右美托咪啶辅助表面麻醉用于患者支气管肺泡灌洗术的效果

Objective To investigate the efficacy of dexmedetomidine-assisted topical anesthesia in patients undergoing bronchoalveolar lavage ( BAL). Methods Twenty-four ASA Ⅱ or Ⅲ patients in ICU, aged 24-64 yr, weighing 50-80 kg, scheduled for BAL, were randomly divided into 2 groups ( n = 12 each) : topical anesthesia group (group A) , topical anesthesia + dexmedetomidine group (group B) . In group A, 0.9% normal saline 5 ml was injected intravenously 30 min before operation, 2% lidocaine 5-10 ml was given via a tracheal tube or cannula 5 min before operation and then an increment of 2% lidocaine 5 ml was given using fibreoptic bronchoscope every 15-30 min as required (the total amount was within 20 ml) . In group B, dexmedetomidine 0.5-1.0 μg/kg was injected (time of injection≥ 10 min) followed by infusion at 0.1-0.5 μg·kg-1 ·h-1 and the topical anesthesia was performed as the method described in group A. The time of lavage, adverse reactions and adverse cardiovascular events were recorded. Blood samples were taken 20 min before lavage, 20 min after the start of lavage and 20 min after the end of lavage (T1-3 ) for determination of the concentrations of plasma catecholamine and serum cortisol. Results The incidences of adverse reactions and adverse cardiovascular events were significantly lower and the operation time was significantly shorter in group B than in group A ( P < 0.05). The concentrations of plasma catecholamine and serum cortisol were significantly higher at T2,3 in group A, while lower at T2,3 in group B than at T1 ( P < 0.05) . The concentrations of plasma catecholamine and serum cortisol were significantly lower in group B than in group A ( P < 0.05). Conclusion Dexmedetomidine-assisted topical anesthesia can be used safely and effectively in BAL.     

右美托咪啶辅助表面麻醉用于患者支气管肺泡灌洗术的效果

Objective To investigate the efficacy of dexmedetomidine-assisted topical anesthesia in patients undergoing bronchoalveolar lavage ( BAL). Methods Twenty-four ASA Ⅱ or Ⅲ patients in ICU, aged 24-64 yr, weighing 50-80 kg, scheduled for BAL, were randomly divided into 2 groups ( n = 12 each) : topical anesthesia group (group A) , topical anesthesia + dexmedetomidine group (group B) . In group A, 0.9% normal saline 5 ml was injected intravenously 30 min before operation, 2% lidocaine 5-10 ml was given via a tracheal tube or cannula 5 min before operation and then an increment of 2% lidocaine 5 ml was given using fibreoptic bronchoscope every 15-30 min as required (the total amount was within 20 ml) . In group B, dexmedetomidine 0.5-1.0 μg/kg was injected (time of injection≥ 10 min) followed by infusion at 0.1-0.5 μg·kg-1 ·h-1 and the topical anesthesia was performed as the method described in group A. The time of lavage, adverse reactions and adverse cardiovascular events were recorded. Blood samples were taken 20 min before lavage, 20 min after the start of lavage and 20 min after the end of lavage (T1-3 ) for determination of the concentrations of plasma catecholamine and serum cortisol. Results The incidences of adverse reactions and adverse cardiovascular events were significantly lower and the operation time was significantly shorter in group B than in group A ( P < 0.05). The concentrations of plasma catecholamine and serum cortisol were significantly higher at T2,3 in group A, while lower at T2,3 in group B than at T1 ( P < 0.05) . The concentrations of plasma catecholamine and serum cortisol were significantly lower in group B than in group A ( P < 0.05). Conclusion Dexmedetomidine-assisted topical anesthesia can be used safely and effectively in BAL.     

妇科腹腔镜手术患者气腹不同阶段伤害性刺激强度的变化

Objective To evaluate the changes in noxious stimulation intensity at different periods of pneumoperitoneum in gynecological laparoscopic surgery. Methods Forty-five ASA Ⅰ orⅡ patients, aged 25-36 yr, with body mass index 18-23 kg/m2 , undergoing elective gynecological laparoscopic surgery, were randomly divided into 3 groups ( n = 15 each) . In group Ⅰ , anesthesia was maintained with TCI of remifentanil (target plasma concentration 4-6 ng/ml) and propofol (target plasma concentration 2 μg/ml) , and the concentrations were ad-justed according to the changes in BP and HR to maintain hemodynamics stable. Ⅱ and Ⅲ groups received inhala-tion of isoflurane (end-tidal concentration 1%-2%) and TCI of remifentanil (target plasma concentration 2-4ng/ml) . TCI of remifentanil was then stopped at 5 min before pneumoperitoneum (group Ⅱ ) or at 5 min after theend of rapid inflation (group Ⅲ ) , and isoflurane was inhaled (end-tidal concentration 1%-2% ) to maintain anes-thesia until the end of operation in Ⅱ and Ⅲ group. Before anesthesia (T0 ), 5 min before pneumoperitoneum (T1), 5 and 15 min of pneumoperitoneum (T2,3), HR and MAP were monitored and venous blood samples were taken for determination of plasma cortisol (Cor) , norepinephrine ( NE) and epinephrine ( E) concentrations. Results HR, MAP and NE and E concentrations at T2,3 , and Cor concentrations at T3 were significantly higher than those at T0 ingroup Ⅱ , and in group Ⅱ than in group Ⅰ (P<0.05). HR, MAP and NE and E concentrations at T2,3 ,and Cur concentrations at T3 were significantly lower in group Ⅲ than in group Ⅱ ( P < 0.05). Conclusion The intensity of noxious stimulation is strongest during rapid inflation among the different periods of pneumoperitoneum in gynecological laparoscopic surgery and the depth of anesthesia should be regulated.     

妇科腹腔镜手术患者气腹不同阶段伤害性刺激强度的变化

Objective To evaluate the changes in noxious stimulation intensity at different periods of pneumoperitoneum in gynecological laparoscopic surgery. Methods Forty-five ASA Ⅰ orⅡ patients, aged 25-36 yr, with body mass index 18-23 kg/m2 , undergoing elective gynecological laparoscopic surgery, were randomly divided into 3 groups ( n = 15 each) . In group Ⅰ , anesthesia was maintained with TCI of remifentanil (target plasma concentration 4-6 ng/ml) and propofol (target plasma concentration 2 μg/ml) , and the concentrations were ad-justed according to the changes in BP and HR to maintain hemodynamics stable. Ⅱ and Ⅲ groups received inhala-tion of isoflurane (end-tidal concentration 1%-2%) and TCI of remifentanil (target plasma concentration 2-4ng/ml) . TCI of remifentanil was then stopped at 5 min before pneumoperitoneum (group Ⅱ ) or at 5 min after theend of rapid inflation (group Ⅲ ) , and isoflurane was inhaled (end-tidal concentration 1%-2% ) to maintain anes-thesia until the end of operation in Ⅱ and Ⅲ group. Before anesthesia (T0 ), 5 min before pneumoperitoneum (T1), 5 and 15 min of pneumoperitoneum (T2,3), HR and MAP were monitored and venous blood samples were taken for determination of plasma cortisol (Cor) , norepinephrine ( NE) and epinephrine ( E) concentrations. Results HR, MAP and NE and E concentrations at T2,3 , and Cor concentrations at T3 were significantly higher than those at T0 ingroup Ⅱ , and in group Ⅱ than in group Ⅰ (P<0.05). HR, MAP and NE and E concentrations at T2,3 ,and Cur concentrations at T3 were significantly lower in group Ⅲ than in group Ⅱ ( P < 0.05). Conclusion The intensity of noxious stimulation is strongest during rapid inflation among the different periods of pneumoperitoneum in gynecological laparoscopic surgery and the depth of anesthesia should be regulated.     

肠癌根治术病人两种容量治疗方案效果的比较

Objective To compare the efficacy of two regimens of volume therapy in patients undergoing radical intestinal cancer operation. Methods Forty ASA Ⅰ or Ⅱ patients, aged 45-64 yr, weighing 42-65 kg,scheduled for radical intestinal cancer operation, were randomly divided into group Ⅰ and group Ⅱ (n = 20 each).In group Ⅰ , 6% hydroxyethyl starch 130/0.4 (HES) 15 ml/kg was infused iv over 30 min before anesthesia induction, and lactated Ringer's solution 15 ml/kg was infused iv over 30 min immediately after anesthesiainduction for hemodilution. In group Ⅱ , lactated Ringer's solution 15 ml/kg was infused iv over 30 min before anesthesia induction, and HES 15 ml/kg was infused iv over 30 min immediately after anesthesia induction for hemodilution. Intraoperative infusion of colloid and crystalloid, blood loss, urine output and allngeneic blood transfusion were recorded. MAP, CVP and HR were recorded after entering the operating room (T0 , baseline),and at 0, 15, 60 and 120 min after anesthesia induction (T<1-4>), and at the end of operation (T5). Blood samples were taken from radial artery at To , T0 , T3 and T5 for blood gas analysis and determination of Hb and Hct. Results Allogeneic blood was not transfused in beth groups. There were no significant differences in infusion of colloid and erystalloid, blood loss, and urine output between the two groups (P>0.05). Compared with the baseline value, no were significant changes in intraoperative MAP, HCO-3, concentrations of lactate, Na+ and K+ were detected (P> 0.05), while CVP was significantly increased, and HR, Het, Hb, and pH value at the end of operation were significantly decreased in group Ⅰ . Compared with the baseline value, intraoperative CVP was significantly increased, and MAP, HR, pH value, and HCO-3 at the end of operation were significantly decreased,while no significant changes in concentration lactate, Na+ and K+ were detected in group Ⅱ (P > 0.05).Intraoperative CVP was significantly higher and lactate concentration at the end of operation significantly lower in group Ⅱ than in group Ⅰ . Conclusion The efficacy of volume therapy with HES before anesthesia induction and lactated Ringer's solution after anesthesia induction for hemodilution is better.     

患者耐受喉罩或气管导管时七氟烷的麻醉深度

Objective To compare the effects of patient's tolerance to laryngeal mask airway (LMA) and tracheal tube (TT) on the appropriate level of sevoflurane anesthesia.Methods Eighty ASA Ⅰ or Ⅱ patients aged 30-60 yr weighing 50-70 kg undergoing elective thyroid or breast surgery were randomly divided into 2 groups (n=40 each):LMA group and TT group.Anesthesia wag induced with propofol 1.6mg/kg,fentanyl 3μg/kg and recuronium 0.6mg/kg.LMA or tracheal tube was inserted,and the patients were mechanically ventilated.Anesthesia was maintained with inhalation of 1.5%-3.0% sevoflurane and 50% N2O in O2 in group LMA,and with 2.5%-5.0% sevoflurane and 50% N2O in O2 in group TT.The flow of O2 and N2O was 0.7-1.0L/min,and the concentration of sevofluranee was adjusted to maintain AAI at 15-25.ECG,HR,MAP,SpO2,PETCO2,AEP and end-tidal sevoflurane concentration were continuonsly monitored.The end-tidal sevoflurane concentration was recorded at 1,5 and 10 min after LMA/TT was placed (T1-3),at 1h after skin incision (T4) and at the end of operation before removal of LMA or extubation (T5).The recovery time of consciousness,adverse cardiovascular events and adverse reactions were recorded.Results The end-tidal sevoflurane concentration was significantly lower,the recovery time of consciousness and removal of LMA or extubation time were shorter,and the incidence of adverse cardiovascular events and adverse reactions was lower in LMA group than in TT group.Conclusion At the same depth of anesthesia (AAI 15-25),sevoflurane concentration is significantly lower in LMA group than in TT group,with fewer complications and smaller cardiovascular reaction.     

患者耐受喉罩或气管导管时七氟烷的麻醉深度

Objective To compare the effects of patient's tolerance to laryngeal mask airway (LMA) and tracheal tube (TT) on the appropriate level of sevoflurane anesthesia.Methods Eighty ASA Ⅰ or Ⅱ patients aged 30-60 yr weighing 50-70 kg undergoing elective thyroid or breast surgery were randomly divided into 2 groups (n=40 each):LMA group and TT group.Anesthesia wag induced with propofol 1.6mg/kg,fentanyl 3μg/kg and recuronium 0.6mg/kg.LMA or tracheal tube was inserted,and the patients were mechanically ventilated.Anesthesia was maintained with inhalation of 1.5%-3.0% sevoflurane and 50% N2O in O2 in group LMA,and with 2.5%-5.0% sevoflurane and 50% N2O in O2 in group TT.The flow of O2 and N2O was 0.7-1.0L/min,and the concentration of sevofluranee was adjusted to maintain AAI at 15-25.ECG,HR,MAP,SpO2,PETCO2,AEP and end-tidal sevoflurane concentration were continuonsly monitored.The end-tidal sevoflurane concentration was recorded at 1,5 and 10 min after LMA/TT was placed (T1-3),at 1h after skin incision (T4) and at the end of operation before removal of LMA or extubation (T5).The recovery time of consciousness,adverse cardiovascular events and adverse reactions were recorded.Results The end-tidal sevoflurane concentration was significantly lower,the recovery time of consciousness and removal of LMA or extubation time were shorter,and the incidence of adverse cardiovascular events and adverse reactions was lower in LMA group than in TT group.Conclusion At the same depth of anesthesia (AAI 15-25),sevoflurane concentration is significantly lower in LMA group than in TT group,with fewer complications and smaller cardiovascular reaction.     

氨溴索预先给药对单肺通气患者炎性反应及脂质过氧化反应的影响

Objective To investigate the effect of ambroxol pretreatment on the inflammatory response and lipid peroxidation during one-lung ventilation (OLV) .Methods Forty-five ASA I or II patients aged 37-64 yr weighing 53-65 kg undergoing thoracotomy under general anesthesia were randomly divided into 3 groups ( n = 15 each): group A two-lung ventilation (TLV); group B OLV and group C ambroxol 1 mg/kg + OLV. Anesthesia was induced with midazolam, fentanyl, propofol and atracurium and maintained with propofol infusion and intermittent iv boluses of fentanyl and atracurium. The patients were mechanically ventilated (VT8-10 ml/kg, RR 12 bpm during TLV, VT 6-7 ml/kg, RR 16 bpm during OLV, I: E 1:2, FiO2 100% ). In group C ambroxol 1 mg/kg in normal saline ( NS) 100 ml was infused at 25 min before OLV (infusion rate 4 ml/min) , while in group A and B equal volume of NS was infused instead of ambroxol. Blood samples were obtained from radial artery before induction of anesthesia and OLV (T0.1 ) and at 0.5, 1, 2 h of OLV (T2-4 ) and 1, 2 h of TLV (T5,6 ) and at 24 h after operation (T7) in group B and C for determination of serum SOD activity and TNF-α, IL-6 and IL-8 concentrations and WBC and neutrophil granulocyte counts. The same indexes were detected in group A at the corresponding time points.Results Serum SOD activity was significantly lower and serum TNF-α, IL-6 and IL-8 concentrations and WBC and neutrophil granulocyte counts were significantly higher in group B than in group A. Serum SOD activity was significantly higher and serum TNF-a, IL-6 and IL-8 concentrations and WBC and neutrophil granulocyte counts were significantly lower in group C than in group B. Conclusion Pretreatment with ambroxol 1 mg/kg can inhibit inflammatory response and lipid peroxidation during OLV.     

氨溴索预先给药对单肺通气患者炎性反应及脂质过氧化反应的影响

Objective To investigate the effect of ambroxol pretreatment on the inflammatory response and lipid peroxidation during one-lung ventilation (OLV) .Methods Forty-five ASA I or II patients aged 37-64 yr weighing 53-65 kg undergoing thoracotomy under general anesthesia were randomly divided into 3 groups ( n = 15 each): group A two-lung ventilation (TLV); group B OLV and group C ambroxol 1 mg/kg + OLV. Anesthesia was induced with midazolam, fentanyl, propofol and atracurium and maintained with propofol infusion and intermittent iv boluses of fentanyl and atracurium. The patients were mechanically ventilated (VT8-10 ml/kg, RR 12 bpm during TLV, VT 6-7 ml/kg, RR 16 bpm during OLV, I: E 1:2, FiO2 100% ). In group C ambroxol 1 mg/kg in normal saline ( NS) 100 ml was infused at 25 min before OLV (infusion rate 4 ml/min) , while in group A and B equal volume of NS was infused instead of ambroxol. Blood samples were obtained from radial artery before induction of anesthesia and OLV (T0.1 ) and at 0.5, 1, 2 h of OLV (T2-4 ) and 1, 2 h of TLV (T5,6 ) and at 24 h after operation (T7) in group B and C for determination of serum SOD activity and TNF-α, IL-6 and IL-8 concentrations and WBC and neutrophil granulocyte counts. The same indexes were detected in group A at the corresponding time points.Results Serum SOD activity was significantly lower and serum TNF-α, IL-6 and IL-8 concentrations and WBC and neutrophil granulocyte counts were significantly higher in group B than in group A. Serum SOD activity was significantly higher and serum TNF-a, IL-6 and IL-8 concentrations and WBC and neutrophil granulocyte counts were significantly lower in group C than in group B. Conclusion Pretreatment with ambroxol 1 mg/kg can inhibit inflammatory response and lipid peroxidation during OLV.     

老年非心脏手术患者术前高敏C反应蛋白与术后心脏不良事件相关性的研究

Objective To investigate the relevance between level of preoperative high-sensitivity C-reactive protein(hsCRP) and the occurrence of postoperative adverse cardiac events in elderly patients underwent noncardiac surgery. Methods 49 patients of more than 65 years that had undergone elective noncardiac surgery were enrolled in the study. And all patients were conformed to the standards of "classification of risk factors for clinical history", content of "Guidelines on Preoperative Cardiovascular Evaluation for Noncardiac Surgery" established by the ACC/AHA .The patients were divided into two groups based on the preoperative hsCRP level:A group:hsCRP ≤ 3mg/L group (n=21) and B group: hsCRP>3mg/L group (n=28). General clinical characteristics of patients were recorded before operation, and 24 hours dynamic ECG was monitored a week prior to and after the operation. All patients taken measures of analgesia after surgery. The incidence of postoperative adverse cardiac events and the hospitalized days was recorded. The distinctions between two groups were analyzed regarding the occurrence of adverse cardiac events and hospitalized days after operation. Results 19 patients had postoperative myocardial ischemia; 4 cases in A group and 15 cases in B group. 7 patients suffered other postoperative adverse cardiac events, including 1 case in A group and the others in B group. There was statistically significant difference considering morbidity of myocardial ischemia in postoperation between the two groups, but there was no statistically significant difference about incidence of other adverse cardiac events and the length of stay in postoperation. Indexes about serious degree of myocardial ischemia:total depression time is(43.5±5.82 )min in A group, is( 135.0±81.2)min in B group. The depression times is(5.2±2.5 )in A group, is( 8.8±3.0)in B group.The longest depression time is( 23.7±9.2)min in A group, is( 84.3±54.1 )min in B group.Total ischemia burden is( 170.1 ±88.8 )mm· min-1 ·24h-1 in A group, is (311.3± 118.8 )mm· min-1 ·24h-1 in B group.There was statistically significant difference between the two groups. Conclusion Level of preoperative hsCRP>3 mg/L was relevant to the incidence of the most common postoperative adverse cardiac events--myocardial ischemia in elderly patients and level of preoperative hsCRP >3 mg/L was one of the risk factors of postoperative myocardial ischemia;Determination of preoperative hsCRP level may improve cardiovascular risk scoring system.     

盐酸利多卡因复合甲磺酸罗哌卡因骶管麻醉用于肛周手术的临床观察

为观察盐酸利多卡因复合甲磺酸罗哌卡因骶管麻醉用于肛周手术的合适剂量及影响因素,将90例肛肠病手术患者随机分为A、B两组,A组（2％盐酸利多卡因7．5ml复合0．898％甲磺酸罗哌卡因7．5ml）和B组（2％盐酸利多卡因5ml复合0．898％甲磺酸罗哌卡因5ml）,每组45例。结果显示,A组阻滞完善时间短于B组,骶管麻醉20rain后麻醉平面高于B组,麻醉维持时间长于B组,患者满意度高于B组（P〈0．05）。两组最大运动评分比较差异无统计学意义（P〉0．05）。两组间低血压、心动过缓、恶心呕吐、直肠牵拉反应、术后排尿情况的比较差异均无统计学意义（P〉0．05）。骶管麻醉20min后麻醉平面与局麻药剂量有关,与身高、体重无关。结果表明,盐酸利多卡因复合甲磺酸罗哌卡因15ml骶管麻醉用于肛周手术,麻醉效果好,不良反应少。     

不同靶控浓度瑞芬太尼联合右美托咪定用于颈椎手术麻醉中经鼻清醒气管插管效果的比较

目的观察不同靶控浓度瑞芬太尼联合右美托咪定用于颈椎手术麻醉经鼻清醒气管插管的安全性和有效性,探讨临床适宜的瑞芬太尼靶控浓度。方法选择择期在全身麻醉下行颈椎手术患者60例,男40例,女20例,年龄18~68岁,ASAⅠ或Ⅱ级,按瑞芬太尼靶控浓度不同随机分为三组:A组:瑞芬太尼1.5ng/ml,B组:瑞芬太尼2.0ng/ml,C组:瑞芬太尼2.5ng/ml。三组患者均给予右美托咪定1μg/kg。观察并记录入手术室时(T_1)、插管前(T_2)、气管导管过鼻咽即刻(T_3)、气管导管过声门即刻(T_4)、导管套囊充气即刻(T_5)、导管进入气管后1min(T_6)的MAP、HR、SpO_2、RR;并记录插管时间、插管一次成功率、患者插管过程中呛咳、肢体运动及呼吸抑制等不良反应和知晓情况。结果与T_1时比较,T_3~T_5时A组MAP明显升高,HR明显增快(P0.05),B组、C组差异无统计学意义;与T_1时比较,T_4~T_6时C组SpO_2明显下降(P0.05),T_3~T_6时C组RR明显减慢(P0.05),A组、B组差异无统计学意义。A组呛咳、肢体运动发生率明显高于B组和C组(P0.05);A组、B组呼吸抑制发生率明显低于C组(P0.05)。结论 2.0ng/ml靶控浓度瑞芬太尼联合右美托咪定能有效抑制插管时的应激反应,减少呼吸抑制发生,适合用于颈椎手术患者电子插管软镜引导经鼻清醒插管。     

Abnormalities in myocardial segmental wall motion during lumbar epidural anesthesia

The effect of lumbar epidural anesthesia on myocardial wall motion was compared in two groups of patients using precordial two-dimensional echocardiography (2DE). All patients were scheduled to undergo lower abdominal or peripheral surgery. Group 1 included five healthy ASA PS 1 subjects and group 2 included 10 patients with coronary artery disease (CAD). In all patients 12.5 ml of 2% lidocaine HCl was injected into the lumbar epidural space, and systolic and diastolic blood pressures, and heart rate were continuously monitored. 2DE evaluation was performed before and at 10, 20, 30, and 60 min (T10-T60) after epidural lidocaine injection. The left ventricular wall was divided into 16 segments for parasternal long-axis, short-axis and apical four-chamber views. The wall motion of each segment was graded on a scale from 1 (dyskinesia) to 6 (hyperkinesia), with 5 representing normal motion. A decrease in segmental wall motion greater than or equal to 2 grades was considered indicative of ischemia. Plasma lidocaine and catecholamine levels were measured before and 10, 20, and 60 min after epidural lidocaine injection. Peak plasma lidocaine levels in groups 1 and 2 were 2.79 +/- 1.06 micrograms/ml (mean +/- SD) and 2.58 +/- 1.48 micrograms/ml at 10 min, respectively (NS). Plasma epinephrine and norepinephrine levels were unchanged from baseline. Systolic pressures decreased significantly in group 2 from T10 to T60. Diastolic pressure decreased significantly in the same group from T20 to T60, and in group 1 only at T10. Mean arterial pressure decreased significantly in both groups at T30, without change in heart rate.(ABSTRACT TRUNCATED AT 250 WORDS)     

支气管内超声引导针吸活检术患者复合咪达唑仑-吗啡时TCI不同浓度异丙酚麻醉的效果

目的 评价支气管内超声引导针吸活检术患者复合咪达唑仑-吗啡时TCI不同浓度异丙酚麻醉的效果.方法 择期行支气管内超声引导针吸活检术患者40例,ASA分级Ⅰ或Ⅱ级,随机分为2组(n=20),P1组和P2组静脉注射咪达唑仑0.03 mg/kg和吗啡0.05 mg/kg,于咽喉部行表面麻醉,TCI异丙酚,P1组和P2组血浆靶浓度分别为3、4 μg/ml.输注异丙酚5 min时开始手术.手术开始后30 min采集动脉血样,进行动脉血气分析;手术结束时记录PETCO2.记录连续呛咳次数、体动、利多卡因用量、定向力恢复时间、患者对麻醉满意度、术中及术后不良反应的发生情况.结果 与P1组比较,P2组pH值和PaO2降低,PaCO2和PETCO2升高(P＜0.05),连续呛咳次数、体动、利多卡因用量、定向力恢复时间、患者对麻醉满意度及不良反应发生率差异无统计学意义(P＞0.05).结论复合咪达唑仑0.03 mg/kg和吗啡0.05 mg/kg时支气管内超声引导针吸活检术患者TCI异丙酚(血浆靶浓度3μg/ml)的麻醉效果好,术后恢复快,安全性良好.     

胸段硬膜外阻滞对老年胸科手术患者苏醒期躁动的影响

目的 观察胸段硬膜外阻滞对老年患者行胸科手术时全麻苏醒期躁动(emergence agitation,EA)的影响.方法 择期行胸科手术的老年患者40例,ASA Ⅱ～Ⅲ级.其中男23例,女17例,年龄65岁～78岁,均为食道癌和肺癌患者.将40例患者用完全随机法分为两组(每组20例),分别给予全麻复合硬膜外麻醉(A组)...     

Use of high-dose dexmedetomidine infusion for anesthesia and sedation in a patient for microlaryngeal surgery maintained with spontaneous breathing

We experienced the anesthetic management using high-dose dexmedetomidine for microlaryngeal surgery maintaining spontaneous breathing. The anesthesia was maintained with dexmedetomidine infusion (initial dose 6 microg x kg(-1) x hr(-1) over 10 min followed by continuous infusion of 0.5 microg x kg(-1) x hr(-1)), intermittent small doses of fentanyl and topical application of lidocaine on the tongue, pharynx and larynx. The infusion of dexmedetomidine was increased over 30 min to 3 microg x kg(-1) x hr(-1) to reach the adequate sedation level and maintained at this rate for a further 15 min during the operation. During the whole perioperative period, there was no respiratory depression as measured by arterial blood gas analysis that recorded normal PaCO2 in the patient breathing supplemental oxygen. Hypotension (systemic arterial blood pressure less than 100 mmHg) occurred twice during dexmedetomidine administration, but was normolized by ephedrine administration. The preservation of respiratory drive offers the possibility that this anesthetic technique may be another method for providing anesthesia for the patient with a difficult airway. Moreover, there is one consensus on the importance of the basic principle that adequate topical or intravenous anesthesia is also essential during high-dose dexmedetomidine infusion.     

雾化吸入利多卡因用于颈髓损伤患者纤维支气管镜引导气管插管时表面麻醉的效果

目的 评价雾化吸入利多卡因用于颈髓损伤高位截瘫患者纤维支气管镜(FOB)引导气管插管时表面麻醉的效果.方法 颈椎骨折并发高位截瘫患者64例,随机分为2组(n=32),雾化吸入组:雾化吸入2%利多卡因;喷雾联合环甲膜穿刺组:咽喉部喷雾联合环甲膜穿刺注射2%利多卡因,随后于FOB引导气管插管前15 min,两组均静脉注射咪达唑仑0.01 mg/kg、芬太尼1 μg/kg.FOB引导气管插管期间,评价气管插管条件,监测MAP、HR、ECG及SpO2.结果 与喷雾联合环甲膜穿刺组相比,雾化吸入组气管插管条件满意率和FOB引导气管插管成功率明显提高,心律失常及不良记忆发生率明显降低(P＜0.05).结论 颈髓损伤高位截瘫患者雾化吸入2%利多卡因表面麻醉,有助于改善FOB引导气管插管的条件,且降低不良反应的发生.     

右美托咪定复合小剂量氯胺酮在困难气道纤维支气管镜插管中镇静遗忘的效果

目的观察右美托咪定复合小剂量氯胺酮在择期手术困难气道患者纤维支气管镜经鼻气管插管中的镇静遗忘的效果。方法择期困难气道纤维支气管镜经鼻插管患者90例,ASAⅠ或Ⅱ级,按照随机数字表法均分为三组:右美托咪定1.0μg/kg+氯胺酮0.5 mg·kg-1·h-1(DK组)、右美托咪定1.0μg/kg+丙泊酚2.0mg·kg-1·h-1(DP组)和右美托咪定1.0μg/kg+瑞芬太尼5.0μg·kg-1·h-1(DR组)。比较三组患者入室后安静10min(T0)、纤维支气管镜置入前(T1)、气管导管进入声门即刻(T2)及插管后5min(T3)时HR、MAP、SpO2及Ramsay镇静评分和不良反应,及术后24h随访患者对气管插管过程的知晓情况。结果与T0时比较,T1时DP和DR组HR明显减慢,MAP明显下降,T1时DP组SpO2明显降低(P0.05);T3时DP和DR组HR明显加快,DR组MAP明显增高(P0.05);T2时DR组MAP明显高于DP组。T2时DP组和DR组Ramsay镇静评分明显低于DK组,T3时DR组Ramsay镇静评分明显低于DK和DP组(P0.05);DP组心动过缓、呼吸抑制发生率明显高于DK组,DR组呛咳、躁动、心动过速、插管知晓发生率明显高于DK组(P0.05)。结论右美托咪定复合小剂量氯胺酮用于困难气道患者经鼻纤支镜插管可保证良好的镇静遗忘效果,维持稳定的血流动力学,并且不良反应发生率低。     

罗哌卡因和利多卡因在腹股沟疝手术中的效果对比

目的探讨罗哌卡因和利多卡因在腹股沟疝手术中局部麻醉的效果差异。方法选择2018年1月至2019年11月在马鞍山中心医院接受腹股沟疝无张力修补手术治疗的患者90例。30例使用利多卡因局部麻醉的患者作为A组,30例使用利多卡因联合0.375%罗哌卡因的患者作为B组,30例使用利多卡因联合0.75%罗哌卡因的患者作为C组。对比3组的血流动力学指标[平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO₂)]、手术情况相关指标(手术耗时、失血量、住院时间)、麻醉效果相关指标[麻醉起效时间、麻醉持续时间、术后患者的视觉模拟评分(VAS)]、术后不良反应。结果3组患者在麻醉前、麻醉后1、5、10 min的MAP、HR、SpO₂数据差异无统计学意义(P>0.05)。3组患者的手术耗时、失血量数据差异无统计学意义(P>0.05)。B组和C组的住院时间短于A组(P<0.05)。B组和C组的麻醉起效时间长于A组(P<0.05)。C组的麻醉持续时间长于B组,B组的麻醉持续时间长于A组(P<0.05)。C组在术后1、3、6、9 h的VAS评分低于B组,B组在术后1、3、6、9 h的VAS评分低于A组(P<0.05)。3组在术后12、24 h的VAS评分差异无统计学意义(P>0.05)。3组的术后不良反应差异无统计学意义(P>0.05)。结论对于接受腹股沟疝无张力修补手术的患者,采用含有利多卡因或者罗哌卡因的局部麻醉方法均可以保证手术过程中的血流动力学稳定以及麻醉效果。利多卡因的起效时间更快,罗哌卡因的镇痛效果维持时间更长,使用浓度为0.75%罗哌卡因与利多卡因联合使用,患者可获得更好的术后镇痛效果,且用药的安全性良好。     

Serum levels of lidocaine as affected by high frequency jet ventilation during bronchoscopies under local anesthesia

Fiberoptic bronchoscopy is a valuable procedure in the diagnosis and treatment of pulmonary disorders and is usually performed under local anesthesia. The local application and ultrasonic nebulization of lidocaine is widely accepted for inducing topical anesthesia in the respiratory tract. We produced local anesthesia of the trachea and bronchial tree by nebulizing lidocaine via high-frequency jet ventilation (HFJV). At the same time, we measured serial plasma concentrations of lidocaine to determine the potential for toxicity due to systemic absorption from the tracheobronchial tree. METHOD. Twelve adult patients without known heart or liver disease were studied during diagnostic bronchoscopy. As premedication 0.5 mg atropine and diazepam (10 mg) or midazolam (5 mg) were given. After topical anesthesia of the oropharynx, all patients were intubated with a Hi-Lo jet endotracheal tube using a flexible bronchoscope. Spontaneous breathing was supported with a high-frequency jet ventilator (Acutronic MK 800). The humidification ventilator pump was used as a device for local anesthetic administration (lidocaine 0.5%). The following continuous application scheme was used: 0-5 min: 100 ml/h; 5-10 min: 50 ml/h; over 10 min: 5-25 ml/h. Plasma samples for lidocaine levels were taken intravenously 5 min after intubation and then at 5-min intervals. The last sample was taken 30 min after bronchoscopy. The plasma lidocaine concentration was determined by liquid chromatography. RESULTS. In general, this mode of lidocaine administration produced adequate anesthesia and was safe. None of the patients studied required additional lidocaine doses during bronchoscopy. Heart rates and blood pressures were stable.(ABSTRACT TRUNCATED AT 250 WORDS)