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.

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.

Postoperative Analgesia and Cesarean Section under General Anesthesia: Multicenter Study

Background: Neuraxial anesthesia with intrathecal morphine is the reference technique in cesarean section anesthesia for the management of postoperative analgesia. If there is a contraindication to this, general anesthesia is required. The objective of the study was to evaluate the analgesic effectiveness of 4 analgesic techniques performed during cesarean section under general anesthesia in two centers with different anesthetic practices (North Franche Comté Hospital and Omar Bongo Ondimba Army Training Hospital). Method: This is a retrospective and descriptive study over 2 years, from January 1, 2019 to December 31, 2020. It involved evaluating the analgesic effectiveness and tolerance of morphine in the epidural catheter, wound infiltration, intravenous analgesia and Transversus Abdominous Plane block (TAP block) from the post-anesthesia care unit (PACU) until the 4th post-operative day. Results: Of the 354 cesarean sections performed, 84 (11.14%) received general anesthesia. The average age was 32.27 years. Acute fetal distress was the first indication for cesarean section (45.2%), followed by hemorrhagic placenta previa (10.7%) and prolapse of the cord (8.33%). Morphine in the epidural catheter was the most used (47.6%) followed by parietal infiltration (36.9%), intravenous analgesia (13.1%) and TAP block (2.38%). The analgesic effectiveness was comparable between the techniques from postoperative day 0 to day 4. No difference in side effects. Postoperative morphine consumption was significantly reduced (p = 0.011) in the infiltration (9 mg) and TAP block (9mg) groups compared to the epidural catheter (16 mg) and intravenous analgesia (17 mg). No difference in 02 rehabilitation criteria (ambulation, first bowel movement). No difference in the occurrence of chronic pain. Conclusion: In the event of a cesarean section under general anesthesia, there are effective and well-tolerated alternatives to neuraxial anesthesia, particularly regional anesthesia techniques (nerve blocks), particularly in countries with low availability of morphine.

Patient-controlled intravenous fentanyl for cystospasm after transurethral resection of the prostate

Objective： To evaluate the clinical efficacy and safety of patient-controlled intravenous analgesia （PCIA） with fentanyl for cystospasm after transurethral resection of the prostate. Methods： Sixty benign prostatic hyperplasia （BPH） patients scheduled for transurethral resection of the prostate （TURP） under general anesthesia with laryngeal mask airway （LMA） were randomly divided into groups F and S. Group F （n=30） received PCIA device with fentanyl 10 ug/kg＋8 mg ondansetron, and Group S （n=30） received placebo （PCIA device with 8 mg ondansetron）. The visual analog scale （VAS） scores for pain were evaluated at 0, 2, 4, 8, 16, 24, and 48 h by the same staff. And recorded were incidence of cystospasm, side effects, application of hemostatic, duration of drawing Foley catheter and continuous bladder irrigation, time of exhaust after operation, time of post-operative stay and cost of hospitalization. Results： The incidence of cystospasm in Group F was significantly lower than that in Group S in the 48 h after operation （P〈0.05）, the VAS scores for pain in Group F was significantly lower than that in Group S within the 48 h after operation （P〈0.01）. The time of exhaust after operation in Group F was significantly later than in Group S （P〈0.05）. No significant difference was observed in applications of hemostatic, duration of drawing Foley catheter, duration of continuous bladder irrigation, time of post-operative stay and cost of hospitalization between the 2 groups. Conclusion： PCIA with fentanyl （10 ug/kg） relieves pain with little side effect and reduces cystospasm satisfactorily.

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。

腰-硬联合麻醉剖宫产术后超声引导双侧腹横肌平面阻滞的镇痛效果探讨

目的探讨静脉自控镇痛联合超声引导双侧腹横肌平面阻滞在腰-硬联合麻醉剖宫产术后的有效性和安全性。方法选取68例剖宫产产妇为研究对象,根据随机数字表法分为两组,各34例。对照组予以静脉自控镇痛,研究组在对照组基础上联合超声引导双侧腹横肌平面阻滞,比较两组的疼痛程度、镇痛效果及应激反应。结果研究组术后12h、24h、48h的视觉模拟评分量表得分均低于对照组,自控镇痛需求次数少于对照组,差异有统计学意义(P<0.05);术后48h,研究组去甲肾上腺素、皮质醇、血管紧张素Ⅱ水平低于对照组,差异有统计学意义(P<0.05);术后48h,研究组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)高于对照组,差异有统计学意义(P<0.05)。结论腰-硬联合麻醉剖宫产术后实施静脉自控镇痛联合超声引导双侧腹横肌平面阻滞,可明显降低产妇疼痛感,减少镇痛药物使用次数,应激反应低,免疫功能影响小,值得应用。

超前镇痛对腹部手术全麻患者术后认知功能障碍的影响

目的分析超前镇痛干预对腹部手术全麻患者术后认知功能的影响。方法择期开腹胃肠部手术、麻醉时间超过3小时的患者40例,分为四组,全凭静脉麻醉组(TIVA组)10例与全凭静脉麻醉+超前镇痛干预组(TIVA干预组)10例;静吸复合麻醉组(CIIA组)10例与静吸复合麻醉+超前镇痛干预组(CIIA干预组)10例。术前1天、术后1天、术后7天对所有患者采用简易精神状态检查量表(MMSE)、连线测验量表(TMT)、简易视觉记忆量表(BVMT)、霍普金斯词语学习量表(HVLT)进行认知功能的评分,并检测血清C-反应蛋白(CRP)、白介素-6(IL-6)含量,对所有患者术后24小时均用视觉模拟评分法(VAS)进行疼痛评分,比较四组患者认知功能、CRP与IL-6含量、VAS评分的差异。结果 TIVA、CIIA、CIIA干预三组患者术后1天MMSE、BVMT、HVLT评分下降明显(P<0.05):MMSE、BVMT评分下降最多的是CIIA组;HVLT-T评分下降最多的是CIIA与CIIA干预组;术后7天TIVA组患者HVLT-R评分恢复到术前1天水平,CIIA组患者HVLT-R评分虽较术后1天有所改善但仍低于术前1天水平(P<0.05);术后7天CIIA、CIIA干预两组患者HVLT-T评仍低于术前1天水平(P<0.05)。TIVA干预与CIIA干预两组术后24小时VAS评分明显低于TIVA与CIIA组(P<0.05)。TIVA干预、CIIA干预两组术后1天CRP、IL-6含量的总体均数明显低于TIVA、CIIA两组(P<0.05)。结论七氟醚在术后短时间POCD发生中占主导地位;而NASIDs类药物帕瑞昔布钠和局部神经阻滞超前镇痛对于POCD的影响有局限性,在全凭静脉麻醉患者应用则有积极作用,对于持续吸入3小时以上七氟醚的静吸复合麻醉患者作用不明显。

手术室外麻醉11878例分析

【目的】对我院开展手术室外麻醉5年来的病例进行回顾性分析,旨在探讨院内进一步开展手术室外麻醉的安全性与可行性。【方法】应用全凭静脉麻醉在门诊内窥镜室开展无痛苦胃肠镜检查,以及与产科联合开展的无痛宫腔内诊疗;应用腰麻-硬膜外联合镇痛(Combined Spinal Epidural Analgesia,CSEA)与自控硬膜外镇痛(Patient Controlled Epidural Analgesia,PCEA)技术为产妇实施无痛分娩。【结果】5年来,共实施手术室外麻醉11878例。在手术室外实施全凭静脉麻醉共11 381例,并发症或意外的发生率仅为1.58‰(18例);在妇产科实施无痛分娩497例,其中自然分娩成功率为94.80%(471/497)。另外,无痛苦胃肠镜及宫腔内诊疗量占年总就诊量的比值逐年上升;总诊疗量5年来也呈现递增现象。【结论】我院开展的四项手术室外麻醉安全、可行,该研究为进一步开展手术室外麻醉提供了有利的临床依据。

开胸手术两种不同麻醉与镇痛方法的效果比较

目的 :比较开胸手术下两种不同麻醉与镇痛方法的效果。方法 :将 10 0例病人随机分成 2组 ,Ⅰ组 60例 ,采用全麻 -硬膜外联合麻醉 ,术中维持用异丙酚 2～ 4mg/ (kg·h)微泵静滴及硬膜外追加 1 2 %利多卡因、0 15 %丁卡因 ,必要时按需吸入少量异氟醚 ,术后行硬膜外镇痛。Ⅱ组 40例 ,采用静吸复合全麻 ,术中维持用异丙酚 2～ 6mg/ (kg·h)及吸入异氟醚维持 ,术后行静脉镇痛。分别监测两组病人麻醉前、插管即刻、去肋开胸、手术探查、拔管时的SBP、DBP、HR ,术后清醒时间、术毕躁动及术后镇痛效果情况。结果 :Ⅰ组病人麻醉及手术过程中 ,BP、HR平稳 ,术后患者苏醒快 ,苏醒质量及术后镇痛效果佳 ;Ⅱ组病人BP、HR波动较大 ,且患者苏醒相对缓慢 ,苏醒质量及术后镇痛效果相对欠佳。结论 :全麻

腰硬联合阻滞与瑞芬太尼静脉镇痛对全程分娩的镇痛效果比较

目的比较腰硬联合阻滞(CSEA)与瑞芬太尼静脉镇痛对全程分娩镇痛的效果。方法自愿接受全程分娩镇痛的产妇150例,根据随机数字表法分为治疗组与对照组各75例,治疗组给予CSEA镇痛,对照组给予瑞芬太尼静脉镇痛,记录镇痛效果与分娩预后。结果在第一产程与第二产程的时间上,两组产妇比较差异无统计学意义(P>0.05),但治疗组患儿的1和5min Apgar评分高于对照组(P<0.05)。治疗组潜伏期末、宫口全开、胎儿娩出时的疼痛VAS评分都低于对照组(P<0.05)。在镇痛期间,瘙痒、低血压等不良反应的发生率方面,治疗组为2.7%,对照组为16.0%,治疗组低于对照组(P<0.05)。治疗组t1、t2时间点的血清皮质醇(CORT)值低于对照组(P<0.05),t3时间点的CD^+4/CD^+8值高于对照组(P<0.05),其他时间点比较差异无统计学意义(P>0.05)。结论相对于瑞芬太尼静脉镇痛,CSEA在全程分娩镇痛中的应用能有效降低产妇的应激反应,有一定的保护作用,能减少对产妇与新生儿的负面影响,发挥更好的镇痛效果。

腰-硬联合麻醉剖宫产术后超声引导双侧TAP阻滞的镇痛效果观察

目的:探讨腰-硬联合麻醉剖宫产术后超声引导双侧腹横肌平面(TAP)阻滞的镇痛效果。方法:选择2018年1月—2018年5月在我院接受剖宫产手术治疗的208例产妇作为研究对象,采用随机数字表法分为对照组和观察组,各104例。两组均采用腰-硬联合麻醉,对照组术后采用静脉自控镇痛,观察组在对照组的基础上给予超声引导双侧TAP阻滞。观察两组术毕、术后24 h、术后48 h时视觉模拟法(VAS)疼痛评分,术前、术毕、术后24 h、术后48 h时皮质醇、血糖、白细胞介素(IL)-6水平,术前、术后1 d、术后3 d、术后7 d焦虑自评量表(SAS)和抑郁自评量表(SDS)评分,统计两组镇痛泵按压次数及恶心呕吐发生率。结果:两组术毕时VAS评分比较差异无统计学意义(P> 0.05);观察组术后24 h、术后48 h时VAS评分低于对照组,差异有统计学意义(P <0.05);两组术毕时皮质醇、血糖、IL-6水平较术前显著升高,差异有统计学意义(P <0.05);两组术后24 h皮质醇、血糖、IL-6水平较术毕时显著降低,且观察组低于对照组,差异有统计学意义(P <0.05);观察组镇痛泵按压次数和恶心呕吐发生率显著低于对照组,差异有统计学意义(P <0.05);观察组术后1 d、术后3 d时SAS和SDS低于对照组,差异有统计学意义(P <0.05)。结论:腰-硬联合麻醉剖宫产术后超声引导双侧TAP阻滞可提高镇痛效果,减少阿片类药物应用,降低恶心呕吐发生率和应激反应程度,消除产妇负性心理,值得临床推广应用。

椎管内联合静脉麻醉不同产程行分娩镇痛可行性初探

目的探讨椎管内联合静脉麻醉不同产程行分娩镇痛的有效性和安全性。方法 450例初产妇随机分为腰麻-硬膜外联合阻滞(CSEA)组、瑞芬太尼(RF)组和对照组,每组150例。CSEA组产妇仅在第一、三产程实施椎管内镇痛;RF组在第一产程实施椎管内镇痛,第二、三产程实施瑞芬太尼自控静脉镇痛;对照组未实施任何镇痛。观察三组在第二产程视觉模拟评分(VAS)、生命体征改变、动脉血气分析、胎心率、第二产程时间、新生儿Apgar评分、不良反应等。结果 RF组第二产程VAS评分明显优于其他两组,RF组动脉血二氧化碳分压(Pa CO2)高于CSEA组和对照组(P<0.05),其他指标三组比较差异无统计学意义(P>0.05)。结论不同产程使用椎管内联合瑞芬太尼自控镇痛行全产程分娩镇痛,尤其是瑞芬太尼静脉自控镇痛应用于第二、三产程,镇痛效果满意,对产妇和胎儿无不良影响,椎管内联合瑞芬太尼自控镇痛,取长补短,是一种安全有效的全产程镇痛方法 ,值得在临床进一步探讨研究。

超声引导双侧TAP阻滞在腰-硬联合麻醉剖宫产术后的应用效果

目的探讨超声引导双侧腹横肌平面(TAP)阻滞在腰-硬联合麻醉剖宫产术后的应用效果。方法选取2020年1月至2021年12月接收的60例腰-硬联合麻醉剖宫产产妇作为研究对象,采用电脑盲选法将其分为对照组(n=30,静脉自控镇痛)和研究组(n=30,超声引导双侧TAP阻滞^(+)静脉自控镇痛)。比较两组的镇痛效果。结果术后12、24、48 h,研究组的视觉模拟评分法(VAS)评分低于对照组,差异具有统计学意义(P<0.05)。术后48 h,研究组的皮质醇(Cor)、去甲肾上腺素(NE)、血管紧张素Ⅱ(AngⅡ)、神经元特异性烯醇化酶(NSE)、中枢神经特异蛋白(S100β)水平低于对照组,白细胞分化抗原3阳性(CD3^(+))、白细胞分化抗原4阳性(CD4^(+))、白细胞分化抗原4阳性/白细胞分化抗原8阳性(CD4^(+)/CD8^(+))高于对照组,差异具有统计学意义(P<0.05)。结论超声引导双侧TAP阻滞用于腰-硬联合麻醉剖宫产术后可减轻疼痛及应激反应,对免疫功能的影响小,值得临床应用和推广。

硬膜外复合全麻在乳腺癌切除同期乳房再造的镇痛效果分析

目的分析硬膜外复合全麻在乳腺癌切除同期乳房再造的镇痛效果。方法选择2018年1月~2020年6月行乳腺癌切除术同期乳房再造的患者作为研究对象。其中采用硬膜外复合全麻28例纳入观察组,单纯全身麻醉者40例纳入对照组。比较不同时间点平均动脉压、心率;术后2h、6h、24h、48h的疼痛视觉模糊评分,48h内PCIA按压次数;皮瓣相关并发症及麻醉相关并发症。结果T0时两组MAP、HR比较差异无统计学意义(P>0.05)。T1-4时观察组MAP、HR均低于对照组,差异有统计学意义(P<0.05)。两组患者术后2hVAS评分比较差异无统计学意义。术后6h、24h、48hVAS评分均低于对照组,差异有统计学意义(P<0.05)。观察组术后48h内PCIA按压(1.68±1.08)次,低于对照组(2.75±1.46)次,差异有统计学意义(P<0.05)。观察组发生皮瓣危象2例,对照组发生皮瓣危象4例,两组比较差异无统计学意义(P>0.05)。观察组发生恶心3例,呕吐2例,少于对照组(恶心15例,呕吐12例),差异有统计学意义(P>0.05)。结论硬膜外复合全麻在乳腺癌切除同期乳房再造中生命体征稳定,且可提高术后镇痛效果,降低术后麻醉相关不良反应。

腰硬联合麻醉分娩镇痛复合静脉和硬膜外布托啡诺安全性及有效性研究

目的探讨静脉和硬膜外复合给予布托啡诺在腰硬联合麻醉分娩镇痛效果中的有效性和安全性。方法选择要求行分娩镇痛的足月自然分娩初产妇297例,按随机数字表法分为3组:无布托啡诺组(Ⅰ组,98例)、布托啡诺硬膜外给药组(Ⅱ组,100例)、布托啡诺静脉+硬膜外联合给药组(Ⅲ组,99例)。3组产妇均行腰硬联合麻醉分娩镇痛:蛛网膜下腔给予舒芬太尼2μg,硬膜外腔分别给予不同混合液3 ml(试验量)+10 ml(Ⅰ组为罗哌卡因150 mg+舒芬太尼48μg,Ⅱ组、Ⅲ组为罗哌卡因150 mg+舒芬太尼48μg+布托啡诺2 mg,均使用生理盐水稀释到200 ml);接着Ⅰ组、Ⅱ组给予生理盐水5 ml,Ⅲ组给予布托啡诺0.5 mg/5 ml入墨菲式滴管静脉滴注;在硬膜外腔以7 ml/h泵入混合液直至胎盘娩出后12 h。宫口开至3 cm分娩镇痛前即刻(T_(0))、给予硬膜外总量后20 min即刻(T_(1))、宫口开全即刻(T_(2))、胎儿娩出即刻(T_(3))、胎盘娩出即刻(T_(4))、胎盘娩出后4 h(T_(5))、胎盘娩出后8 h(T_(6))分别采用视觉模拟评分法(VAS)疼痛评分、Ramsay镇静评分和Bromage改良评分对产妇进行疼痛、镇静和下肢运动神经阻滞程度评分,同时记录产妇T_(1)、T_(2)时的平均动脉压(MAP)、心率、脉搏血氧饱和度(SpO_(2))、呼吸频率;检测T_(0)、T_(4)、T_(6)时产妇静脉血P物质、5-羟色胺(5-HT)、亮脑啡肽、β-内啡肽(β-EP)含量;记录第一、第二、第三产程时间及使用催产素例数,新生儿1 min、5 min、10 min Apgar评分和脐动脉血气分析[pH、动脉血二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2))、乳酸(Lac)];观察记录产妇不良反应(分娩方式改变、呼吸抑制、嗜睡、低血压、恶心、呕吐、寒战、尿潴留、皮肤瘙痒)发生情况。结果T_(2)、T_(3)时,Ⅱ组和Ⅲ组VAS疼痛评分低于Ⅰ组,且Ⅲ组低于Ⅱ组(均P<0.05);T_(1)、T_(2)时,Ⅱ组、Ⅲ组Ramsay镇静评分高于Ⅰ组,且Ⅲ组高于Ⅱ组(均P<0.05);与T_(0)时比较,3组产妇T_(1)~T_(6)时VAS疼痛评分降低(均P<0.05),Ramsay镇静评分升高(均P<0.05);3组产妇Bromage改良评分均为0分。T_(3)时,Ⅲ组MAP低于Ⅰ组和Ⅱ组(均P<0.05);与T_(0)时比较,3组产妇T_(1)~T_(6)时MAP、心率、呼吸频率均降低(均P<0.05)。T_(4)时,Ⅱ组P物质含量低于Ⅰ组,Ⅱ组、Ⅲ组亮脑啡肽、β-EP含量高于Ⅰ组(均P<0.05);与T_(0)时比较,3组产妇T_(4)、T_(6)时P物质、5-HT含量降低,亮脑啡肽、β-EP含量升高(均P<0.05);与T_(4)时比较,3组产妇T_(6)时P物质、亮脑啡肽、β-EP含量降低(均P<0.05)。其余时点各指标差异无统计学意义(均P>0.05)。3组产妇第一、第二、第三产程时间,使用催产素例数,新生儿1 min、5 min、10 min Apgar评分和脐动脉血气分析(pH、PaCO_(2)、PaO_(2)、Lac)差异无统计学意义(均P>0.05)。3组产妇分娩期间未发生分娩方式改变、呼吸抑制、嗜睡、低血压、寒战、尿潴留等不良反应;Ⅲ组恶心、呕吐、皮肤瘙痒发生率低于Ⅰ组、Ⅱ组(均P<0.05),Ⅱ组恶心、呕吐、皮肤瘙痒发生率低于Ⅰ组(均P<0.05)。结论腰硬联合麻醉分娩镇痛中静脉和硬膜外复合给予布托啡诺能最大程度地减轻器质性疼痛及心理应激反应,提高产妇自然分娩时的舒适度,取得良好的分娩镇痛临床效果。

肋间神经阻滞复合全麻联合静脉自控镇痛对胸腔镜肺大疱切除术患者术后镇痛效果及恢复情况的影响

目的:探讨在胸腔镜肺大疱切除术中应用肋间神经阻滞复合全麻联合静脉自控镇痛的术后镇痛效果及患者恢复情况。方法:研究对象选取进行胸腔镜肺大疱切除术的80例患者,依据简单数字表法分为对照组和观察组,每组各40例。对照组接受全麻联合静脉自控镇痛,观察组在此基础上复合肋间神经阻滞,比较两组术后镇痛效果及恢复情况。结果:与术前比,术后12 h、24 h两组患者的CD4^(+)、CD4^(+)/CD8^(+)均先降低后升高,且观察组各时间点均高于对照组;两组患者的CD8^(+)均先升高后降低,且观察组各时间点均低于对照组(P<0.05)。术后24 h、48 h,观察组比对照组在镇痛泵按压次数和输注镇痛药物总量有减少(P<0.05)。与对照组比,观察组患者的术毕到拔管时间、下床活动时间、住院时间均更短(P<0.05)。与对照组(22.50%、20.00%)比,观察组患者的并发症、不良反应总发生率(2.50%、5.00%)更低(P<0.05)。结论:在胸腔镜肺大疱切除术中应用肋间神经阻滞复合全麻联合静脉自控镇痛,取得了显著的镇痛成效,不仅能够减轻患者的术后疼痛,还能减轻机体免疫抑制,同时不增加并发症和不良反应发生风险,临床应用安全性较高。

右美托咪定在剖宫产术麻醉与分娩镇痛中的研究进展

右美托咪定(DEX)是一种高选择性α2肾上腺素受体激动剂,近年已在剖宫产术麻醉与分娩镇痛中广泛应用。临床研究结果证实,DEX在剖宫产术分娩中具有独特优势,如改善剖宫产术中麻醉及术后镇痛效果,有效预防和治疗剖宫产术中寒战、牵拉反应和宫缩剂所致不良反应,维持血流动力学稳定,以及提高分娩镇痛效果。笔者拟就DEX在剖宫产术麻醉与分娩镇痛中的研究进展进行阐述。

不同麻醉方式对早期肺癌术后感染率及疼痛状态的影响

目的:探讨全凭静脉麻醉(TIVA)与全麻复合硬膜外阻滞(CGEA)对早期肺癌术后感染率及疼痛状态的影响。方法:按麻醉方式不同将79例早期肺癌患者分为TIVA组(n=38)与CGEA组(n=41),比较两组苏醒时间、拔管时间、术后切口、肺部感染发生率及术后0、6、12、24、48h的疼痛评分。结果:CGEA组苏醒时间及拔管时间明显少于TIVA组。两组术后感染发生率比较有统计学意义。两组术后0、12、24、48h的疼痛评分比较无统计学意义,CGEA组术后6h的疼痛评分明显低于TIVA组。结论:全麻复合硬膜外阻滞术后肺部感染发生率低,镇痛良好,可作为早期肺癌患者的优选麻醉方法。

Effect of direct current pulse stimulating acupoints of JiaJi (T10-L3) and Ciliao (BL 32) with Han's Acupoint Nerve Stimulator on labour pain in women: a randomized controlled clinical study

OBJECTIVE: To assess the clinical effect and safety of direct current(DC) pulse produced by Han's Acupoint Nerve Stimulator in reduction(HANS) of labor pain.METHODS: Totally 120 participants were enrolled in this clinical trial, and were randomly divided into4 groups including: HANS group, patient controlled intravenous analgesia(PCIA) group, patient-controlled epidural analgesia(PCEA) group and control group. The HANS group was treated by stimulating the acupoints of Jia Ji(T10-L3) and Ciliao(BL 32)with DC pulse of 100 Hz and 15-30 m A produced by a portable battery-powered Han's Acupoint Nerve Stimulator for 30 min. The PCIA group was intravenously infused Ondansetron(8 mg) for 5 min,then tramadol injection(1.5 mg/kg) was slowly dripped by using Baxter APⅡ electronic pump with50 m L tramadol(0.70%) + ondansetron(8 mg),background infusion 2 m L/h, PCA dose of 2 m L,lockout interval of 10 min. In PCEA group, women received intrathecal injection ropivacaine(3 mg) in L2-3, and epidural catheter was connected to Baxter APⅡ electronic pump, with 100 m L Ropivacaine(0.1%) and Sufentanil(50 ug), background infusion5 m L, Patient controlled analgesia(PCA) dose of 5m L, lockout interval of 10 min. The control group was not received analgesia. The visual analogue scale(VAS), stage and manner of labor, Apgar score of newborn, neonatal weights, oxytocin dosage,postpartum hemorrhage and side effects were monitored in all groups.RESULTS: The vital signs were all stable in the four analgesic groups. After analgesia, there was statistical difference in VAS score between HANS group and control group, between PCEA group and the control group, between PCIA group and control group. The analgesic effect in the PCEA group was significantly better than that of other two groups.The second stage of labor in the PCEA group was longer than the other three groups, showing significant difference between them. The Apgar score of newborn 1min after birth in the PCIA group was slightly lower than that of the other two groups,showing significant difference between them. The neonatal weights between four groups were not significantly different. The rate of cesarean sectionin the control group was significantly higher than that of the labor analgesia group, there was statistically difference in four groups. The number of PCIA group that used oxytocin was lower than that of other three groups. There was no significant difference in postpartum hemorrhage between four groups. The side effects of the PCEA group were itching, uroschesis and neonatal asphyxia and PCIA group were nausea and vomiting and neonatal asphyxia. However, fewer side effects were observed in the HANS group.CONCLUSION: The DC pulse produced by HANS may be a non-pharmacological alternative to labor pain with fewer side effects.