舒芬太尼靶控输注对七氟醚MAC_（BAR）影响

目的研究舒芬太尼血浆靶控输注对七氟醚手术切皮无应激反应最低肺泡浓度（MACBAR）的影响。方法40例ASAⅠ级,择期妇科手术患者随机分为舒芬太尼靶浓度（0.5 ng/ml）＋七氟醚吸入组（SS组）与七氟醚吸入对照组（S组）。采用医学序贯试验中的上-下法测定MACBAR。结果SS组手术切皮时七氟醚MACBAR为1.54%,S组为4.95%,两组比较有统计学差异（P〈0.01）。结论舒芬太尼血浆靶控输注可将手术切皮时七氟醚的MACBAR降低约69%。     

七氟醚对插管应激时心率变异性的影响

目的 :观察不同浓度的七氟醚对插管应激时心率变异性的影响。方法 :ASA I～ II级外科择期手术患者 2 3例 ,随机分为 A ,B两组。面罩吸入 1.0 vol% （A组 ）或 3.0 vol% （B组 ）七氟醚和 N2 O∶ O2 （2∶ 1）混和气进行麻醉诱导 ;气管内插管行机械通气。持续监测血流动力学指标 ,记录心电图并进行心率变异功率频谱分析 （HRV - PSA） ;抽取静脉血测定 Pc AMP及 Pc GMP。结果 :插管后 ,所有患者的血压、心率、HRV- PSA有关参数值及 Pc AMP和 Pc GMP均有所增加 （P<0 .0 5 ） ,以 A组 （1.0 vol%七氟醚 ）患者的反应较显著 （P<0 .0 5 ）。结论 :七氟醚用于麻醉诱导可有效地降低低插管所致的循环反应和自主神经反应 ,从而为临床麻醉管理提供依据。     

单纯氯胺酮、氯胺酮复合七氟醚用于小儿非气管插管全麻效果比较

目的比较单纯氯胺酮、氯胺酮复合七氟醚用于小儿非气管插管全麻的效果。方法 2～6岁符合非气管插管全麻条件的患儿60例,随机分为A、B两组,各30例。A组采用单纯氯胺酮静脉麻醉,B组采用氯胺酮静脉麻醉复合七氟醚吸入麻醉。记录两组患儿麻醉诱导期、手术切皮时及苏醒期的心率(HR)、平均动脉压(MAP)、动脉血氧饱和度(SpO2),观察两组呼吸道分泌物增多、呼吸抑制、苏醒期躁动、苏醒延迟等不良反应发生情况。结果A组麻醉诱导期、手术切皮时的HR、MAP、苏醒期躁动、呼吸道分泌物增多及苏醒期延迟发生率明显高于B组(P均<0.05)。结论氯胺酮复合七氟醚相比单纯应用氯胺酮用于小儿非气管插管全麻,麻醉药用量更小,患儿血流动力学更为稳定,能更好地抑制苏醒期躁动、苏醒延迟及呼吸道分泌物增多的发生。     

靶控输注不同剂量舒芬太尼复合依托咪酯对高龄患者气管插管反应影响的研究

目的观察靶控输注不同剂量舒芬太尼复合依托咪酯对高龄患者气管插管反应的影响。方法选择该院2014-05~2015-09收治的需行全身麻醉高龄患者48例作为研究对象,ASA分级Ⅱ~Ⅲ级,按照数字表法分为观察组和对照组两组,每组24例,观察组靶控输注0.35μg/ml舒芬太尼及依托咪酯0.5μg/ml行麻醉诱导,对照组靶控输注0.40μg/ml舒芬太尼及依托咪酯0.5μg/ml行麻醉诱导,比较两组患者诱导时血流动力学变化及不良反应发生率。结果观察组插管后即刻及插管后1 min、3 min、5 min、10 min心率及平均动脉压较对照组更为平稳(P0.05),两组诱导期脑电双频指数(BIS)值比较差异无统计学意义(P0.05)。结论靶控输注0.35μg/ml舒芬太尼及依托咪酯0.5μg/ml对高龄患者气管插管反应影响小,患者血流动力学更为稳定,具有重要临床价值。     

丙泊酚或七氟醚复合舒芬太尼在神经外科手术中的应用

目的比较靶控输注丙泊酚或吸入七氟醚复合舒芬太尼应用于神经外科手术的可行性。方法 60例ASA I~Ⅲ神经外科占位择期手术患者随机分为七氟醚组（S组）和丙泊酚组（P组）。两组复合舒芬太尼及静脉滴注阿曲库铵维持麻醉,术毕前40 min停药。所有患者麻醉诱导插管后行颅内压（ICP）监测,记录诱导后10 min（Ta）、40min（颅骨钻孔前,Tb）时的ICP,记录插管前（T1）、插管后5 min（T2）、放置头架（T3）、切皮（T4）、锯颅骨（T5）、切开硬脑膜时（T6）、拔除气管导管（T7）7个时间点的平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2）和呼气末二氧化碳分压（PetCO2）及拔除气管导管时间。结果 S组术毕拔管时间短于P组（P〈0.05）。Tb期S组ICP高于P组（P〈0.05）。与诱导前比较,两组插管后5 min HR下降（P〈0.05）,其他时点的HR、MAP、SpO2和PetCO2组间和组内比较差异均无统计学意义（P〉0.05）。结论在颅脑手术中采用七氟醚吸入或靶控输注丙泊酚复合舒芬太尼维持麻醉的方法 ,具有可控性好、血流动力学稳定和减少麻醉并发症的特点。     

不同孕酮水平的妇科腹腔镜手术患者瑞芬太尼靶控输注联合七氟醚吸入麻醉效能比较

目的 对比观察不同孕酮水平的妇科腹腔镜手术患者瑞芬太尼靶控输注联合七氟醚吸入的麻醉效能.方法 行择期全麻下妇科腹腔镜手术的患者46例,按孕酮水平分为卵泡期组23例、黄体期组23例.在持续静脉靶控输注1 ng/mL瑞芬太尼的背景下,两组采用七氟醚潮气量法吸入诱导,待患者睫毛反射消失后给予维库溴铵0.15 mg/kg,下颌...     

七氟醚吸入和丙泊酚靶控输注对老年冠心病患者全麻诱导期血流动力学及HRV的影响

老年冠心病患者心血管系统的调节能力较差,在麻醉诱导时,手术应激反应非常明显,容易发生心脑血管意外.如何使老年冠心病患者在手术过程中安全渡过麻醉关,是临床工作中的重要问题[1].七氟醚具有血/气分配系数小、麻醉诱导过程迅速、平稳、不刺激呼吸道、抑制循环系统轻微等特点,且只要术前访视告知七氟醚的特殊气味,使其做好心理准备,仍有大部分成年患者愿意选择吸入诱导,但不能忽视其对心脏的抑制作用[2,3].丙泊酚是目前应用最为广泛的静脉麻醉药,但可引起循环抑制、血压下降、丙泊酚靶控输注,能够维持适宜的麻醉深度,保持血流动力学稳定,抑制气管插管引起的应激反应[4].     

七氟醚或丙泊酚复合瑞芬太尼对妇科腹腔镜手术患者血流动力学的影响

目的比较七氟醚—瑞芬太尼、异丙酚—瑞芬太尼复合麻醉对妇科腹腔镜手术血流动力学的影响。方法选择择期行妇科腹腔镜手术患者60例,ASAⅠ～Ⅱ级,按麻醉方法不同随机分为七氟醚—瑞芬太尼组(S组)和异丙酚—瑞芬太尼组(P组),每组30例,手术前后分别抽取静脉血检测CK-MB、cTnT值,在咪达唑仑0.05～0.1mg/kg、芬太尼2～4μg/kg、维库溴铵0.1 mg/kg基础上,S组吸入七氟醚(6%～8%)+O28 L/min 2 min、P组丙泊酚2 mg/kg诱导,气管插管后行机械通气,维持PETCO235～40 mmHg。两组在持续静脉输注10μg/(kg.h)瑞芬太尼的基础上,S组复合吸2%～3%七氟醚,P组复合静脉输注丙泊酚4～6 mg/(kg.h),两组BIS值均维持在40～60。采用BioZ.com监测仪测定不同时点血流动力学指标变化,包括心率(HR)、平均动脉压(MAP)、心输出量(CO)、每搏输出量(SV)、外周血管阻力(SVR)、加速指数(ACI)、左心室射血时间(LVET)、收缩时间比率(STR)、左心做功指数(LCWI)。结果 CK-MB、cTnT在两组间及手术前后比较均无统计学差异;MAP、HR、SVR、ACI在各时点间有差别(P<0.05),两种麻醉方法间无统计学差异;SV、STR、LCWI在各时点间、两种麻醉方法间有统计学差异(P<0.05);LVET在各时点间无差异,两种麻醉方法间有统计学差异(P<0.05);CO各时点间和两种麻醉方法间均无统计学差异。气腹后两组血流动力学指标的变化趋势表现为HR、MAP、SVR、LCWI升高,STR、SV下降。结论在复合瑞芬太尼的基础上,七氟醚和异丙酚对妇科腹腔镜手术血流动力学的影响趋势一致,两种麻醉方式均可安全用于妇科腹腔镜手术。     

异丙肾上腺素对七氟醚犬心血管效应的影响

目的 :探讨异丙肾上腺素 （ISP）对七氟醚的心血管效应的影响。方法 :本实验分为七氟醚低浓度 [1.45 vol% ,0 .6 MAC（最小肺泡有效浓度 ） ]和高浓度 （2 .90 vol% ,1.2 MAC）两部分。 32只健康杂种犬被随机分为四组 （每组 8例 ） :对照组、七氟醚组、ISP组和 ISP+七氟醚组。监测有创动脉血压、肺动脉压、肺动脉楔压、中心静脉压、心输出量和心率。记录上述参数在用药 2 0 min后的变化。结果 :在硫喷妥钠麻醉犬上静脉滴注 0 .0 2 μg· kg- 1 · min- 1 的ISP和 0 .6 MAC及 1.2 MAC七氟醚的心血管效应之间均没有交互作用。结论 :ISP对临床浓度的七氟醚的心血管效应没有显著影响。     

丙泊酚靶控输注应用于老年患者ERCP的安全性探讨

目的 评价丙泊酚靶控输注在老年患者内镜逆行胰胆管造影术（ERCP）中的应用价值；探讨该类患者ERCP操作过程中麻醉的处理。方法麻醉下行ERCP患者的2081例，根据年龄分成非老年组（1025例）和老年组（1056例），比较两组问操作过程中丙泊酚靶控输注血药浓度，血压变化，氧饱和度变化及不良事件发生率的差异。结果两组患者麻醉后血压、氧饱和度、心率均有所下降，两组间差异不明显，操作时老年组丙泊酚的血药浓度更低。两组问不良事件发生率没有差异没有统计学意义。结论通过完善的术前评价和准备，高龄患者麻醉下行ERCP是安全、可行的。     

Effects of intravenous lidocaine on QTd and HRV changes due to tracheal intubation during sevoflurane induction

The aim of the present study was to evaluate the effects of IV lidocaine on autonomic cardiac function changes in tracheal intubation (TI) during sevoflurane anaesthesia by using more reliable parameters, namely, the analysis of QT dispersion and heart rate variability (HRV) from Holter monitoring. In this prospective, double-blind study, 44 American Society of Anaesthesiologists class I-II patients scheduled for hysterectomy were randomly and equally divided into 2 groups; a control sevoflurane group (group S, n = 22) and a lidocaine sevoflurane group (group LS, n = 22). Before the induction of anaesthesia, the electrocardiograms (ECG) of all patients were recorded for 3 minutes as baseline parameters. In both groups, the anaesthesia was induced with 7% sevoflurane in O(2 )at 6L min(-1) via a facemask for 2 minutes. However, before the induction of sevoflurane anaesthesia in group LS, 1 mg kg(-1) of lidocaine was given intravenously (IV). For muscle relaxation during TI, vecuronium was given to all participants. Three minutes after administration of vecuronium, TI was performed and an ECG was recorded synchronously for another 3 minutes. The results from the later records were used as postintubation parameters. Baseline and postintubation data were analysed. When compared to baseline values, postintubation LF/HF and SDNN values were increased in group S (P = 0.005, P = 0.001, respectively), whereas postintubation LF and HF values were decreased in group LS (P = 0.014, P = 0.041, respectively). Under the influence of sevoflurane anaesthesia, TI resulted in sympathetic activation. However, this activation was attenuated by the administration of IV 1 mg kg(-1) lidocaine 5 minutes prior to TI.     

颅脑手术中颅内操作期间吸入不同浓度七氟醚对脑氧及脑糖代谢的影响

目的观察颅脑手术患者行颅内操作期间应用不同浓度七氟醚联合瑞芬太尼麻醉对脑氧及脑糖代谢的影响。方法将30例颅内幕上占位患者随机分为S1组和S2组各15例。于术中切皮前10min分别予1.0、1.5MAC七氟醚联合瑞芬太尼靶控输注,于切开硬膜即刻（T0）、切开硬膜1h后（T1）、2h后（T2）、关闭硬膜即刻（T3）各个时点分别采取颈内静脉球部血及桡动脉血进行血气分析,测定颈内静脉球氧饱和度（SjvO2）、动脉—颈内静脉球氧含量差（Da-jvO2）和脑氧摄取率（COER）、脑动静脉血糖含量差（Da-jvGlu）、脑动静脉乳酸含量差（Da-jvLac）。结果与T0比较,两组T1、T2、T3时点SjvO2均明显升高（P均〈0.05）;AjvDO2、COER均明显降低（P均〈0.05）;Da-jvGlu、Da-jvLac无明显变化。结论 1.0MAC或1.5MAC七氟醚联合瑞芬太尼麻醉均能降低脑氧代谢,而对脑糖代谢无明显影响。     

老年高血压患者诱导前予右美托咪啶对插管期血流动力学的影响

目的观察右美托咪啶预注对老年高血压,尤其是未控制的老年高血压患者的全麻诱导期气管插管时血流动力学改变的影响。方法：选择未控制和控制良好拟在全麻下行择期手术的老年高血压患者各40例,ASA均为Ⅱ级。分为4组：D1组（血压控制良好组,术前规则服用降压药,血压维持在140—160／80—90mmHg,麻醉诱导前静脉滴注右美托咪啶0．7gg／kg,输注时间10min）,D2组（入院后方诊断为高血压,收缩压〉160mg,麻醉诱导前静脉滴注右美托咪啶0．7gg／kg,输注时间10min）,C1组（入选标准同D1,麻醉诱导前静脉滴注等量生理盐水）和C2组（入选标准同D：组,麻醉诱导前静脉滴注等量生理盐水）,每组各20例。分别记录人室（T0）、用药前（T1）、全麻诱导前（T2）、气管插管前（T2）、插管后即刻（T4）、插管后5min（T5）患者的肱动脉收缩压（SAP）、舒张压（DAP）、心率（HR）和脉搏血氧饱和度（SpO2）。结果：各组基本信息无统计学差异。各组在T0和T1时间点,各观察指标亦无差异俨〉O．05）。与T0相比,右美托咪啶组（Dl和D2）在T2和T3时间点SAP和HR降低（P〈0．05）,插管后（T4）血流动力学基本没有变化;C1和C2组插管后（T4）,SAP、DAP和HR较插管前（T3）上升（P〈0．05）。结论全麻诱导前静脉预注右美托咪啶,不仅能使血压控制良好的老年高血压患者全麻诱导及气管插管期间的血流动力学维持稳定,对血压未经控制的老年高血压患者同样安全有效,且有利于对老年高血压患者更好地进行围术期血流动力学管理。     

利巴韦林累积剂量对基因1型慢性丙型肝炎患者病毒学应答率的影响

目的 研究利巴韦林累积剂量对基因1型慢性丙型肝炎患者病毒学应答率的影响.方法 对哈尔滨医科大学附属第二医院感染病科进行聚乙二醇干扰素α-2a联合利巴韦林治疗的225例基因1型慢性丙型肝炎患者进行回顾性分析.根据利巴韦林累积剂量将患者分为<60%、60%～79%、80%～97%和>97%4组,探讨利巴韦林累积剂量与病毒学应答率的关系.数据行F检验或x2检验.结果 利巴韦林累积剂量≤97%的发生率为43.1% (97/225例),明显高于聚乙二醇干扰素α-2a的27.1%(61/225例)(x2=12.641,P=0.001).利巴韦林累积剂量<60%组的18例患者中,5例有持续性病毒学应答(SVR),SVR率为27.8%明显低于>97%组的65.6%(84/128例)、80%～97%组的60.5%(26/43例)和60%～79%组的58.3%(21/36例)(x2=9.538,P=0.023).利巴韦林累积剂量<60%组获得治疗结束时病毒学应答(ETVR)的13例患者中,8例复发,复发率明显高于>97%组的20.0%(21/105例)、80%～97%组的23.5%(8/34例)和60%～79%组的27.6%(8/29例)(x2=10.837,P=0.013).在获得快速病毒学应答(RVR)的患者中,利巴韦林累积剂量>97%组为25例、80%～97%组为9例、60%～79%组为7例、<60%组为4例,SVR分别为23(92.0%)、8、6和3例(x2=1.098,P=0.778).结论 轻度利巴韦林减量不影响基因1型慢性丙型肝炎患者的SVR,利巴韦林累积剂量<60%的患者复发率高,SVR率低.

Abstract：

Objective To study the impact of ribavirin cumulative dose on virological response rates in genotype 1 hepatitis C virus(HCV)infected patients.Methods The medical records of 225 genotype 1 chronic hepatitis C(CHC)patients treated with peginterferon α-2a plus ribavirin were retrospectively analyzed.These patients were divided into four groups according to ribavirin cumulative dose:>97%,80%-97%,60%-79%and<60%of standard cumulative dose.The relationship between ribavirin cumulative dose and virological response rates was studied.Data as analyzed by chisquare test or F test.Results The incidence of ribavirin cumulative dose<97%was 43.1%(97/225),which was higher than peginterferon alfa-2a(27.1%,61/225)(x2=12.641,P=0.001).The sustained virological response rate(SVR)was 27.8%(5/18)in group of ribavirin cumulative dose <60%,which was much lower than those in groups of ribavirin cumulative dose>97%(65.6%,84/128),80%-97%(60.5%,26/43),60%-79%(58.3%,21/36)(x2=9.538,P=0.023).The relapse rate was 61.5%(8/13)in group of ribavirin cumulative dose<60%,which was significantly higher than those in groups of ribavirin cumulative dose>97%(20.0%,21/105),80%-97%(23.5% ,8/34),60%-79%(27.6%,8/29)(x2=10.837,P-0.013).Among patients achieved rapid virological response(RVR),SVR in groups of ribavirin cumulative dose>97%,80%-97%,60%-79%and<60 % of standard dose were 92.0%(23/25),88.9%(8/9),85.7%(6/7)and 75.0%(3/4),respectively(x2=1.098,P=0.778).Conclusiom Mlid reduction of ribavirin dose not affect SVR of genotype 1 HCV infected patients.However,the relapse rate is high and SVR is low in patients treated with ribavirin cumulative dose<60% of standard dose.     

Effect of smaller droplet size of dornase alfa on lung function in mild cystic fibrosis

Aerosolized recombinant human DNase (dornase alfa) reduces mucus viscoelasticity in vitro and improves pulmonary function in patients with cystic fibrosis (CF). We postulated that if dornase alfa could be delivered more peripherally to small airways in the lung in the form of smaller aerosol droplets in patients with early airway obstruction, the increase in pulmonary function from baseline might be improved. CF patients (n = 749) with mild lung disease (baseline forced vital capacity <*geq>70% predicted) were randomly assigned to receive dornase alfa 2.5 mg daily for 2 weeks by one of two nebulizer systems: 1) the Medic-Aid Durable SideStream nebulizer powered by the MobilAire Compressor (SS/MA) producing a droplet size with a mass median aerodynamic diameter (MMAD) of 2.1 μm; or 2) the Hudson T Up-draft nebulizer with a DeVilbiss Pulmo-Aide compressor (HT/PA) with an MMAD of 4.9 μm. Spirometry was performed at baseline and following 14 days of treatment. Dornase alfa delivered by both nebulizer systems produced small but statistically significant improvements in pulmonary function compared with baseline. There was a trend (P = 0.06) toward greater improvement in forced expiratory flow in 1 s in the SS/MA group (4.3%) compared with the HT/PA group (2.5%). These results indicate that the short-term spirometric response to dornase alfa is influenced in part by the physical characteristics of the aerosol in patients with mild lung disease. We speculate that this may be true for other therapeutic aerosols, and it appears that localization of disease in the lung plays a role in the response to inhaled agents. Pediatr. Pulmonol. 1998; 25:83–87. © 1998 Wiley-Liss, Inc.     

乌司他丁量效关系对心肌保护作用影响的实验研究

目的:探讨乌司他丁(UTI)量效关系对心肌保护作用的影响及其可能机制。方法:腹腔注射阿霉素制作大鼠扩张型心肌病动物模型,40只SD扩张型心肌病模型大鼠被随机均分为空白对照组(给予生理盐水)、低剂量组(UTI 10000U/kg)、中等剂量组(UTI 30000U/kg)、高剂量组(UTI 60000U/kg),连续给药2周,实验前后分别行心脏超声检查,测定左室内径、左室射血分数(LVEF),以黄嘌呤氧化酶法测定血浆超氧化物歧化酶(SOD)水平,氯胺T氧化法测定心肌局部组织羟脯氨酸(Hyp)含量,评估心肌间质纤维化程度。结果:与空白对照组、低和中等剂量组相比,高剂量组治疗后LVEF[(32.49±1.29)%、(53.22±2.13)%、(56.91±2.04)%比(62.61±2.37)%]、SOD水平[(4.06±0.71)U/ml、(5.25±0.18)U/ml、(5.79±0.69)U/ml比(6.96±0.77)U/ml]明显升高(P均<0.05);左室舒张末期内径[LVEDd,(1.53±0.13)mm、(1.21±0.02)mm、(1.21±0.09)mm比(1.01±0.01)mm]明显减小、心肌局部组织Hyp含量[(40.16±2.31)μg/mg、(34.24±1.98)μg/mg、(22.79±1.69)μg/mg比(19.84±1.47)μg/mg]明显降低(P均<0.05)。与空白对照组比较,UTI低、中、高剂量组左室收缩末期内径[LVESd,(1.23±0.02)mm、(0.98±0.04)mm、(0.98±0.12)mm比(0.99±0.03)mm]显著减小(P均<0.05)。结论:大剂量乌司他丁心肌保护作用更好,原因可能与抑制心室重塑、拮抗氧自由基有关。     

Effect of nitroglycerin ointment on the clinical and hemodynamic response to exercise

The effects of nitroglycerin ointment (15 mg nitroglycerin) on hemodynamics at rest and during exercise were studied in 12 patients with coronary artery disease and exertional angina (angina group) and in 8 patients with normal coronary arteriograms or with nonsignificant arteriographic abnormalities who did not have exertional chest pain (nonangina group). In both groups at rest nitroglycerin ointment induced within 15 minutes a significant decrease in left ventricular end-diastolic pressure that was sustained for at least 60 minutes; systemic arterial pressure also decreased within 15 minutes and continued to decrease during the 60 minutes of observation. By 30 to 60 minutes there were significant decreases in cardiac index, stroke index, left ventricular stroke work index and tension-time index.During exercise performed 60 minutes after receiving nitroglycerin ointment, 10 of the 12 patients in the angina group had no pain, whereas 2 had delayed and less severe symptoms. Hemodynamic observations during this exercise period revealed significant decreases in left ventricular end-diastolic pressure, systemic pressure and tension-time index from values in the initial exercise period; heart rate remained unchanged. These data document the protective effect of nitroglycerin ointment for a period of at least 60 minutes and also suggest that the beneficial effects are related to a reduction in myocardial oxygen requirements.