目的 探讨持续静脉镇痛对食管癌手术患者苏醒质量及早期认知功能的影响.方法 选择2016年1月至2018年12月在南通大学附属肿瘤医院择期行食管癌手术患者46例,随机分为硬膜外镇痛组(A组)和持续静脉镇痛组(B组).比较2组视觉模拟量表(VAS)评分、布鲁格曼舒适量表(BCS)评分、术后恢复质量15项量表(QoR-15)评分等指标.结果 2组术毕自主呼吸恢复时间、苏醒时间、拔管时间、Steward苏醒评分达到6分时间比较,差异均无统计学意义(P>0.05).B组拔管后24、48、72 h苏醒期Ramsay镇静评分优于A组,差异均有统计学意义(P<0.05).B组术后谵妄、认知功能障碍、苏醒期间躁动及镇痛引起的不良反应(皮肤瘙痒除外)发生率优于A组,差异均有统计学意义(P<0.05).B组静息及运动时VAS、BCS评分及QoR-15评分优于A组,差异均有统计学意义(P<0.05).结论 食管癌手术患者行持续静脉镇痛可有效改善患者苏醒质量,降低术后谵妄、认知功能障碍、苏醒期间躁动及镇痛引起的不良反应发生率,有利于患者早期下床活动,可提高患者治疗满意度及舒适度.

目的 探究针对行胸腔镜下肺癌根治术的患者,施以右美托咪定复合羟考酮对其术后自控静脉镇痛的重要影响.方法 抽取2018年7月～2020年7月期间,我院接诊的60例胸腔镜下肺癌根治术患者,应用随机数字表法进行划分,对照组(羟考酮)与观察组(右美托咪定复合羟考酮)各30例,对比分析两组的VAS评分及不良反应发生率.结果 观察组各个时间点的VAS评分同比对照组均明显处于更低水平(P＜0.05);观察组10.00%(3/30)的不良反应发生率远低于对照组(P＜0.05),差异具有统计学意义.结论 将右美托咪定复合羟考酮有效施以行胸腔镜下肺癌根治术的术后患者,相比羟考酮的单独应用,患者自控静脉镇痛效果更佳且不良反应发生率更低,值得临床积极采纳并加以大力推广.

目的 探讨丙泊酚复合酮咯酸氨丁三醇麻醉用于无痛人工流产(人流)手术患者的临床效果.方法 无痛人流手术患者180例,随机均分为三组,采用丙泊酚中/长链脂肪乳注射液分别复合酮咯酸氨丁三醇30 mg(麻醉诱导前30 min静脉注射,A组)、雷米芬太尼(B组)或氯胺酮(C组)麻醉.记录麻醉前、麻醉后患者的MAP、HR、RR、SpO2.观察术中呼吸抑制和术中肢动发生情况;计算丙泊酚用量及意识恢复时间;术后询问患者对手术操作过程有无记忆和术毕30 min有无宫缩痛.结果 三组患者镇痛均满意.A、C两组术中MAP、HR、RR、SpQ平稳;B组术中MAP、HR、RR、SpO2均低于麻醉前(P＜0.05).A组患者无术中一过性呼吸抑制,亦无术后宫缩痛病例;B组患者术中均有一过性呼吸抑制,术后官缩痛45例(75℃),C组仅有2例(3℃)发生一过性呼吸抑制.C组术毕意识恢复时间长于A、B两组[(15.21±0.97)min in vs.(7.19±1.05) min、(7.11±1.04) min](P＜0.05).结论 丙泊酚复合酮咯酸氨丁三醇用于无痛人流手术是一种良好的选择.

Objective To observe the effect of dexmedetomidine on the quality of recovery from general anaesthesia in the patients undergoing thoracic surgeries .Methods Sixty patients undergoing thoracic surgeries were equally randomized into three groups ,who anesthetized with same drugs and managements .During operation ,the patients were infused dexmedetomidine 0.2μg?kg-1 ?h-1 (group D1) ,0.4μg?kg-1 ?h-1 (group D2) or normal saline(group C) until the end of operation .The quality of recovery from general anaesthesia was evaluated and compared among three groups .Results The incidence of postoperative agitation was significantly lower in groups of D 1 and D2 than that in group C(P<0 .05) .The time for the patients to get the Steward recovery score of 6 points was shorter in group D1 than that in groups of C and D2(P<0 .05) .Compared to groups of C and D1 ,the times for the recovery of spontaneous breathing ,awakening and extubation in group D2 were longer(P<0 .05) . The Ramsay sedation score at 2 hours after extubation was better in group D1 than that in groups of C and D2 ( P<0 .05 ) .Conclusion Infusion of low-dose dexmedetomidine during operation may effectively improve the quality of recovery from general anaesthesia in the patients undergoing thoracic surgeries .