七氟醚复合丙泊酚在小儿气道异物取出术中的麻醉效果

Objective To observe the anesthetic effect of sevoflurane combined with propofol total general anaesthesia in children undergoing tracheal foreign body removal. Methods Sixty patients aged from 1 to 4 years admitted for tracheal foreign body removal were randomly divided into two groups : sevoflurane group (n = 30) and ketamine group (n = 30). In the sevoflurane group, anaesthesia was induced and maintained with inhalation of sevoflurane and propofol [1.5 mg/(kg · h)] was administered continuously for anesthesia maintenance by micro-pump during operation. The ketamine group were pre-medicated with ketamine 6 mg/kg i. m for sedation, then an-aesthesia was induced with midazolam 0.1 mg/kg and ketamine 1.5 mg/kg i. v and was maintained with intravenous bolus of ketamine. Systolic blood pressure(SBP), Diastolic blood pressure(DBP) ,heart rate(HR) and saturation of percutaneous oxygen(SPO2) were monitored in both groups before anaesthesia inducation (T0) , after anaesthesia inducation and before operation (T1), at the time point of bronchial endoscopy(T2) ,endoscope remoral (T3) ,con-sciousness recovery(T4). The operation condition was evaluated by surgeons, and the incidence of bronchial spasm, glossal drop, nausea and vomiting were recorded both during operation and after operation. Results The SBP and HR increased at the time point of bronchial endoscopy in two groups and decreased after anaesthesia inducation in aevoflurane group. The SPO2 increased in two group after anaesthesia inducation. Compared with ketamine group, the time of consciousness recovery was shorter markedly in sevoflurane group. The occurrence of postoperative glossal drop was higher in ketamine group. Conclusion Sevoflurane combined with propofol is safe and effective during general anaesthesia of children undergoing tracheal foreign body removal.     

长期酗酒对人工流产术异丙酚麻醉的影响

目的 观察长期酗酒对人工流产术异丙酚麻醉的影响.方法 选择行人工流产术妇女160例完全随机分为非酗酒组和酗酒组,各80例.术中根据患者对手术刺激的反应,必要时分次追加异丙酚0.5 mg/kg.监测术前10 min(T1)、人工流产术开始后1、3、5、10 min(T2、T3、T4、T5)以及术后10min(T6)的平均动脉压、心率、呼吸频率、脉搏氧饱和度.记录2组患者异丙酚的诱导剂量以及术中追加剂量;观察人工流产综合征和术后恶心呕吐的发生情况;进行麻醉效果评价并记录患者苏醒时间和离院时间.结果 手术开始后1 min,2组患者平均动脉血压、心率和呼吸频率较术前有所降低(P＜0.05);人工流产术开始后3min,2组患者平均动脉血压恢复到术前水平,而心率和呼吸频率在手术开始后10 min恢复到术前水平.人工流产术开始后1～3 min 2组患者脉搏氧饱和度有轻微下降,但与术前比较,差异无统计学意义(P＞0.05).2组患者麻醉效果差异无统计学意义(P＞0.05).酗酒组患者异丙酚的诱导剂量和术中追加剂量均较非酗酒组患者均明显增加,差异有统计学意义[(150 ±46)mg比(100±16) mg; (42±10)mg比(27±8)mg;P＜0.01].非酗酒组苏醒时间与离院时间均较酗酒组延长,差异有统计学意义[(13±4) min比(8±3)min;(26±7)min比(22 ±5)min;P ＜0.05].结论 长期酗酒可以导致无痛人工流产手术麻醉时异丙酚的诱导剂量和术中追加剂量均明显增加;长期酗酒并不影响无痛人工流产时异丙酚的麻醉效果,异丙酚同样适合酗酒患者无痛人工流产手术麻醉.     

范炳华学术经验述要

浙江省国医名师范炳华从事推拿临床、教学、科研五十载。临证擅中西合参,重审症求因,倡症因相关,循“有症必有因,无因不成症;症因要相关,无关非诊断;治因宜为先,因去症自消”三大原则,凝一病一法一特色,创多种推拿诊疗新技术、新治法。     

突触可塑性的调节及生理学功能研究进展

目前认为大脑是可塑的，并利用大脑的可塑性来治疗多种疾病包括精神分裂症、帕金森氏病、老年记忆丧失、自闭症．等。随着突触可塑性的研究一步深入，发现中枢突触可塑性的调节是一个多因子参与的复杂过程。最近研究发现ATP、反式作用因子AP-1（activator protein-1）、α-synaclein和肌动蛋白在突触可塑性中有重要的调节作用，而且突触的重塑与痛觉过敏的形成和视皮层损伤后功能恢复有关，本文就此作一综述。     

陈氏太极无极桩导引法干预一线救治新型冠状病毒肺炎医护身心健康的思路

本文从一线救治新型冠状病毒肺炎医护的心理健康介入陈氏太极无极桩导引法作为切入点,剖析练习陈氏太极无极桩导引法在干预一线救治新型冠状病毒肺炎医护心理健康的作用,总结推广陈氏太极无极桩导引法价值及社会意义,并建议进一步做好该导引功法的研究,使其既有助于全民健康,也能在这次突发的新冠肺炎疫情中发挥优势。     

仰卧位整复推拿治疗颈源性头痛30例

颈源性头痛是指由颈枕部或／及肩部组织的器质性或功能性病损所致的以同侧头痛为主的综合征。临床上以推拿治疗效果明显。为探讨临床常用的仰卧位整复推拿法的临床疗效，我们自2004年起运用仰卧位整复推拿法治疗该病，并设立药物治疗作为对照组，现报道如下。     

七氟醚复合丙泊酚在小儿气道异物取出术中的麻醉效果

Objective To observe the anesthetic effect of sevoflurane combined with propofol total general anaesthesia in children undergoing tracheal foreign body removal. Methods Sixty patients aged from 1 to 4 years admitted for tracheal foreign body removal were randomly divided into two groups : sevoflurane group (n = 30) and ketamine group (n = 30). In the sevoflurane group, anaesthesia was induced and maintained with inhalation of sevoflurane and propofol [1.5 mg/(kg · h)] was administered continuously for anesthesia maintenance by micro-pump during operation. The ketamine group were pre-medicated with ketamine 6 mg/kg i. m for sedation, then an-aesthesia was induced with midazolam 0.1 mg/kg and ketamine 1.5 mg/kg i. v and was maintained with intravenous bolus of ketamine. Systolic blood pressure(SBP), Diastolic blood pressure(DBP) ,heart rate(HR) and saturation of percutaneous oxygen(SPO2) were monitored in both groups before anaesthesia inducation (T0) , after anaesthesia inducation and before operation (T1), at the time point of bronchial endoscopy(T2) ,endoscope remoral (T3) ,con-sciousness recovery(T4). The operation condition was evaluated by surgeons, and the incidence of bronchial spasm, glossal drop, nausea and vomiting were recorded both during operation and after operation. Results The SBP and HR increased at the time point of bronchial endoscopy in two groups and decreased after anaesthesia inducation in aevoflurane group. The SPO2 increased in two group after anaesthesia inducation. Compared with ketamine group, the time of consciousness recovery was shorter markedly in sevoflurane group. The occurrence of postoperative glossal drop was higher in ketamine group. Conclusion Sevoflurane combined with propofol is safe and effective during general anaesthesia of children undergoing tracheal foreign body removal.     

不同剂量罗库溴铵对血浆去甲肾上腺素水平的影响

目的:观察不同剂量罗库溴铵对兔血浆去甲肾上腺素水平的影响.方法:新西兰大白兔49只,随机分为7组,每组7只.静脉注射罗库溴铵,剂量分别为:A组0.07 mg kg-1,B组0.1 mg kg-1,D组0.3 mg kg-1,E组0.6 mg kg-1,F组1 mg kg-1,G组1.5 mg kg-1;C组生理盐水3ml.静脉给药后检测不同时间点血浆去甲肾上腺素的浓度,并记录平均动脉压和心率的变化.结果:给药后,A、B、C组血浆去甲肾上腺素浓度变化不明显(P＞0.05).D、E、F、G组在给药后2min血浆去甲肾上腺素浓度便明显升高(P＜0.05),10min后达到峰值,D组在15min后恢复到给药前水平(P＞0.05),E、F、G组在30min后恢复到给药前水平.A、B、C组给药后不同时间点平均动脉压无变化(P＞0.05);D组和E组给药后5min血压有明显升高(P＜0.01),F组和G组在给药后2min血压开始升高(P＜0.01).D组10min后恢复到给药前血压水平(P＞0.05),E、F、G组均在30min时血压恢复到给药前水平(P＞0.05).A、B、C、D组给药后心率变化不明显(P＞0.05),E、F、G组在给药后2min心率有所下降,5min后E、F组心率与给药前无差异(P＞0.05),10min后G组心率恢复到给药前水平.结论:罗库溴铵于ED50～3ED90剂量时对血浆去甲肾上腺素浓度无明显影响,血压和心率也无明显改变;当其剂量达到或超过6ED90时,血浆去甲浆肾上腺素浓度明显升高,平均动脉压一过性升高,心率轻微降低,但维持时间较短暂.     

依托咪酯与异丙酚复合芬太尼用于无痛人流麻醉的临床观察

目的观察依托咪酯和异丙酚复合芬太尼应用于无痛人流术的麻醉效果。方法要求行人工流产术妇女180例,随机分为三组,C组不用任何麻醉药及镇痛药;A组静脉推注芬太尼1μɡ/kg后静脉推注依托咪酯0.3mg/kg;B组静脉推注芬太尼1μɡ/kg后静脉推注异丙酚2.0mg/kg。监测人流术前、术中以及术后的平均动脉压(MAP)、心率(HR)、呼吸频率(RR)、脉搏氧饱和度(SpO2)变化;进行镇痛效果评价并观察术中出血量、人流综合征的发生情况以及术后恶心呕吐情况;记录患者苏醒时间和离院时间。结果A组患者MAP在给药后无明显变化;B组患者MAP在给药后1-3分钟有轻微下降(p<0.05)。A、B两组患者心率在给药后均有所降低(p<0.05)。给药后,A、B两组患者自主呼吸频率明显减缓,10分钟后恢复到给药前水平;两组血氧饱和度有所下降,但不明显(p>0.05)。A、B两组镇痛效果明显优于C组(p<0.05);A、B两组镇痛效果差别无显著性(p>0.05)。A组离院时间较B组有所延长(p<0.05)。A、B两组人流综合症发生情况和恶心呕吐发生率明显低于C组(p<0.05)。结论采用依托咪酯或异丙酚复合小剂量芬太尼应用于无痛人流术中,均可产生良好的麻醉与镇痛效果。     

体外循环对血小板数量和功能的影响及机制

体外循环(ECC)后大多数患者血小板数量和功能均下降。一些患者在术后由于血小板数量减少或功能异常而出现凝血功能紊乱、出血、形成血栓、延长住院时间,甚至死亡。ECC本身,以及ECC期间使用的药物等均有可能导致患者血小板数量下降或功能异常。本文就ECC后血小板变化情况和其机制进行综述讨论以期对ECC期间及术后对血小板保护提供参考,改善心脏手术患者预后。