琥珀酰明胶急性高容量血液稀释对脊柱手术患者凝血功能影响

目的 采用琥珀酰明胶行急性高容性血液稀释,观察其对脊柱手术患者凝血功能的影响.方法 30例病人随机分为AHH组和对照组,每组15例.AHH组静脉输注琥珀酰明胶行急性高容性血液稀释,15ml/kg ,速度25 ml/min,切皮前完成,实现扩容20%～30%;对照组为常规输液;分别于麻醉诱导前(T0)和麻醉诱导后1h(T1)、术毕(T2)采颈内静脉血4ml,检测血红蛋白(Hb)、红细胞比容(Hct)、血小板计数(PLC)、凝血酶原时间(PT)、部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB);观察并记录上述三个时点的HR、MAP和CVP.结果 两组HR、MAP组内及组间比较均无统计学的差异(P﹥0.05);AHH组CVP在T1和T2均较T0升高(P﹤0.05),且高于对照组(P﹤0.05),差异有统计学意义;AHH组Hb、HCT在T1和T2均较T0降低(P﹤0.05),且低于对照组,差异有统计学意义(P﹤0.05);AHH组PLC和FIB在T1和T2均较T0减少或降低(P﹤0.05),组间比较无统计学差异(P﹥0.05);两组PT、TT和APTT组内及组间比较无统计学差异(P﹥0.05).结论 以琥珀酰明胶行急性高容性血液稀释,对脊柱手术病人凝血功能无明显影响.     

光棒与插管型喉罩在辅助气管内插管中的比较

目的 比较光棒与插管型喉罩在盲探气管插管中应用的效果.方法 80例择期全身麻醉手术患者,年龄48 ～ 72岁,美国麻醉医师协会分级(ASA)Ⅰ～Ⅱ级,Mallampatis Ⅰ～Ⅱ级,随机分为光棒组(G组)和插管型喉罩组(H组),每组40例,麻醉诱导用药相同.记录两组插管情况及插管时间,于麻醉诱导前3 min (T0)、插管后1 min (T1)、3 min (T2)、5 min(T3)记录患者的平均动脉压(MAP)、心率(HR)变化,记录拔管后患者不良反应发生情况.结果 G组首次插管成功率为80％,二次插管成功率为15％;H组首次插管成功率为85％,二次插管成功率为12％,两组总成功率差异无统计学意义.插管时间G组为(40.2±14)s,明显短于H组(72.4±12)s(P＜0.05).两组插管后1 min、3 min患者的MAP较诱导前升高,HR较诱导前增快[G组(93±18)、(86±13)mm Hg和(70±15)bpm,H组(90±15)、(88±12)mm Hg和(72±9)bpm,1 mm Hg=0.133 kPa,(P＜0.05)],组间比较差异无统计学意义.拔管后呛咳、咽痛等不良反应两组亦差异无统计学意义.结论 光棒与插管型喉罩在盲探气管插管中成功率高、并发症少、对血流动力学影响轻微,是安全有效的气管插管器具.     

硬膜外麻醉对肾移植受体围术期血流动力学及血生化的影响

目的 :探讨硬膜外麻醉行同种异体肾移植术对受体围术期血流动力学及血生化的影响。方法 :随机选择 60例肾移植术受者 ,在硬膜外麻醉前放置SwanGanz漂浮导管行围术期血流动力学分析 ,同时监测血生化改变。结果 :硬膜外阻滞后 3 0min平均动脉压(MAP)、中心静脉压 (CVP)、体循环阻力 (SVR)下降明显 ,阻断髂内动脉后MAP ,CVP逐渐恢复至麻醉前水平 ,肺循环阻力 (PVR)则明显升高。开放供肾血流后 3 0min内 ,心输出量 (CO)、心脏指数(CI)、平均肺动脉压 (MPAP)及PVR明显升高 ,CVP、SVR明显下降。K+ 在肾血管开放时显著升高 ,BUN值在开放供肾血流后 3 0min后明显降低。结论 :硬膜外麻醉用于肾移植术效果理想、确切 ;其对血流动力学的影响随手术步骤而不同 ,并相对较平稳。同时必须密切注意防止因血K+ 浓度过高所致的心律紊乱     

床旁主动脉气囊反搏术在急性心肌梗死并发心源性休克的临床应用疗效分析

目的 研究主动脉气囊反搏(IABP)联合急诊经皮冠状动脉介入治疗(PCI)对急性心肌梗死合并心源性休克的疗效.方法 比较24例患者急性心肌梗死合并心源性休克治疗前后的心脏指数(CI)、中心静脉压(CVP)、平均动脉压(MAP)和小时尿量变化.结果 接受IABP联合PCI治疗后,患者的CVP治疗前后明显降低(10.1±6.6) mm Hg vs (4.2±3.9)mm Hg(P<0.05),而CI、MAP和每小时尿量均较治疗前明显增加,分别为(2.4±1.3) L·min·m2vs (1.4±0.8) L·min·m2,(89.2±12.7) mm Hg vs (52.6±14.3) mm Hg,(48.3±13.8) ml/h vs (10.6±5.9) ml/h(P<0.05).结论 对于急性心肌梗死并发心源性休克的患者,IABP联合急诊PCI治疗,疗效确切.这对不能开展急诊冠状动脉旁路手术的医院,IABP联合急诊PCI治疗具有特殊的临床意义.     

小剂量高渗氯化钠羟乙基淀粉40注射液用于妊高征剖宫产术中的探讨

目的 研究比较高渗氯化钠羟乙基淀粉40注射液(HSH)与羟乙基淀粉注射液(HS)在妊高征剖宫产术中的临床疗效.方法 拟行剖宫产的妊高征产妇60例.随机分成HSH组(n=20例)HS组(n=20例)及对照组(n=20例),患者入室后均在硬膜外麻醉下行剖宫产术,穿刺点为L2～3问隙,在硬膜外腔开始推注局麻药的同时HSH组先输入高渗氯化钠羟乙基淀粉40注射液250ml、HS组先输入羟乙基淀粉注射液250ml,之后两组再输乳酸钠林格液,对照组则一直输乳酸钠林格液.记录麻醉后5、10、30分钟及术毕MAP,术中麻黄素用量;术前和术后患者血清电解质以及新生儿1分钟Apgar评分.结果 三组患者MAP在麻醉后5、10、30分钟及术毕较术前均有明显降低(p<0.05);对照组在麻醉后5、10、30分钟较HSH和HS组有明显降低p<0.05);HSH组在麻醉后5,10分钟时段时高于HS组而术毕时差异已无显著性.麻黄素的应用对照组明显多于HSH和HS组.手术前后患者血清电解质及新生儿1分钟Apgar评分三组间无显著性差异.结论 妊高征患者训宫产术中应用高渗氯化钠羟乙基淀粉40注射液预防术中低血压是较好的选择.     

意识指数(IoC1)联合伤害敏感指数(IoC2)监测在全麻剖宫产中的应用效果

目的探讨脑电意识指数1(IoC1)联合伤害敏感指数2(IoC2)监测在全麻剖宫产术中的应用效果。方法选择60例行全身麻醉下剖宫产手术的患者,ASA分级Ⅰ～Ⅱ级,年龄18～42岁,用随机数字表法将患者平均分为:对照组(C组)以传统血压、心率等临床指标判断麻醉深度指导用药;IoC1联合IoC2监测组(IoC组)以IoC1指导镇静药物的使用,以IoC2指导镇痛药物的使用。观察并记录两组患者的平均动脉压(MAP)、心率(HR),记录术中出现HR、MAP基础值±20%发生率;比较两组患者丙泊酚用量、瑞芬太尼用量、新生儿阿普加评分、麻醉时间和苏醒时间;比较患者术后疼痛评分、恶心、呕吐和术中知晓发生情况。结果与麻醉诱导前(T0)时间点相比,两组患者在麻醉诱导后(T1)时间点HR、MAP均明显降低,C组患者在插管即刻、胎儿娩出后(T2、T3)时间点HR、MAP明显升高,在手术结束时(T4)HR、MAP明显降低(P0.05); IoC组的HR、MAP仅在T2时间点明显增高。与C组相比,IoC组丙泊酚用量、瑞芬太尼用量和苏醒时间明显减少,术中出现HR、MAP基础值±20%发生率、术后恶心、呕吐发生率明显减少(P0.05)。结论在剖宫产施行全身麻醉时,IoC1联合IoC2监测能良好地反映患者意识水平和镇痛程度,指导围术期麻醉用药,缩短麻醉恢复时间,使血流动力学更加稳定,术后并发症减少,有利于提高产科麻醉质量。     

丙泊酚镇静下瑞芬太尼抑制喉罩置管和气管插管心血管反应的半数有效浓度比较

目的 测定抑制喉罩通气道LMA-Fastrach、LMA-Proseal置管和气管插管心血管反应的瑞芬太尼半数有效浓度以及比较置管期间相应脑电双频谱指数(BIS)的变化.方法 择期全麻下行胆囊切除术患者63例,美国麻醉医师协会(ASA)I～II级,按置管类型的不同随机均分为T、F、P 3组,每组21例.4 mg/L启动并调整丙泊酚靶控,使得BIS稳定于45～55,之后按Minto药代模式设置并启动瑞芬太尼效应室靶控,5 min后给0.6 mg/kg罗库溴铵,2 min后置管:T组气管插管,F组LMA-Fastrach置管,P组放置LMA-Proseal.比较患者麻醉诱导前、诱导后平均动脉压(MAP)、心率(HR)值及置管前后的BIS变化.记录置管前1、2min及置管后5min内的MAP、HR值以判定患者有无心血管反应.应用Dixon-Mood序贯法计算抑制3种置管心血管反应的瑞芬太尼的半数有效浓度(EC50).结果 与麻醉诱导前相比,3组麻醉诱导后MAP、HR均明显下降[MAP:T、F、P组麻醉诱导前后分别为(87.9+10.5)mmHg比(71.6+9.0)mm Hg,(91.8+8.8)mm Hg比(73.5±9.9)mm Hg,(87.2±10.2)mm Hg比(70.9+8.6)am Hg,HR:T、F、P组麻醉诱导前后分别为(78.8±11.6)次/min比(68.7+8.5)次/min,(74.8±10.3)次/min比(64.1±6.7)次/min,(76.7±8.2)次/min比(67.3±8.3)次/min,1 mm Hg=0.133 kPa,P<0.05],而置管前后的BIS值则无变化(P>0.05).瑞芬太尼抑制3组置管心血管反应的半数有效浓度依次为T组4.47 μg/L、F组4.78 μg/L、P组2.05 μg/L.结论 Minto模式靶控测得瑞芬太尼抑制3种置管心血管反应的EC50 LMA-Fastrach置管略高于气管插管,LMA-Proseal置管则最低.     

高渗氯化钠羟乙基淀粉40注射液在剖宫产手术中的应用

目的 探讨高渗氯化钠羟乙基淀粉40注射液在剖宫产患者中的应用疗效.方法 将60例行剖宫产的患者随机分位两组,A组:高渗氯化钠羟乙基淀粉40注射液(以下称高渗晶胶液)组;B组:复方氯化钠组.两组患者均于麻醉前输入液体,A组输入高渗晶胶液4ml/kg,B组输入复方氯化钠液体8ml/kg.监测患者入室血压、注药10min、20min的血压以及术前、术后的电解质变化.结果 A组在注药后10min及20min的血压与麻醉前比较无统计学意义.B组在注药后10min及20min血压下降明显,与麻醉前比较有统计学意义(P< 0.05),与A组比较差异有统计学意义(P<0.05).结论 高渗晶胶液可安全有效的应用于剖宫产的患者,对于低血压的预防有一定的作用,对电解质的影响较小.     

右美托咪定对上肢手术止血带反应的影响

目的 观察右美托咪定对臂丛神经阻滞下上肢手术止血带反应的影响.方法 择期上肢手术患者80例,年龄25 ～ 65岁,体质量55～ 75 kg,身高155～ 175 cm,ASA分级Ⅰ或Ⅱ级.采用随机数字表法,将患者随机分为右美托咪定组(D组,n=40)和对照组(C组,n=40).D组于神经阻滞前10min静脉注射右美托咪定负荷剂量1 μg/kg,继之以0.5μg·kg-1·h-1的速率持续输注至手术结束.C组给予等量生理盐水.行超声引导下肌间沟臂丛神经阻滞,定位成功后两组均注射0.5％盐酸罗哌卡因30ml.记录两组止血带反应例数、止血带反应发生时间、止血带反应程度、术中辅助用药情况;记录患者入室时(To)、阻滞后5 min(T1)、10 min(T2)、15 min(T3)、30 min (T4)、60 min(T5)心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO2);记录不良反应发生情况.结果 D组止血带反应例数、止血带反应程度、术中辅助芬太尼用药剂量均低于C组[止血带反应例数:8/40比14/40,止血带反应程度:2.4±0.8比60.2±20.4,辅助芬太尼用药剂量:(4.2±1.2)μg比(130.3±38.6) 1μg,均P＜0.05],止血带反应发生时间迟于C组[(52.2±12.5)min比(30.2±11.8)min,P＜0.05)].To时C组与D组两组HR、MAP、SpO2差异无统计学意义;T1～T5时D组HR较C组减慢(均P＜0.05);T1～T3时两组MAP差异无统计学意义;T4、T5时点D组MAP明显低于C组(P＜0.05);两组术中SpO2差异无统计学意义.D组术中有4例发生心动过缓,两组均未发生低血压、局部麻醉药中毒等不良反应.结论 上肢神经阻滞前10 min静脉注射右美托咪定1 μg/kg,继之以0.5 μg·kg-1·h-1的速率持续输注至手术结束,可明显减少止血带反应例数、减轻止血带反应程度、推迟止血带反应发生时间.     

下腔静脉内径呼吸变异指数超声测量在全身麻醉高龄患者围术期容量负荷的评估价值

目的探讨高龄择期外科手术患者采用经胸多普勒超声定量检测下腔静脉内径呼吸变异指数(RVI_(IVC))在全身麻醉围术期容量评估中的应用价值。方法选择行下肢手术的高龄患者66例,其中男性36例,女性30例;年龄76～85岁,平均年龄79.6岁。根据麻醉诱导前中心静脉压(CVP)将患者分为低容量组[21例,CVP≤0.49 kPa(5 cmH_2O)]、正常容量组[30例,0.49 kPa CVP 1.18 kPa(12 cmH_2O)]和高容量组(15例,CVP≥1.18 kPa)。通过监测平均动脉压(MAP)和CVP数值指导静脉补液,遂行麻醉诱导。检测术前30 min、术中1 h、手术结束前30 min、拔管前10 min和拔管后30 min的RVI_(IVC)和氧合指数,比较不同组间的RVI_(IVC);同时记录低血压发生率,比较低血压患者与正常血压患者各时间点的RVI_(IVC)值。结果术前30 min时,正常容量组RVI_(IVC)(45.5%±6.3%)较高容量组(38.8%±6.6%)高,但低于低容量组(62.7%±9.8%)(F=6.648,P 0.05);但3组其他各时间点RVI_(IVC)比较,差异无统计学意义(F=1.203、0.826、0.802、0.726,P 0.05)。3组各观察时间点氧合指数比较,差异均无统计学意义(F=0.622、0.703、0.614、0.660、0.921,P0.05)。经Pearson检验发现,术前30 min的RVI_(IVC)与术中MAP和CVP呈负相关(r=-0.725、-0.776,P 0.05)。66例患者共发生低血压7例(10.6%),低血压组术中1 h的RVI_(IVC)明显高于正常血压组(47.8%±10.2%vs 41.3%±7.6%;t=6.569,P 0.05),其他时间点RVI_(IVC)比较,差异无统计学意义(P 0.05)。结论高龄手术患者术前30 min的RVI_(IVC)可能是评估术前血容量负荷的敏感性指标,而术中1 h的RVI_(IVC)可能是预测术中及术后苏醒期低血压风险的敏感性指标。     

羟乙基淀粉130／0．4溶液术前扩容对结肠癌患者围术期血液流变学及术后深静脉血栓形成的影响

目的观察羟乙基淀粉（HES）130／0．4溶液术前扩容对结肠癌患者围术期血液流变学及术后深静脉血栓发生率的影响。方法择期行结肠癌根治术的40例患者随机分为两组（n=20）。麻醉诱导时于30min内给两组患者分别输注15ml·kg^-1 HES 130／0．4溶液（HES组）和乳酸钠林格氏（RL）溶液（RL组）。分别于麻醉诱导前（T0）、扩容结束后即刻（T1）、扩容结束后1h（T2）、手术结束后1h（T3）抽取静脉血，检测全血黏度、血浆黏度、红细胞聚集指数（EAI）、纤维蛋白原、血细胞比容（HCT）。采用彩色多普勒超声于术后第7天检查双下肢深静脉血栓形成（DVT）的发生情况。结果与T0比较，HES组T1、T2和T3时全血黏度、血浆黏度、EAI、纤维蛋白原、HCT降低（P〈0．05）。与T0比较，RL组T1时全血黏度、血浆黏度、EAI、纤维蛋白原、HCT降低（P〈0．05），T3时全血低切黏度、红细胞聚集指数增加（P〈0．05）。与RL组比较，HES组T2和T3时全血黏度、EAI、纤维蛋白原和HCT均显著降低（P〈0．05）。HES组术后DVT发生率明显低于RL组（P〈0．05）。结论术前采用HES130／0．4溶液扩容能明显改善结肠癌根治术患者围术期血液流变学指标，并能降低术后DVT的发生率。     

Stroke Volume Variation for Prediction of Fluid Responsiveness in Patients Undergoing Gastrointestinal Surgery

Background: Stroke volume variation (SVV) has been shown to be a reliable predictor of fluid responsiveness. However, the predictive role of SVV measured by FloTrac/Vigileo system in prediction of fluid responsiveness was unproven in patients undergoing ventilation with low tidal volume. Methods: Fifty patients undergoing elective gastrointestinal surgery were randomly divided into two groups: Group C [n₁=20, tidal volume (V_t) = 8 ml/kg, frequency (F) = 12/min] and Group L [n₂=30, V_t= 6 ml/kg, F=16/min]. After anesthesia induction, 6% hydroxyethyl starch130/0.4 solution (7 ml/kg) was intravenously transfused. Besides standard haemodynamic monitoring, SVV, cardiac output, cardiac index (CI), stroke volume (SV), stroke volume index (SVI), systemic vascular resistance (SVR) and systemic vascular resistance index (SVRI) were determined with the FloTrac/Vigileo system before and after fluid loading. Results: After fluid loading, the MAP, CVP, SVI and CI increased significantly, whereas the SVV and SVR decreased markedly in both groups. SVI was significantly correlated to the SVV, CVP but not the HR, MAP and SVR. SVI was significantly correlated to the SVV before fluid loading (Group C: r = 0.909; Group L: r = 0.758) but not the HR, MAP, CVP and SVR before fluid loading. The largest area under the ROC curve (AUC) was found for SVV (Group C, 0.852; Group L, 0.814), and the AUC for other preloading indices in two groups ranged from 0.324 to 0.460. Conclusion: SVV measured by FloTrac/Vigileo system can predict fluid responsiveness in patients undergoing ventilation with low tidal volumes during gastrointestinal surgery.     

肾移植患者围术期麻醉管理：40例资料回顾

背景：从肾移植患者围术期血生化检测结果可以看到,一些酸碱指标及生化指标的变化可能与血液稀释有关。 目的：通过监测肾移植患者围术期血流动力学的变化以及电解质、血生化的改变,麻醉药物使用情况,探讨肾移植患者理想的麻醉管理方法。 方法：分析40例肾移植患者麻醉前、肾动脉血流开放前、血流开放后10 min、手术结束时(T4)各时点平均动脉压、中心静脉压、心率、电解质、血糖和血气参数的变化。 结果与结论：与肾移植患者麻醉前比较,血流开放后10 min平均动脉压、中心静脉压、pH、HCO^3-、BE显著降低(P < 0.01),K⁺和葡萄糖明显增加(P < 0.01)。与肾动脉血流开放前比较,血流开放后10 min平均动脉压、葡萄糖、pH、HCO^3-、BE明显降低而心率明显增高(P < 0.05)。说明充分的移植前准备,合理的麻醉药物选择,以及围术期的循环、呼吸及水电解质酸碱平衡的维持是肾移植术全身麻醉成功的关键。     

Effect of Rapid Plasma Volume Expansion during Anesthesia Induction on Haemodynamics and Oxygen Balance in Patients Undergoing Gastrointestinal Surgery

Aims: To investigate the reasonable dose of Voluven for rapid plasma volume expansion during the anaesthesia induction patients receiving gastrointestinal surgery. Methods: Sixty patients were randomly divided into three groups (n=20): Group A (5 ml/kg), Group B (7 ml/kg) and Group C (9 ml/kg). HES 130/0.4 was intravenously transfused at a rate of 0.3 ml/kg/min) at 30 min before anaesthesia induction. Besides standard haemodynamic monitoring, cardiac index (CI), systemic vascular resistance index (SVRI) and stroke volume variation (SVV) was continuously detected with the FloTrac/Vigileo system. Haemodynamic variables were recorded immediately before fluid transfusion (T₀), immediately before induction (T₁), immediately before intubation (T₂), immediately after intubation (T₃) and 5 min, 10 min, 20 min and 60 min after intubation (T₄-T₇). Arterial and venous blood was collected for blood gas analysis, Hb and Hct before volume expansion (t₀), immediately after volume expansion (t₁) and at 1 h after volume expansion (t₂). Oxygen delivery (DO₂), oxygen extraction ratio (ERO₂) and volume expansion rate were calculated. Results: 1) MAP and CI decreased in Group A in T₂~T₇ and remained changed in Group B and C. 2) CVP increased in three groups after fluid infusion without significant difference. 3) The decrease in SVRI was more obvious in Group B and C than that in Group A after induction and more obvious in Group C than in Group B in T₂-T₄ and T₆~T₇. 4) SVV was lower in Group B and C than that in Group A after intubation, and lower in Group C than that in Group B in T₃-T₆. 5) Hb and Hct decreased after fluid infusion, and the decrease in Hb and Hct was in the order of C>B>A. 6) Volume expansion rate was in the order of C>B>A. 7) ScvO₂, PaO₂ and DO₂ increased in three groups after fluid infusion and the increase in DO₂ was in the order of C>B>A. Conclusions: Rapid plasma volume expansion with Voluven at 7-9 ml/kg can prevent haemodynamic fluctuation during anaesthesia induction, maintain the balance between oxygen supply and oxygen consumption during gastrointestinal surgery, and Voluven at 9 ml/kg can improve the oxygen delivery.     

内源性舒张因子在失血性休克中的变化

目的探讨内源性舒张因子一氧化氮（NO）与一氧化碳（CO）在失血性休克中的变化。方法按照Wigger’s改良法制作家猪失血性休克模型，失血性休克（H）组经股动脉快速放血使MAP降至40mmHg，然后复苏。对照（C）组处理同H组，但未失血。各组分别在休克前、休克末、复苏末、复苏后30、60、120、240min分别记录平均动脉压（MAP）、心率（HR）、中心静脉压（CVP）、肺动脉压（PAP）、肺动脉楔压（PCWP）、气道压（Peak）的变化，采血测定pH值、BE值、CO、NO及乳酸盐（Lae）水平。结果H组休克后MAP、PAP和CVP降低而HR升高，Peak、PCWP无显著变化。血浆NO水平在休克后逐渐升高，复苏后120min显著高于休克前和c组水平，此后一直维持较高水平，240rain时达到高峰。休克后CO水平逐渐增加，复苏后120min显著高于休克前，并高于c组，此后逐渐下降；Lac在失血后显著升高，休克末达峰值，显著高于休克前和c组，以后逐渐下降。pH值、BE值在休克后逐渐下降，与c组相比有显著差异。结论失血性休克后NO、CO水平增加，可能作为两种内源性保护因子起作用。     

Role of the orexinergic system in acute haemorrhage in the rat

Orexins (OXs) stimulate sympathetic nerve activity to increase arterial pressure (AP) and heart rate (HR). We have previously reported that the OX(1)-receptor antagonist SB-334867 reversed the sympathomimetic actions of orexin A (OXA). In the present study we have investigated the role(s) of the orexinergic system in sympathetic activation during haemorrhage in rats. Sixteen Wistar rats, anaesthetised with pentobarbital, were assigned to 2 groups: saline i.p. (group S) and SB-334867 30 mg/kg i.p. (group SB) n=8 each. Haemorrhagic shock was established by acute withdrawal of 10 ml/kg of blood via an arterial catheter three times with a 30 min interval between each withdrawal. Haemodynamics were assessed 30 min after 10, 20, and 30 ml/kg of blood withdrawal. In addition, plasma orexin A and catecholamine concentrations in the shed blood were determined. In both groups, mean AP (MAP) and HR decreased significantly. Plasma catecholamine concentrations significantly increased following blood withdrawal. The reduction in MAP/HR and elevation of catecholamine levels were dependent on the total amount of shed blood. There were no differences between the groups. Plasma OXA concentrations increased to a greater extent in group SB than group S in response to haemorrhage. There was a significant correlation between plasma catecholamines and %change in MAP (epinephrine: r=0.553, p=0.0001, norepinephrine: r=0.374, p=0.0087) and HR (epinephrine: r=0.403, p=0.005, norepinephrine: r=0.436, p=0.002). There was no correlation with plasma orexin A levels. These data suggest that despite a weak activation the orexinergic system is unlikely to make a major contribution to the response to haemorrhage.     

右美托咪定对超声引导下罗哌卡因臂丛神经阻滞效果的影响

目的 观察右美托咪定对超声引导下臂丛神经阻滞时效的影响.方法 择期上肢手术患者60例,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将患者随机分为2组（均为30例）：右美托咪定组（D组）和对照组（C组）.行超声引导下肌间沟臂丛神经阻滞,定位成功后,D组和C组分别注射右美托咪定1 ml（1μtg/kg）＋0.5％盐酸罗哌卡因30 ml和生理盐水1 ml＋0.5％盐酸罗哌卡因30 ml,记录感觉和运动神经阻滞起效时间、作用时间、镇痛维持时间;记录患者入室时（T0）、阻滞后5 min（T1）、10 min（T2）、15 min （T3）、30 min （T4）、60 min （T5）各时间点的心律（HR）、平均动脉压（MAP）、血氧饱和度（SpO2）;记录不良反应发生情况.结果 与C组比较,D组感觉和运动神经阻滞起效时间缩短[感觉：（9.8±3.2）min比（7.4±2.1）min;运动：（12.3±2.5） min比（8.2±1.6）min],作用时间及镇痛维持时间延长（P＜0.05）.与C组比较,T1～T5时D组HR减慢（P＜0.05）,MAP差异无统计学意义.两组术中SpO2差异无统计学意义.D组术中有3例发生心动过缓.两组均未发生低血压、局麻药中毒等不良反应.结论 右美托咪定1μg/kg联合0.5％盐酸罗哌卡因30 ml用于超声引导下臂丛神经阻滞,可明显缩短起效时间、延长作用时间及镇痛时间,但需注意心动过缓的发生.     

Hemodynamic responses to hypoxia and hypercapnia during acute normovolemic hemodilution in anesthetized cats

The present study was undertaken to evaluate the effects of hypoxia and hypercapnia on circulatory parameters during acute normovolemic hemodilution. Cats anesthetized with a mixture of alpha-chloralose and urethane were maintained by positive pressure ventilation. Muscles were paralysed by intramuscular vecuronium (0.1 mg/kg) to eliminate reflex respiratory movements. Cats were exposed to hypoxia (12% O(2) and 7% O(2)) and hypercapnia (4% CO(2) and 7% CO(2)) at normal hematocrit (Ht 40.1 +/- 2.8%) and then at graded levels of normovolemic hemodilution (Ht 24.0 +/- 2.0% and Ht 13.0 +/- 1.5%, respectively). Left ventricular pressure (LVP), LV dP/dt(max), arterial blood pressure (ABP), heart rate (HR), and right atrial pressure (RAP) were recorded on a polygraph. Cardiac output (CO) was measured using a cardiac output computer. Hemodilution per se did not produce any significant change in ABP, RAP or LV dP/dt(max), however, it produced a significant rise in HR and a significant fall in total peripheral resistance (TPR). Exposure to hypoxic gas mixtures caused significant increases in HR and CO at control Ht; but after hemodilution it caused the reverse effects. Hypercapnia did not produce any significant effect on ABP, LV dP/dt(max) or RAP either at control Ht or after hemodilution. Hypercapnia produced a fall in HR, CO and stroke volume (SV) at normal Ht and percent fall in HR response was enhanced following hemodilution. The reversal of chronotropic response to hypoxia and enhanced bradycardia response to hypercapnia, under conditions of acute normovolemic hemodilution would be deleterious as the tissues would become more hypoxic. Such a response may be attributed to altered control mechanisms under such conditions of severe stress.     

Terumo-Triplex grafts for total arch replacement: analysis of postoperative graft performance

We evaluated the performance of Terumo-Triplex (TRP) with a large-diameter vascular graft sealed with non-biodegradable material in 48 patients who underwent total arch replacement under selective cerebral perfusion between 2004 and 2009. TRP grafts were used in 13 patients (T group), Gelseal graft in 15 (G group), Hemashield graft in 10 (H group) and Intergard graft in 10 (I group). The total tube drainage, time to tube removal, graft dilation ratio and inflammation were evaluated postoperatively. Cardiopulmonary bypass and selective cerebral perfusion times did not differ between groups. Two patients died in hospital. The total drain drainage was significantly lower in the T group (956?±?156?ml) than in the H (2058?±?403?ml, p?=?0.001) or I (5959?±?1027?ml, p?=?0.01) groups. The time to tube removal was significantly lower in T group and G group than H and I group (T: 3.7?±?0.4, G: 4.1?±?0.4, H: 8.3?±?1.6, I: 18.6?±?3.6?days, T vs. H, I: p?=?0.07, 0.0002, G vs. H, I: p?=?0.004, <0.0001). The graft dilation ratio was significantly lower in T group than G group (T: 104?±?4 vs. 130?±?7?%, p?=?0.001). The max C-reactive protein level was significantly lower in T group (16.2?±?4.5?mg/dl) than in the G group (19.4?±?3.2?mg/dl, p?=?0.047), H (20.4?±?4.1?mg/dl, p?=?0.048), or I (20.5?±?4.5?mg/dl, p?=?0.013) groups. Maximum body temperature was also lower in the T group (38.2?±?0.5?°C) than in the G (38.7?±?0.4?°C, p?=?0.011), H (38.9?±?0.6?°C, p?=?0.0087), and I (39.3?±?0.7?°C, p?=?0.0005). Thus, TRP graft might attenuate inflammatory response compared to the other sealed grafts for total arch replacement in patients with aortic arch aneurysm or dissection.     

肝移植后肾功能衰竭者的连续血液净化治疗

背景：连续性血液净化又称为肾脏替代疗法,是近年来血液净化治疗技术的一项重要发展,在临床上已成为救治急性肾功能衰竭、多脏器功能衰竭及各种急危重患者必不可少的治疗手段。 目的：总结肝移植后合并肾功能衰竭患者应用连续性血液净化的治疗技术。 方法：回顾性分析10例肝移植后合并急性肾功能衰竭的患者应用BM-25连续性血液净化机治疗的临床资料,治疗模式为连续静静脉血液滤过,置换液使用方式是前/后稀释法,采用普通肝素、低分子肝素或无肝素抗凝。治疗时间为5~30 d。观察患者治疗前及治疗24 h后心率、平均动脉压、中心静脉压、尿素氮、血肌酐、血清钾、动脉血气碱剩余。 结果与结论：10例患者中,好转8例,ICU存活率80.0%。连续性血液净化治疗过程中患者生命体征平稳、血流动力学指标好转,全身水肿逐渐减轻,呼吸状态好转。治疗24 h心率显著下降,平均动脉压明显升高,中心静脉压显著下降。电解质、酸碱平衡维持正常,动脉血气明显改善,尿素氮、血肌酐、血钾明显降低。治疗前后两组数据比较,差异有显著性意义(P < 0.05)。 提示连续性血液净化治疗能明显改善肝移植后急性肾功能衰竭患者的预后,因而在肝移植后并发急性肾功能衰竭患者中得以广泛应用。