Objective To investigate the efficacy and safety of paracervical block combined with alfentanil in hysteroscopic day surgery under total intravenous anesthesia. Methods This study used a prospective randomized controlled study approach. A total of 60 day surgery patients requiring hysteroscopic surgery under general anesthesia admitted to Weifang People’s Hospital between October and December 2020 were randomly selected. All patients were divided into trial group and control group by completely random number table method, with 30 patients in each group. The trial group received paracervical block combined with total intravenous anesthesia with alfentanil, and the control group received total intravenous anesthesia with alfentanil. The general condition, operation time, recovery time, intraoperative propofol dosage, postoperative pain score, intraoperative motion response and postoperative nausea and vomiting incidence were compared between the two groups. Results There was no significant difference in age, body mass index and incidence of comorbidities between the two groups (P>0.05). There was no significant difference in the operation time, recovery time, pain score at 2 hours after operation, and incidence of nausea and vomiting between the two groups (P>0.05). In the control group, the dose of propofol [(34.07±12.67) vs. (28.33±9.10) mL], the pain score on awakening (1.50±0.78 vs. 0.77±0.50), and the incidence of body movement response (20.0 % vs. 0.0%) were higher than the trial group (P<0.05). Conclusion The use of paracervical block combined with alfentanil in hysteroscopic day surgery under total intravenous anesthesia can reduce the amount of propofol during the operation, reduce postoperative pain, and reduce perioperative adverse reactions, which has a good efficacy and safety.
目的:观察等效剂量瑞芬太尼和芬太尼诱导气管插管对小儿血流动力学的影响。方法:40例择期行全麻患儿随机分为瑞芬太尼组和芬太尼组,麻醉诱导使用咪唑安定0.15mg/kg、丙泊酚2.5mg/kg、芬太尼2.5μg/kg或瑞芬太尼2μg/kg和维库溴铵0.1mg/kg。分别于麻醉诱导前(T0)、诱导后2min(T1)、插管后1、2min(T2、T3)记录心率、收缩压和舒张压。结果:两组诱导前血流动力学指标相似。与T0时比较,两组患儿T1时收缩压、舒张压均降低(Plt;0.05或Plt;0.01),心率均减慢(Plt;0.05或Plt;0.01);瑞芬太尼组T2.T3时收缩压、舒张压降低(Plt;0.05或Plt;0.01),心率减慢(Plt;0.05);芬太尼组T2、T3时收缩压、舒张压升高(Plt;0.05),心率增快(Plt;0.05)。与芬太尼组比较,瑞芬太尼组T1、T2和T3时收缩压、舒张压均降低(Plt;0.05),心率减慢(Plt;0.05)。结论:瑞芬太尼比等效剂量芬太尼能更好地抑制小儿全麻诱导气管插管时的心血管反应。
目的 通过对腹部手术后自控静脉镇痛（PCIA）不同药物配方的研究，探讨酒石酸布托啡诺与舒芬太尼用于术后PCIA临床效果。 方法 将2012年2月－8月收治的60例麻醉分级为Ⅰ～Ⅲ级需术后镇痛的腹部手术患者（均无心、肺、肝、肾、脑、内分泌疾病及过敏史）随机分成两组：酒石酸布托啡诺组（N组，n=30），舒芬太尼组（S组，n=30）。观察镇痛效果和不良反应发生率。 结果 两组镇痛效果差异无统计学意义（P＞0.05），不良反应（包括恶心、呕吐、头晕、嗜睡、皮肤瘙痒、呼吸抑制、尿潴留等），N组发生率均低于S组（P＜0.05）。 结论 酒石酸布托啡诺用于PCIA安全、有效，不良反应少。
【摘要】 目的 比较术后芬太尼皮下镇痛（PCSA）与硬膜外镇痛（PCEA）的临床效果，以及对胃肠功能的影响。 方法 2009年1-6月间观察择期硬膜外麻醉下经腹子宫切除术患者120例，术后分别实施PCSA与PCEA，观察术后第4、8、12、24、48 h的镇痛、镇静情况，呼吸循环、恶心呕吐及其他不良事件，记录术后首次肛门排气时间，测评术后镇痛满意度。 结果 术后两组患者镇痛优良率均在90%以上，各时点镇痛评分、镇静评分、恶心呕吐发生率、首次肛门排气时间以及患者镇痛优良率差异均无统计学意义（Pgt;0.05）。 结论 术后芬太尼PCSA与PCEA一样，效果确切，对术后胃肠功能无明显影响，患者满意，是一种安全、有效的镇痛方法。【Abstract】 Objective To compare clinical efficiency and gastrointestinal reaction of subcutaneous patient-controlled analgesia (PCSA) and epidural patient-controlled analgesia (PCEA) with fentanyl analgesic for patients after operation. Methods A total of 120 patients having undergone transabdominal hysterectomy under epidural anesthesia between January and June 2009 accepted PCSA or PCEA after operation. We evaluated the state of analgesia and sedation at the 4th, 8th, 12th, 24th and 48th hour after operation. We also looked into the respiration, blood circulation, nausea, vomiting and other abnormal events of the patients during the first 48 hours after operation. At the same time, we recorded the first time of anal exsufflation after operation and the degree of patients’ satisfaction. Results The analgesic effective rate was higher than 90% in both groups. There were no significant differences in analgesia and sedation scores at above-mentioned points after operation, incidence of nausea and vomiting, first time of anal exsufflation or analgesic effective rate between the two groups. Conclusion PCSA with fentanyl can be as effective in relieving postoperative pain as PCEA with fentanyl without obvious adverse effect in the gastrointestinal function. Therefore, PCSA is a safe and effective method to alleviate postoperative pain.
目的:比较瑞芬太尼联合异丙酚或依托咪酯全麻在腹腔镜妇科手术中的临床效果。方法:择期腹腔镜妇科手术80例,随机分成瑞芬太尼异丙酚组(RP组)和瑞芬太尼依托咪酯组(RE组),各40例。两组全麻诱导用药相同,维持麻醉RP组采用瑞芬太尼联合异丙酚、RE组采用瑞芬太尼联合依托咪酯。记录基础值、诱导后、插管后1 min、3 min、气腹时、气腹后10、20、30、40 min的动脉收缩压(SBP)、舒张压(DBP)、心率(HR);记录停药至自主呼吸恢复、睁眼、拔除气管导管、恢复定向能力的时间;记录清醒即刻及清醒后1、2、4、8、12、16、20、24 h患者疼痛程度,采用VAS评分;记录24 h内不良反应发生情况。 结果: 两组SBP、DBP均在诱导后明显低于基础值(Plt;001), 插管后恢复,气腹开始后趋于平稳;两组HR均在诱导后减慢(Plt;001),插管后及气腹开始时恢复。RP组自主呼吸恢复、呼之能睁眼、拔除气管导管及恢复定向能力的时间均明显短于RE组(Plt;001)。麻醉清醒即刻、清醒后1、2、4、8 h VAS评分RE组明显低于RP组(Plt;005),12、16、20、24 h VAS评分两组比较无显著性差异(Pgt;005)。术后发生恶心呕吐患者数RP组明显减少(Plt;005)。 结论:全麻行腹腔镜妇科手术时,瑞芬太尼联合异丙酚或依托咪酯都能缓解气腹及手术引起的血流动力学变化,瑞芬太尼联合异丙酚术后苏醒快且能明显降低术后恶心呕吐的发生率,但术后疼痛较为严重。
The present study was to investigate the effects of infusing remifentanil-poly-caprolactone (REM-PCL) through the abdominal aorta on spinal cord ischemia reperfusion injury (SCIRI). The model of SCIRI was created by clamping the infrarenal aortic in thirty-six New Zealand white rabbits, which were randomly divided into sham group (group S), control group (group C), and REM-PCL group (group R) with 12 rabbits in each one. The spinal cord microcirculatory blood flow (SCMBF) and blood flow rate (BFR) were monitored before ischemia, 15 min, 30 min, 60 min and 120 min after reperfusion, respectively. Neurologic Function was evaluated before ischemia, 6h, 12h and 24h after reperfusion. The concentration of serum neuron-specific enolase (NSE), interleukin-lβ (IL-lβ) and interleukin-8 (IL-8) were monitored before ischemia, 45 min after ischemia, 30 min, 60 min, 6 h, 12 h and 24 h after reperfusion. The abnormal rate of motor neuron of spinal cord tissues and the level of superoxide dismutase (SOD), reactive oxygen species (ROS), glutathione peroxidase (GSH-PX), malondialdehyde (MDA), total anti-oxidation capacity (T-AOC) and mitochondrial swelling degree (MSD) in neural mitochondria were determined before ischemia, 45 min after clamping, 60 min and 120 min after reperfusion. As a result, the neural mitochondrial SOD, GSH-PX and T-AOC decreased while ROS, MDA, MSD, IL-lβ, IL-8 and NSE distinctly increased after clamping of the abdominal aorta as compared to the value before ischemia in group C (P < 0.01). Neurologic function scores recovered more rapidly in group R than those in group C during reperfusion (P < 0.01). The neural mitochondrial SOD, GSH-PX and T-AOC were distinctly higher while ROS, MDA, MSD, IL-lβ, IL-8 and NSE were distinctly lower in group R than those in group C (P < 0.01). The abnormal rate of motor neuron was significantly higher in group C during reperfusion than that in group R (P < 0.01). It has been shown that the intra-aortic REM-PCL infusion can alleviate SCIRI by inhibiting inflammatory response and improving mitochondrial anti-oxidation capacity.
ObjectiveTo explore the efficacy and safety of different sedative and analgesic methods in emergent endotracheal intubations in RICU. Methods110 cases of tracheal intubation in critically ill patients were divided into 5 groups randomly: ① control group(given no sedative or analgesic drug before intubation); ② fentanyl group(given intravenous fentanyl 2 μg/kg before intubation,followed by fentanyl 2 μg·kg-1·h-1 maintenance); ③ dexmedetomidine hydrochloride+fentanyl group(given dexmedetomidine hydrochloride 1 μg/kg+fentanyl 2 μg/kg before intubation,followed by dexmedetomidine hydrochloride 0.5 μg·kg-1·h-1+fentanyl 2 μg·kg-1·h-1 maintenance); ④ midazolam+fentanyl group(given midazolam 0.05 mg/kg+fentanyl 2 μg/kg before intubation,followed by midazolam 0.05 mg·kg-1·h-1+fentanyl 2 μg·kg-1·h-1 maintenance); ⑤ Propofol+fentanyl group(given propofol 1 mg/kg+fentanyl 2 μg/kg before intubation,followed by propofol 0.4 mg·kg-1·h-1+fentanyl 2 μg·kg-1·h-1 maintenance).The mean arterial pressure(MAP),heart rate(HR),respiratory frequency(RR),PaO2/FiO2,Riker sedation score and agitation were monitored before,during and after intubations.The one-time success rate of intubation and severe arrhythmia (sinus bradycardia,frequent ventricular premature,ventricular fibrillation,and cardiac arrest) incidence rate were recorded. ResultsThe one-time success rates of intubations of the propofol+fentanyl group (95.4%) and the midazolam+fentanyl group (90.9%) were higher than that in the dexmedetomidine hydrochloride+fentanyl group (86.4%,P<0.05),while one-time intubation success rate of three groups were higher than that of the fentanyl group (45.4%) and the control group (31.8%,P<0.05).5 minutes after intubation,the PaO2/FiO2 index of 5 groups of patients were higher than those before intubation,but the PaO2/FiO2 index of the control group and the fentanyl group were lower than those in the other three groups(P<0.05).The occurrence of serious arrhythmia rate in the dexmedetomidine hydrochloride+fentanyl group (0%),the midazolam+fentanyl group (9%) and the propofol+fentanyl group (9%) were lower than that in the control group (13.6%) and the fentanyl group (18.2%).The MAP during intubation and 2 minutes after intubation of the propofol+fentanyl group and the midazolam+fentanyl group were lower than that in the other three groups(P<0.05).The proportion of patients with Riker sedation and agitation score≤4 at intubation in the dexmedetomidine hydrochloride+fentanyl group (68.2%) was lower than that in the propofol+fentanyl group(90.9%) and the midazolam+fentanyl group (86.4%,P<0.05),but higher than those in the fentanyl group(22.7%)and the control group(18.2%,P<0.05). ConclusionPropofol,midazolam or dexmedetomidine hydrochloride with fentanyl are all effective and safe methods of sedation and analgesia in emergent endotracheal intubation in RICU.Dexmedetomidine hydrochloride with fentanyl is an ideal sedative relatively with less influence on cardiovascular system and less myocardial oxygen consumption.
Objective To systematically review the clinical effectiveness and safety of sufentanil-propofol versus remifentanil-propofol during total intravenous anesthesia for neurosurgery. Methods Databases including The Cochrane Library (Issue 3, 2013), the database of the Cochrane Anesthesia Group, MEDLINE, EMbase, PubMed, Ovid, Springer, CNKI, VIP and WanFang Data were electronically searched from inception to May 2013 for the randomized controlled trials (RCTs) of sufentanil-propofol versus remifentanil-propofol during total intravenous anesthesia for neurosurgery. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the quality of included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results Thirteen trials involving 647 patients were finally included. The results of meta-analysis showed that: a) for hemodynamic changes, MAP decreased in the remifentanil-propofol group after induction and decreased 5 minutes after intubation, but no significant difference was found between the two groups; the two groups were alike in MAP changes during craniotomy and extubation, and in HR changes after induction, 5 minutes after intubation, during craniotomy and extubation, with no significant difference. b) The result of intra-operative wake-up test showed that, there was no significant difference in the sedative effect and the time of awaking between the two groups. c) For emergence time and extubation time, compared with the sufentanil-propofol group, emergence time and extubation time were significantly shorter than those in the remifentanil-propofol group. d) For side effects, there was no significant difference in side effects (such as post-operative nausea, vomiting, respiratory depression, restlessness, chills and hypotension) between the two groups. And e) for post-operative pain, compared with the remifentanil-propofol group, post-operative 1-h and 2-h VAS were lower and the number of who need additional analgesic drugs within 24 h after operation was less in the sufentanil-propofol group, with significant differences. Both groups used the similar dosage of propofol with no significant difference. Conclusion Compared with the remifentanil-propofol group, hemodynamics changes in the sufentanil-propofol group is steadier after induction and during intubation. Patients in the sufentanil-propofol group are better in postoperative awakening quality. But they are alike in the incidence of side effects and propofol dosage.
【摘要】 目的 确定在不同浓度七氟醚复合瑞芬太尼诱导无肌松气管插管时瑞芬太尼的半数有效量（ED50）。 方法 2009年7月-2009年11月择期手术患者60例，ASA I~II，年龄20~59岁，按照入室的顺序随机分为Ⅰ组（2%七氟醚组）和Ⅱ组（3%七氟醚组），预冲8%七氟醚诱导，眼睑反射消失后，调节七氟醚呼气末浓度分别维持在2%或3%，同时按照序贯法注入瑞芬太尼，瑞芬太尼注射90 s后气管插管。记录麻醉诱导前、患者意识消失时、插管前1 min、插管后1 min及插管后3 min心率、平均动脉压的变化。 结果 2%、3%的七氟醚复合瑞芬太尼诱导气管插管时瑞芬太尼的半数有效量（ED50）及其相对应的95%可信区间分别为0.585 μg/kg及0.533～0.626 μg/kg和0.492 μg/kg及0.451～0.572 μg/kg。 结论 2%、3%的七氟醚复合瑞芬太尼诱导气管插管时瑞芬太尼的半数有效量及其相对应的95%可信区间分别为0.585 μg/kg及0.533～0.626 μg/kg和0.492 μg/kg及0.451～0.572 μg/kg。【Abstract】 Objective To determine the half effective dose (ED50) of remifentanil dose for tracheal intubation without neuromuscular relaxant in adult when combined with different concentration of sevoflurane. Methods Sixty ASA Ⅰ to Ⅱ adult aged 20 to 59 years old, scheduled for elective surgery under general anesthesia were enrolled in this study between July 2009 to November 2009. All patients were ranged randomly into Group Ⅰ (2% sevoflurane) and Group Ⅱ (3% sevoflurane).Anesthesia was induced with 8% sevoflurane in 100% oxygenat at 6 L/min.After the loss of eyelash reflex, remifentanil was injected over 30 s, end-tidal sevoflurane concentration 2% or 3% was maitained. The dose of remifentanil was determined by up-and-down method. In 90 s after the end of bolus administration of remifentanil, the trachea was intubated. Mean blood pressure and heart rate were recorded at anaesthetic induction, the loss of eyelash reflex, before, in 1 min and 3 min after intubation. Results ED50 values (95% confidence intervals)of remifentanil for tracheal intubation during 2% and 3% sevoflurane induction without neuromuscular relaxant were 0.585 μg/kg and 0.533 - 0.626 μg/kg, and 0.492 μg/kg and 0.451 - 0.572 μg/kg, respectively. Conclusion ED50 values (95% confidence intervals)of remifentanil for tracheal intubation 2% and 3% sevoflurane induction without neuromuscular relaxant are 0.585 μg/kg (0.533 - 0.626 μg/kg) and 0.492 μg/kg (0.451 - 0.572 μg/kg), respectively.