BACKGROUND:This randomized clinical trial determined the effects of electroencephalographic burst suppression on cerebral oxygen metabolism and postoperative cognitive function in elderly surgical patients. METHODS:The patients were placed into burst suppression (BS) and non-burst suppression (NBS) groups. All patients were under bispectral index monitoring of an etomidate target-controlled infusion for anesthesia induction and intraoperative combination sevoflurane and remifentanil for anesthesia maintenance. The cerebral oxygen extraction ratio (CERO2), jugular bulb venous saturation (SjvO2), and difference in arteriovenous oxygen (Da-jvO2) were measured at T0, T1, and T2. One day before surgery, and 1, 3, and 7 days after surgery, postoperative cognitive dysfunction was assessed using the mini-mental state examination (MMSE). RESULTS:Compared with T0, the Da-jvO2 and CERO2 values were decreased, and SjvO2 was increased in the 2 groups at T1 and T2 (P < .05). There was no statistical difference in the SjvO2, Da-jvO2, and CERO2 values between T1 and T2. Compared with the NBS group, the SjvO2 value increased, and the Da-jvO2 and CERO2 values decreased at T1 and T2 in the BS group (P < .05). The MMSE scores on the 1st and 3rd days postoperatively were significantly lower in the 2 groups compared to the preoperative MMSE scores (P < .05). The MMSE scores of the NBS group were higher than the BS group on the 1st and 3rd days postoperatively (P < .05). CONCLUSION:In elderly patients undergoing surgery, intraoperative BS significantly reduced cerebral oxygen metabolism, which temporarily affected postoperative neurocognitive function.

Objective:To explore whether intrathecal transplantation of mesenchymal stem cell (MSC) inhibits the expression of receptor interacting protein kinase 1 (RIPK1) in the spinal cord of rats with ischemia reperfusion injury and promotes neural repair.Methods:A spinal cord ischemia reperfusion injury (SCII) model of SD rats was established. According to the random number table method, 50 rats were divided into five groups ( n=10): a sham-operated (Sham) group, a control (Con) group, a PBS group, a necrostatin-1 (Nec-1) group and a MSC group. In the Sham group, the abdominal aorta of rats was exposed before immediate closure of the abdomen without abdominal aorta occlusion. In the Con group, no intrathecal treatment was performed after SCII. For the PBS group, an equal-volume of PBS was intrathecally injected after SCII. Rats in the Nec-1 group were intravenously injected Nec-1 after SCII. For the MSC group, MSC were intrathecally injected after SCII. Then, the cell markers CD29, CD90, CD34 and CD45 on the surface of MSC were identified by flow cytometry. The second day after SCII, Bisobiti Bresnahan lower extremity motor function score and lower extremity sensory evoked potential were used to monitor the spinal cord nerve function. The number of RIPK1 neurons in the spinal cord was observed by immunohistochemistry and the level of RIPK1 protein in the spinal cord was detected by Western blot. Results:The expression rate was 100% for CD29, 99.6% for CD90, 0.7% for CD34 and 1.0% for CD45. Compared with the Sham group, the Con, PBS, Nec-1 and MSC groups showed decreases in the lower limb motor function score, increases in the number of RIPK1 positive neurons in the spinal cord and the content of spinal cord RIPK1 protein, prolonged P1 and N1 latency of SSEP, and decreased wave amplitude ( P<0.05). Compared with the Con group, the Nec-1 and MSC groups presented increases in the lower limb motor function score, decreases in the number of RIPK1 positive neurons in the spinal cord and the content of spinal cord RIPK1 protein, shortened P1 and N1 latency of SSEP and increased wave amplitude ( P<0.05). Compared with the Nec-1 group, the MSC group showed increases in the lower limb motor function score, the number of RIPK1 positive neurons in the spinal cord and the content of RIPK1 protein in the spinal cord, shortened P1 and N1 latency of SSEP, and increased wave amplitude ( P<0.05). Conclusion:Intrathecal transplantation of MSC may promote the repair of nerve function by inhibiting the expression of RIPK1 in the injured spinal cord after ischemia reperfusion.

目的:针对右侧上肢手术老年患者行超声引导下锁骨上复合锁骨下臂丛神经阻滞,观察患者膈肌功能变化情况.方法:选取我院接受右侧上肢手术的60例患者,年龄65～79岁,ASAⅡ～Ⅲ级并通过简单随机分为两组.S组(锁骨上臂丛神经阻滞组)行超声引导下锁骨上臂丛神经阻滞,注射0.33％的罗哌卡因30 mL;C组(锁骨上复合锁骨下臂丛神经阻滞组)在超声引导下先行锁骨上臂丛神经阻滞,注射0.33％的罗哌卡因10mL,后行锁骨下臂丛神经阻滞,注射0.33％的罗哌卡因20mL.对两组神经根感觉与运动阻滞时间进行观察记录,并组间对比,随访患者有无不良反应,判断类型,比较两组发生率的高低.对阻滞前后患者右侧膈肌移动幅度(平静呼吸与用力呼吸状态下)予以M型超声测量,并依据膈肌移动幅度对患者膈肌麻痹情况进行判断,对比两组膈肌麻痹程度.结果:研究中发现在运动阻滞起效时间方面,S组所需时间短于C组(P<0.05),而在感觉阻滞起效与持续时间、运动阻滞持续时间显示两组差异不大.但两组在阻滞后30min,当处于平静呼吸和深呼吸状态下,右侧膈肌麻痹率S组明显高于C组(P<0.05).结论:超声引导下锁骨上复合锁骨下臂丛神经阻滞可以为老年上肢手术提供良好的麻醉同时降低同侧膈肌麻痹的发生率.

We report the preparation of gallic acid (GA)-modified MoS2 nanosheets (MoS2@GA) with high Fe(III) loading. The MoS2@GA-Fe can function as a "Fenton Nanoreactor" in the tumor microenvironment (TME), in which GA-Fe(III) can be reduced to GA-Fe(II) by glutathione (GSH) and amounts of reactive hydroxyl radicals (center dot OH) are generated during the Fenton reaction. Notably, the MoS2 degrades into small fragments during the process, and more Mo(IV) reaction sites are exposed on the surface, resulting in a "snowball effect" and enhanced center dot OH production. Furthermore, unsaturated S atoms can capture protons in the TME and form hydrogen sulfide (H2S). We combined the photoacoustic imaging and magnetic resonance imaging contrast properties of MoS2@GA-Fe and constructed an imaging-guided chemodynamic treatment, featuring excellent antitumor efficiency and biosafety. The TME-responsive "Fenton Nanoreactor" provides a promising strategy with enhanced translational potency for tumor therapy.

目前公认的经典大麻素受体至少有CB1和CB2两种.CB1参与了中枢神经系统的镇痛机制,却也介导了大麻素的精神副作用[1],主要在中枢神经系统神经元中表达.CB2主要表达于外周免疫细胞上[2].CB2作为CB1的另外一种镇痛选择,在组织或者神经损伤后表达上调,能够产生明显的镇痛作用而不会引起精神副作用,但是CB2的组织分布细胞亚型以及介导的镇痛机制仍然是具有争议的.这将直接影响其临床应用前景,作者将对以上相关问题进行系统的分析和综述.

目的:探讨超声引导肋间臂神经阻滞联合臂丛、锁骨上神经阻滞在肱骨近端手术中的临床麻醉效果.方法:择期行肱骨近端手术患者100例,随机分为超声引导下神经阻滞组(超声引导组)和常规手法神经阻滞组(对照组),每组50例,超声引导组患者麻醉方式选择超声引导肋间臂神经阻滞联合臂丛、锁骨上神经阻滞,对照组患者行解剖标志定位的臂丛神经阻滞和颈浅丛阻滞,记录两组神经阻滞操作时间,神经阻滞起效时间,神经阻滞完善时间,持续时间,麻醉完善例数、不完善例数,麻醉方式更改例数,麻醉并发症.结果:两组神经阻滞操作时间无明显差异,超声引导组麻醉起效时间明显短于对照组,阻滞成功率明显高于对照组,持续时间无明显差异;麻醉完善例数超声引导组96％,对照组60％,对照组40％需辅助静脉麻醉或切口区域局部麻醉,两组均无麻醉更改例数;超声引导组并发症发生率明显低于对照组.结论:肱骨近端手术,超声引导肋间臂神经阻滞联合臂丛、锁骨上神经阻麻醉效果完善,值得临床推广.

Objective:To observe the effects of serratus anterior plane block (SAPB) and subcostal transversus abdominis plane block (TAPB) on patient-controlled intravenous analgesia (PCIA) in patients undergoing thoracoscopic and laparoscopic esophagectomy (TLE).Methods:Sixty-two adult patients undergoing selective TLE in Zhongshan Hospital of Xiamen University, from October 2018 to October 2019, both sexes, aged 40-70 years old, ASA Ⅰ or Ⅱ, were randomly assigned to PCIA group (group C), and SAPB+TAPB+PCIA group (group ST) by random number table, 31 cases in each group. Patients were received ultrasound guidance of SAPB with 0.25% ropivacaine 30 ml and bilateral subcostal TAPB with 0.25% ropivacaine 10 ml at 2 points preoperatively in group ST, while patients were not received these nerve blocks in group C. All patients were received general anesthesia and PCIA. The levels of warmth sense loss were recorded 30 min later. The incidence of postoperative agitation in PACU was recorded. Visual analogue score (VAS) at rest and cough was evaluated at 2, 4, 8, 12, 24 and 48 hous after the operation. The bolus time of PCIA and the dosage of sufentanil during 0-24 hous and 0-48 hous were recorded. The adverse reactions were also recorded.Results:The levels of warmth sense loss were T 3-T 11 in SAPB, and T 6-T 10 in TAPB. VAS and the cases of VAS<3 were significantly lower in group ST than those in group C at 2, 4, 8, 12, 24 hous after the operation (all P<0.05). The incidence of postoperative agitation, nausea and vomiting, times of bolus[(1.13±0.15) vs. (26.02±0.51), (3.06±1.27) vs. (49.01±2.62)] times and the dosage of sufentanil[(62.5±3.3) vs. (87.6±1.8), (126.6±6.5) vs. (160.8±7.8)] μg were significantly less in group ST than those in group C at 24, 48 hous respectively (all P<0.05). No adverse reactions such as severe hypotension, hematoma, respiratory depression were found. Conclusions:Compared with only PCIA, the ultrasound-guided SAPB and TAPB combined with PCIA can provide effective analgesia, reduce opioid consumption and relieve the early postoperative agitation after thoracoscopic and laparoscopic esophagectomy.

目的 在以血浆靶控输注丙泊酚的背景下,分析纳布啡抑制宫腔镜手术患者喉罩置入反应的半数有效剂量(ED50).方法 选择择期行全麻宫腔镜手术患者21例,年龄18～60岁,BMI 19～27 kg/m2,ASAⅠ或Ⅱ级.麻醉诱导采用丙泊酚血浆靶控输注,靶控浓度3.0μg/ml.当效应室浓度与血浆浓度平衡一致时,缓慢静推纳布啡,初始剂量为0.2 mg/kg.注射结束5 min且BIS 50～60时,置入喉罩.采用序贯法确定纳布啡剂量,若置入喉罩时出现阳性反应,下一例患者选用高1个梯度的剂量;反之,则选用低1个梯度的剂量.相邻剂量的比值为1.1.计算靶控输注丙泊酚的背景下,纳布啡抑制喉罩置入反应的ED50和ED95以及各自的95％可信区间(CI).结果 纳布啡抑制宫腔镜手术喉罩置入反应的ED50为0.145 mg/kg(95％CI 0.125～0.165 mg/kg),ED95为0.163 mg/kg(95％CI 0.153～0.417 mg/kg).结论 靶控丙泊酚背景下,纳布啡抑制成年宫腔镜手术患者喉罩置入反应的ED50为0.145 mg/kg(95％CI 0.125～0.165 mg/kg).

目的:观察胃镜喉罩联合低剂量瑞芬太尼全麻在内镜逆行胰胆管造影(ERCP)中的可行性和安全性.方法:选择拟行ERCP的患者80例,随机均分为对照组和观察组,对照组在静脉全麻下手术,观察组在胃镜喉罩联合瑞芬太尼全麻下手术.并记录两组患者进镜前(T0)、内镜通过咽喉后(T1)、进入或切开Oddis括约肌(T2)、术毕(T3)时的平均动脉压(MAP)、心率(HR);观察围麻醉期不良反应、清醒时间、手术时间及手术医生的满意度.结果:两组在T0时刻MAP、HR相比无明显差异(P>0.05);观察组在T1、T2、T3时刻MAP、HR明显低于对照组(P<0.05);观察组不良反应发生率低于对照组,手术时间、清醒时间短于对照组,手术医生的满意度也明显高于对照组,差异均有统计学意义(P<0.05).结论:胃镜喉罩联合低剂量瑞芬太尼全麻可安全应用在内镜逆行胰胆管造影中,麻醉效果显著,值得推广.

目的 观察超声引导下菱形肌-肋间肌-低位前锯肌(RISS)平面阻滞对腹腔镜肾切除术患者术后镇痛的影响.方法 择期行腹腔镜肾切除术患者40例,男19例,女21例,年龄25～65岁,ASAⅠ或Ⅱ级,随机分为单纯全麻组(C组)和全麻联合RISS平面阻滞组(T组),每组20例.T组在麻醉诱导前行超声引导下患侧RISS平面阻滞,注射0.25％罗哌卡因30 ml,C组不行RISS平面阻滞.两组患者手术后均行PCIA.观察术后1、6、12、24、48 h静息及活动时VAS疼痛评分以及舒芬太尼用量、镇痛泵有效按压次数,记录术后48 h内不良反应或并发症情况.结果 T组术后1、6、12、24 h的静息和活动时VAS疼痛评分明显低于C组(P<0.05),舒芬太尼用量和镇痛泵有效按压次数明显少于C组(P<0.05).两组均未观察到气胸、局麻药中毒、血肿、严重低血压等并发症.结论 诱导前RISS平面阻滞可有效提高腹腔镜肾切除术后静脉自控镇痛的效果.

目的 探讨右美托咪定联合舒芬太尼超前镇痛用于上腹部手术的临床效果.方法 选取医院2016年8月至2018年8月收治拟行上腹部手术的患者103例,按随机数字表法分为对照组(51例)和研究组(52例).对照组患者麻醉中予枸橼酸舒芬太尼注射液超前镇痛;研究组患者麻醉中予盐酸右美托咪定注射液联合枸橼酸舒芬太尼注射液超前镇痛.结果 与麻醉前(T0)比较,对照组患者术后2 h(T1)、术后4 h(T2)、术后6 h(T3)、术后12 h(T4)的心率(HR)均显著升高,收缩压(SBP)、舒张压(DBP)均显著降低(P<0.05);与对照组比较,研究组患者T1～T4的HR均显著降低,SBP和DBP均显著升高(P<0.05),T3、T4、术后24 h(T5)、术后48 h(T6)Bruggrmann舒适评分(BCS)和Ramsay镇静评分(RSS)均显著升高(P<0.05),视觉模拟评分(VAS)显著降低;与T0比较,两组患者T5的皮质醇(Cor)、肾上腺素(E)和去甲肾上腺素(NE)水平均显著升高,但研究组显著低于对照组(P<0.05);对照组与研究组患者不良反应发生率相当(27.45％比15.28％,χ2=2.233,P=0.135>0.05).结论 右美托咪定联合舒芬太尼超前镇痛应用于上腹部手术,镇静、镇痛效果较佳,可稳定患者的血流动力学,减轻应激反应,患者术后舒适度明显提升.

目的:评价侧卧位斜轴面超声引导颈内静脉穿刺置管的可行性及临床效果.方法:选择需要颈内静脉穿刺置管的手术患者100例,将患者随机分入平卧位斜轴面组,侧卧位斜轴面组,每组50例.记录并比较两组穿刺次数、一次穿刺成功例数、穿刺成功例数、穿刺失败例数、穿刺时间,以及穿刺并发症的发生情况,记录操作者穿刺过程的舒适度.结果:两组穿刺时间、穿刺次数、一次穿刺成功例数、穿刺成功例数和穿刺失败例数、穿刺并发症发生率比较,差异均无统计学意义(P>0.05);操作舒适度方面,侧卧位操作者舒适度更好.结论:超声引导下侧卧位斜轴面颈内静脉穿刺置管方法简单易操作,相比平卧位操作舒适度上更具有优势,临床操作可行性好,值得临床推广.

目的 探讨超声引导右美托咪定复合罗哌卡因竖脊肌平面阻滞对胸腔镜手术患者疼痛的控制效果.方法 选取我院2017年6月至2018年9月择期胸腔镜手术的90例患者为研究对象,按照数字表法随机分为右美托咪定组(D组)、罗哌卡因组(R组)和对照组(C组),每组30例.三组均在术前行超声引导T5横突竖脊肌平面(Erector spinae plane,ESP)阻滞,D组给予1μg/kg右美托咪定复合0.4％罗哌卡因共25 ml,R组给予0.4％罗哌卡因25 ml,C组给予等量生理盐水,三组术后均连接静脉镇痛泵.记录三组患者术中血液动力学指标变化,术后静息时、咳嗽时VAS评分,记录三组患者镇痛药用量、镇痛泵有效按压次数与实际按压次数比(D1/D2)及不良反应.结果 与C组相比,D组和R组胸腔镜置入前后血流动力学变化更为平稳;三组术后2、6、12、24、36、48 h静息VAS评分和咳嗽VAS评分变化差异有统计学意义(P＜0.05),D组变化更平稳,镇痛效果较好;与R组和C组比较,D组患者术后48 h舒芬太尼用量显著减少(P＜0.05),D1/D2显著增高(P＜0.05).D组术后恶心发生率低于R组、C组,术后呕吐发生率显著低于C组,差异均有统计学意义(P＜0.05).结论 胸腔镜手术术前超声引导右美托咪定复合罗哌卡因ESP阻滞,术中血流动力学更平稳,术后患者疼痛控制的效果更好,并发症更少,值得临床推广.

目的 观察超声引导下腹股沟韧带上髂筋膜阻滞在高龄患者股骨近端防旋髓内钉(PFNA)内固定术的应用效果.方法 选择2017年6-12月我院择期行PFNA内固定术的老年患者50例,将患者随机分为髂筋膜阻滞组(F组,0.25％罗哌卡因30 ml,25例)与生理盐水组(C组,生理盐水30 ml,25例).全麻前于超声引导下行腹股沟韧带上髂筋膜阻滞,根据分组情况单次注射等量药液或生理盐水,随后进行喉罩全麻.术后采用持续静脉患者自控镇痛(Patient controlled analgesia,PCA)至术后48 h.记录患者一般情况、手术时间及术中麻醉药物用量.记录术后4、8、12、24 h静息和运动VAS评分,评估镇痛效果.同时记录各时间点患者自控镇痛舒芬太尼累计用量.记录恶心呕吐、瘙瘁、低氧血症、镇静过度等术后镇痛相关不良反应发生情况.记录术后48 h患者麻醉镇痛满意度评分.结果 两组患者一般情况、术前静息疼痛评分、手术时间比较差异均无统计学意义(P＞0.05).F组患者的丙泊酚用量和瑞芬太尼用量明显减少,与C组比较差异有统计学意义(P＜0.05).F组患者术后各时间点的静息和运动VAS评分均低于C组,其中术后4h与24 h的静息VAS评分比较差异有统计学意义(P＜0.05),术后8h与12h的运动VAS评分比较差异有统计学意义(P＜0.05).与C组相比,F组阻滞后各时间点累计舒芬太尼用量明显减少(P＜0.05).两组患者首次使用PCA时间、48 h患者满意度比较差异有统计学意义(P＜0.05),不良反应发生率比较差异无统计学意义(P＞0.05).C组有3例(20％)、F组有1例(4％)患者经历了至少1次术后恶心呕吐.结论 对拟行PFNA的高龄患者,采用超声引导下腹股沟韧带上入路髂筋膜阻滞复合喉罩全身麻醉方法,能减少麻醉药物用量,提供有效的术后镇痛,降低麻醉相关并发症发生率.

Objective To observe the anesthetic effect of ultrasound guided lateral approach and modified medial approach costoclavicular space (CCS) brachial plexus block. To evaluate the clinical value of CCS via modified medial approach and to explore a new approach for brachial plexus block. Methods Sixty cases scheduled for forearm and hand surgeries were divided into the lateral approach CCS group (group C) and the modified medial approach CCS group (group M) by random number table, 30 cases in each group. Both groups were treated with 0.5% ropivacaine 20 ml for CCS brachial plexus block. The performance block time, the onset of block time and the duration of block time were recorded. The degrees of sensory and motor blockade were assessed at 30 min after anesthetic injection. Also, the adverse reactions were observed. Results The anesthesia performance block time of group M was shorter than that of group C (P<0.05). The onset and maintenance time of anesthesia and the degree of sensory and motor blockade after the injection 30 min in two groups were similar (P>0.05). There was no adverse reaction in both groups. Conclusions The modified medial approach CCS can be safely used for brachial plexus block, which is easier to operate.

目的 评价超声引导下外周神经阻滞在血管外科老年危重患者下肢截肢手术的麻醉效果.方法 选择2016年6月—2018年12月本院收治的择期行截肢手术老年危重患者30例,ASAⅢ或Ⅳ级,采用超声引导下髂筋膜阻滞、闭孔神经总支阻滞、骶丛阻滞,分别给予0.3％罗哌卡因30 ml、10 ml、20 ml.记录患者麻醉前(T0)、麻醉后15分钟(T1)、30分钟(T2)、手术开始时(T3)和手术结束时(T4)SBP、DBP和HR的变化.观察患者感觉和运动阻滞的起效时间、持续时间,评价神经阻滞效果.结果 与T0相比,T1～4各时点SBP、DBP和HR差异无统计学意义(P>0.05),所有患者均获得满意的外周神经超声成像,并顺利完成神经阻滞,感觉起效时间(7.5±2.2)min,维持时间(640±60)min;运动起效时间(15.0±3.2)min,维持时间(450±56)min.25例(83.3％)神经阻滞效果为Ⅰ级,5例(16.7％)效果为Ⅱ级.所有患者未出现明显的麻醉并发症.结论 超声引导外周神经阻滞,具有血流动力学稳定、镇痛完善持久和并发症少等优点,用于血管外科老年危重患者的下肢截肢手术是安全可行的,能够满足外科手术要求.

目的 观察右美托咪定-罗哌卡因混合液选择性颈神经根阻滞对肩关节镜手术术后镇痛效果的影响及安全性分析.方法 选取厦门大学附属中山医院择期行肩关节镜手术患者60例,ASAⅠ或Ⅱ级,随机分为右美托咪定-罗哌卡因混合液组(DR组)和罗哌卡因组(R组),每组30例.两组均于术前30 min行C5、C6神经根阻滞,DR组每个神经根分别予以右美托咪定0.5μg/kg复合0.5％ 罗哌卡因混合液共4 ml,R组每个神经根分别予以0.5％ 罗哌卡因4 ml.所有患者均复合喉罩全身麻醉.记录感觉、运动阻滞起效时间及感觉、运动阻滞持续时间;记录术后不同时间点的视觉模拟评分(VAS评分);记录术后48 h纳布啡补救镇痛的用量;记录患者满意度和不良反应情况.结果 DR组感觉、运动阻滞起效时间短于R组(P<0.05);DR组感觉、运动阻滞持续时间较R组长(P<0.05);DR组术后12、18、24和36 h的VAS评分及术后48 h纳布啡用量较R组低(P<0.05);与R组比较,DR组术后满意度较高(P<0.05);DR组有2例发生心动过缓,两组呼吸困难、声音嘶哑等不良反应差异无统计学意义(P>0.05).结论 右美托咪定-罗哌卡因混合液颈神经根阻滞能明显缩短神经阻滞起效时间,延长肩关节镜手术术后镇痛时间,减少术后镇痛药物的用量,可在肩关节镜手术镇痛中安全运用.

目的:探讨超声引导下前锯肌平面阻滞(serratus anterior plane block,SAPB)复合腹直肌切口局部浸润在胆管结石开腹手术中的临床应用效果.方法:40例择期行胆管结石开腹切除手术患者,随机分为观察组(R组)和对照组(C组),每组20例.R组手术结束关腹前给予腹直肌切口局部浸润,给予0.25％罗哌卡因20 ml,关腹后给予超声引导下前锯肌平面阻滞,给予0.25％罗哌卡因30 ml,接静脉镇痛泵.C组仅给予静脉镇痛泵.记录两组患者术后2、6、12、24、36、48 h视觉模拟评分(VAS)、术后48 h止痛泵按压次数及镇痛满意度;记录两组患者术后不良反应发生情况.结果:与C组相比,R组患者术后2、6、12、24 h VAS评分均低于C组,差异均有统计学意义(P<0.05),镇痛满意度更高(P<0.05);在术后0～2、2～6、6～12、12～24 h R组患者单次使用PCIA次数显著低于C组(P<0.05);两组术后恶心、呕吐、头晕、呼吸抑制发生率比较差异无统计学意义(P>0.05).结论:超声引导下前锯肌平面复合腹直肌切口局部浸润联合静脉镇痛泵与单纯静脉镇痛泵相比,术后24 h镇痛效果好,患者满意度高,是一种值得推荐的麻醉镇痛方式.

目的 探讨超声引导下锁骨上臂丛神经阻滞复合胸壁神经阻滞在尿毒症患者肘上动静脉瘘成形术中的临床应用效果.方法 选择2017年8月至2018年4月在厦门大学附属中山医院行肘上动静脉瘘成形术的尿毒症患者60例,按随机数表法分成两组,每组30例.分别在超声引导下给予锁骨上臂丛神经阻滞(S组)和锁骨上臂丛神经阻滞复合胸壁神经阻滞(C组),比较两组患者的麻醉效果.结果 C组患者动、静脉血管内径均大于S组,差异有显著性(P<0.05);C组术后6h内瘘血管血流量高于S组,差异有显著性(P<0.05);两组患者血栓形成率差异无显著性(P>0.05).C组术中视觉模拟评分法(visual analogue scale,VAS)评分低于S组,差异有显著性(P<0.05);两组患者术后VAS评分均较术中明显改善,且C组明显低于S组,差异有显著性(P<0.05);C组手术时间短于S组,差异有显著性(P<0.05).结论 超声引导下锁骨上臂丛神经阻滞复合胸壁神经阻滞的麻醉效果好,可有效缩短手术时间,缓解疼痛程度.