术前戒烟干预对患者术后戒烟的影响

目的评估麻醉医师术前戒烟干预对患者术后戒烟影响的有效性及安全性。方法选择当前吸烟男性择期手术患者182例,年龄18~79岁,ASAⅠ~Ⅲ级,按1∶1比例及手术大小分层随机分为对照组和干预组,每组91例。在术前访视时实施戒烟干预,措施为:吸烟对麻醉影响宣教、戒烟宣传资料(包括吸烟危害文字部分、吸烟所致器官损害图片、北京朝阳医院戒烟门诊热线电话及微信公众号),记录麻醉方式、手术时间、PACU治疗时间和术中术后并发症发生情况,术后30d电话随访戒烟率、吸烟下降率、戒烟门诊或戒烟热线随访率。结果在182例患者中,失访16例,最后纳入分析166例。术后30d两组戒烟率差异无统计学意义;术后30d干预组自报吸烟下降率(36.9%)明显高于对照组(22.0%);在术后30d自报戒烟患者中,干预组术前呼气末CO值为轻度吸烟者占83.3%,对照组占40.0%(P0.05);两组术中术后并发症发生率差异无统计学意义。结论麻醉医师术前实施戒烟干预具有安全性,可使患者术后30d吸烟量下降,并提高轻度吸烟患者术后30d戒烟率。     

肝移植围术期脑的病理生理和脑保护研究进展

终末期肝病晶病人，其脑血流、脑氧代谢率及其自身调节均有特殊的病理生理改变。肝移植围术期的处理直接关系到术后神经系统并发症的发生率。针对终末期肝病病人特殊的病理生理变化，采取过度通气、低温等相应措施，可进行有效的脑保护，提高肝移植围术期的安全性。     

肝移植围术期脑的病理生理和脑保护研究进展

终末期肝病的病人,其脑血流、脑氧代谢率及其自身调节均有特殊的病理生理改变。肝移植围术期的处理直接关系到术后神经系统并发症的发生率。针对终末期肝病病人特殊的病理生理变化,采取过度通气、低温等相应措施,可进行有效的脑保护,提高肝移植围术期的安全性。     

吸烟对围术期患者病理生理和麻醉效果的影响

背景 每年都有成千上万的吸烟患者需要手术和麻醉,而大多数麻醉医师未充分认识到吸烟对围术期的危害.目的 为提高麻醉管理水平,改善围术期吸烟手术患者的预后,现将吸烟对围术期患者病理生理和麻醉效果的影响作一综述.内容 吸烟不仅能增加术后并发症(包括肺部并发症、心血管并发症和伤口相关并发症),还能增加麻醉相关并发症(譬如低氧血...     

TUVP术围手术期的生理变化与麻醉

目的探讨TUVP术(经尿道前列腺电汽化术)的手术和麻醉安全性。方法观察289例TUVP术和耻骨上前列腺除术患围手术期BP(血压)、P(心率)变化，比较两组输血量、手术时间和术前健康状况分级。结果TUVP术手术时间短，创伤轻微，无一例输血，围术期BP、P较平稳，变化和缓。结论TUVP术对人体生理代谢影响小，手术麻醉安全性高，但术前准备和治疗仍应重视。     

硬膜外麻醉围术期意外低体温

全麻围术期体温过低致苏醒延迟时有报道 ,但是在硬膜外麻醉围术期由于意外的低体温而导致意识障碍罕见 ,本文现报告 1例如下。患者男 ,6 0岁 ,胆囊癌。术前检查心、肺正常 ,肝功能多项指标异常 ,在连续硬膜外麻醉下行胰十二指肠切除术。术前用药为地西泮 10ｍｇ、阿托品 0 5ｍｇ肌注 ,入室后Ｔ8～ 9椎间隙穿刺 ,置管顺利 ,硬膜外推注 2 %利多卡因 5ｍｌ试验量 ,5ｍｉｎ后无局麻药中毒反应及腰麻征 ,追加 2 %利多卡因8ｍｌ,测平面Ｔ3 ～Ｔ11,氟芬合剂 2ｍｌ静注 ,持续面罩吸氧 ,监测ＢＰ、ＥＣＧ及ＳｐＯ2 。 0 75 %布比卡因每次 6～ 7ｍｌ…     

围手术期戒烟干预与骨科手术结果相关性的研究进展

吸烟是骨质疏松症和骨折的危险因素,骨科手术前吸烟的患者通常面临更高的术后并发症风险.研究表明,外科手术术前短期戒烟可以减少呼吸道并发症和伤口并发症,但骨科医生很少推迟手术或采取戒烟干预.目前关于骨科手术围手术期戒烟干预的研究较少,短暂的围手术期戒烟对骨科手术的影响尚不清楚,理想的戒烟时机也未确定.本文通过回顾近年来国内...     

脑垂体腺瘤围术期麻醉管理进展

脑垂体腺瘤是起源于垂体的良性肿瘤。脑垂体腺瘤手术的麻醉管理始于全面的术前评估,重点关注肿瘤解剖与病理生理特征、激素水平变化、气道、呼吸与心功能变化。由于激素水平紊乱,垂体腺瘤患者是围术期潜在困难气道人群。鼻内镜下经蝶窦垂体腺瘤切除术中疼痛刺激大,需要足够的镇静深度及镇痛强度以维持血流动力学稳定。术中麻醉方式的选择以循环稳定为基础,同时达到缩短苏醒时间、提高康复质量的目的。麻醉苏醒期关注通气情况,避免低通气和呼吸道梗阻,及时识别缺氧高危患者,避免术后气颅发生。麻醉科医师应根据垂体腺瘤病理类型及激素表达情况,制定针对性的围术期管理方案。     

The anesthesia preoperative assessment: an opportunity for smoking cessation intervention

Smoking is the single most cause of preventable disease and premature death in the United States. We discuss potential hazards that the anesthesiologist should be aware of when caring for patients who abuse tobacco. A review of recent preoperative smoking cessation initiatives is also provided in addition to recommendations on how anesthesiologists may use the preoperative visit as an opportunity to play a more active role in reducing the burden of tobacco-related disease.     

Strategies of smoking cessation intervention before hernia surgery—effect on perioperative smoking behavior

Background Although it is now generally accepted that patients should be advised to quit smoking before surgery, the effect of low-intensive smoking cessation intervention, both on preoperative smoking behavior and on risk reduction, remains unclear. Our objective was to study the effect on perioperative smoking behavior and on postoperative wound infection of different types of low-intensive intervention before herniotomy. Methods Between October 1998 and October 2000, 180 consecutive smokers scheduled for elective herniotomy were advised to quit smoking perioperatively and subsequently allocated randomly to three low-intensive smoking cessation groups: a standard (control) group, a telephone group, which was reminded by telephone, and an out-patient group, which was reminded by means of an out-patient talk and demonstration of nicotine replacement drugs. Spontaneous perioperative smoking behavior was recorded for 64 consecutive non-advised smokers. Postoperative wound infection was evaluated by independent assessors. Results Of the advised patients, 19% (29/149) stopped smoking before surgery compared with 2% (1/64) in the non-advised cohort (P < 0.01). In the standard group 13% (6/48) quit smoking compared with 23% (23/101) in the pooled telephone and outpatient group (NS). In the last group 64% (65/101) reduced or stopped smoking compared with 42% (20/48) in the standard group (P < 0.05). Predictors of failed perioperative cessation of smoking were a CO breath-test at inclusion above 20 ppm (OR: 0.11; 0.02–0-57) and low motivation to quit smoking (OR: 0.25; 0.09–0.70). Wound infection occurred in 6% (13/213) and there was no difference between the groups. Conclusion Low-intensive smoking cessation intervention helps approximately one fifth of patients to stop smoking perioperatively. Patients who are reminded in addition to preoperative advice are more likely to stop or reduce smoking. Failure to stop smoking is greater if the patients are not motivated and if the CO breath test is high at the time of the preoperative advice.     

Impact of education on smoking cessation counseling by surgical residents

BACKGROUND: Surgeons infrequently provide smoking cessation counseling for patients, in part because they lack training to do so. We investigated the efficacy of 2 methods of teaching smoking cessation counseling to surgical residents. METHODS: Residents' knowledge and attitude toward smoking cessation counseling were assessed by written test. Counseling skills were assessed with standardized patients. Residents were randomized for smoking cessation education: a "Role-play" group received a 1-hour lecture plus an hour of role-playing. An evidence-based medicine (EBM) group attended a 1- hour EBM journal club on related articles. Changes in residents' knowledge, attitude, and skills were assessed after education. RESULTS: Sixteen residents completed the study. After either form of education, residents demonstrated significant improvements in knowledge, attitude, and skills in smoking cessation counseling. There was no significant difference in improvement between the EBM and Role-play groups. CONCLUSIONS: A brief educational intervention can significantly improve residents' knowledge, attitude, and counseling skills for smoking cessation.     

Nicotine smoking: Influences on perioperative pain management

BackgroundThe complex relationship between smoking and pain has clinical relevance in the practice of anesthesiology and pain medicine. The present study investigated the effect of heavy nicotine smoking on perioperative pain management.MethodsThis prospective controlled study was carried out in Alexandria Main University hospital on 80 adult ASA I and II patients scheduled for lower limb fractures fixation under general anesthesia after an informed written consent and approval of the Medical Ethics Committee. Patients were divided into 2 groups: group N included nonsmokers and group S included the heavy smokers. Intraoperative heart rate (HR), mean arterial blood pressure (MAP) and intraoperative analgesia were recorded. Postoperatively; HR, MAP, pain visual analog scale (VAS) and total postoperative analgesic requirements were recorded.ResultsIntraoperative and postoperative HR and MAP showed significantly higher values in group S patients than group N patients. VAS values were significantly lower in group N than group S at recovery, 8 and 24 h postoperatively. Total intraoperative and postoperative analgesic requirements of meperidine were significantly lower in group N than group S.ConclusionsChronic nicotine smoking increases the incidence of perioperative pain. Heavy smokers need more perioperative analgesia than nonsmokers.     

瑞马唑仑围手术期应用研究进展

瑞马唑仑是一种新型的超短效苯二氮 类药物,综合了咪达唑仑和瑞芬太尼的优点,目前已被开发用于诊疗镇静、全麻诱导和维持、重症监护患者的镇静。文章对瑞马唑仑在围手术期应用的相关研究进展进行综述,探讨瑞马唑仑应用的优势和局限性。瑞马唑仑静脉给药适合持续输注,尤其是靶控输注;在持续输注模式下,瑞马唑仑起效和恢复较咪达唑...     

艾司氯胺酮在小儿围术期应用进展

艾司氯胺酮在患儿术前用药、术中麻醉、术后镇痛、门诊及日间手术中已应用广泛。术前用药可有效缓解患儿术前焦虑,促进患儿与父母的顺利分离,术前应用艾司氯胺酮不但有利于相对平稳的麻醉诱导过程,而且能够产生更少的精神不良反应及口腔分泌物。患儿术中持续输注低剂量艾司氯胺酮可有效降低阿片类药物剂量,且不影响苏醒质量,并减轻术后疼痛,同时可用于患儿术后镇痛。艾司氯胺酮单一或联合其他镇静镇痛药物可安全用于患儿内镜检查及治疗、诊断性检查及有创导管置入麻醉的应用,并有效减少其他镇静药物剂量,降低不良反应发生率。本文就艾司氯胺酮在患儿上述各方面应用进展进行综述,以期为临床应用提供参考。     

妊娠合并肺动脉高压剖宫产患者围术期管理回顾

目的探讨妊娠合并肺动脉高压患者行剖宫产手术的结局。方法回顾性分析2006年1月至2016年12月间就诊于本院的妊娠合并肺动脉高压并且行剖宫产手术的52例患者临床资料,年龄21～41岁,ASAⅡ—Ⅳ级。搜集并记录患者基线数据、围术期药物使用、产后1月及1年时生存情况,并进行回顾性队列研究。结果近10年来妊娠合并肺动脉高压且行剖宫产手术患者52例,术后1月随访37例,术后1年随访34例,1月内和1年内死亡病例分别为4例(10.81%)和6例(17.65%);影响患者预后的主要因素为肺动脉高压严重程度和术前SpO2水平。年龄、孕周、麻醉方式、围术期抗凝药物、术中监测等对患者围术期和术后1年生存率无明显影响。结论早期发现和控制肺动脉高压仍是改善预后的重要手段。     

小儿围手术期心理研究进展

背景 患儿和家长由于缺乏麻醉和手术的相关知识,往往会在术前产生焦虑和不安.已证明术前焦虑与术后疼痛、恶心呕吐等相关,并成为影响手术预后的重要因素. 目的 麻醉医师在关爱患儿的同时还应重视其围手术期心理保护.内容 阐述术前焦虑的相关概念、影响因素和危害,介绍应对患儿和家长术前焦虑的处理方法. 趋向 理解小儿围手术期心理学问题,完善情感应激处理方案,将会对患儿和家长产生积极影响.