右美托咪啶的基础和临床.ppt

宝山壁画 宝山壁画是引人注目的昂贵文物。此壁画发现于阿鲁科尔沁旗东沙布乡境内。1994年列为“全国十大考古新发现”之一。宝山壁画中最引人注目的是《杨贵妃教鹦鹉图》。该画高0.7米、宽2.3米，用于笔重彩绘制，最突出的表现了 晚唐风格。唐代擅长绘贵妇仕女的大师周昉绘制了《杨贵妃教鹦鹉图》，不仅享誉中原，而且还影响全国各地。发现于阿旗宝山古墓里的这幅画，就是契丹人聘请中原画家按照周氏风格绘制的， 技法深得周氏画风的真传。在唐人真迹稀如星风的今天，能够从中完整了解唐代人物画的杰出成就，堪称美术史研究的辛事。这幅壁画现今保存在阿鲁科尔沁旗博物馆，历经千年，恍如新绘，是该馆的镇馆之宝。 欢迎大家观看！ * High concentrations of ?2 adrenergic receptors in the brain (locus ceruleus), brain stem, and spinal cord. The locus ceruleus is primarily responsible for regulating stress/anxiety and consciousness. Therefore, activation of these receptors produces sedation and anxiolysis and general decrease in CNS sympathetic discharge. Activation in the spinal cord produces analgesic effect mediated by Substance P. * Locus Ceruleus（蓝斑） Activates transmembrane a2-adrenergic receptor of the noradrenergic neuron, dexmedetomidine. Via subsequent G-protein coupling, one of two effects observed – either inhibition of Ca++ influx (voltage-sensitive calcium channels) or promotion of K+ efflux (potassium channels). The net effect is cell membrane hyperpolarization, making it less likely to fire, thereby decreasing norepinephrine release. Result is an inhibition of histamine release and hypnotoc（催眠） response in a pattern that resembles the natural sleep pathway. * VMC = vasomotor center（血管运动中枢），ANP=心房利纳肽 * Summary of actions: CNS – sedation/anxiolysis (locus ceruleus) CNS – analgesia (spinal, substance P) Cardiovascular – bradycardia (sympathetic inhibition) Cardiovascular – hypertension (early, peripheral ?1 agonism) Cardiovascular – hypotension (later, sympathetic inhibition ? vasodilation) Renal – diuresis (ANP/renin/vasopressin * Bispectral index (BIS) is a widely used quantitative parameter for evaluating anesthesia and sedation levels. Dexmedetomidine is a novel sedative, providing sedation while patients remain cooperative and can be easily aroused; as a consequence, BIS used with dexmedetomidine may poorly characterize sedation. Thus, we tested the hypothesis tha