老年下肢手术左布比卡因复合利多卡因腰麻-硬膜外联合麻醉的疗效分析

目的比较不同剂量的左布比卡因腰麻复合硬膜外利多卡因联合阻滞在老年患者下肢手术中的临床麻醉效应。方法选择ASAⅡ-Ⅲ级患者60例,随机分成两组,每组30例。分别用0．5％左布比卡因1．2ml（A组）、2ml（B组）,于L3-4间隙穿刺,蛛网膜下腔以0．1ml／s速度注入麻醉药,在硬膜外腔留置导管。注药后20分钟感觉阻滞平面未达T,。者,经硬膜外导管追加2％利多卡因3ml。观察生理指标变化、最高阻滞平面、麻醉持续时间、麻醉效果及不良反应。结果两组患者麻醉绝对最高阻滞平面差异有统计学意义（P〈0．05）,感觉运动阻滞持续时间A组明显短于B组,差异有统计学意义（P〈0．05）,且硬膜外腔追加2％利多卡因A组明显多于B组（P〈0．01）,两组麻醉效果差异无统计学意义（P〉0．05）。两组血压手术开始时均低于麻醉前,且B组明显低于A组,差异有统计学意义（P〈0．05）。两组的心动过缓、恶心呕吐、胸闷气短发生率,差异无统计学意义（P〉0．05）。结论在老年患者下肢术中应用小剂量左布比卡因腰麻复合硬膜外利多卡因联合阻滞是安全、有效的。     

2％利多卡因混合0．75％罗比卡因行颈浅丛阻滞麻的临床观察

目的：探讨颈浅丛阻滞麻采用0．75％布比卡因10mL＋2％利多卡因10mL混合液和2%利多卡因10mL馄合液10mL＋0．75％罗比卡因相比较的麻醉效果。方法：对30例甲状腺瘤病人随机分为二组，即A组用局麻药2%利多卡因10mL＋0．75％布比卡因10mL混合液，B组用局麻药0．75％罗比卡因10mL＋2％利多卡因1oml棍合液，均行颈浅神经扇形阻滞。观察两组阻滞前、阻滞后5～30min血压和心率变化。结果：阻滞后5-30min血压升高平均值与阻滞前比较，A，B组有显著差异（P〈0．05），从心率增加看，A组对心率影响较明显。两组阻滞方法的麻醉效果无显著差异（P〉0．05）。结论：用局麻药0．75％罗比卡因10mL＋2％利多卡因10mL混合液，行颈浅神经扇形阻滞对循环系统影响较轻，其心脏毒性低，并发症减少，是颈浅丛阻滞麻一种理想的局麻药配方。     

利多卡因氧气雾化麻醉行电子支气管镜检查的效果观察

目的探索利多卡因氧气雾化麻醉应用于电子支气管镜检查的临床效果。方法将2％利多卡因氧气雾化麻醉和1％丁卡因喉头喷雾麻醉（对照组）效果进行对比。结果利多卡因组麻醉时间8～10min，总满意率95．8％；对照组麻醉时间20～30min，总满意率75．0％，利多卡因组麻醉效果优于对照组（P〈0．05）。结论利多卡因氧气雾化麻醉可作为电子支气管镜检查首选的麻醉方法。     

0．75％罗比卡因混合2％利多卡因行颈浅丛阻滞麻的临床观察

目的：探讨颈浅丛阻滞麻采用0．75％布比卡因10mL＋2％利多卡因10mL混合液和0．75％罗比卡因10mL＋2％利多卡因10mL混合液相比较的麻醉效果。方法：对30例甲状腺瘤病人随机分为二组，即A组用局麻药2％利多卡因10mL＋0．75％布比卡因10mL混合液，B组用局麻药0．75％罗比卡因10mL＋2％利多卡因10ml混合液，均行颈浅神经扇形阻滞。观察两组阻滞前、阻滞后5～30min血压和心率变化。结果：阻滞后5．30min血压升高平均值与阻滞前比较，A、B组有显著差异（P〈0．05），从心率增加看，A组对心率影响较明显。两组阻滞方法的麻醉效果无显著差异（P〉0．05）。结论：用局麻药0．75％罗比卡因10mL＋2％利多卡因10mL混合液，行颈浅神经扇形阻滞对循环系统影响较轻，其心脏毒性低，并发症减少。是颈浅丛阻滞麻一种理想的局麻药配方。     

丁卡因配伍曲马多行硬膜外镇痛的临床观察

目的：观察丁卡因配伍曲马多行硬膜外的镇痛效能及副作用。方法：选择ASA1～2级肝胆手术病人60例，随机分成：丁卡因组（D组，30例，0．1％丁卡因i00mL）和布比卡因组（B组，30例，0．15％布比卡因100mL），两组镇痛液中均含有曲马多400mg，氟哌啶5mg，观察镇痛效果（VAS评分），病人满意度及不良反应。结果：镇痛效果及病人满意度D组均优于B组，两组无明显不良反应。结论：丁卡因配曲马多伍行硬膜外镇痛效果确切。     

碳酸利多卡因和地卡因混合液在腹部手术硬膜外麻醉中的应用

本院应用碳酸利多卡因和地卡因和地卡因混合液用于腹部手术的硬膜外阻滞，取得满意麻醉效果。现报告如下。1资料与方法选择腹部手术60例，ASAI-Ⅱ级，年龄在20—75岁，随机分成两组：A组30例，1．73％碳酸利多卡因10ml加0．3％地卡因10ml，B组(对照组)30例，2％利多卡因10ml加0．3％地卡因10ml，两组均以正入硬膜外穿刺向头侧     

碳酸利多卡因在低位硬膜外麻醉中的临床应用

目的探讨碳酸利多卡因在低位硬膜外麻醉中的优越性。方法选择30例ASA 1～2级骨科下肢手术的患者，随机分成A、B两组，每组15例，均采用低位硬膜外麻醉。硬膜外穿刺置管后A组注入1．73％碳酸利多卡因；B组注入2％盐酸利多卡因，对比观察两组麻醉起效时间、阻滞完善时间、麻醉持续时间和阻滞神经节段数以及对循环系统的影响。结果A组的麻醉起效时间和阻滞完善时间缩短，与B组相比有显著性差异，而麻醉持续时间和脊神经阻滞范围及对循环系统的影响两组无明显差别。结论碳酸利多卡因具有麻醉起效快，阻滞完善，时间短的特点。     

碱化利多卡因与盐酸利多卡因麻醉效果比较

目的;比较碱休利多卡因与盐酸利多卡因用于硬膜外阻滞的麻醉效果。方法;硬膜外阻滞１５０例,随机分为盐酸利多卡因组和碱化利多卡因组,比较两组麻醉效果。结果：Ｂ组起效时间,阻滞完善时间明显短于Ａ组,神经阻滞节段数明显大于Ａ组,作用持续时间无差异。结论;碱多利多卡因较盐酸利多卡因用于硬膜外阻滞,能显著提高麻醉效果。     

罗哌卡因联合碳酸利多卡因在臂丛神经阻滞中的应用

目的研究罗哌卡因联合碳酸利多卡因在肌间沟及腋路臂丛神经阻滞中的麻醉有效性和安全性。方法选择ASAⅠ～Ⅱ级、各类上肢手术的患者60例，随机分成两组：每组30例。R组：0．75％罗哌卡因15ml．；B组：0．75％布比卡因15ml，两组分别联合1．73％碳酸利多卡因15ml及1：20万肾上腺素3滴，按手术部位的不同分别给药。结果两组患者麻醉起效时间及感觉阻滞时间差异无统计学意义（P〉0．05）。运动阻滞维持时间R组明显短于B组，差异有统计学意义（P〈0．01）。麻醉效果R组优者达93％，B组麻醉优者达87％，B组有1例患者术中感疼痛明显需加用静脉辅助药物，并有1例患者出现局麻药中毒反应。结论罗哌卡因联合碳酸利多卡因肌间沟及腋路臂丛神经阻滞，是一种麻醉效果优且安全的方法。     

误用间羟胺致室颤抢救成功1例

1病例报告 女，30岁。体重62kg．入院诊断：G1Po孕40^＋周．羊水过少。拟在连续硬膜外阻滞下行子宫下段剖宫产术。既往无特殊病史，术前辅检无明显异常指标。人室后测得BP140／85mmHg，HR90次／min，SPO2 99～100％，建立通畅的静脉通路。选L（1-2）间隙行连续硬膜外穿刺置管，麻醉药为1．5％利多卡因混合0．25％丁卡因，总量15m1分3次注入，控制阻滞平面为T5～S2，麻醉效果佳，术顺，胎儿娩出后按常规给予催产索1ml静滴，30s后患者突叫头痛，呼吸浅快，     

Topical Tetracaine Attenuates the Pain of Infiltration of Buffered Lidocaine

Objective: To determine whether topical tetracaine attenuates the pain of buffered lidocaine infiltration.
Methods: A prospective, randomized, double-blind trial was conducted involving adults with lacerations being repaired following local anesthesia. Two 0.5-mL injections of buffered lidocaine were given in a standardized manner. Injection 1 was given prior to application of topical study solution. Injection 2 was given on the opposite side of the laceration after topical application of a study solution that was 4 mL of either tetracaine or normal saline. Pain of each infiltration was measured using a visual analog pain scale. Pain score differences (injection 1 - injection 2) were compared for the 2 study solutions using a Wilcoxon 2-sample signed-rank test.
Results: Of 57 subjects studied, 29 received tetracaine and 28 received saline. The groups were similar in age, gender, wound length, wound location, and initial pain score. Pain scores decreased significantly in the tetracaine group as compared with the saline group. The median pain score difference for tetracaine was 12.0 mm, with an interquartile range (IQR) of 2 to 43 mm, as compared with 2 mm, with an IQR of —17 to 21 mm for saline (p = 0.048).
Conclusion: Topical tetracaine attenuates the pain of infiltration of buffered lidocaine.     

罗哌卡因用于分娩镇痛后转剖宫产手术硬膜外麻醉的效果观察及护理

[目的]探讨罗哌卡因用于分娩镇痛后转剖宫产手术硬膜外麻醉的效果观察及护理。[方法]将60例分娩镇痛后转剖宫产产妇随机分为A组和B组,每组30例,A组给予2％利多卡因,B组给予0．75％罗哌卡因行连续硬膜外麻醉。比较两组产妇感觉阻滞起效时间、切皮和术中镇痛效果、不良反应发生情况。[结果]B组产妇切皮时和术中疼痛视觉模拟评分法（VAS）评分低于A组,差异有统计学意义（P〈0．01）;两组感觉阻滞起效时间和不良反应发生率比较,差异无统计学意义（P〉0．05）。[结论]0．75％罗哌卡因应用于分娩镇痛后转剖宫产硬膜外镇痛效果优于2％利多卡因。     

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。     

The effects of spinal anesthesia vs epidural anesthesia on 3 potential postoperative complications: pain,urinary retention,and mobility following inguinal herniorrhaphy

This study was conducted to determine the effects of spinal (n = 113) vs epidural (n = 31) anesthetic techniques on 3 common postoperative complications: pain, urinary retention, and mobility for patients undergoing inguinal herniorrhaphy. The study design was a retrospective chart review. Data were collected on 144 subjects who underwent herniorrhaphy between January 1 and December 31, 1999, had an ASA classification of I to III, and were older than 18 years. The local anesthetics used to provide spinal anesthesia were 5% lidocaine, 0.75% bupivacaine, and 1% tetracaine solutions. The anesthetics used to provide epidural anesthesia were a solution of 2% lidocaine with epinephrine or 3% chloroprocaine with epinephrine. Results revealed that pain was not significantly different between the 2 anesthetic groups (P = .65); however, subjects in the epidural anesthesia group were able to ambulate (P = .008) and void (P = .02) sooner than subjects in the spinal anesthesia group. This study demonstrates that epidural anesthesia results in less urinary retention and earlier mobility than spinal anesthesia in men undergoing inguinal herniorrhaphy. Minimizing postoperative complications is essential in order for the nurse anesthetist to provide a satisfactory anesthetic experience. This study's findings suggest that epidural anesthesia optimizes recovery for the patient undergoing inguinal herniorrhaphy.     

Injectable Lidocaine Provides Similar Analgesia Compared to Transdermal Lidocaine/Tetracaine Patch for the Incision and Drainage of Skin Abscesses: A Randomized,Controlled Trial

Background

Local anesthesia used for incision and drainage of abscesses is known to be painful.

Study Objective

We studied the analgesia provided by a lidocaine/tetracaine patch compared to injectable lidocaine during incision and drainage (I&D) of skin abscesses.

Methods

This was a prospective, double-blind, randomized, controlled trial carried out in the Emergency Department (ED) of an adult tertiary referral center. Adult patients with a skin abscess in need of I&D were randomized to one of two groups. One group received a lidocaine/tetracaine patch and injectable normal saline for anesthesia. The second group received a placebo patch and injectable 1% lidocaine. A visual analog pain scale was used to record the patient's pain level prior to treatment, during the procedure, and after I&D.

Results

There were 20 patients enrolled in the study, including 12 randomized to the lidocaine/tetracaine patch and 8 to the injectable lidocaine. Pain scores preprocedure were similar in the two groups. Pain scores during I&D and postprocedure were compared between groups using a paired t-test. Patients receiving injectable lidocaine experienced pain that was similar (50.1 ± 5.9 mm; 95% confidence interval [CI] 45.2–55.1) to those receiving the transdermal lidocaine/tetracaine patch (60.1 mm ± 11.0; 95% CI = 55.2–68.1), p = 0.04, with a power of 80% to detect a difference of 20 mm at p ≤ 0.05; although this was statistically significant, it was not clinically significant. There was also no statistical difference between the two groups in the postprocedure pain scores (p = 0.65).

Conclusion

Local injection of lidocaine provided clinically similar analgesia compared to the lidocaine/tetracaine patch during I&D of skin abscesses in the ED. Pain at presentation and after the procedure was similar in both groups. Emergency physicians should continue to use a local injected anesthetic for I&D of skin abscesses until a less painful alternative is identified.     

全麻复合硬膜外阻滞在胸腔手术中的应用

目的:观察全麻复合硬膜外阻滞用于胸腔手术的临床效果。方法:90例择期行胸腔手术患者ASAⅠⅡ级,随机分为单纯全麻组(GA组)和全麻复合硬膜外阻滞组(GEA组),每组45例。两组全麻诱导和维持方法相同。GEA组于诱导前取T7～8椎间隙行硬膜外穿刺置管,注入2%利多卡因5ml,测定麻醉平面后给追加量。GEA组术毕行硬膜外镇痛。观察术中全麻药用量,苏醒、躁动和催醒例数,血液动力学、肺功能、术后疼痛和肺部并发症的情况。结果:GEA组较GA组全麻药用量少,苏醒快,躁动和催醒例数少,血压较GA组明显低,HR也相对较慢(P<0.05)。肺功能无显著性差异(P>0.05),GEA组术后无明显疼痛及出现肺部并发症。结论:全麻复合硬膜外阻滞用于胸腔手术病人可减轻应激反应,循环状态稳定,是安全可行的麻醉方法。     

0．75％速卡腰硬联合麻醉在老年患者全髋置换术中的应用

目的探讨0．75％速卡（左旋布比卡因）腰硬联合麻醉在老年患者全髋置换术中的I临床麻醉效果和可行性。方法60例老年全髋置换术患者随机分为两组,每组30例。B组使用0．75％布比卡因,L组使用0．75％左旋布比卡因,两组均行腰硬联合麻醉（CSEA）,鞘内各注人15mg。术中必要时经硬膜外导管注入1．5％利多卡因。术中监测BP、HR、SpO：、R的变化并观察感觉阻滞起效时间、最高感觉阻滞平面、达最高感觉阻滞平面时间、运动阻滞评分以及围术期不良反应的发生。结果两组感觉阻滞起效时间差异无显著性（P〉0．05）;最高感觉阻滞平面L组略低于B组,但差异无显著性;达最高感觉阻滞平面时间L组略短于B组,但无显著性差异;两组患者运动阻滞评分差异无显著性;两组均无神经系统的不良反应。结论0．75％速卡（左旋布比卡因）腰硬联合麻醉用于老年患者全髋置换术中对血流动力学影响小,其临床麻醉效果是安全可行的。     

产妇腰硬联合麻醉硬膜外追加利多卡因和生理盐水对麻醉平面的影响

目的 比较产妇腰硬联合麻醉时硬膜外腔追加生理盐水和利多卡因对腰麻无痛觉平面的影响.方法 90例ASA Ⅰ～Ⅱ择期剖宫产患者,随机分为三组：空白组、利多卡因组和生理盐水组.蛛网膜下腔注药10 min后,生理盐水组和利多卡因组分别向硬膜外腔注入生理盐水8ml、1.73％碳酸利多卡因8ml,而空白组则不加药.观察记录自硬膜外注药后不同时间节点的麻醉无痛觉平面,监测用药后20 min内的血压变化,并观察T10感觉阻滞恢复时间和运动恢复时间（Bromage为3）.结果 生理盐水和利多卡因组麻醉无痛觉平面上升幅度与空白组对比差异均有统计学意义（P＜0.01）,利多卡因组血压下降＞20％需要作升压处理的概率较高,三组间的感觉阻滞维持时间和运动恢复时间比较无统计学差异（P＞0.05）.结论 剖宫产实施腰硬联合麻醉中,硬膜外腔追加生理盐水或利多卡因均能有效扩展无痛觉麻醉平面,而追加生理盐水更为安全.     

利多卡因或罗哌卡因对3ED95顺苯磺阿曲库铵肌松作用的影响

目的 观察静脉或硬膜外注射利多卡因、硬膜外注射罗哌卡因对3ED95顺苯磺阿曲库铵的神经肌肉阻滞作用的影响.方法 60例患者随机分为4组.患者均以顺苯磺阿曲库铵0.15mg/kg诱导,并用TOF监测仪对足拇短屈肌进行监测.静脉利多卡因组（VL组）在诱导前15min静注2%利多卡因1.5mg/kg后以0.03mg/（kg·min）注射,硬膜外利多卡因组（EL组）或罗哌卡因组（ER组）均在诱导前15min行硬膜外穿刺,EL组给予3.3mg/kg 2%利多卡因,1h后追加1.8mg/kg.ER组给予与EL组等容积的0.5%罗哌卡因.记录4组的T1消失、T2和T3恢复时间.结果 VL组T1消失时间比对照组（C组）短（4.44±1.37 vs 6.17 ±1.91min;P〈0.05）;VL组和EL组T2（64.47±9.87、63.87 ±10.06min）、T3恢复时间（66.82±9.80、65.94 ±10.1min）均比C组（54.90 ±5.96、56.59±5.86min）长（P〈0.05）.ER组与C组无显著差异（P〉0.05）.结论 静注利多卡因缩短顺苯磺阿曲库铵的起效时间,静注或硬膜外注射利多卡因都会延长其临床作用时间,但硬膜外注射罗哌卡因对其神经肌肉阻滞作用没有影响.     

罗哌卡因丁丙诺啡硬膜外阻滞复合全身麻醉对上腹部手术应激反应的影响

目的:探讨罗哌卡因丁丙诺啡硬膜外阻滞复合全身麻醉对上腹部手术应激反应的影响。方法:60例择期行上腹部手术的患者,随机分成2组:观察组为罗哌卡因丁丙诺啡硬膜外阻滞复合全身麻醉,对照组为单纯气管插管全身麻醉。分别于麻醉前、切皮时、手术开始60 min、术后3 min采集静脉血检测血糖、血清去甲肾上腺素、肾上腺素、血清皮质醇含量;记录患者平均动脉压、心率、全身麻醉用药量及术毕清醒时间。结果:对照组患者血糖、血清去甲肾上腺素、肾上腺素、皮质醇浓度在切皮时、手术开始60 min、术后3 min明显高于麻醉前(P<0.01),且明显高于观察组(P<0.05,P<0.01),观察组患者平均动脉压、心率在切皮时、手术开始60 min、术后3 min均无异常波动,而对照组显著高于麻醉前(P<0.01)。全身麻醉药用量和术毕清醒时间观察组均明显少于对照组(P<0.05,P<0.01)。结论:罗哌卡因丁丙诺啡硬膜外阻滞复合全身麻醉用于上腹部手术可减轻术中的应激反应,对生理干扰小,术毕清醒快,是一种较好的麻醉方法。