雷米芬太尼对全麻患者气管插管期平均动脉压、心率和QTc间期延长的影响

目的 观察和评价雷米芬太尼对全麻患者气管插管期平均动脉压(MAP)、心率和QTc间期的影响.方法 选取择期全麻手术患者75例,ASA分级Ⅰ～Ⅱ级,按随机数字表法分为三组:对照组(C组)、雷米芬太尼Ⅰ组(R1组)和雷米芬太尼Ⅱ组(R2组),每组25例.麻醉诱导:静脉注射芬太尼3μg/kg、普鲁泊福1.0～1.5 mg/kg和维库溴铵0.1 mg/kg后2 min,双盲法≥40 s给予雷米芬太尼0.50 μg/kg(R1组)或0.75μg/kg(R2组)后,两组分别连续输注雷米芬太尼0.10μg/(kg·min);C组患者给予相同容量的0.9%氯化钠.记录麻醉诱导前(T0)、诱导后2 min(T1)、首次给予雷米芬太尼或0.9%氯化钠后1 min(T2)、气管插管前即刻(T3)及气管插管后30 s(T4)、2 min(T5)和4 min(T6)的MAP和心率,并描记心电图.结果 与C组比较,R2组T4～T6时QTc间期明显缩短(P＜0.05或＜0.01＝;R,组T4和C组T4～T6时QTc间期较T0明显延长(P＜0.05或＜0.01).C组气管插管期OTc间期＞440ms 11例(44%,11/25),R2组3例(12%,3/25),两组比较差异有统计学意义(P＜0.05).结论 芬太尼和普鲁泊福麻醉诱导气管插管期间患者的QTc间期是延长的;插管前1 min静脉注射雷米芬太尼0.75μg/kg,继以0.10 μg/(kg·min)输注可有效抑制气管插管诱发QTc间期延长和血流动力学反应.

Abstract：

Objective To evaluate the effect of remifentanil on mean arterial pressure (MAP), heart rate (HR) and QTc interval during tracheal intubation of general anesthesia patients. Methods Seventy-five ASA Ⅰ -Ⅱ grade patients were selected and allocated to receive either saline (group C), remifentanil 0.50 μg/kg (group R1) or remifentanil 0.75 μg/kg(group R2) by random digits table with 25 cases in each, they were administrated as a bolus intravenous, followed by a continuous infusion at 0.10 μg/ (kg·min), 1 min before laryngoscopy. All patients received fentanyl 3 μg/kg,propofol 1.0 - 1.5 mg/kg and vecuronium 0.1 mg/kg. The ECG.MAP and HR were recorded prior to induction of anesthesia (T0), 2 min following the start of drug intravenous of fentanyl and propofol with vecuronium (T1), 1 min following remifentanil or saline (T2), before laryngoscopy(T3), 30 s (T4), 2 min (T5) and 4 min (T6) after intubation. Results The QTc interval was significantly prolonged immediately following intubation in group C and group R1, but it remained stable in group R2, compared with the QTc interval just before laryngoscopy. In group R2, QTc interval was significantly shorter at T4-T6 compared to group C(P＜ 0.05 or ＜ 0.01). QTc interval significantly increased from baseline at T4 in group R1 and T4-T6 in group C (P＜ 0.05 or ＜ 0.01). The number of patients with QTc interval ＞ 440 ms were significantly greater immediately following tracheal intubation in group C than that in group R2 [44% (11/25) vs. 12% (3/25)] (P ＜ 0.05). Conclusions QTc interval increases following tracheal intubation during induction of anesthesia using fentanyl and propofol. Intravenous of remifentanil attenuates the QTc interval prolongation associated with tracheal intubation. In addition, remifentanil decreases the hemodynamic responses to tracheal intubation.     

纤维支气管镜引导经鼻插管与喉镜明视插管对血流动力学和血氧饱和度的影响

目的 探讨纤维支气管镜(FOB)引导下经鼻气管插管与喉镜明视气管插管对血流动力学和动脉血氧饱和度(SaO2)的影响.方法 将61例行气管插管机械通气的患者按随机数字表法分为观察组(31例)和对照组(30例),分别采用FOB引导下经鼻气管插管和喉镜明视气管插管,测定并记录两组患者在插管前1 min、插管即刻、插管后5 min的收缩压(SBP)、舒张压(DBP)、心率(HR)以及SaO2.结果 两组患者气管插管操作均获得成功,其中观察组用时(35.2±12.5)s,对照组用时(38.7±13.6)s,两组气管插管时间比较差异无统计学意义(P＞0.05).两组患者在插管即刻的SBP、DBP和HR均较插管前1 min显著升高,SaO2则显著下降,而且观察组上述指标的变化幅度均显著小于对照组(P＜0.05).结论 FOB引导下经鼻气管插管对患者血流动力学及SaO2的影响较小,是一种比较安全的气管插管方法,值得临床推广应用.

Abstract：

Objective To investigate the effect of nasal intubation guided by fiberoptic bronchoscope (FOB) and intubation guided by laryngoscope on hemodynamics and arterial oxygen saturation (SaO2).Methods Sixty-one patients received tracheal intubation for mechanical ventilation were divided into observation group (31 cases) and control group (30 cases) by random digits table who received FOB guided nasotracheal intubation and laryngoscope intubation respectively, the systolic blood pressure (SBP),diastolic blood pressure (DBP), heart rate (HR) and SaO2 of all patients in two groups was measured and recorded 1 min before intubation, the intubation moment and 5 min after intubation. Results Patients in two groups were successfully intubated. The average time in observation group was (35.2 ± 12.5) s and in control group was (38.7 ± 13.6) s, and there was no significant difference between two groups (P ＞ 0.05);SBP, DBP and HR of two groups at the intubation moment increased significantly than that at 1 min before intubation, while SaO2 decreased significantly, and the rangeability of above indexes in observation group were significantly lower than those in control group, there were significant differences between two groups (P ＜ 0.05). Conclusion FOB guided nasotracheal intubation has little effect on hemodynamics and blood SaO2, it is a safe method of endotracheal intubation and worthy of clinical application.     

剖宫产时缩宫素对产妇Tp-e和QTc间期的影响

目的 观察和评价脊麻剖宫产时缩宫素对健康产妇Tp-e和QTc间期的影响.方法 ASA分级Ⅰ级择期剖宫产产妇40例,按随机数字表法分为缩宫素静脉推注组(静推组)和缩宫素静脉微泵组(微泵组),每组20例.在胎儿娩出后静推组55～60s静脉单次推注5%葡萄糖5ml+5 U缩宫素,微泵组10 min内静脉匀速泵注完5%葡萄糖20 ml+5 U缩宫素.记录并比较术前与脊麻后1、3、5 min,应用缩宫素后1、3、5、10min的QTc间期、Tp-e间期、平均动脉压(MAP)和心率.结果 静推组在应用缩宫素后1 min较术前心率明显增快[(89±13)次/min比(73±12)次/min],MAP显著降低[(69±12)mm Hg(1 mm Hg=0.133 kPa)比(82±13)mm Hg]和QTc间期明显延长[(426±21)ms比(405±18)ms](P＜0.01);而在应用缩宫素后1、3、5min时Tp-e间期均较术前延长(P＜0.01或＜0.05).结论 单次较大剂量(5 U)缩宫素静脉快速推注可延长健康产妇的QTc和Tp-e间期;而Tp-e间期的延长可能更准确预测室性心律失常的发生.在处理QT间期延长综合征产妇脊麻剖宫产时,缩宫素的使用方式应慎重考虑.

Abstract：

Objective To evaluate the effect of oxytocin on Tp-e and QTc interval during caesarean section under spinal anesthesia in healthy puerperas. Methods Forty ASA Ⅰ puerperas were selected and allocated to receive oxytocin intravenous bolus group (group-IB) or oxytocin continuous infusion group (group-CI) with 20 puerperas in each by random digits table. An intravenous bolus of 5% glucose 5 ml and 5 U oxytocin was administered after delivery a 55-60 s period. A continuous infusion of 5% glucose 5 ml and 5U oxytocin was administered after delivery a 10 min period. Measured the QTc interval,Tp-e interval,mean arterial pressure (MAP) and beart rate ( HR ) pre-operatively, then 1,3 and 5 ain after spinal anesthesia, and at least 1,3,5 and 10 min after oxytocin injection. Results In group-IB:HR was fast 1 min after oxytocin injection compared with pre-operatively [(89 ± 13) beats/min vs. (73 ± 12) beats/min] ,MAP was decreased [(69 ± 12 ) mm Hg ( 1 mm Hg= 0. 133 kPa ) vs. ( 82 ± 13 ) mm Hg] and QTc interval was prolonged [(426 ±21 ) ms vs. (405 ± 18 ) ms] (P ＜ 0.01 ); but Tp-e interval was prolonged 1,3,5 min after oxytocin injection compared with pre-operatively (P ＜ 0.01 or ＜ 0.05 ). Conclusions Single large dose of oxytocin intravenous bolus (5 U) can prolong QTc interval and Tp-e interval in healthy puerperas, and Tp-e interval can exact predict the occurrence of ventricular arrhythmias. The risk-benefit balance of oxytocin bolus during caesarean delivery should be discussed with women with a history of long QT syndrome.     

剖宫产手术SLIPA通气道和气管插管的效果比较

目的探讨SLIPA通气道用于剖宫产手术全麻的安全性和可行性。方法足月单胎妊娠行剖宫产手术产妇50例,随机分为SLIPA组（S组）和气管插管组（T组）,每组各25例。观察插管前后、拔管前后各时间点的平均动脉压（MAP）、心率、呼气末二氧化碳分压（PETCO2）、气道峰压（Paw）的变化;观察插管或置入SLIPA通气道时、拔除前后及术中是否出现呛咳、体动、反流、呕吐、误吸等情况。分别在两组产妇胎儿娩出时抽取脐动、静脉血,进行血气分析。记录两组麻醉诱导至胎儿娩出时间（I-D）、手术时间、新生儿1min和5min Apgar评分。结果S组首次置管成功率为100％,T组有2例再次插管后成功。术中S组有3例出现轻度漏气,不影响呼吸管理。S组心率、MAP比较平稳,插管后2min和拔管后2min与T组比较差异均有统计学意义（P〈0．05）。两组产妇术中均未发生体动、呛咳、呕吐、反流、误吸;但拔管时,T组有17例发生呛咳、体动,术后2、24h咽痛发生例数T组分别为10例和6例,而S组均无拔管反应和术后咽痛,两组比较差异均有统计学意义（P〈0．05）。两组I—D、新生儿1min和5min Apgar评分比较,差异均无统计学意义（P〉0．05）。两组新生儿脐动、静脉血pH值、CO2分压、氧分压比较,差异均无统计学意义（P〉0．05）。结论SLIPA通气道较气管插管对母婴生理功能影响小,术后并发症少,可安全用于剖宫产手术麻醉。     

帕瑞昔布钠与芬太尼对预防雷米芬太尼静脉全麻苏醒期躁动的比较

目的探讨和比较帕瑞昔布钠与芬太尼在预防妇科腹腔镜手术雷米芬太尼复合丙泊酚静脉全麻苏醒期躁动的有效性和安全性。方法择期妇科腹腔镜手术患者150例,ASAⅠ～Ⅱ级,随机分为A、B、C三组,每组50例。三组麻醉方案相同,A组（n=50）全麻诱导前20 min静注帕瑞昔布钠40 mg;B组（n=50）术毕前20 min静注芬太尼1μg/kg;C组（n=50）术毕前20 min静注生理盐水10 ml,记录术毕至拔管所用时间、拔管期间不良事件,评定苏醒躁动程度（RS）、拔管后疼痛程度（VAS）和镇静程度（RASS）。结果 A、B组苏醒期RS评分及VAS评分均显著低于C组（P〈0.05）,RASS评分显著高于C组,（P〈0.05）,A、B组无统计学差异。与A、C组比较,B组患者自主呼吸恢复时间、意识恢复时间及拔管时间有所延长,差异有统计学意义（P〈0.05）。结论超前应用帕瑞昔布钠可有效预防雷米芬太尼复合丙泊酚全麻中苏醒期躁动的发生,其效果与芬太尼比较无统计学差异,同时减少因使用阿片类镇痛药而发生的恶心、呕吐、苏醒延迟、呼吸抑制等副作用。     

舒芬太尼和芬太尼对气管插管患者血流动力学的影响

目的 观察舒芬太尼、芬太尼对手术患者气管插管时血流动力学的影响.方法 选择100例择期全身麻醉手术患者,按随机数字表法分为舒芬太尼组和芬太尼组,每组50例.分别记录两组麻醉诱导前(T0)、诱导后(T1)及气管插管即刻(T2)、3 min(T3)、5 min(T4)、7 min(T5)的收缩压、舒张压、心率.结果 舒芬太尼组和芬太尼组T1时收缩压、舒张压、心率明显低于T0时[舒芬太尼组:(103±10) mm Hg(1 mm Hg=0.133 kPa)比(123±18) mm Hg、(56±10) mm Hg比(75±18)mm Hg、(65±5)次/min比(80±11)次/min,芬太尼组:(105±8)mmHg比(130±15)mmHg、(52±8) mm Hg比(73±16) mm Hg、(73±9)次/min比(84±7)次/min,P＜0.01];T2～T5时舒芬太尼组收缩压、舒张压、心率明显少于芬太尼组[T2:(106±8)mm Hg比(158±14) mm Hg、(58±10) mm Hg比(98±13) mm Hg、(72±5)次/min比(95±13)次/min,T3:(108±15) mm Hg比(150±8)mm Hg、(54±6) mm Hg比(90±10) mm Hg、(73±5)次/min比(94±12)次/min,T4:(104±11) mm Hg比(128±15) mm Hg、(56±4) mm Hg比(85±12) mm Hg、(73±5)次/min 比(70±11)次/min,T5:(100±11) mm Hg比(120±13) mm Hg、(57±11) mm Hg比(76±13) mm Hg、(65±8)次/min比(84±13)次/min,P＜0.01].结论 舒芬太尼和芬太尼对手术患者气管插管时引起的血流动力学波动均有抑制作用,但舒芬太尼能更好地维持循环系统稳定,显示更强的优势,用于手术患者是安全可靠的.     

剖宫产手术SLIPA通气道和气管插管的效果比较

目的 探讨SLIPA通气道用于剖宫产手术全麻的安全性和可行性.方法 足月单胎妊娠行剖宫产手术产妇50例,随机分为SLIPA组(S组)和气管插管组(T组),每组各25例.观察插管前后、拔管前后各时间点的平均动脉压(MAP)、心率、呼气末二氧化碳分压(P_(ET)CO_2)、气道峰压(Paw)的变化;观察插管或置入SLIPA通气道时、拔除前后及术中是否出现呛咳、体动、反流、呕吐、误吸等情况.分别在两组产妇胎儿娩出时抽取脐动、静脉血,进行血气分析.记录两组麻醉诱导至胎儿娩出时间(I-D)、手术时间、新生儿1 min和5 min Apgar评分.结果 S组首次置管成功率为100%,T组有2例再次插管后成功.术中S组有3例出现轻度漏气,不影响呼吸管理.S组心率、MAP比较平稳,插管后2min和拔管后2min与T组比较差异均有统计学意义(P<0.05).两组产妇术中均未发生体动、呛咳、呕吐、反流、误吸;但拔管时,T组有17例发生呛咳、体动,术后2、24 h咽痛发生例数T组分别为10例和6例,而S组均无拔管反应和术后咽痛,两组比较差异均有统计学意义(P<0.05).两组I-D、新生儿1 min和5 min Apgar评分比较,差异均无统计学意义(P>0.05).两组新生儿脐动、静脉血pH值、CO2分压、氧分压比较,差异均无统计学意义(P>0.05.结论 SLIPA通气道较气管插管对母婴生理功能影响小,术后并发症少,可安全用于剖宫产手术麻醉.     

弹性插管探条在异常气道患者手术后气管拔管处理中的应用

目的 总结弹性插管探条在异常气道患者手术后气管拔管处理中的临床经验.方法 18例异常气道患者中,12例行下颌骨肿瘤切除术,术后因钢丝固定不能张口;6例行巨大甲状腺肿物切除术,术后存在气管塌陷可能.其中10例在手术室内麻醉苏醒时试验性拔除气管导管;8例于手术结束1～2d后在ICU试验性拔除气管导管.拔管时,将弹性插管探条经气管导管置入气管内,严密监护下沿弹性插管探条拔除气管导管.若拔管后出现呼吸道梗阻症状,则在留置的弹性插管探条引导下重新插管.记录拔管前后自主呼吸情况下呼吸频率、潮气量、分钟通气量、吸空气时脉搏血氧饱和度(SpO2)、拔管后再插管所用时间.结果18例患者中,12例患者拔管后的30 min观察期内呼吸道通畅、自主呼吸平稳,拔管前后各指标均无明显改变,未再使用弹性插管探条协助插管;6例患者拔管后的30 min观察期内出现上呼吸道梗阻症状,与拔管前相比,拔管后呼吸频率增加,潮气量及分钟通气量明显下降,吸空气时SpO2均不能维持在0.95以上,及时沿留置在气道内的弹性插管探条重新插管,迅速(均10s内)使患者呼吸道恢复通畅.结论 拔管前在气道内留置弹性插管探条是部分异常气道患者手术后试验性拔管过程中及时处理发生呼吸道梗阻的有效方法.     

艾司洛尔复合芬太尼用于气管插管对血液动力学的影响

目的:了解艾司洛尔复合芬太尼预防气管插管引起的血液动力学的变化。方法:40例ASA Ⅰ～Ⅱ级择期手术病人随机分为2组,A组为对照组(n=20),B组为艾司洛尔复合芬太尼组(n=20),静脉注射咪唑安定0．15mg．kg-1、异丙酚 2mg．kg-1、维库溴铵0．08～0．1mg．kg-1诱导气管插管。插管后1、3、5、10min监测并记录收缩压(SP)、舒张压(DP)、心率 (HR)的变化。结果:A组插管1、3、5min时,血压、心率与插管前比较有显著性升高(P<0．01或0．05)。B组插管1、3、5min时, 血压、心率与插管前比较无显著性差异(P>0．05)。组间比较有显著性差异(P<0．01或0．05)。结论:艾司洛尔复合芬太尼可缓解气管插管时的应激性反应。     

舒芬太尼、瑞芬太尼、芬太尼对全麻患者气管插管时心血管反应的影响

目的观察舒芬太尼、瑞芬太尼、芬太尼全麻诱导期患者气管插管时心血管反应,以及血浆血管紧张素(AngⅡ)、肾素活性(PRA)和醛固酮(ALD)水平变化,了解这三种药物对全麻诱导期患者气管插管时心血管反应的影响,为临床上选择全麻诱导期患者气管插管用药提供临床依据。方法将60例择期全麻手术患者随机分为芬太尼组、瑞芬太尼组、舒芬太尼组,每组各20例,分别采用芬太尼、瑞芬太尼和舒芬太尼行麻醉诱导。于诱导前、插管后3min记录收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR),并同时抽取静脉血,用高效液相色谱法测定血浆血管紧张素(AngⅡ)、肾素活性(PRA)和醛固酮(ALD)水平。结果芬太尼组、瑞芬太尼组插管后3min的SBP、DBP、MAP、HR和插管前相比显著升高(p<0.05),舒芬太尼组插管后3min的SBP、DBP、MAP、HR和插管前相比无显著差异(p>0.05)。芬太尼组、瑞芬太尼组插管后3min的AngⅡ、PRA、ALD和插管前相比显著升高(p<0.05),舒芬太尼组插管后3min的AngⅡ、PRA、ALD和插管前相比无显著差异(p>0.05)。结论舒芬太尼抑制插管时应激反应的效果优于瑞芬太尼和芬太尼,瑞芬太尼和芬太尼抑制插管时应激反应的效果相当,舒芬太尼更有利于血流动力学和肾素-血管紧张素系统(RAS)的稳定。     

右美托咪定和咪达唑仑对经鼻插管血流动力学和镇静的影响

目的 对照观察右美托咪定和咪达唑仑对困难气道患者经鼻纤维支气管镜插管血流动力学和镇静的影响.方法 40例ASA分级Ⅰ～Ⅱ级择期手术困难气道患者按住院号奇偶数分为咪达唑仑组(M组)和右美托咪定组(D组),每组20例.M组静脉注射咪达唑仑0.03 mg/kg,D组10 min内恒速泵入右美托咪定Iμg/kg,然后施行经鼻纤维支气管镜插管.记录麻醉前(T0)、纤维支气管镜通过后鼻孔(T1)、窥视会厌(T2)、插管成功即刻(T3)、插管后1 min(T4)、插管后3min(T5)时收缩压、舒张压、平均动脉压(MAP)、心率、脉搏血氧饱和度(SpO2)的变化,Ramsay镇静评分,心率收缩压乘积(RPP),末梢灌注指数(TPI),气道评分,术后随访24h.结果 M组T1～T3收缩压、舒张压、MAP、心率、RPP均较T0和D组同一时间点显著升高(P＜0.05),D组改变差异无统计学意义(P＞0.05).M组T1～T3Ramsay评分、TPI显著低于T0(P＜ 0.05),D组T1～T5Ramsay评分、TPI显著高于T0(P＜ 0.05),D组T1～T5 Ramsay评分、TPI显著高于M组同一时间点(P＜0.05).D组气道评分1分率、插管满意率[100％(20/20)、90％(18/20)]显著高于M组[30％(6/20)、50％(10/20)](P＜ 0.05).D组咽喉疼痛发生率[5％(1/20)]显著低于M组[35％(7/20)](P＜ 0.05).结论 困难气道患者应用右美托咪定行经鼻纤维支气管镜插管时血流动力学稳定,镇静效果满意.     

气管插管全身麻醉联合硬膜外麻醉对腹部手术患者术后感染的研究

目的探讨气管插管全身麻醉与硬膜外麻醉对腹部手术后感染情况及炎症因子、免疫功能、应激反应的影响。方法选取医院2012年1月-2015年11月行腹部手术患者104例为研究对象,按手术麻醉方式的不同分对照组与试验组,各52例,对照组采用气管插管全身麻醉;试验组采用气管插管全身麻醉复合硬膜外麻醉,于麻醉前(T0)、术后2h(T1)及术后1d(T2)时测定血清白细胞介素-1(IL-1)、IL-6、肿瘤坏死因子-α(TNF-α)、CD3+、CD4+、CD4+/CD8+、皮质醇、血糖水平,同时记录两组患者苏醒时间、拔管时间及术后感染状况。结果对照组T1、T2时和试验组T1时血清IL-1、IL-6、TNF-α水平较T0升高(P0.05);与对照组比,试验组T1、T2时血清IL-1、IL-6、TNF-α水平较低(P0.05);与T0比较,对照组T1、T2时和试验组T1时血清CD3+、CD4+、CD4+/CD8+水平降低(P0.05),与对照组比,试验组T1、T2时血清CD3+、CD4+、CD4+/CD8+水平较高(P0.05);与T0比,对照组T1、T2时和试验组T1时血清皮质醇、血糖升高(P0.05),与对照组比,试验组T1、T2时血清皮质醇、血糖较低(P0.05);对照组苏醒时间和拔管时间分别为(15.89±6.52)min和(22.14±8.96)min高于试验组(9.57±5.67)min、(14.62±7.75)min(P0.05)。对照组术后感染率25.00%高于试验组9.62%(P0.05)。结论气管插管全身麻醉复合硬膜外麻醉能降低腹部手术患者感染发生率,可能与降低术后炎症因子、应激反应,提高机体免疫功能相关,且安全性高,是一种有效的方案。     

Effects of shift work on QTc interval and blood pressure in relation to heart rate variability

Objectives: There is evidence that shift work contributes to excess cardiovascular mortality. The purpose of this study was to determine the effects of shift work on heart rate-corrected QT (QTc) and blood pressure in relation to heart rate variability (CV_RR). Methods: The study population consisted of 153 male shiftworkers and 87 male day workers who were employed at a copper-smelting plant. The QTc interval, total power spectral density (t-PSD) of 100 RR intervals, PSDs with frequencies of 0.01 Hz–0.15 Hz and 0.15 Hz–0.40 Hz (PSD_LF and PSD_HF), CV_RR, low frequency (LF) component variability and high frequency (HF) component variability (CCV_LF and CCV_HF) and %LF (PSD_LF/(PSD_LF+PSD_HF) ·100) were measured (LF and HF components are thought to reflect the sympathetic and parasympathetic activities, respectively). Results: The QTc interval was significantly longer in the shiftworkers than in the day workers, although there was no significant difference in systolic or diastolic blood pressure between the two groups. Also, the CCV_LF and log(PSD_LF) were significantly depressed in the shiftworkers. In the day workers, the QTc interval was significantly related to the CV_RR, log(t-PSD), CCV_HF, log(PSD_HF),%LF, and log(LF/HF ratio) (partial correlation coefficient r=–0.305, –0.377, –0.312, –0.355, 0.297, and 0.277, respectively). In the shiftworkers only two relations of the QTc interval to non-specific CV_RR and log(t-PSD) were significant. Conclusion: The clear association between long QTc interval and reduced parasympathetic activity observed in the day workers did not exist in the shiftworkers. Rather, the shiftworkers had a selective reduction in sympathetic drive, which may have compensated for prolonged QTc interval due to shift work. On the other hand, the impact of shift work on hypertension remains unclear, although reduced sympathetic drive in the shiftworkers may explain the absence of differences in blood pressure between shiftworkers and day workers to some extent.     

气管插管全麻术后患者下呼吸道感染情况分析

目的 探讨气管插管全麻术后患者下呼吸道感染的病原菌分布,分析术后下呼吸道感染与手术种类和患者年龄的关系,为预防和治疗下呼吸遭感染提供参考.方法 选取2007年8月—2011年8月医院行气管插管全麻术术后发生下呼吸道感染的患者107例,采用回顾性分析的方法对患者的临床资料进行统计.结果 在所有下呼吸道感染的患者中,所感染的病原菌多为革兰阴性菌,占86.92％;神经系统患者所占比例最高,达43.93％;患者年龄＞60岁发生下呼吸道感染的概率最大,为44.85％.结论 气管插管全麻术后患者下呼吸道感染的发生与患者的年龄和手术种类密切相关,对感染概率较高的患者应采取有效措施进行预防.     

全身麻醉气管插管对患者手术后呼吸道感染的影响

目的探讨全身麻醉气管插管对患者手术后呼吸道感染的影响,为临床预防术后呼吸道感染提供参考依据。方法回顾性分析2014年1月-2016年6月在医院行全身麻醉气管插管的患者5 166例,统计患者呼吸道感染率,病原菌分布及主要病原菌的耐药率;分析患者的性别、年龄、手术部位、麻醉通气时间、术后延迟拔管、插管熟练度以及拔管指征完全,确定患者术后呼吸道感染相关因素。结果 5 166例患者中感染196例(3.8%);感染患者共培养出病原菌224株,其中单一感染患者168例,混合感染患者28例,感染病原菌以革兰阴性菌为主165株占73.7%,革兰阳性菌54株占24.1%,真菌5株占2.2%;革兰阴性菌中铜绿假单胞菌对庆大霉素、头孢吡肟、阿莫西林、诺氟沙星的耐药率较高,对亚胺培南和美罗培南的耐药率均为0;大肠埃希菌对庆大霉素、头孢吡肟、诺氟沙星等耐药率较高,对阿米卡星、亚胺培南和美罗培南的耐药率较低;革兰阳性菌中金黄色葡萄球菌对青霉素、阿莫西林、头孢曲松和头孢唑林等耐药率较高,对苄卡西林和万古霉素的耐药率均为0,表皮葡萄球菌对青霉素、阿莫西林、头孢曲松的耐药率较高,对克林霉素、环丙沙星、苄卡西林和万古霉素等耐药率较低;不同年龄、手术部位、麻醉通气时间、术后延迟拔管、插管熟练度以及拔管指征完全均对全身麻醉气管插管患者术后呼吸道感染率有明显影响。结论临床上要对全身麻醉气管插管患者呼吸道感染的危险因素进行适当干预,降低感染率,对已经发生呼吸道感染的患者,要结合病原菌药敏试验给予合理的抗菌药物治疗。     

依托咪酯或丙泊酚对老年冠心病非心脏手术围插管期心率变异性的影响

目的 研究依托咪酯和丙泊酚对老年冠心病患者行非心脏手术时在全身麻醉诱导气管插管期间心率变异性(HRV)的影响.方法将90例择期行中上腹部手术的老年冠心病患者随机分成依托咪酯组(E组)和丙泊酚组(P组),每组各45例.分别于麻醉前、麻醉诱导后及气管插管后用心率变异功率谱分析技术观察两组患者的HRV变化.结果麻醉诱导后,E组总功率(TP)和HRV低频(LF)[(756±535)ms2/Hz和(316±301)ms2/Hz],P组LF、HRV高频(HF)、LF/HF及TP[(187±168)ms2/Hz、(89±48)ms2/Hz、2.3±1.6和(616±462)ms2/Hz]均较麻醉前显著降低(P<0.05);组间比较,麻醉诱导后,E组LF、HF、LF/HF及TP均显著高于P组(P<0.05).气管插管后,两组LF、HF、LF/HF及TP均较麻醉前显著升高(P<0.05);组间比较,气管插管后两组HRV各指标比较差异均无统计学意义(P>0.05).结论丙泊酚在麻醉诱导时对老年冠心病自主神经功能的抑制作用强于依托咪酯;而对于气管插管引起的心血管反应而言依托咪酯和丙泊酚药效相似.     

依托咪酯或丙泊酚对老年冠心病非心脏手术围插管期心率变异性的影响

目的研究依托咪酯和丙泊酚对老年冠心病患者行非心脏手术时在全身麻醉诱导气管插管期间心率变异性（HRV）的影响。方法将90例择期行中上腹部手术的老年冠心病患者随机分成依托咪酯组（E组）和丙泊酚组（P组）,每组各45例。分别于麻醉前、麻醉诱导后及气管插管后用心率变异功率谱分析技术观察两组患者的HRV变化。结果麻醉诱导后,E组总功率（11P）和HRV低频（LF）[（756±535）ms^2／Hz和（316±301）ms^2／Hz],P组LF、HRV高频（HF）、LF／HF及TP[（187±168）ms^2]Hz、（89±48）ms^2／Hz、2．3±1．6和（616±462）ms^2／Hz]均较麻醉前显著降低（P〈0．05）;组间比较,麻醉诱导后,E组LF、HF、LF／HF及11P均显著高于P组（p〈0．05）。气管插管后,两组LF、HF、LF／HF及11P均较麻醉前显著升高（P〈0．05）;组间比较,气管插管后两组HRV各指标比较差异均无统计学意义（P〉0．05）。结论丙泊酚在麻醉诱导时对老年冠心病自主神经功能的抑制作用强于依托咪酯;而对于气管插管引起的心血管反应而言依托咪酯和丙泊酚药效相似。     

普鲁泊福复合不同剂量瑞芬太尼应用于非肌松剂气管插管的观察

目的 观察普鲁泊福麻醉诱导时复合不同剂量瑞芬太尼应用于非肌松剂气管插管时对患者心血管反应的影响.方法 将60例ASA分级Ⅰ～Ⅱ级的非心、脑外科择期全身麻醉手术患者按随机数字表法分为Ⅰ、Ⅱ、Ⅲ组,每组20例,注射泵输注瑞芬太尼血浆靶控浓度分别为2、3、4ng/ml,输注5 min后开始靶控输注普鲁泊福(血浆靶控浓度3μg/ml).记录三组患者诱导前(T1)、普鲁泊福开始即刻(T2)、气管插管前即刻(T3)、气管插管后1 min(T4)的平均动脉压(MAP)、心率变化,以及气管插管评分和第1次插管成功率.结果 Ⅰ、Ⅱ、Ⅲ组气管插管评分分别为(10.5±2.9)、(7.6±2.3)、(5.8±1.2)分,第1次插管成功率分别为50%(10/20)、80%(16/20)、100%(20/20),三组间比较差异均有统计学意义,Ⅲ组均优于Ⅰ组和Ⅱ组(P＜0.05).T2与T1比较,Ⅱ组和Ⅲ组心率均显著减慢(P＜0.05),Ⅲ组更明显;T4与T3比较,Ⅰ组和Ⅱ组心率显著增快,Ⅰ组明显高于Ⅱ组和Ⅲ组(P＜0.05).T3与T2比较,三组MAP均显著下降;T4与T3比较,Ⅰ组MAP显著上升,且高于Ⅱ组和Ⅲ组(P＜0.05).结论 在不使用肌松剂时,普鲁泊福复合瑞芬太尼靶控浓度3～4 ng/ml能较好地抑制气管插管的应激反应,而又不引起明显的循环抑制,对维持麻醉诱导插管过程的平稳较为有利.

Abstract：

Objective To observe the impacts on the patients with cardiovascular responses when applying propofol combined with different dose of remifentanil in tracheal intubation without the use of muscle relaxants for anesthesia induction. Methods Sixty patients undergoing selective general anesthesia operation of ASA Ⅰ -Ⅱ non-heart and brain surgery were divided into three groups by random digits table, and 20 cases for each group. Target-controlled infusion of remifentanil with respective plasma concentration of 2 ng/ml (group Ⅰ ), 3 ng/ml (group Ⅱ ) and 4 ng/ml (group Ⅲ). Target-controlled infusion of propofol after infusion of remifentanil for 5 min (3 μg/ml of plasma target concentration). The mean arterial pressure (MAP),heart rate (HR), intubation conditions and success rate of patients in different groups before induction(T1), at the beginning moment of propofol(T2),at the immediate moment before tracheal intubation (T3) and at the time of 1 min after tracheal intubation (T4). Results The grade of tracheal intubation was (10.5 ±2.9), (7.6 ±2.3), (5.8 ± 1.2) scores and the success rate of the first intubation was 50%( 10/20), 80%(16/20), 100%(20/20) in group Ⅰ ,Ⅱ and Ⅲ , there were significant differences among three groups (P＜ 0.05),group Ⅲ was superior to group Ⅰ and Ⅱ (P＜0.05). Comparing T2 and Tj,HR in group Ⅱ and Ⅲ slowed down significantly ( P ＜ 0.05), and in group Ⅲ slowed down more significantly (P＜0.05). Comparing T4 and T3,HR in group Ⅰ and Ⅱ quickened significantly, and group Ⅰ was higher than group Ⅱ and Ⅲ (P＜ 0.05). Comparing T3 and T2,MAP decreased significantly among three groups,comparing T4 and T3, MAP increased significantly in group Ⅰ which was higher than that in group Ⅱ and Ⅲ (P ＜ 0.05). Conclusions Without the use of muscle relaxants, propofol combined with remifentanil for 3-4 ng/ml can better restrain the tracheal intubation stress responses and won't cause significant cycle inhibition. They benefit to maintain the smooth intubation process of anesthesia induction.