目的 观察普瑞巴林联合甲钴胺对腰椎手术术后急性疼痛的影响。方法 按照纳入排除标准选择2019年1月—2019年12月在我院行单一节段的腰椎手术患者共60例,缝皮时常规予0.375%罗哌卡因20 mL切口周围浸润,术后使用病人静脉自控镇痛(Patient-Controlled Intravenous Analgesia, PCIA)。患者随机分为2组,实验组:术前1天开始口服普瑞巴林75 mg bid和静脉注射甲钴胺注射液 0.5 mg qd,共5天;对照组:术前1天开始口服普瑞巴林 75 mg bid和注射等体积的生理盐水,共5天。观察术前和术后6、12、24、48 h的VAS评分,在术前、术后24 h和术后48 h进行JOA评分,记录术后24 h和48 h阿片类药物用量、PCIA按压次数、补救用药量和不良反应。结果 两组患者术后12 h内的VAS评分无差异,但是在12～48 h这段时间里实验组的静息VAS和运动VAS评分均低于对照组(P<0.05)。实验组在术后24 h和48 h舒芬太尼消耗量、PCIA按压次数和平均补救用药剂量少于对照组(P<0.05),两组患者的JOA评分和不良反应均无差异(P>0.05)。结论 普瑞巴林联合甲钴胺应用于腰椎手术患者术后镇痛效果良好,药物不良反应发生率低,但仍需进行更大规模的随机对照研究证实该镇痛方案的安全性和有效性。

Objective To observe the effect of pregabalin combined with mecobalamin on acute pain after lumbar surgery. Methods A total of 60 patients underwent single lumbar spine surgery in our hospital from January 2019 to December 2019. The incisions of patients were routinely infiltrated around the incision with 0.375% ropivacaine 20 mL. Patient-controlled intravenous analgesia (PCIA) was used. The patients were randomly divided into two groups. The experimental group: oral pregabalin 75mg bid and intravenous mecobalamin injection 0.5mg qd 1 day before surgery, five days in total. Control group: oral pregabalin 75mg bid and intravenous injection of equal volume of saline 1 day before surgery, five days in total. The VAS scores of preoperative and postoperative 6, 12, 24, and 48 h were observed. JOA scores were performed before surgery, 24 h after surgery, and 48 h after surgery. The doses of opioids, PCIA pressing times, remedial medications and adverse reactions were recorded at 24 h and 48 h after surgery. Results There was no significant difference in VAS scores between the two groups within 12 h after surgery, but the resting VAS and exercise VAS scores in the experimental group were lower than those in the control group during the period of 12～48 h (P<0.05). The amount of sufentanil, the pressing times of PCIA and the average remedial medication in the experimental group were lower than those in the control group at 24 h and 48 h after operation (P<0.05). There were no significant differences in JOA scores and adverse reactions between the two groups (P>0.05). Conclusion Pregabalin combined with mecobalamin in patients with lumbar spine surgery has good postoperative analgesia and low incidence of adverse drug reactions, but more randomized controlled trials are needed to confirm the safety and efficacy.

目的 观察肺保护性通气策略对肺功能不全胃肠手术患者术后转归影响。方法 选取2016年4月—2017年3月期间我院收治的90例肺功能不全胃肠手术患者作为研究对象,根据随机数字表将患者随机分为观察组和对照组,每组各45例。对照组采用传统机械通气方式,观察组采用肺保护性通气方式。观察两组患者动脉血气指标、自主呼吸恢复时间、清醒时间、拔管时间、PACU观察时间及住院期间术后肺部并发症发生情况。结果 两组患者麻醉时间、手术时间、晶胶液输入情况、麻醉药物用量差异无统计学意义（P>0.05）。观察组患者术后PaO₂高于对照组,差异有统计学意义（P<0.05）。两组患者自主呼吸恢复时间、清醒时间、拔管时间、PACU观察时间比较,差异均无统计学意义（P>0.05）。观察组患者住院期间PPCs发生率低于对照组,差异有统计学意义（P<0.05）。结论 肺保护性通气策略可有效改善肺功能不全胃肠手术患者术后氧合,降低患者住院期间PPCs发生率,对于患者术后转归具有积极的作用。

Objective To observe the effect of lung protective ventilation strategy on postoperative outcome of patients with pulmonary insufficiency of gastrointestinal surgery. Methods 90 patients with pulmonary insufficiency gastrointestinal surgery in our hospital from April 2016 to March 2017 were selected as study subjects. According to the random number table,patients were randomly divided into observation group and control group,with 45 cases in each group. The control group used traditional mechanical ventilation,and the observation group used lung protective ventilation. Arterial blood gas parameters,spontaneous breathing recovery time,awakening time,extubation time,PACU observation time and postoperative pulmonary complications in both groups were observed. Results There was no significant difference in anesthesia time,operation time,crystal glue fluid input,and anesthetic drug dosage between the two groups （P>0.05）. The postoperative PaO₂ was higher in the observation group than in the control group （P<0.05）. There was no significant difference between the two groups in spontaneous breathing recovery time,awakening time,extubation time,and PACU observation time （P>0.05）. The incidence of PPCs was lower in the observation group than that in the control group,and the difference was statistical difference （P<0.05）. Conclusion Lung protective ventilation strategy may effectively improve postoperative oxygenation in patients with pulmonary insufficiency and gastrointestinal surgery,reduce the incidence of PPCs during hospitalization,and have a positive effect on postoperative outcome.