硬膜外阻滞复合吸入全麻提早拔管在高龄上腹部手术患者中的应用

【目的】探讨硬膜外阻滞复合吸入全麻提早拔除气管导管在高龄上腹部手术患者中应用的安全性和优越性。【方法】收集本院40例65岁以上择期腹部手术高龄患者，ASAⅠ～Ⅱ级，随机分为观察组（Ⅰ组）和对照组（Ⅱ组），每组20例。两组均采用硬膜外阻滞复合全麻。Ⅰ组患者在腹膜关闭完成后即提早拔除气管内导管；Ⅱ组患者在皮肤缝合完成后拔除气管内导管。观察拔管后1、5、10、20min的血流动力学和血氧饱和度（Sp02）变化。同时观察两组患者术毕至离开手术室时间（滞留时间）。【结果】拔除气管内导管后1、5、10、20min，Ⅱ组的收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）均明显高于Ⅰ组（P〈0．05），而Sp02值则明显低于Ⅰ组值（P〈0．05）；滞留时间Ⅱ组明显长于Ⅰ组（P〈0．05）。【结论】硬膜外阻滞复合吸入全麻提早拔管，能使高龄患者拔管后血流动力保持稳定并缩短手术室滞留时间，是一种安全有效的麻醉方法。     

全麻联合硬膜外麻醉应用于老年腹部手术效果观察

目的 观察全麻联合硬膜外麻醉应用于老年腹部手术患者的临床效果.方法 2008-01-2009-12择期上腹部手术老年患者170例按照随机数字表法分两组各85例,分别进行单纯全麻及硬膜外阻滞加全麻联合.结果 硬膜外阻滞加全麻联合组异氟醚、芬太尼、维库溴铵、丙泊酚用量均少于单纯全麻组;自主呼吸、拔除气管插管、完全清醒也短于单纯全麻组(P＜0.05).结论 硬膜外阻滞复合全身麻是老年人上腹部手术理想的麻醉方法,但操作繁琐,低血压的发生率较高,需要加强管理.     

全麻复合硬膜外阻滞麻醉的术中观察及护理

目的对比全麻复合硬膜外阻滞麻醉与单纯全麻对患者术中的影响，并总结全麻复合硬膜外阻滞麻醉的护理要点。方法选择上腹部手术的全麻复合硬膜外阻滞麻醉患者60例，随机分为联合组和对照组，每组各30例。联合组采用全麻复合硬膜外阻滞麻醉。对照组采用单纯气管内全麻。对插管前后两组患者的生命体征进行观察比较。结果联合组插管前后生命体征变化不明显；对照组插管前后，生命体征变化有统计学差异（均P〈0．05）。且联合组的术后苏醒时间较对照组缩短。结论全麻复合硬膜外阻滞麻醉适用于上腹部手术，患者术中生命体征稳定。护理人员要重视患者术中体位和心理评估。     

不同插管方法全身麻醉复合硬膜外阻滞对老年人血流动力学的影响

目的探讨不同插管方法全身麻醉复合硬膜外阻滞对老年人上腹部手术患者血流动力学的影响。方法将120例择期上腹部手术老年患者,随机分为喉罩全麻复合硬膜外阻滞组（LE）、气管插管全麻复合硬膜外阻滞组（ET）和表面麻醉处理后行气管插管全麻复合硬膜外阻滞组（LET）三组,每组40例。诱导前行第9~10胸椎间隙硬膜外阻滞,1.7%~2.4%七氟烷吸入维持麻醉。LE组置入喉罩,ET组气管插管,LET组插管前行2%利多卡因和复方利多卡因乳膏表面麻醉。分别于麻醉前（T0）、插管（罩）前后（T1、T11）、切皮前后（T2、T22）、腹腔探查前后（T3、T33）、拔管（罩）前后（T4、T44）观察三组患者的平均动脉压（MAP）及心率（HR）变化。结果三组患者一般情况的比较差异无统计学意义（P〉0.05）。LE、ET和LET组内、组间MAP、HR比较差异均有统计学意义（P〈0.05）;ET和LET组内、组间比较MAP、HR差异有统计学意义（P〈0.05）;主要差异在插管（罩）前后和拔管（罩）前后。结论喉罩全麻复合硬膜外阻滞对老年上腹部手术患者的血流动力学影响小,利多卡因表面麻醉和应用涂抹复方利多卡因乳膏的气管导管插管也可减少患者血流动力学波动。     

全麻复合硬膜外阻滞用于高血压患者气管插管心血管反应的临床观察

目的 探讨全麻复合硬膜外神经阻滞对高血压患者气管插管时心血管系统的影响。方法 将40例ASAⅠ～Ⅱ级高血压患者，随机分为A、B两组，A组（n=20）为试验组，采用全麻诱导前先行硬膜外神经阻滞；B组（n=20）为对照组，硬膜外穿刺成功后先不施行神经阻滞，直接进行全麻诱导，对插管前后生命体征进行观察比较。结果 A组插管前后生命体征变化不明显，而B组生命体征变化非常显著（P〈0．01）。结论 全麻复合硬膜外神经阻滞用于高血压患者手术麻醉安全、可靠。     

单纯全麻和全麻复合硬膜外阻滞用于乳癌根治并即时乳房再造术的比较

【目的】比较全身麻醉及全麻复合硬膜外阻滞用于乳癌根治并即时应用带蒂背阔肌皮瓣进行乳房再造术的应用效果、安全性和实用性。【方法】24例择期行乳腺切除＋乳房再造术患者,年龄32～61岁ASAⅠ～Ⅱ级,随机分为：Ⅰ组：单纯全麻组（n=12）。Ⅱ组：全麻复合硬膜外阻滞组（n=12）。观察记录两组麻醉前、全麻诱导时、气管插管时、体位变换时、拔管前后的SBP、DBP、HR、SPO2变化。记录两组患者全麻药用量、术毕至拔管时间、拔管时躁动、苏醒后再入睡及并发症发生等情况。【结果】Ⅱ组气管插管及术毕拔管时的循环波动明显小于Ⅰ组（P〈O．05）,Ⅱ组全麻药用量、术毕苏醒时间、拔管躁动和再入睡例数与Ⅰ组相比有显著差异（P〈O．01）。【结论】全麻复合硬膜外阻滞较单纯全麻术中循环功能稳定,麻醉苏醒较快,苏醒后再入睡发生率低,有利于术后呼吸管理,提高麻醉安全性。     

硬膜外阻滞复合浅全麻用于老年高血压病患者开胸手术

目的观察硬膜外阻滞复合浅全麻对老年高血压患者开胸手术血流动力学变化、术中知晓及苏醒时间的影响。方法择期开胸手术的老年高血压患者60例,随机分为单纯全麻组（Ⅰ组）和浅全麻复合硬膜外阻滞组（Ⅱ组）,监测两组患者术中的血流动力学变化和ECG的变化及全麻药用量和苏醒时间。结果Ⅰ组出现明显的心血管反应,尤以插管及拔管时显著高于基础值（P〈0．05）,Ⅱ组各时点血流动力学稳定,与I组比较有显著差异（P〈0．05）,心肌缺血有所改善,全麻药用量明显少于Ⅰ组（P〈0．01）,术后清醒及气管拔管时间与Ⅰ组比较明显缩短（P〈0．01）。结论硬膜外阻滞复合浅全麻可减轻应激反应,循环状态稳定,全麻用药量减少,苏醒快,是老年高血压患者开胸手术的首选麻醉方法。     

SLIPA喉罩全麻复合硬膜外阻滞在膝关节置换术中的应用

目的：探讨膝关节置换术应用SLIPA喉罩全麻复合硬膜外阻滞的效果,并与气管插管全麻对比。方法：选取140例行全膝关节置换术患者,随机分为两组,观察组（70例）应用SLIPA喉罩通气,对照组（70例）应用气管插管,观察麻醉前、置喉罩或气管插管即刻、置入喉罩或插管后5min、拔除喉罩或气管插管即刻的心率、血压,观察术后咽喉部并发症的情况。结果：观察组在置入及拔除喉罩时血压和心率较对照组稳定;咽喉部并发症发生率观察组（7．14％）明显低于对照组（21．43％）。结论：SLIPA喉罩全麻复合硬膜外阻滞在膝关节置换手术中血流动力学稳定,术后并发症少,使用简便,对喉损伤小。     

Proseal喉罩全麻复合硬膜外阻滞在老年病人上腹部手术中的应用

目的探讨Proseal喉罩全麻复合硬膜外阻滞在老年病人上腹部手术中应用的安全性、可行性。方法40例择期上腹部手术老年患者，美国麻醉师协会（ASA）分级Ⅰ-Ⅱ级，随机分为实验组（LE）、对照组（GE），每组20例。观察比较两组的血流动力学变化和术后并发症的发生情况。结果LE组较GE组患者血流动力学稳定，术后并发症少。结论Proseal喉罩全麻复合硬膜外阻滞可用于老年病人上腹部手术，插喉罩（拔喉罩）对血压、心率的影响不如气管导管剧烈，且全麻药用量更少，拔管反应和术后咽痛少。     

Proseal喉罩对腹腔镜胆囊切除术病人心钠素和皮质醇的影响

目的：比较腹腔镜胆囊切除术中分别采用Proseal喉罩（Proseal-laryngeal mask airway）静吸复合全麻与气管插管（endotracheal intubation）静吸复合全麻对病人心钠素（atrial natriuretic peptide,ANP）和皮质醇（cortisol,COR）的影响。方法：40例病人分为两组,每组20例。Ⅰ组为Proseal喉罩静吸复合全麻,Ⅱ组为气管插管静吸复合全麻。观察记录麻醉插管前后和拔管前后HR、MAP、ANP、COR的变化。结果：Ⅰ组置入喉罩前后HR、MAP、ANP、COR变化不明显,Ⅱ组气管插管前后HR、MAP、ANP、COR明显升高。Ⅰ组拔除喉罩后HR、MAP、ANP、COR的变化较Ⅱ组拔除气管导管后明显减轻,而且Ⅱ组拔除气管导管前后HR、MAP、ANP、COR又进一步升高。结论：腹腔镜胆囊切除术病人术中使用Proseal喉罩静吸复合全麻的方法可显著减轻病人的应激反应,有利于血流动力学稳定。     

Use of crystepin in combination with obsidan in patients with diabetes mellitus with arterial hypertension

Examination included 70 patients with diabetes mellitus in combination with arterial hypertension of different origin (II stage essential hypertension and symptomatic renal arterial hypertension). Crystepin (2-3 tablets per 24 h) in combination with beta-adrenoblocker obsidan (40-80 mg/24 h) was used for treatment. Basic hemodynamic parameters and the state of the renin-aldosterone system were determined. The hemodynamic hypotensive effects in these patients due to the influence of the above therapy are uniform and depend on the form of attendant arterial hypertension. The hypotensive effect of crystepin used in combination with obsidan was more pronounced in patients with diabetes and II stage essential hypertension than that in those with diabetes and renal hypertension. The concentration of aldosterone and renin activity of blood plasma in patients with diabetes and arterial hypertension during treatment with crystepin and obsidan had no regular connection with the hemodynamic parameters.     

硝酸甘油联合托拉塞米在高血压危象并发急性肺水肿患者的应用

目的研究硝酸甘油联合托拉塞米治疗高血压危象合并急性肺水肿的效果。方法选取我院收治的高血压危象合并急性肺水肿患者80例作为研究对象。随机分为对照组40例,采用托拉塞米治疗;试验组40例,采用硝酸甘油联合托拉塞米治疗。比较两组患者治疗效果、临床指标改善程度及并发症发生率。结果治疗后对照组患者血压、呼吸频率及氧分压改善程度均低于试验组,且治疗有效率(77.5%)低于试验组(92.5%),差异显著(P0.05);对照组患者并发症发生率(20.0%)高于试验组(7.5%),差异显著(P0.05)。结论采用硝酸甘油联合托拉塞米在治疗高血压危象合并急性肺水肿安全性高,可减少并发症,改善治疗效果,提高患者生活质量。     

Satisfaction with upper-extremity surgery in individuals with tetraplegia

OBJECTIVE: To measure the satisfaction of individuals with tetraplegia with their upper-extremity reconstructive surgery. DESIGN: Survey. SETTING: Two Spinal Cord Injury Model Systems centers. PARTICIPANTS: Sixty-seven individuals with spinal cord injury at the C4 through C8 motor level (107 arms). INTERVENTIONS: Participants had upper-extremity surgery to improve function. The surgical procedures included tendon transfers for elbow extension, wrist extension, hand grasp, and pinch or hand grasp neuroprosthesis. MAIN OUTCOME MEASURE: A survey was mailed to participants, who were asked to respond to statements such as, "If I had it to do over, I would have the hand/arm surgery again," using a 5-level Likert scale (ranging from strongly agree to strongly disagree). RESULTS: Seventy percent of the participants were generally satisfied with the results of their upper-extremity surgery, 77% reported a positive impact on their lives, 68% reported improvements in activities of daily living (ADLs), 66% reported improved independence, 69% reported improvement in occupation, 71% reported improved appearance or neutral, 78% reported their hand worked as well (or neutral) as it did when surgery was first performed, and 86% reported postoperative therapy as being beneficial. CONCLUSIONS: Upper-extremity surgery had a positive impact on life, increased ability to perform ADLs and to be independent, and improved quality of life.     

Observations with Rabenid in patients with locomotor disease

By examining 139 patients suffering from locomotor diseases the author could observe the characteristic accompanying diseases as well as high uric acid level in 40 cases. She analyses the current opinions on hyperuricaemia and reports on her observations with uricosuric and antithrombotic coated Rabenid tablet (RG). She found sulfinpyrazone to be effective and valuable in the examined indication field.     

休克状态下PSVT多种药物转复成功1例

1 临床资料 患者女，77岁，主因心慌、乏力、大汗六小时就诊。查体，急性面容，血压波动在70～86/37～54mmHg；心率：160次/分；呼吸：26次/分；口唇紫绀，双肺呼吸音清；心率齐，心电图示阵发性室上心动过度，无预激综合症和房颤；血生化示电解质正常。     

Changes in myocardial function in patients with hypertension during treatment with minipress

Altogether 33 patients with arterial hypertension were investigated to study changes of left ventricular systolic phasic analysis, caused by prazosin therapy. Two groups were identified on the basis of these changes: indices in the 1st group (intrasystolic index, myocardial tension index, Blumberger coefficient) improved, in the 2nd group they deteriorated. The antihypertensive effect of prazosin should be assessed not only by the level of BP reduction but also by changes of left ventricular systolic phasic analysis. In the deterioration of indices of left ventricular systolic phasic analysis during a test with single administration of prazosin, antihypertensive therapy should be reconsidered.