病史摘要:本病例报道一例老年女性患者,入院诊断为“右侧输尿管肿瘤”,接受了“腹腔镜下右肾、输尿管及部分膀胱切除术”。术后发生了再度镇静。症状体征:手术结束后,患者在手术室内已恢复意识,自主呼吸良好,配合度高,符合拔管条件,遂予以拔管,随后送至麻醉恢复室(Post-Anesthesia Care Unit, PACU)。然而,进入PACU约十分钟后,患者再次出现意识消失,处于昏睡状态,对一般刺激无反应,考虑发生了再度镇静。诊断方法:患者在手术结束后经评估后拔除气管导管,但进入PACU后意识恢复差,Ramsay镇静评分为5分。在PACU观察125分钟后,患者意识才完全恢复,能够对外界言语刺激做出正确反应。临床转归:这是一例老年肥胖患者,在“腹腔镜下右肾、输尿管及部分膀胱切除术”拔管后出现了再度镇静的病例。经过积极地监护和处理,患者预后良好。Case Summary: This case report describes an elderly female patient diagnosed with a “right ureteral tumor” who underwent a “laparoscopic right nephroureterectomy and partial cystectomy”. Postoperatively, the patient experienced re-sedation. Signs and Symptoms: After the completion of surgery, the patient regained consciousness in the operating room, exhibited good spontaneous breathing, and showed high cooperation, meeting the criteria for extubation. She was subsequently transferred to the Post-Anesthesia Care Unit (PACU). However, approximately ten minutes after entering the PACU, the patient experienced a loss of consciousness, falling into a comatose state with no response to general stimuli, indicating re-sedation. Diagnostic Methods: Postoperatively, the patient was assessed and extubated in the operating room. Upon transferring to the PACU, her level of consciousness deteriorated, with a Ramsay Sedation Score of 5. After 125 minutes of observation in the PACU, the patient’s consciousness fully recovered, and she was able to respond appropriately to ver
目的:比较羟考酮、舒芬太尼用于分娩硬膜外自控镇痛(patient epidural controlled analgesia,PCEA)后的镇痛效果及安全性。方法:选择美国麻醉师协会(american society of anesthesiologists,ASA)Ⅰ~Ⅱ级的初产妇210名,随机分为3组,羟考酮(O)组采用0.1%罗哌卡因复合羟考酮硬膜外镇痛、舒芬太尼(S)组采用0.1%罗哌卡因复合舒芬太尼硬膜外镇痛,罗哌卡因(C)组采用0.1%罗哌卡因硬膜外镇痛,每组70例。记录患者入室(T0)、首剂量给予10 min(T1)、30 min(T2)、宫口全开(T3)时的血流动力学指标、视觉模拟评分法(visual analog scales,VAS)评分,分娩镇痛起效时间,作用持续时间、产程时间和出生后1 min、5 min新生儿Apgar评分。分别抽取T0、T2产妇静脉血及新生儿娩出(T4)后静脉血,分别检测血清皮质醇以及一氧化氮(nitric oxide,NO)浓度。结果:实施分娩镇痛的产妇疼痛缓解,O组、S组与C组在相应时间点VAS评分差异有统计学意义(P<0.05),S组起效时间快于O组、C组,O组持续时间长于S组、C组(P<0.05)。S组、C组较O组NO浓度显著降低,O组较S组、C组皮质醇浓度显著降低(P<0.05)。三组产妇生命体征平稳,产程时间、新生儿Apgar评分无明显差别(P>0.05)。结论:羟考酮起效时间快,镇痛时间长,可延缓母婴NO降低时间,降低皮质醇浓度,降低产妇的应激反应且镇痛效果优于舒芬太尼及罗哌卡因。
