目的：观察右美托咪定联合利多卡因对芬太尼全麻诱导期诱发呛咳反应的影响。方法：选择240例ASAⅠ-Ⅱ级择期行全麻手术患者，随机分为4组（n＝60），对照组给予生理盐水0．15 mL／kg＋生理盐水0．05 mL／kg；右美托咪定组给予右美托咪定0．5μg／kg＋生理盐水0．05 mL／kg；利多卡因组给予利多卡因0．5 mg／kg＋生理盐水0．05 mL／kg；右美托咪定＋利多卡因组给予右美托咪定0．5μg／kg＋利多卡因0．5 mg／kg。麻醉诱导时先于2 s内快速静脉注射芬太尼3μg／kg，2 min后给予其他药物行全麻诱导，记录芬太尼注射后1 min内呛咳反应的发生率、呛咳程度及发生时间；记录给药期间低血压及严重心动过缓的发生情况。结果：与对照组比较，其他3组的呛咳发生率及轻度反应程度明显降低（P＜0．05或P＜0．01），右美托咪定＋利多卡因组中、重度呛咳发生率降低（P＜0．05）；利多卡因组与右美托咪定组呛咳反应发生率间差异无统计学意义；与右美托咪定组、利多卡因组比较，右美托咪定＋利多卡因组呛咳反应的发生率明显降低（P＜0．01）；4组患者芬太尼诱导呛咳的发生时间及低血压、严重窦性心动过缓发生率比较差异均无统计学意义（P均＞0．05）。结论：右美托咪定联合利多卡因能有效抑制芬太尼诱发的呛咳反应。

Objective To evaluate the effects of premedication with intravenous dizocine on fentanyl-induced cough.Methods One hundred ASA Ⅰ or Ⅱ patients undergoing elective surgery were randomly devided into two groups with 50 cases in each group. Five minutes before fentanyl bolus (3 g/kg) iv, patients received either dizocine (5mg diluted to 4 ml with normal saline; group D) or normal saline (4 ml; group C). Two minutes after intravenous injection of fentanyl bolus, the frequency and intensity of coughing were observed. SBP, DBP, HR were recorded before and after intubation.Results The cough frequency was significantly lower in group D than that in group C (2% vs 24%,P<0.01).Conclusion Premedication with intravenous dizocine 5mg may effectively reduce fentanyl-induced cough.

目的:观察预先静脉注射右旋美托咪啶对芬太尼诱发咳嗽反射的影响。方法:100例美国麻醉师协会(ASA)Ⅰ～Ⅱ级择期手术患者,随机分为右旋美托咪啶组(M组)和对照组(C组),每组50例。M组和C组分别于麻醉诱导前静脉注射右旋美托咪啶0.4μg/kg(10 min注射完毕)和等量生理盐水,5 min后于5 s内静脉注射芬太尼3μg/kg,观察2 min,记录芬太尼诱发咳嗽反射的例数和强度;监测并记录麻醉前(T0)、静脉注射右旋美托咪啶(生理盐水)5 min后(T1)、气管插管前即刻(T2)、气管插管后即刻(T3)、气管插管后1 min(T4)气管插管后3 min(T5)、气管插管后5 min(T6)收缩压(SBP)、舒张压(DBP)、心率(HR)的变化。结果:M组芬太尼诱发咳嗽反射的发生率明显低于C组(P<0.05)。与T0时间点相比较,M组T1～T6时间点SBP、DBP、HR均显著降低(P<0.05或P<0.01),而C组T3、T4时间点SBP、DBP、HR均明显升高(P<0.01)。与C组相比较,M组于T3～T6时间点的SBP、DBP、HR均显著降低(P<0.01)。结论:预先静脉注射右旋美托咪啶0.4μg/kg可以有效降低芬太尼诱发咳嗽反射的发生率,并且能有效抑制气管插管引起的心血管反应。

Objective: To explore the efficacy of deliberate hypotension induced by remifentanil combined with nitroglycerin and influences on stress response during neurosurgical operation.Methods: Thirty ASA grade Ⅰ-Ⅱpatients undergoing elective neurosurgery were randomly divided into two groups,group R+N and group N,with 15 cases in each group.Deliberate hypotension of MAP 60-70 mmHg was induced by continuous infusion of remifentanil combined with nitroglycerin or nitroglycerin respectively.The values of MAP,HR,CO were measured and blood glucose,plasma levels of cortisol,epinephrine,norepinephrine,dopamine were detected before anesthesia(T0),before deliberate hypotension(T1),15 min after deliberate hypotension(T2),15 min after termination of deliberate hypotension(T3).Results: Compared with T0 and T1,MAP at T2,T3 were significantly decreased both in group R+N and group N(P0.05 or P0.01),but no significant decrease in CO were seen during deliberate hypotension.During deliberate hypotension,HR increased significantly in group N(P0.01),but no significant increase in HR were observed in group R+N,HR in group R+N were obviously lower than that in group N(P0.05 or P0.01).Compared with T0,the values of blood glucose obviously increased at T1,T2,T3(P0.05 or P0.01),while there were no significant change in group R+N.The levels of epinephrine and norepinephrine at T2 were significantly higher than those at T0 and T1(P0.05 or P0.01).At T2 time point,the levels of epinephrine and norepinephrine in group R+N were obviously lower than those in group N(P0.05).Conclusion: Deliberate hypotension with remifentanil plus nitroglycerin can effectively inhibit stress response,with less influence on hemodynamics in neurosurgical patients.

目的观察超声引导下腹横肌平面(transversus abdominis plane,TAP)阻滞用于结直肠癌手术患者术中及术后的镇痛效果。方法 32例全麻下行结直肠癌手术患者随机均分为两组。于全麻诱导后手术前在超声引导下双侧TAP分别注射0.375%罗哌卡因12～15ml(R组)或等量生理盐水(S组)。所有患者术后均使用静脉自控镇痛泵。比较两组术中切皮反应、芬太尼用量及术后2、6、12、24、48h VAS评分,记录术后镇痛泵按压次数、镇痛满意度及相关并发症。结果与S组相比,R组切皮时BP、HR变化明显减小(P<0.05或P<0.01)。两组镇痛效果良好,且R组术后2、6、12h的VAS评分均低于S组(P<0.05)。R组镇痛泵按压次数减少(P<0.05)。两组均未见TAP穿刺引起的不良反应。结论超声引导下的TAP阻滞定位准确,操作成功率高,用于结直肠癌手术能有效镇痛,明显减少术中及术后静脉镇痛药的需要量。

Objective: To evaluate the effects of nebulized inhalation of ketamine on fentanyl-induced coughing.Methods: Eighty ASA Ⅰ-Ⅱ patients underwent elective surgery were randomly divided into two groups with 40 cases in each group.Five minutes before fentanyl bolus(3 μg/kg) iv,patients inhaled either ketamine(0.25 mg/kg diluted to 4 ml with normal saline;group K) or normal saline(4 ml;group C) via compressed nebulizer.Two minutes after intravenous injection of fentanyl bolus,the frequency and intensity of coughing were observed.Systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rates(HR) were recorded before anesthesia(T0),ketamine inhalation for 5 min(T1),before intubation(T2),immediately after intubation(T3),and 1 min after intubation(T4). Results: The cough frequency was significantly lower in group K than that in group C(P0.01).There were no significant difference between the two groups in SBP,DBP,and HR at the same time point(P0.05). Conclusion: Nebulized inhalation of low-dose ketamine(0.25 mg/kg) effectively reduced fentanyl-induced coughing,with the advantages of less influence on hemodynamics.

Objective To assess the credibility of end-tidal carbon dioxide-partial pressure(PETCO2)monitoring in the elderly during video-assisted thoracic surgery(VATS)under one-lung ventilation(OLV).Methods Thirty-seven elder patients undergoing VATS were given total intravenous anesthesia with OLV by double-lumen endotracheal tubes.Arterial blood gas analysis,PETCO2 and hemodynamics were measured.Oxygenation index(OI,PaO2/FiO2)and arterial blood-endtidal carbon dioxide partial pressure difference(Pa-ETCO2)were calcurated.Results Except at 180 min during OLV,the correlation between PETCO2 and PaCO2 was good.Hypoxemia(OI,SpO290%)during OLV occurred in 5 cases.Conclusion PETCO2 can not reflect the changes of PaCO2 accurately.Arterial blood gas analysis is needed during OLV for a long time in elder patients.

Objective To compare the hemodynamic changes during anesthesia induction with remifentanil or fentanyl. Methods Sixty ASA class Ⅰ or Ⅱ patients aged 18 to 65 years old were randomly divided into two groups with 30 cases each.Patients in group R received induction of general anesthesia with remifentanil 1μg/kg and those in group F with fentanyl 3μg/kg. HR,SBP,DBP,CO,SVR,ACI,TFC and LCW were recorded with impedance cardiography before induction (T0),before intubation (T1), at intubation (T2),1min(T3),and 5min(T4) after intubation. Results HR,SBP,DBP,CO,SVR,LCW of the two groups at T1 were lower than those at T0(P0.05 or P0.01).HR,SBP,DBP,CO,LCW of group F at T4 were obviously lower than those at T0 and those of group R(P0.05 or P0.01).SVR of group R at T2,T3 and of group F at T2-T4 was obviously lower than that at T0 (P0.05).Conclusion Remifentanil 1μg/kg is better than fentany 3μg/kg in keeping hemodynamics stable during induction of general anesthesia.

Objective To investigate the effect of sexuality on the onset time of atracurium applied with priming technique in male and female patients.Methods One hundred and twenty ASA physical status Ⅰ or Ⅱ patients (60 males and 60 females) aged 18-64 yearseld,undergoing elective surgery were randomized into four groups with 15 cases each.All patients were anaesthetised with 0.1 mg/kg midazolam,0.75 mg/kg propofol,3 μg/kg fentanyl,and 0.5 mg/kg atracurium.Group M_1(male)and group F_1 (female) were given atracurium without priming group M_2(male) and group F_2 (female) were priminged with 0.05 mg/kg atracurium before injection of intubation dose of atracurium.Neuromuscular block was monitored with a mechanomyogram eliciting a train-of-four (TOF) stimulating model.In all groups,the trachea was intubated when TOFr was zero.Results The onset time was significantly shorter in group F_2 than that in group M_2 (P<0.05).The patients in group F_2 showed a signigicant faster onset of neuromuscular blockade than those in group F_1 (P< 0.05).Conclusion Atracurium priming can shorten the onset time of atracurium in female patients.

目的观察比较围术期输注国产与进口6％羟乙基淀粉130／0．4注射液（HES）对血流动力学、凝血系统及肾功能的影响。方法选择拟行食管癌或贲门癌根治术患者60例，随机分为国产HES组（天晴宁，HESd组）和进口HES组（万汶，HESi组），每组30例。气管插管前30min内输注复方乳酸钠10ml／kg，全麻诱导插管后HESd组输注国产HES 10ml·kg^1·h^-1，HESi组输注进口HES 10ml·kg^-1·h^-1，输注时间均为2h。分别观察两组输液前（T0）、输注复方乳酸钠毕（T1）、输注HES 1h（T2）、输注HES 2h（T3）及插管后2．25h（T4）的BP、HR、Hb、Hct、电解质（Na^＋、K^＋、Cl^-）、凝血酶原时间（PT）、凝血酶时间（TT）、活化部分凝血活酶时间（APTT）。观察记录两组T0术后24h（T5）的血肌酐（Cr）、血尿素氮（BUN）。结果两组患者术后Hb、Hct较术前均有所下降（P〈0．05）。两组患者电解质（Na^＋、K^＋、Cl^-）、凝血功能（PT、TT、APTT）、肾功能（Cr、BUN）组内、组删比较差异均尤统计学意义。结论国产HES与进口HES一样具有良好的扩容作用，对凝血系统和肾功能几乎无影响，足理想的血浆代用品。

Objective To investigate the effect of voluven(130/0.4,6% hydroethyl starch) /lactate Ringer's solution on hemodynamics and acid-base balance in patients with hysteromyoma.Methods Fifty female patients with hysteromyoma,ASA I-II,were randomly divided into voluven group(group V,n=25) and lactate Ringer's solution group(group L,n=25).They were intravenously quickly infused with voluven or lactate ringer's solution 10 ml/kg within 20 min,and then with lactate ringer's solution 2 ml/kg/h.SBP,DBP,HR,CVP and some results of arterial bloodgas analysis measured(PH,BE,Hb,Lac-,Cl-).Results Compared with the baseline,CVP significantly increased after infusion of fluid in both group(P<0.05),moreover CVP in V group was higher than that in L group(P<0.05).SBP,DBP and HR had no significant changes at every time points in both groups.PH,BE and Hb slightly but significantly decreased after infusion of fluid in both groups(P<0.05),however PH of 60 min and Hb of 40 min,respectively,after infusion of fluid in group L returned to the baseline.Cl-in group V and Lac-in group L significantly increased after infusion of fluid(P<0.05),however Cl-of 60 min after infusion of fluid in group V returned to the baseline.Conclusions Intravenous quick infusion of voluven or lactate Ringer's solution presents the effect of fluid expansion.The effect of fluid expansion of voluven is better and longer than that of lactate Ringer's solution.

诱导插管期血流动力学管理的重点在于预防诱导后的低血压和插管后的高血压,保证足够的心输出量和适当的外周阻力,本文旨在探讨诱导前预扩容对诱导插管期心脏功能和外周血管阻力的影响,观察预扩容是否有利于维持麻醉诱导插管期血流动力学的稳定.

Objective:To observe clinical effect of oesophagus-light-guided orotracheal intubation using blind tracheal intubation instrument(BTⅡ)for patients with gradual inability to open the mouth. Methods:Seventeen cases with nasopharyngeal carcinoma or maxillary sinas carcinoma were selected,and their scales of predication of expected difficult intubation was distance of opening mouth less than 2-3cm. All patients were done oesophagus-light-guided orotracheal intubation by BTⅡ.The effects of intubation,the changes of circulation and respiration and the complications were evaluated. Results: Sixteen cases were performed orotracheal intubation successfully, only one case failed because of tracheal displacement owing to lymph node. There were no changes of circulation and respiration during intubation.No severe complications including laryngalgia and hoarseness were observed. Conclusion: The method of oesophagus-light-guided orotracheal intubation using BTⅡ can be used in difficult intubation successfully.

Objective: To explore the effects of deliberate hypotension induced by remifentanil combined with nitroglycerin on the hemodynamics during neurosurgical operation.Methods: Thirty ASA I～Ⅱpatients undergoing elective neurosurgery were randomly divided into two groups,group R+N and group N,with 15 cases in each group.All patients were received propofol total intravenous anesthesia(TIVA).Deliberate hypotension of MAP 60～70mmHg was induced after dura opening by continuous infusion of remifentanil combined with nitroglycerin or nitroglycerin respectively.The values of MAP、HR,CO,CI,ACI,LCW,SVR were measured at 6 time points of peri hypotension. Results: Compared with the values before hypotension,significant decrease in MAP,SVR,LCW were observed both in group R+N and group N(P<0.01),but no significant decrease in CO,CI,ACI were seen during deliberate hypotension(P>0.05).During deliberate hypotension period,HR increased significantly in group N(P<0.01),but no significant increase in HR were observed in group R+N,HR in group R+N were obviously lower than that of in group N.In group R+N,the dosage of nitroglycerin and fentanyl were lower than those of in group N,the time got to target BP,the recovery time and extubation time were shorter than those in group N. Conclusion: Deliberate hypotension with remifentanil plus nitroglycerin was effective and safe,with less influence on hemodynamics in neurosurgical patients.

Objective To summarize the causes and treatment of arrhythmias during the anesthetic period in thoracic tumor surgery.Methods To use the electrocardio graphic monitoring system to carry out continuous electrocardio graphic monitoring in the period of perioperative-thoracotomy and to observe the rhythms and rates of the hearts.Results 2485 patients undergoing thoracic tumor surgery were included for a retrospective analyses.96.02% of the patients were complicated by arrhythmia.With timely treatment,the arrhythmias were controlled almost in all patients.The causes of arrhythmias during anesthesia mainly were endotracheal intubation and extubation responses,operative stimulation,hypoxia and(or) retention of carbon dioxide,heart and lung diseases,elderly,abnormal ECG before operation.Conclusions It is necessary for the patients in the period of perioperative-anesthesia to carry out continuous ECG monitoring.

丧失手术机会的恶性肿瘤气道狭窄患者,气管支架置入术可有效解除气道狭窄,保持呼吸通畅,延长生命,提高生存质量,但该治疗技术麻醉处理较复杂.我院2001年6月～2005年3月期间19例气管支架置入术,采用德国百瑞"压缩雾化吸入器"表麻,麻醉效果良好,现总结报道如下.

目的探讨肺功能减退肺癌患者施行全肺切除手术的围麻醉期管理经验。方法回顾性分析23例肺功能减退患者行全肺切除手术在围麻醉期的管理,行右全肺切除者10例,左全肺切除者13例。结果所有患者无一例围麻醉期死亡。结论全面衡量患者情况,积极治疗影响肺功能的疾患。术前进行必要的呼吸功能锻炼,术中适当的麻醉处理和术后全面监护、合理的机械通气,可以减少或避免并发症的发生,使患者安全渡过围麻醉期。

Objective To study the effects of deliberate hypotension induced by remifentanil on the hemodynamics during neurosurgical operation.Methods Twenty ASA class Ⅰ or Ⅱpatients(undergoing) elective neurosurgery were received propofol total intravenous anesthesia(TIVA).Deliberate hypotension of MAP 60-70mmHg was induced after dura opening by continuous infusion of remifentanil at 0.5-2μg·kg~(-1)·min~(-1).Hemodynamics were measured at 6 time points of perihypotension.(Results)Compared with the values before hypotension,significant decreases in MAP,SVR,LCW and HR were observed(P<0.05,P<0.01),but no significant decreases in CO,CI,ACI were seen during deliberate hypotension.Conclusion Deliberate hypotension with remifentanil is effective and safe with less influence on cardiac function in neurosurgical patients.

目的总结气管内肿瘤切除和气道重建术的麻醉经验。方法根据气管内肿瘤的部位、形状、大小、气道阻塞程度以及手术方法,制定合适的麻醉方案。结果全组病例在麻醉诱导期间生命体征平稳,术中单肺通气期间SpO2低于90者1例,有1例气管上段肿瘤患者术中切断肿瘤远端气管后,从左右支气管内吸出破碎肿瘤组织3块。术毕均完全清醒、拔除气管导管、无麻醉并发症发生。结论对于上段气管内肿瘤较大者,宜在局麻下于肿瘤下方做气管切开后全麻;对于中下段气管内肿瘤,宜先将气管导管插至肿瘤上方,待切开肿瘤远端气管后插入另一气管导管行控制呼吸。术中麻醉关键在于确保患者良好的通气和氧合以及稳定的血液动力学状态,又要保证手术的顺利进行。