罗哌卡因伍用麻黄碱预防腰硬联合麻醉下剖宫产低血压的临床研究

腰硬联合麻醉（CSEA）用于剖宫产手术，具有麻醉药用量少、始效快、效果确切的优点．又可以发挥连续硬膜外的灵活性，补充腰麻的平面不足，并能提供术后镇痛。但是会引起低血压，在临床上备受关注。笔者试用罗哌卡因伍用麻黄碱预防腰硬联合麻醉下剖宫产病人低血压．以探讨维持腰硬联合麻醉下剖宫产产妇血压稳定的方法。     

预注去氧肾上腺素与麻黄碱对腰-硬联合麻醉剖宫产术胎儿血气的影响

产妇低血压是腰-硬联合麻醉下常见并发症,可对产妇和胎儿产生不利影响.目前临床上除采用改变体位、扩容、以及减缓蛛网膜下腔注药速度等措施外,麻黄碱与去氧肾上腺素是处理产科麻醉低血压的常用血管收缩药[1,2].本文观察麻黄碱和去氧肾上腺素用于产科麻醉对胎儿血气的影响,现报道如下.     

腰-硬联合麻醉在剖宫产中的临床分析(附100例报告)

目的:观察腰-硬联合麻醉(CSEA)用于产妇剖宫产术的安全性.方法:100例产妇经L2～3或L3～4椎间隙用笔尖式腰-硬联合麻醉穿刺针,蛛网膜下腔用药为:重比重或等比重麻醉药液.结果:腰-硬联合麻醉起效时间短(3分钟左右),用麻药量少,便于对产妇循环、呼吸系统监护,术后头痛少,无感觉异常等并发症.结论:腰-硬联合麻醉起效快,镇痛、肌松完善,对产妇、新生儿较安全,适用于一般的剖宫产术;但对前置胎盘或胎盘早剥、重症孕高征孕妇的剖宫产要慎用CSEA.     

腰硬联合复合去氧肾对剖宫产术中母婴的影响

目的探讨腰硬联合复合去氧肾对剖宫产术中母婴的影响。方法以120例接受腰硬联合麻醉的剖宫产产妇为对象。盲选法分为观察组(麻醉后静注去氧肾上腺素)与对照组(麻醉后静注麻黄碱)。比较两组母婴血流动力学指标及产妇不良反应发生率。结果两组麻醉平面分布情况比较无差异(P0.05)。观察组在T1～T5时刻心率(HR)水平均低于对照组(P0.05);两组T2～T5相同时刻收缩压(SBP)水平高于对照组(P0.05),观察组T1时刻SBP水平低于对照组(P0.05)。两组新生儿出生1分钟Apgar评分、氧摄取率(ERO2)、pH、氧分压(PO2)、二氧化碳分压(PCO2)水平比较无差异(P0.05)。观察组产妇不良反应发生率为5.00%(3/60),低于对照组(16.67%(10/60),P0.05)。结论小剂量去氧肾上腺素维持剖宫产术性腰硬联合麻醉后产妇血流动力学稳定的的效果较好,对新生儿的血气、酸碱平衡等无影响,可减少产妇不良反应的发生。     

小剂量布比卡因复合芬太尼腰-硬联合麻醉用于急诊剖宫产的临床观察

目的 探讨小剂量布比卡因复合芬太尼腰-硬联合麻醉在急诊剖宫产手术中应用的可行性.方法 单胎急诊产妇108例,随机均分为布比卡因复合芬太尼组(BF组)和布比卡因组(B组).药物分别为0.75%布比卡因5 mg加芬太尼20μg和0.75%布比卡因7.5 mg.两组产妇均在右侧卧位下于L2～3间隙用针内针方法行腰麻,留置硬膜外导管备用.记录麻醉等待时间、最高平面、硬膜外追加药物的情况,术中心率、血压变化和麻黄碱的使用情况,并记录术中恶心呕吐、胸闷、呼吸困难等不良反应;记录手术医师和产妇对麻醉的评价以及术后下肢肌力完全恢复所需时间.结果 所有患者成功完成手术,无需改变麻醉方式或静脉辅助用药.BF组硬膜外腔追加药物率、低血压发生率和麻黄碱使用率明显少于B组(P＜0.01);麻黄碱平均用量明显少于B组(P＜0.05);恶心呕吐和胸闷的发生率明显低于B组(P＜0.05或P＜0.01);下肢肌力恢复到Bromage 0分的时间短于B组(P＜0.05).结论 0.75%布比卡因5 mg复合芬太尼20 μg腰-硬联合麻醉能为急诊剖宫产提供满意的麻醉.     

腰麻、腰硬联合麻醉、硬膜外麻醉在瘢痕子宫剖宫产手术中的麻醉效果比较

目的 探讨瘢痕子宫产妇剖宫产的麻醉方法.方法 比较腰麻、腰硬联合麻醉、硬膜外麻醉3种麻醉在瘢痕子宫产妇剖宫产手术中的麻醉效果.结果 腰麻、腰硬联合麻醉较硬膜外麻醉起效快、镇痛肌松好,牵拉反应也轻.结论 腰麻、腰硬联合麻醉在瘢痕子宫产妇剖宫产手术中麻醉效果良好.     

剖宫产术应用右美托咪定联合腰-硬联合麻醉对产后出血及泌乳的影响

目的探讨剖宫产术应用右美托咪定联合腰-硬联合麻醉对产后出血及泌乳的影响。方法随机将70例在腰-硬麻醉下行择期剖宫产的产妇分为2组,每组35例。麻醉前观察组先泵入盐酸右美托咪定注射液,对照组泵入相同剂量的氯化钠溶液。对比2组产妇术后的镇痛效果、产后出血量及泌乳时间。结果观察组产妇术后镇痛效果优于对照组,产后出血量低于对照组、泌乳时间早于对照组,差异均有统计学意义(P0.05)。结论应用右美托咪定联合腰-硬麻醉实施剖宫产术,可提高术后镇痛效果,减少产后出血量,缩短首次泌乳时间。     

不同剂量布比卡因腰-硬联合麻醉在高原地区剖宫产术的比较

目的 探讨布比卡因腰-硬联合麻醉在高原地区用于剖宫产手术的合适剂量.方法 选择60例ASA Ⅰ或Ⅱ级剖宫产产妇,行腰-硬联合麻醉,于L2～3间隙穿刺,穿刺成功后分别向蛛网膜下腔注入0.5%布比卡因,硬膜外腔置管备用.根据布比卡因用量不同随机均分为三组,A组6 mg、B组8 mg、C组10 mg.记录麻醉前及麻醉后5、10、15、30 min及手术结束时的BP、HR,SpO2,腰麻阻滞平面及达到阻滞平面的时间,麻醉效果,新生儿Apgar评分,术中、术后并发症.结果 三组产妇术中恶心呕吐发生率、新生儿Apgar评分差异无统计学意义.A、B组腰麻阻滞平面明显低于C组,利多卡因用量多于C组(P＜0.01).C组麻醉效果最佳,但BP、HR变化波动较大,低血压发生率高,麻黄碱用量大于A、B组(P＜0.05).B组腰麻阻滞平面适中,麻醉效果较好,循环相对稳定,而且利多卡因用量少,较符合腰-硬联合麻醉的双重优点.结论 布比卡因腰-硬联合麻醉在高原地区用于剖宫产手术的合适剂量为8 mg.     

腰硬联合麻醉剖宫产术中仰卧位低血压综合征的体位干预

目的:探讨腰硬联合麻醉剖宫产术中低血压反应的体位干预.方法:选择120例一般情况良好,无严重妊娠合并症,无神经系统疾病史或头痛病史,在腰硬联台麻醉下行刮宫产术、手术过程顺利的产妇,术后随机分成2组,实验组为舒适卧位,对照组为去枕平卧位,观察不同卧位的2组产妇血压、头痛、呕吐及舒适度情况.结果:2组产妇术后6h内血压平稳,数值波动在正常范围;24h内头痛、呕吐的发生差异不显著;舒适度对比差异有显著性.结论:腰硬联合麻醉剖宫产术后采用舒适卧位安全、舒适,可减少术后不适,术中术后血压平稳,利于术后康复和母乳喂养.     

剖宫产术应用腰-硬联合麻醉的效果观察

目的比较剖宫产术应用腰-硬联合麻醉与连续硬膜外麻醉的效果。方法将160例接受择期剖宫产术的产妇随机分为观察组和对照组,每组80例。观察组实施腰-硬联合麻醉,对照组给予连续硬膜外麻醉。观察并比较2组患者的麻醉起效时间、手术时间、术中不良反应和新生儿Apgar评分。结果观察组较对照组麻醉起效快、手术时间短、术中不良反应发生率低。2组差异有统计学意义(P<0.05)。结论腰-硬联合麻醉是剖宫产术较理想的麻醉方式,值得临床应用。     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.     

Similarities and differences between female and male sexual functions and dysfunctions

Men and women have 23 pairs of chromosomes. They share 22 of them. In physiologic conditions they differ systematically in only one pair, the sexual one. Females (normally) have what is called an “XX” on the 23rd pair of chromosomes, whereas males have an “XY” pair. The striking sexual differences –anatomic, functional, reproductive, psychological and sociocultural - between men and women depends on or derive from the difference in one critical chromosome out of 46, which contains on average 2% of all the genetic code. Biochemical, neuroendocrine, hormonal, vascular, nervous, and metabolic similarities that both sexes share, based on the common 45 chromosomes and related biologically determined similarities contributing to the secret sexual symmetry between genders, is reviewed. Furthermore the role of the genetically determined brain and somatic gender dymorphism, contributing to gender sexual differences is analyzed. Neuroplasticity and psychoplasticity are praised as basic mechanisms that bridge together and re-shape the individual biological and psychological world through the continuous interaction with the environment. Enhancement of sexual differences in behaviour, meaning of, and motivation to sex by cultural constructs, by religious and social dynamics, and the continuous interaction of each person with a usually role-polarized society during the whole life span will be finally acknowledged. To contribute to a better understanding of the shared biological sexual similarities between genders and their dialectic and continuous relation with biological and socioculturally related sexual differences is the ultimate goal of this introductory article and the following papers of the series.