七氟烷和异氟烷在老年患者全身麻醉中的应用比较

目的：比较七氟烷和异氟烷对老年患者全身麻醉手术中应激反应及术后恢复的影响。方法：选择择期老年手术40例,随机分为观察组和对照组各20例。静脉诱导气管插管后观察组吸入七氟烷维持麻醉,对照组吸入异氟烷。分别于麻醉诱导前,手术开始后10、60min及手术结束时抽取外周静脉血,测定血糖及皮质醇浓度;记录停药后1、2、3、4、5min的吸入麻醉药呼气末浓度（EA）,计算其与停药即刻的吸入麻醉药呼气末浓度（EA0）的比值,比较七氟烷或异氟烷的洗出速率,并记录2组术后睁眼时间和拔管时间。结果：各时间节点2组间血糖及皮质醇比较无显著差异;2组手术开始后60min和术毕时血糖及皮质醇均较麻醉诱导前显著升高（P〈0.05）;停药后观察组药物洗脱速率更快,睁眼、拔管时间均早于对照组（P〈0.05）。结论：老年患者全身麻醉使用七氟烷较异氟烷更易调控麻醉深度,术后恢复更快。     

瑞芬太尼复合丙泊酚麻醉在小儿扁桃体摘除术中的应用

目的探讨瑞芬太尼、丙泊酚全凭静脉麻醉与芬太尼、丙泊酚和异氟烷静吸复合麻醉在小儿扁桃体摘除术中应用的比较。方法40例ASAⅠ~Ⅱ级择期行扁桃体切除患儿,年龄2~9岁,随机分为瑞芬太尼组(Ⅰ组)与芬太尼组(Ⅱ组)。Ⅰ组麻醉诱导后持续输注瑞芬太尼和丙泊酚维持麻醉;Ⅱ组麻醉诱导单次注入芬太尼后持续输注丙泊酚、辅助吸入异氟烷维持麻醉。观察术中血流动力学变化情况,术后苏醒、拔管情况及术后躁动发生情况。结果插管、手术开始后5 min、拔管时Ⅱ组HR、MAP均高于Ⅰ组HR、MAP(P<0.01);两组患儿自主呼吸恢复时间、拔管时间、苏醒时间I组均少于Ⅱ组(P<0.01);而在术后躁动发生率中II组少于Ⅰ组(P<0.05)。结论瑞芬太尼、丙泊酚全凭静脉麻醉用于小儿扁桃体摘除手术较芬太尼、丙泊酚和异氟烷复合麻醉,围术期血流动力学更为平稳,术后苏醒迅速,而术后躁动发生率较高可能与术后疼痛相关。     

右旋美托咪啶辅助七氟烷控制性降压用于鼻内窥镜手术的可行性

目的 探讨鼻内窥镜手术中应用右旋美托咪啶辅助控制性降压的可行性.方法 择期行鼻内窥镜手术患者48例,ASA Ⅰ或Ⅱ级,随机均分为2组(n=24):对照组(Ⅰ组)和右旋美托咪啶组(Ⅱ组).两组均采用静脉注射咪达唑仑、丙泊酚、芬太尼和顺苯磺阿曲库铵麻醉诱导,麻醉维持采用丙泊酚、芬太尼、顺苯磺阿曲库铵辅以七氟烷吸入.桡动脉穿刺置管监测有创平均动脉压(MAP).Ⅰ组通过调整七氟烷的浓度施行控制性降压,Ⅱ组于麻醉诱导前15～30min内静脉泵注右旋美托咪啶0.8μg/kg,以0.4μg/(kg·h)维持,诱导后手术开始时调整七氟烷的吸人浓度,直到降至靶目标血压,维持MAP在65 ～ 75mmHg至手术结束.分别记录麻醉诱导前(T0)、控制性降压开始时(T1)、30min(T2)和拔管时(T3)的心率(HR)、MAP、血浆肾上腺素(E)和去甲肾上腺素(NE)浓度,术中抽取桡动脉血行血气分析和乳酸浓度测定.用Fromme术野质量评分法评定术野质量,同时记录丙泊酚、芬太尼和七氟烷的用量和MAC值,观察麻醉恢复情况和不良反应发生率.结果 与Ⅰ组比较,Ⅱ组丙泊酚、芬太尼、七氟烷用量和MAC值均明显减少(p＜0.01),术野质量提高,术野质量评定(SSFQ)评分明显降低(p＜0.05);与Ⅰ组比较,Ⅱ组T0-T3时点HR明显减慢;T0、T3时点MAP、E、NE明显降低(P＜0.05);两组术中的血气分析和乳酸测定结果以及苏醒时间、拔管时间均无统计学差异(p＞0.05);与Ⅰ组比较,Ⅱ组术后鼻部胀痛头痛、谵妄躁动、寒战的发生率也明显降低(p＜0.05),但Ⅱ组需要干预的心动过缓发生率较Ⅰ组高(P＜0.05),两组均无严重心血管不良事件发生.结论 右旋美托咪啶可以减少麻醉药用量,增强围术期心血管稳定性,改善麻醉恢复过程,用于辅助鼻内窥镜手术控制性降压安全、有效.     

BIS用于经鼻蝶垂体瘤切除术指导异氟烷吸入对麻醉恢复的影响

目的研究脑电双频指数(BIS)在显微镜经鼻蝶垂体瘤切除术中指导异氟烷吸入对麻醉恢复的影响。方法行显微镜经鼻蝶垂体瘤切除术患者30例,年龄18-65岁,ASAⅠ～Ⅱ级,随机分为BIS组和对照组,每组15例。所有患者采用标准麻醉诱导,术中以0.8%～3%异氟烷吸入和标准瑞芬太尼持续微量泵输注维持麻醉。BIS组术中调整异氟烷的浓度使BIS维持在40～60,对照组根据患者血流动力学调整异氟烷浓度。术中每5min记录患者BIS、吸入、呼气末异氟烷浓度等,手术结束记录自主睁眼、呼吸时间、拔管时间和达到Aldrete改良评分9～10的时间。结果与对照组相比,BIS组手术期间的BIS升高、术中异氟烷用量减少、呼气末异氟烷浓度降低,从手术结束至自主睁眼、自主呼吸和Aldrete9～10的时间缩短。结论BIS指导异氟烷吸入能减少经鼻蝶垂体瘤切除术中异氟烷用量,加快患者麻醉恢复,有利于尽早进行神经系统检查。     

七氟烷与丙泊酚用于人工流产麻醉的比较

目的观察七氟烷与丙泊酚用于人工流产的有效性和安全性。方法择期拟行人工流产术患者60例(美国麻醉医师协会病情评估分级Ⅰ~Ⅱ级),汉族,年龄(24.3±5.6)岁,体质量(60±10.5)Kg,妊娠(47.5±7.5)d,随机分为A、B两组,每组30例。A组:七氟烷复合舒芬太尼。B组:丙泊酚复合舒芬太尼。结果七氟烷组与丙泊酚组比较,七氟烷组苏醒时间明显缩短(P<0.05),患者术后满意率明显升高。结论七氟烷麻醉诱导平稳苏醒迅速,是一种用于人工流产病人安全有效的麻醉方法。     

梗阻性黄疸患者丙泊酚和七氟烷麻醉术后苏醒时间的比较

目的比较梗阻性黄疸患者丙泊酚和七氟烷麻醉术后的苏醒时间。方法60例上腹部手术患者,ASAⅠ～Ⅱ级,按血胆红素分为黄疸组和无黄疸对照组,每组30例。其中黄疸组患者均为梗阻性黄疸,血清总胆红素浓度（TBL）≥171μmol/L。再将对照组和黄疸组分别随机分为丙泊酚组和七氟烷组,每组15例。丙泊酚组为常规麻醉诱导后丙泊酚全凭静脉麻醉,维持BIS值45,术毕即停丙泊酚;七氟烷组为常规麻醉诱导后吸入1%～2%七氟烷,维持BIS值45,术毕即停吸七氟烷。同时记录从停药后至BIS值达到90的时间和唤醒时间。结果七氟烷处理的黄疸组苏醒时间长于丙泊酚处理的黄疸组,有统计学差异。丙泊酚处理的黄疸组与对照组的苏醒时间无显著差异。结论黄疸患者七氟烷麻醉苏醒时间延长,但丙泊酚对黄疸患者的苏醒时间无影响,丙泊酚可能比七氟烷适合黄疸患者麻醉。     

三种麻醉方法对老年患者术后认知功能影响的比较

目的探讨异氟烷、地氟烷以及丙泊酚维持麻醉对老年患者术后认知功能恢复的影响。方法96例老年腹部手术患者随机分配到三组,地氟烷组(D组n=32)、异氟烷组(Ⅰ组n=32)和丙泊酚组(B组n=32)。三组麻醉诱导方法相同:芬太尼2μg/kg、依托咪酯0.2mg/kg、阿曲库铵0.5mg/kg诱导插管,分别以1.3MAC的地氟烷、异氟烷和6~8mg/kg丙泊酚维持麻醉,分别观察患者术前、术后1,6,12,24,48h患者认知功能MMS值的变化。结果地氟烷组和丙泊酚组认知功能在术后1~12h三个时间点MMS值降低,24h及以后与术前无差异,异氟烷组认知功能在术后1~24h四个时间点MMS值降低,48h及以后与术前无差异。结论仅从术后认知功能的恢复方面考虑,丙泊酚和地氟烷用于老年病人麻醉较异氟烷更优。     

七氟烷吸入麻醉在脑性瘫患儿腰椎穿刺干细胞治疗中的应用

目的探讨七氟烷吸入麻醉在脑性瘫患儿腰椎穿刺干细胞治疗中的临床效果及实用性。方法选取60例年龄1～6岁行腰椎穿刺干细胞治疗的脑性瘫患儿,ASAⅠ～Ⅱ级,分成两组(n=30),七氟烷组(Ⅰ组)和氯胺酮组(Ⅱ组),观察两组诱导和苏醒时间,诱导的依从性、术中体动和苏醒期躁动的发生率。结果与Ⅱ组比较,Ⅰ组能较好地接受诱导,诱导、苏醒时间较短,术中体动及苏醒期躁动发生率较低(P<0.05)。结论七氟烷吸入麻醉具有麻醉诱导时间短,苏醒快,不良反应少,能较好地应用于脑性瘫患儿腰椎穿刺干细胞治疗。     

非气管插管静吸复合全麻在弹道碎石术中的应用

目的探讨在弹道碎石术中应用七氟烷非气管插管静脉吸入复合全麻的效果和安全性。方法 A组病人予氯胺酮诱导,氯胺酮、丙泊酚维持麻醉。B组以小剂量芬太尼、丙泊酚诱导,以2.5%的浓度七氟烷再进行吸入诱导和维持麻醉,行紧闭循环自主呼吸,两组病人均插入鼻咽通气道预防上呼吸道梗阻。结果 A组病人血压、心率明显增高,术中部分病人肢体抽动,术毕停药后20~30 m in苏醒,个别病人苏醒时间甚至更长,部分病人出现精神症状。B组病人麻醉过程平稳,血压、心率保持稳定,麻醉效果好,停药后5 m in左右即清醒,两组病人均未发生上呼吸道梗阻、胃液反流、误吸等情况。结论七氟烷非气管插管静脉吸入复合全麻是安全有效的,完全适合在弹道碎石术中应用。     

不同麻醉方法对喉返神经实时监控的影响

目的观察不同麻醉方法下对喉返神经运动肌电活动的影响.方法 48例择期甲状腺手术患者,美国麻醉医师协会体格状况分级Ⅰ～Ⅱ级,随机分成两组,每组24例,A组采用全静脉麻醉,B组采用异氟醚吸入复合丙泊酚输注;分别于手术切皮时、手术30 min、分离甲状腺、手术60 min、甲状腺次全切除时及甲状腺缝合完毕,观察血压、心率、喉返神经电刺激变化,记录麻醉药用量.结果分离甲状腺、术中60 min及甲状腺次全切除时,A组患者的血压、心率较B组明显升高(P<0.01),而喉返神经电活动两组均显示良好,监控中维持异氟醚呼气末浓度为(0.43±0.21)MAC.结论低浓度异氟醚吸入复合丙泊酚输注,既不抑制喉返神经电活动,又能有效减轻心血管应激反应.     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.