目的 建立超高效液相色谱-串联质谱法(UPLC-MS/MS)测定人血浆中苯磺酸顺阿曲库铵的含量,并应用于临床治疗中监测老年患者手术后血浆中的药物残留.方法 样品经含0.1％甲酸的乙腈溶液蛋白沉淀处理后,采用SHISEIDO(资生堂)ADME(3.0 mm×100 mm,2.7μm)色谱柱,流动相以含0.1％甲酸的2 mmol/L乙酸铵溶液和乙腈溶液(30:70,V/V),等度洗脱.质谱检测选择AJS-ESI离子源正离子模式,多反应监测(MRM)检测离子对为:苯磺酸顺阿曲库铵464.3→358.2(m/z)、维库溴铵(IS)557.4→356.3(m/z).收集老年脊柱手术患者麻醉诱导后、手术结束、术后0.5 h、术后1 h以及自体血回输时刻血袋内的血浆样品,于事先加入2％甲酸水溶液的冻存管中保存,测定样本中的苯磺酸顺阿曲库铵的含量,评估自体血回输对老年患者术后血浆苯磺酸顺阿曲库铵浓度的影响.结果 人血浆中苯磺酸顺阿曲库铵在20～5000 ng/ml范围内线性良好,r=0.9997;批内和批间的精密度RSD<10％、准确度RE

Objective: To investigate the effect of a single sub-anesthetic dose of ketamine on postoperative anxiety, depression, and inflammatory factors in patients with colorectal cancer.Methods: A total of 104 patients undergoing selective colorectal surgery in our hospital from Jan 2015 to Oct 2017 were included and randomly assigned (1:1:1:1) into a 0.1 mg kg−1 ketamine group (K1 group), 0.2 mg kg−1 ketamine group (K2 group), 0.3 mg kg−1 ketamine group (K3 group), or control group (C group). Corresponding doses of ketamine were given intravenously in the K groups (K1, K2, and K3 groups) 5 min before operation, and the same amount of normal saline was given in the C group. The intravenous analgesia program was identical in the four groups. The patients’ emotional reactions (anxiety and depression) were assessed by the Hospital Anxiety and Depression Scale (HAD), the quality of postoperative recovery was evaluated by the Quality of Recovery-40 (QoR-40) questionnaire, and the levels of IL-6, IL-8, and TNF-α in peripheral blood were detected by enzyme-linked immunosorbent assay (ELISA) on the day before operation and within 24, 48, and 72 h post-operation respectively. Pain was estimated by the visual analog scale (VAS), and sedation was assessed with Ramsay score 30 min after extubation. The time points of anesthetic end and extubation were recorded. The complications during anesthesia and recovery such as cough and agitation 30 min after extubation were recorded.Results: The anxiety score (HAD-A) and depression score (HAD-D) of the K3 group were significantly lower than those of the C group post-operation (p < 0.05). The QoR-40 score of the K3 group was significantly higher than that of the C group (p < 0.05). The serum levels of IL-6, IL-8, and TNF-α in the K3 group were significantly lower than those in the C group (p < 0.05 and p < 0.01). There were no significant differences in HAD-A, HAD-D, and QoR-40 scores or serum levels of IL-6, IL-8, and TNF-α between the K1 and K2 groups and the C group. There were no significant differences in VAS pain score or Ramsay sedation score among the four groups 30 min after extubation. There were no significant differences in extubation time, postoperative cough, emergence agitation, or delirium among the four groups. Dizziness, nausea, vomiting, diplopia, or other adverse reactions were not found 30 min after extubation.Conclusion: A single sub-anesthetic dose (0.3 mg kg−1) of ketamine can significantly improve the postoperative anxiety and depression of colorectal cancer patients and reduce the levels of IL-6, IL-8, and TNF-α.

由于红细胞没有线粒体,其能量供应完全依赖于葡萄糖酵解,但高血糖状态可使血红蛋白糖化,产生氧化应激对细胞组分造成损伤.本文系统回顾糖尿病状态下红细胞的变化,分析糖尿病对红细胞理化性质及免疫功能的影响,以期为糖尿病患者的临床治疗提供参考.

Objective:To explore the suitable blood storage time of preoperative autologous blood donation (PABD) so as to provide theoretical basis for ensuring the safety and effectiveness of autologous blood application.Methods:Ten patients undergoing orthopedic surgery with PABD indications were selected, and the total blood volume was calculated according to the patient's weight. The autologous blood accounting for 10% of the total blood volume was collected one week before operation. The blood routine and hemodynamics were detected before and after blood collection, and 50 ml autologous blood was reserved to prepare red blood cell (RBC) suspension for research use. The effective oxygen-carrying amount (Q), oxygen affinity (P 50), adenosine triphosphate (ATP), 2, 3-diphosphoglycerate (2, 3-DPG), Na +-K +-ATPase, Ca 2+-Mg 2+-ATPase, reactive oxygen species (ROS) of the stored autologous blood samples were measured on days 1, 7, 14, 21 and 28 and their correlations were analyzed. Results:Compared with those before blood collection, the RBC count, hemoglobin (Hb), hematocrit (Hct), RBC aggregation index and RBC rigidity index decreased after blood collection ( P<0.05). Compared with storage for one day, RBC Q value, Na +-K +-ATPase activity and Ca 2+-Mg 2+-ATPase activity decreased on days 7, 14, 21 and 28, ATP and 2,3-DPG content decreased on days 14, 21 and 28, P 50 value decreased on days 21 and 28, and ROS content increased on days 7, 14, 21 and 28 ( P<0.05). Compared with storage for seven days, RBC Q value, 2,3-DPG content and Na +-K +-ATPase activity decreased at days 14, 21 and 28, while P 50 value, ATP and Ca 2+-Mg 2+-ATPase activity decreased on days 21 and 28, and ROS content increased on days 14, 21 and 28 ( P<0.05). The ROS content of RBC was positively correlated with storage time ( P<0.05); RBC Q value, P50, ATP, 2,3-DPG, Na +-K +-ATPase and Ca 2+-Mg 2+-ATPase contents were negatively correlated with storage time and RBC ROS content ( P<0.05). Conclusions:PABD RBC can basically maintain normal oxygen-carrying capacity within 14 days, and the oxygen-carrying capacity of RBC decreases with the prolonging of storage time, which may be related to the oxidative stress injury of RBC.

目的 观察骨科手术患者采取急性等容性血液稀释(ANH)术中自体血回输后对患者脑电双谱指数(BIS)及肌松效应的影响.方法 全身麻醉下骨科手术患者40例,随机分为ANH组(A组)和常规输血输液组(C组).A组患者于麻醉诱导平稳后经桡动脉采集自体血行ANH,主要手术步骤完成后回输采集自体血.C组按常规输血输液处理.分别观察血液稀释前(T1)、血液稀释后即刻(T2)、血液稀释后30 min(T3)、血液回输后(T4)、术毕(T5)患者血流动力学指标、BIS值及肌松效应指标.结果 A组较C组总入量及尿量均增多(P均<0.05);T4时A组HR高于T1和C组(P均<0.05);T3、T4时A组BIS值低于T1和C组(P均<0.05),T5时PTC高于T1(P<0.05).结论 骨科患者应用急性等容血液稀释整个术中肌松效应无明显变化;自体血液回输时脑电双谱指数降低,应减少麻醉药物使用剂量.