右美托咪定静脉给药对罗哌卡因椎旁阻滞镇痛效果的影响

目的 观察右美托咪定（DEX）经静脉给药对罗哌卡因椎旁神经阻滞镇痛效果的影响。方法 选取2017年5月~2019年1月我院择期行胸腔镜手术患者90例,随机分为对照组、DEXIV组和DEXP组,各30例。对照组不使用DEX,DEXIV组为DEX静脉给药,DEXP组为DEX神经周围给药,比较三组患者进入复苏室即刻（PACU）、椎旁神经阻滞后6、12、24 h的VAS疼痛评分,病人自控静脉镇痛（PCIA）术后首次按压时间、累计按压次数、镇痛药物需求及不良反应发生情况。结果 三组PACU时刻VAS评分比较,差异无统计学差异（P＞0.05）;对照组术后6、12 h VAS评分高于DEXIV组和DEXP组,差异有统计学意义（P＜0.05）;DEXIV组与DEXP组术后6、12 h VAS评分比较,差异无统计学意义（P＞0.05）;三组术后24 h VAS评分比较,差异无统计学意义（P＞0.05）。对照组PCIA首次自控按压时间早于DEXIV组与DEXP组,且累计按压次数高于DEXIV组与DEXP组,差异有统计学意义（P＜0.05）;DEXIV组与DEXP组首次按压时间、累计按压次数比较,差异无统计学意义（P＞0.05）。三组额外镇痛药物需求比较,差异无统计学意义（P＞0.05）;DEXIV组仅有1例患者发生心动过缓,三组不良反应比较,差异无统计学意义（P＞0.05）。结论 无论是经静脉还是神经周围给药DEX均能延长罗哌卡因单次胸椎旁神经阻滞的镇痛时间,减少镇痛药物消耗和不良反应发生几率。     

硝酸甘油联合阿司匹林治疗心绞痛的临床效果观察

目的 分析硝酸甘油联合阿司匹林治疗心绞痛的疗效和价值。方法 选取2016年1月~2017年1月我院接收的心绞痛患者86例,随机分为对照组和观察组各43例。对照组应用硝酸甘油治疗,观察组应用硝酸甘油联合阿司匹林治疗。统计两组患者用药后的每日心绞痛频率、每日硝酸甘油用量、心电图缺血时间、心电图缺血次数,观察临床疗效、心电图疗效不良反应发生情况。结果 观察组治疗总有效率（97.67%）高于对照组（76.74%）,差异有统计学意义（P＜0.05）;观察组心电图明显改善率（48.84%）明显高于对照组（32.56%）,差异有统计学意义（P＜0.05）;观察组每日心绞痛次数、硝酸甘油用量、心电图缺血时间、心电图缺血次数均优于对照组,两组差异有统计学意义（P＜0.05）。两组患者的不良反应发生率差异无统计学意义（P＞0.05）。结论 对心绞痛患者采用硝酸甘油联合阿司匹林治疗,可获得较好的治疗效果,值得临床应用及推广。     

尼莫地平与盐酸氟桂利嗪治疗老年偏头痛的临床疗效观察

目的 比较尼莫地平与盐酸氟桂利嗪治疗老年偏头痛的临床效果。方法 选取2017年2月~2018年4月在我院接受治疗的77例老年偏头痛患者,随机分为A组39例和B组38例。A组患者采用盐酸氟桂利嗪治疗,B组患者采用尼莫地平治疗,比较用药前后两组患者头痛发作情况、疼痛程度、临床疗效与副作用。结果 A组发作次数少于B组[（0.62±0.19）次vs（1.13±0.32）次],差异有统计学意义（P＜0.05）;A组发作持续时间少于B组[（1.15±0.34）h vs（2.58±0.57）h],差异有统计学意义（P＜0.05）;A组患者NRS评分为（2.36±0.54）分,低于B组的（4.39±0.71）分,差异有统计学意义（P＜0.05）;A组总有效率高于B组,差异有统计学意义（P＜0.05）,两组副作用发生率比较,差异无统计学意义（P＞0.05）。结论 相较于尼莫地平,应用盐酸氟桂利嗪治疗老年偏头痛可减少偏头痛发作次数,缩短发作持续时间,减轻疼痛、改善治疗效果,同时药物副作用较低。     

巴洛克音乐对全子宫切除术患者围术期焦虑情绪及应激的影响

目的 探讨巴洛克音乐对焦虑患者围术期焦虑情绪及应激反应的影响。方法 选取2015年6月~2017年6月气管插管全麻下行腹腔镜下全子宫切除术的患者40例。随机分为A组和B组,各20例。A组患者常规麻醉,B组在自抽血后（T1）开始全程聆听巴洛克音乐直至拔管结束。聆听音乐后15 min后（T2）行麻醉诱导。比较两组患者T1、T2、拔管后（T3）的血流动力学、焦虑评分,抽血检测血液去甲肾上腺素（NE）浓度;记录患者术后1 h VAS评分及吗啡用量。结果 两组患者手术时间及麻醉时间比较,差异无统计学意义（P＞0.05）;B组T2、T3时患者MAP、心率及血浆NE水平低于A组,差异有统计学意义（P＜0.05）,B组患者的焦虑评分低于A组,差异有统计学意义（P＜0.05）;A组患者清醒后1 h VAS评分高于B组,吗啡用量高于B组,差异均有统计学意义（P＜0.05）。结论 聆听巴洛克音乐可以减轻患者围术期焦虑情绪,其通过减少去甲肾上腺素的分泌来减少应激使患者情绪放松,血流动力学稳定。     

甲状腺癌术后不同时间拔除引流条的效果分析

目的 探讨甲状腺癌术后不同时间拔除引流条的疗效。方法 收集我院80例甲状腺癌手术患者临床资料,术后24 h内拔除引流条40例设为A组,术后24~48 h拔除引流条40例设为B组。比较两组患者手术资料（术中出血量、手术时间、淋巴结转移数）、换药次数、术后48 h平均体温、敷料渗液浑浊率、切口感染率、皮下积液率及手术至出院时间。结果 两组患者年龄、性别、手术时间、出血量、淋巴结转移情况比较,差异无统计学意义（P＞0.05）;B组换药次数为（3.45±0.64）次,较A组（2.10±0.50）次增加,B组患者术后48 h内平均体温为（37.54±0.73）℃,较A组（37.08±0.46）℃升高;B组敷料渗液浑浊率（30.00%）及切口感染率（12.50%）也较A组的（10.00%）、0增加,差异具有统计学意义（P＜0.05）,而皮下积液率及手术至出院时间比较,差异无统计学意义（P＞0.05）。结论 甲状腺癌术后早期拔除引流条安全、有效。     

右美托咪定替代瑞芬太尼对甲状腺手术 全麻患者术后恶心呕吐的影响

目的 观察右美托咪定对甲状腺手术全麻患者术后恶心呕吐的影响。方法 选取我院2016年1月～2017年2月择期全麻甲状腺患者80例,随机分为两组,每组40例。D组给予右美托咪定,R组给予瑞芬太尼。观察患者入室时、插管前、插管后5 min、手术开始后5 min、手术开始后30 min、缝皮时、拔管后5 min的平均动脉压和心率。记录麻醉时间、手术时间、睁眼时间、拔管时间、及入PACU时的警觉镇静评分、术后疼痛评分、补救止吐和镇痛药物的使用。观察患者0～2 h、2～24 h内恶心呕吐发生情况。结果 T2～T7时D组HR低于R组（P＜0.05）,两组间MAP差异无统计学意义（P＞0.05）。R组和D组患者手术时间、麻醉时间对比,差异无统计学意义（P＞0.05）。D组睁眼时间、拔管时间长于R组,D组OAA/S镇静评分低于R组（P＜0.05）;后2个时段,D组恶心发生率低于R组（P＜0.05）;止吐药使用率低于R组（P＜0.05）;两组术后呕吐发生率,差异无统计学意义（P＞0.05）。术后0～2 h疼痛VAS评分,两组差异无统计学意义（P＞0.05）;术后2～24 h,D组VAS评分低于R组;两组补救镇痛率无统计学意义（P＞0.05）。结论 对于甲状腺手术患者,麻醉诱导前右美托咪定负荷量1 μg,维持量0.3～0.5 μg/（kg·h）可有效降低术后恶心呕吐的症状,减少止吐药物的使用,改善术后镇痛效果。     

右美托咪定复合丙泊酚和芬太尼在无痛人流术中的应用观察

目的 观察右美托咪定复合丙泊酚和芬太尼在无痛人流术中的应用。方法 选择择期行无痛人流术的患者400例,随机分为丙泊酚和芬太尼组（P组）以及右美托咪定复合丙泊酚和芬太尼组（EP组）。术前2 min给予芬太尼0.5 μg/kg静注,术中丙泊酚以靶控（TCI）模式输注,右美托咪定以恒速模式输注,根据患者镇静深度适当调整注射速度。记录所有患者的药物起效时间、操作时间、苏醒时间以及出室时间,并记录低血压、心动过缓、缺氧和注射痛等不良事件。结果 EP组围术期低血压、心动过缓、缺氧、注射痛发生率较P组显著降低,差异具有统计学意义（P＜0.01）;EP组患者的起效时间较P组长,差异有统计学意义（P＜0.05）,而两组患者操作时间、苏醒时间、出室时间以及出室前VAS值差异无统计学意义（P＞0.05）。结论 右美托咪定复合丙泊酚和芬太尼在无痛人流术中对呼吸、循环系统影响小,注射痛发生率更小,显著提高无痛人工流产术的安全性及舒适性。     

不同时间段静滴氨甲环酸对膝关节置换术后失血量的影响

目的 探讨膝关节置换不同时间点静滴氨甲环酸对患者围手术期出血及术后静脉血栓栓塞（VTE）发生的影响。方法 选取2016年2月~2018年2月于我院行膝关节置换的患者200例,随机分为A、B、C、D四组,各50例。A组在术前及松止血带前静滴氨甲环酸氯化钠注射液各50 ml,B组在术前静滴100 ml,C组在松止血带前静滴100 ml;D组在术前静滴等量氯化钠注射液。记录各组术后24 h引流量、总引流量及输血率;比较各组术后6、24、48 h血红蛋白（Hb）水平及术后24 h凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）、D-二聚体水平和VTE发生率。结果 A、B、C组术后24 h引流量、总引流量及输血率均少于D组,且A组术后24 h引流量、总引流量及输血率最少,差异有统计学意义（P＜0.05）;A组术后6、24、48 hHb水平均高于B、C、D组,且B、C组高于D组,差异有统计学意义（P＜0.05）;D组术后D-二聚体高于A、B、C组,差异有统计学意义（P＜0.05）,A、B、C三组比较,差异无统计学意义（P＞0.05）;术后24 h四组PT、APTT、FIB比较,差异无统计学意义（P＞0.05）;四组均未出现VTE,术后2周下肢彩超未见血栓形成。结论 氨甲环酸可减少膝关节置换术后出血和输血率,且不增加VTE的发生几率,其中术前与松止血带前静滴氨甲环酸效果最佳,可降低术后引流量,改善患者血红蛋白水平。     

右美托咪定辅助用于小儿尿道下裂修补术后镇痛的效果观察

观察右美托咪定复合芬太尼用于尿道下裂修补术患儿术后镇痛的效果及安全性。方法 选择全麻下择期行尿道下裂修补术的患儿60例,随机分为F组和D组,各30例。F组给予芬太尼0.3 μg/（kg·h）,D组给予右美托咪定0.05 μg/（kg·h）+芬太尼0.2 μg/（kg·h）,所有患者手术结束前30 min,给予芬太尼负荷剂量1 μg/kg。手术结束前即刻连接一次性恒速机械镇痛泵,泵注速率2 ml/h。记录连接镇痛泵后2、4、8、12、24及48 h的Wong-Baker脸谱疼痛评分和Ramsay镇静评分,补救镇痛次数以及术后心动过缓、低血压、恶心呕吐等不良反应发生情况。结果 与F组比较,D组患儿补救镇痛次数、恶心呕吐及躁动发生率降低,患儿2、4、8、12、24及48 h的Wong-Baker脸谱疼痛评分降低、而Ramsay镇静评分增高,差异有统计学意义（P＜0.05）,两组患者在镇痛过程中均未出现心动过缓及低血压。结论 右美托咪定辅助用于小儿尿道下裂术后镇痛能提供较好镇痛效果和较佳镇静舒适度,减少不良反应的发生。     

SEDline镇静监测下瑞马唑仑静脉麻醉联合胸椎旁神经阻滞在胸腔镜肺叶切除术中的应用

目的 探讨在SEDline 镇静监测仪监测下甲苯磺酸瑞马唑仑复合胸椎旁神经阻滞（TPVB）在胸腔镜肺叶切除术中的临床应用效果。方法 前瞻性随机对照研究。纳入2021年6月—2022年5月蚌埠医学院第一附属医院择期行胸腔镜下肺叶切除术患者80例,其中男45例、女35例,年龄40~71岁。80例患者采用数字表法随机分为4组,其中采用甲苯磺酸瑞马唑仑静脉麻醉联合TPVB为TR组,采用甲苯磺酸瑞马唑仑静脉麻醉为R组,采用丙泊酚静脉麻醉联合TPVB为TB组,采用丙泊酚静脉麻醉为B组,每组20例。患者均在SEDline镇静监测仪监测下行胸腔镜肺叶切除术,术中根据患者大脑状态指数（PSI）调控麻醉药用量,PSI维持在25~50。观察指标：（1）比较4组患者性别、年龄、体质量指数（BMI）、术前血清同型半胱氨酸（Hcy）、术前简易精神状态检查量表（MMSE）认知功能评分等临床基线资料;（2）记录对比4组患者麻醉诱导前（T₀）、切皮时（T₁）、单肺通气30 min（T₂）、术毕即刻（T₃）的血氧饱和度（SPO₂）、心率、平均动脉压（MAP）,以及血清丙二醛（MDA）、晚期氧化蛋白产物（AOPP）水平;（3）记录对比4组患者手术时间、术中输液量、出血量和盐酸瑞芬太尼用量;（4）对比术后6、24 h 疼痛VAS评分和Ramsay 镇静评分,术后24 h血清Hcy水平、MMSE评分、镇痛泵按压次数。结果 （1）4组患者性别、年龄、BMI、术前Hcy、术前MMSE评分等临床基线资料比较,差异均无统计学意义（P值均>0.05）。（2）组内比较：R组心率不同时间点差异有统计学意义（F=3.30,P=0.025）,TR组、TB组、B组心率在不同时间点差异均无统计学意义（P值均>0.05）;各组中的MAP、SPO₂、MDA、AOPP不同时间点差异均有统计学意义（P值均<0.05）。组间比较：在T₀,4组间MAP、心率、SPO₂、MDA、AOPP差异均无统计学意义（P值均>0.05）。在T₁、T₂,心率、MDA、AOPP差异均有统计学意义（P值均<0.05）,其中TB组心率均最低,TR组MDA、AOPP均最低;而MAP、SPO₂差异均有统计学意义（P值均<0.05）。在T₃,MAP、MDA、AOPP差异均有统计学意义（P值均<0.05）,其中B组MAP最低,TR组MDA、AOPP均最低;而心率、SPO₂差异均无统计学意义（P值均>0.05）。（3）TR组、TB组患者术中盐酸瑞芬太尼用量较少,R组、B组较多,4组间比较差异有统计学意义（F=23.67,P<0.001）;而手术时间、术中输液量、术中出血量4组间比较,差异无有统计学意义（P值均>0.05）。（4）4组患者术后6、24 h疼痛VAS评分和Ramsay镇静评分,以及术后24 h血清Hcy水平、MMSE认知功能评分、镇痛泵按压次数比较,差异均有统计学意义（P值均<0.05）。结论 甲苯磺酸瑞马唑仑联合TPVB应用于胸腔镜肺叶切除术中,能更精准地控制麻醉状态,且患者循环指标波动范围较小,术后镇静、镇痛效果更有优势。     

Vasopressor choice for hypotension in elective Cesarean section: ephedrine or phenylephrine?

Introduction

Hypotensive episodes are a common complication of spinal anesthesia during Cesarean section. The purpose of this study was to compare the effectiveness and the side effects of vasopressors, ephedrine and phenylephrine, administered for hypotension during elective Cesarean section under spinal anesthesia.

Material and methods

The study consisted of 100 selected ASA I/II females scheduled for elective Cesarean section under spinal anesthesia. Each patient was randomly assigned to one of the two double-blind study groups. Group E received 1 ml ephedrine (5 mg/ml) with normal saline if hypotension was present (n=50). Group P received 1 ml phenylephrine (100 µg/ml) with normal saline if hypotension developed (n=50). Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) were compared within and between groups to basal levels at time increments of 0, 2, 4, 6, 8, 10, 15, 20, 25, 30, 45, and 60 min from start of surgery. Incidence of side effects and neonatal outcomes were studied between groups.

Results

All patients required vasopressor therapy for hypotension. Administration of phenylephrine was associated with significant drop in HR. Changes in SBP, DBP, and MAP were similar in both groups for most observed times. The incidences of nausea/vomiting and tachycardia were significantly higher in the ephedrine group.

Conclusions

Phenylephrine and ephedrine are acceptable choices to combat maternal hypotension related to spinal anesthesia in elective Cesarean section. Complications of intra-operative nausea and vomiting, tachycardia and bradycardia should be considered when choosing a vasopressor, suggesting phenylephrine may be more appropriate when considering maternal well-being.     

BIS指导下右美托咪定监护麻醉在OVCF椎体成形术患者中的应用价值

目的 探究脑电双频谱指数(BIS)指导下右美托咪定(Dex)监护麻醉对OVCF椎体成形术患者的的影响.方法 选择我院收治的128例OVCF椎体成形术患者作为研究对象,按随机数表法将其分为观察组和对照组,每组各64例.对照组患者给予局部麻醉,观察组患者行脑电双频谱指数(BIS)指导下右美托咪定麻醉监护.记录并比较两组患者...     

A randomised controlled trial comparing weight adjusted dose versus fixed dose prophylactic phenylephrine infusion on maintaining systolic blood pressure during caesarean section under spinal anaesthesia

BackgroundSpinal anaesthesia is the standard of care for elective caesarean delivery. It has advantages over general anaesthesia. However the sympathetic blockade induced by spinal anaesthesia results in an 80 percent incidence of hypotension without prophylactic management. Current evidence supports co-loading with intravenous fluids in conjunction with the use of vasopressors as the most effective way to prevent and treat the hypotension. Phenylephrine is the accepted vasopressor of choice in the parturient. A prophylactic phenylephrine infusion combined with a fluid co-load is proven to be an effective and safe method of maintaining maternal hemodynamic stability. While most published studies have assessed the effectiveness of a prophylactic phenylephrine fixed dose infusion, few studies have assessed the effect of a prophylactic phenylephrine weight adjusted dose infusion on maintaining maternal hemodynamic stability following spinal anesthesia for a cesarean delivery.ObjectiveTo compare the incidence of hypotension between women undergoing elective caesarean section under spinal anaesthesia, receiving prophylactic phenylephrine infusion at a fixed dose of 37.5 micrograms per minute versus a weight adjusted dose of 0.5 micrograms per kilogram per minute.MethodsOne hundred and eight patients scheduled for non-urgent caesarean section under spinal anaesthesia were randomized into 2 groups; control group and intervention group using a computer generated table of numbers.Control group; Received prophylactic phenylephrine fixed dose infusion at 37.5 micrograms per minute.Intervention group; Received prophylactic phenylephrine weight adjusted dose infusion at 0.5 micrograms per kilogram per minuteResultsThe two groups had similar baseline characteristics in terms of; Age, sex, weight and height. There was a 35.2% incidence of hypotension in the fixed dose group and an 18.6% incidence of hypotension in the weight adjusted dose group. This difference was found to be of borderline statistical significance p-value 0.05, and the difference in the incidence rates between the two groups was found to be statistically significant p= 0.03. The difference in the incidence of reactive hypertension and bradycardia between the two groups was not statistically significant: p-value of 0.19 for reactive hypertension and p-value of 0.42 for the incidence of bradycardia. There was also no statistically significant difference in the use of phenylephrine boluses, use of atropine, intravenous fluid used and the number of times the infusion was stopped.ConclusionAmong this population, the incidence of hypotension was significantly less in the weight adjusted dose group than in the fixed dose group. There was no difference in the number of physician interventions required to keep the blood pressure within 20% of baseline, and no difference in the proportion of reactive hypertension or bradycardia between the two groups. Administering prophylactic phenylephrine infusion at a weight adjusted dose of 0.5 micrograms per kilogram per minute results in a lower incidence of hypotension compared to its administration at a fixed dose of 37.5 micrograms per minute.     

全麻与腰硬联合麻醉对老年骨科手术患者认知功能及镇痛效果的影响

目的 探讨采用全麻与腰硬联合麻醉对老年骨科患者认知功能及镇痛效果的影响。方法 回顾性分析我院2017年7月~2018年12月骨科手术的60例老年患者,根据术中麻醉方式分为对照组（n=28）及观察组（n=32）。对照组于骨科手术中选用全麻方式,观察组术中选用腰硬联合麻醉方式,比较两组认知功能（MMSE评分）、镇痛效果（VAS评分）及血流动力学指标。结果 对照组T1、T2时间点MMSE评分较观察组低,差异有统计学意义（P＜0.05）;两组术后2、6、12 h VAS评分逐渐降低,差异有统计学意义（P＜0.05）;但两组不同时间点VAS评分对比,差异无统计学意义（P＞0.05）;观察组手术前后血压、心率指标对比,差异无统计学意义（P＞0.05）;与术前相比,对照组术后血压降低,心率升高,差异有统计学意义（P＜0.05）。结论 全麻与腰硬联合麻醉对老年骨科手术患者均具有良好镇痛效果,但腰硬联合麻醉对患者认知功能及血流动力学指标影响更小,且有利于患者术后恢复。     

超声引导双侧胸椎旁神经阻滞用于开放性 胃癌根治术患者的镇痛效果观察

目的 观察超声引导双侧T7-9椎旁神经阻滞用于开放性胃癌根治术患者的镇痛效果。方法 选择择期开放性胃癌根治手术患者50例,随机数字表法随机分为全麻组（G组）和全麻复合椎旁神经阻滞组（P组）,各25例。G组行气管插管静脉全麻,P组于全麻前行超声引导椎旁神经阻滞。记录基础值（T0）、手术前（T1）、手术5 min（T2）、手术探查时（T3）、手术20 min（T4）、手术1 h（T5）、手术结束（T6）各时间点的MAP和HR,患者术后2 h、4 h、8 h、12 h、24 h、48 h的静息和活动时的VAS评分,术中及术后镇痛药物用量,气管拔管时间,PACU停留时间,观察相关并发症的发生率。结果 与G组对比,P组术后4 h、8 h、12 h、24 h的静息及12 h内的活动时VAS评分降低,气管拔管时间缩短,术后躁动发生率降低,差异均具有统计学意义（P＜0.05）,术中舒芬太尼及术后追加镇痛药用量降低,T2、T3时间点的MAP及T2、T3、T4、T5时间点的HR较低,更为平稳。结论 超声引导双侧T7-9椎旁神经阻滞用于开放性胃癌根治手术患者具有良好的镇痛作用。     

A randomized controlled trial comparing haemodynamic stability in elderly patients undergoing spinal anaesthesia at L5, S1 versus spinal anaesthesia at L3, 4 at a tertiary African hospital

Background

Spinal anaesthesia is a routinely used anaesthetic technique in elderly patients (> 60 years) undergoing operations involving the lower limbs, lower abdomen, pelvis and the perineum. Spinal anaesthesia has several advantages over general anaesthesia including stable haemodynamic variables, less blood loss, less post-operative pain, faster recovery time and less post-operative confusion. Despite these advantages, the sympathetic blockade induced by spinal anaesthesia can result in hypotension, bradycardia, dysrhythmias and cardiac arrests. Conventionally, spinal anaesthesia is performed at the level of L3,4 interspace; with a reported incidence of hypotension in the elderly ranging between 65% and 69%. A possible strategy for reducing spinal induced hypotension would be to minimize the peak block height to as low as possible for the planned procedure.

Objective

To determine the difference in haemodynamic stability between elderly patients undergoing spinal anaesthesia at L5, S1 interspace compared to those at L3, 4.

Methods

Thirty two elderly patients scheduled for lower limb or pelvic surgery under spinal anaesthesia were randomized into 2 groups (control group and intervention group) using a computer generated table of numbers.Control group; received 2.5 mls 0.5% hyperbaric bupivacaine injected intrathecally at the L3, 4 interspace and Intervention group; 2.5mls 0.5% hyperbaric bupivacaine injected intrathecally at the L5, S1 interspace

Results

The two groups had similar baseline characteristics in age, sex, body mass index and use of anti-hypertensive medications. There was 68.8% proportion of hypotension in the control group and 75% in the intervention group. The difference was not found to be statistically significant (p= 0.694). During the study period, there were 106 episodes of hypotension, out of which, 65 were in the control group and 41 in the intervention group (p=0.004).. Linear regression analysis of the decrease in mean arterial pressures (MAP) showed a higher decrease in MAP in the control group (p 0.018). There were more crystalloids used in the control group (1006mls ± 374) than in the intervention group (606mls ±211) with a p< 0.0001. There was no difference in the amounts of vasopressors used between the two groups (p=0.288). There was no difference in the change in heart rates, conversion to general anaesthesia, use of supplementary intravenous fentanyl and the peak maximum block level achieved. The time to peak maximum sensory block level was 9.06min and 13.07min in the control group and intervention groups, respectively (p<0.0001).

Conclusion

Among this population, there was no difference in the proportion of those with hypotension between the elderly patients who received their spinal anaesthesia at L3,4 and those who received spinal anaesthesia at L5,S1. The intervention group had better outcomes with significantly less episodes of hypotension. It took a longer time to achieve a maximum peak sensory block in the intervention group. Performing spinal anaesthesia at the level of L5,S1 was found to provide an adequate sensory block for a wide range of pelvic, perineal and lower limb surgeries.     

硬脊膜穿破硬膜外阻滞在子痫前期孕妇剖宫产术中的应用效果观察

目的:探讨硬脊膜穿破硬膜外（DPE）阻滞在子痫前期孕妇剖宫产术中的应用效果。方法:前瞻性随机对照研究。纳入2019年3月—2021年3月安徽省妇幼保健院择期行剖宫产术的子痫前期孕妇90例,年龄21～38（27.4±3.8）岁,孕周36～41（38.2±1.3）周,孕次1～4（1.7±0.9）次,均为单胎且首次行剖宫产术...     

Cardiovascular and temperature changes in spinal cord injured rats at rest and during autonomic dysreflexia

In patients with high spinal cord injuries autonomic dysfunction can be dangerous, leading to medical complications such as postural hypotension, autonomic dysreflexia and temperature disturbance. While animal models have been developed to study autonomic dysreflexia, associated temperature changes have not been documented. Our aim here was to use radiotelemetry and infrared thermography in rodents to record the development of cardiovascular and skin temperature changes following complete T4 transection. In adult male Wistar rats ( n = 5), responses were assessed prior to spinal cord injury (intact) and for 6 weeks following injury. Statistical analysis by a repeated-measure ANOVA revealed that following spinal cord injury (SCI), rats exhibited decreased mean arterial pressure (MAP, average decrease of 26 mmHg; P < 0.035) and elevated heart rate (HR, average increase of 65 bpm, P < 0.035) at rest. The basal core body temperature following SCI was also significantly lower than intact levels (−0.9°C; P < 0.0035). Associated with this decreased basal core temperature following SCI was an increased skin temperature of the mid-tail and hindpaw (+5.6 and +4.0°C, respectively; P < 0.0003) consistent with decreased cutaneous vasoconstrictor tone. Autonomic dysreflexia, in response to a 1 min colorectal distension (25 mmHg), was fully developed by 4 weeks after spinal cord transection, producing increases in MAP greater than 25 mmHg ( P < 0.0003). In contrast to the tachycardia seen in intact animals in response to colorectal distension, SCI animals exhibited bradycardia ( P < 0.0023). During episodes of autonomic dysreflexia mid-tail surface temperature decreased (approx. −1.7°C, P < 0.012), consistent with cutaneous vasoconstriction. This is the first study to compare cardiovascular dysfunction with temperature changes following spinal cord transection in rats.