氯胺酮对单肺通气患者围术期炎性细胞因子和自由基的影响

目的观察氯胺酮对单肺通气(OLV)患者围术期炎性细胞因子和自由基的影响。方法拟行肺叶切除术肺癌患者24例,随机均分为氯胺酮组(K组)和对照组(C组)。两组患者分别在麻醉诱导后(T1)、OLV45min(T2)、90min(T3)及术后2h(T4)采取静脉血,测定血清肿瘤坏死因子α(TNF-α)、白细胞介素(IL)-6、IL-8、IL-10浓度、超氧化物歧化酶(SOD)活性及丙二醛(MDA)浓度。结果两组TNF-α、IL-6和IL-8于T2时明显上升(P<0.05),IL-10于T3时明显上升(P<0.05)。K组T3、T4时TNF-α、IL-6和IL-8均明显低于C组(P<0.05),而IL-10高于C组(P<0.05)。两组MDA在T3、T4时显著升高(P<0.05),K组在T3、T4时显著低于C组(P<0.05)。两组SOD在T3、T4时较T1时降低(P<0.05),K组在T3、T4时高于C组(P<0.05)。结论氯胺酮可减轻OLV患者肺的炎性反应。     

氨溴索预先给药对单肺通气患者炎性反应及脂质过氧化反应的影响

目的 评价氨溴索预先给药对单肺通气患者炎性反应及脂质过氧化反应的影响.方法 选择开胸手术患者45例,年龄37～64岁,体重53～65 kg,ASAⅠ或Ⅱ级,随机分为3组(n=15),双肺通气组(TLV组)、单肺通气组(OLV组),单肺通气+氨溴索组(OLV+AMB组)于单肺通气前25 min开始静脉输注氨溴索1 mg/kg(100 ml,4 ml/min),TLV组和OLV组静脉输注等容量生理盐水.OLV组和OLV+AMB组于麻醉诱导前(T0)、单肺通气前即刻(T1)、单肺通气0.5 h(T2)、1 h(T3)、2 h(T4)、恢复双肺通气后1 h(T5)、2 h(T6)和术后24 h(T7)时,TLV组于上述对应时点,采集桡动脉血样,测定血清TNF-α、IL-6、IL-8浓度和SOD活性,进行WBC和中性粒细胞(PMN)计数.结果 与TLV组比较,OLV组血清IL-6、IL-8、TNF-α浓度升高,SOD活性降低,WBC和PMN计数升高(P<0.05或0.01);与OLV组比较,OLV+AMB组血清IL-6、IL-8和TNF-α浓度降低,SOD活性升高,WBC和PMN计数降低(P<0.05或0.01).结论 氨溴索1 mg/kg预先给药可减轻单肺通气患者炎性反应及脂质过氧化反应.     

丙泊酚或异氟醚麻醉对单肺通气时氧化应激反应的影响

目的 观察丙泊酚或异氟醚麻醉对单肺通气(OLV)时氧化应激反应的影响.方法 48例择期行食管癌根治术患者,随机分为丙泊酚单肺通气组(Pro-OLV组)、异氟醚单肺通气组(Iso-OLV组)、丙泊酚双肺通气组(Pro-TLV组)和异氟醚双肺通气组(Iso-TLV组),每组12例.于开胸前(T0)、OLV后(TLV组于开胸后)30 min(T1)、90 min(T2)、150 min(T3)、手术结束时(T4)测定血清超氧化物歧化酶(SOD)、丙二醛(MDA)及NO浓度.结果 与T0时比较,OLV组T1～T4时的SOD活性降低,MDA浓度及NO浓度升高(P<0.01),而TLV组无明显变化.与TLV组比较,OLV组T1～T4时的SOD活性降低,MDA及NO浓度升高(P<0.01).结论 丙泊酚或异氟醚麻醉均不能减轻OLV时氧化应激反应.     

多索茶碱在食管癌根治术中的肺保护作用

目的探讨多索茶碱对食管癌根治术患者所致肺损伤的保护作用。方法选取择期全麻下行中下段食管癌根治术患者60例,男35例,女25例,年龄45~70岁,BMI 20~30kg/m~2,ASAⅠ或Ⅱ级,一秒用力呼气容积/用力肺活量(FEV_1%)50%。采用随机数字表法将患者分为两组:多索茶碱组(D组)和对照组(C组),每组30例。两组常规静脉诱导后,予以右侧双腔支气管插管后机械通气。D组于双腔支气管插管后静脉滴注多索茶碱4 mg/kg,30 min内滴注完毕,C组静脉滴注等量的生理盐水。在单肺通气(OLV)前10 min(T_0)、OLV后60 min(T_1)、双肺通气后(T_2)及手术结束(T_3)采集桡动脉血检测血清超氧化物歧化酶(SOD)活性和TNF-α、IL-6、IL-10、丙二醛(MDA)浓度,并检测各时点的血气。记录术中OLV时间、失血量、补液量和尿量,观察术后低氧血症、肺部炎症等不良反应的发生情况。结果与T_0时比较,T_1~T_3时两组血清SOD活性和PaO_2明显降低,TNF-α、IL-6、IL-10和MDA浓度均明显升高(P0.05)。与C组比较,T_1~T_3时D组血清SOD活性和PaO_2明显升高,TNF-α、IL-6、IL-10和MDA浓度明显降低(P0.05)。D组术后低氧血症和肺部炎症发生率明显低于C组(P0.05)。结论多索茶碱可抑制食管癌根治术患者OLV后的炎症反应和氧化应激反应,降低术后低氧血症、肺部炎症的发生率,减轻食管癌根治术引发的肺损伤。     

单肺通气肺叶切除术时动脉血TNF-α、IL-6和IL-8的变化

目的观察单肺通气(OLV)肺叶切除术时动脉血肿瘤坏死因子α(TNF-α)、白细胞介素(IL)-6和IL-8的变化。方法肺叶切除术患者20例分为OLV组和双肺通气(TLV)组,分别于麻醉前(T0)、机械通气后30min(T1)、1h(T2)、2h(T3)、胸内操作结束后1h(T4)、2h(T5)、术后24h(T6)、48h(T7)采桡动脉血测定TNF-α、IL-6和IL-8。结果OLV组TNF-α在T3时开始上升,T7达峰值,且明显高于TLV组(P<0·05)。两组IL-6和IL-8均在T2时开始上升(P<0·05),T5时达高峰,T6、T7时回降,但仍高于T0(P<0·05)。OLV组T3~T6时IL-6和IL-8均高于TLV组(P<0·05)。结论OLV和TLV均可导致动脉血IL-6和IL-8升高,OLV更显著;OLV可致TNF-α升高。     

氨溴索对单肺通气患者围术期炎性反应的抑制作用

目的 评价小剂量氨溴索对单肺通气(OLV)患者炎性反应的影响.方法 剖胸手术OLV患者30例,随机均分为两组:A组于OLV前25 min静脉输注氨溴索1 mg/kg(生理盐水稀释至100 ml,5 ml/min),B组静脉输注等容量生理盐水作为对照.于麻醉诱导前(T0)、OLV前即刻(T1)、OLV 30min(T2)、1 h(T3)、2 h(T4)、恢复双肺通气(TLV)1 h(T5)、2 h(T6)和术后24 h(T7)采集桡动脉血样,测定血清肿瘤坏死因子α(TNF-α)、白细胞介素(IL)-6、IL-8的浓度,并行WBC和中性粒细胞(PMN)计数.结果 与B组比较,A组的IL-6在T5～T7时、IL-8在T3～T7时、TNF-α在T4～T7时、WBC计数在T4～T7时、PMN计数在T5～T7时均降低(P<0.05或P<0.01).结论 氨溴索1 mg/kg可减轻OLV患者炎性反应.     

肢体缺血预处理对兔肺组织缺血再灌注后氧自由基及细胞因子分泌的影响

目的 研究肢体缺血预处理对兔肺组织缺血再灌注后氧自由基及细胞因子分泌的影响.方法 将18只日本大耳白兔随机分为对照组(C组)、缺血再灌注组(I/R组)及肢体缺血预处理组(L组),每组6只.实验结束时,取肺组织测定湿/干重比(W/D)、超氧化物歧化酶(SOD)和髓过氧化物酶(MPO)活性、丙二醛(MDA)和肿瘤坏死因子(TNF)-α、白介素(IL)-6、IL-8及IL-10的含量;检测支气管肺泡灌洗液和血清中蛋白含量,计算肺通透性指数;观察肺组织病理学变化.结果 与I/R组比较,L组W/D、肺通透性指数、MPO活性、MDA和TNF-α、IL-6、IL-8的含量均降低(P<0.05),SOD活性(P<0.05)和IL-10含量升高(P<0.01).C、L两组间上述指标的差异无统计学意义(P>0.05).光镜榆查结果发现L组肺组织病理学改变较I/R组明显减轻.结论 肢体缺血预处理可以抑制缺血再灌注肺组织中氧自由基产生和促炎细胞因子TNF-α、IL-6、IL-8的释放,上调抗炎细胞因子IL-10的合成,从而减轻肺缺血再灌注损伤.     

不同压力持续气道正压对单肺通气氧化应激反应的影响

目的比较不同压力持续气道正压(CPAP)对单肺通气氧化应激反应的影响。方法择期行食管癌根治术患者48例,随机均分为双肺通气组(A组)、单肺通气组(B组)、单肺通气非通气肺给予2cmH2OCPAP组(C组)及5cmH2OCPAP组(D组)。分别于开胸前(T0)、单肺通气后(A组于开胸后)30min(T1)、90min(T2)、150min(T3)、手术结束(T4)时测定血清超氧化物歧化酶(SOD)活性、丙二醛(MDA)、NO浓度。结果 T1～T4时B、C组及T2～T4时D组的SOD活性明显低于A组,T1～T4时B、C、D组MDA及NO浓度高于A组(P0.05)。T1～T4时C、D组MDA及NO浓度均显著低于B组(P0.05),T3时C、D组SOD活性显著高于B组(P0.05);T3时D组MDA及NO浓度高于C组(P0.05)。结论 CPAP能减轻单肺通气氧化应激反应,且2cmH2OCPAP优于5cmH2OCPAP。     

雾化吸入小剂量氨溴索对开胸食道手术患者单肺通气时炎性反应的影响

目的 评价雾化吸入氨溴索对开胸食道手术患者单肺通气时炎性反应的影响.方法 择期行开胸食道手术患者60例,ASA分级Ⅰ或Ⅱ级,年龄39～64岁,体重50～85 kg,身高153～181cm.采用随机数字表法,将患者随机分为3组(n=20):对照组(C组)、静脉输注氨溴索组(IA组)和雾化吸入氨溴索组(AIA组).单肺通气前10 min,C组静脉输注生理盐水250 ml;IA组静脉输注氨溴索10mg/kg(用生理盐水稀释至250 ml);AIA组采用自制装置氧气驱动雾化吸入氨溴索4 ml(30 mg)+生理盐水2 ml,氧流量5～6 L/mim.于麻醉诱导后给药前1 min(T0)、单肺通气90 min(T,)和恢复双肺通气30 min(T2)时,采集桡动脉血样,采用双抗体夹心ELISA法测定血清TNF-α、IL-1β、IL-8和IL-10的浓度.结果 与T0时比较,各组T1和T2时血清TNF-α、IL-1β、IL-8的浓度升高,IL-10浓度降低(P＜0.05);与C组比较,LA组和AIA组T1和T2时血清TNF-α、IL-1β、IL-8的浓度降低,IL-10浓度升高(P＜0.05);IA组和AIA组各时点血清TNF-α、IL-1β、IL-8、IL-10的浓度差异无统计学意义(P＞0.05).结论 雾化吸入小剂量氨溴索可抑制开胸食道手术患者单肺通气导致的炎性反应,且与静脉注射大剂量氨溴索效果相似.

Abstract：

Objective To investigate the effects of inhaled aerosolized low dose ambroxol on the inflammatory response to one-lung ventilation ( OLV) in patients undergoing open-chest esophagus surgery. Methods Sixty patients with normal heart and lung function undergoing open-chest esophagus surgery were randomly divided into 3 groups ( n = 20 each): control group (group C) ; group IA received Ⅳ ambroxol 10 mg/kg after induction of anesthesia and group AIA inhaled aerosolized ambroxol 30 mg after induction of anesthesia. Arterial blood samples were taken after induction of anesthesia before ambroxol administration (T0, baseline) , at 90 min of OLV (T1 )and at 30 min after OLV (T2) for determination of plasma concentrations of TNF-α, IL-1β, IL-8 and IL-10 by ELBA.Results Plasma TNF-α, IL-1β, and IL-8 concentrations were significantly increased while plasma IL-10 concentration was significantly decreased at T1 and T2 as compared with the baseline at T0 in all 3 groups. Plasma TNF-α, IL-1β, and IL-8 concentrations were significantly lower and plasma IL-10 concentration was significantly higher at T1 and T2 in groups IA and AIA than in group C. Conclusion Both Ⅳ large dose ambroxol and inhaled aerosolized low dose ambroxol can inhibit the inflammatory response to OLV in patients undergoing open-chest esophagus surgery.     

空气肺复张对食管癌根治术患者单肺通气后肺组织氧化应激损伤的影响

目的 评价空气肺复张对食管癌根治术患者单肺通气后肺组织氧化应激损伤的影响.方法 择期拟行食管癌根治术患者24例,ASA Ⅱ或Ⅲ级,年龄40～60岁,体重44～65 kg,随机分为2组(n=12),纯氧肺复张组(纯氧组):术中单肺通气结束肺复张时以纯氧膨肺;空气肺复张组(空气组):术中单肺通气结束肺复张时以空气膨肺.于单肺通气开始即刻(T_1)、单肺通气转为双肺通气即刻(T_2)和单肺通气转为双肺通气后30 min(T_3)时,抽取肘静脉血样,测定血浆蛋白羰基浓度,血清丙二醛(MDA)浓度和超氧化物歧化酶(SOD)活性.术后2 h时,抽取桡动脉血样,测定肺氧合指数.结果 与T_1和T_2时比较,纯氧组T_3时血浆蛋白羰基浓度和血清MDA浓度升高,血清SOD活性降低(P<0.05),空气组T_3时各指标差异无统计学意义(P>0.05).与纯氧组比较,空气组T_3时血浆蛋白羰基浓度和血清MDA浓度降低,血清SOD活性升高,术后2 h时肺氧合指数升高(P<0.05).结论 空气肺复张可减轻食管癌根治术患者单肺通气后肺组织氧化应激损伤,对术后肺功能具有一定的保护作用.     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.     

Similarities and differences between female and male sexual functions and dysfunctions

Men and women have 23 pairs of chromosomes. They share 22 of them. In physiologic conditions they differ systematically in only one pair, the sexual one. Females (normally) have what is called an “XX” on the 23rd pair of chromosomes, whereas males have an “XY” pair. The striking sexual differences –anatomic, functional, reproductive, psychological and sociocultural - between men and women depends on or derive from the difference in one critical chromosome out of 46, which contains on average 2% of all the genetic code. Biochemical, neuroendocrine, hormonal, vascular, nervous, and metabolic similarities that both sexes share, based on the common 45 chromosomes and related biologically determined similarities contributing to the secret sexual symmetry between genders, is reviewed. Furthermore the role of the genetically determined brain and somatic gender dymorphism, contributing to gender sexual differences is analyzed. Neuroplasticity and psychoplasticity are praised as basic mechanisms that bridge together and re-shape the individual biological and psychological world through the continuous interaction with the environment. Enhancement of sexual differences in behaviour, meaning of, and motivation to sex by cultural constructs, by religious and social dynamics, and the continuous interaction of each person with a usually role-polarized society during the whole life span will be finally acknowledged. To contribute to a better understanding of the shared biological sexual similarities between genders and their dialectic and continuous relation with biological and socioculturally related sexual differences is the ultimate goal of this introductory article and the following papers of the series.