右美托咪啶辅助表面麻醉用于患者支气管肺泡灌洗术的效果

Objective To investigate the efficacy of dexmedetomidine-assisted topical anesthesia in patients undergoing bronchoalveolar lavage ( BAL). Methods Twenty-four ASA Ⅱ or Ⅲ patients in ICU, aged 24-64 yr, weighing 50-80 kg, scheduled for BAL, were randomly divided into 2 groups ( n = 12 each) : topical anesthesia group (group A) , topical anesthesia + dexmedetomidine group (group B) . In group A, 0.9% normal saline 5 ml was injected intravenously 30 min before operation, 2% lidocaine 5-10 ml was given via a tracheal tube or cannula 5 min before operation and then an increment of 2% lidocaine 5 ml was given using fibreoptic bronchoscope every 15-30 min as required (the total amount was within 20 ml) . In group B, dexmedetomidine 0.5-1.0 μg/kg was injected (time of injection≥ 10 min) followed by infusion at 0.1-0.5 μg·kg-1 ·h-1 and the topical anesthesia was performed as the method described in group A. The time of lavage, adverse reactions and adverse cardiovascular events were recorded. Blood samples were taken 20 min before lavage, 20 min after the start of lavage and 20 min after the end of lavage (T1-3 ) for determination of the concentrations of plasma catecholamine and serum cortisol. Results The incidences of adverse reactions and adverse cardiovascular events were significantly lower and the operation time was significantly shorter in group B than in group A ( P < 0.05). The concentrations of plasma catecholamine and serum cortisol were significantly higher at T2,3 in group A, while lower at T2,3 in group B than at T1 ( P < 0.05) . The concentrations of plasma catecholamine and serum cortisol were significantly lower in group B than in group A ( P < 0.05). Conclusion Dexmedetomidine-assisted topical anesthesia can be used safely and effectively in BAL.     

产后出血的急救措施与护理体会

产后出血是产后常见的最严重的并发症之一，也是导致产妇死亡的主要原因之一。近年由于加强了孕妇产期的保健，特别是对孕妇孕期、产时、产后出血的防治与护理，降低了产后出血的发生率及病死率。2004年我院有3800例产妇分娩，经阴道分娩2200例，剖宫产1600例，共发生产后出血6例，无一例产妇因产后出血而死亡。现将产后出血的急救护理措施总结如下。     

一种检测气管导管位置的新方法

气管插管操作不当会造成气管导管误入食管,误入一侧支气管或滑出气管,发现不及时会产生严重后果。目前临床上一般采用听诊,支气管镜检查,呼气末CO2检测,变色试纸等方法来判断。本文利用Hall传感器可以检测微     

锚状电极高温射频消融对正常兔肺组织作用安全性和有效性的研究

目的　探讨多电极高温射频对正常肺组织作用的生物学效应和作用方式 ,为多电极射频治疗肺肿瘤提供实验依据。方法　CT引导经皮肺穿刺 ,将电极定位于新西兰白兔右肺下叶行射频消融。电极展开的直径为 1 .5cm。起始功率 2 0W ,每分钟上升 1 0W ,一直到阻抗上升至999Ω完成治疗。射频消融后即刻观察肺组织及细胞的变化。结果　所有实验动物均能安全地耐受射频消融。CT扫描可见右肺下叶一椭圆形的密度增高区 ,直径为 (1 .9± 0 .2 )cm。镜下可见毁损灶发生凝固性坏死 ,直径为 (1 .8± 0 .2 )cm ,外周为 2～ 3mm红色充血区。气胸的发生率 6/ 2 0(30 % ) ,血胸发生率 2 / 2 0 (1 0 % )。结论　多电极高温射频作用于肺组织 ,引起一定范围的组织凝固性坏死 ,其安全性及有效性有待进一步临床观察     

右美托咪啶辅助表面麻醉用于患者支气管肺泡灌洗术的效果

目的 探讨右美托咪啶辅助表面麻醉用于患者支气管肺泡灌洗术的效果.方法 拟行支气管肺泡灌洗术的ICU患者24例,ASA分级Ⅱ或Ⅲ级,体重50～80 kg,年龄24～64岁,采用随机数字表法,将患者随机分为2组(n=12),A组术前30 min静脉注射0.9%生理盐水5 ml,术前5 min经气管导管或气管套管内注入2%利多卡因5～10 ml,随后按需每15～30 min经纤维支气管镜追加2%利多卡因5 ml,总量控制在20 ml以内;B组术前30 min缓慢静脉注射右美托咪啶0.5～1.0 μg/kg,随后以0.1～0.5 μg·kg-1·h-1速率维持,表面麻醉方法同A组.记录灌洗时间、不良反应及心血管不良事件的发生情况.于灌洗前20 min(T1)、灌洗开始后20 min(T2)、灌洗结束后20 min(T3)时采集血样,测定血浆儿茶酚胺浓度和血清皮质醇浓度.结果 与A组比较,B组血清皮质醇浓度、血浆儿茶酚胺浓度降低、不良反应及心血管不良事件发生率降低,操作时间缩短(P<0.05).与T1时比较,A组T2,3时血清皮质醇及血浆儿茶酚胺浓度升高,B组T2,3时血清皮质醇及血浆儿茶酚胺浓度降低(P<0.05).结论 右美托咪啶辅助表面麻醉可安全有效地用于患者支气管肺泡灌洗术.

Abstract：

Objective To investigate the efficacy of dexmedetomidine-assisted topical anesthesia in patients undergoing bronchoalveolar lavage ( BAL). Methods Twenty-four ASA Ⅱ or Ⅲ patients in ICU, aged 24-64 yr, weighing 50-80 kg, scheduled for BAL, were randomly divided into 2 groups ( n = 12 each) : topical anesthesia group (group A) , topical anesthesia + dexmedetomidine group (group B) . In group A, 0.9% normal saline 5 ml was injected intravenously 30 min before operation, 2% lidocaine 5-10 ml was given via a tracheal tube or cannula 5 min before operation and then an increment of 2% lidocaine 5 ml was given using fibreoptic bronchoscope every 15-30 min as required (the total amount was within 20 ml) . In group B, dexmedetomidine 0.5-1.0 μg/kg was injected (time of injection≥ 10 min) followed by infusion at 0.1-0.5 μg·kg-1 ·h-1 and the topical anesthesia was performed as the method described in group A. The time of lavage, adverse reactions and adverse cardiovascular events were recorded. Blood samples were taken 20 min before lavage, 20 min after the start of lavage and 20 min after the end of lavage (T1-3 ) for determination of the concentrations of plasma catecholamine and serum cortisol. Results The incidences of adverse reactions and adverse cardiovascular events were significantly lower and the operation time was significantly shorter in group B than in group A ( P < 0.05). The concentrations of plasma catecholamine and serum cortisol were significantly higher at T2,3 in group A, while lower at T2,3 in group B than at T1 ( P < 0.05) . The concentrations of plasma catecholamine and serum cortisol were significantly lower in group B than in group A ( P < 0.05). Conclusion Dexmedetomidine-assisted topical anesthesia can be used safely and effectively in BAL.     

硬膜外阻滞35例肝癌动脉栓塞化疗应用评价

[目的]评价在硬膜外阻滞下行肝动脉栓塞化疗的可行性和安全性。[方法]68例肝恶性肿瘤患者随机分为A组35例在硬膜外阻滞下肝动脉栓塞化疗,B组33例行常规肝动脉栓塞化疗。观察两组术中疼痛反应情况、手术时间和射线辐射时间。[结果]A组采用硬膜外阻滞下行肝动脉栓塞化疗术中腹痛不适发生率14.3%（5/35）明显低于常规肝动脉栓塞化疗组75.8%（25/33）（P〈0.05）,而且手术时间减少和射线辐射时间缩短。[结论]硬膜外阻滞下行肝动脉栓塞化疗能减轻患者术中腹痛等不适,减少手术时间,降低射线辐射量,是安全、可行的。     

老年烧伤患者健康教育体会

老年人烧伤后创面愈合时间长，并发症多，病死率高。我院对老年烧伤患及家属开展了有针对性的健康教育，缩短了治疗时间，减少了并发症的发生，现报告如下。     

枢丹联合氟哌利多预防术后硬膜外自控镇痛恶心呕吐

硬膜外病人自控镇痛(PCEA),已在临床广泛应用.但同时也存在着一些并发症,其中恶心呕吐是最常见的,严重影响病人术后康复,为此,我们使用枢丹或氟哌利多单独或联合用药,以观察其对硬膜外镇痛致恶心呕吐的预防效果.……     

深度烧伤患者正确体位的护理指导

INTRODUCTIONBurnscarisrelatedtodepthofburnwoundsurfaceanddegreeofcontractureandfunctionalrecoveryisrelatedtoeffectivefunctionalexercises.Selectionofcorrectpositionforfunctionalexercisesindeepburnisanimportantcontentinnursingofburn.MATERIALSANDMETHODSMaterials20patientswithdeepburnwereinvestigatedincluding15malesand5femalesaged15-26yearsamongwhichwere12casesofburnsofneckandbothhands;8casesofburnofbigarea.All20patientsunderwentfunctionexercisesatcorrectposition.NursinginstructionFun…