芬太尼与异丙酚联合静脉麻醉用于人工流产术效果观察

对280例早孕妇女采用1μg/kg芬太尼与1－1.5mg/kg异丙酚联合静脉麻醉下行无痛人工流产术，并与无麻醉下人工流产术300例进行比较。观察镇痛效果，宫颈松弛度，人流综合征发生率，阴道出血量，呼吸、循环系统反应。结果观察组术中镇痛效果确切，受术者无疼痛感，宫颈松弛，无1例人流综合征发生，两组比较，差异有极显著性意义（均P＜0.01)；两组阴道出血量比较，差异无显著性意义（P＞0.05)；麻醉诱导时观察组19例出现一过性呼吸抑制。提示小剂量芬太尼与异丙酚联合静脉麻醉用于人工流产术可镇痛，避免人流综合征发生，但对呼吸的抑制不可忽视，需严密监测。     

两种镇痛方法用于无痛人工流产术的观察

目的探讨芬太尼联合丙泊酚静脉麻醉用于无痛人工流产术的效果评价。方法选择无痛人工流产患者200例,随机分为对照组100例（丙泊酚组）,观察组100例（芬太尼联合丙泊酚组）。结果观察组出血量及人流综合征发生率不升高,镇痛效果满意,丙泊酚用量明显减少,苏醒时间明显缩短,手术更为安全。结论芬太尼联合丙泊酚静脉麻醉应用于人工流产术安全有效,值得临床推广应用。     

异丙酚静脉麻醉在人工流产术中的应用

目的观察异丙酚静脉麻醉用于人工流产术的临床效果。方法选择2005年3月至2006年3月要求施行无痛人工流产术的早孕妇女180例静脉推注异丙酚20mg/kg为观察组,并与自愿要求无麻醉手术的120例对照组进行比较。结果观察组镇痛效果确切,有效率为100%,无一例人流综合征发生,宫口松弛十分明显,术中出血量明显减少,与对照组比较差异有统计学意义(P<0.01)。结论异丙酚静脉麻醉用于人工流产术中,具有起效快、恢复迅速、镇痛效果确切、安全、无体内蓄积现象等优点,不失为一种好方法,值得在临床推广应用。     

异丙酚在人工流产手术中的应用观察

目的　观察异丙酚在人工流产手术中麻醉效果及其对人工流产的影响。　方法　选择2004年1~6月自愿接受人工流产术的早孕患者200例,分为观察组和对照组各100例,观察组静脉注射异丙酚行无痛人工流产,对照组不给麻醉药物予常规人工流产。两组手术方法相同。　结果　观察组镇痛率为100%,无人工流产综合征发生,对照组均感疼痛,发生人工流产综合征25例,两组比较差异显著(P<0. 01)。观察组宫颈松弛程度和术中反应均优于对照组(P<0. 01);两组术中出血量比较无统计学差异(P>0. 05)。　结论　异丙酚用于人工流产手术镇痛效果好,可避免人工流产综合征的发生,减少术中不良反应,缩短手术时间,对子宫收缩无影响,可广泛应用于无痛人流手术。     

丙泊酚在人工流产术中的应用232例疗效观察

目的:了解丙泊酚应用于人工流产术时对受术者疼痛等情况的影响。方法:选择在我院行无痛人工流产术的232例受术者作为观察组,随机选择同期行普通人工流产术的46例受术者作为对照组,比较两组受术者镇痛效果及手术时间、阴道出血、人工流产综合征发生率。结果:镇痛效果:观察组100%,对照组26.15%,差异有统计学意义(P<0.05);手术时间及术中出血量:观察组与对照组比较无显著性差异;人工流产综合征:观察组未出现,对照组出现2例,差异有统计学意义(P<0.05)。结论:丙泊酚可降低人工流产综合征发生率,既可以满足受术者的"无痛"要求,又可满足临床手术效果,值得大力推广。     

异丙酚加芬太尼在无痛人流术中的应用

目的:观察异丙酚加芬太尼静脉全麻在人工流产术中的麻醉效果及临床应用价值。方法:对120例妊娠6~10周行人工流产患者,60例静脉注射异丙酚加芬太尼为观察组;60例1％利多卡因宫旁神经阻滞麻醉为对照组。结果:观察组麻醉效果满意,镇痛效果理想;对照组可不同程度地减轻疼痛,但不能达到无痛。结论:异丙酚加芬太尼静脉全麻可解除人流术中的疼痛,缩短手术时间,有较好的临床应用价值。     

笑气与异丙酚用于无痛人工流产术中镇痛效果对比分析

目的:对比分析异丙酚、笑气(50％氧化亚氮,50％氧气)应用于无痛人工流产的临床效果.方法:选取2006年8月～2011年6月在我院门诊采用异丙酚镇痛的患者358例,笑气镇痛的患者297例,与不采用镇痛措施的人工流产手术对比,观察镇痛效果、人流综合征的发生率、宫颈松弛情况、术中出血量及不良反应等指标.结果:异丙酚的镇痛率为100％,笑气的镇痛率为89.23％,二者均可降低人流综合征的发生而不增加手术出血量.结论:异丙酚及笑气用于人工流产镇痛是确实可靠的.     

丙泊酚复合芬太尼在无痛人流中的应用

目的探讨芬太尼复合丙泊酚用于人工流产术的临床效果和安全性以寻求一种人流无痛的麻醉方法。方法 100例自愿终止妊娠且无禁忌征的早孕妇女,随机分为观察组和对照组,对照组50例不用任何药物,观察组50例,静脉注射丙泊酚和芬太尼,观察比较两组患者在人工流产中的疼痛程度,血压、心率、氧饱和度、宫颈松弛度和出血量及人流综合症的发生率等。结果观察组镇痛效果100%,对照组4.2%,两组比较有显著性差异（P〈0.01）,观察组无1例发生人工流产综合症,对照组12例发生,两组比较有显著差异性（P〈0.01）,两组术中血压、心率、氧饱和度、出血量无显著差异。结论丙泊酚配伍芬太尼复合麻醉用于人工流产安全有效,并有助于减少及预防人流综合症等并发症的发生。     

3种镇痛方法用于人工流产术镇痛效果比较

目的 探讨无痛人工流产术的有效性、安全性及实用性。方法 将250例人工流产者随机分为A组（80例）、B组（92例）、C组（78例）。A组采用异丙酚静脉麻醉，B组采用氧化亚氮（50％氧化亚氮与50％氧气混合气体）吸入，C组进行利多卡因宫颈局麻。观察3组人工流产术中镇痛效果、生命体征变化、宫颈口松弛情况、术中出血、人工流产综合征（RAAS）发生率及手术时间。结果 A组镇痛有效率为100．0％，宫颈松弛有效率为91．2％，显著高于B、C组（P〈0．05、P〈0．01），且无RAAS发生，但术中易发生一过性血压、心率降低。3组术中出血、手术时间比较，差异无显著性意义（均P〉0．05）。结论 3种镇痛方法均安全有效，其中异丙酚能达到完全镇痛效果，使人工流产更具有人性化，利于提高育龄妇女的生活质量。     

静脉麻醉在家庭化人工流产中的应用

为探讨静脉麻醉在家庭化人工流产手术中应用的效果,随机抽取门诊手术室实施静脉麻醉的家庭化人工流产病人50例作为观察组,同时随机抽取传统人工流产病人56例作为对照组,比较两组病觉、手术时间、人工流产综合症发生率、出血量.结果:观察组镇痛率高达100％,手术时间明显短于对照组,且无一例人工流产综合症发生,而对照组有8例发生人工流产综合症.两组相比,有统计学意义.实施静脉麻醉及家庭化人工流产术,可有救地缓解疼癌及人工流产综合症的发生.适合于门诊实施人工流产术.     

Addition of fentanyl to mepivacaine in axillary brachial plexus block. Effects on the anesthetic and postoperative analgesic quality

The possible potentiating effect of phentanyl on mepivacaine in brachial plexus blockade was evaluated, both for operative anesthesia and postoperative analgesia. Sixty ASA I patients, scheduled for upper limb surgery, were selected and distributed in 3 groups: 1) Mepivacaine 1% 40 ml (control group); 2) Mepivacaine 1% 40 ml + phentanyl 100 micrograms; 3) Mepivacaine 1% 40 ml + subcutaneous phentanyl 100 micrograms. The latency time and the quality of anesthesia were evaluated. The duration of analgesia was evaluated on the basis of the time from the administration of the first analgesic. There were no significant differences between the 3 groups in the latency times of the development of blockade nor in the quality of surgical anesthesia. Also, there were no significant differences in the duration of postoperative analgesia (307, 316 and 326 minutes, respectively, in each group). It was concluded that the addition of phentanyl 100 micrograms to the local anesthetic in the axillary blockade of the brachial plexus does not change the anesthetic characteristics nor the time of postoperative analgesia.     

新生化颗粒联合米索前列醇治疗药物流产后阴道流血的疗效观察

目的观察新生化颗粒联合米索前列醇治疗药物流产后阴道流血的临床疗效。方法选取我院2012年4月-2013年10月期间收治的药物流产患者68例,按照随机分配的原则,分为观察组和对照组各34例。观察组在常规治疗的基础上给予米索前列醇联合新生化颗粒口服,对照组在常规治疗的基础上给予益母草浸膏口服。对两组的临床疗效进行比较。结果治疗组阴道流血量明显少于对照组,出血持续时间≤1周也明显短于对照组（P〈0.05）。对药物流产后阴道流血的总有效率,治疗组明显高于对照组（P〈0.05）。结论新生化颗粒联合米索前列醇治疗药物流产后阴道流血疗效确切,可以明显缩短药物流产后阴道流血时间和减少流血量,值得临床推广使用。     

Effects of S(+) ketamine added to bupivacaine for spinal anaesthesia for prostate surgery in elderly patients

BACKGROUND AND OBJECTIVE: Intrathecal ketamine as the sole anaesthetic agent has demonstrated a lack of cardiovascular depression that should be of advantage in an elderly population. S(+) ketamine has three-times the analgesic potency of R(-) ketamine and its antinociceptive effects after intrathecal administration in rats are known. We decided to evaluate the effects of intrathecal S(+) ketamine added to a small dose of spinal bupivacaine in elderly patients undergoing transurethral prostate surgery. METHODS: Forty males over 60 yr old, scheduled for transurethral prostate resection under spinal anaesthesia, were studied in a prospective, double-blinded, randomized way. Patients were allocated to receive either bupivacaine 10 mg or bupivacaine 7.5 mg combined with S(+) ketamine 0.1 mg kg(-1). Spinal block onset time, maximum sensory level, duration of blockade, haemodynamic variables, postoperative analgesic requirements and adverse events were recorded. RESULTS: Onset times of motor and sensory block were shorter in the bupivacaine plus S(+) ketamine group. Incomplete motor block of the lower extremities was seen in 80% of the patients in bupivacaine plus S(+) ketamine group. Duration of complete motor block and spinal analgesia was shorter in the bupivacaine plus S(+) ketamine group. There was no significant difference in arterial pressure. Heart rate decreased after spinal anaesthesia in the bupivacaine plus S(+) ketamine group and was significantly lower until the end of anaesthesia. The incidence of adverse effects was not different between groups. CONCLUSIONS: Intrathecal S(+) ketamine administered with a low dose of bupivacaine provides shorter motor and sensory block onset time, shorter duration of action and less motor blockade in elderly males.     

Intrathecal morphine for postoperative pain]

At the beginning, the way intrathecal morphine was used for postoperative pain relief was quite unfortunate, because the doses derived from experience with morphine-tolerant cancer patients were considerably too high and respiratory depression occurred frequently. Subsequent dose-finding studies showed that the doses of morphine used initially could be reduced by a factor of ten without loss of the analgesic effect and with a marked reduction in side-effects. No respiratory depression has been reported when doses below 0.1 mg morphine are used. METHOD. In this prospective study the effect of 0.06 to 0.08 mg intrathecal morphine, mixed with the local anaesthetic for spinal anesthesia, was investigated in surgical patients aged 21 to 81 years, ASA grade I or II, scheduled for orthopaedic operations or herniorraphies. Thirty unpremedicated patients were enrolled in the study and were, after informed consent, randomly allocated to a control group without morphine or to a morphine group. The analgesic effect was assessed by the time interval between the administration of the spinal anaesthesia and the first demand for an analgesic medication. The mood state was evaluated with the adjective checklist of Janke and Debus 6 h after the spinal anaesthesia. RESULTS AND DISCUSSION. In the control group half of the patients asked for an analgesic medication within 275 min (median) after the spinal anaesthesia, and all patients within 420 min, whereas in the morphine group half of the patients asked for an analgesic within 1170 min (median). Seven patients had not required an analgesic at the termination of the observation period 20 h after the spinal anaesthesia. The mood status showed no difference between the two groups, in particular, no dizziness or drowsiness after morphine. There was no difference in the incidence of side-effects such as nausea or urinary retention between the two groups. Pruritus was not reported spontaneously but was found upon questioning in five patients. It was in no case disturbing. CONCLUSIONS. Morphine (0.06 to 0.08 mg) mixed with the local anaesthetic for spinal anaesthesia provided for an analgesia of more than 20 h duration in half of the patients. This technique is safe, simple, reliable and virtually free of side-effects. No particular supervision due to the administration of intrathecal morphine is necessary in this dose range if systemic opiates are avoided. If the analgesia is unsatisfactory, a non-opioid analgesic is recommended.     

Alfentanil as an adjunct to thiopentone and nitrous oxide in short surgical procedures

Alfentanil, a new narcotic analgesic with a rapid onset and short duration of action was used as an adjunct to thiopentone and nitrous oxide anaesthesia in 109 patients undergoing dilatation and curettage (D&C) or therapeutic abortion (TA). The mean alfentanil dose was 19.7 +/- 9.6 microgram X kg-1 (D&C Group) and 23.3 +/- 6.6 micrograms X kg-1 (TA Group), with a mean duration of anaesthesia of about 30 minutes. The anaesthetic effect was judged excellent in virtually all patients (94.7 per cent in the TA group and 96.7 per cent in the D&C group). There were no significant changes in haemodynamic parameters intraoperatively. Apnea or hypoventilation was observed in four patients and was easily reversed by naloxone. Most patients (95.4 per cent) demonstrated complete recovery of consciousness, motor activity, respiratory and circulatory function and skin colour within 60 minutes of arrival in recovery room. The only consistent side effect was minor chest wall rigidity which was eliminated by pretreatment with d-tubocurarine. One patient experienced a serious adverse reaction which was reversed with naloxone. We have found alfentanil to be well suited as an adjunct to nitrous oxide and thiopentone in short surgical procedures.     

The effect of adding intrathecal magnesium sulphate to bupivacaine-fentanyl spinal anaesthesia

BACKGROUND: The addition of intrathecal (IT) magnesium to spinal fentanyl prolongs the duration of spinal analgesia for vaginal delivery. In this prospective, randomized, double-blind, controlled study, we investigated the effect of adding IT magnesium sulphate to bupivacaine-fentanyl spinal anaesthesia. METHODS: One hundred and two ASA I or II adult patients undergoing lower extremity surgery were recruited. They were randomly allocated to receive 1.0 ml of preservative-free 0.9% sodium chloride (group S) or 50 mg of magnesium sulphate 5% (1.0 ml) (group M) following 10 mg of bupivacaine 0.5% plus 25 microg of fentanyl intrathecally. We recorded the following: onset and duration of sensory block, the highest level of sensory block, the time to reach the highest dermatomal level of sensory block and to complete motor block recovery and the duration of spinal anaesthesia. RESULTS: Magnesium caused a delay in the onset of both sensory and motor blockade. The highest level of sensory block was significantly lower in group M than in group S at 5, 10 and 15 min (P < 0.001). The median time to reach the highest dermatomal level of sensory block was 17 min in group M and 13 min in group S (P < 0.05). The mean degree of motor block was also lower in group M at 5, 10 and 15 min (P < 0.001). The median duration of spinal anaesthesia was longer in group M (P < 0.001). CONCLUSION: In patients undergoing lower extremity surgery, the addition of IT magnesium sulphate (50 mg) to spinal anaesthesia induced by bupivacaine and fentanyl significantly delayed the onset of both sensory and motor blockade, but also prolonged the period of anaesthesia without additional side-effects.     

A comparison of alfentanil and fentanyl in short operations with special reference to their duration of action and postoperative respiratory depression

Ninety women undergoing short gynaecological operations were included in a double-blind comparison of fentanyl and alfentanil, a structurally related and very short-acting narcotic analgesic. Anaesthesia was induced by methohexitone followed by a double-blind injection of either alfentanil (0.5 mg/ml) or fentanyl (0.05 mg/ml). Depending on the expected duration of the procedure 3 or 5 ml of the analgesic was given. For the same duration of anaesthesia, respiratory depression had to be reversed in 11% of the alfentanil and 51% of the fentanyl group and the time of awakening was significantly shorter in the alfentanil group. Cardiovascular parameters remained stable with both analgesics. There were no troublesome side-effects.     

Addition of dexmedetomidine to lidocaine for intravenous regional anaesthesia

BACKGROUND AND OBJECTIVE: The aim of this study was to determine the duration of onset and regression time of sensory and motor blocks, the quality of anaesthesia and postoperative analgesia by the addition of dexmedetomidine to local anaesthetic solution in intravenous regional anaesthesia (IVRA). METHODS: Forty patients scheduled for elective hand surgery participated in this prospective randomized double-blind study. The IVRA was achieved using 3 mg kg(-1) lidocaine diluted with saline to a total volume of 40 mL in the control group or 1 microg kg(-1) of dexmedetomidine + 3 mg kg(-1) lidocaine diluted with saline to a total volume of 40 mL in the dexmedetomidine group. The onset and regression times for sensory and motor blocks were recorded. Qualities of anaesthesia, intraoperative and postoperative analgesic requirements were noted. RESULTS: There was no difference between the groups with respect to sensory and motor blocks onset and regression time. The quality of anaesthesia was better in the dexmedetomidine group than the control group and the difference was statistically significant. Intraoperative and postoperative analgesic requirements were greater in the control group than in the dexmedetomidine group. CONCLUSIONS: Addition of dexmedetomidine to local anaesthetic solution in IVRA improved the quality of anaesthesia and decreased analgesic requirements, but had no effect on the sensory and motor blocks onset and regression times.     

阴道成形术后阴道模具固定带的制作及应用

目的探讨自制阴道模具固定带在阴道成形术后患者中的应用效果。方法将57例先天性无阴道综合征并行阴道成形术患者按住院号尾数奇偶分为观察组29例和对照组28例,术后分别使用自行设计的固定带和普通卫生带固定阴道模具。随访6个月评价效果。结果观察组阴道长度和成熟率显著高于对照组,模具脱出率显著低于对照组,佩戴耐受率显著高于对照组(均P0.05);观察组术后并发症(阴道狭窄、粘连、感染和闭锁)发生率低于对照组。结论先天性无阴道综合征患者阴道成形术后使用新型固定带可以减少模具脱出率,降低术后并发症,提高佩戴耐受率,从而促进阴道成熟。     

阴道前后壁修补术联合阴式子宫全切术治疗中重度子宫脱垂的疗效

目的探究阴道前后壁修补术联合阴式子宫全切术治疗中重度子宫脱垂的疗效及其对性功能的影响。 方法选择芜湖市第五人民医院妇产科自2014年8月至2018年8月收治的中重度子宫脱垂患者60例,随机分为观察组与对照组,每组各30例。观察组行阴式全子宫切除术加阴道前后壁修补术治疗,对照组行单纯阴道前后壁修补术治疗,对比2组围手术期临床指标、术后并发症发生率及复发情况,采用盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）对比2组术前、术后随访6个月的性功能变化情况。 结果观察组平均手术时间、肛门排气时间、住院天数明显短于对照组,观察组术中出血量少于对照组,差异有统计学意义（P<0.05）;观察组术后并发症发生率与对照组差异无统计学意义（P>0.05）;观察组的治愈率为90.00%,好转率为10.00%,高于对照组的80.00%、3.33%,观察组无复发者,对照组复发率为16.67%,差异均有统计学意义（P<0.05）;术后随访6个月后观察组PISQ-12评分为（35.12±3.37）分,低于对照组（38.83±5.62）分,差异有统计学意义（P<0.05）。 结论阴式全子宫切除术联合阴道前后壁修补术治疗中重度子宫脱垂的临床效果较理想,与单纯阴式子宫切除术相比可显著缩短手术时间较短,减少术中出血,提高手术疗效,降低术后复发率,但在改善术后性功能方面并不具有优势。