目的 观察帕瑞昔布钠与舒芬太尼用于无痛胃镜麻醉的安全性和有效性及对患者满意度的影响，为提高临床无痛胃镜麻醉的安全性和舒适性提供依据。 方法 采取前瞻性随机双盲对照方法，纳入2011年8月－12月拟行无痛胃镜检查的患者120例，随机分为3组。患者于胃镜检查开始前口服利多卡因胶浆，静脉注射舒芬太尼、帕瑞昔布钠或生理盐水10 mL。检查时静脉注射异丙酚。记录患者检查过程中生命体征、异丙酚使用量、诱导时间、检查时间、苏醒时间、医师以及患者满意度、舒适度等数据。 结果 舒芬太尼组检查中各时间点平均动脉压明显低于帕瑞昔布组（P=0.029），血管活性药物用量明显高于帕瑞昔布组（P=0.036）。医师以及患者满意度舒芬太尼组和帕瑞昔布组相当，且均高于对照组（P＜0.05）。除呛咳外，帕瑞昔布组其他不良反应的发生率明显低于舒芬太尼组（P＜0.05）。 结论 实施无痛胃镜检查前15 min静脉注射帕瑞昔布钠0.6 mg/kg或舒芬太尼0.10 μg/kg均可以获得满意的麻醉效果，麻醉医师和患者及家属的满意度明显增高，且帕瑞昔布对呼吸和循环的影响更小，安全性更高。
【摘要】 目的 比较靶控诱导后Shikani喉镜、Macintosh直接喉镜和GlideScope®视频喉镜插管时的应激反应。 方法 选取2008年12月-2009年2月期间ASA Ⅰ~Ⅱ级、拟于全身麻醉下行择期颅内占位病变切除术的患者30例，随机分为Shikani喉镜组（S组）、Macintosh直接喉镜组（M组）与GlideScope®视频喉镜组（G组）。靶控异丙酚和瑞芬太尼诱导，分别采用上述3种喉镜行经口气管插管。记录患者的心率、血压，计算心率收缩压乘积（RPP）。 结果 3组插管时间、心率、血压和RPP比较差异无统计学意义（Pgt;0.05）。S组和M组插管后心率、血压及RPP均较插管前显著升高（Plt;0.05），而G组插管后的心率、60~300 s时的收缩压、平均动脉压和RPP与插管前比较，差异无统计学意义（Pgt;0.05）。 结论 3种喉镜进行经口气管插管时具有相似的血流动力学反应，GlideScope®视频喉镜更有利于循环稳定。【Abstract】 Objective To compare the hemodynamic responses of orotracheal intubations with GlideScope® videolaryngoscope, Macintosh direct laryngoscope, and Shikani optical stylet after target-controlled-infusion (TCI). Methods Thirty patients with American Society of Anesthesiologists (ASA) physical status Ⅰ-Ⅱ, scheduled for elective intracranial mass lesion surgery under general anesthesia were randomly allocated equally to Shikani optical stylet group (group S) Macintosh laryngoscope group (group M), and GlideScope® videolaryngoscope group (group G). After the patients became unconscious by TCI induction of propofpol and remifentanil, the endotracheal intubation were carried out through above three laryngoscope. The heart rate (HR), blood pressure and rate pressure product (RPP) were recorded. Results The differences of intubation time, HR, blood pressure and RPP in three groups were not statistically significant (Pgt;0.05). After intubation, the HR, blood pressure and RPP of group S and M were obviously higher than those before intubation (Plt;0.05); while there was no obvious change on the HR, systolic pressure at 60-300 s, mean arterial pressure and RPP of group G compared before intubation (Pgt;0.05). Conclusions There are similar hemodynamic responses in the three laryngoscope. GlideScope® is more advantageous to cycle stability.
检测结直肠癌患者血清巨噬细胞集落刺激因子(M-CSF)的含量并探讨其临床意义。方法:采用酶联免疫吸附分析法(ELISA)对62例经病理证实的术前结直肠癌患者、40例结直肠良性病患者和40例健康体检者血清M-CSF水平进行检测。结果:结直肠癌患者血清M-CSF水平明显高于结直肠良性病患者和健康体检者(Plt;0.01);结直肠癌患者血清M-CSF水平与肿瘤分期、淋巴结转移及远处转移有关(Plt;0.05),与性别、年龄、分化程度不相关(Pgt;0.05)。结论:M-CS与结直肠癌的肿瘤分期、淋巴结转移及远处转移有关,可能是一个判断结直肠癌预后的生物学指标。
Objective To discuss the prophylactic effect of handling inguinal nerves correctly duing Lichtenstein inguinal hernia repair on chronic pain after operation. Methods 158 patients with inguinal hernia who were treated in our hospital from February 2007 to March 2010 were given Lichtenstein hernia repair. The ilioinguinal nerves were carefully identified and preserved during the operation, the nerve excision had been carried on only in the cases of existing nerve injuried or interference with the position of the mesh. Results The identification rate of iliohypogastric nerve, ilioinguinal nerve, and genital branch of genitofemoral nerve was 87.97%（139/158）, 82.28%（130/158）, and 34.18%（54/158）, respectively. The postoperative complication rate was 5.06%（8/158）, in which subcutaneous hydrops 5 cases, scrotal hematoma 2 cases, and wound infection 1 case, all recovered by conservative management. There was not inguinal hernia recurrence in 12 months of follow-up. In 1 month after operation, there were 63（39.87%） patients suffered from mild pain and 34（21.52%） patients suffered from moderate pain in inguinal region, there was no patient with severe pain, the mean pain score was 0.83. The incidence of chronic groin pain in 6 months was 5.06% （8/158）, in which 7（4.43%） patients suffered from mild pain, and 1（1/158） patient suffered from moderate pain. In 12 months, only 4（2.53%） patients still experience occasional pain or discomfort, the mean pain score was 0.03. Multinomial logistic regression analysis indicated that neurectomy had no influence on postoperative pain（P＞0.05）and non-identification of ilioinguinal nerve was a risk factor for early（1 month） postoperative moderate pain（OR=3.373, P=0.030）. Conclusions Standard surgical procedure acted according to the Lichtenstein guidelines and handling inguinal nerves correctly can result in low incidence of chronic pain after operation, and can make the patients have a better quality of life.
ObjectiveTo explore the influence of propofol as well as sevoflurane on the histamine release induced by mivacurium chloride. MethodsForty patients with American Sociaty of Anesthesiologists stage Ⅰ-Ⅱ scheduled to receive ear-nose-throat surgery between March and October 2012 were recruited and were randomly assigned into two groups:propofol group and sevoflurane group. Patients in the propofol group were induced with targeted intravenous infusion with propofol. Patients in the sevoflurane group was induced with sevoflurane. The blood specimen was prepared before mivacurium chloride (0.16 mg/kg) infusion (T0), 1 minute (T1), 3 minutes (T2), and 5 minutes (T3) after the infusion. Mean blood pressure (MBP) and heart rate (HR) were recorded at corresponding time points. In addition, we recorded the symptoms of anaphylactic reaction such as skin erythema or bronchospasm. ResultsBoth MBP and HR decreased after anesthesia induction. However, there was no significant difference from that before the induction in both groups, and no difference was found between the two groups (P>0.05). The concentration of histamine in both groups at T1 and T2 was significantly higher than that at T0 (P<0.05). The concentration of histamine in both groups at T4 was significantly higher than that at T0 (P<0.05). The concentration of histamine in the propofol group was higher than that in the sevoflurane group. No skin erythema or bronchospasm was found in any of the two groups. ConclusionMivacurium chloride at a dose of 0.16 mg/kg can be safely used in propofol anesthesia, as well as sevofluane anesthesia, with no clinically significant histamine release or adverse hemodynamic fluctuation.