Objective To observe the influences of 1.3 minimum alveolar concentration (MAC) sevoflurane and desflurane on continuous infusion rate of rocuronium in children undergoing surgery.Methods Sixty children undergoing surgery under general anesthesia were randomly divided into three groups consisting of 20 children each.At first all the patients adopted the target controlled infusion of propofol (plasma concentration 3-4 ag · min-1) for induction and maintenance of anesthesia,and accepted intravenous injection of 0.6 mg · kg-1 rocuronium for intubation.TOF-Watch SX monitor was used to exert a train-of-four stimulation (TOF) at ulnar nerve in wrist,then the adductor pollicis muscle appeared muscle twitch 4 times in turn which was recorded T1,T2,T3and T4 respectively.When T1 at 5％,intravenous infusion of rocuronium began and T1 was maintained at 8％-10％ all the time.The infusion rate of rocuronium was defined the initial state when T1at 8％ -10％ for 5 min (t0).Then the infusion of propofol stopped in desflurane group (treatment Ⅰ group) and sevoflurane group (treatment H group),desflurane and sevoflurane began to be inhaled respectively and maintained end-tidal concentration at 1.3 MAC.Control group continued infusion of propofol.The infusion rates of rocuronium were recorded every 10 min,which marked with t1,t2,t3,t4 respectively(by such analogy).The recovery times of muscle relaxant in three groups were recorded which including the times of T1 from 0 to 25％,T1 from 25％ to 75％ (recovery index),TOF ratio(TOFr) from 0 to 90％.Results In treatment Ⅰ group,treatment Ⅱ group and control group,the initial infusion rates of rocuronium were (9.02 ± 1.94),(9.25 ± 2.01),(9.08 ± 1.96) μg · kg-1 · min-1 respectively.The infusion rates gradually decreased in treatment Ⅰ group and treatment Ⅱ group after sevoflurane and desflurane were inhaled,which were (4.49 ± 0.98),(4.63 ± 1.12) μg · kg-1 · min-1 respectively at t7 (P ＜ 0.05),there were no obvious change in control group at each time point (P ＞ 0.05).Compared with control group,the infusion rates of treatment Ⅰ group and treatment H group decreased significantly at t1-t7 (P ＜ 0.05).Compared with treatment Ⅱ group,the infusion rates of treatment Ⅰ group decreased significantly at t1-t5 (P ＜ 0.05).In treatment Ⅰ group,treatment H group and control group,the time of T1 from 0 to 25％ was (16.65 ± 10.96),(24.30 ± 2.35),(18.25 ± 11.31) min;the time of T1 from 25％ to 75％ (recovery index) were (7.40 ± 2.54),(14.11 ± 3.07),(8.55 ±4.60) min;the time of TOFr from 0 to 90％ were (39.58 ±4.07),(53.05 ±4.12),(40.72 ±5.85) min.Compared with control group,the recovery time of muscle relaxant had no significant different in treatment Ⅱ group (P ＞ 0.05).Compared with treatment Ⅱ group,the recovery time of muscle relaxant had significant difference in treatment Ⅰ group (P ＜ 0.05).There were no serious adverse drug reaction,the incidence of adverse drug reaction no statistical differences in three groups (P ＞ 0.05).Conclusion The 1.3 MAC sevoflurane and desflurane can significantly reduce continuous infusion rate of rocuronium in children,in a certain period of time the effect of desflurane is stronger than sevoflurane,and donot effect muscle relaxant recover time.

Objective: To explore the effect of single short-term sevoflurane general anesthesia on early postoperative intelligence development in children aged 0-3 years. Methods: Gesell development scale was used to evaluate the neurological development (DQ) of 200 children aged 0 to 3 years old 1 day preoperatively and 3 months after operation. Another 200 normal children in the same age range were selected respectively as control group I and control group Ⅱ which compared and contrasted with those in anesthesia group. Results: Compared with the DQ scores preoperative 1 day, the developmental age (motor, adaptive, verbal, social) of the four energy regions of children increased to varying degrees after 3 months of anesthesia (P<0.001). The difference of DQ scores of four energy regions 1 day preoperatively and 3 months after operation was not statistically significant (P>0.05). There was no significant difference in DQ scores of four energy regions between anesthesia group and control group (P>0.05). Conclusion: A single short-term sevoflurane general anesthesia has no significant effect on the postoperative DQ of Gesell development scales in children aged 0-3 years, and all energy regions are nor-mal development with age.

Objective: To observe the intraoperative influences on pharmacodynamics of rocuronium in children inhaling sevoflurane and desflurane for 40 min balance. Methods: Ninety children (ASAⅠ-Ⅱ) undergoing elective surgery with general anesthesia in Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University from July 2015 to May 2016 were randomly assigned into six groups (n=15): Sevoflurane group (group S1 and S2), Desflurane group (group D1 and D2) and Propofol group (group P1 and P2). Children in group D1, S1 and P1 were allocated to research the dose-effect relationship of rocuronium, children in group D2, S2 and P2 were allocated to research the time-effect relationship of rocuronium. TOF-Watch SX monitor was used to exert a train-of-four stimulation (TOF) at ulnar nerve in wrist, then the adductor pollicis muscle appeared muscle twitch 4 times in turn which was recorded T(1, )T(2, )T(3) and T(4) respectively. After the success of the muscle relaxant calibration, 1.3 MAC sevoflurane and desflurane were inhaled and maintained for 40 min respectively in children in Sevoflurane group (group S1 and S2) and Desflurane group (group D1 and D2), Plasma target controlled infusion of 3.5-4.0 μg/ml propofol was always administered in Propofol group (group P1 and P2). 75 μg/kg rocuronium was injected each time in group S1, D1 and P1 respectively. Maximum inhibited effect of T(1) was recorded after every injection until inhibition of T(1) more than 95% eventually. The method of cumulative dose four times was used to calculate the efficiency curve of rocuronium[median effective dose (ED(50)), 90% effective dose (ED(90)) and 95% effective dose (ED(95))]. 0.6 mg/kg rocuronium was injected respectively through vein in group S2, D2 and P2. The recovery times of muscle relaxant were recorded which including time of T(1) disappeared (onset time), T(1) from 0% to 5% (peak effect time), T(1) from 0% to 25% (clinical effect time), T(1) from 25% to 75% (recovery index), T(1) from 0% to 70% (internal effect time), T(4)/T(1) (TOFr) from 0% to 70% and 90%. Results: ED(50, )ED(90) and ED(95) in group D1 were 128.73, 212.45 and 245.78 μg/kg respectively. ED(50, )ED(90) and ED(95) in group S1 were 132.46, 218.94 and 252.30 μg/kg respectively. ED(50, )ED(90) and ED(95) in group P1 were 230.56, 381.02 and 439.55 μg/kg respectively. ED(50, )ED(90) and ED(95) in group D1 and S1 were significantly lower than those in group P1 (all P<0.05), but there was no significant difference between D1 and S1 group (P>0.05). Compared with group P2, the shorter onset time, the longer peak effect time and clinical effect time was observed in group D2 and S2, the longer recovery index, internal effect time and TOFr from 0% to 70% and 90% was observed in group S2 (all P<0.01). Conclusions: 1.3 MAC sevoflurane and desflurane inhaling for 40 min significantly reduces ED(50) and ED(95) of rocuronium, prolongs the onset time and action time of rocuronium in children. Sevoflurane can significantly prolong the recovery characteristics of rocuronium.

目的:探讨分析中西医结合治疗静吸复合麻醉下患儿行腺样体及扁桃体切除后插管疼痛的临床效果并作出评价.方法:依据纳入排除标准,选取2012年1月-2014年12月医院儿科108例腺样体及扁桃体切除的患儿,并随机分两组;对照组采取常规手术治疗措施,研究组常规措施+中药疗法;将两组患儿的临床治疗效果、不良反应发生率进行比较分析.结果:研究组患儿术后均无复发,疗效较佳,腺样体及扁桃体切除术后出血,伤口感染、疼痛情况的发生率与对照组比较有明显降低,总不良反应发生率分别为7.4％、37.2％ (P ＜0.05),有统计学意义.两组治疗前中医症候评分比较(P＞0.05)差异无统计学意义,两组治疗后较治疗前评分均降低,研究组效果显著优于对照组,差异有统计学意义(P＜0.05).研究组治疗总有效率98.1％显著高于对照组81.5％(P＜0.05),有统计学意义.结论:中西医结合治疗静吸复合麻醉下患儿行腺样体及扁桃体切除后插管疼痛的临床效果较佳,能显著提高治疗有效率,降低不良反应发生率,值得临床推广使用.

Objective To evaluate the effect of isoflurane preconditioning on cell apoptosis during renal ischemia-reperfusion (I/R) in rats.Methods Thirty male Sprague-Dawley rats, aged 12-14 weeks, weighing 300-320 g, were randomly divided into 3 groups (n =10 each) using a random number table: sham operation group (group S);I/R group;isoflurane preconditioning plus I/R group (group Iso+I/R).The rats were anesthetized with intraperitoneal pentobarbital sodium 30 mg/kg.To establish the model of renal I/R injury, the right kidney was removed, and the left renal pedicle was occluded for 30 min with atraumatic mini-clamp for 30 min, followed by 2 h reperfusion.In Iso+I/R group, 1.5％ isoflurane was inhaled for 1 h, followed by 30 min of washout before I/R.In S and I/R groups only oxygen 2 L/min was inhaled for 1 h.Arterial blood samples were taken at 2 h of reperfusion to determine the concentrations of serum creatinine (Cr), blood urea nitrogen (BUN) and cystatin C (CysC).The animals were then sacrificed, and left kidneys were sampled for determination of the cell apoptosis (by TUNEL), expression of p53, Bax and Bcl-2 mRNA (using real-time fluorescent quantitative PCR), and expression of Bax, Bcl-2, and caspase-3 (by Western blot analysis).The Bcl-2/Bax ratio was calculated.Results Compared with group S, the serum Cr, BUN, and CysC concentrations were significantly increased, the Bcl-2/Bax ratio was decreased, Bcl-2 mRNA, Bax mRNA, Bcl-2, Bax and caspase-3 expression was up-regulated, and AI was increased in group I/R.Compared with group I/R, the serum Cr, BUN, and CysC concentrations were significantly decreased, the Bcl-2/Bax ratio was increased, Bcl-2 mRNA, Bax mRNA, Bax and caspase-3 expression was down-regulated, and AI was decreased in group Iso+I/R.There was no significant difference in p53 mRNA expression among the three groups.Conclusion Regulating the balance between Bcl-2 and Bax and inhibiting apoptosis in kidney cells are involved in the mechanism by which isoflurane preconditioning reduces renal I/R injury in rats.

Objective To investigate effect of dexmedetomidine on postoperative analgesia pump dose and effect.Methods 50 cases of patients with abdominal surgery under general anesthesia were selected.According to the postoperative analgesic drugs were divided into control group and experimental group, 25 cases in each group were given corresponding drug treatment.After treatment, the visual analogue scale, comfort score, adverse reaction rate and dosage of analgesic drugs were detected and compared.Results Compared with the control group,the VAS score were lower(P <0.05),the BCS score were higher(P<0.05),the adverse reaction rate were lower(P<0.05),the dosage of analgesic pump were lower(P<0.05). Conclusion Dexmedetomidine can significantly reduce postoperative pain degree of patients, reduce the incidence of adverse reaction, reduce analgesic dosage of the drug pump.

目的 研究右美托咪定对内毒素诱导感染性休克大鼠细胞免疫的作用.方法 选取12周龄雄性Walse大鼠18只,采用数字表法随机分为空白组(S组)、内毒素组(E组)和右美托咪定治疗组(D组),每组6只.S组静脉推注1.0 mL/kg 0.9％生理盐水后,持续泵入同浓度的生理盐水,E组、D组均采用静脉注射内毒素(LPS)建立感染性休克大鼠模型,D组在注射内毒素后持续微泵右美托咪定.持续监测心率(HR)、呼吸、有创动脉血压(ABP)及平均动脉压(MAP),用药后0.5、1、2、3、4、6h检测血清中IL-4(白介素-4)、IL-10、IFN-γ(γ干扰素)和IL-2的浓度,6h后处死大鼠,检测大鼠脾脏及胸腺caspase-3、caspase-8、caspase-9活性,测定淋巴细胞凋亡情况及Th1/Th2.结果 ①与S组相比,E组、D组大鼠血清的抗炎因子IL-4、IL-10和促炎因子IFN-γ、IL-2均显著提高,其差异均有统计学意义(P＜0.05).随着治疗时间延长,E组的IL-4、IL-10水平降低,IFN-γ、IL-2水平升高;D组IL-4、IL-10水平升高,IFN-γ、IL-2水平降低;两组比较差异有统计学意义(P＜0.05).②与E组相比,D组大鼠脾脏及胸腺caspase-3、caspase-8、caspase-9表达及淋巴细胞凋亡的阳性细胞数均显著减少,差异有统计学意义(P＜0.05).③D组大鼠脾脏及胸腺Th1/Th2比率均显著高于E组,差异有统计学意义(P＜0.05).结论 右美托咪定对感染性休克大鼠具有减轻炎症反应和改善免疫功能的作用,有利于改善预后.

[目的]探讨姜黄素对自发性高血压大鼠缺血再灌注后视网膜细胞凋亡及凋亡相关基因p53表达的影响和意义.[方法]制作大鼠视网膜缺血再灌注(retinal ischemia reperfusion,RIR)模型,将自发性高血压大鼠(spontaneously hypertensive rat,SHR)随机分为假手术组(SH)、缺血再灌注组(IR)、姜黄素处理组(CU)和时照组(SC),每组又分为再灌注后2h、6h、24h、72h和7d等5个亚组(n=9).用TUNEL(terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling)法观察大鼠视网膜和视网膜毛细血管细胞凋亡,分光光度法检测视网膜Caspase-3酶表达活性,用免疫组织化学SP法检测再灌注后不同时段视网膜组织中p53蛋白表达变化.[结果]与IR组比较,CU组能显著减少视网膜和视网膜毛细血管的细胞凋亡数量(P＜0.01),抑制p53蛋白表达(P＜0.01).[结论]姜黄素对SHR视网膜缺血再灌注损伤有保护作用,调控凋亡相关基因p53蛋白的表达可能是其作用机制之一.

[Objective]To investigate the apoptosis and the expression of p53 in retina of spontaneously hypertensive rat(SHR) after retina ischemia reperfusion(RIR) and the effect of curcumin on apoptosis and the expression of p53 in retina.[Methods]Ischemic reperfusion injury model was used.Male SHR were randomly divided into sham group(SH),ischemia reperfusion group(IR),curcumin group(CU) and solvent control group(SC).Each group was subdivided into 2h,6h,24h,72h and 7d after reperfusion respectively (n=9).Retina and the retinal capillary apoptosis was detected by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling(TUNED methods and the caspase-3 activity was evaluated by caspase-3 spectrophotometric analysis.The expression of p53 was determined by streptavidin-perosidase(SP) immunohistochemistry.[Results]The number of apoptosis in retina and the retinal capillary was smaller in CU group than in IR group obviously.The expression of p53 was less in retina in CU group than in IR group.[Conclusions]Curcumin can protect retina and retinal capillary of SHR against RIR.It may be one of the protective mechanisms by modulating the expression of apoptosis related gene p53.

OBJECTIVE:To investigate the diversify of the nuclear pathway of c-Jun NH2-terminal kinases (JNK) during transient brain ischemia/reperfusion injury in hippocampal neuron apoptosis in spontaneously hypertensive rats (SHR) and to test whether the neuroprotection of curcumine on transient brain ischemia/reperfusion injury in SHR is related to the nuclear pathway of JNK.METHODS:Male Wistar-Kyoto (WKY) rats and SHR were randomly divided into five groups (n = 6): WKY sham group (W-Sham), WKY ischemia/reperfusion group (W-I/ R), SHR sham group (S-Sham), SHR ischemia/reperfusion group (S-I/R) and SHR curcumine (a chinese traditional medicine)100 mg/kg treatment group (S-Cur), which were sacrificed at 2 h, 6 h, 24 h, 3 d and 7 d after reperfusion. Global brain ischemic model was established by 4-VO method. The TdT-mediated dUTP nick end labeling (TUNEL) method was used to detect the neuron apoptosis in hippocampal CA1 region. The immunohistochemical method was applied to investigate the expressions of c-jun and c-fos in hippocampal CA1 region.RESULTS:The expressions of apoptosis and c-jun and c-fos in CA1 region in S-Sham group, W-I/R group and S-I/R group were more than those in W-Sham group (P < 0.05), were significantly increased in S-I/R group than those in W-I/R group (P < 0.05), and were significantly decreased in S-Cur group than those in S-I/R group (P < 0.05).CONCLUSION:Neuronal apoptosis and the expressions of c-jun and c-fos are more in SHR hippocampal. Global brain ischemia/reperfusion injury induces more expressions of apoptosis in hippocampal neuron in SHR, and the more expressions of c-jun and c-fos may participate in that process. The neuroprotection of curcumine in SHR is related to c-jun and c-fos.

目的 探讨姜黄素对大鼠视网膜缺血再灌注后细胞凋亡及凋亡相关基因p53 表达的影响.方法 作大鼠视网膜缺血再灌注模型,并随机分为假手术组(SH组)、缺血再灌注组(IR组)、姜黄素处理组(CU组)和对照组(SC组),分别于再灌注后2、6、24、72h和7d时观察大鼠视网膜和视网膜毛细血管细胞的凋亡情况,并检测视网膜Caspase-3 酶的表达活性及p53基因的表达情况. 结果 各组模型均制作成功,细胞组织学检查可见CU组损伤明显轻于其他组.CU组视网膜和视网膜毛细血管的细胞凋亡数量均显著多于SH组(均P<0.01),但显著少于IR组(P<0.01);CU组p53表达水平及Caspase-3 酶活性均显著强于SH组(均P<0.01),但显著弱于IR组(P<0.01).结论 姜黄素对大鼠视网膜缺血再灌注损伤具有保护作用,调控凋亡相关基因p53 蛋白的表达可能是其作用机制之一.

Objective To investigate the effect of apoptosis-related gene p53 on the apoptosis of retinal capillary cells in rats with spontaneously hypertensive (SHR) after ischemic reperfusion injury. Methods A total of 60 SHR rats were randomly divided into sham group (SHR-SH) and retinal ischemie reperfusion group (SHR-RIR), which were subdivided into 5 subgroups according to the time after RIR: 2, 6, 24, and 72 hours and 7 days, with 6 rats in each subgroup. Another 60 Wistar-Kyoto (WKY) rats were divided into the same groups as the SHR rats as the control. The RIR model was set up. The apoptosis of retinal capillary cells was detected by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) methods and the expression of p53 was determined by streptavidin-perosidase (SP) immunohistochemistry. Results The apoptosis rate of retinal capillary cells in the 5 SHR-RIR groups was (8.64±0.56)%, (14.92±0.99)%, (24.72±2.98)%, (16.53±1.80)%, and (7.12±1.10)%,respectively. The expression of p53 in SHR-RIR groups increased at the 2nd hour after RIR, reached the peak at the 24th hour, kept the high level at the 72nd hour, and remained a little at the 7th day, which was significantly different from which in the SHR-SH groups (P<0. 01). The expression of p53 were higher in SHR-IR groups than that in the WKY-RIR groups (P<0. 01). Conclusions p53 may play a part in RIR injury by inducing or promoting apoptosis. The apoptosis of retinal capillary cells after RIR is more severe under the hypertension, and reaches the peak at the 24 hour after RIR.

Objective:To investigate the effect of vitamine B12(VitB12) on neuropathic pain in rats and measure the serumal Vit B12 concentrations.Methods:Thirty two male SD rats were randomly divided into 4 groups:Control group(Con),Sham operation group(Sham),Chronic constriction injury group(CCI)and VitB12 treated group(CCI+VitB12).CCI model was adopted,thermal withdrawal latency(TWL) and mechanical withdrawal threshold(MWT) of rats were measured at 1st,2nd day pre-operation and 1st,3th,5th,7th,10th,14th day post-operation.Serumal VitB12 concentration of rats were measured at 3rd,7th,14th day post-operation.Results:TWL and MWT in CCI group were significantly lower than those in Sham group at 3rd post-operation day(P<0.01);TWL in group CCI+VitB12 was higher than that in CCI group at 1st,3rd,10th,14th day post-operation,there was no significant difference in MWT between the two groups.There was no difference in serumal VitB12 concentration between Sham and Congroups(P>0.05);serumal VitB12 concentration in CCI group was lower at 3rd day post-operation than that in CCI group at 14th day post-operation(P<0.05),serumal VitB12 concentration in CCI group was lower than that in Sham,Con(P<0.05),CCI+VitB12 groups(P<0.01);Serumal VitB12 concentration in CCI+VitB12 group at 7th,14th day post-operation was significantly higher than that in Con,Sham and CCI groups(P<0.01).Conclusion:VitB12 can alleviate thermal hyperalgesia induced by CCI,but not the mechanical hyperalgesia;Serumal VitB12 concentration decreases in the early stage of nerve injury in CCI rats.