目的：探討丙泊酚、芬太尼用于纖支鏡檢查的安全性。方法：60例纖支鏡檢查患者分為丙泊酚組和對照組。丙泊酚組采用芬太尼1～15 μg/kg,丙泊酚1～2 mg/kg靜脈麻醉，觀察檢查前、纖支鏡進入聲門后5分鐘、檢查后的HR、BP、RR 、SpO2變化及兩組病例術中、術后的反應。結果：丙泊酚組檢查中HR、BP較對照組平穩(P＜0.01), RR、SpO2變化與對照組比較無明顯統計學差異(P＞0.05)，丙泊酚組檢查中、檢查后不良反應少，蘇醒快，患者滿意。結論：丙泊酚、芬太尼用于纖支鏡檢查，減少了患者的恐懼與痛苦，提供了良好的檢查條件，同時也是安全可行的。
The present study was to investigate the effects of infusing remifentanil-poly-caprolactone (REM-PCL) through the abdominal aorta on spinal cord ischemia reperfusion injury (SCIRI). The model of SCIRI was created by clamping the infrarenal aortic in thirty-six New Zealand white rabbits, which were randomly divided into sham group (group S), control group (group C), and REM-PCL group (group R) with 12 rabbits in each one. The spinal cord microcirculatory blood flow (SCMBF) and blood flow rate (BFR) were monitored before ischemia, 15 min, 30 min, 60 min and 120 min after reperfusion, respectively. Neurologic Function was evaluated before ischemia, 6h, 12h and 24h after reperfusion. The concentration of serum neuron-specific enolase (NSE), interleukin-lβ (IL-lβ) and interleukin-8 (IL-8) were monitored before ischemia, 45 min after ischemia, 30 min, 60 min, 6 h, 12 h and 24 h after reperfusion. The abnormal rate of motor neuron of spinal cord tissues and the level of superoxide dismutase (SOD), reactive oxygen species (ROS), glutathione peroxidase (GSH-PX), malondialdehyde (MDA), total anti-oxidation capacity (T-AOC) and mitochondrial swelling degree (MSD) in neural mitochondria were determined before ischemia, 45 min after clamping, 60 min and 120 min after reperfusion. As a result, the neural mitochondrial SOD, GSH-PX and T-AOC decreased while ROS, MDA, MSD, IL-lβ, IL-8 and NSE distinctly increased after clamping of the abdominal aorta as compared to the value before ischemia in group C (P < 0.01). Neurologic function scores recovered more rapidly in group R than those in group C during reperfusion (P < 0.01). The neural mitochondrial SOD, GSH-PX and T-AOC were distinctly higher while ROS, MDA, MSD, IL-lβ, IL-8 and NSE were distinctly lower in group R than those in group C (P < 0.01). The abnormal rate of motor neuron was significantly higher in group C during reperfusion than that in group R (P < 0.01). It has been shown that the intra-aortic REM-PCL infusion can alleviate SCIRI by inhibiting inflammatory response and improving mitochondrial anti-oxidation capacity.
目的:探討甲狀腺手術中氟比洛芬酯對丙泊酚—瑞芬太尼麻醉效果的影響。方法:將210例擇期丙泊酚—瑞芬太尼麻醉下行甲狀腺手術患者隨機分為對照組和氟比洛芬酯組,每組105例。于切皮前30 min,對照組靜脈注入等量生理鹽水10mL,氟比洛芬酯組經靜脈注入氟比洛芬酯注射液100 mg。分別記錄患者麻醉前10 min (T0)、切皮時(T1)、切皮后10 min (T2)、切除腺體時 (T3)以及拔管時 (T4) 的血流動力學 (SBP、DBP、HR) 的變化以及術后口述描述評分(VRS)。結果:與對照組比較, 氟比洛芬酯組T14時SP、DP均降低,兩組差別有統計學意義(Plt;005)。氟比洛芬酯組離開手術室時無痛率明顯高于對照組,兩組差別有統計學意義(Plt;005)。結論:氟比洛芬酯對丙泊酚—瑞芬太尼麻醉下行甲狀腺手術患者血流動力學影響小,且減輕術后疼痛,術后恢復更為舒適。
【摘要】 目的 確定在不同濃度七氟醚復合瑞芬太尼誘導無肌松氣管插管時瑞芬太尼的半數有效量（ED50）。 方法 2009年7月-2009年11月擇期手術患者60例，ASA I~II，年齡20~59歲，按照入室的順序隨機分為Ⅰ組（2%七氟醚組）和Ⅱ組（3%七氟醚組），預沖8%七氟醚誘導，眼瞼反射消失后，調節七氟醚呼氣末濃度分別維持在2%或3%，同時按照序貫法注入瑞芬太尼，瑞芬太尼注射90 s后氣管插管。記錄麻醉誘導前、患者意識消失時、插管前1 min、插管后1 min及插管后3 min心率、平均動脈壓的變化。 結果 2%、3%的七氟醚復合瑞芬太尼誘導氣管插管時瑞芬太尼的半數有效量（ED50）及其相對應的95%可信區間分別為0.585 μg/kg及0.533～0.626 μg/kg和0.492 μg/kg及0.451～0.572 μg/kg。 結論 2%、3%的七氟醚復合瑞芬太尼誘導氣管插管時瑞芬太尼的半數有效量及其相對應的95%可信區間分別為0.585 μg/kg及0.533～0.626 μg/kg和0.492 μg/kg及0.451～0.572 μg/kg。【Abstract】 Objective To determine the half effective dose (ED50) of remifentanil dose for tracheal intubation without neuromuscular relaxant in adult when combined with different concentration of sevoflurane. Methods Sixty ASA Ⅰ to Ⅱ adult aged 20 to 59 years old, scheduled for elective surgery under general anesthesia were enrolled in this study between July 2009 to November 2009. All patients were ranged randomly into Group Ⅰ (2% sevoflurane) and Group Ⅱ (3% sevoflurane).Anesthesia was induced with 8% sevoflurane in 100% oxygenat at 6 L/min.After the loss of eyelash reflex, remifentanil was injected over 30 s, end-tidal sevoflurane concentration 2% or 3% was maitained. The dose of remifentanil was determined by up-and-down method. In 90 s after the end of bolus administration of remifentanil, the trachea was intubated. Mean blood pressure and heart rate were recorded at anaesthetic induction, the loss of eyelash reflex, before, in 1 min and 3 min after intubation. Results ED50 values (95% confidence intervals)of remifentanil for tracheal intubation during 2% and 3% sevoflurane induction without neuromuscular relaxant were 0.585 μg/kg and 0.533 - 0.626 μg/kg, and 0.492 μg/kg and 0.451 - 0.572 μg/kg, respectively. Conclusion ED50 values (95% confidence intervals)of remifentanil for tracheal intubation 2% and 3% sevoflurane induction without neuromuscular relaxant are 0.585 μg/kg (0.533 - 0.626 μg/kg) and 0.492 μg/kg (0.451 - 0.572 μg/kg), respectively.
Objective To systematically evaluate effectiveness, dosage and adverse reaction of sufentanil versus fentanyl for postoperative patient-controlled epidural analgesia (PCEA), so as to provide evidence for rational drug use in clinic. Methods Databases including The Cochrane Library, the special trials registered in the Cochrane anesthesia group, MEDLINE, EMbase, CBM, CNKI, VIP and WanFang Data were searched by the end of 2012, and the relevant periodicals were also manually searched to collect the randomized controlled trials (RCTs) on sufentanil versus fentanyl for postoperative patient-controlled epidural analgesia. According to the Cochrane Handbook 5.0, literature was screened, data were extracted, and quality of the included studies was critically assessed. Then meta-analysis was performed using RevMan 5.1 software. Results A total of 25 RCTs involving 1 944 patients were included. The results of meta-analyses showed that: a) as for visual analog scale (VAS), compared with the fentanyl group, the postoperative VAS at 2-hour, 4-hour, 8-hour, 12-hour, 24-hour and 48-hour was decreased in the sufentanil group; b) as for sedation scale, the fentanyl group, the postoperative sedation at 12-hour and 24-hour was lower in the sufentanil group when adopting 0 to 3 points scoring method, but there were no significant differences at other time points; c) as for drug dosage, compared with the fentanyl group, the postoperative drug consumption at 24-hour and 48-hour was less in the sufentanil group; d) as for adverse reaction, the incidence of postoperative nausea, vomiting, dizziness and somnolence in the sufentanil group was lower than those in the fentanyl group. But there was no significant difference in other adverse reactions such as skin itching, limbs numbness and motor disturbance between the two groups; and e) as for the demands of additional analgesic drugs, compared with the fentanyl group, the incidence of demanding additional analgesic drugs was lower in the sufentanil group. Conclusion Compared with fentanyl, sufentanil has better effects of analgesia and sedation for PCEA; Its dosage and incidence of adverse reactions are lower, so sufentanil is safer in clinic.
目的 通過對腹部手術后自控靜脈鎮痛（PCIA）不同藥物配方的研究，探討酒石酸布托啡諾與舒芬太尼用于術后PCIA臨床效果。 方法 將2012年2月－8月收治的60例麻醉分級為Ⅰ～Ⅲ級需術后鎮痛的腹部手術患者（均無心、肺、肝、腎、腦、內分泌疾病及過敏史）隨機分成兩組：酒石酸布托啡諾組（N組，n=30），舒芬太尼組（S組，n=30）。觀察鎮痛效果和不良反應發生率。 結果 兩組鎮痛效果差異無統計學意義（P＞0.05），不良反應（包括惡心、嘔吐、頭暈、嗜睡、皮膚瘙癢、呼吸抑制、尿潴留等），N組發生率均低于S組（P＜0.05）。 結論 酒石酸布托啡諾用于PCIA安全、有效，不良反應少。
目的 觀察右美托咪啶復合舒芬太尼用于經腹子宮全切術后患者自控靜脈鎮痛（PCIA）的效果。 方法 2011年3月－2012年6月選擇經腹子宮全切術患者90例，年齡39～68歲，體重48～72 kg，美國麻醉醫師協會分級Ⅰ～Ⅱ級。采用隨機數字表法，將患者隨機分為3組，每組各30例。于手術結束即刻行PCIA。對照組（C組）采用舒芬太尼150 μg+昂丹司瓊12 mg；S1組采用右美托咪定200 μg+舒芬太尼100 μg+昂丹司瓊12 mg；S2組采用右美托咪定200 μg+舒芬太尼150 μg+昂丹司瓊12 mg。3組均用生理鹽水稀釋至100 mL，負荷劑量均為舒芬太尼0.1 μg/kg，靜脈鎮痛泵背景輸注速度2 mL/h，自控給藥劑量0.5 mL，鎖定時間15 min。記錄術后6、12、24和48 h Ramsay鎮靜評分和視覺模擬評分（VAS），記錄不良反應發生情況和患者對術后鎮痛的滿意度。 結果 3組患者均能獲得較好的鎮痛效果。其中C組VAS評分較低，但惡心、嘔吐、皮膚瘙癢發生率升高；與C組相比，Sl組和S2組Ramsay鎮靜評分升高，惡心、嘔吐、皮膚瘙癢發生率降低，患者滿意度升高。S1組患者滿意度最高；S2組VAS評分最低。3組均未發生心動過緩、低血壓、過度鎮靜和呼吸抑制。 結論 右美托咪啶可增加經腹子宮全切術患者術后舒芬太尼自控靜脈鎮痛的效果，提高患者滿意度，降低不良反應。