神经阻滞联合喉罩保留自主呼吸全麻在小儿断指再植手术中的应用效果

目的 探讨神经阻滞联合喉罩保留自主呼吸全麻与神经阻滞联合基础麻醉在小儿断指再植术中的应用效果.方法 选择2013年8月-2016年8月行断指再植手术的患儿60例,根据麻醉方法分为观察组和对照组,每组30例.观察组实行神经阻滞联合喉罩保留自主呼吸全麻方案,对照组采用神经阻滞联合基础麻醉方案.记录2组麻醉前、插入气管导管或置入喉罩时、麻醉后心率、平均动脉压(MAP)和血氧饱和度(SpO2),观察2组疼痛情况和术后苏醒时间及不良反应情况.结果 观察组置入喉罩和麻醉后心率高于麻醉前,对照组插入气管导管和麻醉后HR、MAP均高于麻醉前(P＜0.05);观察组置入喉罩和麻醉后心率、MAP低于对照组(P＜0.05);观察组视觉模拟疼痛评分和不良反应发生率低于对照组,苏醒时间和不良反应消失时间短于对照组(P＜0.05).结论 神经阻滞联合喉罩保留自主呼吸全麻应用于断指再植术中镇痛效果较好,术后不良反应消失快.     

喉罩保留自主呼吸全麻联合臂丛神经阻滞在小儿上肢手术中的应用效果

目的 探讨喉罩保留自主呼吸全麻联合臂丛神经阻滞在小儿上肢手术中的应用效果.方法 选择2014年8月-2016年10月收治的行上肢手术的患儿90例,根据麻醉方法分为联合组、喉罩全麻组与气管插管全麻组,每组30例.联合组给予喉罩保留自主呼吸全麻联合臂丛神经阻滞,喉罩全麻组和气管插管全麻组分别给予喉罩全麻和气管插管全麻.比较3组术前(T0)、插入气管导管或置入喉罩即刻(T1)、切皮时(T2)、手术开始后0.5h(T3)、术毕时(T4)血流动力学指标、麻醉起效时间、麻醉用药量及并发症发生情况.结果 联合组、喉罩全麻组T1、T2、T4心率及T1 ～4平均动脉压均明显低于气管插管全麻组(P＜0.05).联合组苏醒时间均短于气管插管全麻组和喉罩全麻组,联合组疼痛出现时间晚于气管插管全麻组与喉罩全麻组,丙泊酚、瑞芬太尼用量少于喉罩全麻组与气管插管全麻组(P＜0.05).联合组和喉罩全麻组并发症发生率低于气管插管全麻组(P＜0.05).结论 喉罩保留自主呼吸全麻联合臂丛神经阻滞具有血流动力学稳定、苏醒快、麻醉药物用量少、并发症少等特点.     

喉罩全麻联合神经刺激仪辅助定位下臂丛神经阻滞在小儿上肢手术中的应用

目的观察与单纯气管插管全麻方法作比较喉罩全麻联合神经刺激仪辅助定位下臂丛神经阻滞在小儿上肢手术中的应用利弊,为小儿麻醉方法提供参考。方法选择美国麻醉师协会(ASA)评分Ⅰ-Ⅱ级,上肢手术患儿46例,随机分为两组:喉罩复合神经阻滞组(L组,23例)和气管插管组(T组,23例)。分别记录两组患儿麻醉前(T0)、插喉罩或气管导管时(T1)、拔喉罩或气管导管时(T2)、的MAP、HR、Sp02;并记录两组患儿术后疼痛、停药后苏醒时间、苏醒时躁动及术后嗜睡发生情况。结果两组患儿麻醉前(T0)的MAP、HR、Sp02值相比较差异无统计学意义(P>0.05);而在插喉罩或气管导管时(T1)、拔喉罩或气管导管时(T2),L组的MAP、HR低于T组,差异有统计学意义(P<0.05),L组的术后疼痛评分(VAS)低于T组,差异有统计学意义(P<0.05),停药后苏醒时间短于T组,差异有统计学意义(P<0.05),苏醒时躁动及术后嗜睡发生率明显低于T组,差异有统计学意义(P<0.05)。结论喉罩全麻联合神经刺激仪辅助定位下臂丛神经阻滞在小儿上肢手术中循环系统稳定,术后疼痛明显降低,苏醒质量高,不良反应小,值得临床推广。     

小儿上肢手术应用喉罩保留自主呼吸全麻联合臂丛神经阻滞的价值分析

目的:探讨小儿上肢手术应用喉罩保留自主呼吸全麻联合臂丛神经阻滞的价值。方法:随机将某院2017年5月～2019年1月小儿上肢手术治疗的100例患儿分为喉罩组和联合组各50例,喉罩组进行喉罩保留自主呼吸全麻,联合组进行喉罩保留自主呼吸全麻联合臂丛神经阻滞,比较效果。结果:联合组各时点RR、HR、SPO_2的比较无统计学差异(P0.05);喉罩组气管插管后即刻至手术开始后15min(A_1～A_3时点)的HR显著高于麻醉诱导前(A_0时点),且与联合组同时点也存在明显差异(P0.05);联合组苏醒时间短于喉罩组,丙泊酚以及瑞芬太尼的用量、并发症发生率少于喉罩组,差异具有统计学意义(P0.05)。结论:喉罩保留自主呼吸全麻联合臂丛神经阻滞用于小儿手术麻醉的效果良好.     

超声引导坐骨神经阻滞复合喉罩全麻对胫骨粉碎性骨折患者的影响

目的:探讨超声引导坐骨神经阻滞复合喉罩全麻对胫骨粉碎性骨折患者各时间点血压(BP)、心率(HR)变化及术后视觉模拟量表(VAS)评分的影响.方法:选取我院胫骨粉碎性骨折患者82例(2018-01 ～2019-02),依据随机数字表法分组,各41例.对照组采用喉罩全麻,研究组采用超声引导坐骨神经阻滞复合喉罩全麻.比较两组麻醉前(T0)、置入喉罩时(T1)、切皮时(T2)、取出喉罩时(T3)平均动脉压(MAP)、HR、术后1h、6h、12h VAS评分及丙泊酚用量、苏醒时间.结果:To两组MAP、HR比较无显著差异(P＞0.05),T1、T2、T3研究组MAP、HR低于对照组(P＜0.05),对照组波动较大,研究组相对平稳;术后1h两组VAS评分无明显差异(P＞0.05),术后6h、12h VAS评分研究组低于对照组(P＜0.05);与对照组比较,研究组丙泊酚用量较少,苏醒时间较短(P＜0.05).结论:超声引导坐骨神经阻滞复合喉罩全麻应用于胫骨粉碎性骨折患者,可降低全麻药物用量,稳定血流动力学,促进意识恢复,减轻术后疼痛.     

老年患者胃造瘘术中区域阻滞复合保留自主呼吸全身麻醉的应用对麻醉时间、苏醒时间的影响

目的 探讨老年患者胃造瘘术中区域阻滞复合保留自主呼吸全身麻醉的应用对麻醉时间、苏醒时间的影响.方法 选取我院在2019年7月-2020年7月收治的胃造瘘术患者60例,依据不同麻醉方式分为两组,对照组应用保留自主呼吸全麻,研究组应用区域阻滞复合保留自主呼吸全麻.结果 两组不同时间点下的相关血流动力学指标HR水平及MAP水平均无显著差异(P均>0.05).对照组术中瑞芬太尼的平均用量为(1013.1±10.6)μg,研究组术中瑞芬太尼的平均用量为(689.9±4.5)μg,研究组术中的瑞芬太尼的平均用量显著比对照组低(T=16.121,P<0.05).研究组术后不同时间点下的VAS评分均比对照组低(P<0.05).结论 老年患者胃造瘘术中使用区域阻滞复合保留自主呼吸全麻,可显著延长麻醉时间,缩短苏醒时间,降低患者术后的疼痛情况.     

老年患者胃造瘘术中区域阻滞复合保留自主呼吸全身麻醉的应用对麻醉时间、苏醒时间的影响

目的 探讨老年患者胃造瘘术中区域阻滞复合保留自主呼吸全身麻醉的应用对麻醉时间、苏醒时间的影响.方法 选取我院在2019年7月-2020年7月收治的胃造瘘术患者60例,依据不同麻醉方式分为两组,对照组应用保留自主呼吸全麻,研究组应用区域阻滞复合保留自主呼吸全麻.结果 两组不同时间点下的相关血流动力学指标HR水平及MAP水平均无显著差异(P均>0.05).对照组术中瑞芬太尼的平均用量为(1013.1±10.6)μg,研究组术中瑞芬太尼的平均用量为(689.9±4.5)μg,研究组术中的瑞芬太尼的平均用量显著比对照组低(T=16.121,P<0.05).研究组术后不同时间点下的VAS评分均比对照组低(P<0.05).结论 老年患者胃造瘘术中使用区域阻滞复合保留自主呼吸全麻,可显著延长麻醉时间,缩短苏醒时间,降低患者术后的疼痛情况.     

七氟醚联合supreme喉罩全麻在老年患者粗隆间骨折手术中的应用

目的探讨七氟醚联合supreme喉罩全身麻醉在老年患者粗隆间骨折手术中的应用。方法择期全身麻醉下行粗隆间骨折切开复位内固定术的老年患者40例,随机分为七氟醚联合supreme喉罩组（S组）和丙泊酚联合supreme喉罩组（P组）,各20例。观察两组麻醉诱导前（T0）、插入喉罩前（T1）、插入喉罩后即刻（T2）、切皮即刻（T3）、拔出喉罩前（T4）、拔出喉罩后即刻（T5）MAP、HR。记录清醒时间（停止全麻药至呼之睁眼时间）、拔出喉罩时间（停止全麻药至拔出时间）及在麻醉苏醒室观察并记录术后2 h的恶心、呕吐、躁动、过度镇静等不良反应。结果与T0比较,T1、T2时S组与P组MAP均降低（P〈0.05）,P组MAP降低程度大于S组（P〈0.05）;与S组比较,P组T1、T2时HR减慢（P〈0.05）。P组清醒时间和拔出喉罩时间长于S组（P〈0.05）,S组恶心、呕吐、躁动发生率明显高于P组（P〈0.05）,P组易引起过度镇静,两组间差异有统计学意义（P〈0.05）。结论七氟醚联合supreme喉罩全身麻醉与丙泊酚联合supreme喉罩全身麻醉均可安全用于老年粗隆间骨折手术,但是七氟醚联合supreme喉罩全身麻醉术中血流动力学更平稳,苏醒更迅速,更适合于老年患者全身麻醉。     

两种不同麻醉方法对老年全髋关节置换术患者术中和术后相关指标影响的对比研究

目的 对比喉罩全麻复合腰丛-坐骨神经阻滞与单纯喉罩全麻对全髋关节置换手术期间和术后相关指标,探索老年患者全髋关节置换术的最优麻醉方案.方法 选取我院因股骨头或股骨颈骨折拟行全髋关节置换术治疗的65岁以上老年患者60例,随机分为喉罩全麻复合腰丛-坐骨神经阻滞组(A组)和单纯喉罩全麻组(B组).对比两组患者术中和术后相关指标;记录两组患者手术中丙泊酚的用量、出血量、术后呼吸系统并发症、术后苏醒延迟、术后恶心呕吐(PONV)、入ICU的例数.结果 A组丙泊酚的用量(320±20)mg低于B组(450±30)mg,A组苏醒时间(16.2±2.2)min早于B组(23.5±3.2)min,A组术后恶心呕吐(PONV)例数5例少于B组12例,差异均有统计学意义(P<0.05).结论 研究发现喉罩全麻复合腰从-坐骨神经阻滞麻醉效果优于单纯喉罩全麻,值得推广应用.     

超声引导下腹横肌平面阻滞联合喉罩全麻在老年患者腹股沟疝修补术中的应用

目的:探讨超声引导下腹横肌平面阻滞联合喉罩全麻在老年患者腹股沟疝修补术中的应用效果。方法:择期行腹股沟疝修补术的老年患者40例,随机分为两组:TAPB组(T组)和对照组(C组)。麻醉诱导后置入喉罩,在超声引导下行术侧TAPB,分别注入0.33%罗哌卡因20ml(T组)或等容量生理盐水(C组)。记录两组患者苏醒时间、拔除喉罩时间、不良反应及术后2 h(T1)、6 h(T2)、12 h(T3)、24 h(T4)的VAS疼痛评分。结果:与C组比较,T组苏醒时间、拔喉罩时间明显缩短;躁动发生率明显降低;T1～T3时VAS评分降低(P0.05)。结论:超声引导下腹横肌平面阻滞联合喉罩全麻用于老年患者腹股沟疝修补术可缩短复苏时间提高复苏质量,减轻患者术后疼痛。     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg x kg(-1)) or i.p. (50 mg x kg(-1)) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) 1 x h(-1) x kg(-1) in the male rat and 10.6 (95% CI: 7.5, 15.0) 1 x h(-1) x kg(-1) in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was approximately 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p < 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p < 0.001) in plasma obtained from the male (8.8 +/- 2.0%) compared with the female rat (11.7 +/- 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Hyperkalaemia in patients in hospital

A survey of all laboratory blood specimens with a plasma potassium concentration greater than or equal to 5.5 mmol/L was conducted over a three month period. Of 331 specimens with hyperkalaemia, 71 were excluded because the specimens was haemolysed, old or contaminated. The laboratory served a population of 348,561 and during this time measured the plasma potassium on 25,016 occasions. Sixty-six outpatients and 20 neonates were not evaluated. The survey was undertaken on 86 of 102 inpatients (46 males), 48 of whom were over 66 years of age. Fifty-seven patients were admitted under a medical service and 29 under a surgical service. Fifty-nine had a single episode of hyperkalaemia. Thirty-two underwent a surgical procedure. The commonest contributing factor was impaired renal function which was present in 71 (83%) patients. Although a definitive causative role for drugs could be identified in only five patients, in 52 (60%) patients drugs were a contributing factor (potassium supplements 24, ACE inhibitors 16, nonsteroidal antiinflammatory drugs 12). Thirty-five of the 86 (41%) patients died during their hospital admission. Nineteen of the 35 deaths occurred within three days of the hyperkalaemia being recorded. A normal plasma potassium was eventually documented in 50 of the 86 patients. Of the remaining 36 patients, 25 (69%) subsequently died. In general the treatment of patients with hyperkalaemia focused on identifying and treating the underlying cause. Hyperkalaemia must always be considered seriously and regard given to the overall clinical status of the patient, with particular attention to drug therapy, renal and cardiac function, acid base status and the possibility of sepsis.