目的 观察布托啡诺联合舒芬太尼镇痛方案在重症监护病房（ICU）机械通气患者中的效果及对血流动力学的影响。方法 采用前瞻性、随机对照研究,选取2021年3月—2023年3月商丘市第三人民医院ICU收治的118例机械通气患者,按1∶1随机分为观察组、对照组各59例。观察组采取布托啡诺联合舒芬太尼镇痛方案,对照组采取舒芬太尼镇痛方案。比较两组镇静、镇痛情况（镇静起效时间、停药后苏醒时间、机械通气时间、ICU住院时间、丙泊酚总用量）。以用药前（T0）、用药后6 h（T1）、12 h（T2）、24 h（T3）为时间节点,比较两组血流动力学指标[心率（HR）、平均动脉压（MAP）]。以用药后6 h（t1）、12 h（t2）、18 h（t3）、24 h（t4）为时间节点,比较两组Ricker镇静-躁动评分（SAS）、重症监护疼痛观察工具（CPOT）评分。比较两组不良反应发生情况。结果 用药后观察组镇静起效、停药后苏醒、机械通气、ICU住院时间均短于对照组,丙泊酚总用量少于对照组（P<0.05）;t1~t4时观察组CPOT评分均低于对照组,SAS评分均高于对照组（P<0.05）;T1、T2、T3时观察组HR、MAP波动幅度小于对照组（P<0.05）;观察组不良反应总发生率为10.17%,与对照组15.25%相比,差异无统计学意义（P>0.05）。结论 布托啡诺、舒芬太尼联合治疗ICU机械通气患者,可有效增强镇静、镇痛效果,维持血流动力学稳定,且安全性较高,有利于促进患者病情转归。

Objective To observe the effect of butorphanol and sufentanil combined analgesia regimen in patients with mechanical ventilation in intensive care unit（ICU）and its influence on hemodynamics．Methods A prospective,randomized controlled study was carried out on 118 patients with mechanical ventilation in ICU from March 2021 to March 2023,and the enrolled patients were randomly divided into observation group and control group with 59 cases in each group．The observation group received butorphanol combined with sufentanil analgesia regimen,and the control group received sufentanil analgesia regimen．The conditions of sedation and analgesia（sedation onset time,recovery time after drug withdrawal,mechanical ventilation time,ICU stay length,total dosage of propofol）were compared between the two groups．The hemodynamic indexes [heart rate（HR）and mean arterial pressure（MAP）] of the two groups were compared before medication（T0）,6 h（T1）,12 h（T2）and 24 h（T3）after medication as time nodes．At 6 h（t1）,12 h（t2）,18 h（t3）,24 h（t4）after medication,Ricker Sedation-Agitation Scale（SAS）and Critical Care Pain Observation Tool（CPOT）score were compared between the two groups．The occurrence of adverse reactions was compared between the two groups．Results The onset of sedation,recovery after drug withdrawal,mechanical ventilation and ICU stay in the observation group were shorter than those in the control group,and the total dosage of propofol was lower than that in the control group（P<0.05）．At t1 to t4,CPOT score of observation group was lower than that of control group,and SAS score was higher than that of control group（P<0.05）．The fluctuation amplitude of HR and MAP in the observation group was smaller than that in the control group at T1,T2 and T3（P<0.05）．The total incidence of adverse reactions in the observation group was 10.17%,compared with 15.25% in the control group,the difference was not statistically significant（P>0.05）．Conclusions The combination of butorphanol and sufentanil in the treatment of patients with mechanical ventilation in ICU can effectively enhance sedation and analgesia,maintain hemodynamic stability,and have high safety,which is conducive to promote the outcome of the disease．

目的 探讨右美托咪定（Dex）分别联合丙泊酚或依托咪酯在颅内动脉瘤介入术中的镇静效果及对患者血流动力学的影响。方法 将60例颅内动脉瘤介入术患者按照随机数表法分为A组（Dex+丙泊酚,n=30）、B组（Dex+依托咪酯,n=30）。记录两组不同时间点的平均动脉压（MAP）、心率（HR）,比较苏醒期的镇静效果、呛咳程度、拔管时间、苏醒时间、清醒时间及术后不良反应。结果 A组患者T₁MAP、HR为（84.56±5.13）mmHg、（65.87±5.14）次/分和T₂（83.29±5.47）mmHg、（65.87±5.14）次/分均低于B组T₁（87.89±3.88）mmHg、（70.22±5.67）次/分和T₂（86.71±3.75）mmHg、（69.97±5.87）次/分（t分别为2.836、2.825、3.113、3.391,均P<0.001）。两组苏醒期各项指标和躁动（10.00% vs 0%,P=0.757）、呼吸抑制发生率（3.33% vs 0%,P=0.313）比较差异均无统计学意义（均P>0.05）,A组恶心、呕吐发生率（3.33%）较B组（20.00%）更低（χ²=4.043,P=0.044）。结论 Dex联合丙泊酚、依托咪酯麻醉在颅内动脉瘤介入术中均可发挥良好安全的麻醉作用,降低患者术后躁动和呼吸抑制的发生率,使用Dex联合依托咪酯在患者围插管期的血流动力学的稳定性效果更好,但在降低患者术后恶心呕吐的风险方面效果较差。

Objective To evaluate the sedative effect of dexmedetomidine（Dex）combined with propofol or etomidate during cerebral aneurysm intervention and its effect on patient hemodynamics．Methods A total of 60 cerebral aneurysm patients were randomly divided into two groups：Group A（Dex + propofol,n=30）and Group B（Dex + etomidate,n=30）．Mean arterial pressure（MAP）and heart rate（HR）were recorded at different time points in the two groups,and the sedation effect,choking degree,extubation time,waking up time,waking time and postoperative side effects were compared．Results T₁ MAP,HR of（84.56±5.13）mmHg,（65.87±5.14）times / min and T₂（83.29±5.47）mmHg,（65.87±5.14）times / min in group A were lower than those in group B T₁（87.89±3.88）mmHg,（70.22±5.67）times / min and T₂（86.71±3.75）mmHg,（69.97±5.87）times / min（t=2.836,2.825,3.113,3.391,all P<0.001）．There was no significant difference in the incidence of emergence agitation（10.00 % vs 0.00 %,P=0.757）and respiratory depression（3.33 % vs 0.00 %,P=0.313）between the two groups（P>0.05）．The incidence of nausea and vomiting in group A（3.33 %）was lower than that in group B（20.00 %）（χ²=4.043,P=0.044）．Conclusions Dex combined with propofol and etomidate anesthesia can have a good and safe anesthesia effect in intracranial aneurysm intervention,and reduce the incidence of postoperative agitation and respiratory depression in patients．Hemodynamic stabilization during the tube phase is more effective,but less effective in reducing the risk of postoperative nausea and vomiting in patients．

目的 探讨肌电生物反馈对正常人脑血流动力学的影响及其变化规律。方法 总数30人的健康正常受试者纳入研究,按照表格法随机分为生物反馈实验组和对照组。其中生物反馈组20人,对照组10人。该试验采用肌电生物反馈作为反馈方法,记录两组试验前后双侧大脑前动脉、大脑中动脉和大脑后动脉的平均血流速度和脉动指数。每次生物反馈试验后间隔3天,作为一个生物反馈阶段,总共进行7个阶段。结果 生物反馈组大脑中动脉的平均血流速度在试验前、后高于对照组(P<0.05),而其脉动指数则低于对照组(P<0.05)。生物反馈组在试验前、后大脑中动脉的平均血流速度随着生物反馈次数的增加而增快(P<0.05),而脉动指数则随之而降低(P<0.05)。结论 肌电生物反馈能够增加正常人大脑中动脉的平均血流速度和降低其脉动指数,且随着生物反馈次数的增加而呈现累积效应。

Objective To discuss the effect of electromyographic biofeedback on cerebral hemodynamics in health people. Methods A total of 30 healthy volunteers were enrolled in this study, and randomly divided into biofeedback group (n=20) and control group (n=10). The biofeedback group had been done with electromyographic biofeedback for seven times with 3 days intervals after each test. The data including the mean velocity (Vm) and pulse index (PI) of anterior cerebral artery, middle cerebral artery (MCA) and posterior cerebral artery were collected bilaterally before and after the test using transcranial Doppler in the two groups. Results The values of Vm (P<0.05) were higher and PI (P<0.05) were lower in biofeedback group than those in control group before and after the test. The values of Vm (P<0.05) increased and PI (P<0.05) decreased gradually in biofeedback group from 1st to 7th tests. Conclusion The electromyographic biofeedback can induce to the increasing of velocity of cerebral blood flow and decreasing of PI in MCA, and the additive effect was observed during the 7 tests in biofeedback group.