小儿异氟醚吸入全麻的血流动力学监测

目的监测小儿异氟醚吸入全麻期间的血流动力学变化。方法46例小儿均采用异氟醚吸人全麻，观察插管时、插管后5min、切皮时及手术中血流动力学变化。结果显示插管时EVI、SI、CI均明显降低，SVRI、MAP、HR明显升高，其余各项指标和各时相血流动力学无明显变化。结论异氟醚对小儿血流动力学影响轻微，适于小儿全身麻醉。     

术中心肌梗塞2例

术中心肌梗塞２例李毅海，李爱芝（烟台毓璜顶医院麻醉科，２６４０００）例１，男，７０岁，ＡＳＡⅠ级，患左腹股沟斜疝．术前检查除示心电图ＱＲＳ低电压外余均正常。术前肌注安定１０ｍｇ．入室ＢＰ１６／１２．５ｋＰａ，Ｐ９５ｂｐｍ，ＳａＯ２９７％。病人精神高度...     

二氧化碳气腹对全身麻醉下肺萎陷的影响

目的 观察二氧化碳(CO2)气腹对全身麻醉下肺萎陷程度及肺部氧合的影响.方法 选择术前心肺功能正常,预在全身麻醉下行胆囊切除手术的患者40例.分别于诱导前、诱导后10 min和气腹后10 min抽取患者桡动脉血行血气分析,记录pH值、动脉血氧分压(PaO2)、动脉血气二氧化碳分压(PaCO2)、肺泡-动脉氧分压差[D(A-a)O2];同时采用密闭式氯稀释法测量肺功能残气量(FRC).结果 与诱导前比较,诱导后10min,惠者FKC明显降低(P＜0.01);与诱导后10 min比较,气腹后10 min,患者FRC进一步降低(P＜0.01).与诱导后10 min比较,气腹后10 min患者PaCO2明显增高(P＜0.01),PaO2轻度升高、D(A-2)O2和pH轻度降低,但无统计学意义(P＞0.01).结论 二氧化碳气腹可以使全身麻醉下肺萎陷程度加重,但短时间内不会引起PaO2下降.     

硬膜外麻醉对剖宫产手术病人循环功能的影响

对４０例硬膜外麻醉下行剖宫产术病人麻醉前后的有关循环指标进行测定。结果表明，麻醉后血氧饱和度（ＳａＯ２）、脉压差（ＰＰ）有明显下降，血管弹性扩张系数（ＥＴＫ）有明显升高，差异均有显著性（Ｐ＜０．０５）；左心有效泵力（ＶＥＰ）、平均动脉压（ＭＡＰ）与，总周围阻力（ＴＰＲ）均明显降低，差异均有极显著性（Ｐ＜０．０１）。提示硬膜外麻醉有一定抑制心肌收缩、降低外周血管阻力及血氧含量的作用。     

雾化吸入小剂量氨溴索对开胸食道手术患者单肺通气时炎性反应的影响

目的 评价雾化吸入氨溴索对开胸食道手术患者单肺通气时炎性反应的影响.方法 择期行开胸食道手术患者60例,ASA分级Ⅰ或Ⅱ级,年龄39～64岁,体重50～85 kg,身高153～181cm.采用随机数字表法,将患者随机分为3组(n=20):对照组(C组)、静脉输注氨溴索组(IA组)和雾化吸入氨溴索组(AIA组).单肺通气前10 min,C组静脉输注生理盐水250 ml;IA组静脉输注氨溴索10mg/kg(用生理盐水稀释至250 ml);AIA组采用自制装置氧气驱动雾化吸入氨溴索4 ml(30 mg)+生理盐水2 ml,氧流量5～6 L/mim.于麻醉诱导后给药前1 min(T0)、单肺通气90 min(T,)和恢复双肺通气30 min(T2)时,采集桡动脉血样,采用双抗体夹心ELISA法测定血清TNF-α、IL-1β、IL-8和IL-10的浓度.结果 与T0时比较,各组T1和T2时血清TNF-α、IL-1β、IL-8的浓度升高,IL-10浓度降低(P＜0.05);与C组比较,LA组和AIA组T1和T2时血清TNF-α、IL-1β、IL-8的浓度降低,IL-10浓度升高(P＜0.05);IA组和AIA组各时点血清TNF-α、IL-1β、IL-8、IL-10的浓度差异无统计学意义(P＞0.05).结论 雾化吸入小剂量氨溴索可抑制开胸食道手术患者单肺通气导致的炎性反应,且与静脉注射大剂量氨溴索效果相似.

Abstract：

Objective To investigate the effects of inhaled aerosolized low dose ambroxol on the inflammatory response to one-lung ventilation ( OLV) in patients undergoing open-chest esophagus surgery. Methods Sixty patients with normal heart and lung function undergoing open-chest esophagus surgery were randomly divided into 3 groups ( n = 20 each): control group (group C) ; group IA received Ⅳ ambroxol 10 mg/kg after induction of anesthesia and group AIA inhaled aerosolized ambroxol 30 mg after induction of anesthesia. Arterial blood samples were taken after induction of anesthesia before ambroxol administration (T0, baseline) , at 90 min of OLV (T1 )and at 30 min after OLV (T2) for determination of plasma concentrations of TNF-α, IL-1β, IL-8 and IL-10 by ELBA.Results Plasma TNF-α, IL-1β, and IL-8 concentrations were significantly increased while plasma IL-10 concentration was significantly decreased at T1 and T2 as compared with the baseline at T0 in all 3 groups. Plasma TNF-α, IL-1β, and IL-8 concentrations were significantly lower and plasma IL-10 concentration was significantly higher at T1 and T2 in groups IA and AIA than in group C. Conclusion Both Ⅳ large dose ambroxol and inhaled aerosolized low dose ambroxol can inhibit the inflammatory response to OLV in patients undergoing open-chest esophagus surgery.     

手术中心肌梗塞二例报告

手术中心肌梗塞二例报告李毅海，李爱芝例１男，７０岁。ＡＳＡ分级Ｉ级。因“左腹股沟斜疝”入院手术治疗。既往无高血压和心绞痛病史，术前查体除心电图ＱＲＳ低电压外余检查均正常。术前１ｈ肌注安定１０ｍｇ。入室后测ＢＰ１６／１２．５ｋＰａ、Ｐ９５ｂｐｍ、ＳｐＯ...