复合麻醉在小儿手术中的应用

复合麻醉在小儿手术中的应用孙星白小儿单一麻醉，很难满足较长时间的手术，复合麻醉可扬长避短，以提高小儿麻醉的成功率及其安全性。我院应用该方法施行小儿手术３６６例，麻醉安全有效，优于单一麻醉。资料与方法本组３６６例，男２１１例，女１５５例，年龄１～１４岁...     

复合手术在主动脉夹层二期手术中的应用

目的探讨复合手术在主动脉夹层二期手术治疗中的效果。方法分析2010年5月至2018年5月宜昌市第一人民医院收治的累及腹腔内脏动脉的主动脉夹层进行二期手术中接受复合手术的6例患者的临床资料。结果 6例患者手术均获得成功,术中造影显示所有患者腹主动脉破口完全隔绝,2例假腔延迟显影,破口位于髂动脉,其余假腔不显影。术后无截瘫、内漏、出血、血栓形成和感染等并发症。二期手术后随访0.5～3年,患者人工血管及支架内血流均通畅,5例患者假腔完全血栓化,1例患者因髂总动脉远端有破口假腔未完全血栓化,因假腔未见增大,未做处理,继续观察。结论复合手术能简化传统手术治疗方法,扩大覆膜支架腔内治疗的适应证范围,值得在临床中推广。     

平痛新、杜冷丁、冬眠合剂在骨伤病中的镇痛比较

近三年来,作者随机观察了264例三类常见骨伤疾患分别应用平痛新加非那根(简称平非合剂)、杜冷丁加非那根(杜非合剂)、冬眠灵加非那根(冬眠合剂)混合肌注的镇痛效果。这三类疾患。(1)腰椎术后(均为腰椎间盘突出症或伴椎管狭窄);(2)软伤、手足伤(均为中轻度软组织挫裂伤、非毁损手足伤);(3)骨折术前、后(股骨骨折、尺挠骨骨折、胫腓骨骨折,均力单发骨折)。药物剂量、用法:平痛新30mg、杜冷丁50mg、冬眠     

KDN复合麻醉在短时间手术中的应用

从1983年6月至1987年5月,我们应用氯胺酮100mg、氟哌啶5mg、1％普鲁卡因15ml(简称KDN)复合液在短时间手术中(1h内)取得满意的效果。临床资料:本组113例,男性66例,女性47例,年龄7～63岁。手术种类:阑尾、疝36例,烧伤清创22例,切痂植皮26例,四肢软组织复合伤10例,颌面眼科手术10例,乳腺脓肿切开引流9例。麻醉方法:术前半h肌注东茛菪碱0.3mg或将东莨菪碱0.3mg混入KDN复合液中,配在20ml注射器内。     

静脉复合麻醉在医学美容手术中的应用

自2003年9月至2005年10月，笔者采用静脉复合麻醉的方法对280例接受美容手术的患者进行麻醉。现将临床体会报道如下。     

复合控制性降压在颅脑手术中的应用

目的:为减少或消除硝普钠的耐药性、毒性及反射性心动过速、反跳性血压增高等副作用。方法;采用单纯应用硝普钠、艾司洛尔、复合硝普钠控制性降压,各选20例。结果:艾司洛尔复合硝普钠控制性降压克服了单纯应用销普钠的缺点,血压下降平稳容易,停药后无反跳性高血压及反射性心动过速,从而降低了心肌耗氧量。结论:艾司洛尔复合硝普钠用于颅脑手术长时间控制性降压,安全易行,脑氧供需基本平衡,副作用少,是值得推广的一种方法。     

术前口服能量合剂在下肢关节置换手术中的应用

目的探讨术前口服能量合剂对全麻下择期行下肢关节置换手术患者安全性、舒适性的影响,为术前快速康复外科(ERAS)提供参考。方法选择择期全麻下行关节置换手术的患者51例,男24例,女27例,年龄18～65岁, BMI 18.9～23.6 kg/m~2,ASAⅠ—Ⅲ级。随机分为能量合剂组(EM组,n=16)、糖盐组(GN组,n=17)、空白组(N组,n=18)。EM组和GN组术前1 d 22:00后开始禁食,术前2 h EM组口服能量合剂(术能)5 ml/kg,GN组口服5%糖盐水5 ml/kg。N组术前1 d 22:00点开始禁食,午夜后开始禁水。记录三组患者手术当日晨7:00(饮用前)、饮用后1、2 h或同时段的胃窦残余容量面积(CSA)。评估三组饮用前、饮用后1 h、麻醉诱导前饥饿评分和口渴评分;EM组和GN组对口服饮料的口感评分。检测并记录患者术前1 d、入室时、术后2 h血糖(Glu)、电解质(Na~+、K~+、Ca~(2+))。记录术后恶心呕吐等不良反应发生情况。结果饮用后1 h EM组和GN组CSA均明显大于N组(P0.05);饮用前、饮用后2 h三组CSA差异无统计学意义。饮用后1 h和麻醉诱导前EM组和GN组饥饿评分和口渴评分明显低于N组(P0.05),EM组口渴评分明显低于GN组(P0.05)。EM组口感评分明显高于GN组(P0.05)。与术前1d比较,入室时、术后2 h N组Glu明显升高(P0.05),Na~+明显升高(P0.05)。三组患者均未见术后恶心呕吐等不良反应。结论术前2 h口服能量合剂(术能)对择期全麻下行下肢关节置换手术患者是安全的,能明显缓解患者术前饥饿、口渴等不适感,且口感易被接受,能维持患者围术期血糖、电解质的稳定,更利于患者术后快速康复。     

复合麻醉在膀胱肿瘤手术中的临床应用

目的超声引导下闭孔神经阻滞复合全麻在膀胱肿瘤电切中的临床研究。方法选取本院2017年1月至2018年10月收治的96例膀胱肿瘤电切患者,随机分为观察组和对照组,每组48例。对照组行全身麻醉,观察组行超声引导下闭孔神经阻滞复合全麻。对比两组患者闭孔反应发生率、肿瘤复发率、术后意识恢复时间、术后疼痛评分以及术后初次下床活动时间。结果观察组患者闭孔反应发生率、肿瘤复发率低于对照组,差异具有统计学意义(P0.05),两组患者术后意识恢复时间、术后疼痛评分以及术后初次下床活动时间相近,差异无统计学意义(P0.05)。结论在膀胱肿瘤电切治疗中,超声引导下闭孔神经阻滞复合全麻可提升手术安全性,控制肿瘤复发,且不会增加并发症,应予以推广。     

静脉复合麻醉在脑积水分流手术中的应用

脑积水病人一般对长时间的吸入性全身麻醉耐受性较差,我们对7例脑积水在行侧脑室肾脂肪囊分流术时复合应用羟基丁酸钠和硫贲妥钠为主的静脉麻醉效果满意。麻醉时间最短1小时55分,最长8小时5分,平均4小时。此7例中除1例成人外,其余     

丙泊酚氯胺酮复合麻醉在剖宫产手术中的应用

本文观察丙泊酚、氯胺酮静脉复合麻醉用于剖宫产术，报告如下。     

氯胺酮复合硬膜外麻醉在小儿手术中的应用

小儿是一个特殊的群体，麻醉方法的正确选择，对疾病的恢复，减少术后并发症至关重要。我院自1998年1月～2004年1月对56例小儿手术病人行氯胺酮复合硬膜外麻醉，取得了满意的麻醉效果，现报告如下：     

静脉复合麻醉在美容整形外科手术中的应用

自 1990年 7月至 2 0 0 0年 7月 ,采用普鲁卡因 +氯胺酮静脉复合麻醉实施整形外科手术 10 0 0例 ,观察麻醉效果 ,及其对呼吸、循环功能的影响和不良反应 ,评价其实用性和安全性 ,现报道如下。1　临床资料　本组 10 0 0例患者 ,男 5 6 1例 ,女 4 39例。年龄 2～ 71岁 ,体重 9～ 80ｋｇ ,ＡＳＡⅠ～Ⅱ级 ,实施手术如下 :全身大面积烧伤植皮术 342例 ;唇裂修补术 15 8例 ;手足部烧伤严重畸形修复术 5 0例 ;游离皮瓣转移修复肢体缺损术 134例 ;四肢大关节部位外伤晚期瘢痕畸形修复术 10 0例 ;隆、缩乳术 36例 ;斜颈矫治术 4 7例 ;脂肪抽吸术 2 3…     

静脉复合麻醉在美容整形外科手术中的应用

自1990年7月至2000年7月,采用普鲁卡因+氯胺酮静脉复合麻醉实施整形外科手术1000例,观察麻醉效果,及其对呼吸、循环功能的影响和不良反应,评价其实用性和安全性,现报道如下.     

异丙酚复合氯胺酮在脊柱手术中的辅助应用

脊柱手术存在脊髓或神经损伤的危险，连续硬膜外麻醉可使病人在清醒状态下接受手术，因而可避免脊髓或神经的损伤。但部分病变严重的患因术中对神经根的强烈刺激，使患难以忍受，所以手术无法进行，对于这部分患，我们用异丙酚静滴复合氯胺酮肌注来强化麻醉，取得良好效果。     

冬眠—氯胺酮肌肉注射复合麻醉在乳癌根治术的临床应用

我院自1972年5月～84年5月,用冬眠4号加氯胺酮肌肉注射复合麻醉,在乳腺癌根治术中麻醉效果满意。麻醉方法麻醉前半小时肌注苯巴比妥钠0.1或哌替定50mg,阿托品0.5mg,入手术室测血压脉搏,呼吸后即肌注哌替定2mg/kg,异丙嗪1mg/kg,乙酰普马嗪0.4mg/kg,手术前15分钟肌注氯胺酮1-2mg/kg,第二次追加药量是第一次用药的1/2。临床资料本组共58例,男性1例,女性57例,年龄20～70     

简易自体血回收装置在宫外孕、脾破裂手术中的应用

<正> 在多年的工作中,我们对宫外孕、脾破裂等急性闭合性腹腔内出血病人,年龄18～50岁,B超提示出血量在800～2000ml,出血时间在24小时内的病人,应用简易自体血回收装置进行自体血回收并回输,取得了很好的效果,具体方法介绍如下。 1 材料与方法 一个带双孔橡皮塞的2000～5000ml负压吸器瓶,一个漏     

冬眠疗法在自残性断指再植中的应用

自残性断指多因患者情绪激动时自行用刀砍下自己的手指,治疗期间患者因情绪波动,并特续较长时间,极易导致术后血管危象的发生.我科自2004年3月～2006年3月两年间临床收治自残性断指22例,经再植术后使用冬眠疗法,取得较好疗效,报道如下.……     

早期应用冬眠合剂对严重烫伤大鼠小肠的保护作用

Objective To study the protective effect of early application of lytic cocktail on small intestine of severely scalded rats. Methods Sixty-six male SD rats were divided into sham injury group (SI, n =6) , scald group (S, n = 30) and scald + lytic cocktail group (SL, n =30) according to the random number table. After anesthesia, rats in the latter 2 groups were inflicted with 30% full-thickness scald, while rats in S group were sham scalded with 37 ℃ water. Resuscitation was carried out by intraperitoneal injection with 2 mL · kg-1 · %TBSA-1 lactated Ringer's solution in all rats; meanwhile 12 mL/kg lytic cocktail [ 1 mL pethidine (50 mg/mL) + 1 mL chlorpromazine (25 mg/mL) + 1 mL promethazine (25 mg/mL) + 125 mL saline] was hypodermically injected to rats in SL group, while 12 mL/kg saline was injected into rats in the other 2 groups. Samples of blood and small intestine were harvested from S and SL groups at post scald hour (PSH) 3, 6, 12, 24, 48 and from SI group at PSH 3, with 6 rats in each group at each time point. Pathological changes in intestine were observed, and the expression of intercellular adhesion molecule 1 (ICAM-1) and CD68 were determined with immunohistochemistry at PSH 24 for S and SL groups and at PSH 3 for SI group. Plasma levels of D-lactate, diamine oxidase (DAO) , IL-1β, TNF-α, IL-10 were determined with ELISA. Data were processed with one-way analysis of variance. Results (1) At PSH 24, mild hemorrhage, inflammatory cell infiltration and epithelial cell shedding were observed in small intestinal mucosa of rats in S group.Compared with S group, the intestinal villi of SL group were arranged regularly without obvious hyperemia and edema. (2) Expression levels of ICAM-1 and CD68 [(1. 69 ± 0.27)%, (0.80 ±0.09)%] in S group were significantly higher than those in SI group [(0.77 ± 0. 10) % , (0. 30 ± 0. 05) % , with F value respectively 77. 303 and 66. 933 , P < 0.05 or P < 0.01] and SL group [(0. 53 ± 0.09) % , (0. 32 ± 0. 06) % , with F value respectively 77. 303 and 66. 933 , P values all below 0.01]. (3) D-lactate levels of rats in SL group were significantly lower than those of rats in S group at PSH 12, 24 (with F value respectively 20. 936 and 19. 854, P values all below 0.01), while DAO levels of rats in SL group were significantly lower than those of rats in S group at PSH 3, 12 (with F value respectively 21. 930 and 11. 342 , P values all below 0. 05).(4) The levels of IL-1β and TNF-α in S group were significantly higher than those of SI group at each time point (P values all below 0.01). The levels of IL-1β and TNF-α in SL group were significantly higher than those of S group at PSH 6, 12 and 24 (with F value respectively 96. 517 , 17.365, 79.715 and 21. 328, 17. 682, 28.424, P <0.05 or P <0.01). IL-10 level in SL group was higher than that in S group at each time point, and the differences were statistically significant at PSH 6 and 24 (with F value respectively 8. 668, 19. 634, P < 0.05 or P < 0.01). Conclusions Early administration of lytic cocktail can attenuate edema and injury of intestinal mucosa in severely scalded rats. The mechanism may lie in that it can reduce the expression of ICAM-1 in intestinal mucosa, decrease the number of intestinal inflammatory cells and regulate the levels of inflammatory cytokines.     

早期应用冬眠合剂对严重烫伤大鼠小肠的保护作用

Objective To study the protective effect of early application of lytic cocktail on small intestine of severely scalded rats. Methods Sixty-six male SD rats were divided into sham injury group (SI, n =6) , scald group (S, n = 30) and scald + lytic cocktail group (SL, n =30) according to the random number table. After anesthesia, rats in the latter 2 groups were inflicted with 30% full-thickness scald, while rats in S group were sham scalded with 37 ℃ water. Resuscitation was carried out by intraperitoneal injection with 2 mL · kg-1 · %TBSA-1 lactated Ringer's solution in all rats; meanwhile 12 mL/kg lytic cocktail [ 1 mL pethidine (50 mg/mL) + 1 mL chlorpromazine (25 mg/mL) + 1 mL promethazine (25 mg/mL) + 125 mL saline] was hypodermically injected to rats in SL group, while 12 mL/kg saline was injected into rats in the other 2 groups. Samples of blood and small intestine were harvested from S and SL groups at post scald hour (PSH) 3, 6, 12, 24, 48 and from SI group at PSH 3, with 6 rats in each group at each time point. Pathological changes in intestine were observed, and the expression of intercellular adhesion molecule 1 (ICAM-1) and CD68 were determined with immunohistochemistry at PSH 24 for S and SL groups and at PSH 3 for SI group. Plasma levels of D-lactate, diamine oxidase (DAO) , IL-1β, TNF-α, IL-10 were determined with ELISA. Data were processed with one-way analysis of variance. Results (1) At PSH 24, mild hemorrhage, inflammatory cell infiltration and epithelial cell shedding were observed in small intestinal mucosa of rats in S group.Compared with S group, the intestinal villi of SL group were arranged regularly without obvious hyperemia and edema. (2) Expression levels of ICAM-1 and CD68 [(1. 69 ± 0.27)%, (0.80 ±0.09)%] in S group were significantly higher than those in SI group [(0.77 ± 0. 10) % , (0. 30 ± 0. 05) % , with F value respectively 77. 303 and 66. 933 , P < 0.05 or P < 0.01] and SL group [(0. 53 ± 0.09) % , (0. 32 ± 0. 06) % , with F value respectively 77. 303 and 66. 933 , P values all below 0.01]. (3) D-lactate levels of rats in SL group were significantly lower than those of rats in S group at PSH 12, 24 (with F value respectively 20. 936 and 19. 854, P values all below 0.01), while DAO levels of rats in SL group were significantly lower than those of rats in S group at PSH 3, 12 (with F value respectively 21. 930 and 11. 342 , P values all below 0. 05).(4) The levels of IL-1β and TNF-α in S group were significantly higher than those of SI group at each time point (P values all below 0.01). The levels of IL-1β and TNF-α in SL group were significantly higher than those of S group at PSH 6, 12 and 24 (with F value respectively 96. 517 , 17.365, 79.715 and 21. 328, 17. 682, 28.424, P <0.05 or P <0.01). IL-10 level in SL group was higher than that in S group at each time point, and the differences were statistically significant at PSH 6 and 24 (with F value respectively 8. 668, 19. 634, P < 0.05 or P < 0.01). Conclusions Early administration of lytic cocktail can attenuate edema and injury of intestinal mucosa in severely scalded rats. The mechanism may lie in that it can reduce the expression of ICAM-1 in intestinal mucosa, decrease the number of intestinal inflammatory cells and regulate the levels of inflammatory cytokines.