异丙酚对小鼠海马脑片细胞外信号调节激酶ERK1/2磷酸化水平的影响

目的 观察异丙酚对小鼠海马脑片细胞外信号调节激酶ERK1／2磷酸化水平的影响。方法BALB／C小鼠，体重18～22g，雌雄不拘，迅速断头取脑，取海马用震动切片机切成450μm厚的脑片。量效实验随机将脑片分为空白对照组（C组）及不同浓度异丙酚组[10^-4mmol／L（P1组）、10^-5mmol／L（P2组）、10^-6mmol／L（P3组）、10^-7mmol／L（P4组）、10^-8mmol／L（P5组）、10^-8mmol／L（P6组）]；分别以不同浓度的异丙酚36℃恒温孵育海马脑片1h。时效实验应用5μmol／L异丙酚孵育脑片，分别于孵育即刻、1、2、5、7、9、12、15、30、60min取出脑片；取5μmol／L异丙酚孵育5min后的部分脑片，以人工脑脊液洗出异丙酚，分别于洗出2、4、7、10、25min取出脑片。应用SDS-PAGE和Westem blot生化技术及Gel Doc凝胶成像系统半定量检测小鼠海马p-ERKI／2水平。结果 异丙酚能降低ERK1／2磷酸化水平，降低呈时间、浓度依赖性（P〈0．05）。随异丙酚孵育5min后洗出时间延长，ERK1／2的磷酸化水平逐渐恢复，但洗出25min时仍明显低于药物处理前水平（P〈0．01）。结论 异丙酚能显著地抑制小鼠海马脑片细胞外信号调节激酶ERK1／2磷酸化水平。     

吗啡预处理-后处理对大鼠离体心脏缺血再灌注损伤的影响

Objective To evaluate the effects of morphine preconditioning-postconditioning on ischemia-reperfusion (I/R) injury in isolated rat hearts. Methods Male SD rats weighing 180-200 g were killed after intraperitoneal injection of heparin 500 U/kg. The hearts were immediately removed and perfused in a Langendorff apparatus with K-H solution gassed with 95%O2-5%CO2 .HR and left ventricular systolic pressure (LVSP) were measured from a fluid-filled latex balloon in the left ventricle. Global myocardial ischemia was induced by interrupting perfusion for 45 min followed by 60 min reperfusion. Forty isolated rat hearts were randomly divided into 5 groups (n = 8 each): group 1 (I/R); group II morphine preconditioning (M1 ); group Ⅲ morphine postconditioning (M2); group IV M1 + M2; group V 5-hydroxydecanoate (5-HD) + M2. Group M1 was perfused with K-H solution containing morphine 3.0 μmol/L for 20 min 30 min before ischemia followed by 10 min normal K-H solution perfusion. Group M2 was perfused with K-H solution containing morphine 3.0 μmol/L for 10 min at the beginning of reperfusion followed by 50 min normal K-H solution perfusion. Group 5-HD + M2 was perfused with K-H solution containing morphine 3.0 μmol/L+ 5-HD 10-4 mmol/L for 10 min at the beginning of reperfusion followed by 50 min normal K-H solution perfusion. Myocardial CK-MB activity was measured and myocardial infarct size (IS/AAR) detennined (by 2,3,5-triphenyl tetrazolium staining) at the end of 60 min reperfusion. Results The preconditioning, postconditioning and combination of preconditioning and postconditioning with morphine 3.0 μmol/L perfusion for 10 min all provided cardio-protective effects in terms of IS/AAR and myocardial activation of CK-MB. Conclusion Although the combination of morphine preconditioning and postconditioning can protect the heart against I/R injury, the effects are similar to those of either of them alone, and the reason may be that either of them alone protects the heart against I/R injury via activating mitoKATP .     

吗啡预处理-后处理对大鼠离体心脏缺血再灌注损伤的影响

Objective To evaluate the effects of morphine preconditioning-postconditioning on ischemia-reperfusion (I/R) injury in isolated rat hearts. Methods Male SD rats weighing 180-200 g were killed after intraperitoneal injection of heparin 500 U/kg. The hearts were immediately removed and perfused in a Langendorff apparatus with K-H solution gassed with 95%O2-5%CO2 .HR and left ventricular systolic pressure (LVSP) were measured from a fluid-filled latex balloon in the left ventricle. Global myocardial ischemia was induced by interrupting perfusion for 45 min followed by 60 min reperfusion. Forty isolated rat hearts were randomly divided into 5 groups (n = 8 each): group 1 (I/R); group II morphine preconditioning (M1 ); group Ⅲ morphine postconditioning (M2); group IV M1 + M2; group V 5-hydroxydecanoate (5-HD) + M2. Group M1 was perfused with K-H solution containing morphine 3.0 μmol/L for 20 min 30 min before ischemia followed by 10 min normal K-H solution perfusion. Group M2 was perfused with K-H solution containing morphine 3.0 μmol/L for 10 min at the beginning of reperfusion followed by 50 min normal K-H solution perfusion. Group 5-HD + M2 was perfused with K-H solution containing morphine 3.0 μmol/L+ 5-HD 10-4 mmol/L for 10 min at the beginning of reperfusion followed by 50 min normal K-H solution perfusion. Myocardial CK-MB activity was measured and myocardial infarct size (IS/AAR) detennined (by 2,3,5-triphenyl tetrazolium staining) at the end of 60 min reperfusion. Results The preconditioning, postconditioning and combination of preconditioning and postconditioning with morphine 3.0 μmol/L perfusion for 10 min all provided cardio-protective effects in terms of IS/AAR and myocardial activation of CK-MB. Conclusion Although the combination of morphine preconditioning and postconditioning can protect the heart against I/R injury, the effects are similar to those of either of them alone, and the reason may be that either of them alone protects the heart against I/R injury via activating mitoKATP .     

靶控输注异丙酚意识消失时血浆和效应室浓度的EC50与脑电双频谱指数的关系多中心大样本临床研究

目的 研究择期手术患者靶控输注（TCI）异丙酚意识消失时血浆、效应室靶浓度的50%患者意识消失时的药物浓度（EC50）与脑电双频谱指数（BIS）的关系。方法 5家医疗中心405例择期手术患者（国人）,ASAⅠ或Ⅱ级。靶控输注异丙酚,以血浆靶浓度1．2μg/ml为起点,到达预期血浆靶浓度后每30秒递增0．3μg/ml,直至患者意识消失。采用概率单位回归分析计算患者意识消失时异丙酚血浆靶浓度、效应室靶浓度的EC05、EC50和EC95及其所对应的BIS。结果 择期手术患者TCI异丙酚意识消失时异丙酚血浆靶浓度EC05、EC50和EC95分别是2．9μg/ml、3．8μg/ml和4．8μg/ml,效应室靶浓度EC05、EC50和EC95分别是1．3μg/ml、2．2μg/ml和3．2μg/ml,50%患者意识消失的BIS是58,5%和95%患者意识消失的BIS分别是77和40。结论 择期手术患者TCI异丙酚意识消失时血浆靶浓度和效应室靶浓度EC50及95%置信区间分别是3．8μg/ml（3．8～3．9μg/ml）和2．2μg/ml（2．2～2．3μg/ml）, 50%患者意识消失的BIS用95%置信区间是58（58～59）。     

可乐定对悬雍垂腭咽成形术患者麻醉恢复期应激反应的影响

悬雍垂腭咽成形术是重症阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的主要治疗手段.麻醉恢复期是急性气道梗阻、出血及心脑血管意外等严重并发症的高发期[1-3],有必要采取有效的措施以降低术后并发症的发生.研究表明,肾上腺素能α2受体激动剂可乐定具有镇静和抗伤害性作用,与麻醉药物复合应用时可产生协同效应[4].     

音乐治疗对眼底手术病人焦虑的影响

目的：在于观察经听觉通道输入音乐对眼底手术病人焦虑状态的影响。方法：实验对象为39名择期进行眼底手术的男性病人，他们被随机地分为实验和对照两组，其中实验组19人，对照组20人，在手术过程中通过耳机给患者输入他们自己选定的音乐、观察焦虑（STAI），抑郁（SDS），视觉模拟焦虑（VAS）和脑电（BI）的变化。结果：实验组STAI，SDS，VAS值与对照组比明显降低，病人的焦虑、抑郁情绪有了明显改善，而脑电的变化没有显著性的差异。结论：音乐治疗可降低择期眼底手术男性病人的焦虑、抑郁与视觉模拟焦虑水平。     

法乐四联症儿童肥厚右心室细胞瞬间外向钾电流的研究

目的观察压力增高导致的人肥厚心室组织离子通道的特性.方法应用酶解分离技术从法乐四联症(F4)患儿的心脏右室得到单个细胞,应用膜片钳全细胞记录技术观察了细胞Ito1的特征.结果将钙电流阻断后,去极化至-20mV～+60mV时均可记录到Itn1,激活后电流衰减速度不随去极化程度的增强而改变,在0、20、40、60mV时分别为123ms±6ms、131ms±10ms、122ms±6ms、122ms±6ms,去极化至60mV时的电流密度为4.7pA/pF±0.8pA/pF,半数最大激活电位为4.1mV±2.8mV,半数最大失活电位出现在-41mV±4mV,失活后再激活的恢复时间常数为83ms±4ms.这种电流可被10mM4-AP基本抑制.结论肥厚的人右室细胞存在Itn1,通道动力学特征与成人心房肌细胞类似.     

OSAHS患者术前体格情况、AHI指数及Mallampti分级关系的探讨

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)患者的体格情况、睡眠呼吸暂停低通气指数(apnea-hypopnea index,AHI)及Mallampati分级的关系.为OSAHS患者临床麻醉气道困难预测及疾病严重程度评估提供参考.方法 回顾性研究120例经睡眠呼吸监测中心多导睡眠监测诊断为重度OSAHS的男性成年患者,ASA Ⅱ～Ⅲ级,根据术前Mallampati分级分成4组(Ⅰ组即Mallampati Ⅰ级组,Ⅱ组即MallampatiⅡ级组,Ⅲ组即MallampatiⅢ级组,Ⅳ组即MallampatiⅣ级组).记录年龄、身高、体重(body weight,BW)、体重指数(body mass index,BMI)、术前最低血氧饱和度(the preoperative lowest oxygen saturation,LSAT-PREOP)、术前血红蛋白含量(hemoglobin,Hb)、AHI指数,并分析各指标与Mallampati分级的关系以及各指标与AHI指数的关系.结果 Ⅰ组分别与Ⅱ、Ⅲ、Ⅳ组,以及Ⅱ与Ⅳ组组间进行比较:BW、BMI差异有统计学意义(P＜0.05).Ⅰ、Ⅱ组分别与Ⅲ、Ⅳ组.以及Ⅲ与Ⅳ组组间进行比较:LSAT-PREOP、AHI指数差异有统计学意义(P＜0.05).患者BW、BMI、LSAT-PREOP、Hb、AHI指数与Mallampati分级有相关性(rs=0.371、0.346、-0.472、0.470、0.719).患者BW、BMI、LSAT-PREOP与AHI指数具有相关性(r=0.411、0.423、-0.551).结论 OSAHS患者的BW、BMI、LSAT-PREOP、AHI指数与术前Mallampati分级具有相关性,可为临床评估困难气道情况提供参考.Mallampati分级、BW、BMI、LSAT-PREOP对于预测OSAHS严重程度有一定参考价值.     

控制性降压麻醉在鼻内窥镜手术中的应用

鼻硬性内窥镜直视下进行各类复杂困难手术，出血多，止血困难。选５２例Ⅱ～Ⅳ期鼻窦炎、鼻息肉患者。随机分为降压组和对照组各２６例，在全麻下用硝普钠（０．５～５μｇ／ｋｇ／分钟）进行控制性降压，以减少术中出血。对降压组各项血流动力学和血气分析变化进行观察，结果表明降压组出血量比对照组减少４５％，手术时间缩短４２％，效果显著，无并发症。降压后心率（ＨＲ）增快，每搏量（ＳＶ）、心输出量（ＣＯ）、中心静脉压（ＣＶＰ）降低。表明有相对血容量不足的倾向，应注意充分扩容。     

心律平对缺血再灌注心脏保护作用的实验研究

目的 探讨心律平（抗心律失常药）对缺血再灌注心肌的保护效果.方法 大鼠24只,离体心脏灌注,随机分为试验组与对照组：2组均应用停跳液,心脏停跳后,停灌注120 min,再灌注30 min,实验组在停跳液中加入心律平.分别测定再灌注5,10,30 min时,左心室收缩功能（LVDPi）及冠脉流量（Vi）,检测冠脉流出液中CPK-MB、LDH、TnT量;再灌注30 min,取左心室前壁内膜,检查心肌超微结构变化.结果 再灌注5,10,30 min实验组左心肌收缩功能恢复均好于对照组;漏出液中CPK-MB、LDH、TnT含量均少于对照组组.实验组超微结构损害较对照组轻.结论 停跳液中加用心律平,可减少缺血再灌注损伤,有显著的心肌保护作用.