Objective:To compare the safety apnea time during endotracheal intubation in the patients from different altitudes using oxygen reserve index (ORI).Methods:Sixty American Society of Anesthesiologists physical status Ⅰor Ⅱ patients, aged 18-70 yr, undergoing elective surgery requiring tracheal intubation under general anesthesia and requiring catheterization via arterial puncture, were included.Among the patients, 30 cases who had long lived at an altitude of 1 500-3 000 m in Qinghai Province People′s Hospital (Xining, 2 200 m above sea level) served as middle-altitude group, and 30 Tibetan patients who had long lived at an altitude >3 000-meter area in Yushu People′s Hospital (Yushu, 3 600 m above sea level) served as high-altitude group.The patients were preoxygenated for 5 min before induction of anesthesia, and then endotracheal intubation was performed with a video laryngoscope.Before induction (T 0), at 3 min of pre-oxygenation (T 1), and at 5 min of pre-oxygenation (T 2), arterial blood was collected for blood gas analysis, and PaO 2 was recorded, ORI and SpO 2 were simultaneously recorded.The time from the beginning of intubation to the time when ORI was decreased to 0 and the time from the beginning of intubation to the time when SpO 2 was decreased to 98% were recorded. Results:Compared with middle-altitude group, the time from the beginning of intubation to the time when ORI was decreased to 0 and the time from the beginning of intubation to the time when SpO 2 was decreased to 98% were significantly prolonged ( P<0.05), and no significant change was found in SpO 2, ORI and PaO 2 at each time point in high-altitude group ( P>0.05). Conclusions:The safety apnea time during endotracheal intubation is longer in the patients at high altitudes (altitude > 3000 m) than those at the moderate altitudes (altitude 1500-3000 m).

近年来随着人民生活水平的不断提高,人们对无痛胃肠镜检查的需求越来越大,目前国内无痛胃肠镜麻醉方式主要为静脉注射丙泊酚、咪达唑仑、舒芬太尼等,每种药物各自有优缺点.瑞马唑仑是一种新的短效镇静药,2020年7月全球同步上市,为我国1.1类新药[1],起效快、代谢快.本研究以丙泊酚复合阿芬太尼为对照,观察瑞马唑仑复合阿芬太尼在无痛胃肠镜检查中的效果.

目的:探索苯磺酸瑞马唑仑在老年无痛胃肠镜检查中的应用价值及对患者血流动力学的影响.方法:选择行无痛胃肠镜检查的老年患者60例,随机分为两组,A组为丙泊酚联合阿芬太尼,B组为苯磺酸瑞马唑仑联合阿芬太尼,每组30例,A组丙泊酚1～2 mg/kg复合阿芬太尼4μg/kg,B组苯磺酸瑞马唑仑7 mg复合阿芬太尼4μg/kg;睫毛反射消失后开始内镜检查,如术后发生体动反应分别追加丙泊酚0.2～0.5 mg/kg或苯磺酸瑞马唑仑3 mg;记录患者麻醉诱导前(T1)、胃镜通过喉部(T2)、肠镜时(T3)、肠镜通过肝区(T4)、检查结束时(T5)时的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2),起效时间、苏醒时间、离室时间以及不良反应(包括呛咳、体动反应、呼吸抑制、注射痛、谵妄等)的发生率.结果:两组间比较:MAP在T2时点,HR在T2、T3、T4时点比较差异有统计学意义(均P<0.05),SpO2两组比较各时点差异无统计学意义(P>0.05).组内比较:A组MAP T1时点比T2、T3、T4时点降低差异有统计学意义(P<0.05),T2时点比T3、T4、T5时点升高差异有统计学意义(均P<0.05),T3时点比T5时点升高差异有统计学意义(P<0.05);B组MAP T1时点比T2、T3、T4、T5时点降低差异有统计学意义(均P<0.05);A组HR T1与T2、T3、T4比较差异有统计学意义(均P<0.05),T2比T4、T5升高差异有统计学意义(均P<0.05),T3比T5升高差异有统计学意义(P<0.05).B组HR T1比T2、T3下降差异有统计学意义(P<0.05).两组SpO2在T1时点与T2、T3、T4、T5比较均升高,差异有统计学意义(均P<0.05).B组起效时间较A组长,B组苏醒时间较A组短,两组差异均有统计学意义(均P<0.05),两组患者离室时间比较差异无统计学意义(P>0.05).B组的呛咳发生率较A组高,A组呼吸抑制、嗜睡、头晕、恶心呕吐、谵妄发生率较B组高,两组比较差异均有统计学意义(均P<0.05).结论:苯磺酸瑞马唑仑联合阿芬太尼用于老年患者无痛胃肠镜的麻醉时循环稳定、呼吸抑制较轻,苏醒完全且不良反应发生率低.

目的 探讨氨甲环酸(TXA)对高海拔地区(海拔≥2200m)肝包虫病肝部分切除术患者术中输血(量)和术后凝血功能的影响.方法 从青海省人民医院包虫科2018年10月～2019年12月全身麻醉后行择期肝包虫肝部分切除术的患者44名,年龄(39.09±14.70)岁,男性19名、女性25名,ASA分级Ⅰ～Ⅲ级,Child-Pugh评分A～B级,术前凝血功能正常,随机均分为TXA注射组:术前30 min静脉注射TXA10 mg/(kg·人),对照组:术前30 min静脉注射等体积的0.9％氯化钠注射液;静脉注射前和手术结束时各抽取患者动脉血3 mL/人,做血栓弹力图(TEG)检测;比较2组患者的术中失血量、输血量及手术前后的Pit、Hb与TEG参数,采用SPSS22.0统计学软件做统计学分析.结果 TXA组与对照组术中出血量(mL)分别为300(200,1000)vsl 400(1000,2100),血浆输注量(mL)0(0,O)vs 380(0,575),红细胞悬液输注量(mL)0(0,400)vs1200(800,600);术前TEG各参数相近(P＞0.05);术后R时(min)分别为8.32±2.24 vs 10.78±2.67,K时(min)分别为2.80(2.10,3.30) vs 3.70(3.20,4.80),Angle角(.)分别为54.76±9.48 vs 43.70±9.02(P＜0.05).结论 高海拔地区肝包虫肝部分切除术患者术前使用TXA能减少术中出血量、减少术中血浆及红细胞悬液的输注量、节约高海拔地区血液资源;明显改善患者TEG参数(即凝血功能).

目的:观察舒芬太尼清醒镇静用于胃镜下食管静脉曲张治疗的效果及最佳剂量.方法:将90例拟在胃镜下行硬化治疗的患者随机分为Ⅰ组(安慰剂)、Ⅱ组(舒芬0.1ug/kg)、Ⅲ组(0.2μg/kg)各30例,3组患者吸氧、连接监护仪后Ⅰ组3ml生理盐水入壶,Ⅱ组舒芬太尼0.1μg/kg入壶,Ⅲ组舒芬太尼0.2ug/kg入壶.记录给药前(T0)、给药后(T1)、胃镜过咽部时(T2)、结束后(T3)的收缩压(SBP)、舒张压(DBP)、心率(HR)、血氧饱和度(SpO2).记录呛咳、剧烈呕吐、呼吸抑制、低氧饱和度等不良事件.结果:Ⅱ、Ⅲ组患者T2,T3时的SBP,DBP较Ⅰ组平稳,差异有统计学意义(P<0.05),Ⅰ组的HR在T1,T2,T3时波动较Ⅱ、Ⅲ组明显,Ⅲ组最平稳,差异有统计学意义(P<0.05),SpO23组比较各时点差异无统计学意义(P>0.05),Ⅲ组的不良事件发生率最低,效果评定Ⅲ组优于Ⅰ、Ⅱ组,患者主观舒适度Ⅲ组优于Ⅰ、Ⅱ组,差异有统计学意义(P<0.05).结论:0.2ug/kg舒芬太尼用于清醒镇静胃镜下食管静脉曲张硬化治疗安全有效,患者舒适度满意度高,血流动力学稳定.

目的:观察在高原地区全身麻醉用于高危产妇剖腹产手术围术期的安全性.方法:选择50例急诊行剖腹产的患者.分Ⅰ组(全麻组)和Ⅱ组(椎管内麻醉组)每组25例.分别记录患者入室到麻醉开始的时间(T1),麻醉开始至手术开始的时间(T2),手术开始至胎儿娩出的时间(T3),胎儿娩出1 min、5min、10min的Apgar评分(A1、A2、A3),产妇麻醉前的平均动脉压(MAP1),手术开始切皮时的平均动脉压(MAP2),胎儿取出时的平均动脉压(MAP3),以及相应时间点的心率(HR1、HR2、HR3),进行统计学分析.结果:三个时点的MAP之间差异有统计学意义(P＜0.05),与麻醉方法有关系(P＜0.05),多重比较MAP1、MAP2、MAP3之间两两比较差异均有统计学意义(P＜0.05).三个时点的HR比较差异有显著性意义(P＜0.05),多重比较HR1与HR2、HR3比较差异有统计学意义(P＜0.05),两组各时段Apgar评分比较差异无统计学意义(P＞0.05).两组比较T1、T2、T3差异有统计学意义(P＜0.05).结论:高原地区全麻用于高危剖腹产手术时围术期是较安全的,能尽快娩出胎儿,并且围术期母婴均安全,对婴儿的Apgar评分无影响,产妇的血流动力学较稳定.

呼吸过滤器(breathing filter,BF)也称生物过滤器、热湿交换过滤器、人工鼻等,是一人类在呼吸回路中使用的过滤器,具有不同程度的生物滤过功能和加温保温作用.近年BF在临床广泛推广使用,作为机械通气(mechamcal ventilation,MV)期间保护气道、降低呼吸回路微生物污染,以及在肺功能等的临床检测时的应用以避免交叉感染是控制院内交叉感染的措施之一.

目的：评价腰硬联合麻醉与单纯硬膜外麻醉在高龄产妇行剖腹产时的麻醉效果。方法：选择ASA1-2级的拟行剖腹产的高龄产妇40例（年龄），随机分为腰硬联合组和单纯硬膜外组分别监测在麻醉前（T0），麻醉后2分钟(T1)，麻醉后5分钟（T2），麻醉后10分钟（T3）的收缩压，舒张压，心率，麻醉平面到达T6的时间，手术开始至胎儿娩出时间及Apgar评分。结果：两组血流动力学波动差异有统计学意义（P＜0.05）两组麻醉平面到达T6的时间及胎儿娩出的时间差异有统计学意义（P＜0.05），两组间的新生儿的Apgar评分差异无统计学意义（P＞0.05）。结论：腰硬联合麻醉在高龄产妇的剖腹产手术中起效快，肌松满意，不影响新生儿的Apgar评分，是安全有效的麻醉方法。

目的：通过网络系统使省级专家与基层现场救治医生建立即时连接，进行早期生命救治，降低患者的死亡率及致残率。方法：通过网络系统支持平台、项目专家库及基层医疗队伍建设，使省级专家与基层医疗单位实现实时信息联动机制，第一时间对患者进行有效规范的早期救治。结果：网络支持下的远程早期生命救治在基层医疗单位中的应用是切实可行的。结论：基层医疗单位遇到需要早期生命救治的患者时，可通过网络技术，迅速有效地寻求知识、技术及疑惑咨询。通过省级专家与基层医生联动机制能够做到信息、人员、技术到位，使需要早期救治的患者得到有效治疗。

Objective:To observe effect of multimodal analgesia on patients who would undergo open thoracic surgery.Methods:40 patients,who would be conducted routine thoracotomy,were randomly divided into two groups of 20 cases each.Group A received ROM nerve block before thoracic closure and parecoxib(intravenous drip),and received patient-controlled analgesia with sufentanil at the end of the surgery;Group B is given patient-controlled analgesia with sufentanil only at the end of the surgery.The analgesic VAS score,calm Ramsay score and adverse reaction were recorded before 2,4,6,8,12,24,48 and 72 h beginning of PCIA.Results:As compared with group B,the VAS score,comfortable state scores,sufentanil dosage and PCA effective pressing number was decreased obviously at rest and action;PCA pressing number in group B is more than that in group A(P<0.05).After operation,there was no difference in the vital signs,calm score,exhaust time,nausea,vomiting,itchy skin,bosom frowsy between the both groups(P>0.05).Conclusions:Multimodal analgesia therapy is ideal perioperative analgesia in patients under thoracic surgery.

objective:To observe the effect of intraoperative insulation on the metabolic process of cisatracurium in general anesthesia.Methods:24 patients undergoing elective surgery and according with ASA grade(Ⅰ~Ⅱ)were randomLy divided into group Ⅰ served as controlled group free warming,and group Ⅱ accepted intraoperative heat preservation by fluid warming device and using 37℃ warming blanket.The neurotransmission function of ulnar nerve and thumb adductor were monitored with TOF frequency for 2 Hz,strung interval of 15s,the stimulus current for 50mA.Cisatracurium was continuously injected by pump when T1 value reached to 10% and regulated T1 to 10% until muscle suture,and record the amount of cisatracurium.Results:Body temperature was 36 ℃ bellower in group i but 36 ℃ higher for group Ⅱ at end of operation.There was no statistical difference in age,sex ratio,weight and amount of cisatracurium between the two groups(P>0.05).Muscular relaxation recovery time was significantly shortened in group Ⅱ as compared with group I(P<0.05).Conclusions:Intraoperative insulation plays an important role in reduction of perioperative complications resulted from drug residue and pharmacokinetics.