【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.
【摘要】 目的 觀察不同劑量的舒芬太尼用于剖宮產術后硬膜外自控鎮痛的效果比較。 方法 將2009年4-11月60例硬膜外麻醉下行剖宮產手術術后的患者隨機分為三組，術后鎮痛液A組采用0.125%羅哌卡因復合0.3 μg/mL舒芬太尼；B組為0.125%羅哌卡因復合0.4 μg/mL舒芬太尼；C組0.125%羅哌卡因復合0.5 μg/mL舒芬太尼，觀察三組患者的術后鎮痛效果（視覺模擬法評分，即VAS評分）及不良反應。 結果 A組VAS評分高于B組和C組，B組VAS評分高于C組（Plt;0.05）。三組患者術后惡心嘔吐、運動阻滯、嗜睡及腸蠕動抑制等并發癥無統計學差異（Pgt;0.05）。 結論 0.125%羅哌卡因復合0.5 μg/mL舒芬太尼以4 mL/h持續輸注用于剖宮產術后患者自控硬膜外鎮痛術后疼痛VAS評分最小，患者鎮痛滿意度最高。【Abstract】 Objective To observe the effect of postoperative patient-controlled epidural analgesia (PCEA) with three different doses of sufentanil combined with 0.125% ropivacaine after cesarean section. Methods Data was collected from April 2009 to November 2009. Sixty patients after cesarean section under continuous epidural anesthesia were randomly divided into three different groups.Group A was given sufentanil 0.3 μg/mL and 0.125% ropivacaine for PCEA, group B was given sufentanil 0.4 μg/mL and 0.125% ropivacaine, group C was given sufentanil 0.5 μg/mL and 0.125% ropivacaine. The analgesia effects were evaluated by the visual analogue scales (VAS). Side effects were also recorded. Results The VAS scores were significantly the highest in group A than that in group B and group C, the VAS scores in group B were higher than that in group C (Plt;0.05). The incidence of side effects, such as postoperative nausea and vomiting, lethargy, and pruritus, was not significant among the three groups (Pgt;0.05). Conclusion 0.5 μg/ mL sufentanil and 0.125% ropivacaine recommended for PCEA with background 4 mL/h is safe and effective for patients after cesarean section.
ObjectiveTo study the feasibility of using propofol and remifentanil for tracheal intubation in patients who are awake, and investigate the influence of tracheal intubation on such vital signs as blood pressure and heart rates.
MethodsEighty ASA I-Ⅱ patients who underwent general anesthesia in our hospital between December 2012 and April 2013 were randomly divided into two groups. Patients in group A received fentanyl-propofol, while patients in group B received remifentanyl-propofol-lidocaine. There was no significant difference between the two groups in gender, age, and body weight (P>0.05). Conventional intubation induction method was used for group A:0.05-0.10 mg/kg midazolam, 4 μg/kg fentanyl, 1.0-1.5 mg/kg propofol, and 0.6-0.9 mg/kg atracurium were given and tracheal intubation was performed after muscle relaxation. Group B patients were treated with remifentanyl propofol-lidocaine compound liquid slow intravenous injection, and compound cricothyroid membrane puncture method before endotracheal intubation. We observed the two groups of patients for vital signs before and after induction, and choking cough reactions.
ResultsPatients in both the two groups were all able to complete tracheal intubation. Circulation change and incidence of tachycardia in patients of group A were significantly higher than those in group B (P<0.05). The rates of bradycardia, hypoxemia, and choking cough response were low in both groups with no statistically significant difference (P>0.05).
ConclusionRemifentanyl propofol-lidocaine compound liquid can be safely used for implementation of endotracheal intubation in patients who are awake, and the hemodynamic stability can be maintained.
【摘要】 目的 比較術后芬太尼皮下鎮痛（PCSA）與硬膜外鎮痛（PCEA）的臨床效果，以及對胃腸功能的影響。 方法 2009年1-6月間觀察擇期硬膜外麻醉下經腹子宮切除術患者120例，術后分別實施PCSA與PCEA，觀察術后第4、8、12、24、48 h的鎮痛、鎮靜情況，呼吸循環、惡心嘔吐及其他不良事件，記錄術后首次肛門排氣時間，測評術后鎮痛滿意度。 結果 術后兩組患者鎮痛優良率均在90%以上，各時點鎮痛評分、鎮靜評分、惡心嘔吐發生率、首次肛門排氣時間以及患者鎮痛優良率差異均無統計學意義（Pgt;0.05）。 結論 術后芬太尼PCSA與PCEA一樣，效果確切，對術后胃腸功能無明顯影響，患者滿意，是一種安全、有效的鎮痛方法。【Abstract】 Objective To compare clinical efficiency and gastrointestinal reaction of subcutaneous patient-controlled analgesia (PCSA) and epidural patient-controlled analgesia (PCEA) with fentanyl analgesic for patients after operation. Methods A total of 120 patients having undergone transabdominal hysterectomy under epidural anesthesia between January and June 2009 accepted PCSA or PCEA after operation. We evaluated the state of analgesia and sedation at the 4th, 8th, 12th, 24th and 48th hour after operation. We also looked into the respiration, blood circulation, nausea, vomiting and other abnormal events of the patients during the first 48 hours after operation. At the same time, we recorded the first time of anal exsufflation after operation and the degree of patients’ satisfaction. Results The analgesic effective rate was higher than 90% in both groups. There were no significant differences in analgesia and sedation scores at above-mentioned points after operation, incidence of nausea and vomiting, first time of anal exsufflation or analgesic effective rate between the two groups. Conclusion PCSA with fentanyl can be as effective in relieving postoperative pain as PCEA with fentanyl without obvious adverse effect in the gastrointestinal function. Therefore, PCSA is a safe and effective method to alleviate postoperative pain.
【摘要】 目的 探討術中應用曲馬多、芬太尼對全麻蘇醒期鎮痛效果的影響。 方法 2009年10月-2010年4月將80例靜脈麻醉下行胃癌根治術的患者隨機分為4組:Q1組曲馬多1 mg/kg、F1組芬太尼1 μg/kg、Q2組曲馬多2 mg/kg、F2組芬太尼2 μg/kg。各組分別于術畢前30 min靜注給藥。手術結束后送恢復室，比較4組的呼喚睜眼時間、拔管時間、拔管后即刻疼痛評分（VAS評分）、術前術后平均動脈壓（MAP）、心率（HR）、脈搏血氧飽和度（SpO2）的變化以及不良反應的發生情況。 結果 4組患者呼喚睜眼時間差異無統計學意義（Pgt;0.05），F2組的拔管時間明顯長于其他3組（Plt;0.05），Q1組和F1組的疼痛評分明顯高于Q2組和F2組（Plt;0.05），在T2時點，Q2組和F2組的MAP值明顯低于Q1組和F1組（Plt;0.05）。 結論 曲馬多2 mg/kg與芬太尼2 μg/kg的鎮痛效果的效果相當，但安全性更高，更加適合全麻蘇醒期的鎮痛治療。【Abstract】 Objective To investigate the effects of tramadol and fentanyl on analgesia in the early recovery period after general anesthesia. Methods A total of 80 patients who underwent the operation of gastric cancer under general anesthesia from October 2009 to April 2010 were randomly divided into four groups: group Q1 received tramadol 1 mg/kg, group F1 received fentanyl 1 μg/kg, group Q2 received tramadol 2 mg/kg, and group F2 received fentanyl 2 μg/kg. Thirty minutes before the end of surgery, intravenous administration was performed on all of the patients. In the recovery room, the wake-up time, extubation time, pain level evaluated by Visual Analogue Scale (VAS), the mean arterial pressure (MAP), heart rate (HR) and pulse oxygen saturation (SpO2) before and after the surgery, and incidence of complications were recorded. Results No significant differences in wake-up time among the four groups were found (Pgt;0.05). The extubation time was longer in group F2 than that in the other three groups (Plt;0.05). The VAS scores in group Q1 and F1 were higher than those in group Q2 and F2. At the T2 time point, MAP in group Q2 and F2 were lower than those in group Q1 and F1 (Plt;0.05). Conclusion The analgesic efficacy of tramadol 2 mg/kg is similar to that of fentanyl 2 μg/kg, but tramadol is more suitable for analgesic treatment in recovery period after general anesthesia due to the higher security.
