七氟醚复合瑞芬太尼在烧伤患者手术中的临床应用

目的评价七氟醚复合瑞芬太尼在烧伤患者手术中的临床应用效果。方法选择本院2016年6月至2017年6月择期行烧伤整形植皮手术的患者,性别不限,年龄19~53岁,ASA分级Ⅰ~Ⅱ级。采用随机数字表将患者分为七氟醚+瑞芬太尼组(T组)和丙泊酚+瑞芬太尼组(C组),每组各100例。T组患者吸入6%七氟醚联合顺阿曲库铵0.1mg/kg进行麻醉诱导。采用0.75~1.25MAC七氟醚联合瑞芬太尼0.05~0.15μg/kg/min、间断注射顺阿曲库铵进行麻醉维持。C组患者采用咪达唑仑0.05mg/kg、丙泊酚1~2mg/kg、顺阿曲库铵0.15mg/kg、瑞芬太尼1μg/kg进行麻醉诱导,以丙泊酚4~12mg/kg/h、瑞芬太尼0.05~0.15μg/kg/min、间断注射顺阿曲库铵进行麻醉维持。记录两组患者麻醉诱导前(T_0)、气管插管时(T_1)、手术开始即刻(T_2)、手术开始后30分钟(T_3)、术毕即刻(T_4)的收缩压(SBP)、舒张压(DBP)及心率(HR)。记录两组患者睁眼时间、拔管时间、术中低血压、PONV、寒战、苏醒期躁动发生情况。结果在T_2、T_3、T_4时点,C组患者SBP、DBP、HR均显著低于T组患者,差异有统计学意义(P0.05)。两组患者睁眼时间、拔管时间差异无统计学意义(P0.05)。C组患者术中低血压发生率显著低于T组,差异有统计学意义(P0.05)。但两组患者PONV、术后寒战、苏醒期躁动发生率差异无统计学意义(P0.05)。结论与丙泊酚复合瑞芬太尼相比,七氟醚复合瑞芬太尼能够有效维持术中血流动力学稳定,降低术中低血压的发生风险。     

七氟醚复合瑞芬太尼在小儿扁桃体手术中的应用

目的分析七氟醚复合瑞芬太尼在小儿扁桃体手术中的应用效果。方法将择期行扁桃体手术治疗的100例患儿随机分为2组,每组50例。观察组采用七氟醚复合瑞芬太尼麻醉,对照组给予丙泊酚复合瑞芬太尼麻醉。观察2组患儿麻醉前(T_0)、拔管后5 min(T_1)、手术开始后5 min(T_2)、插管后5 min(T_3)各时间点SBP、DBP、HR的变化和自主呼吸恢复时间、苏醒时间、气管拔管时间及不良反应发生率。结果 2组患儿T_0和T_3时间点SBP、DBP、HR比较,差异无统计学意义(P0.05)。观察组在T_1、T_2的HR、SBP与T_0、T_3比较,波动较小,差异无统计学意义(P0.05)。对照组T_1、T_2SBP、DBP、HR与T_0、T_3比较,波动较大,差异有统计学意义(P0.05)。观察组术后自主呼吸恢复时间、苏醒时间和气管拔管时间均显著短于对照组,差异有统计学意义(P0.05)。2组患儿均未出现呼吸抑制、心律失常、喉水肿等不良反应。结论小儿扁桃体手术中采用七氟醚复合瑞芬太尼麻醉,术中血流动力学平稳,麻醉恢复时间短,不良反应发生率无明显增加,安全性高。     

七氟醚与丙泊酚对腹腔镜子宫全切除患者术中C肽、胰岛素及血糖水平的影响

目的探讨七氟醚与丙泊酚对腹腔镜子宫全切除术患者术中C肽、胰岛素及血糖水平的影响。方法随机将62例丙泊酚、舒芬太尼、罗库溴铵麻醉诱导下接受腹腔镜子宫全切除术的患者分为2组,每组31例。诱导后七氟醚组以吸入七氟醚维持麻醉,丙泊酚组以靶控输注丙泊酚维持麻醉。术中控制BIS值40~55。分别测定2组诱导前(T_0)、手术开始时(T_1)、完成手术时(T_2)的C肽、皮质醇、胰岛素、血糖水平及术后不良反应。结果 T_0时间点,2组C肽、皮质醇、胰岛素、血糖水平差异无统计学意义(P0.05)。T_1、T_2时间点,七氟醚组C肽、胰岛素水平明显低于丙泊酚组,且皮质醇、血糖水平明显高于丙泊酚组,差异有统计学意义(P0.05)。2组术后不良反应发生率差异无统计学意义(P0.05)。结论腹腔镜子宫全切除术中应用丙泊酚维持麻醉,可有效促进胰岛素及C肽大量分泌,抑制胰高血糖素及皮质醇分泌,降低术中血糖水平,且不良反应无明显增加。     

七氟醚与丙泊酚对冠心病患者行非心脏手术心肌的影响

目的 比较冠心病患者行非心脏手术时七氟醚与丙泊酚对心肌的影响.方法 40例心功能Ⅰ或Ⅱ级择期行上腹部手术的冠心病患者随机分为丙泊酚组(PR组)与七氟醚组(SE组).PR组丙泊酚靶控输注血药浓度维持在2～3μg/ml,SE组呼气末七氟醚浓度维持在2%～3%,连续监测血流动力学及ECC变化,检测麻醉前与术毕血清白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)、心肌钙蛋白(cTnI)及糖原磷酸化酶BB(GP-BB)浓度.结果 术毕PR组血清IL-6、TNF-α、cTnI及GP-BB浓度明显高于麻醉前及SE组(P＜0.05).结论 冠心病行非心脏手术时七氟醚对心肌的保护效应优于丙泊酚.     

七氟醚对老年冠心病患者胃癌根治术的心肌保护作用

目的比较老年冠心病患者胃癌根治术中七氟醚和丙泊酚麻醉的心肌保护作用。方法择期行胃癌根治手术患者40例,ASAⅡ或Ⅲ级,年龄65～85岁,随机均分为丙泊酚复合瑞芬太尼组(P组)和七氟醚复合瑞芬太尼组(S组)。记录术中血管活性药物使用情况。分别于术前、术后即刻、术后6、12、24h抽取中心静脉血测定血清心肌肌钙蛋白I(cTnI)和肌酸激酶同工酶(CK-MB)浓度。结果两组血管活性药物使用情况差异无统计学意义。术后6、12、24hS组CK-MB、cTnI浓度明显低于P组(P<0.05)。结论七氟醚复合瑞芬太尼比丙泊酚复合瑞芬太尼麻醉对老年冠心病患者行胃癌根治术具有更好的心肌保护效果。     

七氟醚和丙泊酚对腹腔镜下行子宫肌瘤切除术患者胰岛功能的影响

目的探讨七氟醚和丙泊酚对腹腔镜下行子宫肌瘤切除术患者胰岛功能的影响。方法选择择期行腹腔镜下子宫肌瘤切除术患者40例,年龄40~55岁,ASAⅠ或Ⅱ级,随机数字表法分为七氟醚组(S组)和丙泊酚组(P组),每组20例。所有患者采用丙泊酚2 mg/kg、舒芬太尼0.5μg/kg、罗库溴铵0.9mg/kg常规麻醉诱导,麻醉维持:S组吸入麻醉维持七氟醚MAC 0.7~1.3,P组靶控输注丙泊酚维持其血浆靶浓度为2.0~5.0μg/ml。术中控制BIS值在40~55,分别检测诱导前(T_0)、手术开始时(T_1)、手术结束时(T_2)的血糖、胰岛素、C肽、胰高血糖素、皮质醇浓度。结果与T0时比较,T_1、T_2时两组患者血糖、胰岛素、C肽、胰高血糖素、皮质醇明显升高(P0.05);与T_1时比较,T_2时两组患者血糖、胰岛素、C肽、胰高血糖素、皮质醇明显升高(P0.05)。T_1、T_2时P组血糖、胰高血糖素、皮质醇明显低于S组(P0.05),胰岛素明显高于S组(P0.05)。结论与七氟醚比较,丙泊酚更能促进胰岛素和C肽的分泌,抑制皮质醇和胰高血糖素的分泌,抑制术中血糖的升高。     

七氟醚与丙泊酚对肺癌单肺通气下肺叶切除患者血流动力学的影响研究

目的探析七氟醚与丙泊酚对肺癌单肺通气下肺叶切除患者血流动力学的影响。方法选择2015-06—2017-12间新乡市中心医院接受单肺通气下行肺叶切除术的100例肺癌患者,随机分为2组,各50例。对照组给予丙泊酚靶控输注麻醉诱导、丙泊酚和芬太尼麻醉维持。观察组给予吸入七氟醚预处理后,行与对照组一致的麻醉诱导和麻醉维持。比较2组患者麻醉诱导前即刻(T_0)、单肺通气开始前即刻(T_1)、手术后30 min(T_2)、手术后60 min(T_3)、单肺通气结束前即刻(T_4)、手术结束关胸后即刻(T_5)、术后24 h(T_6)的血流动力学指标。结果 2组患者T0的各个指标差异无统计学意义(P0.05);T_1~T_6点2组患者MAP和CVP均较T0有较大波动,且观察组患者的MAP均明显高于对照组,CVP明显低于对照组,差异有统计学意义(P0.05);T_0~T_6点2组CO比较,差异均无统计学意义(P0.05);术后2 h,观察组的肺氧合指数高于对照组,差异有统计学意义(P0.05)。结论肺癌患者单肺通气下肺叶切除术的麻醉中给予七氟醚预处理,有助于维持术中血流动力学的平稳,保证手术顺利进行,减轻肺损伤,促进术后康复。     

丙泊酚与七氟醚对结直肠癌根治术患者缺氧诱导因子-1水平的影响

探讨丙泊酚与七氟醚对结直肠癌根治术患者围手术期血清缺氧诱导因子-1（hypoxia inducible factor-1, HIF-1）的影响。 方法 选择符合纳入标准结直肠癌根治术患者40例,采用随机数字表法分为两组：丙泊酚组（P组）和七氟醚组（S组）,每组20例。P组采用全凭静脉全身麻醉,常规静脉诱导,靶控输注（target-controlled infusion, TCI）丙泊酚,术中维持：瑞芬太尼TCI、丙泊酚TCI。S组采用静吸复合全身麻醉,常规静脉诱导,术中维持：瑞芬太尼TCI、七氟醚吸入。于麻醉前30 min（T0）、手术结束即刻（T1）、术后24 h（T2）时采集患者颈内静脉血样4 ml,采用双抗体夹心ELISA法检测HIF-1血清浓度。 结果 P组T1时点HIF-1浓度小于T0时点,差异有统计学意义（P＜0.05）。S组T1时点HIF-1浓度大于T0时点,差异有统计学意义（P＜0.05）。与P组比较,S组T1时点HIF-1浓度升高（P＜0.05）。 结论 丙泊酚可以使结直肠癌患者血清HIF？蛳1的浓度降低,而七氟醚上调其表达水平,提示丙泊酚更适用于此类患者,对肿瘤后期治疗及康复有意义。     

七氟醚复合瑞芬太尼麻醉用于小儿扁桃体切除术的效果

目的观察七氟醚复合瑞芬太尼麻醉用于小儿扁桃体切除术的效果。方法选取2017-01—2018-06间在郑州二砂医院接受气管插管全麻下扁桃体切除术的86例患儿,依据不同麻醉用药分为2组,各43例。对照组应用丙泊酚,观察组采用七氟醚复合瑞芬太尼。比较2组麻醉前(T_0)、插管后5 min(T_1)、手术开始后5 min(T_2)及拔管时(T_3)患儿的平均动脉压(MAP)、HR(心率)、指氧饱和度(SpO_2)的水平,以及术后恢复自主呼吸时间、意识恢复时间、拔管时间和不良反应。结果 2组患儿T_0和T_3时点的MAP、HR和各时点SpO_2比较,差异均无统计学意义(P0.05)。观察组T_1～T_3时间点的MAP、HR波动幅度小于对照组,差异有统计学意义(P0.05)。观察组患儿术后恢复自主呼吸和意识时间及拔管时间均显著短于对照组,差异有统计学意义(P0.05)。2组患儿均无心律失常、呼吸抑制等不良反应。结论七氟醚复合瑞芬太尼麻醉用于小儿扁桃体切除术,围术期易于控制麻醉深度,且血流动力学波动小,不良反应少,术后苏醒质量肯定。     

七氟醚预处理对高原地区肝包虫手术肝缺血-再灌注损伤的作用

目的探讨七氟醚预处理对减轻高原地区肝包虫患者缺血-再灌注损伤的作用,进而为肝包虫病手术中合理用药提供理论依据。方法选取2017年9月至2018年7月本院收治的泡型肝包虫手术患者50例,男27例,女23例,年龄22～68岁,体重40～90 kg,ASAⅠ或Ⅱ级,Child-Pugh分级A级。随机分为七氟醚预处理组(SEV组)与对照组(TIVA组)。SEV组持续性吸入2%的七氟醚,于手术结束前30 min停止。TIVA组给予全凭静脉麻醉,采用瑞芬太尼0.2μg·kg~(-1)·min~(-1)和丙泊酚1.5～2.5μg/ml靶控输注,间接追加顺式阿曲库铵。记录麻醉诱导前(T_0)、肝门阻断(T_1)、肝门开放(T_2)、缺血-再灌注1 h(T_3)、6 h(T_4)、24 h(T_5)两组患者ALT、AST、乳酸(Lac)、肿瘤坏死因子-α(TNF-α)、白细胞介素-1(IL-1)浓度,检测肝组织丙二醛(MDA)、超氧化物歧化酶(SOD)活性和NF-κB、ICAM-1蛋白相对含量,观察两组患者术中出血量、拔管时间、下床活动时间、术后住院时间、肝衰竭发生等情况。结果 T_2—T_5时,SEV组ALT、AST、Lac、MDA、TNF-α、IL-1明显低于TIVA组(P0.05),NF-κB和ICAM-1蛋白相对含量明显低于TIVA组(P0.05),SOD活性明显强于TIVA组(P0.05)。SEV组患者术中出血量明显少于TIVA组(P0.05),术后住院时间、下床活动时间明显短于TIVA组(P0.05),肝衰竭发生率明显低于TIVA组(P0.05)。结论七氟醚预处理可减轻高原地区肝包虫手术肝缺血-再灌注损伤,可能与减少炎性因子生成、增强肝脏自由基清除能力有关。     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.