右旋美托咪啶预防老年胸科手术患者拔管不良反应的疗效

目的 观察右旋美托咪啶对老年胸科手术患者拔管不良反应的影响.方法 选择全麻胸科手术老年患者70例,随机分为A组和B组,每组35例.A组:术毕静滴生理盐水10 min后拔管;B组:术毕停用麻醉药即刻,手术结束后静注0.6 μg/kg右旋美托咪啶10 min再行拔管.记录停用麻醉前、拔管即刻、拔管后5 min心率、血压,并对躁动程度、镇静状态、躁动发生率、麻醉苏醒期不良反应进行评估.结果 两组患者 HR、MAP 在停药前均在相同水平(P＞0.05);拔管即刻与拔管后5 min,A组HR、MAP与停药前比较均显著升高(P＜0.05).B组在拔管即刻HR、MAP较停药前明显升高(P＜0.05),拔管后5 min与停药前相比无明显差异(P＞0.05).B组拔管即刻和拔管后5 min,HR、MAP均明显低于A组(P＜0.05).B组麻醉苏醒期躁动程度明显低于A组(P<0.05),镇静状态评分明显高于A组(P<0.05);躁动发生率明显低于对照组(P<0.05).结论 术毕静注0.6 μg/kg右旋美托咪啶10 min可以抑制老年胸科手术全麻气管拔管不良反应,有利于老年患者平稳渡过麻醉苏醒期.     

盐酸右美托咪定在老年全麻腹部手术患者苏醒拔管期的应用价值

目的探讨盐酸右美托咪定在老年全麻腹部手术患者苏醒拔管期的应用价值。方法选择该院2012年6月至2014年6月老年腹部手术患者92例,随机分为两组,各46例,两组患者均在全麻下行腹部手术治疗,研究组患者手术结束前10 min给予小剂量右美托咪定泵注,对照组给予等量生理盐水泵注,观察两组患者泵药前(T1)、拔管前(T2)、拔管时(T3)、拔管后5 min(T4)、拔管后10 min(T5)心率(HR)、血压变化,比较两组患者各时间点Ramsay镇静评分及拔管时间,记录患者苏醒期躁动发生率。结果两组T1时收缩压(SBP)、舒张压(DBP)、HR无统计学差异(P0.05);T2、T3、T4、T5时研究组患者SBP、DBP、HR明显低于对照组(P0.05)。T1时两组Ramsay评分无明显差异(P0.05),T2、T3、T4、T5时研究组Ramsay镇静评分明显高于对照组(P0.05);研究组苏醒期躁动发生率明显低于对照组(P0.05)。结论老年全麻腹部手术患者苏醒期拔管前应用右美托咪定能减轻拔管期血流动力学波动,减少苏醒期躁动,对提高拔管安全性有重要作用。     

地佐辛防治全麻苏醒期躁动的效果分析

目的探讨地佐辛在防治全麻苏醒期躁动的临床效果。方法将2013-02~2014-12该院择期在气管插管全麻下进行手术治疗的94例患者按随机数字表法分为两组,观察组(48例)在手术结束前15 min静注地佐辛0.1 mg/kg,对照组(46例)在手术结束前15 min静注相同容积生理盐水,观察两组患者自主呼吸恢复时间、唤醒时间、拔管时间等,以及两组患者躁动发生率、不良反应发生情况。结果观察组躁动发生率和躁动程度明显低于和轻于对照组(P0.05);观察组自主呼吸恢复时间和拔管时间比对照组明显缩短(P0.01);观察组不良反应发生率低于对照组,但比较差异无统计学意义(P0.05)。结论地佐辛能有效预防全麻苏醒期躁动,并能缩短自主呼吸恢复时间和拔管时间。     

地佐辛对老年心血管病患者腹部手术全身麻醉恢复期质量的影响

目的探讨地佐辛对老年心血管病患者腹部手术全身麻醉恢复期质量的影响。方法择期行腹部手术的老年心血管病患者80例,随机分为对照组和地佐辛组(观察组)各40例,分别于手术结束前10min静脉输注2ml生理盐水或地佐辛0.1mg/kg。2组均采用全身麻醉,记录自主呼吸恢复时间、苏醒时间、拔除气管导管时间及全身麻醉恢复期不良反应,采用视觉模拟评分(VAS)评估拔管后各时间点镇痛效果,Ramsay镇静评分评估镇静等级。结果观察组镇痛有效率明显高于对照组,差异有统计学意义(P<0.05),躁动、呛咳、恶心呕吐、心血管事件等不良反应的发生率均明显低于对照组(均P<0.05),拔管后5min、30min、60min、120minVAS评分均明显低于对照组,差异有统计学意义(均P<0.05),Ramsay镇静评分在拔管后5min、30min均明显高于对照组,差异有统计学意义(均P<0.05)。结论术毕前静脉输注地佐辛可改善老年腹部手术患者全身麻醉恢复期的质量。     

全麻下双肺同期手术病人自然苏醒与催醒的比较

目的比较全麻下双肺同期手术病人自然苏醒和拮抗药催醒状况。方法选取我院全麻双侧肺同期手术病人100例,随机分两组,A组为自然苏醒组,B组为拮抗药催醒组,观察停用全麻药和拔管时两组病人的MAP、HR、脉搏氧饱和度(SPO2);记录A组病人停全麻药后和B组病人给拮抗药后2、4、6、8、10 min各时点患者的CSI值;记录病人苏醒期能按指令睁眼时间、拔管时间、回麻醉恢复室监测时间;记录病人苏醒期躁动、苏醒延迟病例数。结果 B组注药后CSI在各时点的值与A组病人比较差异有统计学意义(P<0.05);B组对按指令睁眼时间、拔管时间、麻醉恢复室监测时间均短于A组(P<0.05);B组苏醒期躁动和苏醒延迟发生例数明显少于A组。结论全麻下双侧肺同期手术病人恢复期拮抗药催醒可减少病人苏醒延迟和躁动等并发症的发生,缩短全麻恢复时间。     

小剂量纳美芬对老年腹腔镜结直肠癌根治病人术后苏醒的影响

目的观察小剂量纳美芬在行全麻腹腔镜结直肠癌根治术的老年病人术后苏醒期的应用效果。方法将全麻下拟行腹腔镜结直肠癌根治术的老年病人60例随机分为对照组及纳美芬组,术毕2组病人分别经静脉给予生理盐水及纳美芬0.15μg/kg。观察并记录2组病人术毕呼吸恢复时间、拔出气管导管时间、术后血流动力学变化、拔管后Ramsay评分、视觉模拟(VAS)评分及术后并发症的发生率。比较2组病人手术结束时及拔管后20 min动脉血p H值、动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)及血糖的变化。结果纳美芬组呼吸恢复时间及拔管时间显著低于对照组(P0.05);纳美芬组拔管后20 min PaO_2及PaCO_2分别为(89.3±2.4)mm Hg、(40.3±1.8)mm Hg,对照组病人拔管后20 min PaO_2及PaCO_2分别为(83.0±2.3)mm Hg、(44.7±1.9 mm)Hg,差异均有统计学意义(P0.05);纳美芬组术后呼吸抑制及恶心呕吐的发生例数显著少于对照(P0.05)。术毕2组血糖及各时点血流动力学变化、Ramsay评分、VAS评分及术后躁动的发生差异均无统计学意义。结论小剂量纳美芬用于老年病人腹腔镜结直肠癌根治术后,能缩短病人术后拔管时间,促进病人呼吸的恢复,减少麻醉复苏时间,且血流动力学平稳,不良反应少,安全性高。     

曲马多对全身麻醉后寒战的干预治疗效果观察

目的探讨曲马多对全身麻醉后寒战的预防及治疗作用。方法将120例全身麻醉下行腹部手术的患者随机分为A、B、C组和对照组各30例。A组气管插管拔管前30min静注曲马多1mg/kg;B组拔管后静注曲马多0.5mg/kg,间隔10min后再次静注0.5mg/kg;C组拔管后单次静注曲马多1mg/kg;对照组拔管前30min单纯静注生理盐水,量同A组。记录麻醉后2h寒战发生情况。结果 A、B、C组寒战发生率明显低于对照组;A、B组明显低于C组（P均〈0.05）。结论曲马多预防麻醉后寒战安全有效;麻醉结束前预注或者术后小剂量分次静注效果更好。     

不同剂量丙帕他莫对胃癌根治术老年患者麻醉恢复期躁动与寒战的影响

目的 观察不同剂量丙帕他莫对胃癌根治术老年患者麻醉恢复期躁动与寒战的影响.方法 将90例择期全麻下行胃癌根治术老年患者随机分为A、B、C组各30例.手术结束前20 min,A、B组分别单次缓慢静注1、2 g丙帕他莫,C组静注生理盐水5 mL;分别于进入麻醉恢复室时（T1）、吸痰拔管（T2）、拔管后5 min（T3）、拔管后10 min （T4）,记录患者的MAP、HR和SpO2;记录各组麻醉恢复期躁动、寒战和呼吸抑制的发生情况.结果 各组手术时间、术中出血量、术中输液量、自主呼吸恢复时间、呼之睁眼时间及拔管时间比较,P均＞0.05.与C组比较,A、B组T2～T4时MAP和HR降低、SpO2升高（P均＜0.05）,A、B组各时点MAP、HR、SpO2比较,P均＞0.05.与C组比较,A、B组躁动、寒战和呼吸抑制发生率降低（P均＜0.05）;与A组比较,B组T2～T4躁动、寒战及呼吸抑制发生率进一步降低（P均＜0.05）.结论 静注2 g丙帕他莫可有效降低胃癌根治术老年患者全麻苏醒期躁动与寒战的发生率,且无呼吸抑制作用.     

帕瑞昔布钠在丙泊酚、瑞芬太尼全麻超前镇痛及预防苏醒期躁动中的应用

目的探讨帕瑞昔布钠在丙泊酚、瑞芬太尼全麻超前镇痛及预防苏醒期躁动中的效果及安全性。方法将60例ASAⅠ～Ⅱ级择期腹腔镜胆囊切除术患者随机分为A、B、C三组各20例。三组均采用丙泊酚、瑞芬太尼复合全麻,其中A组和B组分别于麻醉诱导前20min和术毕前20min静注帕瑞昔布钠40mg,C组麻醉诱导前20min静注生理盐水10ml。分别于麻醉诱导前（T1）、拔除气管导管前（停药10min,T2）、拔管时（T3）、拔管后10min（T4）,观察三组MAP、HR、SpO2及躁动评分（RS）、镇静评分（RSS）、全麻后身体舒适度评分（BCS）、瑞芬太尼用量。结果B、C组T2～T4各点MAP、HR较T1及A组显著升高,尤以C组为著（P〈0．05）;A、B组RS评分显著低于C组,RSS评分及BCS评分显著高于C组,瑞芬太尼用量少于C组,尤以A组为著（P〈0．05）。结论帕瑞昔布钠用于丙泊酚、瑞芬太尼全麻术中可产生明显超前镇痛作用,并可预防苏醒期躁动发生,术前静注效果更好。     

右美托咪定对高血压病患者全麻苏醒期的影响

目的 观察右美托咪定对高血压病患者全麻苏醒期的影响。方法 选取在全麻下行颈椎手术的高血压病患者60例,随机均分为右美托咪定组（试药组,D组）和对照组（C组）,于术毕前10 min分别泵入右美托咪定0.5 μg/kg和芬太尼1 μg/kg。观察麻醉前（T0）、术毕前10 min(T1)、 术毕时(T2)、拔管前即刻 (T3)、拔管后5 min和10 min(T4、T5)时HR、SBP和DBP值。记录T5时Ramsay镇静评分和 VAS疼痛评分及苏醒期不良反应的发生情况。结果 试药组T2时心率显著低于T1时（P<0.05）;对照组T3、T4时HR、SBP均高于麻醉前（P<0.05或P<0.01）;试药组T3~T5时HR、SBP和DBP值均显著低于对照组（P<0.05或P<0.01）。试药组Ramsay镇静评分显著高于对照组（P<0.05）。两组术后VAS评分无显著差异。试药组苏醒期时呛咳、躁动发生率低于对照组（P<0.05）。结论 高血压病患者全麻结束前静脉给予小剂量的右美托咪定能够减轻苏醒期血流动力学波动,可减少不良反应的发生率。     

Nucleation time and growth time in patients with cholesterol gallstone--factors affecting nucleation time and growth time and effect of UDCA and CDCA

Nucleation time (NT) and growth time (GT) were measured in gallbladder bile of patients with cholesterol gallstones. NT was significantly shortened (NT less than 10 days) in pure cholesterol stones but was moderately shortened (11 less than or equal to NT less than or equal to 21) in mixed and combination stones. GT also was accelerated (GT less than 7 days) in cholesterol stones. NT was shortened in increased biliary total protein, but on the contrary, was shortened in decreased apo A-I. NT of bile by UDCA therapy but not CDCA was extended. This suggests that increased apo A-I during UDCA therapy might imply extension of NT. The strong negative correlation between GT and CSI of bile suggests that CSI plays an important role in crystal growth.     

Laboratory controls of heparin therapy with thrombin time, partial thromboplastin time and activated recalcification time

For the laboratory control of a heparin therapy thrombin time, partial thromboplastin time and activated recalcification time are used. On account of distinct differences in the heparin sensitivity of these reactions an indication-related application is necessary. The ability of evidence and the possibility of establishing test-specific therapeutic regions are restricted by differences caused by reagents, individual variability and influence by accompanying haemostasiological changes. The own approach, taking into consideration the so-called heparin resistance, it presented.     

Influence of fibrinogen degradation products on thrombin time, activated partial thromboplastin time and prothrombin time of canine plasma

To investigate how thrombin time, activated partial thromboplastin time (APTT) and prothrombin time are influenced by fibrinogen degradation products (FDP), different concentrations (0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.8 and 1.0 mg/ml) of the purified FDP X, Y, D and E were added to the plasma of healthy dogs. If fragment Y was added to the plasma a considerable inhibitory effect could be demonstrated for all three test systems. A significant prolongation (p < 0.05) was found for concentrations of > or =0.1 mg/ml (thrombin time, APTT) and > or =0.2 mg/ml (prothrombin time). With FDP Y concentrations from >0.185 mg/ml (prothrombin time) to >0.24 mg/ml (APTT) coagulation time was prolonged beyond the respective reference range. As regards the other fragments, a comparable inhibitory effect could only be shown for fragment X added to the thrombin time test system. This effect can most probably be explained by the competition of the FDP X and fibrinogen for the fibrinogen binding sites of thrombin, rather than by a fibrin polymerization disorder. The results demonstrate that for plasma with normal fibrinogen concentration the group tests are only prolonged beyond the reference range at FDP concentrations very rarely found in spontaneous hyperfibrinolysis.     

Diagnostic uses of the activated partial thromboplastin time and prothrombin time

The activated partial thromboplastin time (APTT) and prothrombin time (PT) have three principal uses. In screening for coagulation disorders (or increased risk of postoperative hemorrhage), the tests add no information to the preoperative care of patients without clinical findings indicative of increased bleeding risk. Furthermore, the prevalence of asymptomatic congenital coagulopathies is so low that false-positive test results greatly outnumber true-positive results. Thus, clinicians may use clinical assessment to screen and should reserve coagulation tests to investigate patients with abnormal findings. In evaluating abnormal bleeding, these tests are sufficiently sensitive that if both are negative, further investigation of the coagulation system is obviated. If one or both tests are positive, the pattern of results directs further attention to limited segments of the coagulation sequence. In monitoring anticoagulation therapy, the APTT and PT tests appear to contribute to the safety and effectiveness of heparin and warfarin therapies, respectively.