目的:观察术中应用艾司氯胺酮对肺叶切除术患者术后的镇痛作用.方法:择期行胸腔镜下肺叶切除术患者60例,随机分为艾司氯胺酮(ESK)组和生理盐水(SAL)组,每组30例.ESK组:予以艾司氯胺酮诱导剂量0.2 mg/kg,维持剂量0.12 mg·kg-1·h-1.SAL组:予以等剂量的生理盐水.记录患者术后出恢复室即刻(T1),6 h(T2),24 h(T3),48 h(T4)平静呼吸和咳嗽状态下的VAS评分、炎症因子表达,以及焦虑抑郁量表评分及相关不良反应.结果:两组患者人口统计学资料无统计学差异.与SAL组相比,ESK组患者术后VAS评分在平静呼吸T1、T2和T4时刻及咳嗽状态T1时刻显著降低(P<0.05),且地佐辛使用量更少.ESK组患者术后白细胞总数明显低于SAL组,而IL-6差异无统计学意义.两组患者术后SpO2及恶心,呕吐,头晕,分离症状等不良反应差异无统计学意义(P>0.05).结论:术中应用艾司氯胺酮能够减轻胸腔镜下肺叶切除术患者术后急性疼痛且不显著增加相关不良反应,其机制可能与减轻术后白细胞增多有关.

目的 观察羟考酮能否有效抑制妇科腔镜手术病人全麻术后拔管时的呛咳反应.方法 选择2018年7月至2019年8月在南京医科大学第一附属医院于气管插管全麻下行择期妇科腔镜手术的病人120例,ASA分级Ⅰ～Ⅱ级,年龄范围为18～65岁,采用随机数字表法分为羟考酮组(0.1 mg/kg)和对照组(等量0.9％氯化钠溶液),每组60例.两组病人分别于手术结束前10 min静脉注射羟考酮0.1 mg/kg或等量0.9％氯化钠溶液.记录两组病人入恢复室时(T1)、拔管时(T2)以及拔管后3 min(T3)的血流动力学变化、拔管时间、拔管期间咳嗽的发生例数和咳嗽严重程度;拔管期间气道不良反应例数以及拔管后5 min和30 min时的视觉模拟评分法(VAS)评分;记录术后需追加镇痛药、术后不良反应的例数及拔管后30 min改良Aldrete评分.结果 羟考酮组与对照组相比,在T1、T2、T3时间点血流动力学变化未见明显差异;拔管期间咳嗽的发生率及严重程度明显降低(咳嗽例数31/46例;重度咳嗽2/11例,P<0.05);拔管时间、拔管期间气道不良反应、拔管后药物副作用及拔管后30 min改良Aldrete评分未见明显差异;羟考酮组拔管后5 min、30 min时VAS评分均明显低于对照组[(2.1±1.2)比(4.2±1.3)分;(1.9±1.1)比(4.1±2.2)分,P<0.05]且需追加镇痛药例数少于对照组(0例/7例,P<0.05).结论 妇科腔镜手术结束前10 min静脉注射羟考酮0.1 mg/kg能明显减少拔管时的呛咳反应,减轻术后疼痛且不增加不良反应.

目的 探讨双腔支气管插管单肺通气麻醉对肺癌患者血清丙二醛(MDA)、还原型谷胱甘肽(GSH)、超氧化物歧化酶(SOD)水平及术后并发症的影响.方法 选取南京医科大学第一附属医院自2018年1月至2020年1月收治的120例接受肺癌手术患者为研究对象.根据不同麻醉方案将其分为A组(n=58)与B组(n=62).A组患者采用单腔气管插管联合封堵器单肺通气麻醉,B组患者采用双腔支气管插管单肺通气麻醉.记录并比较两组患者一次插管成功率与低氧血症发生率、麻醉指标及麻醉前后血清MDA、GSH、SOD水平.比较两组患者术后疼痛数字评价量表(NRS)评分及并发症发生情况.结果 B组患者一次插管成功率显著高于A组,低氧血症发生率显著低于A组,差异均有统计学意义(P<0.05).麻醉后,B组患者MDA水平显著低于A组,GSH、SOD水平显著高于A组,差异均有统计学意义(P<0.05).术后1、2 h,B组患者NRS评分均显著低于A组,差异均有统计学意义(P<0.05).B组患者术后并发症发生率显著低于A组,差异有统计学意义(P<0.05).结论 双腔支气管插管单肺通气麻醉可以显著降低患者体内氧化应激反应,具有更高的插管成功率,而且能有效降低术后并发症发生率.

全麻诱导时静脉注射芬太尼容易诱发咳嗽,导致患者颅内压、眼内压和腹内压升高,对患者极为不利.在麻醉诱导前静脉注射地塞米松常被用来预防术后恶心、呕吐,本研究拟观察静脉注射地塞米松对芬太尼诱发咳嗽发生率及严重程度的影响.

Objective To observe the effects of different potent vasopressor agents on intestinal injury in rats with septic shock.Methods Fifty healthy male SD rats weighing 250-300 g,were randomized into 5 groups:normal saline group(NS group),noradrenaline group(NE group),dopamine group(DA group),arginine vasopressin group(AVP group),and dobutamine combined with arginine vasopressin group(DOB+AVP group).After establishing the septic shock model via the injection of lipopolysaccharide 15 mg/kg,normal saline 10 ml·kg-1·h-1 was intravenously infused for volume resuscitation together with the same volume of NS,NE 1 μg·kg-1·min-1,DA 10 μg·kg-1·min-1,AVP 0.04 U·kg-1·min-1,or DOB 10 μg·kg-1·min-1 combined with AVP 0.04 U·kg-1·min-1.The doses of vasopressor were adjusted to maintain mean arterial pressure(MAP) around 90 mm Hg.Four hours later,intestinal tissue was obtained to detect the levels of TNF-α,IL-6,and IL-10,and to observe the injury degree of intestinal tissue and mitochondria.Results The levels of intestinal TNF-α and IL-6 were significantly lower in DOB + AVP group and NE group than NS group,DA group,or AVP group(P0.05.There was no significant difference in IL-10 between any two groups.DOB+AVP group had milder injury of intestinal tissue and mitochondria than the other 4 groups.Conclusion DOB combined with AVP may reduce the intestinal inflammatory responses and relieve the injury of intestinal tissue and mitochondria in septic shock.

Levosimendan(LS) is a new calcium sensitizer with inotropic and vasodilatory actions mediated by the sensitization of contractile proteins to calcium and opening of potassium channels.LS does not increase myocardial oxygen demand,therefore it is suitable for the cardiotonic support in patients with heart failure,myocardial ischemia,and cardiogenic shock.Updated studies suggest that LS has anti-inflammatory and anti-apoptotic effects,which implies that LS possesses advantages in the cardiotonic treatment of septic shock.This review summarizes the recent researches of LS.

Fentanyl-induced cough is not an uncommon condition during the induction of general anesthesia. A preliminary randomized controlled study was designed to observe the effects of different priming doses of propofol on fentanyl-induced cough during anesthesia induction. A total of 120 patients were randomized into 4 groups (n = 30) to receive the intravenous injection of intralipid (group I), propofol 1 mg center dot kg<SU-1</SU (group II), propofol 1.5 mg center dot kg<SU-1</SU (group III), or propofol 2 mg center dot kg<SU-1</SU (group IV) 1 minute before a bolus of fentanyl 2.5 mu g center dot kg<SU-1</SU. The occurrence and severity of cough were recorded for 2 minutes after fentanyl bolus. The severity of cough was graded as none (grade 0), mild (grade 1-2), moderate (grade 3-4), or severe (grade 5 or more). The average bolus time of fentanyl was 1.5 +/- 0.3 seconds in the present study. The incidence of fentanyl-induced cough was 80.0% in group I, 40.0% in group II, 6.7% in group III, and 3.3% in group IV, respectively. Groups II, III, and IV had a lower incidence and less severity of cough than group I (P < 0.05). Groups III and IV had a lower incidence and less severity of cough than group II (P < 0.05). In summary, a priming dose of more than 1 mg center dot kg<SU-1</SU of propofol is effective to suppress fentanyl-induced cough in a dose-dependent manner. We suggest using a priming dose of propofol 1.5 mg center dot kg<SU-1</SU to suppress cough during the anesthesia induction with propofol and fentanyl in clinical practice.