围术期红细胞丙酮酸激酶活性的变化

目的：观察围术期红细胞内丙酮酸激酶（ＰＫ）活性的变化。方法：将３０例上腹部手术病人分成硬膜外阻滞（ＥＢ）和静脉普鲁卡因复合麻醉（ＩＰＢＡ）两组。结果：两组病人血糖于手术６０分时均开始明显升高，术后第一天值与基础值比较，ＥＢ组：８．２９±５０，４．８０±０．１８ｍｍｏｌ／Ｌ（Ｐ＜０．０１）；ＩＰＢＡ组：６．３６±０．３３，４．５５±０．１８ｍｍｏｌ／Ｌ（Ｐ＜０．０１）。红细胞内２，３－ＤＰＧ浓度无明显改变。但两组ＰＫ活性于术毕６０分时明显下降。其术后第一天值与基础值分别相比较，ＥＢ组：７．５９±１．０１，１１．６２±１．０６ＩＵ／ｇＨｂ（Ｐ＜０．０５）；ＩＰＢＡ组：７．７５±０．９４，１１．８４±１．１２ＩＵ／ｇＨｂ（Ｐ＜０．０５）。结论：在手术创伤后的高血糖反应下，红细胞内ＰＫ活性明显下降，２，３－ＤＰＧ浓度无变化。这可能与红细胞内糖酵解通路受抑制有关。     

普鲁卡因静脉复合麻醉对肝脏血流和氧耗影响的实验研究

采用电磁血流仪和血气分析等技术，研究普鲁卡因静脉复合麻醉对犬体循环血流动力学及肝脏血流和氧耗影响。 １％普鲁卡因复合液以 １．０ｍｇ· ｋｇ－１／ｍｉｎ速度静滴时，随麻醉时间延长，血浆普鲁卡因浓度逐渐升高，６０分钟达５６．９±８．７ｍｇ／Ｌ。体循环各项血流动力学参数趋于稳定，仅在６０分钟产生明显的体循环抑制效应。心率和平均动脉压分别降低２７％、２５％，心指数由３．５２±０．２１Ｌ·ｍｉｎ－１／ｍ２降至 ３． ０８±０．１２Ｌ· ｍｉｎ－１／ｍ２。肝总血流量和氧耗与体循环动力学呈一致性变化。因此，肝脏疾患及肝手术的患者，只要控制血中普鲁卡因浓度不过高，仍可安全实施普鲁卡因静脉复合麻醉。     

腹腔镜胆囊切除术中肺功能变化的临床研究

本文观察了１２例ＡＳＡ１级胆囊结石病人腹腔镜胆囊切除术中的肺功能变化。年龄为４０．７±９．４岁，体重６１．４±９．４ｋｇ。Ｍｉｄａｚｏｌａｍ－Ｆｅｎｔａｎｙｌ－Ｉｓｏｆｌｕｒａｎｅ－Ｔｒａｃｒｉｕｍ维持麻醉，控制呼吸，间歇正压通气。连续监测吸气气道峰压（ＰＩＰ），动态肺应性（ＬＣ），ＰＥＣＯ２，ＥＫＧ，ＮＩＢＰ和ＳｐＯ２。结果：体位改变对ＰＩＰ和ＰＥＣＯ２无明显影响（Ｐ＞０．０５），却使ＬＣ下降９．７％（Ｐ＞０．０５）。腹腔充气后３０分钟ＰＩＰ上升１７％（Ｐ＜０．０５），ＬＣ与麻醉后和充气前相比分别下降２５．８％和２０．８％（Ｐ＜０．０１），ＰＥＣＯ２增加１９．１％（Ｐ＜０．０１）；腹腔充气后６０分钟，ＰＩＰ和ＰＥＣＯ２未继续增加，但ＬＣ继续下降，比麻醉后和充气前下降３４．２％和２７．１％（Ｐ＜０．０１）。本文显示腹腔镜胆囊切除术中肺顺应性显著下降，气道压明显升高，ＰＥＣＯ２明显增加。     

急性代谢性酸中毒和肾上腺素对血浆钾离子浓度的影响

报告两种实验性代谢性酸中毒以及外源性肾上腺素对血浆钾离子浓度的影响。静脉输入２Ｍ乳酸溶液造成酸中毒（ｐＨ７．００）时对血钾水平的影响不明显（从３．３４±０. ２７升至３．７１±０．４０ｍｍｏｌ／Ｌ，Ｐ＞０．０５），而输入 ２Ｍ盐酸造成同样程度的酸中毒则引起血钾水平明显升高（从 ３． ７８± ０．４９升至 ４． ５８±０．５８ｍｉｎｏｌ／Ｌ，Ｐ＜０．０５）。外源性肾上腺素在酸中毒环境下对血钾浓度影响不明显，而在对照组可引起血钾浓度的降低。     

三组复合麻醉术对上腹部手术病人血浆β-内啡肽血糖及胰岛素的影响

目的：比较三组不同复合麻醉方法对手术病人血浆β－ＥＰ、血糖和胰岛素水平的影响。方法：２７例择期上腹部手术病人随机分成三组，静脉普鲁卡因组（Ⅰ组，９例）；硬膜外阻滞复合静脉麻醉组（Ⅱ组，９例）和静脉普鲁卡因复合麻醉复合Ｎ２Ｏ（６０％）组（Ⅲ组，９例）。采血时相为术前安静状态下、全麻诱导气管插管后５ｍｉｎ、手术切皮后６０ｍｉｎ、切除脏器后３０ｍｉｎ。结果：（１）Ｉ组切器官后３０ｍｉｎ血糖值显著高于麻醉前值（Ｐ＜０．０５）；（２）三组切皮后６０ｍｉｎ和切器官后３０ｍｉｎβ－ＥＰ值均显著高于麻醉前值（Ｐ＜０．０５、Ｐ＜０．０１）。结论：本文结果提示，上腹部手术中β－ＥＰ的明显升高尚不能被上述的三组复合麻醉方法有效地抑制。     

前列腺癌患者血清及尿液唾液酸测定的意义

为观察前列腺癌患者血唾液酸（ＳＡ）与病情、疗效及血清ＰＳＡ的关系，按血ＰＳＡ高低将病人分为３组：Ａ组（治疗前，１７例）血ＰＳＡ≥５０μｇ／Ｌ，７０７％为临床Ｃ、Ｄ１、Ｄ２期，病情进展，前列腺症状或骨痛明显。Ｂ组（治疗前，６例）血ＰＳＡ８～３７μｇ／Ｌ，临床分期为Ｃ、Ｄ期，占５０％。Ｃ组（治疗后，８例）血ＰＳＡ＜４μｇ／Ｌ，除临床Ｃ期１例，余均为临床Ｂ期术后，病愈或明显好转。血ＳＡ均值，Ａ组为３０８ｍｍｏｌ／Ｌ，大于Ｂ组２８１ｍｍｏｌ／Ｌ及Ｃ组２１４ｍｍｏｌ／Ｌ；Ａ、Ｃ间有非常显著性差异（Ｐ＜０００１），尿ＳＡ结果同血ＳＡ，Ｐ＜００５。此外，血ＰＳＡ与血ＳＡ（或尿ＳＡ）密切相关，Ｐ＜００１。同为阳性（或阴性）一致率血ＳＡＰＳＡ为８１６％，尿ＳＡＰＳＡ为７２２％。本实验所用“一步法”简便快速，血ＳＡ敏感性１０００％，特异性７８１％，不需进口试剂或设备，有助于前列腺癌的检出与病情疗效追踪观察。     

血栓素合酶反义核酸抗内毒素血症大鼠血栓形成的研究

目的研究反义寡核苷酸（ＯＤＮ）对大鼠血栓形成的影响。方法鼠静脉注射反义寡核苷酸Ⅰ（ＯＤＮⅠ）,２０Ｏ．Ｄ．／２００ｇ体重,检测其对血浆ＴＸＡ２浓度及血栓形成的影响。结果经ＯＤＮⅠ注射以后,内毒素血症大鼠血浆ＴＸＡ２水平从（２９５１．８±５８８．３）ｎｇ／Ｌ,降至（４３３．９±２５．７）ｎｇ／Ｌ,（Ｐ＜０．００１）;相应的血栓湿重分别为（１７．８±４．０）ｍｇ和（１１．２±３．１）ｍｇ（Ｐ＜０．０１）。结论ＯＤＮⅠ能减轻由内毒素所引起的ＴＸＡ２生成增加及血栓形成加强。     

腹腔镜胆囊切除术的麻醉

总结了５００例腹腔镜胆囊切除术的麻醉经验。以静吸复合维持麻醉。诱导后，静滴普鲁卡因１ｍｇ·ｋｇ－１／ｍｉｎ－琥珀胆碱４０μｇ．ｋｇ－１／ｍｉｎ并吸入１％安氟醚。ＣＯ２气腹后，ＰＥＴＣＯ２升高（Ｐ＜０．００１）。牵拉胆囊时６０％患者血压升高。术中肌肉松弛满意，术毕迅速清醒。     

I-EO2在静吸复合全麻监测中的意义

目的：探讨Ｉ－ＥＯ２在全麻监测中的意义。方法：对４１例普鲁卡因静吸复合麻醉病人术中同步持续监测Ｉ－ＥＯ２和ＥＴＣＯ２和ＥＴＣＯ２在全麻控制呼吸时均无明显变化,而在自主呼吸恢复和拔管和拔管前显著增高（Ｐ〈０．０５和〈０．０１）。控制呼吸时和自主呼吸恢复后ＥＴＣＯ２（ｘ）和Ｉ－ＥＯ２（ｙ）的直线回归分析分别为ｙ１（％）＝０．０７９（ｍｍＨｇ）＋１．０１７（ｒ＝０．６９３,Ｐ〈０．００１）和ｙ＾２（％）     

静脉注射不同剂量异丙酚对血流动力学及通气功能的影响

应用阻抗法和分气流监测法观察静脉注射不同剂量异丙酚（Ｐｒｏｐｏｆｏｌ，ＰＲＯ）后患者血流动力学（ＭＡＰ、ＮＲ、ＳＬＣＩ、ＩＦＩ、ＶＥＴ、ＥＶＩ、ＳＶＲＩ、ＩＣ、ＰＦＩ、ＬＳＷＩ）与通气功能（ＶＴ、ＲＲ、ＶＥ、ＦＥＶ１％、ＥＴＣＯ２、ＳＰＯ２、 Ｉ－ＥｔＯ２）的变化。 ４０例（ＡＳＡⅠ～ Ⅱ）随机分成四组，ＰＲＯ剂量分别为 １．０ｍｇ／ｋｇ、１．５ｍｇ／ｋｇ、２．０ｍｇ／ｋｇ、２．５ｍｇ／ｋｇ。结果：（１）１～４组呼吸暂停发生率为０％、２０％、３０％、８０％，苏醒时间分别为３ ０±１．５、７．４±２．３、９．１±３．６、９．６±４．２分钟：（２）静脉注射不同剂量ＰＲＯ启ＳＡＰ、ＤＡＰ、ＭＡＰ、ＳＩ下降，ＨＲ、ＣＩ、ＳＶＲＩ无明显变化，心肌收缩性（ＩＣ、ＰＦＩ、ＥＶＩ）明显减弱，ＳＶＲＩ减少；（３）ＰＲＯ对呼吸有抑制作用，以ＶＴ和ＶＥ影响最大，与剂量呈正相关；对面罩吸氧患者ＳｐＯ２、ＲＲ、ＥＴＣＯ２无明显改变，Ｉ－ＥｔＯ２减少；舌后坠者托起下颌对ＶＴ、ＶＥ的恢复颇为有效。     

Effects of famotidine and cimetidine on plasma levels of epidurally administered lignocaine

The effects of two H2-receptor antagonists, famotidine and cimetidine, on the plasma levels of epidurally administered lignocaine were studied. Group A (n = 20) received famotidine 20 mg orally the night before surgery and 20 mg intramuscularly 60 minutes before induction of anaesthesia. Group B (n = 15) received cimetidine 200 mg orally the night before the surgery and 400 mg orally 60 minutes before the anaesthetic induction. Group C (n = 20) received neither famotidine nor cimetidine and served as controls. Twelve millilitres of 2.0% lignocaine with adrenaline 1:200,000 was injected into the epidural space in all patients, after the establishment of general anaesthesia with nitrous oxide, oxygen, and enflurane (0.3-0.5%). The patients who received cimetidine showed significantly higher plasma concentrations of lignocaine compared with either group A or group C at all investigation times (p less than 0.01). The mean peak plasma concentrations were 2.4 (SEM 0.1), 3.2 (SEM 0.2) and 2.3 (SEM 0.1) micrograms/ml in group A, B, and C, respectively. This study suggests that famotidine is preferable to cimetidine for control of gastric acidity before the use of lignocaine as the epidural anaesthetic.     

Comparison of single-breath vital capacity rapid inhalation with sevoflurane 5% and propofol induction on QT interval and haemodynamics for laparoscopic surgery

BACKGROUND AND OBJECTIVE: To compare two techniques to achieve induction of anaesthesia for laparoscopic surgery. A single-breath vital capacity rapid inhalation induction with sevoflurane was compared to intravenous propofol. Their effects on haemodynamics and the QT interval of the electrocardiogram were assessed. METHODS: Forty-four ASA I-II patients scheduled to undergo elective laparoscopic gynaecological surgery were divided into two groups. In the sevoflurane group (Group S, n = 22), general anaesthesia was induced with a single-breath vital capacity rapid inhalation of sevoflurane 5% with nitrous oxide (N2O) 65% in O2 and then anaesthesia was maintained with sevoflurane 1-1.5% with N2O 65% in O2. In the propofol group (Group P, n = 22), general anaesthesia was induced with propofol 2 mg kg(-1) intravenously and maintained with propofol 6 mg kg(-1) h(-1). Systolic, diastolic and mean arterial pressures, heart rate and end-tidal CO2 values were recorded before anaesthesia (basic value), during the induction period (time X), at 10 min (time Y) and at 30 min (time Z) of CO2 insufflation in all patients. QT intervals were calculated using Bazett's equation. RESULTS: Systolic, diastolic and mean arterial pressure values during the induction period (time X) were lower than the basic value in both groups (P < 0.05). In Group S, QTc intervals were significantly longer during the induction period (time X) and at the tenth min of CO2 insufflation (time Y) than Group P (P < 0.05). Five patients at time X and two patients at time Y developed ventricular dysrhythmias, which improved spontaneously in Group S. In Group P, there was no significant difference in QTc intervals and only one patient developed a ventricular dysrhythmia at time Y. CONCLUSIONS: Single-breath vital capacity rapid inhalation induction technique with sevoflurane can cause prolongation of the QT interval and dysrhythmias, compared with induction and maintenance of anaesthesia with propofol in laparoscopic surgery.     

Midazolam-sufentanilvs sufentanil-enflurane for induction of anaesthesia for CABG surgery

PURPOSE: To compare the effects of midazolam-sufentanil (Group I) and sufentanil-enflurane (Group II) anaesthesia on myocardial oxygenation and metabolism in patients with preserved ventricular function undergoing CABG surgery. METHODS: Patients randomized to Group I (n = 16) received midazolam 0.3 mg.kg-1 at induction of anaesthesia, 0.15 mg.kg-1 after tracheal intubation, followed by an infusion of 2.5-10.0 micrograms.kg-1.min-1. Supplemental sufentanil (cumulative maximum of 5 micrograms.kg-1) was given for adverse haemodynamic responses. Group II (n = 16) received 5 micrograms.kg-1 sufentanil at induction. Additional sufentanil (maximum 5 micrograms.kg-1), and enflurane (0-3% inspired concentration) were administered for adverse haemodynamic responses. Haemodynamics, myocardial oxygen consumption (MVO2), and lactate extraction were determined at the following times: I) awake (AWA), 2) after induction (IND), and 3) after tracheal intubation (ETT). RESULTS: Systemic haemodynamics and myocardial metabolism were similar at AWA. Heart rate response was attenuated and MVO2 reduced in Group I at IND (P < 0.05). Following AWA, myocardial lactate production (MLP) occurred more frequently in Group II vs Group I patients (9/16 vs 2/16) and at more individual measurement points (Group II: 10/64 vs Group I: 3/64). Myocardial lactate flux demonstrated a deleterious trend in Group II at ETT. CONCLUSIONS: Compared with sufentanil-enflurane, midazolam-sufentanil anaesthesia resulted in comparable and acceptable haemodynamics and myocardial oxygenation in CABG patients.     

A comparison of the myocardial metabolic and haemodynamic changes produced by propofol-sufentanil and enflurane-sufentanil anaesthesia for patients having coronary artery bypass graft surgery

The purpose of this study was to compare propofol-sufentanil with enflurane-sufentanil anaesthesia for patients undergoing elective coronary artery bypass graft (CABG) surgery with respect to changes in (1) haemodynamic variables; (2) myocardial blood flow and metabolism; (3) serum cortisol, triglyceride, lipoprotein concentrations and liver function; and (4) recovery characteristics. Forty-seven patients with preserved ventricular function (ejection fraction greater than 40%, left ventricular end diastolic pressure less than or equal to 16 mmHg) were studied. Patients in Group A (n = 24) received sufentanil 0.2 microgram.kg-1 and propofol 1-2 mg.kg-1 for induction of anaesthesia which was maintained with a variable rate propofol (50-200 micrograms.kg-1.min-1) infusion and supplemental sufentanil (maximum total 5 micrograms.kg-1). Patients in Group B (n = 23) received sufentanil 5 micrograms.kg-1 for induction of anaesthesia which was maintained with enflurane and supplemental sufentanil (maximum total 7 micrograms.kg-1). Haemodynamic and myocardial metabolic profiles were determined at the awake-sedated, post-induction, post-intubation, first skin incision, post-sternotomy, and pre-cardiopulmonary bypass intervals. Induction of anaesthesia produced a larger reduction in systolic blood pressure in Group A (156 +/- 22 to 104 +/- 20 mmHg vs 152 +/- 26 to 124 +/- 24 mmHg; P less than 0.05). No statistical differences were detected at any other time or in any other variable including myocardial lactate production (n = 13 events in each group), time to tracheal extubation and time to discharge from the ICU. We concluded that, apart from hypotension on induction of anaesthesia, propofol-sufentanil anaesthesia produced anaesthetic conditions equivalent to enflurane-sufentanil anaesthesia for CABG surgery.     

Prolonged elimination of midazolam after i. m. administration

The elimination pharmacokinetics of midazolam after i.m. administration was compared with combined i.m. and i.v. administration in a randomized study of 55 gynaecological patients in outpatient general anaesthesia. Group 1 (n = 40) received midazolam 0.1 mg/kg i.m. as premedication 45 min before induction of general anaesthesia with midazolam 0.3 mg/kg i.v. Group 2 (n = 15) received midazolam 0.1 mg/kg i.m. as premedication 45 min before induction of general anaesthesia with thiopentone 4 mg/kg. Serum midazolam concentration measurements were performed regularly post-induction for 7 h in each patient. The elimination half-life of midazolam after i.m. administration (Group 2) was 6.6 +/- 1.2 h (mean +/- s.e. mean), which was significantly longer (P less than 0.05) than the 3.9 +/- 0.3 h observed after the combined i.m. and i.v. administration of midazolam (Group 1), and significantly longer than 2.9 h obtained from a calculated i.v. administration curve. We postulate a slow i.m. depot release of midazolam, representing the rate-limiting step in the elimination of midazolam after i.m. administration.     

Clonidine premedication effects on inhaled induction with sevoflurane in adults: a prospective, double-blind, randomized study

BACKGROUND: The purpose of this study was to evaluate whether oral clonidine premedication becomes an alternative to N2O in terms of shortening the induction time and attenuation of the adrenergic response to tracheal intubation during inhalation induction with sevoflurane, and to evaluate the quality of anesthetic induction according to the patient's satisfaction. METHODS: We studied 84 female patients who were randomly allocated into four study groups: Groups I and II received a placebo orally, and Groups III and IV received clonidine at 150 and 300 microg, respectively, 90 min before induction of anaesthesia. Patients were anesthetized using a triple-deep-breath technique with 5% sevoflurane in Groups I, III and IV, and with 60% N2O-5% sevoflurane in group II. RESULTS: Induction time was significantly longer (P < 0.05) in Group I. Increases in mean blood pressure and heart rate after tracheal intubation were significantly suppressed in Groups III and IV but not in Group II compared with Group I. Comfort and impression of anesthesia was better in Groups III and IV than in Groups I and II. CONCLUSION: In volatile anesthetic induction, pre-anesthetic clonidine may become an alternative to N2O and may provide more comfort than with N2O.     

Myocardial protection related to magnesium content of cold blood hyperkalemic cardioplegic solutions in CABG

The objective of this study was to investigate whether the addition of magnesium to a hyperkalemic cardioplegic solution containing 1.2-1.5 mmol/L ionized calcium improves myocardial protection. Twenty-seven coronary artery disease (CAD) patients underwent coronary artery bypass grafting (CABG) received hyperkalemic (20-22 mmol/L potassium) cardioplegic solutions containing 1.2-1.5 mmol/L ionized calcium and were randomized to one of the following groups: Group A (n = 9) received 3-4 mmol/L magnesium cool blood cardioplegia (4 degrees C), Group B (n = 9) received 8-10 mmol/L magnesium cold blood cardioplegia (4 degrees C). Group C (n = 9) received 16-18 mmol/L magnesium cold blood cardioplegia (4 degrees C). The effect of myocardium protection of the three kinds of cardioplegic solutions were evaluated by clinical outcome, cTnI and CK-MB mass. Serial venous blood samples were obtained before induction, after cardiopulmonary bypass (CPB), postoperative 6 h, 24 h, 72 h, and 6th day, respectively. The percentage of myocardial autoresusciation in group B (100%) was significantly higher than that in groups A (77.8%) and C (66.7%). One patient in group A and two patients in group C needed an interim pacemaker, but none in group B. The period of postoperative mechanical ventilation and ICU stay in group B was shorter than in the other two groups. The level of cTnI and CK-Mb mass increased from postoperative 6 h (p < .05), reached peak in 24 h-72 h, and recovered postoperative 6th day. As compared with groups A and C, the plasma concentrations of cTnI and CK-MB mass in group B were significantly lower at 6 h, 24 h, and 72 h (p < .01). 8 approximately 10 mmol/L magnesium cold blood cardioplegia provides better myocardium protection than higher or lower concentrations.     

Inhaling nitrous oxide reduces the induction dose requirements of propofol

Inhaling nitrous oxide (N(2)O) before propofol induction appears to decrease propofol usage. To investigate the efficacy of N(2)O as a component of the drugs used to induce anesthesia, the effect of inhaling a N(2)O:oxygen (O(2)) mixture on the dose of propofol required to induce anesthesia was determined in a double-blinded manner. We randomized 117 unpremedicated patients scheduled for elective surgery into three groups. Group FN received 1 microg/kg fentanyl and breathed 4 L/min N(2)O + 2 L/min O(2). Group PN received placebo and breathed 4 L/min N(2)O + 2 L/min O(2). Group FO received 1 microg/kg fentanyl and breathed 6 L/min O(2). Propofol was infused at 20 mg/min after 1 min of gas mixture inhalation, and the infusion stopped when there was loss of response to verbal command. The mean (SD) propofol dose was 0.75 (0.30), 0.84 (0.26), and 1.33 (0.51) mg/kg, and the induction time 133 (57), 142 (47), and 226 (78) s for Groups FN, PN, and FO, respectively. We conclude that inhalation of 66% N(2)O in O(2) 1 min before the IV induction of anesthesia with propofol at 20 mg/min, reduces the induction dose of propofol by 44% and decreases the time required for the induction of anesthesia (P < 0.001).     

Ondansetron does not modify emergence agitation in children

In this prospective, placebo-controlled study, we evaluated the effect of prophylactic ondansetron therapy on emergence agitation of children who underwent minor surgery below the umbilicus. Seventy children aged one to six years and American Society of Anesthesiologists physical status I were studied. Children were premedicated with midazolam rectally and were randomly assigned to receive either ondansetron (Group O) or placebo (Group P) in combination with caudal anaesthesia. Children in Group O received intravenous ondansetron (0.1 mg/kg for children weighing < 40 kg, 4 mg for children weighing > 40 kg) and Group P (n = 35) received normal saline 2 ml following anaesthesia induction with sevoflurane. Airway management was provided with LMA-Proseal without muscle relaxation and anaesthesia maintenance was provided with a 60:40 N2O:O2 mixture and sevoflurane. Emergence agitation was evaluated with a ten point scale and pain level was assessed every 10 minutes for the first 30 minutes after admission to the recovery room. There were no significant differences between the placebo and ondansetron groups with respect to demographic, anaesthetic and surgical details. Incidences of emergence agitation in ondansetron and placebo groups were similar (32.4% and 30.3% at 10 minutes respectively). Mean modified Children's Hospital of Eastern Ontario pain scale scores and mean ten-point scale scores and emergence agitation incidences decreased similarly after 10 minutes in both groups. Ready time for discharge was similar between the groups. Agitated patients had significantly increased ready time for discharge compared to non-agitated patients (P = 0.001). Prophylactic intravenous ondansetron administration does not reduce emergence agitation comparing to placebo after sevoflurane anaesthesia.     

库存红细胞清洗在新生儿及小婴儿体外循环手术中的应用

目的 对比体外循环(CPB)心脏手术中接受洗涤及未洗涤的库存红细胞(PRBC)对血清钾离子浓度(K+)及乳酸浓度(LAC)的影响.方法 选取复杂先天性心脏病(先心病)行CPB心脏手术的新生儿及小婴儿为研究对象,排除术前血乳酸大于3.0mmol/L的病婴.对照组(15例)接受未洗涤的PRBC进行CPB预充及术中添加,试验组(15例)接受用血液回收机(Medtronic Autolog)洗涤过的PRBC.在CPB前、CPB 3、15min、CPB复温、停止CPB前、术毕、术后4、24h比较血K+及LAC浓度.结果 洗涤PRBC显著降低供血中K+浓度[从(19.3±0.9)mmol/L降至(1.1±0.3)mmol/L,p<0.001]及IAC浓度[从>15mmol/L降至(7.8±1.2)mmol/L,P<0.001].对照组预充液的K+及ILAC浓度显著高于试验组[K+(9.0±0.5)rranol/L对(2.6±0.1)mmol/L,P<0.001;LAC浓度(9.5±0.5)mmol/L对(4.7±1.1)nrml/L,P<0.001].CPB 3min、CPB复温时对照组血清K+浓度显著高于试验组[CPB 3 min(5.6±0.9)mmol/L对(3.5±0.4)mmol/L,P<0.01;CPB复温时(4.8±0.7)mmol/L对(3.7±0.6)mmol/L,P<0.01];其余时点对照组K+浓度高于试验组,差异无统计学意义.CPB 3、15 min、CPB复温、停止CPB前、术毕、术后4 h对照组IAC浓度高于试验组,但差异无统计学意义.结论 洗涤PRBC降低血清钾及乳酸负荷,可预防cPB中高血钾.在新生儿及小婴儿复杂先心病CPB手术中应考虑应用清洗PRBC.