靶控输注丙泊酚-瑞芬太尼清醒镇静镇痛麻醉在老年患者胃镜检查中的应用

目的研究靶控输注丙泊芬-瑞芬太尼清醒镇静镇痛麻醉用于老年患者胃镜检查中的有效性、安全性。方法将60例ASAI～Ⅲ行胃镜检查的老年患者随机分为麻醉组（A组）和对照组（B组）,每组30例。A组：丙泊酚血浆靶浓度0．6-1．2ug／ml,瑞芬太尼血浆靶浓度0．6—0．9ng／ml同时输注,待患者进入镇静分级评分（Ramsay）2级时开始行胃镜检查,胃镜抵达十二指肠时停止给药。B组：未用药。结果Ramsay评分：A组2级83％,B组2级20％（P〈0．01）。A组入镜时间短于B组（P〈0．05）。检查过程中收缩压、舒张压、心率、呼吸B组明显上升（P〈0．05或0．01）,脑电双频指数A组明显降低（P〈0．01）,A组检查成功率、操作者和患者满意率明显高于B组（P〈0．01）。结论靶控输注丙泊酚-瑞芬太尼用于老年人胃镜检查能达到良好的清醒镇静镇痛麻醉效果,能有效抑制应激反应,血流动力学稳定,患者的耐受性和依从性好,检查成功率高,是一种安全、有效、可行的麻醉方法。     

靶控输注舒芬太尼或瑞芬太尼用于妇科腹腔镜手术麻醉的临床研究

目的:比较靶控输注（Target controlled infusion,TCI）舒芬太尼和瑞芬太尼用于妇科腹腔镜手术麻醉的临床效果。方法：92例美国麻醉医师协会（American society of anesthesiology,ASA）Ⅰ～Ⅱ级择期妇科腹腔镜手术患者,随机分为舒芬太尼组（S组）和瑞芬太尼组（R组）,每组46例。舒芬太尼组麻醉诱导效应室TCI舒芬太尼0.5 ng/ml和血浆TCI丙泊酚3 μg/ml,麻醉维持舒芬太尼0.3 ng/ml,丙泊酚3 μg/ml输注;瑞芬太尼组麻醉诱导血浆TCI瑞芬太尼4 ng/ml和血浆TCI丙泊酚3 μg/ml,麻醉维持瑞芬太尼3 ng/ml,丙泊酚3 μg/ml输注。记录2组麻醉前（T0）、诱导后3 min（T1）、插管时（T2）、切皮（T3） 、腹腔镜探查时（T4）、拔管（T5）时的收缩压、舒张压和心率的变化,比较术后患者的恢复情况,统计2组丙泊酚的用量。结果：2组T1时心率比T0均显著降低（P＜0.05）,瑞芬太尼组T1时的收缩压、舒张压低于舒芬太尼组（P＜0.05）;2组在T2、T3、T4时的收缩压、舒张压和心率差异无统计学意义（P＞0.05）;瑞芬太尼组T5时的收缩压、舒张压和心率高于舒芬太尼组（P＜0.05）;瑞芬太尼组停药至拔管的时间少于舒芬太尼组（P＜0.05）;2组丙泊酚的用量差异无统计学意义（P＞0.05）。结论：TCI舒芬太尼或瑞芬太尼用于妇科腹腔镜手术麻醉的围术期血流动力学平稳,但术毕TCI瑞芬太尼的患者应提前给予镇痛药。     

腹腔镜宫外孕术中不同浓度丙泊酚、瑞芬太尼靶控输注的麻醉效果观察

目的探讨腹腔镜宫外孕术中不同血浆浓度丙泊酚、瑞芬太尼靶控输注的麻醉效果。方法30例ASAⅠ～Ⅱ级急诊腹腔镜宫外孕手术患者,随机分为3组,分别接受不同血浆浓度的丙泊酚和瑞芬太尼,每组10例。A组：丙泊酚与瑞芬太尼血浆靶浓度分别为2.5μg/ml与8ng/ml,B组：丙泊酚与瑞芬太尼血浆靶浓度分别为3μg/ml与6ng/ml,C组：丙泊酚与瑞芬太尼血浆靶浓度分别为3.5μg/ml与4ng/ml。记录麻醉诱导前、插管前、插管后即刻、CO2气腹时、CO2气腹后5min、气腹后15min、拔管时、拔管后5min的MAP、HR。以停麻药的时间为零点计时,记录患者苏醒时间、拔管时间及警觉/镇静评分（OAA/S）。结果3组患者插管前的MAP、HR均明显低于麻醉诱导前（P〈0.05）,插管后至拔管时各时间点的MAP、HR与插管前的无差异。拔管后5min的MAP、HR与麻醉诱导前无差异。A组的苏醒时间、拔管时间最短,且术后苏醒质量评分最佳。B组次之,C组最长（P〈0.05）。结论靶控输注丙泊酚复合瑞芬太尼全凭静脉麻醉适用于腹腔镜宫外孕手术,低浓度的丙泊酚复合高浓度的瑞芬太尼麻醉效果好,苏醒快、质量佳。     

乳房纤维腺瘤切除手术靶控输注舒芬太尼、咪达唑仑联合局部麻醉的效果

目的：评价乳房纤维腺瘤切除手术患者靶控输注舒芬太尼、咪达唑仑联合局部麻醉的效果。方法拟在局麻下行乳房纤维腺瘤切除手术患者120例，ASAⅠ或Ⅱ级，年龄20-45岁，体重指数〈30kg／m^2。随机分为4组（n=30），N组：持续静脉输注生理盐水0．15ml／（k·小时）；M组：靶控输注咪达唑仑辅助，效应室靶浓度（Ce）60ng／ml；S组：靶控输注舒芬太尼辅助，效应室靶浓度0．15ng／ml；MS组：靶控输注舒芬太尼0．1mg／ml，咪达唑仑40ng／ml。10分钟后用含1：20万肾上腺素的利多卡因行术野局部浸润麻醉。术中每5分钟采用Rammsay评分评价镇静程度；采用视觉模拟评分法（VAS评分）评价镇痛程度。S组VAS评分〉3分时为麻醉失败，其余3组VAS评分〉3分时，增加靶控浓度或静脉注射咪达唑仑2mg或舒芬太尼5μg；如出现Rammsay评分〉3分或呼吸抑制[RR〈8次／分和（或）SPO2〈94％]，则为麻醉失败。于手术前和切皮后加分钟时记录BP和HR。记录术中躁动、上呼吸道梗阻、呼吸抑制、低血压、肌强直等不良反应情况。结果：S组、SM组麻醉成功率（分别为92％、100％）高于N组、M组（分别为38％、62％）（P〈0．05）。与N组比较，术中20分钟时M组SP、DP和HR差异无统计学意义（P〉0．05），S组和SM组SP、DP和HR降低（P〈0．05）。M组躁动发生率较高，4组不良反应发生率比较差异无统计学意义（P〉0．05）。结论：靶控输注舒芬太尼Ce0．15mg／ml和咪达唑仑Ce40ng／ml复合舒芬太尼Ce0．1ng／ml联合利多卡因局部浸润麻醉可安全、有效地用于患者乳房纤维腺瘤切除手术。     

不同靶浓度瑞芬太尼全麻诱导对心率变异性的影响

目的研究不同靶浓度瑞芬太尼全麻诱导时对心率变异性（Heart Rate Variability）的影响,及用于气管插管的最佳剂量。方法36例ASAⅠ～Ⅱ级患者,随机分为3组：R2组（瑞芬太尼2ng／ml,n=12）,R4组（瑞芬太尼4ng／ml,n=12）,R6组（瑞芬太尼6ng／ml,n=12）全麻诱导时给予靶控异丙酚血浆浓度3．5μg／ml,5min后依分组情况给予血浆靶浓度的瑞芬太尼,3min后行气管插管,并记录每分钟的平均动脉压、心率、心率变异性功率谱（HF、LF、HF／LF）,并将病人人室后（T0）,给瑞芬太尼前（T1）,气管插管前（T2）,气管插管后5min内的最大值（T3）,切皮前（T4）以及切皮后5min内的最大值（L）纳入统计分析。结果靶控输注异丙酚后三组BP、HF、LF均显著降低,靶控输注瑞芬太尼后,R6组HF显著高于R2组,R6组BP低于R2组,R4组、R6组HR较R2组显著降低,插管后、切皮后R2组BP、HR、LF均显著升高。R4组、R6组与插管前相比各指标无显著差异。结论较高靶浓度瑞芬太尼对迷走神经有兴奋作用。在靶控输注异丙酚浓度3．5μg／ml靶控输注瑞芬太尼4ng／ml可以制止插管心交感张力的增高,血流动力学平稳,减少应激刺激。     

清醒镇静：经鼻纤支镜清醒插管时靶控输注与持续输注瑞芬太尼的比较

目的研究经鼻纤支镜清醒插管时TCI与持续输注瑞芬太尼对患者清醒镇静、插管条件和血流动力学的影响。方法患者分为T组和C组。T组以瑞芬太尼血浆靶浓度3ng/mL进行靶控输注,C组给予瑞芬太尼负荷剂量（0.75μg/kg）＋0.075μg/kg·min-1持续输注。气道表面麻醉后行经鼻纤支镜清醒插管。分别记录2组开始输注瑞芬太尼后不同时间点OAA/S评分、纤支镜和气管导管置入所需时间和血流动力学变化。结果 T组镇静评分和纤支镜和气管导管置入时间低于C组,其余没有差异。结论经鼻纤支镜清醒插管时TCI输注瑞芬太尼的清醒镇静作用优于持续输注,减少插管时间。     

老年肺癌患者行肺叶切除术采用不同浓度舒芬尼、丙泊酚靶控输注麻醉与传统静脉麻醉比较

目的：比较不同浓度舒芬尼和丙泊酚联合靶控输注麻醉（TCI）与传统全凭静脉麻醉（TIVA）对老年患者行开胸肺叶切除时血流动力学、意识和苏醒的影响。方法：60例全身麻醉下行肺叶切除术的病人,随机分为3组（n=20）,舒芬尼初始靶浓度为0．2ng／ml TCI（Ⅰ组）、舒芬尼初始靶浓度为0．3ng／ml TCI（Ⅱ组）、舒芬尼＋丙泊酚单次输注、连续输注（Ⅲ组）。在麻醉的不同阶段分别设定不同的舒芬尼靶浓度,同时根据病人意识情况和脑电双频谱指数（BIS）的变化调整丙泊酚靶浓度,记录入室时（基础值base）、气管插管前即刻（T1）、双腔管调整到位时（T2）、气管插管后3min时（T3）、手术切皮时（T4）、手术后15min（T5）和拔管即刻（T6）,记录MAP、HR、BIS、丙泊酚、舒芬尼用量及术毕睁眼时间和拔管时间。结果：3组间脑电双频谱指数（BIS）比较差异无统计学意义（P〉0．05）。舒芬尼用量Ⅰ组与Ⅱ组和Ⅲ组比较差异有统计学意义（P〈0．05）,Ⅱ组和Ⅲ组比较差异无统计学意义（P〉0．05）。丙泊酚用量Ⅰ组与Ⅱ组和Ⅲ组比较有统计学意义（P〈0．05）,Ⅱ组和Ⅲ组比较差异有统计学意义（P〈0．05）。结论：舒芬尼0．2～0．6ng／ml靶控输注既能保证充分的镇痛和足够意识水平深度,有利于术中控制性降压,又不影响中等长度手术患者的术后苏醒和拔管;而单次和持续输注30～40ml／h,亦能达到同样的效果,且舒芬尼和丙泊酚用量明显小于靶控输注组。     

瑞芬太尼对依托咪酯乳剂全麻诱导插管时血流动力学的影响

目的 比较不同靶浓度瑞芬太尼对依托咪酯乳剂全麻诱导插管时血流动力学的影响。方法 50例择期全麻手术病人按瑞芬太尼的血浆靶浓度随机分为5组（R0、R2、R4、R6、R8），即0、2、4、6、8ng／ml组。依托咪酯血浆靶浓度为0．6μg／ml，与瑞芬太尼同时输注诱导，病人意识消失后静注罗库溴铵辅助插管，记录病人意识消失的时间及意识消失时瑞芬太尼和依托咪酯的血浆靶浓度和效应室靶浓度，监测诱导过程中及插管后血压、心率的变化。结果 R0和R2组诱导时间明显长干R4、R6和R8组（P〈0．05），R0和R2组意识消失时的依托咪酯的效应部位计算值高干R4、R6和R8组（P〈0．05）。R2和R4组插管后1min及2min的MAP均高干插管前（P〈0．05）．而R6和R8组插管后1min及2min的MAP与插管前比较差异无显著性（P〉0．05）。结论 依托咪酯和瑞芬太尼在全麻诱导时具有协同作用，瑞芬太尼血浆靶浓度6ng／ml复合依托咪酯血浆靶浓度0．6μg／ml诱导能较好地控制插管时的血流动力学反应。     

数字化技术在高龄患者TCI麻醉中的应用

目的：探讨数字化技术在高龄患者TCI麻醉时的应用价值。方法：择期行腹部手术,ASA为II—III级的高龄患者60例,随机分为2组（n=30）：TCI麻醉监测组（以下简称“T组”）和对照组（以下简称“P组”）。麻醉诱导均为芬太尼3．3ug／kg、咪唑安定0．05mg／kg、依托咪酯0．3mg／kg、顺阿曲库铵0．15mg／kg,诱导插管后T组采用血浆靶控TCI维持麻醉,术中根据AAI值调整丙泊酚和瑞芬太尼的TCI血浆浓度及应用肌松监测反馈仪闭环给予肌松药。丙泊酚的血浆靶浓度为2．3—2．8ug／ml,瑞芬太尼的血浆靶浓度为3．6-4．8ng／ml,顺阿曲库铵则是闭环给药;而P组只根据血压、脉搏和麻醉医师经验调节控制丙泊酚和瑞芬太尼的输注速度,丙泊酚的输注速度为75一i00IJ．g／kg／min,瑞芬太尼输注速度为150—200ng／kg／min,顺阿曲库铵是每隔30—45分钟给予2—3mg。分别观察记录T组和P组于诱导用药后气管插管前（T1）;气管插管时（T2）：气管插管后切皮时（T3）;开始进腹或进腔镜时（T4）;腹部探查游离或腔镜游离时（T5）;脏器切除时（T6）;拔管时（T7）等七个时段的心率（HR）、血压（SBP、DBP）、体动情况、肌松满意程度,麻醉药用量等。此外,还观察苏醒期问的苏醒时间、苏醒的完全程度、苏醒期间的并发症等。以上几方面的数字技术最终通过麻醉信息系统进行整合分析记录。结果：T4-T7时,心率、血压T组与P组比较差异有统计学意义（P〈0．05）;T组术中无体动,P组有6例出现体动（P〈0．05）;T组肌松满意程度较好,TOF值〈0．1,P组有7例出现短暂肌松不良（P〈0．05）;T组麻醉药和肌松药用量均更少,术后苏醒和肌松恢复更快,术后躁动发生率更低（P〈0．05）。结论：高龄患者术中应用TCI麻醉,配合肌松闭环给药、AAI监测调控、麻醉信息系统整合等具有很大优势,使高龄患者的麻醉过程更加平稳、苏醒质量更优、可控性和精确性更强、安全性更高。     

靶控输注丙泊酚-瑞芬太尼在胃肠镜检查的应用

目的探讨靶控输注丙泊酚-瑞芬太尼在胃肠镜检查的安全性和有效性。方法将80例行胃肠镜检查的患者随机分为麻醉组（A组）和对照组（B组）各40例。A组丙泊酚血浆靶浓度1．0～1．5μg／m1,瑞芬太尼血浆靶浓度0．5～1．0ng／ml同时输注,待患者睫毛反射消后失开始镜检,术中根据患者体动反映情况,酌情追加丙泊酚和瑞芬太尼。记录麻醉诱导前即刻、麻醉后进镜1min、进镜5min及出镜后5min时患者的平均动脉压（MAP）、心率（HR）、呼吸频率（RR）、脉搏血饱和度（SpO2）及镜检时间以及术后并发症（头晕、恶心、呕吐）。结果麻醉诱导前即刻两组患者MAP、HR、RR、SpO2比较,差异无统计学意义（P〉0．05）。镜检开始后B组MAP、HR、RR明显上升,术中肢体扭动高于A组（P〈0．05）。B组无呼吸抑制,A组呼吸抑制高于B组（P〈0．05）。镜检时间A组（9±4）min,B组（17±3）min。术后患者满意率A组明显高于B组。结论靶控输注丙泊酚-瑞芬太尼应用在胃肠镜检查能达到良好的镇静、镇痛麻醉效果,稳定血流动力学,缩短镜检时间,提高患者的耐受性和依从性,是一种安全有效可行的的麻醉方法。但需严密检测呼吸循环和加强管理。     

Anesthesia

Effects of DO2-directed hemodynamic management on pulmonary function in to course of anaesthesia of liver transplantation; Rectal midazolam, atropine and ketamine as premedication for infants and young children; Supraclavicular subclavian venous catheterization through the insertion point medial to the middle of clavicle in infants; Effect of acute normovolemic hemodilution on context-sensitive half-time for propofol given by target controlled infusion during hip joint replacement; Effect of acute hypervolemic hemodilution on pharmacokinetics of propofol in patients undergoing total hip replacement; Influence of leukocyte filtration on systemic inflammatory response to cardiopulmonary bypass in dogs;Effect of urapidil on L-type calcium current in rat ventricular myocytes; Changes in systemic and pulmonary hemodynamics in patients with liver cirrhosis and portopulmonary hypertension during liver transplantation;……     

Anesthesia

Effect of propofol on the release of glutamate γ-amino-butyric acid in hippocampus in rats during recovery from paradoxical steep deprivation;The effect-site concentration of midazolam achninistered by TCI and BIS values for conscious sedation in patients of differmt ages;Effects of ephedrine pretreatment and rocuronium priming on the rocuronium-induced neuromuscular blockade;Effects of different doses of propofol on cerebral venous blood S-100 protein and neuron-specific eno- lase in patients undergoing open heart surgery under CPB at mild hypothermia;Effect of different doses of ambroxol in car- diopulmonary bypass induced lung injury in children     

Anesthesia

Protective effects of colquhounia root tablet against oleic acid induced acute lung injury in rats , Effect of ketamine on iNOS mRNA expression in spinal cord of mice in the development of morphine tolerance, Analgesic effect of intrathecal SB203580 in a rat model of neuropathic pain , Interleukin.lO gene therapy for neuropathic pain in a rat model of chronic constriction injury , Effects of epidural capsaicin on pain thresh. old, neurological function and spinal neurons in rabbits, Effects of different concentrations of heparin in the preservation solution on blood coagulation after reperfusion in patients undergoing orthotopie liver transplantation, Influence of lidocaine on systemic inflammatory response to cardiopulmonary bypass in patients undergoing coronary artery bypass grafting , Effect of midazolam pretreatment on neurotoxicity of ropivacaine in rats , Anesthetic efficacy of epidural ropivaeaine mixed with different doses of sufentanil for hysterectomy     

Anesthesia

<正>209163 Changes in plasma colloid osmotic pressure during off-pump orthotopic liver transplantation/Zhang Xiaomei(Dept Anesthesiol,Tianjin 1st Centre Hosp,Tianjian 300192)…∥Chin J Anesthesiol.-2009,29(2).-151~153Objective To investigate the changes in plasma colloid osmotic pressure(COP)in patients undergoing off-pump orthotopic liver transplantation(OLT).Methods Thirty ASA Ⅱ-Ⅳ patients(liver function Child-Pugh grade B or C)aged 35-60 yr undergoing off-pump OLT were studied.Anesthesia was induced with midazolam,sufentanil,propofol and vecuronium and maintained with propofol infusion,isoflurane inhalation and intermittent iv boluses of sufentanil and vecuronium.Human albumin and fresh frozen plasma were infused during operation.Hemoglobin was maintained at 70-80 and 80-100 g/L during preanhepatic and anhepatic phase respectively.Urine output was maintained at 1,0.5 and 1-2 ml·kg-1·min-1 while CVP at 4-7,0-3 and 4-10 mm Hg respectively during preanhepatic,anhepatic and neo-hepatic phase.Blood samples were taken immediately before intravenous line was established (T0,baseline),at skin incision(T1),60 min of preanhepatic phase(T2)beginning of anhepatic phase(T3),30 min of anhepatic phase (T4),beginning of neohepatic phase(T5),30 min of neohepatic phase(T6) and the end of operation(T7)from internal jugular vein for determination of plasma COP,crystalloid osmotic pressure and serum albumin concentration.     

Anesthesia

<正>209016 Effects of flurbiprofen on cellular immune function during patient-controlled intravenous analgesia with fentanyl in patients after esophagectomy/Feng Yanping(冯艳平,Dept Anesthesiol,Cancer Hosp He’nan Province,Zhengzhou 450003)…∥Chin J Anesthesiol. -2009,29(9). -773～774 Objective To investigate the effects of flurbiprofen on cellular immune function during patient-controlled in- travenous analgesia(PCIA) with fentanyl in the patients after esophagectomy.     

Anesthesia

Preventive effects of remifentanil on sympathetic activation induced by desflurane,Effects of different doses of ketamine on cognitive function in aged rats,Efficacy of sufentanil combined with propofol for video-assisted endoscopic transthoracic sympathectomy,Accuracy of target-controlled infusion of sufentanil in clinical anesthesia.     

Anesthesia

Anesthetic choice for patients undergoing simuitaneous pancreas-kidney transplantation,Effect of morphine pretrealment on expression of substance P and calcitonin gene related peptide in myocardium following acute myocardial ischemia in rats,Effects of lidocaine and ropivacaine on con- tractility of isolated pregnarlt rat myometrium,Effect of acute hypervolemic hemodilution with different colloids on GP Ⅱ b/Ⅲ a and P-selectin expression in patients with colon cancer during perioperative period,Effects of propofol on extracellular signal-regulated kinase 1/2 phosphorylation in mouse hippocampal slices[第一段]     

探讨腰麻-硬膜外联合阻滞麻醉与单纯硬膜外麻醉的临床麻醉效果

目的 评价腰麻-硬膜外联合阻滞麻醉与单纯硬膜外麻醉的临床麻醉效果.方法 方便选取2016年1月—2017年2月,重庆市武警重庆市消防总队医院普外科、骨外科等科室收治的下肢手术患者90例,黑箱摸球分组,42例纳入硬膜外组,48例纳入腰硬组.对比血压变化差值、术后腰痛VAS水平、不良事件发生情况.结果 腰硬组手术期间HR、SBP、DBP峰值与谷值差值分别为(7.54±1.65)次/min、(17.43±5.58)mmHg、(13.65±5.16)mmHg低于硬膜外组(11.47±5.51)次/min、(23.52±6.33)mmHg、(18.26±5.46)mmHg,腰硬组术后腰痛VAS评分(1.3±0.5)分、术中呼吸循环紊乱发生率22.92%低于硬膜外组(2.5±1.0)分、57.14%,差异有统计学意义(P<0.05).结论 下肢手术更适合腰麻-硬膜外联合阻滞麻醉.     

Anesthesia

Cerebral protective effect of nicorandil premedication in patients undergoing coronary artery bypass grafting with cardiopuimonary bypass;Protective effects of remifentanil preconditioning on myocardium against ischemia-reperfusion injury in rats; Effects of ultrarapid opiate detoxification during general anesthesia on plasma morphine concentration and brain β-endorphin content in rats addicted to morphine;The effect of propofol on platelet aggregation and blood coagulation in patients undergoing upper ab- dominal surgery/Tao Guocai ; Protective effects of pretreatment with rosigli tazone on the lungs against endotoxin-induced acute injm＇y in rats; ……     

Anesthesia

<正>209480 Effect of high thoracic epidural block on expression of β1-ARK mRNA in lymphocytes in elderly patients with essential hypertension complicated with