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。     

综合保温护理在腰椎融合手术患者中的应用

目的 探讨综合保温护理对在全身麻醉下腰椎融合手术患者术后应激反应及并发症的影响。方法 选取62例本院手术室接受全身麻醉下腰椎融合手术的患者,随机分为试验组和对照组各31例。试验组接受常规护理,对照组接受综合保温护理。记录患者入麻醉苏醒室和出麻醉苏醒室时的麻醉恢复评分、肾上腺素(adrenaline, AD)和去甲肾上腺素(noradrenaline norepinephrine, NE)水平、围手术期出现低体温和寒战次数,以及两组患者术前、术中1 h、进入麻醉苏醒室及出麻醉苏醒室时的机体核心体温,并进行统计学分析。结果 两组患者入麻醉苏醒室时的麻醉苏醒评分无统计学差异(P>0.05),试验组出室时的麻醉苏醒评分显著高于对照组(P<0.05);试验组患者的AD、NE水平显著低于对照组(P<0.05),试验组围手术期出现低体温及寒战的次数也显著低于对照组(P<0.05)。两组患者术前体温无明显差异,但试验组术中1 h、进入麻醉苏醒室及出麻醉苏醒室的体温均显著高于对照组(P<0.05)。结论 全身麻醉下腰椎融合手术患者采用综合保温护理,有助于术后意识恢复、缩短苏...     

多感官唤醒方案在全身麻醉胸科手术患者中的应用

目的 探讨多感官唤醒方案在全身麻醉胸科手术患者中的应用效果。方法 将2021年1~8月的胸科手术患者按住院时间分为对照组与干预组各51例,对照组采用传统语音唤醒方案,干预组采用多感官唤醒方案,比较两组自主呼吸恢复时间、苏醒室停留时间,咽喉痛、躁动发生程度以及平均动脉压波动发生率。结果 干预组自主呼吸恢复时间、苏醒室停留时间显著短于对照组（均P＜0.05）;干预组咽痛、躁动发生程度显著低于对照组,平均动脉压波动发生率显著低于对照组（均P＜0.05）。结论 多感官唤醒方案扩展了原有单一感官的唤醒模式,能缩短胸科手术患者的苏醒时间及苏醒室停留时间,提高苏醒质量。     

老年腹部手术患者应用芬太尼与瑞芬太尼麻醉临床分析

目的分析瑞芬太尼与芬太尼在老年腹部手术患者麻醉中的应用价值。方法将68例老年腹部手术患者随机分成2组,每组34例。观察组患者给予瑞芬太尼麻醉,对照组患者给予芬太尼麻醉,观察2组患者手术期间心率(HR)、收缩压(SBP)、舒张压(DBP)和术后患者自主呼吸恢复时间、睁眼时间以及定向力恢复时间等情况。结果 2组患者诱导后HR、SPB、DPB均显著低于诱导前,差异均有统计学意义(P0.05)。观察组插管后及拔管后HR、SPB、DPB、术后自主呼吸恢复时间、睁眼时间以及定向力恢复时间均低于对照组,差异均有统计学意义(P0.05)。结论老年腹部手术患者实施瑞芬太尼麻醉,术中血流动力学稳定,术后苏醒时间短。     

胸腔镜肺叶手术患者苏醒室低体温现况及影响因素

目的 探讨胸腔镜肺叶手术患者苏醒室低体温现况及影响因素,为开展针对性体温干预提供参考。方法 回顾性调查胸腔镜肺叶手术患者222例,将发生苏醒室低体温的患者作为病例组,以1∶1比例匹配苏醒室未发生低体温的患者(对照组),比较两组围手术期特征。结果 胸腔镜肺叶手术患者中93例(41.89%)发生苏醒室低体温;匹配成功两组各92例,经单因素与多因素分析,年龄、BMI、麻醉类型、麻醉时长、入室核心体温、手术准备时间是患者苏醒室低体温发生的主要影响因素(P<0.05,P<0.01);苏醒室低体温患者苏醒室停留时间、住院时间显著延长,并伴有尿量减少(均P<0.01)。结论 胸腔镜肺叶手术患者苏醒室低体温发生率偏高,护理人员应评估围手术期患者年龄、麻醉类型、麻醉时长、准备时间、BMI、入手术室核心体温,积极预防苏醒室低体温的发生,同时关注苏醒室低体温给患者造成的风险。     

静脉麻醉复合切口局部浸润麻醉用于老年股骨颈骨折手术的效果

目的 评价静脉麻醉复合切口局部浸润麻醉用于老年股骨颈骨折手术的效果。方法 择期全麻下行手术治疗的老年股骨颈骨折患者94例,性别不限,年龄61～79岁,体质量45～80 kg;伤后至入院时间1～8 h, ASA分级Ⅰ～Ⅱ级。采用随机数字表法分为静脉麻醉复合切口局部浸润麻醉组(观察组)和单纯静脉麻醉组(对照组),各47例。比较2组患者的麻醉苏醒情况和麻醉诱导前(T₀)、术毕拔管时(T₁)、出麻醉恢复室时(T₂)的心率(HR)、中心静脉压(CVP)。结果 观察组患者睁眼、拔管,以及麻醉恢复室停留时间均短于对照组,差异有统计学意义(P<0.05)。与T₀时点比较,2组患者T₁、T₂时的HR均下降,CVP均上升,其中观察组患者的变化幅度均小于对照组,差异均有统计学意义(P<0.05)。结论 对行股骨颈骨折手术的老年患者,应用静脉麻醉复合切口局部浸润麻醉,可缩短麻醉苏醒时间,且对麻醉苏醒期患者的HR、CVP影响较小。     

瑞芬太尼复合丙泊酚靶控输注在老年腹腔镜胆囊切除术中的应用

目的探讨瑞芬太尼复合丙泊酚靶控输注在老年腹腔镜胆囊切除术(LC)中的应用效果。方法随机将接受LC的70例老年患者分为2组,每组35例。观察组采用瑞芬太尼复合丙泊酚靶控输注麻醉,对照组采用瑞芬太尼复合丙泊酚持续静脉输注麻醉。通过警觉/镇静评分系统(OAA/S)对麻醉效果进行评定,并比较2组患者的呼吸恢复时间、睁眼时间、拔管时间。结果 2组患者术中、术后各个时间段OAA/S评分差异无统计学意义(P0.05);观察组患者的呼吸恢复时间、睁眼时间、拔管时间均优于对照组,差异有统计学意义(P0.05)。结论老年患者LC时应用瑞芬太尼复合丙泊酚靶控输注麻醉效果优秀,安全性高。麻醉撤药后患者苏醒快,利于老年人术后恢复。     

老年全髋置换术全麻和腰硬联合麻醉对术后麻醉恢复效果的影响

目的对比分析全麻、腰硬联合麻醉对全髋置换术老年患者术后麻醉恢复效果的影响。方法随机将60岁以上行全髋关节置换术的70例患者分为2组,每组35例。观察组采用腰硬联合麻醉,对照组进行全麻。比较2组手术时间、出血量、输血量、输液量、术后呼吸恢复时间、拔管时间、睁眼时间及定向力恢复时间及拔管时骚动发生情况。结果 2组手术时间、出血量、输血量及输液量方面对比,差异无统计学意义(P0.05)。观察组术后呼吸恢复时间、拔管时间、睁眼时间、定向力恢复时间及拔管时躁动发生率均显著优于对照组,差异有统计学意义(P0.05)。结论腰硬联合麻醉用于老年全髋置换术,利于术后麻醉恢复,提高苏醒质量,但应严格掌握适应证。     

全身麻醉复合硬膜外麻醉用于老年高血压患者腹腔镜胆囊切除术的效果

目的分析全身麻醉复合硬膜外麻醉用于老年高血压患者腹腔镜胆囊切除术(LC)的效果。方法随机将76例接受LC的老年高血压患者分为2组,各38例。对照组实施全身麻醉,观察组实施全身麻醉复合硬膜外麻醉。比较2组患者入室后(T_0)、气管插管即刻(T_1)、气腹后15 min(T_2)、气管拔管后10 min(T_3)的收缩压(SBP)、舒张压(DBP)、心率(HR)及术后睁眼时间、定向力恢复时间、术后2 h疼痛程度及苏醒期烦躁发生率。结果 (1)2组患者T_0时各项血流动力学指标差异无统计学意义(P0.05)。(2)2组患者T_1、 T_2、T_3时各项血流动力学指标均明显高于T_0时,差异有统计学意义(P0.05)。(3)观察组T_1、T_2、T_3时各项血流动力学指标均明显低于对照组,差异有统计学意义(P0.05)。(4)观察组术后睁眼时间、定向力恢复时间均短于对照组,术后2 h疼痛程度VSA评分和苏醒期烦躁发生率均低于对照组,差异有统计学意义(P0.05)。结论全身麻醉复合硬膜外麻醉用于老年高血压患者LC,有利于维持术中血流动力学稳定,缩短术后恢复时间和降低苏醒期疼痛和烦躁程度,效果肯定。     

右美托咪定预防静吸全麻苏醒期患者躁动效果观察

目的探讨右美托咪定预防静吸全麻苏醒期患者躁动的效果。方法随机将60例静吸全麻下行择期手术的患者分为2组,各30例。手术结束后患者进恢复室。观察组:静脉输注右美托咪定0.4μg∕kg,输注时间10 min。对照组:10 min内静脉输注等容量的生理盐水。记录:(1)2组患者的自主呼吸恢复时间、拔管时间、定向力恢复时间、恢复室停留时间及躁动发生率。(2)2组患者在拔管时(T1)、拔管后5 min(T2)、拔管后10 min(T3)、拔管后20 min(T4)的RSS镇静评分。结果(1)2组患者的自主呼吸恢复时间、拔管时间、定向力恢复时间、恢复室停留时间比较,差异均无统计学意义(P0.05)。(2)观察组躁动发生率低于对照组,T1~T4各时点RSS镇静评分高于对照组,差异均有统计学意义(P0.05)。结论静吸全麻手术结束后,静脉输注右美托咪定,不延长患者的苏醒时间,可提高RSS镇静评分并降低苏醒期患者的躁动发生率。     

Early reversal of postoperative hypoxemia.

Peridural analgesia was combined with the respiratory-stimulant effect of doxapram for intermittent hyperinflation of the lungs to reverse early postoperative (PO) hypoxemia following inhalation anesthesia for upper abdominal operations. Twenty unpremedicated men undergoing upper abdominal operations were studied for 5 hours in the recovery room. Ten of these patients received doxapram plus peridural analgesia; the other 10, doxapram plus morphine analgesia. Rectal temperature, PaO2, PaCO2, respiratory rate, exhaled minute ventilation (VE), tidal volume (VT), and blood pressure and pulse were measured. The mean increase from control for VE was 9.6 L/min and for VT, 356 ml/breath during doxapram therapy for the morphine group. Corresponding values for the peridural group were 14.4 L/min for VE and 660 ml/breath for VT. Mean PaO2 for the morphine group decreased significantly from the corresponding preoperative value (p less than 0.005). Lack of significant change between preoperative and PO values for PaO2 for the peridural group would indicate that under the conditions of this study, early PO hypoxemia can be reversed by the combination of peridural analgesia with doxapram therapy.     

Influence of a Forced Air Warming System on Morbidly Obese Patients Undergoing Roux-en-Y Gastric Bypass

Background: Hypothermia during and after major abdominal surgery decreases host defenses, increases the incidence of coagulopathy and may alter blood pressure, cardiac contractility and myocardial stability. Methods: We designed a prospective randomized study to compare the benefits of a forced air warming system with warm blanket treatments in minimizing the effects of hypothermia on 64 morbidly obese patients undergoing Roux-en-Y gastric bypass. Results: Patients in the forced air warming group (n = 32) had significantly higher perioperative body core temperature, lower central venous pressure and blood pressure readings, lower incidence of shivering, less blood loss intraoperatively and achieved a higher post anesthesia Aldrete Score than those patients in the warmed blanket group (n = 32). Conclusion: The forced air warming system is safe, cost effective and beneficial in minimizing the undesirable consequences of hypothermia in morbidly obese patients undergoing Roux-en-Y gastric bypass.     

Prevention of hypothermia by cutaneous warming with new electric blankets during abdominal surgery

We have evaluated the efficacy of new electric warming blankets, which meet the requirements of the international standard for perioperative electrical and thermal safety, in preventing intraoperative hypothermia. We studied 18 patients undergoing abdominal surgery, allocated to one of two groups: in the control group, there was no prevention of intraoperative hypothermia (n = 8) and in the electric blanket group, two electric blankets covered the legs and upper body (n = 10). Anaesthesia duration was similar in the two groups (mean 201 (SEM 11) min), as was ambient temperature (20.5 (0.1) degrees C). Core temperature decreased during operation by 1.5 (0.1) degrees C in the control group, but only by 0.3 (0.2) degree C in the electric blanket group (P < 0.01). Five patients shivered in the control group compared with one in the electric blanket group (P < 0.05). We conclude that cutaneous warming with electric blankets was an effective means of preventing intraoperative hypothermia during prolonged abdominal surgery.      

The effects of warming intravenous fluids on intraoperative hypothermia and postoperative shivering during prolonged abdominal surgery

Background: The infusion of several liters of crystalloid solution at room temperature may significantly contribute to intraoperative hypothermia because warming fluid to core temperature requires body heat. The aim of this study was to evaluate the effect of delivering warmed intravenous (IV) fluid to the patient on preventing intraoperative hypothermia.
Methods: Intraoperative core and mean skin temperatures were measured during prolonged abdominal surgery in 18 patients randomly divided into two groups according to intraoperative IV fluid management. In 9 patients (control group) all IV fluids infused were at room temperature. In the other 9 patients (group receiving warmed fluids) all IV fluids were warmed using an active IV fluid tube-warming system. In all 18 patients a warming blanket covered the skin surface available for cutaneous warming. Intraoperative changes in total body heat content (kJ) were calculated from core and mean skin temperatures.
Results: At the end of surgery, core temperature was 36.7±0.2°C in the group receiving warmed fluids and 35.8±0.2°C in the control group ( P <0.05). The estimated reduction in heat loss provided by warming IV fluid was 217 kJ, a value very close to the theoretical value expected from thermodynamic calculation. During recovery, one patient shivered in the group receiving warmed fluids and seven in the control group ( P <0.05).
Conclusion: In conclusion, infusion of warmed fluids, combined with skin-surface warming, helps to prevent hypothermia and reduces the incidence of postoperative shivering.     

EFFECT OF PEROPERATIVE NORMOTHERMIA ON POSTOPERATIVE PROTEIN METABOLISM IN ELDERLY PATIENTS UNDERGOING HIP ARTHROPLASTY

We have examined in elderly patients the effect of maintenanceof normothermia during hip surgery on postoperative proteinmetabolism. In one group of six patients (warmed group) heatloss was minimized during surgery and in the recovery periodby warming fresh gases, i.v. fluids and wrapping the exposedparts of the body with a warming blanket. In a second groupof six patients (cold group), routine care was provided. Generalanaesthesia consisted of thiopentone, tubocurarine and halothanein both groups. Urinary excretion of urea nitrogen and 3-methylhistidine(3-MeH) after surgery was significantly lower in the warmedgroup compared with the cold group (P < 0.05). There waslittle effect of normothermia on amino acid concentrations inplasma after surgery. Muscle glutamine concentration 4 daysafter surgery decreased by 50% in the cold group and 18% inthe warmed group. Total body potassium (TBK), measured as anindex of body cell mass, decreased significantly after surgeryin both groups. However, 7 days after surgery the reductionin TBK in the cold group remained significantly lower than thatof the warmed group (P < 0.05). Maintenance of normothermiaduring hip surgery appeared to attenuate, but not eliminate,protein breakdown and nitrogen loss after surgery.     

Epidural morphine in the elderly

The effectiveness of epidurally administered morphine in the relief of pain after upper abdominal surgery was assessed in a controlled study involving 20 patients aged 61 to 78 years. Analgesia provided by epidural morphine was comparable to that obtained in matched patients given an intramuscular regime. The total dose required by the epidural route was less than one-fifth that required intramuscularly, and sedation was correspondingly reduced. Postoperative respiratory mechanics, however, were not significantly improved and delayed respiratory depression was observed in one patient. It is concluded that in elderly patients undergoing upper abdominal surgery the risks related to the use of morphine by the epidural route outweigh the marginal advantages it may offer over conventional analgesic techniques.     

Relationship between postoperative hypoxemia and the operative site

The effect of the site of operation on postoperative hypoxemia was studied in 104 patients undergoing thoraco-abdominal, thoracic, upper abdominal, lower abdominal, extra-abdominal and non-thoracic operations. The degree of postoperative hypoxemia was the most extensive in patients undergoing thoraco-abdominal, moderate in thoracic and upper abdominal operations, and minimal in lower abdominal and other operations. On the other hand, the duration of hypoxemia also differed with the surgical procedures. Arterial oxygen tension returned to almost control values by the 3rd postoperative day in cases of lower abdominal and extremity operations and by the 7th postoperative day in those undergoing thoracic and upper abdominal surgery. Postoperative hypoxemia, however, remained throughout the fourteen day study period, in patients undergoing thoraco-abdominal operation. True shunt was measured in 27 patients with thoraco-abdominal, thoracic and upper abdominal operations. An increase in true shunt was evident postoperatively in the entire group of patients. The increase was significantly larger and longer lasting in cases of thoraco-abdominal incision than that in cases of thoracic and upper abdominal incision alone. Differences in postoperative true shunt between cases of thoracic and upper abdominal incisions were nil.     

Relationship between postoperative hypoxemia and the operative site

The effect of the site of operation on postoperative hypoxemia was studied in 104 patients undergoing thoraco-abdominal, thoracic, upper abdominal, lower abdominal, extra-abdominal and non-thoracic operations. The degree of postoperative hypoxemia was the most extensive in patients undergoing thoraco-abdominal, moderate in thoracic and upper abdominal operations, and minimal in lower abdominal and other operations. On the other hand, the duration of hypoxemia also differed with the surgical procedures. Arterial oxygen tension returned to almost control values by the 3rd postoperative day in cases of lower abdominal and extremity operations and by the 7th postoperative day in those undergoing thoracic and upper abdominal surgery. Postoperative hypoxemia, however, remained throughout the fourteen day study period, in patients undergoing thoraco-abdominal operation. True shunt was measured in 27 patients with thoraco-abdominal, thoracic and upper abdominal operations. An increase in true shunt was evident postoperatively in the entire group of patients. The increase was significantly larger and longer lasting in cases of thoraco-abdominal incision than that in cases of thoracic and upper abdominal incision alone. Differences in postoperative true shunt between cases of thoracic and upper abdominal incisions were nil.     

The efficacy of carbon-fiber resistive-heating in prevention of core hypothermia during major abdominal surgery

BACKGROUND: Perioperative hypothermia causes numerous severe complications, such as coagulopathy, surgical wound infections, and morbid myocardial outcomes. For prevention of intraoperative hypothermia, an inexpensive, non-disposable carbon fiber resistive warming system has been developed. METHODS: We evaluated the efficacy of resistive-heating, comparing to circulating-water mattress and forced-air warming system. Twenty four patients undergoing elective abdominal surgery were randomly assigned to warming with: 1) a circulating water mattress, 2) a lower-body forced-air system, or 3) a carbon-fiber, resistive-heating blanket. RESULTS: Tympanic membrane temperature in the first two hours of surgery decreased by 1.9 +/- 0.5 degrees C in the water mattress group, 1.0 +/- 0.6 degree C in the forced-air group, 0.8 +/- 0.2 degree C in the resistive-heating group. The decreases in core temperature by the end of surgery were 2.0 +/- 0.8 degrees C in the water mattress group, 0.6 +/- 1.1 degrees C in the forced-air group, and 0.5 +/- 0.4 degree C in the resistive blanket group, respectively. There was no significant difference in the changes of core temperature between the forced-air group and the resistive-heating group. No side effects related to resistive-heating blanket were observed. CONCLUSIONS: Even during major abdominal surgery, carbon-fiber resistive-heating maintains core temperature as effectively as forced air.     

Effects of preinduction and intraoperative warming during major laparotomy

We have investigated the influence of active warming before and during operation on blood loss, transfusion requirements, duration of stay in the post-anaesthesia care unit (PACU) and perioperative costs in 40 patients undergoing major abdominal surgery. Patients were allocated randomly to one of two groups: in the study group (n = 20), patients were actively warmed using forced air for 30 min before induction of general anaesthesia and during anaesthesia. Passive protection against heat loss consisted of circulating water mattresses, blankets and fluid warming devices, and was used both in the active warming group and in the control group (n = 20). At the end of surgery the change in core temperature was significantly less in the group of actively warmed patients (0.5 (SD 0.8) degree C vs 1.5 (0.8) degree C; P < or = 0.01). Blood loss and transfusion requirements were less in the actively warmed patients, who had a shorter duration of stay in the PACU (94 (SD 42) min vs 217 (169) min; P < or = 0.01) and a 24% reduction in total anaesthetic costs.