Objective To explore the application effect of ultrasound-assisted localization in spinal anesthesia for elderly patients with hip fractures.Methods A total of 114 elderly patients undergoing hip fracture surgery with spinal anesthesia in our hospital from September 2022 to June 2024 were enrolled.The random number table method was applied to allocate participants into two groups:surface anatomical landmark localization group and ultrasound-assisted localization group,with 57 patients in each group.Both groups of patients underwent spinal anesthesia via the paramedian approach for puncture.The first-attempt puncture success rate,success rate of the initial puncture site,number of skin punctures,number of adjusted epidural needle direction,positioning time of the puncture point,puncture time(puncture success time,anesthesia time,and total time),adverse events during the puncture process(nerve hypersensitivity and accidental puncture of the dura mater),spinal anesthesia related complications(back pain,headache,and nerve injury),patient satisfaction and hospital stay were observed and compared between the two groups.The quality of early postoperative recovery was evaluated by using the 15-Item Quality of Recovery(QOR-15)scale at 24 h after surgery.Results The first-attempt puncture success rate in the ultrasound-assisted localization group was 71.9％(41/57),which was significantly higher than that in the surface anatomical landmark localization group[28.1％(16/57),x2=21.930,P=0.000].The success rate of the initial puncture site in the ultrasound-assisted localization group was 87.7％(50/57),which was significantly higher than that in the surface anatomical landmark localization group[54.4％(31/57),x2=15.396,P=0.000].The number of skin punctures and adjusted epidural needle direction in the ultrasound-assisted localization group were 1(1,1)and 0(0,1)times,while in the surface anatomical landmark localization group were 2(1,3)and 3(0,5)times,with statistically significant differences(all P=0.000).The puncture positioning time in the ultrasound-assisted localization group was 2.2(1.7,3.2)min,which was significantly longer than that in the surface anatomical landmark localization group[0.8(0.5,1.2)min,Z=-8.418,P=0.000].The puncture success time,anesthesia time,and total time of the ultrasound-assisted localization group were 1.9(1.7,2.3),4.9(4.3,5.3),and 7.1(6.3,8.7)min,while of the surface anatomical landmark localization group were 5.1(2.3,8.0),7.9(5.7,11.0),and 8.6(6.6,12.0)min,with statistically significant differences(all P＜0.05).There were no statistically significant differences in the incidence of nerve hypersensitivity during operation(3.5％vs.7.0％,x2=0.176,P=0.675),accidental puncture of the dura mater by epidural needles(0％vs.3.5％,P=0.496),postoperative headache(0％vs.3.5％,P=0.496),and back pain(1.8％vs.10.5％,x2=2.435,P=0.119)between the two groups.Both groups of patients showed no symptoms of nerve injury after surgery.There were no statistically significant differences in QOR-15 scores at 24 h postoperatively[119(115,124)points vs.116(112,121)points,Z=-1.858,P=0.063]and length of hospital stay[10.0(9.0,12.5)dvs.10.0(8.0,13.0)d,Z=-0.043,P=0.966]between the two groups.The satisfaction of patients in the ultrasound-assisted localization group was significantly higher than that in the surface anatomical landmark localization group(P=0.004).Conclusion Application of ultrasound-guided localization in spinal anesthesia for elderly patients with hip fractures significantly improves the first-attempt puncture and initial puncture site success rates,reduces skin puncture attempts and adjustments of the epidural needle direction,shortens time of anesthetic procedure,and enhances patient satisfaction,making it highly recommendable for clinical use.

Objective To explore the application effect of ultrasound-assisted localization in spinal anesthesia for elderly patients with hip fractures.Methods A total of 114 elderly patients undergoing hip fracture surgery with spinal anesthesia in our hospital from September 2022 to June 2024 were enrolled.The random number table method was applied to allocate participants into two groups:surface anatomical landmark localization group and ultrasound-assisted localization group,with 57 patients in each group.Both groups of patients underwent spinal anesthesia via the paramedian approach for puncture.The first-attempt puncture success rate,success rate of the initial puncture site,number of skin punctures,number of adjusted epidural needle direction,positioning time of the puncture point,puncture time(puncture success time,anesthesia time,and total time),adverse events during the puncture process(nerve hypersensitivity and accidental puncture of the dura mater),spinal anesthesia related complications(back pain,headache,and nerve injury),patient satisfaction and hospital stay were observed and compared between the two groups.The quality of early postoperative recovery was evaluated by using the 15-Item Quality of Recovery(QOR-15)scale at 24 h after surgery.Results The first-attempt puncture success rate in the ultrasound-assisted localization group was 71.9％(41/57),which was significantly higher than that in the surface anatomical landmark localization group[28.1％(16/57),x2=21.930,P=0.000].The success rate of the initial puncture site in the ultrasound-assisted localization group was 87.7％(50/57),which was significantly higher than that in the surface anatomical landmark localization group[54.4％(31/57),x2=15.396,P=0.000].The number of skin punctures and adjusted epidural needle direction in the ultrasound-assisted localization group were 1(1,1)and 0(0,1)times,while in the surface anatomical landmark localization group were 2(1,3)and 3(0,5)times,with statistically significant differences(all P=0.000).The puncture positioning time in the ultrasound-assisted localization group was 2.2(1.7,3.2)min,which was significantly longer than that in the surface anatomical landmark localization group[0.8(0.5,1.2)min,Z=-8.418,P=0.000].The puncture success time,anesthesia time,and total time of the ultrasound-assisted localization group were 1.9(1.7,2.3),4.9(4.3,5.3),and 7.1(6.3,8.7)min,while of the surface anatomical landmark localization group were 5.1(2.3,8.0),7.9(5.7,11.0),and 8.6(6.6,12.0)min,with statistically significant differences(all P＜0.05).There were no statistically significant differences in the incidence of nerve hypersensitivity during operation(3.5％vs.7.0％,x2=0.176,P=0.675),accidental puncture of the dura mater by epidural needles(0％vs.3.5％,P=0.496),postoperative headache(0％vs.3.5％,P=0.496),and back pain(1.8％vs.10.5％,x2=2.435,P=0.119)between the two groups.Both groups of patients showed no symptoms of nerve injury after surgery.There were no statistically significant differences in QOR-15 scores at 24 h postoperatively[119(115,124)points vs.116(112,121)points,Z=-1.858,P=0.063]and length of hospital stay[10.0(9.0,12.5)dvs.10.0(8.0,13.0)d,Z=-0.043,P=0.966]between the two groups.The satisfaction of patients in the ultrasound-assisted localization group was significantly higher than that in the surface anatomical landmark localization group(P=0.004).Conclusion Application of ultrasound-guided localization in spinal anesthesia for elderly patients with hip fractures significantly improves the first-attempt puncture and initial puncture site success rates,reduces skin puncture attempts and adjustments of the epidural needle direction,shortens time of anesthetic procedure,and enhances patient satisfaction,making it highly recommendable for clinical use.

Pre-testing preparation is the basis and starting point of genetic testing.The process includes collection of clinical information,formulation of testing scheme,genetic counseling before testing,and completion of informed consent and testing authorization.To effectively identify genetic diseases in clinics can greatly improve the diagnostic rate of next generation sequencing (NGS),thereby reducing medical cost and improving clinical efficacy.The analysis of NGS results relies,to a large extent,on the understanding of genotype-phenotype correlations,therefore it is particularly important to collect and evaluate clinical phenotypes and describe them in uniform standard terms.Different types of genetic diseases or mutations may require specific testing techniques,which can yield twice the result with half the effort.Pre-testing genetic counseling can help patients and their families to understand the significance of relevant genetic testing,formulate individualized testing strategies,and lay a foundation for follow-up.

Objective To observe the analgesic effect of ultrasound guided fascia iliaca compartment block on postural changes in patients with the femoral neck fracture.Methods From January 2017 to November 2017, 60 patients with femoral neck fracture of American Society of Anesthesiologists ( ASA) anesthesia grade Ⅱ -Ⅲundergoing elective surgery in the Hospital of Yanqing District were selected , and they were divided into the ultrasound guided fascia iliaca compartment block group ( F group) and the intravenous dezocine analgesia group ( D group) according to the random number table ,with 30 cases in each group.The F group received ultrasound guided fascia iliaca compartment block with 30 mL 0.45%ropivacaine mesylate,30 min before entering the operating room. The D group received intravenous injection of dezocine 0.1 mg/kg,10 min before entering the operating room.The VAS scores were recorded at entered the operating room ( T1),overing the bed ( T2), the position for intraspinal anesthesia(T3),and the occurrence of adverse reactions were observed.Results The VAS scores of the F group at T1,T2,T3 were lower than those of the D group[(2.07 ±0.52)points vs.(2.90 ±0.80)points,t＝4.77,(2.80 ± 0.61)points vs.(3.83 ±0.59)points,t＝6.66,(3.83 ±0.65)points vs.(5.27 ±0.58)points,t＝9.01],the differ-ences were statistically significant (all P＝0.00).There were no complications such as puncture site hematoma and local anesthetic toxicity in the F group.There were 8 dizziness patients (26.67%) and 4 nausea patients (13.33%) in the D group.Conclusion The analgesic effect of ultrasound guided fascia iliaca compartment block relative to intravenous drug on postural changes in patients with the femoral neck fracture is more obvious and has less adverse reactions,and it is suitable for clinical use.

Objective To observe the application effects of postoperative analgesia of ultrasound -guided transversus abdominis plane ( TAP) block in radical resection of colorectal cancer patients .Methods Fifty patients undergoing radical resection of colorectal cancer in our hospital within nearly two years were divided into two groups,according to number table mehtod ,25 cases in each group.Patients of group A were injected with 0.45%ropivacaine mesylate 20 mL in ultrasound-guided bilateral TAP after the end of surgery before extuba-tion;the patients of group B were injected with the same amount of normal saline in ultrasound -guided bilateral TAP block,Postoperative patient -controlled intravenous analgesia with sufentanil was provided to all patients . The VAS score of two groups after operation record the postoperative dosage of sufentanil in 24h,pressing times of analgesia pump ,the satisfaction of patients with postoperative analgesia and adverse reactions .Results The VAS score of group A(1.08 ±0.86),(1.60 ±0.71),(1.92 ±0.49),(2.28 ±0.61),(2.44 ±0.51)were lower than that of group B(1.88 ±0.73),(2.24 ±0.72),(2.68 ±0.56),(2.96 ±0.54),(3.24 ±0.44).The dos-age of sufentanil in group A(53.20 ±1.39)μg vs.group B(59.18 ±2.82)μg,pressing times of analgesia pump,group A(10.40 ±2.78)vs.group B(22.36 ±5.63),the satisfaction of patients with postoperative analge-sia,group A(9.12 ±0.78)vs.group B(7.52 ±0.77).There were 2 cases of postoperative nausea and vomiting in group B vs 8 cases in group A,The above -mentioned indexes difference had statistical significance except postoperative 4h score.The indicators of respiratory depression in the two groups did not occur .Conclusion The application of postoperative analgesia of ultrasound -guided transversus abdominis plane ( TAP) block in radical resection of colorectal cancer patients ,can reduce postoperative intravenous analgesic drug usage ,decrease the in-cidence of adverse reactions induced by opioid drugs ,and the analgesic effect is more effective with the positioning accuracy ,convenient operation ,less injury ,high safety and suitable for clinical application .

Objective To compare the efficacy of ultrasound -guided bilateral superficial cervical plexus block combined with general anesthesia and single general anesthesia in patients undergoing thyroidectomy.Methods 60 patients with ASAI ~II undergoing thyroidectomy,in accordance with the random number table,were divided into bilateral superficial cervical plexus block combined with general anesthesia group (group A)and single general anesthesia group(group B),30 cases in each group.In group A,the patients were provided ultrasound -guided bilateral superficial cervical plexus block with 0.4% ropivacaine 40 ml(20 mL for each side)before general anesthesia induction.In group B,the patients were directly induced for general anesthesia.The patients of the two groups had the same general anesthesia induction drugs.SBP,DBP and HR were monitored and recorded at the time of pre -anesthesia,skin incision, postoperation and extubation.The cumulative amount of propofol and remifentanil during the operation were recorded. The extubation time was recorded and each patient was assessed 1,2,3,4h after surgery for resting VAS score. Results Blood pressure and heart rate at the different time points during operation were higher than pre -anesthesia significantly in group B[skin incision SBP (134.8 ±8.5)mmHg,the end of operation SBP (123.4 ±5.1)mmHg, tracheal extubation SBP (138.7 ±8.5)mmHg vs preanesthesia SBP (117.3 ±9.8)mmHg,t =7.39,3.02,9.04,all P =0.00;skin incision DBP (86.7 ±7.6)mmHg,the end of operation DBP (80.6 ±7.8)mmHg,tracheal extubation DBP (87.4 ±5.8)mmHg vs preanesthesia DBP (75.6 ±6.6)mmHg,t =6.04,2.68,7.35,all P =0.00;skin incision HR (92.4 ±6.5)times/min,the end of operation HR (86.8 ±6.3)times/min,tracheal extubation HR (96.9 ± 7.2)times/min vs preanesthesia HR (78.9 ±6.8)times/min,t =7.86,4.67,9.96,all P =0.00].The cumulative amount of general anesthesia during operation in group A was less than that in group B,the extubation time in group A was shorter than that in group B[propofol doses of group A (650.6 ±50.3)mg vs group B (762.3 ±43.5)mg,t =9.2,P =0.00;remifentanil doses of group A (0.61 ±0.08)mg vs group B (0.95 ±0.06)mg,t =18.62,P =0.00;extubation time of group A (10.6 ±5.1)min vs group B (15.5 ±5.2)min,t =3.68,P =0.00].The resting VAS score at the different time points after surgery in group A was less than that in group B[the resting VAS score at 1,2, 3,4h after surgery in group A vs group B,(0.99 ±0.81)vs (1.75 ±1.23),t =2.83,P =0.00;(1.23 ±1.02)vs (3.45 ±0.84),t =9.2,P =0.00;(2.80 ±0.85)vs (3.71 ±1.19),t =3.41,P =0.00;(3.11 ±1.02)vs (5.19 ± 1.36),t =6.7,P =0.00],there were statistically significant differences.Conclusion Ultrasound -guided bilateral superficial cervical plexus block combined with general anesthesia used in patients undergoing thyroidectomy can maintain the intraoperative hemodynamic stability effectively,reduce the amount of general anesthetics,shorten the extubation time,and ease the early postoperative pain,the efficacy is significantly better than single general anesthesia.

Objective To observe the clinical effect of dexamethasone combined with dezocine on the ultrasound guided interscalene brachial plexus block.Methods Accordance with the random number table,80 patients with ASAⅠ ~Ⅱ undergoing upper extremity operations were divided into four groups,with 20 cases in each group:group A was treated with 0.45% ropivacaine mesylate 20mL;group B was treated with 0.45% ropivacaine mesylate combined with dexamethasone 0.1mg/kg 20mL;group C was treated with 0.45% ropivacaine mesylate combined with dezocine 0.1mg/kg 20mL;group D was treated with 0.45% ropivacaine mesylate combined with dexamethasone 0.1mg/kg and dezocine 0.1mg/kg 20mL.The onset time,maximum block time,analgesia duration and the incidence of adverse reactions were recorded in the four groups.Results The onset time of group C and group D were faster than group A and group B[group C(3.65 ±0.88)min vs.group A(5.60 ±0.88)min,group B(5.35 ±0.81)min,t =7.303, 6.367,all P =0.000;group D(3.30 ±0.80)min vs.group A,group B,t =8.614,7.678,all P =0.000],the maximum block time of group C and group D were faster than those of group A and group B[group C(8.45 ±1.19)min vs. group A(12.75 ±2.05)min,group B(12.65 ±1.90)min,t =8.583,8.383,all P =0.000;group D(7.80 ±0.89)min vs.group A,group B,t =9.880,9.680,all P =0.000].The analgesia duration of the other groups were longer than those of group A[group B(430.50 ±30.86)min,group C(435.00 ±38.46)min,group D(534.50 ±46.73)min vs. group A(314.50 ±33.32)min,t =9.696,10.072,18.388,all P =0.000],group D was the best(group D vs.group B,group C,t =8.693,8.317,all P =0.000),there were no significant differences between group B and group C (group C vs.group B,t =0.376,P =0.708).In the 80 patients,only one case of group C had postoperative nausea and vomiting symptoms,there were no significant differences between the groups(all P >0.05).Conclusion Dexa-methasone combined with dezocine on the ultrasound guided interscalene brachial plexus block is a method with faster onset time,shorter maximum block time,longer analgesia duration,and it has less adverse reactions and better anesthetic effect,and it is more suitable for upper extremity operations.

Objective To explore the application value of three-dimensional visualization technology in associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). Methods Clinical data of one patient with hepatocellular carcinoma (HCC) undergoing ALPPS using three-dimensional visualization technology were analyzed retrospectively. The patient was female, aged 44 years, was hospitalized due to transaminase elevation for 3 months and solid hepatic lesion for 3 d. She had a history of hepatitis B. She was diagnosed with massive HCC in the right liver lobe. The informed consents of the patient was obtained and the local ethical committee approval was received. Preoperative evaluation and surgical planning were performed using computer tomography (CT) scan and medical imaging three-dimensional visualization system (MI-3DVS). Results Total liver volume was 1 033 ml and the left lobe volume was 195 ml, accounting for 16%of the standard liver volume measured by three-dimensional visualization technology before the ifrst-stage surgery. The right branch of portal vein was ligated and the left and right liver lobes were separated. Total liver volume was 1 048 ml and the left lobe volume was 394 ml, accounting for 33%of the standard liver volume measured by three-dimensional visualization technology 3 weeks after surgery. Right hemihepatectomy was performed during the second stage. The ifndings of preoperative three-dimensional visualization technology were consistent with intraoperative observation. Preoperative surgical planning was in accordance with intraoperative procedures. No apparent complication was observed after surgery. Conclusion Three-dimensional visualization technology is a favorable supplementary option for ALPPS in making the preoperative precise diagnosis and detailed surgical planning.