Assessing the Impact of General Anesthesia and Bronchial Intubation in Conjunction with Thoracic Paravertebral Nerve Block on Cellular Immunity and Surgical Management in Tuberculous Pyothorax Patients

Objective:This study aims to investigate the impact of combining general anesthesia with bronchial intubation and thoracic paravertebral nerve block during surgery for patients with tuberculous pyothorax.Methods:Eighty patients diagnosed with tuberculous pyothorax,admitted to the hospital between January 2023 and September 2023,were randomly selected for this study.The patients were divided into control and study groups using a numerical table method.The control group underwent general anesthesia with bronchial intubation,while the study group received general anesthesia with bronchial intubation in conjunction with thoracic paravertebral nerve block.Subsequently,the patients were monitored to assess mean arterial pressure,heart rate variations,and adverse reactions to anesthesia.Results:The study group exhibited significantly lower mean arterial pressure and heart rate levels during the post-surgical incision,immediate end of surgery,and immediate extubation periods compared to the control group(P<0.05).Furthermore,the Ricker and Ramsay scores in the study group were significantly lower than those in the control group(P<0.05).Conclusion:The combined use of general anesthesia via bronchial intubation and thoracic paravertebral nerve block has been found to stabilize mean arterial pressure and heart rate while providing effective sedation for surgical treatment in patients with tuberculous septic thorax.

Peripheral Nerve Block Combined with Epidural Anesthesia for Incarcerated Inguinal Hernia Repair in a Patient with Severe Chronic Obstructive Pulmonary Disease: A Case Report

Background: Invasive mechanical ventilation worsens prognosis in patients with severe chronic obstructive pulmonary disease (COPD). To avoid complications in these patients, anesthesia should be carefully considered. Case presentation: A 78-year-old man with COPD presented with dyspnea and pain from the epigastric to the umbilical regions. He was diagnosed with left incarcerated inguinal hernia and underwent radical inguinal hernia repair and surgical ileus treatment. To avoid general anesthesia with tracheal intubation, epidural anesthesia was combined with peripheral nerve blocks. An epidural catheter was inserted from T12/L1, and ilioinguinal-iliohypogastric and genitofemoral nerve blocks were performed under ultrasound guidance. No post-surgery complications or pain symptoms were noted. Conclusions: General anesthesia would likely have been challenging due to the patient’s COPD;however, management of peritoneal traction pain is difficult using peripheral nerve block alone. By combining epidural anesthesia with peripheral nerve blocks, we safely performed a procedure in a patient with severe COPD while avoiding invasive positive pressure ventilation.

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.

Combined Sciatic-Lumbar Plexus Block with General Anesthesia: Efficacy in Preventing Tourniquet-Induced Hemodynamic Changes

Background: Pneumatic arterial tourniquet is a utilized strategy in limb surgeries to provide bloodless field to facilitate surgical procedure. Be that as it may, arterial tourniquet has numerous injurious impacts including hemodynamic changes and tourniquet-induced pain which sometimes can be severe and intolerable. Objectives: Our primary aim was to assess the impact of performing “Lumbar Plexus Block and sciatic nerve block” with General Anesthesia (GA) on the degree of arterial tourniquet-induced hemodynamic effects. On the other hand, our secondary aims were: amount of postoperative analgesic prerequisites, patient satisfactory score and documented side effects. Settings and Design: Ain Shams University, Orthopedic operating theatre;a prospective, randomized, double-blind study. Methods and Material: The physical status of 50 patients (both sexes) including I and II patients from American Society of Anesthesiologists, whose ages are from 20 - 40 years, is not so ideal when they are undergoing elective knee Arthroscopy. The duration lasts no more than ninety minutes under GA with application of tourniquet. Patients were allotted haphazardly to one of two groups. In Group C (Control group): Only GA. In Group B: LPB and sciatic nerve block were performed just before GA administration. Intraoperative hemodynamics was recorded at specific timings. Results: Incidence of tourniquet induced hypertension (TIH) was markedly less with Group B at: forty five, sixty, seventy five mins after tourniquet inflation and just before tourniquet deflation. Also, the total ketorolac consumption during first 24 hours of postoperative period was significantly less with Group B (p Conclusions: Combined Sciatic-Lumbar plexus blocks when combined with general anesthesia were very effective in attenuating TIH.

The gap junction blocker carbenoxolone enhances propofol and sevoflurane-induced loss of consciousness

General anesthetics induce loss of consciousness by inhibiting ascending arousal pathways, and they interfere with gap junction electrical coupling. The present study aimed to determine whether inhibition of gap junction-mediated signaling could influence general anesthetic-induced loss of consciousness. The general anesthetics sevoflurane and propofol were used. Intracerebroventricular administration of carbenoxolone, a gap junction blocker, significantly decreased the time to loss of the righting reflex （P 0.05）, but prolonged the time to recovery of the reflex （P 0.05）. Moreover, intracerebroventricular administration of carbenoxolone increased the sensitivity to sevoflurane, with a leftward shift of the loss of righting reflex dose-response curve, and decreased the 50% effective concentration of sevoflurane. These results suggest that the gap junction blocker carbenoxolone enhances propofol and sevoflurane-mediated general anesthesia.

Regional anesthesia for orthopedic procedures:What orthopedic surgeons need to know

Regional anesthesia is an integral component of successful orthopedic surgery.Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia.Patient evaluation for regional anesthesia should include neurological,pulmonary,cardiovascular,and hematological assessments.Neuraxial blocks include spinal,epidural,and combined spinal epidural.Upper extremity peripheral nerve blocks include interscalene,supraclavicular,infraclavicular,and axillary.Lower extremity peripheral nerve blocks include femoral nerve block,saphenous nerve block,sciatic nerve block,iPACK block,ankle block and lumbar plexus block.The choice of regional anesthesia is a unanimous decision made by the surgeon,the anesthesiologist,and the patient based on a risk-benefit assessment.The choice of the regional block depends on patient cooperation,patient positing,operative structures,operative manipulation,tourniquet use and the impact of postoperative motor blockade on initiation of physical therapy.Regional anesthesia is safe but has an inherent risk of failure and a relatively low incidence of complications such as local anesthetic systemic toxicity(LAST),nerve injury,falls,hematoma,infection and allergic reactions.Ultrasound should be used for regional anesthesia procedures to improve the efficacy and minimize complications.LAST treatment guidelines and rescue medications(intralipid)should be readily available during the regional anesthesia administration.

不同麻醉方式对老年全膝关节置换术早期预后的影响:一项单中心回顾性研究

目的 探讨不同麻醉方式对老年全膝关节置换术后早期预后的影响。方法 回顾性分析2018年10月至2021年9月在我院骨科行单侧全膝关节置换术病人的临床资料,根据麻醉方式分为全身麻醉组(GA组)、复合麻醉组(CA组)、外周神经阻滞组(PNB组)和腰麻组(SA组),与GA组和CA组比较,PNB组和SA组病人美国麻醉医师协会(ASA)分级,合并症比率更高,差异有统计学意义(P<0.05)。记录病人的一般资料、手术时间、麻醉时间、术后恢复室(PACU)观察时间和术后住院天数;记录低血压、血管活性药物泵注、术后24 h补救镇痛、舒芬太尼用量、术后炎性指标和48 h内并发症的发生率。结果 与GA组、CA组比较,PNB组和SA组病人低血压、低氧血症、血管活性药物泵注、急性心肌损伤、术后谵妄、术后恶心呕吐(PONV)、补救镇痛、入住ICU的发生率更低,舒芬太尼用量、炎性指标水平更低,术后PACU观察时间和住院时间缩短,差异均有统计学意义(P<0.05)。与GA组比较,CA组术中舒芬太尼用量、术中低血压、血管活性药物泵注和补救镇痛率显著降低,差异有统计学意义(P<0.05)。结论 与全身麻醉和复合麻醉相比,外周神经阻滞和腰麻是老年病人全膝关节置换术推荐的麻醉方式,可以改善早期预后。

神经刺激仪引导下腰丛联合骶丛神经阻滞麻醉在股骨颈骨折患者中的应用

目的:探讨在股骨颈骨折患者中应用神经刺激仪引导下腰丛联合骶丛神经阻滞麻醉的效果。方法:选取2020年1月—2023年6月桂林市中医医院收治的98例股骨颈骨折患者作为研究对象,按照随机数表法将其分为对照组和研究组,各49例。对照组采用传统的腰硬联合麻醉,研究组采用神经刺激仪引导下腰丛联合骶丛神经阻滞麻醉。比较两组麻醉效果、平均动脉压(MAP)、心率(HR)、皮质醇(Cor)和儿茶氨酚(CA)及不良反应。结果:两组麻醉效果比较,差异无统计学意义(P>0.05)。研究组麻醉后15 min(T_(2))、麻醉后30 min(T_(3))时MAP高于对照组,差异有统计学意义(P<0.05);研究组麻醉后5 min(T_(1))、T_(2)、T_(3)、手术结束后(T_(4))时HR高于对照组,差异有统计学意义(P<0.05)。研究组术中(Tb)时CA、Cor低于对照组,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:股骨颈骨折患者应用神经刺激仪引导下腰丛联合骶丛神经阻滞麻醉能稳定血流动力学,缓解应激反应,具有良好的麻醉效果和较高的安全性。

右美托咪定复合罗哌卡因收肌管阻滞辅助全身麻醉在全膝关节置换术中的应用效果

目的:探讨右美托咪定复合罗哌卡因收肌管阻滞辅助全身麻醉在全膝关节置换术(TKA)中的应用效果。方法:选取2019年3月至2020年3月于该院行TKA治疗的110例膝关节病患者进行前瞻性研究,按照随机数字表法将其分为观察组和对照组各55例。在全身麻醉基础上,对照组采用罗哌卡因行超声引导下收肌管阻滞,观察组采用右美托咪定复合罗哌卡因行收肌管阻滞。比较两组神经阻滞效果[感觉阻滞起效时间(OTSB)、运动阻滞起效时间(OTMB)、感觉阻滞持续时间(DSB)、运动阻滞持续时间(DMB)]、术中血流动力学指标[麻醉诱导完成后(T_(0))、切皮时(T_(1))、手术开始后30 min(T_(2))、术毕时(T_(3))的平均动脉压(MAP)和心率]水平、术后疼痛[视觉疼痛模拟评分法(VAS)]评分、麻醉药物用量、术后镇痛泵按压次数及不良反应发生率。结果:两组OTSB、OTMB比较,差异均无统计学意义(P>0.05);观察组DSB、DMB均长于对照组,差异有统计学意义(P<0.05);T_(1)、T_(2)、T_(3)时,观察组MAP、心率水平均低于对照组,差异有统计学意义(P<0.05);观察组术后12、24、48 h时的VAS评分均低于对照组,差异有统计学意义(P<0.05);观察组丙泊酚、舒芬太尼、瑞芬太尼用量及术后镇痛泵按压次数均少于对照组,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:右美托咪定复合罗哌卡因收肌管阻滞辅助全身麻醉用于TKA患者可缩短麻醉起效时间,延长神经阻滞持续时间,维持术中血流动力学稳定,提高术后疼痛效果,减少术中及术后麻醉药物用量,且不增加不良反应。

腰硬联合麻醉复合髋关节囊周围神经阻滞在老年髋部骨折患者中的应用效果

目的分析老年髋部骨折患者联合腰硬复合麻醉、髋关节囊周围神经阻滞的作用。方法非随机选取2021年1月—2023年1月新疆生产建设兵团第十三师红星医院收治的120例老年髋部骨折患者为研究对象,均予以外科手术治疗,按照不同麻醉方式分为两组,各60例。对照组采取腰硬联合麻醉,观察组采取腰硬联合麻醉复合髋关节囊周围神经阻滞,比较两组患者应用效果。结果观察组术后中枢神经特异蛋白、β-淀粉样蛋白1-40水平分别为(94.28±13.23)mg/L、(6.52±0.94)mg/L,均较对照组的(130.54±23.89)mg/L、(9.81±1.55)mg/L低,差异有统计学意义(t=9.044、7.837,P均<0.05);观察组术后2、4、6、12 h的VAS评分较对照组低,差异有统计学意义(P均<0.05)。结论联合腰硬复合麻醉、髋关节囊周围神经阻滞用于老年髋部骨折患者,能够减轻患者术后疼痛,并降低术后中枢神经系统的损伤。

神经阻滞后反跳痛的研究进展

随着超声可视化技术不断地发展,神经阻滞作为一种镇痛技术,广泛地应用于临床麻醉中。传统的以阿片类药物为主的镇痛模式,正在向以外周神经阻滞为主的多模式镇痛转变。全身麻醉复合外周神经阻滞有很多优势,如减少阿片类药物用量,促进病人早期活动,加快术后康复等。但部分病人在神经阻滞作用消退时发生反跳痛,其表现为难以忍受的剧痛,不仅增加术后镇痛药的使用,而且严重影响着术后恢复。本文旨在探讨神经阻滞后反跳痛的定义、临床表现、危险因素、发生机制以及预防和治疗方法的最新进展,为临床麻醉中合理应用神经阻滞作为辅助镇痛提供指导。

股神经阻滞联合关节腔浸润麻醉在膝关节镜手术中的应用效果

目的评价股神经阻滞联合关节腔浸润麻醉在膝关节镜手术中的安全性和有效性。方法选择滨州医学院附属医院骨关节外科2022年1月至6月因半月板损伤、游离体、骨性关节炎计划行单侧膝关节镜手术患者120例,随机分为股神经阻滞联合关节腔浸润麻醉组(F/I组)和腰硬联合麻醉组(CSEA组),每组60例。F/I组中男32例,女28例,年龄(38.75±11.35)岁;CSEA组中男25例,女35例,年龄(37.80±10.85)岁。比较两组术中补救例数、术后视觉模拟评分法(VAS)评分、术后感觉恢复时间及首次下地活动时间、术后并发症、住院花费及住院天数等指标的差异。采用t检验、χ^(2)检验、Fisher确切概率法。结果F/I组术后6 h VAS评分低于CSEA组[(2.08±0.61)分比(2.54±0.64)分],差异有统计学意义(t=-2.484,P=0.018)。F/I组感觉恢复时间长于CSEA组[(6.25±0.40)h比(3.60±0.31)h,首次下地活动时间短于CESA组[(2.99±1.05)h比(8.14±1.88)h],差异均有统计学意义(t=14.095、-12.263,均P<0.001)。术后并发症:F/I组术中加用麻醉发生率3.3%(2/60)、尿潴留发生率0、下肢静脉血栓发生率1.7%(1/60)、恶心呕吐发生率3.3%(2/60),CSEA组术中加用麻醉发生率0、尿潴留发生率10.0%(6/60)、下肢静脉血栓发生率5.0%(3/60)、恶心呕吐发生率16.7%(10/60),两组尿潴留、恶心呕吐发生率比较差异均有统计学意义(均P<0.05)。F/I组住院时间为(3.90±0.63)d、住院费用为(9612.67±507.15)元,CESA组分别为(5.27±0.75)d、(11401.52±530.01)元,差异均有统计学意义(t=-8.862、-15.425,均P<0.001)。结论股神经阻滞联合关节腔浸润麻醉在膝关节镜手术中能够减少术后并发症、缩短住院时间、降低住院费用,并提供良好的麻醉效果。

小剂量轻比重腰-硬联合麻醉和股神经及坐骨神经阻滞麻醉在老年创伤性下肢骨折患者内固定术中的应用对比

目的探究小剂量轻比重腰-硬联合麻醉和股神经及坐骨神经阻滞麻醉在老年创伤性下肢骨折(TLEF)患者内固定术中的应用效果。方法随机选取南阳市中心医院在2020年5月至2022年5月收治的80例老年TLEF患者作为本次研究对象,用随机数字法将其分为对照组(40例)和研究组(40例)。两组患者均行内固定术治疗,对照组术中行小剂量轻比重腰-硬联合麻醉;研究组术中行股神经及坐骨神经阻滞麻醉。比较两组麻醉效果、生命体征变化、凝血功能、术后不良反应、术后恢复情况。结果两组麻醉起效时间、完全麻醉时间、感觉神经完全麻醉时间、运动神经完全麻醉时间比较,差异无统计学意义(P>0.05)。麻醉后,两组心率(HR)和平均动脉压(MAP)水平均低于麻醉前(P<0.05),两组麻醉后HR和MPA水平比较,差异无统计学意义(P>0.05)。术后,两组凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)水平均高于术前,研究组高于对照组(P<0.05),两组纤维蛋白原(FIB)水平低于术前,研究组低于对照组(P<0.05)。两组术后不良反应差异无统计学意义(P>0.05)。研究组术后苏醒时间、拔管时间、下肢运动恢复时间及排尿恢复时间均低于对照组(P<0.05)。结论老年TLEF患者内固定术中接受小剂量轻比重腰-硬联合麻醉和股神经及坐骨神经阻滞麻醉均有较好麻醉效果,但股神经及坐骨神经阻滞麻醉可明显减轻血液高凝状态,减少麻醉不良反应,有效促进患者术后恢复。

股神经联合股外侧皮神经阻滞麻醉与腰硬联合麻醉在老年危重症患者下肢骨折手术中的应用效果比较

目的探讨股神经联合股外侧皮神经阻滞麻醉与腰硬联合麻醉应用于老年危重症患者下肢骨折手术中的应用效果。方法选取2022年6月至2023年6月至福建医科大学附属漳州市医院骨科就诊的100例老年危重症下肢骨折手术患者作为研究对象,采用随机数字表法将其分为对照组(50例)和观察组(50例),对照组采用腰硬联合麻醉方法,观察组采用股神经+股外侧皮神经阻滞麻醉方法,比较两组麻醉前(T_(0))、麻醉即刻(T_(1))、麻醉后30 min(T_(2))、术毕即刻(T_(3))的血流动力学指标、氧化应激指标、不良反应。结果两组T_(0)的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)水平比较,差异无统计学意义(P>0.05),观察组T_(1)~T_(3)时间的SBP、DBP、MAP水平高于对照组,差异有统计学意义(P<0.05);两组T_(0)时间点的去甲肾上腺素(NE)、丙二醛(MDA)水平比较,差异无统计学意义(P>0.05),观察组T_(1)~T_(3)时间的NE、MDA水平低于对照组,差异有统计学意义(P<0.05);观察组不良反应总发生率低于对照组,差异有统计学意义(P<0.05)。结论股神经联合股外侧皮神经阻滞麻醉方式,用于老年危重症患者下肢骨折手术中,便于降低氧化应激反应,稳定血流动力学指标水平,安全性较高。

超声引导神经阻滞复合全身麻醉对创伤性胫腓骨骨折患者的应用研究

目的:分析超声引导下腘窝处坐骨神经-股神经阻滞复合全身麻醉对创伤性胫腓骨骨折患者血流动力学及术后谵妄的影响,以探讨其应用效果。方法:回顾性纳入2022年1月—2023年11月乐平市中医医院收治的110例创伤性胫腓骨骨折患者的临床资料,根据术中采用的麻醉方法分为对照组(45例)和观察组(65例)。对照组采取全身麻醉诱导手术,观察组采用超声引导的神经阻滞复合全身麻醉。观察患者血流动力学及术后谵妄情况。结果:观察组气管拔管和苏醒时间均早于对照组,丙泊酚用量明显少于对照组(P<0.05)。麻醉前,两组收缩压及心率比较,差异均无统计学意义(P>0.05);麻醉结束时,观察组收缩压及心率均明显高于对照组(P<0.05)。术后1、2、3 d,观察组术后谵妄[简易智能精神状态检查量表(MMSE)]评分高于对照组,静息状态下疼痛视觉模拟评分法(VAS)评分明显低于对照组(P<0.05)。结论:超声引导神经阻滞复合全身麻醉治疗创伤性胫腓骨骨折患者,有利于手术中血流动力学管理,减少阿片类镇痛药物的使用,减少患者术后谵妄发生率,安全性良好。

超声引导下胸椎旁神经阻滞复合全身麻醉在乳腺癌根治术中的应用及对疼痛、血流动力学的影响

目的:分析在乳腺癌根治术中应用超声引导下胸椎旁神经阻滞复合全身麻醉的效果。方法:采用回顾分析法开展研究,根据不同麻醉方案,将2021年6月—2023年7月于武汉大学中南医院兴山医院行乳腺癌根治术的70例患者分为参照组与研究组,将实施全身麻醉加用超声引导下胸椎旁神经阻滞的35例纳入研究组,仅实施全身麻醉的35例纳入参照组。对比两组围手术期入室时(T_(0))、麻醉时(T_(1))、插管时(T_(2))、切皮时(T_(3))、腋窝清扫时(T_(4))、拔管时(T_(5))、出室时(T_(6))的麻醉效果、血流动力学变化情况和术后不同时间点的疼痛评分。结果:在T_(3)、T_(4)时,研究组的脑电双频指数均低于参照组,差异均有统计学意义(P<0.05)。在T_(1)、T_(2)、T_(3)、T_(4)、T_(5)、T_(6)时,研究组心率、平均动脉压均低于参照组,差异均有统计学意义(P<0.05);研究组各时间点的心率、平均动脉压对比,差异无统计学意义(P>0.05);参照组T_(0)后各时间点的心率、平均动脉压均高于T_(0)时,差异均有统计学意义(P<0.05)。研究组术后2、6、8、12 h的疼痛评分均低于参照组,差异均有统计学意义(P<0.05)。结论:超声引导下胸椎旁神经阻滞复合全身麻醉可增强麻醉效果,且减少患者围手术期血流动力学的波动,还可维持长期术后镇痛效果。

超声引导下腰丛复合坐骨神经阻滞麻醉在老年人工股骨头置换术中的应用价值分析

目的 探究超声引导下腰丛复合坐骨神经阻滞麻醉在老年人工股骨头置换术中的应用价值。方法 非随机选取2021年5月—2023年5月江苏省如东县中医院收治的146例行人工股骨头置换术的老年患者为研究对象。按照不同的麻醉方法分为对照组和观察组,各73例。对照组予以全身麻醉,观察组予以超声引导下腰丛复合坐骨神经阻滞麻醉。对比两组麻醉后的生理指标、围术期情况及不良反应发生情况。结果 观察组心率、平均动脉压、醛固酮、肾上腺素及血浆肾素活性均低于对照组,差异有统计学意义(P均<0.05);观察组各围术期情况均优于对照组,差异有统计学意义(P均<0.05);对照组不良反应发生率(13.70%)高于观察组(4.11%),差异有统计学意义(χ^(2)=4.137,P<0.05)。结论 针对行人工股骨头置换术的老年患者,采取超声引导下腰丛复合坐骨神经阻滞麻醉有利于减轻生理应激反应,且优化围术期各项指标,降低不良反应发生率,值得临床借鉴。

腰硬联合麻醉与全麻联合神经阻滞麻醉运用于下肢远端骨折患者的比较

目的对比分析下肢远端骨折患者手术治疗前采用腰硬联合麻醉方案与全麻联合神经阻滞麻醉方案的效果与安全性。方法选择2021年1月—2022年8月在本院接受手术治疗的下肢远端骨折患者60例作为观察对象,根据麻醉方式的不同划分对照组(30例)与观察组(30例),对照组采取腰硬联合麻醉方案,观察组实施全麻联合神经阻滞麻醉方案,观察对比两组患者麻醉效果,记录两组患者麻醉期间及术后恢复情况,分别监测各组患者麻醉期间血压、心率指标变化,观察各组患者麻醉后出现不良反应的具体表现,统计总发生概率。结果观察组患者麻醉效果明显高于对照组(P<0.05),同时观察组患者感觉阻滞维持时间、运动阻滞维持时间、术后镇痛持续时间均长于对照组,下床活动时间短于对照组(P<0.05)。麻醉10min、30min及手术结束时观察组患者平均动脉压、心率测定值均高于对照组(P<0.05)。两组患者麻醉后不良反应总发生率比较差异无统计学意义(P>0.05)。结论临床手术治疗下肢远端骨折疾病可采取全麻联合神经阻滞麻醉方案,相比腰硬联合麻醉效果更佳,优点是术后疼痛轻,可早期进行功能锻炼,无需留置导尿管等,值得推广。

罗比卡因用于腰丛-坐骨神经联合阻滞的临床观察

目的 比较长效局麻药罗比卡因应用于单侧腰丛 坐骨神经联合阻滞和硬膜外麻醉时临床麻醉起效和恢复时间、术后镇痛效果及对血液动力学的影响。方法 34例临床拟行单侧下肢手术的病人 ,随机分为腰丛 坐骨神经联合阻滞 (NER ,n =17)和硬膜外麻醉 (EPI,n =17)两组 ,分别施行单侧腰丛复合坐骨神经阻滞和硬膜外麻醉。NER组腰丛和坐骨神经阻滞采用神经刺激器定位技术 ,刺激器电流频率 2Hz,起始强度 1～ 2mA ,正确定位后两点分别给予 0 5 %罗比卡因 2 0～ 30ml;EPI组则选择L2～ 3 或L3～ 4间隙行硬膜外麻醉 ,予 0 75 %罗比卡因 15～ 2 0ml。记录麻醉前 ,手术开始 ,手术开始后 15、30、45、6 0分钟 ,术后 1小时的收缩压 (SBP)、舒张压 (DBP)和心率 (HR) ,以及感觉、运动神经阻滞起效及恢复时间、镇痛维持时间及效果 (术后 1、4小时VAS评分 )、局麻药和辅助药物用量、术中输液量、药物不良反应等指标。结果 手术开始后 15分钟 ,EPI组病人DBP降低明显 (P <0 0 5 ) ,随后 30、45、6 0分钟及术后 1小时EPI组病人的SBP、DBP均明显低于NER组 ;NER组感觉、运动神经阻滞起效时间均小于EPI组 (P <0 0 5 ) ,EPI组感觉神经、运动神经恢复较NER组快 (P <0 0 5 ) ;NER组罗比卡因平均用量大于EPI组 (P <0 0 5 )。NER?

区域神经阻滞技术在创伤胫腓骨骨折患者麻醉中的应用

目的探讨区域神经阻滞技术在未来下肢战伤麻醉救护中的价值。方法模拟下肢战伤麻醉处理方式,为58例下肢开放性胫腓骨骨折患者外固定支架固定及清创实施麻醉。经抗休克稳定后,将拟接受手术救治的患者随机分入P组和S组,各29例。P组患者采用神经阻滞技术,在超声引导下实施髂筋膜和坐骨神经联合阻滞后行清创和骨折固定手术;S组则采用传统的椎管内麻醉(蛛网膜下隙阻滞复合硬膜外麻醉)方法,麻醉后接受相同的手术救治。分析比较两组患者的一般情况、术中麻醉意外发生情况、麻醉效率、麻醉后持续镇痛时间和患者整体感受(视觉模拟评分)。结果术前两组患者一般情况的差异无统计学意义。实施麻醉后,S组有20例(71%)患者循环不稳定、2例(7%)患者呼吸困难,经麻醉医师处理后稳定(1例因插管改全麻退出研究),而P组患者无一例发生麻醉并发症;P组患者从入手术室到手术前的麻醉时间短于S组(P<0.01),同时P组患者输液量低于S组(P<0.01);术后P组麻醉镇痛时间长于S组(P<0.01);患者整体感受提示P组患者从麻醉开始直至术后的舒适度优于S组(P<0.01)。结论从安全性和整体舒适度方面比较创伤胫腓骨骨折患者的麻醉处理方式,区域神经阻滞技术优于传统的椎管内麻醉方式。