小儿全麻术后在麻醉恢复室的护理体会

<正>麻醉恢复是指患者从麻醉状态逐渐苏醒的过程,建立麻醉恢复室是为患者提供良好的苏醒条件,可有效地减少麻醉后并发症,提高麻醉质量与安全性。全身麻醉是小儿麻醉的主要方式,麻醉恢复期是小儿麻醉及术后较脆弱的一个时期,患儿的变化不易预测,35%的围手术期严重心肺意外发生在麻醉恢复期。因此加强麻醉恢复期的护理尤     

全身麻醉苏醒期并发症的观察与护理

麻醉苏醒期是指患者停用麻醉药物后从麻醉状态苏醒的过程[1],易发生一些并发症,如护理不当或处理不及时,将影响患者后期的恢复,甚至危及患者生命安全.为此,笔者对全身麻醉患者326例苏醒期的并发症进行观察及护理,以总结护理经验,现报告如下.     

全麻手术后患者苏醒后的护理

目的对进行全麻手术的患者苏醒后恢复过程进行分析并探讨其护理措施。方法对2009年1月至2011年1月在我院进行全麻手术的89例患者在苏醒期出现进行一般护理、呼吸道护理、保暖护理、循环系统护理、疼痛护理、其他护理等综合护理措施。结果 89例患者麻醉恢复期并发症以循环、呼吸及神经系统为主,其中呼其中呼吸系统并发症3例,占3.37%;循环系统并发症5例,占5.61%;神经系统并发症7例,占7.87%;其他并发症12例,占13.48%。经过积极有效护理,患者均恢复,有效率达100%。结论在全麻后苏醒期并发症的出现与药物作用、引流管刺激等有关,麻醉恢复至正常生理状态的过程是麻醉苏醒期处理的关键环节,对患者制定一套健全且规范的护理十分必要,经对症治疗护理患者后可很快恢复。     

丙泊酚联合舒芬太尼用于胸外科围手术期麻醉62例及护理分析

目的 观察丙泊酚联合舒芬太尼在胸外科手术围手术期麻醉后不同护理方式对患者麻醉效果及恢复情况的影响.方法 采用随机数字表法将120例胸外科手术围手术期患者分为两组,对照组予围手术期患者常规护理,试验组在对照组护理基础上,针对丙泊酚联合舒芬太尼麻醉后可能出现的不良反应,增加术后未苏醒患者的呼吸道护理和体位护理,并对患者术中和术后突发情况给予应急处理;对比两组患者拔管时间、自主呼吸恢复时间、术后60 min时的血氧饱和度和OAAS意识评分、术后不良麻醉反应发生情况.结果 采用不同护理后试验组麻醉后自主呼吸恢复时间与拔管时间均短于对照组（P＜0.05）;试验组术后60 min时的血氧饱和度和OAAS意识评分显著高于对照组（P＜0.05）;试验组术后不良反应发生率显著低于对照组（P＜0.05）.结论 对于丙泊酚联合舒芬太尼在胸外科手术围手术期的患者在常规围手术期患者护理基础上,结合呼吸道护理和体位护理,有利于患者尽早苏醒和恢复术前生命体征水平,同时能有效减少术后不良反应发生,值得临床推广.     

氯胺酮麻醉术后苏醒期的护理

目的 探讨氯胺酮麻醉术后苏醒期的临床护理对策。方法 对需要氯胺酮全身麻醉的56例术后苏醒期患者实施心理护理、呼吸道护理、惊厥护理和躁动护理,观察疗效。结果 氯胺酮全身麻醉术后苏醒期的56例患者经过心理护理、呼吸道护理、惊厥护理和躁动护理后,有效51例,无效5例,总有效率91.07%。结论 氯胺酮全身麻醉术后苏醒期患者实施心理护理、呼吸道护理、惊厥护理和躁动护理后,不仅提高了手术治疗的成功率,而且使患者恢复了自信,提高了生活质量。     

老年患者全麻苏醒期呼吸系统并发症的观察及护理

手术结束后麻醉苏醒期是麻醉后重要生理功能全面恢复的时期。对进入麻醉复苏室的大多数患者而言,从麻醉中恢复是一个平稳的过程,但术后即刻的呼吸系统并发症可能是突发并危及生命的,尤其多见于高龄患者。老年人机体细胞逐渐退化,     

全身麻醉苏醒期护理

随着医学的不断发展，全身麻醉在临床应用日益广泛。但是全麻结束后，麻醉对病人的影响并未全部消除，一些保护性反射未恢复到正常水平，全麻也有一些并发症易在苏醒期发生。因此，苏醒期要加强对病人的观察及护理。患者在苏醒过程中随时可出现呼吸、循环、代谢等方面的异常。我院于2007年7月-2009年6月，对268例全麻患者苏醒期进行密切观察和护理，效果满意。现报告如下：     

麻醉复苏期患者的并发症护理

麻醉苏醒期是麻醉后重要生理功能全面恢复的时期,随着施行麻醉和手术的增加,手术的结束并不意味着麻醉作用的消失和主要生理功能的完全复原,再加上手术麻醉期间已发生的循环、呼吸、代谢等功能的紊乱未能彻底纠正,患者保护性反射尚未完全恢复,麻醉苏醒期仍有发生各种并发症的危险[1],因此麻醉复苏期患者并发症的护理是确保患者预后的保障,本文通过分析了部分麻醉复苏期患者的护理措施,报告如下。     

麻醉恢复室患者低体温护理观察

目的:通过对麻醉恢复室患者低体温的护理观察临床效果。方法:按数字化完全随机法分为观察组和常规组各60例,观察两组生命体征、麻醉时间、自主呼吸恢复时间、意识恢复时间、在麻醉恢复室停留时间的差异,观察两组寒战发生率的差异。结论:对全麻手术后低体温患者在麻醉恢复室实施加温系统主动保温,可以预防患者苏醒期低体温状态,有利于患者尽快康复。     

麻醉苏醒期患者躁动的原因及护理分析

麻醉苏醒期患者发生躁动是麻醉后最常见的并发症之一,也是护理中最常遇到的问题。苏醒期的患者有的可在短时间唤醒,有的则可出现意识模糊、嗜睡、极度定向障碍及躁动不安等脑功能障碍情况,是麻醉苏醒期的一种不适当行为。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.