目的比较腹横筋膜阻滞复合腹直肌鞘阻滞(TFP-RSB)与腹横筋膜平面阻滞(TFP)对糖尿病患者行妇科腹腔镜全子宫切除术后的镇痛功效及对患者炎性反应的影响。方法选取山西医科大学第二医院2021年12月至2022年9月行妇科腹腔镜全子宫切除术的2...目的比较腹横筋膜阻滞复合腹直肌鞘阻滞(TFP-RSB)与腹横筋膜平面阻滞(TFP)对糖尿病患者行妇科腹腔镜全子宫切除术后的镇痛功效及对患者炎性反应的影响。方法选取山西医科大学第二医院2021年12月至2022年9月行妇科腹腔镜全子宫切除术的2型糖尿病患者90例,将患者分为TFP-RSB组(n=30)、TFP组(n=30)和空白对照组(n=30),TFP-RSB组术后镇痛采用超声引导下的TFP-RSB,TFP组采用TFP,药物选用0.375%的罗哌卡因,TFP-RSB组和TFP组均联合静脉自控镇痛泵(PCIA)复合镇痛。空白对照组仅术后使用PCIA,比较3组患者围手术期镇痛效果、术后睡眠质量及术后6、12、24 h VAS评分,于术前及术后6、12、24 h检测IL-6、Apelin-13,术后6、12、24 h进行血糖测定。结果TFP-RSB组和TFP组术后6、12、24 h血糖均低于空白对照组(P<0.05);TFP-RSB组术后各时间段血糖均低于TFP组(P<0.05);3组术中镇静药物丙泊酚和镇痛药物瑞芬太尼用量差异无统计学意义(P>0.05);TFP-RSB组术后12、24 h VAS评分低于TFP组(P<0.05),但术后6 h VAS评分两组间差异无统计学意义(P>0.05);TFP-RSB和TFP组术后6、12、24 h VAS评分均低于空白对照组(P<0.05);术后24 h舒芬太尼消耗量TFP-RSB组少于TFP组(P<0.05);TFP-RSB组匹兹堡睡眠质量指数(PQS)优于TFP组与空白对照组(P<0.05);TFP-RSB组IL-6水平低于TFP组和空白对照组(P<0.05),TFP组和空白对照组术后24 h IL-6水平差异无统计学意义(P>0.05);3组术前Apelin-13水平低于术后各时间段(P<0.05);术后6、12、24 h TFP-RSB组血清Apelin-13水平低于TFP组(P<0.05),同时TFP-RSB组与TFP组均低于空白对照组(P<0.05);术后恶心呕吐率TFP组(26.6%)低于空白对照组(50.0%),但差异无统计学意义(P>0.05);TFP-RSB组(3.3%)低于TFP组(26.6%)和空白对照组(50.0%),差异有统计学意义(P<0.05)。结论相较于TFP阻滞,TFP-RSB对于行妇科腹腔镜全子宫切除术的糖尿病患者来说术后镇痛效果更好、血糖波动更小、抑制炎性反应效果更明显。展开更多
The earthworm-like robot is designed for prospective applications such as disaster rescue and pipeline detection in natural environments.However,current studies on the interaction modeling between the earthworm-like r...The earthworm-like robot is designed for prospective applications such as disaster rescue and pipeline detection in natural environments.However,current studies on the interaction modeling between the earthworm-like robot and the environment only consider rigid contact.This simplification limits the reliability of dynamic analysis and locomotion optimization on soft surfaces,such as sand.Therefore,developing a method for refined contact modeling for the earthworm-like robot and describing the contact effect induced by the soft environmental medium is urgent.To this end,this paper proposes a new modeling architecture called the elementary mechanical network(EMN).EMN is constructed as fractal structures for the convenience of network reconfiguration.First,elementary mechanical elements,such as the damper,spring,and slider,are parallelly connected to constitute a basic module.Second,the modules are serially linked to create a group.Finally,the groups are parallelly assembled to form the network.EMN is also proven to be equivalent to recurrent neural networks in specific forms.Therefore,EMN inherits the advantages of physical interpretability from mechanical elements and universal approximability from conventional networks.In addition,particle swarm optimization and Boolean operation are employed for network weight training and topological minimization.Numerical examples show that using EMNs with identical initial structures can accurately describe diverse empirical models in the minimum realization.EMN is applied for contact modeling for the earthworm-like locomotion robot in the dry sand based on such versatility.The experiment measures the normal and tangential ground reaction forces with different sinkage depths and locomotion speeds.Trained results reveal a common law that the contact effect in the dry sand is similar to Coulomb friction.The proposed EMN does not require prior system knowledge and promises a minimal physical representation,thus encouraging a successful exploration of constitutive modeling in broad scopes.展开更多
文摘目的比较腹横筋膜阻滞复合腹直肌鞘阻滞(TFP-RSB)与腹横筋膜平面阻滞(TFP)对糖尿病患者行妇科腹腔镜全子宫切除术后的镇痛功效及对患者炎性反应的影响。方法选取山西医科大学第二医院2021年12月至2022年9月行妇科腹腔镜全子宫切除术的2型糖尿病患者90例,将患者分为TFP-RSB组(n=30)、TFP组(n=30)和空白对照组(n=30),TFP-RSB组术后镇痛采用超声引导下的TFP-RSB,TFP组采用TFP,药物选用0.375%的罗哌卡因,TFP-RSB组和TFP组均联合静脉自控镇痛泵(PCIA)复合镇痛。空白对照组仅术后使用PCIA,比较3组患者围手术期镇痛效果、术后睡眠质量及术后6、12、24 h VAS评分,于术前及术后6、12、24 h检测IL-6、Apelin-13,术后6、12、24 h进行血糖测定。结果TFP-RSB组和TFP组术后6、12、24 h血糖均低于空白对照组(P<0.05);TFP-RSB组术后各时间段血糖均低于TFP组(P<0.05);3组术中镇静药物丙泊酚和镇痛药物瑞芬太尼用量差异无统计学意义(P>0.05);TFP-RSB组术后12、24 h VAS评分低于TFP组(P<0.05),但术后6 h VAS评分两组间差异无统计学意义(P>0.05);TFP-RSB和TFP组术后6、12、24 h VAS评分均低于空白对照组(P<0.05);术后24 h舒芬太尼消耗量TFP-RSB组少于TFP组(P<0.05);TFP-RSB组匹兹堡睡眠质量指数(PQS)优于TFP组与空白对照组(P<0.05);TFP-RSB组IL-6水平低于TFP组和空白对照组(P<0.05),TFP组和空白对照组术后24 h IL-6水平差异无统计学意义(P>0.05);3组术前Apelin-13水平低于术后各时间段(P<0.05);术后6、12、24 h TFP-RSB组血清Apelin-13水平低于TFP组(P<0.05),同时TFP-RSB组与TFP组均低于空白对照组(P<0.05);术后恶心呕吐率TFP组(26.6%)低于空白对照组(50.0%),但差异无统计学意义(P>0.05);TFP-RSB组(3.3%)低于TFP组(26.6%)和空白对照组(50.0%),差异有统计学意义(P<0.05)。结论相较于TFP阻滞,TFP-RSB对于行妇科腹腔镜全子宫切除术的糖尿病患者来说术后镇痛效果更好、血糖波动更小、抑制炎性反应效果更明显。
基金supported by the National Natural Science Foundation of China (Grant Nos.11932015 and 11902077)the Shanghai Sailing Program(Grant No.19YF1403000)the Science and Technology Commission of Shanghai Municipality (Grant No.19511132000)。
文摘The earthworm-like robot is designed for prospective applications such as disaster rescue and pipeline detection in natural environments.However,current studies on the interaction modeling between the earthworm-like robot and the environment only consider rigid contact.This simplification limits the reliability of dynamic analysis and locomotion optimization on soft surfaces,such as sand.Therefore,developing a method for refined contact modeling for the earthworm-like robot and describing the contact effect induced by the soft environmental medium is urgent.To this end,this paper proposes a new modeling architecture called the elementary mechanical network(EMN).EMN is constructed as fractal structures for the convenience of network reconfiguration.First,elementary mechanical elements,such as the damper,spring,and slider,are parallelly connected to constitute a basic module.Second,the modules are serially linked to create a group.Finally,the groups are parallelly assembled to form the network.EMN is also proven to be equivalent to recurrent neural networks in specific forms.Therefore,EMN inherits the advantages of physical interpretability from mechanical elements and universal approximability from conventional networks.In addition,particle swarm optimization and Boolean operation are employed for network weight training and topological minimization.Numerical examples show that using EMNs with identical initial structures can accurately describe diverse empirical models in the minimum realization.EMN is applied for contact modeling for the earthworm-like locomotion robot in the dry sand based on such versatility.The experiment measures the normal and tangential ground reaction forces with different sinkage depths and locomotion speeds.Trained results reveal a common law that the contact effect in the dry sand is similar to Coulomb friction.The proposed EMN does not require prior system knowledge and promises a minimal physical representation,thus encouraging a successful exploration of constitutive modeling in broad scopes.
