腰硬联合镇痛及患者自控镇痛对产程及分娩结局的影响

目的 探讨腰硬联合(CSEA)及患者自控镇痛(PCEA)对产程及分娩结局的影响。方法 随机选取2014年1~12月足月待产、无妊娠合并症和并发症初产妇996例,其中503例产妇于活跃期实施CSEA+PCEA镇痛(分娩镇痛组),493例未行分娩镇痛(对照组),分别记录并比较两组产妇各产程时间、子宫收缩、镇痛效果、运动神经阻滞程度、产程中缩宫素的使用率、产后出血率、羊水Ⅲ度污染率、新生儿Apgar评分、产钳助产和剖宫产率。结果 分娩镇痛组第一产程、第二产程较对照组有所延长,差异有统计学意义(P<0.05);第三产程无明显改变;子宫收缩力减弱;分娩镇痛组较对照组镇痛效果显著,差异有统计学意义(P<0.05);运动阻滞程度低;缩宫素使用率、产后出血率、羊水Ⅲ度污染率、及新生儿Apgar评分及产钳助产和剖宫产率两组比较,差异均无统计学意义(P>0.05)。结论 腰硬联合分娩镇痛可能会使第一产程、第二产程延长,对子宫收缩力有一定的影响,但并未增加缩宫素的使用率及产钳助产和剖宫产率,其镇痛效果显著,运动阻滞程度低,对分娩结局无不良影响。     

Intravenous or rectal administration of sedatives in outpatient oral surgery

A number of cross-over studies on sedation in outpatient oral surgery investigated the quality of sedation produced by intravenous or rectal administration of diazepam. The sedation methods were equally efficient with a mean dose of 0.24 mg/kg (range 0.1–0.4) for i.v. administration and 0.53 mg/kg (range 0.5–0.6) for rectal administration. Eighty-five percent of the patients preferred surgery under sedation and local anaesthesia to local anaesthesia alone. The patients preferred the session in which they experienced stronger sedation, regardless of the route of administration.     

疏可眠胶囊镇静作用的实验研究

且的:观察疏可眠胶囊对小鼠的镇静作用。方法:采用旷野活动法观察疏可眠胶囊不同给药剂量、给药时间对小鼠自主活动的量效、时效作用;对士的宁诱发惊厥小鼠的作用。结果:连续给药7d,疏可眠低中剂量(1g·k~(-1)、2g·kg~(-1))均能显著减少小鼠的自主活动;疏可眠高剂量(3g·kg~(-1))给药后1h～2h自主活动显著减少;给药后2h,呈现量效关系,随着剂量增加小鼠自主活动减少。各剂量组均可延长士的宁诱发小鼠惊厥出现的时间及死亡时间。结论:疏可眠胶囊具有减少小鼠自主活动和抗惊厥作用。     

Anaesthetic management during awake craniotomy in a 12-year-old boy

We present our approach to the preoperative preparation and anaesthetic management for awake craniotomy in a 12-year-old boy. Management included conscious sedation with a propofol infusion plus local anaesthetic infiltration of the scalp, periosteum, and dura. The complications which may be encountered during such procedures and their treatments are reviewed.     

End-tidal Carbon Dioxide Monitoring during Procedural Sedation

OBJECTIVE: To prospectively determine whether end-tidal carbon dioxide (ETCO2) monitors can detect respiratory depression (RD) and the level of sedation in emergency department (ED) patients undergoing procedural sedation (PS). METHODS: This was a prospective observational study conducted in an urban county hospital of adult patients undergoing PS. Patients were monitored for vital signs, depth of sedation per the physician by the Observer's Assessment of Alertness/Sedation scale (OAA/S), pulse oximetry, and nasal-sample ETCO2 during PS. Respiratory depression was defined as an oxygen saturation <90%, an ETCO2 >50 mm Hg, or an absent ETCO2 waveform at any time during the procedure. The physician also determined whether protective airway reflexes were lost during the procedure and assisted ventilation was required, or whether there were any other complications. Rates of RD were compared with the physician assessment of airway loss and between agents using chi-square statistics. Spearman's rho analysis was used to determine whether there was a correlation between ETCO2 and the OAA/S score. RESULTS: Seventy-four patients were enrolled in the study. Forty (54.1%) received methohexital, 21 (28.4%) received propofol, ten (13.5%) received fentanyl and midazolam, and three (4.1%) received etomidate. Respiratory depression was seen in 33 (44.6%) patients, including 47.5% of patients receiving methohexital, 19% receiving propofol (p = 0.008), 80% receiving fentanyl and midazolam, and 66.6% receiving etomidate. No correlation between OAA/S and ETCO2 was detected. Eleven (14.9%) patients required assisted ventilation at some point during the procedure, all of whom met the criteria for RD. Pulse oximetry detected 11 of the 33 patients with RD. Post-hoc analysis revealed that all patients with RD had an ETCO2 >50 mm Hg, an absent waveform, or an absolute change from baseline in ETCO2 >10 mm Hg. CONCLUSIONS: There was no correlation between ETCO2 and the OAA/S score. Using the criteria of an ETCO2 >50 mm Hg, an absolute change >10 mm Hg, or an absent waveform may detect subclinical RD not detected by pulse oximetry alone. The ETCO2 may add to the safety of PS by quickly detecting hypoventilation during PS in the ED.     

十二指肠乳头括约肌切开胆总管取石术前静注咪唑安定对麻醉及手术效果的影响

目的　探讨在十二指肠乳头括约肌切开 (EST)胆总管取石术前静注咪唑安定的可行性及价值。方法　将 71例拟行 EST胆总管取石患者随机分为咪唑安定组 (试验组 ) 5 1例和对照组 (2 0例 ) ,两组术前均给予 6 5 4 -2 (10 mg)静脉注射 ,试验组同时静脉注射咪唑安定 (3～ 5 mg)。观察两组患者的进镜时间、麻醉程度 ,患者的反应与配合程度、自身感受程度 ,同时监测患者的血压、心率、血氧饱和度。结果　试验组进镜时间缩短、镇静程度适中、患者自身感受好 ,与对照组比较 ,差异有显著性 (P<0 .0 1) ;患者心血管及呼吸参数无明显变化。结论　EST胆总管取石术前静脉注射咪唑安定可提高麻醉效果 ,有利于提高患者配合的依从性 ,对血压、心率、血氧饱和度无明显影响     

绵毛黄芪苷和苦玄参苷的中枢抑制作用

报道了绵毛黄芪苷(SK)及其同类结构苦玄参苷(PIA)给予昆明种式BLC_(57)/1小鼠50mg/kg腹腔注射能明显延长硫贲妥钠的睡眠时间,用扭体法或热板法证实同量SK或PIA静脉注射能产生明显的镇痛作用。用格斗试验证实:同量SK或PIA腹腔注射可使小鼠格斗试验次数明显减少。提示两种苷可能具有中枢镇静、镇痛和安定作用;此类中枢抑制作用说明四环三萜皂苷类具有药用价值的前景。