目的 比较超声引导下两种不同浓度罗哌卡因用于腹股沟韧带上髂筋膜间隙阻滞(S-FICB)的起效时间.方法 限期行股骨近端髓内针内固定术的股骨转子间骨折患者60例,男28例,女32例,年龄65～85岁,ASAⅠ ～ Ⅲ级,所有患者在行椎管内麻醉摆放体位前20 min,均在超声引导下行S-FICB,根据给药浓度不同,随机分为两组,每组30例,A组注射0.25％ 罗哌卡因30 ml,B组注射0.4％ 罗哌卡因30 ml.记录阻滞操作时间、股神经及股外侧皮神经阻滞起效时间及阻滞效果.记录阻滞前(T1)和阻滞后5 min(T2)、10 min(T3)、15 min(T4)及侧卧位即刻(T5)的VAS疼痛评分、MAP和HR.结果 两组阻滞操作时间、股神经阻滞效果差异无统计学意义.B组股神经及股外侧皮神经阻滞起效时间明显短于A组(P<0.05),与T1时比较,T2～T5时两组VAS疼痛评分明显降低(P<0.05).T2-4时B组VAS评分明显低于A组(P<0.05),T1和T5时两组VAS疼痛评分差异无统计学意义.与T1时比较,T2～T5时两组患者M AP明显降低(P<0.05),HR变化及两组患者各时点M AP和HR差异无统计学意义.结论 采用0.25％ 罗哌卡因30 ml和0.4％ 罗哌卡因30 ml用于超声引导下S-FICB对股骨转子间骨折患者术前摆放侧卧位时均有良好镇痛效果,后者起效更快.

Objective:To evaluate the effect of sufentanil on activation of Schwann cells after peripheral nerve injury in mice.Methods:Eighty healthy pathogen-free male Balb/c mice, aged 6-8 weeks, weighing 18-22 g, were divided into 4 groups ( n=20 each) using a random number table method: peripheral nerve injury group (group PNI), high dose sufentanil group (group H), medium dose sufentanil group (group M) and low dose sufentanil group (group L). The model of unilateral sciatic nerve transaction was established in ketamine-anesthetized mice.Immediately after establishment of the model, sufentanil 10, 5 and 2.5 μg/kg was injected intraperitoneally once a day for 3 consecutive days in H, M and L groups, respectively, while the equal volume of normal saline was given instead in group PNI.Sciatic function index (SFI) was calculated at 4, 8 and 12 weeks after establishment of the model.At 2, 4, 8 and 12 weeks, 5 mice in each group were sacrificed, and segments of the injuried ipsilateral sciatic nerve were removed for examination of the ultrastructure of the sciatic nerve (with a transmission electron microscope) and for detection of the expression of glial fibrillary acidic protein (GFAP) of sciatic nerve (by immunohistochemistry). Results:Compared with group PNI, SFI was significantly increased, and the expression of GFAP was up-regluated at each time point after establishment of the model in H and M groups ( P<0.05) and no significant change was found in SFI and GFAP expression after establishment of the model in group L ( P>0.05). Compared with group L, SFI was significantly increased, and GFAP expression was up-regluated in H and M groups ( P<0.05). There was no significant difference in SFI and GFAP expression between group H and group M ( P>0.05). The thickness of myelin lamellae was dense, and the proliferation of Schwann cells was not marked in H and M groups.The thickness of myelin lamellae was thin, and the proliferation of Schwann cells was marked in L and MO groups. Conclusion:The mechanism by which sufentanil improves repair after peripheral nerve injury may be related to promoting activation of Schwann cells in mice.

Objective To evaluate the effect of sufentanil on apoptosis in spinal cord neurons of mice with peripheral nerve injury. Methods One hundred and fifty clean-grade healthy male BALB∕c mice, aged 6-8 weeks, weighing 18-22 g, were divided into 3 groups ( n=50 each) using a random number table method: sham operation group (group Sham), peripheral nerve injury group (group PNI) and sufentanil group ( group SF) . The model of unilateral sciatic nerve injury was established in PNI and SF groups. After establishing the model, sufentanil 5. 0 μg∕kg was intraperitoneally injected once a day for 3 consecutive days in group SF, while the equal volume of normal saline was given instead of sufentanil in Sham and PNI groups. Five mice in each group were sacrificed at days 1, 3, 7, 14 and 28 after surgery ( T0-4 ) , and L4-6 segments of the injure ipsilateral spinal cord were removed for examination of pathological changes ( with a light microscope) and for determination of neuronal apoptosis ( by TUNEL assay) . The ap-optosis index ( AI) was calculated. Five mice in each group were sacrificed at T0-4 , and L4-6 segments of the injured ipsilateral spinal cord were removed for detection of the expression of Bcl-2, Bax and cleaved caspase-3 by Western blot. The ratio of Bcl-2 expression to Bax expression ( Bcl-2∕Bax ratio) was calculat-ed. Results Compared with group Sham, the AI was significantly increased, the expression of Bcl-2 pro-tein was down-regulated, and the expression of cleaved caspase-3 and Bax was up-regulated in PNI and SF groups ( P<0. 05) . Compared with group PNI, the AI was significantly decreased, the expression of Bcl-2 protein was up-regulated, the expression of cleaved caspase-3 and Bax was down-regulated, the Bcl-2∕Bax ratio was increased (P<0. 05), and the pathological changes were significantly attenuated in group SF. Conclusion Sufentanil can inhibit apoptosis in spinal cord neurons of mice with peripheral nerve injury.

Objective To investigate the effects of sufentanil on activation of spinal astrocytes in mice after unilateral sciatic nerve injury.Methods Eighty healthy male BALB/c mice,aged 6-8 weeks,weighing 18-22 g,were randomly divided into 4 groups (n=20 each): sufentanil high dose group (group H),middle dose group (group M),low dose group (group L) and model group (group MO).After model of sciatic nerve injury was established by unilateral sciatic nerve transection,group H,M and L,sufentanil 10 μg/kg,5 μg/kg,2.5 μg/kg was injected intraperitoneally once a day continuously for 3 days,while the equal volume of saline was injected in group MO.Five mice in each group were selected,and the sciatic nerve functional index were measured at 4,8,12 weeks.The 5 mice were sacrificed from each group and the damage on the same side L4-L6 segments of the spinal cord were removed at 2,4,8,12 weeks.The pathological changes were examined under light microscope at 8 week point.The expression of GFAP was determinatied at each time points by immuno-histochemistry.Results Compared with group L and MO,sciatic nerve functional index significantly was increased in groups H and M (P<0.05),and no significantly change was found in group L.Spinal cord neurons had a better morphology in groups H and M than in group L and MO.Compared with group MO,The expression of GFAP were significantly up-regulated in groups H,M and L (P<0.05).Compared with group L,the expression of GFAP were significantly up-regulated in groups H and M (P<0.05).Conclusion Sufentanil promotes spinal astrocyte activation after peripheral nerve injury in mice and improves repair after peripheral nerve injury.