Objective To investigate whether capnography is superior to pulse oximetry and visual assessment for the prevention of hypoxemia during therapeutic hysteroscopy. Methods 60 patients undergoing sedation and analgesia procedure receiving therapeutic hysteroscopy were randomly divided into two groups (C group and P group).P group received standard monitoring that included HR, ECG,NBP and pulse oximetry.C group received capnography monitoring through modified nasopharyngeal airway plus standard monitoring.Apnea and disordered respiration (ADR)and incidence of hypoxemia were investigated and rectified.Results Thirty-three episodes of ADR were discovered in C group while sixteen episodes of ADR were found in P group.There were two cases of hypoxemia and nine cases in P group.The incidence of hypoxemia in C group was significantly lower than in P group (6.7%vs.30%, <0.05). Conclusion Capnography is superior to pulse oximetry and visual assessment for the prevention of hypoxemia during therapeutic hysteroscopy.Modified nasopharyngeal airway provides a"closed loop"which is beneficial to capnography monitoring while it is minimal invasive and easy to practice.

目的 比较超声引导下比较超声引导下两种颈神经丛阻滞(颈丛阻滞)方法即C4横突一点法和C2、C3、C4横突三点法的麻醉效果及并发症的发生情况.方法 择期拟行单侧甲状腺次全切除术患者60例,性别不限,ASA Ⅰ或Ⅱ级,随机分为2组(n=30):两组均作双侧颈浅丛阻滞及术侧颈深丛阻滞.颈浅丛阻滞均为在超声引导下将局麻药注射在胸锁乳突肌中点后缘下方.C4横突一点法组(A组)在超声引导下在C4横突处注射局麻药9ml;C2、C3、C4横突三点法组(B组)超声引导下于C2、C3、C4横突处各注射局麻药3ml.记录起效时间、麻醉优良率、阻滞前和阻滞后5、10、15、20、30min的生命体征,并观察并发症的发生情况.结果 超声引导C2、C3、C4横突三点法颈深丛阻滞和C4横突一点法颈深丛阻滞进行对比,三点法组的耳大神经分布区域起效时间短于一点法组,而锁骨上神经分布区域起效时间长于一点法组(P＜0.05).三点法组的深部麻醉优秀率较一点法更为完善(P＜0.05),两种方法成功率比较,差异无统计学意义.一点法A组出现1例Horner's综合征,两组均无膈神经阻滞、喉返神经阻滞、误入血管、局部麻醉药中毒.结论 超声可以作为颈深丛阻滞的定位方法并可进行实时引导颈丛神经阻滞.通过超声准确定位,进行C2、C3、C4横突三点法和C4横突一点法两种颈深丛阻滞方法的麻醉效果比较发现,三点法颈深丛阻滞比一点法更为完善,术中患者循环更为稳定,且并发症发生例数较少,但差异无统计学意义.

Objective To evaluate the effects of sirolimus on scopolamine-induced cognitive dysfunction in rats.Methods Thirty male Wistar rats,aged 3 months,weighing 200-250 g,were equally randomized into 3 groups:normal saline group (NS group),scopolamine group (SC group) and scopolamine + sirolimus group (SS group).Normal saline,scopolamine 0.8 mg/kg and sirolimus 3.5 mg/kg + scopolamine 0.8 mg/kg were injected intraperitoneally in groups NS,SC and SS,respectively,and the injection was continued for 14 consecutive days.The cognitive function was assessed by Morris water maze test on 15th day.After behavior test,the rats were sacrificed and the prefrontal cortex and hippocampus were harvested for determination of amyloid β protein (Aβ) and Tau protein expression.Results Compared with NS group,the escape latency was significantly prolonged,the ratio of time spent in the target quadrant was decreased,Aβ expression in prefrontal cortex and hippocampus was upregulated and Tau protein expression in prefrontal cortex and hippocampus was down-regulated in group SC (P ＜0.05 or 0.01).Compared with SC group,the escape latency was significantly shortened,the ratio of time spent in the target quadrant was increased,Aβ expression in prefrontal cortex and hippocampus was down-regulated and Tau protein expression in prefrontal cortex and hippocampus was up-regulated in group SS (P ＜ 0.05 or 0.01).Conclusion Sirolimus can significantly improve scopolamine-induced cognitive dysfunction in rats and the changes in the expression of Aβ and Tau protein in prefrontal cortex and hippocampus may be involved in the mechanism.

目的比较GlideScope视频喉镜和直接喉镜用于阻塞性睡眠呼吸暂停综合征(OSAS)患者气管插管的临床效果。方法全麻下行悬雍垂腭咽成形术(UPPP)的OSAS患者60例随机均分为两组:G组应用视频喉镜,D组应用直接喉镜。术前行改良Mallampati分级评估,静脉麻醉诱导并在视频喉镜或直接喉镜引导下经鼻气管插管。记录麻醉诱导前(T1)、诱导后1min(T2)、插管即刻(T3)以及插管后1min(T4)的脉搏氧饱和度(SpO2)、收缩压(SBP)、舒张压(DBP)、心率(HR),计算SBP-HR的乘积(RPP)。结果G组气管插管中位时程60(38-115)s,明显短于D组的83(42-165)s(P<0.05)。与T2相比,两组T3、T4都有明显的血流动力学变化(P<0.05);但T3时G组的SBP、DBP、HR和RPP均明显低于D组(P<0.05)。视频喉镜能降低喉头分级。G组气管插管成功率为100.0%,明显高于D组的86.7%(P<0.05)。结论 GlideScope视频喉镜可明显改善咽喉部暴露,特别适用于气道评估为Ⅲ-Ⅳ级的患者,应用于OSAS患者气管插管时操作简单,安全可行。

目的探讨脑电双频指数（BIS）监测在老年患者选择丙泊酚诱导用量的指导价值。方法全麻老年患者40例,年龄65～75岁,ASAⅠ或Ⅱ级,随机分为两组。A组在BIS监测下缓慢推注丙泊酚,使BIS值降至40～50时停止;B组根据经验使用丙泊酚1.5～2 mg/kg。两组均复合维库溴胺0.1 mg/kg,芬太尼3μg/kg后行气管插管。连续监测围诱导期的血压（BP）、心率（HR）和BIS;记录丙泊酚的用量和BIS值。结果A组诱导用丙泊酚总量平均（1.33±0.50）mg/kg,明显少于B组的（1.62±0.70）mg/kg（P＜0.05）;B组BP和BIS值均明显降低于A组（P＜0.05）。结论BIS监测能指导临床选择合适的丙泊酚诱导用量;在老年全麻患者,诱导用丙泊酚（1.33±0.5）mg/kg,既能取得足够的麻醉深度,又能维持较稳定的血流动力学状态。

Objective To study the effects of remifentanil on heart rate variability (HRV)in surgical patients.Methods Forty patients (35-60 years old )undergoing selective upper abdominal surgery were divided randomly into remifentanil group(R)and general anesthesia combined with epidural block group(E) with 20 cases each.The changes of HRV were analized before anesthesia(T0),after induction (T1),exploring abdomen(T2),at 1 h(T3),2 h(T4)during operation and 10 min after extubation(T5).Results Compared with those at T0,TP and LFR decreased significantly at T3 and T4 in group R(P0.01).HFR in group R was lower than that in group E.HFR decreased significantly in group E at T2. TP,LFR and LF/HF were not changed much.TP and HFR increased significantly in group R at T2 (P0.01),but LF and LF/HF decreased significantly(P0.01).Compared with that at T3,HR increased significantly in group R at T2,but decreased significantly in group R at T2,T3 and T4 .Conclusion The balance of sympathetic and parasympathetic nervous activity could be kept during general anesthesia combined with epidural block.Remifentanil depresses sympathetic activity obviously resulting in imbalance of autonomic nervous system.

Objective To observe the anesthetic effect and recovery from anesthesia with small-dose ketamine combined with remifentanil in patients operated for abdominal surgery.Methods Sixty selective abdominal surgical patients were divided randomly into fentanyl group(F),remifentanil group(R), and ketamine plus remifentanil group(RK)with 20 cases each. The circulatory changes,recovery of anesthesia and side effects were observed.Results MAP and HR in group R were significantly lower than those in group F and group RK during intubation,skin incision,and maintenance of anesthesia.MAP and HR in group RK were lower than those in group F during maintenance of anesthesia. After the completion of anesthesia,the time of spontaneous respiration reestablishment was(7.2±3.6)min,of eye opening(10.1±3.4)min,of extubation (12.9±7.1)min,and of orientation (14.9±4.6)min in group RK,which were all shorter than those in group F .The quality of anesthesia recovery was better in group RK than that in group R and F.Conclusion Anesthesia with small-dose ketamine combined with remifentanil has the advantages of stable circulatory function,quicker awakeness,and better quality of recovery.

目的小剂量氯胺酮对丙泊酚镇静效果的影响。方法40例在硬膜麻醉外择期行下肢、会阴手术病人,随机分为丙泊酚组、丙泊酚+氯胺酮组。结果与给药前比较,丙泊酚组MAP及HR均显著下降(P<0.05或P<0.01),丙泊酚+氯胺酮组改变不明显,镇静过程中出现手动、多语、SpO2给药后一过性下降丙泊酚+氯胺酮组较丙泊酚组少,清醒时间长。结论认为丙泊酚复合小剂量氯胺酮用于硬膜外麻醉中镇静是安全可靠。

Objective To investigate the changes in T-lymphocyte subsets and natural kill(NK) cell after perioperative allogenic whole-blood transfusion, leukocyte-reduced allogenic red blood cells transfusion or 6%hydroxyethyl starch.Methods Thirty-six patients with rectal or colon cancer were randomly divided into 3 groups.GroupⅠreceived 6%hydroxyethyl starch, group Ⅱ allogenic whole-blood transfusion, and group Ⅲ leukocyte-reduced red cell blood cells transfusion . Venous blood samples were taken before surgery, on the 1st, 3rd and 7th postoperative day for determination of the counts of T-lymphocyte subsets and NK cells by flow cytometry. Results Compared with the baselines,CD3~+, CD4~+, CD4~+/CD8~+and CD56~+ were all decreased signifantly in the three groups on the 1st and 3 rd postoperative day. On the 7th postoperative day, CD3~+, CD4~+, CD4~+/CD8~+and CD56~+ recovered to the preoperative level in groupⅠand group Ⅲ, which remained at a lower level in group Ⅱ. Conclusion Perioperative transfusion has serious and prolonged inhibition effects on immunity function in the patients with rectal or colon cancer . When 6%hydroxyethyl starch or leukocyte -reduced red cells is used instead of whole blood, the immunity inhibition is mild and with a quicker recovery.

Objective To observe the circulatory changes and recovery from anesthesia in patients oper ated for upper abdominal surgery under anesthesia with ramifentanil and propofol . MethodAccording to the anesthet ic method used , 60 selective upper abdominal surgical patients were divided ra n domly into fentanyl group(F), ramifentanil group(R), and ramifentanil plus epi du ral block group(C) with 20 cases each. The circulatory changes, recovery of ane s thesia and side effects were observed perianesthestically. Results MAP and HR in group R and C were significantly lower th an those in group F during intubation, skin incision, and maintenance of anest hesia. After the completion of anesthesi a, the time of spontaneous respiration reestablishment was (7.5±4.1)min, of eye opening (10.1±4.7)min, of extubation (12.5±5.0)min, and of orientation (14.3±6.5) min in group R, which were all shorter than those in group F. The quality of ane sthesia recovery was better in group C than that in group R and F. Conclusion Anesthesia with ramifentanil combined with epidural block has the advantages of stable circulatory function, quicker awakeness , a nd better quality of reco very.

目的观察脊髓星型胶质细胞(AST)在吗啡耐受过程中的变化.方法建立慢性吗啡耐受大鼠模型,用丙戊茶碱(propentofylline)进行干预,用免疫组织化学方法测定脊髓后角AST活性在吗啡耐受过程中的变化,用热辐射抬足法测定痛阈.结果吗啡耐受形成过程中胶质纤维酸性蛋白(GFAP)免疫反应呈强阳性,丙戊茶碱有部分抗吗啡耐受作用,并且可以使吗啡耐受过程中GFAP免疫反应阳性产物减少.结论吗啡耐受的机制可能涉及脊髓AST的激活,丙戊茶碱可能通过抑制脊髓AST激活而具有部分抗吗啡耐受作用.

2000年1月至2004年1月,我们采用恩丹西酮合用地塞米松预防腹腔镜胆囊切除术(LC)后患者恶心、呕吐,效果满意.现报告如下.