Hemodynamic and catecholamine responses during tracheal intubation using a lightwand device (Trachlight) in elderly patients with hypertension

Purpose.Tracheal intubation using a lightwand device (Trachlight) should minimize hemodynamic change by avoiding direct-vision laryngoscopy. We evaluated hemodynamic and catecholamine responses during tracheal intubation using a Trachlight in elderly patients with hypertension.Methods.Twenty-six hypertensive patients aged over 65 years undergoing orthopedic surgery were randomly divided into two groups, group L (n = 13) and group T (n = 13). Anesthesia was induced with fentanyl (2g·kg^–1) and propofol (1.5mg·kg^–1), and then muscle relaxation was obtained with vecuronium (0.15mg·kg^–1). The trachea was intubated with either a Macintosh laryngoscope (group L) or a Trachlight (group T). Hemodynamics, plasma catecholamine concentrations, and arterial blood gases were measured before the induction of anesthesia (T0), before tracheal intubation (T1), immediately after tracheal intubation (T2), and 3min after tracheal intubation (T3).Results.The intubation time was shorter in group T than in group L (12.6 ± 1.7 vs 23.5 ± 2.9s, mean ± SE; P 0.01). Compared with the preinduction (T0) value, systolic blood pressure (SBP) showed a significant decrease at T1 and T3 in group L and at T1, T2, and T3 in group T. The heart rate (HR) and plasma norepinephrine (NE) concentration showed no change in either group throughout the time course, whereas the plasma epinephrine (E) concentration showed a significant decrease at T2 and T3 in both groups. The mean values of the rate-pressure product (RPP: HR × SBP) were less than 15 000 after tracheal intubation in both groups. There was no significant difference in hemodynamic or catecholamine responses between groups at any point. No patient had ischemic ST-T changes in either group.Conclusion.A lightwand has no advantage over a laryngoscope in terms of hemodynamic and plasma catecholamine responses to tracheal intubation in elderly patients with hypertension, despite a shorter intubation time.     

原发性气管肿瘤的外科治疗

目的 总结外科手术治疗原发性气管肿瘤的临床经验。方法 回顾性分析我科1968—2001年70例原发性气管肿瘤的外科治疗资料。结果 气管节段切除39例,隆凸切除13例,气管侧壁切除10例,肿瘤局部剔除5例,全肺切除1例,开胸探查2例。并发症发生率31％(22／70)。气管切除与重建术后30d内死亡率8％(4／52)。良性肿瘤14例,恶性肿瘤56例。其中腺样囊性癌和鳞癌是最常见的类型,分别为45％(25／56)和23％(13／56)。良性肿瘤随诊平均5．7年。恶性肿瘤切除术后5、10年生存率分别为64％(21／33)和54％(14／26)。结论 手术切除是治疗气管肿瘤最有效的方法。气管节段切除是治疗气管恶性肿瘤的主要术式,良性肿瘤可以考虑保守的术式。降低手术并发症是取得良好手术疗效的关键。     

"Porcine bronchus" diagnosed in neonatal period

“Porcine bronchus” is a right upper lobe bronchus arising directly from the trachea. This is an infrequent congenital abnormality and it usually represents the displaced origin of a normal bronchus. We herewith report a case of a child who was diagnosed to have tracheal bronchus in neonatal period and followed subsequently until 13 months of age.     

聚丙烯网状材料与颈前皮瓣联合重建气管的实验研究

目的 通过构建犬颈段气管缺损与重建的实验动物模型,寻找一种通过一期手术即能与自体气管完全愈合为一体的人工气管材料和手术方法.方法 将8只犬一期手术切除3.5～4.0 cm长的颈部气管,采用可以永久保留在体内的聚丙烯网状材料与颈前皮瓣联合行气管重建,术后初期管腔内置入Z型金属覆膜气管支架,观察犬的生存期、生存质量,通过纤维气管镜、X线片及组织切片观察吻合口愈合情况及病理变化.结果 8只犬中1只犬因继发呼吸衰竭于术后2 d死亡,1只犬因吻合口感染术后10 d死亡.存活的6只犬中除1只并发轻度气管狭窄,其余5只犬生活质量好,术后第2 d即可正常饮水及进食,无呼吸困难等并发症.术后2、4、8周及6个月处死动物取出重建气管标本,见2周时有软组织长入聚丙烯网孔,使其硬度增加并具有一定的支撑度;4周时长入网孔的软组织增多;8周及6个月时软组织将聚丙烯网完全覆盖,并发生纤维化使网的支撑度明显增加.病理检查显示,术后2、4、8周时可见吻合口肉芽生长,术后6个月时肉芽组织较前缩小,皮瓣的鳞状上皮与黏膜的柱状上皮愈合良好.结论 具有良好的组织相容性的聚丙烯网状材料与颈前皮瓣联合一期成形重建气管可与自体气管融为一体,成为自体气管的一部分,此种重建气管方法有望应用到临床.     

胸锁乳突肌肌骨膜瓣修复颈段气管缺损

目的:探讨利用胸锁乳突肌肌骨膜瓣修复颈段气管缺损的方法。方法:对13例恶性肿瘤侵犯颈段气管及原发性气管肿瘤患者,切除肿瘤及受累气管壁后利用胸锁乳突肌肌骨膜瓣修复气管壁缺损。结果:13例患者中,气管切开患者为10例,9例分别于术后1~5个月拔除气管套管,1例因声门区狭窄,戴管呼吸,3例未行气管切开患者术后呼吸通畅。结论:带蒂胸锁乳突肌肌骨膜瓣是较好的气管修复材料。     

盐酸丁丙诺啡抑制气管拔管期应激反应的作用

目的观察盐酸丁丙诺啡对全身麻醉苏醒拔管期机体应激反应的影响。方法60例ASAⅠ～Ⅱ级择期全麻下剖腹手术患者,随机分为三组,每组20例,对照组(C组)注射生理盐水;盐酸丁丙诺啡3μg/kg组(B3组)缝皮前静脉注射3μg/kg盐酸丁丙诺啡;盐酸丁丙诺啡6μg/kg组(B6组)缝皮前静脉注射盐酸丁丙诺啡6μg/kg。所有患者均给予异丙酚、维库溴胺、芬太尼作为全麻诱导用药,气管插管后及手术中微泵持续静脉注射异丙酚,间断静脉注射维库溴胺维持全麻及肌松。分别于术前、拔管时和拔管后5min测量血压、心率和呼吸及血氧饱和度;并对血压、呼吸、患者清醒程度、肢体运动进行评估。记录拔管时躁动的发生率及清醒时的拔管时间。结果C组血液动力学受影响较大,拔管时SBP和HR与术前比较有非常显著升高(P<0.01);盐酸丁丙诺啡B3组和B6组血液动力学较平稳,SBP、HR和SPO2与术前比较无显著性差异(P>0.05)。拔管后5min各组各项指标基本恢复到术前水平。结论盐酸丁丙诺啡能减轻全身麻醉苏醒拔管期机体应激反应,盐酸丁丙诺啡3μg/kg静脉注射即能很好的抑制应激反应。     

丙泊酚和咪唑安定在麻醉苏醒期气管拔管应用的观察

目的观察丙泊酚、咪唑安定镇静对术后气管拔管病人的影响。方法60例ASAⅠ～Ⅱ级腹部手术病人。均于手术结束停麻药后即予吸除吸呼道分泌物，等待达到拔管条件后随机分为三组：丙泊酚组（P组）静脉注射丙泊酚1-2mg／kg 1min后拔管；咪唑安定组（M组）静注咪唑安定0．02-0．04mg／kg 3min后拔管；对照组（D组）即按传统清醒拔管。比较患者MAP、HR变化、呛咳反应、拔管后清醒时间、拔管知晓率及心理反应。结果P组各时点MAP、HR均无显著变化。呛咳反应轻，M组拔管即刻与拔管后5min MAP、HR均明显增加，呛咳反应明显，但较D组轻微（P〈0．05或P〈0．01）。P组、M组清醒时间延长（P〈0．05）。D组拔管知晓率明显增高，心理反应明显（P〈0．01）。结论气管拔管中予适度镇静能抑制心血管反应及心理伤害反应，丙泊酚较咪唑安定用于气管拔管镇静更优越。     

全麻和高位硬膜外联合臂丛麻醉在乳腺癌手术中的比较

目的 观察两种不同的麻醉方法用于乳腺癌根治术对呼吸循环功能的影响以及并发症的发生率.方法 选择诊断明确的乳腺癌患者120例,ASAⅠ～Ⅱ级,随机分为两组.A组66例采用气管插管静脉复合麻醉,B组54例采用高位硬膜外麻醉联合臂丛神经阻滞.结果 A组患者麻醉后平均动脉压(MAP)、心率(HR)相对平稳;B组患者麻醉后MAP下降,HR减慢,与A组比较差异有统计学意义(P<0.05).B组患者麻醉后呼吸抑制发生率较高,脉搏氧饱和度(SpO2)在麻醉后、切皮时及切皮后10 min均低于基础值,A组麻醉后无呼吸抑制,特别在切除腋窝淋巴结时由于静脉注射氯胺酮而引起一过性SpO2下降.B组患者的术中知晓率及麻黄素和阿托品的应用率均高于A组(P均<0.05).结论 气管插管静脉复合麻醉用于乳腺癌根治术具有安全、麻醉效果确切、术中血流动力学平稳等优点,避免了由高位硬膜外麻醉引起的呼吸抑制、硬膜外血肿等一系列并发症. Abstract： Objective To observe the effect of breath and circulation and the incidence rate of complication during the breast cancer radical correction with this two methods of anaesthesia. Methods To select 120 patients,all definite diagnosed breast cancer,ASAⅠ-Ⅱdegree,and divided into two groups(group A and group B)at random. Group A received tracheal intubation balanced anesthesia;Group B received high epidural anesthesia with plexus brachialis nerves block. Results The patients of group A with a correspondence MAP and HR after anaesthesia;while MAP decrease(P<0.05) and HR step down (P<0.05) on the patients in group B,compare with group A has obvious statistical significance.The incidence rate of respiratory depression in group B was high, all the SpO2 after anaesthesia, the time of cutting skin and after cut skin 10 min under the base value. None respiratory depression in group A, especially SpO2 temporal descend because of intravenous injection the ketamine when ablate axillary nodes. The rate of awareness in group B, admove ephedrine and atropinic are all higher than that in group A(P<0.05).Conclusions Received tracheal intubation balanced anesthesia in the breast cancer radical correction has several good quality,such as safety, the effect of anesthesia is precisely,an equability haemodynamics;hemodynamics during the operation, to avoid respiratory depression and epidural hematoma;extradural hematoma and other complication originated by the epidural anesthesia.