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Objective:To observe the effects of ultrasound-guided paravertebral nerve block combined with general anesthesia on intraoperative stress response, hemodynamics and postoperative pain of patients undergoing laparoscopic cholecystectomy.Methods:A total of 92 patients undergoing elective laparoscopic cholecystectomy in Wuhan Third Hospital between January 2017 and August 2019 wereselected. They were divided into the control group (63 cases) and the observation group (29 cases) by voluntary. The control group were given simple general intravenous anesthesia, and the observation group were given ultrasound-guided paravertebral nerve block combined with general intravenous anesthesia. Changes in hemodynamic parameters and concentrations of blood angiotensin-Ⅱ (AT-Ⅱ) and cortisol (Cor) in the two groups were observed. The cerebral state indexes (CSI) of both groups were recorded, and pain degree of patients was evaluated with the visual analogue scale (VAS).Results:The mean arterial pressure (MAP) and heart rate (HR) of the observation group were higher than those of the control group at 30 min after anesthesia, 30 min after operation, 3 hours after operation ( P<0.05), the stroke volume variation (SVV) was lower than that of the control group ( P<0.05); the AT-Ⅱ, Cor and CSI in the observation group were lower than those in the control group at each time point ( P<0.05); The dosage of narcotic drugs in the observation group was significantly lower than that in the control group ( P<0.05); The recovery time of spontaneous breathing, recovery time, extubation time and respiratory satisfaction time in the observation group were less than those in the control group ( P<0.05), and the VAS scores at 3 h, 6 h and 12 h after operation in the observation group were lower than those in the control group ( P<0.05). Conclusions:Ultrasound-guided paravertebral nerve block combined with general anesthesia can effectively reduce the patient's stress response during laparoscopic cholecystectomy, with good analgesic effect, which is helpful to maintain the hemodynamic stability of patients.
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Objective To investigate cancer patients′nutritional status after operative treatment and analysis of risk factors for malnutrition, which provides the basis for maintaining patients′ nutrition support after discharge. Methods One hundred and thirty patients treated with tumor in Liuan Hospital affiliated to Anhui Medical University were investigated. The nutritional status of patients discharged from hospital was evaluated by subjective comprehensive assessment, and the risk factors of malnutrition when they were discharged from hospital were analyzed. Results In 130 patients, 76 patients (58.46%) were assessed as no or mild malnutrition, and 54 patients (41.54%) as moderate or severe malnutrition. Univariate analysis showed that body mass index < 18.5 kg/m2 at admission, nutritional risk screening 2002(NRS2002) ≥ 3 scores, smoking and drinking were related to the occurrence of malnutrition after tumor surgery (P<0.05). Logistic regression analysis showed that NRS2002≥3 scores at admission and smoking were independent risk factors for malnutrition at discharge (P < 0.05). Conclusions The incidence of malnutrition in patients after tumor surgery is high, and there are many risk factors. Therefore, early nutrition support should be provided to patients, and family nutrition intervention after discharge is also very necessary.
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Objective@#To investigate the incidence rate of nutritional risk and malnutrition in patients with acute cerebral infarction, and analyze the influence factors of nutritional risk and malnutrition, so as to provide evidence for targeted nutritional intervention.@*Methods@#Nutritional risk screening 2002 (NRS2002), subjective global assessment (SGA) and body mass index (BMI) were applied to screen nutritional risk and assess nutritional state for hospitalized patients with acute cerebral infarction from January to October 2017, and to investigate the incidence rate of nutritional risk and malnutrition. Univariate analysis was used to analyze the relationship of nutritional risk and malnutrition with the basic information and habits of patients. Logistic regression was used to analyze the independent risk factors.@*Results@#The incidence rate of the nutritional risk (NRS2002 ≥ 3 scores) was 61.0% (122/200) in 200 cases of acute cerebral infarction patients. If BMI<18.5 kg/m2 was used to evaluate the nutritional deficiencies, the incidence rate of undernutrition was 8.5% (17/200). The incidence rate of malnutrition was 25.5% (51/200) using the SGA evaluation method. The univariate analysis showed that the nutritional risk was associated with age, drinking, combined infection, fluid diet, dysphagia/cough, and BMI (<18.5 kg/m2)(P<0.05 or<0.01), and the malnutrition was associated with age, combined infection, disturbance of consciousness, fluid diet, dysphagia/cough and BMI (<18.5 kg/m2) (P<0.01). Logistic regression analysis showed that the age, fluid diet were the independent risk factors for nutritional risk (P<0.05 or<0.01). The age, combined infection, fluid diet and BMI (<18.5 kg/m2) were the independent risk factors of malnutrition (P<0.05 or<0.01).@*Conclusions@#The incidence of nutritional risk and malnutrition in patients with acute cerebral infarction is relatively high. Nutritional risk screening and nutritional assessment should be performed at the time of admission. Early nutrition intervention should be used to prevent malnutrition and improve the prognosis of patients.