Objective The aim of this study was to investigate if target-controlled-infusion of remifentanil as sole agent affect bispectal index(BIS) and auditory evoked potential index (AEPI).Methods Twenty two ASAⅠ-Ⅱpatients...Objective The aim of this study was to investigate if target-controlled-infusion of remifentanil as sole agent affect bispectal index(BIS) and auditory evoked potential index (AEPI).Methods Twenty two ASAⅠ-Ⅱpatients scheduled for elective surgery were enrolled in this study.A effect-site target-controlled infusion of remifentanil was started to increase concentration gradually , the initial remifentanil concentration was set at 2.0 ng·mL -1 and was increased by 1.0 ng·mL -1 until 8.0 ng·mL -1.At baseline and at each successive target concentration of remifentanil ,the BIS,AEPI ,observer’s assessment of alertness/sedation (OAA/S) ,hemodynamic variables and respiratory rate were recorded.Results Increasing predicted remifentanil effect-site concentration(CeREMI) decreased BIS value,compared with 0 ng·mL -1,the mean values of BIS were significantly reduced from 4.0 ng·mL -1(P<0.05).No significant difference in AEPI values were found.There was great variation existing in reaction to remifentanil in patients.BIS value decreased obviously in 9 patients(≤70)but in another 10 patients remained unchanged(≥90).In 9 remifentanil-sensitive patients,the spearman correlation coefficient of BIS mean value between CeREMI was -0.715 and between OAA/S was 0.705.However,in another10 remifentanil-insensitive patients,we had not found any correlation in BIS mean value between CeREMI or OAA/S. Conclusion We conclude that at the concentration used in clinical practice,great variation exists in patients’ reaction to remifentanil.Whether remifentanil affects BIS or not depend on if it produce sedative effect in patients.We have to consider the individual difference of BIS in remifentanil application.展开更多
目的观察经耳蜗侧壁打孔（侧壁径路）和经圆窗膜、基底膜穿刺（双膜径路）两种内淋巴系统给药方式对豚鼠耳蜗整体形态结构和功能的影响并比较两种方式的优劣。方法40只正常健康杂色豚鼠分为A、B两组（每组20只），所有动物左侧为给药耳...目的观察经耳蜗侧壁打孔（侧壁径路）和经圆窗膜、基底膜穿刺（双膜径路）两种内淋巴系统给药方式对豚鼠耳蜗整体形态结构和功能的影响并比较两种方式的优劣。方法40只正常健康杂色豚鼠分为A、B两组（每组20只），所有动物左侧为给药耳，右侧为非给药耳。A组采用侧壁径路进入中阶灌注携带增强型绿色荧光蛋白基因的5型重组腺病毒（adenovims5-enhanced green fluorescence protein，AdS—EGFP）5μl；B组采用双膜径路进入中阶灌注AdS-EGFP5μ1。给药前后行听眭脑干反应（ABR）测试，观察听功能改变。耳蜗冰冻切片直接荧光观察腺病毒分布，HE染色观察手术径路的愈合情况。基底膜铺片鬼笔环肽染色观察毛细胞受损情况，扫描电镜观察局部损害情况。结果所有动物术后均存活。穿刺部位修复良好，耳蜗的完整性得以保持。EGFP在Corti器和血管纹内壁细胞内标记明显，表明两种给药径路都可以将药物成功注入内淋巴系统。A组证实成功14只（70％），手术前后ABR反应阈（声压级）变化[（33．1±10．3）dB]与对侧非给药耳[（9．4±3．9）dB]比较差异具有统计学意义（F=46．34，P=0．0005）；B组证实成功8只（40％）手术前后阈值改变[（2．5±3．8）dB]与对侧耳[（2．5±3．8）dB]比较差异无统计学意义（F=0．00，P=1．000）。两种方法在部分动物中都有药物渗漏入外淋巴的现象，给药局部产生炎性反应，侧壁径路对毛细胞的损害范围大于双膜径路。结论两种手术径路都可将药物成功注入豚鼠耳蜗的内淋巴系统中，局部有炎性反应，术后耳蜗的完整性可以获得完全恢复。侧壁径路对豚鼠耳蜗毛细胞缺失和ABR反应阈的影响大于双膜径路，但是经侧壁径路进入中阶的手术成功率高于双膜径路，选择何种灌注径路需要根据实验要求来定。展开更多
文摘Objective The aim of this study was to investigate if target-controlled-infusion of remifentanil as sole agent affect bispectal index(BIS) and auditory evoked potential index (AEPI).Methods Twenty two ASAⅠ-Ⅱpatients scheduled for elective surgery were enrolled in this study.A effect-site target-controlled infusion of remifentanil was started to increase concentration gradually , the initial remifentanil concentration was set at 2.0 ng·mL -1 and was increased by 1.0 ng·mL -1 until 8.0 ng·mL -1.At baseline and at each successive target concentration of remifentanil ,the BIS,AEPI ,observer’s assessment of alertness/sedation (OAA/S) ,hemodynamic variables and respiratory rate were recorded.Results Increasing predicted remifentanil effect-site concentration(CeREMI) decreased BIS value,compared with 0 ng·mL -1,the mean values of BIS were significantly reduced from 4.0 ng·mL -1(P<0.05).No significant difference in AEPI values were found.There was great variation existing in reaction to remifentanil in patients.BIS value decreased obviously in 9 patients(≤70)but in another 10 patients remained unchanged(≥90).In 9 remifentanil-sensitive patients,the spearman correlation coefficient of BIS mean value between CeREMI was -0.715 and between OAA/S was 0.705.However,in another10 remifentanil-insensitive patients,we had not found any correlation in BIS mean value between CeREMI or OAA/S. Conclusion We conclude that at the concentration used in clinical practice,great variation exists in patients’ reaction to remifentanil.Whether remifentanil affects BIS or not depend on if it produce sedative effect in patients.We have to consider the individual difference of BIS in remifentanil application.
文摘目的观察经耳蜗侧壁打孔（侧壁径路）和经圆窗膜、基底膜穿刺（双膜径路）两种内淋巴系统给药方式对豚鼠耳蜗整体形态结构和功能的影响并比较两种方式的优劣。方法40只正常健康杂色豚鼠分为A、B两组（每组20只），所有动物左侧为给药耳，右侧为非给药耳。A组采用侧壁径路进入中阶灌注携带增强型绿色荧光蛋白基因的5型重组腺病毒（adenovims5-enhanced green fluorescence protein，AdS—EGFP）5μl；B组采用双膜径路进入中阶灌注AdS-EGFP5μ1。给药前后行听眭脑干反应（ABR）测试，观察听功能改变。耳蜗冰冻切片直接荧光观察腺病毒分布，HE染色观察手术径路的愈合情况。基底膜铺片鬼笔环肽染色观察毛细胞受损情况，扫描电镜观察局部损害情况。结果所有动物术后均存活。穿刺部位修复良好，耳蜗的完整性得以保持。EGFP在Corti器和血管纹内壁细胞内标记明显，表明两种给药径路都可以将药物成功注入内淋巴系统。A组证实成功14只（70％），手术前后ABR反应阈（声压级）变化[（33．1±10．3）dB]与对侧非给药耳[（9．4±3．9）dB]比较差异具有统计学意义（F=46．34，P=0．0005）；B组证实成功8只（40％）手术前后阈值改变[（2．5±3．8）dB]与对侧耳[（2．5±3．8）dB]比较差异无统计学意义（F=0．00，P=1．000）。两种方法在部分动物中都有药物渗漏入外淋巴的现象，给药局部产生炎性反应，侧壁径路对毛细胞的损害范围大于双膜径路。结论两种手术径路都可将药物成功注入豚鼠耳蜗的内淋巴系统中，局部有炎性反应，术后耳蜗的完整性可以获得完全恢复。侧壁径路对豚鼠耳蜗毛细胞缺失和ABR反应阈的影响大于双膜径路，但是经侧壁径路进入中阶的手术成功率高于双膜径路，选择何种灌注径路需要根据实验要求来定。
