Objective:To investigate the effects of etomidate on lipopolysaccharide (LPS)-induced inflammation and apoptosis of cardiomyocytes and its possible mechanism.Methods:According to the random number table method, rat cardiomyocytes H9c2 cultured in vitro were divided into five groups ( n=3, and each experiment was repeated three times): a normal control (Con) group, a LPS group, a LPS+20 μmol/L etomidate (E-L) group, a LPS+50 μmol/L etomidate (E-M) group, and a LPS+100 μmol/L etomidate (E-H) group. The Con group was normally cultivated; the LPS group was cultured in dulbecco's modified eagle medium (DMEM) medium containing 1 mg/L LPS for 24 h; and the E-L group, E-M group, and E-H group were treated with different concentrations (20, 50 μmol/L, and 100 μmol/L) etomidate and 1 mg/L LPS in DMEM medium for 24 h. According to the random number table method, normal cultured cardiomyocytes were divided into two groups ( n=3, and each experiment was repeated three times): a LPS+100 μmol/L etomidate+anti-microRNA (microRNA, miR)-NC (anti-miR-NC) group and a LPS+100 μmol/L etomidate+anti-miR-214-3p (anti-miR-214-3p) group. The anti-miR-NC group and anti-miR-214-3p group were transfected with anti-miR-NC or anti-miR-214-3p to cardiomyocytes, respectively, before cultivation with DMEM medium containing 100 μmol/L etomidate and 1 mg/L LPS for 24 h. The enzyme-linked immunosorbent assay (ELISA) method was used to detect the levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-6, and IL-1β, while flow cytometry was used to detect cell apoptosis rate. The quantitative real-time polymerase chain reaction (qRT-PCR) was used to detect the expression of miR-214-3p and transducin β-like 1X related protein 1 (TBL1XR1). The dual luciferase report test was used to verify the targeted regulation relationship between miR-214-3p and TBL1XR1. The expression of TBL1XR1 and B-cell lymphoma-2 (Bcl-2)-associated X protein (Bax), Bcl-2 was measured by Western blot. Results:Compared with the Con group, the LPS group presented remarkable increases in the levels of TNF-α, IL-6, IL-1β and Bax protein, apoptosis rate and the amount of TBL1XR1 mRNA ( P<0.05), and decreases in the level of Bcl-2 and miR-214-3p protein ( P<0.05). Compared with the LPS group, the levels of TNF-α, IL-6, IL-1β, and Bax, apoptosis rate and the amount of TBL1XR1 mRNA in the E-L, E-M, and E-H group decreased in a dose-dependent manner ( P<0.05), while the level of Bcl-2 and miR-214-3p increased in a dose-dependent manner ( P<0.05), and statistical differences were found among the E-L, E-M, and E-H groups ( P<0.05). MiR-214-3p negatively regulated the expression of TBL1XR1 ( P<0.05). Compared with the anti-miR-NC group, the levels of TNF-α, IL-6, IL-1β, and Bax, apoptosis rate in the anti-miR-214-3p group increased ( P<0.05), while the level of Bcl-2 decreased ( P<0.05). Conclusions:Etomidate inhibits LPS-induced inflammation and apoptosis in cardiomyocytes through regulating the miR-214-3p/TBL1XR1 molecular axis.

目的:分析不同剂量的右美托咪啶对眼科手术患儿认知功能的影响，为临床治疗提供参考。方法:回顾性分析本院2015年6月至2018年6月期间采用不同剂量右美托咪啶的眼科手术患儿的临床资料，按照右美托咪啶剂量分为低剂量组( n＝40，0.50 μg/kg)；高剂量组( n＝40，1.00 μg/kg)；对照组( n＝45，未用右美托咪啶)，所有患儿均用0.375%的布比卡因行球后神经阻滞，分析患儿治疗前后早期认知功能的变化。 结果:三组患儿用药后镇静/警觉评分均明显降低( P<0.05)，且用药15、30 min时高剂量组的镇静/警觉评分明显低于低剂量组和对照组( P<0.05)；与术前比较，三组患儿术后简易精神状态检查量表(MMSE)评分明显降低( P<0.05)，且高剂量组和低剂量组的MMSE评分降低更明显。三组患儿术后神经元特异性烯醇化酶(NSE)及S100β水平明显升高( P<0.05)，同时高剂量组和低剂量组NSE、S100β水平低于对照组( P<0.05)，但高剂量组与低剂量组差异无统计学意义( P<0.05)；三组患儿的不良反应包括苏醒期躁动、恶心呕吐及低血压，三组总不良反应、POCD发生率方面比较差异无统计学意义( P>0.05)。 结论:0.50～1.00 μg/kg剂量的右美托咪啶能有效降低眼科手术患儿镇静/警觉评分且不增加认知功能异常或不良反应发生，可用于小儿眼科手术麻醉。

目的 探讨右美托咪定对老年白内障手术球后神经阻滞患者镇静效果的最佳维持剂量.方法 白内障手术的90例老年患者随机分为3组各30例.由同一位医生行球后神经阻滞麻醉,麻醉完毕10 min内,3组分别以0.2、0.4、0.6 μg·kg-1·h-1的速率静脉维持给予右美托咪定.记录并比较3组入室时(T0)、神经阻滞完毕即刻(T1)、用药后10 min(T2)、20 min(T3)、30 min(T4)、60 min(T5)时的心率(HR)、呼吸频率(BR)、平均动脉压(MAP)、Ramsay镇静评分(RSS)及口述评分法(VRS).评价并比较3组手术前后焦虑自评量表(SAS)评分及术后患者、医生满意度评分.结果 3组在T2~T5时间点时的RSS均明显大于T0时,HR水平均明显小于T0时,并且观察3组在T3~T5时间点时的RSS均明显大于观察1组和观察2组、HR水平均明显小于观察1组和观察2组(P<0.05);3组在各时间点时的VRS、BR、MAP比较差异均无统计学意义(P>0.05). 观察1组和观察2组的患者满意度均明显高于观察3组(P<0.05);3组术前SAS评分、术后SAS评分及医生满意度评分比较差异均无统计学意义(P>0.05).结论 右美托咪定对老年白内障手术球后神经阻滞患者镇静效果的最佳维持剂量为0.2~0.4 μg·kg-1·h-1.

Objective To investigate the feasibility and safety analysis of laryngeal mask airway ( LMA) for general anesthesia in children.Methods Total of 80 children undergoing elective operation scheduled in Hainan Eye Hospital from Apr.2013 to Sep.2014 were included in the study,and divided into LMA group and tracheal intubation general anesthesia group according to random number table method,45 cases each. Both groups received anesthesia induction with 6% sevoflurane followed by intravenous midazolam 0.05 mg/kg and fentanyl 4 μg/kg,and intravenous infusion of propofolum 4 mg/( kg? h) .Then LMA was given in the LMA group and tracheal intubation was given in the tracheal intubation group before the start of surgery .Both groups were administrated with continuous 1%-2% sevoflurane during surgery.Propofol and sevoflurane were stopped 3 minutes before the end of operation.Heart rate(HR),mean arterial blood pressure(MAP) and pulse oxygen saturation(SpO2) at pre-anesthesia (T0),5 minutes after the beginning of anesthesia (T1),20 minutes after the beginning of anesthesia ( T2 ) , end of the operation ( T3 ) were recorded.Results The recovery time of LMA group was shorter than that of tracheal intubation general anesthesia group,the differ-ence was statistically significant [ ( 9.5 ±3.1 ) min vs ( 11.4 ±2.9 ) min, P <0.05 ] .The incidence of adverse reactions in LMA group was 0,in tracheal intubation general anesthesia group was 15 cases.The HP and MAP at T0,T1,T2 and T3 time points in LMA group were gradually decreasing [HP:(91 ±8),(86 ± 10),(85 ±9),(84 ±8)times/min; MAP:(65 ±10),(63 ±8),(62 ±8),(62 ±7) mmHg],and there was a peak at T1 point and then gradually decreasing in tracheal intubation general anesthesia group [ HP:(90 ±8),(110 ±11),(86 ±9),(85 ±8) times/min; MAP:(63 ±11),(68 ±9),(64 ±8),(63 ±7) mmHg];the SpO2 of LMA group first increased and then decreased [(0.988 ±0.008),(0.996 ±0.006), (0.994 ±0.007),(0.995 ±0.008)],and of tracheal intubation general anesthesia group first decreased and then increased[(0.987 ±0.005),(0.925 ±0.009),(0.989 ±0.006),(0.991 ±0.007)].The HR, MAP and SpO2 of the two groups were statistically significantly different(all P<0.05).The HR at different time points of the two groups was statistically significantly different(P<0.05),while the difference of MAP and SpO2 was not statistically significant ( P >0.05 ) .The HR, MAP and SpO2 at different time points between the two groups were significantly different ( all P <0.05 ) .Conclusion The clinical efficacy of LAM in the treatment of pediatric anesthesia is exact,with high safety,therefore has a certain clinical value.