两种不同的静脉全麻方式行经皮肝穿刺射频消融术的临床观察

目的:比较咪唑安定和丙泊酚分别复合舒芬太尼用于B超引导下经皮肝穿刺射频消融术(PRFA)的麻醉效果。方法:选择2011年7月至2013年5月需行PRFA肝癌患者60例,随机分成丙泊酚组和咪达唑仑组各30例,分别复合舒芬太尼静注行全身麻醉。记录麻醉前(T0)、麻醉后5分钟(T1)、手术开始时(T2),手术开始后5分钟(T3),15分钟(T4),手术结束时(T5)的平均动脉压(MAP)、心率(HR)和血氧饱和度(Sp O2)。记录两组患者苏醒时间和定向力恢复时间,并进行术后6小时、12小时、24小时视觉模糊评分(VAS)。结果:丙泊酚组T1时的MAP明显低于麻醉前(P0.05),且明显低于咪达唑仑组(P0.05),两组患者T1时的HR明显低于麻醉前(P0.05),丙泊酚组患者T1时的Sp O2明显低于麻醉前(P0.05)。咪达唑仑组苏醒时间明显短于丙泊酚组,咪达唑仑组术后6小时VAS评分明显低于丙泊酚组(P0.05)。结论:与丙泊酚比较,咪达唑仑复合舒芬太尼静脉全麻具有对循环影响小、苏醒迅速,患者舒适无痛等优点,是较为合适的麻醉方式。     

咪达唑仑复合舒芬太尼在机械通气患者中的镇静效果观察

目的观察咪达唑仑复合舒芬太尼在机械通气患者中的镇静效果。方法将2013年10月~2014年5月在ICU行机械通气患者68例按照入院时间顺序进行分组,前34例为对照组,后34例为观察组。观察组应用咪达唑仑复合舒芬太尼,对照组仅使用咪达唑仑,并对两组效果进行比较分析。结果咪达唑仑复合舒芬太尼的镇静作用强,起效时间短,对呼吸、循环等重要系统影响小,患者生命体征平稳,躁动发生少,减少了机械通气人机对抗的发生,减少了使用呼吸机天数。而单纯用咪达唑仑的镇静效果浅,躁动及人机对抗的发生率较高。两组比较差异有统计学意义(P0.05)。结论咪达唑仑复合舒芬太尼用于机械通气患者能达到理想的镇静效果,安全性高,值得临床应用。     

小剂量右美托咪定用于局麻下玻璃体切割术的镇静效果观察

目的:探讨右美托咪定用于局麻下玻璃体切割术的镇静效果。方法:选择拟在局麻监测下行玻璃体切割术患者50例为研究对象,年龄20-72岁,ASA分级Ⅱ级~Ⅲ级,随机分为右美托咪定组(D组)和咪达唑仑组(M组),每组25例。D组患者于术前10min静脉泵注右美托咪定0.5μg/kg,后以0.2-0.4μg/kg.h的速度持续输注,M组术前10 min缓慢静脉注射咪达唑仑0.02 mg/kg,术中按需静注0.5 mg/次。维持VAS评分≤4分,Ramsay评分2-4分。记录和比较两组患者术中血压、心率、呼吸的变化、辅助用药及患者对镇静效果的满意度。结果:给药后,M组T5时点MAP较T0显著下降(P0.05),D组T10及以后各时点MAP较T0显著下降(P0.05);D组T5及以后各时点BP较T0显著下降(P0.05),但组间及M组组内BP比较差异无统计学意义(P0.05);M组T30时点HR较T0显著下降(P0.01),而在T5时,组间比较差异有统计学意义(P0.01),即D组下降更为显著。给药后各时点,D组VAS评分均显著低于M组(P0.05),30 min时达最低。两组Ramsay镇静评分给药后5 min均达2级以上,与给药前比较均显著升高(P0.05),D组给药后30 min及以后各时点Ramsay镇静评分均显著高于M组(P0.01)。给药后各时点,两组组内和组间SPO2和RR比较均无统计学差异(P0.05)。D组患者满意度较M组更高(P0.05)。结论:小剂量右美托咪定用于玻璃体切割术可使患者血流动力学平稳,镇静效果良好,疼痛感觉减轻,舒适度提高。     

右美托咪定与咪达唑仑用于肠镜检查患者镇静效果比较

目的:比较右美托咪定与咪达唑仑用于肠镜检查患者效果比较。方法:肠镜检查的患者60例,随机分为两组:D组静脉输注右美托咪定0.6μg/kg,M组静脉输注咪达唑仑0.08 mg/kg,均用生理盐水10 mL稀释,10 min输注完毕后进行肠镜检查。观察患者血流动力学指标及呼吸指标的变化,是否完成肠镜,患者的满意度以及检查过程中的不良反应。结果:右美托咪定组所有患者镇静满意,均能很好耐受肠镜检查,并且检查过程中MAP、HR和SpO2稳定(P0.05)。咪达唑仑组镇静时有轻度呼吸抑制,肠镜检查过程中MAP和HR升高(P0.05),插管耐受率低于右美托咪定组(P0.05)。结论:右美托咪定用于肠镜镇静有效,无呼吸抑制,血流动力学稳定,是理想的辅助药。     

舒芬太尼复合小剂量咪达唑仑在下肢骨折椎管内麻醉前的应用观察

目的观察舒芬太尼复合小剂量咪达唑仑在下肢骨折椎管内麻醉前的应用效果。方法选取我院收治的下肢骨折患者450例,采取数字随机法分为观察组和对照组。对照组在椎管内麻醉前给予小剂量咪达唑仑,观察组在对照组的基础上于椎管麻醉前加用舒芬太尼,比较两组的应用效果。结果观察组给药后收缩压(SBP)、舒张压(DBP)、心率(HR)水平均低于入室时(P0.05),而且也明显低于对照组(P0.05)。两组血氧饱和度(SpO2)水平在入室时、给药后比较,差异无统计学意义(P0.05)。观察组给药后30、45min的镇静、镇痛效果评分均高于对照组(P0.05),而且观察组给药后45min的镇静、镇痛效果评分低于给药后30min(P0.05)。结论舒芬太尼复合小剂量咪达唑仑在下肢骨折椎管内麻醉前的应用效果显著,可达到镇静、止痛作用。     

小剂量右美托咪定用于局麻下玻璃体切割术的镇静效果观察

目的：探讨右美托咪定用于局麻下玻璃体切割术的镇静效果。方法：选择拟在局麻监测下行玻璃体切割术患者50 例为研究对象,年龄20-72岁,ASA 分级Ⅱ级~Ⅲ级,随机分为右美托咪定组（D组）和咪达唑仑组（M 组）,每组25 例。D组患者于术前10min 静脉泵注右美托咪定0.5 滋g/kg,后以0.2-0.4 μg/kg.h 的速度持续输注,M组术前10 min 缓慢静脉注射咪达唑仑0.02 mg/kg,术中按需静注0.5 mg/ 次。维持VAS 评分≤ 4 分,Ramsay评分2-4 分。记录和比较两组患者术中血压、心率、呼吸的变化、辅助用药及患者对镇静效果的满意度。结果：给药后,M组T5时点MAP较T0显著下降（P〈0.05）,D组T10及以后各时点MAP 较T0显著下降（P〈0.05）;D 组T5及以后各时点BP 较T0显著下降（P〈0.05）,但组间及M 组组内BP 比较差异无统计学意义（P〉0.05）;M 组T30时点HR 较T0 显著下降（P〈0.01）,而在T5时,组间比较差异有统计学意义（P〈0.01）,即D 组下降更为显著。给药后各时点,D 组VAS 评分均显著低于M组（P〈0.05）,30 min 时达最低。两组Ramsay镇静评分给药后5 min 均达2 级以上,与给药前比较均显著升高（P〈0.05）,D组给药后30 min 及以后各时点Ramsay镇静评分均显著高于M组（P〈0.01）。给药后各时点,两组组内和组间SPO2和RR 比较均无统计学差异（P〉0.05）。D 组患者满意度较M组更高（P〈0.05）。结论：小剂量右美托咪定用于玻璃体切割术可使患者血流动力学平稳,镇静效果良好,疼痛感觉减轻,舒适度提高。     

右美托咪定与咪达唑仑对前列腺电切术患者术后认知功能的影响

目的:分析右美托咪定与咪达唑仑对前列腺电切术(TURP)患者认知功能的影响。方法:选择2013年5月-2015年5月在我院接受TURP治疗的良性前列腺增生患者73例作为研究对象。根据麻醉方法不同,将所选患者分为右美托咪定组和咪达唑仑组,分别采用右美托咪定和咪达唑仑麻醉。观察并比较不同时间点两组患者的心率(HR)及平均动脉压(MAP)的变化情况。应用精神状态量表(MMSE)评估两组患者手术前后的认知功能。结果:两组患者术前HR及MAP比较,差异均无统计学意义(P0.05);两组患者手术不同时间点HR、MAP均显著低于术前,且右美托咪定组低于咪达唑仑组,差异具有统计学意义(P0.05);两组患者术前MMSE评分比较,差异无统计学意义(P0.05);两组患者术后MMSE评分均低于术前,且右美托咪定组低于咪达唑仑组,差异均具有统计学意义(P0.05);右美托咪定组术中寒战发生率显著低于咪达唑仑组,差异具有统计学意义(P0.05)。结论:右美托咪定与咪达唑仑对TURP患者均会造成早期认知功能障碍,但右美托咪定的影响较小,患者生命体征较平稳,值得临床推广应用。     

氯胺酮复合咪达唑仑全麻在无水乙醇治疗先天性周围血管畸形中的效果评价

目的:观察氯胺酮复合咪达唑仑在无水乙醇治疗儿童先天性周围血管畸形的应用效果。方法:选择择期全麻下行无水乙醇治疗周围血管畸形儿童50例,随机分为两组:氯胺酮复合咪达唑仑组(M组)和丙泊酚持续输注组(P组),M组以咪达唑仑和氯胺酮基础下全麻,P组采用芬太尼镇痛基础下丙泊酚持续静注全麻,观察并记录入室(T_0)、麻醉诱导后5 min(T_1)、手术开始后30、60、90 min(分别为T_2、T_3、T_4)、拔管后5 min(T_5)的MAP与HR,监测脑电双频指数(bispectral index,BIS)并记录BIS40次数、平均注射无水乙醇量、术中输液量、苏醒时间及苏醒后5 min视觉模拟评分(Visual analog scales,VAS)、Ramsay镇静评分结果。结果:(1)与M组相比,P组MAP(T_2～T_54个时间点)、HR(T_1～T_55个时间点)和BIS值(T_3和T_42个时间点)均显著降低,差异有统计学意义(P0.05);三个指标其余时间点两组患儿相比,差异均无统计学意义(P0.05);(2)与M组患儿相比,P组BIS值40的患儿例数以及应用阿托品和麻黄碱例数均显著增加,差异具有统计学差异(P0.05);两组患儿平均无水乙醇注射量比较显著差异无统计学意义(P0.05);(3)与M组相比,P组患儿全麻苏醒拔管后5 min VAS评分显著降低,Ramsay评分显著升高(P0.05);两组患儿不良事件发生率均无统计学差异(P0.05)。结论:氯胺酮复合咪达唑仑下全麻应用于无水乙醇注射治疗儿童周围血管畸形,能维持术中血流动力学平稳,且缩短苏醒时间。     

咪达唑仑联合舒芬太尼在ICU机械通气患者中的应用效果观察

目的探讨咪达唑仑联合舒芬太尼在ICU机械通气患者中的镇静效果。方法选取我科2017年1～12月行机械通气患者60例为研究对象,随机分为观察组和对照组各30例,观察组采用咪达唑仑联合舒芬太尼镇静,对照组单纯采用咪达唑仑镇静,并采用Ramsay镇静评分法评估两组患者治疗前后的镇静效果以及治疗前后呼吸、循环指标变化情况。结果观察组患者镇静后Ramsay评分高于对照组,且观察组患者镇静后心率、呼吸、PCO_2较对照组明显下降,SpO_2、PO_2较对照组明显改善,组间比较差异均有统计学意义(P0.05)。结论 ICU机械通气患者使用咪达唑仑联合舒芬太尼的镇静效果显著,且安全性高,并发症发生率低,有利改善患者预后。     

右美托咪啶与咪达唑仑在重症破伤风患者镇静中效果比较

目的:比较右美托咪啶与咪达唑仑用于重症破伤风患者镇静中效果。方法:选取2012年1月~2015年12月间在我院治疗的重症破伤风患者72例,通过随机数表法分为右美托咪啶组与咪达唑仑组,各36例,给予右美托咪啶组静脉泵入右美托咪啶1μg/kg持续时间为10 min,之后以0.3~0.6μg/kg进行维持,咪达唑仑组静脉泵入咪达唑仑0.05 mg/kg,持续时间为1 min,之后以0.02~0.1/kg·h进行维持。监测两组患者用药前及用药12 h后平均动脉压(MAP)、呼吸频率(RR)、血氧饱和度(SpO_2)和心率(HR)深用Ramasy评分法评估镇静程度。结果:两组患者治疗后HR、RR、MAP水平明显降低而SpO_2明显上升且右美托咪啶组HR、RR、及SpO_2改善更显著差异均有统计学意义(P0.05);两组用药后4 h、8 h、12 h时Ramasy评分在组间、组内比较差异均无统计学意义(P0.05);右美托咪啶组不良反应发生率为5.56%,低于咪达唑仑组的16.67%,差异有统计学意义(P0.05)。结论右美托咪啶有助于维持患者血流动力学的稳定减少重症破伤风患者心动过速、心率增快、呼吸抑制等不良反应情况的发生。     

超声引导下髂腹下－髂腹股沟神经阻滞应用于男性全身麻醉后导尿管相关膀胱刺激征临床效果的回顾性研究

摘要 目的：探讨超声引导髂腹下－髂腹股沟神经阻滞应用于男性全身麻醉后导尿管相关膀胱刺激征（CRBD）的临床效果。方法：回顾性分析本院收治的60例择期全身麻醉下行下肢清创、皮瓣转移或植皮的男性患者,且术中需留置导尿管者的临床资料。按是否行超声引导下髂腹下－髂腹股沟神经阻滞分为观察组和对照组,观察组在全身麻醉后,超声引导下进行双侧髂腹下-髂腹股沟神经阻滞,神经阻滞完成后行导尿管留置术。对照组麻醉诱导完成后,即行导尿管留置术。记录拔除气管导管后10 min（T1）、1h（T2）、3h（T3）CRBD严重程度评分和Riker镇静-躁动评分。记录术前（T0）和T1、T2、T3对应时点的收缩压（SBP）、舒张压（DBP）、心率（HR）,对比两组的苏醒质量和麻醉相关不良反应。结果：术后各时段观察组CRBD严重程度评分和Riker镇静-躁动评分均明显低于对照组（P＜0.05）;术后各时段观察组的SBP、DBP、HR与对照组相比均明显降低 （P＜0.05）;观察组PACU内非计划性使用镇痛药、非计划性拔除尿管的比例低于对照组,PACU的停留时间短于对照组（P <0.05）;两组麻醉相关不良反应发生率对比未见统计学意义（P >0.05）。结论：超声引导下髂腹下－髂腹股沟神经阻滞操作简便,减轻全身麻醉后CRBD的效果确切,患者对导尿管有良好的耐受,术后血流动力学和循环更稳定,苏醒质量更高。     

婴幼儿机械通气时使用右旋美托咪定和咪达唑仑的效果评价

目的:比较婴幼儿在机械通气镇静时使用右旋美托咪定和咪达唑仑效果。方法:收集我院2009年2月至2011年10月入住ICU需要机械通气且镇静时间大于24h的患儿60例,随机分为3组,每组20例,右旋美托咪啶1组(输注剂量为0.25μg.kg-1.h-1,D1组)、2组(输注剂量为0.5μg.kg-1.h-1,D2组)维持镇静,咪达唑仑组(输注剂量为0.05 mg.kg-1.h-1,M组)维持镇静。同时根据病情需要间断给予吗啡镇痛。镇静的疗效评估采用Ramsay镇静评分以及脑电双屏指数(BIS)评价。结果:60例患儿分为3组,每组20例,咪达唑仑组(M组)的输注持续时间(h)为22±8 h,0.25μg(D1组)和0.5μg(D2组)右旋美托咪啶组输注持续时间分别为21±10 h和22±9 h;M组的平均输注速率为0.22±0.05 mg.kg-1.h-1,D1组和D2组平均输注速率分别为0.28±0.07μg.kg-1.h-1和0.21±0.05μg.kg-1.h-1;三组差异无统计学意义。其中M组、D1组、D2组使用吗啡的剂量是分别为36 mg.kg-1.24h-1、29 mg.kg-1.24h-1和20mg.kg-.124h-1。D1组与M组使用吗啡的剂量差异无统计学意义。D2组与M组使用吗啡的剂量差异有统计学意义(P<0.05)。三组患儿BIS值和Ramsay评分监测差异无统计学意义。结论:右旋美托咪啶应用于婴幼儿是安全有效的,0.5μg.kg-1.h-1右旋美托咪啶组镇静更加有效,24小时吗啡的使用剂量显著减少。     

丙泊酚与咪哒唑仑复合氯胺酮用于小儿心导管术麻醉效果研究

目的:探讨丙泊酚与咪哒唑仑复合氯胺酮用于小儿心导管术麻醉的优缺点与安全性。方法:将2008年7月~2012年7月入住我院的100例行心导管术的先心病患儿按照抽签法随机地均分为A、B组,A组采用6 mg/(kg·h)丙泊酚+3 mg/(kg·h)氯胺酮维持,B组采用0.15 mg/(kg·h)咪达唑仑+3 mg/(kg·h)氯胺酮维持,比较两组麻醉效果、HR、SPO2、MAP、体动次数、停药唤醒时间及不良反应发生率。结果:对照组麻醉优良率为80.00%,小于观察组(100.00%)(P0.05);两组术前MAP、HR差异无统计学意义(P0.05),但股动脉穿刺时二者差异具有统计学意义(P0.05),两组术中SPO2差异无统计学意义(P0.05),两组体动次数、停药唤醒时间相比,具有统计学差异(P0.05,P0.01);对照组不良反应发生率为24.00%,明显大于观察组(10.00%),两组相比,差异具有显著的统计学意义(P0.01)。结论:咪哒唑仑复合氯胺酮用于小儿心导管术麻醉效果显著,安全性高,值得在临床上加以推广并应用。     

The use of propofol for electroejaculation in domestic cats

The objective was to evaluate the use of propofol as an anesthetic drug for electroejaculation in the domestic cat. Cortisol concentrations, heart rates and respiratory rates of 20 male domestic cats were examined. The animals were randomly allocated into three groups. Group A (n = 8), were anesthetized with propofol (10 mg/kg) and underwent electroejaculation. Group B (n = 6), were pre-medicated with buprenorphine (0.01 mg/kg), anesthetized with propofol (5 mg/kg) and underwent electroejaculation. Group C (n = 6), the cats were anesthetized with propofol (10 mg/kg) without electroejaculation (control group). Blood samples were collected at four time points (30 min before propofol administration, immediately after the surgical plane of anesthesia was induced, immediately post-electroejaculation, and at the onset of anesthetic recovery). In the control group, the sampling time coincident with the end of electroejaculation was assigned as 21 min after the induction of anesthesia. The mean (+/- S.E.M.) duration time for electroejaculation was 18 +/- 3 min. The duration of anesthesia did not differ (P > 0.05) among the three groups of cats (26 +/- 2 min). Most of the cats (17/20) recovered smoothly. Pre-anesthetic medication with buprenorphine did not reduce the requirement of propofol for anesthesia. The cortisol concentrations, heart rates and respiratory rates of the three groups of cats did not differ (P > 0.05). A marked decline in cortisol levels was observed immediately post-electroejaculation. Propofol was a useful anesthetic for electroejaculation in felids with rapid onset, optimal duration of anesthesia for performing electroejaculation, and smooth recovery.     

异丙酚复合咪达唑仑与舒芬太尼在老年无痛结肠镜检查的临床观察

目的:观察异丙酚复合咪达唑仑与舒芬太尼在老年无痛结肠镜检查的麻醉效果。方法:将2010年5月至2011年9月期间共126例患者随机分成3组,每组42例,即异丙酚组(A组),舒芬太尼+异丙酚组(B组),咪达唑仑+舒芬太尼+异丙酚组(C组)。比较各组用药前、术中及苏醒后的SBP、DBP、HR、SPO2,同时比较异丙酚用药总量、苏醒时间和留院观察时间。结果:三组患者在用药后5 min SBP、DBP、HR、SpO2均出现一定程度的下降,B组与C组SBP、DBP的组内比较有统计学差异(P0.05);A组HR组内比较有统计学意义(P0.05);三组患者的SBP、DBP、HR比较有统计学意义(P0.05);三组患者的异丙酚用量,恢复时间有统计学差异(P0.05);术后不良反应的比较无统计学意义(P0.05)。结论:异丙酚复合咪达唑仑与舒芬太尼是一种安全可行的无痛结肠镜麻醉方法,值得推广。     

Effect of Dexmedetomidine on Preventing Postoperative Agitation in Children: A Meta-Analysis

Background

Emergence agitation (EA) is one of the most common postoperative complications in children. The purpose of this meta-analysis is to assess the effect of dexmedetomidine for preventing postoperative agitation in children.

Methods

We searched the Cochrane Central Register of Controlled Trails, MEDLINE, and EMBASE. Randomized controlled trials were included. The following outcome measures were evaluated: incidence of EA, number of patients requiring rescue, time to eye-open, time to extubation, time to discharge from the postanesthesia care unit (PACU).

Results

We analyzed 19 trials (1608 patients) that met the inclusion criteria. Compared with placebo, intravenous dexmedetomidine significantly reduced the incidence of EA [risk ratio (RR) 0.34, 95% confidence interval (CI) 0.25–0.44, P<0.00001). Dexmedetomidine also decreased the incidence of severe pain (RR 0.41, 95% CI 0.27–0.62, P<0.0001) and requirement of a rescue drug (RR 0.31, 95% CI 0.18–0.53, P<0.0001). However, compared with placebo, dexmedetomidine increased the time to eye-open by 0.98 min (P = 0.01) and the time to PACU discharge by 4.63 min (P = 0.02). Dexmedetomidine was also compared with midazolam, propofol, ketamine, and fentanyl, among others. No significant difference was found in the incidence of EA for most of these comparisons, with the exception of fentanyl and propofol, where dexmedetomidine was more beneficial.

Conclusions

Dexmedetomidine was proved effective for preventing EA and for reducing severe pain and the requirement of rescue drugs. It slightly increased the time to eye-open and the time to PACU discharge. Dexmedetomidine was also more beneficial than propofol or fentanyl in preventing EA.     

A single dose of dezocine suppresses emergence agitation in preschool children anesthetized with sevoflurane-remifentanil

Background

Emergence agitation (EA) is a common phenomenon in preschool children during emergence from general anesthesia. This study evaluated the safety and efficacy of dezocine for emergence agitation in preschool children anesthetized with sevoflurane-remifentanil.

Methods

A total of 100 preschool children, scheduled for elective laparoscopic repair of an inguinal hernia by high ligation of the hernia sac under sevoflurane-remifentanil anesthesia were randomized into two groups: Group C (n?=?50) received Ringer’s lactate 10 mL and Group D received Ringer’s lactate 10 mL containing dezocine 0.1 mg/kg, postoperatively.

Results

Incidence of EA, defined as a score?≥?3 on Aono’s four point scale or Pediatric Anesthesia Emergence Delirium (PAED) score?≥?10 in the PACU (10% vs. 76%) and the percentage of patients with severe EA (PAED score?≥?13) (12% vs. 76%) were significantly lower in Group D compared to Group C (P?<?0.05). Mean Children and Infants Postoperative Pain Scale (CHIPPS) score was significantly lower in Group D compared to Group C (1.2?±?0.5 vs. 5.2?±?0.6; P?<?0.05). Patients need for fentanyl (18% vs. 4%) or propofol rescue (20% vs. 0) was significantly greater in Group C compared to Group D. No significant differences in other relative aspects after surgery between groups.

Conclusion

Administration of dezocine 0.1 mg/kg decreased the incidence and severity of EA in preschool children that had undergone laparoscopic repair of an inguinal hernia by high ligation of the hernia sac under sevoflurane-remifentanil anesthesia.

Trial registration

A single dose of dezocine suppresses emergence agitation in preschool children anesthetized with sevoflurane-remifentanil effectively: A double-blind, prospective, randomized, controlled study, Chinese Clinical Trial Registry (ID: ChiCTR-IOR-16010033), retrospectively registered on November 21, 2016.

     

手术前后注射帕瑞昔布钠对脑膜瘤切除术后的镇痛效果评价

目的:比较手术前后注射帕瑞昔布钠对脑膜瘤切除术后的镇痛效果。方法:收集我院收治的120例行脑膜瘤切除术患者,随机分为术前组、术后组以及对照组,每组40例。术前组在麻醉前15 min静注帕瑞昔布钠40 mg所有患者行麻醉诱导(咪达唑仑+异丙酚+罗库溴铵+舒芬太尼)静脉注射,维持麻醉采用异丙酚+瑞芬太尼静脉泵注,行脑膜瘤切除术术毕根据患者具体情况停用异丙酚、瑞芬太尼术后组患者在手术结束前15 min静注帕瑞昔布钠40 mg,对照组患者在手术结束前15 min静注生理盐水2mL。观察并比较三组患者各时间点的疼痛视觉模拟评分(VAS)、简易智能状态量表(MMSE)评分、血清皮质醇(cortisol)水平以及患者不良反应发生率。结果:与对照组相比术前组、术后组患者术后1 h的VAS评分水平较低差异具有统计学意义(P0.05);与术后组相比术前组患者的术后1 h的VAS评分水平较低差异具有统计学意义(P0.05);术后三组患者的MMSE评分与术前相比均下降(P0.05),与对照组相比术前组患者的术后1 h、术后24h MMSE评分较高差异具有统计学意义(P0.05);与对照组相比术前组、术后组患者术后1 h以及术后24 h的皮质醇水平较低差异具有统计学意义(P0.05);与术后组相比术前组患者的皮质醇水平较低差异具有统计学意义(P0.05);三组患者的副作用发生率相比无明显差异(P0.05)。结论:术前注射帕瑞昔布钠的镇痛效果较术后注射更好术后认知功能恢复较快。     

Clinical effects of constant rate infusions of medetomidine–propofol combined with sevoflurane anesthesia in Thoroughbred racehorses undergoing arthroscopic surgery

Background

The aim of the present study was to evaluate clinical efficacy of constant rate infusions (CRIs) of medetomidine–propofol combined with sevoflurane anesthesia in Thoroughbred racehorses undergoing arthroscopic surgery. Thirty horses were sedated intravenously (IV) with medetomidine (6.0 μg/kg) and midazolam (0.02 mg/kg) and induced IV with ketamine (1.0 mg/kg) and propofol (1.0 mg/kg). These horses were randomly allocated to three groups and maintained with sevoflurane and CRI of either medetomidine (3.0 μg/kg/h) (Group M; n?=?10); or medetomidine (3.0 μg/kg/h) and propofol (3.0 mg/kg/h) (Group MP3; n?=?10); or medetomidine (3.0 μg/kg/h) and propofol (6.0 mg/kg/h) (Group MP6; n?=?10). End-tidal sevoflurane concentration (ET_SEVO), cardiovascular parameters, plasma propofol concentration, and recovery time and quality were compared among groups. Data were analyzed by using ANOVA with Tukey’s multiple comparison test, considering P?<?0.05 significant.

Results

ET_SEVO (%) was 2.4?±?0.1 in Group M, 1.7?±?0.2 in Group MP3, and 1.4?±?0.2 in Group MP6; ET_SEVO declined significantly in a propofol-dose-dependent manner. The rates of dobutamine infusion (μg/kg/min) required to keep the mean arterial blood pressure over 70 mmHg were significantly lower in Group MP3 (0.20?±?0.10) and Group MP6 (0.15?±?0.06) than in Group M (0.37?±?0.18). Recovery time and quality did not differ among groups. All horses in Group MP3 required only one attempt to stand, and recovery quality was excellent. Plasma propofol concentrations were stable throughout maintenance of anesthesia in Group MP3, whereas those in Group MP6 increased significantly with increasing duration of maintenance.

Conclusions

CRIs of medetomidine–propofol reduced the sevoflurane requirement for surgical anesthesia as the propofol dose increased, compared with a CRI of medetomidine alone. Additionally, the two propofol protocols provided good maintenance of cardiovascular function. CRIs of medetomidine (3.0 μg/kg/h) and propofol (3.0 mg/kg/h) resulted in excellent-quality recovery. This protocol could therefore be an especially useful additive to sevoflurane anesthesia in Thoroughbred racehorses undergoing arthroscopic surgery.