异丙酚与芬太尼、氯胺酮不同配伍用于人工流产手术麻醉

过去人工流产不在麻醉下实施手术，患者不仅要承受人流的心理压力，且面对创伤和疼痛的打击。术中血压下降、心率减慢、恶心呕吐、面色苍白、四肢厥冷等人流样反应症状时有发生。无痛人流系指在异丙酚复合其它镇痛药物静脉全麻下实施人工流产术，以     

芬太尼与异丙酚联合用于人工流产术的麻醉

异丙酚近来广泛应用于门诊人工流产术的麻醉。但异丙酚镇痛作用弱 ,遇疼痛等强刺激时常需以深镇静来对抗。本文旨在通过观察不同剂量的芬太尼对异丙酚静脉麻醉人工流产术患者脑电双频指数 (ＢＩＳ)和血浆皮质醇水平的影响 ,探讨两者合理的配伍。资料与方法表 1　四组患者术中血压、心率的变化项目Ⅰ组Ⅱ组Ⅲ组Ⅳ组ＭＡＰ Ｔ0 86 2 1± 10 1984 36± 14 14 87 15± 11 2 790 0 4± 13 15(ｍｍＨｇ) Ｔ1 76 6 2± 11 97 71 72± 14 17 83 5 6± 9 8185 49± 11 0 2Ｔ2 83 14±12 43 78 2 3±13 39 80 42± 10 75 83 6 4± 9 4…     

异丙酚静脉麻醉配伍芬太尼用于人工流产镇痛效果的临床观察

人工流产是目前广泛应用于避孕失败的补救措施之一。为了解除受术者的恐惧心理,减轻术中的痛苦,笔者应用异丙酚静脉麻醉配伍小剂量芬太尼于人工流产,取得了无痛人工流产的满意效果。现报告如下。1资料与方法1.1一般资料:本研究选取的160例患者为本院2003年2月至2003年12月妇产科门诊收治的早孕妇女。年龄20～40岁,平均26岁;孕龄45～70天。要求终止妊娠,无手术禁忌症。随机分为实验组与对照组各80例。两组年龄、孕次及产次,均无显著性差异(P>0.05)。1.2方法:观察组于术前常规禁饮禁食4小时以上,术中常规吸氧,建立静脉通路,常规监测BP、HR、…     

异丙酚伍用少量麻黄碱用于人工流产手术麻醉的观察

异丙酚是一种新型超短效静脉全麻药,近年来许多人应用于人工流产手术的麻醉[1].但由于异丙酚对循环、呼吸的抑制作用,使异丙酚在应用时受到限制.为此,我们将异丙酚与少量麻黄碱混合后,用于人工流产手术的麻醉,重点观察对麻醉效应、呼吸、循环系统的影响,现报告如下.     

不同配伍异丙酚麻醉在人工流产手术中的应用

异丙酚近来广泛应用于人工流产术的麻醉。 但异丙酚镇痛作用弱,遇疼痛等强刺激时常需以深镇静来对抗;异丙酚作用时间相当短,遇手术时间长者用药量过大。本文旨在通过比较异丙酚复合应用芬太尼、咪唑安定、氯胺酮的临床效果,寻找一种最佳的配伍方案。     

芬太尼与异丙酚联合静脉麻醉用于人工流产术效果观察

对280例早孕妇女采用1μg/kg芬太尼与1－1.5mg/kg异丙酚联合静脉麻醉下行无痛人工流产术，并与无麻醉下人工流产术300例进行比较。观察镇痛效果，宫颈松弛度，人流综合征发生率，阴道出血量，呼吸、循环系统反应。结果观察组术中镇痛效果确切，受术者无疼痛感，宫颈松弛，无1例人流综合征发生，两组比较，差异有极显著性意义（均P＜0.01)；两组阴道出血量比较，差异无显著性意义（P＞0.05)；麻醉诱导时观察组19例出现一过性呼吸抑制。提示小剂量芬太尼与异丙酚联合静脉麻醉用于人工流产术可镇痛，避免人流综合征发生，但对呼吸的抑制不可忽视，需严密监测。     

不同剂量雷米芬太尼伍用丙泊酚用于无痛人流手术麻醉

近年来无痛人流的需求量逐年上升,丙泊酚无痛人流技术已广泛用于临床,但该技术致今仍存一定缺憾。本研究拟观察不同剂量雷米芬太尼与丙泊酚配伍用于无痛人流手术的安全性及可行性,探求合理的配伍。     

异丙酚在人工流产手术中的应用观察

目的　观察异丙酚在人工流产手术中麻醉效果及其对人工流产的影响。　方法　选择2004年1~6月自愿接受人工流产术的早孕患者200例,分为观察组和对照组各100例,观察组静脉注射异丙酚行无痛人工流产,对照组不给麻醉药物予常规人工流产。两组手术方法相同。　结果　观察组镇痛率为100%,无人工流产综合征发生,对照组均感疼痛,发生人工流产综合征25例,两组比较差异显著(P<0. 01)。观察组宫颈松弛程度和术中反应均优于对照组(P<0. 01);两组术中出血量比较无统计学差异(P>0. 05)。　结论　异丙酚用于人工流产手术镇痛效果好,可避免人工流产综合征的发生,减少术中不良反应,缩短手术时间,对子宫收缩无影响,可广泛应用于无痛人流手术。     

Upper Airway Reflexes during a Combination of Propofol and Fentanyl Anesthesia

Background: The effects of intravenous anesthetics on airway protective reflexes have not been fully explored. The purpose of the present study was to characterize respiratory and laryngeal responses to laryngeal irritation during increasing doses of fentanyl under propofol anesthesia.

Methods: Twenty-two female patients anesthetized with propofol and breathing through the laryngeal mask airway were randomly allocated to three groups: (1) eight patients who received cumulative total doses of 200 [micro sign]g fentanyl given in the form of two doses of 50 [micro sign]g and one dose of 100 [micro sign]g spaced 6 min under mechanical controlled ventilation while end-tidal carbon dioxide tension (PCO2) was maintained at 38 mmHg (fentanyl-controlled ventilation group), (2) eight patients who received cumulative total doses of 200 [micro sign]g fentanyl while breathing spontaneously while end-tidal PCO2 was allowed to increase spontaneously (fentanyl-spontaneous ventilation group), and (3) six spontaneously breathing patients who were anesthetized with propofol alone (propofol group). The laryngeal mucosa of each patient was stimulated by spraying the cord with distilled water, and the evoked responses were assessed by analyzing the respiratory variables and endoscopic images.

Results: Before administration of fentanyl, laryngeal stimulation caused vigorous reflex responses, such as expiration reflex spasmodic panting, cough reflex, and apnea with laryngospasm. Increasing doses of fentanyl reduced the incidences of all these responses, except for apnea with laryngospasm, in a dose-related manner in both the fentanyl-controlled ventilation and the fentanyl-spontaneous ventilation groups. Detailed analysis of endoscopic images revealed several characteristics of laryngeal behavior during the airway reflex responses.     

丙泊酚联合芬太尼复合麻醉在面部整形美容手术中的应用效果

分析在面部整形美容手术中应用丙泊酚与芬太尼复合麻醉的临床价值。方法 选取2022年 1月-2023年11月我院行面部整形美容手术患者72例,通过随机数字表法分为对照组和观察组,各组36例。 对照组术中为丙泊酚麻醉,观察组术中为丙泊酚+芬太尼复合麻醉,比较两组相关麻醉质量指标、麻醉不 良反应及术后疼痛情况。结果 观察组麻醉诱导时间、自主呼吸恢复时间、定向力恢复时间、气管导管拔 除时间均短于对照组,丙泊酚用量少于对照组（P ＜0.05）;观察组麻醉不良反应发生率为2.78%,与对照 组的5.56%比较,差异无统计学意义（P＞0.05）;观察组术后30、60 min及2、6 h的VSA疼痛评分均低于对 照组（P ＜0.05）。结论 在面部整形手术中通过给予患者丙泊酚+芬太尼复合麻醉方案能够有效提升麻醉 质量,减轻疼痛程度,且安全性良好。     

Awakening Propofol Concentration with and without Blood-Effect Site Equilibration after Short-term and Long-term Administration of Propofol and Fentanyl Anesthesia

Background: The propofol awakening concentration can vary. However, the effect site awakening propofol concentration will be a fixed value. The purpose of this study was to determine the awakening propofol concentrations obtained from infusion Schede using abrupt discontinuation of propofol (half-maximal effective concentration [EC sub 50]) or a descending decrease in concentration to allow blood-effect site equilibration (EC50 eq).

Methods: Patients undergoing short-term (group 1) and long-term (group 2) elective surgery were anesthetized with computer-assisted continuous infusion of propofol and fentanyl, with both groups receiving the same propofol (3 micro gram/ml) and fentanyl (1 ng/ml) concentrations 20-30 min before the end of surgery until the end. Then both groups were further divided into two subgroups: subgroup A abrupt discontinuation, and subgroup B descending concentrations of propofol (15-min duration per concentration). In the A subgroups, the response to verbal command was evaluated every 30 s. In the B subgroups, the blood propofol concentrations just permitting and just preventing response to command were averaged individually. The EC50 and EC50 eq values were determined by probit analysis.

Results: The EC50 of group 1A was 1 micro gram/ml, which was significantly less than the 1.6 micro gram/ml of group 2A (P < 0.05). The awakening time of group 1A was 5.2 +/- 1.8 min, which was significantly shorter than the 9.3 +/- 3.5 min of group 2A (means +/- SD). The EC50 eq of both groups 1B and 2B was 2.2 micro gram/ml.     

依托咪酯复合芬太尼在无痛人工流产中的应用

为减少人工流产术中的不良反应,减轻患者术中疼痛,自2002年7月起我科对100例人工流产患者进行了依托咪酯复合芬太尼静脉麻醉的前瞻性随机研究,报道如下。1临床资料1.1一般资料要求终止妊娠且无手术禁忌症者100例,随机分为:观察组50例,经产妇16例,初产妇34例;对照组50例,经产妇1     

瑞芬太尼复合芬太尼全凭静脉麻醉用于腹腔镜胆囊切除术的临床研究

目的对比研究瑞芬太尼复合芬太尼全凭静脉麻醉与单纯使用瑞芬太尼或芬太尼静脉复合麻醉用于腹腔镜胆囊切除术（LC）的效果。方法60例择期LC患者，随机分为三组：单纯瑞芬太尼组（R）、瑞芬太尼＋芬太尼组（RF）和单纯芬太尼组（F）（n=20）。观察记录全麻诱导、维持及苏醒期平均动脉压（MAP）、心率（HR）、SpO2，停药至患者自主呼吸恢复时间、意识恢复时间、拔除气管导管时间，病人拔管后即刻、1、3、7、12h的疼痛程度评分（VRS）、意识状态评分（OAAS）及苏醒期并发症。结果与RF、F组及组内诱导前比，R组诱导插管时MAP较低，HR较快，术毕MAP较高，HR增快，术中维持过程无明显差异。RF、F两组间及组内在诱导与维持过程MAP及HR无明显差异，拔管及离开手术室时RF组MAP升高、HR增快。R、RF两组术后各观察指标时间差异无显著性，F组明显延长。三组术后并发症无统计学差异。R组术后VRS明显高于RF、F组（P〈0．01）；组内与拔管后即刻相比，R组术后VRS评分均明显升高，RF、F组无明显变化。F组在拔管后即刻，术后1、3h的OAAS均明显低于R、RF组（P〈0．01）。结论与单纯使用瑞芬太尼或芬太尼麻醉相比较，在麻醉诱导期复合使用瑞芬太尼和芬太尼，后期再以瑞芬太尼维持麻醉，其麻醉效应更加平稳，苏醒质量不受明显影响，术后不良反应更轻，并可减少患者术后对于镇痛的要求。     

芬太尼在异丙酚诱导期间对脑电双频指数及血压心率的影响

目的 :观察在异丙酚诱导期间 ,不同剂量芬太尼对脑电双频指数 (BIS)为参考指标的皮层功能状态的影响以及相应的血压心率变化。方法 :选择 40例ASAⅠ～Ⅱ级病人 ,随机分成四组 :Ⅰ组为对照组 ,Ⅱ、Ⅲ、Ⅳ组分别接受芬太尼 2 μg/kg、4μg/kg、8μg/kg ,静注生理盐水或芬太尼后 ,通过输液泵持续输注异丙酚使BIS稳定在 45± 5并维持 3分钟后插管。试验采用双盲法。结果 :置喉镜插管后 ,Ⅰ、Ⅱ组血压、心率较基础值明显升高 ,Ⅲ、Ⅳ组则升高不明显(P >0 0 5)、插管刺激使Ⅰ、Ⅱ、Ⅲ组BIS较插管前明显升高 ,而Ⅳ组BIS升高却不明显。SEF对插管刺激缺乏特异性变化。结论 :4μg/kg以上的芬太尼可以有效减弱插管所致的心血管反应 ,而 8μg/kg的芬太尼才可削弱置喉镜插管对皮层状态的激活 ,BIS不能预测气管插管引起的心血管反应     

Collapsibility of the Upper Airway at Different Concentrations of Propofol Anesthesia

Background: This study investigated the effect of varying concentrations of propofol on upper airway collapsibility and the mechanisms responsible for it.

Methods: Upper airway collapsibility was determined from pressure-flow relations at three concentrations of propofol anesthesia (effect site concentration = 2.5, 4.0, and 6.0 [mu]g/ml) in 12 subjects spontaneously breathing on continuous positive airway pressure. At each level of anesthesia, mask pressure was transiently reduced from a pressure sufficient to abolish inspiratory flow limitation (maintenance pressure = 12 +/- 1 cm H2O) to pressures resulting in variable degrees of flow limitation. The relation between mask pressure and maximal inspiratory flow was determined, and the critical pressure at which the airway occluded was recorded. Electromyographic activity of the genioglossus muscle (EMGgg) was obtained via intramuscular electrodes in 8 subjects.

Results: With increasing depth of anesthesia, (1) critical closing pressure progressively increased (-0.3 +/- 3.5, 0.5 +/- 3.7, and 1.4 +/- 3.5 cm H2O at propofol concentrations of 2.5, 4.0, and 6.0 [mu]g/ml respectively; P < 0.05 between each level), indicating a more collapsible upper airway; (2) inspiratory flow at the maintenance pressure significantly decreased; and (3) respiration-related phasic changes in EMGgg at the maintenance pressure decreased from 7.3 +/- 9.9% of maximum at 2.5 [mu]g/ml to 0.8 +/- 0.5% of maximum at 6.0 [mu]g/ml, whereas tonic EMGgg was unchanged. Relative to the levels of phasic and tonic EMGgg at the maintenance pressure immediately before a decrease in mask pressure, tonic activity tended to increase over the course of five flow-limited breaths at a propofol concentration of 2.5 [mu]g/ml but not at propofol concentrations of 4.0 and 6.0 [mu]g/ml, whereas phasic EMGgg was unchanged.