Increasing evidences show that a gradual trend away from deep hypothermia toward moderate hypothermic circulatory arrest, which has been proved to be safe and effective in clinic. By summarizing and analyzing the research progress and applying status of the moderate hypothermia circulatory arrest with selective antegrade cerebral perfusion, the article aims at promoting the application of this tenique as a cerebral protection strategy in aortic arch surgery for adults in China.
【摘要】 目的 评价α2受体激动剂是否可以降低七氟烷引起的小儿术后躁动的发生率。 方法 通过检索Medline、荷兰医学文摘、Cochrane临床试验数据库、中国生物医学文献数据库和中国期刊网全文数据库等数据库，收集可乐定或右美托咪啶对七氟烷引起的小儿术后躁动的预防作用的随机对照试验（randomized controlled trial，RCT），提取资料和评估方法学质量，采用Cochrane协作网RevMan 5.0软件进行Meta分析。 结果 最终纳入11个RCT，其中104例患儿预防性使用右美托咪啶，268例患儿使用可乐定，365例患儿使用安慰剂。Meta分析显示，可乐定组小儿术后躁动发生率的比值比（OR）为0.31，95%CI为（0.15，0.61）（P=0.000 8）；右美托咪啶组小儿术后躁动发生率的OR为0.16，95%CI为（0.08，0.31）（Plt;0.000 01）。 结论 α2受体激动剂可以显著降低七氟烷引起的小儿术后躁动的发生率。【Abstract】 Objective To determine whether alpha2-adrenoceptor agonists can decrease emergence agitation (EA) in pediatric patients after sevoflurane anesthesia. Methods The Medline, Embase, Cochrane Library, CBM and CNKI were searched. All randomized controlled trials comparing clonidine or dexmedetomidine with other interventions in preventing emergence agitation after sevoflurane anesthesia were retrieved. Study selection and assessment, data collection and analyses were undertaken. Meta-analysis was done using the Cochrane Collaboration RevMan 5.0 software. Results Eleven articles reached our inclusion criteria and were included in the Meta-analysis. A total of 104 children treated with dexmedetomidine, 268 children treated with clonidine, and 365 children treated with placebo were evaluated for the incidence of emergence agitation. The pooled odds ratio for the clonidine subgroup was 0.31, with a 95% confidence interval of 0.15-0.61 (P=0.000 8). The pooled odds ratio for the dexmedetomidine subgroup was 0.16, with a 95% confidence interval of 0.08-0.31 (Plt;0.000 01). Conclusion Alpha2-adrenoceptor agonists can significantly decrease the incidence of emergence agitation in pediatric patients after sevoflurane anesthesia.
目的 探讨在丙泊酚诱导麻醉的改良电休克治疗中脑双频谱指数(BIS)与动作发作时间的关系，以及其他因素对电休克动作发作时间的影响。 方法 2012年4月－5月，记录28名患者的107次治疗中的不同时刻脑双频谱指数（BIS）值诱导前、睫毛反射消失时、治疗前即刻、动作发作结束即刻、动作发作结束后60 s）、麻醉药物剂量、动作发作时间及治疗不良反应，并根据动作发作时间将治疗分为A组（治疗无效组，动作发作时间＜17 s）和B组（治疗有效组，动作发作时间≥17 s）。探讨不同时刻BIS值与癫痫发作时间的关系并比较A、B组之间BIS值、麻醉药物剂量差异。 结果 两组间睫毛反射消失时及治疗前即刻BIS值差异有统计学意义（P＜0.05）。动作发作时间与治疗前即刻BIS值呈正相关（r=0.245，P=0.012），与治疗次数呈负相关（r=−0.283，P=0.004）。 结论 治疗前即刻BIS值与动作发作时间呈正相关，因此，此时的BIS值也许可以作为预测动作发作时间长短的指标。
目的 观察电压依赖性钙通道是否作用于大鼠脊髓背角胶状质层（SG）神经元大振幅微小兴奋性突触后电流的形成。 方法 选用成年雄性Sprague-Dawley（SD）大鼠，2%～3%异氟烷麻醉后，分离其腰骶部的脊髓，然后切片。采用全细胞电压钳技术，玻璃微电极的电阻为4~6 MΩ，钳制电压为?70 mV，记录胶状质层神经元微小兴奋性突触后电流（mEPSC）电流。将电流信号用Axopatch 200来放大并储存于电脑。对照组和用药结束后，持续采样mEPSC电流30 s。mEPSC电流的频率和振幅用Clampfit 8.1进行分析。 结果 钳制电压为?70 mV时，所有SG神经元均有自发性的EPSC。辣椒素增加mEPSC发生的频率和波幅。钴离子抑制辣椒素诱导的大振幅mEPSC。钴离子抑制辣椒素诱导的mEPSC的平均振幅，而不抑制其发生频率。 结论 电压依赖性钙离子通道参与了辣椒素引起的痛觉形成。
【摘要】 目的 研究双侧迷走神经切断对肺缺血再灌注引起的氧化应激反应的影响。 方法 将24只健康雄性新西兰大白兔随机分为:假手术组（S组）、缺血再灌注组（IR组）、双侧迷走神经切断合并缺血再灌注组（NIR组）。缺血前和再灌注末抽取动脉血进行血气分析，观察动脉血氧分压PaO2及肺泡动脉氧分压差（A-aDO2）的变化。再灌注末取肺组织检测肺的湿干重比值（W/D）和氧化应激指标，包括丙二醛（MDA）、超氧化物歧化酶（SOD）及过氧化氢酶（CAT）。 结果 与S组比较，缺血再灌注明显降低了PaO2，增加了A-aDO2和W/D值，增加了肺组织MDA含量并降低了SOD、CAT活性；双侧迷走神经切断进一步降低了SOD活性。 结论 切断实验兔的双侧迷走神经，降低了肺组织抗氧化酶-超氧化物歧化酶的活性，提示迷走神经在降低肺缺血再灌注引起的氧化应激反应中发挥了重要的调节作用。【Abstract】 Objective To evaluate the effect of bilateral vagal nerves transection on lung ischemia-reperfusion induced oxidative stress. Methods A total of 24 New Zealand male rabbits were randomly divided into 3 groups: sham group (S group), ischemia-reperfusion group (IR group), and bilateral vagal nerves transection with ischemia-reperfusion group (NIR group). Before ischemia and at the end of reperfusion, arterial blood samples were collected for blood gas analysis. Arterial partial pressure of oxygen (PaO2) and alveolo-arterial oxygen tension difference (A-aDO2) were detected. At the end of reperfusion, lung tissues were obtained to measure wet/dry weight ratio (W/D). Evaluation of oxidative stress indicators, including content of lung malondialdehyde (MDA), superoxide dismutase enzyme (SOD) and catalase (CAT) activities was also performed. Results Compared with the S group, lung ischemia-reperfusion significantly decreased the PaO2, elevated A-aDO2 and lung W/D weight ratio. At the same time, MDA level in the lung tissue was elevated and SOD and CAT activities were decreased. After bilateral vagal nerves transection, SOD activity was further decreased. Conclusion Transection of bilateral vagal nerves reduced the activity of antioxidant enzyme, especially superoxide dismutase in lung tissue, suggesting that the integrity of the vagal nerves plays an important regulatory role in ischemia-reperfusion mediated oxidative stress in the lung.