Application of PDCA cycle on improving the anesthesia teacher training / 中华医学教育探索杂志

Nowadays, PDCA circle is a widely used theory of quality management system. Through the PDCA approach, the management reform was conducted in 17 anesthesia teachers of the Anesthesiology department. After 18 months of training and promotion, the problems such as lack of enthusiasm for teaching, uneven level of teachers, and boring single teaching method were basically solved, which improved their teaching skills. Certain effectiveness has been achieved in teacher training management including continuity of quality management, timely feedback and emphatically improvement, student-center teaching philosophy, and mutual promotion of teaching and learning.

Effects of methomyl on acetylcholinesterase in erythrocyte membrane and various brain areas / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To study the toxicity of methomyl to acetylcholinesterase (AChE) in different regions.</p><p><b>METHODS</b>The optimal temperature and time for measurement of AChE activity were determined in vitro. The dose- and time-response relationships of methomyl with AChE activity in human erythrocyte membrane, rat erythrocyte membrane, cortical synapses, cerebellar synapses, hippocampal synapses, and striatal synapses were evaluated. The half maximal inhibitory concentration (IC50) and bimolecular rate constant (K) of methomyl for AChE activity in different regions were calculated, and the type of inhibition of AChE activity by methomyl was determined.</p><p><b>RESULTS</b>AChE achieved the maximum activity at 370 °C, and the optimal time to determine initial reaction velocity was 0-17 min. There were dose- and time-response relationships between methomyl and AChE activity in the erythrocyte membrane and various brain areas. The IC50 value of methomyl for AChE activity in human erythrocyte membrane was higher than that in rat erythrocyte membrane, while the Ki value of methomyl for AChE activity in rat erythrocyte membrane was higher than that in human erythrocyte membrane. Among synapses in various brain areas, the striatum had the highest IC50 value, followed by the cerebellum, cerebral cortex, and hippocampus, while the cerebral cortex had the highest Ki value, followed by the hippocampus, striatum, and cerebellum. Lineweaver-Burk diagram demonstrated that with increasing concentration of methomyl, the maximum reaction velocity (Vmax) of AChE decreased, and the Michaelis constant (Km) remained the same.</p><p><b>CONCLUSION</b>Methomyl is a reversible non-competitive inhibitor of AChE. AChE of rat erythrocyte membrane is more sensitive to methomyl than that of human erythrocyte membrane; the cerebral cortical synapses have the most sensitive AChE to methomyl among synapses in various brain areas.</p>

Analysis of the application of PONV intensity scale among the Chinese patients with laparoscopic operation / 中国基层医药

Objective To esplore the effecf and the practical utility of the postoperative nausea and vomiting intensity scale for Chinese patients with laparoscopic operation .Methods Ninety patients with ASA I-II,Apfel≥2 were enrolled .Interviews were carried out at 6 and 24 hours postoperatively .Measurements included the PONV Inten-sity Scale,nausea and pain visual analogue scale .Quality of Recovery Score and antiemetic were used .The patients whose PONV intensity score ≥50 were assessed by PONV intensity scale and PONV VAS .Results There was signif-icant difference of the occurrence of clinical PONV between the patients with Apfel ≥3 and those with Apfel=2(P<0.05).The PONV Intensity Scale had a stronger correlation with PONV VAS ,r=0.946(P<0.01).The PONV In-tensity Scale had a stronger correlation with QOR,r=-0.937(P<0.01).Patients with clinically important PONV at 24 hours required more antiemetic therapy (P=0.024).PONV rate of the patients with a clinically significant score VS those without a clinically significant score was 80%VS 18%(P<0.05).Conclusion PONV intensity scale can distinguish trivial from clinically important PONV availably in Chinese Laparoscopic operation .It is more reliable than PONV VAS.Patients with clinically important PONV required more antiemetic therapy .Clinically important PONV ,as determined by the PONV Intensity Scale ,was associated with a poor quality of recovery .

Reconstruction of rotation center in revision hip arthroplasty / 中华骨科杂志

Objective To discuss the feasibility of positioning the acetabular center,fixing acetabular implant correctly and reconstructing hip rotation center according to Harris fossa and the remaining anatomical markers of acetabular notch in revision hip arthroplasty.Methods Twenty-eight patients underwent revision hip arthroplasty from April 2007 to June 2009.Based on Paprosky type,3 cases with type Ⅰ were treated with biological fixed acetabular component;8 cases with ⅡA and ⅡB were reconstructed with using of morselized bone grafting and large diameter cemented acetabular prosthesis;17 cases with type ⅡC,ⅢA and ⅢB were treated with using of morselized bone grafting and fixation of acetabular reinforcement ring.Among them,5 patients with massive bone loss in acetabular wall were reconstructed with the use of the structural and morselized bone grafting.The center of the original acetabulum was believed to be in the lunate cartilage surface which was closed to Harris fossa.During the operation,the center was located in the site which was 25-28 mm above in line with perpendicular bisector of acetabular notch connecting line.The acetabular center was the point of positioning acetabular prosthesis (Ⅰ type) or making new acetabulum by impaction bone grafting.Acetabular reinforcement ring (Ⅱ,Ⅲ type) was fixed in accordance with proper transverse angle and anteversion angle.The vertical distance from hip rotation center to teardrop connection and the horizontal distance from hip rotation center to teardrop were measured on preoperative and postoperative radiograph.And the outcomes of reconstruction of rotation center were evaluated.Results The vertical distance was changed from (14.22±3.39) mm preoperatively to (32.64±4.51) mm postoperatively.The difference was statistically significant (t=3.65,P＜ 0.05).The horizontal distance was changed from (25.13±3.46)mm preoperatively to (32.87±4.73) mm postoperatively.The difference was statistically significant (t=2.72,P＜0.05).Conclusion Using residual Harris fossa and acetabular notch as the anatomical markers in revision hip arthroplasty,the restoration of the anatomical hip center has shown to be favorable.

Surface tractotomy of trigeminal nerve sensory root:a new tractotomy for the treatment of trigeminal neuralgia / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the feasibility of surface tractotomy of trigeminal nerve sensory root (STS) for the treatment of trigeminal neuralgia (TN).@*METHOD@#Seven patients with TN were operated on using the STS. The six patients were followed up for 4.8-9.8 years. The trigeminal nerve root (TNR) obtained from 30 cadavers were performed microanatomical research using paraffin embedding and hematoxylin-eosin staining technique.@*RESULT@#Clinically, the patients' symptoms, such as face ache, disappeared after the surface nerve fiber bundles of trigeminal nerve sensory root (TNSR) were cut off. Only one patient died of brainstem bleeding on postoperative day 18. Histological examination: The common type of sensory root fibers were arranged parallel for 3-6 mm at its exit of brainstem, and then the glial myelin transformed to Schwann cells. The axon bifurcated from outer layer to middle region, and gradually formed the tiny nerve fiber bundles in the surface layer and the giant nerve fiber bundles in the center of the root.@*CONCLUSION@#TN can be radical cured by STS without lesioning of nerve functions. Therefore,this new approach is an effective, advanced surgical technique for TN treatment.

Effect of spinal anesthesia on serum troponin T in the elderly patients during the perioperation / 中国基层医药

Objective To explore the security of spinal anesthesia by observing the pefioperation serum troponin T in the elderly patients with coronary heart disease who underwent spinal anesthesia.Methods 40 case8 were divided into two groups according to the elderly patients with or without the history of coronary heart disease.Group Ⅰ 0f 20 cases were the patients with the history of coronary heart disease.Group Ⅱ of 20 cases were the patients without the history of coronary heart disease.Both groups were undertaken single spinal anesthesia combined with epidural anesthesia.The blood samples were collected at the time of perioperation,the end of the operation and 24 hours after surgery.The serum troponin T Was tested by Roche fully automated ehemiluminescent analyzer E170.The symptoms and signs of the coronary heart disease in the patient were observed.And the age,operation time,anesthesia lever,the amount of bleeding and transfusion were recorded,and at the same time,electrocardiogram,heart rate,pulse,cerebral oxygen saturation were monitored.Results There was no significant difference between two groups in age,operation time,anesthesia lever,the amount of bleeding and transfusion,heart rate,pulse,cerebral oxygen saturation.There was no significant difference between two groups in seram troponin T.No symptoms and signs of the coronary heart disease were observed in two groups.There Was no significant difference between two groups in constituent ratio of positive rate of serum troponin T.There was one case in each group that serum lroponin T was more than reference value (0.010μg/L)during the perioperation while the patient was no discomfort.Conclusion Spinal anesthesia has no impact on the change of perioperative 8ertlm troponin T in the elderly patients with coronary heart disease.

Nosocomial Lower Respiratory Infection and General Anesthesia: A Risk Factor Analysis and Prophylaxis / 中华医院感染学杂志

OBJECTIVE To explore the factors and effective preventive method of nosocomial lower respiratory(infection) after general anesthesia through trachea intubation.METHODS Using bacterial culture and identification technique to detect the samples collected from pipe and the sides of anesthetic machine,from disposable virus/(bacteri)a respiratory filter and buccal and bronchial secretion of patients with general anesthesia through trachea(intubation.) RESULTS Eight of 15 anesthetic machines without disinfection were with positive bacterial culture.All sides of virus/bacteria respiratory filter,and buccal and bronchial secretion of patients during operation had same(bacteria.) No bacteria growth was found in anesthetic machine and disposable virus/bacteria respiratory filter used after operation.The same bacteria as from buccal secretion were isolated from anesthetic machine in patients(without) using virus/bacteris respiratory filter.CONCLUSIONS The(results) showed the anesthetic machine is more easy to be contaminated by patients,and the reuse of anesthetic machine is an important factor for nosocomial(lower) respiratory infection after general anesthesia through trachea intubation.Intensifying periodic disinfection of(anesthetic) machine and using virus/bacteria respiratory filter can prevent contamination between anesthetic(machine) and patients and decrease nosocomial lower respiratory(infection) after operation.

Observation on therapeutic effect of tramadol combined with fentanyl in patient controlled intravenous analgesia after nucleotomy of intervertebral disc / 中国基层医药

Objective To observe the therapeutic effect of tramadol combined with fentanyl in patient controlled intravenous analgesia after nucleotomy of intervertebral disc.Methods 60 patients under general anesthesia,scheduled for nucleotomy of intervertebral disc,were randomly divided into three group(n=20):group tramadol(group T),group fentanyl(group F) and group tramadol+fentanyl(group TF).All patients were received patient controlled intravenous analgesia by loading dose+background dose+PCA bolus dose.The BP,HR,RR,VAS at 6,12,24,48h of postoperation were observed.The sedation score in 24h,average effective-press times and drug dose in 48h of postoperation were recorded.The incidence of nausea and vomiting during 24h of postoperation were observed.Results It had no significantly difference of BP,HR,RR,VAS among three groups.The average effective-press times of group TF (8?2) were significantly less than those of group T (14?3) and group F (12?3).The drug dose of 48h was tramadol (17.9?1.5)mg/kg(group T),fentanyl (16.8?1.5)?g/kg(group F) and tramadol (11.5?0.7)mg/kg+fentanyl (9.1?0.7)?g/kg(group TF).The drug dose of group TF showed significant difference compared with others.The sedation score in group F was the highest,it had significant difference compared with the other two group.The frequency of nausea and vomiting in group T was significantly more than that in others.Conclusion Tramadol or fentanyl gived alone can afford the same satisfied analgesic effect on nucleotomy of intervertebral disc.But there is high nausea-vomiting frequency in tramadol and strong sedation frequency in fentanyl.Tramadol combined with a little opioid fentanyl can afford more satisfying analgesic effect,and is provided with advantage in less drug and side-effect.

To observe the treatment effect of nicardipine for the presence of hypertension responses at during thyroidectomy under cervical plexus nerve block / 中国基层医药

Objective To observe the treatment effect of nicardipine for the presence of hypertension responses during thyroidectomy under cervical plexus nerve block.Methods Patient without hypertension before the operation was brought into if he received thyroidectomy under cervical plexus nerve block,and with the presence of hypertension responses during the operation,and without effect after injected innovar one dose or dolantin 50mg by vein when the blood pressure was over 160/90mmHg.20 patients according to the criterion mention above were dripped nicardipine 20?g/kg by vein.The SBP,DBP,MAP,HR,SpO_2 and ECG were recorded at 3min,5min,15min,30min,45min after injection and the side effects were also recorded.Results The SBP,DBP,MAP of all patients were fallen distinctly at 3min after injection,and reached lowest at 5min.The blood pressures were steady at other points.There was significantly difference between the point before and after injection(P