目的 探讨由脉压变异度指导的目标导向液体治疗在儿童颅咽管瘤切除术中的应用以及对患儿转归的影响.方法 以2020年3月至2021年10月首都医科大学附属北京儿童医院择期行颅咽管瘤切除术的40例患儿为研究对象,年龄1～5岁,性别不限,美国麻醉医师协会分级(American Society of Anesthesiologists,ASA)Ⅱ～Ⅲ级.采用前瞻性研究设计,按随机数字表法分为目标导向液体治疗(goal-directed fluid therapy,GDFT)组(G组)和传统液体治疗组(C组).G组术中采用脉压变异度(pulse pressure variability,PPV)指导的GDFT方案输注液体,C组术中采用传统"4-2-1"补液原则进行液体输注.记录手术开始时(T1)、切开硬脑膜前(T2)、手术结束时(T3)的平均动脉压(mean arterial pres-sure,MAP),心率(heart rate,HR),术中各种类型液体出入量,抗利尿药物、血管活性药使用率,电解质情况和术后住院时间.结果 C组患儿T3时间点HR值显著高于T1时间点[(96.1±22.4)次/分比(82.4±8.4)次/分],且T3时间点C组HR值显著高于G组[(96.1±22.4)次/分比(83.2±12.8)次/分](P＜0.05);其余时间点两组HR值及MAP值差异无统计学意义(P＞0.05).在液体出入量方面,G组输注晶体液量、尿量显著多于 C 组[(826.0±341.8)mL 比(610.0±266.7)mL;(495.0±216.2)mL比(284.0±202.1)mL](P＜0.05),其余指标差异无统计学意义(P＞0.05).G组电解质紊乱的发生率低于C组[血K+异常0％(0/20)比25％(5/20)](P＜0.05),术后住院时间明显少于C组[(8.6±1.8)d比(10.6±3.2)d](P＜0.05).两组术中抗利尿药物[5％(1/20)比5％(1/20)]与血管活性药物使用率[0％(0/20)比 5％(1/20)]以及手术时间[(324.8±47.7)min 比(328.0±68.0)min]差异无统计学意义(P＞0.05).结论 脉压变异度引导GDFT应用于择期颅咽管瘤切除术患儿,有助于维持其术中血流动力学稳定,降低术后电解质紊乱的发生率,缩短术后住院时间.

目的 探索猪的外周型静脉-动脉体外膜氧合及羊的左心室辅助的中短期大动物心肺辅助模型建立的可行性和稳定性.方法 选取家猪3只(体重74 kg、82 kg、110 kg;均为雌性,月龄5～6个月),实验用小型猪1只(体重43 kg,雄性,月龄5～6个月);山羊1只(体重78 kg,雌性,月龄5～6个月).所有实验动物均为健康动物,术前禁食12 h,禁水4 h.实验猪常规术前准备后完成颈动、静脉置管的外周型静脉-动脉体外膜氧合并转流24～72 h.实验羊完成心尖部和降主动脉置管的清醒左心室辅助,转流时间为24 h.实验过程中监测血气、凝血相关指标及游离血红蛋白浓度并及时调整管理策略,实验结束后动物于麻醉状态下处死.结果 所有动物均顺利完成实验,术中生命体征平稳,检测指标结果满意,未出现不良事件.结论 猪的外周型静脉-动脉体外膜氧合及羊的左心室辅助的中短期大动物心肺辅助模型可行性及稳定性高、易于管理.

OBJECTIVESThe intestinal injury during deep hypothermic circulatory arrest (DHCA) is harmful to clinical outcomes. Cold-inducible RNA-binding protein (CIRBP) plays a protective role in hypothermia. The aim of this study was to explore the effects of CIRBP on intestinal barrier during DHCA.METHODSSprague-Dawley (wild type, n = 13) and knockout of Cirbp (Cirbp-/-, n = 8) rats were used in the model of DHCA. The histomorphology of the epithelial barrier was evaluated by haematoxylin-eosin, Chiu's scores, Gram's stain and Ki67. The function of the intestinal barrier was evaluated by serum intestinal fatty acid-binding protein, diamine oxidase and d-lactate. The structure of the epithelial barrier, phosphocreatine-creatine kinase system and adenosine triphosphate were assessed in the intestine.RESULTSThe expression of CIRBP significantly increased in the intestine during DHCA. Cirbp-/- rats showed obvious destruction of intestinal barrier after DHCA. Chiu's scores, intestinal fatty acid-binding protein, diamine oxidase and d-lactate significantly increased in the Cirbp-/- group. Ki67 showed that cell proliferation decreased in the Cirbp-/- rats. In the Cirbp-/- group, zonula occludens-1, E-cadherin and occludin levels were significantly decreased, and these proteins either disappeared or redistributed in the monolayer. Besides, Cirbp-/- resulted in decreased levels of creatine kinase B, glycine amidinotransferase, adenosine triphosphate and creatine contents in the intestine, affecting energy metabolism and balance, which is associated with the maintenance of epithelial barrier during acute injury.CONCLUSIONSCIRBP is related to the maintenance of the intestinal epithelial barrier during DHCA, which is expected to be a new target for the prevention of intestinal injury.

目的 建立无血预充的大鼠静脉-动脉体外膜氧合(V-A ECMO)模型,为进一步探讨和研究ECMO期间的器官损伤机制及相应保护策略等问题奠定基础.方法 随机选取5只成年SD雄性大鼠,七氟烷诱导麻醉,颈静脉置入自制多孔静脉引流管作为静脉引流端,左侧股动脉置入22 G一次性使用静脉留置针监测血压,右侧股动脉置入同款留置针为动脉灌注端.从监测端动脉通路给予肝素(500 U/kg)抗凝,活化凝血时间达400 s以上开始ECMO运转,2 h后停止运转.分别于术前,术中1 h,2 h三个时间点抽取动脉血气分析,记录各时间点血气值,并于术中实时监测记录动脉压及心率.结果 所有大鼠均顺利完成实验,并在撤除ECMO后于麻醉状态下处死.各时间点血气结果平稳.术中心率在300次/min左右,无恶性心律失常,血压平稳,平均动脉压维持在70～90 mm Hg.结论 本实验成功建立大鼠外周V-A ECMO模型,术前无需血液预充,术中麻醉深度精准可控、呼吸循环稳定、血气结果满意,操作简便易行,成功率高,可用于研究ECMO期间血流动力学改变,同时使脏器损伤的机制探讨及干预治疗的靶点研究成为可能.