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 探讨超声引导下宫颈癌根治术的应用效果及对患者远期生存率的影响。方法 选取本院2015年1月—2017年12月共收治的70例宫颈癌患者作为研究对象,将2016年7月—2017年12月纳入的患者作为观察组,2015年1月—2016年6月纳入的患者作为对照组,各35例,给予对照组患者常规腹腔镜根治术,给予观察组患者超声引导定位下腹腔镜宫颈癌根治术联合高强度凝聚超声热凝技术治疗。对比两组患者的治疗效果、远期生存率与复发率以及术后6个月、1年、2年、3年的FACT-G评分情况。结果 两组疾病控制率对比无差异(97.14% vs 85.71%,P＞0.05);观察组的治疗总有效率为高于对照组的(85.71% vs 60.00%,P＜0.05);观察组和对照组患者1年生存率对比无差异(P＞0.05),观察组2年、3年生存率高于对照组(P＜0.05),观察组和对照组1年局部复发率对比无差异(P＞0.05),观察组的2年、3年局部复发率低于对照组(P＜0.05);观察组术后6个月、1年、2年、3年的FACT-G评分高于对照组(P＜0.05)。结论 应用超声引导定位下腹腔镜宫颈癌根治术联合高强度凝聚超声热凝技术治疗宫颈癌能够提升患者的治疗效果,减少疾病复发和提高远期生存率,提升患者的生存质量,值得临床应用推广。

Objective To investigate the application effect of ultrasound-guided radical hysterectomy for cervical cancer and its influence on the long-term survival rate of patients. Methods A total of 70 patients with cervical cancer admitted from January 2015 to December 2017 were selected as the research subjects, and the patients enrolled from July 2016 to December 2017 were selected as the observation group, patients from January 2015 to June 2016 as the control group, each with 35 cases. The control group was given conventional laparoscopic radical hysterectomy, and the observation group was given ultrasound-guided laparoscopic radical hysterectomy combined with high-intensity ultrasound coagulation technology. The treatment effect, long-term survival rate, recurrence rate and FACT-G scores 6 months, 1 year, 2 years and 3 years after operation were compared between the two groups. Results There were no significant differences in disease control rates between the two groups (97.14% vs 85.71%, P>0.05); the total effective rate of treatment in the observation group was higher than that in the control group (85.71% vs 60.00%, P<0.05). There was no significant difference in the 1-year survival rate between the observation and the control group (P>0.05). The 2-year and 3-year survival rate of the observation group were higher than that of the control group (P<0.05). There was no significant difference in comparison of 1-year local recurrence rate between the observation group and the control group (P>0.05). The 2-year and 3-year local recurrence rate of the observation group were lower than that of the control group (P<0.05). FACT-G scores in the observation group after surgery at 6 months, 1 year, 2 years, and 3 years were significantly higher than the control group (P<0.05). Conclusion The application of ultrasound-guided laparoscopic radical hysterectomy combined with high-intensity ultrasound coagulation in the treatment of cervical cancer can improve the treatment effect, reduce disease recurrence rate, increase long-term survival rate, and improve the quality of life of patients, which is worthy of clinical application and promotion.

目的 探讨配偶参与式护理对腹腔镜保留盆腔自主神经子宫切除术年轻患者功能恢复的影响效果。方法 按时间先后将96例患者分为实验组50例和对照组46例,对照组按常规护理,实验组采用先培训配偶,然后让配偶与护士共同对患者实施整体护理,6个月后测试患者膀胱和性功能恢复情况。结果 实验组术后7天膀胱功能恢复41例,尿管留置时间为(10.8±2.1),术后6个月FSFI评分为(29.11±3.65),均优于对照组,两组比较差异均有统计学意义(P＜0.05)。结论 配偶参与式护理可使腹腔镜保留盆腔自主神经子宫切除术年轻患者得到更多专业的照顾,利于术后膀胱功能和性功能的恢复。

Objective To evaluate the influence of spouse participatory nursing on functional recovery of young patients who experienced laparoscopic nerve-sparing radical hysterectomy. Methods 96 patients were divided into the experiment group (50 patients) and the control group (46 patients) according to the timeline. The control group accepted normal nursing while the experiment group accepted the method that the spouse was provided with training first and then nurses provided overall nursing to the patient along with the spouse. Six months later, patients' recovery of bladder and sexual function were assessed. Results In the experimental group, 41 patients' bladder function recovered in seven days after the surgery, and the catheter retention time was(10.8±2.1); the FSFI score was (29.11±3.65)in six months after the surgery, and the score was better than that in the control group. The differences between both groups had statistical significance (P<0.05). Conclusion Spouse participatory nursing can provide more professional care to young patients who experienced laparoscopic nerve-sparing radical hysterectomy, therefore help to recover bladder and sexual function.

目的 探讨快速康复外科理念对降低子宫全切术后患者下肢深静脉血栓形成的应用效果。方法 采用方便抽样的方法,将185例子宫全切术后患者分为观察组(95例)和对照组(90例)。观察组实施快速康复外科护理路径,对照组实施常规护理路径。结果 两组患者术后的下肢深静脉血栓发生率、D-二聚体水平、日常生活活动能力评分的比较差异均有统计学意义(P<0.05);观察组下肢深静脉血栓形成的发生率和D-二聚体水平低于对照组(P<0. 01),观察组日常生活活动能力评分低于对照组(P<0.05)。结论 快速康复外科理念应用于子宫全切术后患者,可降低患者下肢深静脉血栓的发生率,提高患者自理能力,使患者尽快恢复健康水平。

Objective To explore the effect of fast-track surgery on the treatment of lower extremity deep venous thrombosis in patients after total hysterectomy. Methods A total of 185 patients with hysterectomy were divided into observation group(n=95) and control group (n=90) randomly. The observation group implemented a rapid rehabilitation surgical care path, and the control group implemented routine nursing path. Results There were significant differences in the incidence of deep venous thrombosis, D-dimer level and daily living activity score between the two groups (P<0.05). The incidence of deep venous thrombosis and the level of D-dimer in the lower extremity of the observation group were significantly lower than those in the control group (P<0.01). The score of the daily living activity was lower in the observation group than that of control group (P<0.05). Conclusion Fast-track surgery for patients after total hysterectomy could reduce the incidence of postoperative deep venous thrombosis and improve the self-care abilities of patients, so that patients may return to health as soon as possible.

目的 研究右旋美托咪啶联合低浓度罗哌卡因腹横肌膜神经阻滞在老年患者阴式子宫切除术中应用的有效性及安全性。方法 选择择期行阴式子宫切除术患者40例(ASA Ⅰ～Ⅱ级),随机分成两组,选择硬腰联合麻醉下手术,麻醉平面固定后以超声引导给予患者双侧腹横肌膜神经阻滞,Ⅰ组患者选用0.5 μg/kg右旋美托咪啶+0.2%罗哌卡因,每侧20 mL,Ⅱ组以相同方法给予同量生理盐水。记录麻醉前(T₀)、麻醉平面确定后(T₁)、手术开始(T₂)、牵拉子宫(T₃)、术毕(T₄)患者的HR、MAP、SpO₂及NTI评分;评价并记录牵拉反应、术后认知功能障碍及谵妄的发生及患者舒适度及满意度。结果 两组患者一般情况无显著性差异(P>0.05);与I组相比,Ⅱ组HR在T₃时刻有显著性降低,差异有统计学意义(P<0.05),牵拉反应评价Ⅰ组评为优的患者个数明显多于Ⅱ组,差异有统计学意义(P<0.05);Ⅰ组舒适度及满意度评定为优的患者个数明显多于Ⅱ组,差异有统计学意义(P<0.05)。结论 右旋美托咪啶联合低浓度罗哌卡因腹横肌膜神经阻滞在老年患者阴式子宫切除术中应用是安全有效的。

Objective To observe the effectiveness and safety of ultrasound-guided subcostal transverses abdominis plane block with dexmedetomidine and low-concentration ropivacaine in elder vaginal hysterectomy. Methods Forty scheduled for vaginal hysterectomy (ASAⅠ～Ⅱ)were randomly assigned to 2 groups. All patients received spinal anesthesia, and ultrasound-guided subcostal transverses abdominis plane block then, Group Ⅰ: 0.5 μg/kg dexmedetomidine and 0.2% ropivacaine 20 mL for each side, and saline was used for Group Ⅱ. HR、MAP SpO₂ and NTI scale were recorded at the time points of pre-anesthesia(T₀), confirmation of anesthesia plane (T₁), beginning of surgery (T₂), pulling uterus (T₃), surgery end(T₄). Effect of dragging reaction, POCD and delirious and degree of comfort and degree of satisfaction of patients were valuated. Results The general condition did not differ between the two groups(P>0.05). Compared to Group Ⅰ, HR of Group Ⅱ at the time point of T3 was significant lower(P<0.05), number of patients with excellent dragging reaction of Group Ⅰ was significant higher (P<0.05)and patients of Group Ⅰ were more comfortable and satisfied than patinents of Group Ⅱ(P<0.05). Conclusion Ultrasound-guided subcostal transverses abdominis plane block with dexmedetomidine and low-concentration ropivacaine is effective and safe for vaginal hysterectomy in elderly female.

目的 研究地佐辛复合丙泊酚对腹式子宫切除术牵拉反应的预防作用。方法 选择择期行腹式子宫切除术患者60例(ASA I ~Ⅱ级),随机分成三组。所有患者给予腰麻,麻醉平面调节并固定于T₆后,给予A组患者0.1 mg/kg地佐辛,静脉注射;B组静脉注射0.1 mg/kg地佐辛后丙泊酚持续泵注2~4 mg/(kg·h);C组单次静注丙泊酚1.5 mg/kg后持续泵注2~4mg/(kg·h)。记录麻醉前(T₀)、腰麻平面固定后(T₁)、静注药物后5min(T₂)、切皮(T₃)、牵拉子宫时(T₄)、术毕(T₅)患者的HR、MAP及Ramesay镇静评分;评价肌松效果、牵拉反应、患者舒适度及满意度。结果 三组患者一般情况无差异(P＞0.05);与T₀相比,Ⅲ组T₂及T₅时刻MAP与T₀相比差异有统计学意义(P＜0.05),T₂、 T₃ 、T₄及T₅时刻HR与T₀相比差异有统计学意义(P＜0.05);与T₀相比,Ⅱ组及Ⅲ组Ramesay镇静评分在T₂、 T₃及T₄时刻均升高,差异有统计学意义(P＜0.05);Ⅱ组及Ⅲ组Ramesay镇静评分在T₂、T₃及T₄时刻高于I组,差异有统计学意义(P＜0.05)。牵拉反应评价I组评为优的患者个数明显少于II组及III组,评为良及差的患者个数多于II组及III组,此差异有统计学意义(P＜0.05);II组及III组舒适度及满意度评定为优的患者个数明显多余I组,差异有统计学意义(P＜0.05)。结论 0.1 mg/kg地佐辛复合丙泊酚可以很好预防腹式子宫切除手术中的牵拉反应,提高患者舒适度和满意度。

Objective To observe whether dezocine combined with propofol can prevent intra operative dragging reaction during hysterectomy or not. Methods Sixty patients(ASAⅠ~Ⅱ)which through hysterectomy surgery were randomly arranged to 3 groups. All the patients were under spinal anesthesia, adjusted the anesthesia plane to T6. Group l: dezocine 0.1 mg/kg were intravenous injected, Group ll: dezocine 0.1 mg/kg were intravenous injected and then propofol 2~4 mg/kg/h were intravenous pumped, Group lll: propofol 1.5 mg/kg were intravenous injected and then propofol 2~4 mg/kg/h intravenous were pumped. HR、MAP and Ramesay scale were recorded at the time points of pre-anesthesia(T₀)、pre-injection(T₁)、5 min after injection(T₂)、skin incision(T₃)、dragging uterus(T₄)、after surgery(T₅),the effect of muscle relaxation and the reaction of patients were recorded in the mean time, comfort degree and satisfaction degree of patients were evaluated after surgery. Results There was no significant difference of general condition between the three groups (P>0.05). At the time point of T₂ and T₅, MAP of Group lll patients were significant lower than the base value(P<0.05). At the time point of T₂、T₃、T₄ and T₅, HR of Group lll patients were significant lower then base value(P<0.05). Dragging reaction during the surgery were significant reduced in Group ll and Group lll but not in Group l(P<0.05). Group ll and Group lll patients felt more comfortable and more satisfied than Group l patients(P<0.05). Conclusion 0.1 mg/kg dezocine combined with propofol can prevent intra operative dragging reaction and make patient feel more comfortable during hysterectomy.