Objective:Postoperative cognitive dysfunction (POCD), characterized by cognitive and memory decline following anesthesia and surgery, is a common complication in elderly patients. Nuclear factor erythroid-derived 2-like 2 (NRF2), a key regulator of cellular redox balance, has been implicated in cognitive processes in various neurological disorders. Electroacupuncture (EA), with its controllable stimulation parameters, has shown preventive effects against cognitive dysfunction. This study aimed to investigate whether NRF2 mediates the beneficial effects of EA on cognitive function in POCD. Methods:A POCD model was established in 20-month-old male Sprague-Dawley rats undergoing tibial fracture surgery. Beginning on postoperative day 24, EA was administered at the Hegu (LI4), Neiguan (PC6), and Zusanli (ST36) acupoints once daily for five consecutive days. The specific NRF2 antagonist ML385 (30 mg/kg) was intraperitoneally administered 2 hours before each EA session over the same period. Behavioral tests, including the T-maze test, fear conditioning (FC), and novel object recognition (NOR), were conducted on postoperative day 30. Immunofluorescence staining was used to assess neuronal count, apoptosis, microglial activation, and the percentage of NRF2-positive microglia. Electrophysiological recordings of brain activity were also performed. Results:EA treatment significantly improved cognitive and memory performance in POCD rats. Immunofluorescence analysis revealed reduced neuronal apoptosis, increased synaptic density, suppressed microglial activation, and enhanced nuclear translocation of NRF2, indicating attenuated neuroinflammation and oxidative stress. Furthermore, EA strengthened the phase-amplitude coupling between theta and gamma oscillations. Notably, all these neuroprotective and cognitive-enhancing effects of EA were abolished by ML385. Conclusion:In a POCD rat model, our findings demonstrate that EA ameliorates cognitive impairment, and this effect is potentially mediated through NRF2 pathway activation.

Flurbiprofen axetil or dezocine monotherapy has been applied for analgesia of postoperative non-small cell lung cancer (NSCLC); however, their combination is rarely investigated. Consequently, the present study aimed to explore the effect of flurbiprofen axetil plus dezocine on postoperative pain, surgical outcomes and its safety profile in patients with NSCLC. A total of 150 patients with resectable NSCLC were enrolled and randomized into three groups: i) The flurbiprofen axetil plus dezocine group (n=50), ii) the flurbiprofen axetil group (n=51) and iii) the dezocine group (n=49). A total of 50 mg flurbiprofen axetil, 5 mg of dezocine or their combination were administered intravenously 3 h prior to surgery and subsequently every 12 h until day 3 (D3) following surgery. The postoperative pain was lower in the flurbiprofen axetil plus dezocine group compared with that of the flurbiprofen axetil group at 6 h (P=0.008), 12 h (P=0.003), day 1 (D1) (P=0.013), day 2 (D2) (P=0.036) and D3 (P=0.010); in addition, it was lower in the flurbiprofen axetil plus dezocine group compared with that of the dezocine group at 6 h (P=0.010), 12 h (P=0.012) and D1 (P=0.020). Patient-controlled analgesia consumption was also lower in the flurbiprofen axetil plus dezocine group compared with that of the flurbiprofen axetil (P=0.010) and dezocine (P=0.002) groups. Furthermore, the length of hospital stay was lower in the flurbiprofen axetil plus dezocine group compared with that of the flurbiprofen axetil (P=0.008) and dezocine (P=0.048) groups, while other surgical outcomes and adverse events were similar among these three groups. Moreover, the expression of tumor necrosis factor-α was lower in the flurbiprofen axetil plus dezocine group compared with that of the dezocine group at 12 h (P<0.001), D1 (P<0.001) and D3 (P=0.033). The data indicated that flurbiprofen axetil and dezocine combination was superior to monotherapy for postoperative analgesia in patients with resectable NSCLC.

Objective: To investigate the effects of sevoflurane combined with propofol continuous anaesthesia on anaesthesia and postoperative analgesia and recovery in elderly patients undergoing lower limb fracture surgery.Methods: In this study, 344 elderly patients who underwent surgical treatment for lower limb fractures in our hospital between June 2020 and May 2022 were enrolled for prospective analysis, and the patients were equally divided into a control group and an experimental group by the random number table method, with 172 patients in each group.In the control group, continuous anaesthesia with propofol was used, while in the experimental group, continuous anaesthesia with sevoflurane and propofol was used. The anesthetic effect, postoperative analgesic effect, recovery effect and adverse reactions of the patients in the two groups were compared.Results: The excellent anesthesia rate in the experimental group was significantly higher than that in the control group (P<0.05); VAS scores at T1, T2, T3 and T4 were significantly lower in the experimental group than in the control group (P>0.05); Time to awaken, time to extubation and time to leave the anesthesia recovery room were all significantly lower in the experimental group than in the control group (P<0.05); The difference in the incidence of postoperative adverse reactions between the two groups was not statistically significant (P>0.05).Conclusion: Sevoflurane combined with propofol continuous anaesthesia is ideal for anaesthesia in elderly patients undergoing lower limb fracture surgery. This protocol is effective in suppressing postoperative pain and facilitating recovery from anaesthesia and does not increase the risk of postoperative adverse effects in patients.

Background: The superiority between remimazolam and propofol for anesthesia is controversial in elderly patients (>= 60 years). This meta-analysis aimed to systematically compare anesthetic effect and safety profile between remimazolam and propofol in elderly patients under any surgery. Methods: Cochrane Library, Web of Science, and PubMed were searched until December 25, 2023 for relevant randomized controlled trials. Results: Ten studies with 806 patients receiving remimazolam (experimental group) and 813 patients receiving propofol (control group) were included. Time to loss of consciousness [standard mean difference (SMD) (95% confidence interval (CI): 1.347 (-0.362, 3.055), p = 0.122] and recovery time [SMD (95% CI): -0.022 (-0.300, 0.257), p = 0.879] were similar between experimental and control groups. Mean arterial pressure at baseline minus 1 min after induction [SMD (95% CI): -1.800 (-3.250, -0.349), p = 0.015], heart rate at baseline minus 1 min after induction [SMD (95% CI): -1.041 (-1.537, -0.545), p < 0.001], incidences of hypoxemia [relative risk (RR) (95% CI): 0.247 (0.138, 0.444), p < 0.001], respiratory depression [RR (95% CI): 0.458 (0.300, 0.700), p < 0.001], bradycardia [RR (95% CI): 0.409 (0.176, 0.954), p = 0.043], hypotension [RR (95% CI): 0.415 (0.241, 0.714), p = 0.007], and injection pain [RR (95% CI): 0.172 (0.113, 0.263), p < 0.001] were lower in the experimental group compared to the control group. Postoperative nausea and vomiting was not different between groups [RR (95% CI): 1.194 (0.829, 1.718), p = 0.341]. Moreover, this meta-analysis displayed a low risk of bias, minimal publication bias, and good robustness. Conclusion: Remimazolam shows comparative anesthetic effect and better safety profile than propofol in elderly patients under any surgery.

In this study, an electrochemical sensor for the real-time monitoring of propofol (PPF) in anesthesia was developed using molecularly imprinted polymers and reduced graphene oxide-modified glassy carbon electrodes (MIPs/rGO/GCE). To make the electrode, GO was thermally reduced into rGO, which was then electrodeposited on GCE (rGO/GCE), followed by the electropolymerization of MIPs using LiClO4, pyrrole, and PPF (template) solution on rGO/GCE (MIPs/rGO/GCE). The PPF was then taken out of the pyrrole polymer. X-ray Diffraction (XRD), Scanning Electron Microscopy (SEM), and X-ray Photoelectron Spectroscopy (XPS) examinations of surface composition and morphology revealed that electropolymerization MIP on rGO/GCE and reduction and deposition of rGO on GCE were both successful processes. MIPs/rGO/GCE revealed significant sensitivity and selectivity towards PPF in electrochemical tests utilizing cyclic voltammetry (CV) and amperometry. Results demonstrated a linear range from 0.5 to 250 μM that was steady and wide, with a sensitivity of 1.0776 μA/μM and a detection limit value of 0.08 μM. MIPs/rGO/GCE demonstrated outstanding electrocatalytic activity over a broad linear range and a reasonable detection limit value for PPF concentrations. To assess the method's applicability for the analysis of PPF, it was applied to real biological samples of human plasma and urine.

Non-small cell cancer (NSCLC) is the most common cancer in the world, but its effective therapeutic methods are limited. Tilianin and sufentanil alleviate various human tumors. This research aimed to clarify the functions and mechanisms of Tilianin and sufentanil in NSCLC. The functions of Tilianin and sufentanil on NSCLC cell viability, apoptosis, mitochondrial dysfunction, and immunity in vitro were examined using Cell Counting Kit-8 assay, flow cytometry, reactive oxygen species level analysis, CD8+ T cell percentage analysis, Western blot, and enzyme-linked immunosorbent assay, respectively. The molecular mechanism regulated by Tilianin and sufentanil in NSCLC was assessed using Western blot, and immunofluorescence assays. Meanwhile, the roles of Tilianin and sufentanil in NSCLC tumor growth, apoptosis, and immunity in vivo were determined by establishing a tumor xenograft mouse model, immunohistochemistry, and Western blot assays. When sufentanil concentration was proximity 2 nM, the inhibition rate of NSCLC cell viability was 50%. The IC50 for A549 cells was 2.36 nM, and the IC50 for H1299 cells was 2.18 nM. The IC50 of Tilianin for A549 cells was 38.7 mu M, and the IC50 of Tilianin for H1299 cells was 44.6 mu M. Functionally, 0.5 nM sufentanil and 10 mu M Tilianin reduced NSCLC cell (A549 and H1299) viability in a dose-dependent manner. Also, 0.5 nM sufentanil and 10 mu M Tilianin enhanced NSCLC cell apoptosis, yet this impact was strengthened after a combination of Tilianin and Sufentanil. Furthermore, 0.5 nM sufentanil and 10 mu M Tilianin repressed NSCLC cell mitochondrial dysfunction and immunity, and these impacts were enhanced after a combination of Tilianin and Sufentanil. Mechanistically, 0.5 nM sufentanil and 10 mu M Tilianin repressed the NF-kappa B pathway in NSCLC cells, while this repression was strengthened after a combination of Tilianin and Sufentanil. In vivo experimental data further clarified that 1 mu g/kg sufentanil and 10 mg/kg Tilianin reduced NSCLC growth, immunity, and NF-kappa B pathway-related protein levels, yet these trends were enhanced after a combination of Tilianin and Sufentanil. Tilianin strengthened the antitumor effect of sufentanil in NSCLC. Tilianin strengthened the antitumor impact of sufentanil in NSCLC through NF-kappa B. image

Rationale: Hereditary hearing loss is known to exhibit a significant degree of genetic heterogeneity. Herein, we present a case report of a novel mutation in the tenascin-C (TNC) gene in Chinese patients with nonsyndromic hearing loss (NSHL). Patient concerns: This includes a young deaf couple and their 2-year-old baby. Diagnoses: Based on the clinical information, hearing test, metagenomic next-generation sequencing (mNGS), Sanger sequencing, protein function and structure analysis, and model prediction, in our case, the study results revealed 2 heterozygous mutations in the TNC gene (c.2852C>T, p.Thr951Ile) and the TBC1 domain family member 24 (TBC1D24) gene (c.1570C>T, p.Arg524Trp). These mutations may be responsible for the hearing loss observed in this family. Notably, the heterozygous mutations in the TNC gene (c.2852C>T, p.Thr951Ile) have not been previously reported in the literature. Interventions: Avoid taking drugs that can cause deafness, wearing hearing AIDS, and cochlear implants. Outcomes: Regular follow-up of family members is ongoing. Lessons: The genetic diagnosis of NSHL holds significant importance as it helps in making informed treatment decisions, providing prognostic information, and offering genetic counseling for the patient’s family.

目的 探讨酒石酸布托啡诺对冠状动脉旁路移植术(CABG)患者丙泊酚麻醉诱导期血流动力学的影响.方法 将纳入的94例行CABG治疗的患者随机分为观察组和对照组,各47例.观察组患者麻醉诱导前给予40μg/kg酒石酸布托啡诺,对照组患者麻醉诱导前给予等量生理盐水,2组麻醉诱导及维持方法相同.于给予酒石酸布托啡诺或生理盐水前(T0)、插管即刻(T1)、插管后1 min(T2)、插管后3 min(T3)、插管后5 min(T4)记录2组患者平均动脉压(MAP)、心率(HR),同时检测血清皮质醇(Cor)、促肾上腺皮质激素(ACTH)、去甲肾上腺素(NE)水平.统计2组患者麻醉诱导期不良反应发生情况.结果 2组患者T1时MAP、H R均明显低于T 0时(P<0.05);对照组T2～T4时MAP、HR较T0时明显升高(P<0.05),观察组T2～T4时MAP、HR较T0时明显降低(P<0.05);T1时观察组MAP、HR明显较对照组高(P<0.05),T2～T4时观察组MAP、HR明显较对照组低(P<0.05).观察组T2时血清Cor、ACTH、NE水平较T0时明显升高(P<0.05);对照组T1～T4时血清Cor、ACTH、NE水平较T0时升高(P<0.05),观察组T1～T4时血清Cor、ACTH、NE水平均明显较对照组低(P<0.05).观察组麻醉诱导期低血压、高血压发生率均较对照组低(P<0.05).结论 酒石酸布托啡诺用于CABG中有利于减轻患者丙泊酚麻醉诱导期的应激反应,避免患者丙泊酚麻醉诱导期血流动力学的剧烈波动.

目的 探讨不同时间点脑血流量/脑氧代谢率(CBF/CMRO2)值对老年食管癌患者术后认知功能障碍(POCD)的预测价值.方法 选取 140 例行手术治疗的老年食管癌患者,根据术后蒙特利尔认知评估(MoCA)量表评分将其分为A组(POCD患者)58 例和B组(非POCD患者)82 例.比较两组患者的一般资料,以及麻醉诱导前(T1)、麻醉诱导后2 h(T2)、麻醉诱导后24 h(T3)、麻醉诱导后48 h(T4)的颈静脉球部血氧饱和度(SjvO2)和CBF/CMRO2 值.绘制受试者工作特征(ROC)曲线,评估不同时间点CBF/CMRO2 值对老年食管癌患者发生POCD的预测价值.结果 两组患者的SjvO2 比较,差异无统计学意义(P>0.05).两组患者的CBF/CMRO2 值比较,差异有统计学意义(P<0.05),两组的 CBF/CMRO2 值均有随时间变化的趋势(均P<0.05),其中A组T2、T3 时的CBF/CMRO2 值均低于B组(均P<0.05).ROC曲线分析结果显示,T1、T2、T3、T4 的CBF/CMRO2 值预测老年食管癌患者发生POCD的曲线下面积(AUC)分别为 0.521、0.821、0.698、0.555,其中T1 与T4 的AUC 差异无统计学意义(P>0.05),而 T2、T3、T4 的 AUC 依次降低(均 P<0.05).结论 CBF/CMRO2值与老年食管癌患者发生POCD相关,麻醉诱导后2h监测CBF/CMRO2 值能较好地预测老年食管癌患者POCD的发生.

Patients with perioperative neurocognitive disorders（PND） are at risk for serious complications that can lead to dementia and even death. At present, the specific mechanism of PND is not clear.More and more studies suggest that pro-inflammatory signaling molecules have been found both in patients with perioperative neurocognitive impairment and in animal models. The peripheral inflammatory, the destruction of blood-brain barrier, the occurrence of central nervous inflammation, neuronal apoptosis and synaptic loss suggest that inflammatory mechanisms may play a key role in the pathogenesis of PND. This review briefly describes the research progress of neuroinflammation and perioperative neurocognitive disorders, and provides new ideas for basic research and clinical practice.

目的 观察乌司他丁联合右美托咪定对全腔镜食管癌根治术术中炎症和肺损伤标记物以及肺功能的影响.方法 选择择期行全腔镜食管癌根治术手术患者 90 例,采用随机数字表法分为对照组(Con组)、右美托咪定组(DEX组)和乌司他丁联合右美托咪定组(U+DEX组),每组 30 例.DEX组于麻醉诱导后泵注 0.5 μg·kg-1·h-1 右美托咪定,直至术毕前 1 h;U+DEX组于麻醉前 30 min给予乌司他丁 1 万单位/kg静脉滴注,余同DEX组;Con组给予等量的生理盐水.分别在麻醉诱导后侧卧位前(气道相对稳定)(T0)、单肺通气后 1 h(T1)、恢复双肺通气后 1 h(T2),手术结束拔管前(T3),记录气道峰压(peak airway pressure,Ppeak)、胸肺顺应性(thorac-pulmonary compliance,Cdyn),血氧分压(partial pressure of oxygen,PaO2)和血二氧化碳分压(carbon dioxide partial pressure,PaCO2);在T0 和T3 时刻用酶联免疫吸附法(enzyme-linked immunosorbent assay,ELISA)检测支气管肺泡灌洗液(bronchoalveolar lavage fluid,BALF)和血清中肿瘤坏死因子α(tumor necrosis factor-α,TNF-α),白细胞介素 8(interleukin-8,IL-8)、克拉拉细胞分泌蛋白(Clara cell protein 16,CC16)含量.结果 3 组术中肺功能比较 Cdyn、PaCO2、PaO2 呈先降低再逐渐增高的趋势,Cdyn、PaO2 在组间、时点间、组间·时点间交互作用差异均有统计学意义(P<0.05),PaCO2 在组间、时点间差异有统计学意义(P<0.05),组间·时点间交互作用差异无统计学意义(P>0.05).与Con组比较,T3 时 DEX 组、U+DEX 组肺泡灌洗液和血清 TNF-α,IL-8 水平均显著下降(P<0.05),血清中CC16 水平显著下降(P<0.05),但肺泡灌洗液中 CC16 水平差异无统计学意义(P>0.05);与 DEX组比较,T3 时U+DEX组肺泡灌洗液和血清TNF-α,IL-8 水平均显著下降(P<0.05),血清中CC16 水平显著下降(P<0.05),但肺泡灌洗液中CC16 水平差异无统计学意义(P>0.05).结论 乌司他丁联合右美托咪定能改善全腔镜食管癌根治术术中肺功能状态,降低了术中炎症反应.

目的 探讨局部脑氧饱和度(rSO2)与血浆β-淀粉样蛋白(Aβ)对术后认知功能障碍(POCD)的影响.方法 选取我院收治的择期行心脏手术的患者86例,根据患者是否发生POCD将其分为POCD组与非POCD组.比较2组患者围术期临床资料,并采用多因素Logistic回归分析明确患者发生POCD的独立危险因素,绘制受试者工作特征(ROC)曲线分析rSO2％max、Aβ对POCD的预测价值.结果 86例患者中,有29例发生POCD,发生率为33.72％.POCD组与非POCD组患者年龄、受教育程度、冠脉阻断时间、机械通气时间、rSO2％max、Aβ水平比较差异有统计学意义(P<0.05).多因素Logistic回归分析结果显示,年龄≥55岁、受教育程度为小学及以下、Aβ≤102.45 pg/mL、rSO2％max≤11.15％是患者发生POCD的独立危险因素(P<0.05).当rSO2％max最佳临界值为10.24％时,预测POCD的曲线下面积(AUC)为0.894(95％CI:0.847～0.951),敏感度和特异度分别为86.21％、82.76％.Aβ最佳临界值为91.85 pg/mL时,预测POCD的AUC为0.902(95％CI:0.851～0.988),敏感度和特异度分别为89.66％、86.21％.二者联合时预测POCD的AUC为0.913(95％CI:0.859～1.000),敏感度和特异度分别为93.10％、89.66％.结论 年龄≥55岁、受教育程度为小学及以下、Aβ≤102.45 pg/mL、rSO2％max≤11.15％是心脏手术患者发生POCD的独立危险因素.rSO2％max联合Aβ可提高对POCD的预测效能.

目的 探讨右美托咪定复合罗哌卡因用于胸腔镜术胸椎旁阻滞对患者术后睡眠质量的影响.方法 选取医院2019年4月至2020年8月收治的非心脏手术患者160例,按随机数字表法分为A组(54例)、B组(53例)、C组(53例).3组患者均行超声引导胸椎旁神经阻滞,A组患者经导管注入盐酸右美托咪定注射液,B组患者经导管注入盐酸罗哌卡因注射液,C组患者联用A组和B组用药方案.结果 C组患者围术期的丙泊酚用量显著少于A组和B组(P＜0.05).与术后2 h比较,3组患者术后4,8h的视觉模拟量表(VAS)评分均显著升高;与术后8 h比较,3组患者术后12 h VAS评分均显著降低,且C组均显著低于A组和B组(P＜0.05).与术后1 d比较,3组患者术后2 d的匹兹堡睡眠质量指数各项评分均显著降低,且C组显著低于A组和B组(P＜0.05).3组患者术后1 d的5-羟色胺(5-HT)、白细胞介素1(IL-1)、白细胞介素6、肿瘤坏死因子-α水平均显著升高,且C组患者均显著低于A组和B组(P＜0.05).3组患者恶心呕吐、心动过缓、呼吸抑制、补救镇痛发生率均无显著差异(P＞0.05).结论 右美托咪啶复合罗哌卡因用于胸腔镜术胸椎旁阻滞,有利于减少术中丙泊酚用量,可下调5-HT,IL-1等血清学指标,减轻疼痛,改善睡眠质量.

目的 观察两种麻醉深度对腹部手术患者脑氧代谢及致痛物质的影响.方法 回顾性选取2019年6月至2021年6月邯郸市中心医院收治的全凭静脉麻醉下行腹部手术的患者150例进行研究,依据麻醉深度不同分为浅麻醉组和深麻醉组,各75例.术中以脑电双频指数(BIS)检测麻醉深度,浅麻醉组BIS维持在50～59,深麻醉组BIS维持在30～39.统计两组手术时间、麻醉时间、苏醒时间、拔管时间、出血量.观察两组麻醉诱导前(T0)、插管前(T,)、插管后(T2)、手术前(T3)、手术后(T4)、拔管时(T5)的平均动脉压(MAP)和心率,测定两组T0、T1、T2、T3、T4、T5脑氧代谢指标[脑动脉-静脉血氧含量差(Da-jvO2)、脑氧摄取率(CERO2)],测定两组T0、术后12 h(T6)、24 h(T7)、48 h(T8)血清致痛物质[5-羟色胺(5-HT)、P物质、肾上腺素(E)],测定两组术前、术后3 d、术后7 d的炎症因子[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)],统计两组不良反应发生情况.结果 两组手术时间、麻醉时间、拔管时间、出血量比较,差异均无统计学意义(P＞0.05);深麻醉组的苏醒时间显著多于浅麻醉组,差异有统计学意义(P＜0.05).术中不同时点两组MAP、心率比较,差异均无统计学意义(P＞0.05).T1、T2、T3、T4、T5时,深麻醉组Da-jvO2、CERO2均显著低于浅麻醉组,差异均有统计学意义(P＜0.05).T6、T7、T8时,深麻醉组5-HT、P物质、E水平均显著低于浅麻醉组,差异均有统计学意义(P＜0.05).术前、术后3 d、术后7 d,两组IL-6、TNF-α水平比较,差异均无统计学意义(P＞0.05).深麻醉组不良反应发生率显著低于浅麻醉组,差异有统计学意义(P＜0.05).结论 深度麻醉(BIS维持在30～39)下行腹部手术会抑制脑氧代谢,并抑制术后血清致痛物质5-HT、P物质、E水平,减轻痛觉信息传递,有利于降低不良反应发生率.

目的 探讨加速康复外科(ERAS)下硬膜外盐酸吗啡注射液复合盐酸丁丙诺啡注射液用于胸腔镜术后多模式镇痛.方法 选取2019年 10 月—2022 年 10 月邯郸市中心医院行胸腔镜手术 100 例患者,将所有患者随机分为对照组和治疗组,每组各 50 例.所有患者进行ERAS干预.对照组患者硬膜外盐酸吗啡注射液体复合注射用帕瑞昔布钠,治疗组患者硬膜外盐酸吗啡注射液复合盐酸丁丙诺啡注射液.镇痛至术后 72 h.比较两组镇痛效果、炎症反应、镇痛泵使用和不良反应情况.结果 术后4、24、48、72 h两组静息和活动时VAS评分均明显降低(P＜0.05);治疗组术后 4、24、48、72 h静息和活动时VAS评分明显低于对照组(P＜0.05).术后 72 h,两组血清白细胞介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平均明显下降(P＜0.05),且治疗组血清IL-6、CRP、TNF-α水平明显低于对照组(P＜0.05).治疗组镇痛泵按压次数、吗啡累积使用量明显低于对照组(P＜0.05).治疗组的不良反应发生率明显低于对照组(P＜0.05).结论 ERAS下硬膜外盐酸吗啡注射液复合盐酸丁丙诺啡注射液对胸腔镜手术后具有良好的镇痛作用,能够改善炎症反应,降低镇痛泵按压次数和吗啡累积使用量,且具有良好的安全性.

OBJECTIVETo observe the effects of electroacupuncture pretreatment on postoperative cognitive dysfunction (POCD), neuronal apoptosis and neuron-inflammation in aged rats.METHODSThirty-six male SD rats aged 20 months were randomly divided into sham operation group, model group and electroacupuncture (EA) group, with 12 rats in each group. The POCD rats model was prepared by internal fixation of left tibial fracture. Five days before modeling, EA stimulation (2 Hz/15 Hz, 1 mA, 30 min) was applied to "Zusanli" (ST36), "Hegu" (LI4) and "Neiguan" (PC6) on the unaffected side of rats in the EA group, once a day for consecutive 5 d. The learning and memory abilities of rats were evaluated by water maze test 31-35 days after operation. The apoptosis of hippocampal neurons was observed by Tunel/NeuN double staining. The expressions of high mobility group protein B1 (HMGB1) and phosphorylated (p)-nuclear factor (NF)-κB in microglia cells in hippocampal dentate gyrus were detected by immunofluorescence staining. The expression levels of interleukin (IL)-6 and IL-1β in the hippocampus were detected by Western blot.RESULTSCompared with the sham operation group, the escape latency was prolonged (P<0.05); the frequency of crossing the original platform, ratio of the swimming distance and the time in the target quadrant of the Morris water maze were significantly decreased (P<0.05); the apoptosis rate of hippocampal neurons was significantly increased (P<0.05); the expressions of HMGB1 and p-NF-κB in microglia cells in the dentate gyrus and the expression levels of IL-6 and IL-1β in hippocampus were increased (P<0.05) in the model group. Compared with the model group, the results of the above indexes were all opposite (P<0.05) in the EA group.CONCLUSIONEA preconditioning can regulate hippocampal inflammatory response, alleviate neuronal apoptosis rate and long-term cognitive dysfunction in aged rats with POCD, the mechanisms may be related to the inhibition of microglia HMGB1/NF-κB pathway in hippocampal dentate gyrus.

目的 研究beta肾上腺素受体1(ADRB1)基因多态性与肺癌根治术后舒芬太尼镇痛效果的相关性.方法 以2021年6月-2022年12月邯郸市中心医院胸外科收治的210例接受肺癌根治术的患者为研究对象,采用直接测序法检测患者ADRB1 rs1801252和rs1801253的基因多态性.患者入组后抽取2 mL静脉血用于基因多态性分析,记录术中麻醉药物用量及手术时间,术后收集48 h内舒芬太尼的追加镇痛药次数及使用量,采用视觉模拟评分法(VAS)评估患者疼痛感;采用医生整体评估量表(PGA)评价整体情况,记录患者恶心和呕吐情况.结果 ADRB1 rs1801252 AA、AG、GG 携带者人数分别为 108 例(51.4％),82 例(39.1％)及 20 例(9.5％);ADRB1 rs1801253 CC、CG、GG 携带者人数分别为 158 例(75.2％),38 例(18.1％)及 14 例(6.7％).ADRB1 rs1801252术后舒芬太尼镇痛效果GG携带者最好,AG携带者次之,AA携带者最差.ADRB1 rs1801253基因多态性与术后舒芬太尼镇痛效果无明显关联.结论 ADRB1 rs1801252基因多态性与肺癌根治术后舒芬太尼镇痛效果相关,遗传因素是导致镇痛效果个体差异的原因之一.

目的 探讨老年膝骨性关节炎(KOA)患者行全膝关节置换术(TKA)术后急性疼痛(APSP)的危险因素,并进一步构建预测模型.方法 回顾性纳入行TKA治疗的236例老年KOA患者.术后72 h,采用疼痛数字评分法(NRS)评定疼痛,并分为APSP组94例(39.83％)和非APSP组142例(60.17％).收集2组患者的临床资料,采用多因素Logistic回归分析筛选APSP发生的危险因素,并以此为基础构建预测模型;采用受试者工作特征(ROC)曲线对预测模型的性能进行评定,结果以曲线下面积(AUC)、敏感性和特异性表示.结果 单因素分析显示,APSP组年龄＞75岁、糖尿病、术前睡眠障碍、焦虑及术后并发症的比例以及术前视觉模拟评分法(VAS)、术前西安大略和麦克马斯特大学骨关节炎指数量表(WOMAC)及止血带使用时间均高于或长于非APSP组,差异有统计学意义(P＜0.05).多因素Logistic回归分析结果提示,年龄＞75岁(OR=1.318,95％CI:1.030～1.686)、糖尿病(OR=1.489,95％CI:1.134～1.954)、术前 VAS 评分＞4 分(OR=1.551,95％CI:1.095～2.197)、睡眠障碍(OR=1.398,95％CI:1.093～1.789)、焦虑(OR=1.709,95％CI:1.247～2.343)是 KOA 患者TKA术后发生APSP的独立危险因素.采用ROC曲线结果显示,内部验证时,模型预测APSP的AUC为0.894(95％CI:0.843～0.945),敏感性为82.98,特异性为85.92％,准确率为84.75％;外部验证时AUC为0.858(95％CI:0.797～0.919),敏感性为78.22％,特异性为81.36％,准确率为80.22％.结论 高龄、合并糖尿病、术前疼痛、睡眠障碍、焦虑是行TKA治疗的老年KOA患者发生APSP的独立危险因素,以此构建的模型可预测APSP发生风险.

目的 探讨右美托咪定对高血压脑出血(HICH)患者颅内血肿清除术中动脉血气指标及应激反应的影响.方法 选取医院2020年4月至2021年12月收治的HICH患者160例,按随机数字表法分为观察组和对照组,各80例.两组患者均行颅内血肿清除术,术前实时监测生命体征,肌肉注射0.5 mg阿托品与0.6μg/kg舒芬太尼.对照组患者静脉滴注6 mg/(kg·h)丙泊酚维持麻醉,观察组患者静脉滴注2μg/(kg·h)右美托咪定维持麻醉,局部麻醉待患者自主呼吸恢复平稳后,对其行头部电子断层扫描(CT)定位、钻孔并开始手术,维持麻醉至手术结束.结果 与麻醉诱导前(T0)比较,两组患者钻孔时(T1)、缝皮时(T2)、拔除气管导管即刻(T3)、拔除气管导管后30 min(T4)时的动脉血气指标[氧合指数(OI)和二氧化碳分压(PaCO2)]均显著降低(P<0.05),且观察组均显著高于对照组(P<0.05);血流动力学指标[心率(HR)和平均动脉压(MAP)]均显著降低(P<0.05),且观察组均显著高于对照组(P<0.05);血糖(Glu)和皮质醇(Cor)水平均显著升高(P<0.05),且观察组均显著低于对照组(P<0.05);去甲肾上腺素(NE)和肾上腺素水平均显著升高(P<0.05),且观察组均显著低于对照组(P<0.05).观察组不良反应发生率为20.00％,显著低于对照组的30.00％(P<0.05).结论 右美托咪定用于HICH颅内血肿清除术时患者应激反应较小,血流动力学稳定,且安全性良好.

术后认知功能障碍(postoperative cognitive dysfunction,POCD)是老年人群常见的并发症.一种胆碱能依赖信号,α7-烟碱乙酰胆碱受体(α7-nAChR),已被认为在各种神经系统疾病中调节认知过程.为探讨电针预处理是否能改善老龄大鼠术后长期认知功能障碍以及其可能机制.通过将 60 只清洁级雄性SD(Sprague-Dawley)大鼠(20 月龄)随机分为 5 组(样本数n =12):假手术组(S组)、模型组(M组)、电针组(EA组)、银环蛇毒+电针组(Y + EA组)、银环蛇毒+模型组(Y + M组).在术后30d后,分别对各组采用新物体识别实验评价认知功能,采用尼氏(Nissl)染色检测神经元数量,免疫荧光检测小胶质细胞活化、蛋白质印迹法(Western blot)检测海马IL-6、NF-κB和IL-1β的水平.实验结果表明:电针预处理增加了对新物体的探索,恢复了大鼠术后神经元的数量,降低了小胶质细胞激活,降低海马炎性因子蛋白表达,而α-BGT部分逆转了电针的作用.可见电针预处理改善了老龄大鼠长期术后认知功能障碍和海马炎症,其机制可能与激活α7nAChR介导的胆碱能抗炎通路有关.