الملخص
Objective:To investigate the effects of B ultrasound-guided lumbar plexus combined with sciatic nerve block on immune function, stress response, and postoperative analgesia in older adult patients undergoing hip surgery, providing theoretical evidence for clinical diagnosis and treatment.Methods:We included 300 older adult patients undergoing hip surgery who received treatment in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from August 2018 to August 2019 in this study. We randomly allocated them into the observation and control groups ( n = 150/group). The control group was subject to general anesthesia and the observation group was subject to B ultrasound-guided lumbar plexus combined with sciatic nerve block. Hemodynamic changes and plasma cortisol levels were recorded in each group immediately after endotracheal intubation (T1), at 2 hours of surgery (T2), at the end of surgery (T3), and 24 hours after surgery (T4). Each patient's immune function was assessed 3 months after surgery. The Visual Analog Scale score at each time point was compared between the two groups. Results:The systolic blood pressure, diastolic blood pressure, and heart rate in the observation group at T1-T4 were (122.14 ± 8.68) mmHg, (117.41 ± 8.72) mmHg, (109.62 ± 8.43) mmHg, (127.82 ± 7.83) mmHg, (83.47 ± 6.32) mmHg, (72.34 ± 7.02) mmHg, (67.13 ± 6.72) mmHg, (74.15 ± 7.12) mmHg, (71.94 ± 7.64) beats/minute, (71.84 ± 7.11) beats/minute, (63.52 ± 6.16) beats/minute, (73.43 ± 7.29) beats/minute , respectively, which were significantly lower than those in the control group [(131.22 ± 8.69) mmHg, (125.81 ± 8.76) mmHg, (115.11 ± 8.44) mmHg, (133.26 ± 7.85) mmHg, (89.28 ± 6.12) mmHg, (77.64 ± 7.13) mmHg, (75.51 ± 8.02) mmHg, (81.13 ± 7.14) mmHg, (79.24 ± 7.65) beats/minute, (75.27 ± 7.13) beats/minute, (70.54 ± 6.22) beats/minute, (80.11 ± 7.32) beats/minute, t = 9.05, 8.32, 5.63, 6.00, t = 8.08, 6.48, 9.80, 8.47, t = 8.26, 4.17, 9.82, 7.91, all P < 0.001]. Plasma cortisol levels in the observation group at T2-T4 were (332.28 ± 15.64) ng/L, (334.67 ± 15.77) ng/L, (331.40 ± 15.68) ng/L, respectively, which were significantly lower than those in the control group [(344.75 ± 15.63) ng/L, (346.02 ± 15.76) ng/L, (345.83 ± 15.66) ng/L, t = 6.90, 6.23, 7.97, all P < 0.001]. At 3 months after surgery, the proportion of CD 4+ helper T cells, the proportion of CD 8+ cytotoxic T cells, and the ratio of proportion of CD 4+ Helper T cells to the proportion of cytotoxic CD 8+ T cells in the observation group were (31.39 ± 6.72)%, (25.73 ± 6.24)%, 1.31 ± 0.38, respectively, which were significantly lower than those in the control group [(38.61 ± 6.73)%, (32.79 ± 6.25)%, 1.52 ± 0.39, t = 9.29, 9.79, 4.72, all P < 0.001]. At 12-48 hours after surgery, The Visual Analog Scale scores in the observation group were (1.59 ± 0.54) points, (1.47 ± 0.33) points, (1.55 ± 0.41) points, respectively, which were significantly lower than those in the control group [(2.72 ± 0.55) points, (2.29 ± 0.36) points, (2.39 ± 0.43) points, t = 17.95, 20.56, 17.31, all P < 0.001]. Conclusion:B ultrasound-guided lumbar plexus combined with sciatic nerve block can effectively stabilize the hemodynamics in older adult patients undergoing hip surgery, reduce the occurrence of the stress response, promote the recovery of immune function, and alleviate pain.
الملخص
Objective To compare the effects of bispectral index (BIS) monitoring with three different depths of sedation in lucid fiberoptic bronchoscopy. Methods Ninety patients underwent lucid fiberoptic bronchoscopy from July 2017 to January 2018 in Wenzhou Integrated Traditional Chinese and Western Medicine Hospital in Zhejiang Province were selected. The patients were divided into group A, group B and group C according to the random digits table method with 30 cases each. The depth of sedation in group A was set BIS at 65 to 69, in group B BIS at 70 to 74, and in group C BIS at 75 to 79. At the beginning of sedation, propofol and remifentanil were administered continuously intravenously at a target concentration of 1 μg/ml and 3 ng/ml, then 0.25 μg/ml of propofol was adjusted according to the change of BIS. Fiberoptic bronchoscopy was performed after the patient′s BIS reached the pre-set target value. The BIS, heart rate, mean arterial pressure (MAP) and pulse oxygen saturation (SpO2) at admission to the examination room (T0), sedation (T1), fiberoptic bronchoscopy through glottis (T2), fiberoptic bronchoscopy into trachea (T3), 15 min after the examination (T4) were recorded. During fiberoptic bronchoscopy, the numbers of cough accompanied by body movement, additional injection of lidocaine, hypoxemia, assisted ventilation, detection time and degree of patients or doctors satisfaction were recorded. Results The heart rate and MAP at T1 in 3 groups were significantly lower than those at T0, and there were statistical differences (P＜0.05); the heart rate and MAP at T2 and T3 in group C were significantly higher than those at T1 and the same time points in group A and group B, and there were statistical differences (P＜0.05); the SpO2 at T3 in group A was significantly lower than that in group B and group C, and there was statistical difference (P＜0.05). The incidences of cough accompanied by body movement and additional injection of lidocaine in group C were significantly higher than those in group A and group B: 63.3% (19/30) vs. 10.0% (3/30) and 13.3% (4/30), 50.0% (15/30) vs. 6.7% (2/30) and 10.0% (3/30), and there were statistical differences (P＜0.05); the incidence of hypoxemia in group A was significantly higher than that in group B and group C: 63.3% (19/30) vs. 23.3% (7/30) and 6.7% (2/30), group B was significantly higher than group C, and there were statistical differences (P＜0.05); the incidence of assisted ventilation in group A was significantly higher than that in group B and group C:36.7% (11/30) vs. 3.3% (1/30) and 0, there was statistical difference (P＜0.05). The detection time in group B was significantly shorter than that in group A and group C: (17.6 ± 2.8) min vs. (22.6 ± 3.3) and (21.0 ± 2.6) min, the degree of patients satisfaction in group A and group B was significantly higher than that in group C: (95.5 ± 2.6) and (95.2 ± 3.3) scores vs. (79.3 ± 2.9) scores, the degree of doctors satisfaction in group B was significantly higher than that in group A and group C: (95.8 ± 3.3) scores vs. (83.9 ± 4.2) and (81.0 ± 2.6) scores, there were statistical differences (P＜0.05). Conclusions The BIS setting of sedation depth between 70 and 74 during lucid fiberoptic bronchoscopy has more advantages, less adverse reactions, stable hemodynamics, and higher degree of patients and doctors satisfaction.
الملخص
Objective To investigate the feasibility of ultrasound-guided interscalenus brachial plexus block used for the emergency surgery.Method From August to December 2007 80 patients from the Integrated Traditional Chinese and Western Medicine Hospital of Wenzhou,ASA Ⅰ to Ⅲ,age 18 to 68 years old,weight 45 to 75 kg,without deformity on the shoulder or neck,without limb paresthesia,without contraindications of interscalenus brachial plexus block,were scheduled for emergency surgery of upper limb.They were randomly divided into two groups:interscalenus block guided by ultrasound group(group U,re =40)and nerve stimulator group(group N,re = 40).Patients of both groups received 20 mL mixture of 0.75%ropivacaine and 2%lidocaine.The onset time,and the analgesic efficacy of axillary nerve,lateral antebrachial cutaneous nerve,radial nerve,median nerve,median cutaneous nerve of arm,median antebrachial cutaneous nerve and ulnar nerve,and duration of anesthesia were observed.Statistical analysis was performed by t test,rank sum test and X2 test.Results The onset time of analgesia after nerve block was shorter in group U than that in group N(P＜0.01).The rate of perfect analgesia after nerve block in group U was higher than that in group N(100%vs.87.5%,X2 = 5.267,P = 0.027).The duration of anesthesia lasted in group U was(378 ± 151)minutes and that in group N was(365 ± 163)minutes(t= 0.363,P = 0.718).ConclusionsCompared with the method of nerve block guided by nerve stimulator,the ultrasound-guided interscalenus block offers faster onset and better analgesic efficacy.It is an ideal technique of brachial plexus block for the emergency surgery.