磷酸肌酸钠用于心肌缺血患者围手术期的疗效评价

目的 观察磷酸肌酸钠对心肌缺血患者围手术期血流动力学、人心肌脂肪酸结合蛋白(hFABP)及心肌肌钙蛋白I(cTnI)的影响.方法 选择术前心电图检查提示有广泛心肌缺血患者40例,ASA分级Ⅱ～Ⅲ级,采用随机数字表法分为磷酸肌酸钠组和对照组,每组20例.两组均常规术前准备,磷酸肌酸钠组手术前3 d加用磷酸肌酸钠2g/d,至手术当日麻醉诱导前.分别记录手术前3 d(T0)、麻醉诱导前即刻(T1)、气管插管后即刻(T2)、气管拔管后即刻(T3)血流动力学参数:平均动脉压(MAP)、心率、心排出量(CO)、每搏指数(SI)、肺血管阻力(PVR);各时间点分别抽静脉血测定hFABP及cTnI的含量.结果 两组心率在T0～T3比较差异无统计学意义(P＞0.05),磷酸肌酸钠组T1～T3 MAP、C0、SI明显高于对照组(P＜0.05),PVR、hFABP及cTnI明显低于对照组(P＜0.05).磷酸肌酸钠组术中心律失常发生率[20%(4/20)]明显低于对照组[45%(9/20)](P＜0.05).结论 心肌缺血患者围手术期应用磷酸肌酸钠对心肌有良好的保护作用.

Abstract：

Objective To observe the influence of sodium phosphocreatine on the hemodynamics,human heart fatty acid binding protein (hFABP),cardiac troponin Ⅰ (cTnI) during perioperative period.Methods Forty patients (ASA grade Ⅱ to Ⅲ ) with extensive myocardial ischemia diagnosed by preoperative electrocardiogram were divided into two groups:sodium phosphocreatine group (group A) and control group (group B) with 20 cases each by random digits table. Both groups underwent routine preoperative preparation and group A were given sodium phosphocreatine 2 g/d till anesthesia induction immediately in the operation day. Hemodynamic parameters including mean artery pressure (MAP),heart rate (HR),cardiac output (CO), stroke index (SI) and pulmonary vascular resistance (PVR) were recorded respectively at 3 d before treatment (T0), anesthesia induction immediately before ( T1 ), tracheal intubation immediately after (T2),tracheal extubation immediately after (T3). And blood hFABP and cTnl levels were detected. Results Compared with group B, there was no significant difference in HR of group A at To to T3 (P ＞ 0.05 ). MAP,CO, SI at T1 to T3 of group A were significantly higher than those of group B(P＜ 0.05 ) ;whereas PVR,blood hFABP and cTnI levels were lower than those of group B (P ＜ 0.05 ). The incidence of arrhythmogenesis of group A [20%(4/20)] was lower than that of group B [45%(9/20)](P＜0.05). Conclusion Sodium phosphocreatine has good protective effect on the myocardium in the patients with myocardial ischemia during perioperative period.     

普鲁泊福复合不同剂量瑞芬太尼应用于非肌松剂气管插管的观察

Objective To observe the impacts on the patients with cardiovascular responses when applying propofol combined with different dose of remifentanil in tracheal intubation without the use of muscle relaxants for anesthesia induction. Methods Sixty patients undergoing selective general anesthesia operation of ASA Ⅰ -Ⅱ non-heart and brain surgery were divided into three groups by random digits table, and 20 cases for each group. Target-controlled infusion of remifentanil with respective plasma concentration of 2 ng/ml (group Ⅰ ), 3 ng/ml (group Ⅱ ) and 4 ng/ml (group Ⅲ). Target-controlled infusion of propofol after infusion of remifentanil for 5 min (3 μg/ml of plasma target concentration). The mean arterial pressure (MAP),heart rate (HR), intubation conditions and success rate of patients in different groups before induction(T1), at the beginning moment of propofol(T2),at the immediate moment before tracheal intubation (T3) and at the time of 1 min after tracheal intubation (T4). Results The grade of tracheal intubation was (10.5 ±2.9), (7.6 ±2.3), (5.8 ± 1.2) scores and the success rate of the first intubation was 50%( 10/20), 80%(16/20), 100%(20/20) in group Ⅰ ,Ⅱ and Ⅲ , there were significant differences among three groups (P＜ 0.05),group Ⅲ was superior to group Ⅰ and Ⅱ (P＜0.05). Comparing T2 and Tj,HR in group Ⅱ and Ⅲ slowed down significantly ( P ＜ 0.05), and in group Ⅲ slowed down more significantly (P＜0.05). Comparing T4 and T3,HR in group Ⅰ and Ⅱ quickened significantly, and group Ⅰ was higher than group Ⅱ and Ⅲ (P＜ 0.05). Comparing T3 and T2,MAP decreased significantly among three groups,comparing T4 and T3, MAP increased significantly in group Ⅰ which was higher than that in group Ⅱ and Ⅲ (P ＜ 0.05). Conclusions Without the use of muscle relaxants, propofol combined with remifentanil for 3-4 ng/ml can better restrain the tracheal intubation stress responses and won't cause significant cycle inhibition. They benefit to maintain the smooth intubation process of anesthesia induction.     

高频喷射通气对单肺通气患者氧化应激反应的影响

Objective To determine the effects of high-frequency jet ventilation (HFJV) on oxidative stress in patients during one-lung ventilation (OLV). Methods Forty-five patients undergoing elective radical esophageal cancer resection were divided into three groups with 15 cases each by random digits table: two lung ventilation group ( group A), OLV group (group B), HFJV- OLV group ( group C, working pressure 1 kg/cm2 and frequency 100 times/min). Venous blood samples were taken before induction (T0),at30min (T1),90min (T2),150min (T3) after OLV and the end of operation (T4) for measuring serum superoxide dismutase(SOD),malondialdehyde (MDA) and nitric oxide (NO). Results SOD was lower at T2-T4 in group B[(47 ± 10), (37 ±9), (41 ±7) kU/L] and group C[(58 ± 12), (51 ± 11), (49 ± 9) kU/L] than those in group A [(78 ±8), (75 ±7), (79 ±6) kU/L](P＜ 0.05),and MDA and NO were lower at T1-T4 in group B and group C than that in group A(P＜ 0.05). SOD was higher at T3 in group C than that in group B (P ＜ 0.05), MDA at T1-T4 and NO at T2-T4 were lower in group C than those in group B (P ＜ 0.05). Conclusion HFJV can effectively decrease oxidative stress in patients during OLV.     

普鲁泊福复合不同剂量瑞芬太尼应用于非肌松剂气管插管的观察

目的 观察普鲁泊福麻醉诱导时复合不同剂量瑞芬太尼应用于非肌松剂气管插管时对患者心血管反应的影响.方法 将60例ASA分级Ⅰ～Ⅱ级的非心、脑外科择期全身麻醉手术患者按随机数字表法分为Ⅰ、Ⅱ、Ⅲ组,每组20例,注射泵输注瑞芬太尼血浆靶控浓度分别为2、3、4ng/ml,输注5 min后开始靶控输注普鲁泊福(血浆靶控浓度3μg/ml).记录三组患者诱导前(T1)、普鲁泊福开始即刻(T2)、气管插管前即刻(T3)、气管插管后1 min(T4)的平均动脉压(MAP)、心率变化,以及气管插管评分和第1次插管成功率.结果 Ⅰ、Ⅱ、Ⅲ组气管插管评分分别为(10.5±2.9)、(7.6±2.3)、(5.8±1.2)分,第1次插管成功率分别为50%(10/20)、80%(16/20)、100%(20/20),三组间比较差异均有统计学意义,Ⅲ组均优于Ⅰ组和Ⅱ组(P＜0.05).T2与T1比较,Ⅱ组和Ⅲ组心率均显著减慢(P＜0.05),Ⅲ组更明显;T4与T3比较,Ⅰ组和Ⅱ组心率显著增快,Ⅰ组明显高于Ⅱ组和Ⅲ组(P＜0.05).T3与T2比较,三组MAP均显著下降;T4与T3比较,Ⅰ组MAP显著上升,且高于Ⅱ组和Ⅲ组(P＜0.05).结论 在不使用肌松剂时,普鲁泊福复合瑞芬太尼靶控浓度3～4 ng/ml能较好地抑制气管插管的应激反应,而又不引起明显的循环抑制,对维持麻醉诱导插管过程的平稳较为有利.

Abstract：

Objective To observe the impacts on the patients with cardiovascular responses when applying propofol combined with different dose of remifentanil in tracheal intubation without the use of muscle relaxants for anesthesia induction. Methods Sixty patients undergoing selective general anesthesia operation of ASA Ⅰ -Ⅱ non-heart and brain surgery were divided into three groups by random digits table, and 20 cases for each group. Target-controlled infusion of remifentanil with respective plasma concentration of 2 ng/ml (group Ⅰ ), 3 ng/ml (group Ⅱ ) and 4 ng/ml (group Ⅲ). Target-controlled infusion of propofol after infusion of remifentanil for 5 min (3 μg/ml of plasma target concentration). The mean arterial pressure (MAP),heart rate (HR), intubation conditions and success rate of patients in different groups before induction(T1), at the beginning moment of propofol(T2),at the immediate moment before tracheal intubation (T3) and at the time of 1 min after tracheal intubation (T4). Results The grade of tracheal intubation was (10.5 ±2.9), (7.6 ±2.3), (5.8 ± 1.2) scores and the success rate of the first intubation was 50%( 10/20), 80%(16/20), 100%(20/20) in group Ⅰ ,Ⅱ and Ⅲ , there were significant differences among three groups (P＜ 0.05),group Ⅲ was superior to group Ⅰ and Ⅱ (P＜0.05). Comparing T2 and Tj,HR in group Ⅱ and Ⅲ slowed down significantly ( P ＜ 0.05), and in group Ⅲ slowed down more significantly (P＜0.05). Comparing T4 and T3,HR in group Ⅰ and Ⅱ quickened significantly, and group Ⅰ was higher than group Ⅱ and Ⅲ (P＜ 0.05). Comparing T3 and T2,MAP decreased significantly among three groups,comparing T4 and T3, MAP increased significantly in group Ⅰ which was higher than that in group Ⅱ and Ⅲ (P ＜ 0.05). Conclusions Without the use of muscle relaxants, propofol combined with remifentanil for 3-4 ng/ml can better restrain the tracheal intubation stress responses and won't cause significant cycle inhibition. They benefit to maintain the smooth intubation process of anesthesia induction.     

支气管堵塞器与双腔气管导管在单肺通气中对呼吸力学和血气影响的比较

Objective To compare the influences between bronchial blocker (BB) and double lumen tube (DLT) in respiratory mechanics and blood gas in one lung ventilation. Methods Thirty-six patients undergoing pulmonary lobectomy or radical operation of esophageal carcinoma were randomized into group BB (17 cases) and group DLT (19 cases). In group BB,BB was intubated under the guidance of a fibreoptic bronchoscope after intubation of single lumen tube; while in group DLT, the position of the tube was confirmed using fibreoptic bronchoscopy after intubation. The peek airway pressure (Pmax) and pulmonary dynamic compliance (CLdyn) during double lung ventilation and one lung ventilation were recorded in recumbent position. Blood samples were taken from, radial artery 20 min after one lung ventilation for blood gas analysis,partial pressure of oxygen in artery(PaO2), partial pressure of carbon dioxide in artery(PaCO2), saturation of arterial blood oxygen (SaO2) were recorded. Results No significant difference was found in Pmax and CLdyn between two groups during double lung ventilation,but Pmax was significantly lower in group BB [(21.00 ± 3.59) cm H2O,1 cm H2O = 0.098 kPa] than that in group DLT [(26.89 ±4.21) cm H2O] (P＜0.05), and CLdyn was greater in group BB [(28.10 ±6.24) ml/cm H2O] than that in group DLT [(24.00±7.13) ml/cm H2O ] (P ＜ 0.05); there were no significant differences in PaO2, PaCO2, SaO2 betweentwo groups during one lung ventilation (P＞ 0.05). Conclusion The influence to respiratory mechanics in one lung ventilation is smaller using BB than using DLT, BB has blocker well applicable value in clinics.     

雷米芬太尼对全麻患者气管插管期平均动脉压、心率和QTc间期延长的影响

Objective To evaluate the effect of remifentanil on mean arterial pressure (MAP), heart rate (HR) and QTc interval during tracheal intubation of general anesthesia patients. Methods Seventy-five ASA Ⅰ -Ⅱ grade patients were selected and allocated to receive either saline (group C), remifentanil 0.50 μg/kg (group R1) or remifentanil 0.75 μg/kg(group R2) by random digits table with 25 cases in each, they were administrated as a bolus intravenous, followed by a continuous infusion at 0.10 μg/ (kg·min), 1 min before laryngoscopy. All patients received fentanyl 3 μg/kg,propofol 1.0 - 1.5 mg/kg and vecuronium 0.1 mg/kg. The ECG.MAP and HR were recorded prior to induction of anesthesia (T0), 2 min following the start of drug intravenous of fentanyl and propofol with vecuronium (T1), 1 min following remifentanil or saline (T2), before laryngoscopy(T3), 30 s (T4), 2 min (T5) and 4 min (T6) after intubation. Results The QTc interval was significantly prolonged immediately following intubation in group C and group R1, but it remained stable in group R2, compared with the QTc interval just before laryngoscopy. In group R2, QTc interval was significantly shorter at T4-T6 compared to group C(P＜ 0.05 or ＜ 0.01). QTc interval significantly increased from baseline at T4 in group R1 and T4-T6 in group C (P＜ 0.05 or ＜ 0.01). The number of patients with QTc interval ＞ 440 ms were significantly greater immediately following tracheal intubation in group C than that in group R2 [44% (11/25) vs. 12% (3/25)] (P ＜ 0.05). Conclusions QTc interval increases following tracheal intubation during induction of anesthesia using fentanyl and propofol. Intravenous of remifentanil attenuates the QTc interval prolongation associated with tracheal intubation. In addition, remifentanil decreases the hemodynamic responses to tracheal intubation.     

高频喷射通气对单肺通气患者氧化应激反应的影响

目的 研究高频喷射通气(HFJV)对单肺通气患者氧化应激反应的影响.方法 择期行食管癌根治术患者45例,按随机数字表法分为双肺通气组(A组)、单肺通气组(B组)、单肺通气时非通气侧给予HFJV(驱动压力1 kg/cm2,频率100次/min)组(C组),每组15例.分别于开胸前(T0),单肺通气后(A组于开胸后)30 min(T1)、90 min(T2)、150 min(T3),手术结束时(T4)测定超氧化物歧化酶(SOD)活性及丙二醛(MDA)、一氧化氮(NO)浓度.结果 T2～T4时B、C组SOD活性[B组:(47±10)、(37±9)、(41±7)kU/L;C组:(58±12)、(51±11)、(49±9)kU/L]低于A组[(78±8)、(75±7)、(79±6)kU/L](P＜0.05),T1～T4时B、C组MDA、NO浓度高于A组(P＜0.05);T3时C组SOD活性明显高于B组(P＜0.05),T1～T4时C组MDA浓度及T2～T4时NO浓度低于B组(P＜0.05).结论 HFJV能在一定程度上抑制单肺通气患者的氧化应激反应.

Abstract：

Objective To determine the effects of high-frequency jet ventilation (HFJV) on oxidative stress in patients during one-lung ventilation (OLV). Methods Forty-five patients undergoing elective radical esophageal cancer resection were divided into three groups with 15 cases each by random digits table: two lung ventilation group ( group A), OLV group (group B), HFJV- OLV group ( group C, working pressure 1 kg/cm2 and frequency 100 times/min). Venous blood samples were taken before induction (T0),at30min (T1),90min (T2),150min (T3) after OLV and the end of operation (T4) for measuring serum superoxide dismutase(SOD),malondialdehyde (MDA) and nitric oxide (NO). Results SOD was lower at T2-T4 in group B[(47 ± 10), (37 ±9), (41 ±7) kU/L] and group C[(58 ± 12), (51 ± 11), (49 ± 9) kU/L] than those in group A [(78 ±8), (75 ±7), (79 ±6) kU/L](P＜ 0.05),and MDA and NO were lower at T1-T4 in group B and group C than that in group A(P＜ 0.05). SOD was higher at T3 in group C than that in group B (P ＜ 0.05), MDA at T1-T4 and NO at T2-T4 were lower in group C than those in group B (P ＜ 0.05). Conclusion HFJV can effectively decrease oxidative stress in patients during OLV.     

普鲁泊福复合瑞芬太尼控制性降压在小儿鼻内镜手术中的应用

目的 观察普鲁泊福复合瑞芬太尼控制性降压在小儿鼻内镜手术中的效果.方法 择期行鼻内镜下腺样体切除术患儿40例,ASA分级Ⅰ级,按随机数字表法分为对照组和降压组,每组20例.两组均采用静脉注射普鲁泊福和瑞芬太尼.对照组不施行控制性降压,降压组瑞芬太尼由初始0.2μg/(kg·min),每隔2 min增加0.1 μg/(kg·min),直到无创平均动脉压(MAP)降为55～60 mm Hg(1 mm Hg=0.133 kPa),并调节输注速度维持MAP于此水平.全麻诱导后放置激光多普勒血流仪探头,开始(To)监测鼻咽部黏膜血流量,15 min后(T1)开始手术,在手术开始后15 min(T2)进行术野质量评分.结果 降压组从控制性降压开始至达目标血压所需时间(2.5±0.3)min,术中控制性降压时瑞芬太尼输注速度(0.43±0.16)μ g/(kg·min).降压组T1和T2时心率、MAP均低于本组T0和对照组同一时点(P＜0.05).降压组T1时的鼻咽部黏膜血流量[(68.3±8.3)%]明显少于对照组[(99.8±7.9)%](P＜0.05),手术时间[(21±4)min]明显短于对照组[(32±6)min](P＜0.05),术野质量评分[(1.8±0.1)分]明显低于对照组[(3.5±0.5)分](P＜0.05).术后两组患儿均在10 min内清醒拔管,均未出现麻醉相关并发症.结论 普鲁泊福复合瑞芬太尼用于小儿鼻内镜下腺样体切除术控制性降压时,能显著减少鼻咽部黏膜血流量,为手术提供满意的术野质量.

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Objective To observe the effect of remifentanil combined with propofol to induce and sustain controlled hypotension in children during endoscopic sinus surgery(ESS). Methods Forty ASA Ⅰ children undergoing adenoidectomy in ESS were divided into control group and controlled hypotension group by random digits table with 20 cases in each group. No controlled hypotension in control group. Anesthesia was induced with propofol,remifentanil and atracurium, and maintained with continuous infusion of propofol 2 min until the target mean arterial pressure (MAP)(55 - 60 mm Hg, 1 mm Hg = 0.133 kPa) was reached,and MAP was maintained at this level during operation in controlled hypotension group. During 15 min before surgical procedure pharynx nasalis blood flow was measured and recorded with laser Dopper flowmetry continuously. The quality of the surgical field in term of blood loss and dryness was established at 15 min after operation starting. Results Controlled hypotension was induced within (2.5 ± 0.3 ) min, the infusion rate ofMAP and heart rate at 15 min after controlled hypotension and 15 min after operation starting were significantly lower than those at controlled hypotension instantly in controlled hypotension group and control group (P ＜ 0.05 ). The pharynx nasalis blood flow decreased at 15 min after controlled hypotension from baseline [(68.3 ± 8.3 )% vs. (99.8 ± 7.9 )%] (P ＜ 0.05 ). The operation time and the quality of the surgical field in term of blood loss and dryness in controlled hypotension group were better than those in control group [(21 ± 4) min vs. (32 ± 6) min and ( 1.8 ± 0.1 ) scores vs. (3.5 ± 0.5) scores] (P ＜ 0.05 ). The awakeextubate time was within 10 min in two groups, and there were no anesthesia related complications.Conclusion Remifentanil combined with propefol can induce and sustain controlled hypotension,reduce pharynx nasal is blood flow and provide good surgical conditions in children for ESS.     

胸科手术多模式镇痛的临床观察

目的 探讨硬膜外利多卡因联合静脉注射帕瑞昔布钠,术后患者自控硬膜外镇痛(PCEA)多模式镇痛对胸科手术术后疼痛的影响.方法 选择行胸科手术患者90例,按随机数字表法分为甲、乙、丙三组,每组30例.甲组切皮前5 min硬膜外给予1%利多卡因5ml,关胸时静脉注射帕瑞昔布钠40 mg;乙组切皮前5 min硬膜外给予1%利多卡因5 ml,关胸时静脉注射0.9%氯化钠2 ml;丙组切皮前5 min硬膜外给予0.9%氯化钠5 ml,关胸时静脉注射0.9%氯化钠2 ml.三组术后均给予PCEA.观察三组患者术后多时点血流动力学指标,静态和动态视觉模拟评分(VAS),瑞芬太尼用量,术后疼痛开始时间,PCEA 48h内用药量,哌替啶使用率,患者和医护人员对镇痛的满意度.结果 甲、乙组瑞芬太尼用量[(0.72±0.26)、(0.84±1.20)μg/(kg·min)]明显少于丙组[(1.80 ±0.84)μg/(kg·min)](P<0.05);甲、乙组术后疼痛开始时间[(35.00±2.78)、(12.09±6.27)min]显著晚于丙组[(5.95±3.65) min](P<0.05);PCEA 48 h内用药量三组依次递增[(180.40±20.48)、(192.54±40.15)、(220.26±36.78)ml](P<0.05);而三组血流动力学指标及静态VAS比较差异均无统计学意义;甲组术后即刻、1 h时动态VAS与乙、丙组比较差异有统计学意义(P<0.05);甲组患者及医护人员对镇痛满意度较高.结论 硬膜外给予1%利多卡因联合静脉注射帕瑞昔布钠40 mg、术后PCEA对缓解胸科手术术后疼痛有效.

Abstract：

Objective To evaluate the effect of multiple-mode analgesia consists of epidural administration of lidocaine,parecoxib intravenously and patient-controlled epidural analgesia (PCEA) on patients after thoracic surgeries. Methods Total 90 patients treated with thoracic surgeries were allocated into 3 groups by random digits table,each with 30 cases. Patients accepted 1% lidocaine 5 ml epidurally 5 min before incision in group A and B,and 5 ml saline as control in group C. When chest closing parecoxib 40 mg were given in group A,and 2 ml saline as control in group B and C. All the patients were given PCEA. Postoperative hemodynamics,dosage of remifentanil and analgetics of PCEA within 48 h, visual analogue scale (VAS) of pain, rescue of pethidine, duration for first pain calling,and satisfactory scores of patients, doctors and nurses were recorded. Results Dosage of remifentanil was lower [(0.72±0.26), (0.84±1.20) μg／(kg·min)], and duration for first pain calling was longer[(35.00±2.78),(12.09±6.27) min] in group A and B than that in group C significantly[(1.80±0.84) μ,g／(kg·min) and (5.95±3.65) min](P<0.05). Analgetics of PCEA with in 48 h in group A was lower than that in group B which was lower than that in group C[(180.40±20.48), (192.54±40.15), (220.26±36.78) ml](P< 0.05). No difference was found on VAS of pain and hemodynamics among three groups when patients were kept immobilized, but VAS of pain in group A and B was lower than that in group C when patients kept moving. Satisfactory scores of patients,doctors and nurses in group A were higher. Conclusion Epidural administration of 1% lidocaine combined with intravenous paiecoxib 40 mg and PCEA an offer satisfactory postoperative analgesia for patients after elective thoracic surgeries.     

不同血浆靶浓度的普鲁泊福对鼻内镜手术应激反应的影响

Objective To observe the effect of propofol target controlled infusion with different blood plasma target concentration on stress reaction during the nasal endoscope operation. Methods Sixty patients with ASA Ⅰ - Ⅱ scheduled for the nasal endoscope operation were divided into three groups by random digits table: each group was 20 patients, group A, B, C was given propofol target controlled infusion with blood plasma target concentration 3,4,5 μ g/mi respectively. Heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2), blood glucose, serum cortisol, bispectral index ( BIS ), extubation time were recorded before anesthesia,at 30 min after the operation starting and 60 min after the extubation.Results The descent degree of HR and MAP at 30 min after the operation starting were group C ＞ group B ＞ group A (P = 0.024,0.010 );the descent degree of MAP at 60 min after the extubation were group C ＞group B ＞ group A (P = 0.011 ). BIS and extubation time were 65 ± 8 and (25 ± 7) min in group A, 53 ± 11 and( 36 ± 13 ) min in group B, 45 ± 12 and(45 ± 9 ) min in group C, there were significant differences among three groups(t = 2.476,P= 0.023;t = 2.657,P= 0.012). The blood glucose was increased at 30 min after the operation starting and 60 min after the extubation, the ascensus degree were group A ＞ group B ＞ group C (P= 0.000、0.000);the serum cortisol was decreased at 30 min after the operation starting, the descent degree was group C ＞ group B ＞ group A (P= 0.000), increased at 60 min after the extubation, the ascensus degree was group A ＞ group B ＞ group C (P= 0.001 ). Conclusions Propofol target controlled infusion with blood plasma target concentration 4-5 μ g/ml can ensure eligible depth of anesthesia, decrease pain stimulus, remain stable vital sign,depress the stress reaction caused by nasal endoscope operation efficiently,with short extubation time. It is an eligible blood plasma target concentration.     

腹腔镜胆囊切除术中应用帕瑞昔布和舒芬太尼的临床效果

目的评价静脉全麻醉下行腹腔镜胆囊切除术中应用帕瑞昔布和舒芬太尼的临床效果。方法选取拟行腹腔镜胆囊切除术的患者120例,根据术中给予镇痛药不同随机分为四组(n=30):帕瑞昔布组(P组)、舒芬太尼组(S组)、帕瑞昔布+舒芬太尼组(PS组)、等剂量的生理盐水组(N组),所有患者采用BIS监测下靶控输注丙泊酚和瑞芬太尼的麻醉方法,常规监测ECG、BP、HR、SpO2、PETCO2和BIS,术中维持BIS值于45～55之间并适当应用血管活性药物维持血流动力学稳定,在手术结束前20 min分别于P组、S组、PS组和N组给予帕瑞昔布40 mg、舒芬太尼0.2μg/kg、帕瑞昔布40 mg+舒芬太尼0.2μg/kg和等剂量的生理盐水。观察并记录术毕即刻(T0)、术毕10 min(T1)、拔管前1 min(T2)、拔管即刻(T3)、拔管后5 min(T4)、10 min(T5)平均动脉压(MAP)和心率(HR)。记录自主呼吸恢复时间、苏醒时间和拔管时间。分别于拔管后10 min、30 min、60 min、4 h、12 h进行视觉模拟疼痛评分(VAS评分)。观察并记录苏醒期的麻醉并发症。结果与T0相比,N组、P组于T1～5时MAP升高,HR增快(p<0.05),分别与N组、P组相比,S组和PS组于T1～5时MAP下降,HR减慢(p<0.05);四组的呼吸恢复时间、苏醒时间和拔管时间组间比较无统计学意义。S组和PS组术后早期的VAS评分较N组和P组低(p<0.05),P组和PS组术后晚期的VAS评分较F组低(p<0.05),N组和P组术后出现苏醒期烦躁的发生率较高,四组患者术后无出现嗜睡和呼吸抑制。结论靶控输注丙泊酚和瑞芬太尼行腹腔镜胆囊切除术中给予帕瑞昔布40 mg+0.2μg/kg舒芬太尼能维持苏醒期稳定的血流动力学,有效地缓解术后疼痛且不影响术后苏醒恢复,有利于围苏醒期安全。     

二氧化碳气腹对不同手术患者血流动力学的影响

目的　观察腹腔镜胆囊切除术(LC)与腹腔镜妇科诊治术(LP)中二氧化碳气腹、体位对血压、心率、脉搏血氧饱和度(　SpO2)的影响.方法选择ASA分级Ⅰ～Ⅱ级行LC患者(LC组,12例)及LP患者(LP组,13例).予丙泊酚、芬太尼、恩氟烷、阿曲库铵维持麻醉与肌松,分别记录术前、充气后即刻、调整体位后、充气后30　min、放气后的收缩压、舒张压、心率、SpO2.结果LC组患者充气后即刻、调整体位后及充气后30　min收缩压、舒张压[收缩压:(138.75±13.22)、(　140.42±15.88)、(　138.67±16.35)　mm　Hg(1mm　Hg　=0.133　kPa);舒张压:(94.42±5.76)、(96.25±8.26)、(90.42±7.36)　mm　Hg]均较术前[收缩压:(135.50±15.31　)mm　Hg;舒张压:(83.58±6.70)　mmHg]升高(P＜0.01),LP组患者调整体位后及充气后30　min收缩压、舒张压[收缩压:(136.76±12.55)、(136.85±13.22)　mm　Hg;舒张压:(88.38±6.54)、(87.23±6.34)　mm　Hg]均较术前[收缩压:(132.52±10.11)　mm　Hg;舒张压:(74.61±5.23)mmHg]升高(P＜　0.05);两组各时间点心率、SpO2比较差异均无统计学意义(P＞0.05).结论LC与LP由于麻醉、体位、二氧化碳人工气腹的影响,在气腹后收缩压、舒张压均明显高于术前,但两者比较差异无统计学意义.     

普鲁泊福复合芬太尼静脉麻醉用于纤维支气管镜检查的效果评价

目的 评价普鲁泊福复合芬太尼静脉麻醉用于纤维支气管镜(纤支镜)检查的效果.方法 择期行纤支镜检查患者40例,ASA分级Ⅰ～Ⅱ级,按随机数字表法分为对照组和普鲁泊福复合芬太尼静脉麻醉组(静脉麻醉组),每组各20例.两组术前均使用2%利多卡因行鼻腔和咽喉部表面麻醉.对照组静脉注射0.9%氯化钠10 ml后检查,术中行鼻导管给氧;静脉麻醉组静脉注射普鲁泊福1.5 mg/kg、芬太尼1 μg/kg麻醉诱导后开始检查,术中行内镜面罩给氧.记录两组患者麻醉前(T_1)、静脉注药后1 min(T_2)、纤支镜入声门即刻(T_3)、纤支镜人声门后3 min(T_4)、检查结束后患者完全清醒时(T_5)的平均动脉压(MAP)、心率和脉搏血氧饱和度(SpO_2).记录检查时间、苏醒时间、术后疼痛视觉模拟评分(VAS)、重复检查依从性评分和术中知晓情况.结果40例患者均顺利完成纤支镜检查.静脉麻醉组患者术后VAS和重复检查依从性评分[(1 ±2)、(2±3)分]均低于对照组[(7±1)、(7±3)分](P<0.05).对照组T_3、T_4、T_5MAP和心率较T_1升高(P<0.05);静脉麻醉组T_2MAP和心率较T_1降低(P<0.05),T_3心率较T_1升高(P<0.05).与对照组比较,静脉麻醉组T_3、T_4、T_5MAP和心率降低(P<0.05),T_2心率降低(P<0.05).静脉麻醉组患者均无术中知晓发生.结论 普鲁泊福复合芬太尼静脉麻醉可安全有效地用于纤支镜检查.     

雷米芬太尼对全麻患者气管插管期平均动脉压、心率和QTc间期延长的影响

目的 观察和评价雷米芬太尼对全麻患者气管插管期平均动脉压(MAP)、心率和QTc间期的影响.方法 选取择期全麻手术患者75例,ASA分级Ⅰ～Ⅱ级,按随机数字表法分为三组:对照组(C组)、雷米芬太尼Ⅰ组(R1组)和雷米芬太尼Ⅱ组(R2组),每组25例.麻醉诱导:静脉注射芬太尼3μg/kg、普鲁泊福1.0～1.5 mg/kg和维库溴铵0.1 mg/kg后2 min,双盲法≥40 s给予雷米芬太尼0.50 μg/kg(R1组)或0.75μg/kg(R2组)后,两组分别连续输注雷米芬太尼0.10μg/(kg·min);C组患者给予相同容量的0.9%氯化钠.记录麻醉诱导前(T0)、诱导后2 min(T1)、首次给予雷米芬太尼或0.9%氯化钠后1 min(T2)、气管插管前即刻(T3)及气管插管后30 s(T4)、2 min(T5)和4 min(T6)的MAP和心率,并描记心电图.结果 与C组比较,R2组T4～T6时QTc间期明显缩短(P＜0.05或＜0.01＝;R,组T4和C组T4～T6时QTc间期较T0明显延长(P＜0.05或＜0.01).C组气管插管期OTc间期＞440ms 11例(44%,11/25),R2组3例(12%,3/25),两组比较差异有统计学意义(P＜0.05).结论 芬太尼和普鲁泊福麻醉诱导气管插管期间患者的QTc间期是延长的;插管前1 min静脉注射雷米芬太尼0.75μg/kg,继以0.10 μg/(kg·min)输注可有效抑制气管插管诱发QTc间期延长和血流动力学反应.

Abstract：

Objective To evaluate the effect of remifentanil on mean arterial pressure (MAP), heart rate (HR) and QTc interval during tracheal intubation of general anesthesia patients. Methods Seventy-five ASA Ⅰ -Ⅱ grade patients were selected and allocated to receive either saline (group C), remifentanil 0.50 μg/kg (group R1) or remifentanil 0.75 μg/kg(group R2) by random digits table with 25 cases in each, they were administrated as a bolus intravenous, followed by a continuous infusion at 0.10 μg/ (kg·min), 1 min before laryngoscopy. All patients received fentanyl 3 μg/kg,propofol 1.0 - 1.5 mg/kg and vecuronium 0.1 mg/kg. The ECG.MAP and HR were recorded prior to induction of anesthesia (T0), 2 min following the start of drug intravenous of fentanyl and propofol with vecuronium (T1), 1 min following remifentanil or saline (T2), before laryngoscopy(T3), 30 s (T4), 2 min (T5) and 4 min (T6) after intubation. Results The QTc interval was significantly prolonged immediately following intubation in group C and group R1, but it remained stable in group R2, compared with the QTc interval just before laryngoscopy. In group R2, QTc interval was significantly shorter at T4-T6 compared to group C(P＜ 0.05 or ＜ 0.01). QTc interval significantly increased from baseline at T4 in group R1 and T4-T6 in group C (P＜ 0.05 or ＜ 0.01). The number of patients with QTc interval ＞ 440 ms were significantly greater immediately following tracheal intubation in group C than that in group R2 [44% (11/25) vs. 12% (3/25)] (P ＜ 0.05). Conclusions QTc interval increases following tracheal intubation during induction of anesthesia using fentanyl and propofol. Intravenous of remifentanil attenuates the QTc interval prolongation associated with tracheal intubation. In addition, remifentanil decreases the hemodynamic responses to tracheal intubation.     

氟比洛芬酯对颅内动脉瘤血管内治疗术后头痛的镇痛作用

目的观察氟比洛芬酯对普鲁泊福、瑞芬太尼维持麻醉的颅内动脉瘤血管内治疗术后头痛的镇痛作用。方法将40例ASA分级Ⅰ～Ⅱ级需接受血管内治疗的颅内动脉瘤患者按照信封抽取法随机分为氟比洛芬酯组和对照组,每组20例。氟比洛芬酯组在穿刺前10 min及手术结束时分别给予氟比洛芬酯1 mg/kg;对照组在相应的时间给予相应剂量的脂肪乳剂。观察两组患者在术前与术后循环的变化情况,术后头痛视觉模拟评分(VAS)及身体舒适度评分(BCS)。结果对照组在术后1、2、3h平均动脉压(MAP)较术前明显升高(P＜0.05),心率无明显变化(P＞0.05);氟比洛芬酯组在术后1、2、3 h MAP和心率与术前比较差异均无统计学意义(P＞0.05)。氟比洛芬酯组术后1、2、3h的头痛VAS[分别为(0.30±0.65)、(0.30±0.57)、(0.25±0.44)分]均明显低于对照组[分别为(3.25±1.58)、(3.00±1.56)、(2.90±1.48)分](P＜0.05),BCS[分别为(3.30±0.86)、(3.45±0.86)、(3.62±0.86)分]明显高于对照组[分别为(1.20±1.00)、( 1.45±0.94)、( 1.50±1.00)分](P＜0.05)。结论氟比洛芬酯可减轻颅内动脉瘤血管内治疗术后的头痛。     

血液稀释联合氨甲环酸在神经外科手术中的应用

目的探讨急性高容量血液稀释(AHH)联合氨甲环酸(TA)在神经外科手术中使用的安全性和有效性。方法将40例择期行神经外科手术患者,采用随机数字表法分为试验组和对照组,每组20例。两组全身麻醉后均输入6％羟乙基淀粉(130/0.4) 20 ml/kg做AHH,试验组将TA静脉注入负荷量10 mg/kg,以l mg/(kg·h)持续静脉输注直至手术结束;对照组仅做AHH。测定两组AHH前(T0)、AHH完成即刻(T1)、AHH后1 h(T2)、手术结束时(T3)的平均动脉压(MAP)、中心静脉压(CVP)、心率(HR)、脉搏血氧饱和度(SpO2)。并在对应各时点采静脉血测定血红蛋白(Hb)、红细胞压积(Hct)和凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血小板计数(Plt)、纤维蛋白原(FIB)。统计两组术中出血量、输血量和输血率。结果两组患者HR、MAP组内各时点及组间比较差异无统计学意义(P＞0.05),T1、T2时点CVP显著高于T0时点(P＜0.05),T1、T2、T3时点Hb、Hct均显著低于T0时点(P＜0.05)。对照组T2、T3时点PT、APTT明显长于T0时点(P＜0.05);两组T1、T2、T3 时点Plt均显著低于T0时点(P＜0.05),对照组Plt在T2、T3时点较试验组降低更显著(P＜0.01);对照组FIB在T2、T3时点显著低于T0时点(P＜0.05)。试验组术中出血量、输血量、输血率分别为(650±560) ml、( 150±50) ml、30％(6/20),明显低于对照组的(820±410) ml、(380±290) ml、60％(12/20),差异均有统计学意义(P＜0.05)。结论AHH联合TA静脉输注应用于神经外科手术,患者血流动力学稳定,对凝血功能影响小,有明显的节约用血效应。     

不同麻醉方式下经皮肾穿刺碎石术的临床观察

目的 比较全身麻醉与椎管内麻醉下经皮肾穿刺碎石术(PCNL)患者循环、呼吸、体温的变化以及麻醉恢复期相关并发症的发生情况,以评价麻醉效果与安全性.方法 ASA分级Ⅰ～Ⅱ级择期行PCNL患者40例,按随机数字表法分为气管内插管全身麻醉组(Ⅰ组)和椎管内麻醉组(Ⅱ组),每组20例.记录两组患者的体温、心率、平均动脉压(MAP)、脉搏血氧饱和度(SpO2)的变化及恢复期不良反应发生情况.结果 Ⅰ组麻醉过程平稳,各时间点MAP、心率无明显变化;Ⅱ组麻醉效果确切,但麻醉后15 min的MAP及截石位后、俯卧位后的心率和MAP均较麻醉前和Ⅰ组有明显变化(P＜0.05).两组患者麻醉后30、60、90、120min的体温均较麻醉即刻有不同程度的下降(P＜0.05),且Ⅰ组患者麻醉后30、60min体温[(35.8±0.6)、(34.8±0.5)℃]明显低于Ⅱ组[(36.2±0.6)、(35.6±0.5)℃](P＜0.05).两组患者麻醉恢复期寒战、恶心、咽痛、背部不适均有发生,其中以发生寒战者最多.结论 两种麻醉方式均适用于PCNL;椎管内麻醉下术中需严密观察患者的各项生命指标;而对于肥胖、体质较弱、呼吸循环代偿功能较差的患者宜选用气管内插管全身麻醉.

Abstract：

Objective To compare the influences of general anesthesia and intra spinal anesthesia on circulation, respiration, body temperature and anesthesia-related complications in patients undergoing percutaneous nephrolithotomy (PCNL), and assess the effectiveness and safety of both anesthesia. Methods Forty ASA Ⅰ - Ⅱ patients elective for PCNL surgery were divided into two groups by random digits table with 20 cases each:group Ⅰ (endotracheal general anesthesia) and group Ⅱ (intra spinal anesthesia). The temperature, heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2) values and postoperative shivering, nausea, vomiting, back discomfort and the incidence of sore throat were observed and recorded. Results The anesthesia was stable, there were no changes in MAP, HR at different time in group Ⅰ . The anesthesia in group Ⅱ was effective, MAP at 15 min after anesthesia,and HR,MAP after lithotomy position and prone position were obviously changed in group Ⅱ compared with those before anesthesia and group Ⅰ (P ＜ 0.05 ). The temperature at 30,60,90, 120 min after anesthesia decreased compared with that before anesthesia in two groups (P ＜ 0.05 ), and the temperature at 30,60 min after anesthesia in group Ⅰ [(35.8 ±0.6), (34.8 ± 0.5)℃] was lower than that in group Ⅱ [(36.2 ± 0.6),(35.6 ± 0.5)℃](P＜ 0.05).During recovery,complications such as shivering, nausea,sore throat, back discomfort occurred to some extent, of which the incidence of shivering was the highest. Conclusion Both of two anesthesia are applicable to PCNL. When intra spinal anesthesia is used,the life indicators of patients need to be observed and general anesthesia is preferable for the obesity,less physical and the old with poorly compensatory function.     

靶控输注依托咪酯与普鲁泊福麻醉对糖尿病患者围手术期血糖及血流动力学变化的临床研究

目的 观察靶控输注依托咪酯与普鲁泊福麻醉对糖尿病患者围手术期血糖及血流动力学变化的影响.方法 择期手术的糖尿病患者(ASA分级Ⅰ～Ⅱ级)60例随机分为两组,每组各30例.E组:使用靶控输注依托咪酯进行麻醉;P组:使用靶控输注普鲁泊福进行麻醉.分别于麻醉诱导前5min(T0)、插管时(T1)、插管后5min(T2)、手术结束(T3)、术后24h(T4)、术后48 h(T5)采静脉血测定血糖,并记录各时间点收缩压(SBP)、舒张压(DBP)、心率(HR)、脉搏血氧饱和度(SpO2).结果 P组T1及T2的SBP和DBP分别为(110.63±16.92)、(108.80±20.97)mm Hg(1 mm Hg=0.133 kPa)和(66.37±8.00)、(68.60±11.19)mm Hg,心率分别为(73.77±8.13)、(74.67±8.33)次/min,均较T0有所下降[SBP、DBP和HR分别为(135.01±13.45)、(79.37±8.58)mm Hg和(79.73±9.06)次/min],P＜0.05;E组T1及T2的SBP和DBP与T0比较差异无统计学意义(P＞0.05),E组T2的心率为(89.20±9.06)次/min,较T0[(80.97±8.91)次/min]有所增快(P＜0.05).两组血糖在T1～T5均有所增高,但与T0比较差异无统计学意义(P＞0.05).结论 与靶控输注普鲁泊福麻醉相比,靶控输注依托咪酯麻醉对糖尿病患者围手术期具有更好的血流动力学稳定性;二者对患者围手术期血糖变化没有明显影响;靶控输注普鲁泊福及依托咪酯可安全用于ASA分级Ⅰ～Ⅱ级的糖尿病患者的手术麻醉.