目的 观察超声引导低位前锯肌平面阻滞(SSPB)对胃癌根治术后炎症及康复的影响.方法 采用随机数字表法将2018年5月至2019年12月该院收治的80例择期行胃癌根治术患者分为C组(单纯全身静脉麻醉)和SSPB组(全身麻醉复合SSPB),每组40例.SSBP组在麻醉诱导后行超声引导双侧腋中线第8肋水平型前锯肌平面阻滞,分别注入0.25％罗哌卡因,每侧各30 mL.两组均采用全身麻醉气管插管,术毕均给予患者自控静脉镇痛.记录两组患者术中芬太尼、瑞芬太尼用量;测定两组患者术前,术后1、3 d C反应蛋白(CRP)水平及中性粒细胞计数;记录两组患者术后24、48 h视觉模拟疼痛量表(VAS)评分,恶心、呕吐发生次数,术后镇痛泵有效按压次数及补救镇痛例数;记录两组患者首次排气时间、住院时间及术后不良反应发生情况;记录两组患者术前、术后3 d恢复质量.结果 SSBP组患者术中瑞芬太尼用量明显低于C组,差异有统计学意义(P<0.05);两组患者术后1、3 d CRP水平及中性粒细胞计数均明显升高,但SSBP组患者术后1、3 d CRP水平及中性粒细胞计数明显低于C组,差异均有统计学意义(P<0.05);与C组比较,SSPB组患者术后24 h VAS评分明显降低,术后24、48 h内有效按压次数、术后48 h内镇痛补救发生率均明显减少,术后首次排气时间明显缩短,差异均有统计学意义(P<0.05);但两组患者术后48 h VAS评分、住院时间、术后不良反应发生率比较,差异均无统计学意义(P>0.05).SSBP组患者术后3 d术后恢复质量QoR-40量表总分及各系项目评分均明显高于C组.结论 超声引导SSPB可降低胃癌根治术患者术后CRP水平及中性粒细胞计数,改善机体的炎性反应及术后疼痛,提高患者术后早期恢复质量.

Objective:To observe the effects of ultrasound-guided transverse abdominal muscle plane block (TABP) on neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) in the peripheral blood of patients undergoing radical gastrectomy.Methods:A total of 100 patients who were scheduled for radical gastrectomy were selected. According to the random number table method, they were randomly divided into two groups ( n=50): a TAPB combined with general anesthesia group (group TAP+GA) and a general anesthesia group (group GA). Group TAP+GA and group GA underwent ultrasound-guided TABP assisted with general anesthesia, and routine general anesthesia, respectively. Both groups were compared for operation time, anesthesia time, blood loss, and the dosages of fentanyl and remifentanil. Their counts of neutrophils, platelets and lymphocytes, NLR and PLR in the peripheral blood were recorded before and 24 h and 72 h after surgery. Their Visual Analogue Scale (VAS) scores 24 h and 48 h after operation, adverse reactions and the length of hospitalization stay were recorded. Results:There were no significant differences in operation time, anesthesia time, blood loss and fentanyl dosage between the two groups. Compared with group GA, the dosage of remifentanil in group TAP+ GA was significantly reduced ( P<0.05). There were no statistical differences in the counts of neutrophils, platelets and lymphocytes, PLR and NLR in the peripheral blood between the two groups ( P>0.05). Compared with group GA, group TAP+GA presented remarkably reduced counts of neutrophils in the peripheral blood 24 h and 72 h after operation ( P<0.05). There were no statistical differences in the counts of lymphocytes and platelets and PLR between the two groups 24 h and 72 h after operation ( P>0.05). No statistical difference was found in the value of NLR between the two groups 24 h after operation ( P<0.05). The value of NLR in the peripheral blood of group TAP+GA was significantly lower than that in group GA 72 h after operation ( P>0.05). The VAS score 24 h and 48 h after operation in group TAP+GA were lower than that in group GA ( P<0.05). Postoperative nausea and vomiting were significantly reduced in group TAP+GA, compared with group GA ( P<0.05). There were no statistical differences in the length of hospitalization stay, postoperative pulmonary infection, anastomotic fistula, and postoperative intestinal obstruction between the two groups ( P>0.05). Conclusions:Ultrasound-guided TABP assisted general anesthesia is useful for reducing the counts of neutrophils and NLR in patients. It also improves postoperative pain, and reduces the occurrence of postoperative nausea and vomiting.

Objective To study and analyze the effect of psychological nursing in operating room on patients undergoing elective general anesthesia. Methods A total of 120 patients who received elective general anesthesia in our hospital from October 2020 to October 2021 were selected as the observation objects of this study. According to the computer randomized method, the patients were divided into study group and control group, with 60 patients in each group. The score of symptom check list-90 (SCL-90) and the influence of stress response (heart rate, systolic blood pressure, diastolic blood pressure and blood biochemical indexes) were compared and analyzed between the two groups. T test was used for normal measurement data. Results There was no significant difference in SCL-90 scores between the two groups after nursing (P＞0.05). There were no significant differences in heart rate and blood pressure between the two groups 1 day before surgery (P＞0.05). The heart rate and blood pressure of the study group were significantly better than those of the control group before entering the operating room and anesthesia (P＜0.05). There were no significant differences in adrenocortical hormone, blood glucose, norepinephrine concentration and epinephrine concentration between the study group and the control group on the day of admission (P＞0.05). At 30 min and 2 h after surgery, the concentrations of adrenocortical hormone, blood glucose, norepinephrine and epinephrine in the study group were significantly lower than those in the control group (P＜0.05). Conclusion Intensive psychological nursing on the basis of routine operation nursing is beneficial to reduce the body stress response of patients undergoing elective general anesthesia.

目的 探讨血清中性粒细胞/淋巴细胞比值(NLR)预测老年胃癌根治术患者术后认知功能障碍(POCD)的价值.方法 选择择期行胃癌根治术患者100例,男67例,女33例,年龄≥65岁,ASA Ⅱ或Ⅲ级.患者手术均在气管插管全麻下进行,在术前及术后第7天通过Z计分法评估患者认知功能,根据评分结果将患者分为两组:POCD组和NPOCD组.记录术前1 d、术后1、3 d血清中NLR的变化.应用受试者工作特征(ROC)曲线,分析各时点血清NLR对老年胃癌根治术患者发生POCD的预测价值.结果 术后7 d发生POCD患者22例(22％).与术前1 d比较,术后1、3 d两组NLR明显升高(P＜0.05).术后1、3d POCD组血清NLR明显高于NPOCD组(P＜0.05).术后3 d血清中NLR预测老年胃癌根治术患者发生POCD的最佳界值为6.986,预测POCD发生的AUC为0.818(95％CI 0.728～0.888),敏感性和特异性分别为88.5％和68.2％,高于术后1 d NLR的AUC为0.799(95％CI 0.707～0.872).结论 老年胃癌根治术患者术后3 d NLR对术后7 d POCD发生的预测价值较高,血清中NLR的升高可能与术后POCD的发生相关,术后NLR升高是发生POCD的危险因素.

Objective To observe the effects of ulinastatin conbined with dexmedetomidine (Dex) on early postoperative cognitive function in elderly patients undergoing esophageal cancer operations.Methods Sixty patients (ASA Ⅰ-Ⅲ,aged 65-84 y) scheduled for surgeries for esophageal cancer were randomized into intervention group (group Ⅰ,n=30) and control group (group Ⅱ,n=30).After intravenous induction and tracheal intubation,the patients in the intervention group Ⅰ were infused intravenously 2×105 U ulinastatin in 100 ml normal saline in 30 min and Dex 0.5 μg·kg-1·h-1 to 30 min before end of the operation,the patients in group Ⅱ received the same volume of saline infusion only.Comprehensive neuro-psychological tests were performed at day 1 before and day 1,3 after operation to assess preopereative cognitive function of patients.Peripheral artery blood was extracted to determine levels of serum S-100β protein,neuron-specific enolase(NSE) and IL-6 with ELISA before anesthesia induction(T0),at the end of the surgery (T1),and at day 1 (T2) and day 3 (T3) after operation.Results The difference between the test scores before and after the operation (X values) was significantly smaller in the group Ⅰ than in the group Ⅱ (P＜0.05).The group Ⅰ showed a significantly lower incidence rate of postoperative cognitive dysfunction (POCD) than the group Ⅱ (6.7％ vs 30.0％,P＜0.05).Compared with the group Ⅱ,the group Ⅰ exhibited significantly lower serum levels of S-100β protein,NSE and IL-6 at T1 (P＜0.05),significantly lower NSE and IL-6 levels at T2 (P＜0.05) time point,and significantly lower IL-6 level at T3 (P＜0.05).Conclusions Intravenous injection of ulinastatin and Dex during the operation can reduce the incidence of POCD in elderly patients undergoing surgeries for esophageal tumors possibly in relation to decreased serum S-100β,NSE and IL-6 levels.

目的 探讨长期接触亚麻醉浓度氟烷、七氟烷、地氟烷对大鼠学习记忆的影响.方法 将40只SD大鼠分为4组,分别为对照组、氟烷组、七氟烷组、地氟烷组,每组10只.对照组给予吸入氧气3 L/min,其余3组除给予吸入氧气3 L/min外,分别给予吸入体积分数0.1％氟烷、体积分数0.3％七氟烷、体积分数0.6％地氟烷,每天9:00-13:00给予吸入,持续30 d后进行孔板实验测试、Morris水迷宫测试,观察4组大鼠在孔板测试中5 min内头部进入洞板次数、探索时间,定位航行实验潜伏期和空间探索实验60 s内通过平台位置次数.结果 氟烷组、七氟烷组、地氟烷组大鼠头部进入洞板次数((6.8±3.2)、(7.3±3.6)、(5.8±2.7)次)、探索时间((86.4±26.3)、(97.1±33.2)、(144.5±42.8)s)和60 s内通过平台次数((4.6±1.2)、(4.8±1.7)、(3.3±0.9)次)明显少于对照组((11.3±3.8)次、(246.2±53.7)s、(9.2±3.3)次)(P＜0.05或P＜0.01),到达平台潜伏期((44.1±9.2)、(47.7±9.8)、(58.4±11.3)s)明显长于对照组((24.3±5.1)s)(P＜0.01);地氟烷组与氟烷组和七氟烷组比较差异有统计学意义(P＜0.05或P＜0.01),氟烷组与七氟烷组比较差异无统计学意义(P＞0.05或P＜0.01).结论 长期慢性吸入氟烷、七氟烷、地氟烷均可影响大鼠学习记忆功能,其中地氟烷影响最大.

Objective To discuss the effect of nursing intervention in patients with chronic glomerulonephritis. Methods At our hospital for treatment of 88 cases of patients with chronic glomerulonephritis, and randomly divided into control group and observation group, 44 cases each. Given to patients in the observation group nursing intervention in routine care, patients in the control group received routine care and treatment effect was observed in both groups of patients. Results The patient group was observed after nursing intervention therapy significantly higher total efficiency, the presence of significant statistical significance (P<0.05) differences. Conclusion Chronic glomerulonephritis patients given the right care interventions can improve the therapeutic effect.

目的:探讨脑中风患者后遗症偏瘫术后早期康复干预效果。方法:本次研究选择的对象共80例,均为我院2010年9月至2012年9月收治的脑中风后遗症偏瘫患者,随机按观察组和对照组各40例划分,对照组采用常规护理,观察组加强术后早期康复干预,回顾相关资料。结果:两组干预前痉挛评分及日常生活能力评分无明显差异,干预后均有改善,但观察组改善情况显著优于对照组(P<0.05)。结论:加强脑中风患者后遗症偏瘫术后早期康复干预,可显著改善预后,提高患者生活质量,具有非常积极的临床价值。

目的探讨TOSIGHT视频喉镜与McCoy喉镜插管的应用效果比较,及麻醉气管插管时的护理配合。方法选择100例拟行气管插管全麻的患者,随机均分为两组(T组采用视频喉镜进行气管插管,M组采用McCoy喉镜进行气管插管)。结果 T组暴露声门的Cormack-Lehane分级结果明显优于M组,两组患者的血流动力学变化、插管时间及插管尝试次数没有显著差异。结论 TOSIGHT视频喉镜与McCoy喉镜相比可以明显改善声门的暴露状况,尤其对困难气道患者的麻醉管理具有一定的优势。在气管插管前护士做好患者的心理护理、患者准备及物品准备,插管时与麻醉医师紧密配合,可保证插管过程平稳,成功率高,大大提高了插管的安全性。