艾司氯胺酮复合丙泊酚静脉麻醉对小儿腹腔镜疝修补术的应用

目的 研究艾司氯胺酮+丙泊酚静脉麻醉运用在小儿腹腔镜疝修补术中的价值。方法 简单随机选取2021年3月—2022年3月深圳市龙岗区人民医院收治的小儿腹腔镜疝修补术患儿80例,以随机数表法分为研究组和对照组,各40例。研究组采取艾司氯胺酮+丙泊酚静脉麻醉,对照组采用氯胺酮全麻。对比两组拔管、自主呼吸、指令性睁眼、PACU停留时间,测定两组麻醉前(T1)、麻醉后10 min(T2)、手术开始后5 min(T3)、手术开始后10 min(T4)、手术结束即刻(T5)、苏醒即刻(T6)的平均动脉压(MAP)、心率(HR),统计两组苏醒期躁动发生率与麻醉不良反应情况。结果 研究组拔管、自主呼吸、指令性睁眼、PACU停留时间均短于对照组,差异有统计学意义(t=4.023、3.678、6.556、3.657,P<0.05)。T1时,两组MAP、HR比较,差异无统计学意义(P>0.05);T2、T3、T4、T5、T6时,研究组MAP、HR均低于对照组,差异有统计学意义(t=9.769、11.841、10.213、9.201、9.298、9.436、14.664、15.686、14.892、...     

内镜面罩在无痛胃镜检查中的应用与护理

异丙酚静脉麻醉下行胃镜检查可减轻病人在检查中的不适,深受病人和医务人员的欢迎。但在异丙酚静脉麻醉过程中,可发生抑制呼吸的现象,使血氧饱和度下降,严重者需停止检     

靶控输注瑞芬太尼和异丙酚麻醉诱导时镇静催眠效应的相互作用

Objective To investigate the sedative and hypnotic interaction between remifentanil and propofol by target-controlled infusion (TCI) during induction of anesthesia.Methods Third-two ASA Ⅰ or Ⅱpatients,aged 22-63 yr,body mass index 18-25 kg/m2,scheduled for elective surgery under general anesthesia,were randomly divided into 4 groups(n=8 each).Group Ⅰ only received TCI pmpofol.GroupⅡ,Ⅲ,and Ⅳreceived a target concentration of 2,4 or 6 ng/ml remifentanil respectively.While the blood-effect site concentrations of remifentanil were equilibrated,patients received TCI of propefol,with an initial target concentration of 0.5μg/ml.After the blood-effect site concentrations of propofol were equilibrated then with 0.5μg/ml increments until the loss consciousness was achieved.The eyelash reflex and state of consciousness were assessed and radial arterial blood sample 6 ml was taken every 3 min to determine the remifentanil and propofol concentrations in blood.Propofol and remifentanil concentrations in blood were measured by reversed-phase high-performance liquid chromatography and high-performance liquid chromatography with ultraviolet detection respectively.The sedative and hypnotic interaction between propofol and remifentanil was determined with a pharmacodynamie interaction model by regression analysis and determined using the isobolographic method.Results Propofol concentrations in blood were lower in group Ⅱ,Ⅲ and Ⅳ than group Ⅰ(P<0.05).The propofol concentratopms in blood were significantly decreased in trun with the increase in the remifentanil concentrations in blood in group Ⅱ-Ⅳ(P<0.05).At loss of eyelash reflex and loss of consciousness of patients,the pharmacodynamic interaction model by curve fitting was superior to linear regression (P<0.05).At loss of eyelash reflex of patients,the curve fitting result showed EC50,prop=2.77μg/ml and EC50,rem=26.67 ng/ml,and the isobolographic method equation is ECprop/2.77+ECrem/26.67=0.69.At loss of consciousness of patients,the curve fitting result showed EC50,prop==3.76μg/ml and EC50,rem=31.56ng/ml,and the isobolographic method equation is Ecprop/3.76+Ecrem/31.56=0.65.Conclusion Remifentanil (Cp 2-6 ng/ml) and propofol by TCI shows a synergistic type of pharmacodynamic interaction on the sedative and hypnotic during induction of anesthesia.     

无痛人工流产受术者术前焦虑、抑郁状况的调查分析

目的:调查无痛人工流产受术者术前焦虑和抑郁状况.方法:选取2009年8～12月自愿接受无痛人工流产受术者150例,收集其年龄、文化程度、婚姻状况、生育史和人流史等一般资料,采用焦虑自评量表(SAS)和抑郁自评量表(SDS)进行测评.结果:无痛人工流产受术者SAS和SDS标准分均值分别为42.78和46.45,高于中国常模分值,术前SAS≥50分占52.7%,SDS≥53分占54.2%.不同文化程度之间的焦虑和抑郁程度比较无显著性差异,未婚和无生育史者的焦虑和抑郁程度明显高于已婚和有生育史者,接受过非无痛人流和初次无痛人流者焦虑和抑郁程度重于接受过无痛人流者.结论:不同人群对无痛人流术前的焦虑和抑郁程度不同,有必要对其进行心理干预.     

两种方法使用利多卡因缓解异丙酚注射痛的效果观察及护理

目的：探讨2种方法使用利多卡因缓解异丙酚注射痛的效果及护理措施。方法：选择150例自愿接受无痛人工流产的患者,随机分3组,每组50例,Ⅰ组静注生理盐水2ml60s后静脉推注异丙酚;Ⅱ组静脉注射2％利多卡因2ml 60s后静脉推注异丙酚;Ⅲ组前臂扎止血带后静脉注射2％利多卡因2ml且维持止血带60s后静脉推注异丙酚。各组均进行心理护理、选择肘部静脉、选择留置针及局部按摩护理措施,采用4分评分法对异丙酚注射痛进行评价。结果：Ⅰ、Ⅱ、Ⅲ组异丙酚用药后注射部位无痛发生率分别为30％（15例）、66％（33例）、84％（42例）,3组阍比较有统计学意义（P〈0．001）。绪论：扎止血带后静脉注射2％利多卡因2ml且维持止血带60s缓解异丙酚注射痛效果更好,同时配合有效的护理措施是减轻注射痛的保证。     

小儿麻醉前镇静药物及给药途径新进展

<正>小儿在围术期出现焦虑、恐惧等一系列应激反应,不仅影响麻醉诱导及手术的平稳,还会造成儿童术后不同程度的人格和行为改变,如梦游、夜尿、激惹增多等现象,给儿童身心健康带来巨大的伤害[1,2]。因此,如何避免这些伤害,保护儿童身心健康已成为当今社会研究的一个热点问题。研究表明,适宜的麻醉前镇静药可缓解患儿围术期的焦虑情绪,易于麻醉诱导,减少全身麻醉药用量,提高患儿麻醉恢复质量,降低术后行为扰乱、睡眠障碍、夜梦以及大便习惯改变的发     

靶控输注瑞芬太尼和异丙酚麻醉诱导时镇静催眠效应的相互作用

Objective To investigate the sedative and hypnotic interaction between remifentanil and propofol by target-controlled infusion (TCI) during induction of anesthesia.Methods Third-two ASA Ⅰ or Ⅱpatients,aged 22-63 yr,body mass index 18-25 kg/m2,scheduled for elective surgery under general anesthesia,were randomly divided into 4 groups(n=8 each).Group Ⅰ only received TCI pmpofol.GroupⅡ,Ⅲ,and Ⅳreceived a target concentration of 2,4 or 6 ng/ml remifentanil respectively.While the blood-effect site concentrations of remifentanil were equilibrated,patients received TCI of propefol,with an initial target concentration of 0.5μg/ml.After the blood-effect site concentrations of propofol were equilibrated then with 0.5μg/ml increments until the loss consciousness was achieved.The eyelash reflex and state of consciousness were assessed and radial arterial blood sample 6 ml was taken every 3 min to determine the remifentanil and propofol concentrations in blood.Propofol and remifentanil concentrations in blood were measured by reversed-phase high-performance liquid chromatography and high-performance liquid chromatography with ultraviolet detection respectively.The sedative and hypnotic interaction between propofol and remifentanil was determined with a pharmacodynamie interaction model by regression analysis and determined using the isobolographic method.Results Propofol concentrations in blood were lower in group Ⅱ,Ⅲ and Ⅳ than group Ⅰ(P<0.05).The propofol concentratopms in blood were significantly decreased in trun with the increase in the remifentanil concentrations in blood in group Ⅱ-Ⅳ(P<0.05).At loss of eyelash reflex and loss of consciousness of patients,the pharmacodynamic interaction model by curve fitting was superior to linear regression (P<0.05).At loss of eyelash reflex of patients,the curve fitting result showed EC50,prop=2.77μg/ml and EC50,rem=26.67 ng/ml,and the isobolographic method equation is ECprop/2.77+ECrem/26.67=0.69.At loss of consciousness of patients,the curve fitting result showed EC50,prop==3.76μg/ml and EC50,rem=31.56ng/ml,and the isobolographic method equation is Ecprop/3.76+Ecrem/31.56=0.65.Conclusion Remifentanil (Cp 2-6 ng/ml) and propofol by TCI shows a synergistic type of pharmacodynamic interaction on the sedative and hypnotic during induction of anesthesia.     

内镜面罩在无痛胃镜检查中的应用与护理

异丙酚静脉麻醉下行胃镜检查可减轻病人在检查中的不适,深受病人和医务人员的欢迎。但在异丙酚静脉麻醉过程中,可发生抑制呼吸的现象,使血氧饱和度下降,严重者需停止检     

盐酸丙帕他莫与曲马多用于人工流产术镇痛的双盲对照研究

目的:评价盐酸丙帕他莫与曲马多用于人工流产术镇痛的效果.方法:选择ASAⅠ级,孕(6～12) 周,自愿接受无痛人工流产的患者80 例,随机分P组和T组两组,每组40 例,P 组术前30min 静注生理盐水2ml 后静脉滴注丙帕他莫2g 溶于100ml 生理盐水;T组术前30min 静注曲马多100mg(2ml) 后静脉滴注100ml 生理盐水.两组手术消毒时开始靶控输注(TCI) 异丙酚,术毕停药.按随机双盲目对比研究,记录术前和术中平均动脉压(MBP) 、心率(HR) 和血氧饱和度(SpO2)变化,评价注射痛、术中麻醉镇痛效果、术后10min 、30min 、1h 、2h 、4h 、6h 镇痛(采用VAS 评分法)评分和不良反应.结果:两组术中MBP 较术前明显下降(P<0.01),HR 、SpO2无明显变化;两组注射痛和术中镇痛效果差异无显著性(P>0.05);P 组术后10min 、30min 、1h 、2h 的VAS 值小于T组(P<0.01);T 组术后30min 内恶心、呕吐及头晕的发生率高于P组(P<0.05).结论:丙帕他莫与曲马多可安全有效的用于人工流产术,丙帕他莫术后镇痛效果强于曲马多,且不良反应少.