Objective To investigate the expression and function of intravitreal injection of pigment epitheliumderived factor(PEDF)gene eukaryotic expression vector in proliferative vitreoretinopath(PVR)model eye,and to clarify the inhibitory effect of PEDF gene transfection on PVR induced by macrophages in rats.Methods The pcDNA3-PEDF with cationic liposome was injected into vitreous of 36SD rats(the right eye of each rat as the experimental eye and the left eye as the negative control eye).The rats were divided into PVR control group(injecting macrophages in the vitreous cavity to induce PVR),saline control group(injecting macrophages 3dafter intravitreal injection of saline)and transfection group(injecting macrophages 3dafter intravitreal injection of liposome and pcDNA3-PEDF),and there were 12rats in each group.Then the ophthalmoscope and fundus pre-set lens were used to observe the vitreous and retinal conditions of the rats in each group;the stuctures of the vitreous and retinal layers and the cell proliferation of the specimens of the rats in various groups were detected by HE staining under light microscope.Results The ophthalmoscope and fundus pre-set lens results showed that after intravitreal injection of macrophages,there was more significant vitreous proliferation in PVR control group and saline control group compared with transfection group 1week after injection,there was vitreous proliferation in PVR control group and saline control group.2-3weeks after injection,the proliferation was gradually increased and retina began to detach in PVR control group and saline control group.4 weeks after injection,there was significant proliferation in all model eyes,and traction retinal detachment occurred in PVR control group and saline control group.Only one eye of the rats in transfection group showed vitreous traction and shallow retinal detachment,and the other eyes were normal.The HE staining and light microscope results showed that the structurs of retina cells of most eyes were clear,only one eye occured shallow retinal detachment with epiretinal membrane proliferation and small amount of inflammatory cell infiltration in transfection group.There was inflammatory response with the progression of the disease,accumulation of inflammatory cells,proliferation of fibroblasts,and formation of eyeball atrophy in PVR control group and saline control group.Conclusion PEDF transfected by intravitreal injection in rats' eyes can significantly inhibit the formation and development of PVR induced by macrophages.

彩色多普勒成像技术(Color Doppler flow imagine,CDI)是目前临床常用的无创性诊断方法,它在二维显像的基础上,获取血流频谱,进行血流动力学研究.我们利用CDI检测了正常人15例(30眼)及CACG患者25例(36眼)手术前后眼动脉(ophthalmic artery ,OA)、视网膜中央动脉(central retinal artery,CRA)和睫状后短动脉(short posterior ciliary artery,SPCA)的血流参数,探讨原发性闭角型青光眼视神经损害与眼底血流动力学改变的相关关系.

目的:通过对喉罩、气管内插管及静脉氯胺酮3种全身麻醉方式在小儿尿道下裂手术中的比较,探讨喉罩全身麻醉的优越性.方法:选择60例行尿道下裂手术的患儿,随机分为3组,喉罩组(L组)、气管插管组(T组)、静脉氯胺酮组(K组),每组各20例.观察各组的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)和术后清醒时间及各种不良反应的发生率.结果:L组术后清醒比T组及K组快,L组术后躁动和恶心、呕吐的发生率明显低于T组和K组(P＜0.05).结论:使用喉罩通气进行全身麻醉,术中生理指标变化小,术后并发症少,较其余两种方式更具优越性.

1 临床资料 患者,男性,36岁,体质量74 kg,身高1.84 m,因车祸致右上颌骨、颧骨、颧弓、右下颌升支骨折16 d入院,拟全麻下行颌骨内固定术.术前检查患者无脑外伤及神经精神异常,脊柱四肢运动自如,张口度1 cm.术前常规检查、胸透、心电、脑CT正常.麻醉术前会诊发现,患者除颜面肿胀明显,不能张口,余无异常,拟采用清醒盲探气管内插管全麻下手术.

本文探讨老年口腔恶性肿瘤手术低体重患者人群(体重＜40 kg)的麻醉特点. 1 资料与方法 1.1 一般情况 我院1990～2010年共收治年龄≥65岁口腔恶性肿瘤12例,男7例,女5例.心功能Ⅱ～Ⅲ级,患者除体质消瘦,还伴有低血压、贫血、低蛋白、冠心病、糖尿病、高血脂等老年疾病.疾病种类包括舌癌、牙龈癌、颊癌、口底癌、上颌窦癌等.部分患者行单侧颈淋巴结清扫及颌骨切除术.手术时间2～5 h.

1.临床资料 患者,男性,73岁.左腮腺导管癌伴左颈部淋巴结转移.患者有糖尿病史2年,无高血压、心脏病等其他病史.拟全麻下行左腮腺扩大切除术及左颈淋巴结清扫术.患者一般状态尚可,常年用降糖药物控制血糖,曾多次空腹晕厥,每次进餐后需立即口服药物控制血糖,本次全麻手术需空腹6～8 h.

盐酸戊乙奎醚是一种新型的胆碱能受体阻断药,有研究表明盐酸戊乙奎醚对CPB过程中心、脑等重要器官具有保护作用,其机制可能与其扩张外周血管,改善微循环有关[1-2].TXA2和PGI2是影响血小板功能、调节外周血管阻力的重要物质[3].本研究拟通过观察盐酸戊乙奎醚对CPB下心脏瓣膜置换术患者血浆TXA2和PGI2的影响,探讨盐酸戊乙奎醚对CPB过程中器官保护作用的可能机制.

病人自控静脉镇痛临床应用配方较多,舒芬太尼因为具有高选择性、高强度阿片受体激动剂样作用,在临床麻醉中被广泛应用,近期也在术后镇痛方面被广泛应用.但老年颌面肿瘤患者术后自控静脉镇痛配方却很少报道.口腔手术特点多是舌颌颈联合根治,必须全麻插管,术前术后常因解剖及生理异常改变导致上呼吸道梗阻.如何达到术后无痛,又不影响呼吸功能是口腔临床麻醉亟待解决的问题.本文拟探讨老年颌面肿瘤术后自控静脉镇痛的合理配方.

Objective To investigate the expression of ClC-2 chloride channels in rat trabecular meshwork as well as possible role of ClC-2 in onset mechanism of glaucoma.Methods Rat model of chronic high intraocular pressure was established by injecting sodium hyaluronate into anterior chamber.The trabecular meshwork tissues of normal and model rats were isolated,in which the transcription level of ClC-2 mRNA was determined by RT-PCR,and the expression level of ClC-2 protein by immunohistochemical method.Results The transcription of ClC-2 mRNA and expression of ClC-2 protein were observed in the trabecular meshwork tissues of beth normal and model rats,while the transcription and expression levels in model rats were lower than those in normal rats.Conclusion The expression of ClC-2 chloride channels was proved in rat trabecular meshwork,which was influenced by some pathological factors of trabecular meshwork.

目的: 探讨鼻咽通气管在婴幼儿唇裂手术麻醉中的通气效果.方法: 将80例先天性唇裂婴幼儿平分为实验组和对照组,实验组麻醉拔管后对存在舌后坠的患儿,将气管导管从鼻腔插入鼻咽腔位置,起到抬起舌根保证正常通气效果作用.对照组麻醉拔管后对存在舌后坠的患儿,仍采取传统处理方法,既托下颌法、缝合舌体外牵引法、口咽通气道纠正法等.结果: 对照组有效通气达52.5%,发生托下颌无法纠正的上呼吸道梗阻2例,缝合舌体外牵引导致喉痉挛2例、口咽通气道使用导致呕吐3例.结论: 鼻咽通气管在婴幼儿唇裂手术麻醉中通气效果安全可靠.

本研究观察氯诺昔康和芬太尼联合用于老年患者术后镇痛效果及安全性.

老年患者颌面部手术后最多见的危险是多种原因导致的二氧化碳蓄积,常危及生命.早期的预防、及时的发现与纠正,完全可以达到麻醉恢复期的满意效果.本文回顾性分析100例颌面部手术后患者出现异常的临床资料,并将其对比分析,以探讨老年人全麻恢复期最安全有效的措施.

目的:观察5-HT3受体拮抗剂恩丹西酮对术后恶心呕吐(PONV)时效。方法:选择妇科手术患者232例,随机分为两组即生理盐水对照组(A组)20例,恩丹西酮8 mg(B组)212例。术毕观察两组患者恶心呕吐的例数,恶心呕吐的严重程度,发生率及患者对恩丹西酮的满意度。结果:术后恶心呕吐发生率A组明显高于B组(P<0.01)。结论:恩丹西酮能有效防治术后镇痛引起的恶心呕吐,使患者更舒适,术后恢复更快。

小儿颞颌关节强直多伴有严重的张口受限.小儿颞颌关节强直成型矫治术需要插管全麻,目前大多数情况下均选择气管切开插管全麻,此方法患儿痛苦大、护理繁琐,并发症多,且患儿家长大多难以接受.因此,手术最大的问题经常发生在麻醉诱导及术后麻醉恢复期中,其中气管内插管过程最为关键.以往普通的盲探插管方法难以调节声门位置,同时常并发如窒息、喉痉挛、上呼吸道梗阻、喉水肿和呼吸心跳骤停等严重并发症.近5 年来,我科对小儿颞颌关节强直手术的气管内插管方法进行了临床研究,采用自制改良导管进行盲探插管取得了良好效果,对提高插管成功率、减少并发症具有一定的临床意义,现报告如下:

目的观察老年病人上腹部手术后病人自控静脉镇痛(PC IA)对内分泌和呼吸功能的影响。方法37例65岁以上全麻下行上腹部手术的老年人随机分为两组。Ⅰ组(对照组n=18例)术后按需肌肉注射哌替啶50 mg/次。Ⅱ组(PC IA组n=19例)术后行PC IA镇痛,分别于麻醉前、术毕1 h、24 h、48 h、72 h采血测定血糖(G lu)、皮质醇浓度(Col),同时监测呼吸频率(RR)、潮气量(Vt)、每分钟通气量(MV)和脉搏血氧饱和度(SpO2)。结果Ⅱ组病人VAS评分低,血糖于术后48 h基本恢复至术前水平,24 h皮质醇基本恢复正常;而Ⅰ组病人48 h后血糖及皮质醇仍居高不下,同时,Ⅱ组呼吸功能改善明显。结论PC IA改善了老年人术后的肺功能,减轻了应激反应。

副肿瘤性肢端角化病,由Bazex等于1965年首先描述,也称伴肿瘤性肢端角化症、类肿瘤性肢端角化症,其病因认为与体内癌病灶有密切关系,属恶性肿瘤特别是喉癌的重要皮肤标志之一.此病非常少见,我们近来遇见1例,现报道如下.

心肌缺血处理不当可转为急性心肌梗死、心律失常,病死率很高[1].有些发生心肌缺血病人同时患有颌面肿瘤,急需早日择期手术,给围术期及麻醉带来难题.

目的探讨腰麻-硬膜外麻醉在老年股骨头置换术中应用的可行性.方法选择ASAⅡ～Ⅲ级,老年股骨头置换术病人41例,随机分为两组,Ⅰ组为硬膜外组(n=20);Ⅱ组腰麻和硬膜外联合组(n=21).在L3～4或L4～5间隙行硬膜外穿刺成功后,Ⅰ组置入硬膜外导管,2%利多卡因分次给药.Ⅱ组采用针内针技术,首先于蛛网膜下腔注入0.75%布比卡因7～11 mg,然后置入硬膜外导管.结果Ⅰ组局麻药用量大,麻醉起效慢,阻滞不十分完全,循环波动差异大,作用时效短.Ⅱ组局麻药用量小,起效迅速,阻滞完全,循环波动小,作用时效长.结论腰麻-硬膜外麻醉在老年股骨头置换术中应用起效快、安全有效、与硬膜外麻醉相比有一定的优势.

为了研究氯胺酮麻醉对免疫器官免疫细胞的作用,特选择小白鼠作为实验动物,在氯胺酮麻醉后检测胸腺及脾脏免疫细胞的功能.

对比观察比较0.5%罗哌卡因与1.5%利多卡因在乳腺手术硬膜外阻滞中对感觉、运动及血流动力学的影响.结论:0.5%罗哌卡因用于乳腺手术硬膜外阻滞镇痛效果确切,感觉阻滞持续时间较1.5%利多卡因长,对运动肌力及血流动力学影响小,明显优于1.5%利多卡因.