组织内激光介入溶脂在面部改型术中的临床应用

目的 通过组织内激光介入治疗的方法,对面部皮下脂肪进行溶脂,以达到重塑面型的目的.方法 于面部鼻唇沟部位做长3 mm的皮肤切口,将半导体激光机（Velure S9,波长980 nm）的光纤置于面部皮下脂肪层,能量为9J;按照扇形分布方式作用于面部脂肪组织;术后加压包扎,3d后改用弹力面套包扎1个月.对照术前、术后面部形态的改变.结果 术后面颊部、下颌缘、下颌角、颏下区等脂肪堆积部位软组织厚度变薄、下垂消失,面部形态改善较好.结论 组织内激光介入溶脂治疗是一项安全、有效的微创面型重塑方法,操作简单、效果可靠,可以重复治疗.     

连续激光溶脂和重复脉冲激光溶脂的有效性和安全性分析

目的:探讨连续激光溶脂和重复脉冲激光溶脂的有效性和安全性。方法:以离体脂肪细胞为研究对象,随机分为实验组和对照组,实验组以功率为8W、波长为980nm的半导体激光,以连续或不同脉宽的重复脉冲激光行激光溶脂术,记录不同能量时管壁温度及离心后的上层油脂量。结果:离心后上层油脂量重复脉冲激光组连续激光组空白对照组,且随着脉宽增加,上层油脂量越大,相应地,管壁温度越高。脉宽超过90ms,总能量超过1 500J(平均150J/ml)时,管壁温度超过42℃安全值。结论:①重复脉冲激光溶脂作用较连续激光好,且脉宽越大,溶脂效果越好;②重复脉冲激光溶脂较连续激光产生的温度高,且脉宽越大,温度越高;③脉宽90ms以下、能量小于1500J(150J/ml)是较为安全的溶脂激光设定参数。     

激光溶脂技术的临床应用

目的:探讨激光溶脂技术的临床应用方法和疗效。方法:2006年3月￣2006年6月对54例患者采用了激光溶脂技术进行局部减脂塑身,均来自保加医疗美容上海和香港两诊所门诊病人。术后随访3月,根据术者和患者的综合判断,评价该技术的疗效。结果:术后3周术区开始缩小,3月效果非常明显。18例仅行溶脂的病例无瘀血发生,2￣5天后完全消肿,皮肤柔软平整,无脂肪液化后囊肿形成。其余溶脂后再吸脂患者,皮肤平整,2月后恢复柔软。全部患者均未出现皮肤松弛现象。结论:激光溶脂技术是一种创伤小、恢复快、疗效好的减脂塑身方法。     

丙泊酚复合瑞芬太尼全身麻醉在隆乳术中的应用

目的 探讨丙泊酚复合瑞芬太尼全身麻醉在隆乳术中应用的效果与安全性.方法 选择美国麻醉医师协会(ASA)分级,Ⅰ、Ⅱ级隆乳求美者30例,入室后给予静脉注射芬太尼0.20μg/kg和丙泊酚2.0～2.5mg/kg麻醉诱导,经口腔插入喉罩至口咽部行间歇正压通气(IPPV)模式控制呼吸,维持气道压＜20kPa;术中以微量泵每分钟持续泵入丙泊酚6.00～9.00μg/kg、瑞芬太尼0.10～0.15μg/kg维持麻醉效果;消毒铺巾后,采用肿胀麻醉技术行双侧乳房局部麻醉,在手术结束前10min停止静脉给药,待受术者清醒后拔出喉罩.结果 全部病例麻醉经过顺利,效果满意,血流动力学平稳,受术者对手术耐受性良好,术后清醒时间为10～25min,无不适感觉和明显的不良反应.结论 丙泊酚复合瑞芬太尼全身麻醉在隆乳术中的应用安全、易行.     

瑞芬太尼复合丙泊酚靶控输注喉罩静脉麻醉用于颈部手术效果观察

目的观察瑞芬太尼复合丙泊酚靶控输注喉罩静脉麻醉应用于颈部手术的效果。方法随机将68例接受颈部手术的患者分为观察组和对照组,各34例。2组均实施喉罩静脉麻醉,观察组采用瑞芬太尼复合丙泊酚靶控输注,对照组患者采用丙泊酚靶控输注。比较2组患者在各时的SBP、DBP、HR变化及丙泊酚的用量。结果 2组患者麻醉前和停药时点的SBP、DBP、HR差异无统计学意义(P0.05);在喉罩置入前、后1 min时SBP、DBP、HR的差异有统计学意义;观察组丙泊酚使用量少于对照组,2组差异有统计学意义。结论颈部手术应用瑞芬太尼复合丙泊酚靶控输注喉罩静脉麻醉,对患者血液动力学影响较小,且可减少丙泊酚用量,效果满意。     

瑞芬太尼对小儿插入喉罩丙泊酚ED_(50)的影响

目的观察瑞芬太尼对小儿插入喉罩(LMA)丙泊酚ED50的影响。方法 50例行下腹部或会阴部手术患儿随机均分为丙泊酚复合瑞芬太尼组(PR组)与丙泊酚组(PS组)。两组分别静注1μg/kg瑞芬太尼或等容量生理盐水,30 s后静注1%丙泊酚,面罩吸氧90 s后插入LMA。按序贯试验原则确定丙泊酚剂量,丙泊酚初始剂量为2 mg/kg。Probit检验计算两组LMA插入丙泊酚ED50。结果 PR组LMA插入时丙泊酚ED50为1.91 mg/kg[95%可信区间(CI)1.06~3.03mg/kg],明显低于PS组的3.18 mg/kg(95%CI 2.86~3.60 mg/kg)(P<0.05)。结论 1μg/kg瑞芬太尼可降低小儿LMA插入丙泊酚ED50。     

普通喉罩在俯卧位脂肪抽吸手术中的应用

目的 探讨普通喉罩在俯卧位脂肪抽吸术中应用的可行性与安全性.方法 选择ASAI～Ⅱ级腰背部脂肪抽吸手术女性住院患者30例,入室后患者俯卧,头偏向左侧,静脉注射芬太尼0.2 μg/kg、丙泊酚2.0 ～2.5 mg/kg诱导,插入喉罩,行IPPV模式控制呼吸,维持气道压20 kPa以内,术中以微量泵持续泵入丙泊酚、瑞芬太尼维持麻醉,手术结束前10 min停药,待患者醒后拔出喉罩;消毒铺巾后利用肿胀术行腰背部肿胀麻醉,之后开始手术直至结束.结果 全部患者俯卧位下喉罩置入顺利,麻醉效果满意,血流动力学平稳,术后10 ～ 25 min清醒,感觉舒适,安全返回病房,无明显不良反应.结论 普通喉罩在俯卧位脂肪抽吸手术中应用简单、安全、易行.     

喉罩麻醉采用靶控输注丙泊酚复合瑞芬太尼的临床效果分析

目的应用靶控输注丙泊酚与瑞芬太尼方式对接受手术治疗的患者实施喉罩麻醉的临床效果进行研究。方法将我院收治的88例接受手术治疗的患者随机分为对照组和观察组,分别给予靶控输注丙泊酚方式和靶控输注丙泊酚与瑞芬太尼方式实施喉罩麻醉。结果观察组患者手术麻醉效果明显优于对照组。结论应用靶控输注丙泊酚与瑞芬太尼方式对接受手术治疗的患者实施喉罩麻醉的临床效果非常明显。     

激光注射溶脂懒人超适用

衣服越穿越薄了．女孩子们在日渐温热的气候里一边花枝招展地展示着自己的华服，一边急急忙忙投入到减肥大战里——可不是嘛。单薄的衣服太容易暴露冬天养起的赘肉了。但是，顽固的局部赘肉可没那么容易除掉．节食、锻炼太考验毅力．抽脂手术又太需要勇气。懒人MM们总希望有种睡觉就能把赘肉减掉的方法。     

定位塑身溶脂针

“有没有一种减肥方法能让我想瘦哪里就瘦哪里，而且不用节食、不用手术、没有痛苦、见效快、效果持久？”波拉从QQ给我敲过来一行字，我彻底无语了。这个减肥狂，向往魔鬼身材向往得快发疯了!     

Pretreatment with small-dose ketamine reduces predicted effect-site concentration of propofol required for loss of consciousness and Laryngeal Mask Airway insertion in women

Study Objective

To investigate the effect of small-dose ketamine on the predicted effect-site concentration of propofol required for loss of consciousness (LOC) and Laryngeal Mask Airway (LMA) insertion.

Design

Randomized, double-blinded study.

Settings

Operating room.

Patients

50 ASA physical status 1 and 2 women scheduled for elective breast or gynecological surgery.

Interventions

Patients were randomly allocated to a ketamine group or a control group. Thirty seconds before propofol injection, ketamine group patients received ketamine 0.2 mg/kg, while control group patients received saline. Propofol was given in a target-controlled infusion and target blood concentration was gradually increased until LOC. The effect-site concentrations for attempting LMA insertion was predetermined by modifying Dixon's up and down method. LMA insertion was attempted without muscular blocking agents.

Measurements

Pain scores on propofol injection, effect-site concentrations at LOC, hemodynamic variables, and patient movement or side effects on LMA insertion were recorded.

Main Results

The effect-site concentration of propofol required for LOC was 2.14 μg/mL for the control group and 1.66 for the ketamine group (P = 0.0082). The predicted effect-site concentration of propofol alone at which 50% of patients did not move with LMA insertion (EC₅₀LMI) was 3.59 μg/mL (95% CI: 3.18∼4.19 μg/mL). Pretreatment with ketamine 0.2 mg/kg decreased EC₅₀LMI from 3.59 (3.18∼4.19) to 2.39 (1.22∼2.99).

Conclusions

Pretreatment with ketamine 0.2 mg/kg reduced the propofol concentration required for both LOC (22%) and LMA insertion (33%) in women.     

Airway management in spontaneously breathing anaesthetized children: comparison of the Laryngeal Mask Airway with the cuffed oropharyngeal airway

BACKGROUND: The efficacy and safety of the smallest size of the cuffed oropharyngeal airway (COPA) for school age, spontaneously breathing children was investigated and compared with the Laryngeal Mask Airway (LMA). METHODS: Seventy children of school age (7-16 years) were divided into two groups: the COPA (n=35) and the LMA (n=35). Induction was with propofol i.v. or halothane, nitrous oxide, oxygen and fentanyl. After depression of laryngopharyngeal reflexes, a COPA size 8 cm or an LMA was inserted. Ventilation was manually assisted until spontaneous breathing was established. For maintenance, propofol i.v. and fentanyl or halothane with nitrous oxide were used. Local anaesthesia or peripheral blocks were also used. RESULTS: Both extratracheal airways had a highly successful insertion rate, but more positional manoeuvres to achieve a satisfactory airway were required with the COPA, 28.6% versus LMA 2.9%. The need to change the method of airway management was higher (8.6%) in the COPA group. After induction, the need for assisted ventilation was higher in the LMA group 54.3% versus 20% in the COPA group. Airway reaction to cuff inflation was higher in the LMA group 14.3% versus COPA 5.7%. Problems during surgery were similar, except continuous chin support to establish an effective airway was more frequent (11.4%) in the COPA group. In the postoperative period, blood on the device and incidence of sore throat were detected less in the COPA group. CONCLUSIONS: The COPA is a good extratracheal airway that provides new possibilities for airway management in school age children with an adequate and well sealed airway, during spontaneous breathing or during short-term assisted manual ventilation.     

The Laryngeal Mask Airway Supreme for positive pressure ventilation during laparoscopic cholecystectomy

Study Objective

To evaluate the Laryngeal Mask Airway Supreme (SLMA) in patients undergoing laparoscopic cholecystectomy.

Design

Prospective observational study.

Setting

University-affiliated hospital.

Patients

100 ASA physical status 1, 2, and 3 adult patients undergoing laparoscopic cholecystectomy with general anesthesia.

Interventions

The SLMA was inserted in all study patients. Patients were placed in the reverse Trendelenburg position.

Measurements

Ease of insertion of the device and the drain tube, oropharyngeal leak pressure, frequency of postoperative sore throat, and other adverse events were recorded. The surgeon scored stomach size on an ordinal scale of 0–10 at insertion of the laparoscope and before decompression of the pneumoperitoneum.

Main Results

Insertion of the SLMA was successful in all patients (91 pts on the first attempt, 9 pts on the second attempt). Gastric tube insertion was successful in all patients (easy in 97 pts, difficult in 3 pts). Initial mechanical ventilation was adequate in all cases. Mean oropharyngeal leak pressure at the 60 cm H₂O cuff pressure level was 28.8 cm H₂O (±5.2; range 18–40 cm H₂O). Mean airway pressure before pneumoperitoneum was 17.5 cm H₂O (±3.3; cm; range 11–26 cm H₂O) and 22.9 cm H₂O (±4 cm; range 16–32 cm H₂O) after pneumoperitoneum. Median (range) stomach size on insertion of the laparoscope and change in stomach size during surgery did not interfere with the procedure in any patient. Twelve patients (12%) complained of a mild sore throat postoperatively. No other complications were reported.

Conclusions

The SLMA is easy to insert and it is an effective ventilatory device for laparoscopic cholecystectomy.     

Rapid injection of propofol reduces vascular pain and facilitates Laryngeal Mask Airway insertion

Study Objective

To compare the clinical efficacy of a rapid injection of propofol in regard to pain and ability to facilitate Laryngeal Mask Airway (LMA) insertion.

Design

Randomized, single-blinded, placebo-controlled study.

Setting

University hospital.

Patients

120 ASA physical status 1 and 2 patients undergoing elective orthopedic surgeries.

Interventions

Patients were randomly allocated to one of 4 groups. Group A patients were pretreated with normal saline followed by propofol 2.0 mg/kg at 3.3 mg/sec. Group B patients were pretreated with lidocaine 0.5 mg/kg followed by propofol 2.0 mg/kg at 3.3 mg/sec. In Group C, patients were pretreated with lidocaine 1.0 mg/kg followed by propofol 2.0 mg/kg at 3.3 mg/sec. In Group D, patients were pretreated with normal saline followed by propofol 2.0 mg/kg at 50 mg/sec.

Measurements

Pain on injection was measured using a 4-point scale. Scale and success rate of smooth LMA insertion also were recorded.

Main Results

Rapid injection was less painful than after pretreatment with lidocaine 0.5 mg/kg, but was similar to slow injection after pretreatment with lidocaine 1.0 mg/kg. Rapid injection facilitated LMA insertion, unlike slow injection with lidocaine 0.5 mg/kg pretreatment, and was similarly successful to slow injection after pretreatment with lidocaine 1.0 mg/kg.

Conclusions

The rapid administration of propofol reduces pain and facilitates LMA insertion versus slow administration of propofol.     

严重气道狭窄患者气管内治疗的麻醉管理

目的：探讨严重气道狭窄患者气管内治疗的麻醉管理方法。方法：10例不同原因气道狭窄患者分别进行狭窄气道内支架置入术、支架或异物取出术或气管造口处“T”管置入术,分别于全身麻醉下采用气管插管、喉罩及高频喷射等不同的保障气道及通气的方法。结果：经气管导管或喉罩支气管镜下定位气道内支架成功放置7例;感染气管支架或异物取出失败各1例,但均清除部分坏死组织,解除部分气道梗阻;经气管导管手控呼吸及高频喷射通气下“T”型硅胶管成功放置1例。结论：严重气道狭窄患者气管内治疗的麻醉管理关键在于保障气道内操作时的气道通畅。气管插管、喉罩及高频喷射等可灵活应用于不同的病例,其选择主要取决于气道梗阻的部位、严重程度及治疗方法,医护人员的通力协作也是成功的保障之一,经喉罩通气下行气管内操作为可行的方法之一。     

喉罩应用于瑞芬太尼静脉麻醉下气管狭窄的介入手术

目的：观察瑞芬太尼维持麻醉下喉罩在支气管镜下气管狭窄介入手术的应用情况。方法选择限期或急诊行气管狭窄介入手术患者29例,瑞芬太尼和异丙酚麻醉下置入喉罩,观察整个麻醉和手术过程中的平均动脉压（MAP）、心率（HR）、气道压变化、清醒时间和拔管时间,以及是否存在通气不良、缺氧、呛咳、体动及咽痛等其他不良反应。结果插管前后平均动脉压明显降低,分别为（85．8±21．6）mmHg 和（78．0±20．3）mmHg,P ＜0．05;心率无明显变化,分别为（89．9±25．4）次／min和（92．1±21．7）次／min。拔管期间均未见平均动脉压和心率明显变化,治疗前后气道压明显降低,分别为（22．5±03．81）cmH2 O 和（19．90±3．00）cmH2 O,清醒时间和拔管时间平均在（13．40±4．39）min。1例因患者气道压过高,超过喉罩的漏气压发生漏气,12人拔管后感觉咽痛。结论瑞芬太尼维持麻醉下喉罩应用于气管狭窄介入手术心血管刺激小、通气效果良好,适合高风险的患者,但仍有漏气的风险及咽痛的不适。     

右美托咪定在宫腔镜手术静脉麻醉中的应用

目的探讨右美托咪定联合丙泊酚和瑞芬太尼用于宫腔镜手术的麻醉效果。方法 2012年4～8月选择ASAⅠ～Ⅱ级择期行宫腔镜下子宫肌瘤、子宫内膜息肉、子宫纵膈、宫腔粘连电切术80例,根据医生意愿分为2组（右美托咪定组和对照组）,每组40例。右美托咪定组术前给予右美托咪定0.125 ml/kg（1支右美托咪定200μg,用生理盐水稀释至50ml,终浓度为4μg/ml）,即小剂量0.5μg/kg,由微量注射泵10 min泵完,泵注完成后对患者行Ramsay镇静评分,然后由微量注射泵泵入瑞芬太尼1.0μg.kg-1.min-1,1 min后静脉推入丙泊酚,待病人睫毛反射消失后,手术开始。对照组术前给予生理盐水0.125 ml/kg,其余同右美托咪定组。2组病人术中根据情况随时静脉推入丙泊酚,手术结束时停止瑞芬太尼的输入。记录手术中收缩压、心率、呼吸频率和SPO2最低值;术中应用丙泊酚的总量;术前镇静评分;术后清醒时间及苏醒程度;术中呼吸抑制、术后恶心呕吐、头晕及苏醒期躁动等不良反应;术后宫缩痛的情况。结果右美托咪定组患者术中收缩压[（97.5±7.7）mm Hg vs.（84.0±5.5）mm Hg,t=9.023,P=0.000]、心率最低值[（66.0±6.5）次/min vs.（58.5±5.5）次/min,t=5.571,P=0.000]均显著高于对照组。右美托咪定组患者术前的Ramsay镇静评分明显优于对照组[（3.1±0.5）分vs.（1.2±0.4）分,t=18.767,P=0.000],苏醒时间明显长于对照组[（6.2±1.0）min vs.（5.7±0.7）min,t=2.591,P=0.011],清醒程度优于对照组[（5.0±0.2）分vs.（3.0±0.5）分,t=23.489,P=0.000],所需丙泊酚明显少于对照组[（110.2±6.2）mg vs.（180.4±6.7）mg,t=-48.637,P=0.000],右美托咪定患者术后恶心呕吐、兴奋躁动等不良反应明显优于对照组[6例（15%）vs.16例（40%）,χ2=6.270,P=0.012;4例（10%）vs.12例（30%）,χ2=5.000,P=0.025];术后宫缩痛程度明显低于对照组（Z=-4.137,P=0.000）。结论小剂量0.5μg/kg右美托咪定可安全应用于宫腔镜手术,并能明显减少丙泊酚的用量,降低术后不良反应的发生,缓解术后宫缩痛。