恶性肠梗阻的病机为中焦气滞、痰浊、血瘀、热毒壅滞而致浊阴不降,腑气不通,病位在大肠,与脾、胃、肝、肾亦相关.针对邪实,以辛味药开壅滞之中焦,以苦味药降不通之腑气.辛味药主行善散,可助脾升清阳、运化精微以行气、活血、化湿;苦味药主泄善降,可助胃之降逆,通腑以祛郁结.辛苦同用,则脾升胃降,复司其职,清浊回归本位.

赵国定教授认为在心系疾病中,痰湿是重要的致病因素.在诊治痰湿相关心系疾病时,重视脾胃、气候及个体差异,善用对药,从通、清、益等不同治法辨治相关疾病,并举相关临床验案三则.

Objective To conclude and discuss the anesthesia for Microlaryngoscopic Surgery under Suspension Laryngoscope. Methods 80 cases of laryngeal disease were observed and operated under microlaryngoscopy, involving the polyp of the vocal cords, cyst of epiglottis and so on. All patients under Combined Intravenous (or with Inhalation) Anesthesia had an American Society of Anesthesiologists physical status classification of I～II. Changes of vital signs in peri-anesthesia、recovery time from anesthesia and adverse reactions during the anesthesia were observed and recorded. Results Systolic blood pressure of all patients were increased immediately after implantation laryngoscope. Compared with the pre-induction, there was a significant difference (P0.05). Heart rates were increased immediately after intubation and P0.05; but instead decreased immediately after implantation laryngoscope and P0.05. There was no significant changes in SpO2 in each time points. All adverse reactions during anesthesis were handled properly. Conclusion Choose the right patients and the appropriate anesthesia treatment is the key to successful surgical treatment.

OBJECTIVE:To investigate the value of video laryngoscope in localization diagnosis of upper airway stricture in obstructive sleep apnea-hypopnea syndrome (OSAHS) during drug-induced sleep.METHOD:One hundred and thirty two patients with OSAHS were randomly divided into group A and B in this study. In group A, the patients were examined with video laryngoscope to locate the upper airway stricture under midazolam-induced sleep. In group B, the patients had conventional physical examination and video laryngoscope when awake. And the operation plans of both groups were made based on the localization diagnosis results.RESULT:In group A, 72.1% patients have several stricture levels and in group B only 33.8%. The patients was followed up time more than 6 months, and the cure rate, the excellent effective rate, and the total effective rate of group A were significantly higher than those in group B respectively (P<0.05).CONCLUSION:Most patients of OSAHS have several stricture levels of upper airway under Midazolam- induced sleep. Localization diagnosis of upper airway stricture in patients with OSAHS with video laryngoscope before operation can improve the cure efficiency significantly.

Objective To evaluate the efficacy and safety of sufentanil and flurbiprofen axetil,used alone or in combination,for postoperative patient-controlled intravenous analgesia(PC/A)in patients undergoing ab- dominal surgeries.Methods Eighty ASAⅠ-Ⅲpatients undergoing elective abdominal surgeries were ran- domized equally into 4 groups(groups A,B,C,and D),and all received intraoperative intravenous combined with inhalation anesthesia and postoperative PCIA.For postoperative PCIA,the patients in group A received a protocol of sufentanil(150μg)+ droperidol(5 mg)+0.9% NaCl solution,those in group B had a protocol con- sisting of flurbiprofen axeyil injection(100 mg)+droperidol(5 mg)+0.9% NaCl solution,those in group C had flurbiprofen axeyil injection(100 mg)+sufentanil(75μg)+droperidol(5 mg)+0.9% NaCl solution,and those in group D received flurbiprofen axeyil injection(200 mg)+droperidol(5 mg)+0.9% NaCl solution.All the anesthetic agents were diluted to 100 mL and infused by a pump at the background dose rate of 2 mL/h with a patient-controlled bolus of 1.5 mL and the lock out time of 20 min.The visual analogue scale(VAS)and Ramsay scores were used to evaluate the analgesic effect at 2,4,8,12,24 and 48 h after surgery,and the number of button-pressing times during PCIA and the adverse effects associated with PCIA were recorded in the 48 h post- operatively.Results All the patients showed good pain relief with PCIA,but patients in groups A and C had slightly lower VAS scores than those in groups B and D,which,however,did not indicate a statistically signifi- cant difference(P0.05).In groups Band C,the average Ramsay score was significantly lower than that in group A(P0.05),but only slightly lower than that in group D(P0.05)at 2 and 4 h after the operation. At 8 h.the average Ramsay score was still lower in groups B and C,but the differences were not significant (P0.05).Within 48 h after the operation,no significant difference was found in the number of times of button pressing during PCIA between the 4 groups.The PCIA protocol in group A was associated with slightly,but not significantly,higher incidences of nausea,vomiting,lethargy and skin itching than the protocols in the other 3 groups(all P0.05).Respiratory inhibition or abnormal bleeding occurred in none of the cases in the 4 groups.Conclusion PCIA with a combination of flurbiprofen axeyil and low-dose sufentanil produces better an- algesic effect than sufentanil or flurbiprofen axeyil used alone,and can significantly reduce the dose requirement of sufentanil as well as its associated adverse effects.(Shanghai Med J.2008,31:161-164)

Objective To appraise the clinical application of laryngeal mask airway(LMA)during general anesthesia in breast surgery.Methods Forty ASA I-Ⅱpatients(female)undergoing breast surgery were ran- domly divided into two groups:TT group and LMA group(20 patients in each)without any preoperative medica- tion.MAP,HR,EKG,SpO_2,P_(ET)CO_2 were monitored during anesthesia.The followings were recorded:changes in MAP,HR,EKG,SpO_2,P_(ET) CO_2 during anesthesia;recovery of spontaneous breathing and orientation after termination of anesthesia;postoperative outcome and complications including sore throat,nausea and vomiting. Results MAP and HRs were significantly lower in LMA group than those in TT group during intubation (P＜0.05),but SpO_2,P_(ET)CO_2 revealed no significant difference(P＞0.05).The duration from termination of anes- thesia to full recovery of spontaneous breathing,LMA group showed much better and shorter than those of the TT group (P＜0.05).The side effects(including sore throat)were nearly the same between the two groups.Conclu- sion LMA under general anesthesia is safe and effictive for breast surgery with less instant reaction,low medica- tion dose,quick resuscitation and few complications of respiratory tract.

异丙酚是一种新型短效静脉全麻药.其临床特点是起效快,作用时间短,恢复迅速、平稳而彻底,不良反应少,除了全麻诱异和维持外,近期我院麻醉科还将此药用于肠镜检查以减轻患者的痛苦.现就在纤维肠镜检查中异丙酚的较为合理的用药,及对患者的各生命体征进行观察及比较.

近期,我院收治了1例消化道穿孔并发急性腹膜炎、脓毒血症患者.在全麻下行剖腹探查术时,发现在使用肌松剂时(先使用非去极化肌松剂,后改用去极化肌松剂)患者腹壁无法松弛.现报道如下: