目的 观察超声引导下踝部神经阻滞麻醉在老年阿尔茨海默病患者踝远端手术中的麻醉效果和对血流动力学的影响.方法 回顾性分析唐山市第二医院2010年1月-2019年1月收治的进行踝部神经阻滞的患者62例,34例患者实施超声引导的踝部神经阻滞(A组),28例患者实施硬膜外麻醉(B组),二组均静脉给予盐酸右美托咪定1 μg/kg持续泵入,泵入时间12 min,待患者处于完全镇静即深睡眠状态后给予静脉盐酸右美托咪定0.7～0.8 μg/(kg·h)持续泵入,维持镇静状态,记录动脉穿刺置管完后1 min(T0)、局麻药注射完成后5 min(T1)、手术切皮即刻(T2)、手术开始后15 min(T3)、30 min(T4)、手术结束苏醒即刻(T5)时的HR、MAP,分析血流动力学变化,并通过镇静评分和观察应激性体动反应评估麻醉效果是否完善.结果 A组在所有时间点镇静评分均达到0分,无1例应激性体动;B组在T2时间点有4例镇静评分为1分,并出现应激性体动,差异均无统计学意义(均P＞0.05).血流动力学方面,二组在T0、T3、T4、T5时HR、MAP差异无统计学意义(P＞0.05);T1、T2时A组HR明显低于B组、MAP明显高于B组,差异有统计学意义(P＜0.05).结论 老年阿尔茨海默病患者行足踝远端手术中,应用右美托咪定镇静后实施超声引导下踝部神经阻滞,麻醉效果确切、完善,对患者血流动力学影响极小,具有较高的安全性.

目的 观察骨科全麻术前预输注右美托咪定(DEX)对患者麻醉深度及血流动力学的影响.方法 选取2018年1月至2019年1月于我院手术治疗的40例骨科手术患者,ASA Ⅰ～Ⅱ级,随机分为观察组和对照组,两组均在常规全身麻醉下完成手术,观察组患者在麻醉诱导前15 min内泵注DEX,应用剂量为1μg/kg;对照组于相同时间泵入等量生理盐水.对比两组患者T1(入室后)、T2(泵入前5 min)、T3(泵入后)、T4(插管前)、T5(插管后)、T6(切皮时)、T7(术中峰值)、Ts(拔管)时血流动力学指标、脑状态指数(Cerebral state index,CSI)、镇静评分(Ramsay);并在T8时使用视觉模拟评分法(VAS)对患者术后疼痛程度进行评分.结果 观察组T3～T8时心率均小于对照组(P＜0.05),T4、T5、T7、T8时SBP低于对照组(P＜0.05),T4、T5、T8时DBP低于对照组(P＜0.05);两组各时点SpO2比较差异无统计学意义(P＞0.05);观察组T2、T3时CSI值低于对照组(P＜0.05),Ramsay评分高于对照组(P＜0.05);两组T8时VAS评分比较差异无统计学意义(P＞0.05);观察组术中使用丙泊酚注射液及盐酸瑞芬太尼用量均少于对照组(P＜0.05).结论 骨科手术患者麻醉诱导前预输注DEX,可提高术中及术后镇静、镇痛效果,减轻患者插、拔管反应,对稳定围术期血流动力学指标具有显著效果.

Objective To explore the effect of dexmedetomidine (Dex) on serum inflammatory cytokines in patients undergiong thoracoscopic radical resection of esophageal carcinoma (EC) . Methods A total of 58 patients with esophageal carcinoma (EC) in our hospital from January 2016 to November 2017 receiving thoracoscopic radical resection of EC were included in the study and randomized into observation group and control group, 29 cases in each group. After anesthesia induction, the double-lumen tube tracheal intubation was performed under the location of fiber bronchoscope. Respiration was controlled by single lung. Patients in observation group were given 1 μg/kg Dex, while the patients in control group were given 0. 5 ml/kg normal saline. Patients were given patient-controlled analgesia pump after operation. The levels of M AP and HR were measured before anesthesia induction (T0) and at 0 h, 24 h and 72 h after operation (T1, T2 and T3) , and the internal jugular venous blood was collected at the same time. The levels of IL-1β, IL-6 and TNF-α were detected by ELISA. Results The levels of M AP and HR in observation group were lower than those in control group at T1 (P < 0. 05) , and the levels of serum IL-1β, IL-6, and TNF-α in observation group were lower than those in control group at T1, T2 and T3 (P < 0. 05) . Conclusion Dex can effectively improve the perioperative inflammatory reaction in patients undergoing thoracoscopic radical resection of EC, and maintain the stability of perioperative hemodynamics.

Effect of dexmedetomidine assisted anesthesia on the inflammatory cytokines and T lymphocyte subsets in elderly patients with Alzheimer disease underwent total hip replacement Xiao-Rui Wang, Yang-Yang Li, Liang Wan, Wen-Yan Guo, Bo-Qian Li, Li-Tao Zhang, Yue-Ying Dong Department of Anesthesia, the Second Hospital Affiliated to Tangshan City, Hebei, 063000 Department of ENT, Tangshan Union Medical College Hospital, Hebei, 063000 Journal of Hainan Medical University

Objective: To explore the effect of dexmedetomidine assisted anesthesia on the inflammatory cytokines and T lymphocyte subsets in elderly patients with Alzheimer disease (AD) underwent total hip replacement (THR).Methods: A total of 60 patients with AD who were admitted in our hospital from October 2014, to October 2016 for THR were included in the study and randomized into the observation group and the control group with 30 cases in each group.Strict preoperative preparation was performed.The patients in the two groups were given intravenous injection of midazolam (0.04 mg/kg), propofol (0.5~1.5) mg/kg, cisatracurium (0.15 mg/kg), and fentanyl (4 μg/kg) for anesthesia induction, continuously venous pumping of propofol (1.5~2.5) mg/kg/h and remifentanil (0.04~0.40) μg/kg/min in maintaining the anesthesia depth, and cisatracurium for intermittent muscle relaxation.The patients in the observation group were given venous pumping of dexmedetomidine (1 μg/kg) 15 min before anesthesia induction, and dexmedetomidine (0.2~0.7) μg/kg/h for maintenance until the end of operation.The peripheral venous blood before operation, the time immediately after operation, 12 h and 24 h after operation in the two groups was collected.ELISA was used to detect CRP, IL-6, and TNF-α.FCM was used to detect T lymphocyte subsets (CD3+, CD4+, and CD8+).CD4+/CD8+ were calculated.Ramsay sedation grading was performed before operation, the time immediately after operation, 12 h and 24 h after operation.Results: Ramsay sedation score the time immediately after operation and 12 h after operation in the observation group was significantly greater than that in the control group (P<0.05).The serum CRP, IL-6, and TNF-α levels the time immediately after operation, 12 h and 24 h after operation in the observation group were significantly lower than those in the control group (P<0.05).The serum CD3+, CD4+, CD8+, and CD4+/CD8+ the time immediately after operation, 12 h and 24 h after operation in the observation group were significantly higher than those in the control group (P<0.05).Conclusions: Dexmedetomidine applied in patients with AD underwent THR has a unique analgesia and sedation effect, and can effectively inhibit the release of inflammatory cytokines in order to improve the immunological function.

目的 探讨右美托咪啶对老年阿尔茨海默病(AD)患者髋关节置换术(THR)围麻醉期氧代谢的影响.方法 选取2014年11月-2016年11月收治的AD患者实施THR 64例为研究对象,随机分为观察组和对照组各32例.入室后常规低流量吸氧,进行心率、血压、呼吸、脉搏、血氧饱和度等监测,罗哌卡因行L2~3节段腰硬联合麻醉,观察组将右美托咪啶溶于48 mL生理盐水,浓度调至4μg·mL-1,微泵静脉泵入,速率为0.4μg·(kg·h)-1,10 min后速率调至0.2μg·(kg·h)-1,对照组给予等量生理盐水微泵静脉泵入.两组患者于麻醉前、术中30 min、术中60 min、术毕即刻采集桡动脉和颈内静脉球部血标本进行血气分析,记录并计算颈内静脉血氧饱和度(SjvO2)、脑氧含量(CjvO2)、动脉-颈内静脉氧含量差[D(a-jv)O2]、脑氧摄取率(CERO2)、动脉血氧含量(CaO2);采用ELISA法测定颈内静脉血样血清S-100β蛋白浓度;测量各时间点心率(HR)、平均动脉压(MAP).结果 观察组术中30 min、术中60 min、术毕即刻SjvO2、CjvO2、CaO2高于同期对照组,D(a-jv)O2、CERO2低于同期对照组,两组患者间比较差异有统计学意义(P<0.05);观察组术中30 min、术中60 min血清S-100β蛋白水平低于同期对照组(P<0.05);观察组术中30 min、术中60 min、术毕即刻MAP、HR低于同期对照组(P<0.05).结论 右美托咪啶可有效降低AD患者实施THR围麻醉期脑代谢水平,减轻脑损伤,对改善患者预后有积极意义.

目的：对有智力障碍的老年髋部骨折患者选择硬膜外麻醉,观察麻醉的效果及安全性。方法选择智力障碍老年患者下肢骨科手术80例,随机分为A组(硬膜外组)和B组(全麻组),麻醉前A组应用舒芬太尼复合咪达唑仑充分镇静、镇痛后,选择硬膜外麻醉；B组选择静脉麻醉。监测并记录两组患者术中的收缩压、舒张压、心率、血氧饱和度和不良事件,评价两种麻醉方法的效果和不良反应。结果与患者静脉注药前即刻(T1)比较,两组注药后5分钟(T2)、10分钟(T3)、30分钟(T4)时收缩压、舒张压均显著下降(P<0.05),血氧饱和度均升高显著(P<0.05)；T2时间点,B组收缩压显著低于A组；T5时间点B组收缩压、舒张压显著高于A组(P<0.05)。 A组无不良反应病例,所有患者在术后10分钟恢复自主意识；B组出现10例收缩压下降超过20%,6例术后呼吸抑制。结论在应对智障老年患者髋部骨科手术麻醉时,充分镇静、镇痛后实施硬膜外麻醉效果好,对患者循环系统影响较全身麻醉小,更安全。