目的 采用肺电阻抗成像(EIT)法评价不同浓度罗哌卡因肌间沟臂丛神经阻滞对肺通气的影响.方法 选择2021年10月-2022年4月于安徽医科大学第二附属医院拟择期行肌间沟臂丛神经阻滞麻醉的上肢手术患者75例,采用随机数字表法分低浓度组(A组)、中浓度组(B组)和高浓度组(C组),每组25例.三组患者均在超声引导下行肌间沟入路臂丛神经阻滞,分别在肌间沟注射0.25％、0.33％和0.50％的罗哌卡因20 ml.连续监测EIT,评估肺通气变化;进行改良Bromage评分,评估运动阻滞情况;记录阻滞前(T0)、阻滞后10min(T1)、阻滞后20 min(T2)和阻滞后30 min(T3)通气中心(CoV)、依赖静止区(DSS)和非依赖静止区(NSS)的面积百分比及改良Bromage评分.结果 与T0相比,T1、T2和T3时A组、B组和C组的NSS和DSS均增加(P＜0.05);与T0相比,T2和T3时A组及T1、T2和T3时B组和C组的CoV均增加(P＜0.05);T1、T2和T3时,B组和C组的NSS和DSS高于A组(P＜0.05);T1时,B组和C组的CoV高于A组(P＜0.05);与T0相比,3组各时点的改良Bromage评分均增加(P＜0.05);T1时,B组改良Bromage评分高于A组(P＜0.05);T1、T2和T3时,C组的改良Bromage评分高于A组(P＜0.05).结论 肺电阻抗成像可以实时监测肺局部通气变化,用于观察肌间沟臂丛神经阻滞对肺通气的影响;另外,更高浓度的局麻药物可更快的引起肺通气变化.

目的:评价超声引导全程可视化挠动脉穿刺置管方法在肥胖病人麻醉中的临床应用效果.方法:选择体质量指数≥28 kg/m2拟行手术,需要动脉穿刺置管病人100例,随机分为超声引导长轴平面内组(L组)和超声引导短轴平面外组(S组);比较穿刺一次成功率、穿刺时间、穿刺次数、穿刺并发症等.结果:L组穿刺一次成功率高于S组(P<0.05);S组4例出现穿刺部位血肿,均更换对侧挠动脉穿刺成功,L组未发生穿刺部位血肿,2组差异有统计学意义(P<0.05);2组病人穿刺时间、穿刺次数、穿刺针使用数量差异均无统计学意义(P>0.05).结论:超声引导长轴全程可视化挠动脉穿刺置管操作成功率高于超声引导短轴平面外技术.

Myocardial ischemia reperfusion injury (IRI) is a typical clinically pathophysiological process. Although no breakthrough has been made in preventing myocardial IRI, many drugs have shown promising clinical effects. Morphine, as a traditional opioid analgesic, can alleviate the IRI of the normal myocardium and reduce the post-ischemic injury of the myocardium under certain pathological conditions. This paper aims to review the application of morphine in myocardial protection and its mechanism to provide scientific reference for the clinical application and further research of morphine in alleviating myocardial ischemia.

Myocardial ischemic reperfusion injury (MIRI) is a common complication of reperfusion therapy, such as early thrombolysis and coronary intervention after myocardial infarction, which seriously affects the prognosis of patients. Effectively reducing MIRI has always been an essential focus of medical workers. In addition to the analgesic effect, morphine can stimulate the heart and beyond the heart opioid receptors, especially the central nervous system, to trigger a myocardial protective effect. This review systematically summarizes the myocardial protective mechanisms involved in the central nervous system (lateral ventricle, intrathecal, and cephalic pulp extension ventrolateral areas) morphine preconditioning to regulate multiple mediators (adenosine, calcitonin gene-related peptide, substance P, etc) for providing new ideas to the clinical use of morphine to improve myocardial ischemic reperfusion injury.

Objective:To investigate the role of IL-6 trans-signaling pathway in perioperative neurocognitive disorder in mice.Methods:Eighty-four SPF healthy male C57BL/6 wild-type mice and 84 SPF healthy male IL-6R -/- mice, aged 12-14 weeks, weighing 25-35 g, were used.The 84 wild-type mice were divided into 4 groups ( n=21 each) using a random number table method: sham group (SH group), surgery group (S group), sgp130Fc (specific IL-6 trans-signaling pathway blocker) group (F group), and sgp130Fc+ surgery group (FS group). In S group and FS group, internal fixation was performed under general anesthesia with sevoflurane after tibial fracture.Mice only received anaesthesia with sevoflurane in SH group and F group.In FS group and F group, sgp130Fc 10 mg/kg was intraperitoneally injected before anesthesia.Blood samples were collected from the celiac vein at 24 h after surgery for determination of the concentrations of interleukin 6 (IL-6), IL-1β and tumor necrosis factor (TNF)-α in plasma by enzyme-linked immunosorbent assay (ELISA). Then the mice were sacrificed, brains were removed, and hippocampal tissues were obtained for measurement of the contents of IL-6, IL-1β and TNF-α (by ELISA) and for observation of activation of microglias in the hippocampal DG region (by immunofluorescence staining, n=6). Cognitive function was evaluated by contextual fear conditioning test ( n=15) on 3 days after surgery.Eighty-four IL-6R -/- mice were randomly divided into 4 groups ( n=21 each): sham group (KO-SH group), surgery group (KO-S group), saline group (KO-C group), and hyper IL-6 (specific IL-6 trans-signaling pathway activator) group (KO-H group). The treatment in KO-SH group and KO-S group was the same as those previously described in SH group and S group, respectively.0.9% NaCl solution 100 μl was intraperitoneally injected in KO-C group, 100 μl hyper IL-6 40 μg/kg was intraperitoneally injected in KO-H group, and 24 h later blood was collected from the celiac vein for measurement of the concentrations of IL-6, IL-1β and TNF-α in plasma by ELISA.Then the mice were sacrificed, brains were removed, and hippocampal tissues were obtained for determination of the contents of IL-6, IL-1β and TNF-α (by ELISA) and for observation of activation of microglias in the hippocampal DG region (by immunofluorescence staining, n=6). Cognitive function was evaluated by contextual fear conditioning test ( n=15) on 3 days after surgery. Results:Compared with SH group, the percentage of freezing time in the contextual fear conditioning test was significantly decreased, and the activation of microglias in the hippocampal DG region and levels of IL-6, IL-1β and TNF-α in plasma and hippocampi were increased in S group ( P<0.05). Compared with S group, the percentage of freezing time in the contextual fear conditioning test was significantly increased, and the activation of microglias in the hippocampal DG region and levels of IL-6, IL-1β and TNF-α in plasma and hippocampus were decreased in FS group ( P<0.05). There were no significant differences in the percentage of freezing time, activation of microglias in the hippocampal DG region, and levels of IL-6, IL-1β and TNF-α in plasma and hippocampi between KO-S group and KO-SH group ( P>0.05). Compared with KO-C group, the percentage of freezing time in the contextual fear conditioning test was significantly decreased, and the activiation of microglias in the hippocampal DG region and levels of IL-6, IL-1β and TNF-α in plasma and hippocampus were increased in KO-H group ( P<0.05). Conclusions:IL-6 trans-signaling pathway is involved in the process of perioperative neurocognitive disorder in mice.

Myocardial ischemia/reperfusion injury (MI/RI) is a common complication of coronary artery recanalization after myocardial infarction, which seriously affects the recovery of patients and even threatens their life. Opioids can not only provide analgesia, but also protect the heart, which depends on the activation of opioid receptor (OR). The activation of κ-OR and δ-OR is directly involved in myocardial protection, while the role and mechanism of μ-OR remain controversial. In addition, the affinity of different agonists to three OR subtypes makes the conclusion "OR mediated cardiac protection" controversial. This paper reviews the protective effects of endogenous opioid peptides and exogenous opioids such as morphine, fentanyl, remifentanil, butorphanol and methadone on MI/RI. At the same time, we will further discuss the mechanisms of different opioid receptors mediated cardioprotection, their crosstalk with other members of the G protein-coupled receptor (GPCR) family, and possible upstream and downstream signaling pathways to provide enlightenment for development of drugs in the future.

目的 探讨6-甲基腺嘌呤(m6 A)去甲基化酶ALK-BH5在大鼠心肌成纤维细胞(CFs)活化增殖中的作用.方法 取1～3 d新生SD乳鼠心脏,剪碎消化后进行CFs原代培养,并在显微镜下观察细胞形态.细胞贴壁生长后加入TGF-β1诱导构建CFs活化增殖模型,模型构建成功后分别向各组细胞转染ALKBH5(慢病毒过表达ALKBH5)及慢病毒空载体24～48 h.运用RT-qPCR方法检测ALKBH5、α-平滑肌肌动蛋白(α-SMA)、I型胶原(CollagenⅠ)和增殖细胞核抗原(PCNA)mRNA的表达;Western blot检测ALKBH5、α-SMA、CollagenⅠ及PCNA蛋白的表达;CCK-8法和EdU染色检测细胞增殖活性变化.结果 在CFs活化增殖模型中,与对照组CFs相比,模型组CFs中ALKBH5蛋白和mRNA的表达降低,而与活化增殖相关蛋白PCNA、α-SMA及CollagenⅠ的表达增加.此外,在慢病毒转染ALKBH5过表达组的CFs中,α-SMA、CollagenⅠ和PCNA蛋白和mRNA同ALK-BH5病毒空载体组相比表达下降.CCK-8与EdU染色实验表明,与空载体组相比,ALKBH5过表达组CFs增殖活性受到抑制.结论 过表达ALKBH5明显抑制CFs的增殖活性,提示ALKBH5可能是参与调控CFs活化增殖的关键因子.

目的 探讨右美托咪定滴鼻预防硬膜外分娩镇痛爆发痛的效果.方法 选择单胎足月初产妇100例,美国麻醉医师协会(ASA)Ⅰ或Ⅱ级,随机分为对照组和右美托咪定滴鼻组(观察组).观察组在硬膜外镇痛后20 min给予0.8μg/kg右美托咪定滴鼻,对照组给予等量生理盐水滴鼻.记录各组爆发痛发生率、首次爆发痛发生时间、患者自控硬膜外镇痛(PCEA)按压次数、镇痛药总量、产妇满意度和产程时间,评价右美托咪定滴鼻对硬膜外分娩镇痛爆发痛的预防效果.记录硬膜外镇痛前(T0)、镇痛后1 h(T1)、2 h(T2)、3 h(T3)、4 h(T4)、宫口开全时(T5)、胎儿娩出时(T6)产妇的疼痛视觉模拟评分(VAS)、Ramsay镇静评分、胎心率(FHR)及新生儿Apgar评分、脐动脉血气分析值等,评估其对产妇及新生儿的安全性的影响.结果 本研究最终纳入91例产妇,年龄20～36岁.与对照组(45例)相比,观察组(46例)爆发痛发生率显著降低,首次爆发痛发生时间显著推迟,PCEA次数与镇痛药总量显著减少,产妇满意度显著增高,T1～3时VAS评分显著降低,Ramsay评分显著增高(P<0.05).2组产程时间、FHR、新生儿Apgar评分、脐动脉血气分析值及不良反应发生率差异均无统计学意义(P>0.05).结论 右美托咪定滴鼻用于硬膜外分娩镇痛可降低爆发痛发生率,推迟首次爆发痛发生时间,减少局麻药用量,对产妇和新生儿无明显不良影响.

With the development of enhanced recovery after surgery (ERAS) and the application of the comfortable medical treatment principle, perioperative pain management has become an increasingly attention topic. Anesthesiologists have played an essential role in perioperative pain management. However, anesthesiologists also faced three major challenges, which are how to provide effective analgesia, how to prevent the side effects of opioids, and how to avoid drug abuse addiction. In this review, we summarized the progress of clinical research on opioid-sparing anesthesia as follows: A new-multimodel anesthesia strategy of non-opioid analgesics, regional anesthesia that helps to reduce the consumption of opioids as well as the related side effects. Perioperative opioid-sparing anesthesia leads to achieve comfortable anesthesia and analgesia, which subsequently improve the prognosis of patients.

目的 评价以麻醉护士、外科护士、麻醉医生和外科医生共同参与的围术期多学科合作在腹腔镜腹股沟疝修补术患儿加速术后康复(ERAS)中应用效果.方法 选取2020年1～12月于我院择期行腹腔镜腹股沟疝修补术的106例患儿为研究对象,按随机数字表法结合手术先后顺序分为对照组(n=53)和干预组(n=53).对照组采用外科医生和外科护士常规的围术期治疗及护理,干预组采用ERAS理念下以麻醉护士、外科护士、麻醉医生和外科医生共同参与的围术期治疗及护理.比较2组患儿麻醉复苏留观时间、术后6h内平均疼痛评分、麻醉复苏期躁动发生率、首次进食饮水时间、首次下床活动时间及照顾者对医疗护理工作满意度的差异.结果 干预组患儿在麻醉复苏留观时间、术后6h内平均疼痛水平、麻醉复苏期躁动发生率、首次进食饮水时间及首次下床活动时间上均低于对照组;干预组患儿照顾者对医疗护理工作满意度评分高于对照组,差异均有统计学意义(P<0.05).结论 多学科合作模式联合ERAS理念提高了腹腔镜腹股沟疝修补术患儿麻醉复苏质量,促进了患儿术后生理功能的恢复,降低了术后的并发症,提高了患儿照顾者对医疗护理工作满意度.

目的 探讨术后右美托咪定给药剂量差异对接受妇科腹腔镜手术患者恶心呕吐发生风险的影响.方法 选取安徽医科大学附属安庆医院自2017年1月至2020年9月收治的155例接受妇科腹腔镜手术患者为研究对象.根据术后不同的右美托咪定给药剂量将其分为A组(n=80)与B组(n=75).A组给予右美托咪定1μg/kg输注,B组给予右美托咪定2μg/kg输注.比较两组患者术中临床指标、视觉评定量表(VAS)评分及不良反应发生率.分别于患者进入麻醉后恢复室(T1)、回病房后6 h(T2)、回病房后6～12 h(T3)、回病房后12～24 h(T4)及回病房后24～48 h(T5),记录两组患者恶心呕吐发生情况.结果 两组患者术中临床指标比较,差异均无统计学意义(P>0.05).两组患者T1时的恶心呕吐发生率比较,差异无统计学意义(P>0.05);T2～T5时,B组患者恶心呕吐发生率均低于A组,差异均有统计学意义(P<0.05).B组患者术后12、24、48 h的VAS评分均低于A组,差异均有统计学意义(P<0.05).A组患者的PCIA按压次数为(4.08±1.21)次,显著多于B组的(1.85±0.46)次,差异有统计学意义(P<0.05).两组患者的不良反应发生率比较,差异无统计学意义(P>0.05).结论 术后右美托咪定2μg/kg给药可有效降低接受妇科腹腔镜手术患者恶心呕吐发生风险,且无明显并发症发生,推荐采用右美托咪定2μg/kg给药剂量.

目的 分析右美托咪定应用于老年结直肠癌根治术中对麻醉苏醒期及神经认知功能的保护作用.方法 选择2015年1月至2017年6月收治的88例需行腹腔镜下结直肠癌手术患者,随机分为对照组(45例)和观察组(43例).观察组结直肠癌根治术前注射适量右美托咪啶,对照组注射等量生理盐水.记录患者麻醉开始时及2h后心率、血压、呼吸频率,比较两组临床表现及不良反应、血糖水平等,检测患者手术前后血浆皮质醇水平.结果 两组手术时间、术中出血量及苏醒时间差异无统计学意义(P>0.05).两组镇静开始时心率、血压、呼吸频率差异无统计学意义(P>0.05),镇静开始后2 h,两组均有所改善,观察组心率、呼吸频率下降显著优于对照组(P<0.05).两组术前简易智力状态检查量表(MMSE)评分无统计学意义(P>0.005),术后,观察组MMSE评分下降幅度小,两组差异显著(P<0.05).观察组术后认知功能正常率明显高于对照组(P<0.05),且出现早期认知功能障碍的患者中,观察组障碍程度也明显轻于对照组(P<0.05).两组术前血浆皮质醇及血糖水平无明显差异(P>0.05),治疗后两组均显著降低,且观察组治疗效果更显著(P<0.05,P<0.01).观察组出现不良反应的情况较少,与对照组相比有明显差异(P<0.05).结论 老年结直肠癌根治术中应用右美托咪定的应用效果明显,能够预防患者术后发生认知障碍,不会对老年患者血压、心率等造成较大影响,不良反应少,预后佳.

目的:观察护理干预套囊压力联合雾化吸入对改善继发甲状旁腺功能亢进(甲旁亢)手术病人术后咽喉部不适的疗效.方法:将90例继发甲旁亢病人随机分为A、B、C 3组,各30例.其中A组病人给予全身麻醉,术后病人清醒拔管后立即入麻醉恢复室(PACU)行PACU常规护理;B、C组术中麻醉、插管方式与A组相同,气囊充气外接套囊压力表动态调整套囊压力,压力维持在25～30 cmH2 O,B组病人术后清醒拔管后入PACU行PACU常规护理;C组术后清醒拔管后入PACU立即予布地奈德2 mg+0.9％氯化钠溶液5 mL雾化吸入.分别记录3组病人拔管后入PACU(T1)、出PACU(T2)、术后6 h(T3)、术后24 h(T4)咽痛、咽干、恶心呕吐、声嘶发生率和严重程度,并询问病人满意度,横向对比2种护理方式对病人全麻气管插管后咽喉部并发症的干预效果.结果:T1时C组咽痛评分低于A、B组(P<0.01),咽干评分3组差异无统计学意义(P>0.05);T2、T3和T4时,咽痛和咽干评分均C组<B组<A组(P<0.01);C组满意度优于B组和A组(P<0.05),A组和B组差异无统计学意义(P>0.05).结论:护理干预套囊压力联合雾化吸入可减轻术后病人咽痛、咽干程度,加速病人术后恢复,提高病人的满意度.

Objective:To investigatethe the effects of dexmedetomidine (Dex) on postoperative recurrence in patients with renal secondary hyperparathyroidism (SHPT).Methods:A total of 354 renal SHPT patients who underwent total parathyroidectomy and autologous transplantation (tPTX+AT) in the Second Affiliated of Anhui Medical University from January 2017 to August 2018 were enrolled and their clinical data were retrospectively analyzed. All the patients were followed up for recurrence of SHPT within one year after surgery, and they were divided into two groups: a recurrence group ( n=36) and a non-recurrence group ( n=318). Univariate Logistic regression and multivariate Logistic regression were performed to determine the related factors of postoperative recurrence. According to the presence of Dex infusion, they were divided into two groups: a Dex group ( n=133) and a control (Con) group ( n=221), and the differences in perioperative data between the two groups were compared. Results:According to univariate Logistic regression analysis, the age of recurrence group was higher than that of non-recurrence group, and the incidence of using Dex was less than that of non-recurrence group ( P<0.05). According to multivariate Logistic regression analysis, age [odds ratio (OR)=1.081, 95% confidence interval (CI) 1.038-1.126, P<0.001], postoperative intactparathyroid hormone (iPTH) level (OR=1.011, 95% CI 1.000-1.021, P=0.041) as well as intraoperative use of dexmedetomidine (OR=0.222, 95%CI 0.083-0.594, P=0.003) were the influencing factors of postoperative recurrence in patients with renal SHPT. Compared with the Con group, the Dex group presented remarkable decreases in the dosage of sufentanil and the incidence of salvage analgesia during postanesthesia care unit (PACU), but increases in the incidence of bradycardia ( P<0.05). There was no significant difference in general information and other perioperative indexes between the two groups ( P>0.05). Conclusions:Intraoperative use of Dex is a protective factor for postoperative recurrence in patients with renal SHPT, which can reduce the dosage of intraoperative opioids and provide better postoperative analgesia.

Objective:To evaluate the accuracy of changes in pulse pressure variation (ΔPPV) and changes in stroke volume variation (ΔSVV) in predicting fluid responsiveness in the patients ventilated in pressure-controlled ventilation-volume guaranteed (PCV-VG) mode.Methods:Sixty patients of both sexes, aged 18-64 yr, with body mass index of 18.5-23.9 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective resection of gastrointestinal tumor with general anesthesia, were enrolled in the study.After intravenous anesthesia induction and before the start of the surgery, the patients were ventilated in PCV-VG mode with tidal volume (V T) 6 ml/kg, and the PPV 6 and SVV 6 were recorded.TVC was then performed, V T was increased from 6 ml/kg to 8 ml/kg and maintained at this level for 1 min, and PPV 8 and SVV 8 were then monitored and recorded.The ΔPPV and ΔSVV were calculated before and after TVC.When TVC was completed, the V T was adjusted back to 6 ml/kg for fluid replacement test.Increase in cardiac index after fluid replacement test ≥15% was considered to be a positive response.The receiver operating characteristic curve for each indicator in predicting fluid responsiveness was drawn. Results:The results of receiver operating characteristic curve analysis showed that the area under the curve for PPV 6, SVV 6, PPV 8, SVV 8, ΔPPV and ΔSVV in predicting fluid responsiveness (95% confidence interval) was 0.57 (0.43-0.72), 0.62 (0.47-0.76), 0.83 (0.73-0.87), 0.76 (0.64-0.88), 0.95 (0.90-1.00) and 0.91 (0.86-0.99), respectively, the cutoff value of PPV 8, SVV 8, ΔPPV and ΔSVV was 10.5%, 13.5%, 4.5% and 5.5%, respectively, the sensitivity was 75%, 78%, 88% and 85%, respectively, and the specificity was 88%, 87%, 95% and 98%, respectively. Conclusion:ΔPPV and ΔSVV can accurately predict fluid responsiveness in the patients ventilated in PCV-VG mode.

目的 采用电阻抗断层成像(EIT)技术观察容量控制通气(VCV)和压力控制容量保证通气(PCV-VG)模式对腹腔镜下Trendelenburg体位患者全麻术中肺通气的影响.方法 择期全麻下行腹腔镜下Trendelenburg体位妇科手术患者60例,年龄40～65岁,BMI 18～30 kg/m2,ASAⅠ或Ⅱ级,采用随机数字表法将患者分为两组:VCV模式组(V组)和PCV-VG模式组(P组),每组30例.V组术中采用VCV模式,P组采用PCV-VG模式.记录入室后(T0)、插管后5 min(T1)、更改体位(由平卧位更改为Trendelenburg体位)后即刻(T2)、更改体位后30 min(T3)、更改体位后60 min(T4)、更改体位后120 min(T5)、改平卧位(T6)时的MAP、HR、通气中心(CoV)、依赖静止区(DSS)、非依赖静止区(NSS)的面积百分比.记录T1、T3—T5时气道峰压(Ppeak)、pH、PaO2、PaCO2、氧合指数(OI).记录术后7 d内肺部感染、呼吸衰竭等肺部并发症发生情况.结果 T0—T6时两组MAP、HR差异无统计学意义.与V组比较,T3—T6时CoV面积百分比明显升高,DSS面积百分比明显降低(P<0.05),T3—T5时Ppeak明显降低(P<0.05),T4、T5时PaO2、OI明显升高(P<0.05).两组术后7 d内均无肺部并发症.结论 PCV-VG通气模式可明显改善腹腔镜下Trendelenburg体位患者术中肺通气及肺氧合功能.

目的 采用电阻抗成像法(EIT)评价顺式阿曲库铵在老年患者膝关节置换术中对肺通气功能的影响.方法 选择择期行人工膝关节置换术的老年患者60例,男14例,女46例,年龄65～80岁,ASAⅡ或Ⅲ级,随机分两组:为使用顺式阿曲库铵组(C组)和不使用顺式阿曲库铵组(N组),每组30例.C组在全麻时使用顺式阿曲库铵0.15 mg/kg诱导,N组在全麻时不使用顺式阿曲库铵诱导.分别在麻醉诱导前(T0)、喉罩置入后5 min(T1)、喉罩置入后30 min(T2)、喉罩置入后60 min(T3)、拔除喉罩后5 min(T4)实施EIT监测,记录中心通气区(CoV)面积百分比、依赖静止区(DSS)面积百分比、非依赖静止区(NSS)面积百分比及T1—T3时气道压力;术前、术后1、3、5 d进行肺功能检测和血气分析.记录术后3 d内不良反应发生情况.结果 T0、T3、T4时两组NSS、CoV和DSS面积百分比差异无统计学意义.T1、T2时C组CoV面积百分比明显高于N组(P<0.05).T1—T3时C组气道压力明显低于N组(P<0.05).两组术前和术后1、3、5 d的第一秒用力呼气容积(FEV1)、用力肺活量(FVC)、最大通气容积(MVV)、PaO2、PaCO2及氧合指数(PaO2/FiO2)差异无统计学意义.两组不良反应发生率差异无统计学意义.结论 顺式阿曲库铵可改善膝关节置换术患者术中通气情况,对术后肺功能无明显影响.

目的 观察右美托咪定复合纳布啡对腹部大手术病人术后早期急性疼痛治疗的效果.方法 2016年11月至2018年11月安徽医科大学第二附属医院收治的在普外科上腹部开放性手术术后进入麻醉科重症监护室(AICU)的病人60例,均疼痛评分>3分,随机数字表法分为2组,纳布啡组(N组)和右美托咪定复合纳布啡组(YN组),N组病人给予纳布啡20 mg静脉推注,YN组给予纳布啡20 mg静脉推注,同时右美托咪定1.0μg/kg在15 min泵注,接着0.3μg·kg-1·h-1速度泵注30 min.每15分钟测一次视觉模拟评分(VAS),如果仍然>3分,给予舒芬太尼3微克/次.比较两组病人VAS评分,镇静评分(Ramsay),舒适度(BCS)评分,对AICU治疗满意度,AICU驻留时间,术后早期舒芬太尼累计用量,基本生命体征变化以及常见不良反应发生情况.结果 治疗后15 min和30 min两个时点YN组VAS评分分别为(2.61±0.91)分、(2.14±0.67)分,低于N组(3.33±1.15)分、(2.92±0.94)分;两组病人比较差异有统计学意义(P<0.05).治疗后15 min,YN组病人舒适评分为(0.68±0.12)分,高于N组(0.36±0.49)分,两组病人比较差异有统计学意义(P<0.05).治疗后1 h,2 h舒芬太尼累计用量分别为YN组分别为(3.5±1.5)、(6.7±1.7)μg,明显小于N组的(4.6±2.3)、(7.8±2.4)μg(P<0.05).治疗后30 min,60 min,120 min 3个时点,镇静评分=1分、2～4分者,病人对AICU治疗满意度,两组比较均差异有统计学意义(P<0.05).AICU驻留时间、基本生命体征变化及各种不良事件发生率两组差异无统计学意义.结论 右美托咪定复合纳布啡对腹部大手术病人术后早期急性疼痛治疗效果确切,提高了病人对AICU治疗的满意度.

目的 探讨超声引导下单次竖脊肌平面阻滞(ESPB)联合自控静脉镇痛(PCIA)对胸腔镜下肺叶切除老年患者术后的镇痛效果.方法 选择在全麻下行胸腔镜肺叶切除术的老年肺占位患者60例,ASAⅡ～Ⅲ级,随机分为单次ESPB联合PCIA组(EP组)30例和单纯PCIA组(P组)30例.EP组入预麻间后,0.5％罗哌卡因20 mL行单次ESPB,30 min后测定阻滞效果,P组予常规监测,不进行ESPB操作.术毕两组均接镇痛泵.记录两组术后入麻醉恢复室即刻(T0)、PACU期间最大(T1)、12 h时(T2)、24 h时(T3)、48 h时(T4)安静、咳嗽状态下视觉模拟评分(VAS);记录T0～T2、T2～T3、T3～T4时段内静脉镇痛泵的有效按压次数;记录T0～T3、T3～T4时段内追加镇痛药物例数;记录恶心呕吐、呼吸抑制等不良反应发生例数;记录肺不张、肺部感染发生例数;计算患者对镇痛效果的总满意率.结果 EP组安静、咳嗽时VAS低于P组,镇痛泵的有效按压次数、镇痛药物术后追加患者比例均少于P组(P均<0.05).EP组恶心、呕吐及肺不张、肺部感染的发生率均低于P组(P均<0.01).EP组总满意率高于P组(P<0.01).结论 与单纯PCIA相比,超声引导下单次ESPB联合PCIA对行胸腔镜肺切除术老年患者的镇痛效果更佳,术后不良反应少,患者满意率更高.