不同液体术前急性高容量血液稀释对深静脉血栓病人血液流变学的影响

Objective To investigate the effects of acute hypervolemic hemodilution (AHH) with different fluids on blood rheology in patients with deep vein (femoral and iliac) thrombosis. Methods Thirty ASA I or II patients aged 40-64 yr who had developed deep vein thrombosis in 48 h and were scheduled for embolectomy were randomly divided into 3 groups ( n = 10 each) ; group I normal saline (NS) ; group II 6 % HES 200/0.5 ( HES) ; group IE gelofusine (GEL). AHH was performed with normal saline, 6% HES or gelofusine infusion at 20 ml·kg-1 ·h-1 for 40 min. MAP, HR and SpO2 were monitored. Blood loss, volume of blood transfusion and fluid infused and urine output during operation were recorded. Anesthesia was induced with fentanyl 3-5 fig/kg, etomidate 0.15-0.30 mg/kg, propofol 1-2 mg/kg and succinylcholine 1-2 mg/kg and maintained with 2% isoflurane and propofol infusion at 5-8 mg·kg-1·h-1 and intermittent iv boluses of vecuronium. The patients were mechanically ventilated (VT 8 ml/kg, RR 12 bpm). PaO2 and PaCO2 were maintained within normal range. Venous blood samples were obtained before and after AHH for measurement of hematocrit (Hct), whole blood viscocity (WBV) at low or high shear rates, plasma viscosity, RBC aggregation and RBC deformation. RBC aggregation index and RBC deformation index were calculated. Results MAP and HR were stable in all patients. The amount of blood transfusion and fluid infused was significantly less in group HES and GEL than in group NS. The WBV at low or high shear rates in group HES and GEL, Hct in all 3 groups and RBC aggregation index in group HES were significantly decreased after AHH, but the RBC deformation index was significantly increased in group HES. Conclusion Colloid is better than crystalloid and HES is better than gelofusine in improving intraoperative hypercoagulability and sluggish blood flow.     

不同液体术前急性高容量血液稀释对深静脉血栓病人血液流变学的影响

Objective To investigate the effects of acute hypervolemic hemodilution (AHH) with different fluids on blood rheology in patients with deep vein (femoral and iliac) thrombosis. Methods Thirty ASA I or II patients aged 40-64 yr who had developed deep vein thrombosis in 48 h and were scheduled for embolectomy were randomly divided into 3 groups ( n = 10 each) ; group I normal saline (NS) ; group II 6 % HES 200/0.5 ( HES) ; group IE gelofusine (GEL). AHH was performed with normal saline, 6% HES or gelofusine infusion at 20 ml·kg-1 ·h-1 for 40 min. MAP, HR and SpO2 were monitored. Blood loss, volume of blood transfusion and fluid infused and urine output during operation were recorded. Anesthesia was induced with fentanyl 3-5 fig/kg, etomidate 0.15-0.30 mg/kg, propofol 1-2 mg/kg and succinylcholine 1-2 mg/kg and maintained with 2% isoflurane and propofol infusion at 5-8 mg·kg-1·h-1 and intermittent iv boluses of vecuronium. The patients were mechanically ventilated (VT 8 ml/kg, RR 12 bpm). PaO2 and PaCO2 were maintained within normal range. Venous blood samples were obtained before and after AHH for measurement of hematocrit (Hct), whole blood viscocity (WBV) at low or high shear rates, plasma viscosity, RBC aggregation and RBC deformation. RBC aggregation index and RBC deformation index were calculated. Results MAP and HR were stable in all patients. The amount of blood transfusion and fluid infused was significantly less in group HES and GEL than in group NS. The WBV at low or high shear rates in group HES and GEL, Hct in all 3 groups and RBC aggregation index in group HES were significantly decreased after AHH, but the RBC deformation index was significantly increased in group HES. Conclusion Colloid is better than crystalloid and HES is better than gelofusine in improving intraoperative hypercoagulability and sluggish blood flow.     

简易硬膜外穿刺模型在麻醉教学中的应用

在目前的麻醉教学中,硬膜外麻醉是讲课的重要章节,而实际操作则是实习重点,但由于临床操作危险性大,学生几乎没有在患者身上实习的可能,因此也就体会不到穿刺过程中经过各层的感觉及确定硬膜外腔所做的各项试验,单纯从理论讲     

保障临床医学专业硕士学位研究生临床轮转质量的策略

专业学位是现代高等教育发展的产物,它和学术学位处于同一层次。我国于1998年开始实行医学专业学位教育。在教学实践工作中作者发现临床轮转质量是影响专业学位培养质量的一个重要环节。师资不足不均、轮转科室的教师责任心不强、学生本科基础薄弱、部分师生对轮转必要性认识不足、管理部门不能有效合理地支配师资资源及考核机制不健全等是影响临床轮转质量的重要因素。定期规范化培训,增强导师的责任心、成立二级学科的研究生培养指导工作小组、为学生制定明确的轮转培养计划、制定导师考核标准等策略是保证临床轮转质量的保障。     

全麻开胸术中彩超检测膈肌厚度对呼吸动力学的评价

目的为了探讨膈肌厚度与呼吸功能的关系,对全麻开胸患者术中进行膈肌厚度检测并评价其呼吸动力学参数。方法选择110例肺叶切除手术病例在开胸术中采取直视下彩超测量膈肌厚度,术前后检测呼吸动力学指标进行对照研究。结果膈肌厚度在4 mm组和5 mm组的各项肺功能指标均优于膈肌小于3 mm组和大于6 mm组的病例,5 mm组的肺功能达到最佳,大于6 mm组最差(P<0.05)。结论膈肌厚度是影响呼吸功能的重要因素,尤其在肺脏功能受到损害条件下是评价呼吸动力泵代偿能力的参考依据。     

围手术期超容血液稀释对机体内环境影响

目的:探讨术前用羟乙基淀粉行急性超容血液稀释对胃肠择期手术病人内环境的影响。方法:选择90例ASA~级的择期胃肠手术病人,随机等分成3组:H组(贺斯组)、B组(输血组)和R组(对照组),3组病人均采用静吸复合全麻。H组和B组分别用贺斯、血液术前扩容。结果:13组患者AHH前后,Na 、Ca2 、K 、Cl-均在正常范围之内;H组和R组血液稀释后的pH值较稀释前降低,但实际差别很小,无临床意义。23组患者AHH前后血液动力学MAP,CVP,HR,HCT无明显变化。结论:1急性超容性血液稀释不影响机体内环境的稳定。2本研究证实新一代人工胶体羟乙基淀粉液(贺斯6%HES 200/0.5),扩容效果和维持时间同血液相似,且优于晶体液,能有效维持循环稳定,是一种简单可行、安全有效的血液保护方法,值得临床推广应用。     

脊麻硬膜外复合麻醉用于剖宫产时脊麻左旋布比卡因剂量的探讨

脊麻硬膜外复合麻醉(SECA)用于剖宫产时脊麻用药各家报道不一,本文比较三种不同剂量0.5%A等比重左旋布比卡因脊麻与硬膜外利多卡因复合以求左旋布比卡因的适合剂量.     

射频热凝术联合硬膜外阻滞治疗腰椎间盘突出症的临床疗效观察

目的:观察X线引导下射频热凝术联合硬膜外阻滞治疗腰椎间盘突出症(Lumbar Disc herniation,LDH)的临床疗效,并观察在射频热凝术基础上,进行硬膜外前间隙阻滞与硬膜外后间隙阻滞治疗LDH的效果比较。方法:LDH患者60例,均分为三组:A组行单纯射频热凝术;B组射频热凝术联合硬膜外后间隙阻滞治疗;C组射频热凝术联合硬膜外前间隙阻滞治疗。术前,术后3天、2周、3个月、6个月测定疼痛视觉模拟评分(VAS),观察临床疗效及不良反应。结果:三组患者术后VAS评分较术前均明显降低,有统计学差异(P<0.05)。C组术后3d、2周、3个月、6个月VAS评分较A、B两组降低更明显(P<0.05),B组效果也优于A组(P<0.05)。A组术后2周、3个月、6个月优良率分别为:16/20、15/20、14/20。B组术后2周、3个月、6个月优良率分别为18/20、17/20、16/20。C组术后2周、3个月、6个月优良率分别为20/20、19/20、18/20。C组术后2周、3个月、6个月优良率均较A组与B组高。治疗后三组患者均无严重不良反应发生。结论:X线引导下射频热凝术联合硬膜外前后间隙阻滞治疗LDH效果较单纯射频热凝术好,尤其射频热凝术联合硬膜外前间隙阻滞效果更佳,值得临床推广应用。     

剖胸术中控制肺膨胀度的低通气策略

目的:为了给胸外科开胸手术提供开阔的术野,探讨了术中控制肺膨胀度采取低潮气量通气技术的临床可行性.方法:对90例肺切除病例依据肺膨胀度80%,50%和30%随机分为3组,在麻醉术中设计低潮气量通气模式,在手术进行0min,30min,60min,90min和120min各时段监测SaO2%和ETCO2,并记录数据.设置...     

丙泊酚用于胃镜检查20例麻醉体会

我院于2006-07～2007—11应用丙泊酚进行胃镜检查20例,效果满意．现报道如下。