目的:评估儿童运动测试成套工具(movement assessment battery for children-second edition,MABC-2)在青少年运动功能评估的效度和信度,为临床应用提供理论依据.方法:首先汉化英文版MABC-2,招募439名青少年,使用针对运动协调能力的MABC-2第三阶段及面向发育性协调障碍的问卷(developmental coordination disorder questionnaire,DCDQ)进行评估,并采用多种指标对信度和效度进行评价:信度使用内部一致性信度、重测信度;效度使用内容效度、结构效度、效标效度.结果:第三阶段儿童运动测试成套工具的Cronbach α系数为0.523,内部一致性信度一般;重测ICC系数0.420-0.829,重测信度良好.内容效度方面,除描画轨迹外,第三段MABC-2各因子与总分的相关系数为0.395-0.562(P＜0.05),三个分项与总分的相关系数为0.537-0.739,内容效度良好;结构效度方面,采用验证性因子分析,提取3个公因子,累计方差贡献率53.744％,相应因子的因子载荷均＞1,结构效度良好;MABC-2总分与DCDQ总分相关(r=0.435,P＜0.05),效标效度一般.结论:第三阶段MABC-2的信度和效度良好,但需要对其项目做适当修正才能更加适用于青少年发育性运动协调障碍疾病(developmental coordination disorder,DCD)及运动协调能力的筛查及大规模的DCD流行病学调查.

目的:调查带教师资和专硕规培学员参与模拟教学的现状,分析总结师资和学员对模拟教学的认知和满意度、临床带教需求及存在问题,为管理者从发展角度提升住培质量,提出优化措施.方法:采用问卷调查方式,调研常州市153名规培带教师资和119名专硕学员参与模拟教学现状,剖析专硕规培中开展模拟教学存在问题并提出改进策略.结果:30.06%带教老师开展过教学方法、操作技能、改善医疗行为、多学科协作的模拟教学研究,67.97%带教老师准备开展模拟教学;开展过模拟教学的老师认为模拟教学在提升学员基本技能操作和沟通协调能力上教学效果明显;三个年级的学员接受过模拟教学,认为收获很大,并希望开展结合具体病例专科模拟教学.结论:专硕规培学员希望进行模拟教学的意愿较高,带教老师对专硕规培学员已开展一定的模拟教学研究,但需进一步结合专硕规培学员的特点和需求,开展相应的模拟教学,进一步提升专硕规培质量.

目的:评估成年版发育性协调障碍问卷(adult developmental co-ordination disorders/dyspraxia checklist,ADC)的效度和信度,为临床推广及应用提供理论依据.方法:对英文版ADC量表进行翻译汉化,招募580例卫生职业学校学生,用汉化后的ADC量表进行测验,完成填写后统计问卷得分,用内容效度、结构效度、内部一致性信度、分半信度、重测信度对测试结果进行评价.结果:内容效度方面,除A1、B2、B3、B5、B7、B15外,成年版发育性协调障碍问卷各因子与总分的相关系数在0.301-0.60之间(P＜0.05),两个分项与总分的相关系数在0.791-0.973之间,具有良好的内容效度;采用验证性因子分析,提取公因子8个,累计方差贡献率为50.97％,各条目在相应因子的因子载荷均＞0.5,结构效度良好.成年版发育性协调障碍问卷的Cronbach a系数为0.860,内部一致性信度高,分半信度为0.619,分半信度良好;重测ICC系数0.324-0.909之间,重测信度良好.结论:成年版发育性协调障碍问卷是一份具有良好效度和较好信度的测评工具.ADC可用于发现成年发育性协调障碍(developmental coordination disorder,DCD)疾病及运动协调能力的筛查,也可应用于DCD大规模流行病学调查.

Abstract The effectiveness of anterior serratus plane block in postoperative analgesia of thoracic surgery is beginning to emerge. Currently, there are 2 methods of anterior serratus plane block: deep serratus plane block (DSPB) and superficial serratus plane block (SSPB). In clinical practice, there is no an unified view regarding the advantages and disadvantages between 2 methods. This study aimed to observe and compare the analgesic effects of 2 methods on patients undergoing thoracoscopic lobectomy, in order to provide some suggestions for anesthesiologists when they choose anterior serratus plane block to perform postoperative analgesia for patients. Patients were randomly divided into 3 groups (21 patients/group):1. general anesthesia group (P group);2. combined general anesthesia and SSPB group (S group), and3. combined general anesthesia and DSPB group (D group). The patients in groups S and D received 0.4 ml/kg of 0.375% ropivacaine for ultrasound-guided block after surgery. Postoperatively, flurbiprofen was used for rescue analgesia. Visual analog scale (VAS) pain scores were recorded at 6 hours, 12 hours, and 24 hours after surgery, and rescue analgesia, post-operative nausea, and vomiting were reported within 24 hours after surgery. At 6 hours, 12 hours, and 24 hours, the VAS scores and the rescue analgesia rates in groups S and D were significantly lower than those in group P (all P < .001). With prolonging time, the VAS in group D was significantly increased by 0.11 per hour as compared with that of group P (P < .0001); VAS in group D was significantly increased by 0.12 per hour as compared with that of group S (P < .0001). Ultrasound-guided anterior serratus plane block can provide adequate analgesia for patients undergoing thoracoscopy lobectomy. SSPB can significantly improve VAS scores as compared to DSPB at 24 hours.

Objective:To evaluate the effect of regional oxygen saturation (rSO 2)-guided low-dose norepinephrine on postoperative cognitive dysfunction (POCD) in elderly patients undergoing hip replacement under general anesthesia. Methods:One hundred and twenty patients of both sexes, aged 65-80 yr, with body mass index of 18-24 kg/m 2, of American Society of Anesthesiologists physical statusⅠ-Ⅲ, scheduled for hip replacement under general anesthesia, were divided into 2 groups ( n=60 each) using a random number table method: control group (group C) and low-dose norepinephrine guided by rSO 2 group (group RN). The patients in both groups received superior inguinal fascial space block combined with general anesthesia under laryngeal mask placement.In group C, the fluctuation range of mean arterial pressure (MAP) was not more than 20% of the baseline, vasoactive agents were administered according to the changes in blood pressure, rSO 2 was monitored continuously, but the change rate of rSO 2 was not used as the regulating index.In group RN, norepinephrine was infused continuously via the central vein at 0.01-0.10 μg·kg -1·min -1 after anesthesia induction, the dose was adjusted according to rSO 2, the rSO 2 change rate was maintained≤10%, the fluctuation range of mean arterial pressure was not more than 20% of the baseline, and vasoactive agents were administered when necessary.MAP, end-tidal pressure of carbon dioxide (P ETCO 2) and rSO 2 were recorded after inhalation of oxygen (T 0), at 5 min after anesthesia induction (T 1), at 30 min after skin incision (T 2), at the end of surgery (T 3) and after recovery and extubation (T 4), and the change rate of rSO 2 was calculated.The occurrence of adverse events and amount of vasoactive drugs used were recorded.The cognitive function was assessed using Montreal Scale at 1 day before surgery and 7 days after surgery, and the development of postoperative cognitive dysfunction (POCD) was calculated using Z score.The postoperative hospital stay time was recorded. Results:Compared with group C, MAP and rSO 2 were significantly increased, and the change rate of rSO 2 was decreased at T 1, 2 in group RN ( P<0.05). Compared with group C, the requirement for intraoperative vasoactive drugs was significantly decreased, the consumption of norepinephrine was increased, MoCA total score, attention and delayed recall sub-score were increased at 7 days after surgery, the incidence of POCD was decreased, and the postoperative hospital stay time was shortened in group RN ( P<0.05). Conclusion:Low-dose norepinephrine guided by rSO 2 can decrease the development of POCD in elderly patients undergoing hip replacement under general anesthesia.

Objective:To evaluate the role of Nod-like receptor family pyrin domain-containing 2 (NLRP2) in the dorsal root ganglion (DRG) in neuropathic pain (NP) in rats.Methods:Thirty-two male Sprague-Dawley rats in which intrathecal catheters were successfully implanted, aged 2-3 months, weighing 200-250 g, were divided into 4 groups ( n=8 each) using a random number table method: sham operation group (S group), NP group, NP plus NLRP2-siRNA group (NP+ siRNA group) and NP plus NLRP2-scrRNA group (NP+ scrRNA group). The right sciatic nerve was only exposed but not ligated in group S. NP was induced by chronic constriction injury (CCI) to the sciatic nerve in anesthetized rats in group NP, group NP+ siRNA and group NP+ scrRNA.NLRP2-siRNA and NLRP2-scrRNA were intrathecally injected at 3 days before CCI in group NP+ siRNA and group NP+ scrRNA, respectively.The mechanical paw withdrawal threshold (MWT) was measured at 1 day before CCI (T 0) and 1, 3, 7 and 10 days after CCI (T 1-4). The rats were sacrificed after the last measurement of pain threshold, and the L 4, 5 segments of the DRG on the operated side were removed for determination of the expression of NLRP2 and caspase-1 (by Western blot), the expression of NLRP2 mRNA (by real-time polymerase chain reaction) and interleukin-1beta (IL-1β) content (by enzyme-linked immunosorbent assay). Results:The MWT was significantly lower at T 2-4 than at T 0 in group NP, group NP+ siRNA and group NP+ scrRNA ( P<0.05). Compared with group S, the MWT was significantly decreased at T 2-4, the expression of NLRP2 protein and mRNA and caspase-1 was up-regulated, and the content of IL-1β was increased in group NP ( P<0.05). Compared with group NP, the MWT was significantly increased at T 2-4, the expression of NLRP2 protein and mRNA and caspase-1 was down-regulated, and the content IL-1β was decreased in group NP+ siRNA ( P<0.05), and no significant change was found in the parameters mentioned above in group NP+ scrRNA ( P>0.05). Conclusion:NLRP2 in DRG is involved in the development of NP, and the mechanism is related to NLPR2 inflammasomes-induced peripheral neuroinflammation in rats.

目的 分析腰-硬联合与单纯硬膜外阻滞麻醉在分娩镇痛中的效果.方法 选择2017年12月至2018年12月本院收治的产妇60例,采取抽签分组方式分为观察组与对照组,各30例.观察组实施腰-硬联合麻醉,对照组实施单纯硬膜外阻滞麻醉,两组产妇的各项指标进行对比.结果 观察组产妇的T1(1.40±1.01)分、T2(0.85±0.61)分、T3(0.92±0.71)分时间段VAS评分优于对照组产妇(P<0.05);观察组产妇的镇痛起效时间(2.85±1.37)min短于对照组产妇的镇痛起效时间(6.21±2.11)min(P<0.05).结论 腰-硬联合麻醉在分娩镇痛中效果显著,麻醉起效时间快.

目的:探讨用舒芬太尼复合丙泊酚对接受腹腔镜下胆囊切除术(laparoscopic cholecystectomy,LC)的患者进行麻醉的效果.方法:选择2016年3月至2020年3月在常州市第一人民医院进行LC的100例患者作为研究对象.随机将其分为观察组(n=60)与对照组(n=40).术中,用瑞芬太尼复合丙泊酚对对照组患者进行麻醉,用舒芬太尼复合丙泊酚对观察组患者进行麻醉,然后比较两组患者的各项临床指标.结果:观察组患者术中体动的发生率低于对照组患者,P<0.05.术后2 h、6 h和12 h,观察组患者视觉模拟评分法(VAS)的评分均低于对照组患者,P<0.05.观察组患者麻醉不良反应的发生率低于对照组患者,P<0.05.结论:用舒芬太尼复合丙泊酚对接受LC的患者进行麻醉能有效地降低其术中体动的发生率,减轻其术后疼痛的程度,且用药的安全性较高.

目的:评价超声引导下胸椎旁神经阻滞在胸腔镜下肺癌根治术中的临床应用价值.方法:选取我院2018年3-12月择期行胸腔镜下肺癌根治术的患者60例,随机划分为A组(全麻复合胸椎旁阻滞)、B组(全麻复合硬膜外麻醉)、C组(全身麻醉),各20例.比较各组患者血流动力学指标.结果:各组患者T0时刻M A P比较差异不显著(P>0.05);和T0相比,A组T1-T8时段M A P、H R无显著改变(P>0.05),但B组和C组波动幅度差异显著(P<0.05);C组T3-T6时刻B I S值均低于A组和B组,各数据间比较差异有统计学意义(P<0.05).同时,A组麻醉药剂量及苏醒时间少于B组和C组,差异有统计学意义(P<0.05).结论:胸腔镜下肺癌根治术采用超声引导下胸椎旁神经阻滞能够有效改善机体血流动力学指标,安全可靠.

Objective To compare the cost-effectiveness of non-intubated general anesthesia with conventional general anesthesia for thoracoscopic bulla resection. Methods Sixty patients scheduled for elective thoracoscopic bulla resection, were divided into two groups (30 each) using a random number table: the conventional general anesthesia group (T group) and the non-intubated general anesthesia group (NT group). Patients in group T were induced with conventional general anesthetic, single-lung ventilated after intubation with double-lumen bronchial catheters. Patients in group NT were induced with general anesthesia combined nerve block, and spontaneous breathings were retained. The results of blood gas analysis, anesthesia time, operation time, intraoperative blood loss, time for orientation recovery and modified Aldrete score ≥ 9 minutes were recorded. The intraoperative and postoperative complications, postoperative hospital stay time, VAS and PC A scores 48 h after operation were recorded. Calculate the cost of anesthesia and the total cost of hospitalization. Results Compared with T group, NT group had lower pH value and higher PCO2 at 30 min before and after the thoracic closure, oxygenation index in the NT group increased at 30 min after the thoracic closure (P < 0.05). Compared with T group, anesthesia time, time for orientation recovery and modified Aldrete score ≥ 9 minutes, incidence of postoperative sore throat, postoperative hospital stay time, VAS scores at 6, 12 h and PC A at 48 h after the operation, anesthesia costs, and total hospitalization costs in the NT group were all reduced (P < 0.05). Conclusions Fully considering the safety, compared with the traditional tracheal intubation general anesthesia, non-intubation general anesthesia can not only promote postoperative outcomes but also improve the cost-effectiveness in the patients undergoing thoracoscopic bulla resection.

目的:评价聚二磷酸腺苷核糖聚合酶-1(PARP-1)在右美托咪定减轻大鼠心肌缺血再灌注损伤中的作用.方法:健康清洁级雄性成年SD大鼠48只,体重200～240 g,8～12周龄,采用随机数字表法分为3组(n=16):假手术组(S组)、缺血再灌注组(I/R组)和缺血再灌注+右美托咪定组(I/R+Dex组).S组仅开胸穿线不结扎;I/R组和I/R+Dex组采用结扎冠状动脉左前降支30 min恢复再灌注120 min的方法制备大鼠心肌缺血再灌注损伤模型;I/R+Dex组于再灌注前15 min腹腔注射右美托咪定5μg/kg,S组和I/R组给予等容量生理盐水.分别于缺血前(T0)、缺血30 min(T1)、再灌注60 min(T2)和再灌注120 min(T3)时观察并记录平均动脉压(MAP)、心率(HR)和心率收缩压乘积(RPP);再灌注120 min时取左心室组织,称重并计算心肌梗死体积比率;采用Western blot法检测心肌组织PARP-1活化产物PAR和凋亡相关蛋白Caspase-3的表达;采用ELISA法测定心肌组织中TNF-α和IL-6的含量.结果:与T0时比较,I/R组和I/R+Dex组在T1～T3时MAP、HR和RPP水平降低(P＜0.05);与S组比较,I/R组和I/R+Dex组在T1～T3时MAP、HR和RPP水平降低,梗死体积比率、TNF-α和IL-6含量升高,PAR和Caspase-3表达水平上调(P＜0.05);与I/R组比较,I/R+Dex组在T1、T2时MAP、HR和RPP水平降低,T3时水平升高,梗死体积比率、TNF-α和IL-6含量降低,PAR和Caspase-3表达水平下调(P＜0.05).结论:右美托咪定可减轻大鼠心肌缺血再灌注损伤,机制与降低PARP-1活化抑制炎症和凋亡有关.

Sevoflurane is a new type of inhalation anesthetic used widely in the clinic. It has the characteristics of rapid induction, rapid recovery, and less irritative to the airway. Studies have shown that sevoflurane can affect the invasion and migration of a variety of malignant tumors. However, its effects on human glioma cells and related mechanisms are not clear. Cultured U251 and U87 cells were pretreated with sevoflurane. The effect of sevoflurane on proliferation was evaluated by MTT, and cell migration assay, cell apoptosis, and invasion ability were evaluated by wound-healing assay, cell apoptosis, and Transwell assays. Insulin-like growth factor-1 (IGF-1) and PI3K/AKT signaling pathway gene expression in sevoflurane-treated cell lines was measured by western blotting analysis, respectively. 5% sevoflurane significantly inhibited proliferation ability in both U251 and U87 cells. Sevoflurane inhibited glioma cells invasion and migration, and promoted apoptosis. Sevoflurane inhibited IGF-1 and promoted the expression of apoptosis-related proteins in glioma cells. In addition, sevoflurane inhibited the PI3K/AKT signaling pathway in glioma cells. This study clarifies that sevoflurane inhibits proliferation, invasion, and migration, and promotes apoptosis in glioma cells. These effects are regulated by IGF-1, an upstream gene of the PI3K/AKT signaling pathway. These findings may be significant for the selection of anesthetic agents in glioma surgery to improve the prognosis of patients.

Objective To evaluate the effect of hydrogen sulfide on myocardial exogenous apoptotic pathway in a rat model of hemorrhagic shock and resuscitation.Methods Sixty clean-grade healthy male Sprague-Dawley rats,aged 8 weeks,weighing 250-300 g,were divided into 4 groups (n =15 each) using a random number table method:sham operation group (group S),sham operation plus sodium sulphid (NaHS) group (group S+NaHS),hemorrhagic shock group (HS group),and hemorrhagic shock plus sodium sulphid group (group HS+NaHS).Rats only underwent arterial and intravenous puncture in group S.Hemorrhagic shock was induced by withdrawing blood from the femoral artery until mean arterial pressure (MAP) was reduced to 35-40 mmHg within 10 min and maintained for 1.5 h.NaHS 28 μmol/kg was intraperitoneally injected at 10 min before resuscitation in group HS+NaHS.The equal volume of NaHS was administered at the same time in group S+NaHS.Immediately before blood letting and at 0,1.5,2,3,4 and 6 h after blood letting (T1-5),MAP was recorded and blood samples were collected from the femoral vein for determination of serum creatine kinase (CK) and lactate dehydrogenase (LDH) concentrations by chemical colorimetry.Rats were then sacrificed and hearts were removed for examination of the pathological changes of myocardial tissues (with a light microscope) and for determination of cell apoptosis (by TUNEL),expression of caspase-3 and caspase-8 (by Western blot) and expression of Fas and FasL (by immunohistochemistry).Apoptosis index was calculated.Results Compared with group S,MAP was significantly decreased at T1-5,the serum CK and LDH concentrations at T1-5 and apoptosis index at T5 were increased,and the expression of Fas,FasL,caspase-3 and caspase-8 was up-regulated in group HS (P＜ 0.05).Compared with group HS,MAP was significantly increased at T1-3,the serum CK and LDH concentrations at T3-5 and apoptosis index at T5 were decreased,and the expression of Fas,FasL,caspase-3 and caspase-8 was down-regulated in group HS+NaHS (P＜0.05).The pathological changes of myocardial tissues were significantly attenuated in group HS+NaHS when compared with group HS.Concclusion The mechanism by which hydrogen sulfide attenuates myocardial injury induced by hemorrhagic shock and resuscitation is associated with inhibiting the exogenous apoptotic pathway in rats.

目的 评价控制性保温模式对老年腹腔镜胰十二指肠切除术患者术后转归及费效的影响.方法 选取择期行腹腔镜胰十二指肠切除术患者60例,性别不限,年龄65～80岁,BMI 18～24 kg/m2,ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为两组:传统保温组(S组)和控制性保温组(C组),每组30例.S组采用传统保温措施;C组于麻醉诱导前30 min通过充气式加温毯置于身下,术中使用加温至37℃液体输注及冲洗腹腔,维持膀胱温36.9℃-37.9℃至术毕.于麻醉诱导后(T1)、麻醉后30、60、90、120、180 min和术毕(T2-7)时记录膀胱温度;于麻醉诱导前(T0)、术后1d和术后3d(T8-9)时采集肘静脉血样测定血浆C反应蛋白和中性粒细胞计数;记录术中出血量、异体输血情况、术后拔除气管导管时间、PACU停留时间、术后寒战、低体温发生情况、住院时间;计算患者麻醉费用和住院总费用.结果 与S组比较,C组体温T2-7时升高,术中出血量、异体输血率、术后拔除气管导管时间、PACU停留时间、术后寒战和低体温发生率、T8-9时血浆C反应蛋白和中性粒细胞计数减低,麻醉费用增加,住院时间和住院总费用减少(P＜0.05).结论 控制性保温模式不仅促进老年腹腔镜胰十二指肠切除术患者术后转归,同时可以改善费效.

Objective To compare the safety and early clinical efficacy of thoracoscopic lobectomy by nonintubated versus traditional intubated anesthesia.Methods We retrospectively analyzed clinical data of 30 patients treated with non-intubated thoracoscopic lobectomy in the Third Affiliated Hospital of Soochow University from June to December,2016.Meanwhile we selected 30 patients treated with thoracoscopic lobectomy by traditional intubated anesthesia as a control group.Clinical results of two groups were compared.Results There was no statistical difference in preoperative clinical data between the two groups.All patients were successfully operated.Patients in non-intubation group had shorter durations of anesthesia induction time and back to awake time,shorter duration of chest drainage and hospital stay,less C-reactive protein levels after surgery,compared with the control group(all P＜0.05).Conclusion Non-intubated thoracoscopic lobectomy is technically feasible and safe with reduced complications of traditional anesthesia,less postoperation pain,shorter hospital stay and less hospitalization costs which fit the idea of fast recovery.

How hydrogen sulfide (H2S) protects against myocardial ischemia-reperfusion (I/R) injury is poorly understood. By using a slow-releasing H2S donor, we investigated if H2S protected against myocardial I/R injury by activating AMPK and restoring I/R-impaired autophagic flux. Male rats received anterior descending coronary artery occlusion followed by reperfusion. The H2S donor ADT and/or the AMPK inhibitor, compound C (CC), were administered after occlusion. Infarction was analyzed histologically. AMPK activation was assessed in the ischemic heart by analyzing phosphorylation of AMPK and S6 ribosomal protein. Autophagy was assessed by analyzing the following markers: microtubule-associated protein 1 light chain 3 (LC3) I and II, lysosome associated membrane protein-2 (LAMP-2), P62 and beclin-1. We further investigated if blocking autophagic flux with chloroquine abolished ADT cardioprotection in vivo. Myocardial I/R reduced serum H2S levels, which was elevated by ADT. ADT enhanced AMPK activation and reduced infarction following I/R, and both effects were abolished by AMPK inhibition. Myocardial I/R induced autophagosome accumulation, as evidenced by the increased ratios of LC3-II/LC3-I, upregulation of beclin-1 and P62 and reduction in LAMP-2. ADT blunted these autophagic changes induced by I/R, indicating that ADT restored I/R-impaired autophagic flux. The AMPK inhibitor CC blocked ADT effects on restoring I/R-impaired autophagy flux. Moreover, chloroquine pretreatment abolished cardioprotection of ADT and increased autophagosome accumulation in the ADT-treated heart following I/R. In conclusion, AMPK activation and subsequent restoration of I/R-impaired autophagic flux are unrecognized mechanisms underlying cardioprotective effects conferred by H2S donors.

Objective To evaluate the role of nitric oxide in sevoflurane postconditioning-induced mitigation of autophagy and cell apoptosis during ischemia/reperfusion (I/R) in isolated rat hearts.Methods The hearts of male Sprague-Dawley rats,aged 2-3 months,weighing 250-300 g,were excised and retrogradely perfused in a Langendorff apparatus.One hundred and eight isolated rat hearts,which were successfully perfused in a Langendorff apparatus,were equally and randomly divided into 6 groups:control group (C group),sevoflurane group (S group),I/R group,sevoflurane postconditioning group (SSP group),sevoflurane postconditioning + L-NAME (non-selective nitric oxide synthase (NOS) inhibitor group (SSP + L group),and L-NAME group (L group).The hearts were perfused with K-H solution for 150 min in C group.The hearts were continuously perfused for 180 min and perfused with K-H solution containing 3％ sevoflurane for 15 min starting from 60 min of perfusion in S group.After being perfused with K-H solution for 30 min,the hearts were subjected to occlusion for 30 min followed by reperfusion for 120 min in the other groups except C and S groups.After onset of reperfusion,the hearts were perfused with K-H solution containing 3％ sevoflurane for 15 min in SSP group,the hearts were perfused with K-H solution containing 3％ sevoflurane and L-NAME 100 μmol/L for 15 and 60 min,respectively,in SSP + L group,and the hearts were perfused with K-H solution containing L-NAME 100μmol/L for 60 min in L group.Inn ediately before ischemia,and at 30,60,90 and 120 min of reperfusion,each parameter of cardiac function was recorded.At the end of reperfusion,myocardial specimens were obtained at the end of reperfusion for measurement of the infarct size,NOS activity,NO content,and expression of Bcl-2,Beclin 1 and caspase-3,for observation of formation of autophagosomes,and for examination of the pathological changes.Results Compared with C group,LVSP,+ dp/dtmax,-dp/dtmax,NOS activity and NO content were significantly decreased,and LVEDP was increased in I/R and SSP groups.Compared with I/R group,LVSP,+ dp/dtmax,-dp/dtmax,NOS activity and NO content were significantly increased,LVEDP was decreased,Bcl-2 expression was down-regulated,and the expression of Beclin 1 and caspase-3 was up-regulated in SSP group,and no significant changes were found in each index in SSP+ L and L groups.Compared with SSP group,LVSP,+ dp/dtmax,-dp/dtmax,NOS activity and NO content were significantly decreased,LVEDP was increased,Bcl-2 expression was down-regulated,and the expression of Beclin 1 and caspase-3 was up-regulated in SSP + L group.Conclusion The mechanism by which sevoflurane postconditioning reduces I/R injury may be related to promoted NO product and inhibited autophagy and cell apoptosis in isolated rat hearts.