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ObjectiveTo investigate current status of hospital infection management in psychiatric hospitals in the Ningxia Hui Autonomous Region， so as to provide references for improving the level of hospital infection management of psychiatric hospitals. MethodsIn December 2020， on-site supervision was conducted on hospital infection management in all 9 psychiatric hospitals in the Ningxia Hui Autonomous Region， meantime， the self-compiled questionnaire on hospital infection management status was used for investigation. ResultsAmong the selected hospitals， nine （100.00%） psychiatric hospitals had the main hospital leaders in charge of hospital infection management， five （55.56%） hospitals had established a hospital infection management committee， six （66.67%） hospitals had established an independent hospital infection management department， and one （11.11%） hospital had developed all 13 systems mentioned in the questionnaire related to hospital infection management and job responsibilities. In terms of hospital infection management staff， there were 23 staff members in the nine psychiatric hospitals， including 3 in the specialty （13.04%） and 20 in the part-time setting （86.96%）. The score of the implementation of the basic system of hospital infection management in nine hospitals was （3.28±2.22）. ConclusionThe system specification related to hospital infection management in the Ningxia Hui Autonomous Region psychiatric hospitals needs to be improved and further strengthened， the professionalism of hospital infection management personnel needs to be improved.
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Objective:To investigate the effect of preventive use of antiemetic drugs on postoperative nausea and vomiting (PONV) in patients with cesarean section(CS) under multi-mode analgesia.Methods:The clinical data of 5530 patients with cesarean section in the University of Hong Kong-Shenzhen Hospital (HKU-SZH) from February 1, 2016 to January 31, 2020 were retrospectively collected and divided into four groups: Ondansetron 4 mg group (group A, n=2 712), Dexamethasone 5 mg group (group B, n=39), Ondansetron 4 mg combined with Dexamethasone 5 mg group (Group C, n=413), and blank group (Group D, n=2 366). All drugs were given before the end of theoperation. The prophylactic effectiveness with different antiemetic prescription has been compared in this study. Results:There were no significant differences in height, weight, age, the ratio of NRs≥6 at 24 h and oxycodone usage among the four groups ( P>0.05). The incidence of postoperative nausea and vomiting was 2.29%(62/2 712), 0(0/39), 1.45%(6/413) and 1.90%(45/2 366), respectively. There was no significant difference between the four groups ( P=0.463). Conclusions:Prophylaxis antiemetic administration seems do not reduce the incidence of PONV after CS under this strategy of multi-mode analgesia.
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Major obstetric hemorrhage (MOH) may endanger the life of maternal during the perioperative period. Its highly efficient management involves multidisciplinary co-operation and is a complex clinical emergency situation which needs teamwork to complete. Anesthesiologist, as the key member of the obstetric MOH management team, should actively cooperate with the obstetricians once they decide to perform an emergency procedure for the parturient. They should possess perfect skill in resuscitation and rich experiences for assessment of MOH. They also should be professional in monitoring and caring for the critically ill patient. Constantly simulation training also should be actively carried out for MOH. In this review, the definition and etiology of MOH, drug and surgical treatment, anesthesia management (including preparation before anesthesia, hemorrhagic shock assessment, choice of anesthesia methods, blood transfusion, blood cell salvage, coagulation function and hemodynamic monitoring) were reviewed, and the conclusions were just for references.
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Objective To study the characteristics of colorectal cancer patients in Yunnan Tumor Hospital, and to provide the basis for the prevention and treatment of colorectal cancer. Methods Retrospective analysis was used to review colorectal cancer patients who were diagnosed first and received the main treatment in Yunnan Cancer Hospital from March 2005 to December 2014.According to the sampling principle ,there were 100 cases each year , with a total of 1000 cases. The clinical and pathological data were analyzed, including age, gender, pathogenesis, pathological type, and TNM stage. Results The average age of the 1000 patients enrolled in the survey was (63.4±12.8) years old, the male and female age group (60-69) accounted for the highest proportion.both men and women aged between 60 and 69 had a high occurance rate, and male patients were more than the female with a fraction of 1.42:1. Rectum is the most common primary site, accounting for 57%, followed by ascending colon, sigmoid colon, straight B junction, transverse colon, descending colon, and cecum. Adenocarcinoma was the main pathological type, accounting for 89.4%.Stage Ⅲ was the most common in TNM staging, accounting for 35.9%, followed by stage Ⅱ, Ⅰ, and stage Ⅳ. Most rectal cancers were found at stage Ⅲ, and colon cancer at stage Ⅱ . Conclusion The proportion of colorectal cancer in the age group (60-69 years) was the highest; the proportion of middle-aged and male was significant.The high incidence of colorectal cancer was 60～69 years old, especially males.The main part of colorectal cancer was located in the rectum.Adenocarcinoma was the most common pathological type. Most patients were later stage when diagnosed.
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Objective To explore the sleep quality and its influencing factors among the patients with schizophrenia of Hui and Han populations in the rural areas in Ningxia Hui Autonomous Region.MethodsTotally 296 patients with schizophrenia of Hui and Han populations in the rural areas were selected from 2 counties of Wuzhong and Zhongwei in Ningxia Hui Autonomous Region by using cluster random sampling method.Self-made general information questionnaire was used to collect the demographic and clinical characteristics of the patients with schizophrenia.The Pittsburgh Sleep Quality Index(PSQI) was used to evaluate the sleep quality.Brief Psychiatric Rating Scale(BPRS),Hamilton Depression Scale(HAMD) and Hamilton Anxiety Scale(HAMA) were used to measure the psychotic symptoms,depressive symptoms and anxiety symptoms,respectively.ResultsIn the rural areas,the incidence of sleep disorder in the patients with schizophrenia of Hui and Han populations was 84.5%.The influencing factors of sleep disorder in the patients with schizophrenia in the rural areas were age(B=0.055,P=0.012,OR=1.057,95%CI:1.012-1.103),nationality(B=2.250,P<0.01,OR=9.485,95%CI:2.701-33.319),marital status(B=-1.506,P=0.003,OR=0.222,95%CI:0.081-0.605),course of disease(B=-0.003,P=0.089,OR=0.997,95%CI:0.993-1.001),the total score of HAMD(B=0.079,P=0.007,OR=1.083,95%CI:1.021-1.148)and the total score of HAMA(B=0.060,P=0.036,OR=1.061,95%CI:1.004-1.122).ConclusionSleep disorders are common and associated with multiple factors in patients with schizophrenia of Hui and Han populations in Ningxia rural area.In clinical practice,more attention should be paid to the identification and intervention of sleep disorders,so as to improve the sleep quality for the patients with schizophrenia.
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Objective To investigate the relationship between autophagy in spinal dorsal horn and development of morphine tolerance in rats.Methods Twenty-four healthy male Sprague-Dawley rats,in which intrathecal (IT) catheters were successfully placed,were randomly divided into 3 groups (n =8 each):control group (group C),morphine tolerance group (group M) and morphine + rapamycin as a reinforcing agent for autophagy group (group MR).Morphine tolerance was induced with IT morphine 20 μg twice a day for 7 consecutive days.While the equal volume of normal saline was given in group C.In addition,rapamycin 2.3μg was injected intrathecally at the second injection of morphine on 3rd day lasting for 3 consecutive days in group MR.Mechanical withdrawal threshold (MWT) to yon Frey filament stimulation was measured before IT injection and 30 min after the second IT injection on 1st,3rd,5th and 7th days.The rats were sacrificed 1 h after the last MWT measurement and the L4-6 segment of the spinal cord was removed for determination of the total mammalian target of rapamycin (mTOR) and phosphorylated mTOR(p-mTOR) and autophagy marker protein LC3 Ⅱ expression in spinal dorsal horn by Western blot.The percentage of p-mTOR expression in total mTOR expression was considered as reflection of the activity.Results MWT was gradually decreased with the prolongation of time of IT injection (P ＜ 0.05).Compared with group C,MWT was significantly increased during IT injection,mTOR activity was decreased and LC3 Ⅱ expression was up-regulated in groups M and MR (P ＜ 0.05).Compared with group M,MWT was significandy increased on 3rd,5th and 7th days after IT injection,mTOR activity was decreased and LC3 Ⅱ expression was up-regulated in group MR (P ＜ 0.05).Conclusion Increased autophagy in spinal dorsal horn is the regulatory mechanism of the body during the development of morphine tolerance in rats and can delay the development of morphine tolerance.
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Objective To evaluate the role of microglial activation in dorsal root ganglia in a rat model of persistent postoperative pain evoked by skin/muscle incision and retraction (SMIR).Methods Seventy male Sprague-Dawley rats,weighing 200-250 g,were randomly divided into 2 groups (n =35 each):group sham operation (group S) and group SMIR.The rat model of persistent postoperative pain evoked by SMIR was established according to the method described by Flatters.Pain behavior was assessed by mechanical paw withdrawal threshold to yon Frey filament stimulation at 1 day before and 1,3,7,12,22 and 32 days after operation.Five animals were sacrificed at each time point in each group for microglia count in dorsal root ganglia.Results Compared with group S,mechanical paw withdrawal threshold was significantly decreased at 3-22 days after operation,and microglia count was significantly increased at 3-12 days after operation in group SMIR (P ＜ 0.05).Conclusion Microglial activation in dorsal root ganglia may be involved in the development of SMIR-evoked persistent postoperative pain in rats.
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Objective To investigate the effect of dexmedetomidine on norepinephrine(NE)release in midbrain periaqueductal gray(PAG)in a rat model of incisional pain.Methods Twenty-four male Wistar rats in which microdialvsis catheter was successfully placed in the ventrolateral region of PAG without complications were randomly divided into 4 groups(n=6 each):group control(group C);group incisional pain(group IP);group dexmetomidine(group D)and group dexmedetomidine+yohimbine(group DY).Incisional pain was induced by an incision made into the plantar surface of left hindpaw in IP,D,DY groups.Dexmedetomidine 30 μg/kg and dexmedetomidine 30 μg/kg+yohimbine 0.5 mg/kg were given intraperitoneally at 15 min before plantar incision in group D and group DY respectively.Mechanical paw withdrawal threshold(MWT)to von Frey filament stimulation was measured at 30 min before(baseline)and 1,2,3,4 h after operation in C,IP,D groups,and at 30 min before(baseline),and 1 h after operation in group DY.Dialysate samples were collected at 30 min before(baseline)and at evcry 30 min after operation for 4 h via cerebral microdialysis catheter for determination of the NE concentration in C,IP,D groups,and at 30 min before(baseline),30,60 min after operation in group DY.Results Incisional pain significantly decreased MWT and increased the NE concentration in dialysate in group IP.Dexmedetomidine premedication significantly inhibited mechanical hyperalgesia and attenuated incisional pain-induced increase in the NE concentration in dialysate in group D.Yohimbine counteracted effects of dexmedetomidine.Conclusion Dexmedetomidine has analgesic effect though inhibition of NE release from PAG.
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Objective To investigate the pharmacodynamics of different local anesthetics administered intrathecally for elderly patients undergoing transurethral resection of the prostate (TURP). Methods Ninety ASA Ⅰ - Ⅲ elderly patients, aged 69-82 yr, with body mass index less than 30 kg/m2 , undergoing TURP under combined spinal-epidural anesthesia, were randomly divided into 3 groups ( n = 30 each): levobupivacaine group (group L), ropivacaine group (group R) and bupivacaine group (group B). Group L, R and B received intrathecai (IT) 0.5 % levobupivacaine, 0.5 % ropivacaine and 0.5 % bupivacaine respectively. The initial dose was 7,10 and 6 mg in group L, R and B respectively. The ratio of two successive doses was 0.9. If the upper sensory block reached T10 within the 20 min after IT injection, the IT analgesia was considered to be effective. The median effective dose (EDs0) and 95 % confidence interval (95 % CI) were calculated by Dixon. Results The ED50 and 95% CI of levobupivacaine, ropivacaine and bupivacaine were 6.781 (95% CI 6.561-7.024) mg, 9.135 (95%CI8.670-9.616) mg and 5.170 (95% CI 5.012-5.333) ng respectively. The relative potency ratio between levobupivacaine, ropivacaine and bupivacaine is 0.76∶0.57∶1.00. ConclusionThe relative potency ratio be tween levobupivacaine, ropivacaine and bupivacaine is 0.76∶0.57∶1.00.
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Objective To investigate the effects of intrathecal (IT) dexmedetomidine on analgesia and neurotoxicity produced by ropivacaine spinal block .Methods Male SD rats weighing 250-300 g were used in this study. The animals were anesthetized with intraperitoneal 10% chloral hydrate 300 mg/kg. IT catheter was placed according to the technique described by Yaksh and Rudy. The tip of the IT catheter was positioned at lumbar region. Thirty-six SD rats in which IT catheter was successfully placed without complication were randomly allocated into 6 groups (n = 6 each): group Ⅰ received normal saline IT (group C); group Ⅱ received 0.5% ropivacaine 20 μl IT (group R); group Ⅲ received dexmedetomidine 3 μg/kg IT (group D ); group Ⅳ, Ⅴ , Ⅵ received 0.5% ropivacaine 20 μl + dexmedetomidine 1, 2 and 3 μg/kg IT respectively (group DR1, DR2, DR3). Tail-flick test, paw withdrawal threshold to yon frey stimuli and incline plate test were performed at 5, 30, 60, 120 and 240 min after IT drug administration. Two weeks later, the animals were sacrificed and the lumbar segment of the spinal cord was removed for microscopic examination. Results The duration of spinal block was significantly longer and the effect stronger in group DR1, DR2 and DR3 than in group R. Electron microscope showed that the injury to the myelin sheath of axon was the most severe in group DR3. Little or no damage to the axon was found in the other 5 groups (pathological score = 0). Conclusion Dexmedetomidine IT can enhance spinal block produced by 0.5 % ropivacaine, and there is celling effect.
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Objective To assess the analgesic effect of continuous infusion of 0.2% ropivacaine with epidural catheter placed at T11-12 or L2-3 after abdominal hysterectomy. Methods Eighty ASA Ⅰ -Ⅱ patients undergoing elective abdominal hysterectomy were randomly divided into 4 groups with 20 patients in each group : in group Al and A2 the epidural catheter was placed at T11-12 and in group Bl and B2 at L2-3 . After surgery two infusion pumps were used. The first pump was used for continuous epidural infusion of 0.2% ropivacaine in the 4 groups. The second pump was used for patient controlled intravenous analgesia (PCIA) with 0.08% lornoxicam in group Al and Bl or with 0.1% morphine in group A2 and B2. The PCIA bolus dose was 1 ml with a lockout time of 5 min. The analgesic effect (assessed using VAS) and the consumption of lomoxicam / morphine were compared among the four groups. Results The ropivacaine consumption was 192 mg during the 24 h after operation in the 4 groups. The lornoxicam and morphine consumption were (3.9?2.8) mg and (4.6?3.5) mg in group Al and A2 with the epidural catheter placed at T11-12 and (7.7?2.5) mg and (7.8?2.4) mg in group B2 and B2 with catheter placed at L2-3.The consumption of lomoxicam or morphine was significantly less with epidural catheter placed at T11-12 than that with epidural catheter at L2-3 (P
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Objective To compare auditory evoked potential index (AEPI) , BIS , heart rate variability (HRV) and spectral edge frequency (SEF) for monitoring the level of analgesia and sedation produced by different analgesic mixture of PCEA. Methods Thirty ASA Ⅰ-Ⅱ patients undergoing upper abdominal surgery under general anesthesia were enrolled in the study.Patients with mental or hearing disorders were excluded. The patients were randomly divided into three groups . The basic analgesic mixture for PCEA was 0.2% ropivacaine + 0.01% morphine in the 3 group and the PCEA regimen was : loading dose 5ml , background infusion 1ml?h-1, bolus dose 1ml and lock-out interval 10 min. The difference among the 3 groups was that the 5ml loading dose contained clonidine l00?g in group Ⅱ or midazolam 2mg in group Ⅲ. The patients were premedicated with phenobartital and scopolamine. Epidural catheter was placed at T9-10 , a test dose of 1 % lidocaine 3-5ml was given to confirm the correct placement of the epidural catheter. General anesthesia was induced with midazolam 0.06mg?kg-1, fentanyl 4?g?kg-1, propofol 0.5mg?kg-1 and vecuronium 0.1mg?kg-1. Anesthesia was maintained after tracheal intubation with isoflurane inhalation and propofol infusion. Patients were transported to PACU after operation.PCEA was started after extubation when the patients was awake and complained of pain. The AEPI, BIS , HRV and SEF values and VAS, OAA/S scores were recorded before induction of anesthesia (T0 ) at the end of surgery (T1), 5, 15, 30 , 60 , 90 min and 2h, 4h, 8h, 20h, 24h after loading dose (T2-12). Results (1) AEPI was significantly higher than the baseline value when the patient was awake and feel pain ( P
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0 05)respeetively before induction, which shoued no statistic difference between two groups.AEP index and BIS of two groups after induction were decreased to below 30 a nd 55 respeetively(T 1 vs. T 0 ,P0 01) ) . The changing tendency of the elderly group and the young group were identical a t all time points. Conclusions AEP index can be used for the anesthesia depth monitoring for the elderly without obvious auditory dysfunction during tracheal intubation.
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Objective To investigate the changes in the expression of connexin 43 ( Cx43) in astrocytes in the spinal dorsal horn in a rat model of chronic neuropathic pain. Methods Twenty male SD rats weighing 200-250 g were randomly divided into 2 groups : (A) chronic constriction injury group (CCI) received 4 loose ligatures placed on the right sciatic nerve according to Xie[5] (n = 10) and (B) sham operation group in which the right sciatic nerve was exprosed but not ligated ( n = 10) . The pain behavior was evaluated and the paw withdrawal thermal latency (PWTL) and paw withdrawal electric threshold (PWET) were measured the day before operation (D0 baseline) and on the 1st, 3rd, 5th, 7th and 14th day after operation (T1 , T3, T5, T7, T14 ) . On the 14th postoperative day the animals were sacrificed and the L4-5 segment of spinal cord was removed for detection of the expression of Cx43 and glial fibrillary acid protein ( GFAP) in the spinal dorsal horn by immuno-histochemistry. Results In CCI group the rats displayed pain behavior after operation and only 2 of them recovered normal behavior on D14 and their PWTL was shortened and PWET lowered after operation compared to the baseline values (D0), while in the sham operation group PWTL and PWET returned to the baseline after D7. The GFAP positively stained area was significantly larger in the right spinal dorsal horn in CCI group (29?7% ) than in sham operation group (19?5% ). The Cx43 positively stained area was 17?3% in CCI group and 4?1 % in sham operation group. Conclusion Cx43 and GFAP expression increase in the astrocytes in the spinal dorsal hom of the affected side in rats with chronic neuropathic pain, suggesting that the astrocytic gap junction may play an important role in chronic neuropathic pain.
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Objective Uterine artery embolization (UAE) is a new but well accepted technique for uterine myoma but patients feel severe pain and cramp during and after operation. The purpose of this study was to determine the effectiveness and safety of PCEA with ropivacaine during and after UAE. Methods Eighty ASA 1 - D patients undergoing UAE were randomly divided into four equal groups with twenty patients in each group: group C received oral nimesulide and/or intramuscular pethidine; in group RD0, RD1 and RD2 patients received PCEA with a mixture of 0.2% ropivacaine + 0.004% morphine. An additional 0.005% (RD1 ) or 0.01 % droperidol (RD2 ) was added to the mixture in group RD1 and RD2 . The PCEA regimen consisted of loading dose 6ml, background infusion 2ml/h, bolus dose 2ml and lockout time 10 min. The VAS pain score, Ramsay score, Bruggman comfort score (BCS) and side effects like nausea, vomiting and pruritus were recorded and compared among the 4 groups. Results Pain and cramp in pelvis were common (90% ) during UAE in group C while the patients in groups RD0, RD1 and RD2 felt no pain and cramp. The patients were quiet and cooperative (Ramsay score 2) in group RD0, RD1 and RD2 while the patients in group C were anxious and agitated. The rate of nausea and vomiting was lower in group RD1 and RD2 than that in group C and RD0. No respiratory depression, hypotension and bradyarrliythmia were observed in the four groups. Conclusion PCEA with ropivacaine and morphine can affectively relieve pain during and after UAE with faster recovery and less side effects. PCEA with moderate droperidol (0.005% ) can reduce the rate of natisea and vomiting.
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0.05 as compared with T3 ) . (3) 3 min after propofol injection OAA/S score dropped to 0 in all patients; AEP index and BIS decreased to 28.97?11 and 50? 11 respectively.Conclusions Induction of anesthesia with intravenous midazolam-fentanyl-propofol is smooth and effective with little circulatory disturbance.