病人自控镇静的研究进展

在临床工作中 ,麻醉医生面对的病人由于对手术麻醉的恐惧或在局麻、神经阻滞和椎管内麻醉下行手术时的不适及对手术室环境的陌生感 ,将会产生焦虑、紧张不安等情绪反应 ,这些不良反应需辅助一些镇静药物来消除 ,传统的方法是由麻醉医生根据病人情况给予一定剂量的药物 ,即 (ａｎｅｓｔｈｅｔｉｓｔ ｃｏｎｔｒｏｌｌｅｄｓｅｄａｔｉｏｎ ,ＡＣＳ) ,因ＡＣＳ不能根据药效动力学和药代动力学的个体差异用药 ,常出现镇静不足或镇静过度 ,不能满足病人需求或引起呼吸循环抑制。自 1989年Ｇａｌｌｅｔｌｙ将ＰＣＡ泵用来给予安定控制焦虑 ,并提…     

平衡镇静在部位麻醉中的应用

有效的镇静是部位麻醉病人术中麻醉处理的重要方面，平衡镇静方法利用不同麻醉药物的组合，达到镇静，抗焦虑和镇痛等效果，提高了麻醉质量。     

平衡镇静在部位麻醉中的应用

有效的镇静是部位麻醉病人术中麻醉处理的重要方面。平衡镇静方法利用不同麻醉药物的组合,达到镇静、抗焦虑和镇痛等效果,提高了麻醉质量。     

病人自控镇静与麻醉医师控制镇静的临床效果比较

目的：在整形外科局部麻醉手术中，比较病人自控镇静技术（PCS）与麻醉医师控制镇静技术（ACS）的临床效果。方法：50例择期整形个科手术，采用局部麻醉辅助镇静技术，ASAⅠ～Ⅱ级，随机分为两组，A组采用麻醉医师控制镇静技术，即在手术开始前分别给予镇静镇痛药，负荷剂量咪达唑仑0.05mg/kg，芬太尼0.05μg/kg和氯胺酮0.3mg/kg；根据镇静深度，按需逐步减量法间断使用上述三种药物。P组采用病人自控镇静技术，镇静药配方包括咪达唑仑、芬太尼和氯胺酮；负荷量1ml（含咪达唑仑0.4mg，芬太尼4μg和氯胺酮2mg），泵输速度200ml/h，病人自己按组给药以达到满意的镇静深度，初始锁定时间为0，待咪达唑仑用量达0.1mg/kg后，锁定时间设为2min。术中观察生命体征及镇静评分（SS），记录有无低氧血症、呼吸暂停以及术中、术后24h恶心呕吐等副反应。结果：两组病人术中镇静镇痛效果均满意，用药量基本相同。P组用药量存在较大的个体差异，按组次数在3-438次之间。术中P组的镇静深度平均为3.5分，A组平均为4.5分，有显著性差异（P=0.001）。P组术中呼吸抑制和术后恶心呕吐的发生率降低。结论：PCS与ACS用于整形外科局部麻醉手术均可取得良好的镇静镇痛效果，但PCS能实现个体化用药，提高病人的满意度，可有效减少和避免术中镇静过量或不足，是一种安全而有效的新型个体化给药模式。     

丙泊酚自控镇静术在高血压患者颈丛麻醉术中的应用

颈丛阻滞麻醉对血液动力学造成一定影响,加大高血压患者术中风险。我们采用丙泊酚自控镇静术(patient-con-trolled sedation,PCS)取得了满意效果,现报道如下。     

病人自控镇静的临床应用进展

病人自控镇静术（ＰＣＳ）是继病人自控镇痛术（ＰＣＡ）之后发展起来的一项新的术中镇静技术,其目的是探索一种安全、有效,能满足在局麻、各种阻滞麻醉下手术的病人对不同程度镇静要求的镇静方法。本文就ＰＣＳ的起源、药物选择及近年来的临床应用进展情况作一综述。     

异丙酚用于病人自控镇静术的可行性

目的：比较异丙酚病人自控镇静术和医生控制镇静术在硬膜我麻醉中的实用性及优缺点。方法：４０例下腹部手术病人随机分为两组，ＰＣＳ组病人应用Ｇｒａｓｅｂｙ ＰＣＡ注射泵自我控制用药，ＰＣＳ单次用药量为异丙酚２０ｍｇ加芬太尼１０μｇ；ＤＣＳ组病人微量泵连续静注异丙酚３．６ｍｇ．ｋｇ＾－１．ｈ＾－１和芬太尼１．８μｇ．ｋｇ＾－１，ｈ＾－１。     

病人自控镇静的临床应用进展

病人自控镇静术(patient-controlled sedation, PCS)是继病人自控镇痛术(patient-controlled analgesia, PCA)之后发展起来的一项新的术中镇静技术,其目的是探索一种安全、有效,能满足在局麻、各种阻滞麻醉下手术的病人对不同程度镇静要求的镇静方法。本文就PCS的起源、药物选择及近年来的临床应用进展情况作一综述。     

Patient-Controlled Sedation

Patient-controlled sedation was utilized in patients aged 15 to 85 yr who were undergoing surgery under local or regional anesthesia. Midazolam, propofol, and methohexitone were used, either by themselves or in combination with fentanyl or alfentanil. Sedation was mild to moderate in the majority of patients, and operating conditions were good. The sedation method provided patients the ability to control the sedation and to vary the degree of sedation according to the environment and to the stress of the procedure. Sedation of the elderly, which tends to be problematic, was made easy using this method, and the elderly patients appeared to enjoy the option. The problems encountered were oversedation, respiratory depression, pain during injection, and postural hypotension.     

依托咪酯联合丙泊酚麻醉在老年患者无痛胃肠镜检查中的应用效果观察

为观察依托咪酯、丙泊酚药物联合应用在老年患者无痛胃肠镜检查中的麻醉效果,将我院行无痛胃肠镜检查的老年患者600例分为观察组324例和对照组276例.对照组患者给予丙泊酚药物进行麻醉,观察组患者给予依托咪酯、丙泊酚药物联合麻醉,比较2组患者麻醉效果、认知功能以及不良反应发生情况.结果显示,观察组患者苏醒时间、检查时间、定...     

Sedation during Spinal Anesthesia

Background: Central neuraxial anesthesia has been reported to decrease the dose of both intravenous and inhalational anesthetics needed to reach a defined level of sedation. The mechanism behind this phenomenon is speculated to be decreased afferent stimulation of the reticular activating system. The authors performed a two-part study (nonrandomized pilot study and a subsequent randomized, double-blind, placebo-controlled study) using the Bispectral Index (BIS) monitor to quantify the degree of sedation in unmedicated volunteers undergoing spinal anesthesia.

Methods: Twelve volunteers underwent BIS monitoring and observer sedation scoring (Observer's Assessment of Alertness/Sedation Scale [OAA/S]) before and after spinal anesthesia with 50 mg hyperbaric lidocaine, 5%. Subsequently, 16 volunteers blinded to the study were randomized to receive spinal anesthesia with 50 mg hyperbaric lidocaine, 5% (n = 10) or placebo (n = 6) and underwent BIS and OAA/S monitoring.

Results: In part I, significant changes in BIS scores of the volunteers occurred progressively (P = 0.003). The greatest variations from baseline BIS measurement occurred at 30 and 70 min. In part II, there were significant decreases in OAA/S and self-sedation scores for patients receiving spinal anesthesia versus control patients (P = 0.04 and 0.01, respectively). The greatest decrease in OAA/S scores occurred at 60 min. BIS scores were similar between groups (P = 0.4).     

小剂量持续静脉泵入对患者自控镇痛效果的影响

目的 :对患者自控镇痛 (PCA)使用或不使用背景灌注 (CI)两种镇痛模式进行观察比较。方法 :4 0例ASAⅠ或Ⅱ级腹部手术后患者 ,随机分为不使用背景灌注的PCA组与使用背景灌注的PCA +CI组 ,每组 2 0例 ,以吗啡作镇痛剂 ,观察两组的临床疗效 ,并测定血清吗啡浓度。结果 :两组在镇痛效果 (VAS均低 )及夜间睡眠上均满意 ;2 4小时吗啡总用量 (2 3 5 6± 13mg和 2 8 91± 13 88mg) ,最低有效吗啡血清浓度 (变化在 17 2～ 3 9 7ng/ml及 2 1 8～3 9 5ng/ml之间 )及HR、BP、RR、VT、SpO2 两组间变化相似 (P >0 0 5 ) ;而吗啡用量的个体差异较大 (3 5 6～ 4 9 76mg及 13 3 8～ 61 72mg) ;副作用恶心呕吐各为 4例和 6例 ,PCA +CI组 1例皮肤瘙痒 ,无临床呼吸抑制病例。结论 :PCA及PCA联合低剂量CI两种镇痛模式均是术后镇痛的安全有效方法。     

Thermoregulation: Physiological and Clinical Considerations during Sedation and General Anesthesia

Mild hypothermia is common during deep sedation or general anesthesia and is frequently associated with patient discomfort and shivering. Greater declines in temperature can produce an even greater number of significant detrimental effects. This article reviews principles of thermoregulation and influences of anesthetic agents. An understanding of these will provide a foundation for strategies to reduce heat loss and better manage patient discomfort when it occurs.