靶控输注异丙酚复合瑞芬太尼麻醉时NI与BIS监测镇静深度的比较

Objective To compare bispectral index (BIS) with narcotrend index (NI) during propofol-remifentanil anesthesia administered by target-controlled infusion (TCI).Methods Ten ASA Ⅰ or Ⅱ pafients aged 18-56 yr weighing 52-67kg undergoing abdominal surgery lasting>1h were included in this study.BIS and NI were monitored simultaneously.Anesthesia was induced with TCI of propofol with target plasma concentration (Cp) of 3～4μg/ml and remifentanil (Cp 3-4ng/ml).Tracheal intubation was facilitated with cis-atracurium 0.3 mg/kg.The patients were mechanically ventilated.PETCO2 was maintained between 30-35 mm Hg.Anesthesia was maintained with TCI of propofol and remifentanil by the anesthesiologist bhnded to BIS and NI values.according to hemedynamic parameters.BIS and narcotrend values were recorded every minute and compared by another anesthesiologist.All data were compared by Bland-Altman analysis and with Kappa coefficient for agreement.The correlation between BIS and NI was tested by Spearman correlation analysis.The number of error ofjudgement (Type Ⅰ was defined as BIS<40 and NI>62;Type Ⅱ was defined as BIS>60 and NI<20)Was counted.Results The correlation and agreement between BIS and NI during maintenance of propofol-remifentanil anesthesia administered by TCI showed good consistency.Conclusion Both NI and BIS Can help anesthesiologist control the depth of anesthesia during TCI of propofol-remifentanil.     

瑞芬太尼与芬太尼复合异丙酚在脑功能区手术唤醒麻醉中的应用

目的 比较靶控输注(TCI)瑞芬太尼与间断静脉注射芬太尼联合靶控输注异丙酚在脑功能区手术唤醒麻醉中的效果.方法 40例择期行脑功能区手术的患者随机分为两组:靶控输注瑞芬太尼、异丙酚组(RF组)和间断静注芬太尼加靶控输注异丙酚组(F组),每组各20例.通过镇静(OAA/S)和镇痛(VAS)评分评价瑞芬太尼或芬太尼复合异丙酚是否能够提供合适的镇静、镇痛,比较两组患者之间的血流动力学变化、唤醒时间、苏醒质量和术中并发症的发生率.结果 瑞芬太尼组唤醒时间明显小于芬太尼组(P＜0.05);术中唤醒后5,10 minRF组的镇静评分明显高于F组(P＜0.05),清醒后5,10 min疼痛评分及清醒后20 min的镇静、镇痛评分两组无明显统计学差异;F组唤醒和脑电刺激时血压明显高于基础值(P＜0.05),RF组唤醒和脑电刺激时血压与基础值比较差异无显著性(P＞0.05),上头架、切皮时RF组BP和HR明显低于F组(P＜0.05);术中并发症发生率两组比较差异无显著性.结论 瑞芬太尼可更好地替代芬太尼联合异丙酚靶控输注,为脑功能区手术唤醒麻醉提供满意的效果.     

丙泊酚复合瑞芬太尼靶控输注在神经外科手术中的应用

目的探讨丙泊酚复合瑞芬太尼靶控输注全静脉麻醉在神经外科手术中应用的临床意义。方法对66例神经外科择期手术病人采用丙泊酚复合瑞芬太尼靶控输注全静脉麻醉。丙泊酚、瑞芬太尼靶浓度分别为2￣4m g/L和2￣5μg/L,间断追加维库溴胺。记录围麻醉期血流动力学、麻醉药用量以及麻醉后恢复情况。结果麻醉诱导后病人收缩压、舒张压均显著性降低(P<0.05),心率减慢(P<0.05),气管插管、切皮前后无明显改变,手术结束后睁眼时心率明显增快(P<0.05),麻醉恢复时病人苏醒较快,自觉舒适,无呼吸再抑制现象。结论丙泊酚复合瑞芬太尼靶控输注,麻醉诱导迅速,维持平稳,停药后清醒快,对气管导管耐受性好,适用于神经外科手术。     

Intraoperative awake anesthesia applied for tumor excision in cerebral functional areas

Objective ： To observe the feasibility and safety of awake anesthesia for tumor excisions in patients with brain tumors involving cerebral functional areas. Methods ： Fifty patients with brain tumors involving cerebral functional areas, ASA Ⅰ - Ⅱ grade, were enrolled in this study. Propofol and remifentanil were used for total intravenous anesthesia, and a laryngeal mask airway （LMA） was inserted for the airway opening and synchronized intermittent mandatory ventilation （SIMV）. At the surgeon＇s request for an intraoperative wake-up test, the propofol infusion was stopped advance of 10-15 min, the remifentanil infusion rate was decreased to 0. 050-0. 075 μg/kg from 0. 10-0. 20 μg/kg per min for easing surgical pain. The LMA was removed until the patient awakened. The anesthesiologist then kept up an on-going neurological examination. After that, anesthesia was re-deepened and LMA was re-inserted until the whole surgery was accomplished. Results： Forty-six of 50 patients （92%） were successfully awakened and 4 （8%） failed to complete the intraoperative wake-up test because of dyspnea, over-sedation, or severe hypertension. No severe complications occurred during the whole process. Conclusions： During the awake anesthetic period, the intraoperative wake-up test combined with navigation, evoked potential and ultrasound techniques can help surgeons excise maximumly and precisely the brain tumors near to or in the functional areas.     

靶控输注丙泊酚复合芬太尼、利多卡因或氯胺酮全静脉麻醉

目的探讨靶控输注芬太尼、利多卡因或氯胺酮对丙泊酚静脉麻醉效能、血流动力学、麻醉恢复以及药物费用的影响。方法随机选择250例ASA Ⅰ-Ⅲ级择期手术患者靶控输注丙泊酚(P组,n=50)、丙泊酚复合芬太尼2μg/L(PF组,n=53)、利多卡因4 mg/L(PL组n=52)或氯胺酮0.4 mg/L(PK1组,n=47)、氯胺酮0.6 mg/L(PK2组,n=48)全静脉麻醉,PF组手术结束前30min停用芬太尼。观察麻醉期间HR,MAP变化以及术后苏醒情况,记录给药时间、用药量,计算各组患者药物费用。结果P组、PF组、PL组患者麻醉期间HR无明显改变, MAP在麻醉诱导时降低(P<0.05),气管插管、切皮时PF组恢复正常,P组、PL组升高,以P组明显。PKI组、PK2 组麻醉诱导、气管插管前后、切皮前后及术中HR,MAP无明显改变(P>0.05)。与单用丙泊酚组相比,PF组、PL 组、PK1组、PK2组麻醉诱导与维持丙泊酚用量分别较P组降低20%-30%(P<0.01),药物费用降低28.19%- 36.75%,以PK2组明显。各组患者麻醉恢复无明显差异。结论芬太尼、利多卡因和氯胺酮能明显增强丙泊酚麻醉效能,血流动力学稳定,降低丙泊酚用量和药物费用,以氯胺酮0.6 mg/L最为明显。     

右美托咪啶复合七氟烷全身麻醉对矫形外科术后镇痛效果的影响

目的 观察七氟烷麻醉时复合右美托咪啶(dexmedetomidine, Dex)对腰椎间盘后路融合手术后曲马多静脉自控镇痛效果的影响.方法 75例ASAⅠ～Ⅱ级行腰椎融合全麻手术患者,随机分成D1、D2、D3、D4 4个治疗组和1个正常对照组(NC组),每组各15例,对应右美托咪啶0.2、0.4、0.6、0.8 μg/(kg·h).术后行患者静脉自控镇痛(PCIA).分别记录术后1、2、4、8、12、24 h的疼痛视觉模拟评分(VAS),患者对镇痛治疗的总体满意度和不良反应.结果 术后1、2、4、8、12 h VAS评分D1组与NC组相比无显著差异(P>0.05),术后1、2、4、8、12、24 h VAS评分D3组与D2相比无显著差异(P>0.05),术后24 h VAS评分D4与D3无显著差异(P>0.05);术后1、2、4h VAS评分D2、D3、D4组小于NC组和D1组(P<0.05);术后8、12 h VAS评分D2、D3、D4组小于NC组(P<0.05),D3组和D4组小于D1组(P<0.05);术后24 h VAS评分D1、D2、D3、D4组小于NC组(P<0.05),D2、D3、D4组小于D1组(P<0.05).患者对镇痛治疗的总体满意度各治疗组均大于对照组(P<0.05).与对照组相比各治疗组恶心、呕吐发生率低(P<0.05),口干发生率高(P<0.05).结论 七氟烷麻醉术中持续输注右美托咪啶增加术后镇痛效果和镇痛治疗的总体满意度,且其效应随着剂量的增大而增加.     

靶控输注异丙酚复合瑞芬太尼或舒芬太尼全静脉麻醉

目的比较靶控输注异丙酚复合瑞芬太尼或舒芬太尼全静脉麻醉的血流动力学、脑电双频指数(BIS)以及术后麻醉恢复情况。方法选择40例择期手术患者,随机分为两组。以血浆药物浓度为靶浓度,靶控输注瑞芬太尼(PR组,n=20)(3~4)μg/L或舒芬太尼(PS组,n=20)(0·4~0·6)μg/L后,逐步升高异丙酚靶浓度至BIS(45%~60%)。术中视情况调整瑞芬太尼或舒芬太尼靶浓度维持麻醉平稳,观察血流动力学、BIS值以及麻醉恢复情况。结果麻醉诱导后两组患者收缩压(SBP)、舒张压(DBP)均降低(P<0·05),PR组心率(HR)降低明显(P<0·01)。气管插管、切皮及术中血流动力学稳定,PR组停药后约10min患者HR增快(P<0·01)。两组患者异丙酚诱导后BIS值明显降低(P<0·01),组间BIS值差异无显著性(P>0·05)。停药后呼吸频率、潮气量PR组恢复迅速,PS组恢复较慢。停药至拔管时间PR组、PS组分别为(13·2±3·8)min、(29±7·5)min(P<0·01)。结论靶控输注异丙酚复合瑞芬太尼或舒芬太尼全静脉麻醉能达到满意的麻醉效果,瑞芬太尼或舒芬太尼浓度改变时BIS值无明显影响,复合瑞芬太尼时麻醉恢复彻底,复合舒芬太尼时麻醉恢复平稳。     

便携式麻醉机的回顾与发展展望

介绍了便携式麻醉机的基本组成及其对于野战和院外急救具有的重要作用。对国内外便携式麻醉机的发展历史进行了回顾。指出便携式麻醉机正在朝着专业化、智能化、集成化的方向发展,多功能、耐用和结构紧凑是其发展的最终目标。     

Cellular-Ⅰ型便携式野战麻醉机的研制

目的研发一套适用于现场紧急医疗救援的便携式野战麻醉机。方法利用Pro/E建模软件进行3维结构设计,并根据GB9706.29要求及相关国家标准进行机械加工。结果该机体积小、重量轻,符合便携式的要求,适宜很多院内外场合使用。样机具有呼吸支持和麻醉功能,可以满足成人及儿童的麻醉,同时具备参数安全报警功能。结论便携式麻醉机对于野战和院外的紧急医疗救援具有重要的作用。     

靶控输注丙泊酚和雷米芬太尼复合右旋美托咪啶在高龄患者脑功能区唤醒麻醉中的临床效果观察

<正>本研究旨在观察靶控输注丙泊酚和雷米芬太尼复合右旋美托咪啶应用于高龄患者脑功能区唤醒麻醉的临床效果。1资料与方法1.1一般资料:4例择期行脑功能区手术患者,其中2例患者有高血压病史并长期服用降血压药物,血压控制良好;所