Objective To observe the influence of the oxidative stress reaction in elderly patients with lobectomy under epidural blockade combined with either propofol or sevoflurane.Methods Sixty elderly patients with lobectomy were enrolled in this study,ASA Ⅰ-Ⅲ grade.The patients were divided into propofol combined with epidural blockade group (group P,30 patients) and sevoflurane combined with epidural blockade group (group S,30 patients) by random digits table method.The depth of anesthesia in group P was kept by 40-50 μ g/ (kg ·min) propofol and in group S was kept by 1％-2％ sevoflurane continuous inhalation.The level of malondialdehyde (MDA),nitric oxide (NO),superoxide dismutase (SOD),glutathione peroxidase (GSH-Px) in two groups before surgery (T0),one lung ventilation (T1),2 h during surgery (T2),surgery end (T3),2 h postoperatively (T4) and 24 h postoperatively (T5) in venous blood were detected and compared.Results The level of systolic blood pressure (SBP),diastolic blood pressure (DBP) and heart rate (HR) at T2 was significantly decreased compared with T0 in two groups (P ＜ 0.05).The level of SBP,DBP and HR at every point had no significant difference between two groups (P ＞ 0.05).The level of NO and MDA were increased at T1,T2 in group P and T1-T5 in group S compared with T0,the level of SOD and GSH-Px at T1-T5 in group S were decreased compared with T0,there were significant differences (P ＜0.05).The level of NO and MDA at T3-T5 were decreased and the level of SOD and GSH-Px were increased in group P compared with those in group S,there were significant differences (P ＜0.05).Conclusion Propofol can reduce the oxidative stress reaction more effectively comparing with sevoflurane,and has some help on the prognosis of the elderly.

Objective:To assess the clinical efficacy and safety of ultrasound-guided brachial plexus block combined with superficial cervical plexus block during the internal fixation of clavicle fractures.Methods:A prospective randomized controlled study was conducted on 100 patients suffering from clavicular fractures who underwent open reduction and internal fixation at Yiwu Central Hospital between June 2019 and March 2022. Using a random number table method, the patients were divided into two groups: a conventional group ( n = 50) and an ultrasound-guided group ( n = 50). The conventional group received blind brachial plexus block combined with superficial cervical plexus block, while the ultrasound-guided group received brachial plexus block combined with superficial cervical plexus block under ultrasound guidance. The anesthesia indices of the patients were recorded, intraoperative vital signs were monitored, the anesthesia effect was evaluated, and adverse reactions to anesthesia were observed. Results:There were no significant differences in general data between the two groups, including age, sex, and ASA grading ( P > 0.05). The duration of anesthesia operation and the onset time of nerve block in the ultrasound-guided group [(5.70 ± 0.79) minutes and (7.28 ± 0.90) minutes] were significantly shorter compared with the conventional group [(12.18 ± 1.03) minutes and (14.55 ± 1.17) minutes, t = 18.92, 21.63, both P < 0.001]. However, the duration of nerve block in the ultrasound-guided group was (417.84 ± 13.88) minutes, which was significantly longer than that in the conventional group [(361.47 ± 12.19) minutes, t = 16.37, P < 0.001]. Additionally, the mean arterial pressure and heart rate in the ultrasound-guided group [(103.36 ± 2.22) mmHg (1 mmHg = 0.133 kPa), (103.02 ± 2.26) mmHg, (76.66 ± 4.51) beats/minute and (75.94 ± 4.34) beats/minute] were significantly lower compared with the conventional group [(103.36 ± 2.22) mmHg, (103.02 ± 2.26) mmHg, (76.66 ± 4.51) beats/minute, and (75.94 ± 4.34) beats/minute, t = 6.83, 5.52, 6.27, 4.96, all P < 0.001]. Furthermore, the effective rate of anesthesia in the ultrasound-guided group was 94.00% (47/50), which was significantly higher than that in the conventional group [76.00% (38/50), χ2 = 6.35, P < 0.05]. The overall incidence of adverse reactions to anesthesia in the ultrasound-guided group was 4.00% (2/50), which was significantly lower than that in the conventional group [20.00% (10/50), χ2 = 6.06, P < 0.05]. Conclusion:Ultrasound-guided brachial plexus block combined with superficial cervical plexus block for internal fixation of clavicular fractures can effectively shorten the onset time of anesthesia, minimize fluctuations in patients' intraoperative vital signs, improve the efficiency of anesthesia, and reduce the risk of adverse reactions.