病例分析教学法在麻醉教学中的应用效果

目的:探讨病例分析教学法(CBS)在麻醉教学中的应用效果.方法:将我院麻醉专业学生∞例以班为单位分为观察组和对照组,对照组给予常规教学模式,观察组给予CBS教学模式,评估两组教学效果.结果:观察组的操作技能成绩及平均总成绩明显高于对照组,两组比较差异具有统计学意义(P＜0.05).观察组在激发学习兴趣、提高自学能力、分析问题能力、解决问题能力、培养临床思维能力、提高沟通能力及学习效率方面的满意度明显高于对照组,两组比较差异有显著性(P＜0.05).结论:CBS教学法在麻醉教学的应用效果明确,值得应用.     

“3＋2”模式下麻醉专业本科实习医生独立临床工作能力培训探索

根据新教学模式特点,制定针对性的临床带教计划,激发实习学员的临床实践热情有利于培训其独立的临床工作能力。     

平衡麻醉对老年上腹部手术围术期心肌酶及肌钙蛋白Ⅰ的影响

目的：观察平衡麻醉对老年患者上腹部手术围术期心肌酶及肌钙蛋白I的影响。方法：择期行胃癌根治术老年患者38例，ASAⅠ～Ⅱ级，随机分为全凭静脉麻醉组（A组）与硬膜外复合全麻组（B组）。分别于麻醉前、插管及拔管后5min、术后6、24h采集静脉血5ml，测定血清心肌酶和肌钙蛋白I（cTnI），同时观察血流动力学变化。结果：两组术中麻醉效果均满意。CK、CK—MB、LDH、cTnI；A组在拔管后5min及术后24h均明显高于麻醉前（P〈0．05），A组明显高于Bgt（P〈0．05）,B组未见明显改变。结论：静脉全麻复合硬膜外阻滞麻醉用于老年上腹部手术能有效减轻患者围手术期心肌的损害。     

小切口不停跳心内直视手术的麻醉

目的：探讨小切口不停跳心内直视手术的麻醉处理。方法：回顾性分析235例小切口不停跳体外循环下心脏手术的麻醉。结果：全组早期死亡3例，死亡串1.28％。术中血流动力学稳定，42例患者心内畸形矫正后应用正性肌力药。96.17％(226/235)患者术后4h内拔除气管导管。术后无空气栓塞、神经系统并发症或麻醉死亡病例。结论：小剂量芬太尼、异氟醚复合麻醉是小切口不停跳心内直视手术的一种较好的麻醉方法，术中应注意彻底排气、加强呼吸道管理和循环功能支持。     

Perioperative Cardiac Risk Reduction in Noncardiac Surgery

Major adverse cardiovascular events are a significant source of morbidity and mortality in the perioperative setting, estimated to occur in approximately 5% of patients undergoing nonemergent noncardiac surgery. To minimize the incidence and impact of these events, careful attention must be paid to preoperative cardiovascular assessment to identify patients at high risk of cardiovascular complications. Once identified, cardiovascular risk reduction is achieved through optimization of medical conditions, appropriate management of medication, and careful monitoring to allow for early identification of—and intervention for—any new conditions that would increase the risk of adverse cardiovascular outcomes. The major cardiovascular and anesthesiology societies in the United States, Europe, and Canada have published guidelines for perioperative management of patients undergoing noncardiac surgery. However, since publication of these guidelines, there has been a practice-changing evolution in the medical literature. In this review, we attempt to reconcile the recommendations made in these 3 comprehensive guidelines, while updating recommendations, based on new evidence, when available.     

Elevated catecholamines during cardiac surgery: consequences of reperfusion of the postarrested heart

This study determines whether reperfusion of the heart with elevated blood levels of epinephrine (E) and norepinephrine (NE) during cardiac surgery produces deleterious effects. The study was conducted in 60 patients undergoing coronary artery bypass surgery. Arterial catecholamine values increased significantly (p less than 0.05), from prebypass control levels of 152 +/- 29 and 327 +/- 30 pg/ml of E and NE, respectively, to 415 +/- 78 and 554 +/- 49 pg/ml, at initiation of perfusion of the heart after the aortic cross-clamp was removed. Serial measurement of arterial (A) and coronary sinus (CS) E, NE, potassium, lactate, PO2 and CK-MB revealed that during 10 minutes of reperfusion the heart extracted E (positive A-CS difference, p less than 0.05), but that the NE A-CS difference was 0. The CS effluent contained significantly (p less than 0.05) higher concentrations of potassium, lactate and CK-MB during reperfusion than before aortic occlusion. There was no significant correlation of arterial E and NE, CS E and NE or A-CS differences in E and NE with myocardial release of lactate, potassium or CK-MB. There was a weak association (r = 0.4, p less than 0.01) between coronary sinus CK-MB and aortic occlusion time. Maximal arterial E and NE values did not correlate with 10-hour postoperative (maximal) CK-MB values. These results indicate that reperfusion of the postarrested ischemic heart with high levels of endogenously released catecholamines does not worsen ischemia or contribute significantly to myocardial damage.     

对麻醉学科教育改革的思考

目前,麻醉学本科教育设立的大环境已经不再存在,其专业面狭窄的副作用日益显现,取消麻醉学本科专业势在必行。麻醉学科教育必须进行改革,但是改革的方向并不明确。“麻醉长学制教育”和“麻醉和围术期医学教育”是两个可能的方向,各具优点和缺点。比较而言,“麻醉和围术期医学教育”是麻醉学教育改革的一个较优方向。