目的 探讨超声引导下竖脊肌平面阻滞在后腹腔镜肾切除术围术期镇痛的应用价值.方法 选择2019年9月～2021年11月择期全麻后腹腔镜肾切除术60例,随机分为联合竖脊肌平面阻滞组(E组)和对照组(C组),每组30例.E组在麻醉诱导前行超声引导下竖脊肌平面阻滞,于T10横突注射0.33％罗哌卡因30 ml,C组注射生理盐水30 ml.2组全麻方法相同.2组术毕均给予静脉患者自控镇痛(patient-controlled intravenous analgesia,PCIA).记录麻醉药用量、拔管时间、麻醉恢复室(postanesthesia care unit,PACU)停留时间.记录术后即刻、1、6、12、24和48 h疼痛视觉模拟评分(Visual Analogue Scale,VAS)、PCIA泵有效按压次数、补救镇痛药物用量、不良反应发生率.结果 与C组比较,E组瑞芬太尼和帕瑞昔布用量明显减少[(1353.4±117.5)μg vs.(1514.6±179.1)μg,t=-4.121,P=0.000;(25.3±30.6)mg vs.(73.3±23.7)mg,t=-6.795,P=0.000],术后拔管时间和PACU停留时间均明显缩短[(11.7±2.2)min vs.(17.5±1.9)min,t=-10.738,P=0.000;(21.9±2.1)min vs.(26.9±2.8)min,t=-7.996,P=0.000],术后48 h镇痛泵有效按压次数明显减少[(17.4±2.2)次vs.(26.0±1.6)次,t=-17.701,P=0.000],术后1、6、12和24 h静息和活动VAS评分均较低,且术后不良反应明显减少(P<0.05).结论 超声引导下竖脊肌平面阻滞在后腹腔镜肾切除术的围术期可提供充分的镇痛.

目的探讨右美托咪定联合罗哌卡因行坐骨神经阻滞用于骨科创伤清创探查术的镇痛效果。方法 2018年9月-2019年6月60例因骨科创伤清创探查术行坐骨神经阻滞的患者随机分为R组、RD组及RL组各20例。坐骨神经阻滞R组给予0.3%罗哌卡因30ml、RD组给予0.3%罗哌卡因+右美托咪定0.75μg/kg共30ml、RL组给予0.3%罗哌卡因+右美托咪定0.5μg/kg共30ml。比较三组感觉和运动神经阻滞起效时间和阻滞维持时间。结果三组一般资料差异均无统计学意义（P＞0.05）。与R组比较,RD组及RL组感觉神经（6.59±2.1、7.01±1.4）和运动神经（13.55±3.1、12.34±3.6）阻滞起效时间均较短（P＜0.05）。与R组比较,RD组及RL组感觉神经（778.90±82.6、735.72±88.4）和运动神经（665.62±70.2、673.17±53.6）阻滞维持时间均较长（P＜0.05）;三组术后6h及24hVAS评分无统计学差异,术后10hRL组及RD组VAS评分（2.23±0.9、2.42±0.6）低于R组（5.33±1.2）;三组各测量时间点心率（HR）、平均动脉压（MAP）及血糖波动无明显统计学差异;三组均未发生局麻药不良反应,安全性良好。结论对于骨科创伤后行清创探查术的患者,0.3%罗哌卡因复合右美托咪定行坐骨神经阻滞,感觉和运动神经阻滞起效时间短,阻滞维持时间长,并且安全可靠。

目的 分析讨论血浆白蛋白浓度对淋巴外科胸导管成形术全麻苏醒时间及苏醒期丙泊酚效应室浓度的影响.方法 选择2018-2019年我院因胸导管梗阻、狭窄的患者择期全麻下行胸导管成形术手术患者90例,根据患者术前白蛋白的含量随机均分为A、B、C 3组(n=30).术中3组患者给予相同的麻醉处理,记录3组患者诱导时患者失去意识的时间(T1)、各组停药时BIS值、停药到BIS≥80恢复时间(T2)、自主呼吸恢复时间(T3)、苏醒时间(T4)、拔管时间(T5).记录两组患者的丙泊酚意识消失Ce、停药到BIS≥80丙泊酚Ce、丙泊酚苏醒Ce.血流动力学事件发生例数和发生概率.结果 一般资料比较差异无统计学意义(P>0.05);T2、T3、T4、T5等对比差异无统计学意义(P>0.05);3组患者在停药时BIS值对比差异有统计学意义,组间比较A、B两组与C组比较差异有统计学意义(P<0.05),A、B两组组间对比差异无统计学意义(P>0.05).3组患者T1对比,组间两两比较差异均有统计学意义(P>0.05);3组患者血流动力学发生概率对比差异有统计学意义(P<0.05).结论 胸导管梗阻、狭窄的患者行淋巴外科胸导管成形术时,不同程度血浆白蛋白浓度的患者在丙泊酚靶控输注全麻中基本呈现相似的变化趋势,但低蛋白血症患者麻醉诱导时意识消失快,更易出现血流动力学事件.

目的 探讨中药热奄包外敷治疗全肠外营养输注所致局部疼痛的临床效果.方法 选取静脉全肠外营养输注时因药物原因所致局部疼痛的患者76例,随机分为2组,试验组(中药热奄包组)38例和对照组(热水袋组)38例,分别记录观察组和对照组治疗前后患者的视觉模拟评分法.结果 试验组和对照组临床资料差异无统计学意义,两组资料具有可比性.在T1时间点,试验组和对照组的视觉模拟评分差异无统计学意义(P＞0.05),在T2和T3时间点试验组和对照组的视觉模拟评分差异有统计学意义(P＜0.05),试验组止痛效果要明显优于对照组.在患者治疗满意度调查方面,试验组患者治疗满意度要明显高于对照组(P＜0.05).不良事件发生率比较,两组差异无统计学意义(P＞0.05).结论 中药热奄包外敷对全肠外营养输注所致局部疼痛具有良好的镇痛作用,值得临床推广应用.

目的 探讨右美托咪定联合罗哌卡因在淋巴静脉吻合术中臂丛神经阻滞的效果.方法 将2014年9月～2015年6月100例因上肢淋巴水肿行臂丛神经阻滞下的淋巴静脉吻合术随机分为RD组和R组各50例.肌间沟臂丛神经阻滞RD组给予0.3％罗哌卡因+右美托咪定0.8μg/kg共30 ml,R组给予0.3％罗哌卡因30 ml.比较2组感觉和运动神经阻滞起效时间和阻滞维持时间.结果 与R组比较,RD组感觉、运动神经阻滞起效快[感觉神经(6.1±1.8)min vs.(12.2±3.1)min,t=-9.463,P=0.000;运动神经(6.9±2.6)min vs.(14.3±3.2)min,t=-9.896,P=0.000],维持时间长[感觉神经(659.0±44.8)min vs.(533.5±94.7)min,t=6.562,P=0.000;运动神经(597.1±33.4)min vs.(521.8±65.2)min,t=5.628,P=0.000].结论 对于上肢淋巴静脉吻合术,在0.3％罗哌卡因中加入右美托咪定0.8μg/kg行肌间沟臂丛神经阻滞,感觉和运动神经阻滞起效时间短,阻滞维持时间长,并且安全、可靠.

Objective Compared with the effects of Dexmedetomidine on the induction of anaesthesia using Marsh and Schnider models of propofol Target-controlled Infusion. Methods 60 patients with colorectal cancer scheduled for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy under general anesthesia were randomly divided into 2 groups: Marsh group (group M, n=30) and Schnider group (group S, n=30). All the patients received 0.8 μg/kg loading dose of dexmedetomidine, followed by TCI anaesthesia with remifentanil at 2 ng/mL. After the effect-site concentration of remifentanil reached 2 ng/mL, propofol TCI induction was started. Anaesthesia induction commenced in the Marsh group at a target plasma concentration of 2 μg/mL, whereas it started in the Schnider group at a target effect-site concentration of 2 μg/mL. If induction was delayed after 3 min, the target concentration was gradually increased to 0.5 μg/mL every 30 sec until successful induction. The Ct at successful induction, Ce at successful induction, induction time, and haemodynamic parameters were recorded. Results The requirement of Ct for successful induction by Schnider model was significantly lower than that of Marsh model (3.43±0.22 VS 4.06±0.29μg/ml; P=0.05). Compared with Marsh model, the induction time of Schnider model was shorter (128.3±5.31 vs 160.7±3.30; P=0.01), and there was no significant change in hemodynamic parameters after successful induction. Conclusions In the inter-group comparison, dexmedetomidine reduced the Ct concentration required for induction of Schnider model and shortened the induction time.

目的 比较丙泊酚靶控输注Marsh模式和Schnider模式在腹腔热灌注化疗中的应用效果.方法 选择我院因结直肠癌择期全麻下行腹腔热灌注患者60例.随机分为两组:Marsh模式组(M组,n=30)和Schnider模式组(S组,n=30).M组和S组分别采用丙泊酚靶控输注系统的改进Marsh模式和Schnider模式并复合Minto模型靶控输注瑞芬太尼进行麻醉的诱导和维持.结果 两组患者意识消失时间和意识恢复的效应室浓度差异无统计学意义(P>0.05);而麻醉中丙泊酚总用药量和单位时间用药量S组高于M组(P<0.05),停药至苏醒时间、停药至拔管时间S组长于M组(P<0.05).各时点M组与S组比较,MAP、HR、SVV无明显变化,BIS维持在正常范围之内.结论 丙泊酚靶控输注麻醉在CRS联合HIPEC手术中Marsh模式优于Schnider模式.

目的 探讨右美托咪定联合帕瑞昔布超前镇痛在老年髋关节骨折手术患者中的镇痛效果及安全性.方法 60例择期行股骨切开复位内固定老年患者,随机分为两组,每组30例.实验组患者建立静脉通路后,予帕瑞昔布钠40 mg,然后右美托咪定0.5μg/(kg·h)持续泵注.对照组予同样体积的0.9％生理盐水.两组输注10 min后,实施椎管内麻醉,选择L2-3间隙进行腰硬联合麻醉.腰麻时注入0.75％罗哌卡因2 ml,后头端留置硬膜外导管3 cm,固定后恢复平卧位.记录患者一般资料,记录T1(患者从运送床搬至手术床时),T2(实施椎管内麻醉,摆放患者体位时)及T3(麻醉完成后恢复平卧位时)时的疼痛评分;记录T4(患者入手术室后),T5(搬送至手术床后),T6(椎管内麻醉摆放体位后)及T7(麻醉完成后恢复平卧位后)时的平均动脉压、心率及血氧饱和度,记录麻醉时间及OAA/S镇静评分,记录不良事件发生情况.结果 与对照组相比,在T1,T2,T3时点,实验组患者疼痛评分,OAA/S评分及麻醉时间均显著低于对照组,差异有统计学意义(P<0.05).在T5,T6,T7时点,实验组患者平均动脉压及心率均显著低于对照组,差异有统计学意义(P<0.05).两组患者血氧在任何时点均无统计学差异(P>0.05).另外,实验组有5例患者发生心动过缓,与对照组相比差异有统计学意义(P<0.05),予阿托品进行纠正.其余不良反应两组之间无统计学差异(P>0.05).结论 在椎管内麻醉前10 min,给予右美托咪定0.5μg/(kg·h)泵注联合帕瑞昔布钠40 mg干预,能有效抑制高龄患者搬动及麻醉体位改变造成的二次疼痛.同时不抑制患者循环和呼吸,是比较安全的.

Objective Investigate the efficacy of intracuff injection of lidocaine carbonate into tracheal catheter in the prevention of tracheal extubation response in weight-loss surgery.Methods 80 patients scheduled for (laparoscopic sleeve gastrectomy were randomly divided into 2 groups.Air was filled into tracheal intubation airbag in group A.1.73％ lidocaine carbonate was filled into tracheal intubation airbag in group C.The mean artery pressure (MAP) and heart race (HR) were recorded before induction (T1), immediately after extubation (T2), and 5 min after extubation (T3);The scoring of cough during extubation was recorded.Sore throat scores were recorded 30 min, 1 h, 2 h, 6 hand24 hafter extubation.Results There was no significant difference in the basic conditions between the two groups.Compared with group A, there was no significant difference in HR and MAP between T and T2 time points in group C;HR at time T3 (101.5±13.5 in group A, 86.8±11.5 in group C) and MAP (98.8±12.1 in group A and 85.6±11.4 in group C) were lower than group A, P＜0.05.The cough score of group C (2.1±0.4) was significantly lower than that of group A (3.4±0.3), P＜0.05;the VAS scores of sore throat at 0.5, 1, 2, 6 and 24 hours after extubation were compared.The time review score was significantly lower than that of group A, P＜0.05.Conclusion Lidocaine carbonate filled into tracheal intubation airbag can effectively reduce the cardiovascular response of extubation, relieve the incidence of postoperative cough and sore throat.

目的 探讨含罗哌卡因的膨胀液在吸脂术中的有效性.方法 选择2015年1月～2017年1月因下肢淋巴水肿择期行吸脂术60例,随机分为2组各30例,分别用2％利多卡因25 ml(L组)或0.75％罗哌卡因30 ml(R组),加入碳酸氢钠1.5 g、肾上腺素3 mg和生理盐水配制成3000 ml膨胀液.记录2组诱导前(T0)、注射膨胀液前(T1)、术毕(T2)和拔除气管导管时(T3)的平均动脉压(MAP)和心率(HR);记录拔除气管导管时(T3)、术后1 h(T4)、2 h(T5)、6 h(T6)、12 h(T7)和24 h(T8)各时间点疼痛视觉模拟评分(VAS)和追加镇痛药物例数.结果 2组术中MAP、HR无统计学差异(P>0.05).在T4、T5、T6和T7时间点,R组VAS评分低于L组[T4:(2.2±0.8)分vs.(4.1±0.6)分,t=-10.226,P=0.000;T5:(2.3±0.8)分vs.(4.2±0.6)分,t=-9.517,P=0.000;T6:(2.7±0.8)分vs.(4.4±0.7)分,t=-8.932,P=0.000;T7:(2.8±0.9)分vs.(3.6±0.6)分,t=-3.981,P=0.000].在T4、T5和T6时间点,R组追加镇痛药物例数少于L组[T4:2例vs.9例,χ2=5.455,P=0.020;T5:2例vs.12例,χ2=9.317,P=0.002;T6:3例vs.11例,χ2=5.963,P=0.015].结论 在吸脂手术中含罗哌卡因的膨胀液具有较高的安全性,并可提供良好的术后镇痛.

目的 探讨不同剂量右美托咪定联合罗哌卡因对颈丛神经阻滞的影响.方法 将颈丛神经阻滞下行甲状腺良性肿瘤切除术的90例患者分为3组:0.375％罗哌卡因20 mL(R组)、0.375％罗哌卡因20 mL+右美托咪定0.5μg/kg(D1组)、0.375％罗哌卡因20 mL+右美托咪定0.75μg/kg(D2组).记录麻醉前(T1)、颈丛神经阻滞后10 min(T2)、手术开始(T3)、分离甲状腺上极(T4)、手术结束(T5)的平均动脉压、心率和Ramsay镇静评分,观察感觉阻滞起效时间及持续时间、镇痛持续时间和不良反应发生率.结果 在T2、T3、T4和T5时,D1、D2组的平均动脉压低于R组、心率慢于R组(P<0.05).在T2、T3、T4和T5时,D1、D2组的Ramsay评分大于R组(P<0.05).感觉阻滞起效时间D1、D2组短于R组,D2组短于D1组(P<0.05).感觉阻滞持续时间D1、D2组长于R组,D2组长于D1组(P<0.05).镇痛持续时间D1、D2组长于R组,D2组长于D1组(P<0.05).结论 0.75μg/kg右美托咪定联合罗哌卡因可明显改善颈丛神经阻滞效果,安全性好.

Objective To investigate the application value of local anesthesia with lidocaine carbonate and tetracaine in the prevention of tracheal intubation and extubation response in nasal endoscopy. Methods From January 2016 to March 2017, 90 patients scheduled for endoscopic sinus surgery were randomly divided into 3 groups,with 30 cases in each group.Before endotracheal intubation,1%tetracaine was used for endotracheal surface anesthesia,and air was filled into tracheal intubation airbag(group T). The intratracheal surface was sprayed with physiological saline and 1.73%lidocaine carbonate was filled into tracheal intubation airbag (group C).The 1%tetracaine was used for endotracheal surface anesthesia,and 1.73%lidocaine carbonate was filled into tracheal intubation airbag(group TC).The mean artery pressure(MAP)and heart race(HR)were recorded before induction(T1), immediately after intubation(T2),immediately after extubation(T3),and 5 min after extubation(T4).The scoring of cough during extubation was recorded.Sore throat scores were recorded by using Visual Analogue Scale(VAS)at 30 min,1 h,2 h,6 h and 24 h after extubation,respectively. Results The MAP and HR were less in the group T and TC than those in the group C at T 2(F=8.384,P=0.000;F=6.154,P=0.003), less in the group C and TC than in the group T at T 3(F=14.112, P=0.000; F=3.514,P=0.034).The cough scores were the lowest in the group TC(0.9 ±0.7), median in the group C(1.3 ±0.7), and the highest in the group T(1.7 ±0.5)(F=10.307, P=0.000).The VAS scores of pharyngalgia were the lowest in the group TC (2.1 ±0.8),median in the group C(3.0 ±1.2),and the highest in the group T(3.8 ±1.3)(F=17.961,P=0.000)at 30 min after surgery,and lower in the group TC(1.8 ±0.7)than in the group T(2.5 ±1.0)(F=5.058,P=0.008)at 1 h after surgery.Conclusion Local anesthesia combined with lidocaine carbonate and tetracaine can effectively reduce the cardiovascular response of endotracheal intubation and extubation and relieve the incidence of postoperative cough and sore throat.

Objective To evaluate the analgesic efficiency of patients controlled intravenous analgesia ( PCIA) with sufentanil and dexmedetomidine after hyperthermic intraperitoneal chemotherapy ( HIPC) . Methods A total of 45 patients undergoing HIPC were randomly divided into 3 groups with 15 in each group .They received PCIA after operation with a background infusion rate of 2 ml/h, a loading dose of 2 ml, a lockout time of 15 min, and a liquid volume of 100 ml.The PCIA formulation in each group was as follows:group A (sufentanil 3.0 μg/h), group B (sufentanil 2.0 μg/h), and group C (sufentanil 2.0 μg/h +dexmedetomidine 4.0 μg/h).The VAS, Ramsay sedation scale, patient pressing times, and the adverse effects were recorded at 1 h (T1), 2 h (T2), 6 h (T3), 12 h (T4), 24 h (T5), and 48 h (T6) after surgery.Results The VAS scores of the group B were higher than those in the other two groups at T3-T6 time points [T3:(2.9 ±0.5) points vs.(3.5 ±0.8) points, q=3.600, P<0.05, (2.8 ±0.6) points vs.(3.5 ±0.8) points, q=4.200, P<0.05;T4:(2.4 ±0.6) points vs.(2.9 ±0.7) points, q=3.049, P<0.05;(2.3 ± 0.6) points vs.(2.9 ±0.7) points, q=3.659, P<0.05;T5:(1.9 ±0.6) points vs.(2.5 ±0.5) points, q=3.838, P<0.05;(1.8 ±0.7) points vs.(2.5 ±0.5) points, q=4.477, P<0.05;T6:(1.6 ±0.5) points vs.(2.0 ±0.4) points, q=3.303, P<0.05;(1.5 ±0.5) points vs.(2.0 ±0.4) points, q=4.129, P<0.05].The Ramsay scores of the group A were statistically higher than those of the group B at T5 and T6 [T5:(2.5 ±0.5) points vs.(2.1 ±0.5) points, q=2.893, P<0.05;T6: (2.3 ±0.5) points vs.(1.9 ±0.3) points, q=3.493, P<0.05].The Ramsay scores of the group B were statistically lower than those of the group C at T3-T6 [T3:(2.4 ±0.5) points vs.(3.1 ±0.7) points, q=4.477, P<0.05; T4: (2.2 ±0.4) points vs.(2.8 ± 0.7) points, q=4.243, P<0.05;T5:(2.1 ±0.5) points vs.(2.6 ±0.6) points, q=3.617, P<0.05;T6:(1.9 ±0.3) points vs.(2.4 ±0.5) points, q=4.367, P<0.05].The incidence of nausea and vomiting in the group A was higher than that in the group C [7 cases (46.7%) vs.1 case (6.7%),χ2 =4.261, P=0.039], while there were no differences between group B and C and between group A and B (P>0.05).The number of pressing times in the group B was more than that in the other two groups [(5.3 ±2.6) times vs.(8.4 ±4.2) times, q=3.662, P<0.05; (4.5 ±2.8) times vs.(8.4 ±4.2) times, q=4.608, P<0.05 ] . Conclusion Dexmedetomidine can reduce postoperative consumption of sufentanil in patients undergoing HIPC and decrease the incidence of nausea and vomiting .

Objective To explore the analgesic effect of ropivacaine and flurbiprofen for patients with secondary upper extremity lymphedema after lymphatic venous anastomosis . Methods A total of 45 cases of lymphatic venous anastomosis under general anesthesia between October 2014 and March 2016 were randomly allocated to 3 groups: ropivacaine group ( group R ) , flurbiprofen preprocessing group (group F1), and flurbiprofen postprocessing group (group F2), with 15 cases in each group.Local infiltration anesthesia was made with 0.2% ropivacaine 10 ml at the incision before the end of operation in the group R .The flurbiprofen 100 mg was intravenously injected at 5 minutes before the induction of anaesthesia in the group F 1 and 5 minutes before the end of operation in the group F 2 .The visual analogue scale ( VAS) scores and the number of patients using analgesics after operation at 1, 2, 6, 12, 24 and 48 h were recorded. Results The rest pain and movement pain VAS scores at postoperative 2 h were lower in the group R than those in the group F1 and F2[rest pain:(3.4 ±0.7) points vs.(4.2 ±0.9) points vs.(4.1 ±1.0) points, F=3.741, P=0.032;movement pain:(3.7 ±0.6) points vs.(4.6 ±0.9) points vs.(4.4 ±1.0) points, F=4.305, P=0.020]. The rest pain VAS scores at postoperative 6 h were lower in the group R than those in the group F 1 and F2 [(2.7 ±0.5) points vs. (3.4 ±0.5) points vs.(3.1 ±0.6) points, F=5.783, P=0.006].The number of patients requiring analgetics was lower in the group R than that in the group F1 and F2 at postoperative 2 h (1 case vs.7 cases vs.5 cases,χ2 =6.058, P=0.048). Conclusion Local anesthesia with ropivacaine in patients after lymphatic venous anastomosis can achieve good postoperative analgesia .

Objective To observe the efficiency and safety of dexmedetomidine and tramadol to prevent postoperative shivering after liposuction. Methods A total of 80 patients undergoing liposuction were randomly divided into 4 groups with 20 cases in each group:dexmedetomidine 0.4 μg/kg(D1 group),dexmedetomidine 0.6 μg/kg(D2 group),tramadol 1 mg/kg(T group),and saline control group(N group).These patients received an intravenous injection of dexmedetomidine, tramadol, or saline at the time of surgical suture.The respiratory recovery time,awakening time, extubation time, orientation recovery time, the case of shivering and adverse reactions after surgery were recorded. Results The respiratory recovery time,awakening time, and extubation time in the group D2 were longer than those in the other 3 groups[respiratory recovery time:(5.5 ±1.3)min vs.(6.2 ±1.2)min vs.(5.1 ± 1.8)min vs.(5.0 ±0.9)min,F=3.330,P=0.024;awakening time:(10.2 ±1.3)min vs.(11.5 ±1.5)min vs.(9.7 ±2.7) min vs.(9.5 ±1.8)min,F=4.429,P=0.006;extubation time:(12.9 ±1.5)min vs.(14.2 ±1.6)min vs.(12.8 ±2.4)min vs.(12.7 ±1.9)min,F=2.845,P=0.043].Postoperative shivering incidence in the group N was higher than those in the other 3 groups(3 cases vs.2 cases vs.3 cases vs.9 cases,χ2=9.188,P=0.027).The incidence of nausea and vomiting in the group T was higher than those in the other 3 groups(2 cases vs.1 case vs.8 cases vs.4 cases,χ2=9.436,P=0.024).The incidence of tachycardia in the group D2 was higher than those in the other 3 groups(3 cases vs.7 cases vs.1 case vs.1 case,χ2=9.412, P=0.024). Conclusion Dexmedetomidine 0.4 μg/kg by intravenous injection can treat postoperative shivering after liposuction effectively and reduce the adverse reactions.

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopneasyndrome,OSAHS)患者手术麻醉困难气道的因素预测. 方法 选择ASA Ⅰ～Ⅱ级择期行改良悬雍垂腭咽成形术(Han-uvulopalatopharyngoplasty,H-UPPP)60例,分别按照Mallampati分级、面罩通气分级和Cormack-Lehane声门分级(C/L分级)分组,分析年龄、BMI、Hb、呼吸暂停低通气指数(apnea hypopnea index,AHI)和最低血氧饱和度(the lowest oxygen saturation,LSaO2)与3种分级的关系. 结果 3种分级组间进行比较:BMI、LSaO2和AHI差异有统计学意义(P＜0.05).患者BMI、LSaO2和AHI与Mallampati分级、面罩通气分级和C/L分级有相关性(rBMI=0.530、0.326、0.488,P均＜0.05;rAHI=0.617、0.408、0.581,P均＜0.05;rLSaO2=-0.794、-0.587、-0.735,P均＜0.05). 结论 OSAHS患者的BMI、LSaO2、AHI与Mallampati、面罩通气分级和C/L分级有相关性,可为临床评估困难气道提供参考.

Objective To evaluate the analgesic efficiency and safety of patient-controlled intravenous analgesia ( PCIA) with both flurbiprofen and sufentanil after Han-uvulopalatopharyngoplasty ( H-UPPP) surgery. Methods Patients undergoing H-UPPP surgery ( n=60 ) were randomly divided into four groups with 15 cases in each group .They received PCIA after operation with a loading dose of 2 ml, lockout time of 15 minutes, background infusion rate of 2 ml/h and liquid volume of 100 ml.The PCIA formulation in each group was as follows:sufentanil 3.0 μg/h in group A;sufentanil 3.0 μg/h+flurbiprofen 4.0 mg/h in group B;sufentanil 2.0μg/h+flurbiprofen 4.0 mg/h in group C;sufentanil 1.0μg/h+flurbiprofen 4.0 mg/h in group D.The visual analogue scale (VAS) and Ramsay sedation scale were recorded at 2, 6, 12, 24, and 48 h after surgery (T1 -T5 time points).Patient pressing times and the adverse effects within 48 h after surgery were counted . Results The VAS scores of the group D were higher than those in the other three groups at T1 and T2 time points (P<0.05).The Ramsay scores of the group D were lower than those in the other three groups at T1 and T2 time points (P<0.05).The numbers of pressing times in the group D were more than those in the other three groups (P<0.05). Conclusion PCIA with both flurbiprofen 4.0 mg/h and sufentanil 2.0 μg/h is effective for postoperative analgesia after H-UPPP.

目的：探究氯胺酮诱导脑皮质神经细胞的凋亡及其机制。方法分别用30、60、80、100 mg／ml氯胺酮分别处理小鼠脑皮质神经细胞6、12、18、24 h，采用MTT法检测氯胺酮处理后小鼠皮质神经细胞的凋亡率；用100 mg／ml氯胺酮不用时间处理小鼠皮质神经细胞，乳酸脱氢酶（ LDH）试剂盒检测处理前后皮质神经细胞LDH释放率的变化；将不同处理后的神经细胞进行总蛋白提取，Western印迹法检测GSK-3β蛋白的表达；用100 mg／ml氯胺酮处理后的小鼠皮质神经细胞18 h后采用流式细胞仪检测处理后皮质神经细胞的凋亡。结果30 mg／ml的氯胺酮处理6 h，细胞的凋亡率仅为（12.4±2.47）％，对照组没有出现细胞凋亡，随着浓度的增加和作用时间的延长，凋亡率逐渐增加；100 mg／ml氯胺酮处理24 h时小鼠神经细胞的抑制率达到最大值为（58.7±5.86）％。100 mg／ml的氯胺酮不用时间处理皮质神经细胞后LDH释放率与氯胺酮作用时间呈正相关，其中18 h释放率较大，24 h皮质神经细胞的LDH释放率为（192±4.39）％，在6～24 h达到最大，约为6 h处理的1.8倍。6 h GSK-3β蛋白表达量升高，约为对照组的（105.4±4.13）％，12 h的GSK-3β蛋白表达量呈现较低水平为（118.7±3.56）％，18 h表达量明显升高为（144.7±3.72）％，24 h为对照组的（197.3±4.36）％。与对照组相比，氯胺酮处理后的皮质神经细胞出现了大量的凋亡。结论高剂量氯胺酮能够诱发小鼠脑皮质神经细胞凋亡，可能与GSK-3β蛋白激活相关。