电子胃镜检查使用镇静麻醉药的护理研究

目的探讨电子胃镜检查时应用镇静麻醉药的临床护理效果。方法抽取300例患者随机分为观察组和对照组,观察组使用镇静麻醉药加多种护理配合,对照组作常规胃镜检查加多种护理配合,在两组之间进行检查和护理效果比较。结果观察组胃镜检查成功率为100%,全部患者插管均无发生任何合并症或危重症状,仅11%的患者出现恶心呕吐,7.5%的患者对麻醉药非常敏感。对照组成功率为100%,全部患者插管也无发生任何合并症或危重症状,但有21%的患者出现恶心呕吐,多数患者情绪稳定较差,诊断的准确性也比较差。结论电子胃镜检查时使用静脉镇静药,其检查效果非常理想,而多种护理配合对这种效果起着重要作用。     

不同剂量舒芬太尼复合罗哌卡因用于术后 硬膜外镇痛效应比较

目的:研究不同剂量的舒芬太尼复合0.125%罗哌卡因用于硬膜外上腹部术后镇痛的临床疗效和安全性。方法:选择60例麻醉风险评级(ASA)I-II级,年龄(56±12.3)岁,在静脉快速诱导气管插管静吸复合全身麻醉下行上腹部手术的病人随机均分为四组,分别为0.125%罗哌卡因(R)组,0.125%罗哌卡因+0.25ug/ml舒芬太尼(R+0.25S)组,0.125%罗哌卡因+0.5ug/ml舒芬太尼(R+0.5S)组,0.125%罗哌卡因+0.75ug/ml舒芬太尼(R+0.75S)组。于T9-11行硬膜外穿刺置管后接入镇痛泵行术后持续硬膜外输注镇痛,观察术后3、6、12、24小时VAS评分,辅助镇痛用药量及恶心、呕吐、皮肤骚痒、呼吸抑制等副作用。结果:(R+0.5S)组和(R+0.75S)组的患者静息和咳嗽时的VAS评分、24小时内辅助镇痛用药量均显著低于(R)组和(R+0.25S)组,(P<0.05);(R)组、(R+0.25S)组、(R+0.5S)组、(R+0.75S)组四组的瘙痒发生率分别为0%、27.2%、54.5%、63.6%,各组间瘙痒的发生率有显著差异(P<0.05)。60例患者均未发生呼吸抑制等严重并发症;四组间的镇静评分、恶心、呕吐发生率无显著性差异。结论:0.5ug/ml舒芬太尼复合0.125%罗哌卡因可取得较佳的镇痛效果及较少的副作用。     

经皮穴位电刺激对甲状腺手术后围拔管期应激反应的影响

目的:观察经皮穴位电刺激对行甲状腺手术的患者全麻围拔管期应激反应的影响。方法:选择择期行甲状腺手术的患者60例,随机分为经皮穴位电刺激(T)组和假电刺激(C)组,T组麻醉诱导前30分钟给予电刺激,C组患者仅将电极片贴附在相同穴位但不给予电刺激。记录两组在入室(T0)、手术结束时(T1),拔管后即刻(T2),拔管后5 min(T3),拔管后10 min(T4)的血压(NIBP)、平均动脉压(MAP)、心率(HR)以及静脉血中的肾上腺素(E)、去甲肾上腺素(NE)、皮质醇(Cor)的浓度;记录两组的拔管质量评分以及Ricker镇静-躁动评分。结果:T组在T2~T4时的NIBP、MAP、HR以及E、NE、Cor的浓度均较C组显著降低(P0.05);与C组比较,T组的拔管质量评分以及Ricker镇静-躁动评分降低(P0.05)。结论:经皮穴位电刺激能够减轻行甲状腺手术患者全麻围拔管期的应激反应,有利于维持血流动力学稳定。     

微创引流术与开颅术在硬脑膜外血肿患者围手术期的治疗体会及临床疗效评价

目的:分析微创引流术与开颅术在硬脑膜外血肿患者围手术期的治疗体会及临床疗效评价。方法:选取本院2015年1月至2016年10月期间诊断为硬脑膜外血肿的患者100例,随机均分成两组,即对照组和观察组。对照组采用常规开颅手术,观察组给予微创引流手术治疗。比较两组手术效果及治疗前后生活质量改善情况。结果:观察组手术效果优于对照组(P0.05);观察组颅脑缺损(0%)、再出血率(6%)明显低于对照组(12%,20%)(P0.05),观察组生活质量高于对照组(P0.05)。结论:与常规开颅术相比,微创引流术创伤小、恢复快、效果好,值得临床推广应用。     

盐酸羟考酮注射液用于腹部全麻患者术后镇痛的有效性和安全性

目的:探讨盐酸羟考酮注射液用于腹部全麻患者术后镇痛的有效性和安全性。方法:选择2016年1月至2016年12月来我院治疗的择期全麻下行腹部手术的患者60例。按照治疗方法,采用随机数字表法将患者平均分为硫酸吗啡注射组(简称吗啡组)和盐酸羟考酮注射组(简称羟考酮组),每组30例。用药3、24、48 h后,采用VAS方法对患者进行疼痛评分。记录术后48 h内患者补救镇痛率以及患者对镇痛的满意度。记录72 h后患者恶心、呕吐等不良事件的发生情况。结果:镇痛48 h内的不同时间点,两组间VAS评分、补救镇痛率与吗啡组相比无显著差异(P0.05)。羟考酮组术后不良事件发生率为16.7%,显著低于吗啡组40.0%(P0.05),羟考酮组患者镇痛满意度显著高与吗啡组(93.3%vs.70.0%),差异具有统计学意义(P0.05)。结论:盐酸羟考酮注射液的镇痛效果与硫酸吗啡相当,且可安全有效地改善患者术后生活质量,提高患者满意度。     

平行侧入法硬膜外穿刺CSEA对剖宫产术后腰背痛的影响

目的:探讨平行侧入法硬膜外穿刺腰硬联合麻醉对剖宫产术后腰背痛的影响。方法:选择2014年10月至2016年9月在我院行剖宫产的产妇95例,将其随机分为两组。对照组45例,产妇接受平行直入法硬膜外穿刺腰硬联合麻醉,观察组50例产妇接受平行侧入法硬膜外穿刺麻醉。比较两组产妇术后宫缩、伤口、腰背疼痛VAS评分、术中穿刺情况、术后使用镇痛泵的有效按压次数及术后3 d、7 d、14 d和2个月后腰背疼痛的情况。结果:观察组产妇术后宫缩、伤口以及腰背疼痛评分、术后使用镇痛泵的有效按压次数均显著低于对照组(P0.05),且术中一次性穿刺成功率显著高于对照组(P0.05),且术后7 d、14 d以及2个月腰背痛的发生率显著低于对照组(P0.05)。结论:平行侧入穿刺法行腰硬联合麻醉可有效提高剖宫产产妇一次穿刺成功率,显著缓解产妇的术后疼痛,并降低术后腰背疼痛的发生率。     

七氟醚-瑞芬太尼静吸复合麻醉对妇科腹腔镜子宫肌瘤摘除术患者术后认知功能的影响

目的:分析七氟醚-瑞芬太尼静吸复合麻醉对妇科腹腔镜子宫肌瘤摘除术患者术后认知功能的影响。方法:选取我院妇科收治行腹腔镜子宫肌瘤摘除术患者148例,采取数字随机法分成观察组和对照组,观察组采取七氟醚-瑞芬太尼静吸复合麻醉,对照组采取丙泊酚-瑞芬太尼静脉复合麻醉,比较两组麻醉方式对术后认知功能的影响。结果:对照组患者术后1天认知功能评分低于术前1天,差异有统计学意义(P0.05)。观察组患者术后1天认知功能评分高于对照组,差异有统计学意义(P0.05)。对照组患者术后1天TMT完成时间慢于术前1天,差异有统计学意义(P0.05)。观察组患者术后1天TMT完成时间快于对照组,差异有统计学意义(P0.05)。观察组患者术后呼吸抑制、恶心呕吐、躁动、嗜睡、头晕发生率均低于对照组,差异有统计学意义(P0.05)。结论:七氟醚-瑞芬太尼静吸复合麻醉对妇科腹腔镜子宫肌瘤摘除术患者术后认知功能的影响较小,并且比较安全,是较为适宜的麻醉方法。     

Mechanism of Action of Volatile Anesthetics: Role of Protein Kinase C

1. It is not completely clear how volatile anesthetics cause anesthesia, but one possible consequence of their action is to alter presynaptic activity and the release of neurotransmitters due to alterations in intracellular signaling. 2. Protein kinase C (PKC) is a signal transducing enzyme that is an important regulator of multiple physiological processes like neurotransmitter release, ion channel activity, and neurotransmitter receptor desensitization. Thus, PKC is an attractive molecular target for the synaptic action of general anesthetics. 3. However, the effects of these agents on PKC activity are not yet fully understood and there are several contradictory data on the literature regarding the in vitro and in vivo preparations. 4. Here, we will review some evidence for volatile anesthetics effects on neuronal PKC activation.     

Interactions Between Neuronal Histamine and Halothane Anesthesia in Rats

Abstract: Using an in vivo microdialysis method, we measured the release of histamine in the anterior hypothalamic area (AHy) of rats under several concentrations of halothane anesthesia (1, 0.5, and 0.2%). The release of histamine increased to 341 and 325% at halothane concentrations of 0.5 and 0.2%, compared with the basal level at anesthesia induced by 1% halothane. α-Fluoromethylhistidine (100 mg/kg i.v.), a specific and irreversible inhibitor of histidine decarboxylase, reduced the histamine release to <35% of the basal value at 1% halothane anesthesia in the AHy, and also decreased the anesthetic requirement for halothane, evaluated as the minimum alveolar concentration (MAC), by 26%. Furthermore, pyrilamine (20 mg/kg i.v.), a brain-penetrating H₁ antagonist, and zolantidine (20 mg/kg i.v.), a brain-penetrating H₂ antagonist, reduced the MAC for halothane by 28.5 and 16%, respectively. Although thioperamide (5 mg/kg i.v.), an antagonist of presynaptic H₃ autoreceptor, induced an approximate twofold increase in the level of histamine release in conscious freely moving rats, the same dose of thioperamide had little effect on the release of histamine under 1% halothane anesthesia in the AHy. Furthermore, thioperamide did not change the anesthetic requirement (MAC) for halothane. The present findings indicate that halothane anesthesia inhibits the release of neuronal histamine and that histaminergic neuron activities change the anesthetic requirement (MAC) for halothane through H₁ as well as H₂ receptors.     

Neuropharmacology of rotifer feeding,oviposition, and anesthesia

Effect of acetylcholine and anticholinergic drugs on feeding, oviposition, and anesthesia in rotifers was investigated. Neurotransmitter as well as antagonist drugs inhibited feeding in Brachionus calyciflorus in a dose-dependent manner. Most antagonist drugs caused an oscillating tachyphylaxis (drug habituation): the drug effect wore off and returned several times within an hour. Acetylcholine inhibited oviposition in Philodina acuticornis, and this effect was antagonized by all groups of anticholinergic drugs. The strongest antagonism was caused by neuromuscular blockers, and thus the cause of oviposition inhibition may be a cloacal sphincter spasm. Acetylcholinesterase inhibitory insecticides also antagonize the acetylcholine effect. Acetylcholine potentiates the anesthetic activity of ionizing local anesthetics (procaine, lidocaine) as well as that of atropine and the beta-adrenergic blocker propranolol. Muscarinic antagonists (atropine, benactyzine) and propranolol caused foot paralysis in B. calyciflorus, which is also potentiated by acetycholine. Further details of these results are given by Nogrady and Keshmirian (1986a, b).