腭裂修复手术方式与手术时间对术后早期低氧血症的影响

为测定不同腭裂修复手术方式和手术时间对术后早期低氧血症的发生率，持续时间以及明显呼吸道梗阻发生率，经用脉搏血氧饱和度仪观察证实：腭裂修复手术后低氧血症和严重低氧血症的发生率分别为３４．６％和１２．３％，其中７５．６％的病人发生在３０分钟内。手术后低氧血症，严重低氧血症以及明显气道梗阻的发生率与腭裂修复手术的创伤程度，手术时间明显相关。     

腭裂修复手术方式与手术时间对术后早期低氧血症的影响

为测定不同腭裂修复手术方式和手术时间对术后早期低氧血症的发生率，持续时间以及明显呼吸道梗阻发生率，经用脉血氧度仪观察证实；腭裂修复手术手低氧下和严重低氧血症的发生率分别为３４．６％和１２．３％，其中７５．６％的病人发生在３０分钟内，手术后低氧血症，严重低氧血症以及明显气道梗阻性率与腭裂修复手术的创伤程度，手术时间明显相关。     

腭裂修复手术方式与手术时间对术后早期低氧血症的影响

为测定不同腭裂修复手术方式和手术时间对术后早期低氧血症的发生率,持续时间以及明显呼吸道梗阻发生率,经用脉搏血氧饱和度仪观察证实:腭裂修复手术后低氧血症和严重低氧血症的发生率分别为34.6%和12.3%,其中75.6%的病人发生在30分钟内。手术后低氧血症,严重低氧血症以及明显气道梗阻的发生率与腭裂修复手术的创伤程度,手术时间明显相关。     

小儿和成人整形外科手术后早期低氧血症

７００例施择期整形外科手术的病人，在麻醉恢复室用脉搏氧饱和度仪持续监测ＳｐＯ２，以观察年龄对术后早期低氧血症的影响。根据年龄将病人分成四组：Ⅰ组为年龄小于１岁的婴儿；Ⅱ组为年龄１～３岁的幼儿；Ⅲ组为年龄大于３岁的儿童；Ⅳ组为年龄１８～５８岁的成人。结果发现年龄愈小，手术后早期的ＳｐＯ２愈低，低氧血症的发生率愈高。到达麻醉恢复室后，Ⅰ、Ⅱ、Ⅲ、Ⅳ组病人的低氧血症发生率分别为４４．４％、３１．７％、１７．３％和８．３％。婴儿的低氧血症主要发生在术后４０分钟内，而１岁以上小儿和成人则主要发生在术后１５分钟内。     

小儿和成人整形外科手术后早期低氧血症

700例施择期整形外科手术的病人,在麻醉恢复室用脉搏氧饱和度仪持续监测 SpO_2,以观察年龄对术后早期低氧血症的影响。根据年龄将病人分成四组:Ⅰ组为年龄小于1岁的婴儿;Ⅱ组为年龄1～3岁的幼儿;Ⅲ组为年龄大于3岁的儿童;Ⅳ组为年龄18～58岁的成人。结果发现年龄愈小,手术后早期的 SpO_2愈低,低氧血症的发生率愈高。到达麻醉恢复室后,Ⅰ、Ⅱ、Ⅲ、Ⅳ组病人的低氧血症发生率分别为44.4%、31.7%、17.3%和8.3%。婴儿的低氧血症主要发生在术后40分钟内,而1岁以上小儿和成人则主要发生在术后15分钟内。     

小儿腭裂术后呼吸道水肿的原因

本文回顾性总结我科１０年间小儿腭裂６６４例修复术后呼吸道水肿的有关问题，并与同期１７９例非腭裂小儿气管内全麻手术进行对照。结果腭裂组的呼吸道水肿有１０３例（１５．５％），非腭裂组有１７例（９．５％），两组比较有显著性差异；腭裂组各年龄段、平均体重和所...     

枢复宁TM预防小儿腭裂修补术后恶心,呕吐的临床研究

探讨了小儿腭裂手术后静脉注射枢复宁ＴＭ对术后恶心呕吐的影响。４５例ＡＳＡⅠ～Ⅱ级，年龄３～１０岁，择期行腭裂修补术的患儿随机分成三组：第Ⅰ组不用枢复宁ＴＭ，第Ⅱ组于麻醉后手术前静脉注射枢复宁ＴＭ０．１ｍｇ／ｋｇ，第皿组术毕静脉注射枢复宁ＴＭ０．１ｍｇ／ｋｇ。麻醉前３０分钟肌注阿托品０．０１ｍｇ／ｋｇ和苯巴比妥钠３ｍｇ／ｋｇ。用氯胺酮５ｍｇ／ｋｇ肌肉注射或１ｍｇ／ｋｇ静脉注射行麻醉诱导后，用羟丁酸钠５０ｍｇ／ｋｇ和０．１％氯胺酮维持麻醉。术毕患儿均在恢复室观察直至完全清醒方送近病房。醒后４小时开始进流质。结果第Ⅰ、Ⅱ、Ⅲ组患儿术后恶心、呕吐发生率分别为１１／１５（７３．３３％）、７／１５（４６．６７％）、２／１５（１３．３３％）（Ｐ＜０．０１）。本研究表明：术毕静脉注射枢复宁ＴＭ０．１ｍｇ／ｋｇ能有效预防小儿腭裂术后恶心、呕吐，不提倡术前预防性应用枢复宁ＴＭ。     

腭裂手术年龄对语音清晰度的影响

目的：通过回顾性调查,研究在不同年龄修复腭裂对术后语音清晰度的影响.方法：将102例年龄在10岁以上,腭裂术后2年以上的单侧完全性唇腭裂患者,根据接受腭裂手术的年龄分为3组,A组：0～3.00岁手术组（n=37）、B组：3.01～6.00岁手术组（n=36）和C组：6.01岁以上手术组（n=29）.随访时进行录音检查,对其语音清晰度进行判定,并对不同手术年龄组间语音清晰度的差异进行统计学检验.结果：3组患者的语音清晰度均值分别为91.7％、81.4％、和73.3％,统计学检验显示,术后语音清晰度在3组间的差异有显著性（P＜0.05）.结论：在不同年龄进行腭裂修复术,其术后语音清晰度的恢复不同.手术年龄越小,语音清晰度的恢复越好.     

腭裂早期修复13例观察

腭裂早期修复，平均手术年龄１５个月，共１３例，均无发生麻醉意外和手术并发症，术后随访发音优，良率达７０％；对小儿腭裂手术时机，手术时间和发音效果的关系，早期手术是否影响上腭部发育等问题，就本组病例实践提出了我们的初步见解。     

小儿全麻术后低氧血症的监测与氧治疗

观察７２例小儿全麻术后的脉搏血氧饱和度（ＳｐＯ２）变化，发现术毕患儿拔除气管导管或保留气管导管转入ＩＣＵ后均有不同程度的低氧血症发生，其ＳｐＯ２≤９０％者１８例占２５％。将低氧患儿与非低氧患儿进行比较，发现年龄、胸内手术和术中芬太尼用量对术后低氧血症的发生有明显影响（Ｐ＜０．０５），经吸氧后ＳｐＯ２均能很快回升并保持在正常水平。认为氧疗是防治小儿全麻术后低氧血症的重要措施，尤其应注意术毕运送患儿途中亦应常规吸氧。对年龄小，胸腹大手术，麻醉未醒患儿应延迟拔除气管导管。     

Nocturnal oxygenation during patient-controlled analgesia.

Patient-controlled analgesia (PCA) has become a standard modality for the management of postoperative pain, although anecdotal reports of excessive sedation and respiratory depression impugn its safety. To study the prevalence and severity of nocturnal hypoxemia, we measured arterial oxygen saturation (SpO2) continuously overnight in 32 postoperative patients who were receiving morphine via PCA. To evaluate the potential benefit of providing concurrent supplemental oxygen, the patients breathed oxygen-enriched air the night of surgery and room air the next night. Patients experienced more pain and consumed twice as much morphine the first night. However, breathing supplemental oxygen that night, the nocturnal mean SpO2 was 99%+/-1%, 94%+/-4% (P<0.001), and only four patients had periods of hemoglobin desaturation <90%. In contrast, breathing room air the subsequent night, the mean SpO2 was lower (94%+/-4%; P<0.001), and hypoxemia occurred more frequently and was more severe: 18 patients experienced episodes of SpO2 <90%, 7 patients experienced episodes of SpO2 <80%, and 3 patients experienced episodes of SpO2 <70%. One patient required resuscitation for profound bradypnea and cyanosis, but none suffered permanent sequelae. We conclude that when postoperative patients use PCA at night, hypoxemia can be substantial and oxygenation can be improved by providing supplemental oxygen. IMPLICATIONS: Oxygen saturation was measured postoperatively in patients using morphine patient-controlled analgesia. Substantial nocturnal hypoxemia occurred in half of the patients while they breathed room air. The severity of the hypoxemia was reduced when patients received supplemental oxygen.     

The Effect of Subareolar Isosulfan Blue Injection on Pulse Oximeter Readings

Besides several side effects including anaphylaxis, blue dyes are also known to cause false pulse oximeter readings. We aimed to examine the effects of subareolar isosulfan blue injection on pulse oximeter (SpO2) readings. The study group included 27 patients undergoing SLNB using both radiocolloid and isosulfan blue. Another group of 27 patients constituted the control group. Pulse oximeter readings were compared. SpO2 decline ≥4 % was defined as significant. All but one (96.2 %) of the patients in the study group showed SpO2 declines, compared to only one patient in the control group. Median ± Interqartile Range (IR) SpO2 decrease was 3.0 ± 4.0 % in the study and 0.0 ± 1.0 % in the control group (p < 0.001). There were significant (≥4 %) SpO2 decreases in 13 (48.1 %) patients in the study group. Statistically significant differences were noted between the two groups in all recordings between 15 and 180 min (p < 0.001). Initial time for SpO2 fall and the time to the lowest SpO2 recording were 10.0 ± 10.0 and 40.0 ± 30.0 min respectively. Using subareolar injection, the frequency of false readings is comparable with intraparenchymal injections, and is higher than intradermal injections. Time to peak SpO2 fall, and the recovery period, are delayed in the subareolar technique.     

Efficacy and safety of the laryngeal mask airwayvs Guedel airway following tracheal extubation

PURPOSE: To compare the safety and efficacy of the laryngeal mask airway (LMA) with the Guedel airway during the recovery period. METHODS: In a prospective randomised trial in the Post Anesthesia Care Unit (PACU), 52 patients (ASA 1 and 2) were randomised to receive either a laryngeal mask airway (LMA: n = 26) or a Guedel airway (n = 26) during the recovery period after middle ear surgery. Ease of airway maintenance was graded and the presence of coughing was noted. Peripheral arterial oxygen saturation (SpO2) was measured continuously by pulse oximetry in the PACU. Readings were taken on arrival (time 0) and for five minutes afterwards. RESULTS: There was no difference in sex, age, weight or incidence of smoking between the two groups. In the LMA group 25 patients required no airway manipulation and only one patient required repositioning of the LMA. In the Guedel group severe difficulty maintaining the airway was experienced in two patients, moderate difficulty in five patients and mild difficulty in 12 patients. Seven patients required no airway manipulation. The LMA group showed higher ease of airway maintenance scores, (P = < 0.0001) and less coughing (P = 0.0496). At time 0 and at one minute the LMA group had higher median SpO2 (97% and 97%) than the Guedel group (95% and 96%), (P = 0.0002 and 0.0362). There was no further difference in SpO2. CONCLUSIONS: The LMA provides easier airway maintenance, less coughing and initially higher median SpO2 when compared with the Guedel airway in the recovery period.     

Ineffectiveness of arterial pressure measurement and cardiac rate in detecting hypoxemia in the postanesthetic period]

The purpose of the study was to analyze the hemodynamic response to hypoxemia induced during the first postoperative hour. We studied 151 patients who underwent general anesthesia for elective surgery. Arterial saturation of oxyhemoglobin (SpO2), heart rate (HR), and systolic arterial pressure (SAP) during respiration with atmospheric air were measured 20 min and 80 min after admission at the recovery room. We compared HR and SAP between hypoxemic (SpO2 less than or equal to 90%) and non-hypoxemic patients (SpO2 greater than 90%) and we did not find significant differences. SpO2 failed to correlate with HR or with SAP in any of the time samples. This lack of correlation was also observed between patients with or without halogenated anesthetic treatment. Our results indicate that the possible inhibitory effect of anesthesia on hemodynamic response to hypoxemia lasts at least during the first postoperative hour and it does not depend on the administration of halogenated anesthetics. We also conclude that postoperative hemodynamic stability is not an accurate index of the status of arterial oxygenation.     

Supreme喉罩用于腹腔镜手术患者气道管理的效果

目的 评价Supreme喉罩用于腹腔镜手术患者气道管理的效果.方法 择期全麻下行腹腔镜手术的患者120例,性别不限,年龄35～60岁,体重48～85 kg,ASA Ⅰ或Ⅱ级,Mallampatis Ⅰ～Ⅲ级,随机分为2组(n=60):Supreme喉罩组(S组)和气管插管组(T组).S组根据患者体重选择喉罩型号,麻醉诱导后置入喉罩,并经引流管放置胃管,T组在直接喉镜下行气管插管.记录气管插管或喉罩置入时间及置人情况;记录S组胃管置入状况和喉罩气道密封压,并行纤维支气管镜检查评分,以评价喉罩对位情况;记录术中SpO2、PrrCO2和气道峰压(Ppeak),记录拔除气管导管或喉罩后不良反应的发生情况;记录手术时间、麻醉时间、拔管时间和苏醒时间.结果 与T组比较,S组喉罩置入时间、拔管时间和苏醒时间缩短,拔除喉罩后低氧血症、呛咳、咽喉痛的发生率降低(P<0.05);两组均无返流误吸发生.各时点spO2、PETCO2、Ppeak均在正常范围内,组间比较差异无统计学意义(P>0.05).S组喉罩置入成功率和T组气管插管成功率比较差异无统计学意义(P>0.05),S组喉罩气道密封压为(25±4)cm H2O,喉罩对位准确率95%,胃管放置成功率100%.结论 Supreme喉罩通气效果好,气道密封性可靠,拔除后不良反应少,可安全有效地用于腹腔镜手术患者的全麻气道管理.     

Treatment of hypoxemia during one-lung ventilation using intravenous almitrine

We performed this prospective randomized double-blinded study to assess the ability of almitrine to treat hypoxemia during one-lung ventilation (OLV). Twenty-eight patients were anesthetized with propofol, sufentanil, and atracurium; lung separation was achieved with a double-lumen tube. A transesophageal Doppler probe was inserted to evaluate cardiac index. If SpO(2) was equal to or decreased to <95% during OLV (inspired fraction of oxygen of 0.6), patients were included in the study and received a placebo or almitrine (12 microg x kg(-1) x min(-1) for 10 min followed by 4 microg x kg(-1) x min(-1)) infusion until SpO(2) reached 90% or decreased to <90% (exclusion from the study). Eighteen of the 28 patients were included and received either almitrine (n = 9) or a placebo (n = 9). Treatment was discontinued in 1 patient in the almitrine group and 6 in the placebo group (P < 0.05). Treatment was successful (SpO(2) remaining >or=95% during OLV) in 8 patients in the almitrine group and 1 in the placebo group (P < 0.01). Heart rate, arterial blood pressure, and cardiac index did not change throughout the study, but we could obtain an adequate aortic blood flow signal in only half of the patients. Almitrine could be used to treat hypoxemia during OLV. IMPLICATIONS: IV almitrine improves oxygenation during one-lung ventilation without hemodynamic modification. Such treatment could be used when conventional ventilatory strategy fails to treat hypoxemia or cannot be used.     

Continuous, Noninvasive, and Localized Microvascular Tissue Oximetry Using Visible Light Spectroscopy

Background: The authors evaluated the ability of visible light spectroscopy (VLS) oximetry to detect hypoxemia and ischemia in human and animal subjects. Unlike near-infrared spectroscopy or pulse oximetry (SpO2), VLS tissue oximetry uses shallow-penetrating visible light to measure microvascular hemoglobin oxygen saturation (StO2) in small, thin tissue volumes.

Methods: In pigs, StO2 was measured in muscle and enteric mucosa during normoxia, hypoxemia (SpO2 = 40-96%), and ischemia (occlusion, arrest). In patients, StO2 was measured in skin, muscle, and oral/enteric mucosa during normoxia, hypoxemia (SpO2 = 60-99%), and ischemia (occlusion, compression, ventricular fibrillation).

Results: In pigs, normoxic StO2 was 71 +/- 4% (mean +/- SD), without differences between sites, and decreased during hypoxemia (muscle, 11 +/- 6%; P < 0.001) and ischemia (colon, 31 +/- 11%; P < 0.001). In patients, mean normoxic StO2 ranged from 68 to 77% at different sites (733 measures, 111 subjects); for each noninvasive site except skin, variance between subjects was low (e.g., colon, 69% +/- 4%, 40 subjects; buccal, 77% +/- 3%, 21 subjects). During hypoxemia, StO2 correlated with SpO2 (animals, r2 = 0.98; humans, r2 = 0.87). During ischemia, StO2 initially decreased at -1.3 +/- 0.2%/s and decreased to zero in 3-9 min (r2 = 0.94). Ischemia was distinguished from normoxia and hypoxemia by a widened pulse/VLS saturation difference ([DELTA] < 30% during normoxia or hypoxemia vs. [DELTA] > 35% during ischemia).     

探究围绝经期亚临床甲状腺功能减退症患者的糖脂代谢、骨密度的变化

目的探讨围绝经期亚临床甲状腺功能减退症(SCH)患者糖脂代谢、骨密度(BMD)的变化。方法选取2016年1月至2018年8月在医院内分泌专科就诊的围绝经期SCH患者120例为研究组,另选取同期至我院体检中心体检的围绝经期健康女性120名为对照组。采集2组受试人员空腹静脉血,检测并对比血清促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT_3)、游离甲状腺素(FT_4)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)水平;检测并对比2组受试者口服糖耐量及C肽(CP)释放试验中空腹血糖(FPG)、服糖1 h后血糖(PBG1h)、服糖2 h后血糖(PBG2h)水平及各时刻点C肽释放量(CP0h、CP1h、CP2h);检测并对比2组受试者腰椎L_(2-4)、髋部总体、左股骨颈、左股骨大转子骨密度(BMD)水平,采用Pearson相关性分析法评价TSH水平与糖脂代谢、BMD变化的关系。结果研究组TSH、TC、TG、LDL、CP0h、CP1h、CP2h、FPG、PBG1h、PBG2h水平均明显高于对照组,且差异有统计学意义(P0.05);研究组HDL、腰椎L_(2-4)、髋部总体、左股骨颈、左股骨大转子BMD水平均明显低于对照组,且差异有统计学意义(P0.05);研究组患者血清TSH水平与血清TC、TG、LDL、FPG、PBG1h、PBG2h、CP0h、CP1h、CP2h水平呈显著正相关(P0.05),研究组患者血清TSH水平与血清HDL、腰椎L_(2-4)、髋部总体、左股骨颈、左股骨大转子BMD水平呈显著负相关(P0.05)。结论围绝经期SCH患者糖脂代谢紊乱,BMD降低,且SCH水平与糖脂代谢、BMD有紧密关系。     

ProSeal™ LMA Increases Safe Apnea Period in Morbidly Obese Patients Undergoing Surgery under General Anesthesia

Background

Morbidly obese patients are at risk of hypoxemia at the time of induction of anesthesia. The aim of this study was to assess the possible increase in the safe apnea time with the use of ProSeal laryngeal mask airway (PLMA) as a conduit prior to laryngoscope-guided intubation in morbidly obese patients undergoing surgery under general anesthesia.

Methods

Hundred patients with BMI greater than 35 kg/m², undergoing surgery under general anesthesia, were randomly divided to receive either PLMA or facemask with oropharyngeal airway (FM) as the airway device. Following preoxygenation with 100 % oxygen with continuous positive airway pressure of 10 cm H₂O, in ramp position for 5 min the patients were made apneic. From start of apnea to the time to reach SpO2 to 92 % was recorded as safe apnea time. Ventilation was initiated and time to reach SpO2 of 100 % was recorded as recovery time.

Results

The mean safe apnea time was 205 (96–320)?s in FM vs. 337 (176–456) s in PLMA (P?=?0.0000). The mean recovery period was 49 (36–68)?s in FM vs. 42(30–56)?s in PLMA groups (P?=?0.0000). Arterial blood gas analysis showed significant difference in pO2 between the two groups.

Conclusion

The use of ProSeal laryngeal mask airway prior to laryngoscope-guided intubation is beneficial in increasing safe apnea period and achieving faster recovery from hypoxemia in morbidly obese patients.