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.

Safety of applying midazolam-ketamine-propofol sedation combination under the supervision of endoscopy nurse with patient-controlled analgesia pump in colonoscopy

AIM To compare the results of midazolam-ketaminepropofol sedation performed by an endoscopy nurse and anaesthetist during colonoscopy in terms of patient satisfaction and safety.METHODS American Statistical Association(ASA) Ⅰ-Ⅱ 60 patients who underwent colonoscopy under sedation were randomly divided into two groups: sedation under the supervision of an anaesthetist(SSA) and sedation under the supervision of an endoscopy nurse(SSEN). Both groups were initially administered 1 mg midazolam, 50 mg ketamine and 30-50 mg propofol. Continuation of sedation was performed by the anaesthetist in the SSAgroup and the nurse with a patient-controlled analgesia(PCA) pump in the SSEN group. The total propofol consumption, procedure duration, recovery times, pain using the visual analogue scale(VAS) and satisfaction score of the patients, and side effects were recorded. In addition, the patients were asked whether they remembered the procedure and whether they would prefer the same method in the case of re-endoscopy.RESULTS Total propofol consumption in the SSEN group was significantly higher(P < 0.05) than that in the SSA group. When the groups were compared in terms of VAS score, recovery time, patient satisfaction, recall of the procedure, re-preference for the same method in case of re-endoscopy, and side effects, there were no significant differences(P > 0.05) between the two groups. No long-term required intervention side effects were observed in either group.CONCLUSION Colonoscopy sedation in ASA Ⅰ-Ⅱ patients can be safely performed by an endoscopy nurse using PCA pump with the incidence of side effects and patient satisfaction levels similar to sedation under anaesthetist supervision.

COMBINATION OF ACUPUNCTURE ANALGESIA AND EPIDURAL BLOCK IN RENAL TRANSPLANTATION

One hundred patients undergoing renal transplantation were randomly divided into com-bined acupuncture-epidural anesthesia group (group A, points selected: Ciliao, Sanyinjiao, Taixi to-gether with Shenyu and para-incision or Zusanli; combined with small dose of epidural block) and epidural block group (group C), each 50 patients. The initial dose and total dose of local anesthetics were 5. 6 ±0. 3 ml and 13. 5±1.0ml in group A, and 14. 5±0. 4 ml and 25. 4 ±1. 2 ml in group C,respectively. There was very significant difference between the two groups (P< 0.001 ). During the operation the hemodynaminc changes were greater in group C. Ephedrine and atropine were used in 1 and 2 cases in group A, and in 9 and 5 cases in group C, respectively. The starting time of urination of the transplanted kidney was shorter in group A than in group C, being 209±25 s and 410±47 s, re-spectively (P<0.001 ). There was no significant difference in the indices of immmunologic function between the two groups. The anesthetic results in group A were evaluated according to the initial dose of epidural anesthetics. Those were excellent in 31 cases (62 % ) and good in 13 (26% ) with the ex-cellent-good rate 88 %.

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后发热对母婴分娩结局的影响

目的探讨腰硬联合麻醉分娩镇痛后发热对分娩结局的影响,以期改善母婴结局。方法选取2020年1月至2022年6月进行腰硬联合麻醉分娩镇痛的300例产妇作为研究对象,根据镇痛后是否出现发热将产妇分为两组。对照组为未出现发热的产妇,共150例;观察组为出现发热的产妇,共150例。比较两组产妇的阴道操作次数、破膜时间、总产程时间、缩宫素使用比例、分娩方式、产妇不良结局发生率以及新生儿不良结局发生率。结果观察组阴道操作次数(7.56±1.12)次,破膜时间为(11.86±2.03)h,总产程时间为(17.08±2.34)h,使用缩宫素加强宫缩为51例(34.00%),对照组阴道操作次数(5.41±1.04)次,破膜时间为(8.69±1.75)h,总产程时间为(15.04±1.84)h,使用缩宫素加强宫缩为20例(13.33%),两组产妇的阴道操作次数、破膜时间、总产程时间、缩宫素使用比例等指标比较差异均有统计学意义(P<0.001)。观察组产妇自然分娩82例(54.67%),剖宫产45例(30.00%),器械助产23例(15.33%),对照组产妇自然分娩121例(80.67%),剖宫产19例(12.67%),器械助产10例(6.67%),两组产妇的分娩方式比较差异有统计学意义(P<0.05或0.001)。观察组产妇出现低血压、头痛、产后出血、产褥感染等总不良结局发生率为60.67%(91/150),对照组产妇出现低血压、头痛、产后出血、产褥感染等总不良结局发生率为31.33%(47/150),两组产妇总不良结局发生率差异有统计学意义(P<0.001)。观察组出现胎儿窘迫、新生儿窒息、新生儿败血症、新生儿高胆红素血症等总不良结局发生率为40.67%(61/150),对照组出现胎儿窘迫、新生儿窒息、新生儿败血症、新生儿高胆红素血症等总不良结局发生率为22.67%(34/150),两组新生儿总不良结局发生率差异有统计学意义(P<0.001)。结论产时发热是一种临床表现,早发现早预防非常重要。对于产科医生而言,应加强产程管理,掌握阴道操作指征,严格遵循无菌操作,以预防感染性产时发热。同时,要避免产时发热相关因素的叠加,防止非感染性发热的发生。此外,还需综合分析产时发热的原因,动态监测各项指标,仔细鉴别,并采取适宜的产程处理措施。

罗哌卡因联合右美托咪定对剖宫产产妇镇痛效果、术后恢复和血清炎症因子的影响

目的:探讨罗哌卡因联合右美托咪定对剖宫产产妇镇痛效果和术后恢复的影响。方法:按镇痛方案不同,将行116例剖宫产术的产妇分为对照组与试验组,每组各58例。对照组使用罗哌卡因+舒芬太尼镇痛;试验组使用罗哌卡因+右美托咪定镇痛。分别于术后3、6、12、24、及48 h,对产妇的疼痛程度进行评估;记录产妇术后镇痛泵使用情况;记录两组产妇阻滞时效和术后恢复相关指标;检测产妇术前及术后24 h血清白细胞介素6(IL-6)和肿瘤坏死因子α(TNF-α)水平;记录产妇术后48 h内不良反应发生情况。结果:两组术后3~48 h各时间点VAS评分、首次镇痛按压时间及术后48 h内镇痛泵按压次数差异均无统计学意义(P>0.05)。与对照组比较,试验组腰麻感觉阻滞达到最高平面经历的时间、感觉恢复时间较长(P<0.05),两组腰麻感觉阻滞起效时间无统计学差异(P>0.05)。与对照组相比,试验组首次肛门排气时间、泌乳始动时间均明显提前(P<0.05),48 h哺乳次数增多(P<0.05)。与对照组比较,试验组术后24 h血清IL-6、TNF-α水平更低(P<0.05),术后48 h内恶心呕吐发生率、皮肤瘙痒发生率更低(P<0.05)。结论:与罗哌卡因联合舒芬太尼比较,在腰硬联合麻醉中使用罗哌卡因联合右美托咪定也能够提供确切镇痛效果,且可减少不良反应,更能促进产妇术后恢复。

舒芬太尼复合罗哌卡因腰硬联合麻醉在分娩镇痛中的应用效果

目的探讨舒芬太尼复合罗哌卡因腰硬联合麻醉在分娩镇痛中的应用效果。方法选取2022年1月至2023年6月北海市妇幼保健院收治的150例产妇作为研究对象,按照随机数字表法分为对照组(75例)和观察组(75例)。对照组采用罗哌卡因腰硬联合麻醉,观察组采用舒芬太尼复合罗哌卡因腰硬联合麻醉,比较两组镇痛效果、疼痛程度和新生儿结局。结果观察组镇痛起效时间与完全阻滞时间均短于对照组(P<0.05);观察组第一产程数字分级评分法评分低于对照组(P<0.05);两组新生儿Apgar评分比较,差异无统计学意义(P>0.05)。结论舒芬太尼复合罗哌卡因腰硬联合麻醉在分娩镇痛中的应用效果较好,可缩短镇痛起效时间与完全阻滞时间,减轻第一产程疼痛感,且不会影响新生儿结局。

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。

Labour analgesia effects on foetal heart rate. A mini-review

Foetal well-being during labour is of utmost importance. One of the ways to attempt to assess foetal well-being is by recording foetal heart rate (FHR). Loss of variability and deceleration patterns are known to be associated with foetal distress. Decelerations and foetal bradycardia have been described after any type of effective labour analgesia. This review addresses the questions if certain analgesic techniques and/or analgesics lead to clinically relevant FHR changes, what is their aetiology, and how we should manage these FHR changes.

全身麻醉复合硬膜外麻醉联合多模式镇痛对宫颈癌根治术患者疼痛程度、炎性反应及应激反应的影响

目的探讨全身麻醉复合硬膜外麻醉联合多模式镇痛对宫颈癌根治术患者疼痛程度、炎性反应及应激反应的影响。方法将102例宫颈癌患者按麻醉方式的不同分为对照组和研究组,每组51例。对照组患者采用全身麻醉复合硬膜外麻醉,研究组患者在对照组的基础上采用多模式镇痛。比较两组患者疼痛程度、炎性反应指标、T淋巴细胞亚群、应激反应指标。结果术后1、6、12、24 h,研究组患者视觉模拟评分法(VAS)评分均明显低于对照组,差异均有统计学意义(P<0.01),且随着时间延长,两组患者VAS评分均逐渐降低。治疗后,研究组患者肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、皮质醇、肾上腺素、去甲肾上腺素(NE)和CD8^(+)水平均明显低于对照组,CD3^(+)和CD4^(+)水平均明显高于对照组,差异均有统计学意义(P<0.01)。结论全身麻醉复合硬膜外麻醉联合多模式镇痛能减缓宫颈癌根治术后患者疼痛程度,改善炎症因子水平,提高T淋巴细胞亚群水平,降低应激反应,具有较高的临床应用和推广价值。

羟考酮预防性镇痛及麻醉维持在老年舌颌颈联合根治术中应用效果

目的探讨盐酸羟考酮预防性镇痛及麻醉维持对老年舌颌颈联合根治术患者应激反应、镇痛及安全性的影响。方法选取2021年7月至2022年6月在唐山市协和医院拟行舌颌颈联合根治术的老年患者152例,年龄60~80岁,采用奇偶数法随机分为两组,奇数纳入羟考酮组,偶数纳入对照组,每组各76例。羟考酮组术中静脉滴注丙泊酚+盐酸羟考酮麻醉维持,术毕前15 min静注盐酸羟考酮预防性镇痛;对照组术中静脉滴注丙泊酚+瑞芬太尼麻醉维持,术毕前15 min静注舒芬太尼预防性镇痛。比较两组不同时刻血流动力学参数、血清应激指标水平、镇痛评分及不良反应。结果切皮时、术毕即刻及术后2 h,羟考酮组平均动脉压及心率均低于对照组(P<0.05)。术毕即刻及术后1 d,两组去甲肾上腺素(NE)、肾上腺素(E)、皮质醇(Cor)水平均较术前升高,但羟考酮组上述因子水平均低于对照组(P<0.05)。术后6、12、24、48 h,两组疼痛视觉模拟评分(NRS)均较术后2 h降低,且羟考酮组低于对照组(P<0.05)。羟考酮组术后自主呼吸恢复时间、苏醒时间较对照组缩短,24 h内镇痛泵按压次数较对照组减少(P<0.05)。羟考酮组术后不良反应发生率为7.89%,低于对照组的21.05%(P<0.05)。结论盐酸羟考酮预防性镇痛及麻醉维持可有效抑制老年舌颌颈联合根治术患者应激反应,缓解疼痛,且能维持围术期血流动力学稳定,安全性好。

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。

地佐辛联合右美托咪定在颅脑外伤患者镇痛镇静中的应用效果

目的研究地佐辛联合右美托咪定在颅脑外伤患者镇痛镇静中的应用效果。方法随机选取2021年1月—2022年1月昆山市中医医院的100例ICU颅脑外伤患者,按照不同治疗方法分成对照组和观察组,每组50例。对照组联合应用咪达唑仑注射液、地佐辛,观察组联合应用右美托咪定、地佐辛。利用视觉模拟评分(VAS)对比两组术后3 h(T3)、6 h(T4)、12 h(T5)、24 h(T6)的镇痛效果;观察患者采取镇静方案后的机械通气时间、停药后自醒时间、平均住入ICU时间、平均住院费用、镇静评分(RASS);比较两组患者在麻醉前(T1)、手术结束时(T2)、术后24 h(T6)、术后48 h(T7)的免疫指标;运用谵妄评估量表(CAM-ICU)比较两组的谵妄发生情况以及不良反应情况。结果两组术后VAS评分均呈现逐渐下降趋势,观察组T4、T5、T6的VAS评分均低于对照组,差异有统计学意义(P<0.05);观察组机械通气时间、停药后自醒时间和平均住入ICU时间明显缩短,平均住院费用减少,RASS镇静评分优于对照组,差异有统计学意义(P<0.05)。两组T2、T6、T7的CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)均比T1低,并且观察组术后48 h以上免疫指标均高于对照组,另外NK细胞活性低于对照组,差异有统计学意义(P<0.05)。观察组的谵妄发生率(8.00%)和总不良反应率(12.00%)明显低于对照组(24.00%、30.00%),差异有统计学意义(χ^(2)=4.762、4.882,P<0.05)。结论右美托咪定联合地佐辛镇痛方案更优,镇痛效果显著,对免疫功能影响小,有利于神经功能的恢复。

腰硬联合麻醉复合硬膜外镇痛对妊娠高血压产妇行无痛分娩的产程时间及术后血清PRL、t-PA水平的影响

目的探讨腰硬联合麻醉复合硬膜外镇痛对妊娠高血压产妇行无痛分娩产程时间及术后血清泌乳素(serum prolactin,PRL)、组织型纤溶酶原激活物(tissue-type plasminogen activator,t-PA)水平的影响。方法回顾性分析2019年5月至2020年4月妊娠高血压产妇的临床资料,选取其中122例一般情况相近的病例,按照镇痛方法不同分为对照组和观察组,每组61例。2组一般资料比较差异无统计学意义(P>0.05)。对照组产妇采用导乐分娩镇痛措施,观察组产妇采用腰硬联合麻醉复合硬膜外镇痛措施。比较2组产妇产程时间、血清PRL水平、血清t-PA水平、疼痛程度、收缩压和舒张压、产后出血情况和分娩方式。结果镇痛干预后2组产妇第二产程时间、自然分娩率、剖宫产率、产钳助产率、新生儿Apgar评分比较差异无统计学意义(P>0.05)。观察组第一产程、第三产程时间低于对照组(P<0.05);2组产妇分娩后3、12 h血清PRL水平显著升高,观察组高于对照组(P<0.05);分娩后血清t-PA水平升高(P<0.05),观察组低于对照组(P<0.05);镇痛后产妇第一、二、三产程疼痛程度缓解,观察组疼痛程度水平低于对照组(P<0.05);镇痛后5、10 min及活跃期、第二产程2组产妇收缩压与舒张压均下降,观察组低于对照组,差异有统计学意义(P<0.05)。结论对妊娠高血压产妇分娩采用腰硬联合麻醉复合硬膜外镇痛可有效减少产程时间、降低血压水平,升高产后血清PRL水平、降低t-PA水平,镇痛效果良好,值得临床参考应用。

超声引导下改良阴部神经阻滞用于肛周脓肿镇痛的临床研究

目的分析超声引导下改良阴部神经阻滞用于肛周脓肿镇痛的临床研究。方法采取前瞻性随机对照研究方法,选择2020年1月至2022年12月在四川省第二中医医院行手术治疗的120例肛周脓肿患者作为研究对象,采用随机数字表法分为2组,每组60例。2组均实施腰硬联合麻醉,在此基础上,对照组术后给予阿司匹林镇痛,观察组术后给予超声引导下改良阴部神经阻滞镇痛,比较2组手术结束时、术后48 h、术后72 h疼痛程度[视觉模拟评分法(VAS)],比较2组术前、术后48 h、术后72 h的炎性因子水平[C-反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)],比较2组补救镇痛率及不良反应发生情况。结果观察组术后48 h、术后72 h VAS评分均低于对照组,组间、时点、组间·时点交互比较有差异(P<0.05);观察组术后48 h、术后72 h CRP、IL-6、TNF-α水平均低于对照组,组间、时点、组间·时点交互比较有差异(P<0.05);观察组术后48 h、术后72 h睡眠质量均高于对照组,组间、时点、组间·时点交互比较有差异(P<0.05);观察组补救镇痛率低于对照组,差异有统计学意义(P<0.05);2组不良反应发生情况比较无差异(P>0.05)。结论超声引导下改良阴部神经阻滞可有效减轻肛周脓肿患者术后疼痛程度,降低炎性因子水平,提高睡眠质量,减少术后补救镇痛次数,且安全性较好。

不同剂量纳布啡预防给药对急诊剖宫产腰硬联合麻醉产妇术后镇痛效果的影响

目的 探讨不同剂量纳布啡预防给药对急诊剖宫产腰硬联合麻醉产妇术后镇痛效果的影响。方法 选取在武警重庆总队医院行急诊剖宫产手术腰硬联合麻醉的产妇105例,以电脑随机数字表法将其分为对照组(n=35)、低剂量组(n=35)及高剂量组(n=35)。对照组给予0.9%的生理盐水4 mL,低剂量组予以0.9%的生理盐水稀释纳布啡0.08 mg/kg至4 mL,高剂量组予以0.9%的生理盐水稀释纳布啡0.12 mg/kg至4 mL,3组均在开放静脉后即刻静脉推注。比较3组手术及麻醉情况、术后不同时段数字等级评定量表(Digital rating scale, NRS)评分及补救镇痛情况、手术前后炎性水平,并评估孕妇及胎儿安全性。结果 3组手术指标(手术时间、术中输液量、术中失血量)及麻醉情况(试验药物给药至鞘内给药时间、鞘内给药至胎儿娩出时间)比较,差异均无统计学意义(P>0.05);术后6、12、24、48 h,高剂量组NRS评分及镇痛补救率均低于低剂量组、对照组(P<0.05),且低剂量组NRS分值及镇痛补救率低于对照组(P<0.05);与对照组比较,高剂量组产妇不良反应发生率较低(P<0.05);3组胎儿出生后指标[动脉血pH值和剩余碱(Base excess, BE)值,出生后1 min、5 min的Apgar评分]比较,差异均无统计学意义(P>0.05);与术前比较,3组术后24 h血清白细胞介素-6(interleukin 6,IL-6)、白细胞介素-1β(interleukin 1β,IL-1β)和肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平均升高(P<0.05);术后24 h,高剂量组血清IL-6、IL-1β、TNF-α低于低剂量组与对照组,低剂量组低于对照组(P<0.05)。结论 纳布啡0.08 mg/kg、0.12 mg/kg对急诊剖宫产的产妇均具有良好的术后镇痛效果,能有效地降低炎性细胞因子水平,及产妇术后并发症的发生率,且对新生儿无不良影响,但0.12 mg/kg的纳布啡效果更佳。

腰硬联合阻滞、硬脊膜穿破硬膜外阻滞及单纯硬膜外阻滞在初产妇分娩镇痛中应用效果的比较

目的 探究腰硬联合阻滞(CSE)、硬脊膜穿破硬膜外阻滞(DPE)及单纯硬膜外阻滞(EP)在初产妇分娩镇痛中的应用效果。方法 选取2019年9月至2020年9月期间于河北省秦皇岛市妇幼保健院分娩的150例初产妇作为研究对象,随机分为EP组(n=42)、CSE组(n=46)和DPE组(n=48)。比较三组产妇的镇痛效果、分娩相关指标、新生儿健康情况及不良反应。结果 EP组、CSE组T1、T2视觉模拟评分法(VAS)评分呈下降趋势,但T3 VAS有所回升;DPE组T1、T2、T3 VAS呈逐渐下降趋势,且各时点VAS均低于EP组、CSE组(P<0.05)。CSE组、DPE组使用催产素情况、镇痛泵(PCA)次数、舒芬太尼总量、罗哌卡因总量少于EP组(P<0.05),首次PCA时间晚于EP组(P<0.05);DPE组使用缩宫素情况、PCA次数、舒芬太尼总量少于CSE组(P<0.05)。DPE组、CSE组脐带血皮质醇水平均低于EP组(P<0.05)。DPE组不良反应总发生率低于EP组(P<0.05)。结论 相对于EP,CSE、DPE镇痛效果更好,可减少药物总量和PCA次数,并延长首次PCA时间,但DPE效果更显著,且安全性更好。

腰硬联合麻醉对骨科手术患者血流动力学、疼痛程度和认知功能的影响

目的:探讨腰硬联合麻醉对骨科手术患者血流动力学、疼痛程度和认知功能的影响。方法:回顾性分析2021年6月—2022年6月宁夏回族自治区人民医院收治的72例骨科手术患者的临床资料。根据不同麻醉方式将其分为观察组和对照组,各36例。对照组给予全身麻醉,观察组给予腰硬联合麻醉。比较两组麻醉前(T_(0))、手术开始前(T_(1))、手术30 min时(T_(2))、手术结束时(T_(3))的血流动力学,术后6 h、12 h、1 d、2 d的疼痛程度,术后1 h、6 h、12 h、1 d的认知功能及不良反应。结果:T_(1)、T_(2)、T_(3),两组心率(HR)和平均动脉压(MAP)均较T_(0)时下降,但观察组HR和MAP均明显高于对照组,差异有统计学意义(P<0.05)。术后6 h、12 h、1 d、2 d,观察组视觉模拟评分法(VAS)评分低于对照组,差异有统计学意义(P<0.05)。术后1 h、6 h、12 h、1 d,观察组简易精神状态量表(MMSE)评分均明显高于对照组,差异有统计学意义(P<0.05)。观察组术后不良反应发生率明显低于对照组,差异有统计学意义(P<0.05)。结论:腰硬联合麻醉应用于骨科手术中具有显著的效果,可稳定患者术中的血流动力学,发挥良好镇痛效果,减轻患者术后疼痛,对患者认知功能的影响更小,且安全性高,可减少患者术后不良反应风险。

腰硬联合分娩镇痛对初产妇产程进展及产时发热影响

目的探讨腰-硬联合阻滞分娩镇痛方式对初产妇在产程进展及产时发热的影响,为临床实践提供理论依据。方法回顾性分析2020年12月—2021年12月在广州市某三甲医院产科分娩产妇535例的基本资料。观察组(285例)采用腰-硬联合阻滞麻醉分娩镇痛,对照组(250例)选择常规无干预分娩。结果观察组中的产妇第一产程和第二产程的时间比对照组更长,且产后2 h出血量高于对照组,差异有统计学意义(P<0.05),除此之外,2组产妇产时发热率比较差异也有统计学意义(P<0.01)。结论腰硬联合阻滞分娩镇痛在一定程度上会延长产程,且产后2 h的出血量较多,同时也会增加产时发热的概率,存在一定不良反应,故需要密切观察,保证母儿安全。