目的 观察超声引导下踝部神经阻滞麻醉在老年阿尔茨海默病患者踝远端手术中的麻醉效果和对血流动力学的影响.方法 回顾性分析唐山市第二医院2010年1月-2019年1月收治的进行踝部神经阻滞的患者62例,34例患者实施超声引导的踝部神经阻滞(A组),28例患者实施硬膜外麻醉(B组),二组均静脉给予盐酸右美托咪定1 μg/kg持续泵入,泵入时间12 min,待患者处于完全镇静即深睡眠状态后给予静脉盐酸右美托咪定0.7～0.8 μg/(kg·h)持续泵入,维持镇静状态,记录动脉穿刺置管完后1 min(T0)、局麻药注射完成后5 min(T1)、手术切皮即刻(T2)、手术开始后15 min(T3)、30 min(T4)、手术结束苏醒即刻(T5)时的HR、MAP,分析血流动力学变化,并通过镇静评分和观察应激性体动反应评估麻醉效果是否完善.结果 A组在所有时间点镇静评分均达到0分,无1例应激性体动;B组在T2时间点有4例镇静评分为1分,并出现应激性体动,差异均无统计学意义(均P＞0.05).血流动力学方面,二组在T0、T3、T4、T5时HR、MAP差异无统计学意义(P＞0.05);T1、T2时A组HR明显低于B组、MAP明显高于B组,差异有统计学意义(P＜0.05).结论 老年阿尔茨海默病患者行足踝远端手术中,应用右美托咪定镇静后实施超声引导下踝部神经阻滞,麻醉效果确切、完善,对患者血流动力学影响极小,具有较高的安全性.

目的 观察骨科全麻术前预输注右美托咪定(DEX)对患者麻醉深度及血流动力学的影响.方法 选取2018年1月至2019年1月于我院手术治疗的40例骨科手术患者,ASA Ⅰ～Ⅱ级,随机分为观察组和对照组,两组均在常规全身麻醉下完成手术,观察组患者在麻醉诱导前15 min内泵注DEX,应用剂量为1μg/kg;对照组于相同时间泵入等量生理盐水.对比两组患者T1(入室后)、T2(泵入前5 min)、T3(泵入后)、T4(插管前)、T5(插管后)、T6(切皮时)、T7(术中峰值)、Ts(拔管)时血流动力学指标、脑状态指数(Cerebral state index,CSI)、镇静评分(Ramsay);并在T8时使用视觉模拟评分法(VAS)对患者术后疼痛程度进行评分.结果 观察组T3～T8时心率均小于对照组(P＜0.05),T4、T5、T7、T8时SBP低于对照组(P＜0.05),T4、T5、T8时DBP低于对照组(P＜0.05);两组各时点SpO2比较差异无统计学意义(P＞0.05);观察组T2、T3时CSI值低于对照组(P＜0.05),Ramsay评分高于对照组(P＜0.05);两组T8时VAS评分比较差异无统计学意义(P＞0.05);观察组术中使用丙泊酚注射液及盐酸瑞芬太尼用量均少于对照组(P＜0.05).结论 骨科手术患者麻醉诱导前预输注DEX,可提高术中及术后镇静、镇痛效果,减轻患者插、拔管反应,对稳定围术期血流动力学指标具有显著效果.

Objective To explore the effect of dexmedetomidine (Dex) on serum inflammatory cytokines in patients undergiong thoracoscopic radical resection of esophageal carcinoma (EC) . Methods A total of 58 patients with esophageal carcinoma (EC) in our hospital from January 2016 to November 2017 receiving thoracoscopic radical resection of EC were included in the study and randomized into observation group and control group, 29 cases in each group. After anesthesia induction, the double-lumen tube tracheal intubation was performed under the location of fiber bronchoscope. Respiration was controlled by single lung. Patients in observation group were given 1 μg/kg Dex, while the patients in control group were given 0. 5 ml/kg normal saline. Patients were given patient-controlled analgesia pump after operation. The levels of M AP and HR were measured before anesthesia induction (T0) and at 0 h, 24 h and 72 h after operation (T1, T2 and T3) , and the internal jugular venous blood was collected at the same time. The levels of IL-1β, IL-6 and TNF-α were detected by ELISA. Results The levels of M AP and HR in observation group were lower than those in control group at T1 (P < 0. 05) , and the levels of serum IL-1β, IL-6, and TNF-α in observation group were lower than those in control group at T1, T2 and T3 (P < 0. 05) . Conclusion Dex can effectively improve the perioperative inflammatory reaction in patients undergoing thoracoscopic radical resection of EC, and maintain the stability of perioperative hemodynamics.

目的:探讨右美托咪定用于老年阿尔茨海默病患者术后镇痛的效果.方法:选取2015年6月至2018年5月唐山市第二医院收治的拟行上肢骨折手术的老年阿尔茨海默病患者100例,按照随机数字表法分为观察组和对照组,每组50例.两组患者均采用腋路臂丛神经阻滞麻醉,对照组患者术后给予罗哌卡因,观察组患者术后在对照组的基础上加用右美托咪定.观察两组患者的麻醉前(T0)、术后麻醉1 h(T1)及术后6 h(T2)的镇静情况,术后镇痛效果、术后血流动力学指标水平及麻醉效果.结果:T1时,观察组患者的警觉/镇静评分明显低于对照组;T2时,观察组患者的警觉/镇静评分明显高于对照组;术后,观察组患者的视觉模拟评分明显低于对照组,上述差异均有统计学意义(P<0.05).给药6、12及24 h后,观察组患者的心率明显高于对照组,血氧饱和度水平明显低于对照组;给药12、24 h后,观察组患者的平均动脉压水平明显低于对照组,差异均有统计学意义(P<0.05).观察组患者的感觉阻滞时间明显短于对照组,而感觉阻滞持续时间、镇痛持续时间明显长于对照组,差异均有统计学意义(P<0.05).结论:右美托咪定用于老年阿尔茨海默病患者术后镇痛效果显著.

Objective: To explore the effect of dexmedetomidine assisted anesthesia on the inflammatory cytokines and T lymphocyte subsets in elderly patients with Alzheimer disease (AD) underwent total hip replacement (THR).Methods: A total of 60 patients with AD who were admitted in our hospital from October 2014, to October 2016 for THR were included in the study and randomized into the observation group and the control group with 30 cases in each group.Strict preoperative preparation was performed.The patients in the two groups were given intravenous injection of midazolam (0.04 mg/kg), propofol (0.5~1.5) mg/kg, cisatracurium (0.15 mg/kg), and fentanyl (4 μg/kg) for anesthesia induction, continuously venous pumping of propofol (1.5~2.5) mg/kg/h and remifentanil (0.04~0.40) μg/kg/min in maintaining the anesthesia depth, and cisatracurium for intermittent muscle relaxation.The patients in the observation group were given venous pumping of dexmedetomidine (1 μg/kg) 15 min before anesthesia induction, and dexmedetomidine (0.2~0.7) μg/kg/h for maintenance until the end of operation.The peripheral venous blood before operation, the time immediately after operation, 12 h and 24 h after operation in the two groups was collected.ELISA was used to detect CRP, IL-6, and TNF-α.FCM was used to detect T lymphocyte subsets (CD3+, CD4+, and CD8+).CD4+/CD8+ were calculated.Ramsay sedation grading was performed before operation, the time immediately after operation, 12 h and 24 h after operation.Results: Ramsay sedation score the time immediately after operation and 12 h after operation in the observation group was significantly greater than that in the control group (P<0.05).The serum CRP, IL-6, and TNF-α levels the time immediately after operation, 12 h and 24 h after operation in the observation group were significantly lower than those in the control group (P<0.05).The serum CD3+, CD4+, CD8+, and CD4+/CD8+ the time immediately after operation, 12 h and 24 h after operation in the observation group were significantly higher than those in the control group (P<0.05).Conclusions: Dexmedetomidine applied in patients with AD underwent THR has a unique analgesia and sedation effect, and can effectively inhibit the release of inflammatory cytokines in order to improve the immunological function.

目的 探讨右美托咪啶对老年阿尔茨海默病(AD)患者髋关节置换术(THR)围麻醉期氧代谢的影响.方法 选取2014年11月-2016年11月收治的AD患者实施THR 64例为研究对象,随机分为观察组和对照组各32例.入室后常规低流量吸氧,进行心率、血压、呼吸、脉搏、血氧饱和度等监测,罗哌卡因行L2~3节段腰硬联合麻醉,观察组将右美托咪啶溶于48 mL生理盐水,浓度调至4μg·mL-1,微泵静脉泵入,速率为0.4μg·(kg·h)-1,10 min后速率调至0.2μg·(kg·h)-1,对照组给予等量生理盐水微泵静脉泵入.两组患者于麻醉前、术中30 min、术中60 min、术毕即刻采集桡动脉和颈内静脉球部血标本进行血气分析,记录并计算颈内静脉血氧饱和度(SjvO2)、脑氧含量(CjvO2)、动脉-颈内静脉氧含量差[D(a-jv)O2]、脑氧摄取率(CERO2)、动脉血氧含量(CaO2);采用ELISA法测定颈内静脉血样血清S-100β蛋白浓度;测量各时间点心率(HR)、平均动脉压(MAP).结果 观察组术中30 min、术中60 min、术毕即刻SjvO2、CjvO2、CaO2高于同期对照组,D(a-jv)O2、CERO2低于同期对照组,两组患者间比较差异有统计学意义(P<0.05);观察组术中30 min、术中60 min血清S-100β蛋白水平低于同期对照组(P<0.05);观察组术中30 min、术中60 min、术毕即刻MAP、HR低于同期对照组(P<0.05).结论 右美托咪啶可有效降低AD患者实施THR围麻醉期脑代谢水平,减轻脑损伤,对改善患者预后有积极意义.

目的 探讨婴幼儿不同分型中耳炎的治疗策略,预防抗生素滥用.方法 对该院2015年1月—2016年12月门急诊收治的婴幼儿中耳炎患者1 080例(其中急性中耳炎864例,分泌性中耳炎179例,非渗出性中耳炎26例,咽鼓管功能障碍11例)做回顾性研究.结果 1 080名中耳炎患儿依家长自愿分为血清降钙素原组(PCT组)和经验治疗组(非PCT组),动态检测PCT组抗生素使用时间及使用率均小于非PCT组,差异有统计学意义(P＜0.01),而治疗时间和有效率差异无统计学意义(P＞0.05).结论 采用降钙素原(PCT)动态检测指导婴幼儿中耳炎治疗可降低抗生素的使用,在取得良好治疗效果的同时,避免抗生素滥用,降低药品花费.

目的：对有智力障碍的老年髋部骨折患者选择硬膜外麻醉,观察麻醉的效果及安全性。方法选择智力障碍老年患者下肢骨科手术80例,随机分为A组(硬膜外组)和B组(全麻组),麻醉前A组应用舒芬太尼复合咪达唑仑充分镇静、镇痛后,选择硬膜外麻醉；B组选择静脉麻醉。监测并记录两组患者术中的收缩压、舒张压、心率、血氧饱和度和不良事件,评价两种麻醉方法的效果和不良反应。结果与患者静脉注药前即刻(T1)比较,两组注药后5分钟(T2)、10分钟(T3)、30分钟(T4)时收缩压、舒张压均显著下降(P<0.05),血氧饱和度均升高显著(P<0.05)；T2时间点,B组收缩压显著低于A组；T5时间点B组收缩压、舒张压显著高于A组(P<0.05)。 A组无不良反应病例,所有患者在术后10分钟恢复自主意识；B组出现10例收缩压下降超过20%,6例术后呼吸抑制。结论在应对智障老年患者髋部骨科手术麻醉时,充分镇静、镇痛后实施硬膜外麻醉效果好,对患者循环系统影响较全身麻醉小,更安全。

Objective To study the clinical efficacy of phosphate tromethamine dispersion combined with ceftriaxone in the treatment of children with suppurative otitis media. Methods A total of 54 cases of children with suppurative otitis media without tympanic membrane perforation in Xiehe Hospital of Tangshan from May 2012 to May 2013 were selected,they were randomly divided into experimental group( 29 cases) and control group( 25 cases). The experimental group was treated with phosphate tromethamine dispersion combined with ceftriaxone; Control group was simply given ceftriaxone treatemnt,two groups were treated for 7 days. The clinical efficacy of treatment for 3 days,5 days,7 days between the two groups were compared. Results The clinical efficacy of treatment for 3 days,5 days,7 days in experimental group were better than control group,the differences were statistically significant( P 0. 05). Two groups of children with drug adverse reaction was not found. Conclusion The clinical efficacy of phosphate tromethamine dispersion combined with ceftriaxone in the treatment of children with suppurative otitis media are sure and safe.

Objective To investigate factors affecting unilateral low-middle frequency sudden hearing loss . Methods This is a retrospective analysis of 109 cases (109ears) of unilateral low-middle frequency sudden hearing loss from 2005 to 2013. Treatments included vasodilators and glucocorticoids. Cases were grouped based on gender, onset age, daration of dis?ease, degree of hearing loss, presence of high frequency hearing damage, comorbid diabetes mellitus, hyperlipidemia and oth?er factor. Correlations between these factors and treatment efficacy were studied using variable analysis followed by logistic linear regression analysis. Results In this study, the total effectiveness rate was 73.4%(80/109). The rates of full recovery and no efficiency were 71.6%(78/109) and 26.6%(29/109), respectively. Patients' gender, disease duration, degree of hear?ing loss, high frequency hearing impairment, hyperlipidemia, and blood viscosity had no obvious effects on treatment out?comes, whereas onset age and co-existing diabetes did. Conclusion Age over 50 years and glucose levels higher than 7.0 mol/l can negatively affect treatment outcomes in unilateral low-middel frequency sudden hearing loss.

Objective To investigate The effect of dexmedetomidine in elderly patients with Alzheimer disease under-going upper extremity fractures operation under brachial plexus block. Method Fifty-two patients with Alzheimer dis-ease undergoing upper limb operation,were randomly divided into two groups:group D(Dex),group P(Propofol). HR,MAP,SPO2 , RR,OAA/ S sadation scale and the time of recovery were record during the operation. Result There were not significant differences between two groups in OAA/ S scores (P>0. 05). Compare with group P,HR of group D is lower P at T3 ~ T5 (P<0. 05),MAP of group D is lower at T5,T6(P<0. 05), SPO2 is higher at T3 ~T6(P<0. 05). In group P,among 26 patients,adverse reactions occurred in 2,while the case number is 0 in group D. Conclusion To elderly patients with Alzheimer disease undergoing upper extremity fractures operation under bra-chial plexus block, dexmedetomidine provide good analgesia and sedation in the assisted anesthesia,and was proved to be security.

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)是指由于上呼吸道阻塞性病变引起的睡眠呼吸暂停低通气综合征,学龄前儿童OSAHS多由扁桃体和腺样体肥大堵塞上呼吸道引起,临床上多采用手术切除扁桃体和腺样体治疗,由于手术部位的特殊性,术后常有吞咽痛,影响患儿进食,延迟伤口的愈合,导致出血、感染等并发症[1].由于学龄前儿童无法使用自控镇痛泵,目前临床上多采用无需患儿控制的一次性持续微量静脉输注镇痛泵缓解学龄前儿童的术后吞咽痛,然而,镇痛泵中主要使用的阿片受体激动剂,如芬太尼、舒芬太尼等,镇痛作用强,有呼吸抑制作用,而儿童OSAHS术后舌后坠、悬雍垂水肿、咽腔狭窄可造成急性上气道阻塞,这些增加了术后窒息缺氧的风险[2].因此,儿童OSAHS术后镇痛的安全性成为了首要问题.

Objective:To study the etiology of the degenerative and hypertrophied lumbar ligamentum flavum,and its relationship with lumbar spinal stenosis (LSS). Methods:Ligamentum flavum specimens were obtained from a total of 25 cases of LSS and 25 cases of lumbar disc herniation (LDH) in operation. These slices were selected for HE staining and immunohistochemistry staining. With immunohistology stain, expressions of the three cytokines,TGF-β1, TNF-α and IL-6 were observed and compared between LSS and LDH groups. Results:HE staining showed that in LSS group, large fibrotic areas where collagenous tissue increased were almost consistently observed. Fibrocytes were fewer and fibroblasts were more numerous than normal. The fibrocartilaginous zone near the bone insertion underwent enlargement. Areas of calcification were often observed in the ligamentous tissue of stenotic patients, particularly the most elderly ones. Blood vessels increased and inflammatory cells were observed occasionally; LDH group, the center portion of the lumbar ligamentum flavum, except for the area in close proximity to the bone attachment had an uniform appearance. It was regular and parallel to the major axis of the ligamentum flavum. In proximity to the laminal insertion, the ligaments had fibrocartilagineous features. Proliferation of the collagen fibers was obviously slighter than that of LSS group. The immunohistochemistry staining showed that the positive expressions of TGF-β1 ,TNF-α and IL-6 were significantly different in ligamentum flavum between LSS and LDH groups(P < 0.01). Conclusion: The expressions of inflammatory cytokines,TGF-β1,TNF-α and IL-6,were relatively consistent in hypertrophy of ligamentum flavum of spinal stenosis,which were significantly higher compared with those of LDH. The sterile inflammatory cytokines also lead to the degeneration, proliferation and hypertrophy in the lumbar ligamentum flavum.