目的 讨论右美托咪定(dexmedetomidine,Dex)联合咪达唑仑对腰麻-硬脊膜外联合麻醉下行剖宫产产妇的镇静效果.方法 选取在腰麻-硬脊膜外联合麻醉下接受剖宫产术且术中麻醉效果良好的产妇120例,随机将其分为生理盐水组、咪达唑仑组、Dex组及Dex+咪达唑仑组共4组,每组30例.观察产妇在不同给药时间的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、呼吸频率(respiratory rate,RR)、脉搏血氧饱和度(oxygen saturation,SpO2)、动脉血二氧化碳分压(partial pressure of carbon dioxide,PaCO2)、Ramsay镇静评分以及术后2h内产妇的不良反应发生情况,并统计产妇对术中镇静效果的满意度评分.结果 组内比较:4组产妇在T1时间点的MAP、HR、RR与T0相比明显升高,差异均具有统计学意义(P＜0.05);生理盐水组T2～T6与T1比较,MAP、HR、RR、Ramsay评分、PaCO2、SpO2变化差异无统计学意义(P＞0.05);咪达唑仑组T2～T4,Dex组T4～T5,Dex+咪达唑仑组T2～T6与T1比较,MAP、HR、RR明显降低、Ramsay评分明显升高,差异具有统计学意义(P＜0.05).组间比较:4组产妇T2～T6时间点的MAP、HR、RR以及Ramsay评分差异都有统计学意义(P＜0.05),4组产妇SpO2、PaCO2水平各时间点组间比较差异均无统计学意义(P＞0.05);与生理盐水组相比,咪达唑仑组在T2～T4,Dex组T4～T5,Dex+咪达唑仑组T2～T6时间点的MAP、HR、RR明显降低、Ramsay评分明显升高,差异具有统计学意义(P＜0.05),其中Dex组RR水平在T5时间点上与生理盐水组比较差异无统计学意义(P＞0.05);Dex+咪达唑仑组与咪达唑仑组相比在T5～T6时间点上的MAP、HR、RR明显降低、Ramsay评分明显升高,差异有统计学意义(P＜0.05);Dex+咪达唑仑组与Dex组相比在T2～T3,T5～T6时间点上的HR、RR明显降低、Ramsay评分明显升高,MAP水平在T2 ～T3,T6时间点上明显降低,差异有统计学意义(P＜0.05).Dex+咪达唑仑组不良反应发生情况、对产妇的术后随访满意度与其他3组比较,差异均具有统计学意义(P＜0.05).结论 与单独应用Dex和咪达唑仑相比,二者联合应用起效更快,术中全程镇静,镇静效果好,不良反应发生率低,术后随访产妇满意度高.

Objective To discuss the practicability and safety of 3.5 mm superfine bronchoscope in children's difficult airway.Methods Twenty-eight children with difficult airway,aged 4 months to 8 years were selected.Intravenous anesthesia was used and autonomous respiration was maintained.The 3.5 mm superfine bronchoscope was used to guide tracheal intubation by nose(mouth).Results Among 28 cases, 1 case had oral bleeding and succeeded after suction and pressurized oxygen supply, and the rest was successful in the first time.The intubation time was(1.50 ± 0.25)min.There was no damage to the whole airway.Success rate was 100%.Conclusions The 3.5 mm superfine bronchoscope in guiding tracheal intubation of children's difficult airway has obvious advantages and security, and it deserves clinical attention and promotion.

目的 研究脑电监测期丙泊酚个体化用药对癫痫术中脑皮层电图(electrocorticography,ECoG)监测和术毕清醒时间的影响.方法 选择择期行癫痫病灶切除术的患者60例,均采用丙泊酚靶控输注,丙泊酚靶浓度为3μg/ml,诱导时记录患者意识消失时效应室浓度(calculated effect site concentration at loss of consciousness,CeLOC).切开硬脑膜后随机分成两组(每组30例),对照组丙泊酚靶控输注浓度降至1.5μg/ml联合泵入右美托咪定,负荷量0.5μg/kg,输注15 min,继以0.5 μg/(kg·h)维持输注;实验组丙泊酚靶控输注浓度降至CeLOC维持.术中ECoG监测结束将丙泊酚靶控输注浓度调回至3μg/ml,对照组停止右美托咪定输注.观察两组用药方案对ECoG监测的影响、术中知晓情况以及术毕清醒时间.结果 两组用药剂量均不影响术中ECoG监测,均无术中知晓.术毕清醒时间实验组较对照组明显缩短(P＜0.05).结论 采用麻醉诱导期患者CeLOC作为术中ECoG监测的个体化用药剂量,既无术中知晓,又不影响ECoG监测,术后清醒快,简化了麻醉用药,可安全用于致痫灶切除术的麻醉.

目的 提取救治羊水栓塞(amniotic fluid embolism,AFE)产妇的成功经验,为临床提高羊水栓塞产妇救治水平提供实践参考.方法 对2007-01/2015-12月作者医院14例产妇发生围产期AFE的临床救治资料进行回顾性分析,同时进行文献循证.结果 本组AFE产妇14例(重型10例),其中单胎12例,双胎2例;发生于剖官产9例(64.29％),阴道分娩5例(35.71％);以急性肺动脉高压为首发症状者11例(78.57％),以产后出血凝血功能障碍为首发症状者3例(21.43％);成功救治12例(85.71％),死亡2例(14.29％),子宫切除2例(14.29％);娩(剖)出活婴15例,死胎1例.结论 AFE临床发生率虽低,但绝非罕见;临床症状是目前AFE早期诊断、及时救治的重要依据;增强对AFE的防范意识是成功救治AFE的前提条件;尽早纠正低氧血症及心肺复苏是成功救治AFE的有效措施;尽早抗休克是成功救治AFE的关键环节;早期处理弥漫性血管内凝血(disseminated intravasculalk coagulation,DIC)是成功救治重症AFE的重要保证;实施产科有效止血措施是成功救治AFE的重要途径;多学科协作是成功救治重症AFE的必要条件.

目的:研制一种简易吸入麻醉诱导装置,以对不合作患儿进行麻醉.方法:该吸入诱导装置由呼吸器组件、输氧组件、面罩及T型接头组成,输氧组件为人工鼻者为Ⅰ型,输氧组件为雾化器者为Ⅱ型.临床应用患者30例,其中Ⅰ型10例,将七氟烷药液注入人工鼻滤纸上;Ⅱ型20例,将药液注入雾化器内.观察该装置应用的可行性与安全性.结果:麻醉诱导时间平均(62±20)s,麻醉效果优良29例,一般1例;七氟烷用量,Ⅰ型4～5 ml,Ⅱ型3～4 ml;麻醉诱导过程中,SpO2≥97％ 29例,SpO2≤94％1例.结论:小儿简易吸入麻醉诱导装置结构合理、材料简单易得、七氟烷用量少、麻醉效果满意,既可在有氧源条件下使用,又可在缺乏氧源,利用空气条件下使用,且安全、方便、可行.

Objective To observe the effect and safety of intravenous anesthesia with propofol plus remifentanil and dexmedeto-midine during the process of endoscopic retrograde cholangiopancreatography ( ERCP) . Methods Seventy patients, who would undergo ERCP, were divided into intravenous anesthesia group (trial group) and routine group (control group) according to wheth-er the voluntary acceptance of intravenous anesthesia or not. The trial group received intravenous anesthesia with sufentanil (3 to 5μg / kg) and propofol (1 to 2 mg / kg) for induction, and when the patients fall into sleep, propofol (200 mg), remifentanil (300μg) and dexmedetomidine (20μg) were added to 50 ml of solution, which were pumped in at the speed of 2 / 3 of the body mass number (ml/ h) for 3 to 5 minutes and then the speed was decreased down to 1 / 2 of the body mass for maintenance. The control group was intramuscularly anaesthetized with scopolamine (0. 3 mg), pethidine (50 mg) and diazepam (5 to 10 mg) before opera-tion. Mean arterial pressure (MAP), heart rate (HR), pulse oxygen saturation (SpO2 ) and changes in body movement were mo-nitored and recorded at the time of preoperation (T0 ), endoscopy passing through throat (T1 ), incision of sphincter of Oddis (T2 ) and closure of surgery (T3 ). Induction time, operation time, recovery from anesthesia, adverse reactions including cough, nausea and vomiting were recorded. The awakening quality was assessed. Results In the trial group, the induction time was(63 ± 14)s, and the time of recovery from anesthesia was(127 ± 19)s. The awakening quality was excellent in 76. 3% and good in 23. 7% ,yet the control group was all awake. Compared with preoperation, the trial group had no significant changes in HR and MAP at T1 ,T2 and T3 (P > 0. 05), while the control group had significant increases in HR and MAP ( P < 0. 05), and there were significant differences between the two groups (P < 0. 01) at the same time. However, the SpO2 of the two groups was of no significant differ-ence (P > 0. 05). As for anesthesia assessment, the number of level Ⅰ and Ⅱ was significantly higher in the trial group than in the control group, while the incidence of adverse reactions was significantly less in the trial group than in the control group (P <0. 05). Conclusion The intravenous anesthesia with propofol combined with remifentanil and dexmedetomidine is safe during the process of ERCP, and it has better anesthesia quality and less adverse reaction.

ObjectiveTo observe the effects of postpartum hemorrhage induced by tourniquet strapping uterine isthmus intervening placenta.MethodClinical data of 110 puerpera in our hospital obstetrics from March 2010 to August 2014 were retrospectively analyzed. These puerpera had cesarean section delivery and postpartum hemorrhage induced by placental abnormality. They were divided into control group and study group according to the tourniquet strapping usage condition, 55 cases in each group. Puerpera in control group were not given any elastic tourniquets during the cesarean section, while puerpera in study group were given tourniquet strapping uterine isthmus after delivery. The operation time, amount of bleeding during the operation, blood transfusion rate, hysterectomy rate, amount of bleeding in 24 hours after operation, postpartum hemorrhage incident rate and length of stay were compared between the two groups. All puerpera were followed up for six months and their complications incident condition and the prognosis were summed up.ResultThe operation time of study group was obviously longer than control group, the amount of bleeding during the operation and blood transfusion rate were obviously lower than control group (P<0.05). There was no signiifcant difference in hysterectomy rate between the two groups (P>0.05). The amount of bleeding in 24 hours after operation, postpartum hemorrhage incident rate and length of stay in study group were obviously longer than control group (P<0.05). There was no signiifcant difference of complications incident rate between the two groups (χ2=0.10,P>0.05). All puerpera had normal menstrual cycle during the follow-up visit period and no menstrual disorder cases were found.ConclusionPostpartum hemorrhage induced by placenta factors and tourniquet strapping uterine isthmus can lengthen the operation time, it can&nbsp;stop the postpartum hemorrhage to a great extent, and signiifcantly decrease the amount of blood transfusion and help the patients' rehabilitation.

Objective To investigate the safety and effectiveness of deXmedetomidine (DEX) used in cesarean section under the com-bined spinal - epidural anesthesia for the patients with pregnancy induced hypertension syndrome (PIHS) . Methods 60 cases of PIHS requiring cesarean section were selected and divided into two groups: the eXperimental group(D, n = 30) and the control group(C, n = 30) . The combined spinal - epidural anesthesia was performed and after finishing the anesthetic puncture, the group D was given DEX 0. 5 μg / kg, diluting to 20 mL with normal saline by pump infusion at a velocity of 80 mL / h, while the group C was given the same volume of normal saline by pump infusion at a same velocity. Then the perioperative hemodynamic parameters, sedation degree scores, adverse reac-tions, neonatal Apgar scores after delivery and neonatal behavioral neurological assessment(NBNA) were observed in the two groups. Results mAP and HR in the group D were obviously lower than those in the group C with statistical differences( P < 0. 05); RR and SpO2 had no statistical differences between the two groups( P > 0. 05); the Ramsay sedation scores of the group D were significantly superior to those of group C, the difference had statistical significance( P < 0. 05); the neonatal Apgar scores and NBNA scores had no statistical differences between the two groups( P > 0. 05) . Conclusion The application of DEX in cesarean section under the combined spinal - epidural anesthesia for the patients with PIHS has good sedative effect and stable hemodynamics without significant adverse ef-fects on newborn.

Objective To observe the effects of the α2 adrenaline receptor agonists-Dexmedetomidine ( DEX) used in the wake-up surgery of brain function language areas. Method There were 20 patients of ASAⅠ~Ⅱthe brain function language area surgery with general anesthesia. Randomly divided into two groups, 10 cases of the Dexmedetomidine group ( group D) and 10 cases of the control group ( group C) , the two groups are the craniotomy with propofol add remifentanyl add muscle relaxant maintain anesthesia, when skull flap opens, two groups of stopping the anesthetic, group D to the right supporting the Dexmedetomidine 0. 5μg/(kg·h), replacement, to wake up and before awaken-ing period to 0. 1μg/(kg·h). The propofol of the group C were less to 30μg/(kg·min) before waking up. Respec-tively observe the two groups of the time of awake, and MAP, HR, SpO2 during awake period, blood gas analysis, clear quality ( including consciousness, language, instructions, intracranial pressure rating) and adverse reactions. Result Waking time of the group D was significantly shorter than the group C, awake period MAP and heart rate of the group D were more stable than group C, awake quality of the group D was obviously better than the group C, adverse reaction of the group D was significantly less than group C. Conclusion The sedation type of the Dexmedetomidine has no effect on breathing, is very suitable for intraoperative awaken medication, can improve the quality of intraoperative awakening period awake during anesthesia, is worthy of clinical application research further.

Objective To explore the application of brain mapping in the surgical management of hemisphere lesion induced epilepsy.Methods A retrospective analysis of 30 patients with hemisphere lesion induced epilepsy were enrolled,including 21 males and 9 females,whose average age was 12.9 ± 8.7 years (range from 4 months to 30 years) with the average disease duration of 7.8 years (range from 1 month ～ 29 years).The seizures were unable to be controlled by using up to four antiepileptic drugs.Preoperatively we conducted scalp video-EEG (sVEEG) and MRI examination to confirm the epileptogenichemisphere,and the function of epileptogenic hemisphere was evaluated by the handedness assessment,hand fine motor,fMRI,DTI and Wada test.Hemispherectomy was performed for patients with a nonfunctioning hemisphere.For the patients with hemisphere remained partially functional,we performed combined surgery preserved eloquent brain region,identified by intraoperative electrical stimulations.Results 20 cases (20/30) underwent hemispherectomy,and 10 cases (10/30) underwent combined surgery with reserving eloquent brain regions.Postoperative follow-up analysis showed 14 cases (14/30) achieved improvement in language function,and 9 cases(9/30) achieved improvement in motor function of contralateral lower extremity and 10 cases (10/30) achieved improvement in gross motor function of contralateral upper extremity.None of them became worse after surgery.Meanwhile,there were 7 cases (7/30) who achieved improvement in contralateral hand fine motor,while 3 case (3/30)who underwent hemispherectomy became worse after surgery.Twenty-six cases were followed up more than six months,and the control rate of epilepsy was assessed.Among them,24 cases (24/30) were satisfied with results,1 case (1/30) was significantly improved and 1 case (1/30) was beneficial; All of 18 cases who underwent hemispherectomy were satisfied,while among the other 8 cases underwent combined surgery,6 cases were satisfied,1 case was significantly improved and 1 case was beneficial.Conclusions For patients with hemisphere lesion induced epilepsy,the surgical procedure was closely related to the postoperative seizure control rate and the incidence rate of neurological dysfunction.And brain mapping was crucial for surgerystrategy management.

目的：将特制的食管鼻咽腔导管与食管咽腔导管和喉罩进行临床观察比较，为脑功能区唤醒麻醉提供安全可行的通气设备。方法：ASAⅠ～Ⅱ级，择期普通外科、妇科行腹腔镜手术患者180例，年龄20～40岁，体质量40～70 kg ，随机分为三组，每组60例，分别观察漏气情况、生理指标、不良反应。 ASAⅠ～Ⅱ级，择期行涉及脑功能区全麻手术需术中唤醒患者30例，年龄18～43岁，体质量51～74 kg ，随机分为三组，每组10例，分别观察漏气情况、讲话效果、患者耐受、不良反应。结果：全部患者置管顺利，置管过程中血压、心率平稳，与基础值无明显差异。所有患者的生理指标以及血气分析均在正常值范围；患者对食管鼻咽腔导管和喉罩的耐受较食管咽腔导管要好。食管鼻咽腔导管带管讲话效果方面要明显优于食管咽腔导管。结论：食管鼻咽腔导管用于全麻过程中行机械通气是安全的，用于脑功能区手术唤醒麻醉要优于食管咽腔导管和喉罩。

Objective To explore the value of afterdischarges monitoring for intraoperative electrical stimulation for brain mapping. Methods 34 patients received cerebral cortex electrical stimulation for brain mapping during operation of brain function area , afterdischarges were monitored simultaneously to determine the upper limit of stimulus intensity. Results 34 cases underwent electrical stimulation successfully , and received surgery without neurologic decline except 2 cases of hypokinesia. Conclusion After discharges monitoring improve the accuracy, reduce the risk of intraoperative cerebral cortex electrical stimulation.

Objective To research the appropriate dose of dexmedetomidine (Dex) in the anesthesia of the brain functional epilepsy resection,which does not affect the electroencephalogram and the electrophysiological monitoring situation.Methods Sixty patients with ASA Ⅰ-Ⅱ selective cerebral functional area surgery,male 34 cases,female 26 cases,ages 18 to 45 years old,40 kg-74 kg weight.Using the random number table method,divided into four groups (n=15).The control group (group C),the Dex group intravenous injection respectively 0.25 μg·kg-1·h-1 (group D1),0.50 μg·kg-1·h-1 (group D2),1.00 μg·kg-1·h-1 (group D3).Three groups of intravenous loading doses within 15 min.And then respectively with the rate 0.25,0.50 μg·kg-1·h-1 or 1.00 μg·kg-1·h-1 until the end of surgery by intravenous infusion.Record the electroencephalogram and electrophysiological monitoring of the situation,the dosage of propofol,recovery times,the value of BIS,the changes of blood pressure,heart rate and the occurrence of adverse reactions intraoperative.Results Compared with group C,the BIS value of group D1,D2 and D3 had been significantly decreased (P＜0.05).The ECoG amplitude of group C was higher,the inclusion of the interference wave was more,sometimes propofol caused the outbreak of the inhibition; the ECoG amplitude of group D3 was obviously lower; the ECoG amplitude of group D1 and D2 were moderate.Conclusions The adaptive dose range of the brain function lesion resection in patients with epilepsy in anesthesia appropriate ECoG and electrophysiological monitoring is 0.25 μg ·kg-1·h1 and 0.50 μg ·kg-1 ·h1.It is more suitable for the brain functional areas location of focal epilepsy surgery anesthesia.

In asleep-awake-asleep anaesthesia, removal and reinsertion of endotracheal tubes are associated with significant difficulty and risk. To overcome this, an oesophageal naso-pharyngeal catheter was developed. Its sealed distal end is placed in the oesophagus via the nose and the proximal end is connected to a ventilator or breathing circuit. For anaesthesia, the distal end balloon is inflated to seal the oesophagus and the larger proximal balloon is inflated to seal the naso- and oro-pharyngeal cavities. Ventilation occurs via the side holes on the tube located between the balloons and which sit over the laryngeal inlet. This eliminates the need to remove and reestablish airway devices with the associated risks. The authors report the preliminary experience using this device in 17 patients who underwent awake craniotomy for surgery adjacent to the 'eloquent' areas.

目的 观察轻比密等容量不同浓度罗哌卡因腰麻用于85岁以上超高龄患者髋关节置换术的临床效果及安全性.方法 选取拟行髋部手术的85岁以上超高龄患者75例,采用随机数字表法随机分成Ⅰ、Ⅱ、Ⅲ组,每组25例.Ⅰ组:用0.2％罗哌卡因;Ⅱ组:用0.25％罗哌卡因;Ⅲ组:用0.3％罗哌卡因.各组均使用2 ml.于L3-4间隙穿刺,腰穿针回抽脑脊液通畅后注入轻比密罗哌卡因.观察镇痛起效时间、运动阻滞起效时间、最高痛觉阻滞平面、麻醉持续时间、最大运动阻滞程度、痛觉及运动恢复时间、Bromage评分及用药后的MAP、HR变化.结果 三组感觉阻滞起效时间差异无统计学意义,最高锐痛觉阻滞平面0.3％浓度组最高(P＜0.05),麻醉持续时间Ⅲ组和Ⅱ组长于Ⅰ组(P＜0.05);运动阻滞起效时间Ⅲ组短于Ⅰ组和Ⅱ组(P＜0.05).Bromage评分＜3分的例数,Ⅲ组＞Ⅱ组＞Ⅰ组(P＜0.05).下肢运动恢复时间随着罗哌卡因浓度的增加而逐渐延长,组间差异有统计学意义(P＜0.05).结论 85岁以上超高龄老年患者髋关节置换术麻醉适宜腰麻浓度和剂量为0.25％罗哌卡因2 ml,在轻比密、同等容量前提下较0.2％罗哌卡因有效,较0.3％罗哌卡因安全.

Objective To design a series of extemalglottis breath catheters to solve the conflict between breath and sound production in wake-up patients during operation.Methods We have designed three model catheters,esophaguspharynx catheter (type Ⅰ),esophagusnasopharynx catheter (type Ⅱ),esophagusnasopharynx catheter with suction (type Ⅲ).These catheters were applied to 60 patients who were implemented general anesthesia.20 paitents were wake-uped during operation.Ruselts Intubation were successfully.All paitents had nice ventilation.Tidal volume leak was less than 56 ml,air passage pressure was under 20 cm H2O (1 cm H2O=0.098 kPa),and blood gas analysises were normal.All patients had not found carbon dioxide cumulation nor anoxia.All paitents could speak with catheter,the pronounce articulation of type Ⅱ and type Ⅲ were better than type Ⅰ (P＜0.01).Conclusions Patient can speak distinctly with these catheter in operation.The series of catheters can provide nice ventilation,which are safety under mechanical ventilation and general anesthesia.Type Ⅱ and type Ⅲ are better.These catheters solved the conflict between breath and sound production in wake-up patients during operation in intraoperation wake-up,and can enhance the safety of brain operation.

Objective To investigate Dexmedetomidine combined with Sufentanil and Tetracaine mixed liquid membrane injection anesthesia technique for bronchoscopy guided endotracheal intubation feasibility and its safety.Methods Sixty patients(39 males,21 females) with difficult airway who required endotracheal intubation were divided into Group A(n = 40) and Group B(n = 20).Group A was treated with Dexmedetomidine(0.5 μg / kg) pumped in 12 minutes,1% Tetracaine(2 ml) + Sufentanil(20 μg) via cricothyroid membrane implantation 5 minutes later,and bronchoscopy guided endotracheal intubation,and Group B with the same except that Sufentanil was not added to 1% Tetracaine(2 ml).BP,HR,SpO2 and cough response were observed while fibrobronchoscopy,as well as endotracheal tube,was passing through the glottis.Results In Group A,the patients were sedative without choking in 95%(38 /40) ones,and their BP,HR and SpO2 kept stable,and 5%(2 /40) patients suffered from mild cough.In Group B,almost 100% patients suffered from cough.Conclusion Dexmedetomidine sedation via vein combined with Sufentanil and Tetracaine anesthesia is a safe,effective,painless,convenient anesthesia method to those with difficult airway for bronchoscopy guided endotracheal intubation.

Objective To study a safe,effective,convenient,comfortable and painless bronchoscopy anesthesia method.Methods Total 50 cases proposed to performed the fiberbronchoscopy were divided into A,B and C group,group A:dexmedetomidine(0.5 μg/kg 15 min) was pumped into vein,sufentanil(20 μg) and 1% tetracaine(2 ml) mixture were given by cricothyroid membrane puncture;group B:dexmedetomidine(0.5 μg/kg 15 min) was pumped into vein,1% tetracaine(2 ml) were given by cricothyroid membrane puncture;group C:midazolam(2 mg) was given by IV,sufentanil(20 μg) and 1% tetracaine(2 ml) mixture was given by cricothyroid membrane puncture.The levels of MAP,HR and SpO2 at each time point,analgesic effect,and the degree of satisfaction for the bronchoscopic placement and tolerance of patients were observed and recorded in the three groups.Results The surface anesthesia effect was very satisfactory in group A and C two.The fiberbronchoscopy was smoothly placed over the glottis,and the patients were with no choking and body movement;but the cough reflex was obvious in group B.The sedative effect of both A and B group were satisfied,but group C had a transient over sedation.Conclusion The dexmedetomidine pump plus sufentanil and tetracaine cricothyroid membrane puncture can achieve an ideal sedative and surface analgesic effect.The placement of fiberbronchoscopy cannot cause the cough,pain expression and body movement;the patients' tolerance and spontaneous breathing is well,the levels of MAP and HR are stable,SpO2 and blood gas are normal in nasal catheter oxygen.This anesthesia technique is safe,effective,convenient,comfortable and painless for bronchoscopy.

目的 观察膝关节镜术后关节腔内注射复合麻醉剂的临床效果.方法 膝关节镜手术120例,男60例,女60例,随机分为注射组和对照组各60例,注射组手术结束前给予关节腔内复合麻醉剂12 ml,其中含0.75%罗哌卡因10 ml+舒芬太尼10 ug+玻璃酸钠注射液20 mg.对照组未注射任何药品.观察比较两组患者术后不同时点膝关节疼痛评分、术后追加止痛剂及术后并发症的发生情况.结果 注射组可以明显缓解患者术后疼痛的发生.尤其在术后4、6、12、24 h,4个时点VAS评分明显小于对照组(P＜0.05),仅术后48h时点两组VAS评分无统计学差异(P>0.05).术后患者血压、心率平稳、意识清醒、伤口愈合良好、无感染发生、无皮肤瘙痒及术后软骨损害等并发症,两组比较无统计学意义.结论 膝关节镜术后关节腔内注射复合麻醉剂镇痛效果好、并发症少及操作简单、安全等优点.

Objective To study the esophageal nasopharyngeal catheter,a kind of supraglottic ventilator allowing voice communication,and evaluate its ventilation and communication.Methods The frontier opening of ID6.5 tracheal catheter was closed and equipped with a cuff,another cuff was located 8-10cm above the former,and there were 6 side holes between the two cuffs.The catheter was introduced into the esophagus along the posterior pharyngeal wall through the posterior nares,when the side holes was towards the pharyngolaryngeal cavity and the external aperture was connected with the anesthesia machine with the esophagus,nasopharyngeal cavity and oropharyngeal cavity closed by the inflation of two cuffs.The air came into the pharyngolaryngeal cavity through the side holes,and then into the respiratory tract through the glottis to form a closed breathing circuit,finally the supraglottic ventilation was realized.The esophageal nasopharyngeal catheter was used in 20 cases of hysteroscopy laparoscopy explorations and 6 cases of brain areas surgeries,and the ventilation and voice communication during the operation were observed.Results Tube insertion was realized in one time for all the 26 cases,with 0-56mL air leakage and the mean value of(26±10) mL,and 12-25cmH2O airway pressure and the mean value of(16±4) cmH2O.The blood gas indexes were in normal range and the voice communication was fluent.Conclusion The esophageal nasopharyngeal catheter is a kind of supraglottic ventilator allowing voice communication,which can close the esophagus,nasopharyngeal cavity and oropharyngeal cavity strictly without any interference to the motion of the head and neck.With this catheter,intraoperative wake-up can be performed for brain areas surgery with the deflation of the upper cuff.