Analysis of the incidence and related factors of hypothermia in patients with continuous renal replacement therapy / 中华危重病急救医学

OBJECTIVE@#To investigate the incidence and risk factors of hypothermia in patients with acute renal injury (AKI) receiving continuous renal replacement therapy (CRRT), and to compare the effects of different heating methods on the incidence of hypothermia in patients with CRRT.@*METHODS@#A prospective study was conducted. AKI patients with CRRT who were admitted to the department of critical care medicine of the First Affiliated Hospital of Wannan Medical College (Yijishan Hospital) from January 2020 to December 2022 were enrolled as the study subjects. Patients were divided into dialysate heating group and reverse-piped heating group according to randomized numerical table method. Both groups were provided with reasonable treatment mode and parameter setting by the bedside physician according to the patient's specific condition. The dialysis heating group used the AsahiKASEI dialysis machine heating panel to heat the dialysis solution at 37 centigrade. The reverse-piped heating group used the Barkey blood heater from the Prismaflex CRRT system to heat the dialysis solution, and the heating line temperature was set at 41 centigrade. The patient's temperature was then continuously monitored. Hypothermia was defined as a temperature lower than 36 centigrade or a drop of more than 1 centigrade from the basal body temperature. The incidence and duration of hypothermia were compared between the two groups. Binary multivariate Logistic regression analysis was used to explore the influencing factors of hypothermia during CRRT in AKI patients.@*RESULTS@#A total of 73 patients with AKI treated with CRRT were eventually enrolled, including 37 in the dialysate heating group and 36 in the reverse-piped heating group. The incidence of hypothermia in the dialysis heating group was significantly lower than that in the reverse-piped heating group [40.5% (15/37) vs. 69.4% (25/36), P < 0.05], and the hypothermia occurred later than that in the reverse-piped heating group (hours: 5.40±0.92 vs. 3.35±0.92, P < 0.01). Patients were divided into hypothermic and non-hypothermic groups based on the presence or absence of hypothermia, and a univariate analysis of all indicators showed a significant decrease in mean arterial pressure (MAP) in hypothermic patients (n = 40) compared with the non-hypothermic patients [n = 33; mmHg (1 mmHg ≈ 0.133 kPa): 77.45±12.47 vs. 94.42±14.51, P < 0.01], shock, administration of medium and high doses of vasoactive drug (medium dose: 0.2-0.5 μg×kg-1×min-1, high dose: > 0.5 μg×kg-1×min-1) and CRRT treatment were significantly increased [shock: 45.0% (18/40) vs. 6.1% (2/33), administration of medium and high doses of vasoactive drugs: 82.5% (33/40) vs. 18.2% (6/33), administration of CRRT (mL×kg-1×h-1): 51.50±9.38 vs. 38.42±10.97, all P < 0.05], there were also significant differences in CRRT heating types between the two groups [in the hypothermia group, the main heating method was the infusion line heating, which was 62.5% (25/40), while in the non-hypothermia group, the main heating method was the dialysate heating, which was 66.7% (22/33), P < 0.05]. Including the above indicators in a binary multivariate Logistic regression analysis, it was found that shock [odds ratio (OR) = 17.633, 95% confidence interval (95%CI) was 1.487-209.064], mid-to-high-dose vasoactive drug (OR = 24.320, 95%CI was 3.076-192.294), CRRT heating type (reverse-piped heating; OR = 13.316, 95%CI was 1.485-119.377), and CRRT treatment dose (OR = 1.130, 95%CI was 1.020-1.251) were risk factors for hypothermia during CRRT in AKI patients (all P < 0.05), while MAP was protective factor (OR = 0.922, 95%CI was 0.861-0.987, P < 0.05).@*CONCLUSIONS@#AKI patients have a high incidence of hypothermia during CRRT treatment, and the incidence of hypothermia can be effectively reduced by heating CRRT treatment fluids. Shock, use of medium and high doses of vasoactive drug, CRRT heating type, and CRRT treatment dose are risk factors for hypothermia during CRRT in AKI patients, with MAP is a protective factor.

Effect of different connection schemes of continuous renal replacement therapy and extracorporeal membrane oxygenation on arterial and venous pressure: an in vitro and in vivo study / 中华危重病急救医学

Objective:To investigate the effects of different connection schemes of continuous renal replacement therapy (CRRT) and extracorporeal membrane oxygenation (ECMO) on arterial pressure (PA), venous pressure (PV), and transmembrane pressure (TMP), and to provide a theoretical basis for choosing a suitable connection scheme.Methods:① In vitro study: the different connection schemes of CRRT and ECMO were simulated and divided into 6 schemes according to the connection between CRRT and ECMO circuits at different positions. Scheme A: connected to the front and back points of the oxygenator; scheme B: connected to the points behind and in front of the oxygenator; scheme C: connected to the points in front of the oxygenator and in front of the centrifugal pump; scheme D: connected to the points behind the oxygenator and in front of the centrifugal pump; scheme E: connected to the points in front of the oxygenator and the return catheter; scheme F: connected to the points after the oxygenator and the return catheter. Each set of ECMO circuits was measured 5 times under each connection scheme and different flow rates (2, 3, 4, 5, 5.5 L/min). Six ECMO circuits for a total of 30 measurements, and the PA, PV, and TMP of the 6 schemes were compared. ② In vivo study: the patients who were treated with ECMO combined with CRRT in the department of critical care medicine of the First Affiliated Hospital of Wannan Medical College from August 2017 to August 2021 changed the connection scheme due to high PA or PV (from scheme A or B to scheme E or F) were retrospectively analyzed. The changes of PA and PV before and after changing the scheme were compared. Results:① In vitro study results: there was no significant difference in PA between schemes A and B, C and D, E and F under different ECMO blood flow (2-5.5 L/min). The PA of schemes C and D was the lowest, followed by schemes E and F. PV of scheme B was higher than that of scheme A under different ECMO blood flow (2-5.5 L/min). There was no significant difference in PV between schemes C and D, E and F under high ECMO blood flow (3-5.5 L/min), and the absolute value of PV was lowest in schemes E and F. Compared with schemes A and B [partial PA > 300 mmHg (1 mmHg≈0.133 kPa) at high flow rate], C and D (partial PV > 350 mmHg at high flow rate), schemes E and F were more reasonable connection schemes. TMP was negative in schemes C and D at ECMO blood flow of 5 L/min and 5.5 L/min (mmHg; 5 L/min: scheme C was -29.14±11.42, scheme D was -42.45±15.70; 5.5 L/min: scheme C was -35.75±13.21, scheme D was -41.58±15.42), which indicated the presence of dialysate reverse filtration. Most of the differences in TMP among schemes A, B, E, and F under different ECMO blood flow (2-5.5 L/min) were statistically significant, and the absolute value of mean fluctuation was 9.89-49.55 mmHg, all within the normal range. ② In vivo study results: a total of 10 patients who changed the connection scheme (from scheme A or B to E or F) due to high PA or PV were enrolled, including 8 males and 2 females; 7 cases of venous-arterial ECMO (VA-ECMO) and 3 cases of venous-venous ECMO (VV-ECMO), all used continuous veno-venous hemodiafiltration (CVVHDF) mode. After changing the scheme, both PA and PV decreased significantly as compared with those before changing [PA (mmHg): 244.00±22.58 vs. 257.20±21.92, PV (mmHg): 257.20±18.43 vs. 326.40±15.41, both P < 0.01], and PV decreased more significantly than PA [difference (mmHg): 69.20±6.55 vs. 13.20±5.45, P < 0.01]. Conclusion:For patients treated with ECMO in combination with CRRT, the scheme of connecting the access line of CRRT to the pre-oxygenator or post-oxygenator and connecting the return line to the point of the return catheter can significantly reduce PA and PV and maintains normal CRRT operation even running high-flow ECMO.

Analysis of the effect of sequential high-flow nasal canula oxygen therapy in post-extubation mechanically ventilated patients in intensive care unit / 中华危重病急救医学

Objective:To observe the application effect of high-flow nasal canula oxygen therapy (HFNC) after extubation in patients with mechanical ventilation (MV) in the intensive care unit (ICU).Methods:A prospective study was conducted. From January 2018 to June 2020, 163 MV patients admitted to Yijishan Hospital of Wannan Medical College were enrolled, and they were divided into HFNC group (82 cases) and traditional oxygen therapy group (81 cases) according to the oxygen therapy model. The patients included in the study were given conventional treatment according to their condition. In the HFNC group, oxygen was inhaled by a nasal high-flow humidification therapy instrument. The gas flow was gradually increased from 35 L/min to 60 L/min according to the patient's tolerance, and the temperature was set at 34-37 ℃. The fraction of inspiration oxygen (FiO 2) was set according to the patient's pulse oxygen saturation (SpO 2) and SpO 2 was maintained at 0.95-0.98. A disposable oxygen mask or nasal cannula was used to inhale oxygen in the traditional oxygen therapy group, and the oxygen flow was 5-8 L/min, maintaining the patient's SpO 2 at 0.95-0.98. The differences in MV duration before extubation, total MV duration, intubation time, reintubation time, extubation failure rate, ICU mortality, ICU stay, and in-hospital stay were compared between the two groups, and weaning failure were analyzed. Results:There was no significant differences in MV duration before extubation (days: 4.33±3.83 vs. 4.15±3.03), tracheal intubation duration (days: 4.34±1.87 vs. 4.20±3.35), ICU mortality [4.9% (4/82) vs. 3.7% (3/81)] and in-hospital stay [days: 28.93 (15.00, 32.00) vs. 27.69 (15.00, 38.00)] between HFNC group and traditional oxygen therapy group (all P > 0.05). The total MV duration in the HFNC group (days: 4.48±2.43 vs. 5.67±3.84) and ICU stay [days: 6.57 (4.00, 7.00) vs. 7.74 (5.00, 9.00)] were significantly shorter than those in the traditional oxygen therapy group, the reintubation duration of the HFNC group was significantly longer than that of the traditional oxygen therapy group (hours: 35.75±10.15 vs. 19.92±13.12), and the weaning failure rate was significantly lower than that of the traditional oxygen therapy group [4.9% (4/82) vs. 16.0% (13/81), all P < 0.05]. Among the reasons for weaning failure traditional oxygen therapy group had lower ability of airway secretion clearance than that of the HFNC group [8.64% (7/81) vs. 0% (0/82), P < 0.05], there was no statistically differences in the morbidity of heart failure, respiratory muscle weakness, hypoxemia, and change of consciousness between the two groups. Conclusion:For MV patients in the ICU, the sequential application of HFNC after extubation can reduce the rate of weaning failure and the incidence of adverse events, shorten the length of ICU stay.

Study on the extracorporeal membrane oxygenation inter-hospital transport during coronavirus disease 2019 epidemic: based on the transport experience of 6 cases of severe H1N1 influenza virus pneumonia on extracorporeal membrane oxygenation / 中华危重病急救医学

Objective:To provide a reference for extracorporeal membrane oxygenation (ECMO) inter-hospital transport during coronavirus disease 2019 (COVID-19), based on the transport experience of 6 patients with severe H1N1 influenza virus pneumonia using ECMO.Methods:Clinical data of patients with severe H1N1 influenza virus pneumonia implemented by ECMO in the First Affiliated Hospital of Wannan Medical College from October 2018 to December 2019 were retrospective analyzed, including general information, ECMO transport distance, time, clinical parameters before and after ECMO, including the patients' oxygenation index (PaO 2/FiO 2), respiratory rate (RR), pulse blood oxygen saturation (SpO 2), arterial blood carbon dioxide partial pressure (PaCO 2), and pH value, various complications during transport, mechanical ventilation time, patients' prognosis and other indicators. Experience from the aspects of personal protection, transport process and equipment, team cooperation, mid-transit monitoring, quality control, etc., was summarized to provide suggestions for patients with severe COVID-19 using ECMO during inter-hospital transport and protection. Results:A total of 6 patients with severe H1N1 influenza virus pneumonia were transported on ECMO. All patients were transported to the intensive care unit (ICU) of the First Affiliated Hospital of Wannan Medical College by the ECMO transport team after the establishment of ECMO in the local hospital. The transfer distance was 11 to 197 km, with an average of (93.8±58.6) km; the transfer time was 30 to 150 minutes, with an average of (79.2±40.6) minutes. Two patients experienced a drop in ECMO flow and SpO 2 during the process, and the main reason was insufficient volume, which was improved after fluid resuscitation and posture adjustment. All patients maintained SpO 2 above 0.93. Six patients survived and were discharged. ECMO assisted time was 4-9 days, with an average of (6.5±1.5) days; mechanical ventilation time was 7-24 days, and median time was 10.0 (8.0, 14.5) days. No H1N1 transmission occurred in medical personnel. To achieve good therapeutic effect, the main experience was to choose the proper timing and mode of ECMO; intact transportation vehicles and equipment to reduce or avoid mechanical complications; the effective management of respiration and circulation during the transportation to avoid ventilation-associated lung injury (VALI) and serious hypoxemia; the appropriate space for the transfer team to quickly handle various critical situations; and personal protection to avoid infection. Conclusion:With an experienced ECMO transport team, good transport equipment, comprehensive protection measures, reasonable transport procedures, and a perfect emergency plan, it is safe to use ECMO transport for COVID-19 patients.

Role and mechanism of splenic myeloid-derived suppressor cells in sepsis-induced adrenal injury in mice / 中华危重病急救医学

Objective:To investigate the role and mechanism of splenic myeloid-derived suppressor cells (MDSCs) in sepsis-induced adrenal injury (SAI).Methods:Thirty male C57 mice aged 6-8 weeks were randomly divided into normal control group ( n = 5), sham operation group (Sham group, n = 5), sepsis model group [cecal ligation and perforation (CLP) group, n = 10] and sepsis+splenectomy group (CLPS group, n = 10). The sepsis model of mice was reproduced by CLP method. In Sham group, only the cecum was opened and separated, then closed, without CLP. In CLPS group, the spleen was removed before CLP. In normal control group, no challenge was given. After 24 hours, the rats were sacrificed by anesthesia, and peripheral blood, spleen, bone marrow, and bilateral adrenal glands were harvested. The pathological of adrenal gland was assessed by hematoxylin-eosin (HE) staining under optical microscope. The ratio of MDSCs in peripheral blood, spleen and bone marrow was determined by flow cytometry. The expressions of MDSCs surface antigen CD11b, Gr-1 and interleukins (IL-6, IL-1β) mRNA in adrenal tissue were measured by real-time quantitative reverse transcription-polymerase chain reaction (RT-PCR). Western Blot was used to detect the expressions of mammalian rapamycin target protein (mTOR) pathway related proteins including total mTOR (T-mTOR), phosphorylation of mTOR (p-mTOR) and caspase-3. Results:The adrenal cortex and medulla of the normal control group and Sham group were intact and the structure was clear under optical microscope, while in the CLP group, the adrenal gland showed edema, cortical hemorrhage and cell edema. Compared with the CLP group, the adrenal tissue injury was significantly reduced in the CLPS group. Compared with the normal control group and Sham group, MDSCs ratio in the peripheral blood was significantly increased and significantly reduced in the spleen in the CLP group, but there was no significant difference in bone marrow, the expression levels of CD11b, Gr-1, IL-6, IL-1β mRNA and caspase-3 protein were increased significantly and p-mTOR protein expression was significantly decreased in adrenal tissue, there was no significant difference in the expression of T-mTOR protein. Compared with the CLP group, in the CLPS group, the MDSCs ratio in the peripheral blood was significantly decreased (0.143±0.011 vs. 0.324±0.023, P < 0.01), the expression levels of CD11b, Gr-1, IL-6 , IL-1β mRNA and caspase-3 protein in adrenal gland were significantly decreased [CD11b mRNA (2 -ΔΔCt): 2.90±0.56 vs. 5.74±0.13, Gr-1 mRNA (2 -ΔΔCt): 2.71±0.14 vs. 4.59±0.46, IL-6 mRNA (2 -ΔΔCt): 2.44±0.64 vs. 5.17±1.04, IL-1β mRNA (2 -ΔΔCt): 3.58±0.52 vs. 4.44±0.26, caspase-3 protein (caspase-3/GAPDH): 0.05±0.01 vs. 0.13±0.02, all P < 0.01], the p-mTOR protein expression was significantly increased (p-mTOR/GAPDH: 0.61±0.11 vs. 0.27±0.04, P < 0.01). Conclusions:The spleen is the major source of MDSCs in SAI. Splenectomy can attenuate SAI by reducing mobilization of MDSCs and activating the mTOR signaling pathway.

Analysis of risk factors of delirium in critically ill patients / 临床麻醉学杂志

Objective To investigate the risk factors of ICU delirium in critically ill patients. Methods A total of 1 74 critically ill patients in ICU who were older than 18 yrs and stayed in ICU exceeding 24 hs from January 201 5 to June 201 5 were enrolled.Patients were divided into delirium group and non delirium group.Delirium was assessed twice daily with the Confusion Assessment Method for the ICU (CAM-ICU)during the first 7 days.The factors such as history of alcoholism and other 12 factors were analyzed by univariate and multivariate logistic regression analysis to identify those risk factors associated with delirium.Results With 22 cases of delirium in 1 74 patients,the in-cidence of delirium was 12.64% (delirium group).Variables associated with delirium were coronary heart history,operation,tracheal intubation,clinical use of mechanical ventilation,hypoxemia and Benzodiazepine.Multivariate logistic regression analysis showed that coronary heart disease (OR 3.932,95%CI 1.225-12.61 7),surgery(OR 9.691,95%CI 2.103-44.657),hypoxemia(OR 6.595, 95%CI 1.377-31.585),Benzodiazepine use (OR 7.620,95%CI 1.713-33.899)was independent risk factors of delirium in critically ill patients (P < 0.05 or P < 0.01 ).Conclusion Coronary heart disease,surgery,hypoxemia and Benzodiazepine are independent risk factors of ICU delirium in criti-cally ill patients.Early screening and prevention of delirium should be given to reduce the occurrence of delirium for patients in ICU.

Clinical value of MGFA classification and QMG score on predicting late extubation after thymectomy in patients with myasthenia gravis / 临床麻醉学杂志

Objective To evaluate clinical value of MGFA classification and QMG score on pre-dicting late extubation after thymectomy for myasthenia gravis(MG).Methods Total of 61 patients with MG received extended thymectomy from January 2007 to February 2012 were enrolled.Patients were divided into two groups:normal extubation group contained the other 47 patients without pro-longed postoperative mechanical ventilation and delayed extubation group included 14 patients with prolonged postoperative mechanical ventilation.The following factors were evaluated:gender,age, weight,MGFA classification,QMG score,history of steroid hormones or anticholinesterase drugs be-fore operation,the function of liver and kidney before operation,preoperative electrolyte,preoperative hemoglobin content,etc.Receiver operator characteristic curve (ROC)was plotted,and the predictive value, sensitivity and specificity of preoperative MGFA clinical classification and QMG score predicting postoperative ventilation in MG were calculated.Results Fourteen patients(22.95%)de-veloped breathing support after the anaesthetic or endotracheal intubation again in 48 hours.the area under ROC curve(AUC)for preoperative MGFA clinical classification predicting postoperative ventila-tion was 0.723 in MG,it had the sensitivity of 78.5% and specificity of 63.8%.The AUC for QMG score predicting postoperative ventilation was 0.866,the QMG score threshold value of 8.5 had the sensitivity of 78.6% and specificity of 87.2%.Conclusion MGFA classification and QMG score can predict late extubation after thymectomy in patients with myasthenia gravis.

Nursing care on the sedation of patients with non-invasive ventilation / 中国实用护理杂志

Objective To investigate the effect of the nursing care of critically ill patients in intensive care unit(ICU) with non-invasive ventilation assisted by sedation simultaneously. Methods During the intervention phase from June 2012 to June 2013 of 28 patients in ICU treated by non-invasive ventilation, sedatives were adjusted according to Ramsay Scale, and the parameters of the life signs (heart rate, blood pressure, oxygen saturation,etc) were measured by nurses. Results 89.3%(25/28) patients obtained the improvement of the disease despite of the complications such as over-sedation and instable hemodynamics. Conclusion The key points can increase tolerance of non-invasive ventilation and improve clinical outcomes, develop comprehensive nursing strategies on safety and effectiveness of sedation and non-invasive ventilation .

Effect of esmolol on fluid responsiveness and hemodynamic parameters in patients with septic shock / 中华危重病急救医学

Objective To study the effects of esmolol on fluid responsiveness and hemodynamic parameters in patients with septic shock.Methods A prospective self-control study was conducted.Fifteen septic shock patients undergoing mechanical ventilation admitted to Department of Critical Care Medicine of Yijishan Hospital from January 2015 to August 2015 were enrolled.All patients enrolled in this study were given the treatment based on American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) Consensus 2012.Esmolol was intravenously injected at a beginning rate of 6 mg·kg-1·h-1, and then the dose was adjusted to reduce heart rate by 10％ from baseline.The changes in hemodynamic and systemic oxygen metabolism indexes were monitored by pulse indicator continuous cardiac output (PiCCO) before and 2 hours after the esmolol administration, and the fluid responsiveness was evaluated by stroke volume variation (SVV).SVV ≥ 10％ was considered to be a positive fluid responsiveness.Results In 15 patients, 9 were male and 6 female, with an age of 65 ± 16.Among them 10 patients suffered from pulmonary infection, and 5 patients with abdominal infection.Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was 21 ±9;sequential organ failure score (SOFA) was 8 ±4.28-day mortality was 40.0％.SVV was significantly decreased after esmolol infusion as compared with baseline [(14 ± 5)％ vs.(17 ±7)％, t =2.400, P =0.031].Heart rate [HR (bpm): 100±4 vs.112±8, t =8.161, P =0.000], cardiac output [CO (L/min):6.13 ± 1.45 vs.7.88 ± 1.82, t =4.046, P =0.001], cardiac index [CI (mL·s-1·m-2): 51.51 ± 11.00 vs.66.18 ± 11.48, t =4.131, P =0.001], stroke volume index [SVI (mL/m2): 31.0 ± 6.4 vs.35.4 ± 6.5, t =2.577, P =0.020], the maximum rate of left ventricular pressure rise [dp/dt max (mmHg/s): 927±231 vs.1 194±294, t =3.775, P =0.002], global ejection fraction (GEF: 0.21 ±0.05 vs.0.24±0.06, t =3.091, P =0.008), cardiac function index (CFI: 5.03 ± 1.37 vs.6.59 ± 1.92, t =4.769, P =0.000) showed significant decrease during esmolol infusion.On the other hand, central venous pressure [CVP (mmHg, 1 mmHg =0.133 kPa): 9±3 vs.8±3, t =-3.617, P =0.003], diastolic blood pressure (DBP, mmHg: 69± 15 vs.66± 13, t =-2.656, P =0.019), systemic vascular resistance index (SVRI, kPa·s·L-1·m-2:206.8±69.8 vs.206.8±69.8, t =-3.255, P =0.006) were significantly increased during esmolol infusion.No significant difference was found in systolic blood pressure [SBP (mmHg): 120 ± 25 vs.123 ± 18, t =0.678, P =0.509],mean arterial pressure [MAP (mmHg): 86 ± 18 vs.85 ± 14, t =-0.693, P =0.500], global end diastolic volume index [GEDVI (mL/m2): 614 ± 84 vs.618 ± 64, t =0.218, P =0.830], extravascular lung water index [EVLWI (mL/kg):5.99±1.50 vs.5.73±1.14, t =-1.329, P =0.205], central venous oxygen saturation (ScvO2: 0.711±0.035 vs.0.704 ± 0.048, t =-0.298, P =0.773), arterial blood lactate [Lac (mmol/L): 3.1± 0.3 vs.3.0 ± 0.4, t =-0.997, P =0.345],and difference of central venous-arterial carbon dioxide partial pressure [Pcv-aCO2 (mmHg): 4.1 ± 0.9 vs.4.7 ± 0.5,t =1.445, P =0.182] as compared with those before esmolol treatment.Conclusion Heart rate control with esmolol infusion may reduce fluid responsiveness, cardiac function, heart rate and cardiac output without adverse effect on systemic perfusion in septic shock patients.

Diagnosis of fallopian tube patency by combination of four-dimensional and two-dimensional transvaginal hysterosalpingo-contrast sonography / 中华超声影像学杂志

Objective To evaluate the value of diagnosis in fallopian tube patency by using four dimensional transvaginal hysterosalpingo-contrast sonography (4D-HyCoSy) and two-dimensional transvaginal hysterosalpingo-contrast sonography(2D-HyCoSy) with SonoVue in infertile women.Methods First,fifty seven infertile women(113 fallopian tubes) were examined by 4D-HyCoSy,then examined by 2D-HyCoSy,and the results of examination were respectively recorded.Results By 4D-HyCoSy,54 fallopian tubes were patency,42 were unobstructed but unsmooth flow,17 were obstructed.By 2D-HyCoSy,48 of them were patency,40 of them were unobstructed but unsmooth flow,25 of them were obstructed.Three fallopian tubes were obstructed by 4D-HyCoSy,but by 2D-HyCoSy they were patency.Eleven fallopian tubes were patency by 4D-HyCoSy,but obstructed by 2D-HyCoSy.Nine fallopian tubes were patency by 4D-HyCoSy,but fimbriated extremity of these fallopian tubes were far awary from homolateral overys.They were unuseful.Eighteen patients underwent laparoscopy,30 fallopian tubes (91.4％) were concordant with laparoscopy using combination of 4D-HyCoSy and 2D-HyCoSy,the sensitivity,specificity,positive predictive value and negative predictive value were 86.7 ％,90.5 ％,86.7 ％ and 90.5 ％.The concidence rate,sensitivity,specificity,positive predictive value and negative predictive value were 85.7％,84.6％,90.5％,84.6％ and 86.4％ by 4D-HyCoSy and 71.4％,64.7％,70.0％,64.7％ and 77.8％ by 2D-HyCoSy,respectively.Accuraty of combination of 4D-HyCoSy and 2D-HyCoSy was similar with laparoscopy.Five patients appeared moderate pelvic pain,three patients appeared mild pelvic pain,two patients appeared nausea and vomiting.None need resuscitation.Conclusions Combination of 4D-HyCoSy and 2D-HyCoSy can more accurately diagnose fallopian tube patency,it can judge if fallopian tube is valuable or not and reduce misdiagnosing.It is a simple,safe,accurate,efficient method for evaluating the fallopian tube patency.

Study on the feasibility of establishing the critical care specialty in the medical undergraduate course / 中华医学教育探索杂志

As an important component of modern medicine , the critical care medicine has sprung up for years. Nevertheless, based on the postgraduate education and the further education like 5C training, the existing talent training pattern has been unable to solve the serious problem of the deficiency in the human capital of critical care medicine in hospitals of different levels. With the eco-nomic development of the society and the constant emergence of the new medical technologies , the critical care medical specialty should be quickly established in medical colleges, especially facing the modern demand on curriculum reformation in the undergraduate course. As the “National Compre-hensive Reforms Pilot Unit of Anesthesiology”, the School of Anesthesiology of Wannan Medical Col-lege is obliged to cater for the social need and respond to the national policy. Despite of the insuffi-ciency of teaching and cases, the school endeavors to build up the reformed “2+1+2” curriculum system on the basis of strengthening the major advantages. With the core of the teaching mold reform, the new system aims to enhance the clinical training and introduce the teaching mold reforms of “or-ganic system-based”, PBL and CBL, etc. Therefore, the sound training mold of critical care medicine could be further explored significantly.

Difference in time-course of relaxant effect of rocuronium between patients with ocular and generalized myasthenia gravis / 中华麻醉学杂志

Objective To compare the time-course of relaxant effect of rocuronium between patients with ocular and generalized myasthenia gravis (MG).Methods Twenty-seven ASA physical status I or Ⅱ patients with MG of both sexes,aged 12-64 yr,with body mass index of 17-26 kg/m2,scheduled for elective extended thymectomy,were divided into 2 groups according to Osserman stage:ocular group (group O,n =10) and generalized group (group G,n =17).Anesthesia was induced with iv injection of fentanyl 2 μg/kg,midazolam 0.05 mg/kg,and propofol 1.5 mg/kg.All patients were tracheal intubated and mechanically ventilated.Anesthesia was maintained with iv infusion of propofol 4-8 mg· kg-1 · h-1 and remifentanil 0.2 μg· kg-1 · min-1.Twitch tension was monitored in the adductor pollicis muscle by train-of-four stimulation of the ulnar nerve (intensity 60 mA,interval 12 s,frequency 2 Hz,wave length 0.2 ms).Rocuronium 0.6 mg/kg was injected intravenously after calibration.Mean arterial pressure (MAP),HR,heart rate variability (HRV) and low frequency and high frequency (LF/HF) ratio was recorded.The onset time of muscle relaxation,time for T1 to recover to 25％,time for T1 to recover to 50％ and recovery index were recorded.Results Compared with the baseline value,there were no significant changes in MAP,HR,HRV,LF/HF ratio at all time points in the two groups (P ＞ 0.05).Compared with group O,there was no significant change in the onset time of muscle relaxation,and the time for T1 to recover to 25％,time for T1 to recover to 50％ and recovery index were significantly prolonged in group G (P ＜ 0.05).Conclusion The duration of rocuronium-induced neuromuscular block is significantly longer in patients with generalized MG than those with ocular MG,while the onset time is comparable between the two groups.

Effects of different modes of delivery on arterial oxygen saturation in the fetus / 中华麻醉学杂志

Objective To compare the effects of different modes of delivery on arterial oxygen saturation in the fetus.Methods One hundred and twenty ASA Ⅰ or Ⅱ parturients aged 22-32 yr with a single fetus at full term lying in normal headdown position were divided into 3 groups according to the modes of delivery (n =40 each):group cesarean section (group CS) ; group labor analgesia (group LA) and group spontaneous labor (group SL).In group CS cesarean section was performed under epidural anesthesia with 0.5％ ropivacaine.Epidural catheter was placed at L2,3 interspace in groups CS and LA.In group LA labor analgesia was started from the first stage and maintained until complete cervical dilatation.The patients received epidural PCA (PCEA) with O.125 ％ropivacaine plus fentanyl 2 μg/ml.PCEA setting was as follows:a loading dose of 8-10 ml; demand bolus 5 ml;20 min lockout; background infusion 6-10 ml/h.Blood samples were taken from umbilical artery at delivery for blood gas analysis and determination of serum concentrations of lactate,β-endorphin (β-EP) and neuropeptide Y (NP-Y).Apgar score and neurological and adaptive capacity score (NACS) were recorded.Results There was no significant difference in Apgar score,NACS and NP-Y and β-EP concentrations in umbilical arterial blood among the 3 groups.The lactate concentration and the absolute value of BE were significantly higher while pH was lower in group SL than in groups CS and LA.PO2 was significantly higher while PCO2 was lower in group LA than in groups SL and CS,and the lactate concentration and absolute value of BE were significantly lower while pH was higher in group LA than in group SL.Conclusion The 3 modes of delivery have significant effects on arterial oxygenation in fetus but have no clinical significance.

Effects of different delivery methods on maternal and fetal complications during labor / 复旦学报（医学版）

Objective To investigate the effects of 3 different delivery methods on maternal and fetal complications during labor and determine better mode of delivery. Methods Sixty pregnant women with ASA class Ⅰ or Ⅱ were randomly divided into three groups with 20 cases each: the cesarean section group (group Ⅰ), the pain relief group (group Ⅱ) and normal delivery group (group Ⅲ). In group Ⅰ and Ⅱ, an epidural catheter was placed through L_(2-3) interval. 0.5% ropivacaine was injected via the epidural catheter for continuous epidural anesthesia in group Ⅰ. After a loading dose of 8-10 mL 0.125% ropivacaine+2 μg/mL fentany, the patient-controlled epidural analgesia (PCEA) during labor was started with bolus 5 mL, lockout interval 20 min and back ground infusion rate 6-8 mL/h in group Ⅱ. The level of block was controlled below T_(10). BP, HR and RR were continuously monitored during labor. Blood samples were taken from umbilical vein at delivery for blood gas analysis and determination of lactate concentration. Neonates were assessed by Apgar score and neurological and adaptive capacity score (NACS). Maternal postoperative complications were recorded. Results There was no statistical differences in plasma pH, PCO_2, PO_2, SO_2, Apgar score and NACS among 3 groups. The umbilical vein blood lactate concentration was significantly increased in group Ⅱ and Ⅲ compared to the group Ⅰ, while blood lactate concentration in group Ⅱ was lower than that in the group Ⅲ (P<0.05). Base excess (BE) was significantly higher in group Ⅲ than in group Ⅰ. Compared with group Ⅱ and Ⅲ, maternal postoperative complications such as urinary retention, postpartum hemorrhage and so on were increased significantly in group Ⅰ (P<0.05). PCEA provided satisfactory effect in group Ⅱ. Conclusions Epidural labor analgesia with 0.125% ropivacaine+2 μg/mL fentany can provide comparative and effective analgesia for pain relief during labor without adverse effects on the mothers and fetuses and may reduce the postoperative complications. It is a safer and more effective technique in pain relief during labor.

Effects of acute hypervolemic hemodilution with hydroxyethyl starch 13010.4 on intestinal mucosal barrier in a rabbit model of sepsis / 中华麻醉学杂志

Objective To investigate the effects of acute hypervolemic hemodilution (AHH) with hydroxyethyl starch (HES) 130/0.4 on intestinal mucosal barrier in a rat model of sepsis.Methods Thirty healthy New Zealand rabbits of both sexes weighing 2.0-3.0 kg were randomly divided into 3 groups (n=10 each):group I sham operation; group II sepsis and group III AHH+sepsis.Sepsis was produced by modified colon ascendens stent peritonitis(CASP).At 4 h after CASP group III meceived HES 130/0.4 20 ml/kg iv at a rate of 20 ml/min.The MAP and HR were monitored and recorded at 4 h (before AHH) and 5,6,7,8 h after CASP.Blood samples were taken from carotid artery and superior mesenterie vein (SMV) at 4 h and 8 h after CASP for blood gas analysis and determination of plasma D-lactate concentration and intestinal oxygen extraction ratio.The rabbits were sacrificed at 8 h after CASP and a segment of ileum of 3 cm in length,5 cm from ileocecal valve,was removed for determination of wet/dry ileum weight ratio and microscopic examination.The degree of damage to intestinal mucous membrane was scored according to Chiu score (0=normal,5=severe damage).Results Sepsis-induced hypotension and metabolic acidosis,increased plasma D-lactate concentration,decreased intestinal oxygen extraction ratio,increased wet/dry ileum weight ratio and Chiu score in group II as compared with group I.AHH with HES 130/0.4 20 ml/kg significantly attenuated the scpsis-induced changes in group III.Conclusion AHH with HES 130/0.4 can attenuate damage to intestinal mucosal barrier produced by sepsis.

Influence of exercise at high temperature on blood biochemical indexes and HSP72 expression in adult males / 华中科技大学学报（医学）（英德文版）

The influence of exercise at high temperature on adult males' routine blood indexes and biochemical indexes and the expression of HSP72 in peripheral blood lymphocytes (PBLs) was studied in order to provide theoretical ground for health supervision of adults receiving exercise at high temperature. 180 adult males were selected and divided into exercise group and control group, in which the exercise group was subdivided into subgroup 1 and subgroup 2 receiving exercise at high temperature in the afternoon and in the morning, respectively. Peripheral venous blood was phlebotomized before and after the exercise to examine routine blood indexes and blood biochemical indexes. The expression levels of HSP72 in PBLs were detected by flow cytometry. The results showed that the routine blood indexes and biochemical indexes in each group were within the range of normal values of male adults. There was no significant difference between each exercise group and control group in indexes before exercise. After exercise, the expression levels of HSP72 in PBLs in exercise groups were higher than those before exercise, and HSP72 expression levels in subgroup 1 were obviously higher than those in subgroup 2 and control group. The contents of ALT, urea, Na+, Cl-, Ca2+ and K+ in subgroups 1 and 2 were lower than those in control group, but CK level was higher than in control group (P<0.05). The contents of Na+ and Cl- in subgroup 1 were relatively lower than those in subgroup 2 (P<0.05). It was concluded that while receiving exercise at high temperature, adult males' HSP72 levels in PBLs could be increased and the biochemical indexes changed. Attention should be paid to health supervision to avoid obvious body injuries at high temperature.

Effect of low concentration desflurane on hemodynamics and fibrinolysis in patients with elective chest surgery during general anesthesia / 中国临床药理学与治疗学

AIM: To investigate the effect of low concentration desflurane on hemodynamics and fibrinolysis in patients during general anesthesia. METHODS: Twenty eight ASA grade Ⅰ-Ⅱ patients during general anesthesia, scheduled for elective chest surgery, were studied, and hemodynamics and fibrinolysis were observed after inhalation of desflurane at 0.5 and 1.0 MAC , respectively. RESULTS: Compared with those before anesthesia, SBP, DBP, and MAP remarkably decreased and HR significantly increased at intubation. However, the changes were more remarkable than those of before anesthesia when inhalation of desflurane at 0.5 and 1.0 MAC ; blood pressure did not further decreased; and HR did not increased in comparison with intubation. The level of plasma tissue plasminogen activator (t PA) remarkably increased and the level of plasma plasminogen activitor inhibitor (PAI) significantly decreased when inhalation of desflurane. The level of plasma t PA further increased and the level of plasma PAI further decreased as inhalation of increased desflurane concentration. CONCLUSION: There are some effects of low concentration desflurane on hemodynamics and fibrinolysis in patients with chest surgery during general anesthesia.

Effect of continuous epidural analgesia of tramadol on postoperative gastrointestinal function and serum motilin level / 中国临床药理学与治疗学

AIM: To observe the effect of continuous epidural analgesia (CEA) of tramadol on postoperative gastrointestinal function and serum motilin level in the patients with cholecystectomy. METHODS: Twenty eight ASAⅠ-Ⅱpatients (8 male, 20 female) aged 24-56 yr, scheduled for elective cholecystectomy under epidural anesthesia, were randomly divided into tramadol group (T, n=14) and control group (C, n=14). The combination of tramadol 800 mg+ bupivacaine 150 mg+ droperidol 5 mg, which diluted with normal saline to 100 ml and pumped 2 ml?h -1, was administered in group T. The combination in group C was bupivacaine 150 mg+ droperidol 5 mg. The VAS values, the first anorectum exhaust timing (FAET), and the time of the first eliminating stool timing (FEST) were recorded, and serum motilin level measured with radioimmunoassay at the different times after surgery. RESULTS: There was a significant difference in the mean VAS values between group T ( 1.2? 1.2) and group C ( 3.3? 1.3) (P

Effect of acute hypervolemic hemodilution on cerebral O_2 supply/consumption and energy metabolism during general anesthesia combined with epidural block in adults / 中华麻醉学杂志

Objective To investigate the effects of acute hypervolemic hemodilution (AHH) on cerebral O2 supply/consumption and energy metabolism in patients undergoing elective surgery under general anesthesia combined with continuous epidural block. Methods Fourteen ASA Ⅰ or Ⅱ patients of both sexes (9 male, 5 female) aged 44-62 yrs weighing 55-70 kg undergoing elective surgery under general anesthesia combined with epidural block were enrolled in this study. Lactated Ringer's solution 6-8 ml?kg-1 was infused before anesthesia. After correct placement of epidural catheter was confirmed radial artery was cannulated for BP monitoring and blood sampling. BP, EGG, SpO2 and PET CO2 were continuously monitored during anesthesia. General anesthesia was induced with fentanyl, midazolam, propofol and rocuronium and maintained with iaoflurane and intermittent i. v. boluses of vecuronium. The patients were intubated and mechanically ventilated. PET CO2 was maintained at 30-35 mm Hg. Epidural block was produced by a mixture of 1.33 % lidocaine + 0.167 % dicaine. Right internal jugular vein was retrogradely cannulated and advanced cephalad until jugular bulb for blood sampling. AHH was conducted by infusing 6% HES 20 ml?kg-1 at 50 ml?min-1 after induction of general anesthesia. Blood samples were taken from artery (a) and jugular venous bulb (jv) simultaneously before AHH (T0) at 15 min (T1) and 120 min (T2) after AHH was accomplished for blood gas analysis and determination of Hb, glucose and lactate concentrations. Cerebral O2 extraction rate (CERO2), glucose extraction rate (CMRglu) , arterial-jugular bulb venous O2 content difference (D a-jvO2) and arterial-jugular bulb venous lactate difference (VADL) were calculated. Results At the end of AHH Hct and Hb decreased by 20% as compared to the baseline values before AHH. S jvO2 was significantly higher, D a-jvO2 smaller and CERO2 lower at T1 than at T0. There were no significant differences in BP, HR, CMRglu and VADL at all time points. Conclusion AHH can increase cerebral O2 supply and has no significant effect on cerebral glucose metabolism during operation performed under general anesthesia combined with epidural block.