Résumé
Objective:To observe the dexmedetomidine by nasal drip on perioperative spinal surgery patients sedation and the effect of hemodynamic changes.Methods:90 ASA grade Ⅰ ～ Ⅲ,years 18 to 65,and in general anesthesia spinal surgery,and postoperative patients have to extube the endotracheal,were randomly divided into three groups:control group (group C),the dexmedetomidine 0.1 μg/kggroup (D1) and dexmedetomidine 1.5 μg/kggroup (D2),(n=30).Record into the OR (T0),before the induction (T1),1 min before intubation (T2),1 min after intubation (T3),start surgy (T4),began to stop general anesthetics (T5),1 min before extubation (T6),3 min after extubation (T7),and into the PACU (T8).The patient's heart rate (HR),mean arterial pressure (MAP),oxygen saturation (SPO2),finish operation from the general anesthetics toextube the endotracheal tube,stay time,patients in the postoperative recovery room Ramsay sedation scores.Results:Three groups of patients when T0 HR,MAP,SPO2,Ramsay sedation scores had no statistical difference (P≥ 0.05);Compared with group C,D1 and D2 group significantly lower each time point of HR,MAP,Ramsay sedation scores increase (P≤ 0.05),SPO2 no significant change (P≥ 0.05);Each time point compared with group D1,D2 group HR,MAP,significantly decreased,Ramsay sedation scores increase (P≤ 0.05),SPO2 no significant change (P≥ 0.05);D1 group HR,MAP,SPO2 at each time point,Ramsay sedation scores have no obvious difference (P≥ 0.05);D2 group HR,MAP,SPO2,Ramsay sedation scores significantly difference (P≥ 0.05).Group C T3,T4,T5,T6,T7 has each time point,T8 HR,MAP,up from T1,T2,Ramsay sedation scores were significantly improved (P≤ 0.05),SPO2 no significant change (P≥ 0.05).Conclusions:40 min before anesthesia induction dexmedetomidine by nasal drip can effectively inhibit intubation and extubation reaction,make the hemodynamic changes is more stable,and significantly reduce the incidence of patients with postoperative agitation.
Résumé
Objective To study the sedation and amnesia of midazolam in patients with different ages of lumbar epidural anesthesia . Methods From January to July 2015, 235 patients in the first affiliated of xian jiaotong unniversity,who were implemented abdominal surgery under combined spinal epidural anesthesia and American Society of anesthesiologists (ASA) grade was I-II , were divided into three groups:young group (n=70); middle-aged group (n =82); elderly group (n =83).Intraoperative continuous monitoring of respiratory and circulatory function index,and recorded MAP,SpO2, HR before and 5, 15, 30 min after injection.ResuIts MAP, HR and SpO2 of three groups were compared with the same time points pre-and post used of midazolam, there was no significant difference among indicators.; Compared with the same group at different time points, MAP(FYG =9.2547,FMG =12.8181,FOG =17.77)和 SpO2 (FYG =190.3835,FMG =196.2393,FOG =270.5609),there were significant difference.The difference was not statistically significant between HR group and the same group at different time points and forgetting degree and sedation score , but compared with OG,there were significant difference(P<0.05).The total number of adverse reactions in YG group and MG group was less than that of OG group(X2 =11.2516,X2 =10.4491, P<0.05).ConcIusion The effect of the same dose of midazolam on sedation and amnesia in patients with different ages of lumbar epidural anesthesia is different, and the degree of the effect of the elderly patients is significant,but will produce more adverse reactions.Therefore, in the combined spinal epidural anesthesia,it is necessary to consider the patient's individual differences, rational use of sedative and narcotic drugs.
Résumé
Objective To explore effect of CYP3A4 gene polymorphism and genetic testing on the efficacy of fentanyl in patients with extensive burns.Methods A prospective randomized controlled study, 149 patients with extensive burns were picked from Feburary to July in 2015.Patients were randomly divided into matched group ( n=56 ) and experimental group ( n=93 ) . The matched group was treated with fentanyl 5 g/kg to finish implementation of anesthesia induction.Depends on the gene detection results, the patients in experimental group were treated with 6 g/kg, 5 g/kg or 4 g/kg fentanyl.The VAS score at different time after operation in the experimental group and the control group were compared , and the dosage of fentanyl was observed.Patients whose VAS score was greater than 7 should treated with intramuscular injection of pethidine 100 mg, recorded all patients with pethidine,s additional cases and the times.At the same time, the adverse reactions of the two groups were recorded before and after hospital discharge. ResuIts The score of VAS was not significantly different after wake up immediatly after the surgery , and the score of VAS was significantly lower in the experimental group patients in 6h,12h after the surgery (P<0.05).The dosage of fentanyl in the experimental group and the number of the cases and the times were significantly decreased (P<0.05).The adverse reactions after the surgery such as nausea, vomiting, itching, drowsiness, and adverse reactions were significantly lower in the experimental group (P<0.05).ConcIusion CYP3A4 gene detection in patients with large area of burn in the individual drug use is important, because of patients’ genotype adjusting fentanyl dosagecan, it enhances significantly the analgesic effect, reduces the amount of drug use, and effectively reduces the adverse reactions.