罗比卡因与布比卡因硬膜外麻醉剖宫产术时心电图及心肌酶的变化

目的　比较硬膜外麻醉剖宫产术时罗比卡因和布比卡因对心电图及心肌酶的影响。方法　择期剖宫产手术病人 30例 ,硬膜外麻醉时Ⅰ组 (15例 )用 0 5 %罗比卡因 ,Ⅱ组 (15例 )用0 5 %布比卡因。观察麻醉手术期间心电图P R、QRS波间期以及肌酸磷酸激酶 (CK)和同工酶 (CK MB)的变化 ,同时观察麻醉镇痛、肌松效果和不良反应。结果　两组病人P R、QRS波间期均在正常范围内 (P >0 0 5 )。两组病人CK术后 2 4h值明显高于术前 (P <0 0 5 ) ,但反映心肌受损特异性较高的CK MB则无明显变化 (P >0 0 5 ) ,两组间亦无差异 (P >0 0 5 )。麻醉效果及不良反应两组间无差异。结论　硬膜外麻醉时罗比卡因与布比卡因对心电图及心肌酶影响无明显差异     

不同麻醉方式对儿童腹腔镜疝囊高位结扎术应激反应的影响

目的探讨两种麻醉方法对儿童腹腔镜疝高位结扎术（lapamscopic hernia sac high ligation）应激反应的影响。方法ASAⅠ-Ⅱ级择期行腹股疝疝囊高位结扎术患儿60例，年龄6—12岁，随机分为硬膜外麻醉组（E组）和单纯气管内全麻组（G组）各30例。检测术中不同时点血浆皮质醇（Cor）、去甲肾上腺素（NE）、肾上腺素（E）、促肾上腺皮质激素（ACTH）浓度并观察平均动脉压（MAP）和心率（HR）的变化。结果E组各时点Cor、NE、E、ACHT浓度无明显变化（P〉0．05），G组气腹后上述各指标较气腹前明显增高（P〈0．05）且显著高于E组同时点（P〈0．05）（见表2）；E组气腹后平均动脉压及心率变化无统计学意义（P〉0．05），而G组的则显著升高（P〈0．05）；两组患儿气腹10min后PaC02均显著增加（P〈0．05），停气腹后渐恢复至正常，血PH值则变化不明显。结论硬膜外麻醉复合基础麻醉相对于单纯气管内全麻更能有效抑制儿童腹股疝疝囊高位结扎术的应激反应。     

A comparative study on therapeutic method of traumatic epidural hematoma

Objective： To explore the therapeutic methods, surgical indications and clinical practice of minimally invasive surgery on traumatic epidural hematoma （EDH）. Methods： Retrospective study was made on 135 patients with traumatic EDH admitted into our hospital from June 2002 to August 2005. Sixty-five patients were treated with mini-invasive negative pressure drainage （treatment group）, 70 patients with comparable condition used traditional craniotomy （control group ）. The mean time of operation, average days in hospital, expenditure and prognosis of two groups were recorded and analyzed. Results： There was no significant difference in therapeutic efficacy between two groups. Patients in treatment group had a shorter hospital stay and less expenditure than those in control group. Conclusion： Mini-invasive negative pressure drainage is simple, effective, economical and applicable to some traumatic EDH patients.     

Oesophageal atresia: caudo-thoracic epidural anaesthesia reduces the need for post-operative ventilatory support

The mortality of neonates with oesophageal atresia in the Third World remains high because of delays in presentation and diagnosis. Lack of appropriate intensive care facilities is a further contributing factor. Caudothoracic epidural anaesthesia was used during surgical repair of oesophageal atresia in 35 patients in an attempt to minimise the need for post-operative ventionally support. This group was compared with 36 patients whose surgery was performed under general anaesthesia. The age at the time of referral, sex ratio, and weight were comparable in both groups. Using the Waterson classification, a greater number of poorer prognostic patients were seen in the epidural group (P <0.02). In all Waterson risk categories fewer patients required ventionally support post-operatively, which was statistically significant (P <0.01) when all categories were combined. We are encouraged by our results and believe this technique has a rôle in the management of neonates undergoing major surgery, both where neonatal intensive care exist or is deficient as in many parts of the Third World.     

Epidural Spinal Cord Infiltration: A Rare Complication of Acute Myeloblastic Leukaemia

Epidural infiltration by leukemic cells in Acute Non Lymphoblastic Leukemia (ANLL), and extradural granulocytic sarcomas as a cause of spinal cord compression are extremely rare phenomena. Very few cases have been recorded in the literature. In this brief case report we describe a young patient with acute myeloblastic leukemia (M4, FAB) who presented with sudden spinal cord compression during relapse after bone marrow transplantation. The literature on this subject is also reviewed.     

Comparison of circulatory and respiratory responses between supplementary epidural buprenorphine and eptazocine administration during and immediately after total intravenous anesthesia

Opioid supplements are often required in total intravenous anesthesia (TIVA). Most ϰ-opiate receptors are found in the spinal cord, wherea μ-opiate receptors are widespread throughout the brain and spinal cord. Buprenorphine has a strong μ-action with a minute ϰ-action, while eptazocine stimulates ϰ-receptors only. From these, epidural eptazocine is expected to exert strong spinal analgesia by ϰ-stimulation without μ-action, which produces circulatory and respiratory depression. Therefore, the clinical effects of epidural opioids on circulation, respiration, and analgesia were compared. Continuous epidural administration of eptazocine or buprenorphine was combined with TIVA in patients scheduled for elective abdominal surgery. Epidural opioid administration was continued throughout and for 72h after anesthesia. A significant analgesic effect (P<0.01) of epidural eptazocine without circulatory and respiratory depression was observed. With epidural buprenorphine, circulatory and respiratory depression during and immediately after anesthesia were significant (P<0.05). These results suggest that medullary μ-stimulation by an epidural opioid induces circulatory (hypervagotonicity and hypervagosensitivity) and respiratory depression, while ϰ-stimulation produces only minimal effects on circulatory and respiratory systems.     

小剂量氯胺酮咪唑安定辅助硬膜外下剖腹产手术的临床探讨

目的对比观察剖腹产选用连续硬膜外麻醉时，辅助麻醉用药镇静及对牵拉反应抑制效果。方法选择行剖腹产手术产妇60例在硬膜外麻醉效果满意后，随机分两组各30例。Ⅰ组：哌替啶50mg，异丙嗪25mg单次静注。Ⅱ组：氯胺酮28．5mg，咪达唑仑1．42mg单次静注。分组记录用药前，1min，5min，15min及术毕产妇SpO2、RR、HR、MAP值；记录手术时间、术毕苏醒例数、术中恶心躁动例数；记录术毕产妇OAA／S评分；记录新生儿娩出时Apger评分。结果两组术中镇静、抑制牵拉反应效果均满意。两组RR、BP、HR、SpO2均平稳；术毕两组OAA／S评分均为4-5分；新生儿Apger评分均正常。结论两组方法效果确切，对产妇和新生儿安全。     

臂丛神经阻滞麻醉进针点选择体会

目的总结锁骨下血管旁间隙臂丛神经阻滞麻醉的体会及效果。方法分析1997年以来行锁骨下血管旁间隙臂丛神经阻滞麻醉100例患者的临床资料。结果无1例出现并发症,麻醉效果佳。结论此法切实可取。     

Clinical evaluation of a new epidural pressure monitor

Summary Comparative measuring of epidural pressure using the Spiegelberg probe 1 and ventricular fluid pressure was carried out in 15 neurosurgical intensive-care patients. Deviations in both directions were established, with a trend toward overestimating ventricular pressure in epidural pressure measuring (r=0.77). Individual pulsations, spontaneous wave courses and therapy-induced pressure changes were reflected without delays. There were no complications observed with probe implantation periods for up to 6 days. The system has been shown to be mechanically stable and easy to implant. We believe the device to be fit for trend monitoring of intracranial pressure. As with other epidural pressure monitoring systems, false assessments of ventricular pressure may lead to wrong decisions as to the required therapy.