目的:观察超声引导下胸椎旁神经阻滞联合全身麻醉在腹腔镜胆囊切除术(LC)患者中的应用效果。方法:回顾性分析2022年2月至2023年3月于该院行LC的86例患者的临床资料,按照麻醉方案不同将其分为研究组和对照组各43例。对照组实施全身麻醉,...目的:观察超声引导下胸椎旁神经阻滞联合全身麻醉在腹腔镜胆囊切除术(LC)患者中的应用效果。方法:回顾性分析2022年2月至2023年3月于该院行LC的86例患者的临床资料,按照麻醉方案不同将其分为研究组和对照组各43例。对照组实施全身麻醉,研究组在对照组基础上联合超声引导下胸椎旁神经阻滞。比较两组镇痛泵按压次数,不同时间[麻醉前(T_(0))、麻醉后20 min(T_(1))、拔管时(T_(2))]血流动力学指标[心率、平均动脉压(MAP)]水平,术后不同时间疼痛[视觉模拟评分法(VAS)]评分,手术前后应激指标[皮质醇(Cor)、去甲肾上腺素(NE)]水平,以及不良反应发生率。结果:研究组镇痛泵按压次数少于对照组,差异有统计学意义(P<0.05);T_(1)、T_(2)时,研究组心率、MAP水平均高于对照组,差异有统计学意义(P<0.05);研究组术后1、3、6 h VAS评分均低于对照组,差异有统计学意义(P<0.05);术后1 d,研究组Cor、NE水平均低于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:超声引导下胸椎旁神经阻滞联合全身麻醉应用于LC患者可减少镇痛泵按压次数,稳定血流动力学指标水平,降低术后疼痛评分和应激指标水平,效果优于单纯全身麻醉。展开更多
本文报道一例乳腺化生性癌伴BRCA1基因突变患者的临床资料。患者为26岁女性,因“发现左乳腺结节1月”入院,彩超示左乳分叶状低回声结节,形态不规则,内未探及血流信号。行乳腺区段切除术,术后病理提示形态学结合免疫组化符合伴间叶分化...本文报道一例乳腺化生性癌伴BRCA1基因突变患者的临床资料。患者为26岁女性,因“发现左乳腺结节1月”入院,彩超示左乳分叶状低回声结节,形态不规则,内未探及血流信号。行乳腺区段切除术,术后病理提示形态学结合免疫组化符合伴间叶分化的化生性癌,癌细胞ER(−)、PR(−)、Her-2(0),BRCA1基因突变检测结果:c.192T > G (p.C64W),突变类型为4类–疑似有害变异,术后予AC-T方案化疗6个周期,序贯奥拉帕尼使用1年,目前随访25个月,无局部复发和远处转移。This paper reports the clinical data of a case of breast metaplastic carcinoma with BRCA1 gene mutation. The patient was a 26-year-old woman who was admitted to the hospital with a left breast nodule that had been detected for one month. Ultrasound showed a lobulated hypoechoic nodule in the left breast with an irregular morphology, and no blood flow signals were detected in it. We performed segmental mastectomy for the patient, and postoperative pathology suggested that the morphology combined with immunohistochemistry was consistent with a metaplastic carcinoma with mesenchymal differentiation, and the cancer cells were ER(−), PR(−), and Her-2(0), and the results of the mutation test of the BRCA1 gene were: c.192T > G (p.C64W), and the mutation type was class 4-suspected deleterious variant. After surgery, she was given 6 cycles of chemotherapy with AC-T regimen, sequential Olaparib had been used for one year, and she was followed up for 25 months with no obvious signs of local recurrence or distant metastasis.展开更多
文摘目的:观察超声引导下胸椎旁神经阻滞联合全身麻醉在腹腔镜胆囊切除术(LC)患者中的应用效果。方法:回顾性分析2022年2月至2023年3月于该院行LC的86例患者的临床资料,按照麻醉方案不同将其分为研究组和对照组各43例。对照组实施全身麻醉,研究组在对照组基础上联合超声引导下胸椎旁神经阻滞。比较两组镇痛泵按压次数,不同时间[麻醉前(T_(0))、麻醉后20 min(T_(1))、拔管时(T_(2))]血流动力学指标[心率、平均动脉压(MAP)]水平,术后不同时间疼痛[视觉模拟评分法(VAS)]评分,手术前后应激指标[皮质醇(Cor)、去甲肾上腺素(NE)]水平,以及不良反应发生率。结果:研究组镇痛泵按压次数少于对照组,差异有统计学意义(P<0.05);T_(1)、T_(2)时,研究组心率、MAP水平均高于对照组,差异有统计学意义(P<0.05);研究组术后1、3、6 h VAS评分均低于对照组,差异有统计学意义(P<0.05);术后1 d,研究组Cor、NE水平均低于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:超声引导下胸椎旁神经阻滞联合全身麻醉应用于LC患者可减少镇痛泵按压次数,稳定血流动力学指标水平,降低术后疼痛评分和应激指标水平,效果优于单纯全身麻醉。
文摘本文报道一例乳腺化生性癌伴BRCA1基因突变患者的临床资料。患者为26岁女性,因“发现左乳腺结节1月”入院,彩超示左乳分叶状低回声结节,形态不规则,内未探及血流信号。行乳腺区段切除术,术后病理提示形态学结合免疫组化符合伴间叶分化的化生性癌,癌细胞ER(−)、PR(−)、Her-2(0),BRCA1基因突变检测结果:c.192T > G (p.C64W),突变类型为4类–疑似有害变异,术后予AC-T方案化疗6个周期,序贯奥拉帕尼使用1年,目前随访25个月,无局部复发和远处转移。This paper reports the clinical data of a case of breast metaplastic carcinoma with BRCA1 gene mutation. The patient was a 26-year-old woman who was admitted to the hospital with a left breast nodule that had been detected for one month. Ultrasound showed a lobulated hypoechoic nodule in the left breast with an irregular morphology, and no blood flow signals were detected in it. We performed segmental mastectomy for the patient, and postoperative pathology suggested that the morphology combined with immunohistochemistry was consistent with a metaplastic carcinoma with mesenchymal differentiation, and the cancer cells were ER(−), PR(−), and Her-2(0), and the results of the mutation test of the BRCA1 gene were: c.192T > G (p.C64W), and the mutation type was class 4-suspected deleterious variant. After surgery, she was given 6 cycles of chemotherapy with AC-T regimen, sequential Olaparib had been used for one year, and she was followed up for 25 months with no obvious signs of local recurrence or distant metastasis.
