优质护理在小儿麻醉诱导中的应用效果

目的：探讨优质护理在小儿麻醉诱导中的应用效果。方法回顾性分析2013年5月~2014年3月本院手术麻醉室行麻醉诱导的患儿60例。将患者随机分成对照组和实验组各30例,其中对照组采用常规护理,实验组采用优质护理。结果实验组总体配合率显著高于对照组,和对照组相比具有统计学意义(P<0.05)。结论优质护理对于患儿麻醉诱导具有积极地作用,能够帮助患儿更好的配合麻醉诱导治疗,提升手术成功率,且操作简单值得未来临床推广。     

基于单个颈动脉压力波形获取主动脉脉搏波速度的可行性研究

目的评估基于单个颈动脉压力波形分解以获取主动脉脉搏波速度(aortic pulse wave velocity,ao PWV)的可行性,验证该方法是否适用于动脉硬化的早期筛查。方法研究对象为53名无明显心血管病的健康人群[男性22人,女性31人,(58.6±13.7)岁]。利用压力传感器同步获取颈动脉和股动脉脉搏波形,计算颈股动脉脉搏波传导时间(carotid-femoral pulse transit time,cf PTT)和传导速度(carotid-femoral pulse wave velocity,cf PWV)。利用阻抗分析技术将颈动脉压力波形分解为前向波和反向波。通过对前向波和反向波进行相关分析获得主动脉脉搏波传导时间(aortic pulse transit time,ao PTT)和传导速度(aortic pulse wave velocity ao PWV)。评估ao PTT与cf PTT以及ao PWV与cf PWV之间的相关性和一致性。结果基于单个颈动脉压力波形分解获得的ao PTT与实测的cf PTT显著相关(r=0.624,P0.001),组内相关系数为0.621;ao PWV与cf PWV之间的相关系数为0.476(P0.001),组内相关系数等于0.452。老年人(年龄≥60岁,29人)ao PWV与cf PWV间的相关性显著低于中青年人(0.267 vs 0.549,P0.001)。结论基于单个颈动脉压力波形分解获取ao PWV与实测的cf PWV之间只具有中度的相关性和一致性,且在老年人中相关性更低。该方法可能不适用于老年人的ao PWV检测。     

不同麻醉药物在老年腹腔手术中的应用

随着科技的发展和医学技术的进步,手术中可以选择的麻醉药物和方法也呈现出多样化.但是不同的药物麻醉效果与产生的反应也不尽相同.本文通过临床,研究比较了咪唑安定、丙泊酚静脉复合麻醉与两者复合吸入七氟烷三种全身麻醉方法在老年腹腔镜手术中的应用,最后,经过临床实践得出丙泊酚静脉复合麻醉是较适合老年人全身麻醉的麻醉方法.     

全身麻醉联合硬膜外阻滞麻醉在腹腔镜胆囊切除手术中的应用

目的观察和探讨全身麻醉联合硬膜外阻滞麻醉在腹腔镜胆囊切除手术中的临床疗效及不良反应。方法选取2011年4月~2013年4月来我院住院行胆囊切除手术的患者56例,将其随机分为观察组(全身麻醉联合硬膜外阻滞麻醉)和对照组(仅全身麻醉),每组各28例,观察并监测两组患者在术中心率、血压变化和术后呼吸功能恢复情况、清醒及拔管时间以及全身麻醉用药的总量。结果观察组在气管插管、术中探查、拔管时HR、BP较对照组明显稳定,两组之间差异有统计学意义(<0.05);对照组在术毕至拔气管时间上较观察组长,且对照组较观察组麻醉用药量和不良反应发生率多,两组之间差异有统计学意义(<0.05)。结论全身麻醉联合硬膜外阻滞麻醉在腹腔镜胆囊切除手术中应用,能明显减轻围术期应激反应,且对患者生命体征影响小、术毕清醒快、不良反应少,故值得临床上进一步推广应用。     

全身麻醉苏醒期躁动情况的调查和分析

目的:调查全身麻醉苏醒期躁动的发生率并分析其可能原因.方法:全身麻醉下行外科手术的患者1 600例,手术结束后在麻醉恢复室采用Riker镇静、躁动评分(Sedation-Agitation Scale, SAS)进行躁动诊断,调查躁动的发生率. 结果:1 600例患者中出现苏醒期躁动有114例(7.1%),其中糖尿病史患者有15例(13.2%),麻醉诱导后导尿患者86例(75.4%),乳腺手术患者19例(16.7%),腹部手术患者35例(30.7%),泌尿外科手术患者25例(21.9%),七氟烷麻醉患者54例(47.4%).苏醒期躁动与糖尿病史、麻醉诱导后导尿、手术时间、乳腺手术、腹部手术、泌尿外科手术及七氟烷麻醉相关;与年龄、性别、体质量、ASA分级、高血压病史及既往手术史无关. 结论:糖尿病史、麻醉诱导后导尿、手术时间、乳腺手术、腹部手术、泌尿外科手术及七氟烷麻醉是全身麻醉苏醒期躁动的主要危险因素.     

膈肌活动度监测在胸部手术麻醉中的应用

目的 探讨一种判断麻醉深浅程度的新方法,在开胸术中应用彩超监测膈肌运动并与常规麻醉监测方法对比研究.方法 依据麻醉监测方法不同将病例随机分为2组,常规组60例和膈肌组60例,常规组采取血流动力学监测麻醉深浅度,膈肌组除了常规组方法外还增加了床旁彩超检测膈肌活动度指标,对2组进行比较.结果 常规组术中心率(HR)为(112.50±16.27)次／分;平均动脉压(MBP)为(64.40±14.19) mmHg;呼吸(RR)为(16.00±2.7)次／分;机械通气时间(292.00 ±34.58) min;麻醉苏醒时间(39.90±11.18) min;膈肌组HR(91.70±15.97)次／分;MBP为(51.30±9.90) mmHg;RR为(13.00±2.54)次／分;机械通气时间(236.80±38.12) min;麻醉苏醒时间(25.50±10.12) min;膈肌组均小于常规组(P＜0.05).结论 膈肌活动度监测比常规方法在判断麻醉程度方面有更高的敏感性和准确性,是一种理想实用的麻醉术中监测手段.     

基于脑电非线性特征和AdaBoost算法的诱导期麻醉深度检测

提出一种结合自适应增强学习AdaBoost算法和脑电非线性特征的麻醉深度评估方法,通过提取脑电信号中的4种非线性特征（KC复杂度、小波熵、排序熵、模糊熵）作为输入,以双谱指数作为参考输出,将诱导期麻醉深度分为清醒、轻度麻醉、中度麻醉。使用9例全麻患者的诱导期脑电信号对该方法进行评估,3种不同麻醉状态分类准确度为86.69%,Kappa系数为0.837,表明该方法可以较好地区分诱导期3种不同麻醉水平,为麻醉深度监测提供新思路。     

影响小儿全麻诱导期依从性的因素

目的 探讨与小儿吸入麻醉诱导期依从性相关的因素.方法 纳入拟行择期手术的2～12岁患儿共102例.父母陪同患儿在术前等候区等候时,利用改良的耶鲁术前焦虑评分表(m-YPAS)对患儿焦虑程度进行评分.父母不陪同患儿进行麻醉诱导.所有患儿均接受O2-NO2-七氟烷面罩诱导麻醉,期间利用诱导期依从性量表(ICC)评估患儿依从性.陪同父母利用状态-特质焦虑量表(STAI)分别于术前1日和术前等候区等待时对自身特质焦虑和状态焦虑程度进行自评.结果 患儿ICC评分与患儿年龄呈明显负相关(P＜0.01),与术前等候区患儿m-YPAS评分以及父母STAI-T评分均呈明显正相关(P＜ 0.01,P＜0.05).患儿m-YPAS评分与年龄呈明显负相关(P＜0.01),与父母STAI-T及STAI-S评分呈明显正相关(P ＜0.01,P＜0.05).结论 在父母不陪同患儿进行麻醉诱导的情况下,患儿年龄越小、术前焦虑程度越高以及父母特质焦虑程度越高,其全麻诱导期依从性越差;父母术前等候区状态焦虑程度不影响患儿诱导期依从性.     

不同方式全麻复合腰硬联合麻醉在高龄病人下肢骨科手术的应用

目的评估不同方式全麻复合腰硬联合麻醉在高龄病人下肢骨科手术中的应用价值。方法45例行下肢骨科手术的高龄病人患者,根据麻醉方法的不同将病人随机分为三组（n=15）,组Ⅰ行气管插管控制呼吸全麻,组Ⅱ全麻＋腰硬联合麻醉（CSEA）,组Ⅲ全麻＋CSEA,自主呼吸。观察不同麻醉方法的麻醉效应及对各组病人术后恢复的影响。结果全麻诱导后血压、心率下降（P〈0.05）,切皮时恢复麻醉前水平,各组间的变化差异无显著性。组Ⅱ、组Ⅲ舒芬太尼和异丙酚用量较组Ⅰ显著降低,术后清醒和气管拔管时间各组间差异显著（P〈0.05）。结论不同方式全麻复合腰硬联合麻醉应用于高龄病人安全可靠,可减少全麻药物用量,使术后苏醒更为迅速。     

麻醉期心率变异性的分形特性分析

采用关联维数、分形维数、尺度指数分析38例受试者麻醉期心率变异性信号的分形特性。结果表明:麻醉期心搏周期有显著性的分形特性变化,麻醉状态下心率变异性信号的关联维数(P<0.000001)明显低于清醒状态,而短时程尺度指数α1(P<0.0001)显著性地高于清醒状态。说明了麻醉期心率变异性信号的分形特性有明显地变化,提示运用非趋势波动分析方法分析麻醉期心率变异性信号的分形特性更适合于临床麻醉深度监测。     

Blood pressure waveform analysis by means of wavelet transform

The assessment of cardiovascular function by means of arterial pulse wave analysis (PWA) is well established in clinical practice. PWA is applied to study risk stratification in hypertension, with emphasis on the measurement of the augmentation index as a measure of aortic pressure wave reflections. Despite the fact that the prognostic power of PWA, in its current form, still remains to be demonstrated in the general population, there is general agreement that analysis and interpretation of the waveform might provide a deeper insight in cardiovascular pathophysiology. We propose here the use of wavelet analysis (WA) as a tool to quantify arterial pressure waveform features, with a twofold aim. First, we discuss a specific use of wavelet transform in the study of pressure waveform morphology, and its potential role in ascertaining the dynamics of temporal properties of arterial pressure waveforms. Second, we apply WA to evaluate a database of carotid artery pressure waveforms of healthy middle-aged women and men. Wavelet analysis has the potential to extract specific features (wavelet details), related to wave reflection and aortic valve closure, from a measured waveform. Analysis showed that the fifth detail, one of the waveform features extracted applying the wavelet decomposition, appeared to be the most appropriate for the analysis of carotid artery pressure waveforms. What remains to be assessed is how the information embedded in this detail can be further processed and transformed into quantitative data, and how it can be rendered useful for automated waveform classification and arterial function parameters with potential clinical applications.     

Insight i53可视喉镜在全身麻醉气管插管中的应用效果

目的:探讨Insight i53可视喉镜在临床全身麻醉应用中的效果。方法:回顾性分析160例行全身麻醉气管插管患者的一般临床资料,依据气管插管方式进行分组,将采用普通喉镜纳入对照组（n=79）,采用Insight i53可视喉镜插管者纳入观察组（n=81）,比较不同插管方式对患者插管前（T0）、插管后1 min（T1）、插管后5 min（T2）血流动力学的影响。结果:观察组插管时间、插管次数显著少于对照组,一次插管成功率高于对照组,按压喉部发生率低于对照组,均有统计学差异（P<0.05）;观察组喉镜显露有效率为93.83%,显著高于对照组的81.01%（P<0.05）;两组T0、T1、T2刻血氧饱和度（SpO2）比较无显著差异（P>0.05）,两组T1、T2刻平均动脉压（MAP）、心率（HR）均较T0刻升高,但T2刻两组MAP、HR均较T1刻降低,且T1、T2刻观察组MAP、HR均显著低于对照组（P<0.05）。两组不良反应发生率比较无显著差异（P>0.05）。结论:Insight i53可视喉镜较普通喉镜在全身麻醉气管插管患者中喉镜显露有效率更佳,对减少患者插管次数、暴露声门、血流动力学指标影响均较小。     

Assessment of the agreement between photoplethysmographic and arterial waveform respiratory variation in patients undergoing spine surgery

Abstract

Respiratory variation in the arterial blood pressure and photoplethysmographic (PPG) waveforms have both been shown to predict the haemodynamic response to volume administration. Whether or not the two can be considered interchangeable is controversial. Twenty-three patients undergoing spine surgery received both a 20 gauge intra-arterial catheter and a Masimo adult adhesive SpHb sensor connected to a Radical-7 monitor. Pulse pressure variation (PPV) was calculated off-line at 1-min intervals. Pleth Variability Index (PVI) and Perfusion Index data were recorded. After exclusion of outliers, agreement between PPV and PVI was assessed using a repeated measures Bland-Altman approach. Concordance between changes in PPV and PVI was assessed using a four-quadrant plot with a 20% zone of exclusion. In total, 6549?min of data were collected. Repeated measures Bland-Altman analysis identified a bias of 2.2% and 95% confidence intervals of ±15.3% (limits of agreement ?13.1 and +17.6%). The concordance rate between changes in PPV and changes in PVI was 51%. The agreement between respiratory variation in the arterial blood pressure and PPG waveforms is poor and these two should not be considered interchangeable. Changes in PPV are unrelated to changes in PVI. The data, combined with recently published work from other authors, suggests that the low frequency oscillations in the PPG waveform are not related to the low frequency oscillation in the systemic arterial blood pressure tracing and may be related to changes in venous pressure, peripheral tone or other physiologic phenomena yet to be described.     

基于PPG收缩期上升波形特征参数的无创血压检测模型

旨在提出一种基于光电容积脉搏波（PPG）收缩期上升波形（SUW）特征提取的血压计算模型。首先,采集130例成年志愿者的II导心电图、手指PPG信号以及袖带血压值。数据被随机分为训练集（共80例,其中46例血压正常）和测试集（共50例,其中35例血压正常）。然后从PPG信号的SUW中提取时间、面积、斜率最大点与波谷点连线与时间轴夹角的正切值、上升期占脉宽的比例等特征,采用偏最小二乘回归法分别建立收缩压和舒张压的检测模型。最后与基于脉冲到达时间（PAT）的模型以及PAT联合PPG的模型进行对比。结果显示,本模型计算的收缩压和舒张压与参考值的相关系数分别为0.80和0.62,判断血压异常的准确率为90%。这些指标均显著高于基于PAT和PAT联合PPG参数的血压模型（P<0.05）。研究表明,基于PPG收缩上升波形特征参数的无创血压检测模型具有较好的鲁棒性和较强的异常血压检测能力。     

基于多域脑电参数分析的麻醉深度评估

提出一种结合随机森林模型的输出和脑电参数共同评估麻醉深度的方法,以提高评估麻醉深度的可靠性。首先通过滤波方式处理脑电信号,然后把信号分割成等长的多段,从每段中提取非线性域、频域、时域的10种参数,得到脑电参数-BIS值数据集;然后建立评估麻醉深度的随机森林回归模型,并在这些脑电参数中筛选出用于辅助模型评估的参数;最后在测试集上验证模型和参数的效果。该模型在测试集上的估计值与真实值之间存在很好的一致性和相关性（Pearson相关性=0.975）,筛选出的参数在测试集上也达到了82.3%的总准确率,表明该方法在评估麻醉深度方面具有较好的应用价值。     

BP网络在麻醉深度监测算法上的应用

麻醉是临床手术中必不可少的环节,但麻醉的过深或过浅可能给病人带来伤害,因而对麻醉深度的监测具有较高的临床价值。脑电是目前检测麻醉深度最有潜力的方法,首先通过滤波等处理方式得到较为纯净的脑电信号,分析时域和频域的特征,计算相应的参数,并将该参数作为前向反馈神经网络的输入参数,选择合适的BP神经网络拟合得到一个能够评价麻醉深度的无量纲常数。使用BP神经网络拟合结果来表征麻醉深度准确率普遍在90%以上,反映了BP神经网络在麻醉深度监测上具有较高的应用价值。     

Noninvasive assessment of arterial distensibility in adolescents using the second derivative of photoplethysmogram waveform

To clarify the clinical usefulness of the second derivative of the waveform of the fingertip photoplethysmogram (SDPTG), we examined the relationship between the pattern of the SDPTG waveform and risk factors related to atherosclerosis in 1,495 boys and girls aged 9–17 years. The fingertip photoplethysmogram and its second derivative wave were automatically recorded from the second digit of the right hand with the subjects lying in a supine position. The SDPTG waveform consisted of a, b, c and d waves in systole and an e wave in diastole. The heights of the a and d waves were measured from the baseline, and the ratio of the height of the d wave to that of the a wave (d/a ratio) was calculated. The d/a ratio had a negative correlation with the systolic (SBP) and diastolic blood pressures (DBP), atherogenic index (AI) and immunoreactive insulin concentrations (IRI) after adjustment for age. Multiple linear regression analysis revealed that the d/a ratio was associated more with body height than the risk factors for atherosclerosis in boys and girls at the growth period. The effect of sex- and height-specific cutoff values of the 10th percentile for the d/a ratio was therefore tested. The results showed that subjects with d/a ratios lower than the 10th percentile had significantly higher SBP, DBP, AI and IRI values compared to those with higher d/a ratios. These findings suggest that differences in the length of the vascular system, which are related to increases in body height, may modify the SDPTG waveform pattern during adolescence. When the body height as well as age and sex is adequately allowed for, the d/a ratio may be useful for the evaluation of arterial distensibility and for identification of individuals at an increased risk of developing atherosclerosis. Electronic Publication     

Remifentanil prevents tourniquet-induced arterial pressure increase in elderly orthopedic patients under sevoflurane/N2O general anesthesia

Aims: Prolonged tourniquet inflation produces a hyperdynamic cardiovascular response. We investigated the effect of continuous remifentanil infusion on systemic arterial pressure, heart rate, and cardiac output changes during prolonged tourniquet use in elderly patients under sevoflurane/N₂O general anesthesia.Methods: Thirty female patients scheduled for knee replacement arthroplasty were infused with either remifentanil at a target organ concentration of 2.0 ng/mL (remifentanil group, n = 15) or saline (control group, n = 15) after induction of anesthesia. Anesthesia was maintained with sevoflurane and N₂O. Heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), cardiac index (CI), total systemic vascular resistance index (TSVRI), BIS, end-tidal sevoflurane concentration (EtSEVO), and end-tidal carbon dioxide concentration (EtCO₂) were measured during the study period.Results: There were significant differences in mean HR, SAP, DAP, and EtSEVO over time between the groups (P = 0.047, P < 0.001, P = 0.017, and P < 0.001, respectively). There was a statistically significant time trend effect (P < 0.001) in HR, SAP, DAP, and CI between the groups, with a statistically significant time-group interaction between the two groups (P = 0.02, 0.007, 0.001, 0.01, respectively).Conclusion: The present study demonstrated that infusion with remifentanil prevented an increase in hemodynamic pressure during tourniquet inflation in elderly patients under sevoflurane/N₂O general anesthesia.     

近似熵在脑电监测麻醉深度中的应用

目的:探究脑电近似熵在麻醉深度监测中的应用。 方法:以2017年1月~2018年1月择期行全麻手术的80例患者为研究对象,测定所有患者麻醉前、麻醉诱导5 min、术中60 min、麻醉苏醒时脑电双频指数（BIS）、脑电近似熵,且观察不同丙泊酚血浆浓度、改良镇静/警觉评分（MOAA/S）BIS值、脑电近似熵值的变化情况,Pearson相关性分析BIS、脑电近似熵值与丙泊酚血浆浓度的相关性。 结果:麻醉诱导5 min、术中60 min BIS值、脑电近似熵值比麻醉前均显著降低（P<0.05）,且术中60 min的值显著低于麻醉诱导5 min时的值（P<0.05）;BIS值、脑电近似熵值随丙泊酚血浆浓度上升而下降,均呈显著负相关（P<0.05）;脑电近似熵在MOAA/S评分0~1分变化中有显著差异（P<0.05）,而BIS值无显著差异（P>0.05）。 结论:脑电近似熵对丙泊酚药效变化评价效果与BIS相当,但其相对在麻醉镇静深度判断上有优势。