Effects of dexmedetomidine combined with ultrasound-guided nerve block on hemodynamics, immune function and cortisol levels in patients undergoing inguinal surgery

Objective:To investigate the effect of dexmedetomidine combined with ultrasound guided nerve block on the hemodynamics, immune function and cortisol level in the patients undergoing inguinal surgery.Methods:A total of 120 patients who underwent unilateral inguinal surgery in our hospital were randomly divided into control group and observation group, 60 cases in each group. The control group was induced by intravenous anesthesia with sufentanil. The observation group was given dexmedetomidine combined with ultrasound guided ilioinguinal/iliac hypogastric nerve block. Hemodynamics, immune function and cortisol levels were compared between the two groups before and after anesthesia induction. Results:After anesthesia, in surgical incision and recovery time, the levels of HR in the two groups were significantly lower than that before the anesthesia, and the levels of HR in the observation group were significantly lower than that in the control group. After anesthesia, in surgical incision and recovery time, the levels of CD3+, CD4+ and CD4+/CD8+ in the control group were significantly lower than that of the group before anesthesia. After anesthesia, the levels of CD3+, CD4+ and CD4+/CD8+ in the observation group were significantly lower than that of the group before anesthesia. In surgical incision and recovery time, there was no significant difference in the levels of CD3+, CD4+ and CD4+/CD8+ in the observation group before anesthesia. After anesthesia, in surgical incision and recovery time, the levels of CD3+, CD4+ and CD4+/CD8+ in the observation group were significantly higher than that of the control group. The levels of serum PI3K, ET -1, CRP and cortisol of the two groups were significantly higher than those before anesthesia, and the levels of PI3K, ET -1, CRP and cortisol in the serum of the patients in the observation group were significantly lower than those in the control group.Conclusion: The effect of dexmedetomidin combined with ultrasound guided nerve block anesthesia on the patients with inguinal surgery can effectively maintain the hemodynamic stability of the patients and have less influence on the immune function and the stress response. The security is higher.

“局部解剖学”课程为依托的医学生生命教育

医学生是未来肩负救死扶伤神圣使命的特殊群体,对医学生进行生命教育具有重要意义。本研究分析在医学院校开展生命教育必要性的基础上,以局部解剖学课程为例,就生命教育的可行性和以大体老师为载体的融合课堂内教学与课堂外实践的生命教育实施途径进行探讨和阐述,并对生命教育的效果进行初步分析。研究表明,生命教育不仅使医学生建立正确的生死观,学会敬畏生命,还极大地激发学生的内驱力,提高学习成绩。在局部解剖学教学过程中融入生命教育,不仅是将生命教育与医学专业课程相结合的一次大胆尝试,也为其他医学专业课程开展生命教育提供思路和借鉴。

基于TBL的博士生高级局部解剖选修课教学改革探究

为了进一步提升博士生的高级局部解剖学选修课的教学质量,加强专业课程建设,开展基于TBL的教学改革。选课的博士生首先根据专业分成4个大组,每大组再分成3~4个小组。通过教师专题讲座、分组讨论和解剖操作,提高学员们的学习积极性,使其学习目的性更明确。通过学生问卷调查和非任课教师的课堂评估,反映出博士生对教学模式和内容的满意度较高,学习效果好。

下颌前牙区种植术后血管神经损伤防治策略

下颌前牙区种植术中可能损伤下颌切牙管、舌孔、口底血管等重要解剖结构,从而导致患者口底血肿、窒息、疼痛、感觉异常等症状发生,严重者可危及生命。下颌前牙区相对不足的颌骨空间和血管神经的解剖变异是种植术中血管神经损伤高风险的原因。一旦血管损伤,应当进行气道控制和止血;神经损伤则应采取移除种植体以及早期药物治疗等措施。种植医生应熟悉下颌前牙区的解剖结构,术前行锥形束计算机断层扫描并进行合理设计,术中借助数字技术实现精准植入种植体,以避免下颌前牙区种植术中血管神经损伤。本文通过文献回顾下颌前牙区的解剖结构及其变异,探讨下颌前牙区种植术中血管神经损伤的防治策略,为临床提供参考。

局部解剖学考核评价体系改革与实践

针对局部解剖学课程考核评价体系特点及存在的问题进行改革,设置新的考核评价体系,从考核的方式和内容进行改革和创新,以期更加客观和全面地评价学生局部解剖学课程学习的效果。

局部解剖结构在激光眼损伤效应观察实验教学中的应用

目的探究应用局部解剖结构在激光眼损伤效应观察实验教学中的效果。方法选取2023年秋季学期参与陆军军医大学军队劳动卫生与作业医学课程学习的2020级预防医学本科生为研究对象,随机分为对照组和试验组。对照组采用传统教学法,试验组在实验课前和课上均安排解剖学相关知识的学习和复习,并在实验课前进行实验相关操作技能的观摩,比较两组教学效果。结果共纳入60名学生,对照组和试验组各30名。与对照组相比,试验组实验操作时间明显减少,实验报告评分更高,教学满意度评分更高,且差异均具有统计学意义(P<0.001)。结论实验课前和课上指导学生补充学习相关解剖学知识,有助于实验教学的顺利进行,达到更好的教学效果。

提高局解实验教学“无言良师”综合利用率的实践探索

局部解剖学实验教学是医学人才培养过程中的关键环节,丰富和高质量的实验标本是保证教学质量的前提,在多层次、多专业、多轮次的教学形式下,标本需求量大、损耗率高,而尸体标本材料来源日益困难。为此,通过课程思政融入局部解剖学实验教学,使学生对“无言良师”获得全新的认知,感受“无言良师”的大爱,更加珍惜来之不易的教学资源;通过各种局部解剖学标本的制作,将局部解剖学实践操作后的“无言良师”变废为宝,所制标本不仅可用于今后的实验教学,还能为实验室及陈列室的建设增加标本储备,同时锻炼了实验技术人员的专业技能,激发了其创造力;通过第二课堂实验教学的开展,不仅能有效提高解剖学实验教学效果,还能提高学生的综合能力,同时该活动的开展还能提高“无言良师”的综合利用,节约教学资源。

坚固内固定结合牵引复位固定术对口腔颌面部创伤性骨折患者颌面解剖结构及口腔功能恢复的影响

目的分析坚固内固定结合牵引复位固定术对口腔颌面部创伤性骨折患者颌面解剖结构、口腔功能恢复的影响。方法74例口腔颌面部创伤性骨折患者,以1∶1随机分组方式分为对照组和观察组,每组37例。对照组采用坚固内固定术治疗,观察组采用坚固内固定结合牵引复位固定术治疗。对比两组口腔颌面解剖结构恢复情况、口腔功能恢复情况。结果观察组口腔功能恢复率、容貌恢复满意度以及颌面解剖结构复原度分别为91.89%、97.30%、100.00%,高于对照组的72.97%、75.68%、78.38%,差异显著(P<0.05)。术后,两组患者颌面功能评分、咬合接触面积总和、咬合点最大力度总和较本组术前提高,咬合不对称指数较本组术前降低,咬合接触时间较本组术前缩短,且观察组患者颌面功能评分(17.44±0.34)分、咬合接触面积总和(321.44±58.41)mm2、咬合点最大力度总和(31.44±3.84)kg高于对照组的(15.98±0.23)分、(264.42±48.97)mm2、(27.13±2.46)kg,咬合不对称指数(20.48±2.33)%低于对照组的(24.36±4.12)%,咬合接触时间(1.45±0.21)s短于对照组的(1.89±0.46)s(P<0.05)。结论针对口腔颌面部创伤性骨折患者在坚固内固定术基础上增加牵引复位固定术治疗,能够促进患者口腔功能、口腔颌面解剖结构的恢复,值得推广。

课程思政融入局部解剖学教学的实践和探索

随着高等教育事业新局面的到来,将思想政治融入教育教学全过程,全面推进高校课程思政建设,成为高校全面高水平人才培养的重要任务。对于医学高等人才的培养,局部解剖学是医学专业学生重要的专业基础课程,将课程思政育人元素全方位、全过程融入局部解剖学教学过程中,对于立德树人、培养德才兼备医学人才具有重要意义。本文通过上好局部解剖学实验第一课,局部解剖学专业知识与思政元素融合,解剖实践操作,走进“生命科学馆”,开展学生科普志愿服务工作,解剖绘图竞赛等路径,在局部解剖学课程中融入思政元素,丰富思政形式和内容,逐步构建与思政教育全方位融合的局部解剖学教学体系。

基于OBE理念的局部解剖学教学实践与探索

为适应新时期高层次医学人才培养的需要,优化现有的教学方法体系,文章明确了局部解剖学课程特征和临床医学生培养目标。基于OBE理念,对教学方法进行了改进和整合,将CBCL教学法融入课程体系,从教学模式、实践教学、考核评价等方面进行了探索与改革,旨在提升课程的创新性和挑战性,充分调动学生的学习积极性,培养学生的创新能力和解决问题的能力。

Crucial anatomy and technical cues for laparoscopic transabdominal preperitoneal repair: Advanced manipulation for groin hernias in adults

Groin hernias include indirect inguinal, direct inguinal, and femoral hernias. Obturator and supravesical hernias appear very close to the groin. High-quality repairs are required for groin hernias. The concept of "tension-free repair" is generally accepted, and surgical repairs with mesh are categorized as "hernioplasties". Surgeons should have good knowledge of the relevant anatomy. Physicians generally focus on the preperitoneal space, myopectineal orifice, topographic nerves, and regional vessels. Currently, laparoscopic surgery has therapeutic potential in the surgical setting for hernioplasty, with laparoscopic transabdominal preperitoneal(TAPP) repair appearing to be a powerful tool for use in adult hernia patients. TAPP offers the advantages of accurate diagnoses, repair of bilateral and recurrent hernias, less postoperative pain, early recovery allowing work and activities, tension-free repair of the preperitoneal(posterior) space, ability to cover obturator hernias, and avoidance of potential injury to the spermatic cord. The disadvantages of TAPP are the need for general anesthesia, adhering to a learning curve, higher cost, unexpected complications related to abdominal organs, adhesion to the mesh, unexpected injuries to vessels, prolonged operative time, and as-yet-unknown long-term outcomes. Both technical skill and anatomical familiarity are important for safe, reliable surgery. With increasing awareness of the importance of anatomy during TAPP repair, we address the skills and pitfalls during laparoscopic TAPP repair in adult patients using illustrations and schemas. We also address debatable points on this subject.

Comparative Anatomical Structure of the Leaf of <i>Allium suworowii</i>Regel (Amaryllidaceae) in Different Ecological Conditions

First studied the anatomy of the leaf Allium suworowii in different ecological conditions: Jizzakh region and the Tashkent Botanical Garden named after academician F.N. Rusanov at the Institute of Botany of the Academy of Sciences of the Republic of Uzbekistan. Identifying diagnostic signs of the leaf and determining a different combination of xeromorphic and mesomorphic features ensure adaptation to habitat conditions. Under the conditions that nature mesomorphic signs predominate, and introduction-xeromorphic signs prevail, this indicates that they are adapted to the conditions of introduction of this species.

Fascinating history of groin hernias:Comprehensive recognition of anatomy,classic considerations for herniorrhaphy,and current controversies in hernioplasty

Groin hernias include indirect inguinal,direct inguinal,femoral,obturator,and supravesical hernias.Here,we summarize historical turning points,anatomical recognition and surgical repairs.Groin hernias have a fascinating history in the fields of anatomy and surgery.The concept of tension-free repair is generally accepted among clinicians.Surgical repair with mesh is categorized as hernioplasty,while classic repair without mesh is considered herniorrhaphy.Although various surgical approaches have been developed,the surgical technique should be carefully chosen for each patient.Regarding as interesting history,crucial anatomy and important surgeries in the field of groin hernia,we here summarized them in detail,respectively.Points of debate are also reviewed;important points are shown using illustrations and schemas.We hope this systematic review is surgical guide for general surgeons including residents.Both a skillful technique and anatomical knowledge are indispensable for successful hernia surgery in the groin.

Comparative Study of the Anatomical Structure of Some Vegetative Organs <i>Allium caspium</i>(pall.) M. Bieb. and <i>Allium tschimganicum</i>B. Fedtsch. Ex Popov Growing in Natural Conditions of Uzbekistan

The results of a comparative study of the structure of some vegetative organs of A. caspium and A. tschimganicum growing in natural conditions in Uzbekistan are presented for the first time. During the study of the desert representative A. caspium, the following diagnostic, structural features were revealed: ribbing of the peduncle and pedicel;thickening of the outer wall of the epidermis and wavy folding of the cuticle of the parenchymal-bundle type of structure;deep submergence of stomata: extensive core: thinness of the crustal parenchyma, the presence of lactic acid in it;the presence of a highly sclerified sclerinchymal ring between the crustal parenchyma and the central cylinder: the vastness of the core and the presence of hydrocytic cells in it, as well as the similarity of the structure of the stem and pedicel. In this species, a predominance of xeromorphic characters was noted, due to a tendency indicating xerophilization and adaptation to desert conditions. In A. tschimganicum, the following mesomorphic diagnostic structural features, opposite to the desert one, were also revealed: roundness of the stem and pedicel, dense folding of the cuticle surface, the presence of lactates in the crustal parenchyma, weak thickening of the crustal parenchyma, and the presence of a weakly sclerized sclerenchymal ring in the central color parenchyma: parenchymal-bundle type of structure, weak thickening of the outer wall of the epidermis and slightly waviness of the cuticle surface, the presence of lactic acid in the crustal parenchyma. Weak submergence of stomata, large-cell crustal parenchyma, extensive, large-cell, thin-walled, poorly sclerified central cylinder, also similarity to the structure of the stem with pedicel, but the presence of a cavity in the stem. The predominance of mesomorphic traits in this endemic species indicated more favorable mountain humid growing conditions were noted.

基于数字教育资源的局部解剖学智慧教学探索与实践

智慧教育背景下,局部解剖学传统教学模式亟须改革和完善。局部解剖学是基础医学与临床医学各学科之间的重要桥梁课程,文章论述了局部解剖学的课程特点和数字教育资源的建设情况,探讨局部解剖学智慧教学的实施路径,并初步建立局部解剖学形成性评价和终结性评价相结合的智慧评价体系,构建具有医学专业特色的局部解剖学智慧教学体系,促进教学改革和创新,推动医学智慧教学的发展。

转化医学理念在局部解剖学教学中的应用

转化医学研究已成为适应新时代要求的现代医学发展新趋势。而局部解剖学作为基础医学与临床医学之间的桥梁课程,是医学生迈向临床的重要课程。文章结合现代医学的发展方向,加强师资培养,在局部解剖学教学中运用转化医学理念,优化教学模式,融入临床案例和学科的前沿研究等内容,能有效发挥转化医学在局部解剖学教学与临床实践间的纽带作用,提升局部解剖学教学与学习效果,对局部解剖学教育和培养应用型转化医学人才有重要意义。

疫情时期局部解剖学网上授课结合翻转课堂的实践结果研究

在新冠疫情期间,响应教育部“停课不停学”的号召,浙江大学开展了基于使用“浙大钉”软件网上授课,使用“学在浙大”网站来进行备课和批改作业的教学实践工作。具体到局部解剖学这门需要将理论知识传授与实际解剖操作相结合的课程,采取了翻转课堂教学方法。实践证明,较之传统教学方法,这种方法有效地提高了学生的成绩。

浅谈提升“局部解剖学”教学质量的主要环节

“局部解剖学”是临床本科医学教育的必修课,着重研究人体各局部区域的层次结构、形态、器官位置和毗邻关系的解剖学,是临床医学尤其是外科学和影像诊断学的基础。“局部解剖学”具有很强的实践特征和应用价值,通过动手解剖与观察才能掌握其理论和操作技能。如何在新时代新医科背景下为精准医疗强化基础教学,通过教师教学、学生学习、教师和学生的教与学互动三个环节,探讨如何保障和提升“局部解剖学”的教学质量。

基于CT血管成像技术的下腰椎侧方髂血管临床解剖学研究

目的应用CT血管成像技术探究下腰椎侧方大血管的解剖,为下腰椎侧方入路手术提供血管解剖学参考。方法选取贵州省人民医院2016年6月至2018年11月间行腹部大血管CT血管成像病人影像资料200例(男女各100例),进行相关观察、测量研究。(1)测量下腰椎左侧方:左髂总动脉后缘与L4-L5椎间隙上、下缘后侧及L5-S1椎间隙上、下缘后侧之间的距离;(2)测量下腰椎右侧方:右髂总静脉后缘与L4-L5椎间隙上、下缘后侧及L5-S1椎间隙上、下缘后侧之间的距离;(3)计算下腰椎侧方髂血管走行安全区“髂血管梯形”面积;(4)将测量、计算结果进行男性、女性差异性比较。结果(1)下腰椎左侧方:左髂总动脉后缘与L4-L5椎间隙上缘、下缘后侧的距离:男性(38.17±3.49)mm、(35.39±3.92)mm,女性(34.53±2.84)mm、(31.60±3.32)mm;左髂总动脉后缘与L5-S1椎间隙上缘、下缘后侧的距离:男性(24.97±5.96)mm、(18.86±5.91)mm,女性(20.67±4.88)mm、(14.97±4.40)mm。(2)下腰椎右侧方:右髂总静脉后缘与L4-L5椎间隙上缘、下缘后侧的距离:男性(31.86±3.50)mm、(29.26±3.77)mm,女性(27.71±3.45)mm、(25.10±3.26)mm;右髂总静脉后缘与L5-S1椎间隙上缘、下缘后侧的距离;男性(21.92±4.63)mm、(17.59±4.81)mm,女性(18.17±4.90)mm、(14.62±3.43)mm。(3)下腰椎“髂血管梯形”(左髂总动脉、L4-L5椎间隙上缘、L5-S1椎间隙下缘、下腰椎后侧缘围成)面积左侧:男性(1146.95±206.34)mm^(2)、女性(956.63±143.79)mm^(2)。右侧:男性(955.38±188.50)mm^(2)、女性(816.25±135.48)mm^(2)。以上指标男女两组比较均差异有统计学意义(P<0.05)。结论下腰椎左侧方“髂血管梯形”面积明显大于右侧方“髂血管梯形”面积,且下腰椎左侧方髂总动脉靠髂总静脉之后,血管损伤风险低于右侧方,因此,若左右侧方入路均满足手术需求时,建议选择下腰椎左侧方入路。下腰椎侧方入路手术术前完善下腰椎前大血管CT血管成像,明确下腰椎左、右侧方髂血管走行,据此制定可靠规避血管损伤的手术入路方案,可有效避免血管损伤的发生。

情景式病例讨论在局部解剖学实验教学中的应用

目的探讨情景式病例讨论在局部解剖学实验教学中的应用效果。方法选取2022—2023学年第一学期(2022年9—12月)沈阳医学院2020级临床医学专业60名本科生为研究组,以2021—2022学年第一学期(2021年9—12月)同学院2019级临床医学专业60名本科生为对照组。研究组采用情景式病例讨论教学模式进行教学,对照组采用传统教学模式。通过课程满意度调查问卷、教学效果调查问卷以及期末实验课考试成绩评估两组教学效果。结果研究组教学效果均优于对照组,差异有统计学意义(P<0.05)。两组课程满意度评分比较,差异有统计学意义(P<0.05)。研究组学生期末实验课成绩高于对照组,差异有统计学意义(P<0.05)。结论情景式病例讨论教学模式能有效提升学生学习效果。