曲马多在剖宫产术中预防寒战的效果比较

目的观察曲马多、氟哌利多在剖宫产手术中预防寒战的效果。方法选择60例A SAⅠ、Ⅱ级剖宫产孕妇,无其它并发症,随机分为3组:曲马多组、氟哌利多组、生理盐水组。胎儿取出后从静脉分别注入曲马多1.0~1.50m g/kg,氟哌利多0.05m l/kg,生理盐水2m l,观察预防寒战的效果。结果寒战发生率及程度为:曲马多组:1级1例,2级1例,占10.0%;氟哌利多组:1级3例,2级3例,3级1例,占35.0%;生理盐水组:1级3例,2级2例,3级3例,占40.0%。后两组与曲马多组比较,差异有统计学意义(P=0.026)。讨论剖宫产手术患者术中应用曲马多能有效减少寒战的发生率,减轻患者的不舒适性,氟哌利多作用不明显。     

Does feeding regime affect physiologic and thermal responses during exposure to 8, 20, and 27° C?

Summary When the loss of body heat is accelerated by exposure to low environmental temperatures, additional substrates must be oxidized to provide energy to sustain temperature homeostasis. Therefore, the present investigation examined the relation between feeding regime [pre-experimental carbohydrate feeding (FED) vs a fast (FAST)], during 120 min of exposure to 8, 20, and 27° C in well-nourished men. The following were examined: tissue insulation (I; °C · m² · W^–1), rectal temperature (T _re; °C), and oxygen consumption ( O₂; ml · kg^–1 · min^–1). O₂, T _re, and I revealed no significant differences between treatments (FED vs FAST) at any temperature. At 27° C, I was less (P < 0.05) than at 20 and 8° C, and decreased (P < 0.05) as exposure time increased. At 8° C, O₂was higher (P < 0.5) than at 20 or 27°C, and O₂increased as time increased (P < 0.05). T _re decreased (P < 0.05) as time increased for all conditions. Respiratory exchange ratio (R) differed (P < 0.05) between treatments (FED vs FAST), temperature (8 vs 20° C), and across time. Values for R suggests that carbohydrate accounted for 56% and 33% of caloric utilization during the FED vs FAST conditions, respectively. At 8 vs 20° C, R represented 54% vs 30% of cabohydrate utilization. Across time, R demonstrated that in both conditions (FED vs FAST) there was a decreased reliance on carbohydrate utilization for energy provision. From these data it appears that while substrate utilization differed between dietary treatment and across time this did not differentially affect O₂or T _re during protracted exposure to 8, 20, and 27° C. The higher R in the 8° C condition for both dietary treatments demonstrates that carbohydrate utilization is increased in shivering cold-exposed humans. However, the reduction in R across time suggests that fat oxidation is also involved in metabolic heat production and core temperature maintenance during shivering in the cold.     

右美托咪定对全麻下脊柱手术患者术后寒颤的治疗作用

目的:观察右美托咪定对全麻下脊柱手术患者术后寒颤的治疗作用。方法:选择全身麻醉下行脊柱手术术后出现4级全身寒颤的患者60例,随机分为右美托咪定组(A组)、曲马多组(B组)及对照组(C组)。当寒颤持续5 min未自行缓解时,A、B、C组分别于5 min内静脉注射右美托咪定0.4μg/kg、曲马多1 mg/kg及等量生理盐水。记录3组患者给药前及给药后1 min、5 min、10 min的血压、心率、脉搏氧饱和度、寒颤程度及Ramsay镇静评分值;记录A、B两组患者寒颤治疗有效率、起效时间及给药60 min后的寒颤复发率;记录患者头晕、恶心、呕吐、呼吸抑制等不良反应发生率。结果:A组患者在给药5 min及10 min后Ramsay镇静评分值比B组及C组明显增高(P<0.05)。A组患者在给药5 min后寒颤治疗有效率比B组明显高(P<0.01),但在给药10 min后两组治疗有效率无明显差异。A组起效时间比B组明显缩短(P<0.01),而B组寒颤复发率比A组明显增高(P<0.05)。A组不良反应发生率比B组明显减少(P<0.05)。结论:静注0.4μg/kg右美托咪定可以快速而有效地治疗全麻术后寒颤,值得临床推广运用。     

A mechanistic study of the tremor associated with epidural anaesthesia for intrapartum caesarean delivery

BackgroundIt is not known if the tremor associated with an epidural top-up dose for intrapartum caesarean delivery is thermoregulatory shivering. A tremor is only shivering if it has the same frequency profile as cold stress-induced shivering. Thermoregulatory shivering is a response to a reduction in actual body temperature, whereas non-thermoregulatory shivering may be triggered by a reduction in sensed body temperature. This mechanistic study aimed to compare: 1. the frequency profiles of epidural top-up tremor and cold stress-induced shivering; and 2. body temperature (actual and sensed) before epidural top-up and at the onset of tremor.MethodsTwenty obstetric patients received an epidural top-up for intrapartum caesarean delivery and 20 non-pregnant female volunteers underwent a cold stress. Tremor, surface electromyography, core temperature, skin temperature (seven sites) and temperature sensation votes (a bipolar visual analog score ranging from −50 to +50 mm) were recorded.ResultsThe mean (SD) primary oscillation (9.9 (1.9) Hz) frequency of epidural top-up tremor did not differ from that of cold stress-induced shivering (9.0 (1.6) Hz; P=0.194), but the mean (SD) burst frequency was slower (6.1 (1.2) × 10⁻² Hz vs 6.9 (0.7) × 10⁻² Hz, respectively; P=0.046). Before the epidural top-up dose, the mean (SD) core temperature was 37.6 (0.6) °C. Between the epidural top-up dose and the onset of tremor the mean (SD) core temperature did not change (–0.1 (0.1) °C; P=0.126), the mean (SD) skin temperature increased (+0.4 (0.4) °C; P=0.002) and the mean (SD) temperature sensation votes decreased (−12 (16) mm; P=0.012).ConclusionThese results suggest that epidural top-up tremor is a form of non-thermoregulatory shivering triggered by a reduction in sensed body temperature.     

复合保温措施对剖宫产产妇围术期低体温和寒战发生的影响

目的 探讨复合保温措施防止剖宫产产妇围术期低体温和寒战发生的作用,为建立围术期患者有效的保温模式提供实验依据.方法 选择健康初产妇120例,将其随机分为对照组（62例）和观察组（58例）,对照组在手术恒温床上施行剖宫产术并采取常规保温方式,观察组在此基础上采取调整手术室温度,静脉输注液、冲洗液和纱布预温,使用强制充气加温毯以及减少身体裸露面积等的复合保温措施;监测产妇入室至手术结束的口腔温度和寒战状况,并进行统计学比较.结果 对照组产妇手术20 min、手术40 min和手术结束时的体温均低于入室时（P＜0.01）,观察组产妇手术20 min、手术40 min和手术结束时的体温与入室时比较,差异无统计学意义（P＞0.05）,且均分别高于同时间点的对照组（P＜0.05）;对照组的低体温发生率显著高于观察组（51.6％ vs 3.4％,P＜0.01）;两组产妇均未发生3、4级寒战,对照组的1、2级寒战发生率显著高于观察组（22.6％vs 3.4％,P＜0.01）.结论 复合保温措施能有效维持剖宫产产妇围术期体温恒定,预防术中低体温和寒战的发生.     

右美托咪定对瑞芬太尼复合全麻术后舒芬太尼自控镇痛效果的影响

目的评价右美托咪定对瑞芬太尼复合麻醉患者术后舒芬太尼静脉自控镇痛效果的影响。方法择期行腹腔镜肠癌切除术成年患者60例,随机分为右美托咪啶组(D组)和对照组(C组),各30例。D组诱导前静脉予右美托咪定负荷量1μg/kg,并以0.3μg/(kg·h)维持至术毕,C组为空白对照组。两组术后接镇痛泵,行舒芬太尼PCIA。记录患者定向力恢复时(Ta)、接泵后1 h(Tb)、3 h(Tc)、6 h(Td)、12 h(Te)、24 h(Tf)的VAS和BCS评分;记录术后24 h的PCA总按压次数及舒芬太尼总用量;记录术后恶心、呕吐、寒颤、呼吸抑制的发生情况。结果Ta、Tb时,D组患者VAS评分低于C组(p<0.05),D组BCS评分高于C组(p<0.05);D组术后24 h舒芬太尼用量和PCA按压次数少于C组(p<0.05);D组恶心、呕吐、寒颤的发生率少于C组(p<0.05)。结论右美托咪定1 ug/kg负荷剂量麻醉前给予和0.3 ug/(kg·h)持续维持,能减轻患者瑞芬太尼麻醉苏醒后早期的术后疼痛,减少术后自控镇痛舒芬太尼用量及术后恶心、呕吐、寒颤等不良反应的发生。     

曲马多和哌替啶预防硬膜外麻醉后寒战反应的对比观察

目的　观察曲马多和哌替啶预防硬膜外麻醉期间寒战反应的临床表现。方法　选择1 2 0例准备在硬膜外麻醉下行下腹部、下肢或脊柱手术的成年患者,随机分为3组:A组(曲马多组) ,B组(哌替啶组) ,C组(对照组)。三组均于硬膜外注药前30分钟分别肌注:曲马多1 .5 mg/kg(A组) ,氟哌啶5 mg(B组) ,同等容量的生理盐水(C组)。观察麻醉及手术过程中寒战的发生率,寒战的严重程度及术前、术中、术后的体温、平均动脉压(MAP)、心率(HR)、血氧饱和度(SPO2 )的变化。结果　A组、B组、C组寒战发生率为5 .0 %,1 0 .0 %和30 .0 %;C组分别与A、B组比较,差异有统计学意义(P<0 .0 1 ) ;3组患者术前、术中、术后的体温、MAP、HR、SPO2组间和组内对比,差异均无统计学意义(P>0 .0 5 ) ;不良反应发生率,B组较高,与A、C组比较,差异有统计学意义(P<0 .0 1 )。结论　硬膜外注药前肌注曲马多和哌替啶有助于预防硬膜外麻醉后寒战反应,其中曲马多的效果优于哌替啶。     

曲马朵、咪达唑仑预防剖宫产术中寒战的临床观察

目的观察曲马朵、咪达唑仑预防剖宫产术中寒战的临床效果。方法 120例ASA Ⅰ-Ⅱ级择期剖宫产产妇,随机分成3组,每组40例,入手术室后,组Ⅰ静脉注射曲马朵1 mg/kg;组Ⅱ静脉注射咪达唑仑0．04 mg／kg;组Ⅲ静脉注射生理盐水2 ml。观察术中寒战反应情况和新生儿 1 min、5 min Apgar评分。结果组I无寒战反应;组Ⅱ8例出现寒战反应,其中1级5例,2级3例, 与组Ⅰ比较差异有统计学意义(P<0．05);组Ⅲ17例出现寒战反应,其中1级10例,2级6例,3级1 例,与组Ⅰ和组Ⅱ比较差异有统计学意义(P<0．01和P<0．05)。在组Ⅱ和组Ⅲ10例2级、3级寒战反应产妇,静脉注射曲马朵1 mL／kg,10 min后寒战反应消失。3组新生儿1 min、5 min Apgar评分差异均无统计学意义(P>0．05)。结论曲马朵和咪达唑仑能有效预防剖宫产术中寒战反应,其中曲马朵的效果更好。     

术中保温预防妇科腹腔镜手术低体温性寒战的临床观察

目的：观察术中保温对预防妇科腹腔镜手术患者低体温性寒战的效果。方法：将73例腹腔镜手术患者随机分为对照组和实验组，对照组术中不采取任何保温措施，实验组采用电子恒温水温箱和棉被进行术中体温保护，比较两组体温变化、出血量及寒战发生情况。结果：实验组患者术中体温维持稳定，手术前后体温无明显变化；对照组患者术中体温显著下降，与术前及保温组比较均显著下降（P〈0．01）；术中出血量两组患者比较差异无统计学意义，实验组寒战发生率显著低于对照组（P〈0．01）。结论：对妇科腹腔镜手术患者采用术中保温措施可维持患者体温的恒定，降低术中寒战的发生率，同时不会增加术中失血量。     

病人加温系统与液体加温输入法对剖宫产产妇术中体温及麻醉后寒战的影响

目的探讨病人加温系统与液体加温输入法对剖宫产产妇术中体温及麻醉后寒战的影响。方法选择ASAⅠ-Ⅱ级择期剖宫产手术患者90例,随机分为加温系统组(F组),液体加温输入加温组(W组)及对照组(C组)每组30例。三组均行蛛网膜下腔麻醉(腰麻)。记录产妇的体温,麻醉后寒战的发生率和强度,及热舒适度模拟评分。结果麻醉后20 min上肢体温增加最明显,且F组明显高于W组和C组(P0.01);麻醉后40 min机体核心温度下降最明显,且F组、W组明显低于C组(P0.05);麻醉后寒战的发生率F组、W组明显低于C组(P0.05),且F组高于W组(P0.05);热舒适度模拟评分三组差异无统计学意义(P0.05)。结论病人加热系统与液体加温输入法对防止剖宫产手术产妇术中低体温及降低麻醉后寒战有明显作用。