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find Author "周裕凯" 4 results
  • 全身麻醉药物与手术后认知功能障碍

    全身麻醉药物被认为是造成手术后认知功能障碍的重要因素之一,前期实验大都是推理性和描述性的,样本规模小,不能充分说明两者间的关系。为今后从大脑神经元形态学和神经生物学研究方面获得突破,现从吸入麻醉药、静脉麻醉药各自对认知功能的影响和可能机制,以及不同麻醉药的比较等方面进行综述。

    Release date:2016-09-08 09:12 Export PDF Favorites Scan
  • 全身麻醉中羟乙基淀粉130/0.4致过敏性休克一例及文献分析

    目的总结1例全身麻醉中羟乙基淀粉(HES)130/0.4致过敏性休克的临床特点及治疗效果。 方法1例老年女性患者于2012年6月2日在全身麻醉下行右内、外踝骨折切开复位内固定术时,静脉输入HES130/0.4氯化钠注射液引起过敏性休克。检索1979年1月-2013年1月中国期刊全文数据库中有关HES过敏的个案报道并查阅全文,得到符合条件的文献26篇共31例患者,其中详述29例。结合文献分析HES过敏的特点,探索减少其发生的方法。 结果根据查阅文献结果分析,HES引起的过敏大都程度较轻,多在输入后即刻发生,经积极抢救预后较好。其致敏机制尚不清楚,所以减少发生的重点在预防。 结论围手术期过敏发生率低,HES过敏更为少见,麻醉医生容易忽略该类问题,但因其发生有突发性,可危及患者生命,须提高警觉意识,及时发现,系统治疗。

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  • Results and Analysis of A Nationwide Survey on Painless Digestive Endoscopy in China

    ObjectiveTo know the fundamental status of painless digestive endoscopy in China. MethodsA 23-item survey including multiple choices and fill-in-the-blank questions on 3 pages was performed on anesthesiologists in China excluding Taiwan, Macao and Hong Kong on www.xqnmz.com and www.dxy.cn/bbs from November 1 to December 31, 2013, among which 5 questions were on personal details, 9 on hospital and department, and 9 on clinic details. The results about the basic facts, risk factors of anesthesia and drug use and monitoring of painless digestive endoscopy in China were analyzed. ResultsA total of 726 questionnaires were collected, among which 667 (91.87%) were considered valid. Interviewed hospitals included hospitals from 31 provinces, municipalities and autonomous regions excluding Taiwan, Macao and Hong Kong. Thirty questionnaires were from the first-grade hospitals (4.5%), 292 from the second-grade (43.78%), and 345 from the third-grade (51.72%). And 69.12% of the questionnaires showed these hospitals could only carry out painless gastroscopy and/or colonoscopy, while 80.81% showed the number of the mean painless endoscopy cases was 0-30 per day; 47.23% of the respondents working in digestive endoscopy center had to complete the anesthesia procedure alone, and 35.83% of the respondents illustrated their digestive endoscopy centers had established the post anesthesia care unit; 62.97% were equipped with anesthesia apparatus or ventilator; 89.96% were equipped with tracheal intubation tool; and 21.44% were equipped with defibrillator. Among them, 25.79% did not prepare rescue medicines regularly in digestive endoscopy center. Propofol was the most frequently used anesthetic, and composited fentanyl was at the highest use rate for gastrointestinal endoscopy. Respondents who used electrocardiogram, non-invasive blood pressure and pulse oxygen saturation the least to monitor during painless gastroscopy and colonoscopy took up 43.48% and 46.08% respectively. ConclusionPainless digestive endoscopy needs further development and standardization with the regulation of related guidelines and standardized residents training.

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  • Influence of dexmedetomidine on stress of elderly patients with cardiovascular risk undergoing gastrointestinal laparoscopic surgery

    Objective To evaluate the influence of dexmedetomidine on the stress of elderly patients with cardiovascular risk undergoing gastrointestinal laparoscopic surgery. Methods From August 2014 to December 2015, 210 patients undergoing elective laparoscopic gastrointestinal operations were randomly divided into three groups, including the low concentration group (group D1), the high concentration group (group D2), and the control group (group C), with 70 cases in each group. The patients in group D1 and group D2 were injected with dexmedetomidine (0.4 and 0.8 μg/kg respectively) by infusion pump before anesthesia induction, and were continuously pumped with dexmedetomidine [0.4 and 0.8 μg/(kg·h) respectively] until the end of the surgery. Meanwhile, the patients in group C were injected with normal saline of the equal volumes. The heart rate and mean arterial pressure (MAP) was recorded before anesthesia, after endotracheal intubation and extubation. Myocardial ischemia and cardiovascular adverse events thatneeded to be handled were recorded. The concentrations of dopamine, adrenaline (AD) and noradrenaline (NE) were monitored at 15:00 one day before surgery (Ty), one hour after the beginning of surgery (T0), and at 15:00 of the 1st, 2nd, and 3rd day after surgery (T1, T2, T3). Results A total of 178 patients completed the study and were enrolled in this study, including 60 cases in group D1 and 59 cases in group D2 and C respectively. In group D1 and D2, the heart rates after intubation [(80.4±9.6), (68.2±10.5) times/minutes], extubation [(70.1±6.2), (69.7±7.8) times/minutes] and MAP after extubation [(100.2±12.0), (98.0±13.1) mm Hg (1 mm Hg=0.133 kPa)] were lower than those in group C [(98.4±10.5) and (95.2±7.3) times/minutes; (121.8±10.5) mm Hg], and the differences were significant (P<0.05). The bradycardia and hypotension in group D2 (27.12%, 22.03%) was significantly higher than those in group C (3.39%, 8.47%). Hypertension in group D1 and D2 (5.00%, 1.69%) was significantly lower than that in group C (37.29%), and the differences were significant (P<0.05). Compared with the base value at Ty in the three groups, the concentration of dopamine at T0-T3 in group C, at T0-T1 in group D1, and at T0 in group D2 increased significantly (P<0.05); the AD at T0-T3 in group C, at T0-T2 in group D1, and at T0-T1 in group D2 increased significantly (P<0.05); the NE at T0-T2 in group C, and at T1 in group D1 increased significantly (P<0.05). Compared with group C at the same time, the DA at T3 in group D1 and at T1-T3 in group D2, the AD at T2-T3 in group D1 and at T0-T3 in group D2, the NE at T0-T1 in group D1 and T0-T3 in group D2, decreased significantly (P<0.05). Conclusions Dexmedetomidine can effectively restrain the changes of hemodynamics and catecholamine induced by perioperative stress responses in a dose-dependent manner. During the surgery of elderly patients with cardiovascular risk, the concentration of dexmedetomidine should be controlled moderately to gain the optimal effect.

    Release date:2017-10-27 11:09 Export PDF Favorites Scan
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