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The development of multi-campus is an effective way to expand and enlarge high-quality medical resources for public hospitals. In view of the problems in the relationship between power, responsibility and benefit, functional positioning, discipline layout, homogenization of medical quality and service, and management of human and financial resources in multi-campus, the authors introduced the integrated management system built by the Second Affiliated Hospital Zhejiang University School of Medicine in the process of multi-campus construction. The system included a standard-oriented quality system, a demand-oriented service system, a position-oriented personnel system, an efficiency-oriented financial system, a sharing-oriented information system and a mutual integration-oriented culture system, and formed an integrated management mode of " hospital-area synergy, differential positioning, and homogeneous development" , which significantly improved the management efficiency, service capacity and operational efficiency of the hospital, and could provide an effective reference for public hospital managers.
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Objective To investigate the risk factors of acute kidney injury (AKI) in patients undergoing cardiac valve surgery with cardiopulmonary bypass (CPB).Methods A retrospective cohort database study was conducted, involving 1 349 patients undergoing heart valve surgery with CPB technique.Logistic regression was used to screen out the risk factors of AKI after the surgery.Results Of the 1 349 patients, the incidence of AKI in valve surgery was 28.4%.One year older (OR=1.05, 95%CI 1.03-1.06, P<0.001), diabetes (OR=2.11, 95%CI 1.22-3.68, P=0.008), anemia (OR=1.50, 95%CI 1.05-2.21, P=0.026), each additional basic serum creatinine of 1 mg/dl (OR=1.01, 95%CI 1.01-1.02, P=0.001), each additional operation time of 1 hour (OR=1.28, 95%CI 1.15-1.41, P<0.001), plasma transfusion during surgery (OR=1.50, 95%CI 1.14-1.97, P=0.004) were the independent risk factors for AKI in multivariate logistic regression model.Conclusion AKI is a common and serious complication following cardiac valve surgery.More attention should be paid to the patients with elder age, anemia, prolonged operation time, diabetes, increased basic serum creatinine and requirement of plasma transfusion during surgery.
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Objective To evaluate the effects of ischemic time factors on reduction of myocardial ischemia-reperfusion injury by sulfentanil postconditioning in rats .Methods Healthy adult male Sprague-Dawley rats ,weighing 230-250 g ,were heparinized and anesthetized with intraperitoneal 5% chloral hydrate 8 ml/kg .The hearts were excised and perfused in a Langendorff apparatus with K-H solution .After 30 min of stabilization ,48 isolated rat hearts were randomly assigned into 6 groups (n=8 each) using a random number table .In I/R1-3 groups ,the hearts were subjected to 30 ,45 ,and 60 min of myocardial ischemia ,respectively ,followed by 90 min of reperfusion . In SP1-3 groups , the hearts were subjected to 30 , 45 , and 60 min of myocardial ischemia , respectively ,followed by 90 min of reperfusion ,and sulfentanil 100 nmol/L was added to K-H solution at 15 min of reperfusion for postconditioning . Left ventricular end-diastolic pressure (LVEDP ) , left ventricular developed pressure (LVDP) ,+dp/dtmax ,-dp/dtmax ,HR and coronary flow (CF) were measured at the end of equilibration and 15 ,30 ,60 and 90 min of reperfusion .Creatine kinase (CK) and lactate dehydrogenase (LDH) activities in coronary effluent were measured at 5 min of reperfusion .Myocardial infarct size was determined in 5 hearts chosen randomly at 90 min of reperfusion .Results LVEDP was significantly higher ,and LVDP , ± dp/dtmax and CF were lower at each time point of reperfusion than at the end of equilibration in I/R1-3 groups ( P0.05 ) .Conclusion Sulfentanil postconditioning can attenuate myocardial ischemia-reperfusion injury when the rats are subjected to 30 or 45 min of ischemia ,however ,it provides no myocardial protection when the rats are subjected to 60 min of ischemia .
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Objective To evaluate the efficacy of midazolam premedication for prevention of emergence agitation (EA) after sevoflurane anesthesia in children undergoing minor surgery.Methods One hundred and twenty ASA physical status Ⅰ or Ⅱ paediatric patients,aged 3-9 yr,weighing 15-35 kg,scheduled for elective tonsillectomy and adenoidectomy,were randomly divided into 4 groups (n =30 each):control group (group C) and midazolam 0.25,0.50 and 0.75 mg/kg groups (groups M1-3).The 10 ml mixture of midazolam 0.25,0.50 and 0.75 mg/kg and 10％ glucose was taken orally at 30 min before anesthesia in M1-3 groups,respectively,while 10 ml of 10％ glucose was taken orally in group C.Anesthesia was induced with inhalation of sevoflurane and maintained with iv infusion of remifentanil and inhalation of sevoflurane.EA was assessed using the Pediatric Anesthesia Emergence Delirium (PAED) scale.Results Compared with group C,the PAED scores and incidence of EA were significantly decreased in groups M2 and M3 (P ＜ 0.05),and no significant change was found in group M1 (P ＞ 0.05).Compared with group M1,the PAED scores and incidence of EA were significantly decreased in groups M2 and M3 (P ＜ 0.05).There was no significant difference in the PAED scores and incidence of EA between groups M3 and M2 (P ＞ 0.05).Conclusion Premedication with oral midazolam can prevent EA following sevoflurane anesthesia in children undergoing minor surgery and the optimum dose is 0.50 mg/kg.
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Objective To investigate the effects of sufentanil postconditioning and sevoflurane postconditioning on myocardial ischemia/reperfusion (I/R) injury in isolated rat hearts. Methods Healthy male SD rats weighing 230-250 g were anesthetized with intraperitoneal 5% chloral hydrate 8 ml/kg. Their hearts were excised and perfused in a Langendorff apparatus with modified K-H solution saturated with 95% O2-5% CO2 at 37℃. Forty isolated rat hearts with I/R injury were randomly assigned into 4 groups ( n = 10 each): Ⅰ I/R group, Ⅱ sevoflurane postconditioning group, Ⅲ sulfentanil postconditioning group and Ⅳ postconditioning with sevoflurane and sulfentanil group. After 30 min of stablization, the hearts were subjected to 40 min of global ischemia followed by 120 min of reperfusion. Fifteen minutes of drug postconditioning were performed in group Ⅱ , Ⅲ and Ⅳ:3.0% sevoflurane was introduced into K-H solution in group Ⅱ , 100 nmol/L sulfentanil was added to K-H solution in group Ⅲ , sevoflurane postconditioning and sulfentanil postconditioning were performed simultaneously in group Ⅳ . Left ventricular systolic pressure (LVSP), left ventricular end-diastolic pressure ( LVEDP), left ventricular developed pressure (LVDP), maximum increase in rate of LVDP ( + dp/dtmax), maximum decrease in rate of LVDP ( - dp/dtmax), HR and coronary flow (CF) were measured at the end of 30 min stablization (baseline), and at 15, 30, 60, 90 and 120 min of reperfusion. Coronary effluent was collected at 5 min of reperfusion for determination of activities of creatine kinase (CK) and lactate dehydrogenase (LDH). Myocardial tissues were obtained at the end of reperfusion for determination of infarct size (by triphenyltetrazolium chloride staining) and expression of Bcl-2 and Bax (by Western blot). The ratio of Bcl-2/Bax was calculated. Results LVSP, LVDP, ± dp/dtmax,CF, Bcl-2 expression and ratio of Bcl-2/Bax were significantly higher, LVEDP, activities of CK and LDH and Bax expression were significantly lower, and the infarct size was smaller in group Ⅱ , Ⅲ and Ⅳ than in group Ⅰ (P ＜ 0.05 or 0.01 ). There were no differences in the indices mentioned above between Ⅱ , Ⅲ and Ⅳ groups.Conclusion Sufentanil postconditioning can attenuate myocardial I/R injury, and there is no enhancement of myocardial protection when combined with sevoflurane postconditioning. The mechanism of myocardial protection is related to the inhibition of cell apoptosis via up-regulation of Bcl-2 expression and down-regulation Bax expression.
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Objective To investigate the effect of gender factors on the reduction of ischemia-reperfusion (I/R) injury by sevoflurane postconditioning in isolated rat cardiomyocytes. Methods Sixty 2-month-old SD rats (30 male, 30 female) were used in this study. Male rats were randomly assigned into 2 groups (n = 15 each):control group (group MC) and sevoflurane postconditioning group (group MS). Female rats were also randomly assigned into 2 groups (n= 15 each): control group (group FC) and sevoflurane postconditioning group (group FS).The rats were anesthetized with intraperitoneal pentobarbital 60 mg/kg. Their hearts were excised and perfused in a Langendorff apparatus with K-H solution saturated with 95% O2-5% CO2 at 37 ℃. I/R was produced by 40 min of global ischemia followed by 120 min of reperfusion. Control groups received perfusion with K-H solution saturated with O2 . Sevofiurane postconditioning groups received 10 min of perfusion with K-H solution saturated with 3%sevoflurane and O2 and then 110 min of perfusion with K-H solution saturated with O2 . HR, left ventricular enddiastolic pressure (LVEDP) and left ventricular developed pressure (LVDP) were measured before ischemia and during reperfusion. Coronary effluent was collected at 5 min of reperfusion for determination of LDH activity and infarct size. The total Akt (t-Akt) and phosphorylated Akt (p-Akt) expression in cardiomyocytes was detected. The ratio of p-Akt to t-Akt (p-Akt/t-Akt) was calculated. Results LVDP, p-Akt expression and p-Akt/t-Akt were significantly higher, LVEDP and LDH activity were significantly lower, and the infarct size was smaller in group MS and FC than in group MC (P ＜ 0.05). LVDP was significantly lower, LVEDP and LDH activity were significantly higher, and the infarct size was larger in group FS than in group MS. There was no significant difference in LVDP and LVEDP between group FC and FS (P ＞ 0.05). Conclusion There are gender differences in the reduction of I/R injury by sevoflurane postconditioning in isolated rat cardiomyocyes, the protective effect is stronger in male rats than in female rats, and the differences may be related to the activation of Akt.
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Objective To evaluation the efficacy of ketamine on the expression of adhension molecular CR3and intracellular cAMP, cGMP in neutrephils in patients associated with cardiopulmonary bypass (CPB), as well as the cardiovascular function of the CPB patients. Method Sixty patients operated on with prosthetic valve replace-rnent under CPB were randomly divided into 4 groups: placebo, ketamine 0.1 mg/kg ( ketamine Ⅰ) ,ketamine 0.5 mg/kg ( ketamine Ⅱ) ,ketamine 1 mg/kg( ketamine Ⅲ). Each group included 15 eases. Venous blood sam-pies were obtained during anesthesia induction (T1), 10 min before CPB (T2), end of CPB (T3) and 24 hoursafter operation (T4). The expression of CR3 was measured by Flow cytometry and the concentration of cAMP/cGMP by HPLC. Results Ketamine with various dosages decreased the expression of CR3 at the T3 and T4 inpatients of ketamine groups compared with patients of placebo group (P<0.05). The dosages of ketamine Ⅱgroup and ketamine Ⅲ group had more significant effect than that of ketamine Ⅰ group. The dosages of ketamineⅡ and ketamine Ⅲ group increased the intracellular cAMP at the T3 and T4 compared with ketamine Ⅰ groupand placebo (p<0.05), respectively. However,cGMP was lower in ketamine Ⅱ and ketamine Ⅲ group thanthat in ketamine Ⅰ group and placebo (P<0.05) at the T3.Morever,the mean arterial blood pressure was higherin ketamine Ⅱ and ketamine Ⅲ group at T4. Only the patients of ketamine Ⅲ group required less inotropic drugsafter operation. Conclusions Ketamine can reduce the expression of adhhension molecular CB3 and intracellularcAMP, cGMP in neutrophils from patients associated with CPB.