艾司洛尔预防气管内插管心血管反应的临床观察

研究艾司洛尔静注预防气管插管时心血管反应的效果。将９０例ＡＳＡⅠ～Ⅱ级择期全麻下手术患者随机分为３组,Ａ组（ｎ＝３０）静注艾司洛尔１ｍｇ．ｋｇ－１,Ｂ组（ｎ＝３０）静注艾司洛尔２ｍｇ．ｋｇ－１,Ｃ组（ｎ＝３０）为对照组,静注同等容量的生理盐水。观察注药前、插管前及插管后１ｍｉｎ、２ｍｉｎ、３ｍｉｎ、５ｍｉｎ、１０ｍｉｎ时,心率、收缩压和舒张压的变化。结果显示：Ａ组和Ｂ组均能较好地缓解窥喉和气管插管时心率增快和血压升高的心血管反应,效果尤以Ｂ组为佳;３组中各有１例发生心动过缓和低血压,未见哮喘和过敏。研究提示：艾司洛尔能安全有效地减轻插管时的心血管反应。     

原发性气管癌的CT诊断

①目的　提高原发性气管癌的诊断水平。②方法　回顾性分析 １１ 例经手术及病理确诊的原发性气管癌的临床表现、病理分型及 Ｃ Ｔ表现。③结果　１１ 例中腺样囊性癌６ 例,鳞状细胞癌４ 例,腺癌１ 例。主要 Ｃ Ｔ 表现为向腔内突出的结节６ 例,局部气管壁弥漫性增厚５ 例。④结论　 Ｃ Ｔ检查是发现和诊断原发性气管癌的有效方法之一。     

Postoperative sore throat: cause, prevention and treatment

Sore throat is a common postoperative complaint, occurring most often following tracheal intubation. Factors such as tracheal-tube size and cuff design have been shown to be important causative factors. Routine tracheal intubation for elective surgical procedures can result in pathological changes, trauma and nerve damage which may also account for postoperative throat symptoms. Sore throat following the use of a laryngeal mask appears to be related to the technique of insertion but the contribution of intracuff pressure remains to be clarified. It would appear, however, that high intracuff pressure is associated with nerve palsies due to neuropraxia and nerve compression. Careful insertion techniques for both the tracheal tube and laryngeal mask are of paramount importance in the prevention of airway trauma and postoperative sore throat.     

Experimental study of human tracheal heterografts in pigs

Summary In 12 three-months-old pigs a window-shaped tracheal defect was made and the defect closed by a precisely fitting Cialit-fixed, human tracheal heterograft. The macroscopic, microscopic, scanning and transmission electron microscopic investigation of the grafted area revealed that the tracheal epithelium was formed by microvillous epithelial cells primarily. 3 months after grafting cartilage of the tracheal transplant survived but after 9 months was replaced by a tight scar. The connective tissue plate thus formed was sufficiently stable to maintain normal respiration in the pigs.This work was supported by the Fonds zur Förderung der wissenschaftlichen Forschung (Project no. 3494)The authors thank A. Laminger and G. Sulzer for photographic work     

Anesthetic management of a patient with Hallermann-Streiff syndrome

Key words  airway management - difficult intubation - Hallermann-Streiff syndrome     

高血压病史对体外循环冠脉搭桥术后早期预后的影响

目的 :了解高血压病史对体外循环下冠脉搭桥术后早期预后的影响。方法 :对高血压和非高血压行体外循环下冠脉搭桥术年龄大于60岁的冠心病患者65例术前和术后早期的临床资料进行分析。结果 :与非高血压患者相比 ,患高血压的病人冠脉搭桥术后心律失常的发生率增高 ,术后30min动脉氧分压与吸入氧浓度 (PaO2/FiO2)比值明显低下 ,机械通气时间明显延长 ,术后24h内胸腔引流量明显增加 ,术后大剂量多巴胺 (>10μg·kg-1·min -1)应用率及重症监护时间无显著性差异。结论 :高血压病史使患者冠脉搭桥术后早期肺功能下降、心律失常发生率增高、出血倾向增加 ,提示维持高血压患者围手术期血压的正常有利于改善患者预后     

可乐定对气管拔管患者应激反应的影响

目的探讨可乐定对气管拔管应激反应的预防作用.方法22例气管插管全麻手术病人,随机分为对照组和可乐定组(每组11例).可乐定组病人于麻醉前 60 min 加服可乐定 5 μg*kg-1,其它麻醉前用药两组病人相同.分别在麻醉前、拔管前、拔管后1、2、5、10 min 采集动脉血标本,测定血浆儿茶酚胺、血管紧张素Ⅱ、皮质醇、血糖、血乳酸浓度,做血气分析,计录各时点的血流动力学参数.结果两组病人气管拔管期间血浆儿茶酚胺、皮质醇、血糖、血乳酸浓度均明显增高,可乐定组增高程度明显低于对照组.结论麻醉前服用可乐定能明显减轻气管拔管引起的应激反应.     

食管异物摘取术的麻醉选择

为探讨食管异物摘取术的麻醉方法，提高手术效果，对７２例食管异物患者采用强化表面麻醉法和气管内插管麻醉法进行了手术和对比观察。７２例异物均取出顺利，无严重并发症发生。资料显示：两种麻醉各具优越性，前者适用于年龄较大的儿童和成人，后者适用于食管异物并呼吸困难的小儿。     

原发性气管肿瘤的外科治疗

 自1991年6月至1996年11月, 我们对原发性气管肿瘤23例进行手术治疗, 其中良性肿瘤2例, 恶性肿瘤21例, 施行气管节段切除11例, 侧壁切除6例, 气管腔内肿瘤刮除加电灼术6例。 术后无发生气管瘘、无手术死亡。 术后1、3、5年生存率分别是86％、53％和21％。 作者认为应根据气管肿瘤的病理性质, 病变范围和外侵程度, 酌情使用气管节段切除、侧壁切除和肿瘤刮除加电灼术。     

艾司洛尔对气管插管期间脑电双频指数的影响

目的　探讨艾司洛尔对气管插管期间血流动力学和脑电双频指数(BIS)的影响。方法　30例行腹腔镜胆囊切除术的患者,随机分为2组:艾司洛尔组(试验组)和生理盐水组(对照组)。全麻诱导: 2组均靶控输注异丙酚,血浆浓度为4μg·mL-1, 维库溴铵0. 1mg·kg-1。试验组在异丙酚输注5min后,予艾司洛尔1mg·kg-1, 并以150μg·(kg·min)-1维持;对照组予生理盐水。异丙酚输注10min后,行气管插管。观察诱导前、插管前及插管后1, 3, 5min平均动脉压(MAP)、心率(HR)及BIS的变化。结果　插管后1, 3min,对照组MAP、HR显著高于诱导前,试验组与诱导前比较差异无显著性。插管后1, 3min,对照组BIS较插管前显著升高,试验组BIS与插管前比较差异无显著性。结论　气管插管时,艾司洛尔即可减轻病人的心血管反应,又可抑制插管刺激引起的大脑皮层兴奋性的增加。