目的 分析神经阻滞麻醉联合全麻在髋关节置换术患者中的麻醉效果.方法 回顾性分析80例髋关节置换术患者的临床资料,依据麻醉方案不同,分为观察组(给予神经阻滞麻醉联合全麻)与对照组(给予全麻),各40例.比较两组麻醉效果、生命体征.结果 观察组苏醒、拔管时间短于对照组,丙泊酚、瑞芬太尼用量少于对照组(P＜0.05);麻醉后,两组血氧饱和度(SpO2)均未发生明显变化,且两组SpO2比较差异无统计学意义(P＞0.05);与麻醉前比较,对照组麻醉后平均动脉压(MAP)、心率(HR)均上升,但观察组麻醉后MAP、HR低于对照组(P＜0.05).结论 神经阻滞麻醉联合全麻对髋关节置换术患者麻醉效果佳,可促进苏醒及拔管,有利于减少镇痛药剂量及稳定患者生命体征.

目的 观察地佐辛术后镇痛对硬腰联合麻醉下老年患者术后认知功能的影响.方法 择期行下肢骨科手术患者120例,年龄70～ 82岁,ASAⅡ～Ⅲ级,均采用硬腰联合麻醉.患者随机分为3组(n=40),无术后镇痛组(C组)、地佐辛静脉镇痛组(D组)和硬膜外自控镇痛组(E组).C组给予等容量的生理盐水,D组使用地佐辛35mg+托烷司琼5mg+生理盐水至100ml;E组使用舒芬太尼50μg+1％罗哌卡因30ml+生理盐水至100ml.分别于术前1d、术后1d、3d、5d和7d由本院同一心理医生对患者进行一次简易智力状态检测评分(MMSE).结果 术前1d,3组患者的MMSE评分差异无统计学意义(P＞0.05).术后1d和3d,D组和E组与C组比较,评分差异有统计学意义(P＜0.05),D组与E组比较差异无统计学意义(P＞0.05).术后5d和7d,3组评分差异无统计学意义(P＞0.05).结论 地佐辛静脉镇痛可安全用于老年下肢手术患者,且可降低老年患者术后认知功能的发生率.

目的 研究核潜艇远航期间艇员动脉血二氧化碳分压(PaCO2)的变化,寻找吸入二氧化碳浓度(FICO2)和动脉血二氧化碳分压的线性相关关系.方法 某型核潜艇执行远航任务期间,采用改良后的氧烛-氢氧化锂的荆量和比例,在水上航行第3天(T1)、潜航第10天(T2)、第20天(T3)、第30天(T4)4个时间点测定艇员的PaCO2变化,并记录测定时间点的FICO2,利用统计学软件计算两者的相关性.结果 血气分析结果显示,T3与T4时间点的PaCO2明显高于T1扣T2时点,差异有统计学意义(P＜0.05),且艇员FICO2与PaCO2具有线性相关关系.结论 核潜艇远航中及时合理调整氧烛-氢氧化锂剂量和比例有助于维持艇员正常的生理状态.为维护艇员PaCO2生理水平,需将舱室CO2浓度维持到0.39％以下.

剖宫产术后早期泌乳是促进产妇康复和确保母乳喂养的关键[1].血清泌乳素(prolactin, PRL)水平是决定泌乳时间和量的关键因素[2].剖宫产术后疼痛可抑制泌乳素的分泌[3-4].纳布啡是一种阿片受体激动-拮抗剂(κ受体激动、μ受体拮抗),其起效迅速,能够有效抑制内脏痛,可安全用于剖宫产术后镇痛[5].既往研究报道,纳布啡能够增加健康受试者的血清泌乳素水平[6] ,但其对剖宫产产妇术后PRL的影响尚不清楚.本研究旨在探讨纳布啡用于剖宫产术后患者自控静脉镇痛( patient-controlled intravenous analge-sia, PCIA)的效果及对PRL水平的影响,为纳布啡用于剖宫产术后镇痛提供参考.

Objective: To investigate the efficacy of dexmedetomidine on postoperative nausea, vomiting and pain in patients with laparoscopic cholecystectomy. Methods: A total of 180 patients subjected to laparoscopic cholecystectomy were divided into three groups based on a random number table, with 60 patients in each group. In the control group, 4 mg of ondansetron was administrated intravenously after the operation. As for the observation group, 0.5 mu g/kg dexmedetomidine was intravenously given 10 minutes before anesthesia induction, then, the infusion velocity was maintained at 0.5 mu g.kg(-1).h(-1). In the blank group, no dexmedetomidine nor ondansetron was administrated. Patients in all groups were subjected to intravenous-inhalation combined anesthesia. Extubation time, inhalation anesthesia time and sevoflurane consumption, as well as the incidences of nausea and vomiting at 8 h, 24 h and 48 h after surgery were compared in the three groups. Mean artery pressure (MAP) and heart rates at different moments were also compared. Results: By contrast with the control group and blank group, inhalation concentration of sevoflurane was significantly lower in the observation group (P<0.001); the incidences of nausea and vomiting at 8 h, 24 h and 48 h in the blank group were all significantly higher than those in the observation and control groups (P<0.05). There were no differences in heart rates at T-1 (entering the operating room) among the three groups (P>0.05); however, heart rates at T-2 to T-7 (T-2, before tracheal intubation; T-3, 5 minutes after tracheal intubation; T-4, after 5-minutes operation; T-5, after 30-minutes operation; T-6, skin suturing; T-7, 5 minutes after tracheal extubation) in the observation group were significantly below those in control and blank groups (all P<0.05). No significant difference was found in MAP among the three groups (P>0.05). Preoperative pain score in the observation group exhibited no differences compared with control and blank groups; postoperative pain scores at 6 h and 24 h in the observation group were lower than those in the control group (both P<0.05). Conclusion: Dexmedetomidine plays a role in effectively lowering the incidences of nausea and vomiting for patients undergoing laparoscopic cholecystectomy and alleviating their pain sensations.

目的 调查核潜艇远航期间艇员心理健康状况,并分析相关影响因素.方法 对三次执行核潜艇长航任务的126名艇员在远航前封舱期和返航后采用症状自评量表(SCL-90)和艾森克个性问卷(EPQ)进行测评和结果比较.结果 核潜艇长航后SCL-90量表中,除人际关系敏感、偏执及精神病性外,其他因子分与中国军人常模相比,差异有统计学意义(P＜0.05).核潜艇远航后EPQ精神质(P)分、神经质(N)分明显高于封舱期(P＜0.05),内外向(E)分和掩饰(L)分远航前后无明显差异(P＞0.05).结论 核潜艇远航特殊的生活和作业环境造成了艇员心理健康水平的下降,针对核潜艇远航特点应给与必要的心理干预.

Objective To study the effect of different regulation modes of the air in cabin on the arterial blood gas of mariners during a prolonged voyage in a nuclear submarine. Methods During three long distance voyages of the same nuclear submarine, the same air-regeneration device was adopted. According to the different doses and percentages of the oxygen-lithium hydroxide absorbers, the mariners of three voyages were divided by sequence of voyages into control group (C), observation group 1 (A), and observation group 2 (B). The change in arterial blood PaO2 and PaCO2 of mariners in the three groups were detected on the third day of surface navigation (T1), 10th day (T2), 12nd day (T3), 13th day (T4) of submarine navigation, and the day before returning (T5). Result There was no difference between the three groups in T1 and T2 (P>0.05). There was a significant difference in PaO2 and PaCO2 between the two observation groups and the control group on T3, T4 and T5 (P<0.05). Conclusions Different amount and percentage of the oxygenlithium hydroxide showed an influence on PaO2 and PaCO2 of the mariners. Optimal amount and percentage of the oxygen-lithium hydroxide is very important in keeping normal physiological status of mariners in a nuclear submarine. DOI: 10.11855/j.issn.0577-7402.2015.03.14

Objective To observe the effects of dexmedetomidine on hemodynamics of the patients with intracranial aneurysm under going transcatheter embolization in induction period of general anesthesia. Methods The Admitted in author's hospital the 60 patients with intracranial aneurysm (ASAⅠ-Ⅱ) under going transcatheter embolization were randomly divided into control group (C) and dexmedetomidine group (D),30 cases for each. Before the induction,the patients in the two groups received dexmedetomidine 0.4 μg/kg or equivalent normal saline with in 15 minutes,respectively. All the patients got the same anesthetics for induction. The parameters of systolic blood pressure (SBP),diastolic pressure (DBP),mean arterial pressure (MAP),heart rate (HR) of every patient were recorded at the following time-points:before anesthesia induction (T0),before and immediately endotracheal intubation (T1 and T2),1,3and 5 minutes after intubation (T3,T4 and T5). Results Compared with group C,all parameters were lower at T0. All paremeters of all patients rised. But the extent of rise in group C was obvious(P<0.05). There was no significant difference at T5(P>0.05). Conclusion Infusion of DEX is efficient to control the fluctuation of haemodynamics of induction perios in the patients under going transcatheter embolization for intracranial aneurysm. Accordingly the risk of aneurysm ruptured decreased.

2011年至2013年期间，笔者所在医院奉命随海军某型核潜艇先后执行了4次战备远航卫勤保障任务，累计航程×××××海里、航行时间长×××d，其中水下潜航×××d。通过数次远航卫勤保障工作的开展，笔者对艰苦、恶劣环境下，特别是核潜艇远航期间卫勤工作展开有了更深的了解与体会，现将其特点及经验做法介绍如下。

Objective To study the effects of synthesized intervention measures on improving the level of serum electrolyte in nuclear submariner during submerged voyage,so as to provide scientific basis for working out measures of health security. Methods The submariners were divided into two groups: intervention group,and non-intervention group. The intervention group was given some synthesized intervention measures such as taking electrolyte enriched food,multivitamin 29,calcium carbonate D3,and fluorescent lamp shining,etc. The level of serum Na+,K+,Ca2 +was examined before sailing,and on the 3rd d,10th d,20th d,and 30th d of sailing. Results( 1) The incidence of hypokalemia in non-intervention group,and intervention group was 35%,and 5% respectively( P 0.05); that of hypocalcemia 37. 5%,and 10% respectively( P 0. 05).( 2) The level of serun K+in non-intervention group on the 10th d 〔( 3. 52 ± 0. 21) mmol /L〕,20th d 〔( 3. 55 ± 0. 23) mmol /L〕,and 30th d 〔( 3. 6 ± 0. 17)mmol /L〕was lower than that before sailing,as well as on the 3rd d〔( 4. 05 ± 0. 84),( 3. 80 ± 0. 23) mmol /L respectively〕( P 0. 05).( 3) The levels of serum K+,Ca2 +during submerged voyage in intervention group were not significantly different from those before voyage( P 0. 05),but were lower than those at the corresponding time in non-intervention group( P 0. 05). Conclusion The synthesized intervention mesures could reduce the incidence of hypokalemia and hypocalcemia in the submariners during submerged voyage.