新生儿食管闭锁手术的麻醉体会

目的 探讨新生儿先天性食道闭锁手术麻醉管理方法.方法 22例患儿全部采取气管内插管全身麻醉,监测心率(HR)、平均动脉血压(MBP)、脉搏、血氧饱和度(SpO2)、呼气末二氧化碳分压(PETCO2)、体温(T),记录术中出血量、尿量及输入液体总量,追踪术后患儿转归.结果 术中患儿循环稳定,分离食管时出现SpO2下降、P...     

丙泊酚复合布托啡诺应用于无痛人流术的临床观察

目的 观察丙泊酚复合布托啡诺应用于无痛人流术的临床效果,评价其可行性及安全性.方法 选择ASAⅠ～Ⅱ级,自愿行无痛人工流产术且无经阴道分娩史患者80例,随机分成A、B两组(n=40).A组为单纯丙泊酚组,B组为丙泊酚复合布托啡诺组.观察两组的心率(HR)、平均动脉压(MAP)、血氧饱和度(SPO2)情况,记录丙泊酚用量、苏醒时间及注射痛发生情况,并对术中镇痛效果评级、术后宫缩痛进行VAS评分.结果 和A组比较,B组丙泊酚的用量减少,注射痛发生率降低,苏醒时间缩短,术后宫缩痛VAS评分较低(P<0.01).结论 丙泊酚复合布托啡诺应用于无痛人流术能增强麻醉效能,安全可行.     

产前抗焦虑干预对镇痛分娩效果的影响

目的 探讨产前抗焦虑干预对产时镇痛分娩效果的影响.方法 选择80例足月、单胎、头位、无产科合并症和精神疾病史,在本院例行产检和分娩的初产妇.所有产妇于住院前孕32～ 36周在产前门诊用焦虑自评量表（SAS）法进行焦虑评分,且SAS≥50分.根据是否参加在本院进行镇痛分娩知识培训干预分为两组（每组40例）：培训组（T组）和非培训组（N组）.两组产妇入院后镇痛前和胎儿娩出后24h同样进行SAS焦虑评分.两组镇痛模式相同,于宫口扩张至2～4 cm时行分娩镇痛,经L2～3行脊椎-硬膜外穿刺成功后,蛛网膜下腔注射舒芬太尼7.5μg,硬膜外置管,接硬膜外自控镇痛（PCEA）装置,以0.1％罗哌卡因配伍0.5 μg/ml舒芬太尼的混合液100 ml行硬膜外镇痛,设定单次剂量6ml,锁定时间15 min,无背景剂量.记录不同时点SAS焦虑评分、产程中疼痛程度的级别、镇痛总时间、PCEA实际按压次数、PCEA有效按压次数、用药总量,由于镇痛不全求助医务人员的总次数；记录分娩方式、新生儿Apgar评分及产妇对镇痛满意度.结果 SAS焦虑评分入院后镇痛前、分娩后24 hT组明显低于N组（P＜0.01）,与入院前比较,T组显著降低（P＜0.01）,而入院前两组无统计学差异（P＞0.05）；分娩前后,T组较N组疼痛程度明显减轻（P＜0.01）；PCEA实际按压次数、PCEA有效按压次数、用药总量、由于疼痛不适求助医务人员的总次数T组显著低于N组（P＜0.01）；镇痛满意度T组较N组明显增高（P＜0.01）；两组分娩方式和新生儿Apgar评分差异无统计学意义（P＞0.05）.结论 产前抗焦虑干预可以减轻产妇住院分娩期间的焦虑程度,提高镇痛效应和满意度,减少镇痛药物的需要量和因疼痛求助医务人员的次数.     

腹腔镜手术患儿压力控制通气和容量控制通气效果的比较

Objective To compare the efficacy of pressure-controlled ventilation and volume-controlled ventilation in children undergoing laparoscopic surgery. Methods Thirty ASA Ⅰ or Ⅱ children of both sexes,aged 12-36 months, weighing 9-15 kg, scheduled for laparoscopic surgery, were randomly divided into 2 groups (n = 15 each): pressure-controlled ventilation group (group P) and volume-controlled ventilation group (group V) . Anesthesia was induced with propofol 2-4 mg/kg, vecuronium 0.1 mg/kg and fentanyl 2 μg/kg. The children were tracheal intubated and mechanically ventilated. The maximum inspiratory pressure was adjusted to make the tidal volume (VT ) achieve 12 ml/kg in group P and the VT was set at 12 ml/kg in group V. PETCO2 was maintained at 35-45 mm Hg. MAP, HR, PETCO2 , minute ventilation and peak airway pressure were recorded immediately after intubation (T0 ) , immediately before skin incision (T1 ) , 30 min of pneumoperitoneum (T2 ) and 15 min after the end of pneumoperitoneum (T3 ) . Arterial blood samples were taken at the same time points mentioned above for blood gas analysis. Dynamic lung compliance and physiological dead space to tidal volume ratio were calculated.Results Compared with group V, PaCO2 and PETCO2 were significantly decreased and dynamic lung compliance was significantly increased at T1,2 , and minute ventilation and peak airway pressure were significantly decreased at T0-3 in group P ( P < 0.01) . There was no significant difference in MAP, HR and physiological dead space to tidal volume ratio between the two groups ( P > 0.05) . Conclusion Compared with volume-controlled ventilation, pressure-controlled ventilation can better improve the ventilatory efficacy, is more beneficial to gas exchange and reduces the influence of pneumoperitoneum on respiratory function in children undergoing laparoscopic surgery.     

腹腔镜手术患儿压力控制通气和容量控制通气效果的比较

Objective To compare the efficacy of pressure-controlled ventilation and volume-controlled ventilation in children undergoing laparoscopic surgery. Methods Thirty ASA Ⅰ or Ⅱ children of both sexes,aged 12-36 months, weighing 9-15 kg, scheduled for laparoscopic surgery, were randomly divided into 2 groups (n = 15 each): pressure-controlled ventilation group (group P) and volume-controlled ventilation group (group V) . Anesthesia was induced with propofol 2-4 mg/kg, vecuronium 0.1 mg/kg and fentanyl 2 μg/kg. The children were tracheal intubated and mechanically ventilated. The maximum inspiratory pressure was adjusted to make the tidal volume (VT ) achieve 12 ml/kg in group P and the VT was set at 12 ml/kg in group V. PETCO2 was maintained at 35-45 mm Hg. MAP, HR, PETCO2 , minute ventilation and peak airway pressure were recorded immediately after intubation (T0 ) , immediately before skin incision (T1 ) , 30 min of pneumoperitoneum (T2 ) and 15 min after the end of pneumoperitoneum (T3 ) . Arterial blood samples were taken at the same time points mentioned above for blood gas analysis. Dynamic lung compliance and physiological dead space to tidal volume ratio were calculated.Results Compared with group V, PaCO2 and PETCO2 were significantly decreased and dynamic lung compliance was significantly increased at T1,2 , and minute ventilation and peak airway pressure were significantly decreased at T0-3 in group P ( P < 0.01) . There was no significant difference in MAP, HR and physiological dead space to tidal volume ratio between the two groups ( P > 0.05) . Conclusion Compared with volume-controlled ventilation, pressure-controlled ventilation can better improve the ventilatory efficacy, is more beneficial to gas exchange and reduces the influence of pneumoperitoneum on respiratory function in children undergoing laparoscopic surgery.     

两种不同硬膜外给药方式在分娩镇痛中的临床观察

目前国内外镇痛分娩的方法多数是采用病人自控硬膜外镇痛（PCEA）或腰一硬联合阻滞（CSEA）。镇痛药物普遍使用局麻药布比卡因或罗哌卡因复合阿片类药物芬太尼或舒芬太尼。在镇痛分娩中医务人员最担心的问题是麻醉药物对母婴的不良影响。因此，在满足镇痛的前提下，如何减少药物的用量，提高安全性是分娩镇痛关注的焦点。作者观察比较蛛网膜阻滞后复合不同的硬膜外镇痛模式在镇痛分娩中的安全性、有效性和用药的情况。报道如下。     

丙泊酚复合布托啡诺应用于元痛人流术的临床观察

目的观察丙泊酚复合布托啡诺应用于无痛人流术的临床效果,评价其可行性及安全性。方法选择ASAⅠ-Ⅱ级,自愿行无痛人工流产术且无经阴道分娩史患者80例,随机分成A、B两组（n=40）。A组为单纯丙泊酚组,B组为丙泊酚复合布托啡诺组。观察两组的心率（HR）、平均动脉压（MAP）、血氧饱和度（SPO2）情况,记录丙泊酚用量、苏醒时间及注射痛发生情况,并对术中镇痛效果评级、术后宫缩痛进行VAS评分。结果和A组比较,B组丙泊酚的用量减少,注射痛发生率降低,苏醒时间缩短,术后宫缩痛VAS评分较低（P〈0．01）。结论丙泊酚复合布托啡诺应用于无痛人流术能增强麻醉效能,安全可行。     

腹腔镜手术患儿压力控制通气和容量控制通气效果的比较

目的 比较腹腔镜手术患儿压力控制通气和容量控制通气的效果.方法 择期行腹腔镜手术患儿30例,性别不限,年龄12～36月,ASA分级Ⅰ或Ⅱ级,体重9～15 kg,采用随机数字表法,将其随机分为2组(n=15):压力控制通气组(P组)和容量控制通气组(V组).麻醉诱导后气管插管行机械通气,P组调节麻醉机最大吸气压力使潮气量达到12 ml/kg,V组设置潮气量12 ml/kg,维持PETCO235～45mmHg.于气管插管后即刻(T0)、切皮前即刻(T1)、气腹30 min(T2)和气腹结束后15 min (T3)时,记录MAP、HR、PETCO2、分钟通气量和气道峰压,并采集动脉血样,进行血气分析,计算肺动态顺应性和生理死腔量/潮气量.结果 与V组比较,P组T1,2时PaCO2和PETCO2降低,肺动态顺应性升高,T0～3时分钟通气量和气道峰压降低(P<0.01),MAP、HR和生理死腔量/潮气量差异无统计学意义(P>0.05).结论 与容量控制通气相比,压力控制通气可更好地改善腹腔镜手术患儿肺通气效果,有利于气体交换,减少气腹对呼吸功能的影响.

Abstract：

Objective To compare the efficacy of pressure-controlled ventilation and volume-controlled ventilation in children undergoing laparoscopic surgery. Methods Thirty ASA Ⅰ or Ⅱ children of both sexes,aged 12-36 months, weighing 9-15 kg, scheduled for laparoscopic surgery, were randomly divided into 2 groups (n = 15 each): pressure-controlled ventilation group (group P) and volume-controlled ventilation group (group V) . Anesthesia was induced with propofol 2-4 mg/kg, vecuronium 0.1 mg/kg and fentanyl 2 μg/kg. The children were tracheal intubated and mechanically ventilated. The maximum inspiratory pressure was adjusted to make the tidal volume (VT ) achieve 12 ml/kg in group P and the VT was set at 12 ml/kg in group V. PETCO2 was maintained at 35-45 mm Hg. MAP, HR, PETCO2 , minute ventilation and peak airway pressure were recorded immediately after intubation (T0 ) , immediately before skin incision (T1 ) , 30 min of pneumoperitoneum (T2 ) and 15 min after the end of pneumoperitoneum (T3 ) . Arterial blood samples were taken at the same time points mentioned above for blood gas analysis. Dynamic lung compliance and physiological dead space to tidal volume ratio were calculated.Results Compared with group V, PaCO2 and PETCO2 were significantly decreased and dynamic lung compliance was significantly increased at T1,2 , and minute ventilation and peak airway pressure were significantly decreased at T0-3 in group P ( P < 0.01) . There was no significant difference in MAP, HR and physiological dead space to tidal volume ratio between the two groups ( P > 0.05) . Conclusion Compared with volume-controlled ventilation, pressure-controlled ventilation can better improve the ventilatory efficacy, is more beneficial to gas exchange and reduces the influence of pneumoperitoneum on respiratory function in children undergoing laparoscopic surgery.     

术前不同剂量布托啡诺对宫腔镜术患者术后苏醒及镇痛的影响

目的 比较术前预注不同剂量的布托啡诺对宫腔镜术患者术后苏醒及镇痛作用的影响.方法 80例静脉麻醉下行宫腔镜术的患者,随机分为四组(n=20):对照组A组和观察组B1、B2、B3组.所有患者用依托咪酯、丙泊酚和瑞芬太尼麻醉,B1、B2、B3组于手术前5 min分别静脉注射布托啡诺10 μg/kg、20 μg/kg、30 μg/kg(用生理盐水稀释至10 ml),对照组于同一时点静注生理盐水10 ml.分别记录术后苏醒时间、评估Ramsay镇静评分、视觉模拟镇痛评分(VAS),比较患者对麻醉的满意度以及记录不良反应.结果 与A组比较,B3组苏醒时间明显延长(P＜0.05),而B1、B2两组差异无统计学意义(P＞0.05);B1、B2、B3组术后15 min的Ramsay评分较A组明显升高(P＜0.05),而与B1、B2组相比,B3组Ramsay评分明显升高(P＜0.05);与A、B1组比较,B2、B3组在苏醒后15 min VAS镇痛评分明显降低(P＜0.05),而B2、B3两组间镇痛评分差异无统计学意义(P＞0.05);B3组患者术后头晕、嗜睡发生率较其他三组明显升高(P＜0.05);而B2组患者对麻醉的满意度评分最高(P＜0.05).结论 术前静脉注射20 μg/kg布托啡诺用于宫腔镜术具有良好的术后镇痛效果,镇静适度,苏醒平稳,无明显的不良反应,是较为适宜的剂量.