罗库溴铵和阿曲库铵联合应用的肌松效应分析

目的探讨罗库溴铵和阿曲库铵联合应用时的肌松效应。方法择期全麻手术女性成年患者147例,丙泊酚和舒芬太尼静脉诱导,输注丙泊酚维持麻醉。面罩辅助或控制呼吸,用加速度仪以连续4次刺激(TOF)方式透皮刺激腕部尺神经,获取肌松药作用起效时间和T1最大抑制程度(Tmax)。按观测项目将患者均分成四组。结果阿曲溴铵ED95为(220.8±3.6)μg/kg,罗库溴铵ED95为(286.3±3.1)μg/kg。0.5×ED95的罗库溴铵与阿曲库铵联合使用,肌松效应达到T1抑制93%~97%时,阿曲库铵的剂量为63.6μg/kg。罗库溴铵0.5×ED95与阿曲库铵63.6μg/kg联合使用,Tmax为(95.3±0.9)%,变异系数1.0%。Ⅳ组中三个亚组的Tmax基本相同,合用组作用起效时间比阿曲库铵组快(P<0.01)。给予肌松药前和注药后5min内,MAP和HR的波动幅度均小于5%。结论罗库溴铵与阿曲库铵合用呈协同作用。当罗库溴铵剂量为0.5×ED95时,为获得T1抑制95%的肌松效应,阿曲库铵的合理用量为63.6μg/kg,比阿曲库铵的ED95减少71.2%。     

甲苯磺酸瑞马唑仑联合瑞芬太尼对无痛胃镜置入反应的药效学研究及其性别差异

目的探讨甲苯磺酸瑞马唑仑联合瑞芬太尼抑制无痛胃镜置入反应的半数有效剂量(ED_(50))及95%有效剂量(ED_(95))及性别差异。方法66例无痛胃镜检查患者分为A、B及C组,A组性别不限(20例),B组仅纳入男性患者(23例),C组仅纳入女性患者(23例)。各组第1例患者均接受0.5μg/kg瑞芬太尼联合0.2 mg/kg瑞马唑仑静脉注射麻醉,2min后置入上消化道内镜,依据改良序贯法(Dixon)以0.05mg/kg为剂量梯度,当患者出现置入反应时,下一例患者瑞马唑仑用药剂量增加一级,否则降低一级,以阳性反应转阴性为交叉点,在第7个交叉点出现后结束研究。采用概率单位回归分析法计算各组瑞马唑仑ED_(50)、ED_(95)及95%置信区间(95%CI).结果A组ED_(50)为0.206 mg/kg(95%CI:0.161〜0.234 mg/kg),ED_(95)为0.320 mg/kg(95%CI:0.244〜0.501 mg/kg);B组ED_(50)为0.177mg/kg(95%CI:0.148〜0.232mg/kg),ED_(95)为0.253 mg/kg(95%CI:0.213〜0.417 mg/kg);C组ED_(50)为0.229 mg/kg(95%CI:0.185〜0.274mg/kg),ED_(95)为0.354mg/kg(95%CI:0.270〜0.536mg/kg).3组中C组ED_(50)及ED_(95)最高,A组次之,B组最低。结论甲苯磺酸瑞马唑仑联合瑞芬太尼抑制无痛胃镜置入反应的ED_(50)为0.206mg/kg,ED_(95)为0.320 mg/kg,且女性患者甲苯磺酸瑞马唑仑ED_(50)及ED_(95)高于男性患者。     

右美托咪啶辅助表面麻醉用于患者支气管肺泡灌洗术的效果

Objective To investigate the efficacy of dexmedetomidine-assisted topical anesthesia in patients undergoing bronchoalveolar lavage ( BAL). Methods Twenty-four ASA Ⅱ or Ⅲ patients in ICU, aged 24-64 yr, weighing 50-80 kg, scheduled for BAL, were randomly divided into 2 groups ( n = 12 each) : topical anesthesia group (group A) , topical anesthesia + dexmedetomidine group (group B) . In group A, 0.9% normal saline 5 ml was injected intravenously 30 min before operation, 2% lidocaine 5-10 ml was given via a tracheal tube or cannula 5 min before operation and then an increment of 2% lidocaine 5 ml was given using fibreoptic bronchoscope every 15-30 min as required (the total amount was within 20 ml) . In group B, dexmedetomidine 0.5-1.0 μg/kg was injected (time of injection≥ 10 min) followed by infusion at 0.1-0.5 μg·kg-1 ·h-1 and the topical anesthesia was performed as the method described in group A. The time of lavage, adverse reactions and adverse cardiovascular events were recorded. Blood samples were taken 20 min before lavage, 20 min after the start of lavage and 20 min after the end of lavage (T1-3 ) for determination of the concentrations of plasma catecholamine and serum cortisol. Results The incidences of adverse reactions and adverse cardiovascular events were significantly lower and the operation time was significantly shorter in group B than in group A ( P < 0.05). The concentrations of plasma catecholamine and serum cortisol were significantly higher at T2,3 in group A, while lower at T2,3 in group B than at T1 ( P < 0.05) . The concentrations of plasma catecholamine and serum cortisol were significantly lower in group B than in group A ( P < 0.05). Conclusion Dexmedetomidine-assisted topical anesthesia can be used safely and effectively in BAL.     

罗哌卡因在剖宫产腰麻-硬膜外联合麻醉中的量效关系

目的 探讨0.33%罗哌卡因在剖宫产行腰麻-硬膜外联合麻醉时的量效关系.方法 择期剖宫产患者30例,选择L2-3间隙行腰麻-硬膜外联合麻醉,根据切皮是否镇痛、腹肌松弛度和患者的反应判断麻醉效果,罗哌卡因的量效关系按序贯法确定,步长为0.1 mL.结果 使50%患者达到麻醉优良时所需0.33%罗哌卡因容量为1.70(1.68～1.71)mL,使95%患者达到麻醉优良时所需0.33%罗哌卡因容量为1.94(1.92～1.95)mL.结论 0.33%罗哌卡因用于腰麻-硬膜外联合麻醉适合于剖宫产手术,当95%患者达到麻醉优良时其所需容量为1.94 mL.     

地佐辛对老年心血管病患者腹部手术全身麻醉恢复期质量的影响

目的探讨地佐辛对老年心血管病患者腹部手术全身麻醉恢复期质量的影响。方法择期行腹部手术的老年心血管病患者80例,随机分为对照组和地佐辛组(观察组)各40例,分别于手术结束前10min静脉输注2ml生理盐水或地佐辛0.1mg/kg。2组均采用全身麻醉,记录自主呼吸恢复时间、苏醒时间、拔除气管导管时间及全身麻醉恢复期不良反应,采用视觉模拟评分(VAS)评估拔管后各时间点镇痛效果,Ramsay镇静评分评估镇静等级。结果观察组镇痛有效率明显高于对照组,差异有统计学意义(P<0.05),躁动、呛咳、恶心呕吐、心血管事件等不良反应的发生率均明显低于对照组(均P<0.05),拔管后5min、30min、60min、120minVAS评分均明显低于对照组,差异有统计学意义(均P<0.05),Ramsay镇静评分在拔管后5min、30min均明显高于对照组,差异有统计学意义(均P<0.05)。结论术毕前静脉输注地佐辛可改善老年腹部手术患者全身麻醉恢复期的质量。     

不同复合麻醉方式对腹腔镜异位妊娠患者术后意识状态和认知功能的影响

目的 比较不同复合麻醉方式对腹腔镜异位妊娠术后意识状态和认知功能的影响.方法 选取2017-2018年绍兴第二医院收治的异位妊娠患者70例均于腹腔镜下实施手术,术前随机分为观察组和对照组各35例,观察组接受咪唑安定+芬太尼+右美托咪定+丙泊酚+维库溴胺麻醉,对照组接受咪唑安定+芬太尼+丙泊酚+维库溴胺麻醉.比较两组患者...     

七氟醚复合舒芬太尼在学龄前儿童全麻喉罩置入时呼气末肺泡有效浓度的作用

目的探讨七氟醚复合舒芬太尼在学龄前儿童全麻喉罩置入时呼气末肺泡有效浓度(EC50)。方法择期全麻手术患儿23例,ASAⅠ~Ⅱ级,年龄3~6岁。当吸入4%的七氟醚诱导后立即开通外周静脉,七氟醚浓度维持在预定值10min,在喉罩置入前5min静注舒芬太尼0.5μg.kg-1,面罩辅助或控制呼吸。用序贯法确定七氟醚浓度,初始呼气末七氟醚浓度为2%,相邻呼气末浓度差为0.25%,如喉罩置入时评级为满意,则下一例患儿降低1个浓度梯度;如喉罩置入时评级为不满意,则下一例患儿升高1个浓度梯度。喉罩无法置入或喉罩置入后1min内出现呛咳、喉痉挛、肢体运动为不满意,反则为满意。结果符合满意的喉罩置入条件时七氟醚的EC50为1.24%。结论当达到满意的喉罩置入条件时七氟醚复合0.5μg.kg-1芬太尼在学龄前儿童喉罩置入时的EC50为1.24%。     

穴位刺激辅助麻醉对老年髋部骨折患者术后苏醒期躁动及血清阿片类物质、淀粉样蛋白A水平的影响

目的探讨穴位刺激辅助麻醉对老年髋部骨折患者术后苏醒期躁动及血清阿片类物质(Opiorphin)、淀粉样蛋白A(SAA)水平的影响。方法采用前瞻性研究的方法, 选择2020年2月至2021年9月在绍兴第二医院医共体总院行髋部骨折手术的患者86例, 按随机数字表法分为常规组和研究组, 每组43例, 分别给予穴位假刺激、穴位刺激, 观察两组手术一般指标、苏醒质量、认知功能及血清Opiorphin、SAA水平变化。结果两组患者手术时间、麻醉时间、苏醒时间和术中输血率比较差异无统计学意义(P>0.05)。研究组瑞芬太尼用量少于常规组[(270.64 ± 17.62) μg比(291.82 ± 23.34) μg], 差异有统计学意义(P<0.05)。研究组苏醒期躁动发生率低于常规组[13.95%(6/43)比48.84%(21/43)], 差异有统计学意义(P<0.05)。研究组术后12、24、48 h简易智力状态检查量表(MMSE)评分高于常规组[(22.80 ± 2.04)分比(19.31 ± 3.61)分、(24.92 ± 2.44)分比(21.49 ± 3.58)分、(...     

右美托咪啶辅助表面麻醉用于患者支气管肺泡灌洗术的效果

目的 探讨右美托咪啶辅助表面麻醉用于患者支气管肺泡灌洗术的效果.方法 拟行支气管肺泡灌洗术的ICU患者24例,ASA分级Ⅱ或Ⅲ级,体重50～80 kg,年龄24～64岁,采用随机数字表法,将患者随机分为2组(n=12),A组术前30 min静脉注射0.9%生理盐水5 ml,术前5 min经气管导管或气管套管内注入2%利多卡因5～10 ml,随后按需每15～30 min经纤维支气管镜追加2%利多卡因5 ml,总量控制在20 ml以内;B组术前30 min缓慢静脉注射右美托咪啶0.5～1.0 μg/kg,随后以0.1～0.5 μg·kg-1·h-1速率维持,表面麻醉方法同A组.记录灌洗时间、不良反应及心血管不良事件的发生情况.于灌洗前20 min(T1)、灌洗开始后20 min(T2)、灌洗结束后20 min(T3)时采集血样,测定血浆儿茶酚胺浓度和血清皮质醇浓度.结果 与A组比较,B组血清皮质醇浓度、血浆儿茶酚胺浓度降低、不良反应及心血管不良事件发生率降低,操作时间缩短(P<0.05).与T1时比较,A组T2,3时血清皮质醇及血浆儿茶酚胺浓度升高,B组T2,3时血清皮质醇及血浆儿茶酚胺浓度降低(P<0.05).结论 右美托咪啶辅助表面麻醉可安全有效地用于患者支气管肺泡灌洗术.

Abstract：

Objective To investigate the efficacy of dexmedetomidine-assisted topical anesthesia in patients undergoing bronchoalveolar lavage ( BAL). Methods Twenty-four ASA Ⅱ or Ⅲ patients in ICU, aged 24-64 yr, weighing 50-80 kg, scheduled for BAL, were randomly divided into 2 groups ( n = 12 each) : topical anesthesia group (group A) , topical anesthesia + dexmedetomidine group (group B) . In group A, 0.9% normal saline 5 ml was injected intravenously 30 min before operation, 2% lidocaine 5-10 ml was given via a tracheal tube or cannula 5 min before operation and then an increment of 2% lidocaine 5 ml was given using fibreoptic bronchoscope every 15-30 min as required (the total amount was within 20 ml) . In group B, dexmedetomidine 0.5-1.0 μg/kg was injected (time of injection≥ 10 min) followed by infusion at 0.1-0.5 μg·kg-1 ·h-1 and the topical anesthesia was performed as the method described in group A. The time of lavage, adverse reactions and adverse cardiovascular events were recorded. Blood samples were taken 20 min before lavage, 20 min after the start of lavage and 20 min after the end of lavage (T1-3 ) for determination of the concentrations of plasma catecholamine and serum cortisol. Results The incidences of adverse reactions and adverse cardiovascular events were significantly lower and the operation time was significantly shorter in group B than in group A ( P < 0.05). The concentrations of plasma catecholamine and serum cortisol were significantly higher at T2,3 in group A, while lower at T2,3 in group B than at T1 ( P < 0.05) . The concentrations of plasma catecholamine and serum cortisol were significantly lower in group B than in group A ( P < 0.05). Conclusion Dexmedetomidine-assisted topical anesthesia can be used safely and effectively in BAL.     

靶控输注丙泊酚复合舒芬太尼在无肌松药行气管插管时EC50的测定

目的探讨在不用肌松药行气管插管术中丙泊酚靶控输注复合舒芬太尼时丙泊酚的半数有效血浆靶浓度(EC50)。方法择期手术患者22例,在舒芬太尼0.5μg/kg推注复合靶控输注(TCI)丙泊酚4min后经口行气管插管,并根据下颌松弛程度、声带位置和对气管插管的反应进行插管评级(优、良、一般和差;优、良认为是临床满意而一般,差看作临床不满意)。丙泊酚的半数有效血浆靶浓度按序贯法确定,相邻血浆靶浓度差为0.5μg/ml。结果当达到临床满意的气管插管条件时丙泊酚的半数有效血浆靶控浓度为6.69μg/ml,95%的可信区间为5.999~7.463μg/ml。结论复合舒芬太尼0.5μg/kg时,在不用肌松药行气管插管术达到插管条件为优良时丙泊酚的半数有效血浆靶浓度是6.69μg/ml。