目的 探讨不同剂量右美托咪定对学龄前儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)应激反应及术后苏醒期躁动的影响.方法选取2017年8月～2020年12月在中国人民解放军联勤保障部队第904医院行手术治疗的学龄前OSAHS患儿128例,以随机数字表法分为A组(0.2 μg/kg右美托咪定10 mL)、B组(0.4 μg/kg右美托咪定10 mL)、C组(0.6μg/kg右美托咪定10 mL)、D组(0.9％氯化钠溶液10 mL),每组各32例.对比4组患儿手术时间、苏醒时间及拔管时间;对比4组患儿不同时刻应激反应相关指标;对比4组患儿苏醒即刻及术后2 h的Ram-say评分及苏醒期躁动发生率.结果C组苏醒时间长于A组、B组及D组(P＜0.05).4组患儿术前30 min、手术15 min血清血管紧张素Ⅱ(angiotensin Ⅱ,Ang Ⅱ)、肾上腺素(adrenaline,AD)水平比较,差异均无统计学意义(P＞0.05);B组、C组术后l h血清Ang Ⅱ、AD水平均低于A组、D组(P＜0.05).B组、C组苏醒即刻、术后2 h Ramsay评分均高于A组、D组(P＜0.05).A组、B组、C组苏醒期躁动发生率分别为15.63％、3.13％、3.13％,与D组34.38％比较,差异均有统计学意义(P＜0.05);B组、C组苏醒期躁动发生率低于A组、D组(P＜0.05).结论 右美托咪定可有效降低学龄前儿童OSAHS术后苏醒期躁动发生率,学龄前儿童OSAHS手术中更适合应用0.4 μg/kg剂量的右美托咪定.

目的 观察氢吗啡酮复合右美托咪定硬膜外注射对老年全髋关节置换术术后镇痛的效果.方法 将78例全髋关节置换术患者随机分为研究组和对照组,每组39例.对照组术毕硬膜外注射氢吗啡酮0.3 mg,研究组依次注射右美托咪定0.5μg/kg及氢吗啡酮0.3 mg.2组术后均采用舒芬太尼静脉自控镇痛.比较2组术后1 h(T1)、4 h(T2)、12 h(T3)、24h(T4)视觉模拟评分法(VAS)评分、Ramsay镇静评分、心率(HR)、平均动脉压(MAP)及血氧饱和度(SpO2),记录舒芬太尼消耗量及不良反应的发生情况.结果 研究组静息和运动状态下T3、T4时点的VAS评分及Ramsay评分均低于对照组,差异有统计学意义(P＜0.05);研究组T4时点Ramsay评分低于T1,差异有统计学意义(P＜0.05).研究组T2～T4时点HR及T1～T3时点MAP低于对照组,差异有统计学意义(P＜0.05);研究组T2～T4时点HR低于T1时点,对照组T2 ～ T4时点MAP低于T1时点,差异有统计学意义(P＜0.05).研究组舒芬太尼消耗量少于对照组,差异有统计学意义(P＜0.05).2组不良反应比较,差异无统计学意义(P＞0.05).结论 氢吗啡酮复合右美托咪定硬膜外注射对老年全髋关节置换术后镇痛效果显著,可稳定血流动力学指标,利于术后恢复.

Objective:To observe the hemodynamic change and inhibitory effect on stress response of oxycodone during induction, maintenance and resuscitation period of general anesthesia in patients undergoing gastric cancer surgery.Methods:60 patients with general anesthesia undergoing elective gastric cancer from March 2018-March 2019 in No.904 Hospital were selected. According to the random number table method, they were randomly divided into two groups ( n=30): Oxycodone group (group O) and Fentanyl group (group F). The anesthesia was induced by intravenous oxycodone 0.3 mg/kg (group O) or fentanyl 3 μg/kg (group F), propofol 2 mg/kg and cisatracurium 0.25 mg/kg. Oxycodone (group O) or fentanyl (group F) with sevoflurane were used for maintenance of general anesthesia. The mean arterial pressure (MAP) and heart rate (HR) were recorded before anesthesia induction (T 0), immediately intubation (T 1), 1 min (T 2) and 5 min (T 3) after intubation, immediately skin incision (T 4), surgery for 1 h (T 5), the end of operation (T 6) and 1 min (T 7) and 5 min (T 8) after extubation. The concentration of glucose (Glu), cortisol (Cor), epinephrine (E) and norepinephrine (NE) were detected in time T 0,T 2, T 4,T 5 and T 7. The time of extubation and the visual analogue scale (VAS) scores after extubation and 30 min after entering postanesthesia care unit (PACU) were recorded. The incidence of cough during induction, dysphoria during extubation and the adverse effects such as nausea, vomit and respiratory depression during PACU were also observed. Results:There were no significant difference between two groups in MAP and HR at the time point from T 0 to T 8 ( P>0.05); there were no significant difference about concentrations of Glu, Cor, E and NE at the time point of T 0,T 2,T 4,T 5 and T 7 ( P>0.05). Extubation time and VAS scores of 30 min after entering PACU in group O were significantly lower than those of group F ( P<0.05). Meanwhile, the incidences of cough during induction, dysphoria during extubation and respiratory depression in group O were significantly lower than in group F ( P<0.05). There was no significant difference in the incidence of nausea and vomiting ( P>0.05). Conclusions:Oxycodone can be safely and effectively used for induction and maintenance of general anesthesia in gastric cancer surgery, inhibit intraoperative stress response, and improve the quality of recovery period.

Objective To observe the effects of propofol combined with atracurium cis-benzenesulfonate on muscle relaxa-tion and hemodynamics in patients undergoing laparoscopic cholecystectomy (LC). Methods 90 patients with LC were randomly divided into the control group (n=45) and the observation group (n=45) according to the lottery method. Both groups were induced by anesthesia. The control group was given propofol combined with vecuronium anesthesia. The observation group given propofol combined with triptolide sulfonate anesthesia, and other auxiliary anesthesia drugs are the same. The effect of muscle relaxa-tion and tracheal intubation in two groups of LC patients are observed. During after anesthesia (T0), endotracheal intubation (T1), cutaneous (T2), extubation (T3) and extubation (T4), the changes in hemodynamics were measured. Result The onset time and muscle relaxation recovery time of the muscle relaxants in the observation group were significantly lower than those in the control group. The clinical time and the rate of tracheal intubation were significantly higher in the observation group than in the control group, and the difference was statistically significant. At T0, there were no significant differences in the hemodynamic indexes between the two groups. At T1, T2, T3 and T4, the systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) of the observation group were significantly lower than those of the control group, and compared with T0 was no significant difference. While the control group SBP, DBP and HR levels was significantly higher than T0, and the difference was statistically significant. Conclusion Acetylcidate sulfonate combined with propofol anesthesia, has good muscle relaxion effect and high level of tracheal intubation assessment, and can stabilize hemodynamics, which is one of the clinical effective LC anesthesia program.

目的 探讨瑞芬太尼联合右美托咪啶腰硬麻醉在子宫肌瘤切除术中应用对老年病人应激反应、生命指征、手术时间、疼痛评分和Ramsay评分的影响.方法 选取我院2014年3月至2017年5月期间因子宫肌瘤需行手术治疗老年病人152例,随机分为2组,每组76例,设置为观察组和对照组,2组病人均常规监测生命体征,于麻醉前30 min予以羟乙基淀粉和复方乳酸林格液,并于完成穿刺后予以罗哌卡因,确定无呼吸抑制存在后调节感觉平面到第8胸椎水平.在此基础上,对照组予以瑞芬太尼麻醉,观察组则予以瑞芬太尼联合右美托咪啶腰硬麻醉,比较2组麻醉前(T0)、麻醉后1 h(T1)和术毕后30 min(T2)应激反应、心率(HR)、平均动脉压(MAP),并对比2组手术时间以及术后1 h、4 h、8 h和12 h的视觉模拟评分法(VAS)评分和Ramsay评分.结果 观察组T1和T2的皮质醇(Cor)、肾上腺素(E)和去甲肾上腺素(NE)水平低于对照组,HR和MAP低于对照组,差异具有统计学意义(P<0.05);观察组手术时间和对照组比较,差异无统计学意义(P>0.05);观察组术后1 h、4 h、8 h和12 h的VAS评分低于对照组,Ramsay评分高于对照组,差异具有统计学意义(P<0.05).结论 瑞芬太尼联合右美托咪啶腰硬麻醉在老年子宫肌瘤切除术中应用临床麻醉效果较好,可有效抑制应激反应,稳定生命指征,具有缓解疼痛,增加镇静的效果.

Objective:To investigate the effect of oxycodone hydrochloride injection preemptive analgesia on serum in-flammatory factors,neurotransmitter index and immune function in patients with laparoscopic cholecystectomy.Methods:Ac-cording to random data table,113 patients undergoing laparoscopic cholecystectomy were divided into control group (n =57) and observation group (n =56),patients in the control group were treated with sufentanil citrate injection analgesia,and the observation group patients were given oxycodone hydrochloride injection analgesia,the levels of serum inflammatory factors [tumor necrosis factor-α (TNF-α),interleukin-6 (IL-6 )],neurotransmitter index [5-hydroxy tryptamine (5-HT),P sub-stance]and immune function index [CD4 + ,CD8 + ,CD4 +/CD8 + ]of two groups between preoperative and postoperative 1 d were compared.Results:There were no significant differences in levels of TNF-α,IL-6,5-HT,P substance,CD4 + ,CD8 + and CD4 +/CD8 + between the two groups preoperative (P >0.05).Compared with the levels of the same group preoperative,post-operative 1 d,the levels of TNF-α,IL-6,5-HT,P substance,CD8 + were significantly increased,and levels in the observation group were significantly lower compared with the control group,the difference was statistically significant (P <0.05);Postop-erative 1 d,the levels of CD4 + ,CD4 +/CD8 + in the two groups were significantly lower than the preoperative level within the group,and the observation group was significantly higher than the control group (P <0.05 ).Conclusion:Oxycodone hydro-chloride injection preemptive analgesia in laparoscopic cholecystectomy can effectively reduce serum inflammatory factors and neurotransmitter index release,improve immune function,has an important clinical value.