过度通气对糖尿病病人脑氧供需平衡的影响

目的研究过度通气对手术中糖尿病病人脑氧供需平衡的影响。方法择期全麻下行腹部手术病人30例,2型糖尿病组15例(DM组),非糖尿病组15例(对照组,C组),所有病人术中均随机分别进行三种不同模式机械通气：正常通气量通气[模式I,动脉血二氧化碳分压(PaCO2)维持在35～40mmHg]、轻度过度通气(模式Ⅱ,PaCO2维持在30～35mmHg)、中度过度通气(模式Ⅲ,PaCO2维持在25～30mmHg),检测两组病人在三种不同通气模式下动脉血氧饱和度(SaO2)、动脉血氧分压(PaO2)、动脉血乳酸盐浓度(ABL)、颈内静脉血氧饱和度(SjvO2)、颈内静脉血氧分压(PjvO2)和颈内静脉血乳酸盐浓度(JVBL),并计算病人在不同通气模式下动脉血氧含量(CaO2)、颈内静脉血氧含量(CjvO2)、氧摄取率(CERO2)和颈内静脉与桡动脉血乳酸差(DL A-v)。结果两组病人CjvO2和SjvO2在以模式Ⅲ通气时均明显低于以模式Ⅰ通气,CERO2在模式Ⅲ通气时明显高于以模式Ⅰ通气。DM组病人JVBL和DI A—v在模式Ⅲ通气时均明显高于以模式Ⅰ通气。中度过度通气时,DM组病人DL A-v高于C组。结论中度过度通气可影响2型糖尿病病人脑氧供需平衡,导致大脑组织乏氧代谢增加。     

The effect of music on the neurohormonal stress response to surgery under general anesthesia

Several pharmacological interventions reduce perioperative stress hormone release during surgery under general anesthesia. Listening to music and therapeutic suggestions were also studied, but mostly in awake patients, and these have a positive effect on postoperative recovery and the need for analgesia. In this study, we evaluated the effect of listening to music under general anesthesia on the neurohormonal response to surgical stress as measured by epinephrine, norepinephrine, cortisol, and adrenocorticotropic hormone (ACTH) blood levels. Thirty female patients scheduled for abdominal gynecological procedures were enrolled and randomly divided into two groups: group NM (no music) and group M (music). In group M, music was played from after the induction of anesthesia until the end of surgery. In the NM group, the patients wore the headphones but no music was played. We established three sample times for hormonal dosage during the procedure and one in the recovery room. Hemodynamic data were recorded at all times, and postoperative consumption of morphine in the first 24 h was noted. There was no group difference at any sample time or in the postoperative period in terms of mean arterial blood pressure, heart rate, isoflurane end-tidal concentration, time of the day at which the surgery was performed, bispectral index (BIS) value, doses of fentanyl, or consumption of postoperative morphine. There was no difference between the two groups with regard to plasmatic levels of norepinephrine, epinephrine, cortisol, or ACTH at any sample time, although the blood level of these hormones significantly increased in each group with surgical stimulation. In conclusion, we could not demonstrate a significant effect of intraoperative music on surgical stress when used under general anesthesia. IMPLICATIONS: Listening to music under general anesthesia did not reduce perioperative stress hormone release or opioid consumption in patients undergoing gynecological surgery.     

七氟醚麻醉对大鼠脑ATP酶的动态影响

目的 观察七氟醚吸入麻醉不同时期大鼠各脑区Na~ 、K~ -ATP酶和Ca~(2 )-ATP酶活性动态变化规律,以了解脑ATP酶活性变化在七氟醚麻醉效应中的地位。方法 40只SD大鼠随机均分为对照组、诱导期组、麻醉期组、恢复期组和清醒期组。分光光度法测定不同时期大脑皮质、脑干、海马Na~ 、K~ -ATP酶和Ca~(2 )-ATP酶活性变化。结果 与对照组比较,大鼠大脑皮质、脑干、海马Na~ 、K~ -ATP酶活性在诱导期分别降低21.9％、10.5％、19.3％(P<0.05),麻醉期分别降低37.2％、33.5％、38.9％(P均<0.01),恢复期又开始回升,但仍低于对照组水平(P<0.05或P<0.01),而清醒期基本恢复至对照组水平(P>0.05);大脑皮质、脑干、海马Ca~(2 )-ATP酶活性在诱导期分别降低34.3％、44.3％、25.5％(P<0.05 or P<0.01),麻醉期分别降低39.6％、60.4％、57.6％(P均<0.01),恢复期开始回升,清醒期基本恢复至对照组水平(P>0.05)。结论七氟醚对大鼠大脑皮质、脑干、海马Na~ 、K~ -ATP酶和Ca~(2 )-ATP酶活性的抑制程度与麻醉时相相对应,ATP酶活性与麻醉深度具有相同的变化趋势,表明上述脑区ATP酶可能是七氟醚的作用靶点,与七氟醚的麻醉效应有关。     

The effect of the laryngeal mask airway on coughing after eye surgery under general anesthesia.

Twenty-nine patients scheduled for elective eye surgery under general anesthesia were randomized into two groups, A and B. After induction of anesthesia, the airway of those in group A was maintained with a conventional tracheal tube; in group B, with a laryngeal mask airway. In the immediate postoperative period, 13 of the 14 patients in group A coughed; none of those in group B did (P < .001).     

阿芬太尼静脉全麻对呼吸的影响

选择在全麻气管插管下行各种择期手术的成年病人 ４０例， ＡＳＡⅠ－Ⅱ 级。第一组为临床组（ｎ＝２０），静脉泵入阿芬太巳，诱导剂量为４０μｇ／ｋｇ，维持剂量为每分钟１μｇ／ｋｇ，第二组为对照组（ｎ＝２０），静脉泵人芬大尼，诱导剂量为４μｇ／ｋｇ，维持剂量为每分钟０．１μｇ／ｋｇ，维持期间皆吸入０．５％～１．５％安氟醚和氧气，酌情使用维库溴铵维持肌肉松弛、观察两组在人室、给药后１～５分钟和拔管０～１０分钟时的血氧饱和度、呼吸频率、潮气量的变化，实验结果发现阿芬太尼和芬太尼都具有呼吸抑制作用，且阿芬太尼的呼吸抑制作用更强。阿芬太尼还可产生迟发性呼吸抑制。因此，我们建议在临床使用阿芬太尼时保证供氧，并常规监测ＳPＯ２，术后２～４小时留恢复室观察。     

Esophageal tear in a patient undergoing stereotactic brain biopsy under general anesthesia

Injuries of the esophagus with resultant mediastinitis have been reported following endotracheal intubation. Herein, we report a case of esophageal perforation that resulted from difficulty with intubation in a patient with a stereotactic head frame. A 52-year-old woman underwent a stereotactic brain biopsy of a left temporal tumor. After a stereotactic head frame was applied, intubation for anesthesia required three attempts. On postoperative day 2, she complained of worsening dysphagia and chest pain. A 4-mm tear in the right posterior cervical esophagus was discovered and repaired. Esophageal perforation may arise from limited neck extension imposed by a stereotactic head frame. Unexplained dysphagia postoperatively is the hallmark of this rare complication.     

脑肿瘤唤醒麻醉下低龄手术患者的护理

对4例脑功能区肿瘤患者实施唤醒麻醉下肿瘤切除术。术前访视详细讲解相关知识,输液部位选择患侧下肢,于清醒下导尿;术中改进肢体约束方法,侧放手术灯,用保温毯保温;术后探访患者告知术后表现与应对方法等,4例患者手术均获成功。提出针对患者特点不断总结护理经验,改进护理方法,可有效提高手术配合水平,利于拓展手术适应证。     

The effects of sevoflurane/halothane anesthesia during normo- and hyperventilation on the energy metabolism of the cat brain]

Energy metabolism of the cat brain was studied using phosphorous-31 nuclear magnetic resonance (31P-NMR) during sevoflurane/halothane anesthesia with normo- and hyperventilation. Under normocapnia, the findings associated with abnormal energy metabolism were not observed at concentration of sevoflurane/halothane up to 2 MAC. Meanwhile under hypocapnia by hyperventilation, the value of phosphocreatine began to decrease at and below 20 mmHg of PaCO2 (2 MAC sevoflurane) and 30 mmHg of PaCO2 (2 MAC halothane) respectively. These abnormal findings of brain metabolism were limited to the cases with cerebral blood flow (CBF) of less than a half of control state (nonanesthetized and normoventilated), and they were normalized with increased CBF by the vasoconstrictor, metaraminol. From the above data, it was concluded that the deteriorated energy metabolism by hyperventilation was due to decrease in CBF with hypotension and there was no direct effect on cerebral metabolism with less than 2MAC of both sevoflurane and halothane.