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Objective:To evaluate the efficacy of ultrasound-guided adductor canal approach to nerve block using one-puncture four-point technique for analgesia after total knee arthroplasty (TKA).Methods:Sixty patients of both sexes, aged 65-80 yr, with body mass index of 18-27 kg/m 2, of American Society of Anesthesiologists physical status Ⅱor Ⅲ, scheduled for elective unilateral TKA under general anesthesia, were enrolled in this study.Peripheral nerve block was performed for postoperative analgesia under ultrasound guidance.All the patients were allocated into 2 groups ( n=30 each) using a random number table method: adductor canal block combined with posterior approach to sciatic nerve block group (group ASB) and adductor canal approach to nerve block using one-puncture four-point technique including sciatic nerve, medial vastus muscle nerve, saphenous nerve, anterior femoral cutaneous nerve at adductor canal level group (group ANSB). When visual analogue scale score ≥4 during postoperative movement, ketorolac tromethamine 0.6 mg/kg was intravenously injected as rescue analgesic. The muscle strength of quadriceps on the affected side, range of knee joint motion and rate of the ability to walk for 10 m using the walker were recorded at 2, 8, 24 and 48 h after surgery.The consumption of analgesics for rescue analgesia, manipulation completion time, length of hospital stay and patients′ satisfaction score were recorded within 48 h after surgery. Results:Compared with group ASB, the consumption of ketorolac tromethamine was significantly reduced, manipulation completion time and length of hospital stay were shortened, patients′ satisfaction scores were increased, and the range of knee joint motion and rate of the ability to walk for 10 m using the walker were increased at 2, 8, 24 and 48 h after surgery in group ANSB ( P<0.05). There was no significant difference in muscle strength of quadriceps between two groups ( P>0.05). Conclusion:Ultrasound-guided adductor canal approach to nerve block using one-puncture four-point technique provides better efficacy than adductor canal block combined with posterior approach to sciatic nerve block when used for analgesia after TKA.
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Objective To compare of the application of tracheal intubation guided by Lightwand,Shikani optical stylet,or Macintosh. Methods Ninety ASA Ⅰ~Ⅱ patients undergoing elective general anesthesia were randomly divided into three groups(n = 30):Macintosh group(group M),Lightwand group(group L)and Shi-kani optical stylet group(group S). MAP and HR were recorded at the time of entering the operating room(T1), before intubation(T2),at the immediate time of intubation(T3),3 mins(T4)and 5 mins after intubation(T5). The intubation duration,the first intubation success rate,the number of intubation,and the incidence of complications including sore throat were observed. Results As compared with T1,MAP and HR decreased significantly at T2in the three groups(P<0.05). As compared with T2,HR increased in group L and MAP and HR increased in group S at T3(P<0.05). As compared with group M,MAP and HR at T4and T5were lower in groups L and S(P<0.05). The first intubation time was obviously shorter in group L than in other groups(P<0.05). The incidence of compli-cations was lower in group S(P < 0.05). The first success rate of intubation,the intubation times and the inci-dence of airway complications did not differ significantly among the three groups.(P > 0.05). Conclusions As compared with Macintosh,Lightwand and Shikani optical stylet have less influence on hemodynamic parameters. Lightwand needs shorter intubation time,Shikani optical stylet has the lowest rate of sore throat.
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Objective To compare the application of Shikani optical stylet(SOS)and Clarus Video Sty-let(Tracway)in patient with cervical spine immobilization in tracheal intubation. Method Sixty patients,ASAⅠ~Ⅱ,undergoing cervical internal fixation operation,were randomly divided into Shikani optical stylet group (Group S,n = 30)and Clarus Video Stylet group(Group T,n = 30). MAP,HR and RPP(The rate-pressure product)were recorded at the point before induction of anesthesia(T1),before intubation(T2),at the immediate time of intubation(T3)and 1 min(T4),3 mins(T5),and 5 mins after intubation(T6).The intubation time,one-time success rate of intubation,the number of intubation times and the incidence of sore throat and other complica-tions were observed. Results The one-time intubation time in group S was obviously shorter than that in group T (P<0.05).The incidence of mild sore throat and intubation throat injury rate were lower in group S than those in group T(P<0.05).Compared with those at T1,MAP and RPP decreased significantly at point of T2~T6in both of two groups(P<0.05).There was no significantly difference in MAP,HR and RPP at any points of time between the two groups. The one-time success rate of intubation,the number of intubation times and the incidence of air-way complications in two groups(P>0.05)were no significantly different. Conclusions Compared with Clarus Video Stylet(Tracway),Shikani optical stylet can shorten the intubation time in patients with cervical spine immo-bilization,but no difference was found in regard to the hemodynamic influence on intubation,success rate of intu-bation,the intubation times,the sore throat and the other related complications.
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Objective To investigate the internal quality control ( IQC ) on clinical chemistry , clinical immunology and clinical hematology in mutual recognition laboratories in medical institutions in Beijing.Methods By means of questionnaire survey and on -site investigation, fresh frozen serum and whole blood samples with assigned values by reference method were measured to investigate the status of IQC on clinical chemistry , clinical immunology and clinical hematology in 142 mutual recognition laboratories in medical institutions of Beijing,and results were analyzed.Results 142 copies of questionnaireson clinical chemistry, clinical immunology and clinical hematology were send out and 120, 97, and 101 laboratories returned the questionnaires respectively .The information feedback rate was 84.5%, 68.3% and 71.1%respectively .All the questionnaires were effective .Questionnaires survey results showed that more than 50%laboratories set up quality control goals and the most of the goals were probability for error detection ( Ped) 95%, probability for false rejection(Pfr)5%;About 70% laboratories usecd the same quality control plan for different tests ;The most frequently used quality control rules are 12s/13s/22s.On-site investigation showed that ,take the results of clinical chemistry for example , based on the desirable biological variation and WS/T 403 -2012 , most of the tests can't meet the quality control goalsunder the existing quality controlcondition.Conclusion Clinical laboratories should consider their actual situations , assess their own qualitylevels that they can reach , set reasonable quality standards for themselves , and make appropriateindividualized quality control plan.
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Objective To investigate the distribution of critical values of adults in Beijing, to provide the evidence for the formulation of the Standardized Management Guideline in Critical Values, in order to promote the accurate management of critical values.Methods A total of 110 398 data of critical values from the tertiary and above medical institutions during January 1 to May 31 in 2015 in Beijing were collected by the way of on-site inspection, covering the disciplines of hematology, clinical chemistry, coagulation and blood gas analysis.Fristly, the selected critical values were classified by the factor of admission departments and disease types,then were analyzed by using Kruskal-Wallis test, to compare the differences in each group.Secondly,the combined groups were classified by the factor of gender then were analyzed by using Mann-Whithey U test, to compare the differences in each group.Finally, the stratification thresholds of critical values were established.Results Except for the upper limits of Ca, pH, pCO2, Hb and the lower limits of Glu, pH, the rest of thresholds of critical values had significant differences due to different admission departments and disease types and/or gender.Conclusion Depending on the different admission departmentsces disease types and/or gender, hierarchical limit values on each critical value were formulated.
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Objective To investigate the effects of sevoflurane postconditioning on intestinal ischemiareperfusion (I/R) injury in rats.Methods Thirty-six adult male Sprague-Dawley rats,weighing 200-220 g,were randomly divided into 4 groups (n =9 each):sham operation group (group Sham),group I/R,ischemic postconditioning group (group Ipo) and sevoflurane postconditioning group (group Sevo).Intestinal I/R was induced by clamping the superior mesenteric artery (SMA) for 60 min followed by 120 min of reperfusion in groups I/R,Ipo and Sevo.In group Ipo the animals were subjected to 3 cycles of 30 min reperfusion-30 min ischemia starting from the beginning of reperfusion.The animals inhaled 1.15％ sevoflurane for 30 min starting from the beginning of reperfusion in group Sevo.The animals were sacrificed at 120 min of reperfusion and then the small intestines were removed for determination of malondialdehyde (MDA) content and superoxide dismutase (SOD) activity (by colorimetric method) and caspase-3 protein expression in intestinal tissues (by Western blot).The density of apoptotic cells was calculated by TUNEL.Results Compared with group Sham,the intestinal injury score,density of apoptotic cells and MDA content were significantly increased,SOD activity was decreased,and caspase-3 protein expression was up-regulated in groups I/R,Ipo and Sevo (P ＜ 0.05).Compared with group l/R,the intestinal injury score,density of apoptotic cells and MDA content were significantly decreased,SOD activity was increased,and caspase-3 protein expression was down-regulated in groups Ipo and Sevo (P ＜ 0.05).There was no significant difference in the intestinal injury score,density of apoptotic cells,SOD activity,MDA content and caspase-3 protein expression between Sevo and Ipo groups (P ＞ 0.05).Conclusion Sevoflurane postconditioning can attenuate intestinal I/R injury through reducing lipid peroxidation and cell apoptosis in rats,and the protective effect is similar to that of ischemic post-conditioning.
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Objective To use enzyme-linked immunosorbent assay (ELISA) for measuring thrombospondin-1 (TSP-1),and to analyze its diagnostic value for prostatic carcinoma.Methods The possible difficulties and the way to solve the difficulties with ELISA spot were explored first.Three agents which could segregate idio-antigen and one technique which could depurate proteinum were designed and developed.The non- idio- proteinum cross reaction problems were solved and the routine method to measure TSP-1 with ELISA was set up successfully.The serum TSP-1 was measured in 14 patients with benign prostatic hyperplasia (BPH) and 18 patients with prostatic carcinoma.Results The TSP-1 values were (73.77±12.72)% and (121.86±-19.47)% in prostatic carcinoma group and benign prostatic hyperplasia group,respectively (t= 8.44,P＜0.01).The diagnostic sensitivity and specificity of TSP-1 and prostate specific antigen (PSA) for prostatic cancer were 92.7%,88.9% and 85.7%,66.7%,respectively (P＜0.01).The area under the receiver operating characteristic curve (ROC) of TSP-1 and PSA were 0.9663 and 0.7421 (P＜0.05).Conclusions The determination of TSP-1 with ELISA is feasible.TSP-1 is an ideal diagnostic parameter for prostatic carcinoma and it may distinguish BPH from malignant prostatic disease more exactly than PSA.