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例 1 男 ,6 0岁 ,体重 6 2 kg。因左支气管肿瘤拟在全身麻醉下行左全肺切除术。查体 :左肺呼吸音低 ,右肺呼吸音正常。胸部 CT示 :左肺上叶有多个纤维索条影 ,左肺不张。纤维支气管镜检查 :肿瘤位于靠近肺门的左支气管内。患者行麻醉诱导、经口气管内插单腔管 (8.0 F)顺利 ,术中左肺动、静脉已断离 ,拟断左肺支气管时 ,呼吸道压力突然骤升 ,血压 (BP)升高、心率 (HR)增快 ,脉搏血氧饱和度 (Sp O2 )由 0 .98骤降至0 .4 0 ,考虑为左支气管内肿瘤脱落入健侧肺所致 ,急行左支气管切断 ,开放气管 ,用 1根气管导管 (7.0 F)插入健侧支气管 ,接… 相似文献
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安定在气管插管前的应用(摘要)朱德璋1姬佩敏2临床资料本组病人75例,男40例,女35例;年龄7~78岁。其中呼吸衰竭45例,脑外伤病人30例。所有病人神志欠清,查体不合作,咽反射增强。气管插管前清除口咽部分泌物,1%地卡因1~2ml行环甲膜穿刺(脑... 相似文献
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病人,男,38岁,体质量75kg.有高血压病史17年,因胸痛120d,近来加剧急症人院.经胸部X线、心脏超声及磁共振检查诊断为升主动脉夹层动脉瘤.升主动脉瘤样扩张,最大径70mm,主动脉弓扩张,内径47mm,主动脉前璧内膜剥离,形成假腔(最大径38mim1),远端开口在无名动脉和左颈总动脉之间.人院后严密监测心电图及血压,镇静、吸氧,微量泵静注硝普钠控制血压为(11~13)/(9~11)kPa.拟在全麻超深低温停循环、上腔静脉逆行灌注下行升主动脉及主动脉弓人工血管置换术. 相似文献
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感染性心内膜炎手术治疗的麻醉处理 总被引:3,自引:0,他引:3
①目的 探讨感染性心内膜炎病人手术治疗的麻醉处理方法。②方法 对 2 6例心功能Ⅱ~Ⅳ级的感染性心内膜炎病人均采用以芬太尼为主的低温低压体外循环静脉或静吸复合全麻。③结果 2 6例病人平均麻醉时间 (330± 10 1)min ,芬太尼平均用量 (5 0± 7) μg/kg,潘库溴铵平均用量 (0 .30± 0 .0 6 )mg/kg ,安氟醚平均吸入体积分数 0 .134± 0 .0 0 4 ,地西泮平均用量 (0 .6 0± 0 .2 1)mg/kg。 2 6例病人中心脏自动复搏 18例 ,电击复搏 8例。除 1例因多器官功能障碍综合征死亡外 ,其余恢复顺利。④结论 缓慢的麻醉诱导 ,以芬太尼为主的静脉或静吸复合全麻 ,配合应用适当的血管活性药物 ,能保持围麻醉期循环稳定 相似文献
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目的 探讨右美托咪啶对异氟醚抑制切皮时患者体动反应的肺泡气最低有效浓度(MAC)的影响.方法 择期全身麻醉下行上腹部手术患者,年龄40~60岁,ASA分级Ⅰ或Ⅱ级,体重指数22~27 kg/m2,采用随机数字表法,将患者随机分为3组:对照组(C组)、小剂量右美托咪啶组(D1组)和大剂量右美托咪啶组(D2组).麻醉诱导前静脉输注右美托咪啶(生理盐水稀释至15 ml)0.4 μg/kg(D1组)、0.8μg/kg(D2组)及生理盐水15 ml(C组),15 min内输注完毕.静脉注射芬太尼-异丙酚-琥珀酰胆碱麻醉诱导,气管插管后机械通气并开启异氟醚挥发罐.采用序贯法确定麻醉维持期间异氟醚的呼气末浓度,C组、D1组和D2组第1例患者异氟醚呼气末浓度分别设定为1.0%、0.8%和0.6%,当异氟醚呼气末浓度达到预设水平并维持15 min以上,且肌颤搐恢复到对照值90%以上时开始手术,相邻浓度差值为0.2%.于切皮时评估患者体动反应,以各交叉点异氟醚呼气末浓度的均数为MAC,并计算95%可信区间(CI).结果 C组、D1组和D2组入选病例分别为15、17和16例.异氟醚抑制切皮时体动反应的MAC及其95%CI分别为:C组(1.03±0.23)%(95%CI 0.83%~1.21%)、D1组(0.72±0.19)%(95%CI 0.58%~0.85%)、D2组(0.51±0.27)%(95%CI 0.30%~0.71%).与C组比较,D1组和D2组MAC降低(P<0.01),D2组MAC明显低于D1组(P<0.05).结论 右美托咪啶可明显降低异氟醚抑制切皮时患者体动反应的MAC,且与剂量有关.Abstract: Objective To investigate the effect of dexmedetomidine on minimum alveolar concentration (MAC) of isoflurane required to inhibit the body movement during skin incision. Methods Forty-eight ASA Ⅰ or Ⅱ patients aged 40-60 yr with body mass index of 22-27 kg/m2 undergoing elective upper abdominal surgery under general anesthesia were randomly divided into 3 groups: control group (group C, n = 15);low dose dexmedetomidine group (group D1, n = 17) and high dose dexmedetomidine group (group D2, n = 16). The patients were unpremedicated. Dexmedetomidine 0.4 and 0.8 μg/kg in normal saline (NS) 15 ml was infused over 15 min before induction of anesthesia in D1 and D2 groups respectively. Anesthesia was induced with fentanyl-propofol-succinylcholine. The patients were mechanically ventilated after tracheal intubation. Anesthesia was maintained with isoflurane. MAC of isoflurane was determined by up-and-down technique. The initial end-tidal isofiurane concentration was set at 1.0%, 0.8% and 0.6% in C, D1 and D2 groups respectively. Each time the end-tidal isoflurane concentration was increased/decreased by 0.2%. Skin incision was made after 15 min of equilibration, when the twitch height returned to more than 90% of its control value. Movement of body and limbs including swallowing and coughing were carefully looked for when skin incision was made. MAC of isoflurane was the mean of end-tidal concentration of isoflurane of each crossover pair, and 95 % CI was calculated. Results MAC of isoflurane was significantly decreased in D1 and D2 groups as compared with group C and in group D2 as compared with group D1( P < 0.05 or 0.01 ). Conclusion Dexmedetomidine can significantly decrease MAC of isoflurane required to inhibit the body movement during skin incision in a dose-dependent manner. 相似文献
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目的:探讨铁调素在多巴胺能神经细胞内铁代谢调节的作用。方法:体外培养MES23.5细胞,经用枸橼酸铁胺处理4 h后应用RT-PCR检测铁调素mRNA的表达,Western blot检测膜铁转运蛋白1(FPN1)的表达。结果:高铁作用4 h后观察到MES23.5细胞内铁调素表达增高,FPN1表达降低(P〈0.05)。结论:铁调素通过减少FPN1影响多巴胺能神经元的铁转出,参与帕金森病的铁聚积。 相似文献
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