Effect of Sedation Anesthesia With Intravenous Propofol on Transrectal Ultrasound-Guided Prostate Biopsy Outcomes

BackgroundSedation anesthesia during transrectal ultrasound (TRUS)-guided prostate biopsy is known to decrease patient pain and anxiety, but little is known whether it affects the procedure’s prostate cancer detection and complication rates. This study aimed to determine the effect of sedation anesthesia with intravenous (IV) propofol on TRUS-guided prostate biopsy outcomes.MethodsA retrospective analysis of 2,119 patients who underwent TRUS-guided prostate biopsy between November 2009 and February 2019 was undertaken. The patients were divided into two groups: patients who underwent sedation anesthesia with IV propofol and patients who underwent local anesthesia with intrarectal lidocaine gel instillation. Cancer detection and complication rates were compared between the two groups. Univariate and multivariate binary logistic regression and multinomial logistic regression analyses were conducted to investigate the effects of sedation anesthesia with IV propofol on prostate cancer detection and complication rates.ResultsThe cancer detection rate of patients in the sedation group was 34.0%, whereas it was 29.2% in the local group (P = 0.024). Multivariate logistic regression analysis regarding factors associated with cancer detection rate after TRUS-guided prostate biopsy in patients with prostate specific antigen (PSA) < 10 showed that IV propofol usage, age, PSA density and core length were significant factors. Multivariate logistic regression analysis regarding factors associated with complications (voiding dysfunction, bleeding and infection) showed that IV propofol usage, age and prostate size were significant factors for voiding dysfunction.ConclusionSedation anesthesia with IV propofol during TRUS-guided prostate biopsy was associated with a higher cancer detection rate than local anesthesia with intrarectal lidocaine gel instillation. Cancer detection rate could be an important factor to consider when selecting for the optimal anesthesia for TRUS-guided prostate biopsy.     

硬膜外麻醉复合吸入全麻与全凭静脉麻醉临床效果分析

目的：研究比较硬膜外麻醉复合吸入全麻与全凭静脉麻醉的临床效果。方法选取在我院进行腹部手术治疗的患者160例,分为研究组和对照组,每组各80例患者,研究组患者采用硬膜外麻醉复合吸入全麻,对照组患者采用全凭静脉麻醉,比较两组患者的用药及术后苏醒情况。结果研究组患者的平均吞咽反射恢复时间为(6.12±1.19)min、平均拔管时间为(7.08±1.16)min、平均唤醒时间为(12.03±1.16)min、完全清醒时间为(16.19±1.31)min,均低于对照组患者。结论采用硬膜外麻醉复合吸入全麻,患者在全麻时的药物用量更少,术后拔管及清醒时间明显缩短,对于提高术后苏醒质量具有重要的意义。     

用于静脉麻的微机输液泵系统

CACI系统由IBM-PC微机与输液泵组成。它按照药物的分布、结合、转化与排泄规律给药以达到控制血药浓度的目的。 实验分三组,第1组7例病人,应用本系统在静脉麻醉中控制硫喷妥钠10μg/me的恒定血药浓度;第2组10例病人,硫喷妥钠的血药浓度按临床需要调整;第3组10例病人,普鲁卡因控制在15μg/me恒定的血药浓度,三组均获得满意结果。 作者认为CACI系统的设计达到了以下目的:静脉麻醉中控制稳定的血药浓度,避免血药浓度的剧烈波动,预测血药浓度的变化,进而调节控制静脉麻醉中的血药浓度。     

神经外科手术全凭静脉麻醉和吸入麻醉meta分析

目的 评估在神经外科手术中使用全凭静脉麻醉和吸入麻醉对颅内压(ICP)以及术后早期恶心呕吐(PONV)的影响.方法 采用固定效应模型进行数据分析.结果 分析显示使用全凭静脉麻醉的颅内压较吸入麻醉平均可降低4.05 mmHg,95%CI为2.22-5.88(p＜0.0001).术后早期恶心呕吐两组之间无统计学差异(P=0.50).结论 神经外科手术中使用全凭静脉麻醉可有效地降低颅内压,但并不能改善术后恶心呕吐的发生几率.     

舒芬太尼应用于静脉术后镇痛及临床麻醉的效果

目的 观察舒芬太尼应用于静脉术后镇痛及临床麻醉的效果。方法 选择2017年5月~2019年5月在我院接受手术治疗的患者60例,采用随机数字表法分为对照组和观察组,各30例。对照组采用芬太尼进行麻醉,观察组采用舒芬太尼麻醉,比较两组临床麻醉效果、术后疼痛评分以及临床不良反应。结果 观察组麻醉起效时间（3.51±1.22）min、清醒时间（26.81±7.09）min、自主呼吸恢复时间（7.98±1.22）min均低于对照组（9.11±2.56）min、（50.12±1.07）min、（14.23±2.18）min,差异有统计学意义（P＜0.05）;观察组术后疼痛评分为（3.32±0.58）分,低于对照组的（5.82±11.12）分,差异有统计学意义（P＜0.05）;观察组临床不良反应发生率为3.33%,低于对照组的16.67%,差异有统计学意义（P＜0.05）。结论 舒芬太尼用于静脉术后镇痛及临床麻醉效果良好,可缩短患者清醒时间,减轻术后疼痛及不良反应发生率,促进患者术后恢复。     

内分泌激素RIA在不同全麻诱导药麻醉过程中的临床观察

目的：评价三种静脉麻醉药，在全麻诱导时对内分泌功能的影响。方法：将择期全麻手术病人48例，随机分为三组：I组异丙酚组18例，Ⅱ组硫喷妥钠组和Ⅲ组依托咪酯组各15例，在诱导前（T0），窥喉插管即刻（T1），插管后（T2）、5min(T3)、15min(T4)取外周静脉血，用放射免疫法测定血浆去甲肾上腺素（NE），肾上腺素（E），皮质醇（Cort)泌乳素（PRL），生长素（GH），β－内啡肽（β－EP）水平。结果：三药在气管插管诱导期，无一能抑制NE分泌，但异丙酚对NE及垂体内分泌影响较小，优于硫喷妥钠和依托咪酯。结论：三类全麻诱导药相比较异丙酚在抑制NE分泌及对内分泌影响方面，其安全性优于硫喷妥钠和依托咪酯。     

腹腔镜下子宫全切除术的麻醉体会

目的探讨全麻下腹腔镜子宫全切除术中气腹对患者呼吸及循环功能的影响。方法气腹前、气腹后10min、气腹后30min及放气后监测患者BP、HR、SpO2、Paw的变化情况,并进行统计学分析。结果术中CO2气腹后患者的BP、HR、Paw与气腹前相比明显增加,差异有统计学意义。结论腹腔镜子宫全切除术气腹后患者的BP、HR、Paw升高。     

静-吸复合麻醉和全凭静脉麻醉对肝炎肝硬化患者围术期 免疫功能的影响分析

目的 观察静-吸复合麻醉和全凭静脉麻醉对肝炎肝硬化患者围术期免疫功能的影响。方法 选取我院2016年4月~2017年4月接收的126例肝炎肝硬化患者作为研究对象,按照麻醉方式的不同分成两组,对照组61例行全凭静脉麻醉,实验组65例行静-吸复合麻醉,对比两组不同时点肝功能指标、免疫功能指标变化。结果 实验组T1、T2时点ALB分别为（41.20±12.27）g/L、（39.52±9.64）g/L,高于对照组,且T2时点ALT为（12.46±2.81）IU/L,低于对照组,差异具有统计学意义（P＜0.05）。实验组T2时点CD4+（32.85±3.65）%、CD4+/CD8+（1.20±0.14）高于对照组,差异具有统计学意义（P＜0.05）。结论 静-吸复合麻醉较之全凭静脉麻醉对肝炎肝硬化患者围术期肝功能、免疫功能影响显著减小。     

静脉麻醉和腰-硬膜外麻醉对髋关节置换术患者血流动力学和血液流变学指标的影响

目的:比较髋关节置换术行静脉全麻和腰-硬膜外麻醉患者的血流动力学和血液流变学指标变化。方法:92例髋关节置换术患者按随机数字表法分为静脉全麻组和腰-硬膜外麻醉组,每组各46例。静脉全麻组行气管内插管后微量泵静脉给予瑞芬太尼(0.1-0.5μg/kg/h)和丙泊酚(4-6mg/h),腰-硬膜外麻醉组行L2-3腰-硬膜外穿刺给药予0.5%左布比卡因2ml。对比两组麻醉前(T0)、麻醉5min(T1)、麻醉30min(T2)及术后5min(T3)、30min(T4)的血流动力学和血液流变学指标以及药物起效、阻滞完成时间和麻醉并发症发生率的差异。结果:两组T0血流动力学及血液流变学指标差异无统计学意义(P0.05)。腰-硬膜外麻醉组T1、T2、T3、T4时血压(BP)、心率(HR)、血氧饱和度(SPO2)均明显高于静脉全麻组(P0.05),全血黏度、全血还原黏度、血浆黏度亦明显高于静脉全麻组(P0.05)。腰-硬膜外麻醉组内各时相的BP、HR、SPO2、全血黏度、全血还原黏度、血浆黏度均无明显差异(P0.05);而静脉全麻组内各时相上述各指标均存在明显差异(P0.05),T1-T4均低于T0(P0.05)。同时,腰-硬膜外麻醉组麻醉起效时间、阻滞完全时间短于静脉全麻组(P0.05)。两组均未发生药物不良反应和麻醉并发症。结论:髋关节置换术患者采用腰-硬膜外麻醉更合适。     

麻醉复苏室的精神及心理护理体会

目的：探讨患者在麻醉复苏室的精神及心理护理。方法通过对我院221例麻醉复苏患者的护理,总结出适合我院的护理方法,促进患者早日康复。结果对患者除积极地配合治疗外,做好精神及心理的护理,为其早日康复具有重要作用。结论在病情观察、精神、心理等方面的护理对促进患者康复具有重要意义,应引起足够的重视。     

全凭静脉麻醉对腹腔镜手术CO2气腹患者内脏器官灌注的影响

目的：观察异丙酚-舒芬太尼全凭静脉麻醉对腹腔镜下CO2气腹患者内脏器官灌注的影响。方法：40例择期行腹腔镜手术的患者,随机均分为异氟醚静吸复合麻醉组（静吸组）和异丙酚-舒芬太尼全凭静脉麻醉组（静脉组）。测定气腹前（T0）、气腹后30min（T1）、60min（T2）和放气后10min（T3）时动脉pH（pHa）、PaCO2、i-pH、PgCO2和PCO2gap。术中同时记录心电图（ECG）、心率（HR）、收缩压（SBP）、舒张压（DBP）、血氧饱和度（SpO2）、气道压力（AWP）。结果：与T0比较,两组T1、T2和静吸组T3时PCO2gap升高,i-pH降低（P〈0.01或P〈0.05）。与静吸组比较,静脉组T1、T2和T3时PCO2gap降低,i-pH升高（P〈0.05）。与T0比较,两组T1、T2的AWP和HR升高（P〈0.01）。两组SBP、DBP、SpO2、pHa无显著性差异。结论：异丙酚-舒芬太尼全凭静脉麻醉可减轻腹腔镜患者CO2气腹期间的内脏低灌注,优于静吸复合麻醉。     

Intravenous Immunoglobulin in Women With Five or More Abortions

PROBLEM: Treatment for recurrent miscarriage has usually been given to all women with three or more abortions of unknown cause. As these patients have a 50–60% subsequent live birth rate, no treatment has been shown to unequivocally improve the live birth rate. Immunoglobulin is the latest treatment to be applied. In order to determine if immunoglobulin improves the live birth rate, we analyzed the results of patients expected to have a poor outcome in the subsequent pregnancy if left untreated, i.e., women with five or more abortions, who have aborted after paternal leucocyte immunization or who continue to abort despite possessing anti-paternal complement dependent antibody (APCA). METHODS: A preliminary trial was carried out using immunoglobulin (Sandoglobulin, Sandoz, Switzerland). It was infused at a dose of 400mg/Kg body weight, in the follicular phase of a cycle in which pregnancy was planned. A booster dose was administered as soon as pregnancy was diagnosed. RESULTS: Twelve patients were treated, ten conceived. Five have had subsequent live births. Two infants were premature but their size was appropriate for gestational age. The other three infants delivered at term. CONCLUSIONS: This is still too small a group from which to draw definite conclusions about the efficacy of immunoglobulin to prevent abortion. However, five live births in ten patients is an encouraging result, especially when the expected poor obstetric outcome is considered. Hence the efficacy of immunoglobulin should be evaluated further in high risk patients.     

急性心肌梗死静脉溶栓治疗和心电监护的体会

目的探讨静脉溶栓治疗和心电监护对急性心肌梗死(AMI)的疗效。方法全部病例均符合WHO规定的AMI诊断标准,治疗均给予尿激酶(UK)100 U～150万U,加生理盐水100 ml,静脉点滴,30 min滴完。同时给予心电监护,以期能及时发现患者存在的各种心律失常。结果本组72例中,均无牙齿出血、消化道出血及出血性脑卒中等并发症的发生,1例出现静脉穿刺部位皮肤瘀斑;所有患者均好转出院。结论静脉溶栓治疗和心电监护对急性心肌梗死(AMI)的疗效可靠,值得在基层医院使用。     

Outcomes of Empirical Treatment With Intravenous Immunoglobulin G Combined With Low-Dose Aspirin in Women With Unexplained Recurrent Pregnancy Loss

BackgroundTo assess the clinical efficacy of intravenous immunoglobulin G (IVIG) administration combined with low-dose aspirin in women with unexplained recurrent pregnancy loss (RPL).MethodsWe retrospectively analyzed the medical records of patients who had been diagnosed with unexplained RPL and treated with IVIG and low-dose aspirin between January 2000 and March 2020 at Asan Medical Center. We analyzed pregnancy outcomes and their association with the percentage of natural killer (NK) cells.ResultsThe study analyzed a total of 93 patients and 113 natural and assisted reproductive technology pregnancy cycles. The live birth rate per cycle was 73.5% (83/113), and the term delivery rate was 86.7% (72/83). The live birth rate was high regardless of the type of RPL, method of pregnancy, timing of IVIG treatment, and presence or absence of autoantibodies. In addition, the live birth rate was significantly higher in patients who received IVIG more than once, compared with patients who received IVIG only once (77.8% vs. 42.9%, P = 0.006). There was no significant association between the NK cell counts and live birth rate (65.5% in the group with NK cell < 12%, and 69.7% in that with NK cell ≥ 12%, P = 0.725). Among all patients, 87.6% had no complications, and there were no congenital malformation among newborn babies.ConclusionIVIG combined with low-dose aspirin treatment showed favorable pregnancy outcomes regardless of the patient’s NK cell counts (%).     

长托宁和东莨宕碱作为全身麻醉前静脉用药的比较

目的 观察在拟行甲状腺部分切除术的患者中麻醉前静脉应用长托宁和东莨菪碱对循环系统的影响及并发症.方法 选择40例ASA Ⅰ～Ⅱ级需要行甲状腺次全切除术的患者,麻醉前随机静脉注射长托宁0.01mg/kg(Ⅰ组,n=20)和东莨菪碱0.01mg/kg(Ⅱ组,n=20),10min后,常规进行麻醉诱导和维持.结果 Ⅰ组SBP、DBP、HR在给药后均有下降趋势(P＜0.05),而Ⅱ组SBP、HR在给药后第3～5 min时明显升高(P＜0.05),也显著高于Ⅰ组(P＜0.01),10min后回落至正常水平(P＜0.01).Ⅰ组在给药后未发生心悸,而Ⅱ组中有8例(P＜0.01),面红、口干的发生率也较少(P＜0.05),而术中及术毕时的痰量却少于Ⅱ组(P＜0.05).结论 长托宁为长效的腺体分泌抑制剂,可以在麻醉前静脉应用,特别适用于心率不宜增快的患者.     

七氟醚与丙泊酚静脉麻醉对老年髋关节置换术患者 认知功能的影响

目的 比较七氟醚复合静脉麻醉与丙泊酚静脉麻醉对老年髋关节置换术患者认知功能的影响。方法 择期拟行髋关节置换术老年患者60例,采用随机数字表法分为七氟醚组和丙泊酚组,各30例,七氟醚组常规麻醉诱导后予2.5%~3.5%七氟醚,丙泊酚组常规麻醉诱导后予丙泊酚静脉靶控输注,分别于术前1 d 和术后7 d行镇静/警觉评分和简明精神状态量表评分评价患者认知功能。结果 丙泊酚组OAA/s评分（4.21±0.40）分,高于七氟醚组（3.98±0.35）分,差异有统计学意义（P＜0.05）;术后7 d丙泊酚组MMSE评分、语言能力,高于七氟醚组,差异有统计学意义（P＜0.05）,定向力、记忆力、注意力和计算力、回忆能力与七氟醚组,差异无统计学意义（P＞0.05）。结论 丙泊酚静脉麻醉引起的术后认知功能损害低于七氟醚复合静脉麻醉,是老年患者更为理想的麻醉方案。     

The Effects of Intravenous Ephedrine During Spinal Anesthesia for Cesarean Delivery: A Randomized Controlled Trial

We designed a randomized, double-blinded study to determine the efficacy and safety of 0.5 mg/kg intravenous ephedrine for the prevention of hypotension during spinal anesthesia for cesarean delivery. Patients were randomly allocated into two groups: ephedrine group (n=21) and control group (n=21). Intravenous preload of 15 mL/kg lactated Ringer''s solution was given. Shortly after the spinal injection, ephedrine 0.5 mg/kg or saline was injected intravenous for 60 sec. The mean of highest and lowest heart rate in the ephedrine group was higher than those of control group (P<0.05). There were significant lower incidences of hypotension and nausea and vomiting in the ephedrine group compared with the control group (8 [38.1%] vs. 18 [85.7%]); (4 [19%] vs. 12 [57.1%], respectively) (P<0.05). The first rescue ephedrine time in the ephedrine group was significantly longer (14.9±7.1 min vs. 7.9±5.4 min) than that of the control group (P<0.05). Neonatal outcome were similar between the study groups. These findings suggest, the prophylactic bolus dose of 0.5 mg/kg intravenous ephedrine given at the time of intrathecal block after a crystalloid fluid preload, plus rescue boluses reduce the incidence of hypotension.