可控式电热保温毯配合术中液体加温在老年人工髋关节置换术中的应用效果

目的 分析可控式电热保温毯配合术中液体加温对老年人工髋关节置换术患者的作用。方法 选取60例需要进行人工髋关节置换术的老年患者,通过随机排列表法分为两组各30例,对照组利用常规保温干预,观察组另外给予可控式电热保温毯配合术中液体加温干预,比较整体效果。结果 麻醉开始时(T0)、手术开始时(T1)时,两组体温差异无统计学意义(P>0.05);手术开始后20 min(T2)、40 min(T3),手术结束时(T4),观察组体温较高,差异显著(P<0.01);术前,两组凝血功能差异无统计学意义(P>0.05);术后,观察组凝血功能指标变化幅度小,差异显著(P<0.01);术前,两组免疫功能指标差异无统计学意义(P>0.05);术后12、24 h,观察组CD4⁺、CD4⁺/CD8⁺显著高于对照组,CD8⁺显著低于对照组(P<0.01);观察组术后苏醒时间、住院时间、拔管时间、首次下床活动时间显著低于对照组(P<0.01);观察组不良反应发生率显著低于对照组(P<...     

综合保温措施对老年膝关节镜手术患者麻醉复苏质量的影响

目的探讨综合保温措施对老年膝关节镜手术患者麻醉复苏质量的影响。方法 68例择期行单侧膝关节镜手术的老年患者,按照随机数字表法分为实验组与对照组各34例,对照组患者入室后给予单一、常规的保温措施,实验组在常规保温措施上给予术前预热、术中保温、术后保温等综合保温措施。结果实验组在手术进行60 min(T1)与手术结束时(T2)两个节点体温较对照组具有明显的优势(P0.01);同时,实验组患者拔管时间及术毕送入麻醉苏醒室(PACU)停留时间均较对照组时间短,术后并发症发生率也低于对照组。结论综合保温措施能够有效维持老年膝关节镜手术患者的核心体温,预防因麻醉引起的低体温;同时,缩短了拔管时间与PACU停留时间,降低了寒战、恶心呕吐等并发症的发生率,从而改善了麻醉后复苏的质量,值得推广与应用。     

保温护理对老年宫颈癌患者麻醉恢复期体温及并发症的影响

目的研究不同保温护理对老年宫颈癌患者麻醉恢复期体温及并发症的影响。方法选择2017年9月至2019年10月我院收治的98例老年宫颈癌患者作为研究对象,采用随机数表法分为对照组(n=49)和观察组(n=49),对照组行常规保温护理,观察组行综合保温护理。观察并对比两组患者麻醉恢复期的体温变化和术后并发症发生情况。结果观察组患者的T0、T1、T2以及T3时期的温度比对照组高,差异有统计学意义(P<0.05);观察组并发症发生率(2.04%)低于对照组并发症发生率(16.33%),差异有统计学意义(P<0.05)。结论综合保温护理可保证老年宫颈癌患者麻醉恢复期体温平稳且正常,并可降低术中低温等并发症的发生率。     

全麻复合硬膜外麻醉对脑腔镜手术患者循环稳定性的影响

腹腔镜胆囊切除术 ( LC)已为临床广泛应用 ,临床一般选择全麻 ,但术中气腹对循环干扰甚大。为此 ,我们对 1 4例 LC患者应用全麻复合硬膜外麻醉 ,并与同期 1 4例全麻患者进行比较 ,观察其对 LC患者循环稳定性的影响。现报告如下。1　资料与方法1 .1　一般资料　 LC患者 2 8例 ,男 9例 ,女 1 9例 ;年龄 40～ 5 1岁 ,ASA ～ 级 ,无重要器官合并症。随机分为全麻复合硬膜外麻醉组 ( GE组 )和全麻组 ( G组 ) ,各 1 4例。1 .2麻醉方法　术前 30分两组均肌注苯巴比妥钠0 .1 g,阿托品 0 .5 mg。 GE组先取 T10 -11间隙行硬膜外穿刺 ,头向置管…     

早期液体复苏对重症急性胰腺炎患者疗效的影响

目的 探讨早期液体复苏对重症急性胰腺炎(SAP)患者治疗效果的影响.方法 将发病72 h内就诊的70例SAP患者纳入研究.液体复苏达标参数:心率＜120次/min;尿量≥1 ml·h-1 ·kg-1;血细胞比容≤35％;平均动脉压65～85 mmHg(1 mmHg =0.133 kPa).回顾分析液体复苏达标时间(＜48h、48 ～72 h、＞72 h)和达标项目数(0～1、2、3、4项)对患者疗效的影响.结果 70例患者中41例(58.6％)发生并发症,20例(28.6％)中转手术,10例(14.3％)病死.中位住院天数为23.5 d,中位治疗费用为7.19(0.57～56.74)万元.＜48 h、48～72 h、＞72 h液体复苏达标患者的中转手术率(20.0％、33.3％、75.0％)、急性肾损伤发生率(20.0％、25.0％、75.0％)和并发症发生率(50.0％、83.3％、100％)在3组间均有统计学意义(P＜0.05).发病48 h内液体复苏后0～1、2、3、4项达标者的中转手术率(50.0％、26.3％、13.0％、25.0％)、急性肾损伤发生率(45.0％、31.6％、17.4％、0)、ARDS发生率(35.0％、31.6％、13.0％、0)均呈显著下降趋势.结论 SAP发病48 h内,合理的液体复苏策略有利于提高疗效,改善患者预后.     

全程保温措施对心源性心脏骤停心肺复苏后康复的影响

目的：探讨全程保温措施对于心脏骤停心肺复苏后患者康复的影响。方法：选取2008年1月至2014年4月我院ICU收治的院内心搏骤停、且行心肺复苏成功患者35例,采用数字随机分组方法将其随机分为观察组以及对照组,观察组18例采用全程保温护理治疗(将中心体温降至32～34℃,并应用电脑降温毯维持24h),对照组17例采用传统的降温保温法(如头部冰帽．颈部、腹股沟冰敷)诱导降温。观察并比较两组患者的24h、72h、1周的GCS评分及APACHEⅡ评分,比较2组复苏后的血乳酸水平以及6h、24h血乳酸清除率。结果：在心肺复苏术后7d,观察组患者G.C.S评分明显高于对照组,APACHE评分低于对照组,24h后的血乳酸清除率观察组亦高于对照组。结论：应用亚低温治疗并配合积极的全程保温护理措施有利于促进心肺复苏患者的自主循环恢复以及脑功能的改善,降低病死率。     

不同麻醉药物对腹腔镜下肿瘤切除手术患者血流动力学的影响

目的探讨不同麻醉药物配伍对老年腹腔镜下肿瘤切除手术患者血流动力学的影响。方法选取行老年腹腔镜下肿瘤切除术患者86例,分为观察组与对照组各43例。对照组采用丙泊酚配合右美托咪定麻醉维持,观察组采用七氟烷配合右美托咪定麻醉维持。结果观察组麻醉总满意率(97. 67%)显著高于对照组(79. 07%,P<0. 05);两组术后3 h和24 h OAAS评分较术毕显著增加(P<0. 05);观察组术后3 h和24 h OAAS评分显著高于对照组(P<0. 05);观察组拔管时间、呼之睁眼时间和自主呼吸恢复时间显著快于对照组(P<0. 05);两组T1时刻心率(HR)、平均动脉压(MAP)较T0时刻显著降低(P<0. 05),对照组T2时刻HR、MAP较T0时刻显著降低(P<0. 05),而观察组T2时刻HR、MAP较T0时刻无明显变化(P>0. 05);观察组T1和T2时刻HR、MAP显著高于对照组(P<0. 05)。结论七氟烷配合右美托咪定麻醉配伍对老年腹腔镜下肿瘤切除手术患者效果明显,且对血流动力学影响小。     

暖毯机对食管癌术后患者全麻苏醒的影响

目的探讨暖毯机对食管癌患者术后体温及麻醉苏醒的影响。方法选择食管癌根治术患者30例,随机分为两组。实验组入麻醉恢复室（PACU）后应用暖毯机,对照组只给予常规保温措施,记录两组术前、术毕体温,入PACU 30、60、90 min体温,观察苏醒时间及拔管时间。结果两组入PACU后体温均有所上升,但实验组体温较对照组上升迅速（P〈0.05）,60 min即恢复至术前水平;对照组90 min恢复至术前水平。实验组苏醒时间及拔管时间均明显缩短（P均〈0.05）。结论麻醉苏醒期应用暖毯机可加快食管癌根治术患者体温恢复并缩短苏醒时间。     

不同麻醉药物对老年腹腔镜胆囊切除术患者麻醉深度及应激反应的影响

目的 探讨不同麻醉药物在腹腔镜胆囊切除术患者麻醉深度以及应激反应中的影响.方法 老年腹腔镜胆囊切除术患者148例分为三组,A组丙泊酚+芬太尼诱导后异氟烷维持,B组丙泊酚+瑞芬太尼诱导后持续维持.C组丙泊酚+瑞芬太尼诱导后七氟烷联合丙泊酚维持,观察三组术中基本情况及应激反应相关指标的差异.结果 三组患者术中各项指标对比中,B组患者T2、T3、T4时间段中收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、血氧饱和度(SpO2)要显著低于A、C组(P＜0.05).三组患者围麻醉期皮质醇(Cor)、血糖(Glu)、IL-6及C反应蛋白(CRP)的变化对比中,B组患者T2、T3、T4时间段中Cor、Glu、IL-6及CRP要显著低于A、C组(P＜0.05).结论 三种麻醉方法均不能完全达到抑制腹腔镜胆囊切除术中的应激反应,但是全凭静脉靶向输注的丙泊酚复合瑞芬太尼麻醉能给较好地控制手术以及气腹对机体的应激反应影响.     

Effects of general anesthesia on quality of recovery after transaxillary endoscopic breast augmentation: A randomized controlled trial

Background:Types of general anesthesia may affect the quality of recovery, but few studies have investigated the quality of postoperative recovery, and none has focused on patients undergoing breast augmentation.Methods:This prospective, parallel, randomized controlled study enrolled 104 patients undergoing transaxillary endoscopic breast augmentation. Eligible patients were randomly assigned to receive inhalation anesthesia (IH, n = 52) or total intravenous anesthesia (TIVA, n = 52). Quality of recovery was assessed on the first and on the second postoperative days using the 15-item Quality of Recovery questionnaire (QoR-15). Baseline demographic, clinical characteristics, and operative data were also collected.Results:The IH and TIVA groups had similar QoR-15 total scores on the first postoperative day (P = .921) and on the second postoperative day (P = .960), but the IH group had a significantly higher proportion of patients receiving antiemetics than the TIVA group (53.6% vs 23.1%, P = .002). Multivariate analysis revealed that the type of general anesthesia was not significantly associated with QoR-15 total scores on the first postoperative day (β = 0.68, P = .874) and with QoR-15 total scores on the second postoperative day (β = 0.56, P = .892), after adjusting for age, BMI, operation time, steroids use, and antiemetics use.Conclusion:For the patients undergoing transaxillary endoscopic breast augmentation, the type of general anesthesia did not significantly impact the quality of recovery. Both IH or TIVA could provide good quality of recovery demonstrated by high QoR-15 total scores. The results suggested that the type of general anesthesia may not be the most critical factors of quality of recovery in the patients undergoing transaxillary endoscopic breast augmentation.     

Risk factors of delayed recovery from general anesthesia in patients undergoing radical biliary surgery: What can we prevent

Delayed recovery (DR) is very commonly seen in the patients undergoing laparoscopic radical biliary surgery, we aimed to investigate the potential risk factors of DR in the patients undergoing radical biliary surgery, to provide evidences into the management of DR.Patients who underwent radical biliary surgery from January 1, 2018 to August 31, 2020 were identified. The clinical characteristics and treatment details of DR and no-DR patients were compared and analyzed. Multivariable logistic regression analyses were conducted to identify the potential influencing factors for DR in patients with laparoscopic radical biliary surgery.We included a total of 168 patients with laparoscopic radical biliary surgery, the incidence of postoperative DR was 25%. There were significant differences on the duration of surgery, duration of anesthesia, and use of intraoperative combined sevoflurane inhalation (all P < .05), and there were not significant differences on American Society of Anesthesiologists, New York Heart Association, tumor-lymph node- metastasis, and estimated blood loss between DR group and control group (all P > .05). Multivariable logistic regression analyses indicated that age ≥70 years (odd ratio [OR] 1.454, 95% confidence interval [CI] 1.146–1.904), body mass index ≥25 kg/m² (OR 1.303, 95% CI 1.102–1.912), alcohol drinking (OR 2.041, 95% CI 1.336–3.085), smoking (OR 1.128, 95% CI 1.007–2.261), duration of surgery ≥220 minutes (OR 1.239, 95% CI 1.039–1.735), duration of anesthesia ≥230 minutes (OR 1.223, 95% CI 1.013–1.926), intraoperative combined sevoflurane inhalation (OR 1.207, 95% CI 1.008–1.764) were the independent risk factors for DR in patients with radical biliary surgery (all P < .05).It is clinically necessary to take early countermeasures against various risk factors to reduce the occurrence of DR, and to improve the prognosis of patients.     

右美托咪定用于妇科腹腔镜手术患者全麻苏醒期的有效性和安全性

目的探讨右美托咪定应用于妇科腹腔镜手术患者中对全麻苏醒期的效果及应用价值。方法选取该院进行腹腔镜手术治疗的104例子宫肌瘤或者卵巢囊肿患者,按随机数字表法将患者分为观察组(右美托咪定组)和对照组(生理盐水组)各52例,观察两组麻醉效果和苏醒期的有效性和安全性。结果观察组拔管时平均动脉压(MAP)(101.84±5.41)mm Hg,拔管后5 min MAP(91.38±5.06)mm Hg,拔管后10 min MAP(90.34±4.89)mm Hg,拔管后15 min MAP(86.47±4.32)mm Hg;拔管时心率(HR)(88.34±6.45)次/min,拔管后5 min HR(83.48±5.78)次/min,拔管后10 min HR(81.53±5.15)次/min,拔管后15 min HR(80.02±4.47)次/min;均优于对照组,组间比较差异有统计学意义(P0.05)。观察组呼吸恢复时间(5.32±1.83)min,意识恢复时间(9.22±2.36)min,拔管时间(11.89±2.88)min;对照组分别为(5.41±1.79)min、(9.19±2.41)min、(11.95±2.79)min,组间比较差异无统计学意义(P0.05)。观察组Riker镇静和躁动评分(4.03±0.57)分,躁动发生率为5.77%,对照组为(5.32±1.63)分、34.62%,组间比较差异有统计学意义(P0.01)。结论右美托咪定应用于妇科腹腔镜手术患者中可以让血流动力学更加稳定,术后苏醒迅速、完全,值得临床推广应用。     

加速康复外科理念在老年患者行腹腔镜胆道探查术中的应用

目的探讨加速康复外科(ERAS)理念下行腹腔镜胆道探查术(LCBDE)对老年胆总管结石患者的效果。方法入选2014年2月至2018年3月内蒙古医科大学第三附属医院普外科收治的老年胆总管结石患者120例,随机数字表法分为ERAS组及对照组,每组60例。ERAS组给予加速康复方案治疗,对照组给予常规治疗,比较2组患者的术后疗效、术后并发症及术后镇痛效果。采用SPSS 18. 0统计软件对数据进行处理。组间比较采用t检验、χ~2检验或秩和检验。结果 ERAS组患者相比对照组患者术后下床时间[(9. 62±2. 35) vs (22. 51±3. 32) h]、排气时间[(22. 13±5. 12) vs(37. 51±6. 43)h]、进食时间[(18. 75±3. 28) vs (34. 69±4. 47)h]、住院天数[(9. 73±1. 48) vs (14. 73±2. 92)d]明显提前,住院费用降低[(1. 68±0. 23)×10~4vs (2. 47±0. 32)×104RMB$],肺部感染[5. 00%(3/60) vs 13. 33%(8/60)]、尿路感染[3. 33%(2/60) vs 11. 67%(7/60)]、腹胀发生率[8. 33%(5/60) vs 20. 00%(12/60)]均降低,差异均具有统计学意义(P 0. 05)。ERAS组患者术后镇痛达到优者占81. 67%(49/60),明显高于对照组的48. 33%(29/60),差异有统计学意义(P 0. 05)。结论老年患者在ERAS原则下行LCBDE安全、有效,值得推广。     

The 95% effective dose of nalbuphine in patient-controlled intravenous analgesia for patients undergoing laparoscopic total hysterectomy compared to equivalent sufentanil: Retraction

Purpose:To evaluate the 95% effective dose of nalbuphine in patient-controlled intravenous analgesia (PCIA) by the sequential method and compare the analgesia efficacy with the equivalent dose of sufentanil on patients undergoing laparoscopic total hysterectomy.Methods:In the first part, we defined a successful analgesia as the highest VAS ≤3 in 24 hours postoperatively. On the contrary, a failed analgesia was the highest VAS>3. According to the last patient''s outcome, the next patients would be given an increase or decreased dose grade. This process ended up with 9 cross-over points. In the second part, 60 patients undergoing laparoscopic total hysterectomy were selected. They were randomly divided into 2 groups (n = 30 each group): receiving sufentanil 1.78 μg/kg (group S) and nalbuphine 1.78 mg/kg (group N). PCIA pump was given at the end of the operation with 5 mL bonus loading. The total amount of PCIA was 100 mL and programmed to deliver 0.5 mL each time with a lockout interval of 15 minutes and the background infusion amount of 2 mL/h. The VAS score and Ramsay score of were collected after the operation, the number of effective pressing times of PCIA were also recorded. Adverse reactions were documented in detail.Results:The 95% effective dose of nalbuphine in PCIA on patients undergoing laparoscopic total hysterectomy was 1.78 mg/kg. There was no significant difference in VAS between the sufentanil group and the nalbuphine groups (P > .05), but the number of the use of PCIA in the group S was more than that in the group N obviously (P <.05). The group S has a lower ramsay sedation score than group N at every time point. (P <.05). The incidence of nausea and vomiting was not statistically significant differences between two groups in the first 24 hours after colonoscopy (P >  q .05).Conclusion:Nalbuphine 1.78 mg/kg in PCIA is recommended for the patients undergoing laparoscopic total hysterectomy. And nalbuphine is a reasonable alternative to sufentanil when used in PCIA.     

右美托咪定对全麻下腹腔镜完全腹膜外疝修补术患者的应激及苏醒的影响

目的探讨右美托咪定对腹腔镜完全腹膜外疝修补术患者在围手术期应激及苏醒质量的影响。方法将择期行腹腔镜下完全腹膜外腹股沟疝修补术40例患者,随机分为右美托咪定组(D组)和生理盐水组(C组),每组20例。两组患者均采用气管插管静脉麻醉。D组在麻醉诱导前15 min予负荷剂量盐酸右美托咪定0. 2μg/kg,术中右美托咪定以0. 4μg/(kg·h)维持静脉泵注,直至手术结束前20 min结束泵注。C组患者予相同方式泵入同等量的生理盐水。麻醉维持均采用丙泊酚和瑞芬太尼静脉泵注,维持脑电双频谱指数(BIS) 40～60。记录麻醉诱导前15 min(T0)、气管插管后1 min(T1)、手术开始时(T2)、气管插管拔管时(T3)及术后30 min(T4)的平均动脉压(MAP)、心率(HR)。抽取外周静脉血,检测这几个时间点的肾上腺素(E)、去甲肾上腺素(NE)水平和血糖(Glu)值。记录心动过缓、心动过速、高血压、拔管后躁动及呕心呕吐等不良事件发生情况。结果 D组患者在T1、T2、T3、T4的E、Glu较T0时明显升高,在T1、T2、T3的NE较T0也明显升高(P 0. 05)。C组患者在T1、T2、T3、T4的E、NE、Glu均较T0明显升高(P 0. 05)。与C组相比较,D组在T1、T2、T3、T4各时间的E、NE和Glu均明显降低(P 0. 05)。不良反应方面对比,D组的心动过速、高血压、拔管后躁动、恶心呕吐发生例数少于C组,但心动过缓发生例数多于C组。D组总的不良反应发生率(20. 0%)较C组(65. 0%)明显降低(P 0. 05)。结论右美托咪定是一种高选择性α2肾上腺素能受体激动剂,具有中枢抗交感神经作用,有明确的镇静、镇痛作用,可以抑制腹腔镜完全腹膜外疝修补术患者的应激反应,保证手术安全性,提高复苏质量。     

妇科腹腔镜手术全身浅麻醉术中患者知晓率调查及其影响因素分析

目的调查在全身浅麻醉下行妇科附件良性肿瘤腹腔镜手术中患者的知晓率并分析其影响因素。方法随机选择900例在全身浅麻醉下行腹腔镜手术的妇科附件良性肿瘤患者,术后第1天及第2天调查患者有无术中知晓情况并统计知晓率,采用多元Logistic回归对相关影响因素进行分析。结果 900例中有11例发生术中知晓,知晓率为1.22%。术中知晓的发生与年龄、术中低血压、过早停药、急诊手术等因素有关。结论妇科附件良性肿瘤腹腔镜手术全身浅麻醉知晓与年龄、术中低血压、过早停药、急诊手术等因素有关。预防术中知晓的根本措施在于合理监测麻醉深度。     

不同穴位按摩对老年患者腹腔镜胆囊切除术后胃肠功能影响

目的 观察老年患者腹腔镜胆囊切除术后单穴与多穴位按摩对改善胃肠功能的效果.方法 选择2014年12月-2017年2月在上海市中医医院住院行腹腔镜胆囊切除术及胆囊切除加胆管探查术的老年患者72例,采用随机数字分组法分为3组,单穴位按摩为A组、多穴位按摩为B组、常规护理为C组,每组24例.3组患者均采用腹腔镜胆囊手术常规治...