Pneumocephalus Following Combined Spinal-Epidural Anesthesia: A Case Report Analysis

Background: Combined spinal-epidural anesthesia (CSEA) is widely used in clinical anesthesia due to its rapid onset, reliable anesthetic effect, and strong controllability. Although advancements in technique have reduced the frequency and severity of common complications, reports of rare and serious complications such as pneumocephalus, remain scarce. Case Report: This article presents a case of pneumocephalus following CSEA in a middle-aged female patient undergoing surgery for an intrauterine space-occupying lesion. The patient experienced severe headache postoperatively, and imaging confirmed the presence of intracranial air. After receiving active symptomatic treatment, the patient recovered and was discharged. Conclusion: This case underscores the importance of adhering to standard anesthesia protocols and increasing awareness of rare CSEA complications, particularly the risk of pneumocephalus. Early recognition and timely management are crucial. There is a need to further enhance training and research in anesthetic procedures to improve clinical anesthesia quality and ensure patient safety.

Effects of combined spinal-epidural anesthesia on anxiety,labor analgesia and motor blocks in women during natural delivery

BACKGROUND The background of this study was analgesia in natural delivery.The combined spinal-epidural anesthesia has obvious analgesic effect on the parturients in natural labor,and combined spinal-epidural anesthesia has been widely used in anesthesia for various diseases.AIM To study the effects of combined spinal-epidural anesthesia on anxiety,labor analgesia,and motor blocks in parturients during natural delivery.METHODS A total of 120 women who gave birth at Changning District Maternal and Child Health Hospital between December 2021 to December 2022 were included;a random number table approach was employed to divide the women into a control group and a joint group,with each group consisting of 60 women.The control group was given epidural anesthesia,while the joint group was given combined spinal-epidural anesthesia.The visual analog scale(VAS)was used to evaluate the degree of maternal pain.Comparisons were made between the two groups’conditions of childbirth and the duration of labor.Apgar scores were used to evaluate the status of the newborns at birth;Self-rating Anxiety Scale(SAS)and General Self-Efficacy Scale(GSES)scores,umbilical artery blood gas analysis indices and stress indices were compared between the two groups;and the frequencies of motor block and postpartum complications were analyzed.RESULTS In comparison to the control group,in the joint group,the VAS scores for the first,second,and third stages of labor were lower(P<0.05).The rates of conversion to cesarean section and postpartum blood loss in the joint group were lower than those in the control group(P<0.05).No significant differences were observed in the Apgar score,the duration of the first stage of labor,or the total duration of labor between the two groups(P>0.05).The second and third stages of labor in the joint group were shorter than those in the control group(P<0.05).When compared to the control group,the postpartum SAS score of the joint group was lower,while the GSES score was greater(P<0.05).Between the control group and the joint group,the differences observed in pH,arterial carbon dioxide partial pressure,arterial oxygen partial pressure,or arterial hydrogen ion concentration were not significant(P>0.05).Nitric oxide,cortisol,and adrenaline levels were lower in the joint group than in the control group(P<0.05).There were no substantial differences in Bromage grade or rate of complications between the two groups(P>0.05).CONCLUSION For parturients during natural delivery,combined spinal-epidural anesthesia can reduce anxiety,provide labor analgesia,shorten labor time,and reduce postoperative stress levels but did not result in a motor block.

Efficacy of low-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia

Objective: To study the efficacy of low-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia. Methods: Puerperae who underwent vaginal delivery under combined spinal-epidural anesthesia for labor analgesia in Lincheng People's Hospital between June 2014 and March 2017 were selected and randomly divided into three groups, group A received 15 μg small-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia, group B received 25 μg large-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia, and group C received ropivacaine epidural anesthesia alone for labor analgesia. During delivery, the serum in the second stage of labor was collected to determine the contents of pain transmitters, inflammatory cytokines and stress response indexes. Results: During delivery, serum SP, 5-HT, DA, NE, DYN, TNF-α, IL-1β, IL-6, IL-10, PGE2, Cor, C-P, MDA and AOPP contents of group A and group B were lower than those of group C and serum SP, 5-HT, DA, NE, DYN, TNF-α, IL-1β, IL-6, IL-10, PGE2, Cor, C-P, MDA and AOPP contents of group A were not significantly different from those of group B. Conclusion: 15 μg small-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia is with exact efficacy and good safety.

Effects of Combined Spinal Epidural Anaesthesia and Spinal Anaesthesia on Peri-Operative Pulmonary Status in Geriatric Patients in Lower Extremity Surgery

Background: Lower extremity surgeries performed in elderly people usually have high prevalence of peri-operative medical problems related to anaesthesia. The overall objective of peri-operative care of geriatric population is to fast recovery from anaesthesia and avoid functional decline. Objective: To compare the peri-operative pulmonary status of combined spinal epidural anaesthesia (CSEA) and spinal anaesthesia (SA) in geriatric patients underwent lower extremity surgeries. Methods: This prospective comparative study was conducted at Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2016 to June 2018. A total of 70 geriatric cases that underwent lower extremity surgeries were included in this study. Cases were randomly allocated into two groups;35 in Group A (CSEA) and 35 in Group B (SAB). The different outcome variables between the groups like-duration of anaesthesia, respiratory rates (RR), oxygen saturation (SpO2), end tidal CO2 (EtCO2), peak expiratory flow rate (PEFR), breath holding test (BHT), peri-operative side effects of anaesthesia and post-operative visual analogue score (VAS) were analyzed and compared by statistical tests. Results: The mean age, weight, BMI of Group A and Group B patients were not significantly different (p > 0.05). No significant differences were observed in duration of surgery, gender and ASA grade between the groups (p > 0.05). Mean duration of anaesthesia, mean time to achieve target level of sensory block and mean time to achieve complete motor block were significantly higher in Group A (p < 0.001). Mean RR, SpO2, EtCO2, PEFR and BHT of both groups were not significantly different (p > 0.05). Peri-operative side effects of anaesthesia and post-operative VAS were significantly less in group A patients (p < 0.05). Conclusion: Combined spinal epidural anaesthesia is effective and safe;produces stable peri-operative pulmonary status with prolonging analgesia and fewer side effects as compared to spinal anaesthesia in geriatric patients.

Cardiopulmonary,Biochemical and Haematological Effects of the Tiletamine/Zolazepam-Xylazine-Tramadol Combination to Provide Anaesthesia in Miniature Pigs

The objective of this study was to investigate the suitability of tiletamine/zolazepam-xylazine-tramadol combination for miniature pigs. Fourteen Chinese experimental miniature pigs subjected to this study received 3.5 mg tiletamine/zolazepam kg-1 bw, 1.32 mg xylazine kg-1 bw and 1.8 mg tramadol kg-1 bw intramuscularly, as a mixture of the drugs. Cardiopulmonary, biochemical and haematological parameters were recorded before drug administration and after anaesthesia. The combination of the compounds resulted in anaesthesia lasting about 87 min and a satisfactory immobilization for handling. Cardiopulmonary parameters were changed after administration, but there were within biologically acceptable limits. Biochemical and haematological values decreased after drug administration, however, they returned to the baseline at 24 h. At the doses described, tiletamine/zolazepam-xylazine-tramadol combination produced good immobilization in miniature pigs with minimal changes over time in cardiopulmonary, biochemical and haematological parameters.

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。

Anesthetic dilemmas in an achondroplastic patient undergoing elective cesarean section

Achondroplasia is a genetic condition characterized by skeletal dysplasia that results in characteristic craniofacial and spinal abnormalities.It is the most common form of short-limbed skeletal dysplasia.A morbidly obese pregnant patient warrants specific anatomical and physiological considerations,such as a difficult airway with potential hypoxia,full stomach precautions,and a reduced functional residual capacity.Achondroplasia increases the risks of maternal and fetal complications.Although neuraxial techniques are generally preferred for cesarean sections,there is no consensus among patients with achondroplasia.We aimed to discuss the anesthetic challenges in an achondroplastic patient and report our regional anesthesia approach for an elective cesarean section.

Regional anesthesia in a patient with primary ciliary dyskinesia:A case report

BACKGROUND Primary ciliary dyskinesia(PCD)is an inherited autosomal-recessive disorder of impaired mucociliary clearance characterized by chronic respiratory diseases,otolaryngological diseases,central nervous system abnormalities,reproductive system abnormalities,and cardiac function abnormalities.General anesthesia in these patients is associated with a higher incidence of respiratory complications than in patients without the disease.CASE SUMMARY A 16-year-old male patient was referred to the emergency room complaining of right ankle pain due to distal tibiofibular fracture.Three years prior,he had been diagnosed with PCD.At that time,he had experienced several episodes of pneumonia,sinusitis,and chronic middle ear infections,for which he underwent surgical interventions.At the current admission,he presented with cough and sputum but no other respiratory symptoms.A chest computed tomography scan revealed centrilobular ground-glass opacities in both lower lobes and a calcified nodule in the left lower lobe.For the surgical procedure and postoperative pain management,combined spinal-epidural anesthesia was employed.The patient’s postoperative pain score was measured by the numerical rating scale(NRS).On the day of surgery,his NRS was 5 points.By the second postoperative day,the NRS score had decreased to 2–3 points.The epidural catheter was removed on the fourth day following the operation.The patient was subsequently discharged no respiratory complications.CONCLUSION We performed combined spinal-epidural anesthesia in a patient with PCD.The patient experienced no additional respiratory complications and was discharged with a low NRS score for pain.

瑞芬太尼复合麻醉对腹腔镜下胆囊切除患者血清IL⁃6、IL⁃2及T淋巴细胞亚群的影响

目的探讨瑞芬太尼复合麻醉对腹腔镜下胆囊切除(LC)患者血清IL⁃6、IL⁃2及T淋巴细胞亚群的影响。方法选取无为市人民医院2019年10月至2023年7月收治的122例行LC治疗患者为研究对象,根据麻醉药物不同分为对照组(n=59,七氟烷+丙泊酚复合麻醉)和观察组(n=63,瑞芬太尼+丙泊酚复合麻醉)。比较两组麻醉恢复情况、血清IL⁃6、IL⁃2水平、T淋巴细胞亚群变化及不良反应。结果观察组术后苏醒时间、自主呼吸恢复时间和导管拔除时间均短于对照组,差异具有统计学意义(P<0.05);两组T0时IL⁃6、IL⁃2水平比较,差异无统计学意义(P>0.05);T_(1)(术后6小时)、T_(2)(术后12小时)、T_(3)(术后24小时)时,观察组IL⁃6水平低于对照组,IL⁃2水平高于对照组,差异有统计学意义(P<0.05);两组T0时CD_(3)^(+)、CD_(4)^(+)、CD_(8)^(+)、CD_(4)^(+)/CD_(8)^(+)比较,差异无统计学意义(P>0.05);在T_(1)、T_(2)、T_(3)时比较,观察组CD_(3)^(+)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)高于对照组,CD_(8)^(+)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)。结论与七氟烷复合麻醉比较,瑞芬太尼复合麻醉对LC患者血清IL⁃6、IL⁃2水平及免疫系统的影响较小,可加快术后患者清醒和麻醉恢复,安全性尚可。

Acupoint Injection Decreases Anesthetic Cosumption during Combined Spinal-Epidural and Patient-Controlled Epidural Labor Analgesia

Objective:To explore if acupoint injection can improve analgesic effects or delivery outcomes in parturients who received combined spinal-epidural analgesia(CSEA)and patient-controlled epidural analgesia(PCEA)for labor analgesia.Methods:A total of 307 participants were prospectively collected from July 2017 to December 2019.The participants were randomized into the combined acupoint injection with CSEA plus PCEA group(AICP group,n=168)and CSEA plus PCEA group(CP group,n=139)for labor analgesia using a random number table.Both groups received CSEA plus PCEA at cervical dilation 3 cm during labor process,and parturients of the AICP group were implemented acupoint injection for which bilateral acupoint of Zusanli(ST 36)and Sanyinjiao(SP 6)were selected in addition.The primary outcome was Visual Analogue Scale(VAS)score,and the secondary outcomes were obstetric outcomes and requirement of anesthetics doses.Safety evaluations were performed after intervention.Results:The VAS scores were significantly lower in the AICP group than in the CP group at 10,30,60,and 120 min after labor analgesia(all P<0.05).The latent phase of the AICP group was shorter than that of the CP group(P<0.05).There were less additional anesthetics consumption,lower incidences of uterine atony,fever,pruritus and urinary retention in the AICP group than those in the CP group(all P<0.05).Conclusion:Acupoint injection combined CSEA plus PCEA for labor analgesia can decrease the anesthetic consumption,improve analgesic quality,and reduce adverse reactions in the parturients.(Registration No.ChiMCTR-2000003120)

腰硬联合麻醉分娩镇痛相关产时发热危险因素模型构建及防范策略

目的构建腰硬联合麻醉分娩镇痛相关产时发热的危险因素模型,并提出针对性防范策略。方法回顾性分析行腰硬联合分娩镇痛的产妇202例为研究对象。根据是否发生产时发热(母体口腔体温峰值≥38℃)分为发生产时发热组32例和未发生产时发热组170例。比较2组产妇一般资料;采用多因素Logistic回归分析法分析腰硬联合分娩镇痛产妇产时发热的危险因素;采用Hosmer-Lemeshow检验评估模型拟合优度;绘制受试者工作特征(ROC)曲线评价模型预测效果。结果2组使用球囊促宫颈成熟、羊水污染、分娩镇痛时间、产程时间、产前白细胞(WBC)计数、产前C反应蛋白(CRP)水平比较,差异有统计学意义(P<0.05)。Logistic回归分析显示,使用球囊促宫颈成熟、羊水污染、产程时间>9 h、分娩镇痛时间>5 h、产前WBC>10×10^(9)/L、产前CRP水平>10 mg/L是腰硬联合麻醉分娩镇痛相关产时发热的危险因素(P<0.05)。Hosmer-Lemeshow检验显示,模型拟合优度良好;根据预测值和真实值绘制ROC曲线,曲线下面积(AUC)为0.869(95%CI:0.815-0.912),说明模型预测价值良好。当最佳截断值>13.2时,敏感度为78.12%,特异度为85.29%,显著性水平P<0.001,模型预测价值良好。结论使用球囊促宫颈成熟、羊水污染、分娩镇痛时间>5 h、产程时间>9 h、产前WBC>10×10^(9)/L、产前CRP水平>10 mg/L是腰硬联合麻醉分娩镇痛相关产时发热的危险因素,值得临床关注。

不同剂量罗哌卡因腰-硬联合麻醉用于下肢手术的效果比较

目的比较不同剂量低浓度罗哌卡因腰-硬联合麻醉用于下肢手术的麻醉效果。方法择期下肢手术患者136例,急诊下肢手术患者83例。按腰麻用药分为0.1%、0.15%和0.2%罗哌卡因3组,每组73例,各组剂量从3mg开始递增,顺序完成3mg各3例,4mg各10例,5、6、7mg各20例。硬膜外腔维持用药均为0.2%罗哌卡因。术前不用药。患者侧卧位,患侧在上,L2-3套针法穿刺,调整麻醉平面在T9-10。观察麻醉效果,BP、HR、SpO2、Bromage评分等。结果优良率6-7mg时为95%、5mg时为50%-55%、4mg时为30%,剂量为3mg时虽有镇痛平面,但不能行手术,均为麻醉失败,剂量为7mg时无失败病例。患者术中BP、HR、SpO2平稳,无恶心呕吐。头痛1例,尿潴留2例。术中患肢Bromage评分为2-3分,健肢为0-1分。结论0.1%-0.2%罗哌卡因6-7mg腰麻与0.2%罗哌卡因硬膜外阻滞联合麻醉,具有用药少,起效快,镇痛完善,BP、HR、SpO2平稳,副作用小,麻醉消退快,能早期活动,利于搬运转移患者等优点,不仅可用于无严重创伤性休克患者下肢不同部位手术的麻醉,而且可为战时手术方舱内的手术提供一种麻醉选择。

胶体液预扩容联合预注血管活性药对产妇腰-硬联合麻醉后血流动力学的影响

目的研究胶体液预扩容联合预注小剂量血管活性药对剖宫产腰-硬联合麻醉(CSEA)后产妇血流动力学及新生儿血气和Apgar评分的影响。方法择期行CSEA下剖宫产术的产妇60例,于麻醉前30min输入6%羟乙基淀粉130/0.415ml·kg-1·h-1,扩容完成后行腰麻穿刺。随机均分为:胶体液+麻黄碱组(HES-E组)、胶体+去氧肾上腺素组(HES-P组)、胶体组(HES-C组)。HES-E组静脉泵注麻黄碱8mg;HES-P组泵注去氧肾上腺素100μg;HES-C组泵入等容量1ml生理盐水。监测麻醉前(基础值,T1)、扩容后(T2)以及麻醉后2、3、5、10min(T3～T6)、切皮时(T7)、手术结束(T8)的MAP、HR及CO等,记录产妇低血压以及恶心呕吐发生率。记录新生儿Ap-gar评分及脐带血气分析。结果 HES-E、HES-P组低血压发生率明显低于HES-C组(P<0.05)。与T1时比较,T3～T5时HES-E组和T4、T5HES-C组HR明显增快、而T3～T5时HES-P组HR明显减慢(P<0.05);T4、T5时HES-C组MAP明显降低(P<0.05);T3～T6时HES-P、HES-C组CO明显下降(P<0.05)。与HES-C组比较,T3～T6时HES-E、HES-P组MAP明显升高(P<0.05);T3～T5时HES-E组CO明显升高(P<0.05)。三组新生儿脐血的pH值、PCO2、PO2、Lac、BE以及Apgar评分差异无统计学意义。结论胶体液的预扩容联合小剂量的血管活性药预注减少了低血压和恶心呕吐的发生率,积极有效地防治剖宫产术CSEA中所致的低血压,并且不会引起胎儿脐血pH、BE值的下降。

腰硬联合麻醉下剖宫产术中甲氧明的用药时机

目的:探讨剖宫产手术中甲氧明防治低血压的最佳用药时机。方法:择期行子宫下段剖宫产手术产妇90例,分为3组。Ⅰ组在腰麻药注入后即刻静脉注射甲氧明0.02 mg/kg,Ⅱ组在腰麻药注入后1 min时静脉注射甲氧明0.02 mg/kg,Ⅲ组在腰麻药注入后产妇出现血压下降超过基础值10%时静脉注射甲氧明0.02 mg/kg,分别记录腰麻前(T0),腰麻后1(T1)、2(T2)、3(T3)、5(T4)、10(T5)、15(T6)min时的心率、连续无创动脉血压以及新生儿脐动脉血气分析和1 min、5 min Apgar评分,记录3组高血压、低血压及恶心、呕吐等不良反应发生情况。结果:与T0比较,Ⅰ组在T1、T2时血压升高(P<0.05),Ⅲ组在T2时血压下降(P<0.05),Ⅱ组血压无明显被动。3组在用药后心率均明显下降(P<0.05),但逐渐趋于平稳,未出现心动过缓。Ⅰ组、Ⅱ组恶心发生率低于Ⅲ组(P<0.001)。Ⅰ组高血压的发生率高于Ⅱ组和Ⅲ组(P<0.001)。3组新生儿脐动脉血气分析和1 min、5 min Apgar评分差异均无统计学意义(P>0.05)。结论:在腰硬联合麻醉下剖宫产手术中,容量共同负荷及腰麻后1 min是使用甲氧明防治产妇低血压的最佳时机。

罗比卡因椎管内联合麻醉对产妇皮质醇及胎儿的影响

目的 :探讨罗比卡因椎管内联合麻醉对剖宫产妇皮质醇及胎儿的影响。方法 :选择ASAⅠ～Ⅱ级足月妊娠产妇 40例 ,随机双盲等分两组。腰麻用药分别为罗比卡因 (R组 )或布比卡因 (B组 ) 1 0～ 1 5ml。术中麻醉效果下降时可从硬膜外置管中补充 1 6 %利多卡因。围术期连续监测呼吸和循环状态 ,定时测产妇血糖、血清皮质醇浓度 ,评估出生时新生儿Apgar评分并行脐动脉血气分析 ,记录术中产妇安全相关指标。结果 :两组产妇术中清醒合作 ,麻醉效果均可以满足手术要求。两组产妇新生儿出生时Apgar评分均为 10分 ,脐动脉血气结果正常。术中R组产妇胎儿娩出和术毕时MAP下降明显 (P <0 0 5 ) ,且组间差异明显 (P <0 0 5 ) ,同时胎儿娩出时HR增快 (P <0 0 5 ) ,术毕HR减慢 (P <0 0 5 ) ;B组产妇仅胎儿娩出时MAP下降 (P <0 0 5 )。两组产妇于胎儿娩出和术毕时血糖浓度明显升高 (P <0 0 5 ) ,皮质醇浓度仅B组产妇术中明显升高 (P <0 0 5 )。R组HR减慢次数明显增多 (P <0 0 5 )。结论 :0 75 %罗比卡因适用于椎管内联合麻醉剖宫产 ,麻醉效能与同等浓度布比卡因相近 ,对新生儿无不良影响 ;但罗比卡因对交感神经的阻滞性强于布比卡因 ,术中易有BP波动 ,抑制皮质醇分泌明显。

葡萄糖对罗哌卡因蛛网膜下腔阻滞的影响

目的观察100 g.L-1葡萄糖对罗哌卡因蛛网膜下腔阻滞时感觉、运动神经阻滞的影响。方法随机选取择期行下腹部及以下手术的患者24例,ASA分级Ⅰ～Ⅱ级,随机分为对照组和观察组。腰硬联合麻醉下,蛛网膜下腔给药。对照组蛛网膜下腔朝头侧注入7.5 g.L-1罗哌卡因1.33 mL＋9 g.L-1NaC l 0.67 mL,观察组蛛网膜下腔朝头侧注入7.5 g.L-1罗哌卡因1.33 mL＋100 g.L-1葡萄糖。观察比较2组的感觉阻滞起效时间、感觉阻滞持续时间、运动阻滞起效时间、运动阻滞持续时间、最高感觉阻滞平面、最高感觉阻滞时间、最大运动阻滞程度、最大运动阻滞时间。结果观察组感觉阻滞起效时间、感觉阻滞持续时间、运动阻滞起效时间、运动阻滞持续时间以及最大运动阻滞时间均明显短于对照组（P〈0.05）,最高感觉阻滞平面、最大运动阻滞程度高于对照组（P〈0.05）,最高感觉阻滞时间2组间无显著差异（P〉0.05）。结论罗哌卡因蛛网膜下腔阻滞时,加入100 g.L^-1葡萄糖可明显缩短感觉、运动阻滞的起效时间和持续时间,增加感觉阻滞的平面及运动阻滞的程度。

不同量表评估全麻后老年病人早期认知功能意义的比较

目的探讨老年病人行全麻下非心脏手术后早期认知功能的评估策略并比较全凭静脉和静吸复合麻醉对术后早期认知功能的影响。方法选择全麻下行择期非心脏手术且年龄≥65岁的老年病人142例,全麻方式为全凭静脉与静吸复合麻醉,选用包括简易智力量表(MMSE)、数字广度测验、数字符号测验、循迹连线测验和理解记忆等5项测验的一系列神经心理学评估量表评估认知功能,分为MMSE和全套量表测试两组:MMSE测试组于术前及术后1、3、5、7 d单独应用MMSE,全套量表测试组在术前及术后第7天采用全套量表评估。结果 MMSE评分随测验次数的增多而升高,所诊断的认知功能障碍发生率逐次下降,在术后第7天时明显低于全套量表评估所得发生率。全凭静脉麻醉后认知功能障碍发生率略低于静吸复合组,但差异无统计学意义。结论全套量表较MMSE更适于评估老年病人术后早期认知功能,全凭静脉和静吸复合麻醉对术后早期认知功能影响的差异无统计学意义。

针药复合麻醉在妇科宫腔镜手术中镇痛及镇静作用的临床研究

目的观察针药复合麻醉在妇科宫腔镜术中及术后的镇痛及镇静作用。方法将76例拟行宫腔镜手术的患者,按随机数字表法分为对照组与试验组。对照组予假针刺麻醉联合静脉麻醉,试验组予针药复合麻醉。观察术中及术后VAS评分,术中改良OAA/S评分、Ramsay镇静评分、BCS评分,以及术中、术后麻醉安全指标(心率、平均动脉压、氧饱和度),内啡肽系统指标血清β-内啡肽(β-EP)、强啡肽(Dyn)水平,比较不良反应的发生情况。结果①术中VAS评分虽然试验组与对照组有统计学差异(P<0.05),但在患者完全可以忍受的程度之内,仅(2.80±1.76)分。术后两组VAS评分差异无统计学意义(P>0.05)。②试验组Ramsay镇静评分显著低于对照组(P<0.05),改良OAA/S评分显著高于对照组(P<0.05),BCS评分显著低于对照组(P<0.05)。③除术后12 h的SpO2水平外,两组各时间点的HR、MAP、SpO2水平比较,差异均有统计学意义(P<0.05);但此类差异均无临床意义。④对照组、试验组不良反应发生率分别为53.13%、34.29%,组间不良反应发生率差异有统计学意义(P<0.05),试验组明显低于对照组。结论针药复合麻醉下行宫腔镜手术的镇痛、镇静效果患者可耐受,术后不良反应发生更少,可更好地改善患者的手术应激状态。

地佐辛与曲马多治疗剖宫产术中寒战的对比研究

目的比较地佐辛与曲马多在治疗剖宫产术中寒战的效果。方法选择在腰硬联合麻醉后发生寒战的剖宫产手术患者60例,随机分为地佐辛组(D组,0.1 mg/kg)、曲马多组(T组,1 mg/kg),每组30例,均在胎儿娩出后,用生理盐水分别稀释药物至10 ml静脉注入,比较两组治疗寒战的疗效、术中镇静情况及不良反应,并监测平均动脉压(MAP)、脉搏氧饱和度(SpO2)变化。结果两组患者术中生命体征平稳,两组治疗寒战疗效比较差异无统计学意义(P>0.05);D组Ramsay评分≥3分者15例(50%),T组Ramsay评分≥3分者3例(10%),两者比较差异有统计学意义(P<0.01)。D组无恶心呕吐发生,T组有13例(43%),两组比较差异有统计学意义(P<0.01)。结论地佐辛治疗产妇腰硬联合麻醉后镇静评分和恶心、呕吐发生优于曲马多。

不同麻醉方法行经皮肾镜钬激光碎石术的临床观察

目的：观察腰-硬联合麻醉（CSEA）和全凭静脉麻醉（TIVA）下经皮肾镜钬激光碎石术的有效性和安全性。方法：285例患者随机分为CSEA组（n=120）和TIVA组（n=165）。术中监测血压（BP）、心率（HR）、呼吸（R）、血氧饱和度（SpO2）变化及不良反应。结果：CSEA组感觉平面出现为1～3min，阻滞范围T5-10～S5，麻醉后30min血压下降（P〈0．05）。TIVA组术中心率减慢（P〈0．05），麻醉平稳，苏醒期无明显的躁动。结论：CSEA和TIVA均可用于经皮肾镜钬激光碎石手术，对于年龄较大、体形过于肥胖或预计手术时间较长者，以选择TIVA为好。