目的:觀察丙泊酚靜脈泵注復合腰硬聯合麻醉于剖宮產術中的可行性及安全性。方法:50例ASA I~II級行擇期剖宮產術產婦,于L2-3行腰硬聯合麻醉,確定麻醉平面為T4-6,取出胎兒后靜脈緩推丙泊酚1mg/kg,然后2~4mg·kg-1·h-1靜脈泵入,連續監測平均動脈壓,心率,血氧飽和度,呼吸頻率。結果:腰硬聯合麻醉及靜脈推注負荷劑量丙泊酚后平均動脈壓降低,但無臨床意義。余心率,氧飽和度,呼吸頻率各時點無統計學差異。結論:丙泊酚復合腰硬聯合麻醉用于剖宮產術患者生命體征平穩,鎮靜效果良好。
Objective To explore the effects of propofol and thiopental sodium injection on convulsive seizure in electro-convulsive therapy(ECT) and to provide evidence to help the selection of intravenous anaesthetics in improved ECT. Methods Total of 111 patients who received ECT in the 3rd Pepole’s Hospital of Panzhihua from July to December 2005 were divided into a thiopental sodium group (n =62) and a propofol group (n =49). These patients received intravenous anaesthesia with suxamethonium plus thiopental sodium or propofol for the implementation of ECT, respectively. The status of convulsive seizure was compared between the two groups. Results There were no significant differences between the two groups in terms of main demographic data, disease category and ECT parameters (Pgt;0.05). Motor seizure and electricity discharge lasted significantly longer in the propofol group than in the thiopental sodium group (Plt;0.01). Conclusion Thiopental sodium can increase the excitation threshold of brain cortical neurons and decrease the level of convulsive seizure induced by ECT. Propofol may decrease the excitation threshold, and increase the level of convulsive seizure under the same ECT parameters, but may have the potential to induce epileptic seizure.
Objective To evaluate the sedative and analgesic efficacy and adverse effect of dexmedetomidine versus propofol on the postoperative patients in intensive care unit (ICU). Methods The relevant randomized controlled trials (RCTs) were searched in The Cochrane Library, MEDLINE, PubMed, SCI, SpringerLinker, ScinceDirect, CNKI, VIP, WanFang Data and CBM from the date of their establishment to November 2011. The quality of the included studies was evaluated after the data were extracted by two reviewers independently, and then the meta-analysis was performed by using RevMan 5.1. Results Ten RCTs involoving 793 cases were included. The qualitative analysis results showed: within a certain range of dosage as dexmedetomidine: 0.2-2.5 μg/(kg·h), and propofol: 0.8-4 mg/(kg·h), dexmedetomidine was similar to propofol in sedative effect, but dexmedetomidine group needed smaller dosage of supplemental analgesics during the period of sedative therapy. The results of meta-analysis showed: the percentage of patients needing supplemental analgesics in dexmedetomidine group was less than that in propofol group during the period of sedative therapy (OR=0.24, 95%CI 0.08 to 0.68, P=0.008). Compared with the propofol group, the duration of ICU stay was significantly shorter in the dexmedetomidine group (WMD= –1.10, 95%CI –1.88 to –0.32, P=0.006), but the mechanical ventilated time was comparable between the two groups (WMD=0.89, 95%CI –1.15 to 2.93, P=0.39); the incidence of adverse effects had no significant difference between two groups (bradycardia: OR=3.57, 95%CI 0.86 to 14.75, P=0.08; hypotension: OR=1.00, 95%CI 0.30 to 3.32, P=1.00); respiratory depression seemed to be more frequently in propofol group, which however needed further study. Mortalities were similar in both groups after the sedative therapy (OR=1.03, 95%CI 0.54 to 1.99, P=0.92). Conclusion Within an exact range of dosage, dexmedetomidine is comparable with propofol in sedative effect. Besides, it has analgesic effect, fewer adverse effects and fewer occurrences of respiratory depression, and it can save the extra dosage of analgesics and shorten ICU stay. Still, more larger-sample, multi-center RCTs are needed to provide more evidence to support this outcome.
【摘要】 目的 觀察丙泊酚在重癥監護室（ICU） 外科術后對患者的鎮靜效果及作用。 方法 2006年7月-2008年7月，對行外科手術后在ICU觀察室采用丙泊酚鎮靜的45例患者的鎮靜效果、停藥蘇醒時間及給藥前后呼吸、循環參數的變化進行觀察，并與治療前進行比較。 結果 丙泊酚鎮靜起效快，鎮靜治療后大多數患者開始血壓有所下降（Plt;0.05）但不久恢復正常，所有患者心率、呼吸頻率、血氧飽和度無明顯變化（Pgt;0.05），停藥后蘇醒快。 結論 丙泊酚是外科術后患者較理想的鎮靜劑，但應根據患者情況調整給藥速度、劑量及時間。 【Abstract】 Objective To observe the sedative effect of propofol on the patients after surgical operations in intensive care unit (ICU). Methods Forty-five patients underwent the injection with propofol after surgical operations in ICU from July 2006 to July 2008. The sedative efficacy, recovery time after the propofol administration, and changes of respiratory, circulate parameter before and after medication were observed, which were compared with those before the treatment. Results The sedative reactive time of propofol was short. Most of the patients had decreased blood pressure after injection with propofol (Plt;0.05) but recovered soon. The heart rate, respiratory rate, and pulse oxygen saturation did not significantly changed (Pgt;0.05). The recovery time was short after propofol administration was stopped. Conclusion Propofol is an effective sedative for the patients after surgical operations in ICU, but the medicated speed, amount and time according to state of the patients should be adjusted.
Objective To investigate clinical application and safety evaluation of sedative demulcent anesthesia in therapeutic endoscopic retrograde cholangiopancreatography (ERCP).Methods Totally 1660 patients underwent ERCP at the First Hospital of Lanzhou University were prospectively divided into two groups: venous sedative demulcent group (n=800, using sufentanil and midazolam and propofol continuing infusion) and conventional sedative demulcent group (n=860, using common medicine). The heart rate (HR), respiration (R), blood pressure (BP) and peripheral oxygen saturation (SpO2) of pre-anesthesia, post-anesthesia, during operation and after analepsia in every group were detected. The narcotism was evaluated by Ramsaymin grading method and the related adverse reactions such as cough, restlessness, harmful memory, and abdominal pain after operation were recorded. Results Compared with conventional sedative demulcent group, vital signs of patients in venous sedative demulcent group were more stable. For postoperative adverse reactions, abdominal pain, abdominal distension and nausea and vomiting were respectively 4.4%(35/800), 2.6%(21/800) and 3.6%(29/800) in venous sedative demulcent group, which were respectively higher of the incidence of 36.3%(312/860), 49.0%(421/860) and 53.0%(456/860) in conventional sedative demulcent group (P＜0.01). The postoperative satisfaction and adverse reactions recall between venous sedative demulcent group and conventional sedative demulcent group was respectively significant different (96.9% vs. 2.9%, 4.8% vs. 97.9%, P＜0.01). Conclusion Sufentanil and midazolam and propofol continuing infusion have good effect of sedative demulcent anesthesia, which can be widely used.
目的 探討全憑靜脈麻醉中腺苷對丙泊酚用量的影響。 方法 2011年1月－12月期間59例行擇期手術的患者全憑靜脈麻醉，隨機分為腺苷靜脈持續輸注組（A組）和對照組（B組），A組患者麻醉誘導后持續輸注腺苷70 μg/（kg·min），直至術畢。B組麻醉后按常規處理。比較兩組患者麻醉時間、蘇醒時間、瑞芬太尼用量，麻醉過程中平均動脈壓（MAP）、心率，以及麻醉過程中丙泊酚的用量。同時記錄使用腺苷過程中的不良反應。 結果 兩組患者麻醉時間、蘇醒時間、瑞芬太尼用量比較均無明顯差異，無統計學意義（P＞0.05）。兩組患者麻醉過程中MAP、心率比較亦無明顯差異，無統計學意義（P＞0.05）。兩組患者麻醉過程中丙泊酚平均用量比較，A組明顯低于C組，差異有統計學意義（P＜0.05），且不良反應發生率低。 結論 腺苷能明顯降低全憑靜脈麻醉中丙泊酚的使用劑量。
ObjectiveTo compare the effect of pretreatment with butorphanol or tramadol for prevention of propofol-induced injection pain by intravenous injection or drip, in order to explore a safe and effective method. MethodsWe chose 150 patients of ASAⅠ-Ⅱundergoing elective surgery between October 2012 and March 2013 in Sichuan Orthopedic Hospital as the study subjects. They were randomly divided into five groups with 30 patients in each group:butorphanol injection and drip group (group BI and group BD), tramadol injection and drip group (group TI and group TD), control group (group C). Five minutes before anesthesia induction, patients in group BI, TI and C were respectively injected with butorphanol 2 mg, tramadol 100 mg, and saline; patients in group BD and TD were respectively injected with butorphanol 2 mg and tramadol 100 mg before receiving propofol (2.5 mg/kg) for 2 minutes. Assessment of pain during injection was done by using a four-point scale. ResultsThe pre-injection pain incidence in group BI and TI was significantly higher than that in group BD, TD and C(P < 0.05), and it was significantly higher in group BI than group TI (P < 0.05). The incidence of propofol injection pain in group BI, BD, TI and TD were significantly lower than that in group C (P < 0.05), and it was the lowest in group BD (P < 0.05) followed by group BI (P < 0.05). The total rate of pain in group BD was only 6.67%, significantly lower than other groups (P < 0.05). ConclusionsThe pretreatment with butorphanol and tramadol by intravenous injection or drip can reduce the incidence of propofol injection pain. Pretreatment with butorphanol at 2 mg by intravenous drip is more effective, but should be closely observed to avoid adverse events.
目的 研究腦電雙頻指數（BIS）在小兒麻醉中的應用，為BIS在小兒臨床麻醉上的廣泛應用及提高小兒麻醉的安全性提供依據。 方法 2011年1月－3月擬行腹部外科手術的患兒60例，男39例，女21例；年齡1～4歲，美國麻醉醫師協會分級Ⅰ～Ⅱ級，隨機分為兩組，每組各30例。S組：七氟醚、瑞芬太尼和維庫溴銨維持麻醉；P組：丙泊酚、瑞芬太尼和維庫溴銨維持麻醉。采用BIS監測麻醉深度，將BIS控制在50 ± 5，記錄麻醉誘導前到手術探查期間不同時點的血流動力學參數及蘇醒、拔管時間。 結果 手術過程中P組血壓及心率明顯低于麻醉前水平（P＜0.05）。S組蘇醒迅速、完全，蘇醒時間與P組比較差異有統計學意義（P＜0.05）。S組的血流動力學穩定性優于P組，蘇醒時間、拔管時間相對較短。麻醉誘導前兩組的BIS值均為97 ± 1，意識消失時的BIS值為71 ± 2。BIS值為50 ± 5時，結果顯示手術過程中（T4、T5、T6、T7）兩組的心率、血壓都很平穩。 結論 BIS作為小兒麻醉鎮靜深度的監測指標有臨床意義。
Objective To systematically review the impacts of general anesthesia using sevoflurane versus propofol on the incidence of emergence agitation in pediatric patients. Methods Such databases as PubMed, EMbase, Web of Science, The Cochrane Library (Issue 4, 2012), CNKI, CBM, WanFang Data and VIP were electronically searched from inception to December 2012, for comprehensively collecting randomized controlled trials (RCTs) on the impacts of general anesthesia using sevoflurane versus propofol on the incidence of emergence agitation in pediatric patients. References of included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results A total of 9 RCTs involving 692 children were included, of which, six were pooled in the meta-analysis. The results of meta-analysis showed that: a) after anesthesia induction using sevoflurane, intravenous propofol maintenance was associated with a lower incidence of emergence agitation compared with sevoflurane maintenance (RR=0.57, 95%CI 0.39 to 0.84, P=0.004); and b) patients anesthetized with total intravenous propofol had a lower incidence of emergence agitation compared with total inhalation of sevoflurane (RR=0.16, 95%CI 0.06 to 0.39, Plt;0.000 1). Conclusion The incidence of emergence agitation after general anesthesia using sevoflurane is higher than that using propofol. Due to the limited quantity and quality, the application of sevoflurane should be chosen based on full consideration into patients’ conditions in clinic.