全麻下肾移植术中的血压变化及调控

目的总结全麻下肾移植术中各阶段的血压变化特点,并分析其原因及调控方法。方法病人术前经过血液透析及内科治疗使血压有所下降,行慢诱导气管插管。术中通血管前血压控制在经常血压水平。通血管后出现血压下降,可用多巴胺维持血压,拔管力求平稳并记录病人术前、术中关键阶段的血压变化。结果通血管后SBP、DBP和MAP降低(P<0.01)。结论此类患者术中血压变化较剧烈。只有通过调节麻醉深浅、灵活运用血管活性药物及适当扩容,在各阶段维持适当的血压,才能保证患者安全和手术成功。     

全麻患者手术期体温变化的分析

人体通过自身调节来维持正常的体温，以进行正常的生理代谢过程。全身麻醉后，由于人体温度调节功能受到抑制。机体长时间暴露于手术室22～24℃的室温环境中和体温的再分布，易造成低体温的发生。日本的高桥指出：手术患者应保持适当的体温，术中体温的管理对于患者术后早期的全身状态具有很大的影响。2004年6月～2007年10月，我们观察了患者手术期体温的变化，探讨了手术期体温管理对预防术中、术后低体温发生的作用，现报告如下。     

不同保温措施对全麻开腹手术患者术中体温的影响

摘要：目的 探讨不同保温措施对全麻下开腹手术患者术中体温的影响。方法 选择2009年7月~2011年3月我院全麻下择期行开腹手术的患者130例,随机分为3组：常规保温组（A组）44例、提高室温组（B组）43例和主动加温组（C组）43例。A组：室温调节至23℃、非手术部位用不同形状棉毯保护、腹腔冲洗液加温至37℃; B组：在常规保温基础上将室温调节至25℃ ; C组：在常规保温基础上 电子加温仪加温静脉输入液体（37℃）。监测并记录患者麻醉诱导即刻、切皮时、切皮后30、60、90、120、150、180min及手术结束时的体温变化。结果 在切皮和切皮后各时间点,A组体温明显低于B组和C组,差别有统计学意义（P<0.05）;在切皮后120min及以后各时间点,C组体温明显高于B组,差别有统计学意义（P<0.05）。结论 对全麻下开腹手术患者采取主动加温措施可维持患者术中的体温稳定。     

全麻手术期间病人体温变化的观察

正常的体温是保持病人各项生理功能的基本条件之一.人体需要体温恒定,通过体温调节系统使产热和散热保持动态平衡,从而维持中心体温在37℃±0.4℃.在麻醉状态下的病人体温会随环境温度而变化,可使体温升高或降低.体温的变化增加了产生不良生理影响的危险性.随着外科手术的发展,对体温的有效监测和调节已成为保证麻醉顺利、手术成功、降低术后并发症的重要措施之一.本研究选择了在全麻下的病例进行研究,观察手术中病人体温变化规律,旨在探讨其相应处理措施.     

全麻患者术中低体温的处理

体温是患者基础生命体征之一,麻醉后患者会出现明显的体温降低,低体温带来大量并发症,术中保温对于患者术后恢复和舒适性、经济性有着积极的意义,需要得到麻醉医生的重视。本文围绕全麻患者低体温的现象,了解全麻期间低体温的机制,讨论对低体温的处理措施及利弊,提示临床麻醉中的体温监测的重要性。     

全麻期手术患者体温的护理体会

目的探讨全麻期手术患者体温的护理。方法总结分析全麻术中患者低温的危害及护理措施。结果与同组诱导前相比P〈0．05,与Ⅱ组同一时间相比P〈0．05。结论加强手术期患者的体温监测,对于早期发现低体温是十分重要的。护理人员应重视术中保暖,采取有效的措施对体温进行有效监测和调节,保证手术的成功。     

全麻与腰硬联合麻醉对腹部手术患者核心体温的影响

目的探析全麻与腰硬联合麻醉对腹部手术患者核心体温的影响。方法选择2012年11月~2013年11月来本院进行诊治的开腹手术患者100例,随机分为试验组与对照组,试验组采用腰硬联合麻醉,对照组采用全麻。监测患者麻醉前、麻醉后、半小时后、45 min、60 min、75 min和手术完成即刻体温,以及完全清醒状态寒战发生的时间、级别、发生率,进行比较。结果试验组麻醉后核心体温下降速度较缓,术前与术前体温存在差异。对照组核心体温在麻醉后40 min最低,10 min后术前与术后体温差异显著。寒战发生级别与发生率无显著性差异,对照组寒战持续时间小于试验组(P<0.05)。结论腰硬联合麻醉和全麻均使核心体温下降,但全麻下降时间更短,下降温度更大。     

红外辐射加温对全麻患者术中体温及凝血功能的影响

目的研究红外辐射加温对全麻手术患者术中低温维护的效果及对术后并发症的影响。方法将100例全麻手术患者随机分成实验组和对照组,分别在术中对患者进行加温和不加温,观察患者术中体温及凝血功能变化。结果对照组术后体温较术前降低1．2℃,实验组术后体温较术前降低0．56℃,差异有统计学意义（P〈0．01）,两组患者术前、术后24h血小板、PT系列比较差异有统计学意义（P〈0．05）。结论红外辐射加温是一种疗效确切、使用安全的术中保温方法,在临床上值得推广使用。     

老年患者术中体温变化观察

本文旨在观察老年病人术中体温变化 ,分析相关因素 ,以期提供预防和减少其发生术中低温的护理措施依据。对象和方法一、对象本院胃肿瘤手术病人８６例 ,平均年龄(５５．８７±１３．１４)岁 ,开腹胃癌根治或胃大部切除手术。均无甲亢、甲状腺功能低下和粘液性水肿等影响代谢的内分泌疾病。大于６０岁老年组４１例 (男２８例 ,女１３例 ) ,６０岁以下非老年组４５例 (男２９例 ,女１６例 )。两组基本情况及术中输血量、麻醉前体温无统计学差异。２、方法手术室温２４～２６℃ ,病人入室后盖以薄被保温 ;给予心电、ＳｐＯ２和无创血压监护。采…     

Prevention of regurgitation and aspiration during emergency care of patients under general anesthesia

This study has provided new data on methods for preventing regurgitation and aspiration under general anesthesia, by using parenteral and enteral antacids as premedication in urgent surgery. There is evidence that with 60-minute delay in starting surgery, omeprazole, 40 mg, has the highest alkalizing effect. Second- and third-generation H2-blockers have a persistent and good antacid effect. In emergencies, 30 ml of 3% sodium citrate solution show a rapid and effective antacid effect, which eliminates or drastically reduces the likelihood of aspiration pulmonitis even in case of regurgitation and aspiration of the gastric contents. Based on the findings, the authors have developed a patient preparation protocol for general anesthesia in urgent surgery as the standard for the practical use in general anesthesiology.     

肾脏移植术中血流动力学的变化研究

目的 探讨肾脏移植手术期间血流动力学的变化规律和处理方法.方法 尿毒症患者365例在联合腰麻-硬膜外阻滞麻醉下行肾脏移植术,分别于麻醉后手术开始前、麻醉后30 min、手术结束前,记录心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)等参教,连续监测术中尿量及输血、输液情况.结果 365例肾脏移植患者全部进入结果分析.伴随着肾移植术后肾功能的改善,患者心率、血压、中心静脉压指教均较术前下降(P＜0.05).结论 肾移植术后随着尿毒症状态的纠正,患者血流动力学得到明显改善,通过监测血流动力学变化可以用来评估移植肾的功能.     

Metabolism of maltose during surgery in patients with diabetes mellitus under general anesthesia

During a surgical operation under general anesthesia, maltose was administered at a rate of 1g/kg BW to 9 diabetic and 18 non-diabetic patients.The disappearance curve of maltose from blood was similar between diabetics and non-diabetics. Blood sugar tended to rise but no significant difference was found between the two groups. Lactic acid and pyruvic acid showed a tendency toward a rise, but the change was non-significant. NEFA and uric acid failed to change. Urinary excretion of maltose was not different between diabetics and non-diabetics. After 120 min., urinary excretion of maltose was similar between the two groups, but excretion as glucose was greater in the diabetic group.     

局部麻醉与全身麻醉下小儿肾穿刺护理的特点分析

笔者比较了局部麻醉与全身麻醉下小儿肾穿刺护理的特点。局部麻醉组着重做好术前患儿深呼吸及摒气训练，术中加强与患儿沟通．减少恐惧感。全身麻醉组着重做好术前心理护理，加强术中及术后生命体征观察。     

SLIPA喉罩通气全身麻醉在腹腔镜胆囊切除术中的应用

目的 探讨SLIPA喉罩通气全身麻醉在腹腔镜胆囊切除术中临床应用的可行性和安全性.方法 120例行腹腔镜胆囊切除术患者,随机分成两组:SLIPA喉罩组(SLIPA组,60例)和气管插管组(TT组,60例).人工气腹后SLIPA喉罩组选择相对低潮气量和较快的呼吸频率进行机械通气,TT组常规机械通气.监测平均动脉压(MAP)、脉搏氧饱和度(SP02)、心率(HR)、气道峰压(P(peak)、肺顺应性(COMPl)、呼气末二氧化碳分压(P(et)CO2).观察有无反流误吸情况,记录拔管(喉罩)时躁动、呛咳、咽喉痛、声音嘶哑、喉罩或气管导管沾染血迹等发生情况.结果 SLIPA组喉罩置入成功率98.33%,气腹后相对低潮气量和较快呼吸频率通气未发生低氧血症和二氧化碳蓄积,各监测时间点SPO2、P(et)CO2均在正常范围,两组间差异无显著性(P>0.05).气管插管(喉罩)和拔管(喉罩)时,TT组MAP增高、HR加快变化明显(P<0.05),而SLIPA组则较为平稳(P>0.05).SLIPA组躁动、呛咳、咽喉痛、声音嘶哑、喉罩或气管导管沾染血迹等发生率也低于TT组(P<0.05).结论 SLIPA喉罩通气全身麻醉用于腹腔镜胆囊切除术,可减轻插管时对咽喉及气道的刺激,维持血流动力学相对稳定,确保气道通畅和有效通气.     

Remimazolam benzenesulfonate anesthesia effectiveness in cardiac surgery patients under general anesthesia

BACKGROUNDSedation with propofol injections is associated with a risk of addiction, but remimazolam benzenesulfonate is a comparable anesthetic with a short elimination half-life and independence from cell P450 enzyme metabolism. Compared to remimazolam, remimazolam benzenesulfonate has a faster effect, is more quickly metabolized, produces inactive metabolites and has weak drug interactions. Thus, remimazolam benzenesulfonate has good effectiveness and safety for diagnostic and operational sedation. AIMTo investigate the clinical value of remimazolam benzenesulfonate in cardiac surgery patients under general anesthesia.METHODSA total of 80 patients who underwent surgery in the Department of Cardiothoracic Surgery from August 2020 to April 2021 were included in the study. Using a random number table, patients were divided into two anesthesia induction groups of 40 patients each: remimazolam (0.3 mg/kg remimazolam benzenesulfonate) and propofol (1.5 mg/kg propofol). Hemodynamic parameters, inflammatory stress response indices, respiratory function indices, perioperative indices and adverse reactions in the two groups were monitored over time for comparison.RESULTSAt pre-anesthesia induction, the remimazolam and propofol groups did not differ regarding heart rate, mean arterial pressure, cardiac index or volume per wave index. After endotracheal intubation and when the sternum was cut off, mean arterial pressure and volume per wave index were significantly higher in the remimazolam group than in the propofol group (P < 0.05). After endotracheal intubation, the oxygenation index and the respiratory index did not differ between the groups. After endotracheal intubation and when the sternum was cut off, the oxygenation index values were significantly higher in the remimazolam group than in the propofol group (P < 0.05). Serum interleukin-6 and tumor necrosis factor-α levels 12 h after surgery were significantly higher than before surgery in both groups (P < 0.05). The observation indices were re-examined 2 h after surgery, and the epinephrine, cortisol and blood glucose levels were significantly higher in the remimazolam group than in the propofol group (P < 0.05). The recovery and extubation times were significantly lower in the remimazolam group than in the propofol group (P < 0.05); there were significantly fewer adverse reactions in the remimazolam group (10.00%) than in the propofol group (30.00%; P < 0.05). CONCLUSIONCompared with propofol, remimazolam benzenesulfonate benefited cardiac surgery patients under general anesthesia by reducing hemodynamic fluctuations. Remimazolam benzenesulfonate influenced the surgical stress response and respiratory function, thereby reducing anesthesia-related adverse reactions.     

拔管前给予小剂量芬太尼对减轻应激反应及脑电双频指数值的影响

目的观察全麻患者拔管前预先使用小剂量芬太尼对围拔管期血流动力学、血糖、脑电双频指数、呼吸及意识水平的影响。方法选择ASAⅠ~Ⅱ。在全麻下行胃癌根治手术的患者100例,年龄38~79岁,男63例、女37例,随机分为芬太尼组(F组n=50)和对照组(C组n=50),两组均于关腹前30 m in停用麻醉剂,F组腹膜关闭后,静注芬太尼1μg/kg;C组予以等量0.9%氯化钠溶液。术毕所有患者符合拔管指征后拔管,观察围拔管期B IS值、血流动力学、血糖、意识状态及呛咳、SPO2下降的发生情况。结果围拔管期血流动力学变化幅度芬太尼组明显小于对照组(P<0.01),B IS值两组无差异(P>0.05),苏醒质量无明显差异。结论全麻末期小剂量芬太尼可减轻拔管时应激反应,而不影响苏醒质量。     

Continuous gastric suctioning decreases measured esophageal temperature during general anesthesia

Objective. This study sought to determine whether continuous gastric suctioning influences esophageal temperature measurements.Methods. This study evaluated 21 patients scheduled for extremity or lower abdominal surgery. After induction of general endotracheal anesthesia, an orogastric tube, and esophageal and nasopharyngeal temperature probes were placed in functional positions. Baseline esophageal (Tes) and nasopharyngeal (Tnas) temperatures were recorded and the orogastric tube was placed on continuous suction. After the first 11 patients (Group I) were studied, 10 additional patients (Group II) were studied with more frequent data collection to improve the time resolution of temperature changes. Temperatures were recorded for patients in Group I at 2 and 10 min with suctioning and 10 min after cessation of suctioning. In Group II, temperatures were recorded at 1, 2, 5 and 10 min with suctioning and 10 min after cessation of suctioning. Analysis of data was performed using repeated measures analysis of variance and pairedt-tests with the Bonferroni correction.Results. In Group I, Tes decreased significantly from 35.9 ± 0.2 °C (mean ± SE) to 35.1 ± 0.4 °C at 2 min and 34.8 ± 0.3 °C at 10 min of suctioning (p < 0.01). Ten minutes after cessation of suctioning, Tes was not significantly different from the baseline measurement. Tnas did not change significantly over the 20 min observation period. In Group II, Tes continually decreased from 36.2 ± 0.1 °C to 34.8 ± 0.3 °C after 10 min of suctioning (p < 0.006) and returned to near baseline 10 min after cessation of suctioning. There was no significant change in Tnas over the 20 min observation period.Conclusion. We conclude that continuous gastric suctioning decreases esophageal temperature measurements. This phenomenon should be recognized as an artifactual change in esophageal temperature and not a reflection of core temperature.This study was presented, in part, at the 1995 Annual Meeting of the American Society of Anesthesiologists, Atlants, GA, October 1995.     

全身麻醉下手术治疗的伴鼾症患者术后麻醉复苏期间的观察及护理

目的探讨全身麻醉下行手术治疗的伴鼾症患者术后麻醉恢复期间的病情观察及护理措施。方法选取78例接受全身麻醉下手术治疗的伴鼾症患者作为研究对象,术后转入麻醉后监测治疗室,在麻醉复苏期间观察其临床症状并采取相应护理措施。结果 78例患者中,29例(37.18%)出现低氧血症、10例(12.82%)发生呼吸抑制、9例(11.54%)发生高血压、6例(7.70%)发生低血压、3例(3.85%)出现心律失常、8例(10.26%)发生低体温。结论在全身麻醉下行手术治疗的伴鼾症患者术后麻醉复苏期间进行病情观察及护理,能够有效预防或及时处理并发症。     

Awareness under general anesthesia

General anesthesia aims to eliminate patients' awareness of excruciating pain during surgery. Nevertheless, rare occurrences of patient awareness continue because the problem is not yet completely preventable. One study puts the incidence of awareness at 0.18% for patients receiving muscle relaxants and at 0.10% for patients not given relaxant drugs. Awareness experiences frighten patients and impact their implicit and explicit memories in ways that can leave a lifetime of residual emotional and psychological problems ranging from sleep disturbances, nightmares, and daytime anxiety that may subside with time to development of post-traumatic stress disorder. Most anesthetists monitor depth of anesthesia by assessing intraoperative hemodynamic responses to surgical stimuli--an approach questioned by some authors. Several depth-of-anesthesia monitors are available, but there is no ideal monitor that is 100% reliable. This review provides an overview of literature that reports findings associated with the monitoring and occurrence of intraoperative awareness. These studies indicate assessment methods that can be trusted when we provide general anesthesia and what measures can be taken to prevent recall by patients under general anesthesia.