【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.
This study was designed to determine the effects of different anaesthesia on the postoperative gastrointestinal motility after cholecystectomy. Postoperative gastrointestinal motility were recorded continuously by means of gastrointestinal manometry in 20 patients subject to cholecystectomy (general anaesthesia 10, epidural anaesthesia 10). Normal migrating motor complex (MMC) was abolished during the early postoperative period in all patients. The time of reappearance of intestinal MMC varied from 0.5 to 2 hours . Gastric MMC recurred 5.5 to 14 hours postoperatively and the normal MMC completely recovered 22 to 43 hours after the operations. Ingestion of food changed the MMC into a fed pattern during the early postoperative period. There was no difference between the general anaesthesia group and epidural anaesthesia group in terms of gastrointestinal motility. The results indicate that postoperative gastrointestinal motility recovers faster than that was thought conventionally. Cholecystectomy under general anaesthesia or under epidural anaesthesia makes no difference in postoperative gastrointestinal motility.
【摘要】 目的 評價腦電雙頻指數（BIS）監測全身麻醉深度的準確性及實用性。 方法 2007年10月-2009年10月擇期行腹腔鏡膽囊切除手術的40例ASAⅠ或Ⅱ級患者隨機平均分為A、B組，兩組均采用丙泊酚、瑞芬太尼誘導和維持。A組以BIS值判斷麻醉深度并指導調整用藥，B組根據經驗調整用藥，使BIS值維持在50±5、MAP和HR維持在基礎值±20%范圍內。常規監測收縮壓（SBP）、舒張壓（DBP）、心率（HR）和BIS，計算用藥總量，記錄蘇醒時間；誘導期進行改良警覺/鎮靜（OAA/S）評分，評價BIS對全身麻醉手術期間麻醉深度的監測和指導意義。 結果 麻醉期間，B組SBP、DBP、HR和BIS波動明顯大于A組（Plt;0.05）；A組的蘇醒時間（7.5±2.5） min明顯短于B組（9.8±3.9） min（Plt;0.05）；拔管后，A組躁動、嗜睡、惡心、嘔吐患者少于B組；A組無1例發生手術中知曉，B組1例發生手術中知曉。 結論 BIS可動態反映大腦生理功能的變化，有助于臨床判斷全身麻醉深度，指導麻醉用藥。【Abstract】 Objective To evaluate the accuracy and practicality of bispectral index (BIS) used in patients undergoing general anesthesia. Methods Forty patients of ASA class Ⅰ or Ⅱ were randomly divided into group A and B,20 patients in each group. Anesthetic depth was judged and anesthetics was administered by BIS monitoring (being kept in 50±5) in group A or based on the experience of anesthetist in group B. After anesthesia induction, target propofol and remifentanil concentrations were adjusted to maintain the MAP, HR within the range of ±20% of preinduction values. Systolic pressure (SBP), distolic pressure (DBP), HR, SpO2 and BIS were monitored. Awake time and anesthetic consumption were recorded. Results The changes of SBP, DBP, HR and BIS were less in group A than those in group B (Plt;0.05).Awake time was shorter in group A than that in group B and restlessness drowsiness, nausea and vomitting after extubation were less in group A than those in group B. No awareness patient during operation was seen in group A, but one patient suffered from awareness in group B. Conclusion BIS monitoring can dynamicly reflect cerebral physilological function during general anesthesia and is helpful in judging anesthesia depth and directing the administration of anesthetics.
【摘要】 目的 探討腰硬聯合麻醉復合丙泊酚恒速輸注清醒鎮靜的可行性、理想的藥物劑量、術中知曉情況以及麻醉質量和效果。 方法 收集2009年3-12月480例美國麻醉醫師協會（ASA）Ⅰ～Ⅲ級擬在腰硬聯合麻醉下行下腹部、會陰部、下肢手術的患者480例，隨機分為咪達唑侖組（M組）、丙泊酚Ⅰ組（PA組）、丙泊酚Ⅱ組（PB組）、丙泊酚Ⅲ組（PC組），每組各120例。四組患者均于腰2-3或腰3-4行腰硬聯合麻醉，蛛網膜下腔注入輕比重0.2 %布比卡因12～15 mg，麻醉平面確切后，M組予以咪達唑侖0.04~0.06 mg/kg，PA組先予以負荷量丙泊酚0.50 mg/kg再以2.00 mg/（kg?h）劑量持續泵注，PB組予以負荷量丙泊酚0.75 mg/kg再以3.00 mg/（kg?h）劑量持續泵注，PC組予以負荷量丙泊酚1.00 mg/kg再以3.75 mg/（kg?h）劑量持續泵注。觀察患者給藥前（T0）、給藥1（T1）、3（T2）、5（T3）、10（T4）、30（T5）、60 min（T6）各時點血流動力學平均動脈血壓（MAP）、心率（HR）的變化、腦電雙頻指數（BIS）值及鎮靜評分、術中所看到的圖片的回憶及不良反應。 結果 各組在給予鎮靜藥后MAP、HR均有所下降，但測量值的變化在正常范圍內；在T3時間點，各組BIS值及鎮靜/警醒OAA/S評分降低，與T0比較，差異有統計學意義（Plt;0.05）；與其他3組比較，在T4、T5、T6時點PC組BIS值與OAA/S評分降低，差異有統計學意義（Plt;0.05），PC組的鎮靜遺忘滿意率高于其他3組；各組間未見發生嚴重的舌后墜、呼吸暫停和血氧飽和度（SpO2）lt;90%。 結論 在下腹部、下肢手術中，應用腰硬聯合麻醉復合1.00 mg/kg負荷量的丙泊酚繼而以3.75 mg/（kg?h）劑量持續泵注，可取得良好的鎮靜效果，不良反應小。【Abstract】 Objective To investigate the feasibility, ideal dose, intra-operative awareness as well as the quality and effectiveness of constant infusion of propofol under combined spinal-epidural anesthesia (CSEA) for conscious sedation. Methods A total of 480 patients at ASA grade Ⅰ-Ⅲ to be operated in the lower abdomen, perineum and lower limbs under CSEA from March to December 2009 were randomly divided into four groups: midazolam group (M group), propofol group Ⅰ (PA group), propofol group Ⅱ (PB group), and propofol group Ⅲ (PC group), with 120 patients in each group. All four groups of patients underwent CSEA at L2-3 or L3-4 and accepted pinal injection of 12-15 mg of 0.2% hypobaric bupivacaine. After the anesthetic plane was confirmed, patients in M group accepted 0.04-0.06 mg/kg of midazolam; patients in PA group accepted propofol at a loading dose of 0.50 mg/kg followed by continuous infusion at a dose of 2.00 mg/(kg?h); patients in PB group accepted propofol at a loading dose of 0.75 mg/kg followed by continuous infusion at a dose of 3.00 mg/(kg?h); patients in PC group accepted propofol at a loading dose of 1.00 mg/kg followed by continuous infusion at a dose of 3.75 mg/(kg?h). The change of hemodynamics including the mean arterial pressure (MAP) and the heart rate (HR), bispectral index (BIS) values, sedation scores, memory of pictures seen during operation and adverse effects before drug administration (T0), at minute 1 (T1), 3 (T2), 5 (T3), 10 (T4), 30 (T5) and 60 (T6) after drug administration were observed. Results MAP and HR decreased in all the four groups after administration of sedatives, but the changes of measured values were within normal ranges. BIS value and the Observer’s Assessment of Alertness and Sedation (OAA/S) scale decreased in all groups at T3, compared with those at T0 (Plt;0.05). Compared with the other 3 groups, BIS valueand OAA/S scale were significantly lower in PC group at T4, T5 and T6 (Plt;0.05), and the satisfaction rate of sedation and amnesia was much higher. No serious glossocoma, apnea and SpO2 below 90% was observed in all the four groups. Conclusion During the surgery of lower abdomen and lower limbs, application of CSEA combined with propofol at a loading dose of 1.00 mg/kg followed by continuous infusion at a dose of 3.75 mg/(kg?h) can achieve a good sedative effect, with little side effect.
目的 探討在局部麻醉下行痔上黏膜環形切除釘合術（procedure for prolapse and hemorrhoids，PPH）治療重度內痔的可行性及臨床應用價值。方法 筆者所在醫院科室從2005年起對32例Ⅲ度及Ⅳ度脫垂性內痔（含1例混合痔）患者均采用苯巴比妥＋氫溴酸東莨菪堿＋利多卡因肛管直腸環形局部浸潤麻醉行PPH術，對其麻醉效果、手術時間、術中及術后疼痛、尿潴留、術后感染、肛門狹窄、住院時間、治療滿意度等進行分析。結果 32例患者均順利完成手術，有1例術中改行低位連續硬膜外麻醉，1例輔加鎮靜劑及鎮痛劑。術后28例對疼痛能耐受，4例需鎮痛藥物；1例患者有肛門墜脹感；所有患者傷口均一期愈合，無尿潴留、術后感染、出血、肛門狹窄等并發癥發生；31例對療效滿意，有1例感肛門墜脹，行溫水坐浴及痔瘡膏納肛治療1周后緩解。住院時間3～6d，平均4d。32例患者均進行有效隨訪，隨訪時間2～4個月，平均3個月，無大便失禁或復發，肛門控便能力均可。結論 局部麻醉下行PPH術治療重度內痔是一種安全可行的手術方法，麻醉操作護理簡單，療效確切，術后并發癥少，術后恢復快，并可減少醫療費用。
