目的:探讨高海拔地区≥70岁以上老年人术中腰硬联合麻醉(CSEA)的应用效果及安全性.方法:选取在海拔3200米及以上地区居住二十年及以上,年龄≥70岁拟行下肢或下腹部或会阴部手术的老年患者240例进行CSEA.分别在麻醉前、切片时和手术结束时监测并记录血浆肾素(PRA)、血管紧张素Ⅱ(ATⅡ)、醛固酮(ALD)、皮质醇(COR)、胰岛素(INS)、生长素(GH)、血糖(GLU)浓度以及无创血压(NBP)、心电图(ECG)、心率(HR)、脉搏氧饱和度(SPO2).对比不同时期患者的体内激素水平,并分别比较不同年龄、不同性别及有无呼吸系统疾病病史对患者体内激素水平的影响.结果:麻醉前、切片时及手术后的INS、GH、GLU、COR、ALD、PRA及AT-Ⅱ水平比较差异无统计学意义(均P＞0.05).不同年龄组,不同性别组及不同呼吸系统疾病病史组各时期INS、ALD、GH、COR、PRA、AT-Ⅱ、GLU水平水平比较差异均无统计学意义(均P＞0.05).结论:CSEA对循环影响小,阵痛完善,安全有效,对老年患者血流动力学影响小,并能一定程度上抑制手术造成的应激反应,适用高海拔地区老年病人手术中的麻醉.

目的 分析右美托咪定复合罗哌卡因用于老年股骨近端骨折患者外周阻滞麻醉的临床效果.方法 选取130例通过外周神经阻滞麻醉行股骨近端骨折手术的老年患者,随机分为对照组和观察组.对照组采用罗哌卡因行外周神经阻滞麻醉,观察组采用右美托咪定复合罗哌卡因行外周神经阻滞麻醉.评估两组麻醉起效和维持时间;监测阻滞前、后血流动力学情况;记录术后疼痛、镇静程度及不良反应发生率.结果 与对照组相比,观察组神经阻滞起效时间较短、麻醉维持时间较长且术后疼痛感较低(P<0.05).神经阻滞麻醉后,对照组平均动脉压(MAP)显著高于观察组(P<0.05),而血氧饱和度(SpO2)显著低于观察组(P<0.05).两组术后镇静程度和不良反应的发生率均无统计学差异(P>0.05).结论 右美托咪定复合罗哌卡因行外周阻滞麻醉能显著缩短老年患者神经阻滞起效时间并延长术后麻醉时间.

Objective To observe the effect of local infiltration anesthesia combined with propofol intravenous anesthesia on cognitive function in elderly patients undergoing hip fracture surgery. Methods Totally 140 elderly patients undergoing hip fracture surgery in Qinghai Provincial People′s Hospital from January 2017 to January 2019 were randomly divided into control group and observation group, with 70 cases in each group. The control group had propofol intravenous anesthesia;the observation group had local infiltration combined with propofol intravenous anesthesia. Onset time and duration time of pain block were observed. Scores of Montreal Cognitive Assessment Scale(MoCA), Mini-Mental State Examination(MMSE) and Self-Rating Depression Scale(SDS) were recorded before and 4 weeks after operation. Serum levels of neuron specific enolase( NSE) , central neuron specific protein ( S100β) ,β-amyloid protein( Aβ) , C-reactive protein( CRP) and interleukin-1β( IL-1β) were tested by enzyme-linked immunosorbent assay. Results Onset time of pain block in observation group was significantly shorter while duration time of pain block was significantly longer than those in control group[(40 ±7)s vs (67 ±9)s, (499 ± 33)min vs (314 ± 24)min](both P<0. 05). There were no significant differences of MoCA score, MMSE score, SDS score, serum NSE, S100β, Aβ, CRP and IL-1βlevels between groups before and after operation( all P>0. 05). At 4 weeks after operation, MoCA score and MMSE score significantly decreased and SDS score, serum NSE, S100β, Aβ, CRP and IL-1βlevels significantly increased compared to those before operation in both groups(all P<0. 05). Conclusion Local infiltration combined with propofol intravenous anesthesia shows a good pain block effect on elderly patients undergoing hip fracture surgery without impairing the cognitive function.

目的 探讨丙泊酚与七氟醚两种全身麻醉方式对行腹腔镜下广泛全子宫切除术患者术后认知功能的影响.方法 选取自2016年9月至2017年9月于青海省人民医院行腹腔镜下广泛全子宫切除术的80例患者为研究对象.采用随机数字表法将所有患者分为丙泊酚组和七氟醚组,每组各40例.比较两组患者常规指标、不同时间认知功能障碍(POCD)发生率及不良反应发生情况.结果 丙泊酚组自主呼吸恢复时间、患者苏醒时间、定向力恢复时间、拔管时间均低于七氟醚组(P<0.05).七氟醚组术中维库溴铵和舒芬太尼用量明显少于丙泊酚组(P<0.05).七氟醚组术后1、3、7、30 d的POCD发生率均显著高于丙泊酚组(P<0.05).丙泊酚组躁动、寒颤、上呼吸道梗阻发生率均显著低于七氟醚组(P<0.05).结论 丙泊酚麻醉用于腹腔镜下根治性广泛全子宫切除术更有利于术后麻醉的恢复,可显著降低患者POCD发生率.

目的 探讨腰硬联合麻醉在老年人髋关节置换术中的应用效果与管理方法.方法 选取2015年6月至2017年5月在我院行髋关节置换术的老年患者180例,按照随机数字表法分成观察组和对照组各90例,观察组采用腰硬联合麻醉,对照组采用硬膜外麻醉,比较2组麻醉起效时间、麻醉药用量及麻醉效果,记录麻醉前及麻醉后5min、10min、30min、60min血流动力学和血气指标变化,统计术后不良反应发生情况.结果 观察组麻醉起效时间和麻醉药用量显著少于对照组(P<0.05),麻醉成功率显著高于对照组(P<0.05);在MAP、HR上,与对照组比较,观察组麻醉后5min、10min、30min、60min明显下降并趋于稳定;在SpO2上,与对照组比较,观察组更为稳定;2组均无严重不良反应发生.结论 腰硬联合麻醉在老年人髋关节置换术中整体麻醉效果优于硬膜外麻醉,可作为临床首选麻醉方式.

Objective To analyse the influence of hemodynamic and anesthesia trend index by propofol and sevoflurane anesthesia in laparoscopic high ligation of hernial sac.Methods 102 cases of laparoscopic hernia sac high ligation patients from May 2015 to May 2016 in our hospital were selected,according to draw method divided into control group and research group,each group of 51 cases,two groups of hemodynamics before and after operation[heart rate(HR),mean arterial pressure(MAP),diastolic blood pressure(DBP),systolic blood pressure(SBP)],anesthesia trend index(NI),EEG Bispectral Index(BIS) and peripheral perfusion index(PI) changed,wake up of time and extubation time,and the rate of complications were compared.Results Postoperative,the HR,MAP,DBP and SBP in research group were higher than those in the control group(111.63±5.81) times/min,(74.16±4.07) mm Hg,(60.48±5.11) mm Hg,(105.53±8.67)mm Hg vs.(104.67±5.65)times/min,(71.43±4.03)mm Hg,(56.35±4.43)mm Hg,(99.84±8.20)mm Hg,the difference was statistically significant(P<0.05);Research NI was higher than that in the control group [(50.63±6.80) vs.(46.79±6.51)],the difference was statistically significant (P<0.05).The BIS,PI in research group were higher than control group (P<0.05).The research awaken time and extubation time were superior to control group(P<0.05).Complication rate had no difference compared the two groups(P>0.05).Conclusion Sevoflurane can keep patients with laparoscopic hernia sac high ligation of hemodynamic stability,less effect on the trend of anesthesia index,can avoid the depth of anesthesia.

OBJECTIVE To analyze the pathogen distribution and its effect on recognition function in acute intrace‐rebral hemorrhage patients with general anesthesia ,so as to provide reference for clinical treatment .METHODS A total of 170 cases of patients got infections after general anesthesia operation for the acute intracerebral hemorrhage in our hospital from Sep .2012 to Sep .2014 were enrolled as infected group .Another 170 cases of healthy subjects at the same period in our hospital were taken as control group .And another 170 cases of uninfected patients after general anesthesia operation for acute intracerebral hemorrhage were taken as uninfected group .The changes of recognition function , serum fibroblast growth factor and inflammatory factors were compared in these three groups .RESULTS A total of 170 strains of pathogens were isolated from the 170 cases of patients ,including 77 (45 .3% ) strains of gram‐positive bacteria ,mainly Staphylococcus aureus 18 (10 .6% ) strains , Staphylococcus saprophyticus 12(7 .1% ) strains ,and Enterococcus f aecalis 11(6 .5% ) strains .There were 93 (54 .7% ) strains of gram‐negative bacteria ,including Pseudomonas aeruginosa 18 (10 .6% ) strains , Enterobacter aerogenes 17 (10 .0% ) strains ,and Neisseria meningitides 16(9 .4% ) strains .The MMSE scores of infected patients were de‐creased obviously ,and catalase and superoxide dismutase in serum were lower than control group and uninfected group obviously ,but MDA ,IL2 ,IL10 and TNF‐α were increased significantly compared with control and unin‐fected groups (P<0 .05) .CONCLUSION There is big chance for acute intracerebral hemorrhage patients got infec‐ted ,and which could influence the cognition function of patients .

目的：探讨自体肝移植手术的麻醉管理。方法：回顾性分析青海省人民医院2013年5月和2014年3月10日实施的三例离体肝切除、自体肝移植治疗肝泡型包虫病的临床资料及围手术期的麻醉管理，检索国内外医学数据库相关文献，进一步探讨该类手术围手术期的病理生理改变、血流动力学及各种细胞因子变化，对一般规律进行总结，从而辅助患者手术麻醉管理意见的改善与优化。结果：1．本组所收治3例患者在手术治疗期间均出现无肝期CVP下降的问题，同时无肝期至新肝期状态下的PH指标有一定下降取值，GLU水平、Lac血浆水平呈现出明显升高取值，BE指标则表现为显著下降取值，血清中血红蛋白检出值以及血钙检出值明显降低，血钾检出浓度有一定升高趋势。以上变化与既往有关肝移植患者手术期间的变化规律是基本一致的。2．本次研究中所收治3例自体肝移植患者在手术期间出血量最多者达12000ml，术中血流动力学、水电解质、酸碱平衡、中心体温及血糖均有不同程度的变化，给予相应纠正后患者都安全离开手术室。结论：1、本文主要探讨肝泡型包虫病患者自体肝移植手术围手术期的麻醉管理，但由于所研究患者样本数量较少（本次研究患者共3例），故而在临床认识上存在一定的局限性，为了进一步得出更加准确的结论，就需要通过扩展样本数量的方式，丰富对患者病情的认识。2、自体肝移植围手术期麻醉中应确保患者血流动力学相关指标处于稳定状态，对水电解质存在的紊乱问题进行及时的就诊，同时重视对患者凝血功能相关指标以及血气生化指标的分析工作，确保手术麻醉效果能够达到理想状态。3、通过回顾性分析得出肝泡性包虫病患者行离体肝切除、自体肝移植手术，术前精确评估，术中精准操作，术后精心管理是手术成功的关键。

Objective To observe the perioperative change of plasma neuropeptide Y (NPY) in patients undergoing cholecystectomy.Methods The plasma NPY of thirty patients was measured before, during and after operation by radioimmunassay. Results Theplasma NPY level descend significantly during and 24 h after operation (p0.05). Conclusion Analgesia can depress perioperative stress response effectively, particularly the postoperative 24 h in analgesia NPY level descend more obviously.

我院自2000年10月至2001年10月成功地进行了3例背驮式无转流同种异体肝移植手术.3例患者均为男性,体重偏低,最低1例仅39kg,年龄分别为46、47、52岁.分别诊断为:酒精性肝硬化,门脉高压;原发性肝癌,肝硬化失代偿期;肝炎后肝硬化伴巨块型肝癌.

老年人胆囊切除术，由于术中麻醉、手术刺激及牵拉胆囊等多种原因的影响，往往会造成术中患者呼吸频率、幅度的减慢和降低，心率的下降，易造成心率失常。因而容易发生缺氧、血压波动，使手术风险增加。据报道，参附注射液具有升压、稳压和抗快速及缓慢心率失常的双……

目的：研究在高海拔地区运用力月西(咪唑安定)在术中的不同方法和剂量对呼吸、循环的影响；方法：力月西(咪唑安定)运用于单纯上腹部胆囊切除术患者60例，且随机分为A组：单纯运用力月西组(0.05mg/kg)；B组：力月西(0.03mg/kg)和度冷丁50mg混合液静脉注射；C组：先静注50mg度冷丁，5分钟后再静注力月西0.03mg/kg，每组各20例，通过监测观察血压、血氧饱和度(SpO_2)、心率(HP)变化，并行镇静分级，分级标准以Breggren方法，3组患者组间均无统计学差异，均未用术前药；结果：A、B、C 3组术中血压、饱和度均有所下降，但无统计学意义(P＞0.05)，且3组术后均不能回忆术中情况，对术中操作无记忆(顺行性遗忘)，但A、B两组均有术中患者出现烦躁，几乎不能配合手术，需加大剂量后才能符合术中要求，而C组无一例发生；结论：小剂量力月西0.03mg／kg复合度冷丁间断给药的运用对血管系统影响甚微，不至于引起血压下降，镇静、抗焦虑完全，无呼吸抑制，尤为适合高海拔、低氧环境，此不失为一种较为完全的术中辅助用药。

我院自2000年10月至2001年10月成功地进行了3例背驮式无转流同种异体肝移植手术，对在围麻醉期的处理上对于高海拔地区具有一定特殊性，现作如下探讨。 资料与方法 1 一般资料 患者3例均为男性，体重偏低，最低一例仅39kg，年龄分别为46岁、47岁、52……