外科重症病人脑电双频指数指导靶控输注咪达唑仑的镇静效果

目的评价外科重症监护病房(SICU)病人脑电双频指数(BIS)指导靶控输注(TCI)咪达唑仑的镇静效果。方法SICU病人30例,随机分为3组(n=10):A组采用恒速输注咪达唑仑0．06 mg·kg-1·h-1镇静;B组采用咪达唑仑TCI镇静,初始血浆靶浓度为60 ng/ml;C组在BIS指导下咪达唑仑TCI镇静,初始血浆靶浓度为60 ng／ml。每30 min采用Ramsay镇静评分评估镇静深度,若Ramsay镇静评分小于或大于4分,则A组输注速率增加或减少0．02 mg·kg-1·h-1,B组血浆靶浓度增加或减少20 ng／ml。C组若BIS大于或小于70,则血浆靶浓度增加或减少20 ng／ml。B、C组均随机抽取30份2 ml动脉血样,测定咪达唑仑血药浓度,用偏离性和精密度评价TCI系统的性能。结果咪达唑仑TCI系统的偏离性为12．5％,精密度为22．5％。咪达唑仑实测血药浓度与Ramsay镇静评分的相关系数为0．67(P<0．05)。镇静过程中C组Ramsay镇静评分4分所占比例(54％)高于A组(28％)和B组(40％)(P<0．01)。结论咪达唑仑TCI系统的性能可靠,用于SICU病人以BIS为70调控咪达唑仑TCI,可产生良好的镇静效果。     

不同液体术前急性高容量血液稀释对深静脉血栓病人血液流变学的影响

Objective To investigate the effects of acute hypervolemic hemodilution (AHH) with different fluids on blood rheology in patients with deep vein (femoral and iliac) thrombosis. Methods Thirty ASA I or II patients aged 40-64 yr who had developed deep vein thrombosis in 48 h and were scheduled for embolectomy were randomly divided into 3 groups ( n = 10 each) ; group I normal saline (NS) ; group II 6 % HES 200/0.5 ( HES) ; group IE gelofusine (GEL). AHH was performed with normal saline, 6% HES or gelofusine infusion at 20 ml·kg-1 ·h-1 for 40 min. MAP, HR and SpO2 were monitored. Blood loss, volume of blood transfusion and fluid infused and urine output during operation were recorded. Anesthesia was induced with fentanyl 3-5 fig/kg, etomidate 0.15-0.30 mg/kg, propofol 1-2 mg/kg and succinylcholine 1-2 mg/kg and maintained with 2% isoflurane and propofol infusion at 5-8 mg·kg-1·h-1 and intermittent iv boluses of vecuronium. The patients were mechanically ventilated (VT 8 ml/kg, RR 12 bpm). PaO2 and PaCO2 were maintained within normal range. Venous blood samples were obtained before and after AHH for measurement of hematocrit (Hct), whole blood viscocity (WBV) at low or high shear rates, plasma viscosity, RBC aggregation and RBC deformation. RBC aggregation index and RBC deformation index were calculated. Results MAP and HR were stable in all patients. The amount of blood transfusion and fluid infused was significantly less in group HES and GEL than in group NS. The WBV at low or high shear rates in group HES and GEL, Hct in all 3 groups and RBC aggregation index in group HES were significantly decreased after AHH, but the RBC deformation index was significantly increased in group HES. Conclusion Colloid is better than crystalloid and HES is better than gelofusine in improving intraoperative hypercoagulability and sluggish blood flow.     

静脉与硬膜外注射氯胺酮行超前镇痛的疗效比较

1　临床资料　行择期肺叶切除的患者 36 (男 2 4 ,女 12 )例 ,年龄 4 8～ 6 5岁 ,身高 15 8～ 175cm ,体质量 4 7～ 87kg ,ASAI Ⅱ级 ,分为 3组 ,每组 12例 .入手术室后在T6～ 7间隙行硬膜外穿刺 ,注入 2 0 g·L-1利多卡因 5mL ,出现相对阻滞平面后分组 ,组Ⅰiv 9g·L-1氯化钠 2mL ;组Ⅱiv氯胺酮 0 .5mg·kg-1;组Ⅲ硬膜外注射氯胺酮 0 .5mg·kg-1.之后iv咪达唑伦 2mg ,异丙酚 0 .5～ 0 .7mg·kg-1,芬太尼 3～ 5 μg·kg-1、琥珀胆碱 1.5～ 2 .0mg·kg-1快速诱导插管 ,插管成功后硬膜外腔注入 2 0g·L-1利多卡因 5mL ,之后每隔 5 0～ 6 …     

异丙酚抑制脑肿瘤病人全麻拔管应激反应的临床研究

探讨异丙酚抑制颅内肿瘤患者全麻拔管时的应激反应.选择开颅脑肿瘤切除术患者40例,停止吸入异氟醚后,两组患者分别静注异丙酚1 mg/kg和等容量生理盐水.改良Ramsay镇静评分法评估镇静程度,同时进行血流动力学及呼吸功能监测.结果:异丙酚组患者拔管前后镇静程度良好,而对照组镇静程度下降,两组间有统计学差异(P＜0.01).异丙酚组循环平稳,拔管时生命体征平稳,异丙酚有效地抑制脑肿瘤切除术患者全麻拔管期间的应激反应,同时不延长拔管时间.     

艾司洛尔对大鼠离体心脏缺血-再灌注时心肌C-fos基因表达的影响

心肌缺血．再灌注损伤机制的研究表明：兔、鼠和人类的心肌细胞在经过一定时间的缺血一再灌注后可出现明显的细胞凋亡，缺血时间越长c-fos表达越多，c-fos参与了心肌缺血．再灌注损伤。艾司洛尔是选择性8受体阻断剂，可降低心肌氧和能量的消耗，临床研究证明冠状动脉含艾司洛尔温血液灌注可避免心肌缺血，减少心肌水肿，产生心肌保     

异丙酚和七氟醚麻醉对颅内占位病人颅内压的影响

目的:观察异丙酚和七氟醚麻醉对颅内占位病人颅内压的影响.方法:ASA I～II级、格拉斯哥评分15分、行择期开颅手术病人24例,随机分为七氟醚组(n=12)和异丙酚组(n=12).用依托咪酯、芬太尼、琥珀胆碱麻醉诱导.麻醉维持七氟醚组吸入2%七氟醚,异丙酚组先静注异丙酚1.5 mg/kg,后以8～10 mg·kg-1·h-1维持麻醉,记录诱导前、插管后、给药后5,10和20 min的收缩压、舒张压、平均动脉压、心率和脑脊液压,计算脑灌注压值. 结果:异丙酚组给药后5,10和20 min时比诱导前平均动脉压分别下降12.28%、13.36%和9.64%,七氟醚组分别下降8.26%、11.1%和10.94%,两组差异显著(P<0.05);异丙酚组脑灌注压分别下降12.34%、10.76%和11.0%,七氟醚组分别下降4.1%、7.5%和8.54%,两组差异显著(P<0.05).结论:对颅内占位病人异丙酚麻醉维持能使平均动脉压、脑灌注压和颅内压下降.七氟醚麻醉维持对血流动力学影响较轻,但颅内压有轻度升高,在过度通气条件下可用于无颅内高压症状对颅内占位病人的麻醉.     

不同液体术前急性高容量血液稀释对深静脉血栓病人血液流变学的影响

Objective To investigate the effects of acute hypervolemic hemodilution (AHH) with different fluids on blood rheology in patients with deep vein (femoral and iliac) thrombosis. Methods Thirty ASA I or II patients aged 40-64 yr who had developed deep vein thrombosis in 48 h and were scheduled for embolectomy were randomly divided into 3 groups ( n = 10 each) ; group I normal saline (NS) ; group II 6 % HES 200/0.5 ( HES) ; group IE gelofusine (GEL). AHH was performed with normal saline, 6% HES or gelofusine infusion at 20 ml·kg-1 ·h-1 for 40 min. MAP, HR and SpO2 were monitored. Blood loss, volume of blood transfusion and fluid infused and urine output during operation were recorded. Anesthesia was induced with fentanyl 3-5 fig/kg, etomidate 0.15-0.30 mg/kg, propofol 1-2 mg/kg and succinylcholine 1-2 mg/kg and maintained with 2% isoflurane and propofol infusion at 5-8 mg·kg-1·h-1 and intermittent iv boluses of vecuronium. The patients were mechanically ventilated (VT 8 ml/kg, RR 12 bpm). PaO2 and PaCO2 were maintained within normal range. Venous blood samples were obtained before and after AHH for measurement of hematocrit (Hct), whole blood viscocity (WBV) at low or high shear rates, plasma viscosity, RBC aggregation and RBC deformation. RBC aggregation index and RBC deformation index were calculated. Results MAP and HR were stable in all patients. The amount of blood transfusion and fluid infused was significantly less in group HES and GEL than in group NS. The WBV at low or high shear rates in group HES and GEL, Hct in all 3 groups and RBC aggregation index in group HES were significantly decreased after AHH, but the RBC deformation index was significantly increased in group HES. Conclusion Colloid is better than crystalloid and HES is better than gelofusine in improving intraoperative hypercoagulability and sluggish blood flow.     

肠组织血红素加氧酶-1在失血性休克复苏大鼠肠粘膜损伤中的作用

失血性休克是创伤及外科手术中较常见的并发症，此时发生全身血流再分布，导致肠道血流量减少，绒毛顶部的粘膜细胞缺血、缺氧、坏死和脱落，复苏时的再灌注可加重肠粘膜损伤，导致肠粘膜屏障受损，肠道内大量细菌向肠腔外迁移，此过程称为细菌移位，可触发全身炎性反应和多器官功能衰竭。血红素加氧酶（HO）作为血红素代谢过程中的起始酶和限速酶，包括3种同工酶：HO-1、HO-2和HO-3，其中只有HO-1是诱导型酶。HO-1表达上调可减轻失血复苏大鼠肝损伤。HO-1在失血性休克复苏时肠粘膜损伤中的作用有待进一步探讨。本研究拟评价肠组织HO-1在失血性休克复苏大鼠肠粘膜损伤中的作用。     

网上麻醉学临床与教学信息资源精析

国内麻醉学专业人员利用网上资源日益增多,从浩如烟海的网络资源中精选与掌握核心信息源是一大难题.本文介绍国际权威搜索引擎,检索麻醉学网上信息.     

SICU救治严重颈椎与颈髓损伤21例

急性呼吸衰竭是严重颈椎及颈髓损伤的主要死亡原因 ,其致死率达 80 %以上 [1 ]。现将我院 SICU自 1992年 6月至 1998年2月救治的严重颈椎及颈髓损伤 2 1例治疗体会介绍如下。1　资料和方法1.1　临床资料　 2 1例中男 17例 ,女 4例。年龄最小 16岁 ,最大 6 3岁 ,平均 42 .33±12 .5 1岁。全部为伤后 6～ 2 4h入院 ,检查无颅脑损伤 ,均有颈部外伤史。其中完全截瘫 11例 ,不全截瘫 10例 ,知觉障碍均在 T4平面以上 ,其中 12例患者 X线检查发现合并有颈椎骨折或脱位。全部患者在受伤后 1～ 6 d出现呼吸困难 ,其中 8例发生呼吸心跳骤停 ,心肺复…