静脉复合麻醉对血液流变学的影响

在许多临床研究工作中,如循环系统内氧的运输总量和血管周围阻力的测定、深静脉栓塞的发病机理、心内直视手术的组织灌流等,血液流变学起了重要作用,研究各项麻醉对血液流变学的影响,对麻醉人员在麻醉中管理及治疗有着积极意义。我们对28例病人在静脉复合麻醉前、后的血液流变学进行了观察。     

不同麻醉方法对乳腺癌患者血液流变学的影响

目的比较两种麻醉方法对乳腺癌患者血液流变学的影响。方法32例ASAⅠ~Ⅱ级行择期乳腺癌根治术患者随机分为两组:Ⅰ组为全麻组;Ⅱ组为硬膜外加全麻组,诱导前硬膜外给2%利多卡因5 ml,继之行全麻诱导。全麻用药两组相同,Ⅱ组术中每50分钟硬膜外给2%利多卡因6~8 ml。术后24 h内用0.5%布比卡因镇痛,Ⅰ组术后肌注哌替啶镇痛。分别于麻醉前、麻醉后30、90 min各取桡动脉血10 ml,测血液流变学指标。结果两组麻醉后309、0 min全血高切及低切粘度、红细胞压积及红细胞聚集指数下降(P<0.05),但Ⅱ组这几项指标下降明显且持续时间长,且有血浆粘度及纤维蛋白原浓度的下降(P<0.05)。结论全麻加用硬膜外阻滞对血液流变学的影响更有利于预防术后上肢静脉血栓的形成。     

高血压患者硬膜外麻醉前后血液流变学的变化

目的:了解高血压患者硬膜外麻醉前后的血液流变学的变化。方法:采用国产SA-B型多功能电脑血液流变学监测仪,对40例高血压患者进行了硬膜外麻醉前后血液流变学各项指标的监测。结果:麻醉后红细胞压积、血液粘度均降低,红细胞变形指数增大。结论:硬膜外麻醉有助于改善微循环。     

硬膜外阻滞和全身麻醉对Ⅱ型糖尿病患者血液流变学的影响

目的：研究Ⅱ型糖尿病患者和非糖尿病患者在连续硬膜外阻滞和全身麻醉下的血液流变学变化。方法：46例患者实施连续硬膜外阻滞或全身麻醉，其中24例Ⅱ型糖尿病患者，22例非糖尿病患者，根据麻醉方式的不同随机分为四组，比较麻醉前后血液流变学的变化。结果：麻醉后糖尿病患者：（1）硬膜外阻滞组麻醉全血低切和高切粘度、低切和高切还原粘度较麻醉前降低；（2）全麻组血液流变学指标与麻醉前相比无显著性差异；（3）硬膜外阻滞组的全血高切粘度比全麻组低。结论：连续硬膜外麻醉使Ⅱ型糖尿病患者的血液粘滞性降低，有益于患者脏器的血流灌注。     

术后不同镇痛方式对全髋置换术老年病人血液流变学的影响

老年病人多因近端股骨骨折或股骨颈骨折而行全髋置换术。由于老年人血管结构改变,代谢紊乱,手术刺激可致血管活性物质形成,因此常处于高凝状态并持续到术后;全髋置换术时,骨水泥单体的释放,更易诱发血栓形成和心脑血管意外,加之此类病人常需长期卧床,因而易发生术后深静脉血栓。血液流变学的改变在血栓形成中起重要作用,不同麻醉方法下全髋置换术病人术后血液流变学的变化已有报道,术后不同镇痛方式对全髋置换术老年病人血液流变学的影响尚未定论。本研究拟比较术后病人自控硬膜外镇痛(PCEA)和病人自控静脉镇痛(PCIA)对全髋置换术老年病人血液流变学的影响。     

不同麻醉方法对全髋置换术患者的血液流变学的影响

目的：对比研究单纯全麻醉与硬膜外加全麻对全髋转换术患者的血液流变学的影响。方法：１６例ＡＳＡＩ￣Ⅱ行,行择期全髋置换术患者随机分为两组。Ⅰ组为全麻组,Ⅱ组为硬膜外加全麻组,诱导前硬膜外给２％利多卡因５ｍｌ,有平面后行全麻诱导,全麻用药与Ⅰ组相同,术中用利多卡因硬膜外阻滞,每５０ｍｉｎ给药６￣８ｍｌ,术后２４ｈ内用０．５％布比卡因镇痛,Ⅰ组术后肌注哌替啶镇痛。结果：两组血液流变学的主要差异：Ⅱ组的血     

腹腔镜胆囊切除术对患者血气及血液流变学影响的临床研究

目的　探讨气管插管全身麻醉下腹腔镜胆囊切除术 (LC)时CO2 气腹对患者血气变化和血液流变学的影响 ,观察LC的适应性及安全性。方法　选择的 3 5例均为因胆囊炎而行择期LC手术的患者 ,无呼吸系统及循环系统疾病 ,全部采用气管插管全身麻醉。分别于麻醉后气腹前及手术结束前抽取足背动脉血进行血气分析 ;于术前 2 4h及手术结束前 ,抽取颈内静脉血进行血液流变学检查。结果　气腹前后 pH、PaO2 、T CO2 、AB值均有明显改变 ,P <0 .0 5 ;而全血粘度、血浆粘度、红细胞压积均有明显下降 ,P <0 .0 5。结论　LC手术中CO2 气腹对患者血气变化及血液流变学有一定的影响。其中 ,pH、PaCO2 、T CO2 、AB值的变化在正常范围之内 ,而血液流变学各项指标均有所下降。表明在气管插管全身麻醉下行胆囊切除术是安全可靠的 ,不会引起高碳酸血症及高粘滞血症     

麻醉对血液流变学的影响

本文综述了血液流变特点,重点讨论了麻醉方式、药物、输液及其它因素对其的影响,旨在保证麻醉期间高质量的组织灌注及氧供,减少术中、术后并发症。     

关于隆乳术麻醉方法有效性的思考

目的探讨隆乳术有效的麻醉方式.方法总结383例患者以各种麻醉方式隆乳的临床经验.分析隆乳术疼痛产生的机制和隆乳术的应用神经解剖.结果硬膜外麻醉和肋间神经阻滞技术不是胸大肌下间隙隆乳术理想的麻醉方式.局部肿胀麻醉只适用于乳房下间隙隆乳术和肌肉不发达的部分胸大肌下间隙隆乳术的患者.全身麻醉对任何术式均有效.结论隆乳术中应根据不同情况采用不同的麻醉方式.     

老年患者全髋置换术的麻醉体会

目的 总结老年患者全髋置换术的麻醉体会.方法 仝绀50例,全部采用连续硬外麻醉,术中常规监测MAP、HR、SPO2,合并糖尿病者约45 min监测血精一次.结果 硬膜外阻滞下,所有患者麻醉效果满意,血压均有不同程度下降,适量应用胶体溶液进行容量治疗,备好麻黄碱和阿托品,既有利于维持血压平稳、改善血液流变学指标,节约川血和减少输血发症,也可以减少老年患者肺郎感染的发生率,还呵以用硬膜提供良好的术后镇痛,减少术后并发症的发生.结论 老年患者全髋置换术行连续硬膜外麻醉有利于减少老年人术后并发症的发生,提高康复质量.     

小儿深麻醉下气管拔管的研究进展

随着小儿手术的日益增多,小儿全身麻醉气管插管增多,拔管相关的并发症相应增多,气管拔管的方法和时机的选择日益受到麻醉医师关注。如何在保证患儿安全的前提下使患儿在较为舒适的环境下苏醒,是小儿麻醉医师不断追求的目标。已有大量临床研究证实,深麻醉下拔管可减少患儿麻醉苏醒期呼吸道并发症,减轻血流动力学波动,减少拔管后患儿躁动,使患儿在较为舒适的状态下度过麻醉苏醒期。文章就深麻醉下拔管对机体的影响、拔管方法和用药及局限性等方面进行综述。     

硬膜外麻醉髋关节置换术100例临床观察

目的：观察连续硬膜外麻醉髋关节置换术的安全性。方法：回顾分析100例连续硬膜外麻醉髋关节置换术的麻醉经过．分析总结连续硬膜外麻醉髋关节置换术中生命体征及并发症的发生率。结果：全部患者平稳度过麻醉期．未发生严重并发症。结论：术前准备充分．术中观察和处理及时,术后使用硬膜外镇痛．连续硬膜外麻醉髓关节置换术是安全有效的。     

Specialist training in pediatric anesthesia – the Scandinavian approach

There has been a great deal of focus on specialist training in pediatric anesthesia in the last decade or so. Internationally, however, there is still no uniform agreement as to how such a training program should be arranged and organized. Since September 2003, the Scandinavian Society of Anaesthesiology and Intensive Care Medicine has coordinated an advanced Inter-Nordic educational program in pediatric anesthesia and intensive care. The training program is managed by a Steering Committee. This program is intended for physicians who recently have received their specialist degree in anesthesiology and intensive care. The training period is 12 months of which 9 months are dedicated to pediatric anesthesia and 3 months to pediatric intensive care. During the 1-year training period, the candidates are designated a Scandinavian host clinic (at a tertiary pediatric center in Scandinavia approved by the Steering Committee). The host clinic employs the candidate in an appropriate position for the duration of the training program. The program also includes three theoretical courses each of 4 days duration and a 4-week exchange module at another pediatric center inside or outside Scandinavia. In this article the Scandinavian training program in pediatric anesthesia and intensive care is presented and discussed in more details. International collaboration on how best to arrange and organize a training program in pediatric anesthesia and intensive care is encouraged.     

A Comparison of Neuraxial and General Anesthesia for Thirty-Day Postoperative Outcomes in United States Veterans Undergoing Total Knee Arthroplasty

BackgroundThe aim of this study is to investigate which anesthetic technique is superior on 30-day outcomes after primary total knee arthroplasty (TKA) in United States veteran patients. To our knowledge, this is the first account from the Veterans Health Administration comparing the effects of different anesthesia modalities in patients undergoing TKA.MethodsThe Veterans Affairs Surgical Quality Improvement Program database was utilized to analyze patients undergoing primary TKA during the period of 2008-2015. Subjects were divided into 2 cohorts based on the method of surgical anesthesia used: general anesthesia or neuraxial anesthesia. Propensity score matching was utilized to avoid possible selection bias between the 2 cohorts when assessing patient demographics and comorbidities. The 2 groups were analyzed for 30-day postoperative complications, using multivariable logistic regression techniques to evaluate independent associations between anesthetic method and postoperative outcomes.ResultsAll Veterans Affairs patients undergoing primary TKA under general anesthesia (n = 32,363) and neuraxial anesthesia (n = 14,395) within the study period were included in this study. Following propensity score matching, multivariable analysis revealed significantly lower risks of cardiovascular (adjusted odds ratio [AOR] 0.74, 95% confidence interval [CI] 0.6-0.88, P < .001), respiratory (AOR 0.75, 95% CI 0.57-0.97, P = .03), and renal complications (AOR 0.62, 95% CI 0.4-0.9, P = .01) in patients receiving neuraxial anesthesia compared to those receiving general anesthesia. Neuraxial anesthesia was also associated with reduced hospital stay and lower odds of prolonged hospitalization (AOR 0.85, 95% CI 0.8-0.9, P < .001).ConclusionVeteran patients undergoing TKA under neuraxial anesthesia had reduced postoperative complications and decreased hospitalization stay compared to patients undergoing general anesthesia.     

Combined general-epidural anesthesia decreases the desflurane requirement for equivalent A-line ARX index in colorectal surgery

BACKGROUND: The present study used the A-line ARX index, derived from auditory evoked potential measurements, to examine the effect of epidural lidocaine on the end-tidal concentration of desflurane during general anesthesia. METHODS: Thirty ASA I-II patients scheduled for elective colorectal surgery were included and randomized, in a double-blinded fashion, to receive general anesthesia, and 15 ml of either 2% lidocaine (group GE, n=15) or normal saline (group GS, n=15) was administered epidurally with a maintenance infusion rate of 6 ml h-1. After a 10-min high-flow oxygen wash-in period, desflurane was titrated to a target A-line ARX index (AAI) of 20+/-5. RESULTS: Epidural lidocaine reduced the end-tidal concentration of desflurane required to maintain an adequate clinical effect by 42% compared to general anesthesia alone (2.6% vs. 4.5%, respectively; P<0.001). The initial mean value of AAI was 87.8 (range 78-99) in group GE and 88.13 (79-99) in group GS before general anesthesia induction, the AAI values were approximately 19.7 (15-25) in group GE and 20.2 (16-25) in group GS during anesthesia maintenance, and returned to 84.53 (77-98) in group GE and 86.87 (79-98) in group GS when the patients regained consciousness in the recovery room. No statistical difference in the AAI values was observed either before, during, or after emergence of anesthesia. No patient reported intraoperative awareness. CONCLUSIONS: Lower-than-expected concentrations of volatile anesthetics are sufficient to maintain appropriate a clinical anesthesia effect during combined general-epidural anesthesia under auditory-evoked potential monitoring.     

Postoperative analgesia in herniorrhaphy with local anesthesia and monitored anesthesia care

Summary In this study the authors evaluated the grade of acceptance and the operating conditions of unilateral primary herniorrhaphy under local anesthesia and monitored anesthesia care (MAC). The amount of pain in the immediate postoperative period was assessed and the efficacy of treatment using a popular non-opiate analgesic, magnesic metamizol, by the oral route was studied. In a period of six months 63 consecutive patients were operated on by the same surgeon using the same technique of hernia repair (Shouldice technique) with local infiltration anesthesia supplemented by MAC in the form of conscious sedation. A mixture of 300 mg of plain mepivacaine and 50 mg of plain bupivacaine was used for infiltration. A standard dose of fentanyl 0.10 mg and midazolam 2 mg was used for conscious sedation. Propofol in continuous infusion was also employed. The average dose of propofol varied from 1–3 mg/kg/h. Conscious level was assessed using a five-point sedation score. A level-3 end point was persued (closed eyes, but answer verbal orders). Pain intensity in the postoperative period was measured by the visual analogue scale (VAS) and the verbal pain scale (VPS), based on the McGill pain questionnaire. The operating conditions were excellent in all cases except in three patients. In no case conversion to general anesthesia was necessary. In the postoperative period, 5 patients (8%) never felt pain and 58 (92%) felt pain on the average 4 hours 36 minutes after the local infiltration (VAS=2.5; VPS=1.45). Of the 58 patients 49 took the first dose of oral analgesic 6 hours 40 minutes after infiltration (VAS=4; VPS=1.97). All patients were satisfied with the anesthetic-surgical technique and were ready to repeat the experience. However, when the patients took the second dose of oral analgesic 28% of them had moderate pain and 9% severe pain. Our conclusions are that local infiltration with MAC is a valid and satisfying experience for both the patient and the surgeon. Nevertheless, further attempts should be made to better the postoperative pain relief when the oral route is elected.     

中国古代麻醉术的迷失

从公元二至三世纪外科鼻祖华佗（约145-208）的“麻沸散”到1846年威廉·莫顿实施第一例乙醚麻醉,时光跨过了1700多年！这是怎样的时空转变？在17个世纪长河中,不但没有对古代中国麻醉学的任何发展,同时还失去了对“麻佛散”的一切记忆和传承,这是多么悲哀的事情！从反思这个问题的角度出发,该文从这段时期的生态环境、社会背景、宗教、中医药传承、以及西方人文理念和医学侵入等各个方面论述了中国古代麻醉术的迷失原因和后期发展,论述了近两千多年中国社会的发展和传统文化对古代麻醉医学发展的推动性与制约性,同时阐述了开放和包容的中国传统文化对现代麻醉学发展的影响。     

Thoracic epidural anesthesia for laparoscopic cholecystectomy in an elderly patient with severely impaired pulmonary function tests

Regional anesthesia for laparoscopic cholecystectomy has been reported in patients with severe respiratory disease and is a safe alternative to general anesthesia. Hemodynamic instability can occur on initiating pneumoperitoneum and the respiratory acidosis can last into the post-operative period without careful monitoring and management. This case report describes such an episode in an elderly patient with severely impaired respiratory function who was given thoracic epidural anesthesia for laparoscopic cholecystectomy.     

88岁以上老年人的手术麻醉方法与管理

目的总结88岁以上高龄患者的麻醉方法和管理体会。方法回顾性分析61例88岁以上患者的麻醉处理,采用全麻12例,硬膜外麻醉37例,静脉麻醉5例,臂丛麻醉3例,局麻4例。结果本组手术时间平均66(15～150)min,术中出血平均180(0～500)ml。1例硬膜外麻醉阻滞不全改为全身麻醉,各项生命体征平稳。硬膜外麻醉局麻药初量平均为7.3(4～11)ml,阻滞平面2例为T8,其余均控制在T10以下。所有全麻患者术毕清醒后均拔出气管导管。61例均安全度过手术期并顺利出院。结论术前准确评估和充分准备,选择恰当的麻醉方法,加强围术期监测,及时进行术中、术后并发症防治及麻醉管理,是高龄患者安全度过围术期的重要措施,可减少麻醉风险。