目的:比较舒芬太尼与芬太尼复合七氟烷麻醉在神经外科手术中对血流动力学、拔管时间、苏醒时间及术后疼痛情况的影响。方法:择期开颅手术患者60例,随机分为舒芬太尼(S)组和芬太尼(F)组,每组30例。将S和F的效能比定为10:l,复合咪唑安定、维库溴胺、异丙酚来进行麻醉诱导;麻醉维持均复合七氟烷。分别记录麻醉前、诱导后、插管时和拔管时血压和心率变化;呼吸恢复、睁眼和拔管时间以及拔管后半小时疼痛评分(VAS评分)。结果:两组麻醉诱导后收缩压(SBP)、舒张压(DBP)、心率(HR)均较诱导前有显著性下降(Plt;0．05)。F组插管及拔管时,血流动力学变化均较S组有显著性升高(Plt;0.05)。S组苏醒期呼吸恢复、睁眼、拔管时间较F组明显缩短;拔管后半小时疼痛评分(VAS评分)S组低于F组。结论:与芬太尼相比,等效剂量的舒芬太尼用于脑外科手术患者麻醉诱导可更有效地减轻全麻诱导气管插管时的心血管反应;在麻醉苏醒期,更有利于呼吸管理及术后镇痛。舒芬太尼在神经外科麻醉中具有很好的临床应用价值。
Objective To determine risk factors of delayed recovery of consciousness after aortic arch surgery underdeep hypothermic circulatory arrest （DHCA） and antegrade selective cerebral perfusion （ASCP）. Methods We retrospectively analyzed clinical data of 113 patients who underwent aortic arch surgery under DHCA＋ASCP in the Affiliated Drum Tower Hospital， Medical School of Nanjing University from October 2004 to April 2012. According to whether they regained consciousness within 24 hours after surgery， all the 113 patients were divided into normal group （73 patients including 55 males and 18 females with their average age of 48.1±10.9 years） and delayed recovery group （40 patients including 29 males and 11 females with their average age of 52.2±11.4 years）. Risk factors of delayed recovery of consciousness after surgery were evaluated by univariate analysis and multivariate logistic regression analysis. Results Nine patients （8.0%） died postoperatively， including 5 patients with multi-organ failure， 2 patients with heart failure， 1 patient with mediastinal infection， and 1 patient with pulmonary hemorrhage. There were 7 deaths （17.5%） in the delayed recovery group and 2 deaths （2.7%） in the normal group， and the in-hospital mortality of the delayed recovery group was significantly higher than that of the normal group （P=0.016）. A total of 94 patients （including 65 patients in the normal group and 29 patients in the delayed recovery group） were followed up for 4-95 months. Eight patients （including 5 patients in the normal group and 3 patients in the delayed recovery group） died during follow-up， including 2 patients with stroke， 3 patients with heart failure， 2 patients with pulmonary hemorrhage and 1 patient with unknown cause. Ten patients were lost during follow-up. Univariate analysis showed that age （P=0.042）， hypertension （P=0.017）， emergency surgery （P=0.001）， cardiopu- lmonary bypass （CPB） time （P=0.007）， aortic cross-clamp time （P=0.021）， and blood transfusion（P=0.012）were risk factors of delayed recovery of consciousness after aortic arch surgery. Multivariate logistic regression showed that emergency surgery （P=0.005） and CPB time＞240 minutes （P=0.000） were independent risk factors of delayed recovery of consciousness after aortic arch surgery. Conclusion Delayed recovery of consciousness after aortic arch surgery is attributed to a combination of many risk factors. Correct patient diagnosis， lesion site and involved scope should be made clear preoperatively in order to choose appropriate surgical strategies. During the surgery， strengthened brain protection， shortened operation time， improved surgical techniques， and perioperative stable circulation maintenance are all important measures to prevent delayed recovery of consciousness after aortic arch surgery.
ObjectiveTo observe the incidence of hypotension in general anesthesia patients in post anesthesia care unit (PACU), compare the blood pressure before and after treatment, and analyze hypotension causes. MethodBetween September 2012 and July 2013, data of 18 931 patients in PACU after general anesthesia were retrospectively analyzed for the incidence of hypotension. At the same time, the change of blood pressure was also detected before and after treatment. ResultsSixty-two patients had hypotension during the anesthesia recovery period after general anesthesia. The incidence was 0.33%. The proportion was the highest among patients who underwent abdominal surgery, reaching 41.9%. Systolic pressure and diastolic pressure improved significantly after treatment (P<0.05). ConclusionsIt is important to perform comprehensive evaluation of vital signs, closely observe disease conditions and vital sign changes, find out and manage low blood pressure for patients in PACU, which secure their safety.
Objective To evaluate the effects of low-dose epinephrine on cerebral oxygen saturation (rScO2) and awakening time during one-lung ventilation (OLV) for thoracic surgery. Methods Thirty consecutive patients undergoing lobectomy from March to July 2016 in our hospital were randomly divided into an epinephrine group (n=15, 8 males and 7 females at an average age of 58.70±11.40 years) or a saline group (n=15, 7 males and 8 females at an average age of 57.00±11.40 years). They were continuously infused with 0.01 μg/(kg·min) epinephrine or saline after general induction. Hemodynamics was maintained ±20% of the baseline value. All patients were ventilated by a pressure control mode during OLV with tidal volume of 5-8 ml/kg and end-tidal carbon dioxide tension (EtCO2) of 35-45 mm Hg. Regional cerebral oxygen saturation (rScO2) was monitored using near-infrared spectroscopy (NIRS) continuously. Results Compared with the saline group, the epinephrine group had a high rScO2 during OLV, with a statisitical significance at OLV 40 min and 50 min (67.76%±4.64% vs. 64.08%±3.07%, P=0.016; 67.25%±4.34% vs. 64.20%±3.37%, P=0.040). In addition, the awakening time of patients in the epinephrine group was shorter than that of the saline group (P=0.004), and the awakening time was associated with the duration of low-dose rScO2 (r=0.374). Conclusion Continuous infusion of 0.01 μg/(kg·min) could improve the rScO2 during OLV and shorten awakening time in thoracic surgery.
ObjectiveTo analyze the occurrence of arrhythmia in patients during the recovery period of anesthesia, in order to take appropriate measures in nursing care to ensure the safety of patients. Method We carried out a retrospective analysis of 18 931 general anesthesia post-operative patients (aged 16-84 years old) transferred to anesthesia recovery from September 2012 to July 2013, and we observed the incidence rate of arrhythmia, and documented the clinical manifestations of the patients. ResultsDuring the anesthesia recovery, out of 18 931 general anesthesia postoperative patients, 269 cases of arrhythmia occurred, and the incidence rate was 1.42%. Twenty minutes after nursing intervention and use of medication, the difference of systolic blood pressure, bradycardic heart rate, and tachycardic heart rate of the patients were statistically better than those beofre the treatment (P＜ 0.05) . ConclusionEarly discovery and analysis of arrhythmia in patients during anesthesia recovery, along with timely provision of analgesic and antiarrhythmic treatment can effectively improve the circulation status of the patients, thus ensure the safety of the patients during anesthesia recovery.