目的 探讨脑蛋白水解液(CHI)对七氟醚麻醉导致的大鼠学习记忆障碍的影响,并分析其可能作用机制.方法 将32只大鼠随机分为七氟醚组、CHI高剂量组、CHI低剂量组和对照组,每组8只.七氟醚组吸入2％ 七氟醚,每天2 h,连续7 d,CHI高剂量组每天吸入七氟醚之前,尾静脉注射脑蛋白水解液1200μL,CHI低剂量组每天吸入七氟醚之前,尾静脉注射脑蛋白水解液300μL.对照组不吸入七氟醚,尾静脉注射生理盐水.通过水迷宫实验记录大鼠学习记忆能力;HE染色法观察各组大鼠海马组织病理学改变;ELISA检测各组大鼠海马组织中MDA、SOD水平;TUNEL检测各组大鼠海马神经元细胞凋亡情况;RT-qPCR检测各组海马组织中SYT1 mRNA表达情况;Western blot检测各组大鼠海马组织中SYT1、Bax、Bcl-2、cleaved-Caspase3蛋白表达情况.结果 与对照组相比,七氟醚组大鼠逃避潜伏期显著增加(P<0.05),穿越平台次数显著减少(P<0.05),平台停留时间显著缩短(P<0.05),海马组织神经元细胞排列散乱,边界不清,细胞核固缩,出现空泡,着色较深,海马组织神经元细胞凋亡率显著升高(P<0.05),MDA、Bax、cleaved-Caspase3蛋白含量显著升高(P<0.05),SOD、Bcl-2、SYT1 mRNA和蛋白含量显著下降(P<0.05);与七氟醚组比,CHI高剂量组大鼠逃避潜伏期显著缩短(P<0.05),穿越平台次数显著增加(P<0.05),平台停留时间显著延长(P<0.05),海马组织神经元细胞排列相对紧密,胞核固缩和空泡现象得到改善,海马组织神经元细胞凋亡率显著下降(P<0.05),MDA、Bax、cleaved-Caspase3蛋白含量显著下降(P<0.05),SOD、Bcl-2、SYT1 mRNA和蛋白含量显著升高(P<0.05);而CHI低剂量组大鼠各项指标与模型组比并无显著改善(P>0.05).结论 七氟醚吸入前预先给予高剂量CHI能够改善七氟醚麻醉导致的大鼠学习记忆障碍,其机制可能与降低氧化应激损伤,抑制海马神经元细胞凋亡和增加SYT1表达有关.

目的 探讨七氟烷复合瑞芬太尼与丙泊酚复合瑞芬太尼麻醉对老年腹腔镜胆囊切除术患者血流动力学的影响及麻醉效果.方法 选取2018年1-12月于西安交通大学第一附属医院行腹腔镜胆囊切除术治疗的老年患者156例,应用随机数字表法分为对照组和观察组,各78例.对照组在常规麻醉基础上使用七氟烷复合瑞芬太尼麻醉,观察组在常规麻醉基础上使用丙泊酚复合瑞芬太尼麻醉.比较2组患者麻醉期间血流动力学变化情况(诱导前、插管时和拔管时收缩压、舒张压和心率)、术后恢复情况(呼之睁眼时间、恢复膝跳反射时间和拔管时间)、手术前后认知情况和患者意识[简易精神状态检查量表(MMSE)评分、观察者警觉镇静量表(OAA/S)评分]、苏醒期躁动情况和焦虑程度(Ramsay镇静评分、Riker镇静和躁动评分)和麻醉用药满意度.结果 观察组插管时和拔管时收缩压、舒张压和心率均低于对照组,术后呼之睁眼时间、恢复膝跳反射时间、拔管时间均早于对照组[(5.3±2.3)min比(11.4±4.2)min、(6.3±2.7)min比(10.5±5.3)min、(7±5)min比(14±4)min],术后6 h MMSE量表评分高于对照组[(29.5±3.6)分比(23.5±3.7)分],喉罩拔除后1、3 min时OAA/S评分高于对照组[(4.6±0.8)分比(3.8±0.6)分、(4.8±0.5)分比(3.7±0.6)分],苏醒时和苏醒后30 min的Riker镇静躁动评分低于对照组、Ramsay镇静评分高于对照组,麻醉用药的满意度高于对照组[92.3％(72/78)比75.6％ (59/78)],差异均有统计学意义(均P＜0.05).结论 在老年患者腹腔镜胆囊切除术中给予丙泊酚复合瑞芬太尼麻醉,能够较好地维持患者血流动力学稳定性及镇静效果,患者苏醒时间更短,恢复情况及麻醉感觉更为良好.

目的:研究右美托咪定联合舒芬太尼对老年下肢骨折手术患者全麻苏醒期血流动力学 、应激状态 、辅助T细胞因子及疼痛程度的影响.方法:收集2017年6月 ～2018年7月于西安交通大学第一附属医院接受骨折手术并实施全麻的老年下肢骨折患者95例,根据其麻醉方式不同,分为舒芬太尼维持麻醉组(舒芬太尼组)46例,右美托咪定联合舒芬太尼维持麻醉组(联合组)49例.在整个手术过程中时刻监测两组患者不同时刻血流动力学指标心率(HR)、血氧饱和度(SpO2)和平均动脉压(MAP)的变化,并采用酶联免疫法检测两组患者在麻醉维持中及麻醉苏醒期应激状态指标皮质醇(Cor)、肾上腺素(E)、胰岛素(FIns)的变化,计算胰岛素抵抗指数(HOMA-IR).比较2组患者术前及手术完成24 h后,疼痛介质一氧化氮(NO)、内啡肽(β-EP)、P物质(SP)及辅助T细胞因子 γ-干扰素(IFN-γ)、肿瘤坏死因子-α(TNF-α)的变化.结果:联合组患者HR、SpO2、MAP和舒芬太尼组患者的SpO2在麻醉过程中变化程度较小,差异无统计学意义(P>0.05),舒芬太尼组患者T2、T3的HR和MAP与其T0时差异显著,且显著高于联合组T2、T3时HR和MAP,差异具有统计学差意义(P<0.05).2组患者麻醉苏醒期应激指标Cor、E、FIns及HOMA-IR水平均显著高于麻醉维持时,差异具有统计学意义(P<0.05),联合组患者苏醒期血清应激指标Cor、E、FIns、HOMA-IR水平均显著低于舒芬太尼组.联合组患者手术后24 h辅助T细胞因子IFN-γ 水平显著高于舒芬太尼组,TNF-α 水平显著低于对照组患者,差异具有统计学意义(P<0.05).2组患者手术后24 h血清疼痛介质NO、β-EP、SP水平均显著高于手术前,差异具有统计学意义(P<0.05),且联合组患者手术前及手术后24 h血清疼痛介质NO、β-EP、SP均显著低于舒芬太尼组,差异具有统计学意义(P<0.05).结论:右美托咪定联合舒芬太尼可稳定老年下肢骨折手术患者全麻苏醒期血流动力学状态 、减轻机体应激状态 、减弱机体免疫抑制作用,减轻患者手术疼痛程度.

目的 探讨异丙酚通过Rho/Rock信号通路调控大鼠呼吸机相关性肺损伤的机制.方法 40只成年雄性SD大鼠随机分为4组,每组10只,分别为双肺通气组(TLV组),单肺通气组(OLV足),单肺通气+异丙酚组(D组),单肺通气+异丙酚+法舒地尔组(DL组).对各组大鼠血清血清TNF-α、IL-6及IL-10含量及肺组织RhoA及Rock2蛋白水平和基因表达水平进行测定.结果 D组和DL组大鼠血清TNF-α、IL-6水平低于TLV和OLV组,IL-10水平高于TLV和OLV组,差异有统计学意义(P＜0.05).DL组血清TNF-α、IL-6水平低于D组,IL-10水平高于D组,差异有统计学意义(P＜0.05).D组和DL组大鼠W/D及BALF总蛋白水平低于TLV和OLV组,差异有统计学意义(P＜0.05).D组和DL组大鼠RhoA和Rock2蛋白含量低于TLV和OLV组,差异有统计学意义(P＜0.05).DL组大鼠RhoA和Rock2蛋白含量水平低于D组,差异有统计学意义(P＜0.05).结论 异丙酚能够有效缓解呼吸机相关肺损伤的炎性反应,同时其作用机制可能与其能够抑制Rho/Rock信号通路的激活有关.

目的 比较瑞芬太尼和咪达唑仑用于ICU患者治疗过程中镇痛的临床效果.方法 收集行冠状动脉手术和(或)心脏瓣膜手术的患者72例,随机分为对照组33例和试验组39例.试验组患者使用瑞芬太尼+丙泊酚麻醉,对照组患者使用咪达唑仑+芬太尼麻醉.比较2组患者临床治疗过程中麻醉效果的起效时间、持续时间和镇痛作用.结果 试验组患者麻醉开始时间至减药时间、麻醉开始时间至拔管时间、拔管时间至ICU出院时间和麻醉开始时间至ICU出院时间均显著低于对照组(P<0.05).试验组患者麻醉过程及麻醉后战栗、疼痛、心动过速、呼吸功能不全及低血压等不良反应的发生情况显著小于对照组(P<0.05).试验组麻醉诱导后2 min、气管插管后2 min、手术开始20 min及拔管时心率(HR)均显著低于对照组(P<0.05);试验组患者麻醉诱导后2 min、气管插管后2 min、手术开始20 min以及拔管时试验组的Ramsay评分均显著高于对照组(P<0.05);试验组患者麻醉诱导后2 min、气管插管后2 min、手术开始20 min以及拔管时的平均动脉压(MAP)均显著低于对照组(P<0.05).结论 ICU治疗患者在麻醉的过程中,相比于使用咪达唑仑/芬太尼的患者,使用瑞芬太尼/丙泊酚麻醉的患者麻醉起效时间较快,持续时间较短,镇痛作用较好,能够在ICU患者在治疗过程中发挥良好的镇痛、镇静效果.

胸外科手术中常需利用双腔管达到隔离双肺的目的 ,而如何达到精准 、快速定位是麻醉医师关注的重点问题.传统的定位方式存在各种弊端,该研究旨在从教学效果和术者满意度两方面评价多元综合教学法与传统教学法在胸外科手术双腔管插管定位教学中的表现差异.结果发现,多元综合教学法显著激发了麻醉医师的学习兴趣和热情 、独立完成双腔支气管插管的信心,提高了一次插管成功率,缩短了插管时间.多元综合教学法可行性强,对设备要求不高,在临床教学中显示出巨大的优势,值得推广.

目的 探究氟比洛芬酯与舒芬太尼联用对于经皮肾镜钬激光碎石术后镇痛的临床效果.方法 选取2015年6月-2016年6月于西安交通大学第一附属医院接受治疗的94例患者,随机分为治疗组和对照组,每组各47例.其中对照组采用舒芬太尼,治疗组采用氟比洛芬酯联合舒芬太尼.于治疗前后测定两组患者C反应蛋白(CRP)、白细胞介素(IL)-6水平,并对所有患者进行镇痛评分,以比较两组疗效差异.并统计两组治疗期间不良反应以评价氟比洛芬酯在经皮肾镜钬激光碎石术后镇痛中的价值.结果 手术完成后分别于0,4,12,24,48 h对两组患者进行镇痛强度评分发现,0和48 h时两组数据差异无统计学意义(P＞0.05),4,12,24h时治疗组评分明显低于对照组,两组数据差异有统计学意义(t=3.411,5.606,3.767,P＜0.05).采取镇痛措施后,两组炎症因子水平均有一定程度降低,且治疗组降低更为明显,差异有统计学意义(t=3.957,3.793,P＜0.05).两组均有不良反应发生,治疗组不良反应发生率为6.38％,对照组不良反应发生率为8.51％,差异无统计学意义(P＞0.05).治疗组镇痛满意度为80.85％,明显高于对照组的57.45％,差异有统计学意义(x2=6.034,P=0.014).结论 氟比洛芬酯与舒芬太尼联用较单独使用舒芬太尼对经皮肾镜钬激光碎石术后镇痛效果更好,可有效改善炎症因子水平,安全性较高,具有一定的临床应用价值.

Objective:To analyze the analgesic effect of combined spinal epidural anesthesia (CSEA) and lumbar plexus-sciatic nerve blocks (LPSB) on the elderly patients with lower limb orthopedic surgery.Methods:158 cases of elderly patients with surgical treatment of lower limb fracture in our hospital were chosen.The patients were randomly divided into two groups (combined spinal epidural anesthesia was performed in the combined spinal epidural anesthesia (CSEA) group and the lumbar plexus and sciatic nerves were blocked in the lumbar plexus-sciatic nerve blocks (LPSB) group.The onset of sensory-motor block,success in providing adequate anesthesia,hemodynamic changes,first analgesic request time and VAS socrewere recorded.Results:One patient in the CSEA group and three patients in the LPSB group required general anesthesia due to failed block of each patient were observed.There was no significant differences in the success of providing adequate anesthesia between two groups.The onset of sensory-motor block and the first analgesic request time were significantly later in the LPSB group than CSEA group.However,the duration of analgesia in the LPSB group were longer than CSEA group,the VAS score in LPSB group was significantly lower than CSEA group.Conclusions:The lumbar plexus-sciatic nerve blocks could provide effective unilateral anesthesia and offer a beneficial alternative to combined spinal epidural anesthesia in patients undergoing lower limb orthopedic surgery.

Objective To optimize the extraction of shikonin from A rnebia euchroma with solvent extraction in four solvents .Meth-ods The extractions were carried out in petroleum ether ,ethanol ,chloroform ,and 10 g ? L - 1 NaOH solution with stirring at 25 ℃ ,solvent extraction time of 30 min ,and solid to liquid ratio 1 ∶ 9 .The extraction process was conducted in duplicate .The shikonin content in extracts were measured by HPLC with gradient elution .Extraction methods were evaluated by extraction yield .Results The yield of shikonin extraction differed in four solvents (10 g ? L - 1 NaOH solution > ethanol > chloroform > petro-leum ether) .Conclusion The shikonin extraction in NaOH solution provides higher extraction yield and significantly reduces the amount of organic solvent .This economic and environmental method is suitable for shikonin extraction from A rnebia enchroma .

Objective To prepare Naringin Buccal Adhesive Tablets and to investigate the drug release feature of Buccal Adhesive Tablets in vitro .Methods Naringin Buccal Adhesive Tablets were prepared by direct compression technique by using HPMC K4M and Carbomer 940 as mucoadhesive polymers .Drug release of the mucoadhesive tablets in vitro were investigated by the basket method ,employing 500 mL water containing 5 .0 g · L -1 sodium dodecyl sulfate as dissolution medium at 50 r · min-1 . Results From Buccal Adhesive Tablets ,naringein was slowly released over a period of 10 h ,and the maximum accumulative re-lease of naringin reached more than 90% .Conclusion The release profiles of Buccal Adhesive Tablets comply with the general re-quirements of the design .

Objective To establish an extraction process of folium syringae with protocatechuic acid and protocatechuic aldehyde as the index components .Methods The solvent ratios ,extraction time and the reflux counts were evaluated .An HPLC system was used to determine the contents of protocatechuic acid and protocatechuic aldehyde .The chromatographic conditions were as fol-lows :planetsil C18 (150 mm × 4 .6 mm ,5μm) was utilized with a mixture of methanol-water-glacial acetic acid (12∶78∶0 .5) as the mobile phase ,the flow rate was 1 .0 mL · min-1 ,the detection wavelength was 280 nm ,and the column temperature was set at 30 ℃ .Results The highest extraction rate was obtained after three extractions (2 ,2 ,1 h) with 100 folds of water .The con-tents of protocatechuic acid and protocatechuic aldehyde were ranged from 20 .7 to 23 .1 μg · g -1 and 83 .3 to 92 .4 μg · g -1 ,re-spectively .Conclusion An extraction method with relatively high extraction rate was established .The method could be utilized to extract the bioactive constituents from folium syringae .

Objective To observe the impact of Parecoxib combined with Tramadol on peri-operative pain and inflammatory cytokines in lung cancer patients undergoing video-assisted lung lobectomy.Methods Totally 48 patients of elective lung lobectomy via video-assisted thoracic surgery under general anesthesia were randomly divided into observation group(P group)and control group(C group).The drugs for induction and maintenance of anesthesia were used identically in the two groups.In P group,Parecoxib(40 mg)was given intravenously 30 min before surgery;Parecoxib(20 mg)and Tramadol(2 mg/kg)were given intravenously 30 min before the end of surgery.In C group,normal saline(4 mL)was given intravenously 30 min before surgery;normal saline(2 mL)and Tramadol(2 mg/kg)were given intravenously 30 min before the end of surgery.Anesthesia time,operation time,recovery time and dosage of analgesic during operation were recorded;heart rate(HR)and mean arterial pressure(MAP)during recovery were noted;serum IL-6 and IL-8 levels were measured in each group perioperatively;postoperative pain was assessed using visual analog scales(VAS).Meanwhile,adverse events were observed.Results There was no significant difference between the two groups regarding anesthesia time,operation time or recovery time(P0.05).Remifental used during operation was significantly less in P group than in C group(P 0.05).HR and MAP were significantly higher immediately at extubation,5 min and 10 min after extubation in C group than in P group(P0.05).Serum IL-6 and IL-8 levels were increased 6 h,12 h and 24 h after surgery in C group,having significant difference from those in P group(P0.05).VAS was significantly lower 15 min,1 h,2 h,4 h,8 h and 12 h after surgery in P group than in C group(P0.05).The two groups did not differ significantly in adverse events(P0.05).Conclusion Parecoxib used in video-assisted thoracic surgery for lung lobectomy can decrease analgesic dosage during operation,provide satisfactory pain control and suppress inflammatory cytokines after surgery,without increasing adverse events.

目前,在我国最常用的剖宫产术后硬膜外镇痛方法是持续性低剂量的输注布比卡因和芬太尼,芬太尼的加入减少了布比卡因的用量,从而减少了运动神经被阻滞的机率,增加了硬膜外镇痛过程中产妇的满意度[1].

目的:研究行原位肝移植术患者围手术期的麻醉管理特点.方法:25例行原位肝移植术的终末期肝病患者,采用静吸复合全麻;术中通过无创监测HR、SPO2、ECG、PETCO2、尿量、鼻咽温,有创监测AP、PCWP、CO、动脉血气分析、电解质、血糖等进行血流动力学、凝血功能、酸碱平衡、电解质、血糖、体温的调控和肾功能保护.根据成人原位肝移植术无肝前期、无肝期、新肝期的特点,给予相应的处理措施.结果:血液动力学和酸碱平衡在无肝期和新肝早期出现剧烈改变;围术期电解质变化突出在血钾和血钙上;无肝期血糖升高,新肝期血糖逐渐下降;凝血功能有一定程度的紊乱,需及时补充凝血因子,适当使用止血药物;术中体温下降明显,需注意保温.结论:充分的麻醉前准备,完善的监测手段,合理的血管活性药物的应用,良好的血流动力学、凝血功能、酸碱平衡、血气电解质、血糖、体温调控以及肾功能保护均有助于提高原位肝移植术麻醉的安全性,故肝移植各期的麻醉管理和监测非常重要.

目的观察尼卡地平和艾司洛尔联合应用预防双腔气管导管插管引起的心血管副反应.方法60例患者随机分为对照组(A组)和联合用药组(B组),每组30例,患者均行双腔气管导管插管.诱导用药依次静脉注射芬太尼2.0μg/kg,依托咪酯0.3 mg/kg,维库溴铵0.15 mg/kg,A组静脉注射生理盐水3 ml;B组静脉注射尼卡地平10μg/kg和艾司洛尔0.5 mg/kg,分别记录给药前(基础值),双腔气管导管插管前,插管即刻,插管后1,3,5min时的收缩压(SBP),舒张压(DBP),平均动脉压(MAP)和心率(HR),并在给药前和双腔气管导管插管后3 min,抽取血标本用放射免疫法测定血管紧张素Ⅰ(AⅠ)、血管紧张素Ⅱ(AⅡ)和皮质醇浓度,用试纸法测血糖浓度.结果两组静脉注射诱导药后SBP,DBP,MAP和HR均有不同程度的下降,在插管即刻、插管后1,3,5 min时,A组较诱导前显著增高(P＜0.05),B组较诱导前轻度增加(P＞0.05),明显低于A组同期水平(P＜0.05).AⅠ、AⅡ、皮质醇和血糖水平,A组较诱导前显著增高(P＜0.05),B组轻度增加(P＞0.05),且明显低于A组同期水平(P＜0.05).结论在全麻诱导双腔气管导管插管时,尼卡地平10μg/kg和艾司洛尔0.5 mg/kg联合应用能有效地预防插管引起的心血管副反应.

全麻围术期体温过低致苏醒延迟时有报道,但是在硬膜外麻醉围术期由于意外的低体温而导致意识障碍罕见,本文现报告1例如下.

面部巨大血管瘤切除常导致大量出血,而输人大量库存血可产生严重的并发症.我科采用快速血液稀释和控制性降压减少血管瘤出血量获得满意的效果,现报告如下.1病例资料患者张某,男,56岁,左面颊部巨大蔓状血管瘤病史22年,近3个月生长加快.人院查体全身一般情况尚可,心肺腹部查体无异常.专科情况;肿瘤位于左侧面颊部,上界达睑裂平面,下界为颌下,后界位于左耳屏前,前界达鼻翼旁及上唇正中.

异丙酚与咪唑安定联用麻醉起效快、苏醒迅速而平稳、副作用少,已广泛用于各科手术麻醉.我们联合应用这两种药物进行全静脉复合麻醉行腹腔镜手术,取得满意效果,现报告如下.