目的:在麻醉/脑电意识监测系统(Narcotrend)指导下,比较瑞芬太尼和芬太尼联合丙泊酚全麻诱导时对经口气管插管患儿血压和心率的影响.方法:选择进行经气管插管全麻手术患儿60例,年龄3～10岁,美国麻醉医师协会分级I级,随机分为瑞芬太尼组(R组)和芬太尼组(F组).丙泊酚静脉泵注,待Narcotrend指数(NI)在D2～E1时,静脉注射顺式阿曲库铵0.2 mg/kg,R组给予瑞芬太尼2μg/kg,F组给予芬太尼3μg/kg,随后在可视喉镜下经口气管插管.调整丙泊酚输注速度,使NI维持在D2～E1.监测患儿入室后基础值(T1)、麻醉诱导用药后(T2)、插管即刻(T3)和插管后1、3、5、7 min(T4、T5、T6、T7)的血压和心率;记录NI首次达D2～E1时丙泊酚输注量.结果:R组患儿在T3～T5的心率、T3～T4的血压均低于F组,差异均有统计学意义(均P＜0.05).结论:丙泊酚联合瑞芬太尼2μg/kg较芬太尼3μg/kg能更有效的抑制经口气管插管全麻诱导对患儿血压和心率的影响.

目的:观察地佐辛联合酮咯酸氨丁三醇超前镇痛预防小儿全麻苏醒期躁动的有效性和安全性.方法:选择在全麻下行腹腔镜阑尾切除术的患儿90例,ASA Ⅰ～Ⅱ级,随机分为3组,每组30例,于麻醉诱导前分别给予地佐辛0.1 mg/kg(Ⅰ组),地佐辛0.1 mg/kg及酮咯酸氨丁三醇0.5 mg/kg (Ⅱ组)、生理盐水10 mL (Ⅲ组).记录3组手术结束至拔管的时间,从手术结束至拔管后30 min内的躁动发生率、PAED评分及FLACC评分和手术结束24 h内的不良事件发生情况.结果:3组从手术结束至拔管的时间差异无统计学意义.Ⅰ组和Ⅱ组患儿的躁动发生率、PAED评分和FLACC评分均明显低于Ⅲ组(P＜0.05),Ⅱ组患儿的躁动发生率、PAED评分和FLACC评分明显低于Ⅰ组(P＜0.05).3组患儿手术结束后24 h内的不良反应发生情况差异无统计学意义.结论:地佐辛联合酮咯酸氨丁三醇可安全有效地预防小儿全麻苏醒期躁动.

Objective To explore the effect of morphine on the neurological behavior,the expression of growth associated protein-43 (GAP-43) and nerve growth factor (NGF) in the dorsal root ganglion in neuropathic pain rat model induced by peripheral nerve chronic constriction injury.Methods Sixty-five SD rats were randomly divided into normal group (n =5),chronic constriction injury of the sciatic nerve (CCI) group (n =20),NS group (n =20,CCI + 0.9％ sodium chloride) and M group (n =20,CCI + morphine).The rats in CCI,NS,M groups were divided equally into 4 subgroups according to the time points (1,3,7 and 14 days after surgery).In surgery,the right sciatic nerve was injured and the left side nerve was as a normal control.The morphine was given with a dosage of 5 mg/kg.The mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL) of the rats in CCI,NS,M groups 1,3,7 and 14 days after operation were measured;the dorsal root ganglions of injured sciatic nerves were harvested and immunohistochemistry was used to examine the expression of GAP-43 and NGF.Results Compared with those in normal group,the MWT and TWL in CCI,NS,M groups were significantly decreased 3 days [(7.3 ± 1.2),(7.2 ±0.9),(12.6±1.6) g vs (14.8 ±0.6) g;(1.07 ±0.05),(1.05 ±0.06),(1.31 ±0.16) s vs (1.45 ±0.11) s],7days [(5.9±0.7),(5.8 ±0.6),(7.9±0.8) gvs (14.8±0.7) g;(0.97±0.05),(0.96±0.05),(1.10±0.12) s vs (1.45±0.10) s] and 14 days after surgery [(4.3 ±0.4),(4.5±0.7),(5.4±0.6) gvs (14.8±0.5) g;(0.86±0.04),(0.88±0.07),(1.01 ±0.06) s vs (1.45 ±0.12) s] (P＜0.01).The expressions of GAP-43 and NGF in the dorsal root ganglion had a significant increase in CCI,NS,M groups compared with those in control group3 days [(114.8±6.3),(118.8±6.4),(94.4±5.2) vs (62.2±2.5);(134.0±3.8),(131.5±3.6),(98.3±3.6) vs (71.6±3.4)],7 days [(118.0 ±4.3),(122.4 ±5.5),(89.7 ±3.0) vs (62.2 ±2.5);(120.4 ±4.7),(118.9 ±4.4),(103.2 ±7.2) vs (71.6 ±3.4)] and 14 days after surgery [(140.2 ±5.2),(135.7 ±5.9),(84.5±8.1) vs (62.2±2.5);(117.9±4.1),(116.5±5.9),(95.4±3.6) vs (71.6±3.4)] (P＜0.01).Compared those in NS group,the MWT and TWL were significantly increased and the expressions of GAP-43 and NGF were significant declined in M group at the same time points (P ＜0.01).Conclusion Morphine can effectively relieve the symptom of heat and mechanical hyperalgesia after CCI,and it can also inhibit the high expression of GAP-43 and NGF.

目的:探讨低浓度罗哌卡因局部麻醉在婴儿唇裂修复术后的镇痛效果和安全性.方法:唇裂修复术婴儿80例随机分为对照组(0.5％利多卡因)和3个实验组(R1组0.15％,R2组0.2％和R3组0.25％罗哌卡因).患儿全麻后予局麻药术区局麻,记录患儿术后1、2h疼痛评分.结果:各组均安全度过围术期,对照组术后疼痛评分均明显高于R2、3组(P＜0.05);R2、3组术后1、2h疼痛评分均＜3分,两组评分差异比无统计学意义.结论:0.2％罗哌卡因局部麻醉在婴儿唇裂修复术后镇痛效果好,安全性可.

目的:探讨腭裂患儿气管导管内径型号的选择.方法:分析222例(1～6岁)全麻插管下行腭裂修复术患儿的年龄与管径型号的关系.结果:本组年龄与管径型号显著相关(P＜0.01):1岁选用3.5号导管,2～3岁4号,4～6岁4.5号.结论:根据年龄段按新的参照关系能有效指导腭裂患儿气管导管内径型号的选择.

Objective:To study the effect of orotracheal endotracheal intubation by Discopo endoscope in patients scheduled for general anesthesia. Method:40 ASA Ⅰ-Ⅱ patients without difficult airway were randomly divided into Discopo endoscope group(D group) and Macintosh direct laryngoscope group(M group),20 cases in each group.After a routine intravenous anesthetic induction,orotracheal endotracheal intubation was performed with Discopo endoscope or direct laryngoscope.The systolic blood pressure,diastolic blood pressure and heart rate of patients were recorded respectively at the time before anesthesia induction,before intubation,immediately after intubation and 2 minutes after intubation.Time required for intubation,successful intubation in once,traumatic and complications of intubation were also recorded.Result:Intubation time of D group was shorter than that of M group(P<0.05),successful intubation in once was higher than M group,traumatic and complications of intubation were less than M group(P<0.05),hemodynamics in T2 and T3 were better than M group(P<0.05). Conclusion:Application of Discopo endoscope for orotracheal endotrachealintubation is safe and effective,and should be promoted.

Objective To compare the effects of bronchovideoscope and fiberoptic bronchoscope guided endotracheal intubation in patients undergoing cervical surgery.Methods Thirty-two patients undergoing cervical operations under general anesthesia were randomly divided into bronchovideoscope group(Group A) and fiberoptic bronchoscope group(Group B).Intubation time,intubation success rate,intubation-related complications,mean blood pressure(MBP) and heart rate(HR) before anesthesia induction(T0),immediately before(T1) and after(T2),5 min(T3) after tracheal intubation were recorded.Results MBP and HR of both groups decreased at T1,increased at T2 and decreased again at T3(P0.05).Compared with group A,the intubation time of group B was longer(P0.01) with one failed on the first attempt.There was no significant difference in the intubation related complication between two groups.Conclusion Compared with group B,bronchovideoscope technique could shorten the endotracheal intubation time with higher success rate of one-tine intubation in patients undergoing cervical surgery.

目的:探讨胸片预测腭裂小儿气管导管内径(ID)的效果.方法:数字化X光胸片测量患儿第6颈椎(C6)的气管内径,通过与实际插管型号的关系推导出预测公式(推导组),以此胸片公式预测ID(验证组),与年龄公式进行统计学比较.结果:得到胸片公式为ID (mm) =0.5×气管内径(mm)+0.6.C6气管内径与ID存正相关(r=0.944,P＜0.01).预测成功率87.1％,高于年龄公式的50.9％ (P＜0.01).结论:应用胸片能有效预测1～6岁腭裂小儿的ID.

目的:探讨电子支气管镜引导经鼻气管插管在颌骨骨折患者中的应用效果。方法:经鼻气管插管全麻下行颌骨骨折手术患者(32例)随机分为电子支气管镜(A)组和直接喉镜(B)组,记录两组麻醉诱导前(T0)、气管插管前即刻(T1)、气管插管后即刻(T2)、插管后5min(T3)的平均动脉压(MAP)、HR、插管时间及插管相关并发症。结果:与T0比,两组在T1的MAP和HR显著降低(P<0.01),T2明显升高(P<0.01),T3 B组MAP、HR再次降低(P<0.01,P<0.05),A组MAP降低但HR加快(P<0.01)。两组插管时间比无统计学意义。A组气管插管并发症少于B组(P<0.05)。结论:电子支气管镜引导插管技术具有快速准确、不受张口度影响、并发症少和高安全性的优点。

Objective To compare the effects of volume replacement with sodium potassium magnesium calcium and glucose injection and glucose injection on pediatric intraoperative blood glucose.Method 40 ASAⅠ~Ⅱ pediatric patients aged 1~6 years old were randomly divided into experimental group(group E,n=20) and control group(group C,n=20).Group E was infused with sodium potassium magnesium calcium and glucose injection while group C was infused with glucose injection.Arterial blood glucose was measured before infusion,1 hour and 2 hours after infusion.The operative time was not more than two hours and intraoperative blood loss was less(small).Result Blood glucose concentration fluctuated in group E less than in group C.There were significant differences between the two groups(P<0.05).Conclusion Sodium potassium magnesium calcium and glucose injection can not only provide energy,but also have litter effect on blood glucose in pediatric operation.

目的:观察全麻诱导前预注阿托品对芬太尼诱发咳嗽的影响.方法:100例拟行全麻择期手术患者随机均分为阿托品组(A组)和对照组(C组),两组分别于静脉注射芬太尼3μg/kg(3 s内注射完毕)前5min预注阿托品0.5 mg或生理盐水1 mL.记录预注阿托品或生理盐水前(T0)、预注后5 min(T1)、注射芬太尼后1 min (T2)、2 min(T3)的血流动力学改变和芬太尼注射后2 min内出现的咳嗽反应.结果:两组咳嗽发生率分别为30％和34％(A组为15例,C组为17例,P＞ 0.05),两组间差异无统计学意义.A组在T1、T2、T3时HR明显加快,T1和T2时MBP明显升高(P＜0.01).C组在T2和T3时HR减慢(P＜0.05).结论:全麻诱导前预注阿托品0.5 mg并未能降低芬太尼诱发咳嗽的发生率.

Objective To observe the clinical effect of pentazocine on revival period. Methods Ninety patients (ASAⅠ～Ⅱ grade) under general anesthesia were randomly divided into Group A, B, C with 30 cases in each group, which were given respectively normal saline 2 ml, Lornoxicam 0.2 mg/kg and pentazocine 0.5 mg / kg iv, 30 minutes before operations ended. Heart rate (HR) and the mean arterial pressure (MAP) before anesthesia (T1), endotracheal extubation (T2) and 5 minutes after extubation (T3) were recorded. Agitation score at T2 , the ramsay sedation score and the VAS pain score at T 3 were observed. Duration from the end of the operation to the extubation was also recorded. Results HR and MAP obviously raised at T2 among groups(P0.05), which were also increased markedly at T3 in Group A (P0.05) but not in Group B and C. HR and MAP at T2 and T3 in Group B and C were obviously lower than those in Group A (P0.05). Agitation score at T2 was significantly lower in Group B and C than those in Group A (P0.05). Sedation and pain scores at T3 were obviously better in Group C and Group B than those in Group A (P0.05). Sedation score was better in Group C than those in Group B (P0.05). Conclusion 0.5 mg / kg pentazocine intravenous injection before 30 min of the end of the surgery did not affect extubation time and could effectively enhance the analgesic effect.

目的:观察静注氯诺昔康对患者静注芬太尼诱发呛咳反应的预防作用。方法:择期全麻手术患者60例随机分为对照组(30例。静注0.9%NS2mL)和实验组(30例。静注氯诺昔康8mg)。15min后麻醉诱导:依次静注咪达唑仑0.1 mg/kg、芬太尼2.0μg/kg(时间<2 s)、丙泊酚1.5mg/kg、顺阿曲库铵0.2mg/kg。注药完毕后2min行气管插管。插管前观察呛咳发生情况。结果:与对照组比,实验组呛咳发生率和程度降低(P<0.05);余指标比无统计学意义。结论:静注氯诺昔康能有效预防患者全麻诱导期芬太尼诱发的呛咳反应。

Objective: To observe the efficacy and safe of dezocine on prevention of emergence agitation in patients undergoing laparoscopic cholecystectomy(LC).Methods: Ninety patients(ASA Ⅰ～Ⅱ grade)undergoing LC under general anesthesia were ramdonly divided into Group Ⅰ～Ⅲ with 30 cases in each group,which were given respectively normal saline 2 mL,lornoxicam 0.2 mg/kg and dezocine 0.1 mg/kg iv.30 minutes before operations ended.Heart rate(HR)and the mean arterial pressure(MAP)before anesthesia(T1),endotracheal extubation(T2)and 5 minutes after extubation(T3)were recorded.Agitation score at T2,the Ramsay sedation score and the VAS pain score at T3 were observed.Duration from the end of the operation to the extubation was also recorded.Results: HR and MAP obviously raised at T2 among groups(P0.05),which were also increased markedly at T3 in Group Ⅰ(P0.05)but not in Group Ⅱ and Ⅲ.HR and MAP at T2 and T3 in Group Ⅱ and Ⅲ were obviously lower than those in Group Ⅰ(P0.05),which had no difference between Group Ⅱ and Ⅲ.Agitation score at T2 was significantly lower in Group Ⅱ and Ⅲ than in Group Ⅰ(P0.05)but had no difference between Group Ⅱ and Ⅲ.Sedation and pain scores at T3 were obviously better in Group Ⅱ and Group Ⅲ than in Group Ⅰ(P0.05).Sedation score was better in Group Ⅲ than in Group Ⅱ(P0.05)and the pain score between Group Ⅱ and Ⅲ had no difference.Duration from the end of operation to extubation had no statistic differences among groups.Conclusion: Dezocine can effectively and safely prevent emergence agitation in patients undergoing LC.

<正>瑞芬太尼是一种具有超短半衰期的强效阿片类镇痛药,但停药后爆发性疼痛的出现常使患者在苏醒期发生躁动。局部浸润麻醉则能提供围术期镇痛,此前国内在小儿腭裂修复术中局麻药多为利多卡因,对采用新型长效局麻药罗哌卡因的报道甚少。本研究探讨瑞芬太尼复合罗哌卡因局部浸润用于小儿腭裂修复术的麻醉及术后镇痛的效果。一、资料与方法 1.一般资料:选择2010年4月至2011年12月在汕头大学医学院第二附属医院择期全麻下行腭裂修复术患儿40例为研究对象,ASAⅠ～Ⅱ级,男27例,女13例,年龄1～3岁,体重8～15kg。随机分为瑞芬太尼组(R组),瑞芬太尼复合罗哌卡因组(C组),每组20例。

目的 比较全凭静脉麻醉下手控辅助呼吸与静吸复合麻醉下机械通气两种不同方法,用于经数字减影血管造影(DSA)行颅内动脉瘤电解可脱性弹簧圈(GDC)栓塞术的麻醉特点.方法 随机选择32例ASA(Ⅱ-Ⅳ)级患者,比较两种麻醉方法(气管插管静脉全身麻醉和不行气管插管静脉全身麻醉)的手术时间、术中低氧血症及偶有躁动的情况.结果 与不行气管插管组比较,气管插管组术程术中低氧血症发生较少且程度轻,并且几乎没有躁动,手术过程较为顺利.结论 行DSA治疗的麻醉方法选择气管插管全身麻醉,可提高手术成功率和安全性,降低并发症.

Objective:To study the effect and the feasibility of nicardipine combined with esmolol for controlled hypotension during palatoplasty.Methods:Forty ASA Ⅰ～Ⅱ patients with Ⅱ～Ⅲ degree of cleft palate were randomly divided into controlled hypotension group and control group,20 for each group.The mean arterial blood pressure(MAP)and heart rate(HR)between two groups were recorded respectively before anesthesia induction,15 minutes after the beginning of the operation,at the end of operation and when eyes opened for extubation.The duration of operation,the time for extubation,and the score of operative field were also recorded.Results:There were no significant difference in MAP and HR between two groups before anesthesia induction.MAP and HR in the controlled hypotension group were significantly lower at 15 minutes after the beginning of the operation and at the end of operation than those in the control group(P0.05).For extutation,the MAP in the controlled hypotension group was significantly lower than that in the control group(P0.05),but the HR had no statistical difference.The duration of operation in the controlled hypotension group was significantly shorter than that in the control group(P0.05).The score of operative field was significantly lower in the controlled hypotension group(P0.05).There was no statistical difference for time of extubation.Conclusion:Nicardipine combined with esmolol for controlled hypotension during palatoplasty is safe and effective,and should be promoted.

目的 比较PVC气管导管和加强型气管导管这两种导管在室温下和60 ℃温箱热软化后经鼻插管时鼻出血机率的差别.方法 100例病人随机分为4组,每组25例:分别为室温PVC导管组和室温加强型导管组,60 ℃热软化PVC导管组和60 ℃热软化加强型导管组;经标准的麻醉诱导,充分的润滑后进行气管插管,插管时观察病人鼻出血的情况.结果 4个组的鼻出血几率依次为18/25、14/25、4/25和5/25.经60 ℃温箱热软化后的两种气管导管均比室温下的同种导管引起鼻出血的机率明显降低(P＜0.05),而两种导管无论是在室温下还是60 ℃温箱热软化后经鼻气管插管时鼻出血的几率其差别均无统计学意义(P＞0.05).结论 60 ℃温箱对气管导管进行热软化能显著降低经鼻气管插管时的鼻出血,而这两种气管导管无论在室温下或者60 ℃温箱热软化后,经鼻插管时鼻出血的几率相当.

Objective: To investigate the effect of dezocine on prevention of emergence agitation.Methods: One hundred and eighty patients undergoing elective surgeries under general anethesia were ramdonly devided into NS,fentanyl and dezocine groups(each was given respectively normal saline 2 mL,fentanyl 1 μg/kg and dezocine 0.1 mg/kg i.v 15 minutes before operations ended).The level of restlessness and pain scores during analqesia period were recorded.Spontaneous breath recovery time,extubation time,respiratory rate at 5 minutes after extubation,and side-effects were recorded as well.Results: The level of restlessness and pain scores were significantly lower in fentanyl and dezocine groups than that in NS group(P0.05).The spontaneous breath recovery time and extubation time in fentanyl group were longer those that of NS group(P0.05),the respiratory rate at 5 minutes after extubation in fentanyl group were less than that of NS group(P0.05),the incidence of side-effects as less in dezocine group,compared to NS and fentanyl group(P0.05).Conclusion: Dezocine can safely and effectively prevent the incidence of emergence agitation,so that to ensure the patients during analqesia period.

目的:探讨潮汕地区腭裂儿童的体质量与气管导管内径的关系。方法:回顾性分析262例(1～12岁)行腭裂修复手术儿童的临床资料。麻醉诱导后行气管插管,记录本组体质量、年龄及气管导管内径,并进行统计学处理。结果:本组体质量、年龄均与气管导管内径存在线性正相关,Pearson相关系数分别为0.845 5和0.843 6,P<0.001。结论:腭裂儿童体质量可用于估算气管导管内径,且与用年龄估算气管导管内径比,用腭裂儿童体质量估算气管导管内径也不失为一种好方法。