宫颈癌患者术前辅助化疗和不同麻醉方法对血液流变学的影响

目的观察术前辅助化疗宫颈癌患者和不同麻醉方法对其血液流变学的影响。方法选择60例宫颈癌患者,分为A、B两组,每组30例。A组为化疗组,术前接受过三个疗程的化疗;B组为非化疗组,术前未给予化疗。A、B组又随机分为两个亚组,每组15例:A1、B1组行全麻复合硬膜外麻醉;A2、B2组行单纯全麻。所有患者均于麻醉诱导前5min、麻醉诱导后60min、手术结束时分别抽取外周静脉血5ml行血液流变学各项指标的检测。结果与B组比较,术前A组红细胞变形指数(EDI)降低、刚性指数(ERI)及全血粘度升高(P0.05)。与麻醉诱导前5min比较,麻醉诱导后60min、手术结束时A1、B1组EDI增加,血浆粘度(ηP)、Hct和红细胞聚集指数(EAI)均明显降低(P0.01);而A2、B2组Hct降低。结论宫颈癌患者术前辅助化疗后存在以红细胞变形力下降为特征的血液流变学变化。全麻复合硬膜外麻醉能明显改善血液流变参数,可为临床提供参考。     

不同麻醉方法对乳腺癌患者血液流变学的影响

目的比较两种麻醉方法对乳腺癌患者血液流变学的影响。方法32例ASAⅠ~Ⅱ级行择期乳腺癌根治术患者随机分为两组:Ⅰ组为全麻组;Ⅱ组为硬膜外加全麻组,诱导前硬膜外给2%利多卡因5 ml,继之行全麻诱导。全麻用药两组相同,Ⅱ组术中每50分钟硬膜外给2%利多卡因6~8 ml。术后24 h内用0.5%布比卡因镇痛,Ⅰ组术后肌注哌替啶镇痛。分别于麻醉前、麻醉后30、90 min各取桡动脉血10 ml,测血液流变学指标。结果两组麻醉后309、0 min全血高切及低切粘度、红细胞压积及红细胞聚集指数下降(P<0.05),但Ⅱ组这几项指标下降明显且持续时间长,且有血浆粘度及纤维蛋白原浓度的下降(P<0.05)。结论全麻加用硬膜外阻滞对血液流变学的影响更有利于预防术后上肢静脉血栓的形成。     

硬膜外阻滞和全身麻醉对Ⅱ型糖尿病患者血液流变学的影响

目的：研究Ⅱ型糖尿病患者和非糖尿病患者在连续硬膜外阻滞和全身麻醉下的血液流变学变化。方法：46例患者实施连续硬膜外阻滞或全身麻醉，其中24例Ⅱ型糖尿病患者，22例非糖尿病患者，根据麻醉方式的不同随机分为四组，比较麻醉前后血液流变学的变化。结果：麻醉后糖尿病患者：（1）硬膜外阻滞组麻醉全血低切和高切粘度、低切和高切还原粘度较麻醉前降低；（2）全麻组血液流变学指标与麻醉前相比无显著性差异；（3）硬膜外阻滞组的全血高切粘度比全麻组低。结论：连续硬膜外麻醉使Ⅱ型糖尿病患者的血液粘滞性降低，有益于患者脏器的血流灌注。     

高血压患者硬膜外麻醉前后血液流变学的变化

目的:了解高血压患者硬膜外麻醉前后的血液流变学的变化。方法:采用国产SA-B型多功能电脑血液流变学监测仪,对40例高血压患者进行了硬膜外麻醉前后血液流变学各项指标的监测。结果:麻醉后红细胞压积、血液粘度均降低,红细胞变形指数增大。结论:硬膜外麻醉有助于改善微循环。     

硬膜外麻醉对血液流变学的影响

本组通过25例应用硬膜外麻醉的择期手术病人,采用自身对照的方法,于麻醉前、麻醉后取血测试全血比粘度、血浆比粘度、全血还原比粘度、红细胞压积、红细胞沉降率、血沉方程K值等项指标。其结果经统计学处理:硬膜外麻醉后血浆比粘度、红细胞压积、血沉方程K值较麻醉前均有显著差异(P<0.05)。即硬膜外麻醉对血液流变学有一定的影响,这些变化可能与硬膜外麻醉对垂体肾上腺皮质系统的抑制有关。     

不同液体术前急性高容量血液稀释对深静脉血栓病人血液流变学的影响

目的 探讨不同液体术前急性高容量血液稀释(AHH)对深静脉血栓病人血液流变学的影响.方法 拟行股静脉取栓术病人30例,年龄40～64岁,栓塞时问<48 h,随机分为3组(n=10):生理盐水组(NS组)、羟乙基淀粉组(HES组)和琥珀酰明胶组(GEL组).麻醉诱导前分别静脉输注生理盐水、6%羟乙基淀粉(HES,200/0.5)或琥珀酰明胶40 min,输注速率20 ml·kg-1·h-1.分别于AHH 前、后即刻采集静脉血样5 ml,测定全血粘度高切变率、全血粘度低切变率、血浆粘度、红细胞压积、红细胞聚集指数和变形指数,并记录MAP、HR和SpO2.记录术中输液量和输血量.结果 AHH前、后三组血液动力学指标均在正常范围内.与NS组比较,HES组AHH后即刻全血粘度高切变率、全血牯度低切变率和红细胞聚集指数降低,血浆粘度和红细胞变形指数升高,GEL组AHH后即刻全血粘度高切变率和低切变率降低,血浆粘度升高(P<0.05或0.01);与HES组比较,GEL组全血粘度低切变率、红细胞聚集指数升高,红细胞变形指数降低(P<0.01).结论 6%羟乙基淀粉(200/0.5)和琥珀酰明胶术前AHH改善深静脉血栓病人血液流变学状态的效果优于生理盐水,且6%羟乙基淀粉的效果更优,可改善该类病人血液流动缓慢和血液高凝状态,降低了再次发生血栓的危险.＃     

羟乙基淀粉200/0.5和羟乙基淀粉130/0.4术前急性高容量血液稀释对结肠癌根治术患者血液流变学的影响

目的 评价6%羟乙基淀粉(HES)200/0.5和6%HES 130/0.4术前急性高容量血液稀释(AHH)对结肠癌根治术患者血液流变学的影响.方法 择期在全麻下行结肠癌根治术患者40例,ASA Ⅰ或Ⅱ级,随机分为2组(n=20),麻醉诱导期间于30 min内静脉输注15 ml/kg HES 200/0.5(Ⅰ组)或HES 130/0.4(Ⅱ组),AHH结束后开始手术.分别于麻醉诱导前(基础状态,T0)、AHH后即刻(T1)、AHH结束后1 h(T2)和术后1 h(T3)时抽取静脉血样,检测全血粘度、血浆粘度、红细胞聚集指数、血小板聚集指数和红细胞压积(Hct).结果 与T0时比较,Ⅰ组T1时全血低切粘度和红细胞聚集指数降低,T1-3时全血中切粘度、全血高切粘度、血浆粘度、血小板聚集指数和Hct降低,Ⅱ组T1-3时全血低切粘度、全血中切粘度、全血高切粘度、血浆粘度、红细胞聚集指数和Hct降低(P<0.05);与Ⅰ组比较,Ⅱ组T2,3时全血低切粘度和红细胞聚集指数降低,T1-3时血小板聚集指数升高(P<0.05).结论 6%HES 200/0.5与6%HES 130/0.4(15 ml/kg)术前AHH均能改善结肠癌根治术患者围术期血液流变学,其中6% HES 130/0.4的效果较好.     

控制性低中心静脉压对肝叶切除术患者血液流变学的影响

目的 探讨肝叶切除术中控制性低中心静脉压(LCVP)技术对患者血液流变学的影响.方法 24例择期全麻下行肝叶切除术患者,随机均分为LCVP组(L组)和对照组(C组).L组患者在肝脏实质完全离断前将CVP控制在0～5 cm H2O,随后通过输液将CVP升至6～12cmH2O.C组CVP维持在6～12 cmH2O.在麻醉前(T0)、麻醉后30 min(T1)、肝叶切除结束即刻(T2)、手术结束即刻(T3)抽取静脉血测定血液流变学各指标.结果 两组患者的血液粘度在T1～T3时均低于T0时(P<0.05或P<0.01).L组全血低切粘度在T1～T3时高于C组,全血高切粘度、血浆粘度在T2时高于C组(P<0.05或P<0.01).红细胞压积在C组T2、T3时、L组T3时明显下降,T2时L组高于C组.在T1、T2时L组红细胞聚集指数高于C组(P<0.01).在T1、T2时L组红细胞变形指数明显低于C组(P<0.05或P<0.01).结论 在肝叶切除术中应用LCVP技术患者血液粘度较麻醉前降低.在LCVP期间血液枯度、红细胞聚集指数均较正常输液患者高,红细胞变形指数较正常输液患者低.     

门脉高压症手术前后血液流变学观察

观察了２８例肝炎后肝硬变门静脉高压症（ＣＰＨ）及其手术后血液流变学变化，结果：（１）ＣＰＨ病人全血粘度尚在正常范围，红细胞压积（ＨＣＴ），纤维蛋白原（Ｆｉｂ）及血小板（ＰＣ）显著降低，红细胞硬度指数（ＴＫ）显著升高（即红细胞变形性降低）；（２）ＣＰＨ病人术后１～１４天存在明显的血液高粘滞，主要表现在全血低切粘度升高，红细胞聚集性增强Ｆｉｂ及ＰＣ增多等，因此ＣＰＨ病人在治疗中应注意改善红细胞变形性，手术后注意防治血液高粘滞及其并发症。     

麻醉诱导和维持期间人体血液流变学的变化

用锥板粘度计、红细胞变形仪和扫描电镜对２０例患者观察了临床麻醉用药时血液流变学变化。结果表明快速诱导以及安氟醚、芬太尼维持麻醉都可致红细胞压积、红细胞聚集指数降低，红细胞变形指数增大．而红细胞形态未见改变，提示麻醉对红细胞变形能力有增强作用，同时可降低血粘度，有助于改善微循环。     

联合椎管内麻醉时硬膜外注药升高阻滞平面的机制研究

探讨联合椎管内麻醉时硬膜外注药升高阻滞平面的机制。方法：３０例下肢矫形手术患者均采用蛛网膜下隙与硬膜外联合穿刺针行Ｌ２－３穿刺,蛛网膜下隙注入等比重的０．７５％布比卡因１．５ｍｌ后硬膜外置管。患者随机分成三组,每组１０例：硬膜外不给药（Ａ组）,蛛网膜下腔注射药后１５、２０、２５分钟经硬膜外导管给予２％利多卡因各３ｍｌ（Ｂ组）或生理盐水各３ｍｌ（Ｃ组）。结果     

Regional versus general anesthesia in high-risk surgical patients: The need for a clinical trial

Regional anesthesia is often preferred over general anesthesia for patients with cardiovascular disease because of presumed decreased risk of perioperative myocardial ischemia. However, few studies have addressed this issue directly. To determine whether the type of anesthesia is independently associated with myocardial ischemia, records of 134 patients undergoing peripheral vascular grafting under general or regional anesthesia were examined. There were no significant differences preoperatively between groups in ASA class, age, sex, or prevalence of angina, diabetes, or hypertension. Twelve patients developed myocardial ischemia or infarction within 7 days of operation; 11 of these 12 patients had received regional anesthesia (p < 0.015). The association between anesthetic approach and perioperative myocardial ischemia or infarction remained after adjustment for preoperative factors associated with ischemia or with type of anesthesia. General anesthesia does not appear to be associated with increased risk of myocardial ischemia, and stringent recommendations to avoid it in this population may be unfounded. A clinical trial is needed to define more clearly the risks and benefits of different types of anesthesia in high-risk patients.     

Finland's first anaesthesia revealed by newspapers

Background: According to the literature on the history of anaesthesia, Finland's first anaesthesia was given on March 8, 1847 for a ligature of an aneurysm of the subclavian artery. It has, however, not been possible to verify the date with certainty. We therefore wanted to find out whether newspapers might give additional information and how this exceptionally important medical invention had been received by the Finnish newspapers.
Methods: Microfilms of the 10 newspapers which appeared in Finland in 1847 were studied at the Helsinki University library.
Results: The first report which made reference to English newspapers was published on February 10 by "Borgå Tidning". On March 6, "Helsingfors Tidningar" wrote that two anaesthesias had already been given in Helsinki; the first of them for a difficult varicose veins operation and the second for an exarticulation of a shoulder. But there was no information regarding the dates of the operations. Fortunately, both operations had been recorded in the patient diary of the clinic, although without any information about the anaesthesia. According to the diary, Johan August Örn was operated for varicose veins on February 16 and Anders Gustaf Henrikson had his right arm exarticulated on March 3. Both patients recovered. In total, only six pieces of news on anaesthesia were found.
Conclusions: Finland's first anaesthesia was given on February 16, 1847, which is three weeks earlier than had been previously assumed.     

不同麻醉方式对血液流变学的影响

麻醉对外科手术患者术中及术后早期血液流变学产生一定的影响,这可能与围手术期血栓形成等因素有一定的关联.而不同麻醉方式对血液流变学的影响不同,现就此进行综述,为临床麻醉方式的选择提供一定的参考.     

Musculoskeletal Sonopathology and Ultrasound-Guided Regional Anesthesia

The use of real-time ultrasound guidance has revolutionized the practice of regional anesthesia. Ultrasound is rapidly becoming the technique of choice for nerve blockade due to increased success rates, faster onset, and potentially improved safety. In the course of ultrasound-guided regional anesthesia, unexpected pathology may be encountered. Such anomalous or pathological findings may alter the choice of nerve block and occasionally affect surgical management. This case series presents a variety of musculoskeletal conditions that may be encountered during ultrasound-guided regional anesthesia practice.     

Comparison of Acceptance,Preference, and Efficacy Between Jet Injection INJEX and Local Infiltration Anesthesia in 6 to 11 Year Old Dental Patients

Needleless devices have been developed to provide anesthesia without injections. Little controlled research has examined the acceptability of needleless devices in pediatric patients. The aims of the study were to compare children’s acceptance and preference for one type of needleless jet injection with classical local infiltration as well as to evaluate the efficacy of the needleless anesthesia. Eighty-seven nonfearful children with no previous experience of dental anesthesia were studied using a split-mouth design. The first dental procedure was performed with the classical infiltration anesthesia. The same amount of anesthetic was administered using the INJEX needleless device in a second session 1 week later, during which a second dental procedure was performed. Patients rated their acceptance and preference for the 2 methods, and the dentist recorded data about the need for additional anesthesia. More negative experiences were reported for the INJEX method. Most (73.6%) of the children preferred the traditional method. Among the 87 treatment procedures attempted following the use of INJEX, 80.5% required additional anesthesia, compared with 2.3% of those attempted following traditional infiltration. Traditional infiltration was more effective, acceptable, and preferred, compared with the needleless INJEX.     

Comparação entre anestesia intravenosa e inalatória na náusea e vômito pós‐operatórios em laparotomia: estudo clínico randomizado

BackgroundPostoperative Nausea and Vomiting (PONV) is a multifactorial surgical complication with an unclear underlying cause. Anesthetic methods, patients’ characteristics and the type of surgery are considered as factors affecting PONV. This study was designed to compare the effect of inhalational and intravenous anesthesia in abdominal surgery on the incidence and severity of PONV.MethodsA single‐blinded prospective randomized clinical trial on 105 patients aged 18 − 65 years was carried out. Patients were divided in two groups of Total Intravenous Anesthesia (TIVA) and Inhalational anesthesia. The incidence and severity of PONV were examined at 0, 2, 6, 12, and 24 hours after the surgery. The use of a rescue antiemetic was also evaluated.ResultsFifty point nine percent of the patients in the inhalation group and 17.3% of the patients in the intravenous group developed PONV (p < 0.001). The incidence of vomiting was reported in 11.3% of the Inhalational group and 3.8% of the TIVA group (p = 0.15), and 24.5% of patients in the Inhalation group and 9.6% of patients in the intravenous group needed an antiemetic medication (p = 0.043).ConclusionThe incidence of postoperative nausea and vomiting and the need for administration of an antiemetic rescue drug, and the severity of nausea in patients were significantly lower in the TIVA group.     

Semi-automated,slow subcutaneous infusion anesthesia (SIA) with diluted mixtures of prilocaine and ropivacaine

In recent years it has been found that local anesthesia, which often suffices for surgery of the skin and superficial structures, can be adequately administered using large amounts of highly diluted anesthetic solutions combined with epinephrine. This has considerably increased application of local anesthesia in plastic surgery. Using one or more conventional infusion pumps for slow subcutaneous infusion anesthesia (SIA), we injected mixed anesthetic solutions painlessly and automatically into the subcutaneous layer. The local anesthetics used were equivalent mixtures of prilocaine and ropivacaine (Xylonest and Naropin); these were diluted with original Ringers solution containing epinephrine (1:1,000,000) in 500-ml bottles. The concentrations of the mixtures varied between 0.3% and 0.06% depending on the requirements of surgery. Routinely available 18- to 30-gauge needles were used. The speed of injection varied between 30 ml and 1500 ml per hour depending on the location, the requirements of surgery, and the needle size. Volumes usually ranged from 2 ml to 1000 ml depending on the concentrations. The maximum dose was approximately 4 mg of prilocaine and 2 mg/kg of ropivacaine, which is the maximum tolerated dose. Regardless of secondary disorders, all patients scheduled for skin and lymph node operations under local anesthesia underwent surgery using this kind of anesthesia, including those for the nose and ear region. No suprarenin was added for nerve blocks of the fingers and penis. This technique was used in 20,310 major and minor skin operations in 11,810 patients ranging in age from 0.5 years (510 children under 14 years) to 95 years (mean age 55 years; 49% females, 51% males), including all types of local flaps and grafts. There were no complications whatsoever from local anesthesia. The technique proved safe and comfortable even for children and very sensitive patients. The median duration of postoperative anesthesia was 4.3 h (maximum 23 h). We found that experience is required for correct selection of the needle position, the flow rate, and the volume.