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中华麻醉学杂志
中华麻醉学杂志

罗爱伦

月刊

0254-1416

cja@vip.163.com

0311-85989621

050071

石家庄市和平西路299号

中华麻醉学杂志/Journal Chinese Journal of AnesthesiologyCSCD北大核心CSTPCD
查看更多>>1981年3月创刊，中华医学会主办。本刊是反映了我国麻醉学临床、科研发展的水平，促进了国内外麻醉学科的学术交流，引导着我国麻醉学的发展方向；杂志发行世界104个国家，编委会中有美国、加拿大、新加坡、台湾地区、香港地区的国际知名专家加盟，被《化学文摘》等国际检索系统收录，且荣登《化学文摘》千刊表；首批获准加入WHO西太平洋地区医学索引。曾荣获 “百种中国杰出学术期刊”及“中国精品科技期刊”称号。
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    新年献词：创新推动麻醉学科高质量发展

    熊利泽彭云水
    1-2页
    查看更多>>摘要：日月开新元，天地又一春。在这辞旧迎新的美好时刻，谨此代表《中华麻醉学杂志》编委会及编辑部，对长期以来热忱支持和关心本刊发展与建设的各位编审专家，向广大的作者、读者及企业一如既往的大力支持，致以诚挚的谢意！并预祝大家龙年大吉、顺遂安康！
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    年终盘点：2023年《NEJM》发表麻醉学领域相关研究亮点精粹

    雷翀熊利泽周晓云
    3-10页
    查看更多>>摘要：2023年《The New England Journal of Medicine》(NEJM)出版52期，共发表研究型论著208篇。今年主编推荐的"NEJM最佳论文"重点关注了各种疾病的新疗法，如"通用"嵌合抗原受体T细胞对肿瘤的治疗、新的抗肿瘤靶点、新的肾脏疾病治疗靶点等，还有药物的新应用，如度普利尤单抗用于嗜酸性粒细胞计数升高的慢性阻塞性肺病患者，胰高血糖素样肽-1激动剂司美格鲁肽用于射血分数保留的心力衰竭肥胖患者，三重激素受体激动剂利拉鲁肽治疗肥胖，氯胺酮治疗难治性抑郁等。针对围术期领域，本年度相关论文主要集中于血液管理、心搏骤停的救治、评估与监测、重症患者的治疗与管理、新的治疗方法或药物新的治疗场景等领域。本文精选以上5个主题的17篇相关亮点研究，以飨读者。
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    经鼻高流量支持下无气管插管深肌松麻醉专家共识

    苏殿三周晓云
    11-14页
    查看更多>>摘要：气管插管全身麻醉是目前临床主要的全麻方式，然而气管插管会导致声带损伤等相关并发症，用于短小手术时手术周转效率低。将经鼻湿化快速充气交换通气技术和新型肌松拮抗剂结合，即经鼻高流量支持下无气管插管深肌松麻醉(H-NIDP)，可以解决这一临床问题。该方法目前尤其适用于部分咽喉部短小手术。为进一步推广H-NIDP，中国心胸血管麻醉学会创新与推广分会组织专家制定了首部H-NIDP专家共识，该共识介绍了H-NIDP的应用范围、相关实施细则等规范。该共识虽历经专家反复修改讨论，但不足之处在所难免，欢迎读者提出意见和建议，以便进一步更新。 General anesthesia with tracheal intubation is currently the most widely used anesthesia strategy. But it would still inevitably cause related complications, including vocal cord injury, blood pressure fluctuations, etc. The turnaround efficacy of surgery is low when it is used for minor surgeries. A new anesthesia strategy, which combined with transnasal humidified rapid insufflation ventilatory exchange and a new type of muscle relaxant antagonist, called non-intubated deep paralysis with high-flow nasal oxygen (H-NIDP), can solve this clinical problem. This strategy is particularly suitable for some minor surgeries in the throat. In order to further promote the H-NIDP technology, Chinese Society of Cardiothoracic Anesthesiology on Promotion Society of New Anesthesia Technology organized experts and made up a task force to formulate the first " expert consensus on non-intubated deep paralysis with high-flow nasal oxygen" . This consensus introduces the application scope of H-NIDP technology and formulates relevant implementation rules and specifications. Although the consensus has been repeatedly revised and discussed by experts, deficiencies are inevitable. Readers are welcome to provide opinions and suggestions for further updates in the future.

    经鼻高流量通气支持下无气管插管深肌松麻醉经鼻湿化快速充通气专家共识

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    髋部骨折老年患者术后1年死亡的危险因素及其预测模型的准确性：基于LASSO-logistic回归

    吴红蔡伟茶金琪琪周盈丰...
    15-19页
    查看更多>>摘要：目的 基于LASSO-logistic回归分析，筛选髋部骨折老年患者术后1年死亡的危险因素并评价预测模型的准确性。 方法 对2019年1月至12月在温州医科大学附属第二医院行髋部骨折手术治疗的老年患者(年龄≥65岁)进行病例对照研究。根据患者术后1年的生存状态分为死亡组和存活组。获取患者一般资料及术前实验室指标。采用LASSO回归筛选出变量后将其纳入多因素logistic回归分析筛选髋部骨折老年患者术后1年死亡的危险因素。根据结果建立预测模型并对模型进行评价。 结果 死亡组63例，存活组564例。经LASSO回归筛选变量及多因素logistic回归分析，年龄、术前认知功能障碍、查尔森合并症指数(CCI)≥3分和术前血清前白蛋白(PAB)水平是髋部骨折老年患者术后1年死亡的独立危险因素(P<0.05)。预测模型的受试者工作特征曲线下面积为0.788(95%CI 0.731～0.846)，灵敏度和特异度分别为76.2%和68.6%。校准曲线的平均绝对误差为0.007。Hosmer-Lemeshow拟合优度检验结果显示模型预测值与实际观测值差异无统计学意义(χ2＝5.065，P＝0.751)。决策曲线分析显示阈概率范围为0～0.7时患者的净获益率较高。 结论 年龄、术前认知功能障碍、CCI≥3分和术前PAB水平是髋部骨折老年患者术后1年死亡的独立危险因素，基于LASSO-logistic回归建立的预测模型准确性较高。 Objective To identify the risk factors for 1-year death after surgery in elderly patients with hip fractures and evaluate the accuracy of the prediction model based on LASSO-logistic regression analysis. Methods A case-control study was conducted on elderly patients (age ≥65 yr) who underwent surgical treatment for hip fractures in the Second Affiliated Hospital of Wenzhou Medical University from January to December 2019. Patients were divided into death group and survival group according to their survival status at 1-year after surgery. General data and preoperative laboratory indicators were obtained. The variables were selected by utilizing LASSO regression and incorporated into multivariate logistic regression analysis to identify the risk factors for 1-year death after surgery in elderly patients with hip fractures. Then a prediction model was established based on the results and evaluated. Results There were 63 patients in death group and 564 in survival group. The results of LASSO regression and multivariate logistic regression analysis showed that age, preoperative cognitive dysfunction, Chalson comorbidity index ≥3 points and preoperative serum prealbumin level were the independent risk factors for 1-year death after surgery in elderly patients with hip fractures (P<0.05). The area under the receiver operating characteristic curve of the prediction model was 0.788 (95% confidence interval [0.731-0.846]), with the sensitivity and specificity of 76.2% and 68.6% respectively. The average absolute error of the calibration curve was 0.007. The results of Hosmer-Lemeshow goodness-of-fit test showed that there was no significant difference between the predicted value and actual observed value (χ2=5.065, P=0.751). Decision curve analysis showed that patients had a high net benefit rate when the threshold probability range was 0-0.7. Conclusions Age, preoperative cognitive dysfunction, Chalson comorbidity index ≥3 points and preoperative serum prealbumin level are the independent risk factors for 1-year death after surgery in elderly patients with hip fractures, and the prediction model developed based on LASSO-logistic regression has high accuracy.

    髋部骨折老年人危险因素预测模型LASSO-logistic回归

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    全麻食管癌根治术患者PACU-LOS延长的危险因素及预测模型建立

    李冰刘瑶刘新民赵影...
    20-25页
    查看更多>>摘要：目的 筛选全麻食管癌根治术患者麻醉恢复室停留时间(PACU-LOS)延长的危险因素并建立预测模型。 方法 选取2019年1月至2020年12月本院全麻食管癌根治术后带气管插管转入PACU患者的临床资料，性别不限，年龄40～80岁，ASA分级Ⅰ-Ⅲ级。收集患者年龄、性别、ASA分级、吸烟史、饮酒史、非胸外科手术史、高血压史、糖尿病史、术前贫血、呼吸系统疾病、麻醉药物剂量、术前神经阻滞情况、术中阿片类药物和右美托咪定用量、手术方式(开胸/腔镜)、手术时间、血管药物使用情况、心动过缓和低血压发生情况、红细胞输注量、血浆输注量、总输液量、出血量、尿量。收集PACU气管拔管时间、气管拔管后10 min静态VAS评分、PACU期间补救镇痛药物用量、气管拔管后低氧血症和恶心呕吐发生情况。根据PACU-LOS将患者分为PACU-LOS正常组(PACU-LOS≤2 h)和PACU-LOS延长组(PACU-LOS>2 h)。采用logistic回归模型筛选PACU-LOS延长的危险因素，建立预测模型并进行验证，采用受试者工作特征曲线评估模型区分度，采用Hosmer-Lemshow拟合度检验评估模型一致性。 结果 本研究共纳入943例患者，术后PACU-LOS延长发生率15.7%。logistic回归分析显示，慢性阻塞性肺疾病病史(OR＝4.900，95%CI 2.512～9.556)、年龄65～74岁(OR＝22.154，95%CI 6.736～73.003)、气管拔管时间延长(OR＝1.214，95%CI 1.174～1.256)和气管拔管后低氧血症(OR＝4.891，95%CI 2.167～11.039)是全麻食管癌根治术患者PACU-LOS延长的危险因素(P<0.05)；术前神经阻滞(OR＝0.358，95%CI 0.190～0.672)是食管癌根治患者PACU-LOS延长的保护因素(P<0.05)。预测模型的受试者工作特征曲线下面积为0.947(95%CI 0.925～0.963)，灵敏度为0.878，特异度为0.906；采用验证集对预测模型进行受试者工作特征曲线内部验证，曲线下面积为0.942(95%CI 0.895～0.942，P<0.001)，约登指数为0.784。列线图预测模型经Hosmer-Lemshow检验，P<0.001，可视化列线图模型C指数为0.946。 结论 术前合并慢性阻塞性肺疾病、年龄增加、气管拔管时间延长和拔管后低氧血症是PACU-LOS延长的危险因素；术前神经阻滞是保护因素；基于此建立的风险预测模型可有效预测全麻食管癌根治术患者PACU-LOS延长的发生。 Objective To identify the risk factors for prolonged length of stay in post-anesthesia care unit (PACU-LOS) and development of a prediction model in the patients undergoing radical esophagectomy. Methods The medical records from patients of both sexes, aged 40-80 yr, of American Society of Anesthesiologists Physical Status classificationⅠ-Ⅲ, transferred to PACU with tracheal intubation after radical esophagectomy under general anesthesia in our hospital from January 2019 to December 2020, were retrospectively collected. The patient′s age, gender, American Society of Anesthesiologists Physical Status classification, smoking history, drinking history, history of non-thoracic surgery, history of hypertension, history of diabetes mellitus, preoperative anemia, respiratory diseases, doses of anesthetics, preoperative nerve block, intraoperative consumption of opioids and dexmedetomidine, operation method (thoracotomy and endoscopic surgery), operation time, usage of vascular drugs, bradycardia, hypotension, red blood cell infusion, plasma infusion, total infusion volume, blood loss and urine volume were collected. The extubation time in PACU, visual analog scale scores at rest at 10 min after extubation, consumption of rescue analgesics in PACU, hypoxemia after extubation, and occurrence of nausea and vomiting were also collected. Patients were divided into PACU-LOS normal group (PACU-LOS≤2 h) and PACU-LOS prolonged group (PACU-LOS>2 h) according to the PACU-LOS. Logistic regression analysis was used to identity the risk factors for prolonged PACU-LOS in the patients undergoing radical esophagectomy, and the predictive model was established and verified. The receiver operating characteristic curves were used to evaluate the model discrimination and Hosmer-Lemshow goodness-of-fit test was used to evaluate the consistency of the model. Results A total of 943 patients were included in this study, and the incidence of prolonged PACU-LOS was 15.7%. The results of logistic regression analysis showed that chronic obstructive pulmonary disease (OR=4.900, 95% confidence interval [CI] 2.512-9.556), increasing age (OR=22.154, 95% CI 6.736-73.003), prolonged time of extubation (OR=1.214, 95% CI 1.174-1.256) and hypoxemia after extubation (OR=4.891, 95% CI 2.167-11.039) were risk factors for prolonged PACU-LOS, and the preoperative use of nerve block (OR=0.358, 95% CI 0.190-0.672) was a protective factor for prolonged PACU-LOS in the patients undergoing radical esophagectomy (P<0.05). The area under the receiver operating characteristic curve (95%CI) was 0.947 (0.925-0.963), the sensitivity was 0.878, and the specificity was 0.906. The internal validation of the prediction model was carried out using the receiver operating characteristic curve in the validation set, and the area under the curve (95% CI) was 0.942 (0.895-0.942, P<0.001) and the Youden index was 0.784. The line chart prediction model was developed. The prediction analysis model was verified by Hosmer-Lemshow test,P<0.001, and the C-index visualized line chart prediction model was 0.946. Conclusions Preoperative chronic obstructive pulmonary disease, increasing age, prolonged time of extubation and hypoxemia after extubation are risk factors for prolonged PACU-LOS, and preoperative use of nerve block is a protective factor for prolonged PACU-LOS. The risk prediction model developed can effectively predict the occurrence of prolonged PACU-LOS in the patients undergoing radical esophagectomy.

    苏醒室住院时间食管癌食管切除术危险因素预测

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    新型冠状病毒感染后肺部手术时机与术后肺部并发症的关系：前瞻性队列研究

    杨大威李敏段鲜宁张建友...
    26-30页
    查看更多>>摘要：目的 探讨新型冠状病毒感染后肺部手术时机与术后肺部并发症(PPCs)的关系。 方法 采用前瞻性队列研究设计，纳入2023年1至5月择期行胸腔镜下肺部分切除术患者68例，年龄30～75岁，性别不限，ASA分级Ⅰ或Ⅱ级，BMI 18～30 kg/m2，均为2022年12月之后首次感染新型冠状病毒。依据手术日期距离新型冠状病毒感染的时间将患者分为2组(n＝34)：5～10周组和11～16周组。记录术前持续症状、呼吸困难情况；分别于术前1 d、术后2 h、1和2 d时采用ELISA法检测血清IL-6和TNF-α浓度；分别于术前1 d、术后1和2 d时检测WBC计数和血清CRP浓度。记录术后住院期间PPCs发生情况和术后住院时间。采用logistic回归分析PPCs与新型冠状病毒感染后肺部手术时机的关系。 结果 2组各有2例患者因术中转开胸手术而剔除研究，最终每组纳入32例患者。与5～10周组比较，11～16周组术前持续症状和呼吸困难比率降低，术后各时点血清IL-6、TNF-α、CRP浓度和WBC计数降低，PPCs和术后肺部感染发生率降低，术后住院时间缩短(P<0.05)。多因素logistic回归分析显示，手术日期距离新型冠状病毒感染时间短(OR＝1.754，95%CI 1.509～2.038，P<0.001)、术前存在持续症状(OR＝2.523，95%CI 2.047～3.110，P<0.001)、术前存在呼吸困难(OR＝1.875，95%CI 1.406～2.500，P<0.001)和术后1 d时WBC计数高(OR＝0.676，95%CI 0.651～0.701，P<0.001)是PPCs的独立危险因素。 结论 新型冠状病毒感染后11～16周相较于感染后5～10周行肺部手术PPCs风险降低；手术日期距离新型冠状病毒感染时间短是肺部手术PPCs的独立危险因素。 Objective To investigate the relationship between the timing of pulmonary surgery and postoperative pulmonary complications (PPCs) after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Methods Sixty-eight American Society of Anesthesiologists Physical Status classification Ⅰor Ⅱ patients of either sex, with body mass index of 18-30 kg/m2, who were first infected with SARS-CoV-2 after December 2022, undergoing elective thoracoscopic partial pneumonectomy from January to May 2023, were included in this prospective cohort study. The patients were divided into 2 groups (n=34 each) according to the time between the date of surgery and SARS-CoV-2 infection: 5-10 weeks group and 11-16 weeks group. The preoperative persistent symptoms and dyspnea before operation were recorded. The serum concentrations of interleukin-6 and tumor necrosis factor-alpha were determined by enzyme-linked immunosorbent assay at 1 day before operation and 2 h and 1 and 2 days after operation. The white blood cell count and serum C-reactive protein concentration were measured at 1 day before operation and 1 and 2 days after operation. The occurrence of PPCs and length of postoperative hospital stay were recorded. Logistic regression was used to analyze the relationship between PPCs and timing of pulmonary surgery after SARS-CoV-2 infection. Results Two patients in each group were excluded from the study because of conversion to thoracotomy. Thirty-two patients were finally included in each group. Compared with 5-10 weeks group, the ratio of preoperative persistent symptoms and dyspnea was significantly decreased, the serum concentrations of interleukin-6, tumor necrosis factor-alpha and C-reactive protein and white blood cell count were decreased at each time point after operation, the incidence of PPCs and postoperative pulmonary infection was decreased, and the length of postoperative hospital stay was shortened in 11-16 weeks group (P<0.05). Multivariate logistic regression analysis showed that short time from the date of surgery to infection (OR=1.754, 95% confidence interval[CI] 1.509-2.038, P<0.001), preoperative persistent symptoms (OR=2.523, 95% CI 2.047-3.110, P<0.001), preoperative dyspnea (OR=1.875, 95% CI 1.406-2.500, P<0.001) and high white blood cell count at 1 day after surgery (OR=0.676, 95% CI 0.651-0.701, P<0.001) were independent risk factors for PPCs. Conclusions The risk of PPCs is lower in the patients undergoing pulmonary surgery at 11-16 weeks after SARS-CoV-2 infection than at 5-10 weeks after infection. Short time from the date of surgery to infection is an independent risk factor for PPCs.

    新型冠状病毒肺切除术手术后并发症肺

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    儿童感染新型冠状病毒后第3周行日间手术的可行性

    宋玉婷蔡巍维顾伟仲山...
    31-35页
    查看更多>>摘要：目的 回顾性分析儿童感染新型冠状病毒后第3周行日间手术的可行性。 方法 收集2022年11月1日至2023年2月28日行日间手术患儿的临床资料，手术时间≤1 h，ASA分级Ⅰ或Ⅱ级，性别不限，年龄≤14岁，BMI 10～30 kg/m2。根据是否感染过新型冠状病毒将患儿分为新冠组和对照组，主要结局指标为患儿术后30 d内呼吸系统相关并发症发生率。次要结局指标包括患儿术后30 d内非计划通气、延迟出院和二次入院率，患儿术前肌酸激酶同工酶(CK-MB)、AST、ALT、Hb、白细胞计数、CRP水平、口咽黏膜炎症分级、手术时间、苏醒时间、术中呼吸抑制、喉痉挛、低氧血症、低血压、窦性心动过缓发生率和追加抢救药物率。 结果 新冠组337例，对照组1 396例。与对照组比较，新冠组患儿术前CK-MB浓度升高，Hb浓度降低(P<0.05)。2组患儿术后30 d内呼吸系统相关并发症发生率、非计划通气、延迟出院和术后二次入院率、术前AST、ALT浓度、白细胞计数、CRP浓度、口咽黏膜炎症分级、手术时间、术中呼吸抑制、喉痉挛、低氧血症、低血压、窦性心动过缓发生率、追加抢救药物率及苏醒时间比较差异无统计学意义(P>0.05)。 结论 儿童在感染新型冠状病毒后第3周行日间手术的可行性良好。 Objective To retrospectively analyze the feasibility of undergoing day surgery at 3rd week after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children. Methods The clinical data from children who underwent day surgery from November 1, 2022 to February 28, 2023, with operation time ≤1 h, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, regardless of gender, aged≤14 yr, with body mass index of 10-30 kg/m2, were divided into SARS-CoV-2 group and control group according to whether the children had been infected with the SARS-CoV-2. The main outcome measure was the incidence of respiratory system-related complications within 30 days after surgery. Secondary outcome measures included the rate of unplanned ventilation, delayed discharge and secondary admission within 30 days after surgery. Preoperative creatine kinase isoenzyme (CK-MB), aspartate aminotransferase (AST), alanine aminotransferase (ALT), hemoglobin (Hb), white blood cell count, C-reactive protein (CRP) level, grade of oropharyngeal mucosa inflammation, operation time, emergence time, intraoperative respiratory depression, laryngeal spasm, hypoxemia, hypotension, incidence of sinus bradycardia and rate of additional rescue drugs were recorded. Results There were 337 cases in SARS-CoV-2 group and 1 396 cases in control group. Compared with control group, CK-MB concentrations were significantly increased, and the Hb concentration was decreased before surgery in SARS-CoV-2 group (P<0.05). There were no statistically significant differences in the incidence of respiratory system-related complications, unplanned ventilation, delayed discharge and rate of postoperative secondary admission, preoperative AST and ALT concentrations, white blood cell count, CRP concentrations, grade of oropharyngeal mucosa inflammation, operation time, intraoperative respiratory depression, laryngeal spasm, hypoxemia, hypotension, incidence of sinus bradycardia, rate of additional rescue drugs and emergence time between the two groups (P>0.05). Conclusions Feasibility of undergoing day surgery is good at the third week after being infected with the SARS-CoV-2 in children.

    儿童新型冠状病毒手术时间可行性研究

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    小剂量艾司氯胺酮对非心脏手术老年患者术后认知功能的影响

    汪玫车建翔陈磊宋婷婷...
    36-40页
    查看更多>>摘要：目的 评价小剂量艾司氯胺酮对非心脏手术老年患者术后认知功能的影响。 方法 择期全身麻醉下行非心脏手术患者124例，年龄65～80岁，性别不限，BMI 18～35 kg/m2，ASA分级Ⅰ或Ⅱ级，采用随机数字表法分为艾司氯胺酮组(E组，n＝64)和对照组(C组，n＝60)。E组静脉注射艾司氯胺酮0.5 mg/kg，C组静脉注射等容量生理盐水，2组静脉注射芬太尼、丙泊酚和罗库溴铵行麻醉诱导；采用静吸复合麻醉进行维持；术后行PCIA。分别于术前1 d和术后30 d行简易精神状态检查、听觉词语学习测试、循迹连线测验A版和B版、数字符号替换测试、波士顿命名测试、复杂图形测试，采用Z计分法判断术后认知功能障碍发生情况。术后1～7 d采用意识模糊评估法评估谵妄发生情况。记录术中低血压和术后苏醒延迟、恶心呕吐、幻觉等发生情况。记录自主呼吸恢复时间、呼唤睁眼时间和气管拔管时间。 结果 与C组相比，E组术后30 d时认知功能障碍发生率和术中低血压发生率降低(P<0.05)，自主呼吸恢复时间、呼唤睁眼时间、气管拔管时间、术后苏醒延迟、谵妄、幻觉、恶心呕吐发生率差异无统计学意义(P>0.05)。 结论 小剂量艾司氯胺酮可改善非心脏手术老年患者术后认知功能。 Objective To assess the effect of low-dose esketamine on postoperative cognitive function in elderly patients undergoing non-cardiac surgery. Methods One hundred and twenty-four patients, aged 65-80 yr, regardless of gender, with a body mass index of 18-35 kg/m2, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, were assigned to either esketamine group (group E, n=64) or control group (group C, n=60) using a random number table method. Group E received intravenous esketamine at a dose of 0.5 mg/kg, while group C received an equal volume of normal saline intravenously. Anesthesia was induced with intravenous fentanyl, propofol and rocuronium and maintained using combined intravenous-inhalational anesthesia in both groups. Patient-controlled analgesia was carried out postoperatively. Cognitive function tests including a simple mental state examination, auditory word learning test, tracking connection test A and B, number symbol replacement test, Boston naming test and complex graph test were performed at 1 day before surgery and 30 days after surgery, and postoperative cognitive dysfunction was determined using Z-score method. Delirium was assessed using Confusion Assessment Method from 1 to 7 days after operation. The operative hypotension, postoperative delayed emergence, nausea and vomiting, and hallucinations were recorded. The recovery time of spontaneous breathing, eye opening to verbal command and extubation time were recorded. Results Compared with group C, the incidence of cognitive dysfunction at 30 days after surgery and intraoperative hypotension was significantly decreased (P<0.05), and no significant change was found in the recovery time of spontaneous breathing, eye opening to verbal command, extubation time, incidence of postoperative delayed emergence, delirium, nausea and vomiting, and hallucinations in group E (P>0.05). Conclusions Low-dose esketamine can improve postoperative cognitive function in elderly patients undergoing non-cardiac surgery.

    氯胺酮老年人术后认知并发症

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    睡眠剥夺对幼鼠小脑沉默信息调节因子6表达的影响

    肖岚高尘怡陈婷张学敏...
    41-45页
    查看更多>>摘要：目的 评价睡眠剥夺对幼鼠小脑沉默信息调节因子6(SIRT6)表达的影响。 方法 SPF级健康雄性C57BL/6小鼠50只，4周龄，体质量14～16 g，采用随机数字表法分为2组(n＝25)：对照组(Con组)和睡眠剥夺组(SD组)。采用多平台水环境法制备小鼠睡眠剥夺模型，每天睡眠剥夺20 h，连续10 d。睡眠剥夺后行平衡木实验检测小鼠平衡和协调能力，麻醉后处死小鼠，取小脑组织，透射电子显微镜观察超微结构，采用高尔基染色法测定小脑浦肯野细胞树突棘密度，采用免疫荧光法检测小脑浦肯野细胞SIRT6和钙结合蛋白D-28k(CbD-28k)共表达情况，检测小脑葡萄糖转运体3(Glut3)表达。 结果 与Con组比较，SD组小鼠平衡木通过时间延长，后足滑脱次数增加，小脑4-6cb神经元突触间隙增大，突触后致密物厚度、浦肯野细胞树突棘密度及SIRT6与CbD-28k共表达阳性细胞数降低，Glut3表达下调(P<0.05)。 结论 睡眠剥夺降低幼鼠平衡和协调能力的机制与下调小脑浦肯野细胞SIRT6表达，降低神经元糖代谢，从而损伤小脑突触可塑性有关。 Objective To evaluate the effect of sleep deprivation on the expression of sirtuin 6 (SIRT6) in the cerebellum of immature mice. Methods Fifty SPF healthy male C57BL/6 mice, aged 4 weeks, weighing 14-16 g, were divided into 2 groups (n=25 each) using a random number table method: control group (Con group) and sleep deprivation group (SD group). The chronic sleep deprivation model was prepared by using the multi-platform water environment method, with 20 h of sleep deprivation per day for 10 consecutive days. After sleep deprivation, a balance beam experiment was performed to test the balance and coordination ability of mice. The mice were sacrificed after anesthesia and cerebellar lobular IV-VI (4-6 cb) tissues were taken for microscopic examination of the ultrastructure (with a transmission electron microscope) and for determination of the dendritic spine density of cerebellar 4-6cb Purkinje neurons (by Golgi staining), co-expression of SIRT6 and Calbindin D-28k (CbD-28k) and expression of glucose transporter Glut3 of cerebellar 4-6cb (by immunofluorescence staining). Results Compared with group Con, the duration of passage through the balance beam was significantly prolonged, and the number of posterior foot slips was increased, the synaptic gap of cerebellar 4-6cb neurons was increased, the thickness of postsynaptic density was increased, the density of dendritic spines of Purkinje cells and the number of positive cells co-expressing SIRT6 and CbD-28k were decreased, and the expression of Glut3 was down-regulated in group SD (P<0.05). Conclusions The mechanism by which sleep deprivation decreases the abilities of balance and coordination is related to down-regulating SIRT6 expression in cerebellar Purkinje cells and decreasing neuronal glucose metabolism, thus damaging the synaptic plasticity of cerebellum in immature mice.

    睡眠剥夺小脑沉默信息调节因子6

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    CIP2A在术前睡眠剥夺加重老龄小鼠术后认知功能障碍中的作用

    刘阳李慧敏巩红岩魏苗苗...
    46-52页
    查看更多>>摘要：目的 评价抑癌因子蛋白磷酸酶2A(CIP2A)在术前睡眠剥夺加重老龄小鼠术后认知功能障碍中的作用。 方法 SPF级健康C57BL/6J小鼠110只，雌雄不拘，18～20月龄，体质量29～35 g。采用随机数字表法分为5组(n＝22)：假手术组(S组)、腹部手术组(O组)、术前睡眠剥夺＋腹部手术组(D＋O组)、CIP2A shRNA＋腹部手术组(CS＋O组)和CIP2A shRNA＋术前睡眠剥夺＋腹部手术组(CS＋D＋O组)。术前14 d时，S组、O组和CS＋O组海马注射对照shRNA慢病毒，D＋O组和CS＋D＋O组海马注射CIP2A shRNA慢病毒。术前连续3 d行睡眠剥夺。术后7～11 d采用Morris水迷宫实验评估认知功能。术后3 d时深麻醉下处死小鼠取海马，采用Western blot法测定CIP2A、高迁移率族蛋白B1(HMGB1)、离子化钙结合适配蛋白-1(Iba-1)、蛋白磷酸酶2A的α亚单位(PP2Aa)、蛋白磷酸酶2A的催化亚单位(PP2Ac)、磷酸化tau蛋白(p-tau) (S396)和p-tau (S404)表达，检测海马ROS、MDA和SOD的水平，免疫荧光染色法计数海马CA1区Iba-1阳性细胞。 结果 与S组比较，O组逃避潜伏期延长，穿越平台位置次数减少，目标象限停留时间缩短，海马CIP2A、Iba-1和HMGB1表达上调，PP2Ac表达下调，ROS、MDA水平和Iba-1阳性细胞计数升高，SOD活性降低(P<0.05)；与O组比较，D＋O组逃避潜伏期延长，穿越平台位置次数减少，目标象限停留时间缩短，海马CIP2A、Iba-1和HMGB1表达上调，PP2Ac表达下调，ROS、MDA水平和Iba-1阳性细胞计数升高，SOD水平降低，CS＋O组逃避潜伏期缩短，穿越平台位置次数增加，目标象限停留时间延长，海马CIP2A、Iba-1和HMGB1表达下调，PP2Ac表达上调，ROS、MDA水平和Iba-1阳性细胞计数降低，SOD活性升高(P<0.05)；与D＋O组比较，CS＋D＋O组逃避潜伏期缩短，穿越平台位置次数增加，目标象限停留时间延长，海马CIP2A、Iba-1和HMGB1表达下调，PP2Ac表达上调，ROS、MDA水平和Iba-1阳性细胞计数降低，SOD水平升高(P<0.05)。5组海马PP2Aa表达比较差异无统计学意义(P>0.05)。 结论 术前睡眠剥夺加重老龄小鼠术后认知功能障碍的机制与上调CIP2A的表达，促进氧化应激反应、神经炎症反应以及tau蛋白磷酸化有关。 Objective To evaluate the role of cancerous inhibitor of protein phosphatase 2A (CIP2A) in preoperative sleep deprivation (PSD)-induced aggravation of postoperative cognitive dysfunction (POCD) in aged mice. Methods One hundred and ten healthy C57BL/6J mice of either sex, aged 18-20 months, weighing 29-35 g, were divided into 5 groups (n=22 each) using a random number table method: sham operation group (S group), abdominal surgery group (O group), PSD + abdominal surgery group (D+ O group), CIP2A shRNA + abdominal surgery group (CS+ O group), and CIP2A shRNA+ PSD+ abdominal surgery group (CS+ D+ O group). At 14 days before surgery, control shRNA lentivirus was injected into the hippocampus in S, O and CS+ O groups, and CIP2A shRNA was injected into the hippocampus in D+ O and CS+ D+ O groups. PSD was carried out for 3 consecutive days prior to surgery. Cognitive function was assessed using the Morris water maze test at days 7-11 after surgery. The mice were sacrificed under deep anesthesia at day 3 after surgery, and hippocampal tissues were obtained to determine the expression of CIP2A, high mobility group box 1 (HMGB1), ionized calcium-binding adapter molecule 1 (Iba-1), alpha subunit of protein phosphatase 2A (PP2Aa), catalytic subunit of protein phosphatase 2A (PP2Ac), phosphorylated tau protein (p-tau) (S396), and p-tau (S404) (by Western blot), levels of reactive oxygen species (ROS), malondialdehyde (MDA), and superoxide dismutase (SOD), and count of Iba-1 positive cells in the hippocampal CA1 region (using immunofluorescence staining). Results Compared with S group, the escape latency was significantly prolonged, the frequency of crossing the platform was reduced, duration of stay in the target quadrant was shortened, the expression of CIP2A, Iba-1 and HMGB1 was up-regulated, PP2Ac expression was down-regulated, levels of ROS and MDA and count of Iba-1 positive cells were increased, and the activity of SOD was decreased in O group (P<0.05). Compared with O group, the escape latency was significantly prolonged, the frequency of crossing the platform was reduced, duration of stay in the target quadrant was shortened, the expression of CIP2A, Iba-1 and HMGB1 was up-regulated, PP2Ac expression was down-regulated, levels of ROS and MDA and count of Iba-1 positive cells were increased, and the activity of SOD was decreased in D+ O group, and the escape latency was significantly shortened, the frequency of crossing the platform was increased, duration of stay in the target quadrant was prolonged, the expression of CIP2A, Iba-1 and HMGB1 was down-regulated, PP2Ac expression was up-regulated, levels of ROS and MDA and count of Iba-1 positive cells were decreased, and the activity of SOD was increased in CS+ O group (P<0.05). Compared with D+ O group, the escape latency was significantly shortened, the frequency of crossing the platform was increased, duration of stay in the target quadrant was prolonged, the expression of CIP2A, Iba-1 and HMGB1 was down-regulated, PP2Ac expression was up-regulated, levels of ROS and MDA and count of Iba-1 positive cells were decreased, and the activity of SOD was increased in CS+ D+ O group (P<0.05). There was no significant difference in PP2Aa expression among the five groups (P>0.05). Conclusions The mechanism by which PSD aggravates POCD is related to up-regulating the expression of CIP2A and promoting oxidative stress responses, neuroinflammatory responses and phosphorylation of tau protein in aged mice.

    睡眠剥夺术后认知并发症抑癌因子蛋白磷酸酶2A

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