目的 分析全凭静脉麻醉对腔镜下甲状腺手术患者术后苏醒躁动及镇痛效果的影响.方法 将200例行腔镜下甲状腺手术的患者按照手术麻醉方法将其分为观察组(采用全凭静脉麻醉,n=100)和对照组(采用静脉联合吸入麻醉,n=100).测评两组患者术后1,6,12,24 h的疼痛评分并比较,苏醒时进行Rsmsay镇静和ASA躁动评分并行组间比较.比较两组患者自主呼吸回复时间、苏醒时间和拔管时间、麻醉相关并发症率.结果 观察组术后1,6,12,24 hVAS评分均较对照组低(P＜0.05);自主呼吸恢复时间、苏醒时间和拔管时间较对照组短(P＜0.05);苏醒时Rsmsay镇静评分较对照组高,ASA躁动评分较对照组低(P＜0.05);术后麻醉相关并发症率低于对照组患者(P＜0.05).结论 全凭静脉麻醉可有效降低腔镜下甲状腺手术患者的疼痛感受,提高苏醒质量,降低患者术后麻醉相关并发症率,提高患者手术安全性,具有较高的临床价值.

口腔颌面部间隙感染是一种起病急、发展快,且常会危及生命的口腔颌面外科的临床急症.张口受限、颌面部广泛肿胀、呼吸困难或窘迫、感染性休克、心力衰竭等是此类患者较常见的临床表现;高血压、糖尿病、冠心病及慢性阻塞性肺气肿等也是常见的并存疾病,因此,颌面部间隙感染围术期麻醉管理极具挑战性.本文通过从术前麻醉访视、麻醉诱导及气道建立、术中及术后麻醉管理等方面进行了全面探讨,期望能对颌面部间隙感染患者的围术期麻醉管理提供最佳方案.

Children's dental treatment under ambulatory general anesthesia is to treat all the decayed teeth and the children can go home safely at the same day.Owing to the restriction of medical condition, technology and conception, children's dental treatment under general anesthesia started late in our country but it has large demand.The difficult part of children's dental treatment under ambulatory general anesthesia lies in the anesthesia.In order to guarantee the safety of anesthesia and improve the quality and comfort, it's essential to have the criteria of patient selection, thorough configuration of facility and staff, well-prepared, detailed anesthesia management, complete records and follow-ups.Nowadays, there are no selection and guideline of anesthesia related to children's dental treatment under general anesthesia.The aim of this work is to summarize the experience we had, and try to make standardized management for children's dental treetment under ambulatory general anesthesia.