High power lateral green laser assisted non-blocking laparoscopic partial nephrectomy for T 1a renal tumors / 中华泌尿外科杂志

Objective:To explore the safety and efficacy of laparoscopic non-blocking partial nephrectomy assisted by high power lateral green laser in the treatment of T 1a renal tumor. Methods:The clinical data of 10 patients with T1a stage renal tumor from February 2021 to April 2021 in department of urology, Gongli hospital affiliated to Naval Military Medical University were retrospectively analyzed. There were 7 males and 3 females, aged 47.0-74.0 years, with average of(58.8±9.7)years old. The diameter of the tumor ranged from 2.0 cm to 3.8 cm, with an average of (3.1±0.6)cm. There were 6 cases on the left side and 4 cases on the right side, locate on lumbar side in 9 cases and ventral sied in 1 case. The R. E.N.A.L score was 4.0-6.0, with an average of (5.0±0.8). The preoperative creatinine was 66.9-90.1μmol/L, with an average of (75.1±9.0)μmol/L, preoperative GFR of 44. 6- 67. 3 ml /min, with an average of(56.7±7.7)ml/min, preoperative hemoglobin level of 119.0-156.0g/L, with an average of (135.8±11.4)g/L. All patients underwent laparoscopic non-blocking partial nephrectomy assisted by 180w lateral green laser, free the surrounding area of the tumor fully and completely expose the renal tumor. The laser fiber was placed through the green laser hand piece, and the fiber was connected with normal saline to wash the strip. The initial green laser vaporization power was set at 80W, and the hemostasis power at 35W.About 3mm away from the edge of the tumor, and one optical fiber away from the renal parenchyma, the renal parenchyma was cut with 80W power. In order to reduce the interference by smoke, high-pressure flushing was used through the optical fiber while vaporizing, and an attractor was used to push and peel the tumor. In case of bleeding during operation, hemostatic power can be used to close the bleeding point and gradually advance until the tumor was completely removed. The wounds of renal inner medulla and renal outer cortex were continuously sutured in 1-3 layers with barbed suture. It involved 9 cases via retroperitoneal approach and 1 case via abdominal approach. The operation time, postoperative hemoglobin decrease, extraction time of negative pressure drainage, postoperative hospital stay, postoperative pathology and postoperative complications were recorded, and the serum creatinine level and GFR level of the affected side were followed up 1 month after operation.Results:All the operations were successfully completed, and there was no conversion to open surgery or radical nephrectomy. One case changed to scissors fast resection and sutured hemostasis due to severe intraoperative bleeding. The operation time was 90.0-120.0 min, with the average of (104.5±9.0)min. The postoperative hemoglobin level was 96.0-132.0g/L, with an average of (115.2±11.8)g/L, and the difference was statistically significant ( P<0.05). The postoperative hemoglobin decreased from 12.0g/L to 25.0g/L, with an average of (20.6±4.6)g/L. The time of vacuum drainage was 5.0-7.0 days, with an average of (5.7±0.7)d. Postoperative hospital stay was 6.0-8.0 days, with an average of (6.7±0.7)d. No bleeding, urinary leakage and other complications occurred in all patients. There were 7 cases of clear cell carcinoma, 2 cases of papillary renal cell carcinoma and 1 case of angiomyolipoma. All margins were negative. One month after operation, creatinine ranged from 66.0 to 90.4μmol/L, with an average of (76.8±8.3)μmol/L, which was not significantly different compared with that before operation ( P>0.05). One month after operation, GFR was 45.1-60.8 ml/min, and with an average of (55.5±4.7)ml/min, and there was no significant difference compared with preoperative data( P>0.05). Conclusions:For T 1aN 0M 0 stage and exophytic renal tumors, laparoscopic non-blocking partial nephrectomy assisted by lateral green laser is safe and effective.

The value of esophageal activity examination under X-ray fluoroscopy and chest CT in assessing the resectability of upper thoracic esophageal cancer / 中国胸心血管外科临床杂志

@#Objective    To investigate the value of esophageal activity examination under X-ray fluoroscopy and chest CT in evaluating the resectability of upper thoracic esophageal cancer. Methods    A total of 221 upper thoracic esophageal carcinoma patients underwent radical operation between 2009 and 2015 in our hospital were enrolled, including 141 males and 80 females with a median age of 59 (47-79) years. Preoperative routine esophageal activity examination under X-ray fluoroscopy and chest enhanced CT were performed to determine whether the tumor had external invasion. The results of the two methods were compared with that observed during the operation. Results    The number of patients with esophageal activity score 1-6 was 70, 85, 32, 29, 2 and 3, respectively. The area under the receiver operating characteristic (ROC) curve (AUC) of esophageal activity examination was 0.897 (95%CI 0.85-0.93, P<0.001), and the cut off value was >3. According to the ROC curve activity score, 4-6 points were considered as invasion, and 1-3 points were non-invasion. The sensitivity, specificity, accuracy and misdiagnosis rate of esophageal activity examination was 75.0%, 89.3%, 88.2%, 10.7%, respectively, and those of CT scan were 75.0%, 66.8%, 67.4%, 33.2%, respectively. Compared with CT scan, the specificity of esophageal activity examination was higher and the misdiagnosis rate was lower. Compared with the detection during the operation, 86.7% of patients with actual invasion of trachea and 85.7% of patients with actual invasion of other parts were in accordance with the esophageal activity examination results. Conclusion    Esophageal activity examination under X-ray fluoroscopy can accurately predict the resectability of upper thoracic esophageal cancer, which is a useful supplement to chest CT examination, especially in the aspect of judging the relationship between lesions and the trachea.

Initial application experience of six-step method high power side-emitting greenlight laser transurethral anatomical vapor incision technique for the treatment of benign prostate hyperplasia / 中华泌尿外科杂志

Objective:To explore the efficacy and safety of transurethral anatomical vapor incision technique of prostate (VIT) with six-step method high power side-emitting greenlight laser in the treatment of benign prostatic hyperplasia (BPH).Methods:A retrospective analysis of 82 patients with BPH who used high power side-out green laser in the treatment from October 2018 to June 2020 in Gongli Hospital of Naval Medical University was performed. Among them, 40 patients were treated with six-step method VIT, and 42 patients were treated with photoselective vaporization of prostate (PVP). The two groups of patients were compared in age [(71.1±8.7)years vs.(72.1±7.0)years], prostate volume [75 (68.25, 89.00) ml vs. 73 (63.25, 85.00) ml], and peak urinary flow rate (Q max) [6.20 (5.20, 8.20) ) ml/s vs. 5.9 (4.75, 7.50) ml/s], post-void residual volume (PVR) [74.00 (42.50, 103.75) ml vs. 67.00 (58.00, 84.50) ml], international prostate symptom score (IPSS) [(21.2±5.2) vs. ( 21.0±3.9)], quality of life score (QOL) [5 (4, 6) vs. 5 (4, 6) ], prostate specific antigen (PSA) [6.20 (4.12, 8.43) ng/ml vs. 5.40 (3.88, 7.13) ng/ml ]. In general, there was no statistical difference ( P>0.05). The VIT group adopts the six-step method of marking, removing film, grooving, excision, trimming and crushing. In the PVP group, the prostate tissue was uniformly vaporized layer by layer from the inside to the outside. Perioperative indexes and complications were compared between the two groups. The Q max, IPSS, QOL, PVR and PSA between the two groups before and 3 months after surgery were compared. Results:All patients in the VIT group and PVP group successfully completed the surgery, and there was no case of transfer to TURP or open surgery. The average operation time was [60.00(50.00, 73.75)min vs. 70.00(50.00, 73.75)min] ( P<0.05). There was no significant difference in the amount of postoperative hemoglobin decline[15.00(10.00, 17.75)g/L vs. 16.00(14.00, 19.25)g/L], average bladder irrigation time[1(1, 1)d vs. 1(1, 1)d], indwelling catheterization time[3(3, 3)]d vs. 3(3, 3)d] and hospitalization time in patients after operation[4(3, 4)d vs. 4(4, 4)d] ( P>0.05). All patients had no blood transfusion, second bleeding, readmission, TURS, urethral stricture and urinary incontinence.There were 2 cases (5.0%) of postoperative urinary tract infection in the VIT group and 9 cases (21.4%) of postoperative urinary tract infection in the PVP group ( P<0.05), and they were cured after anti-inflammatory treatment. Three months after operation, Q max, IPSS, QOL, PVR and PSA in the two groups were significantly improved compared with preoperatively. Among them, the differences of IPSS [(5.7±2.5) points vs. (7.5±2.8) points] and PSA [2.65(2.10, 3.90)ng/ml vs. 4.00(2.45, 4.45)ng/ml] in the VIT group and PVP group after operation were statistically significant ( P<0.05). Conclusions:Applying the six-step method high power side-emitting greenlight laser transurethral anatomical VIT to treat BPH, there is less intraoperative and postoperative bleeding, short operation time, significant decrease in PSA, and fewer complications. It is a safe and effective minimally invasive technology for the treatment of BPH.

Analysis of the effect and prognosis of lymph tracing in different lymph regions of esophageal cancer with nano carbon suspension / 中华胸心血管外科杂志

Objective:In the operation of esophageal cancer, nano carbon suspension was used for lymph tracing, and the effect of lymph tracing in different regions and its influence on prognosis were analyzed.Methods:From July 2013 to August 2014, 100 patients under esophageal cancer surgery in our department were analyzed. Randomly divided into experimental group and control group, 50 cases each. During the operation, nano carbon suspension was used to trace the lymph nodes in the experimental group, while conventional operation was only used in the control group. The general baseline data, the number of lymph nodes and positive lymph nodes in each region in the two groups were compared, the lymph node metastasis and survival were followed up, and the prognosis of the two groups were compared.Results:There was no significant difference in baseline data between the two groups( P>0.05). The average number of lymph nodes in the experimental group was 18.6 per case, and that in the control group was 15.1 per case. There was significant difference between the two groups( P=0.003). There was no significant difference in the number and degree of metastasis between the two groups( P=0.233, P=0.463). The effect of nano carbon suspension on tracing lymph nodes around the lower mediastinal esophagus was better. In the experimental group, 4.38 lymph nodes were removed in this area on average, 0.34 of which were metastatic lymph nodes. In the control group, 2.52 lymph nodes were removed in each case on average, 0.10 of which were metastatic lymph nodes. The comparison between the two groups was significantly higher than that of the control group( P=0.001, P=0.011 respectively). In the upper mediastinum, abdominal cavity and other mediastinal lymph nodes, there was no significant difference in the number of lymph nodes, the number of lymph nodes and the degree of metastasis between the two groups( P>0.05). The time of lymph node metastasis in the experimental group was significantly later than that in the control group( P=0.048, log rank test). There was no significant difference in survival time between the two groups( P=0.692, log rank test) . Conclusion:The results show that the nano carbon suspension has a good effect on the lymph node tracing during the operation of esophageal cancer, and the effect on the lymph node tracing around the lower mediastinal esophagus is better.In the area close to the lung drainage area, the tracer effect is poor, and it has certain effect in reducing or delaying lymph node metastasis.

Relationship of treatment outcome with thyroid hormone content in patients with biphasic disorder and depressive disorder / 中国基层医药

Objective:To explore the correlation between thyroid hormone content and treatment outcome in patients with biphasic disorder (BPD) and depressive disorder (DPD) before and after treatment.Methods:From June 2017 to June 2019, 72 patients with BPD(BPD group), 46 patients with DPD(DPD group) who met the diagnostic criteria of International Statistics and Classification of Disease and Health problems-10th Edition (ICD-10) in the Third People′s Hospital of Jiangmen, and 20 normal controls(control group) in our Hospital were enrolled in this study.The serum concentrations of total thyroxine (TT 4), total triiodothyronine (TT 3) and high sensitivity thyrotropin (HS-TSH) were measured at baseline, and the above hormone concentrations were measured in the study group after treatment for 12 weeks.The 17 Hamilton depression scale (HAMD-17) and Hamilton anxiety scale (HAMA), Bech-Rafaesdn Mania Rating Scale(BRMS) were used to evaluate the severity of symptoms at baseline and at the end of treatment.The curative effect was compared between the two groups, and the correlation between the curative effect (score reduction rate) and thyroid hormone level (concentration change) was observed. Results:At baseline, the concentrations of TT 4, TT 3 of patients with depressive phase in BPD group[(54.75±12.26)nmol/L, (86.26±15.29)nmol/L] were lower than those in the control group[(145.64±12.15)nmol/L, (156.78±36.54)nmol/L], and the TSH level in BPD group[(68.97±5.98)mIU/L]was higher than that in the control group[(45.59±9.28)mIU/L]; the levels of TT 4, TT 3 of patients with manic and mixed phase in BPD group[(166.75±12.25)nmol/L, (186.36±35.15)nmol/L] were higher than those in the control group, and the level of TSH in BPD group[(7.87±3.56)mIU/L] was lower than that in the control group; the concentrations of TT 4, TT 3 in DPD group[(65.59±23.11)nmol/L, (92.21±19.36)nmol/L] were lower than those in the control group, and the TSH level in DPD group[(69.38±14.75)mIU/L] was higher than that in the control group, the differences were ststistically significant ( t=5.867, 4.657, 2.369, 2.789, 3.247, 6.356, 4.358, 3.265, 2.365, all P<0.05). After treatment for 12 weeks, there were no statistically significant differences in TT 3, TT 4, HS-TSH concentrations among the three groups (all P>0.05). After treatment for 12 weeks, the scores of HAMa+ d, BRMS in BPD group and DPD group were significantly lower than those at baseline ( t=8.854, 12.321, 6.756, all P<0.05). The score of HAMa+ d was negatively correlated with TT 4, TT 3 concentrations, and positively correlated with HS-TSH concentration.The score of BRMS was positively correlated with TT 4, TT 3 concentrations, and negatively correlated with HS-TSH concentration. Conclusion:The level of thyroid hormone in patients with biphasic disorder and depressive disorder is different from that in normal subjects, and the level of thyroid hormone is closely related to the curative effect.

The planning, simulating and executing for the surgery of bilateral renal masses used the three-dimensional intelligent qualitative and quantitative analysis system(IQQA) / 中华泌尿外科杂志

Objective To explore the application of three-dimensional intelligent qualitative and quantitative analysis system (IQQA) in the planning,simulation and implementation of precise surgery for bilateral renal tumors.Methods A retrospective analysis a total of 7 patients with bilateral kidney tumors in our center from June 2017 to August 2018 was performed.There were 5 males and 2 females,with an average age of (54.6 ± 6.0) years,ranging 47.0-63.0 years.The average BMI index was (23.4 ± 2.4) kg/m2,ranging 21.2-28.0 kg/m2.The average diameter of 14 renal tumors in 7 patients was (3.8 ± 1.1) cm,ranging 1.9-5.3 cm.The average R.E.N.A.L score was 6.6 ± 1.2,ranging 5.0-9.0.The tumor stage was T1N0M0.The mean preoperative hemoglobin,albumin,creatinine and GFR were (138.6 ± 17.0)g/L and (47.3 ± 2.5 g/L),(51.6 ± 19.1) μmol/Land (56.9 ± 6.7) ml/min,respectively.Before operation,the original data of CT were input into IQQA system.Then we reconstructed kidney,blood vessel,collecting system and tumors using system.And the structure of kidney,tumors and vessels was visualized directly.The systematic analysis of the operation is carried out at terminals vary from various angles,and the surgical resection simulation.The position,angle and curvature of the cut surface are adjusted according to the effect.The plan of partial nephrectomy is designed.The resection area,remaining area of kidney is calculated.In this way,we can construct individualized and accurate laparoscopic partial nephrectomy planning before operation.Last,we carried out the operation according to the designed plan.The laparoscopic standard partial nephrectomy was performed in 11 cases.The laparoscopic selective partial nephrectomy was performed in 2 cases.One underwent laparoscopic partial nephrectomy without obstruction.We achieved precise resection of tumors and rapid suture of wounds according to the preoperative planning of excision and suture.We collected of the surgical success rate,conversion to opening rate,operation time,warm ischemia time,intraoperative bleeding volume,complications and hospitalization after operation.The related laboratory indicators such as eGFR and creatinine were followed up for 3 months,and the prognostic indicators such as renal CT and pulmonary CT for 6 months after operation were evaluated and analyzed.Result 14 renal tumors were successfully reconstructed by IQQA in 7 patients.The operations were completed successfully without conversion to open surgery or radical nephrectomy.The average operative duration was (68.9 ± 9.2) minutes,ranging 50.0-80.0 minutes.The average renal artery occlusion duration was (20.7 ± 4.1) minutes,ranging 15.0-29.0 minutes.The average intraoperative bleeding volume was (70.7 ± 29.7) ml,ranging 30.0-120.0 ml.The average indwelling time of drainage tube was (5.5 s0.7) days,ranging 5.0-7.0 days.The average hospitalization time was (6.3 ± 0.5) days,ranging 6.0-7.0 days.There were no perioperative complications such as bleeding,urinary leakage,infection,incision dehiscence and pulmonary infection.Postoperative pathology revealed 13 clear cell renal carcinoma and 1 renal angiomyoma.No recurrence or metastasis was found in chest CT and lung CT after 6 months follow-up.The creatinine and GFR in 3 months after operation were (52.0 ± 15.2) μmol/L(36.0-72.0 μmol/L) and (56.7 ± 5.3) ml/min(46.7-66.3 ml/min).There was no significant difference of creatinine and GFR with the preoperative (P ＞ 0.05).The mean Hb and albumin levels in 3 months after operation were (120.9 ± 17.0) g/L(90.0-147.0 g/L) and (41.4 ± 2.6) g/L (38.0-46.0 g/L),which were significantly lower than those before operation (P ＜ 0.05).Conclusions The three-dimensional intelligent qualitative and quantitative analysis system (IQQA) can visualize the kidney,tumor and the vasculature of bilateral kidney tumors by preoperative three-dimensional reconstruction.The optimal surgical plan of partial nephrectomy can be designed by preoperative operation planning and computer terminal in order to enhance the safety of partial nephrectomy for bilateral kidney tumors and preserve the possibility of kidney,and protect the renal function to the greatest extent.To accurately predict the retention of renal function after operation,so that patients with bilateral renal tumors can get the greatest benefit in partial nephrectomy.

Clinical efficacy of acupuncture and moxibustion in the adjuvant treatment of internet addiction disorder / 中国基层医药

Objective@#To investigate the clinical efficacy and safety of acupuncture and moxibustion in the adjuvant treatment of internet addiction disorder.@*Methods@#From January 2013 to April 2015, a total of 38 patients with internet addiction disorder were randomly selected and divided into study group(19 cases) and control group(19 cases) according to the odd and even order of hospitalize.The control group received psychological therapy, antianxiety therapy and antidepression therapy.The study group received acupuncture and moxibustion in addition to all therapies of the control group.The patients were treated for 8 weeks.Chiese Internet Addiction Scale(CIAS), Family Assessment Device(FAD), HAMD, HAMA were used to determine the internet addiction severity and social function of the two groups at baseline and the 8th weekend of treatment, and TESS at the 8th weekend of treatment.@*Results@#At the 8th weekend of treatment, the scores of CIAS, FAD, HAMA+ HAMD in the two groups were all significantly lower than baseline[(86.8±13.6)points vs.(38.3±11.5)points, t=11.872, (85.6±12.3)points vs.(54.6±18.2)points, t=7.123; (185.8±31.5)points vs.(80.6±29.4)points, t=10.643, (182.7±12.7)points vs.(110.5±32.3)points, t=9.068; (53.4±7.6)points vs.(21.7±9.7)points, t=11.215, (55.2±8.3)points vs.(35.2±8.3)points, t=7.428)](all P<0.05). At the 8th weekend of treatment, the scores of CIAS, FAD, HAMA+ HAMD in the study group were significantly lower than those in the control group(t=3.301, 2.985, 10.825, all P<0.05). There was no statistically significant difference in the incidence rate of side effects between the two groups(all P>0.05).@*Conclusion@#Acupuncture and moxibustion is effective and safe in the treatment of patients with internet addiction disorder.

Clinical observation of conventional antipsychotics combined with agomelatine in schizophrenia patients with obsessive-compulsive symptoms / 中国神经精神疾病杂志

Objective To examine the efficacy, safety, economic benefits and social function of conventional antipsychotics combined with agomelatine in the treatment of schizophrenia patients with obsessive-compulsive symptoms. Methods Eighty schizophrenic patients with obsessive-compulsive symptoms were randomly divided into two groups. The study group was treated with conventional antipsychotic drugs combined with agomelatin, and the control group combined with clomipramine for 8 weeks. Positive and negative symptom scale (PANSS) and Yale-Brown obsessive-compulsion scale (Y-BCOS) were used to evaluate the symptoms at before treatment, at discharge and one month after discharge. Social disability screening scale (SDSS), treatment emergent symptom scale (TESS) and the economic benefits was used to evaluate the social function, treatment efficacy and economic status. Results Before treatment, there was no significant difference in the scores of each scale between the two groups (P＞0.05). There was no significant difference in PANSS scores between the two groups at all time points (P＞0.05). The difference between Y-BCOS score and pre-treatment value was higher in the study group than in the control group (P<0.05). The difference between SDSS score and pre-treatment value was higher in the study group than in the control group (P<0.05). The TMRs were lower in the study group than in the control group at one month after discharge (P<0.05). The TESS score was lower in the study group than in the control group at discharge and one month after discharge. The cost and income were higher and the cost-effect ratio was lower in the study group than in the control group at one month after discharge (P<0.05). PANSS and Y-BCOS were positively correlated with TMR, SDSS and CER (P<0.05), but not with TESS at one month after discharge (P＞0.05). TESS was positively correlated with TMR, SDSS and CER (P<0.05). Conclusion The treatment of conventional antipsychotics combined with agomelatine in schizophrenia patients with obsessive-compulsive symptoms are safe and effective. Patients can achieve better social function, good economic and social benefits.

Safety evaluation of dexmedetomidine sedation in ICU patients undergoing mechanical ventilation / 中华危重病急救医学

Objective To observe the occurrence of cardiovascular adverse events in patients undergoing mechanical ventilation with dexmedetomidine sedation,and to evaluate its safety in intensive care unit (ICU).Methods A prospective randomized controlled trial was conducted.Adult critical patients undergoing mechanical ventilation over 48 hours admitted to ICU of Zigong First People's Hospital in Sichuan Province were enrolled.The patients were divided into dexmedetomidine group (Dex group) and midazolam group (Mid group) according to the randomise number generated by computer.The patients in both groups were given slow intravenous infusion of 0.05 mg/kg midazolam and 1-2 μg/kg fentanyl to induce anesthesia before tracheal intubation,followed by 0.06 mg· kg-1· h-1 midazolam and 20-50 μg· kg-1 · h-1 fentanyl or 0.1-0.2 μg· kg-1 · h-1 sufentanil for continuous intravenous pumping to maintain analgesia and sedation;on the next day,the patients in Dex group was given dexmedetomidine (with the initial dose of 0.4 μg· kg-1 · h-1,and maintenance dose of 0.1-0.7 μg· kg-1 · h-1),and midazolam was stopped half an hour later;the original sedation and analgesia plan remained unchanged in Mid group.The goal of sedation was to maintain a Richmond agitation-sedation scale (RASS) score of-2 to 1 or a Ramsay sedation score of 3 to 4;patients were given midazolam if obvious agitation occurred,in combination with propofol for sedation if necessary;wakeup test was performed every day.Observation endpoints included patients discharged from ICU,death or mechanical ventilation over 28 days.Occurrence of cardiovascular adverse events during sedation such as hypertension,hypotension,bradycardia,tachycardia and arrhythmia,dose of sedatives and analgesics,duration of mechanical ventilation,length of ICU stay and 28-day mortality were observed in two groups.Results A total of 383 patients were enrolled,with 190 patients in Dex group and 193 in Mid group.There was no statistically significant difference in general data such as gender,age,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and predicted mortality between two groups.Doses of midazolam,propofol and fentanyl in Dex group were reduced as compared with those of Mid group,while the dose of sufentanil was similar in two groups.The Ramsay score and RASS score of Dex group were significantly reduced as compared with those of Mid group (3.34± 0.63 vs.3.95 ± 0.86,-1.33 ±0.87 vs.-1.98 ± 1.27,both P ＜ 0.01).Bradycardia was prominent in Dex group,which was observed in more than half of patients at the beginning of the treatment (1-2 hours),but the patients requiring isoprenaline treatment for heart rate lower than 50 bpm were less than that of Mid group (3.7％ vs.5.2％,x 2 =0.506,P =0.477).The incidences of hypotension (45.3％ vs.68.4％),tachycardia (16.3％ vs.33.7％) and arrhythmia (14.7％ vs.31.1％) in Dex group were significantly lower than those of Mid group (all P ＜ 0.01),and no other cardiovascular adverse events such as cardiac arrest,sinus arrest,hyperglycemia or hypoglycemia were observed in two groups.There was no statistically significant difference in duration of mechanical ventilation between Dex group and Mid group [days:5 (2,28) vs.4 (2,56),Z =-1.917,P =0.055],but compared with Mid group,the length of ICU stay in Dex group was significantly prolonged [days:9 (2,67) vs.6 (2,57),Z =-4.302,P =0.000],and the 28-day mortality in Dex group was significantly reduced (22.6％ vs.44.6％,x2 =20.610,P =0.000).Conclusion Long time dexmedetomidine sedation is safe in critical patients undergoing mechanical ventilation,which can significantly reduce cardiovascular adverse events except bradycardia,and lower the 28-day mortality.