Rationale: Postdural puncture headache (PDPH) is a common complication in lactating mothers after cesarean delivery. It was reported that postdural puncture headache was managed through a novel approach by administration of neostigmine-atropine. Neostigmine-atropine is commonly used to reverse residual non-depolarizing neuromuscular blocking agents. The method is simple, well-tolerated, and has fewer side effects compared to epidural blood patch procedure. We report a case of a patient who presented severe side effects following treatment using this method. Patient concerns: A 29-year-old female presented with uncontrollable head shaking (no studies reported) after using neostigmine/atropine. Diagnosis: Based on the clinical, using of neostigmine, the patient was diagnosed with severe side effects of neostigmine. Interventions: Comforted the patient until all symptoms disappeared (self-care). Outcomes: Approximately 10 minutes after administration of neostigmine/atropine, the patient exhibited trembling in the upper limbs, followed by severe head shaking from side to side with large amplitude above 90 degrees. The rate of head shaking was approximately 100 times min−1. The patient complained of stomachache and vomited about 20 mL light yellow liquid. After 20 minutes, the uncontrollable head shaking presented as a slight up-and-down nod. All the symptoms disappeared after approximately 50 minutes. The patient was fully conscious throughout the process and responded normally. Physical examination showed stable vital signs. The patient was discharged after 2 days. The patients were followed up for 1 year and everything was normal. Lessons: There are many side effects observed with neostigmine, such as uncontrollable head shaking. Patients should be informed of all the possible side effects during the consenting process to avoid panicking; dilution of the medications, and the drugs should be administered gradually to minimize side effects.

目的 探讨肝硬化患者腹腔镜手术误伤附脐静脉致大出血的临床特点及麻醉管理注意事项.方法 选取2019年11月至2022年11月首都医科大学附属北京佑安医院肝硬化患者腹腔镜手术误伤附脐静脉致大出血4例,分析术前一般情况及检验结果、术中麻醉管理、术者操作、术后转归,并复习相关文献.结果 4例患者术中均因脐部Trocar置入操作导致附脐静脉不同程度损伤,伴不同程度出血,经过积极手术处理、术中抢救后术后恢复良好.相关文献显示,不同肝功能分级的肝硬化患者的附脐静脉发生率不同,但肝功能损伤程度与脐静脉开放率不相关.结论 对于伴有肝硬化拟行腹腔镜手术的患者,建议术前超声评估附脐静脉扩张程度,可采取脐下切口和开放式操作建立气腹;若行闭合式建立气腹,建议在超声实时引导下置入,避免损伤附脐静脉导致大出血.

INTRODUCTION:Ropivacaine oil delivery depot (RODD) can slowly release ropivacaine and block nerves for a long timejavascript:;. The aim of the present work was to investigate the safety, pharmacokinetics, and preliminary pharmacodynamics of RODD in subcutaneous injection among healthy subjects.METHODS:The abdomens of 3 subjects were subcutaneously administered with a single-needle RODD containing 12~30 mg of ropivacaine. The irritation, nerve blocking range and optimum dose were investigated. Forty-one subjects were divided into RODD groups containing 150, 230, 300, 350 and 400 mg of ropivacaine and a ropivacaine hydrochloride injection (RHI) 150 mg group. Multineedle subcutaneous injection of RODD or RHI was performed in the abdomens of the subjects. The primary endpoint was a safe dose or a maximum dose of ropivacaine (400 mg). Subjects' vital signs were observed; their blood was analyzed; their cardiovascular system and nervous systems were monitored, and their dermatological reactions were observed and scored. Second, the ropivacaine concentrations in plasma were determined, pharmacokinetic parameters were calculated, and the anesthetic effects of RODD were studied, including RODD onset time, duration and intensity of nerve block.RESULTS:Single-needle injection of RODD 24 mg was optimal for 3 subjects, and the range of nerve block was 42.5±20.8 mm. Multineedle subcutaneous injection of RODD in the abdomens of subjects was safe, and all adverse events were no more severe than grade II. The incidence rate of grade II adverse events, such as pain, and abnormal ST and ST-T segment changes on electrocardiography, was approximately 1%. The incidence rate of grade I adverse events, including erythema, papules, hypertriglyceridemia, and hypotension was greater than 10%. Erythema and papules were relieved after 24 h and disappeared after 72 h. Other adverse reactions disappeared after 7 days. The curve of ropivacaine concentration-time in plasma presented a bimodal profile. The results showed that ropivacaine was slowly released from the RODD. Compared with the 150 mg RHI group, Tmax was longer in the RODD groups. In particular, Tmax in the 400 mg RODD group was longer than that in the RHI group (11.8±4.6 h vs. 0.77±0.06 h). The Cmax in the 150 mg RODD group was lower than that in the 150 mg RHI group (0.35±0.09 vs. 0.58±0.13 μg·mL-1). In particular, the Cmax increased by 48% when the dose was increased by 2.6 times in the 400 mg group. Cmax, the AUC value and the intensity of the nerve block increased with increasing doses of RODD. Among them, the 400 mg RODD group presented the strongest nerve block (the percentage of level 2 and 3, 42.9%). The corresponding median onset time was 0.42 h, and the duration median was 35.7⁓47.7 h.CONCLUSIONS:RODD has a sustained release effect. Compared with the RHI group, Tmax was delayed in the RODD groups, and the duration of nerve block was long. No abnormal reaction was found in the RODD group containing 400 mg of ropivacaine after subcutaneous injection among healthy subjects, suggesting that RODD was adequately safe.TRIAL REGISTRATION:Chictr.org: CTR2200058122; Chinadrugtrials.org: CTR20192280.

目的 观察临床麻醉实习生在传统教学方法与微视频预学习方法对带教老师满意度.方法 选择2018年6-7月于首都医科大学附属北京佑安医院麻醉科实习的34名卫生事业管理专业本科实习生,随机分为传统带教组和新型带教组,每组各17名,传统带教组采用以往的带教方法,新型带教组采用先观看微视频进行预习,之后再进行临床实习.所有实习生在实习结束后,统一填写评教问卷,进行满意度调查.结果 此次调查共收到教师评教满意度问卷34份,剔除无效问卷1份,得到有效问卷33份,其中传统带教组16份,新型带教组17份.新型带教组学生对带教内容的学习能力培养、激发学生兴趣、授课效果总体评价满意度高于传统带教组,差异有统计学差异(P＜0.05).2组学生对带教态度满意度无统计学差异(P＞0.05).满意度的不同维度中,新型带教组在激发学生兴趣、授课效果总体评价的非常满意率均达到90％以上.其中对激发学生兴趣的非常满意度达100％.结论 新型教学方法激发了非麻醉专业对临床麻醉实习的兴趣,对带教老师满意度高.

The results in Table 3 (highlighted) have been corrected to be consistent with the results reported in the text.Reference:YingHao Cao, Ping Chi, Chen Zhou, WenFei Lv, ZheFen Quan, Fu Shan Xue: Remimazolam Tosilate Sedation with Adjuvant Sufentanil in Chinese Patients with Liver Cirrhosis Undergoing Gastroscopy: A Randomized Controlled Study. Med Sci Monit, 2022; 28: e936580.DOI: 10.12659/MSM.936580

Sedation is routinely provided for patients undergoing gastrointestinal endoscopy. Remimazolam tosilate is a novel and short‐acting sedative agent that has been used for sedation during endoscopic procedures. The optimal dose of remimazolam in gastrointestinal endoscopy for patients with liver cirrhosis has not been elucidated.

目的 设计并制作动静脉内瘘手术器械台,并探讨其应用效果.方法 自制的动静脉内瘘手术器械台包括器械台面板、手部支撑组件、支撑杆、底座和万向轮5个部分.选取2021年1月—12月北京市某三级甲等医院的120例动静脉内瘘手术患者为研究对象,按手术排程顺序编号,采用随机数字表法分为试验组和对照组,每组各60例.试验组采用动静脉内瘘手术器械台进行手术,对照组采用现有手术器械台.比较两组皮肤消毒用时、患者及医护人员对手术器械台的满意度.结果 试验组皮肤消毒用时低于对照组,差异具有统计学意义(t=-11.936,P<0.001).试验组手术患者对手术器械台有利于支撑、舒适度及省时节力3个方面满意度高于对照组,差异具有统计学意义(Z=-4.421,-3.235,-4.449,均P<0.05);试验组医护人员对手术器械台有利于消毒、操作便捷、省时节力3个方面满意度高于对照组,差异具有统计学意义(Z=-4.861,-2.709,-4.464,均P<0.05).结论 动静脉内瘘手术器械台操作便捷、有利于患者支撑、方便手术医生消毒、省时节力,有助于提升手术患者的舒适度和满意度,提高医护人员的工作效率.

目的 探讨血清β2微球蛋白(β2-microglobulin,β2-MG)数值参考范围在判断肝移植术后急性肾损伤(acute kidney injury,AKI)的价值和AKI各分级的意义.方法 选取2003年6月至2013年12月首都医科大学附属北京朝阳医院、解放军总医院第三医学中心和首都医科大学附属北京佑安医院完成肝移植手术的患者697例,分别定义β2-MG≤3mg/L组、β2-MG＞3 mg/L组和非AKI组、AKI(1级、2级、3级)组.收集患者性别、年龄、体质量、终末期肝病模型(model ofend-stage liver disease,MELD)评分、Hb、SCr、β2-MG、合并症、病因、术式、肾脏替代治疗(model of end-stage liver disease,RRT)和28 d病死率.结果 697例患者肝移植术后AKI的总体发生率为40.9％,其中AKI 1级、2级、3级分别占21.5％、8.8％和10.6％.与β2-MG≤3 mg/L组比较,β2-MG＞3 mg/L组体质量、MELD评分、Hb、SCr、β2-MG、AKI分级、贫血、腹水、肺部感染、肝肾综合征、乙型肝炎肝硬化、丙型肝炎、肝癌和28d病死率均增多,差异有统计学意义(P＜0.05).AKI分级后,AKI3级组的β2-MG水平[(4.80±4.12)mg/L]与非AKI组[(2.95±1.68)mg/L]、AKI 1 级组[(3.15±1.65)mg/L]和 AKI2 级组[(2.78±1.70)mg/L]比较,差异均有统计学意义(P＜0.001).进一步按β2-MG数值分组后,β2-MG≤3mg/L的AKI2级组与非AKI组比较[(1.98±0.46)mg/L比(2.17±0.49)mg/L],差异有统计学意义(P=0.036);β2-MG＞3 mg/L的AKI 3级组与非AKI组和β2-MG＞3 mg/L的 AKI 1 级组比较[(6.97±4.38)mg/L 比(4.44±1.54)mg/L、(4.64±1.55)mg/L],差异均有统计学意义(P＜0.001,P=0.001).β2-MG＞3mg/L的AKI 3级组β2-MG水平最高,为(6.97±4.38 mg/L).体质量(OR=1.010,95％CI:1.010～1.037,P=0.001)和贫血(OR=1.571,95％CI:1.056～2.338,P=0.026)是肝移植术后 AKI 的危险因素.结论 β2-MG用于评价肝移植术后AKI各级有一定的参考价值,尤其在AKI 3级.虽然只验证到体质量和贫血为肝移植术后AKI的独立危险因素,但3 mg/L以上β2-MG的意义仍值得进一步探讨.

目的 探讨血β2-微球蛋白(β2-MG)数值范围在肝移植急性肾损伤(AKI)的分级价值和意义.方法 本研究通过回顾性队列研究,选取2009年6月至2019年12月在首都医科大学附属北京朝阳医院、解放军总医院第三医学中心和首都医科大学附属北京佑安医院行肝移植手术的病例纳入研究.共收集肝移植病例1636例,546例纳入分析.根据发生AKI的情况将其分为AKI组(n=219)和非AKI组(n=327).定义AKI(1、2、3级)组和β2-MG≤3 mg/L组、β2-MG>3 mg/L组.收集非AKI组与AKI组性别、年龄、体重、终末期肝病模型(MELD)评分、血红蛋白(Hb)、Cr、β2-MG、合并症、病因、术式、肾脏替代疗法(RRT)、28 d死亡率数据.比较AKI组各级β2-MG均值及β2-MG≤3 mg/L、β2-MG>3 mg/L分布.用COX多变量回归分析AKI的影响因素.结果 与非AKI组比较,AKI组血滤(P<0.001),28 d死亡率(P=0.006)明显增加.219例AKI患者1、2、3级分别为120、49、50例.β2-MG在AKI 3级均值为(4.81±4.11)mg/L,明显高于非AKI组(P=0.001)、AKI 1级(P=0.012)、AKI 2级(P=0.002).按β2-MG≤3 mg/L和β2-MG>3 mg/L进行分组后,在AKI各级的人群分布差异有统计学意义(P=0.007).COX多变量回归分析显示体重(OR:1.031;95％CI:1.015～1.046;P=0.001)和贫血(OR:1.651;95％CI:1.050～2.598;P=0.031)为肝移植术后AKI的独立危险因素.结论 β2-MG评价肝移植术后AKI各级有一定的参考价值,尤其在AKI 3级.虽然只验证到体重和贫血为肝移植术后AKI的独立危险因素,但3 mg/L以上β2-MG的意义仍值得进一步探讨.

羟考酮是一种阿片类双受体激动药,分别通过μ阿片受体和κ阿片受体作用于中枢神经系统和平滑肌,从而发挥镇痛作用.该药通过激动平滑肌κ受体,参与内脏痛的调控,在缓解内脏性疼痛方面相比于单纯μ阿片受体激动剂具有明显优势[1].有研究[2]在门诊无痛结肠镜检查术中发现,羟考酮联合咪达唑仑患者术中轻度低氧血症发生率以及丙泊酚追加率低于舒芬太尼联合咪达唑仑患者.Quan等[3]等在肝硬化患者接受静脉全麻内镜下硬化剂治疗术( endo-scopic injection sclerotherapy, EIS)时,进行羟考酮与等效剂量舒芬太尼比较,发现羟考酮镇痛效果好,而且呼吸抑制更弱,镇痛时间更长,是目前EIS术比较理想的镇痛药物.但羟考酮在肝硬化患者硬化剂治疗术中使用的适宜剂量,目前还缺乏相关研究.本研究通过观察不同剂量羟考酮联合咪达唑仑在肝硬化患者行无痛EIS术时的临床效果,探讨其适宜剂量和安全性.

目的 探讨混合式线上麻醉见习对非麻醉专业本科学生的教学效果评价.方法 通过腾讯会议课件直播+操作视频分享+班级微信群答疑的混合式线上麻醉见习方法,对首都医科大学2018级公共卫生医学事业管理专业22名学生进行教学,并采用问卷调查和测试的方式对混合式线上教学进行教学效果的评价.结果 医学生在见习后对手术室、麻醉医生及麻醉工作内容了解程度有了极大提高(P<0.01)差异有统计学意义,对麻醉学概论的答题测试成绩为5.64±0.95(满分8分),平均正确率为70.45％.结论 混合式线上麻醉见习可有效提高非麻醉专业学生对手术室、麻醉医生及麻醉工作内容的了解程度,可作为传统见习的替代方式.

Objectives. This multicenter retrospective study aimed to compare the effects of HES and gelatin (GEL) on the risk of post-OLT AKI. Method. A total of 1,672 patients undergoing OLT were enrolled from major transplant centers in China between 2005 and 2013. These patients were divided into three groups: GEL, hydroxyethyl starch (HES), and GEL + HES group. Results. There was no significant difference in the incidence of post-OLT AKI among the GEL, HES, and GEL + HES groups. The GEL + HES group had a lower incidence of stage II post-OLT AKI than the other two groups. Compared with patients receiving GEL, patients receiving HES did not harbor an increased risk of AKI. Our results showed that MELD score (adjusted odds ratio [OR], 1.579; 95% confidence interval [CI], 1.123-2.219; P = 0.009) and preoperative anemia ( adjusted OR, 1.533; 95% CI, 1.212-1.939; P < 0.001) were independent risk factors for post-OLT AKI, and normal preoperative Scr level (vs abnormal; adjusted OR, 0.402; 95% CI, 0.222-0.729; P = 0.003) was independent protective factors for post-OLT AKI. Conclusion. This large-scale multicenter retrospective study found that the intraoperative use of HES did not increase the overall incidence of post-OLT AKI in patients when compared with GEL, and whether to increase the risk of post-OLT AKI needs to be further explored.

目的 探讨新冠疫情期间混合式线上麻醉见习对非麻醉专业学生的效果评价.方法 对首都医科大学2018级公共卫生医学事业管理专业22名学生进行腾讯会议课件直播+操作视频分享+班级微信群答疑的混合式线上麻醉见习教学,并采用问卷调查的方式对混合式线上教学进行教学效果和教学满意度的评价.结果 95.45％的学生对于混合式线上麻醉见习满意,但86.36％的学生仍然渴望进行手术室线下麻醉见习.结论 医学生对本次混合式线上麻醉见习满意度较高,但仍然渴望进行手术室实地麻醉见习.

肝移植是目前治疗终末期肝脏疾病最有效的手段,然而移植前患者往往合并认知功能障碍及脑部病变,移植后在肝脏功能恢复后仍常常伴随神经、精神并发症,及时诊断肝移植患者的神经、精神并发症及脑部病变十分关键.尤其对于肝移植围术期患者,提高监测水平,正确认识神经、精神并发症及脑部病变,并给予科学合理的管理,对减少围术期及长期并发症、提高生存率和生活质量尤为重要.

目的 总结危重型新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)患者气管插管的方法及医护人员的隔离防护措施.方法 选择2020年2月5日至2月14日首都医科大学附属北京佑安医院7例危重型COVID-19患者,回顾性分析对患者的气管插管方法及医学防护措施.结果 7例患者均采用快速全麻诱导下可视喉镜经口气管插管,过程顺利平稳、未发生呛咳且均一次成功.共有4位麻醉医师参与7例患者的气管插管,操作过程中均未发生痰液喷溅,穿脱防护服流程经评估后全部合格,并对其追踪随访14d后,4位医师均未被新型冠状病毒感染.结论 快速诱导可视喉镜下气管插管对危重型COVID-19患者安全有效,规范化的医疗防护措施能有效防止医务人员感染.

肝移植是治疗各种终末期肝病患者的最有效手段之一.由于肝移植手术时间长,过程复杂,创伤性大,以及部分肝病患者的凝血状况差,术中出血的风险极高.为纠正凝血功能异常以及补充血容量,围手术期常需输入血液制品.相比其他手术,肝移植围手术期血液制品的需求量较大,涉及的血液制品种类较多,常用的主要有悬浮红细胞、新鲜冰冻血浆(FFP)、血小板、纤维蛋白原(Fg)等.合理应用和规范化管理各种血液制品,避免不必要的浪费,在目前血源紧张的大环境下意义重大.本文就肝移植围手术期血液制品的合理应用及规范化管理作一阐述.

目的 探讨超声引导下双线定位技术在桡动脉穿刺中的临床效果.方法 选取2018年9月～2019年6月首都医科大学附属北京佑安医院拟行桡动脉穿刺的患者80例,依据随机数字表法将其分为对照组和观察组,每组40例.对照组采用常规超声引导下桡动脉穿刺,观察组采用双线隔离线定位技术,比较两组首次穿刺成功率、穿刺失败率、超声定位时间和并发症发生情况.结果 观察组首次穿刺成功率高于对照组,超声定位时间短于对照组,差异均有统计学意义(均P＜ 0.05);两组穿刺失败率比较,差异无统计学意义(P＞0.05).观察组出血发生率低于对照组,差异有统计学意义(P＜0.05).结论 双线隔离线定位技术能明显提高超声引导下桡动脉穿刺的首次穿刺成功率和超声定位时间.

目的 探讨瑞苏太尼复合丙泊酚靶控输注(TCI)麻醉用于肝脏部分切除术(PHX)患者的麻醉效果.方法 2017年4月～2019年1月我院行PHX的原发性肝癌(PLC)患者86例,随机将患者分为研究组43例和对照组43例,给予对照组患者常规麻醉,给予研究组瑞芬太尼复合丙泊酚TCI麻醉,评价苏醒室标准(Aldrete)和改良警觉-镇静量表(OAA/S)评分.结果 研究组患者拔管时间为(12.7±3.3)min,呼之睁眼时间为(10.1±3.2) min,自主呼吸恢复时间为(9.4±2.1)min,均显著短于对照组[分别为(18.4±5.2)min、(17.6±3.4)min和(16.4±5.4) min,P＜0.05];在T0时,两组应激反应指标比较无显著性差异(P＞0.05),但术中研究组应激反应指标水平整体优于对照组(P＜0.05);拔管后即刻和拔管后15min,研究组患者Aldrete评分分别为(9.4±0.7)分和(9.4±0.8)分,OAA/S评分分别为(4.3±0.4)分和(4.7±0.4)分,显著高于对照组[分别为(8.3±0.4)分和(8.9±0.5)分,和(3.4±0.4)分和(4.2±0.5)分,P＜0.05];研究组不良反应发生率为11.6％,显著低于对照组的27.9％ (P＜0.05).结论 应用瑞苏太尼复合丙泊酚TCI麻醉应用于PHX手术可有效减轻术中应激反应,提高术后苏醒效果,且具有较高的安全性,值得临床验证.

目的 探讨微视频预复习在非本专业临床见习中的应用效果.方法 选择2019年6月-8月在首都医科大学附属北京佑安医院参与麻醉学见习的33名实习生作为研究对象,根据随机表随机分为对照组(16例)和实验组(17例).对照组采用常规见习教学方法,实验组在见习教学前首先观看与见习内容相关的5个微视频,之后再进行临床见习,两组教学时数和教学目标均相同.教学结束后,采用试卷和问卷调查进行教学效果和教师满意度评价.结果 通过微视频进行预复习的实验组在无菌规范操作和麻醉学基本知识方面的得分显著高于对照组,差异具有统计学意义(P<0.05).实验组在及时评价教学质量、反馈,对学生的耐性程度和用语恰当、范围3个条目的满意度明显高于对照组(P<0.05).结论 见习前通过微视频预复习见习内容有助于非本专业学生掌握教学内容和提高实习生对教师的满意度.

目的 探讨不同浓度罗哌卡因复合右美托咪定对妊娠高血压综合征(妊高征)产妇分娩镇痛的效果.方法 选择2018年5月至2019年5月首都医科大学附属北京友谊医院收治的180例妊高征患者,按照随机数字表法分为3组,各60例.0.05％、0.075％、0.1％浓度组患者分别经硬膜外导管注入0.05％、0.075％、0.1％罗哌卡因复合0.5 mg/L右美托咪定混合液10 ml.比较3组产妇不同时点的疼痛视觉模拟量表评分及体温,T0为分娩镇痛即刻、T1～T6分别为镇痛后1～6h.比较3组产妇硬膜外阻滞安全性、镇痛时间、产程时间、镇痛药物使用情况(罗哌卡因、右美托咪定用量及硬膜外自控镇痛按压次数)、催产素使用比例、分娩方式(自然分娩、应用产钳、中转剖宫产)和产妇满意度.结果 治疗后,3组产妇T1～T6时点的疼痛视觉模拟量表评分均低于T0时点,T4～ T6时点体温均高于T0时点,且0.05％浓度组、0.075％浓度组T4、T5时点体温低于0.1％浓度组,差异均有统计学意义(均P＜0.05).0.05％浓度组、0.075％浓度组产间发热比例均低于0.1％浓度组[6.7％(4/60)、8.3％(5/60)比23.3％(14/60)],差异均有统计学意义(均P ＜0.05).3组产妇的改良Bromage评分＞1分、单侧阻滞、1 min新生儿Apgar评分＞8分和5 min新生儿Apgar评分＞8分比例、胎心率、出血量、新生儿体质量比较,差异均无统计学意义(均P＞0.05).0.05％浓度组、0.075％浓度组产妇硬膜外自控镇痛按压次数均多于0.1％浓度组[(1.9±0.7)、(1.6±0.9)次比(1.3±0.5)次],0.05％浓度组产妇右美托咪定用量多于0.075％浓度组和0.1％浓度组[(46±7)mg比(36±6)、(36 ±7)mg],差异均有统计学意义(均P＜0.05).3组产妇镇痛时间、产程时间、罗哌卡因用量比较,差异均无统计学意义(均P ＞0.05).0.075％浓度组产妇治疗满意度显著高于0.05％浓度组和0.1％浓度组(均P＜O.05);3组产妇催产素使用比例、分娩方式比较,差异均无统计学意义(均P ＞0.05).结论 妊高征产妇应用0.075％罗哌卡因复合右美托咪定行分娩镇痛,可有效改善分娩疼痛感,安全性及产妇满意度均较高.