置入食管引流型喉罩和经典喉罩对小儿伤害性刺激程度的比较

目的 比较置入食管引流型喉罩(PLMA)与经典喉罩(CLMA)对小儿伤害性刺激的程度.方法 择期全麻手术患儿47例,性别不限,年龄3-12岁,体重11-36 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将患儿随机分为PLMA组(n=23)和CLMA组(n=24).采用序贯法进行试验,靶控输注异丙酚行麻醉诱导,待效应室浓度与预设的血浆靶浓度平衡后置入喉罩.PLMA组和CLMA组首例患儿异丙酚血浆靶浓度分别设为6.0和4.4 μg/ml,存在喉罩置入反应,则下一例患儿异丙酚血浆靶浓度升高1个浓度梯度,无喉罩置入反应,则下一例患儿异丙酚血浆靶浓度降低1个浓度梯度,浓度梯度为0.2 μg/ml.喉罩置入反应的标准为:下颌松弛困难无法置入、置入即刻、置往后1 min内出现呛咳、吞咽、肢体运动、屏气或喉痉挛.计算异丙酚抑制喉罩置往反应的半数有效血浆靶浓度及其95％置信区间.结果 异丙酚抑制小儿PLMA和CLMA置入反应的半数有效血浆靶浓度及其95％置信区间分别为5.87(5.62～ 6.11)和4.53(4.38 ～ 4.69)μg/ml,差异有统计学意义(P＜0.01).结论 置入PLMA对3～12岁小儿的伤害性刺激程度较CLMA增强.     

氯诺昔康在鼻内镜手术后患者自控静脉镇痛中的疗效观察

目的 观察氯诺昔康用于鼻内镜手术后患者自控静脉镇痛(PCIA)的临床效果和安全性.方法 74例拟行全身麻醉下鼻内镜手术患者完全随机分为试验组和对照组,每组37例.试验组予氯诺昔康行PCIA,对照组予芬太尼行PCIA.分别记录2组患者术后2、4、8、24、32 h的疼痛视觉模拟评分(VAS)、警觉/镇静评分(OAA/S)和血氧饱和度(spO2),并记录PCIA期间2组患者不良反应发生率.结果 手术后各时间点2组患者VhS评分均在3分以下,组间差异无统计学意义,P>0.05.各时间点OAA/S评分和spO2,试验组均高于对照组,P<0.05.试验组不良反应总发生率13.5%(5例)显著低于对照组45.9%(17例),P<0.05.结论 氯诺昔康用于鼻内镜手术后PCIA镇痛效果确切,对患者意识水平和呼吸影响小,不良反应发生率低.

Abstract：

Objective To evaluate the clinic efficacy and safety of lornoxicam for patient controlled intravenous analgesia after functional endoscopic sinus surgery. Methods Seventy-four patients undergoing functional endoscopic sinus surgery under general anesthesia were randomly divided into experimental group and control group, with 37 cases in each group. Lornoxicam was administered in experimental group and fentanyl was applied in control group. The visual analogue scale (VAS) score, OAA/S(observer assessment alertness/sedation) score and SpO2 were recorded at 2, 4, 8, 24 and 32 hours after the operation respectively. The adverse reactions were also recorded. Results The VAS scores at each timepoint in both groups were all not more than 3 and there was no significantly difference between the two groups (P > 0.05 ). The OAA/S score and SpO2 in each timepoint were higher in experimental group than those in control groups (P < 0.05 ). The incidence of adverse reactions was significandy lower in experimental group than that in control group (P <0.05). Conclusion Patient controlled intravenous analgesia (PCI A) with lornoxicam can provide efficient and safe postoperative analgesia for patients of functional endoscopic sinus surgery relatively with few influence on the level of consciousness and respiration.     

帕瑞昔布钠用于预防鼻内镜手术后的气管拔管反应

目的 观察帕瑞昔布钠用于预防鼻内镜手术后全麻拔管期反应的临床效果.方法 60例ASAⅠ～Ⅱ级拟行全麻下鼻内镜手术患者随机分为实验组(P组)和对照组(C组),每组30例.气管插管后,实验组和对照组分别静脉注射帕瑞昔布钠40mg和等容量生理盐水.记录手术结束时(T0)、拔管时(T1)、拔管后5min(T2)、拔管后10min(T3)时的MAP和HR;记录停止注射麻醉药物后患者呼吸恢复时间、睁眼时间以及拔管时间.结果 P组在气管导管拔除前后各时间点的MAP和HR相比较,差异均无统计学意义,P>0.05; C组拔管时(T1)和拔管后5min(T2)的MAP和HR均显著高于手术结束时(T0),P<0.05.两组患者的呼吸恢复时间、睁眼时间和拔管时间的差异没有统计学意义(P>0.05).结论 帕瑞昔布钠可预防和减轻鼻内镜手术后全麻拔管期反应,而对麻醉苏醒时间没有影响.     

氟比洛芬酯超前镇痛对烧伤整形术后镇痛的影响

目的 研究氟比洛芬酯用于烧伤整形手术超前镇痛的效果.方法 60例ASA Ⅰ-Ⅱ级行烧伤整形手术的患者,随机分为两组,每组30例.F组术前30 min静脉缓慢注射氟比洛芬酯100 mg;C组术前30 min静脉注射生理盐水10 ml.术毕两组均接受曲马多静脉镇痛.分别记录术后1、2、4、8、12、24h的疼痛评分(VAS),24h曲马多用量和不良反应.结果 F组术后1、2、4、8 h VAS均低于C组(P<0.05=,F组术后24 h的曲马多用量(182.9±37.4)mg低于C组(227.3±49.8)mg(P<0.05),两组的不良反应差异无显著意义(P>0.05).结论 氟比洛芬酯超前镇痛能有效减轻烧伤患者整形术后疼痛,减少术后曲马多镇痛药物用量并提高镇痛质量.     

0.75%速卡腰硬联合麻醉在老年患者全髋置换术中的应用

Objective To evaluate the efficacy and safety of 0.75% levobupivacaine for combined spi-nal and epidural anesthesia (CSEA) in old patients undergoing total hip replacement surgery. Methods Sixty ASA Ⅰ～Ⅱ patients, scheduled for selective total hip replacement surgery, were randomly divided into two groups. The patients in group L, received 0.75% levobupivaeaine 15 nag(2 ml)for spinal anesthesia, and those in group B, received same amount of 0.75 % bupivacane. 2% lidocaine was supplemented via epidural catheter when spinal analgesia was inadequate. During operation, BP, HR and SpO2 were monitored continually. Sensory and motor blockade, side effects were recorded. Results The plane of block, onset time, duration of blockade, motor block were comparable between two groups. There was no neural side effects in both groups. Conclusion 0.75% levobupivacaine for CSEA is effective and safe for total hip replacement surgery.     

地佐辛与诺扬用于无痛人流手术应用研究

目的探讨地佐辛复合丙泊酚与诺扬复合丙泊酚用于无痛人流手术中安全性和有效性。方法100例早孕（孕6～8周）女性,年龄20～35岁ASAI～II级。术前禁食8h,禁饮4h。并签署麻醉知情同意书。随机将其分成2组﹙n=50﹚：A地佐辛组、B诺扬组,分别复合丙泊酚静脉麻醉。观测用药前后患者生命体征变化及观测术后生命体征、疼痛评分及术后1h头晕、呕吐发生率。结果生命体征变化、术后疼痛评分,两组相比差异无统计学意义﹙P0.05﹚;但两组术后1h恶心、呕吐的发生率比较差异有统计学意义﹙P0.01或P0.05﹚。结论在无痛人流麻醉中,地佐辛复合丙泊酚比诺扬复合丙泊酚术后恶心、呕吐发生机率小,舒适度佳。     

硬膜外注气对脊椎-硬膜外联合阻滞时腰穿的影响

Objective To investigate the effect of injection of air into the epidural space on the subarachnoid puncture during the combined spinal-epidural anesthesia (CSEA) .Methods Two hundred and ten ASA Ⅰ or Ⅱ parturients who were at full term with a singleton fetus, aged 20-42 yr, weighing 57-82 kg (height 152-170cm) , undergoing cesarean section under CSEA, were randomly divided into 3 groups ( n = 70 each) : hanging drop technique group (group Ⅰ ) and injection of small volume of air group (group Ⅱ ) and injection of large volume of air group ( group Ⅲ ) . The epidural space was indentified using hanging drop technique in group Ⅰ and using loss of resistance to air technique in Ⅱ and Ⅲ groups. Injection of air was stopped as soon as the clear loss of resistance identified the epidural space in group Ⅱ , whereas all 4 ml of air was injected in group Ⅲ . After the epidural space was confirmed at L3,4 interspace, a 25-gauge spinal needle protruding 14 mm beyond the 18-gauge epidural needle was introduced through the epidural needle. Subarachnoid placement was confirmed by backflow of cerebrospinal fluid (CSF) . If no backflow of CSF was observed, the spinal needle was withdrawn and an epidural catheter was inserted through the epidural needle to perform epidural anesthesia. Successful subarachnoid puncture, failures to observe backflow of CSF and adverse reactions were recorded. Results The three groups were comparable with respect to age, height, body weight and gestation weeks. The success rate of subarachnoid puncture was 91% ,93% and 79% in Ⅰ ,Ⅱ and Ⅲ groups respectively, and it was significantly higher in Ⅰ and Ⅱ groups than in group Ⅲ ( P < 0.05) . There was no significant difference in the success rate of subarachnoid puncture between Ⅰand Ⅱ groups ( P > 0.05) . Bilateral segmental analgesia presented in all cases who received only epidural anesthesia after no backflow of CSF was observed, and the expected analgesia also presented in all cases in whom back flow of CSF was observed. No adverse reactions occurred. Conclusion Injection of air into the epidural space is related to the success of subarachnoid puncture during CSEA and injection of a large volume of air lowers the success rate.     

X线引导下矫正锁骨下静脉穿刺误入颈内静脉1例分析

对X线引导下矫正锁骨下静脉穿刺误入颈内静脉1例分析如下。     

0.75%速卡腰硬联合麻醉在老年患者全髋置换术中的应用

Objective To evaluate the efficacy and safety of 0.75% levobupivacaine for combined spi-nal and epidural anesthesia (CSEA) in old patients undergoing total hip replacement surgery. Methods Sixty ASA Ⅰ～Ⅱ patients, scheduled for selective total hip replacement surgery, were randomly divided into two groups. The patients in group L, received 0.75% levobupivaeaine 15 nag(2 ml)for spinal anesthesia, and those in group B, received same amount of 0.75 % bupivacane. 2% lidocaine was supplemented via epidural catheter when spinal analgesia was inadequate. During operation, BP, HR and SpO2 were monitored continually. Sensory and motor blockade, side effects were recorded. Results The plane of block, onset time, duration of blockade, motor block were comparable between two groups. There was no neural side effects in both groups. Conclusion 0.75% levobupivacaine for CSEA is effective and safe for total hip replacement surgery.