Increasing evidences show that a gradual trend away from deep hypothermia toward moderate hypothermic circulatory arrest, which has been proved to be safe and effective in clinic. By summarizing and analyzing the research progress and applying status of the moderate hypothermia circulatory arrest with selective antegrade cerebral perfusion, the article aims at promoting the application of this tenique as a cerebral protection strategy in aortic arch surgery for adults in China.
【摘要】 目的 评价α2受体激动剂是否可以降低七氟烷引起的小儿术后躁动的发生率。 方法 通过检索Medline、荷兰医学文摘、Cochrane临床试验数据库、中国生物医学文献数据库和中国期刊网全文数据库等数据库，收集可乐定或右美托咪啶对七氟烷引起的小儿术后躁动的预防作用的随机对照试验（randomized controlled trial，RCT），提取资料和评估方法学质量，采用Cochrane协作网RevMan 5.0软件进行Meta分析。 结果 最终纳入11个RCT，其中104例患儿预防性使用右美托咪啶，268例患儿使用可乐定，365例患儿使用安慰剂。Meta分析显示，可乐定组小儿术后躁动发生率的比值比（OR）为0.31，95%CI为（0.15，0.61）（P=0.000 8）；右美托咪啶组小儿术后躁动发生率的OR为0.16，95%CI为（0.08，0.31）（Plt;0.000 01）。 结论 α2受体激动剂可以显著降低七氟烷引起的小儿术后躁动的发生率。【Abstract】 Objective To determine whether alpha2-adrenoceptor agonists can decrease emergence agitation (EA) in pediatric patients after sevoflurane anesthesia. Methods The Medline, Embase, Cochrane Library, CBM and CNKI were searched. All randomized controlled trials comparing clonidine or dexmedetomidine with other interventions in preventing emergence agitation after sevoflurane anesthesia were retrieved. Study selection and assessment, data collection and analyses were undertaken. Meta-analysis was done using the Cochrane Collaboration RevMan 5.0 software. Results Eleven articles reached our inclusion criteria and were included in the Meta-analysis. A total of 104 children treated with dexmedetomidine, 268 children treated with clonidine, and 365 children treated with placebo were evaluated for the incidence of emergence agitation. The pooled odds ratio for the clonidine subgroup was 0.31, with a 95% confidence interval of 0.15-0.61 (P=0.000 8). The pooled odds ratio for the dexmedetomidine subgroup was 0.16, with a 95% confidence interval of 0.08-0.31 (Plt;0.000 01). Conclusion Alpha2-adrenoceptor agonists can significantly decrease the incidence of emergence agitation in pediatric patients after sevoflurane anesthesia.
ObjectiveTo evaluate if intravenous lidocaine can reduce the stress response induced by fiberoptic bronchoscopy in patients under general anesthesia. MethodsSixty patients undergoing fiberoptic bronchoscopy under unconsciousness between November 2013 and July 2014 were randomly divided into two groups: lidocaine group (n=30) and control group (n=30). Patients in the lidocaine group received an intravenous injection of lidocaine for 1 mg/kg during induction and then continuous intravenous infusion of 2% lidocaine with a dose of 3 mg/(kg·h). The same volume of saline was given to patients of the control group in the same way. Laryngeal mask airway was placed after anesthesia induction. Variables of heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and pulse oxygen saturation were observed and recorded at five time points: before induction, immediately after induction, immediately after laryngeal mask airway placement, fiberoptic bronchoscopy across tracheal carina and before leaving examination room. Complications including cough reflex, toxicity reaction of local anesthetics, and injection pain were also observed. ResultsThe examination was successfully completed in all patients. Blood pressure and heart rate increased in all patients when fiberoptic bronchoscopy got across tracheal carina. There were no statistically significant differences in the two groups (P>0.05). Patients in the two groups had no statistic difference in tinnitus and numbness of tongue (P>0.05). Compared with the control group, patients in the lidocaine group had lower incidence of injection pain (P<0.05). ConclusionIntravenous lidocaine cannot suppress stress response induced by fiberoptic bronchoscopy effectively.
目的：探讨在不同年龄SD大鼠右心房注射前列腺素E2（PGE2）对呼吸的影响。方法：7～9 d和21～23 d大鼠在迷走神经完整和迷走神经切断的情况下从右心房注射PGE-2，观察呼吸指标的变化。结果：①右心房注射PGE2在7～9 d和21～23 d大鼠中均引起呼吸暂停，呼气延长时间分别为基础呼气时间的9.5和7.5倍（Plt;0.05）；②切断迷走神经后，右心房注射PGE-2在7～9 d和21～23 d大鼠均不再产生呼吸暂停，仅出现轻微呼吸抑制。结论：右心房注射PGE2在7～9 d和21～23 d大鼠均产生呼吸暂停，且依赖于迷走神经的完整性。
Gastrointestinal complications after cardiac surgery are rare, but they are associated with significant morbidity and mortality. The mechanisms of gastrointestinal complications after cardiac surgery may be unique, as the abdominal cavity is not involved. This review summarizes the current evidence of the pathophysiology, clinical manifestations, risk factors, and management of gastrointestinal complications after cardiac surgery, aiming to improve the recognition of gastrointestinal complications after cardiac surgery.
目的 探讨在丙泊酚诱导麻醉的改良电休克治疗中脑双频谱指数(BIS)与动作发作时间的关系，以及其他因素对电休克动作发作时间的影响。 方法 2012年4月－5月，记录28名患者的107次治疗中的不同时刻脑双频谱指数（BIS）值诱导前、睫毛反射消失时、治疗前即刻、动作发作结束即刻、动作发作结束后60 s）、麻醉药物剂量、动作发作时间及治疗不良反应，并根据动作发作时间将治疗分为A组（治疗无效组，动作发作时间＜17 s）和B组（治疗有效组，动作发作时间≥17 s）。探讨不同时刻BIS值与癫痫发作时间的关系并比较A、B组之间BIS值、麻醉药物剂量差异。 结果 两组间睫毛反射消失时及治疗前即刻BIS值差异有统计学意义（P＜0.05）。动作发作时间与治疗前即刻BIS值呈正相关（r=0.245，P=0.012），与治疗次数呈负相关（r=−0.283，P=0.004）。 结论 治疗前即刻BIS值与动作发作时间呈正相关，因此，此时的BIS值也许可以作为预测动作发作时间长短的指标。