Objective To compare the effect of dexmedetomidine combined with butorphanol to prevent the adverse effects of carboprost tromethamine druing cesarean delivery.Methods Ninety parturients with the risk factor of uterine atony,aged 24-40 years,weighting 55-85 kg,ASA physical status Ⅰ or Ⅱ,undergoing full term cesarean section,were randomly divided into dexmedetomidine combined with butorphanol group (group DB,n=30),butorphanol group (group B,n=30)and control group (group N,n=30).Three groups were intravenously injected corresponding drugs of carboprost tromethamine into uterus.Group DB was given intravenous injection dexmedetomidine 1 μg/kg combined with butorphanol 20 mg/kg.Group B was given butorphanol 20 mg/kg.Group N was given 0.9% sodium chloride solution.MAP,HR,and SpO2were recorded at different times,10 min after go into operation room (T0),10 min after carboprost tromethamine into uterus (T1),end of operation (T2).Ramsay sedation score was recorded at T1.The adverse effects of carboprost tromethamine were recorded.The initial time of lactation after operation was recorded.The initial time of lactation after operation,the height of uterine fundus at 1,3,5 d after operation,the oxyto-cin doses within 72 h after operation were recorded.Results Compared with group N,the MAP and HR of group DB and group B decreased obviously at T1(P<0.05),and group DB was lower than group B obviously at T1(P<0.05).Compared with group N,the scores of Ramsay in group DB and group B were significantly higher (P<0.05),group DB was higher than that of group B(P<0.05). Compared with group N,the incidence of nausea,vomiting,chest tightness,chest pain,hyperten-sion,tachycardia and chills in group B and group DB were significantly lower (P<0.05),and group DB was lower than that of group B (P<0.05).There were no significant differences of the initial time of lactation after operation,height of uterine fundus at 1,3,5 d after operation,the oxytoxin doses within 72 h after operation between the three groups.Conclusion Dexmedetomidine combined with butorphanol can effectively reduce the adverse effects of carboprost tromethamine druing cesarean delivery,the more stable hemodynamics and sedative effect,the effect is better than the sin-gle application of butorphanol,at the same time does not affect lactation,it is safe and effective for clinical use.

Objective To investigate the effect of dexmedetomidine combined with sufentanil on postoper-ative analgesia in patients undergoing thoracoscopic lobectomy. Methods Sixty patients undergoing thoracoscopic lobectomy were randomly divided into the dexmedetomidine group(DS group)and the control group(S group). The two groups were treated with PCIA.The Group DS:dexmedetomidine 2 μg/kg+sufentanil 1.5 μg/kg+ondan-setron 8 mg;and the group S:sufentanil 2 μg/kg+ondansetron 8 mg,in which all drugs were dissolved in 100 mL 0.9 normal saline. Parameters:loading dose 2 mL;infusion speed 2 mL/h;PCA dosage 2 mL each time;lock time:15 min. The mean arterial pressure(MAP),heart rate(HR),resting(VASR)and cough(VASC)VAS score,and Ramsay sedation score were recorded at 2,6,12,24,36 and 48 h after surgery.The number of press analgesic pump,the amount of sufentanil used,the incidence of adverse reactions such as,the nausea and vomit-ing,respiratory depression,bradycardia and so on were recorded within 48 h after operation. Results Compared with the group S,the MAP and HR of patients in the group DS decreased significantly at each time(P < 0.05), the scores of VASR and VASC decreased obviously at 6,12,24 h after surgery(P<0.05),the number of press analgesic pump,the amount of sufentanil used,the incidence of nausea and vomiting decreased obviously within 48 h after operation(P<0.05).Conclusions Dexmedetomidine combined sufentanil administration in PCIA after thoracoscopic lobectomy can obtain satisfactory analgesic effect and more stable hemodynamics,and reduce the dosage of sufentanil,the incidence of nausea and vomiting.

Objective To compare the postoperative analgesic effect between serratus plane block and thoracic paravertebral block in patients undergoing thoracoscopic surgery.Methods Sixty patients undergoing thoracoscopic surgery, 38 males and 22 females, aged 18-65, BMI 18-25 kg/m2, falling into ASA physical status I or II.They were divided into groups S and T by random number table, 30 cases in each group.Two groups of patients were treated with general anesthesia with endobronchial intubation and PCIA after operation.Group S performed Ultrasound-guided serratus plane block and group T performed thoracic paravertebral block, 0.4％ropivacaine 30 ml were used in the two groups.The two groups of patients were observed 30 min after block, and the sensory block plane was measured with acupuncture and recorded.Recording operation time, onset time and duration of the block.Resting and cough VAS score were recorded at 2, 4, 8, 12, 24, and 48 hafter surgery.The first pressing time of the analgesic pump and times of press analgesic pump, the amount of sufentanil used and times the number of cases of useing piperidine were recorded within 48 hafter operation.Block related complications and analgesic related adverse reactions were recorded.Results Compared with group T, the operation time of the block obviously shortening but the duration obviously lengthening (P<0.01).Resting and cough VAS score at 12 hafter surgery significantly was lower (P<0.01).The first pressing time of the analgesic pump obviously lengthening, the number of press analgesic pump and the amount of sufentanil used significantly were reduced (P<0.01) in group S.Conclusion Ultrasound guided SP block and TPVB block can provide good postoperative analgesia for patients undergoing thoracoscopic surgery, but SP block is more durable, with less operation time and complications than TPVB block, and can effectively reduce the opioid demand and incidence of nausea and vomiting after operation.