Objective:To evaluate the role of Nod-like receptor family pyrin domain-containing 2 (NLRP2) in the dorsal root ganglion (DRG) in neuropathic pain (NP) in rats.Methods:Thirty-two male Sprague-Dawley rats in which intrathecal catheters were successfully implanted, aged 2-3 months, weighing 200-250 g, were divided into 4 groups ( n=8 each) using a random number table method: sham operation group (S group), NP group, NP plus NLRP2-siRNA group (NP+ siRNA group) and NP plus NLRP2-scrRNA group (NP+ scrRNA group). The right sciatic nerve was only exposed but not ligated in group S. NP was induced by chronic constriction injury (CCI) to the sciatic nerve in anesthetized rats in group NP, group NP+ siRNA and group NP+ scrRNA.NLRP2-siRNA and NLRP2-scrRNA were intrathecally injected at 3 days before CCI in group NP+ siRNA and group NP+ scrRNA, respectively.The mechanical paw withdrawal threshold (MWT) was measured at 1 day before CCI (T 0) and 1, 3, 7 and 10 days after CCI (T 1-4). The rats were sacrificed after the last measurement of pain threshold, and the L 4, 5 segments of the DRG on the operated side were removed for determination of the expression of NLRP2 and caspase-1 (by Western blot), the expression of NLRP2 mRNA (by real-time polymerase chain reaction) and interleukin-1beta (IL-1β) content (by enzyme-linked immunosorbent assay). Results:The MWT was significantly lower at T 2-4 than at T 0 in group NP, group NP+ siRNA and group NP+ scrRNA ( P<0.05). Compared with group S, the MWT was significantly decreased at T 2-4, the expression of NLRP2 protein and mRNA and caspase-1 was up-regulated, and the content of IL-1β was increased in group NP ( P<0.05). Compared with group NP, the MWT was significantly increased at T 2-4, the expression of NLRP2 protein and mRNA and caspase-1 was down-regulated, and the content IL-1β was decreased in group NP+ siRNA ( P<0.05), and no significant change was found in the parameters mentioned above in group NP+ scrRNA ( P>0.05). Conclusion:NLRP2 in DRG is involved in the development of NP, and the mechanism is related to NLPR2 inflammasomes-induced peripheral neuroinflammation in rats.

目的 观察胃肠癌术后老年患者三个月内血压、心率变化及影响因素.方法 年龄≥60岁的胃肠癌择期手术患者42例(n=42),采取物联网智能语音电子血压计测量血压.测量时间:术前一天,术后当天及术后每周(每周至少三次以上)连续三个月,每周血压、心率取平均值记录.结果 术后三个月,收缩压和舒张压及心率变化整体呈下降趋势,术后第二周起的血压、心率与术前一天相比具有显著差异性(P<0.05).收缩压术后第7周达到最低,多因素分析表明术后收缩压变化与术前高血压、性别为女性相关(P<0.05).结论 胃肠癌术后老年患者三个月内的血压、心率显示下降趋势;胃肠癌老年患者术后收缩压变化与术前高血压及性别有一定关系;建议出院患者术后持续三个月以上监测血压和心率,并规范术后相关心血管药物的使用.

目的 探讨右美托咪定在肌间沟臂丛神经阻滞麻醉中的辅助镇痛效果观察.方法 选取2013-01/2018-12期间于我院接受肌间沟臂丛神经阻滞麻醉的60例患者作为研究对象,采用随机数表法分为对照组(n=30)和研究组(n=30),对照组予以患者氯化钠注射溶液行辅助镇痛,研究组予以患者右美托咪定行辅助镇痛,对比2组患者的麻醉持续时间、术后疼痛程度及术后24 h使用自控镇痛的药物剂量.结果 研究组患者麻醉持续时间长于对照组时间(P<0.05),研究组患者感觉阻滞起效时间以及运动阻滞起效时间均短于对照组时间(P<0.05);术中研究组患者收缩压(SBP)、 平均动脉压(MAP)及心率(HR)水平低于对照组(P<0.05);2组患者术后2 h的视觉模拟评分法(VAS)评分具有一致性(P>0.05),研究组患者术后12 h及术后24 h VAS评分均低于对照组(P<0.05).研究组术后患者自控镇痛(PCA)药物使用剂量低于对照组(P<0.05);研究组患者术后不良反应发生率为10.00％;对照组患者术后不良反应发生率为26.67％,组间比较差异有统计学意义(P<0.05).结论 右美托咪定在肌间沟臂丛神经阻滞麻醉中具有辅助镇痛效果,可有效加强麻醉阻滞效果,术中循环及血流动力学稳定,降低术后疼痛及术后不良反应发生情况.

目的 探讨脉冲式全自动注药泵用于硬膜外分娩镇痛中的价值.方法 选取该院2018年1月-2019年6月接收的行硬膜外分娩镇痛产妇60例作为研究对象,采用数字法随机分为对照组和观察组,各30例,对照组采用常规全自动注药泵镇痛,观察组采用脉冲式全自动注药泵镇痛,对两组镇痛情况、分娩情况进行比较分析.结果 两组镇痛前、镇痛后5 min的视觉模拟评分法(VAS)评分比较差异无统计学意义(P＞0.05),观察组镇痛后15 min、30 min的VAS评分分别为(1.82±0.65)、(0.71±0.42)分,显著低于对照组(2.43±0.72)、(1.29±0.56)分(t=3.444、4.538,P＜0.05);观察组剖宫产率、缩宫素使用率为3.33％、13.33％,比对照组20.00％和36.67％明显更低(x2=4.043、4.355,P＜0.05).结论 硬膜外分娩镇痛采用脉冲式全自动注药泵能够提高镇痛效果,降低剖宫产率,减少缩宫素的使用.

Objective To evaluate the effect of hydrogen sulfide on myocardial exogenous apoptotic pathway in a rat model of hemorrhagic shock and resuscitation.Methods Sixty clean-grade healthy male Sprague-Dawley rats,aged 8 weeks,weighing 250-300 g,were divided into 4 groups (n =15 each) using a random number table method:sham operation group (group S),sham operation plus sodium sulphid (NaHS) group (group S+NaHS),hemorrhagic shock group (HS group),and hemorrhagic shock plus sodium sulphid group (group HS+NaHS).Rats only underwent arterial and intravenous puncture in group S.Hemorrhagic shock was induced by withdrawing blood from the femoral artery until mean arterial pressure (MAP) was reduced to 35-40 mmHg within 10 min and maintained for 1.5 h.NaHS 28 μmol/kg was intraperitoneally injected at 10 min before resuscitation in group HS+NaHS.The equal volume of NaHS was administered at the same time in group S+NaHS.Immediately before blood letting and at 0,1.5,2,3,4 and 6 h after blood letting (T1-5),MAP was recorded and blood samples were collected from the femoral vein for determination of serum creatine kinase (CK) and lactate dehydrogenase (LDH) concentrations by chemical colorimetry.Rats were then sacrificed and hearts were removed for examination of the pathological changes of myocardial tissues (with a light microscope) and for determination of cell apoptosis (by TUNEL),expression of caspase-3 and caspase-8 (by Western blot) and expression of Fas and FasL (by immunohistochemistry).Apoptosis index was calculated.Results Compared with group S,MAP was significantly decreased at T1-5,the serum CK and LDH concentrations at T1-5 and apoptosis index at T5 were increased,and the expression of Fas,FasL,caspase-3 and caspase-8 was up-regulated in group HS (P＜ 0.05).Compared with group HS,MAP was significantly increased at T1-3,the serum CK and LDH concentrations at T3-5 and apoptosis index at T5 were decreased,and the expression of Fas,FasL,caspase-3 and caspase-8 was down-regulated in group HS+NaHS (P＜0.05).The pathological changes of myocardial tissues were significantly attenuated in group HS+NaHS when compared with group HS.Concclusion The mechanism by which hydrogen sulfide attenuates myocardial injury induced by hemorrhagic shock and resuscitation is associated with inhibiting the exogenous apoptotic pathway in rats.

目的 探讨射频消融联合臭氧治疗神经根型颈椎病的临床效果.方法 采用射频消融联合臭氧治疗颈椎病36例.射频消融:在C型臂X射线机辅助下定位穿刺,置入射频电极,测阻抗在150～250 Ω;分别用高频50Hz、0.5～2.0 mA低电流行感觉测试,低频2 Hz、0.5～2.5 mA高电流行运动测试;若无异常反应后,则行60℃、70℃和80℃各60 s,85℃治疗120 s.臭氧治疗:射频结束后,拔出电极,抽臭氧(60 mg/ml)共3～5 ml,缓慢推注.术后24 h、1周、1个月和6个月随访疗效.结果 术后24 h、1周、1个月和6个月的有效率分别为97.2％、94.4％、94.4％和94.4％,优良率分别为94.4％、88.8％、80.5％和86.1％.随访期未见并发症.结论 射频消融联合臭氧治疗神经根型颈椎病安全、有效.

目的 比较下肢神经阻滞和硬膜外麻醉对高龄髋关节手术患者血流动力学的影响.方法 择期高龄行髋部手术的患者40例随机均分为腰丛-坐骨神经-椎旁神经阻滞(A组)和硬膜外麻醉(B组).记录麻醉前(T0)、麻醉给药后10 min(T1)、20 min(T2)、30 min(T3)和60 min(T4)的收缩压(SBP)、舒张压(DBP)、HR、心输出量(CO)和体循环阻力(SVR).结果 A组SBP、DBP、HR、CO和SVR各时间点均无统计学差异(P＞0.05).B组T2-T4的SBP和DBP低于T0(P＜0.05);B组T3时的CO为(3.52±0.78) L/min,低于T0时的(4.30±1.30) L/min和A组T3时的(4.28±0.89) L/min(P＜0.05).结论 下肢神经阻滞对高龄患者髋关节手术的血流动力学影响较硬膜外麻醉小.

目的 观察椎旁阻滞治疗神经根型颈椎病的疗效.方法 将120例神经根型颈椎病患者随机分为治疗组和对照组,治疗组采用椎旁神经阻滞,对照组采用口服药物加牵引热敷,治疗效果分为3级:痊愈、显效、无效.结果 治疗组的总有效率90％,对照组总有效率68.3％,两组间差异明显(P＜0.01).结论 椎旁神经阻滞治疗神经根型颈椎病疗效高.

目的 探讨射频消融联合臭氧治疗腰椎间盘突出症的临床效果.方法 采用射频消融联合臭氧治疗腰椎间盘突出症48例.射频消融:在C型臂X线机辅助下定位穿刺,置入射频电极,测阻抗在150-250Ω时,分别用高频(50Hz)低电流(0.5-2.0 mA)行感觉测试和低频(2 Hz)高电流(0.5-2.5 mA)行运动测试后行60℃、70℃、80℃分别治疗60 s,然后再用90℃治疗120 s.臭氧治疗:射频结束后拔出电极,置入穿刺针芯继续刺入椎间盘髓核内,抽臭氧5-10 ml,缓慢推注；退针至椎间盘外硬膜外前间隙,注入消炎镇痛液10 ml.术后1周、1个月、6个月和12个月随访4次,评估疗效.结果 术后1周、1个月、6个月和12个月的有效率分别为91.6％、79.2％、87.5％和89.6％,优良率分别为70.8％、60.4％、77.1％和75.o％.无不良反应.结论 射频消融联合臭氧治疗腰椎间盘突出症疗效稳定可靠,无不良反应.

屈指肌腱腱鞘炎,又称屈指肌腱狭窄性腱鞘炎,是手部软组织损伤的常见病症,好发于中老年,且以女性居多,常见于拇指、中指和环指.病变易发生于掌骨头相对应的屈指肌腱纤维鞘管的部位,在伸屈活动中常发生"咔嗒"弹响声和扳机样屈伸,故名"弹响指"、"扳机指".该疾病采用以局部注射为主的保守治疗常能取得较好的疗效,但复发率较高[1].开放手术可以治疗本病,但易引发感染、神经损伤、疤痕疼痛和关节挛缩等并发症,影响患者对手术的依从性[2-3].本研究采用针刀松解加局部注射的方法治疗狭窄性腱鞘炎,取得了良好效果,现报告如下.

下腰痛是骨科和疼痛科门诊中常见的疾患,极大地影响患者的生存质量和劳动能力.临床报道患病率从11.8%～40%不等.以往多认为椎间盘突出是间盘疾病导致下腰痛的先决条件,但最近研究表明,即使没有椎间盘突出,发生于椎间盘内部的病变也能引起下腰痛,它与椎间盘自身结构病变有关,这种因椎间盘病变引起的腰痛称为腰椎间盘源性下腰痛.(Discogenic Low Back Pain)[1～3].经皮穿刺臭氧治疗即利用臭氧具有氧化髓核内蛋白多糖的能力,具有抗炎和镇痛作用,从而消除椎间盘内的炎症、降低椎间盘内压力,从而改善临床症状

目的探讨在脑动脉瘤开颅术中采用瑞芬太尼和硝普钠控制性降压效果。方法择期行脑动脉瘤开颅切除术患者30例,ASA分级Ⅱ～Ⅲ级,随机分为瑞芬太尼(R组)和硝普钠组(N组),每组15例。两组于切皮前即刻开始降压,R组持续静脉输注瑞芬太尼0.3-0.7ug·kg-1·min-1,N组持续静脉输注硝普钠0.5-6.0ug·kg-1·min-1。使MAP降至术前基础值的70%左右(60-70mmHg)并维持至术毕,分别于控制性降压前(T0),控制性降压20min(T1)、40min(T2),术毕(T3)时记录MAP、HR,并于上述各时点抽取动脉血,进行血气分析,测定Hb、Hct、血乳酸(Lac)水平;记录开始降压至目标血压所需的时间,停降压药后MAP恢复的时间,以及术中的出血量,输血量。结果两组降压诱导时间,MAP恢复时间差异无统计学意义(P>0.05),与N组比较,R组T1,T2时HR降低(P<0.01),R组出血量减少(P<0.05)。N组有4例患者使用艾司洛尔。N组T3时有2例患者发生反跳性高血压,R组无一例发生。两组术后均未见并发症。结论脑动脉瘤开颅术中持续静脉输注瑞芬太尼0.3-0.7ug·kg-1·min-1,控制性降压可控性好,降压及恢复平稳,且血液保护作用好于硝普钠。

目的比较不同浓度局麻药配伍用于腋路臂丛神经阻滞的效果。方法选择期单侧前臂手术的患者60例,随机分为两组(n=30):高浓度组(0.5%利多卡因+0.375%罗哌卡因)和低浓度组(0.25%利多卡因+0.25%罗哌卡因)。均给予腋路臂丛神经阻滞,自注入局麻药后的30分钟内,每隔5分钟评价臂丛神经支配区域的感觉,运动阻滞情况。记录臂丛神经阻滞(感觉和运动)起效时间和作用持续时间以及术中及术后并发症。结果两组患者术中和术后均未出现并发症。与高浓度组比较,低浓度组感觉,运动阻滞起效时间延长(P<0.05),但两组感觉,运动阻滞作用时间比较差异无统计学意义(P>0.05)。结论采用低浓度的局麻药配伍(0.25%利多卡因+0.25%罗哌卡因)即可提供满意的麻醉效果。