右美托咪定预防小儿七氟烷麻醉后苏醒期的躁动反应

[目的]探讨右美托咪定对小儿七氟烷麻醉后苏醒期躁动的预防作用。[方法]本院80例急诊手术患儿,按实验设计分成右美托咪定组（A组）和对照组（B组）,每组40例。两组患儿均采用七氟烷吸入诱导,气管插管后行机械通气,术中予吸入七氟烷-空氧混合气体维持。A组在此基础上连续静脉输注右美托咪定0．5μg/（kg ＆#183; h ）至手术结束前5 min停用。采用改良Aldrete评分、PAEDS评分和CHEOPS评分对两组患儿的复苏状况、苏醒期躁动和术后疼痛进行评估。[结果]两组患儿麻醉后恢复室（PACU）停留时间相比较差异无显著性（ P＞0．05）,A组苏醒期各时间段躁动发生率均小于B组（ P＜0．05）。两组患儿各时段改良 Aldrete评分比较无统计学差异。入PACU后B组各时点PAEDS评分均高于 A组（ P ＜0．05）,且第20 min和第30 min B组CHEOPS评分高于 A组（ P ＜0．05）。[结论]静脉连续输注右美托咪定不会显著延长小儿的苏醒时间,且苏醒过程中躁动的发生率明显降低,因此右美托咪定能预防小儿七氟烷麻醉后苏醒期的躁动反应。     

小剂量右美托咪定滴鼻预防七氟烷麻醉患儿苏醒期躁动分析

目的:探讨小剂量右美托咪定滴鼻对七氟烷麻醉患儿苏醒期躁动情况的预防作用。方法:选取我院2014年6月~2015年12月收治的48例外科手术患儿为研究对象,随机分为观察组和对照组各24例。观察组给予小剂量右美托咪定滴鼻治疗,对照组给予等量的0.9%氯化钠注射液滴鼻治疗,比较两组患儿苏醒期躁动情况。结果:观察组患儿苏醒期躁动发生率、躁动评分及持续时间均显著低于对照组,各时点VAS评分和Ramsay评分显著优于对照组(P<0.05)。结论:七氟烷麻醉患儿苏醒期给予小剂量右美托咪定滴鼻治疗,可有效避免患儿苏醒期躁动事件的发生,显著改善患儿不同时点的VAS评分和Ramsay评分,值得临床推广应用。     

右美托咪定对小儿七氟烷吸入麻醉苏醒期躁动的影响

目的探讨右美托咪定对小儿七氟烷吸入麻醉苏醒期躁动的影响。方法选择2011年3月-2012年1月美国麻醉医师协会分级Ⅰ～Ⅱ级、年龄2～8岁、择期行疝囊高位结扎术和隐睾下降固定术患儿40例,随机分为2组,右美托咪定组(A组)和对照组(B组),两组患儿在年龄、体重、手术种类无明显差异。两组患儿均采用面罩8%七氟烷吸入麻醉诱导,开放静脉,给予盐酸戊乙奎醚0.1 mg/kg、顺式阿曲库铵0.15 mg/kg,插入喉罩,麻醉维持根据血压、心率及脑电双频指数调节吸入麻醉药浓度。A组静脉给予1μg/kg右美托咪定,B组给予同等容量的生理盐水。入室至手术结束时连续观察收缩压、舒张压、心率、血氧饱和度,记录清醒时间、拔除喉罩时间,记录苏醒期并发症的发生数。记录入麻醉恢复室即刻(0 min)、15、30、60、90 min患儿疼痛和躁动评分。结果两组患儿在手术时间、清醒时间以及拔除喉罩时间差异无统计学意义(P>0.05),A组术后入恢复室0、15、30 min疼痛评分和躁动评分均低于B组(P<0.05),两组患儿围术期均未出现低血压和心动过缓。结论右美托咪定用于小儿七氟烷吸入麻醉能够增强术后镇痛,减少苏醒期躁动。     

右美托咪定对先心病患儿心导管术后苏醒期躁动的影响

[目的]探讨右美托咪定对先心病患儿心导管术后苏醒期躁动的影响.[方法]93例拟行心导管介入手术的先心病患儿随机分成三组.给予七氟烷面罩吸入诱导,静脉注射舒芬太尼0.1 μg/kg和罗库溴铵0.6 mg/kg,气管插管后行定压型模式通气.术中A组患儿以吸入七氟烷维持,B组患儿以吸入七氟烷复合静脉持续输注瑞芬太尼0.25 μg/(kg·min)维持,C组患儿以吸入七氟烷复合静脉持续输注右关托咪定0.5μg/(kg·h)维持.记录患儿苏醒期情况,并采用改良Aldrete评分、PAEDS评分和CHEOPS评分对患儿复苏、苏醒期躁动和术后疼痛进行评估.[结果]三组患儿苏醒期各时间段躁动发生率:A组＞B组＞C组(P＜0.05),C组麻醉后恢复室(PACU)停留时间较A组和B组延长(P＜0.01).三组患儿改良Aldrete评分比较无统计学差异.入PACU后C组前3个时间点的PAEDS评分均低于A组和B组(P＜0.05),且第15min和第30 min C组PAEDS评分明显低于A组(P＜0.01).第30 min和第45 min C组CHEOPS评分低于A组和B组(P＜0.05).[结论]右美托咪定有助于预防先心病患儿心导管手术麻醉苏醒期躁动的发生,提高患儿苏醒质量.     

右美托咪啶预防儿童术后躁动的观察及护理

目的 探讨右美托咪啶预防儿童吸入七氟烷全身麻醉后躁动的疗效及护理.方法 选择60例5～8岁拟行全身麻醉的患儿,随机分为观察组和对照组,每组30例.观察组予手术结束前30min静脉推注右美托咪啶0.2μg/kg.对照组静脉推注生理盐水10 ml.记录苏醒时间、拔除气管导管时间及发生躁动、恶心、呕吐的例数.结果 两组苏醒时间、拔除气管导管时间比较无显著性差异（P＞0.05）.手术后躁动的发生率观察组2例（6.7％）比对照组12例（40.0％）低,有显著性差异（P＜0.05）;结论 右美托咪啶能降低七氟烷吸入全身麻醉患儿术后麻醉恢复期躁动,护理观察重点是保证患儿呼吸道的通畅、预防患儿外伤、坠床和脱管等.     

脊柱手术七氟烷全身麻醉患者中应用右美托咪定对苏醒期躁动的影响

目的:探讨脊柱手术七氟烷全身麻醉患者中应用右美托咪定对患者苏醒期躁动影响。方法;选取2015年5月~2017年1月我院七氟烷全身麻醉脊柱手术患者64例随机分为干预组和对照组,干预组给予右美托咪定,对照组给予相同剂量生理盐水,比较两组患者手术时间、苏醒时间、镇静及躁动情况和相关并发症发生率。结果:两组患者手术时间、苏醒时间比较无统计学意义(P>0.05);干预组患者Ramsay、Riker评分均低于对照组(P<0.05)。干预组患者躁动、恶心呕吐发生率均低于对照组(P<0.05)。结论;右美托咪定在脊柱手术七氟烷全身麻醉患者中应用,具有较强镇静效果,能降低患者苏醒期躁动发生率。     

右美托咪定麻醉对小儿血流动力学、苏醒期躁动、疼痛程度的影响

目的探讨右美托咪定在小儿麻醉中的应用效果。方法选取116例进行全麻手术的患儿作为研究对象,将其分为右美托咪定组与丙泊酚组,各58例。对比2组患儿用药后的血流动力学、术后疼痛程度、躁动量化评分和手术效果。结果 2组麻醉时间、拔管时间及苏醒时间相比,差异无统计学意义(P 0. 05);右美托咪定组的躁动评分、疼痛评分以及躁动发生率均显著低于丙泊酚组(P 0. 05); 2组恶心、呕吐发生率相比,差异无统计学意义(P 0. 05);右美托咪定组T1时点的平均动脉压低于丙泊酚组,T1、T3时点的心率低于丙泊酚组,差异均有统计学意义(P 0. 05)。结论全麻手术患儿采用右美托咪定维持麻醉,血流动力学稳定,躁动发生率低,疼痛感较轻。     

经鼻滴入右美托咪定对Ganz骨盆截骨术患儿术后苏醒期躁动的影响

目的观察经鼻滴入右美托咪定预防儿童全身麻醉苏醒期躁动的临床效果。方法选ASA分级I~Ⅱ级、在丙泊酚瑞芬太尼复合七氟醚静吸复合麻醉下行发育性髋关节脱位矫正术的12~14岁患儿60例。随机分为对照组和右美托咪定组各30例。在手术结束前30 min右美托咪定组给予1μg/kg右美托咪定滴鼻,对照组给予生理盐水0.01 ml/kg滴鼻。记录患儿苏醒即刻(T0)、苏醒5 min后(T1)、苏醒10 min后(T2)、苏醒30 min后(T3)的心率(HR),以及拔管3 min(T4)、拔管5 min(T5)、拔管10 min(T6)的血氧饱和度(Sp O2)以及拔管10 min时Aono躁动评分和儿童麻醉苏醒谵妄PAED评分及躁动发生率。结果右美托咪定组Aono评分、PAED评分及躁动发生率均显著低于对照组(P0.05)。两组患儿苏醒时各时间点Sp O2、HR均无统计学差异(P0.05)。所有患儿在麻醉手术过程中均无呕吐、喉痉挛、误吸等不良反应发生。结论手术结束前30 min经鼻给予1μg/kg右美托咪定可以明显减少手术患儿全麻苏醒期躁动的发生,是临床上预防苏醒期躁动的一个行之有效且安全的给药方法。     

右美托咪啶与芬太尼对七氟醚麻醉术后躁动的预防作用研究

探讨右美托咪啶与芬太尼对七氟醚麻醉术后躁动的预防作用。选取实施外科手术并采用七氟醚麻醉的患者120例,按照随机数表法分为右美托咪啶组、芬太尼组和氯化钠组各40例,分别在手术结束前10min给予右美托咪啶、芬太尼和氯化钠溶液,观察三组用药后的躁动情况、苏醒时间及麻醉恢复时间。三组的躁动率分别为10.00%、17.50%和35.00%,,右美托咪啶组的躁动预防效果最好,其次为芬太尼组;三组苏醒时间比较,氯化钠组最短,三组对比差异有统计学意义(P0.05);三组麻醉恢复时间对比无显著差异(P0.05)。右美托咪啶与芬太尼对七氟醚麻醉术后患者躁动均有一定的预防作用,右美托咪啶抑制躁动的效果更佳,值得临床推广应用。     

右美托咪啶与氯胺酮对小儿扁桃体切除术麻醉苏醒期的影响效果比较

目的观察右美托咪啶与氯胺酮对小儿扁桃体切除术麻醉苏醒期的影响。方法将2010年1月至2014年6月行双侧扁桃体切除术患儿分为右美托咪啶组(58例)、氯胺酮组(58例)、对照组(52例)。麻醉诱导10 min前,右美托咪啶组患儿泵注右美托咪啶(0.5μg/kg),氯胺酮组患儿泵注氯胺酮(0.5 mg/kg),而对照组患儿泵注10 ml生理盐水,其余麻醉用药和操作相同。记录3组患儿的复苏低氧、恶心呕吐、复苏15 min内出现严重躁动的情况,躁动评分和疼痛评分,同时统计3组患儿在麻醉前(T0)、拔管时(T1)、拔管后5 min(T2)、10 min(T3)、15 min(T4)、30 min(T5)的平均动脉压(MAP)和心率(HR)。利用t检验和χ2检验分析相关数据。结果与对照组患儿相比,右美托咪啶组和氯胺酮组患儿出现复苏15 min内严重躁动的比率、躁动评分、疼痛评分明显降低(P均<0.05),而且MAP和HR在T1、T2、T3时更加平稳(P均<0.05);与右美托咪啶组患儿相比,对照组患儿出现复苏低氧和恶心呕吐的比率明显增高(P均<0.05),而且氯胺酮组患儿出现恶心呕吐的比率也明显高于右美托咪啶组患儿(P<0.05)。结论右美托咪啶和氯胺酮均可以减少扁桃体切除术麻醉苏醒期躁动等并发症,而且右美托咪啶还可以明显降低复苏低氧和恶心呕吐的发生率。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.