3种七氟烷吸入麻醉诱导方式的临床研究

目的探讨3种七氟烷吸入麻醉诱导方式的临床效果。方法诱导开始前,打开七氟烷挥发罐,根据分组情况不同,分别选定9％（A组、B组）和4％（C组）,同时氧流量3 L/min预充连接管道。完成后,A组（肺活量呼吸法）嘱咐患者尽力呼气后,面罩紧密置于口鼻部,再尽力吸气,并且连续用肺活量呼吸方式呼吸数次;B组（潮气量呼吸法）将面罩紧密置于患者口鼻部,嘱咐患者正常呼吸;C组（逐渐增加浓度法）用4％七氟烷预充连接管道后,将面罩紧密置于患者口鼻部,嘱咐患者正常呼吸,每25秒增加七氟烷吸入浓度1．5％。设定潮气量为7～9 mL/kg ,呼吸频率为13次/min ,异丙酚60～90μg/kg · min静脉泵注射进行麻醉维持,同时可加用瑞芬太尼0．2～0．3μg/kg · min。结果 A组、B组和C组在不同时间点的收缩压、舒张压和平均压力都得到了抑制（P＜0．05）,并且在时间点T3抑制效果显著（P＜0．01）。A组、B组和C组在不同时间点与心率变化和肌肉松弛效果无密切关联（P＞0．05）。结论通过实验得出3种不同浓度和吸入方式的七氟烷吸入诱导方式均能取得理想的临床效果,都体现出了七氟烷诱导快、刺激性小、对血流动力学影响较平稳的优点。     

持续吸氧致胃破裂1例

1病例介绍病人,女,63岁,工人,因右肺癌于2005年11月8日入当地医院,经术前准备后于11月12日在全身麻醉下行右肺上叶切除术,术后当日12:00时返回病房,术后常规经鼻腔插吸氧管持续吸氧,氧流量2L/min~4L/min,术后第1天08:00,病人突然剧烈腹痛,严重腹胀,呼吸困难,后经120急救车送入我院,门诊以腹痛待查弥漫性腹膜炎收入我科。查体,一般状态差,烦躁不安,血压12/8kPa,脉搏148/min,呼吸32/min,意识清楚,口唇发绀,心肺未见异常,腹式呼吸消失。全腹有压痛、反跳痛,以右上腹为重,腹部叩诊鼓音,右下腹试验穿刺,有大量气体排出,给予留置胃管行胃肠减压,…     

持续吸氧致胃破裂1例

病人，女，63岁，工人，因右肺癌于2005年11月8日入当地医院，经术前准备后于11月12日在全身麻醉下行右肺上叶切除术，术后当日12：00时返回病房，术后常规经鼻腔插吸氧管持续吸氧，氧流量2L／min～4L／min，术后第1天08：00。病人突然剧烈腹痛，严重腹胀，呼吸困难，后经120急救车送入我院。门诊以腹痛待查弥漫性腹膜炎收入我科。     

环磷酰胺对大鼠吸入性损伤肺组织中细胞因子的影响

目的：探讨吸入性损伤后，早期给予注射低剂量环磷酰胺(cyclophosphamide, CY)对大鼠肺组织中肿瘤坏死因子(tumor necrosis factor-α, TNF-α)和白介素2 (Interleukin-2，IL-2) 细胞因子水平的影响。 方法：选用90只雄性Wister大鼠，随机分为10只为空白组，40只为对照组，40只为处理组，将后两组大鼠制成吸入性损伤模型。其中空白组不予任何处理，处理组于伤后1小时腹腔注射CY 2mg/kg，对照组则注射相同剂量的等渗生理盐水。伤后分别于2h、6h、12h 、24h取大鼠肺组织制成匀浆，用酶联免疫吸附（ELISA）法测定TNF-α、IL-2的含量。 结果：与空白组比较，吸入性损伤后2种细胞因子含量均明显升高（P<0.05）；伤后2h、6h、12h 、24h，处理组TNF-α、IL-2均低于对照组(P<0.05)。 结论：低剂量CY可降低大鼠吸入性损伤后肺组织中TNF-α、IL-2的水平从而改善肺损伤的程度,有望成为一种治疗吸入性损伤的新手段。     

Reduced gas-flow inhalation anesthesia in traumatology and orthopedics

Whether reduced gas-flow inhalational anesthesia using sevorane might be used in traumatological and orthopedic care was studied. A hundred and thirty-six reduced gas-flow anesthetic aids were applied. These included 41 aids during high risk surgical interventions (ventral spondylodesis under artificial pneumothorax; two-stage surgical interventions in thoracic and thoracolumbar injuries; total knee joint endoprosthesis, corrective osteotomy and synthesis in limb fractures), 66 aids during moderate-risk ones (transpedicular fixation, total hip joint endoprosthesis, intervertebral herniotomy), and 30 aids during low-risk ones (interbody spondylodesis in cervical spinal injuries, hardware removal, arthroscopy, etc.). Under low-flow anesthesia, the parameters of oxygenation, gas exchange, respiratory function, and hemodynamics were beyond the normal physiological values. The developed procedure makes it possible to employ reduced gas-flow inhalational anesthesia using sevorane at the maximum allowable concentration of 0.8 for traumatological and orthopedic operations. The use of sevorane for anesthetic maintenance reduces a pharmacological load on the patient's homeostasis and the synergism with a central analgesic (fentanyl) and a myorelaxant diminishes both a stress-induced response to surgical aggression and an anesthetic agent. Reduced gas-flow anesthesia promotes the exclusion of intraoperative cold gas cooling that is typical of high-flow anesthesia. It is necessary to continue studies to comparatively analyze the consumables in compliance with the requirements for the quality of high-technology surgical interventions since the application of high-grade disposable consumables reduces airway microbial contamination, the time of disinfection of anesthesia-monitoring apparatuses and the consumption of disinfectant agents.     

雾化吸入硫酸沙丁胺醇发生过敏反应1例

硫酸沙丁胺醇是临床上用于雾化吸入的常用药物 ,是选择性 β2 -肾上腺能受体激动剂 ,在治疗剂量下作用于支气管平滑肌上的 β2 -肾上腺能受体。应用于支气管痉挛的常规处理及治疗严重的急性哮喘发作。 2 0 0 4年 12月 14日我科 1例病人应用此药雾化吸入 2min后发生急性过敏反应。现报告如下。1　病例介绍　　病人 ,女 ,74岁。 2 0 0 4年 12月 7日因发热、呼吸困难 1周而入院 ,入院时查体 :体温 3 8℃ ,脉搏 96/min ,呼吸 2 4/min ,血压 2 2 .67/12 .0 0kPa。诊断 :肺炎、系统性红斑狼疮、冠心病。病人曾因患有系统性红斑狼疮而多次住院治疗…     

七氟烷吸入麻醉与丙泊酚静脉麻醉在小儿扁桃体手术中的应用对比

目的比较丙泊酚和七氟烷应用于小儿扁桃体手术的麻醉效果和安全性。方法选取接受扁桃体手术的患儿52例,随机分为七氟烷组和丙泊酚组各26例,分别采用丙泊酚静脉麻醉和七氟烷吸入麻醉。比较两组患儿麻醉诱导前、手术开始2 min后、手术结束前2 min的血压、心率和血氧饱和度波动情况;比较两组患者的麻醉诱导时间、苏醒时间、定向力恢复时间和不良反应发生情况。结果两组开放静脉一次成功率比较,差异有统计学意义(χ2=8.31,P<0.05)。丙泊酚组患儿的收缩压、舒张压、心率在3个不同时间点比较,差异均有统计学意义(F分别=4.01、6.47、14.03,P均<0.05);七氟烷组患儿的收缩压、舒张压、心率在3个不同时间点比较,差异均没有统计学意义(F分别=0.93、0.90、0.21,P均>0.05)。两组患儿麻醉诱导前的收缩压、舒张压、心率的对比,差异均没有统计学意义(t分别=0.17、0.07、0.54,P均>0.05);手术开始2 min后,丙泊酚组患儿的收缩压、舒张压、心率均明显低于麻醉诱导前(t分别=2.65、2.76、5.08,P均<0.05),手术结束前2 min,丙泊酚组的收缩压、舒张压、心率和麻醉诱导前对比,差异均没有统计学意义(t分别=0.17、1.24、1.12,P均>0.05)。七氟烷组患儿麻醉诱导时间明显长于丙泊酚组,而苏醒时间明显短于丙泊酚组,差异均有统计学意义(t分别=12.31、12.97,P均<0.05)。两组定向力恢复时间比较,差异没有统计学意义(t=0.24,P>0.05)。丙泊酚组诱导时有3例出现气道不通畅,血氧饱和度下降最低达88%,七氟烷组有2例出现屏气,未出现血氧饱和度下降,两组患者术后均有1例出现恶心呕吐。结论七氟烷吸入麻醉在小儿扁桃体手术诱导平稳,患儿易接受,苏醒较快,且不良反应少,是小儿扁桃体手术较为理想的麻醉方式。     

Severe status asthmaticus: management with permissive hypercapnia and inhalation anesthesia

OBJECTIVE: To describe the difficulties that can be encountered during mechanical ventilation of severe status asthmaticus and to discuss the safety of permissive hypercapnia as a ventilatory strategy and the role and limitations of inhalation anesthesia in the treatment of refractory cases. DESIGN: Case series and review of literature. SETTING: Intensive care unit of a tertiary care hospital. PATIENTS: Two patients with severe status asthmaticus. INTERVENTIONS: Administration of inhalational anesthetics. MEASUREMENTS AND MAIN RESULTS: Both patients had respiratory failure secondary to status asthmaticus requiring mechanical ventilation and permissive hypercapnia. They also received inhalational anesthetics because of refractory bronchoconstriction. Levels of PaCO(2) in each case were among the highest and most prolonged elevations (>150 mm Hg for several hours) reported to date. In one case, life-threatening difficulties with ventilation were encountered related to the use of an anesthesia ventilator. Although they had complications related to the severity of their illnesses, both were treated to recovery. CONCLUSIONS: Mechanical ventilation in severe status asthmaticus can be challenging. Permissive hypercapnia is a relatively safe strategy in the ventilatory management of asthma. High levels of hypercapnia and associated severe acidosis are well tolerated in the absence of contraindications (i.e., preexisting intracranial hypertension). Inhalation anesthesia may be useful in the treatment of refractory cases of asthma but should be used carefully because it may be hazardous owing to poor flow capabilities of most anesthesia ventilators.     

七氟烷吸入复合利多卡因表面麻醉用于经鼻纤维支气管镜插管

目的观察七氟烷吸入复合利多卡因表面麻醉用于经鼻纤维支气管镜插管(FOB)的效果。方法 ASAⅠ、Ⅱ级,择期行颈椎手术的患者40例,随机分为4%七氟烷吸入组(S组)和4%七氟烷吸入复合2%利多卡因表面麻醉组(SL组),记录吸入诱导前基础值(T0)、FOB插管前即刻(T1)、插管后1 min(T2)、插管后3 min(T3)、插管后5 min(T4)时的平均动脉压(MAP)、心率(HR)、脑电双频指数(BIS)。结果与T0比较,两组T1时的MAP、HR均明显下降(P0.05)。S组MAP、HR在T2、T3较T1明显升高(P0.05)。SL组MAP、HR在T2、T3较T1有所升高,但差异无显著性(P0.05),且与S组相比,升高幅度较低(P0.05)。两组的BIS值在T1～T4与T0比均明显下降(P0.05),但两组T1～T4时间点组内及组间差异无显著性(P0.05)。结论七氟烷吸入复合利多卡因表面麻醉能有效抑制经鼻纤维支气管镜插管反应,安全可行。     

七氟烷吸入复合骶管麻醉用于小儿下腹部手术的观察与护理

目的探讨七氟烷复合骶管麻醉用于小儿下腹部手术的麻醉效果与护理措施。方法将60例下腹部手术患儿随机分成两组,七氟烷单纯吸入者为A组,七氟烷＋骶管麻醉者为B组,记录两组各时点T0（麻醉用药前）、T1（切皮时）、T2（手术结束）、T3（停药后30 min）的呼吸心率、平均动脉压的变化,以及患儿术中所需七氟烷的维持浓度、苏醒时间及恶心、呕吐、躁动等不良反应的发生率。结果两组患儿呼吸（RR）、心率（HR）、平均动脉压（MAP）在T0、T1、T2比较差异无统计学意义,T3A组明显高于B组,差异有统计学意义（P〈0.05）。术中七氟烷的维持浓度A组明显高于B组,差异有统计学意义（P〈0.05）。术后清醒时间A组明显长于B组（P〈0.05）,A组不良反应躁动的发生率明显高于B组,差异有统计学意义（P〈0.05）。恶心呕吐两组比较差异无统计学意义。结论七氟烷吸入复合骶管麻醉用于小儿手术麻醉平稳,苏醒快,不良反应少,减轻了护理压力,是一种较好的麻醉方法。     

Ventricular arrhythmias induced in monkeys by the inhalation of aerosol propellants

After inhaling fluoroalkane gases, which are used as aerosol propellants, some people have died suddently and unexpectedly. Seeking an explanation, we had 14 monkeys inhale these gases. All developed ventricular premature beats, bigeminy, or tachycardia, which began at an average of 39 (SE +/-4.2) sec. Fluoroalkanes were present in blood, but arterial hypoxemia or hypercapnia was absent, and arterial pressure was reduced only slightly. In contrast, without fluoroalkanes, 3 min of asphyxia or anoxia caused arrhythmias in only one monkey whose arterial oxygen tension had fallen to 16 mm Hg. The ventricular arrhythmias caused in well oxygenated monkeys by fluoroalkane gases may either be mediated through beta adrenergic receptors, since propranolol abolished these arrhythmias, or result from a nonadrenergic, direct, toxic effect of these gases on the heart. These results suggest that some deaths after propellant inhalation may be caused by ventricular tachycardia or fibrillation.     

静脉麻醉与吸入麻醉药物对择期腹部手术老年患者的术后认知的影响

目的探讨静脉麻醉与吸入麻醉药物对择期腹部手术老年患者的术后认知的影响。方法 80例择期行腹部手术的老年患者分为观察组和对照组。对照组使用静脉麻醉,观察组使用吸入麻醉。观察2组患者在不同时间点血流动力变化、术前及术后各阶段MMSE评分变化,并比较苏醒时间与导管拔出时间。结果观察组在诱导后、插管后3 min、拔管前、拔管后SBP、DBP、HR水平均显著低于对照组(P0.05)。观察组在术后1、3、6、24 h时MMSE评分均显著高于对照组(P0.05)。观察组苏醒时间、导管拔出时间均显著短于对照组(P0.05)。结论在老年患者中,进行瑞芬太尼复合丙泊酚的全屏静脉麻醉效果更加优异。     

静吸复合与全凭静脉2种麻醉方式对乳腺癌炎性细胞因子的影响

目的探讨静吸复合麻醉及全凭静脉麻醉2种麻醉方式对乳腺癌患者炎性细胞因子的影响。方法选取2011年11月-2012年10月在本院乳腺外科行手术治疗132例乳腺癌患者,随机分为A（静吸复合组,n=66）、B（全凭静脉组,n=66）2组,分别给予静吸复合麻醉与全凭静脉麻醉,于麻醉前、术后4h、术后6h进行血白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）检测并对比分析。结果2组患者IL-6、TNF-α水平均显著增高（P〈0．05）,术后6hA组IL-6显著高于B组（P〈0．01）,术后4h、6hA组TNF-α均显著高于B组（P〈0．01）。结论全凭静脉麻醉在乳腺癌患者中能够更好地抑制术后血清IL-6及TNF-α等炎性细胞因子的增高,避免过度应激反应,值得推广。     

Sevoflurane inhalation anesthesia for short surgical interventions]

Sevoflurane, a new halogen inhalation anesthetic for mononarcosis, was used in 33 patients aged 22-57 years subjected to noncavitary general surgical and urological operations lasting for 50 +/- 9 min. Induction anesthesia consisted in sevoflurane inhalation in a semi-open contour. The anesthetic was delivered first in a dose of 0.2 vol% which was increased to 3-4 vol% by the end of induction (1.5-1.8 MAC). Laryngeal mask was used in 28 patients, in the rest tracheal intubation was carried out after succinyl choline. Maintenance dose of sevoflurane was 2-3 vol%. Electrocardiogram was recorded and arterial pressure monitored by indirect methods, pulse oxymetry and capnography were carried out. For evaluating the probable toxic effect, serum levels of total bilirubin, SGPT, creatinine, alkaline phosphatase, urea, albumin, potassium, and sodium were measured. Sevoflurane did not suppress the respiration and allowed assisted ventilation of the lungs, if necessary. No appreciable changes in the hemodynamics were observed, though heart rate was to be monitored. There were no biochemical shifts indicative of hepatic or renal involvement. Sevoflurane is recommended for total anesthesia in short non-cavitary interventions as mononarcosis, that is, such anesthesia requires virtually no extra narcotics, neuroleptics, or ataractics.     

胰岛素吸入给药降血糖的效果评价

背景:口服胰岛素易被胃酸及胃肠道内的各种酶降解,难以透过胃肠道上皮细胞膜,针剂形式也至少需要36 h注射1次.近年正在不断研究各种肺部给药制剂如干粉型吸入剂、吸入气雾剂、电喷雾剂、胰岛素纳米化技术和吸收增强剂等,具有较好的应用前景.目的:观察胰岛素溶液经正常大鼠吸入后的降血糖作用.方法:体质量(220±30)g的健康雄性大鼠30只,随机分为7组.其中3组分别予吸入胰岛素溶液1.0,5.0,10.0U/kg,每组4只:另3组分别给予吸入2.0 U/kg胰岛素溶液+5％的卵磷脂、2.0 U/kg胰岛素溶液+1％的油酸、2.0 U/kg胰岛素溶液+1％DTPA,每组5只;剩余3只为空白对照组.分别于给药后0,30,60,120,180,240 min从大鼠尾部取血15 Μl,使用ONE TOUCH~(TM)BASIC~(TM)PLUS稳捷基础倍加型血糖仪测定血糖,计算不同条件下胰岛素溶液的药理生物利用度.结果与结论:1 U/kg的胰岛素溶液经大鼠吸入后即有明显的降血糖作用,随着剂量的增加,大鼠体内血糖下降幅度随之增大,10 U/kg的剂量降血糖最低可降至14.5％.1 U/kg的胰岛素溶液经吸入后,在不加吸收促进剂的条件下的药理生物利用度为11.5％.吸收促进剂油酸、DTPA和卵磷酯的加入均能显著地增强胰岛素溶液的降血糖作用.