小剂量氯胺酮在断指再植围术期的平衡镇痛作用

目的 观察小剂量氯胺酮在断指再植围术期的平衡镇痛作用。方法 选取ASAⅠ~Ⅱ级断指再植病人120例,随机分为氯胺酮组(K组)和生理盐水组(N组),每组60例。于神经丛刺激仪下行腋路臂丛神经阻滞麻醉,手术开始前5min,K组静注氯胺酮0.15mg/kg,N组静注生理盐水0.15mg/kg。术后两组病人均给予自控静脉镇痛(PCIA),将舒芬太尼150μg加托烷司琼5 mg以生理盐水稀释至120 mL,以2.0 mL/h持续镇痛48h。比较两组臂丛麻醉效果,止血带耐受效果,术后镇痛效果,PCIA需求按压和有效按压次数,术后恶心呕吐、皮肤瘙痒发生率。结果 K组臂丛麻醉效果及止血带耐受效果均优于N组(u=3.154、1.986,P<0.05)。两组术后镇痛效果均满意,视觉模拟评分差异无统计学意义(P>0.05)。K组术后48h内PCIA需求按压和有效按压次数均显著低于对照组(t=5.7、3.7,P<0.05)。两组术后恶心呕吐、皮肤瘙痒发生率差异无统计学意义(P>0.05)。结论小剂量氯胺酮在断指再植围术期中的平衡镇痛作用效果显著,提高了阻滞麻醉的满意率和止血带耐受率,减少了PCIA按压次数,且并未增加病人不良反应。     

不同浓度丙泊酚对断指再植手术患者患肢缺血再灌注及一周成活率的影响

目的观察不同浓度丙泊酚对臂丛神经阻滞断指再植手术患者患肢血浆中丙二醛（malondialdehyde,MDA）、缺血修饰白蛋白（ischemiamodifiedalbumin,IMA）、超氧化物歧化酶（superoxidedismutas,SOD）以及术后一周成活率的影响。方法选取60名急诊行断指再植手术患者,美国麻醉协会（AmericanSocietyofAnesthesiologists,ASA）分级I～Ⅱ级。电脑随机将所有患者均分为3组（n=20）：对照组（C组）、低浓度丙泊酚组（L组）以及高浓度丙泊酚组（H组）。所有患者均采用喙突下单点法臂丛神经阻滞,神经刺激仪定位。L组术中丙泊酚靶控血浆效应室浓度设置为0．5μg／ml,H组术中丙泊酚靶控血浆效应室浓度设置为2．0μg／ml。分别于术前（T0）,臂丛神经阻滞完成后15min（T1）,使用止血带60min（T2）,松止血带后10rain（L）、60rain（T4）抽取术侧肘部静脉血,测定血浆MDA、IMA、SOD的浓度。术后一周对所有患者随访,记录患者血管危象次数及再植断指成活率。结果松止血带后10min：C组及L组MDA、IMA值较术前明显增高,H组较术前无明显变化;C组及L组SOD值较术前明显降低,H组较术前无明显变化。松止血带后60min：C组IMA值较术前明显增高。L组及H组IMA值较对照组明显降低;c组及L组SOD值明显低于术前,H组SOD值较术前无明显变化。术后一周随访：H组患者血管危象发生率较C组及L组明显降低。H组再植断指成活率较C组及L组明显增高。结论丙泊酚可有效减轻肢体使用止血带所引起的缺血再灌注损伤,提高机体耐受缺血缺氧能力,且这种保护效果随着丙泊酚浓度的增高而增加。     

护航舰艇编队开展海上实战化自救互救训练工作的思考

亚丁湾护航任务呈现实战化、复杂化趋势, 护航编队航行时间长, 活动海区广, 对海上特殊环境下舰员的自救互救能力提出新的要求, 结合远海伤员救治的海基条件和实际困难, 通过分析护航任务期间海上实战化自救互救训练工作的特点和问题, 探索更加适合远海环境下的自救互救训练方式, 以期有针对性地提高远海护航自救互救能力, 并为海上实战化自救互救训练工作提供理论参照。     

改良型腋窝顶定位穿刺锁骨下位点阻滞麻醉的临床研究

Objective To study the feasibility of subclavicular brachial plexus block with localized puncture at the apex of the axilla.Methods 520 adult patients who underwent upper limb emergency surgery were randomly assigned to receive subclavicular brachial plexus block with localized puncture at the apex of the axilla ( experimental group) and block anesthesia with intraclavicular route ( control group).Patients in both groups received 0.375% ropivacaine, volume (40.0± 2.7)ml.During the 30 minutes after the blockade, the onset and effect of motor and sensory block, the sensory block effect of each nerve branches and integrated effect of nerve block were recorded.The VAS score and acesodyne duration with tourniquet were compared between the two groups at 2, 4, 6 and 8 hours after the drug had been used for 30 minutes.Results Within 30 minutes after the drug was delivered, the onset of motor and sensory block in the experimental group was evidently shorter than that in the control group, while the duration of motor and sensory block was evidently longer ( P ＜ 0.01).There were no statistically significant differences in motor and sensory block score, median nerve block effect and ulnar nerve block effect between the two groups.The musculocutaneous nerve and radial nerve block effects in the experimental group were better than those in the control group ( P ＜ 0.05).After the drug had been used for 30 minutes, VAS score of the experimental group at each point time was significantly lower than that of the oontrol group ( P ＜0.01).The analgesia duration of tourniquet in the experimental group was significantly longer than that of the control group ( P ＜ 0.01 ).Conclusion The modified subclavicular brachial plexus block with localized puncture at the apex of the axilla can provide perfect blockade, satisfactory anesthetic effect and higher safety in upper limb surgery.     

改良型腋窝顶定位穿刺锁骨下位点阻滞麻醉的临床研究

Objective To study the feasibility of subclavicular brachial plexus block with localized puncture at the apex of the axilla.Methods 520 adult patients who underwent upper limb emergency surgery were randomly assigned to receive subclavicular brachial plexus block with localized puncture at the apex of the axilla ( experimental group) and block anesthesia with intraclavicular route ( control group).Patients in both groups received 0.375% ropivacaine, volume (40.0± 2.7)ml.During the 30 minutes after the blockade, the onset and effect of motor and sensory block, the sensory block effect of each nerve branches and integrated effect of nerve block were recorded.The VAS score and acesodyne duration with tourniquet were compared between the two groups at 2, 4, 6 and 8 hours after the drug had been used for 30 minutes.Results Within 30 minutes after the drug was delivered, the onset of motor and sensory block in the experimental group was evidently shorter than that in the control group, while the duration of motor and sensory block was evidently longer ( P ＜ 0.01).There were no statistically significant differences in motor and sensory block score, median nerve block effect and ulnar nerve block effect between the two groups.The musculocutaneous nerve and radial nerve block effects in the experimental group were better than those in the control group ( P ＜ 0.05).After the drug had been used for 30 minutes, VAS score of the experimental group at each point time was significantly lower than that of the oontrol group ( P ＜0.01).The analgesia duration of tourniquet in the experimental group was significantly longer than that of the control group ( P ＜ 0.01 ).Conclusion The modified subclavicular brachial plexus block with localized puncture at the apex of the axilla can provide perfect blockade, satisfactory anesthetic effect and higher safety in upper limb surgery.     

围手术期快速康复外科路径管理对足部组织瓣移植修复手部缺损手术效果的影响

目的 探讨加速康复外科(enhanced recovery after surgery,ERAS)在足部游离组织移植修复手部缺损围手术期的应用效果,建立该术式标准化、规范化的手术路径.方法 选取自2015年6月至2019年12月我们收治的足部游离组织移植修复手部组织缺损的患者98例,随机分为ERAS组和对照组,每组49...     

超声引导下甲哌卡因与罗哌卡因联用对断指再植患者神经阻滞的效果

目的 评价10.00 g/L甲哌卡因与不同浓度罗哌卡因联合用于断指再植患者腋路臂丛神经阻滞的效果.方法 选择按照美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级急诊断指再植者90例,采用随机数字表法将患者分为A、B、C 3组,每组30例.各组在超声联合神经刺激器定位下行腋路臂丛神经阻滞.A组局麻药采用10.00 g/L甲哌卡因+...