全凭静脉与吸入全身麻醉苏醒期躁动发生率的临床观察

目的比较丙泊酚、地氟烷、七氟烷复合瑞芬太尼全身麻醉苏醒期躁动的发生情况。方法90例ASAⅠ～Ⅱ级择期全身麻醉下行乳腺癌根治术及鼓室成形术。随机分成三组：丙泊酚组、地氟烷组、七氟烷组。观察各组苏醒期躁动发生率和睁眼时间、拔管时间,监测躁动发生前后血压、心率及脉搏血氧饱和度。结果地氟烷组和七氟烷组苏醒期躁动发生率分别为31．03％和33．33％,高于丙泊酚组的3．33％（P〈0．05）;睁眼时间、拔管时间差异不具有显著性意义（P〉0．05）;躁动发生前后血压、脉搏血氧饱和度差异无显著性意义（P〉0．05）,而心率在躁动发生后明显增快（P〈0．05）。结论地氟烷、七氟烷吸入麻醉苏醒期躁动发生率明显高于丙泊酚全身麻醉。     

七氟醚用于成人全身吸入麻醉的随机、开放、多中心、阳性对照临床研究

目的评估七氟醚和异氟醚全身麻醉后的苏醒时间及其安全性。方法前瞻性、开放、随机、多中心、异氟醚平行对照临床研究,222例手术时需要全身麻醉、气管插管、预计手术持续时间在2～3h之间的成年择期手术患者,按1:1随机入组接受七氟醚或异氟醚吸入麻醉。评估苏醒时间、拔管时间、改良Aldrete评分达到9分时间、苏醒时间和麻醉药用量之间的关系。根据生命体征、记录的不良事件评价其安全性。结果222例患者中220例完成全部研究过程,其中七氟醚组111例,异氟醚组109例。与异氟醚组相比,七氟醚组苏醒时间缩短5.4min、改良Aldrete评分达到9分时间缩短8.4min、拔管时间缩短4.6min(P<0.01)。两组苏醒时间与麻醉药用量之间均具有相关性,即麻醉药用量越大苏醒时间越长。七氟醚组发生的不良事件均为轻度或中度,且不良事件类型和发生率与异氟醚组相似。结论七氟醚全麻恢复效果优于异氟醚,且安全性和耐受性良好。     

Effectiveness of Montessori-based activities on agitation among Asian patients with dementia: A systematic review and meta-analysis

Objectives:Montessori based activity are supposed to be an effective nonpharmacological intervention in the treatment of agitation in western countries. However, most studies conducted to evaluate the effectiveness of Montessori based activities on agitation in Asian patients were small sample size, as well as inconsistent outcomes, which may limit the reliability of the conclusions. The present pooled analysis, hence, was conducted to evaluate the effectiveness of the activity on agitation related with dementia in Asian patients with dementia.Design:Prospective randomized clinical studies were included, of which available data was extracted. Outcomes of physical aggressive behaviors, physical nonaggressive behaviors, and verbal aggressive behaviors were pooled for the analysis by weighted mean differences.Data sources:Medline, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), WanFang, and China Science and Technology Journal Database (VIP)Eligibility criteria:Prospective, randomized, controlled clinical studies, conducted to evaluate the effectiveness of the activity on agitation related with dementia in Asian patients with dementia.Data extraction and synthesis:Available data including baseline characteristics and interested outcomes from the included literature were extracted independently by 2 investigators. Measuring scales including CMAI and NOSIE were adopted for the efficacy comparison between Montessori based activity and standard activity. Weighted mean difference was used for the pooled analysis.Results:A total of 460 participants were included in the present meta-analysis. The pooled mean difference agitation for Montessori based activity was –3.86 (95% CI: –7.38 to –0.34, P = 0.03) comparing to standard activity. The pooled mean differences for physical aggressive behaviors, physical nonaggressive behaviors, and verbal aggressive behaviors in Montessori based activity group were –0.82 (95% CI: –1.10 to –0.55; P < 0.00001), –0.81 (95% CI: –1.68 to 0.55; P = 0.07), and 0.38 (95% CI: –0.92 to 1.68; P = 0.57).Conclusions:Montessori based activities may reduce the frequency of agitation, especially in physical aggressive behaviors comparing to standard activities in Asian patients with dementia. However, the effectiveness of Montessori based activities on reduction of subcategorized agitated behaviors including physical nonaggressive behaviors, and verbal aggressive behaviors may not be reliable as physical aggressive behaviors.     

喉罩通气在成人中耳显微手术中的应用

目的评价喉罩通气在全身麻醉中耳显微手术中的安全性和有效性。方法 100例美国麻醉医师协会（ASA）Ⅰ-Ⅱ级择期行中耳显微手术的成年中耳炎患者,随机分为喉罩组（LMA组,n=50）和气管插管组（ETT组,n=50）。记录患者进入手术室至手术开始的时间,各时间点的心率和血压变化：麻醉前（T0）、插管/罩前即刻（T1）、插管/罩后即刻（T2）、拔管/罩前即刻（T3）、拔管/罩后即刻（T4）。记录2组患者插管/罩时体动或呛咳和拔管/罩时的呛咳反应。记录手术结束至拔除管/罩的时间和麻醉恢复室停留时间。结果喉罩组患者进入手术室至手术开始时间低于气管插管组（P〈0.05）;喉罩组和气管插管组T1时平均动脉压（MAP）、心率显著低于T0时（P〈0.05）;气管插管组T2和T4时MAP和心率较T0时显著升高（P〈0.05）;组间比较T2和T4时气管插管组MAP和心率均显著高于喉罩组（P〈0.05）。置入管/罩及拔管/罩时气管插管组呛咳发生率分别为25%和84%,明显高于喉罩组的0和4%（P〈0.05）。气管插管组手术结束至拔除通气装置的时间高于喉罩组（P〈0.05）。结论喉罩通气用于成人中耳显微手术气道管理,易于维持血流动力学稳定,有效避免了拔管时呛咳。     

应用Narcotrend监测麻醉苏醒期患者意识

目的:观察不同麻醉维持方法下Narcotrend(NT)在全麻苏醒期对患者意识监测的准确性。方法:将ASAⅠ-Ⅱ级、择期腹腔镜胆囊切除术的60例患者作为研究对象。术中麻醉维持随机分为丙泊酚-瑞芬太尼组和七氟醚组,每组各30例。2组均采用NT监测镇静深度并统计术毕患者睁眼时的NT和时间,继而计算受试者工作特征曲线下面积(AUCROC)来判断NT对意识恢复判断的准确性。结果:2组比较,睁眼时NT值无显著性差异(P>0.05),睁眼时间有显著性差异(P<0.05)。丙泊酚-瑞芬太尼组和七氟醚组的AUCROC分别为0.913和0.920。结论:无论丙泊酚-瑞芬太尼全凭静脉或七氟醚吸入维持全身麻醉,NT均可准确反映患者意识变化。     

舒芬太尼与芬太尼在开胸术后全麻苏醒期镇静观察

目的比较舒芬太尼和芬太尼对择期开胸术全麻术后苏醒期患者的镇静效果。方法将42例行择期开胸手术的患者随机分为芬太尼组和舒芬太尼组。在手术结束前10min,分别给予芬太尼和舒芬太尼。观察两组患者术后的自主呼吸恢复时间、睁眼时间、拔管时间、麻醉恢复室的时间;拔管即刻、拔管后3min、出麻醉恢复室时的Ramsay镇静评分、躁动评分,并进行统计学分析。结果舒芬太尼组的Ramsay镇静评分明显高于芬太尼组,而其躁动评分低于芬太尼组。结论与芬太尼组比较,开胸患者手术结束前加用舒芬太尼能明显减少术后全麻苏醒期躁动的发生率,有利于患者的术后康复,减少术后并发症的发生。     

右美托咪定对七氟醚复合骶管阻滞小儿麻醒期躁动的预防作用及炎症应激反应的影响

目的:研究右美托咪定对七氟醚复合骶管阻滞小儿麻醒期躁动的预防作用及炎症应激反应的影响.方法:将2012年3月～2014年6月期间在我院接受腹部以下手术的90例患儿纳入研究,随机分为两组,并接受七氟醚复合骶管阻滞麻醉,观察组在麻醉诱导完成后给予右美托咪定静脉注射,对照组给予等剂量生理盐水静脉注射,比较两组患儿的生命体征指标、炎症反应指标以及应激反应指标.结果:(1)生命体征:观察组患儿的心率(HR)、心脏指数(CI)和心脏与收缩压乘积(RPP)均低于对照组(P＜0.05);(2)炎症反应:观察组患儿的磷脂肌醇3激酶(PI3K)、内皮素-1(ET-1)含量低于对照组,一氧化氮(NO)含量高于对照组(P＜0.05);(3)应激反应:观察组患儿的皮质醇、醛固酮以及血糖水平低于对照组(P＜0.05).结论:右美托咪定有助于稳定生命体征、缓解炎症和应激反应,是小儿七氟醚复合骶管阻滞麻醉后预防苏醒期躁动的理想方法.     

舒芬太尼和曲马多预处理对小儿苏醒期躁动影响的比较

目的:比较舒芬太尼、曲马多预处理对小儿腺样体+扁桃体摘除手术全身麻醉苏醒期躁动(EA)的影响。方法:3~7岁行腺样体+扁桃体摘除手术小儿54例,随机分为3组:对照组(C组)、舒芬太尼组(S组)、曲马多组(T组),分别在手术结束前5 min静脉注射生理盐水5 ml、舒芬太尼0.1μg/kg、曲马多1 mg/kg,观察记录各组患儿在注药前(T1)、术后5 min(T2)、拔管前(T3)、拔管后10 min(T4)时的心率(HR)、平均动脉压(MAP);记录患儿手术时间(Ts)、苏醒时间(Ta);使用小儿麻醉苏醒期躁动量表(PAED)对苏醒时小儿进行躁动评分。结果:T2时3组的HR、MAP比T1时有不同程度降低;与T1时比较,T3、T4时3组的HR、MAP升高(P<0.05)。T3、T4时S组、T组的HR、MAP较C组降低(P<0.05);与C组比较,S组、T组的Ta延长,PAED评分和躁动发生率降低(P<0.05)。结论:舒芬太尼或曲马多预处理都可以降低小儿腺样体+扁桃体摘除手术全身麻醉拔管时的心血管反应,减少苏醒期躁动,但可致苏醒时间延长。     

Zuclopenthixol,melperone and haloperidol/levomepromazine in the elderly. Meta-analysis of two double-blind trials at 15 nursing homes in Norway

Summary

A meta-analysis was carried out of the data from two double-blind. multi-centre studies with identical methodology which compared the effectiveness of treatment of elderly patients with zuclopenthixol and with other antipsychotic drugs. In one study, patients were treated for 4 weeks with either zuclopenthixol or melperone; in the other, with either zuclopenthixol or a combination of haloperidol and levomepromazine. The meta-analysis evaluated the results of 96 patients, 49 in the zuclopenthixol group and 47 in the comparison group. Doses, which were adjusted to individual patient's needs, were low as shown by the percentages of defined daily doses for each of the study drugs. The results indicated that all three treatment alternatives were effective in the treatment of elderly patients with symptoms of agitation and hostility/aggressiveness. There was a trend, however, for zuclopenthixol to have a more rapid onset of effect. Zuclopenthixol also has the advantage for both patients and nursing stuff that dosage is once daily. Only few and mild side-effects were reported with the three drug regimens.