曲马多对剖宫产患者术中寒战疗效的临床研究

目的比较曲马多和哌替啶对剖宫产患者术中抗寒战的效果及副作用,为其临床合理应用提供参考。方法将90例硬膜外麻醉后发生寒战产妇随机分为对照组、哌替啶组和曲马多三组,分别在发生寒战后注射生理盐水、哌替啶0.5mg/kg和曲马多1mg/kg,比较注射后产妇寒战的改善程度、患者的不良反应、新生儿Apgar评分。结果应用曲马多和哌替啶后患者对寒战的明显改善率为96.6%和80.0%,两组间无明显差异,而生理盐水组明显改善率为10.0%,与曲马多和哌替啶组相比差异有显著性。哌替啶组的不良反应总体发生率明显高于曲马多组和对照组。新生儿Apgar评分哌替啶组为8.3±1.2,明显低于曲马多组的9.6±0.5和生理盐水组的9.5±0.5。结论曲马多比哌替啶更适用于治疗剖宫产患者术中寒战反应。     

Is this the time for Magnesium sulfate to replace Meperidine as an antishivering agent in spinal anesthesia?

Background & AimShivering is one of the serious complications during spinal anesthesia. Mepreidine is considered the most common drug used for control of shivering. The aim of this study is to detect if Magnesium sulfate can replace Mepreidine, in the prevention of shivering in patients undergoing spinal anesthesia during knee arthroscopy.MethodsThe study included 50 patients scheduled for elective knee arthroscopy, aged 20–50 years under spinal anesthesia. The patients were randomly divided into two equal groups. Patients in Group (M) (n = 25) received single intravenous bolus dose of Meperidine 0.5 mg/kg while patients in group (Mg) (n = 25) received intravenous (IV) MgSO₄ in a dose of 50 mg/kg over 20 min followed by 0.5 mg/kg/min both. The both test drugs were administered after establishment of spinal anesthesia. The incidence and severity of shivering were recorded during the operation and in the recovery room.ResultsShivering occurred in 68% of patients in group (M) when compared to group (Mg) where only 28% suffered from shivering. This difference in % was found to be statistically significant. Regarding the complications, local allergy significantly occurred in group (M) in five patients when compare to one patient in group (Mg). There was no significant difference between group (M) and group (Mg) regarding the body core temperature.ConclusionMgSO₄ was found to be an effective way for the control shivering and it could replace Meperidine in middle age patients under spinal anesthesia.     

保暖结合体位调节对剖宫产产妇术中寒战及仰卧位低血压综合征的影响

目的 观察保暖结合体位调节对剖宫产产妇术中寒战及仰卧位低血压综合征的预防效果。 方法 选取2018年1-12月于我院性剖宫产手术产妇82例,采用随机数字表法将其分为观察组(n=40)和对照组(n=42),对照组采用常规护理方式,观察组在对照组基础上增加环境保暖结合体位调节干预。比较2组寒战和母婴不良事件发生情况。 结果 观察组术中寒战程度轻于对照组(Z=-2.700,P=0.007);仰卧位低血压综合征、低氧血症、新生儿窒息发生率均低于对照组(χ²=8.010,P=0.005;χ²=8.040,P=0.005;χ²=5.311,P=0.021)。 结论 采用环境保暖结合体位调节的护理方式可有效减轻剖宫产产妇术中寒战,减少仰卧位低血压综合征、低氧血症、新生儿窒息等不良事件,保证母婴安全。     

Effects of halothane and enflurane on the peripheral vasoconstriction and shivering induced by internal body cooling in rabbits

General anesthetic agents have central and peripheral effects on body temperature regulation, and its alterations are related to the depth of anesthesia. To evaluate the effect of halothane and enflurane on thermoregulation, we investigated the threshold of body core temperatures to induce peripheral vasoconstriction and shivering in spontaneously breathing rabbits. Rabbits were anesthetized with halothane or enflurane at 0.0 (control), 0.2, and 0.4 MAC (minimum alveolar concentration). Internal whole body cooling was performed by perfusion with cold water (10°C) through a U-shaped intestinal thermode placed in the colon. Core (esophageal) and peripheral (ear skin)_temperatures were measured with thermistor probes. The esophageal temperatures at the beginning of peripheral vasoconstriction and shivering induced by internal whole body cooling were determined. Core temperature threshold values for peripheral vasoconstriction were significantly higher than those for shivering in both groups. The incidence of peripheral vasoconstriction was not significantly affected by halothane or enflurane. However, the incidence of shivering decreased in a dose-dependent fashion with both anesthetic agents. At 0.2 MAC, the incidence of shivering in the enflurane group was significantly higher than that in the halothane group, suggesting that suppression of shivering by halothane is stronger than enflurane.     

Simulation of human thermoregulation during water immersion: Application to an aircraft cabin water-spray-system

A model was developed of transient changes in metabolic heat production and core temperature for humans subjected to cold conditions. It was modified to predict thermal effects of the upper parts of the body being sprayed with water from a system designed to reduce the smoke effects of an airplane fire. Temperature changes were computed at 25 body segments in response to water immersion, cold-air exposure, and windy conditions. Inputs to the temperature controller were:(a) temperature change signals from skin segments and (b) an integrated signal of the product of skin and head-core (hypothalamic) temperature changes. The controller stimulated changes in blood flow to skin and muscle and heat production by shivering. Two controller parameters were adjusted to obtain good predictions of temperature and heat-production experimental data in head-out, water-immersion immersion (0°–28°C) studies in humans. A water layer on the skin whose thickness decreased transiently due to evaporation was added to describe the effects of the water-spray system. Because the layer evaporated rapibly in a very cold and windy environment, its additional cooling effect over a 60-min exposure period was minimal. The largest additional decrease in rectal temperature due to the water-layer was <1°C, which was in normal conditions where total decreases were small.     

曲马多联合地塞米松治疗剖宫产产妇硬膜外麻醉寒战反应的效果

目的 探讨曲马多联合地塞米松治疗剖宫产产妇硬膜外麻醉寒战反应的效果与价值。方法 选取2019 年1 月至2020 年5 月本院收治的剖宫产产妇硬膜外麻醉寒战反应80 例,采用随机分组法将产妇分为两组,40 例作为对照组采用芬太尼联合咪达唑仑进行治疗,40 例作为试验组采用曲马多联合地塞米松进行治疗,对比两组治疗效果、用药不良反应发生率及用药满意度。结果 试验组产妇寒战消失率为97.5%,高于对照组的80.0%,差异有统计学意义（P＜0.05）;试验组产妇寒战消失时间为（2.6±0.3）h,短于对照组的（3.9±0.7）h,差异有统计学意义（P＜0.05）;试验组产妇术后寒战复发率为0,低于对照组的10.0%,差异有统计学意义（P＜0.05）;试验组产妇术后8 h 复发率为2.5%,低于对照组的17.5%,差异有统计学意义（P＜0.05）;试验组产妇术后用药不良反应总发生率为7.5%,低于对照组的25.0%,差异有统计学意义（P＜0.05）;试验组产妇用药满意度为100.0%,高于对照组的80.0%,差异有统计学意义（P＜0.05）。结论 寒战反应是剖宫产硬膜外麻醉后常见的一种并发症,严重影响手术的实际实施,采用曲马多联合地塞米松治疗,产妇寒战反应得到明显缓解,寒战持续时间明显缩短,且药物不良反应发生率极低,使用安全性较高,产妇的用药满意度提高,临床效果较好,值得推广使用。     

Application of therapeutic hypothermia in the intensive care unit

Induced hypothermia can be used to protect the brain from post-ischemic and traumatic neurological injury. Potential clinical applications and the available evidence are discussed in a separate paper. This review focuses on the practical aspects of cooling and physiological changes induced by hypothermia, as well as the potential side effects that may develop. These side effects can be serious and, if not properly dealt with, may negate some or all of hypothermias potential benefits. However, many of these side effects can be prevented or modified by high-quality intensive care treatment, which should include careful monitoring of fluid balance, tight control of metabolic aspects such as glucose and electrolyte levels, prevention of infectious complications and various other interventions. The speed and duration of cooling and rate of re-warming are key factors in determining whether hypothermia will be effective; however, the risk of side effects also increases with longer duration. Realizing hypothermias full therapeutic potential will therefore require meticulous attention to the prevention and/or early treatment of side effects, as well as a basic knowledge and understanding of the underlying physiological and pathophysiological mechanisms. These and other, related issues are dealt with in this review.     

Estudo prospectivo randômico,duplo‐cego e controlado comparando tramadol,clonidina e dexmedetomidina para tremores pós‐raquianestesia

Introduction

Shivering, a common intraoperative problem under spinal anesthesia increases the oxygen consumption considerably and is uncomfortable and distressing to the patient, anesthesiologist as well as surgeon. The present study was designed to explore the effectiveness of tramadol, clonidine and dexmedetomidine in the treatment of post spinal anesthesia shivering and to look for their adverse effects.

术中保温对预防经尿道前列腺电切术患者低温性寒战的效果观察

目的 观察术中保温对预防经尿道前列腺电切术患者低温性寒战的效果。方法 将60例经尿道前列腺电切术（TURP）患者随机分为保温组和对照组，每组各30例。对照组患者术中不采用任何升温装置，使用室温灌洗液进行膀胱冲洗；保温组患者术中采用输液加温器及充气升温毯加温，选用加温至37℃的灌洗液进行膀胱冲洗。测定术前及术后核心体温，比较2组术中出血量及发生寒战情况。结果 保温组患者术中体温维持稳定，手术前后体温无明显变化；对照组患者术中体温显著下降，与术前及保温组比较均显著下降（P〈0．05）；术中出血量2组患者比较差异无统计学意义，而保温组寒战发生率显著低于对照组（P〈0．01）。结论 TURP采用术中保温措施可维持患者体温的恒定，有效降低术中寒战的发生率。同时不会增加术中失血量。     

右美托咪啶和曲马多预防宫腹腔镜联合手术患者术后寒颤效果比较

目的比较右美托咪啶和曲马多预防宫腹腔镜联合手术患者术后寒颤的效果。方法择期行宫腹腔镜联合手术患者120例,采用随机数字表法将其分为3组（n=40）：右美托咪啶组（D组）,曲马多组（T组）和生理盐水对照组（N组）。麻醉诱导：依次静注咪达唑仑0．1mg／kg、舒芬太尼0．25肛∥kg和顺式阿曲库铵0．15mg／kg,TCI丙泊酚血浆浓度3．0ng／ml。插入喉罩后行机械通气。麻醉维持：静脉泵注瑞芬太尼0．1μg/（kg·min）,TCI丙泊酚血浆浓度3．Ong/m1,间断静脉注射顺阿曲库铵0．1mg／kg,手术开始缝皮时三组分别静脉泵注右美托咪啶0．5μg/kg、曲马多2mg／kg和0．9％NaCl。结果与N组相比,D组和T组术后寒颤的发生率降低（P〈0．05）。与D组和N组相比,T组术后1h内不良事件发生率升高（P〈0．05）。结论右美托咪啶和曲马多可降低宫腹腔镜联合术后寒颤的发生率,对苏醒时间影响小,且右美托咪啶的不良反应发生率低于曲马多。