瑞芬太尼和氯胺酮静脉麻醉用于重睑术的效果比较

目的：比较瑞芬太尼复合异丙酚和氯胺酮复合异丙酚在重睑成形手术中的静脉镇痛、镇静效果及清醒时间、手术时间和不良反应的发生率。方法：选择200例ASAⅠ-Ⅱ级择期行重睑成形术患者,随机分为A、B两组各100例。A组：瑞芬太尼复合异丙酚;B组：氯胺酮复合异丙酚。分别以瑞芬太尼复合异丙酚或氯胺酮复合异丙酚缓慢静脉推注,观察记录两组患者在入室麻醉前（t0）、静脉麻醉后即刻（t1）、局部浸润麻醉后即刻（t2）、局部浸润麻醉后5min（t3）、局部浸润麻醉后10min（t4）、局部浸润麻醉后20min（t5）时的心率（HR）、收缩压（SBP）、舒张压（DBP）变化情况及脉搏血氧饱和度（SpO2）,并记录两组患者的静脉麻醉镇痛与镇静效果、清醒时间、手术时间以及术中与术后恶心呕吐、呼吸抑制及躁动等不良反应。结果：A组患者静脉麻醉后（t1）与麻醉前（t0）相比HR、SBP、DBP有所下降,但差异无统计学意义（P＞0.05）;B组患者静脉麻醉后（t1）HR、SBP、DBP较麻醉前（t0）有所升高,差异有统计学意义（P＜0.05）;t1、t2、t3、t4节点B组HR、SBP、DBP均明显高于A组,两组差异有统计学意义（P＜0.05）;两组患者的静脉麻醉镇痛、镇静效果均很好,差异无统计学意义（P＞0.05）;A组与B组清醒时间分别为（6.5±2.2）min、（25.1±4.5）min,差异有统计学意义（P＜0.05）;A组与B组手术时间分别为（50.1±9.7）min、（83.4±11.5）min,差异有统计学意义（P＜0.05）;A组不良反应、并发症低于B组,差异有统计学意义（P＜0.05）。结论：瑞芬太尼与异丙酚静脉复合麻醉用于重睑成形术对患者的心血管刺激小,血流动力学影响小、并发症少;患者清醒时间、手术时间均较氯胺酮复合异丙酚麻醉时间短。总之,瑞芬太尼与异丙酚静脉复合麻醉用于重睑成形术效果优于氯胺酮复合异丙酚麻醉。     

Bispectral Index Monitoring during Anesthesiologist-Directed Propofol and Remifentanil Sedation for Endoscopic Submucosal Dissection: A Prospective Randomized Controlled Trial

Purpose

Endoscopic submucosal dissection (ESD) is a technically difficult and lengthy procedure requiring optimal depth of sedation. The bispectral index (BIS) monitor is a non-invasive tool that objectively evaluates the depth of sedation. The purpose of this prospective randomized controlled trial was to evaluate whether BIS guided sedation with propofol and remifentanil could reduce the number of patients requiring rescue propofol, and thus reduce the incidence of sedation- and/or procedure-related complications.

Materials and Methods

A total of 180 patients who underwent the ESD procedure for gastric adenoma or early gastric cancer were randomized to two groups. The control group (n=90) was monitored by the Modified Observer''s Assessment of Alertness and Sedation scale and the BIS group (n=90) was monitored using BIS. The total doses of propofol and remifentanil, the need for rescue propofol, and the rates of complications were recorded.

Results

The number of patients who needed rescue propofol during the procedure was significantly higher in the control group than the BIS group (47.8% vs. 30.0%, p=0.014). There were no significant differences in the incidence of sedation- and/or procedure-related complications.

Conclusion

BIS-guided propofol infusion combined with remifentanil reduced the number of patients requiring rescue propofol in ESD procedures. However, this finding did not lead to clinical benefits and thus BIS monitoring is of limited use during anesthesiologist-directed sedation.     

右美托咪啶静脉复合麻醉在腹腔镜胆囊切除术的临床观察

目的：观察右美托咪啶复合瑞芬太尼行静脉麻醉用于腹腔镜胆囊切除术（Lc）的麻醉效果及术中知晓情况。方法：择期行Lc患者240例,随机分均为右美托咪啶组（D组）和丙泊酚组（P组）。D组给以右美托咪啶复合瑞芬太尼和顺阿曲库铵麻醉诱导和维持,P组则以丙泊酚复合瑞芬太尼和顺阿曲库铵行麻醉诱导和维持。记录麻醉诱导、插管及腹腔充气的心血管反应;记录术中用药、术后恢复情况以及患者的满意度。并调查术中知晓发生率。结果：D组患者的麻醉诱导和气管插管未见血压明显变化,腹腔充气血压升高（P〈0．01）,拔管后血压降低（P〈0．01）;P组患者麻醉诱导后血压降低（P〈0．01）。D组麻醉和手术过程心率降低（P〈0．01）而P组心率保持不变。P组清醒拔管时间均少于D组（P〈0．05）。D组阿托品和乌拉地尔的使用较多（P〈0．01）,麻黄碱使用较少（P〈0．05）。D组术后即时镇痛（P〈0．01）、恶心呕吐发生率少于P组（P〈0．05）。结论：右美托咪啶复合瑞芬太尼麻醉效果确切、安全,是腹腔镜胆囊切除术麻醉选择方法之一,术中注意右美托咪啶诱导给药速度、加强心率监护和管理,且无术中知晓发生。     

瑞芬太尼及丙泊酚静脉用药对高龄患者术后认知功能恢复的影响

目的探讨瑞芬太尼及丙泊酚对高龄患者静脉麻醉后认知功能恢复的影响。方法2009年1月-2013年1月我院行食管癌根治术患者32例,年龄70-80岁,ASAⅠ-Ⅱ级,随机分为两组,分别采用瑞芬太尼＋丙泊酚＋卡肌宁（瑞芬太尼组,n=16）及芬太尼＋丙泊酚＋卡肌宁（芬太尼组,n=16）行麻醉诱导维持。术后记录自主呼吸恢复时间、呼之睁眼时间、拔管时间及自我陈述时间,分别于术前24h、术后2h、24h应用简易精神状态量表评估患者认知功能。结果两组自主呼吸恢复时间未见显著差异（P〉0．05）,瑞芬太尼组呼之睁眼时间、拔管时间及陈述自己姓名时间均明显早于芬太尼组（P〈0．05）。术后2h两组简易精神状态量表评分均较术前明显降低（P〈0．05）,术后24h评分两组较术前均无统计学差异（P〉0．05）。结论瑞芬太尼与丙泊酚合用对高龄患者术后认知功能影响小,值得临床推广应用。     

瑞芬太尼与芬太尼在小儿先天性心脏病介入手术麻醉中的效果分析

目的 探讨瑞芬太尼与芬太尼在小儿先天性心脏病介入手术麻醉中的效果。方法 80例小儿先天性心脏病患儿入院后被分为两组,对照组（40例）给予芬太尼麻醉,观察组（40例）给予瑞芬太尼麻醉,依据麻醉前后不同时间的收缩压（SDP）、舒张压（DBP）、心率（HR）,两种麻醉药物的拔管时间、苏醒时间及麻醉用药量及麻醉期间患儿出现的不良反应情况,评价瑞芬太尼与芬太尼在小儿先天性心脏病介入手术麻醉中的效果。结果 与诱导前的基础值相比,麻醉药物诱导后两组SDP、DBP值均降低,组内比较差异有统计学意义（P<0.05）;两组HR水平与诱导前的基础值相比,差异无统计学意义。观察组拔管时间、苏醒时间均短于对照组,组间差异有统计学意义（P<0.05）;但观察组麻醉药物用量多于对照组,两组比较差异显著（P<0.05）。麻醉期间,两组不良反应率相比,差异无统计学意义。结论 瑞芬太尼对小儿先天性心脏介入手术麻醉效果好,对心功能的影响较小,术后能早期拔管,副作用较小,是目前临床上一种理想的麻醉药物。     

Non-neuraxial analgesia in labour

Pain in labour is often described as one of the most severe pains experienced. Neuraxial techniques provide the most effective form of labour analgesia. However, not all women wish to have this or indeed want complete pain relief in labour. There are also subgroups of women in whom neuraxial techniques are contraindicated or attempted placement is unsuccessful. Therefore delivery units must be able to offer a range of non-neuraxial analgesia options for labour.     

Increased Tidal Volume Variability in Children is a Better Marker of Opioid-Induced Respiratory Depression than Decreased Respiratory Rate

OBJECTIVE: During opioid administration, decreasing respiratory rate is typically used as a predictor of respiratory depression. Prior to opioid-induced apnea, progressively irregular breathing patterns have been noticed. We hypothesize that opioid administration to children will increase tidal volume variability (TV(var)) and that this will be a better predictor of respiratory depression than a decrease in respiratory rate. METHODS: We recruited 32 children aged 2-8 years scheduled to undergo surgery. During spontaneous ventilation, flow rates and respiratory rates were continuously recorded, while remifentanil was infused at stepwise increasing doses each lasting 10 min. The infusion was continued until the patient showed signs of respiratory depression. Flow data from each dose was used to calculate tidal volumes, from which TV(var) was calculated. The respiratory rate and TV(var) during the last (D(last)), second to last (D-2), and third to last (D-3), administered doses were compared to those during baseline (fourth to last dose). We chose a threshold of TV(var) increase and compared it to a decrease in respiratory rate below 10 breaths per min as predictors of respiratory depression. RESULTS: Compared to baseline, the TV(var) increased by 336% and 668% during D(-2) and D(last), respectively, whereas respiratory rate decreased by 14.3%, 31.7%, and 55.5% during D(-3), D(-2), and D(last), respectively. A threshold increase in TV(var) of 150% over baseline correctly predicted respiratory depression in 41% of patients, compared to a drop in respiratory rate correctly predicting 22% of patients. CONCLUSIONS: TV(var) increases as children approach opioid-induced respiratory depression. This is a more useful predictor of respiratory depression than a fall in respiratory rate because the TV(var) increase is 10 times the drop in respiratory rate. A TV(var) increase also correctly predicts respiratory depression twice as often as decreased respiratory rate and is independent of age-related alterations in physiologic respiratory rates.     

靶控输注瑞芬太尼控制性降压用于维吾尔族、汉族患者鼻内镜手术的临床研究

目的 观察靶控输注瑞芬太尼控制性降压用于维吾尔族及汉族鼻内镜手术患者临床效果.方法 纳入该院2013年3-6月期间择期行鼻内镜手术患者60例,ASA I或Ⅱ级,其中汉族患者30例（A组）,维吾尔族患者30例（B组）.桡动脉穿刺置管监测有创动脉血压.瑞芬太尼起始效应室靶浓度5 μg·L-1,每隔2 min增加靶浓度0.5 μg·L-1,直至平均动脉压维持在50～70 mmHg至手术结束.分别记录控制性降压即刻（T1）、术中5 min（T2）、30 min时刻（T3）及停药10 min时（T4）平均动脉压（MAP）、心率（HR）,并于T1、T3时刻抽静脉血测定乳酸水平.术毕记录瑞芬太尼总用药量、达到目标血压瑞芬太尼靶浓度、达到目标血压所用时间、手术持续时间、控制性降压持续时间及术野出血评分.结果 T1、T3两时点乳酸水平比较差异无统计学意义（P＞0.05）;B组瑞芬太尼总用药量、达到目标血压瑞芬太尼靶浓度、达到目标血压所用时间明显多于A组（P＆lt;0.05）.结论 汉族与维吾尔族患者采用靶控输注瑞芬太尼控制性降压均可得到满意的降压效果;其中维吾尔族患者控制性降压所用瑞芬太尼总量、达到目标血压所用时间及瑞芬太尼靶浓度大于汉族患者.