ABSTRACT
Objective To select the appropriate postoperative analgesia,through the application of different methods in the postoperative analgesia of the patients with breast cancer.Methods Ninety female patients undergoing unilateral breast cancer radical surgery in general anesthesia,aged 35-60 years,weighing 45-80 kg,falling into ASA physical status Ⅰ or Ⅱ,were ran domly divided into simple intravenous postoperative analgesia group (group P,n =30),local infiltration plus intravenous postoperative analgesia group (group R,n =30),ultrasound guided thoracic nerve block plus intravenous postoperative analgesia (group TP,n =30),group P used dexmedetomidine 2μg/kg plus sufentanil 2μg/kg,group R used 0.375％ ropivacaine 20 ml local infiltration added dexmedetomidine 2μg/kg plus sufentanil 2 μtg/kg,group TP used 0.375％ ropivacaine 20 ml vertebral side block added dexmedetomidine 2μg/kg plus sufentanil 2 μg/kg.The VAS scores and Ramsay score was recorded 6,12,24,48 h after surgery,the deep sleep quality score at preoperative postoperative 24 h and 48 h,the number of postoperative analgesia pump pressure,the use of sufentanil and the nausea,vomiting,itching,bradycardia,respiratory depression happened in 24 h were documented.Results The VAS scores in groups R and TP 6 h after surgery were significantly lower than that of group P.The VAS scores in group TP 12 h after surgery were significantly lower than that of groups R and P (P＜0.05).The sedation scores were not statistically significant among the three groups.The deep sleep quality scores at 24 h in group TP were significantly lower than those of groups R and P (P＜ 0.05).The number of compressions and the use of the sufentanil in 24 h after surgery in group TP were significantly lower than those of groups R and P,and that in group R was significantly lower than that in group P (P＜0.05).The incidence of nausea,vomiting,itching,bradycardia,respiratory depression were not statistically significant in 24 h,and there were no postopera tive complications related to neurologic blocking of lateral vertebral nerve.Conclusion Three methods were safe and effective for postoperative analgesia in patients with radical surgery breast cancer.Ultrasound guided by thoracic nerve block combined intravenous postoperative analgesia was obviously better than local infiltration plus infiltration postoperative analgesia and infiltration postoperative analgesia in terms of postoperative analgesia,quality of sleep and the number of sufentanil.
ABSTRACT
Objective Postoperative cognitive dysfunction (POCD) is a common complication of cardiac surgery, which seriously affects the prognosis of the patient.This study aimed to explore the risk factors for early POCD in patients undergoing cardiac valve surgery and the correlation between early POCD and the serum S100B protein level.Methods Eighty patients underwent mitral valve replacement surgery in combination with tricuspid plasty.At 1 day before and 5 days after surgery, we assessed the cognitive function of the patients and divided them into a POCD and a non-POCD group.We obtained such data as the age, sex, education, New EuroSCORE Ⅱ, and preoperative NYHA cardiac function grades and left ventricle ejection fraction (LVEF) of the patients, collected the venous blood to determine serum S100B protein concentration by ELISA, and analyzed the independent risk factors of early POCD using single-factor and binary logistic regression analyses.Results POCD was found in 20 (25%) of the patients, , Logistic regression analysis showed the independent risk factors for early POCD to be hyperglycemia (OR=6.038, 95% CI: 1.202-30.337), operation time (OR=6.423, 95% CI: 1.276-32.332), and aspartate aminotransferase (AST, 2 times higher than normal) (OR=12.878, 95% CI: 2.289-72.445).The serum S100B protein concentrations in the POCD group were (1.9±0.3) μg/L and (1.7±0.4) μg/L at 48 and 72 hours after cardiopulmonary bypass, significantly lower than (2.4±0.4) μg/L and (2.1±0.3) μg/L at 30 minutes and 24 hours (P<0.05), and so was it in the non-POCD group at 72 than at 48 hours postoperatively ([1.4±0.4]) vs [1.5±0.4] μg/L, P<0.05).Conclusion Long operation time, perioperative hyperglycemia and high AST are independent predictors and the serum S100B protein level is a significant marker of early POCD.