目的 探讨保留自主呼吸非插管麻醉对胸腔镜(VATS)手术患者脑氧代谢、术后认知功能的影响.方法 选取自2020年5月至2021年9月于中国医科大学肿瘤医院择期行VATS手术的80例肺肿瘤患者为研究对象.采用随机数字表法将患者分为保留自主呼吸非插管麻醉(NI)组(n=40)与双腔管气管插管单肺通气(DO)组(n=40).NI组采用喉罩通气保留自主呼吸,DO组采用双腔气管插管单肺通气.记录麻醉诱导前(T0),以及手术开始/单肺通气后30 min(T1)、60 min(T2)、90 min(T3)、拔管(喉罩)后15 min(T4)的局部脑氧饱和度(rScO2)、平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)、呼气末二氧化碳分压(ETCO2)、动脉血氧分压(PaO2)、二氧化碳分压(PaCO2)、PH值.比较两组rScO2变化情况,以及苏醒期躁动、术后谵妄(POD)的发生率.结果 两组T1、T2、T3时的MAP、HR、ETCO2比较,差异有统计学意义(P＜0.05).NI组T1、T2、T3、T4时的rScO2明显高于DO组,差异有统计学意义(P＜0.05).NI组T1、T2、T3时的PaCO2明显高于DO组,差异有统计学意义(P＜0.05).NI组T1、T2、T3 时PH值明显低于DO组,差异有统计学意义(P＜0.05).两组rScO2下降＞20％总时间、rScO2最小值、rScO2最大值比较,差异有统计学意义(P＜0.05).NI组术后1 d、3 d的POD发生率低于DO组,差异有统计学意义(P＜0.05).结论 保留自主呼吸非插管麻醉可显著提高VATS手术患者术中rScO2,降低术后1 d、3 d的POD发生率,改善临床预后.

Objective To investigate the effect of dexmedetomidine on perioperative cardiac function in patients with mild cardiac dysfunction undergoing laparoscopic radical resection of rectal cancer. Methods Sixty patients scheduled with laparoscopic radical resection of rectal cancer with mild heart failure were selected, with New York Heart Association (NYHA) cardiac function gradingⅠtoⅡ, American Association of Anesthesiologists (ASA) grading Ⅱ to Ⅲ, and age from 63 to 72 years. The patients were divided into dexmedetomidine group (group D) and control group (group C) according to the random digits table method with 30 cases each. At the beginning of induction, the patients in group D were given intravenous infusion a loading dose of dexmedetomidine at 0.5 μg/kg for more than 10 min. Then continuous intravenous infusion of dexmedetomidine was given at 0.3 μg/(kg·h) for 60 min. The patients in group C were given 0.9% sodium chloride with the same method. The small vessel resistance (SVR), left ventricular end-diastolic volume (LVEDV), left ventricular ejection fraction (LVEF), cardiac output (CO) and myocardial working index (Tei index) before induction (T0) and after administration of 20 min (T1), 40 min (T2), 60 min (T3) were measured by color Doppler ultrasound, and the heart rate (HR) and mean arterial pressure (MAP) were recorded at the same times. The time from the end of operation to extubation and incidences of agitation during recovery period were recorded. Results The T1to T3SVR in group D were significantly lower than those of T0: (883 ± 30), (827 ± 36) and (804 ± 38) dyn·s·cm-5vs. (1 075 ± 37) dyn·s·cm-5, and there were statistical differences (P＜0.05); compared with those in group C, the T1 to T3 SVR in group D were significantly lower, and there were statistical differences (P＜0.05). In group D, there were no statistical differences in CO between T1to T3 and T0(P＞0.05); compared with those in group D, the T1 to T3 CO in group C were significantly lower: (3.4 ± 0.6) L/min vs. (4.4 ± 1.0) L/min, (3.2 ± 0.7) L/min vs. (4.3 ± 0.8) L/min and (3.3 ± 0.9) L/min vs. (4.4 ± 0.9) L/min, and there were statistical differences (P＜0.05). In group D, there were no statistical differences in LVEF between T1to T3 and T0(P＞0.05); compared with those in group D, the T1to T2 LVEF in group C were significantly lower, and there were statistical differences (P＜0.05). In group D, there were no statistical differences in Tei index between T1 to T3 and T0(P＞0.05); compared with group D, the T1 to T2 Tei index in group C were significantly higher, and there were statistical differences (P＜0.05). There were no statistical differences in LVEDV after intra-group and inter-group comparison (P＞0.05). In group D, the T1 to T3 HR were significantly lower than T0: (68.1 ± 12.8), (67.3 ± 11.9) and (65.4 ± 11.7) times/min vs. (88.2 ± 15.1) times/min, and there were statistical differences (P＜0.05); compared with those in group C, the T1 to T3 HR in group were significantly slower. In group D, the T1 MAP significantly increased, significantly higher than those in T0 and in group C (P＜0.05). There was no statistical difference in the time from the end of operation to extubation between 2 groups (P＞0.05). The incidence of agitation during recovery period in group D was significantly lower than that in group C. Conclusions Dexmedetomidine can effectively promote the perioperative cardiac function recovery in patients with cardiac dysfunction undergoing laparoscopic radical resection of rectal cancer, suggesting that it has a certain myocardial protection effect.

Objective To investigate the effects of dexmedetomidine on corrected QT (QTc) and T-wave peak to end point (Tp-e interval) in patients undergoing laparoscopic radical resection of rectal cancer with Steep Trendelenburg Position.Methods Sixty cases, aged 45~60 years old, ASA Ⅰ or Ⅱ, who were scheduled with laparoscopic radical resection of rectal cancer, were randomly divided into two groups: group C and group D (n=30).D group intravenous infusion of dexmedetomidine at 0.3 μg/(kg·h), and volume matched 0.9% saline infusion was administered in group C, from the beginning to the end of the pneumoperitoneum with Steep Trendelenburg Position.Time points of QTc and Tp-e intervals and hemodynamic parameters were recorded before induction with supine position(T0), 30min(T1), 60 min(T2), 90 min(T3) after pneumoperitoneum with Steep Trendelenburg Position, 15 min(T4), 60 min(T5) after remove the pneumoperitoneum and Steep Trendelenburg Position, and the time from the end of the operation to extubation, the incidence of agitation during recovery period.Results In group C, the QTc(ms) intervals at T1~T5 were (390.7±4.2),(397.3±4.0),(395.4±5.2),(407.5±4.4) and (406.1±4.4), respectively, which were significantly increased compared with that at T0 (P<0.05).In group D, there was no significant difference of QTc interval compared with that at T0(P>0.05), except at T4(P<0.05).The QTc(ms) intervals in group D at T2~T5 was significantly shortened compared with group C (P<0.05).The HR(bpm) of group D were respectively (69.1±13.7),(67.0±12.6), (65.4±11.9) and (64.6±12.2) at T1~T4, which were slower than that at T0 and at the corresponding time point of group C (P<0.05).HR of group C were no significantly different (P>0.05).There was no significant different of Tp-e interval and MAP inside and between groups (P>0.05).The time from the end of the operation to extubation was no significant difference between groups (P>0.05).The incidence of agitation in group D was significantly lower than group C (P<0.05).There was no significant difference in the incidence of hypotension and bradycardia between the two groups (P> 0.05).No serious adverse cardiovascular events occurred.Conclusion Dexmedetomidine would significantly reduce the QTc interval and the incidence of agitation in patients who undergoing laparoscopic radical resection of rectal cancer with Steep Trendelenburg Position, then reduce the incidence of adverse cardiovascular events.

Objective To explore the optimal concentration of sevoflurane for general anesthesia with tracheal intubation among newborns.Methods Sixty newborns undergoing selective operation were divided into 1.5 minimum alveolar concentrations( MAC) group (n=15),1.8MAC group(n=15),2.1MAC group(n=15) and 2.4MAC group(n=15) by random number table.The tracheal intubation was conducted in all groups 4 minutes after inhalation of sevoflurane.Heart rate( HR) and mean arterial pressure( MAP) were recorded at following time points:the moment of entering the operation room(T0),the moment of loss of consciousness(T1),the moment of performing laryngeal endoscopy( T2 ) ,the instant of intubation( T3 ) and one minute after intubation( T4 ) .The duration for loss of consciousness was also recorded.And the tracheal intubation condition was scored.Results There were no significant differences in HR among four groups(P>0.05). HR showed significant difference over time in each group(P<0.01).There was no interaction effect between time and HR(P>0.05).There were no significant differences in MAP among four groups(P>0.05).MAP showed significant difference over time in each group;There was no interaction effect between time and MAP(P>0.05).There was no significant difference in the duration for loss of consciousness among four groups(P>0.05).1.5MAC group gained significantly higher score of body movement during intubation compared to other groups(P<0.01),but no significant difference was observed in the score among the other groups(P>0.05).Compared to 1.5MAC group,another three groups obtained significantly lower scores of glottis exposure(P<0.01),and the scores decreased gradually with the increasing concentration of sevoflurane in each group (P<0.05).There is no significant difference in the scores of cough and body movement after intubation between 1.8MAC group and 1.5MAC group(P>0.05).The scores of cough and body movement after intubation in 2.1MAC group were significantly lower than that in 1.5MAC group or 1.8MAC group(P<0.01).The scores of cough and body movement after intubation in 2.4MAC group were significantly lower compared to those in another three groups(P<0.01).Conclusion Inhalation of sevoflurane for 4 minutes and the end-tidal concentration of 2.1MAC can provide a satisfactory intubation condition.

【Objective】 To compare and assess the inducing effect of sevoflurane with different concentrations on QT interval of newborn.【Methods】 Selected 60 cases of newborns of 1 month old who have undergone elective surgery,weight 2.9～4.5 kg.According to the end-expiratory concentration of sevoflurane the cases were randomly divided into 4 groups: 5% group,6% group,7% group and 8% group,15 cases each.Continuous inhalation of sevoflurane for 4min,heart rate(HR),blood pressure(BP) and electrocardiogram were recorded at the following time points: baseline values(T0),consciousness loss(T1),immediately after intubation(T2).QT interval and QT interval after correction(QTLC) values were measured by electrocardiogram at all three time points mentioned above.【Results】 Compared with T0,HR decreased significantly(P 0.01),QT,QTLC interval were significantly prolonged(P 0.01) at T1 and T2 time points in the same group.HR,QT,QTLC interval had no significant difference between T1 and T2 time points in the same group.Compared with T0,MAP decreased not obviously at T1 time point(P 0.05),but MAP decreased significantly at T2 time point(P 0.01) in the same group.HR,MAP,QT,QTLC interal had no significant difference at the same time point between the four groups(P 0.05).【Conclusion】 Sevoflurane induction can also lead to neonatal QT interval prolongation,but the neonatal QT prolongation has no significant difference between the different end-expiratory sevoflurane concentrations.