目的:研究老年肿瘤患者又合并有心脏病的麻醉处理。方法:168例70岁以上老年肿瘤病人合并有心脏病患者,其中心脏病是指下列有一项以上异常者:高血压或低血压、心绞痛、心肌缺血、室性早博>5次/分、II°以上房室传导阻滞、完全性右束支和/或左束支传导阻滞、房颤、窦性心动过缓等。给予扩冠药物,行心脏保护,控制血压,纠正贫血、低蛋白及电解质紊乱,抗心率失常,作好术前准备工作。依手术种类和术前病情特点,选择相应的麻醉方法。力求麻醉过程平稳,避免麻醉诱导和苏醒期过度应激。加强麻醉管理与监测。术中依据出血量、体液丢失量和血液动力学的变化,调整输液、输血速度,以维持循环稳定。必要时使用血管活性药及抗心率失常药物,维持心肌的氧供大于(或等于)氧的消耗。结果:本组ECG异常者155例(92%)、高血压92例(55%)、脑梗塞、肺、肝功能异常者分别为0.6%、4.2%、1.8%。神经外科手术均选用全麻(4/4),开胸手术(肺癌、食道癌)及普外科上腹手术(胃、肝胆、胰腺)均选用全麻复合硬膜外麻醉(18/18、28/28),下腹手术:单纯全麻、椎管内麻醉及全麻复合硬膜外麻醉各占4.1%(2/49)、59%(29/49)、42.9%(21/49)。泌尿外科及妇科手术均以椎管内麻醉为主,各占100%(27/27)、86%(6/7)。术毕16例患者行PCA镇痛,141名患者行PCEA镇痛,均达满意镇痛效果。术后有1例患者出现呼吸功能衰竭而需呼吸支持治疗,出现循环不稳定老二5例。麻醉死亡率为0,术后死亡率为0.6%(见表3)。结论:做好充分的术前准备,选择合适的麻醉方法,加强麻醉管理,采取积极预防措施,对避免或降低不良事件发生是必要的。

Objective: To evaluate the efficacy of xafon and tramadol on patient-controlled intravenous analgesia (PCIA) in patients underwent larynx cancer operations. Methods: 40 patients (ASA Ⅰ-Ⅱ) larynx cancer operations under general anesthesia were randomly allocated to either group L or gruop T with 20 cases each.At the time of wound closure,xafon was administered intravenously at a dose kf 8mg(group L), tramadol was administered intravenously at a dose of 100 mg (group T). The analgesic prescription included xafon 48mg diluted with Ns to 120ml(group L),tramadol 1000mg diluted with Ns to 120ml(group T),and continuous infused at a rate of 2ml/h, bolus dose was 0.5ml and lock-out interval 15min. To observe the visual analgesia score (VAS)、Bruggrmann comfort score(BCS) and adverse events during the analgesia. Results: There was no statistical difference in VAS and BCS (P0.05). Group T was higher than group L in nausea、vomitus and diaphoresis,et al. Conclusion: Group L can provide the same analgesic efficacy as group T. Postoperative analgesia with xafon is more worthy of application in clinic associated with a lower incidence of adverse events.

麻醉时因返流而误吸胃内容物可引起一系列并发症甚至危及生命,尤其以急诊饱胃患者全麻时的发病率最高.误吸入大量胃内容物的死亡率可高达70%,麻醉期间预防返流和误吸的发生是非常重要的.在急诊手术中,饱胃患者占有相当大比例,现将我院近期收治的48例急症饱胃患者麻醉处理方法总结如下.

Objective To compare the effects of desflurane and isoflurane on EEG. Methods 20 ASA grade Ⅰ～Ⅱ, aged 20～50 year-old, unpremedicated adults patients undergoing elective surgery were randomly divided into two groups: desflurane (n=10) and isoflurane group (n=10). Anesthesia was induced with propofol 2mg/kg and succinylcholine 2mg/kg intravenously and maintained with inhalation anesthetics. After incubation patients were ventilated mechanically to maintain PetCO 2 between 4.7 and 6.0kPa. The TOF ratio of T4/T1 was maintained less than 25% throughout anesthesia. Two channels EEG monitor was applied. End-tidal concentration was adjusted at 0.5, 0.8, 1.0, 1.3 and 1.5 MAC in sequence was maintained for 10 min before SEF and BIS were recorded. Results There were negative remarkable correlation between either SEFor BIS and MAC in both groups (r=-0.95 and -0.99, P0.01) There was no significant difference between two groups in EEG. Conclusion The EEG may be useful in evaluating anesthesia depth. The effects of desflurane and isoflurane on EEG were similar at equivalent effective concentration.

术后镇痛的研究在国内广泛兴起，已经证明良好的术后镇痛可抑制机体的应激反应，有利于术后病人呼吸，循环稳定，减少术后并发症。我院近年来开展了术后硬膜外持续镇痛这项工作，并把曲马多作为主要镇痛药物。取得了比较满意的镇痛效果，并与传统的镇痛药物吗啡进行对照观察，现……

地氟醚是一种新的吸入麻醉药，由于具有很多优点，被普遍认为是目前较理想的吸入麻醉药。但快速增加呼气末地氟醚浓度超过lMAC可产生交感兴奋作用，增加了冠心病病人手术时心肌缺血的危险。本文旨在通过对血液动力学的观察和儿茶酚胺的测定比较两者对交感神经系统的影响。……