目的 探讨气腹状态下不同潮气量(VT)所对应每搏量变异度(SVV)之间的线性关系.方法 择期行腹腔镜结直肠根治术患者57例,在常规麻醉后通过FloTrac传感器进行每搏量变异度监测,在建立人工气腹并调整至Trendelenburg体位后对VT进行设置.按随机顺序设置为6、8、10 mL/kg(以标准体质量计算),记录每搏量变异度等相关数据.结果 随着VT增加,SVV呈进行性增加,且其数值之间有显著的相关性(SVV6与SVV8:r=0.927,P<0.01;SVV8与SVV10:r=0.926,P<0.01;SVV6与SVV10:r=0.867,P<0.01).结论 气腹状态下不同VT所对应SVV之间存在一定的线性关系.根据线性回归方程,可以基于给定VT的已知SVV来计算任何不同VT的SVV.

目的:探讨颈动脉校正血流时间(FTc)对剖宫产产妇腰-硬联合麻醉(CSEA)后低血压的预测价值.方法:择期行剖宫产术的足月单胎产妇122例,麻醉前超声测量并计算颈动脉FTc,记录麻醉前、麻醉10 min后的心率(HR)、收缩压(SBP)、舒张压(DBP).麻醉10 min内SBP下降30％或下降至80 mmHg(1 mmHg=0.133 kPa)以下为低血压.绘制麻醉前FTc预测麻醉后低血压的ROC曲线.结果:共有48例产妇发生低血压.与无低血压组(74例)相比,低血压组产妇ΔSBP、ΔDBP、ΔHR、颈动脉FTc升高(P<0.05).麻醉前颈动脉FTc预测麻醉后低血压的ROC曲线的AUC(95％CI)为0.926(0.864～0.965),诊断界值为327.15 ms,敏感度为0.896,特异度为0.797.结论:超声测量颈动脉FTc可用于剖宫产CSEA后低血压的预测.

Objective:To evaluate the role of spinal peroxisome proliferation-activated receptor-γ (PPAR-γ) in protectin D1 (PD1)-induced reduction of neuropathic pain (NP) in rats.Methods:Forty-eight clean-grade healthy male Sprague-Dawley rats, aged 6-8 weeks, weighing 200-250 g, were divided into 4 groups ( n=12 each) by a random number table method: sham operation group (Sham group), NP group, NP plus PD1 group (NP+ PD group), and NP plus PD1 plus GW9662 group (NP+ PD+ GW group). Neuropathic pain was induced by spared nerve injury in anesthetized rats.In NP+ PD and NP+ PD+ GW groups, PD1 900 ng (diluted to 20 μl in dimethyl sulfoxide [DMSO]) was intrathecally injected once a day for 8 consecutive days starting from 30 min before establishing the model.In NP+ PD+ GW group, the PPAR-γ antagonist GW9662 200 ng (diluted to 20 μl in DMSO) was intrathecally injected once a day for 8 consecutive days starting from 45 min before establishing the model.The equal volume of DMSO was intrathecally injected in Sham group.The mechanical paw withdrawal threshold (PWT) was measured before establishing the model and at 1, 3, 5, 7, 10 and 14 days after establishing the model.Six rats in each group were sacrificed on day 14 after establishing the model, and their lumbar enlargements were removed for determination of the expression of PPAR-γ, TNF-α and IL-6 by Weston blot.Six rats in each group were sacrificed on day 14 after establishing the model, L 4, 5 segments of the spinal cord were removed, and the co-expression of PPAR-γ with neuron-specific nucleoprotein (NeuN), glial fibrillary acidic protein (GFAP) or serum calcium binding adapter molecule 1 (Iba-1) was determined by immunofluorescence staining. Results:Compared with group Sham, PWT was significantly decreased at each time point after establishing the model, the expression of PPAR-γ was down-regulated, and the expression of TNF-α and IL-6 was up-regulated in the other three groups ( P<0.05). Compared with group NP, PWT was significantly increased at 7-14 days after establishing the model, the expression of PPAR-γ was up-regulated, and the expression of TNF-α and IL-6 was down-regulated in group NP+ PD, and no significant change was found in the parameters mentioned above in group NP+ PD+ GW ( P>0.05). Compared with group NP+ PD, PWT was significantly decreased at 7-14 days after establishing the model, the expression of PPAR-γ was down-regulated, and the expression of TNF-α and IL-6 was up-regulated in group NP+ PD+ GW ( P<0.05). The results of immunofluorescence staining of the spinal cord showed that PPAR-γ was co-expressed with NeuN and GFAP. Conclusion:The mechanism by which PD1 mitigates NP is related to promoting the activation of PPAR-γ in spinal cord neurons and astrocytes and inhibiting inflammatory responses in rats.

目的 探讨意识指数(IoC)监测在老年患者全身麻醉下腹腔镜肾部分切除术中的应用效果.方法 选择2019年9—11月郑州大学第一附属医院择期于全身麻醉下接受腹腔镜下肾部分切除手术的患者58例,采用随机数表法将患者分为两组,BIS组接受脑电双频指数(BIS)监测麻醉深度,IoC组接受IoC监测麻醉深度.记录术中麻醉药物用量、术毕苏醒时间和拔管时间;统计术中循环波动和不良反应发生率;于术前1 d及术后1、3、7 d应用简易精神状态量表(MMSE)进行评分.结果 IoC组术中丙泊酚、瑞芬太尼用量[(618.9±46.8)、(1.5±0.1)mg]少于BIS组[(673.8±38.8)、(1.6±0.1)mg],苏醒时间和拔管时间[(15.4±6.2)、(17.4±7.1)min]短于BIS组[(21.5±10.6)、(22.6±10.0)min],差异有统计学意义(P<0.05).IoC组术中循环波动发生率[10.0％(3/30)]与BIS组[25％(7/28)]比较,差异无统计学意义(P>0.05);IoC组不良反应发生率为0,BIS组为3.6％(1/28),组间比较,差异无统计学意义(P>0.05).IoC组术前及术后1、3、7 d的MMSE评分[(29.3±0.5)、(29.4±0.5)、(29.3±0.5)、(29.4±0.4)分]与BIS组[(29.3±0.4)、(29.1±0.5)、(29.3±0.5)、(29.3±0.5)分]比较,差异无统计学意义(P>0.05).结论 IoC监测可准确反映老年患者全身麻醉下行腹腔镜肾部分切除术的麻醉深度,且能明显减少麻醉药物用量,更好地维持术中血流动力学平稳,但对围手术期神经认知功能无明显影响.