目的 观察不同给药模式在瑞芬太尼静脉分娩镇痛中的应用,为临床提供安全有效的镇痛方式.方法 选择2014年6月-2015年4月武汉市妇女儿童医疗保健中心收治的450例拟行阴道分娩的产妇,其中未采用分娩镇痛150例(无分娩镇痛组);选择分娩镇痛的300例按照抽签法随机分入瑞芬太尼静脉持续输注组和瑞芬太尼静脉间断单次输注组,每组150例,分别以瑞芬太尼0.1 μg/(kg·min)静脉持续输注和每隔3 min单次给予5μg/mL瑞芬太尼20 μg.记录并比较3组产妇分娩过程中不同时间点的疼痛视觉模拟评分(VAS评分)、Ramsay镇静评分和血流动力学指标,各产程时间和分娩过程中胎心率,剖宫产率、催产素使用率、器械助产率和不良反应发生率,以及瑞芬太尼静脉持续输注组、瑞芬太尼静脉间断单次输注组的瑞芬太尼总用药量和脐动脉/脐静脉血药浓度比.记录并比较3组新生儿娩出后1和5 min时的Apgar评分,以及脐动脉血气分析指标.结果 瑞芬太尼静脉持续输注组和瑞芬太尼静脉间断单次输注组产妇活跃期每间隔15 min、宫口开全时、胎儿娩出时的疼痛VAS评分分别显著低于无分娩镇痛组同时间点(P值均＜0.05),活跃期每间隔15 min、宫口开全时、胎儿娩出时的Ramsay镇静评分分别显著高于无分娩镇痛组同时间点(P值均＜0.05),前两组间各时间点的疼痛VAS评分和Ramsay镇静评分的差异均无统计学意义(P值均＞0.05).3组产妇不同时间点的心率、平均动脉压的差异无统计学意义(P值均＞0.05).瑞芬太尼静脉持续输注组和瑞芬太尼静脉间断单次输注组产妇的第一产程活跃期时间均显著短于无分娩镇痛组(P值均＜0.05),前两组间的差异无统计学意义(P＞0.05);3组间产妇的第二、第三产程时间和分娩过程中胎心率的差异均无统计学意义(P值均＞0.05).瑞芬太尼静脉持续输注组和瑞芬太尼静脉间断单次输注组产妇的剖宫产率、催产素使用率、器械助产率均显著低于无分娩镇痛组(P值均＜0.05).3组间产妇恶心呕吐、呼吸抑制、心率减慢、宫缩乏力发生率的差异均无统计学意义(P值均＞0.05).瑞芬太尼静脉持续输注组与瑞芬太尼静脉间断单次输注组间产妇的瑞芬太尼总用药量和脐动脉/脐静脉血药浓度比的差异均无统计学意义(P值均＞0.05).3组新生儿均未发生新生儿窒息,娩出后1和5 min时的Apgar评分,以及脐动脉血气分析各指标的差异均无统计学意义(P值均＞0.05).结论 瑞芬太尼静脉持续和间断单次输注用于分娩镇痛的效果均较明显.

Objective To observe the anesthesia effect of dezocine and pentazocine in painless artificial abortion, in order to provide a basis for safe use of anesthesia drug in clinical practice. Methods Totally,300 patients undergoing painless artificial abortion were included in this study.The patients were randomly divided into four groups: group A (simple propofo), group B ( propofol combined with fentanyl) ,group C ( propofol combined with dezocine) and group D ( propofol combined with pentazocine)(n=75 each).Four groups of patients were intravenously injected with propofol (1-1.5 mg?kg-1) according to the situation in operation when necessary to maintain anesthesia effect.Heart rate (HR),mean arterial pressure (MAP),arterial oxygen saturation ( SpO2 ) and respiratory frequency were observed and recorded before induction,after induction,at the beginning of the operation,during operation and anesthesia recovery. The onset time of anesthesia, the recovery time, the recovery time of orientation,the postoperative pain score and the incidence of adverse reaction of the four groups were recorded. Results All of&nbsp;the patients achieved good effects of anesthesia in operations. There was no significant difference in the onset time of anesthesia (P>0.05).Awakening time and time of orientation recovery in groups B,C and D were significantly shorter than those in group A (P<0.05).The dosages of propofol in group C and D were significantly less than those in group A and B (P<0.05).The changes of HR,MAP,SpO2 and respiratory frequency after induction were not significantly different in group B,C and D (P>0.05),but the changes were relatively stable as compared with group A (P<0.05).The rates of adverse reactions in group B,C and D were significantly lower than that in group A (P<0.05).The incidence rates of respiratory depression,nausea and vomiting in group C and D were significantly lower than those in group A and B (P<0.05).The postoperative pain scores of VAS in group B,C and D were significantly lower than that of group A (P<0.05). Conclusion The analgesia effects of dezocine and pentazocine are similar.Application of them can reduce the dosage of propofol and shorten the anesthesia awakening time in painless artificial abortion,at the same time they have less adverse reactions,and they are safe and effective to be used in clinical anesthesia.

Objective:To evaluate the effects of pressure controlled ventilation for tracheobronchial foreign body removal in children.Method: Ninety ASAⅡor Ⅲ children,aged 10 months to 3 yr,weighing 8-16 kg undergoing removal of airway foreign body were randomly divided into 3 groups(n=30 each):groupⅠpressure controlled ventilation(P)，group Ⅱ high-frequency jet ventilation(H),and group Ⅲ, reserve spontaneously breathings.Arterial blood gas analysis of Pre-operation and the end of operation,the occurrence of hypoxia during operation,the duration of operation,anesthesia emergence time and perioperative side effects were recorded. Result:The arterial blood gas analysis(PaO₂,PaCO₂,SaO₂)and SPO₂of Pre-operation in group P and H had no significant difference. The PaO₂ of the end of operations was significantly higher,and PaCO₂ was lower in group H. The occurrence of hypoxia during operation, the duration of operation,anesthesia emergence time and perioperative side effects in two group had no significant difference.Conclusion:The effects of pressure controlled ventilation and high-frequency jet ventilation for tracheobronchial foreign body removal in children were nearly the same,and pressure controlled ventilation can be commonly used in clinic.

目的 观察超声引导下腹横肌平面(transversus abdominis plane,TAP)阻滞用于剖宫产腰麻硬膜外联合麻醉时的效果.方法 腰麻硬膜外联合麻醉下行剖宫产术患者150例,随机分为两组:A组行腰麻硬膜外联合麻醉+TAP阻滞麻醉,B组行腰麻硬膜外联合麻醉+超声引导TAP阻滞麻醉,各75例.两组患者均采用腰麻硬膜外联合麻醉,记录患者术中不同时间点的平均动脉压(mean artery pressure,MAP)、心率(heart rate,HR)、疼痛评分以及术中牵拉反射发生率,同时观察并记录患者手术结束后2小时、4小时、8小时、16小时、24小时、36小时的疼痛评分、术后不良反应发生率、患者术后镇痛泵按压次数以及患者首次下地活动时间.结果 B组患者术中不同时间点MAP、HR的变化以及疼痛评分优于A组(P＜0.05);B组患者术中牵拉反射发生率明显低于A组(P＜0.05);两组患者术后2小时的疼痛评分比较差异无统计学意义(P＞0.05),但是B组患者术后4 ～36小时的疼痛评分明显优于A组(P＜0.05),B组患者术后不良反应发生率以及镇痛泵按压次数也少于A组(P＜0.05);B组患者首次下地活动时间明显提前于A组(P＜0.05).结论 超声引导下TAP阻滞用于剖宫产腰硬联合麻醉时成功率高,麻醉效果更加确切,不良反应少且术后持续镇痛效果好.

目的:探讨瑞芬太尼主导多维模式分娩镇痛对新生儿Apgar评分的影响及镇痛效果.方法:该院2012年6月～2013年6月共150例符合条件的足月产待产孕妇,将150例孕妇分为单一镇痛组、多维镇痛组和对照组,单一镇痛组孕妇给予瑞芬太尼自控式静脉用药,多维镇痛组给予瑞芬太尼、音乐疗法、经皮神经穴位电刺激疗法联合镇痛,对照组不给予分娩镇痛.比较3组孕妇分娩过程中的疼痛等级、各产程持续时间、对镇痛效果的满意度以及新生儿的Apgar评分.结果:多维镇痛组疼痛等级与单一镇痛组间无统计学差异(P＞0.05),但镇痛效果均显著优于对照组(P＜0.05).多维镇痛组第一产程持续时间显著低于单一镇痛组和对照组(P＜0.05),第二、第三产程持续时间3组产妇间无统计学差异(P＞0.05);多维镇痛组对镇痛的满意度显著高于单一镇痛组(P＜0.05);单一镇痛组1 min、5min新生儿Apgar评分分别为(9.89±0.65)分、(9.85±0.59)分,多维镇痛组分别为(9.83 ±0.58)分、(9.93±0.61)分,对照组分别为(9.86±0.66)分、(9.89±0.57)分,3组新生儿1 min、5 min新生儿Apgar评分无统计学差异(P＞0.05).结论:在瑞芬太尼自控式分娩镇痛的基础上,给予音乐疗法、经皮神经穴位电刺激疗法等多维镇痛,尽管不能降低产妇的疼痛等级,提高新生儿Apgar评分,但能够有效缩短第一产程持续时间,并提高产妇对于分娩镇痛的满意度.

目的：探讨瑞芬太尼静脉分娩镇痛在产程潜伏期的应用对产妇和新生儿的影响。方法选择经阴道分娩的初产妇300例随机分为Ⅰ组：潜伏期分娩镇痛，Ⅱ组：活跃期分娩镇痛，Ⅲ组：对照组，不用任何镇痛药物，每组100例。观察产妇疼痛视觉模拟评分（VAS），记录产程、分娩方式、新生儿 Apgar评分和不良反应。结果ⅠⅡ组VAS评分明显低于Ⅲ组，而头晕、恶心呕吐发生率明显高于Ⅲ组，但产科其他观察指标三组无统计学差异。新生儿Apgar评分和呼吸频率三组也无统计学差异。结论产妇自潜伏期开始使用瑞芬太尼静脉分娩镇痛可以明显缓解疼痛，而对产程和新生儿无不良影响。

OBJECTIVE To investigate the effect of intrathecal continuous infusion of small doses of sufentanil for labor analgesia.METHODS Forty ASA physical status Ⅰ or Ⅱ full-term primiparous parturients were randomly divided into two groups(Ⅰ group no epidural labor analgesia and Ⅱ group intrathecal sufentanil analgesia group),and each group was twenty women.VAS pain scores,uterine contractility,the first and second stage of labor time,utilization of oxytocin,mode of delivery and fetal Apgar score were observed when uterine cervical dilatation to 3cm,one hour later,two hour later,four hour later and the whole cervix.RESULTS Compared with Ⅰ group,Ⅱ group VAS pain scores decreased significantly after labor analgesia in Ⅱ group(P0.01),but uterine contractility,the first and second stage of labor time,utilization of oxytocin,mode of delivery and fetal Apgar was same in two group(P0.05).CONCLUSION Intrathecal continuous infusion of small doses of sufentanil for labor analgesia have excellent analgesic effect,have no effect on uterine contractility,the first and second stage of labor time,utilization of oxytocin,mode of delivery and fetal Apgar,and is a security,satisfactory analgesia method.

目的 探讨雷米芬太尼复合七氟烷联合喉罩麻醉在小儿眼科手术中的应用.方法 选取拟行眼科手术患儿48例,按随机数字表法分为雷米芬太尼复合七氟烷组(SR组)和雷米芬太尼复合普鲁泊福组(PR组),每组24例.监测记录麻醉前(T0)、麻醉诱导后(T1)、置入喉罩即刻(T2)、手术开始后15 min(T3)及手术结束时即刻(T4)的收缩压、舒张压、心率和脉搏血氧饱和度(SpO2).记录恢复自主呼吸、拔除喉罩以及恢复意识时间和苏醒期躁动、呛咳及拔除喉罩后恶心呕吐发生情况.结果 SR组T1及PR组T1～T4收缩压、舒张压、心率均较T0降低(P<0.05);PR组T2～T4收缩压、舒张压、心率较SR组同一时间点明显降低(P<0.05).两组各时间点SpO2无明显变化(P>0.05).SR组术中无一例出现体动,术后无躁动、呛咳、疼痛等发生;PR组术中有2例出现体动,拔除喉罩时有2例出现呛咳屏气,吸氧后缓解.SR组恢复自主呼吸时间、拔除喉罩时间及恢复意识时间均短于PR组(P<0.05).结论 雷米芬太尼复合七氟烷联合喉罩麻醉,操作简单且安全有效,对气道刺激小,血流动力学稳定,术后并发症少,苏醒迅速且彻底,可在小儿眼科手术中推广应用.

目的 观察丙泊酚复合瑞芬太尼靶控输注对人工流产止痛的疗效。方法 对1 10例早孕妇要求人工流产的孕妇，随机分为两组，瑞芬组：瑞芬太尼2 μg/L(靶控输注)+异丙酚1 mg/kg(静脉输注)55例；丙泊组：单用异丙酚2.0 mg/kg(静脉输注)55例。检测麻醉前、术中、醒后MAP、HR、SpO2和麻醉诱导时间、术后意识恢复时间、离院时间、镇痛效果及不良反应发生情况。结果 术中患者的MAP较用药前降低(P＜0.05)，术中瑞芬组患者呼吸抑制较明显，瑞芬组的SpO2低于丙泊组(P＜0.05)。术前麻醉诱导时间和离院时间瑞芬组均短于丙泊组(P＜0.05)。瑞芬组意识恢复时间虽略快于丙泊组，但二者差异无统计学意义(P＞0.05)。术中呼吸抑制在瑞芬组中较为明显，表现为患者呼吸浅且慢，SpO2下降。术后丙泊组不良反应主要为头晕，嗜睡，恶心和疼痛。结论 瑞芬太尼复合丙泊酚靶控输注静脉麻醉用于门诊人工流产手术，安全且有效，镇痛效果佳，患者苏醒快且彻底，麻醉后遗效应小，应广泛开展运用。

目的探讨妊娠期硬膜外麻醉的效果及对阻滞平面和范围的影响,评价妊娠是否能提高硬膜外麻醉对运动神经的阻滞效果。方法将择期在硬膜外麻醉下行剖宫产手术和子宫或卵巢切除的病人50例,分成妊娠手术组和非妊娠手术组,每组各25例。两组分别测试患者的头侧和尾侧平面,并在随后的5、10、15、20和25min及采用相同的电刺激方式,测试患者右侧L2、S1和S3区域的痛觉消失阈值。结果两组间患者体质量、向头侧扩散平面及向尾侧扩散平面有显著性差异,两组间运动评分无显著性差异,两组间L2、S1和S3区的疼痛阈值或线性回归斜率无显著性差异,两组组内S1和S3区的疼痛阈值明显低于L2,妊娠组L2和骶区的线性回归斜率也有显著性差异,痛阈和时间正相关。结论妊娠不能提高硬膜外麻醉下运动神经的阻滞效果。

AIM:To evaluate the preventive effect of tramadol on restlessness during palinesthesia in children.METHODS:Forty children undergong selective tonsillectomy and(or)adenoidectomy were included in the study and allocated randomly into tramadol group and control group.Arterial pressure,electrocardiogram,heart rate,peripheral oxygen saturation were monitored continuously during the operation,record the surgery time,anesthesia time,extubation time.At the time of palinesthesia,a blind observer accessed the Comfort score before extubation.RESULTS:There was no significant difference among the surgery time,anesthesia time,extubation time,postoperative hypoxemia,nausea and vomiting in two group.According to Comfort score,the satisfaction rate and the rate of inadequate sedation was significant different between the two group(P<0.05 or 0.01).According to the restlessness score:The rate of no or mild restlessness and the rate of severe restlessness was significant different between the 2 group(P<0.05).CONCLUSION:The preventive function of tramadol can make the favorable sedation effect during palinesthesia and decrease the restlessness at the time of extubation in children undergoing tonsillectomy and(or)adenoidectomy surgery,meanwhile,tramadol didn't prolong the extubation time or increase the rate of the postoperative hypoxemia,nausea and vomiting.

AIM:To access the surgical outcomes of early excision of corneal dermoids with isoflurane inhalation in infancy.METHODS:Eighteen patients aged from 1 to 6 months with corneal dermoids underwent simple excision.The incision was covered by conjunctiva or amniotic membrane under isoflurane inhalation.Intravenous inhalational anesthesia was adopted.RESULTS:The lesions of all 18 cases were located near the limbus of the cornea in the inferotemporal quadrant,and could only rarely be observed in more central regions of the cornea existed.The way of isofluane inhalation was safe to children and supported by operation at early age.With 6 months to 5 years follow-up,17 cases postoperative results reached to uncomplicated healing with cosmetic improvement,only 1 case recurrent.CONCLUSION:Surgical interventions in children of corneal dermoids with isoflurane inhalation before 6 months are recommended.

眼部手术或牵拉眼外肌时,使迷走神经兴奋性增强,加强食管和胃的蠕动,出现恶心、呕吐或腹痛等胃肠功能紊乱称眼-胃反射(oculogastvic reflex).眼-胃反射可发生在术中或术后,有时呕吐为持续性,也有术后数日不能进食,严重者可因呕吐出现脱水及电解质紊乱.

我科应用体表胃电描记法对静吸复合麻醉下,斜视手术前儿童进行了胃电活动(GMA)监测,现将观察、研究结果进行报告,以探讨麻醉对胃电活动的影响.

临床资料与方法本组病例100例,其中对照组50例.全部病例男性60例,女性40例,新生儿及婴幼儿各占50%,其中5例为极低体重儿仅1.8～2.5kg.手术种类:新生儿肠道畸形35例,嵌顿疝20例,急性肠套叠20例,肾胚胎瘤15例,颌面部手术10例.选择性手术,术前常规禁食6h,禁水4h.麻醉前30min肌注阿托品0.02mg.kg-1,新生儿肌注海俄辛0.01mg.kg-1.麻醉诱导方法:为了对照观察本组病例均分为两组即快诱导组和慢诱导组.快诱导以字母Q表示,慢诱导以字母S表示.Q组诱导方法为:静注1%氨胺酮2mg.kg-1、咪唑安定0.2mg.kg-1、万可松0.1mg.kg-1.S组诱导方法为:静注1%氨胺酮2mg.kg-1、γ-羟其丁酸钠80mg.kg-1、咪唑安定0.2mg.kg-1.两组病例均在气管插管前行面罩给氧、去氮,插管后全部病例均接麻醉机,行机械控制呼吸和静吸复合麻醉.S组病例在插管后给予万可松0.1mg.kg-1.全部病例均采用静吸复合维持麻醉.术中均采用连续SpO2、ECG监测.

幼儿麻醉前用药及给药途径很多.本文评价麻醉前咪唑安定或氯胺酮经鼻给药对幼儿镇静效果的影响.

梗阻性黄疸在新生儿期甚为多见,部分病例早期诊断困难,本组5例经腹部B超、CT、MRCP等检查无法鉴别是先天性胆道闭锁还是新生儿肝炎,经腹腔镜检查,3例确诊为新生儿肝炎,2例为新生儿胆道闭锁,并得到相应及时治疗.