The effect of fascia iliaca compartment block continuous analgesia in the early stage on early postoperative cognitive in patients with hip fractures / 中国医师进修杂志

Objective:To investigate the effect of fascial iliaca compartment block (FICB) continuous analgesia in the early stage after admission on early postoperative cognitive and motor function in elderly patients with hip fractures.Methods:A total of 80 elderly patients with hip fractures admitted toThe First Affiliated Hospital of Tsinghua University from June 2018 to June 2020 were selected and randomly divided into the control group and the observation group, with 40 cases in each group. The control group adopted the routine postoperative analgesia regimen, while the observation group adopted FICB analgesia immediately after admission to the hospital until before the operation. Postoperative analgesia pattern was consistent with that of the control group, and both groups were given postoperative analgesia for 48 h. The scores of visual analogue scale (VAS), mini mental state assessment scale (MMSE), Harris hip score (Harris) and surgical indexes, stress indexes and incidence of adverse reactions were compared between the two groups.Results:The levels of postoperative blood glucose, cortisol, angiotensin Ⅱin the observation group were lower than those in the control group: (5.21 ± 1.03) mmol/L vs. (7.03 ± 1.06) mmol/L, (643.08 ± 77.28) nmol/L vs. (747.96 ± 82.80) nmol/L, (41.03 ± 5.22) ng/L vs. (57.15 ± 8.16) ng/L, there were statistically differences ( P<0.05). The dosage of sufentanil in the observation group was lower than that in the control group: (27.48 ± 3.25) mg vs. (58.54 ± 4.86) mg, there was statistically difference ( P<0.05). The scores of VAS score at 12 h before surgery, 12 h and 48 h after surgery in the observation group were lower than those in the control group, and the scores of MMSE score were higher than those in the control group, there were statistically differences ( P<0.05). After the surgery, the Harris scores in the observation group was higher than that in the control group: (76.09 ± 6.11) scores vs. (65.62 ± 6.13) scores, there was statistically difference ( P<0.05). The incidence rate of postoperative cognitive dysfunction (POCD) in the observation group was lower than that in the control group: 2.5%(1/40) vs. 15.0%(6/40), there was statistically difference ( χ2 = 3.91, P<0.05). Conclusions:FICB continuou sanalgesic in the early stage after admission of elderly patients with hip fracture is satisfactory, which can effectively relieve postoperative pain, while the stress response is relatively mild, the recovery of postoperative cognitive function and hip function is good.

Study on rapid eye movement sleep behavior disorder in patients with Parkinson disease psychosis / 中华行为医学与脑科学杂志

Objective To explore the sleep structure characteristics and risk factors in patients with Parkinson disease psychosis (PDP).Methods Fifty-one patients with Parkinson disease were enrolled.Sixteen cases met the diagnostic criteria of Parkinson disease psychosis were included in the PDP group,while the remaining 35 cases were included in the PD group as the control group.Sleep status was monitored by polysomnography.Neuropsychological assessment of patients with Parkinson disease was performed by Parkinson quality of life questionnaire,Montreal cognitive assessment(MoCA)and Hoehn-Yahr state (H-Y) of Parkinson disease.Results There were statistically significant differences in age of onset in PD group and PDP group (64.11±8.87,57.44±10.07,t=1.242),course of disease (2 (1,4),6 (4,7),Z=-3.888),HY stage (2 (1.5,2.5),3 (2,3),Z=-2.487)(all P＜0.05).The total sleep time in the PDP group was lower than that in the PD group ((344.06±26.39)min,(361.74± 17.16)min,P＜0.05).Compared with the PD group,the proportion of slow wave sleep phase Ⅰ in the PDP group was bigger ((42.88 ± 7.99) ％,(37.14±5.21) ％,t=-3.065),and the proportion of slow wave sleep phase Ⅱ in the PDP group was smaller ((31.19±5.92) ％,(37.51±5.70) ％,t=3.634) (P＜0.05).Single factor binary logistic regression analysis showed that the course of disease,age of onset,RBD,HY stage,PDQ-39 questionnaire score,total sleep time,slow wave sleep stage Ⅰ (％) and slow wave sleep stage Ⅱ (％) were the risk factors of PDP (P＜0.05).Multivariate binary logistic regression analysis showed that the course of disease and RBD were independent risk factors for patients with PDP (P＜ 0.05).Conclusion Sleep structure changes in patients with PDP,and RBD is the independent risk factor for patients with Parkinson's psychotic disorders.

Efficacy of radiofrequency ablation performed under sevoflurane anesthesia in pediatric patients with ventricular premature beats / 中华麻醉学杂志

Objective To evaluate the efficacy of radiofrequency ablation performed under sevoflurane anesthesia in the pediatric patients with ventricular premature beats (VPBs).Methods Twenty American Society of Anesthesiologists physical status Ⅰ or Ⅱ pediatric patients,with non-organic heart disease and VPBs,aged 3-12 yr,weighing 19-53 kg,undergoing elective radiofrequency ablation,were divided into propofol group (Pro group) and sevoflurane group (Sev group) using a random number table.Anesthesia was induced with midazolam 0.05 mg/kg,sufentanil 0.3-0.5 μg/kg,propofol 2.5-4.0 mg/kg (in Pro group) and 8％ sevoflurane (in Sev group).Supreme laryngeal mask airway was placed when eyelash reflex disappeared.Propofol 6 mg· kg-1 · h-1 was intravenously infused in Pro group,and 2％-3％ sevoflurane was inhaled in Sev group,and bispectral index value was maintained at 50-60.The frequency of VPBs developed was recorded before induction and at 1,5 and 10 min after induction,and the recurrence was observed within 1 month after operation.Results Compared with that before induction,the frequency of VPBs developed was significantly decreased at 1,5 and 10 min after induction in Pro group (P＜0.05),and no significant change was found in Sev group (P＞0.05).The frequency of VPBs developed was significantly higher at 1,5 and 10 min after induction in Sev group than in Pro group (P＜0.05).The recurrent rate was 30％ within 1 month after operation in Pro group,no recurrence was found in Sev group,and there was significant difference between Sev group and Pro group (P＜0.05).Conclusion The efficacy of radiofrequency ablation performed under sevoflurane anesthesia is better than that performed under propofol anesthesia in the pediatric patients with VPBs.

The comparison of different inserting time on patients under propofol combined sufentanil anesthesia in gastroscopy / 临床麻醉学杂志

Objective To compare the anesthetic effect of different inserting time on patients under propofol combined sufentanil anesthesia in gastroscopy.Methods A total of 120 out-patients aged 18-60 years underwent gastroscopy were randomly divided into two groups (A and B,60 cases each).They received sufentanil 0.1μg/kg combined with propofol 1.5 mg/kg intravenously.Gastros-copy was inserted into patients’mouth immediately when the patients’consciousness lost and eyelash reflex disappeared (group A)or 30 s later (group B).When necessary (cough or movement),addi-tional propofol 0.5 mg/kg was added to enhance and maintain anesthesia.HR,BP and SpO2 were re-corded before induction (T0 ),before inserting (T1 ),gastroscopy passing through throat (T2 )and after procedure (T3 ).We observed and recorded cough,hiccup,body movement,recovery time and total dosage of propofol.Results Compared with T0 ,MAP (T1 )of both groups were lower (P <0.05).There was no statistic different in MAP on T2 and T3 .There was no statistic different in HR, MAP and SpO2 on T0-T3 between two groups.The incidence of cough and body movement were lower in group B than in group A (P <0.05).Group B had shorter recovery time and less propofol usage than group A (P <0.05).Conclusion Inserting gastroscopy 30 s after consciousness and eyelash re-flex disappear in propofol combined sufentanil anesthesia can reduce the incidence of cough and move-ment,reduce propofol consumption,and shorten recovery time but without respiratory and haemody-namic adverse effects.

Analysis of breast cancer using low-dose thin-thickness dynamic-enhanced MDCT / 肿瘤研究与临床

Objective To investigate the value of low-dose MDCT in the diagnosis of breast cancer using ROC analysis. Methods Retrospectively analyze the breast images of 105 cases that had performed both 64-row CT and pathological examinations. The case number that underwent CT examination with routinedose parameters was 48; and that with low-dose was 57. Two radiologists with clinical experiences more than 5 years evaluated the breast lesions, respectively. And ROC curve was used to test the diagnostic efficacy of breast cancer between the two groups. Results Compared with the routine-dose group, the quality of CT image was high enough to disclose the breast lesions while the exposure dose was significantly decreased. The areas under the ROC curve between the routine-dose group (0.943) and the low-dose group (0.908) did not show significant difference (P >0.05). Conclusion Low-dose thin-slice MDCT with contrast enhancement can efficiently and safely diagnose breast cancer.

Anesthesia for aortic valve insufficiency complicated with extremely dilated left ventvicle / 国际外科学杂志

Objective To retrospectively review the experience of anesthesia for aortic valve insufficiency complicated with extremely dilated left ventricle.Methods The patients were premedieated with morphine 10 mg and scopolamine 0.3 mg IM.Anesthesia was induced with etomidate 0.1-0.2 ms/ks.sufentanil 1μ/kg and pipecuronium 0.1 mg/kg.After the patients were intubated,anesthesia wag maintained beween 1.0%and 1.5% isoflurane and intermittent Ⅳ boluses of sufentanil and pipecuronium.ECG,direct BP,SpO2,PET CO2,CVP and body temperature were monitored during anesthesia.Result All patients Were rehabilitated without ventricular fibrillation and arrhythmia.Conlusions Measures are taken before the surgery to maintain preload,increase heart rate,reduce afterload moderately and maintain myocardial contractility.After the surgery,maintenance of preload is helpful for ensuring adequate forward flow and benefcial to patients using dopamine and nitrolycerin.

Comparison between ropivacaine or bupivacaine combined with fentanyl respectively for postoperative continuous epidural analgesia / 中国康复理论与实践

@# ObjectiveTo compare the clinical effect of 0.2% ropivacaine and bupivacaine combined with fentanyl respectively for postoperative continuous epidural analgesia(CEA).Methods50 patients of American Society of Anesthesiologists(ASA) grade Ⅰ~Ⅱ after abdomen operation were divided randomly into group ropivacaine + fentanyl(RF) and bupivacaine + fentanyl(BF). 5min before operation finished, group RF was given 0.2% ropivacaine plus 5 μg/ml fentanyl 5 ml, group BF was given 0.2% bupivacaine plus 5μg/ml fentanyl 5ml, and followed by a continuous infusion of 0.2% ropivacaine or bupivacaine plus 2 μg/ml fentanyl 2 ml/h at the end of operation respectively. The analgesic and paralytic effects expressed in VAS and modified Bromage degrees respectively were recorded 1h, 8h, 24h and 48h after operation.ResultsThere were no significant difference between group RF and group BF in VAS scales(P>0.05), but there were significant difference between group RF and group BF in modified Bromage degrees (P<0.05).ConclusionRopivacaine and bupivacaine combined with fentanyl could be safely and effectively used for postoperative analgesia. Because of the lower incidence of complications, ropivacaine combined with fentanyl will be more satisfactory.

Anesthesia of Children with Grave Congenital Heart Diseas es during Cardiac Catheterization and Ventriculography——369 Cases Review / 中国循环杂志

Objective:To introduce our experience on extra-operating room anesthesia of children with grave congenital heart diseases during cardiac catheterization an d ventriculography. 　　Methods:Three hundred and sixty-nine children with grave congenital heart d iseases undergoing cardiac catheterization or ventriculography were selected for this study,among whom 86 are presented with left to right shunt and pulmonary a rtery hypertention,11 with pulmonic stenosis and primary pulmonary artery hypert ention,and 272 with right to left shunt.They were routinely fasted before the pr ocedure.O2 Saturation(SpO2) and electrocardiogram were monitored and blood p ressure were recorded.With oxygen inhalated by mask and venous route established ,the children were injected with scolapamine (0.02 mg/kg) and ketamine (1-2 mg /kg) for anesthesia induction.When patients lost conciousness,ketamine (6-8 mg/ kg) and droperidol (0.15-0.30 mg/kg) were given intromascularly for maintaine nce.During the procedure,ketamine (1-2 mg/kg) were given to deepen anethesia. 　　Results:The procedures were fufiled steadily.Eighteen patients presented wit h different kinds of complications such as abdomen distention,vomitting,arrhymia and refractory anoxia to defferent degrees.One patient died,and the mortality w as 0.27%. 　　Conclusions:Anesthesia of children with grave heart diseases during cardiac catheterization and ventriculography is particular.It is important for the anest hesiologists to be familiar with the pathophysiology of heart diseases,and suppl y sufficiant oxygen,keep airway open and unobstructed,avoid stomach regurgitatio n and inhalation and maintain sufficient sedation during the procedure.Oxygen sh ould be given continuously and SpO2 monitored posoperatively to avoid any comp lication.

Safety of delivering nitric oxide through nitrous oxide path in anesthesia machine / 中华麻醉学杂志

To evaluate the feasibility of delivering NO through N_2O path in anesthesia machine,NO at 800 ppm was delivered through nitrous oxide path in anesthesia machine SIEMENS Ventilator 710 or NARKOMED 2B,to ventilate a test lung. The minute volume of ventilation (MV) was set from 2 to 6L/min, and NO concentration from 10 to 80 ppm. NO and NO_2 concentrations were measured by hemiluminescence and electro-chemical fuel cell technique. SIEMENS Ventilator 710:Non-rebreathing model,its inspiratory limb was prolonged to 7 meters,the NO level was adjusted at 80ppm before passing through soda lime, NO and NO_2 samples were taken before absorber,after absorber, 1, 2,4 and 6 meter site in inspiratory limb. NARKOMED 2B:Oxygen flows were at the rates epual to the MV mentioned above, NO concentration was at 10,20,40,60 and 80 ppm,the inspiratory gas mixture was sampled immediately passing through absorber, NO_2 levels were less than 5.0ppm in all conditions listed above. With SIEMENS Ventilator 710, the highest level of NO_2 was 3.45 ppm before absorber and 2.43 ppm after absorber,with NARKOMED 2B,that was 3.6 ppm. As MV increased,NO_2 level before absorber decreased (P