目的 探討磷丙泊酚鈉后處理對大鼠肝臟缺血再灌注損傷的影響及是否呈劑量相關性。 方法 40只SD大鼠隨機分為5組（每組n=8），即：假手術組（SP組）、生理鹽水后處理組（NS組）、丙泊酚后處理組（PRO組）、低劑量磷丙泊酚鈉[6 mg/（kg·h）]后處理組（LFOS組）、高劑量磷丙泊酚鈉[12 mg/（kg·h）]后處理組（HFOS組）。除SP組外，其余4組在肝臟缺血60 min后給予藥物后處理直至手術結束。在缺血60 min、再灌注60 min和120 min時采集血樣，測定血清中丙氨酸氨基轉移酶（ALT）、天門冬氨酸氨基轉移酶（AST）、乳酸脫氫酶（ LDH）含量；在灌注120 min時取大鼠肝左外葉，用于HE染色，觀察肝臟的形態學改變。 結果 與NS組相比，SP組、PRO組、LFOS組和HFOS組血清中的ALT、AST、LDH值明顯降低（P＜0.05）；與SP組比較，PRO組、LFOS組、HFOS組和NS組的ALT、AST、LDH值升高（P＜0.05）；與PRO組比較，LFOS組的ALT、AST和LDH值差異無統計學意義（P＞0.05），HFOS組的ALT、AST和LDH值降低（P＜0.05）；LFOS組與HFOS組比較，HFOS組的ALT、AST和LDH值降低更為明顯（P＜0.05）。 結論 磷丙泊酚鈉后處理對大鼠肝臟缺血再灌注損傷具有保護作用，且高劑量磷丙泊酚鈉[12 mg/（kg·h）]的保護作用更為明顯，保護作用存在劑量依賴性。
ObjectiveTo study the feasibility of using propofol and remifentanil for tracheal intubation in patients who are awake, and investigate the influence of tracheal intubation on such vital signs as blood pressure and heart rates. MethodsEighty ASA I-Ⅱ patients who underwent general anesthesia in our hospital between December 2012 and April 2013 were randomly divided into two groups. Patients in group A received fentanyl-propofol, while patients in group B received remifentanyl-propofol-lidocaine. There was no significant difference between the two groups in gender, age, and body weight (P>0.05). Conventional intubation induction method was used for group A:0.05-0.10 mg/kg midazolam, 4 μg/kg fentanyl, 1.0-1.5 mg/kg propofol, and 0.6-0.9 mg/kg atracurium were given and tracheal intubation was performed after muscle relaxation. Group B patients were treated with remifentanyl propofol-lidocaine compound liquid slow intravenous injection, and compound cricothyroid membrane puncture method before endotracheal intubation. We observed the two groups of patients for vital signs before and after induction, and choking cough reactions. ResultsPatients in both the two groups were all able to complete tracheal intubation. Circulation change and incidence of tachycardia in patients of group A were significantly higher than those in group B (P<0.05). The rates of bradycardia, hypoxemia, and choking cough response were low in both groups with no statistically significant difference (P>0.05). ConclusionRemifentanyl propofol-lidocaine compound liquid can be safely used for implementation of endotracheal intubation in patients who are awake, and the hemodynamic stability can be maintained.
【摘要】 目的 比較瑞芬太尼、丙泊酚、艾司洛爾用于支撐喉鏡手術氣管插管時患者的心血管反應。 方法 選取2009年1-3月就診的60例擬于全身麻醉下行擇期支撐喉鏡下聲帶息肉切除術的患者，隨機分為丙泊酚組、艾司洛爾組和瑞芬太尼組，每組20例。麻醉誘導采用咪達唑侖、芬太尼和丙泊酚，患者意識消失后給予琥珀膽堿。1 min后各組分別給予丙泊酚2 mg/kg、艾司洛爾1 mg/kg和瑞芬太尼1 μg/kg。30 s后進行氣管插管。記錄患者誘導前及插管前、插管后1、3、5 min的心率和血壓水平。 結果 各組插管前的收縮壓和心率較誘導前明顯降低，插管后1、3 min的收縮壓和心率較插管前升高（Plt;0.05)。丙泊酚組和艾司洛爾組插管后的收縮壓較瑞芬太尼組升高（Plt;0.05)。丙泊酚組插管后心率較瑞芬太尼組增加（Plt;0.05)。 結論 對行支撐喉鏡手術的患者，氣管插管前30 s給予1 μg/kg瑞芬太尼較2 mg/kg丙泊酚和1 mg/kg艾司洛爾能更有效地減輕氣管插管時的血流動力學反應。【Abstract】 Objective To assess the different effects of remifentanil, propofol, and esmolol on hemodynamic responses during intubation in CO2 laser endolaryngeal microsurgery (CO2-LELM). Methods A total of 60 patients aged from 18 to 65 years, admitted from January to March 2009 and scheduled to undergo elective CO2-LELM under general anesthesia for treatment of vocal cord polyp were randomly assigned to a propofol group, an esmolol group, and a remifentanil group. Anesthesia was induced with midazolam (0.015-0.02 mg/kg), fentanyl (1 μg/kg), and propofol (1 mg/kg). After the patients became unconscious, succinylcholine (1 mg/kg) was given one minute later. Then the patients in the three groups received propofol (2 mg/kg), esmolol (1 mg/kg), and remifentanil (1 μg/kg), respectively. Intubation was performed 30 secconds later. Heart rate (HR) and systolic blood pressure (SBP) were measured noninvasively before general anesthesia induction (baseline, Tb), just before intubation(Ti), and one, three, and five minutes after intubation (T1, T3, T5). Results The demographic data including age, sex and body weight were comparable in the three groups. Tracheal intubation caused significant increases in SBP and HR in all groups compared with Ti (Plt;0.05). After intubation, SBP in the propofol group and the esmolol group were significantly higher than that in remifentanil group (Plt;0.05), and HR in the propofol group was significantly higher than that in the remifentanil group (Plt;0.05). Conclusion In patients with CO2-LELM, remifentanil (1 μg/kg) administrated 30 seconds before intubation is maximal effective compared with propofol (2 mg/kg) or esmolol (1 mg/kg) in attenuating the hemodynamic responses to oraltracheal intubation.
目的 探討丙泊酚-瑞芬太尼對肝臟缺血再灌注損傷的保護作用以及作用機制。 方法 2009年6月－2011年12月選擇擇期需阻斷肝門的肝臟手術患者40例，隨機分為丙泊酚-瑞芬太尼組（P組）和異氟醚組（I組），每組20例。在術前（T0）和肝門阻斷開放后30 min（T1）、60 min（T2）、6 h（T3）、24 h（T4）、72 h（T5）分別抽取動脈血，測定天冬氨酸氨基轉移酶（AST）、丙氨酸氨基轉移酶（ALT）和腫瘤壞死因子α（TNF-α）的含量。 結果 兩組AST、ALT、TNF-α較術前均有增高，差異有統計學意義（P＜0.05）；P組增高幅度明顯低于I組，差異有統計學意義（P＜0.05）。 結論 丙泊酚-瑞芬太尼對肝臟缺血再灌注損傷具有保護作用，抑制TNF-α的產生可能為其作用機制之一。
目的:比較七氟醚吸入麻醉和丙泊酚、瑞芬太尼靜脈麻醉用于小兒手術的臨床效果。方法:100例1～8歲的患兒隨機分為丙泊酚、瑞芬太尼組(A組)與七氟醚吸入組(B組）。麻醉誘導后,A組持續輸注丙泊酚和瑞芬太尼維持麻醉,B組吸入七氟醚維持麻醉。術中根據生命體征調整丙泊酚、瑞芬太尼的輸注速度及七氟醚的吸入濃度,記錄術中循環變化、術后麻醉恢復情況。結果:與B組相比,A組術中MAP下降明顯(Plt;005)。結論:與A組相比,B組術中生命體征控制平穩;術后清醒迅速、完全、平穩,拔管時間無明顯差異。
ObjectiveTo evaluate the association of anesthesia regime (volatile or intravenous anesthetics) with the occurrence of postoperative pulmonary complications (PPCs) in adult patients undergoing elective cardiac surgery under cardiopulmonary bypass (CPB).MethodsThe electronic medical records of 194 patients undergoing elective cardiac surgery under CPB at West China Hospital, Sichuan University between September 2018 and February 2019 were reviewed, including 92 males and 102 females with an average age of 53 years. The patients were classified into a volatile group (n=94) or a total intravenous anesthesia (TIVA) group (n=100) according to anesthesia regimen during surgery (including CPB). The primary outcome was the incidence of PPCs within first 7 d after surgery. Secondary outcomes included incidence of reintubation, duration of mechanical ventilation, ICU stay and hospital stay.ResultsThere was no significant difference in the incidence of PPCs between the two groups (RR=1.020, 95%CI 0.763-1.363, P=0.896), with an incidence of 48.9% in the volatile group and 48.0% in the TIVA group. Secondary outcomes were also found no significant difference between the two groups (P>0.05).ConclusionNo association of anesthesia regimen with the incidence of PPCs is found in adult patients undergoing elective cardiac surgery under CPB.
ObjectiveTo evaluate the effects of sevoflurane and propofol on preoperative implicit and explicit memories in general anaesthesia patients of elective surgery. MethodsThe surgical inpatients in Sichuan Provincial People's Hospital were enrolled from December 2013 to May 2014, and were randomly divided into three groups (S, P, M). In Group S, anesthesia was induced and maintained with sevoflurane. In Group P, anesthesia was induced and maintained with propofol. Midazolam was not utilized throughout the whole anaesthesia for the above groups. Patients in Group S and Group P were given a list of test materials to remember and listen before the anesthesia. Within 12 to 36 hours after operation, memory was assessed, based on the Buchner's model applied on the process dissociation procedure (PDP) using a phrases task. The Group M was given the same test materials, and received test with the PDP in 12 to 36 hours before surgery. Value A and value R were used to represent the implicit memory score and the explicit memory score, respectively. ResultsA total of 150 patients were included, and 50 cases were included in each group. During testing, 2 cases were excluded, 3 cases were loss to follow-up, so finally 49 cases were included in the Group S, 47 cases in the Group P and 49 cases in the Group M. The results showed that there were significant differences in the implicit memory score (A) and the explicit memory score (R) among the three groups (all P values <0.05). The explicit memory score (R) of the Group M was higher than those of the Group P and Group S (all P values <0.05), the implicit memory score (A) in the Group M was higher than those of the Group S and Group P (all P values <0.05), and the implicit memory score (A) in the Group S was higher than that of the Group P (P<0.05). ConclusionPropofol and sevoflurane can decrease the score of explicit memory after anesthesia within 12 to 36 hours, and there are no significant differences in explicit memory between the two drugs. Both propofol and sevoflurane can decrease the score of implicit memory, but the influence of sevoflurane on the implicit memory is less than propofol within 12 to 36 hours.
目的 評價硬膜外麻醉合用丙泊酚用于腹腔鏡膽囊切除術的可行性。方法 擇期行腹腔鏡膽囊切除術患者850例，經T 9～10椎間隙行硬脊膜外腔穿刺置管，給予常規劑量的2%利多卡因或0.75%布比卡因，氣腹前靜脈注射丙泊酚1～2 mg/kg,直至患者意識消失，繼以10 mg/(kg·h)維持麻醉深度。結果 全組850例患者術中麻醉效果好，腹肌松弛，意識消失后避免了氣腹引起的牽扯反射，停止使用丙泊酚10 min左右時間，大部分患者即恢復呼喚反應。 結論 硬膜外麻醉合用丙泊酚用于腹腔鏡膽囊切除術是一種效果很好的臨床麻醉方法。
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.
【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.