目的 观察右美托咪定作为佐剂对罗哌卡因在锁骨上入路臂丛神经阻滞效果的影响。方法 将55例上肢择期手术的受试者随机分为右美组和对照组。右美组:30 μg右美托咪定(0.3 mL)＋0.5%罗哌卡因,对照组:生理盐水(0.3 mL)＋0.5%罗哌卡因。在臂丛神经阻滞操作后,按步骤评估和记录臂丛感觉、运动阻滞程度和起效时间。在术中定期监测和记录生命体征、不良事件的发生。手术后评估和记录术毕24小时生命体征、术后镇痛时间、臂丛神经感觉、运动阻滞的持续时间、术后恶心呕吐评分、补救镇痛药物用量和不良事件等数据。结果 在臂丛神经的感觉和运动起效时间、感觉和运动阻滞持续时间、术后镇痛时间方面,右美组长于对照组,存在统计学差异(P<0.05)。两组间在术后生命体征变化、补救镇痛药物用量、术后恶心呕吐评分、不良事件等数据的比较,未见明显统计学差异(P>0.05)。结论 右美托咪定(30 μg)作为佐剂能加快罗哌卡因在锁骨上入路对臂丛神经阻滞的起效时间,增加其术后镇痛时间和对臂丛神经的感觉、运动阻滞时间,同时较少影响患者生命体征,具备一定的有效性和临床安全性。

Objective To observed the effect of dexmedetomidine as an adjunction with ropivacaine in supraclavicularbrachial plexus block. Methods 55 subjects with elective upper extremity operation were randomly divided into two groups: DEX group and control group. The drugs in DEX group was 30 μg dexmedetomidine (0.3 mL) + 0.5% ropivacaine, 20 mL in total. And the one in control group was normal saline (0.3 mL) +0.5% ropivacaine, 20 mL in total. After the operation of brachial plexus block, the value of sensory and motor block of brachial plexus and the onset time were evaluated and recorded according to the protocol. Vital signs and adverse events were monitored and recorded regularly during the operation.Postoperative vital signs, postoperative analgesia time, duration of brachial plexus sensationsensory and motion block, postoperative nausea and vomiting score, dosage of remedial analgesics and adverse events were assessed and recorded in 24 hours after surgery. Results In terms of sensory and motor onset time of brachial plexus, duration of sensory and motor block and postoperative analgesia, DEX group was longer than the control group, with statistical differences (P<0.05).There were no significant statistical differences between the two groups in postoperative vital signs, the amount of remedial analgesic drugs, postoperative nausea and vomiting scores, adverse events etc(P>0.05). Conclusion As an adjuvant, dexmedetomidine (30 μg) can accelerate the onset time of ropivacaine in the supraclavicular approach of brachial plexus block.It can also increase the postoperative analgesia time and sensory and motor block time of brachial plexus.With less impact on the vital signs of patients, the efficacy and clinical safety of dexmedetomidinecan be found in our study.

目的 评价鞘内注射雷帕霉素对CCI神经病理性痛大鼠的痛阈及脊髓背角胶质细胞表达的影响。方法 健康雄性SD大鼠30只随机分为6组:①CCI组:CCI术后14天处死;②正常对照组:不做任何处理; ③前对照剂组:鞘内置管3天后行CCI术,术后4小时后鞘内给同体积生理盐水,连给3天; ④前给药组:鞘内置管3天后行CCI术,术后4小时鞘内给雷帕霉素溶液,连给3天; ⑤后对照剂组:鞘内置管3天后行CCI术,术后7天鞘内给同体积生理盐水,连给3天;⑥后给药组:鞘内置管3天后行CCI术,术后7天鞘内给雷帕霉素溶液,连给3天。各组于CCI术前1天和术后第2、4、6、8、10、12、14天测机械痛阈和热痛阈。术后14天测痛后用多聚甲醛灌注大鼠,取L4~5脊髓,免疫组化染色,星形胶质细胞标记蛋白(GFAP)检测星形胶质细胞表达变化,并定量分析。结果 与对照组相比,CCI手术组热痛阈和机械痛阈从CCI手术后第4天开始下降(P<0.05);前后给药对照剂组与CCI组相比,差别无统计学意义(P>0.05)。前给药组痛阈从CCI手术后第4天开始上升并持续至手术后第14天,与CCI组相比,差别有统计学意义 (P<0.05)。与CCI组相比,后给药组痛阈从CCI第8天开始上升并持续至手术后第14天,差别有统计学意义(P<0.05)。 与正常对照组比较,CCI组、前、后对照剂组手术侧脊髓背角GFAP染色阳性区平均光密度与阳性面积均有增加,差别有统计学意义(P<0.05)。前、后给药组手术侧GFAP染色阳性区平均光密度与阳性面积与CCI组比较,均有明显降低,差别有统计学意义(P<0.05)。结论 鞘内注射雷帕霉素可缓解大鼠神经病理性痛,并抑制脊髓背角胶质细胞的激活。

Objective To evaluate the effects of intrathecal injection of rapamycin on pain threshold and spinal cord gliacyte activation in rats of neuropathic pain. Methods Healthy 30 male SD rats were randomly divided into 6 groups(n=5 in each group): ① control group without operation or intrathecal injection. ②CCI group without intrathecal injection. ③ intrathecal injection of rapamycin 10 μg(10 μL) 4 hours after CCI operation and the next 2 days once a day. ④ intrathecal injection of NS10 μL 4 hours after CCI operation and the next 2 days once a day. ⑤ intrathecal injection of rapamycin 10 μg(10 μL) 7 days after CCI operation and the next 2 days once a day.⑥ intrathecal injection of NS10 μL 7 days after CCI operation and the next 2 days once a day. Mechanical and thermal threshold were tested 1 day before the CCI operation and 2^th、4^th、6^th、8^th、10^th、12^th、14^th days after the CCI operation for all the rats. Lumbar segment of spinal cords was removed for determination of glial fibrillary acidic protein(GEAP) in spinal cord by immuohistochemistry dyeing and assay in the 14th day after CCI operation for all the rats. Results Mechanical and thermal hyperalgesia emerged on 4th day and maintained till 14th day after CCI operation(P<0.05). After intrathecal injection of rapamycin 4 hours or 7days after CCI, mechanical and thermal threshold significantly increased compared to intrathecal injection of NS(P<0.05). And the sum area of GFAP positive and the mean density of GFAP positive area in the dorsal horn of operation side greatly increased in rapamycin treated groups compared NS treated groups(P<0.05). Conclusion Intrathecal injection of rapamycin may attenuate CCI induced hyperalgesia and inhibit the activation of astrocyte.

目的 评价围术期目标导向液体治疗用于老年高危患者的优越性。方法 50例行择期全髋关节置换术的老年患者,随机分成传统液体治疗组(C组)和目标导向治疗组(GDT组),每组25例。C组以MAP和CVP为指导进行围术期液体管理,GDT组以每搏量(SV)和氧供指数(DO₂I)最大化进行围术期液体管理。观察和比较两组患者围术期液体出入量、MAP、HR、SV和CI等参数。结果 GDT组总输液量、晶体液和胶体液的输注总量均高于C组(P＜0.05);GDT组各时点MAP、HR、SV和CI高于C组(P＜0.05),与基础值比较,GDT组无变化,而C组在麻醉后和应用骨水泥后,MAP、HR、SV和CI一过性下降(P＜0.05)。结论 与传统围术期液体管理方案相比,以SV和DO₂I最大化为目标的GDT方案用于高危病人全髋置换手术,能使心脏前负荷处于更理想的充盈状态,血流动力学更稳定,并能有效预防骨水泥引起的循环抑制作用。

Objective To evaluate the priority of goal-directed fluid therapy(GDT) in high risk elderly patients. Methods Fifty elderly patients undergoing total hip replacement were randomly divided into traditional fluid therapy group(group C) and goal-directed fluid therapy group(group GDT). Group C received perioperative fluid management based on MAP and CVP, while Group GDT received goal-directed fluid therapy based on SV and DO₂I optimization. MAP, HR, SV, and CI were recorded at different time points; the intraoperative blood loss, fluid volume, and urine volume were also recorded. Results The total fluid volume, colloid volume and crystal volume of group GDT were much more than group C(P＜0.05); the intraoperative MAP, HR, SV, and CI in group GDT were much higher than group C(P＜0.05); compared withbaseline of MAP, HR, SV, and CI, there were no obvious change in group GDT, while there were significant decline in group C, especially after anesthesia and implantation of bone cements(P＜0.05). Conclusion Compared with traditional fluid management strategy, SV and DO₂I optimization based goal-directed fluid therapy has a significant priority in high risk elderly patients undergoing total hip replacement.It can maintain better preload and provide more stable hemodynamic status, and prevent cardiac side effect induced by implantation of bone cements

目的 研究术中麻醉深度监测在全麻下行下腹部手术患者苏醒质量和护理工作应用。方法 选取择期全麻下行下腹部手术患者120例(ASAⅠ~Ⅱ级),随机分成NT组和NNT组,NT组患者(60)术中用Narcotrend监测,NNT组患者(60)术中不用Narcotrend监测。记录术中丙泊酚用量;记录术后气管导管拔管时间和麻醉恢复室(postanesthesia care unit, PACU)留观时间;记录恢复室Ricker镇静—躁动评分;记录恶心呕吐及术后谵妄的发生率。结果 NT组患者术中麻醉药物丙泊酚的用量比NNT组明显减少(P<0.05);NT组患者术后的拔管时间与PACU留观时间比NNT明显缩短(P<0.05);NT组患者术后的Ricker 镇静-躁动评分比NNT明显降低(P<0.05);NT组患者与NNT组术后恶心呕吐及术后谵妄发生率无明显差别。NT组比NNT组降低了护理工作量(P<0.05)。结论 在麻醉深度监测仪Narcotrend下行下腹部手术,通过有效的麻醉深度监测,可以改善患者术后的苏醒质量,这些有利于减少PACU护理工作量,提高了护理质量,也有助于PACU护理规范化。

Objective To investigate the effect of anesthesia depth monitoring on the recovery quality and nursing quality of patients treated with lower abdominal surgery under general anesthesia. Methods A total of 120 patients who underwent the lower abdominal surgeries from June 2015 to December 2015 were randomly divided into 2 groups: non-Narcotrend monitoring group (non NT group) and Narcotrend monitoring group (NT group). And each group contains 60 cases. All patients were set in the same induce plan, and maintained by propofol-fentanyl during the operation. The dosage of propofol, the time of tracheal extubation, the PACU staying time, the Ricker sedation-agitation scale, the incidence of PONV and POD, the nursing quality and nursing working load were recorded in the project. Results Using Narcotrend to monitor the anesthesia depth could significantly decrease the dosage of propofol (P<0.05). The tracheal extubation time and the PACU staying time of patients in NT group were much shortened than patients in non NT group (P<0.05). In NT group the Ricker scores of patients were much lower than patients in non NT group (P<0.05). And the effective anesthesia depth monitoring using Narcotrend could significantly decrease the nursing working load and improve the nursing quality (P<0.05). Conclusion Effective anesthesia depth monitoring using Narcotrend may improve the recovery quality in the PACU, which may decrease the working load of nurses and improve the nursing quality in PACU.

目的 观察术前宣教对支撑喉镜喉肿物摘除患者全麻苏醒期的影响。方法 选择择期支撑喉镜喉肿物摘除全身麻醉手术的患者72例。随机分成两组进行效果对比,一组为接受常规护理的对照组,另一组为本次接受术前宣教观察组。分别对两组患者术后苏醒期躁动发生情况、心血管变化及配合性进行对比。结果 观察组患者通过术前宣教,有效减少全麻苏醒期患者躁动相关情况的发生,其心率、血压水平也较稳定,与对照组相比较差异有统计学意义(P<0.05);两组患者配合性相比较,差异有统计学意义(P<0.05)。结论 对支撑喉镜喉肿物摘除行全麻手术的患者进行术前宣教护理,可以有效减少苏醒期患者躁动的发生率,减轻气管拔管对心血管影响。提高整体治疗护理效率,达到更高的满意度,该方法切实可行,值得临床广泛运用。

Objective To obeserve the effect of preoperative education on the recovery period of general anesthesia after suspension laryngoscopic surgery. Methods Seventy-two adult patients undergoing suspension laryngoscopic surgery were randomly divided for the effect contrast.Routine nursing were adopted for control-group while the only difference for the observation group was the preoperative education. The occurrence of emergence agitation, hemodynamic, and compliance degree were compared between the two groups. Results Through preoperative education,observation group can significantly reduce the occurrence of agitation effectively and keep hemodynamics more stable than control group.Moreover,the compliance degree in two groups also has statistical significance (P<0.05). Conclusion Preoperative education can succeed in reducing the incidence of emergence agitation,inhibiting the responses to endotracheal extubation after suspension laryngoscopic surgery. Thus, preoperative education is feasible to enhance the overall effectiveness of treatment and nursing care. It is worth in popularization and application in clinical practice.