目的：：观察预充6%中分子羟乙基淀粉(130/0.4,万汶)对在硬膜外麻醉下行剖宫产术产妇术中凝血及血流动力学的影响。方法：40例行剖宫产手术病人随机分为万汶组(A组,n=20)和乳酸林格氏液组(B组, n=20)。麻醉前30min 从外周静脉分别注入万汶和复方乳酸钠林格氏液组500mL,然后实施L2-L3连续硬膜外麻醉。于输液前(T0)、输液后(T1)、硬膜外后5min(T2)、15min(T3)和术毕(T4)记录 BP、 HR、 SpO2。同时测定输液前后血细胞比容( Hct)、血小板计数( Plt)、凝血酶原时间( PT)、部分激活凝血活酶时间( APTT)和纤维蛋白原( Fib)含量。结果：两组产妇 T1时点收缩压和舒张压较T0都有所提高,在 T2~T4时较T0都有所下降。但B组下降较A组更显著(P<0.05)。 B组低血压和恶心呕吐发生率显著高于A组(P<0.05)。两组输液后Hct均降低,A组下降较B组更显著(P<0.05)。两组预充后PT、APTT、 Fib测定均在正常范围之内。结论：硬膜外麻醉前输入万汶500mL较复方乳酸钠液500mL能更有效地扩充剖宫产产妇的血容量,维持循环功能的稳定,对凝血系统无明显影响。

[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.

目的观察异丙酚复合舒芬太尼在人工流产中的疗效。方法对100例早孕妇女,在常规消毒的同时,静脉注射异丙酚复合芬太尼(丙泊酚200mg/支及舒芬太尼50ug/支)8～14ml。观察其麻醉效果。并分别记录推药前、入睡后、手术时、清醒后P、SPO2参数,以及苏醒情况。结果异丙酚复合舒芬太尼应用于人工流产术,起效快,镇痛效果显著,麻醉效果满意,苏醒早,正常脉搏、SPO2无明显变化,出血量无差异。结论异丙酚镇静作用强,有抗恶心、呕吐作用,舒芬太尼镇痛作用强,二者半衰期均短,复合应用,取长补短,是人工流产术中适宜的麻醉方法之一,在临床上值得推广应用。

[Objective]To compare the effects of sufentanil and fentanyl on the hemodynamics in the induction of general anesthesia on elderly patients.[Methods]Totally 40 cases of elderly patients who would be conducted general anesthesia were divided randomly into 2 groups(each for 20 cases),sufentanil and fentanyl was used for induction in S group and F group respectively.The values of mean arterial pressure(MAP) and heart rate(HR) were recorded before anesthesia,2 minutes after induction,at the point of intubation,1,3,5,10 minutes after intubation.[Results]The changing trend of MAP and HR in both 2 groups was same,but the fluctuation of MAP and HR in F group was much more obvious.[Conclusion]Compared with fentanyl,the sufentanil has less effect on hemodynamic parameters during the process of the induction of general anesthesia on elderly patients,and can keep the circulation system more stable.

老年妇科肿瘤伴2型糖尿病,给手术实施带来了一定的风险及困难,为了提高手术的安全性,现将我院1995年1月-2006年6月期间收治的21例老年妇科肿瘤伴2型糖尿病患者围手术治疗情况报告如下.

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.

脊柱手术时多采用俯卧位,硬膜外麻醉时对呼吸有何影响,是否出现缺氧和二氧化碳蓄积,是临床麻醉所关注的问题.本文对48例俯卧位脊柱手术进行了临床观察,现报道如下.

宫外孕破裂或流产,由于病情危急,来势凶猛,腹腔内出血多,故患者都有不同程度的失血及休克表现.此类患者多需急诊手术救治,现将我院近年78例宫外孕手术的麻醉处理报告如下.