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@#Objective To explore the predictive value of systolic pulmonary artery pressure (SPAP) on autonomic nerve excitation in patients with valvular disease, so as to provide reference for the formulation of clinical intervention plans. Methods The clinical data of patients with valvular disease who received surgical treatment in the General Hospital of Northern Theater Command from August 28, 2020 to February 3, 2021 were prospectively collected. According to the standard deviation of normal-to-normal R-R intervals (SDNN) of the heart rate variability (HRV) of the long-range dynamic electrocardiogram (ECG) 7 days before the operation, the patients were divided into three groups: a sympathetic dominant (SE) group (SDNN≤50 ms), a balance group (50 ms<SDNN<100 ms) and a parasympathetic dominant (PSE) group (SDNN≥100 ms). The correlation between the changes of echocardiographic indexes and autonomic nerve excitation among the groups and the predictive values were analyzed. Results A total of 186 patients were enrolled, including 108 males and 78 females aged 55.92±11.99 years. There were 26 patients in the SE group, 104 patients in the balance group, and 56 patients in the PSE group. The left anteroposterior diameter (LAD), left ventricular end diastolic inner diameter, ratio of peak E to peak A of mitral valve (Em/Am), left ventricular end diastolic volume, left ventricular end systolic volume and SPAP in the SE group were higher than those in the balance group (P<0.05), while peak A of tricuspid valve (At) and left ventricular ejection fraction (LVEF) were lower than those in the balance group (P<0.05). The LAD and Em/Am in the balance group were significantly higher than those in the PSE group (P<0.05). Multivariate analysis showed that patients in the SE group had lower At (right atrial systolic function declines), lower LVEF and higher SPAP than those in the balance group (P=0.04, 0.04 and 0.00). When HRV increased and parasympathetic nerve was excited in patients with valvular disease, Em/Am decreased (left atrial function and/or left ventricular diastolic function declined) with a normal LAD. Pearson analysis showed that there was a linear negative correlation between SPAP and SDNN, with a coefficient of −0.348, indicating that the higher SPAP, the lower HRV and the more excited sympathetic nerve. Receiver operating characteristic curve showed that when SPAP≥45.50 mm Hg (1 mm Hg=0.133 kPa), the sensitivity and specificity of sympathetic excitation in patients with valvular disease were 84.60% and 63.70%, respectively. Conclusion Parasympathetic excitation is an early manifestation of the disease, often accompanied by decreased left atrial function and/or left ventricular diastolic function. Sympathetic nerve excitation can be accompanied by the increase of SPAP and the decrease of left ventricular and right atrial systolic function. SPAP has a unique predictive value for the prediction of autonomic nerve excitation in patients with valvular disease.
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ObjectiveTo explore the impact of autonomic nerve function on motor function in patients with post-stroke depression (PSD) from the perspective of regional homogeneity (ReHo). MethodsFrom January to December, 2020, a total of 60 inpatients and outpatients with cerebral infarction in the Affiliated Brain Hospital of Nanjing Medical University were divided into control group (n = 30) and PSD group (n = 30). Two groups were assessed using Fugl-Meyer Assessment (FMA), modified Barthel Index (MBI) and Hamilton Depression Scale (HAMD). Heart rate variability (HRV) was measured. Ten patients in each group were selected randomly to undergo resting state functional magnetic resonance imaging (rs-fMRI) to calculate ReHo. ResultsAll HRV indices were lower in PSD group than in the control group (|t| > 2.092, P < 0.05). In PSD group, FMA and MBI scores showed positive correlations with 24-hour standard deviation of normal-to-normal R-R intervals (SDNN), the root mean square of successive differences between normal heartbeats over 24 hours (RMSSD), the percentage of differences between adjacent normal R-R intervals over 24 hours that were greater than 50 ms (PNN50), total power (TP), very low frequency power (VLF) and low frequency power (LF) (r > 0.394, P < 0.05), and showed negative correlations with HAMD scores (|r| > 0.919, P < 0.001). HAMD scores in PSD group were negatively correlated with SDNN, RMSSD, PNN50, TP and VLF (|r| > 0.769, P < 0.001). Compared with the control group, the ReHo increased in PSD group in the right rectus gyrus (142 voxels, t = 6.575), the left medial and paracingulate gyri (204 voxels, t = 4.925) (GRF correction, P-Voxel < 0.005，P-Cluster < 0.05); and reduced in the right cerebellum (191 voxels, t = -6.487), the left middle temporal gyrus (140 voxels, t = -5.516), and the left precentral gyrus (119 voxels, t = -4.764) (GRF correction, P-Voxel < 0.005，P-Cluster < 0.05) in PSD group. ConclusionAutonomic nerve function is related to motor dysfunction in patients with PSD. The modulation of emotional, cognitive and motor brain regions by the autonomic nervous system may play a role in influencing the motor function in patients with PSD.
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By summarizing and analyzing the research status of the influence of needling different acupoints on heart rate variability (HRV) and autonomic nervous function, it is found that Neiguan (PC 6), Zusanli (ST 36) and Shenmen (HT 7) are common acupoints for HRV analysis involving Tongli (HT 5), Hegu (LI 4), Taichong (LR 3), Zhongwan (RN 12), Danzhong (RN 17), Xinshu (BL 15), Shenshu (BL 23) and other acupoints. Different acupoints have different influences on HRV but followed by some rules, which are possibly related to the efficacy of acupoints, meridian tropism and acupoint distributions. Needling on the same acupoint also has different influences on HRV, which is possibly affected by sample size, intervention object, data processing method and other factors, so more standardized measurement process is required in further studies.
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Abstract Background Dexmedetomidine (Dex) is widely used, and its most common side effect is bradycardia. The complete mechanism through which Dex induces bradycardia has not been elucidated. This research investigates the expression of gap junction proteins Connexin30.2 (Cx30.2) and Connexin40 (Cx40) within the sinoatrial node of rats with Dex-induced sinus bradycardia. Methods Eighty rats were randomly assigned to five groups. Saline was administered to rats in Group C. In the other four groups, the rats were administered Dex to induce bradycardia. In groups D1and D2, the rats were administered Dex at a loading dose of 30 μg.kg−1 and 100 μg.kg−1 for 10 min, then at 15 μg.kg−1.h−1 and 50 μg.kg−1.h−1 for 120 min separately. The rats in group D1A and D2A were administered Dex in the same way as in group D1and D2; however, immediately after the administration of the loading dose, 0.5 mg atropine was administered intravenously, and then at 0.5 mg.kg−1.h−1 for 120 min. The sinoatrial node was acquired after intravenous infusion was completed. Quantitative real-time polymerase chain reaction and western blot analyses were performed to measure mRNA and protein expression of Cx30.2 and Cx40, respectively. Results The expression of Cx30.2 increased, whereas the expression of Cx40 decreased within the sinoatrial node of rats with Dex-induced sinus bradycardia. Atropine reversed the effects of Dex on the expression of gap junction proteins. Conclusion Dex possibly altered the expression of gap junction proteins to slow down cardiac conduction velocity in the sinoatrial node.
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Animals , Rats , Sinoatrial Node/metabolism , Dexmedetomidine , Arrhythmias, Cardiac , Atropine Derivatives/metabolism , Bradycardia/chemically induced , Connexins/genetics , Connexins/metabolismABSTRACT
Objective:To investigate the 12-lead electrocardiogram findings and their clinical significance in children with orthostatic hypertension (OHT), providing evidence for clinical diagnosis and treatment of OTH.Methods:Thirty-four children with OHT who received diagnosis and treatment in the Zhuji Second People's Hospital from January 2017 to December 2019 were included in the OHT group. An additional 34 healthy children who concurrently received routine physical examination were included in the control group. Both groups of children underwent a 12-lead electrocardiogram in lying and standing positions. The changes in ST-segment and T-wave amplitudes in the lying position relative to the standing position were compared between the two groups.Results:The changes in T-wave amplitude of leads II, V 5, and V 6 in the OHT group were (0.07 ± 0.11) mV, (0.13 ± 0.12) mV, and (0.14 ± 0.11) mV, respectively, which were significantly higher than those in the control group [(0.02 ± 0.07) mV, (0.05 ± 0.06) mV, (0.03 ± 0.04) mV, t = 2.24, 3.48, 5.48, P = 0.029, 0.001, < 0.001). There were no significant differences in the changes in T-wave amplitude of other leads between the two groups (all P > 0.05). There was no significant difference in change in ST-segment amplitude on 12-lead electrocardiogram images between the two groups (all P > 0.05). The area under the curve of the changes in T-wave amplitude of leads II and V 5 in predicting OHT in children was 0.596 and 0.672 respectively, the sensitivity was 64.71% and 55.88%, respectively, and the specificity was 70.59% and 61.76%, respectively. The changes in T-wave amplitude of leads II and V 5 had low efficacy in predicting OHT in children. The area under the curve of the change in T-wave amplitude of lead V 6 in predicting OHT in children was 0.738, and the sensitivity and specificity were 76.47% and 67.65%, respectively. The change in T-wave amplitude of lead V 6 had moderate efficacy for predicting OHT in children. Conclusion:The changes in T-wave amplitude of lead V 6 on the electrocardiogram image taken in the lying position relative to the standing position are of certain value in predicting OHT in children. The 12-lead electrocardiogram can provide important evidence for clinical prediction and diagnosis of OHT in children.
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Rectal cancer is a common malignant tumor of the digestive tract, and surgery is the main treatment strategy. Disorders of bowel, anorectal and urogenital function remain common problems after total mesorectal resection (TME), which seriously decreases the quality of life of patients. Surgical nerve damage is one of the main causes of the complications, while TME with pelvic autonomic nerve preservation is an effective way to reduce the occurrence of adverse outcomes. Intraoperative nerve monitoring (IONM) is a promising method to assist the surgeon to identify and protect the pelvic autonomic nerves. Nevertheless, the monitoring methods and technical standards vary, and the clinical use of IONM is still limited. This review aims to summarize the researches on IONM in rectal and pelvic surgery. The electrical nerve stimulation technique and different methods of IONM in rectal cancer surgery are introduced. Also, the authors discuss the limitations of current researches, including methodological disunity and lack of equipment, then prospect the future direction in this field.
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Humans , Autonomic Pathways , Pelvis/surgery , Quality of Life , Rectal Neoplasms/surgery , Rectum/surgeryABSTRACT
Alzheimer's disease (AD) is one of the most common neurodegenerative diseases in the elderly. The aim of this study was to explore the effects of AD on cardiac function and autonomic nervous function, and the feasibility of electrocardiogram (ECG) in monitoring the development of AD. APP/PS1 double transgenic mice were used in the Morris water maze (MWM) experiment to evaluate the changes of cognitive ability of AD mice, then the non-invasive ECG acquisition system was used and the changes of ECG intervals and heart rate variability (HRV) were analyzed. AD mice already had cognitive dysfunction at the age of 5 months, reaching the level of mild dementia, and the degree of dementia increased with the course of disease. There were no significant changes in ECG intervals in the AD group at each month. The mean square of successive RR interval differences, percentage of intervals >6 ms different from preceding interval, and normalized high frequency power component in the AD group were decreased and low-to-high frequency power ratio and normalized low frequency power component were increased. Combined with the results of the MWM, it was shown that the regulation mechanism of sympathetic and parasympathetic nerves in mice was already imbalanced in early stage AD, which was manifested as the increase of excessive activity of sympathetic nerves and the inhibition of parasympathetic activities. Therefore, ECG-based analysis of HRV may become a means of daily monitoring of AD and provide an auxiliary basis for clinical diagnosis.
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At Kobe Minato Hot Spring Lotus, a hot spring health promotion facility certified by the Ministry of Health, Labor and Welfare, the effect of subjective evaluation and measurement of blood pressure and autonomic nerves before and after the intervention of the participants. We verified and aimed to build a hot spring utilization type health promotion accommodation type program that can contribute to the physical and mental improvement of participants by short-term accommodation. As a relaxation-based program, basic yoga, underwater exercise, healing yoga, morning yoga, wellness walking, sound healing, bedrock hot yoga, bathing, were carried out. The survey target was recruited after obtaining approval for the use of the “Healthcare Development Citizen Supporter” at the Foundation for Biomedical Research and Innovation at Kobe, and was recruited on 31 women participated in this program (age 53.4±7.3 years old, BMI 22.4±3.4). One week before and one week after the intervention, the Chalder’s fatigue survey was carried out by mail, and blood pressure and autonomic nerves were measured immediately before and immediately after the intervention. The effects were verified from two viewpoints of subjective evaluation and changes in mind and body by measuring autonomic nerves by blood pressure and ccvTP. Before and after the intervention, systolic blood pressure (121.1±13.9 mmHg and 114.6±13.3 mmHg; p＝0.0101) decreased, and diastolic blood pressure (79.0±16.0 mmHg and 72.8±16.6 mmHg; p＝0.0027) also decreased. The overall fatigue (3.07±2.29 and 2.11±2.10; p＝0.0080) of the Chalder’s fatigue survey before and after the intervention was also reduced. No change in autonomic nerves due to ccvTP before and after the intervention was confirmed. In this survey, it was confirmed that Chalder’s fatigue was improved and blood pressure was improved, but the autonomic nerve was not improved. However, since blood pressure has been reported to be related to the autonomic nerves, it may improve the autonomic nerves after long-term stay and after home life, but further investigation is required.
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Children and adolescents with orthostatic intolerance (OI) have autonomic nervous dysfunction.The autonomic nervous system is closely related to the cardiovascular system, and autonomic nervous dysfunction can cause changes in electrocardiographic (ECG) indexes, including the heart rate variability (HRV), ventricular late potential (VLP), P wave dispersion (Pd), QT interval dispersion (QTd), T peak-T end interval and etc.In this paper, the recent research progress on the electrocardiogram changes of OI in children and adolescents is reviewed.
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The difficulty of transanal total mesorectal excision (TME) is to find the correct dissection plane of perirectal space. As a complex new surgical procedure, the fascial anatomic landmarks of transanal approach operation are more likely to be ignored. It is often found that dissection plane is false after the secondary injury occurs during the operation, which results in the damage of pelvic autonomic nerves. Meanwhile, the mesorectum is easily damaged if the dissection plane is too close to the rectum. Thus, the safety of oncologic outcomes could be limited by difficulty achieving adequate TME quality. The promotion and development of the theory of perirectal fascial anatomy provides a new thought for researchers to design a precise approach for transanal endoscopic surgery. Transanal total mesorectal excision based on fascial anatomy offers a solution to identify the transanal anatomic landmarks precisely and achieves pelvic autonomic nerve preservation. In this paper, the authors focus on the surgical experience of transanal total mesorectal excision based on the theory of perirectal fascial anatomy, and discuss the feature of perirectal fascial anatomy dissection and technique of pelvic autonomic nerve preservation during transanal approach operation.
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Humans , Autonomic Pathways/surgery , Proctectomy , Rectal Neoplasms/surgery , Rectum/surgery , Transanal Endoscopic SurgeryABSTRACT
Urinary and sexual dysfunctions due to intraoperative pelvic autonomic nerve injury have become the most common complications of rectal cancer surgery, seriously affecting postoperative quality of life. How to protect the nerve and urogenital function while ensuring radical resection for rectal cancer has become the focus of research. We previously carried out a series of systematic studies on Denonvilliers fascia, an important anatomical structure closely related to protection of pelvic autonomic nerve, and demonstrated the importance of Denonvilliers fascia in preservation of intraoperative pelvic autonomic nerve and protection of postoperative urogenital function from aspects of anatomy, physiology, tissue, operation practice and so on. Meanwhile, based on the interim results of our multicenter randomized controlled study, we confirmed that total mesorectal excision with preservation of Denonvilliers fascia (innovative TME, iTME) could effectively reduce the incidence of postoperative urinary and sexual dysfunctions in male patients with mid-low rectal cancer, without sacrificing oncologic outcome. In this article, combined with our research results, we review the literature on anatomy research progress of Denonvilliers fascia to demonstrate the significance and research prospect of Denonvilliers fascia in the pelvic autonomic nerve preservation surgery for rectal cancer.
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Humans , Male , Autonomic Pathways , Fascia , Multicenter Studies as Topic , Pelvis/surgery , Quality of Life , Randomized Controlled Trials as Topic , Rectal Neoplasms/surgery , Rectum/surgeryABSTRACT
Bidirectional regulation is one of the key function of acupuncture. The stimulator, mediator and receptor are the basis while the specificity of acupoints and the multi-target regulation of receptors receiving stimulation signals are the essential link of the bidirectional regulation of acupuncture. The possible mechanisms of bidirectional regulation of acupuncture are discussed in 4 aspects, i.e. homeostasis mechanism, stress reaction, central adaptive regulation and autonomic nerve regulation. Knowing the limitations of bidirectional regulation and exploring suitable researchmethods are proposed to be the key points in future researches.
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Acupuncture , Acupuncture Points , Acupuncture TherapyABSTRACT
Atrial fibrillation (AF) is the most common arrhythmia in clinical work, accounting for about 1/3 of patients in hospital due to arrhythmia. Recently, more and more studies have shown that cardiac autonomic nerve and its remodeling are involved in the occurrence and maintenance of AF, which is one of the important mechanisms of AF. At present, the treatment methods of AF include drug therapy and radiofrequency ablation. As we all know, drug therapy has many limitations. In this paper, the mechanism of sympathetic, parasympathetic nerve and AF and the changes of cardiac autonomic nerve and its remodeling area before and after the occurrence of AF were studied, so as to explore a better treatment method of AF, and then simplify the tedious steps of radiofrequency ablation, reduce the scope of ablation, more accurately locate ectopic trigger point and vulnerable matrix, reduce the intensity of ablation, improve the success rate of operation and obtain good economic benefits.
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[Purpose] This study is a case report of an acupuncturist's new evaluation index for acupuncture treatment aimed at reducing or eliminating cardiac rehabilitation inhibitory factors in home medical care due to exacerbation of heart failure. [Method] Acupuncture was evaluated by heart rate variability, respiratory sinus arrhythmia, and saturation pulse O2. [Results] In severe heart failure in the evaluation index used in this study, there was no significant change in the autonomic function of the heart before and after acupuncture stimulation.[Discussion] In order for acupuncture to be accepted as a member of team medical care in the future, acupuncturists need to share objective information for multi-professional collaboration.
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Background: The occurrence of gastrointestinal symptoms in cirrhotic patients with gastroesophageal varices (GOV) after endoscopic treatment is obvious, and the role of gastric myoelectrical activity (GMA) and autonomic nerve function imbalance in the development of gastrointestinal symptoms has not been clarified. Aims: To investigate the changes of GMA and autonomic nerve function in cirrhotic patients with GOV after endoscopic treatment. Methods: Twenty-five cirrhotic patients with GOV from May 2019 to October 2019 at the First Affiliated Hospital of Nanjing Medical University were enrolled, and 10 patients with gastric polyp were served as controls. Electrogastrogram (EGG) and heart rate variability (HRV) were detected before the operation, 1 day after the operation and 5 days after the operation in GOV group. For the gastric polyp group, EGG and HRV were detected before the operation and 1 day after the operation. Changes of GMA and autonomic nerve function were compared between the two groups. Results: No significant differences in GMA and autonomic nerve function were found between GOV group and gastric polyp group before and 1 day after the operation (P>0.05). LF, LF/HF were significantly increased 1 day after the operation in GOV group (P0.05). There were no significant differences in GMA and autonomic nerve function 1 day after the operation compared with pre-operation in gastric polyp group (P>0.05). Compared with Child-Pugh A group, Child-Pugh B group had more obvious GMA abnormalities, and the difference was statistically significant (P<0.05). Conclusions: In cirrhotic patients with GOV, the percentage of bradygastria and the sympathetic activity increased, and the vagal activity decreased 1 day after the operation. These results suggest that GMA and autonomic nerve dysfunction may be related to the gastrointestinal symptoms after endoscopic treatment.
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Pulmonary artery denervation (PADN) can block local sympathetic nerve of pulmonary artery,reduce the hemedynamic parameters of pulmonary arterial hypertension(PAH),attenuate pulmonary vascular remodeling,right ventricular hypertrophy and fibrosis,thus improving cardiac function.Early basic experiment has determined the position of sympathetic nerve of pulmonary artery in pulmonary endarterium and confirmed the safety and effectiveness of PADN in the animal model of PAH.PADN may play a role by inhibiting execssive activation of the sympathetic nervous system and renin-angiotension-aldosterone system.PADN has been applied to adult clinical research,and has achieved a good clinical effect.On this basis,the possibility of applying PADN to children's PAH is being explored preliminarily.
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Pulmonary artery denervation (PADN) can block local sympathetic nerve of pulmonary artery, reduce the hemodynamic parameters of pulmonary arterial hypertension(PAH), attenuate pulmonary vascular remodeling, right ventricular hypertrophy and fibrosis, thus improving cardiac function.Early basic experiment has determined the position of sympathetic nerve of pulmonary artery in pulmonary endarterium and confirmed the safety and effectiveness of PADN in the animal model of PAH.PADN may play a role by inhibiting execssive activation of the sympathetic nervous system and renin-angiotension-aldosterone system.PADN has been applied to adult clinical research, and has achieved a good clinical effect.On this basis, the possibility of applying PADN to children′s PAH is being explored preliminarily.
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Blast wave can stimulate the sympathetic and parasympathetic nervous system, leading to the changes of autonomic nervous function. It can also damage the hypothalamus and pituitary, and activate the hypothalamic-pituitarytarget gland axis and the locus ceruleus-sympathetic-adrenal medulla axis, resulting in the changes of endocrine level. In addition, it can activate inflammatory cells, synthesize and release different inflammatory mediators, resulting in the changes of inflammatory response. This paper reviews the changes and interactions of autonomic nervous function, endocrine level and inflammatory response in blast wave injury, and further explains the injury mechanism of blase wave, providing references for the treatment of blast wave injury..
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At Kobe Minato Hot Spring Lotus, a hot spring health promotion facility certified by the Ministry of Health, Labor and Welfare, the effect of subjective evaluation and measurement of blood pressure and autonomic nerves before and after the intervention of the participants. We verified and aimed to build a hot spring utilization type health promotion accommodation type program that can contribute to the physical and mental improvement of participants by short-term accommodation. As a relaxation-based program, basic yoga, underwater exercise, healing yoga, morning yoga, wellness walking, sound healing, bedrock hot yoga, bathing, were carried out. The survey target was recruited after obtaining approval for the use of the “Healthcare Development Citizen Supporter” at the Foundation for Biomedical Research and Innovation at Kobe, and was recruited on 31 women participated in this program (age 53.4±7.3 years old, BMI 22.4±3.4). One week before and one week after the intervention, the Chalder’s fatigue survey was carried out by mail, and blood pressure and autonomic nerves were measured immediately before and immediately after the intervention. The effects were verified from two viewpoints of subjective evaluation and changes in mind and body by measuring autonomic nerves by blood pressure and ccvTP. Before and after the intervention, systolic blood pressure (121.1±13.9 mmHg and 114.6±13.3 mmHg; p＝0.0101) decreased, and diastolic blood pressure (79.0±16.0 mmHg and 72.8±16.6 mmHg; p＝0.0027) also decreased. The overall fatigue (3.07±2.29 and 2.11±2.10; p＝0.0080) of the Chalder’s fatigue survey before and after the intervention was also reduced. No change in autonomic nerves due to ccvTP before and after the intervention was confirmed. In this survey, it was confirmed that Chalder’s fatigue was improved and blood pressure was improved, but the autonomic nerve was not improved. However, since blood pressure has been reported to be related to the autonomic nerves, it may improve the autonomic nerves after long-term stay and after home life, but further investigation is required.
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Objective To investigate effects of laryngeal mask ventilation combined with continuous nerve block analgesia versus the endotracheal intubation under general anesthesia on postoperative lung infection in elderly patients undergoing orthopedic surgery,so as to provide a theoretical basis for a reasonable anesthesia method.Methods A total of 180 elderly patients undergoing lower extremity orthopedic surgery at our hospital from January 2016 to December 2016 were enrolled and randomly divided into two groups.The control group (n =90) were treated with endotracheal intubation under general anesthesia and intravenous analgesia after the operation,and the observation group (n =90)received the ultrasound-guided continuous nerve block analgesia in spontaneous respiration with laryngeal mask ventilation.The anesthetic dosage,awakening time,visual analogue scale(VAS)scores,and incidence of lung infections at 7 days after surgery were compared between the two groups.Pathogenic strains causing lung infections were isolated and identified.Results The anesthetic dosage was lower in the observation group than in the control group(P ＜ 0.05).The awaking time was shorter in the observation group than in the control group[(22.4±4.4) min vs.(34.1±8.5)min,P ＜0.05].The VAS scores under postoperative exercise were lower in the observation group than in the control group(P ＜0.05).The adverse reaction rate after surgery was lower in the observation group than in control group(3.3％ or 3/90 cases vs.41.1％ or 37/90 cases,P ＜0.05).The incidence of lung infections at 7 days after surgery was lower in the observation group than in the control group(3.3％ or 3/90 cases vs.11.1％ or 10/90 cases,P＜0.05).Ten pathogenic strains were isolated from control group,of which 9 strains were gram-negative bacteria,accounting for 90.0％.Three pathogenic strains were isolated from the observation group,of which 2 strains were gram-negative bacteria,accounting for 66.7％.Conclusions Laryngeal mask ventilation combined with continuous nerve block analgesia can reduce the anesthetic dosage,shorten the awaking time,provide a better analgesic effect and decrease the incidence of lung infections in elderly patients undergoing lower extremity orthopedics.The main pathogenic bacteria are gram-negative bacteria.