Optimum compatibility of ropivacaine and sufentanil for isobaric spinal anesthesia in caesarean section / 中华麻醉学杂志

Objective To investigate the optimum compatibility of ropivacaine and sufentanil for isobaric spinal anesthesia in caesarean section.Methods A total of 160 nulliparous parturients who were at full term with a singleton fetus,of American Society of Anesthesiology physical status Ⅰ or Ⅱ,scheduled for elective caesarean section under subarachnoid block,were divided into 4 groups (n =40 each) using a random number table method:1％ ropivacaine 1.5 ml (15 mg)-normal saline 3.5 ml group (group A),1％ ropivacaine 1.2 ml (12 mg)-sufentanil 0.5 mi (5 μg)-normal saline 3.3 ml group (group B),1％ ropivacaine 1 ml (10 mg)-sufentanil 0.5 ml (5 μg)-normal saline 3.5 ml group (group C),and 1％ ropivacaine 0.8 ml (8 mg)-sufentanil 0.5 ml (5 μg)-normal saline 3.7 ml group (group D).Drugs were injected in cephalad direction at a rate of 0.1 ml/s.The upper spread of sensory block,degree of motor block,abdominal muscle tension,traction response,requirement for atropine and ephedrine and neonatal Apgar scores were recorded.Results Neonatal Apgar scores were all within the normal range.A,B and C groups had similar upper spread of sensory block which was higher than that in group D.The onset time of block was significantly prolonged,and the requirement for atropine and ephedrine was increased in group A as compared with B,C and D groups (P＜0.05).The degree of intraoperative pain,abdominal muscle tension and traction response was significantly lower in A,B and C groups than in group D (P＜0.05),however,there was no significant difference among A,B and C groups (P＞0.05).The requirement for supplemented epidural local anesthetics was 30％ (12 cases) in group D.The recovery time to ambulation was significantly shorter in C and D groups than in A and B groups (P＜0.05).The duration of spinal anesthesia was significantly longer in B and C groups than in A and D groups (P＜0.05),however,there was no significant difference between group B and group C (P＞0.05).Conclusion One percent ropivacaine 1 ml (10 mg)-sufentanil 0.5 ml (5 μg)-normal saline 3.5 ml is the optimum compatibility of ropivacaine and sufentanil for isobaric spinal anesthesia in caesarean section.

Distribution characteristics of blood culture pathogens / 中国综合临床

Objective To investigate distribution characteristics of blood culture pathogens,and provid a basis for clinical prevention and control in bloodstream infections.Methods The data of the patients with positive blood culture and the nonduplicate strains were retrospectively analyzed with WHONET 5.6 software in the First People's Hospital of Shangqiu from January 2011 to December 2014.Results The total number of positive strains of blood culture was 1 306 from 25 397 blood cultures,and the positive rates were 5.1％,of which gram positive cocci and gram negative organisms accounted for 64.8％ (846/1 306) and 31.2％ (408/1 306),respectively.Candida accounted for 4.0％ (52/1 306).Gram positive bacteria were mainly Coagulase negative Staphylococcus (CNS) of 564 (43.2％) strains,Staphylococcus aureus of 96 (7.4％) strains,Enterococcus faecium of 48 (3.7％) strains and Streptococcus pneumoniae of 31 (2.4％) strains.The isolated rate of Enterococcus faecium was more than Enterococcus faecalis 20 strains (1.5％).The isolated rate of Escherichia coli,Klebsiella pneumoniae,Acinetobacter Bauman and Pseudomonas aeruginosa were 12.5％ (163 strains),6.2％(81 strains),2.0％(26 strains) and 1.8％(23 strains),respectively.Conclusion The isolated rate of Enterococcus faecium more than Enterococcus faecalis in blood culture,the main pathogens are gram positive cocci in children group.Isolates of gram positive bacteria in the proportion of infants,children and adults with blood culture were 85.2％,87.0％,46.5％.There were 264 strains bacteria isolated in infants and young children's intensive care unit,accounting for 67.3％ of all bacteria isolated from infants and young children.There were 122 strains bacteria isolated in pediatric intensive care unit,accounting for 56.7％ of all bacteria isolated from childen.There were 255 strains bacteria isolated in adult intensive care unit,accounting for 36.5％ of all bacteria isolated from adult.Severe basic diseases were the vulnerable groups of bloodstream infections.

Analysis on the main pathogenic bacteria and risk factors of 891 cases in hospital with urinary tract infections / 中国综合临床

Objective To investigate the distribution and drug resistance of major pathogens for urinary tract infections and related risk factors of hospitalized patients for prevention and treatment of urinary tract infections and to guide the reasonable application of antibiotics.Methods From January 2007 to December 2013 ,the risk factors and pathogen resistance of hospitalized patients with urinary system infection in the First People' s Hospital of Shangqiu were analyzed.Results Totally 891 strains were isolated, in which 638 (71.6％) were Gram-negative strains, 218 (24.5％) were Gram-positive strains, and 35 (3.9％) were Candida.Among Gram-negative strains, Escherichia coli was the most prevalent species, accounting for 43.5％, followed by Enterococcus spp(22.1％), major strains were Enterococcus faecalis and Enterococcus faecium.About 62.1％ (553/891) of the strains were isolated from female patients, 37.9％ (338/891) from male patients.The prevalence of ESBLs-producing strains in Escherichia coli, Klebsiella spp and P.Mirabilis were 59.0％ (526/891), 57.8％ (515/891) and 15.1％ (135/891).ESBLs-producing Enterobacteriaceae strains were more resistant than non-ESBLs-producing strains in terms of antibiotic resistance rate.The ESBLs-producing Enterobacteriaceae strains were highly susceptible to carbapenems.The average prevalence of Pseudomonas aeruginosa was 4.0％(36/891).Six strains were identified as multi-drug resistance of Pseudomonas aeruginosa were respectively, and 3 were carbapenem-resistant strains.Enterococcus spp were completely sensitive to linezolid, vancomycin and teicoplanin.Among Candida strains,the major strains Candida albicans was completely sensitive to amphotericin B, amphotericin and nystatin.The percentage of Candida albicans resistant to itraconazole,voriconazole and fluconazole was 13.0％ (116/891), 17.4％ (155/891) and 39.1％ (348/891).Clinical urinary tract infections related to sex, age, basic diseases, invasive operation and unreasonable application of antibiotics significantly (P＜0.05).Conclusion Escherichia coli is the leading clinical isolates strains account for most urinary tract infections in the First People' s Hospital of Shangqiu, followed by Enterococcus spp.The prevalence of Candida albicans is the major strains among Candida strains.Should be pay attention to the susceptible population and apply anbiotics reasonably.

Effect of Amlodipine Atorvastatin Tablets on Blood Pressure and Blood Lipid of Patients with Hypertension Complicated with Coronary Heart Disease / 中国药师

Objective:To investigate the effect of amlodipine atorvastatin on blood pressure and blood lipid in the patients with hy-pertension complicated with coronary heart disease (CHD). Methods: Totally 80 cases of outpatients with hypertension complicated with CHD were randomly divided into the observation group (40 cases) and the control group (40 cases). The control group was given amlodipine 10 mg,po,qn, and the observation group was given amlodipine and atorvastatin tablets 20 mg,po,gn, and the treatment course was 6 weeks. The changes of blood pressure and blood lipid in the two groups before and after the treatment were observed, and the clinical curative effect and adverse reactions were also studied. Results:Compared with those before the treatment, systolic blood pressure, diastolic blood pressure and blood fat in the two groups were all improved after the treatment, and the difference was statisti-cally significant (P0. 05). Conclusion: Amlo-dipine atorvastatin tablets can significantly improve blood pressure and blood lipid in the patients with hypertension complicated with CHD with promising clinical curative effect and few side effects, which is worthy of wide use in clinics.

The detection and clinical significance of eosinophil and eotaxin in the children with virus associated wheezing diseases / 中国医师进修杂志

Objective To detect the levels of eosinophil and eotaxin in the children with virus associated wheezing diseases,and explore the role of both in virus correlation breathing occurrence and development.Methods Sixty-eight cases of children with virus associated wheezing diseases were selected as observation group,and the other 42 cases of healthy children were selected as control group.The peripheral eosinophil count and serum eotaxin level were detected and compared in observation group and control group on the acute stage and recovery stage.Results The eosinophil count in observation group on the acute stage was (1.12 ± 0.62) × 1099/L,the recovery stage was (0.34 ± 0.13) × 109/L,control group was (0.16 ± 0.07) ×109/L,the eosinophil count in observation group on the acute stage was higher than that on the recovery stage and control group,the eosinophil count in observation group on the recovery stage was higher than that in control group,there were statistically significant differences (P ＜ 0.05).The eotaxin level in observation group on the acute stage was (437.2 ±87.6) ng/L,the recovery stage was (182.4 ±56.2) ng/L,control group was (84.1 ± 39.7) ng/L,the eotaxin level in observation group on the acute stage was higher than that on the recovery stage and control group,the eotaxin level in observation group on the recovery stage was higher than that in control group,there were statistically significant differences (P ＜0.05).There were positively correlated between the eosinophil count and the eotaxin level in observation group on the acute stage,recovery stage and control group (r =0.579,0.593,0.581,P＜ 0.05).Conclusions The eosinophils and eotaxin may be involved in the children with virus associated wheezing diseases pathophysiological process,the levels of the eosinophils and eotaxin can monitor the course change,and be helpful for clinical diagnosis and treatment.

Analysis of bacteria culture results of pulmonary infection in patients with severe brain injury / 中国综合临床

Objective To investigate the characteristics of pathogenic bacteria and drug resistance and susceptible factors of pulmonary infection in patients with severe brain injury and to provide a guideline for the prevention and control of infection.Methods Bacteria culture results combined with clinical data of pulmonary infection in patients with severe brain injury were analyzed retrospectively in our hospital from Jan.2004 to Dec.2008.Results The patients with severe brain injury were often complicated by pulmonary infection.Gramnegative bacilli were main pathogenic bacteria leading to pulmonary infection ( 74.8% ),including pseudomonas aeruginosa ( 21.0% ),Escherichia coli ( 16.5% ),baumanii ( 13.6% ),pneumobacillus ( 7.7% ),enterobacter cloacae (6.3% ) and others.Thirty-nine Gram-positive bacilli were observed including Staphylococcus anreus,coagulase negative staphylococcus,enterococcus and others.There were 21 fungus infection observed.Conclusions Overall and systematically monitoring the condition of pathogenic bacteria distribution and drug resistance of pulmonary infection in patients with severe brain injury have important significance to select antibiotics and effectively prevent and control pulmonary infection.

Neuroform self-expanding stent for treatment of symptomatic intracranial vertebrobasilar arterial stenosis / 中国组织工程研究

OBJECTIVE:To study the safety and efficacy of Neuroform self-expanding stent for symptomatic intracranial artery stenosis.METHODS:A total of 37 patients with symptomatic intracranial artery stenosis received treatment at the Department of Neurosurgery,Affiliated Hospital of Behua University and Xuanwu Hospital were selected,who were ineffective to anticoagulation and antiplatelet treatment,including 24 males and 13 females,aged from 49 to 72 years,mean aged 64 years.All patients were received Neuroform self-expanding stent following angiography.RESULTS:All patients underwent PTAS with mean preoperative stenosis were reduced from 64% to 24% after percutaneous transluminal angioplasty (PTAS).The technically successful rate was 100%.All the patients were received a 6-22 month follow-up (average 13 months).The average artery stents was retrieved by 50%-90% after stent deployment.There was no arterial dissection,acute occlusion of the target artery or symptomatic distal emboli.Within the follow-up period,1 patient endured asymptomatical artery full occlusion.Two stents were implanted simultaneously in 3 patients,1 of them suffered bilateral vertebral artery stenosis,and 2 had right vertebral arterial and basilar artery stenosis.One patient suffered acute in-stent thrombosis and recovered after thrombolytic therapy.No pathogenetic condition was aggravated in the follow-up.CONCLUSION:The application of Neuroform self-expanding stent can alleviate the ischemic symptoms of patients with vertebrobasilar stenosis and elevate the operative safety and effectiveness.However,further study is needed to evaluate the long-term therapeutic effect.