非甾体抗炎药与麻醉药的相互作用

非甾体抗炎镇痛药(Non-steroidal anti-inflammatory drugs,NSAIDs)主要用于围手术期超前镇痛。本文对NSAIDs与常用的麻醉药如阿片类药、吸入麻醉药、静脉麻醉药和苯二氮艹卓类药物的相互作用加以综述。     

Three concentrations of levobupivacaine for ilioinguinal/iliohypogastric nerve block in ambulatory pediatric surgery

Study ObjectiveTo compare the postoperative analgesia of three different concentrations of levobupivacaine for ilioinguinal/iliohypogastric (II/IH) block in children undergoing inguinal hernia repair.DesignDouble-blind, prospective, randomized, controlled trial.SettingOperating room and postoperative recovery area of a university hospital.Patients73 ASA physical status I and II children, aged one to 6 years, scheduled for outpatient inguinal hernia repair.InterventionsPatients were randomized to receive one of three levobupivacaine concentrations: 0.125% (L0.125), 0.25% (L0.25), or 0.375% (L0.375). All patients received standard anesthesia with sevoflurane and II/IH nerve block.MeasurementsHeart rate (HR), non invasive blood pressure (NIBP), respiratory rate, end-tidal carbon dioxide concentration (ETCO₂), and oxygen saturation via pulse oximetry (SpO₂) were monitored during surgery. Postoperative pain scores with CHEOPS (Children's Hospital of Eastern Ontario Pain Scale) and need for rescue analgesia postoperatively were measured and recorded.Main Results60 patients entered the postoperative observational period. The number of patients who received rescue analgesia was comparable in the three groups. In Group L0.125, mean CHEOPS score was significantly higher, and time to first administration of rescue analgesia was shorter, than in the other two groups (P < 0.05). Pain scores and time to first administration of rescue analgesia were comparable between Groups L0.25 and L0.375.ConclusionsII/IH nerve block using 0.4 mL kg^-1 of 0.25% levobupivacaine provided satisfactory postoperative pain relief after inguinal herniorraphy.     

紧闭循环麻醉时七氟醚对病人肝肾功能的影响

目的 评价紧闭循环麻醉时七氟醚对病人肝肾功能的影响.方法 拟行普外科手术病人40例,ASA Ⅰ或Ⅱ级,年龄20～60岁,随机分为2组(n=20),麻醉诱导后S1.组和S2组分别吸人6%～8%国产或进口七氟醚,新鲜气流量2～4 L/min,2～3 min后调整新鲜气流量至0.18～0.30 L/min,随后维持七氟醚呼气末浓度2.6%～3.5%.于术前、术毕、术后1、2、3和5 d时测定血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)活性、总胆红素(TB)、肌酐(Cr)、尿素(BUN)、β2-微球蛋白(β2-MG)浓度和尿液β2-MG浓度.结果 与术前比较,术毕、术后1、2 d时两组尿液β2-MG浓度升高(P<0.05),术后1～5血清ALT、AST活性和TB、Cr、BUN和β2-MG浓度差异无统计学意义(P0.05);各指标组间比较差异无统计学意义(P0.05).结论 紧闭循环麻醉时七氟醚对病人肝肾功能无明显影响.     

不同血浆靶浓度瑞芬太尼对患儿吸入七氟烷诱导气管插管最低肺泡有效浓度的影响

目的 评价不同血浆靶浓度瑞芬太尼对患儿吸入七氟烷诱导气管插管最低肺泡有效浓度(MAC)的影响.方法 择期全麻患儿126例,年龄3～8岁,ASAⅠ或Ⅱ级,随机分为4组,对照组(C组,n=30);R1组(n=30)、R2组(n=30)和R3组(n=36)瑞芬太尼血浆靶浓度分别为1、2、3 ng/ml.均吸入5%七氟烷行麻醉诱导,睫毛反射消失后鼻腔置入导管连接气体分析仪,建立静脉通路,注射阿托品0.01 mg/kg,R1-3 组靶控输注瑞芬太尼.C组注射阿托品、R1-3组瑞芬太尼血浆浓度与效应室浓度达平衡后,采用改良序贯法进行试验,初始呼气末七氟烷浓度均为3.0%,相邻浓度比值为1.2,七氟烷呼气末浓度达到预定值并维持10 min后行气管插管.气管插管条件满意的标准:气管插管条件评分为6分.计算每组七氟烷MAC,并观察不良反应的发生情况.结果 C组、R1-3组患儿吸入七氟烷诱导气管插管的MAC分别为5%、3%、2%、1%,依次降低(P<0.01);所有患儿均无心动过缓、低血压等发生,R2组3例、R3组8例患儿因下颌松弛度差致喉镜无法置人或声门关闭,静脉注射罗库溴铵完成气管插管.结论 瑞芬太尼1 ng/ml可降低患儿吸入七氟烷诱导气管插管的最低肺泡有效浓度,且不良反应少.     

七氟烷后处理对大鼠肺缺血再灌注损伤的影响

Objective To investigate the effects of aevoflurane postconditioning on lung iscbemia-reperfusion (IR) injury in rats and the mechanism involved. Methods Ninety-six male SD rots weighing 270-330 g were randomly divided into 4 groups (n = 24 each): sham operation group (group S), group IR, sevoflurane preconditioning group (group SPr), and sevoflurane postconditioning group (group SPo). The animals were anesthetized with intraperitoneal 10% chloral hydrate 400 mg/kg, tracheostomized and mechanically ventilated. Lung IR was produced by occlusion of the hilum of the left lung for 45 min and then it was unclamped for reperfusion, in group SPr, sevoflurane was inhaled at the end-tidal concentration of 2.1% 30 min before lung ischemia. In group SPo, sevoflurane was inhaled at the end-tidal concentration of 2.1% immediately before reperfusiun. Six rats from each group were sacrificed at 30 min, 1 h, 2 h, and 4 h of reperfnsion respectively. The TNF-α, IL-1 and IL-6 concentrations, and WBC count in broncho-alveolar lavage fluid (BALF) were determined.The percentage of PMN in WBC was calculated. The lungs were removed for determination of the cdntent of TNF-α, IL-1 and IL-6 in the lung tissues and microscopic examination. The apoptosis index (AI) was calculated by TUNEL assay. Lung injury was scored. Results The levels of TNF-α, IL-1 and IL-6 in lung tissues and BALF, AI, WBC count, percentage of PMN, and lung injury scores were significantly higher in group IR than in group S (P < 0.01). The content of TNF-α, IL-1 and IL-6 in lung tissues was significantly higher in group SPr and SPo than in group S (P < 0.01). The indices mentioned above were all significantly lower in group SPr and SPo than in group IR (P < 0.05 or 0.01). No significant differences were found in the indices mentioned above between group SPr and SPo (P > 0.05). Conclusion Sevoflurane postconditioning can protect the lungs from IR injury by decreasing the inflammatory reaction and inhibiting the apoptosis in pulmonary vascular endothelial and alveolar epithelial cells, and the effect is similar to that of sevoflurane preconditioning.     

七氟烷对血管性认知功能损害大鼠炎性反应的影响

目的 探讨七氟烷对血管性认知功能损害大鼠炎性反应的影响.方法 成年雌性Wistar大鼠42只,体重200～250 g,随机分为3组:假手术组(S组,n=6)、血管性认知功能损害组(VCI组,n=18)和七氟烷组(Sev组,n=18).采用永久结扎大鼠双侧颈总动脉法建立血管性认知功能损害模型.Sev组于双侧颈总动脉结扎后,持续吸入七氟烷(呼气末浓度1.8%)和氧气0.5 L/min 12 h.S组于干预结束后2 d,VCI组和Sev组于干预结束后2、14、26 d时进行水迷宫实验和穿梭箱实验,记录学习、记忆潜伏期和被动、主动逃避次数.S组于干预结束后12 d,VCI组和Sev组于吸入七氟烷后12、24、36 d时各取6只大鼠,心脏取血后处死,取皮质和海马组织,采用酶联免疫吸附法测定血清和脑组织白细胞介素-1β(IL-1β)和肿瘤坏死因子-α(TNF-α)的水平,采用RT-PCR法测定脑组织IL-1β mRNA和TNF-α mRNA的表达.结果 与S组比较,VCI组和Sev组学习潜伏期延长,记忆潜伏期、被动和主动逃避次数降低,脑组织和血清IL-1β和TNF-α的水平升高,脑组织IL-1β mRNA和TNF-αmRNA的表达上调(P<0.01);与VCI组比较,Sev组学习潜伏期缩短,记忆潜伏期、被动和主动逃避次数增加,脑组织和血清IL-1β和TNF-α的水平降低,脑组织IL-1β mRNA和TNF-α mRNA的表达下调(P<0.01).结论 七氟烷可通过抑制炎性反应减轻大鼠血管性认知功能损害.     

老年患者七氟醚复合麻醉与异丙酚复合麻醉效果的比较

目的 比较老年患者七氟醚复合麻醉与异丙酚复合麻醉的效果.方法 择期行腹部手术的老年患者60例,年龄65～80岁,ASAⅡ或Ⅲ级,随机分为2组(n=30):七氟醚复合麻醉组(S组)和异丙酚复合麻醉组(P组).麻醉诱导:舒芬太尼初始效应室靶浓度为0.25 ng/ml,异丙酚初始血浆靶浓度为2.0 μg/ml,患者意识消失时,静脉注射罗库溴铵0.6 mg/kg,气管插管后行机械通气.麻醉维持:S组吸入七氟醚,呼气末浓度1.0%～2.0%,P组靶控输注异丙酚,血浆靶浓度2～4 μg/ml,两组均靶控输注舒芬太尼,效应室靶浓度0.15 ng/ml,静脉输注罗库溴铵0.15 mg·kg-1·h-1.两组均维持脑电双频谱指数40～60,平均动脉压、心率波动不超过基础值的30%.记录围术期血管活性药物使用情况、苏醒时间、拔管时间和清醒时间.结果 与P组比较,S组乌拉地尔使用率降低,苏醒时间、拔管时间和清醒时间缩短(P<0.05或0.01).结论 与异丙酚复合舒芬太尼麻醉比较,老年患者七氟醚复合舒芬太尼麻醉时血液动力学更加平稳,麻醉恢复较快,更适于老年患者.     

氯胺酮对腹部手术患者七氟醚MAC_(BAR)的影响

目的 评价氯胺酮对七氟醚抑制50%腹部手术患者切皮时应激反应的最低肺泡有效浓度(MAC_(BAR))的影响.方法 择期腹部手术患者44例,ASA Ⅰ或Ⅱ级,年龄30～60岁,随机分为2组(n=22):对照组(K_0组)和氯胺酮组(K_1组).麻醉诱导:静脉注射异丙酚2 mg/kg、芬太尼3 μg/kg和顺阿曲库铵0.15 mg/kg,气管插管后行机械通气.K_0组吸入七氟醚,K_1组吸入七氟醚的同时静脉输注氯胺酮14 μg·kg~(-1)·min~(-1).初始七氟醚呼气末浓度为3.0%.采用改良的序贯法进行试验,切皮时患者的心率或平均动脉压升高幅度≥基础值的15%定义为阳性反应,记录平衡点后各个由阳性反应到阴性反应的中点的浓度,取其平均值,即为MAC_(BAR),并计算其95%可信区间.结果 K_0组七氟醚MAC_(BAR)为3.25%(95%可信区间为3.05%～3.45%);K_1组七氟醚MAC_(BAR)为2.20%(95%可信区间为1.96%～2.44%),K_1组七氟醚MAC_(BAR)低于K_0组(P<0.05).结论 静脉输注氯胺酮14 μg~(-1)·min~(-1)可降低腹部手术患者七氟醚MAC_(BAR),增强七氟醚抑制应激反应的效应.     

无痛胃镜检查1000例临床研究

目的探讨无痛胃镜检查术的优越性和安全性。方法应用丙泊酚行无痛胃镜检查1000例,常规胃镜检查1000例作为对照。记录所有患者不适反应以及心率(HR)、血氧饱和度(SpO2)、血压(BP)的变化。结果无痛组患者咳嗽、咽痛等不适反应的发生率明显低于常规胃镜检查组,二者有显著性差异(P<0.01);96%的无痛组患者愿意再次接受胃镜检查,较常规组(22.0%)有显著性差异(P<0.01)。两组检查前或麻醉前HR、SBP、DBP、SpO2均正常,无痛组检查中、检查后上述指标同检查前比较无显著性差异(P>0.05),常规组检查中HR、SBP、DBP升高,与检查前差异有显著意义(P<0.05),检查中两组HR、SBP、DBP比较,差异有显著意义(P<0.05)。结论无痛胃镜检查是一种安全、有效的检查方法。     

腹横肌平面阻滞：腹壁区域阻滞新方法

侧腹壁由三层肌肉组成：腹外斜肌、腹内斜肌、腹横肌及其筋膜鞘。支配正中腹壁的神经走行于腹内斜肌与腹横肌之间的神经筋膜层。在此神经筋膜层注射局麻药可以阻滞前腹壁神经,提供良好的腹壁镇痛,此腹壁区域阻滞新方法,称为腹横肌平面阻滞。现就腹横肌平面阻滞的解剖基础、阻滞方法、临床效果、适应证、并发症等方面作一综述。