全麻与硬膜外阻滞复合全麻对开胸手术患者围术期T细胞亚群的影响

目的 研究全麻与硬膜外阻滞复合全麻对开胸手术患者围术期T细胞、T辅助细胞和白细胞介素－10（IL－10）的影响。方法 选择择期开胸手术病人30例，随机分为两组。对照组（全麻组）：地西泮、芬太尼、丙泊酚、维库溴铵诱导，芬太尼、丙泊酚、维库溴铵、安氟醚维持；观察组（复合组）：全麻方法同上；术前术中硬膜外持续输利多卡因、芬太尼混合液。两组于麻醉前（T1）、切皮后2小时（T2）和术后24小时（T3）、48小时（T4）测外周血CD3、CD4、CD8、CD23^ B细胞及单核细胞HLA－DR表达和IL－10变化。同时测定外周血肾上腺素（E）、去甲肾上腺素（NE）。结果 对照组切皮后2小时CD3细胞下降，术后24小时CD4细胞和CD4／CD8比值降低，试验组切皮后2小时CD4／CD8升高。两组术后24小时CD23^ B细胞和IL－10均显著升高，单核细胞HLA－DR表达下降。复合组在术中、术后NE值均显著低于对照组。结论 硬膜外阻滞加全麻能够较好地抑制手术应激反应，抑制术后CD3、CD4细胞下降。     

选择性肝外血管阻断技术在肝肿瘤切除术中的临床应用价值和意义

目的 探讨选择性肝外血管阻断方法进行肝肿瘤切除术的临床应用和意义.方法 自2005年6月-2008年8月,对43例肝肿瘤切除术患者分别采用选择性肿瘤侧肝外血管游离阻断或结扎以及建立肝后隧道放置阻断带联合阻断法(SHVE)(19例)和Pringle法(24例)两种不同的阻断方式进行比较.两组肿瘤大小:SHVE组6 cm×6 cm～12 cm×12 cm,平均9 cm×9 cm.Pringle组6cm×6 cm～11 cm×11 cm,平均8 cm×8 cm.两组手术方式(叶或段切除):SHVE组Ⅱ～Ⅴ 4例,Ⅰ～Ⅳ 1例,Ⅳ+Ⅴ 2例,Ⅴ～Ⅷ9例,Ⅳ～Ⅷ3例.PrinCe组Ⅱ～Ⅴ 10例,Ⅳ+Ⅴ1例,Ⅳa～Ⅷ1例,Ⅴ～Ⅶ4例,Ⅴ～Ⅷ8例.将两组患者术中失血量、输血量、术中和术后并发症以及术后住院时间进行分析比较.结果 SHVE阻断组患者顺利将肿瘤侧肝动脉、门静脉结扎和肝静脉并予以结扎或置阻断带(其中肝右静脉出现小破裂口2例)和放置肝后下腔静脉阻断带.两组术中出血量、输血量和术后住院时间相比差异有统计学意义(分别t=3.93、3.19和3.04,均P<0.01).在术后第3天和7天肝功能的ALT、TBIL、PT变化情况相比差异有统计学意义(分别t=3.97、6.15、3.62、7.25、3.02、3.19,均P<0.01).结论 由于SHVE的肝肿瘤切除术其血流阻断只限于肿瘤一侧肝组织,故阻断时间可以不受到时间的严格限制,同时可以减少术中出血、防止预留侧肝再灌注损伤,对促进患者术后肝功能的恢复均有重要的实用意义.     

改良的星状神经节阻滞实验动物模型研究

目的：探讨颈5和颈7椎体水平穿刺入路的星状神经节阻滞效果是否相同。方法：12只雄性中国本兔,随机分为颈5（mSGB组）和颈7椎体阻滞水平组（SGB组）．分别注射0．25％布比卡因2ml后观察5．10．15,20．30．45．60分钟眼睑下垂情况。后注射0．5％亚甲蓝2ml．并处死．尸检观察记录颈交感链着色范围。结果：mSGB组及SGB组星状神经节阻滞后眼睑下垂程度无明显统计学差异．颈交感神经着色范围相同。结论：颈5和颈7水平穿刺入路星状神经节阻滞效果相同。     

Lateral popliteal sciatic nerve block: a single injection targeting the tibial branch of the sciatic nerve is as effective as a double-injection technique

BACKGROUND: Evidence indicating that single- and double-injection techniques for inducing a sciatic nerve block via a posterior subgluteal approach yield a similar success rate prompted us to investigate whether the two anesthetic techniques yield a similar success rate via a lateral approach. We also hypothesized that, owing to the peculiar anatomic features of the sciatic nerve at the popliteal level, a single injection via the lateral approach might induce effective anesthesia by targeting the tibial nerve only. METHODS: Ninety-six patients undergoing popliteal sciatic nerve block via a lateral popliteal approach for foot surgery were randomized to receive a single 30-ml injection of ropivacaine 7.5 mg/ml to block the tibial nerve (TN group, n= 32) or the common peroneal nerve (CPN group, n= 32), or two separate 15-ml injections (TN + CPN group, n= 32), after stimulation to evoke motor responses from the target nerves. RESULTS: The mean time to obtain a complete sensory blockade (surgical anesthesia) was shorter in the TN group than in the CPN and TN + CPN groups (14 +/- 7 min vs. 23 +/- 17 and 21 +/- 14 min, respectively; P < 0.05). The success rate was similar in the TN and TN + CPN groups (94%) and, 25 min after the initial injection, was already better in these groups than in the CPN group (94% vs. 75%; P < 0.05). CONCLUSIONS: A lateral popliteal sciatic nerve block obtained with a single 30-ml injection of ropivacaine 7.5 mg/ml after electrostimulation to locate the tibial nerve is as effective as multiple TN + CPN stimulation and injection, and local anesthesia has a significantly shorter onset time.     

腱膜性腹股沟疝修补术治疗腹股沟疝54例分析

目的探讨腱膜性腹股沟疝修补术治疗腹股沟疝的疗效。方法回顾性分析我院1996年9月~2004年9月采用腱膜性腹股沟疝修补术治疗54例腹股沟疝患者的临床资料。结果手术后所有病人切口疼痛轻微,无切口感染,1例并发阴囊血肿,经穿刺抽液治愈。手术后6~7 d拆线岀院。平均随访42(12~72)个月,无睾丸坏死或萎缩,无复发。结论应用腱膜性腹股沟疝修补术治疗腹股沟疝具有操作简单、效果良好、术后疼痛轻微、无严重并发症等优点,是治疗腹股沟疝较理想的手术方式。     

暂时性神经综合征的研究进展

暂时性神经综合征是椎管内麻醉所引起的脊神经暂时性功能障碍。其临床表现为术后24h内出现腰背部持续性疼痛,可放射到双侧臀部和下肢。疼痛区痛觉过敏或感觉迟钝。非甾体类抗炎药可缓解症状。疼痛具有白限性,一般可在2d～5d内消退。复原后无永久性运动及感觉神经功能障碍。就其原因可能与局麻药毒性或穿刺过程的机械性损伤有关。     

全麻复合硬膜外阻滞与单纯全麻的比较

比较全麻复合硬膜外阻滞和单纯全麻在围术期对机体应激、炎性、免疫等方面的影响。使用全麻加硬膜外麻醉能有效地抑制手术引起的应激反应，稳定循环状态，减少并发症，使病人在术中更为安全平稳，麻醉效果更为可靠，术毕清醒快，术后镇痛有利于术后病人咳嗽咯痰，并且能减轻围手术期对T细胞亚群的影响。     

肝移植手术不同分期对罗库溴铵药效学的影响

目的观察肝移植术中罗库溴铵的药效学。方法全身麻醉下肝移植术患者30例，随机分为罗库溴铵间断组（Ⅰ组）和连续输注组（Ⅱ组）。采用TOF刺激方式，监测拇内收肌收缩反应，记录肌松效应及用药量等。结果两组年龄、体重、尿量、出血量、无肝期及手术时间的差异无统计学意义。两组肌松起效和恢复时间及用药量差异无统计学意义。Ⅰ组无肝期临床作用时间（97．9±26．1）min和新肝期肝动脉开放前第一次给药的作用时间（82．0±20．9）min，明显长于无肝前期（65．0±22．2）min。Ⅰ组和Ⅱ组无肝期及新肝期罗库溴铵的用量分别为（1．61±1．18，2．16±1．23）μg·kg^-1·min^-1和（1．44±0．53，2．01±1．24）μg·kg^-1·min^-1，显著低于无肝前期（5．07±1．01，5．68±1．75）μg·kg^-1·min^-1。术中转氨酶显著升高（P〈0．01），血尿素氮和肌酐有增高趋势，肌酐清除率有降低趋势。无肝期和新肝初期内环境变化显著。结论肝移植术中间断和连续两种给药方式，罗库溴铵的用药量和肌松恢复时间相似。无肝期肝功能缺如、新肝缺血再灌注及肝动脉化，以及肝外途径等协同作用，使得无肝期和新肝期罗库溴铵的作用时间延长，维持同等程度肌松时用药量明显低于无肝前期。     

髂腹下及髂腹股沟神经阻滞用于小儿腹

目的：探讨小儿腹股沟区手术麻醉安全便利的麻醉方法。方法：小儿腹股沟部手术40例．随机分成二组．1组20例以氯胺酮肌注后行髂腹下及髂腹股沟神经阻滞：Ⅱ组20例以氯胺酮胍注后行骶管阻滞麻醉。监测Bp、P．R．SpO2变化,及术毕清醒时间、术中不良反应。结果：平均年龄、手术时间两组无统计学意义（P〉0．05）．所有病例均较好地完成手术。两组生命体征．清醒时间无明显差异;切皮时Ⅱ组有4例出现肢体躁动;处理疝囊及牵拉精索时Ⅰ组中有4例出现肢体躁动;Ⅱ组有4例经多次穿刺成功．1例局部血舯。结论：作者认为髂腹下及髂腹股沟神经阻滞操作简单,穿刺引起的并发症及危险性少,麻醉效果与骶麻相似,可作为小儿腹股淘部手术的麻醉方法之一,特别是骶管阻滞困难时。     

Feasibility and efficacy of placement of continuous sciatic perineural catheters solely under ultrasound guidance in children: a descriptive study

Background: Placement of sciatic catheters with ultrasound and stimulating catheters is known. Literature regarding catheter placements with only ultrasound is limited. We aimed to investigate the feasibility of performing continuous sciatic nerve block exclusively with ultrasound guidance and minimal equipment. Method: Forty ASA 1 and 2 patients aged 8 months–10 years posted for congenital talipoequinovarus surgery were included in the study. Continuous sciatic catheters were placed under ultrasound guidance with 18‐ gauge Tuohy needle at the infragluteal fold. Then, 0.25% of bupivacaine 0.5 ml·kg^?1 bolus was injected followed by continuous infusion later. Half the volume of the drug was injected prior to catheter insertion to improve visibility. The sciatic nerve, needle tip and shaft, catheter tip and the drug spread were visualized. The efficacy of the block intraoperatively and postoperatively was evaluated. Results: The sciatic nerve, needle shaft, and tip were well visualized in all 40 patients. The catheter tip was seen in 72.5% of patients. The effect of block was complete intraoperatively and postoperatively. Clinically significant complications were absent. Conclusion: We conclude that in children, continuous sciatic catheters can be accurately and efficaciously placed with minimal equipment with ultrasound alone.