硬膜外麻醉复合气管插管静吸全麻对胸腔镜肺大疱切除术患者术后苏醒期躁动、疼痛和短期认知功能的影响

目的探讨硬膜外麻醉复合气管插管静吸全麻(全麻)对胸腔镜肺大疱切除术患者术后苏醒期躁动、疼痛和短期认知功能的影响。方法随机将72例择期行胸腔镜下肺大疱切除术的患者分为2组,每组36例。对照组行全麻,观察组行硬膜外麻醉复合全麻。结果观察组患者的苏醒期躁动发生率、术后NRS疼痛评分及短期认知功能评分均显著优于对照组,差异有统计学意义(P0.05)。结论硬膜外麻醉复合全麻应用于胸腔镜下肺大疱切除术,可有效降低患者苏醒期躁动发生率、减轻疼痛程度和改善短期认知功能,有利于患者术后恢复。     

丙泊酚与七氟醚复合麻醉对肝炎肝硬化患者腹部手术后苏醒质量的评价

目的评估肝炎肝硬化患者腹部手术中应用丙泊酚靶控输注与七氟醚吸入复合麻醉对术后苏醒质量的影响。方法选择我院行腹部手术的86例肝炎肝硬化患者进行前瞻性研究,按随机原则分为两组:研究组43例,行丙泊酚靶控输注与七氟醚吸入复合麻醉;对照组43例,行丙泊酚全凭静脉麻醉。分别于拔管后即刻(T0)、拔管后15 min(T1)、30 min(T2)、60 min(T3)、90 min(T4)五个时间点评估并比较两组患者改良Aldrete评分、改良OAA/S评分及脑电双频指数(BIS)。应用Pearson相关分析苏醒时间与上述指标的相关性。比较两组患者术后自主呼吸恢复时间、拔管时间、苏醒时间及躁动发生率。同时记录并比较两组患者术后呛咳反应及恶心呕吐(PONV)等相关并发症发生率。结果随着拔管时间的延长,两组改良Aldrete评分及改良OAA/S评分均增加,而BIS指数降低,差异均有统计学意义(P0.05);同一时间点研究组改良OAA/S评分及改良Aldrete评分高于对照组,而BIS指数低于对照组,差异有统计学意义(P0.05)。Pearson分析显示苏醒时间与改良Aldrete评分及改良OAA/S评分正相关,而与BIS负相关(P0.05)。研究组患者自主呼吸恢复时间、拔管时间、苏醒时间及躁动发生率均显著低于对照组(P0.05)。两组患者术后并发症发生率比较无统计学差异(P0.05)。结论肝炎肝硬化患者腹部手术应用丙泊酚联合七氟醚静-吸复合麻醉苏醒较迅速,术后苏醒质量及安全性均较好。     

充气式保温毯用于麻醉复苏室全麻恢复期患者的效果观察

目的评价充气式保温毯在麻醉复苏室预防全麻患者恢复期低体温及寒颤的效果。方法将80例择期全麻手术患者随机分为观察组和对照组各40例。对照组入麻醉恢复室后给予常规太空被保暖;观察组使用充气式保温毯保暖。评价两组患者体温变化及寒颤、苏醒延迟发生率。结果观察组低体温及苏醒延迟率显著低于对照组,入麻醉复苏室30 min、出室时体温显著高于对照组(P0.05,P0.01)。结论应用充气式保温毯能有效降低全麻恢复期患者低体温,促进患者麻醉后苏醒。     

右美托咪啶对全麻患者苏醒期不良反应的影响

目的:观察右美托咪啶对全麻患者苏醒期内不良反应的影响.方法:选择全麻下择期手术患者120例,ASA分级Ⅰ～Ⅱ级,随机分为右美托咪定观察组和生理盐水对照组,每组60例.术前对照组微量泵静注生理盐水10ml,观察组微量泵静注右美托咪啶0.5 g/kg(生理盐水稀释到10ml).两组采用相同麻醉方法.记录两组患者苏醒期心血管反应(0～2级)、躁动程度(0～3级)、术后切口疼痛程度评分(口述描绘评分法)、术后咽喉疼痛程度评分(Prince-Henry评分法).结果:观察组1～2级心血管反应发生率、躁动程度0级率及术后切口疼痛发生率均低于对照组(p＜0.05).结论:右美托咪啶能显著减少全麻患者苏醒期不良反应的发生.     

氟比洛芬酯超前镇痛用于乳腺癌根治术患者的临床观察

目的:探讨氟比洛芬酯超前镇痛对乳腺癌根治术患者术后疼痛以及全麻苏醒期躁动的影响。方法:选择全身麻醉下乳腺癌根治术患者(ASA I～II级)120例,随机分为A组(麻醉诱导完成后立即给予50 mg氟比洛芬酯,切口缝合完成时再给予50 mg),B组(麻醉诱导完成后立即给予100 mg氟比洛芬酯),C组(切口缝合完成时给予100 mg氟比洛芬酯)D组(对照组,切口缝合完成时换等量的生理盐水),每组30例。比较各组患者术后1,3,6,12,24 h的VAS评分,手术结束时与拔管时的心血管反应,以及全麻苏醒躁动情况。结果:3个观察组术后12 h内各时间点VAS评分均明显低于对照组(均P<0.05),其中A组各时间点均明显低于C组(均P<0.05),在1,3 h明显低于B组,而B组在1,3 h明显低于C组(均P<0.05),术后24 h的VAS评分4组间差异无统计学意义(均P>0.05);手术结束时4组间平均动脉压(MAP)和心率(HR)变化差异无统计学意义(P>0.05),但3个观察组患者拔管时的MAP,HR的变化均小于对照组(均P<0.05),其中A组变化最小,其次为B组和C组(均P<0.05),B组明显低于C组(均P<0.05);各组全麻苏醒期躁动发生率分别为:A组13.3%,B组23.3%,C组33.3%,D组43.3%,各组间的差异均有统计学意义(均P<0.05)。结论:氟比洛芬酯超前镇痛能有效减轻乳腺癌根治术患者术后早期疼痛程度、心血管反应,以及降低全麻苏醒期躁动的发生率。     

全麻苏醒期家长陪伴对患儿麻醉恢复和术后心理的影响

【摘要】〓目的〓探讨全麻苏醒期家长陪伴对患儿复苏效果和术后心理的影响。方法〓对照组患儿手术后由复苏室护士全程照顾,观察和护理。观察组患儿除由复苏室护士照顾、观察和护理外,还选拔一名患儿信任的家长在患儿临近苏醒时进入复苏室陪伴,比较两组患儿复苏时间、全麻苏醒期躁动和术后不良行为发生情况。结果〓两组患儿复苏时间比较(P<0.05)全麻苏醒期躁动发生率比较(P<0.05),术后不良行为发生发生率比较(P<0.01)。结论〓全麻苏醒期家长陪伴可减轻患儿心理创伤,有效地降低全苏醒期躁动和术后不良行为的发生。     

全身麻醉术后患者苏醒期并发症发生情况调查分析

目的了解全麻术后患者苏醒期并发症发生情况,为临床监护及制定个体化护理方案提供参考。方法将2 938例全麻术后入麻醉恢复室患者按年龄段分为儿童组(285例)、青年组(816例)、中年组(1 432例)及老年组(405例),观察、记录并发症发生情况。结果全麻术后苏醒期567例(19.30%)患者发生并发症;四组高血压、低血压、低氧血症、躁动、苏醒延迟发生率比较,差异有统计学意义(均P0.01);苏醒时间老年组最长、儿童组最短(均P0.05)。结论患者全麻术后苏醒期并发症发生率较高,老年组以高血压、低氧血症、苏醒延迟发生率偏高,青年组以低血压发生率偏高,儿童组以躁动发生率偏高。应根据患者年龄与并发症特点采取相应护理措施,确保患者安全复苏。     

竖脊肌平面阻滞在老年全麻髋部手术中的应用效果

目的 探讨老年人全麻髋部手术前行L₄横突竖脊肌平面阻滞(erector spinae plane block, ESPB)减轻围术期疼痛和应激从而减少阿片类药用量和提高术后苏醒质量的效果。方法 选择2023年1～12月65岁及以上单侧髋关节手术60例,按随机数字表法分为2组(n=30),阻滞组诱导前在超声引导下于L₄横突水平行ESPB(局麻药为0.3%罗哌卡因0.5 ml/kg),对照组未行ESPB。2组均采用喉罩全麻,诱导、麻醉维持方法一致。使用数字评价量表(Numerical Rating Scale, NRS)评价术后8、24 h疼痛程度,记录术后24 h内镇痛泵按压次数;观察2组术中各时点血流动力学变化;记录手术结束至患者完全苏醒时间、拔除喉罩时间;记录术中和麻醉后恢复室(Postanesthesia Care Unit, PACU)的阿片类药物使用量;记录术后躁动、恶心呕吐、头晕发生率及苏醒质量评分。结果 术后8、24 h静息及运动疼痛NRS评分阻滞组均明显低于对照组,24 h镇痛泵按压次数阻滞组明显少于对照组(P<0.05)...     

罗哌卡因髂腹下/髂腹股沟神经阻滞在儿童腹股沟疝围手术期的效果

目的探讨罗哌卡因髂腹下/髂腹股沟神经阻滞在儿童腹股沟疝围手术期中的应用效果。 方法将2018年8月至2019年7月仙桃市第一人民医院收治的108例腹股沟疝患儿以抽签法分为对照组（54例）和观察组（54例）,均行腹股沟疝手术,对照组常规全身麻醉,观察组在常规全麻基础上于超声引导下行罗哌卡因髂腹下/髂腹股沟神经阻滞,观察2组不同时间点血流动力学指标,包括心率（HR）、收缩压（SBP）、舒张压（DBP）,记录其术中全麻药物（舒芬太尼和丙泊酚）用量、术后拔管时间、苏醒时间、麻醉复苏室（PACU）留观时间、术后特殊患者疼痛评估量表（FLACC）评分、麻醉不良反应,并采用躁动评分（PAED）评估2组患儿躁动发生及严重程度。 结果观察组入室后（T₀）HR、SBP、DBP与对照组均无显著差异（P>0.05）;切皮时（T₁）、术毕时（T₂）HR、SBP、DBP均低于对照组（P<0.05）。观察组舒芬太尼和丙泊酚使用剂量均少于对照组（P<0.05）,术后拔管时间、苏醒时间、PACU留观时间均短于对照组（P<0.05）,术后30 min、术后2、6、12和24 h FLACC评分均低于对照组（P<0.05）,恶心呕吐及躁动发生率、PAED评分均低于对照组（P<0.05）。 结论罗哌卡因髂腹下/髂腹股沟神经阻滞有利于维持儿童腹股沟疝围手术期血流动力学稳定,减轻术后疼痛。     

右美托咪定联合强化护理干预对鼻内镜手术患者苏醒期躁动的影响

目的减少鼻内镜手术患者苏醒期躁动。方法将80例鼻内镜手术患者随机分为对照组与观察组各40例。对照组给予右美托咪定及常规护理预防苏醒期躁动;观察组给予右美托咪定联合强化护理干预。结果观察组躁动评分、拔管时间、复苏室停留时间、术后4h疼痛评分显著低于或短于对照组(均P0.05)。结论右美托咪定联合强化护理干预可减少鼻内镜手术患者麻醉苏醒期躁动,促进患者康复。     

专业素养培训对本科实习护生临床实践行为及专业承诺的影响

目的探讨专业素养培训对本科实习护生临床实践行为及职业承诺的影响。方法对341名本科实习护生实施专业素养培训,包括岗前职业教育、职业技能培训、双导师负责制、护生管床制、实习大讲堂、护生风采展示。实习结束时采用临床实践行为问卷、护理专业承诺问卷进行调查。结果本科实习护生临床实践行为得分为3.81±0.65,护理专业承诺得分为84.67±13.74,显著高于国内常模(P<0.05,P<0.01)。结论专业素养培训有助于培养具有较高临床实践行为水平及稳定专业承诺意向的本科护生。     

眼科护理人文关怀沟通记录表的设计与应用

目的提高眼科病区住院患者护理服务满意度。方法将530例眼科住院患者按时间段分为对照组和观察组各265例;两组均遵医嘱行常规护理,对照组行常规沟通,观察组根据自行设计的眼科护理人文关怀沟通记录表进行沟通。结果观察组对护士关怀护理服务的满意度显著高于对照组(P<0.05,P<0.01)。结论按照护理人文关怀沟通记录表要求进行护患沟通,可提高患者对护士关怀护理服务的满意度。     

ST段抬高型心肌梗死再灌注患者基于时刻APP的救治流程改进

目的探讨时刻APP对ST段抬高型心肌梗死(STEMI)患者再灌注救治流程的优化作用。方法根据就诊时间将中国胸痛中心认证数据管理云平台收录的急诊就诊STEMI患者分为对照组(n=19)和观察组(n=23)。对照组按胸痛中心原流程救治,并通过填写胸痛中心急性胸痛诊治时间节点记录表录入D2B时间。观察组采取以时刻APP分析为指导的改进流程进行救治,并通过时刻APP录入D2B时间。结果流程改进后,观察组从诊断到启动导管室和导管室激活到患者到达2个时间段达标率显著优于对照组(均P<0.01),患者D2B时间的总达标率高于对照组(P<0.05)。结论以时刻APP为指导的救治流程改进可以提高胸痛中心STEMI患者D2B时间达标率,进而改善患者预后。     

麻醉护士在快速康复外科模式下急性疼痛服务中的作用

目的探讨麻醉护士在快速康复外科(ERAS)模式下急性疼痛服务(APS)中的作用。方法根据入院时间将患者分为两组,2016年3~9月收治的80例胃肠手术患者(对照组)按照ERAS模式及APS进行围手术期管理,2016年10月至2017年3月收治的73例患者(观察组)在对照组管理基础上增设麻醉护士岗位并使其参与术后疼痛管理,包括APS小组构建、患者疼痛管理档案的建立及APS活动沟通平台的运行。结果两组术后各时间点VAS疼痛评分及术后首次下床时间、首次排气时间、多模式镇痛及自控镇痛率比较,差异有统计学意义(P<0.05,P<0.01)。结论麻醉护士在ERAS模式下APS中有重要作用,有利于麻醉护士专科化发展。     

Development of postoperative delirium in relation to a room change in the general surgical unit

To analyze the relationship between the development of postoperative delirium and a change of the patient's room, 1,006 cases of patients who had undergone surgery with general anesthesia were reviewed. Postoperative delirium developed in 84 (8.3%) cases. On the basis of symptomatic features, postoperative delirium was divided into four types: (1) excitement type, (2) excitement-hallucination type, (3) hallucination type, and (4) disorientation type. Of the 31 excitement-type cases, 21 developed within the 2nd postoperative day (POD) while 27 of 29 hallucination types developed after POD 2. Of 29 hallucination types, 22 developed after a room change while 20 of these 22 cases were transferred to a single room before POD 2. A quiet, dark, and isolated environment in a single room is suggested to contribute to the development of hallucinations. The development of postoperative delirium with hallucinations alone should thus be taken into consideration whenever a room change is decided.     

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??A method of pancreatieojejunostomy in pancreaticoduodenectomy??An analysis of 83 cases ZHANG Jian, WANG Jian-ming, MA Chao-qun, et al. Department of General Surgery, Tongji Hospital??Tongji Medical College, Huazhong University of Science and Technology??Wuhan 430030??China
Corresponding author: WANG Jian-ming, E-mail??kangaroozj@yahoo.com.cn
Abstract Objective To explore a method of pancreaticojejunostomy in pancreaticoduodenectomy. Methods The clinical data of 83 cases of pancreaticoduodenectomy using the modified technique of duct to mucosa pancreaticojejunostomy from July 2009 to December 2012 in Department of General Surgery, Tongji Hospital??Tongji Medical College, Huazhong University of Science and Technology were analyzed retrospectively. Results The average time was 20±2 min for the anastomosis in the 83 cases. There were only two cases of pancreatic leakage postoperatively with the incidence of 2.4%??2/83??. Conclusion The pancreaticojejunostomy is easy to perform and time-saving with obviously reducing incidence of pancreatic fistula??It is proved to be a kind of safe and efficient anastomosis.     

门静脉高压症断流术后门静脉血栓形成诊治分析

目的 探讨门静脉高压症断流术后门静脉系统血栓形成（PVT）的诊治方法。 方法 回顾性分析华中科技大学同济医学院附属同济医院1993年4月至2008年10月行断流术后并发PVT的72例病人临床资料。结果 断流术后PVT于术后9～21d好发于脾静脉、门静脉主干等部位,经溶栓、抗凝或手术治疗,除1例因肠坏死合并中毒性休克而死亡外,余经治疗PVT均消失,其中1例发生短肠综合征。结论 腹部彩超或CT是PVT的确诊方法,术中操作轻柔、术后监测血小板计数、腹部彩超或CT、早期溶栓抗凝、及时手术是防治PVT的有效方法。     

The effect of advanced recovery room care on postoperative outcomes in moderate-risk surgical patients: a multicentre feasibility study

Postoperative complications are common and may be under-recognised. It has been suggested that enhanced postoperative care in the recovery room may reduce in-hospital complications in moderate- and high-risk surgical patients. We investigated the feasibility of providing advanced recovery room care for 12–18 h postoperatively in the post-anaesthesia care unit. The primary hypothesis was that a clinical trial of advanced recovery room care was feasible. The secondary hypothesis was that this model may have a sustained impact on postoperative in-hospital and post-discharge events. This was a multicentre, prospective, feasibility before-and-after trial of moderate-risk patients (predicted 30-day mortality of 1–4%) undergoing non-cardiac surgery and who were scheduled for postoperative ward care. Patients were managed using defined assessment checklists and goals of care in an advanced recovery room care setting in the immediate postoperative period. This utilised existing post-anaesthesia care unit infrastructure and staffing, but extended care until the morning of the first postoperative day. The advanced recovery room care trial was deemed feasible, as defined by the recruitment and per protocol management of > 120 patients. However, in a specialised cancer centre, recruitment was slow due to low rates of eligibility according to narrow inclusion criteria. At a rural site, advanced recovery room care could not be commenced due to logistical issues in establishing a new model of care. A definitive randomised controlled trial of advanced recovery room care appears feasible and, based on the indicative data on outcomes, we believe this is warranted.     

肝内胆管结石合并肝胆管癌32例诊治分析

目的 探讨肝内胆管结石合并肝胆管癌的临床特点和诊治经验。方法 对1993-2007年间华中科技大学同济医学院附属同济医院肝胆胰外科研究所收治的32例肝内胆管结石并发肝胆管癌病例的临床资料进行回顾性分析。结果 32例肝胆管癌占同期肝内胆管结石病人的1.9%,术前确诊率为59 .4%（19/32）。其中周围型胆管癌占43.8%（14/32）,肝门部胆管癌占50%（16/32）。肿瘤根治性切除率为31.3%（10/32）,姑息性手术46.9%（15/32）。有随访资料的28例中,根治组平均存活时间22个月,姑息手术组平均存活9个月。结论 肝内胆管结石造成的胆管系统内慢性炎症环境可能是诱发胆管癌的重要原因。对于有长期肝内胆管结石病史以及胆道手术史的病人,必须警惕并发肝胆管癌的可能。该病的早期诊断和根治性切除率低,预后差。     

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??Diagnosis and treatment of portal vein thrombosis in patients with portal hypertension disconnection after operation WU Jian-li, YANG Zhen, WANG Chao, et al. Department of General Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan430030, China Corresponding author??YANG Zhen, E-mail?? zyang@tjh.tjmu.edu.cn Abstract Objective To investigate diagnosis and treatment of portal vein thrombosis ??PVT??in patients with portal hypertension disconnection after operation. Methods The clinical data of 71 cases of PVT after disconnection admitted between April 1993 and October 2008 at Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology were analyzed retrospectively. Results The predilection area of postoperative PVT was splenic vein and portal vein in 9—21d after operation.Among them, except for one case died of intestinal necrosis combined toxic shock, all cases were recovered. But one case occurred in short bowel syndrome. Conclusion Abdominal doppler ultrasound or CT is the road of definite diagnosis. Operation standardization, dynamic examining platelet count, routine doppler ultrasonography or CT examining, early thrombolysis and anticoagulation therapy are the effective methods in preventing and managing PVT postoperation for potal hypertension disconnection.