轻比重与重比重布比卡因腰硬联合麻醉在老年髋关节置换术中的效果

目的探究轻比重与重比重布比卡因腰硬联合麻醉在老年髋关节置换术中的应用效果。方法选取2016年2月至2018年2月广东省佛山市中医院麻醉科收治的112例髋关节置换术老年患者作为研究对象,按照麻醉方式不同分为观察组(3 ml 0.25%轻比重布比卡因腰硬联合麻醉)和对照组(3 ml 0.50%重比重布比卡因腰硬联合麻醉),各组56例。比较2组患者麻醉效果,麻醉前及麻醉后5、10、15、30及60 min(T1～T5)各时间点心率(HR)、平均动脉压(MAP)与动脉血氧饱和度(SpO_2)水平,下肢运动阻滞程度(采用改良Bromage法评价)以及不良反应等情况。采用SPSS 17.0统计软件分析数据。结果与对照组比较,观察组患者麻醉维持时间显著升高[(123.3±10.5)和(110.2±10.3)s,P=0.031],感觉阻滞起效时间[(35.6±7.4)和(45.7±7.9)s,P=0.008]及运动阻滞起效时间[(235.7±34.7)和(270.7±39.7)s,P=0.041]显著降低,差异有统计学意义。在T0～T3各时间点,2组患者HR比较差异不显著(P0.05),但T4～T5时间点观察组HR显著低于对照组(P0.05)。在T0～T5各时间点,2组患者MAP比较差异无统计学意义(P0.05)。在T1～T4时间点观察组患者SpO_2显著高于对照组(P0.05)。观察组HR、MAP、SpO_2在T0～T5不同时间点水平略有不同,但差异无统计学意义(P0.05)。与T0比较,对照组患者T1～T5的HR及T2～T5的MAP发生显著变化,差异有统计学意义(P0.05)。与术前相比,术后观察组(P=0.013)及对照组(P=0.015)Bromage 2级比例均显著升高,3级比例(P=0.038;P=0.021)显著下降。同时术后观察组1级(P=0.021)、2级(P=0.039)比例显著高于对照组,差异有统计学意义。轻比重与对照组患者不良反应总发生率比较差异有统计学意义[8.9%(5/56)和37.5%(21/56);P=0.000]。结论在老年髋关节置换术中采用轻比重布比卡因腰硬联合麻醉效果显著,可降低术中血流动力学波动,减少并发症发生,可靠性及安全性较高。     

不同比重液单侧腰麻在老年人髋部手术中的麻醉效果观察

目的观察不同比重液单侧腰麻在老年人髋部手术中的麻醉效果及并发症。方法将60例择期行髋部手术的老年患者随机分为两组:轻比重组(A组)30例(0.75%布比卡因与灭菌注射用水混合);重比重组(B组)30例(0.75%布比卡因与5%葡萄糖注射液混合)。两组均选择腰硬联合麻醉(CSEA),混合液含布比卡因8~15 mg,推注速度0.1 ml/s,注药完毕后维持穿刺体位不变至麻醉平面固定。观察麻醉起效时间、阻滞完全时间、持续时间、血流动力学变化及不良反应发生率。结果两组患者术中麻醉效果均满意,A组麻醉起效时间及平面固定时间均较B组延长(P0.01),而维持时间较B组短(P0.01)。与A组相比,B组血流动力学波动较大,需要辅助使用血管活性药,差异有统计学意义(P0.05)。结论轻比重与重比重单侧腰麻均可适用于老年髋部手术麻醉,但轻比重单侧腰麻的血流动力学更趋于稳定,更加安全可行。     

不同全身麻醉药物诱导对老年患者心功能的影响

目的探讨不同全身麻醉药物诱导对老年患者心功能的影响。方法选择非心脏手术美国麻醉医师协会分级为Ⅰ～Ⅱ级的老年患者75例,随机分为七氟醚组(S组)、丙泊酚组(P组)和咪达唑仑组(M组),每组各25例。3组患者分别在麻醉诱导前(T_0)、诱导插管前1 min(T_1)、插管后2 min(T_2)、插管后5 min(T_3)、插管后10 min(T_4)5个时间点,应用心输出量超声监测仪,监测患者的左心室输出量、每搏输出量、外周血管阻力、峰值速度、净射血时间百分比、心率情况。结果与T_0比较,S组T_1、T_2、T_3、T_4时间点的平均动脉压、外周血管阻力均明显下降,差异有统计学意义(P<0.05);P组T_1、T_2、T_3、T_4时间点的平均动脉压、外周血管阻力显著下降(P<0.01),左心室输出量、每搏输出量、峰值速度降低,净射血时间延长,差异有统计学意义(P<0.05)。与S组和M组比较,P组T_1、T_2、T_3、T_4时间点的平均动脉压、外周血管阻力明显下降,差异有统计学意义(P<0.05);与M组比较,S组T_1、T_2、T_3、T_4时间点的外周血管阻力明显下降,差异有统计学意义(P<0.05)。结论 3种全身麻醉药物均可对老年患者进行安全、有效地诱导;但丙泊酚对老年患者心功能影响最大,咪达唑仑最小。     

两种比重的左旋布比卡因用于儿童腰硬联合麻醉60例效果比较

0.2%轻比重左旋布比卡因与0.5%重比重左旋布比卡因用于儿童患者腰硬联合麻醉中,比较其麻醉效果及并发症。认为儿童患者应用重比重左旋布比卡因行腰硬联合麻醉起效快,维持时间长,更适用于时间较长的手术。     

左旋布比卡因、罗哌卡因在妇科手术硬膜外麻醉中的应用效果比较

目的比较左旋布比卡因和罗哌卡因在妇科手术硬膜外麻醉中的应用效果。方法妇科手术患者102例,随机分为观察组和对照组各51例,观察组采用左旋布比卡因连续硬膜外麻醉,对照组采用罗哌卡因连续硬膜外麻醉。观察两组感觉阻滞起效时间、恢复时间及运动阻滞起效时间、恢复时间,检测麻醉诱导前(T0)、手术45min(T1)、术后1 d(T2)血清皮质醇(Cor)和超敏C反应蛋白(hs-CRP)。观察两组麻醉过程中不良反应。结果两组感觉阻滞起效时间、恢复时间及运动阻滞起效时间、恢复时间比较差异均无统计学意义(P均>0.05);T0时两组血清Cor、hs-CRP比较差异均无统计学意义(P均>0.05),T1、T2时观察组血清Cor、hs-CRP均低于对照组(P<0.05或<0.01)。两组麻醉过程中不良反应比较差异无统计学意义(P>0.05)。结论妇科手术硬膜外麻醉中应用左旋布比卡因和罗哌卡因的麻醉效果相当,不良反应均轻微,但左旋布比卡因可减轻手术引起的应激反应。     

密封帽联合喉罩通气在无痛纤维支气管镜诊治中的应用效果

目的探讨密封帽联合喉罩通气在无痛纤维支气管镜(纤支镜)诊治中的应用效果。方法选取广西医科大学第四附属医院2011年1月—2015年8月收治的肺部阴影拟行纤支镜诊治的患者120例,采用计算机随机法将患者分成密封帽组(A组)及非密封帽组(B组),各60例。两组患者在术前均静脉注射丙泊酚与瑞芬太尼,A组置入喉罩联合密封帽通气下行纤支镜诊治,B组置入喉罩,未封闭密封帽,行纤支镜诊治。比较两组患者镜检时间、支气管镜检查中断发生率,麻醉前5min(T_0)、插管前即刻(T_1)、插管后即刻(T_2)、插管后3min(T_3)、拔管时(T_4)、拔管后3min(T_5)、通气5min(T_6)、通气10min(T_7)时的收缩压、舒张压、血氧饱和度(SpO_2)、心率(HR)的变化情况,T_6、T_7时潮气量(VT)、气道峰压(Ppeak),并发症发生情况(呛咳、憋气、肢体运动、呼吸道损伤)及麻醉满意度。结果 A组镜检时间短于B组,支气管镜检查中断发生率低于B组(P0.05)。T_2、T_3时B组患者收缩压、舒张压、HR、SpO_2高于T_0(P0.05)。T_2时B组患者平均动脉压高于T_0(P0.05)。A组在各个时间点收缩压、舒张压、平均动脉压、HR、SpO_2无显著性改变。T_7时B组患者VT低于T_6时,Ppeak高于T_6时(P0.05)。A组T_6、T_7时VT、Ppeak平稳。A组患者体动、呛咳、憋气发生率低于B组,麻醉满意度高于B组(P0.05)。结论密封帽联合喉罩通气下行无痛纤支镜检查安全、有效、可行。     

右美托咪定复合芬太尼对老年ERCP和ESD麻醉质量及体征的影响观察

目的观察右美托咪定复合芬太尼对老年内镜下逆行胰胆管造影术(ERCP)与内镜黏膜下剥离术(ESD)患者麻醉质量及体征的影响。方法选取88例行择期ERCP或ESD手术患者,随机分为观察组与对照组,各44例。对照组采取芬太尼复合咪达唑仑麻醉,观察组采用芬太尼复合右美托咪定。比较两组患者麻醉前后不同时刻的心率(HR)、血氧饱和度(SpO_2)、舒张压(DBP)、收缩压(SBP)、血清皮质醇(Cor)浓度及不良反应总发生率。结果用药后两组HR、DBP、SBP均有不同程度变化,SpO_2无明显变化;观察组T_2、T_3、T_4、T_5等时刻的HR、DBP、SBP均低于对照组(P0.05)。两组麻醉前血清Cor水平的差异P0.05;用药后两组Cor均升高,观察组ERCP开始即刻与术后10 min的Cor水平分别为(262.46±23.51)nmol/L、(244.76±20.40)nmol/L,均低于对照组(P0.05)。观察组不良反应总发生率为13.64%,低于对照组38.6%(P0.05)。结论右美托咪定复合芬太尼用于老年ERCP、ESD患者的麻醉质量佳,应激反应轻,不良反应少,效果理想。     

两种比重的左旋布比卡因用于儿童腰硬联合麻醉6O例效果比较

0.2％轻比重左旋布比卡因与0．5％重比重左旋布比卡因用于儿童患者腰硬联合麻醉中，比较其麻醉效果及并发症。认为儿童患者应用重比重左旋布比卡因行腰硬联合麻醉起效快，维持时间长，更适用于时间较长的手术。     

罗哌卡因辅助地佐辛浸润麻醉对幕上肿瘤切除术患者的麻醉效果

目的观察罗哌卡因辅助地佐辛麻醉对幕上肿瘤切除术患者麻醉恢复情况及恢复期应激反应的影响。方法选取2017年3月至2019年5月四川省内江市第二人民医院麻醉科接受幕上肿瘤切除术患者60例,按随机数表法分为研究组和对照组,各组30例。2组患者均采取全身麻醉。对照组于切皮前10 min予以生理盐水20 ml浸润麻醉,术毕前30 min静注10 mg地佐辛;研究组于切皮前10 min予以罗哌卡因浸润麻醉,术毕前30 min静注10 mg地佐辛。对比2组患者麻醉前(T_0)、术毕时(T_1)、拔管即刻(T_2)、拔管后30 min(T_3)的心率(HR)、舒张压(DBP)、收缩压(SBP)、应激反应指标[肾上腺素(E)、去甲肾上腺素(NE)、皮质醇(Cor)、血糖(Glu)]水平,并比较2组患者低血压发生率、血管活性药物使用情况、麻醉恢复情况、不良反应发生率、麻醉苏醒期镇静评分(SAS)、疼痛程度评分(VAS)。采用SPSS 23.0统计软件进行分析。根据数据类型,组间比较采用t检验或卡方检验。结果 T_0时,2组患者HR、DBP、SBP、E、NE、Cor、Glu水平相比差异无统计学意义(P0.05)。在T_1、T_2、T_3时,研究组上述指标均低于对照组(P0.05)。与T_0相比,研究组T_1、T_2、T_3时上述指标变化不明显(P0.05),但对照组变化较明显,差异有统计学意义(P0.05)。对照组和研究组分别发生低血压20.00%(6/30)和6.67%(2/30),2组低血压发生率比较差异无统计学意义(χ~2=1.298,P=0.255)。对照组使用血管活性药物NE、多巴胺、麻黄碱的患者有4、4、10例,研究组依次有0、2、2例。2组患者使用血管活性药物构成比比较,差异有统计学意义(χ~2=6.667,P=0.010)。与对照组比较,研究组气管拔管时间[(15.41±3.20)和(24.02±4.93)min,t=8.024,P0.001]、麻醉恢复时间[(10.67±3.38)和(15.24±4.26)min,t=4.603,P0.001]显著缩短,镇痛效果持续时间[(11.73±1.59)和(7.91±1.28)h,t=10.250,P0.001]显著延长,麻醉苏醒期SAS[(3.82±0.41)和(5.06±0.50)分,t=10.504,P0.001]、VAS[(2.25±0.21)和(4.30±0.36)分,t=26.941,P0.001]评分、以及不良反应发生率[10.00%(3/30)和33.33%(10/30),χ~2=4.812,P=0.028]显著降低,差异均有统计学意义。结论罗哌卡因辅助地佐辛麻醉应用于幕上肿瘤切除术患者可促进麻醉后恢复,稳定恢复期血流动力学,减轻恢复期应激反应,提升镇静、镇痛效果,减少不良反应发生。     

麻黄碱预先给药在老年低体能患者行无痛胃镜中的应用

目的观察在无痛胃镜静脉麻醉中麻黄碱预先给药对低体能老年患者的血流动力学影响。方法选择2017年4月至2017年8月徐州医科大学附属医院麻醉科行无痛胃镜检查的低体能老年患者70例,随机分成丙泊酚组(对照组)和丙泊酚+麻黄碱组(麻黄碱组),每组35例。给药后待患者入睡、睫毛反射消失、呼吸平稳后行胃镜检查。观察指标为两组丙泊酚麻醉诱导前(T_1)、麻醉诱导后1 min(T_2)、进镜时(T_3)、进镜后3 min(T_4)、退镜时(T_5)、退镜后5 min(T_6)、苏醒时(T_7)患者心率(HR)、平均动脉压(MAP)及脉搏血氧饱和度(Sp O2)。记录两组患者丙泊酚用量、疼痛评分、麻醉效果(优良率)、离院时间及不良反应发生率。采用SPSS 22.0统计软件进行数据分析,根据数据类型,采用t检验、秩和检验、重复测量设计的方差分析或χ~2检验进行分析。结果对照组T_2~T_7时间点的HR较T_1低(P0.05),麻黄碱组T_4、T_6较T_1低,麻黄碱组T_2、T_3时间点较对照组HR升高[(76.29±10.59)vs(69.46±8.49)次/min,(81.09±10.16)vs(74.97±8.16)次/min;P0.05]。两组T_2~T_7时间点的MAP较T_1低(P0.05),但麻黄碱组在T_2~T_6时间点的MAP较对照组升高,差异有统计学意义[(88.71±6.75)vs(77.29±9.82)mm Hg,(93.60±7.38)vs(86.97±10.79)mm Hg,(87.09±5.90)vs(81.51±9.92)mm Hg,(90.26±5.58)vs(86.34±11.81)mm Hg,(83.60±6.56)vs(75.66±10.36)mm Hg;P0.05]。两组T_6时间点Sp O2与T_1比较显著降低(P0.05),T_2、T_3、T_5较T_1显著升高,但两组各时间点SpO_2比较,差异无统计学意义(P0.05)。与对照组相比,麻黄碱组疼痛比例及疼痛评分均显著低于对照组,差异有统计学意义[7(20%)vs 14(40%),1(0,2)vs 0(0,1)分;P0.05]。麻黄碱组血压下降发生率显著降低[3(9%)vs 20(57%),P0.05],其余不良反应发生率差异无统计学意义。结论老年低体能患者丙泊酚麻醉无痛胃镜检查时,麻黄碱预先给药可减轻血流动力学的变化幅度,有利于维持循环稳定,并降低疼痛发生率和强度,较安全可靠。     

Optimizing safe femoral access during cardiac catheterization.

This article describes the natural variability of femoral arterial anatomy as seen by angiography in a standard position. An analysis of 60 consecutive peripheral angiograms revealed data on average vessel diameter, variability in that diameter and the level of bifurcation of the common femoral artery into its two main branches. The statistical likelihood of optimal femoral arterial access through a standard dermotomy placed midway between, and 3 cm below, the imaginary line extending from the superior anterior iliac spine to the pubic symphysis was calculated. Our research disclosed average vessel diameters of 6.6 mm (3.9-8.9 mm), 5.2 mm (2.5-9.6 mm), and 4.9 mm (2.7-7.6 mm) for the common femoral artery, superficial femoral artery and deep femoral artery, respectively. The bifurcation of the common femoral artery into its branches averaged 5.5 mm below the inferior margin of the femoral head in most cases (76% of the time). In our laboratory, the average distance from the inferior border of the femoral head to our actual arteriotomy was 14.0 mm. Using our standard dermotomy, we achieved this favorable access position in 97% of cases.     

Proximal femoral fracture in patients with rheumatoid arthritis

Hip fracture occurrence was examined cross-sectionally in Japanese patients with rheumatoid arthritis (RA). Between January 2005 and June 2006 we studied RA outpatients with a past history of hip fractures. Patients included 1 man and 25 women. As 3 women had bilateral hip fractures, the total number was 29. Age at the time of fracture was 72.1 ± 4.5 years. Of the 29 fractures, 22 were cervical and 7 were trochanteric. Four fractures were spontaneous while the others occurred in falls. 24 fractures were associated with oral steroid administration. All 5 fractures unassociated with prednisolone were cervical. Of the 26 patients, 8 were taking bisphosphonate when fracture occurred. Cervical fracture was treated with total hip arthroplasty in 1 patient whose hip showed RA changes. In others whose hip joint lacked RA change, procedures included osteosynthesis in 2 patients with good function over 6 years; and hemiarthroplasty with a bipolar system in 19 displaced fractures, with good function over 4.1 years. Osteosynthesis was performed for all 7 trochanteric fractures. Trabeculae were thin, and fewer transverse trabeculae could be found in specimens from cervical fracture. Hip fracture in RA patients occurred 10 years earlier than in the general population, and many fractures were cervical.     

防旋型股骨近端髓内钉治疗高龄不稳定股骨粗隆间骨折的临床研究

目的探讨防旋刊股骨近端髓内钉（PFNA）在治疗高龄不稳定股骨粗隆间骨折中的疗效。方法2007年9月-2010年3月采用闭合复位PFNA内同定法治疗75岁以上高龄不稳定股骨粗隆间骨折患者41例,其中男20例,女21例。根据Evans分型骨折类型：Ⅲ型25例,Ⅳ型16例。受伤至手术时间1～14d,平均6d。术后复查x线片并进行功能柃查,采用Sanders评分标准进行临床评价。结果所有患者术后伤口均Ⅰ期愈合,无感染及死亡病例。41例中38例得到随访,随访时间4～18m（平均12m）。术后愈合时间3～6m,无内固定断裂、螺旋刀片拔出或穿透股骨头关节面等并发症发生。根据Sanders髋关节创伤股骨粗隆间骨折的评定标准,获优11例、良24例、中3例,优良率92．11％。结论闭合复位PFNA内同定法具有操作时间短、出血少、患者康复快、并发症少等优点,是治疗75岁以上高龄不稳定粗隆问骨折的理想方法。     

Proximal femoral fracture in patients with rheumatoid arthritis

Abstract

Hip fracture occurrence was examined cross-sectionally in Japanese patients with rheumatoid arthritis (RA). Between January 2005 and June 2006 we studied RA outpatients with a past history of hip fractures. Patients included 1 man and 25 women. As 3 women had bilateral hip fractures, the total number was 29. Age at the time of fracture was 72.1 ± 4.5 years. Of the 29 fractures, 22 were cervical and 7 were trochanteric. Four fractures were spontaneous while the others occurred in falls. 24 fractures were associated with oral steroid administration. All 5 fractures unassociated with prednisolone were cervical. Of the 26 patients, 8 were taking bisphosphonate when fracture occurred. Cervical fracture was treated with total hip arthroplasty in 1 patient whose hip showed RA changes. In others whose hip joint lacked RA change, procedures included osteosynthesis in 2 patients with good function over 6 years; and hemiarthroplasty with a bipolar system in 19 displaced fractures, with good function over 4.1 years. Osteosynthesis was performed for all 7 trochanteric fractures. Trabeculae were thin, and fewer transverse trabeculae could be found in specimens from cervical fracture. Hip fracture in RA patients occurred 10 years earlier than in the general population, and many fractures were cervical.     

全身麻醉联合硬膜外麻醉在老年高血压患者腹腔镜胆囊切除术中的应用

目的 探讨全身麻醉联合硬膜外麻醉在老年高血压患者腹腔镜胆囊切除术（LC）中的麻醉效果。方法 将择期行LC的老年高血压患者64例分为对照组32例和观察组32例,分别采用全身麻醉和全身麻醉联合硬膜外麻醉,比较两组患者术中血流动力学情况[收缩压（SBP）、舒张压（DBP）、心率（HR）］、激素[生长激素（GH）、催乳素（PRL）和皮质醇（Cor）］水平及术后麻醉恢复情况。结果 在T1、T2 和T3 时,观察组SBP和DBP均显著低于对照组（P<0.05）,HR显著快于对照组（P<0.05）;观察组GH分别为（11.44±2.27） mg/L、（8.03±2.56） mg/L和（9.34±2.82） mg/L,显著低于对照组的[（13.25±3.56） mg/L、（9.51±3.14） mg/L和（10.92±3.25） mg/L,P<0.05或P<0.01];PRL分别为（70.76±5.55） mg/L、（60.43±7.85） mg/L和（64.36±7.59） mg/L,显著低于对照组的[（81.32±4.03） mg/L、（73.01±8.04） mg/L和（76.39±6.65） mg/L,P<0.05或P<0.01]; Cor分别为（480.33±26.16） mg/L、（469.27±28.76） mg/L和（477.91±21.78） mg/L,显著低于对照组的[（511.45±27.69） mg/L、（484.21±23.13） mg/L和（495.40±26.67） mg/L,P<0.05或P<0.01];观察组患者术后呼吸恢复时间、睁眼时间、拔管时间、定向力恢复时间分别为（7.81±3.12） min、（8.25±3.23） min、（16.73±4.28） min和（19.55±5.23） min,均显著短于对照组的[（10.20±3.87） min、（10.21±3.84） min、（21.45±4.50） min和（23.29±5.41） min,P<0.05或P<0.01];对照组苏醒期8例（25.0%）发生烦躁,明显高于观察组2例（6.3%,P<0.05）。结论 全身麻醉联合硬膜外麻醉用于老年高血压患者行LC 时血流动力学指标更稳定,激素应激反应更轻,麻醉恢复快。     

Biomechanical analysis of the closed reduction internal fixation with cannulated screw of femoral neck fractures

The influencing factors in closed reduction internal fixation with cannulated screw of femoral neck fractures have not been well investigated. This study evaluated these factors in patients with femoral neck fractures.Fifty-seven patients (36 males and 21 females) diagnosed with femoral neck fracture with the average age of 52.44 ± 15.04 years who underwent closed reduction internal fixation with cannulated screw were included in this study. Data were collected through case report reviews, phone call follow-ups, and outpatient follow-ups to evaluate pre- and postoperative radiograph images. Statistical analysis was performed using Garden classification, binary and multinomial logistic regression analysis by including factors such as patient''s age, gender, fracture type, time to fixation, reduction quality, functional recovery period, removal of cannulated screw, and preoperative traction. Logistic regression analysis revealed that age and reduction quality was statistically significant (P < .05) to clinical outcome and other factors were not statistically significant.The main factors affecting clinical outcomes were functional recovery and reduction quality. The biomechanical effects of fixation provide a good foundation for fracture healing. Patient''s conditions should be carefully evaluated before selecting reduction procedures to reach an optimal surgical outcome.     

Popliteal artery embolization with the Mynx closure device

Several different arterial puncture closure devices are available for use after cardiovascular procedures. The main advantages include decrease need of manual compression, reduce patient discomfort, and the time to ambulation. Access site complications are not rare after vascular closure device use. We report a case of popliteal artery emobilization after using an extravascular water soluble plug‐mediated vascular puncture closure device. © 2009 Wiley‐Liss, Inc.