腰麻-硬膜外联合阻滞应用于饱胃急诊剖宫产手术105例分析

我院2003—05／2006—10采用腰硬联合阻滞麻醉（CSEA）技术用于饱胃急诊剖宫产手术患者105例，取得满意的效果，现分析如下。     

小儿术后皮下自控镇痛的效果

目的比较皮下自控镇痛（PCSA）与静脉自控镇痛（PCIA）在小儿术后自控镇痛的安全性和有效性。方法全麻下行扁桃体切除术后患儿50例,随机均分为PCSA组和PCIA组。PC－SA组配方为芬太尼0．5mg,PCIA组配方为芬太尼0．3mg,两组均加甲氧氯普胺5mg,均以生理盐水稀释成100ml,背景剂量2ml／h,锁定时间15min,单次按压负荷量0．5ml,镇痛持续48h。观察患儿术后的镇痛效果,记录镇痛满意率、PCA总按压次数、PCA有效按压次数及并发症。结果PC－SA组与PCIA组满意率分别为88％（22／25例）和92％（23／25例）,差异无统计学意义（P〉O．05）。但PCSA组恶心呕吐发生率（8％）低于PCIA组（20％）（P〈0．05）。两组均未见嗜睡、呼吸抑制病例。结论PCSA可安全有效地用于全麻患儿术后镇痛。     

老年非心脏手术患者术前高敏C反应蛋白与术后心脏不良事件相关性的研究

Objective To investigate the relevance between level of preoperative high-sensitivity C-reactive protein(hsCRP) and the occurrence of postoperative adverse cardiac events in elderly patients underwent noncardiac surgery. Methods 49 patients of more than 65 years that had undergone elective noncardiac surgery were enrolled in the study. And all patients were conformed to the standards of "classification of risk factors for clinical history", content of "Guidelines on Preoperative Cardiovascular Evaluation for Noncardiac Surgery" established by the ACC/AHA .The patients were divided into two groups based on the preoperative hsCRP level:A group:hsCRP ≤ 3mg/L group (n=21) and B group: hsCRP>3mg/L group (n=28). General clinical characteristics of patients were recorded before operation, and 24 hours dynamic ECG was monitored a week prior to and after the operation. All patients taken measures of analgesia after surgery. The incidence of postoperative adverse cardiac events and the hospitalized days was recorded. The distinctions between two groups were analyzed regarding the occurrence of adverse cardiac events and hospitalized days after operation. Results 19 patients had postoperative myocardial ischemia; 4 cases in A group and 15 cases in B group. 7 patients suffered other postoperative adverse cardiac events, including 1 case in A group and the others in B group. There was statistically significant difference considering morbidity of myocardial ischemia in postoperation between the two groups, but there was no statistically significant difference about incidence of other adverse cardiac events and the length of stay in postoperation. Indexes about serious degree of myocardial ischemia:total depression time is(43.5±5.82 )min in A group, is( 135.0±81.2)min in B group. The depression times is(5.2±2.5 )in A group, is( 8.8±3.0)in B group.The longest depression time is( 23.7±9.2)min in A group, is( 84.3±54.1 )min in B group.Total ischemia burden is( 170.1 ±88.8 )mm· min-1 ·24h-1 in A group, is (311.3± 118.8 )mm· min-1 ·24h-1 in B group.There was statistically significant difference between the two groups. Conclusion Level of preoperative hsCRP>3 mg/L was relevant to the incidence of the most common postoperative adverse cardiac events--myocardial ischemia in elderly patients and level of preoperative hsCRP >3 mg/L was one of the risk factors of postoperative myocardial ischemia;Determination of preoperative hsCRP level may improve cardiovascular risk scoring system.     

老年非心脏手术患者术前高敏C反应蛋白与术后心脏不良事件相关性的研究

目的 研究老年非心脏手术患者术前高敏C反应蛋白(high-sensitivity C-reactive protein,hsCRP)与术后心脏不良事件发生之间的相关性. 方法 65岁以上行择期非心脏手术的患者49例,具有ACC/AHA"围术期心血管风险评估指南"中"临床病史危险因素分级"的至少1项中危因素或两项及以上低危因素.按术前所测hsCRP的水平分为2组即A组:hsCRP≤3mg/L组(n=21)和B组:hsCRP>3 mg/L组(n=28).收集患者围术期一般资料,并在术前1周内任1 d及术后行24 h动态心电图监测;均实施术后镇痛,随访术后住院期间心脏不良事件的发生并记录术后住院天数.比较2组术后心脏不良事件发生情况及术后住院时间的差异. 结果 2组有19例术后发生心肌缺血,其中A组4例,B组15例;术后7例发生了其他的心脏不良事件,其中A组1例,B组6例.2组术后心肌缺血的发生率差异有统计学意义,但其他事件的发生率及术后住院时间差异无统计学意义.反应心肌缺血严重程度的指标:总压低时间A组(44±6)min、B组(135±81)min,压低阵次A组(5.2±2.5)次、B组(8.8±3.0)次,最长压低阵次A组(24±9)min、B组(84±54)min,缺血总负荷A组(170±89)mm·min-1·24h-1、B组(311±119)mm·min-1·24 h-1,组间差异有统计学意义. 结论 老年患者术前hsCRP>3 mg/L与术后最常见的心脏不良事件--心肌缺血的发生之间具有相关性;术前hsCRP>3mg/L是术后心肌缺血的危险因素之一;术前hsCRP水平的测定可能可以补充完善以往心血管风险评分系统.     

罗哌卡因头皮浸润复合全麻在开颅手术中的应用

本文旨在观察罗哌卡因术前切口浸润对开颅手术中全麻药用量、血流动力学的影响,能否在减轻全麻术中及苏醒期应激反应的同时,提高患者的苏醒质量,为临床应用提供参考.     

术前应用倍他乐克的老年非心脏手术患者术后心脏不良事件调查

目的探讨老年非心脏手术患者术前48 h开始预防性服用倍他乐克是否能够降低围术期心脏不良事件的发生率.方法76例65岁以上拟行择期非心脏手术、具有ACC/AHA＂非心脏手术围术期心血管风险评估指南＂中至少一项中危因素同时不存在高危因素的患者,随机分为倍他乐克组和对照组,每组38例.倍他乐克组于术前48 h开始至术晨早晚各口服倍他乐克25～50 mg,对照组术前不服用任何β-受体阻滞剂.围术期监测（1）记录术中发生血流动力学紊乱的病例数和处理血流动力学紊乱所用药物的总用量及气道压;（2）入选患者在术前1周内服用倍他乐克前任1 d、手术当天至术后1～3 d进行Holter监测记录围术期心脏不良事件的发生情况;（3）术前1周内服用倍他乐克前1 d、手术结束后2 h、术后1～3 d测定肌钙蛋白I.结果对照组发生高血流动力学紊乱的患者例数和硝酸甘油用量多于倍他乐克组,差异有显著统计学意义（P〈0.01）.SBP〈90 mmHg、HR〈50次/min的患者例数和麻黄素、阿托品用量两组间差异无统计学意义（P〉0.05）;倍他乐克组没有明显的气道压升高.两组术前Holter监测发现的心肌缺血例数无显著性差异（P〉0.05）;术中、术后发现的心脏不良事件病例数组间差异有统计学意义（P〈0.05）,术中对照组8例、倍他乐克组1例发生心肌缺血;术后对照组有17例患者发生心肌缺血,其中2例并存室速、4例并存房颤,3例伴肌钙蛋白I阳性的心肌缺血,倍他乐克组3例发生心肌缺血;两组患者术后均未发生心肌梗死及死亡.结论术前48 h口服倍他乐克可以降低老年非心脏手术患者围术期心脏不良事件的发生率,且不增加心血管及呼吸系统副反应的发生.