作为一种外科常用的手术麻醉方式,气管插管全身麻醉具有适用性强的优势,不仅能够保证麻醉的效果,还能有效改善患者的呼吸状况,确保围手术期间患者可以保持呼吸通畅.但同时气管插管的麻醉方式属于侵袭性操作,易对患者的呼吸道组织造成一定的损伤,且由于老年患者恢复能力降低,容易发生术后并发症.

Objective:To systematically evaluate the clinical efficacy and safety of stellate ganglion block for migraine.Methods:The PubMed, Embase, Cochrane Library, China Biology Medicine disc, China National Knowledge Infrastructure, China Science and Technology Journal Database, and WanFang Data were searched for randomized controlled trials on stellate ganglion block in the treatment of migraine from their establishment to September 2022. A risk of bias assessment tool recommended by the Cochrane Handbook was used to evaluate the inherent bias of the included studies. The data were statistically analyzed by the RevMan 5.4 software.Results:In the final meta-analysis, 26 studies with a total of 2 074 patients were included. The results showed that the effective rate in treating migraine in the stellate ganglion block group was higher than that in the control group ( RR=1.21, 95% CI 1.15-1.29, P<0.001). The duration of headache attacks ( MD=-2.80, 95% CI -4.32-1.28, P<0.001) and the headache score of Visual Analogue Scale ( MD=-1.02, 95% CI -1.35-0.68, P<0.001) after the treatment in the stellate ganglion block group were lower than those in the control group. There was no statistical difference in the incidence of adverse reactions between the two groups ( RR=0.98, 95% CI 0.46-2.09, P=0.95). Conclusion:The stellate ganglion block, an effective treatment for migraine, has obvious advantages in terms of reducing headache severity and improving headache duration, and does not increase its related adverse reactions.

通过分析、概括近年来的相关文献,从肝脏缺血再灌注损伤(hepatic ischemia reperfusion injury,HIRI)的发生机制及当归多糖防治HIRI的研究现状和理论依据等方面进行阐述,旨在指导临床实践,为临床肝脏保护的研究提供一些新的线索.

探讨了氯胺酮基础麻醉联合骶管阻滞在小儿发育性髋关节脱位(DDH)手术中应用的有效性及安全性。选择择期行DDH手术患儿(1～7岁)70例,ASAⅠ级,随机分为A、B两组,每组35例,A组:氯胺酮基础麻醉复合骶管麻醉组;B组:氯胺酮全麻组。两组患儿均在麻醉复苏室内肌注氯胺酮5mg/kg行基础麻醉,A组患儿加用骶管麻醉,记录麻醉诱导前、切皮时、手术结束时的平均动脉压(MAP)、心率(HR)、呼吸频率(RR)、脉搏氧饱和度(SpO2),及观察两组氯胺酮用量、术中和术后的不良反应及患儿术后苏醒时间和术后安静程度。A组MAP、HR、RR都较B组平稳(P<0.01),A组的氯胺酮用量明显少于B组,不良反应明显少于B组,苏醒时间短于B组,A组患儿明显较B组患儿安静。氯胺酮基础麻醉复合骶管麻醉用于小儿先天性髋关节脱位手术,麻醉效果满意,苏醒快,安全性高。

Objective: To evaluate efficacy and safety of dezocine combined with sufentanil in patient-controlled intravenous analgesia(PCIA) for spinal surgery. Methods:Sixty ASAⅠ-Ⅲ patients scheduled for spinal surgery under total intravenous anesthesia were randomly divided into observation group and control group with 30 cases each group. Patients in observation group were given dezocine 0.1mg/kg +sufentanil 1μg/kg +granisetron 9mg,and 100ml NS;while patients in control group were given sufentanil 2ug/kg + granisetron 9mg,and 100ml NS. Loading dose of analygesic pump was set as 2 ml,patient-controlled analgesia(PCA)sdoes of 0.5ml and lockout time of 15 min. Visual analogue scale (VAS) score at 4,8,12,24,48h and adverse reaction of two groups were recorded. Results:The analgesic effect was significantly better (P 0.05),and the incidence of adverse effect was significantly lower and satisfaction was higher(P0.05) in observation group than those in the control group. Conclusion: Dezocine combined with sufentanil is effective on PCIA after spinal surgery,and can obviously relief adverse effect due to sufentanil.

<正>1病例患者,男,60岁,体重80kg,ASAⅡ级,诊断为腰椎管狭窄症,拟在全麻下经后路行切开复位、椎板减压、钉棒系统内固定术。患者既往体健,无哮喘及食物、药物过敏史,查体及实验检查均无异常。患者入室后开放右上肢静脉,输注复方氯化钠溶液,因患者紧张及肢体疼痛,开放静脉后立刻静脉注射咪达唑仑2mg,芬太尼0.05mg,常规吸氧,连接心电监护,BP140/