患儿,女,1岁,65 cm,7 kg,因"发现骶尾部包块1年余"入院,初步诊断为"骶尾部包块,气道狭窄".胎龄22周时,超声检查发现骶尾部一包块(约2 cm×1 cm).37周顺产,出生时发现骶尾部有"鹌鹑蛋"大小包块.1月龄时曾就诊外院拟行手术,全麻诱导后可视喉镜发现声门下气道软骨呈"O"型闭合环,尝试插入ID 2. 5 mm普通气管导管失败,未行手术,后转入我院.1月龄时第1次入院,查体:双肺可闻及喘鸣和湿啰音,哭闹时可出现明显三凹征、口唇紫绀、喘憋和呼吸困难等症状,平静后可缓解.1月龄时胸部CT:主气管胸廓入口段管径稍窄,最窄径约2. 9 mm,上下范围约10 mm.经多学科会诊后建议暂缓手术.1岁时再次入院,自诉偶有轻微咳嗽,咳痰等症状,无活动性气促、呼吸困难等情况.查体:活动如常,心功能Ⅰ级;右中下肺少许干啰音及轻微哮鸣音,哭闹时未出现三凹征、口唇发绀、喘憋和呼吸困难等症状.1岁时胸部CT:双肺纹理增粗模糊、双肺透亮度减低;气道自胸廓入口至气道分叉上方管腔稍变窄,最窄径约4. 3 mm,矢状位测量狭窄累及长度约22. 1 mm,右肺中间干支气管入口局部管腔稍窄,最窄处管径约2. 4 mm;未见明显胸膜增厚与胸腔积液征象(图1).入院后行抗感染、雾化吸入等积极治疗1周后,患儿咳嗽咳痰症状有所改善,平静呼吸时听诊未闻及明显干湿啰音.术前诊断:骶尾部肿物.拟于全麻下行"骶尾部肿物切除术".

目的 探讨在超声引导下使用0.375％罗哌卡因20 ml或30 ml行肌间沟臂丛神经阻滞的效果及对膈肌麻痹的影响.方法 选择拟在超声引导下行肌间沟臂丛神经阻滞的右侧前臂手术患者54例,男39例,女15例,年龄18～65岁,ASAⅠ或Ⅱ级,随机分为A组(0.375％罗哌卡因20 ml)和B组(0.375％罗哌卡因30 ml),每组27例.记录臂丛各分支神经阻滞起效时间和痛觉阻滞情况,使用超声测量并记录麻醉前、注药后15、30 min时平静呼吸和用力呼吸时膈肌移动度以及RR,记录神经阻滞相关不良反应.结果 两组臂丛分支神经痛觉阻滞完全率差异无统计学意义.与A组比较,B组桡神经、腋神经、尺神经阻滞起效时间明显缩短(P<0.05);注药后30 min,B组RR明显增快(P<0.01),平静呼吸和用力呼吸时膈肌移动度均明显减少(P<0.05),膈肌麻痹率明显升高(P<0.05).结论 采用20 ml和30 ml的0.375％罗哌卡因在超声引导下行肌间沟臂丛神经阻滞均能达到理想麻醉效果,但20 ml对膈肌麻痹影响更小.

Objective To investigate the correlation between preoperative anxiety and emergence agitation(EA)in children after sevoflurane anesthesia.Methods A total of 120 children who were going to receive an elective surgery were recruited in this study.The preoperative anxiety in these children was measured through the Modified Yale Preoperative Anxiety Scale(mYPAS)at the following time:during the preoperative interview(T1),waiting period in surgery waiting room(T2),after the children entered the operating room(T3)and at the beginning of sevoflurane inhalation induction(T4).The emergence agitation(EA)scores were obtained by using the Pediatric Anesthesia Emergence Delirium(PAED) Scale after the surgery.Results After adjusting for the effect of age,it was found that the anxiety scores at T1 and T2 had no significant correlation with EA,while those in T3 and T4 showed a statistically significant correlation with EA.The level of anxiety at the beginning of induction showed a strong positive correlation with EA,and the correlation coefficient was 0.708(P<0.01).Conclusion The preoperative anxiety in the operating room and at the beginning of induction of anesthesia is correlated with EA in children receiving sevoflurane anesthesia.

Objective To investigate the effect of parental presence on the anxiety of children during induction of anesthesia with sevoflurane. Methods One hundred and twenty children (ASA Ⅰ or Ⅱ ) aged 2-12 yr weighing 12-32 kg were assigned to one of 2 groups using a random number table ( n = 60 each): control group (group C) and parental presence group (group P). Preoperatiave visit was made the day before surgery in both groups. In group P a parent played with toys with the children for 15 min before induction of anesthesia, while in group C a nurse played with them. Anesthesia was induced with 8% sevoflurane in O2 delivered at 6 L/min through a scented face mask held by the parent or anesthesiologist talking with them in soft words. Modified Yale preoperative anxiety scale (mYPAS) was used to measure anxiety of the children during preoperative visit, before and during induction of anesthesia. Induction compliance checklist (ICC) was used to measure behavioral compliance during induction. ICC score ＞ 5 implied failure of induction of anesthesia with sevoflurane. Adverse events were recorded. Results The mYPAS scores were significantly lower before and during induction of anesthesia in group P than in group C (P ＜ 0.05), but there was no significant difference in ICC scores between the 2 groups ( P ＞0.05). There was no failure of induction in group P while in group C there were 3 failures. Cough occurred in 2 patients in group P but in 3 patients in group C. One patient vomited during induction of anesthesia in group C.Conclusion Parental presence is effective in reducing anxiety of children during induction of anesthesia.

Objective To determine whether music can reduce parental and children preoperative anxiety and thus allow children to benefit from parental presence during induction of anesthesia.Methods The children and the parental anxiety throughout the perioperative period was taken as the primary endpoint of the study,and the parental satisfaction as the secondary endpoint.One hundred children were assigned randomly to a music group(parental presence with music)or a control group(parental presence without music).By using Modified Yale Preoperative Anxiety Scale(mYPAS),preoperative anxiety of children was measured;By using State-Trait Anxiety Inventory,anxiety of parents was measured;By using VAS Inventory,satisfaction of parents was measured.Results Music group had a lower level anxiety of parents and a higher level satisfaction of parents.Both groups had the same level of mYPAS.Conclusion Music is effective in reducing the anxiety of parents at induction of anesthesia,but the children can not be benefited.

<正>结直肠癌(colorectal cancer)是欧美第二高发的恶性肿瘤。近年来,由于饮食结构和生活方式的改变,我国结直肠癌发病率在不断增高,并有年轻化的趋势。结直肠癌治疗的关键是及时手术切除。与传统开腹手术相比,腹腔镜结直肠手术有明显的微创

To observe the effect of Sim2, a Down syndrome critical locus gene, on the differentiation of PC12 cells, and to explore the role of Sim2 in the pathogenesis of Down syndrome, PC12 cells were transfected with the pcDNA3-mSim2 plasmid. The morphology of PC12 cells was observed by phase-contrast microscopy. mRNA expression of mSim2, GAP43 and synapsin I was determined by reverse transcription-polymerase chain reaction (RT-PCR). GAP43 protein expression was detected by flow cytometry. Abundant mSim2 expression was observed in PC12 cells transfected with pcDNA3-mSim2. In these cells, there were less neurites, and their length was shorter (P<0.05). The mRNA expression of GAP43 and synapsin I was significantly decreased. Flow cytometry experiments showed that mSim2-transfected cells had significantly suppressed GAP43 protein expression (P<0.05). All the results suggest that Sim2 may play an important role in the pathogenesis of Down syndrome by influencing neurite growth and inhibiting the differentiation of neurons.