异丙酚复合阿托品在门诊肠镜检查手术麻醉中的应用

目的 :了解异丙酚复合阿托品静脉麻醉对肠镜检查的麻醉效果和安全性的影响。方法 :选择门诊肠镜检查的病人 40例 ,随机分A ,B两组 (各 2 0例 ) ,A组为异丙酚组 ,B组为异丙酚加阿托品组 ;A组静注异丙酚 ,B组静注异丙酚和阿托品复合液 ,之后再分次追加异丙酚至手术结束。结果 :( 1)A组术中心率下降与术前基础值相比差异有显著意义 (P <0 0 1)。B组心率麻醉前后差异无显著意义 (P >0 0 5 )。 ( 2 )A、B两组收缩压较术前比较均有显著下降 (P <0 0 1) ,两组舒张压变化不明显 (P >0 0 5 )。 ( 3)两组异丙酚用量比较 ,B组用药量明显少于A组(P <0 0 5 )。 ( 4 )全部患者术毕对术中疼痛无记忆。结论 :异丙酚复合阿托品用于门诊肠镜检查 ,能减少异丙酚用药 ,加强镇痛效果 ,减轻异丙酚对心血管的副作用 ,提高了门诊小手术麻醉的安全性。     

异丙酚和七氟烷麻醉对心率变异性的不同影响

目的 观察异丙酚和七氟烷麻醉对心率变异性的不同影响.方法 选择择期行妇科腹腔镜手术病人40例,随机分为两组,异丙酚组（P组,20例）术中以异丙酚麻醉维持,七氟烷组（S组,20例）术中以七氟烷麻醉维持.记录麻醉前、麻醉诱导后、插管后、切皮后、气腹形成后、关气腹、拔管后10min七个时点的心率（HR）、平均动脉压（MAP）、BIS和低频（LF）、高频（HF）、低高频比值（LF/HF）、心率变异指数（HRV）等心率变异性指标.结果 麻醉诱导后两组病人的HR、MAP、BIS、HRV、HF、LF、LF/HF均显著性下降（ P〈0.05）,两组间无显著差异.在麻醉维持过程中P组LF值显著降低,HF值不降低甚至略有升高,LF/HF值显著下降;S组LF及HF均显著降低,与P组相比LF降低更明显（ P〈0.05）,S组LF/HF值无明显变化,与P组有显著性差异（ P〈0.05）.结论 异丙酚对交感神经系统抑制明显,异丙酚麻醉自主神经系统向副交感神经占优势的方向转变;七氟烷对迷走神经系统和交感神经系统均有抑制,对自主神经系统的平衡性无明显影响.     

心率窗对阿托品应用的临床意义

有机磷农药中毒需用阿托品 ,阿托品用量不足会造成有机磷农药中毒症状的加重反跳 ,阿托品应用过量会引起阿托品中毒。两者都可严重地危及患者的生命。本文通过对阿托品用量反应最灵敏、最佳的指标心率 ,对阿托品用量的指导作用进行讨论。1　临床资料1.1　一般资料　住院急性重症有机磷农药中毒 (均为自服 )174例 ,年龄 18～ 42岁 ,男性 81例 ,女性 93例 ,既往均体健 ,无心律失常、心衰等心脏病史 ,在治疗过程中无水电解质紊乱。随机分成Ａ、Ｂ、Ｃ三组 ;Ａ组 5 8例 ,男性 2 7例 ,女性 31例 ,平均年龄 (2 9± 8.5 )岁 ;Ｂ组 6 0例 ,男性 2 5…     

异丙酚对压力感受器的影响

异丙酚是临床麻醉中最常用的静脉全麻药之一,它起效快,维持时间短,苏醒迅速,无积蓄,副作用小等,但也有比较突出的缺点--循环抑制,可产生与剂量相关的血压下降、心率减慢.Tramer等报道7个异丙酚麻醉病人中有1个会发生严重的心动过缓.阿托品是治疗心动过缓的首选药物,但对异丙酚麻醉下阿托品剂量反应性少见报道,因此,本研究拟探讨较大剂量异丙酚麻醉下阿托品对心率和血压的影响.     

阿托品配伍异丙酚用于无痛人工流产的临床研究

人工流产术是避孕失败的一种补救措施,随着开始性生活年龄的不断提早,非意愿妊娠的妇女逐年增多,这些妇女将面临采取终止妊娠的痛苦及恐慌的压力,为减轻人工流产手术给孕妇带来的痛苦,我院自2004年6月~2005年10月以阿托品配伍异丙酚注射用于6~9周人工流产术中镇痛,取得了满意疗     

心率窗对阿托品使用的指导作用

有机磷农药中毒都需要阿托品治疗 ,阿托品用量不足会造成有机磷农药中毒症状的加重反跳 ,过量会引起阿托品中毒 ,两者都可严重危及患者的生命。本文就心率对阿托品用量的指导作用作一讨论。１临床资料１．１一般资料本组共１０７例 ,均为急性重症有机磷农药中毒患者 ,年龄 (１８～４２)岁 ,男性为４３例 ,女性为６４例 ,既往均体健 ,无心律失常、心衰等心脏病史 ,在治疗过程中无水电解质紊乱。随机分成Ａ、Ｂ、Ｃ三组。Ａ组３３例 ,男性１２例 ,女性２１例 ,平均年龄 (２９±８．５)岁 ;Ｂ组４０例 ,男性１４例 ,女性２６例 ,平均年龄 (２８…     

不同剂量阿托品对全麻患者心率的影响

目的:观察静脉注射不同剂量阿托品对气管内全麻患者心率的影响.方法:将120例需行气管内全麻病人随机分成4组(Ⅰ、Ⅱ、Ⅲ、Ⅳ组),每组30例,在全麻诱导稳定后,4组患者分别静脉注射生理盐水、阿托品3、6、10μg/kg,记录用药前后各时间点病人的心率.结果:与Ⅰ组对比,Ⅱ组各时间点心率无明显变化,Ⅲ组用药1min以后各时间点心率有明显增快,差异有极显著性(P＜0.01),Ⅳ组用药30 s以后各时间点心率有明显增快,差异有极显著性(P＜0.01).Ⅱ组用药后各时间点心率与用药前心率比较差异无显著性.Ⅲ组用药30 s后与用药前比较差异有显著性(P＜0.05).Ⅳ组用药30 s以后与用药前比较差异有显著性(P＜0.05).结论:在全麻情况下,各个不同剂量阿托品静脉注射在各个不同时间点均不减慢心率,小剂量(3μg/kg)阿托品对患者心率的影响不明显,6、10μg/kg的阿托品静脉注射都可以明显增快心率,6μg/kg作用较为缓和.     

阿托品三种给药途径心率效应的临床研究

本文观察三种给药途径阿托品心率效应的区别，给药后连续监测心率变化。结果每种给药途径收率高峰民自基础值差异极显著（Ｐ〈０．００１）。三种给药途径显效时间差异不显著（Ｐ〉０．０５）。研究表明三种途径应用阿托品都能起到显著的心率加快效应。其中静脉组作用高峰出现最快，气管内组最慢。为野虎或紧急状态下因地制宜地造反化合敌我矛盾 依据。     

异丙酚静脉麻醉对患者心率变异和血糖水平变化的影响

目的研究异丙酚静脉麻醉对糖尿病患者心率变异和血糖水平变化的影响。方法将56例全麻患者分为两组,治疗组29例为糖尿病患者,对照组患者27例均未患糖尿病。两组患者均静脉滴注异丙酚0.7 mg/kg,然后根据情况追加首次量的1/4～1/2,监测两组患者平均动脉压(MAP)、动脉血氧饱和度(SpO2)、心率(HR)及警觉/镇静评分达3分即刻、5 min、10 min时HRV各参数;监测麻醉诱导前、诱导后插管前、插管后5 min、插管后30 min、拔管后10 min的血糖水平。结果与对照组相比,插管后实验组患者LF、HF和TP均低于对照组(P0.05),两组患者LF/HF均较基础值升高,而实验组LF/HF较对照组升高显著(P0.05)。结论异丙酚有加重糖尿病患者术中自主神经的紊乱性和升高血糖的不良反应,对于糖尿病患者的手术麻醉应慎用异丙酚。     

Effects of pharmacological adrenergic and vagal modulation on fractal heart rate dynamics

Breakdown of short‐term fractal‐like behaviour of HR indicates an increased risk for adverse cardiovascular events and mortality, but the pathophysiological background for altered fractal HR dynamics is not known. Our aim was to study the effects of pharmacological modulation of autonomic function on fractal correlation properties of heart rate (HR) variability in healthy subjects. Short‐term fractal scaling exponent (α₁) along with spectral components of HR variability were analysed during the following pharmacological interventions in healthy subjects: (i) noradrenaline (NE) infusion (n=22), (ii) NE infusion after phentolamine (PHE) (n=8), (iii) combined NE + adrenaline (EPI) infusion (n=12), (iv) vagal blockade with high dose of atropine (n=10), (v) and vagal activation by low dose of atropine (n=10). Then α₁ decreased progressively during the incremental doses of NE (from 0·85 ± 0·250 to 0.55 ± 0·23, P<0·0001). NE also decreased the average HR (P<0·001) and increased the high frequency spectral power (P<0·001). Vagal blockade with atropine increased the α₁ value (from 0·82 ± 0·22 to 1·24 ± 0·41, P<0·05). Combined NE + EPI infusion and vagal activation with a low dose atropine did not result in any changes in α₁, and α‐adrenergic blockade by PHE did not completely reverse the effects of NE on α₁. Increased levels of circulating NE result in reduction of short‐term correlation properties of HR dynamics. The results suggest that coactivation of cardiac vagal outflow at the time of high levels of a circulating sympathetic transmitter explains the breakdown of fractal‐like behaviour of human HR dynamics.     

超声监测早孕期胎心率变化规律的初步研究

目的初步探讨早孕期胎儿心率变化规律,建立参考值范围。方法收集2016年1月至2018年1月于我院产前检查的早孕期胎儿的胎心率及孕妇的相关临床资料。应用超声测量胎儿胚芽或头臀长(CRL),观测胎心搏动,M型超声或脉冲多普勒测量胎心率。结果孕龄40~41 d或CRL 2~3 mm时胎心率为(117.31±11.64)次/min,胎心率随着孕龄或CRL逐渐增加而上升,并在孕龄63~69 d或CRL 23~30 mm时胎心率达到峰值(172.69±9.27)次/min,随后胎心率随着孕龄或CRL的增长缓慢下降,趋于稳定。基于各时期胎心率变化规律建立回归方程:胎心率=-223.751+11.746孕龄-0.086孕龄^2(R^2=0.772,R=0.877,P<0.001);胎心率=101.83+5.108CRL-0.084CRL^2(R^2=0.765,R=0.875,P<0.001)。结论以孕龄及CRL为基准,初步建立了早孕期第5、50、95百分位胎心率参考值范围,为临床预测流产风险提供参考依据。     

芬太尼不同给药速度复合丙泊酚静脉全麻用于人工流产551例观察

目的比较芬太尼与丙泊酚复合麻醉用于人工流产术时,不同给药速度对麻醉效果、不良反应及麻醉追加量的影响。方法回顾性分析2008～2009年4月无痛人流584例。其中观察组551例注入茂菲氏管静滴芬太尼,对照组33例静推芬太尼。结果观察组与对照组扩张宫口时的反应及追加剂量的例数比较,差异有统计学意义（P＜0.025）,呼吸暂停的发生例数比较,差异有统计学意义（P＜0.01）。结论静滴芬太尼比静推芬太尼复合丙泊酚麻醉效果好、不良反应少、麻醉追加量少,更加安全。     

Estimating oxygen consumption from heart rate and heart rate variability without individual calibration

Heart rate (HR) as an estimator of oxygen consumption (VO(2) ) usually requires HR to be individually calibrated in a separate test. This study examined the validity of a new HR - and HR variability-based method (Firstbeat PRO heartbeat analysis software) in the estimation of VO(2) in real-life tasks. The method takes into account the respiration rate determined from HR variability and the differences in the on/off dynamics of HR and VO(2) , and no calibration tests are needed. Ten men and nine women performed 25 tasks representing different types of daily activities. Portable devices were used to measure R-to-R intervals (ECG), VO(2) and respiration rate. In pooled regression analysis, the estimated VO(2) accounted for 87% of the variability in the actual VO(2) , SEE 3·5 ml min(-1) kg(-1) (1 MET). At group level, the method underestimated slightly the measured VO(2) (mean difference - 1·5 ml min(-1) kg(-1) or - 0·4 METs). Some of the values at low exercise intensities were markedly underestimated, but the agreement was better during light and heavy activities. The limits of agreement for the data were from -8·4 to 5·4 ml min(-1) kg(-1) or from -2·4 to 1·5 METs. At individual level, the average deviations of the predicted VO(2) ranged from -1·0 to 0·6 METs and R(2) from 0·77 to 0·94, respectively. The present data indicate that the prediction method may be considered sufficiently accurate to determine the average VO(2) in field use, but it does not allow precise estimation of VO(2) .     

老年直肠癌患者丙泊酚静脉麻醉期血流动力学与血液流变学变化的关系

目的 探讨老年直肠癌患者在丙泊酚静脉麻醉下的血液流变学变化及与血流动力学变化的关系.方法 实施择期直肠癌根治手术、美国麻醉医师协会分级Ⅰ～Ⅱ级、无影响血液黏度疾病的患者50例,按照年龄分为中青年组(18～64岁,C组)和老年组(≥65岁,E组),每组25例.分别在麻醉输液前(T0)、麻醉诱导插管后,双频谱指数达到40～60并维持1 h(T1),手术结束前10 min(T2),术毕拔管患者送入麻醉复苏室后30 min(T3)4个时点经肘静脉各采血5 mL,检测高切全血黏度(Hηb200 s-1)、中切全血黏度(Mηb30 s-1)、低切全血黏度(Lηb3 s-1).从麻醉前开始至出PACU时,每5分钟记录两组患者心率(HR)、收缩压(SBP)、舒张压(DBP)、血氧饱和度值.评估全血黏度(ηb)指标在组间不同时段(T1-0、T2-1、T3-2)的变化幅度,即ηb指标在相邻时点的绝对差值为Δηb;同理,列表血压绝对差值(ΔP,记作ΔBP).结果 50例患者中共44例最终进入统计分析,其中C组23例,E组21例.(1)两组患者一般情况等比较差异均无统计学意义(P>0.05).(2)各种切变率下的Δηb,组间比较:E组各时段(T1-0、T2-1、T3-2)的ΔHηb、ΔMηb、ΔLηb均较C组高 (P<0.05);组内比较:两组都在T1-0变化幅度最大,而T2-1、T3-2较之T1-0变化幅度减小.E组T2-1、T3-2ηb变化幅度与T1-0比较无统计学差异(P>0.05),而与C组差异有统计学意义(P<0.05).(3)两组ΔBP比较,组间比较:①ΔSBP,E组变化幅度T1-0和T2-1 大于C组 (P<0.05);ΔDBP,各时段均无统计学差异(P<0.05).②组内比较,E组ΔSBP T3-2较T1-0明显降低(P<0.05).(4)ΔSBP与ΔMηb的相关性,C组ΔSBP与ΔMηb在T1-0呈显著正相关[r=0.528,P<0.05,95%可信区间(CI)=0.104～0.772].E组在各时段ΔSBP与ΔMηb无明显相关(P>0.05).结论 (1)老年患者麻醉期血液流变学变化较中青年患者高; (2)中青年患者在麻醉诱导期及以后一段时期SBP和Mηb的变化幅度呈显著正相关,而老年患者麻醉期未观察到两项指标变化有明显相关性.     

癫痫发作期心脏自主神经功能的研究

目的通过视频脑电-心电监测,研究部分性癫痫发作期心率变化,探讨不同部位起源、不同发作形式以及睡眠与觉醒对心率变化的影响,总结并分析癫痫发作前后心率演变规律。方法回顾性分析2011-2013年81例癫痫患者181次发作的视频脑电-心电监测资料,将癫痫发作期心率变化幅度分成5种类型,绘制心率变化曲线图,并从发作部位（额、颞、枕）、发作形式（SPS、CPS和CPS．G）、睡眠与觉醒等方面分析癫痫发作对心率变化的影响。结果181次发作心率差值（53．2±26．7）次/min,额、颞、枕心率差值分别为（53．3±28．5）次／min、（53．2±24．1）次／min和（52．8±31．9）次／min;睡眠期（72次）和清醒期（109次）发作心率差值分别为（62．8±25．4）次／min和（46．8±25．7）次,min;SPS、CPS和CPS-G发作心率差值分别为（32．8±24．4）次/min、（47．7±20．6）次／min和（79．3±22．4）次／min。结论发作类型为CPS．G、睡眠期、右侧起源、男性、年龄大于14岁的患者心率变化显著,癫痫发作期的心率随时间变化有一定的演变规律。     

丙泊酚麻醉对老年小鼠空间记忆能力的影响

目的:探讨丙泊酚麻醉对老年小鼠空间记忆能力的影响。方法:采用15个月龄的雄性C57BL/6小鼠18只随机均分为丙泊酚麻醉组和对照组,丙泊酚麻醉组行250 mg/kg丙泊酚腹腔注射,对照组予20%中/长链脂肪乳注射液腹腔注射。麻醉前先行转棒实验记录小鼠运动的平均速度。腹腔注射麻醉24 h后行放射状水迷宫实验(radial arm water maze, RAWM),连续2 d,记录小鼠进入错误臂道的次数。比较两组小鼠第2天5个实验组错误次数的差异。结果:两组小鼠转棒时间差异无统计学意义。丙泊酚麻醉组和对照组9只小鼠中均有3只小鼠在放射状水迷宫实验中未达到学习标准,占30%。丙泊酚麻醉组和对照组RAWM第2天5组实验的错误次数差异无统计学意义(P=0.089)。结论:250 mg/kg剂量的丙泊酚腹腔注射对15个月龄小鼠短期空间记忆能力无明显影响。     

Heart rate turbulence and heart rate variability in patients with atrial synchronous ventricular pacing

Background: Heart rate turbulence (HRT) and heart rate variability (HRV) have been shown to be independent and powerful predictors of mortality in a specific group of cardiac patients. Pacing has unfavorable effects on autonomic function. Our aim is to investigate autonomic responses to atrial synchronous ventricular pacing (VDD) by evaluating HRT and HRV parameters.
Methods and Results: The study groups comprised 12 control and 12 patients without organic heart disease and with normal sinus function who were implanted with a permanent VDD pacing system for high-degree atrioventricular block. The HRV and HRT analysis were assessed from a 24-hour Holter recording. There was no statistically significant difference between the two groups for HRV parameters. When HRT parameters were compared, turbulence onset was significantly higher in the cardiac paced group than the controls group (2.729 ± 8.818 vs –1.565 ± 8.301, P = 0.006), but no statistically significant difference was found between the two groups for turbulence slope (11.166 ± 10.034 vs 31.675 ± 28.107, P = 0.68). The number of patients who had abnormal HRT onset was significantly higher in the paced group than controls (9 vs 2, P = 0.004).
Conclusion: Atrial synchronous pacing has unfavorable effects on autonomic function. Altered ventricular depolarization sequence may lead to changes in autonomic response. Although we found no difference in HRV parameters between the control and VDD patient groups, the HRT onset and number of patients with abnormal HRT onset was significantly higher in VDD patients. HRT onset can be a better way of noninvasive autonomic response predictor in VDD patients.     

Correlation of heart rate recovery and heart rate variability with atrial fibrillation progression

ObjectiveTo examine the combination of heart rate recovery (HRR) and heart rate variability (HRV) in predicting atrial fibrillation (AF) progression.MethodsData from patients with a first detected episode of AF who underwent treadmill exercise testing and 24-h Holter electrocardiography were retrospectively analysed. Autonomic dysfunction was verified using HRR values. Sympathetic and parasympathetic modulation was analysed by HRV. AF progression was defined as transition from the first detected paroxysmal episode to persistent/permanent AF.ResultsOf 306 patients, mean LF/HF ratio and HRR did not differ significantly by AF progression regardless of age (< or ≥65 years). However, when the LF/HF ratio was divided into tertiles, in patients aged <65 years, the mid LF/HF (1.60–2.40) ratio was significantly associated with lower AF progression rates and longer maintenance of normal sinus rhythm. For patients aged <65 years, less metabolic equivalents were related to higher AF progression rates. For patients aged ≥65 years, a low HRR was associated with high AF progression rates.ConclusionIn relatively younger age, high physical capacity and balanced autonomic nervous system regulation are important predictors of AF progression. Evaluation of autonomic function assessed by age could predict AF progression.