超声引导下腹横肌平面阻滞在腹腔镜下胆囊切除术术后镇痛的疗效与评价

目的 探讨超声引导下腹横肌平面阻滞在腹腔镜下胆囊切除术术后镇痛的疗效与评价。方法 将2018年1月～2019年3月在我院肝胆外科行腹腔镜下胆囊切除术的60例患者随机分为两组,对照组使用气管插管全身麻醉,观察组使用气管插管全身麻醉联合超声引导下腹横肌平面阻滞,比较两组患者术后静息及咳嗽时的疼痛情况、术后镇静程度、不同时间点血压及心率变化、不良反应情况。结果 在静息及咳嗽状态下,观察组出PACU时、术后4 h、术后24 h的VAS疼痛评分均明显低于对照组(P0.05);观察组入PACU后5 min、10 min、15 min的镇静评分低于对照组(P0.05),而入PACU后30 min的镇静评分无明显差异(P0.05);两组在术中及入PACU后各时间点的MAP无明显差异(P0.05),观察组在入PACU 10 min的心率慢于对照组(P0.05),其他时间点无明显差异(P0.05);观察组术后头痛、头晕、嗜睡、恶心呕吐、皮肤瘙痒、颤抖等不良反应发生率与对照组相比无明显差异(P0.05)。结论 超声引导下腹横肌平面阻滞在腹腔镜下胆囊切除术术后镇痛的疗效显著,对血流动力学影响小,安全性高,具有积极的临床意义。     

Weakness May Have a Causal Association With Early Mortality in Older Americans: A Matched Cohort Analysis

ObjectivesQuantifying the association between muscle weakness and mortality with carefully matched cohorts will help to better establish the impact of weakness on premature death. We used a matched cohort analysis in a national sample of older Americans to determine if those who were weak had a higher risk for mortality compared with control groups with incrementally higher strength capacities.DesignLongitudinal panel.SettingDetailed interviews that included physical measures were conducted in person, whereas core interviews were often performed over the telephone.ParticipantsData from 19,729 Americans aged at least 50 years from the 2006-2014 waves of the Health and Retirement Study were analyzed.MeasuresA handgrip dynamometer was used to assess handgrip strength (HGS) in each participant. Men with HGS <26 kg were considered weak, ≥26 kg were considered not weak, and ≥32 kg were considered strong. Women with HGS <16 kg were classified as weak, ≥16 kg were classified as not-weak, and ≥20 kg were classified as strong. The National Death Index and postmortem interviews determined the date of death. The greedy matching algorithm was used to match cohorts.ResultsOf the 1077 weak and not-weak matched pairs, 401 weak (37.2%) and 296 not-weak (27.4%) older Americans died over an average 4.4 ± 2.5-year follow-up. There were 392 weak (37.0%) and 243 strong (22.9%) persons who died over a mean 4.5 ± 2.5-year follow-up from the 1057 weak and strong matched pairs. Those in the weak cohort had a 1.40 [95% confidence interval (CI) 1.19, 1.64] and 1.54 (CI 1.30, 1.83) higher hazard for mortality relative to persons in the not-weak and strong control cohorts, respectively.Conclusions and ImplicationsOur findings may indicate a causal association between muscle weakness and mortality in older Americans. Health care providers should include measures of HGS as part of routine health assessments and discuss the health risks of muscle weakness with their patients.     

Excitability of motor and sensory axons in multifocal motor neuropathy

ObjectiveTo assess excitability differences between motor and sensory axons of affected nerves in patients with multifocal motor neuropathy (MMN).MethodsWe performed motor and sensory excitability tests in affected median nerves of 20 MMN patients and in 20 age-matched normal subjects. CMAPs were recorded from the thenar and SNAPs from the 3rd digit. Clinical tests included assessment of muscle strength, two-point discrimination and joint position.ResultsAll MMN patients had weakness of the thenar muscle and normal sensory tests. Motor excitability testing in MMN showed an increased threshold for a 50% CMAP, increased rheobase, decreased stimulus-response slope, fanning-out of threshold electrotonus, decreased resting I/V slope, shortened refractory period, and more pronounced superexcitability. Sensory excitability testing in MMN revealed decreased accommodation half-time and S2-accommodation and less pronounced subexcitability. Mathematical modeling indicated increased Barrett-Barrett conductance for motor fibers and increase in internodal fast potassium conductance for sensory fibers.ConclusionsExcitability findings in MMN suggest myelin sheath or paranodal seal involvement in motor fibers and, possibly, paranodal detachment in sensory fibers.SignificanceExcitability properties of affected nerves in MMN differ between motor and sensory nerve fibers.