article: Effects of ultrasound-guided brachial plexus block combined with laryngeal mask sevoflurane general anesthesia on inflammation and stress response in children undergoing upper limb fracture surgery - Minerva Pediatrics 2021 Dec 21 - Minerva Medica - Journals

目的:通过对比妊娠中、晚期胎儿脐动脉栓塞(UAE)的超声表现及妊娠结局,探讨产前超声在妊娠中、晚期胎儿UAE中的应用价值.方法:选取2017年1月1日至2020年10月1日于石家庄市第四医院(河北医科大学附属妇产医院)行产前超声诊断并临床病理证实为UAE的单胎妊娠孕妇44例,其中中孕期(孕20～ 28周)UAE 27例,晚孕期(孕周＞28周)UAE 17例,对比两组间超声表现及妊娠结局差异,并进行统计学分析.结果:晚孕期UAE明确诊断率高于中孕期,而中孕期UAE两条脐动脉内径不对称者比例明显高于晚孕期UAE组;晚孕期UAE组大脑中动脉血流参数异常者比例、胎儿宫内窘迫发生率及孕妇剖宫产率明显高于中孕期UAE组,但中孕期UAE组的分娩孕周大于晚孕期UAE组.结论:产前超声检查是UAE的首选检查.妊娠中晚期发生的UAE要区别对待,尤其是晚孕期UAE,密切监护,及时终止妊娠,以减少不良结局的发生.

Objective:To compare the different optimized anesthesia strategies in pediatric patients undergoing hypospadias surgery.Methods:Ninety pediatric patients with distal hypospadias undergoing Duckett operation, of American Society of Anesthesiologists physical status Ⅰor Ⅱ, aged 1-6 yr, weighing 10-25 kg, were divided into 3 groups ( n=30 each) using a random number table method: caudal block combined with general anesthesia group (group CG), neurostimulator-guided pudendal nerve block combined with general anesthesia group (group PG) and ultrasound-guided dorsal penile nerve block combined with general anesthesia group (group DPG). Anesthesia was induced with propofol-fentanyl, patients were ventilated through the laryngeal mask and maintained spontaneous breathing, and anesthesia was maintained with sevoflurane.The corresponding regional block was performed in each group, and block was performed with 0.25% ropivacaine 1, 0.25 and 0.15 ml/kg in CG, PG and DPG groups, respectively.The consumption of ropivacaine, occurrence of insufficient analgesia during operation, emergence time, duration of post-anesthesia care unit stay, time of the first requirement for analgesics, requirement for analgesics within 24 h after operation, occurrence of postoperative agitation, nausea and vomiting and lower extremity motor block, and patients′ satisfaction score at 24 h after operation were recorded. Results:Compared with group CG, the consumption of ropivacaine was significantly reduced, the time of the first requirement for analgesics was prolonged, the postoperative requirement for analgesics was decreased, duration of post-anesthesia care unit stay was shortened, the incidence of lower extremity motor block was decreased, and patients′ satisfaction score was increased in group PG and group DPG, and the incidence of nausea and vomiting was decreased in group DPG ( P<0.05). Compared with group PG, the consumption of ropivacaine was significantly reduced, and the time of the first requirement for analgesics was shortened in group DPG ( P<0.05). There was no significant difference in the incidence of insufficient analgesia during operation (3% in group DPG) and incidence of postoperative agitation among the three groups ( P>0.05). Conclusion:Ultrasound-guided dorsal penile nerve block combined with general anesthesia provides significant efficacy with a higher safety, and the efficacy is better than that of caudal block combined with general anesthesia and neurostimulator-guided pudendal nerve block general anesthesia when used for pediatric patients undergoing hypospadias surgery.

目的 观察症状性和无症状性颈内动脉狭窄患者支架置入术(CAS)前后颈内动脉狭窄侧与健侧收缩期峰值流速比值(rPSV)、阻力指数比值(rRI)变化,并探讨其临床意义.方法 选择行CAS治疗的颈内动脉狭窄患者43例,有明显缺血性卒中、短暂性脑缺血发作等症状者26例(有症状组),无明显症状者17例(无症状组).所有患者CAS治疗前后分别测量患侧与健侧收缩期峰值流速(PSV)、阻力指数(RI),计算rPSV、rRI.结果 有症状组CAS治疗前rPSV高于CAS治疗后,rRI低于CAS治疗后(P均<0.05).无症状组CAS治疗前rPSV高于CAS治疗后(P<0.05),但CAS治疗前后rRI比较P>0.05.结论 症状性颈内动脉狭窄患者接受CAS治疗后rPSV明显降低、rRI明显升高,无症状性颈内动脉狭窄患者接受CAS治疗后rPSV明显降低,而rRI变化不明显.因此,CAS更适合治疗症状性颈内动脉狭窄.

Objective:To evaluate the improved effects of dexmedetomidine mixed with ropivacaine on pudendal nerve block in the pediatric patients undergoing hypospadias repair.Methods:Sixty pediatric patients, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, aged 1-6 yr, weighing 10-25 kg, undergoing elective hypospadias repair, were divided into 2 groups by a random number table method: ropivacaine group (group R) and dexmedetomidine mixed with ropivacaine group (group DR), with 30 cases in each group.All cases received anesthesia induction with sevoflurane inhaled via the laryngeal mask and maintained spontaneous breathing.After laryngeal mask was fixed, pediatric patients underwent pudendal nerve block under ultrasound guidance with 0.2% ropivacaine 0.2 ml/kg in group R, while with 0.2% ropivacaine 0.2 ml/kg and dexmedetomidine 0.75 μg/kg in group DR.The occurrence of insufficient analgesia during operation, emergence time, duration of the first requirement for analgesics, requirement for analgesics, patients′ satisfaction score, and occurrence of adverse reaction such as postoperative agitation, nausea and vomiting, over-sedation, bradycardia, respiratory depression, and parental satisfaction score were recorded.Results:Compared with group R, the duration of the first requirement for analgesics was significantly prolonged, the requirement for paracetamol was decreased, the incidence of agitation and nausea and vomiting was decreased, parental satisfaction scores were increased ( P<0.05), and no significant change was found in the incidence of insufficient analgesia and emergence time in group DR ( P>0.05). No pediatric patients developed adverse reactions such as over-sedation, bradycardia, and respiratory depression in two groups. Conclusion:Dexmedetomidine 0.75 μg/kg mixed with 0.2% ropivacaine can prolong the duration of pudendal nerve block for analgesia with lower incidence of adverse reactions and optimizes the efficacy of pudendal nerve block in pediatric patients undergoing hypospadias repair.

目的 研究彩色多普勒超声对糖尿病下肢血管病变的评估价值及其与血清脂蛋白相关磷脂酶A2(Lp-PLA2)、25-羟维生素D3[25(OH)D3]水平的关系.方法 选取2015年2月～2016年2月石家庄市第一医院收治的糖尿病患者200例,根据彩色多普勒超声检查结果将糖尿病下肢血管病变患者43例作为A组,无下肢病变患者157例作为B组,并选择同期体检健康者40例作为健康对照组.应用彩色多普勒超声检查各组动脉血管内径以及动脉血流量,应用酶联免疫吸附法检测各组血清Lp-PLA2、25(OH)D3水平,应用Pearson相关性分析分析动脉血管内径以及动脉血流量与血清Lp-PLA2、25(OH)D3的相关性.结果 A组股动脉、胭动脉、足背动脉内径显著低于B组和健康对照组,且股动脉、胭动脉、足背动脉血流量显著低于B组和健康对照组(P＜0.05),以上各指标在健康对照组与B组间差异无统计学意义(P＞0.05).A组血清Lp-PLA2水平显著高于B组和健康对照组,25(OH)D3水平显著低于B组和健康对照组(P＜0.05),而健康对照组与B组Lp-PLA2和25(OH)D3水平比较差异无统计学意义(P＞0.05).糖尿病下肢血管病变患者动脉血管内径以及动脉血流量与血清Lp-PLA2水平呈正相关(r=0.562、0.621,P＜0.05),而与血清25(OH)D3水平均呈负相关(r=-0.663、-0.582,P＜0.05).结论 糖尿病下肢血管病变患者存在下肢动脉狭窄、血流速度缓慢情况以及血清Lp-PLA2、25(OH)D3的异常改变,患者动脉血管内径以及动脉血流量与血清Lp-PLA2和25(OH)D3水平密切相关.

患者男性,36岁.主因头晕、头痛、右侧上肢酸麻乏力、活动后加重来我院就诊.查体:左上肢血压100/80 mm Hg(1mm Hg=0.133 kPa),右上肢血压75/60 mm Hg,右侧桡动脉搏动减弱.否认高血压、糖尿病、吸烟史.颈动脉彩色超声示:右侧锁骨下动脉起始部管腔内可见条带状高回声结构自前后管壁凸向管腔,近中央部厚约1.9mm,近管腔基底部较厚处约4.7 mm,不随血流移动,原始管腔径约20.9 mm,残余管径约2.1 mm。

目的应用瞬时波强技术(WI)的相关参数检测缺血性心肌病患者左室功能。方法用WI软件测量分析34例缺血性心肌病患者和30例正常对照组,采集WI相关参数,即瞬时加速度波强(W1),瞬时减速度波强(W2),负向波面积(NA),射血时间(W1-W2),射血前期(R-W1)。结果与正常对照组比较,缺血性心肌病组W1明显减低(P<0.01);W2和NA减低(P<0.05);W1-W2明显缩短(P<0.05);R-W1差异无统计学意义(P>0.05)。结论 WI评价左室功能,为临床评价心力衰竭的程度提供了新的途径和方法。

目的探讨颈动脉瞬时波强(WI)评价慢性肾衰竭(CRF)患者左室功能改变的价值。方法用WI技术检查CRF患者30例及正常对照组30例,采集相关参数W1、W2、NA、R-W1、W1-W2。结果与正常对照组比较,CRF患者W2、NA增高(P<0.05),W1减低(P<0.05),W1-W2和R-W1差异无统计学意义(P>0.05)。结论 WI技术是评价CRF患者左心功能改变的一种新方法。

不明原因的下肢肢体疼痛是临床常见的症状,其病因的发现成为临床医生较为棘手的问题.部分患者被考虑为下肢动脉的粥样硬化引起的动脉狭窄或闭塞,下肢深静脉血栓形成等.虽然彩色超声观察静脉血栓的技术非常成熟,但是在日常的诊断工作中,他们中的一部分人下肢动脉或深静脉没有明显病变或病变的程度较轻,发现小腿肌间静脉血栓形成者仍然存在漏诊.