目的 观察超声引导低位前锯肌平面阻滞(SSPB)对胃癌根治术后炎症及康复的影响.方法 采用随机数字表法将2018年5月至2019年12月该院收治的80例择期行胃癌根治术患者分为C组(单纯全身静脉麻醉)和SSPB组(全身麻醉复合SSPB),每组40例.SSBP组在麻醉诱导后行超声引导双侧腋中线第8肋水平型前锯肌平面阻滞,分别注入0.25％罗哌卡因,每侧各30 mL.两组均采用全身麻醉气管插管,术毕均给予患者自控静脉镇痛.记录两组患者术中芬太尼、瑞芬太尼用量;测定两组患者术前,术后1、3 d C反应蛋白(CRP)水平及中性粒细胞计数;记录两组患者术后24、48 h视觉模拟疼痛量表(VAS)评分,恶心、呕吐发生次数,术后镇痛泵有效按压次数及补救镇痛例数;记录两组患者首次排气时间、住院时间及术后不良反应发生情况;记录两组患者术前、术后3 d恢复质量.结果 SSBP组患者术中瑞芬太尼用量明显低于C组,差异有统计学意义(P<0.05);两组患者术后1、3 d CRP水平及中性粒细胞计数均明显升高,但SSBP组患者术后1、3 d CRP水平及中性粒细胞计数明显低于C组,差异均有统计学意义(P<0.05);与C组比较,SSPB组患者术后24 h VAS评分明显降低,术后24、48 h内有效按压次数、术后48 h内镇痛补救发生率均明显减少,术后首次排气时间明显缩短,差异均有统计学意义(P<0.05);但两组患者术后48 h VAS评分、住院时间、术后不良反应发生率比较,差异均无统计学意义(P>0.05).SSBP组患者术后3 d术后恢复质量QoR-40量表总分及各系项目评分均明显高于C组.结论 超声引导SSPB可降低胃癌根治术患者术后CRP水平及中性粒细胞计数,改善机体的炎性反应及术后疼痛,提高患者术后早期恢复质量.

Bone cancer pain (BCP) severely compromises the life quality of patients with advanced cancer or bone metastases. This study investigates the analgesic effect of sodium aescinate (SA) on BCP, and the underlying mechanisms within the spinal cord (SC) and dorsal root ganglion (DRG). Walker 256 cells were intratibially inoculated into rats to establish a BCP model. 10, 20, and 40 g/L of SA was intrathecally injected, respectively, and then, hyperalgesia and allodynia were evaluated by measuring the paw withdrawal threshold (PWT) and paw withdrawal latency (PWL). The effect of SA on neuroinflammation was observed by detecting the production of the pro-inflammatory cytokines based on RT-qPCR and ELISA. The NF-κB and p38 MAPK/c-Fos signaling was detected by WB analysis. Furthermore, RT-qPCR and WB analyses of Iba-1and CD206 were performed to assess microglial activation. The development of hyperalgesia and allodynia, and an increase of pro-inflammatory cytokines production, as well as microglial activation, were observed in the BCP rats. SA (40 g/L) not only relieved the pain-related behaviors induced by BCP but also suppressed the release of pro-inflammatory cytokines and the activation of microglia in the SC and DRG. SA could also inhibit p38 MAPK/c-Fos signaling in both the SC and DRG, which might contribute to the suppression of microglial activation. Our findings suggest that SA plays a promising analgesic role in the BCP rats by suppressing inflammation and microglial activation, and these effects may be associated with the suppression of p38 MAPK/c-Fos signaling.

Objective:To observe the effects of ultrasound-guided transverse abdominal muscle plane block (TABP) on neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) in the peripheral blood of patients undergoing radical gastrectomy.Methods:A total of 100 patients who were scheduled for radical gastrectomy were selected. According to the random number table method, they were randomly divided into two groups ( n=50): a TAPB combined with general anesthesia group (group TAP+GA) and a general anesthesia group (group GA). Group TAP+GA and group GA underwent ultrasound-guided TABP assisted with general anesthesia, and routine general anesthesia, respectively. Both groups were compared for operation time, anesthesia time, blood loss, and the dosages of fentanyl and remifentanil. Their counts of neutrophils, platelets and lymphocytes, NLR and PLR in the peripheral blood were recorded before and 24 h and 72 h after surgery. Their Visual Analogue Scale (VAS) scores 24 h and 48 h after operation, adverse reactions and the length of hospitalization stay were recorded. Results:There were no significant differences in operation time, anesthesia time, blood loss and fentanyl dosage between the two groups. Compared with group GA, the dosage of remifentanil in group TAP+ GA was significantly reduced ( P<0.05). There were no statistical differences in the counts of neutrophils, platelets and lymphocytes, PLR and NLR in the peripheral blood between the two groups ( P>0.05). Compared with group GA, group TAP+GA presented remarkably reduced counts of neutrophils in the peripheral blood 24 h and 72 h after operation ( P<0.05). There were no statistical differences in the counts of lymphocytes and platelets and PLR between the two groups 24 h and 72 h after operation ( P>0.05). No statistical difference was found in the value of NLR between the two groups 24 h after operation ( P<0.05). The value of NLR in the peripheral blood of group TAP+GA was significantly lower than that in group GA 72 h after operation ( P>0.05). The VAS score 24 h and 48 h after operation in group TAP+GA were lower than that in group GA ( P<0.05). Postoperative nausea and vomiting were significantly reduced in group TAP+GA, compared with group GA ( P<0.05). There were no statistical differences in the length of hospitalization stay, postoperative pulmonary infection, anastomotic fistula, and postoperative intestinal obstruction between the two groups ( P>0.05). Conclusions:Ultrasound-guided TABP assisted general anesthesia is useful for reducing the counts of neutrophils and NLR in patients. It also improves postoperative pain, and reduces the occurrence of postoperative nausea and vomiting.

目的 探讨血清中性粒细胞/淋巴细胞比值(NLR)预测老年胃癌根治术患者术后认知功能障碍(POCD)的价值.方法 选择择期行胃癌根治术患者100例,男67例,女33例,年龄≥65岁,ASA Ⅱ或Ⅲ级.患者手术均在气管插管全麻下进行,在术前及术后第7天通过Z计分法评估患者认知功能,根据评分结果将患者分为两组:POCD组和NPOCD组.记录术前1 d、术后1、3 d血清中NLR的变化.应用受试者工作特征(ROC)曲线,分析各时点血清NLR对老年胃癌根治术患者发生POCD的预测价值.结果 术后7 d发生POCD患者22例(22％).与术前1 d比较,术后1、3 d两组NLR明显升高(P＜0.05).术后1、3d POCD组血清NLR明显高于NPOCD组(P＜0.05).术后3 d血清中NLR预测老年胃癌根治术患者发生POCD的最佳界值为6.986,预测POCD发生的AUC为0.818(95％CI 0.728～0.888),敏感性和特异性分别为88.5％和68.2％,高于术后1 d NLR的AUC为0.799(95％CI 0.707～0.872).结论 老年胃癌根治术患者术后3 d NLR对术后7 d POCD发生的预测价值较高,血清中NLR的升高可能与术后POCD的发生相关,术后NLR升高是发生POCD的危险因素.

Objective To investigate the role of triggering receptor expressed on myeloid cells 1 (TREM1)in rats with neuropathic pain and its possible mechanism.Methods Forty-eight male a-dult Sprague-Dawley rats,weighing 220-300 g,were successfully placed intrathecal catheters,and then randomly divided into 4 groups (n=1 2 ):sham operation group (group S),neuropathic pain group (group CCI),TREM1 shRNA group (group RNAi)and negative lentivirus group (group Vi-rus).The neuropathic pain was induced by chronic sciatic nerve compression injury (CCI).In group RNAi,30 μl pGLVU6/RFP/Puro-shRNA (1×109IU/ml)was injected intrathecally 1 week before modeling.Group Virus was injected with 30 μl negative lentivirus,whereas group CCI and group S with equal amount of normal saline.MWT and TWL were measured 1 day before (baseline)and 1,3, 7,14 day after modeling.When behavioral test finished,the expression levels of TREM1,TLR4, MyD88,IκBαand p-NF-κB p65 in spinal cord were determined by Western blot.Whereas the mRNA expression levels of IL-1β,TNF-αand IL-6 in spinal cord were measured by RT-PCR.Results Com-pared with group S,the expression levels of TREM1 in groups CCI and Virus significantly increased (P<0.05).While compared with group CCI,the TREM1 expression of group RNAi in spinal cord significantly decreased (P<0.05).Compared with group S,MWT and TWL of groups CCI,Virus and RNAi after modeling and the expression of IκBαsignificantly decreased (P<0.05),whereas the expression of TLR4,MyD88,p-NF-κB p65 increased significantly (P<0.05),as well as the expres-sion of IL-1β,TNFαand IL-6 mRNA (P<0.05).Compared with group CCI,the MWT and TWL of group RNAi after modeling and the expression of IκBαremarkably increased (P<0.05),whereas the expression of TLR4,MyD88 and p-NF-κB p65 in the spinal cord remarkably decreased (P<0.05), as well as the expression of IL-1β,TNF-αand IL-6 mRNA (P<0.05).Conclusion TREM1 knock-down can alleviate neuropathic pain,the underlying mechanism might be the inhibition of TLR4/MyD88/NF-κB signaling pathway.

Purpose: To investigate the role of chemokine in the anterior cingulate cortex (ACC) in a rat model of chronic neuropathic pain. Methods: 80 male Sprague-Dawley rats were randomly assigned into 4 groups (n = 20): the sham group, the control group, the PBS treatment group and the anti-CX3CL1 treatment group. In the sham group, the unilateral infraorbital nerve was only exposed, but not ligated; in the control group, the unilateral infraorbital nerve was exposed and ligated. In the sham and the control group, the behavioral test was undertaken and the protein expression of CX3CL1 and CD11b was compared. Results: Compared with the sham group, there was a significant reduction in the feeling threshold in the ipsilateral ION territory from 3 d to 14 d after CCI-ION in the control group (P<0.05). Rats given antibody in the anti-CX3CL1 treatment group showed an evident increase of the feeling threshold compared with the PBS group (P<0.05). Conclusion: The ACC may take part in the chronic neuropathic pain via associating with the activated microglial cells and increased expression of CX3CL1.

患者,女,62岁,体重54 kg,ASA Ⅲ级。因“胰腺癌伴肝转移化疗介入治疗后半月余”入院,拟在全麻下行“胰腺肿瘤纳米刀消融术”。既往无传染病病史,无高血压、心脏病、糖尿病等慢性病史。确诊胰腺恶性肿瘤后经八个周期的化疗后病情稳定,各项指标除 CA12556.73 U/ml,CA199181.3 U/ml之外无明显异常。术前 MRI 示：肝右前叶病灶合并治疗后改变较前相似,余肝内多发转移灶较前增大。患者于2016年4月21日转入介入科行肝动脉化疗栓塞术,控制肝内转移灶。

随着全球人口老龄化，老年癌症病人的比例相应增加，约60％的癌症病人年龄≥65岁，在这些老年癌症病人中中晚期的疼痛尤为多见，而其中≥30％的老年癌症病人疼痛未能得到有效治疗，这是非常重要的社会医疗问题［1?2］。如何处理老年癌症病人肿瘤本身引起的疼痛及癌症相关疼痛越来越值得我们关注。本文现就老年癌症病人疼痛病因、病理生理改变、治疗方法进行综述。

Objective To observe the effects of ulinastatin conbined with dexmedetomidine (Dex) on early postoperative cognitive function in elderly patients undergoing esophageal cancer operations.Methods Sixty patients (ASA Ⅰ-Ⅲ,aged 65-84 y) scheduled for surgeries for esophageal cancer were randomized into intervention group (group Ⅰ,n=30) and control group (group Ⅱ,n=30).After intravenous induction and tracheal intubation,the patients in the intervention group Ⅰ were infused intravenously 2×105 U ulinastatin in 100 ml normal saline in 30 min and Dex 0.5 μg·kg-1·h-1 to 30 min before end of the operation,the patients in group Ⅱ received the same volume of saline infusion only.Comprehensive neuro-psychological tests were performed at day 1 before and day 1,3 after operation to assess preopereative cognitive function of patients.Peripheral artery blood was extracted to determine levels of serum S-100β protein,neuron-specific enolase(NSE) and IL-6 with ELISA before anesthesia induction(T0),at the end of the surgery (T1),and at day 1 (T2) and day 3 (T3) after operation.Results The difference between the test scores before and after the operation (X values) was significantly smaller in the group Ⅰ than in the group Ⅱ (P＜0.05).The group Ⅰ showed a significantly lower incidence rate of postoperative cognitive dysfunction (POCD) than the group Ⅱ (6.7％ vs 30.0％,P＜0.05).Compared with the group Ⅱ,the group Ⅰ exhibited significantly lower serum levels of S-100β protein,NSE and IL-6 at T1 (P＜0.05),significantly lower NSE and IL-6 levels at T2 (P＜0.05) time point,and significantly lower IL-6 level at T3 (P＜0.05).Conclusions Intravenous injection of ulinastatin and Dex during the operation can reduce the incidence of POCD in elderly patients undergoing surgeries for esophageal tumors possibly in relation to decreased serum S-100β,NSE and IL-6 levels.

Myeloid-derived suppressor cells (MDSCs),a heterogeneous population of immature myeloid cells,play an important role in immune tolerance and immune suppression.In recent years,more and more research results show that the prostaglandin E2 (PGE2) has an inseparable relationship with MDSCs,and PGE2 through its relevant receptors,regulating signal transducer and activator of transcription 3 (STAT3) and protein kinase A cell signaling pathways and secretion cytokines in tumor microenvironment,affects the development,differentiation and function of MDSCs.

目的：观察右美托咪定联合利多卡因对芬太尼全麻诱导期诱发呛咳反应的影响。方法：选择240例ASAⅠ-Ⅱ级择期行全麻手术患者，随机分为4组（n＝60），对照组给予生理盐水0．15 mL／kg＋生理盐水0．05 mL／kg；右美托咪定组给予右美托咪定0．5μg／kg＋生理盐水0．05 mL／kg；利多卡因组给予利多卡因0．5 mg／kg＋生理盐水0．05 mL／kg；右美托咪定＋利多卡因组给予右美托咪定0．5μg／kg＋利多卡因0．5 mg／kg。麻醉诱导时先于2 s内快速静脉注射芬太尼3μg／kg，2 min后给予其他药物行全麻诱导，记录芬太尼注射后1 min内呛咳反应的发生率、呛咳程度及发生时间；记录给药期间低血压及严重心动过缓的发生情况。结果：与对照组比较，其他3组的呛咳发生率及轻度反应程度明显降低（P＜0．05或P＜0．01），右美托咪定＋利多卡因组中、重度呛咳发生率降低（P＜0．05）；利多卡因组与右美托咪定组呛咳反应发生率间差异无统计学意义；与右美托咪定组、利多卡因组比较，右美托咪定＋利多卡因组呛咳反应的发生率明显降低（P＜0．01）；4组患者芬太尼诱导呛咳的发生时间及低血压、严重窦性心动过缓发生率比较差异均无统计学意义（P均＞0．05）。结论：右美托咪定联合利多卡因能有效抑制芬太尼诱发的呛咳反应。

Objective To explore the effect of TOSIGHT video laryngoscope and McCoy laryngoscope in tracheal intubation.Methods A total of 132 patients receiving tracheal intubation were randomly divided into T group receiving TOSIGHT video laryngoscope and M group receiving McCoy laryngoscope,with 66 patients in each group.The following data were observed including the Cormack-Lehane grade,overall intubation time,success rate of one-time intubation,and the hemodynamic alteration in two groups.Results The overall intubation time was(18.2±4.1)s in T group,significantly lower than that in M group((21.3±8.2)s)(P0.01).The overall intubation time of patients withⅠ~ⅡCormack-Lehane((16.2±2.1),(17.5±1.6)s)were lower than those in patients with Ⅲ ~ Ⅳ Cormack-Lehane((24.7±6.3),(33.0±13.5)s)in T and M groups(P0.01).There was no significant difference in one-time intubation success rate in patients withⅠ~Ⅱ Cormack-Lehane between M group(94.7%)and T group(100.0%)(P0.05).The one-time intubation success rate in patients with Ⅲ~Ⅳ Cormack-Lehane was higher in T group(81.3%)than that in M group(71.4%)(P0.05).The systolic blood pressure(SBP)((92±10),(103±9)mm Hg),diastolic blood pressure(DBP)((65±9),(73±10)mm Hg),and heart rate(HR)((87±9),(85±8)beats/min)at intubation and 1min after intubation in patients withⅢ~Ⅳ Cormack-Lehane in T group,significantly lower than those in M group(SBP:(97±10),(114±8)mm Hg;DBP:(57±7),(69±11)mm Hg,HR:(93±10),(91±8)beats/min)(P0.05,P0.01).The incidence of complications was lower in T group(3.03%)than that in M group(12.12%)(P0.05).Conclusion TOSIGHT video laryngoscope is superior to McCoy laryngoscope for patients with difficult airway.

<正>近20年来胸段硬膜外麻醉应用越来越广泛,不仅于外科学而且广泛使用于产科学、急慢性损伤、癌性镇痛上。有大量报道显示它能提供很好的术中及术后镇痛、提早拔管、加快胃肠功能恢复、减轻应激反应及提高术后肺功能。本文主要是就TEA对各个系统的影响做一综述其中主要集中在心脏、呼

Objective To investigate the effect of etomidate on the expression of activation makers of platelet CD62p and CD41/ 61 in peripheral venous blood in patients with lung cancer. Methods Peripheral venous blood samples were taken from 10 healthy volunteers (group E) and 40 patients with lung cancer. The 40 patients with lung cancer were randomly divided into 4 groups (n=10 each): groups A, B, C and D. The blood samples in groups E and A were incubated without etomidate, while the blood samples in groups B, C and D were incubated with etomidate 0.2, 2 and 20 mg/L, respectively. The inhibitory effects of etomidate on expression of activation makers of platelet CD62p and CD41/61 were determined by flow cytometry. Results The five groups were comparable with respect to age, body weight, platelet count and coagulation time. The expression of C D62p (37.1±20.3) %、 CD41/61 (97.2±1.4) % on the platelet surface was significantly increased in patients with lung cancer than the expression of CD62p (3.3±1.9)%, CD41/61 (93.1±3.4)% in healthy adults (P<0.01).Compare with group A, the expression of activation makers of platelet CD62p (20.9±9.2)%on the platelet surface in group C was decreased (P<0.05)and the expression of activation makers of platelet CD62p (17.9±15.6)% in group D was significantly decreased(P<0.01),whereas etomidate 0.2 mg/L had no significantly effect on CD62p and CD41/61. Conclusion The expression of activation makers of plateleta significantly increased in patients with lung cancer compared with healthy adults. In vitro,etomidate 2 and 20 mg/L can inhibit the expression of CD62p.