异丙酚和硫贲妥钠混用预防气管插管反应30例分析

20 0 0年 3～ 4月 ,我科观察了安定 氟芬合剂 异丙酚 硫贲妥钠 琥珀胆碱静脉诱导与安定 氟芬合剂 硫贲妥钠 琥珀胆碱静脉诱导对气管插管心血管反应的影响 ,现将结果报告如下。1　资料和方法1 1　观察对象　选择 6 0例ＡＳＡⅠ～Ⅱ级腹腔镜胆囊切除病人 ,年龄 2 5～ 5 5岁 ,术前血压、心电图正常。随机分为 2组 ,术前 2组资料无差异 (Ｐ >0 0 5 )。1 2　麻醉方法　病人入室后开放 2条静脉通道 ,吸氧去氮 ,实验组 (Ⅰ组 )应用安定 0 2ｍｍ/ｋｇ 氟芬合剂 异丙酚 0 5 6ｍｇ/ｋｇ 2 5 %硫贲妥钠 0 86ｍｇ/ｋｇ[1] 氯化琥珀胆碱…     

硝酸甘油滴鼻预防全麻拔管期心血管反应的临床观察

我们试用硝酸甘油滴鼻在全麻拔管期给药 ,预防插管时的心血管反应 ,现报告如下。1　临床资料和结果选择全麻腹部手术 4 0例 ,ＡＳＡⅠ～Ⅱ级 ,年龄 4 2～ 71岁 ,男 2 0例 ,女 2 0例。术前常规肌注苯巴比妥钠 0 .1ｇ ,阿托品 0 .5ｍｇ或东莨菪碱 0 .3ｍｇ ,随机分为硝酸甘油滴鼻 (Ⅰ组 ,ｎ =2 0 )对照 (Ⅱ组 ,ｎ =2 0 ) ,麻醉诱导为氟哌利多 5ｍｇ ,芬太尼 2～ 4 μｇ/ｋｇ,2 .5 %硫喷妥钠 2 .5～ 4 .5ｍｇ/ｋｇ ,琥珀胆碱 1.5～ 2ｍｇ/ｋｇ ,麻醉维持以 1%的普鲁卡因 ,0 .0 75 %琥珀胆碱复合液静滴维持 ,低流量吸入 1%～ 2 %安氟醚维持麻醉…     

异丙酚、氯胺酮等四组麻醉诱导对血流动力学的影响

异丙酚或硫喷妥钠麻醉诱导时常出现血流动力学改变。有报道异丙酚和氯胺酮联合应用能维持血流动力学稳定。作者采用Ｍ超声心动图对 4 0例病人进行了对比观察。1　对象和方法1 1　对象　ＡＳＡⅠ级病人 4 0例 ,2 2～ 64岁 ,无心脏病史。随机分为 4组 ,每组 10例 :异丙酚 (Ｐ)组、硫喷妥钠 (Ｔ)组、氯胺酮 (Ｋ)组、氯胺酮异丙酚 (Ｋ Ｐ)组。各组年龄、性别、病种、手术要求等基本相近 ,具可比性。1 2　方法　均于术前半小时肌注阿托品 0 5ｍｇ ,地西泮 10ｍｇ。入室后开放静脉 ,面罩给氧 ,采用中立ＢＰ 92 0 0自动血压监视器测定血压并记录 ,…     

异丙酚复合全麻减少腹腔镜胆囊切除术围拔管期不良反应的临床观察

普鲁卡因静吸复合全麻下行腹腔镜胆囊切除术 (ＬＣ) ,术毕气管拔管时容易出现血压升高、心率加快、恶心呕吐及躁动不安等不良反应。我院用异丙酚复合全麻明显降低了这些不良反应 ,现总结报告如下。1　资料和方法1 1　一般资料　ＬＣ手术患者 5 0例 ,ＡＳＡⅠ～Ⅱ级 ,年龄 31～ 6 5岁 ,体重 49～ 85ｋｇ ,检查无心血管疾病 ,肝肾功能正常 ,随机分为Ａ组 (异丙酚组 ,ｎ=2 5 )和Ｂ组 (对照组 ,ｎ =2 5 ) 。1 2　麻醉方法　术前 30ｍｉｎ肌注苯巴比妥钠 0 1ｇ ,阿托品0 5ｍｇ或东莨菪碱 0 3ｍｇ ,两组均用芬太尼 1～ 2 μｇ/ｋｇ,2 5 %硫喷…     

异丙酚静脉麻醉在无痛人工流产中的应用体会

20 0 0年 11月— 2 0 0 1年 11月 ,笔者应用异丙酚静脉麻醉配合妇产科实施无痛人工流产或诊断性刮宫 5 5例 ,效果满意 ,现报告如下。1　资料与方法1 1　一般资料　 5 5例自愿终止妊娠的早孕妇女和诊刮患者 ,ＡＳＡⅠ～Ⅱ级 ,年龄 19～ 5 3岁 ,体重 4 0～ 6 2ｋｇ。无药物过敏史。1 2　麻醉方法　所有患者术前未禁食 ,不用术前药 ,病人入室后连续监测ＢＰ ,ＨＲ ,ＳｐＯ2 ,开放静脉输注 5 %葡萄糖。先行静注 0 5 %利多卡因 2～ 3ｍｌ,然后静注异丙酚 1ｍｇ/ｋｇ至病人意识消失 ,扩张宫颈口时追加异丙酚 0 .5ｍｇ/ｋｇ。同时 ,严密观察生命体…     

维库溴铵预防琥珀胆碱致术后肌痛效果观察

全麻气管插管常用琥珀胆碱做诱导 ,以方便插管 ,但插管当时易出现肌颤和术后肌痛。为此 ,我们用小剂量维库溴铵进行预防 ,效果满意。1　对象和方法1 1　对象　择期上腹部手术 75例 ,男 4 8例 ,女 2 7例 ;年龄 18～ 5 5岁。ＡＳＡⅠ～Ⅱ级。术前无神经肌肉系统疾病。随机分为单纯诱导组、地西泮组和维库溴铵组 ,每组 2 5例。1 2　方法　全部采用芬太尼 4 μｇ/ｋｇ ,2 5 %硫喷妥钠 6ｍｇ/ｋｇ ,琥珀胆碱 2ｍｇ/ｋｇ诱导插管。单纯诱导组不另给药 ,地西泮组、维库溴铵组诱导前 3ｍｉｎ分别注地西泮 10ｍｇ ,维库溴铵 0 0 2ｍｇ/ｋｇ。插管后…     

异丙酚加氯胺酮对小儿气管插管时血流动力学影响

异丙酚、氯胺酮应用于小儿全麻气管插管各有不足之处 ,为此 ,我们将二药合用于小儿插管 ,观察其对血流动力学的影响 ,以探讨二药合用的特点和应用前景。1　对象和方法1 1　对象　患儿 4 3例 ,男 2 3例 ,女 2 0例 ;年龄 2～ 10岁 ,体重 12～ 31ｋｇ ;ＡＳＡⅠ～Ⅱ级。术前 30ｍｉｎ肌注东莨菪碱 0 0 1ｍｇ/ｋｇ ,入室前肌注氯胺酮5ｍｇ/ｋｇ ,待入睡后入室 ,开放静脉通道 ,ＤａｔｅｘＣａｒ ｄｉｏｃａｐ Ⅱ监测仪监测基础平均动脉压和心率 ,随机分为 3组。1 2　方法　气管插管诱导方法 :异丙酚 氯胺酮组15例 ,用每毫升含异丙酚和氯胺酮各 …     

异丙酚或硫喷妥钠复合芬太尼对神经肽Y及降钙素基因相关肽的影响

本研究观察了异丙酚或硫喷妥钠复合芬太尼行全麻诱导气管插管后 ,血浆神经肽Ｙ(ＮＰＹ)及降钙素基因相关肽(ＣＧＲＰ)含量的变化 ,以了解其对血液动力学的影响。资料与方法1 5 0例患者均为ＡＳＡⅠ～Ⅱ级的择期上腹部手术患者 ,将其随机分为Ａ组 :2 5例 ,男 13例 ,女 12例 ,平均年龄(35± 6 5 )岁 ,平均体重 (5 5± 4 7)ｋｇ ;Ｂ组 :2 5例 ,男 14例 ,女 11例 ,平均年龄(37± 4 5 )岁 ,平均体重 (5 4± 4 2 )ｋｇ ,2组年龄、体重差异无显著性 ,均无糖尿病及心血管等疾患 ,肝肾功能正常 ,无激素用药史。麻醉方法 :术前按体重肌肉注射鲁米那钠…     

静注异丙酚辅助硬膜外麻醉电视腹腔镜阑尾切除术的体会

硬膜外麻醉下经腹腔镜阑尾切除术中 ,患者常出现恶心、呕吐、胸闷等不适 ,我们采用小剂量异丙酚持续静注辅助硬膜外麻醉取得了良好效果 ,现报告如下。1　临床资料和方法急慢性阑尾炎 3 2例 ,心功能ＡＳＡⅠ～Ⅱ级 ,男 1 8例 ,女 1 4例 ,年龄 1 2～ 68岁。术前 3 0ｍｉｎ肌注苯巴比妥钠0 1ｇ,阿托品 0 5ｍｇ。于Ｔ11～ 12 硬膜外穿刺成功 ,置管 3～4ｃｍ ,用药为 1 66%利多卡因与 0 2 %丁卡因混合液 ,阻滞平面控制在Ｔ6 以下。于ＣＯ2 气腹前 1 0ｍｉｎ静脉注射安定5ｍｇ加异丙酚 2ｍｇ/ｋｇ/ｈ。本组病人常规监测ＥＣＧ ,无创血压、ＳＰ…     

复合全麻对急诊开颅手术患者血浆一氧化氮的影响

急诊开颅手术常用巴比妥类、苯二氮卓类镇痛药、肌松药及吸入全麻药复合应用 ,配伍各不相同 ,本研究选取三种复合全麻 ,探讨对患者血浆ｎｉｔｒｉｃｏｘｉｄｅ(ＮＯ)的影响 ,以便为临床合理选择用药提供理论依据。1　资料和方法1.1　资料 :选择ＡＳＡⅢ～Ⅳ的急诊开颅手术 90例 ,随机分为Ａ、Ｂ、Ｃ三组 ,每组 3 0例。麻醉前静注阿托品 0 .0 2ｍｇ·ｋｇ-1,入室后建立静脉通道 ,套管针穿刺留置供采血样。1.2　方法 :Ａ组 :硫喷妥钠 5ｍｇ·ｋｇ-1、2 5 %羟丁酸钠 80ｍｇ·ｋｇ-1,氟芬合剂诱导 ,去氮插管。用 2 5 %羟丁酸钠 40ｍｇ·ｋｇ-1、…     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.