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目的观察微量小剂量芬太尼与氯胺酮联合于术后病人自控静脉镇痛(PCIA)的效果及不良反应,并与较大剂量芬太尼PCIA进行比较。方法选择ASAⅠ~Ⅱ级、年龄(45.8±11.2)岁、全麻下行腹部手术病人80例,随机分为4组:Ⅰ组为芬太尼2.0 mg,Ⅱ组为芬太尼1.5 mg+氯胺酮250 mg,Ⅲ组为芬太尼1.5mg+氯胺酮500 mg,Ⅳ组为芬太尼1.5 mg+氯胺酮750 mg;各组均加5 mg氟哌啶,然后加生理盐水至100mL。PCIA持续输注速度为24μL.kg-1.h-1。记录术后4、24、48及72 h的VSA评分、镇静评分、呼吸次数及SpO2变化情况。结果Ⅱ组VAS评分4个时点均明显高于Ⅰ组(P<0.05或P<0.01)。Ⅰ组出现睡眠的病人也较多。结论适量小剂量芬太尼与氯胺酮联合用于术后PICA,能明显改善病人嗜睡的状况,镇痛效果也较理想,从而减少了术后嗜睡和呼吸抑制的状况。 相似文献
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J. BARTHOLDY K. SPERLING M. IBSEN K. ELIASEN T. MOGENSEN 《Acta anaesthesiologica Scandinavica》1994,38(3):262-265
In a randomized, blinded trial we assessed the value of adding preoperative infiltration of the surgical area with bupivacaine to a low dose epidural regimen for postoperative pain treatment. Forty–nine patients scheduled for major upper abdominal surgery during combined thoracic epidural (bupivacaine + morphine) and general anaesthesia were studied. Postoperative analgesia was epidural bupivacaine 10 mg hr-1 + morphine 0.2 mg hr-1 for 72 h. The patients randomly received preoperative infiltration of the surgical area with bupivacaine 0.25%, 40 ml (group I); or no infiltration (group II). Pain was evaluated at rest, during cough and during mobilization six and eight h after start of surgery, and at 8 a.m. and 4 p.m. on the following days until 72 h after start of surgery. The sensory level of analgesia was evaluated by pin prick. We found no difference between the two groups during rest and cough. However, during mobilization group I had lower pain scores compared to group II ( P < 0.05). There was a significant reduction in the need for supplemental intramuscular morphine in the treatment group compared to the control group ( P <0.05). Thus an enhanced analgesic effect was demonstrated by adding preoperative infiltration of the surgical area with local anaesthetic to a low dose epidural bupivacaine/morphine regimen after upper abdominal surgery. 相似文献
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Albertini-Yagi CS Oliveira RC Vieira JE Negri EM de Oliveira LR Saldiva PH Lorenzi-Filho G 《Respiratory physiology & neurobiology》2005,145(1):101-110
The study objectives were to compare in vitro transportability and physical properties of respiratory mucus, obtained invasively by direct collection (DC) right after endotracheal intubation and non-invasively by sputum induction with 3% hypertonic saline solution inhalation (SI) 24 h before the anesthesia. Twenty-two patients with no pulmonary disease scheduled for elective abdominal surgical procedures were studied. The parameters analyzed and the main results are as follows. (1) Transportability by cilia (MCT), SI was higher than DC (0.94+/-0.25 and 0.62+/-0.25; P<0.001). There was a significant correlation between the two methods and DC could be estimated by: DC=0.21+(0.44 SI) (r=0.44; P<0.001). (2) Transportability by cough (CC), SI was higher than DC (68.23+/-32.1 and 33.58+/-19.04 mm; P=0.002). (3) Contact angle (CA), SI was lower than DC (10+/-3 degrees and 22+/-14 degrees ; P=0.025). (4) Rheological properties (no significant difference obtained between SI and DC). These results indicated that SI changes mucus physical properties and transportability in non-expectorators. 相似文献
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R.A. Guerri-Guttenberg F. Siaba-Serrate F.J. Cacheiro 《Revista espa?ola de anestesiología y reanimación》2013,60(8):448-456
The baroreflex, chemoreflex, pulmonary reflexes, Bezold-Jarisch and Bainbridge reflexes and their interaction with local mechanisms, are a demonstration of the richness of cardiovascular responses that occur in human beings. As well as these, the anesthesiologist must contend with other variables that interact by attenuating or accentuating cardiopulmonary reflexes such as, anesthetic drugs, surgical manipulation, and patient positioning. In the present article we review these reflexes and their clinical relevance in anesthesiology. 相似文献
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