目的 观察支撑喉镜手术前后气管导管套囊压力的变化.方法 选取2016年6月至2017年6月择期全身麻醉支撑喉镜下行声带息肉切除手术的患者43例,年龄33～60岁,美国麻醉医师协会(ASA)Ⅰ～Ⅱ级.气管导管套囊充气后,采用漏气试验,用套囊压力表记录套囊压力的基础值,同时记录放置支撑喉镜后的套囊压力,观察患者术中及拔管期间反流误吸、喘鸣、声音嘶哑等情况.结果 放置支撑喉镜前后套囊内压力分别为(28.0±1.5)、(38.0±6.0)cm H2O,差异有统计学意义(P＜0.05).43例患者有28例(65.1％)置入支撑喉镜后气管导管的套囊压力升高;13例(30.2％)患者置入支撑喉镜后气管导管的套囊压力下降;2例(4.7％)患者置入支撑喉镜后气管导管的套囊压力不变.结论 支撑喉镜手术体位可引起气管导管套囊压力升高或降低,建议在此类手术中持续监测套囊压力的变化.

Objective To observe the clinical effect of dexmedetomidine for preventing agitation during extubation period in the patients undergoing percutaneous nephrostolithotomy.Methods Sixty ASA Ⅰ-Ⅱ patients with elective percutaneous nephrostolithotomy under general anesthesia were selected and randomly assigned to the dexmedetomidine (DEM) and normal saline group (NS),30 cases in each group.The DEM group was given dexmedetomidine 0.5 μg/kg by intravenous pumping at 30 min before the end of the operation,while the NS group was given the equal volume of normal saline by intravenous pumping for 10 min.MAP and HR were recorded before anesthesia induction(T0),at the end of skin suturing(T1),at the moment of extubation(T2),at 5 min (T3) and 10 min(T4)after extubation.The eye opening time and extubation time,and incidence of agitation were observed in the two groups.Results MAP and HR at T2,T3 and T4 in the DEM group were lower than those in the NS group(P＜0.05).MAP and HR at T2,T3,T4 in the NS group were higher than those before anesthesia induction(P＜0.05).The total incidence rate of agitation during extubation period in the DEM group was also significantly lower that that in the NS group(P＜0.01).No statistically significant differences were found between the two groups in the recovery time and extubation time(P＞0.05).Conclusion Intravenous pumping of dexmedetomidine 0.5 μg/kg at 30 min before the end of percutaneous nephrostolithotomy can effectively reduce the occurrence of agitation during extubation period.

Objective To compare the effect on intraoperative cerebral metabolism between the propofol combined with remifentanil infusion in total intravenous anesthesia and the desflurane combined with remifentanil intravenous inhalation anesthesia in patients in neurosurgery.Methods Thirty-four patients were randomly divided into the propofol combined with remifentanil group (group A,n=16) and the desflurane combined with remifentanil group (group B,n =18).The B-ultrasound under the guide of retrograde catheterization through right internal jugular vein and artery was prepared after the patients entered the operation room.Atropine,propofol,fentanyl,rocuronium were used in the induction of anesthesia.The mechanical ventilation was applied after conventional trachea cannula.Once patients were anesthetized steadily,jugular bulb venous oxygen saturation (SjvO2),jugular bulb venous oxygen partial pressure (PjvO2),Jugular Bulb venous hemoglogin (Hbv),jugular bulb venous lactate (Ljv),jugular bulb venous gluxose (Gv),arterial oxygen saturation (SaO2),arterial oxygen pressure (PaO2),arterin (Hba),arterial blood lactate (La),arterial blood gluxose (Ga),arterial blood oxygen content (CaO2),jugular bulb venous oxygen content (CjvO2),arteriovenous oxygen difference (AVDO2),cerebral extraction of oxygen (CEO2),cerebral lactate production rate (CLP) and cerebral glucose uptake rate (CGU) at different time [before anesthesia induction (T1),1 hours after the start of the operation (T2),2 hours after the start of the operation (T3),half an hour after the operation]were collected.Results (1) The value of SjvO2,PjvO2,CjvO2 and CaO2 in group B was significantly higher than that in group A (P＜0.001);The value of AVDO2 and CEO2 in group B was lower than that in group A (P＜0.05);(2) The value of Gv and Ga in group B was higher than that in group A (P＜0.05);There were no significant differences about CGU in two groups (P＞0.05);(3) The value of CLP in group B was lower than that in group A (P＜0.05);there were no significant differences about Ljv and La in two groups (P＞0.05);(4) Compared with the value at moment of T1 between group A and group B,the value ofPaO2,SaO2,PjvO2 and SjvO2 were increased with time (P＜0.05),the value of CaO2,CjvO2,AVDO2 and CEO2 showed a downward trend (P ＜0.05).Conclusion (1) Both total intravenous anesthesia and intravenous inhalation anesthesia can reduce the cerebral oxygen metabolism;(2) For the cerebral protection of neurosurgery operation,it seems that the effect of intravenous inhalation anesthesia is more stronger than total intravenous anesthesia.

目的 观察阿扎司琼预防月经期女性患者腹腔镜胆囊切除术后恶心呕吐(PONV)的效果.方法 选择ASA Ⅰ～Ⅱ级择期全麻下行腹腔镜胆囊切除术的月经期女性患者40例,采用随机数字表法,将患者随机分为对照组和阿扎司琼组,每组20例.2组患者均采用常规的麻醉诱导和维持.手术结束前30 min阿扎司琼组静脉注射阿扎司琼10 mg,对照组予等量生理盐水50 mL.观察术后48 h内2组患者PONV的发生率及严重程度.结果 对照组和阿扎司琼组患者术后48 h内PONV的总发生率分别为90％和35％,阿扎司]琼组48 h PONV总发生率明显降低(P＜0.01);阿扎司琼组,术后恶心呕吐Ⅳ级的发生率也低于对照组(P＜0.05).结论 阿扎司琼可以减少月经期女性患者行腹腔镜胆囊切除术后恶心呕吐的发生率及降低其严重程度.

目的 评估右美托咪定与咪达唑仑用于局麻下经皮穿刺椎间孔镜手术的有效性和安全性.方法 选择35～65岁,美国麻醉医师协会(ASA)Ⅰ～Ⅱ级择期局麻下经皮穿刺椎间孔镜手术的患者60例,随机分为右美托咪定组(D组)和咪达唑仑组(M组),每组30例.D组静脉注射右美托咪定1μg/kg,注药时间10min,术中以0.4μg·kg-1·h-1维持.M组予咪达唑仑0.06mg/kg,注药时间10min,术中以0.04mg·kg-1·h-1维持.观察两组给药前(T0)、穿刺时(T1)、打磨小关节(T2)、神经松解时(T3)、缝合伤口(T4)各个时间点的心率(HR)、平均动脉压(MAP)变化,记录术中不良反应、舒芬太尼的使用情况、Ramsay镇静评分以及手术医生和患者的满意度.结果 两组的MAP变化差异无统计学意义(P＞0.05).与T0时点比较,T1～T4时点D组HR明显减慢;与M组比较,D组心率在T1～T3时点明显减慢(P＜0.05);用药后两组镇静评分差异无统计学意义(P＞0.05),均达到良好镇静效果,但D组手术医生和患者满意度均高于M组(P＜0.05).结论右美托咪定用于局麻下经皮穿刺椎间孔镜手术可以达到与咪达唑仑一样的镇静效果,患者和手术医生满意度高,但有减慢心率的作用.

Objective To compare the feasibility and efficacy between dexmedetomidine and midazolam in herniorrhaphy surgery for older patients. Methods Sixty American Society of Anesthesiology (ASA) gradeⅠ~Ⅱpatients, treated by herniorrhaphy surgery under local anesthesia,were randomly divided into dexmedetomidine group (n=30) and midazolam group (n=30) .Patients in dexmedetomidine group were given dexmedetomidine at a loading dose of 1μg/kg for 10 min,then they were injected continuously by 0.4μg/(kg·h),whereas midazolam group were given midazolam at a loading dose of 0.06 mg/kg, then 0.04 mg/(kg·h) injected continuously.The mean blood pressure (MAP) and heart rate (HR) were recorded before infusion (T0),incision of skin (T1),15min (T2) and 30 min (T3) after administration and when sutured skin (T4), adverse reaction were also assessed. Results The difference of sedation level was not significant between the two groups (P>0.05) .Compared with T0 , the decrease of HR was significantly more in dexmedetomidine group from T1 to T4 (P<0.05) . Compared with midazolam group , the decrease of HR was significantly more in dexmedetomidine group from T1 to T4 (P<0.05) . Compared with dexmedetomidine group, the rate of respiratory depression and restlessness were more in midazolam group, but bradycardia was lower (P<0.05) .Conclusions Dexmedetomidine is a comparable alternative to midazolam for sedation in herniorrhaphy surgery under local anesthesia. It is associated with better respiration and lower restlessness but with a high incidence of bradycardia.

Objective To analyze the dose‐effects of different doses of dexmedetomidine for sedation and sleep of the patients under epidural nerve block anesthesia .Methods A total of 82 patients undergoing elective lower limbs surgery(ASA grade Ⅰ - Ⅱ) were randomly divided into 4 different doses of dexmedetomidine groups(group 1 ,n=19 ;group 2 ,n=22 ;group 3 ,n=20;group 4 , n=21) ,under continuous epidural nerve block ,the loading dose of dexmedetomidine 0 .7 ,0 .8 ,0 .9 ,1 .0μg · kg -1 · h-1 was intrave‐nously pumped for 30 min ,then pumped at a rate of 0 .7 ,0 .8 ,0 .9 ,1 .0 μg · kg -1 · h-1 in the group 1 ,2 ,3 and 4 respectively .If any patient in 4 groups fell asleep at less than half an hour ,the loading dose was stopped and the continuous dose was changed to pump , the drug administration was discontinued at wound dressing after operation .Whether the patient falling asleep was recorded ,and the mean arterial blood pressure ,heart rate at 4 time points of 10 ,30 ,60 ,90 min after infusion of dexmedetomidine were also recorded . The 50% effective dose(ED50 ) ,ED95 and 95% confidence interval(CI) were calculated by using the Probit method .Results ED50 and ED95 of dexmedetomidine were 0 .65μg/kg(95% CI:0 .36-0 .73μg/kg)and 1 .00 μg /kg(95% CI:0 .90-1 .74μg/kg) ,which could decrease the heart rate and increase the arterial blood pressure .Conclusion Although dexmedetomidine can decrease the heart rate and increase the arterial blood pressure ,but the patients quietly fall asleep without discomfort and pain occurrence by the intra‐venous administration under continuous epidural nerve block .

目的比较七氟醚静吸复合麻醉与丙泊酚全凭静脉麻醉用于腹腔镜胆囊切除术时循环的变化及术毕的清醒情况。方法选择行腹腔镜胆囊切除术的患者40例,随机分为七氟醚组和丙泊酚组,观察麻醉诱导、气腹前后及术毕的血压、心率变化及手术结束后患者清醒及拔管时间、苏醒期恶心呕吐、烦躁等并发症的发生情况,并比较两组间丙泊酚及瑞芬太尼的用量。结果两组患者在麻醉诱导前后、气腹前、气腹毕及术毕的血压、心率变化差异无统计学意义,气腹后5 min丙泊酚组血压升高、心率增快,与气腹前比较差异有统计学意义;七氟醚组变化不明显,两组间比较差异有统计学意义。术毕停药后两组患者均迅速苏醒、拔管早,定向力恢复快。七氟醚组丙泊酚及瑞芬太尼的用量均明显低于丙泊酚组。结论腹腔镜胆囊切除术中应用七氟醚联合瑞芬太尼、丙泊酚静吸复合麻醉,术中循环平稳,术毕苏醒迅速,并发症少,是值得临床推广应用的一种快通道麻醉方法。

目的:观察两种直径的人工角膜在兔角膜应用的生物学反应.方法:两种人工角膜均由光学中心和周边支架组成.23只人工角膜分两组植入兔角膜并观察6个月以上.术前人工角膜经rf-argon-plas-ma处理并进行细胞培养.结果:最佳人工角膜的直径是4.5～6mm.植入28d后纤维细胞迁徙入多孔的周边支架并有胶元蛋白沉积.组织学分析证实,6w后GAG和生长因子沉积在周边支架.结论:rf-argon-plasma处理可增加材料的组织相容性,上皮细胞可迁徙至人工角膜的光学中心.