Univent导管在开胸手术单肺通气麻醉中的应用

目的：探讨Univent导管在开胸手术单肺通气麻醉中的应用。方法：对65例开胸手术患者使用Univent导管作气管内插管．根据手术需要行单肺通气麻醉。结果：40例食管癌根治术，10例肺叶切除术，5例纵隔肿块切除术，10例胸腔镜手术患者均用Univent导管单肺麻醉，效果满意。结论：Univent导管运用于某些开胸手术行单肺通气，有适应证广、插管简便，不易发生低氧血症等优点。     

复方利多卡因软膏涂布气管导管全麻后拔管观察

目的观察使用2.5%复方利多卡因软膏涂布气管导管行全麻,对患者拔管即刻及之后血压、心率、血氧饱和度的影响及对拔管后咽痛、声嘶、呛咳、低氧血症的预防性作用。方法将40例年龄20～55岁ASAⅠ～Ⅱ级行择期手术,无特殊心血管疾病,非甲状腺手术,非颌面外科手术患者随机分为治疗组和对照组各20人,其中乳腺手术6例,肝胆外科手术14例、妇科手术20例。在常规麻醉诱导维持基础上于治疗组患者所使用气管导管下2/5段进行复方利多卡因乳膏涂布处理,对照组不进行任何特殊处理,对手术结束即刻(t1)、吸痰时(t2)、拔管即刻(t3)、拔管后5min(t4)时患者收缩压、舒张压、心率、无创血氧饱和度进行记录。并记录患者拔管时呛咳状况及患者清醒后咽痛与否。结果复方利多卡因乳膏涂布气管导管组较对照组组呛阿咳反应减少,低氧血症和咽痛的发生率低,血流动力学变化小。结果2.5%复方利多卡因乳膏涂布气管导管组较非涂布组呛咳、声嘶、咽痛、低氧血症发生率低,血流动力学变化小。结论复方利多卡因软膏涂布导管在全麻手术后患者拔管即刻及之后血压、心率、血氧饱和度波动范围缩小,拔管时患者基本状况更加平稳,拔管后不良反应发生率降低,患者苏醒后舒适度增加,利于术后复苏室管理。     

盐酸阿扎司琼致丙氨酸氨基转移酶显著升高1例

病例：患者，女，35岁，体重56kg。入院诊断：卵巢囊肿（左侧）。拟于硬膜外麻醉下行“左侧卵巢囊肿剥除术”。麻醉前访视该患者健康状况分级（ASA）为I级，患者既往身体健康，无心、肺疾病史，无肝病史及药物过敏史。术前血常规、血生化等各项检查无异常，其中丙氨酸氨基转移酶（ALT）为16U／L。患者入手术室后行血压、血氧饱和度及心电监测，鼻导管吸氧。经腰椎（L1—2）间隙行硬膜外腔穿刺术，穿刺成功后硬膜外腔首次注入2％利多卡因注射液5mL，第2次注入（1：0．375％）利多卡因及罗哌卡因混合液12mL，麻醉效果良好，患者各项生命体征均平稳。     

钉棒内固定手术的麻醉方案临床数据分析

目的:钉棒内固定手术采用硬膜外麻醉和气管插管全麻两种麻醉方案临床数据分析。方法:A组(硬膜外麻醉)选择好间隙一般(胸10到腰2之间)行硬膜外穿刺,确已证明在硬膜外腔,则分次注入麻醉药,一般药物都是0.4%~0.5%罗派卡恩;B组(气管插管全麻)直接进行常规静脉诱导行气管插管全麻,导管插入气管内的深度成人为4~5cm,导管尖端至门齿的距离约18~22cm,进行气管插管全麻的注射。结果:B组在术中出血情况明显比A组术中出血情况要低,B组在术中病人舒适度明显比A组术中舒适感要好,B组手术后病人满意率明显比A组手术后病人满意率高。结论:硬膜外麻醉对钉棒内固定手术和气管插管全麻对钉棒内固定手术有很明显的对比,所以气管插管全麻麻醉对钉棒内固定手术比硬膜外麻醉对钉棒内固定手术好。     

预充液对硬膜外腔内置管血管损伤的影响

目的：探讨预充液可明显减少硬膜外腔内置管血管的损伤。方法：对实行硬膜外麻醉的240例患者随机分为2组,每组120例。Ⅰ组为对照组,直接行硬膜外导管置入。Ⅱ组为观察组,硬膜外腔先注入生理盐水3ml后再置入硬膜外导管。观察并记录置入导管过程中血管损伤的例数,并进行统计学分析。结果：Ⅰ组损伤23例,Ⅱ组损伤4例。结论：预充液可明显减少硬膜外腔内置管血管损伤的发生,是预防硬膜外血管损伤的有效方法,能更大程度地避免硬膜外血肿的发生。     

碳酸利多卡因用于剖腹产术硬膜外麻醉400例临床观察

1资料与方法 选择ASAⅠ-Ⅱ级拟行急症剖腹产孕妇400例,年龄24—38岁,体重65-86kg,随机分为盐酸利多卡因组（Ⅰ组）和碳酸利多卡因组（Ⅱ组）,每组200例。麻醉前30分钟肌注安定10mg。经L2-3。椎间隙行硬膜外腔穿刺、头向置管。Ⅰ组产妇经硬膜外导管注入2％盐酸利多卡因5ml,观察3分钟无腰麻症状后再注入7-8ml。Ⅱ组产妇应用1．73％碳酸利多卡因,容量与方法同工组。测定麻醉完善时间、麻醉阻滞平面及婴儿娩出时间。     

腰麻后即刻硬膜外腔注入与手术结束时注入生理盐水预防剖宫产术后头痛效果比较

目的：探讨腰麻后即刻硬膜外腔注入与手术结束时注入生理盐水预防剖宫产术后头痛的临床效果。方法：选择正常足月孕妇100例．分为腰麻后即刻注入组（A组）和手术结束时注入组（B组）,每组各50例。腰麻后即刻注入组（A组）选择LⅥ间隙行腰穿,进入蛛网膜下腔且见脑脊液流出后注入10％葡萄糖1ml＋0．75％布比卡因1．5ml,退出腰穿针约0．5cm。无脑脊液流出后注入生理盐水10ml。手术结束时注入组（B组）,选择L3-4间隙行硬膜外穿刺,成功后经硬膜外穿刺针置入腰穿针,进入蛛网膜下腔且见脑脊液流出后注入10％葡萄糖1ml＋0．75％布比卡因1．5ml,退出腰穿针,置入硬膜外导管进入硬膜外腔约3．5cm,手术结束时经硬膜外导管注入生理盐水10ml。术后住院期间每天访视并记录产妇是否出现头痛。结果：A组术后头痛2例,发生率为4％。B组术后头痛3例,发生率为6％。结论：腰麻后即刻硬膜外腔注入与手术结束时注入生理盐水均能够有效预防剖宫产术后头痛。     

42例胸科手术硬膜外阻滞的体会

选择开胸手术42例。男38例,女4例;年龄29～75岁。无硬膜外麻醉禁忌证,无严重呼吸循环功能障碍。其中食管癌27例,贲门癌10例,肺癌4例,支气管扩张症1例。方法:患者右侧卧位,选择T7～8或T8～9椎间隙行硬膜外穿刺,成功后头向留置硬膜外导管4.0cm。硬膜外注入1.5%～2.0%盐酸利多卡因     

硬膜外阻滞中寒战的临床研究

目的 以非手术状态下为主探讨硬膜外阻滞中寒战的原因.方法 择期行下腹部手术成年患者406例随机分6组,硬膜外穿刺成功后Ⅰ组不注药,Ⅱ、Ⅲ、Ⅳ组分别注入低温生理盐水、含酒精的常温生理盐水、1.5%利多卡因,Ⅴ组硬膜外腔注入1.5%利多卡因后常规消毒手术,Ⅵ组硬膜外注入1.5%利多卡因非手术区加盖保温毯后手术.观察各组病人寒战发生情况.结果 寒战发生率:Ⅰ组0.95%,Ⅱ、Ⅲ组0.0%,Ⅳ组7.25%,Ⅴ组23.08%(明显高于Ⅳ组,P＜0.01),Ⅵ组9.46%(明显低于Ⅴ组,P＜0.05).结论 硬膜外穿刺操作和硬膜外腔注入药物后硬膜外腔的容量压力和温度改变均不是导致寒战发生的主要原因;硬膜外混杂进酒精也不会引起寒战;注入硬膜外腔的局麻药产生的效应可能是导致硬膜外阻滞中寒战的重要因素.保温措施可以降低硬膜外阻滞中寒战的发生率.     

硬膜外腔注入利多卡因对血清细胞因子的影响

目的 观察硬膜外麻醉及术后硬膜外腔持续注入利多卡因对上腹部手术患者围术期血清TNF-α、IL-1、IL-4、IL-6变化的影响。方法 36例择期上腹部手术患者，随机分为硬膜外麻醉加术后硬膜外腔注入利多卡因组（Ⅰ组，n=12），全麻加术后硬膜外腔注入利多卡因组（Ⅱ组，n=12）和全麻加术后硬膜外腔注入生理盐水组（Ⅲ组，n=12）。分别于术前0、5h、术后0h、24h和48h抽取血样测定白细胞计数（WBC）及血清TNF-α、IL-1、IL-4、IL-6浓度。同时记录体温（T）、心率（HR）和平均动脉压（MAP）。结果 ①各组患者体温、心率变化均不明显（P〉0.05）；平均动脉压变化：Ⅱ组术后0h及Ⅲ组术后0h、24h较术前明显增高；白细胞计数变化：3组患者白细胞计数术后0h均较术前明显升高（P〈0，01），Ⅱ、Ⅲ组较Ⅰ组亦明显升高（P〈0、01），随后均下降，术后24hⅢ组明显高于Ⅱ组。②3组TNF-α、IL-1在各时点均逐渐上升，术后0hⅡ组TNF-α明显高于Ⅰ组，术后24h、48hIll组TNF-α、IL-1均明显高于Ⅰ组，术后48hⅢ组IL-1明显高于Ⅱ组；3组IL-6水平术后0h均为最高，其中Ⅰ组变化无统计学意义，Ⅱ、Ⅲ组明显高于术前；3组IL-4水平术后0h均为最低，在术后的上升过程中，Ⅲ组较慢，术后48h明显低于Ⅰ组。结论 硬膜外麻醉及术后硬膜外腔持续注入利多卡因可有效抑制促炎细胞因子的释放．术后硬膜外腔注入利多卡因尚可促进术后抑类细胞因子的上升。     

Effect of almitrine bismesylate on breathing pattern during hypoxia/hypercapnia in rats and ferrets

1. Ventilatory measurements and functional residual capacity (FRC) were recorded from anaesthetized rats and ferrets using a whole body plethysmograph. Simulation of aspects of human chronic obstructive airways disease (COAD) was attempted by making animals acutely hypoxic or hypoxic and hypercapnic by causing them to breath appropriate gas mixtures or by increasing the tracheal resistance or dead-space. Some chronically hypoxic rats, which have muscularized pulmonary arterioles similar to COAD patients, were also studied. 2. In 18 chronically hypoxic (CH) rats and 17 littermate control rats (C), breathing air, doses of almitrine bismesylate caused greater increases in ventilation (VE) in C than in CH rats. FRC, which was initially greater in CH rats, increased significantly in both groups after almitrine. 3. In C rats, breathing hypoxic or hypoxic/hypercapnic gas mixtures caused large increases in VE. Slow infusions of almitrine caused a further increase in VE usually via an increase in tidal volume (VT) but not frequency (f). 4. In two series of rats (n = 9; n = 6) severe and moderate degrees of tracheal obstruction caused a fall in PaO2 and a rise in PaCO2, a fall in VE due to both VT and f and large changes in oesophageal pressure (Poes), which often became positive on expiration. Almitrine infusions usually caused a rise in PaO2, a rise in VT and no change in f; with moderate obstruction, Poes also rose. The results were thought to depend on the balance between improved ventilation and increased O2 demand of the respiratory muscles. 5. Eleven ferrets were made hypoxic and hypercapnic by adding a large dead-space to the trachea. A slow infusion of almitrine caused a significant rise in PaO2 before any significant change in VE was detected; PaCO2 fell at some time during the infusion, but not significantly. The initial significant rise in PaO2, at 2.5 min, was not associated with significant changes in T1 (time of inspiration) and VT/TI. At 5 min VT/TI and PaO2 were all significantly altered. 6. Infusions of almitrine into hypoxic and hypercapnic animals caused improvements in the arterial oxygen tension which were associated with subtle changes in the breathing pattern; inspiratory time and inspiratory flow rate changed in the absence of an increase in total VE. Possible conclusions with respect to the action of almitrine in patients with COAD are discussed.     

吡咯卡因的抗心律失常作用

吡咯卡因能对抗乌头碱引起的麻醉大鼠心律失常;能使BaCl_2诱发的大鼠室性心动过速转为正常;能提高豚鼠心脏哇巴因中毒的耐受量;并能降低CaCl_2—ACh诱发的小鼠心室纤颤的发生率和死亡率,其50％有效剂量(ED_(50))与利多卡因相近。本实验测得小鼠ip吡咯卡因和利多卡因的半数致死剂量(LD_(50))分别为140±11mg/kg和143±15mg/kg,但吡咯卡因的急性心脏毒性作用则明显低于利多卡因。     

地佐辛辅助腰硬联合麻醉时对二氧化碳通气反应的影响

目的：观察地佐辛辅助腰硬联合麻醉对二氧化碳通气反应的影响。方法：选20例择期腹部手术患者,于腰硬联合麻醉前后及辅助静注地佐辛5mg后5min分别观测患者的呼吸频率（RR）、潮气量（VT）、脉搏氧饱和度（SpO2）,呼气末二氧化碳分压,并记录地佐辛使用前后5min患者吸入二氧化碳的通气反应。结果：在腰硬联合麻醉及地佐辛使用前后,患者的SpO2、RR及呼气末二氧化碳分压均无明显改变。潮气量在腰硬联合麻醉前后无明显改变,但在地佐辛使用后5min明显下降（P〈0.01）。二氧化碳通气反应曲线的斜率未见明显改变。结论：地佐辛辅助腰硬联合麻醉对患者的VT有一定影响,但对呼吸中枢的抑制作用较轻。     

Effect of experimental diabetes on pharmacokinetic parameters of lidocaine and MEGX in rats

The aim of the study was to evaluate the effect of experimental diabetes on pharmacokinetic parameters of lidocaine and its metabolite monoethyl-glycylxylidide (MEGX) after a single intravenous administration in rats. The study was performed on male Wistar rats, randomized into 2 groups: group I--control animals and group II--animals with experimental diabetes induced by streptozotocin. Evaluation of lidocaine pharmacokinetics was performed 10 days after streptozotocin administration. Lidocaine concentrations were lower in rats with experimental diabetes compared with the values in the control group. In rats with diabetes, the shorter phase of distribution and faster drug elimination has been observed. During the pharmacokinetic study, the dynamic reduction of lidocaine concentration was accompanied by the increase in MEGX concentration in blood. Drug elimination rate constant (gammaz) increased by 68% in rats with experimental diabetes which had an effect on the shortening of lidocaine half-life in those animals (t1/2 by 39%) and on the increase in absolute clearance (CL) to 1.46 l/h comparing to control group (0.95 l/h), i.e. by 54%. The distribution rate constant of lidocaine (gamma1) was significantly greater in the animals with experimental diabetes (by 138%). The volume of distribution (Vd) in those animals decreased by 30% in comparison with the control group. The area under the plasma concentration-time curve (AUC) decreased by 48% in rats with experimental diabetes. The MEGX half-life (t1/2) increased from 0.34 h in the control group to 0.89 h in the rats with diabetes, i.e. by 165%. It reflects the impaired MEGX elimination in experimental diabetes. The results suggest that experimental diabetes can have an effect on lidocaine pharmacokinetics towards enhanced lidocaine elimination with accompanied increase in its metabolite (MEGX) concentration.     

Effect of glycerol-induced acute renal failure on the pharmacokinetics of lidocaine after transdermal application in rats

In this study, the effect of glycerol-induced acute renal failure (ARF) on the pharmacokinetics of lidocaine after transdermal application was investigated in rats. Microdialysis method was applied in vitro and in vivo to the abdominal skin of rats. After topical application of 1% lidocaine, the cumulative amount of lidocaine permeated through the excised rat abdominal skin showed parallel effect between normal and ARF rats with no significant difference in the in vitro permeability coefficient of lidocaine between them, while area under the plasma concentration versus time curve of lidocaine in ARF rats increased significantly. The protein binding rate of lidocaine in ARF plasma and the blood vessel permeability to muscle tissues, assessed by beta-D-glucopyranosyl fluorescein isothiocyanate-labeled (FITC) albumin, increased significantly. After intravenous infusion of 5 mg/h/kg lidocaine, both of the total body clearance and the volume of distribution of lidocaine in the ARF rats decreased significantly. These results suggested that renal dysfunction did not have any effect on the skin permeability of lidocaine, but might change the plasma protein binding of drug and blood vessel permeability which led to high plasma concentration of lidocaine.     

不同潮气量、通气时间对家兔呼吸机相关肺损伤模型的影响

目的 探索不同潮气量、通气时间对制作家兔呼吸机肺损伤模型的影响.方法 54只家兔随机分为3组：常规潮气量组（VT10组,VT10 ml/kg）、中潮气量组（VT20组,VT20 ml/kg） 、大潮气量组（VT40组,VT40 ml/kg）;各组内再根据通气时间分别分为2 h、4 h和6 h 3个亚组.监测通气过程中的动脉血气、肺机械力学和血流动力学变化,肺组织大体标本及HE染色观察肺损伤情况,测定肺湿干比、BALF蛋白浓度,计数BALF中有核细胞和中性粒细胞数目.结果 VT10组在各时间点PaO2/FiO2保持稳定,VT20和VT40两组PaO2/FiO2随通气时间延长有下降趋势,其中VT20组通气4 h、6 h后PaO2/FiO2均＜300 mmHg,VT40组通气后2 h、4 h、6 h的PaO2/FiO2值均＜300 mmHg.VT10组肺组织肉眼及光镜下未见明显的改变.VT20组随着通气时间延长,可见一定程度的肺损伤,至通气6 h时,大体标本肉眼可见散在出血点,而VT40组通气2 h后肺组织就出现轻度损伤改变,通气4 h损伤显著.各组家兔的肺湿干比、BALF蛋白含量、有核细胞总数及中性粒细胞计数均随通气时间延长而升高.结论以VT40 ml/kg通气4 h为成功复制呼吸机所致肺损伤家兔模型的最理想条件.     

Controlled Release Gel of Ibuprofen and Lidocaine in Epidural Use—Analgesia and Systemic Absorption in Pigs

Purpose. Reduction of the frequency of injections and localization of the absorption of drug molecules to the injection site would be of great advantage in epidural pain treatment. The epidural use of a controlled release gel of lidocaine and ibuprofen was studied. Methods. The effect of a poloxamer gel (25%) containing 2% lidocaine HC1 and 2% ibuprofen Na on the duration of analgesia after epidural administration to pigs was compared with drug in solution. Analgesia was assessed by observing the motor function and the nociceptive reflex-withdrawal response to painful pressure stimulation on the feet. Pharmacokinetic and histological examinations were performed. Results. Analgesia lasted significantly longer after epidural lidocaine gel injection in comparison with the solution. The gel prolonged the systemic absorption, thereby increasing the epidural availability of lidocaine for spinal analgesia. Although the absorption of ibuprofen was prolonged after epidural gel injection, the duration of analgesia as compared with the solution was not prolonged. After epidural injection, only slight inflammatory changes were observed in the tissue structures of the epidural space, but none in the spinal cord. Conclusions. These results demonstrate poloxamer gel to be a promising controlled-release, injectable epidural formulation for the management of pain.     

荭草苷对缺氧模型小鼠的抗缺氧作用研究

目的:研究荭草苷对缺氧模型小鼠的抗缺氧作用。方法:通过常压耐缺氧、亚硝酸钠中毒、氰化钾中毒、利多卡因中毒、夹闭气管及断头等建立小鼠缺氧模型,于造模前20min给予相应药物,观察药物的抗缺氧作用。结果:与生理盐水空白对照组比较,荭草苷可明显延长模型小鼠在常压缺氧、亚硝酸钠中毒、氰化钾中毒、利多卡因中毒时的存活时间,延长夹闭气管后的心电图消失时间及断头后的喘气时间。结论:荭草苷对缺氧模型小鼠具有抗缺氧作用。     

小儿围手术期利多卡因连续硬膜外镇痛与芬太尼静脉镇痛的比较

目的:对小儿患者全麻联合硬膜外麻醉及术后镇痛与全麻后芬太尼静脉给药镇痛效果进行比较.方法:将91例行下肢手术的小儿患者随机分为硬膜外利多卡因组(n=61)及静脉芬太尼组(n=30).在手术过程中,控制呼气末安氟醚浓度,使患儿血压及心率变化范围维持在术前数值的10%以内.术后6,24 h,测定家长视觉模拟量表(PVAS)、目标疼痛评分(OPS)、恶心及呕吐的发生率.结果:硬膜外利多卡因组安氟醚用量显著低于静脉芬太尼组(P＜0.05).硬膜外利多卡因组6 h后目标疼痛评分(OPS)显著低于静脉芬太尼组.6,24 h后硬膜外利多卡因组家长视觉模拟量表(PVAS)评分显著低于静脉芬太尼组.两组术后恶心及呕吐发生率没有显著差异.结论:全麻联合硬膜外麻醉与单独全麻相比呼气末安氟醚浓度显著降低.小儿术后,持续硬膜外自控镇痛与芬太尼静脉自控镇痛相比,患儿硬膜外自控镇痛术后疼痛评分显著降低,两组均无严重并发症.     

Efficacy of epicardial controlled-release lidocaine for ventricular tachycardia induced by rapid ventricular pacing in dogs.

The effects of epicardial lidocaine on ventricular tachycardia (VT) induced by rapid ventricular pacing (50 Hz) were studied in dogs. Lidocaine-polyurethane (28% wt/wt) matrixes (40-50 mg, 5 x 5 mm) were placed proximal to bipolar left ventricular epicardial electrodes in open-chest anesthetized dogs (n = 9) after VT was established by rapid ventricular pacing. In the first set of experiments, matrices were removed immediately after VT had converted to sinus rhythm. Control animals underwent VT induction protocol with a nondrug-containing matrix positioned next to the epicardial electrode. In the lidocaine-treated animals, VT conversion was noted in all animals and occurred after 51.7 +/- 8.9 s (mean +/- SE), with a VT threshold current elevation of 73.5 +/- 11.2% above baseline at the time of conversion which progressed to 259 +/- 44% of the initial value by 5.4 +/- 0.5 min post-matrix placement. Lidocaine 1.4 +/- 0.1 mg was delivered to the myocardium at the time of VT conversion (0.11 +/- 0.01 mg/kg). In comparison, accelerated VT persisted for 5 min in three of five control animals, and progressed to ventricular fibrillation (VF) in the other two animals. In a separate series of eight dogs, the lidocaine-polyurethane matrixes were left in palce for 4 h so that we could study the sustained antiarrhythmic action of controlled-release lidocaine on VT induction. The results of these experiments demonstrated a maintenance of the VT threshold elevation at a level of 53.9 +/- 10.8% after 4 h, with a net lidocaine dose of 0.52 +/- 0.06 mg/kg after 4 h of controlled release.(ABSTRACT TRUNCATED AT 250 WORDS)