目的 比较瑞芬太尼与芬太尼对老年全凭麻醉术后认知功能的影响.方法 选择2014年6月至2016年5月该院接受腹腔镜胆囊切除术的老年患者60例,按麻醉方法不同分为观察组与对照组各30例.两组均静滴咪达唑仑、丙泊酚、维库溴铵麻醉诱导,对照组加用芬太尼进行全凭静脉麻醉,观察组加用瑞芬太尼,两组均联合丙泊酚靶控输注维持麻醉.比较两组患者术后睁眼时间、拔管时间、应答时间、简易精神状况检测量表(MMSE)评分、视觉模拟疼痛评分(VAS);比较手术时间及术中不良反应.结果 两组手术时间接近;观察组患者睁眼时间、拔管时间、语言应答时间均早于对照组,术后3~12小时MMSE评分、VAS值明显高于对照组;术后24小时两组MMSE评分、VAS值接近.结论 瑞芬太尼全凭麻醉用于老年患者腹腔镜胆囊切除术,可以缩短患者认知功能恢复时间及麻醉恢复时间,虽然会增加术后早期疼痛敏感性,但术后24小时后即可恢复,安全性较好.

目的 探讨音乐疗法在体检中心抽血检查中应用的效果.方法 便利选取该院2016年2月—2017年2月体检中心抽血检查的300名体检者,随机分为两组,各150名.对照组按照常规方式进行抽血检查,实验组播放音乐对抽血检查进行干预,比较两组体检者一次穿刺成功率、抽血平均时长以及体检者满意度之间的差异.结果 实验组患者的一次穿刺成功率为95.3%,对照组一次穿刺成功率为90.7%,实验组明显优于对照组;实验组患者满意度达到90.0%,对照组满意为80.7%,实验组患者满意度优于对照组;实验组抽血平均时长为(3.91±0.12)s,对照组为(4.13±0.09)s,实验组抽血平均时长明显比对照组短,差异有统计学意义(P<0.05).结论 在体检中心抽血检查时采用音乐疗法,能够有效地提高一次穿刺成功率和体检者满意度,缩短抽血的时间,具有临床推广的意义.

Objective To evaluate the role of real-time two-dimensional ultrasound guidance for internal jugular vein cannulation. Methods Totally 180 patients were divided into two groups, including group A(100 patients underwent conventional internal jugular vein cannulation ) and group B(80 patients underwent internal jugular venous cannulation under ultrasound-guidence). Before the operation, the difficulty of cannulation and possible complications were simply evaluated. During the operation,the prepared time,access time,number of attempts,success rate,one-attempt success rate and procedural complications were recorded. Results Fifteen cases were assessed to be difficult for cannulation of the internal jugular vein in group A and 32 cases in group B. Cannulation of the internal jugular vein was achieved in 89 patients(89%) in group A,and in all patients(100%) in group B,there was significant difference(P < 0.05). The average access time in group B[(10.7±4.6)s] was shorter than that in group A[(450.7±233.8)s],there was significant difference(P < 0.05). Four patients with difficult cannulation in group A were one-attempt success,the total success rate was 60%,while 27 patients with difficult cannulation in group B were one-attempt success,the total success rate was 100%. The occurence rates of accidently injure in artery and brachia plexus, pneumothorax and hematoma in group A and group B were 10.0%,2.0%,4.0%,1.0% and 2.0%,1.0%,1.0%,0. Conclusion Real-time two-dimensional ultrasound can significantly improve the success rate and safety of internal jugular vein cannulation.

<正>临床上处理困难气管插管多采用呼吸道黏膜表面麻醉或清醒镇静麻醉,借用张口器或牙垫,并在助手帮助下进行纤维支气管镜(FOB)引导下经口气管插管。口咽通气道可以协助打开咽腔,对于初学者辅助FOB气管插管有一定的帮助。本文观察右美托咪定复合舒芬太尼清醒镇静麻醉联合表面麻醉下,口咽通气道辅助FOB引导困难气管插管的效果,现报道如下。

目的研究右旋美托咪啶复合舒芬太尼对颈丛神经阻滞下甲状腺切除手术患者应激反应的影响。方法将60例ASA分级为I～Ⅱ级在颈丛神经阻滞下行甲状腺切除术患者分为右旋美托咪啶复合舒芬太尼组(R组)和咪唑安定复合舒芬太尼组(M组),各30例。记录两组入室时(T0)、麻醉前(T1)、麻醉后(T2)及甲状腺切除时(T3)的中心静脉压(MAP)、心率(HR)、去甲肾上腺素(NE)及肾上腺素(E)的浓度水平。结果两组T0时点MAP、HR、NE及E浓度差异均无统计学意义(均>0.05)。T1时点,两组MAP、HR、NE及E浓度差异均有统计学意义(均<0.05);T2及T3时点,M组MAP、HR、NE及E的浓度明显高于T1时和R组(均<0.05)。两组麻醉满意度差异有统计学意义(<0.05)。结论颈丛神经阻滞加强化麻醉(右旋美托咪啶复合舒芬太尼)能够有效减轻甲状腺手术时应激反应所导致的血流动力学、NE及E的浓度变化。

目的探讨氧驱动雾化吸入表面麻醉在清醒下纤维光导喉镜(以下简称纤支镜)引导插管中的效果。方法 30例烧伤后面颈部瘢痕患者静脉注射咪唑安定1 mg及舒芬太尼5 g,使用气驱雾化吸入器进行气道表面麻醉(2%利多卡因10 ml,10 min,氧流量5 L/min)。表面麻醉完成后,行纤支镜引导气管插管。结果 30例患者均在5 min之内顺利完成气管插管,全程患者意识清楚,表面麻醉完善,配合度高。导管由纤支镜引导下进入气管,固定导管时均无明显恶心、干呕及剧烈呛咳发生,在操作过程中患者血压、心率及心电图维持平稳(波动在10%以内),血氧饱和度均在95%～100%,未出现相关并发症。结论氧驱动雾化吸入表面麻醉清醒下纤支镜引导插管效果肯定,患者易于接受,且安全无交叉感染,操作简便,值得在临床上广泛使用。

Objective Toobserve theeffects andsideeffectsofpostoperative analgesiaby propacetamolcombined with flurbiprofen axetil and sufentanyl on burned patients undergoing burn wound excision and skin grafting.Me-thods 60 cases were randomly divided into 3 group,with 20 cases in each group.In group A,the load dose of suf-entanyl was 5 g,and for the pump,there were sufentanyl(150 g)+0.9% sodium chloride solution diluting to 100 ml.In group B,the load dose of flurbiprofen axeti was 50 mg,and flurbiprofen axeti 100 mg+sufentanyl 100 g+0.9% sodium chloride solution diluting to 100 ml were infused.In Group C,15 minutes before completing operationi,ntra-venous dripping 2 g of propacetamol were performanced(with 100 ml of sodium chloride solution,15 min);the the load dose of sflurbiprofen axeti was 50 mg,and flurbiprofen axeti(100 mg)+sufentanyl(100 g)+0.9% sodium chlor-ide solution diluting to 100 ml were infused.The maintenance dose was 2 ml/h with single load dose of 0.5 ml and lock time of 15 minutes.After operation,the visual analogue scales(VAS) of quiet and activities after 2,6,12,24 and 48 hours were recorded;and the adverse reactions were compared.Results All the results in three groups are sati-sfying.After 2 and 6 hours,the scores of quiet and activities in group C were lower than those of group A and B( 0.05).There were statistical significances among 3 groups in adverse reactions( 0.05).Conclusions After undergoing burn wound excision and skin grafting,it is more more efficiently and security in analgesia by propaceta-mol combined with flurbiprofen axetil and sufentanyl.

Objective:To observe the difference of effect and side effect between sufentanil composite flurbiprofen axetil in the vein automatic control analgesia and sufentanil composite ropivacaine in the controlled epidural analgesia of burn patients.Methods:Divide 90 cases into 2 groups,45 cases in each group.PCIA group should be used for sufentanil composite flurbiprofen axetil in the vein automatic control analgesia;PCEA group should be used for sufentanil composite ropivacaine in the controlled epidural analgesia When analgesic effect started at h2,h4,h12,h24 and h48,multiparameter were evaluated according to visual analog score (VAS).Observed and recorded the values of the blood pressure,pulse,respiration and pulse oximeter saturation value,side effects.Results:Analgesic effect and side effect between PCIA group and PCEA group was no significant difference(p>0.05);and the different periods of Ramsay score and the dose of sufentanil between PCIA and PCEA group was no significant difference(p>0.05).Conclusion:Sufentanil composite flurbiprofen axetil on moderate and severe pain in the early stages of burn patients have a better analgesic effect,and relatively safe,less side effects,and is worthy to recommend.

目的探讨SLIPA喉罩在甲状腺手术全身麻醉中的应用效果。方法将60例ASAⅠ～Ⅱ级择期行甲状腺手术患者随机分为SLIPA喉罩组(L组)和气管插管组(T组),各30例。观察并记录两组麻醉诱导前(T0)、麻醉诱导后(T1)、置入气管导管(喉罩)时(T2)、手术开始10min(T3)及术毕拔管(喉罩)时(T4)患者心率(HR)、血氧饱和度(SpO2)、收缩压(SBP)和舒张压(DBP),记录人工气道建立成功时、成功后30min及手术结束时的气道压(Pmean)、气道峰压(Ppeak)、呼气末二氧化碳分压(PETCO2)和术后咽喉疼痛的病例数。结果两组T0～T4时点SpO2均为100%,T2～T4时点T组HR、SBP和DBP较L组明显升高,差异均有统计学意义(<0.05)。两组间人工气道建立成功时、成功后30min及手术结束时Pmean、Ppeak及PETCO2差异均无统计学意义(>0.05)。T组有8例出现不同程度的咽喉疼痛或不适,L组无一例出现。结论全身麻醉下SLIPA喉罩通气用于甲状腺手术效果优于气管插管,其对血流动力学影响小,应激反应轻微。

近年来,门诊无痛人流都是用丙泊酚实施无痛人流.但丙泊酚其镇痛作用弱,常引起呼吸抑制和循环抑制及术后疼痛反应.舒芬太尼是新一代麻醉性镇痛药.其具有起效快、镇痛作用强、清除率快的优点,我们使用舒芬太尼实施无痛人流,现报道如下:

我院在为1例下颌骨骨折手术患者行经鼻气管插管时,发现导管折叠并嵌入声门.为引以重视,特报告如下.