喉罩全麻在颈动脉狭窄造影及介入治疗术中的应用

目的：观察喉罩全麻下行颈动脉狭窄的造影诊断及介入治疗术的临床效果。方法：择期DSA下颈动脉狭窄患者23例，年龄42-78岁，无明显肺部疾患及喉罩禁忌症患者，异丙酚（Pmpofol）泵入静脉全麻下插入喉罩完成手术，观察其不同时段的BP（MAP）、SpO2、HR、ECG（ST-Ⅱ）。结果：各时段的BP（MAP）、Sp02、HR、ECG（ST-Ⅱ）比较无显著性差异。结论：喉罩全麻在行颈动脉狭窄的造影诊断及介入治疗术的临床效果是肯定的。喉罩全麻颈动脉狭窄造影介入治疗     

The haemodynamic response to the insertion of the laryngeal mask airway: a comparison with laryngoscopy and tracheal intubation

The haemodynamic response to the insertion of the laryngeal mask airway (LMA) was assessed and compared to that of laryngoscopy and tracheal intubation in a study of forty patients (ASA 1) randomly allocated into two groups and anaesthetised using a standard balanced anaesthetic technique. The results show that the changes in all cardiovascular parameters measured following LMA insertion were significantly less (P<0.05) when compared with those following laryngoscopy and tracheal intubation. We conclude that airway management with the LMA may be used to avoid the haemodynamic response to tracheal intubation where such a response is undersirable.     

LMAsupreme^TM喉罩与气管插管静脉全麻在腹腔镜直肠癌切除手术中的应用

目的：探讨LMAsupreme ^TM喉罩和气管插管静脉全麻两种方法用于腹腔镜直肠癌切除手术时对患者血流动力学、呼吸参数变化及术中术后不良反应发生率的影响,评估LMAsupreme^TM喉罩在腹腔镜直肠癌切除术中应用的安全性及优越性。方法：选择腹腔镜直肠癌切除手术患者40例,ASAⅠ～Ⅱ级,随机分成2组,即LMAsupreme^TM喉罩组（s组）和气管插管组（T组）,每组20例。麻醉诱导后分别插入LMAsupreme^TM喉罩和气管插管,记录并比较两组在麻醉诱导前、喉罩和气管导管插入前即刻及插入后即刻、1min和5min时收缩压（SBP）、舒张压（DBP）、心率（HR）。记录建立二氧化碳（CO2）气腹前、后和体位改变后气道平台压（Pplat）、气道峰压（Ppeak）;观察手术过程中返流误吸、术后声嘶、咽痛、呛咳不良反应。结果：与T组比较,S组血流动力学平稳（P〈0．05）,呼吸参数稳定变化小（P〈0．05）,术中发生返流误吸无统计学差异,术后声嘶、咽痛、呛咳显著减少（P〈0．05）。结论：LMAsupremeTM喉罩在腹腔镜直肠癌切除术中应用能达到与气管导管同样的通气效果,对麻醉过程中血流动力学、呼吸参数影响更小,术中术后不良反应显著减少,且操作简单、易学,与气管插管方法相比在临床应用有更好的安全性及优越性。     

两种喉罩定位方法在鼻内窥镜手术中的应用

目的 观察听诊和纤维支气管镜评分两种喉罩定位方法在鼻内窥镜手术中的应用.方法 将60例使用喉罩通气全麻的成年患者随机分为2组,分别通过听诊法(L组)和纤维支气管镜评分法(F组)评估喉罩位置,记录置人情况和纤维支气管镜评分,潮气量(Vt)、呼气末二氧化碳分压(PETCO2)、气道峰压(Peak)和最大漏气压.结果 听诊法和纤维支气管镜评分法判断喉罩对位后,两组患者最大漏气压、Vt、PErCO2、Peak差异均无统计学意义(P＞0.05).L组喉罩一次到位成功25例,明显高于F组(15例,P＜0.05).两组患者喉罩对位后纤支镜评分差异有统计学意义(P＜0.05),L组有15例患者纤支镜评分为2分,F组所有患者评分均在3分以上.结论 采用听诊法和纤维支气管镜评分定位法判断喉罩对位都可以满足临床通气需要.听诊法简单可靠,即使纤支镜评分2分,也可达到良好的通气和密闭效果,满足手术需要.     

Comparative study between Air-Q and Intubating Laryngeal Mask Airway when used as conduit for fiber-optic

This study compared Air-Q and Intubating LMA when used as a conduit for endotracheal intubation.MethodsOne hundred patients scheduled for surgical operations under general anesthesia were randomly allocated into two equal groups (n = 50). Group I: Air-Q and group II: Intubating Laryngeal Mask Airway (ILMA) in both groups intubation was done by Fiberoptic bronchoscope (FOB) through study device. After induction of anesthesia, patients were ventilated with Air-Q or ILMA. Then, endotracheal tube (ETT) was inserted through study device. Recorded measurements were as follows: number of attempts and duration of insertion of device, peak airway pressure and fiberoptic grading of laryngeal view. Also, we recorded number of attempts and duration of insertion of ETT and the incidence of blood stain on device and sore throat grading.ResultsDuration of insertion of Air-Q was 13.300 ± 3.471 s, whilst that of ILMA was 19.640 ± 4.737 s (p < 0.001). In group I, peak airway pressure was 26.400 ± 2.176 cmH₂O, whilst, in group II, it was 25.260 ± 1.468 cmH₂O (p < 0.01). Full view of vocal cords amounted to 78% and 26% of Groups I and II patients, respectively (p < 0.001). Time of insertion of ETT was 33.5 ± 6.795 s in group I, whilst in group II, it was 39.5 ± 6.566 s (p < 0.001). Blood stain was found on supraglottic device in 46% and 22% of cases in Groups I and II, respectively (p < 0.01).ConclusionAir-Q proved to be an excellent conduit for endotracheal intubation compared to the ILMA.     

I-gel喉罩全麻对介入手术患者机体应激反应的影响

目的使用I—gel喉罩进行介入手术的全身麻醉,研究对手术患者机体应激反应的影响。方法60例介入手术患者,随机分为两组（n=30）,常规气管插管组（E组）,I-gel喉罩组（I组）。麻醉诱导后,分别置入气管插管和I—gel喉罩。于麻醉前（T,）、插管后（T2）、麻醉苏醒后（L）、及术后24h（T4）,各时间点记录循环和呼吸变化,并抽取静脉血标本,用放射免疫法检测血浆皮质醇（Cor）,血管紧张素（AngII）水平变化。结果I组较E组在T2和T3时点的BP和HR明显降低（P〈0．05）,差异有显著性。在T2、T3时,I组患者Cor水平明显低于E组（P〈0．05）,在L时,I组患者Angll水平明显低于E组（P〈0．05）。结论I-gel喉罩全麻能有效地降低机体手术创伤和心理应激反应影响,血液动力学稳定性好,具有安全性和可行性。     

Monoliths with chiral surface functionalization for enantioselective capillary electrochromatography

The state-of-the-art in CEC enantiomer separations with monolithic capillary columns is comprehensively reviewed. The various types of monolithic columns comprising in situ organic polymer monoliths, molecularly imprinted polymer (MIP) monoliths, silica monoliths and monoliths made from particles are discussed with a focus on materials’ synthesis, chemistry and properties as well as column aspects. Monolithic MIP-type porous layer open-tubular (PLOT) columns are treated herein as well. From this survey of the literature, the authors come to the conclusion that monolithic silica capillaries appear to become the preferred column type for CEC enantiomer separations of low-molecular drugs and other chiral pharmaceuticals or chemicals.     

食管引流型喉罩在腹腔镜胆囊摘除术中的应用

目的探讨食管引流型喉罩通气道在腹腔镜胆囊摘除术全麻中应用的安全性。方法80例腹腔镜胆囊摘除术患者随机分为喉罩组（Ⅰ组,n=40）和气管插管组（Ⅱ组,n=40）,监测2组插管前,插管后即刻,拔管期心率（HR）、收缩压（SBP）、舒张压（DBP）及拔管期出现呛咳、体动等发生率。结果Ⅰ组置入喉罩即刻及拔管期HR、SBP、DBP无明显变化（P〉0．05）,拔管期呛咳、体动发生率低（P〈0．05）;Ⅱ组气管插管后即刻及拔管期HR、SDP、DBP有显著变化（P〈0．05）,拔管期呛咳、体动发生率高（P〈0．05）。结论食管引流型喉罩通气道全身麻醉方法具有操作简单,血流动力学平稳,能维持有效通气,呼吸道并发症少等优点,而且安全性比气管插管明显提高,对呼吸道损伤小,适合腹腔镜胆囊摘除术的患者。     

国家起源:一种新契约论

国家是拥有最高权力的社会,它区别于其他社会的根本性质是最高权力。因此,哪里有最高权力,哪里就有国家;最高权力的起源就是国家的起源。最高权力必然产生、形成和起源于社会成员的普遍同意或契约;因为一切权力——最高权力并不例外——都具有同意或契约的性质：权力是仅为管理者拥有且被社会成员普遍同意的迫使被管理者服从的强制力量。因此,人类一切社会——从家庭到国家——无不必然源于某种契约：社会必然源于人们就“权力”问题所缔结的契约;国家则必然源于人们就“最高权力”问题所缔结的契约。