Objective: To observe the effect of using mild intraoperative hyperventilation on the incidence of postlaparoscopic shoulder pain（PLSP） in patients undergoing laparoscopic sleeve gastrectomy.Methods: Eighty patients undergoing laparoscopic sleeve gastrectomy, aged 22 to 36 years, with American Society of Anesthesiologists（ASA） grade Ⅰ or Ⅱ,were divided into two groups according to method of random number table.A mild hyperventilation was used in group A with controlling pressure of end-tidal carbon dioxide(P ET CO 2 ) of 30 to 33 mmHg（1 mmHg≈0.133 kPa）,while conventional ventilation was used in group B with P ET CO 2 35 to 40 mmHg during the operation.The incidence and severity of PLSP,cumulative analgesic dosage and adverse reactions such as nausea and vomiting at 12,24,48,72 h and 1 week after surgery were recorded.Arterial blood gas was recorded before anesthesia induction, 5 min af-ter pneumoperitoneum, at the end of the operation, and 24 h postoperatively.Results: Compared with 12,24,48,and 72 h after operation, the incidence of PLSP at 1 week decreased significantly（P＜0.01）.Compared with group B,the incidence of PLSP,pain score, and dose of analgesic medication at 12,24,48,72 h, and 1 week were significantly decreased（P＜0.01）.There was no significant difference between the two groups in arterial blood gas analysis before anesthesia induction, 5 min after pneumoperitoneum, postoperatively, and 24 h after surgery（P＞0.05）.There were no significant difference of the occurrence of adverse reactions such as nausea and vomiting between the two groups within 1 week after surgery（P＞0.05）.Conclusion: Mild hyperventilation can reduce the incidence and severity of PLSP after laparoscopic sleeve gastrectomy without increasing the associated adverse effects.

目的 总结重症腺病毒肺炎(severe adenovirus pneumonia,SAP)的临床特点,分析其并发闭塞性细支气管炎(bronchiolitis obliterans,BO)的危险因素.方法 对南京医科大学附属儿童医院呼吸科2017年1月至2019年12月住院的125例SAP患儿进行回顾分析,总结其临床特点.根据是否发展为BO将患儿分为BO组和非BO组,并对临床资料进行分析.结果 发病年龄≤24月龄80例(64％);热峰≥39℃者115例(94.3％),热程≥10 d者89例(72.9％);气喘82例(65.6％);单纯腺病毒感染35例(28％),72％的患儿合并其他病原体感染[肺炎支原体(MP)40.8％,细菌35.2％];并发呼吸衰竭32例(25.6％),肺外并发症以循环系统(36％)和消化系统并发症(22.4％)多见.实访122例SAP患儿,53例(43.4％)最终发展为BO.多因素Logistic回归分析显示呼吸衰竭和合并MP感染是SAP后BO的独立危险因素(P＜0.05).结论 SAP主要发生于2岁以下的婴幼儿,多为高热且持续时间长,多数患儿存在喘息,混合感染率高;最常见的并发症是呼吸衰竭、心功能不全、肝功能损害和中毒性脑病.呼吸衰竭和合并MP感染是SAP后BO的独立危险因素.

目的 探讨全麻复合羟考酮与芬太尼用于门诊纤支镜检查中的镇痛效果及安全性.方法 随机选取2016年1月-2017年12月该院100例门诊纤支镜检查患者为研究对象,依据镇痛方法不同分为实验组(全麻复合羟考酮,50例)和对照组(全麻复合芬太尼,50例),对比观察两组镇痛效果,统计不良反应.结果 实验组术中镇痛优良率96.0%,术后镇痛优良率90.0%,均优于对照组,差异有统计学意义(x2=5.42,P<0.05;x2=4.63,P<0.05,);实验组不良反应发生率(4.0%)低于对照组(12.0%),差异有统计学意义(x2=3.16,P<0.05).结论 门诊纤支镜检查采用全麻复合羟考酮术中、术后镇痛效果确切,不良反应少,安全性高,可提高患者舒适度,保证检查顺利完成,值得推广使用.

Objective To observe the effect of coenzyme complex on bispectral index(BIS)and recovery quality during recovery period of general anesthesia in elderly patients.Methods Ninety patients aged ≥ 65 years undergoing cholecystectomy under general anesthesia were equally randomized into three groups.The patients in groups of A and B were intravenously infused coenzyme complex 100 U and 200 U in 30 minutes after skin incision.The patients in group C were given equal volume of normal saline instead of coenzyme complex.HR and BIS were recorded before anesthesia induction,during sputum aspiration,during extubation and at 1,5,10 and 15 minutes after extubation. The operation time,extubation time,awakening time and Steward recovery scores at 1,5,10 and 15 minutes after extubation were recorded as well.The occurrence of arrhythmias in operation was observed.Results Compared with group C,BIS value during sputum aspiration,during extubation and at 1 and 5 minutes after extubation and Steward recovery scores at 1 and 5 minutes after extubation were increased(P<0.05),and extubation time and awakening time were shortened in groups of A and B(P<0.05).The incidence of arrhythmias in operation was higher in group C than those in groups of A and B(30.0% vs.13.3% and 3.3%)(P<0.05),which was higher in group A than that in group B (P<0.05).Conclusion Intravenous infusion of coenzyme complex 200 U in operation after skin incision is able to improve BIS value and recovery quality and reduce the occurrence of arrhythmia during recovery from general anesthesia in elderly patients.

Objective To determine the effect of oxycodone on emergence pain after intravenous remifentanil anesthesia in elderly patients with laparoscopic cholecystectomy.Methods Thirty-two ASA Ⅰ or Ⅱ patients,aged 65-74 years undergoing laparoscopic cholecystectomy under general anesthesia were studied.Anesthesia was induced with etomidate 0.3 mg/kg,then administrated remifentanil with the Minto model of target controlled infusion (TCI) to the concentration of 3.0 μg/L.When the numerical value of BIS was 40 to 45 we used cisatracurium 0.2 mg/kg and completed intubation and mechanical ventilation in 5 min.Besides remifentanil,no other analgesic drugs were added.Anesthesia was maintained with propofol and remifentanil by the model of TCI which were terminated at the end of surgery.Oxycodone was injected 5 min before the end of surgery by using modified Dixon's up-and-down method.VAS scores≥4 was defined as postoperative acute pain.ED50 and 95％ confidence interval (CI) of oxycodone on postoperative acute pain were calculated.The time of total operation,extubation after operation and side effects such as nausea and vomiting were recorded.Results ED50 was 0.126 mg/kg.95％CI was 0.093-0.181 mg/kg.There was only one in thirty-two patients which nausea and vomiting occurred.No other adverse reactions occurred.Conclusions Oxycodone(0.126 mg/kg) can inhibit the acute pain after intravenous remifentanil anesthesia in elderly patients undergoing laparoscopic cholecystectomy.

目的 探讨丙泊酚复合雷米芬太尼静脉麻醉下腹腔镜胆囊切除术(LC)苏醒期羟考酮镇痛半数有效量(ED50)的年龄差异.方法 62例全麻LC患者分为中年组(45～54岁,30例)和老年组(65～74岁,32例).麻醉诱导:依托咪酯0.3mg/kg;靶控输注(TCI)雷米芬太尼.采用TCI丙泊酚和雷米芬太尼维持麻醉.手术结束前5 min采用改良序贯法静脉注射羟考酮,拔管后30 min行VAS疼痛评分,VAS≥4分定义为急性疼痛,采用Probit回归方法分析各组羟考酮ED60及其95％可信区间(CI).结果 中年组羟考酮抑制疼痛的ED50为0.143 mg/kg(95％CI=0.098～0:205 mg/kg),大于老年组0.126 mg/kg(95％CI=0.093～0.181 mg/kg)(P＜0.05).结论 抑制丙泊酚复合雷米芬太尼静脉麻醉下LC中年患者苏醒期疼痛的羟考酮ED50大于老年患者.

目的 观察地佐辛抑制雷米芬太尼和丙泊酚静脉复合麻醉下中、老年患者腹腔镜胆囊切除术(LC)后苏醒期疼痛的半数有效量(ED5o).方法 选择拟行LC的中年(中年组,45～54岁)和老年(老年组,65～74岁)患者各32例,两组麻醉诱导和维持用药方法一致,术中除雷米芬太尼外,不再追加任何镇痛药物.手术结束前10 min采用改良序贯法静脉注射地佐辛.术毕停用丙泊酚和雷米芬太尼.拔管后30 min测定患者VAS疼痛评分,VAS疼痛评分≥4分为术后急性疼痛.采用Probit回归方法分析地佐辛ED50并计算其95％可信区间(CI).记录手术时间、拔管时间及术后不良反应情况.结果 中年组使用地佐辛的剂量高于老年组[(0.147±0.015)mg/kg vs.(0.116±0.011)mg/kg] (P＜0.05),地佐辛抑制两组患者苏醒期疼痛的ED50及95％CI分别为0.145(0.139～0.171)mg/kg和0.117(0.112～0.141)mg/kg.两组手术时间、拔管时间及术后不良反应发生率差异无统计学意义(P＞0.05).结论 地佐辛抑制雷米芬太尼和丙泊酚静脉复合麻醉下中年患者LC后苏醒期疼痛的ED50值明显高于老年患者.

Objective To observe the effect of creatine phosphate sodium on BIS and recovery quality during general anesthesia emergence period in elderly patients.Methods Sixty ASA Ⅰ or Ⅱpatients,31 males,29 females,aged 65-80 yr undergoing transabdominal cholecystectomy by general anesthesia were randomly allocated into two groups(n=30 each):group creatine phosphate (P)and group control(C)according to random numbers generated by computer.Patients were intravenously infused with 1.0 g creatine phosphate sodium melted in 100 ml normal saline or only 100 ml normal saline in group P or C respectively in thirty minutes at the same time of surgical incision.The heart rate(HR)and bispectral index(BIS)were recorded before anesthesia induction (T0 ),during sputum aspiration (T0 ),during extubation (T2 )and 1(T3 ),5(T4 ),10(T5 ),15 minutes (T6 )after extubation. The dosage of propofol,remifentanil and cisatracurium,anesthesia duration,operation time,awake time,extubation time,recovery time of consciousness and Steward recovery scores on T3-T6 were also recorded,and the occurrence of tachycardia during the operation was observed at the same time. Results Compared with T0 ,the BIS value were lower significantly and HR were significantly in-creased on T1-T4 in the two groups(P <0.05).Compared with group C,the BIS value were signifi-cantly higher in group P on T1-T4 (P <0.05).Compared with group C,awake time,extubation time, recovery time of consciousness significantly shortened in group P (P <0.05).There were six cases of tachycardia occurring in group C which were significantly higher than two cases in group P (P <0.05).Steward recovery scores on T3 and T4 were also higher in group P (P <0.05).Conclusion Not only can 1.0 g creatine phosphate sodium administered during transabdominal cholecystectomy im-prove the BIS value of general anesthesia recovery period and recovery quality,but also effectively re-duce the incidence rate of tachycardia during operation in elderly patients.

目的：观察地塞米松对老年下肢手术患者小剂量布比卡因复合芬太尼腰椎麻醉的影响。方法120例择期行下肢手术的老年患者，根据腰椎麻醉用药的不同均分为3组：A组注入总容积2 mL生理盐水（含布比卡因4 mg、芬太尼20μg），同时静脉注射2 mL生理盐水；B组注入总容积2 mL生理盐水（含布比卡因4 mg、芬太尼20μg、地塞米松粉剂5 mg），同时静脉注射2 mL生理盐水；C组注入总容积2 mL生理盐水（含布比卡因4 mg、芬太尼20μg），同时静脉注射2 mL生理盐水溶解的5 mg地塞米松粉剂。比较3组麻醉前、后20 min内平均动脉压（ MAP）、HR；记录感觉和运动阻滞起效、消退时间及术后不良反应发生情况等。结果3组手术时间、术中补液量及出血量、使用麻黄碱及阿托品例数、麻醉起效时间、最高感觉阻滞平面及达最高平面时间、运动阻滞持续时间、不良反应发生率比较差异均无统计学意义（P均＞0．05）。 B组感觉阻滞持续时间比A组和C组长（P均＜0．05）。结论蛛网膜下腔辅用地塞米松可延长老年患者下肢手术中小剂量布比卡因复合芬太尼腰椎麻醉的感觉阻滞持续时间。

Objective To investigate the clinical effects of using 10μg or 20μg fentanyl combined with 4 mg bupivacaine in elderly patients undergoing lower limb surgery.Methods One hundred and twenty cases of elderly patients undergoing lower limb operation,ASA I or II,were randomly divided into three groups according to drug of lumbar anesthesia:group A received a subarachnoid injection of 4 mg 0.5% bupivacaine,whereas groups B and C received subarachnoid injections of 4mg 0.5%bupivacaine plus 10μg or 20μg fentanyl,respectively.The spinal anesthesia drugs of all three groups were diluted to 2 ml isobaric solution using normal saline.BP,HR,the incidence of hypotension,ephedrine usage,sensory and motor block onset time and the occurrence of adverse reactions after operations were also recorded in all three groups.In case the level of sensory block could not meet the operation requirements,patients received an extra 5-10ml of 1.5%lidocaine epidurally.Results Patients in groups B and C were all satisfied with anesthesia while five patients in group A required supplementary epidural anesthetics.The highest level of sensory block in group A was lower than those in groups B and C.There was no significant difference between the latter two groups.One patient in each of groups A and B required ephedrine due to hypotension,while no patients in group C had this requirement.Duration of sensory block in group C was significantly longer than those in groups A and B(P<0.05)and the duration in group B was significantly longer than that in group A(P<0.05).There was no significant difference in motor block time among the three groups.There was no significant difference in adverse reactions among the three groups either. Conclusion Subarachnoid 20μg fentanyl combined with 4mg bupivacaine provides long duration of sensory blockade,light degree of motor block,little adverse reaction and few impacts on hemodynamics in elderly patients.