罗哌卡因对胸段硬膜外麻醉患者心率变异及肺功能的影响

目的探讨罗哌卡因对胸段硬膜外麻醉患者心率变异及肺功能的影响。方法选择我院胸段硬膜外麻醉下行手术治疗的82例患者,按照随机分层分组法将所有患者分为观察组和对照组,对照组硬膜外麻醉给予利多卡因,观察组硬膜外麻醉给予罗哌卡因,观察两组不同时间段心率变异性(HRV)和肺功能。结果两组阻滞后5、15 min较阻滞前心率(HR)、收缩压(SBP)、舒张压(DBP)及HRV均有所下降(均P0.05),两组阻滞后15min较阻滞前肺活量(VC)、第1s用力肺活量(FVC1)、潮气量(VT)及最大通气量(MMV)显著下降(均P0.05)。对照组阻滞后5、15 min的HRV、HR、SBP及DBP与观察组比较有所下降(均P0.05),而两组肺功能各项指标无显著差异(均P0.05)。结论罗哌卡因应用于胸段硬膜外麻醉对于感觉神经阻滞良好,对患者HRV及肺功能影响较小,有较好的临床应用价值。     

低浓度罗哌卡因硬膜外阻滞用于分娩镇痛80例分析

2002年3月至2003年1月，我院对80例的产妇行低浓度罗哌卡因 芬太尼硬膜外阻滞镇痛分娩。现报告如下。     

罗哌卡因硬膜外腔阻滞对老年患者心肌毒性的研究

目的:探讨罗哌卡因硬膜外腔阻滞时对老龄患者心肌的毒性。方法:60例ASAⅡ～Ⅲ级拟硬膜外阻滞下择期手术的老龄患者,随机分成试验组和对照组(各30例)。试验组和对照组硬膜外腔阻滞分别使用罗哌卡因和利多卡因。分别于麻醉前、术毕和术后24 h检测AST、CK、CK-MB和LDH。结果:试验组术毕和手术后24 h心肌酶谱值分别与麻醉前相比均升高(P0.05)。对照组分别在同一时间点的心肌酶谱值亦较麻醉前升高(P0.05)。试验组和对照组间相应时间点心肌酶谱值变化无明显差异。结论:与临床常用药物利多卡因相比,罗哌卡因硬膜外腔阻滞并不增加对老龄患者心肌的毒性。     

预防性肌注麻黄素对硬膜外复合异丙酚全麻患者血压及心率的影响

硬膜外复合全身麻醉因其诱导期常伴随明显的循环抑制 ,增加了老年患者特别是伴有心血管疾患患者发生围术期心脑血管意外的风险 ,2 0 0 1年以来我院将麻黄素预防性应用于 3 0例硬膜外复合异丙酚全麻患者中 ,其对防治循环抑制反应的效果满意 ,现报告如下。1　资料与方法1 .1　一般资料　 3 0例胸外科择期手术患者 ,男 2 3例 ,女 7例 ,年龄 5 5～ 67岁 ;体重 5 5～ 72 kg;ASAI～ II级 ;随机分为麻黄素防治组与对照组 ,每组 1 5例。两组患者年龄、性别、体重比较 P均 >0 .0 5 ,有可比性。1 .2　方法　所有患者均于麻醉前 3 0分钟肌注阿托品 0…     

甲磺酸罗哌卡因用于高位硬膜外麻醉效果观察

目的 探讨甲磺酸罗哌卡因用于高位硬膜外麻醉的临床效果和安全性.方法 将80例拟于高位硬膜外麻醉下施行手术的80例患者随机分成观察组和对照组各40例,观察组予0.447％甲磺酸罗哌卡因进行麻醉,对照组予0.375％盐酸布比卡因进行麻醉.观察两组阻滞起效时间、最大阻滞时间、运动阻滞恢复时间、镇痛效果、生命体征、麻醉恢复情况.结果 两组镇痛效果均满意,观察组阻滞起效时间、最大阻滞时间和运动阻滞恢复时间明显短于对照组(P＜0.01).观察组麻醉后MAP、HR、SPO2均明显低于麻醉前(P均＜0.05).结论 0.447％甲磺酸罗哌卡因用于上胸段硬膜外阻滞麻醉效果满意,与布比卡因比较对呼吸和循环功能的影响小,更适合于高位硬膜外阻滞.     

罗哌卡因复合芬太尼硬膜外阻滞镇痛分娩80例观察

2004年4月～2005年4月,我们共实施硬膜外阻滞镇痛分娩80例,效果满意。现报告如下。 资料与方法：选择无阴道分娩和椎管阻滞禁忌证,要求镇痛分娩的初产妇80例作为观察组,年龄20～28岁;孕龄32～36周。以同期常规分娩的120例产妇为对照组。两组产妇年龄、孕龄比较差异无显著性（P均〉0.05）。     

全麻复合硬膜外阻滞及单纯全麻对胸腹部手术应激反应的影响

目的比较全麻复合硬膜外阻滞及单纯全麻对胸腹部手术患者应激反应的影响。方法50例择期行胸腹部手术的患者,随机分为全麻复合硬膜外阻滞组（A组）和单纯全麻组（B组）,各25例。分别于麻醉前、切皮时及切皮后60win和拔管后即刻测外周血中血浆皮质醇（Cor）、肾上腺素（E）、血管紧张素Ⅱ（A-Ⅱ）及血糖（BG）。结果两组术中Cor、E、A—Ⅱ和Bc水平均增高,拔管后达高峰,但A组低于B组（P〈0．05）。结论全麻复合硬膜外阻滞麻醉对胸腹部手术患者应激反应的影响较小。     

罗哌卡因硬膜外麻醉用于妇科手术临床观察

目的:观察同等浓度罗哌卡因与布比卡因硬膜外阻滞麻醉用于妇科手术的临床效果。方法:选择ASAⅠ~Ⅱ级择期行子宫次全切除术患者60例,随机分为布比卡因组(n=30)和罗哌卡因组(n=30);硬膜外隙注入试验量1.33%利多卡因3ml后,分别再小剂量(3ml)分次注入0.75%布比卡因或0.75%罗哌卡因至要求麻醉平面。分别观察感觉阻滞平面及下肢运动阻滞的起效时间和维持时间,以及镇痛效果、手术时间、用药总剂量及不良反应。结果:罗哌卡因较布比卡因感觉神经阻滞起效快,运动神经阻滞则起效缓慢、维持时间短及下肢运动阻滞强度弱,术中不良反应发生率低。结论:罗哌卡因麻醉应用于妇科手术,具有良好的临床应用前景。     

高浓度甲磺酸罗哌卡因用于下肢硬膜外阻滞的临床观察

目的探讨高浓度甲磺酸罗哌卡因用于下肢手术硬膜外麻醉对感觉和运动阻滞情况。方法将40例下肢手术患者随机分为两组,甲罗组以0.89%甲磺酸罗哌卡因麻醉和左布组以0.75%盐酸左布比卡因麻醉,每组各20例,硬膜外注入10～15ml药物,首次给药后60min针刺患者胫骨平台区皮肤,观察患者对针刺的感觉和痛觉反应及髋、膝、踝关节的运动情况。结果甲罗组对针刺无感觉无痛觉的患者,阻滞强的一侧为18例,多于左布组的10例;对髋、膝、踝关节运动阻滞的患者也多于左布组,差异有统计学意义（P〈0.05）;尤其踝关节阻滞强的一侧为13例,明显多于左布组的2例,差异有统计学意义（P〈0.01）。结论 0.89%甲磺酸罗哌卡因用于硬膜外麻醉,其感觉和运动的阻滞均很强且是一致的,无运动感觉分离现象。     

0.25%罗哌卡因硬膜外阻滞复合全身麻醉在老年患者开胸术中的临床应用

硬膜外阻滞复合全身麻醉有利于减少术中麻醉药的用量和促进病人术后的复苏。     

Evaluation of ropivacaine combined with dexmedetomidine versus ropivacaine alone for epidural anesthesia: A meta-analysis

Background:Ropivacaine is considered the most commonly used for epidural anesthesia. We compared the efficiency and safety of ropivacaine alone (R group) and ropivacaine combined with dexmedetomidine (RD group).Method:PubMed, the Cochrane Library, Google Scholar, Ovid Medline, the Web of Science, Scopus, Embase, and ScienceDirect were searched. We considered sensory and motor block, duration of anesthesia, time to rescue, hemodynamics, and adverse effects as the primary endpoints.Results:Eleven randomized controlled trials were included with 337 patients in the R group and 336 patients in the RD group. The RD group had a shorter time to onset of sensory (mean difference [MD]: 3.97 [1.90–6.04] minutes; P = .0002) and motor (MD: 2.43 [0.70–4.16] minutes; P = .006) block and a longer duration of anesthesia (MD: -164.17 [-294.43 to -33.91]; P = .01) than the R group. Comparison of the time to rescue between the groups showed no significant difference (MD: -119.01[-254.47–16.46] minutes; P = 0.09). The R group showed more stable hemodynamics than the RD group in heart rate and arterial pressure at 10 minutes. The R group had a lower incidence of bradycardia and a higher incidence of shivering than the RD group.Conclusion:RD may be a more suitable choice for epidural anesthesia with better anesthetic outcomes than R alone. However, the safety of the combination must be carefully assessed.     

硬膜外阻滞复合全麻对非体外循环冠状动脉旁路移植术患者应激反应的影响

目的 比较单纯全麻和胸段硬膜外阻滞复合全麻对非体外循环冠状动脉旁路移植术（OPCAB）患者应激反应的影响.方法 选择30例行OPCAB的患者,分别采用胸段硬膜外阻滞复合全麻及单纯全麻.手术前麻醉诱导后及手术后1、2、48h检测血浆中内皮素（ET）、白细胞介素（IL）介素-6（IL-6）、IL-8、IL-10及肿瘤坏死因子（TNE-α）的含量.结果 两组血浆中ET、IL-6、JL-8、JL-10及TNE-α水平在术前差异无显著性（P＞0.05）;两组术后均明显升高,与麻醉诱导后相比,差异有显著性（P＜0.05）,但观察组明显低于对照组（P＜0.05）.结论 高胸段硬膜外阻滞复合全麻能明显降低OPCAB患者的应激反应.     

高位硬膜外阻滞治疗克山病疗效观察

目的 探讨高位硬膜外阻滞术对慢型克山病患者心脏收缩功能及心腔大小的影响。方法 9例慢型克山病心力衰竭患者，NYHA(纽约心脏病协会)心功能分级为Ⅲ～Ⅳ级，胸3-4或胸4-5棘突间隙穿刺至硬膜外腔，留置硬膜外导管，每2h推注1次0．5％利多卡因3～5ml，阻滞胸1-5交感神经，持续4～6周。观察高位硬膜外阻滞前及阻滞后4周临床症状、体征、心功能改善情况。结果 高位硬膜外阻滞治疗过程中，所有患者临床症状、体征缓解迅速。治疗4周后，患者NYHA心功能分级改善。超声心动显示心脏收缩功能提高，心腔缩小。结论 高位硬膜外阻滞可改善慢型克山病心力衰竭患者心脏功能，缩小扩大的心腔。     

Efficacy and safety of general anesthesia combined with paravertebral blockade on postoperative recovery in patients undergoing pulmonary surgery: a systematic review and meta-analysis

BackgroundResearch on analgesic effect, stress response, and lung function of thoracic epidural blockade (TEB) and paravertebral blockade (PVB) are inconsistent. This study conducted a meta-analysis of related literature, aiming at comparing the clinical efficacy and safety of two analgesic methods, and providing scientific evidence-based basis for clinical choice of analgesic methods.MethodsPubMed, Embase, MEDLINE, Science Direct, Cochrane Library, CNKI, China Biomedical Resources Database, Wanfang Database, VIP, and Foreign Medical Journal Full-Text Service were searched. Keywords were as follows: thoracic epidural block (TEB), paravertebral blockade (PVB), paravertebral catheterization, thoracotomy, and analgesia. Two professionals independently screened documents and extracted data, and used Cochrane System Evaluator Manual (version 5.1.0) to repeatedly assess the bias risk of the documents included in the study.ResultsA total of 9 articles were included. Of the 9 RCTs in the present study, 5 described the allocation concealment in detail, 9 described the correct random allocation method, and 1 did not use the blind method. The visual simulation scores of the PVB group and TEB group at 24 and 48 h were not statistically significant [mean difference (MD): −0.17, 95% confidence interval (CI): −0.43 to 0.08, P=0.18; MD: 0.21, 95% CI: −0.06 to 0.48, P=0.13]. The fixed-effects model was used to analyze the incidence of hypotension, nausea, vomiting, and urinary retention. The results showed that there was significant difference between the PVB group and TEB group [hypotension: relative risk (RR): 0.16, 95% CI: 0.06–0.46, P=0.0006; nausea: RR: 0.40, 95% CI: 0.25–0.66, P=0.0002; vomiting: RR: 0.23, 95% CI: 0.06–0.87, P=0.03; urinary retention: RR: 0.36, 95% CI: 0.15–0.87, P=0.02].DiscussionThe meta-analysis confirmed that PVB has the same analgesic effect and postoperative pulmonary function as epidural blockade in open thoracotomy lung surgery. In addition, PVB can reduce the incidence of analgesia-related complications and postoperative chronic pain.     

全麻联合硬膜外阻滞在肝脏手术中的应用

目的观察异氟醚吸入麻醉联合硬膜外阻滞对肝癌切除手术患者肝脏功能的影响。方法选择ASAⅠ～Ⅱ级Child Pugh分类为A级的肝段切除患者46例,随机分为全麻联合硬膜外组（联合组）和单纯全麻组（全麻组）各23例。比较两组诱导前（T0）、诱导后（T1）、切皮（T2）、手术30min（T3）和60min（T4）及拔管（T5）时的血流动力学变化;术中液体输入量和用药情况;测定术前、术后第1天、第3天、第5天的肝功能。结果两组诱导后平均动脉压（MAP）均明显下降,全麻组在拔管时又明显升高,两组在T1、T2及T5点有统计学差异;联合组中心静脉压（CVP）在T1～T3点低于全麻组;全麻组心率（HR）在拔管时升高,与联合组比较有统计学差异。联合组麻醉药用量较全麻组少。两组ALT在术后第1天、第3天明显升高,但联合组升高幅度小于全麻组,联合组在第5天基本恢复正常;两组AST在第1天明显升高,联合组在第3天基本恢复正常,而全麻组第5天恢复;两组TBIL第3天时升高,联合组低于全麻组。结论全麻联合硬膜外阻滞对肝脏切除手术患者肝功能保护作用好于单纯全麻。     

硬膜外阻滞复合全身麻醉在老年原发性肝癌患者肝叶切除术中的应用价值分析

目的 研究硬膜外阻滞复合全身麻醉(epidural block combined with general anesthesia,GEA)在老年原发性肝癌(primary liver cancer,PHC)患者肝叶切除术中的应用价值.方法 选择2018年7月-2020年6月于四川省遂宁市中心医院住院诊治的70例老年PH...     

Nonanalgesic benefits of combined thoracic epidural analgesia with general anesthesia in high risk elderly off pump coronary artery bypass patients

Objective:

Epidural anesthesia is a central neuraxial block technique with many applications. It is a versatile anesthetic technique, with applications in surgery, obstetrics and pain control. Its versatility means it can be used as an anesthetic, as an analgesic adjuvant to general anesthesia, and for postoperative analgesia. Off pump coronary artery bypass (OPCAB) surgery triggers a systemic stress response as seen in coronary artery bypass grafting (CABG). Thoracic epidural anesthesia (TEA), combined with general anesthesia (GA) attenuates the stress response to CABG. There is Reduction in levels of Plasma epinephrine, Cortisol and catecholamine surge, tumor necrosis factor-Alpha(TNF ά), interleukin-6 and leucocyte count.

Design:

A prospective randomised non blind study.

Setting:

A clinical study in a multi specialty hospital.

Participants:

Eighty six patients.

Material and Methods/intervention:

The study was approved by hospital research ethics committee and written informed consent was obtained from all patients. Patients were randomised to receive either GA plus epidural (study group) or GA only (control group). Inclusion Criteria (for participants) were -Age ≥ 70 years, Patient posted for OPCAB surgery, and patient with comorbidities (diabetes mellitus, chronic obstructive pulmonary disease, cerebrovascular disease, peripheral vascular disease, renal dysfunction). Serum concentration of Interlukin: – 6, TNF ά, cortisol, Troponin – I, CK-MB, and HsCRP (highly sensitive C reactive protein), was compared for both the group and venous blood samples were collected and compared just after induction, at day 2, and day 5 postoperatively. Time to mobilization, extubation, total intensive care unit stay and hospital stay were noted and compared. Independent t test was used for statistical analysis.

Primary Outcomes:

Postoperative complications, total intensive care unit stay and hospital stay.

Secondary Outcome:

Stress response.

Result:

Study group showed decreased Interlukin – 6 at day 2, TNF ά at day 2 and 5, troponin I at day 5, and decreased total hospital stay (p < 0.05).

Conclusion:

Thoracic epidural anesthesia decreases stress and inflammatory response to surgery and decreases hospital stay. However a large multicentre study may be needed to confirm it.     

高位硬膜外阻滞对老年人扩张型心肌病心脏收缩功能及心腔大小的影响

目的　探讨高位硬膜外阻滞 (TEB)对老年人原发性扩张型心肌病 (IDC)心脏收缩功能及心腔大小的影响。方法　老年 IDC患者 1 4例 ,经胸 3～胸 4棘突间隙穿刺至硬膜外腔 ,留置硬膜外导管 ,0 .5%利多卡因 3～ 5 ml每 2 h推注 1次 ,持续 4～ 6 w,适当辅以常规治疗。测定并比较TEB治疗前及治疗后 4 w超声心动图射血分数 (EF)、短轴缩短率 (FS)、左心室收缩末期容积 (ESV)、左心室舒张末期容积 (EDV)、左心室收缩末内径 (Ds)、左心室舒张末内径 (Dd)、左房径 (LAD)等指标的变化。结果　 TEB治疗过程中 ,所有患者临床症状及体征缓解迅速。TEB治疗后 4 w:(1 )纽约心功能分级由治疗前的 3.5± 0 .5级降至治疗后的 1 .7± 0 .5级 (P<0 .0 5) ;(2 ) EF、FS、EDV、ESV、DS、Dd、LAD等指标均有明显改善 ;(3)平均随访 8.5± 2 .5个月 ,无一例死亡 ,所有患者生活均能自理 ,生活质量明显提高。结论　高位硬膜外阻滞可改善老年人原发性扩张型心肌病心脏收缩功能 ,缩小扩大的心腔 ,提高生活质量。     

上腹部手术不同麻醉方法对心率变异性的影响

目的 :探讨上腹部手术不同麻醉方法对心率变异性 （HRV）的影响。方法 :30例择期上腹部手术患者分为全麻复合硬膜外腔麻醉 （CA）组和全麻 （GA）组。测定麻醉前 （T0 ）、气管插管后 5 m in（T1）、腹腔探查时 （T2 ）、术中 1h（T3）和 2 h（T4）、术毕拔气管导管前 （T5 ）和拔气管导管后 15 min（T6 ）的 HRV。结果 :与 T0相比 ,CA组标化低频值 （L Fnorm）在 T2 ,T3,T4,T5和 T6均显著降低 （P<0 .0 1） ,L F/ HF在 T1,T2 ,T3和 T4也均显著降低 （P<0 .0 1）。 GA组围麻醉期 HRV的各项数据均无显著变化。组间比较 ,CA组 L Fnorm在 T3显著低于 GA组 （P<0 .0 5 ） ,L F/ HF在 T3和 T4也显著低于 GA组 （P<0 .0 5 ）。结论 :全麻下行上腹部手术心脏自主神经功能稳定 ,而全麻复合硬膜外腔麻醉显著抑制交感神经