七氟烷和复合丙泊酚在小儿气管异物取出术中的应用

目的:探讨七氟烷和复合丙泊酚在小儿气管异物取出术中的应用。方法:选择2012年1月至2015年6月我院收治的80例行气管异物取出术的患儿作为研究对象,根据不同麻醉方式把80例患儿分成对照组与观察组,对照组患儿应用丙泊芬复合芬太尼进行麻醉,观察组应用七氟烷复合丙泊酚进行麻醉,比较两组患儿手术前后各项生命指标的变化。结果:在插管后、清醒后两组患儿各项生命指标均有下降,对比差异显著(P<0.05);观察组患儿出现呛咳、恶心、呕吐等不良反应明显少于对照组(P<0.05);观察组手术时间、麻醉恢复时间均比对照组短(P<0.05)。结论:七氟烷和复合丙泊酚在小儿气管异物取出术中应用效果理想,安全有效且不良反应少。

Effect of electroacupuncture on Sevoflurane anesthesia in patients undergoing resection of supratentorial tumor

Objective To observe the supplementary analgesic effect of electroacupuncture and its influence on the maintenance of anesthesia and the speed of recovery of patients undergoing craniotomy. Methods Eighty cases of supratentorial tumor resection were randomly divided into a group A and a group S, 40 cases in each group. All the patients were anesthetized with 2% Sevoflurane. The patients in group A received eleetroacupuneture at Hegu （合谷 LI 4） and Waiguan （外关 TE 5）, Jinmen （金门 BL 63） and Taichong （太冲 LR 3）, Zusanli （足三里 ST 36） and Qiuxtu（丘墟 GB 40） from anesthesia beginning to the end of operation, and in group S without electroacupuncture. tidal Sevoflurane concentration, minimum alveolar concentration （MAC）, bispectral index （BIS） and the information during anesthesia recovery stage were recorded, respectively. Results The end-tidal concentration and MAC of Sevoflurane in group A at all times were significant lower than those in group S （P〈0.05, P〈0.01） with a Sevoflurane saving of 9.62% on average. The BIS in group A during a few phases were higher than that in group S （all P〈0.05）. During anesthesia recovery stage, the time of each phase in group A was significantly shorter than that in group S （all P〈0.01）. No dysphoria and one case with nausea and vomiting were shown in group A, but in group S, 2 patients had dysphoria and 3 patients had nausea and vomiting. Conclusion Electroacupuncture combined with Sevoflurane anesthesia can decrease the dosage of Sevoflurane, shorten the recovery time of anesthesia and improve the quality of anesthesia recovery of the patients undergoing resection of supratentorial tumor.

Decreased PSD95 expression in medial prefrontal cortex(mPFC) was associated with cognitive impairment induced by sevoflurane anesthesia

Objective： Though sevoflurane has been widely used as an anesthetic in surgery, recent studies have shown that exposure to sevoflurane alone could lead to postoperative cognitive dysfunction （POCD）, of which the mechanisms still remain largely unknown. The medial prefrontal cortex （mPFC） is known to be implicated in various cognitive impairments, including working memory and attentional processes. In the present study, we tried to identify dysregulated gene expression in mPFC and investigate the underlying mechanisms involved in POCD. Methods： Behavioral tests, including elevated plus-maze, O-maze, and Y-maze tests, were performed on Wistar rats exposed to sevoflurane. Whole-genome mRNA profiling of mPFC from Wistar rats after exposure to sevoflurane was carried out. Real-time polymerase chain reaction （PCR） was done to verify the differentially expressed genes. Results： Significant impairment of working memory of rats after exposure to sevoflurane was observed. A total of 119 of 7319 detected mRNAs showed significantly different expression between rats with and without sevoflurane exposure （fold change （FC）〉2.0, P〈0.05, and false discovery rate （FDR）〈0.05）, among which 74 mRNAs were down-regulated and 45 mRNAs were up-regulated. Postsynaptic density-95 （PSD95, also named DLG4） showed the most significantly de- creased expression in mPFC and further investigation indicated that PSD95 expression level was correlated with spatial working memory performance. Conclusions： Our study revealed that PSD95 might be involved in the mecha- nism of POCD, which could provide clues for preventing POCD in clinical operations.