颅脑手术的麻醉与脑保护

目的：探讨颅脑手术的脑细胞保护和麻醉。方法：30例颅脑手术均采用气管插管静吸复合全麻、局部低温、过度通气、控制性降压等综合治疗保护脑组织。结果：30例病人29例效果良好,1例因脑疝术后2d死亡。结论：麻醉诱导平稳、术中合适的麻醉深度及颅内压、麻醉苏醒期平稳是脑细胞保护的关键既有效措施。     

麻醉药物脑保护作用的研究概况

脑代谢率非常高 ,缺血严重则影响神经元代谢。某些麻醉药可以影响缺血过程中的某些因素 ,从而减轻神经元不可逆损伤。药理性脑保护的概念可追溯到 2 0世纪 70年代 ,麻醉药抗缺氧缺血性神经损伤的保护作用机制的早期理论认为 ,麻醉药和麻醉状态减少生理电活动 ,从而降低伤害期间     

慢性酒精中毒大鼠学习记忆及内侧隔核胆碱能神经元的变化

目的 研究酒精致大鼠学习记忆障碍与基底前脑内侧隔核胆碱能神经元变化的关系。方法 将24只雄性Wister大鼠随机均分成对照组和酒精中毒组．酒精中毒组大鼠隔日胃内注入含酒精（2．5g／kg）的蒸馏水2ml共90d，对照组则注入不舍酒精的蒸馏水2ml。然后采用Morris水迷宫扣免疫组织化学技术，分析大鼠基底前脑内侧隔核胆碱能神经元、海马星形胶质细胞数的变化扣学习记忆能力的关系。结果酒精中毒组大鼠Morris水迷宫潜伏期明显延长，基底前脑内侧隔核胆碱能神经元数目明显减少．海马星形胶质细胞数目反应性增生。结论 酒精致大鼠学习记忆能力障碍与基底前脑内侧隔核胆碱能神经元减少有关。     

脑立体定向术治疗精神病之麻醉处理（附61例报告）

脑立体定向术治疗精神病之麻醉处理（附６１例报告）柳州铁路局中心医院麻醉科沈薇脑立体定向术是当代精神外科领域中一门新兴的学科．国外始于４０年代初，我国于６０年代初用于临床，然其真正进入一个飞速发展阶段的是８０年代［１］，该方法对脑的侵袭小，能安全精确地...     

脑电双频指数反馈调控在全身麻醉中的应用

目的探讨脑电双频指数（BIS）在判断全身麻醉深度时的准确性及反馈调控输注全麻药物的可操作性。方法选择40例择期腹腔镜胆囊切除手术的患者，随机分为对照组和反馈组，对照组按常规速度给予麻醉药；反馈组应用BIS监测麻醉深度，调节麻醉药物用量，观察麻醉药物用量盼变化及苏醒时间等指标。结果反馈组的全麻用药量明显小于对照组（P〈0．01）；反馈组患者苏醒时间明显少于对照组（P〈0．05）。结论脑电双频指数可有效反馈调控输注全麻药物、减少全身麻醉用药，缩短苏醒时间。     

脑电双频指数在老年患者全身麻醉中的应用

目的 探讨脑电双频指数（BIS）在老年患者全身麻醉中的作用.方法 选择2010年1月至2011年12月来汉川市人民医院就诊的实施全身麻醉的老年患者80例,按照随机数字表法分为观察组和对照组,每组各40例.观察组维持脑电双频指数在40 ～60、对照组维持平均动脉压（MAP）在70 ～100 mm Hg实施全身麻醉,记录并比较两组患者在T0、T1、T2、T3、T4、T5点的平均动脉压,心率,脑电双频指数值及麻醉药用量,拔管和苏醒室留观时间.结果 与对照组比较,观察组麻醉药用量显著减少,平均动脉压、脑电双频指数升高,差异有统计学意义（P＜0.05）,且显著缩短了苏醒室留观和拔管的时间（P＜0.05）.结论 依据脑电双频指数实施全身麻醉能减少老年患者麻醉药用量,准确评估麻醉深度,加快麻醉恢复.     

脑动脉瘤介入治疗围术期的麻醉管理

通过总结水解可脱弹簧圈栓塞治疗脑动脉瘤破裂急性期麻醉管理的体会,得出结论 :全身麻醉用于脑动脉瘤介入治疗是安全有效的.     

择期颅脑外科手术全身麻醉期间进行性脑膨出的临床分析

目的:回顾性分析择期颅脑外科手术全身麻醉下发生进行性脑膨出的临床特点、原因及诊断,探讨其防治对策.方法:对2002～2008 年期间择期颅脑外科手术全身麻醉下手术过程中8例并发进行性脑膨出的特征、诊断及诱因和所采取的处理措施进行回顾性分析.结果:3例头钉造成硬膜外或下血肿、2例同侧硬膜下纵深部血肿、1例对侧硬膜下血肿、1例巨大颅咽管瘤术中因损伤下视丘、1例体位不当+气道痰栓阻塞致CO2蓄积;均表现为手术初期颅内压无异常,手术进程中异常进行性局灶性脑组织膨出,降低颅内压措施无效;生命体征相对稳定;6 例术中、1例术毕经紧急CT 确诊;8 例病例中6例先紧急行血肿清除术,再行病灶切除,1 例病灶清除后术毕再行血肿清除,同时适度低温、脑脱水等措施,6 例术后苏醒(75.0%),2 例术后严重脑损伤死亡(25.0%); 术后疗效采用GOS 标准,于治疗6个月评定结果,重残1例(12.5%) 、中残1例(12.5%) 、良好4例(50.0%).结论:择期颅脑外科手术全身麻醉下发生进行性局灶性脑膨出应警惕安置头钉和硬膜下探查造成的硬膜下血肿;术中CT 可明确诊断并有利于及时行血肿清除;积极预防、快速诊断和及时治疗有助于改善患者的预后,提高生存质量.     

全身麻醉联合硬膜外阻滞麻醉深度的探讨

目的：评价全身麻醉联合硬膜外阻滞麻醉中麻醉深度、内脏神经功能及循环稳定性，并探讨其临床意义。方法：选择22例上腹部手术患者，随机分为静吸复合全麻联合组（E组）和静吸复合全麻醉组（Ⅰ组）。采用HXDI电脑型多功能麻醉监测仪观察脑电双频指数（BIS）、心率变异性（HRV）、心率变异指数（HRVI）及血液动力学的变化。结果；两组BIS值在各时点无显著差异情况下，E组的血液动力学、HRV比Ⅰ组更稳定，E组的HRVI比Ⅰ组术中各时点小20－30分值。结论：全身麻醉联合硬外阻滞较单纯全麻循环稳定、麻醉完善、经济实用。     

刺激延髓网状结构对外伤性脑水肿的影响

目的:探讨刺激延髓网状结构对外伤性脑水肿发生发展的影响。方法:自制家兔局限性脑挫裂伤模型,伤后23 h电刺激双侧延髓网状结构,取距离挫伤灶不同部位脑组织进行含水量测定。结果:脑损伤后挫伤灶周边区脑组织含水量明显增加,距离挫伤灶越远含水量增加越不明显,刺激延髓网状结构引起伤侧大脑半球脑水肿基础上含水量明显增加。结论:延髓网状结构的过度兴奋在外伤性脑水肿的发生发展过程中起重要作用。     

Effect of Intracerebroventricular injection of thyrotropin-releasing hormone on the nociceptive discharges in mesencephalic reticular formation in the rat

Extracelluar recording method was used to examine the effect of thyrotropin-releasing hormone (TRH) on 71 unit discharges of pain-excited neurons (PEN) in mesencephalic reticular formation (MRF) in 58 rats. Intracerebroventricular (icv) injection of TRH (10 Hg/10 μ) produced significant decrease of pain discharge rate of PEN. TRH potentiated the inhibitory effect of el elctroacupuncture (EA) on nociceptive discharges when application of EA at bilateral “Zusanli” was coupled with icv injection of TRH. Both of these inhibiting effects of TRH were completely offset or strikingly decreased by icv preinject ion of the cholinergic M-receptor blocker atropine. The results mentioned above and the mechanism of the inhibitory effect of TRH on pain discharges were discussed in this paper.     

Central pontine myelinolysis: a rare presentation secondary to hyperglycaemia

Central pontine myelinolysis (CPM) is classically described as a demyelinating condition that results from the rapid correction of hyponatraemia. CPM has also been reported to arise from hyperglycaemia in association with concomitant acidosis, hypernatraemia and hyperosmolar syndrome. Herein, we report a rare presentation of CPM, which was purely secondary to hyperosmolar hyperglycaemia. The patient presented with ataxia and pseudobulbar affect, which evolved subacutely over a duration of two weeks. It is important to note that, in addition to acute changes in osmolality, a subacute shift secondary to hyperglycaemia may also lead to CPM.     

大剂量人体丙种球蛋白冲击治疗脑桥中央髓鞘溶解症1例及文献复习

目的:探讨大剂量静滴人体丙种球蛋白(intravenous immunoglobulin,IVIG)治疗脑桥中央髓鞘溶解症(central pontine myelinolysis,CPM)的疗效。方法:利用IVIG冲击治疗1例CPM患者和文献复习并阐述其原理。结果:大剂量IVIG冲击治疗CPM具有一定效果。结论:大剂量IVIG冲击疗法可用于治疗CPM。     

肿胀麻醉技术在腹股沟疝腹膜前间隙修补术中应用的回顾性分析

目的 评价肿胀麻醉技术在腹股沟疝腹膜前间隙修补手术的疗效及安全性.方法 回顾性分析本院2012年1月至2016年3月诊断为腹股沟疝患者的临床资料.根据病例资料术中麻醉方法不同分为两组,采用0.5％利多卡因的常规局部麻醉(LA组)和采用肿胀麻醉(TLA组),均使用强生公司疝修补装置(ultrapro hernia system,UHS)补片行腹膜前间隙修补完成手术.以手术时间、术中利多卡因的使用剂量、术后镇痛效果持续时间、术后3d疼痛消失例数、术后1d止痛药使用例数、术后7d疼痛发生例数,以及术后并发症发生率作安全性指标.结果 共筛选出86例术中采用常规局部麻醉的临床资料,98例术中采用肿胀麻醉的临床资料.两组的一般资料比较差异无统计学意义(P＞0.05).两组均顺利完成手术,未出现局麻中毒反应,术中均未更改麻醉方法.TLA组利多卡因使用量和手术时间明显低于LA组[(140 ±8)mg vs (278 ±9)mg;(41 ±7)min vs(48 ±7)min,P＜0.01],术后镇痛持续时间长于LA组[(4.2±0.8)h vs(1.2±0.3)h,P＜0.01],TLA组术后ld使用镇痛药物的比例低于LA组(P＜0.01),两组术后3d疼痛消失例数、持续性疼痛发生率,术后并发症发生率差异均无统计学意义(P＞0.05).结论 肿胀麻醉在腹股沟疝腹膜前修补术中缩短了手术时间,减少了利多卡因用量,有良好的术中麻醉镇痛效果以及安全性,术后镇痛持续时间优于常规局部麻醉.     

Reconstruction of the Medial Patellofemoral Ligament Using Hamstring Tendon Graft With Different Methods： a Biomechanical Study

Objective To measure the tensile strength of the normal medial patellofemoral ligament （MPFL）, and evaluate the biomechanics of different fixation methods of the hamstring tendon graft on the patella. Methods Eight fresh cadaver knees were prepared by isolating the patella, leaving only the MPFL as its attachment to the medial condyle of femur, The MPFL was reconstructed by three different methods： four-suture fixation, anchors-single suture fixation, and anchors-double suture fixation. The tensile strength and the elongation of the normal MPFL and the tendon grafts were measured. Results The tensile strength of the four-suture fixation group （234.86±49.02 N） was stronger than that of the normal MPFL （146.91 ±25.30 N, P=0.0014） and the anchors-single suture group （159.17±49.07 N, P=0.0077）, while weaker than that of the anchors-double suture group （314.74±78.46 N, P=0.0052） Conclusions With regard to the tensile strength, the four-suture fixation method is reliable for clinical use. Compared with the anchor-suture method, the four-suture fixation method which has no specific implants is more economical, convenient and efficient.     

治疗炎性疾病的新靶点——α7烟碱型乙酰胆碱受体

胆碱能抗炎通路是新近发现的一种神经-免疫调节通路,其潜在的药物作用靶点是α7烟碱型乙酰胆碱受体(α7 nicotinic acetylcholine receptor,α7nAChR).近年来大量的研究证明特异性激动α7nAChR能够有效减少促炎细胞因子的释放.本文综述了α7nAChR在炎性疾病发生发展中的作用,拟为炎性疾病的治疗提供新的理论和思路.     

Acupuncture accelerates recovery after general anesthesia:a prospective randomized controlled trial

BACKGROUND: Acupuncture anesthesia was created in the 1950’s in China and continues to be used there today during most major surgeries. It is widely used in China for such complex operations as brain, heart, and abdominal surgery. It is popular in China because it is economical, practical, and beneficial to the patients. With acupuncture anesthesia there is less bleeding during surgery and there is also quicker post-operative recovery.OBJECTIVE: This randomized prospective study aims at comparing the effect of two acupoints(Yongquan, KI1 and Renzhong, DU26) with sham acupuncture and no acupuncture on the time to recovery of consciousness after general anesthesia by means of the Bispectral Index monitor(BIS).DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: This is a prospective randomized controlled study. We randomly assigned 50 patients to 5 groups during recovery from surgical anesthesia. Four groups had acupuncture on KI1(group A), DU26(groups B), both KI1 and DU26(group C), and sham points(group D), and one had no acupuncture(group E).MAIN OUTCOME MEASURES: Bispectral Index(BIS), time to spontaneous eye opening, time to tracheal extubation, and time to following commands were measured as the main outcome measures.RESULTS: Time to spontaneous eye opening differed among groups(P=0.002), as well as time to tracheal extubation(P<0.000 1) and time to following commands(P=0.000 6). BIS values differed significantly among groups both 5 and 10 min after the end of anesthesia(P<0.000 1 and P=0.000 4,respectively). BIS values of groups D and E were lower than those of the other groups and those of group C were higher. The same pattern was observed also 15 and 30 min after the end of anesthesia, although the difference among groups was not significant at these time points(P=0.164 and P=0.104, respectively).CONCLUSION: Acupuncture on DU26 and KI1 accelerates recovery of consciousness after general anesthesia. Moreover, a possible synergistic effect of DU26 and KI1 is suggested. This issue may play a role in the optimization of operating room management and raise interest about the usefulness of acupuncture on unconsciousness states of different nature.     

S100A4:潜在抑制膀胱癌干细胞的靶分子

目的 应用siRNA技术沉默S100A4基因表达对膀胱癌干细胞增殖及成瘤能力的影响.方法 筛选鉴定出MB49膀胱癌干细胞后,应用核素标记相对和绝对定量(iTRAQ)技术,发现MB49膀胱癌细胞与膀胱癌干细胞表达差异的蛋白质S100A4蛋白.设计并合成S100A4基因特异性的siRNA序列,转染膀胱癌干细胞,应用Western blot和qPCR检测在siRNA对S100A4的影响,体内、外实验观察siRNA抑制S100A4后对膀胱癌干细胞增殖及成瘤能力的影响.结果 通过iTRAQ核素标记结合液相色谱和串联质谱分析,共鉴定出差异蛋白共65个,S100A4在基因表达水平差异最显著(差异为5.70,P<0.05).与空白对照组、阴性对照组相比,S100A4 siRNA转染组的S100A4基因和蛋白表达降低(P<0.05).CCK8实验和裸鼠成瘤实验发现,与空白对照组与阴性对照组相比较,siRNA干扰S100A4表达后,膀胱癌干细胞生长明显受到抑制,成瘤能力受到抑制(P<0.05).结论 膀胱癌干细胞中S100A4表达与膀胱癌的复发、转移有关,S100A4蛋白可能成为消灭膀胱癌干细胞,治疗膀胱癌的分子靶标.     

Tumor-associated macrophages: a novel potential target for cancer treatment

Special emphasis about cancer metastasis was concentrated on tumor cells themselves, and we usually considered the ability of migration and invasion was the final decider. Recently, bewaring of tumor microenvironment is a fundamental determinant in metastasis has become the most outstanding breakthrough. Considerable “microbes” in the microenvironment are closely linked with tumor metastatic behaviors, and the major proportion of them is tumor-associated macrophages (TAMs). Actually, TAMs conserve immediate “cross-talk” with cancer cells throughout tumor development. It is generally accepted that TAMs have mostly pro-tumoral functions and play an important role in several stages of tumor progression. This progression involves a series of events that leads from the primary site to the metastatic site, including tumor cell growth, angiogenesis, migration, invasion, intravasation and finally extravasation at distant site where the process begins again (metastasis). Thereby, TAMs has attracted substantial attentions in recent years and could become a promising therapeutic strategy. In this review, we focus on the multi-functions of TAMs in cancer and certain drugs targeting TAMs for cancer treatment those are under experimental research procedures or have even been entered human clinical tests.