后腹腔镜下单侧肾上腺嗜铬细胞瘤摘除术后拔管时间延长

目的比较后腹腔镜下单侧肾上腺嗜铬细胞瘤或其他类型肾上腺肿瘤摘除术后患者的气管导管拔除时间改变。方法回顾性分析我院2014年11月至2017年4月全身麻醉下行后腹腔镜下单侧肾上腺嗜铬细胞瘤摘除术的19例高血压患者的电子麻醉记录单(S组),并选取同期于全身麻醉下行后腹腔镜下单侧肾上腺其他类型肿瘤摘除术的38例高血压患者为对照组(D组)。比较两组患者性别、ASA分级、年龄、身高、体重、手术时长、麻醉时间、术中镇静、镇痛及肌松药用量、拔管时间及PACU滞留时间。结果两组性别、ASA分级、年龄、身高、体重、手术时间及麻醉时间差异无统计学意义。术中镇静、镇痛及肌松药用量差异无统计学意义。S组拔管时间明显长于D组[30.0(25.0~42.5)min vs 20.0(15.0~20.0)min,P0.05]。S组PACU滞留时间亦明显长于D组[70.0(57.5~82.5)min vs 45.0(33.5~55.0)min,P0.05]。结论全身麻醉下行后腹腔镜下单侧肾上腺嗜铬细胞瘤摘除术的患者与同等条件下行肾上腺其他类型肿瘤摘除术的患者比较,术后拔管时间与PACU滞留时间明显延长,可能与术中麻醉药物用量无关。     

影响PACU运转的相关因素分析

目的探讨影响麻醉后恢复室（PACU）运转的相关因素，合理分配人力资源，减少 PACU并发症的发生。方法选择2011年11月-2012年11月入PACU的8046例患者，记录在PACU中的带管时间、留观时间和并发症的发生情况。结果8046例中普外科患者最多（26．5％），其次为妇科（19．2％）、耳鼻喉科（17．8％）；并发症总的发生率为14．3％，其中发生率最高的为高血压（7．6％）；平均带管时间为（28．9±26．5）min，平均留观时间为（81．8±33．2）min。胸外科带管时间最长，为（39．0±35．2）min，留观时间最长，为（98．1±40．3）min，其次是神经外科。年龄≥70岁患者留观时间最长，为（108．5±43．4）min。结论年龄≥70岁患者、胸科和神经外科、高血压等并发症是影响PACU周转的重要因素。     

Patient recovery and the post-anaesthesia care unit

Patient recovery is a period of active patient monitoring and management during which time airway reflexes return and respiratory and cardiovascular stability should be achieved. The post-anaesthetic care unit (PACU) is the specially designed clinical area in which staff trained in the recognition and management of potential complications arising during this time care for patients. National guidance on the responsibilities and training of staff, the monitoring required during the recovery period and criteria for discharge serves to ensure patient safety and efficient theatre throughput.     

腹腔镜胆囊切除术患者在PACU应用羟考酮注射液镇痛疗效观察

目的:观察腹腔镜胆囊切除患者术后在麻醉恢复室(PACU)应用羟考酮注射液(奥诺美)镇痛的疗效及安全性。方法:随机选择ASAⅠ或Ⅱ级腹腔镜胆囊切除术后视觉模拟评分(VAS)为7分及以上的患者60例,分为两组各30例;镇痛组患者给予羟考酮注射液5 mg稀释至5 ml经静脉注射,对照组患者给予0.9%Na Cl注射液5 ml经静脉注射,采用VAS疼痛评分。并记录注药前及注药后每隔5 min的NT值。同时观察患者生命体征变化,以及恶心、呕吐、呼吸抑制等不良反应。结果:镇痛组患者在注药5 min后VAS评分明显下降,于20 min后降至0分;而对照组患者在注药10 min后VAS评分已升至10分,直至离开PACU;镇痛组患者在注药10 min后出现NT值一过性下降,但很快恢复;镇痛组患者的生命体征注药后无明显变化,未延长患者在PACU的滞留时间;不良反应无明显增多。结论:羟考酮注射液可安全用于腹腔镜胆囊切除患者术后镇痛,适合于PACU的镇痛管理。     

肿瘤患者全麻术后并发症的临床观察

目的通过对麻醉恢复室（PACU）收治的1 001例肿瘤患者资料的回顾性分析,探讨全麻插管术后肿瘤患者在PACU中并发症的发生情况。方法选择2008年8月-2009年3月本院PACU收治的全麻插管肿瘤患者1 001例,观察、记录患者的一般情况,及其在PACU期间的血压、心率、血氧饱和度、呼吸频率、麻醉苏醒时间和各种并发症的发生率。结果肿瘤患者术后在PACU内各种并发症的总发生率为15.8%。中、青年人患者与老年患者比较,高血压、心律失常、低氧血症、支气管痉挛、苏醒延迟并发症有统计学差异（P〈0.05）。结论在PACU内,高血压、心律失常、低氧血症、支气管痉挛、苏醒延迟,恶心、呕吐及疼痛是最常见的,老年患者发生并发症的发生率高。     

A comparative study of the postoperative allogeneic blood-sparing effects of tranexamic acid and of desmopressin after total knee replacement

BACKGROUND: Tissue hypoxia and reperfusion induce abnormal hemostatic function. Therefore, bleeding after total knee replacement (TKR) may be a result of a tourniquet-induced imbalance of the procoagulant and fibrinolytic systems. Because laboratory confirmation of tourniquet-induced abnormal hemostasis is difficult to obtain, indirect evidence must be sought. STUDY DESIGN AND METHODS: A prospective, single-blind study of 40 patients undergoing TKR was performed. In the tranexamic acid (TA) group, in the 30 minutes before the limb tourniquet was deflated, an IV bolus dose of TA (15 mg/kg) was administered. Thereafter, a constant IV infusion of 10 mg per kg per hour was administered until 12 hours after tourniquet deflation. In the desmopressin group, desmopressin (0.3 mg/kg) and saline were administered by a similar protocol. No blood was administered intraoperatively. A postoperative Hct <27 percent constituted the postoperative transfusion trigger. Patients were examined daily for signs of lower-limb deep vein thrombosis, and they underwent lower-limb Doppler ultrasound on postoperative Day 5. Three months after surgery, the incidence of delayed thromboembolic events was assessed. RESULTS: During the first 12 postoperative hours, blood accumulation in the surgical drain was significantly (p<0.05) lower in the TA group (162 mL +/- 129) than in the desmopressin group (342 mL +/- 169). From the sixth postoperative hour until 3 days postoperatively, Hct levels were significantly lower in the desmopressin group than in the TA group. Significantly more allogeneic blood was transfused in the desmopressin group (11 patients received 16 units) than in the TA group (3 patients each received 1 unit) (p<0.02). There were no clinical signs of deep vein thrombosis or abnormal Doppler ultrasound studies. Three months postoperatively, there were no thromboembolic events among the 37 patients interviewed. CONCLUSION: TA induces better blood sparing than desmopressin. Therefore, a tourniquet-induced increase in fibrinolysis is the likely cause of delayed bleeding after TKR surgery. However, before routine administration, the effect of TA on the incidence of thromboembolic events requires further investigation.     

酒石酸布托啡诺用于全麻术后镇痛的临床观察

目的：评价布托啡诺用于全麻手术后进入麻醉复苏室的病人的可行性和安全性。方法：选择90例全麻病人随机分为布托啡诺组（A组=30）、杜冷丁组（B组=30）和不给予任何镇痛药物组（C组=30）,A组给予酒石酸布托啡诺1～2mg静脉莫非氏滴管静注;B组给予杜冷丁50-100mg肌注。观察并记录A、B两组注药后10min、30min、1h、4h的疼痛视觉模拟评分（VAS值）、镇静评分（采用Ramsay评分）、生命体征的变化和不良反应的发生情况并与C组进行对照分析。结果：给予镇痛药的两组的镇痛镇静率均在86％以上,但是布托啡诺组的副反应如心慌、呼吸抑制较杜冷丁组少。布托啡诺组术后恶心、呕吐发生率低于不给药物组（P〈0．05）,注药后1h布托啡诺组头晕和嗜睡的发生率明显高于杜冷丁组（P〈0．05）。结论：布托啡诺和杜冷丁用于麻醉复苏室患者均具有良好的术后镇痛效果,术后不良反应发生率低。