目的 探讨超声引导下星状神经节阻滞(stellate ganglion block,SGB)联合耳穴贴压对髋关节置换(total hip arthroplasty,THA)患者术后睡眠障碍(postoperative sleep disturbance,POSD)的影响.方法 选取择期在腰硬联合麻醉下初次行THA的患者105例,男52例,女53例,年龄25～75岁,BMI 18～28 kg/m2,美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级,随机分为耳穴组、SGB联合耳穴组(联合组)和假刺激组,每组35例.耳穴组患者予患肢同侧耳穴行王不留行籽耳贴贴压,联合组患者在耳穴组基础上,行超声引导下SGB,假刺激组患者给予不带王不留行籽的耳穴贴,方法同耳穴组.记录患者术前1 d匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQi)评分.记录术后当晚实际睡眠时长,深、浅、快速眼动睡眠(rapid eye movement,REM)时长及占比,觉醒次数及时长.记录术后当晚St.Mary's医院(St.Mary's Hospital,SMH)睡眠问卷评分和静息视觉模拟评分法(VAS)评分.记录术后1 d患者自控镇痛(PCA)次数、追加镇痛药量和恶心、呕吐发生率.记录患者住院天数、SGB和耳贴不良反应发生情况.结果 与假刺激组比较,耳穴组和联合组患者术后当晚实际睡眠时长、深睡眠时长及占比、睡眠效率明显增加(均P＜0.05),联合组患者POSD发生率、夜间觉醒次数及时长明显减少,REM时长明显增加(均P＜0.05).与耳穴组比较,联合组患者实际睡眠时长、深睡眠时长、REM时长和睡眠效率明显增加(均P＜0.05).与假刺激组比较,耳穴组和联合组患者睡眠深度和SMH总分明显升高(均P＜0.05),联合组患者夜醒频率、日间功能及睡眠满意度得分明显升高(均P＜0.05).结论 SGB联合耳穴贴压可明显改善THA患者术后当晚的主客观睡眠质量,且能降低POSD发生率.

目的:观察温中行气中药香囊治疗妇科门诊手术术后头晕呕吐的临床疗效.方法:将106例妇科门诊手术术后头晕呕吐患者随机分为观察组52例和对照组54例,对照组采用常规护理、情志调护和西药对症处理模式,观察组在对照组治疗的基础上加用温中行气中药香囊进行干预;观察比较2组临床疗效、不同时间内头晕呕吐改善情况,以及治疗前后患者头晕呕吐视觉模拟评分法(VAS)评分.结果:总有效率观察组为100％,对照组为98.14％,2组比较,差异无统计学意义(P＞0.05).治疗后,2组头晕呕吐VAS评分均较治疗前明显下降(P＜0.05);而2组间VAS评分比较,差异无统计学意义(P＞0.05).头晕呕吐症状改善时间小于30 min的病例,观察组为32例,对照组为12例,2组比较,差异有统计学意义(P＜0.05).结论:温中行气中药香囊可有效缓解妇科门诊手术术后头晕呕吐的临床症状,加速患者康复.

目的:研究不同浓度罗哌卡因复合右美托咪定在肛肠疾病日间手术中的麻醉效果.方法:选取2016年5月～2018年5月期间于我院行肛肠疾病日间手术的患者123例为研究对象.根据随机数字表将患者分成A、B、C三组,每组各41例,其中A组麻醉时注入右美托咪定复合0.375％罗哌卡因20 mL,B组麻醉时注入右美托咪定复合0.5％罗哌卡因20 mL,C组注入右美托咪定复合0.75％罗哌卡因20 mL.比较三组患者麻醉后镇痛效果,比较三组麻醉前、麻醉30 min后的呼吸循环指标,比较三组患者感觉神经、运动神经阻滞情况,记录三组患者术后不良反应发生情况.结果:B组、C组镇痛优良率显著高于A组(P＜0.05),但B组、C组镇痛优良率组间比较差异无统计学意义(P＞0.05).三组患者麻醉前、麻醉30 min后心率(HR)、收缩压(SBP)、舒张压(DBP)、血氧饱和度(SPO2)整体比较差异均无统计学意义(P＞0.05).B组、C组感觉神经阻滞起效时间均较A组短,且C组短于B组(P＜0.05),而B组、C组感觉神经阻滞持续时间均较长,且C组长于B组(P＜0.05);B组、C组Bromage评分1分人数均较A组少,且C组少于B组(P＜0.05),B组、C组Bromage评分2分人数均较A组多,但C组较B组少(P＜0.05),C组Bromage评分3分人数较A组和B组多(P＜0.05),三组Bromage评分4分人数整体比较差异均无统计学意义(P＞0.05).C组患者术后不良反应总发生率高于A组、B组(P＜0.05),但A组、B组不良反应总发生率组间比较差异无统计学意义(P＞0.05).结论:0.5％、0.75％罗哌卡因复合右美托咪定应用于肛肠疾病日间手术的镇痛效果、麻醉效果优于0.375％罗哌卡因复合右美托咪定,但是0.75％罗哌卡因复合右美托咪定的不良反应发生率偏高,0.5％罗哌卡因复合右美托咪定是肛肠疾病日间手术中更为合适的麻醉方案.

目的 观察罗哌卡因蛛网膜下腔阻滞用于肛肠日间手术的最低有效浓度,探讨其在肛肠日间手术中的合理用药浓度和安全性.方法 30例在日间行肛肠手术的患者,根据序贯方法,以上一例患者的麻醉效果,确定下一患者所用的罗哌卡因浓度,初始罗哌卡因浓度为0.50％,间隔浓度为0.05％,麻醉诱导后观察阻滞起效时间、阻滞完善时间、改良Bromage评分、VAS评分;术后随访观察麻醉镇痛时间、术后运动功能恢复时间、术后排尿功能恢复时间、不良反应及患者满意度.结果 罗哌卡因用于肛肠日间手术的最低有效浓度为0.35％,剂量为7 mg,EC50为0.366％(95％CI:0.255％ ～0.423％),阻滞起效时间、阻滞完善时间、改良Bromage评分、VAS评分、麻醉镇痛时间、术后运动功能恢复时间与麻醉浓度差异有统计学意义(P<0.05).药物浓度越高,阻滞起效时间、阻滞完善时间越短;药物浓度越低,麻醉镇痛时间越短,术后运动功能恢复越快,麻醉浓度与术后排尿功能恢复时间差异无统计学意义(P>0.05).结论 罗哌卡因用于肛肠日间手术的最低有效浓度为0.35％,剂量为7 mg,合适浓度罗哌卡因不仅能满足肛肠日间手术需求,也利于术后早期康复,为患者早日下床功能锻炼提供可能,安全有效,值得推广.

Objective To investigate the safety and efficacy of ultrasound-guided abdominal rectus sheath block (RSB) for peritoneal dialysis catheter. Methods Sixty patients with chronic renal insufficiency were included in the study between September 2015 and July 2016,and were randomly divided into the abdominal RSB group (group R) and topical anesthesia group (group L),n=30 each. Group R underwent ultrasound-guided abdominal RSB at the midpoint line incision,and group L underwent local infiltration anesthesia with unified operation and anesthesiologists. The vital signs at each time point ,times of remedial local anesthesia,times of successful catheter and the duration of surgery were recorded. Results There was no statistically significant difference in the general data between the two groups(P>0.05). There were statistically significant differences in the effect(time)and interation of time and grouping between MAP and HR in the two groups(P<0.05). The MAP and HR changes in the trend figure showed that during the surgery,especially pulling the rectus abdominis(T4)and at the end of the surgery(T5),the vital signs in group L significantly fluctuated. When pulling the rectus abdominis(T4),there were significantly significant differences in MAP and HR between the two groups. Compared with group L,the times of remedial local anesthesia in group R was significantly reduced,and the times of required catheter was less and the operation time was shorter. Conclusion Using ultrasound-guided abdominal RSB is safe and effective for peritoneal dialysis catheter. It can improve the comfort of the patients during the operation,and the procedure is more smooth,which justifies widespread use.

Objective To preliminarily analyze the credibility and validity of Chinese Medical Constitution Questionnaire(CMCQ).Methods CMCQ was used to investigate the distribution of Chinese medical constitution types of 450 women inpatients with postoperative nausea and vomiting (PONV) after gynecologic laparoscopic surgery from March to October of 2013.Credibility and validity were analyzed by Cronbach's α coefficient and factor analysis.Results Mixed constitution was identified in 184 (40.9％) patients.Cronbach's α coefficient of two dimensions (yang deficiency and qi stagnation) of CMCQ was proper,being 0.815 and 0.803 respectirely,while that of the dimension of harmony type was the lowest (0.514).The total variance explained by 9 common factors extracted from the results of factor analysis was only 48.5％.Conclusion CMCQ may need further revision based on the results of clinical application.

目的:探寻妇科腹腔镜术后恶心呕吐(PONV)与患者体质类型的关系.方法:对450例拟行妇科腹腔镜手术患者进行体质判定,统一麻醉方法,记录所有患者的一般资料、体质类型和PONV的情况,采用Epidata 3.0软件录入数据,并用SPSS 18.0统计软件进行t检验、卡方检验、相关回归分析.结果:450例患者PONV的发生率为39.3％,相关分析发现PONV发生率较高的患者体质类型为气虚质(45.9％)、血瘀质(43.8％)以及阳虚质(43.0％).多因素回归分析显示PONV的危险因素是气虚质、既往有PONV病史、手术时间长,而平和质和气郁质为PONV的保护因素.结论:全麻下行妇科腹腔镜PONV发生率为39.3％;该类人群发生PONV的危险因素有气虚质、阳虚质、既往有PONV史、手术时间长;平和质及气郁质患者不易发生PONV.

目的:观察中药联合超声引导下行颈神经注射治疗痛型颈椎病的临床效果.方法:将痛型颈椎病患者90例随机分为2组各45例,对照组给予超声引导下行高选择性目标颈神经注射治疗,观察组在对照组基础上加用活血通络方治疗;疗程为15天,观察比较2组临床疗效,治疗前后血液流变学指标红细胞压积、全血黏度、血浆黏度水平,并采用视觉模拟评分法(VAS)评估2组治疗前后疼痛程度.结果:总有效率观察组为93.33％,对照组为77.78％,2组比较,差异有统计学意义(P＜0.05).治疗后2组红细胞压积、全血黏度、血浆黏度均显著降低(P＜0.01),且观察组上述指标改善较对照组更显著(P＜0.05).治疗7天及治疗结束时观察组VAS评分均低于对照组(P＜0.05).结论:中药活血通络方联合超声引导下行高选择性目标颈神经注射治疗痛型颈椎病临床疗效显著,效果优于单纯西药治疗.

困难气道是严重威胁患者生命安全的一种临床危象，一直以来都备受重视，相关培训和研讨在各地广泛开展。由于各地条件和技术的差异，其困难气道管理理论与实战技能参差不齐。我院面向全国举办困难气道管理学习班已有7年时间，积累了一定的教学经验，形成了较成熟的困难气道管理理念，现对教学过程中学员比较关注的问题进行探讨。

Objective To evaluate the safety and efficacy of ultrasound-guided thoracic paravertebral block (TPVB)in day surgery for breast. Methods Eighty patients scheduled to undergo day surgery for breast were enrolled and randomly divided into the TPVB and topical anesthesia groups(n=40 for each group).After entering into the operating room,all patients were administered with dexmedetomidine at a dose of 0.8 mg/kg via intravenous drip. In the TPVB group,patients received ultrasound-guided TPVB at T4 thoracic ver-tebrae and those were treated with local infiltration anesthesia in the topical anesthesia group. Vital signs,fre-quency of topical anesthesia,operation time and time of post anesthetic discharge scoring system (PADSS)≥9 were recorded in both groups. Results In two groups,postoperative mean arterial pressure and heart rate were significantly lower compared with those before entering into operating room (both P<0.05 ),whereas no statistical significance was noted between two groups (both P>0.05 ). In the TPVB group,vital signs were more stable than those in the topical anesthesia group throughout the surgery. Compared with the topical anes-thesia group,frequency of intraoperative topical anesthesia in the TPVB group was significantly lower (P<0.05),whereas the time of postoperative PADSS≥9 did not significantly differ between two groups(P>0.05).Conclusion Under appropriate sedation status,application of ultrasound-guided TPVB can enhance clinical efficiency and ensure safety of day surgery for breast.

Objectives To analyze the postoperative nausea and vomiting (PONV) situation in the patients with gyneco-logical laparoscopy for investigating its occurrence rule. Methods 450 patients undergoing gynecologic laparoscopic operation in the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from May to December 2013 were selected as the research subjects. The anesthesia method was unified and the general data, related disease history, PONV related risk fac-tors and PONV occurrence situation were recorded in all the cases. The data entry adopted the EpiData 3.0 software and the relat-ed analysis was performed by the SPS18.0 software. Results The incidence rate of PONV in 450 patients was 39.3%(177/450), which mostly occurred within 24 h after operation. Compared with the predicting model of the Apfel simplified risk evaluation scale, influencing degrees of different risk factors on the incidence rate of PONV were significantly smaller. The unmarried pa-tients were easier to develop PONV. However ,the patients with motion sickness history did not significantly increase the PONV risk. Conclusion The incidence rate of PONV in the patients with gynecological laparoscopic operation is still close to 40%;the 4-factor predictive model of the Apfel simplified risk evaluation scale has poor predictive ability for PONV in these patients;the marital status may affect the incidence rate of PONV.

目的 探讨丙泊酚滴定法靶控输注用于重症心脏瓣膜病患者全麻诱导的安全性和有效性.方法 重症心脏瓣膜病患者47例,随机分成丙泊酚组(P组,n=24)和依托咪酯组(E组,n=23).P组以丙泊酚靶控输注,初始血浆靶浓度1.0 μg/ml,采用改良警觉/镇静(MOAA/S)评分行镇静评分,每2分钟递增靶浓度0.2 μg/ml,至患者MOAA/S评分≤1分时给予芬太尼5μg/kg、维库溴铵0.1 mg/kg.E组使用依托咪酯0.25～0.30mg/kg和同剂量的芬太尼、维库溴铵并行气管插管.记录入室(T1)、MOAA/S评分≤1分(T2)、诱导期收缩压最低点(T3)、插管前(T4)、插管完毕(T5)、插管后5 min(T6)时的SBP、DBP、HR、CVP;记录血管活性药物的使用情况.结果 与T1时比较,P组T2～T6时SBP、DBP明显下降,HR明显减慢(P＜0.05或P＜0.01),E组T2～T4、T6时的SBP,T2～T6时的DBP明显下降,T2～T4时HR明显减慢(P＜0.05或P＜0.01),T3、T4时两组CVP明显降低(P＜0.05或P＜0.01).与E组比较,P组T5时的SBP,T5、T6时的DBP明显降低,T5、T6时HR明显减慢(P＜0.05或P＜0.01).P组患者在T2时的血浆靶浓度平均值为1.61 μg/ml.结论 丙泊酚滴定法靶控输注用于重症心脏瓣膜病患者全麻诱导的安全性与依托咪酯相似,并且能更好地抑制气管插管后的应激反应.

阻塞性睡眠呼吸暂停综合征(OSAS)是指睡眠状态下上气道软组织、肌肉的可塌陷性增加,引起的反复呼吸暂停和通气不足,使机体发生一系列病理、生理改变的临床综合征.OSAS患者多有肥胖、颈短、软腭增长和舌体肥大等现象,造成气管插管和术后气道管理困难,增大麻醉的难度和危险性,在清醒镇静状态下由纤维支气管镜引导气管插管是最安全的选择.本研究旨在比较右美托咪定复合表面麻醉与单纯表面麻醉用于OSAS患者纤维支气管镜引导下经口气管插管的效果和患者满意率.

目的观察川芎嗪对缺氧/复氧大鼠海马神经元超氧化物歧化酶（SOD）、丙二醛（MDA）和乳酸脱氢酶（LDH）表达和神经元凋亡的影响,探寻川芎嗪的神经元保护原理及其较佳剂量。方法以培养7~9 d的胎鼠海马神经元为研究对象,随机分为5组:L组（低浓度川芎嗪60μg/mL）、M组（中浓度川芎嗪200μg/mL）、H组（高浓度川芎嗪800μg/mL）、C组（川芎嗪浓度0μg/mL）、N组（正常对照）。除N组外分别加入相应浓度的川芎嗪,作用1 h后放入90%N2+10%CO2培养箱中诱导缺氧2 h,然后放入5%CO2培养箱中复氧24 h。倒置显微镜观察细胞形态学变化,透射电镜观察细胞超微结构变化,分光光度计检测培养上清中MDA、SOD、LDH的含量,流式细胞仪检测神经元凋亡率。结果缺氧/复氧损伤后L、M、H组MDA、SOD、LDH的含量分别为（3.75±0.26）、（2.43±0.86）、（3.45±0.47）nmol/mL,（30.76±4.28）、（41.53±3.28）、（33.54±5.07）U/mL,（623.71±102.83）、（276.63±75.59）、（537.80±109.18）U/L,神经元凋亡率为（13.47±3.86）%、（3.65±1.42）、（7.78±1.72）%,与C组比较差异有统计学意义（P＜0.01）。M组与L、H组比较差异有统计学意义（P＜0.01）。结论川芎嗪60、200、800μg/mL预给药均可不同程度减少缺氧/复氧诱导海马神经细胞的凋亡和坏死,抑制LDH的漏出,减少MDA的产生,促进SOD的生成。200μg/mL浓度的川芎嗪保护作用最显著。

目的 比较Macintosh喉镜与Cook气道交换导管引导更换双腔气管导管的临床应用效果.方法 随机选择双腔气管导管插管患者48例,随机分为两组,术毕均需换成单腔气管导管,分别采用Cook气道交换导管(C组)和Macintosh喉镜(M组)引导更换.记录手术时间、出血量、导管更换时间、插入次数;观察入室安静后(基础值,T0)、手术缝皮结束时(T1)、Cook气道交换导管经双腔气管导管或Macintosh喉镜经口插入时(T2)、单腔气管导管插入后即刻(T3)及插入后1 min(T4)、3 min(To)时的HR和SBP、DBP.术后48 h随访记录咽喉痛、声嘶、创伤等并发症.结果 与M组比较,C组更换导管时间明显缩短(P＜0.05),两组更换气管导管插入次数差异无统计学意义.与T0时比较,T1时两组HR明显减慢,SBP、DBP明显下降(P＜0.05),但组间差异无统计学意义;与T1时比较,T2时M组HR明显增快,SBP、DBP明显升高(P＜0.05),且C组HR明显慢于,SBP、DBP明显低于M组(P＜0.05).C组咽喉疼痛2例、声音嘶哑1例、无一例创伤,明显少于M组的咽喉疼痛8例、声音嘶哑4例、创伤2例(P＜0.05).结论 与Macintosh喉镜比较,应用Cook气道交换导管更换双腔气管导管,成功率较高,更换时间更短,对血流动力学影响较小,不良反应减少.

Combined with the traditional teaching method,the application of altrasonic technology in teaching anesthesia students about jugular venous catheterization makes contents richer and more vivid,thus greatly enhancing teaching quality.

目的:观察Airtraq视频喉镜用于颈部活动受限患者气管插管的可行性和安全性。方法:采用Airtraq视频喉镜对18例颈部活动受限患者进行气管插管。记录插管次数、气管插管时间、喉部显露分级和围插管过程4个时间点的血流动力学变化。结果:18例患者均1次插管成功,插管时间(63±14)s,Cormack-Lehane分级均为Ⅰ～Ⅱ级。操作过程中血流动力学改变较轻。结论:Airtraq视频喉镜引导气管插管能更好的显露声门,降低插管难度,且操作便捷、安全,是解决颈部活动受限导致的困难气管插管的有效方法之一。

目的观察GlideScope视频喉镜用于阻塞性呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)患者进行气管插管的安全性和可行性。方法38例OSAS患者在气管内全麻下行悬雍垂腭咽成形术(UP-PP)术,男29例,女9例,ASA分级Ⅱ~Ⅲ级,年龄35~57岁。术前每例患者行改良Mallampati分级,静脉麻醉诱导并在GlideScope视频喉镜引导下经鼻气管插管。记录所有患者在GlideScope视频喉镜下的Cormack-Lehane咽喉部暴露分级和此过程3个时间点的血流动力学变化。结果38例患者由GlideScope视频喉镜引导经鼻插管成功率100%,气管插管时程40~115s,平均63s。GlideScope视频喉镜下Cormack-Lehane分级Ⅰ~Ⅱ级37例,Ⅲ级1例。有1例患者在插管过程中脉搏血氧饱和度最低至91%,血流动力学变化方面:与T1(麻醉诱导前基础对照值)相比,T2(全麻药诱导后1min)的收缩压、舒张压、心率都显著下降,T3(气管插管后1min)收缩压、舒张压有所下降,心率无明显改变。与T2相比,T3收缩压、舒张压有所回升,心率明显回升。结论将GlideScope视频喉镜应用于阻塞性呼吸暂停综合征患者的气管插管过程中安全、可行。

Objective To investigate the effect of tetramethylpyrazine pretreatment on the expression of cfos and heat shock protein (HSP70) during hypoxia-reoxygenation (H/R) in cultured fetal rat hippocampal neurons. Methods After the neurons were cultured and identified, they were randomly divided into 5 groups ( n = 24each): control group (group C), H/R group, and low, median and high concentration of tetramethylpyrazine pretreatment groups (group L, M and H). The neurons were exposed to 2 h of hypoxia followed by 24 h of reoxygenation. Tetramethylpyrazine was added with the final concentrations of 60, 200 and 800 μg/ml in group L, M and H respectively, and then the neurons were incubated for 1 h before H/R. The apoptosis rate, cell viability and expression of c-fos and HSP70 were detected. Results The cell viability was significantly lower, while the apoptosis rate was significantly higher in group A/R, L and H than in group C (P ＜0.01). The cell viability and HSP70expression were significantly higher, while the apoptosis rate and c-fos expression were significantly lower in group L, M and H than in group A/R, and in group M and H than in group L (P＜ 0.05). The cell viability and HSP70expression were significantly lower, while the apoptosis rate and c-fos expression were significantly higher in group H than in group M ( P ＜ 0.01 ).Conclusion The mechanism by which tetramethylpyrazine pretreatment inhibits the apoptosis in cultured fetal rat hippocampal neurons during H/R may be related to the dowm-regulation of c-fos expression and up-regulation of HSP70 expression.