目的 通过应用漂浮导管监测背驮式肝移植患者的心、肺血流动力学指标,分析背驮式肝移植患者不同时段的容量管理.方法 选择117例肝移植患者,随机分为Ⅰ、Ⅱ两组.Ⅰ组:术中适量控制输液及血液制品;Ⅱ组:大容量输注晶、胶体及血液制品.两组均应用血管活性药物维持麻醉平稳,经颈内静脉置放Swan-Ganz漂浮导管成功,监测术前(T1)、无肝期前5 min (T2)、无肝期30 min (T3)、新肝期30 min(T4)中心静脉压(CVP)、肺动脉楔压(PCWP)、心排量(CO)、右心室舒张末期容积指数(RVEDVI)、输入量、出血量及尿量.结果 两组患者入、出总量及血流动力学等指标有显著性差异(P＜0.05).结论 大容量输注不利于背驮式肝移植术的麻醉管理.

2011年至2013年期间，笔者所在医院奉命随海军某型核潜艇先后执行了4次战备远航卫勤保障任务，累计航程×××××海里、航行时间长×××d，其中水下潜航×××d。通过数次远航卫勤保障工作的开展，笔者对艰苦、恶劣环境下，特别是核潜艇远航期间卫勤工作展开有了更深的了解与体会，现将其特点及经验做法介绍如下。

Objective To study the effects of synthesized intervention measures on improving the level of serum electrolyte in nuclear submariner during submerged voyage,so as to provide scientific basis for working out measures of health security. Methods The submariners were divided into two groups: intervention group,and non-intervention group. The intervention group was given some synthesized intervention measures such as taking electrolyte enriched food,multivitamin 29,calcium carbonate D3,and fluorescent lamp shining,etc. The level of serum Na+,K+,Ca2 +was examined before sailing,and on the 3rd d,10th d,20th d,and 30th d of sailing. Results( 1) The incidence of hypokalemia in non-intervention group,and intervention group was 35%,and 5% respectively( P 0.05); that of hypocalcemia 37. 5%,and 10% respectively( P 0. 05).( 2) The level of serun K+in non-intervention group on the 10th d 〔( 3. 52 ± 0. 21) mmol /L〕,20th d 〔( 3. 55 ± 0. 23) mmol /L〕,and 30th d 〔( 3. 6 ± 0. 17)mmol /L〕was lower than that before sailing,as well as on the 3rd d〔( 4. 05 ± 0. 84),( 3. 80 ± 0. 23) mmol /L respectively〕( P 0. 05).( 3) The levels of serum K+,Ca2 +during submerged voyage in intervention group were not significantly different from those before voyage( P 0. 05),but were lower than those at the corresponding time in non-intervention group( P 0. 05). Conclusion The synthesized intervention mesures could reduce the incidence of hypokalemia and hypocalcemia in the submariners during submerged voyage.

<正>本组30例。年龄23～34岁。足月、单胎,ASAⅠ级符合剖宫产指征,均在硬膜外麻醉下行剖宫产术,术后舒芬太尼静脉镇痛。30例产妇均无乳房发育缺陷及胎儿宫内窘迫、妊高症等严重高危妊娠情况。入手术室后建立静脉通道,常规监测ECG、HR和SpO2,产妇均左侧卧位,经L1～2间隙行硬膜外

<正>快速康复外科(fast-track surgery,FTS)作为一种新的治疗模式在外科领域已广泛开展,其目的是加快手术患者术后康复、减少并发症的发生、缩短住院日,减少治疗费用,降低患者病死率,减轻患者的应激反应及器官功能损害。主要包括快速通道麻醉、微创技术、术后镇痛及强有力的术后护理等[1]。维和二级医院医疗资源有限,不仅要保证择期手术的进

Objective To observe the effectiveness of i-STAT portable blood gas analyzer in testing the blood gas analysis index of the nuclear submarine sailors during long voyage.Methods The i-STAT portable blood gas analyzer was applied to testing the blood gas analysis index of 20 nuclear submarine sailors during long voyage.Results During navigating underwater,the test results of PaCO2,PaO2,SaO2 were higher than those sailing on the surface of sea.The differences were significant(P<0.05),and serumpotassium decreased significantly(P<0.05).During underwater navigation,serumsodium and serum-calcium almost didn't change.The serum calcium was in low level of normal range.HCT and Hb tended to decrease(P<0.05).Conclusion The i-STAT portable blood gas analyzer can test the arterial blood gas analysis index of nuclear submarine sailors on the site during long voyage.

Objective To study intraoperative epilepsy inducing test and its effect in the epileptogenic focus resection.Method The study included 118 patients with refractory epilepsy.During surgery,the patients were first woken up.With cortical and depth electrodes,the patient's spike wave,sharp wave or spike slow,sharp slow complex wave,etc.were monitored.The range of epileptogenic foci was marked with digital label.Under deep anesthesia,the foci was resected and the cortex was heat burned.The patients were woken up again,and hyperventilated,the carbon dioxide partial pressure (PCO2) kept at 20 ～ 25 mmHg for 5 minutes.The brain waves were measured again.After marking the spike and sharp waves,the anesthesia was deepened again,and resection and cortex heat burning were applied.Results (1) Of the 118 patients,except 3 children performed under light anesthesia because of noncooperation,115 patients all successfully underwent the surgery,going through consciousness recovery,hyperventilation inducing test after general anesthesia,without intraoperative seizures.(2)According to the results by arousal conditions,despite postoperative epileptic wave basically disappeared,the epileptic waves were still detected in 63 patients after hyperventilation inducing test.The epileptic wave disappeared after repeated operation and hyperventilation inducing test.(3) Postoperative follow - up showed no operative death,incomplete motor aphasia in 2 cases and recovered in 6 months.2 cases with incomplete paralysis recovered after 1 year.3 patients with glioblastoma died.5 patients were not traceable.110 patients were followed up for 3 -33 months (mean 18.5 months).According to Engel's postoperative evaluation,74 cases were grade Ⅰ,27 cases were grade Ⅱ,6 cases were grade Ⅲ,3 cases were grade Ⅳ.Conclusions Intraoperative epilepsy inducing test has very important significance in the epileptic focus resection and deserves to further exploration.

Objective To evaluate the efficacy of pressure bladder indicator in guiding epidural puncture.Methods Test Ⅰ Thirty-two patients scheduled for epidural puncture were studied. After successful epidural puncture, the end of the epidural needle was connected to a pressure sensor to measure the epidural space pressure. Test Ⅱ Seventy patients scheduled for epidural puncture were studied. The epidural puncture was performed using the pressure bladder indicator. The successful condition of the pressure bladder indicator in guiding epidural puncture was recorded. Results The epidural space pressure was ( 10 ± 4) cm H2O. Seventy patients completed epidural pucture under the guidance of the pressure bladder indicator. The success rate was 100%.Conclusion The pressure bladder indicator can serve as an assistance for epidural puncture and has clinical application value.

Objective To make further subdivision of anhepatic phase in Piggy-back liver transplanta-tion and investigate capacity management at every phase.Method The 67 patients undergoing Piggy-back liver transplantation surgery were selected.The anhepatic period was partitioned into portal vein cross-clamping period and inferior vena cava cross-clamping period.Result By contrast with that in anhepatic prophase,urinary volume decreased in inferior vena cava cross-clamping period and that in neo-liver period was increased significantly;oliguria incidence rate was increased and oliguria rectification rate was decreased significantly in inferior vena cava cross-clamping period and neo-liver period;9 cases(13.4%)fited diagnostic criteria of ARF.The time of anhepatic phase,hypotension during operation and hypotension after operation were no prolongation notably.But bleeding volume increased and oliguria time prolonged notably during operation.Conclusion It is feasible to make anhepatic phase subdivision and maintain urinary volume by adding capacity discretely.Haemodynamics during operation is stable and recovery of renal function after operation is satisfactory relatively.

笔者所在医院对430例小儿斜视矫正术实施非气管插管静脉麻醉,现将临床资料总结报告如下. 1 资料与方法 1.1 一般资料 本组斜视患者430例.男229例,女201例;年龄最小2岁,最大12岁;体重12～60.5kg.眼肌矫正2～4条/例.患者均无近期上感及其它先天性疾病史,术前检查心电图、血常规及肝肾功能正常.

我院自2002年开始将硬膜外自控镇痛术应用于腰椎术后镇痛,取得了良好效果,现报告如下. 1 资料与方法 1.1 一般资料选择2002年9月～2006年5月在我院实施L4、L5椎管狭窄探查减压、内固定术,并要求实施术后自控镇痛术的患者46例,其中男性39例,女性7例;ASA Ⅰ～Ⅱ级;年龄39～63岁,平均53岁;体重45～83kg,平均61 kg;手术时间150～240分钟,平均195分钟;患者一般情况均较好,无贫血及其他先天性疾病,心、肝、肺、肾和凝血功能正常.

将20例原位肝移植患者随机分为A、B组各10例,A组持续输注多巴胺,初始速率为1～4μg/(kg.min);术中B组持续输注去甲肾上腺素,初始速率为0.03～0.05μg/(kg.min)。于无肝前期(T_1)、无肝期30min (T_2)、新肝期30min(T_3)、术毕(T_4)测定血流动力学和肾功能指标。结果两组平均动脉压(MAP)维持较平稳,A组心率快于B组(P<0.05),但均在正常范围内;与T_1比较,T_2时两组中心静脉压(CVP)、肺动脉压(PAP)、肺动脉嵌压(PAWP)、心输出量(CO)降低(P<0.05),SVR和PVR上升(P<0.05);与T_2比较,T_3时CVP、PAP、PAWP、CO上升(P<0.05),而SVR下降(P<0.05)。两组术中Cr和BUN均在正常范围内。认为肝移植术麻醉中适量应用去甲肾上腺素有利于维持术中血流动力学稳定,对肾脏功能无毒副作用。

<正>晚期肝硬化患者血流动力学多数呈高动力血流状态。麻醉管理的关键是克服脏器因低血管阻力所致的低灌注压性损害[1]。在无肝期使用静脉-静脉转流技术,能对经典原位肝移植术血流动力学起很大的稳定作用。随着手术技术的成熟,笔者对52例肝移植手术中12例在无静脉转流下完成。本文着重探讨去甲肾上腺素对非静脉转流下经典式肝移植术围术期血流动力学的影响。

肝移植术后早期急性肾功能衰竭(post-operation earlystage acute renal failure,以下简称ARF)是常见而严重的并发症[1].背驮式肝移植术中血流动力学稳定,术后肾功能衰竭并发症罕见.自2003年9月至2005年9月我院共做背驮式肝移植手术30例,本文回顾性分析术中的容量管理的特点及术后早期ARF发生情况,并探讨处理策略.

A 52-year-old woman was scheduled to undergo right partial thyroidectomy for right thyroid occupying lesion.Preoperative electrocardiographic monitoring showed the following records:BP 140/83 mmHg,HR 90 beats/min,ECG normal,pulse oxygen saturation(SpO2)0.96.She received 20 ml of a mixed solution prepared with 0.75% ropivacaine solution and 2% lidocaine solution in a ratio of 1 to 1 for bilateral cervical plexus block.Five minutes after administration,the woman developed palpitation,chest distress,breath holding,mental stress,excitation and logorrhea.His BP was 168/95 mmHg,his HR was 120 beats/min with frequent premature ventricular contraction and occasional bigeming,and his SpO2 was 0.90.And the auscultation revealed wheezes in the lungs and arrhythmia.After receiving midazolam,lidocaine,dexamethasone,and oxygen,she recovered gradually.

<正>手术部设计要求严谨,部向合理设计布局时矛盾很多,考虑不周很容易留下遗憾。作为使用者作者曾参与手术部的设计工作,下面结合笔者所在医院的情况谈一点看法。1手术部的房间总体设计①手术用房:有普通手术间、专科手术间、急诊手术间、感染手术间、防X射线手术间等,手术间又有不同的净化级别;②保洁用房:有污物通道、垃圾站、洗涤室、工具库等;③手术辅助用房:有净化过渡区、洗手处、大设备存放室、体外循环设备室等,这些房间一般要紧邻手术间,位于净化区内;

为了了解航行训练舰员的心理健康状态和心理干预对舰员心理变化的影响,我们对2艘同一型号舰艇的艇员在航行训练前、中、后进行了跟踪调查,现将调查结果报告如下.

Objective To measure the pressure inside epidural;to introduce a show device which produces an objective indicating signal when epidural centesis is successful.Methods a)For 30 patients undergoing epidural centesis,after successful breakthrough of the dural,a pressure sensor machine was attached to the epidural needle to measure pressure in the epidural,b)The inventor designed a vacuole device indicating pressure change during epidural centesis.This device was tested on epidural centesis procedures performed on 50 patients.Result Pressure inside epidural was 10.8±4.2cmH_2O.The vacuole device successfully indicated pressure change 100% of the time.Conclusion The ideal vacuole device should be one-time-use disposable.It should be very cheap,small,easily sterilized,and consumes no electricity.It also does not change the original operating procedures adopted by anesthesiologists during epidural centesis.The vacuole injection device serves only as a reference.

<正>肝脏移植是终末期肝病和早期原发性肝癌病人最有效的治疗措施。肝移植手术创伤大、时间长,围术期凝血机制及电解质、酸碱平衡紊乱明显。良好的麻醉监测与管理是肝移植成功的关键之一。我们对32例肝脏移植病人围手术期凝血机制的异常变化及电解质、酸碱平衡紊乱进行了处理,现报告如下。 1 材料与方法 1．1 一般资料本组32例,男30例,女2 例,年龄33-56岁,体重42-87kg,其中乙肝后肝

<正>随着我国进入老龄化国家行列,高龄老年病人的外科手术适应症也逐渐放宽,我院近3年来对93 例70岁以上需行下肢手术及下腹部盆腔手术的高龄老年病人均实施腰-硬联合麻醉,取得了满意效果,分析如下。 1 资料与方法 1．1 一般资料本组93例,ASAⅡ-Ⅲ级; 男60例,女33例;年龄70-103岁,平均年龄78．8 岁;体重46-88kg,平均58．2kg。手术时间110- 370min,平均195．6min。患者多伴有高血压、冠心