BACKGROUND:Sleep deprivation (SD) is a growing global health problem with many deleterious effects, such as cognitive impairment. Microglia activation-induced neuroinflammation may be an essential factor in this. Propofol has been shown to clear sleep debt after SD in rats. This study aims to evaluate the effects of propofol-induced sleep on ameliorating sleep quality impairment and cognitive decline after 48 h SD. METHODS:Almost 8-12-week-old rats were placed in the SD system for 48 h of natural sleep or continuous SD. Afterwards, rats received propofol (20 mg·kg-1·h-1, 6 h) via the tail or slept naturally. The Morris water maze (MWM) and Y-maze test assessed spatial learning and memory abilities. Rat EEG/EMG monitored sleep. The expression of brain and muscle Arnt-like protein 1 (BMAL1), brain-derived neurotrophic factor (BDNF) in the hippocampus and BMAL1 in the hypothalamus were assessed by western blot. Enzyme-linked immunosorbent assay detected IL-6, IL-1β, arginase 1 (Arg1), and IL-10 levels in the hippocampus. Immunofluorescence was used to determine microglia expression as well as morphological changes. RESULTS:Compared to the control group, the sleep-deprived rats showed poor cognitive performance on both the MWM test and the Y-maze test, accompanied by disturbances in sleep structure, including increased total sleep time, and increased time spent and delta power in non-rapid eye movement sleep. In addition, SD induces abnormal expression of the circadian rhythm protein BMAL1, activates microglia, and causes neuroinflammation and nerve damage. Propofol reversed these changes and saved sleep and cognitive impairment. Furthermore, propofol treatment significantly reduced hippocampal IL-1β and IL-6 levels, increased BDNF, Arg1, and IL-10 levels, and switched microglia surface markers from the inflammatory M1 type to the anti-inflammatory M2 type. CONCLUSION:Propofol reduces SD-induced cognitive impairment and circadian rhythm disruption, possibly by lowering neuronal inflammation and switching the microglia phenotype from an M1 to an M2 activated state, thus exerting neuroprotective effects.

目的 探讨右美托咪定辅助硬膜外麻醉在中转剖宫产手术中的应用价值,观察不同方案的麻醉效果.方法 选取2016年1月-2019年12月在该院阴道试产失败中转剖宫产并接受右美托咪定辅助硬膜外麻醉的42例产妇为观察组,同期在该院阴道试产失败中转剖宫产并接受生理盐水辅助硬膜外麻醉的38例产妇为对照组,回顾性分析两组研究对象临床资料.比较两组产妇感觉阻滞起效时间,感觉阻滞时间及最高阻滞平面;比较两组产妇镇静评分(Ramsay评分),牵拉反应评分及新生儿娩出后1min、5min的Apgar评分;比较两组产妇麻醉前(T0)、切皮时(T1)胎儿取出时(T2)、关腹时(T3)的平均动脉压(MAP)、心率(HR)和血氧饱和度(SPO2)等血流动力学情况;记录两组产妇不良反应发生情况.结果 观察组产妇感觉阻滞起效时间短于对照组,感觉阻滞时间长于对照组,最高阻滞平面高于对照组,差异均有统计学意义(均P＜0.05).观察组产妇Ramsay评分和牵拉反应评分均高于对照组,差异均有统计学意义(均P＜0.05).两组新生儿Apgar评分比较,差异均无统计学意义(均P＞0.05).T1～T3时,观察组产妇HR、MAP水平均低于T0时,且观察组低于对照组,差异均有统计学意义(均P＜0.05).两组产妇各时点SPO2水平相近,差异均无统计学意义(均P＞0.05).两组产妇不良反应发生率比较,差异无统计学意义(P＞0.05).结论 右美托咪定辅助硬膜外麻醉在中转剖宫产手术中的应用效果较好,更利于稳定产妇术中血流动力学稳定,产妇获得的镇静效果及感觉阻滞效果更好,且不会增加不良反应,安全性较高.

Objective:To investigate the effect of glycosylated hemoglobin (HbA1c) level on cisatracurium-induced muscle relaxation in the patients undergoing general anesthesia.Methods:One hundred and sixty patients of both sexes, aged 30-60 yr, with body mass index of 20-25 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective endoscopic sinus surgery with general anesthesia, were included in the study.According to the HbA1c level at 1 day before operation, the patients were divided into 4 groups ( n=40 each): HbA1c ≤6% control group (group C), 6%<HbA1c≤7% group (group D 1), 7%<HbA1c≤9% group (group D 2), and HbA1c>9% group (group D 3). The duration of diabetes mellitus was ≥5 yr, and the preoperative fasting blood glucose was 6.1-10.0 mmol/L in D 1, D 2 and D 3 groups.After anesthesia was induced with intravenous midazolam, fentanyl and propofol, muscle relaxation was monitored.When T 1 was maintained at 100%, cisatracurium 0.15 mg/kg was intravenously injected, and endotracheal intubation was performed after onset of the muscle relaxant.Anesthesia was maintained with infusion of propofol, remifentanil and dexmedetomidine.The onset time, clinical action time, recovery time, recovery index and 90% recovery index were recorded. Results:Compared with group C and group D 1, the onset time, clinical action time, recovery time, recovery index and 90% recovery index were significantly prolonged in D 2 and D 3 groups ( P<0.05). There was no significant difference in each parameter between group C and group D 1 ( P>0.05). Compared with group D 2, the onset time, clinical action time, recovery time, recovery index and 90% recovery index were significantly prolonged in group D 3 ( P<0.05). Conclusion:HbA1c >7% can prolong onset time and time for action of cisatracurium and inhibit the recovery of muscle relaxation in patients undergoing general anesthesia, and the higher the level of HbA1c, the greater the effect on the cisatracurium-induced muscle relaxation.

目的:通过对比分析姜黄素对高浓度七氟醚所致老年大鼠学习记忆能力改变及环氧化酶2(Cyclooxygenase-2,COX-2)表达的影响,为预防治疗老年患者术后学习记忆能力下降提供理论依据.方法:选取无特定病原体级SD雄性大鼠48只为研究对象,随机分为三组,每组16只大鼠,分别为七氟醚组、空白对照组和姜黄素组,使用酶连免疫法检测三组大鼠海马内β-淀粉样蛋白(amyloidβ-protein,Aβ)表达水平,使用Western检测法检测三组大鼠海马内COX-2和γy-分泌酶(human beat-site app-cleaving enzy me-1,BACE-1)表达水平,记录水迷宫测试结果.结果:七氟醚组大鼠第3天、5天潜伏期明显长于对照组大鼠,5天潜伏期明显长于姜黄素组大鼠,5天总路程明显长于对照组大鼠和姜黄素大鼠,随着吸入七氟醚时间延长,七氟醚组大鼠穿越平台象限次数明显少于对照组和姜黄素大鼠,姜黄素组大鼠3天、5天潜伏期长于对照组大鼠,差异有统计学意义(P＜0.05),姜黄素组大鼠总路程及穿越平台次数与对照组大鼠相比差异无统计学意义(P＞0.05);姜黄素组与七氟醚组大鼠海马内Aβ表达水平均高于对照组大鼠,七氟醚组大鼠海马内Aβ表达水平明显高于姜黄素组大鼠,差异有统计学意义(P＜0.05);七氟醚组大鼠BACE-1表达水平高于对照组和姜黄素组大鼠,姜黄素组大鼠BACE-1表达水平高于对照组大鼠,差异有统计学意义(P＜0.05);三组大鼠COX-2表达水平无明显差异(P＞0.05).结论:姜黄素能够降低老年大鼠海马组织内Aβ和BACE-1表达水平,减轻高浓度七氟醚对老年大鼠学习记忆能力的损害.

目的 探讨右美托咪定(Dex)对蛛网膜下腔出血(SAH)大鼠早期脑损伤的影响,并探讨其作用机制.方法 将SD大鼠分为假手术组、SAH组和SAH+Dex组,SAH组和SAH+Dex组采用颈内动脉刺破法建立SAH模型,假手术组仅进行手术操作但不穿孔.术后2 h,SAH+Dex组腹腔注射25 g/kg Dex,SAH组腹腔注射等体积生理盐水,假手术组不进行药物干预.术后24 h,对存活大鼠进行神经功能评分;处死大鼠,测算脑水分含量;暴露脑组织基底池,进行SAH分级评分;取脑组织,采用免疫荧光双标法检测小神经胶质细胞及其亚型含量,ELISA法检测炎症因子IL-4、IL-13、IL-1、IL-6、TNF-α含量,Western blotting法检测血脑屏障相关蛋白Occludin、ZO-1及凋亡相关蛋白caspase-3、Bax、Bcl-2表达.结果 与假手术组比较,SAH组神经功能评分降低,脑水分含量和SAH分级评分增加;脑组织小神经胶质细胞数和M1型含量增加;脑组织IL-13含量降低,IL-1、IL-6、TNF-α含量升高;脑组织Occludin、ZO-1、Bcl-2蛋白表达降低,caspase-3、Bax蛋白表达及Bax/Bcl-2比值升高(P均<0.05).与SAH组比较,SAH+Dex组神经功能评分增加,脑水分含量降低;脑组织小神经胶质细胞数和M1型含量降低,M2型含量增加;脑组织IL-4、IL-13水平升高,IL-1、IL-6、TNF-α水平降低;脑组织Occludin、ZO-1和Bcl-2蛋白表达增加,caspase-3、Bax蛋白表达及Bax/Bcl-2降低(P均<0.05).结论 Dex对SAH后大鼠具有神经保护作用,其机制可能与修复血脑屏障、调整小神经胶质细胞的亚型、抑制促炎因子的释放、降低细胞凋亡有关.

Objective To investigate the optimal dose of dexmedetomidine （DEX） combined with sufentanil 0.3μg·kg-1 for anesthesia of radio frequency ablation（RFA）for liver cancer geriatrics.Methods Our study was a random,single blind one.Sixty patients of both sexes,males 53 and females 7,aged 65-84 years,BMI 18.1-35.4 kg/m2,falling into ASA physical statusⅡ orⅢ and Child-Pugh class A or B,scheduled for elective RFA for liver cancer,were randomly assigned into 3 groups（n =20 each）.All groups received different dose of DEX and 0.3μg/kg sufentanil infused 20 minutes before RFA surgery:group D1 (DEX 0.3μg·kg-1·h-1),group D2(DEX 0.5μg·kg-1·h-1),and group D3(DEX 0.7μg·kg-1·h-1).Ramsay sedation score were recorded at the following time points:patients entered into the operating room （T0）,20 minutes after DEX infused （T1）,ablation beginning（T2）,10 minutes after ablation beginning （T3） and the end of operation （T4）.Visual analogue scale（VAS）was recorded at T4,and 2,4,8,12 hours after the ablation respectively.The dosages of etomidate,nitroglycerin,urapidil,and naloxone were noted.The complications and side effects were also noted.The complications of intraoperative awareness,respiratory obstruction,puncture needle displacement,and submembrane hematoma of the liver,and the adverse reaction of hypertention,hypotension and tachycardia were recorded.Results Compare to T0,Ramsay sedation score of groups D2 and D3 at T2-T3 was increased significantly （P <0.05）.Compare to group D1,VAS of groups D2 and D3 at 2,4,8 hours after the ablation were decreased significantly （P < 0.05）.The dosage of etomidate,nitroglycerin,and urapidil in groups D2 and D3 were decreased significantly compare to group D1 （P <0.05）.Compare to group D2,the incidence of intraoperative awareness of group D1 were increased significantly（P < 0.05）,the dose of naloxone of group D3 （70.48±21.38μg）was increased significantly （P < 0.05）,the incidence of transient hypertension,bradycardia and respiratory depression of group D3 were increased significantly （P <0.05）.Conclusion The combination dexmedetomidine 0.5μg·kg-1·h-1 with sufentanil 0.3μg/kg can provide good conscious analgesia,reduce respiratory depression and adverse reactions is a reasonable clinical use for elderly patients under going RFA.

1临床资料<br>　　患者男性，88岁。因肺炎与冠心病致心功能及呼吸功能不全住ICU治疗。患者意识清楚，血压90/54 mmHg，心率75次/min，机械通气SpO2100%。因病情监测需要，选择右锁骨下静脉穿刺行中心静脉置管。穿刺点为锁骨内1/3交界处锁骨下约1 cm，穿刺针尖指向同侧胸锁关节。回吸有暗红色血液，固定穿刺针，将引导钢丝置入穿刺针内，沿导丝退出穿刺针。将中心静脉导管沿导丝置入锁骨下静脉内8~10 cm，连接输液泵。次日在更换注射药物时发现，血液返流至输液管路且压力大，考虑导管误置入锁骨下动脉。停止泵注药物。考虑即刻拔管可能导致局部出血血肿，未将导管拔出。连续观察患者局部情况与生命体征，行超声检测未发现局部血肿。于导管置入12 d后，考虑已形成窦道，决定在手术室实施导管拔除术。同时请胸外科、B超科协助。平卧位，监测血压、心电、脉搏氧饱和度，置入导丝并沿导丝拔除导管。B超持续观察未见血肿，胸腔少量积液同前。约3 min后退出导丝，并行局部加压。再行超声检测，未发现出血及血肿。患者生命体征稳定，观察30 min后返回ICU。拔除导管后24 h、48 h分别复查胸部平片和CT，均未见纵隔、胸腔异常，局部亦无出血及血肿发生。

<正>1临床资料患者男性,88岁。因肺炎与冠心病致心功能及呼吸功能不全住ICU治疗。患者意识清楚,血压90/54 mmHg,心率75次/min,机械通气SpO2100%。因病情监测需要,选择右锁骨下静脉穿刺行中心静脉置管。穿刺点为锁骨内1/3交界处锁骨下约1 cm,穿刺针尖指向同侧胸锁关节。回吸有暗红色血液,