ABSTRACT
Objective@#To observe the clinical effect of ultrasound-guided thoracic paravertebral nerve block on anesthesia and postoperative analgesia in patients undergoing radical resection of lung cancer.@*Methods@#From August 2016 to August 2018, 88 patients who had undergone selective radical resection of lung cancer in the Traditional Chinese Medicine Hospital of Jinhua were divided into study group and control group according to random number table, with 44 cases in each group.The patients in the control group were given epidural block combined with general anesthesia.The patients in the study group were given ultrasound-guided thoracic paravertebral nerve block combined with general anesthesia.The hemodynamic parameters such as SpO2, MAP and HR were monitored before and after anesthesia(T0), after blocking anesthesia administration(T1), after induction and extubation(T2), after skin incision(T3) and extubation(T4). The serum levels of NE, Cro, hs-CRP and TNF-α were measured before and after operation.The VAS scores were scored at different time points after operation.The adverse reactions after anesthesia were observed.@*Results@#The values of MAP and HR at each time point of T1-T4 in the control group were significantly lower than those at T0(t=5.067-14.839, all P<0.05), while there were no statistically significant differences in the study group between the values of MAP and HR at each time point of T1-T4 and those at T0(t=0.241-0.619, all P>0.05). At 6h, 12h, 24h and 48h after operation, the levels of serum NE, Cro, hs-CRP and TNF-α in both two groups were significantly higher than those before operation(t=16.289-38.520, all P<0.05), and the levels of serum NE, Cro, hs-CRP and TNF-α in the study group were significantly lower than those in the control group at all time points after operation(t=4.925-12.162, all P<0.05). The VAS scores of resting state and cough state at different time points in the study group were significantly lower than those in the control group(t=6.593-8.424, all P<0.05). The overall incidence of adverse reactions in the study group[18.18%(8/44)] was significantly lower than that in the control group[38.64%(17/44)](χ2=4.526, P=0.033).@*Conclusion@#Compared with epidural anesthesia, ultrasound-guided thoracic paravertebral nerve block combined with general anesthesia can effectively maintain the stability of blood flow, reduce the level of post-operative stress and inflammatory reaction, alleviate the degree of post-operative pain response, and prevent the occurrence of adverse reactions after anesthesia, which is worthy of clinical application.
ABSTRACT
Objective To further improve the comprehensive evaluation program of patient satisfaction in view of the defective item screening and weight design short of considerations for patients'psychological expectation and rational judgment, based on the theory of bounded rationality. Methods A satisfaction measurement scale was compiled and used to survey 847 inpatients in July-August 2017. The internal consistency test, correlation and factor analysis were used to evaluate the reliability and validity of the scale. The combination weight PWi was calculated based on patients' importance of the five satisfaction dimensions and the scoring of certainty degree of their responses. The combination weight EWi was calculated based on the five-dimension importance and operability scoring of expert consultation. The indicator combination weight OWi was determined using the integrated factors scoring, TOPSIS, weight rank-sun ratio, gray correlation method, and synthetic index method were used in a general assessment of patient satisfaction of a hospital in question. Results The Cronbach α coefficient of the patient satisfaction rating scale was 0.939, and the half-reliability coefficient was 0.951. The cumulative contribution rate of the five common factors variance extracted from the factor analysis was 71. 4%. The rational weights of five dimensions of service environment, service efficiency, service attitude, service technology, and service costs were 0.220, 0.214, 0.217, 0.179, and 0.171 respectively, while the comprehensive weights of the five dimensions were 0.115, 0.233, 0.196, 0.264, and 0.192 respectively. The comprehensive evaluation results of the two correlation coefficients were greater than 0.95. Conclusions The patient satisfaction measurement scale developed based on the theory of bounded rationality can expand the index connotation and items of core elements such as service technology and cost. The design of index weights fits with the concern of medical service factors and the degree of rational judgment in the patient's medical treatment process. The evaluation results are basically consistent with the actual situation and can be used as a reference tool for the scientific rational evaluation of patient satisfaction.