目的 研究亚麻醉剂量艾司氯胺酮对甲状腺癌根治术(Radical resection of thyroid carcinoma,RRTC)后患者苏醒及疼痛的影响.方法 选取2020年8月-2021年3月安庆市立医院麻醉科行RRTC的90例患者为研究对象,采用随机数字表法将患者分为A、B、C组,每组30例,A组术中持续输注生理盐水;B组术中持续输注艾司氯胺酮0.25 mg·kg-1·h-1;C组术中持续输注艾司氯胺酮0.5 mg·kg-1·h-1.观察各组患者术中各时间点[麻醉诱导前(T0)、注射药物5 min后(T1)、气管插管后(T2)、手术结束(T3)、术后1 h(T4)]心率(Heart rate,HR)、平均动脉压(Mean arterial pressure,MAP)、动脉压水平波动情况,统计术中丙泊酚、瑞芬太尼用量;观察各组患者术后不同时间的镇静情况(Ramsay镇静评分)及疼痛情况(VAS评分).统计手术相关指标,并记录患者麻醉不良反应发生情况.结果 与本组T0 时刻比较,A组T1 时刻HR降低,A、B、C组T2 时刻HR升高,差异有统计学意义(P＜0.05);与A组T1 时刻比较,C组T1 时刻HR升高,差异有统计学意义(P＜0.05);与A组T2 时比较,B、C组T2 时刻HR降低,差异有统计学意义(P＜0.05).与本组T0 时刻比较,B、C组T1 时刻 MAP升高,A、B、C组T2 时刻 MAP升高,差异有统计学意义(P＜0.05);与A组T1 时刻比较,B、C组T1 时刻MAP升高,差异有统计学意义(P＜0.05);与A组T2 时比较,C组T2 时刻MAP升高,差异有统计学意义(P＜0.05);与A组T4、T5 时刻比较,B、C组T4、T5 术后Ramsay镇静评分均升高,差异有统计学意义(P＜0.05);与本组T4 时刻比较,3组T6、T7、T8 时刻术后Ramsay镇静评分均降低,差异有统计学意义(P＜0.05);与B组T4、T5、T6、T7、T8 时刻比较,C组术后T4、T5、T6、T7、T8 时刻Ramsay镇静评分比较,差异无统计学意义(P＞0.05);与B组T7、T8 时刻比较,C组T7、T8 时刻VAS评分降低,差异有统计学意义(P＜0.05);与本组T4 时刻比较,3组T6、T7、T8 时刻VAS评分均降低(P＜0.05);3组拔管时间、苏醒时间比较,差异无统计学意义(P＞0.05);与A组术后第1天引流量比较,B、C组术后第1天引流量均降低,拔管呛咳的发生率降低,差异有统计学意义(P＜0.05).结论 0.25 mg·kg-1·h-1 亚麻醉剂量的艾司氯胺酮能够维持RRTC患者术中血流动力学稳定,改善患者术后镇静及疼痛情况,未延长苏醒及拔管时间,同时能够减少术后引流量及拔管呛咳的发生,具有良好的安全性.

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 探讨不同剂量的右美托咪定在小儿无痛纤维支气管镜(简称纤支镜)中的应用效果.方法 择期行纤支镜检查和治疗的患儿60例,年龄2～13岁,ASAⅠ或Ⅱ级,按随机数字表法分为A组,B组,C组,每组20例.患儿入室后泵注右美托咪定负荷剂量,A组0.5μg/kg,B组1.0μg/kg,C组1.5μg/kg,泵注10 min后,以0.4μg/kg/h持续泵注,同时静脉注射芬太尼1μg/kg,2 min后行纤支镜检查.术中如患儿出现体动反应,静脉追加丙泊酚.观察3组患儿入室后(T0),开始检查即刻(T1),纤支镜抵达声门即刻(T2),检查完毕(T3),检查完成后10 min(T4)时脉搏血氧饱和度(SPO2)、心率(HR)、血压(MAP)和警觉/镇静(OAA/S)评分,记录术中丙泊酚用量、纤支镜检查时间、术中患儿体动次数和呛咳反应、苏醒时间及术中不良反应发生情况.结果 与A、B组比较,C组术中丙泊酚用量和体动次数及呛咳反应程度明显减少(P<0.05),苏醒时间明显延长(P<0.05),与A组比较,T1-T4时C组MAP和HR明显降低(P<0.05),T3、T4时B组MAP明显降低(P<0.05),T1、T3、T4时B组HR明显降低(P<0.05),T2时B组和C组SPO2明显升高(P<0.05),T2、T4时B组和C组OAA/S明显降低(P<0.05).与B组比较,T2-T4时C组MAP明显降低(P<0.05),T1-T4时C组HR明显降低(P<0.05),T2时C组SPO2明显升高(P<0.05),T1、T3、T4时C组OAA/S明显降低(P<0.05).结论 1.5μg/kg右美托咪定的负荷剂量术中镇静效果满意,呛咳反应轻,血流动力学稳定,丙泊酚用量少,但苏醒时间延长.

Objective To discuss the effect of transversus abdominis plane ( TAP) combined with iliohypogastric-ilioinguinal ( II) block under ultrasound on the pain in children undergoing high ligation of inguinal hernia surgery. Methods From January 2017 to December 2017, 80 children un-dergoing high ligation of inguinal hernia surgery were selected in our hospital. According to the random digital table method, they were divided into II-TAP group and TAP group, 40 cases in each group. TAP group was given TAP block under ultrasound, II-TAP group on this basis was given II block un-der ultrasound, the analgesic effect, hemodynamics, adverse reaction and awakening were compared in the two group. Results The after anesthesia 10 min ( T1 ) , skin cutting ( T2 ) , end of operation (T3) pain Wong-Baker facial expression scale (WB-FPRS) scores, mean arterial pressure (MAP), heart rate ( HR) in the II-TAP group were significantly lower than those in the TAP group, the differ-ence was statistically significant (P<0. 05). The dosage of narcotic drugs, adverse reaction rate and opening eyes, clenching, extubation, and awakening time in the II-TAP group were significantly low-er than those in the TAP group, the difference was statistically significant (P<0. 05). Conclusions TAP combined with II block under ultrasound can effectively improve the analgesic effect, hemodynam-ics of the children undergoing high ligation of inguinal hernia surgery, and it is beneficial to reduce the dosage of narcotic drugs, adverse reactions and improve the quality of recovery of the children, it's worth for further clinical promotion.

Objective To observe the ventilation effect of I-gel laryngeal mask in endoscopic thyroid surgery under general anesthesia. Methods A total of 60 cases of endoscopic thyroid surgery under general anesthesia, were randomly di?vided into 3 groups (n=20):the group that patients used endotracheal intubation (Group Q);the group that patients employed Supreme laryngeal mask (Group S);the group that patients wore I-gel laryngeal mask (Group I). Success rate of insertion, du?ration of insertion, endotracheal pressure of Group S and Group I worerecored, and fiberoptic bronchoscopy was performed in Group S and I to evaluate the position of laryngeal mask. Mean arterial pressure(MAP), heart rate(HR), pulse oxygen satura?tion (SpO2) at time points of before insertion (T0), 1 min after insertion (T1), 3 min after insertion (T2), before the establishment of CO2 operating space (T3), 30 min after the establishment of CO2 operating space (T4), 10 min after the resection of speci?mens (T5), 1 min before removal of laryngeal mask (T6) and 1 min after the removal of laryngeal mask (T7) were recorded and the end-tidal carbon dioxide pressure [ p(CO2) ]and peak airway pressure (Ppeak) form T1 to T5. were also recorded. Occur?rence of nausea and vomiting, sore throat and other adverse reactions after removal of laryngeal mask were also noted. Re?sults The successful rate of insertion was not significant different among all three groups. Compared with Group Q, inser?tion time was significantly shorter in Group I and S (P<0.05). Endotracheal pressure and fiberoptic bronchoscopy score are not statistically different between Group S and I. Compared with Group Q, MAP and HR in T1, T6 and T7 were significantly lower in Group S and I (P<0.05). SpO2,p(CO2) and Ppeak show no statistical difference between three groups. Compared with Group S and Q, the occurrence of sore throat, painful swallowing and bleeding which is indicated by the appearance of blood in laryngeal were all significantly lower in Group I (P<0.05). Conclusion Both I-gel laryngeal mask and Supreme laryngeal mask can be used safely and effectively in airway management of endoscopic thyroid surgery patients while I-gel laryngeal mask is less hurting and more comfortable than Supreme laryngeal mask.