Application of the “Three Threes” Method in Clinical Teaching of Internal Jugular Vein Puncture

Objective: To clarify the role of the “Three Threes” method in clinical teaching of internal jugular vein puncture and explore improvements in teaching methods. Methods: A doctor was assigned to the induction room of the Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital) for two months. The time required for catheterization, the first puncture success rate, and occurrence of puncture-related complications were compared before and after learning the “Three Threes” method. Results: Using the “Three Threes” method reduced the catheterization time by 43%, increased the first puncture success rate by 17%, and led to fewer puncture-related complications. Conclusion: The application of the “Three Threes” method not only improves the success rate of internal jugular vein puncture but also reduces complications, making it easier for students to master the technique.

“Three Methods and Three Points” regulates p38 mitogen-activated protein kinase in the dorsal horn of the spinal cord in a rat model of sciatic nerve injury

Tuina is a traditional Chinese treatment for sensory disturbances caused by peripheral nerve injury and related diseases. Our previous studies showed that tuina regulates relevant regions and indices of the spinal dorsal horn using the Dian, Bo, and Rou method in Yinmen（BL37）, Yanglingquan（GB34）, and Weizhong（BL40）. Treatment prevents muscle atrophy, protects spinal cord neurons, and promotes sciatic nerve repair. The mechanisms of action of tuina for treating peripheral nerve injury remain poorly understood. This study established rat models of sciatic nerve injury using the crushing method. Rats received Chinese tuina in accordance with the principle of ＂Three Methods and Three Points,＂ once daily for 20 days. Tuina intervention reduced paw withdrawal latency and improved wet weight of the gastrocnemius muscle, as well as promoting morphological recovery of sciatic nerve fibers, Schwann cells, and axons. The protein expression levels of phospho-p38 mitogen-activated protein kinase, tumor necrosis factor-α, and interleukin-1β also decreased. These findings indicate that ＂Three Methods and Three Points＂ promoted morphological recovery and improved behavior of rats with peripheral nerve injury.

Continuous cerebrospinal fluid drainage by spinal puncture for cerebrospinal fluid rhinorrhea after pituitary adenoma surgery

Objective： Cerebrospinal fluid （CSF） rhinorrhea may be a serious complication after neurosurgery. Some of them can be treated conservatively by continuous CSF drainage with a lumbar subarachnoid catheter. On the other hand, spinal puncture may result in headache by CSF leakage. Methods： Present a 17-year-old female who suffered from CSF rhinorrhea after pituitary surgery was treated by making use of spinal puncture after failed catheter drainage. Results： The patient was successfully treated by this way. Conclusion： Spinal puncture by 16-gauge Touhy needle seems to be a possible way to substitute the traditional continuous lumbar subarachnoid catheter to drain the CSF in patients with rhinorrhea.

C-C motif chemokine ligand 2/C-C motif chemokine receptor 2 pathway as a therapeutic target and regulatory mechanism for spinal cord injury

Spinal cord injury involves non-reversible damage to the central nervous system that is characterized by limited regenerative capacity and secondary inflammatory damage.The expression of the C-C motif chemokine ligand 2/C-C motif chemokine receptor 2 axis exhibits significant differences before and after injury.Recent studies have revealed that the C-C motif chemokine ligand 2/C-C motif chemokine receptor 2 axis is closely associated with secondary inflammatory responses and the recruitment of immune cells following spinal cord injury,suggesting that this axis is a novel target and regulatory control point for treatment.This review comprehensively examines the therapeutic strategies targeting the C-C motif chemokine ligand 2/C-C motif chemokine receptor 2 axis,along with the regenerative and repair mechanisms linking the axis to spinal cord injury.Additionally,we summarize the upstream and downstream inflammatory signaling pathways associated with spinal cord injury and the C-C motif chemokine ligand 2/C-C motif chemokine receptor 2 axis.This review primarily elaborates on therapeutic strategies that target the C-C motif chemokine ligand 2/C-C motif chemokine receptor 2 axis and the latest progress of research on antagonistic drugs,along with the approaches used to exploit new therapeutic targets within the C-C motif chemokine ligand 2/C-C motif chemokine receptor 2 axis and the development of targeted drugs.Nevertheless,there are presently no clinical studies relating to spinal cord injury that are focusing on the C-C motif chemokine ligand 2/C-C motif chemokine receptor 2 axis.This review aims to provide new ideas and therapeutic strategies for the future treatment of spinal cord injury.

Effect of modified puncture method on catheter-related bloodstream infection after PICC catheterization in patients with tumor

Objective: To explore the preventive effect of modified puncture method on catheter-related bloodstream infection after PICC catheterization in patients with tumor. Methods: A total of 95 cases of tumor admitted to our hospital from February 2015 to February 2017 were selected according to the order of admission, divided into the study group (n=47) and the control group (n=48). In the control group, the traditional blind catheterization was carried out, and the research group improved the puncture method. The rate of puncture success (onetime puncture success rate, total success rate), puncture time and complication rate were compared between the two groups. Results: The total success rate (77.1%) of the study group (97.9%) was significantly higher than control group, The puncture time of the study group was significantly shorter than control group. Incidence of complications in the study group (4.3%) was significantly lower than that in the control group (22.9%). Conclusions: The improved puncture method can significantly reduce the incidence of complications after PICC catheterization, shorten the puncture time and improve the success rate of puncture, which is worthy of reference and promotion.

Prospective evaluation of point-of-care ultrasound for pre-procedure identification of landmarks versus traditional palpation for lumbar puncture

BACKGROUND: The objective of this study is to determine if point-of-care ultrasound(POCUS) pre-procedure identification of landmarks can decrease failure rate, reduce procedural time, and decrease the number of needle redirections and reinsertions when performing a lumbar puncture(LP).METHODS: This was a prospective, randomized controlled trial comparing POCUS preprocedure identifi cation of landmarks versus traditional palpation for LP in a cohort of patients in the emergency department and intensive care unit.RESULTS: A total of 158 patients were enrolled. No signifi cant difference was found in time to completion, needle re-direction, or needle re-insertion when using POCUS when compared to the traditional method of palpation.CONCLUSION: Consistent with fi ndings of previous studies, our data indicate that there was no observed benefi t of using POCUS to identify pre-procedure landmarks when performing an LP.

Simulation of Lumbar Spinal Stenosis Using the Finite Element Method

Lumbar spine stenosis(LSS)is a narrowing of the spinal canal that results in pressure on the spinal nerves.This orthopedic disorder can cause severe pain and dysfunction.LSS is a common disabling problem amongst elderly people.In this paper,we developed a finite element model(FEM)to study the forces and the von Mises stress acting on the spine when people bend down.An artificial lumbar spine(L3)was generated from CT data by using the FEM,which is a powerful tool to study biomechanics.The proposed model is able to predict the effect of forces which apply to the lumbar spine.In addition,FEM allows us to investigate the tests into the lumbar spine instead of applying the tests to the real spine in humans.The proposed model is highly accurate and provides precise information about the lumbar spine(L3).We investigate the behavior of humans in daily life which effects to the lumbar spine in a normal person and a patient with LSS.The computational results revealed high displacement levels around the spinal canal and lower displacement levels in the spinal body when bending down.The total displacement of the axial load in a normal person was higher when compared with patients with LSS.Higher degree bends resulted in a lower total displacement when compared with lower degree bends,while the von Mises stress decreased as the bending degree increased.

Post Dural Puncture Headache—Review and Suggested New Treatment

Objectives: After reading this article, readers should be able to recognize Post Dural Puncture Headache, understand its mechanism and diagnostic criteria, evaluate the different treatment options available, and be familiar with a novel treatment option. Background: Post-dural puncture headache is the most common serious complication resulting from lumbar puncture and epidural or spinal anesthetics. The syndrome is characterized by severe headache that occurs within 48 hours following the puncture, located in the frontal and/or occipital region, worsened in the upright position and refractory to routine analgesia. The syndrome incidence was reported to be approximately 1% with typical obstetric anesthesiology practice which reflects more than 20,000 cases per 2014 in the US. Two possible mechanisms are hypothesized as responsible for this syndrome;cerebrospinal fluid leakage and pneumocephalus. Multiple methods of treatment have been applied with wide-ranging results. Design or Methods: Review article with introduction of a novel treatment option. Results: We postulate that Hyperbaric Oxygen Therapy can be used to treat post-dural puncture headache. The rationale for treatment is dual: enhancement of fibroblast proliferation at the site of dural puncture to facilitate faster closure of the tear and compression of air bubbles in case of pneumocephalus according to Boyle’s law. We also claim that hyperbaric oxygen therapy should be considered a prophylactic treatment, if a dural tear is suspected.

Fever glove hand-shake method safe blood collection from children's fingertips in COVID-19 fever clinic

BACKGROUND During the coronavirus disease 2019(COVID-19)epidemic,the fever clinic is an important link for screening and diagnosing whether a patient is infected with the novel coronavirus.Blood collection from children’s fingertips is a commonly used detection method;however,in children,the blood collection process may cause discomfort and resistance.To address this problem,the use of heating gloves combined with hand swinging can be considered for fingertip blood collection in children.AIM To explore the application of fever gloves with the handshaking method for fingertip blood collection from children in fever clinics during the COVID-19 epidemic.METHODS A total of 100 children were selected for fingertip blood collection at the fever clinic of our hospital from June 2022 to June 2023 and were divided into two groups using a randomized numerical table method,with 50 cases in each group,including the control and observation groups.The patients in the control group followed the doctor's instructions to cooperate with the routine fingertip blood collection method,and the patients in the observation group followed the doctor's instructions to cooperate with the static fever gloves with the shaking hands method of children's fingertip blood collection.The level of the six blood routine and collection indexes,and the satisfaction of the examination of the patients in the peripheral blood group and the fever gloves with the shaking hands method of the children's fingertip blood collection group were compared.RESULTS The red and white blood cell count,hemoglobin,and red blood cell pressure volume in the observation group were higher than those in the control group(P<0.05);the platelet count in the control group was lower than that in the observation group(P<0.05);the number of times of squeezing the fingertip,the average time of blood collection,and the score of puncture pain in the observation group were significantly better than those in the control group(P<0.05);and satisfaction with the routine blood examination in the observation group was greater than that in the control group.CONCLUSION The application value of the fever gloves with shaking hands method for children's fingertip blood collection was better,the accuracy of examination indexes was higher,and patient satisfaction with the examination was greater.

Is It Safe to Perform an Autologous Epidural Blood Patch on Patients with Underlying Spinal Stenosis or Lumbar Disc Disease? Case Report and Literature Review

The most common spinal pathology seen in the obstetric population is lumbar disc herniation. There is currently no literature documenting the safety of performing an epidural blood patch on obstetric patients with underlying spinal pathology. We present a case of a patient with known severe lumbar spinal stenosis with compressive radiculopathy who received a successful epidural blood patch without worsening her underlying neurologic symptoms. Epidural blood patches can be safely performed in this patient population. However, the anesthesiologist should be aware of the risk of potentially worsening preexisting neurological deficits. Thus, we advise caution prior to placing an epidural blood patch on these patients. The risks and benefits of the procedure should be carefully weighed and considered. It is important to have a thorough discussion with the patient regarding the risks of an epidural blood patch prior to performing the procedure.

不同刺孔时间和刺孔方式对黑木耳生长发育的影响

在浙江省内黑木耳“全日光”栽培模式下,开展不同刺孔时间和刺孔方式对黑木耳生长发育影响的试验,旨在为黑木耳精准化栽培提供技术支撑。结果表明,不同刺孔时间处理中,以10月中上旬进行刺孔的试验组菌丝恢复生长快、出耳整齐、污染率低、产量高;而在9月中下旬刺孔则表现较差。不同刺孔方式处理中,随着刺孔数量的增多,流耳率增高、产量降低;刺孔的孔径越大产量越高,且菌棒失水脱袋情况也越多。综合分析,黑木耳刺孔时间应选择10月中上旬,刺孔数230~270个、孔径0.5 cm为最佳刺孔方式。

全脑血管造影术后即刻采用轴线翻身法的临床效果

目的 探讨全脑血管造影术后即刻采用轴线翻身法对患者穿刺点出血情况、腰背部疼痛及满意度的影响。方法 选取2021年6月至2022年6月解放军总医院第一医学中心神经内科医学部收治的236例行全脑血管造影术患者为研究对象,按照随机数字表法将其分为对照组和观察组,每组118例。对照组术后采用常规护理,平卧6 h后进行轴线翻身;观察组术后即刻采用轴线翻身法翻身。比较两组穿刺点出血情况、腰背部疼痛程度及满意度。结果 两组穿刺点皮下血肿、少量渗血、明显出血发生率比较,差异无统计学意义(P>0.05)。观察组腰背部视觉模拟评分法评分低于对照组,满意度高于对照组,差异有统计学意义(P<0.05)。结论 全脑血管造影术后即刻采用轴线翻身法,可降低患者腰背部疼痛程度,改善术后舒适度,提高满意度,且即刻轴线翻身法并不增加穿刺点出血发生率。

纳布啡用于硬脊膜穿破硬膜外阻滞分娩镇痛的有效性及安全性

目的探讨纳布啡用于硬脊膜穿破硬膜外阻滞分娩镇痛的有效性及安全性。方法选择经阴试产的足月单胎初产妇319例,按使用药物不同分为舒芬太尼硬脊膜穿破硬膜外阻滞组(A组)160例,纳布啡硬脊膜穿破硬膜外阻滞组(B组)159例。两组均采用硬脊膜穿破硬膜外阻滞分娩镇痛法,置入硬膜外导管后,注入1.5%利多卡因3 mL试验量,然后A组注入0.5 mg/L舒芬太尼复合1 mg/L罗哌卡因混合液,B组注入0.3 g/L纳布啡复合1 mg/L罗哌卡因混合液,均6~15 mL为首次量,30 min后两组均连接电子镇痛泵,分别使用舒芬太尼和纳布啡进行自控硬膜外镇痛。收集两组患者的如下指标:镇痛起效时间、首次自控按压镇痛(PCA)时间、PCA有效按压次数、罗哌卡因用量;镇痛前(T0)、镇痛后30 min(T1)、宫口开全(T2)与用力分娩(T3)时疼痛视觉模拟(VAS)评分及Ramsay镇静评分;产妇发热、恶心呕吐、皮肤瘙痒、术后头痛发生等不良反应情况以及胎儿胎心减速发生率、新生儿1 min Apgar评分≤7分发生率、脐动脉血气分析,新生儿神经与适应能力评分。结果与A组比较,B组恶心呕吐、皮肤瘙痒、胎心减速及新生儿1 min Apgar评分≤7分的发生率显著降低(χ^(2)=4.159~5.628,P<0.05),PCA有效按压次数、罗哌卡因用量显著增加(χ^(2)=8.594、6.363,P<0.05),T2及T3产妇VAS评分明显升高(F=45.314、26.717,P<0.05),其他观察指标两组间比较差异无统计学意义(P>0.05)。结论纳布啡用于硬脊膜穿破硬膜外阻滞分娩镇痛与舒芬太尼相比第一产程镇痛效果类似,第二产程效果较差,但可降低产妇镇痛相关不良反应发生率,对新生儿具有较高的安全性。

基于行为研究法的健康管理在脊柱外科围术期患者中的应用

目的:探讨基于行为研究法的健康管理在脊柱外科围术期患者中的应用效果。方法:选取2021年1月1日~2022年12月31日脊柱外科收治的88例患者作为研究对象,按照单双号法随机分为管理组和常规组各44例,常规组采用脊柱外科常规围术期护理,管理组在常规组基础上采用基于行为研究法的健康管理。比较两组深静脉血栓形成(DVT)发生率、DVT风险[采用Caprini风险评估量表]、血栓相关指标[包括D-二聚体(D-D)、纤维蛋白原(Fg)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)]、疾病认知(采用骨科手术患者深静脉血栓认知水平问卷)、生活质量[采用生活质量综合评定问卷(GQOL-74)]。结果:管理组DVT发生率低于常规组(P<0.05);术后1、3 d,两组Caprini风险评估量表评分均低于术后即刻(P<0.05),且管理组低于常规组(P<0.01);术后3 d,两组D-D、Fg、PT、APTT均低于术后1 d(P<0.05),且管理组低于常规组(P<0.05);干预后,两组疾病认知水平、GQOL-74评分均高于干预前(P<0.05),且管理组高于常规组(P<0.05)。结论:基于行为研究法的健康管理能降低脊柱外科手术患者围术期DVT发生风险,提升患者疾病相关知识认知水平,改善生活质量。

基于术前CT测量精准定位穿刺与传统穿刺经皮椎体成形术治疗胸腰椎压缩性骨折的对照研究

目的:通过和传统经皮穿刺方法的回顾性研究,探讨基于术前CT测量精准定位穿刺点的经皮穿刺技术辅助的经皮球囊扩张椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性椎体压缩骨折(Osteoporotic vertebral compressive fractures,OVCFs)患者的临床疗效。方法:回顾性分析2017年1月至2021年6月采取经皮穿刺球囊扩张椎体后凸成形术治疗的56例骨质疏松性椎体压缩性骨折患者,均为单节段骨折,受伤至手术时间小于一个月。根据术中定位穿刺点方法的不同分为两组:A组:基于术前CT测量精准定位穿刺组,B组:传统方法定位穿刺组。每组各28例,对比两组患者术中穿刺次数、透视次数及手术时间,采用手术前后的视觉模拟评分(Visual analogue scale,VAS)评估临床疗效;同时观察手术相关并发症发生情况。结果:56例患者均获成功穿刺,术后随访8~16个月,平均随访时间10个月。基于术前CT测量方法精准定位穿刺组手术时间(34.1±7.5)min,术中穿刺过程中C臂机透视(9.9±2.5)次,每节病椎骨水泥注入量(5.7±0.8)mL。术前VAS评分(8.2±0.8),术后6月为(1.4±0.6)。传统方法定位穿刺组手术时间(48.8.±9.5)min,术中穿刺过程中C臂机透视(14.5±3.5)次,每节病椎骨水泥注入量(5.6±0.6)mL。术前VAS评分(8.2±0.7),术后6月为(1.5±0.6)。两组骨水泥注入量和及术后6月的VAS评分差异无统计学意义(P>0.05);术中穿刺次数、手术时间和术中透视次数差异有统计学意义(P<0.05)。其中基于术前CT测量定位穿刺组一次性穿刺成功率为92.9%(26/28)。远高于传统穿刺组53.6%(15/28)。A组发生2例向椎体后缘或侧方骨水泥渗漏;B组3例发生椎体后缘及椎体前方和侧方渗漏。两组术中均未出现神经脊髓损害并发症发生,无感染等伤口并发症发生。结论:相较于传统经皮穿刺方法,基于术前PACS系统CT精准测量定位穿刺点的技术,可大大提高一次性穿刺成功概率,明显改善经皮穿刺技术的精准性;从而可以减少手术穿刺过程中的C臂机透视次数及手术时间,具有更加精准、微创的特点,是一种精准有效和安全可靠的穿刺定位技术。

基于督脉理论探讨“通督益髓”针法治疗脊髓损伤的研究进展

脊髓损伤是一种严重的神经系统疾病,属于中医“痿证”“体惰”范畴,“督脉受损、肾阳不足”是脊髓损伤的主要病因病机,从督脉论治脊髓损伤是中医治疗的关键。文章基于督脉理论,介绍了中医学对脊髓损伤的认识以及“通督益髓”法理论的形成,简述了“通督益髓”法电针治疗脊髓损伤的临床应用及机制研究,以期为脊髓损伤的中医理论及临床研究提供新思路。

瑞马唑仑用于椎管内穿刺时辅助镇静的效果分析

目的探讨膝关节置换术患者行椎管内穿刺时瑞马唑仑辅助镇静的安全性和有效性。方法选择2022年3月至2023年5月于海南省人民医院在椎管内麻醉下行膝关节置换术患者60例,美国麻醉医师协会分级Ⅰ~Ⅲ级,采用随机数字表法分为3组:对照组(C组)、瑞马唑仑0.04 mg/kg组(R1组)、瑞马唑仑0.06 mg/kg组(R2组),每组20例。所有患者在摆好左侧屈膝位后,分别缓慢推注生理盐水及瑞马唑仑0.04、0.06 mg/kg,1 min后开始在L_(2~3)间隙局部麻醉下行椎管内穿刺,记录给药前和给药后1、2、3、4、5、6、7、8、9、10、15 min时心率、平均动脉压(MAP)、脉搏血氧饱和度(SpO_(2))、改良警觉/镇静(MOAA/S)评分及患者满意度。结果R2组给药后2、3、4、5、6、7、8、9、10 min心率及MOAA/S评分均低于C组(均P<0.05),R2组给药后4、5、6 min的MAP低于C组(均P<0.05);R2组给药后2、3、4、5、6、7、8 min的MOAA/S评分低于R1组(均P<0.05);R2组给药后3、4、5、6、7、8、9、10、15 min心率低于给药前(均P<0.05),R2组给药后4、5、6、7、8、9、10、15 min的MAP低于给药前(均P<0.05),R2组给药后2、3、4、5、6、7、8、9、10 min的MOAA/S评分低于给药前(均P<0.05)。3组各时点SpO_(2)比较差异均无统计学意义(均P>0.05)。R2组患者非常满意百分比高于R1组和C组[90.0%(18/20)比60.0%(12/20)、30.0%(6/20)](均P<0.05)。结论膝关节置换术患者椎管内穿刺时用0.06 mg/kg瑞马唑仑辅助镇静效果更佳,呼吸抑制影响甚微,心率血压稳定,安全性高。

零压力改良穿刺法在新动静脉内瘘穿刺患者中的应用效果

目的探讨零压力改良穿刺法对血液透析患者新动静脉内瘘穿刺成功率的影响。方法选取2021年1月至2023年12月中国人民解放军联勤保障部队第九一〇医院收治的103例接受新动静脉内瘘穿刺的血液透析患者作为研究对象,按照随机数字表法分为对照组(51例)与研究组(52例),对照组采用常规穿刺法,研究组采用零压力改良穿刺法。比较两组患者的穿刺质量、疼痛情况、焦虑情况以及并发症情况。结果研究组的穿刺成功率高于对照组,穿刺点渗血、血流量不足、穿刺点硬结发生率低于对照组,差异有统计学意义(P<0.05)。研究组的疼痛和焦虑评分低于对照组,差异有统计学意义(P<0.05)。研究组的并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论零压力改良穿刺法在血液透析患者的新动静脉内瘘穿刺中具有显著的优势,它不仅能够提高穿刺的质量,减少疼痛感和并发症发生情况,还能减轻患者焦虑,为患者在透析过程中带来更好的体验。

脊髓损伤患者二元应对干预方案的构建

目的构建适用于脊髓损伤(spinal cord injury,SCI)患者的二元应对(dyadic coping,DC)干预方案。方法以系统交互模型(systemic-transactional model,STM)作为理论基础,通过文献分析法、结构化访谈形成干预方案初稿。采用德尔菲法进行2轮函询,根据专家函询意见对方案进行修改,形成干预方案终稿。结果17名专家进行了2轮德尔菲函询,问卷回收率分别为85%、100%;专家权威系数为0.885;经过2轮专家函询,各个条目的重要性变异系数为0~0.180,肯德尔和谐系数为0.201,差异具有统计学意义(P<0.001)。最终形成SCI患者DC干预方案。结论本研究构建的SCI患者DC干预方案具有科学性、可靠性和实用性,可为SCI患者及其配偶共同积极应对疾病提供参考。

等效剂量罗哌卡因和布比卡因腰麻-硬膜外联合麻醉用于Misgave-Ladach-Method剖宫产术的临床研究

目的 探讨等效剂量罗哌卡因、布比卡因腰麻-硬膜外联合麻醉用于Misgave -Ladach -Method剖宫产术的临床效能及安全性。方法 选择ASAⅠ～Ⅱ级足月妊娠初产妇80例,随机双盲法分为两组,每组各4 0例。罗哌卡因组(R组) :0 75 %罗哌卡因2ml+10 %葡萄糖液0 5ml;布比卡因组(B组) :0 75 %布比卡因1 2 5ml+10 %葡萄糖液1 2 5ml。术中麻醉效应不足时经硬膜外导管补充2 %利多卡因。术中连续监测呼吸和循环状况,评估麻醉效能,观察围手术期不良反应的发生和新生儿情况。结果 两组麻醉效能、最高阻滞平面、新生儿Apgar评分及不良反应相似(P >0 0 5 ) ,但R组起效慢,维持时间短(P <0 0 5 ) ;下肢运动阻滞程度R组显著低于B组(P <0 0 5 )。结论 等效剂量的罗哌卡因和布比卡因腰麻-硬膜外联合麻醉用于剖宫产术安全有效,与布比卡因相比,罗哌卡因对下肢运动阻滞弱且恢复迅速。