目的 探讨剖宫产围术期患者采用布托啡诺治疗寒战的最佳剂量.方法 选取2019年10月—2020年11月期间于本院分娩的150例剖宫产妇女作为研究对象,按照随机数字表法分为A组、B组、C组,各组50例.A组给予0.01 mg/kg布托啡诺静脉注射,B组给予0.02 mg/kg,C组给予0.03 mg/kg.比较3组临床疗效、血流动力学、镇静(Ramesay)评分、不良反应、新生儿Apgar评分.结果 3组治疗有效率、血流动力学、T1、T2时间段Ramesay评分及1 min、5 min、10 min新生儿Apgar评分比较,差异无统计学意义(P>0.05);C组不良反应发生率高于B组与A组(P<0.05);T3时间段Ramesay评分C组<B组<A组(P<0.05).结论 0.02 mg/kg剂量布托啡诺治疗剖宫产围术期寒战效果最为理想,产妇围术期血流动力学稳定,不良反应较轻,且对新生儿无明显影响.

目的 分析不同剂量右美托咪定对老年髋关节骨折患者术后谵妄的影响.方法 选取2019年10月—2020年10月期间收治的150例髋关节骨折患者作为研究对象,按照随机数字表法分为A组、B组、C组,每组各50例.A组持续麻醉静脉泵注0.7μg/(kg·h)的右美托咪定,B组持续麻醉静脉泵注0.33μg/(kg·h)的右美托咪定,C组给予等容量的0.9％生理盐水.比较三组围术期指标、应激反应、术后谵妄发生率、认知功能(MMSE评分)、不良反应.结果 三组麻醉时间、术后苏醒时间、意识恢复清醒时间、术后谵妄总发生率、不良反应发生率比较,差异无统计学意义(P>0.05);T2、T3时点三组应激反应各指标均较T1时点升高,但在T4时点回降基本接近T0时点水平,三组间上述指标水平组间时点、组间时点交互比较,B组升高浮动趋势较小,恢复较快(P<0.05);术后3 h,三组MMSE评分均降低,术后24 h,三组MMSE评分均升高至正常水平,A、B组高于C组,B组评分评分变化最大(P<0.05).结论 持续麻醉静脉泵注0.7μg/(kg·h)与0.33μg/(kg·h)的右美托咪定在围术期恢复上无明显差异,但0.33μg/(kg·h)剂量的右美托咪定应激反应更小,更利于术后认知功能恢复,控制术后谵妄风险,且不良反应较轻.

Objective To evaluate the effect of resuscitation with Ringer′s malate solution on acute lung injury caused by hemorrhagic shock in rats. Methods Forty-eight SPF healthy male Sprague-Dawley rats, aged 7-9 weeks, weighing 280-320 g, were assigned into 4 groups ( n＝12 each) using a random number table method: sham operation group (group S), normal saline group (group NS), Ringer′s lac-tate solution group ( group RL) and Ringer′s malate solution group ( group RM). In NS, RL and RM groups, the model of hemorrhagic shock was established, and rats were resuscitated after 60 min of hemor-rhagic shock. Rats were sacrificed at 3 h after resuscitation, and bronchial alveolar lavage fluid ( BALF) was collected to count neutrophils. Lung tissues were obtained for determination of the wet∕dry weight ratio (W∕D ratio), myeloperoxidase (MPO) activity, and contents of tumor necrosis factor-alpha (TNF-α), interleukin-1beta (IL-1β) and IL-6. Lung tissues were obtained for examination of the pathological changes. Results Compared with group S, the neutrophil count in BALF, W∕D ratio, MPO activity and contents of TNF-α, IL-1β and IL-6 were significantly increased in NS, RL and RM groups ( P＜0. 05). Compared with NS and RL groups, the neutrophil count in BALF, W∕D ratio, MPO activity and contents of TNF-α, IL-1β and IL-6 were significantly decreased in NS and RL groups (P＜0. 05). Conclusion The severity of acute lung injury is reduced when Ringer′s malate solution is used for resuscitation as compared with that when normal saline and Ringer′s lactate solution are used in a rat model of hemorrhagic shock.

目的 探讨气管导管及创面联合应用利多卡因乳膏预防扁桃体切除患儿麻醉苏醒期躁动的有效性.方法 将108例择期行扁桃体切除的患儿采用随机数字表法分为对照组和观察组各54例.对照组常规用复方利多卡因乳膏涂抹润滑气管导管后插管,观察组在此基础上于术毕在手术创面涂抹复方利多卡因乳膏.记录两组插管前、术毕时、拔管时、苏醒时以及离手术室时的心率及平均动脉压,苏醒期躁动发生情况,拔管后咽喉痛发生情况及家属满意度.结果 两组不同时间心率、平均动脉压比较,差异有统计学意义(均P＜0.01);对照组苏醒期躁动发生率、评分以及咽喉痛评分显著高于观察组,家属满意率显著低于观察组(均P＜0.01).结论 气管导管及手术创面联合应用利多卡因乳膏,可降低麻醉苏醒期躁动,减轻咽喉痛,维持较平稳的心率和血压.

目的 观察乌司他丁对老年患者胸腔镜辅助肺叶切除术后认知功能障碍(POCD)的影响.方法拟行胸腔镜辅助肺叶切除术的老年患者60例,随机分为观察组和对照组,每组30例,观察组在麻醉诱导前静脉注射乌司他丁20万U,然后以10万U/h的速度持续静脉泵注射至患者离室,对照组给予等剂量的生理盐水.测定患者手术前1 d(T0)、手术结束时(T1)、手术后第1天(T2)和手术后第3天(T3)血浆白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)的浓度,并在T0、T2、T3时点完成简易精神状态检查量表(MMSE)评分,记录POCD发生率.结果观察组T1、T2时点IL-6和TNF-α水平低于对照组(P<0.05),两组T1时点IL-6和TNF-α水平高于其他时点(P<0.05),对照组T2时点IL-6和TNF-α水平高于T0、T3(P<0.05).观察组T2时点MMSE评分高于对照组(P<0.05),对照组T2时点MMSE评分低于T0、T3(P<0.05).POCD发生率观察组低于对照组(P<0.05).结论乌司他丁降低老年患者胸腔镜辅助肺叶切除术后血浆IL-6和TNF-α水平,减少POCD的发生.

Objective To investigate effects of dexmedetomidine-dexamethasone combination on membrane permeability of alveolar capillaries in one lung ventilation rats.Methods Male SD rats(n=80) were randomly divided into five groups(n=16): normal saline control group(NS group), OLV group(O group), OLV-dexamethasone group(O+D group), OLV-dexmedetomidine group(O+E group), OLV-dexmedetomidine-dexamethasone group(O+D+E group).Bilateral lung were ventilated for 2.5 h in NS group and were treated with saline(0.1 mg/kg, iv) followed by an infusion of 0.9% normal saline 0.5 μg/(kg·h) immediately after ventilation.The right lung was ventilated for 2.0 h followed by 0.5 h two lung ventilation in O group and were treated with normal saline(0.1 mg/kg iv) followed by an infusion of 0.9% normal saline [0.5 μg/(kg·h)] immediately after ventilation.The right lung was ventilated for 2.0 h followed by 0.5 h two lung ventilation in O+D group and were treated with dexamethasone(0.1 mg/kg, iv) followed by an infusion of 0.9% normal saline [0.5 μg/(kg·h)] immediately after ventilation.The right lung was ventilated for 2.0 h followed by 0.5 h two lung ventilation in O+E group and were treated with 0.9% normal saline(0.1 mg/kg, iv) followed by an infusion of dexmedetomidine [0.5 μg/(kg·h)] immediately after ventilation.The right lung was ventilated for 2.0 h followed by 0.5 h two lung ventilation in O+D+E group and were treated with dexamethasone(0.1 mg/kg, iv) followed by an infusion of dexmedetomidine [0.5 μg/(kg·h)] immediately after ventilation.The animals were sacrificed and 1 mL arterial blood was collected to determine the PaO2.Their lungs were removed for evaluating histological characteristics and determining the lung wet/dry weight ratio(W/D) and MPO activity.The protein concentrations, total cell counts in bronchoalveolar lavage fluid(BALF) were obtained.The expression of iNOS, COX2 and the concentration of TNF-α, IL-1β, NO, PGE2 in lung tissues were determined.Lung tissues were obtained for determination of Evans blue concentrations.Results The PaO2 was lower in O group, than those in NS group, while PaO2 in O+D+E group but not in D group and E group was higher than those in O group.The W/D and MPO activity in O group were higher than those in NS group, while these parameters in O+D+E group but not in D group and E group were lower than those in O group.The protein concentrations, total cell counts in BALF in O group were higher than those in NS group, while these parameters in O+D+E group but not in D group and E group were lower than those in O group.The concentrations of Evans blue, TNF-α, IL-1β, NO, PGE2 and the expression of iNOS, COX2 in O group were higher than those in NS group, while these parameters in O+D+E group but not in D group and E group were lower than those in O group.Compared with NS group, OLV induced marked pulmonary edema, which was less pronounced in dexmedetomidine-dexamethasone combination but not by dexmedetomidine or dexamethasone alone.Conclusion Dexmedetomidine-dexamethasone combination can reduce alveoli-capillary permeability in rats with OLV.Its mechanism may be associated with inhibition of iNOS/NO and COX2/PGE2 expression.

目的：比较依托咪酯乳剂与丙泊酚用于老年人无痛诊断性刮宫术的效果。方法拟行诊断性刮宫术的老年患者60例，随机分为A组和B组，每组30例。手术开始前A组静脉注射丙泊酚1．5 mg／kg，B组静脉注射依托咪酯乳剂0．25 mg／kg，记录手术时间、麻醉苏醒时间、恢复行走时间，观察麻醉用药前（ T0）、注药后1 min （T1）、5 min（T2）、患者清醒时（T3）的MAP和HR的变化，记录注射痛、术中体动、低血压、心动过缓、低氧血症及术后恶心、呕吐的发生率。结果 A组T1时点MAP低于其他时点（ P＜0．05）， T2时点MAP低于T0、T3时点（P＜0．05）。 A组T1、T2时点MAP低于B组（P＜0．05），B组注射痛、低血压和低氧血症发生率低于A组（P＜0．05）。结论与丙泊酚相比，依托咪酯乳剂用于老年人无痛诊断性刮宫术，对循环和呼吸的影响小，注射痛发生率低。

目的研究静脉注射利多卡因对胸腔镜肺大疱切除术患者镇痛的影响。方法选择胸腔镜肺大疱切除术患者60例,ASAⅠ-Ⅱ级,随机分为利多卡因组（L组）和生理盐水组（S组）。L组于麻醉诱导前静脉单次注射利多卡因1.5mg·kg-1,随后以2mg·kg-1·h-1持续输注至术毕,术后以1.33mg·kg-1·h-1的速度持续输注24h;S组给予等容量的生理盐水。两组患者均采用丙泊酚、瑞芬太尼全凭静脉维持麻醉。记录两组患者手术时间;术中瑞芬太尼用量;苏醒时间;术后2h（T1）、4h（T2）、8h（T3）、12h（T4）、24h（T5）和48h（T6）静息和咳嗽时的VAS评分;PCIA按压次数;恶心呕吐发生率;利多卡因不良反应。结果两组患者年龄、体重、手术时间、苏醒时间等差异均无统计学意义。L组术中瑞芬太尼用量低于S组（P<0.05）。咳嗽时VAS评分T1-T5时L组低于S组（P<0.05）。48小时PCIA按压次数L组较S组明显减少（P<0.05）。恶心呕吐发生率L组明显低于S组（P<0.05）。L组未见利多卡因相关不良反应。结论静脉注射利多卡因可降低胸腔镜肺大疱切除术患者术中阿片类药物用量,增强术后镇痛效果,减少了术后并发症的发生,治疗剂量无明显不良反应。

目的:观察静注利多卡因对老年胸腔镜肺叶切除患者术后谵妄的影响. 方法:选择 80 例择期全身麻醉下行胸腔镜肺叶切除患者,年龄≥65 岁. 随机均分为利多卡因组( L 组)和生理盐水组(S 组). L 组于麻醉诱导前静脉单次注射利多卡因 1.5 mg/kg,随后以 2 mg/(kg·h)持续输注至术毕;S 组给予等容量的生理盐水. 记录两组患者手术时间;单肺通气时间;术中七氟醚用量;苏醒时间;术后 2 h ( T1 )、4 h ( T2 )、8 h ( T3 )、12 h ( T4 )、24 h ( T5 )和 48 h ( T6 )的 Price-Henry 疼痛评分, 48 h PCIA按压次数, 术后 1 周谵妄发生率, 利多卡因不良反应. 结果:L 组术中七氟醚用量低于 S 组 (P <0.05).Price-Henry 疼痛评分 T1 ~ T5 时 L 组低于 S 组(P < 0.05).48 h PCIA 按压次数 L 组较 S 组明显减少(P < 0.05).L 组谵妄发生率明显低于 S 组(P < 0.05).结论:静注利多卡因可降低老年胸腔镜肺叶切除患者术后谵妄的发生.

目的 观察布托啡诺复合右美托咪啶用于老年人ERCP的效果.方法 拟行ERCP老年患者40例,随机分为观察组和对照组,每组20例.两组于手术开始前15min内均静脉泵注射右美托咪啶0.5μg/kg,继以0.5μg/(kg·h)维持至手术结束,观察组手术前5min复合静脉注射布托啡诺1mg.记录麻醉开始前(T0)、静脉注射右美托咪啶和布托啡诺后(T1)、进镜(T2)、十二指肠乳头插管(T3)、注入照影剂(T4)及术毕(T5)时的平均动脉压(MAP)、HR、RR和SPO2及T1～T5时点Ramsay评分,观察心动过缓、低血压、低氧血症、心律失常和镇静过度等不良反应的发生率及患者的配合度及满意度.结果 对照组T3时点MAP与观察组比较差异有显著性(P＜0.05);对照组术中各时点Ramsay评分与观察组比较差异有显著性(P＜0.05);观察组患者配合度和满意度优于观察组(P＜0.05).结论 布托啡诺复合右美托咪啶用于老年人ERCP,血流动力学平稳,镇痛镇静效果好,术中患者配合度和满意度高,且不增加不良反应.

AIM:To observe the influence of dexmedetomidine on analgesic quality of patient controlled intravenous analgesia with tramadol after laparoscopy assisted radical gastrectomy.METHODS:Sixty patients scheduled to undergo laparoscopy assisted radical gastrectomy were randomly assigned to two groups (observation and control group) with 30 each.All patients were given general anesthesia and PCIA with tramadol 800 mg and tropisetron 5 mg.Dexmedetomidine 200 μg was added to PCIA in observation group.MAP,HR,RR,SpO2 was determined before anesthesia (T0) and at 2 hours (T1),4 hours(T2),8 hours(T3),12 hours (T4) and 24 hours(T5) after operation.Postoperative pain was assessed by visual analogue score(VAS) at T1-T5.The total dose of tramadol and pressure times of PCIA within 24 hours after operation,cases of using pethidine,bradycardia,hypotension,hypoxemia,excessive sedation,nausea,vomiting were also recorded.RESULTS:Compared with the control group,the MAP,HR,VAS were lower at T1--T4 in observation group (P ＜ 0.05).MAP,HR were higher at T1-T4 than those at T0,T5 in control group (P ＜ 0.05).Compared with control group,the total dose of tramadol,pressure times of PCIA,cases of using pethidine and incident of nausea were less than those in observation group(P＜0.05).CONCLUSION:Dexmedetomidine can improve the quality of PCIA with tramadol,decrease the dose of tramadol and reduce the incident of nausea after laparoscopy assisted radical gastrectomy.

Objective To investigate the clinic effect and security of butorphanol preemptive analgesia with different administration methods in the elderly undergoing radical mastectomy surgery.Methods 100 elective radical mastectomy patients(ASAⅠ~Ⅱ) over 60 years old,were randomly divided into the group BV1,group BV2,group BM1,group BM2 and group C(control group).10 minutes before incision,group BV1 receives butorphanol 10μg/kg iv,group BV2 receives butorphanol 15μg/kg iv,group BM1 receieves butorphanol 10μg/kg im,group BM2 receives butorphanol 15μg/kg im,group C receieves 2ml of saline iv.Record the time from stopping drugs to open eyes,VAS score at 4 hours(T1),8 hours(T2),12 hours(T3) and 24 hours(T4) after operation,Ramsay score after extubation,the frequency of use of analgesics within 24 hours after operation.The occurrence of adverse reactions like nausea,vomiting,chills,respiratory and circulatory depression were also recorded.Results The time from stopping drugs to open eyes: group BV2 was significantly longer than group BV1,BM1,BM2 and C(P<0.05).At time T1~T4,VAS score of group BV1,BV2,BM1,BM2 was significantly lower than group C(P<0.01),and the VAS score of group BV1,BV2,BM2 was lower than group BM1(P<0.05).The Ramsay score after extubation of group BV2 was higher than group BV1,BM1,BM2 and C(P<0.05).The frequency of use of analgesics within 24 hours after operation: group BV1,BV2,BM1 and BM2 was significantly lower than group C(P<0.01),group BV1,BV2 and BM2 was lower than group BM1(P<0.05).There was no significant differences about the occurrence of adverse reactions among all groups(P>0.05).Conclusions Butorphanol preincisional used in surgery has the effect of preemptive analgesia,the administration methods of intravenous 10μg/kg and intramuscular 15μg/kg can achieve satisfactory analgesia without affecting the wake of the patients under general anesthesia,thus can be effectively and safely used for the elderly radical mastectomy surgery.

目的探讨曲马多患者自控静脉镇痛(patient-controlled intravenous analgesia,PCIA)用于剖宫产术后镇痛的剂量。方法择期剖宫产术患者60例,随机分为A、B、C三组,每组20例,采用连续性硬膜外麻醉,缝皮前静脉注射曲马多2mg/kg后接静脉镇痛泵,泵内含曲马多和5mg托烷司琼,其中曲马多剂量A组6mg/(kg.d),B组7mg/(kg.d),C组8mg/(kg.d),观察术后2、4、8、12、24、36h的视觉模拟评分(Visual Analogue Score,VAS)。结果 VAS评分B组2h、4h和C组2h、4h、8h、12h时点与A组比较差异有统计学意义(P<0.05),C组2h、4h、8h、12h时点与B组比较差异有统计学意义(P<0.05)。结论负荷剂量2mg/kg,继而8 mg/(kg.d)曲马多复合托烷司琼5mgPCIA用于剖宫产术后镇痛,可取得满意镇痛效果。