Crystalloid and colloid preload for maintaining cardiac output in elderly patients undergoing total hip replacement under spinal anesthesia

The aim of the present study was to compare the effects of colloid and crystalloid preload on cardiac output （CO） and incidence of hypotension in elderly patients under spinal anesthesia （SA）. A randomized, double-blinded study was conducted including 47 elderly patients undergoing scheduled total hip replacement （THR）, who were randomized to three groups： the control group （C group, n = 15）, crystalloid （RS group, n =16） and colloid group （HES group, n = 16）. An intravenous preload of 8 mL/kg of either lactated Ringer’s solution in the RS group or 6% hydroxyethyl starch in the HES group was infused within 20 min before SA induction, while no intravenous preload was given in the C group. There was a trend of decrease in CO and systolic blood pressure after SA with time in the C group. In the RS and HES groups, CO increased significantly after fluid preloading as compared with baseline （P 0.01）. Thereafter, CO remained higher than baseline until 30 min after SA in the HES group. The change of systolic blood pressure was similar to CO, but no significant difference from baseline was observed in each group. Hypotension occurred in 3 patients in the C group and one each in the RS and HES group, respec-tively （P = 0.362）. Intravascular volume preload with colloid is more effective than crystalloid solution in main-taining CO, which may be improved the hemodynamic stability in elderly patients during SA.

Effect of Mixed Anesthesia on Cardiac Function by Phonocardiogram

Objective of this investigation is to further analyze the cardiac function status change by phonocar-diogram during mixed anesthesia which is conducted by midazolam,skelaxin,fentanyi and propofol.The results show that blood pressure,heart rate,amplitude of R wave and T wave,amplitude of first heart sound（S1）and second heart sound（S2）about 37 subjects after anesthesia decrease compared with baseline,while the ratio of first heart sound and second heart sound（S1/S2）and the ratio of diastole duration and systole duration（D/S）increase.Our study demonstrates that phonocardiogram as a noninvasive,high benefit/cost ratio,objective,repeatable and portable method can be used for the monitoring and evaluation of cardiac function status during anesthesia and operations.

Mechanism exploration on effects of cardiac sympathetic anesthesia on cardiac performance of dilated cardiomyopathy

Objective To explore the mechanism of effects o f cardiac sympathetic anesthesia on left ventricular ejection fraction(LVEF)and left cardiac cavity size of patie nts with dilated cardiomyopathy.Method121consecutive patients with dilat ed cardiomyopathy were divided into cardiac sympathetic nerve blockade group(TEAgroup)and control group(c group).In TEAgroup,5%lidocaine was injected into thoracic epidural cavity for about 4to 8weeks in addition with routine therapy.In c group,only routine therapy was use d.We observe the changes of LVEF and left cardiac cavity size before a nd after treatment in both groups.Result I n TEAgroup,after anesthesia,LVEF w as increased from(31.3±12.8)to(47.3±21.3),P <0.001;left ventricular end -dia stolic diameter was reduced from(69.1±7.1)to(65.1±8.0),P <0.001;left atrial diameter was decreased from(44.0±6.2)to(39.4±7.2),P <0.001.Conclusion Cardiac sympathetic anesthesia can effectively improve the ejectio n performance of dilated cardiomyopathy and make the dilated cardiac cavity turn to normal level.

Continuous versus bolus cardiac output monitoring during orthotopic liver transplantation

BACKGROUND: Cardiac output monitoring is important for critical patients. This study aimed to determine the delayed response of continuous cardiac output (CCO) thermodilution measurement, whether CCO and bolus cardiac output (BCO) thermodilution agree sufficiently to be used interchangeably, and whether CCO monitoring is reliable for patients undergoing liver transplantation. METHODS: Thirteen patients undergoing liver transplantation without veno-venous bypass were studied (37-66 years old, weight 46-75 kg). Continuous and bolus thermodilution measurements were performed at predefined time points using an 'Opti-Q' SvO(2)/CCO monitor (Abbott Laboratories, North Chicago, IL, USA). Bias and 95% limits of agreement were calculated according to Bland and Altman analysis. The limits of agreement by which two methods are judged to be interchangeable were defined in advance as +/-(13%X BCO(mean)) L/min. The repeatability and relative error of CCO, and the differences between CCO and the mean of the two measurements were calculated. RESULTS: Cardiac output measurements yielded 196 data pairs with ranges of 1.9 to 17.9 L/min for CCO and 2.1 to 18.3 L/min for BCO. The response time of CCO was delayed in the early phases after caval clamping and after reperfusion. At most of the measurement points, bias and 95% limits of agreement were -0.18 +/- 1.91 L/min. 95% limits of agreement did not fall within the predetermined limits of agreement of +/- 1.14 L/min. The repeatability coefficient of CCO was 0.36 L/min and the relative error was 4.6 +/- 4.7%. The mean difference between CCO and the average of the two methods was -0.09 L/min (0.49 L/min). CONCLUSIONS: In patients undergoing liver transplantation, the delayed response of CCO limits its application during the early phases after caval clamping and after reperfusion of the graft. The two methods are not interchangeable even in hemodynamic stability. Continuous thermodilution monitoring, however, is reliable or acceptable for clinical purposes.

Brugada Syndrome: Anesthesia Management

Brugada’s Syndrome (BrS) is a rare but highly risky medical condition. It is a genetic disorder that may result in Ventricular Fibrillations (VF) that can lead to sudden cardiac arrest. The highest possible standards of safety in anesthetic medications must be followed and adequate measures must be taken with sufficient monitorization in patients with BrS. We wanted to mention the importance of monitorization in the early detection of possible complications and a careful follow-up even though no administration of anesthetic medication is present.

Anaesthetic Challenges in Cardiac Interventional Procedures

The increasing scope of interventions in the cardiac catheterization laboratory (CCL) and electrophysiological laboratory (EPL) has resulted in new challenges for the anaesthesia teams where they deal with different patient categories, complications and safety issues. Collaboration and planning between cardiologist and anaesthesiologist are required for both patient safety and procedural success. This review aims to discuss procedures performed in interventional cardiology and the importance of anaesthesiologists in managing such patients. Percutaneous interventions are being increasingly performed in adult as well as in pediatric patients. Procedures are usually done under mild to moderate sedation. General anaesthesia is required in certain conditions and also in pediatric patients. Knowledge of echocardiography, individual disease condition and fluoroscopy is important. Anaesthesiologists are assuming an increasingly important role in the multidisciplinary management of complex patients and interventions. A comprehensive understanding of procedures is essential to provide a high level of anaesthetic care and maintain patient safety.

麻醉精准干预在高危心血管病患者非心脏手术围手术期的应用效果

目的探讨麻醉精准干预在高危心血管病患者非心脏手术围手术期的应用效果。方法选取2022年1月至12月四川省广元市第一人民医院收治的190例高危心血管病患者作为研究对象,按照随机数字表法分为观察组(95例)与对照组(95例),对照组采用普通经验管理,观察组采用麻醉精准干预措施,比较两组患者的血清学指标和心脏不良事件发生率。结果术后观察组肌钙蛋白(cTn)、肌酸激酶同工酶(CK-MB)、肌红蛋白(Mb)、高敏肌钙蛋白T(hs-TnT)、脑钠肽(BNP)、氨基末端脑钠肽前体(NT-proBNP)、C反应蛋白(CRP)均低于对照组,差异有统计学意义(P<0.05)。观察组心脏不良事件总发生率低于对照组,差异有统计学意义(P<0.05)。结论麻醉精准干预应用于高危心血管患者非心脏手术围手术期能进一步减轻对心脏损伤,且降低不良事件发生率,值得临床应用。

Comparison of the Hemodynamic Effects of the Induction Agents Ketamine, Etomidate and Sevoflurane Using the Model of Electrical Velocimetry Based Cardiac Output Monitoring in Pediatric Cardiac Surgical Patients

Objective: To compare the haemodynamic effects of the induction agents ketamine, etomidate and sevoflurane using the model of electrical velocimetry based cardiac output monitoring in paediatric cardiac surgical patients. Design: Prospective randomized study. Setting: Tertiary care hospital. Participants: 60 children < 2 years age undergoing cardiac surgery. Interventions: The patients were randomized into 3 equal groups to receive 1.5-2.5 mg/kg iv ketamine (group K), 0.2-0.3 mg/kg iv etomidate (group E) or upto 8% sevoflurane (group S) as the induction agent. Hemodynamic parameters were noted before and after induction of anaesthesia utilizing a noninvasive cardiac monitor based on the model of electrical velocimetry. Measurements and Main Results: The demographic characteristics of the patients were similar in the three groups. The HR decreased in all groups, least in group E (P ≤ 0.01) but the MAP decreased only in group S (P ≤ 0.001). In group S, the stroke volume improved from 9 ± 3.2 ml to 10 ± 3.2 ml (P ≤ 0.05) and the stroke volume variation decreased from 25% ± 6.4% to 13% ± 6.2% (P ≤ 0.001). The stroke index and systemic arterial saturation improved in all groups (P ≤ 0.01). The cardiac index and index of contractility were unchanged. The transthoracic fluid content reduced in groups E and S, but did not change in group K (P ≤ 0.05). Conclusions: Etomidate appeared to provide the most stable conditions for induction of anesthesia in children undergoing cardiac surgery, followed by ketamine and sevoflurane.

瑞马唑仑对体外循环下心脏瓣膜置换手术老年患者的应用效果观察

目的观察瑞马唑仑对体外循环(CPB)下心脏瓣膜置换手术老年患者的应用效果。方法招募2022年6月至2023年6月郑州人民医院收治的择期行CPB下心脏瓣膜置换手术的老年患者334例,采用随机数字表法将其分为瑞马唑仑组(R组)和丙泊酚组(P组),每组167例,根据剔除标准最终分别纳入160例和159例。R组麻醉诱导时静脉注射瑞马唑仑0.2~0.3 mg/kg,麻醉维持时静脉泵注瑞马唑仑0.5~1.0 mg/(kg·h);P组麻醉诱导时静脉注射丙泊酚1.0~2.0 mg/kg,麻醉维持时静脉泵注丙泊酚4~10 mg/(kg·h)。两组其余的麻醉诱导和维持均一致。于术后3 d内采用重症监护室意识障碍评估法(CAM-ICU)评判术后谵妄(POD)的发生情况。比较两组手术及麻醉相关指标、POD发生情况、视觉模拟量表(VAS)评分、Ramsay镇静量表评分及术中、术后不良事件发生情况。结果与P组比较,R组患者术后麻醉苏醒时间、拔除气管导管时间、ICU停留时间及住院时间更短,差异均有统计学意义(P<0.05)。两组POD发生率、严重程度及持续时间比较差异均无统计学意义(P>0.05)。两组术后不同时间点VAS评分和Ramsay镇静量表评分比较差异均无统计学意义(P>0.05)。R组术中窦性心动过缓和低血压发生率低于P组,差异有统计学意义(P<0.05)。结论与丙泊酚比较,瑞马唑仑用于CPB下心脏瓣膜置换手术老年患者的全身麻醉诱导和维持不会提高POD发生率,且安全性良好,有助于患者术后快速康复。

Endovascular Abdominal Aortic Aneurysm Repair under General Anesthesia Does Not Decrease Perioperative Myocardial Ischemic Events Compared with Open Repair

Objectives: Endovascular abdominal aortic aneurysm repair (EVAR) is a common procedure for abdominal aortic aneurysm (AAA), based on minimal invasiveness compared with open surgical repair (OSR). However, general anesthesia can cause considerable perturbations in patients with AAA undergoing operative repair. The aim of this study was to compare the incidence of myocardial ischemic events in association with hemodynamic changes during EVAR and OSR under general anesthesia. Methods: We retrospectively reviewed the anesthetic and medical records of patients who underwent elective abdominal aortic aneurysm repair. ST segment changes on electrocardiography and hemodynamic changes were reviewed by the attending physicians. Results: Among 120 patients, EVAR and OSR were performed in 81 and 39 patients, respectively. There were no significant differences in preoperative morbidity between the two groups. The amount of estimated blood loss was significantly lower in EVAR than OSR. The incidence of ST?segment changes in the two groups (EVAR: 16%, OSR: 23%) was not statistically different. ST segment changes occurred mainly postoperatively at resolution of anesthesia in EVAR, compared with intraoperatively in OSR. ST segment changes were mostly accompanied by tachycardia in EVAR patients, whereas they were associated with hypotension in OSR. Conclusion: Our results demonstrated a comparable incidence of perioperative ST segment changes under general anesthesia in EVAR and OSR. Patients who undergo EVAR and develop tachycardia are at risk of myocardial ischemia at resolution of anesthesia.

Preliminary Validation of Transcutaneous CO₂Monitoring in Patients Undergoing Cardiac Ablation Using Jet Ventilation

Objectives: There is no data in the current medical literature on efficacy or accuracy of transcutaneous (tcPCO2) monitoring during jet ventilation for cardiac ablation. The use of tcPCO2 during cardiac ablation procedures offers the opportunity to compare end-tidal and transcutaneous methods of CO2 measurement before and after the use of the jet ventilation. Comparison of these measurements with arterial blood gas CO2 levels allows evaluation of the accuracy of the tcPCO2 technique for use during jet ventilation. Design: Observational study;patients served as their own controls. Setting: Cardiac electrophysiology laboratory. Participants: 15 adult patients (9 M), ASA III-IV, aged 26 to 82 years (median 66 years) undergoing radiofrequency ablation for atrial fibrillation. Interventions: Jet ventilation (JV) versus conventional ventilation. Measurements and Main Results: Paired measurements of end-tidal CO2 (EtCO2) and transcutaneous CO2 (tcPCO2) were recorded during periods of conventional ventilation. Paired measurements of arterial blood CO2 (PaCO2) levels and tcPCO2 were recorded during JV. ABG samples were drawn at the anesthesiologist’s discretion to assess the patient’s respiratory status. The level of agreement between the three methods was compared using the Bland Altman plot. We found that tcPCO2 values consistently provided a close approximation to PaCO2 levels. The mean difference between tcPCO2 and EtCO2 values in baseline and post-JV was on the order of 3 - 5 mmHg, with standard deviation of 4 - 6 mmHg. This is well within the range of variability that is accepted in clinical practice. Conclusions: These preliminary results suggest that tcPCO2 provides an acceptable estimate of CO2 concentration in arterial blood during JV, as well as prior to and following JV.

艾司氯胺酮在心血管手术中的应用进展

艾司氯胺酮是氯胺酮的旋光异构体,兼有镇静、镇痛和遗忘三重作用,在药效和可控性等方面均优于消旋氯胺酮,目前已在欧美等国家广泛应用于麻醉、急救及重症等领域,在国内临床多用于镇静、镇痛、抗抑郁等。艾司氯胺酮在心血管手术中有利于维持稳定的血流动力学、减少炎性因子分泌、缓解术后疼痛。艾司氯胺酮具有拟交感神经作用,可用于血流动力学不稳定及急性心梗患者的麻醉诱导。本文综述了艾司氯胺酮用于心血管手术围术期临床应用价值和局限性,为艾司氯胺酮在心血管手术围术期的应用提供参考。

瑞马唑仑快通道麻醉在改善心脏瓣膜手术患者术后恢复的作用

目的评价瑞马唑仑快通道麻醉对心脏瓣膜手术患者术后早期恢复质量的改善情况,为临床优化快通道麻醉和术后快速康复(ERAS)方案提供参考依据。方法选择全麻体外循环下行正中开胸心脏瓣膜置换和(或)成形术的择期手术患者,在常规麻醉评估和快通道麻醉适应证评估基础上,严格按照纳入标准和排除标准入组研究对象228例,随机分为两组:瑞马唑仑组、异丙酚组,每组114例。瑞马唑仑组患者麻醉诱导与麻醉维持均使用瑞马唑仑,对照组患者则使用异丙酚。记录患者的一般资料、手术资料等;记录术前1 d、术后1 d、术后3 d和出院前1 d的QoR-15评分;记录入室后主要时间点的血流动力学指标、麻醉后低血压及心动过缓的发生情况、手术持续时间、麻醉持续时间、术后机械通气时间、ICU停留时间、术后住院时间等;以及围术期心血管不良事件的发生率以及术后近期并发症的发生率等。结果(1)两组间一般资料及术前1 d的QoR-15评分比较,差异无统计学意义(P>0.05)。(2)瑞马唑仑组的QoR-15评分在出院前1 d与异丙酚组相比有所增高,差异有统计学意义(P<0.05),但差异小于最小临床差异即小于8,无明显的临床获益。(3)气管插管后1 min及切皮后1 min异丙酚组心率减慢并且MAP明显降低,组间比较差异有统计学意义(P<0.05);其余时刻的心率、MAP差异无统计学意义(P>0.05)。术中低血压和心动过缓发生率瑞马唑仑组低于异丙酚组,差异有统计学意义(P<0.05)。术后机械通气时间、ICU停留时间、术后住院时间以及再次插管率瑞马唑仑组均短于异丙酚组,并且快通道麻醉成功率高于异丙酚组,差异有统计学意义(P<0.05)。围术期并发症发生率方面两组差异无统计学意义。结论与常用的静脉麻醉药异丙酚相比,瑞马唑仑快通道麻醉方案虽未明显改善心脏瓣膜手术患者术后恢复质量评分,但瑞马唑仑在维持循环稳定、提高快通道麻醉成功率、缩短术后ICU停留时间和术后住院时间等方面具有明显优势。对于心脏手术患者来说,瑞马唑仑是可供选择的静脉麻醉药。

心脏瓣膜置换术后低体温相关因素的前瞻性队列研究

目的研究行心脏瓣膜置换术后患者发生低体温相关因素。方法选取2020年3月至2023年3月进行心脏瓣膜置换术治疗的心脏瓣膜患者352例,建立前瞻性队列。搜集患者临床基本资料,352例行心脏瓣膜置换术患者按照术后是否发生低体温将其分为常温组279例和低体温组73例,对比2组不同时间段体温变化情况、心率及收缩压情况。单因素分析及多因素Logistics回归分析探讨心脏瓣膜置换术后低体温发生的相关因素。结果低体温组进行手术1 h(T3)、术毕30 min(T4)时体温低于常温组(P<0.05);低体温组心率、收缩压水平情况均低于常温组(P<0.05)。单因素分析显示,年龄、手术时间、麻醉时间、输液量、输血量、ASA分级在行心脏瓣膜置换术后患者发生低体温中差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄≥60岁、手术时间≥3 h、麻醉时间≥3 h、输液量≥500 mL、输血量≥500 mL、ASA分级Ⅲ~Ⅳ级是影响心脏瓣膜置换术后发生低体温的主要危险因素(P<0.05)。结论年龄≥60岁、手术时间≥3 h、麻醉时间≥3 h、输液量≥500 mL、输血量≥500 mL、ASA分级Ⅲ~Ⅳ级是影响心脏瓣膜置换术后发生低体温的主要危险因素;通过对以上因素进行分析,能够针对性的对患者制定治疗方案及干预措施,降低术后低体温发生率,提高患者预后。

全凭静脉麻醉对心脏封堵术患者昼夜节律的影响

目的评估全凭静脉麻醉对非体外循环心脏封堵手术患者昼夜节律的影响。方法择期静脉麻醉下心脏封堵术的患者30例,采用自身配对t检验比较麻醉前后生物钟基因时钟节律调节分子(CLOCK)、脑肌类芳烃受体核转位样蛋白1(BMAL1)、隐花色素生物钟(CRY)1、周期昼夜节律生物钟(PER)2 mRNA的表达水平,慕尼黑时间类型问卷(MCTQ)和匹兹堡睡眠质量指数(PSQI)的差异;多元逐步回归方法筛选术后1周睡眠时型和PSQI总分的影响因素。结果与术前比较,术后CLOCK mRNA表达水平明显增加[1.38±1.23比1.90±1.47;MD(95%CI):0.52(0.20~0.84),t=3.327,P=0.002];CRY1 mRNA表达水平明显下降[1.56±1.50比1.13±0.98;MD(95%CI):-0.43(-0.81~-0.05),t=-2.319,P=0.028];PER2 mRNA表达水平明显下降[0.82±0.63比0.50±0.31;MD(95%CI):-0.33(-0.53~-0.12),t=-3.202,P=0.003]。术后1周睡眠时型明显提前[3∶03±0∶59比2∶42±0∶37,MD(95%CI):-21(-40~-1),t=-2.172,P=0.038],睡眠潜伏期明显缩短[(67±64)min比(37±21)min;MD(95%CI):-30.33(-55.28~-5.39),t=-2.487,P=0.019],睡眠时长明显延长[(436±83)min比(499±83)min;MD(95%CI):62.80(26.93~98.67),t=3.581,P=0.001],睡眠效率明显增加[(87.59±10.35)%比(92.98±4.27)%;MD(95%CI):5.39(1.21~9.58),t=2.636,P=0.013],睡眠质量评分明显下降[1.13±0.78比0.80±0.71,MD(95%CI):-0.33(-0.62~-0.05),t=-2.408,P=0.023]。术后1周PSQI总分明显下降[6.60±3.17比4.03±2.58;MD(95%CI):-2.57(-3.87~-1.27),t=-4.039,P<0.001]。体重指数(BMI)(B=-227.460,SE=95.475,t=-2.382,P=0.025)、麻醉时长(B=-47.079,SE=18.506,t=-2.544,P=0.017)与PER2 mRNA表达量(B=2815.804,SE=1080.183,t=2.607,P=0.015)共同影响术后1周睡眠时型,麻醉用药量(B=0.067,SE=0.028,t=2.385,P=0.024)独立影响术后1周PSQI总分。结论全凭静脉麻醉可通过提前睡眠时型发挥改善睡眠习惯的作用。BMI、麻醉时长、PER2 mRNA表达量共同影响术后1周睡眠时型。麻醉用药量是术后1周PSQI总分的独立影响因素。

地氟烷对非心脏手术患者围手术期心肌损伤的预防价值研究

目的观察地氟烷对非心脏手术患者围手术期心肌损伤的预防价值。方法本研究为前瞻性研究,研究对象为南阳医学高等专科学校第一附属医院2022年1月至2023年8月期间收治的99例非心脏手术患者,应用电脑随机分组法将入组患者列为常规组(49例)和地氟烷组(50例)。常规组予以常规全身麻醉,地氟烷组采用地氟烷辅助全身麻醉,比较两组术后镇痛、镇静效果,心肌损伤情况,手术应激情况及麻醉安全性。结果在不同麻醉方案下,地氟烷组术后1 h、3 h、5 h的视觉模拟疼痛量表(VAS)评分均低于常规组;地氟烷组术后1 h、3 h、5 h的Ramsay镇静(RSS)评分均高于常规组;地氟烷组的术后肌红蛋白(MYO)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)均低于常规组;地氟烷组的去甲肾上腺素(NE)、皮质醇(Cor)、血管紧张素Ⅱ(AngⅡ)均低于常规组,差异具有统计学意义(P<0.05)。地氟烷组的麻醉相关不良反应发生率8.00%与常规组4.08%比较,差异无统计学意义(P>0.05)。结论地氟烷辅助全身麻醉能增强非心脏手术患者的术后镇痛、镇静效果,可在不增加麻醉风险同时,有效减轻手术应激并预防心肌损伤。

快通道麻醉对心脏手术患者血流动力学、苏醒质量及神经功能的影响

目的 探讨快通道麻醉对心脏手术患者血流动力学、苏醒质量及神经功能的影响。方法 选取130例心脏手术患者作为研究对象,采用随机数字表法分为对照组与研究组,每组65例。收集患者的临床资料,比较2组患者的血流动力学指标、苏醒质量、神经功能及术后并发症发生率。结果 研究组患者枸橼酸芬太尼注射液、罗库溴铵用量均低于对照组,差异有统计学意义(P<0.05)。麻醉诱导后、气管插管后,2组患者心率(HR)、平均脉动压(MAP)、心输出量(CO)、心脏指数(CI)、脑电双频指数(BIS)均较麻醉诱导前发生变化,但研究组变化程度低于对照组,差异有统计学意义(P<0.05)。研究组术后恢复呼吸时间、苏醒时间、拔管时间、ICU停留时间、术后住院时间均短于对照组,拔管后躁动发生率低于对照组,差异有统计学意义(P<0.05)。研究组患者动脉开放后180 min的神经元特异性烯醇化酶(NSE)、β淀粉样蛋白(Aβ)水平均低于对照组,差异有统计学意义(P<0.05)。研究组术后并发症总发生率为3.08%,低于对照组的16.92%,差异有统计学意义(P<0.05)。结论 快通道麻醉能够有效稳定心脏手术患者的血流动力学状态,改善患者的苏醒质量及神经功能,并降低术后并发症发生率。

艾司氯胺酮对心脏瓣膜置换术患者诱导期血流动力学及苏醒质量的影响

目的观察艾司氯胺酮对体外循环下心脏瓣膜置换术患者诱导期血流动力学及苏醒质量的影响。方法择期行瓣膜置换术的116例患者随机均分为观察组和对照组,对照组采用0.05 mg/kg咪达唑仑、0.5μg/kg舒芬太尼、0.6 mg/kg罗库溴铵以及0.3 mg/kg依托咪酯常规麻醉诱导,观察组在上述诱导方案实施前先静脉注射0.25 mg/kg艾司氯胺酮,诱导成功后行气管插管机械通气,两组患者采用相同方案行静吸复合麻醉维持;比较两组患者诱导期低血压的发生率,观察麻醉诱导前(T_(0))、给药后1 min(T_(1))、插管后即刻(T_(2))及插管后5 min(T_(3))时间点的心率、血压等变化情况及苏醒质量。结果观察组诱导期低血压的发生率低于对照组(P<0.05),观察组T_(1)时点的平均动脉压(MAP)变化幅度、诱导期ΔMAP低于对照组(P<0.05);两组心脏瓣膜疾病手术患者心率、恶心呕吐、苏醒期躁动及拔管时间比较,差异无统计意义(P>0.05);观察组手术患者重症监护室(ICU)停留时间较对照组缩短(P<0.05)。结论艾司氯胺酮能降低体外循环心脏瓣膜置换术患者诱导期低血压的发生率,维持诱导期的血流动力学相对稳定,但不影响患者的拔管时间和苏醒期并发症。

盐酸氢吗啡酮用于ICU全身麻醉心瓣膜术后机械通气患者镇痛的有效性及安全性分析

目的:分析盐酸氢吗啡酮用于ICU全身麻醉心瓣膜术后机械通气患者镇痛的有效性及安全性。方法:选取2022年4月—2023年5月重庆市人民医院(重庆大学附属人民医院)重症医学科收治的全身麻醉心瓣膜术后行机械通气的患者60例作为研究对象,随机分为观察组和对照组,各30例。观察组给予盐酸氢吗啡酮镇痛,对照组给予芬太尼镇痛。比较两组患者各时间点重症监护疼痛观察工具评分(CPOT)、呼吸频率(RR)、心率(HR)、平均动脉压、试验用药时间、有创机械通气时间、入住ICU时间、不良反应发生情况。结果:两组患者用药后6 h、12 h、24 h各时间点的CPOT评分比较,差异无统计学意义(P>0.05),但CPOT评分均低于用药前,差异有统计学意义(P<0.05)。用药后,随着时间的延长,RR和HR逐渐增加,且观察组HR随时间增加的速度快于对照组,差异有统计学意义(P<0.05)。观察组试验用药时间、有创机械通气时间及入住ICU时间短于对照组,差异有统计学意义(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(χ^(2)=0.647,P=0.421)。结论:对于全身麻醉心瓣膜术后机械通气的患者,氢吗啡酮与芬太尼镇痛效果相当,导致谵妄的可能性更小,对呼吸的抑制更小,能缩短该类患者机械通气及ICU的住院时间。

超快通道麻醉在心脏体外循环手术中的应用

超快通道麻醉(ultra-fast-track anesthesia,UFTA)指在手术后立即恢复患者的自主呼吸并拔除气管导管,已成为心脏外科手术的一个重要议题。这种方法旨在通过缩短机械通气时间,降低术后并发症的风险,加快康复进程,从而优化医疗资源的使用并改善患者的预后。本综述围绕加强康复外科(enhanced recovery after surgery,ERAS)的理念,探讨UFTA在心脏手术中的应用,分析其优点、潜在风险与局限性,并探索现有研究进展和未来的发展方向,以便为临床实践和未来研究提供指导和启示。