联合应用缺血后处理、远隔缺血后处理和纳洛酮后处理对大鼠脑缺血-再灌注损伤的影响

Objective To assess the effects of ischemic postconditioning, remote ischemic postconditioning and naloxone postconditioning on focal cerebral ischemia-reperfusion injury in rats.Methods A total of 110 adult SD rats were randomly divided into 5 groups (n =22 each). The focal cerebral ischemia-reperfusion injury was induced by a 90-minute occlusion of right middle cerebral artery (MCA) and a 24-hour reperfusion sequentially. Group 1 was of ischemia-reperfusion control; Group 2 ischemic postconditioning induced by three 30-second cycles of MCA occlusion followed by a 30-second reperfusion; Group 3 remote ischemic postconditioning performed via a transient occlusion of right femoralartery at 5 min before the initiatlon of reperfusion:Group 4 naloxone posteonditioning with naloxone 10 mg/kg intraperitoneaUy injected at the initiation of reperfusion;Group 5 combined ischemic,remote ischernic & naloxone postconditioning performed simultaneously in accordance with the methods used in Groups 2,3 & 4.The neumlogie deftcit scores(NDS)were obtained at 2 h & 24 h post-reperfusion.At 24 h post-reperfusion.the anesthetized rat was sacrificed by decapitation and the brain rapidly extracted to asseSS the size ofcerebral infaret(n=10),detect the cerebral expression of microtubule-associated protein2(MAP2)(n=6),measure the plasma volume of cerebral tissues and quantify the diameter and segment artery at 5 min before the initiation of reperfusion; Group 4 naloxone postconditioning with naloxone 10 mg/kg intraperitoneally injected at the initiation of reperfusion; Group 5 combined ischemic, remote ischemic & naloxone postconditioning performed simultaneously in accordance with the methods used in Groups 2, 3 & 4. The neurologic deficit scores ( NDS) were obtained at 2 h & 24 h post-reperfusion. At 24 h post-reperfusion, the anesthetized rat was sacrificed by decapitation and the brain rapidly extracted to assess the size of cerebral infarct (n = 10), detect the cerebral expression of microtubule-associated protein2 ( MAP2) (n =6) , measure the plasma volume of cerebral tissues and quantify the diameter and segment length of cerebral microvessel (n = 6 ). Results There were no significant differences in the heart rate (HR) and mean arterial pressure (MAP) among the above five groups at all observed time points (P ＞ 0. 05). At 24 h post-reperfusion, the percentage of ischemic cerebral infarct size was 43% ±6% , 31% ±4% , 32% ±5% , 28% ±6% & 21% ±7% in ipsilateral hemisphere area (i. e. , cerebral infarct severity)in Groups 1-5 respectively. Compared with Group 1, the levels of NDS and cerebral infarct severity significantly decreased at ischemic side in Groups 2-5 ( P ＜ 0. 05 ). And the cerebral expression of MAP2,plasma volume of cerebral tissues, diameter and segment length of cerebral microvessel significantly increased at the ischemic side (all P＜0. 05). However, there were no significant differences in the abovementioned parameters at ischemic side among Groups 2, 3 and 4 (all P ＞0. 05). The parameters of NDS,cerebral infarct severity, cerebral expression of MAP2 and plasma volume of cerebral tissues in the ischemic side significantly increased in Group 5 compared with Groups 1,2,3 and 4 (all P ＜ 0. 05). The diameter and segment length of cerebral microvessel at ischemic side were not different among Groups 2,3,4 and 5 (all P＞0. 05). Conclusion In focal cerebral ischemia-reperfusion rats, ischemic, remote ischemic and naloxone postconditioning may produce significant neuroprotective effects of reduced cerebral infarct severity and improved neurologic dysfunctions. A combination of three postconditioning approaches enhances the above neuroprotective effects.     

蛛网膜下腔自发性出血致围术期猝死

本文介绍我院1984～1996年收治4例经腰穿和尸体解剖证实为蛛网膜下腔出血的围手术期猝死病例,以引起同道重视。临床资料例1.女,27岁。有头痛和癫痫病史。1984年4月10日在全麻下行胆囊切除术。手术顺利,术毕清醒,安返病房。术后9小时30分患者突然抽搐后呼吸停止,双侧瞳孔散大,各种反射消失。经抢救无效3天后死亡。发病48小时后腰穿为浑浊血性脑脊液。会诊意见:蛛网膜下腔出血,脑血管畸形破裂?例2.女,34岁。有偏头痛病史。1992年4月20日在全麻下行子宫及左侧附件切除术。手术经过顺利,术毕清醒,安返病房。术后7小时病人诉心烦、恶心伴抽搐。给…     

喷他佐辛和曲马多用于胸科手术后镇痛的效果比较

目的研究食管癌术后静脉自控镇痛（PCIA）时应用喷他佐辛的镇痛效果和不良反应,并与曲马多作比较。方法选择食管癌手术60例（ASAⅠ～Ⅱ）,随机分为两组（A组和B组）,每组30例。A组为喷他佐辛组,喷他佐辛6mg/kg;B组为曲马多组,曲马多5mg/kg。两组术后镇痛治疗均采用一次性非电力静脉自控输注泵,流速为2ml/h,容量为100ml。观察术后镇痛效果和不良反应。结果两组镇痛效果和不良反应发生率均无显著性统计学差异。结论喷他佐辛和曲马多二者皆可用于胸科手术患者的术后镇痛,均能达到良好的镇痛效果,但喷他佐辛作用较曲马多更强。     

HPLC法测定人体内咪达唑仑血药浓度

目的建立人体血浆中同时测定咪达唑仑HPLC测定法。方法采用HPLC法,色谱柱为Hypersil ODS C18柱(250mm×4.6mm,5μm),流动相为甲醇:水(60:40)(含0.1%二乙胺,0.05%磷酸溶液),流速为1.0ml/min,柱温为室温,检测波长225nm。结果咪达唑仑在0.25~4μg/ml内呈良好的线性关系(r=0.9997),咪达唑仑最低检测浓度为50ng/ml,回收率96.81%~100.98%,萃取回收率87.69%~92.99%。日内、日间RSD(n=3)均小于5.89%。结论本方法简便、准确,可靠,可用于人体血浆中测定咪达唑仑的浓度。     

甘露醇对小鼠脑缺血再灌注后环氧化酶-2表达的影响

目的探讨不同时间甘露醇处理对小鼠前脑缺血再灌注损伤细胞内环氧化酶-2（COX-2）表达的影响。方法采用双侧颈总动脉结扎脑缺血再灌注损伤模型,随机分为6组,假手术组、缺血再灌注损伤组和甘露醇即刻、30min、1h、1.5h干预组。分别用HE和COX-2免疫组化染色,观察再灌注损伤后不同时间点甘露醇干预后海马CA1区神经元病理组织形态学特点,运用BI2000医学图像分析系统检测COX-2表达平均光密度值。结果甘露醇即刻干预组小鼠海马CA1区COX-2表达平均光密度值明显低于缺血再灌注对照组（P〈0.05）,而与假手术组比较无统计学意义（P〉0.05）;30min后甘露醇干预组COX-2蛋白表达增多、光密度值增高,与缺血再灌注损伤组比较均无统计学意义（P〉0.05）。结论早期应用甘露醇能够有效防止COX-2表达,避免了脑缺血再灌注损伤后COX-2介导的神经细胞不逆性损伤。再灌注30min以后甘露醇干预基本无效。     

丙泊酚复合浅麻醉在高龄患者胃镜检查中的应用

<正>近年来,丙泊酚静脉麻醉已广泛应用于无痛胃镜的检查,使患者处于清醒镇静或浅睡眠状态,减少刺激反应,提高患者的耐受性,静脉麻醉在高龄患者中的应用也越来越广泛[1]。作者于2008年6月至2009年6月对38例80岁以上高龄患者行丙泊酚静脉复合浅麻醉下无痛苦胃镜检查,探讨此方法的安全性,现报告如下。     

颌面部肿瘤手术麻醉意外及并发症分析

我院自１９９２年３月－１９９７年３月共施行颌面颈部手术２７００例,其中全麻病人１３５０例,发生全麻意外及并发症５０例,占３．７０％,现报告分析如下。１资料与方法１．１一般资料：本组５０例中男２８例,女２２例。术前ＡＳＡ分级为Ⅰ级～Ⅲ级,年龄７岁～７６...     

高效液相色谱法测定血浆中异丙酚浓度

[目的]建立反相高效液相色谱法测定血浆中异丙酚浓度的方法，为临床异丙酚的药理学研究提供科学的分析技术。[方法]用环己烷提取血浆中的异丙酚，用HPLC测定异丙酚含量。色谱柱为YWG—C18柱，乙腈-水(70：30)为流动相，以麝香草酚为内标，用紫外检测，波长254nm。[结果]本方法回收率高，重现性好，线性范围为0．5—10μg/ml，最低检测浓度为50ng/ml。[结论]本方法较为简单，结果准确可靠，适用于异丙酚的药代动力学研究及临床手术过程中异丙酚血药浓度检测。     

截流式肺泡二氧化碳监测的可行性

由于呼气末二氧化碳分压(PETCO2)监测具有直观、简便、无创等优点，已在临床广泛应用，其与动脉二氧化碳分压(PaCO2)的良好相关性早已被证实。但在很多情况下，PETCO2还不能准确评估PaCO2。除一些病理生理、仪器校准误差等因素外，采气方法是又一重要影响因素。目前临床上普遍采用主流式和旁流式采气法，     

肌松监测仪在肌松监测中的临床意义

肌松监测在临床使用过程中具有十分重要的作用。本文概述了肌松监测的意义、肌松监测基本原理、神经电刺激模式、各项监测指标及其临床意义和使用范围，并对肌松监测的影响因素进行了分析，以期对正确使用临床肌松监测评估肌松作用有所帮助。