目的:探讨Narcotrend指数(NI)指导七氟烷吸入麻醉与靶控输注(TCI)丙泊酚和瑞芬太尼麻醉诱导至气腹后5 min的血流动力学对比,提供一种能够保证足够的麻醉深度及平稳的麻醉方法.方法:择期手术患者60例行腹腔镜手术患者,按随机数字表法分为两组:丙泊酚联合瑞芬太尼TCI组(TCI组,n=30)和全凭吸入麻醉组(七氟烷组,n=30)比较两组分别在入室时(T1)、NI=40时(T2)、插管后5 min(T3)、气腹开始5 min后(T4)时段的心率(HR)、平均动脉压(MAP)、每搏变异度(PVV)、周围血管阻力指数(SVRI)、心输出量(CO)、每搏量(SV).结果:在T2时,七氟烷组HR高于TCI组,MAP、SVRI低于TCI组,且均低于T1时,差异有统计学意义(P<0.05);在T4时,七氟烷组的MAP、SVRI低于TCI组,差异有统计学意义(P<0.05);T3时,七氟烷组NI值低于TCI组,差异有统计学意义(P<0.05).结论:在Narcotrend监测仪和MostCare血流动力学监测下,靶控输注丙泊酚及瑞芬太尼比吸入七氟烷麻醉更能使患者的MAP、HR、SV、PVV等血流动力学指标趋于平稳,减少低血压的发生.

目的:探讨右美托咪定用于老年下肢骨科手术麻醉中的效果.方法:选取2019年1月至2019年12月在我院接受治疗老年下肢骨科手术的70例患者作为研究对象,根据患者手术治疗时间顺序,随机分为两组分别是观察组35例和对照组35例,给予两组患者不同的方式麻醉,观察组给予右美托咪定镇静,对照组给予用丙泊酚镇静,比较两组患者手术当中的镇定效果,结果:两组患者不同手术围术期间的Ramsay评分,观察组患者在整个手术围术期Ramsay评分结果显著低于对照组,对比结果差异有统计学意义(P<0.05).两组患者生命指标评分对比中,观察组患者的血氧饱和度、收缩压、舒张压、心率以及呼吸频次指标显著优于对照组,差异有统计学意义(P<0.05).结论:对老年下肢骨科手术患者给予不同的麻醉镇定手段,采用右美托咪定麻醉手段的观察组在镇静效果和患者生命体征监测上效果显著,有效提升临床治疗效果,具有推广价值.

目的:分析不同麻醉方式联合腹横肌平面阻滞对老年结肠癌患者的影响.方法:选择2019年1～12月期间收治的96例老年结肠癌手术治疗患者,随机分为参照组、研究组,各48例,分别予以七氟烷联合腹横肌平面阻滞、右美托咪定联合腹横肌平面阻滞,观察术后疼痛及康复情况、应激反应、不良反应.结果:研究组动态VAS低于参照组,排气时间、下床时间短于参照组,差异显著(P＜0.05).术前,两组患者BG、Cor、CRP差异均无统计学意义(P＞0.05);术后,研究组BG、Cor、CRP均低于参照组,差异显著(P＜0.05).两组患者不良反应总发生率(12.50％vs10.42％)差异无意义(P＞0.05).结论:老年结肠癌手术中,应用右美托咪定静脉麻醉联合腹横肌平面阻滞,有助于减轻术后疼痛、促进术后康复、减轻手术应激反应.

目的:探讨使用不同剂量的盐酸右美托咪定对接受腹腔镜手术的妇科疾病患者进行静脉麻醉的效果.方法:将在深圳市龙岗区人民医院进行腹腔镜手术的187例妇科疾病患者随机分为A组、B组、C组及D组.术中为A组患者静脉滴注生理盐水,为B组、C组及D组患者分别静脉注射0.3μg/(㎏·h)、0.4μg/(㎏·h)及0.5μg/(㎏·h)的盐酸右美托咪定.然后比较四组患者简易智力状态检查量表(MMSE)的评分和不良反应的发生情况.结果:手术后第1天、第2天,C组患者、D组患者MMSE的评分均高于B组患者,P<0.05.手术后,C组患者不良反应的总发生率低于D组患者,P<0.05.结论:与使用0.3μg/(㎏·h)的盐酸右美托咪定相比,使用0.4μg/(㎏·h)、0.5μg/(㎏·h)的此药对接受腹腔镜手术的妇科疾病患者进行静脉麻醉,可促使其认知功能较快地恢复.与使用0.5μg/(㎏·h)的盐酸右美托咪定相比,使用0.4μg/(㎏·h)的此药对其进行静脉麻醉时较少引起不良反应.

目的 观察多潘立酮片结合标准三联疗法治疗小儿幽门螺杆菌(Hp)感染伴功能性消化不良的临床效果.方法 将120例Hp感染伴功能性消化不良患儿随机分为两组各60例.对照组采用标准三联疗法治疗,观察组在对照组基础上采用多潘立酮片治疗.治疗1个月后,比较两组的临床疗效、 血清胃肠激素水平及Hp根除率.结果 治疗1个月后,观察组的总有效率、H p根除率均高于对照组(P<0.05);两组的血清P物质、MTL水平均高于治疗前,且观察组的血清P物质、MTL水平均高于对照组(P<0.05).结论 多潘立酮片结合标准三联疗法治疗小儿Hp感染伴功能性消化不良效果确切,可提高Hp根除率,改善患儿胃肠激素水平,值得临床推广.

目的 探讨麻醉前含服不同剂量右美托咪定(Dex)对七氟烷抑制小儿喉罩置入反应半数有效浓度(EC50)的影响.方法 选择择期手术拟行全麻患儿,年龄1～3岁,ASA分级Ⅰ级,随机分为3组.吸入麻醉诱导前1h,N组患几经口含服氯化钠注射液1 mL,D2组、D4组分别经口含服Dex 2、4μg·kg-1(用氯化钠注射液稀释至1 mL).入室后吸入5％七氟烷诱导,意识消失后按改良序贯法调整七氟烷呼气末浓度,起始为2％,依据喉罩置入反应确定下一例患儿增加或降低0.2％七氟烷呼气末浓度,直至出现七个交换点即研究结束.评估Dex给药45～60 min后患儿与父母分离镇静水平及吸入诱导患儿面罩接受程度.用概率单位回归分析法测定七氟烷抑制患儿喉罩置入反应的EC50及相应的95％可信区间(95％CI).结果 N组、D2组和D4组分别纳入患儿26、27和28例.D4组患儿与父母分离满意率和面罩接受满意率均明显高于D2组和N组(P＜0.05).N组、D2组和D4组七氟烷抑制患儿喉罩置入反应的EC50分别为2.02％ (95％CI:1.73％～2.32％)、1.77％ (95％CI:1.47％ ～ 2.05％)和1.60％ (95％CI:1.21％～ 1.82％).结论 麻醉前含服Dex 4μg·kg-1的镇静效果优于Dex 2μg·kg-1,含服Dex 2和4μg·kg-1可使七氟烷抑制小儿喉罩置入反应EC50分别降低12％和21％.

AIM To compare the sedation effect of the same dose of intranasal and buccal dexmedetomidine for mnask acceptance during inhalational induction in pediatric patients.METHODS Seventysix patients,ASA physical status Ⅰ,aged 2 to 6 years,scheduled for acceptance of face mask during inhalational induction were randomly divided into two groups,with 36 in each.The buccal group or theintranasal group received dexmedetomidine,either 2.5 μg ·kg-1 intranasally or 2.5 μg·kg-1 buccally for premedication at one hour before the induction of anesthesia.They were separated from parents and transferred to the operating room at one hour after received dexmedetomidine.Anesthesia induction was performed with 5％sevoflurane using face mask.Heart rate (HR),systolic blood pressure (SBP),pulse oxygen saturation (SpO2)and Ramsay sedation scores were measured before (T0) and every 20 min (T2,T3 and T4) after administering dexmedetomidine in all patients.Drug acceptance,parental separation,and face mask acceptance scores were recorded.RESULTS Compared with T0,Ramsay sedation scores were increased in both groups at T2,T3 and T4(P ＜ 0.05),and significantly higher in the intranasal group than the buccal group at T3 and T4 (P ＜ 0.05).Drug acceptance satisfaction rate was significantly lower in the intranasal group than in the buccal group (P ＜0.05).Face mask acceptance satisfaction rate was significantly higher in the intranasal group than in the buccal group (P ＜ 0.05).There was no significant difference between the two groups in parental separation (P ＞ 0.05).HR and SBP were significantly lower in both groups at T3 and T4 compared with T0 (P ＜ 0.05),and there was no significant difference between the two groups (P ＞ 0.05).CONCLUSION Intranasal dexmedetomidine 2.5 μg·kg-1 is more effective than buccal dexmedetomidine 2.5 μg·kg-1 for mask acceptance during inhalational induction in pediatric patients,but buccal dexmedetomidine is more acceptable for children.

目的:观察磷酸肌酸钠治疗小儿轮状病毒肠炎合并心肌损害的疗效.方法:选定本院儿科收治的轮状病毒肠炎合并心肌损害患者116例,2016年4月至2018年4月为研究时段,遵循随机数字表法的分组原则,分试验组、对照组,每组样本容量58例.对照组采纳常规临床治疗,试验组在对照组基础上行磷酸肌酸钠治疗,比较心肌酶检测结果、CTnⅠ变化情况、临床疗效.结果:试验组治疗后a-HBDH、CK-MB、CK、CTnⅠ均显著较对照组低,P＜0.05(具统计学差异);试验组临床总有效率显著较对照组高,P＜0.05(具统计学差异).结论:磷酸肌酸钠可有效改善小儿轮状病毒肠炎合并心肌损害患者病情,效果显著,值得借鉴.

AIM To investigate the effect of dexmedetomidine combined with compound lidocaine cream in prevention of anesthesia emergence agitation and urinary catheter-induced discomfort of male patients after thoracic surgery.METHODS One hundred male patients undergoing selective thoracic surgery were enrolled and divided into four groups randomly,dexmedetomidine group (group D),lidocaine group (group L),dexmedetomidine combined with lidocaine group (group DL) and control group (group P),each group of 25 cases.Urinary catheterization was performed using a silicone catheter after anesthesia induction.The group D and group P used paraffin oil daub routine catheterization catheter front end,while the group L and group DL used compound lidcoaine cream daub catheter front of urethral catheterization.The group D and group DL were given intravenous pumped infusion of dexmedetomidine 1 μg·kg-1 in 15 min before the end of surgery,while the group P and group L were given sodium chloride injection by the same methods.The systolic blood pressure (SBP),heart rate (HR) and pulse oxygen saturation were recorded at the time points of before induction (T0),tracheal extubation immediately (T1),3 min (T2),10 min (T3) and 20 min (T4) after tracheal extubation.The agitation scores,visual analogue scale (VAS) for pain and degree of urinary catheter-induced discomfort after tracheal extubation were also recorded.RESULTS The SBP and HR of the group D and group DL were lower than the group L and group P at T1 to T4 (P ＜ 0.05).The SBP and HR of the group L were lower than the group P at T2 to T3 (P ＜ 0.05).The incidence of emergence agitation in the group D,group L and group DL were significantly lower than in the group P (P ＜ 0.05),but no statistical differences existed between the group D and group L (P ＞ 0.05).The VAS scores in the group D and group DL were significantly lower than in the group P and group L (P ＜ 0.05),but no statistical differences existed between the group L and group P (P ＞0.05).The incidence of urinary catheter-induced discomfort in the group D,group L and group DL were significantly lower than in group P (P ＜ 0.05).CONCLUSION Dexmedetomidine combined with lidocaine cream can effectively prevent and reduce anesthesia emergence agitation and urinary catheter-induced discomfort of male patients after thoracic surgery,and do not affect hemodynamics and postoperative recovery.

目的:探讨右美托咪定辅助麻醉在老年重症患者术后的应用效果.方法:按照入院顺序随机抽取我院自2015年2月至2017年2月收治的老年重症手术患者80例,分为观察组(n=40)和对照组(n=40).两组均进行硬膜外麻醉联合全麻.观察组进行右美托咪定静脉注射,对照组进行生理盐水静脉注射.比较两组的谵妄发生率、VAS评分、睡眠质量以及血流动力学指标.结果:对照组的谵妄发生率、VAS评分均比观察组的低;与对照组的睡眠质量、血流动力学指标比较,观察组的较好,差异显著(P＜0.05).结论:右美托咪定辅助麻醉可有效降低术后谵妄发生率,减轻疼痛,改善睡眠质量,值得借鉴和推广.

目的：探讨五行音乐干预对缺血性中风后抑郁患者生活质量的影响。方法将100例缺血性中风后抑郁患者按照随机数字表法分为对照组和干预组，干预组给予五行音乐干预治疗，对照组予阿普唑仑0．4 mg口服，使用HAMD量表及SF－36量表分别在患者入组1 d、入组60 d评定其抑郁程度及生活质量，并进行组间比较。结果2组治疗前HAMD量表及SF－36量表各维度的得分比较差异均无统计学意义（P均＞0．05），治疗后干预组与对照组HAMD量表的得分均呈下降趋势，SF－36量表的得分均呈上升趋势，在治疗60 d时干预组2个量表的得分情况均优于对照组（ P均＜0．05）。结论五行音乐干预疗法能明显改善缺血性中风后抑郁患者的抑郁程度及生活质量，提高临床疗效。

目的 探讨社区康复教育联合布地奈德/福莫特罗在慢性阻塞性肺疾病(COPD)治疗中的应用价值.方法 选取2012年1—12月在深圳市坪山新区人民医院诊断为COPD的患者60例作为研究对象,按随机数字表法将其分为对照组与试验组,各30例.两组患者均按照病情需要给予合适药物治疗,在此基础上对照组患者给予社区康复教育,试验组患者在对照组基础上给予布地奈德/福莫特罗.比较两组患者一般资料、治疗前后自我评估测试问卷(CAT)评分及肺功能.结果 治疗1年后,试验组患者的CAT评分明显低于对照组,差异有统计学意义(P<0.05);治疗1年后,试验组患者的第1秒钟用力呼气容积(FEV1)占预计值百分比明显高于对照组,差异有统计学意义(P<0.05).结论 实施社区康复教育及联合使用布地奈德和福莫特罗对改善COPD患者的生命质量和肺功能有一定的积极意义.

Objective To determine the ED50 of intranasal dexmedetomidine(Dex) sedation for acceptance of mask inhalation anesthesia induction in children,and to compare the difference of ED50 among infants,preschool and school-age children.Methods ASA physical status Ⅰ or Ⅱ children,scheduled for mask inhalation anesthesia induction,were allocated into 3 groups according to age:infant group(1-3 y),preschool group(4-6 y) and school-age group(7-12 y),and the case number expectation for each group is 35.Every child was titrated Dex into nostril 1 h before inhalational induction,and the initial dose of Dex was set at 2 μg/kg.Using the modified Dixon's up-and-down method depending on the sedation effect of the previous child,the dose of Dex in the next child was increased or decreased by 0.25 μg/kg.The tolerant degree of face mask was evaluated using a different 4-point scale.1-2 scores were considered as unsatisfactory and 3-4 scores were considered as satisfactory.Probit analysis was used for calculating ED5o and 95％ confidence interval (CI) of intranasal Dex sedation.Results 31,28 and 30 cases were practically used in infant group,preschool group and school-age group,respectively.The ED50 of Dex for intranasal sedation was 1.94 μg/kg in infant group (95％CI:1.72-2.18 μg/kg),1.61 μg/kg in preschool group (95％CI:1.41-1.82 μg/kg),and 1.30 μg/kg in school-age group (95％CI:1.13-1.47 μg/kg),respectively.The ED50 among the three groups have significant difference (P＜0.05).Conclusions The ED50 of Dex required for intranasal sedation before mask inhalation anesthesia induction is decreased followed by the increase of age in children.

目的：探讨阿司匹林在社区血栓栓塞性疾病二级预防及治疗中的应用情况。方法通过问卷调查形式，采集X城区并选取X所社区卫生服务中心从2014年10月至2015年12月在上述社区卫生机构就诊的患者的基本资料及治疗信息，从中筛选出180例具有血栓栓塞性疾病的患者，按疾病分类分为冠心病组及脑卒中组，每组90例，同时针对性收集其抗栓治疗信息。比较两组患者的相关抗栓治疗信息等。结果冠心病组患者既往服用阿司匹林81例（90.0％），通过新处方服用3例（3.3％），总体服用84例（93.3％）；脑卒中组患者既往服用阿司匹林75例（83.3％），通过新处方服用2例（2.2％），总体服用77例（85.6％）。两组患者绝大部分对阿司匹林的服用率均较高；冠心病组患者阿司匹林服用率略高于脑卒中患者；两组患者中均有近25.0％服用β受体阻滞剂；两组患者中均有近33.3％服用 ACEI或 ARB 药物、两组患者中均有近40.0％服用中药及中成药。结论阿司匹林在社区血栓栓塞性疾病二级预防实践中的应用较为广泛而显著；对于血栓栓塞性疾病患者同样可以服用例如β受体阻滞剂、ACEI 或相应中药及中成药以改善病情。

目的 对比分析老年腹腔镜手术患者应用不同浓度七氟醚对患者认知功能的影响.方法 选取150例老年腹腔镜手术患者作为研究对象.所有患者均采用依托咪酯、芬太尼、维库溴铵进行麻醉诱导,再根据维持麻醉方式不同将上述患者分为两组,其中观察组83例,采用3%~5%七氟醚维持麻醉,并使脑电双频指数(BSI)维持在35~40;对照组67例,采用1%~2%七氟醚维持麻醉,并使BSI维持在50~60.结果 ①手术前,观察组与对照组患者简易精神状态评价量表(MMSE)评分相比差异无统计学意义(P>0.05);手术后第1 d、第7 d,观察组MMSE评分均显著高于对照组(P<0.05).②手术前,观察组与对照组患者血清神经组织蛋白S100(S100β蛋白)差异无统计学意义(P>0.05);手术后第1 d、第7 d,观察组血清S100β蛋白均显著低于对照组(P<0.05).③手术前,观察组与对照组患者全血白细胞计数(WBC)、中性粒细胞百分比(NEU%),血清C-反应蛋白(CRP)相比差异无统计学意义(P>0.05).手术后第1 d、第7 d,观察组全血WBC、NEU%,血清CRP均显著低于对照组(P<0.05).结论 老年腹腔镜手术患者应用七氟醚深度麻醉具有认知功能与中枢神经系统损伤小、炎症反应轻等优点.

目的 探讨辨证施膳对胸痹患者血脂水平及生活质量的影响。 方法 将200例胸痹患者随机分为干预组和对照组各100例,对照组采用常规护理和健康宣教,干预组在对照组基础上行辨证施膳干预,比较两组患者干预前后血脂中甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)的水平及生活质量评分。 结果 干预组TG、TC、LDLC水平明显降低,HDL-C升高,与对照组比较差异有统计学意义(P<0.01);两组干预前后生活质量评分比较,差异有统计学意义(P<0.01)。 结论 辨证施膳能有效降低胸痹患者的血脂水平,提高患者的生活质量。

目的:探讨腰-硬联合麻醉在老年患者骨科手术中的临床应用效果.方法:选取本院骨科手术患者156例为研究对象,分成了对照组和观察组,每组78例.分别采用硬膜外麻醉和腰硬联合麻醉.以两组患者的麻醉起效时间、完全阻滞时间和硬膜外麻醉药物用量和应激反应程度为观察指标.结果:观察组患者的麻醉起效时间和完全阻滞时间均低于对照组患者;观察组患者的硬膜外麻醉药物用量低于对照组患者;观察组患者的肾上腺素(E)、去甲肾上腺素(NE)、肾素(R)以及血管紧张素Ⅱ(ATII)等指标均低于对照组患者,组间比较,差异具有统计学意义(P＜0.05).结论:在临床针对骨科手术患者实施麻醉的实践过程中,腰硬联合麻醉的综合效果显著,是骨科手术中理想麻醉方式.

Objective To evaluate the effects of different doses of dexmedetomidine administered intranasally on the median effective concentration (EC50) of sevoflurane inhibiting responses to laryngeal mask airway (LMA) insertion in the pediatric patients.Methods American Society of Anesthesiologists physical status Ⅰ or Ⅱ pediatric patients of both sexes, aged 1-3 yr, with body mass index of 20-25 kg/m2, scheduled for elective surgery under general anesthesia, were randomly divided into 3 groups: control group (group C) , dexmedetomidine 1 μg/kg group (group D1) , and dexmedetomidine 2 μg/kg group (group D2).In D1 and D2 groups, dexmedetomidine 1 and 2 μg/kg (in 1 ml of normal saline) were administered intranasally at 1 h before induction of anesthesia, respectively.Group C received the equal volume of normal saline administered intranasally.The children were separated from their parents at 45-60 min after intranasal administration and admitted to the operating room.The children inhaled 8％ sevoflurane until they lost consciousness.After loss of consciousness, the end-tidal concentration of sevoflurane was determined using the modified Dixon's up-and-down method.The initial end-tidal concentration of sevoflurane was set at 2％.The concentration was increased/decreased by 0.2％ in the next patient according to the response to LMA insertion.The patient's sedation status and with LMA acceptance were evaluated, and the patient's satisfaction with sedation and with LMA acceptance was recorded.Probit analysis was used to calculate the EC50 and 95％ confidence interval of sevoflurane inhibiting responses to LMA insertion.Results The patient's satisfaction with sedation and with LMA acceptance was significantly higher in D1 and D2 groups than in group C, and in group D2 than in group D1 (P＜0.05).The EC50 (95％ confidence interval) of sevoflurane inhibiting responses to LMA insertion was 2.03％ (1.91％-2.15％), 1.76％ (1.65％-1.87％) and 1.63％ (1.53％-1.73％) in C, D1 and D2 groups, respectively.The EC50 was significantly lower in D1 and D2 groups than in group C, and in group D2 than in group D1 (P＜0.05).Conclusion Dexmedetomidine 1 and 2 μg/kg administered intranasally can decrease the EC50 of sevoflurane inhibiting responses to LMA insertion in the pediatric patients, and 2 μg/kg produces better efficacy.

Objective To determine the ED50 and ED95 of intranasal dexmedetomidine sedation for MRI scanning with the modified Dixon's up-and-down method in children. Methods 30 Cases of ASA physical status Ⅰor Ⅱchildren,aged 1-6 years old,sched-uled for MRI scanning were randomly enrolled in this study. Dexmedetomidine was dropped into each nostril at the time of 30 to 45 minutes before MRI scanning,and the dose of intranasal dexmedetomidine was determined using the modified Dixon's up-and-down method by the sedation effect of the previous children,in an increment or decrement of 0. 25 μg/kg. Probit analysis was used for cal-culating ED50,ED95 and 95% confidence interval ( CI) of intranasal dexmedetomidine sedation. Results The ED50 of intranasal dexmedetomidine sedation was 2. 15 μg/kg (95% CI was 1. 93-2. 32 μg/kg),and ED95 intranasal dexmedetomidine sedation was 2. 60 μg/kg(95% CI was 2. 39-3. 68 μg/kg). Conclusion The intranasal route to dexmedetomidine delivery is a simple security,good patient compliance and fewer side effects for MRI scanning in children. The ED50 and ED95 of intranasal dexmedetomidine sedation are 2. 15 μg/kg and 2. 60 μg/kg respectively with the modified Dixon's up-and-down method.

Objective To explore the effect of head and face manipulation combined with five elements music therapy on the vertigo patients with insomnia in order to improve their sleep quality .Methods Sixty-eight vertigo patients with insomnia were chosen and divided into the control group ( n=33) and the intervention group ( n=35) .The control group received the oral estazolam , and the intervention group received the head and face manipulation combined with five elements music therapy .The curative effect and sleep quality were compared between two groups .Results The total effective rate was 94.29%in the intervention group , and was 75.75%in the control group, and the difference was statistically significant (U=3.88, P<0.01).Conclusions The head and face manipulation combined with five elements music therapy can significantly improve sleep quality of the vertigo patients with insomnia , and increase the clinical effect and life quality of patients .