摘要:目的:探討通過(guò)腹腔內(nèi)注射局部麻醉藥在腹腔鏡膽囊切除術(shù)中的鎮(zhèn)痛效果。方法:52例患者隨機(jī)分為4組,Ⅰ組術(shù)前腹腔內(nèi)噴灑0.75％羅哌卡因20 mL;Ⅱ組術(shù)后腹腔內(nèi)噴灑0.75％羅哌卡因20 mL;Ⅲ組為術(shù)后腹腔內(nèi)噴灑0.5％布比卡因20 mL;Ⅳ組術(shù)后腹腔內(nèi)噴灑生理鹽水20 mL。麻醉方法均為全憑靜脈麻醉。術(shù)后1、2、3、4 h 4個(gè)時(shí)間點(diǎn)記錄患者術(shù)后疼痛視覺(jué)模擬評(píng)分(VAS)。并觀察4組術(shù)后使用鎮(zhèn)痛藥物的例數(shù)和肩背痛、惡心嘔吐發(fā)生率。結(jié)果:術(shù)后1、2、3、4 h VAS評(píng)分Ⅱ組lt;Ⅲ組lt;Ⅰ組lt;Ⅳ組(Plt;0.05)。Ⅳ組使用鎮(zhèn)痛藥物的例數(shù)明顯高于Ⅰ組、Ⅱ組和Ⅲ組(Plt;0.05)。4組術(shù)后肩背痛、惡心嘔吐發(fā)生率差異無(wú)顯著性(Pgt;0.05)。結(jié)論:經(jīng)腹腔給局麻藥鎮(zhèn)痛效果明顯,術(shù)畢給藥鎮(zhèn)痛效果優(yōu)于術(shù)前給藥,羅哌卡因鎮(zhèn)痛效果優(yōu)于布比卡因。Abstract: Objective: To investigate the effect of intraperitoneal local anesthetic on patients undergone laparoscopiccho1ecystectomy.Methods:Fiftytwo patients were randomly divided into four groups. Group Ⅰ received preoperational anesthetic spary with 20 mL of 0.75％ ropivacaine. Group Ⅱ was given the anesthetic ata same dosage after the operation. Group Ⅲ received preoperational anesthetic spary with 20 mL of 0.5％ bupivacaine. Group Ⅳ received preoperational anesthetic spary with 20 mL saline. The LC was completed under general anesthesia.After the operation,visual analog scale (VAS)was recorded at 1,2,3 and 4 hours to evaluate the degree of postoperative pain.Meanwhile,the number of the patients who received anesthetics after the surgery,as well as the incidence rates shoulder or back pain and nausea or vomiting were recorded. Results: Postoperative VAS of the group Ⅱ was significantly lower than that of the other three groups, while the VAS of group Ⅲ was significantly lower than that in group Ⅰ(both Plt;0.05).Compared to groups Ⅰ, Ⅱ and Ⅲ,more patients in the group Ⅳ needed anesthetics after the operation (Plt;0.05).No significant diference was noticed in the incidence rates of shoulder or back pain and nausea or vomiting among the four groups (Pgt;0.05).Conclusions: Intraperitoneal local anesthetic can significantly reduce postoperative pain after LC. It is more effective to give local anesthetic at the end of the procedure than using it before operation. The effect of ropivacaine is better than bupivacaine.
摘要:目的:定量測(cè)定50 %小兒在喉罩表面涂抹丁卡因膠漿的情況下平穩(wěn)拔除喉罩時(shí)呼氣末七氟烷濃度。方法:25例擇期行四肢及體表手術(shù)的患兒,高流量吸入七氟烷誘導(dǎo)并以七氟烷和氧化亞氮維持麻醉,不使用肌肉松弛劑及靜脈麻醉藥物,手術(shù)結(jié)束后停止吸入氧化亞氮,并維持設(shè)定的七氟烷濃度10min后拔除喉罩。根據(jù)Dixon序貫法確定喉罩拔除時(shí)的七氟烷濃度,每0.1 Vol%七氟烷為1個(gè)增減單位?；純何闯霈F(xiàn)咳嗽、牙關(guān)緊閉、體動(dòng)、屏氣及喉痙攣則認(rèn)為拔除喉罩平穩(wěn)。結(jié)果:50 %小兒平穩(wěn)拔除喉罩時(shí)呼氣末七氟烷濃度(EC50)為1.22 Vol%(95 %的置信區(qū)間分別為0.99 Vol%～1.49 Vol%)。結(jié)論:在喉罩表面涂抹丁卡因膠漿的情況下,3～8歲患兒喉罩滿意拔除時(shí)呼氣末七氟烷EC50值為1.22 Vol%。Abstract: Objective: To determine the concentration of sevoflurane where 50%( EC50 ) of the attempts to remove the laryngeal mask airway (LMA ) with the Teracainum Gel would be successful in children. Methods: Twentyfive nonpremedicated children, aged 38 years old, ASA physical status I, scheduled for extremities or peripherical surgery were enrolled in this study. General anesthesia was induced with sevoflurane and maintained with sevoflurane and nitrous oxide in oxygen. After the surgery, the target concentration was maintained for at least 10 min, and then the LMA was removed. Each target concentration was predetermined by the Dixon’s upanddown method (with 0.1 Vol% as a step size), starting at 1.20 Vol% concentration of sevoflurane. A removal accomplished without coughing, teeth clenching, gross purposeful movement, breath holding or laryngospasm, during or within 1 min after removal was considered to be successful. Results:The concentration of sevoflurane to achieve successful LMA removal in 50% of children was 1.22 Vol% (95%CL, 0.99 Vol%1.49 Vol%). Conclusion: The EC50 value of sevoflurane for LMA smooth extubation in children aged 38 years old with teracainum gel was 1.22 Vol%.
肺移植是終末期肺疾病患者唯一的治療手段，該領(lǐng)域也是目前國(guó)際范圍內(nèi)的研究熱點(diǎn)。相關(guān)研究既促進(jìn)了肺移植的進(jìn)步與發(fā)展，也改善了移植后患者的生活質(zhì)量。隨著肺移植技術(shù)的發(fā)展，適應(yīng)人群相關(guān)指南不斷修訂，供體肺來(lái)源也一直是所有移植中心亟待解決的問(wèn)題。移植期的規(guī)范化管理涉及麻醉誘導(dǎo)、術(shù)中液體管理、氣道管理、重要步驟的處理及術(shù)后疼痛管理等方面。體外生命支持（ECLS）包括體外循環(huán)（CPB）及體外膜肺氧合（ECMO）。隨著 ECLS 技術(shù)的發(fā)展，ECMO 作為肺移植橋梁在術(shù)中及術(shù)后循環(huán)支持中的優(yōu)更加突出，幫助受體患者順利度過(guò)肺移植窗口期。雖然肺移植在基礎(chǔ)科學(xué)和臨床研究方面都有許多進(jìn)展，但要提高移植后的生存率，還須克服包括如何成功完成肺移植、擴(kuò)大肺供體庫(kù)、誘導(dǎo)耐受、預(yù)防移植后并發(fā)癥、原發(fā)性移植物功能障礙（PGD）、細(xì)胞和抗體介導(dǎo)的排斥反應(yīng)以及感染等在內(nèi)的諸多問(wèn)題。
目的評(píng)估心臟手術(shù)中麻醉藥物的選擇（丙泊酚或吸入麻醉藥物）與術(shù)后譫妄發(fā)生的關(guān)系。方法本研究為一項(xiàng)回顧性研究，篩選 2018 年 10 月至 2019 年 3 月于四川大學(xué)華西醫(yī)院行擇期體外循環(huán)下心臟手術(shù)成年患者。根據(jù)誘導(dǎo)后麻醉維持藥物（包括體外循環(huán)期間），將患者分為丙泊酚組和吸入麻醉組。主要結(jié)局指標(biāo)為術(shù)后 3 d 譫妄發(fā)生率。使用 logistic 回歸分析來(lái)確定麻醉藥物與術(shù)后譫妄發(fā)生的關(guān)系。結(jié)果共納入 197 例符合納入標(biāo)準(zhǔn)的受試患者，平均年齡 53 歲，女性占 51.8%（102/197）。整體譫妄發(fā)生率為 21.3%（42/197），丙泊酚組為 21.4%（21/98），吸入麻醉組為 21.2%（21/99），兩組差異無(wú)統(tǒng)計(jì)學(xué)意義（RR=1.01，95%CI 0.51～2.00，P=0.970）。采用 logistic 回歸模型校正相關(guān)混雜因素后，顯示麻醉維持藥物不是心臟手術(shù)術(shù)后譫妄發(fā)生的危險(xiǎn)因素（OR=1.05，95%CI 0.48～2.32，P=0.900）。結(jié)論體外循環(huán)下心臟手術(shù)術(shù)中麻醉維持藥物（丙泊酚或吸入麻醉藥物）的選擇不增加術(shù)后譫妄的發(fā)生風(fēng)險(xiǎn)。
術(shù)后譫妄是嚴(yán)重的術(shù)后并發(fā)癥，與住院時(shí)間延長(zhǎng)、再入院率增加等不良預(yù)后顯著相關(guān)。術(shù)后譫妄是多因素作用的結(jié)果，針對(duì)其危險(xiǎn)因素進(jìn)行干預(yù)可顯著降低術(shù)后譫妄的發(fā)生率。目前，術(shù)后譫妄預(yù)防趨于多學(xué)科、集束化，致力于形成流程化、全圍手術(shù)期的評(píng)估及干預(yù)路徑。然而，目前對(duì)于術(shù)后譫妄圍麻醉期干預(yù)的研究較少，且爭(zhēng)論較多，各指南及專家共識(shí)在這一部分也是空白，需要進(jìn)一步研究以彌補(bǔ)空白。該文通過(guò)探討目前術(shù)后譫妄的圍麻醉期預(yù)防策略，以期指引未來(lái)的研究，進(jìn)一步完善圍麻醉期術(shù)后譫妄干預(yù)策略，從而降低其發(fā)生。
目的 探討麻醉藥物（揮發(fā)性麻醉藥或靜脈麻醉藥）與成人體外循環(huán)下心臟手術(shù)患者術(shù)后感染發(fā)生風(fēng)險(xiǎn)的關(guān)系。方法 回顧性分析2019年6月—2020年6月四川大學(xué)華西醫(yī)院496例擇期行成人體外循環(huán)下心臟手術(shù)患者的臨床資料，其中女251例、男245例，平均年齡（54.1±11.4）歲。美國(guó)麻醉醫(yī)師協(xié)會(huì)分級(jí)Ⅰ～Ⅲ級(jí)。根據(jù)麻醉藥物，將患者分為兩組：以七氟烷或地氟烷為主的吸入麻醉組243例，以丙泊酚為主的靜脈麻醉組253例。主要結(jié)局指標(biāo)：術(shù)后30 d內(nèi)感染發(fā)生率，包括肺部感染、手術(shù)部位感染、膿毒血癥和泌尿系統(tǒng)感染。次要結(jié)局指標(biāo)：術(shù)后機(jī)械通氣時(shí)間、再次氣管插管率、ICU停留時(shí)間、術(shù)后住院時(shí)間、住院總費(fèi)用。結(jié)果 共155例（31.3%）患者發(fā)生了術(shù)后30 d內(nèi)感染，吸入麻醉組發(fā)生率32.9%，靜脈麻醉組發(fā)生率29.6% ，差異無(wú)統(tǒng)計(jì)學(xué)意義［RR=1.111，95%CI（0.855，1.442），P=0.431］。兩組次要指標(biāo)差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。結(jié)論 術(shù)中麻醉維持藥物（揮發(fā)性麻醉藥或靜脈麻醉藥）的選擇，不影響成人體外循環(huán)下心臟手術(shù)患者術(shù)后感染的發(fā)生風(fēng)險(xiǎn)。