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.
Gastrointestinal complications after cardiac surgery are rare, but they are associated with significant morbidity and mortality. The mechanisms of gastrointestinal complications after cardiac surgery may be unique, as the abdominal cavity is not involved. This review summarizes the current evidence of the pathophysiology, clinical manifestations, risk factors, and management of gastrointestinal complications after cardiac surgery, aiming to improve the recognition of gastrointestinal complications after cardiac surgery.
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。
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。
ObjectiveTo evaluate if intravenous lidocaine can reduce the stress response induced by fiberoptic bronchoscopy in patients under general anesthesia. MethodsSixty patients undergoing fiberoptic bronchoscopy under unconsciousness between November 2013 and July 2014 were randomly divided into two groups: lidocaine group (n=30) and control group (n=30). Patients in the lidocaine group received an intravenous injection of lidocaine for 1 mg/kg during induction and then continuous intravenous infusion of 2% lidocaine with a dose of 3 mg/(kg·h). The same volume of saline was given to patients of the control group in the same way. Laryngeal mask airway was placed after anesthesia induction. Variables of heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and pulse oxygen saturation were observed and recorded at five time points: before induction, immediately after induction, immediately after laryngeal mask airway placement, fiberoptic bronchoscopy across tracheal carina and before leaving examination room. Complications including cough reflex, toxicity reaction of local anesthetics, and injection pain were also observed. ResultsThe examination was successfully completed in all patients. Blood pressure and heart rate increased in all patients when fiberoptic bronchoscopy got across tracheal carina. There were no statistically significant differences in the two groups (P>0.05). Patients in the two groups had no statistic difference in tinnitus and numbness of tongue (P>0.05). Compared with the control group, patients in the lidocaine group had lower incidence of injection pain (P<0.05). ConclusionIntravenous lidocaine cannot suppress stress response induced by fiberoptic bronchoscopy effectively.
【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.
This study aims to investigate the effect of lung ischemia reperfusion injury (LIRI) on expression of transient receptor potential vanilloid 1 (TRPV1) in the lung and brainstem of rats. Sixteen adult male Sprague Dawley rats weighing 250-320 g were randomly divided into Sham group and ischemia reperfusion group (IR group). Before ischemia, 0.5 hour and 4 hours after the reperfusion, respectively, arterial partial pressure of oxygen (PaO2) and arterial-alveolar oxygen pressure gradient (A-aDO2) were recorded and calculated, respectively. Left lung tissues and the brainstems were obtained at the end of the experiment. Lung tissue malondialdehyde (MDA), myeloperoxidase (MPO) activities, calcitonin gene related peptide (CGRP) and substance P (SP) levels were assessed. The mRNA and protein expressions of TRPV1 in the lung and brainstem were measured by qRT-PCR and Western blot. Compared with in the Sham group, rats in the IR group had a poorer blood gas exchange (P<0.05) and the MPO activity and MDA level of lung tissues in the IR group were significantly higher than those in the Sham group (P<0.05). CGRP level in the IR group increased remarkably (P<0.05), while SP level did not differ statistically between the two groups (P>0.05). The mRNA and protein expressions of TRPV1 in the lung tissue were upregulated in the IR group (P<0.05), but there were no differences of those in the brainstem between the two groups (P>0.05). The results suggest that LIRI could upregulate the expressions of TRPV1 and evoke CGRP release in the lung.