喉罩通气在小儿脑立体定向术全身麻醉中的应用

目的：探讨喉罩通气在小儿脑立体定向术全身麻醉中应用的安全性。方法：选择脑立体定向手术患儿60例,随机分为喉罩组（观察组）和气管插管组（对照组）各30例。全身麻醉药物诱导完全起效后分别行喉罩和气管导管置入通气,记录两组麻醉诱导前、喉罩（气管插管）置入前、置入后、术后撤除喉罩（气管插管）时的平均动脉压（MAP）、心率（HR）、脉氧饱和度（SpO2）值,并对撤除喉罩（气管插管）后并发症发生情况进行比较。结果：两组麻醉诱导前、喉罩（气管插管）置入前的MAP、HR、SpO2相比较,差异均不显著（P〉0.05）;喉罩（气管插管）置入后、术后撤除喉罩（气管插管）时,观察组的MAP及HR显著低于对照组（P〈0.05）;术后并发症发生率比较,观察组非常显著低于对照组（P〈0.01）。结论：喉罩通气可安全应用于小儿脑立体定向术全身麻醉中。     

喉罩通气在妇科腹腔镜手术中的应用研究

目的：探讨喉罩通气在妇科腹腔镜手术中的应用价值。方法：选择择期妇科腹腔镜手术60例,随机分为观察组及对照组各30例,分别采用喉罩及气管导管进行麻醉呼吸管理,观察麻醉诱导前（T0）、诱导后（T1）、气管导管或喉罩置人后1min（T2）、腹腔注气后5min（T3）及术毕拔管时（T4）的平均动脉压（MAP）、心率（HR）及脑电双频指数（BIS）变化,并记录麻醉用药量、苏醒时间和不良反应等。结果：两组诱导前MAP、HR及BIS差异不显著,而T2、L时点对照组MAP、HR高于观察组（P〈O．05）,T2时点对照组BIS高于观察组（P〈O．05）,其他各时点组间比较均差异不显著;观察组较对照组术中麻醉用药量少、术后苏醒快（P〈O．05）。结论：妇科腹腔镜手术中应用喉罩进行呼吸管理效果较好。     

Supreme喉罩用于老年结直肠癌根治术麻醉效果观察

目的：观察Supreme喉罩用于老年结直肠癌根治术的麻醉效果。方法：择期行全麻老年结直肠癌根治术53例,随机分为喉罩组（观察组）26例和气管插管组（对照组）27例。采用丙泊酚全凭静脉麻醉,观察比较两组丙泊酚、瑞芬太尼、维库溴铵用量、手术时间、麻醉时间、清醒时间、拔管时间和入室后（T0）、诱导后（T1）、插管（喉罩）即刻（T2）、插管（喉罩）3min（T3）、拔管（喉罩）即刻（T4）、拔管（喉罩）3min（TS）不同时间节点的SBP、DBP、MBP和HR水平变化。结果：观察组丙泊酚和维库溴铵用量均显著少于对照组（P〈0．05）,瑞芬太尼用量两组比较,差异不显著（P〉0．05）;苏醒时间和拔管时间均显著早于对照组（P〈0．05）,手术时间和麻醉时间两组比较,均差异不显著（P〉0．05）。观察组T2、T3、T4、T5时间节点的SBP、DBP、MBP和HR水平均显著低于对照组（P〈0．05）;对照组T2、T3、T4、T5时间节点的SBP、DBP、MBP和HR水平均显著低于T0（P〈0．05）。结论：Supreme喉罩应用于老年结直肠癌根治术全身麻醉效果优于气管插管。     

喉罩用于老年腹部恶性肿瘤手术麻醉效果观察

目的：观察喉罩用于老年腹部恶性肿瘤手术的麻醉效果。方法：将腹部恶性肿瘤手术40例随机分为观察组和对照组各20例。观察组麻醉采用双管型喉罩,对照组采用气管内插管,两组均采用静脉快速诱导,术中行机械通气。比较两组拔管或拔喉罩时间、丙泊酚、瑞芬太尼用量;以及插入前、插入即刻和拔除即刻的平均动脉压（MAP）、心率（HR）变化。结果：观察组丙泊酚、瑞芬太尼用量显著少于对照组（P〈0.05）;拔喉罩时间显著短于对照组（P〈0.05）。两组插入即刻、拔除即刻的MAP、HR显著高于插入前（P〈0.05）;观察组插入即刻、拔除即刻的MAP、HR显著低于对照组（P〈0.05）。结论：喉罩用于老年腹部恶性肿瘤手术麻醉效果优于气管内插管。     

喉罩通气复合瑞芬太尼及异丙酚全凭静脉麻醉在颅内动脉瘤栓塞术的应用

目的对比研究喉罩通气和气管插管复合瑞芬太尼、异丙酚全凭静脉麻醉在颅内动脉瘤栓塞术的应用。方法40例经DSA行颅内动脉瘤栓塞术的患者随机分为喉罩组和气管插管组,术中以微量泵持续泵注异丙酚、瑞芬太尼维持麻醉。记录在麻醉诱导前、插入喉罩或气管导管前、插入后、股动脉穿刺、动脉瘤栓塞及苏醒时、拔除喉罩或气管导管时、拔除后5min的血压、心率、血氧饱和度的变化,观察术毕病人自主呼吸恢复时间、睁眼时间、拔管时间、定向力恢复时间以及拔除时病人是否呛咳、躁动、恶心呕吐和术后并发症,及每例异丙酚、瑞芬太尼用药量。结果喉罩通气复合瑞芬太尼异丙酚全凭静脉麻醉行颅内动脉瘤栓塞术的患者在麻醉诱导、术中维持及术后苏醒血液动力学平稳,异丙酚、瑞芬太尼用量少,苏醒迅速,咽痛发生率低。结论喉罩通气操作简单,刺激小,通气可靠,复合应用瑞芬太尼异丙酚全凭静脉麻醉,术中血液动力学平稳,术后苏醒快,定向力恢复好,只要掌握好适应证,较气管插管复合全凭静脉更适合应用于颅内动脉栓塞术。     

瑞芬太尼复合丙泊酚TCI联合喉罩在胆囊切除术中的应用

目的 探讨瑞芬太尼复合丙泊酚靶控输注(TCI)联合喉罩麻醉在腹腔镜胆囊切除术中的临床价值和安全性。方法选择择期行腹腔镜胆囊切除术的患者124例,随机分为瑞芬太尼复合丙泊酚TCI联合喉罩组(R组,n=62)和常规插管全麻组(C组,n=62),比较两组术中各时点心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(Sp O2)的变化及麻醉效果,观察记录手术结束到拔喉罩(拔管)时间和患者清醒时间、术后并发症。结果 两组手术时间和气道峰压基本相似,R组在喉罩置入和拔除喉罩前后HR、MAP无显著变化;C组在T1、T2、T3、T4时的HR、MAP均有显著变化(P<0.05)。组间比较,在T1、T2、T3、T4时点,C组HR、MAP均明显高于R组(P<0.05)。两组各时点Sp O2均无显著变化。C组手术结束到拔管时间和清醒时间明显长于R组,术后并发症的发生率明显高于R组(均P﹤0.05)。结论 瑞芬太尼复合丙泊酚TCI联合喉罩麻醉能够满足腹腔镜胆囊切除术的要求,简单易行,安全有效,是较为理想的一种麻醉方法。     

Supreme喉罩在西宁地区老年人麻醉中的应用

目的：探讨Supreme喉罩在高海拔地区老年人麻醉中使用的安全性及有效性。方法：择期腹部手术全麻患者50例,年龄60岁～78岁,随机均分为喉罩组（S组）及气管插管组（T组）。全麻诱导后插入Supreme喉罩/气管导管。记录一次插入成功率及所需时间;记录两组患者麻醉诱导前（T1）、插入前（T2）、插入时（T3）、拔除喉罩/气管导管前（T4）及拔除喉罩/气管导管时（T5）的收缩压（SBP）、舒张压（DBP）及心率（HR）,术中指脉氧饱和度（SpO2）、呼气末二氧化碳分压（PETCO2）和气道峰压（Peak）;观察术中误吸、拔除喉罩/气管导管时呛咳及拔除喉罩/气管导管后低氧血症、咽喉疼痛情况。结果：与T组比较,S组喉罩一次插入成功率较高（P〈0.05）、插入时问明显缩短（P〈0.01）;T3、T5时SBP、DBP、HR波动明显小;拔除喉罩后低氧血症及咽喉痛发生率少（P〈0.01）,且无呛咳病例。两组术中SpO2、PErCO2和Peak均在正常范围内,均无误吸发生。结论：Supreme喉罩操作简便易行,插入/拔除操作对血流动力学无明显影响。不引起呛咳,术后不良反应少,术后肺部感染发生率明显降低,可安全有效地用于老年患者全麻气道管理。     

亚甲蓝肋间神经阻滞联合地佐辛胸科术后镇痛的效果

目的观察亚甲蓝肋间神经阻滞联合地佐辛多模式镇痛对胸科手术患者术后镇痛的效果。方法 84例全麻开胸手术患者随机分为观察组和对照组,两组均于术毕行地佐辛静脉自控镇痛,观察组术前行手术切口部位亚甲蓝罗哌卡因肋间神经阻滞。记录患者麻醉前10 min（T1）、术后30 min（T2）、6 h（T3）、12 h（T4）、24 h（T5）时的平均动脉压（MAP）、心率（HR）;记录两组麻醉苏醒时间,术后24 h内地佐辛用量、有效按压次数;记录患者术后躁动、谵妄、寒战、恶心、呕吐、呼吸抑制例数。结果观察组血流动力学稳定,苏醒时间缩短,地佐辛用量及镇痛泵有效按压次数较少,苏醒期躁动例数少于对照组,差异均有统计学意义（P〈0.05）。结论亚甲蓝肋间神经阻滞联合地佐辛多模式镇痛用于胸科手术患者术后镇痛效果较好,副作用较少,血流动力学较平稳。     

三种麻醉方式在高龄患者人工股骨头置换术中的效果分析

目的 探讨三种不同麻醉方式在急性股骨颈闭合性骨折高龄患者人工股骨头置换术中的疗效分析.方法 前瞻性分析2014年2月—2020年10月上海交通大学医学院附属新华医院(崇明)麻醉科收治120例急性股骨颈闭合性骨折高龄患者行人工股骨头置换手术,男性55例,女性65例;年龄70～90岁,平均75.5岁;均为单侧股骨颈骨折;患者受伤致手术时间2～4d.根据随机数字表法分为全身麻醉插管组(插管组)、全身麻醉喉罩组(喉罩组)、连续硬膜外神经阻滞组(神经阻滞组),每组40例,三组患者均在一个手术治疗组.记录并进行比较手术中三组患者的麻醉效果(麻醉操作时间、术中出血量、术中输液量、术中输血量、手术时间、术后睁眼时间、术后定向力恢复时间、术后麻醉随访情况).结果 术前操作时间神经阻滞组高于插管组(27.8±1.5)min vs.(17.1±1.5)min及喉罩组(22.3±1.6)min,插管组又高于喉罩组;术中出血量、术中输液量、术中输血量和手术时间三组差异无统计学意义(P>0.05);神经阻滞组术后睁眼时间(手术操作过程中会给予镇静药物让患者入睡)[插管组(17.5±3.2)min,喉罩组(17.6±3.3)min,神经阻滞组(11.2±3.2)min]和术后定向力恢复时间[插管组(17.7±2.9)min,喉罩组(17.9±3.1)min,神经阻滞组(11.9±2.7)min]均较插管组及喉罩组显著缩短(P<0.05);神经阻滞组麻醉恢复期骚动发生率显著低于插管组及喉罩组,但同时术后随访时,患者不适主诉发生率神经阻滞组明显高于插管组及喉罩组(P<0.05).结论 三种麻醉方法在高龄人工股骨头置换术中各有优缺点,喉罩麻醉具有操作简单,麻醉效果满意,术后不适主诉少的优点,更值得在临床上推广.     

喉罩通气麻醉在乳腺癌根治手术中对血流动力学和通气的影响

目的观察乳腺癌根治手术中运用喉罩通气对血流动力学和通气功能的影响。方法择期行乳腺癌根治术患者50例，年龄25～65岁，ASAⅠ-Ⅱ级，随机分为气管导管组（T组）和喉罩组（L组），每组25例。记录患者人室安静5min时（TO），插管前即刻（T1）、插管后即刻（T2）、插管后3min（T3）、拔管时（T4）和拔管后3min（T5）的平均动脉压（MAP）和心率（HR）；记录间歇通气10min时（T6）、30min时（T7）和60min时（T8）的气道峰压（Ppeak）、分钟通气量（MV）、潮气量（VT）、呼气末二氧化碳分压（PETCO2）和脉搏血氧饱和度（SPO2）。结果阿组插管时、间歇通气10min、30min时MV、VT、SPO2的差异无统计学意义（P〉0.05），L组间歇通气60min时的Ppeak和PETCO2高于T组（P〈0.05），L组插管后即刻、插管后3min、拔管时和拔管后3min的MAP和HR较T组降低（P〈0.05）。结论喉罩通气麻醉操作简便，对心血管系统刺激性小，通气可靠。     

Dealing with cancer--conversations with radiotherapy patients

Thirty in-patients treated by radiotherapy were questioned in qualitative interviews about the information they had received from the physicians and their way to deal with the disease and the physicians. Furthermore 18 persons out of this group were accompanied continuously. The confidential relationships between the patients and the author of the study brought about spontaneous conversations showing some new aspects of the way to experience disease and therapy. Despite a poor prognosis and an initially insufficient information, the patients formulated their questions openly. Generally they desired a clearer communication. They criticized above all the lack of information and attention from the physicians. A need for confidence, frankness, and the conveyance of a justified hope was expressed. The physician's stress and resulting lack of time was complained of. During the time of accompanying which lasted several weeks, it became evident that information means a way to deal with the disease to which the patient can make his individual contribution. The majority of questions as well as emotional reactions as fear or depression came from those patients who seemed to be quiet persons.     

Radiochemotherapy with temozolomide for patients with glioblastoma

Background

The objective of this retrospective analysis was to assess long-term outcome and prognostic factors of unselected patients treated for glioblastoma (GB) at a single center with surgery, standard radiotherapy (RT), and concomitant temozolomide (TMZ). From 1999?C2005, the institutional protocol included surgery and RT with TMZ. From 2005 on, adjuvant TMZ was routinely added.

Patients and Methods

Between April 1999 and September 2009, 181 patients with GB were treated with RT (60 Gy in 30 fractions) and concomitant TMZ (75 mg/m²/day throughout RT). Biopsy only had been performed in 53 patients (29.3%), 128 patients (70.7%) had undergone resection, which was complete based on postoperative MRI in 51 patients (28.2%). Adjuvant TMZ was applied in 67 of 181 patients (37%).

Results

Median overall survival (OS) and progression-free survival (PFS) were 15.0 (95% CI, 13.1?C16.8) and 7.2 months (95% CI, 5.9?C8.5), respectively. After complete resection, partial/subtotal resection and biopsy, median OS was 23.20, 14.75, and 7.89 months (p < 0.001), respectively. In multivariate Cox proportional hazards regression models, extent of resection (p < 0.0001), Karnofsky??s performance score (p < 0.0001) and adjuvant TMZ (p = 0.001) were significant independent prognostic factors for OS. RT with concomitant TMZ was well tolerated in the majority of patients and could be completed as scheduled in 146 patients (80.7%), while 11 patients (6.1%) discontinued RT. Another 35 patients (19.3%) interrupted concomitant chemotherapy.

Conclusion

RT with concomitant TMZ is a feasible regimen with acceptable toxicity in routine practice. Our data are compatible with a beneficial effect of adjuvant TMZ on OS and PFS.     

湿润烧伤膏与手术联合治疗褥疮的护理

目的 :减少溃疡期褥疮的术前准备时间 ,缩短褥疮的总病程。方法 :将 1996年 5月至 2 0 0 2年 5月收住院的 4 2例溃疡期褥疮病人按随机原则分为 2组 ,2 1例术前用湿润烧伤膏纱换药处理 ,为A组 (试验组 ) ;2 1例用庆大霉素紫草油纱布换药处理 ,为B组 (对照组 )。 2组病例的年龄、性别、发病原因、病灶部位、病灶范围等经统计学处理 ,无显著性差别 ,有可比性。两组病人均换药至创面新鲜行皮瓣转移手术 ;比较两组平均术前换药时间 ,及换药 +手术的总住院日。术前术后两组患者均运用护理程序施行整体护理。结果 :A组术前平均换药时间为 8 4 9± 2 2 3天 ,B组为 15 6 0± 6 70天 ;A组平均治愈时间为 2 0 5 0± 4 81天 ,B组为 35 31± 7 70天。结论 :湿润烧伤膏换药与庆大霉素紫草油纱布换药比较 ,前者可明显缩短褥疮手术的术前准备时间及病人的总住院天数。     

Bronchogenic carcinoma: staging with MR compared with staging with CT and surgery

Thirty-three patients suspected of having bronchogenic carcinoma were studied prospectively using magnetic resonance (MR). In this group, 30 underwent examination with computed tomography (CT), 15 underwent thoracotomy, six had mediastinal biopsy procedures performed, and eight underwent bronchoscopy. MR studies, which included transaxial spin-echo imaging (TR, 0.5 and 2.0 sec; TE, 28 and 56 msec) of all patients and sagittal or coronal imaging of 18, were performed without knowledge of CT findings, using only plain radiographs as a guide. CT and MR studies were interpreted separately. CT and MR provided comparable information regarding the presence and size of mediastinal lymph nodes. MR better discriminated mediastinal nodes from vascular structures. However, in two of 11 patients who had multiple mediastinal lymph nodes that were normal in size at CT examination and surgery, MR suggested a confluent abnormal mass, probably because of its poorer spatial resolution. MR was superior to CT in showing enlarged hilar lymph nodes, but CT was better for demonstrating bronchial abnormalities. In three of four patients who had a proved hilar mass with distal obstructive pneumonia, MR (TR, 2.0 sec) helped distinguish between the mass and collapsed lung.     

臭氧治疗船员下肢损伤89例

2006年10月至2007年4月,我科采用引进的德国赫尔曼Medozon型臭氧发生装置系统产生的臭氧治疗船员下肢损伤89例,疗效满意.现报告如下.     

多虑平、雷尼替丁治疗消化性溃疡81例临床观察

1995年 1月～ 1 998年 2月 ,我们采用多虑平、雷尼替丁治疗消化性溃疡 (ＰＵ) ,并与雷尼替丁为对照组进行治疗观察 ,疗效满意 ,现总结报告如下。1　临床资料1 1　一般资料　本组 81例ＰＵ均因上腹痛、返酸、腹胀及食欲不振等症状 ,经胃镜诊断为溃疡活动期患者。病程 2个月～ 5ａ,平均 1 7ａ。伴有焦虑、抑郁及夜眠欠佳等症者59例。随机分为 2组 :治疗组 4 1例 ,男 3 8例 ,女 3例 ;年龄 1 8～ 3 6岁 ,平均 2 4岁。其中胃溃疡 1 1例 ,十二指肠球部溃疡 3 0例。对照组 4 0例 ,男 3 7例 ,女 3例 ;年龄 1 9～ 3 5岁 ,平均 2 4 5岁 ;胃溃疡 1 2…     

Tumor Burden Assessment with Positron Emission Tomography with

Objective: In patients with advanced cancer, total tumor burden affects the likelihood of tumor response and has important implications for prognosis. The aim of this study was to select the optimum 2-[F-18]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG PET) tumor uptake parameter to accurately measure tumor burden in advanced metastatic renal cell cancer, in comparison with volumes measured with computed tomography (CT), as a reference test.Materials and Methods: Six patients with metastatic renal cell carcinoma measurable on CT were studied. CT and FDG PET scans were carried out on all patients within 4 weeks prior to their entry into a phase I-II radioimmunotherapy trial. CT-based evaluation of disease extent (tumor volume) and 4 PET-based measurements (standardized uptake value[SUVmax], SUVav, volume, and total lesion glycolysis [TLG]) were performed independently by a radiologist (VN) and a nuclear medicine physician (TA). The degree of correlation between conventional (CT) extent of disease and parameters describing tumor concentration of FDG was then determined.Results: Fifty-seven CT-measurable metastatic lesions in lung, abdomen, and scalp were evaluated in 6 patients. There was a high correlation between CT and FDG PET volume estimates for lesions greater than 5 cm(3) in size. However, a PET-derived parameter that embodies both FDG uptake and lesion size, the TLG, correlated better with CT-derived tumor volume than did FDG PET volume alone.Conclusion: Using CT volume as a gold standard, the optimal PET-based estimate of total tumor burden in patients with metastatic renal cancer is the sum over all lesions of the total lesion glycolysis.     

MEBO药纱门诊治疗烧(烫)伤71例的体会

作者报道用MEBO药纱敷盖门诊治疗烧（烫）伤71例，均获治愈。经随访1年，深Ⅱ度创面疤痕发生率为15％（3／20），浅Ⅲ度创面疤痕发生率为38．9％（7／18）。