小儿斜视矫治术可弯曲喉罩下七氟烷吸入麻醉的效果

目的 评价可弯曲喉罩通气下七氟烷麻醉用于小儿斜视矫治术的效果.方法 择期行斜视矫治术患儿60例,按随机数字表法分为气管导管组和可弯曲喉罩组,每组30例.气管导管组静吸复合麻醉,气管插管,机械通气;可弯曲喉罩组七氟烷麻醉,置入可弯曲喉罩,保留自主呼吸.记录多时点气道峰压和平均气道压.记录气管导管或喉罩置人即刻(T1)、1 min(T2)、3 min(T3)、5 min(T4)和拔出气管导管或喉罩即刻(T5)时血压、心率.记录苏醒时间和拔管时间;患儿从苏醒到拔出气管导管或喉罩时呛咳、躁动和术后咽痛的情况及家长的满意度.结果 与基础值比较,气管导管组T1时收缩压下降,T2、T3、T5时收缩压升高,T2～T5时心率升高,可弯曲喉罩组T1～T4时收缩压、舒张压下降(P<0.05);与气管导管组比较,可弯曲喉罩组T2～T5时收缩压、舒张压、心率均降低(P<0.05).气管导管组苏醒时间(8.1±2.6)min,拔管时间(12.6±3.2)min,从苏醒到拔出气管导管或喉罩时呛咳发生率66.7%(20/30)、咽痛发生率40.0%(12/30)、躁动评分0～1分7例,可弯曲喉罩组分别为(5.2±1.1)min、(6.3±1.5)min、0、6.7%(2/30)、25例,两组比较差异有统计学意义(P<0.05).与气管导管组比较,可弯曲喉罩组患儿家长的满意度高,差异有统计学意义(P<0.05).结论 可弯曲喉罩通气下七氟烷麻醉更适合于小儿斜视矫治术.

Abstract：

Objective To evaluate the efficacy of flexible laryngeal mask airway and sevoflurane in pediatric strabismus surgery. Methods Totally 60 children undergoing elective strabismus surgery were recruited and divided into two groups with 30 cases each by random digits table:group T, in which children accepted endotracheal tube intubation and combined intravenous and inhalation anesthesia with mechanically ventilation; and group F, in which children adopted both flexible laryngeal mask airway and inhalation anesthesia of sevoflurane with spontaneous breath. Airway peak pressure (Ppeak), average airway pressure (Pmean), blood pressure (Bp) and heart rate (HR) at induction (T1), 1 min (T2), 3 min (T3) and 5 min (T4) after induction, removal of endotracheal tube or laryngeal mask airway (T5), awaking time and extubation time, occurrence of cough, dysphoria and pharyngodynia from being awake to extubation, satisfaction of patients were recorded. Results When compared to baseline, systolic pressure was lower at T, and higher at T2, T3 and T5, and HR was higher at T2-T5 in group T(P< 0.05),Bp was lower at T1-T4 in group F (P < 0.05). Bp and HR at T2-T5 in group F were lower than those in group T (P < 0.05). The awaking time was (8.1 ?2.6) min, the extubation time was (12.6 ?3.2) min, the occurrence of cough and pharyngodynia was 66.7%(20/30), 40.0%( 12/30), the dysphoria (0-1 score) was 7 cases in group T,(5.2 ± 1.1) min, (6.3 ± 1.5) rain,0,6.7%(2/30),25 cases in group F. There were significant differences between two groups (P<0.05). The satisfaction of patients in group F was higher than that in group T, there was significant difference between two groups (P< 0.05). Conclusion Flexible laryngeal mask airway with sevoflurane could offer high efficacy in pediatric strabismus surgery.     

纤维支气管镜引导经鼻插管与喉镜明视插管对血流动力学和血氧饱和度的影响

目的 探讨纤维支气管镜(FOB)引导下经鼻气管插管与喉镜明视气管插管对血流动力学和动脉血氧饱和度(SaO2)的影响.方法 将61例行气管插管机械通气的患者按随机数字表法分为观察组(31例)和对照组(30例),分别采用FOB引导下经鼻气管插管和喉镜明视气管插管,测定并记录两组患者在插管前1 min、插管即刻、插管后5 min的收缩压(SBP)、舒张压(DBP)、心率(HR)以及SaO2.结果 两组患者气管插管操作均获得成功,其中观察组用时(35.2±12.5)s,对照组用时(38.7±13.6)s,两组气管插管时间比较差异无统计学意义(P＞0.05).两组患者在插管即刻的SBP、DBP和HR均较插管前1 min显著升高,SaO2则显著下降,而且观察组上述指标的变化幅度均显著小于对照组(P＜0.05).结论 FOB引导下经鼻气管插管对患者血流动力学及SaO2的影响较小,是一种比较安全的气管插管方法,值得临床推广应用.

Abstract：

Objective To investigate the effect of nasal intubation guided by fiberoptic bronchoscope (FOB) and intubation guided by laryngoscope on hemodynamics and arterial oxygen saturation (SaO2).Methods Sixty-one patients received tracheal intubation for mechanical ventilation were divided into observation group (31 cases) and control group (30 cases) by random digits table who received FOB guided nasotracheal intubation and laryngoscope intubation respectively, the systolic blood pressure (SBP),diastolic blood pressure (DBP), heart rate (HR) and SaO2 of all patients in two groups was measured and recorded 1 min before intubation, the intubation moment and 5 min after intubation. Results Patients in two groups were successfully intubated. The average time in observation group was (35.2 ± 12.5) s and in control group was (38.7 ± 13.6) s, and there was no significant difference between two groups (P ＞ 0.05);SBP, DBP and HR of two groups at the intubation moment increased significantly than that at 1 min before intubation, while SaO2 decreased significantly, and the rangeability of above indexes in observation group were significantly lower than those in control group, there were significant differences between two groups (P ＜ 0.05). Conclusion FOB guided nasotracheal intubation has little effect on hemodynamics and blood SaO2, it is a safe method of endotracheal intubation and worthy of clinical application.     

普鲁泊福复合不同剂量瑞芬太尼应用于非肌松剂气管插管的观察

Objective To observe the impacts on the patients with cardiovascular responses when applying propofol combined with different dose of remifentanil in tracheal intubation without the use of muscle relaxants for anesthesia induction. Methods Sixty patients undergoing selective general anesthesia operation of ASA Ⅰ -Ⅱ non-heart and brain surgery were divided into three groups by random digits table, and 20 cases for each group. Target-controlled infusion of remifentanil with respective plasma concentration of 2 ng/ml (group Ⅰ ), 3 ng/ml (group Ⅱ ) and 4 ng/ml (group Ⅲ). Target-controlled infusion of propofol after infusion of remifentanil for 5 min (3 μg/ml of plasma target concentration). The mean arterial pressure (MAP),heart rate (HR), intubation conditions and success rate of patients in different groups before induction(T1), at the beginning moment of propofol(T2),at the immediate moment before tracheal intubation (T3) and at the time of 1 min after tracheal intubation (T4). Results The grade of tracheal intubation was (10.5 ±2.9), (7.6 ±2.3), (5.8 ± 1.2) scores and the success rate of the first intubation was 50%( 10/20), 80%(16/20), 100%(20/20) in group Ⅰ ,Ⅱ and Ⅲ , there were significant differences among three groups (P＜ 0.05),group Ⅲ was superior to group Ⅰ and Ⅱ (P＜0.05). Comparing T2 and Tj,HR in group Ⅱ and Ⅲ slowed down significantly ( P ＜ 0.05), and in group Ⅲ slowed down more significantly (P＜0.05). Comparing T4 and T3,HR in group Ⅰ and Ⅱ quickened significantly, and group Ⅰ was higher than group Ⅱ and Ⅲ (P＜ 0.05). Comparing T3 and T2,MAP decreased significantly among three groups,comparing T4 and T3, MAP increased significantly in group Ⅰ which was higher than that in group Ⅱ and Ⅲ (P ＜ 0.05). Conclusions Without the use of muscle relaxants, propofol combined with remifentanil for 3-4 ng/ml can better restrain the tracheal intubation stress responses and won't cause significant cycle inhibition. They benefit to maintain the smooth intubation process of anesthesia induction.     

普鲁泊福复合不同剂量瑞芬太尼应用于非肌松剂气管插管的观察

目的 观察普鲁泊福麻醉诱导时复合不同剂量瑞芬太尼应用于非肌松剂气管插管时对患者心血管反应的影响.方法 将60例ASA分级Ⅰ～Ⅱ级的非心、脑外科择期全身麻醉手术患者按随机数字表法分为Ⅰ、Ⅱ、Ⅲ组,每组20例,注射泵输注瑞芬太尼血浆靶控浓度分别为2、3、4ng/ml,输注5 min后开始靶控输注普鲁泊福(血浆靶控浓度3μg/ml).记录三组患者诱导前(T1)、普鲁泊福开始即刻(T2)、气管插管前即刻(T3)、气管插管后1 min(T4)的平均动脉压(MAP)、心率变化,以及气管插管评分和第1次插管成功率.结果 Ⅰ、Ⅱ、Ⅲ组气管插管评分分别为(10.5±2.9)、(7.6±2.3)、(5.8±1.2)分,第1次插管成功率分别为50%(10/20)、80%(16/20)、100%(20/20),三组间比较差异均有统计学意义,Ⅲ组均优于Ⅰ组和Ⅱ组(P＜0.05).T2与T1比较,Ⅱ组和Ⅲ组心率均显著减慢(P＜0.05),Ⅲ组更明显;T4与T3比较,Ⅰ组和Ⅱ组心率显著增快,Ⅰ组明显高于Ⅱ组和Ⅲ组(P＜0.05).T3与T2比较,三组MAP均显著下降;T4与T3比较,Ⅰ组MAP显著上升,且高于Ⅱ组和Ⅲ组(P＜0.05).结论 在不使用肌松剂时,普鲁泊福复合瑞芬太尼靶控浓度3～4 ng/ml能较好地抑制气管插管的应激反应,而又不引起明显的循环抑制,对维持麻醉诱导插管过程的平稳较为有利.

Abstract：

Objective To observe the impacts on the patients with cardiovascular responses when applying propofol combined with different dose of remifentanil in tracheal intubation without the use of muscle relaxants for anesthesia induction. Methods Sixty patients undergoing selective general anesthesia operation of ASA Ⅰ -Ⅱ non-heart and brain surgery were divided into three groups by random digits table, and 20 cases for each group. Target-controlled infusion of remifentanil with respective plasma concentration of 2 ng/ml (group Ⅰ ), 3 ng/ml (group Ⅱ ) and 4 ng/ml (group Ⅲ). Target-controlled infusion of propofol after infusion of remifentanil for 5 min (3 μg/ml of plasma target concentration). The mean arterial pressure (MAP),heart rate (HR), intubation conditions and success rate of patients in different groups before induction(T1), at the beginning moment of propofol(T2),at the immediate moment before tracheal intubation (T3) and at the time of 1 min after tracheal intubation (T4). Results The grade of tracheal intubation was (10.5 ±2.9), (7.6 ±2.3), (5.8 ± 1.2) scores and the success rate of the first intubation was 50%( 10/20), 80%(16/20), 100%(20/20) in group Ⅰ ,Ⅱ and Ⅲ , there were significant differences among three groups (P＜ 0.05),group Ⅲ was superior to group Ⅰ and Ⅱ (P＜0.05). Comparing T2 and Tj,HR in group Ⅱ and Ⅲ slowed down significantly ( P ＜ 0.05), and in group Ⅲ slowed down more significantly (P＜0.05). Comparing T4 and T3,HR in group Ⅰ and Ⅱ quickened significantly, and group Ⅰ was higher than group Ⅱ and Ⅲ (P＜ 0.05). Comparing T3 and T2,MAP decreased significantly among three groups,comparing T4 and T3, MAP increased significantly in group Ⅰ which was higher than that in group Ⅱ and Ⅲ (P ＜ 0.05). Conclusions Without the use of muscle relaxants, propofol combined with remifentanil for 3-4 ng/ml can better restrain the tracheal intubation stress responses and won't cause significant cycle inhibition. They benefit to maintain the smooth intubation process of anesthesia induction.     

支气管堵塞器与双腔气管导管在单肺通气中对呼吸力学和血气影响的比较

Objective To compare the influences between bronchial blocker (BB) and double lumen tube (DLT) in respiratory mechanics and blood gas in one lung ventilation. Methods Thirty-six patients undergoing pulmonary lobectomy or radical operation of esophageal carcinoma were randomized into group BB (17 cases) and group DLT (19 cases). In group BB,BB was intubated under the guidance of a fibreoptic bronchoscope after intubation of single lumen tube; while in group DLT, the position of the tube was confirmed using fibreoptic bronchoscopy after intubation. The peek airway pressure (Pmax) and pulmonary dynamic compliance (CLdyn) during double lung ventilation and one lung ventilation were recorded in recumbent position. Blood samples were taken from, radial artery 20 min after one lung ventilation for blood gas analysis,partial pressure of oxygen in artery(PaO2), partial pressure of carbon dioxide in artery(PaCO2), saturation of arterial blood oxygen (SaO2) were recorded. Results No significant difference was found in Pmax and CLdyn between two groups during double lung ventilation,but Pmax was significantly lower in group BB [(21.00 ± 3.59) cm H2O,1 cm H2O = 0.098 kPa] than that in group DLT [(26.89 ±4.21) cm H2O] (P＜0.05), and CLdyn was greater in group BB [(28.10 ±6.24) ml/cm H2O] than that in group DLT [(24.00±7.13) ml/cm H2O ] (P ＜ 0.05); there were no significant differences in PaO2, PaCO2, SaO2 betweentwo groups during one lung ventilation (P＞ 0.05). Conclusion The influence to respiratory mechanics in one lung ventilation is smaller using BB than using DLT, BB has blocker well applicable value in clinics.     

雷米芬太尼对全麻患者气管插管期平均动脉压、心率和QTc间期延长的影响

目的 观察和评价雷米芬太尼对全麻患者气管插管期平均动脉压(MAP)、心率和QTc间期的影响.方法 选取择期全麻手术患者75例,ASA分级Ⅰ～Ⅱ级,按随机数字表法分为三组:对照组(C组)、雷米芬太尼Ⅰ组(R1组)和雷米芬太尼Ⅱ组(R2组),每组25例.麻醉诱导:静脉注射芬太尼3μg/kg、普鲁泊福1.0～1.5 mg/kg和维库溴铵0.1 mg/kg后2 min,双盲法≥40 s给予雷米芬太尼0.50 μg/kg(R1组)或0.75μg/kg(R2组)后,两组分别连续输注雷米芬太尼0.10μg/(kg·min);C组患者给予相同容量的0.9%氯化钠.记录麻醉诱导前(T0)、诱导后2 min(T1)、首次给予雷米芬太尼或0.9%氯化钠后1 min(T2)、气管插管前即刻(T3)及气管插管后30 s(T4)、2 min(T5)和4 min(T6)的MAP和心率,并描记心电图.结果 与C组比较,R2组T4～T6时QTc间期明显缩短(P＜0.05或＜0.01＝;R,组T4和C组T4～T6时QTc间期较T0明显延长(P＜0.05或＜0.01).C组气管插管期OTc间期＞440ms 11例(44%,11/25),R2组3例(12%,3/25),两组比较差异有统计学意义(P＜0.05).结论 芬太尼和普鲁泊福麻醉诱导气管插管期间患者的QTc间期是延长的;插管前1 min静脉注射雷米芬太尼0.75μg/kg,继以0.10 μg/(kg·min)输注可有效抑制气管插管诱发QTc间期延长和血流动力学反应.

Abstract：

Objective To evaluate the effect of remifentanil on mean arterial pressure (MAP), heart rate (HR) and QTc interval during tracheal intubation of general anesthesia patients. Methods Seventy-five ASA Ⅰ -Ⅱ grade patients were selected and allocated to receive either saline (group C), remifentanil 0.50 μg/kg (group R1) or remifentanil 0.75 μg/kg(group R2) by random digits table with 25 cases in each, they were administrated as a bolus intravenous, followed by a continuous infusion at 0.10 μg/ (kg·min), 1 min before laryngoscopy. All patients received fentanyl 3 μg/kg,propofol 1.0 - 1.5 mg/kg and vecuronium 0.1 mg/kg. The ECG.MAP and HR were recorded prior to induction of anesthesia (T0), 2 min following the start of drug intravenous of fentanyl and propofol with vecuronium (T1), 1 min following remifentanil or saline (T2), before laryngoscopy(T3), 30 s (T4), 2 min (T5) and 4 min (T6) after intubation. Results The QTc interval was significantly prolonged immediately following intubation in group C and group R1, but it remained stable in group R2, compared with the QTc interval just before laryngoscopy. In group R2, QTc interval was significantly shorter at T4-T6 compared to group C(P＜ 0.05 or ＜ 0.01). QTc interval significantly increased from baseline at T4 in group R1 and T4-T6 in group C (P＜ 0.05 or ＜ 0.01). The number of patients with QTc interval ＞ 440 ms were significantly greater immediately following tracheal intubation in group C than that in group R2 [44% (11/25) vs. 12% (3/25)] (P ＜ 0.05). Conclusions QTc interval increases following tracheal intubation during induction of anesthesia using fentanyl and propofol. Intravenous of remifentanil attenuates the QTc interval prolongation associated with tracheal intubation. In addition, remifentanil decreases the hemodynamic responses to tracheal intubation.     

支气管堵塞器与双腔气管导管在单肺通气中对呼吸力学和血气影响的比较

目的 比较支气管堵塞器(BB)与双腔气管导管(DLT)在单肺通气中对呼吸力学和血气的影响.方法 将36例择期行肺叶切除术和食管癌根治术患者按投硬币法随机分为BB组(17例)和DLT组(19例).BB组完成单腔管插管后在纤维支气管镜引导下置入BB,DLT组完成插管后用纤维支气管镜检查确定DLT位置.摆好体位后记录两组双肺通气和单肺通气的气道峰压(Pmax)与肺动态顺应性(CLayn),单肺通气20 min后采动脉血,行动脉血气分析:动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、动脉血氧饱和度(SaO2).结果 两组双肺通气时的Pmax和CLdyn比较差异无统计学意义(P＞0.05).单肺通气时BB组Pmax[(21.00 ±3.59)cm H2O,1 cm H2O=0.098 kPa]明显低于DLT组[(26.89 ±4.21)cm H2O](P＜0.05),CLdyn[(28.10 ±6.24)ml/cm H2O]明显高于DLT组[(24.00±7.13)ml/cm H2O](P＜0.05);两组单肺通气20min后PaO2、PaCO2、SaO2比较差异无统计学意义(P＞0.05).结论 使用BB行单肺通气对呼吸力学参数的影响较使用DLT小,具有很好的临床应用价值.

Abstract：

Objective To compare the influences between bronchial blocker (BB) and double lumen tube (DLT) in respiratory mechanics and blood gas in one lung ventilation. Methods Thirty-six patients undergoing pulmonary lobectomy or radical operation of esophageal carcinoma were randomized into group BB (17 cases) and group DLT (19 cases). In group BB,BB was intubated under the guidance of a fibreoptic bronchoscope after intubation of single lumen tube; while in group DLT, the position of the tube was confirmed using fibreoptic bronchoscopy after intubation. The peek airway pressure (Pmax) and pulmonary dynamic compliance (CLdyn) during double lung ventilation and one lung ventilation were recorded in recumbent position. Blood samples were taken from, radial artery 20 min after one lung ventilation for blood gas analysis,partial pressure of oxygen in artery(PaO2), partial pressure of carbon dioxide in artery(PaCO2), saturation of arterial blood oxygen (SaO2) were recorded. Results No significant difference was found in Pmax and CLdyn between two groups during double lung ventilation,but Pmax was significantly lower in group BB [(21.00 ± 3.59) cm H2O,1 cm H2O = 0.098 kPa] than that in group DLT [(26.89 ±4.21) cm H2O] (P＜0.05), and CLdyn was greater in group BB [(28.10 ±6.24) ml/cm H2O] than that in group DLT [(24.00±7.13) ml/cm H2O ] (P ＜ 0.05); there were no significant differences in PaO2, PaCO2, SaO2 betweentwo groups during one lung ventilation (P＞ 0.05). Conclusion The influence to respiratory mechanics in one lung ventilation is smaller using BB than using DLT, BB has blocker well applicable value in clinics.     

不同血浆靶浓度的普鲁泊福对鼻内镜手术应激反应的影响

Objective To observe the effect of propofol target controlled infusion with different blood plasma target concentration on stress reaction during the nasal endoscope operation. Methods Sixty patients with ASA Ⅰ - Ⅱ scheduled for the nasal endoscope operation were divided into three groups by random digits table: each group was 20 patients, group A, B, C was given propofol target controlled infusion with blood plasma target concentration 3,4,5 μ g/mi respectively. Heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2), blood glucose, serum cortisol, bispectral index ( BIS ), extubation time were recorded before anesthesia,at 30 min after the operation starting and 60 min after the extubation.Results The descent degree of HR and MAP at 30 min after the operation starting were group C ＞ group B ＞ group A (P = 0.024,0.010 );the descent degree of MAP at 60 min after the extubation were group C ＞group B ＞ group A (P = 0.011 ). BIS and extubation time were 65 ± 8 and (25 ± 7) min in group A, 53 ± 11 and( 36 ± 13 ) min in group B, 45 ± 12 and(45 ± 9 ) min in group C, there were significant differences among three groups(t = 2.476,P= 0.023;t = 2.657,P= 0.012). The blood glucose was increased at 30 min after the operation starting and 60 min after the extubation, the ascensus degree were group A ＞ group B ＞ group C (P= 0.000、0.000);the serum cortisol was decreased at 30 min after the operation starting, the descent degree was group C ＞ group B ＞ group A (P= 0.000), increased at 60 min after the extubation, the ascensus degree was group A ＞ group B ＞ group C (P= 0.001 ). Conclusions Propofol target controlled infusion with blood plasma target concentration 4-5 μ g/ml can ensure eligible depth of anesthesia, decrease pain stimulus, remain stable vital sign,depress the stress reaction caused by nasal endoscope operation efficiently,with short extubation time. It is an eligible blood plasma target concentration.     

雷米芬太尼对全麻患者气管插管期平均动脉压、心率和QTc间期延长的影响

Objective To evaluate the effect of remifentanil on mean arterial pressure (MAP), heart rate (HR) and QTc interval during tracheal intubation of general anesthesia patients. Methods Seventy-five ASA Ⅰ -Ⅱ grade patients were selected and allocated to receive either saline (group C), remifentanil 0.50 μg/kg (group R1) or remifentanil 0.75 μg/kg(group R2) by random digits table with 25 cases in each, they were administrated as a bolus intravenous, followed by a continuous infusion at 0.10 μg/ (kg·min), 1 min before laryngoscopy. All patients received fentanyl 3 μg/kg,propofol 1.0 - 1.5 mg/kg and vecuronium 0.1 mg/kg. The ECG.MAP and HR were recorded prior to induction of anesthesia (T0), 2 min following the start of drug intravenous of fentanyl and propofol with vecuronium (T1), 1 min following remifentanil or saline (T2), before laryngoscopy(T3), 30 s (T4), 2 min (T5) and 4 min (T6) after intubation. Results The QTc interval was significantly prolonged immediately following intubation in group C and group R1, but it remained stable in group R2, compared with the QTc interval just before laryngoscopy. In group R2, QTc interval was significantly shorter at T4-T6 compared to group C(P＜ 0.05 or ＜ 0.01). QTc interval significantly increased from baseline at T4 in group R1 and T4-T6 in group C (P＜ 0.05 or ＜ 0.01). The number of patients with QTc interval ＞ 440 ms were significantly greater immediately following tracheal intubation in group C than that in group R2 [44% (11/25) vs. 12% (3/25)] (P ＜ 0.05). Conclusions QTc interval increases following tracheal intubation during induction of anesthesia using fentanyl and propofol. Intravenous of remifentanil attenuates the QTc interval prolongation associated with tracheal intubation. In addition, remifentanil decreases the hemodynamic responses to tracheal intubation.     

高频喷射通气对单肺通气患者氧化应激反应的影响

Objective To determine the effects of high-frequency jet ventilation (HFJV) on oxidative stress in patients during one-lung ventilation (OLV). Methods Forty-five patients undergoing elective radical esophageal cancer resection were divided into three groups with 15 cases each by random digits table: two lung ventilation group ( group A), OLV group (group B), HFJV- OLV group ( group C, working pressure 1 kg/cm2 and frequency 100 times/min). Venous blood samples were taken before induction (T0),at30min (T1),90min (T2),150min (T3) after OLV and the end of operation (T4) for measuring serum superoxide dismutase(SOD),malondialdehyde (MDA) and nitric oxide (NO). Results SOD was lower at T2-T4 in group B[(47 ± 10), (37 ±9), (41 ±7) kU/L] and group C[(58 ± 12), (51 ± 11), (49 ± 9) kU/L] than those in group A [(78 ±8), (75 ±7), (79 ±6) kU/L](P＜ 0.05),and MDA and NO were lower at T1-T4 in group B and group C than that in group A(P＜ 0.05). SOD was higher at T3 in group C than that in group B (P ＜ 0.05), MDA at T1-T4 and NO at T2-T4 were lower in group C than those in group B (P ＜ 0.05). Conclusion HFJV can effectively decrease oxidative stress in patients during OLV.     

双管喉罩与食管气管联合导管在困难气道应用中的对比研究

目的 比较围手术期成年患者双管喉罩(PLMA)与食管气管联合导管(ETC)在困难气道应用中的临床效果.方法 选择困难气道的成年患者40例,ASA分级Ⅰ～Ⅱ级,按机械抽样法随机分为PLMA组和ETC组,每组各20例,常规麻醉诱导后,分别置人PLMA或ETC.分别观察记录插管次数、插管时间、手术时间,以及置入前(T_1)、置入即刻(T_2)、置入后1min(T_3)、置入后5 min(T_4)、置入后10min(T_5)、拔管即刻(T_6)的收缩压、舒张压、心率.同时记录患者的并发症和呼吸道损伤情况.结果 两组均首次置入即获得满意肺通气.T_2、T_3、T_6时收缩压、舒张压、心率,ETC组[T_2:(143.2±11.4)mm Hg(1mm Hg=0.133 kPa)、(86.9±10.7)mm Hg、(145.8±10.2)次/min,T_3:(140.0±11.3)mm Hg、(84.5±10.7)mm Hg、(142.5±11.5)次/min,T_6:(147.7±11.3)mm Hg、(87.2±9.7)mm Hg、(145.4±10.9)次/min]显著高于PLMA组[T2:(123.5±12.7)mm Hg、(72.6±11.4)mm Hg、(129.0±11.0)次/min,T3:(120.0±11.5)mm Hg、(69.7±10.5)mm Hg、(125.7±10.6)次/min,T6:(122.5±11.6)mm Hg、(71.4±9.4)mm Hg、(127.8±11.3)次/min]及T1[(122.7±12.1)mm Hg、(74.1±9.6)mm Hg、(121.0±11.8)次/min](P<0.05).两组并发症和呼吸道损伤情况比较,差异均无统计学意义(P＞0.05).结论 PLMA和ETC用于围手术期困难气道的成年患者均可获得满意的肺通气,是围手术期困难气道患者安全有效的呼吸道管理工具,但PLMA应激反应轻微,血流动力学更稳定.     

双管型喉罩在妇科急诊腹腔镜手术中的应用

目的探讨双管型喉罩(PLMA)在妇科急诊腹腔镜手术麻醉中应用的可行性及优越性。方法20例急诊宫外孕腹腔镜手术病人,随机分成两组:喉罩通气组(L组,n=10)和气管插管组(E组,n=10)。全麻醉诱导后,L组置入喉罩,E组行气管内插管。两组均行控制呼吸。在麻醉诱导前(T0)、气管插管(或置喉罩)前(T1)、气管插管(或置喉罩)后即刻(T2)、气管插管(或置喉罩)后通气5min(T3)、20min(T4)、拔管(或拔除喉罩)即刻(T5)、拔管(或拔除喉罩)后5min(T6)分别记录收缩压(SBP)、舒张压(DBP)、HR、SpO2、气道峰压(Ppeak)、潮气量(VT)和呼气末CO2分压(PETCO2),并统计插管或置入喉罩困难例数、术后苏醒时间、术后发生声音嘶哑、咳嗽例数。结果两组的插管时、间歇正压通气5min、20min、拔管时的Ppeak、VT、SpO2、PETCO2、和PaCO2差异无统计学意义(p>0.05)。心率与血压:诱导前后无显著变化;气管插管(或置喉罩)后即刻比较气管插管(或置喉罩)前,L组无显著变化(p>0.05),E组明显增高,且组间比较差异显著(p<0.05);拔管(或拔除喉罩)即刻比较气管插管(或置喉罩)前,L组无显著变化(p>0.05),E组明显增高,且组间比较差异显著(p<0.05)。喉罩留置时间(43.3±9.6)min。术后E组有60%发生咳嗽和挣扎反应,术后24小时发生咽痛者占28%。L组无拔管反应和术后咽痛。结论双管型喉罩置入通气全麻应用于妇科急诊腹腔镜手术安全可行,对循环系统无刺激性影响,无气管插管的刺激症状,与传统的气管内麻醉相比具有显著的优越性。     

经ProSeal喉罩吸入七氟醚全麻在腹腔镜手术中的临床应用

目的探讨妇科腹腔镜手术时经ProSeal喉罩(PLMA)吸入七氟醚的临床麻醉和通气效果。方法 40例择期妇科腹腔镜手术患者,随机分为气管导管组(ET组)和PLMA组(PL组),每组20例。全麻诱导依次静注芬太尼4μg/kg、丙泊酚2～2.5mg/kg、阿曲库铵0.6mg/kg。分别置入气管导管(ET组)或PLMA(PL组),行容量控制呼吸。麻醉维持为吸入七氟醚0.9～1.2MAC,持续输注瑞芬太尼0.1～0.2μg·kg-1·min-1,间注阿曲库铵0.25mg/kg。结果两组患者全麻诱导期SBP、DBP及HR均下降(P<0.01);在气管插管或置入PLMA后,ET组SBP、DBP、HR均明显较PL组高(P<0.05或P<0.01);PL组Cp在机械通气期间显著高于ET组(P<0.01);PL组术后咽喉痛、声嘶患者少于ET组。结论 PLMA可以安全有效地应用于腹腔镜手术全麻中通气,相比于气管插管,本方法可减少气管插管常并发的气管、咽喉损伤,术中血流动力学更平稳,苏醒质量更佳。     

欧普乐喉罩在腹腔镜肝癌射频消融术全麻中的临床应用

目的：评价欧普乐喉罩通气在腹腔镜肝癌射频消融术全麻中应用的安全性和可行性。方法：选择40例择期全麻腹腔镜肝癌射频消融术患者,ASAⅡ～Ⅲ级,按随机数字表法分为欧普乐喉罩组（A组）和气管内插管组（B组）各20例。观察记录两组患者在麻醉诱导前（T0）、插入喉罩或气管导管前（T1）、插入喉罩或气管导管后即刻（T2）、插入喉罩或气管导管后5 min（T3）、拔除喉罩或气管导管后即刻（T4）,5个时间点的收缩压（SBP）、舒张压（DBP）、心率（HR）与脉搏血氧饱和度（SpO2）。并记录麻醉相关并发症。结果：B组T1与T4时点的SBP、DBP和HR水平均明显高于A组,差异均有统计学意义（P〈0.05）;A组呛咳、苏醒期躁动、术后咽痛、痰多等并发症明显少于B组,差异均有统计学意义（P〈0.05）。结论：欧普乐喉罩通气应用于腹腔镜肝癌射频消融术,较气管内插管全麻围术期循环功能更加稳定,麻醉相关并发症更少。     

单次静脉注射小剂量普鲁泊福对围拔管期患者应激反应影响的临床观察

目的 观察拔管前单次静脉注射小剂量普鲁泊福对围拔管期患者的应激反应及苏醒情况的影响.方法 选择ASA分级Ⅰ～Ⅱ级,拟于全麻下择期行卵巢癌手术的患者50例,按照随机数字表法随机分为七氟烷组(S组)和普鲁泊福组(P组),每组各25例.S组在预计手术结束前2min停止吸入七氟烷.P组在预计手术结束前5 min停止吸入七氟烷,同时静脉单次推注普鲁泊福0.5 mg/kg.观察两组患者拔管前5 min、拔管时、拔管后1 min、拔管后5 min的收缩压、舒张压、心率,以及患者意识恢复时间,躁动、剧烈呛咳及恶心呕吐的情况.结果 两组在拔管时至拔管后5 min心率、收缩压、舒张压比较差异均有统计学意义(P<0.01). P组意识恢复时间[(10.39±1.26)min]与S组[(9.57±1.25)min]比较差异有统计学意义(P<0.05),但是并不显著延长拔管时间.P组2例发生躁动,S组9例发生躁动,两组比较差异有统计学意义(P<0.05).结论 拔管前单次静脉注射小剂量普鲁泊福可减小围拔管期患者的应激反应,且患者意识恢复良好,不良反应发生率低.     

不同药物配伍用于双腔支气管插管全麻诱导的临床研究

目的探讨双腔支气管插管全麻诱导的最佳药物配伍。方法拟施行胸外科择期手术需双腔支气管插管患者80例,ASAⅠ-Ⅱ,分为A、B两组,A组采用咪达唑仑、芬太尼、丙泊酚、阿曲库铵静脉诱导插管;B组以舒芬太尼替代芬太尼,其余同A组。分别记录两组麻醉诱导前（Tn）、注药后插管前即刻（T1）、双腔支气管插管后即刻（T2）、插管后1min（T3）、3min（T4）和5min（T5）各时点的收缩压（SBP）、舒张压（DBP）、心率（HR）值。结果两组患者Tn时SBP、DBP、HR[（124．9±16．0）mmHgvs（125．8±6．4）mmHg、（73．1±9．9）mmHgVS（74．3±10．4）mmHg、（81．8±6．6）次／minvs（82．4±8．1）次／min]组间比较差异无统计学意义（P〉0．05）。诱导后T1两组[（94．8±10．03）mmHgvs（96．9±10．1）mmHg、（57．3±7．66）mmHgvs（55．4±7．03）mmHg、（69．6±7．43）次／minvs（66．3±7．03）次／min]患者与T0比较各指标均显著降低（P〈0．05）。插管后T2-T4各时点A组各指标[SBP：（146．3±14．2）mmHg、（141．2±10．63）mmHg、（137．2±13．23）、（122．9±11．6）mmHg;DBP：（94．9±10．6）mmHg、（84±9．63）mmHg、（79．9±9）mmHg、（75．8±8．3）mmHg;HR：（102±10．63）次／min、（97．6±9．23）次／min、（87．7±8．2）次／min、（82．1±7．32）次／min]与基础值比较均明显升高（P〈0．05）,B组[SBP：（130±11．6）mmHg、（125．6±10．43）mmHg、（120．1±12．3）mmHg、（116．8±11．4）mmHg;DBP：（75．6±9．12）mmHg、（76．2±9．8）mmHg、（73．1±9．2）mmHg、（71．6±8．46）mmHg;HR：（88±9．12）次／min、（82．9±7．5）次／min、（81．9±8．2）次／min、（79．9±7．8）次／min]虽也升高但与基础值相比差异无统计学意义（P〉0．05）。组间比较T2～T4点的A组SBP、DBP、HR明显高于B组（P〈0．05）。结论舒芬太尼诱导行双腔支气管插管抑制插管心血管反应的作用强于芬太尼,期间血流动力更稳定,值得推广。     

Proseal型喉罩与气管导管对老年高血压患者血流动力学的影响

目的比较Proseal型喉罩拔除与气管拔管对老年高血压患者血流动力学的影响。方法择期手术全麻下患者60例，年龄65—85岁，ASAⅡ或Ⅲ级，均合并高血压疾病，随机均分为Proseal型喉罩组（PLMA组）和气管导管组（ETT组）。术中采用七氟醚复合瑞芬太尼血浆靶控输注麻醉。记录麻醉诱导前（T0），拔出喉罩或气管导管即刻（T1）、拔管后1min（T2）、2min（T3）、3min（T4）、5min（T5）、10min（T6）的平均动脉压（MAP）、收缩压（SBP）、心率（RR）、RPP（RPP=收缩压×心率）。结果两组患者的心率都增加，但是与PLMA组相比较，ETT组T1、T2、T3、T4、T5心率显著增加（P〈0．001）。PLMA组与ETT组在T6时，两组心率相比较差异无统计学意义。与PLMA拔出比较，气管拔管后T1、T2、T3、T4、T5平均动脉压均显著升高（P〈0．001），气管拔管后T1、T2、T3、T4、T5RPP显著升高（P〈0．001），两组患者R时RPP相比较差异无统计学意义（P=0．556）。结论老年高血压患者气管导管拔管期间循环波动大，Proseal型喉罩拔除期间的循环波动比气管导管拔管期间循环波动更小，因此，Proseal型喉罩更适合老年高血压患者。     

靶控输注依托咪酯与普鲁泊福麻醉对糖尿病患者围手术期血糖及血流动力学变化的临床研究

目的 观察靶控输注依托咪酯与普鲁泊福麻醉对糖尿病患者围手术期血糖及血流动力学变化的影响.方法 择期手术的糖尿病患者(ASA分级Ⅰ～Ⅱ级)60例随机分为两组,每组各30例.E组:使用靶控输注依托咪酯进行麻醉;P组:使用靶控输注普鲁泊福进行麻醉.分别于麻醉诱导前5min(T0)、插管时(T1)、插管后5min(T2)、手术结束(T3)、术后24h(T4)、术后48 h(T5)采静脉血测定血糖,并记录各时间点收缩压(SBP)、舒张压(DBP)、心率(HR)、脉搏血氧饱和度(SpO2).结果 P组T1及T2的SBP和DBP分别为(110.63±16.92)、(108.80±20.97)mm Hg(1 mm Hg=0.133 kPa)和(66.37±8.00)、(68.60±11.19)mm Hg,心率分别为(73.77±8.13)、(74.67±8.33)次/min,均较T0有所下降[SBP、DBP和HR分别为(135.01±13.45)、(79.37±8.58)mm Hg和(79.73±9.06)次/min],P＜0.05;E组T1及T2的SBP和DBP与T0比较差异无统计学意义(P＞0.05),E组T2的心率为(89.20±9.06)次/min,较T0[(80.97±8.91)次/min]有所增快(P＜0.05).两组血糖在T1～T5均有所增高,但与T0比较差异无统计学意义(P＞0.05).结论 与靶控输注普鲁泊福麻醉相比,靶控输注依托咪酯麻醉对糖尿病患者围手术期具有更好的血流动力学稳定性;二者对患者围手术期血糖变化没有明显影响;靶控输注普鲁泊福及依托咪酯可安全用于ASA分级Ⅰ～Ⅱ级的糖尿病患者的手术麻醉.     

超滑涂层气管导管用于全麻下非困难气道气管插管的临床效果

目的:与普通气管导管相比,观察超滑涂层气管导管是否减轻全麻插管刺激及改善操作效果。方法:选取2016年7月~2017年1月全麻插管的患者60例,ASA分级Ⅰ~Ⅱ级,患者随机分为超滑气管导管组(观察组)和普通气管导管组(对照组)。记录插管时间和插管阻力评价;记录诱导前(T0)、插管前(T1)、插管即刻(T2)、插管后1min(T3)、3min(T4)、5min(T5)、术毕自主呼吸恢复(T6)SBP、DBP、MAP和HR;记录拔管后和术后24h出现咽痛的情况。结果:两组患者T2、T3、T6时对照组SBP、DBP和MAP明显高于观察组(P<0.01),T2、T3、T4时对照组HR明显高于观察组(P<0.01),观察组插管时间短于对照组(P<0.05),对照组术后咽痛发生高于观察组(P<0.05)。结论:超滑气管导管在非困难气道使用时有益于患者血流动力学平稳,缩短插管时间,有效降低术后咽痛的发生率,是一种安全有效的气管插管工具。