1患者资料 患儿,女,3岁,身高95 cm,体质量13 kg,因"发现右侧腹部包块1周"入院.既往史无特殊;第2胎第2产,足月剖宫产,出生过程顺利,生长发育正常.入院体格检查:体温36.8℃,心率(HR)100次/min,呼吸频率(RR)22次/min,血压(BP)90/60 mmHg,神志清楚,双肺无异常,全腹软,右侧腹部饱满,脐右侧可触及实质性肿物,大小约10 cm×8 cm×8 cm,表面不规则,边界清楚,活动差,伴有触痛,无反跳痛,移动性浊音(-),双下肢无水肿.腹部超声:肝肾间隙、腹膜后巨大(11 cm×10 cm×10 cm)实性占位,考虑神经母细胞瘤?

目的 评价二十二碳六烯酸(DHA)预处理是否增强脑胶质细胞对氧糖剥夺(OGD)条件下脑血管内皮细胞的保护作用.方法 原代培养的胶质细胞,分别在正常氧含量或低氧条件培养24 h,收集各组培养上清液.再将原代培养的血管内皮细胞按实验设计分别与胶质细胞培养上清液共培养.利用流式技术检测凋亡率,Western检测Bax、bcl-2、caspase-3、pTie-2、pAkt、ZO-1.结果 经DHA预处理后的胶质细胞培养上清液能够降低低氧条件下血管内皮细胞的凋亡(P＜0.01),降低Bax、caspase-3的表达(P＜0.01),而增加bcl-2、bcl-2/Bax、pTie-2、pAkt、ZO-1表达(P＜0.01).结论 DHA预处理能够增强脑胶质细胞对氧糖剥夺条件下血管内皮细胞的保护作用.其机制可能与增加Ang1分泌、激活Tie-2受体、从而促进抗凋亡作用相关.

Objective To investigate the effect of ulinastatin pretreatment on hippocampal CA1 region with ischemia-reperfusion (I/R) injury in rats and its mechanism. Methods A total of 90 male SD rats were randomly divided into the sham operation group (group S), group I/R and ulinastatin pretreatment group (group U), 30 rats in each group. The three groups were further divided into the reperfusion 2 h, 6 h, 1 d, 3 d and 7 d subgroups, 6 rats in each subgroup. Global cerebral I / R model was established by 4-VO method. The TdT-mediated dUTP nick end labeling (TUNEL) method was used to detect the neuron apoptosis in hippocampal CA1 region. The enzyme linked immunosorbent (ELISA) method was used to measure the serum concentrations of YKL-40, and the immunohistochemical method was applied to investigate expression of phosphorylated c-Jun N-terminal kinase (p-JNK) and phosphorylated extracellular-regulated protein kinase (p-ERK) in hippocampal CA1 region. Results The serum concentrations of YKL-40, the number of apoptotic cells and expression of p-JNK and p-ERK after reperfusion at each time point all showed significant differences among the three group (all P<0.05). Compared with group S, the serum concentrations of YKL-40, the number of apoptot ic cells and expression of p-JNK and p-ERK were significantly increased at each time point after reperfusion in group I/R (all P<0.05). Compared with group I/R, the serum concentrations of YKL-40 and expression of p-JNK were higher, while the number of apoptotic cells and the expression of p-ERK was lower at each time point after reperfusion in group U as compared with group I/R (all P<0.05). Conclusion Ulinastatin pretreatment can reduce I/R injury in rats hippocampus CA1 region, which may be associated with the increased serum concentrations of YKL-40, up-regulation of p-ERK expression, down-regulation of p-JNK expression and neuronal apoptosis.

目的:观察经鼻粘膜给予小剂量硝酸甘油对腹腔镜胆囊手术气腹血流动力学的影响,并与经静脉给药比较.方法:选择全麻腹腔镜手术60例,应用数字随机法分为3组:对照组(A组)、硝酸甘油单次静脉给药组(B组)、硝酸甘油经鼻粘膜给药组(C组),每组各20例.在气腹前3min,B组经静脉单次给予硝酸甘油10μg/kg,C组经鼻粘膜给予硝酸甘油10μg/kg.分别观察并记录麻醉诱导前(T0)、气腹前3min(T1)、人工气腹时(T2)、气腹后3min (T3)、气腹后10min(T4)患者SBP、DBP、MAP、HR的变化.结果:与T0比较,3组T1时间点SBP、DBP、MAP、HR均呈一过性降低或减慢(P＜0.05);与L比较,A组T2、T3、T4中SBP、DBP、MAP、HR均显著升高(P＜0.05);与T0比较,B组T2、T3中HR显著增快,SBP、DBP和MAP显著降低(P＜0.05);与T0比较,C组T2、T3、T4时间点SBP、DBP、MAP、HR无统计学差异(P＞0.05);与B组比较,在T2、T3时间点,C组SBP、DBP、MAP、HR有明显差异(P＜0.05).结论:硝酸甘油经鼻粘膜给药能较好维持腹腔镜手术气腹后血流动力学的稳定.

Objective To observe the effects of target controlled infusion of remifentanil and constant infusion of dexmedetomidine on extubation response and emergence delirium during emergence from total intravenous anesthesia (TIVA) for pediatric patients. Methods 90 children undergoing adenotonsillectomy under TIVA were randomly divided into control group (group C) , remifentanil (group R) and dexmedetomidine group (group D). Dexmedetomidine was infused at the rate of 0.3μg·kg-1·h-1 in group D until extubation after anesthesia induction. At 2 minutes before the end of the surgery, propofol was ceased and infusion of remifentanil was stopped in group C and group D and maintained in group R at target organ concentration of 1.5 ng/ml until extubation. Mean artery pressure (MAP) and heart rate (HR) were recorded before Dex delivery (T0), the end of the surgery (T1), 1 min (T2) before extubation, during extubation (T3) and 1 (T4), 5 (T5), 10 min (T6) after extubation. Time from stopping propofol to extubation and opening eyes and cough reflex score during extubation were recorded. According to the Pediatric Anesthesia Emergence Delirium to mark the delirium of the patient per 5 minutes after extubation, the highest score was used to effective value, and at the same time, mark the degree of pain according to the modified Children’s Hospital of Eastern Ontario Pain Scale. Results Compared with T0, MAP and HR at T2-T6 in group C and at T5-T6 in group R were significantly higher (P<0.05), at each time point in group D were no significant difference (P>0.05). Compared with group C , MAP and HR at T2-T4 in group R and T2-T6 in group D were significantly lower (P<0.05). Compared with group R, MAP and HR at T5-T6 in group D were significantly lower (P<0.05). There was no significant difference in extubation time and opening eyes time between the three groups (P>0.05). Cough reflex score of group R and group D was significantly lower than group C (P<0.05), PAED and pain score of group D was significantly lower than group C (P<0.05) and group R (P<0.05). Conclusion Target controlled infusion of remifentanil (1.5 ng/ml) and continuous infusion of dexmedetomidine (0.3 μg·kg-1·h-1) can effectively inhibit extubation response and don’t increase the postoperative recovery time in pediatric adenotonsillectomy under TIVA. While continuous infusion of dexmedetomidine can decrease the incidence rate of emergence delirium, more applicable to infusion during emergence from TIVA for pediatric patients.

目的 探讨右美托咪定对神经外科手术患者麻醉苏醒期躁动的影响.方法 选择本院2010年6月～2012年12月神经外科手术患者48例,将全部患者随机分为研究组和对照组,每组各24例,两组患者的手术方式及麻醉期用药相同,研究组患者围麻醉期加用右美托咪定,观察两组患者苏醒期躁动评级情况,记录患者的苏醒时间、拔管时间、自主呼吸恢复时间、拔管时镇静-躁动(SAS)评分、拔管后10 min Ramsay评分、疼痛评分(VAS).结果 研究组患者的苏醒期躁动发生率明显低于对照组,差异有统计学意义(P＜0.05);两组患者的苏醒时间、拔管时间、自主呼吸恢复时间比较,差异无统计学意义(P＞0.05);研究组患者拔管时SAS评分、拔管后10 min Ramsay评分、VAS评分明显优于对照组,差异有统计学意义(P＜0.05).结论 右美托咪定可减少神经外科手术患者麻醉苏醒期躁动情况,有效缓解疼痛,对患者术后恢复有重要作用,值得应用.

目的:探讨术中静脉应用硫酸镁对维库溴铵肌松作用的影响及其安全性.方法:60例择期行腰椎间盘髓核摘除+内固定术的患者,随机分为两组,各30例.麻醉诱导插管后,A组静脉滴注40 mg/kg的硫酸镁,B组给予同体积的生理盐水.术中通过血浆浓度靶控输注丙泊酚(3.0～3.5 μg/ml)、瑞芬太尼(3.0～4.0 ng/ml),维持脑双频指数(bispectorial index,BIS)为45～55;设定四个成串刺激(train off our,TOF)为0,通过闭环肌松集成靶控注射系统输注维库溴铵.在术前(t1),输注硫酸镁或安慰剂完毕后10 min(t2)、60 min(t3),停用维库溴铵时(t4)4个时间点上,检测血清MG2+、Ca2+与K+度.测量在输注硫酸镁或安慰剂完毕后5 min时的心率和平均动脉压.记录使用维库溴铵的总剂量,停用维库溴铵后TOF恢复达70％的时间T70%.结果:A组血清Mg2+度在t2时达到最高(1.33±0.19) mmol/L,随着手术时间的延长逐渐降低(P＜0.05);到t3、t4时,A组血清Mg2+浓度仍较B组高(P＜0.05);两组患者的血清Ca2+、K+浓度,以及心率和平均动脉压均无显著性差异(P均＞ 0.05).A组维库溴铵剂量为(3.22±0.57)μ g/(kg·min),明显少于B组(3.81±0.58) μg/(kg·min)(P=0.000 2);A组T70％为(26.3±3.6)min,较B组(28.7±4.3)min减少(P=0.022 5).结论:静脉应用40 mg/kg硫酸镁可增强维库溴铵的肌松作用,减少其用量,缩短肌力恢复时间,对血清Ca2+、K+浓度及血流动力学无显著影响.

Objective To investigate the efficacy of heart rate variability in patients receiving off-pump coronary artery bypass grafting(OP-CABG) with remifentanil target controlled infusion for anasthesia. Methods A total of 65 patients undergoing elective OP-CABG were randomly divided into the target controlled infusion group(group Ⅰ, 32 cases) and constant infusion group(groupⅡ, 33 cases). The hemodynamic parameters and the plasma epinephrine, cortisol, blood glucose, lactate were detected and recorded at a series of time points: before induction(T0), after induction(T1), during intubation(T2), 2 min after sternum saw(T3), exposure and stabilization of the left anterior descending artery(T4), the circumflex or right coronary artery(T5), at the end of operation(T6), during extubation(T7), and 24 h after operation(T8) HRV indices were also recorded by frequency domain analysis: the total power, low frequency power, high frequency power and low frequency power / high frequency power,at each time point. Results The indices of heart rate, mean artery pressure, epinephrine and cortisol at T7 in the two groups were much higher than those at T0(all P < 0.05). The levels of blood glucose and lactic acid in the two groups increased at T3, and were higher at T5, T6, T7 in the group Ⅱ than those in group Ⅰ(all P < 0.05). HRV indices in the two groups all decreased after the induction, whereas high frequency power, the total power, low frequency power and low frequency power / high frequency power raised at T5 and T7, and the total power, low frequency power and low frequency power / high frequency power at T5 were much higher in the group Ⅱ than those in group Ⅰ(all P < 0.05). Conclusion Remifentanil target controlled infusion can suppress the stress response and maintain the balance of cardiac autonomic nervous system in OP-CABG by HRV.

OBJECTIVE:To investigate the effects of magnesium sulfate infusion on shiver in patients with subarachnoid blockduring surgery. METHODS:60 patients scheduled for elective transurethral prostatectomy after subarachnoid block were random-ized into control group and treatment group. Treatment group received an intravenous bolus of magnesium sulfate 60 mg·kg-1 viasyringe pump in 30 minutes,followed by a constant pumped infusion of 1.5 g·h-1. Motor blockade was evaluated by bromage mo-tor scale. Sensory block level was assessed by pinprick test. Shiver reaction was assessed after the completion of subarachnoid blockand side effects were recorded. RESULTS:Hypothermia was observed in all patients in treatment group and in 70.0% patients incontrol group(P<0.05) . The decrease in core temperature in treatment group was more significant than control group(P<0.01) .The incidence of shiver in control group(73.3%) was higher than in treatment group(10.0%)(P<0.01) . CONCLUSIONS:Mag-nesium sulfate infusion significantly relieves shiver in patients underwent transurethral prostatectomy after subarachnoid block but in-creases the risk of hypothermia.

Objective To assess the analgesic efficacy and safety of Parecoxib Sodium after transurethral resection of prostate.Methods 60 patients undergoing transurethral resection of prostate under spinal combined epidural anesthesia were randomly divided into group A and group B.Patients of group A were intravenous injected 40 mg Parecoxib Sodium that was dissolved in 2 mL Normal Saline before anesthesia induction 30 min.Patients of group B were intravenous injected 2 mL Normal Saline before anesthesia induction 30 min.Postoperative pain scores were evaluated at 30 min,1,2,4 and 6 hours after administration of each Analgesic,using a visual analogue scale(VAS).Furthermore,preoperative and postoperative hemoglobin(Hb) levels and hemostatic variables [prothrombin time(PT) and the international normalized ratio(INR)] were recorded in all patients.Results The score of VAS of group A at the time of T1,T2,T3,T4,T5 were lower than that of group B,there were significant decreases(P 0.05).There was no significant difference on the amount of resection tissue,operating time,preoperative-postoperative Hb levels and hemostatic variables between the two groups.There was no patient required blood transfusion after operation in the two groups.Conclusion Parecoxib Sodium of NSAIDs has not a contraindication to TURP and should be used for the control of postoperative pain.

Objective To investigate the effects of peritoneal resuscitation on liver function in rabbits with hemorrhagic shock. Methods Twenty-one male rabbits were randomly divided into 3 groups: no hemorrhagic shock group(Group A),conventional resuscitation group(Group B),and peritoneal resuscitation group(Group C).Rabbits in Group B and C were exsanguinated until mean blood pressure(MAP) reached 40 mmHg within 10 minutes.MAP was kept at 40 mmHg for 60 minutes prior to resuscitation with shed blood plus double hemorrhage volumes of sodium lactate.Meanwhile,2.5% clinical dialysis fluid,which was replaced with saline in Group A and B,was intraperitoneally injected in Group C.The alanine aminotransferase(ALT) and asparate aminotransferase(AST) were measured at baseline,60 minutes after shock,and 60 and 180 minutes after resuscitation.The livers were obtained for assessment of dry/wet weight ratio,malondialdehyde(MDA),superoxide dismutase(SOD),and the pathological change,3 hours after resuscitation. Results Significant reduction in ALT,AST and MDA was revealed in Group C,comparing with those in Group B(P0.05).Meanwhile,significantly increase of dry/wet weight ratio and SOD was revealed in Group C,comparing with those in Group B(P0.05).Furthermore,more prominent pathological change was observed in Group B,comparing with that in Group C.No significant difference in pathological change was observed between Group A and C. Conclusion Peritoneal resuscitation improves the liver function in rabbits with hemorrhagic shock.

【Objective】 To observe the changes of plasma endothelin(ET) and calcitonin gene-related peptide(CGRP) in elderly patients subjected to deliberate hypotension with prostaglandin E1.【Methods】 86 elderly patients scheduled for nasal endos copic surgery in general anesthesia were randomly divided into groups of prostaglandin E1(group P) and nitroglycerin(group N).Hypotension was induced with prostaglandin E1 and nitroglycerin through continuous infusion respectively,and the mean arterial blood pressure(MAP) was reduced to about 25%～30% reduction of baseline MAP.The MAP and heart rate(HR) were continuously monitored,and the venus blood samples were taken for the measurements of plasma LAC,ET,CGRP and the rates of ET/CGRP before controlled hypotension(T0),at drop to target blood pressure(T1),at 30 min when hypotension has been maintained(T2),at the end of hypotension(T3) and 30 min after the halt of hypotension(T4).【Results】 The HR of patients in group N after controlled hypotension significant increased,but that of in group P is no significantly difference.The HR in group P was significantly slower than group N(P 0.05).Compared with T0,the patients in groups N after controlled hypotensiion significant increased in ET,but that in group P has not only changed and significantly lower than group N(P 0.05).The CGRP of group P rised significantly at T2,T3,T4,nevertheless,that in group N was not significantly changed throughout observation.The ET/CGRP in group P have no increase;while in group N are raised significantly at T2,T3,T4.【Conclusion】 Prostaglandin E1 for controlling hypotension are more likely to maintain ET/CGRP balance that is helpful for elderly patients to maintaining the normal regulation of vascular function during induced hypotension.

OBJECTIVE:To investigate the effects of Xingnaojing injection on the cognitive function in elderly patients in early postoperative and recovery period after general intravenous anesthesia. METHODS:80 elderly patients with elective abdominal surgery after general intravenous anesthesia were randomly divided into Xingnaojing group(group X)and control group(group C) with 40 patients in each group. MiniMental State(MMS)detection was used to evaluate cognitive function before anesthesia and at 1 h,3 h,6 h and 24 h after operation. The content of S100ββ protein and IL6 were detected at different time points. RESULTS:MMS scoring of patients in two groups were decreased and reached the lowest point at 1 h after operation. In group X the score was decreased significantly at 1 h after operation(P<0.05)and recovered at 3 h after operation. In group C the score was decreased significantly at 1 h and 3 h after operation P<0.05). And the decrease of score in group C at 1 h,3 h and 6 h after operation was more significant than in group X(P<0.05). The level of S100ββ protein and IL6 was highest at the end of operation. The level of S100ββ protein in group C at 1 h and 6 h after operation and the level of IL6 at 1 h,6 h and 24 h after operation were all higher than in group X. CONCLUSION:Xingnaojing injection could promote analgesia in elderly patients with general intravenous anesthesia and improve cognitive function,which may be associated with inhibition effect of Xingnaojing injection on the secretion of S100ββ protein and IL6 and inflammatory reaction.

目的比较芬太尼和雷米芬太尼靶控输注(TCI)用于单肺通气的效果。方法将58例拟行肺叶切除手术的患者随机分为Ⅰ组和Ⅱ组各29例,分别施行芬太尼—异丙酚和雷米芬太尼—异丙酚TCI的全静脉麻醉。诱导插管成功后分别于平卧位双肺通气20 min(T1)、左侧卧位双肺通气20 min(T2)及左侧单肺通气20 min(T3)、40min(T4)、60 min(T5)行血气分析,计算肺内分流率(Qs/Qt),并记录脉搏氧饱和度(SpO2)、平均动脉压(MAP)、中心静脉压(CVP)、HR及拔管时间。结果平卧位转为侧卧位、双肺通气转为单肺通气时两组Qs/Qt均明显增加(P<0.05);两组Qs/Qt在T3时均最大、在T1最低,其中T3、T4时Ⅰ组少于Ⅱ组(P均<0.05);术后Ⅰ组的拔管时间长于Ⅱ组(P<0.05);两组术中SpO2均≥92%,MAP、CVP、HR无显著差异。结论与雷米芬太尼比较,芬太尼TCI对单肺通气时肺内分流影响更小,可安全有效地用于时间<2 h的手术。

目的探讨术前急性超容血液稀释(AHH)对单次插管剂量(3ED95)的顺式阿曲库铵肌松作用的影响。方法将80例行胸腰椎手术患者随机分为实验组(AHH组)和对照组(C组),各40例。AHH组术前予6%羟乙基淀粉(HES)130/0.4注射液15 mL/kg,C组常规补液(Ringer′s液,约5 mL/kg)。记录两组患者补液前后血流动力学指标心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)及红细胞比容(HCT)、血红蛋白浓度(Hb)、pH、K+、Na+、Ca2+,以及清蛋白(Alb)和总蛋白(TP)含量;以肌松监测仪测量顺式阿曲库铵阻滞起效时间、成串刺激(TOF)无反应期、阻滞持续时间、肌松恢复指数、体内作用时间及插管条件。结果AHH组CVP增高,HCT、Hb、K+、Ca2+、总蛋白、清蛋白降低,顺式阿曲库铵起效时间缩短,差异均有统计学意义(P<0.05)。结论AHH时,顺式阿曲库铵起效时间缩短,肌松程度及恢复时间差异无统计学意义(P>0.05)。

Objective To investigate the clinical efficacy of remifentanil target-controlled infusion (TCI) used in anesthesia for off-pump coronary artery bypass graft (CABG). MethodsFourty patients undergoing off-pump CABG were randomly divided into two groups with 20 cases each.Remifentanil TCI was administrated in group Ⅰ,or in constant-speed infusion in group Ⅱ. The hemodynamics were record before and during operation.The blood concentrations of epinephrine(E),glucose(BG) and lactic acid(LAC) were measured as well. Results No statistical difference of the hemodynamics,extubation time and ICU stay was found between the two groups.The concentrations of BG and LAC were higher in group Ⅱthan those in group Ⅰ at the time of exposing and fixing the coronary arteries and the end of operation (P0.05). Much more phenylephrine was used for maintaining blood pressure in group Ⅱ (P0.05).Conclusion Remifentanil TCI is better than insusion for the maintenance of anesthesia in reducing strss response to surgery,which is more suitable for fast track anesthesia in the patients undergoing off-pump CABG.

【Objective】 To investigate the preventive effect of atelectasis following thoracotomy by penehyclidine hydrochloride. 【Methods】 One hundred and fifty-two patients receiving selective operation or limited operation of chest (lung, esophagus) surgery were divided randomly into two groups with 76 patients each: penehyclidine hydrochloride group(group A) and control group(group B). Group A was given penehyclidine hydrochloride 13.7 μg/kg by intramuscular injection in preoperative and postoperative 1～4 days; group B was given scopolamine of conventional dosage. The hemodynamic parameters including HR, SBP, DBP, the volume dose of aspirate sputum in operation, the volume dose of begma postoperative and the quantity of two groups postoperative atelectasis were noted. 【Results】 There were no significant differences between two groups in the hemodynamic parameters (P 0.05).The volume dose of sputum in group A was lower than that in group B (P 0.05). None in group A while 3 in group B was of postoperative atelectasis, there were significant differences between two groups in the quantity of postoperative atelectasis (P 0.01). 【Conclusion】 Penehyclidine hydrochloride preventing atelectasis following thoracotomy is safe and effective, but to the dosage and course of treatment of drug we need study any further.

Objective To assess the effects and security of Remifentanil in anaesthesia in children's tonsillectomy and Adenoidectomy.Methods Sixty children aged 3～8 undergoing elective operation for obstructive sleep apnea hypohea syndrome,were randomized to one of three groups to reseeive the following:remifentanil combined with propofol group(goup R),fentanyl combined with propofol group(group F),ketamine combined with propofol group(group K).After the implementation of the induction of anesthesia endotracheal intubation,parallel mechanical ventilation.Records before the induction of anesthesia(T0),endotracheal intubation instantly(T1),started operation after 30 min(T2),the end of operation(T3),extubation after 5min(T4) of heart rate(HR),upper limb systolic blood pressure(SBP),Diastolic blood pressure(DBP),the pulse of oxygen saturation(SpO2).Each group of children with complete withdrawal to resume breating independently and extubation time.Results Among all groups of children with sex ratio,age,weight,anesthesia time difference was not significant.Compared with the K Group,the modynamics of group R and F at T1 fell more,had a significant difference(P<0.05);shortest Breathing independently recovery time,time to extubation group R,F Group followed,K longest group(P<0.05,orP<0.01).Conclbsion Remifentanil combined with propofol intravenous anesthes8ia for children's tonsils and adenoids removed for safe,effective,rapid induction and regained consciousness.