Ondansetron预防眼科全麻术后恶心、呕吐的临床观察

Ondansetron是一种新型的强效、具有高度选择性的5-HT3受体拮抗剂,已广泛用于癌症病人化疗所致的恶心、呕吐的预防和治疗。最近有研究表明Ondansetron对术后恶心、呕吐有预防和治疗效果。我院于2001年1～4月对眼科全麻手术病人用或不用Ondansetron的术后恶心、呕吐的发病情况进行了双盲法比较观察,以探讨Ondansetron预防和治疗术后恶心、呕吐的效果。     

异丙酚复合瑞芬太尼与七氟烷复合芬太尼对斜视术后麻醉恢复的对比研究

目的 比较异丙酚复合瑞芬太尼与七氟烷复合芬太尼对全麻术后快速动眼运动恢复时间的影响.方法 60例成年患者,随机分为两组,每组30例.R组(异丙酚复合瑞芬太尼)用异丙酚复合瑞芬太尼进行诱导及麻醉维持,S组(七氟烷复合芬太尼)用异丙酚及芬太尼诱导,七氟烷维持麻醉.麻醉停药后开始每2分钟评价麻醉恢复程度.至患者可行快速动眼运动为恢复时间,麻醉恢复后开始进行眼科评价.结果 快速动眼运动平均恢复时间,R组短于S组[(14.72±5.10)min比(23.43±5.52)min,P=0.000],差异有统计学意义.术后S组恶心呕吐发生率高于R组(37%比10%,P=0.037),差异有统计学意义.结论 需要进行即时术后眼科评估的斜视手术中,异丙酚复合瑞芬太尼更有优势.     

自控镇静镇痛在斜视手术的应用

目的探讨患者自控镇静镇痛(PCSA)在斜视手术的应用。方法将68例斜视手术患者随机分为舒芬太尼联合异丙酚PCSA组(P组)和单纯局麻组(C组)。P组局麻辅以PCSA。术中观察收缩压、心率、镇静评分、患者合作度评分、满意度评分、疼痛评分及眼心反射、低氧血症等不良反应。结果与基础值比较,P组仅术中10min的收缩压升高、心率加快;C组术中各时点均显著升高。P组镇静评分、合作度和满意度评分显著高于C组,而疼痛评分、躁动、呻吟发生率显著低于C组。结论舒芬太尼联合异丙酚PCSA应用于斜视手术是安全有效的麻醉方式。     

术前应用氟比洛芬酯与阿扎司琼对小儿斜视矫正术术后疼痛及呕吐的影响

Objective To study the effect of preoperative flurbiprofen axetil combined with azasetron on postoperative pain and nausea and vomiting in children undergoing strabismus surgery. Methods A total of 60 children, ASA Ⅰ -Ⅱ, aged 8-14, scheduled for strabismus surgery with total intravenous general anesthesia were randomly assigned to 3 groups(n=20). In group FA, flurbiprofen axetil(1mg/kg)combined with azasetron(0.2mg/kg)was intravenously injected; only flurbiprofen axetil(1mg/kg)was give in group F and only azasetron(0.2mg/kg)was injected in group A. The above drugs were all administered 10 min before the anesthetic induction. VAS scores and glucose at the end of surgery and after surgery were recorded individually.The incidence rate of restless, nausea and vomiting after surgery were recorded. Results The incidence rate of pain in group FA and group F were significantly lower than that in group A(P <0.05). The postoperative glucose in group A were significantly higher than that in group FA and group F(P <0.05). The incidence rate of nausea and vomiting in group FA and group A were significantly lower compared with group F(P <0.05).Conclusions Flurbiprofen axetil combined with Azasetron can reduce the adverse reactions, such as pain,nausea and vomiting in children undergoing strabismus surgery.     

罗哌卡因在眼科局麻手术中的应用

目的:评价罗哌卡因在眼科局麻手术应用中的优越性。方法:选择200例需要做眼科手术的病人,由手术医生吸取20mg/mL利多卡因5mL及7.5mg/mL罗哌卡因5mL混和后根据手术要求给病人作球后或球周、眼轮匝肌阻滞及结膜下侵润等局部麻醉。结果:200例病人均能在局部麻醉下顺利完成手术,术中生命体征监测与术前无明显改变,未出现全身毒性反应及其他严重不良反应者。术后对受试者就术中疼痛情况进行视觉模拟评分法(VAS),在200例受试者中,其中评为“优”者为181例,“良”者为17例,“可”者为2例。结论:0.75％罗哌卡因在眼科局麻手术应用中有一定的优越性,值得在眼科手术中推广应用。     

高乌甲素贴片用于翼状胬肉切除术后镇痛的临床研究

目的研究高乌甲素贴片用于翼状胬肉切除术后镇痛的效果及不良反应,以评价其有效性和安全性。方法90例行胬肉切除术的患者,随机分成3组：对照组A组,高乌甲素组B组和芬必得组C组。手术结束后,A组不作任何镇痛;B组于手术开始时予高乌甲素贴片贴于双耳后;C组于术毕予口服芬必得胶囊1粒(20mg)。观察指标：各组发生术后疼痛的人数、疼痛的严重程度(VAS评分法)、病人对止痛药物的满意度及副作用。结果(1)B、C组术后疼痛的发生率及VAS评分均明显小于A组;(2)B、C组术后疼痛的发生率及VAS评分组间比较无明显差异,但B组的病人对止痛药物的满意度高于C组。结论高乌甲素贴片可有效地治疗胬肉切除术后的疼痛,与口服镇痛药相比镇痛效能相若;其用药方法简便,不良反应较少,患者的整体满意度高。     

术前应用氟比洛芬酯与阿扎司琼对小儿斜视矫正术术后疼痛及呕吐的影响

目的 观察术前联合应用氟比洛芬酯与阿扎司琼对小儿斜视矫正术术后疼痛及恶心呕吐的影响.方法 临床病例对照研究.选择中山大学中山眼科中心就诊的60例按美国麻醉医师协会(ASA)标准的Ⅰ～Ⅱ级、年龄8～14岁、择期行斜视矫正术的患儿,均采用异丙酚、芬太尼及阿曲库胺全凭静脉麻醉,根据诱导前辅助用药的不同随机分为3组(n=20):FA组静脉推注氟比洛芬酯1mg/kg+阿扎司琼0.2mg/kg;F组给予氟比洛芬酯1mg/kg+等量生理盐水;A组给予阿扎司琼0.2mg/kg+等量生理盐水,均在诱导前10min静脉注射.观察术前、术始、术毕、术后各时点的镇痛评分(VAS)及血糖变化,并观察各组苏醒期躁动、术后咽喉部疼痛及恶心、呕吐等不良反应发生情况.结果 FA组和F组术后V.AS评分显著低于A组(P<0.05),术后各时点A组血糖水平明显高于FA组和F组(P<0.05),FA组和A组术后恶心呕吐发生率明显低于F组(P<0.05).结论 术前氟比洛芬酯与阿扎司琼联合应用于小儿斜视矫正术既可明显改善术后疼痛又能减少恶心呕吐等不良反应.

Abstract：

Objective To study the effect of preoperative flurbiprofen axetil combined with azasetron on postoperative pain and nausea and vomiting in children undergoing strabismus surgery. Methods A total of 60 children, ASA Ⅰ -Ⅱ, aged 8-14, scheduled for strabismus surgery with total intravenous general anesthesia were randomly assigned to 3 groups(n=20). In group FA, flurbiprofen axetil(1mg/kg)combined with azasetron(0.2mg/kg)was intravenously injected; only flurbiprofen axetil(1mg/kg)was give in group F and only azasetron(0.2mg/kg)was injected in group A. The above drugs were all administered 10 min before the anesthetic induction. VAS scores and glucose at the end of surgery and after surgery were recorded individually.The incidence rate of restless, nausea and vomiting after surgery were recorded. Results The incidence rate of pain in group FA and group F were significantly lower than that in group A(P <0.05). The postoperative glucose in group A were significantly higher than that in group FA and group F(P <0.05). The incidence rate of nausea and vomiting in group FA and group A were significantly lower compared with group F(P <0.05).Conclusions Flurbiprofen axetil combined with Azasetron can reduce the adverse reactions, such as pain,nausea and vomiting in children undergoing strabismus surgery.     

自控镇静镇痛在斜视手术的应用

目的探讨患者自控镇静镇痛（PCSA）在斜视手术的应用。方法将68例斜视手术患者随机分为舒芬太尼联合异丙酚PCSA组（P组）和单纯局麻组（C组）。P组局麻辅以PCSA。术中观察收缩压、心率、镇静评分、患者合作度评分、满意度评分、疼痛评分及眼心反射、低氧血症等不良反应。结果与基础值比较。P组仅术中10min的收缩压升高、心率加快；C组术中各时点均显著升高。P组镇静评分、合作度和满意度评分显著高于C组，而疼痛评分、躁动、呻吟发生率显著低于C组。结论舒芬太尼联合异丙酚PCSA应用于斜视手术是安全有效的麻醉方式。