目的 探讨新斯的明联合不同剂量舒更葡糖钠在腹腔镜胆囊切除术中逆转深度肌松的效果.方法 收集接受腹腔镜胆囊切除术患者48例,随机分为NS2组、NS1组、NS0.5组和S4组,每组12例.术中使用罗库溴铵维持深度肌松,强直刺激(PTC)=1～2,术后NS2组、NS1组及NS0.5组在PTC=1～2时静注新斯的明60 μg/kg+阿托品15 μg/kg,在四个成串刺激(TOF)=1～2时分别静脉注射舒更葡糖钠2 mg/kg、1 mg/kg、0.5 mg/kg,S4组在PTC=1～2时静注舒更葡糖钠4 mg/kg.记录使用首剂肌松拮抗药到成串刺激比(TOFr)恢复至0.9和拔除气管导管的时间;记录使用首剂肌松拮抗剂时、使用后5 min及10 min的平均动脉压和心率、麻醉恢复室(PACU)停留时间、术后肌松残余发生率和围术期不良反应发生率.结果 4组从使用首剂肌松拮抗药到TOFr恢复至0.9的时间差异有统计学意义(P＜0.05);NS2组拔管时间与S4组相近(P=0.911),明显短于其他两组(P＜0.05);4组使用肌松拮抗剂后的血压及心率变化、PACU停留时间差异均无统计学意义(均P＞0.05);4组均无术后肌松残余及围术期不良反应发生.结论 舒更葡糖钠(4 mg/kg)逆转深度肌松的恢复时间明显短于新斯的明联合小剂量的舒更葡糖钠,联合用药并不能减少舒更葡糖钠的剂量.

目的 初步分析围术期导致小儿认知和行为功能改变的麻醉相关因素.方法 大样本观察并有效随访温州医科大学附属第二医院2012～2017年期间接受择期非神外非心外手术行全身麻醉的4～7岁学龄前患儿共17854例,将患儿分别按照麻醉方法(静脉麻醉和吸入麻醉)、术中有无低氧血症、低血压、低体温、输血、阿托品使用和胶体使用输血等分组,统计分析导致围术期小儿认知和行为功能改变的麻醉相关因素.结果 17854例患儿中,术后发生认知和行为功能改变者为1.82％(325例).其中吸入麻醉组发生率显著高于静脉麻醉组(302 vs 23例,1.93％vs 1.00％,P<0.05);术中发生低氧血症组(185例,6.80％)较无低氧血症组发生率显著增高(140例,0.93％,P<0.05);术中发生低血压组(54例,3.30％)较无低血压组显著增高(271例,1.67％,P<0.05);术中发生低体温组(243例,6.27％)较无低体温组显著增高(82例,0.59％,P<0.05);有无使用阿托品、胶体和输血分析比较差异均无统计学意义(P均>0.05).多因素Logistic回归分析发现术中低氧血症、低血压、低体温和使用吸入麻醉均是患儿发生围术期认知功能和行为改变的危险因素(OR=4.66,2.34,10.59,1.72),曲线下面积发现以上因素的ROC值分别为0.91、0.79、0.89、0.76.结论 术中低氧血症、低体温、低血压和使用吸入麻醉是患儿发生围术期认知功能和行为改变的独立危险因素.

Objective: To compare the perioperative effects of ultrasound-guided serratus anterior plane block (SAPB) and erector spinae plane block (ESPB) in radical mastectomy. Methods: One hundred and fifty patients,undergoing radical mastectomy from May 2016 to Jan 2019,the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, were randomly divided into SAPB group, ESPB group and control group. Patients in SAPB group and ESPB group were received corresponding blocks before induction of general anesthesia. The control group was only received routine general anesthesia without any block. Patient-controlled intravenous analgesia (PCIA) was performed in all the patients postoperatively. The VAS score at rest or coughing and Ramsay score at 2, 4, 8, 12, 24, 48 h after operation were compared among the three groups. The intraoperative dosages of propofol and remifentanil,press times and sufentanil cumulative dosage of PCIA in 48 hours after operation, postoperative rehabilitation indicators and adverse effects were all compared. Results: In all the three groups,the VAS scores at rest and coughing increased first and then decreased 2 h to 48 h after operation. The VAS scores in SAPB group and ESPB group were lower than that in control group (P<0.05), whereas, no significant difference was observed between SAPB group and ESPB group (P>0.05). For Ramsay score, among the three groups, there were no significances of the main effects of group and time point, as well as interaction effect (all P>0.05). The intraoperative dosages of propofol and remifentanil in SAPB group and ESPB group were lower than those in control group (P<0.05), the press times and sufentanil cumulative dosage of PCIA after operation were also lower than those in control group (P<0.05). There was no significant difference in feeding time after operation among the three groups (P>0.05). The times of first anal exhaust, ambulation and hospitalization after operation in ESPB group and SAPB group were significantly shorter than those in control group (P<0.05). However, there was no significant difference between ESPB group and SAPB group in postoperative rehabilitation indicators mentioned above (P>0.05). The incidences of skin itching and nausea in ESPB and SAPB groups were lower than those in control group (P<0.05). There was no difference in the incidence of vomiting among the three groups (P>0.05). Conclusions: Both SAPB and ESPB can provide good and safe analgesia for radical mastectomy,with equivalent performances in analgesia and adverse effect.