目的   探讨超声引导下腹横肌平面阻滞（TAP）联合无阿片药全身麻醉（全麻）在腹腔镜子宫全切术中的应用效果。方法   选取武威市凉州医院2021年5月—2023年5月收治的60例择期行腹腔镜子宫全切术患者展开前瞻性研究，应用抽签法将其分为观察组与对照组，各30例。对照组患者实施常规阿片类药物全麻，观察组采用TAP联合无阿片药全身麻醉。对比两组患者入室后（T₀）、切皮时（T₁）、手术10 min后（T₂）和手术结束即刻（T₃）生命体征变化，麻醉后监测治疗室（PACU）恢复情况，术后1、4、8、12、24、48 h疼痛程度，最后对比其48 h内不良反应发生率。结果   两组T₀、T₁、T₂、T₃时间血氧饱和度（SpO₂），T₀、T₃时间平均动脉压（MAP）、心率水平无明显变化，两组对比差异无统计学意义（P＞0.05），T₁、T₂时间对照组MAP、心率升高，观察组T₁、T₂的MAP、心率均低于对照组（P＜0.05）；观察组PACU停留时间、首次肛门排气时间明显低于对照组（P＜0.05）；观察组术后1、4、8、12、24、48 h活动时视觉模量表（VAS）评分与静息时VAS评分低于对照组（P＜0.05）；观察组术后48 h内不良反应发生率比对照组更低（P＜0.05）。结论   针对腹腔镜子宫全切术患者采取超声引下TAP联合无阿片药全麻可稳定患者术中生命体征，缩短患者术后恢复时间，减轻疼痛程度，且可降低术后48 h内不良反应发生率。

       Objective  To explore the application effect of ultrasound-guided transverse abdominis plane（TAP）block combined with opioid-free general anesthesia in laparoscopic total hysterectomy．Methods  A prospective study was conducted in 60 patients who underwent selective laparoscopic total hysterectomy in Wuwei Liangzhou Hospital from May 2021 to May 2023．They were divided into a observation group and a control group using a lottery method，30 cases in each group．The control group received routine opioid general anaesthesia，while the observation group received TAP in combination with opioid-free general anaesthesia．Comparing the changes of vital signs after invasion（T₀），skin cutting（T₁），10 min after operating（T₂），the end of surgery（T₃），and condition in the post-anesthesia care unit（PACU）after anesthesia，the pain degree at 1 h，4 h，8 h，12 h，24 h and 48 h after surgery，and the incidence of adverse reactions within 48 h．Results  There were no significant changes in blood SpO₂，mean arterial pressure（MAP）and heart rate at T₀，T₁，T₂ and T₃ in both groups，and no significant difference between the two groups（P＞0.05）．MAP and heart rate increased in the control group at T₁ and T₂，while those in the observation group were lower than the control group（P＜0.05）．The observation group had significantly shorter PACU time and first anal exhaust time than the control group（P＜0.05）．VAS scores at 1 h，4 h，8 h，12 h，24 h and 48 h after surgery and VAS score at rest in the observation group were lower than in the control group（P＜0.05）．The incidence of adverse reactions within 48 h after surgery was lower in the observation group than in the control group（P＜0.05）．Conclusions  Ultrasound guided TAP combined with opioid-free general anesthesia can stabilize intraoperative vital signs，shorten postoperative recovery time，alleviate postoperative pain，and reduce the incidence of anesthesia related adverse reactions within 48 hours for patients undergoing laparoscopic total hysterectomy．

目的 探讨全身麻醉（全麻）髋关节置换术后苏醒期患者家属迁移应激水平及其相关影响因素。方法 选取2021年4月—2022年10月在南昌市洪都中医院行全麻髋关节置换术苏醒期的108例患者,使用ICU转出患者家属应激压力评估量表评价患者家属迁移应激水平,调查患者及家属相关资料,分析全麻髋关节置换术后苏醒期患者家属迁移应激水平的相关影响因素。结果 108例全麻髋关节置换术后苏醒期患者家属迁移应激得分为（56.35±5.86）分,家属迁移应激水平中等;经多元线性回归分析显示,患者麻醉重症监护室（AICU）住院时间≥24 h、女性、文化水平初中及以下、消极应对是全麻髋关节置换术后苏醒期患者家属迁移应激水平升高的危险因素（P<0.05）。结论 全麻髋关节置换术后苏醒期患者家属迁移应激水平中等,受患者AICU住院时间、家属性别、文化水平、应对方式因素影响。

Objective To analyze the levels of relocation anxiety and its related influencing factors in the family members of patients during the recovery period after hip arthroplasty under general anesthesia．Methods From April 2021 to October 2022,108 patients in Nanchang Hongdu Traditional Chinese Medicine Hospital undergoing total hip arthroplasty under general anesthesia were selected．The levels of relocation anxiety in their families were evaluated using the ICU transferred out patient family stress assessment scale,and the relevant data of the patients and their families were investigated．The relevant factors affecting the levels of relocation anxiety in their families during the recovery period after total hip arthroplasty under general anesthesia were analyzed．Results The relocation anxiety score of 108 patients’ family members during the recovery period after hip arthroplasty under general anesthesia was（56.35±5.86）,with a moderate level．Multiple linear regression analysis showed that patients’ AICU hospitalization time≥24 hours,women,education level of junior high school or below and negative coping were the influencing factors for the level of relocation anxiety of family members of patients during the recovery period after hip replacement under general anesthesia（P<0.05）．Conclusions The level of relocation anxiety in family members of patients undergoing general anesthesia and hip arthroplasty during the recovery period is moderate,which is influenced by factors such as length of patients’ stay in AICU,family members’ gender,educational level and coping styles．

目的 探讨成人全身麻醉（全麻）腹腔镜下腹股沟疝修补日间手术的可行性及安全性。方法 回顾性分析2021年1月—2023年12月广州市第一人民医院收治的进行全麻腹腔镜下疝修补手术治疗的成人患者病历资料,根据患者住院手术模式分为日间手术组、传统手术组。日间手术组采用日间手术模式下全麻腹腔镜腹股沟疝修补术,传统手术组采用传统入院模式下择期全麻腹腔镜下腹股沟疝修补术,对比分析两组可行性（住院时间、住院费用、患者满意度）、安全性（手术时间、手术的出血量、手术并发症的发生率）等。结果 最终纳入199例病例,日间手术组52例（26.1%）,传统手术组147例（73.9%）。与传统手术组相比较,日间手术组住院时间、术前住院时间、术后住院时间缩短,满意度评分升高,差异具有统计学意义（P<0.05）。在手术费用、住院总费用、术后24 h疼痛评分、手术时间、手术的出血量、手术并发症的发生率方面,组间比较差异均无统计学意义（P>0.05）。结论 成人全麻腹腔镜下腹股沟疝修补日间手术,能够缩短患者的住院时间,提高患者的住院满意程度,不增加手术风险和并发症发生率,是安全、有效的。

Objective To explore and analyze the feasibility and safety of laparoscopic inguinal hernia repair surgery under general anesthesia in adults．Methods A retrospective analysis was conducted on the medical records of patients admitted to a hospital from January 2021 to December 2023 who underwent laparoscopic hernia repair surgery under general anesthesia．The patients were divided into day surgery group and traditional surgery group based on their hospitalization surgery mode．The daytime surgery group underwent laparoscopic inguinal hernia repair under general anesthesia in the daytime surgery mode,while the traditional surgery group underwent elective laparoscopic inguinal hernia repair under general anesthesia in the traditional admission mode．The feasibility（hospitalization duration,hospitalization cost,patient satisfaction）and safety（surgery duration,surgical bleeding volume,incidence of surgical complications）of the two groups were compared and analyzed．Results A total of 199 cases were enrolled,with 52 cases（26.1%）in the day surgery group and 147 cases（73.9%）in the traditional surgery group．Compared with the traditional surgery group,the daytime surgery group showed a decrease in length of hospital stay,preoperative hospital stay,and postoperative hospital stay,while the satisfaction score increased,and the difference was statistically significant（P<0.05）．There was no difference（P>0.05）between the two groups in terms of surgical costs,total hospitalization costs,postoperative 24-hour pain scores,surgical time,surgical bleeding volume,and incidence of surgical complications．Conclusion sLaparoscopic inguinal hernia repair under general anesthesia during the day for adults is safe and effective．

目的 研究麻醉恢复室(PACU)全麻患者气管内吸痰的最佳时机与按需吸痰的可行性。方法 选取2021年6月—2021年10月行经口气管插管静吸复合全身麻醉的择期手术患者240例,随机分为A组(拔管前吸痰组)、B组(入室吸痰组)、C组(入室按需吸痰组)3组,每组80例。A组苏醒时拔除导管前常规气道内及口腔吸痰;B组入PACU时提前气道内及口腔吸痰,苏醒时拔除导管,拔管后清理口腔;C组入室后参考吸痰指征评估患者气道分泌物,有吸痰指征患者吸痰,无吸痰指征者不吸痰,苏醒时拔除导管后清理口腔。分别记录患者术后入PACU时、吸痰及拔管后1 min患者的心率、血压、患者因气管刺激引起的呛咳、恶心呕吐及气道痉挛等发生例数,记录躁动评分、术后咽喉痛评分并进行评估。结果 A组与B组比较,每位患者均有吸痰,A组患者心率、血压、血氧饱和度,在吸痰后及拔管后较B组变化幅度大,差异均有统计学意义(P <0.05),气道应激反应方面,C组有20例患者按需吸痰,3组患者均未出现气道痉挛患者,A组有2例患者因拔管时剧烈呛咳引起呕吐,C组呛咳例数低于A组和B组,差异有统计学意义(P <0.05),气道刺激引起的躁动及术后咽喉疼痛C组低于A组,差异有统计学意义(P <0.05)。结论 患者在入室时按需吸痰,拔管时不再吸痰,可减少患者的心血管及气道应激反应,减少术后咽痛。

Objective To investigate the best time for endotracheal suction and the feasibility of on-demand suction in general anesthesia patients of post anesthesia care unit (PACU).Methods A total of 240 selective surgical patients who underwent oral endotracheal intubation with general anesthesia from June 2021 to October 2021 were selected.They were randomly divided into group A (sputum suction before extubation),group B (sputum suction in the room),and group C (in-room sputum suction on demand),80 cases in each group.In group A,routine airway and oral sputum suction was performed before removing the catheter when the patients were waking up.Group B had sputum sucked in the airway and mouth before entering the PACU,removed the catheter when waking up,and cleaned the oral cavity after extubation.In group C,the patients were assessed with reference of suction indications after entering the room.Sputum suction was performed for those with indications,but not for those without indications,and the mouth was cleaned after removing the catheter when awaken.Patient's heart rate,blood pressure,coughing,nausea and vomiting and airway spasm caused by tracheal irritation in 1 minute after suction and extubation were recorded after the patients entered the PACU.The tremor score and sore throat score were recorded and analyzed.Results Comparing group A with group B,each patient had sputum suction.The heart rate,blood pressure,and oxygen saturation of group A changed more significantly than group B after sputum suction and extubation (P<0.05).In terms of airway stress response,20 patients in group C needed suction,none in the three groups had airway spasm.Two patients in group A had vomiting due to severe coughing during extubation.The patients of coughing in group C were significantly less than that of group A and group B,respectively (P<0.05).The dysphoria caused by airway stimulation and postoperative throat pain in group C was significantly lower than that of group A (P<0.05).Conclusions The patient on-demand suction when enter the room,and no suction when extubation,can reduce the patient's cardiovascular and airway stress response and reduce postoperative sore throat.

目的 观察手术前静滴不同剂量复方麝香注射液对老年患者全麻术后早期轻度认知障碍(MCI)发生的影响。方法 选择下肢与下腹部手术全麻患者120例(ASA Ⅰ-Ⅱ级),将其随机分为4组,组Ⅰ(n=30,对照),采用质量浓度为9 g/L的生理盐水100 mL静脉滴注;组II(n=30):应用低剂量复方麝香注射液(0.1 mL/kg,加入质量浓度为9 g/L的生理盐水100 mL)手术开始前0.5 h静脉滴注,其速率为200 mL/h;组Ⅲ(n=30): 应用中剂量复方麝香注射液(0.2 mL/kg), 药物配伍、治疗时间和注射速度与组Ⅱ相同;组Ⅳ(n=30):高剂量复方麝香注射液(0.3 mL/kg),用药方法同组Ⅱ。各组术前用药、麻醉诱导、术中麻醉深度、麻醉苏醒等用药与方法相同;观察各组患者术前、术后第1天、3天、7天的CCSE、FAQ、MMSE评分等。结果 4组患者手术时间、麻醉时间、术中出血量、苏醒时间基本相同(P>0.05),4组手术后第1天、3天及7天CCSE、FAQ、MMSE认知功能评分均减少, 组Ⅱ、组Ⅲ、组Ⅳ下降的变化幅度较小,得分高于组Ⅰ(P<0.05),组Ⅱ、组Ⅲ、组Ⅳ组间比较差异无统计学意义(P﹥0.05);术后第1天、3天、7天MCI发生率,组Ⅰ分别为66.7%、33.3%和16.7%;组Ⅱ为50.0%、16.7%和6.7%;组Ⅲ为50.0%、16.7%和6.7%。组Ⅳ为46.7%、20.0%和10.0%,用药组比组Ⅰ降低(P<0.05),但组Ⅱ、组Ⅲ、组Ⅳ之间无明显差异(P﹥0.05);4组术后不良反应组间比较差异无统计学意义。结论 术前静脉滴注复方麝香注射液0.1 mL/kg可有效降低老年患者全麻术后MCI的发生,增加麝香注射液剂量(0.2 mL/kg、0.3 mL/kg)对于老年手术患者MCI未见增效作用,临床选用静滴的剂量0.1 mL/kg即可。

Objective To observe the effect of different doses of compound musk injection before operation on early mild cognitive impairment (MCI) in elderly patients after general anesthesia. Methods We selected 120 cases of lower limb and lower abdominal surgery general anesthesia (ASA level Ⅰ-Ⅱ),and divided them randomly into 4 groups: Group Ⅰ (n=30,control): 0.9% saline 100mL intravenous infusion; Group Ⅱ (n=30): low dose compound musk injection (0.1 mL/kg,add 0.9% saline 100 mL), 0.5h before the start of surgery, intravenous drip, the rate was 200 mL/h; Group Ⅲ (n=30): medium dose compound musk injection (0.2 mL/kg), the same as group Ⅱ in drug compatibility,treatment time and injection rate; Group Ⅳ (n=30): high dose compound musk injection (0.3 mL/kg), the same as group Ⅱ in drug compatibility, treatment time and injection rate. Each premedication, induction of anesthesia, anesthesia depth,intraoperative awake and anesthesia medication were the same. And we observed each group about preoperative and postoperative CCSE,FAQ and MMSE(mini-mental state examination) score of the 1st days,3rd days and 7th days. Results In the 4 groups of patients,the operation time,anesthesia time,intraoperative blood loss,recovery time were basically the same (P>0.05); CCSE,FAQ,MMSE cognitive function scores of 4 groups were reduced after operation on the first day,the third day and the seventh day; group Ⅱ,group Ⅲ,group Ⅳ decreased slightly.The scores were higher than group Ⅰ (P<0.05),and there were no significant differences between group Ⅱ,group Ⅲ and group Ⅳ (P>0.05); The incidence of MCI in first days, third day and seventh day after operation respectively was: group Ⅰ 66.7%,33.3% and 16.7%; group Ⅱ 50%,16.7% and 6.7%; group Ⅲ 50%,16.7% and 6.7%; group Ⅳ 46.7%,20% and 10%.Those of the drug groups were lower than group Ⅰ (P<0.05), but there was no significant difference between group Ⅱ, group Ⅲ and group Ⅳ (P>0.05).There were no significant differences in the 4 groups in postoperative adverse reactions. Conclusion Preoperative intravenous infusion of compound musk injection 0.1 ml/kg, may effectively reduce the incidence of MCI in elderly patients after general anesthesia. Increasing musk injection dose (0.2 ml/kg,0.3 ml/kg and 0.4 mg/kg) was no synergistic effect on MCI in elderly patients,0.1ml/kg is enough.

目的 研究分析甲强龙静脉注射对老年腹部全麻术患者血流动力学和呼吸动力学的影响。方法 选取2014年3月—2015年3月拟于我院行腹部全麻手术的老年患者76例,随机分为实验组和对照组,每组38例,均对其行全身麻醉。两组病人麻醉诱导用药咪达唑仑0.05 mg/kg,速眠安0.15 mg/kg,乙咪酯 0.2 mg/kg,气管插管后连接麻醉呼吸机。麻醉维持咪达唑仑和速眠安各0.05 mg/kg,给予实验组静脉注射甲强龙1 mL(40 mg),对照组静脉注射生理盐水1 mL。记录两组患者给药前(T₁)、给药后10 min(T₂)、20 min(T₃)、30 min(T₄)、40 min(T₅)的气道峰压(Ppeak)、气道平台压(Pplat)、肺的顺应性(Compl)、气道阻力(Raw)等呼吸动力学参数值。以及两组患者给药前20 min(T₀)和T₁～T₃患者的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)和心率(HR)等血流动力学参数值,并于以上各时间点采取两组患者静脉血测定其血浆中cAMP和cGMP含量。观察比较两组患者各时间点的数据变化以及拔管后10 min(T₆),15 min(T₇)和35 min(T₈)的RAMSAY镇静评分和RASS评分。结果 实验组在T₂～T₅时Compl明显增高,而同期Ppeak、Pplat、Raw则降低(P＜0.05)。与对照组相比较,实验组在T₀到T₄的SBP、DBP、MAP和HR无差异,且各时间点的数值低于同期对照组。两组患者在T₀和T₃cAMP和cGMP含量比较无差异,实验组cAMP和cGMP含量在T₁和T₂时低于对照组,两组患者在T₈时的Ramsay评分和RASS评分比较差异无统计意义,但实验组患者在T₆和T₇时的镇静评分高于对照组(P＜0.05),而同一时间点的RASS躁动——镇静量表评分则低于对照组(P＜0.05)。结论 甲强龙静脉注射能稳定老年腹部全麻术患者的血流动力学和呼吸动力学,抑制手术过程中的应激反应,改善苏醒质量和镇静效果,值得临床上推广使用。

目的 观察术前宣教对支撑喉镜喉肿物摘除患者全麻苏醒期的影响。方法 选择择期支撑喉镜喉肿物摘除全身麻醉手术的患者72例。随机分成两组进行效果对比,一组为接受常规护理的对照组,另一组为本次接受术前宣教观察组。分别对两组患者术后苏醒期躁动发生情况、心血管变化及配合性进行对比。结果 观察组患者通过术前宣教,有效减少全麻苏醒期患者躁动相关情况的发生,其心率、血压水平也较稳定,与对照组相比较差异有统计学意义(P<0.05);两组患者配合性相比较,差异有统计学意义(P<0.05)。结论 对支撑喉镜喉肿物摘除行全麻手术的患者进行术前宣教护理,可以有效减少苏醒期患者躁动的发生率,减轻气管拔管对心血管影响。提高整体治疗护理效率,达到更高的满意度,该方法切实可行,值得临床广泛运用。

Objective To obeserve the effect of preoperative education on the recovery period of general anesthesia after suspension laryngoscopic surgery. Methods Seventy-two adult patients undergoing suspension laryngoscopic surgery were randomly divided for the effect contrast.Routine nursing were adopted for control-group while the only difference for the observation group was the preoperative education. The occurrence of emergence agitation, hemodynamic, and compliance degree were compared between the two groups. Results Through preoperative education,observation group can significantly reduce the occurrence of agitation effectively and keep hemodynamics more stable than control group.Moreover,the compliance degree in two groups also has statistical significance (P<0.05). Conclusion Preoperative education can succeed in reducing the incidence of emergence agitation,inhibiting the responses to endotracheal extubation after suspension laryngoscopic surgery. Thus, preoperative education is feasible to enhance the overall effectiveness of treatment and nursing care. It is worth in popularization and application in clinical practice.