Pneumocephalus Following Combined Spinal-Epidural Anesthesia: A Case Report Analysis

Background: Combined spinal-epidural anesthesia (CSEA) is widely used in clinical anesthesia due to its rapid onset, reliable anesthetic effect, and strong controllability. Although advancements in technique have reduced the frequency and severity of common complications, reports of rare and serious complications such as pneumocephalus, remain scarce. Case Report: This article presents a case of pneumocephalus following CSEA in a middle-aged female patient undergoing surgery for an intrauterine space-occupying lesion. The patient experienced severe headache postoperatively, and imaging confirmed the presence of intracranial air. After receiving active symptomatic treatment, the patient recovered and was discharged. Conclusion: This case underscores the importance of adhering to standard anesthesia protocols and increasing awareness of rare CSEA complications, particularly the risk of pneumocephalus. Early recognition and timely management are crucial. There is a need to further enhance training and research in anesthetic procedures to improve clinical anesthesia quality and ensure patient safety.

Analgesic Effect of Combined Spinal-Epidural Anesthesia and its Effect on TNF-α and CRP Levels in Elderly Patients with Hip Fracture During Surgical Treatment

Objective:To observe the analgesic effect of combined spinal and epidural anesthesia on older patients undergoing hip fracture surgery.Method:One hundred and twenty elderly hip fracture surgery patients treated in our hospital from January 2021 to December 2022 were selected and randomly divided into two groups,with 60 cases in the experimental group and 60 in the control group.The experimental group was given combined spinal-epidural anesthesia intervention measures,while the control group was given epidural anesthesia intervention measures.The analgesic effect,tumor necrosis factor-alpha(TNF-α),C-reactive protein(CRP)levels,and other observation indicators were analyzed after anesthesia intervention.Result:After the intervention,the analgesic effect and the evaluation results of the subjects in the experimental group were better than those in the control group(P<0.05);the obtained values of TNF-αand CRP levels in the experimental group were higher than those of the control group(P<0.05).Conclusion:The combined spinal-epidural anesthesia intervention demonstrated positive outcomes.The analgesic effect of patients during surgery and their inflammatory factor levels improved,which makes this intervention worthy of clinical application and promotion.

Effects of combined spinal-epidural anesthesia on anxiety,labor analgesia and motor blocks in women during natural delivery

BACKGROUND The background of this study was analgesia in natural delivery.The combined spinal-epidural anesthesia has obvious analgesic effect on the parturients in natural labor,and combined spinal-epidural anesthesia has been widely used in anesthesia for various diseases.AIM To study the effects of combined spinal-epidural anesthesia on anxiety,labor analgesia,and motor blocks in parturients during natural delivery.METHODS A total of 120 women who gave birth at Changning District Maternal and Child Health Hospital between December 2021 to December 2022 were included;a random number table approach was employed to divide the women into a control group and a joint group,with each group consisting of 60 women.The control group was given epidural anesthesia,while the joint group was given combined spinal-epidural anesthesia.The visual analog scale(VAS)was used to evaluate the degree of maternal pain.Comparisons were made between the two groups’conditions of childbirth and the duration of labor.Apgar scores were used to evaluate the status of the newborns at birth;Self-rating Anxiety Scale(SAS)and General Self-Efficacy Scale(GSES)scores,umbilical artery blood gas analysis indices and stress indices were compared between the two groups;and the frequencies of motor block and postpartum complications were analyzed.RESULTS In comparison to the control group,in the joint group,the VAS scores for the first,second,and third stages of labor were lower(P<0.05).The rates of conversion to cesarean section and postpartum blood loss in the joint group were lower than those in the control group(P<0.05).No significant differences were observed in the Apgar score,the duration of the first stage of labor,or the total duration of labor between the two groups(P>0.05).The second and third stages of labor in the joint group were shorter than those in the control group(P<0.05).When compared to the control group,the postpartum SAS score of the joint group was lower,while the GSES score was greater(P<0.05).Between the control group and the joint group,the differences observed in pH,arterial carbon dioxide partial pressure,arterial oxygen partial pressure,or arterial hydrogen ion concentration were not significant(P>0.05).Nitric oxide,cortisol,and adrenaline levels were lower in the joint group than in the control group(P<0.05).There were no substantial differences in Bromage grade or rate of complications between the two groups(P>0.05).CONCLUSION For parturients during natural delivery,combined spinal-epidural anesthesia can reduce anxiety,provide labor analgesia,shorten labor time,and reduce postoperative stress levels but did not result in a motor block.

Influence of static cartoons combined with dynamic virtual environments on preoperative anxiety of preschool-aged children undergoing surgery

BACKGROUND Preschoolers become anxious when they are about to undergo anesthesia and surgery,warranting the development of more appropriate and effective interventions.AIM To explore the effect of static cartoons combined with dynamic virtual environments on preoperative anxiety and anesthesia induction compliance in preschool-aged children undergoing surgery.METHODS One hundred and sixteen preschool-aged children were selected and assigned to the drug(n=37),intervention(n=40),and control(n=39)groups.All the children received routine preoperative checkups and nursing before being transferred to the preoperative preparation room on the day of the operation.The drug group received 0.5 mg/kg midazolam and the intervention group treatment consisting of static cartoons combined with dynamic virtual environments.The control group received no intervention.The modified Yale Preoperative Anxiety Scale was used to evaluate the children’s anxiety level on the day before surgery(T0),before leaving the preoperative preparation room(T1),when entering the operating room(T2),and at anesthesia induction(T3).Compliance during anesthesia induction(T3)was evaluated using the Induction Compliance Checklist(ICC).Changes in mean arterial pressure(MAP),heart rate(HR),and respiratory rate(RR)were also recorded at each time point.RESULTS The anxiety scores of the three groups increased variously at T1 and T2.At T3,both the drug and intervention groups had similar anxiety scores,both of which were lower than those in the control group.At T1 and T2,MAP,HR,and RR of the three groups increased.The drug and control groups had significantly higher MAP and RR than the intervention group at T2.At T3,the MAP,HR,and RR of the drug group decreased and were significantly lower than those in the control group but were comparable to those in the intervention group.Both the drug and intervention groups had similar ICC scores and duration of anesthesia induction(T3),both of which were higher than those of the control group.CONCLUSION Combining static cartoons with dynamic virtual environments as effective as medication,specifically midazolam,in reducing preoperative anxiety and fear in preschool-aged children.This approach also improve their compliance during anesthesia induction and helped maintain their stable vital signs.

Evaluation of the Application Effect of Short Video Combined with BOPPPS Teaching Mode in Clinical Anesthesia Teaching

Objective:To study the application effect of short video combined with BOPPPS teaching mode in clinical anesthesia practice.Method:48 students assigned to clinical anesthesia in digestive endoscopy of Shanxi Bethune Hospital from July 1,2022 to April 1,2023 were selected as research objects.They were randomly divided into the control group(PowerPoint presentation teaching group)and the observation group(short video combined with BOPPPS teaching group),with 24 students in each group.After the internship,the students’theoretical and technical scores were tested,the effects of the two teaching modes were compared,and the students’satisfaction was investigated.Results:The test scores of students in the observation group were significantly better than those in the control group(P<0.05).The short video combined with BOPPPS teaching mode can significantly improve students’learning interest,operation skills,and memory(P<0.05).The students’satisfaction in the observation group was higher than that in the control group(P<0.05).Conclusion:In clinical practice,the application of short video combined with BOPPPS teaching mode has achieved great effect,which is worth further promotion and research.

Efficacy of low-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia

Objective: To study the efficacy of low-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia. Methods: Puerperae who underwent vaginal delivery under combined spinal-epidural anesthesia for labor analgesia in Lincheng People's Hospital between June 2014 and March 2017 were selected and randomly divided into three groups, group A received 15 μg small-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia, group B received 25 μg large-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia, and group C received ropivacaine epidural anesthesia alone for labor analgesia. During delivery, the serum in the second stage of labor was collected to determine the contents of pain transmitters, inflammatory cytokines and stress response indexes. Results: During delivery, serum SP, 5-HT, DA, NE, DYN, TNF-α, IL-1β, IL-6, IL-10, PGE2, Cor, C-P, MDA and AOPP contents of group A and group B were lower than those of group C and serum SP, 5-HT, DA, NE, DYN, TNF-α, IL-1β, IL-6, IL-10, PGE2, Cor, C-P, MDA and AOPP contents of group A were not significantly different from those of group B. Conclusion: 15 μg small-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia is with exact efficacy and good safety.

Effects of Total Intravenous Anesthesia and Static Aspiration Combined General Anesthesia on Postoperative Cognitive Function and Psychological State of Elderly Patients with Esophageal Cancer

Objective: To compare the effects of total intravenous anesthesia and static aspiration combined general anesthesia on postoperative cognitive function and psychological state of elderly esophageal cancer patients. Methods: From July 2020 to April 2021, 180 elderly patients who underwent radical esophageal cancer surgery in our hospital were randomly divided into 90 cases in the control group and 90 in the observation group. The control group used static aspiration compound general anesthesia, and the patients in the observation group used intravenous anesthesia to compare the cognitive function and psychological state of the two groups of patients. Results: There was no statistical difference in the cognitive function score of patients in the observation group 30 minutes before anesthesia, 1 h and 24 hours after anesthesia compared with that in the control group, P > 0.05;there was no statistical difference between the Hamilton Anxiety Scale (HAMA) scores 30 minutes before and 24 hours after anesthesia in the observation group compared with the control group, P > 0.05;the cognitive function score of patients in the observation group of 4 h after surgery and 12 h after operation was significantly higher than that of the control group;the HAMA scores of patients in the observation group of 1 h, 4 h and 12 h after surgery were significantly lower than that of the control group, P Conclusion: The application of total intravenous anesthesia in elderly patients with esophageal cancer surgery can reduce the impact of anesthesia on their cognitive function and psychological state, which is worth popularizing and applying in clinical practice.

Effect of epidural block combined intravenous general anesthesia stress on the stress response and T lymphocyte subsets in patients with breast cancer undergoing radical mastectomy

Objective: To investigate the effect of epidural block combined with intravenous anesthesia on stress response and T lymphocyte subsets in patients with breast cancer undergoing radical mastectomy. Methods: In our hospital from July 2016 to June 2017 undergoing radical mastectomy for breast cancer of 88 patients were randomly divided into observation group and control group of 44 cases, 2 patients underwent routine preoperative preparation, and routine blood pressure, heart rate, pulse, oxygen saturation, ECG monitoring, control group with intravenous anesthesia. The observation group was treated with epidural block combined with intravenous anesthesia. 2 groups of patients before anesthesia, 30 MIM (T0), 1 h after skin incision (T1), 4 h after operation (T2), 24 h after operation (T3), 48 h after operation (T4) from peripheral venous blood were measured by interleukin-8 (IL-8) and interferon gamma (IFN-γ), cortisol (Cor), prolactin (PRL), growth hormone (GH) and T lymphocyte subsets (CD3+, CD4+, CD8+), the calculation of CD4+/CD8+ value. Results: the serum IL-8 level of T1, T2, T3and T4 decreased gradually, were lower than at T0, and the control group at each time point had no significant difference, T1, T2, T3group, T4IL-8 levels lower than the control group;the 2 groups of serum IFN-γ levels T1 and T2had no significant change, T3and T4increased gradually, was higher than that of T0, but no significant difference between the 2 groups of IFN-γ levels. 2 serum Cor levels peaked at T1, decreased at T2, was higher than that of T0, T3, T4returned to T0, the observation group T1, T2Cor level lower than the control group;the serum PRL levels of 2 groups reached a peak at T1, T2, T3at the time of T4decreased gradually, was higher than that of T0, T1, T2, T3of the observation group at the PRL level is lower than the control group;the serum level of GH 2 in group T1increased gradually, reached a peak at T2, T3and T4 decreased gradually, was higher than that of T0, the observation group T1, T2, T3, T4, GH levels lower than the control group. 2 groups of CD3+ decreased gradually in T1, T2, were lower than T0, T3, T4returned to T0, the observation group T1, T2CD3+ was higher than the control group;group CD4+ decreased gradually in T1, T2, T3and T4were lower than control, T0when, and the observation group CD4+ in T1, T2, T3, T4, no significant changes were observed in group T1, T2, T3, T4and CD4+ higher than that of the control group;the 2 group CD8+ had no obvious changes in T1, T2, T3, T4;observation group CD4+/CD8+ decreased gradually in T1, T2, were lower than T0, T3, T4returned to T0, the observation group T1, T2CD4+/CD8+ was higher than the control group. Conclusion: epidural block combined with intravenous anesthesia for breast cancer radical mastectomy can effectively relieve the stress and inflammatory reaction, alleviate the immunosuppression, and help to restore the postoperative immune function.

A CLINICAL STUDY ON THE SUBTOTAL GASTRECTOMY UNDER ACUPUNCTURE COMBINED WITH EPIDURAL ANESTHESIA OF SMALL DOSAGE

We have performed operations on the patients with perforation of gastric ulcer forsubtotal gastrectomy under acupuncture combined with epidural anesthesia of smaIl dosage （studygroup） or epidural anesthesia only（control gr0up） at rand0m, 2O cases in each group. There is no ob-vious difference of successful rates between tw0 groups （P】O. O5）. But the fluctuation of the bloodpressure of the study group is smaller than that of the control group（PwtO- O1 ）; the comparison of thefluctuations of capacity of vessel and the changes 0f TMwave of ECG before and during operationshows that the study group is better than control gr0up （PrO. O1, P【O. O5, respectively）; in thestudy group, WBC is decreased significantly after operation, while in the control guoup, CRP（C-re-active pr0tein） is markedIy increased, there are significant differences of these indices between twogroups（P【0. 05, respectively）; complement C3, IgA, IgG and IgM are decreased to a different ex- tent after operation in both groups, but the

Regional anesthesia in a patient with primary ciliary dyskinesia:A case report

BACKGROUND Primary ciliary dyskinesia(PCD)is an inherited autosomal-recessive disorder of impaired mucociliary clearance characterized by chronic respiratory diseases,otolaryngological diseases,central nervous system abnormalities,reproductive system abnormalities,and cardiac function abnormalities.General anesthesia in these patients is associated with a higher incidence of respiratory complications than in patients without the disease.CASE SUMMARY A 16-year-old male patient was referred to the emergency room complaining of right ankle pain due to distal tibiofibular fracture.Three years prior,he had been diagnosed with PCD.At that time,he had experienced several episodes of pneumonia,sinusitis,and chronic middle ear infections,for which he underwent surgical interventions.At the current admission,he presented with cough and sputum but no other respiratory symptoms.A chest computed tomography scan revealed centrilobular ground-glass opacities in both lower lobes and a calcified nodule in the left lower lobe.For the surgical procedure and postoperative pain management,combined spinal-epidural anesthesia was employed.The patient’s postoperative pain score was measured by the numerical rating scale(NRS).On the day of surgery,his NRS was 5 points.By the second postoperative day,the NRS score had decreased to 2–3 points.The epidural catheter was removed on the fourth day following the operation.The patient was subsequently discharged no respiratory complications.CONCLUSION We performed combined spinal-epidural anesthesia in a patient with PCD.The patient experienced no additional respiratory complications and was discharged with a low NRS score for pain.

Comment on visual impact of sub-Tenon anesthesia during combined phacoemulsification and vitrectomy surgery

Dear Editor,We read with interest the article by Chen etaitlj on the visual impact of sub-Tenon anesthesia during combined phacoemulsification and vitrectomy surgery. The authors reported that 93.3% of patients in the study experienced loss of perception of light at least during one of the surgical steps after the contralateral eye was covered intraoperatively. Most of the patients （81%） reported losing light perception between 6min and 30min from the commencement of the surgery.

Effects of acupuncture combined with drug anesthesia on stress reaction and cognitive function in senior patients with total hip arthroplasty

Objective: To investigate the effects of acupuncture combined with anesthesia on stress and cognitive function in senior patients with total hip arthroplasty. Methods: A total of 89 patients who underwent total hip replacement between January 2016 and May 2018 were collected. According to whether acupuncture anesthesia was applied during total hip replacement, the patients were divided into acupuncture combined anesthesia group and drug anesthesia group. Fasting venous blood (3mL) was collected before the operation without electrical stimulation and after the operation. Cortisol (Cor) and β-endorphin (β-EP) were detected by radioimmunoassay, and neuron-specific enolase (NSE) was detected by electrochemical luminescence immunoassay. The levels of s-100β protein (s-100β), c-reactive protein (CRP) and tumor necrosis factor-α (TNF-α) were determined by ELISA. Flow cytometry was used to determine the ratio of T cell subsets (CD3+) and natural killer cells (NK cells) in the blood. Results: The levels of Cor, β-EP, NSE, S-100β, CRP, TNF-α and the ratio of NK cell, CD3+ between the two groups have no significant differences before operation (P>0.05). Serum levels of Cor, β-EP, NSE, S-100β, CRP and TNF-α in patients in the acupuncture combined with drug anesthesia group and the single drug anesthesia group were significantly higher than those before surgery (P<0.05). In addition, serum levels of Cor, β-EP, NSE, S-100β, CRP, TNF-α in the acupuncture combined with anesthesia group were significantly lower than those in the drug group alone (P<0.05). There was no significant difference in NK cell and CD3+ ratio between postoperative and preoperative in the acupuncture combined with drug anesthesia group (P>0.05). The ratio of NK cells and CD3+ in the pure drug anesthesia group was significantly lower than that before surgery (P<0.05). Conclusion: Acupuncture combined with drug anesthesia can effectively reduce the inflammatory stress response of patients undergoing total hip arthroplasty, relieve the immune suppression caused by surgery and anesthesia, reduce the damage to the nervous system, and have a good influence in the cognitive function of the senior patients.

Effect of combined spinal and epidural anesthesia on the level of pain media, stress indicators and inflammatory factors in patients undergoing high altitude cesarean section

Objective: To discuss the effect of combined spinal and epidural anesthesia on the levels of pain media, stress indicators and inflammatory factors in patients undergoing high altitude cesarean section. Methods: Eighty patients who underwent cesarean section in our hospital from January 2017 to April 2019 were enrolled in the hospital. They were divided into two groups according to the patient's anesthesia. Fourty patients receiving epidural anesthesia were included in the control group, and another 40 patients received lumbar stiffness. The combined anesthesia patient was included in the observation group. Changes in pain mediators [Serum neuropeptide Y (NPY), endorphin (β-EP), substance P (SP)], stress indicators [Serum cortisol (Cor), C-peptide (C-P), advanced oxidative protein product (AOPP)], inflammatory factor levels [Hypersensitive C-reactive protein (hs-CRP), tumor necrosis factor-alpha (TNF-α)], and immunoglobulin levels [Serum IgA, IgG, IgM] were compared between the two groups. Results: Before anesthesia, there were no significant difference in pain media, stress index, inflammatory factor level and immunoglobulin level between the two groups (P>0.05). At 12 h after operation, the two groups of patients were NPY, β-EP, SP, Cor. The levels of C-P, AOPP, hs-CRP and TNF-α were higher than those before operation (P<0.05). The levels of IgA, IgG and IgM were lower than those before operation (P<0.05). Among them, observation group NPY, β-EP, SP, Cor, C-P, AOPP, hs-CRP and TNF-α were significantly lower than those of the control group (P<0.05). The serum levels of IgA, IgG and IgM were significantly higher than those of the control group (P<0.05). Conclusion: Combined spinal and epidural anesthesia can more effectively alleviate maternal pain in high altitude cesarean section, more effectively reduce the inflammatory stress response of patients, promote the humoral immune function of patients, and is beneficial to the early recovery of maternal postoperative, and has high clinical value.

A combination therapy of ethanol injection and radiofrequency ablation under general anesthesia for the treatment of hepatocellular carcinoma

AIM: To summarize the effects of laparoscopic ethanol injection and radiofrequency ablation (L-EI-RFA), thora- coscopic (T-EI-RFA) and open-surgery assisted EI-RFA (O-EI-RFA) under general anesthesia for the treatment of hepatocellular carcinoma (HCC). METHODS: Time-lag performance of RFA after ethanol injection (Time-lag PEI-RFA) was performed in all cases. The volume of coagulated necrosis and the applied en- ergy for total and per unit volume coagulated necrosis were examined in the groups treated under general (group G) or local anesthesia (group L). RESULTS: The results showed that the total applied energy and the applied energy per unit volume of whole and marginal, coagulated necrosis were significantly larger in group G than those in the group L, resulting in a larger volume of coagulated necrosis in the group G. The rate of local tumor recurrence within one year was extremely low in group G. CONCLUSION: These results suggest that EI-RFA, un- der general anesthesia, may be effective for the treat- ment of HCC because a larger quantity of ethanol and energy could be applied during treatment under pain- free condition for the patients.

腰硬联合麻醉在老年髋部骨折手术患者中的应用

目的:探析腰硬联合麻醉在老年髋部骨折手术患者中的应用。方法:选取2020年11月—2021年11月江门市新会区人民医院麻醉科收治的80例老年髋部骨折手术患者作为研究对象。根据随机法将其分为常规组和试验组,各40例。常规组给予连续硬膜外麻醉,试验组给予腰硬联合麻醉。比较两组入室时(T_(0))、手术开始后10 min(T_(1))、手术开始后30 min(T_(2))、手术结束时(T_(3))的心率、收缩压及舒张压。比较两组术前、术后12 h应激指标,麻醉效果,麻醉优良率,术后10 min,术后1 h、3 h、6 h、12 h疼痛情况,不良反应。结果:T_(1),试验组心率、舒张压均显著高于常规组,T_(2)、T_(3),试验组心率、舒张压及收缩压均显著高于常规组,差异有统计学意义(P<0.05)。术后12 h,试验组肾上腺素(AD)、去甲肾上腺素(NE)、C反应蛋白(CRP)水平均显著低于常规组,差异有统计学意义(P<0.05)。试验组麻醉起效时间、感觉阻滞完善时间均明显短于常规组,差异有统计学意义(P<0.05)。试验组优良率显著高于常规组,差异有统计学意义(P<0.05)。术后1 h、3 h、6 h、12 h,试验组视觉模拟评分法(VAS)评分低于常规组,差异有统计学意义(P<0.05)。试验组不良反应发生率显著低于常规组,差异有统计学意义(P<0.05)。结论:老年髋部骨折手术患者采用腰硬联合麻醉,其麻醉起效时间短,镇痛效果佳,可减轻患者的应激反应和术后疼痛,且不增加麻醉相关不良反应,可取得安全高效的麻醉效果。

腰硬联合麻醉下凶险性前置胎盘剖宫产术低血压发生的诱导因素及列线图预测模型的构建

目的探讨腰硬联合麻醉(CSEA)下凶险性前置胎盘剖宫产术中低血压发生的诱导因素并构建列线图预测模型。方法选取玉林市妇幼保健院2020年1月—2023年12月收治的腰硬联合麻醉(CSEA)下凶险性前置胎盘剖宫产术产妇130例作为研究对象,采用自编的一般资料调查表对研究对象基本资料及低血压发生情况进行调查,并依据术中低血压发生情况将其分为低血压组47例和无低血压组83例。对2组一般资料进行单因素分析,采用多因素Logistic回归分析法探讨术中发生低血压的诱导因素。结果单因素分析显示,2组体质量指数、麻醉平面情况、是否为多胎妊娠、术前收缩压情况、手术时间、是否出现Bezold-Jarisch反射比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,体质量指数≥24 kg/m^(2)、麻醉平面≥T8、多胎妊娠、术前收缩压<90 mmHg、手术时间>1.5 h、出现Bezold-Jarisch反射是CSEA下凶险性前置胎盘产妇剖宫产术中发生低血压的独立危险因素(P<0.05)。构建CSEA下凶险性前置胎盘剖宫产术中低血压发生的诱导因素回归方程:Logit(P)=-23.211+1.079×(体质量指数≥24 kg/m^(2))+1.101×麻醉平面(≥T8)+3.193×多胎妊娠+2.214×术前收缩压(<90 mmHg)+4.606×手术时间(>1.5 h)+2.011×出现Bezold-Jarisch反射。分析发现列线图对于存在术前收缩压<90 mmHg人群均有较高区分度及准确度;对列线图模型进行Bootstrap重复抽样1000次,获得校准曲线,计算得到的一致性指数为0.850,说明该列线图模型具备较好的校准度;绘制受试者工作特征(ROC)曲线,其曲线下面积为0.896,95%CI为0.802~0.956,提示预测效能较好。结论体质量指数≥24 kg/m^(2)、麻醉平面≥T8、多胎妊娠、术前收缩压<90 mmHg、手术时间>1.5 h、出现Bezold-Jarisch反射是CSEA下凶险性前置胎盘产妇剖宫产术中低血压发生的诱导因素。

右美托咪定复合腰硬联合麻醉对股骨颈骨折患者麻醉效果及应激反应的影响

目的探讨右美托咪定复合腰硬联合麻醉对股骨颈骨折患者麻醉效果及应激反应的影响。方法选取2021年10月至2022年10月我科收治的90例股骨颈骨折患者为研究对象,以随机数字表法将其分为对照组(45例,腰硬联合麻醉)和观察组(45例,右美托咪定复合腰硬联合麻醉)。比较两组的麻醉效果。结果麻醉后15 min(T_(1))、手术完成时(T_(2)),观察组的视觉模拟评分法(VAS)评分低于对照组,Ramsay镇静评分法(RSS)评分高于对照组(P<0.05)。T_(1)、T_(2),观察组的B型尿钠肽(BNP)、D-二聚体(D-D)水平低于对照组(P<0.05)。T_(1)、T_(2),观察组的皮质醇(Cor)、去甲肾上腺素(NE)水平低于对照组(P<0.05)。观察组的不良反应总发生率低于对照组(P<0.05)。结论右美托咪定复合腰硬联合麻醉有助于提高股骨颈骨折患者的麻醉效果,减轻机体应激反应,降低不良反应发生率,值得推广。

影响腰硬联合麻醉下子宫肌瘤剔除术患者DVT发生的相关因素分析

目的:探究影响腰硬联合麻醉下子宫肌瘤剔除术患者深静脉血栓(DVT)发生的相关因素。方法:收集2021年1月-2024年1月本院就诊行腰硬联合麻醉下子宫肌瘤剔除术患者200例,根据术后有无DVT分为DVT组和无DVT组,统计一般资料、实验室指标、手术情况、术后情况等,分析腰硬联合麻醉下子宫肌瘤剔除术患者发生DVT的相关因素。结果:200例术后发生DVT 24例(12.0%)。两组年龄、吸烟、合并高血压、合并血脂紊乱、术前美国麻醉医师协会(ASA)分级、最大肌瘤位置、剔除肌瘤数、手术时间比较无差异(P>0.05);DVT组体质指数(BMI)、合并糖尿病占比、术前D-二聚体、最大肌瘤直径、术中气腹压、术后血红蛋白水平、术后卧床时间水平均高于无DVT组(P<0.05)。多因素logistic回归分析显示,BMI大、合并糖尿病、术前D-二聚体水平高、最大肌瘤直径大、术中气腹压高、术后血红蛋白水平高、术后卧床时间长是腰硬联合麻醉下子宫肌瘤剔除术患者发生DVT的独立危险因素(均P<0.05)。结论:腰硬联合麻醉下子宫肌瘤剔除术患者发生DVT的相关因素较多,临床应重视对DVT高危患者的识别,给予针对性干预。

髂筋膜阻滞复合腰硬联合麻醉 在老年髋部骨折患者中的应用效果评价

目的:探究髂筋膜阻滞复合腰硬联合麻醉在老年髋部骨折患者中的应用效果。方法:将盱眙县中医院麻醉科收治的老年髋部骨折患者80例(收治时间2021年2月—2023年2月)作为研究对象,随机分为两组,每组40例。两组均实施手术治疗,对照组实施腰硬联合麻醉,观察组实施髂筋膜阻滞复合腰硬联合麻醉。比较两组麻醉效果。结果:术前,两组简易精神状态评价量表(MMSE)评分对比,差异无统计学意义(P>0.05);术后6 h、1 d、3 d,两组MMSE评分升高,且观察组均高于对照组(P<0.05)。观察组手术时间短于对照组,舒芬太尼用量少于对照组(P<0.05)。术前,两组视觉模拟评分法(VAS)评分对比,差异无统计学意义(P>0.05);术后6 h、1 d、3 d,两组VAS评分降低,且观察组均低于对照组(P<0.05)。两组麻醉效果相比,差异无统计学意义(P>0.05)。结论:老年髋部骨折患者实施腰硬联合麻醉复合髂筋膜阻滞,能够改善患者术后认知功能,减轻疼痛,缩短手术时间,减少舒芬太尼用量。

腰硬联合麻醉分娩镇痛后发热对母婴分娩结局的影响

目的探讨腰硬联合麻醉分娩镇痛后发热对分娩结局的影响,以期改善母婴结局。方法选取2020年1月至2022年6月进行腰硬联合麻醉分娩镇痛的300例产妇作为研究对象,根据镇痛后是否出现发热将产妇分为两组。对照组为未出现发热的产妇,共150例;观察组为出现发热的产妇,共150例。比较两组产妇的阴道操作次数、破膜时间、总产程时间、缩宫素使用比例、分娩方式、产妇不良结局发生率以及新生儿不良结局发生率。结果观察组阴道操作次数(7.56±1.12)次,破膜时间为(11.86±2.03)h,总产程时间为(17.08±2.34)h,使用缩宫素加强宫缩为51例(34.00%),对照组阴道操作次数(5.41±1.04)次,破膜时间为(8.69±1.75)h,总产程时间为(15.04±1.84)h,使用缩宫素加强宫缩为20例(13.33%),两组产妇的阴道操作次数、破膜时间、总产程时间、缩宫素使用比例等指标比较差异均有统计学意义(P<0.001)。观察组产妇自然分娩82例(54.67%),剖宫产45例(30.00%),器械助产23例(15.33%),对照组产妇自然分娩121例(80.67%),剖宫产19例(12.67%),器械助产10例(6.67%),两组产妇的分娩方式比较差异有统计学意义(P<0.05或0.001)。观察组产妇出现低血压、头痛、产后出血、产褥感染等总不良结局发生率为60.67%(91/150),对照组产妇出现低血压、头痛、产后出血、产褥感染等总不良结局发生率为31.33%(47/150),两组产妇总不良结局发生率差异有统计学意义(P<0.001)。观察组出现胎儿窘迫、新生儿窒息、新生儿败血症、新生儿高胆红素血症等总不良结局发生率为40.67%(61/150),对照组出现胎儿窘迫、新生儿窒息、新生儿败血症、新生儿高胆红素血症等总不良结局发生率为22.67%(34/150),两组新生儿总不良结局发生率差异有统计学意义(P<0.001)。结论产时发热是一种临床表现,早发现早预防非常重要。对于产科医生而言,应加强产程管理,掌握阴道操作指征,严格遵循无菌操作,以预防感染性产时发热。同时,要避免产时发热相关因素的叠加,防止非感染性发热的发生。此外,还需综合分析产时发热的原因,动态监测各项指标,仔细鉴别,并采取适宜的产程处理措施。