Clinical and imaging study on hepatic venous congestion of Ⅴ, Ⅷ segments in living donor liver transplantation

Objective To evaluate MSCT appearance and impaction of Ⅴ, Ⅷ segments' hepatic venous congestion ( HVC ) on hepatic functional recovery in living donor liver transplantation (LDLT).Methods In this study, 83 patients undergoing LDLT in our hospital were included, all subjects received plain and contrast MSCT examinations at early stage (within 1 month) and later stage (3 months later) after LDLT. MSCT appearance of HVC was recorded, at the same time, gutamic pyruvic transaminase ( ALT),glutamic oxalacetic transaminase (AST), total bilirubin (TB) and prothrombin time (PT) of 1 to 7 days after LDLT between congestion group and non-congestion group were recorded and compared.Results Segments Ⅴ and Ⅷ congestion was identified by after LDLT CT scanning in 20 patients (24. 10% ). Congestion volume and congestion ratio was (218. 25 ± 130. 29) cm3 and 16. 68% ±8. 81%,respectively. HVC often appear as hypoattenuation on plain CT scan and arterial phase, mixed or hyperattenuation on portal vein phase. There was no significant difference of ALT, AST, TB and PT after LDLT between congestion group and non-congestion group (P ＞ 0. 05). Conclusions MSCT is a valuable method to evaluate Ⅴ, Ⅷ segments' HVC after LDLT, most HVC has no impaction on hepatic functional recovery in LDLT patients.     

活体肝移植术后Ⅴ、Ⅷ段肝静脉淤血的临床及影像学观察

目的 评价活体肝移植(living donorlivertransplantation,LDLT)术后Ⅴ、Ⅷ段肝静脉淤血(hepatic venous congestion,HVC)的MSCT表现及其对患者术后肝功能恢复的影响.方法83例在天津市第一中心医院移植外科施行活体右半肝移植的患者纳入本研究,所有患者均于术后早期(≤1个月)和术后中晚期(≥3个月)进行MSCT平扫和增强检查,记录淤血区的MSCT表现和患者术后1～7 d丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TB)及凝血酶原时间(PT).比较淤血组和无淤血组上述指标之间的差异.结果 20例患者(24.10%)LDLT术后1个月内出现Ⅴ、Ⅷ段HVC,淤血区体积和淤血率分别为(218.25±130.29)cm3和16.68%±8.81%.淤血区于MSCT平扫及动脉期多呈低密度,门静脉期多呈混杂密度或高密度,增强后动脉期及门静脉期呈持续低密度者预后不良.淤血组与无淤血组患者术后1～7 d各项肝功能化验指标差异均无统计学意义(均P＞0.05).结论 MSCT是评价LDLT术后Ⅴ、Ⅷ段HVC的有效方法,多数HVC对LDLT术后患者肝功能恢复没有影响.

Abstract：

Objective To evaluate MSCT appearance and impaction of Ⅴ, Ⅷ segments' hepatic venous congestion ( HVC ) on hepatic functional recovery in living donor liver transplantation (LDLT).Methods In this study, 83 patients undergoing LDLT in our hospital were included, all subjects received plain and contrast MSCT examinations at early stage (within 1 month) and later stage (3 months later) after LDLT. MSCT appearance of HVC was recorded, at the same time, gutamic pyruvic transaminase ( ALT),glutamic oxalacetic transaminase (AST), total bilirubin (TB) and prothrombin time (PT) of 1 to 7 days after LDLT between congestion group and non-congestion group were recorded and compared.Results Segments Ⅴ and Ⅷ congestion was identified by after LDLT CT scanning in 20 patients (24. 10% ). Congestion volume and congestion ratio was (218. 25 ± 130. 29) cm3 and 16. 68% ±8. 81%,respectively. HVC often appear as hypoattenuation on plain CT scan and arterial phase, mixed or hyperattenuation on portal vein phase. There was no significant difference of ALT, AST, TB and PT after LDLT between congestion group and non-congestion group (P ＞ 0. 05). Conclusions MSCT is a valuable method to evaluate Ⅴ, Ⅷ segments' HVC after LDLT, most HVC has no impaction on hepatic functional recovery in LDLT patients.     

Reconstruction of Ⅴ and Ⅷ bepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation

Objective To summarize the experience of reconstruction of Ⅴ and Ⅷ hepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation. Methods The clinical data of 55 cases of living donor liver transplantation of right lobe without middle hepatic vein were analyzed, and Ⅴ and Ⅷ hepatic veins were reconstructed. All donors underwent evaluation on the basis of vascular anatomy, GRWR and graft volume/ESLV. Fifty-one grafts underwent reconstruction of Ⅴ and Ⅷ hepatic veins with cold-storage cadaveric iliac veins. Great saphenous vein, varicose umbilical veins, recipient intrahepatic portal veins and recipient intrahepatic veins were used respectively in the remaining 4 cases. Results One recipient died of obstruction of out-flow on the postoperative day 43. One recipient was converted to cadaver donor liver transplantation at the 7th day after operation, because of acute liver function failure. The remaining 53 cases recovered successfully. Conclusion Reconstruction of Ⅴ and Ⅷ hepatic veins with proper materials in right lobe (without middle hepatic vein) living donor liver transplantation is feasible, and the effect is satisfactory.     

Reconstruction of Ⅴ and Ⅷ bepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation

Objective To summarize the experience of reconstruction of Ⅴ and Ⅷ hepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation. Methods The clinical data of 55 cases of living donor liver transplantation of right lobe without middle hepatic vein were analyzed, and Ⅴ and Ⅷ hepatic veins were reconstructed. All donors underwent evaluation on the basis of vascular anatomy, GRWR and graft volume/ESLV. Fifty-one grafts underwent reconstruction of Ⅴ and Ⅷ hepatic veins with cold-storage cadaveric iliac veins. Great saphenous vein, varicose umbilical veins, recipient intrahepatic portal veins and recipient intrahepatic veins were used respectively in the remaining 4 cases. Results One recipient died of obstruction of out-flow on the postoperative day 43. One recipient was converted to cadaver donor liver transplantation at the 7th day after operation, because of acute liver function failure. The remaining 53 cases recovered successfully. Conclusion Reconstruction of Ⅴ and Ⅷ hepatic veins with proper materials in right lobe (without middle hepatic vein) living donor liver transplantation is feasible, and the effect is satisfactory.     

Reconstruction of Ⅴ and Ⅷ bepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation

Objective To summarize the experience of reconstruction of Ⅴ and Ⅷ hepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation. Methods The clinical data of 55 cases of living donor liver transplantation of right lobe without middle hepatic vein were analyzed, and Ⅴ and Ⅷ hepatic veins were reconstructed. All donors underwent evaluation on the basis of vascular anatomy, GRWR and graft volume/ESLV. Fifty-one grafts underwent reconstruction of Ⅴ and Ⅷ hepatic veins with cold-storage cadaveric iliac veins. Great saphenous vein, varicose umbilical veins, recipient intrahepatic portal veins and recipient intrahepatic veins were used respectively in the remaining 4 cases. Results One recipient died of obstruction of out-flow on the postoperative day 43. One recipient was converted to cadaver donor liver transplantation at the 7th day after operation, because of acute liver function failure. The remaining 53 cases recovered successfully. Conclusion Reconstruction of Ⅴ and Ⅷ hepatic veins with proper materials in right lobe (without middle hepatic vein) living donor liver transplantation is feasible, and the effect is satisfactory.     

Reconstruction of Ⅴ and Ⅷ bepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation

Objective To summarize the experience of reconstruction of Ⅴ and Ⅷ hepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation. Methods The clinical data of 55 cases of living donor liver transplantation of right lobe without middle hepatic vein were analyzed, and Ⅴ and Ⅷ hepatic veins were reconstructed. All donors underwent evaluation on the basis of vascular anatomy, GRWR and graft volume/ESLV. Fifty-one grafts underwent reconstruction of Ⅴ and Ⅷ hepatic veins with cold-storage cadaveric iliac veins. Great saphenous vein, varicose umbilical veins, recipient intrahepatic portal veins and recipient intrahepatic veins were used respectively in the remaining 4 cases. Results One recipient died of obstruction of out-flow on the postoperative day 43. One recipient was converted to cadaver donor liver transplantation at the 7th day after operation, because of acute liver function failure. The remaining 53 cases recovered successfully. Conclusion Reconstruction of Ⅴ and Ⅷ hepatic veins with proper materials in right lobe (without middle hepatic vein) living donor liver transplantation is feasible, and the effect is satisfactory.     

Reconstruction of Ⅴ and Ⅷ bepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation

Objective To summarize the experience of reconstruction of Ⅴ and Ⅷ hepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation. Methods The clinical data of 55 cases of living donor liver transplantation of right lobe without middle hepatic vein were analyzed, and Ⅴ and Ⅷ hepatic veins were reconstructed. All donors underwent evaluation on the basis of vascular anatomy, GRWR and graft volume/ESLV. Fifty-one grafts underwent reconstruction of Ⅴ and Ⅷ hepatic veins with cold-storage cadaveric iliac veins. Great saphenous vein, varicose umbilical veins, recipient intrahepatic portal veins and recipient intrahepatic veins were used respectively in the remaining 4 cases. Results One recipient died of obstruction of out-flow on the postoperative day 43. One recipient was converted to cadaver donor liver transplantation at the 7th day after operation, because of acute liver function failure. The remaining 53 cases recovered successfully. Conclusion Reconstruction of Ⅴ and Ⅷ hepatic veins with proper materials in right lobe (without middle hepatic vein) living donor liver transplantation is feasible, and the effect is satisfactory.     

Reconstruction of Ⅴ and Ⅷ bepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation

Objective To summarize the experience of reconstruction of Ⅴ and Ⅷ hepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation. Methods The clinical data of 55 cases of living donor liver transplantation of right lobe without middle hepatic vein were analyzed, and Ⅴ and Ⅷ hepatic veins were reconstructed. All donors underwent evaluation on the basis of vascular anatomy, GRWR and graft volume/ESLV. Fifty-one grafts underwent reconstruction of Ⅴ and Ⅷ hepatic veins with cold-storage cadaveric iliac veins. Great saphenous vein, varicose umbilical veins, recipient intrahepatic portal veins and recipient intrahepatic veins were used respectively in the remaining 4 cases. Results One recipient died of obstruction of out-flow on the postoperative day 43. One recipient was converted to cadaver donor liver transplantation at the 7th day after operation, because of acute liver function failure. The remaining 53 cases recovered successfully. Conclusion Reconstruction of Ⅴ and Ⅷ hepatic veins with proper materials in right lobe (without middle hepatic vein) living donor liver transplantation is feasible, and the effect is satisfactory.     

Reconstruction of Ⅴ and Ⅷ bepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation

Objective To summarize the experience of reconstruction of Ⅴ and Ⅷ hepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation. Methods The clinical data of 55 cases of living donor liver transplantation of right lobe without middle hepatic vein were analyzed, and Ⅴ and Ⅷ hepatic veins were reconstructed. All donors underwent evaluation on the basis of vascular anatomy, GRWR and graft volume/ESLV. Fifty-one grafts underwent reconstruction of Ⅴ and Ⅷ hepatic veins with cold-storage cadaveric iliac veins. Great saphenous vein, varicose umbilical veins, recipient intrahepatic portal veins and recipient intrahepatic veins were used respectively in the remaining 4 cases. Results One recipient died of obstruction of out-flow on the postoperative day 43. One recipient was converted to cadaver donor liver transplantation at the 7th day after operation, because of acute liver function failure. The remaining 53 cases recovered successfully. Conclusion Reconstruction of Ⅴ and Ⅷ hepatic veins with proper materials in right lobe (without middle hepatic vein) living donor liver transplantation is feasible, and the effect is satisfactory.     

Reconstruction of Ⅴ and Ⅷ bepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation

Objective To summarize the experience of reconstruction of Ⅴ and Ⅷ hepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation. Methods The clinical data of 55 cases of living donor liver transplantation of right lobe without middle hepatic vein were analyzed, and Ⅴ and Ⅷ hepatic veins were reconstructed. All donors underwent evaluation on the basis of vascular anatomy, GRWR and graft volume/ESLV. Fifty-one grafts underwent reconstruction of Ⅴ and Ⅷ hepatic veins with cold-storage cadaveric iliac veins. Great saphenous vein, varicose umbilical veins, recipient intrahepatic portal veins and recipient intrahepatic veins were used respectively in the remaining 4 cases. Results One recipient died of obstruction of out-flow on the postoperative day 43. One recipient was converted to cadaver donor liver transplantation at the 7th day after operation, because of acute liver function failure. The remaining 53 cases recovered successfully. Conclusion Reconstruction of Ⅴ and Ⅷ hepatic veins with proper materials in right lobe (without middle hepatic vein) living donor liver transplantation is feasible, and the effect is satisfactory.     

Reconstruction of Ⅴ and Ⅷ bepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation

Objective To summarize the experience of reconstruction of Ⅴ and Ⅷ hepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation. Methods The clinical data of 55 cases of living donor liver transplantation of right lobe without middle hepatic vein were analyzed, and Ⅴ and Ⅷ hepatic veins were reconstructed. All donors underwent evaluation on the basis of vascular anatomy, GRWR and graft volume/ESLV. Fifty-one grafts underwent reconstruction of Ⅴ and Ⅷ hepatic veins with cold-storage cadaveric iliac veins. Great saphenous vein, varicose umbilical veins, recipient intrahepatic portal veins and recipient intrahepatic veins were used respectively in the remaining 4 cases. Results One recipient died of obstruction of out-flow on the postoperative day 43. One recipient was converted to cadaver donor liver transplantation at the 7th day after operation, because of acute liver function failure. The remaining 53 cases recovered successfully. Conclusion Reconstruction of Ⅴ and Ⅷ hepatic veins with proper materials in right lobe (without middle hepatic vein) living donor liver transplantation is feasible, and the effect is satisfactory.     

Reconstruction of Ⅴ and Ⅷ bepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation

Objective To summarize the experience of reconstruction of Ⅴ and Ⅷ hepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation. Methods The clinical data of 55 cases of living donor liver transplantation of right lobe without middle hepatic vein were analyzed, and Ⅴ and Ⅷ hepatic veins were reconstructed. All donors underwent evaluation on the basis of vascular anatomy, GRWR and graft volume/ESLV. Fifty-one grafts underwent reconstruction of Ⅴ and Ⅷ hepatic veins with cold-storage cadaveric iliac veins. Great saphenous vein, varicose umbilical veins, recipient intrahepatic portal veins and recipient intrahepatic veins were used respectively in the remaining 4 cases. Results One recipient died of obstruction of out-flow on the postoperative day 43. One recipient was converted to cadaver donor liver transplantation at the 7th day after operation, because of acute liver function failure. The remaining 53 cases recovered successfully. Conclusion Reconstruction of Ⅴ and Ⅷ hepatic veins with proper materials in right lobe (without middle hepatic vein) living donor liver transplantation is feasible, and the effect is satisfactory.     

成人间右半肝活体肝移植的肝动脉重建

Objective To summarize our experience in hepatic artery reconstruction in adult-to-adult right lobe living donor liver transplantation(LDLT).Methods A retrospective analysis was made for 17 cases undergoing LDLT in our center from May 2007 to Oct 2008.Results All the 17 right lobe graft of the liver was supplied by single right hepatic artery and the mean diameter of right hepatic artery was 3.1 mm.The hepatic artery for segment 4 was mainly originated from left hepatic artery(12/17,70.1%).The recipient right or left hepatic artery was used in 14 cases of reconstruction,proper hepatic artery was used in 2 cases,and gastroduodenal artery was used in one case.Anastomosis was performed with interrupted 8-0 prolene and 12-16 stitches were made on the posterior wall first and then the anterior wall to avoid turning over the vessel.The mean anastomosis time was(51±26) minutes and all hepatic arteries were patent immediately after anastomosis.Hepatic arterial complications including hepatic artery thrombosis (HAT)did not occur after LDLT.Conclusions Detailed evaluation and careful protection of the hepatic artery of segment 4 are the key to successful reconstruction of hepatic artery in LDLT.Anastomosis was performed without flipping the artery wall helped to reduce the difficulty of operation remarkably and with a good result.     

成人间右半肝活体肝移植的肝动脉重建

Objective To summarize our experience in hepatic artery reconstruction in adult-to-adult right lobe living donor liver transplantation(LDLT).Methods A retrospective analysis was made for 17 cases undergoing LDLT in our center from May 2007 to Oct 2008.Results All the 17 right lobe graft of the liver was supplied by single right hepatic artery and the mean diameter of right hepatic artery was 3.1 mm.The hepatic artery for segment 4 was mainly originated from left hepatic artery(12/17,70.1%).The recipient right or left hepatic artery was used in 14 cases of reconstruction,proper hepatic artery was used in 2 cases,and gastroduodenal artery was used in one case.Anastomosis was performed with interrupted 8-0 prolene and 12-16 stitches were made on the posterior wall first and then the anterior wall to avoid turning over the vessel.The mean anastomosis time was(51±26) minutes and all hepatic arteries were patent immediately after anastomosis.Hepatic arterial complications including hepatic artery thrombosis (HAT)did not occur after LDLT.Conclusions Detailed evaluation and careful protection of the hepatic artery of segment 4 are the key to successful reconstruction of hepatic artery in LDLT.Anastomosis was performed without flipping the artery wall helped to reduce the difficulty of operation remarkably and with a good result.     

The effects of intravenous fentanyl and lidocaine infiltration on the haemodynamic response to skull pin placement

The aim of this study is to evaluate the effects of intravenous fentanyl and local lidocaine infiltration on the haemodynamic response to Mayfield skull pin head holder (MH) placement. Forty-five patients scheduled for elective craniotomy were studied. They were randomly divided into three groups. Group F received 2 μg/kg^–1 fentanyl i.v. 5 min before placement of the MH, group L was administered 3 ml 1% plain lidocaine by infiltration at each pin site 1 minute later and before placement of the MH, and both methods were applied together in group FL. Mean arterial blood pressure (MAP) and heart rate (HR) were recorded at 5 preset times. Both were significantly increased during and after MH placement in group F compared to groups L and FL. In group L, there was a significant increase in MAP and HR during the placement of MH compared to group FL. In group FL, there was no significant increase in MAP or HR at any time of the recordings. We conclude that intravenous fentanyl with local infiltration of lidocaine into the periosteum is effective in reducing the haemodynamic response to MH placement in patients undergoing craniotomy. Received: 27 December 1999 / Revised: 7 February 2000 / Accepted: 10 February 2000     

右美托咪啶对七氟醚麻醉患儿麻醉恢复期躁动的影响

Objective To investigate the effect of dexmedetomidine on agitation during recovery from sevoflurane anesthesia in children. Methods Three hundred ASA Ⅰ or Ⅱ children, aged 4-7 yr, weighing 16-30kg, scheduled for elective ear-nose-throat operation under general anesthesia, were randomly divided into 2 groups ( n = 150 each) : control group (group C) and dexmedetomidine group (group D) . Dexmedetomidine 0.5 μg/kg in 20 ml was infused intravenously over 10 min before anesthesia induction in group D, while equal volume of normal Saline was infused in group C. Anesthesia was induced with inhalation of 8 % sevoflurane 5 min after the end of administration . The children were tracheal incubated and mechanically ventilated. Anesthesia was maintained with inhalation of 2 % -3 % sevoflurane. BIS was maintained at 40-60 during operation. The recovery time and agitation within 2 h after operation were recorded. Results There was no significant difference in the recovery time between the two groups ( P > 0.05) . The incidence of agitation was significantly lower in group D than in group C ( P <0.05 ) . Conclusion Dexmedetomidine can reduce the occurrence of agitation during recovery from sevoflurane anesthesia in children.     

右美托咪啶对七氟醚麻醉患儿麻醉恢复期躁动的影响

Objective To investigate the effect of dexmedetomidine on agitation during recovery from sevoflurane anesthesia in children. Methods Three hundred ASA Ⅰ or Ⅱ children, aged 4-7 yr, weighing 16-30kg, scheduled for elective ear-nose-throat operation under general anesthesia, were randomly divided into 2 groups ( n = 150 each) : control group (group C) and dexmedetomidine group (group D) . Dexmedetomidine 0.5 μg/kg in 20 ml was infused intravenously over 10 min before anesthesia induction in group D, while equal volume of normal Saline was infused in group C. Anesthesia was induced with inhalation of 8 % sevoflurane 5 min after the end of administration . The children were tracheal incubated and mechanically ventilated. Anesthesia was maintained with inhalation of 2 % -3 % sevoflurane. BIS was maintained at 40-60 during operation. The recovery time and agitation within 2 h after operation were recorded. Results There was no significant difference in the recovery time between the two groups ( P > 0.05) . The incidence of agitation was significantly lower in group D than in group C ( P <0.05 ) . Conclusion Dexmedetomidine can reduce the occurrence of agitation during recovery from sevoflurane anesthesia in children.     

大剂量磷酸肌酸钠预先给药对心脏瓣膜置换术患者心肌缺血再灌注损伤的影响

Objective To investigate the effect of high-dose creatine phosphate (CP) on myocardial ischemia-reperfusion (I/R) injury in patients undergoing cardiac valve replacement. Methods Two hundred and forty-six ASA Ⅱ or Ⅲ patients aged 42-71 yr weighing 45-80 kg undergoing mitral-aortic valve replacement were randomly assigned into 2 groups: control group ( n = 122) and CP group ( n = 124). CP 10 g in 100 ml normal saline (NS) was infused over 60 min starting from the beginning of operation in group CP. In control group NS 100 ml was infused instead of CP. Blood samples were collected before anesthesia and on 1st and 5th postoperative day for determination of serum CK, CK-MB and LDH activity and cTnI concentration. The number of patients receiving dopamine and adrenaline at the time of return of spontaneous heart beat and 12, 24 and 48 h after operation was recorded. The incidence of arrhythmia (auricular fibrillation, ventricular arrhythmia), myocardial infarct and left ventricular ejection fraction (LVEF) were also compared between the 2 groups. Results Serum CK, CK-MB and LDH activity and cTnI concentration on 1st and 5th postoperative day, the doses of dopamine and adrenalin, the incidence of arrhythmia and myocardial infarct were significantly lower in group CP than in control group. The postoperative LVEF and the incidence of spontaneous recovery of spontaneous heart-beat were significantly higher in group CP than in control group. Conclusion Pretreatment with high dose CP can protect myocardium against I/R injury in patients undergoing cardiac valve replacement under CPB.     

瑞芬太尼全麻复合硬膜外麻醉用于开胸手术的临床观察

Objective To investigate the effect and safety of remifentanil anaesthesia combined with epidural anesthesia in thoracic surgery. Methods Two hundred patients, ASA Ⅰ - Ⅱ grade, undergoing thoracotmy were randomly allocated to two groups:Remifentanil group (group R) and Fentanyl group (group F). Two groups were given combined general-epidural anesthesia. Patients in group R received remifentanil. Group F received fentanyl. The blood pressure, heart rate, blood oxygen saturation and plasma cortisol were measured before the operation (T0), 1 min (T1) and 5 min (T2) after tracheal intubation, skin incision(T3) and 5 min after the operation (T4). The endotracheal extubation time and conscious recovery were recorded. Results Compared with group R, the incidence of endotracheal intubation reaction in group F is significantly higher (group F-14/26,53.8% ;group R-4/26,15.4% ;P<0.05 ).All the patients in group R were extubated and recovered conscious completely at 7 min after operation. 6 patients in group F were extubated at 25 min after operation and 3 of them recovered recognition completely one hour later. Conclusion Remifentanil have a faster recovery after surgery than fentanyl, and it can effectively inhibit tracheal intubation stress response. Remifentanil anaesthesia combined with epidural anesthesia can provide perfect acesodyne and maintain steady circulation.     

患者耐受喉罩或气管导管时七氟烷的麻醉深度

Objective To compare the effects of patient's tolerance to laryngeal mask airway (LMA) and tracheal tube (TT) on the appropriate level of sevoflurane anesthesia.Methods Eighty ASA Ⅰ or Ⅱ patients aged 30-60 yr weighing 50-70 kg undergoing elective thyroid or breast surgery were randomly divided into 2 groups (n=40 each):LMA group and TT group.Anesthesia wag induced with propofol 1.6mg/kg,fentanyl 3μg/kg and recuronium 0.6mg/kg.LMA or tracheal tube was inserted,and the patients were mechanically ventilated.Anesthesia was maintained with inhalation of 1.5%-3.0% sevoflurane and 50% N2O in O2 in group LMA,and with 2.5%-5.0% sevoflurane and 50% N2O in O2 in group TT.The flow of O2 and N2O was 0.7-1.0L/min,and the concentration of sevofluranee was adjusted to maintain AAI at 15-25.ECG,HR,MAP,SpO2,PETCO2,AEP and end-tidal sevoflurane concentration were continuonsly monitored.The end-tidal sevoflurane concentration was recorded at 1,5 and 10 min after LMA/TT was placed (T1-3),at 1h after skin incision (T4) and at the end of operation before removal of LMA or extubation (T5).The recovery time of consciousness,adverse cardiovascular events and adverse reactions were recorded.Results The end-tidal sevoflurane concentration was significantly lower,the recovery time of consciousness and removal of LMA or extubation time were shorter,and the incidence of adverse cardiovascular events and adverse reactions was lower in LMA group than in TT group.Conclusion At the same depth of anesthesia (AAI 15-25),sevoflurane concentration is significantly lower in LMA group than in TT group,with fewer complications and smaller cardiovascular reaction.