腹部手术硬全联合麻醉术后谵妄的影响因素

目的:分析腹部手术硬全联合麻醉患者术后谵妄的影响因素。方法:采用病例对照研究方法,选择腹部手术硬全联合麻醉患者,根据患者术后3天内是否发生谵妄分为病例组和对照组,以单因素分析联合多因素分析方法研究患者术后发生谵妄的影响因素。结果:患者术后谵妄发生率4.95%,患者均在术后24 h内发病;高龄、手术时间>2h、术后疼痛评分>2分、肺部慢性疾病史、饮酒史是患者术后发生谵妄的危险因素。结论:对高龄、既往患有肺部慢性疾病、手术时间长的患者,术后密切监测电解质、血气,防治肺部感染的发生,以降低患者术后谵妄的发生率。

硬全联合麻醉在开胸手术中的应用

目的:探讨硬全联合麻醉在开胸手术的应用。方法:麻醉方法不同随机分为A、B两组,每组20例。A组为单纯静吸复合麻醉,B组为硬全联合麻醉,术后可以应用硬膜外自控镇痛。结果:B组患者麻醉维持用量减少(P<0.05),拔管时间和完全清醒时间编短(P<0.05),患者躁动减少。结论:硬全联合麻醉在开胸手术中全麻维持用量减少,缩短患者麻醉苏醒时间,使全麻药物代谢不全引起的躁动减少,而且在心血管规定方面更容易控制,适合于开胸手术患者。

腹部手术中硬-全联合麻醉对血流动力学及牵拉反应的影响

目的探讨腹部手术中硬-全联合麻醉对血流动力学及内脏牵拉反应的影响。方法将上海市中西医结合医院2009年1月至2012年8月收治的行腹部手术的270例患者按麻醉方式分为三组:连续硬膜外麻醉组(A组)、全麻组(B组)、硬-全联合麻醉组(C组),各90例。比较三组入室切皮(T1)、探查(T2)、牵拉(T3)、术毕(T4)的收缩压、舒张压、心率及牵拉反应等发生情况。结果A组的收缩压、舒张压及心率出现较大波动,A组的收缩压、舒张压及心率T3与T1时刻比较差异有统计学意义(P<0.05);B组、C组在T3时的收缩压、舒张压及心率均显著低于A组(P<0.05);A组的牵拉反应显著高于B组和C组(P<0.05)。结论硬-全联合麻醉导致牵拉反应小,血流动力学影响小,可控性好,用于腹部手术麻醉更具有优势。

Comparison of 1.5% lidocaine and 0.5% ropivacaine epidural anesthesia combined with propofol general anesthesia guided by bispectral index

Objective： To compare the effects of epidural anesthesia with 1.5% lidocaine and 0.5% ropivacaine on propofol requirements, the time to loss of consciousness （LOC）, effect-site propofol concentrations, and the hemodynamic variables during induction of general anesthesia guided by bispectral index （BIS） were studied. Methods： Forty-five patients were divided into three groups to receive epidurally administered saline （Group S）, 1.5% （w/w） lidocaine （Group L）, or 0,5% （w/w） ropivacaine （Group R） Propofol infusion was started to produce blood concentration of 4 lag/ml. Once the BIS value reached 40-50, endotracheal intubation was facilitated by 0.1 mg/kg vecuronium. Measurements included the time to LOC, effect-site propofol concentrations, total propofol dose, mean arterial blood pressure （MABP）, and heart rate （HR） at different study time points. Results： During induction of anesthesia, both Groups L and R were similar for the time to LOC, effect-site propofol concentrations, total propofol dose, MABP, HR, and BIS. The total doses of propofol administered until 1 min post-intubation were significantly less in patients of Groups R and L compared with Group S. MABP and HR were significantly lower following propofol induction compared with baseline values in the three groups, or MABP was significantly increased following intubation as compared with that prior to intubation in Group S but not in Groups R and L while HR was significantly increased following intubation in the three groups. Conclusion： Epidural anesthesia with 1.5% lidocaine and 0.5% ropivacaine has similar effects on the time to LOC, effect-site propofol concentrations, total propofol dose, and the hemodynamic variables during induction of general anesthesia.

银杏达莫术中术后治疗心梗患者的体会

目的观察术中术后应用银杏达莫注射液治疗急慢性心梗患者的临床疗效。方法将40例急慢性心梗患者随机分为两组。治疗组20例采用银杏达莫注射液治疗,对照组使用低分子肝素钙治疗,观察比较两组临床疗效。结果总有效率治疗组为92.3%,对照组为69.0%,两组总有效率比较,差异有显著差异(P<0.05),治疗组疗效优于对照组。结论银杏达莫注射液是急慢性心肌梗塞非心脏手术麻醉较适合的术中术后治疗心梗的药物。