Fabius系列麻醉机临床使用的注意事项和维护

现代麻醉机由过去简单的气动系统，发展到以电子、计算机技术为基础的麻醉工作站。现代麻醉机技术尽管复杂．麻醉医生必须懂得自己所使用的麻醉机的特点．方能进行正确的操作和麻醉，这就要求麻醉医师对麻醉机可能发生的功能失常应有充分认识，本文主要介绍在工作中使用Fabius系列麻醉机所遇到的几个问题及对这些问题的分析，提出了预防方法和在使用中应注意的事项。     

Fabius系列麻醉机临床使用的注意事项和维护

现代麻醉机由过去简单的气动系统，发展到以电子、计算机技术为基础的麻醉工作站。现代麻醉机技术尽管复杂，麻醉医生必须懂得自己所使用的麻醉机构特点，方能进行正确的操作和麻醉。这就要求麻醉医师对麻醉机可能发生的功能失常应有充分认识，本文主要介绍在工作中使用Fabius系列麻醉机所遇到的几个问题及对这些问题的分析，提出了预防方法和在使用中应注意的事项。     

北美2B及GS麻醉机吸气流速对预设潮气量的影响及合理设定

北美2B及GS麻醉机的吸气流速（Inspiratory Flow）系手动调节。有较大的调节范围．吸气流速对预设的潮气量有一定的影响，吸气流速的设定应和预设湖气量、呼吸频率、及吸呼比之间有怠好的协调性，过小的吸气流速达不到设定的潮气量，过大的吸气流速将增加不必要的气道压力．每秒的吸气流速和吸气时间的乘积应略大干设定的潮气量。通过一简单方法可以将某一吸气流速的数值大致测定出来．供临床设定时参考。     

麻醉机呼吸环路碱石灰尘埃污染的情况

目的：观察通气时碱石灰尘埃向呼吸环路中的排放及被呼吸道阻留的情况。方法：麻醉机环路连接集尘袋及筛装新碱石灰。ＪＴ库尔特颗粒计数仪动态测定排尘量。其颗粒测量范围为１～１２５μｍ３，通气１０分后测定呼吸环路加集尘袋内的尘埃量即为总尘量，收取称干重得尘埃分散度。通过对Ｎａｒ－ｃｏｍｅｄ、Ｄｒａｇｅｒ、Ｓｕｌａｒ８０８和１０３麻醉机行上述测量后，另以前者（Ｎ机）为例，其环路按相应处理分干燥、湿化和过滤三组，志愿者模拟通气１０分测定环路含尘量后与总尘量差得气管肺的阻留量。结果：四种麻醉机环路内碱石灰尘埃的分散度达１３ｍｇ／ｍ３以上。尘埃排放量与通气时间呈正比（ｒ＝０．９５，Ｐ＜０．０１）。Ｎ机干燥组中总排尘量的半数以上被气管肺阻留。湿化组该阻留量明显下降（Ｐ＜０．０５），而过滤组环路内总排尘量和气管肺阻流量下降更为显著（Ｐ＜０．０１）。结论：使用新碱石灰通气时，麻醉机环路内存在严重的尘埃污染，环路内湿化有一定的防尘作用，但以滤过处理效佳。     

麻醉机通气系统回路内消毒前后细菌培养的对比

目的:观察麻醉机回路内消毒的有效性。方法:240台/次麻醉机按连续使用时间分为3h、6h组,应用回路内消毒机进行消毒,对消毒前后麻醉机吸气端和呼气端细菌培养进行比较。结果:消毒前麻醉机回路端口存在大量细菌,与3h组比较,连续应用6h的麻醉机,细菌数量显著增加,差异有统计学意义[吸气端(56±12)cf u/c2m比(386±101)cf u/c2m,t=22.23,P<0.01;呼气端(53±15)cf u/c2m比(379±98)cf u/c2m,t=24.75,P<0.01];连续应用3h和6h的麻醉机消毒后回路端口细菌培养菌群数显著低于消毒前,差异有统计学意义(3h组吸气端和呼气端消毒前后比较t分别为18.15,15.47;P<0.01;6h组吸气端和呼气端消毒前后比较t分别为20.01,21.33;P<0.01);麻醉机连续应用不同时间消毒前后吸气端与呼气端细菌培养比较,差异无统计学意义(3h组吸气端和呼气端消毒前、后比较,t分别为0.66,0.52;P>0.05;6h组吸气端和呼气端消毒前、后比较,t分别为0.13,1.24;P>0.05)。结论:随着麻醉机连续应用时间的延长,回路内的细菌显著增加;麻醉机麻醉机回路内消毒可有效降低麻醉机细菌培养数量。     

循环紧闭麻醉机在小儿的应用（附12例报告）

循环紧闭麻醉机一般限用于成人,我们将其试用于体重12～15kg的小儿麻醉取得满意效果,现将观测结果报告如下。 临床资料 选择ASAⅠ～Ⅱ级手术病儿12例,其中男8例,女4例,年龄1(1/2)～3岁,体重12～15kg。手术种类:纵隔肿瘤2例,先天性髋关节脱位5例,先天性巨结肠2例,先天性胆总管囊肿3例。术前30min肌注苯巴比妥钠2mg/kg和阿托品0.02mg/kg,肌注氯胺酮5mg/kg。入睡后开放静脉,先静注地塞米松5mg后,依次静     

麻醉机螺纹管，呼气活瓣的细菌学检测

目的：了解麻醉机螺纹管，呼气活瓣的细菌污染状况。方法：采用横断面研究方法，分两次对本院18台（共36台／次）麻醉机螺纹管．呼气活瓣进行采样；采用普通细菌培养法对样本进行细菌培养．菌落计数．使用纲菌鉴定分析仪对细菌进行鉴定。结果：2台，／次麻醉机螺纹管检出细菌，均为洛菲不动杆菌（菌落计数〉200cfu）麻醉机呼气活瓣未检出细菌。结论：麻醉机螺纹管可能是全麻手术患者术后感染的危险因素之一。     

活性炭可有效吸附麻醉机内的吸入麻醉药

目的如果一个恶性高热易感者需要进行麻醉,就要求对先前使用过吸入麻醉药的麻醉机以高流量新鲜气流进行冲洗。关于冲洗时间,既往的研究结果各异,从10—104分钟不等。在先前提出的替代净化技术中,有研究者提出在呼吸回路吸气端安装活性炭过滤器。方法本研究中,我们将活性炭过滤器安置于几种分别受异氟烷、七氟烷和地氟烷污染的麻醉机呼吸回路的吸气和呼气两端,测出为使上述3种麻醉药浓度降至5ppm,用新鲜气流冲洗麻醉机所需要的时间。接下来我们还模拟了临床上麻醉诱导90分钟后被诊断为恶性高热的患者,评估用活性炭过滤器减少麻醉药接触的有效性。结果活性炭过滤器放置于呼吸回路的吸气端和呼气端后,使挥发性麻醉药浓度降低至低于5ppm所需要的时间小于2分钟。麻醉药的浓度可保持远低于5ppm至少60分钟。麻醉诱导后,一旦患者确诊为恶性高热,由于活性炭过滤器的存在,在吸入麻醉药浓度超过5ppm前,可使用同一麻醉机至少67分钟。结论用新鲜气流冲洗的方法清洗用过吸入麻醉药的麻醉机通常需要10—104分钟,安装活性炭过滤器给我们提供了一种取而代之的新方法。     

E-150型呼吸机常见故障及分析处理

纽邦牌微风型E-150呼吸机是一种适用婴儿、儿童及成人的通用型呼吸机.该呼吸机通过空气/氧气混合器来控制氧的浓度,使用者可选择各种通气功能,监护峰值压,平均压和基线压;并带有全面的报警系统以提醒临床医生注意各项指标是否在预置范围.本文介绍对经常遇到的问题进行分析并提供实用的排除故障程序,作为解决问题的参考.     

全自动生物组织脱水机的应用体会及常见故障

本文介绍了使用全自动组织脱水机的体会,总结了常见故障与维修方法,以及设备保养的要求.     

不同药物对大鼠心肌梗死模型的麻醉效果

目的：探讨不同麻醉剂在大鼠心肌梗死模型中的麻醉效果。方法：健康Wistar大鼠60只造模,随机分为水合氯醛组、戊巴比妥钠组、氯胺酮组、乙醚组、乙醚复合氯胺酮麻醉组,分别给药观察大鼠死亡率、麻醉状态、麻醉时间等指标。结果：乙醚组死亡率最高,水合氯醛组和乙醚复合氯胺酮麻醉组最低;复合组的麻醉状态最稳定,乙醚麻醉诱导时间114 s、持续时间284 s,、水合氯醛诱导时间422 s、持续时间6785 s。结论：水合氯醛或乙醚复合氯胺酮麻醉,诱导时间较短,持续时间适中,适合心梗造模手术。     

Use of an anesthetic cream before infiltration with local anesthesia in aesthetic surgery

The use of local anesthesia in aesthetic surgery must be provided to the patient based on its risk/benefit ratio, effective control of postoperative pain, and lower incidence of postoperative disorders. The use of a new anesthetic cream before infiltration with a local anesthetic may cause reduction or elimination of the pain provoked by the needle during the infiltration, increasing the compliance of local anesthesia. Here we describe the modalities and the advantages of using anesthetic cream.     

基于脑组织转录组整合分析探索大鼠氯胺酮的麻醉机制

目的:通过观察氯胺酮麻醉对大鼠大脑皮质转录组表达的影响,探讨其可能的麻醉机制。方法:选择5~6周龄雄性SD大鼠6只,采用完全随机法分为氯胺酮组（KET组）和对照组（Ctrl组）,每组3只。分别腹腔注射麻醉剂量氯胺酮（50 mg/kg）或等体积生理盐水后30 min,提取大脑皮质进行mRNA测序（mRNA sequenc...     

隔离阀对稳定机械通气、回路内药物浓度和气体量的意义

目的：通过对有新鲜气体隔离阀（FGE valve）的麻醉机与普通麻醉机在不同流量下的机械通气性能的比较;探讨隔离阀对稳定机械通气、回路内药物浓度和气体量的意义。方法：在两种麻醉机上分别设定相同分钟通气量（MV）及安氟醚浓度于不同新鲜气流量下测定MV、气道压力、回路内麻醉气体浓度及贮气囊气体量的变化。结果：在有隔离阀的麻醉回路中,新鲜气体流量对MV、气道压力无明显影响,回路内麻醉气体浓度相对稳定,贮气囊气体量随新鲜气体量和泄漏量变化而改变。结论：隔离阀可稳定机械通气、回路内药物浓度及贮气囊中的贮气量,可适时临测和调节回路中气体量。     

Efficacy of anesthetic agents to delay pain onset after periodontal surgery

The aim of this study was to evaluate the influence of 2 anesthetic agents on patients'' postoperative pain perception after periodontal surgery. For this parallel-group, double-blinded, randomized clinical trial, 36 open flap debridement surgeries were performed on patients who presented with periodontal disease with clinical signs of inflammation after nonsurgical treatment on at least 1 quadrant. Patients were allocated to 1 of the following groups: group 1, 2% lidocaine with 1 ∶ 100,000 epinephrine; group 2, 2% mepivacaine with 1 ∶ 100,000 norepinephrine. Pain intensity was assessed using the visual analog scale during the first 8 hours after surgery. All patients received 750-mg acetaminophen tablets, which they were instructed to take as a rescue medication if necessary. The results demonstrated that postoperative pain intensity was statistically lower in group 2 than in group 1 at the 1-, 2-, and 3-hour periods after surgery, although the pain intensity for all groups could be considered mild. In conclusion, patients in both groups reported similar mild pain after periodontal surgery.     

全麻复苏的功能神经网络研究进展

全麻复苏是全身麻醉的重要组成部分,随着神经科学在麻醉领域的深入研究,全麻复苏并非药物代谢的被动过程,其涉及脑内众多功能神经网络的主动活化和相继激活,最终促进意识恢复。然而,苏醒延迟、术后谵妄以及躁动的发生机制依旧不明,而解决此类问题的关键是充分理解全麻复苏的神经网络动态演变过程。本文结合新近研究,综述基底前脑、下丘脑、中脑腹侧被盖区、蓝斑核、乳头结节、臂旁核、中缝背核以及各核团所分泌的主要神经递质在复苏中的网络作用机制,为临床开展意识研究提供理论基础,同时为深入研究苏醒延迟、术后认知功能障碍等问题提供新思路。     

Maternal morbidity and mortality: anesthetic causes

Canadian Journal of Anesthesia/Journal canadien d'anesthésie -     

The diagnostic process and perioperative and anesthetic management of an undiagnosed congenital cyanotic cardiac defect in an adult for trauma surgery

A 39-year-old patient awaiting emergency surgery due to a crush foot injury, with an undiagnosed cyanotic cardiac lesion that was diagnosed later as a complete atrioventricular canal defect, is presented. Complete atrioventricular canal defects usually present in the first few months of life and can be fatal if not treated in the first few years. Adult patients with congenital cardiac malformations seem to be at increased risk for noncardiac surgery. The diagnostic process, perioperative management, and anesthetic implications are discussed.     

Early postoperative renal function following renal transplantation surgery: effect of anesthetic technique

Purpose. The use of continuous epidural anesthesia in patients with chronic renal failure is rare and controversial. In this study, we compared the effects of epidural versus general anesthesia on early postoperative renal function in patients who underwent renal transplantation surgery. Methods. Sixty-eight adult patients were prospectively randomized to two groups. Group 1 (n-37) received epidural anesthesia with bupivacaine and fentanyl, and group 2 (n-31) received general anesthesia with nitrous oxide and isoflurane. The patients' renal function was compared both with qualitative scintigraphic analysis (kidney perfusion, concentration, and excretion capabilities) and biochemically [serum sodium, potassium, creatinine, and blood urea nitrogen) (BUN)] within the first postoperative week. Results. Patient demographics were similar in the two groups, and the scintigraphic and biochemical evaluations were also comparable. The time of the first appearance of Tc-99m diethylene triamine pentaacetic acid (DTPA) was within normal limits in 75.7% of patients in group 1 and 61.3% of those in group 2. The number of patients with normal peak/background activity and 20 min/peak activity were 15 (40.5%) and 19 (51.4%), respectively, in group 1, and 12 (38.7%) and 15 (48.4%) in group 2 (P > 0.05 for both). The levels of serum creatinine and urea in both groups decreased within days postsurgery compared with preoperative levels (P < 0.05), but the changes were similar in the two groups (P > 0.05). A similar number of patients in both groups were treated for acute rejection (P > 0.05). Conclusion. Our results demonstrate the safe use of both anesthetic techniques in renal transplantation surgery. Received: December 25, 2000 / Accepted: November 5, 2001