Pain and immune function in patients undergoing gastric cancer surgery following stellate ganglion block with total intravenous anesthesia

BACKGROUND Stellate ganglion block is a commonly used sympathetic nerve block technique that restores the balance of the sympathetic and vagal nervous systems of the body and inhibits sympathetic nerve activity.AIM To analyze the effect of a stellate ganglion block combined with total diploma intravenous anesthesia on postoperative pain and immune function in patients undergoing laparoscopic radical gastric cancer(GC)surgery to provide a refe-rence basis for the formulation of anesthesia protocols for radical GC surgery.METHODS This study included 112 patients who underwent laparoscopic radical surgery for GC between January 2022 and March 2024.There was no restriction on sex.The patient grouping method used was a digital random table method,and the num-ber of cases in each group was 56.The control group was administered total intravenous anesthesia,and the observation group compounded the stellate gan-glion block according to the total intravenous anesthesia protocol.Postoperative hemodynamics,pain levels,and immune indices were compared between the groups.RESULTS The heart rate and mean arterial pressure in the observation group after in-tubation were lower than those in the control group(P<0.05).Pain levels were compared between the two groups at 2 hours,12 hours,24 hours,and 48 hours after surgery(P>0.05).The number of CD3+,CD4+,and CD4+/CD8+cells at the end of surgery was higher in the observation group than in the control group,and the number of CD8+cells was lower in the observation group than in the control group(P<0.05).There were no significant differences between the two groups in terms of propofol dosage,awakening time,extubation time,or postoperative adverse reactions(P>0.05).CONCLUSION The application of a stellate ganglion block combined with total intravenous anesthesia had no significant effect on postoperative pain levels in patients undergoing laparoscopic radical GC surgery.However,it can safely reduce the effect of surgery on the immune function of patients and is worth applying in clinical practice.

Total Intravenous Anesthesia (TIVA) for Stiff-Person Syndrome

Stiff-Person syndrome is a rare autoimmune neurologic disorder that affects the central nervous system by inhibiting production of the neurotransmitter gamma-aminobutyric acid. Painful muscle spasms and rigidity are the clinical manifestations of the disease. An ideal anesthetic technique has not been described for this patient population because of the rarity of the disease. This case report describes the successful use of total intravenous anesthesia in a patient with Stiff- Person Syndrome.

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 anesthesia combined with total intravenous anesthesia on stress response and coagulation function in and after laparoscopic surgery

Objective:To study the effect of epidural anesthesia combined with total intravenous anesthesia on stress response and coagulation function in and after laparoscopic surgery. Methods: A total of 219 cases of patients who underwent laparoscopic cholecystectomy in our hospital between August 2014 and February 2017 were collected and divided into control group (n=125) who accepted total intravenous anesthesia alone and observation group (n=94) who accepted epidural anesthesia combined with total intravenous anesthesia after the anesthesia scheme was reviewed. Perioperative stress response and coagulation function were compared between two groups of patients.Results: Before operation, differences in the serum stress index contents and peripheral blood coagulation index levels were not statistically significant between two groups of patients. In operation and 2 h after operation, serum stress indexes Cor, Ang-Ⅰ, Ang-Ⅱ and NE contents of observation group were significantly lower than those of control group;peripheral blood coagulation indexes PT, TT and APTT levels were significantly higher than those of control group while TXA2, TXB2 and FBG levels were significantly lower than those of control group.Conclusions: Epidural anesthesia combined with total intravenous anesthesia can effectively alleviate the systemic stress response and reduce the hypercoagulable state in and early after laparoscopic surgery.

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.

IPACK-收肌管阻滞联合TIVA在膝关节置换术麻醉中的应用

目的 探讨膝关节囊后间隙阻滞(IPACK)-收肌管阻滞联合全凭静脉麻醉(TIVA)在膝关节置换术(TKA)麻醉中的应用效果。方法 选择2018年6月至2021年5月在西安交通大学附属红会医院行TKA治疗的100例患者为研究对象,按随机数表法分为观察组和对照组各50例。对照组患者给予TIVK麻醉,观察组患者在对照组基础上联合IPACK-收肌管阻滞麻醉。比较两组患者术后6 h、12 h、24 h、48 h的视觉模拟疼痛(VAS)评分、股四头肌肌力、膝关节活动度变化,以及苏醒情况和不良反应发生情况。结果 观察组患者术后6 h、12 h、24 h、48 h时静息、运动状态的VAS评分[(1.68±0.32)分、(1.88±0.41)分、(2.41±0.39)分、(2.11±0.28)分]、[(2.16±0.35)分、(2.47±0.18)分、(3.41±0.42)分、(2.81±0.38)分]明显低于对照组[(1.85±0.23)分、(2.18±0.73)分、(2.78±0.31)分、(2.57±0.30)分]、[(2.34±0.28)分、(2.66±0.14)分、(3.79±0.35)分、(3.12±0.35)分],差异均有统计学意义(P<0.05);观察组患者的自主呼吸恢复时间、苏醒时间及拔管时间分别为(7.31±1.22) min、(7.98±1.09) min、(10.43±2.11) h,明显短于对照组的(9.89±1.78) min、(12.13±2.21) min、(15.41±9.41) h,差异均有统计学意义(P<0.05);术后12 h、24 h、48 h,两组患者的股四头肌肌力、膝关节活动度均升高,且观察组明显高于对照组,差异均有统计学意义(P<0.05);观察组和对照组患者的总不良反应发生率分别为10.00%、16.00%,差异无统计学意义(P>0.05)。结论 IPACK-收肌管阻滞联合TIVA应用于TKA术中的麻醉效果理想,可缓解术后疼痛,提高肌力,增加关节活动度,安全可靠。

儿童在全凭静脉麻醉下行直接喉镜和支气管镜检查中的麻醉管理

目的探讨不同年龄儿童在保留自主呼吸的全凭静脉麻醉下行直接喉镜和支气管镜检查的麻醉管理。方法选取2022年5月至2023年1月上海交通大学医学院附属上海儿童医学中心收治的气道畸形患儿71例,美国麻醉医师协会(ASA)分级Ⅱ~Ⅲ级,年龄1个月至10岁,按年龄将患儿分成<1岁组(A组)25例,≥1岁且<4岁组(B组)23例,≥4岁且≤10岁组(C组)23例。静脉注射利多卡因、舒芬太尼和右美托咪定结合滴定式静脉注射丙泊酚行麻醉诱导,并以泵注丙泊酚10~12 mg/(kg·h)维持麻醉。采用2.4%利多卡因气雾剂行声带表面麻醉。比较三组患儿麻醉后呼吸暂停、喉痉挛、呛咳和低氧血症等发生率,并记录患儿清醒状态时(T_(0))、置入硬质喉镜时(T_(1))、直接喉镜和支气管镜检查时(T_(2))的生命体征指标。结果三组患儿麻醉后呼吸暂停、喉痉挛和呛咳发生率比较差异无统计学意义(P>0.05)。A组患儿丙泊酚诱导用量较B组和C组显著减少,而低氧血症的发生率较C组显著升高(P<0.05)。A组患儿T_(1)和T_(2)时间点心率(HR)较T_(0)时间点显著降低,B组患儿T_(2)时间点HR较T_(0)时间点显著降低(P<0.05)。三组患儿T_(1)和T_(2)时间点收缩压(SBP)和舒张压(DBP)较T_(0)时间点显著降低(P<0.05)。结论保留自主呼吸的全凭静脉麻醉技术可用于儿童直接喉镜和支气管镜检查,但需注意1岁以下婴儿低氧血症的发生率较年长儿高。

Narcotrend监测下靶控输注丙泊酚TIVA与静吸复合麻醉的对比观察

目的:比较Narcotrend监测下靶控输注丙泊酚全凭静脉麻醉(TIVA)与静吸复合麻醉的临床麻醉效果。方法:80例行腹腔镜下子宫肌瘤剔除术患者随机分为两组:丙泊酚TIVA组(A组,n=40)和静吸复合麻醉组(B组,n=40)。比较两组血压与心率变化、术中Nacotrend指数(NI)、术后麻醉恢复时间及术后不良反应发生率。结果:B组SBP,DBP,HR在切皮时、切皮后5 min、拔管时与A组比较差异有统计学意义(P<0.05);两组在诱导后2 min及手术结束时NI比较差异有统计学意义(P<0.05),麻醉恢复时间A组显著短于B组(P<0.05);两组患者术后不良反应发生率差异无显著性(P>0.05)。结论:Narcotrend监测下靶控输注丙泊酚TIVA较静吸复合麻醉血流动力学更稳定,术中麻醉深度合适,术后恢复时间更短。

Effects of controlled ventilation and positioning on cardiopulmonary function in horses anesthetized with total intravenous anesthesia using a drug combination of medetomidine,lidocaine,butorphanol and propofol (MLBP-TIVA)

The purpose of this study was to evaluate effects of controlled ventilation and positioning on cardiopulmonary function in horses anesthetized with total intravenous anesthesia using a drug combination of medetomidine,lidocaine,butorphanol and propofol (MLBP-TIVA).Five healthy adult horses were anesthetized with MLBP-TIVA for 2-hours on 3-occasions at 4-week interval. In each occasion,horses were anesthetized in lateral recumbency with (CV-LR-group) or without controlled ventilation (SB-LRgroup) or in dorsal recumbency with controlled ventilation (CV-DR-group). Anesthesia was induced with lidocaine (1mg/kg: IV) and propofol (3 mg/kg: IV) following premedications with medetomidine (0. 005 mg/kg: IV) and butorphanol (0. 02 mg/kg: IV),and then maintained by constant rate infusions of propofol (6 mg/kg/hr),medetomidine (0. 0035 mg/kg/h),lidocaine (3 mg/kg/h) and butorphanol (0. 024 mg/kg/h). All horses breathed 100% oxygen during anesthesia. In the CV-groups,horses were mechanically ventilated to maintain arterial CO2pressure (PaCO2)within 40 ~ 50 mmHg. Cardiopulmonary parameters were compared between groups using repeated-measures ANOVA.The level of significance was set at P 【 0. 05.In the SB-LR group,cardiovascular parameters were maintained within acceptable ranges (heart rate: 37 ~ 39beats/min,mean arterial blood pressure: 109 ~ 115 mmHg,mean pulmonary arterial pressure [MPAP]: 28 ~ 29 mmHg,mean right atrial pressure [MRAP]: 19 ~ 21 mmHg,cardiac output: 27 ~ 30 L/min) but severe hypercapnia with insufficient oxygenation (PaCO283 ~ 103 mmHg,arterial O2pressure [PaO2]155 ~171 mmHg) was observed. Cardiopulmonary parameters were maintained with acceptable ranges in the both CV groups. In the CV-LR group,significant decreases in heart rate (29 ~ 31 beats/min,P = 0. 020),cardiac output (17 ~ 21 L/min,P = 0. 005) and PaCO2 (42 ~50 mmHg,P =0. 001) and a significant increase in PaO2 (395 ~419 mmHg,P =0. 005) were observed compared to the SB-group. In the CV-DR group,MPAP (18 ~ 20 mmHg,P = 0. 001),MRAP (15 ~ 17 mmHg,P =0. 003) and PaO2 (171 ~301 mmHg,P =0. 043) were significantly decreased compared to the CV-LR-group.Cardiovascular functions were well maintained in horses during MLBP-TIVA. Controlled ventilation was useful for improving hypercapnia and oxygenation. It is thought that MLBP-TIVA preserves cardiovascular function and provides compensation for decreased preload in horses positioned in dorsal recumbency.

猫丙泊酚全凭静脉麻醉效果的试验研究

丙泊酚是兽医临床常用的静脉全身麻醉药,由于具有良好的药代动力学和药效学特征,被广泛应用于小动物临床,其麻醉平稳、诱导快速、苏醒时间短,可以用于短时间的全凭静脉麻醉。试验选取6只成年猫作为试验用动物,随机编号后按照6个不同剂量(20、24、28、32、36、40 mg/kg·h)进行丙泊酚全凭静脉麻醉,使用电刺激模拟手术中的疼痛刺激,在麻醉维持期内的各个时间点监测猫各项生理指标(包括生物反射分数、体温、心率、脉率、呼吸频率、血氧饱和度)及苏醒过程。结果表明,28 mg/kg·h剂量组猫各项生理指标均处于理想范围,且苏醒平稳,可以维持较好的麻醉效果,并且苏醒时间较短,未出现不良反应;以28 mg/kg·h的维持剂量对猫进行绝育术和去势术,均取得比较理想的麻醉效果。研究结果证实,28 mg/kg·h剂量的丙泊酚全凭静脉麻醉可用于猫临床中短时间手术麻醉,必要时可配伍托芬那酸等镇痛药物。

静吸复合麻醉和全凭静脉麻醉在腹腔镜胆囊手术中的麻醉效果研究

目的研究静吸复合麻醉和全凭静脉麻醉在腹腔镜胆囊手术中的麻醉效果。方法112例腹腔镜胆囊手术患者,以信封随机抽取法分为对照组和观察组,每组56例。对照组患者术中开展静吸复合麻醉,观察组患者术中开展全凭静脉麻醉。比较两组麻醉指标(麻醉拔管时间、苏醒时间、定向力恢复时间)、应激指标[去甲肾上腺素(NE)、皮质醇(Cor)]、生理指标[平均动脉压(MAP)、心率]、免疫指标(CD3+、CD4+、CD4+/CD8+)、炎症因子[超敏C反应蛋白(hs-CRP)、白细胞介素-8(IL-8)、白细胞介素-6(IL-6)]、不良反应发生情况。结果观察组麻醉拔管时间、苏醒时间、定向力恢复时间分别为(6.25±0.62)、(5.67±0.13)、(9.19±1.05)min,显著短于对照组的(7.69±0.69)、(6.95±0.22)、(14.36±1.12)min,差异具有统计学意义(P<0.05)。术后,观察组NE、Cor水平分别为(7.47±0.35)、(216.88±3.30)nmol/L,均低于对照组的(9.72±0.59)、(356.13±3.25)nmol/L,差异具有统计学意义(P<0.05)。插管即刻(T1)、手术开始5 min(T2)、拔管即刻(T3)时,观察组心率、MAP均低于对照组,差异具有统计学意义(P<0.05)。术后,观察组CD3+、CD4+、CD4+/CD8+分别为(69.02±1.46)%、(43.79±0.16)%、(1.42±0.12),均高于对照组的(60.62±1.45)%、(39.68±0.18)%、(1.30±0.11),差异具有统计学意义(P<0.05)。术后,观察组hs-CRP、IL-8、IL-6水平分别为(12.74±3.22)mg/L、(22.25±0.22)pg/ml、(13.36±2.14)pg/ml,低于对照组的(19.65±3.24)mg/L、(35.56±0.25)pg/ml、(24.81±2.26)pg/ml,差异具有统计学意义(P<0.05)。观察组不良反应发生率为1.79%,低于对照组的12.50%,差异具有统计学意义(P<0.05)。结论全凭静脉麻醉在腹腔镜胆囊手术中具有积极的应用价值,可以有效提高麻醉效果,稳定患者血流动力学,降低应激反应、炎症反应,减少对免疫功能的影响,值得临床推广。

TIVA对新辅助化疗后行乳腺癌改良根治术患者骨髓功能及肝肾功能的影响

目的评估全凭静脉麻醉(TIVA)对新辅助化疗后乳腺癌改良根治术患者围术期骨髓功能及肝肾功能的影响。方法收集肿瘤外科住院择期行全麻下行乳腺癌根治手术患者病例资料1 076例,将术前是否行新辅助化疗分2组,其中化疗组143例,非化疗组(对照组)164例。分析2组患者术前、术后外周血WBC(白细胞计数)、RBC(红细胞计数)、PLT(血小板计数)、AST(谷草转氨酶)、ALT(谷丙转氨酶)、BUN(尿素氮)及SCr(血肌酐)数值。结果术前化疗组各项指标较对照组差异无计学意义(P>0.05);对照组术后较术前各项指标改变差异无统计学意义(P>0.05);化疗组术后较术前外周血PLT明显减少,差异有统计学意义(P<0.05);术后化疗组较对照组外周血WBC、PLT明显减少,差异有统计学意义(P<0.05)。结论全凭静脉麻醉可影响化疗后患者骨髓功能,主要以抑制外周血中WBC和PLT为主;全凭静脉麻醉对新辅助化疗后患者肝肾功能无明显影响。

七氟烷、七氟烷复合笑气和TIVA全麻苏醒过程的比较

目的：比较吸入七氟烷（Sevo）、吸入Sevo复合笑气（N2O）以及全凭静脉麻醉（TIVA）行腹腔镜胆囊切除术后患者苏醒的过程。方法：择期腹腔镜胆囊切除手术患者45例随机分为3组（每组15例），Sevo组：以单纯吸入Sevo维持麻醉；（Sevo＋N2O）组：以吸入Sevo复合N2O（60％）维持麻醉，TIVA组：以血浆靶控丙泊酚3μg·mL^-1瑞芬太尼2—4ng·mL^-1维持麻醉。麻醉过程中记录最高和最低吸气，呼气末Sevo的浓度，MAC值，脑电双频指数值（BIS），手术结束后记录患者苏醒时间，拔除气管导管时间，出恢复室时间，唤醒即刻的BIS值，术后2h内疼痛的视觉模拟评分（VAS）。同时记录不良反应。结果：清醒时间和拔管时间：Sevo组分别为（10．4±2．6）和（11．5±3．2）min，（Sevo＋N20）组分别为（8．1±1．7）和（9．1±1．7）min，TIVA组分别为（7．1±1．7）和（8．3±1．7）min。Sevo组和（Sevo＋N2O）组相比有显著性差异（P〈0．05），Sevo组和TIVA组相比有显著性差异（P〈0．01），（Sevo＋N2O）组和TIVA组相比无显著性差异（P〉0．05）。出恢复室时间：Sevo组，（Sevo＋N2O）组和TIVA组分别为（19．3±4．8），（16．6±3．0）和（13．9±2．8）min。Sevo组和TIVA组相比有显著差异（P〈0．001）。清醒即刻的BIS值：Sevo组，（Sevo＋N2O）组和TIVA组分别为（80．4±4．8），（80．8±3．3）和（75．7±2．2）。Sevo组和TIVA组，（Sevo＋N2O）组和TIVA组之间相比均有显著性差异（P〈0．01），Sevo组和（Sevo＋N2O）组相比无显著性差异（P〉0．05）。术毕VAS评分：Sevo组，（Sevo＋N2O）组和TIVA组分别为（2．9±1．2），（2．8±0．7）和（5．0±1．5）。Sevo组和TIVA组，（Sevo＋N2O）组和TIVA组之间相比均有显著性差异（P〈0．001），Sevo组和（Sevo＋N2O）组相比无显著性差异（P〉0．05）。恶心、呕吐、嗜睡等不良反应各组间无显著性差异。结论：七氟烷复合N2O（60％）可以提供较满意的麻醉效果，术后苏醒快，离开恢复室早而且恢复质量高。

全凭静脉全身麻醉与静脉复合七氟烷吸入全身麻醉在小儿麻醉中的安全性比较

目的探讨小儿麻醉中实施全凭静脉全身麻醉与静脉复合七氟烷吸入全身麻醉的效果。方法选取2022年9月至2023年9月日照市中医医院收治的60例手术患儿作为研究对象,采用随机数字表法将其分为对照组和观察组,各30例。对照组患儿采用丙泊酚全凭静脉全身麻醉,观察组患儿采用静脉复合七氟烷吸入全身麻醉。比较两组患儿的血流动力学指标、术后苏醒情况、应激反应指标、谵妄发生情况和不良反应发生情况。结果观察组术中的平均动脉压(MAP)、心率(HR)以及术中、术后20 min的血氧饱和度(SpO_(2))高于对照组,差异有统计学意义(P<0.05)。观察组的拔管时间、定向力恢复时间、苏醒时间短于对照组,插管时间、意识消失时间长于对照组,差异有统计学意义(P<0.05)。观察组术后20 min、气管拔管后的血清去甲肾上腺素(NE)、肾上腺素(E)、皮质醇(Cor)高于对照组,差异有统计学意义(P<0.05)。观察组术后3 d的儿科麻醉后苏醒期谵妄(PAED)量表评分低于对照组,差异有统计学意义(P<0.05)。观察组的不良反应总发生率低于对照组,差异有统计学意义(P<0.05)。结论小儿麻醉中实施静脉复合七氟烷吸入全身麻醉方式,可更好地稳定术中血流动力学,术后快速苏醒及恢复,且减少术后谵妄的发生,安全性有保障,但丙泊酚全凭静脉麻醉可减轻围手术期的应激反应。

MASS及WFTSS在腹腔镜胆囊切除患者ERAS中的比较研究

目的对改良的Aldrete评分系统(modified Aldrete scoring system,MASS)及White快速通道评分系统(White’s fast-track scoring system,WFTSS)在术后快速康复(enhanced recovery after surgery,ERAS)方面做出评价,比较七氟醚与丙泊酚维持麻醉对ERAS的影响。方法选取2021年1月至2023年10月于宁波大学附属第一医院接受腹腔镜胆囊切除手术的患者160例作为研究对象,采用随机数字表法将患者分为七氟醚组和丙泊酚组,每组80例。七氟醚组采用七氟醚-瑞芬太尼维持麻醉,丙泊酚组给予丙泊酚-瑞芬太尼维持麻醉。通过WFTSS和MASS对患者进行ERAS评估。记录麻醉恢复时间、符合ERAS的患者例数、不符合ERAS的相关因素与围手术期并发症。结果与MASS比较,WFTSS对ERAS的出手术室评估更加有效(P=0.031)。拔管时间方面,七氟醚组明显慢于丙泊酚组(P=0.030);在符合ERAS方面,丙泊酚组患者例数明显多于七氟醚组(P=0.026),入复苏室的患者例数明显少于七氟醚组,差异有统计学意义(P=0.025)。结论WFTSS可作为ERAS的出室标准之一。与七氟醚联合瑞芬太尼维持麻醉比较,丙泊酚联合瑞芬太尼维持麻醉能更快达到ERAS手术室内的拔管要求,且不良反应更小。

米库氯铵复合瑞芬太尼全凭静脉麻醉在支气管镜下冷冻治疗中的应用

目的:观察探讨气管支气管结核(TBTB)患者在支气管镜下冷冻治疗中应用米库氯铵复合瑞芬太尼全凭静脉麻醉的效果。方法:选取2019年1月—2022年12月在赣州市第五人民医院进行支气管镜下冷冻治疗的80例TBTB患者,按随机数字表法分为对照组(n=40,行瑞芬太尼+丙泊酚全凭静脉麻醉)、观察组(n=40,行米库氯铵复合瑞芬太尼+丙泊酚全凭静脉麻醉)。对比两组血流动力学、术后恢复质量、认知功能、不良反应。结果:两组麻醉前(T_(0))平均动脉压(MAP)、心率(HR)比较,差异均无统计学意义(P>0.05);麻醉后10 min(T_(1))、麻醉后30 min(T_(2))、术毕时(T_(3))观察组MAP、HR均高于对照组,差异均有统计学意义(P<0.05)。两组术后呼之睁眼时间、意识完全清醒时间、自主呼吸完全恢复时间比较,差异均无统计学意义(P>0.05)。观察组术后6、12、24 h简易智力状态检查量表(MMSE)评分均高于对照组,差异均有统计学意义(P<0.05)。观察组不良反应发生率与对照组比较,差异无统计学意义(P>0.05)。结论:TBTB患者在支气管镜下冷冻治疗过程中行米库氯铵复合瑞芬太尼全凭静脉麻醉有确切效果,能够稳定围手术期血流动力学,对认知功能影响小,术后恢复质量良好,安全性高。

静吸复合麻醉与全凭静脉麻醉在重症颅脑外伤开颅探查术+血肿清除术中的运用对比

目的对比静吸复合麻醉与全凭静脉麻醉在重症颅脑外伤开颅探查术+血肿清除术中的运用效果。方法简单随机选取2022年4月—2023年4月福建省漳平市医院实施开颅探查术+血肿清除术治疗的50例重症颅脑外伤患者作为研究对象,按随机数表法分为研究组和对照组,每组25例。对照组患者采用全凭静脉麻醉,研究组采用静吸复合麻醉。对比两组患者不同时间点血流动力学指标、术后恢复以及麻醉不良反应情况。结果研究组自主呼吸恢复、拔管及苏醒时间依次为(6.17±1.29)、(10.22±2.18)、(6.06±1.08)min,均短于对照组的(8.55±1.41)、(15.25±3.03)、(10.12±1.98)min,差异有统计学意义(t=6.227、6.738、20.373,P均<0.05);两组颅脑外伤者麻醉前平均动脉压、心率水平相比,差异无统计学意义(P均>0.05)。切皮时,两组颅脑外伤者的平均动脉压、心率体征指标与麻醉前相比明显改善,且研究组平均动脉压、心率水平均优于对照组,差异有统计学意义(P均<0.05)。两组颅脑外伤者在切硬脑膜时、术后12 h的平均动脉压、心率体征指标水平与切皮时相比均明显改善,且研究组优于对照组,差异有统计学意义(P均<0.05);研究组的不良反应发生率(4.00%)低于对照组(24.00%),差异有统计学意义(χ^(2)=4.153,P<0.05)。结论静吸复合麻醉在重症颅脑外伤开颅探查术+血肿清除术中的效果优于全凭静脉麻醉。

瑞芬太尼复合丙泊酚全凭静脉麻醉在小儿斜视手术麻醉中的应用效果分析

目的:分析瑞芬太尼复合丙泊酚全凭静脉麻醉在小儿斜视手术麻醉中的应用效果。方法:选取2021年12月—2022年12月于芜湖市眼科医院行手术治疗的60例斜视患儿作为研究对象,采用随机数字表法分为试验组和对照组,各30例。对照组实施氯胺酮、丙泊酚麻醉,试验组实施瑞芬太尼、丙泊酚全凭静脉复合麻醉。比较两组麻醉效果。结果:试验组呼吸恢复时间、拔管时间、麻醉苏醒时间早于对照组,住院时间短于对照组,差异有统计学意义(P<0.05)。麻醉前,两组心率、平均动脉压比较,差异无统计学意义(P>0.05);气管插管后即刻、气管插管后3 min,两组心率、平均动脉压低于麻醉前,但试验组高于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:瑞芬太尼复合丙泊酚全凭静脉麻醉在小儿斜视手术麻醉中的应用效果显著,可缩短恢复呼吸时间、麻醉苏醒时间,维持生命体征平稳,促进患儿康复,且安全性较高。

电针术前预处理对全膝关节置换术术后镇痛效果的影响观察

目的观察电针术前预处理对全麻下行全膝关节置换术(TKA)患者术后镇痛的效果。方法选取2022年10月—2022年12月于徐州市中心医院首次全麻下行单侧TKA患者96例,用随机数字法将患者分为观察组、对照组,各48例。观察组给予电针预处理+局部浸润麻醉+静脉自控镇痛(PCIA),对照组给予局部浸润麻醉+PCIA。比较2组手术前后血浆缓激肽(BK)、前列腺素E2(PGE2)、P物质(SP)、β内啡肽(β-ep)、强啡肽(Dyn),术后12、24、48 h VAS评分,麻醉药物使用情况及不良反应。结果术后2组血浆BK、PGE2、SP、β-ep、Dyn水平与同组术前比较,差异有统计学意义(P<0.01)。观察组血浆BK、PGE2、SP水平低于对照组(P<0.05),β-ep、Dyn水平高于对照组(P<0.05)。静息VAS评分:术后12、24、48 h,2组间VAS评分比较,差异无统计学意义(F=0.694,P=0.406);组内各时间点VAS评分比较,差异有统计学意义(F=256.6,P<0.01)。活动VAS评分:术后12、24、48 h,2组间VAS评分比较,差异有统计学意义(F=7.072,P=0.008);组内各时间点VAS评分比较,差异有统计学意义(F=300.885,P<0.01)。观察组首次按压时间晚于对照组(P<0.01),PCIA总按压次数少于对照组(P<0.01),补救镇痛例数少于对照组,但差异无统计学意义(P>0.05)。观察组术后恶心、呕吐发生率低于对照组(P<0.05);2组头晕、嗜睡、呼吸抑制、瘙痒发生率比较,差异无统计学意义(P>0.05)。结论电针预处理可增强TKA患者术后局部浸润麻醉+PCIA的镇痛效果。

不同全身麻醉方式对颌面部恶性肿瘤患者术后镇痛效果及免疫功能的影响

目的:探讨不同全身麻醉方式对颌面部恶性肿瘤患者术后镇痛效果及免疫功能的影响.方法:选取2019年2月至2022年8月本院收治的80例颌面部恶性肿瘤患者为研究对象.按照随机分组原则,将其分为A组(n=20,采取全凭静脉麻醉),B组(n=20,采取静吸复合麻醉)和C组(n=40,采取吸入麻醉).采用统计学方法,比较3组患者的镇痛效果及免疫功能水平.结果:3组患者的术后视觉模拟评分法(VAS)评分比较,差异有统计学意义(P<0.05);术后2、6、12、24h,3组患者的术后VAS评分从高到低依次为A、B、C组,差异有统计学意义(P<0.05).术后24h,3组患者的CD3+、CD4+、CD4+/CD8+、NK细胞、B淋巴细胞计数比较,差异有统计学意义(P<0.05);3组患者的CD3+、CD4+、CD4+/CD8+、B淋巴细胞计数从高到低依次为A、B、C组;NK细胞从高到低依次为C、B、A组,差异均有统计学意义(P<0.05).结论:吸入麻醉方式应用于颌面部恶性肿瘤的手术治疗中,可显著提升患者的镇痛效果,对免疫功能影响最小,有利于患者的预后.