全麻和高位硬膜外联合臂丛麻醉在乳腺癌手术中的比较

目的 观察两种不同的麻醉方法用于乳腺癌根治术对呼吸循环功能的影响以及并发症的发生率.方法 选择诊断明确的乳腺癌患者120例,ASAⅠ～Ⅱ级,随机分为两组.A组66例采用气管插管静脉复合麻醉,B组54例采用高位硬膜外麻醉联合臂丛神经阻滞.结果 A组患者麻醉后平均动脉压(MAP)、心率(HR)相对平稳;B组患者麻醉后MAP下降,HR减慢,与A组比较差异有统计学意义(P<0.05).B组患者麻醉后呼吸抑制发生率较高,脉搏氧饱和度(SpO2)在麻醉后、切皮时及切皮后10 min均低于基础值,A组麻醉后无呼吸抑制,特别在切除腋窝淋巴结时由于静脉注射氯胺酮而引起一过性SpO2下降.B组患者的术中知晓率及麻黄素和阿托品的应用率均高于A组(P均<0.05).结论 气管插管静脉复合麻醉用于乳腺癌根治术具有安全、麻醉效果确切、术中血流动力学平稳等优点,避免了由高位硬膜外麻醉引起的呼吸抑制、硬膜外血肿等一系列并发症. Abstract： Objective To observe the effect of breath and circulation and the incidence rate of complication during the breast cancer radical correction with this two methods of anaesthesia. Methods To select 120 patients,all definite diagnosed breast cancer,ASAⅠ-Ⅱdegree,and divided into two groups(group A and group B)at random. Group A received tracheal intubation balanced anesthesia;Group B received high epidural anesthesia with plexus brachialis nerves block. Results The patients of group A with a correspondence MAP and HR after anaesthesia;while MAP decrease(P<0.05) and HR step down (P<0.05) on the patients in group B,compare with group A has obvious statistical significance.The incidence rate of respiratory depression in group B was high, all the SpO2 after anaesthesia, the time of cutting skin and after cut skin 10 min under the base value. None respiratory depression in group A, especially SpO2 temporal descend because of intravenous injection the ketamine when ablate axillary nodes. The rate of awareness in group B, admove ephedrine and atropinic are all higher than that in group A(P<0.05).Conclusions Received tracheal intubation balanced anesthesia in the breast cancer radical correction has several good quality,such as safety, the effect of anesthesia is precisely,an equability haemodynamics;hemodynamics during the operation, to avoid respiratory depression and epidural hematoma;extradural hematoma and other complication originated by the epidural anesthesia.     

全麻和颈丛神经阻滞麻醉在甲状腺次全切除术中的比较

目的 观察两种不同的麻醉方法用于甲状腺次全切除术中,对呼吸循环功能的影响以及并发症的发生率.方法 选择甲状腺次全切除患者120例,ASAⅠ～Ⅱ级,随机分为两组.A组采用气管插管静脉复合麻醉;B组采用颈丛神经阻滞麻醉.术中连续监测平均动脉血压(MAP)、心率(HR)和脉搏氧饱和度(SpO2),分别于麻醉前,游离甲状腺时及术终测血糖浓度,并评价麻醉效果. 结果 B组在游离甲状腺时,MAP、HR均明显升高,A组患者麻醉后MAP、HR相对平稳,两组比较差异有统计学意义.两组患者术中血糖水平与术前相比均增高(P<0.05),但A组升高幅度低于B组(P<0.05),A、B两组间比较差异无统计学意义(P>0.05),A组麻醉效果(优良率100%)好于B组(优良率75%).结论 气管插管静脉复合麻醉用于甲状腺次全切除术具有安全、麻醉效果确切、术中血流动力学平稳等优点. Abstract： Objective To observe the effects of two different methods of anesthesia used in the subtotal thyroidectomy on the respiratory and circulatory function, as well as the incidence of complications. Methods Subtotal thyroidectomy patients 120 cases, ASA Ⅰ-Ⅱ, were randomly divided into two groups. Group A of tracheal intubation using intravenous anesthesia; B group use cervical plexus block anesthesia. Intraoperative continuous monitoring of MAP, HR, and SpO2 respectively, before anesthesia, free thyroid surgery during and final test blood glucose levels and to evaluate the anesthetic effect. Results Group B when the free thyroid, MAP, HR was significantly higher, group A of patients after anesthesia MAP, HR is relatively stable, the difference was statistically significant. In group B patients compared with the preoperative blood glucose levels were significantly higher (P<0.05), but the increasing range of group A were lower than group B (P<0.05), the difference between the two groups was not statistically significant (P>0.05), narcotic effect of group A(excellent and good rate of 100%) was better than that in group B (excellent and good rate of 75%). Conclusions Tracheal intubation intravenous anesthesia for thyroid subtotal resection is safe, the effect of anesthesia is effective, intraoperative hemodynamic is stable, etc.     

星状神经节阻滞治疗急性面神经麻痹的疗效观察

目的 观察星状神经节阻滞（SGB）治疗急性面神经麻痹的临床治疗效果.方法 128例急性面神经麻痹患者随机分为两组,对照组给予常规治疗,治疗组给予常规治疗加星状神经节阻滞疗法.以面瘫综合评分法评价两组的疗效,比较两组治疗后面神经麻痹恢复的有效率、治愈率及疗程的长短.结果 治疗组治愈率为65%、有效率为98%,对照组治愈率为35%、有效率为82%,两组治愈率及有效率差异有统计学意义（P＜0.05）.治疗组平均显效时间和治愈时间明显短于对照组（P＜0.05）.结论 星状神经节阻滞合并常规治疗能明显提高急性面神经麻痹的有效率和治愈率,并显著缩短疗程.     

吗啡联合氯胺酮皮下自控镇痛治疗顽固性中、重度癌痛

目的观察吗啡联合氯胺酮皮下自控镇痛（PCSA）治疗顽固性中、重度癌痛的效果及安全性。方法选择60例中、重度癌痛患者,按数字表法随机分成两组（Ⅰ组和Ⅱ组各30例）,Ⅰ组采用吗啡PCSA治疗,Ⅱ组采用小剂量氯胺酮联合吗啡PCSA治疗,两组治疗后1h、24h、48h采用视觉模拟评分法（VAS）评估疼痛程度,采用t检验分析比较两组镇痛效果、采用χ^2检验分析比较两组不良反应发生情况。结果两组治疗后1h、24h、48hVAS评分差异均无统计学意义（均P〉0．05）,但Ⅱ组吗啡用量平均31．23mg明显少于Ⅰ组的56．43mg（χ^2=6．18,P〈0．05）;Ⅱ组恶心呕吐4例（13．3％）、便秘2例（6．7％）、嗜睡2例（6．7％）、皮肤瘙痒0例（0．0）,明显低于Ⅰ组的21例（70．0％）、18例（60．0％）、9例（30．0％）、8例（26．7％）（χ^2=8．96、5．63、3．32、8．67,均P〈0．05）。结论吗啡联合小剂量氯胺酮PCSA具有镇痛作用强、不良反应小等优点,适合治疗中、重度顽固性癌痛。