肾移植患者围术期麻醉管理：40例资料回顾

背景：从肾移植患者围术期血生化检测结果可以看到,一些酸碱指标及生化指标的变化可能与血液稀释有关。 目的：通过监测肾移植患者围术期血流动力学的变化以及电解质、血生化的改变,麻醉药物使用情况,探讨肾移植患者理想的麻醉管理方法。 方法：分析40例肾移植患者麻醉前、肾动脉血流开放前、血流开放后10 min、手术结束时(T4)各时点平均动脉压、中心静脉压、心率、电解质、血糖和血气参数的变化。 结果与结论：与肾移植患者麻醉前比较,血流开放后10 min平均动脉压、中心静脉压、pH、HCO^3-、BE显著降低(P < 0.01),K⁺和葡萄糖明显增加(P < 0.01)。与肾动脉血流开放前比较,血流开放后10 min平均动脉压、葡萄糖、pH、HCO^3-、BE明显降低而心率明显增高(P < 0.05)。说明充分的移植前准备,合理的麻醉药物选择,以及围术期的循环、呼吸及水电解质酸碱平衡的维持是肾移植术全身麻醉成功的关键。     

丹参酮ⅡA对子宫缺血再灌注损伤模型大鼠的保护效应

背景：损伤造成的组织器官暂时缺血现象临床常见,但对其缺血再灌注损伤干预的研究甚少。利用大鼠子宫缺血再灌注损伤模型研究丹参酮ⅡA对改善大鼠子宫缺血再灌注损伤作用有意义。 目的：观察丹参酮ⅡA在干预大鼠子宫中抗缺血再灌注损伤中的作用。 方法：采用线栓法建立子宫缺血再灌注损伤模型大鼠,在术前第5,3,1 天及术前30 min 给予腹腔注射丹参酮ⅡA磺酸钠注射液20 mg/kg,设为干预组,并设模型组和假手术组作对照。 结果与结论：分光光度计测量和免疫组织化学染色结果显示,缺血再灌注1,3 h,与模型组比较,干预组损伤子宫组织中丙二醛浓度、Bax蛋白的表达显著降低(P < 0.05),而超氧化物歧化酶活性、Bcl-2蛋白表达显著提高(P < 0.05)。结果证实,丹参酮ⅡA对大鼠子宫缺血再灌注损伤具有保护作用。中国组织工程研究杂志出版内容重点：肾移植;肝移植;移植;心脏移植;组织移植;皮肤移植;皮瓣移植;血管移植;器官移植;组织工程     

慢性移植肾失功的透析时机及影响因素

背景：移植肾功能丧失后要及时转入透析以继续维持患者生命,并为部分患者的再移植作准备。目前国内有关移植肾功能丧失后透析时机的报道尚不多见。 目的：探讨慢性移植肾失功患者开始透析的时机及其影响因素。 方法：调查2005年7月至 2012年12月上海长征医院肾移植康复病房收治的肾移植后慢性移植肾失功患者98例,回顾性分析其临床资料,主要包括内生肌酐清除率、血肌酐、尿毒症症状及并发症,比较不同血液透析时机患者间的差别,分析影响透析时机的因素。 结果与结论：透析前87%的患者有明显尿毒症症状,78%出现心、脑并发症,31.6%需急诊透析。全部移植肾失功患者进入血液透析时的内生肌酐清除率为(5.94±0.63) mL/min,9例患者内生肌酐清除率> 10 mL/min,51例患者内生肌酐清除率为5-10 mL/min,38例患者内生肌酐清除率< 5 mL/min。其中合并丙肝患者进入血液透析治疗时的内生肌酐清除率明显比非丙肝患者高(P < 0.05)。结果显示,开始透析的慢性移植肾失功患者有明显尿毒症并发症,多数透析时机较迟,尤其是丙肝患者。健康宣教、医疗保健是影响透析时机的关键因素。     

右美托咪定抑制肾缺血/再灌注炎性反应

背景：在缺血/再灌注肾脏损伤的防治研究中,用药物激活或抑制机体某些因子从而保护肾组织,对肾移植和移植物的功能恢复有着重要意义。 目的：探索右美托咪定对大鼠肾缺血/再灌注炎性因子及C-X-C型趋化因子受体4表达的影响。 方法：40只大鼠随机等分为假手术组、缺血再灌注组、右美托咪定预处理组及右美托咪定后处理组。后3组行右肾切除,左肾缺血45 min,再灌注60 min,造肾缺血再灌注模型;右美托咪定预处理组于大鼠股静脉穿刺置管后泵注1 μg/kg右美托咪定,10 min后改为0.5 μg/kg,泵注30 min直至缺血即刻;右美托咪定后处理组于左肾再灌注后静脉泵注0.5 μg/kg右美托咪定 30 min。 结果与结论：肾脏缺血再灌注大鼠肾脏损伤严重,炎症明显,肾小管扩张,有肾小球肾炎表现,血清中白细胞介素1β和肿瘤坏死因子α水平显著升高(P < 0.05),血清和肾脏中C-X-C型趋化因子受体4水平也明显增加(P < 0.05);经右美托咪定预处理或后处理的肾缺血再灌注大鼠血清中白细胞介素1和肿瘤坏死因子α水平明显降低(P < 0.05),血清和肾脏中C-X-C型趋化因子受体4水平也明显降低(P < 0.05)。提示肾缺血再灌注可致以炎性反应为特征的肾损伤;右美托咪定可以抑制炎性反应并弱化C-X-C型趋化因子受体4的表达,具有一定的肾保护作用。 中国组织工程研究杂志出版内容重点：肾移植;肝移植;移植;心脏移植;组织移植;皮肤移植;皮瓣移植;血管移植;器官移植;组织工程全文链接：     

多巴胺预注射在剖宫产腰硬联合麻醉的临床应用

目的 探讨多巴胺预注射在剖宫产腰硬联合麻醉应用对产妇血流动力学及胎儿安全性的影响。方法 选择2015年1月~2017年1月我院行剖宫产孕妇60例,随机分为多巴胺预注射组和一般腰硬联合麻醉组,各30例。一般腰硬联合麻醉组在麻醉前用6%羟乙基淀粉130/0.4氯化钠注射液进行快速扩容。多巴胺预注射组在一般腰硬联合麻醉组基础上,在麻醉前用微量注射泵以1.2 μg/（kg·min）速度进行多巴胺预注射。记录两组产妇麻醉前、麻醉后5 min、麻醉后10 min、麻醉后15 min心率和血压;麻醉前及麻醉后5 min胎心率;新生儿Apgar评分及脐静脉血pH、PaO2、BE值。结果 麻醉前两组HR、SBP和DBP比较,差异无统计学意义（P＞0.05）。多巴胺预注射组与一般腰硬联合麻醉组麻醉后5 min、麻醉后10 min、麻醉后15 min SBP和DBP与麻醉前比较,差异有统计学意义（P＜0.05）。麻醉后15 min,两组HR与麻醉前比较,差异有统计学意义（P＜0.05）。多巴胺预注射组与一般腰硬联合麻醉组比较,胎心率与新生儿Apgar评分、脐静脉血pH、PaO2、BE比较,差异均无统计学意义（P＞0.05）。结论 多巴胺预注射在剖宫产腰硬联合麻醉应用能更好的减少产妇血压明显波动,保持血流动力学稳定性,更利于保证胎儿的安全。     

不同通气方式对髋关节置换高血压患者应激反应的影响

背景：髋关节置换患者全麻时,气管插管可造成咽喉和气管感受器的物理刺激,会引起患者的应激反应增强,尤其是高血压患者。Supreme喉罩能够减轻围术期患者心血管应激反应,降低气道并发症。 目的：观察Supreme喉罩和气管插管对高血压患者髋关节置换应激反应的影响。 方法：取2010年1月至2014年9月于江苏省沭阳仁慈医院行人工髋关节置换的患者45例,采用随机数字表法将患者均分为两组,喉罩组23例,气管插管组22例。两组患者均采用相同的麻醉诱导和维持方法,置换过程中连续监测患者的收缩压、舒张压、心率及血氧饱和度,分别记录两组麻醉诱导前(T0)、插管(喉罩)后即刻(T1)、5 min(T2)、15 min(T3)时收缩压、舒张压、血氧饱和度、心率及血糖、血浆肾上腺素、去甲肾上腺素、血清皮质醇、血管紧张素Ⅱ及心钠素水平。 结果与结论：喉罩组患者收缩压与舒张压在T1-T3时间点较T0时明显降低(P < 0.05);心率、血氧饱和度在T0-T3各时间点比较平稳,差异无显著性意义(P > 0.05)。气管插管组患者收缩压、舒张压在T1时较T0时显著升高,收缩压在T2、T3时较T0明显降低,舒张压在T3时较T0显著降低(P < 0.05),心率、血氧饱和度在T1时间点显著升高(P < 0.05)。与T组比较,喉罩组患者收缩压与舒张压在T1-T3时间点显著降低(P < 0.05),心率在T1、T2较T组明显减慢(P < 0.05),血氧饱和度在T1显著高于T组(P < 0.05)。与T0时比较,T1-T3时气管插管组血糖、血浆肾上腺素、去甲肾上腺素浓度和皮质醇含量明显升高,且显著高于喉罩组(P < 0.05)。T1-T3时气管插管组血管紧张素Ⅱ水平较T0时显著增高,且均高于喉罩组。T1-T3时两组心钠素含量明显升高,气管插管组显著高于喉罩组(P < 0.05)。可见喉罩对于这些与应激相关的生化指标的影响较小,这也是其对患者血流动力学影响较小的生理基础。提示与气管插管比较,喉罩可明显减轻高血压患者全麻状态下髋关节置换时的应激反应。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

老年髋关节置换过程中硬膜外麻醉与腰-硬联合麻醉:血液动力学差异

背景:腰-硬联合麻醉和硬膜外麻醉均是老年人手术中常用的麻醉方式,各有优缺点。采用合适的麻醉方式保持循环稳定可以降低患者的手术风险和并发症,提高治疗成功率。目的:分析对比硬膜外麻醉与腰-硬联合麻醉在老年髋关节置换中的麻醉效果以及对于血流动力学的影响。方法:选择髋关节置换老年患者80例,随机分为两组,每组40例,试验组予以腰-硬联合麻醉,对照组予以硬膜外麻醉。对比两组患者各时间点的平均动脉压、心率和中心静脉压变化,感觉、运动阻滞起效及恢复时间,麻醉后30 min各阻滞平面和Bromage运动阻滞评分以及麻醉效果。结果与结论:对照组麻醉后5 min、30 min和术毕的平均动脉压显著低于麻醉前和试验组同时间点(P0.05);对照组麻醉后5 min、30 min和术毕的心率显著高于麻醉前和试验组同时间点(P0.05);对照组麻醉后5 min、30 min和术毕的中心静脉压显著高于麻醉前和试验组同时间点(P0.05)。试验组的感觉、运动阻滞起效时间显著短于对照组,感觉、运动阻滞恢复时间显著长于对照组(P0.01)。两组患者麻醉后30 min各阻滞平面和Bromage运动阻滞评分差异无显著性意义(P0.05)。试验组的麻醉效果显著优于对照组(χ2=5.691 7,P=0.017 00.05)。提示与硬膜外麻醉相比,腰-硬联合麻醉可以减少髋关节置换患者的血流动力学变化,麻醉效果更佳。     

内皮微粒在肾移植急性排斥反应中的诊断作用

背景：血管内皮细胞的变化与移植排斥反应的关系极为密切,内皮微粒脱落于激活或凋亡的内皮细胞,能直接而特异地反映血管内皮细胞的变化,检测血浆中内皮微粒对肾移植排斥反应的诊断监测具有一定的理论和实际意义。 目的：探讨肾移植急性排斥反应时循环内皮微粒的数量和表型的变化及与急性排斥反应之间的关系。 方法：建立同基因和同种异基因大鼠腹腔原位肾移植模型;移植后5 d苏木精-伊红染色观察肾组织的病理学改变,并进行Banff评分;采用免疫组化法检测肾组织中细胞间黏附分子1表达;采用流式细胞术检测血浆中CD144⁺内皮微粒数量及细胞间黏附分子1⁺/CD144⁺内皮微粒的数量;分析内皮微粒的数量和表型与肾组织病理变化的关系。 结果与结论：与同基因移植组比较,异基因移植组Bnaff评分明显增加(P < 0.01),肾组织中细胞间黏附分子1表达明显增强(P < 0.01);与同基因移植组比较,异基因移植组CD144⁺内皮微粒的数量和携带细胞间黏附分子1的内皮微粒的水平明显增加(P < 0.01)。内皮微粒的数量与移植肾急性排斥反应的程度呈正相关(P < 0.01),携带细胞间黏附分子1内皮微粒的水平与移植肾脏中细胞间黏附分子1的表达呈正相关(P < 0.01)。提示肾移植后对内皮微粒数量和表型进行检测对诊断急性排斥反应的发生有一定意义。     

肾移植后移植肾血流灌注与左心功能相关性分析

目的探讨移植肾彩色多普勒能量图(CDE)与左心功能的关系和临床意义.方法于肾移植前2次血透之间及肾移植后半年内和半年以后,采用CDFI超声诊断仪观察移植肾CDE血流灌注情况并分为4级,同时检测肾移植前后患者心功能指数,对比分析CDE与左心功能指数的相关性.结果 CDE移植肾内血流灌注满意,心功能超声测值有显著改善(p<0.05);而CDE移植肾内血流灌注不满意,心功能超声测值无显著改善(p>0.05).结论 CDE移植肾内血流灌注变化与左心功能改善呈正相关.同时随时间的推移心功能各项指标均有明显改善.     

肾移植术后体外循环下主动脉瓣置换1例

目的总结肾移植术后移植肾功能不全合并主动脉瓣置换患者围术期的管理要点。方法加强围术期移植肾功能的保护,注意长期免疫抑制剂的使用,维持恒定的血药浓度,将手术前后肾功能各项指标及心脏超声进行比较,观察有无感染和排斥反应的发生。结果手术顺利,未出现严重感染和急性排斥反应。结论肾移植术后瓣膜病患者,应注意维持围术期血流动力学的稳定,保证肾血流灌注,尽量减少体外循环引起的肾损伤,注意长期免疫抑制剂的使用,预防感染和急性排斥反应。     

老年高血压患者全膝关节置换中硬膜外复合小剂量静脉麻醉的安全性

背景：老年高血压患者常合并器官组织缺血,在接受关节置换的过程中较易出现各种风险。为保证置换手术的顺利进行,提高安全性,需要选择合适的麻醉方式。 目的：探讨硬膜外复合小剂量静脉麻醉在老年高血压全膝关节置换中的应用安全性。 方法：从2013年12月至2014年12月河北医科大学附属第三医院收治的老年高血压关节置换患者中选择64例,随机分为对照组和观察组,每组32例,分别给予全凭静脉麻醉和硬膜外复合小剂量静脉麻醉。测定麻醉前、麻醉诱导后、麻醉后10 min、应用骨水泥后10 min、置换结束时两组患者的收缩压、舒张压、心率、血氧饱和度、呼吸率变化;记录置换中血管活性药物(包括麻黄碱、多巴胺等)的使用率以及置换后不良事件发生情况等。 结果与结论：较之麻醉前,两组患者在麻醉后10 min、应用骨水泥后10 min的收缩压、舒张压均显著降低,血氧饱和度均升高,差异均有显著性意义(P < 0.05);置换结束时对照组收缩压、舒张压及呼吸率显著高于观察组,差异均有显著性意义(P < 0.05)。观察组和对照组使用血管活性药物,包括麻黄碱、多巴胺等的分别有3例和15例,使用率经比较差异有显著性意义(P < 0.05)。且对照组置换后有5例患者出现呼吸功能不全,给予短期呼吸机支持后明显改善。提示与全凭静脉麻醉相比,在老年高血压患者全膝关节置换中实施硬膜外复合小剂量静脉麻醉具有更高的安全性。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

小剂量不同浓度罗哌卡因在腰硬联合麻醉 前列腺电切术中的效果对比

目的 探讨小剂量不同浓度罗哌卡因在腰硬联合麻醉前列腺电切手术中的麻醉效果。方法 选择2015年2月~2017年10月90例行前列腺电切手术患者,运用随机数字表法将其分为对照组与实验组,各45例。对照组予以2 ml 0.75%的罗哌卡因,实验组予以2 ml 1%的罗哌卡因,观察两组患者的阻滞持续时间、麻醉前后的心率、血压与麻醉效果情况。结果 麻醉前,两组患者的SBP、DBP、心率比较,差异无统计学意义（P＞0.05）;麻醉后,实验组患者心率为（64.21±5.14）次/min,SBP（119.62±7.31）mmHg,DBP（79.41±9.06）mmHg,各指标均低于对照组的心率（71.53±5.83）次/min,SBP（126.94±8.64）mmHg,DBP（85.92±7.53）mmHg,组间差异有统计学意义（P＜0.05）;实验组的阻滞持续时间为（35.46±5.34）min,长于对照组的（26.57±1.09）min,差异有统计学意义（P＜0.05）。结论 小剂量高浓度的罗哌卡因在腰硬联合麻醉前列腺电切手术中阻滞持续时间长,患者生命体征稳定,阻滞持续时间,具有较高的临床应用价值。     

Hemodynamic and emotional responses to a psychological stressor after cardiac transplantation

OBJECTIVE: Because cardiac transplantation entails neuronal decentralization, cardiac responses to a psychological stressor in transplant patients would be expected to rely on circulating hormonal factors and therefore to be delayed and prolonged. We tested this prediction by comparing stress responses after transplantation with those in patients with coronary artery bypass grafts (to control for experience of surgery) or heart failure (to control for heart disease). METHODS: Fifty-six transplantation patients, 66 bypass patients, and 40 patients with heart failure underwent a 10-minute, computer-generated, Stroop color-word conflict test. Heart rate and systolic and diastolic blood pressures were recorded continuously for 1 minute before, during, and 12 minutes after the stressor. Emotional state was measured periodically by questionnaires. RESULTS: All hemodynamic variables were increased by the Stroop test. There was a pattern of blunted response to the Stroop test after cardiac transplantation, particularly in comparison with bypass patients, and slower recovery in comparison with both control groups. Emotional stress responses were similar in each group. CONCLUSIONS: This pattern cannot be attributed to the experience of major heart surgery or to cardiac disease. Nor can it be explained by differences in central processing of stress. Correspondingly the changed hemodynamic response to the Stroop test after cardiac transplantation evidently does not affect patients' emotional responses. The hemodynamic findings are consistent with an increased reliance on hormonal rather than neuronal hemodynamic regulation after cardiac transplantation.     

地佐辛与瑞芬太尼用于无痛人工流产麻醉的效果比较

目的 观察地佐辛与瑞芬太尼复合丙泊酚用于无痛人工流产麻醉的临床效果。方法 选择2018年9月~2019年5月在我院行无痛人工流产患者60例,采用随机数字表法分为对照组和观察组,各30例。对照组采用瑞芬太尼联合丙泊酚麻醉,观察组采用地佐辛联合丙泊酚麻醉,比较两组临床麻醉效果、丙泊酚用量、手术时间、清醒时间、恢复定向时间、术后疼痛评分、不同时间段血压和心率变化以及临床不良反应发生情况。结果 观察组麻醉总有效率优于对照组（P＜0.05）;观察组丙泊酚用量、手术时间、清醒时间、恢复定向时间、术后疼痛评分均低于对照组（P＜0.05）;两组麻醉前舒张压、收缩压、心率比较,差异无统计学意义（P＞0.05）;两组手术开始5 min及术后5 min的舒张压、收缩压、心率均高于麻醉前,且观察组均低于对照组（P＜0.05）;观察组不良反应发生率低于对照组（P＜0.05）。结论 地佐辛联合丙泊酚用于无痛人工流产术麻醉效果优于瑞芬太尼联合丙泊酚,同时可维持患者生命体征稳定,减轻患者疼痛,且不良反应少,临床应用安全性良好。     

Psychophysiological Reactivity in Cardiac Transplant Recipients

To assess the contribution of the heart's autonomic innervation to reactivity to psychological stressors, hemodynamic responsiveness of the denervated human heart was examined in two studies. In Study 1, cardiac output measured by thermodilution. heart rate, and systolic and diastolic blood pressure responses to a 4-min mental arithmetic task were studied in 7 cardiac transplant patients during routine post-transplant cardiac catheterization. In Study II, 6 cardiac transplant patients, 5 normal controls, and 5 renal transplant patients participated in a 78-min psychophysiological stress protocol during which heart rate, systolic and diastolic pressure, and cardiac output (measured noninvasively by impedance cardiography) as well as serum epinephrine and norepinephrine were measured at baseline and while subjects performed mental arithmetic and reaction time tasks. In Study I, transplant patients showed significant increases, relative to baseline, in heart rate, systolic blood pressure, and cardiac output in response to mental arithmetic. The diastolic blood pressure response was marginally significant. In Study II, mental arithmetic produced significant reactivity in systolic blood pressure and marginally significant increases in heart rate and diastolic blood pressure in cardiac transplant patients. Reaction time produced only marginally significant diastolic blood pressure reactivity. Hemodynamic reactivity of the cardiac transplant group generally was lower than that of the two innervated groups, which generally were similar to each other. Although the small number of subjects makes conclusions tentative, these data suggest that: 1) Cardiac transplant patients are capable of significant reactivity to psychological stressors despite the absence of innervation of the heart, and 2) reactivity to these stressors is diminished relative to innervated control subjects. In the absence of cardiac innervation, reactivity is due to the vascular system and cardiac effects mediated by humoral factors.     

清醒心肌缺血模型的可控冠状动脉狭窄程度

BACKGROUND:Anesthesia is a protective measure to animals in animal experiments, but the use of the corresponding anesthetic drugs will have different effects on the experimental results. OBJECTIVE:To analyze the differences of various indexes and the therapeutic effect of myocardial ischemia canine model of coronary stenosis under the condition of consciousness and anesthesia. METHODS:Twenty Beagle canine myocardial ischemia models were equally assigned to five groups, and prepared according to the complete orthogonal Latin square arrangement for the experiment. Intervention procedures included the normal observation (normal control for 10 minutes, observation for 30 minues), conscious model (after normal control, coronary artery stenosis for 10 minutes, and observation for 30 minutes), conscious treatment (after normal control, coronary artery stenosis for 10 minutes, 50 μg/kg nitroglycerin sublingually buccal, and observation for 30 minutes), anesthesia model (animals received anesthesia; after normal control, coronary artery stenosis for 10 minutes, and observation for 30 minutes), anesthesia treatment (animals received anesthesia; after normal control, coronary artery stenosis for 10 minutes, 50 μg/kg nitroglycerin sublingually buccal, and observation for 30 minutes). We recorded canine electrocardiogram, blood pressure, heart rate and body temperature level when animals were conscious after coronary artery stenosis, and mean arterial blood pressure, body temperature, heart rate, electrocardiogram ST segment changes in conscious and anesthetic states in myocardial ischemia dogs, and observed the therapeutic effect of nitroglycerin on conscious and anesthetic states in myocardial ischemia dogs. RESULTS AND CONCLUSION:The electrocardiogram, blood pressure, heart rate and body temperature were changed after the coronary artery stenosis in conscious dogs, and the ST segment of electrocardiogram was significantly increased. The blood pressure and heart rate were significantly higher than that in the conscious state (P < 0.05), and the ST segment of electrocardiogram in dogs was significantly increased in conscious and anesthetic states. After the treatment of nitroglycerin, the effect was obvious in the myocardial ischemia model in conscious state. The results showed that the model of myocardial ischemia and the clinical fitting degree were higher, which could reduce the effect of anesthesia on the experimental results.     

超声引导下腰方肌阻滞联合丙泊酚麻醉在腹腔镜结直肠癌根治术中的应用

目的:研究超声引导下腰方肌阻滞联合丙泊酚麻醉在腹腔镜结直肠癌根治术中的应用价值。方法:选取90例择期进行腹腔镜结直肠癌根治术患者作为研究对象，随机分为观察组和对照组，各45例。对照组采用传统腰麻联合丙泊酚麻醉，观察组采用超声引导下腰方肌阻滞联合丙泊酚麻醉，比较两组患者术中（麻醉后5、15、30、60 min）收缩压（SBP）、舒张压（DBP）、心率（HR）和术后不同时间段的疼痛评分（VAS评分），以及加用镇痛药情况和肠道恢复排气时间和术后48 h内不良反应发生情况。结果:两组患者SBP、DBP、HR组间、不同时间点及交互差异均有统计学意义（P<0.05），且观察组麻醉后上述指标波动较对照组小（P<0.05）；麻醉前，两组患者皮质醇、肾上腺素水平无显著差异（P>0.05），麻醉后各时间点观察组患者上述指标水平均显著低于对照组（P<0.05）；两组患者VAS评分组间、不同时间点及交互差异均有统计学意义（P<0.05），且观察组术后各时间点VAS评分均显著低于对照组（P<0.05）；观察组不良反应发生率显著低于对照组（8.89% vs 24.44%, P<0.05）；观察组患者加用镇痛药的人数、剂量和肠道恢复排气时间均显著少于对照组（P<0.05）。结论:超声引导下腰方肌阻滞联合丙泊酚麻醉在腹腔镜结直肠癌手术中具有良好、稳定的麻醉效果，可有效缓解患者疼痛，减少术后不良反应发生。     

Histamine release during the induction of anesthesia with propofol in allergic patients: A comparison with the induction of anesthesia using midazolam-ketamine

OBJECTIVE: A prospective randomized controlled study was performed for patients with a history of allergy to evaluate the effect of the induction of anesthesia with propofol against histamine release, skin reactions, hemodynamic changes and other clinical symptoms, while also comparing these parameters during the induction of anesthesia with midazolam-ketamine for patients with a history of allergy. SUBJECTS: We examined 40 patients undergoing oral surgery, who had a history of allergy and/or the percentage of eosinophils in the leukocytes was more than 3%. METHODS: Forty patients were randomly allocated into two groups and thus received either midazolam-ketamine (M-K group, n = 20) or fentanyl-propofol (propofol group, n = 20) for the induction of anesthesia. Venous blood samples (4 ml each) were obtained before induction as a control and at 0.5, 1, 3, 5 minutes after the administration of each induction agent, and then furthermore at 0.5, 1, 3, 5 minutes after tracheal intubation in order to measure the plasma histamine level by using the HPLC post-label system. In addition, the blood pressure and heart rate were also simultaneously recorded. Skin reactions were also evaluated by two anesthesiologists. RESULTS: The incidence of 50% histamine release during the induction of anesthesia with propofol occurred in 15% of the patients with a history of allergy. Sixteen patients out of 20 (80%) showed a decrease in the systolic blood pressure after the administration of propofol without any evidence of histamine release. The incidence of 50% histamine release, skin reactions and an increase in the heart rate between the two groups were not statistically significant after the administration of each anesthetic agent. Moreover, some patients also demonstrated histamine release after tracheal intubation. Hemodynamic changes after tracheal intubation showed a similar tendency in both groups. No significant difference was observed regarding the incidence of histamine release, skin reactions and hemodynamic changes between both groups after tracheal intubation. CONCLUSIONS: Propofol was found to show a similar incidence of histamine release during the induction of anesthesia using midazolam-ketamine, and thus was also found to be a useful induction agent against histamine release for patients with a history of allergy when hydroxizine was used as a premedication.