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原發癌腫切除并雙插管化療治療直腸乙狀結腸癌伴肝轉移26例報告

The Half Effective Dose of Remifentanil for Tracheal Intubation with Different Concentration of Sevoflurane without Neuromuscular Relaxant in Adult

【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.

Selection Cannula Vessel of Portal Venous System in Extracorporeal Venous Bypass of Swine Orthotopic Liver Transplantation

【Abstract】ObjectiveTo compare the hemodynamic changes during operation of portal venous intubation or splenic venous intubation in extracorporeal venous bypass of swine orthotopic liver transplantation.MethodsThirty couples of healthy Duloke pigs were selected to perform orthotopic liver transplantation. According to the difference of cannula vessel of portal venous system during extracorporeal venous bypass, these pigs were divided into two groups: portal venous intubation group (n=15) and splenic venous intubation group (n=15). Hemodynamic changes were monitored continuously.ResultsTwo recipients died in portal venous intubation group, one died of unsmooth bypass in the operation, the other died of DIC. In splenic venous intubation group there was only one recipient death, who died of hemorrhagic shock. The time of anhepatic phase of splenic venous intubation group was (44.5±7.6) min, it was significantly shorter than portal venous intubation group(51.5±8.7) min(P＜0.05). Hemodynamic changes in phase Ⅲ and phase Ⅳ of portal venous intubation group were significantly different with that of splenic venous intubation group(P＜0.05). ConclusionApplication of bypass through splenic venous intubation during extracorporeal venous bypass of swine orthotopic liver transplantation can shorten the time of anhepatic phase, keep the hemodymamics relative stable in operation, and reduce the occurrence of postoperative correlative complication. It is an effective venovenous bypass pathway.

1，3-β-D葡聚糖檢測對尿路插管所致真菌感染的診斷價值

【摘要】 目的 探討尿路插管所致真菌感染患者的血漿和尿液中1，3-β-D葡聚糖檢測的臨床意義。 方法 將2009年1-5月47例尿路插管所致真菌感染患者設為試驗組，50例正常健康體檢者設為對照組，分別檢測其血漿和尿液中1，3-β-D葡聚糖的水平。 結果 試驗組與對照組比較，血漿及尿液中1，3-β-D葡聚糖含量差異有統計學意義（Plt;0.001）；試驗組的尿液和血漿中1，3-β-D葡聚糖含量比較，有統計學意義（Plt;0.05），尿液中的1，3-β-D葡聚糖含量高于血漿。 結論 血漿和尿液1，3-β-D葡聚糖水平檢測可作為診斷泌尿系統真菌感染的可靠指標，且尿液樣本的診斷價值高于血漿。

Effects of non-endotracheal intubation versus endotracheal intubation in thoracic surgery

ObjectiveTo investigate the feasibility and safety of non-intubation anesthesia in thoracic surgery.MethodsFrom September 2017 to December 2019, 296 patients were operated at department of thoracic surgery in our hospital. There were 167 males and 129 females with an average age of 50.69±12.95 years, ranging from 16 to 76 years. The patients were divided into two groups according to whether they were intubated: 150 patients were in a non-intubation group, including 83 males and 67 females with an average age of 49.91±13.59 years, ranging from 16 to 76 years, and 146 patients were in an intubation group including 84 males and 62 females with an average age of 51.49±12.26 years, ranging from 16 to 74 years. Intraoperative data, postoperative recovery, inflammatory response of the two groups were compared.ResultsThere was no statistical difference between the two groups in operation time, blood loss, the lowest oxygen saturation or other indicators (P>0.05). But the highest partial pressure of carbon dioxide of the non-intubation group was higher than that of the intubation group (P=0.012). The non-intubation group was superior to the intubation group in postoperative recovery and inflammatory response (P<0.05).ConclusionThe non-intubation anesthesia is safe and maneuverable in thoracic surgery, and it has some advantages in accelerating postoperative rehabilitation.

Thrombolysis infusion via microcatheter treating central retinal artery occlusion

ObjectiveTo investigate the therapeutic effects of thrombolysis infusion via microcatheter on the treatment of central retinal artery occlusion(CRAO). MethodsUrokinase (UK) was directly infused via ophthalmic artery (OA) by microcatheter (6 patients) or via intravenous (7 patients) to dissolve the thrombus. The patency of the artery was evaluated by fundus fluorescein angiography (FFA), and the effect of fibrinolytic activity on the systemic changes was observed by blood biochemical examination simultaneously. ResultsIn 6 patients in the microcatheter group, 5 had completely and 1 had partly reopened OA on the morrow of UK infusion with the patency rate of 83.33%, while in 7 patients in vein group, 3 completely reopened, 2 partly reopened and 2 obstructed OA were found with the patency rate of 42.86%. The difference between the two groups was significant. No obvious change of index of blood coagulation system was found in catheter group, which had great disparity compared with the vein group.ConclusionUrokinase infusion via microcatheter in CRAO has better therapeutic impact and smaller effect on systemic action. (Chin J Ocul Fundus Dis, 2005,21:16-19)

Investigation and analysis of influence factors of thirst in ICU patients with oral tracheal intubation and ventilator assisted ventilation

Objective To investigate the thirst status of patients in intensive care unit (ICU) who underwent oral tracheal intubation and ventilator assisted ventilation, and explore its influence factors. Methods A total of 172 patients with oral tracheal intubation admitted in ICU from June 2020 to September 2021 were investigated, and a numerical rating scale was employed for rating their thirst feelings. The patients were divided into a thirst group and a non-thirst group based on thirst status. The thirst status and influence factors of thirst distress were analyzed. Results The incidence of thirst in the ICU patients with oral tracheal intubation and ventilator assisted ventilation was 88.4%, and the thirst score in the thirst group was 7.70±1.17. Single factor analysis showed statistically significant difference between the two groups in sex, medical payment, smoking, drinking, duration of mechanical ventilation, humidification effect, sputum viscosity, gastrointestinal decompression, fasting, continuous renal replacement therapy, diuretics, 24-hour urine volume and liquid balance, heart function grading, sedatives, agitation, sweating, acute physiology and chronic health evaluation Ⅱ, endotracheal intubation depth, body mass index, PCO2, PO2, HCO3–, tidal volume, and sodium ion (all P<0.05). Multivariable regression analysis demonstrated that diuretics, sputum viscosity, sodium ion, alcohol consumption, smoking, intubation depth, and cardiac function were independent influence factors for the occurrence of thirst in the ICU patients who received tracheal intubation (P<0.01). Conclusions The incidence of thirst was high in ICU patients with airway intubation and ventilator assisted ventilation. Diuretics, sputum viscosity, sodium ion, alcohol consumption, smoking, 24-hour urine volume, and cardiac function grading were independent influence factors for the occurrence of thirst in ICU patients with tracheal intubation. It is necessary to implement targeted intervention to prevent and alleviate the thirst degree of patients, reduce the occurrence of related complications, and improve patient comfort.

Comparison of Proseal Laryngeal Mask Airway with Endotracheal Intubation in General Anesthesia during Gynecologic Laparoscopic Surgery

目的 探討雙管喉罩與氣管插管用于全身麻醉婦科腹腔鏡手術的安全性和可行性。 方法 2009年1月-5月擇期婦科腹腔鏡手術患者60例，ASAⅠ～Ⅱ級，隨機分為喉罩組（P組）和氣管插管組（T組）。記錄入室基礎值（T0），置罩（管）前（T1），置罩（管）后即刻（T2），置罩（管）后5 min（T3 ），拔除罩（管）即刻（T4），拔除罩（管）后5 min（T5）的收縮壓（systolic pressure, SBP），舒張壓（diastolic pressure, DBP），心率（heart rate, HR）和脈搏血氧飽和度（pulse oxygen saturation, SpO2），喉罩和氣管插管控制呼吸時氣腹前后不同時段的氣道峰壓（airway. maximum pressure, Pmax），潮氣量（vital volume, VT）和呼氣末二氧化碳分壓（end tidal CO2, PETCO2）。記錄插罩（管）成功率，及相關并發癥。 結果 T2時T組SBP，DBP和HR顯著高于P組（P＜0.05），兩組術中通氣均滿意；Pmax，VT和PETCO2組間比較各時點無差異（P＞0.05）。氣腹后Pmax和PETCO2組內比較均高于氣腹前，差異有統計學意義（P＜0.05）。置罩（管）成功率組間比較差異無統計學意義，拔罩（管）期及術后24 h并發癥，喉罩組明顯低于氣管導管組，差異顯著（P＜0.05）。 結論 雙管喉罩用于全麻婦科腹腔鏡手術通氣效果滿意，安全可行。

氣管插管氣囊咬斷的緊急處理

氣管插管行機械通氣是近年來救治危重患者的重要手段之一, 尤其是呼吸衰竭( 簡稱呼衰) 患者的救治。本科室2011 年8 月收治1 例病毒性腦炎繼發癲癇后出現呼吸衰竭行氣管插管機械通氣患者, 在癲癇發作時咬斷氣管插管氣囊導管, 采用積極補救, 避免了重新插管, 現報道如下。

CLINICO-PATHOLOGICAL STUDY OF PREOPERATIVE SELECTIVE ARTERIAL PERFUSION CHEMOTHERAPY IN THE TREATMENT OF GASTRIC CANCERS

The effects of preoperative selective arterial perfusion chemotherapy (PSAPC) in the treatment of 20 cases of histologically confirmed gastric cancers is reported in which 12 patients were operated on, and a comparison with that of general chemotherapy in 10 cases of gastric cancers (as controls) was made. In the PSAPC group, besides the improvement of clinical symptoms and singns, the cancer cells of lesions in situ and metastatic lymph nodes have different degrees of degeneration and necrosis. This result show significant differences in two group comparison (Plt;O.01). We conclude that the PSAPC has good short-term effect and little side-effect. It can improve the resection rate and radical resection rate, and prevent the iatrogenic metastasis and implantation during operation, and decrease the postoperative recurrence of the patients with gastric cancer.