血压昼夜节律紊乱患者围全麻诱导插管期血流动力学的变化

随着老龄化社会的到来,合并高血压病的手术患者也日益增多。目前,对并存高血压的择期手术患者是否应推迟手术尚缺乏有力的证据,术前治疗高血压只是基于以下几点共识：（1）围术期只是高血压治疗的一个阶段;（2）未经治疗的高血压患者更易发生围术期血流动力学改变;（3）围术期血流动力学波动与手术患者并发症的发生有一定的关联。防止围术期血压波动是患高血压病的手术患者麻醉管理中的重点,也是难点。本研究观察原发性高血压伴血压昼夜节律紊乱患者围全麻诱导期血流动力学变化的特点,为研究患高血压病的手术患者围术期风险的研究提供新的思路。     

小剂量氯胺酮对妇科下腹部手术患者七氟醚肺泡气最低有效浓度的影响

Objective To investigate the effects of the low-dose ketamine on the minimum alveolar concentration (MAC) of sevoflurane in patients undergoing gynecological abdominal surgery.Methods Fifty-one ASA Ⅰ or Ⅱ patients aged 36-49 yr with body mass index ≤ 30 kg/m2 scheduled for gynecological abdominal surgery were randomly divided into control group (group C, n = 29) and ketamine group (group K, n = 22) . The paitents were unpremedicated. In group K, a loading dose of ketamine 0.2 mg/kg was injected intravenously followed by infusion at a rate of 14 μg·kg-1 ·min-1 , while equal volume of normal saline was given in group C. Anesthesia was induced with inhalation of sevoflurane (end-tidal concentration 4%-5%, maintaining for 5 min) in both groups. Endotracheal intubation was performed. The patients breathed sevoflurane until the predetermined target end-tidal sevoflurane concentration was reached for at least 15 min before skin incision. Occurrence of body movement was determined by any visible contraction of the muscle bundle of trunk, limbs, head and neck during skin incision and/or within 60 s after skin incision. The initial end-tidal concentration of sevoflurane was set at 1.8 % .If body movement occurred, the end-tidal concentration of sevoflurane was increased by 0.2% , while if not, decreased by 0.2% . MACs of sevoflurane were calculated. Results The MAC of sevoflurane was 1.51% (95% confidence interval 1.45%-1.58%) in group K, and 2.49% (95% confidence interval 2.40%-2.57%) in group C, and there was significant difference between the two groups ( P < 0.05) . Conclusion Intravenous infusion of the low-dose ketamine can enhance the anesthetic effect of sevoflurane in patients undergoing gynecological abdominal surgery.     

延续性康复干预对老年三叉神经痛患者术后情绪、疼痛和复发率的影响

目的 观察康复干预对射频热凝联合阿霉素治疗老年三叉神经痛患者术后情绪、疼痛和复发率的影响，为治疗该病症提供方法。方法 选取2020年1月—2021年12月在沧州市人民医院治疗的老年三叉神经痛患者92例，采用数字表法随机分为观察组和对照组。2组均接受射频热凝联合阿霉素治疗。对照组给予健康教育和饮食指导干预，观察组在对照组的干预基础上加用延续性综合康复干预。术后随访期间，观察并比较2组随访期间的情绪(焦虑和抑郁)、疼痛评分以及三叉神经痛复发率。结果 术后7 d, 2组在VAS评分、 SAS评分及SDS评分上差异均无统计学意义(P>0.05)。术后6个月、术后1年，观察组患者VAS评分均低于对照组(P<0.001)。术后6个月、术后1年，观察组患者SAS评分均低于对照组(P<0.05、P<0.001)。术后1年，观察组患者SDS评分低于对照组(P<0.001)。术后1年观察组三叉神经痛复发率低于对照组(χ²=5.059,P=0.025)。结论 延续性综合康复干预可有效降低射频热凝联合阿霉素术后患者三叉神经痛复发率，改善患者情绪，减轻患者疼痛...     

信息意识漫谈之二

信息意识是现代人信息素质的重要组成部分,也是现代人思想素质和文化观念的主要标志之一.本文主要阐述了对信息的"自律"与"放纵"、"重现"与"再造"、"零分"与"整合"、"冗余"与"精简"、"虚拟"与"现实"的辨证关系及思考.     

小剂量氯胺酮对妇科下腹部手术患者七氟醚肺泡气最低有效浓度的影响

Objective To investigate the effects of the low-dose ketamine on the minimum alveolar concentration (MAC) of sevoflurane in patients undergoing gynecological abdominal surgery.Methods Fifty-one ASA Ⅰ or Ⅱ patients aged 36-49 yr with body mass index ≤ 30 kg/m2 scheduled for gynecological abdominal surgery were randomly divided into control group (group C, n = 29) and ketamine group (group K, n = 22) . The paitents were unpremedicated. In group K, a loading dose of ketamine 0.2 mg/kg was injected intravenously followed by infusion at a rate of 14 μg·kg-1 ·min-1 , while equal volume of normal saline was given in group C. Anesthesia was induced with inhalation of sevoflurane (end-tidal concentration 4%-5%, maintaining for 5 min) in both groups. Endotracheal intubation was performed. The patients breathed sevoflurane until the predetermined target end-tidal sevoflurane concentration was reached for at least 15 min before skin incision. Occurrence of body movement was determined by any visible contraction of the muscle bundle of trunk, limbs, head and neck during skin incision and/or within 60 s after skin incision. The initial end-tidal concentration of sevoflurane was set at 1.8 % .If body movement occurred, the end-tidal concentration of sevoflurane was increased by 0.2% , while if not, decreased by 0.2% . MACs of sevoflurane were calculated. Results The MAC of sevoflurane was 1.51% (95% confidence interval 1.45%-1.58%) in group K, and 2.49% (95% confidence interval 2.40%-2.57%) in group C, and there was significant difference between the two groups ( P < 0.05) . Conclusion Intravenous infusion of the low-dose ketamine can enhance the anesthetic effect of sevoflurane in patients undergoing gynecological abdominal surgery.     

小剂量氯胺酮对妇科下腹部手术患者七氟醚肺泡气最低有效浓度的影响

目的 探讨小剂量氯胺酮对妇科下腹部手术患者七氟醚肺泡气最低有效浓度(MAC)的影响.方法 择期拟行妇科下腹部手术患者51例,年龄36～49岁,体重指数≤30 kg/m2,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将患者随机分为对照组(C组,n=29)和氯胺酮组(K组,n=22).K组静脉注射氯胺酮负荷量0.2 mg/kg,随后以14μg·kg-1·min-1维持,C组静脉输注等容量生理盐水,两组均吸入8%七氟醚进行麻醉诱导.麻醉维持:气管插管后,调节七氟醚蒸发罐,使呼气末七氟醚浓度达到预定值并至少稳定15 min后开始切皮.采用序贯法进行试验,初始浓度设为1.8%,发生体动反应,则下一例患者浓度增加0.2%,未发生体动反应,则下一例患者浓度降低0.2%.发生体动反应的标准:切皮时和切皮后60 s内患者躯干、四肢及头颈有可见的肌束收缩.计算七氟醚MAC及其95%可信区间.结果 K组七氟醚MAC为1.51%(95%可信区间为1.45%～1.58%),C组七氟醚MAC为2.49%(95%可信区间为2.40%～2.57%),两组比较差异有统计学意义(P<0.05).结论 静脉输注小剂量氯胺酮可增强七氟醚的麻醉效应.

Abstract：

Objective To investigate the effects of the low-dose ketamine on the minimum alveolar concentration (MAC) of sevoflurane in patients undergoing gynecological abdominal surgery.Methods Fifty-one ASA Ⅰ or Ⅱ patients aged 36-49 yr with body mass index ≤ 30 kg/m2 scheduled for gynecological abdominal surgery were randomly divided into control group (group C, n = 29) and ketamine group (group K, n = 22) . The paitents were unpremedicated. In group K, a loading dose of ketamine 0.2 mg/kg was injected intravenously followed by infusion at a rate of 14 μg·kg-1 ·min-1 , while equal volume of normal saline was given in group C. Anesthesia was induced with inhalation of sevoflurane (end-tidal concentration 4%-5%, maintaining for 5 min) in both groups. Endotracheal intubation was performed. The patients breathed sevoflurane until the predetermined target end-tidal sevoflurane concentration was reached for at least 15 min before skin incision. Occurrence of body movement was determined by any visible contraction of the muscle bundle of trunk, limbs, head and neck during skin incision and/or within 60 s after skin incision. The initial end-tidal concentration of sevoflurane was set at 1.8 % .If body movement occurred, the end-tidal concentration of sevoflurane was increased by 0.2% , while if not, decreased by 0.2% . MACs of sevoflurane were calculated. Results The MAC of sevoflurane was 1.51% (95% confidence interval 1.45%-1.58%) in group K, and 2.49% (95% confidence interval 2.40%-2.57%) in group C, and there was significant difference between the two groups ( P < 0.05) . Conclusion Intravenous infusion of the low-dose ketamine can enhance the anesthetic effect of sevoflurane in patients undergoing gynecological abdominal surgery.     

术前口服小剂量可乐定用于无痛人流手术的可行性

探讨人工流产异丙酚麻醉患者术前口服小剂量可乐定的可行性，尝试口服小剂量可乐定用于门诊手术的麻醉。     

三年制高职生化理论考试改革新思路

三年制高职生源差别较大,掌握生化理论知识的具体情况有所不同,利用传统的考试方式已不能真正反映其对生化知识的掌握程度,为此必须改革生化理论考试。而采取灵活调整考试内容、应用多种试卷、开闭卷并举等方式结合的多样化考试方式,可以有针对性的反映不同层次学生的学习情况,激发其学习生化的积极性,从而达到使生化理论考试立足高职生特点,适应高职教育。     

原发性三叉神经痛患者抑郁发生情况及其影响因素分析

目的 分析原发性三叉神经痛（TN）患者抑郁发生情况及其影响因素,为提高患者生存质量提供参考。 方法 以2014—2019年首次在沧州市某医院诊治的TN患者为研究对象进行问卷调查,包括基本情况、疼痛程度、抑郁状态、睡眠情况等,采用描述流行病学分析方法进行分析,并对抑郁发生影响因素进行单、多因素分析。 结果 共对519例TN患者进行调查,TN患者平均年龄（51.19 ± 7.32）岁,男性306例（占58.96%）,女性213例（占41.04%）。519例TN患者HAMD评分平均为（18.67 ± 5.22）分,147例得分>20分,抑郁发生率为28.32%。年龄<45岁（OR=4.162）、男性（OR=1.307）、病程（OR=3.923）、VAS评分≥7分（OR=5.058）、睡眠障碍（OR=12.949）的TN患者抑郁发生风险较高。 结论 TN患者抑郁发生率较高,青中年、男性、病程较长、中重度疼痛及睡眠障碍者更易发生抑郁,应针对上述影响因素进行综合干预,疏导心理,缓解负性情绪,减低抑郁风险。     

异丙酚镇静联合表面麻醉在胃镜检查中的应用

目的观察异丙酚镇静联合利多卡因喷雾表面麻醉在胃镜检查中的效果。方法选择门诊自愿接受无痛胃镜检查的ASAⅠ～Ⅱ级男性患者90例，随机分成芬太尼复合异丙酚组（FP组，n=30），利多卡因喷雾表面麻醉联合异丙酚麻醉组（LPa组，n=30），利多卡因喷雾表面麻醉联合异丙酚镇静组（LPs组，n=30），LPs组患者若在静注异丙酚过程中出现躁动或兴奋则加深麻醉后归入LPa组。另外选择一组接受普通胃镜检查的ASAⅠ～Ⅱ级男性患者，含服利多卡因胶浆加静注生理盐水作空白对照（L组，n=30）。连续无创监测患者平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2），开放静脉后闭目安静5min记录各参数基础值（T0），分别记录用药后（T1），胃镜通过口咽部（T2），见到十二直肠乳头（T3）及退镜后1min（T4）、5min（T5）、10min（T6）各时点变化值。采用ELISA法测定闭目安静5min后及检查结束即刻血浆去甲肾上腺素（NE）浓度，检查后对患者满意度进行评价。结果胃镜置入口咽部时呕吐呛咳评分L、FP两组明显大于LPa、LPs两组（P〈0.01），异丙酚总用量LPs组小于FP、LPa组（P〈0.01），MAP、HR在镜检中L组显著增高，MAP、HR、SpO2在麻醉诱导后、镜检中及检查后1～5minLPs组下降幅度低于FP、LPa两组（P〈0.05）。术后血浆去甲肾上腺素浓度较基础值L、FP两组升高，LPa组降低（P〈0.01）。结论利多卡因喷雾表面麻醉加异丙酚麻醉或镇静均能有效地降低胃镜操作引起的伤害性刺激，而镇静能维持胃镜检查中呼吸循环稳定，尤其对高龄或体弱患者不失为一种安全、有效的方法。