目的 评价硬膜外麻醉合用丙泊酚用于腹腔镜胆囊切除术的可行性。方法 择期行腹腔镜胆囊切除术患者850例，经T 9～10椎间隙行硬脊膜外腔穿刺置管，给予常规剂量的2%利多卡因或0.75%布比卡因，气腹前静脉注射丙泊酚1～2 mg/kg,直至患者意识消失，继以10 mg/(kg·h)维持麻醉深度。结果 全组850例患者术中麻醉效果好，腹肌松弛，意识消失后避免了气腹引起的牵扯反射，停止使用丙泊酚10 min左右时间，大部分患者即恢复呼唤反应。 结论 硬膜外麻醉合用丙泊酚用于腹腔镜胆囊切除术是一种效果很好的临床麻醉方法。
Objective To observe the changes of serum potassium level and the factors that affected it when preoperative intravenous administration of gelofusine was given rapidly at high dose. Methods Thirty patients scheduled for upper abdominal operation were selected for the study and they were randomizely divided into test group (gelofusion group) and control group with 15 cases in each group. The first blood and urine sample was taken after epidural puncture and the potassium value was used as basic values. Then an intravenous administration of gelofusion at a dose of 10ml/kg was given in gelofusion group within 30min and then the second sample was obtained. Another intravenous administration of gelofusion at a dose of 10 ml/kg was given within 1 hour and the third sample was taken, while the fourth and fifth samples were taken 30 and 90 minutes after the third samples taken respectively. All the blood samples were tested for serum level of electrolytes (Na+,K+,Cl-,Ca2+,Mg2+), pH, Osm, Hct. The value of electrolytes (Na+,K+,Cl-,Ca2+,Mg2+) of urine samples were determined too. The intracellular levels of K+ and Mg2+ of erythrocyte were tested. The gelofusion were replaced by saline solution in control group and the other procedures were the same.Results The serum level of potassium was decreased progressively after rapid intravenous administration of gelofusine at high dose. Conclusion The serum level of potassium will decrease significantly after rapid intravenous administration of gelofusion at high dose during operation.
ObjectiveTo evaluate the ultrasonic pre locating internal jugular venous cannulation in infants, comparison with the external landmark technique.MethodsSixty two infants scheduled for cardiac surgery were randomized prospectively into two groups. In the anatomic landmarks group( n =30), the patient’s internal jugular vein(IJV) were cannulated by using the traditional method of palpation of carotid pulsation and identification of other anatomic landmarks. In the ultrasonic pre locating group ( n =32), an two dimensional ultrasound scanner image made for locating the puncture site of vessels was used with an operative probe of HP SONOS 4500 system. The number of attempts, success rate, and incidence of complications were compared for two groups.ResultsThe success rate was 100% vs 80% in the ultrasonic pre locating group vs anatomic landmarks group, with a 3.1% vs 26 7% incidence of carotid artery punctures and the number of attempts 1.57±1.04 vs 2.55±1.76. All differences were statistically significant ( P lt;0.05,0.05,0.01). Conclusion Ultrasonographic pre-localization of the IJV is superior to the anatomic landmarks technique in terms of overall success , and decreases incidence of carotid artery puncture.
目的 观察不同浓度肾上腺素与利多卡因混合液头皮浸润注射对开颅术患者血流动力学的影响。方法 选取2010年5月－10月80例颅内肿瘤患者，随机分成4组，行1%利多卡因溶液混合不同浓度的肾上腺素16 mL头皮浸润注射。肾上腺素浓度：A组2.5 μg/mL、B组5.0 μg/mL、C组7.5 μg/mL、D组10.0 μg/mL。记录注射前（T0）、注射后5 min内（T1-10）心率（HR）、平均动脉压（MAP）、收缩压（SBP）、舒张压（DBP），根据各时段的MAP最低值和最高值，计算MAP的降低率和升高率，计数各组MAP下降10%以内、10%～20%和20%以上的例数。 结果 C组的MAP下降例数最多且MAP下降率最高，与其他组间比较差异有统计学意义（P＜0.05）。组内比较，C组MAP、SBP在1.5、2.0、2.5 min时、DBP在2 min时和D组MAP和DBP在1.5、2.0 min时下降差异有统计学意义（P＜0.05）。4组血压下降的同时伴HR增快，但HR组间差异无统计学意义（P＞0.05）。 结论 低浓度的肾上腺素与10%利多卡因混合液用于开颅术患者头皮浸润注射时可导致血压下降。