ABSTRACT
Objective To evaluate the accuracy of changing rate of the left ventricular outflow tract velocity time integral (△VTI) in predicting fluid responsiveness in septic patients.Methods Twenty patients diagnosed with sepsis or septic shock and received mechanical ventilation,aged more than or equal to 18 yr,in whom the ventilation mode was SIMV plus VC,were enrolled in this study.The left ventricular outflow tract VTI,stroke volume (SV) and cardiac output (CO) were measured using ultrasound.Sodium potassium magnesium calcium and glucose injection 100 ml was intravenously infused over 1 min,ultrasound measurement was completed within 1 min,and then Sodium potassium magnesium calcium and glucose injection 400 ml was intravenously infused over 14 min.Fluid responsiveness was defined as increase in SV or CO more than 15％ after infusion of 500 ml colloid solution,and then the patients were divided into responsiveness group and non-responsiveness group.△VTI,△SV and △CO were calculated after fluid replacement with 100 ml solution.The receiver operating characteristic curve was used to assess the accuracy of △VTI,△SV and △CO in predicting fluid responsiveness.Results The areas under the receiver operating characteristic curve of △VTI,△SV and △CO were 0.95,0.91 and 0.88,respectively.When △ VTI ≥ 10％ was used as the cut-off point,the sensitivity and specificity of △VTI in predicting fluid responsiveness was 90％ and 80％,respectively.Conclusion △VTI can accurately predict the fluid responsiveness in septic patients.
ABSTRACT
Objective To observe the clinical efficacy of dexmedetomidine combined with sufentanil in the treatment of self?control intravenous an?algesia after laparoscopic surgery. Methods Sixty patients,who underwent laparoscopic sugery and general anaesthesia,American Society of Anes?thesiologistsⅠtoⅡ,were randomly divided into dexmedetomidine(DS)group and sufentanil(S)group,with thirty cases in each group. Group S received sufentanil 2μg·kg-1 and ramosetron hydrochloride 0.3 mg;group DS received sufentanil 2μg·kg-1,dexmedetomidine 200μg and ramose?tron hydrochloride 0.3 mg. Drugs of both groups were dissolved in saline 100 mL,with a loading dose of 4 mL,background infusion of 2 mL·h-1,con?trolled dose of 0.5 mL·h-1,and the lockout time was 15 min. Visual analog scale(VAS)score,Ramsay sedation scale(RSS)score,sufentanil cu?mulative consumption after surgery at 2 h,4 h,6 h,12 h,24 h were recorded,as well as the adverse reactions such as nausea,the occurrence of vomiting and chills within 24 h after surgery,and the satisfaction of patients with postoperative analgesia. Results Six hours post operation,VAS score of group DS was significantly lower than the group S(P<0.05);2 hours post operation,RSS score of group DS was significantly higher than the group S(P<0.05);the cumulative consumption within 6 hours after sufentanil was significantly lower in group DS than group S(P<0.05). The incidence of nausea,vomiting,chills and other adverse reactions were significantly higher in group S than group DS(P<0.05). Conclusion Compared with the simple application of sufentanil,dexmedetomidine combined with sufentanil for postoperative analgesia achieve better analgesic effect,reducing the amount of sufentanil,while reducing the associated sufentanil adverse reactions,improve patient comfort and satisfaction of post?operative analgesia.
ABSTRACT
Objective To evaluate the application of propfol?remifentanil closed?loop and opened?loop anesthesia in children otorhinolaryngologic operation under BIS monitoring. Methods Fourty children underwent elective children tonsillectomy and adenoidectomy were recruited for the study and randomly divided into two groups:closed?loop group(group T)and opened?loop group(group C),with 20 children each. The two groups all received total intravenous induction,then the subjects of closed?loop group were administrated with a method of system automatic regulation of plasma target control and the opened?group cases underwent manual adjustment of plasma target control method according to the BIS value during op?eration. The variables of non?invasive blood pressure(BP),heart rate(HR),pulse oxygen saturation(SpO2),electrocardiogram(ECG),bispec?tral index(BIS),the number of times the manual adjustment of propfol target control applied,and recovery time,were recorded respectively at the time points of before anesthesia(T0),immediately after intubation(T1),5 min after intubation(T2),10 min after(T3),15 min after(T4),30 min after(T5)and the removal of endotracheal intubation(T6). Results The total dosage of propfol in group T was less than the dosage in group C with dosage decrease of 9.83%;there was no significant statistical difference of the total dosage of remifentanil. Conclusion The use of propfol?remi?fentanil closed?loop anesthesia in children otorhinolaryngologic operation is safe,easy,and of strong controllability,which should be widely promoted.