Objective To explore the protective effect of early enteral nutrition on intestinal mucosa barrier in patients with esophageal carcinoma after operation. Methods Fifty six patients with esophageal carcinoma whose weight decreased more than 20% before operation in three months were divided into enteral nutrition group ( n =30) and parenteral nutrition group ( n =26). Plasma concentration of lipopolysaccharide(LPS), tumor necrosis factor (TNF), gastrin, glutamine, and ratio of lactulose and mannitol (L/M) were measured on the 1st, 4th, 8th day after operation respectively. Results Weight loss and infectious complication in enteral nutrition group were less than those in parenteral nutrition group after operation ( P lt;0.01, 0.05). On the 4th and 8th day after operation,the level of LPS,TNF, and L/M were lower in enteral nutrition group than those in parenteral nutrition group ( P lt;0 01), the values of gastrin and glutamine were higher in enteral nutrition group than those in parente...更多ral nutrition group ( P lt;0 01). Conclusion Enteral nutrition can protect the intestinal mucosa barrier and decrease infectious complication after operation.
目的 探讨急性扩容联合控制性降压在脊柱手术的应用。 方法 2007年7月-2009年1月，60例择期脊柱手术患者随机分成3组:A组：对照组；B组：急性扩容组；C组：急性扩容联合控制性降压组。A组输林格氏液15 mL/kg，诱导前30 min输入1/2，另1/2在2~3 h内输完。B组在A组基础上，诱导后30~45 min输入20 mL/kg 6%羟乙基淀粉。C组在B组基础上，持续泵注硝酸甘油0.5~10.0 μg/（kg•min）控制血压，同时增加输液量，增加有效循环血容量；止血后，缝合切口前，静脉注射速尿2~5 mg。 结果 A组平均血压无B、C组稳定，B、C组中心静脉压扩容后显著增加（Plt;0.05），红细胞压积显著降低（Plt;0.05）；C组出血量最少（Plt;0.05）。 结论 急性扩容联合控制性降压在脊柱手术中应用安全，可以大大减少出血量。
【摘要】 目的 比较喉罩全麻与气管插管全麻两种麻醉方法在小儿侧卧位短小手术中的优缺点。 方法 2009年6月-2010年2月，将40例择期行侧卧位短小手术儿患，随机分为喉罩全麻（L）组与气管插管全麻（T）组，每组各20例。观察患儿术中心率（HR）、平均动脉压（MAP）、脉搏血氧饱和度（SpO2）、气道峰压（Pmax），恶心呕吐、术后躁动等围术期不良反应。 结果 T组插管后及拔管后即刻HR、MAP均高于L组患儿（Plt;0.05）；SpO2、Pmax在两组之间比较差异无统计学意义（Pgt;0.05），T组患儿术后躁动发生率明显高于L组（Plt;0.05）。 结论 喉罩可以安全、有效地用于小儿侧卧位短小手术麻醉，且操作简便，插管期和拔管期心血管应激反应轻，术后躁动发生率低。【Abstract】 Objective To compare the safety and efficacy of laryngeal mask airway (LMA) and tracheal tube in lateral general anesthetic operation on children. Methods From June 2009 to February 2010, 40 children scheduled to undergo general anesthesia for minor surgical procedures in lateral position were randomly divided into the laryngeal mask airway group (group L) and the tracheal tube group (group T) with 20 in each. Heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2), top airway pressure (Pmax) of the patients were observed. In addition, side effects such as nausea, vomiting, and emergence agitation were also recorded. Results HR and MAP of patients in group T were significantly higher than those of patients in group L after intubation and after extubation (Plt;0.05). There was no difference in Pmax and SpO2 between the two groups (Pgt;0.05). The incidence of emergence agitation in group T was significantly higher than that in group L. Conclusions LMA intubation can provide the same safe and effective ventilation as tracheal intubation for children undergoing lateral general anesthetic operation. LMA is superior to tracheal intubation in insertion response, and the incidence of emergence agitation is lower.
【摘要】 目的 观察帕瑞昔布钠超前镇痛在小儿上肢骨折手术的镇痛效果及不良反应发生情况。 方法 选择2009年6月－2010年12月气管插管全身麻醉下择期行单侧上肢骨折切开复位内固定手术患儿90例，随机分为帕瑞昔布钠组（P组）、曲马多组（T组）及对照组（C组），每组各30例患儿；于麻醉前分别静脉注射帕瑞昔布钠1 mg/kg、曲马多2 mg/kg、等容量生理盐水。3组患儿年龄、性别、体重、手术时间等一般情况差异无统计学意义（Pgt;0.05）。各组均于术后2、4、6、8 h各时间点观察患儿疼痛评分、镇静评分；观察拔除患儿气管导管后5 min躁动评分；记录患儿术中芬太尼总用量及术后镇痛药物用量；随访术后24 h内不良反应的发生情况。 结果 术后各个时间点P组疼痛评分明显低于T、C组（Plt;0.01）；T组镇静评分于术后2、4、6 h明显高于P、C组（Plt;0.01），镇静评分在P、C组之间比较差异无统计学意义（Pgt;0.05）；P组术后躁动评分明显低于T、C组（Plt;0.01）；P组患儿围手术期芬太尼用量明显少于T、C组（Plt;0.01）；T组术后恶心呕吐发生率明显高于P、C组（Plt;0.05）。P组无呼吸抑制、伤口异常出血等严重不良反应。 结论 帕瑞昔布钠超前镇痛用于小儿上肢骨折手术可产生明显镇痛作用，并可有效预防苏醒期躁动发生，明显减少围手术期芬太尼用量，恶心呕吐等不良反应发生率明显低于曲马多。【Abstract】 Objective To study the efficacy and safety of preemptive analgesia with parecoxib sodium in children undergoing upper limb orthopedic surgery. Methods Ninety children from June 2009 to December 2010 scheduled for elective upper limb orthopedic surgery under general anesthesia were selected and randomly divided into three groups with 30 children in each. For the children in group P (parecoxib sodium), group T (tramadol) and group C (control), preemptive analgesia was induced by an intravenous injection of parecoxib sodium at 1 mg/kg, tramadol at 2 mg/kg, and normal saline respectively before anesthesia. Pain intensity score and sedation score were recorded 2, 4, 6, and 8 hours respectively after operation. The agitation score was measured 5 minutes after extubation. The perioperative fentanyl consumption and postoperative analgesic medicine consumption were recorded. The adverse effects were observed within 24 hours after operation. Results The demographic data such as age, gender, weight, and operation time did not differ statistically among the three groups of children (Pgt;0.05). Compared with groups T and C, the pain score in group P was significantly lower at all time points after operation (Plt;0.01). The sedation score in group T was significantly higher than those in group P and C 2, 4, and 6 hours after operation (Plt;0.01), but the sedation score did not differ significantly between groups P and C (Pgt;0.05). The agitation score after trachea extubation in group P was significantly lower than the other two groups (Plt;0.01). The quantity of fentanyl used in group P was significantly lower than in groups T and C (Plt;0.01). The incidence of postoperative nausea or vomiting in group T was higher than those in groups P and C (Plt;0.05). There was no depression of breath or abnormal hemorrhage in group P. Conclusion Parecoxib sodium has a better analgesic effect in children undergoing upper limb orthopedic surgery. The agitation score and the incidence of postoperative nausea or vomiting are significantly lower, and the use of parecoxib sodium can also significantly reduce the perioperative fentanyl consumption.
ObjectiveTo investigate the effect of acute non-isovolemic hemodilution (ANIH) on spinal surgery. MethodsFrom January 2012 to July 2013, 80 patients scheduled for spinal surgery were enrolled. The patients were randomized into four groups, with 20 in each group. Patients in group A were infused with Ringer's injection and polygeline for fluid loss, physiological needs and blood loss. In group B, the patients were infused with acute hypervolemic hemodilution. In group C, patients were infused with acute nomovolemic hemodilution. In group D, patients were infused with ANIH. The hemodynamics and arterial blood gas indexes were detected in all the patients. ResultsThe mean blood pressure in group A and C was significantly more stable than that in group B and D. The central vein pressure in group B and D was significantly higher than that in group A and C after hemodilution (P<0.05), while the hematocrit in group B and D was significantly lower than that in group A and C (P<0.05). Allogeneic blood transfusion was performed in group A and B, while it was not performed in group C and D. ConclusionANIH can reduce the volume of blood loss during spinal surgery, and it is safe.
ObjectiveTo investigate whether parecoxib sodium preemptive analgesia reduces inflammatory cytokines and stress hormones production in elderly patients after total hip replacement. MethodSixty patients with American Society of Anesthesiologists Classification Ⅰ-Ⅱ undergoing total hip replacement for femoral neck fracture or aseptic necrosis of the femoral head, aged between 60 and 90 years with a body weight more than 50 kg, were randomly divided into preemptive analgesia group (group P, n=30) and control group (group C, n=30). The patients in group P received parecoxib sodium 40 mg intravenously 30 min before skin incision, and another 20 mg 8 hours after the first administration. All the patients in the two groups received the administration of patient-controlled analgesia sufentanyl. We recorded blood levels of interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), cortisol (COR), adrenaline (AD) and noradrenaline (NAD) 30 min before skin incision, and 1 hour, 6 hours, 12 hours and 24 hours postoperatively. ResultsThe blood levels of IL-6, TNF-α, COR, AD and NAD in group P at 1 hour, 6 hours, 12 hours or 24 hours postoperatively were significantly lower than those in group C (P<0.05). ConclusionsParecoxib sodium preemptive analgesia reduces postoperative inflammatory cytokines and stress hormones production in elderly patients undergoing total hip replacement.