We aimed at exploring the role and mechanism of METTL3-mediated m6A modification in neuropathic pain. Male Sprague-Dawley rats were randomly divided into four groups: Sham operation group (Sham group), chronic constriction injury (CCI) of the sciatic nerve model group (NPP group), intrathecal injection of virus down-regulated METTL3 + CCI model group (M3 + NPP group) and intrathecal injection of negative control virus + CCI model group (Scr + NPP group). The M3 + NPP group and the Scr + NPP group were intrathecally injected with virus nineteen days before operation. The paw withdrawal mechanical thresholds and paw withdrawal latency were respectively recorded one day before operation, three days, five days and seven days after oper-ation. The rats were sacrificed on the seventh day after operation, and their spinal cord tissues were taken. The frozen sections of rats were performed to observe the expression of green fluorescent protein of the virus. The methylation level of RNA, the protein expression of m6A-related enzyme (METTL3) and mu opioid receptor (MOR) in spinal cord tissues of the four groups were measured. Downregulation of METTL3 had no effect on the overall methylation level of the spinal cord, but it could regulate the methylation level of the OPRM1 gene RNA encoding MOR, partially restore the expression of MOR, and relieve pain in rats. In the process of NPP, METTL3 may inhibit the expression of MOR by regulating the methylation level of OPRM1 gene RNA encoding MOR, and ultimately promote the occurrence and development of NPP.

神经病理性疼痛是由中枢神经系统及周围神经系统的原发性损害和功能障碍诱发,常会引起痛觉过敏、异常疼痛、自发性疼痛和感觉异常,而这些变化是如何发生的仍然难以确定.最新研究表明,外周有害刺激改变了 RNA修饰、非编码 RNA、DNA甲基化、组蛋白修饰等表观遗传学修饰,这些变化可能与神经病理性疼痛的痛觉敏感有关.本文综述目前神经病理疼痛表观遗传学作用机制的研究进展,以期为该疾病的诊疗提供潜在靶点.

目的 对比以不同方式行星状神经节阻滞术(SGB)对于疗效及并发症的影响.方法 对127例患者分别于超声引导下间断给药(A组,n=45)、超声引导下连续给药(B组,n=42)及解剖定位盲法穿刺给药(C组,n=40)后行首次SGB,比较组间首次穿刺成功率、SGB成功率、药物跨越警戒点(颈总动脉与颈内静脉交汇处)者占比、霍纳综合征出现和维持时间差异及短期并发症情况;以二分类logistic回归模型分析药物跨越警戒点与声音嘶哑的关系.结果 A、B组首次穿刺成功率及SGB成功率均高于C组(P均＜0.05).B组药物跨越警戒点者占比高于A组(P＜0.05).A、B组出现霍纳综合征时间均早于C组(P均＜0.05);A组霍纳综合征维持时间最长,B组次之,C组最短,两两比较差异均有统计学意义(P均＜0.05).术后A组2例、B组8例、C组12例声音嘶哑,B、C组声音嘶哑发生率明显高于A组(P均＜0.05);A组2例、B组2例、C组7例穿刺点疼痛;C组4例食管损伤,其穿刺点疼痛及食管损伤发生率均高于A、B组(P均＜0.05).结论 超声引导下间断给药法SGB较超声引导下连续给药及解剖定位盲法穿刺给药成功率高,维持时间长且并发症少.

感觉神经病是艾滋病患者常见的一种并发症,目前临床医生对人类免疫缺陷病毒(HIV)感觉神经病的临床表现和发生机制认识不足,以及缺乏相应的治疗手段,使得大多数患者无法得到有效的治疗.本文就HIV相关感觉神经病的危险因素、机制和治疗等相关进展进行综述,旨在提高医务人员对HIV相关感觉神经病的诊治水平.

目的 观察右美托咪定(dexmedetomidine,DEX)预处理对结核病(tuberculosis,TB)大鼠CD3+T淋巴细胞、CD4+T淋巴细胞、CD8+T淋巴细胞、自然杀伤细胞(natural killer cell,NK细胞)、γ-干扰素(interferon gamma,IFN-γ)表达及肺损伤的影响,为TB患者手术期间免疫保护提供参考.方法 取SD大鼠30只,随机分为非结核对照组(C组)、结核+生理盐水对照组(T组)、结核+DEX 5μg/kg组(D1组)、结核+DEX 10μg/kg组(D2组)和结核+DEX 15μg/kg组(D3组),每组6只.采用流式细胞仪检测麻醉前30min(T0),手术后1h(T1)、4h(T2)及8h(T3)眼眶静脉血CD3+T淋巴细胞、CD4+T淋巴细胞、CD8+T淋巴细胞、CD4+T淋巴细胞/CD8+T淋巴细胞比值、NK细胞及IFN-γ表达水平的变化;术后12h处死大鼠,观察肺组织的病理学改变.结果 与T0比较,各组术后T淋巴细胞亚群、NK细胞及IFN-γ均出现抑制,但同一时点各组间T淋巴细胞亚群、NK细胞及IFN-γ的变化差异无统计学意义(P>0.05),且TB大鼠术后肺部炎症反应程度相似.结论 TB大鼠围术期采用DEX预处理无明显免疫保护及肺保护作用,该药在TB患者中使用需谨慎.

目的 探讨新型冠状病毒肺炎重症患者有创机械通气的相关影响因素.方法 回顾性分析2020年1～11月深圳市第三人民医院收治的69例新型冠状病毒肺炎重症患者的临床资料.通过电子病历系统收集患者的基本信息,实验室检查基线值和诊疗方案,包括高血压病史、糖尿病病史、胸部CT、肌酐、谷丙转氨酶(ALT)、谷草转氨酶(AST)、凝血酶原时间(PT)、白蛋白、血红蛋白和T淋巴细胞的基线值,病程1周内中药清肺排毒汤、洛匹那韦/利托那韦、激素和胸腺法新使用情况,无创通气、输血史等.根据是否有创机械通气分为有创机械通气组22例和非有创通气组47例.采用单因素及多因素Logistic回归分析有创机械通气的独立危险因素.结果 有创通气组与非有创通气组患者的年龄[(63.05±8.84)岁vs(56.55±11.85)岁]、基线白蛋白[(37.76±4.45)g/L vs(40.43±4.46)g/L]、病程1周内未使用清肺排毒汤(73％vs 23％)或洛匹那韦/利托那韦(77％vs 32％)、输血史(64％vs 13％)比较差异均有统计学意义(P<0.05);多因素Logistic回归分析结果显示,病程1周内未使用清肺排毒汤或洛匹那韦/利托那韦及有输血史是重症患者有创机械通气的独立危险因素(P<0.05).结论 病程1周内未使用清肺排毒汤或洛匹那韦/利托那韦、有输血史为新型冠状病毒肺炎重症患者有创机械通气的独立高危因素.

腹腔镜术后患者常出现肩痛,大多数学者认为其发生机制是气腹或气腹使用的二氧化碳(carbon dioxide,CO2)形成碳酸刺激膈神经导致的.气腹压力过高、残留膈下CO2过多、维持气腹的CO2充气速度过快等都可能引发术后肩痛.腹腔镜术后肩痛(post-laparoscopic shoulder pain,PLSP)以钝痛为主,没有明显的位点,多为轻到中度的疼痛.预防及降低腹腔镜术后肩痛的措施很多,包括外科、药物及护理等方面的措施,但效果各异,目前仍没有一个公认且效果确切的方法.该文就PLSP的发生机制、危险因素及降低术后肩痛方法的研究进展进行综述.

目的 探讨颈淋巴结核对罗库溴铵按体表面积给药肌松效应的影响.方法 选取2017年5～10月于我院行全麻下颈部肿物切除手术40例患者作为研究对象,按照疾病类型将其分为结核病组(T组)与非结核病组(NT组),每组各20例.全麻诱导时按体表面积计算给予2倍ED95罗库溴铵,待拇内收肌四个成串刺激(TOF)第4个肌颤搐与第1个肌颤搐的比值(T4/T1,TOFr)降至0％时行气管插管.记录两组患者的气管插管条件、起效时间、临床作用时间、恢复指数及药理作用时间.结果 两组患者的气管插管条件比较,差异无统计学意义(P＞0.05).两组患者的起效时间、恢复指数及药理作用时间比较,差异无统计学意义(P＞0.05);T组患者的罗库溴铵临床作用时间为(24.0+4.6) min,明显短于NT组的(28.0+3.6)min,差异有统计学意义(P＜0.05).结论 颈淋巴结核患者罗库溴铵按体表面积给药的临床作用时间较非结核患者短,围术期追加用药的间隔时间宜适当缩短.

Fentanyl-induced cough (FIC) is a common complication with a reported incidence from 18.0% to 74.4% during general anesthesia induction. FIC increases the intrathoracic pressure and risks of postoperative nausea and vomiting, yet available treatments are limited. This study was designed to investigate whether administering fentanyl via a slow intravenous fluid line can effectively alleviate FIC during induction of total intravenous general anesthesia. A total number of 1200 patients, aged 18–64 years, were enrolled, all of whom were American Society of Anesthesiologists (ASA) grade I or II undergoing scheduled surgeries. All patients received total intravenous general anesthesia, which was induced sequentially by midazolam, fentanyl, propofol, and cisatracurium injection. Patients were randomly assigned to receive fentanyl 3.5 μg/kg via direct injection (control group) or via a slow intravenous fluid line. FIC incidence and the severity grades were analyzed with the Mann-Whitney test. Other adverse reactions, such as hypotension, hypertension, bradycardia, tachycardia, hypoxemia, vomiting, and aspiration, during induction were also observed. The online clinical registration number of this study was ChiCTR-IOR-16009025. Compared with the control group, the incidence of FIC was significantly lower in the slow intravenous fluid line group during induction (9.1%, 95% confidence interval (CI): 6.7%–11.4% vs. 55.9%, 95% CI: 51.8%–60.0%, P=0.000), as were the severity grades (P=0.000). There were no statistical differences between the two groups with regard to other adverse reactions (P>0.05). The administration of fentanyl via a slow intravenous fluid line can alleviate FIC and its severity during induction for total intravenous general anesthesia. This method is simple, safe, and reliable, and deserves clinical expansion.

目的 比较全身麻醉和椎管内麻醉对卡介苗感染小鼠后脾脏T淋巴细胞亚群、NK细胞及γ-干扰素（IFN-γ）的影响。方法 选取实验用清洁级健康雄性C57BL/6小鼠54只,按照随机数字表法分成全身麻醉组（G组）、椎管内麻醉组（S组）和对照组（T组）,每组18只,建立卡介苗感染模型。于术前30min、术后1d、术后3d分别取各组小鼠各6只处死,对小鼠脾脏CD3 + 、CD4 + 、CD8 + T淋巴细胞,NK细胞及IFN-γ表达水平采用FACS-Caliur流式细胞仪进行检测,计算CD4 + /CD8 + 比值;对三组小鼠不同时间点CD3 + T淋巴细胞、CD4 + T淋巴细胞、NK细胞水平及CD4 + /CD8 + T淋巴细胞比值、IFN-γ百分比进行比较。结果 G组与S组术前30min CD4 + /CD8 + T淋巴细胞比值、NK细胞、IFN-γ百分比分别为2.8±0.3和2.9±0.2,（22.3±2.3）%和（22.8±1.9）%,（1.4±0.4）%和（1.4±0.4）%,术后1d分别为1.8±0.2和1.8±0.1,（15.6±1.4）%和（15.2±1.1）%,（0.6±0.2）%和（0.6±0.3）%,术后3d分别为2.0±0.2和2.1±0.2,（18.7±2.0）%和（19.1±2.3）%,（1.1±0.2）%和（1.1±0.2）%,G组与S组在不同时间点之间的比较,差异均有统计学意义（F值分别为65.40和83.02,41.30和53.65,27.77和17.47,P值均为0.000）。G组与S组术后3dCD3 + T淋巴细胞[（20.9±3.1）%、（21.0±3.2）%]、CD4 + T淋巴细胞[（13.9±1.9）%、（14.1±2.2）%]明显低于T组的（26.5±5.1）%、（18.4±4.1）%,差异均有统计学意义（F=8.00,P=0.001;F=8.54,P=0.001）;且术后3dCD4 + T淋巴细胞均明显低于术前30min[G组与S组分别为（18.2±4.2）%、（17.8±3.5）%],差异均有统计学意义（t=13.36,P=0.005;t=4.19,P=0.006）。但术后3dG组与S组对CD3 + T淋巴细胞[（20.9±3.1）%、（21.0±3.2）%]、CD4 + T淋巴细胞[（13.9±1.9）%、（14.1±2.2）%]、CD4 + /CD8 + T淋巴细胞比值[（2.0±0.2）、（2.1±0.2）]、NK细胞[（18.7±2.0）%、（19.1±2.3）%]、IFN-γ[（1.1±0.2）%、（1.1±0.2）%]的表达两组间差异均无统计学意义（t值分别为0.12、0.23、0.39、0.39和0.46,P值分别为0.902、0.821、0.697、0.697和0.660）。结论 麻醉可抑制卡介苗感染小鼠脾脏T淋巴细胞亚群、NK细胞及IFN-γ的表达,但全身麻醉和椎管内麻醉对CD3 + T淋巴细胞、CD4 + T淋巴细胞、NK细胞、IFN-γ表达及CD4 + /CD8 + 比值的影响差异无统计学意义。

目的 比较丙泊酚和氯胺酮对结核病小鼠术后T淋巴细胞亚群和结核杆菌复制能力的影响.方法 建立实验小鼠结核病模型,选取实验小鼠36只,随机分为3组:P组、K组和C组,每组12只.P组、K组和C组分别施以麻醉药丙泊酚和氯胺酮及生理盐水.然后对3组小鼠行腹腔切开并对肠管施行牵拉刺激术.分别在术前30分钟、术后1天、术后3天抽取小鼠尾静脉血.利用流式细胞仪检测血液样本中CD3+、CD4+细胞、CD4+/CD8+细胞比值及γ-干扰素(IFN-γ)的表达.术后第3周、6周每组各取6只小鼠,处死后取肺组织进行病理形态学染色及结核菌培养实验.结果 与C组相比,P组及K组术后CD3+细胞、CD4+、CD4+/CD8+T细胞比值及IFN-γ表达下降,肺内结核菌定植数增高(P<0.05).与K组比较,P组术后3天的CD3+、CD4+T细胞水平较高,IFN-γ含量较低(P<0.05),但上述两组对肺内结核菌复制的影响无明显差异(P>0.05).结论 丙泊酚和氯胺酮均可抑制结核病小鼠术后T淋巴细胞功能,肺内结核菌定植数增高,但两者对T淋巴细胞亚群及IFN-γ的抑制不同步,尚需进一步开展相关研究.

Objective To determine the dose-response relationship of rocuronium in tuberculo-sis patients using single dose method.Methods Eighty ASAⅠ-Ⅱ patients undergoing elective surgery under general anesthesia were randomized to receive rocuronium 150 μg· kg-1 (groupⅠ),200 μg·kg-1 (groupⅡ),250 μg·kg-1 (group Ⅲ)or 300 μg·kg-1 (group Ⅳ),with 20 pa-tients in each group.The percentage of maximal suppression at the first response of adductor poli-cis muscle to train-of-four(TOF)stimulation and the onset time were recorded,and the initial dose of rocuronium was logarithmically transformed.The dose-response curve was established u-sing the linear regression.Results The ED50 ,ED75 ,ED90 ,and ED95 of rocuronium were 184,218, 254 and 279 μg·kg-1 ,respectively.Conclusion The ED95 of rocuronium is 279 μg·kg-1 in tu-berculosis patients,which is similar to that in common patients.