目的 观察不同给药模式在瑞芬太尼静脉分娩镇痛中的应用,为临床提供安全有效的镇痛方式.方法 选择2014年6月-2015年4月武汉市妇女儿童医疗保健中心收治的450例拟行阴道分娩的产妇,其中未采用分娩镇痛150例(无分娩镇痛组);选择分娩镇痛的300例按照抽签法随机分入瑞芬太尼静脉持续输注组和瑞芬太尼静脉间断单次输注组,每组150例,分别以瑞芬太尼0.1 μg/(kg·min)静脉持续输注和每隔3 min单次给予5μg/mL瑞芬太尼20 μg.记录并比较3组产妇分娩过程中不同时间点的疼痛视觉模拟评分(VAS评分)、Ramsay镇静评分和血流动力学指标,各产程时间和分娩过程中胎心率,剖宫产率、催产素使用率、器械助产率和不良反应发生率,以及瑞芬太尼静脉持续输注组、瑞芬太尼静脉间断单次输注组的瑞芬太尼总用药量和脐动脉/脐静脉血药浓度比.记录并比较3组新生儿娩出后1和5 min时的Apgar评分,以及脐动脉血气分析指标.结果 瑞芬太尼静脉持续输注组和瑞芬太尼静脉间断单次输注组产妇活跃期每间隔15 min、宫口开全时、胎儿娩出时的疼痛VAS评分分别显著低于无分娩镇痛组同时间点(P值均＜0.05),活跃期每间隔15 min、宫口开全时、胎儿娩出时的Ramsay镇静评分分别显著高于无分娩镇痛组同时间点(P值均＜0.05),前两组间各时间点的疼痛VAS评分和Ramsay镇静评分的差异均无统计学意义(P值均＞0.05).3组产妇不同时间点的心率、平均动脉压的差异无统计学意义(P值均＞0.05).瑞芬太尼静脉持续输注组和瑞芬太尼静脉间断单次输注组产妇的第一产程活跃期时间均显著短于无分娩镇痛组(P值均＜0.05),前两组间的差异无统计学意义(P＞0.05);3组间产妇的第二、第三产程时间和分娩过程中胎心率的差异均无统计学意义(P值均＞0.05).瑞芬太尼静脉持续输注组和瑞芬太尼静脉间断单次输注组产妇的剖宫产率、催产素使用率、器械助产率均显著低于无分娩镇痛组(P值均＜0.05).3组间产妇恶心呕吐、呼吸抑制、心率减慢、宫缩乏力发生率的差异均无统计学意义(P值均＞0.05).瑞芬太尼静脉持续输注组与瑞芬太尼静脉间断单次输注组间产妇的瑞芬太尼总用药量和脐动脉/脐静脉血药浓度比的差异均无统计学意义(P值均＞0.05).3组新生儿均未发生新生儿窒息,娩出后1和5 min时的Apgar评分,以及脐动脉血气分析各指标的差异均无统计学意义(P值均＞0.05).结论 瑞芬太尼静脉持续和间断单次输注用于分娩镇痛的效果均较明显.
Objective To observe the anesthesia effect of dezocine and pentazocine in painless artificial abortion, in order to provide a basis for safe use of anesthesia drug in clinical practice. Methods Totally,300 patients undergoing painless artificial abortion were included in this study.The patients were randomly divided into four groups: group A (simple propofo), group B ( propofol combined with fentanyl) ,group C ( propofol combined with dezocine) and group D ( propofol combined with pentazocine)(n=75 each).Four groups of patients were intravenously injected with propofol (1-1.5 mg?kg-1) according to the situation in operation when necessary to maintain anesthesia effect.Heart rate (HR),mean arterial pressure (MAP),arterial oxygen saturation ( SpO2 ) and respiratory frequency were observed and recorded before induction,after induction,at the beginning of the operation,during operation and anesthesia recovery. The onset time of anesthesia, the recovery time, the recovery time of orientation,the postoperative pain score and the incidence of adverse reaction of the four groups were recorded. Results All of the patients achieved good effects of anesthesia in operations. There was no significant difference in the onset time of anesthesia (P>0.05).Awakening time and time of orientation recovery in groups B,C and D were significantly shorter than those in group A (P<0.05).The dosages of propofol in group C and D were significantly less than those in group A and B (P<0.05).The changes of HR,MAP,SpO2 and respiratory frequency after induction were not significantly different in group B,C and D (P>0.05),but the changes were relatively stable as compared with group A (P<0.05).The rates of adverse reactions in group B,C and D were significantly lower than that in group A (P<0.05).The incidence rates of respiratory depression,nausea and vomiting in group C and D were significantly lower than those in group A and B (P<0.05).The postoperative pain scores of VAS in group B,C and D were significantly lower than that of group A (P<0.05). Conclusion The analgesia effects of dezocine and pentazocine are similar.Application of them can reduce the dosage of propofol and shorten the anesthesia awakening time in painless artificial abortion,at the same time they have less adverse reactions,and they are safe and effective to be used in clinical anesthesia.
目的探讨气管插管全麻下不同吸入氧浓度(FiO2)对新生儿肺泡-动脉氧分压差的影响。方法气管插管全麻下行控制呼吸的新生儿手术100例,随机分为A组(FiO2=40%)、B组(FiO2=60%)、C组(FiO2=80%)、D组(FiO2=100%),每组25例。从给氧去氮开始,分别吸入相应的FiO2。于插管前(T0)、麻醉诱导后30min(T1)及手术结束时(T2)采集动脉血样进行血气分析,计算肺泡-动脉氧分压差。结果各组患儿均未出现低氧血症,肺泡-动脉氧分压差随着FiO2的升高而升高,与其他组相比T1、T2时A组的肺泡-动脉氧分压差最低(P<0.05)。结论新生儿气管插管全麻时FiO2越高,则肺泡-动脉氧分压差也随之升高。
喉乳头状瘤又称复发性呼吸道乳头状瘤病,由人类乳头状瘤病毒感染所致.它好发于婴幼儿,特别是5岁以下患儿复发率高.因此手术风险较大,对麻醉的要求较高.术中既要维持声带静止不动,还要保证患儿的有效通气.我科在反复实践中总结出较安全可靠的麻醉方法,现介绍如下.
