Effect of cooperation by using iPAD for preoperative intervention undergoing phimosiectomy / 中国实用护理杂志

Objective To evaluate the effect cooperation by using iPAD for preoperative intervention undergoing phimosiectomy. Methods Totally 60 children,undergoing phimosiectomy,were divided into the experimental group and the control group with 30 cases each by random digits table method. A conventional preoperative interview was performed in the control group. In the experimental group, the parents and the children would be given education about the environment of operation room and materials of educational propaganda by watching video in a preoperative interview,furthermore,the children got the entitlement to chose their favorite cartoons, which would be played in operation room. The age, weight, time for surgery and the number for general anesthesia were recorded. The anxiety level of the parents, assessed by Hamilton Anxiety Scale, were carried out before and after operation. The satisfaction score, coming from the parents for operation room work and the surgeon for the operation process were also carried out. Results The anxiety level of the parents assessed by Hamilton Anxiety Scale, after the operation,the number for general anesthesia and the time for surgery were(44.2 ± 7.4)points,11 cases, (11.9 ± 3.2)points in the experimental group,and (51.2 ± 6.0)points,28 cases,(17.7 ± 5.8)points in the control group, and there were significant differences(t =4.005, 4.704, χ2=10.978, all P<0.01). The satisfaction score, coming from the parents for operation room work and the surgeon for the operation process were higher than that in the control group (χ2=10.162, 14.836, P<0.01). Conclusions The cooperation of the children,undergoing phimosiectomy,could be improved significantly by the application of iPAD in preoperative interview.

Effects of Xuebijing on cerebral cortex apoptosis factors bcl-2 and bax in rats at early stage after cardiopulmonary resuscitation / 中国中西医结合急救杂志

ObjectiveTo observe the effects of different doses of Xuebijing on cerebral cortex apoptosis factors bcl-2 and bax in rats at early stage after cardiopulmonary resuscitation (CPR).Methods Thirty-two healthy SD rats aged 12 weeks were divided into four groups by using a random number table method (each,n = 8); all the rats were intubated through the opening of tracheotomy, and the blood pressure was measured through the left/right femoral artery catheter. Asphyxiation was applied to rats, resulting in cardiac arrest (CA), and then cardiopulmonary resuscitation (CPR) was carried out. After restoration of spontaneous circulation (ROSC), 0.9% normal saline 8 mL/kg, 0.9% normal saline 4 mL/kg + Xuebijing 4 mL/kg, 0.9% normal saline 2 mL/kg + Xuebijing 6 mL/kg and Xuebijing 8 mL/kg were given to model group, Xuebijing low dose group, middle dose group and high dose group respectively. The rat body weight, time of CA, CPR-ROSC time, ROSC ratio and the amounts of dopamine and 0.9% saline used in 24 hours were recorded. The positive protein expression levels of bcl-2 and bax in rat cerebral cortex and the ratio of bcl-2/bax was measured at 24 hours after ROSC.Results Compared with the model group, the amount of 0.9% normal saline (mL: 4.2±1.2, 2.6±1.0, 2.5±1.0 vs. 5.5±1.1,P < 0.05) and of dopamine used in 24 hours (μg: 1865±189, 1376±197, 1215±145 vs. 3526±141,P < 0.05), the levels of positive protein expression of bcl-2 (%: 33.4±4.3, 25.5±4.6, 26.1±4.2 vs. 38.5±5.1), and of bax at 24 hours after ROSC (%: 39.5±4.3, 32.8±3.8, 31.9±3.7 vs. 44.3±5.1) and the ratio of bcl-2/bax (0.87±0.16, 0.72±0.13, 0.71±0.14 vs. 0.89±0.11) was significantly decreased in low, middle and high dose groups (allP < 0.05). Compared with the low dose group, the amount of 0.9% normal saline and dopamine used in 24 hours, protein expression levels of bcl-2 and bax at 24 hours and the ratio of bcl-2/bax in middle dose and high dose groups were all lower than those in low dose group (allP < 0.05).Conclusion Xuebibing 6 mL/kg applied at early stage after CPR in rats may show relatively good protective effect on cerebral cortex.

Ventilatory efficiency and exercise capacity during exercise in patients with idiopathic pulmonary fibrosis / 中华全科医师杂志

Objective To explore the characteristics of ventilatory efficiency and exercise capacity during cardiopulmonary exercise testing in patients with idiopathic pulmonary fibrosis (IPF).Methods Pulmonary function test,arterial blood gas analysis and cardiopulmonary exercise testing were performed in 28 IPF patients (IPF group) from April 2012 to April 2013 and 28 healthy volunteers (control group).And the relevant parameters were measured and compared.Results No significant differences existed in age [(57.8 ±9.8) vs.(59.2 ±5.5) years],gender or body mass index (BMI) [(23.8 ±2.7) vs.(25.0 ± 2.8) kg/m2,P ＞ 0.05].The paramneters of pulmonary function test,such as forced vital capacity ％ predicted (74.8 ± 14.6 vs.101.8 ± 10.8),forced expiratory volume in 1 second ％ predicted (73.8 ± 14.6 vs.97.0 ± 10.1),maximum voluntary ventilation ％ predicted (77.5 ± 14.9 vs.95.4 ±24.5),total lung capacity ％ predicted (75.6 ± 12.4 vs.99.8 ± 5.4),residual volume ％ predicted (80.7 ± 15.4 vs.95.8 ± 11.3),diffusing capacity of lung for carbon monoxide ％ predicted (66.2 ± 13.7 vs.103.2 ± 17.3) in the IPF group,were significantly lower than those of the control group (P ＜ 0.01).The parameters of arterial blood gas analysis,such as PaO2 [(72.7 ± 7.3) vs.(92.6 ± 3.8) mmHg] and SaO2 (94.3 ± 2.1 vs.98.3 ± 0.7),were lower than those of the control group (P ＜ 0.01).Thus P(A-a) O2 in the IPF group was higher than that in the control group (33.3 ± 5.7 vs.17.8 ± 1.9,P ＜0.01).These results strongly suggested that IPF group had restrictive ventilatory dysfunction and impaired gas exchange.The IPF patients had higher VE/VCO2-slope (37.4 ± 5.3 vs.25.7 ± 2.5,P ＜ 0.01) and lowest VE/VCO2 (39.2 ±6.7 vs.30.6 ± 2.7,P ＜ 0.01) than the controls; VE/VCO2 and VD/VT during every period were significantly higher in the IPF group than those in the control group (P ＜ 0.01) ; during peak exercise,peakLoad％pred (70.4 ±±29.9 vs.104.8 ±29.7,P ＜0.01) and peakVO2％pred (68.7 ±29.8 vs.98.7 ±36.4,P =0.001) were significantly lower in the IPF group than those in the control group.In the IPF group,VE/VCO2@AT,VE/VCO2-slope and lowest VE/VCO2 had a negative correlation with DLCO％pred (r=-0.589,P ＜0.01; r=-0.481,P＜0.05; r=-0.527,P＜0.05).In the IPF group,VE/VCO2@AT,VE/VCO2-slope and lowest VE/VCO2 had a negative correlation with peakVO2％ pred (r =-0.548,P ＜ 0.05 ; r =-0.539,P ＜ 0.05 ; r =-0.564,P ＜ 0.05).So the exercise tolerance and ventilation efficiency of the IPF group decreased significantly.Conclusion Cardiopulmonary exercise testing reveals that the ventilation efficiency of IPF patients decreases significantly so as to seriously affect their exercise tolerance

Comparison of the effects of different analgesia methods for artificial abortion / 中国基层医药

Objective To observe the clinical effect of multimodal analgesia for painless artificial abortion . Methods 150 cases of ASA Ⅰ-Ⅱ pregnancy received painless artificial abortion operation ,no contraindication for all patients,were randomly divided into the five groups ,30 cases in each group,the blank control group (group S):do not use any analgesia measure ,intravenous injection of 0.9% sodium chloride 2mL preoperation;the fentanyl group ( F group ) :intravenous injection of fentanyl 1μg/kg preoperation ;the parecoxib group ( group P ) :intravenous injection of parecoxib sodium 40mg preoperation.The patients were given painless artificial abortion after injection the above drugs.Nerve block group ( N group):the implementation of painless induced abortion operation after sleep in patients with the cervical nerve block ,injection of 1%lidocaine 2 mL.Multimodal analgesia group (group M):intra-venous injection of parecoxib sodium 40mg,fentanyl 1μg/kg,then the implementation method the same as N group . The operation time,anesthesia onset time,recovery time,time of accurate orientation and additional dosage of propo-fol;incidence rate of artificial abortion syndrome ,the incidence rate of uterine contraction pain ,10min,30min,1h,6h pain scores after operation; adverse reaction;satisfaction score of analgesic effect postoperative 24h were observed. Results The additional dosage of propofol in the group S ,group F,group P,group N and group M were (78.45 ± 20.36)mg,(15.55 ±12.33)mg,(16.75 ±13.13)mg,(14.55 ±10.25)mg,(9.35 ±8.27)mg.The incidence rates of uterine contraction pain in the group S ,group F,group P,group N and group M were 30%,10%,10%,10%,0. Compared with group M ,the additional dosage of propofol and incidence rate of uterine contraction pain in the other four groups were significantly increased (t=3.05,1.82,1.84,1.78,χ2 =72.1,68.2,68.2,68.2,all P<0.05). Pain scores after operation 10min,30min,1h,6h in the group S were (6.6 ±1.5)points,(5.6 ±1.4)points,(4.6 ± 1.1)points,(3.6 ±1.4)points.Those in group F were (5.1 ±1.5)points,(4.3 ±1.1)points,(3.1 ±0.9)points, (2.8 ±0.8).Pain scores after operation 10min,30min,1h,6h in the group P were (4.6 ±1.5) points,(4.2 ± 0.9)points,(2.9 ±0.8) points,(2.7 ±0.6) points.Those in the group N were (4.5 ±1.5) points,(4.1 ± 0.8)points,(2.9 ±0.8)points,(2.6 ±0.5).Pain scores after operation 10min,30min,1h,6h in the group M were (2.2 ±0.8)points,(1.9 ±0.7)points,(1.5 ±0.5)points,(1.2 ±0.3)points.Compared with the group M,pain scores after operation 10min,30min,1h,6h in the other four groups were significantly elevated ( t=2.03,1.96,1.86, 1.84,1.98,1.82,1.80,1.76,2.05,1.99,1.95,1.86,2.06,1.88,1.82,1.76,all P<0.05).Compared with S group,postoperative 24h satisfaction score of analgesia in the group M was improved significantly ( t =1.98,P<0.05).Compared with group M,the incidence rate of nausea in the other four groups was increased significantly (χ2 =72.2,68.9,68.1,68.1,all P<0.05).Conclusion Multimodal analgesia method can greatly reduce artificial abor-tion postoperative pain ,reduce the adverse reactions ,improve patients'satisfaction score ,ensure the safety of operation .

Correlation of heart rate recovery after exercise test with exercise capacity in patients with stable chronic obstructive pulmonary disease / 中华全科医师杂志

Objective To explore the correlation between heart rate recovery after exercise test and disease severity in patients with chronic obstructive pulmonary disease(COPD)and assess its impact on the exercise capacity of COPD patients.Methods Arterial blood gas analysis, pulmonary lung function test and cardiopulmonary exercise testing were performed in 60 patients with stable COPD and 50 healthy volunteers.Based on the heart rate recovery after exercise test, COPD patients were divided into normal heart rate recovery group(n =41)and abnormal heart rate recovery group(n =19).Results The COPD patients had lower exercise capacity(peak oxygen uptake as percentage of predicted value, peak VO2％ pred)(66 ± 15vs.89±11, P＜0.01), peak heart rate [(134±21)vs.(149±13)beats/min, P＜0.01], heart rate recovery[(18 ± 9)vs.(27 ± 10)beats/min, P ＜ 0.01] and higher resting heart rate [(83 ± 13)vs.(77 ± 13)beats/min, P ＜0.01] than the controls.Compared with normal heart rate recovery group, forced expiratory volume in one second as percentage of predicted(FEV1 ％ pred)and exercise capacity decreased more significantly in abnormal heart rate recovery group(38 ± 15 vs.52 ± 16, P＜0.05 and 57 ± 12 vs.71 ±14, P ＜0.01).Heart rate recovery was significantly correlated with FEV1％ pred and peak V O2％ pred(r=0.42, P ＜ 0.01 and r =0.52, P ＜ 0.01).Multivariate regression analysis showed that heart rate recovery and FEV1 ％ pred could be used as independent predictors of exercise capacity in COPD patients.Conclusion In COPD patients, heart rate recovery is correlated with the degree of disease severity and it may be an independent predictor of exercise capacity.

The effects of ulinastatin on the cells factor and cardiac function after cardiopulmonary resuscitation in rats / 重庆医学

Objective To investigate the protective effects of ulinastatin on the hearts of rats with anoxia-induced cardiac arrest-cardiopulmonary resuscitation(CA-CPR) and the mechanism of improving cardiac dysfunction .Methods Twenty male Sprague Dawley(SD) rats were randomly divided into three experimental groups :sham operation group (group A ,n= 8 ,only anesthesia , tracheotomy tube and vascular puncture) ,control group(group B ,n= 6 ,normal saline 4 mL · kg -1 injected via vein) ,Ulinastatin treatment group(group C ,n=6 ulinastatin 50 000 U/kg+normal saline 3 mL · kg -1 injected via vein);Factors including mean arte-rial pressure(MAP) ,left ventricular end diastolic pressure(LVEDP) ,the maximum rising and falling rates of left ventricular deep pressure(± LVdp .dt-1max) ,brain natriuretic peptide(BNP) ,cardiac troponin T(cTNT) ,IL-12 and TNF-αwere observed at setting time before and after cardiopulmonary resuscitation in rats .Results Compared with those of the group A and before CA-CPR ,the concentrations of IL-12、cTNT、TNF-α、BNP、and LVEDP increased(P<0 .01)while ± LVdp .dt-1max decreased(P<0 .01) at 6 h after CA-CPR in group B ,C .Compared with those of group B ,the concentrations of IL-12、CTNT、TNF-α、BNP and LVEDP of 6 h after CA-CPR in group C were lower and ± LVdp .dt-1max was higher(P<0 .01) ,The concentrations of MAP of 6 h after CA-CPR in group B was lower Compared with that of group A ,C and before CA-CPR(P<0 .01) .Conclusion Ulinastatin can improve cardiac dysfunction by depressing mediators of inflammation and reducing myocardial injury .

Efficacy of laryngeal mask airway Supreme in elderly patients with hypertension / 中华麻醉学杂志

Objective To evaluate the efficacy of laryngeal mask airway (LMA) Supreme in the elderlypatients with hypertension.Methods Forty elderly patients with more than 1-year history of hypertension,aged65-75 yr,weighing 45-70 kg,with body mass index ＜ 35 kg/m2,were randomized into 2 groups (n=20 each):intratracheal intubation group (group T) and LMA Supreme group (group S).Anesthesia was induced with fenta-nyl,propofol and vecuronium.LMA Supreme was inserted in group S or intratracheal intubation was performed ingroup T for mechanical ventilation.Anesthesia was maintained with sevoflurane,propofol and vecuronium.Thesystolic blood pressure (SBP),diastolic blood pressure (DBP),heart rate (HR) and pulse oxygen saturation(SpO2) were recorded after entering the operating room (T0),at 0,1,2 and 5 min after LMA insertion or intuba-tion (T1-4),at skin incision (T5),and immediately after removal of LMA or extubation (T6).Venous blood samples were taken at T0-4,6 for determination of plasma epinephrine (AE),noradrenaline (NE) and dopamine (DA)concentrations.The insertion and removal responses,LMA insertion/intubation time and the number of inserting LMA/intubation were recorded.The lung compliance,airway peak pressure,airway sealing pressure and airway plateau pressure were detected after LMA insertion/intubation.The side effects occurred in the pharynx were recorded after removal of LMA or extubation.Results Compared with group T,the SBP,HR,insertion and removal responses,incidence of side effects and plasma AE,NE and DA concentrations were significantly decreased and LMA insertion/intubation time was significantly shortened in group S (P ＜ 0.05).Compared with the baseline value at T0,the concentration of plasma NE was significantly increased at T2 in group S,the concentration of plasma NE was significantly increased at T1-4.6 and the concentration of plasma AE and DA was significantly increased at T1.3 in group T (P ＜ 0.05).Conclusion LMA Supreme has better efficacy for airway management in the elderly patients with hypertension than intratracheal intubation,with lower insertion and removal responses and fewer side effects occurred in the pharynx.

Efficacy of Discoscope endoscope versus GlideScope video laryngoscope for difficult glottis exposure / 中华麻醉学杂志

Objective To compare the efficacy of Discoscope endoscope and GlideScope video laryngoscope for difficult glottis exposure.Methods Forty adult patients of both sexes scheduled for elective surgery under general anesthesia whose glottis was not visible at laryngoscopy (grade Ⅲ or Ⅳ according to Cormach-Lehane Grading of laryngoscopic view) were randomized into 2 groups (n =20 each):group GlideScope video laryngoscope (group G) and group Discoscope endoscope (group D).The glottis exposure time,intubating conditions,time from exposure of glottis to completion of tracheal intubation and incidence of postoperative sore throat and throat bleeding were recorded and compared between the 2 groups.Results Compared with group G,the glottis exposure time was significantly longer,the rate of backward pressure of cricoid cartilage lower,the time from exposure of glottis to completion of tracheal intubation shorter and the success rate of tracheal intubation at first attempt higher (P ＜ 0.05).There was no significant difference in the success rate of tracheal intubation at second attempt and postoperative incidence of sore throat and throat bleeding between the 2 groups(P ＞ 0.05).Conclusion DiscoScope endoscope is superior to GlideScope video laryngoscope in the management of difficult intubation in term of glottis exposure and success rate of tracheal intubation at first attempt.

The effects of Xuebijing injection on the expressions of transcription factors T-bet and GATA-3 of the rats after cardiopulmonary resuscitation / 中华急诊医学杂志

Objective To investigate the effects of Xuebijing injection on the transcription factors GATA-3 and T-bet of rats after cardiopulmonary resuscitation (CPR). Method The rat models of CPR was made by using asphyxia method. Thirty SD rats were randomly (random number) divided into three groups at random: sham operation rats (B group), conventional CPR rats (C group) and Xuebijing (4 mL/kg) treated rats (D group). The levels of serum IL-12, IL-4, TNF-α and IFN-γ were measured by using ELISA. The expressions of T-bet and GATA-3 mRNA in serum were detected by RT-PCR. The analysis of variance was used to compare the means of different groups including t-test and Wilcoxon test. Results Compared with group B, the levels of serum IL-12, TNF-α and IFN-γ in group C and group D were significantly elevated after CPR for 6 hours (P<0.01). In group C, the expression of GATA-3 mRNA and GATA-3/T-bet decreased (both P < 0.05), while the expression of T-bet mRNA increased (P<0.01) after CPR for 6 hours. In group D, the expressions of GATA-3 mRNA and T-bet mRNA as well as GATA-3/T-bet increased after CPR for 6 hours. The levels of IL-12, IFN-γ and TNF-α in group D were lower than those in groupC (P<0.01). Compared with group C, the expression of GATA-3 mRNA and GATA-3/T-bet were significantly elevated and the expression of T-bet mRNA decreased in group D. ConclusionsThe transcription factors GATA-3 and T-bet may fail to get balance after CPR. The Xiebijing injectio can modulate the balance between GATA-3 and T-bet, and the levels of IL-12,IFN-γ and TNF-α.

Effects of Xuebijing Injection on the Cardiac Function and Calcium Ions in Cardiac Myocytes of Rats after Anoxia-induced Cardiac Arrest-Cardiopulmonary Resuscitation(CA-CPR) / 中国药房

OBJECTIVE: To investigate the effect of Xuebijing injection on the cardiac function and calcium ions of cardiocyte in rats after anoxia-induced cardiac arrest-cardiopulmonary resuscitation(CA-CPR).METHODS: CA-CPR model was induced in rats and then the model rats were randomized to 4 groups,i.e.sham group,model group,Xuebijing injection high dose group(4 mL?kg-1),and Xuebijing injection lowdose group(Xuebijing injection 2 mL?kg-1).Mean arterial pressure(MAP),?LVdp/dt max,average fluorescence intensity of calcium and pathological changes of cardiocytes were observed at 0 and 6 hours after resuscitation,respectively.RESULTS: Compared with model group,Xuebijing ingection high dose group at 6 h showed significantly increased MAP(P