瑞芬太尼预防硬膜外阻滞下阑尾切除术中牵拉反应的效果

连续硬膜外麻醉是阑尾切除手术目前首选的麻醉方法。由于硬膜外阻滞不能有效地抑制术中阑尾及肠系膜的牵拉反应，患者常会出现胃区胀痛、恶心、呕吐、鼓肠等反应，以致腹肌紧张影响手术进行。2006年3至8月，本院用新型阿片类药物瑞芬太尼微泵静脉持续输注防治术中牵拉反应，取得了满意的麻醉效果。现报道如下。     

小儿硬膜外麻醉辅助氯胺酮对牵拉反应的临床观察

我院麻醉科多年来在小儿手术应用硬膜外阻滞时,辅助氯胺酮来防止手术时的牵拉反应及减少恐惧感,取得了满意的效果。现报告如下: 1 资料与方法 1.1 一般资料:选择ASA I-Ⅱ级硬膜外阻滞效果满意的腹部手术病人60例,男45例,女15例,年龄6-15岁,体重     

小剂量氯胺酮辅助硬膜外麻醉对内脏牵拉反应的防治

目的对比观察胆囊切除手术选用连续硬膜外麻醉时,静脉辅助麻醉用药对牵拉反应抑制效果。方法选择硬膜外麻醉下行胆囊切除手术患者80例随机分两组,每组各40例。哌氟组:哌替啶+氟哌利多单次静注。氯咪组:氯胺酮+咪达唑仑单次静注。分组记录注药前、注药后1分钟、5分钟、15分钟及牵拉胆囊时患者平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)值;对内脏牵拉反应进行评定。结果两组患者用药后MAP、HR、SpO2及ECG(心电图)均无明显变化(P>0.05)。手术探查牵拉胆囊时,哌氟组MAP明显下降(P<0.01);氯咪组麻醉后MAP、HR、SpO2无明显下降,(P>0.05)。结论小剂量氯胺酮辅助用于硬膜外麻醉,可明显减轻手术中牵拉内脏时对呼吸、循环系统的影响,简单实用,安全方便,易于掌握,是完全可以应用于硬膜外阻滞时的辅助麻醉。     

不同硬膜外穿刺点对阑尾术中牵拉反应的观察

在硬膜外阻滞麻醉下 ,大部分腹腔内脏手术都有不同程度的术中牵拉反应 ,引起上腹部疼痛不适、恶心、呕吐 ,严重者出现燥动不安和心血管反应 ,从而不能很好地耐受手术 ,我院对阑尾术中不同的硬膜外麻醉穿刺点的牵拉反应进行观察 ,认为在穿刺点麻醉能更好地预防术中的牵拉反应 ,报告如下。临床资料一、一般资料阑尾炎手术病例１２８例 ,年龄１２～６５岁 ,无硬膜外麻醉禁忌症 ,ＡＳＡⅠ—Ⅱ级 ,随机分成二组 ,两组年龄、性别、体重无明显差异。二、方法两组术前均用０．１ｇ鲁米那肌注 ,Ⅰ组选Ｔ１２-Ｌ１ 为硬膜外阻滞穿刺点 ,Ⅱ组选Ｔ１０ -…     

硬膜外注射芬太尼预防内脏牵拉反应

为了解阑尾术中硬膜外使用芬太尼对内脏牵拉反应的影响 ,我们于１９９９年１月～１２月将硬膜外注射芬太尼方法应用在５０例阑尾手术中 ,观察内脏牵拉反应的发生并与对照组比较 ,现报告如下。资料与方法一、临床资料选择无明显心肺器质性疾病的阑尾手术病人１００例 ,随机分为用药组 (以下简称Ⅰ组 )和对照组 (以下简称Ⅱ组 )。年龄１５～６０岁 ,平均（３７．５±２２．５）岁 ;体重３７．５～６５Ｋｇ,平均（５１．２５±１３．７５）Ｋｇ ;ＡＳＡⅠ～Ⅱ级。术前常规安定片口服０．１５ｍｇ／Ｋｇ。组间病人年龄、体重、ＡＳＡ分级无显著…     

超前镇痛止吐对于硬膜外麻醉下子宫手术牵拉反应的临床观察

目的:探讨芬太尼复合恩丹西酮超前镇痛预防妇科手术牵拉反应的效果。方法:选择妇科子宫切除手术病人40例,随机分成I组芬太尼复合恩丹西酮20例,Ⅱ组芬太尼复合氟哌啶20例。观察用药前、探查、牵拉子宫或附件时,收缩压(SBP)、舒张压(DMP)、心率(HR)、经皮脉搏氧饱和度(SPO2)、呼吸频率(HR)以及牵拉反应情况。结果:Ⅰ、Ⅱ组病人探查牵拉子宫附件时,血压均下降(P<0.05),Ⅱ组与Ⅰ组比较牵拉时舒张压及心率下降明显(P<0.05),但探查牵拉时呼吸次数无明显差异(P>0.05),Ⅰ组与Ⅱ组比较Ⅰ组抑制牵拉反应更有效(P<0.05)。结论:芬太尼复合恩丹西酮能更有效地抑制硬膜外麻醉下的妇科手术内脏牵拉反应。     

腰硬联合麻醉与硬膜外麻醉对腹部手术患者血液流变学及术中牵拉反应的影响

目的探讨腰硬联合麻醉与硬膜外麻醉对腹部手术患者血液流变学及术中牵拉反应的影响。方法将2008年12月至2010年12月择期进行腹部手术的患者200例,随机分为观察组和对照组,每组100例。观察组采用腰麻-硬膜外联合麻醉,对照组行用硬膜外麻醉。比较两组患者的麻醉前、麻醉后15 min、手术牵拉时的心率(HR)、收缩压(SPB)、舒张压(DPB)变化,术中牵拉反应,肌松效果及术后疼痛情况。结果麻醉后15 min,两组患者的血压均有所降低,观察组SPB、DPB较麻醉前下降显著(P<0.05)。对照组患者在牵拉时HR变化较为明显,显著低于观察组(P<0.05)。观察组的术中未见恶心、呕吐等牵拉反应,发生率显著少于对照组(P<0.05)。术后疼痛情况显著轻于对照组(P<0.05)。结论腰硬联合麻醉用于腹部手术患者效果满意,血液流变学更稳定,牵拉反应少,镇痛更完全,值得临床推广。     

硬膜外阻滞麻醉腹部手术病人内脏牵拉反应处理及临床观察

硬膜外阻滞麻醉是腹部手术首选麻醉方法之一，尤其是中、下腹部的手术。麻醉效果确切、操作简便、容易掌握。但是在临床应用中也存在些问题。首先是手术过程中牵拉内脏。出现鼓肠、恶心、呕吐等反应。给手术带来了操作方便。我们随机总结600例，观察到哌替啶和芬太尼、氟哌利多对内脏器官牵拉反应或牵引痛有针对性治疗和预防效果，作为硬膜外阻滞麻醉的辅助用药，效果满意。现总结如下。     

小剂量瑞芬太尼在硬膜外麻醉下前列腺电切术中的应用

瑞芬太尼是一种超短效能的阿片μ受体激动剂,具有起效时间短、镇痛作用强、苏醒快等特点,在临床麻醉中已广泛应用。本文探讨小剂量瑞芬太尼辅助硬膜外麻醉前列腺电切术的镇痛效果。1资料与方法1.1一般资料2004年1月至2005年12月在我院就诊的60例前列腺肥大需行前列腺电切术患者     

异丙酚预防硬膜外阻滞阑尾手术牵拉反应效果观察

异丙酚为快速短效静脉麻醉药 ,连续硬膜外阻滞下静脉滴注对预防阑尾手术牵拉反应的应用效果 ,笔者作了初步观察 ,报告如下。１资料和方法选择７５例拟行阑尾切除术的患者 ,男性４５名 ,女性３０名 ,年龄２０～４８岁。术前肌注安定８～１０ｍｇ、阿托品０．４～０．５ｍｇ。选择Ｔ１１～１２椎间隙行硬膜外穿刺置管 ,２ %利多卡因局麻。随机分成三组 ,每组２５例 :Ⅰ组对照组 ,术中不加任何辅助药 ;Ⅱ组杜氟合剂组 ,于皮肤消毒时静注杜氟合剂(杜冷丁５０ｍｇ／ｍｌ、氟哌利多５ｍｇ／２ｍｌ)２．０～２．５ｍｌ;Ⅲ组异丙酚组 ,于切皮时先１…     

上肢再植过程中应用罗哌卡因微量泵持续输注硬膜外麻醉的评价

背景:不同麻醉和镇痛方法应用于上肢再植术各有优缺点,麻醉效果、生理功能的干扰和对疾病转归的影响是主要评价指标.目的:探讨微量泵持续输注低浓度罗哌卡因硬膜外麻醉用于上肢(掌、指)再植术的临床效果及安全性.设计、时间及地点:自身前后对照观察,于2006-06/2008-06在石河子大学医学院第一附属医院麻醉科完成.对象:石河子大学医学院第一附属医院27例行急诊断肢(掌、指)再植手术的患者27例,男19例,女8例;年龄26-53岁,均符合美国麻醉医师协会(ASA)分级标准Ⅰ～Ⅱ级,且对麻醉和术后镇痛方法知情同意.药物配方:10 g/L罗哌卡因20 mL+生理盐水40 mL,即得3.3 g/L罗哌卡因麻醉药液60 mL.方法:全组采用颈部硬膜外麻醉.先同时按压∑键和FAST键快速输注8.0～10.0 mL,继而设定5～7 mL/h的速度恒速输注.每隔5 min以针刺法测定麻醉平面,直至达到手术要求开始手术.术中每隔1.0～2.0 h,静脉注射昧唑安定1.0～2.0 mg清醒镇静.术毕更换2 g/L罗哌卡因镇痛液,4～6 mL/h速度持续输注术后镇痛两三天.主要观察指标:术中监测心电图、血压、心率、呼吸频率、脉搏氧饱和度,并记录麻醉起效时间、镇痛效果、麻醉平面和运动神经阻滞程度;术后镇痛评分、48h血压下降、呼吸抑制、恶心呕吐、尿潴留、皮肤瘙痒等不良事件发生率.结果:27例患者全部进入结果分析.①27例患者均取得满意麻醉效果;目测类比评分0分88.9%,1分7.4%,2分3.7%;麻醉起效时间(15.2±4.3)min;运动神经阻滞轻微,能配合手术要求,术中安静不动.②血压、心率持续输注期间波动轻微;脉搏氧饱和度(98±2)%,高于术前.呼吸频率(16.5±3.6)次/min,较术前缓慢.③术后镇痛效果满意率92.6%.结论:①微量泵持续输注3.3 g/L罗哌卡因硬膜外麻醉可以安全用于上肢(掌、指)再植术,麻醉效果满意,特别适用于手术时间冗长的复杂再植术.②2 g/L罗哌卡因持续输注便于术后镇痛,镇痛效果确切,不良事件发生率低.     

Continuous subcutaneous insulin infusion during general anesthesia: a case report

Care of the patient with diabetes mellitus presents numerous challenges to the anesthesia practitioner. There is no perfect way to care for these patients nor are any 2 patients with diabetes exactly alike. With the advent of subcutaneous insulin pumps, the anesthesia practitioner has another tool to assist him or her in giving high quality care. This case study describes the anesthesia care provided to a patient with type 1 diabetes who wore his continuous subcutaneous insulin infusion (CSII) pump during general anesthesia for surgical repair of a herniated lumbar disk. Importantly, the anesthesia plan involved a collaborative effort with the patient. Blood glucose levels were stable throughout the perioperative period. Little or no extra work was required of the CRNA. This case showed that the CSII could be used to minimize perioperative fluctuations in blood sugar. Postoperatively, the patient expressed a high degree of satisfaction with the anesthetic.     

Continuous epidural anesthesia for elective cesarean hysterectomy

Continuous lumbar epidural anesthesia was the primary anesthetic technique used for 25 patients having elective cesarean hysterectomy at Duke University Medical Center during a 12 1/2-year interval. Seven patients (28%) with initially satisfactory epidural anesthesia required intraoperative induction of general orotracheal anesthesia because of patient discomfort and resultant suboptimal operating conditions. Careful patient selection and preparation, expertise in administering continuous epidural anesthesia, and understanding of the demands of the operative procedure are essential when planning epidural anesthesia for cesarean hysterectomy.     

Continuous infusion of alfentanil for maintenance of anesthesia: comparison with halothane anesthesia

This study compares anesthetic maintenance, hemodynamic stability, and speed of recovery obtained with inhalational halothane versus intravenous alfentanil anesthesia administered continuously. In two groups of patients, anesthesia was induced with sodium thiopental, maintained with 70% nitrous oxide in 30% oxygen, and either halothane (n = 10) or a continuous infusion of alfentanil (n = 10). The administration of the allocated anesthetic was adjusted according to strict predefined criteria of inadequate anesthesia. After endotracheal intubation, hemodynamics (heart rate, systolic and diastolic pressure) changed less in the alfentanil group (P less than .01). Overall hemodynamic stability was the same in both groups. In neither group was there recall of intraoperative events. Recovery was assessed by the time from cessation of nitrous oxide administration to return of spontaneous ventilation, response to simple command, extubation, orientation, and discharge from the recovery area. The time taken to respond to simple command was significantly shorter in the alfentanil group (P less than .05), but other indices of recovery were similar.     

丙泊酚伍用瑞芬太尼消除连续硬膜外麻醉患者术中知晓的研究

目的探讨麻醉安全状态下,丙泊酚伍用瑞芬太尼消除连续硬膜外麻醉患者术中知晓的可行性及两药的最佳用量。方法选择下腹部开腹手术患者60例,行硬膜外麻醉联合靶控输注异丙酚和瑞芬太尼（丙泊酚血浆靶浓度为1．5～2．5μg／ml、瑞芬太尼血浆靶浓度为0．5～1．5ng／ml）,观察患者呼吸指标、循环指标、大脑意识状态指数和警觉／镇静观察评分,并对相关指标进行相关分析。此外,对患者进行调查,统计是否出现术中知晓。结果①丙泊酚血浆靶浓度为1．9～2．5μg／ml、瑞芬太尼血浆靶浓度为1．0～1．5ng／ml）,大脑意识状态指数（CSI）在40～60区间时,患者无知晓,且呼吸循环等生命体征平稳。CSI与警觉-镇静（OAA／S）评分标准呈正相关,OAA／S降低,CSI值也随之降低,而且不同OAA／S评分之间的CSI值有统计学差异。②在呼吸、循环安全范围[最低标准呼吸频率（RR）〉8次／min,脉搏氧饱和度（SpO2）〉90％,心率（HR）〉50bpm,收缩压（SBP）改变〈30％基础值]内,CSI、OAA／S值与丙泊酚、瑞芬太尼两药剂量呈负相关。③当丙泊酚血浆靶浓度低于0．8～1．0μg／ml、瑞芬太尼血浆靶浓度为0．6～0．9ng／ml,CSI〉80时患者会出现术中知晓的情况。结论TCI丙泊酚伍用瑞芬太尼能有效消除CEA患者术中知晓。     

靶控输注瑞芬太尼与恒速输注右美托咪定用于小儿全凭静脉麻醉苏醒期的临床研究

目的观察靶控输注瑞芬太尼与恒速输注右美托咪定对小儿全凭静脉麻醉苏醒期拔管反应及躁动的影响。方法将90例择期全凭静脉麻醉下行扁桃体腺样体切除术患儿,随机分为对照组(C组)、瑞芬太尼组(R组)和右美托咪定(D组)。麻醉诱导后D组静脉持续输注右美托咪定0.3μg·kg-1·h-1直至气管导管拔出。手术结束前2 min,C组和D组停用异丙酚和瑞芬太尼;R组停用异丙酚,将瑞芬太尼的TCI浓度调整为1.5 ng/ml直至气管导管拔出。记录泵注右美托咪定前(T0)、手术结束时(T1)、拔管前1 min(T2)、拔管时(T3)和拔管后1 min(T4)、5 min(T5)、10 min(T6)的平均动脉压(MAP)、心率(HR);记录停用异丙酚至拔管时间、睁眼时间、拔管时呛咳反应评分;根据儿童麻醉后躁动评分(PAED)和改良加拿大东安大略儿童医院疼痛评分量表(m-CHEOPS),拔管后每5 min对患儿进行躁动和疼痛评分,记录所得最高值作为监测有效值。结果与T0时比较,C组T2~T6时、R组T5~T6时MAP和HR均显著升高(P<0.05),D组各时点MAP与HR差异无统计学意义;与C组比较,R组T2~T4时、D组T2~T6时MAP与HR均较低(P<0.05);与R组比较,D组T5~T6时MAP与HR较低(P<0.05)。三组患儿拔管时间、睁眼时间比较差异无统计学意义(P>0.05);拔管时呛咳反应评分R组与D组显著低于C组(P<0.05),PAED评分和疼痛评分D组显著低于C组(P<0.05)与R组(P<0.05)。结论靶控输注瑞芬太尼(1.5 ng/ml)与恒速输注右美托咪定(0.3μg·kg-1·h-1),均能有效抑制小儿扁桃体腺样体切除术全凭静脉麻醉苏醒期的拔管反应,且不延长麻醉苏醒时间。恒速输注右美托咪定还能减少患儿术后躁动的发生,更适用于小儿全麻苏醒期。     

靶控输注丙泊酚复合舒芬太尼或瑞芬太尼用于小儿腹腔镜疝环结扎术的麻醉

目的：评价小儿腹腔镜疝环结扎术中应用靶控输注丙泊酚复合舒芬太尼与瑞芬太尼的麻醉效果与安全性。方法将行腹腔镜疝环结扎术72例患儿,随机分为TCIS组和TCIR组,每组36例,TCIS组予靶控输注舒芬太尼复合丙泊酚诱导与维持麻醉,TCIR组予靶控输注瑞芬太尼复合丙泊酚诱导与维持麻醉。比较两组患儿围麻醉期血流动力学变化、术毕苏醒时间、气管拔管时间、丙泊酚用量和术后Riker镇静和躁动评分（SAS）评分、视觉模拟痛觉（VAS）评分。结果两组患儿在麻醉诱导前,各血流动力学指标差异无统计学意义（t分别=0.12、0.23、0.48、0.31,P均＞0.05）;与TCIS组患儿比较,TCIR组患儿在插管时（T1）的收缩压、舒张压较低,在拔管时（T2）收缩压、舒张压和心率较高,差异均有统计学意义（t分别=5.71、8.63;5.77、4.27、4.00,P均＜0.05）。两组患儿术毕苏醒时间、气管拔管时间和丙泊酚用量比较,差异均无统计学意义（t分别=0.91、1.14、0.94,P均＞0.05）。TCIS组患儿SAS、VAS评分均低与TCIR组,差异均有统计学意义（t分别=7.67、18.57,P均＜0.05）。结论靶控输注丙泊酚复合舒芬太尼用于小儿腹腔镜疝环结扎术,在围麻醉期血流动力学更加平稳、且能更加有效减少患儿术后躁动和疼痛,较复合瑞芬太尼效果佳。     

Continuous epidural infusion of ropivacaine hydrochloride (naropin) during postoperative analgesia in cardiosurgical patients

An efficiency and safety of continuous infusion of naropin in the epidural analgesia of 38 patients after coronary artery bypass grafting were demonstrated. A variation of combined anesthesia, which was elaborated at the Russian Research Center of Surgery of the Russian Academy of Medical Sciences and which comprises (as a basic component of anesthetic management) a high thoracal epidural block (T2-T4) by continuous infusion of a 2% solution of naropin at a velocity of 5 +/- 2 ml/h. Anesthesia was supported by isoflurane (0.5 +/- 0.9%). The patients were extubated in the operated theater and taken to the resuscitation unit with continuous infusion of 0.2% naropin solution. All studied parameters were registered after discharge from the operating theater and 1, 3, 6, and 16-18 hours after surgery. The pain-syndrome intensity was measured at the verbal scale with 0 to 3 points. The mean duration of continuous naropin infusion was 16.7 +/- 0.5 h, mean dose--2.2 +/- 0.2 ml/h. Naropin was administered at a dose of 1-3 ml/h in 89.7% of cases and at a dose of 6 ml/h only in 2.9% of cases. The drug, when used in small doses, ensured a high anesthetic efficiency. A total lack of pain or a mild pain of 0.1 points was observed in 86.5% of patients at stage 5 of examinations and in 100% of patients at stage 3. Naropin infusion did not entail any impairment in ventilation or gaseous metabolism. A reliable decrease of arterial pressure (AP) and of central venous pressure (CVP), (p < 0.05) were registered beginning from stage 2. CVP decrease versus stage 1 was ensured in 38.% of patients by stage 4 and the number of patients with a decreased CVP (less than 60 mm H) went up, versus stage 1, by 3 times. APsyst of less than 90-80 mm Hg was registered in 15 (39.8%) of patients at different examination stages, which necessitated the use of noradrenalin at mean dose of 174 +/- 21 ng/kg.min. The infusion of naropin at dose of 1-6 ml/h did not entail any impairment in the central nervous system (hallucinations, convulsions, and headache).