Remimazolam benzenesulfonate anesthesia effectiveness in cardiac surgery patients under general anesthesia

BACKGROUND Sedation with propofol injections is associated with a risk of addiction,but remimazolam benzenesulfonate is a comparable anesthetic with a short elimination half-life and independence from cell P450 enzyme metabolism.Compared to remimazolam,remimazolam benzenesulfonate has a faster effect,is more quickly metabolized,produces inactive metabolites and has weak drug interactions.Thus,remimazolam benzenesulfonate has good effectiveness and safety for diagnostic and operational sedation.AIM To investigate the clinical value of remimazolam benzenesulfonate in cardiac surgery patients under general anesthesia.METHODS A total of 80 patients who underwent surgery in the Department of Cardiothoracic Surgery from August 2020 to April 2021 were included in the study.Using a random number table,patients were divided into two anesthesia induction groups of 40 patients each:remimazolam(0.3 mg/kg remimazolam benzenesulfonate)and propofol(1.5 mg/kg propofol).Hemodynamic parameters,inflammatory stress response indices,respiratory function indices,perioperative indices and adverse reactions in the two groups were monitored over time for comparison.RESULTS At pre-anesthesia induction,the remimazolam and propofol groups did not differ regarding heart rate,mean arterial pressure,cardiac index or volume per wave index.After endotracheal intubation and when the sternum was cut off,mean arterial pressure and volume per wave index were significantly higher in the remimazolam group than in the propofol group(P<0.05).After endotracheal intubation,the oxygenation index and the respiratory index did not differ between the groups.After endotracheal intubation and when the sternum was cut off,the oxygenation index values were significantly higher in the remimazolam group than in the propofol group(P<0.05).Serum interleukin-6 and tumor necrosis factor-αlevels 12 h after surgery were significantly higher than before surgery in both groups(P<0.05).The observation indices were re-examined 2 h after surgery,and the epinephrine,cortisol and blood glucose levels were significantly higher in the remimazolam group than in the propofol group(P<0.05).The recovery and extubation times were significantly lower in the remimazolam group than in the propofol group(P<0.05);there were significantly fewer adverse reactions in the remimazolam group(10.00%)than in the propofol group(30.00%;P<0.05).CONCLUSION Compared with propofol,remimazolam benzenesulfonate benefited cardiac surgery patients under general anesthesia by reducing hemodynamic fluctuations.Remimazolam benzenesulfonate influenced the surgical stress response and respiratory function,thereby reducing anesthesia-related adverse reactions.

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.

Impact of dexmedetomidine-assisted anesthesia in elderly patients undergoing radical resection of colon cancer

BACKGROUND Radical resection of colon cancer under general anesthesia is one of the main treatment methods for this malignancy.However,due to the physiological charac-teristics of elderly patients,the safety of perioperative anesthesia needs special attention.As anα2-adrenergic receptor agonist,dexmedetomidine(Dex)has attracted much attention from anesthesiologists due to its stabilizing effect on heart rate and blood pressure,inhibitory effect on inflammation,and sedative and analgesic effects.Its application in general anesthesia may have a positive impact on the quality of anesthesia and postoperative recovery in elderly patients undergoing radical resection of colon cancer.METHODS A total of 165 colon cancer patients who underwent radical surgery for colon cancer under general anesthesia at Qingdao University Affiliated Haici Hospital,Qingdao,China were recruited and divided into two groups:A and B.In group A,Dex was administered 30 min before surgery,while group B received an equivalent amount of normal saline.The hemodynamic changes,pulmonary compliance,airway pressure,inflammatory factors,confusion assessment method scores,Ramsay Sedation-Agitation Scale scores,and cellular immune function indicators were compared between the two groups.RESULTS Group A showed less intraoperative hemodynamic fluctuations,better pulmonary compliance,and lower airway resistance compared with group B.Twelve hours after the surgery,the serum levels of TLR-2,TLR-4,IL-6,and TNF-αin group A were significantly lower than those of group B(P<0.05).After extubation,the Ramsay Sedation-Agitation Scale score of group A patients was significantly higher than that of group B patients,indicating a higher level of sedation.The incidence of delirium was significantly lower in group A than in group B(P<0.05).CONCLUSION The use of Dex as an adjunct to general anesthesia for radical surgery in elderly patients with colon cancer results in better effectiveness of anesthesia.

Study on Acupuncture for Side Effects of Etomidate Anesthesia

Objective: To evaluate the effect of acupuncture therapy on the side effect of Etomidate anesthesia and to determine the best timing of acupuncture intervention during Etomidate anesthesia. Methods: Female patients with rectal cancer scheduled to receive radical resection were randomly divided into four groups: a control group(group Ⅰ), a preoperative acupuncture group(group Ⅱ), an intraoperative acupuncture group(group Ⅲ), and a postoperative acupuncture group(group Ⅳ), 25 subjects in each group. The levels of serum cortisol, blood glucose, and gastrin of patients were monitored at the following time-points: preoperative(T0, when having entered the operating room), intraoperative(T1, 30 min after skin cutting), the end of operation(T2, after suturing skin), and postoperative(T3, postoperative 24 h). The cases with massive hemorrhage, unsteady vital sign during operation or operation time longer than 5 h were eliminated, and 92 cases were enrolled into the results of the study. Results: The blood sugar in the four groups increased significantly at T2 and T3, compared to T0(P < 0.05); the blood sugar reached((.(((1.5() mmol(( at T2 in group Ⅲ, and the increase was statistically significant compared to those of the other groups(P<0.05). The levels of serum cortisol of all patients were in normal range. Compare to T0, the cortisol level decreased in group Ⅰ, Ⅲ, at each point, and the decreases Ⅳ were statistically significant(P<0.05). Compared to the other groups, the cortisol level was increased at T1 and T3 in group Ⅱ, and the change was statistically significant(P<0.05). Compared to T0, the gastrin level at T3 increased in group Ⅰ, Ⅲand Ⅳ, but decreased in group Ⅱ, and the changes had statistical significance(P<0.05). Compared to the other groups, the decrease of gastrin level in group Ⅱat T3 was statistically significant(P<0.05). Conclusion: Acupuncture before operation can keep blood sugar and serum cortisol steady during Etomidate anesthesia and reduce gastrin after Etomidate anesthesia, hence regulating the Etomidate-related stress responses effectively.

Effect of acupoint massage plus acupoint sticking therapy for the stress reaction during postoperative anesthesia recovery period in patients undergoing nasal endoscopic surgery

Objective:To observe the effect of acupoint massage plus acupoint sticking therapy for the stress reaction during postoperative anesthesia recovery period in patients undergoing nasal endoscopic surgery.Methods:A total of 120 patients undergoing nasal endoscopic surgery were included,and all patients were under trachea intubation and general anesthesia.The patients were randomized into an observation group and a control group,with 60 patients in each group.Patients in the control group received conventional anesthesia resuscitation,while patients in the observation group received acupoint massage plus acupoint sticking therapy on the basis of conventional anesthesia resuscitation.Changes in the heart rate (HR),systolic blood pressure (SBP) and diastolic blood pressure (DBP) were observed at three time points including the end of the surgery (TO),the removal of the tracheal tube (T1) and 10 min after the removal of the tracheal tube (T2).The awakening and tube removal time,choking cough and restlessness,and adverse reactions (dizziness,nausea and vomiting) in 24 h post-surgery period were compared.Results:At T1 and T2,the comparisons of HR,SBP and DBP between the two groups showed statistical significance (all P＜0.05).Intra-group comparisons showed that the HR,SBP and DBP of the control group at T1 and T2 were significant different from those at TO (all P＜0.05).There were significant differences in the awakening time and tube removal time between the two groups (both P＜0.05).The incidences of choking cough and restlessness were 8.3％ and 3.3％ respectively in the observation group,versus 53.3％ and 30.0％ in the control group,and the between-group comparisons showed statistical significance (both P＜0.05).The incidences of dizziness,nausea and vomiting in 24 h post-surgery period were 3.3％,5.0％ and 0.0％ respectively in the observation group,versus 43.3％,33.3％ and 25.0％ in the control group,and the between-group comparisons showed statistical significance (all P＜0.05).Conclusion:Acupoint massage plus acupoint sticking therapy can effectively regulate the stress reaction during postoperative anesthesia recovery period in patients undergoing nasal endoscopic surgery,and maintain a stable internal environment.

综合肺指数在呼吸功能监测中的应用进展

适当供氧及呼吸功能监测对于镇静或麻醉中的患者极为重要,有效的呼吸监测手段能够及时指导呼吸干预,减少呼吸不良事件的发生,提升患者的安全性。综合肺指数(IPI)是由P_(ET)CO_(2)、PR、SpO_(2)和RR四个参数用模糊逻辑算法组合而成,是评估呼吸功能的新指标。本文综述了IPI的定义、原理、在呼吸功能监测中的应用,以及现阶段存在的不足等内容,为IPI的进一步临床应用和研究提供参考。

子宫肌瘤腹腔镜术丙泊酚与七氟醚麻醉效果及对血流动力学、应激反应影响

目的:子宫肌瘤腹腔镜手术丙泊酚、七氟醚麻醉效果及对受术者血流动力学及应激反应等的影响。方法:纳入2021年3月-2023年8月本院行腹腔镜手术的子宫肌瘤患者90例,随机数字表法分为丙泊酚组和七氟醚组各45例,分别给予丙泊酚复合瑞芬太尼或七氟醚复合瑞芬太尼麻醉干预。对比两组麻醉效果,干预前后应激反应、血流动力学、认知功能,干预后不良反应。结果:七氟醚组自主呼吸时间(5.26±1.17min)、睁眼时间(7.23±1.13min)及拔管时间(8.57±1.65min)均低于丙泊酚组(7.41±1.28min、9.39±1.34min、10.20±1.79min),干预后两组应激反应、血流动力学及认知功能均有变化,但七氟醚组干预后皮质醇、去甲肾上腺素、葡萄糖水平均低于丙泊酚组,心率、平均动脉压及血氧饱和度低于丙泊酚组,干预后简易精神状态量表评分(28.11±0.40分)高于丙泊酚组(25.43±0.32分),连线实验完成时间(35.67±1.72s)低于丙泊酚组(39.68±1.84s),不良反应发生率(15.6%)低于丙泊酚组(35.6%)(均P<0.05)。结论:子宫肌瘤腹腔镜手术麻醉药物选用七氟醚效果优于丙泊酚,七氟醚对患者应激反应、血流动力学及认知功能影响较小,安全性更高。

超声引导下椎管内麻醉穿刺在骨科高龄患者中的应用

目的观察超声引导下的椎管内麻醉穿刺在骨科高龄患者中的应用。方法回顾性分析三明市第二医院2022年1—10月收治的110例骨科高龄手术并接受椎管内麻醉穿刺的患者,根据患者的麻醉实施方式不同分组,其中以常规人工手法定位穿刺者55例为对照组,以超声辅助下定位者55例为研究组。对比2组腰椎间隙定位时间、穿刺定位时间、穿刺总时间、穿刺次数,统计穿刺成功率及不良反应,判定患者对于麻醉的满意度。结果研究组腰椎间隙定位时间、穿刺定位时间、穿刺总时间短于对照组,穿刺次数少于对照组,差异有统计学意义(P<0.05)。研究组中有2例穿刺失败转全身麻醉,而对照组中有10例因穿刺失败转全身麻醉,研究组患者穿刺成功率高于对照组,不良反应总发生率低于对照组,差异有统计学意义(P<0.05)。研究组患者对于麻醉的总满意度高于对照组,差异有统计学意义(P<0.05)。结论在骨科高龄手术患者中,予超声引导下的椎管内麻醉穿刺的麻醉方式,可明显缩短腰椎间隙定位时间、穿刺定位时间、穿刺总时间,减少穿刺次数,穿刺成功率及麻醉成功率均更高,对于减少穿刺不良反应及提升患者对于麻醉的满意度效果理想。

丙泊酚复合舒芬太尼麻醉用于无痛胃肠镜的效果及麻醉复苏情况分析

目的探讨开展无痛胃肠镜检查时提供丙泊酚复合舒芬太尼方案进行麻醉的作用及对麻醉复苏的影响。方法方便选取2022年10月—2023年10月于肥城市人民医院接受无痛胃肠镜检查的98例患者为研究对象,根据不同麻醉方法分为对照组和研究组,每组49例。对照组使用丙泊酚,观察组使用丙泊酚复合舒芬太尼,比较两组患者的麻醉及复苏效果、不同时间点的血流动力学指标、不良反应及认知功能评分。结果观察组丙泊酚用量低于对照组,麻醉诱导时间及麻醉恢复时间均短于对照组,差异有统计学意义(P均<0.05);两组检查时间和麻醉苏醒时间比较,差异无统计学意义(P均>0.05)。两组患者在麻醉前、入睡后、麻醉苏醒时的心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)和血氧饱和度(blood oxygen saturation,SpO_(2))比较,差异无统计学意义(P均>0.05);在检查中,观察组HR、MAP均高于对照组,差异有统计学意义(P均<0.05);两组SpO_(2)比较,差异无统计学意义(P>0.05)。观察组不良反应总发生率为8.16%(4/49),低于对照组的12.24%(6/49),但差异无统计学意义(χ^(2)=0.445,P>0.05)。麻醉前、麻醉苏醒1 h后两组的认知功能评分比较,差异无统计学意义(P均>0.05);麻醉苏醒30 min,观察组的认知功能评分高于对照组,差异有统计学意义(P<0.05)。结论丙泊酚复合舒芬太尼可有效保证无痛胃肠检查的麻醉效果和复苏效果,保证麻醉安全性。

盐酸氢吗啡酮用于ICU全身麻醉心瓣膜术后机械通气患者镇痛的有效性及安全性分析

目的:分析盐酸氢吗啡酮用于ICU全身麻醉心瓣膜术后机械通气患者镇痛的有效性及安全性。方法:选取2022年4月—2023年5月重庆市人民医院(重庆大学附属人民医院)重症医学科收治的全身麻醉心瓣膜术后行机械通气的患者60例作为研究对象,随机分为观察组和对照组,各30例。观察组给予盐酸氢吗啡酮镇痛,对照组给予芬太尼镇痛。比较两组患者各时间点重症监护疼痛观察工具评分(CPOT)、呼吸频率(RR)、心率(HR)、平均动脉压、试验用药时间、有创机械通气时间、入住ICU时间、不良反应发生情况。结果:两组患者用药后6 h、12 h、24 h各时间点的CPOT评分比较,差异无统计学意义(P>0.05),但CPOT评分均低于用药前,差异有统计学意义(P<0.05)。用药后,随着时间的延长,RR和HR逐渐增加,且观察组HR随时间增加的速度快于对照组,差异有统计学意义(P<0.05)。观察组试验用药时间、有创机械通气时间及入住ICU时间短于对照组,差异有统计学意义(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(χ^(2)=0.647,P=0.421)。结论:对于全身麻醉心瓣膜术后机械通气的患者,氢吗啡酮与芬太尼镇痛效果相当,导致谵妄的可能性更小,对呼吸的抑制更小,能缩短该类患者机械通气及ICU的住院时间。

奥赛利定联合右美托咪定预防性镇痛对鼻内镜泪囊鼻腔吻合术患者的应用研究

目的分析奥赛利定(OLI)联合右美托咪定(DEX)对鼻内镜下泪囊鼻腔吻合术(En-DCR)患者的麻醉效果和血流动力学影响。方法招募2024年2月至5月绵阳万江眼科医院行En-DCR患者。根据随机数字表法,将患者随机分为DEX组(仅DEX给药)和联合组(DEX联合OLI给药)。本研究主要观察指标为术后24 h疼痛数字分级评分(NRS)。次要观察指标为心率(HR)、平均动脉压(MAP)、呼吸恢复时间(SRT)、拔管时间(ET)、苏醒时间(AT)、收缩期峰值(PSV)、舒张末期血流速度(EDV)、阻力指数(RI)和血流量(BF)。观察并记录住院期间患者不良反应发生情况。结果研究共纳入患者80例,DEX组和联合组各40例。在镇痛方面,联合组T_(1)(拔出导管后0.5 h内)、T_(2)(术后4 h)、T_(3)(术后8 h)和T_(4)(术后24 h)的NRS均低于DEX组(P<0.05),且联合组补救镇痛率显著低于DEX组(P<0.05)。麻醉效果方面,联合组在T_(6)(麻醉诱导期)、T_(7)(术中)和T_(8)(复苏期间)时间点上的HR和MAP均低于DEX组(P<0.05);与DEX组比较,联合组SRT、ET和AT均较短(P<0.05)。血流动力学方面,术后24 h,两组PSV、EDV和BF较麻醉前明显升高,而RI较麻醉前明显下降(P<0.05);联合组PSV、EDV和BF高于DEX组,RI低于DEX组(P<0.05)。不良反应方面,联合组不良反应发生率显著低于DEX组(P<0.05)。结论OLI联合DEX预防性镇痛对En-DCR患者效果显著,不仅可减轻术后疼痛、稳定血流动力学,缩短拔管及苏醒时间,且减少不良反应发生率。

硬膜外麻醉、腰硬联合麻醉用于剖宫产术中麻醉及术后镇痛效果对比

目的:对比硬膜外麻醉、腰硬联合麻醉用于剖宫产手术中麻醉及术后镇痛效果。方法:选取2021年3月-2023年3月本院收治拟行剖宫产产妇92例,按照麻醉方式分为对照组45例(硬膜外麻醉)和联合组47例(腰硬联合麻醉)。对比两组手术围术期指标、术中麻醉效果、术后2 h(T1)、术后5 h(T2)、术后12 h(T3)、术后1 d(T4)、术后2 d(T5)视觉模拟评分(VAS)、镇静评分(Ramsay)及不良反应。结果:联合组手术时间、麻醉时间、胎儿娩出时间均短于对照组,术中辅助用药产妇比例(42.6%)低于对照组(69.9%),麻醉总有效率(97.9%)高于对照组(86.7%),T1、T2、T3、T4、T5时VAS评分(5.43±1.01分、4.01±1.12分、3.81±1.23分、2.18±0.11分、1.46±0.12分)均低于对照组(6.93±1.25分、5.96±1.91分、4.96±1.74分、2.78±0.38分、1.79±0.65分),两组术后Ramsay评分均上升联合组T1、T2、T3、T4、T5时评分均高于对照组,不良反应发生率(17.0%)低于对照组(42.2%)(均P<0.05)。结论:剖宫产手术中应用腰硬联合麻醉在比硬膜外麻醉麻醉效果更佳,可减轻产妇术后疼痛,降低不良反应,具有一定安全性。

瑞马唑仑与丙泊酚对结肠镜检查患者术后认知功能及恢复质量的影响:临床比较研究

目的:探究瑞马唑仑与丙泊酚对结肠镜检查患者的术后认知功能及术后恢复质量的影响。方法:将150例结肠镜检查患者随机分为P组和R组,各75例。P组采用丙泊酚麻醉,R组采用苯磺酸瑞马唑仑麻醉。比较两组麻醉及苏醒时间、脑电双频指数(BIS)值、认知功能[蒙特利尔认知评估(MoCA)量表]、不良反应。结果:R组麻醉起效、检查结束至苏醒时间短于P组;用药5 min、置入肠镜时、置入肠镜5 min、术毕时的BIS值以及苏醒时的MoCA量表评分均高于P组;不良反应发生率低于P组(P<0.05)。结论:相较丙泊酚,瑞马唑仑用于结直肠镜检查患者的麻醉效果较好,且对患者BIS值及认知功能影响较小,更利于患者术后恢复,安全性较高。

椎管内麻醉与全身麻醉在输尿管镜激光碎石术中的临床应用效果对比研究

目的 对比分析椎管内麻醉与全身麻醉在输尿管镜激光碎石术中的临床应用效果。方法 回顾性选取2022年1月—2023年12月汕头市澄海区人民医院收治的126例输尿管镜激光碎石术患者的临床资料,按麻醉方式不同分为A组与B组,每组63例。A组采用椎管内麻醉,B组采用全身麻醉。对比两组麻醉相关时间、生命体征、不良反应发生率。结果 A组患者麻醉起效时间、术后清醒时间短于B组,麻醉维持时间长于B组,差异有统计学意义(P均<0.05)。麻醉前,两组生命体征对比,差异无统计学意义(P均>0.05);麻醉后30 min,A组患者的术中生命体征比B组更稳定,差异有统计学意义(P均<0.05)。A组患者不良反应总发生率为4.76%(3/63),低于B组的15.87%(10/63),差异有统计学意义(χ^(2)=4.203,P<0.05)。结论在输尿管镜激光碎石术中,椎管内麻醉相较于全身麻醉具有麻醉起效快、苏醒时间短、麻醉维持时间长、术中生命体征稳定以及不良反应发生率低等优势。

球后神经阻滞联合全身麻醉对角膜移植术患者血流动力学波动与麻醉药物用量及不良反应的影响

目的探究球后神经阻滞联合全身麻醉对角膜移植术患者血流动力学波动、麻醉药物用量和不良反应的影响。方法选取2018年12月至2021年10月于厦门大学附属厦门眼科中心行角膜移植术的120例患者作为研究对象,根据麻醉方式的不同分为全麻组(n=52)与联合组(n=68)。全麻组给予全身麻醉,联合组给予球后神经阻滞联合全身麻醉,比较两组血流动力学指标[平均动脉压(MAP)、心率(HR)]、麻醉用药量及不良反应发生情况。结果麻醉后5、30 min,两组HR均快于前一时间点,全麻组MAP均低于麻醉前,差异有统计学意义(P<0.05);麻醉后5min,联合组MAP低于麻醉前,差异有统计学意义(P<0.05);麻醉后30min,全麻组MAP高于麻醉后5min,差异有统计学意义(P<0.05),但联合组麻醉前与麻醉后30min比较差异无统计学意义。麻醉前,两组MAP、HR比较差异无统计学意义;麻醉后5、30min,联合组MAP均高于全麻组,HR均慢于全麻组,差异有统计学意义(P<0.05)。联合组丙泊酚和瑞芬太尼用量均少于全麻组,差异有统计学意义(P<0.05);联合组不良反应发生率低于全麻组,但差异无统计学意义。结论球后神经阻滞联合全身麻醉应用于角膜移植术患者中,可维持血流动力学稳定,减少丙泊酚和瑞芬太尼使用量,且安全性较高。

依托咪酯联合瑞芬太尼在老年患者无痛肠镜麻醉中的应用

目的探讨在老年无痛肠镜麻醉中采用依托咪酯联合瑞芬太尼方案的效果。方法选取2021年1月—2022年12月泰兴市中医院收治的115例无痛肠镜检查患者为研究对象,根据麻醉方案不同分为两组,对照组(n=57)予丙泊酚联合瑞芬太尼方案,观察组(n=58)予依托咪酯联合瑞芬太尼方案,比较两组麻醉及检查情况,评估患者麻醉前后生命体征改变,并对比不良反应发生率。结果观察组麻醉起效、置镜操作、麻醉苏醒时间均较对照组短,差异有统计学意义(P均<0.05)。麻醉后,观察组平均动脉压(82.25±6.14)mmHg、心率(69.48±4.63)次/min、血氧饱和度(97.33±1.79)%,优于对照组的(79.02±6.32)mmHg、(65.55±4.27)次/min、(95.24±1.72)%,差异有统计学意义(t=2.778、4.730、6.383,P均<0.05)。观察组注射痛、呼吸抑制发生率低于对照组,差异有统计学意义(P均<0.05)。结论对老年无痛肠镜检查患者予依托咪酯联合瑞芬太尼麻醉效果确切,能维持循环稳定,减少呼吸抑制,不良反应发生风险低。

喉罩全身麻醉对年龄>70岁髋关节手术患者血流动力学的影响

目的:分析喉罩全身麻醉对年龄>70岁髋关节手术患者血流动力学的影响。方法:选取2019年12月—2021年12月信阳市人民医院骨科收治的104例年龄>70岁髋关节手术患者作为研究对象,按照麻醉方法分为两组,分别是实验组(52例,喉罩全身麻醉)和常规组(52例,气管内全麻)。比较两组患者术后6 h、术后12 h手术麻醉效果和采用视觉模拟评分(VAS),比较两组患者术中0.5 h、1 h血流动力学指标[平均动脉压(MAP)、心率(HR)]以及不良反应发生率。结果:实验组麻醉起效时间少于常规组,麻醉维持时间多于对照组,差异有统计学意义(t=13.809、5.005,P<0.05);术后6 h和术后12 h,实验组疼痛VAS评分低于常规组,差异有统计学意义(t=9.471、6.897,P<0.05);实验组患者MAP水平低于常规组术前、术中0.5 h,HR水平高于常规组,差异有统计学意义(t=7.854、6.694;t=8.241、3.522,P<0.05);实验组的术后发生不良反应率明显低于常规组,差异有统计学意义(χ^(2)=4.981,P<0.05)。结论:对于年龄>70岁髋关节手术患者,喉罩全身麻醉与气管内全麻相比,可改善髋关节手术麻醉效果,缓解疼痛,稳定血流动力学指标,降低不良反应发生率。

腰麻-硬膜外联合麻醉对老年下肢骨折患者术后镇痛的影响效果分析

目的 分析对老年下肢骨折患者开展腰麻-硬膜外联合麻醉的术后镇痛效果。方法 目的选取江苏省盐城市东台梅氏中西医结合医院于2020年1月—2023年1月收治的80例老年下肢骨折手术患者为研究对象,依麻醉方案差异将其分为对照组(n=40,气管插管全身麻醉)和观察组(n=40,腰麻-硬膜外联合麻醉)。对比不同麻醉方式的麻醉效果。结果 观察组术后12、24、48 h疼痛程度评分低于对照组,观察组麻醉相关时间短于对照组,差异有统计学意义(P均<0.05)。观察组不良反应发生率(2.50%)低于对照组(20.00%),差异有统计学意义(χ^(2)=4.507,P<0.05)。结论 与全身麻醉相比,老年下肢骨折患者术中采用腰麻-硬膜外联合麻醉,术后镇痛效果更好,且术后不良反应少。

右美托咪定联合罗哌卡因辅助臂丛神经阻滞麻醉在老年骨折患者中的临床疗效分析

目的:观察右美托咪定联合罗哌卡因在老年骨科手术患者臂丛神经阻滞麻醉中的应用效果及对其生命体征指标的影响。方法:本文为前瞻性研究,病例纳入2020年3月-2022年5月于禹州市人民医院接受手术的126例老年骨折患者作为研究对象,经抽签法,按1∶1比例将其分为联合组和对照组,每组各63例,两组术中均经臂丛神经注射罗哌卡因进行阻滞麻醉,联合组在此基础上采用右美托咪定辅助麻醉,比较两组患者的术中、术后镇痛效果,术后体征指标及不良事件发生情况。结果:两组患者麻醉前(T0)的平均动脉压(MAP)、心率(HR)比较,差异无统计学意义(P>0.05);联合组麻醉10 min (T1)、30 min (T2)、术毕时(T3)的MAP分别为(76.32±0.31) mmHg、(75.35±0.22) mmHg、(74.12±0.33) mmHg,均低于对照组(76.65±0.88) mmHg、(75.62±0.81) mmHg、(74.45±0.83) mmHg,差异有统计学意义(t=2.807、2.553、2.933;P<0.05);HR分别为(65.34±0.11)次/min、(64.21±0.25)次/min、(63.11±0.13)次/min,均低于对照组的(65.66±0.85)次/min、(64.57±0.82)次/min、(63.46±0.81)次/min,差异有统计学意义(t=2.963、3.333、3.203,P<0.05);术后30 min、1 h、3 h、5 h的视觉模拟疼痛(VAS)评分分别为(4.42±0.31)分、(3.77±0.25)分、(3.14±0.25)分、(2.26±0.37)分,均低于对照组的(4.71±0.83)分、(4.04±0.82)分、(3.52±0.85)分、(2.61±0.81)分,差异有统计学意义(t=2.598、2.500、3.404、3.120,P<0.05),自控镇痛泵(PCA)按压次数为(10.11±0.24)次/24 h,低于对照组的(10.48±0.88)次/24 h,差异有统计学意义(t=3.220,P<0.05)、停用时间为(40.25±0.31) h,低于对照组的(40.61±0.83) h,差异有统计学意义(t=3.225,P<0.05);苏醒后的收缩压(SBP)为(125.11±10.32) mmHg,低于对照组的(130.45±10.28) mmHg,差异有统计学意义(t=2.910,P<0.05);舒张压(DBP)为(85.44±1.36) mmHg,低于对照组的(86.26±1.45) mmHg,差异有统计学意义(t=3.274,P<0.05);心率(HR)为(105.44±5.25)次/min,低于对照组的(108.42±5.31)次/min,差异有统计学意义(t=3.168,P<0.05);麻醉药物副反应及术后并发症发生率为7.94%,略高于对照组的6.35%,差异无统计学意义(χ^(2)=0.191,P>0.05)。结论:在老年骨折手术患者术中联合应用右美托咪定辅助罗哌卡因臂丛神经阻滞麻醉可显著增强术中、术后镇痛效果,对维持患者苏醒后体征稳定有积极作用,且此麻醉方法未明显增强副反应以及术后并发症等不良事件发生风险,安全性较高。

超声引导下臂丛神经阻滞麻醉在老年上肢骨折手术患者中的应用效果

目的探讨超声引导下臂丛神经阻滞麻醉在老年上肢骨折手术患者中的应用效果。方法回顾性分析2021年1月至2022年12月我院收治的50例行手术治疗的老年上肢骨折患者的临床资料,按照不同麻醉方式将其分为对照组和研究组,各25例。对照组使用盲探的方法实施臂丛神经阻滞麻醉,研究组实施超声引导下臂丛神经阻滞麻醉。比较两组的麻醉效果。结果研究组的麻醉优良率为100.00%,高于对照组的84.00%,差异具有统计学意义(P<0.05)。麻醉10、30 min,两组的心率(HR)、平均动脉压(MAP)均低于麻醉前(P<0.05);麻醉10、30 min及术毕,研究组的HR、MAP高于对照组,差异具有统计学意义(P<0.05)。研究组的阻滞起效时间短于对照组,镇痛维持时间长于对照组,麻醉药物使用剂量少于对照组(P<0.05)。研究组的不良反应总发生率为4.00%,低于对照组的20.00%(P<0.05)。研究组的麻醉满意度为100.00%,高于对照组的76.00%(P<0.05)。结论超声引导下臂丛神经麻醉在老年上肢骨折手术患者中的麻醉效果显著,其起效时间快,能够维持血流动力学指标的稳定,有效降低不良反应发生率,值得临床推广。