硬膜外阻滞复合气管内全麻在婴幼儿腹部手术的应用

目的：探讨婴幼儿腹部大,中等手术的理想麻醉方法。方法：我院近年来婴幼儿腹部大,中等手术82例,按不同的麻醉方法,分为三组：A组39例,连续硬膜外阻滞＋气管内全麻;B组28例,连续硬膜外阻滞＋基础及辅助用药;C组15例,气管内全麻。分析,比较各组患者的心率（HR）,氧饱和度（SpO2)的变化,麻醉药用量以及患儿苏醒时间,结果：与B,C组相比,A组麻醉效果满意,HR平稳,术后苏醒快,并且SpO2始终达98％以上。结论：连续硬膜外阻滞复合气管内全麻是婴幼儿腹部大,中等手术的安全,有效麻醉方法。     

Selection of baseline blood pressure to guide management of hypotension during spinal anaesthesia for caesarean section

IntroductionRecommendations on vasopressor management during caesarean section under spinal anaesthesia suggest maintaining systolic arterial pressure ≥90% of an accurately measured baseline value. The baseline is often taken as the first reading in the operating room. We hypothesise that this reading may not reflect an accurate baseline value.MethodsA retrospective case note review of 300 non-hypertensive women undergoing caesarean section with neuraxial anaesthesia, including spinal anaesthesia for elective delivery (n=100), and spinal (n=100) and epidural top-up anaesthesia (n=100) for emergency delivery. Systolic arterial pressure values recorded at various time points between the last antenatal visit and the first blood pressure value recorded in the operating room were compared.ResultsThere was a stepwise and significant increase in systolic arterial pressure over three time points (last antenatal clinic, morning of surgery, operating room) before elective caesarean section (all P <0.001). In women having emergency caesarean under spinal anaesthesia, a stepwise increase over four time points (last antenatal clinic, first reading in labour, final reading in labour, operating room) was observed. A similar trend was seen over these time points for women having emergency caesarean under epidural top-up, although the systolic blood pressure did not rise during labour.ConclusionsUsing the initial blood pressure reading in the operating room as the baseline value may lead to unnecessary vasopressor use and hypertension. Prospective research is required to clarify which reading represents the most accurate baseline to maintain homeostasis and reduce the hypotensive sequelae of neuraxial anaesthesia for both the mother and fetus.     

Optimum dose of epidural morphine for postsurgical analgesia

To determine the optimum dose of epidural morphine for postoperative pain control, 0.5–4.0mg of morphine was administered to 198 patients who had undergone operations on lower abdomen or lower extremities under continuous epidural anesthesia. Analgesic effect of morphine and incidence of nausea or vomiting were studied using linear discriminant analysis. As explanatory variables, age and dose of morphine were statistically significant in discriminating analgesic effect of morphine. Among indices for physique of patients, height was the most useful for predicting the analgesic effect. The dose which made the discriminant function zero corresponded to the minimum effective dose (MED) of morphine and it was expressed as follows; MED (mg·meter^–1) = –0.0107 × age + 1.85. Predicting the incidence of nausea or vomiting in relation to the dose of morphine did not reach a level of statistical significance.(Ochi G, Yamane C, Arai T: Optimum dose of epidural morphine for postsurgical analgesia. J Anesth 4: 35–39, 1990)     

星状神经节阻滞对家兔呼吸循环功能影响的初步观察

目的 :观察星状神经节阻滞对家兔呼吸循环功能的影响。方法 :选择健康成年家兔 5只 ,麻醉后暴露右侧星状神经节 ,用 1%利多卡因 1ml作局部浸润麻醉。观察阻滞前后呼吸频率、潮气量、动脉压、心率等的变化。结果 :与阻滞前相比 ,右侧星状神经节阻滞后呼吸频率及潮气量变化不显著 ;动脉压在阻滞后略有下降 ,但与阻滞前相比无显著差异 (P >0 .0 5 ) ;心率由阻滞前 141.8± 9.1次 /分下降到阻滞后 2min、5min、10min时的 12 9.8± 7.3次 /分、12 2 .4± 7.0次 /分、12 4.3± 7.4次 /分 ,且差异有显著性 (P <0 .0 5 )。结论 :右侧星状神经节阻滞对呼吸功能影响不明显 ,但对循环功能有一定的影响。     

大白鼠闭合性脑损伤后神经细胞的凋亡

目的：本实验在改良前脑局部闭合性脑硬膜外占位性颅脑损伤的创伤性模型基础上研究神经元细胞调亡。方法：５６ 只Ｗｉｓｔａｒ大白鼠,采用球囊注水在脑硬膜外造成占位及持续时间不同所形成的分级脑外伤,饲养２ｄ 后脑标本采用原位末端标记（ＴＵＮＥＬ）法进行ＰＣＤ阳性细胞的检测。结果：４０ 只存活鼠中,实验组损伤周围有ＴＵＮＥＬ阳性细胞的表达,在对侧及未损伤区几乎无表达。本实验造成脑损伤的机制中除直接受压区的坏死外受损周围区域有凋亡的参与。提示凋亡可能是脑创伤后脑损伤中神经元细胞死亡的方式之一。     

布比卡因和利多卡因硬膜外麻醉对心率变异性的影响

目的 探讨硬膜外腔使用不同局麻药对心脏自主神经系统的影响。方法 ３０例ＡＳＡⅠ～Ⅱ级的低位硬膜外麻醉病人,随机分布比卡因组（Ｂ组,ｎ＝１５）和利多卡因组（Ｌ组,ｎ＝１５）,两组均于麻醉前、硬膜外用药后５分钟、１０分钟、１５分钟及２０分钟获取ＨＲ、ＳＢＰ、ＤＢＰ、ＭＡＰ及心率变异超低频、低频、高频、超高频、总功率和低频高频比值。结果 Ｂ组心率变异性变化不显著。Ｌ组心率变异性各参数均有不同下降,但低频     

硬膜外麻醉对老年人气管插管时心血管反应抑制作用的临床观察

观察胸部硬膜外麻醉对老年人全麻气管内插管时心血管反应的抑制作用。方法：利用胸部硬膜外麻醉对４０例老年择期全麻手术病人进行分组对比研究,观察全麻气管内插管时血流动力学,心肌耗氧及应激性激素的变化。结果：实验组气管内插管时血流动力学和心肌耗氧指标及ＲＮ、ＡⅡ显著低于对照组并在围插管斯保持平稳。纣胸部硬膜外麻醉可抑制老年手术患者全麻气管内插管时血浆儿茶酚胺分泌,保持插管期间血流动力学的稳定。