240例呼吸功能不全胸科麻醉临床分析

呼吸功能不全病员的麻醉较为复杂,特别是胸科手术给麻醉增加了许多困难,因而在麻醉及呼吸管理上,必须采取有效措施,才能完成麻醉与手术。现将本院240例呼吸功能不全胸科麻醉分析如下: 资料:男179例,女61例。29岁以下75例,30～49岁141例,50岁以上24例。术前肺功能状况:最大通气量60％～40％     

高位硬膜外麻醉在甲状腺手术中的临床应用

目的：探讨高位硬膜外麻醉的优越性和临床应用价值。方法：对100例甲状腺疾病分别采用颈丛神经阻滞麻醉和高位硬膜外麻醉进行手术,观察麻醉后术中血压、心率、呼吸等的影响。结果：高位硬膜外麻醉组与颈丛神经阻滞麻醉组的血压、心率比较差异有统计学意义（P〈0.05）,而呼吸功能比较差异无统计学意义（P〉0.05）。结论：高位硬膜外麻醉下应用于甲状腺疾病的手术有以下特点：血压、心率影响小,出血量少,镇痛效果好,呼吸功能无明显影响。     

单纯全身麻醉与全身麻醉联合硬膜外麻醉在妇科腹腔镜手术患者中的临床应用价值

目的探讨单纯全身麻醉与全身麻醉联合硬膜外麻醉在妇科腹腔镜手术患者中的临床应用价值。方法选取金华市人民医院妇科2016年6月-2018年5月收治拟行腹腔镜手术患者总计134例,根据患者手术顺序分成两组,先行手术的67例患者采取单纯全身麻醉设置为对照组,另67例患者采取全身麻醉联合硬膜外麻醉设置为观察组。对照两组患者不同手术时段呼吸功能、循环功能评价,麻醉后子宫松弛程度评判,实施麻醉所用时间、麻醉结束后恢复自主呼吸时间及麻醉期间并发症的发生率比较。结果在T_2、T_3、T_4时间段观察组患者Paw明显少于对照组,而呼气末二氧化碳分压(PETCO_2)明显高于对照组。T_1各项循环功能和T4段两组患者收缩压(SBP)、舒张压(DBP)差异无统计学意义(P0.05)。观察组余下时间段各项循环功较对照组平稳,观察组患者子宫松弛度优良率为98.51%,对照组患者为86.57%,观察组患者实施麻醉所用时间明显多于对照组,而麻醉后自主呼吸与并发症发生率(1.49%),明显少于对照组麻醉后自主呼吸与并发症发生率(10.45%),差异有统计学意义(P0.05)。结论在妇科腹腔镜患者采取联合麻醉相较于单纯全身麻醉虽可延长麻醉时间,未明显影响患者呼吸功能、循环功能,获得麻醉后良好的子宫松弛程度,缩短患者麻醉后自主呼吸恢复时间,减少麻醉期间患者并发症的发生,效果理想。     

呼吸机基本构造与常见故障

呼吸机是一种用于临床抢救、呼吸衰竭的治疗以及提供麻醉和手术后呼吸支持的重要设备。它是针对无呼吸功能的危重病人,采用人工方法实现呼吸功能的一种常规医疗设备。     

丙泊酚加小剂量安定联合用于人工流产术的麻醉

目的:观察丙泊酚加小剂量安定对人工流产术病人的麻醉效果及其对呼吸、循环功能的影响。方法:选取50例在门诊行人工流产术病人为观察对象,先静脉注射安定5mg,接着静脉注射丙泊酚1.5mg/妇,并继以0.2mg/(kg.min)的速率持续输注。结果:门诊人工流产术病人对麻醉效果满意,丙泊酚加小剂量安定对循环功能影响较轻,对呼吸功能影响较大,呼吸频率减慢发生率为54%,SpO2下降发生率为60%,但在5min内均自行恢复。结论:丙泊酚加小剂量安定联合用于人工流产术的麻醉简便易行,诱导迅速舒适,苏醒快而安全,且药物费用低廉。但应注意其对呼吸、循环功能的抑制     

德国“MEDIMORPH”麻醉呼吸机的临床应用

1990年5月,我们购进一台德国莱比锡医疗器械厂生产的原装 Medimorph 麻醉呼吸机。该机相当于德国 Draeger 厂生产的 Sulla808麻醉机。功能较完善。具有很多报警功能:如氧气供应不足时,笑气自动关闭;掉电及供气中断报警;呼吸道压力过高、过低的报警;氧浓度监视;最高、最低氧气含量的报警等。许多麻醉呼吸的参数可调,如呼吸频率、潮气量、呼吸比等。另外配有抽气机,能够及时抽除手术室中的有害气体。本机计量部件,如流量计、     

芬太尼、异氟醚静吸互补麻醉在心内直视手术中的应用

在心内直视手术的麻醉中，各种麻醉方法及种类繁多，（麻醉质量要求高）麻醉结果有差异，如何寻求最好的麻醉方式，是麻醉医师不懈所追求的。我们用中小剂量芬太尼、异氟醚静吸互补麻醉开展体外循环下心内直视手术220例，麻醉效果满意，对循环功能干扰小，术后循环呼吸功能恢复快，元严重麻醉并发症及麻醉死亡，现将结果报告如下：     

喉罩通气下新生儿腹腔镜下幽门环切术麻醉管理体会

目的:观察喉罩通气下新生儿腹腔镜手术中,CO2气腹对呼吸循环系统功能的影响以及喉罩机械控制通气全身麻醉辅以骶管麻醉用于新生儿腹腔镜下幽门环切手术的安全可靠性。方法:102例腹腔镜幽门环肌切开术的新生儿均采用放置喉罩连接麻醉机控制通气下全身麻醉辅以骶管阻滞,术中潮气(VT)10～15ml/kg、呼吸频率(RR)28～32次/min,调整呼吸参数,以维持PETCO2在生理范围(32～36)并在注气前、气腹中、注气毕记录各时点的呼吸循环动力学指标。结果:气腹后与气腹前基础值相比,气腹后5min,SBP、DBP、HR、PETCO2差别明显(P<0.05),放气后5min各项指标基本恢复至气腹前水平。结论:新生儿气腹可引起呼吸循环功能的改变,插入喉罩机械控制通气全身麻醉辅以骶管麻醉用于新生儿腹腔镜下幽门环切手术是安全可靠的。     

百斯FOCUS6500麻醉呼吸机的常见故障及排除方法

麻醉呼吸机是全麻医学及现代外科手术中必不可少的设备,其主要功能是为病人进行呼吸管理、供氧、吸入麻醉药。笔者主要描述百斯FOCUS6500麻醉呼吸机在日常使用过程中的常见故障,探讨麻醉呼吸机的故障排除方法。     

舒芬太尼应用于全身麻醉诱导及静脉术后镇痛的效果

目的探讨舒芬太尼应用于全身麻醉诱导及静脉术后镇痛的效果。方法回顾性分析2017年1月至2019年6月在天津市黄河医院接受手术治疗的88例患者的病历资料,根据麻醉方法不同分为试验组和对照组,每组44例。试验组予以舒芬太尼麻醉,对照组予以芬太尼麻醉,比较两组的麻醉效果与不良反应。结果试验组麻醉苏醒时间、自主呼吸恢复时间均短于对照组,疼痛阈值低于对照组,认知功能评分高于对照组,不良事件发生率低于对照组,差异均有统计学意义(P<0.05)。结论舒芬太尼能提高手术治疗患者的镇痛效果,缩短麻醉苏醒时间和自主呼吸恢复时间,提高认知功能,并降低不良事件发生率。     

便携式麻醉机的回顾与发展展望

介绍了便携式麻醉机的基本组成及其对于野战和院外急救具有的重要作用。对国内外便携式麻醉机的发展历史进行了回顾。指出便携式麻醉机正在朝着专业化、智能化、集成化的方向发展,多功能、耐用和结构紧凑是其发展的最终目标。     

Experience with the Direx Tripter X-1]

In nonselected patients 81.5% stone-free rate could be reached in 3 months. In authors's opinion Direx Tripter X-1 is suitable in the treatment of renal and ureteral calculi. They treated staghorn calculi by ESWL monotherapy with success. The Direx lithotripter was found to be effective and easy to operate; the potential cost reduction is of great significance. The treatment requires general anaesthesia and the equipment causes significant noise. After all, Direx lithotripter is a useful machine in the armamentarium of stone disease treatment.     

Assessing introduction of spinal anaesthesia for obstetric procedures.

To assess the impact of introducing spinal anaesthesia for obstetric operative procedures on use of general anaesthesia and quality of regional anaesthesia in a unit with an established epidural service a retrospective analysis of routinely collected data on method of anaesthesia, efficacy, and complications was carried out. Data were collected from 1988 to 1991 on 1670 obstetric patients requiring an operative procedure. The introduction of spinal anaesthesia in 1989 significantly reduced the proportion of operative procedures performed under general anaesthesia, from 60% (234/390) in 1988 to 30% (124/414) in 1991. The decrease was most pronounced for manual removal of the placenta (88%, 48/55 v 9%, 3/34) and emergency caesarean section (67%, 129/193) v 38%, 87/229). Epidural anaesthesia decreased in use most significantly for elective caesarean section (65%, 77/118 v 3% 3/113; x2=139, p<0.0001). The incidence of severe pain and need for conversion to general anaesthesia was significantly less with spinal anaesthesia (0%, 0/207 v 3%, 5/156; p<0.05). Hypotension was not a problem, and the incidence of headache after spinal anaesthetic decreased over the period studied. Introducing spinal anaesthesia therefore reduced the need for general anaesthesia and improved the quality of regional anaesthesia.     

建立临床麻醉信息系统的创新实践与现实意义

建立临床麻醉信息系统,可以实现手术麻醉过程的信息化管理,提高手术麻醉相关业务的质量和管理水平,提高医院信息系统数据的完整性。本文介绍了临床麻醉信息系统的组成和功能,主要描述了临床麻醉信息系统在解放军第251医院成功建设实施的情况及其现实意义。     

布比卡因脊麻和硬膜外阻滞用于剖宫产麻醉的临床观察

目的:观察布比卡因硬膜外麻醉和布比卡因重比重腰麻用于剖宫产手术的麻醉效果,以及对患者和胎儿的影响。方法:选择行择期剖宫产手术患者80例,随机分为硬膜外阻滞组和蛛网膜下隙阻滞组,每组40例。监测并记录患者麻醉前、硬膜外或蛛网膜下隙给药后各时点SBP、DBP、MAP、HR、SpO2的变化。记录硬膜外或蛛网膜下隙给药后药物起效时间和维持时间,评价两组患者肌松效果,记录两组患者术中牵拉反应、新生儿Apgar氏评分以及麻醉并发症。结果:SB组药物起效时间较EB组显著缩短(P<0.01)。EB组患者给药后10～30min患者MAP有明显下降(P<0.05),而给药后60～180min MAP水平与给药前相比无明显变化(P>0.05);SB组患者给药后3～10min患者MAP较给药前有显著下降(P<0.05),但给药后30～180min患者MAP与给药前相比无明显变化(P>0.05)。SB组肌松效果明显较EB组好(P<0.01),两组新生儿Apgar氏评分比较差异无显著性(P>0.05)。EB组患者术中有牵拉反应,而且术后出现腰背部疼痛;SB组并未出现此类症状。结论:针对剖宫产手术采用布比卡因重比重蛛网膜下隙阻滞是一种有效的麻醉方法。     

全麻复合硬膜外麻醉在高血压食管癌手术中的应用

[目的]探讨全麻复合硬膜外麻醉在合并高血压食管癌患者手术中的优越性。[方法]选择40例拟行食管癌手术的高血压患者,随机分为单纯全麻(GA)组和全麻复合硬膜外麻醉(CEGA)组,各20例。观察两组麻醉方法围手术期循环功能、全麻用药量和苏醒情况。[结果]CEGA组患者术中循环功能较稳定,全麻用药量小,苏醒快,躁动明显低于GA组。[结论]全麻复合硬膜外麻醉组(CEGA)在高血压患者食管癌手术中应用更安全,是一种较为理想的麻醉方法。     

实现麻醉信息化管理 提高麻醉工作水平

随着信息技术的发展和医院信息系统的广泛应用，医院各业务部门对信息的需求不断增加，越来越多的新系统被开发、应用于临床，《麻醉临床信息系统》就是近年来运用于临床的一个新系统，它能最大限度的提高麻醉医生的工作效率，使麻醉工作更加准确、安全。我院引进《麻醉临床信息系统》，并与我院自行开发的电子病历系统进行了整合，实现了手术麻醉过程的规范化和数字化管理，使医疗信息、麻醉信息充分共享，麻醉医生、手术医生共同受益，收到了很好的效果。     

Clearance and action of insulin during general or epidural anaesthesia

Surgery performed under general anaesthesia induces impaired glucose tolerance together with comparatively low levels of insulin. This contrasts with the normal glucose tolerance and normal insulin levels found in patients operated upon under epidural anaesthesia. The aim of this study was to investigate insulin clearance and insulin action during surgery. Sixteen non-diabetic patients admitted for elective inguinal herniorrhaphy were operated under general anaesthesia (thiopentone, N(2)O/O(2) (2 1 ), fentanyl, pancuronium bromide) or after high epidural blockade with mepivacaine. The clearance and hypoglycemic action of insulin were determined after a 2.5 min infusion of a physiologic dose of insulin. All patients were studied the day before operation and during surgery. The hypoglycemic action of insulin, expressed as % decrement from the pre-test blood glucose level, was unchanged during epidural anaesthesia but reduced during general anaesthesia (22.4 +/- 1.8% pre-operatively vs 7.5 +/- 1.3% intra-operatively, p < 0.01). The insulin resistance during general anaesthesia was associated with a decreased clearance of insulin (20.3 +/- 0.8 ml min(-1) kg(-1) pre-operatively vs 12.7 +/- 1.1 ml min(-1) kg(-1) intra-operatively, p < 0.01), whereas insulin clearance was normal during epidural anaesthesia. It is concluded that general anaesthesia, but not epidural anaesthesia, induces a reduction in both clearance and hypoglycemic action of insulin.     

Focus on the various techniques of anaesthesia in ophthalmologic surgery

Ophthalmologic surgery is not a vital one. It mostly concerns patients in extreme ages: children and old people. The risk of anaesthesia mainly depends on the health conditions of the patient. General anaesthesia through use of intravenous drugs alters the balance of the endocrine and sympathetic systems. Tracheal airway intubation constitutes an added constraint and stress especially for the vascular system. Retrobulbar anaesthesia is not devoid of risks: ptosis, diplopic, orbit haematoma, lesion of the optic nerve, eye perforation, vascular occlusion, intra arterial injection, neurologic and cardiovascular toxic effects of local anaesthetics, are all ever present risk Topical anaesthesia with its various variants (single topic or associated with intracameral injection, subconjunctival, circumferential perilimbal, subtenon) represents an interesting alternative for it is simple, less toxic and harless. In our experience, this method is indicated in surgery of eye's anterior segment. We find it safe, efficacisious and economical. Regional anaesthesia is preferred to general anaesthesia especially in the surgery of dacryocystitis and ptosis. General anaesthesia in stell indicated in case of children.     

异丙酚静脉麻醉在人流手术中的临床流行病学分析

目的　探讨异丙酚静脉麻醉在人流手术中的临床应用效果。　方法　选择自愿要求行人流术的早孕妇女460例 ,随机分为两组 ,一组用异丙酚静脉麻醉 ,另一组用利多卡因局麻 ,进行比较观察。　结果　异丙酚静脉麻醉下行人工流产术镇痛效果明显优于对照组 (P <0 0 1)。　结论　异丙酚静脉麻醉用于人流手术有临床应用价值。