无统计学意义(P>0.05).结论 应用右美托咪定对于心内直视手术患者行麻醉处理时,4μg/ml的浓度以1μg/kg的剂量为最佳剂量,剂量过低会影响麻醉效果,过高会影响患者的MAP及HR等.

目的：寻找右美托咪定用于术后镇痛期间自控镇静效果满意的最佳剂量。方法：选择接受术后镇痛的患者120例，根据不同单次右美托咪定（DEX）注射量分为0.08μg/ kg 组（A 组）、0.12μg/ kg 组（B 组）、0.16μg/ kg 组（C组）和生理盐水组（D 组），每组30例，各组患者年龄、体重等指标比较，差异无统计学意义（P ﹥0.05）。术后镇痛选择舒芬太尼2μg / kg 静脉负荷剂量 PCA 进行镇痛，在镇痛期间患者根据需求自我应用镇静药，每按 l 次按钮追加2ml，观察和比较各组患者单位时间内的给药次数和给药剂量、心率、平均动脉压和脉搏氧饱和度变化、Ramsay 镇静评分、不良反应发生率等指标的变化及差异。结果：0.12μg/ kg DEX 组术后镇痛期间自控镇静满意度显著高于其他组，差异有统计学意义（P ﹤0.05），可有效消除患者不安等情绪，且不良反应少。结论：0.12μg/ kg DEX 组用于术后镇痛期间镇静效果满意，生命体征平稳，不良反应少，值得在今后的临床工作中进一步推广。

目的 研究右美托咪定对剖宫产患者术中寒颤的效果.方法 选取2014年1-8月我院接受剖宫产并行腰-硬联合麻醉后出现寒颤的患者,根据不同剂量DEX分为:0.3 μg/kg组、0.4μg/kg组、0.5μg/kg组、0.8μg/kg组和1μg/kg组,以1 mg/kg曲马多和生理盐水为对照组,共420例.另有一组60例使用1μg/kg DEX联合1 mg/kg曲马多.观察各组寒颤给药前(T0)及给药后15 min(T1)、30 min (T2)时的寒颤程度,采用Wrench分级.结果 T0时,各组间差异无统计学意义(P＞0.05).除了对照组,其他各组Wrench分级得分均下降显著(P＜0.05).DEX组(1μg/kg)下降最多,效果最显著.1mg/kg曲马多Wrench分级得分降低比DEX组少,生理盐水组没有降低(P＞0.05).DEX(1μg/kg)联合曲马多组(1 mg/kg)Wrench分级得分降低最多,优于单用DEX(1μg/kg)和1 mg/kg曲马多(P=0.000).结论 静脉滴注DXE 30 min,时间越长,对剖宫产术中寒颤效果越好,DEX剂量1μg/kg比0.3μg/kg效果好,DEX1μg/kg联合曲马多用药比单独用1μg/kg DEX效果更好.

Objective To investigate the effects of dexmedetomidine on hemodynamics in patients undergoing neurosurgery.Methods Forty patients undergoing selective posterior fossa surgery were randomly divided into two groups (twenty patients in each group):the control group (group C) and the dexmedetomidine group (group D).After induction and tracheal intubation,group D was administrated with dexmedetomidine 0.8 μg·kg-1·h-1 during the anesthesia,group C was administrated with saline.Anesthesia was maintained with propofol,remifentanil and vecuronium.BIS value was controlled at 40~55 during the whole operation.Heart rate (HR),systolic blood pressure (SBP),diastolic blood pressure (DBP) and bispectral (BIS) were recorded at the moment of before induction (T0),induction (T1),15 minutes after induction (T2),skin incision (T3),10 minutes after skin incision (T4),drilling skull (T5) and at end of operation (T6).The dosage of propofol and remifentanil was recorded.Results SBP in the two groups was significantly decreased at T1 and T2 compared with T0,and HR was significantly decreased at T2 compared with T0 (P0.05).At T3,HR of group C was significantly higher than that of group D (P 0.05),and SBP in both groups were increased,with no statistically significant difference between the two groups (P0.05).At T5,HR and SBP of group C were significantly higher than those of group D (P 0.05).At T6,HR of both groups was increased,and the increase in group C was more profound than that in group D (P 0.05).SBP of group C was increased and SBP of group D was decreased at T6 compared with T0,with statistically significant difference between the two groups (P0.05).The dosage of propofol and remifentnil in group D was decreased 30.93% (P 0.01) and 7.69% (P 0.05) respectively compared with group C.Conclusion Administration with demedetomidinecan 0.8 μg·kg-1·h-1 during maintenance of anesthesia decrease the hemodynamical fluctuations in patients undergoing neurosurgery and reduce the dosage of propofol and remifentanil.

Objective: To compare the effect of remifentanil with sevoflurane on oxygenation and intrapulmonary shunt during one-lung ventilation for senile patients.Methods: Forty senile patients with esophageal cancer were randomly divided into remifentanil group(group R: n=20) and sevoflurane(group S: n=20).When anesthesia was induced right-sided double-lumen endobronchial tube(R-DLT) was intubated orally.Then anesthesia was maintained with remifentanil 0.1～0.15μg/(kg·min) in group R,and with 2%～3% sevoflurane inhalation in group S respectively.The other drugs used in both groups for anesthesia maintenance were target-controlled infusion of propofol 2～6 mg/L(plasma concentration).The arterial and mixed venous blood samples were drawn for blood gas analysis and intrapulmonary shunt calculations were taken at the following time: 15 min after two-lung ventilation,15,30,60 and 90 min after one-lung ventilation and 15 min after returning to two-lung ventilation in both groups.Result: The shunt fraction(Qs/Qt) and Ppeak were significantly higher and PaO2 was significantly lower in one-lung ventilation than in two-lung ventilation(P0.05).There was no statistical difference in Ppeak,Qs/Qt,PaO2,recovery time,extubation time and complications between two groups.Conclusion: There was no statistical difference between remifentanil and sevoflurane in oxygenation and intrapulmonary shunt during one-lung ventilation for senile patients.Anesthesia with remifentanil can provide stable hemodynamics and fast consciousness for elderly patients undergoing thoracic surgery.

Objective To observe the clinic effect of Conscious Sedation with dexmede-tomidine on spinal anesthesia. Methods Forty ASA Ⅰ～Ⅱ patients who received operation of lower limbs after spinal anesthesia were randomly divided into five groups(n=8):Group Ⅰ,Ⅱ,Ⅲ,Ⅳ,Ⅴ(the dexmedetomidine was given intravenous injection of 0.1,0.2,0.3,0.4,0.5μg·kg-1·h-1 respectively).The level of sedation was registered through observer's Assessment of alertness sedation scale(OAA/S) and bispectral index(BIS) After infusion of dexmedetomidine 30,60,90mins.The level of oblivion and satisfaction were registered. Results The OAA/S and BIS in group Ⅱ~Ⅴ were less than group I statistically(p0.05).The forgetting rate of anesthesia with dexmedetomidine in groups Ⅱ,Ⅲ,Ⅳ,Ⅴ were 50%,87.5%,100%,100%.The groups Ⅲ,Ⅳ,Ⅴ were satisfied with anesthesia. Conclusion The conscious Sedation with dexmedetomidine on spinal anesthesia was effective and safe.The dose of dexmedetomidine of 0.3 μg·kg-1·h-1 is better.

肥厚型心肌病(HCM)发病率低,围手术期极易发生恶性心脏事件,麻醉风险大处理特殊报道罕见.近期,我们成功抢救1例全麻术中突发室颤(VF)的HCM患者,现报道如下.

Aim:To investigate the effects and mechanisms of oxygenation at high concentration on rat brain injury.Methods: Forty-nine adult male Wistar rats weighting 230~280 g were randomly divided into seven equal groups with seven animals each.Group 1 was normal controls;group 2,3,4 were exposed to oxygen(50% O2) for 15,30,60 min respectively;group 5~7 was exposed to oxygen(100% O2) for 15,30,60 min respectively.The expression of Nuclear FactorκB(NF-кB),induce Nitric Oxide Synthase(iNOS)and Mn-Superoxide Dismutase(Mn-SOD)of rat brains by Western blotting analysis,immunohistochemistry and xanthine oxidase analysis after oxygenation were examined.And the histological injury of rat brains by light microscope simultaneity was also examined.Results: The expression of NF-кB all decreased in oxygenation groups compared with that in the controlled group.The numbers of iNOS positive cells all increased as compared with that in the controlled group.But that only significantly increased in oxygenation(50% O2) for 15,30 min and oxygenation(100% O2) for 15 min groups.The activity of Mn-SOD all increased but that only oxygenation(100% O2) for 60 min group increased significantly.Pathology results: The harm of neurons in oxygenation(100% O2) groups was more serious than in oxygenation(50% O2) groups.The neurons had severe edema and eosinophilic degeneration and so on.Pathology change grade had not relations with oxygenation times.Conclusion:50% oxygenation can lead to slightly reversible injury,but 100% oxgen can lead to serious unreversible injury.oxygenation can not activate NF-κB,those expression all decreased on the contrary.

[Objective] To investigate the therapeutic effect of laparoscopic peritoneal lavage and drainage on severe acute pancreatitis in pig. [Methods] Severe acute pancreatitis models were induced by retrograde injection of 1 mL/kg normal saline containing 5% sodium taurocholate and 4 000 u/mL trypsin through the common pancreatic duct. Ten pigs with severe acute pancreatitis were randomly equally divided into two groups: therapeutic group and control group. The pigs in both group received basic supportive treatment, and laparoscopic peritoneal lavage and drainage were performed in therapeutic group. Serum amylase activity and plasma concentrations of TNF-?琢 and IL-6 were measured before establishing the model and 6, 24, 48 and 72 hours after that. The vital signs of experimental animals were observed at the same time. [Results] There was one dead case in the control group within 72 hours, and the mortality was 20%. There was no dead case in the therapeutic group. After the establishment of models serum amylase activity and plasma concentrations of TNF-а and IL-6 elevated, amylase activity and IL-6 level reached the max which were (4 901.3±512.4) u/L and (542.5±112.5) ng/L in 24 hours, respectively. TNF-а level reached the max [(1476.7±206.2) ng/L] in 6 hours. Amylase activity and levels of TNF-а and IL-6 at corresponding time points in therapeutic group were significantly lower than those in control group (P 0.05). [Conclusion] Laparoscopic peritoneal lavage and drainage are effective ways to reduce the excessive inflammatory reaction in severe acute pancreatitis, lower the mortality and improve prognosis.

Objective To investigate the effects and mechanisms of oxygenation on rat cerebral antioxidant ability.Methods 49 adult male Wistar rats weighting 230~280 g were randomly divided into seven equal groups with seven animals each.1 group was normal controls;2、3、4 group was exposed to oxygenation(50% O2)for 15、30 、60min;5~7 group was exposed to oxygenation(100% O2)for 15、30、60 min.We examined the expression of Nuclear FactorκB,induce Nitric Oxide Synthase and Mn-Superoxide Dismutase at protein level in the brain of rat by Western blotting analysis,immunohistochemistry and xanthine oxidase analysis.All the brains of rats were examination using light microscope to determine the degree of neuronal damage.Results The expression of NF-кB all decreased in oxygenation groups compared with that in the control group;The numbers of iNOS positive cells all increased as compared with that in the control group.But that only significantly increased in oxygenation(50% O2)for 15、30 min and oxygenation(100% O2)for 15min groups.The activity of Mn-SOD all increased but that only oxygenation(100% O2)for 60min group increased significantly.Pathology results:The harm of neurons in oxygenation(100% O2)groups was more serious than in oxygenation(50% O2)groups.The neurons were severe edema and eosinophilic degeneration and so on.Pathology change grade had not relations with oxygenation times.Conclusion 50% oxygenation can lead to slightly reversible injury,but 100% oxygenation can lead to serious unreversible injury.Oxygenation can not activate NF-κB,those expression all decreased on the contrary.

目的 探讨腹腔镜下建立猪重症急性胰腺炎模型的可行性.方法 5头家猪在腹腔镜下,经主胰管汇入十二指肠处向主胰管内加压注入含5%牛磺胆酸钠和4000 U/ml胰蛋白酶的生理盐水溶液诱导重症急性胰腺炎,观察胰腺和肺脏的病理改变,测定血清和腹水淀粉酶,计算建模成功率.结果 5头家猪主胰管的穿刺注药均在腹腔镜下顺利完成,所用时间平均为30 min.注药后主胰管及分支依次扩张变黑,随后胰管周围的胰腺组织肿胀、变黑,范围从胰头向胰体尾扩散,腹腔出现血性渗液.制模后血清淀粉酶明显升高,24 h时达到最高为(4901.3±512.4)U/L.注药后30min时腹水淀粉酶为(9974.2±739.3)U/L.胰腺病理切片呈现出血坏死性胰腺炎表现,肺脏病理切片示肺间质水肿,炎性细胞浸润.建模成功率为100%,72 h内有1头猪死亡,死亡率20%.结论 腹腔镜下能够可重复性完成建模所需的手术操作,建模成功率高,建立的模型不但符合重症急性胰腺炎的病理改变,而且避免了开腹手术创伤的干扰,能够更好地模拟重症急性胰腺炎的自然病程,客观地反应出实验数据.

Objective To explore the feasibility and superiority of using Proseal laryngeal mask airway(PLMA)in gynecological emergencies.Methods Twenty ASAI-II patients with emergencies of ectopic pregnancy aged 22~32 years undergoing laparoscopy were divided into two groups of ten each:Proseal laryngeal mask airway group(L)and endotracheal tube group(E).The patients in group L were conducted of PLMA insertion,while those in group E were performed endotracheal intubation with tracheal tube after induction of anesthesia.All the patients were performed controlled-ventilation.SBP,DBP,HR,SpO2,Ppeak,PETCO2,VT,PaCO2 were monitored at seven time-points:before anesthesia(T0),before insertion of tracheal tube and PLMA(T1),at once after insertion of tracheal tube and PLMA(T2),5min(T3),20min(T4)after insertion,extubation(T5)and 5min after extubation(T6).The parameters measured included cases of difficult insertion or intubation,time of analepsia,cases of celostomia and cough.Results Ppeak、VT,SpO2,PETCO2 and PaCO2 remained unchanged before,during and after surgery in both groups(p0.05).BP and HR at T0 and T1 time points ware similar.BP and HR at T2 and T5 time points increased significantly than that of T0 and T1 time points in group E(p0.05).BP,HR in group E increased significantly than that in group L at T2 and T5 time points(p0.05).Bp,HR,at each time point ware similar in group L(p0.05).SpO2,PETCO2 at the same time point ware similar between the two groups.The retaining time of PLMA was(43.3±9.6)min.The complications after operation included cough(60%),sore-throat(28%)in group E,and there is nothing in group L.Conclusion PLMA can provide the same safe and effective ventilation as tracheal intubation in general anesthesia for gynecological emergencies.Compared with endotracheal intubation,PLMA was easy to use.the stress of patients was low.PLMA avoid the occurrence of complications of pharynxand laryngeal.

目的 探讨预吸氧对新生鼠宫内脑缺血再灌注损伤的影响.方法 取孕21 d Wistar大鼠制成缺血再灌注损伤模型.另有同样孕鼠分别在30%、50%和90%氧浓度下预吸氧30 min后,完成宫内缺血后再灌注模型的制备.取出新生鼠脑组织应用Western印迹分析检测细胞核内核因子(NF)-κB,应用免疫组织化学分析检测诱生型一氧化氮合酶(iNOS)的表达,同时观察脑组织病理变化.结果 新生鼠脑组织细胞核内NF-κB的含量在缺血再灌注后增加.与对照组和再灌注1 h组比较,50%预吸氧组新生鼠脑组织细胞核内NF-κB的含量降低,而30%预吸氧组和90%预吸氧组NF-κB含量增加,其中90%预吸氧组增加最明显.与对照组相比,再灌注组和90%预吸氧组iNOS的表达增加明显.50%预吸氧组与再灌注1 h组相比有显著差异.结论 新生鼠脑缺血再灌注损伤后,NF-κB活化增强诱导iNOS的表达增加是脑损伤的重要因素.高浓度预吸氧加重脑缺血再灌注损伤,而50%预吸氧可能改善其损伤。

目的研究0.15%罗哌卡因复合舒芬太尼采用自控硬膜外镇痛(PCEA)方式进行分娩镇痛的临床效果。方法选择30例足月初产妇,ASAⅠ~Ⅱ级,随机分为两组:镇痛组(n=15)自愿要求硬膜外镇痛的足月初产妇,宫口开2~3 cm时行硬膜外穿刺置管,注入0.15%罗哌卡因与0.25μg/ml舒芬太尼及50μg/ml氟哌利多的混合镇痛液8~10 ml,使镇痛平面控制在T10以下,PCEA基础注药速率为2~4 ml/h,自控镇痛量为2 ml,锁定时间为15 min。对照组(n=15)随机选择同期非镇痛足月初产妇。观察两组产妇疼痛情况、产程、分娩方式、分娩时间及新生儿Apgar评分。结果研究组产妇镇痛有效率达100%,两组产程、新生儿Apgar评分及副作用差异无显著性。结论使用0.15%罗哌卡因复合0.25μg/ml舒芬太尼自控硬膜外镇痛分娩的方法简便、安全,临床效果良好。

目的观察氧气与空气在不同持续气道正压(CPAP)水平下对单肺通气氧合与肺内分流的影响.方法随机将14例单肺通气下行开胸手术的病人平均分成组Ⅰ(氧气组)和组Ⅱ(空气组),常规诱导、插入双腔支气管导管后行单肺通气20min后,组Ⅰ利用氧气向无通气侧肺给予5 cmH2O的CPAP,15 min后再给予10 cmH2O的CPAP;而组Ⅱ利用空气向无通气侧肺给予5 cmH2O的CPAP,15 min后再给予10 cmH2O的CPAP.分别记录单肺通气前、单肺通气20min、5 cmH2O的CPAP15 min、10 cmH2O的CPAP15min、术毕恢复双肺通气15min所测得的动脉血pH、PaO2和PaCO2等数据,并计算Qs/Qt值.结果组Ⅰ:5 cmH2O CPAP 15 min比单肺通气20min:PaO2显著增高(P＜0.05)、Qs/Qt显著降低(P＜0.05).10 cmH2O CPAP 15 min比单肺通气20min:PaO2显著增高(P＜0.05)、Qs/Qt显著降低(P＜0.05).10 cmH2O CPAP 15 min比5 cmH2O CPAP 15 min:PaO2显著增高(P＜0.05)、Qs/Qt显著降低(P＜0.05).组Ⅱ:5 cmH2O CPAP 15 min比单肺通气20min:PaO2、Qs/Qt无显著差异(P＞0.05).10 cmH2O CPAP 15 min比单肺通气20min:PaO2显著降低(P＜0.05),Qs/Qt显著增加(P＜0.05).结论氧气提供CPAP可有效改善单肺通气造成的低氧状况,10 cmH2O CPAP比5 cmH2O CPAP对改善Qs/Qt、提高PaO2更有效.用空气提供CPAP不能使单肺通气产生的低氧状况得到改善.

近10余年来由于肺移植手术的开展,推动了肺手术麻醉研究的巨大进展[1].本文予以介绍.

Objective: To investigate the effects of non-ventilated lung with continuous positive airway pressure(CPAP) on arterial oxygenation during one-lung ventilation.Method: Twenty patients were randomized to receive thoracic operation.ASA Ⅰ～Ⅱ,were selected and were randomly divided into two groups: controlled group(group A,n=10) and observation group(group B,n=10).Group A: There were no ventilation on the non-ventilated lung open to the air;group B: CPAP was administered with O_2(P=0.3KPa) via CPAP system on the non-ventilated lung during one lung ventilation.Blood gas analysis were determined at 30 min after two-lung ventilation(TLV) in the supine position,30 min after one-lung ventilation(OLV) in supine position,30 min and 60 min after OLV in lateral position and at the end of operation.Result: PaO_2 in group B was increased significantly than that of in group A(P0.05) during OLV.Conclusion: CPAP could improve the systemic oxygenation and reduce the intrapulmonary shunt and incidence rate hypoxemia during one lung ventilation.