A clinical investigation of the relationship between different sedation depths and the restlessness after using midazolam as an adjuvant during regional anesthesia

Objective： To investigate the relationship between different sedation depth and the restlessness after using midazolam as an adjuvant during regional anesthesia. Methods ： One hundred and fifty patients undergoing regional anesthesia were randomly divided into three groups. In group A, the patients were sedated at the level of OAA/S IV with midazolam during regional anesthesia. In group B and C, the sedation depths were kept at the levels of Ⅲ and Ⅱrespectively. The changes of BP, HR and SpO2 were recorded before and after midazolam. The rate of restlessness was also evaluated. Results： Blood pressures decreased in certain degree at 5 and 10 min after midazolam compared with those before in all three groups. BP decreased over 20% of the baseline in 4 cases in group A, in 5 cases in group B, and in 5 cases in group C. There was no significant difference in BP dropping among three groups. Compared with group B and C SpO2 dropped significantly at 3 and 5 rain after midazolam in group C, in which SpO2 was less than 93% in 8 cases. The restlessness rate in group C was 22%, which was significantly higher than those in group A （2% ,P〈0.01） and group B（4% ,P〈0.05）. Conclusion： The sedation depth is related to the rate of restlessness when midazolam is used as an adjuvant during regional anesthesia. It is suggested that the appropriate sedation depth for the patients under regional anesthesia is OAA/S Ⅲ.     

Clinical Observation on the Treatment of Atrial Fibrillation with Amiodarone Combined with Shenmai Injection (参麦注射液)

Objective: To observe the therapeutic efficacy and safety of amiodarone combined with Shenmai Injection (参麦注射液) on atrial fibrillation. Methods: A total of 351 patients with atrial fibrillation caused by cardiovascular diseases and idiopathic atrial fibrillation were assigned to amiodarone group (control group, 128 cases) and amiodarone combined with Shenmai Injection group (treatment group, 223 cases). The patients in the control group received intravenous injection of 150 mg amiodarone in 10 min, followed by intravenous drip infusion at 1 mg /min and 6 h later at 0.5 mg /min until 48 h or cardioversion. The patients in the treatment group received the same treatment of amiodarone, while in addition, they received an injection of Shenmai Injection of 100 mL simultaneously. Blood pressure, ventricular rate, and cardioversion were observed. Results: The total efficiency rate was 98% (control group) and 99% (treatment group) (P0.05). The mean ventricular rate decreased 23% and 31% in the control group and the treatment group, respectively (P0.05). The mean cardioversion time of the two groups was 570±211 min and 351±123 min, respectively (P0.05). Only mild side effects were observed in both groups. Conclusion: Compared with amiodarone, amiodarone combined with Shenmai Injection takes effect more quickly with low side effects on the treatment of atrial fibrillation.     

BLOOD PRESSURE CHANGES OF ELDERLY HYPERTENSIVE PATIENTS DURING DENTAL EXTRACTION UNDER SEDATION WITH CONTINUOUS INTRAVENOUS INFUSION OF MIDAZOLAM

Objective To evaluate the changes in blood pressure (BP) of elderly hypertensive patients having dental extraction under sedation with continuous intravenous infusion of midazolam. Methods One hundred elderly hypertensive patients undergoing dental extraction were recruited for this single-blind, randomized, controlled study. Patients in intervention group (n=50) were given midazolam dissolved in glucose solution and patients in control group (n=50) were given glucose solution only with communication technique. Systolic BP (SBP) and diastolic BP (DBP) were recorded in five time points. Results Under basal conditions, intervention group did not show significant difference in BP compared with control group. Before sedation, mean values of SBP and DBP (especially SBP) significantly increased compared with basal conditions in both groups (P<0.05). During dental extraction sessions, mean values of BP in intervention group significantly decreased than control group (P<0.05), but coefficient of variation did show significant difference in both groups. Conclusion Continuous intravenous infusion of midazolam has been proved to be very successful in controlling BP of elderly patients having dental extraction.     

A clinical study of aprotinin blood anesthesia used in the surgery of liver cancer

Abstract Objective: To investigate the role of aprotinin blood anesthesia used in hepatotomy. Methods: Patients with liver cancer undergoing hepatotomy were divided into two groups. In experimental group (40 patients) a loading dose with 1112 EPU aprotinin and maintained by 278 EPU/h was used until 2 h after operation. The control group (42 patients) was treated with 0.9% normal saline. The venous blood was withdrew for blood routine, thrombelastography and coagulable test at the time of preindueed, 1 h, 2 h and 4 h following the operation beginning, 6 h and 12 h after operation. The change of TEG and coagulable profile were monitored during the whole surgery. The volume of blood transfusion and hemorrhage between two groups were compared. Results: After the usage of aprotinin, the preoperative hypercoagulability of the experimental group was remitted and the eoagulative state was kept relatively stable during the operation. However, hypercoagulability of the control group aggravated following the operation beginning and some of them switched to hypocoagulability. The volumes and rates of hemorrhage and transfusion were smaller in the experimental group than in the control group. Conclusion: Aprotinin can stabilize the eoaodable state, reduce the volumes and rates of hemorrhage and transfusion, and is worth using in the surgery of operations of liver cancer.     

Can bispectral index or auditory evoked potential index predict implicit memory during propofol-induced sedation?

Background Some patients still suffer from implicit memory of intraoperative events under adequate depth of anaesthesia. The elimination of implicit memory should be a necessary aim of clinical general anaesthesia. However, implicit memory cannot be tested during anaesthesia yet. We propose bispectral index （BIS） and auditory evoked potential index （AEPI）, as predictors of implicit memory during anaesthesia. Methods Thirty-six patients were equally divided into 3 groups according to the Observer＇s Assessment of Alertness/Sedation Score： A, level 3; B, level 2 ;and C, level 1. Every patient was given the first auditory stimulus before sedation. Then every patient received the second auditory stimulus after the target level of sedation had been reached. BIS and AEPI were monitored before and after the second auditory stimulus presentation. Four hours later, the inclusion test and exclusion test were performed on the ward using process dissociation procedure and the scores of implicit memory estimated. Results In groups A and B but not C, implicit memory estimates were statistically greater than zero （P〈0.05）. The implicit memory scores in group A did not differ significantly from those in group B （P〉0.05）. Implicit memory scores correlated with BIS and AEPI （P〈0.01）. The area under ROC curve is BIS〉 AEPI. The 95% cutoff points of BIS and AEPI for predicting implicit memory are 47 and 28, respectively. Conclusions Implicit memory does not disappear until the depth of sedation increases to level 1 of OAA/S score. Implicit memory scores correlate well with BIS and AEPI during sedation. BIS is a better index for predicting implicit memory than AEPI during propofol induced sedation.     

小剂量瑞芬太尼减少腭咽成形术后全麻苏醒期呛咳反射的发生

目的 观察腭咽成形术后全麻苏醒期静脉输注小剂量瑞芬太尼的效果和不良反应.方法 60例择期行腭咽成形术病人随机分为两组,丙泊酚、芬太尼和阿曲库铵诱导插管后,术中吸入七氟醚复合静脉输注瑞芬太尼维持麻醉.手术结束后,瑞芬太尼组继续经静脉输注瑞芬太尼,速率为0.05 μg/(kg·min);对照组改为静脉输注生理盐水直至拔管后.观察并记录两组病人全麻苏醒期呛咳反射、呼吸抑制和深度镇静的发生率.结果 瑞芬太尼组28例,对照组29例病人完成本研究.瑞芬太尼组呛咳反射发生率显著低于对照组;呼吸抑制和深度镇静的发生率两组比较差异无统计学意义.结论 0.05 μg/(kg·min)瑞芬太尼静脉输注能减少腭咽成形术后苏醒期呛咳反射的发生,且不增加不良反应. Abstract： Objective To investigate the effect of small dose remifentanil infusion during emergence of anaesthesia after uvulopalatopharyngoplasty (UPPP). Methods Sixty patients scheduled for UPPP were randomly divided into two groups.All patients received propofol,fentanyl and atracurium for induction and intubation.After intubation,sevoflurane inhalation and remifentanil infusion were administered for maintenance of anaesthesia.After operation,remifentanil infusion was continued at a rate of 0.05 μg/(kg·min) in the remifentanil group,while saline was infused in the control group until extubation.The incidence of coughing,respiratory depression and deep sedation were observed and recorded. Results Twenty-eight patients in the remifentanil group and 29 patients in the control group completed the study.The incidence of coughing was significantly lower in the remifentnail group.There was no significant differences in the incidence of respiratory depression or deep sedation between the two groups. Conclusions 0.05 μg/(kg·min) Remifentanil infusion is effective for reducing the incidence of coughing during emergence of anaesthesia after UPPP without increasing incidences of side effects.     

Effect and Safety of Hydroxysafflor Yellow A for Injection in Patients with Acute Ischemic Stroke of Blood Stasis Syndrome: A Phase Ⅱ , Multicenter, Randomized, Double-Blind, Multiple-Dose, Active-Controlled Clinical Trial

Objective: To assess the effect and safety of Hydroxysafflor Yellow A for Injection(HSYAI) in treating patients with acute ischemic stroke(AIS) and blood stasis syndrome(BSS). Methods: A multicenter, randomized, double-blind, multiple-dose, active-controlled phase Ⅱ trial was conducted at 9 centers in China from July 2013 to September 2015. Patients with moderate or severe AIS and BSS were randomly assigned to low-, medium-, high-dose HSYAI groups(25, 50 and 70 mg/d HSYAI by intravenous infusion, respectively), and a control group(Dengzhan Xixin Injection(灯盏细辛注射液, DZXXI) 30 mL/d by intravenous infusion), for 14 consecutive days. The primary outcome was the Modified Rankin Scale(mRS) score 1 at days 90 after treatment. The secondary outcomes included the National Institute of Health Stroke Scale(NIHSS) score 1, Barthel Index(BI) score 95, and BSS score reduced 30% from baseline at days 14, 30, 60, and 90 after treatment. The safety outcomes included any adverse events during 90 days after treatment. Results: Of the 266 patients included in the effectiveness analysis, 66, 67, 65 and 68 cases were in the low-, medium-, and high-dose HSYAI and control groups, respectively. The proportions of patients in the medium-and high-dose HSYAI groups with m RS score 1 at days 90 after treatment were significantly larger than the control group(P0.05). The incidences of favorable outcomes of NIHSS and BI at days 90 after treatment as well as satisfactory improvement of BSS at days 30 and 60 after treatment in the medium-and high-dose HSYAI groups were all significantly higher than the control group(P0.05). No significant difference was reported among the 4 groups in any specific adverse events(P0.05). Conclusions: HSYAI was safe and well-tolerated at all doses for treating AIS patients with BSS. The medium(50 mg/d) or high dose(75 mg/d) might be the optimal dose for a phase Ⅲ trial.(Registration No. ChiCTR-2000029608)     

脂肪乳剂对布比卡因中毒犬的血流动力学及药代动力学的影响

Objective To investigate the effects of [ntralipid injection on hemodynamics and pharmacodynamics of mongrel dogs with bupivacaine-induced cardiac depression. Methods Fourteen dogs were randomly divided into Intralipid injection group (the experiment group) and normal saline group(the control group). 0. 5% bupivacaine was administrated at a constant rate until the mean arterial pressure (MAP) decreased to 60% of the basic value. Intralipid injection was administered in the experiment group. The hemedynamic parameters were recorded and blood samples were taken from femoral artery at 0, 5, 10, 15, 20, 30, 45,60, 90,120, 180,240 min after stopping bupivacaine infusion for determination of plasma concentration by HPLC. The pharmacokinetic parameters were calculated by Drug and Statistics soft version 2. O. Results After the treatment of Intralipid injection, MAP, CO, HR increased significantly, compared min-1 in the experiment group and the control group respectively. Vz (4. 5 ± 1.1 L/kg versus 3. 3 ± 0. 9 L/kg)of bupivacaine in the experiment group was significantly higher than that in the control group(P < 0. 05). Conclusion Intravenous infusion of Intralipid have beneficial effects on the hemodynamics of mongrel dogs with bupivaeaine-induced cardiac depression. One of the mechanism of the beneficial effects was probably that Intralipid injection increases the apparent volume of bupivacaine distribution and that decreases blood concentration.     

Release of myocardial noradrenaline during acute hibernation in the isolated rat heart

Objective： To explore the release of myocardial noradrenaline during acute hibernation. Methods： The hearts were gained from rats and set up as modified Langendorf preparations beating isometrically. They were perfused with modified Krebs-Henseleit buffer under controlled pressure. Mechanical measurements and coronary effluent were recorded simultaneously at 30min intervals for 150min. Lactate dehydrogenase in coronary effluent was assayed at the beginning, 60min and 120min low-flow ischemia. Noradrenaline in coronary effluent was determined at the beginning of low-flow and 120min of low-flow ischemia and also in control, during hibernation and after 30min reperfusion during stimulation, myocardial noradrenaline response on tyramine was investigated in absence or presence of desipramine after 30min reperfusion. Results： In the control, there was nosignificant chant in noradrenaline overflow during 120min perfusion; In the acute myocardial hibernation group, there was also nosignificant difference in noradrenaline overflow between the beginning and 120min low-flow ischemia. The electrical field stimulation-induced overflow of noradrenaline during hibernation myocardium was significantly less than preischemia or after reperfusion, but there was nosignificant difference between preischemia and reperfusion group. Tyramine induced significant noradrenaline release in absence of desipramine after 30min reperfusion, but this increase in noradrenaline release had nosignificant in the presence of desipramine. These studies indicated that there was not significant spontaneous noadrenaline overflow during acute myocardial hibernation in isolated rat hearts, the stimulation-induced noradrenaline overflow decreased during hibernation and restored to the level of preischemia after reperfusion, myocardial noradrenaline response to tyramine remained after 30min reperfusion. Conclusion： Myocardial noradrenaline overflow may not contribute to the development of acute myocardial hibernation and the function of sympathetic nerve may also maintain in hibernation as myocardium does during acute myocardial hibernation, reperfusion of myocardium may contribute to restoring the function of sympathetic nerve.     

脂肪乳剂对布比卡因中毒犬的血流动力学及药代动力学的影响

Objective To investigate the effects of [ntralipid injection on hemodynamics and pharmacodynamics of mongrel dogs with bupivacaine-induced cardiac depression. Methods Fourteen dogs were randomly divided into Intralipid injection group (the experiment group) and normal saline group(the control group). 0. 5% bupivacaine was administrated at a constant rate until the mean arterial pressure (MAP) decreased to 60% of the basic value. Intralipid injection was administered in the experiment group. The hemedynamic parameters were recorded and blood samples were taken from femoral artery at 0, 5, 10, 15, 20, 30, 45,60, 90,120, 180,240 min after stopping bupivacaine infusion for determination of plasma concentration by HPLC. The pharmacokinetic parameters were calculated by Drug and Statistics soft version 2. O. Results After the treatment of Intralipid injection, MAP, CO, HR increased significantly, compared min-1 in the experiment group and the control group respectively. Vz (4. 5 ± 1.1 L/kg versus 3. 3 ± 0. 9 L/kg)of bupivacaine in the experiment group was significantly higher than that in the control group(P < 0. 05). Conclusion Intravenous infusion of Intralipid have beneficial effects on the hemodynamics of mongrel dogs with bupivaeaine-induced cardiac depression. One of the mechanism of the beneficial effects was probably that Intralipid injection increases the apparent volume of bupivacaine distribution and that decreases blood concentration.     

右美托咪定靶控输注在腰麻中的应用

目的通过观察脑电双频指数（BIS）监测右美托咪啶（DEX）靶控输注麻醉深度的准确性,探讨DEX靶控输注在蛛网膜下腔阻滞麻醉中的应用价值。方法选择蛛网膜下腔阻滞麻醉手术患者30例,蛛网膜下腔阻滞后切皮前5 min开始静脉持续泵入DEX。DEX泵注分为3个阶段,泵注的第1阶段为负荷剂量加维持剂量阶段,负荷剂量为2.0μg·kg-1,10~20 min恒速输注完成,之后给予维持剂量0.5μg·kg-1·h-1;第2、3阶段仍为维持阶段,维持剂量分别为1.0μg·kg-1·h-1与1.5μg·kg-1·h-1,在手术结束前20~30 min停止输注DEX。在DEX靶控输注过程中,监测心率、血压、呼吸、脉搏氧饱和度,每隔5 min记录1次BIS值并即刻评估警觉/镇静评分（OAA/S）。结果右美托咪定靶控输注过程中,患者生命体征平稳,心率、血压、呼吸、脉搏氧饱和度及心电活动无明显变化;当DEX输注剂量加大时,BIS值逐渐下降。当OAA/S评分从5逐渐降低至1时,BIS值也相应下降。不同级别OAA/S评分的BIS值之间均有明显差异（P〈0.05）。BIS值与OAA/S评分呈正相关（r=0.695,P〈0.05）。结论 DEX靶控输注在腰麻的应用中,患者生命体征平稳,麻醉效果满意;BIS值能准确地监测DEX靶控输注麻醉的镇静深度,在DEX靶控输注麻醉中能够指导DEX的用量,在临床麻醉中值得推广。     

不同时机停用右美托咪啶对全身麻醉患者苏醒的影响

目的 探讨不同时机停用右美托咪啶对全身麻醉患者苏醒的影响.方法 选择淋巴外科手术患者80例（ASAⅠ～Ⅱ级）,按随机数表法分为实验D1、D2、D3组及C组,D1、D2、D3组于诱导前泵注右美托咪啶0.5μg/kg后,以0.5μg/（kg·h）速率持续输注,分别于术毕前lh、术毕前30 min、术毕停药,对照组持续泵注等量生理盐水.观察患者拔管期间的血流动力学变化,记录所有患者术后自主呼吸恢复时间、睁眼时间、拔管时间、定向力恢复时间、苏醒期意识状态评分（OAA/S）、躁动评分、术后2h内VAS评分最大值及镇痛药使用情况和术中丙泊酚、瑞芬太尼总用量等.结果 拔管期间各时点,D2、D3组平均动脉压（MAP）、心率（HR）与术前比较均差异无统计学意义,但与同时点C组比较,则显著降低,差异有统计学意义（P＜0.05）;C组和D1组拔管时、拔管后5 min MAP、HR明显高于术前,差异有统计学意义（P＜0.05）.自主呼吸恢复时间、睁眼时间、拔管时间、定向力恢复时间,D3组与C组比较均明显延长,差异有统计学意义（P＜0.05）,D1、D2组与C组相比差异无统计学意义.D3组拔管时OAA/S评分低于C组（P＜0.05）.躁动发生率、术后2h内VAS评分最大值和镇痛药使用例数,D2、D3组均明显低于C组和D1组,差异有统计学意义（P＜0.05）.与C组相比,D2、D3组术中丙泊酚、瑞芬太尼的用量明显减少,差异有统计学意义（P＜0.05）.结论 持续泵注右美托咪啶辅助全身麻醉,术毕前30 min停药,既不延长苏醒时间,又可改善患者苏醒质量,延长术后镇痛时间,提高了患者术后舒适度.     

小波指数用于全身麻醉患者术中麻醉深度监测的可行性

目的 评价小波指数(WLI)在全身麻醉(全麻)术中的应用价值.方法 选择2009年3至10月在宣武医院行全麻择期手术患者53例,入室后连接脑电双频谱指数(BIS)、WLI和肌松监测仪,记录入室10 min(T1)、诱导开始即刻(T2)、给予丙泊酚后OAA/S评分分别为5(T3)、4(T4)、3(T5)、2(T6)、1(T7)时、给予维库溴胺后四个成串刺激(TOF)值分别为100(T8)、75(T9)、50(T10)、25(T11)、0(T12)时、插管即刻(T13)、捅管后1 min(T14)、3min(T15)、5min(T16)、手术开始前(T17)、手术开始时(T18)、手术开始后1 min(T19)、3 min(T20)、5min(T21)、缝皮时(T22)、术毕(T23)、拔管时(T24)、拔管后1 min(T25)、5 min(T26)、出室前(T27)的BIS、WLI和TOF值.结果 麻醉诱导期与恢复期(T10 ～ T13,T22～T27)WLI高于BIS(P ＜0.05).经Bland-Altman一致性分析,WLI和BIS在进行麻醉深度监测时一致性在可接受范围内(偏差为-2.99,2SD为21.56％和-29.97％).OAA/S评分与BIS和WLI相关系数分别为rBIS =0.884,rWLI =0.757(P =0.000).结论WLI用于全麻患者术中麻醉深度的监测具有可行性.     

状态熵指数与靶控输注异丙酚时镇静深度及预测效应部位浓度的关系

目的：探讨状态熵指数(SE）与靶控输注异丙酚麻醉不同镇静深度及预测效应部位浓度的关系,并与BIS进行比较。方法：择期全麻患者20例,靶控输注异丙酚初始靶浓度为1.0μg/ml,预测效应部位浓度达到设定浓度后1min以0.5μg/ml的浓度梯度递增,目标镇静深度为警觉/镇静（OAA/S）评分1分。结果：SE、BIS与OAA/S评分相关系数分别为0.82（P＜0.01）和0.73（P＜0.01）; SE、BIS与预测效应部位浓度之间相关系数分别为-0.66（P＜0.01）和-0.70（P＜0.01）,50%和90%患者意识消失时的预测效应部位浓度分别为3.55（3.17,4.61）μg/ml和4.83（4.07,7.00）μg/ml。结论：状态熵指数与靶控输注异丙酚时的不同镇静深度以及预测效应部位药物浓度具有良好的相关性。     

不同途径给予咪达唑仑临床效果比较

目的: 比较静脉、肌肉、滴鼻、舌下四种途径给予咪达唑仑的临床效果。方法: ASA Ⅰ~Ⅱ级择期手术患者40例,按不同给药途径随机分成静脉组(V组)、肌肉组(M组)、鼻腔内滴注组(N组)、舌下含服组(S组)。各组依不同途径给予咪达唑仑,观察镇静(OAA/S)程度、BIS指数、VAS评分及记忆情况。结果: 镇静(OAA/S)程度:各组达到3级满意率为V、M组70%,N、S组30%。BIS值:V、M、N、S组分别在用药后5 min、25 min、35 min、35 min逐渐下降,BIS值分别维持在84.3±2.17、89.9±1.23、91.1±0.84、91.3±0.61水平。VA S评分:V、M、N组在用药后均低于治疗前(P<0.05~P<0.01)。遗忘情况:V、M、N、S组产生完全遗忘的百分率间差异有显著性(P<0.005)。结论: 四种途径给予咪达唑仑50 μg/kg,V、M组产生的临床效果优于N、S组。     

右旋美托咪定对全髋置换择期手术全身麻醉患者围拔管期血流动力学及苏醒过程的影响

目的: 观察全髋置换择期手术全身麻醉患者应用不同剂量右旋美托咪定（DEX）
后围拔管期及苏醒过程血流动力学变化,为其临床应用提供理论依据。方法：拟行全髋置换
择期手术、ASA Ⅰ~Ⅱ级的患者80例,随机分为对照组和低、中、高剂量DEX组,每组20例,
术毕前30 min各组患者分别静脉泵注0、0.5、1.5和2.5 μg?kg-1　DEX,10 m
in内泵注完毕。观察并分别记录各组患者用药前（T0）、拔管前（T1）、拔管时（T2）及拔管后3 min
（T3）各时间点的收缩压( SBP)、舒张压( DBP)、心率(HR)和心肌耗氧量（MCO）,同时记录苏醒时
间(t1)、拔管时间(t2)以及术后30 min（Ta）、术后35 min（Tb）、术后40 min（Tc）
3个时间点的警觉镇静评分(OAA/S)。结果：与对照组比较,T2、T3时间点,DEX低剂量组患
者SBP、DBP、HR及MCO差异无统计学意义（P>0.05）,DEX中、高剂量组患者上述指标
均显著下降,差异有统计学意义（P<0.05）,DEX中、高剂量组组间比较差异无统计学意义（P>0.05）。与对照组比较,DEX高剂量组患者拔管时间（t1）、苏醒时间(t2)明显延长,差异有统计学意义（P<0.05）。与对照组比较,DEX高剂量组患者OAA/S明显降低,差异有统计
学意义（P<0.05）,其他3组组间比较差异无统计学意义（P>0.05）。结论：应用1.5 μg.kg-1DEX能稳定全身麻醉患者围拔管期血流动力学指标,缩短患者苏醒时间和拔管时间,维持OAA/S。
［关键词］ ［中图分类号］     

丙泊酚镇静辅助硬膜外麻醉对患者心理应激的影响

目的探讨丙泊酚镇静辅助硬膜外麻醉对患者心理应激的影响。方法60例在硬膜外麻醉下择期行回肠造口关闭术患者, 通过随机数字法将其分为镇静组（P组）和对照组（C组）,每组30例。镇静组静脉给予丙泊酚负荷剂量0.6 mg·kg-1·min-1,警觉/ 镇静（OAA/S）评分达2~3分时调整为维持量3 mg·kg-1·h-1,手术结束时停用丙泊酚;对照组给予等量生理盐水。使用状态焦虑 量表（SAI）于术前1 d和术后第1天分别评定患者术前和术中焦虑程度;记录入室安静5 min（T0）、椎管内穿刺时（T1）、穿刺完成 平卧位时（T2）、给静脉药后20（T3）、40（T4）、60（T5）s、手术开始后2（T6）、4（T7）、6（T8）、8（T9）、10（T10）、40（T11）min患者的MBP、HR、 SpO2、OAA/S评分以及脑功能状态指标：小波指数（WLi）、焦虑指数（ANXi）、舒适指数（CFi）和疼痛指数（Pi）。用视觉模拟量表 （VAS）于术后第1天调查患者的麻醉满意度。测定麻醉前和术毕血清皮质醇浓度,计算△皮质醇浓度=麻醉前皮质醇浓度-术毕 皮质醇浓度。结果两组患者术前SAI差异无统计学意义（P>0.05）;镇静组患者术中SAI较低,但差异无统计学意义（P=0.05）。 镇静组患者T6~T10时间点的MBP、HR、SpO2和T6~T11时间点的OAA/S、WLi、ANXi、CFi、Pi较低,差异有统计学意义（P均<0.05）; 两组其余时间点的上述指标比较差异无统计学意义（P均>0.05）。镇静组患者对麻醉的满意度较高（Z=2.07,P<0.05）。镇静组 患者△皮质醇浓度为正值,说明患者皮质醇浓度术毕较麻醉前低,而对照组患者△皮质醇浓度为负值,说明患者皮质醇浓度术 毕较麻醉前高,两组间△皮质醇浓度有统计学差异（t=4.75,P<0.01）。结论硬膜外麻醉时辅以丙泊酚镇静与单纯硬膜外麻醉相 比,能够降低患者的心理和生理应激,明显缓解患者焦虑情绪,提高患者的舒适度及对麻醉的满意程度。     

右美托咪定复合丙泊酚全麻对骨科腰椎手术患者术后恢复的影响

目的：评价右美托咪定（dexmedetomidine,DEX）复合丙泊酚全麻对骨科腰椎手术患者术后恢复的影响。方法：选择北京大学第一医院2014年1月至5月择期全麻下行腰椎管减压、椎弓根钉内固定植骨融合术患者60例,美国麻醉医师协会（American Society of Anesthesiologists,ASA）分级Ⅰ～Ⅱ级,年龄18～65岁,按随机数字表将患者分为DEX组和对照组,每组30例。两组患者均以咪达唑仑0.03 mg/kg、丙泊酚1～2 mg/kg、舒芬太尼效应室靶控浓度0.5 μg/L和顺式阿曲库铵0.2 mg/kg诱导插管,术中以吸入50%（体积分数）笑气、靶控输注丙泊酚和舒芬太尼维持麻醉。DEX组麻醉诱导前静脉泵入DEX 0.5 μg/kg（10 min）,术中以0.2 μg/(kg·h)持续输注;对照组静脉泵入等量生理盐水。两组术后均采用0.5 g/L吗啡静脉自控镇痛,记录两组患者麻醉诱导、术后拔管及恢复时的平均动脉压（mean arterial pressure,MAP）、心率（heart rate,HR）, 术毕停药后的苏醒时间、拔管时间和定向力恢复时间,术后1 h在麻醉后恢复室（post-anesthesia care unit,PACU）的Ramsay评分和苏醒期躁动RSAS评分,术后48 h内的疼痛视觉模拟评分（visual analogue scale,VAS）、自控镇痛吗啡用量及不良反应发生率。结果：两组患者术后苏醒时间、拔管时间和定向力恢复时间差异均无统计学意义。两组患者PACU停留期间的Ramsay评分及苏醒期躁动RSAS评分差异均无统计学意义。DEX组术后48 h内各时点的VAS评分均显著低于对照组（P<0.05）,术后2 h和6 h的吗啡累计用量小于对照组（P<0.05）。与对照组比较,DEX组于DEX负荷量输注结束时HR显著减慢,MAP明显降低（P<0.05）,于诱导插管、术后拔管各时点及PACU 10 min时HR显著减慢（P<0.05）,于术后拔管各时点和PACU期间MAP显著降低（P<0.05）。与对照组相比,DEX组于DEX输注结束时HR和MAP均显著降低。DEX组于术中诱导插管开始至拔管后各时点及PACU停留10 min时的HR显著低于对照组（P<0.05）;在拔管后各时点及PACU期间,DEX组的MAP显著低于对照组（P<0.05）。结论：DEX复合丙泊酚全麻用于骨科腰椎手术时,可改善术后镇痛效果,节俭术后早期吗啡用量,并减少术后恶心和呕吐发生率。     

脑电双频谱指数对小儿手术中低浓度七氟醚复合瑞芬太尼麻醉后意识状态的监测

目的探讨脑电双频谱指数（BIS）对小儿脊柱侧弯矫形术中低浓度七氟醚复合瑞芬太尼麻醉的意识状态监测作用,评价麻醉方法的有效性、安全性和优越性。方法将30例小儿脊柱侧弯矫形术患者随机分为A组和B组,各15例。于术中切皮前10 min分别予七氟醚最小肺泡浓度（MAC）1.0、1.5联合瑞芬太尼靶控输注,于切开硬膜即刻（T0）、切开硬膜1 h后（T1）、2 h后（T2）、关闭硬膜即刻（T3）各个时点分别采取颈内静脉球部血及桡动脉血进行血气分析,采用警觉/镇静（OAA/S）评分评价意识状态变化。两组患者每3分钟进行一次OAA/S评分,直至患者对轻推无反应（定义为意识消失）后停止给药。记录每次评分前即刻的BIS值及血流动力学指标,分析BIS与OAA/S评分的关系并计算BIS预测镇静深度的概率（Pk）,通过Pk评价BIS对神经功能状态的预测效果。结果随着七氟醚复合瑞芬太尼效应室靶浓度（Ce）增加,两组患者BIS逐渐降低,两组总体变化趋势一致。患者意识消失时,BIS值：A组（61.6±7.9）,B组（72.9±5.9）;Ce：A组（69.8±8.9）μg/L,B组（53.3±9.4）μg/L。同一镇静评分（OAA/S 4～1）时,B组的BIS值明显高于A组。两组BIS对于意识消失的预测概率（Pk）分别：A组（0.883±0.034）,B组（0.819±0.028）。目标控制输注（TCI）期间两组心率和脉搏血氧饱和度无明显改变。与基础值比较,当OAA/S评分降至2以下时,血压下降（P〈0.05）。结论 1.0 MAC或1.5 MAC七氟醚联合瑞芬太尼麻醉期间,BIS能准确的预测意识状态的变化。     

靶控输注不同浓度舒芬太尼对丙泊酚TCI镇静催眠的影响

目的在麻醉诱导期观察靶控输注（TCI）不同浓度舒芬太尼对丙泊酚镇静催眠效应的影响。方法 60例择期手术全麻患者,年龄25～60岁,ASAⅠ～Ⅱ级。随机分为4组,每组15例。A组为单纯丙泊酚组;B、C、D组为丙泊酚＋舒芬太尼组,舒芬太尼的靶效应浓度分别为0.1、0.2、0.3ng/ml。B、C、D组在TCI舒芬太尼达平衡后,TCI丙泊酚。记录舒芬太尼达平衡后1min和丙泊酚效应浓度达1.0、1.5、2.0、2.5、3.0μg/ml时的脑电双频谱指数（BIS）和OAA/S评分。结果在单纯输注舒芬太尼期间,BIS和OAA/S评分无明显变化;随丙泊酚浓度升高,患者BIS和OAA/S评分逐渐下降;相同丙泊酚浓度时,各组间的BIS值无明显差别;丙泊酚浓度为1.0、1.5、2.0μg/ml时,D组的OAA/S评分（4.1±0.3、4.3±0.7、3.1±1.1）明显低于A组（4.1±0.7、3.1±1.3、2.1±1.0,P〈0.05）。结论麻醉诱导期间输注0.1ng/ml和0.2ng/ml浓度的舒芬太尼不增强丙泊酚的镇静催眠效应,0.3ng/ml的舒芬太尼可以增加丙泊酚的镇静催眠效应。