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

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.     

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.     

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

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.     

双管喉罩在脊柱后路手术中的安全性和有效性

目的 探讨双管喉罩在脊柱后路手术中应用的临床效果及安全性.方法 40例ASA分级Ⅰ～Ⅱ级择期行胸腰椎骨折手术患者按照机械抽样法随机分为双管喉罩组和气管插管组,每组20例.两组患者常规麻醉诱导后,分别置入双管喉罩或气管插管.观察记录操作次数、时间;记录诱导前(T0),置入即刻(T1),置入后1 min(T2)、3 min(T3)、5 min(T4)、10 min(T5)及拔除即刻(T6)的收缩压、舒张压、心率;记录置入、拔除及维持通气过程中的并发症.结果 两组置人双管喉罩和气管插管均一次成功,所需时间比较差异无统计学意义(P＞0.05).气管插管组T1、T2、T3、T6时收缩压、舒张压、心率显著高于T0(P＜0.05),且也显著高于双管喉罩组(P＜0.05).气管插管组置人、拔除、维持通气过程中发生并发症者(5、25、36例次)明显多于双管喉罩组(0、1、6例次)(P＜0.05).结论 双管喉罩用于脊柱后路手术是安全和有效的.

Abstract：

Objective To explore the effect iveness and safety of ProSeal laryngeal mask(PLMA)used in posterior spinal surgery. Methods Forty ASA Ⅰ - Ⅱ patients of thoracic-lumbar fracture were randomly divided into PLMA group and tracheal intubation (TI) group by systematic sampling with 20 cases each. PLMA or TI was inserted after intravenous anesthesia induction. The number of intubation, intubation time and time to surgery were recorded, systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded induction (To), during intubation (T1), at 1 min (T2),3 min(T3), 5 min (T4), 10 min after intubation (T5), during extubation (T6). The intubation, extubation, and the maintain ventilation process of the respiratory and respiratory damage were recorded. Results All patients in PLMA group and TI group achieved satisfactory lung ventilation at the first attempt. There were no significant difference in the number of intubation, intubation time and time to surgery between two groups (P ＞ 0.05 ).SBP,DBP,HR at T1,T2,T3,T6 in TI group were significandy higher than To and those in PLMA group (P＜0.05). The intubation, extubation, and the maintain ventilation process of the respiratory and respiratory damage in TI group (5,25,36 cases) were more than those in PLMA group (0,1,6 cases)(P ＜0.05).Conclusion PLMA for posterior spinal surgery is safe and effective.     

等效镇痛剂量舒芬太尼和瑞芬太尼呼吸抑制作用的比较

Objective To observe the respiratory depression of sufentanil and remifentanil with target-controlled infusion under propofol sedation or not, and compare the effect of respiratory depression of the two drugs. Methods Eighty patients scheduled for elective neurosurgery were allocated into four groups by random digits table: the sufentanil group (group S), the remifentanil group (group R), the combination of sufentanil and propofol group (group SP) and the combination of remifentanil and propofol group (group RP),each group was 20 cases. The respiratory rate (RR), minute ventilation (MV),partial pressure of end-tidal carbondioxide ( PETCO2), pulse oxygen saturation (SpO2), mean arterial pressure ( MAP ), heart rate (HR), observer's assessment of alertness/sedation (OAA/S) were measured and respiratory depression was defined as one of the following end points were achieved: muscle rigidity, RR ＜ 6 beats/min, MV ＜ 3 L/min,PETCO2 ＞ 55 mm Hg ( 1 mm Hg = 0.133 kPa), SpO2 ＜ 0.90 or apnea ＞ 15 s. Results The calculated effect concentration (Ce) of sufentanil for respiratory depression were (0.46 ± 0.14) μ g/L in group S and (0.23 ±0.06) μ g/L in group SP, and Ce of remifentanil for respiratory depression were (5.22 ± 2.11 ) μ g/L in group R and (2.22 ± 1.02) μ g/L in group PP. Some respiratory parameters,such as RR,MV were decreased and PETCO2 was increased significantly as the increase of Ce. Conclusions Target-controlled infusion of equal analgesic plasma concentration of sufentanil and remifentanil can suppress spontaneous respiration significantly with the increase of plasma concentration. There will be a synergetic effect after combining with propofol, and respiratory depression will appear at lower concentration. But equal analgesic plasma concentration of the two drugs have no significant difference in the effect of respiratory depression.     

雷米芬太尼在清醒状态下切除脑功能区肿瘤的临床应用

目的 探讨雷米芬太尼在清醒状态下切除脑功能区肿瘤的临床应用.方法 24例脑功能区肿瘤患者,ASA分级Ⅱ～Ⅲ级;采用机械抽样法随机分为对照组和雷米芬太尼组,每组12例.全部患者以0.2%罗哌卡因沿切口行局部浸润麻醉.雷米芬太尼组术中以微量泵持续静脉注射雷米芬太尼0.05～0.10μg/(kg·min),根据手术需要作适当调整;对照组术中以0.9%氯化钠代替雷米芬太尼.两组均保持术中患者意识清醒,监测术中血流动力学变化和并发症情况,记录术后患者对手术过程的满意度.结果 两组患者均能在清醒状态下配合完成手术,雷米芬太尼组的平均动脉压和心率在开颅、颅内手术期、关颅时点均明显低于对照组(P<0.05),未见明显呼吸抑制、恶心呕吐、烦躁不安等并发症,雷米芬太尼组术后满意度评分为(3.3±0.6)分,明显高于对照组的(2.4±0.5)分,差异有统计学意义(p<0.05).结论 在局部麻醉切除脑功能区肿瘤时合理应用雷米芬太尼,可使患者血流动力学稳定,且手术耐受性良好.

Abstract：

Objective To investigate the clinical application of remifentanil in awake state for removal of tumors in functional brain area. Methods Twenty-four patients with tumors in functional brain area were divided into two groups by random digits table with 12 cases each:control group and remifentanil group. Infiltration anesthesia was used in all patients with 0.2% ropivacaine. Remifentanil was injected intravenously with micropump in 0.05-0.10 μg/ (kg·min) in remifentanil group and 0.9% sodium chloride was instead of remifentanil in control group. Patients remained awake during surgery in both groups. The hemodynamic changes and complications during operation were monitored. The satisfaction for surgical procedure was evaluated. Results The patients in two groups could be completed in awake state with surgery;mean artery pressure, heart rate in remifentanil group during opening or closing skull or intracranial period were significantly higher than those in control group(P< 0.05). There were no conspicuous complication in two groups such as respiratory depression, nausea, vomitting and dysphoria. The satisfaction score in remifentanil group[(3.3 ?0.6) scores] was higher than that in control group[(2.4 ?0.5) scores],there was significant difference between two groups (P<0.05). Conclusion Awake brain tumor surgery could be completed in rational use of remifentanil on the base of good local anesthesia, and hemodynamics are stable and the patients are well tolerated.     

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.

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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.     

预注不同剂量雷米芬太尼对依托咪酯引发肌震颤影响的因素分析

目的 探讨预注不同剂量雷米芬太尼对依托咪酯引发肌震颤的影响.方法 选择ASA分级Ⅰ～Ⅱ级,体重指数20～24 kg/m2,无神经肌肉传导功能障碍性疾病的择期手术患者75例,按随机数字表法分为三组:雷米芬太尼0.5 μg/kg组(A组)、雷米芬太尼1.0 μg/kg组(B组)和对照组(C组).预注雷米芬太尼或0.9%氯化钠,2 min后静脉注射依托咪酯0.3 mg/kg;记录预注前即刻及预注结束后1、2 min的收缩压、舒张压、心率、脉搏血氧饱和度(SpO2),观察肌震颤程度并进行评分.结果 三组各时间点收缩压、舒张压、心率、SpO2比较差异均无统计学意义(P＞0.05).A组和B组肌震颤发生率分别为24.0%(6/25)、12.0%(3/25),较C组的64.0%(16/25)明显降低(P＜0.01);体重60～69 kg、≥70 kg患者肌震颤发生率分别为48.0%(12/25)、45.5%(5/11),明显高于体重40～49 kg患者的14.3%(3/21)(P＜0.05).结论 预注雷米芬太尼0.5或1.0 μg/kg均能够显著降低依托咪酯引发的肌震颤,且对呼吸系统和循环系统没有明显影响.     

高频喷射通气对单肺通气患者氧化应激反应的影响

目的 研究高频喷射通气(HFJV)对单肺通气患者氧化应激反应的影响.方法 择期行食管癌根治术患者45例,按随机数字表法分为双肺通气组(A组)、单肺通气组(B组)、单肺通气时非通气侧给予HFJV(驱动压力1 kg/cm2,频率100次/min)组(C组),每组15例.分别于开胸前(T0),单肺通气后(A组于开胸后)30 min(T1)、90 min(T2)、150 min(T3),手术结束时(T4)测定超氧化物歧化酶(SOD)活性及丙二醛(MDA)、一氧化氮(NO)浓度.结果 T2～T4时B、C组SOD活性[B组:(47±10)、(37±9)、(41±7)kU/L;C组:(58±12)、(51±11)、(49±9)kU/L]低于A组[(78±8)、(75±7)、(79±6)kU/L](P＜0.05),T1～T4时B、C组MDA、NO浓度高于A组(P＜0.05);T3时C组SOD活性明显高于B组(P＜0.05),T1～T4时C组MDA浓度及T2～T4时NO浓度低于B组(P＜0.05).结论 HFJV能在一定程度上抑制单肺通气患者的氧化应激反应.

Abstract：

Objective To determine the effects of high-frequency jet ventilation (HFJV) on oxidative stress in patients during one-lung ventilation (OLV). Methods Forty-five patients undergoing elective radical esophageal cancer resection were divided into three groups with 15 cases each by random digits table: two lung ventilation group ( group A), OLV group (group B), HFJV- OLV group ( group C, working pressure 1 kg/cm2 and frequency 100 times/min). Venous blood samples were taken before induction (T0),at30min (T1),90min (T2),150min (T3) after OLV and the end of operation (T4) for measuring serum superoxide dismutase(SOD),malondialdehyde (MDA) and nitric oxide (NO). Results SOD was lower at T2-T4 in group B[(47 ± 10), (37 ±9), (41 ±7) kU/L] and group C[(58 ± 12), (51 ± 11), (49 ± 9) kU/L] than those in group A [(78 ±8), (75 ±7), (79 ±6) kU/L](P＜ 0.05),and MDA and NO were lower at T1-T4 in group B and group C than that in group A(P＜ 0.05). SOD was higher at T3 in group C than that in group B (P ＜ 0.05), MDA at T1-T4 and NO at T2-T4 were lower in group C than those in group B (P ＜ 0.05). Conclusion HFJV can effectively decrease oxidative stress in patients during OLV.     

七氟烷复合咪达唑仑、瑞芬太尼、普鲁泊福用于术中无肌肉松弛药麻醉效果的观察

目的 评价吸入麻醉剂七氟烷复合咪达唑仑、瑞芬太尼、普鲁泊福在患者短小手术中无肌肉松弛药的麻醉效果.方法 选择全麻手术患者50例,ASA分级Ⅰ～Ⅱ级.麻醉诱导:静脉注射咪达唑仑0.03 mg/kg后面罩吸入七氟烷,待患者睫毛反射消失时,1 min内缓慢静脉注射瑞芬太尼2μg/kg,同时继续吸入七氟烷,30 s后气管插管行机械通气.麻醉维持:七氟烷持续吸入、普鲁泊福和瑞芬太尼持续泵注.于诱导前、睫毛反射消失时、气管插管前即刻和气管插管后即刻,记录平均动脉压(MAP)、心率、脉搏血氧饱和度(SpO_2)和脑电双频指数(BIS);记录从开始吸人七氟烷到睫毛反射消失时间;评估气管插管条件,术毕停药后记录呼之睁眼时间、自主呼吸恢复时间、拔管时间及清醒程度(采用拔管后5 min镇静评分判断).结果 50例患者均一次性完成气管插管,气管插管条件达优率为82%(41/50),从开始吸入七氟烷到睫毛反射消失时间为(73±12)s,气管插管后即刻MAP、心率和SpO_2与气管插管前即刻比较差异无统计学意义(P>0.05).气管插管前后维持BIS在45～55.术后苏醒迅速,苏醒质量优良.结论 七氟烷复合咪达唑仑、瑞芬太尼麻醉诱导平稳,气管插管条件优良,再复合普鲁泊福维持麻醉后患者苏醒迅速完全,短小手术中无肌肉松弛药麻醉是一种安全可行的麻醉方法.     

全静脉麻醉与静吸复合麻醉对老年患者术后认知功能的影响

目的探讨丙泊酚与瑞芬太尼、异氟醚与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 60例ASAⅠ～Ⅱ级老年腹部手术患者随机分为两组,全静脉组(A组n=30)、静吸复合组(B组n=30)。两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,分别以瑞芬太尼5～8μg/kg和丙泊酚6～8mg/kg、1.0MAC的异氟醚和丙泊酚6～8mg/kg维持麻醉,分别观察患者术前、术后1,6,12,24,48h认知功能MMS值的变化。结果全静脉组在术后1～12h三个时间点MMS值降低(p<0.05),24h及48h与术前无差异(p>0.05);静吸复合组在术后1～24h四个时间点MMS值降低(p<0.05),48h与术前无差异(p>0.05);在术后1,6h两个时间点静吸复合组相比全静脉组MMS值降低(p<0.05)。结论在术后认知功能的恢复方面,丙泊酚与瑞芬太尼用于老年病人麻醉较异氟醚与丙泊酚更优。     

芬太尼、瑞芬太尼和舒芬太尼联合异丙酚在人工流产镇痛中的比较

目的:比较芬太尼、瑞芬太尼和舒芬太尼联合异丙酚在人工流产镇痛中的镇痛效果、并发症的发生率和唾液皮质醇的变化,探索一种安全有效的人工流产镇痛药物组合。方法:选择妊娠6~12周的患者240例,随机分为芬太尼组(F组)、瑞芬太尼组(R组)和舒芬太尼组(S组),每组80例。手术前1小时阴道放置米索前列醇400μg,手术开始前静脉推注麻醉性镇痛药:F组芬太尼1.5μg/kg,R组瑞芬太尼1.5μg/kg,S组舒芬太尼0.1μg/kg;接着追加异丙酚2 mg/kg。记录生命体征变化,观察宫颈松弛程度、手术时间、术后唤醒时间,观察术中呼吸抑制、术后恶心呕吐、下腹疼痛情况和手术前、后的唾液皮质醇的变化。结果:3组的手术时间、宫颈松弛度、体动反应差异无显著性意义(P>0.05)。S组苏醒时间比F、R组长(P<0.05)。R和S组的低血压发生率比F组高(P<0.05);R和S组的呼吸抑制发生率比F组高(P<0.05)。3组术后30min、2 hr疼痛VAS评分R组比F、S组高(P<0.05)。术后1天R组皮质醇比F、S组高(P<0.05),而F、S组之间差异无统计学意义。结论:芬太尼或瑞芬太尼比舒芬太尼联合异丙酚更适合作为人工流产的镇痛药物。     

瑞芬太尼全麻插管期间听觉诱发电位和血流动力学变化的研究

目的 探讨瑞芬太尼插管期间听觉诱发电位和血流动力学的变化,评价瑞芬太尼抑制气管插管时心血管的副反应,为临床寻求一种安全有效的方法。方法 将30例ASAI-Ⅱ级患者分成二组,麻醉诱导前4min,观察组（Ⅰ组）静注瑞芬太尼1μg/kg后,以美国百特BaxterAS40A型微量泵持续静注瑞芬太尼0．1μg／（kg·min）,诱导时,瑞芬太尼改为0．05μg／（kg·min）。对照组（Ⅱ组）以持续静注艾司洛尔300μg／（kg·min）,诱导时改为200μg／（kg·min）。后静注麻醉诱导剂,待肌肉完全松弛时行气管内插管,至插管后10min停药。比较两组治疗期间AAI、ECG、HR、SBP、RPP,经统计学处理。结果 两组患者各时间点的AAI值无显著性差异（P〉0．05）,观察组ISBP、HR、RPP在气管插管后的全过程变化小。结论 瑞芬太尼静注能够更有效地抑制气管插管时的心血管副反应。     

地佐辛用于全麻诱导的舒适度研究

目的对比研究地佐辛与芬太尼用于全麻诱导对病人舒适度的影响。方法 120例ASAⅠ～Ⅱ级择期手术全麻患者,随机分为D组和F组,每组60例。D组静脉注射0.2 mg.kg-1地佐辛进行麻醉诱导,F组则静脉给予3μg.kg-1芬太尼进行麻醉诱导。观察并记录诱导时丙泊酚的注射痛评分及发生率,插管前呛咳程度及发生率,拔管即刻(T1)、拔管后5 min(T2)的躁动评分,拔管后呕吐发生情况,术后4、8、12小时的VAS评分值,及术后24小时的满意度评分。结果 D组丙泊酚的注射痛评分及发生率,插管前呛咳程度及发生率,拔管即刻(T1)、拔管后5 min(T2)的躁动评分,拔管后恶心呕吐发生率,术后4、8、12小时的VAS评分均低于F组,差异均有统计学意义(p<0.05);D组术后24小时的满意度评分高于F组,差异有统计学意义(p<0.05)。结论地佐辛用于全麻诱导可提高患者的舒适度。     

瑞芬太尼全麻诱导气管插管对血流动力学的影响

目的观察瑞芬太尼全麻诱导插管对血流动力学的影响,探讨瑞芬太尼减轻全麻气管插管引起应激反应的效果及安全性。方法选择期手术、ASAⅠ-Ⅱ级患者40例,随机分为观察组和对照组,每组20例。两组患者入室后静脉输注乳酸钠林格注射液(10ml/kg),观察组依次静注咪达唑仑0.04mg/kg、顺苯磺酸阿曲库铵0.15mg/kg、依托咪酯0.15mg/kg、瑞芬太尼2ug/kg、异丙酚1mg/kg,2min后行气管插管,对照组用生理盐水代替瑞芬太尼,余同观察组用药。记录麻醉诱导前,插管前即刻,插管后1min、3min、5min的HR、MAP及ECG变化。结果与诱导前比较,插管前观察组MAP呈显著性降低(P<0.01);插管后1min对照组MAP显著性增高(P<0.01),而观察组低于诱导前水平(P<0.05);插管后5min两组患者达诱导前水平(P<0.05),组间比较无统计学意义(P>0.05)。插管后1min对照组HR显著高于诱导前(P<0.01),其余各时点两组组内及组间比较无统计学意义(P>0.05)。对照组4例ECG观察到明确的ST-T改变。结论瑞芬太尼可明显减轻气管插管时的心血管反应,但对血容量不足的患者可能存在严重低血压的潜在风险。     

四种常用全麻诱导插管方法对血流动力学的影响

目的观察对比依托咪酯、咪唑安定、异丙酚与咪唑安定联合异丙酚全身麻醉快速诱导对气管插管血流动力学的影响。方法选择ASA I~Ⅱ级需行气管插管全麻的病人60例,随机分为四组(n=15):依托咪酯组(A组)、咪唑安定组(B组)、异丙酚组(C组)与咪唑安定-异丙酚(D组)。麻醉诱导:静脉全麻药A组依托咪酯0.3 mg/kg、B组咪唑安定0.3 mg/kg、C组异丙酚2 mg/kg与D组咪唑安定1 mg/kg+异丙酚1 mg/kg,合用药物均为芬太尼3μg/kg和维库溴铵0.1 mg/kg,诱导后5 min行气管插管。监测记录麻醉前后各时点的BP、HR,观察有无不良反应。结果诱导后各组BP、HR均有下不同程度下降,B、C组BP、HR变化最大,与诱导前比差异有显著性意义(p<0.05);插管后各组BP、HR均有所回升,以A组变化最大,与诱导前比差异有显著性意义(p<0.01);D组插管前、后与基础值比差异无显著性意义(p>0.05)。结论依托咪酯诱导对心血管系统无明显影响,但不能有效抑制气管插管的高血流动力学反应;咪唑安定、异丙酚与咪唑安定联合异丙酚均能有效抑制气管插管的高血流动力学反应,但咪唑安定、异丙酚诱导后对血流动力学影响较大,应引起临床上的注意,咪唑安定联合异丙酚麻醉诱导血流动力学更平稳。     

右美托咪啶对腹腔镜结肠癌切除术患者循环和呼吸的临床观察

目的评估右美托咪啶在腹腔镜下结肠癌切除术患者全麻诱导期中的镇静效应及其对循环和呼吸的影响。方法 60例行结肠癌切除术择期手术成年人,随机分为2组,每组30例。诱导开始后分别在10 min内给予右美托咪啶0.05μg/kg(D组)和咪唑安定对照组0.2 mg/kg(M组)静脉泵注。随后再静注芬太尼、异丙酚、维库溴铵行气管插管。记录诱导前(T1)、诱导开始后10 min(T2)、插管前(T3)、插管后即刻(T4)的脉搏血氧饱和度(SpO2)、呼吸频率(RR)、心率(HR)、收缩压(SBP)和舒张压(DBP)。结果 T2时点D组Ramsay评分值明显大于M组,有统计学差异(p<0.05)。组间比较M组T2和T3时点心率明显高于D组(p<0.05)。与T1时比较,D组的SBP和DBP均显著下降(p<0.05),M组在T3时SBP和DBP显著下降(p<0.05)。结论右美托咪啶在结肠癌切除术患者全麻诱导中可减少气管插管血流动力学变化,提供良好的镇静效应。     

帕瑞昔布钠抑制瑞芬太尼术后痛觉过敏的量效关系

目的探讨帕瑞昔布钠抑制瑞芬太尼致患者术后痛觉过敏的量效关系。方法选择我院2010年1～6月期间,择期全麻下妇科腹腔镜手术患者40例,年龄19～45岁,体重45～70 kg,ASA I～II级。静脉注射芬太尼、丙泊酚和阿曲库铵麻醉诱导后,气管插管行全凭静脉全麻。术中静脉输注0.12μg.kg-1.min-1瑞芬太尼和75～200 mg.kg-1.min-1丙泊酚,间断静脉注射阿曲库铵维持麻醉。麻醉诱导后,采用序贯法静脉注射帕瑞昔布钠,初始剂量为0.6 mg/kg,相邻梯度为0.2 mg/kg,采用概率单位法计算患者术后痛觉过敏抑制时（气管拔管后10 min时VAS评分〈4分）帕瑞昔布钠的半数有效剂量（ED50）、95%有效剂量（ED95）及其95%可信区间。结果帕瑞昔布钠抑制瑞芬太尼致患者术后痛觉过敏的ED50（95%可信区间）为0.63 mg/kg（0.52mg/kg～0.75 mg/kg）,ED95（95%可信区间）为1.10 mg/kg（0.86 mg/kg～2.81 mg/kg）。结论帕瑞昔布钠抑制瑞芬太尼致患者术后痛觉过敏的ED50和ED95分别为0.63 mg/kg和1.10 mg/kg。