纤维支气管镜引导下经鼻气管插管28例体会

目的探讨纤维支气管镜引导下经鼻气管插管的应用价值.方法对28例纤支镜引导下经鼻气管插管应用进行总结分析.结果 28例插管均一次成功,费时30秒至2分钟,平均约1分钟,未出现严重并发症.结论纤维支气管镜引导下经鼻气管插管成功率高,插管时间短,痛苦轻,损伤小,风险小,留置时间长,有较高的应用价值.     

纤维支气管镜引导下经鼻气管插管28例体会

目的 探讨纤维支气管镜引导下经鼻气管插管的应用价值．方法 对28例纤支镜引导下经鼻气管插管应用进行总结分析．结果 28例插管均一次成功，费时30秒至2分钟，平均约1分钟，未出现严重并发症．结论 纤维支气管镜引导下经鼻气管插管成功率高，插管时间短，痛苦轻。损伤小，风险小，留置时间长，有较高的应用价值．     

插管型喉罩air-Q与i-gel引导气管插管临床效果的比较

目的比较插管型喉罩air-Q和i-gel引导气管插管的临床效果。方法择期全麻气管插管手术患者80例,随机分为两组,分别采用air-Q(A组)和i-gel(I组)引导气管插管。记录喉罩置入次数和时间、盲探气管插管次数和时间。若盲探失败,改由纤维光导支气管镜经喉罩引导气道插管。结果 80例患者均成功置入喉罩,A组和I组喉罩置入时间分别为(19±5)s和(21±6)s,首次置入成功率分别为82.5%和77.5%。A组盲探气管插管的总时间显著短于I组[(95±28)s比(113±39)s](P0.05),A组盲探气管插管的总成功率显著大于I组(92.5%比72.5%)(P0.05)。所有盲探失败的病例均成功使用纤维光导支气管镜完成经喉罩引导气管插管。结论相比i-gel喉罩,air-Q喉罩盲探气管插管的成功率更高,时间更短。     

逆行牵拉技术在大鼠气管插管中的应用

目的探讨逆行牵拉技术在大鼠气管插管中的应用价值。方法80只SD大鼠，24号留置针穿刺气管环状软骨缝隙，金属丝通过留置针经气管逆行至口腔，引导气管插管进入气管。结果一次性穿刺气管成功75只大鼠，3只大鼠导丝逆行时有阻力，后证实进入鼻腔或上颚孔，退出一段后调整导丝角度后成功进入口腔后插管成功。2只大鼠插管时有阻力，牵拉鼠舌及左颊部暴露口腔后插管成功；该操作只需时间（1±0．5）min，一人操作即可完成。无1例失败，成功率为100％。结论此种大鼠气管插管术无需特殊辅助设备，是一简单、快速、安全、可靠、值得推广的大鼠气管插管方法。     

气管插管困难的处理

气管内插管是保持上呼吸道通畅的最可靠手段，是临床麻醉中的一个重要组成部分，它不仅广泛用于麻醉实施，而且在危重病人呼吸循环的抢救复苏及治疗中发挥重要作用。在与麻醉有关的死亡病例中，大约30％是由于困难呼吸道管理不当造成的。随着麻醉技术的开展，临床上气管内插管的应用越来越广泛。困难气管插管的发生率有时高达3％，是麻醉医生常遇到的问题。困难气管插管是指气道因解剖异常或病理改变而导致在普通喉镜直视下3次不能将气管导管顺利插入气管内或插管时间超过10min。一些病人体征明显，麻醉前容易引起重视，但有些病人外表似乎正常，仍有可能给插管带来意想不到的困难，若插管前未能料及，并且处理不当，则有死亡的潜在危险。现将气管插管困难及处理综述如下：     

喉罩引导困难气管插管

目的探讨喉罩(LMA)引导气管插管用于困难气管插管的可行性.方法对10例困难气管插管的病人进行喉罩引导气管插管.结果经喉罩引导一次气管插管成功7例(70.0%),二次成功3例(30.0%).结论经喉罩引导气管插管用于困难气管插管是一种安全而可靠的方法.     

喉罩引导困难气管插管

目的　探讨喉罩 (LMA)引导气管插管用于困难气管插管的可行性 .方法　对 10例困难气管插管的病人进行喉罩引导气管插管 .结果　经喉罩引导一次气管插管成功 7例 (70 .0 % ) ,二次成功 3例 (30 .0 % ) .结论　经喉罩引导气管插管用于困难气管插管是一种安全而可靠的方法     

光导管芯引导气管插管的可行性与安全性研究

目的 对光导管芯引导气管插管操作方法的可行性及安全性进行探讨和评价. 方法 240例拟行气管插管的全麻患者,麻醉前预测是否为困难插管条件,分为光导管芯正常插管组、光导管芯困难插管组、喉镜明视正常插管组和喉镜明视困难插管组,每组60例.光导管芯正常插管组和光导管芯困难插管组用光导管芯引导气管插管,喉镜明视正常插管组和喉镜明视困难插管组在喉镜明视下插管,观察记录插管时间、插管次数、插管成功率、血液动力学改变及不良反应. 结果光导管芯正常插管组、光导管芯困难插管组、喉镜明视正常插管组和喉镜明视困难插管组的插管成功例数分别为60、60、60和56,喉镜明视对血液动力学的改变与光导管芯插管比较有显著性差异(P<0.05).结论 光导管芯引导气管插管技术可行性强、安全性高,可作为常规气管插管技术及困难气道、插管困难时的首选方法.     

经口腔气管插管的多元回归方程及其临床意义

目的为经口腔气管插管到气管隆嵴提供解剖学依据。方法测量20具防腐标本的切牙到气管隆嵴、胸骨颈静脉切迹到剑胸结合部、胸骨颈静脉切迹到耻骨联合上缘的长度,并建立多元回归方程。结果多元回归方程为=38.34-0.55X1-0.07X2。结论当进行经口腔气管插管到气管隆嵴时,可根据上述方程估计插管长度。     

纤支镜引导经鼻气管插管抢救呼吸衰竭临床分析

目的观察纤支镜引导经鼻气管插管在临床中抢救呼吸衰竭患者的应用价值。方法对40例重症呼吸衰竭患者采用纤支镜引导经鼻气管插管并进行机械通气,对成功率、操作时间、临床表现及血气指标的变化、留管时间及并发症情况进行回顾性统计分析。结果40例纤支镜引导经鼻气管插管一次成功率100%,插管时间30s~4min,呼吸衰竭均明显改善,留管时间1~9（平均4d）,并发症少。结论纤支镜引导经鼻气管插管抢救呼吸衰竭患者具有安全迅速、易耐受、有效纠正呼吸衰竭、并发症少等优点。     

Retinal nerve fiber layer structure abnormalities in early Alzheimer's disease: Evidence in optical coherence tomography

Alzheimer's disease (AD) patients often have visual disorders which may be due to retinal nerve degenerative changes. The aim of the current study was to determine the thickness changes of retina nerve fibers with optical coherence tomography (OCT) in AD patients. The OCT was used to assess the thickness of retinal nerve fiber layer (RNFL) from 22 AD patients and 22 healthy age-matched controls. The corrected visual acuity and intraocular pressure were measured and the dilated fundus examination and fundus image acquisition were also performed in those subjects. Compared with healthy age-matched controls, the RNFL thickness of AD patients were much thinner (p < 0.05), especially in supra-retina and infra-retina, while no difference was found in the other retinal area. These changes were also confirmed by the fundus images. In conclusion, retinal nerve degeneration is present in the retina of AD patients and this degeneration is likely localized preferentially to the superior and inferior quadrant.     

Development of high throughput optical sensor array for on-line pH monitoring in micro-scale cell culture environment

On-line pH detection of cell culture environment is necessary in a bioprocess or tissue engineering. Devices by means of electrochemical mechanisms for this purpose have been reported to be less suitable compared with optical-based sensing principles. More recently, some non-invasive optical sensing systems have been proposed for online pH monitoring of cell culture environment. However, these devices are not for multi-target pH monitoring purpose, and are large in scale and thus not appropriate for the pH monitoring at a micro scale such as in microbioreactor or microfluidic-based cell culture platform. To tackle these issues, an optical fiber sensor array for on-line pH monitoring was proposed using microfluidic technology. The working principle is based on the optical absorption of phenol red normally contained in culture medium. Different from other device of the similar working principle, the proposed device requires less liquid volume (less than 0.8 μl), is non-invasive, and particularly can be configured as an array for high throughput pH monitoring. The present device has been optimized for the shape of detection chamber in a microfluidic chip with the aid of computational fluid dynamics (CFD) simulation, to avoid flow dead zone and thus to reduce the response time of detection. Both simulation and experimental results revealed that the design of oval detection chamber (axis, 1.5 and 2.0 mm) can considerably reduce the response time. Preliminary test has proved that the optical pH detection device is able to detect pH with average detection sensitivity of 0.83 V/pH in the pH range of 6.8–7.8, which is normally experienced in mammalian cell culture.     

丙戊酸钠对重度烧冲复合伤休克延迟补液大鼠内脏组织灌流和生存率的影响

目的探讨丙戊酸钠对重度烧冲复合伤休克延迟补液大鼠内脏组织灌流和生存率的影响。 方法共360只雄性SD大鼠,(1)实验一,选择300只大鼠,按照随机数字表法分为假伤＋延迟补液组(SD组,n＝50)、假伤＋丙戊酸钠＋延迟补液组(SPD组,n＝50)、烧冲复合伤＋延迟补液组(BD组,n＝100)、烧冲复合伤＋丙戊酸钠＋延迟补液组(BPD组,n＝100)。SD组和SPD组大鼠37 ℃水浴浸泡背部12 s,腹部6 s;BD组和BPD组先用5 g高爆炸药距离大鼠50 cm爆炸致中度冲击伤,然后立即94 ℃沸水浸泡背部12 s,腹部6 s,致50%总体表面积Ⅲ度烧伤;SPD组和BPD组伤后即刻皮下注射丙戊酸钠(300 mg/kg)。SD组、SPD组、BPD组和BD组于伤后6、24 h分别按照Parkland公式腹腔内注射0.9%氯化钠溶液进行补液。于伤后即刻,伤后6、24、48、72 h 5个时间点,每个时间点均从SD组、SPD组、BD组、BPD组选择10、10、20、20只大鼠进行各脏器血流量和血气分析。(2)实验二,选取剩余的60只大鼠,按随机数字表法也分为SD组(n＝10)、SPD组(n＝10)、BD组(n＝20)、BPD组(n＝20)。于造模前48 h进行颈动脉置管。各组大鼠造模、处理同实验一操作。于伤后即刻,伤后6、24、48、72 h 5个时间点,检测各组大鼠平均动脉压(MAP),同时计算各组大鼠生存率。数据比较采用单因素方差分析、t检验、log-rank检验和χ²检验。 结果实验一结果显示：(1)伤后即刻,4组肝脏、肾脏和小肠黏膜血流量比较,差异均无统计学意义(P值均大于0.05);伤后6 h,4组肝脏、肾脏和小肠黏膜血流量组间总体比较,差异均有统计学意义(F＝463.45、267.27、449.64,P值均小于0.05),BPD组与BD组肝脏、肾脏和小肠黏膜血流量比较,差异均无统计学意义(P值均大于0.05);伤后24 h,4组肝脏、肾脏和小肠黏膜血流量组间总体比较,差异均有统计学意义(F＝1 347.52、125.23、1 210.84,P值均小于0.05),BPD组与BD组肝脏、肾脏和小肠黏膜血流量比较,差异均有统计学意义(t＝89.72、6.57、10.23,P值均小于0.05);伤后48 h,4组肝脏、肾脏和小肠黏膜血流量组间总体比较,差异均有统计学意义(F＝1 044.13、20.69、174.35,P值均小于0.05),BPD组与BD组肝脏和小肠黏膜血流量比较,差异均有统计学意义(t＝51.90、34.72,P值均小于0.05),肾脏血流量比较差异无统计学意义(t＝0.37,P>0.05);伤后72 h,4组肝脏、肾脏血流量组间总体比较,差异均有统计学意义(F＝328.27,16.01,P值均小于0.05),小肠黏膜血流量比较,差异无统计学意义(P>0.05),BPD组与BD组肝脏血流量比较,差异有统计学意义(t＝25.32,P<0.05),肾脏血流量比较,差异无统计学意义(P>0.05)。(2)伤后即刻和伤后48 h,4组pH值组间总体比较,差异均无统计学意义(P值均大于0.05);伤后6、24、72 h,4组pH值组间总体比较,差异均有统计学意义(F＝54.48、5.68、1.98,P值均小于0.05),伤后6、24 h,BPD组与BD组pH值比较差异均有统计学意义(t＝5.32、3.51,P值均小于0.05),伤后72 h,2组pH值比较差异无统计学意义(P>0.05);伤后即刻、伤后6、24 h,4组氧分压组间总体比较,差异均有统计学意义(F＝26.55、16.34、2.37,P值均小于0.05),伤后即刻BPD组和BD组氧分压比较差异无统计学意义(P>0.05),伤后6、24 h 2组比较差异均有统计学意义(t＝4.58、0.62,P值均小于0.05);伤后48、72 h,4组血乳酸组间总体比较,差异均无统计学意义(P值均大于0.05),伤后即刻、伤后6、24 h,4组血乳酸总体比较,差异均有统计学意义(F＝3.12、61.67、50.83,P值均小于0.05),伤后即刻BPD组和BD组氧分压比较,差异无统计学意义(P>0.05),伤后6、24 h, 2组比较差异均有统计学意义(t＝6.98、3.56,P值均小于0.05)。实验二结果显示：(1)伤后即刻和伤后72 h,4组MAP总体比较差异均无统计学意义(P值均大于0.05),伤后6、24、48 h,4组MAP总体比较差异均有统计学意义(F＝292.73、104.29、5.01,P值均小于0.05),BPD组与BP组MAP比较,差异均有统计学差异(t＝6.02、6.70、1.24,P值均小于0.05)。(2)伤后72 h,BPD组和BD组的生存率分别为70%和50%,2组比较差异有统计学意义(χ²＝11.03,P<0.05)。 结论丙戊酸钠复合延迟补液能显著增加重度烧冲复合伤休克大鼠肝脏、肾脏和肠道血流灌注,维持伤后早期的血压稳定,降低血乳酸水平,改善伤后72 h存活率。     

光纤硬膜外导管优化与硬膜外腔解剖生理的探讨

目的探讨光纤硬膜外导管下硬膜外腔的解剖生理学特点,分析光纤硬膜外导管下置管较盲探下置管的技术优势。方法选择研究我院2013年1月至11月收治的60例需要进行硬膜外麻醉腹部手术患者资料,麻醉时分别采用普通导管(30例)与光纤硬膜外导管(30例),观察患者的麻醉和硬膜外腔的解剖结构特点。结果患者在插管后5 min、切皮时的HR、SPB和MAP与同组麻醉前、诱导前、插管前及观察组比较,差异具有统计学意义(P0.05)。硬膜外腔与椎管骨膜之间形成1个腔隙,这个腔隙并不与颅腔联通,但是含有一定的结缔组织和静脉丛,腔体容积一般能够达到100 m L左右,其前部与侧方不宽,而后部宽度较大,从颈部开始逐步扩大到腰部之后达到顶峰,而后逐步缩窄,一直到骶裂孔。结论光纤硬膜外导管可使患者的解剖生理结构更加清晰呈现,使麻醉医生从盲目置管达到明视置管。     

Variation in hippocampal dynorphin b-immunoreactive mossy fiber terminal fields of apomorphine-(un)susceptible rats

The size of distinct hippocampal sub-fields were measured in the apomorphine-susceptible and apomorphine-unsusceptible rat lines. Mossy fiber terminal fields were delineated using dynorphin B immunoreactivity and area measurements were taken from (1) the supra-pyramidal mossy fiber terminal field; (2) the intra- and infra-pyramidal mossy fiber terminal field; (3) the hilus of the fascia dentata (4) the non dynorphin B immunoreactive area of the regio inferior and fascia dentata and (5) the total area of regio inferior and fascia dentata. The data indicate that statistically significant differences in the morphometry of the hippocampal subfields of the apomorphine susceptible and unsusceptible rats are confined to the intra- and infra terminal field: the relative size of the left and right intra- and infra terminal field of apomorphine unsusceptible rats are significantly larger than those of the apomorphine susceptible rats. These data explain at least in part the differential response of these rats to novelty.     

Optical imaging of vascular and metabolic responses in the lumbar spinal cord after T10 transection in rats

Neuronal and vascular reorganization after spinal cord injury (SCI) is scarcely known although its characterization has major implications in understanding the functioning of the altered spinal cord. Several electrophysiological and anatomical lines of evidence support plasticity caudal to the lesion site, but do not provide sufficient clues about neuronal and vascular reorganization after SCI. The aim of the present study was to compare neuronal activation in the lumbar spinal cord between uninjured and SCI rats with novel optical imaging technology. The results showed significant haemodynamic response differences after sciatic nerve stimulation in uninjured controls, in comparison to SCI rats. Both timing and shape of the response were modified. In uninjured rats, blood flow presented an initial dip but was rapidly drained from the activation site through the venous system. In comparison, the blood transfer rate in SCI rats was much slower. Damaged blood vessels at the lesion site after thoracic SCI impacted the vascular response upon neuronal activation in the lumbar spinal cord. This observation is important in the study of spinal cord function after SCI by imaging techniques based on haemodynamics (blood oxygenation level-dependent using functional magnetic resonance imaging (BOLD fMRI) and optical imaging). In conclusion, our results indicate that new avenues quantifying the influence of vascular plumbing will have to be developed to explore the efficacy of rehabilitation and pharmacological therapies by haemodynamic imaging.     

脑震荡对大鼠多巴胺能神经元及神经纤维的影响

目的：探讨脑震荡(BC)鼠多巴胺能神经元和神经纤维内酪氨酸羟化酶(TH)含量的变化。方法：用金属单摆打击装置复制 BC 模型。动物随机分为对照组和伤后1～24 d 损伤组;用免疫组织化学结合图像分析方法研究 BC 后中脑黑质致密区(SNC)和腹侧被盖区(VTA)多巴胺能神经元及基底节尾壳核多巴胺能神经纤维 TH 含量的变化。结果：在 SNC 和 VTA 及基底节,BC 后1、4、8及16 d 组的 TH 免疫反应阳性明显高于对照组,其中以4d 组反应最强,24 d 组在 SNC 和基底节与对照组比较无显著性差异,但在 VTA,TH 免疫反应阳性仍高于对照组。结论：BC 后 TH 早期增高可能是脑损伤神经元过度兴奋的反应,随后持续增高一段时间可能是多巴胺能神经元上调其合成能力的一种代偿反应。     

The projection of the temporal retina in rats,studied by retrograde transport of horseradish peroxidase

Summary Horseradish peroxidase (HRP) was injected unilaterally into the lateral geniculate nucleus or tectum, or both, in 26 hooded rats in order to mark the exact extent of the retina from which uncrossed optic axons arise. This region occupied about a quarter of the retina, in the temporal periphery, following thalamic injections, but a much smaller region following tectal injections. By comparing the proportions of HRP positive neurones in nasal and temporal retinae of both eyes it was shown that: (1) within the region supplying uncrossed axons the majority of the ganglion cells nevertheless project contralaterally, (2) a large proportion of the ganglion cells from the temporal crescent project bilaterally, which does not occur from the remainder of the retina, (3) ganglion cells of all sizes contribute to both ipsilateral and contralateral projections. The results also support earlier suggestions that the smallest neurones in the ganglion cell layer do not send an axon into the brain, and are therefore not ganglion cells     

Advances in optical imaging of the newborn infant brain

New methods of imaging the oxygenation, hemodynamics, and metabolism of the newborn infant brain are being developed, based on illumination of the head with near-infrared light. Techniques known as optical topography and optical tomography have the potential to provide valuable information about the function of the normal brain, and about a variety of cerebral pathology such as hypoxic-ischemia. Optical methods provide a unique means of monitoring brain oxygenation safely in an intensive care environment without interference with the normal handling of the infant. Studies on infants have focused on the assessment of steady-state regional cerebral perfusion and tissue oxygenation, as well as monitoring hemodynamic changes in response to sensory stimulation. Recent technological and methodological advances in this research field are reviewed, and the likely impact of optical imaging methods on the care of newborn infants is assessed.