目的 探討成人七氟醚吸入誘導(dǎo)復(fù)合小劑量乙酰膽堿氣管插管對腦電雙頻指數(shù)(BIS)和血流動力學(xué)的影響。方法 采用全麻誘導(dǎo)后及氣管插管前后自身對照的試驗方法，選擇ASAI-II級非困難氣道、擇期手術(shù)病人30例，分別于全麻誘導(dǎo)前 (T1)、誘導(dǎo)后患者入睡時(T2)及氣管插管前(T3)、插管后1 min(T4)、插管后3 min(T5)時，監(jiān)測BIS、心率(HR)及平均動脈壓(MAP) 。結(jié)果 BIS 在T1~T5時分別為：96.8±1.7、70.4±8.8 、39.2±8.4、43.6±12.9、41.6±9.3, 誘導(dǎo)后各時點BIS 值均低于誘導(dǎo)前（Plt;0.05）。T3~T5時的HR均較誘導(dǎo)前升高（Plt;0.05）。MAP在T2和T3時與T1比降低，T4時比T1升高（Plt;0.05）；但在T5時回到誘導(dǎo)前水平（Pgt;0.05）。T4時的BIS值、MAP和HR值均顯著高于T3時（Plt;0.05）。術(shù)后隨訪無1例病人對誘導(dǎo)插管過程有記憶。結(jié)論 七氟醚復(fù)合小劑量乙酰膽堿誘導(dǎo)插管，可提供較好的鎮(zhèn)靜和(或) 麻醉深度，但尚不能很好地消除氣管插管引起的不良應(yīng)激反應(yīng)。
對采用氣管插管進(jìn)行全身麻醉（全麻）術(shù)后發(fā)生肺部感染的文獻(xiàn)進(jìn)行回顧，從術(shù)前、術(shù)中、術(shù)后3個方面分析其危險因素，總結(jié)預(yù)防控制措施。分析顯示，高齡、長期吸煙史、麻醉時間與導(dǎo)管留置時間、術(shù)前呼吸道護理、術(shù)后鎮(zhèn)痛及無菌操作技術(shù)等均可影響全麻術(shù)后肺部感染的發(fā)生率，需對上述危險因素進(jìn)行針對性處理，如術(shù)前戒煙、縮短麻醉時間、術(shù)前霧化吸入、插管過程嚴(yán)格無菌操作等，均可有效地預(yù)防肺部感染。
【摘要】 目的 觀察右星狀神經(jīng)節(jié)阻滯（R-SGB）對全身麻醉氣管內(nèi)插管期心血管反應(yīng)的影響?！》椒ā?009年10-12月選取60例美國麻醉醫(yī)師協(xié)會（ASA）Ⅰ、Ⅱ級擇期全麻手術(shù)患者，隨機分為3組。研究組于全麻誘導(dǎo)前15 min用1%利多卡因10 mL經(jīng)頸6入路行R-SGB，對照組1誘導(dǎo)前同法注射10 mL生理鹽水，對照組2誘導(dǎo)前肌注2%利多卡因5 mL。觀察氣管插管前后收縮壓（SBP）、舒張壓（DBP）、平均動脈壓（MBP）、心率（HR）、心電圖（ECG）、氧飽和度（SpO2）和心率收縮壓乘積（RPP）的變化。 結(jié)果 研究組各時點與進(jìn)入手術(shù)室時的基礎(chǔ)值比較，僅誘導(dǎo)后SBP、DBP、MBP顯著降低，窺喉時HR和RPP顯著升高（Plt;0.01）；在插管3 min后已恢復(fù)至基礎(chǔ)值。對照組1和對照組2誘導(dǎo)后SBP、DBP、MBP顯著降低（Plt;0.01）；窺喉時SBP、DBP、MBP、HR、RPP均顯著升高（Plt;0.01），并持續(xù)至插管后5 min。兩對照組升高的程度均顯著高于研究組（Plt;0.05或Plt;0.01）。 結(jié)論 R-SGB對全麻氣管插管期的心血管反應(yīng)有一定抑制作用，可用于調(diào)控全麻插管期心血管不良反應(yīng)。【Abstract】 Objective To explore the effect of right stellate ganglion block (R-SGB) on cardiovascular response during endotracheal intubation under the general anesthesia. Methods Sixty ASAⅠ-Ⅱpatients who underwent general anaesthesia between October to December 2009 were randomly divided into three groups. The patients in the trial group accepted R-SGB by C6 route with 1% lidocaine (10 mL) 15 minutes before induction of general anesthesia; the patients in control group 1 were injected with 10 mL physiological saline in the same way before the induction; the patients in control group 2 underwent the intramuscular injection of 2% lidocaine (5 mL) before the induction. The changes of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), hear rate (HR), electrocardiogram (ECG), oxygen saturation (SpO2) and heart rate-systolic blood pressure product (RPP) before and after endotracheal intubation were observed and recorded. Results In the trial group, SBP, MAP, and DBP decreased significantly after the induction; HR and RPP increased evidently at the laryngeal exposure compared with the baseline values (Plt;0.01) and recovered three minutes after the intubation. In the control group 1 and 2, SBP, MAP, and DBP decreased significantly after induction (Plt;0.01); SBP, MAP, DBP, HR and RPP increased apparently at the laryngeal exposure compared with the baseline values (Plt;0.01), and the raise continued until five minutes after endotracheal intubation. The difference in the raise between the control groups and the trial group was significant (Plt;0.05 or Plt;0.01). Conclusion R-SGB may effectively inhibit the cardiovascular response during endotracheal intubation under the general anesthesia and can be used to control the negative reaction during the induction.
摘要:目的：探討纖支鏡經(jīng)口引導(dǎo)氣管插管在慢阻肺合并重度呼吸衰竭救治中的臨床應(yīng)用價值。方法：237例慢阻肺合并重度呼吸衰竭患者,隨機分為纖支鏡經(jīng)口引導(dǎo)氣管插管組(纖支鏡組)125例和喉鏡經(jīng)口引導(dǎo)氣管插管組(喉鏡組)112例,分別在纖支鏡和喉鏡引導(dǎo)下按常規(guī)進(jìn)行氣管插管術(shù)。結(jié)果：纖支鏡組和喉鏡組一次獲得插管成功率分別為984%和920%(P＜005),平均插管時間分別為（613±391） min 和（926±415） min(P＜005)。纖支鏡組有5例患者出現(xiàn)咽喉部少量出血,并發(fā)癥發(fā)生率為40%;喉鏡組共有12例發(fā)生并發(fā)癥,并發(fā)癥發(fā)生率為107%(P＜005),其中齒、舌、咽或喉部損傷6例,反射性嘔吐致誤吸2例,單側(cè)肺通氣1例,插入食管2例,心跳呼吸驟停1例。結(jié)論：纖支鏡經(jīng)口引導(dǎo)氣管插管在慢阻肺合并重度呼吸衰竭救治中是一種簡便快速、成功率高和并發(fā)癥少的有效方法,值得臨床推廣應(yīng)用。Abstract: Objective: To evaluate the efficacy of endotracheal intubation under fiberoptic bronchoscope through mouth in severe respiratory failure. Methods:Two hundreds and thirtyseven cases of severe respiratory failure were divided into two groups at random (fiberoptic bronchoscope group and laryngoscope group), 125 cases were intubated through mouth under fiberoptic bronchoscope, the others were intubated through mouth by laryngoscope. Results: The successful rates of endotracheal intubation were 98.4% and 92.0% in two groups respectively (P ＜005), the mean intubation timewere (613±391) min and (926±415) min respectively ( P ＜ 005), 4 cases in fiberoptic bronchoscope group appeared a little blood in throat, the complication rate was 32% 12 cases in the laryngoscope group had complications, the complication rate was 107%( P＜ 005). Among it, 6 cases had the injury of tooth, tongue, gullet and larynx.The cases of reflexvomiting were 2,pulmonary ventilation by single lung were 1, intubation in esophagus were 2, cardiopulmonary arrest were 1.Conclusions:Endotracheal intubation under fiberoptic bronchoscope through mouth was accurate, the fewer complications and effective for patients, and could be used widely in clinical applications.
目的：比較常規(guī)鼻胃管置入法與鼻咽部局部噴霧麻醉后置胃管法對喉癌患者的影響。方法：將需要安置胃管的100例患者隨機分成兩組，每組50例。實驗組行鼻咽部噴霧麻醉，對照組按常規(guī)操作，比較兩組患者流淚、惡心、嘔吐、咳嗽反應(yīng)，一次成功率及插管所需要時間、插入中暫停次數(shù)。結(jié)果：實驗組一次成功率高，患者反應(yīng)輕，插管所需時間有顯著差異。結(jié)論：常規(guī)置胃管常因病員難受而中途暫停置管，實驗組置胃管前先作鼻咽部局部噴霧麻醉，可明顯減輕患者的痛苦，提高插胃管的一次成功率，插管過程中因病員難受暫停次數(shù)也明顯減少，使臨床護理工作時間縮短，對臨床護理工作有積極意義。
對經(jīng)病理組織學(xué)確診的20例胃癌患者手術(shù)前行選擇性動脈插管化療，其中12例手術(shù)，并與同期術(shù)前行全身靜脈化療的10例胃癌患者比較。結(jié)果動脈插管化療組除臨床癥狀有不同程度的改善外，其胃癌原發(fā)灶和淋巴結(jié)轉(zhuǎn)移灶中的癌細(xì)胞均有不同程度的變性壞死。兩組比較有高度顯著性差異（Plt;0.01）。作者認(rèn)為，胃癌患者術(shù)前采用選擇性動脈插管化療，其近期抗癌效果好，毒副反應(yīng)小，不僅可提高胃癌的手術(shù)切除率和根治率，對減少或防止術(shù)中癌細(xì)胞的醫(yī)源性擴散、種植和術(shù)后復(fù)發(fā)也有重要的臨床意義。
目的 分析ICU內(nèi)重癥患者床旁氣管插管的特點及并發(fā)癥發(fā)生率, 探討適宜的插管時 機和策略。方法 收集四川大學(xué)華西醫(yī)院ICU內(nèi)2008 年9 月至2009 年3 月共105 例床旁氣管插管中資料完整的42 例患者, 總結(jié)插管成功次數(shù)、時間及插管并發(fā)癥。醫(yī)師預(yù)先評估有插管指征并作插管準(zhǔn)備者24 例為計劃插管組, 因病情突變或意外拔管作緊急氣管插管者18 例為緊急插管組。結(jié)果 42 例患者中1 次插管成功率較低, 僅為57. 1% ; 插管并發(fā)癥多, 藥物誘導(dǎo)致低血壓19 例( 45. 2% ) , 低氧21 例( 50. 0% ) 。計劃插管組平均插管次數(shù)( 1. 71 ±1. 12 比2. 67 ±1. 75) 、2 次以內(nèi)插管成功率( 87. 5% 比61. 1% ) 、低氧并發(fā)癥發(fā)生率( 29. 1% 比77. 8% ) 均優(yōu)于緊急插管組( P 均lt; 0. 05) 。結(jié)論 ICU內(nèi)氣管插管難度大, 并發(fā)癥顯著。預(yù)先評估病情進(jìn)展趨勢主動插管可提高緊急插管成功率, 減少插管時間及并發(fā)癥。