支撑喉镜下小儿喉乳头状瘤摘除术的麻醉管理

目的 探讨在支撑喉镜下小儿喉乳头状瘤摘除术的麻醉管理。方法 对23例喉乳头状瘤患儿在支撑喉镜下摘除肿瘤的麻醉管理进行总结分析。结果 所有无喉阻塞患儿中均一次气管插管成功;喉阻塞Ⅰ度患儿5例一次气管插管成功,另1例二次气管插管成功;喉阻塞Ⅱ度或Ⅲ患儿中2例一次气管插管成功,1例二次气管插管成功,另1例在麻醉诱导过程中出现吸气性呼吸困难并出现缺氧症状,经及时面罩加压供氧,缺氧症状缓解,即喉镜暴露声门以2%利多卡因喷喉充分表面麻醉快速气管插管且一次成功。23例患儿中无一须要气管切开,所有患儿麻醉诱导均平稳,麻醉效果满意,术后均拔管返回病房。结论 小儿喉乳头状瘤摘除术麻醉管理要点在于麻醉诱导期的气管插管,术中气道保护和术后拔除气管导管 时机的掌握。     

青少年型复发性呼吸道乳头状瘤吸割切除的麻醉方式选择

 [目的]探讨内窥镜辅助支撑喉镜下应用喉吸切钻切除青少年型复发性呼吸道乳头状瘤（JO-RRP）的麻醉方式的选择.[方法]配对比较20例JO-RRP患儿分别在静脉复合麻醉高频通气辅助呼吸和气管内插管全麻下应用内窥镜辅助支撑喉镜下喉吸切钻切除肿物;肿物的严重程度分为三级（轻1分,中2分,重3分）,评价患儿27个呼吸和消化道的解剖亚区,计算总积分并按积分分两组,比较两组同积分病例的手术时间、术后声音质量和麻醉苏醒时间变化.[结果]20例患儿进行了40次手术,相同积分的病例中,高频通气辅助呼吸或气管插管全麻下应用喉吸切钻切除JO-RRP的麻醉苏醒时间、手术时间和术后声音质量均无显著差异.前者有6例出现憋气、喉痉挛等现象,后者无1例出现.[结论]内窥镜辅助支撑喉镜下应用喉吸切钻处理JO-RRP,选择静脉复合麻高频通气辅助呼吸或气管内插管全麻均能顺利完成手术,但后者麻醉风险较少.     

喉罩的临床应用体会

目的 探讨喉罩(LM)用于全麻患者术中维持气道通气的可行性及安全性.方法 对20例患者(包括3例困难气管插管患者)在麻醉诱导后用喉镜辅助置入LM,并连续监测置入LM前后脉搏、血压变化,其中有9例术中连续行SpO2监测.结果 一次性顺利置入成功19例(包括3例困难气管插管),另1例经二次置入成功.置入LM前后脉搏、血压无明显变化(P＞0.05).有2例分别于术中出现气道梗阻及通气不良,因无SpO2监测,其中1例发生呼吸抑制、苏醒延迟.例3因头部移位后LM通气受阻,SpO2迅速下降,经及时发现处理后恢复正常.结论 LM用于手术时间较短及困难气管插管的全麻患者术中维持气道通气是可行的,但必须常规监测SpO2,有条件尚应监测PETCO2.对于手术时间长且术中需进行控制呼吸的患者,以气管插管为好,以策安全.     

GlideScope视频喉镜技术联合支气管堵塞器在胸外科手术困难气道患者单肺通气中的应用

目的探讨GlideScope视频喉镜联合盲插型支气管堵塞器在困难气道患者胸外科手术单肺通气中的应用。方法经术前评估为困难气道的患者18例,于慢诱导保留自主呼吸情况下采用GlideScope视频喉镜暴露声门插入单腔气管导管,加深麻醉之后再经单腔气管导管盲探插入盲插型支气管堵塞器,经纤支镜定位后完成单肺通气。观察记录声门暴露满意度、气管插管一次成功率、置入支气管堵塞器一次成功率及操作完成时间、单肺通气满意度。结果 GlideScope视频喉镜声门暴露满意度优16例(88.9%)、良2例(11.1%);气管内插管和置入支气管堵塞器均一次成功(100%);单肺通气满意度优16例(88.9%)、良2例(11.1%);置入支气管堵塞器操作完成时间3.8 min(2.8~4.4 min);术中血压、心率平稳,无低氧血症;无插管损伤及术后声嘶。所有患者各时点的血流动力学平稳、血氧饱和度正常。均一次气管插管成功,然后完成支气管堵塞器插管进行单肺通气。结论 GlideScope视频喉镜联合支气管堵塞器应用于困难气道病人开胸手术单肺通气安全有效。     

青少年型复发性呼吸道乳头状瘤吸割切除的麻醉方式选择

[目的]探讨内窥镜辅助支撑喉镜下应用喉吸切钻切除青少年型复发性呼吸道乳头状瘤（JO-RRP）的麻醉方式的选择.[方法]配对比较20例JO-RRP患儿分别在静脉复合麻醉高频通气辅助呼吸和气管内插管全麻下应用内窥镜辅助支撑喉镜下喉吸切钻切除肿物;肿物的严重程度分为三级（轻1分,中2分,重3分）,评价患儿27个呼吸和消化道的解剖亚区,计算总积分并按积分分两组,比较两组同积分病例的手术时间、术后声音质量和麻醉苏醒时间变化.[结果]20例患儿进行了40次手术,相同积分的病例中,高频通气辅助呼吸或气管插管全麻下应用喉吸切钻切除JO-RRP的麻醉苏醒时间、手术时间和术后声音质量均无显著差异.前者有6例出现憋气、喉痉挛等现象,后者无1例出现.[结论]内窥镜辅助支撑喉镜下应用喉吸切钻处理JO-RRP,选择静脉复合麻高频通气辅助呼吸或气管内插管全麻均能顺利完成手术,但后者麻醉风险较少.     

咽喉表面麻醉慢诱导经鼻插管在睡眠呼吸暂停综合征手术麻醉中的观察

目的：探求合理安全的麻醉诱导和围术期的麻醉管理，降低阻塞性睡眠呼吸暂停低通气综合征（OSAHS）围术期的麻醉风险及病死率。方法：OSAHS患者30例，采用丁卡因表麻＋镇静健忘经鼻腔气管插管全麻，给予适度镇静催眠药物使患者嗜睡，保留自主呼吸，能按指令主动配合气管插管。先行盲插，失败后喉镜明视，估计插管困难直接用纤支镜引导，病情重者行气管切开。术后拔管指征：患者意识完全清醒，吸空气〉15min，SpO2〉93％，吸净气管、口腔内分泌物后拔管。结果：30例经鼻气管插管，19例盲插成功，9例明视，1例纤支镜引导，1例术前气管切开。诱导期有轻度呼吸抑制，经指令深呼吸和面罩吸氧后，SpO2迅速〉93％，无1例诱导期发生险情。25例术后30min内拔管，4例带管回病房于术后（6±2）h拔管，1例术后气管切开。结论：慢诱导保留患者自主呼吸，为困难插管提供了充裕的插管时间，术后严格掌握拔管指征是预防OSAHS围术期死亡的有效措施。     

不同全身麻醉方法对小儿全麻喉痉挛发生率的影响

目的:观察不同全身麻醉方法在预防小儿全麻并发症喉痉挛中的作用,降低其喉痉挛的发生率。方法:选择1～3岁小儿择期下腹部及四肢短小手术全身麻醉180例,随机分为观察组即气管插管全麻组(A组)和对照组即非气管插管全麻组(B组),每组各90例。A、B2组均静注0.2mg/kg咪达唑仑入室,A组行全麻气管插管机控通气、B组以氯胺酮复合全麻不行气管插管保留自主呼吸,观察并记录2组手术麻醉过程中喉痉挛的发生情况。结果:A组麻醉过程中出现4例喉痉挛,其中2例轻度、2例中度与B组发生喉痉挛6例,其中2例轻度、2例中度、2例重度比,其喉痉挛发生率和重度喉痉挛发生率明显低,差异有显著性(P<0.05)。结论:气管插管全麻组(A组)能有效地降低小儿手术麻醉过程中的喉痉挛的发生率,提高小儿全麻醉的安全性。     

保留呼吸慢诱导经鼻盲探气管插管在颌面外科手术中的应用

目的探讨保留呼吸慢诱导经鼻盲探插管在颌面外科手术困难气管插管中的应用效果。方法选择ASAⅠ～Ⅱ级择期行颌面外科手术的患者47例,术前预测评估为困难气道,年龄11～60岁,采用保留呼吸慢诱导方法经鼻盲探气管插管,观察记录插管次数和血流动力学变化。结果47例中30例一次性插管成功,9例经改变头位,旋转导管方向后试插3次进入气管内,8例能置入喉镜者经口明视下将导管插入气管,插管过程中血流动力学稳定,术后患者对插管过程无记忆,未见与插管有关的并发症。结论保留呼吸慢诱导经鼻盲探气管插管用于颌面外科困难气管插管病人,在插管期间患者处于浅睡眠状态,保留自主呼吸,从而解决快速诱导后发生插管困难以及应用肌松药后气道阻塞的危险后果,而且心血管不良反应小,术后无记忆,插管成功率高,是一种安全有效、并发症少的麻醉方法。     

插管保留自主呼吸的复合麻醉在小儿唇腭裂手术中的可行性研究

目的:探讨插管保留自主呼吸的复合麻醉在小儿唇腭裂手术中的可行性。方法:随机选择唇腭裂残疾患儿80例,分A、B两组麻醉。A组以氯胺酮诱导,七氟醚吸入等静吸复合全麻的方法。插管用肌松药,术中控制呼吸。B组采用以七氟醚诱导维持,另加局部麻醉,辅以少量芬太尼并肛纳对乙酰氨基酚栓等联合镇痛,插管不用肌松药,保留自主呼吸。结果:B组患儿完全清醒和气管拨管时间明显早于A组(P0.05),且该组术后并发症的发生率也明显低于A组(P0.01)。结论:插管保留自主呼吸的复合麻醉在小儿唇腭裂手术中安全可靠,术中血流动力学稳定。术毕患儿清醒快,气管导管拔除早,术后并发症少。     

七氟醚复合笑气吸入联合气管内表面麻醉用于小儿气道异物取出术25例体会

小儿气管及支气管异物是临床常见急症,因异物及分泌物阻塞气道,患儿术前多伴有低氧血症,而小儿的呼吸、循环代偿能力较差,置入气管镜的强烈刺激易导致呛咳、屏气、反射性喉痉挛、呼吸停止甚至心跳骤停,且在麻醉诱导后异物取出期间无法行气管内插管辅助或控制呼吸。因此,小儿气管支气管异物取出术麻醉的关键是保持患儿的自主呼吸以保证充分氧供,     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…