Transversus abdominis plane block is an anesthesia method that injects local anesthetics into the abdominal muscle fascia to produce analgesic effects. It is widely used in abdominal surgery and in pain management. This expert consensus introduces the relevant anatomy, and systematically describes the various techniques, common drugs, indications, contraindications and complications of transversus abdominis plane block, to guide the application of this method in the clinic.

Nerve block is an important part of postoperative multimodal analgesia. Rectus sheath block is one of the commonly used nerve block methods in clinical practice, which mainly blocks the anterior cutaneous branch of intercostal nerves. This method has a clear analgesic effect on midline abdominal incision, and has a good application in pain diagnosis and treatment. This expert consensus introduces the related anatomical structure, blocking method, commonly used drugs, complications and clinical application of rectus sheath block in order to guide the clinical practice.

目的 观察气管插管模型在非麻醉专业规范化培训医师气道管理中的应用效果.方法 选择2018年4月—2019年1月在本院麻醉科进行住院医师规范化培训的轮训医师40名作为研究对象.将其随机分为模型教学组及对照组,对照组进行理论培训,模型教学组在理论培训后进行模型操作练习,正常临床轮训后进行出科理论及操作考核.结果 模型教学组掌握面罩通气技术需要的临床操作次数相比对照组更少,并能更快第一次成功完成临床气管插管(P<0.05).对麻醉科轮训的满意度更高,出科考核理论成绩以及气管插管操作分数平均值差异无统计学意义(P>0.05).结论 麻醉科应常规对非麻醉专业规范化培训医师进行气管插管模型培训.

术后疼痛是指手术所致组织损伤引起的一种不愉快的主观感觉和情绪体验.术后急性疼痛与一般的急性伤害性疼痛不同,术后急性疼痛会出现周围和中枢神经系统敏化的疼痛症候群表现[1].术后急性疼痛控制不佳会引起一系列并发症,影响患者早期与晚期预后.围术期神经认知障碍(perioperative neurocognitive disorders, PND)是2018年由多学科专家组对麻醉和手术相关的认知功能改变进行的规范命名,由原本的术后认知功能障碍( postoperative cognitive dysfunction, POCD)更名而来[2].

Perioperative neurocognitive disorder is a decline in cognitive function of patients after anesthesia and surgery. It seems to be a comprehensive effect of the combination of psychological state before the operation, neurotoxicity of narcotic drugs, inflammation caused by the operation, and sleep deprivation after surgery. The glymphatic pathway is a newly discovered system that clears metabolic waste from the brain. The clearing efficiency of the glymphatic pathway can be influenced by sleep deprivation, some narcotic drugs (like dexmedetomidine and ketamine), and neuroinflammation. We hypothesize that the glymphatic system may play a pivotal role in the occurrence and development of perioperative neurocognitive disorder.

随着现代医学的不断发展,越来越多的新生儿、婴幼儿、孕妇由于接受必要的诊断性检查、手术等需要进行全身麻醉.既往认为,全身麻醉是一种可逆性意识改变.但是鉴于接受全麻的婴幼儿其大脑处于发育高峰期,目前对于短期使用全麻药物是否将对神经发育产生毒性作用,触发持久不可逆的功能形态学改变,进而影响婴幼儿智力发育与认知尚有争议.因此,对全麻药物神经毒性的研究受到较多关注.基于最新相关实验与临床研究情况,综述近年来全麻药物神经毒性可能作用机制的研究进展,旨在为相关科学进一步研究和更为合理的指导临床麻醉实践提供参考.

Objective To explore the effects of isoflurane on blood plasma metabolites (BPM) and its correlation with cognitive dysfunction.Methods Thirty female Sprague-Dawley (SD) rats were randomly divided into two groups:rats in the control group (n =10) received 80％ oxygen for 2 hours (h);and rats in the isoflurane-treated group (n =20) were anesthetized with isoflurane and 80％ oxygen for 2 h.Cognitive functions were examined using a Y-maze test to explore the learning times of rats.The level of blood plasma metabolites was detected through gas chromatography-mass spectrometry (GCMS).Results The learning times of rats in the isoflurane-treated group was more than the learning times of rats in the control group [(70.75 ± 15.30) vs (45.40 ± 11.21),P ＜ 0.05].D-fructose,arabinofuranose,n-butylamine,and inositol significantly increased (P ＜ 0.05),respectively.Whereas,L-analine and L-proline significantly decreased (P ＜ 0.05) in isoflurane-treated rats when compared to those in the control rats (P ＜ 0.05).Moreover,plasma concentrations of d-fructose,arabinofuranose,n-butylamine,inositol,and L-proline were positively correlated with the degree of cognitive dysfunction in the isoflurane-treated rats.Conclusions Changes of plasma concentrations of inositol,and d-fructose in aged rats are useful in predicting the occurrence and progression of post-anesthesia cognitive dysfunction.

目的:对SD(Sprague Dawley)大鼠海马蛋白质组双向凝胶电泳上样量进行筛选,获得优质凝胶图像。方法:本实验为8月龄SD大鼠,注射戊巴比妥钠麻醉后断头取海马组织,称重后加入裂解液,经过匀浆、孵育、离心等处理后测定蛋白浓度。拟采用银染法凝胶染色时上样量分别为200μg、400μg、600μg、800μg;拟采用考马斯亮蓝染法凝胶染色时上样量分别为1 000μg、1 200μg、1 400μg、1 600μg。采用双向凝胶电泳后,分别采用银染和考染法凝胶染色。染色后凝胶采用Umax PowerLookⅢ扫描仪和photo-shop8.0图像软件进行扫描,采用ETTAN ImageMaster 2D Elite 4.01软件进行图像分析。结果:双向凝胶电泳胶图经扫描分析,蛋白质上样量400μg电泳银染后所获得的胶图蛋白质点区隔明显,背景清晰,经过点识别等处理后获得(756±42)个点;而蛋白质上样量200μg、600μg和800μg电泳银染后获得的胶图蛋白质点较少;蛋白质上样量1 600μg电泳考染后所获得的胶图蛋白质点区隔明显,背景清晰,经过点识别等处理后获得(812±60)个点;而蛋白质上样量1 000μg、1 200μg和1 400μg电泳考马斯亮蓝染法后获得的胶图蛋白质点较少。结论:采用银染法SD大鼠海马蛋白质组双向凝胶电泳上样量为400μg时可以获得良好的凝胶图像;而采用考染法SD大鼠海马蛋白质组双向凝胶电泳上样量为1 600μg时即可获得良好的凝胶图像。

Objective To investigate the effects of quercetin on the pharmacokinetics of midazolam in the volunteers with different CYP3A genotypes.Methods Eighteen volunteers whith the genotypes of CYP3A5*1/CYP3A5*1,CYP3A5*1/CYP3A5*3 or CYP3A5*3/CYP3A5*3 were enrolled from 169 volunteers in this study with six people each.The volunteers were given quercetin 500 mg once a day for 13 days,which was followed by midazolam 7.5 mg on the 14th day.One month later,they had placebo once a day for 13 days,which was followed by midazolam 7.5 mg on the 14th day.The pharmacokinetic parameters of midazolam were investigated at each stage.ResultsQuercetin obviously decreased the area under the AUC(P0.05) and T1/2(P0.05) of midazolam in CYP3A5*1/CYP3A5*1 and CYP3A5*1/CYP3A5*3 volunteers,but there was no significant difference in CYP3A5*3/CYP3A5*3 volunteers.The AUC,Cmax,Tmax and T1/2 of midazolam were obviously different with different CYP3A genotypes(P0.05).Conclusion Quercetin can affect the pharmacokinetics of midazolam in people with the genotypes of CYP3A5*1/CYP3A5*1 and CYP3A5*1/CYP3A5*3.CYP3A genotype affects the pharmacokinetics of Midazolam.