目的:探讨罗哌卡因联合奥布卡因对全麻鼻内镜术中的麻醉控制效果及术中应激反应的影响.方法:选择80例行鼻内镜术治疗患者随机为观察组和对照组各40例.对照组局部使用肾上腺素加用利多卡因局部浸润联合丁卡因表面麻醉,观察组局部使用肾上腺素加用罗哌卡因局部浸润联合奥布卡因表面麻醉;比较术后苏醒时间以及不同时刻的视觉疼痛模拟评分(VAS)及术中应激反应;检测术前及术中的血糖和去甲肾上腺素水平.结果:观察组术后苏醒时间显著短于对照组;苏醒即刻时两组VAS评分差异不显著,其余各时刻观察组VAS评分均显著低于对照组;两组术中血糖水平均较术前显著上升但观察组术中血糖显著低于对照组,对照组术中去甲肾上腺素水平显著上升且显著高于观察组(P<0.05).结论:观察组的麻醉方法有助于增加麻醉可控性和安全性,减轻患者术中应激反应及术后疼痛.

目的 探讨气管插管全麻复合硬膜外麻醉下异丙酚维持镇静合理用量.方法 将160例择期上腹部手术病人,选择插管全麻复合硬膜外麻醉,按随机数字表法分为A、B、C、D4组,术中泵注异丙酚速度分别为4、5、6、7mg/(kg·h).记录术中NT指数、平均动脉压、心率和苏醒时间.结果 D组的血流动力学变化较大,血管活性药用量更多,苏醒时间更长,P<0.05;A组的NT指数(NTI)为52±6,B组的NT为48±5,C组的NT为42±5,D组的NT为35±9. 结论 在复合硬膜外麻醉下,异丙酚用量在6mg/(kg·h),能满足所需的麻醉深度,且能保持循环的相对稳定.

Objective With the application of network information technology,it's necessary to change traditional patterns and methods of quality control of medical records in order to lessen work links and reduce human disturbance,which is benefit to summarize and analyze for improvement of work efficiency. Methods Statistical analysis was conducted on quality control and deficiencies of running medical records and filed medical records using quality control software of medical records developed independently by hospital HIS system platform. Results After running of system,work intensity of quality control personnel was reduced with management standardized and work efficiency improved. Conclusion With sufficient utilization of HIS network resources,taking strengthening link quality control as the guidance,medical records quality is improved based on quality control system,quality control methods and system construction.

Objective To discuss the clinical value of the application of ultrasound localization in deep-vein catheterization. Methods first of all,the location of vein puncture was determined by the use of diagnostic ultrasound,and then the deep-vein catheterization was carried out in accordance with the location. Results it was successful for twenty patients to puncture once time by ultrasound localization and no any complications occurred. Conclusion ultrasound localization can contribute to the successful completion of deep-vein catheterization,it is worth popularizing because of simple technologies,security and low-cost.

目的:研究音乐对腰硬联合麻醉下妇产科手术患者的心理安慰作用和手术满意度.方法:选择腰硬联合麻醉下妇产科手术患者120例,随机分为干预组和对照组,每组60例.干预组患者双耳戴上耳机欣赏音乐.对照组不予音乐疗法.结果:干预组平均动脉压、心率和呼吸变化幅度较小,对照组变化幅度较大,差异有统计学意义(P＜0.05).两组病人腰硬联合麻醉药用量差异无统计学意义(P＞0.05).静脉辅助药用量干预组明显少于对照组,差异有统计学意义(P＜0.05).手术过程的满意度调查显示干预组优良率96%,对照组为68%.结论:音乐疗法可以减轻或消除联合麻醉手术患者的紧张焦虑情绪,减少辅助药物用量,提高手术满意度.

Objective To discuss the feasibility,safety and clinical practical value of the ultrasound localization of internal jugular vein catheterization.MethodTotal 40 patients including 29 male and 11 female who needed to make the internal jugular vein catheterization,age 16～73 years old,were randomly divided into the ultrasound group and the control group(n=20).The ultrasound group firstly were determined the location of vein puncture by ultrasonic diagnostic apparatus and then made the success of the internal jugular vein catheterization in accordance with the results of the location.The control group were conducted the catheterization using traditional anatomical location method.A success rate of catheterization and complication rate were respectively observed and compared in the matched ultrasound-control study.ResultsOne time success rate of catheterization in the control group and the ultrasound group were 85% and 100%,respectively,and between the two groups had very significant difference(P0.01).Moreover,the complication rate of the ultrasound group was less than the control group,respectively 0 and 10%,and between the two groups had very significant difference(P0.01).Conclusion The ultrasound localization contributes to the successful completion of deep vein catheterization,with simple and safe technology,little economic burden of patients,therefore,it is worth popularizing.

目的探讨在前列腺汽化电切手术中,加入甘露醇灌洗液对预防水中毒的作用.方法采用随机分组,54例前列腺汽化电切患者分为观察组(5%葡萄糖+5%甘露醇灌洗液)和对照组(5%葡萄糖灌洗液),对术前、术后电解质、血糖进行检测.结果观察组和对照组术前电解质、血糖无显著性差异(P＞0.05),术后比较差异有统计学意义(P＜0.01).结论在前列腺汽化电切手术中,甘露醇加入灌洗液有减轻和缓解水中毒的作用.

目的:寻找一种更安全有效,能在更大程度上减轻硬膜外麻醉下行上腹部手术时的内脏牵拉反应,降低术中知晓率,消除患者对手术的恐惧和紧张。方法:随机选择择期上腹部手术患者40例,分为二组,治疗组开放静脉后先静注杜氟合剂半量,再连接微泵以3~4mg/kg.h的速度输注异丙酚直至关腹。对照组开放静脉后单纯静注杜氟合剂半量,二组进行疗效及统计学比较。结果:治疗组对控制上腹部手术的内脏牵拉反应总有效率达95%,术中无知晓率也达95%;对照组对控制上腹部手术的内脏牵拉反应总有效率仅占70%,对术中情况完全不能回忆仅占20%。两组患者对控制上腹部手术的内脏牵拉反应有效和无效例数以及术中知晓情况,经χ2检验,差异具有显著性(P<0.05)。结论:异丙酚加杜氟合剂组,对减轻硬膜外麻醉下行上腹部手术时的内脏牵拉反应,降低术中知晓率情况明显优于单纯杜氟合剂组,且此方法安全、有效、副作用少,病人易于接受。

危重病人的病情复杂,年龄差别也较大,体格条件各异,病情恢复的程度难以预料,根据病情的需要,建立安全可靠、经久耐用的血管通路显得十分重要.