丙泊酚复合瑞芬太尼全凭静脉或地氟醚平衡麻醉对听神经瘤手术后苏醒的影响

目的观察丙泊酚复合瑞芬太尼全凭静脉或地氟醚平衡麻醉对听神经瘤手术后苏醒的影响。方法40例ASAⅠ~Ⅱ级择期行乙状窦入路或颅中窝入路听神经瘤手术的成年患者,随机分为丙泊酚复合瑞芬太尼组(PR组,n=20)和地氟醚平衡麻醉组(DR组,n=20)。记录患者一般情况;记录唤醒时间、拔除气管导管时间和定向力恢复时间;记录2组患者手术结束时的麻醉深度、肌肉松弛恢复情况、拔管时心率和血压变化;记录术后不良事件。结果PR组唤醒时间早于DR组2.4 min(P=0.033);PR组拔除气管导管时间短于DR组4.9 min(P=0.002);PR组定向力恢复时间短于DR组23.7 min(P=0.049);PR组拔除气管导管时血压和心率变化均小于DR组(P<0.05)。结论丙泊酚复合瑞芬太尼全凭静脉麻醉用于听神经瘤手术利于患者术后快速苏醒,地氟醚组患者拔管时心率和血压变化较明显。     

丙泊酚复合顺式阿曲库铵对行喉罩全身麻醉患者眼压的影响

目的 比较全身麻醉前后眼压的变化及麻醉诱导情况下眼压的变化情况.方法 选择行眼科手术的患者70例(70眼),其中术前正常眼压35例(35眼),为视网膜玻璃体手术患者的正常眼;青光眼高眼压患者35例(35眼),为青光眼手术眼.常规行全身麻醉诱导.选择麻醉诱导前(T0)、充分镇静后(T1)、充分肌肉松弛后(T2)及置入喉罩...     

七氟烷联合右美托咪啶对眼科患儿全身麻醉苏醒期躁动的影响

目的：研究七氟烷联合右美托咪啶对眼科患儿全身麻醉苏醒期躁动(EA)的影响。

方法：抽取2018-05/12我院84例择期行眼科手术的患儿为研究对象,随机分为研究组和对照组各42例。均给予吸入七氟烷维持全身麻醉,麻醉插管完成后研究组患儿给予右美托咪啶0.5μg/kg静脉恒速泵注,对照组患儿给予等容量生理盐水。获取苏醒期心率(HR)、平均动脉压(MAP)及血清应激反应指标去甲肾上腺素(NE)、皮质醇(Cor)监测数据,并记录麻醉恢复、EA及并发症发生情况。

结果：对照组患儿清醒时、拔管后1、5、10min的HR、MAP均明显波动,各时点有明显差异(P<0.05),而研究组无差异(P>0.05),且研究组各时点HR、MAP均低于对照组(P<0.05)。研究组患儿清醒时、拔管后10min血清NE、Cor水平均低于对照组(P<0.05)。两组患儿自主呼吸恢复时间、清醒时间无差异(P>0.05),但与对照组相比,研究组患儿拔管时间短,拔管质量评分低(P<0.05)。研究组患儿EA发生率仅12%,低于对照组的31%(P<0.05),EA程度及并发症发生率无差异(P>0.05)。

结论：七氟烷联合右美托咪啶可有效稳定眼科患儿全身麻醉苏醒期血流动力学,减轻应激反应,有效降低EA发生率,且不影响麻醉恢复质量,安全性较高,但需注意过度镇静现象。     

糖皮质激素受体在豚鼠耳蜗的分布及声损伤对其表达的影响

目的 研究糖皮质激素受体(GR)在豚鼠耳蜗的分布及声损伤对豚鼠耳蜗GR表达的影响.方法 将豚鼠随机分为2组:实验组豚鼠在强度115 dB SPL的白噪声中暴露3h.暴露结束后2h,断头取耳蜗.对照组豚鼠不做处理,取耳蜗.制备耳蜗冷冻切片,采用免疫荧光技术观察豚鼠耳蜗的GR表达情况,并进行荧光强度半定量分析.结果 ①豚鼠耳蜗GR主要的阳性部位:螺旋韧带、血管纹、骨螺旋缘、Corti器及螺旋神经节.螺旋韧带、血管纹、骨螺旋缘及螺旋神经节等区域的GR荧光强度差异无统计学意义(P＞0.05),上述各区域的GR荧光强度与Corti器的GR荧光强度差异有统计学意义(P＜0.05).②声损伤后,豚鼠耳蜗的GR荧光强度在骨螺旋缘、Corti器及螺旋神经节较对照组差异无统计学意义(P＞0.05);螺旋韧带、血管纹区域荧光强度较对照组明显减低,差异有统计学意义(P＜0.01).结论 GR分布于豚鼠耳蜗的螺旋韧带、血管纹、Corti器和螺旋神经节,其中螺旋韧带、血管纹表达最强,Coni器表达最弱;声损伤降低耳蜗各区域GR的表达,以血管纹、螺旋韧带最明显.     

七氟烷、笑气复合七氟烷以及静脉丙泊酚用于小儿斜视手术麻醉的特点比较

目的比较七氟烷、联合氧化亚氮及丙伯酚全麻下行小儿斜视矫正术中麻醉方法的特点。方法择期行小儿斜视手术患儿120例,年龄1-11岁,随机分为三组:七氟烷(S)组(n=40),七氟烷-氧化亚氮(SN)组(n=40),丙泊酚(P)组(n=40),麻醉诱导和维持S组及SN组分别吸入3%七氟烷或3%七氟烷-60%氧化亚氮,P组予以丙泊酚。三组均静脉输入瑞芬太尼0.3μg·kg-·1min-1,意识消失后给予阿曲库铵0.5mg/kg,直视下行气管插管。P组丙泊酚8mg·kg-·1min-1静脉维持。记录患儿诱导及气管插管反应、插管所用时间、瑞芬太尼总用量,在诱导前、诱导后、插管即刻、手术10min、牵拉眼肌及拔管后5min记录HR、MAP、Ppeak、PETCO2以及苏醒情况。记录拔管后发生的不良反应。结果诱导时肢动比较,P组20例,SN组7例,S组9例,三组间比较有统计学意义(P<0.01)。插管反应的比较有统计学意义(P<0.01)。诱导期睫毛反射消失、疼痛反应消失时间及用药至插管时间,三组间有统计学意义,(P<0.001)。MAP在插管时、插管后10min、牵拉眼肌时以及HR在后两个时点均有统计学意义(P<0.01)。MAP均为P组最高、SN组最低。HR则为P组最低、SN组最高。术中出现眼心反射,P组为21例,SN组为0例,S组为1例。PETCO2在各时间点比较,SN组最高,S组最低,有统计学意义,(P<0.05)。Ppeak在前三个时点则有相反变化,即SN组最低、S组最高,有显著统计学意义,(P<0.05)。苏醒时间P组最短,SN组最长。结论七氟烷诱导平顺,血液动力学稳定,可以明显减少眼心反射的发生;丙泊酚静脉麻醉术后苏醒快,较少发生躁动。     

表面麻醉下白内障超声乳化手术对正常眼表的影响

目的:探讨表面麻醉下白内障超声乳化摘除术对正常眼表的影响。方法:对34例(40眼)行白内障超声乳化摘除合并人工晶状体植入术的患者,观察术前、术后3,10d;1,3mo的干眼症状(干涩感、异物感、烧灼感),泪膜破裂时间(BUT)、基础泪液分泌试验(Schinner′I试验)、角膜荧光素染色,并对数据进行统计学分析。结果:白内障超声乳化术后10d内患者有明显的干眼症状,术后3d和10d荧光素试验较术前明显增多;而且泪液分泌量术后10d较术前明显减少(P<0.05);术后1～3mo接近术前水平(P>0.05)。术后3,10dBUT均较术前明显缩短(P<0.05);1～3mo后接近术前水平(P>0.05)。结论:表面麻醉下超声乳化白内障摘除术对眼表具有一定程度的影响,发生机制可能与多种因素有关,临床应积极采取预防、治疗措施。     

显微镜下斜视矫正术对斜视患者视觉恢复及并发症的影响

目的探讨微镜下斜视矫正术对斜视患者视觉恢复及并发症的影响。方法选取2017年3月-2018年7月在我院进行治疗的斜视患者78例,参照随机数字表法的分组方式,分为传统组和显微组,每组各39例。传统组患者采用传统手术治疗,显微组患者采用显微镜下斜视矫正术进行治疗,观察分析两组患者临床指标、视觉恢复状况及不良反应现象。结果显微组患者手术时间及术中出血量显著低于传统组患者,差异有统计学意义(P<0.05);显微组患者视觉恢复状况显著高于传统组患者,差异有统计学意义(P<0.05);显微组患者不良反应发生率显著低于传统组患者,差异有统计学意义(P<0.05)。结论采用显微镜下斜视矫正术治疗可改善斜视患者临床症状,促进视觉恢复,且产生的不良反应较少,安全性较高。     

泪道置管术治疗泪道阻塞或狭窄的临床疗效及并发症处理

目的探讨泪道置管术治疗泪道阻塞或狭窄的临床疗效及术后并发症和处理。方法选取2014年1月至2015年1月因泪道阻塞或狭窄在我院行泪道置管患者34例(41只眼),所有患者均由同一医师完成手术操作、术后复诊及问卷调查。结果 33例(40只眼)完成泪道置管治疗,末次随访时,治愈19只眼,有效14只眼;总有率82.5%。完成泪道置管的33例中28例对治疗结果表示满意,满意率84.85%。术中泪道结构破坏3只眼,记忆针芯出鼻腔困难2只眼,术后眼球复视1只眼,术后内眦部磨3只眼,术后泪囊区疼痛不适19只眼,内眦部痒10只眼,泪小点撕裂1只眼,在戴管过程中出现脓性分泌物2只眼,置入管移位4只眼,术后拔管时仍有流泪症状14只眼,拔管后因流泪症状复发再次就诊7只眼。结论泪道置管术是治疗泪道阻塞或狭窄的有效方法,患者满意度佳。术前鼻腔情况的评定、术中术后泪小点的保护及针对不同的患者,个性化选择置入管及手术方式对减少术后并发症的出现非常重要。     

晚期青光眼术前含服心痛定预防球后麻醉致一过性黑朦

为评价晚期青光眼患者抗青光眼手术中用心痛定预防球后麻醉后发生一过性黑朦的效果,我们对１０２例（１１４眼）晚期青光眼患者于麻醉前１０分钟舌下含服心痛定１０ｍｇ,并与未含服心痛定的对照组２６８例（３０２眼）进行对照研究,结果发现麻醉前含服心痛定组无１例发生一过性黑朦,而对照组却有１０例（３．３１％）发生一过性黑朦,提示心痛定能预防晚期青光眼患者术中球后麻醉后一过性黑朦并发症的发生。     

Effect of Honan balloon compression on peribulbar anesthesia adequacy in cataract surgery.

PURPOSE: To ascertain whether a Honan balloon is necessary to produce effective peribulbar anesthesia in routine cataract surgery by evaluating its effect on intraocular pressure (IOP), surgeon assessment of the anesthesia's effectiveness, and patients' analgesic experience. SETTING: West of England Eye Unit, Royal Devon and Exeter Hospital, England. METHOD: Fifty eyes of 50 patients having routine phacoemulsification cataract extraction and intraocular lens implantation were randomized to have 10-minute ocular compression with the Honan balloon or no compression after peribulbar anesthesia. A single investigator gave all the peribulbar injections using a standard technique. The IOP was measured immediately before and 10 minutes after the injections. Two surgeons who were blinded to the randomization process performed the surgeries and completed an assessment questionnaire on various aspects of the peribulbar block. The patients also scored their level of analgesia during surgery. RESULTS: In the 26 patients who had Honan balloon compression, there was a significant reduction in IOP (mean 6.2 mm Hg; P <.05). In the 24 patients with no balloon compression, there were no significant changes in IOP 10 minutes after the peribulbar injections. There was no statistically significant difference in the surgeons' scores in any aspect of the peribulbar anesthesia (P >.05). All patients experienced a good level of analgesia. CONCLUSIONS: There was a significant reduction in IOP after Honan balloon ocular compression. However, there was no significant increase in IOP without balloon compression. The use of a Honan balloon did not appear to make a significant difference in the effectiveness of the peribulbar anesthesia to the surgeons or patients.     

Tenon囊下麻醉对眼压及眼脉动振幅的影响

目的探讨Tenon囊下麻醉对对眼压(IOP)以及眼脉动振幅(OPA)的影响。方法随机选择单眼白内障患者30例,患眼施行Tenon囊下麻醉,另眼设为对照。分别于麻醉前以及麻醉后1、10 min采用动态轮廓眼压计(DCT)测量注射眼和对照眼的IOP及OPA值,比较分析麻醉前后IOP和OPA的变化。结果注射利多卡因后注射眼和对照眼的眼压均无明显变化。注射眼OPA值在麻醉后即显著下降,而对照眼在注射后10 min OPA值开始降低。结论Tenon囊下麻醉可导致OPA降低,而对眼压无影响。     

Effect of general inhalational anesthesia on intraocular pressure measurements in normal and glaucomatous children

Purpose

To investigate the agreement between the intraocular pressure (IOP) measurements in the awake condition and under different stages of general inhalational anesthesia using sevoflurane in both glaucomatous and normal children.

Methods

A prospective study was performed on 43 glaucomatous children and 30 age-matched controls. Baseline IOP of one eye was measured immediately before general anesthesia using Perkins tonometer and then re-measured under light, intermediate, and deep anesthesia, and then after intubation. Depth of anesthesia was determined using bispectral index pediatric sensor. The agreement between the IOP measurements before and during different stages of anesthesia was analyzed using Bland–Altman plots. Systematic and proportionate deviations between the IOP measurements were analyzed.

Results

The mean age was 58.6?±?41.99 months. The mean IOP was significantly lower at all stages of anesthesia in both groups. The coefficient of variation was over 20% in all measurements under anesthesia. For all IOP measurements during anesthesia, the limits of agreement were?>?7 mmHg difference in the control group and?>?20 mmHg in the glaucomatous group. The best agreement was with the IOP measurement after intubation (mean limit of agreement of -1.4 mmHg, 1.96 s range, ?8.8–6 mm Hg) in the control group and with the IOP measurement under intermediate anesthesia (mean limit of agreement of ?4.2 mmHg, 1.96 s range, ?15.1–6.8 mm Hg) in the glaucomatous group.

Conclusions

Inhalational anesthesia has variable effects on IOP measurement at all stages of anesthesia. Caution should be taken when extrapolating the true IOP from these measurements.

     

Alteration of electroretinographic recordings when performed under sedation or halogenate anesthesia in a pediatric population

Fran The effects of sedation and of halogenate anesthesia on electroretinographic recordings were investigated by reviewing the hospital charts of 27 patients who were eventually diagnosed free of retinal disease. The same ERG protocol was performed in conscious (n=9), sedated (chloral hydrate or pentobarbital sodium, n=9) and anesthetized (halothane or isoflurane, in combination with N2O, n=9) young patients. Sedation decreased the a- and b-wave amplitude of the scotopic bright-flash response, without affecting implicit times. ERG recordings performed in photopic conditions showed minimal disturbances. Anesthesia spared the a-wave of the scotopic bright-flash response but decreased more severely the b-wave. In addition, anesthesia reduced the amplitude and prolonged the implicit time of the photopic responses, affecting predominantly the ionotropic glutamate dependent OFF components (peak of b-wave, 0P4 and 0P5). The normal retinal physiology is affected by sedation and anesthesia through different mechanisms that still remain to be fully elucidated. These alterations in electroretinographic recordings must be considered when evaluating ERGs obtained under similar sedation/anesthetized conditions.