丙泊酚和芬太尼复合麻醉应用于无痛胃镜检查

我院在胃镜检查中采用丙泊酚和芬太尼复合麻醉,并与局麻下胃镜检查相比较,探讨无痛胃镜麻醉效果及安全性。资料与方法一般资料2006年1月1日～2007年1月1日期间来我院行胃镜检查的192例患者按照自愿的原则,108例施行无痛胃镜检查(A组),84例施行普通胃镜检查(B组)。A组男62例,女46例,年龄(48.75±15.35)岁,体重(56.51±11.35)kg;B组男51例,女33例,年龄(46.36±16.74)岁,体重(57.85±10.20)kg。方法胃镜检查前,确认患者无胃镜检查与麻醉禁忌证,重点了解有无过敏史,有无服用特殊药物史,如安眠药、降压药、麻醉药及毒品等,有无怀孕及哺乳等相关…     

丙泊酚和芬太尼复合麻醉应用于无痛结肠镜检查

目的　探讨丙泊酚复合小剂量芬太尼麻醉应用于无痛结肠镜检查的可行性及不良反应。方法　 2 80例ASAⅠ～Ⅲ级患者分为无痛肠镜组 (Ⅰ组 ,n =2 0 0 ) ,常规肠镜组 (Ⅱ组 ,n =80 )。Ⅰ组从静脉缓慢注入芬太尼 0 4 μg/kg和丙泊酚 0 5～ 2mg/kg ,直至患者睫毛反射消失即可插入肠镜 ;Ⅱ组按常规方法进行肠镜检查 ;专人评估患者的术中和术毕恢复情况及术后调查。结果　肠镜检查完成率Ⅰ组高于Ⅱ组 (10 0 % :92 6 0 % )。在检查 5min时Ⅰ组的SBP、MAP、HR比检查前明显下降 (P <0 0 5 ) ;Ⅱ组的SBP、MAP比检查前明显增加 (P <0 0 5 ) ,术毕均恢复至术前水平。患者术毕至清醒、计算能力恢复正常和离开观察室的时间分别为 (1 90± 1 4 0 )min、(4 30± 2 90 )min、(18 30± 5 6 0 )min ;Ⅰ组的患者、检查者、记录者满意度评分和再次检查接受率明显高于Ⅱ组 (P <0 0 5 )。结论　丙泊酚复合小剂量芬太尼麻醉实施无痛肠镜检查是安全可行的     

笑气吸入麻醉在混合痔术中的应用效果观察

为观察笑气吸入麻醉配合利多卡因肛旁注射在混合痔外剥内扎术中的镇痛效果,将90例混合痔患者随机分为观察组和对照组,每组45例.观察组患者采用笑气吸入麻醉配合利多卡因肛旁注射麻醉,对照组患者单纯采用利多卡因肛旁注射麻醉,比较2组患者麻醉效果.结果显示,观察组患者镇痛总有效率为95.6％,高于对照组的75.6％,差异有统计学...     

异丙酚-芬太尼静脉麻醉与笑气-氧吸入麻醉用于人工流产术的观察

本文对人工流产术孕妇分别采用异丙酚-芬太尼静脉麻醉或笑气-氧吸入麻醉，观察比较两者的麻醉效果。现将结果报告如下。     

先天性无痛无汗症患儿七氟醚吸入麻醉1例

先天性无痛无汗症(congenital insensitivity to pain with anhidrosis,CIPA)是一种以痛觉丧失、无汗、反复发热、自残、发育迟缓、不同程度的智力低下为主要临床表现的周围神经病,这是一种因编码酪氨酸激酶受体A(tyrosine kinase receptor A,TrkA)蛋白的神经营养因子酪氨酸激酶受体1型(neurotrophic tyrosine kinase receptor type 1,NTRK1)基因失活突变造成的常染色体隐性遗传病。文章报道1例痛觉丧失、无汗、智力低下,外伤后胫骨骨折的先天性无痛无汗症6岁男孩,该患儿仅用七氟醚吸入麻醉即得到了满意的麻醉效果,血流动力学未发生显著波动。     

牙科恐惧症患者应用笑气镇静的护理

笑气是无色有甜味气体,吸人人体后大脑皮质神经细胞迅速抑制,起到镇静、镇痛作用,恢复迅速,适用于口腔科门诊各项治疗[1].牙科恐惧症是指口腔科患者在治疗过程中出现的由于害怕疼痛而产生的紧张、忧虑和恐惧等不良心理状态,以及由此引起的烦躁、出汗、心率加快、血压升高等生理症状.这种不良心理状态会导致部分患者干扰医生的操作甚至拒绝治疗[2].我科将笑气吸入镇静应用于牙科恐惧症患者的口腔治疗,配合护理措施,取得良好的效果.     

瑞芬太尼用于无痛人工流产手术麻醉的临床观察

目的　观察瑞芬太尼用于无痛人工流产手术的可行性和安全性 ,并与丙泊酚无痛人工流产术比较。方法　选择门诊ASAⅠ级早期妊娠需人工流产者 6 0例 ,随机分成三组 ,瑞芬太尼组 (A组 ) ,瑞芬太尼 +丙泊酚组 (B组 )和丙泊酚组 (C组 ) ,每组 2 0例。A组 :瑞芬太尼 1 5 μg/kg持续静注6 0s,随后以 0 15 μg·kg 1·min 1持续输注至负压吸引结束停药 ;B组 :瑞芬太尼 1 0 μg·kg 1持续静注6 0s,随后以 0 1μg·kg 1·min 1持续输注 ,瑞芬太尼诱导结束后静注丙泊酚 1 0mg/kg ;C组 :单纯静注丙泊酚 2 5mg/kg持续静注 6 0s,必要时追加丙泊酚 0 5～ 1 0mg/kg。结果　术后三组患者对镇痛效果均表示高度满意 ,A、B和C组VAS分别为 (95 6± 11 8)mm、(99 1± 5 5 )mm和 (98 2±12 7)mm ,其中C组 8例术中出现肢体扭动等体动反应。A组和B组患者术中、术后血压和心率与给药前比较无显著变化 (P >0 0 5 ) ;C组术中血压心率较给药前显著下降 (P <0 0 5 ) ,但术后恢复至给药前水平 (P >0 0 5 )。术中三组患者在供氧状态下SpO2 均为 10 0 %。但三组患者呼吸均明显抑制 ,其中B组所有患者给丙泊酚后均出现呼吸暂停 ,C组 8例患者出现呼吸暂停。手术结束时A组和B组患者VT和RR已恢复至术前水平 (P >0 0 5 ) ,C组手术的中     

导乐分娩配合笑气吸入的效果观察

目的探讨导乐分娩配合笑气吸入对分娩的影响。方法选取住院分娩的单胎头位初产妇621例,按照知情同意、自主选择的原则分为2组。A组341例为观察组,给予导乐陪护和笑气吸入;B组280例为对照组,进行常规产前护理。观察2组产妇的产痛程度、产程时间、分娩方式、新生儿Apgar评分及产后出血量情况。结果在产痛程度、产程时间、剖宫产率、产后2h内出血量上,A组均明显低于B组(P0.05),新生儿Apgar评分2组比较差异无统计学意义。结论导乐分娩配合笑气吸入能有效减轻分娩阵痛,缩短产程时间,降低剖宫产率,减少产后出血量,对产妇和新生儿无明显不良影响。     

笑气联合力月西用于无痛人流的临床观察

目的:现察笑气吸入联合力月西用于无痛人流的临床效果.方法:将孕6-8周需终止妊娠并要求无痛人流的100例孕妇,随机分为实验组和对照组各50例.实验组孕妇术前静脉注射力月西0.05mg/kg,再联合笑气吸入实施无病人流;对照组不用力月西,单纯笑气吸入镇痛.结果:研究组的疼痛强度明显低于对照组(P<0.01),研究组宫口较松,极易通过6号扩宫器,便于手术探作,两组宫颈松驰情况差异有显著意义(P<0.05).结论:笑气吸入联合力月西可提高患者痛阈,镇痛作用起效快,效果好,宫颈口松驰,降低了手术操作难度,手术时间短,病人不良反应少,值得临床推广.     

Midazolam sedation and local anaesthesia compared with general anaesthesia for paediatric outpatient dental surgery

Midazolam sedation may offer an alternative to general anaesthesia for dental treatment in children. This study evaluated the efficacy and safety of i.v. midazolam with local anaesthesia in uncooperative paediatric dental patients. Thirty children (aged 2–10 years, physical status ASA 1 or 2) were randomized into two groups to receive general anaesthesia (group G) or local anaesthesia during sedation with i.v. midazolam (group M). Incremental doses of midazolam 0.05 mgkg^-1 were given to a sedative endpoint of 2 on a Sedation Scale of 5–0 (hyperactive–asleep), or 0.4 mgkg^-1 maximum, then as needed to maintain the same level of sedation. Amnesia was tested at the sedative endpoint by showing the child a tinkling ball and checking recall 1 h after surgery. Recovery was assessed by the Post-Anesthetic Recovery Scale at 3 h (0–10) with 10 representing readiness for discharge. Questionnaires were completed by the dentist and anaesthetist during recovery and by telephone to the parents 1–2 weeks later. Dental treatment was completed according to protocol in 11 of the 15 patients in group M (sedative doses: 0.27 0.09 mgkg^-1, mean SD) and all patients in group G. Recovery was similar in both groups, with discharge criteria met after 1 h 30 min in all but one group M patient. None had recall for intra-operative events. However, the variability of responsiveness makes midazolam unreliable when used alone to facilitate dental treatment, and the high dose requirements make close monitoring of paediatric patients mandatory.     

Penile prosthesis surgery under local penile block anaesthesia via the infrapubic space

The aim of this study was to evaluate the effectiveness and patient tolerance to local penile block anaesthesia via the infrapubic space with penile prosthesis implantation. Local anaesthesia was administered using a 23-guage 1.5-inch needle. A 50-50 mixture of 0.5% bupivicaine (Marcaine) and 0.5% lidocaine (Xylocaine) without adrenaline was injected into the infrapubic space with additional subcutaneous penile ring infiltration at the level of the penile root. A total number of 159 patients underwent this technique, mean age 57 years (range 34-86). In 148 (93%) patients, no booster sedation was needed; eight (5%) patients needed a boost of the pre-operative sedative during crural dilatation; three (1.8%) patients required general anaesthesia owing to insufficiently effective local anaesthesia and unexpectedly difficult dilatation. It is concluded that local anaesthesia was effective and safe to produce a pain-free procedure in 93% of cases. However, as the need for booster sedation or general anaesthesia exists, the procedure should be performed under monitored anaesthetic care and pre-operative evaluation should be performed as for general anaesthesia.     

定期口腔健康宣教在牙周病患者种植术后护理中的效果评价

目的：评价定期宣教对牙周病患者种植术后护理的效果。方法：本课题选择西安交通大学口腔医院种植中心接受牙种植术的牙周病患者100名,将100名患者随机分为2组,干预组和对照组;干预组分别在术后1、3、6、12个月对患者进行定期口腔健康教育,而对照组仅实施常规的术后宣教和定期检查。观察各组种植术后社区牙周指数（CPI）的变化以及种植体周围情况的异同。结果：与对照组相比,干预组种植体累积存留率高;干预组牙周状况（CPI）亦优于对照组（P〈0．05）,且具有统计学意义。结论：实施口腔健康教育对牙周病患者种植术后护理有积极作用,可增加种植义齿及自然余留牙的长期稳定性。     

Pharmacology of local anaesthesia in different age groups

Local anaesthetics are usually divided into amino-amides, drugs with a hepatic metabolism, and amino-esters, which are hydrolysed by esterases. Their effects are related to the inactivation of fast sodium channels. Although they have a large volume of distribution for local anaesthetics, neonates and infants have a low protein-binding capacity and a high heart rate. These conditions could increase the risk of bupivacaine cardiotoxicity. However, local anaesthetics have attractive pharmacodynamic characteristics in paediatric patients—such as easiness and safety of peripheral blocks and minor haemodynamic repercussion of central blocks.     

Use of local and local-regional anaesthesia plus sedation during aesthetic plastic surgery procedures in ambulatory and day surgery

In the field of aesthetic plastic surgery the use of local anaesthesia and sedation is continuously increasing due to patient demand and due to its safety. It is also more comfortable for the surgeon to have a cooperative patient. The costs are reduced and the surgery appears to be less traumatic. The local anaesthesia and sedation are to be balanced based on the type of surgery and on the patient's characteristics. A total of 120 patients received intravenous sedation of midazolam and ketamine immediately prior to local anaesthetic injection and successively every 20/30 min intraoperatively. Different mixtures of local anaesthetic at volumes ‘believed’ beyond limits have been used without any trouble at all. There were no perioperative or postoperative complications. Patients and surgeon related a high degree of satisfaction with this approach.     

种植义齿患者口腔健康管理的研究进展

阐述种植义齿患者口腔健康的影响因素包括牙周病史、糖尿病、吸烟史、口腔卫生不良、缺乏定期维护;指出种植义齿患者口腔自我健康管理依从性较差;介绍种植义齿患者口腔管理相关评估工具;患者口腔健康管理的干预措施包括患者及其照顾者管理、医护人员管理、多学科合作管理。指出应加强口腔专科护士在种植义齿患者口腔健康管理中的主导作用,提升口腔护理质量。