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无痛胃肠镜检查患者麻醉苏醒期并发症及护理

【摘要】 目的 探讨无痛胃肠镜检查麻醉苏醒期常见并发症及其护理。 方法 对2003年7月-2009年3月行无痛胃肠镜检查术患者在麻醉苏醒期出现的各种并发症状况及护理方法进行分析总结。 结果 呼吸道不通畅导致的低氧血症是行无痛胃肠镜检查术患者在麻醉苏醒期间最常见的并发症，有756例，其次为因呼吸道分泌物致呛咳（421例）、恶心呕吐（131例）、低血糖（45例）等。经过积极处理后，无一例患者死亡。 结论 低氧血症是行无痛胃肠镜检查术患者在麻醉苏醒期间最常见的并发症，其次为因呼吸道分泌物致呛咳、恶心呕吐、低血糖等。加强麻醉苏醒期的护理可以预防和减少麻醉相关并发症的发生。

A Clinical Trial of Etomidate Continous Infusion Used in General Anesthesia Induction and Maintenance

目的:观察依托咪酯持续输注用于麻醉诱导和维持对肾上腺皮质功能的抑制程度以及评价是否会造成严重不良后果。方法:择期行普外手术患者60例,随机分成依托咪酯组(E组)和异丙酚组(P组)。两组患者常规麻醉诱导后,E组和P组分别采用瑞芬太尼0.1～0.4 μg/kg·min,复合依托咪酯或异丙酚维持,据BIS值调整依托咪酯或异丙酚的输注速率。分别测定麻醉前,手术结束时,术后24 h,术后48 h患者血清皮质醇浓度,记录各组的血压,心率,睁眼时间,拔管时间和术后不良反应。结果:与麻醉前比较,E组和P组患者在手术结束时皮质醇浓度均降低,但E组降低更明显(Plt;0.05),48 h后恢复正常甚至高于麻醉前水平;与诱导前相比,异丙酚组患者诱导后平均动脉压(MAP)明显低于诱导前,而依托咪酯组无明显变化;E组的拔管时间比P组长(Plt;0.05),而睁眼时间无明显差异(Pgt;0.05).结论:1依托咪酯和异丙酚均能抑制患者肾上腺皮质功能,且依托咪酯组更为明显,在术后48 h基本恢复正常,甚至高于术前水平。2依托咪酯在麻醉诱导和维持中比异丙酚具有血流动力学稳定性。3依托咪酯持续输注用于全身麻醉维持并不造成围术期严重不良后果。

THE EFFECTS OF DIFFERENT ANAESTHESIA ON STRESS REACTION DURING LAPAROSCOPIC CHOLECYSTECTOMY

Objective To observe the effects of epidural anaesthesia (EA) and general anaesthesia (GA) on the changes of plasma epinephrine (E) and norepinephrine (NE) during laparoscopic cholecystectomy (LC). Methods Thirty patients undergoing elective LC were randomly divided into GA group (n＝15) and EA group (n＝15). The concentrations of plasma NE and E were measured at the following phases: before anaesthesia, before introducing pneumoperitoneum, during pneumoperitoneum, and at the end of operation. Results In EA group, the concentrations of NE weren′t significantly different at each phase, the concentrations of E significantly increased before and during pneumoperitoneum (Ｐ＜0.05) and returned to the baseline at the end of operation (Ｐ＞0.05). In GA group, the concentrations of NE and E didn′t change significantly before pneumoperitoneum, but increased during pneumoperitoneum (Ｐ＜0.05) and E didn′t return to the baseline at the end of operation (Ｐ＜0.05). The E concentrations of EA group was higher than that of GA group before pneumoperitoneum, but the NE concentration of EA group was lower than that of GA group during pneumoperitoneum (Ｐ＜0.05). Conclusion Both groups has significant stress reaction, but the stress reaction of EA group is weaker than that of GA group during LC.

妇科腹腔镜术中腰-硬联合麻醉对呼吸功能的影响

【摘要】　目的　总结妇科腹腔镜手术中腰-硬联合麻醉对呼吸功能的影响。　方法　将2005年1月-2008年12月180例行妇科腹腔镜手术患者随机分为试验组及对照组:对照组采用全麻，试验组采用腰-硬联合麻醉。　结果　试验组麻醉诱导时间、手术时间、麻药总用量及不良反应明显少于对照组，差异有统计学意义（Plt;0.05）。与麻醉前比较，试验组气腹后5 min的pH值、PETCO2、呼吸频率显著低于对照组，气腹后30 min的pH值、PETCO2显著低于对照组，放气后5 min的pH值显著低于对照组，差异有统计学意义（Plt;0.05）。　结论　腰-硬联合麻醉操作简便，麻醉诱导时间短，平面扩散广，镇痛完善，肌松效果好，减少了麻醉、手术、气腹等造成的不良影响，适用于妇科腹腔镜手术，但麻醉平面不宜高于胸5水平，以保持正常吸气功能完善。

CLINICAL STUDY ON EFFECT OF KEEPING PERIOPERATIVE NORMAL BODYTEMPERATURE ON SKIN FLAP SURVIVAL

Objective To investigate the effect of perioperative body temperature on the survival of skin flap grafting. Methods From July 2005 to November 2006, 50 cases of Ⅰ-Ⅱ grade patients undergoing elective skin flap grafting were randomly divided 2 groups. Pharyngeal temperature (PT) and skin temperature(ST) were monitored and recorded every 15 minutes. Operativetime, anesthetic time, time from the end of operation to extubation, the volume of blood transfusion, the volume of fluid transfusion and the flap survival 7 days after operation were recorded. In the experimental group, the body temperature was maintained in normal range with water market and forced air heater. In the control group， the body temperature was only monitored without any treatment. Results There were no significant differences in operating room temperature, operative time, anesthetic time, the volume of blood transfusion and fluid transfusion between 2 groups(Pgt;0.05). After induction, PT decreased gradually inboth groups during the first 45 minutes, compared with the time point of intubation(Plt;0.05),but there were no significant differences between the 2 groups(Pgt;0.05); and ST rose in both groups during the first45 minutes, compared with the time point of intubation (Plt;0.05). After 45 minutes of induction, in the experimental group, PT was in the normal range(36℃), and ST didn’t change compared with that of the timepoint of induction(Pgt;0.05). In the control group, both PT and ST decreasedgradually and timedependently compared with the time point of intubation (Plt;0.05). In the experimental group, PT and ST at each time point were higher than those in the control group (Plt;0.05). All the skin flap grafts survived in the experimental group, and skin flap grafts necrosed in 2 cases in the control group.Conclusion Keeping normal body temperature can improve the survival ofskin flap grafting. Therefore, the body temperature should be monitored and maintained in a normal range.

全身麻醉后苏醒患者躁动原因的分析及护理对策

【摘要】 目的 分析全身麻醉患者苏醒期发生躁动的原因，提出相应的护理对策。 方法 回顾性分析2008年10月-2009年10月收治的148例全身麻醉患者的临床资料，分析39例患者发生躁动的原因，并加以预防。 结果 148例全身麻醉患者中有39例发生躁动，发生率为26.35%。用纳洛酮催醒患者躁动的发生率为48.6%（36/74），明显高于自动清醒患者4.1%（3/74），两者躁动发生率比较有统计学意义（χ2=37.9139，Plt;0.001）。 全身麻醉患者的躁动发生率为35.3%（36/102），高于全身麻醉复合硬膜外阻滞麻醉患者6.5%（3/46），两者躁动发生率比较有统计学意义（χ2=8.1369，Plt;0.001）。 结论 疼痛、促醒、导管刺激为常见躁动原因；掌握全麻患者苏醒期躁动的原因，加强护理，确保患者安全渡过麻醉苏醒期，可以防止躁动所致伤害的发生。

Analysis of the Use of Anaesthetic Drugs in our Hospital During 2005~2008

目的:分析本院住院部麻醉药品应用的现状及趋势,并作客观评价。方法:对2005~2008年本院麻醉药品的种类、用量、金额、DDDs等进行归类统计、比较和分析。结果:统计结果表明,本院住院部使用麻醉药品的用量及金额呈上升趋势。临床应用以芬太尼类居首。新型麻醉药品的应用也有上升趋势。结论:本院住院部麻醉药品应用基本合理,但仍存在一些不合理的习惯用法,需进一步提高合理用药水平。

Clinical Investigation of Combined Spinalepidural Anesthesia in the Elderly Undergoing TURP Surgery

摘要:目的: 观察腰硬联合麻醉在前列腺电切术患者中的临床应用效果。 方法 : 76例经尿道前列腺电切术患者(78±7岁)随机均分为腰硬联合麻醉组(C组)及硬膜外组(E组)。C组以腰硬联合穿刺针于L34穿刺至蛛网膜下腔后,注入05%布比卡因2 mL,通过硬膜外穿刺针置入硬膜外导管;E组行L34间隙硬膜外穿刺置管。记录麻醉起效时间、麻醉效果、麻醉前及麻醉后5、15、30分钟时血压、心率。 结果 : 所有患者均穿刺顺利,麻醉起效时间C组为36±13 min, E组68±15 min;C组麻醉效果完善率为100%,E组为95%;麻醉后两组血压均下降(〖WTBX〗P lt;005),但降幅均未超过基础值的20%;两组麻醉前及麻醉后血压、心率均无显著性差异。 结论 :腰硬联合麻醉用于前列腺电切术具有起效快、麻醉效果佳的优点。Abstract: Objective: To investigate and compare the clinical efficacy and safety of combined spinalepidural(CSEA) and epidural(EA) anesthesia on elderly patients undergoing transurethral resection of the prostate(TURP). Methods : 76 patients(78±7 years) suffering TURP were divided into two group: group CSEA(38cases) and groupEA(38 cases). The dose of bupivacaine in spinal anesthesia is 10 mg. Blood pressure(BP), heart rate(HR) and anesthesia efficacy were observed before anesthesia, 5, 15 and 30min after anesthesia. Results : BP decreased after anesthesia in two groups than before anesthesia(〖WTBX〗P lt;005). The decreases of BP were less than 20% of basises. There were no significant differents of BP and HR between two groups before and after anesthesia. Conclusion :CSEA with bupivacaine 10 mg is safe and efficient in elderly undergoing TURP.

Clinical Observation of 168 Cases of Improvement of Inguinal Hernia Surgery Using Regional Block Anesthesia

目的 分析改良区域阻滞麻醉法在腹股沟疝手术中的临床应用价值。方法 对2003年12月至2008年12月期间我院收治的168例腹股沟疝患者应用区域阻滞麻醉，对术中疼痛、肌松程度、手术时间、术后并发症、住院时间和住院费用方面进行临床观察。结果 所有患者麻醉效果满意,肌肉松弛,解剖层次清楚,除5例在牵扯精索时有轻微酸痛外,余无任何不适,术后无特殊并发症。平均手术时间40 min(包括麻醉),平均住院9 d,普通疝修补术平均费用1 480元,无张力疝修补术平均费用3 265元。结论 改良区域阻滞麻醉下行腹股沟疝手术麻醉效果满意、安全性高、简单易行、经济实惠,可作为各种腹股沟疝手术的麻醉方法,更适合在基层医院应用。

胸胃-左支气管瘘手术麻醉一例