To investigate the effects of Esketamine combined iliofascia nerve block on postoperative cognitive function in elderly patients with femoral neck fracture. Methods:A total of 80 elderly patients with femoral neck fracture were randomly divided into Esketamine group and control group with 40 cases in each group. Total hip replacement was performed in the control group. Before anes-thesia, the control group was given iliac fascia nerve block 0. 357% 20ml, followed by the same volume of normal saline, and then com-bined lumbar and epidural anesthesia. Esketamine group was given iliofascial nerve block 0. 357% 20ml, followed by intravenous Esket-amine 0. 125mg/kg, and then combined epidural anesthesia. When necessary, small doses of propofol and sufentanil were given to assist sedation and analgesia. The intraoperative propofol dosage, sufentanil dosage, anesthesia time, operation time, intraoperative blood loss and length of hospital stay were compared between the two groups. The numerical pain scale ( NRS) score at different postoperative times, cognitive function and early recovery quality were compared, and the incidence of complications were compared between the two groups. Results:There were no significant differences in anesthesia time, operation time and intraoperative blood loss between the two groups (P>0. 05). The intraoperative dosage of propofol, sufentanil and hospital stay in Esketamine group were significantly lower than those in control group (P<0. 05). There was no significant difference between the two groups in NRS score at 1h postoperative activity and NRS score at resting (P>0. 05), but NRS score at 1h to 4h postoperative activity and NRS score at resting increased and NRS score at 4h to 8h postoperative, 12h postoperative, 24h postoperative and 48h postoperative activity and NRS score at resting decreased. Esket-amine group was lower than control group (P<0. 05);There was no significant difference between the Mini-Mental State Examination ( MMSE) score and the Postoperative Recovery Quality Scale ( QOR-15 ) score 1 day before surgery between the two groups ( P >0. 05), and the MMSE score and QOR-15 score of the two groups decreased 1 day after surgery, but increased 3 days after surgery. Es-ketamine group was higher than control group (P<0. 05);The complication rate of esketamine group was significantly lower than that of control group (P<0. 05). Conclusions: Esketamine combined iliofascial nerve block has a good effect on elderly patients with femoral neck fracture, which can reduce intraoperative anesthetic dosage, reduce postoperative pain, reduce cognitive function injury, promote early recovery of patients, and reduce the occurrence of complications.

Objective To investigate the eff ect of transcutaneous nerve stimulation combined with thoracic paravertebral nerve block on pain and sleep quality after thoracoscopic radical resection of lung cancer. Methods From January 2020 to June 2022, 120 patients with thoracoscopic radical resection of lung cancer were randomly divided into two groups, 60 patients in each group. The control group was treated with thoracic paravertebral nerve block, and the experimental group was treated with transcutaneous nerve stimulation combined with thoracic paravertebral nerve block. NRS was used to evaluate the rest and active pain after operation in the two groups, and the occurrence of postoperative relief analgesia was recorded. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the sleep quality on the 1st, 2nd and 3rd day after operation. Results The NRS score of resting pain at 24 h and 48 h after operation in the experimental group was signifi cantly lower than that in the control group (P＜0.05), while the NRS score of resting pain at 4 h, 8 h, 12 h and 72 h after operation in the two groups was not statistically signifi cant (P＞0.05). The NRS score of active pain in the two groups at 4 h, 8 h, 12 h, 24 h and 48 h after operation was not statistically significant (P ＞0.05). The NRS score of active pain in the experimental group at 72 h after operation was signifi cantly lower than that in the control group (P＜0.05). The rescue analgesia rate in the experimental group was signifi cantly lower than that in the control group (P＜0.05), and there was no signifi cant diff erence in the rescue analgesia rate between the two groups on the fi rst and third day after operation (P＞0.05). The PSQI scores of the experimental group on the 1st and 2nd day after operation were signifi cantly lower than those of the control group (P ＜0.05), and there was no statistically signifi cant diff erence between the two groups on the 3rd day after operation (P＞0.05). Conclusion Compared with simple thoracic paravertebral nerve block, combined with percutaneous nerve electrical stimulation has limited improvement on active pain, but it can eff ectively relieve resting pain, reduce relief pain, and reduce PSQI score.

Objective To investigate the effect of dexmedetomidine combined with the preemptive analgesia with dezocine on the treatment of patients with prolapse and prolapse of hemorrhoids (PPH).Methods A total of 60 patients with PPH were randomly divided into dexmedetomidine + dezocine group (group A) and normal saline + dezocine group (group B).All patients received lowdose saddle anesthesia,and at the time points of saddle anesthesia fixed plane (T0),firing the stapler (T1) and at the end of operation (T2),systolic blood pressure (SBP),diastolic blood pressure (DBP),heart rate (HR),Ramsay sedation score,the incidence of postoperative analgesic effect and complications were compared between two groups.Results At T1 and T2,the SBP,DBP and HR of group A were significantly lower than those of group B (P ＜ 0.05),and the score of Ramsay sedation was significantly higher than that of group B (P ＜ 0.05).The analgesic effect VAS scores of group A at 4,8,12,24 and 48 h after operation were significantly lower than those in group B (P ＜0.05).There was no significant difference in anal distention and discomfort between the two groups (P ＞ 0.05).There were significant differences in the incidence of urinary retention,nausea and vomiting,and nocturnal sleep disorders between the two groups (P ＜ 0.01).Conclusion Dexmedetomidine combined with preemptive analgesia with dezocine is effective in treatment of patients with PPH surgery.

[目的]探讨右美托咪定在老年髋关节置换术中控制性降压期间的脑保护作用.[方法]行髋关节置换术的82例老年患者,随机分为两组,观察组予以右美托咪定+硝酸甘油控制性降压干预;对照组予以硝酸甘油控制性降压干预.比较两组受试者麻醉诱导前(T0)、给药15 min(T1)、停药15 min(T2)等时段内心率(HR)及平均动脉压(MAP)变化及其他相关情况.[结果]T1时,对照组HR水平较T0时显著提高(P<0.05),观察组同T0时比较,差异无显著性(P>0.05);T1时,两组MAP水平均较T0时显著降低,且观察组<对照组(P<0.05);T2时,两组HR及MAP比较差异无显著性(P>0.05).观察组丙泊酚用量、硝酸甘油用量、Fromme术野质量评分、MAP降至既定目标的总耗时、总出血量、拔管时间及清醒时间均显著低于对照组(P<0.05).术后24 h,两组受试者简易智能状态评价量表(MMSE)评分结果均较术前显著降低,且对照组<观察组(P<0.05);术后72 h观察组MMSE评分同术前比较差异无显著性(P>0.05),对照组仍显著低于术前(P<0.05).观察组术后认知异常率及记忆减退率均明显低于对照组(P<0.05).[结论]髋关节置换术中予以右美托咪定控制性降压治疗,能有效降低术后认知异常及记忆力减退风险,具有一定脑保护作用,于老年患者术后恢复有利.

目的:观察地佐辛超前镇痛对小剂量鞍麻下肛肠科吻合器痔上黏膜环切术(PPH术)中肠道牵拉反应的影响.方法:选择60例择期行PPH术的患者,随机分为观察组与对照组.所有患者均实施小剂量鞍麻,在PPH术中击发吻合器前10min,观察组给予地佐辛5m g,对照组给予生理盐水5m l.比较吻合器击发时两组的收缩压、舒张压、心率、呼吸频率的变化;观察两组患者术中牵拉反应的发生率;同时比较两组患者在麻醉穿刺前(T0)和手术后3小时(T1)血糖,C反应蛋白以及血浆皮质醇浓度的变化.结果:观察组吻合器击发时的收缩压、舒张压、心率以及呼吸频率均高于对照组(P<0.05);观察组术中牵拉反应的发生率明显低于对照组(P<0.05);2组患者血糖、C反应蛋白和血浆皮质醇浓度术后3h均明显高于麻醉前(P<0.05),而观察组又低于对照组(P<0.05).结论:地佐辛超前镇痛能对肛肠科PPH术中击发吻合器时引起的盆腔神经反射进行抑制,减轻患者的应激牵拉反应,提高患者PPH术中的安全性和舒适度.

Objective To observe the effect of dezocine and midazolam in epidural anesthesia (CSEA) sedative effect and safety of laparoscopic surgery in gynecology infertility.Methods 60 cases of infertility in our hospital undergoing elective gynecologic laparoscopic surgery, were randomly divided into dezocine group (D) and fentanyl group (F), 30 cases each. All patients received combined spinal epidural anesthesia, preoperative intravenous injection of midazolam 0.05 mg/kg, then treated with dezocine 0.1 mg /kg in D group, group F was treated with fentany l μg/kg.Results In D group, the score of group F at each time point Ramsay sedation comparison, no statistically significant difference (P>0.05), D group glossocoma, respiratory depression, hypotension and bradycardia were lower than those of group F (P<0.05).Conclusion Dezocine and midazolam has good sedative effects, is a safe and effective adjuvant to infertility patients undergoing laparoscopic surgery of spinal anesthesia.

目的:观察比较预输注负荷量羟乙基淀粉或乳酸钠林格氏液对预防老年患者髋关节置换术腰麻后低血压的有效性及安全性.方法:选择本院择期髋关节置换术患者40例,随机分为羟乙基淀粉组( H组)和乳酸钠林格氏液组( L组),每组20例,在麻醉前30min分别输注羟乙基淀粉和乳酸钠林格氏液8~10ml/kg,观察并记录两组患者不同时段的血压、心率、中心静脉压的变化及恶心呕吐等麻醉后不良反应及麻黄碱使用情况.结果:H组MAP及CVP在T1时明显高于T0及L组(P<0.05),在T2~T4明显高于L组(P<0.05),而L组M A P在T2~T4明显低于T0(P<0.05);H组H R在T1~T2明显低于T0且在T1~T4均低于L组(P<0.05),而L组HR在T2~T4明显高于T0(P<0.05).低血压、恶心呕吐发生率及应用麻黄碱次数L组高于H组.结论:预输注负荷量羟乙基淀粉能保持老年髋关节置换术患者腰麻后的血流动力学稳定,减少低血压、恶心呕吐等不良反应的发生率.

目的观察腰硬联合麻醉下心率变异性与肾素-血管紧张素-醛固酮系统的变化及关系。方法选择ASAⅠ~Ⅱ级泌尿外科前列腺汽化电切手术病人24例。行腰硬联合麻醉,分别于麻醉前(T1)、麻醉后10分钟(T2)、置入尿道扩张器后1分钟(T3)、电切前1分钟(T4)、前列腺气化电切后5分钟(T5)、切除前列腺后分钟10(T6)、及术毕(T7)检测心率的变异性(HRV)、无创血压(MAP)和心率(HR)的变化,同时分别与T1、T2、T3、T4、T5、时抽取桡动脉血4ml,测肾素(PRA)、血管紧张素(AⅡ)、醛固酮(ALD)。结果与T1比较,T5时LF/HF显著提高(P<0.01);MAP显著下降(P<0.01);T6、T7时LF及HF下降(P<0.05);PRA、AⅡ在T2、T3、T5、T7时显著下降(P<0.01);ALD在T2时有下降(P<0.05);其余各时点无统计学差异。结论心率的变异性及肾素-血管紧张素-醛固酮系统都能反映机体应激的变化,但心率变异性反应的更加及时。

目的:观察异丙酚复合小剂量芬太尼对心脏术后早期拔管的影响.方法:60例择期房室缺修补手术病人,随机分成芬太尼纽(F组)和异丙酚组(P组),F组使用中剂量芬太尼(30～35μg/kg),P组使用小剂量芬太尼(15～20μg/kg)及持续静脉泵注异丙酚(4～6mg/(kg·h)).两组维库溴胺及咪唑安定用法相同.结果:两组病人血流动力学参数变化差异无显著性(P>0.05),P组拔管的时间明显短于F组(P<0.05),术后呕吐发生率呈减低趋势.结论:房室缺修补术患者术中,异丙酚4～6mg/(kg·h)持续静脉泵注复合小剂量芬太尼维持麻醉有利于术后早期拔管.