紧闭式氧化亚氮麻醉方法的探讨

２５例选择期手术病人采用紧闭式氧化亚氮麻醉方法，术中持续监测呼气末氧和氧化亚氮浓度，脉搏血氧饱和度和呼吸循环指标，术中观察紧闭式麻醉后呼吸末氧化亚氮，氧浓度变化，结果：紧闭式麻醉１，２，３ｈ后氧化亚氮浓度分别为５２．７％，５６％，６４．９％，氧浓度为４２．１％，３４．４％，３０．８％，随麻醉时间的延长，气道压力先降后回升，约３ｈ恢复至紧闭麻醉前的水平，紧闭式麻醉前后在本组观察时间内动脉血气分析提示     

脊柱侧弯矫形术不同麻醉方法的对比研究

选择脊柱侧弯手术病人３０例，观察单纯全麻（Ｉ组），全麻＋控制性降压（Ⅱ）及连硬复合全麻（Ⅲ）三种不同麻醉法对血浆皮质醇，血糖及血流动力学变化，随机分三组，每组１０例，分别于术前，术始，术前刺激最强烈，拔管时及术后３ｈ抽中心静脉血测血浆皮质醇，血糖的浓度，结果表明：Ｉ，Ⅱ组皮质醇，血糖和Ⅲ期血糖均在术中，拔管时和术后３ｈ明显升高，但Ⅲ组皮质醇与术前比较无明显变化（Ｐ〉０．０５），且Ⅲ组皮质醇，血糖在     

不同麻醉方法对全髋置换术患者的血液流变学的影响

目的：对比研究单纯全麻醉与硬膜外加全麻对全髋转换术患者的血液流变学的影响。方法：１６例ＡＳＡＩ￣Ⅱ行,行择期全髋置换术患者随机分为两组。Ⅰ组为全麻组,Ⅱ组为硬膜外加全麻组,诱导前硬膜外给２％利多卡因５ｍｌ,有平面后行全麻诱导,全麻用药与Ⅰ组相同,术中用利多卡因硬膜外阻滞,每５０ｍｉｎ给药６￣８ｍｌ,术后２４ｈ内用０．５％布比卡因镇痛,Ⅰ组术后肌注哌替啶镇痛。结果：两组血液流变学的主要差异：Ⅱ组的血     

胆囊切除术对胃肠动力的影响

目的：了解人胆囊切除术后早期胃肠运动的变化及自然恢复过程。方法：选择单纯胆囊结石病人２０例，分为两且，分别在全麻或硬膜外麻醉直行胆囊切除。手术结束后采用胃肠测压法记录胃肠运动变化，持续至胃肠动力恢复正常。结果：两组病术后早期胃、十二指肠称赞移行性动力复合波（ｍｉｇｒａｔｉｎｇ ｍｏｔｏｒ ｃｏｍｐｌｅｘ，ＭＭＣ）活动均消失，术后０．５￣２ｈ十二指肠ＭＭＣ重新出现，胃ＭＭＣ在术后５．５￣１４ｈ恢复，     

全麻术中知晓的临床回顾

为了解不同全麻方法下知晓的发生率，随访调查了４３９例全麻患者，现回顾报告如下。资料和方法择期手术全麻病人共４３９例，男３３０例、女１０９例，年龄１９～８０岁，手术包括普胸、普外、五官各科，术后２４～４８ｈ内随访了解病人能否回忆术中情况。术前用药均为阿...     

硬膜外布比卡因镇痛减轻上腹部手术病人术后肺功能抑制

目的：研究术后硬膜外镇痛对上腹部手术病人呼吸功能的保护作用。方法：３０例硬膜外麻醉下行胆囊切除术病人分为两组：镇痛组１５例，术后保留硬膜外导管４８ｈ，每４～６ｈ注入０．２％布比卡因５ｍｌ镇痛；对照组１５例，用生理盐水代替布比卡因作对照。围手术期监测肺功能、ＳｐＯ２和血气。结果：两组病人术后早期肺功能均明显抑制。但镇痛组的呼吸抑制远比对照组为轻，术后１２ｈ的Ｖｃ、ＩＲＶ、ＥＲＶ、ＦＥＶ１．０、ＦＶＣ、ＭＭＦ和ＰＦＲ分别达术前值的７０．２１％、６２．３８％、６５．９４％、６１．９２％、６４．７４％、５７．５７％和５９．４０％，术后４８～７２ｈ的肺功能恢复至术前水平的７０％～８０％；术后第７天达９０％左右；ＰａＯ２和ＰａＣＯ２变化不大。结论：术后硬膜外注入０．２％布比卡因镇痛能有效地减轻上腹部手术病人术后肺功能抑制。     

麻醉和手术对肾小球和肾小管功能的影响

目的 了解麻醉与手术对肾小球和肾小管功能的影响。方法 病人分为４组；１、全身麻醉＋较大手术组（Ｇ＋Ｂ）；２、全身麻醉＋较小手术组（Ｇ＋Ｓ）；３、硬膜外阻滞＋较大手术组（Ｅ＋Ｂ）；４、硬膜外阻滞＋较小手术组（Ｅ＋Ｓ）。每组１０例。检测术前、术中１ｈ和术后２４ｈ尿中β２－微球蛋白（β２－ＭＧ）、白蛋白Ａｌｂ）和免疫球蛋白Ｇ（ＩｇＧ）浓度。结果 在不同麻醉方法下行较小手术时，术中及术后尿中β２－ＭＧ、Ａ     

上腹部手术硬膜外麻醉病人术后呼吸功能变化的临床观察

通过对３０例上腹部择期手术硬膜外麻醉病人术后不同时期呼吸功能的临床观察，发现与术前相比，术后早期ＶＴ，ＭＶ，ＶＣ，ＥＲＶ分别下降了３６．０７％、２８．８６％、５２．４９％和４０．７１％（Ｐ＜０．０１）。术后１２－７２ｈ，病人呼吸功能的变化较大，尤其以术后１２ｈ为甚，其中ＶＴ，ＶＣ，ＩＲＶ，ＥＲＶ分别比术前下降了４０．０１％、５４．７５％、７０．３４％和４８．６７％（Ｐ＜０．０１），ｆ增加了５４．４     

小儿氯胺酮复合麻醉后并发急性肠痉挛

近年来我们采用氯胺酮、安定、普鲁卡因复合麻醉或单纯用氯胺酮麻醉行１２岁以下小儿整形烧伤手术４９２例，其中１０例在麻醉清醒后并发急性肠痉挛。肠痉挛均出现在术后２４ｈ内，麻醉清醒后６ｈ内１例，６～１２ｈ３例，１２～２４ｈ６例。６例麻醉前肠鸣音２～３次／分...     

小儿术中输糖量的实验观察

选择手术时间≥２ｈ的小和手术５８例，按输糖量，麻醉方法和年龄分为５组。甲组输５％糖，乙组不输糖，其他组输２．５％糖。丙组＜６岁，丁组≥６岁，其他随机分组。戊组用硫喷妥钠基础＋神经阻滞，其他组分离麻醉。术中均按７ｍｌ／ｋｇ．ｈ匀速滴入。麻醉开发１ｈ，２ｈ各测血糖１次。结果：（１）各组血糖均升高，甲组最显著。（２）各组等１ｈ血糖升高明显，第２ｈ不再继续升高。（３）分离麻醉组血糖升高比硫妥钠基础组显著。     

Changes in SpO2 during total intravenous anesthesia combined with propofol and SpO2 during one-lung anesthesia ventilation

We retrospectively examined SpO2 during one-lung anesthesia (OLA). One hundred and fifty patients of ASA 1 or 2 for thoracoscopic surgery were anesthetized with propofol and fentanyl (n = 93) or pentazocine (n = 57) and mechanically ventilated with FIO2 = 0.6 in the lateral decubitus position. Twelve patients (8%) developed SpO2 < or = 95% in the first 20 minutes of OLA. It has been reported that hypoxemia during OLA occurs in 13-40% of patients under inhalation anesthesia with FIO2 = 1.0. Our results show the total intravenous anesthesia using propofol is useful to maintain SpO2 during OLA. SpO2 during OLA tended to fall in the patients for right side operation, with lower SpO2 during two-lung ventilation and higher body mass index (BMI). However BMI has never been reported as a predictor of hypoxemia during OLA. A gravity-dependent mechanism is considered to be more responsible for the dependent regional volume reduction during OLA in patients in the lateral decubitus position.     

高龄患者颈椎手术围手术期的呼吸循环改变

目的 :观察高龄颈椎手术患者的围手术期呼吸循环改变。方法 :2 0 0例患者按年龄分为两组 ,A组为 70岁以上组 (n =10 0 ) ,B组为 70岁以下组 (n =10 0 )。观察和比较围手术期两组术前合并其他疾病情况、各组血压变化、心律失常的发生率、氧饱和度值及术后近期并发症情况。结果 :A组合并循环、呼吸、血液等系统疾病者较多 ,术中血压下降>15 % ,基础血压的例数明显多于B组 (P <0 .0 5 ) ,出现心动过缓、房性早搏、室性早搏等心律失常的例数亦较B组多 (P<0 .0 5 )。各阶段A组氧饱和度均低于B组 (P <0 .0 1或P <0 .0 5 )。且A组术后近期脑血管并发症也多于B组。结论 :70岁以上颈椎手术患者围手术期易出现呼吸循环功能障碍 ,须引起重视     

Perioperative opioid requirements are decreased in hypoxic children living at altitude

Objectives: To investigate the effect of altitude on perioperative opioid requirements in otherwise healthy children. Aim: To investigate whether children living and having surgery at high altitude received different doses of fentanyl than those living and having surgery at sea level. Background: Recent studies in animals (Anesthesiology, 105, 2006 and 715) and children with obstructive sleep apnea (Anesthesiology, 105, 2006 and 665; Anesthesiology 100, 2004 and 806) suggest that analgesic effects of exogenous opioids are enhanced by hypoxia. However, the effects of hypoxia on perioperative narcotic requirements in otherwise healthy children have not been previously reported. Methods/materials: We reviewed retrospectively the opioid requirements of pediatric patients who underwent cleft lip or palate surgery during Smile Network International mission trips to Cusco and Lima, Peru between 2007 and 2009. Patients who had surgery at high altitude were compared to those who had surgery at sea level. All patients received a standardized anesthetic with intravenous fentanyl as the only perioperative opioid. Results: Hundred and two patients had surgery at 3399 m above sea level (masl) (Cusco) and 169 patients had surgery at 150 masl (Lima). Patients at high altitude had significantly lower baseline oxygen saturations (92 ± 4% vs 98 ± 3%; P < 0.001) and received 40% less opioid (1.2 ± 0.8 vs 2.0 ± 1.4 μg·kg^?1 per h; P < 0.001) compared to patients at sea level. Conclusions: Opioid administration was reduced in otherwise healthy children with altitude‐induced chronic hypoxia when compared to non‐hypoxic children undergoing similar operations under similar anesthetic regimens. Whether this difference is due to altitude or altitude‐induced hypoxia, requires further study.     

曲马多和氟哌利多辅助硬膜外阻滞对胆囊切除术牵拉反应的防治

观察20例硬膜外阻滞下施行胆囊切除手术病人辅用曲马多和氟哌利多(曲氟合剂)对内脏牵拉反应的抑制效果,并与哌替啶和氟哌利多(哌氟合剂,n=20)或芬太尼和氟哌利多(芬氟合剂,n=20)比较。结果显示,曲氟合剂抑制内脏牵拉反应效果与哌氟、芬氟合剂相同,但曲氟组病人用药后SpO_2和RR变化轻微(P>0.05),哌氟组和芬氟组则显著下降(P<0.01),提示胸段硬膜外阻滞时辅用曲氟合剂较哌氟或芬氟合剂安全。     

活体供肝切除术的麻醉管理

目的 回顾性分析45例活体供肝切除术的麻醉管理和手术经过.方法 回顾45例活体肝移植供肝切除术的麻醉处理过程和手术经过,术中持续监测BP、HR、SpO2、CVP、PETCO2等重要的生理指标.在手术开始、供肝切除前、后30 min三个时点分别采血检测血常规、血生化、肝肾功能、凝血功能和动脉血气.结果 术中血流动力学稳定,所有供体均未发生术中并发症和死亡.肝功能的各项指标在供肝切除过程中发生了剧烈的变化,凝血功能随着手术的进行也有一定程度的恶化,肾功能则未受到明显影响.结论 尽管术中多项生理指标发生明显异常,但活体供肝切除术能够在保持血流动力学稳定、术后无手术并发症的情况下顺利完成.     

Influence of surgical technique on early postoperative hypoxaemia in children undergoing elective palatoplasty

We have assessed the influence of different surgical procedures on the incidence, severity and duration of early postoperative hypoxaemia in 312 healthy infants and children undergoing elective palatoplasty. Group 1 patients underwent von Langenbeck palatoplasty (n = 149), group 2 patients underwent push-back palatoplasty (n = 124) and group 3 patients underwent combined push-back palatoplasty and superior pharyngeal flap surgery (n = 39). Arterial oxygen saturation (SpO2) was recorded while patients were breathing air shortly after arrival in the recovery room (0 min), and at 5, 10, 15, 20, 30, 40, 50, 60, 120 and 180 min thereafter. Patients who underwent more complex surgical techniques for palatoplasty had lower postoperative SpO2 values, slower recovery of SpO2 and a higher incidence of hypoxaemia during the early postoperative period. There were significant differences in postoperative SpO2, values and the incidence of hypoxaemia. The incidences of hypoxaemia and severe hypoxaemia were 27% and 1%, respectively, in group 1, 37% and 12% in group 2, and 36% and 33% in group 3. Hypoxaemia occurred most commonly in the first 15 min in children after von Langenbeck palatoplasty, in the first 40 min after push-back palatoplasty and in the 120 min after combined push-back palatoplasty and superior pharyngeal flap surgery. There were significant associations between low SpO2 values, incidence of hypoxaemia on admission to the recovery room and recovery scores.      

Oxyhemoglobin saturation following cesarean section in patients receiving epidural morphine, PCA, or im meperidine analgesia

The frequency and severity of oxyhemoglobin desaturation was compared in 49 patients receiving epidural morphine, 5 mg (n = 21); patient-controlled analgesia (PCA) using meperidine (n = 20); or intramuscular (im) meperidine (n = 8) for postoperative analgesia following elective cesarean section performed with epidural anesthesia. Oxygen saturation (SpO2) was monitored for 24 h using a pulse oximeter; data were continuously collected and stored every 30 s via an interface connected to a computer. For analysis purposes, SpO2 was divided into five categories: 96-100%, 91-95%, 86-90%, 81-85%, and less than or equal to 80%. Although SpO2 remained above 95% for the majority of the monitored period, patients in all groups experienced periods of desaturation. PCA patients spent the longest cumulative time with SpO2 between 91 and 95%, 231 +/- 49 min (mean +/- SEM), compared with only 112 +/- 30 min and 152 +/- 42 min for the epidural and im groups, respectively (P less than 0.05 vs. epidural group). PCA patients also spent longest with SpO2 at 86-90% (19 +/- 10 min, vs. 6 +/- 3 and 0.5 +/- 0.3 min for the epidural and im groups, respectively), although this difference was not statistically significant. Severe desaturation episodes, defined as SpO2 less than or equal to 85% for more than 30 s, occurred in 71% of patients in the epidural group, 30% in the PCA group, and 63% in the im group (P less than 0.05 PCA vs. epidural and im).(ABSTRACT TRUNCATED AT 250 WORDS)     

Epidural block does not worsen oxygenation during one-lung ventilation for lung resections under isoflurane/nitrous oxide anaesthesia

BACKGROUND AND OBJECTIVES: The aim of this prospective, randomized, controlled clinical study was to evaluate the effects of thoracic epidural anaesthesia combined with isoflurane/nitrous oxide anaesthesia on intraoperative oxygenation during one-lung ventilation for lung resections. METHODS: Forty patients were randomly allocated to receive general anaesthesia maintained with isoflurane/nitrous oxide (group General, n = 20) or the same anaesthetic combined with thoracic epidural anaesthesia (group Integrated, n = 20). All patients were mechanically ventilated with the same settings (FiO2 = 0.5; VT = 9 mL kg(-1); inspiratory: expiratory time = 1:1; inspiratory pause = 10%). Effects on oxygenation were evaluated by determining the changes in PaO2/FiO2 ratio at 10, 30, 45 and 60 min of one-lung ventilation as compared to values obtained after induction of anaesthesia (supine, two-lung ventilation). RESULTS: The PaO2/FiO2 ratio was decreased in both groups during one-lung ventilation until the end of surgery. No differences were found at any observation time between the groups. Ventilation with 100% oxygen because of SpO2 decrease <92% was required in nine patients of group General (45%) and in eight patients of group Integrated (40%) (P = 0.64). Manual re-inflation of the operated lung was required in one patient of group General only (P = 0.99). Heart rate was lower in group Integrated than in group General throughout the study. No differences between the two groups in mean arterial pressure were observed. CONCLUSIONS: Adding a thoracic epidural block to isoflurane/nitrous oxide anaesthesia during one-lung ventilation for lung resections does not result in clinically relevant detrimental effects on intraoperative oxygenation.     

Evaluation of prostate-specific antigen in untreated prostatic carcinoma

A study was performed on 290 men to compare the level of serum prostate-specific antigen (PSA) in controls, patients with benign prostatic hyperplasia (BPH) and patients with prostatic cancer. The upper limit of normal was 5.0 micrograms/l as determined in 110 elderly hospitalized males (mean age 62 years) without urological complaints. Of the 106 patients with BPH, 33% had raised values above 5.0 micrograms/l. Values above 10 micrograms/l were found in 18 BPH patients. A positive correlation was found between prostate volume (grams of tissue removed during transurethral resection) and preoperative PSA levels (r = 0.55, n = 106, p less than 0.001). PSA levels above 10 micrograms/l were found in 4% of BPH patients with a prostate volume of less than 20 g (n = 54), in contrast with 45% of patients with a prostate volume above 40 g (n = 20). The sensitivity of this PSA assay (cutoff level 10 micrograms/l) as established in 74 prostate carcinoma patients was 31% for category T0 (n = 13), 56% for category T1-2 (n = 16), 75% for category T3-4 (n = 20) and 100% for category M1 or N1-4 (n = 25). In an earlier study prostatic acid phosphatase (PAP) was measured in these same samples. PSA appeared to be much more sensitive than PAP. Seventeen of the 74 prostatic carcinoma patients (23%) had normal PAP levels but their PSA values were raised above 10 micrograms/l, while in only 2 patients an increased PAP level was combined with a normal PSA.(ABSTRACT TRUNCATED AT 250 WORDS)     

血液稀释对全麻腹腔镜活体肾移植供体围手术期氧合功能的影响

目的:探讨不同血液稀释状态对全麻腹腔镜活体肾移植供体围手术期氧合功能的影响。方法:选择健康成年志愿捐肾者48例,随机分为4组:A组(n=10,对照组,乳酸钠林格氏液CIT)、B组(n=12,4~5ml/kg 4%琥珀酰明胶HHD)、C组(n=13,20ml/kg4%琥珀酰明胶HHD),D组(n=13,30ml/kg4%琥珀酰明胶HHD)在全麻腹腔镜下行肾脏摘除术。B、C、D组于麻醉诱导后至肾动脉阻断前分别以4~5ml/kg、20ml/kg和30ml/kg 4%的琥珀酰明胶静脉输注实施不同程度的血液稀释。术中监测麻醉诱导前(T0)、切皮后30min(T1)、肾动脉阻断时(T2)、肾动脉阻断后15min(T3)、手术结束时(T4)及手术结束后240min(T5)的平均动脉压(MAP)、心率(HR)、心电图(ECG)、脉搏血氧饱和度(SpO2)、中心静脉压(CVP)、心输出量(CO)、心脏指数(CI)等。于各时间点抽取动静脉血进行血气分析;T2、T4时分别记录胶体液、晶体液等。手术期间4组以20ml.kg-1.h-1速率常规输注乳酸钠林格氏液。各组手术期间当MAP的变化超过基础值30%时可静脉输注硝酸甘油或多巴胺给予纠正,阻断肾动、静脉后常规应用速尿40mg。结果:(1)4组ECG、SpO2、晶体液总量等均无显著性差异(P>0.05);(2)C、D组T1、T2、T3、T4时MAP、CVP高于A、B组(P<0.05),但均在正常范围内;(3)与T0时相比,C、D组T2、T3时Hb、HcT降低显著(P<0.05),分别达中度(P<0.05)和重度(P<0.01)血液稀释水平;T2、T3时A、D组PaO2下降(P<0.05),而C组升高(P<0.05)。结论:不同血液稀释状态对全麻腹腔镜活体肾移植供体的氧合功能产生不同的影响,在心肺功能良好的供肾者中实施中等度高容量血液稀释是安全的。