目的 评价麻醉前预输注醋酸钠钾镁钙葡萄糖注射液(乐加)对诱导期患者血流动力学、血糖、酸碱平衡和电解质的影响.方法 选择2013年4～10月拟在全身麻醉下行腹腔镜胆囊切除手术患者30例,年龄50～68岁,随机分为实验组(乐加组)和对照组(乳酸钠林格注射液组),每组15例.实验组患者在30min内输入乐加10ml/kg,对照组患者在30min内输入乳酸林格注射液10ml/kg后开始全麻诱导,两组患者均采用经口气管插管全身麻醉,麻醉诱导和维持方法相同.比较两组患者的MAP、HR、CVP、Sp02、Hb、Hct、血糖和电解质指标.结果 (1)一般资料:两组患者年龄、身高、体重和基础Hb、Hct值组间比较差异均无统计学意义(P＞0.05).(2) MAP、HR两组间比较差异均无统计学意义(P＞0.05).(3)两组内CVP随输液量增加逐渐增高,但组间比较差异均无统计学意义(P＞0.05).(4)对照组患者输液后Mg2+浓度降低(P＜0.05).(5)两组患者输液后血糖水平均升高,组间比较差异均无统计学意义(P＞0.05).结论 腹腔镜胆囊切除手术患者全麻诱导期预输注醋酸钠钾镁钙葡萄糖注射液更有利于维持酸碱和电解质平衡.

目的 探讨指压技术对臂丛神经下干(尺神经)阻滞效果及并发症发生率的影响.方法 选择80例拟行上肢手术的患者,随机分为指压组(A组)和对照组(B组),分别给予0.4％罗哌卡因20ml行肌间沟臂丛神经阻滞术,A组接受指压技术,B组为对照组.观察并记录注药后1、2、5、15min的尺神经、正中神经、桡神经支配区域感觉阻滞起效、完善时间,阻滞完善成功率和并发症的情况.结果 (1)A组对尺神经的阻滞起效时间、完善时间及阻滞完善成功率均优于对照组;(2)A组临床麻醉效果优良率显著提高;(3)麻醉并发症发生率:A组低于B组.结论 指压技术应用于肌间沟臂丛神经阻滞有助于局麻药向下干扩散,从而提高尺神经阻滞成功率,降低并发症,适于在基层医院推广.

[Objective]To observe the therapeutic effects and adverse reaction of patient-controlled intravenous analgesia (PCIA) with tramadol on patients with zonal herpes.[Methods]26 patients were given analgesia solution which consisted of tramadol 800mg,droperidol 7.5 mg,dexamethasone 15 mg,VB 1500mg,VB12 1000 μg,and diluted to 200ml with normal saline.The continuous intravenous administration via micro pump was adopted,72h was a unit of treatment with pause for 2 days,and two units was a course of treatment.The analgesic effect,sedative effect,dose of tramadoland and adverse reactions which included nausea,vomiting,respiratory and circulatory depression,urinary retention were observed.[Results]The marked effective rate of analgesia (complete analgesia) was 88.8%～92.3%,which was significantly higher than that before analgesia (P<0.01).There was no obvious sedative effect and respiratory and circulatory depression,but some patients had nausea,vomiting and urinary retention.[Conclusion]The PCIA with tramadol has remarkable and safe effect on patients with zonal herpes,but some patients had nausea,vomiting and urinary retention.

目的 观察曲马多病人自控镇痛(PCIA)对带状疱疹痛的治疗效果.方法 26例病人接受配方为曲马多800mg+氟哌利多7.5mg+地塞米松15mg+维生素B1500mg+维生素B121000μg+生理盐水稀释到200ml的镇痛液持续静脉微泵滴注,72h为一个治疗单元,间歇2天,两个治疗单元为1个疗程.观察镇痛(VRS)、镇静(SS)情况和恶心呕吐、呼吸循环抑制、尿潴留等不良反应发生情况,以及曲马多用量等.结果 镇痛显效率(完全无痛)为88.8%～92.3%,与镇痛前比较P<0.01.无明显镇静发生,无呼吸和循环抑制发生,有恶心呕吐及尿潴留情况发生.结论 曲马多PCIA对带状疱疹痛的治疗作用是显著和安全的,但有一定的恶性呕吐及尿潴留发生率.

[Objectives]To investigate the prevention and treatment effect of droperidol combined with dexamethasone on nausea and vomiting induced by tramadol for analgesia.[Methods]80 cases of caesarean under epidural anesthesia were randomly divided into four groups of 20 cases in each group. All patients were given postoperative Patient-Controlled Epidural Analgesia (PCEA) with tramadol. The control group (group A) received tramadol 500 mg dilute to 100 ml with normal saline (NS), the droperidol group (group B) received tramadoal 500 mg + droperidal 5 mg dilute to 100 ml with NS, the dexamethasone group (group C) received tramadol 500 mg + dexamethasone 20 mg dilute to 100 ml with NS, the droperidol combined with dexamethasone group (group D) received tramadol 500 mg + droperidal 5 mg +dexamethasone 20 mg dilute to 100 ml with NS. The analgesia effect (VAS scores), the incidence of nausea and vomiting within 24 hours were observed and recorded.[Results]There was no significant difference in VAS scores among four groups. The incidence of nausea and vomiting in group A (35%) was higher than that in group B (15%) and group C (15%). The incidence of nausea and vomiting in group D (5%) was lower than that in group A (P0.01).[Conclusion]The single use of droperidol or dexamethasone can both decrease the incidence of nausea and vomiting induced by tramadol for analgesia, and the combination of two drugs can enhance the effect further.

1资料与方法 选择ASA Ⅰ～Ⅱ级硬膜外阻滞下行择期手术病人30例,其中男性16例,女性14例,年龄25～65岁,体重50～80kg,无严重的心肝肾等器质性疾病,病人随机分为两组:Ⅰ组(咪达唑仑组),Ⅱ组(未应用咪达唑仑组).术中常规监测心率(HR)、血压(Bp)、血氧饱和度(SPO2).焦虑程度采用焦虑视觉模拟评分,0分为镇静不焦虑,10分为极度焦虑.硬膜外阻滞完善后,给Ⅰ组病人静推MDZ 0.02mg/kg作为诱导剂量,然后用静脉输注泵(TCI)以0.05～0.15 mg/kg·h的速度维持,记录HR、Bp、SPO2和焦虑程度,术后24 h随访两组病人对术中的记忆程度.