硫酸镁对子痫前期产妇硬膜外分娩镇痛产时发热的影响

目的 探讨硫酸镁对子痫前期产妇硬膜外分娩镇痛产时发热的疗效及安全性.方法 选择单胎、头位、子痫前期初产妇125例,年龄23～33岁,BMI 23～29 kg/m2,ASAⅡ或Ⅲ级.随机分为两组,硫酸镁组(M组,n=66)和对照组(C组,n=59).M组分娩镇痛前经静脉输注硫酸镁50 mg/kg,持续20 min;C组同...     

Different preloading protocols with constant ephedrine infusion in the prevention of hypotension for elective cesarean section under spinal anesthesia

Ninety ASA I or II parturients were randomly allocated to three groups: group 10RL, 15RL and 20RL to receive 10, 15 and 20 mL/kg of Ringer's lactate (RL) respectively within 15 minutes (min) before the spinal block. Spinal anesthesia was performed with hyperbaric bupivacaine 12 mg, morphine 100 microg and fentanyl 10 microg. The operating table was tilted to the left and an IV infusion of ephedrine of 3 mg/min was immediately started and continued until umbilical cord clamping in all groups. Hypotension was defined as a drop in mean arterial pressure (MAP) of more than 20% from baseline : this was treated with 10 mg ephedrine IV. The incidence of hypotension was 60%, 36.7% and 13.4% in group 10RL, 15RL and 20RL, respectively (p<0.05). Additional ephedrine dose was the lowest in group 20RL compared to the other groups (p<0.05). The total amount of ephedrine was 49.9 +/- 13.5, 46.4 +/- 13.4 and 38.4 +/- 8.5 mg in group 10RL, 15RL and 20RL, respectively (p <0.05). The incidence of nausea and vomiting in group 20RL was significantly less than in group 10RL (p = 0.02). It was concluded that preloading with 20 mL/kg of RL prior to spinal anesthesia followed by constant ephedrine infusion 3 mg/min after spinal block reduced the incidence of hypotension and of nausea and vomiting and decreased the total amount of ephedrine.     

Effect of low dose phenylephrine infusion on shivering and hypothermia in patients undergoing cesarean section under spinal anesthesia: a randomized clinical trial

BackgroundShivering is a common complication of spinal anesthesia. Phenylephrine, due to its peripheral vasoconstrictive effect, may limit the core to periphery redistribution of body temperature following spinal anesthesia, and reduce hypothermia and shivering. We hypothesized that prophylactic phenylephrine infusion would reduce shivering and hypothermia in women undergoing cesarean section under spinal anesthesia.MethodsA two-arm randomized, double-blind, placebo-controlled trial in term pregnant patients undergoing cesarean section. In the phenylephrine group (n=75) prophylactic phenylephrine infusion was administered at 25 µg/min immediately after initiation of spinal anesthesia and continued until the end of the operative period. In the placebo group (n=75) a normal saline infusion was administered during the same period. The primary outcome was the incidence of shivering; secondary outcomes were severity of shivering, changes in nasopharyngeal (core) temperature, and incidence of hypotension and bradycardia.ResultsThe incidence of shivering in the phenylephrine and control groups was 24.0% (95% CI 14.3% to 33.7%) and 53.3% (95% CI 42.0% to 64.6%), respectively. The severity of shivering was greater in the control group (P=0.002) and the mean (±SD) end of surgery core temperature was significantly higher in the phenylephrine group (35.84°C ± 0.60) compared with controls (35.61°C ± 0.48) (P=0.009). The incidence of hypotension was higher in controls (53.4% vs. 2.7%; P <0.001) but bradycardia more frequent in group P (P=0.023).ConclusionThe incidence of shivering and degree of hypothermia were significantly reduced by a prophylactic phenylephrine infusion during cesarean section under spinal anesthesia.     

Effect of preoperative skin infiltration with 0.5% bupivacaine on postoperative pain following cesarean section under spinal anesthesia

Recent work suggests that preoperative skin infiltration with local anesthetic may lead to reduced postoperative pain. We have studied this in a randomised, prospective, double-blind trial of 40 women having cesarean section under spinal anesthesia. After establishment of the spinal block, the incision line was infiltrated in 20 women with 30 ml 0.5% bupivacaine and in 20 with 30 ml normal saline. There was no difference in pain scores between the 2 groups on any of the 3 postoperative days, perhaps due to the high quality analgesia provided by supplemental subarachnoid morphine.     

剖宫产术患者左旋布比卡因蛛网膜下腔阻滞的量效关系

目的 确定剖宫产术患者左旋布比卡因蛛网膜下腔阻滞的量效关系.方法 择期剖宫产术患者印例,年龄25～35岁,体重60～90 kg,ASA Ⅰ或Ⅱ级,随机分为4组(n=15),于L3,4蛛网膜下腔穿刺成功后,分别注射左旋布比卡因7.5 mg(L1组)、10 mg(L2组)、12.5 mg(L3组)和15 mg(L4组),均用5%葡萄糖稀释至3 ml,注药时间30 s.采用视觉模拟评分法(VAS)评价切皮即刻患者疼痛程度,0分为无痛,10分为剧痛.VAS评分=0分为镇痛有效;VAS评分≥1分为镇痛无效,硬膜外追加1%利多卡因5～10 ml.采用Probit法计算50%和95%患者镇痛有效的左旋布比卡因剂量(ED50和ED95)及其95%可信区间.结果 左旋布比卡因的ED50及其95%可信区间为9.0(7.8～9.9)mg,ED95及其95%可信区间为13.2(11.6～17.6)mg.结论 剖宫产术患者左旋布比卡因蛛网膜下腔阻滞的ED50和ED95分别为9.0、13.2 mg.     

Effects of magnesium sulfate on neuromuscular function and spontaneous breathing during sevoflurane and spinal anesthesia

The purpose of the present study was to determine the effects of magnesium sulfate (MgSO⁴) on the neuromuscular function and spontaneous breathing of patients under sevoflurane and spinal anesthesia. Twenty-two patients with a history of arrhythmia undergoing elective knee surgery were randomly assigned to two groups: group M (n = 11), administered with MgSO⁴ 40 mg·kg⁻¹, and group S (n = 11), administered with saline. A combination of spinal anesthesia with 2% sevoflurane inhalation was applied to all patients under spontaneous breathing. Tidal volume (Vt), respiratory rate (RR) and end-tidal carbon dioxide (ET^{CO 2}) were measured before the MgSO⁴ or saline injection and measurements were repeated at 5, 15, 30, and 45 min after the injection. Neuromuscular function was continuously monitored with an acceleromyograph to record the acceleration of the adductor pollicis by stimulating the ulnar nerve at a frequency of 0.1 Hz. The Vt, RR, and ET^{CO 2} showed little change in either group, and there was no significant difference between, the groups. The single-twitch response showed significant differences between the two groups (P = 0.0006). The present study indicated that the MgSO⁴ had a minimal effect on spontaneous breathing in patients undergoing sevoflurane and spinal anaesthesia, but that it attenuated the safety margin of neuromuscular function.     

艾司氯胺酮在硬膜外阻滞剖宫产术中的效果

目的 观察艾司氯胺酮辅助硬膜外阻滞用于剖宫产术的效果及对母婴结局的影响。方法 选择择期硬膜外阻滞下行择期剖宫产术足月单胎产妇90例，年龄20～40岁，BMI 18～35 kg/m²,ASAⅡ级。采用随机数表法将产妇分为两组：艾司氯胺酮组(K组)和对照组(C组),每组45例。硬膜外阻滞后，在切皮前1 min, K组静脉注射艾司氯胺酮0.15 mg/kg, C组静脉注射等容量生理盐水。记录术中产妇牵拉反应情况，胎儿娩出后1、5 min Apgar评分。采集新生儿断脐后、脐带结扎前的脐静脉血，记录新生儿脐静脉血pH、二氧化碳分压(PCO₂)、氧分压(PO₂)、乳酸(Lac)。记录产妇术中恶心、呕吐、幻觉、头晕、噩梦等不良反应发生情况。结果 与C组比较，K组产妇术中牵拉反应发生率明显降低(P<0.05)。两组新生儿1、5 min Apgar评分和脐静脉血pH、PCO₂、PO₂、Lac差异无统计学意义。两组产妇恶心、呕吐、头晕发生率差异无统计学意义。两组产妇均未出现幻觉、噩梦等不良...     

锁骨下静脉塌陷指数对剖宫产产妇腰麻后低血压的预测价值

目的探讨超声测量锁骨下静脉直径(dSCV)及锁骨下静脉塌陷指数(SCV-CI)对剖宫产产妇腰麻后低血压的预测价值。方法纳入择期剖宫产单胎产妇101例,年龄18～40岁,ASAⅠ或Ⅱ级,孕37～42周。于腰麻前后采用超声测量最大dSCV (dSCVmax)和SCV-CI。根据产妇腰麻后是否发生低血压分为两组:未发生低血压组(N组)和发生低血压组(H组)。采用Pearson相关分析dSCVmax、SCV-CI与腰麻后低血压之间的关系,并采用受试者工作特征(ROC)曲线评价dSCVmax、SCV-CI对腰麻后低血压的预测价值。结果腰麻后有44例(43.6%)产妇发生低血压。与N组比较,H组腰麻前后dSCVmax明显降低,SCV-CI明显升高(P0.01)。腰麻前后dSCVmax预测腰麻后低血压的ROC曲线下面积(AUC)分别为0.806、0.903,临界值分别为8.0 cm、6.5 cm,敏感性分别为80.84%、75.00%,特异性分别为57.89%、94.74%(P0.01)。腰麻前后SCV-CI预测腰麻后低血压的AUC分别为0.871、0.914,临界值分别为38.24%、37.68%,敏感性分别为70.45%、93.18%,特异性分别为96.49%、98.25%(P0.01)。结论腰麻前和腰麻后SCV-CI在预测剖宫产产妇腰麻后低血压具有一定价值,且腰麻后SCV-CI更具有临床意义。     

艾司氯胺酮与硫酸镁用于腹腔镜全子宫切除术后镇痛效果的比较

目的 观察和比较艾司氯胺酮与硫酸镁用于腹腔镜全子宫切除术后镇痛的效果。
方法 选择择期在全麻下行腹腔镜全子宫切除术患者135例，年龄18～64岁，BMI 18.5～28.0 kg/m²，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者随机分为两组：艾司氯胺酮组（E组，n=67）和硫酸镁组（M组，n=68）。E组在手术开始前静脉注射艾司氯胺酮0.25 mg/kg，随后持续静脉泵注0.15 mg·kg^-1·h^-1；M组在手术开始前静脉注射硫酸镁50 mg/kg，随后持续静脉泵注8 mg·kg^-1·h^-1。术后行患者自控静脉镇痛（PCIA），配方为氢吗啡酮0.1 mg/kg+帕洛诺司琼0.25 mg。记录术中丙泊酚、瑞芬太尼用量和苏醒时间。记录术后2、6、12、24、48 h氢吗啡酮消耗量（等效界值为0.25 mg）、静息和活动时VAS疼痛评分。记录术后0~2 h、2~6 h、6~12 h、12~24 h和24~48 h内镇痛泵按压次数。记录术后补救镇痛、术后24 h内不良反应发生情况。
结果 与M组比较，E组术中丙泊酚及瑞芬太尼用量明显增加（P＜0.05），苏醒时间明显延长（P＜0.05）。两组术后2、6、12、24、48 h氢吗啡酮消耗量、静息和活动时VAS疼痛评分、术后0~2 h、2~6 h、6~12 h、12~24 h和24~48 h内镇痛泵按压次数、术后补救镇痛率和术后24 h内不良反应发生率差异无统计学意义。
结论 艾司氯胺酮可为腹腔镜全子宫切除术患者提供与硫酸镁相似的术后镇痛效果。     

目标导向液体治疗对剖宫产术产妇蛛网膜下腔阻滞后低血压的影响

目的 评价经胸壁超声(TTE)指导的目标导向液体治疗(GDFT)对降低剖宫产术产妇蛛网膜下腔阻滞后低血压发生率的影响。方法 选择于蛛网膜下腔阻滞下行择期剖宫产术产妇128例,年龄18～35岁,BMI≤30 kg/m²,ASAⅡ级。将产妇随机分为两组：对照组(C组)和GDFT组(T组),每组64例。C组在胎儿娩出前输注复方乳酸钠20 ml·kg^-1·h^-1,胎儿娩出后减至5 ml·kg^-1·h^-1。T组产妇在蛛网膜下腔阻滞后3 min内输注复方乳酸钠3 ml/kg,在TTE指导下使每搏变异度(ΔSV)≤10%,行GDFT前后输注复方乳酸钠5 ml·kg^-1·h^-1。记录输液量、术中低血压的发生情况、去氧肾上腺素用量、术后24 h出血量和术后住院时间。记录麻醉前(t₀)、蛛网膜下腔阻滞注药完成后5 min(t₁)、胎儿娩出时(t₂)和蛛网膜下腔阻滞注药完成后15 min(t...     

择期全麻手术患者舒芬太尼靶控输注系统的评价

目的评价择期全麻手术患者应用Bovill药代动力学参数行舒芬太尼靶控输注（TCI）的准确性。方法择期静吸复合全麻下行腰椎管狭窄症矫正手术患者60例,ASAⅠ或Ⅱ级,按年龄分为老年组（≥65岁,0组）、中年组（45～64岁,M组）和青年组（18～44岁,Y组）,每组20例。麻醉诱导开始舒芬太尼效应室靶浓度为0.4ng/ml,此后每15分钟递增0.2ng/ml,直至0.8ng/ml,15min后降为0.6ng/ml,维持20min后,以0.4ng/ml维持25min,然后停止输注舒芬太尼。术中根据脑电双频谱指数（BIS）、MAP和肌松程度等调整吸入异氟烷浓度和肌松药用量。每组随机选取10例患者,在每一设定的效应室靶浓度维持末[0.4ng/ml（T1）、0.6ng/ml（T2）、0.8ng/ml（T3）、0.6ng/ml（T4）、0.4ng/ml（T5）]采血,以液相色谱.质谱联用法测定舒芬太尼血药浓度。于麻醉诱导前（基础值）、T1、T2、T3、T4、T5和拔管即刻（T6）记录MAP、HR和BIS,并记录睁眼时间和拔管时间,拔管即刻和在麻醉恢复室中伤口疼痛和副作用情况。记录TCI系统的偏离性、精确度和摆动度。结果与基础值比较,3组T1～5时MAP降低,T2～5时HR减慢,T6时HR增快,T1～6时BIS降低（P〈0.05或0.01）。3组舒芬太尼实测血药浓度均随设定的效应室靶浓度的依次升高或降低而升高或降低（P〈0.05）,但3组间各时点比较差异无统计学意义（P〉0.05）。O组、M组和Y组偏离性分别为-9.9%、-9.3%和-8.5%,精确度分别为17.2%、14.5%和20.4%,摆动度分别为12.0%、10.3%和14.5%。结论舒芬太尼TCI系统可安全、有效地用于成人全麻手术患者。采用Bovill药代动力学参数TCI舒芬太尼时,国人的实测血药浓度较血浆靶浓度低10%。     

Effects of crystalloid and colloid preload on blood volume in the parturient undergoing spinal anesthesia for elective Cesarean section

BACKGROUND: The anesthetic requirement is decreased in animals with head injury, but there are no data regarding the effect of intracranial tumor on the potency for intravenous anesthetics. The authors compared the quantal dose-response curves for propofol in patients having large (> or = 30 mm, mass effect) brain tumor with those having smaller (< 30 mm) lesions and with control patients undergoing noncranial surgery. METHODS: Sixty patients in each group were randomly assigned to receive one of the six doses of propofol (0.5, 0.7, 1.0, 1.3, 1.8, or 2.5 mg/kg) over 10 s. Two minutes after drug administration, patients were asked to open their eyes as a test for response to verbal command. Patients who failed to respond were given a 10-s, 50-Hz, 80-mA transcutaneous tetanic electrical current to the ulnar nerve as a test for response to painful stimulus. Purposeful movement indicated positive response. Log dose-response curves for loss of response to verbal command and tetanic stimulus were calculated after logit transformation. RESULTS: The median effective doses (ED50s; 95% confidence interval) for suppressing response to verbal command and tetanic stimulus were 0.75 (0.65-0.86) mg/kg and 1.28 (1.11-1.49) mg/kg, respectively, in patients with large brain tumor. These values were significantly less than the corresponding ED50s in patients with small tumor, 1.01 (0.88-1.15) mg/kg and 1.76 (1.51-2.07) mg/kg, or healthy control subjects, 0.98 (0.86-1.12) mg/kg and 1.89 (1.62-2.23) mg/kg. CONCLUSIONS: The doses of propofol required to suppress response to verbal command and tetanic stimulus were 23% less and 32% less in patients with large brain tumor compared with control subjects. Small tumor did not affect potency of propofol.     

相同浓度的左旋布比卡因、罗比卡因与布比卡因硬膜外腔给药用于剖宫产术时效性的比较

目的比较左旋布比卡因、罗比卡因和布比卡因用于硬膜外麻醉剖宫产术的阻滞效果、母婴安全和药物不良反应.方法采用随机双盲法,将48例择期剖宫产手术的足月单胎产妇分为三组：0.5%左旋布比卡因组（L组）17例、0.5%罗比卡因组（R组）15例和0.5%布比卡因组（B组）16例.记录硬膜外腔给药后产妇的感觉阻滞和运动阻滞的起效和持续时间、肌松满意程度、麻醉质量评价、恶心和呕吐等不良反应及术中心率、血压、脉搏血氧饱和度和新生儿1 min和5 min Apgar评分.结果产妇的一般情况、新生儿的Apgar评分组间无显著性差异;三组术中低血压及其他不良事件（恶心和呕吐）的发生率无显著性差异;各组的麻醉质量（术中的疼痛评分和肌松满意度）基本一致;感觉阻滞起效和维持时间组间无显著性差异,运动阻滞改良Bromage评分为1分的起效时间和持续时间组间有显著性差异.结论常用量0.5%左旋布比卡因、罗比卡因和布比卡因用于剖宫产手术的硬膜外麻醉时具有相似的麻醉效能和安全性.     

硫酸镁对兔脊髓缺血再灌注损伤保护作用的研究

目的:探讨硫酸镁对兔脊髓缺血再灌注损伤的保护效果。方法:27只新西兰大白兔,随机分为A组(硫酸镁处理组)、B组(生理盐水)和C组(假手术对照组)。A、B两组参照Tetik方法建立兔脊髓腰骶段缺血模型,比较三组动物不同时间点的体感诱发电位(SEP)、后肢运动功能评分及缺血再灌注后48h的病理学改变。结果:C组SEP没有明显变化,动物均完全康复。缺血30min时B组波形消失,A组波幅降为基线的(29.3±1.9)%。再灌注60min后A组、B组SEP波幅分别渐升致基线的(74.5±2.3)%和(49.2±2.1)%。A组N1、P1波峰潜伏期在缺血30min及再灌注60min时均明显优于B组(P<0.05);再灌注24h和48h后,A组的后肢运动功能评分均显著高于B组(P<0.05);再灌注48h后A组的脊髓前角神经细胞计数显著高于B组(P<0.01)。结论:硫酸镁具有减轻兔脊髓缺血再灌注损伤及保护神经功能的作用。     

不同剂量去氧肾上腺素静脉注射对腰麻下剖宫产产妇及新生儿的影响

目的观察不同剂量去氧肾上腺素静脉注射对腰麻下剖宫产产妇及新生儿的影响。方法择期腰麻剖宫产单胎产妇60例,随机均分为三组,在蛛网膜下腔注入0.5%重比重布比卡因2.5ml,鞘内注药后立即静脉泵注去氧肾上腺素150μg(P1组)、300μg(P2组)或等量生理盐水(C组)各3ml,速率1ml/min。若发生低血压时追加去氧肾上腺素100μg。监测并记录产妇SBP、DBP、HR、每搏输出量(SV)和心输出量(CO),以及低血压、高血压、恶心呕吐及心动过缓的发生次数。记录新生儿Apgar评分,并取脐带动静脉血行血气分析。结果与入室后比较,腰麻后1、5minC组SBP、DBP明显降低(P<0.05),P1、P2组无显著变化;腰麻后1、5min和分娩前1minP1、P2组HR明显减慢,C组仅在分娩前1min显著减慢(P<0.05);腰麻后1、5minP2组SV显著升高,腰麻后5minC组显著降低(P<0.05),且腰麻后5minP1、P2组明显高于C组(P<0.05);腰麻后5min和分娩前1minP1、P2组CO显著降低(P<0.05),分娩前1minC组也显著降低(P<0.05)。P1组和P2组低血压的发生率显著低于C组(P<0.05)。P1组和P2组分别有1例和3例高血压。结论小剂量去氧肾上腺素静脉输注能减少分娩前产妇低血压的发生率,对母体和胎儿影响较小。     

Comparative study between ephedrine infusion vs. CO/post loading of fluids for prevention of hypotension in emergency cesarean section under spinal anesthesia

IntroductionMaternal hypotension is the most common complication during cesarean section under spinal anesthesia. The aim of this study was to compare the effectiveness of CO/post loading of fluids versus immediate post spinal infusion of ephedrine in prevention of hypotension.MethodsNinety healthy pregnant patients ASA I with single term fetus arrived to the operating room with nonlife threatening cause for emergency cesarean section under spinal anesthesia. The patients were allocated randomly into 3 groups, Group R: started the CO/post loading at the time of spinal injection and continued after it with 0.5 ml/kg/min Lactated Ringer's solution until delivery of the fetus. Group V: started the CO/post loading with 0.5 ml/kg/min Voluven at the same period. Group E: started ephedrine infusion at 1 mg/min via the infusion pump immediately after spinal anesthesia until delivery of the fetus.ResultsThe systolic blood pressure changes were statistically significant but they failed to reach clinical significant values in the three groups. The total dose of ephedrine was significantly higher in Ephedrine group than the other two groups. Intraoperative heart rate increased in the first 30 min in Ephedrine group without any clinical significance. All fetal data were within normal range and comparable between groups. Apger score of the fetuses was not less than 8 in the three groups. The incidence of nausea and vomiting was higher in group R and group V compared to group E.ConclusionIntravenous infusion of ephedrine 1 mg/min immediately after spinal anesthesia for emergency cesarean sections, even if there is no enough time for proper prehydration, can control effectively the hypotension without episodes of hypertension or significant tachycardia, and it had no effect on fetal well-being. It could be as effective as CO/post loading of 0.5 ml/kg/min lactated Ringer or Voluven in controlling systolic blood pressure with fewer incidences of post operative complications.     

硬膜外腔注射生理盐水对剖宫产术患者腰麻效果的影响

目的探讨硬膜外腔注射生理盐水对剖宫产术患者腰麻效果的影响。方法择期行子宫下段剖宫产术患者60例,年龄24～30岁,体重59～73 kg,随机分为2组,每组30例,A组蛛网膜下腔注射规定剂量的0.75%布比卡因后硬膜外腔注射生理盐水5 ml;B组蛛网膜下腔注射0.75%布比卡因。按序贯法进行试验,设定布比卡因的起始剂量为9 mg,剂量梯度为1.5 mg,若上一例有效,则下一例递减一个剂量梯度,若无效则下一例递增一个剂量梯度,蛛网膜下腔阻滞有效的标准为注射布比卡因后20 min内阻滞上平面达T5。采用概率单位法计算ED50。结果A组布比卡因的ED50（5.8 mg）低于B组（8.1 mg）,两组比值为0.72,95%置信区间为0.27～0.98,区间范围不包括1,差异有统计学意义（P〈0.05）。结论硬膜外腔注射生理盐水可增强剖宫产术患者腰麻的效果。