神经安定镇痛普鲁卡因静脉复合麻醉对失血性休克犬体循环和冠…

实验研究神经安定镇痛、普鲁卡因静脉复合麻醉对失血性休克犬体循环和冠脉循环血流动力学及心肌代谢的影响。结果表明，神经安定镇痛、普鲁卡因静脉复合麻醉抑制失血性休克状态下的心血管功能，降低心肌血流量，使得心肌氧供需失衡，心肌缺血缺氧。     

普鲁卡因氯胺酮静脉复合麻醉对失血性休克犬体循环和冠脉循环 …

目的与方法：观察失血性休克犬在普鲁卡因，氯胺酮复合静脉麻醉下６０ｍｉｎ内体循环和冠脉循环血流动力学及心肌代谢的变化。结果：除外周血管总阻力下降外，其他体循环及冠脉循环血流动力学指标均无明显的改变。动脉血和冠状窦血乳酸含量增加，心肌酸摄取速率和摄取率明显上升。结论：在失血性休克状态下应用普鲁卡因，氯胺酮复合静脉麻醉后心血管功能基本稳定在麻醉前水平，心脏后负荷有所降低，心肌氧供略增，氧耗稍减，保持心肌     

静脉普鲁卡因对失血性休克犬血流动力学影响

静脉普鲁卡因复合麻醉在正常血容量下对血流动力学的影响已有报道。但在失血性休克情况下,应用静脉普鲁卡因复合全麻是否适合尚无统一看法。本实验是探讨在失血性休克情况下,静脉普鲁卡因对血流动力学的影响,以便为临床麻醉提供参考。材料和方法 (一)杂种犬7只,雌雄兼有,体重13～20kg。先以戊巴比妥钠25～30mg/kg静脉麻醉,气管     

普鲁卡因氯胺酮静脉复合麻醉对失血性休克犬体循环和冠脉循环血流动力学及心肌代谢的影响

目的与方法：观察失血性休克犬在普鲁卡因、氯胺酮复合静脉麻醉下６０ｍｉｎ内体循环和冠脉循环血流动力学及心肌代谢的变化。结果：除外周血管总阻力下降外,其他体循环及冠脉循环血流动力学指标均无明显的改变。动脉血和冠状窦血乳酸含量增加,心肌乳酸摄取速率和摄取率明显上升。结论：在失血性休克状态下应用普鲁卡因、氯胺酮复合静脉麻醉后心血管功能基本稳定在麻醉前水平,心脏后负荷有所降低,心肌氧供略增,氧耗稍减,保持心肌对乳酸的摄取与其血含量相适应     

普鲁卡因和利多卡因镇痛作用的比较

本实验旨地探讨普钽卡因和利多卡因在静脉复合麻醉作用中的价值。作者用热板法进行了镇痛作用的比较。结果提示，普鲁卡因仅有微弱的镇痛作用，而利多卡因的镇痛作用较强，故利多卡因作为静脉复合的麻醉的配伍药之一，优于普鲁卡因。     

普鲁卡因静脉复合麻醉对肝脏血流和氧耗影响的实验研究

采用电磁血流仪和血气分析等技术，研究普鲁卡因静脉复合麻醉对犬体循环血流动力学及肝脏血流和氧耗影响。 １％普鲁卡因复合液以 １．０ｍｇ· ｋｇ－１／ｍｉｎ速度静滴时，随麻醉时间延长，血浆普鲁卡因浓度逐渐升高，６０分钟达５６．９±８．７ｍｇ／Ｌ。体循环各项血流动力学参数趋于稳定，仅在６０分钟产生明显的体循环抑制效应。心率和平均动脉压分别降低２７％、２５％，心指数由３．５２±０．２１Ｌ·ｍｉｎ－１／ｍ２降至 ３． ０８±０．１２Ｌ· ｍｉｎ－１／ｍ２。肝总血流量和氧耗与体循环动力学呈一致性变化。因此，肝脏疾患及肝手术的患者，只要控制血中普鲁卡因浓度不过高，仍可安全实施普鲁卡因静脉复合麻醉。     

芬太尼静脉复合麻醉术后镇痛效果的观察

芬太尼静脉复合麻醉术后镇痛效果的观察陈良国为观察比较芬太尼静脉复合麻醉的术后镇痛效果，将６０例病人随机分成二组，芬太尼－卡肌宁（组Ⅰ）３０例；普鲁卡因－琥珀胆碱（组Ⅱ）３０例。两组年龄、性别、病种和手术时间无明显区别（表１），观察记录术后病人刀口疼痛...     

普鲁卡因静脉复合麻醉血液流变学的观察

普鲁卡因静脉复合麻醉血液流变学的观察王肇云１武翠梅２普鲁卡因静脉复合麻醉是临床常用的麻醉方法。其对血液流变学的影响国内报道很少。为探索普鲁卡因静脉复合麻醉对血液流变学的影响，我们观察１４例患者血液流变学的各项指标，现介绍如下。资料与方法一、病例选择选...     

颈内静脉穿刺致臂丛神经损伤一例

患者男 ,37岁。因上消化道出血及失血性休克 ,经输血、输液、升压治疗后 ,在普鲁卡因静脉复合麻醉下行急症剖腹探查术。手术开始后 ,为便于测定ＣＶＰ以控制输液速度及输液量 ,行右颈内静脉穿刺 ,取胸锁乳突肌中路进针 ,在锁骨内侧上缘小切迹上约 1 5ｃｍ进针 ,针干与中线平行     

KDPA静脉复合全麻的临床应用

ＫＤＰＡ静脉复合全麻的临床应用任俊才将ＫＤＰＡ复合液（氯胺酮、安定、普鲁卡因、阿托品）用于中小手术静脉全麻和其它手术的全麻诱导等，经临床观察，麻醉效果较满意。现报告如下。资料与方法本组共２７７例。男１２８例，女１４９例，年龄２～７１岁。中小手术麻醉６...     

不同术后镇痛方式对手术患者恢复期心肌缺血的影响

目的研究硬膜外镇痛与静脉镇痛对手术患者恢复期心肌缺血的影响。方法39例行择期腹部手术的患者随机分成两组:硬膜外镇痛组(R组),16例,术中全麻复合硬膜外麻醉,术后硬膜外镇痛;静脉镇痛组(M组),23例,术中全麻,术后静脉吗啡镇痛。维持两组Price-Henry疼痛评分≤3分。所有患者接受24 h动态心电图监测48 h。两组患者在入手术室安静平卧10 min、入SICU后2 h、术后第1天晨、术后第2天晨采集静脉血测定皮质醇浓度。结果术后48 h内,R组心肌缺血发生率比M组低(P<0.05),在术后各时点,R组的皮质醇浓度低于M组(P<0.05)。结论与静脉镇痛相比较,硬膜外镇痛明显减轻应激反应,减少术后心肌缺血发生率。     

磷酸肌酸钠对心肌缺血老年患者心肌保护作用的评价

目的观察磷酸肌酸钠对心肌缺血老年手术患者动脉血氧分压、心肌酶及心律失常的影响。方法选择60例术前心电图检查有心肌缺血的上腹部手术患者，ASAⅡ～Ⅲ级，随机分成对照组和实验组，各30例。实验组麻醉后使用磷酸肌酸钠，对照组为生理盐水100ml。两组均分别在麻醉后、术中1～2h、术毕时行血气分析观察动脉血氧分压的改变，于术后24h抽静脉血检测磷酸肌酸激酶同工酶（CPK—MB）和乳酸脱氢酶（LDH）水平，记录围术期Ⅱ导联心电图室性心律失常的发生情况。结果实验组术中1、2h和术毕时各时点动脉血氧分压的增加均明显高于对照组；术后24h心肌酶较术前均升高，但实验组上升幅度较对照组明显减小；围术期实验组室性心律失常的发生率较对照组低，差异有统计学意义（P值均〈0．05）。结论磷酸肌酸钠能提高心肌缺血老年患者围术期的动脉血氧分压，心肌酶得到明显改善，有效地减少室性心律失常的发生。     

川芎嗪预处理对心肺转流手术患者心肌线粒体变化的影响

目的探讨川芎嗪预处理在心肺转流(CPB)心脏手术中的心肌保护作用。方法28例非发绀型先天性心脏病患者,随机均分为川芎嗪预处理组(川芎嗪组)和对照组。川芎嗪组麻醉诱导后经颈内静脉滴入川芎嗪3mg/kg,30min内滴完,CPB期追加1mg/kg于氧合器中;对照组给予等量生理盐水。分别于CPB前和CPB后(主动脉开放后30min)取右心耳心肌组织,应用电镜技术观察心肌超微结构和心肌线粒体变化。结果川芎嗪组心肌超微结构受损较对照组为轻。川芎嗪组CPB后心肌线粒体记分明显低于对照组(P<0.05)。结论川芎嗪预处理有较好的内源性心肌保护作用。     

Effects of hypocapnia on hemodynamics and myocardial metabolism in anesthetized dogs

The authors previously reported that hypocapnia increased myocardial oxygen demand under droperidol-fentanyl (D-F) anesthesia. In this study, we observed myocardial oxygen tension, hemodynamics, and coronary arterial-venous blood content differences of oxygen and lactate before and after hyperventilation in dogs with and without a narrowed coronary artery under halothane anesthesia. We studied the functional and metabolic responses of the heart to hypocapnia under halothane in comparison with D-F anesthesia. In the intact heart, heart rate, LV dp/dt max and myocardial energy demand (heart rate x systolic aortic pressure x LV dp/dt max), which increased during hypocapnia under D-F anesthesia, were unchanged during hypocapnia under halothane anesthesia. Aortic pressure and coronary flow were unchanged under both types of anesthesia. Though subendocardial oxygen tension decreased significantly, myocardial lactate extraction was unchanged under both types of anesthesia. In the heart with a constricted coronary artery, subendocardial oxygen tension and lactate extraction ratio decreased significantly during hypocapnia under both types of anesthesia. Myocardial lactate production was observed in six of eleven dogs in which myocardial energy demand increased under D-F anesthesia. Myocardial lactate production was observed in one dog under halothane anesthesia. Coronary arterial-venous blood oxygen content difference increased under D-F anesthesia, but not under halothane anesthesia. In summary, hypocapnia increased myocardial oxygen demand under D-F anesthesia but not under halothane anesthesia. In the intact heart under both types of anesthesia, hypocapnia deteriorated myocardial oxygen supply-demand relations, but the evidence of myocardial anaerobic metabolism was not observed.(ABSTRACT TRUNCATED AT 250 WORDS)     

Postoperative wound oxygen tension with epidural or intravenous analgesia: a prospective,randomized, single-blind clinical trial

BACKGROUND: Adequate tissue oxygen tension is an essential requirement for surgical-wound healing. The authors tested the hypothesis that epidural anesthesia and analgesia increases wound tissue oxygen tension compared with intravenous morphine analgesia. METHODS: In a prospective, randomized, blind clinical study, the authors allocated patients having major abdominal surgery (n = 32) to receive combined general and epidural anesthesia with postoperative patient-controlled epidural analgesia (epidural group, n = 16), or general anesthesia alone with postoperative patient-controlled intravenous analgesia (intravenous group, n = 16). An oxygen sensor and a temperature sensor were placed subcutaneously in the wound before closure. Wound oxygen tension (P(w)O(2)) and temperature were measured continuously for 24 h. Other variables affecting wound tissue oxygenation and visual analogue scale (VAS) pain scores were also documented. RESULTS: Despite epidural patients having lower body temperatures at the end of surgery (35.7 +/- 0.3) versus 36.3 +/- 0.5 degrees C, = 0.004), they had significantly higher mean P(w)O(2) over the 24 h period, compared with the intravenous group (64.4 +/- 14 vs. 50.7 +/- 15) mmHg, mean (SD), 95% CI difference, -22 to -5, = 0.002). Area under the P(w)O(2) -24 h time curve was also significantly higher in the epidural group (930 +/- 278 vs. 749 +/- 257) mmHg x h, 95% CI difference -344 to -18, = 0.03). VAS pain scores at rest and moving were significantly lower in the epidural group at all times. CONCLUSION: Epidural anesthesia and postoperative analgesia for major abdominal surgery increases wound tissue oxygen tension compared with general anesthesia and intravenous morphine analgesia.     

Changes in myocardial blood flow and systemic hemodynamics during hypotensive anesthesia induced by adenosine triphosphate with or without dipyridamole]

The changes in myocardial blood flow and systemic hemodynamics during hypotensive anesthesia with adenosine triphosphate (ATP) or ATP with dipyridamole (0.5 mg.kg-1) were studied in 20 mongrel dogs anesthetized with 0.7% halothane in 100% oxygen. In both groups, mean arterial blood pressure (MAP) was reduced to 60 mmHg by intravenous administration of ATP. During hypotensive anesthesia, coronary blood flow, myocardial blood flow and cardiac index increased significantly in both groups. Lactic acid and uric acid increased significantly during hypotensive anesthesia in the group 1. Heart rate, MAP, systemic vascular resistance and coronary vascular resistance decreased significantly during hypotensive anesthesia in both groups. Mean pulmonary arterial pressure, pulmonary arterial wedge pressure and central venous pressure showed no significant changes in both groups. Base excess in the group 1 increased markedly compared with the group 2. We conclude that pretreatment with dipyridamole can prevent metabolic acidosis that occurs during hypotensive anesthesia induced by ATP.     

Regional versus general anesthesia in high-risk surgical patients: The need for a clinical trial

Regional anesthesia is often preferred over general anesthesia for patients with cardiovascular disease because of presumed decreased risk of perioperative myocardial ischemia. However, few studies have addressed this issue directly. To determine whether the type of anesthesia is independently associated with myocardial ischemia, records of 134 patients undergoing peripheral vascular grafting under general or regional anesthesia were examined. There were no significant differences preoperatively between groups in ASA class, age, sex, or prevalence of angina, diabetes, or hypertension. Twelve patients developed myocardial ischemia or infarction within 7 days of operation; 11 of these 12 patients had received regional anesthesia (p < 0.015). The association between anesthetic approach and perioperative myocardial ischemia or infarction remained after adjustment for preoperative factors associated with ischemia or with type of anesthesia. General anesthesia does not appear to be associated with increased risk of myocardial ischemia, and stringent recommendations to avoid it in this population may be unfounded. A clinical trial is needed to define more clearly the risks and benefits of different types of anesthesia in high-risk patients.     

Increasing myocardial oxygen demand during prolonged halothane anesthesia in dogs

The effect of prolonged halothane anesthesia on myocardial oxygen uptake and coronary blood flow is unknown. This 5.5-hr study was undertaken to determine whether myocardial changes occur in dogs during prolonged steady-state halothane anesthesia. Hourly data were collected beginning 1.5 hr after induction of steady-state anesthesia. When compared to values obtained at 1.5 hr of halothane anesthesia, no significant myocardial changes were observed during the initial 3.5 hr. However, after 4.5 hr, mean arterial blood pressure increased 14% (P less than 0.01), coronary sinus flow increased 22% (P less than 0.05), and myocardial oxygen uptake increased 19% (P less than 0.05). At 5.5 hr mean arterial pressure was 18% (P less than 0.01), coronary sinus flow 31% (P less than 0.01), and myocardial oxygen uptake 21% (P less than 0.05) above levels measured at 1.5 hr. At 5.5 hr whole body oxygen uptake was 6% (P less than 0.01) above the 1.5 hr value. Cardiac output, heart rate, and systemic and coronary vascular resistances did not change significantly. This study demonstrates that duration of anesthesia is an important factor in determining the metabolic oxygen requirements of the heart. During prolonged anesthesia, the increase in myocardial oxygen demands may have an unfavorable effect on the myocardial oxygen supply-demand relationship.     

Regional versus general anesthesia in high-risk surgical patients: the need for a clinical trial

Regional anesthesia is often preferred over general anesthesia for patients with cardiovascular disease because of presumed decreased risk of perioperative myocardial ischemia. However, few studies have addressed this issue directly. To determine whether the type of anesthesia is independently associated with myocardial ischemia, records of 134 patients undergoing peripheral vascular grafting under general or regional anesthesia were examined. There were no significant differences preoperatively between groups in ASA class, age, sex, or prevalence of angina, diabetes, or hypertension. Twelve patients developed myocardial ischemia or infarction within 7 days of operation; 11 of these 12 patients had received regional anesthesia (p < 0.015). The association between anesthetic approach and perioperative myocardial ischemia or infarction remained after adjustment for preoperative factors associated with ischemia or with type of anesthesia. General anesthesia does not appear to be associated with increased risk of myocardial ischemia, and stringent recommendations to avoid it in this population may be unfounded. A clinical trial is needed to define more clearly the risks and benefits of different types of anesthesia in high-risk patients.