不同剂量右美托咪定对妊高征剖宫产患者血流动力学的影响

目的探讨不同剂量右美托咪定对妊高征剖宫产患者血流动力学的影响。方法将本院行择期剖宫产术的325例妊高征产妇分为对照组与A、B、C、D组,每组各65例产妇。对照组仅接受基础麻醉,A、B、C、D组在基础麻醉的基础上再分别静脉泵入0.1、0.2、0.3、0.4μg/(kg·h)试验量与维持量右美托咪定直至手术结束。分别记录所有产妇硬膜外给药前(T_0)、切皮时(T_1)、胎儿娩出时(T_2)、手术结束时(T_3)的收缩压(SBP)、舒张压(DBP)、心率(HR)等指标。结果 5组4个时间点SBP、DBP、HR相比差异均有统计学意义(P0.05);T_0时,5组的SBP、DBP、HR均显著高于本组T_1、T_2、T_3时(P0.05);T_1时的SBP、DBP、HR均显著高于本组T_2、T_3时(P0.05),其T_2时的SBP、DBP、HR均显著高于本组T_3时(P0.05)。T_0时,5组研究对象SBP、DBP、HR相比差异均无统计学意义(P0.05);T_1~T_3时,5组研究对象SBP、DBP、HR相比差异均有统计学意义(P0.05),D组的SBP、DBP、HR均显著低于A、B、C组,对照组(P0.05),C组的SBP、DBP、HR均显著低于A、B组,对照组(P0.05),B组的SBP、DBP、HR均显著低于A组、对照组(P0.05),A组与对照组之间SBP、DBP、HR相比差异均无统计学意义(P0.05)。结论在妊高征剖宫产术中,右美托咪定剂量为0.4μg/(kg·h)时具有较好的稳定血流动力学作用,且随着剂量的增加,其效果越明显。     

七氟烷在老年患者手术麻醉中的应用

选择我院2011年6月-2012年12月需要进行手术的老年患者92例,随机分为两组,观察组46例采用七氟烷复合瑞芬太尼麻醉,对照组46例采用异氟烷复合瑞芬太尼麻醉,观察两组平均动脉压(MAP)、心率(HR)的变化及麻醉诱导时间。结果麻醉前两组各指标比较差异无显著性,麻醉开始与手术后HR比较差异无显著性,插管2min后两组SBP和DBP均明显下降,但对照组下降幅度明显大于观察组,两组SBP和DBP比较差异具有显著性,有统计学意义(P<0.05)。七氟烷麻醉可保持术中血压的相对稳定,特别适用于老年人。     

瑞芬太尼微泵注入防治硬膜外麻醉术中牵拉反应临床观察

目的观察小剂量瑞芬太尼用于防治硬膜外麻醉术中牵拉反应的临床效果。方法选择ASAⅠ~Ⅱ级择期肾脏手术患者30例,分为观察组(瑞芬太尼组)和对照组(杜非组)各15例。手术开始时对照组静脉注射杜冷丁50mg和异丙嗪25 mg,观察组静脉注射瑞芬太尼0.5μg/kg,然后以0.06~0.13μg/(kg.m in)微泵注入至关腹。常规吸氧并监测SBP、DBP、ECG、SpO2,观察并记录术中BP、HR、SpO2变化。结果两组在切开肌肉腹膜、手术牵拉肾脏时SBP、DBP、HR差异有显著性意义(P(0.05)。结论小剂量瑞芬太尼微泵注入辅助硬膜外麻醉可有效地减轻术中牵拉反应。     

控制性心动过缓在冠心病人非心脏手术中的临床应用

[目的]评价控制性心动过缓在冠心病人非心脏手术中临床应用的有效性和安全性.[方法]择期在腰硬联合麻醉(CSEA)下行下腹部或盆腔手术的冠心病病人40例,随机分为控制性心动过缓组(Ⅰ组)和对照组(Ⅱ组),每组20例.Ⅰ组先静脉注射艾司洛尔 500 μg/kg,1 min注射完,然后以(10～100) μ g/(kg·min)速率持续泵注,根据心率(HR)反应调节速度,使HR稳定在55～65次/分钟.Ⅱ组予相同量生理盐水静脉注射作对照,HR在50～120次/分钟之间时不予处理.分别于静注艾司洛尔或盐水前10 min(T0)、静注艾司洛尔或盐水后1 min(T1)、10 min(T2)、30 min(T3) 、60 min(T4)、手术结束后10 min(T5)、30 min(T6)记录HR、收缩压(SBP)、舒张压(DBP)等监测参数.术中出现心肌缺血等心电图事件随时记录.[结果]Ⅰ组病人T1～T4时HR、SBP、DBP低于T0时,且差异有显著性( P <0.05);T1～T4时,Ⅰ组病人HR、SBP、DBP均较Ⅱ组下降,且差异有显著性( P <0.05);心电图显示Ⅰ组心肌缺血事件发生率明显低于Ⅱ组( P <0.05).[结论]应用艾司洛尔行控制性心动过缓能减慢HR、降低SBP从而减轻心脏作功,降低心肌耗氧,改善氧供需平衡,达到预防心肌缺血的目的.     

小剂量羟考酮静脉复合丙泊酚与依托咪酯用于人工流产术对于术后宫缩痛的影响

目的观察小剂量羟考酮复合丙泊酚与依托咪酯用于人工流产术对于术后镇痛效果及安全性。方法 100例ASAⅠ~Ⅱ级无痛人工流产患者,随机分为两组,对照组:芬太尼(0.05 mg)(F组)静脉复合丙泊酚和依托咪酯1∶1混合液(按体积,含丙泊酚5 mg/ml及依托咪酯1 mg/ml)。试验组:小剂量羟考酮(0.05 mg/kg)(Q组)静脉复合丙泊酚和依托咪酯1∶1混合液(按体积,含丙泊酚5 mg/ml及依托咪酯1 mg/ml)。记录诱导前、意识消失、负压吸引、手术结束、定向力恢复时各时点心率(HR)、收缩压(SBP)、舒张压(DBP)、血氧饱和度(Sp O2)等。记录术中不良反应(低血压、心动过缓、呼吸困难、流延、躁动、术中知晓、肢体扭动、恶心呕吐)、丙泊酚和依托咪酯混合液用量、诱导时间、手术时间、定向力恢复时间等。结果与诱导前比较,两组在意识消失时SBP、DBP均下降(P<0.05)。与诱导前比较,两组在负压吸引、手术结束时HR均下降(P<0.05)。F组Sp O2在意识消失、宫腔负压吸引、手术结束、定向力恢复与诱导前比较,均下降(P<0.05),但Q组Sp O2下降幅度低,在宫腔负压吸引、手术结束、定向力恢复时与F组比较差异有统计学意义(P<0.05)。F组与Q组低血压、心动过缓、流涎、肢体扭动、头晕差异无统计学意义。手术时间、诱导时间和定向力恢复时间、丙泊酚-依托咪酯混合液用量两组比较,差异无统计学意义。在术中麻醉、术后镇痛中,Q组术后镇痛效果明显高于F组,Q组优良率为90%、94%,F组为84%、70%,其中Q组达优率分别为80%、82%,F组为52%、38%,两组比较差异有统计学意义(P<0.05)。结论小剂量羟考酮辅助丙泊酚和依托咪酯在无痛人工流产术中,不抑制呼吸,循环稳定,不延长患者苏醒时间,术中麻醉镇痛效果确切,不良反应少,对于术后宫缩痛有非常明显的镇痛效果。     

右美托咪定用于乳腺癌根治术气管插管全麻对患者血流动力学的影响

选取2014年1月~2015年11月我院乳腺外科收治的106例乳腺癌患者。随机分为观察组和对照组各53例。观察组气管插管全麻前给予盐酸右美托咪定注射液进行静脉输注,对照组在气管插管全麻前给予同等剂量的生理盐水进行静脉输注,观察两组药物输注前(t_0)、输注后10分钟(t_1)、手术开始5分钟(t_2)、手术开始20分钟(t_3)两组患者血流动力学[收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)]变化情况。同时观察两组用药后不良反应发生情况。用药后观察组t_1时点SBP、DBP、MAP、HR与t_0时点比较,差异显著(P0.05),t_2、t_3时点SBP、DBP、MAP、HR与t_0时点比较,差异无统计学意义(P0.05),对照组t_1、t_2、t_3时点SBP、DBP、MAP、HR与t_0时点比较,具有统计学意义(P0.05),且观察组t_1、t_2、t_3时点SBP、DBP、MAP、HR与对照组比较差异显著(P0.05),观察组不良反应总发生率9.43%较对照组1.89%高,差异不具有统计学意义(P0.05)。右美托咪定用于乳腺癌根治术气管插管全麻对患者血流动力学具有双向调节作用,能很好地稳定患者血流动力学,具有临床应用价值。     

乳腺癌根治术应用连续胸椎旁神经阻滞复合全身麻醉对患者外周血应激反应指标的影响分析

目的 探讨乳腺癌根治术应用连续胸椎旁神经阻滞复合全身麻醉对患者外周血应激反应指标的影响。方法回顾性分析2020年6月至2022年6月于我院行乳腺癌根治术的82例患者的临床资料,依据术中麻醉方式不同分为对照组40例和观察组42例,对照组采取常规全身麻醉,观察组采取连续胸椎旁神经阻滞复合全身麻醉。比较两组患者麻醉前(T0)、插管时(T1)、切皮时(T2)、手术结束时(T3)时的生命体征[收缩压(DBP)、舒张压(SBP)、心率(HR)]差异;比较两组患者镇痛药物舒芬太尼使用量及术后恢复情况（苏醒时间、恢复进食的时间）。对比两组患者术前及术后1 h时外周血应激反应指标[肾上腺素(E)、去甲肾上腺素(NE)、皮质醇(COR)]变化情况。结果 两组患者术后1 h时的各应激反应指标均升高,但观察组低于对照组,差异均有统计学意义(P<0.05)。观察组DBP、SBP、HR波动幅度均低于对照组,差异有统计学意义(P<0.05);两组患者T1、T2时的DBP、SBP、HR均较T0时升高,且观察组低于对照组,差异有统计学意义(P<0.05);其余时间段两组DBP、SBP、HR对比差异均无...     

全麻复合超声引导下连续胸椎旁神经阻滞麻醉在食管癌开胸手术患者中的应用

目的 探讨全麻复合超声引导下连续胸椎旁神经阻滞(CTPVB)麻醉在食管癌开胸手术患者中的应用。方法选取2018年1月～2020年6月我院收治的60例食管癌开胸术患者,随机分为对照组和观察组各30例。对照组给予全身麻醉,观察组给予全麻复合超声引导下CTPVB。比较两组麻醉前(T0)、气管插管即刻(T1)、手术2h(T2)、术毕(T3)时的血流动力学[收缩压(SBP)、舒张压(DBP)及心率(HR)]。结果 T0及T3时刻,两组SBP、DBP及HR比较,差异无统计学意义(P0.05);T1、T2时刻,观察组SBP、DBP及HR均高于对照组,差异有统计学意义(P0.05)。结论食管癌开胸手术患者采用全麻复合超声引导下CTPVB可有效稳定血流动力学,值得推广。     

尼卡地平联合小剂量咪达唑仑对眼科老年高血压患者围术期血流动力学及儿茶酚胺的研究

目的探讨尼卡地平联合小剂量咪达唑仑对眼科合并Ⅱ~Ⅲ级高血压患者围术期血流动力学的影响及血浆儿茶酚胺的变化。方法选择西南医科大学附属医院65岁以上的患者根据美国麻醉师协会(ASA)分为Ⅱ~Ⅲ级,且合并Ⅱ~Ⅲ级围术期高血压眼科手术患者60例。随机分为2组:咪达唑仑+尼卡地平组(A组),咪达唑仑+硝酸甘油(B组),每组30例。患者术前10min静脉缓推咪达唑仑1、5min后血压低于180/110mm Hg行手术治疗。A组:术前5min给予尼卡地平0.5~5.0μg/(kg·min)静脉泵入;B组:术前5min给予硝酸甘油0.1~1.0μg/(kg·min)泵入,根据血压、心率调整泵入速度。观察并记录2组患者给药前(T0)、给药后5min(T1)、注射局麻药时(T2)、手术5(T3)、10(T4)、30min(T5)、术毕(T6)、术后1(T7)、6h(T8)患者的无创袖带收缩压(SBP)、舒张压(DBP)、心率(HR)、心率收缩压乘积(RPP),并于T0及T6时采集静脉血检测血浆肾上腺素(E)、去甲肾上腺素(NE)、多巴胺(D)水平。结果 2组患者基础SBP、DBP、HR、RPP、E、NE、D比较,差异无统计学意义(P0.05);组间HR、RPP比较,差异有统计学意义(P0.05);组内SBP、DBP、E、NE、D比较,差异有统计学意义(P0.05)。结论尼卡地平联合小剂量咪达唑仑能降低眼科手术患者因手术紧张引起的应激反应,降低血压和儿茶酚胺水平,其效果优于硝酸甘油。     

术中保温护理措施对妇科腹腔镜手术患者低体温及并发症的预防效果

目的探讨术中保温护理措施对妇科腹腔镜手术患者低体温及并发症的预防效果。方法将本院接受妇科腹腔镜手术的96例患者随机分为对照组(n=48)和干预组(n=48)。对照组给予手术常规护理,干预组在对照组基础上给予术中保温措施。监测2组术前、术中60 min和术后30 min的鼻咽温度、心率(HR)和收缩压(SBP)、舒张压(DBP)变化,并观察2组低体温和手术相关并发症的发生率。结果 2组手术时间、腹腔冲洗液量、入室后术前鼻咽温度、HR、SBP、DBP比较差异均无统计学意义(P 0.05);干预组术中出血量、麻醉清醒时间优于对照组,术中60 min、术后30 min鼻咽温度高于对照组,HR、SBP、DBP低于对照组,围术期低体温、苏醒期躁动和寒颤发生率低于对照组,差异均有统计学意义(P 0.05)。结论系列保温护理措施能减少术中出血量,缩短麻醉苏醒时间,有效预防围手术期低体温和并发症的发生。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.