目的 探究IL-18结合蛋白(IL-18BP)在创伤性脑损伤(TBI)大鼠认知功能障碍中的作用及其机制.方法 120只健康雄性SD大鼠按随机数字表法分为假手术组、TBI组、TBI+IL-18BP组(经尾静脉注射IL-18BP 1.5 mg/kg)与TBI+IL-18BP+ADU-S100组(经尾静脉注射IL-18BP 1.5 mg/kg,经腹腔注射ADU-S10020 mg/kg),每组30只.应用自由落体法建立TBI模型,造模后30 d行水迷宫实验检测大鼠认知功能,ELISA法检测大鼠血清IL-18、IL-18BP浓度,免疫荧光染色检测海马区星形胶质细胞GFAP、IL-18和cleaved-caspase-3荧光强度,Western blotting检测大鼠海马区干扰素基因刺激蛋白(STING)、磷酸化TANK结合激酶1(p-TBK1)、TBK1、磷酸化干扰素调节因子3(p-IRF3)、IRF3蛋白相对表达量.结果 与假手术组比较,TBI组、TBI+IL-18BP组和TBI+IL-18BP+ADU-S100组大鼠逃逸潜伏期明显延长,穿越平台次数减少,目标象限活动时间百分比降低(P<0.0001),血清IL-18、IL-18BP浓度升高,海马区IL-18和cleaved-caspase-3荧光强度明显增强,STING、p-TBK1、p-IRF3表达明显上调(P<0.05);与TBI组比较,TBI+IL-18BP组大鼠逃逸潜伏期缩短,穿越平台次数增多,目标象限活动时间百分比增高(P<0.0001),血清IL-18浓度降低,IL-18BP浓度升高,海马区IL-18和cleaved-caspase-3荧光强度明显减弱,STING、p-TBK1、p-IRF3表达明显下调(P<0.05);与TBI+IL-18BP组比较,TBI+IL-18BP+ADU-S100组大鼠逃逸潜伏期延长,穿越平台次数减少,目标象限活动时间百分比降低(P<0.0001),血清IL-18浓度升高,IL-18BP浓度降低,海马区IL-18和cleaved-caspase-3荧光强度增强,STING、p-TBK1、p-IRF3表达明显上调(P<0.05).结论 IL-18BP可改善TBI大鼠的认知功能,其机制可能与抑制星形胶质细胞凋亡及抑制STING/TBK1/IRF3信号通路激活有关.

Objective:To evaluate the role of transient receptor potential melastatin2 (TRPM2) in sevoflurane anesthesia-induced necroptosis in hippocampal neurons of aged rats.Methods:Sixty SPF-grade healthy male Sprague-Dawley rats, aged 22 months, weighing 550-600 g, were divided into 3 groups ( n=20 each) using a random number table method: control group (group C), sevoflurane anesthesia group (group M) and sevoflurane anesthesia+ TRPM2 inhibitor group (group M+ A). M and M+ A groups inhaled 2% sevoflurane for 5 h. In group M+ A, TRPM2 inhibitor ACA 20 mg/kg was intraperitoneally injected at 1 h before sevoflurane inhalation, and the equal volume of dimethyl sulfoxide was intraperitoneally injected in group C and group M. Morris water maze test was performed at 1 day after sevoflurane anesthesia. The escape latency, times of crossing the original platform and time spent in the original platform quadrant were collected. The expression of TRPM2 and necroptosis-related proteins (mixed lineage kinase domain-like protein [MLKL], receptor-interacting protein kinase-1 [RIPK1], phosphorylated MLKL [p-MLKL], and phosphorylated RIPK1 [p-RIPK1]) was detected by Western blot. The cytosolic Ca 2+ concentration in and necroptosis rate of hippocampal neurons were determined by flow cytometry. Results:Compared with group C, the escape latency was significantly prolonged, the times of crossing the original platform were decreased and the time spent in the original platform quadrant was shortened, the expression of TRPM2, MLKL, RIPK1, p-MLKL and p-RIPK1 was up-regulated, and the cytosolic Ca 2+ concentrations in hippocampal neurons and necroptosis rate of hippocampal neurons were increased in group M and group M+ A ( P<0.05). Compared with group M, the escape latency was significantly shortened, the times of crossing the original platform were increased, and the time spent in the original platform quadrant was prolonged, the expression of TRPM2, MLKL, RIPK1, p-MLKL and p-RIPK1 was down-regulated, and the cytosolic Ca 2+ concentrations in hippocampal neurons and necroptosis rate of hippocampal neurons were decreased in group M+ A ( P<0.05). Conclusions:Hippocampal TRPM2 is involved in the process of sevoflurane anesthesia-induced necroptosis in hippocampal neurons of aged rats.

Objective:To evaluate the effect of pectoral nerve block type Ⅱ combined with esketamine on anxiety and depression in the patients with breast cancer undergoing modified radical mastectomy under general anesthesia.Methods:Eighty-four female patients, aged 18-64 yr, of American Society of Anesthesiologists physical status Ⅰor Ⅱ, with body mass index of 18-25 kg/m 2, undergoing elective first-time modified radical mastectomy for unilateral breast cancer, were divided into 2 groups ( n=42 each) using a random number table method: routine group (R group) and pectoral nerve block type Ⅱ combined with esketamine group (PS group). Sufentanil was used for anesthesia induction and postoperative patient-controlled intravenous analgesia (PCIA) in group R, esketamine was used for anesthesia induction and postoperative PCIA, and type Ⅱ thoracic nerve block was performed under ultrasound guidance after anesthesia induction in group PS, and the rest of the drugs used were the same in both groups.The observer′s assessment of awareness/sedation scale score was recorded at the end of surgery, 30 min after the end of surgery, and at 6, 12 and 24 h after surgery.The Hospital Anxiety and Depression Scale was used to assess patients′ anxiety and depression at 1 day before surgery and at discharge.The intraoperative consumption of anesthetics, emergence time, postanesthesia care unit stay time, pressing times of PCIA, requirement for rescue analgesia, hospital costs, length of postoperative hospital stay, satisfaction scores of surgeons and patients were recorded at discharge.The occurrence of adverse reactions was also recorded after operation. Results:Compared with group R, the observer′s assessment of awareness/sedation scale score were significantly increased at the end of surgery and 30 min after surgery, the consumption of propofol and remifentanil was decreased, the emergence time and postanesthesia care unit stay time were shortened, the incidence of nausea and vomiting was decreased, the Hospital Anxiety and Depression Scale score was decreased at discharge, the incidence of anxiety and depression was decreased, the satisfaction scores of surgeons and patients were increased, and the length of postoperative hospital stay was shortened in group PS ( P<0.05). Conclusions:Pectoral nerve block type Ⅱ combined with esketamine can optimize the efficacy of anesthesia and relieve early postoperative anxiety and depression in the patients undergoing modified radical mastectomy for breast cancer under general anesthesia.

Objective:To evaluate the role of stimulator of interferon genes (STING) signaling pathway in carbon monoxide (CO)-releasing molecule-3 (CORM-3)-induced reduction of hepatocyte pyroptosis and apoptosis in a rat model of hepatic ischemia-reperfusion.Methods:Forty-eight clean-grade healthy male Sprague-Dawley rats, aged 9-11 weeks, weighing 320-380 g, were divided into 4 groups ( n=12 each) using a random number table method: sham operation group (S group), ischemia-reperfusion group (IR group), CORM-3 group (C group) and STING agonist ADU-S100 group (A group).Hepatic ischemia-reperfusion injury models were developed by reversible ligation of left middle hepatic artery, portal vein and bile duct branches for 45 min, followed by reperfusion in anesthetized animals in IR, C and A groups.In group C, CORM-3 4 mg/kg was injected into the femoral vein immediately after reperfusion.The equal volume of normal saline containing dimethyl sulfoxide was injected into the femoral vein in S, IR and A groups.At 1.5 h after injection into the femoral vein, ADU-S100 10 mg/kg was intraperitoneally injected in A group, and the equal volume of normal saline was given instead in S, IR and C groups.The serum alanine transaminase (ALT) and aspartate transaminase (AST) concentrations were determined at 3 h of reperfusion.The rats were sacrificed at 12 h of reperfusion, and liver tissues were collected for determination of the content of CO (by colorimetry), expression of interleukin-1beta (IL-1β), IL-18, Bcl-2, Bax, interferon regulatory factor 3 (IRF3), phosphorylated IRF3 (p-IRF3), STING, NOD-like receptor protein 3 (NLRP3), aspirin D (GSDMD) and activated caspase-1 (by Western blot), and pyroptosis and apoptosis rates of hepatocytes (by immunofluorescence staining).The liver injury was scored. Results:Compared with group S, the serum ALT and AST concentrations, liver injury score, CO content, and pyroptosis and apoptosis rates of hepatocytes were significantly increased, and the expression of IL-1β, IL-18, p-IRF3, STING, NLRP3, GSDMD and activated caspase-1 was up-regulated, and the Bcl-2/Bax ratio was decreased in group IR ( P<0.05).Compared with group IR, the serum ALT and AST concentrations, liver injury score, and pyroptosis and apoptosis rates of hepatocytes were significantly decreased, the CO content was increased, the expression of IL-1β, IL-18, p-IRF3, STING, NLRP3, GSDMD and activated caspase-1 was down-regulated, and the Bcl-2/Bax ratio was increased in group C ( P<0.05).Compared with group C, the serum ALT and AST concentrations, liver injury score, and pyroptosis and apoptosis rates of hepatocytes were significantly increased, the CO content was decreased, the expression of IL-1β, IL-18, p-IRF3, STING, NLRP3, GSDMD and activated caspase-1 was up-regulated, and the Bcl-2/Bax ratio was decreased in group A ( P<0.05). Conclusions:The mechanism by which CORM-3 attenuates hepatocyte pyroptosis and apoptosis may be related to the inhibition of activation of STING signaling pathway in a rat model of hepatic ischemia-reperfusion.

Objective:To evaluate the improved efficacy of transversus abdominal plane (TAP)-rectus sheath (RS) block combined with general anesthesia in the patients undergoing laparoscopic pancreaticoduodenectomy.Methods:Fifty-six American Society of Anesthesiologists physical status Ⅰ-Ⅲ patients of both sexes, aged 45-64 yr, with body mass index of 18-25 kg/m 2, scheduled for elective laparoscopic pancreaticoduodenectomy, were divided into 2 groups ( n=28 each) using a random number table method: general anesthesia group (group G) and TAP-RS block plus general anesthesia group (group TRG). In group TRG, after induction of general anesthesia, bilateral TAP-RS block was performed with 0.375% ropivacaine mixed with 0.5 μg/kg dexmedetomidine under ultrasound guidance, 20 ml was injected into the plane of bilateral transverse abdominis, and 10 ml was injected into the posterior sheath of the bilateral rectus abdominis, and the tube was placed on the plane of the transverse abdominis, and 5 ml/h was continuously pumped after operation.In both groups, anesthesia was induced with IV midazolam, sufentanil, etomiddate and cisatracurium besylate and maintained using combined intravenous-inhalational anesthesia, and patient-controlled intravenous analgesia (PCIA) was performed after operation.Pulmonary function indexes were measured before induction of anesthesia (T 0) and at 6, 12 and 24 h after removal of the tracheal tube (T 1-3). Blood gas analysis was performed at T 0, T 2 and T 3.The occurrence of high/low blood pressure, tachycardia/bradycardia, consumption of opioids, PACU stay time, pressing times of PCIA within 24 h after surgery, rescue analgesia, time of passing the first flatus, the first postoperative off-bed time, length of postoperative hospital stay, and 48 h quality of recovery-40 (QoR-40) were recorded.The occurrence of adverse reactions and nerve block-related complications were recorded within 48 h after operation. Results:Conversion to laparotomy during operation was found in 4 patients, changing the scope of resection in 2 patients, and a total of 50 patients were enrolled in this study.Compared with group G, the pressing times of PCIA was significantly reduced, the requirement for postoperative rescue analgesia was decreased, the intraoperative consumption of sufentanil and remifentanil was reduced, the incidence of intraoperative hypertension and tachycardia was decreased, the FEV1, FVC and PEFR were increased at T 2, 3, the 48 h QoR-40 score was increased, the time of passing the first flatus, the first postoperative off-bed time, and length of postoperative hospital stay were shortened, the incidence of nausea, agitation, somnolence, and hypoxemia was decreased ( P<0.05), and no significant change was found in the indicators of blood gas analysis at each time point in group TRG ( P>0.05). Nerve block-related complications were not found in group TRG. Conclusion:Compared with general anesthesia alone, TAP-RS block combined with general anesthesia is helpful in carrying out anesthetic model of low-consumption opioids and improving the quality of early postoperative recovery when used in the patients undergoing laparoscopic pancreaticoduodenectomy.

Objective To evaluate the accuracy and feasibility of variation of internal jugular vein respiration (VIJV) in evaluating the volume responsiveness of patients undergoing gastrointestinal surgery.Methods Patients who underwent elective gastrointestinal surgery under general anesthesia,with American Society of Anesthesiologists (ASA) Ⅰ or Ⅱ,heart function Ⅰ,aging 42-74,body mass index (BMI)＜25 kg/m2,were infused with 6％ hydroxyethyl starch 130/0.4 NaCl injection (7 ml/kg) at a rate of 0.4 ml·kg-1·min-1 after anesthesia induction.Patients before volume expansion were classified as responders or non-responders according to the increases in the stroke volume variability (SVV) (≥ 13％ or not).The responders were thought with relatively insufficient volume,and the others were thought with sufficient volume.Sixty patients were enrolled in this study.Thirty one patients were defined as responders and the rest twenty nine were defined as non-responders.Their hemodynamic parameters (heart rate,SVV,CVP,MAP) were recorded before and 3 min after volume expanding.The diameter of the internal jugular vein and inner diameter of inferior vena cava in the end of inspiratory by ultrasonic instrument,variation of internal jugular vein respiration (VLJV) and variation of inferior vena cava respiration (VIVC) were calculated,and the ultrasonic measurement time was recorded.The VIJV,VIVC and SVV were used for Pearson's correlation analysis,and receiver operating characteristic curve (ROC) was plotted.Results There was no statistical difference in basic information between the two groups (P＞0.05).After volume expanding,the responder group showed remarkable decreases in heart rate and SVV,and marked increases in central venous pressure (CVP) and mean arterial pressure (MAP) (P＜0.05),and the non-responder group showed increased CVP (P＜0.05).Compared with before expansion,both groups demonstrated reduced VIJV and VIVC after volume expanding,with shortened VIJV ultrasonic measurement time (P＜0.05).Meanwhile,VIJV and VIVC were positively correlated with SVV (P＜0.05).The areas under ROC curve (AUC) of VIJV and VIVC were 0.829 and 0.928,and the cut off was 18.9％ and 19.7％,respectively.Conclusions The value of VIJV≥ 18.9％ during abdominal surgery can be used to effectively evaluate intraoperative patient volume reactivity,with a sensitivity of 93.3％ and a specificity of 73.3％.It can be used as an alternative index of VIVC.

Objective To investigate the effectiveness of predicting the incidence of supine hy-potension syndrome (SHS)after spinal anesthesia measured by ultrasonic measurement of the varia-tion of brachial artery peak velocity in different positions of parturient.Methods Parturient scheduled for elective cesarean section,ASA physical status Ⅰ or Ⅱ,were divided into SHS group and no-SHS group (SBP in the upper extremity decreased by > 30 mm Hg or decreased to < 80 mm Hg)after spinal anesthesia.HR,SBP,DBP of supine position and left lateral position before anesthesia were re-corded,and brachial artery peak velocity were measured by Ultrasonic.The differences of the above indexs before and after the transformation position were calculated.The receiver operating characteris-tic curve (ROC)was plotted by indexs of which P values were less than 0.05,to evaluate the predic-tive effect of each index on SHS after spinal anesthesia.Results Among the 196 patients,89 cases (45.4%)developed SHS after spinal anesthesia.SBP,DBP,peak velocity of brachial artery (Vpmin) and brachial artery peak velocity variation (ΔVp)were different before and after the transformation position (P<0.05).The difference in SHS group was significantly higher than no-SHS group.The areas under ROC curve (AUC)of ΔSBP,ΔDBP,ΔVpmin,ΔΔVp were 0.711 (95%CI 0.575-0.846), 0.573 (95%CI 0.419-0.727),0.948 (95% CI 0.895-0.987),0.864 (95% CI 0.770-0.958),and the cut-off values were 17.5 mm Hg,7.6 mm Hg,17.8 cm/s,and 13.1%.Conclusion The differ-ence of brachial artery peak velocity measured by ultrasonic in different positions of parturient can ef-fectively predict the occurrence of SHS,in which ΔVpmin≥ 17.8 cm/s has better predictive effect.

Objective To observe the influence and safety of dexmedetomidine 1 μg/kg given before the induction of anesthesia on the analgesic and sedate effects of remifentanil in pediatric postoperative analgesia.Methods Sixty children scheduled for bowel resection surgery were randomly divided into 2 groups:dexmedetomidine combined with remifentanil group (group DR,n=30) and remifentanil group (group R,n=30).Dexmedetomidine 1 μg/kg was given before the induction of anesthesia in group DR,normal saline in group R.Analgesic mixture including remifentanil 24 μg/kg,granisetron 0.1 mg/kg,diluted to 100 ml,was given to both groups.The postoperative analgesia and sedation was assessed with FACES Face Ratings and Ramsay score at the end of operation,and at 2,6,12 and 48 h after surgery.Times of pressed the analgesic pump,the incidence of side effects and parent' s satisfaction scores were recorded.Results FACES and Ramsay scores in group DR were significantly better than those in group R (P ＜ 0.05).There was no occurrence of respiratory depression in both groups.Parent' s postoperative satisfaction score in group DR was higher than that in group R (P＜0.05).There were 5 patients vomiting in group R,but only 1 in group DR (P ＜ 0.05).Conclusion With application of dexmedetomidine 1 μg/kg given before the induction of anesthesia,the analgesic and sedation effects of remifentanil can be improved,with high comfort level and patient' s satisfaction,which is better than application of remifentanil only.

ObjectiveToexploretheeffectsoflidocaineonprognosisofratswithsepsis.MethodsTheanimal models were established by cecal ligation and puncture ( CLP) in 96 male Wistar rats in which 48 rats were divided into four groups:control group (group C),model group (CLP group),early lidocaine treatment group (Lido+CLP group) and late lidocaine treatment group ( CLP+Lido group) ,with 12 rats in each group.The rats were sacrificed at 24h and 48h after CLP, respectively,then blood and lung tissue samples were collected for detecting the serum levels of high mobility group box-1 ( HMGB1) , the expression levels of HMGB1 mRNA in lung tissue and the functional parameters in important organs. Furthermore the survival rates were observed in the other 48 rats.Results The serum levels of HMGB1 were positively correlated to the expression levels of HMGB1 mRNA in lung tissue ( r =0.94, P <0.05).The serum levels of HMGB1 and expression levels HMGB1 mRNA in lung tissue in CLP group, Lido+CLP group and CLP+Lido group were significantly higher than those in group C ( P <0.05),however,which in Lido+CLP group and CLP+Lido group were obviously lower than those in CLP group ( P <0.05).As compared with those in CLP group,the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST),blood urea nitrogen (BUN),creatinine (Cr),creatine kinase (CK) were significantly decreased in Lido+CLP group and CLP+Lido group ( P <0.01).The survival rates of rats in Lido+CLP group and CLP+Lido group were significantly higher than those in CLP group ( P <0.01).Conclusion Lidocaine can significantly improve the survival rate,inhibit HMGB1 expression and protect important organs such as liver,kidney and heart in rats with sepsis.

?Objective?To?investigate?the?effects?of?preconditioning?with?sevoflurane?inhalation?on?postoperative?cognition?disorders?of?aged?rats?and?the?role?of?inflammatory?factor?levels?in?the?hippocampus.?Methods?One?hundred?and?thirty-eight?healthy?male?SD?rats,?aged?18?months,?weighing?400-450?g?were?randomly?devided?into?3?groups?(n=46?each).?Control?group?(group?C)?were?only?anesthetized?with?pentobarbital?and?not?underwent?operation;?operation?group?(group?O)?were?anesthetized?with?pentobarbital?and?underwent?30?min?of?exploratory?laparotomy;?sevoflurane?preconditioning?group?(group?Sev)?were?inhaled?2.4%?sevoflurane?30?min,then?treat?like?group?O?following?by?inhaled?room?air?30?min.?The?escape?latency,?the?time?of?staying?at?the?original?platform?quadrant?and?frequency?of?crossing?the?original?platform?was?assessed?using?Morris?water?maze?on?30?min?before?operation?and?1st,?3rd,?5th,?7th?days?after?operation.?The?brain?tissues?were?taken?for?detecting?the?levels?of?inflammatory?factor,the?apoptotic?rate?and?intracellular?[Ca2+]i?of?hippocampal?neuronal?at?30?min?before?operation?and?1st,?7th?days?after?operation.?And?immediately?after?surgery?arterial?blood?samples?were?taken?for?blood?gas?analysis,?at?the?same?time?points?body?temperature?was?recorded.?Results?Compared?with?group?C,?the?escape?latency?was?prolonged,?the?time?of?staying?at?the?original?platform?quadrant?and?frequency?of?crossing?the?original?platform?were?decreased at all time points in group O and at the 1st, 3rd, 5th day after operation in group Sev; the levels of TNF-α,IL-1β,IL-6 of the hippocampus and?the?apoptotic?rate?and?intracellular?[Ca2+]i?of?hippocampal?neuronal?were?increased?at?the?1st,?7th?day?after?operation?in?group?O?and?at?the?1st?day?in?group?Sev(P<0.05),?compared?with?group?O,?the?escape?latency?was?shorten,?the?time?of?staying?at?the?original?platform?quadrant?and?frequency?of?crossing the original platform were increased, the levels of TNF-α, IL-1β, IL-6 and the apoptotic rate and intracellular [Ca2+]i?of?hippocampal?neuronal?were?decreased?at?all?time?points?after?operation?in?group?Sev(P<0.05).?Conclusion?Sevoflurane?preconditioning?can?improve?postoperative?cognitive?function of aged rats, which may be related to decrease the levels of TNF-α,?IL-1β and IL-6 and regulation of imbalance of calcium homeostasis and reduction?the?apoptotic?rate?of?hippocampal?neuronal.

Objective To investigate the effects of total intravenous anesthesia and combined intravenous-inhalation anesthesia on postoperative cognition disorders of aged patients for laparotomy surgery. Methods Sixty ASAⅡ or Ⅲ patients, aged 65-75 years old, with BMI 19-30 kg/m2, scheduled for laparotomy surgery, were randomly divided into 2 groups:total intravenous anesthesia group (group T, n=30) and combined intravenous-inhalation anesthesia group (group I, n=30). In both groups, anesthesia was induced with iv injection of midazolam 0.1 mg/kg, sufentanil 0.3μg/kg, propofol 2 mg/kg, cis-atracurium 0.2 mg/kg. In group T anesthesia was maintained with continuous infusion of propofol 6-8 mg/(kg?h) and remifentanil 0.25μg/(kg?h), intermittent iv boluses of cis-atracurium 0.1 mg/kg. In group I anesthesia was maintained with propofol 2-3 mg/(kg?h) and remifentanil 0.25μg/(kg?h), intermittent iv boluses of cis-atracurium 0.1 mg/kg and inhalation of 0.8%~1.1%sevolfurane. Cognitive function was assessed by mini-mental state examination at 1 day before surgery and 1, 3, 5, 7 day after surgery. Venous blood samples were collected for determination concentration of plasma TNF-α, IL-1βand IL-6 by ELISA. Results Compared with 1 day before surgery, MMSE scores were decreased at 1, 3, 5, 7 day after surgery, the concentration of plasma TNF-α, IL-1βand IL-6 were increased inboth groups(P<0.05). Compared with group I, MMSE scores were increased at 1, 3, 5 day after surgery, the concentration of plasma TNF-α, IL-1βand IL-6 were decreased in group T(P<0.05). Conclusion Both of total intravenous anesthesia and intravenous combined with inhalation anesthesia can decrease postoperative cognition of aged patients for laparotomy surgery, compared with combined intravenous-inhalation anesthesia, total intravenous anesthesia has less inlfuence on postoperative cognition of aged patients for laparotomy surgery.

目的 探讨盐酸戊乙奎醚(penehyclidine hydrochloride,PHC)对脓毒症大鼠预后的影响.方法 对48只雄性Wistar大鼠进行盲肠结扎穿孔(cecal ligation and puncture,CLP)造模.48只大鼠分为4组,每组12只,包括对照组(C组)、模型组(CLP组)、早期PHC处理组(PHC+ CLP组)和晚期PHC处理组(CLP+ PHC组).每组大鼠分别在CLP后24h和48h处死,收集血和肺组织样本检测血清中高迁移率族蛋白1(high mobility group box-1,HMGB1)水平、肺组织中HMGB1 mRNA表达和重要器官功能指标;同时统计生存率进行分析.结果 血清中HMGB1与肺组织中HMGB1 mRNA明显相关(r=0.945);血清中HMGB1和肺组织中HMGB1 mRNA在CLP组、PHC+ CLP组和CLP+ PHC组明显高于C组(P＜0.05),但在PHC+ CLP组和CLP+ PHC组明显低于CLP组(P＜0.05).与CLP组相比,丙氨酸转氨酶、天冬氨酸转氨酶、尿素氮、肌酐和肌酸磷酸激酶水平在PHC+ CLP组和CLP+PHC组明显降低(P＜0.05).大鼠生存率在PHC+ CLP组和CLP+PHC组明显高于CLP组(P＜0.05).结论 PHC可以明显改善生存率,抑制HMGB1表达和保护脓毒症大鼠肝、肾、心等重要器官.

术后认知功能障碍(POCD)是指手术麻醉后数天内发生的意识、认知、定向、思维、记忆和睡眠等紊乱,是一种可逆的、具有波动性的急性精神紊乱综合征.POCD可导致患者病死率升高、康复延迟、并发症增多、住院时间延长和医疗费用增加等,严重时影响患者出院后的生活质量[1].POCD最早常发生于老年患者心脏手术后,近年来在行非心脏手术的患者中POCD发生率也较高.本研究通过比较异氟烷与七氟烷对术后患者认知功能障碍的影响,为老年患者围术期的管理提供一些参考意见.

Objective To evaluate the effects of penehyclidine hydrochloride on synthesis and release of high mobility group protein box 1 (HMGB1) in macrophages induced by lipopolysaccharide (LPS) in mice.Methods RAW264.7 cells obtained from mice were seeded in the culture dishes.After being cultured for 24 h,the cells were randomly divided into 5 groups (n =6 each) using a random number table.The cells were incubated routinely in group C.The cells were incubated in the presence of LPS 500 ng/ml (group LPS),LPS 500 ng/ml + penehyclidine hydrochloride 0.5 μg/ml (group P1),LPS 500 ng/ml + penehyclidine hydrochloride 2 μg/ml (group P2),or LPS 500 ng/ml + penehyclidine hydrochloride 5 μg/ml (group P3).All the cells were incubated for 24 h.The cells and supernatant were collected.The proliferation of the cells was measured by CCK-8 assay,HMGB1 mRNA expression in the cells was detected by RT-PCR,NF-κBp65 protein expression in the cells was detected by Western blot and the concentration of HMGB1 in the supernatant was detected by ELISA.Results Compared with group C,the expression of HMGB1 mRNA and NF-κBp65 protein in the cells was significantly upregulated,and the concentration of HMGB1 in the supernatant was increased in LPS,P1,P2 and P3 groups (P ＜ 0.05).Compared with group LPS,the expression of HMGB1 mRNA and NF-κBp65 protein in the cells was significantly down-regulated,and the concentration of HMGB1 in the supernatant was decreased in P2 and P3 groups (P ＜ 0.05).Compared with group P1,the expression of HMGB1 mRNA and NF-κBp65 protein in the cells was significantly down-regulated,and the concentration of HMGB1 in the supernatant was decreased in P2 and P3 groups (P ＜ 0.05).There was no significant difference in the indicators mentioned above between group P2 and group P3 (P ＞ 0.05).There was no significant difference in the proliferation of the cells among the 5 groups (P ＞ 0.05).Conclusion Penehyclidine hydrochloride can reduce the synthesis and release of HMGB1 in macrophages induced by LPS through inhibiting NF-κB activation in mice.

Objective To investigate the effect of penehyclidine hydrochloride on expression of high mobility group box 1 (HMGB1) mRNA in lung tissue in septic rats.Methods Thirty male Wistar rats weighing 200-250 g were randomly divided into 3 groups (n =10 each):group sham operation (group S),group sepsis(group L),group penehyclidine hydrochloride (groups PH).Sepsis was induced by cecal ligation and puncture in groups L,PH.Penehyclidine Hydrochloride 0.45 mg/kg were injected intraperitoneally at the end of operation in groups PH.Five animals in each group were sacrificed at 24 and 48 h after operation respectively.The lungs were removed for microscopic examination and determination of HMGB1 mRNA expression,MPO activity and activation of NF-κB.Results Sepsis up-regulated HMGB1 mRNA and increased MPO activity and activation of NF-κB and induced lung histopathological damage.Penehyclidine Hydrochloride attenuated the above mentioned sepsis-induced changes in a dosedependent manner.Conclusions Penehyclidine Hydrochloride can attenuate sepsis-induced acute lung injury by down-regulating HMGB1 mRNA expression and inhibiting activation of NF-κB.

>全身麻醉（全麻）患者在苏醒期出现躁动不安是麻醉苏醒期常见的并发症之一 [1] 。因此如何预防和减少躁动的发生是麻醉管理面临的难题。本研究旨在探讨经静脉输注右美托咪定联合注射氟比洛芬酯对开胸手术患者全麻苏醒期躁动的影响。一、对象与方法1.对象:2012年3至12月在河北省沧州市中心医院麻醉科择期开胸手术患者120例,男78例,女42例,美国麻醉医师协会（ASA）Ⅰ或Ⅱ级,年龄33～56岁,体质量50～71 kg,经沧州市中心医院伦

目的:观察双管型喉罩用于小儿支气管异物取出术的麻醉效果.方法:选择行支气管异物取出术60例,随机分为双管型喉罩组、气管插管组和面罩组各20例.采用静脉注射丙泊酚2.5～3 mg/kg,苯磺顺阿曲库铵0.1～0.2 mg/kg,长托宁0.1～0.2mg,地塞米松0.2 mg/kg,瑞芬太尼2μg/kg进行麻醉诱导和维持,术中高频喷射呼吸机控制通气.比较3组收缩压(SBP)、舒张压(DBP)、平均压(MAP)、心率(HR)和血氧饱和度(SO2)水平的变化,并观察各组不良反应发生情况.结果:双管型喉罩组SBP、DBP、MAP和HR显著低于气管插管组(P＜0.05)；HR显著低于面罩组(P＜0.05)；SO2水平3组间差异不显著(P＞0.05).双管型喉罩组发生咽喉疼痛1例；气管插管组拔出气管导管时发生喉痉挛1例,咽喉疼痛15例；面罩组出现腹胀和托下颌时体动3例；3组均未发生反流和误吸等不良反应.结论:双管型喉罩用于小儿支气管异物取出术中的麻醉效果优于气管插管和面罩.

<正>腰硬联合麻醉是近年来我国应用比较广泛的麻醉方法之一,尤其是在妇科手术麻醉中,但术中知晓常会增加患者的心理压力和恐惧感,给患者留下痛苦回忆,并对身心造成一定伤害,因此,合理选择辅助用药对患者进行适当的镇静,消除患者在麻醉和手术中的不良记忆,具有重要意义。右美托咪啶是一种新型、高选择α2-肾上腺受体激动药,具有镇静、镇痛、抗焦虑作用,作为麻醉辅助药已广泛用于临床。本研究将右美托咪啶

目的:观察瑞芬太尼用于支撑喉镜下声带息肉摘除的麻醉效果。方法:选择行支撑喉镜下声带息肉摘除60例,随机分为瑞芬太尼组(观察组)和芬太尼组(对照组)各30例。两组均静脉注射丙泊酚2mg/kg、阿曲库铵0.7mg/kg进行麻醉诱导,观察组静脉注射瑞芬太尼2μg/kg,对照组静脉注射芬太尼3μg/kg。术中麻醉维持两组均静脉泵入丙泊酚4～7mg/(kg.h),观察组泵入瑞芬太尼0.08～0.30μg/(kg.min),对照组泵入芬太尼0.07～0.25μg/(kg.min)。观察两组血压、心率、血氧饱和度、自主呼吸恢复时间、气管拔管时间和睁眼时间。结果:观察组术后自主呼吸恢复时间,气管拔管时间和睁眼时间均显著短于对照组(P<0.05),血压、心率、血氧饱和度两组比较,差异不显著(P>0.05)。结论:瑞芬太尼用于支撑喉镜下声带息肉摘除的麻醉效果优于芬太尼。

目的比较异丙酚与七氟醚对老年患者全麻后认知功能的影响。方法 40例单纯胆囊切除术患者,65～75岁,ASAⅡ～Ⅲ级,简易智能状态检查(MMSE)评分>24分。随机分为2组:异丙酚组(P组):术中持续泵入异丙酚,3～5mg·kg-1·h-1,总量不超过100mg/kg;七氟醚组(S组):术中持续吸入七氟醚,根据BIS值维持MAC(最低肺泡有效浓度)在0.8～1.1。术中静脉持续泵入顺式阿曲库铵和瑞芬太尼维持肌松和镇痛。围术期呼气末二氧化碳控制在30～40mmHg。术前1d(D0)和术后3h(D1),6h(D2)和术后3d(D3),由我院同一心理咨询师分别进行一次简易智能状态检查(MMSE)评分,得分<24分为术后认知功能障碍(POCD)。结果 2组患者术前年龄、性别比、体重、ASA分级和手术时间等一般资料比较差异无统计学意义(P>0.05)。D0简易智能状态检查(MMSE)评分,2组患者得分比较差异无统计学意义(P>0.05)。D1、D2和D3简易智能状态检查(MMSE)评分,2组患者得分与基础值比较,组内自身配对比较,比术前降低,差异有统计学意义(P<0.05);组间比较,D1,D22组患者得分比较,P组高于S组,差异有统计学意义(P<0.05);D32组患者得分比较,差异无统计学意义(P>0.05)。结论异丙酚和七氟醚均能引起老年患者术后早期认知功能障碍,但异丙酚恢复较快。