控制性降压结合急性高容血液稀释在脑膜瘤手术中的应用

目的　观察控制性降压结合急性高容血液稀释 (AHH)对脑膜瘤手术的安全性及减少出血量和术后血红蛋白 (Hb)、红细胞比积 (Hct)的影响。　方法　择期脑膜瘤手术病人 2 0例 ,随机分成控制性降压结合AHH组 (Ⅰ组 ,n =10 )和对照组 (Ⅱ组 ,n =10 ) ,两组均采用气管内全麻。Ⅰ组病人于气管插管后手术开始前完成AHH并进行控制性降压。比较两组病人术中出血量、输血量和术后Hb、Hct变化。　结果　Ⅰ组病人术中平均出血量 (5 44± 92 )ml ,比Ⅱ组病人的 (10 72± 182 )ml减少 49 7% ;Ⅱ组病人平均输血量 (62 0± 112 )ml ,Ⅰ组病人则完全避免输异体血。两组病人术毕均有轻度贫血 ,但仍在安全水平范围内。　结论　控制性降压结合急性高容血液稀释可安全应用于脑膜瘤手术 ,对有指征病人的使用可避免术中输异体血     

The Cathlocator: A novel non-radiological method for the localization of enteral tubes

Safe placement of nasogastric tubes requires reliable positioning of the tip of the tube within the stomach. Radiology and aspiration are currently used to confirm tube position, but suffer from significant problems of cost and efficacy, respectively. We have developed a novel method to locate the position of a catheter tip within the body, using the detection of a low energy electromagnetic field generated in a coil located in the catheter with an external hand-held unit (Cathlocator). In vitro, the unit detected the distance of the coil from the detector with an accuracy of 0.1 cm over a range of 4–12 cm. In vivo studies were performed in 11 healthy volunteers using a purpose-built manometric assembly that incorporated the signal generating coil in its tip. In all subjects the Cathlocator showed the position of the signal generating coil to be cranial to the xiphisternum when manometric and transmucosal potential difference criteria showed it to be located above the lower oesophageal sphincter. When the coil was within the stomach, the Cathlocator identified its position within the epigastric, umbilical and left hypochondrial regions of the abdomen. The distance of the coil from the surface was significantly greater when in the duodenum mean (±s.e.m. 7.6±0.3 cm; P<0.001) and oesophagus (8.6±0.2 cm; P<0.002) than the stomach (5.0±0.4 cm). In one subject studied twice there was a close correlation between the location and depth measured by the device on each occasion. The Cathlocator is a novel non-radiological device that has the potential to be useful in the placement of gastrointestinal catheters.     

Nasotracheal intubation using fiberoptic bronchoscopy in infants and children

Journal of Anesthesia -     

机械通气气管插管吸痰方法探讨

目的探讨不同的吸痰方法,从而有效地清除气管插管患者的呼吸道分泌物。方法对47例气管插管病人均采用常规法和呛咳法两种方法吸痰,呛咳法要求:吸痰管带负压进入气管插管,随吸痰管插入深度调节负压,适时安全吸痰,适度气道湿化。常规法按临床一般方法进行吸痰。将两种方法吸出的痰量,痰液性状及吸痰前后20min血氧饱和度(SpO2)进行比较。结果两种方法在吸出的痰量,痰液性状和SpO2方面存在着显著差异(P<0.05,P<0.01),呛咳法吸出的痰多且粘稠。吸痰后SpO2明显高于吸痰前和常规法。结论呛咳法吸痰能充分吸出气道深部的痰液,可以有效防止气道阻塞,改善通气功能。     

Ultrasonic vocalizations and maternal-infant interactions in a rat model of fetal alcohol syndrome

When isolated from their dams and littermates, rat pups emit ultrasonic vocalizations to elicit attention and retrieval from their dams. This study examined the effects of perinatal alcohol exposure on ultrasonic vocalizations and maternal-infant interactions. Alcohol was administered throughout gestation to the dams and during the early postnatal period to the pups. Control groups consisted of a nontreated control and an intubated, pair-fed control. Ultrasonic vocalizations were measured on postnatal day (PD) 5 under varying conditions of isolation. Maternal behaviors were examined on PD2, 4, 6, 8, and 10. Maternal behaviors were not significantly affected by prior alcohol administration to either the dams or the pups. However, ethanol-exposed rat pups vocalized more on PD5 than controls regardless of condition. The heightened vocalization response of the ethanol-exposed pups might be an underlying factor in the persistent effects of perinatal ethanol exposure on social behavior.     

困难气管内插管的预测和处理

目的 探讨对困难气管内插管的预测及处理方法。方法 随机选取各类需行气管内插管麻醉下择期手术患者50例,术前测量IG、Slux,TM,HENE,HFNF、气道分类及声门分级等各项指标,并分析它们在气管插管难度之间的关系。结果 50例患者中,气道分类Ⅳ类者7例,声门分级Ⅲ级者17例,Ⅳ级者1例。17例声门Ⅲ级者以EtCO2引导下口腔盲插法插管成功,1例声门Ⅳ级者以气囊充气鼻腔盲控气管内插管法插管成功。结论 术前评价气管插管难易程度应综合考察各项测量指标,这些指标中又以声门分级最为可靠。     

Bolus doses of esmolol for the prevention of perioperative hyper-tension and tachycardia

The effectiveness of esmolol, an ultra short-acting cardioselective beta blocker, in the prevention and treatment of post-intubation haemodynamic perturbations, was investigated. Forty-eight ASA physical status I and II patients undergoing hysterectomy were randomly assigned to receive a single intravenous bolus of placebo, esmolol 100 mg, or esmolol 200 mg in a double-blind fashion. This was administered over 15 sec, and immediately followed by thiopentone 3-5 mg.kg-1, succinylcholine 1.5 mg.kg-1, and tracheal intubation 90 sec later. The heart rate following induction of anaesthesia was lower in the esmolol 200 mg group (P less than 0.01); following intubation, the increase in heart rate in the placebo group was greater than in the esmolol groups (P less than 0.05). The systolic blood pressure post-induction was lower in the esmolol 200 mg group (P less than 0.05); following intubation, however, no significant differences were seen among groups in systolic, diastolic, or mean blood pressures. Following tracheal intubation, the incidence of ventricular arrhythmias was lower in the esmolol groups (P less than 0.05). In summary, esmolol in 100 mg and 200 mg doses was effective in mitigating the haemodynamic response following tracheal intubation.     

尼卡地平预防双腔支气管导管插管反应的观察

目的　观察应用尼卡地平预防双腔支气管导管插管心血管反应的效果。　方法　肺、食道择期手术病人 40例 ,随机分为 2组 ,每组 2 0例。咪唑安定 0 .0 4mg/kg、异丙酚 1.5mg/kg、芬太尼 4μg/kg、维库溴铵 0 .12mg/kg静脉诱导后 ,甲组给予尼卡地平 4μg/kg ,乙组给予生理盐水 3ml作为对照。分别于诱导前、后 ,插管后即刻及 1、3、5min监测收缩压 (SBP)、舒张压 (DBP)、心率 (HR) ,并计算心率收缩压乘积 (RPP)。　结果　A组插管后血压无明显升高 ,心率较诱导前无明显增快 ,B组插管后血压明显升高。　结论　尼卡地平可抑制双腔支气管导管插管时的心血管副反应。