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Objective:To investigate the effect of ropivacaine hydrochloride combined with sufentanil for intraspinal patient-controlled analgesia (PCA) in labor analgesia, and its influence on stress response and pregnancy outcome.Methods:The general data of 97 parturients who underwent intraspinal PCA delivery analgesia in Chengdu Seventh People′s Hospital from April 2019 to March 2021 were retrospectively analyzed. They were divided into the observation group (51 cases) and the control group (46 cases) according to different analgesia methods. The observation group parturients were given ropivacaine hydrochloride combined with sufentanil intraspinal PCA, and the control group parturients were given ropivacaine hydrochloride intraspinal PCA. The numerical scoring system (NRS) was used to evaluate the pain degree of the parturient before, 15 minutes after, 30 minutes after, 45 minutes after analgesia and when the uterine orifice was fully opened. The onset time of analgesia, the time of perfection of analgesia, the amount of ropivacaine hydrochloride, sufentanil and the total amount of analgesic drugs were counted. The levels of serum cortisol (COR), adrenocorticotropic hormone (ACTH) and Norepinephrine (NA) were detected by enzyme-linked immunosorbent assay (ELISA). The time of the first stage of labor, the active stage, the second stage of labor, and the third stage of labor, the amount of vaginal bleeding (during labor and within 2 hours after delivery), the proportion of oxytocin application, normal labor, forceps delivery, lateral perineum resection, and caesarean section, the occurrence of adverse reactions (itching, fever, nausea and vomiting, urinary retention, and fetal bradycardia), and the Apgar score of newborns (1 min and 5 min after birth) were counted.Results:There was no statistically significant difference in the onset time and improvement time of analgesia between the two groups of postpartum women, as well as the NRS scores before and after analgesia at 15, 30, and 45 minutes, as well as when the cervix was fully opened (all P>0.05). The dosage of Ropivacaine hydrochloride and the total amount of analgesics in the observation group were significantly less than those in the control group (all P<0.05). After analgesia, the serum levels of COR, ACTH, and NA in both groups decreased significantly compared to before analgesia (all P<0.05); After analgesia, there was no statistically significant difference in serum COR, ACTH, and NA levels between the two groups (all P>0.05). The second stage of labor in the observation group was shorter than that in the control group, the vaginal bleeding volume and the proportion of caesarean section were lower than those in the control group, the proportion of normal delivery and the Apgar score 1 min after birth of the fetus were higher than those in the control group, and the difference was statistically significant (all P<0.05). There was no statistically significant difference in the analgesic effect and total incidence of adverse reactions between the two groups of postpartum women (all P>0.05). Conclusions:Ropivacaine hydrochloride combined with sufentanil intraspinal PCA can effectively alleviate labor pain, reduce the amount of analgesics, and improve maternal and fetal pregnancy outcomes.
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Objective:To analyze the sedative effect of dexmedetomidine in the elderly patients with intraspinal anesthesia .Meth-ods:Totally 52 elderly patients with intraspinal anesthesia were randomly divided into the observation group (26 cases) and the control group (26 cases).After anesthetized successfully , the patients in the control group were given normal saline with intravenous pum-ping,while those in the observation group were given dexmedetomidine with intravenous pumping .The levels of blood pressure , RR, SpO2and HR, the Ramsay sedation score and the adverse reactions of the two groups before anesthesia (T0),10 min after anesthesia (T1),30 min after anesthesia (T2),60 min after anesthesia (T3) and at the end of operation (T4) were compared.Results:The lev-els of RR, SpO2 and HR in the two groups were maintained within the normal range , while the levels of SBP ,HR at T2 and T3 were sig-nificantly lower than those at T 0 in the observation group , and also lower than those at the same time point in the control group ( P<0.05).The Ramsay sedation score from T2 toT4 were significantly lower than that at T0 in the observation group, and also lower than that at the same time point in the control group (P<0.05).The incidence of adverse reactions in the observation group was obviously lower than that in the control group .Conclusion: Dexmedetomidine used in the elderly patients with intraspinal anesthesia can keep hemodynamic stability and exhibits adequate sedation with significantly reduced adverse reactions , which is worthy of clinical promo-tion.
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Objective To explore the effect of preoperative education via WeChat video on surgery in patients with intraspinal anesthesia. Methods Totally 160 patients with intraspinal anesthesia enrolled from February to November,2016 were divided into experimental group(80 patients)and control group(80 patients)by random digits table method.The control group was given routine preoperative care, while the experimental group was added preoperative animations education via WeChat. Postoperative satisfaction,anesthesia cooperation degrees,anxiety scores and operation stop/delay rates were recorded. Results The satisfaction rate was 96.3%(77/80)and 80.0%(64/80)in the experimental group and the control group, there was significant difference between the two groups(x2= 8.60, P <0.05). Anesthesia coordination degree was 94.9% (74/78) and 86.8% (66/76) in the experimental group and the control group, there was significant difference between the two groups (x2= 5.13, P<0.05). Surgical shutdown/extension rate was 2.5%(2/80)and 12.5%(10/80)in the experimental group and the control group,there was significant difference between the two groups (x2= 4.41, P<0.05). The postoperative anxiety scores before visit in the experimental group and the control group were(63.35±5.76)and(63.66±6.61)points, there was no significant difference between the two groups (P>0.05). After visit, the S-AI scores in the experimental group and the control group were(44.23±5.96)and(49.23±5.85)points,there was significant difference between the two groups(t=2.21, P<0.01). Conclusions Preoperative education via WeChat video can reduce patients' anxiety, lower operation stop rate, increase patient's anesthesia cooperation degree,improve the operation quality and ensure the operation smoothly.
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Objective To explore the risk factors of shivering after intraspinal anesthesia.Methods 640 anesthesia recovery patients after intraspinal anesthesia from February 2011 to May 2015 were selected as the research subjects.According to whether patients appeared shivering,they were divided into research group and control group.The research group had 328 cases of appearing shivering,the control group had 312 cases without shivering. Basic clinical data of patients,operation time and blood loss,tympanic membrane temperature,anesthesia,anesthesia blocks plane indicators were compared to explore the risk factors of shivering after intraspinal anesthesia.Results This study included 640 cases,including 328 cases with chills reaction,the incidence rate was 51.25%.Single factor results showed that the low age,male,central cooler,surgery for a long time,the bleeding of more lumbar hemp,choice of anesthetic methods and anesthetic plane above T8 indicators, there were close relationship with shivering after intraspinal anesthesia,the differences between the two groups were statistically significant (χ2 =40.661,17.208, 32.369,32.931,36.624,14.844,26.84,all P<0.05).Multivariable logistic regression analysis results showed that age,gender,core body temperature,operation time,blood loss,spinal canal anesthesia methods and indexes of anes-thetic plane were important risk factors of chills reaction after anesthesia in patients with spinal canal anesthesia (OR=1.843,1.925,2.183,0.548,0.497,0.529,0.743,all P<0.05).Conclusion Male,younger age,operation for a long time,big intraoperative blood loss,tympanic membrane temperature low mode selection subarachnoid block anesthesia,and the anesthesia plane factor are the main risk factors of spinal canal anesthesia patients to appear chills response,the above factors are needed for close monitoring of patients with intraspinal anesthesia in the preoperative period.
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Objective To compare the influences of general anesthesia and intra spinal anesthesia on circulation, respiration, body temperature and anesthesia-related complications in patients undergoing percutaneous nephrolithotomy (PCNL), and assess the effectiveness and safety of both anesthesia. Methods Forty ASA Ⅰ - Ⅱ patients elective for PCNL surgery were divided into two groups by random digits table with 20 cases each:group Ⅰ (endotracheal general anesthesia) and group Ⅱ (intra spinal anesthesia). The temperature, heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2) values and postoperative shivering, nausea, vomiting, back discomfort and the incidence of sore throat were observed and recorded. Results The anesthesia was stable, there were no changes in MAP, HR at different time in group Ⅰ . The anesthesia in group Ⅱ was effective, MAP at 15 min after anesthesia,and HR,MAP after lithotomy position and prone position were obviously changed in group Ⅱ compared with those before anesthesia and group Ⅰ (P ＜ 0.05 ). The temperature at 30,60,90, 120 min after anesthesia decreased compared with that before anesthesia in two groups (P ＜ 0.05 ), and the temperature at 30,60 min after anesthesia in group Ⅰ [(35.8 ±0.6), (34.8 ± 0.5)℃] was lower than that in group Ⅱ [(36.2 ± 0.6),(35.6 ± 0.5)℃](P＜ 0.05).During recovery,complications such as shivering, nausea,sore throat, back discomfort occurred to some extent, of which the incidence of shivering was the highest. Conclusion Both of two anesthesia are applicable to PCNL. When intra spinal anesthesia is used,the life indicators of patients need to be observed and general anesthesia is preferable for the obesity,less physical and the old with poorly compensatory function.