目的探讨动态监测脑血流及脑氧饱和度对预防沙滩椅位肩关节镜手术后缺血性脑损伤的临床效果。方法选取2014年5月~2016年8月在深圳市第二人民医院进行沙滩椅位肩关节镜手术患者48例作为研究对象,按照简单随机法将患者分为对照组和观察组...目的探讨动态监测脑血流及脑氧饱和度对预防沙滩椅位肩关节镜手术后缺血性脑损伤的临床效果。方法选取2014年5月~2016年8月在深圳市第二人民医院进行沙滩椅位肩关节镜手术患者48例作为研究对象,按照简单随机法将患者分为对照组和观察组,每组各24例。对照组术中监测指端血压及氧饱和度,观察组术中监测脑血压及脑氧饱和度。比较两组患者手术情况、术后7 d ULCA评分、血压及血氧饱和度变化、术后简易精神状态量表(MMSE)评分。结果两组患者手术时间、术中出血量、术后引流量及术后拔管时间差异无统计学意义(P>0.05)。观察组患者术后7 d ULCA评分优良率(87.50%)与对照组(91.67%)差异无统计学意义(P>0.05)。两组患者术后血压及血氧饱和度均明显下降,差异有统计学意义(P<0.05);观察组患者术后血压及血氧饱和度均高于对照组,差异有统计学意义(P<0.05)。两组患者术后MMSE评分均有下降,但是观察组患者MMSE评分明显高于对照组,差异有统计学意义(P<0.05)。结论进行沙滩椅位肩关节镜手术时,动态检测脑血流及脑氧饱和度,可有效降低缺血脑损伤的发生风险,提高患者术后恢复。展开更多
目的研究星状神经节阻滞对肩关节镜手术沙滩椅位脑血流动力学改变的影响。方法取择期行沙滩椅位肩关节镜手术患者40例,随机分为治疗组T组和对照组C组各20例,T组术前行超声引导下SGB,对比两组患者术中生命体征、BIS值、脑氧合饱和度(rSO_...目的研究星状神经节阻滞对肩关节镜手术沙滩椅位脑血流动力学改变的影响。方法取择期行沙滩椅位肩关节镜手术患者40例,随机分为治疗组T组和对照组C组各20例,T组术前行超声引导下SGB,对比两组患者术中生命体征、BIS值、脑氧合饱和度(rSO_(2))、不同时段大脑中动脉血流频谱图像、术后7 d ULCA评分、MMSE评分、RBANS总分,将两组数据进行统计学处理分析。结果T组比C组患者术中生命体征变化波动较小,差异有统计学意义(P<0.05)。不同时段rSO_(2)基本保持在相同水平,差异无统计学意义(P>0.05);T组患者大脑中动脉血流流速比C组要低,但血管内径要大,根据公式得出T组患者在不同时间段血流量都要比C组同时段的多,比较差异有统计学意义(P<0.05)。两组术后7 d ULCA评分、MMSE评分、RBANS总分对比T组明显较高,差异有统计学意义(P<0.05)。结论对沙滩椅位行肩关节镜手术的患者术前实施星状神经阻滞术具有增加脑血供及脑保护作用且对患者术后关节功能恢复有良好的促进作用,有临床推广实用价值。展开更多
The application of traction has enhanced views during arthroscopic shoulder surgery, easing visualization and accurate intervention within the shoulder joint and the subacromial space. Many innovative traction techniq...The application of traction has enhanced views during arthroscopic shoulder surgery, easing visualization and accurate intervention within the shoulder joint and the subacromial space. Many innovative traction techniques are currently employed, including the use of padded traction equipment attached to boom arms and further, pedal-activated, hydraulic traction equipment. Variations in patient positioning and cost-benefit analysis of the use of traction in both beach chair and lateral decubitus positions have been performed in the literature. We demonstrate the use of readily available, simple and inexpensive resources in the beach chair position, allowing the application of traction with minimal set-up time and complexity. Initial equipment outlay requires a drip stand attached to a clamp at the end of the operating trolley, permitting a hook to be applied to the arm that is attached to traction cord and weights. We minimized the cost of ongoing consumable items per case to include a stockinette and benzoic tincture. The theatre team experiences a short learning curve associated with the ease of reliability and reproducibility of this technique.展开更多
Background: Propofol is often the drug of choice for ambulatory orthopedic cases. However, propofol can be associated with apnea or other events requiring airway interventions. Dexmedetomidine (Dex) has the unique pha...Background: Propofol is often the drug of choice for ambulatory orthopedic cases. However, propofol can be associated with apnea or other events requiring airway interventions. Dexmedetomidine (Dex) has the unique pharmacologic profile of providing sedation without respiratory depression. This is particularly relevant in patients with morbid obesity and/or challenging airways. The hypotheses were: 1) Propofol would cause more apnea or require more airway manipulations than dexmedetomidine;2) Propofol would have shorter post anesthesia unit recovery times;and 3) Dexmedetomidine would be associated with more bradycardia and hypotension. Methods: After IRB approval, 50 patients were randomized to receive either propofol or Dex for Total Intravenous anesthesia (TIVA) after interscalene brachial plexus block was performed preoperatively under ultrasound guidance. The main end points that we measured where: airway interventions, intra-operative bradycardia, hypotension, and PACU length of stay. Results: There were more airway interventions in the propofol group compared to the Dex group. Additionally, the Dex group had significantly longer PACU stays. Conclusion: We would recommend that Dex should be preferentially considered for patients predisposed to airway obstruction;however, the standard use of Dex over Propofol needed to reconsider since the use of Dex as the agent for TIVA was associated with longer PACU stays.展开更多
文摘目的探讨动态监测脑血流及脑氧饱和度对预防沙滩椅位肩关节镜手术后缺血性脑损伤的临床效果。方法选取2014年5月~2016年8月在深圳市第二人民医院进行沙滩椅位肩关节镜手术患者48例作为研究对象,按照简单随机法将患者分为对照组和观察组,每组各24例。对照组术中监测指端血压及氧饱和度,观察组术中监测脑血压及脑氧饱和度。比较两组患者手术情况、术后7 d ULCA评分、血压及血氧饱和度变化、术后简易精神状态量表(MMSE)评分。结果两组患者手术时间、术中出血量、术后引流量及术后拔管时间差异无统计学意义(P>0.05)。观察组患者术后7 d ULCA评分优良率(87.50%)与对照组(91.67%)差异无统计学意义(P>0.05)。两组患者术后血压及血氧饱和度均明显下降,差异有统计学意义(P<0.05);观察组患者术后血压及血氧饱和度均高于对照组,差异有统计学意义(P<0.05)。两组患者术后MMSE评分均有下降,但是观察组患者MMSE评分明显高于对照组,差异有统计学意义(P<0.05)。结论进行沙滩椅位肩关节镜手术时,动态检测脑血流及脑氧饱和度,可有效降低缺血脑损伤的发生风险,提高患者术后恢复。
文摘目的研究星状神经节阻滞对肩关节镜手术沙滩椅位脑血流动力学改变的影响。方法取择期行沙滩椅位肩关节镜手术患者40例,随机分为治疗组T组和对照组C组各20例,T组术前行超声引导下SGB,对比两组患者术中生命体征、BIS值、脑氧合饱和度(rSO_(2))、不同时段大脑中动脉血流频谱图像、术后7 d ULCA评分、MMSE评分、RBANS总分,将两组数据进行统计学处理分析。结果T组比C组患者术中生命体征变化波动较小,差异有统计学意义(P<0.05)。不同时段rSO_(2)基本保持在相同水平,差异无统计学意义(P>0.05);T组患者大脑中动脉血流流速比C组要低,但血管内径要大,根据公式得出T组患者在不同时间段血流量都要比C组同时段的多,比较差异有统计学意义(P<0.05)。两组术后7 d ULCA评分、MMSE评分、RBANS总分对比T组明显较高,差异有统计学意义(P<0.05)。结论对沙滩椅位行肩关节镜手术的患者术前实施星状神经阻滞术具有增加脑血供及脑保护作用且对患者术后关节功能恢复有良好的促进作用,有临床推广实用价值。
文摘The application of traction has enhanced views during arthroscopic shoulder surgery, easing visualization and accurate intervention within the shoulder joint and the subacromial space. Many innovative traction techniques are currently employed, including the use of padded traction equipment attached to boom arms and further, pedal-activated, hydraulic traction equipment. Variations in patient positioning and cost-benefit analysis of the use of traction in both beach chair and lateral decubitus positions have been performed in the literature. We demonstrate the use of readily available, simple and inexpensive resources in the beach chair position, allowing the application of traction with minimal set-up time and complexity. Initial equipment outlay requires a drip stand attached to a clamp at the end of the operating trolley, permitting a hook to be applied to the arm that is attached to traction cord and weights. We minimized the cost of ongoing consumable items per case to include a stockinette and benzoic tincture. The theatre team experiences a short learning curve associated with the ease of reliability and reproducibility of this technique.
文摘Background: Propofol is often the drug of choice for ambulatory orthopedic cases. However, propofol can be associated with apnea or other events requiring airway interventions. Dexmedetomidine (Dex) has the unique pharmacologic profile of providing sedation without respiratory depression. This is particularly relevant in patients with morbid obesity and/or challenging airways. The hypotheses were: 1) Propofol would cause more apnea or require more airway manipulations than dexmedetomidine;2) Propofol would have shorter post anesthesia unit recovery times;and 3) Dexmedetomidine would be associated with more bradycardia and hypotension. Methods: After IRB approval, 50 patients were randomized to receive either propofol or Dex for Total Intravenous anesthesia (TIVA) after interscalene brachial plexus block was performed preoperatively under ultrasound guidance. The main end points that we measured where: airway interventions, intra-operative bradycardia, hypotension, and PACU length of stay. Results: There were more airway interventions in the propofol group compared to the Dex group. Additionally, the Dex group had significantly longer PACU stays. Conclusion: We would recommend that Dex should be preferentially considered for patients predisposed to airway obstruction;however, the standard use of Dex over Propofol needed to reconsider since the use of Dex as the agent for TIVA was associated with longer PACU stays.
文摘目的探讨沙滩椅体位下行肩关节手术后发生股外侧皮神经麻痹(lateral femoral cutaneous nerve palsy,LFCNP)的危险因素。方法回顾性分析254例沙滩椅体位下行肩关节手术患者的临床资料。根据患者术后是否发生LFCNP分为LFCNP组(8例)和非LFCNP组(246例),记录比较2组患者的人口统计学特征、美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级、术前合并症(高血压史、2型糖尿病史)、麻醉方法、围术期输液量、尿量、出血量、手术时间。将单因素方差分析中差异有统计学意义的指标纳入二元Logistic回归,分析沙滩椅体位下行肩关节手术后发生LFCNP的危险因素。结果LFCNP组体重指数(body mass index,BMI)明显大于非LFCNP组,手术时间明显长于非LFCNP组,差异均有统计学意义(P<0.05)。2组性别、年龄、身高、体重、ASA分级、术前并发症(高血压史、2型糖尿病史)、麻醉方法、输注液量、尿量、失血量差异均无统计学意义(P>0.05)。Logistic回归分析结果显示,BMI>28和手术时间>2 h是沙滩椅体位下行肩关节手术后发生LFCNP的危险因素。结论BMI>28和手术时间>2 h是沙滩椅体位下行肩关节手术后发生LFCNP的危险因素。
