目的 探讨学生标准化病人(student as standardized patient,SSP)在麻醉专业住院医师规范化培训(简称"住培")教学查房中应用的可行性.方法 选择2020年8月—2022 年 8 月安庆市立医院麻醉科住培医师 60 名,分为研究组和对照组各 30 名,研究组采用将SSP引入教学查房的教学模式;对照组采用传统示教模式,两组完成教学查房 3 个月后采用迷你临床演练评量(mini-clinical evaluation exercise,Mini-CEX)及住培医师满意度调查总结评价教学查房效果.结果 研究组问诊能力、查体能力、临床诊断、人文关怀、组织效能、沟通能力以及整体表现评分均高于对照组,差异有统计学意义(P＜0.001),研究组满意度高于对照组,差异有统计学意义(P＜0.05).结论 麻醉科专业住培教学查房实施过程中引入SSP,调动了住培医师的学习积极性,全面提高了住培医师综合能力与职业素养,可提高麻醉专业住院医师规范化培训教学质量和内涵.

目的 观察右美托咪定联合罗哌卡因切口浸润在小儿腹腔镜手术中的应用效果.方法 选取2017年1月—2018年1月安徽医科大学附属安庆医院行腹腔镜手术患儿120例,采用随机数字表法分为A、B、C 3组,每组40例.A组为对照组,关闭气腹前静脉推注芬太尼1.0μg/kg;B组术毕用0.25％罗哌卡因浸润切口;C组麻醉诱导前静脉泵注右美托咪定0.4μg/kg,术毕用0.25％罗哌卡因浸润切口.记录3组患儿术中麻醉药物的用量,苏醒期躁动发生率,麻醉后恢复室(PACU)停留时间,以及术后4 h、8 h、12 h、24 h、48 h NRS评分、围术期并发症的发生率、住院时间、家长满意度.结果 与A、B两组比较,C组患儿苏醒期躁动发生率明显降低,家长满意度明显提高(P<0.05);与A组比较,B、C两组术后4 h、8 h、12 h NRS评分降低(P<0.05);3组患儿PACU停留时间、住院时间及围术期并发症发生率比较,差异无统计学意义(P>0.05).结论 静脉输注右美托咪定联合罗哌卡因切口浸润可降低小儿腹腔镜术后苏醒期躁动发生率,减轻患儿术后疼痛,提高家长满意度.

目的 比较右美托咪定与硬膜外阻滞对老年全麻胃肠手术患者术后谵妄的影响.方法选择择期胃肠手术患者90例,年龄65～84岁,ASAⅠ～Ⅲ级,采用随机数字表法将患者分为3组(n=30).A组为单纯全身麻醉组;B组为右美托咪定复合全身麻醉组;C组为硬膜外阻滞联合全身麻醉组.记录三组患者术中麻醉药物用量,手术、麻醉时间等一般情况以及术后48 h内VAS评分,观察患者术后1、2、3d谵妄发生率,下床活动时间,首次通气时间,住院时间,住院期间及出院3个月内并发症的发生情况.结果与A组比较,B、C两组术中麻醉药物用量明显减少(P<0.05),术后谵妄发生率显著降低(P<0.05),住院时间明显缩短(P<0.05).与B组比较,C组术中全麻药物使用量显著减少(P<0.01),术后首次通气时间明显缩短(P<0.05).结论右美托咪定与硬膜外阻滞均可降低老年全麻胃肠手术患者术后谵妄发生率并缩短住院时间,两者之间比较无明显区别.

Objective To investigate the effect of modified rapid sequence induction(RSI) on induction of general anesthesia in the surgery. Methods 60 ASA I or II patients, aged 30~60 year, weighing 45~80 kg, scheduled for gastric cancer, colorectal cancer surgery under general anesthesia were randomly divided into two groups (n=30 each):modified RSI and conventional RSI. Heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SPO2 ), arterial partial pressure of (PaO2 ) and arterial carbondioxide partial pressure (PaCO2 ) were recorded at the time of pre-induction(T1 ), post-induction 2 min(T2 ), post-intubation 1 min (T3 ) and post-intuba-tion 5 min (T4 ) in two groups. Vein blood samples were taken for determination of plasma concentrations of cortisol (nmol/L) and blood glucose (mmol/L) at the time of T1 ,T3 and T4 . Results Compared with T1 , the MAP and HR were significantly decreased at T2 in group conventional RSI (P<0.05), while no significant decrease was ob-served in group modified RSI. Compared with T2 , the MAP and HR were significantly increased in group conven-tional RSI (P<0.05), with no significant decrease in group modified RSI. The PaO2 and PaCO2 were no statisti-cally significant in two groups. Compared with group modified RSI, PaO2 were significantly increased in group con-ventional RSI (P<0.05), but induction of anesthesia time was significantly prolonged(P<0.05). Plasma cortisol and blood glucose were of no significant difference in two groups at T1 , T3 and T4 . Conclusion The modified rap-id sequence induction has more hemodynamic stability and lower stress response during induction of general anes-thesia.