Early Application Study of Intravenous Pain Pump Combined with Parecoxib Injection in Relieving Pain in Patients after Thoracoscopy

Objective: To explore the clinical effectiveness of combined use of intravenous pain pump with Parecoxib injection in alleviating pain in patients during the early postoperative period after thoracoscopic surgery. Methods: Eighty patients who underwent thoracoscopic surgery in a tertiary hospital were selected as the study subjects and randomly divided into two groups, with 40 patients in each group. The control group received routine postoperative treatment with intravenous pain pump, while the experimental group received Parecoxib in addition to the standard postoperative pain pump treatment. Visual Analog Scale (VAS) pain scores were used to evaluate postoperative pain relief in both groups, along with adverse reactions, postoperative complications, and patient satisfaction with pain relief. Results: Patients who received Parecoxib injection in addition to the routine use of intravenous pain pump had VAS pain scores lower than 3 points at 6 h, 12 h, 24 h, and 36 h postoperatively compared to those in the control group. The incidence of postoperative lung collapse, pleural effusion, and pulmonary infections was also significantly lower in the experimental group. The differences between the two groups were statistically significant (P Conclusion: Early combined use of Parecoxib injection in the early postoperative period after thoracoscopic surgery has shown good clinical efficacy. It can reduce the level of pain in patients, promote effective coughing and expectoration, facilitate early mobilization of patients, improve patient compliance, reduce complications, shorten hospital stay, and expedite patient recovery. Therefore, it is worth promoting the widespread clinical application of Parecoxib injection in this setting.

Treatment of malignant digestive tract obstruction by combined intraluminal stent installation and intra-arterial drug infusion

AIM: To study the palliative treatment of malignant obstruction of digestive tract with placement of intraluminal stent combined with intra-arterial infusion of chemotherapeutic drugs. METHODS: A total of 281 cases of digestive tract malignant obstruction were given per oral (esophagus, stomach, duodenum and jejunum), per anal (colon and rectum) and percutaneous transhepatic (biliary) installation of metallic stent. Among them, 203 cases received drug infusion by cannulation of tumor supplying artery with Seldinger's technique. RESULTS: Altogether 350 stents were installed in 281 cases, obstructive symptoms were relieved or ameliorated after installation. Occurrence of restenotic obstruction was 8-43 weeks among those with intra-arterial drug infusion, which was later than 4-26 weeks in the group with only stent installation. The average survival time of the former group was 43 (3-105) weeks, which was significantly longer than 13 (3-24) weeks of the latter group. CONCLUSION: Intraluminal placement of stent combined with intra-arterial infusion chemotherapy is one of the effective palliative therapies for malignant obstruction of the digestive tract with symptomatic as well as etiological treatment.

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.

Oncolytic virus-based hepatocellular carcinoma treatment:Current status,intravenous delivery strategies,and emerging combination therapeutic solutions

Current treatments for advanced hepatocellular carcinoma(HCC)have limited success in improving patients’quality of life and prolonging life expectancy.The clinical need for more efficient and safe therapies has contributed to the exploration of emerging strategies.Recently,there has been increased interest in oncolytic viruses(OVs)as a therapeutic modality for HCC.OVs undergo selective replication in cancerous tissues and kill tumor cells.Strikingly,pexastimogene devacirepvec(Pexa-Vec)was granted an orphan drug status in HCC by the U.S.Food and Drug Administration(FDA)in 2013.Meanwhile,dozens of OVs are being tested in HCC-directed clinical and preclinical trials.In this review,the pathogenesis and current therapies of HCC are outlined.Next,we summarize multiple OVs as single therapeutic agents for the treatment of HCC,which have demonstrated certain efficacy and lowtoxicity.Emerging carrier cell-,bioengineered cell mimetic-or nonbiological vehicle-mediated OV intravenous delivery systems in HCC therapy are described.In addition,we highlight the combination treatments between oncolytic virotherapy and other modalities.Finally,the clinical challenges and prospects of OV-based biotherapy are discussed,with the aim of continuing to develop a fascinating approach in HCC patients.

Efficacy of second-course intra-arterial chemotherapy in children for advanced retinoblastoma recurrence after intra-arterial chemotherapy

Purpose: The present study determined the efficacy and toxicity of second-course intra-arterial chemotherapy(IAC) in advanced retinoblastoma(RB) recurrence in children following failed initial IAC. Materials and Methods: A total of 24 child patients with unilateral or bilateral intra-ocular advanced RB(IIRC Group D and Group E) undergoing second-course IAC treatment after initial intra-arterial chemotherapy between September 2011 and November 2016 were enrolled. Global salvage, ocular adverse events, and systemic adverse events were assessed. Results: Following second-course IAC, 15(62.5%) showed complete control at 34 months follow-up, while 8 cases(33.3%) failed the treatment and 1 patient with metastatic disease(4.2%) eventually died of brain metastasis after refusing treatment. Ocular adverse events included eyelid edema(n=12), ptosis(n=5), forehead erythema(n-5), enophthalmos(n=3), and cataract(n=2). None of the patients had systemic adverse events, such as stroke or sepsis. Also, no secondary neoplasms and technical complications were observed. Conclusion: Second-course IAC is a potential alternative to enucleation in children with advanced RB, who fail an initial course of IAC. However, patients with advanced RB should be managed at experienced centers in order to consider all the alternatives before enucleation.

Twenty-eight Cases of Diabetic Foot Ulcer and Gangrene Treated with the Chinese Herbal Medicine Combined with Injection of Ahylsantinfarctase

Since 1995, the Chinese herbal medicine for supplementing qi and activating blood circulation combined with injection of ahylsantinfarctase into the femoral artery has been used in 28 cases of diabetes complicated with gangrene and ulcer of the foot, with quite good therapeutic effects as reported in the following.……

Clinical Observation of Arteriovenous Combined Chemotherapy in Advanced Gastric Cancer

Objective:To analyze the therapeutic effect and influencing factors of arteriovenous combined chemotherapy in 39 patients with advanced gastric cancer,and to explore the choice of therapeutic strategy.Methods:In this group of patients,the sequence of combined use of arteriovenous chemotherapy was 2 cycles of arterial chemotherapy first,followed by 3~4 cycles of systemic intravenous chemotherapy,and then changed to traditional Chinese medicine,oral chemotherapeutic drugs or immunotherapy after stable disease.Results:Thirty-five patients achieved complete disappearance of symptoms,significant tumor reduction of 26%(PR:13/39),moderate tumor reduction of 51%,18 patients with tumor markers decreased by more than 50%,4 patients completely reduced to normal,half-year survival rate of 90%,1-year survival rate of 56%,3-year survival rate of 33%,5-year survival rate of 10%.Conclusion:The use of arteriovenous combined chemotherapy and embolization in patients with middle and advanced gastric cancer is not only feasible,but also less complications.It can enable some patients to achieve stage II surgical resection,reduce or delay the metastasis and recurrence of patients,improve the quality of life of patients and prolong the survival time.

Retrospective analysis of 56 patients with advanced gastric cancer treated with combination of intravenous and intra-arterial intensified neoadjuvant chemotherapy

Background Pre-operative chemotherapy has gained widespread interest while treating advanced gastric cancer in eastern countries. However, there is currently no established standard regimen for gastric cancer. The aim of this research was to explore the value of preoperative chemotherapy with a combination of intravenous and intra-arterial intensified chemotherapy in advanced .qastric cancer.

医联体县级医院静脉输液治疗专科护理帮扶体系的构建

目的:构建医联体县级医院静脉输液治疗专科护理帮扶体系,为医联体县级医院静脉输液治疗专科护理帮扶提供依据。方法:以“结构-过程-结果”三维质量结构理论为理论基础,运用文献回顾、问卷调查、半结构式访谈初步拟定县级医院静脉输液治疗专科护理帮扶体系初稿,采用德尔菲专家咨询法构建医联体县级医院静脉输液治疗专科护理帮扶体系终稿。结果:3轮专家咨询问卷有效回收率分别为91.3%、100.0%、100.0%,专家权威系数均为0.931,肯德尔协调系数分别为0.239、0.244、0.312,经χ2检验,差异均有统计学意义(P<0.001)。最终形成的医联体县级医院静脉输液治疗专科护理帮扶体系包括结构、过程、结果3项一级指标、11项二级指标和54项三级指标。结论:医联体县级医院静脉输液治疗专科护理帮扶体系具有科学性、可靠性和临床适用性,符合静脉输液治疗专科护理临床实践与护理管理特点,能促进静脉输液治疗专科护理优质资源有效、有序地下沉到县级医院。

大隐静脉高位结扎联合静脉腔内激光术+低分子肝素或利伐沙班治疗股腘深静脉反流的疗效对比

目的探讨大隐静脉高位结扎联合静脉腔内激光术+低分子肝素或利伐沙班治疗股腘深静脉反流的临床疗效和安全性。方法收集2020年1月至2022年1月承德医学院附属医院收治的200例股腘深静脉反流患者的临床资料。按照治疗方法的不同将其分为对照组(n=100,采用大隐静脉高位结扎联合静脉腔内激光术+低分子肝素治疗)和观察组(n=100,采用大隐静脉高位结扎联合静脉腔内激光术+利伐沙班治疗)。比较两组患者静脉临床严重程度(VCSS)、手术前后劳动能力丧失程度、生活质量及术后和随访期间并发症发生情况。结果术后,观察组患者静脉临床严重程度评分(VCSS)、劳动能力丢失评分(VDS)均低于对照组患者,下肢慢性静脉功能不全问卷(CIVIQ)评分高于对照组患者,差异均有统计学意义(P﹤0.05)。观察组患者并发症总发生率低于对照组患者,差异有统计学意义(P﹤0.05)。结论大隐静脉高位结扎联合静脉腔内激光术+利伐沙班治疗股腘深静脉反流的临床疗效优于大隐静脉高位结扎联合静脉腔内激光术+低分子肝素,安全性较高,可显著改善患者治疗后劳动力、生活质量,有较高的临床应用价值。

Clinical analysis of colistin sulfate in the treatment of pneumonia caused by carbapenem-resistant Gram-negative bacteria

BACKGROUND Multidrug-resistant Gram-negative bacteria,exacerbated by excessive use of antimicrobials and immunosuppressants,are a major health threat.AIM To study the clinical efficacy and safety of colistin sulfate in the treatment of carbapenem-resistant Gram-negative bacilli-induced pneumonia,and to provide theoretical reference for clinical diagnosis and treatment.METHODS This retrospective analysis involved 54 patients with Gram-negative bacilli pneumonia admitted to intensive care unit of The General Hospital of the Northern Theater Command of the People's Liberation Army of China from August 2020 to June 2022.After bacteriological culture,the patients'airway secretions were collected to confirm the presence of Gram-negative bacilli.The patients were divided into the experimental and control groups according to the medication used.The research group consisted of 28 patients who received polymyxin sulfate combined with other drugs through intravenous,nebulization,or intravenous combined with nebulization,with a daily dosage of 1.5–3.0 million units.The control group consisted of 26 patients who received standard dosages of other antibiotics(including sulbactam sodium for injection,cefoperazone sodium sulbactam for injection,tigecycline,meropenem,or vaborbactam).RESULTS Of the 28 patients included in the research group,26 patients showed improvement,treatment was ineffective for two patients,and one patient died,with the treatment efficacy rate of 92.82%.Of the 26 patients in the control group,18 patients improved,treatment was ineffective for eight patients,and two patients died,with the treatment efficacy rate of 54.9%;significant difference was observed between the two groups(P<0.05).The levels of white blood cell(WBC),procalcitonin(PCT),and C-reactive protein(CRP)in both groups were significantly lower after treatment than before treatment(P<0.05),and the levels of WBC,PCT,and CRP in the research group were significantly lower than those in the control group(P<0.05).Compared with before treatment,there were no significant changes in aspartate aminotransferase,creatinine,and glomerular filtration rate in both groups,while total bilirubin and alanine aminotransferase decreased after treatment(P<0.05)with no difference between the groups.In patients with good clinical outcomes,the sequential organ failure assessment(SOFA)score was low when treated with inhaled polymyxin sulfate,and specific antibiotic treatment did not improve the outcome.Sepsis and septic shock as well as a low SOFA score were independent factors associated with good clinical outcomes.CONCLUSION Polymyxin sulfate has a significant effect on the treatment of patients with multiple drug-resistant Gram-negative bacilli pneumonia and other infections in the lungs and is safe and reliable.Moreover,the administration route of low-dose intravenous injection combined with nebulization shows better therapeutic effects and lower adverse reactions,providing new ideas for clinical administration.

七氟醚静脉-吸入复合麻醉对合并冠心病的老年腹腔镜手术患者麻醉质量心功能和心血管事件的影响

目的探究七氟醚静脉-吸入复合麻醉对合并冠心病的老年腹腔镜手术患者麻醉质量、心功能和心血管事件的影响。方法回顾性分析浙江省台州医院2020年7月至2023年8月收治的行腹腔镜手术的冠心病患者临床资料,从行丙泊酚麻醉的患者中随机抽取40例纳入对照组,从行七氟醚静脉-吸入复合麻醉的患者中随机抽取40例纳入观察组。比较2组患者麻醉质量(麻醉时间、麻醉满意度、清醒时间、定向恢复时间)差异;记录不同时间点[术前(T0)、手术开始时(T1)、手术进行15 min(T2)、术后(T3)]的生命体征[心率、收缩压(SBP)、舒张压(DBP)];比较T0、T3时的心功能[心排量(CO)、左室射血分数(LVEF)、N末端脑钠肽前体(NT-proBNP)]、心肌酶水平[天冬氨酸转氨酶(AST)、乳酸脱氢酶(LDH)、肌酸激酶同工酶(CK-MB)]、氧化应激[血清去甲肾上腺素(NE)、皮质醇(Cor)、促肾上腺皮质激素(ACTH)]水平;比较2组患者不良心血管事件发生情况。结果观察组满意度评分均高于对照组(P<0.05),观察组麻醉时间、清醒时间、定向恢复时间均低于对照组(P<0.05);在T0、T3时,2组患者心率、SBP、DBP水平差异无统计学意义(P>0.05),T1、T2时,观察组心率、SBP、DBP水平均高于对照组(P<0.05);T3时,2组患者CO、LVEF水平均较T0时降低,且观察组高于对照组(P<0.05),2组患者NT-proBNP、AST、LDH、CK-MB、NE、Cor、ACTH水平均较T0时升高,且观察组低于对照组(P<0.05);观察组心血管不良事件发生情况低于对照组(P<0.05)。结论七氟醚静脉-吸入复合麻醉在合并冠心病的老年腹腔镜手术患者中具有较高的麻醉质量,能减少对心功能的损伤,且不会增加不良心血管事件的发生风险。

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。

银杏叶提取物注射液联合阿替普酶静脉溶栓对脑梗死患者临床预后及氧化应激表达的影响

目的探讨银杏叶提取物注射液、阿替普酶静脉溶栓治疗脑梗死患者的疗效。方法选取2021年11月—2023年7月北京市顺义区空港医院收治的86例脑梗死患者为研究对象,通过随机数表法分为两组,各43例。常规组、研究组分别采用阿替普酶静脉溶栓治疗、银杏叶提取物注射液联合阿替普酶静脉溶栓治疗,比较两组治疗结果。结果治疗后,研究组的丙二醛、超氧化物歧化酶水平分别为(6.17±1.06)µmol/L、(120.66±10.73)U/mL,优于常规组,差异有统计学意义(t=5.224、6.834,P均<0.05)。研究组神经功能评分为(4.51±1.07)分,低于常规组的(7.84±1.68)分,差异有统计学意义(t=10.963,P<0.05)。研究组的炎性因子水平和血流动力学指标、脑血流量均优于对照组,差异有统计学意义(P均<0.05)。结论脑梗死患者采取联合药物(银杏叶提取物注射液+阿替普酶静脉溶栓)治疗法,可以改善氧化应激水平,减轻神经功能缺损,提升脑血流量,降低患者炎性因子水平。

静脉辅助镇静镇痛麻醉联合球后麻醉在玻璃体切除手术的有效性和安全性观察

目的观察单纯球后麻醉与静脉辅助镇静镇痛麻醉联合球后麻醉在玻璃体切除手术中的有效性和安全性。方法前瞻性病例对照研究。在本院进行研究的对象为200名患者,手术治疗时间为2022年2月至2023年6月的玻璃体切除手术。通过随机分组的方式,将200名患者分为对照组和联合组。对照组接受单纯球后麻醉,而联合组则接受静脉辅助镇静镇痛麻醉联合球后麻醉。记录对照组和联合组的实验对象在不同时刻的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO_(2))以及镇静评分:入室后静卧10 min为T0、球后麻醉注射操作时为T_(1)、手术进行30 min为T_(2)、结束手术操作时为T_(3)。在T_(1)时点,我们记录了疼痛的发生率,并记录了两组患者在手术过程中出现的不良反应情况。此外,我们还记录了术前30 min和手术结束时的状态焦虑问卷评分(SAI),以及主刀医生和患者的满意度评分。结果在T_(1)、T_(2)和T_(3)时点,联合组的MAP和HR评分均明显低于对照组,同时镇静评分(Ramsay评分)明显高于对照组(均P<0.05)。在各个时点,联合组与对照组的SpO_(2)相比没有统计学意义上的差异。在T_(1)时点,联合组患者的疼痛发生率比对照组下降了39%;手术过程中,对照组和联合组均未出现恶心、呕吐、抑制呼吸等情况;术前30 min时,对照组和联合组的SAI评分差异无统计学意义(P=0.095),但联合组手术后的SAI评分明显低于对照组(P<0.001);手术医生和患者对联合组的满意度评分均高于对照组(P<0.001)。结论在进行玻璃体切除手术时,结合使用静脉辅助镇静镇痛麻醉和球后麻醉,可以更好地保持患者的血流动力学平稳,增加患者的满意度和舒适度,提高手术的安全性。

超声引导下双侧腹横肌平面阻滞复合静脉自控镇痛泵在腰-硬联合麻醉剖宫产术后产妇中的应用

目的探讨超声引导下双侧腹横肌平面阻滞复合静脉自控镇痛泵在腰-硬联合麻醉剖宫产术后产妇中的应用效果。方法选取2022年5月至2023年6月在我院接受腰-硬联合麻醉剖宫产手术的104例产妇,根据术后镇痛方式不同分为参照组(51例)和研究组(53例)。参照组术后予以常规腹横肌平面阻滞复合静脉自控镇痛泵进行镇痛,研究组术后予以超声引导下双侧腹横肌平面阻滞复合静脉自控镇痛泵进行镇痛,均持续干预至出院。比较两组产妇术后疼痛程度、镇痛泵按压次数、首次下地活动时间、术后住院时间及不良反应。结果研究组术后6 h、12 h的VAS评分低于参照组(P<0.05)。研究组镇痛泵按压次数少于参照组,首次下地活动时间、住院时间短于参照组(P<0.05)。研究组不良反应发生率为5.66%,低于参照组的19.61%(P<0.05)。结论腰-硬联合麻醉剖宫产术后产妇应用超声引导下双侧腹横肌平面阻滞复合静脉自控镇痛泵的镇痛效果较好,能明显促进产妇术后尽快恢复,减少不良反应的发生。

三种麻醉方案在小儿扁桃体腺样体切除术中的应用效果分析

目的:分析三种麻醉方案在小儿扁桃体腺样体切除术中的应用效果。方法:选取2021年4月—2022年4月于东营市广饶县人民医院行扁桃体腺样体切除术的368例患儿作为研究对象,依据随机数字表法分为研究组(n=152)、参照组(n=135)、对照组(n=81)。对照组实施全凭静脉麻醉;参照组持续静脉麻醉、吸入七氟醚;研究组手术前期维持静脉麻醉,术毕前10 min转为吸入七氟醚。比较三组麻醉效果。结果:手术开始后5 min、手术结束前5 min,参照组心率(HR)、平均动脉压(MAP)高于切皮前,且高于研究组、对照组,差异有统计学意义(P<0.05);研究组与对照组HR、MAP比较,差异无统计学意义(P>0.05)。三组手术时间比较,差异无统计学意义(P=0.228);研究组拔管时间、苏醒室停留时间短于参照组、对照组,参照组拔管、苏醒室停留时间短于对照组,差异有统计学意义(P<0.05)。参照组躁动发生率高于研究组、对照组,差异有统计学意义(P<0.05);研究组与对照组躁动发生率比较,差异无统计学意义(P=0.170)。结论:小儿扁桃体腺样体切除术中,手术前期维持静脉麻醉、术毕前10 min转为七氟醚吸入的麻醉方案可稳定患儿血流动力学,促进术后苏醒,降低躁动发生率。

不同剂量艾司氯胺酮复合舒芬太尼在剖宫产术后静脉自控镇痛中的应用效果

目的探讨不同剂量艾司氯胺酮复合舒芬太尼在剖宫产术后静脉自控镇痛(PCIA)中的应用效果。方法选取2022年3月至2023年3月上饶市人民医院进行剖宫产术的148例产妇为研究对象,按照随机数字表法分为高剂量组(74例)和低剂量组(74例)。低剂量组注射用生理盐水稀释至150ml的1.5μg/kg的舒芬太尼+4mg的托烷司琼+0.1mg/kg的艾司氯胺酮,高剂量组注射用生理盐水稀释至150ml的1.5μg/kg的舒芬太尼+4mg的托烷司琼+0.2mg/kg的艾司氯胺酮。比较两组产妇术毕,术后1、2d时血流动力学[心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO_(2))]、疼痛情况[McGill疼痛问卷(SF-MPQ)]差异,分析两组产妇麻醉相关不良反应发生差异。结果术后1、2d时,两组产妇的HR、MAP高于本组术毕时,高剂量组产妇的HR、MAP低于低剂量组,差异有统计学意义(P<0.05)。术后1d时,高剂量组产妇的SpO_(2),低于本组术毕时,差异有统计学意义(P<0.05)。术后1、2d时,低剂量组的SpO_(2),均低于本组术毕时,差异有统计学意义(P<0.05)。术后2d时,高剂量组产妇的SpO_(2),与本组术毕时比较,差异无统计学意义(P>0.05)。术后1、2d时,高剂量组产妇的SpO_(2),均高于低剂量组产妇,差异有统计学意义(P<0.05)。术后1、2d时,两组产妇的SF-MPQ评分均低于本组术毕时,且高剂量组产妇低于低剂量组,差异有统计学意义(P<0.05)。高剂量组的不良反应总发生率低于低剂量组,差异有统计学意义(P<0.05)。结论0.2mg/kg艾司氯胺酮复合舒芬太尼在剖宫产术后PCIA中的效果优于0.1mg/kg的艾司氯胺酮,能更有效维持血流动力学指标水平稳定,镇痛效果确切,安全性不受艾司氯胺酮剂量影响。

静吸复合全身麻醉在妇科腔镜手术患者中的应用效果

目的:观察静吸复合全身麻醉在妇科腔镜手术患者中的应用效果。方法:选取2021年4月至2023年6月于该院行妇科腔镜手术治疗的300例患者进行前瞻性研究,按照随机数字表法将其分为对照组和观察组各150例。对照组采用静脉全身麻醉,观察组采用静吸复合全身麻醉。比较两组麻醉相关指标(麻醉起效时间、麻醉清醒时间、拔管时间)水平,不同时间[麻醉诱导前5 min(T_(0))、手术开始后5 min(T_(1))、术毕(T_(2))]血流动力学指标(平均动脉压、心率)水平,术后不同时间疼痛[视觉模拟评分法(VAS)]评分、镇静(Ramsay镇静评分法)评分,以及不良反应发生率。结果:观察组麻醉起效时间、麻醉清醒时间、拔管时间均短于对照组,差异有统计学意义(P<0.05);T_(1)、T_(2)时,两组平均动脉压、心率水平均低于T_(0)时,但观察组高于对照组,差异有统计学意义(P<0.05);术后3、6 h,观察组VAS评分均低于对照组,差异有统计学意义(P<0.05);术后5、15 min,观察组Ramsay镇静评分均高于对照组,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:静吸复合全身麻醉应用于妇科腔镜手术患者可改善麻醉相关指标水平,稳定血流动力学指标水平,降低疼痛评分,提高镇静评分,效果优于静脉全身麻醉。