术前美托洛尔或咪唑安定对全麻诱导丙泊酚用量和血流动力学的影响

目的观察术前口服美托洛尔和肌注咪唑安定对麻醉诱导丙泊酚用量及血流动力学的影响。方法拟全麻行择期手术病人（ASAI-Ⅱ级）60例，随机分为美托洛尔组（Met组）、咪唑安定组（Mid组）和苯巴比妥钠组（Phe组）各20例，三组分别口服美托洛尔50mg、肌注咪唑安定0．04mg／kg、肌注苯巴比妥钠0．1g。以30mg·kg^-1·h^-1恒速推注丙泊酚直至病人入睡，随后静注芬太尼3μg／k，维库溴铵0．1mg／kg，辅助通气3min后进行气管插管。记录丙泊酚用量、入室、诱导前后、插管前后平均动脉压（MAP）和心率（HR）。结果Met组、Mid组、Phe组丙泊酚用量分别为1．36mg／kg±0．22mg／kg、1．40mg／kg±0．08mg／kg、1．61mg／kg±0．23mg／kg，与Phe组相比，Met组和Mid组丙泊酚用量减少（P〈0．01）。血流动力学变化：插管后组间对比Met组和Mid组MAP较Phe组低（P〈0．01）；插管后Mid组和Phe组HR基础值明显升高（P〈0．01或P〈0．05），而Met组无明显差异（P〉0．05）；插管后组间对比Met组和Mid组HR均比Phe组慢（P〈0．01）。结论术前口服美托洛尔或肌注咪唑安定与肌注苯巴比妥钠相比，均能减少丙泊酚诱导用量，但美托洛尔能更有效抑制血流动力学波动。     

Intramuscular dexmedetomidine premedication—an alternative to midazolam-fentanyl-combination in elective hysterectomy?

Sedation, anxiolysis, intubation responses and fentanyl anaesthetic requirements were investigated in a double-blind, randomized study in twenty ASA I-II elective hysterectomy patients. Ten patients received dexmedetomidine 2.5 μg kg^-1 i.m. 60 min before induction and saline placebo i.v. 2 min prior to induction (= DP group). Ten patients received midazolam 0.08 mg kg^-1 i.m. 60 min and fentanyl 1.5 μg kg^-1 i.v. (= MF group) 2 min before induction of anaesthesia with thiopentone 4 mg kg^-1. Anaesthesia was maintained with 70% nitrous oxide in oxygen and with fentanyl 2 μg kg^-1 i.v. increments according to predetermined criteria. Both premedications induced sedation ( P < 0.01 in both groups) and anxiolysis ( P < 0.01 in DP vs <0.05 in MF group) without any differences between the groups. Haemodynamic changes following tracheal intubation did not significantly differ between the groups. Intraoperatively systolic and diastolic arterial pressure were 15% and 13% lower in DP group ( P < 0.01 and P < 0.05 for drug effect), the mean heart rate was approximately 9 beats min^-1 lower in DP group (n.s.). Fentanyl was required more often in MF group: median 3.5 (QD 1.5) vs. 2.5 (QD 0.5) times in DP group ( P < 0.05), the total amount being 57% smaller in DP group: 0.03 (QD 0.01) vs. 0.07 (QD 0.02) μg kg^-1 min^-1 ( P < 0.05). Postoperative course and analgesic requirements were similar in both groups. Dexmedetomidine premedication may offer an alternative to current anaesthesia practice in elective hysterectomy.     

长托宁用于喉罩全麻术前用药的临床观察

目的研究选择性M受体拮抗剂长托宁用于喉罩全麻术前用药的临床效果。方法选取ASAⅠ～Ⅱ级行择期腹腔镜下胆囊切除术患者90例，随机分为3组（每组30例）：对照组（A组），术前不应用任何抗胆能药；阿托品组（B组）和长托宁组（C组），麻醉诱导前30min肌肉注射阿托品或长托宁0．01mg／kg，麻醉诱导后置入标准型喉罩后接麻醉机行机械通气；分别记录气管插管后5min（T1）、气管插管后30min（T2）、气管拨管前（T3）气道内分泌物量以及心率变化。结果在T1、T2、T3三个时点，B组和C组患者的气道分泌物明显少于A组（P〈0．05）；B组在T1时间点的心率明显高于A组与C组（P〈0．05）。结论长托宁用于喉罩全麻术前用药临床效果较好。     

可乐定对气管拔管患者应激反应的影响

目的探讨可乐定对气管拔管应激反应的预防作用.方法22例气管插管全麻手术病人,随机分为对照组和可乐定组(每组11例).可乐定组病人于麻醉前 60 min 加服可乐定 5 μg*kg-1,其它麻醉前用药两组病人相同.分别在麻醉前、拔管前、拔管后1、2、5、10 min 采集动脉血标本,测定血浆儿茶酚胺、血管紧张素Ⅱ、皮质醇、血糖、血乳酸浓度,做血气分析,计录各时点的血流动力学参数.结果两组病人气管拔管期间血浆儿茶酚胺、皮质醇、血糖、血乳酸浓度均明显增高,可乐定组增高程度明显低于对照组.结论麻醉前服用可乐定能明显减轻气管拔管引起的应激反应.     

Arterial Oxygen Tension Changes in Elderly Patients Undergoing Upper Gastrointestinal Endoscopy

Changes in arterial oxygen and carbon dioxide tensions were determined in 56 patients, mean age 67 years, during elective upper gastrointestinal endoscopy with standard or pediatric instruments. All the patients received intravenous atropine, diazepam, and either meperidine or fentanyl premedication. There was an immediate and significant fall in PaO₂ levels (20.3%–16.5%) after both narcotic injections. The oxygen tension remained significantly depressed during the endoscopic examinations except in the group receiving fentanyl premedication and examined with the narrow pediatric instrument. To minimize hypoxemia in elderly patients during endoscopy, a short-acting narcotic or, preferably, no narcotic at all should be used in the premedication, and a narrow, pediatric instrument be used.     

盐酸戊乙奎醚作为冠心病患者术前用药的安全性评价

目的对比评价盐酸戊乙奎醚与东莨菪碱作为冠心病患者术前用药的安全性。方法ASAⅡ~Ⅲ级全麻下行非体外循环冠状动脉搭桥术的冠心病患者40例,随机分为两组,每组20例,P组:术前静注盐酸戊乙奎醚0.01mg/kg,S组:术前静注东莨菪碱0.01mg/kg。分别记录给药前(T0),给药后5min(T1)、10min(T2)、30min(T3)的口干VAS评分;T0、T1、T2、T3、60min(T4)、90min(T5)的唾液分泌量和HR、SBP、DBP、SpO2、RPP。结果口干程度的VAS评分两组在各时点差异无统计学意义(P>0.05)。两组在T1、T2、T3的唾液分泌量与T0比明显减少,与S组相比,P组在T4、T5的唾液分泌量仍显著减少(P<0.05)。P组给药后各时点与给药前比较,HR无显著变化(P>0.05),与P组比较,S组在给药后的HR、RPP显著增加(P<0.05)。结论盐酸戊乙奎醚作为冠心病患者术前用药优于东莨菪碱,对心率影响小,效果确切、安全。     

Oral transmucosal fentanyl citrate as an anaesthetic premedication when dosed to an opioid effect total opioid consumption

Thirty min prior to anaesthetic induction for surgery, children aged 4–12 years old were given a 10 μg·kg⁻¹ oral transmucosal fentanyl citrate (OTFC) and were instructed to suck the OTFC until pruritus appeared (Group 2) or until the entire dose was consumed (Group 1). Sedation, apprehension and cooperation scores were rated, and vital signs including oxygen saturation were monitored until anaesthetic induction. The results showed that pruritus was present in 76% of children; however; in all but one child, it occurred after the OTFC had been completely consumed. There were no significant changes in oxygen saturation, but respiratory rate decreased from 19.6±1.7 to 18.4±1.3. Activity decreased significantly; however, cooperation and apprehension did not change. The conclusion was that pruritus cannot be used as an endpoint for OTFC effectiveness; however, OTFC dosed at 10 μg·kg⁻¹ is effective in providing sedation without causing clinically significant changes in vital signs or oxygen saturation.