目的   探讨口服水合氯醛与鼻内给予右美托咪定中深度镇静下行泪道探通术治疗婴幼儿先天性泪道阻塞的疗效、并发症及安全性。方法   随机选择2021年2月—2023年6月在广州医科大学附属妇女儿童医疗中心就诊的先天性泪道阻塞患儿，将其分为观察组和对照组，观察组行中深度镇静后进行泪道探通术，对照组进行表麻下泪道探通术，对比两组的治愈率及并发症发生率。结果   观察组共76例（97眼），总治愈率98.97%，分为3组，6~12月龄组41例（53眼），12~18月龄组14例（15眼），18~36月龄组21例（29眼），对照组共84例（116眼），总治愈率93.10%，6~12月龄组55例（70眼），12~18月龄组15例（24眼），18~36月龄14例（22眼），观察组泪道探通术治愈率高于对照组，差异有统计学意义（χ ² =4.49，P＜0.05）。观察组一次探通的成功率为92.78%，高于对照组61.21%，差异有统计学意义（χ ² =26.86，P＜0.05）。观察组二次探通的成功率为85.71%，高于对照组44.44%，差异有统计学意义（χ ² =4.13，P＜0.05）。发生的并发症主要是出血、皮下水肿、感染、假道形成，观察组并发症的发生率4.12%，低于对照组15.52%，差异有统计学意义（χ ² =7.40，P＜0.05）。观察组中2例患儿口服水合氯醛出现恶心呕吐，改为右美托咪定滴鼻。3例患儿右美托咪定滴鼻后出现口唇苍白，持续10～15 min即可缓解。其余均未有不良反应。结论   中深度镇静下给予婴幼儿泪道阻塞患儿行泪道探通术相比传统表麻下泪道探通术疗效更好，并发症较少，对孩子的心理创伤小，安全且经济实惠。

       Objective  To explore the efficacy，complications and safety of moderate and deep  sedation  under oral administration of chloral hydrate and intranasal administration of dexmedetomidine for the treatment of congenital nasolacrimal duct obstruction（CNLDO） in infants and young children．Methods  Children with CNLDO who visited our hospital from February 2021 to June 2023 were randomly selected and divided into the observation group and the control group．The observation group was performed with lacrimal duct probing after moderate and deep sedation，while the control group was performed with lacrimal duct probing under surface anesthesia．The cure rate and incidence of complications were compared between the two groups．Adverse reactions after using sedatives were observed．Results  The observation group consisted of 76 cases（97 eyes），with a total cure rate of 98.97%．They were divided into three groups：41 cases（53 eyes）in the aged 6-12 months group，14 cases（15 eyes）in the aged 12-18 months group，and 21 cases（29 eyes）in the aged 18-36 months group．The control group consisted of 84 cases（116 eyes），with a total cure rate of 93.10%．There were 55 cases（70 eyes）in the aged 6-12 months group，15 cases（24 eyes）in the aged 12-18 months group，and 14 cases（22 eyes）in the aged 18-36 months group．The cure rate of lacrimal duct probing in the observation group was significantly higher than that in the control group（χ ² =4.49，P＜0.05）．The success  rate of the first probing in the observation group was 92.78%，significantly higher than that in the control group of 61.21%（χ ² =26.86，P＜0.05）．The success rate of the second probing in the observation group was 85.71%，significantly higher than that in the control group of 44.44%（χ ² =4.13，P＜0.05）．The incidence of complications mainly were bleeding，subcutaneous edema，infection，and false passage formation．The incidence of complications in the observation group was 4.12%，lower than that in the control group 15.52%，and the difference was statistically significant（χ ² =7.40，P＜0.05）．Two cases in the observation group experienced nausea and vomiting after taking chloral hydrate orally，and were replaced with dexmedetomidine nasal drops．Three cases of pediatric patients showed pale lips after nasal administration of dexmedetomidine，which lasted for 10-15 minutes and could be relieved．No other adverse reactions were observed．Conclusions  Under moderate and deep sedation，lacrimal duct probing treatment for infants and young children with CNLDO showed better therapeutic effects，fewer complications，less psychological trauma to these patients，which is safe and cost-effective，and is suitable for promotion compared to under traditional surface anesthesia．

目的 本研究旨在采用连续气道监测法对患者呼吸力学指标进行动态观察,同时监测脑电双频指数（Bispectral index,BIS）和清醒镇静评分（The Observer's Assessment of Alertness/Sedation Scale,OAA/S）,全面系统地评估右旋美托咪定（dexmedetomidine ,Dex）对患者自主呼吸功能和镇静深度的影响,为Dex临床安全应用提供参考依据。方法 80例患者随机分为四组,Dex 0.5 μg/kg组（D₁组）,1.0 μg/kg组（D₂组）,1.5 μg/kg组（D₃组）和对照组（D₀组）,每组病人20例。麻醉诱导前35min分别静脉泵注Dex或0.9%生理盐水10 mL。记录预先给药前（T0 ）、预处理后5min（T1）、10min（T2）、15min（T3）、20min（T4）、25min（T5）和30min（T6）患者的潮气量（V_T）、分钟通气量（MV）、呼气末二氧化碳分压（P_ETCO₂）、呼吸频率（RR）、第一秒呼出率（FEV₁%）、顺应性环（PV环）、阻力环（FV环）、脉搏氧饱和度（SpO₂）、心率（HR）、平均动脉压（MAP）等呼吸力学参数和循环参数及脑电双频谱指数（BIS）及警觉/镇静评分（OAA/S）,并于T0、T1、T3和T6抽取动脉血行血气分析记录PaO₂、PaCO₂和pH值。结果 与对照组相比,D₁组的V_T、RR、MV、P_ETCO₂、FEV₁%、PaCO₂和SpO₂均无变化（P>0.05）,PV环和FV环形态基本正常;D₂组和D₃组MV分别降低16.9%和27.0%;PaCO₂分别升高11.0%和19.9%;FEV₁%分别下降11.0%和14.9%。四组患者均无发生呼吸暂停,而且所有患者SpO₂均在98%或以上。D₃组自主呼吸的PV环和FV环图形面积明显缩小（P<0.05）。D₁组BIS值均在85以上,OAA/S 4分为65%,镇静满意率低,OAA/S 3分仅20%;D₂组镇静满意率最高,OAA/S 3分达70%,且无出现过度镇静;D₃组有60%患者OAA/S评分小于或等于2。结论 静脉泵注Dex所产生的的镇静效应及其对呼吸力学的影响,随着泵注Dex剂量增大,患者镇静程度加深,虽然SpO₂仍在正常范围,但呼吸会受到一定抑制（PV环和FV环图形面积缩小,PaCO₂ 均上升）,临床推荐静脉泵注Dex剂量为0.5 μg/kg~1 μg/kg以策安全。

Objective The purpose of this study was to observe the dynamic indexes of respiratory mechanics in patients with continuous airway monitoring,and to monitor the Bispectral index （BIS） and the Observer's Assessment of Alertness/Sedation Scale （OAA/S）. We evaluated the effect of dexmedetomidine （Dex） on the autonomic respiratory function and the sedative depth of the patients in a comprehensive and systematic way,so as to provide reference for the clinical safety of Dex. Methods In the study,we randomly divided 80 patients into four groups,Dex 0.5,group g/kg （group D₁）,1 group g/kg （group D₂）,1.5 g/kg group （D₃ group） and control group （D₀ group）. There were 20 cases in each group. At about 35min before anesthesia induction,Dex or 0.9% saline 10 mL was injected intravenously. The following time points were selected： pre- administration （T0）,pre-treated 5min （T1）,pre-treated 10min （T2）,pre-processed 15min （T3）,pre-processed 20min （T4）,pre -treated 25min （T5） and pre-treated 30min. The following experimental parameters were recorded at the above time point： tidal volume （VT）,minute ventilation （MV）,end expiratory carbon dioxide partial pressure （P_ETCO₂）,respiratory frequency （RR）,first second exhalation rate （FEV1%）,compliance ring （PV ring）,resistance ring （FV ring）,pulse oxygen saturation （SpO₂）,heart rate （HR）,and respiratory mechanics parameters and circulatory parameters such as mean arterial pressure （MAP）,bispectral index （BIS） and vigilance / sedation score （OAA/S）. At the same time at T0,T1,T3 and T6,arterial blood gas was extracted,and PaO₂,PaCO₂ and pH values were recorded. Results Compared with the control group,the value of VT,RR,MV,PETCO₂,FEV1%,PaCO₂ and SpO₂ in group D₁ did not change significantly （P>0.05）,and the morphology of PV ring and FV ring were basically normal. In group D₂ and group D₃,MV decreased by 16.9% and 27% respectively;PaCO₂ increased by 11% and 19.9% respectively;FEV1% decreased by 11% and 14.9% respectively. No apnea occurred in the four groups,and all patients had SpO₂ at 98% or above. The area of PV rings and FV rings of spontaneous breathing in group D₃ was reduced （P<0.05）. The BIS values in group D₁ were above 85,OAA/S 4 was 65%,sedative satisfaction rate was low,20% patients had a score of 3 in OAA/S;group D₂ had the highest sedative satisfaction rate,70% of patients had a score of 3 in OAA/S,and no excessive sedation;60% of patients in group D₃ with an OAA/S score that was less than or equal to 2. Conclusion The sedation effect that was caused by intravenous infusion of Dex and its effect on respiratory mechanics are as follows： with the increase of Dex's dose,the degree of sedation is deepened. Although SpO₂ is still in the normal range,the respiration will be restrained （the area of PV ring and FV ring is narrowed,the value of PaCO₂ is increased）,and the clinical recommendation of intravenous infusion Dex is at a dose of 0.5µg /kg~1µg /kg for safety reasons. .

       目的   探讨清醒镇静应用在急性缺血性脑卒中血管内治疗中的效果。方法   选择2020年1月—2023年3月医院接收的急性缺血性脑卒中患者82例进行研究，按随机数表法分为2组，每组各41例，两组采取溶栓与取栓治疗，对照组采取全身麻醉方式，观察组采取清醒镇静方式，记录两组治疗相关参数，比较两组近期疗效、并发症发生情况及预后。结果   观察组入院到腹股沟穿刺时间（95.52±3.63）min、穿刺至血管再通时间（72.25±5.58）min低于对照组（112.25±4.18）min、（102.45±10.63）min（t=19.349，P＜0.05）；观察组ICU时间（7.81±2.63）d、住院时间（13.75±3.64）d，与对照组（8.05±2.81）d、（14.52±4.07）d比较差异无统计学意义（t分别为0.524、0.399、0.902，P分别为0.601、0.690、0.369）。观察组近期总有效39例（95.12%）与对照组37例（90.24%）比较差异无统计学意义（χ ² =0.719，P=0.396）。观察组症状性颅内出血3例（7.32%）与对照组6例（14.63%）比较差异无统计学意义（χ ² =1.123，P=0.289）；观察组脑水肿4例（9.76%）、坠积性肺炎12例（29.27%），低于对照组7例（17.07%）、18例（43.90%）（χ 2分别为4.969、6.962，P分别为0.025、0.008）。观察组预后良好21例（51.22%）高于对照组10例（24.39%）（χ ² =6.275，P=0.012）。结论   急性缺血性脑卒中患者溶栓与取栓治疗中采取清醒镇静方式可获得与全身麻醉相近的疗效，而且可进一步缩短治疗时间，促进血管快速再通，减少相关并发症，使患者获得更好的预后。

       Objective  To investigate the conscious sedation effect of endovascular treatment in acute ischemic stroke．Methods  A total of 82 patients with acute ischemic stroke admitted to the hospital from January 2020 to March 2023 were selected and divided into two groups according to the random number table method，with 41 cases in each group．The two groups were treated with thrombolysis and thrombectomy，the control group was treated with general anesthesia，and the observation group was treated with conscious sedation．The short-term efficacy，complications and prognosis were compared between the two groups．Results  The time from admission to groin puncture ［（95.52±3.63）min］ and time from puncture to vascular  recanalization ［（72.25±5.58）min］ in the observation group were significantly lower than those in the control group ［（112.25±4.18）min，（102.45±10.63）min］（t=19.349，P＜0.05）．Observation group ICU time，length of hospital stay（7.81+2.63）d（13.75+3.64）d，and the control group（8.05+2.81）d，（14.52-4.07）d  had  no  statistically  significant  difference in comparison（t were 0.524，0.399，0.902，P were 0.601，0.690，0.369）．Recent total effective cases observation in group was 39（95.12%）and control group was 37（90.24%），there was no statistically significant difference comparing（χ ² =0.719，P=0.396）．Observation group had symptomatic intracranial hemorrhage in three patients（7.32%）and control group had six cases（14.63%），there was no statistically significant difference（χ ² =1.123，P=0.289）．There were four cases（9.76%）of brain edema and 12 cases（29.27%）of hypostatic pneumonia in the observation group，which were significantly lower than seven cases（17.07%）and 18 cases（43.90%）in the control group（χ ² =4.969，6.962，P=0.025，0.008）．The number of patients with good prognosis in the observation group（21 cases，51.22%）was significantly higher than that in the control group（10 cases，24.39%）（χ ² =6.275，P=0.012）．Conclusions In the treatment of acute ischemic stroke patients with thrombolysis and thrombectomy，conscious sedation can achieve the same efficacy as general anesthesia，and can further shorten the treatment time，promote  rapid recanalization of blood vessels and reduce related complications，so that patients can get a better prognosis．