Objective To compare the effects of four different analgesic techniques on hyperglycemia and stress response to abdominal hysterectomy so as to select a more reasonable analgesic model. Methods Forty-eight patients were randomly divided into four groups: groupⅠreceived 0.2% ropivacaine+fentanyl 2 ?g/mL+ 0.008% ondansetron for PCEA; groupⅡreceived fentanyl 8 ?g/mL+ 0.008% ondansetron for PCIA; groupⅢ received 0.2% ropivacaince+tramadol 2 mg/mL+0.008% ondansetron for PCEA and groupⅥ received tramadol 8 mg/mL+ 0.008% ondansetron for PCIA. The four groups all included loading dose of 5 mL, bolus of 1mL with lock time of 10 minutes and background 1 mL/h. The level of blood glucose, insulin and cortisol were observed at five points: before anesthesia, at 2nd hour, 24th hour, 48th hour and 72th hour after the end of surgery. Results All the four analgesic techniques produced satisfactory pain relieve. Hyperglycemia was inhibited more efficiently in groupⅠand group Ⅲ than in groupⅡ and groupⅥ(P

Objective:To investigate the clinical efficacy, safety and tolerance of different enteral nutritional therapy in the treatment of moderately severe acute pancreatitis (MSAP).Methods:From January 2018 to January 2019, 65 patients with MSAP who were hospitalized in Beijing Chao-Yang Hospital, Capital Medical University were prospectively enrolled. According to random number table, the patients were divided into the nasogastric tube enteral nutrition (NGEN) group (35 cases) and the nasojejunal tube enteral nutrition (NJEN) group (30 cases). All the patients received enteral nutrition solution through continuously pumping at a constant speed for 24 h. The two groups were compared in the relief time of abdominal pain, time from admission to receiving enteral nutrition treatment, time to resume oral feeding, computed tomography severity index (CTSI) score 1 week after enteral nutrition, nutrition status, infection parameters, hospitalization time, hospitalization expenses and complications. Independent sample t test and rank sum test of two independent samples were used for statistical analysis. Results:There were no significant differences in age, gender, body mass index (BMI), CTSI score and Ranson score at admission, relief time of abdominal pain, time from admission to receiving enteral nutrition treatment, time to resume oral feeding, CTSI score one week after enteral nutrition or hospitalization time between NGEN group and NJEN group (all P>0.05), and there was no death in both groups. The cost of hospitalization, catheterization time, cost of catheterization of NGEN group were all lower than those of NJEN group ((40.0±10.0) thousand yuan vs. (40.4±9.0) thousand yuan; 2.00 min (1.50 min, 2.50 min) vs. 11.50 min (9.50 min, 12.75 min); 135.42 yuan (135.42 yuan, 135.42 yuan) vs. 1 313.30 yuan (1231.20 yuan, 1 823.72 yuan)), and the differences were statistically significant ( t=2.342, Z=6.737 and 7.687, all P<0.01). The albumin levels of MSAP patients of the NGEN group at admission and 1 week after enteral nutrition were both higher than those of NJEN group ((43.5±5.1) g/L vs. (41.0±4.0) g/L, (42.1±4.1) g/L vs. (39.5±4.4) g/L), and the differences were statistically significant ( t=2.135 and 2.486, P=0.04 and 0.02), however there was no statistically significant difference in the decrease of albumin level between the two groups ( P>0.05). There were no statistically significant differences in the incidence of nutrition-related complications (abdominal distension, diarrhea, gastric retention and lumen obstruction) or the incidence of severe complications (transient organ failure and pancreatic necrosis complicated with infection) between NGEN group and NJEN group (all P>0.05). Conclusions:The efficacy and safety of NGEN are equivalent to NJEN in MSAP. Moreover, it can reduce the medical expenses of patients, and it is convenient to carry out in primary hospitals because of its easy operation.