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Objective:To compare the recovery effect of continuous infusion of dexmedetomidine combined with oxycodone or sufentanil in the anesthesia intensive care unit (AICU) in elderly patients after thoracoscopic radical surgery for lung cancer.Methods:Using the method of prospective study, 80 elderly lung cancer patients underwent selective thoracoscopic radical surgery under general anesthesia in Nanjing First Hospital from February 2021 to May 2022 were selected. The patients were divided into dexmedetomidine combined with sufentanil group (S group) and dexmedetomidine combined with oxycodone group (Q group) by random digits table method with 40 cases each group. On the basis of routine monitoring and treatment after operation, the patients in Q group were continuously injected with oxycodone 0.03 mg/(kg·h) and dexmedetomidine 0.4 μg/(kg·h) through analgesia pump, the patients in S group were continuously injected with sufentanil 0.03 mg/(kg·h) and dexmedetomidine 0.4 μg/(kg·h) through analgesia pump. The wake-up time, extubation time, awakening quality (Aldrete score and bucking score) and comfort level (Bruggrmann comfort scale score, BCS score) after entering the AICU were record; the sedation score (Ramsay score) and pain relief score (numerical rating scale score, NRS score) and hemodynamic changes (mean arterial pressure and heart rate) 3, 5, 7, 10 and 14 h after entering the AICU were record; the level of serum inflammatory factors, including tumor necrosis factor (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) immediately, 5 h and 14 h after entering the AICU; press times of analgesia pump, adverse events, bleeding volume of drainage tube during AICU and overall satisfaction score when leaving the AICU were record.Results:The bucking score in Q group was significantly lower than that in S group: (1.02 ± 0.77) scores vs. (1.88 ± 0.34) scores, the Aldrete score and BCS score were significantly higher than those in S group: (8.93 ± 0.25) scores vs. (5.97 ± 0.32) scores and (3.03 ± 0.32) scores vs. (0.93 ± 0.52) scores, and there were statistical differences ( P<0.01); there were no statistical difference in wake-up time and extubation time between two groups ( P>0.05). There were no statistical difference Ramassy score, NRS score 3 and 5 h after entering the AICU, mean arterial pressure and heart rate between two groups ( P>0.05); the Ramassy score 7, 10 and 14 h after entering the AICU in Q group was significantly lower than that in S group, the NRS score, mean arterial pressure and heart rate were significantly lower than those in S group, and there were statistical differences ( P<0.01). There were no statistical differences in TNF-α, IL-6 and CRP immediately after entering the AICU between two groups ( P>0.05); the TNF-α, IL-6 and CRP 5 and 14 h after entering the AICU in Q group were significantly lower than those in S group, and there were statistical difference ( P<0.01). The press times of analgesia pump, bleeding volume of drainage tube and the incidences of nausea vomiting, respiratory depression, lethargy, restlessness, fever and lung infection in Q group were significantly lower than those in S group: (4.63 ± 1.10) times vs. (18.80 ± 1.54) times, (129.67 ± 4.14) ml vs. (164.00 ± 8.14) ml, 10.0% (4/40) vs. 52.5% (21/40), 2.5% (1/40) vs. 25.0% (10/40), 7.5% (3/40) vs. 47.5% (19/40), 0 vs. 20.0% (8/40), 2.5% (1/40) vs. 22.5% (9/40) and 2.5% (1/40) vs. 20.0% (8/40), and there were statistical differences ( P<0.01 or <0.05); there was no severe hypotension, severe bradycardia and delirium in both groups. The overall satisfaction score in Q group was significantly higher than that in S group: (3.53 ± 0.63) scores vs. (2.70 ± 0.65) scores, and there was statistical difference ( P<0.01). Conclusions:Continuous micro-pump infusion of dexmedetomidine combined with oxycodone in AICU elderly patients with lung cancer after thoracoscopic radical surgery can significantly improve the quality of recovery and comfort during extubation, without affecting the extubation time, and can effectively reduce the degree of pain, stress and inflammatory reaction in the early recovery period, and reduce the incidence of adverse events after surgery.
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China’s anti-epidemic actions has always adhered to the value of people first and life first, which has profoundly affected the perception of medical humanism by the whole society, especially medical workers. The epidemic prevention and control has put forward new requirements for medical personnel to practice medical humanism, reflecting the unique connotation of the times. In the context of normalized epidemic prevention and control, it is timely to reshape the humanistic spirit of medicine, which has extremely important value of the times. On the basis of explaining the connotation and significance of medical humanism, this paper analyzed the impact and influence of the epidemic on the medical humanism of medical personnel. The value orientation of medical humanism, which is the unity of synergy and innovation, the unity of doctor’s kindness and social responsibility, and the unity of national spirit and human health community, was constructed, and suggestions for reconstructing medical humanism were put forward in terms of improving institutional norms, strengthening education and training, promoting the synergistic development of medical technology and medical humanism, and creating a harmonious humanistic atmosphere.
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TCM service trades are an inevitable choice for TCM development, and also one of the most important levels in the national development strategy pattern. For the Belt and Road, it is necessary to promote the rapid development of TCM service trades, not only for promoting transformation cross domain development of TCM industry in Gansu, but also for promoting Gansu economic and social development. Based on the analysis of the significance and opportunities of the TCM service trades, this article proposed the specific strategies for promoting the development of TCM service trades in Gansu Province.
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OBJECTIVE:To provide reference for improving the food and drug inspection and testing system in Gansu prov-ince. METHODS:The food and drug inspection and testing institutions in Gansu province were investigated by using questionnaires and interview. Information about resource allocation,operational capacity and business scope in various levels of food and drug in-spection and testing institutions in Gansu province were collected. Problems existing in food and drug inspection and testing system in Gansu province were analyzed,and countermeasures were put forward. RESULTS & CONCLUSIONS:The food and drug in-spection and testing system in Gansu province is not perfect,showing unreasonable resource allocation,lack of inspection and test-ing resources as a whole,low resource utilization,imperfect management mechanism,weak normativity and other problems. In or-der to achieve the improvement of food and drug inspection and testing system in Gansu province,countermeasures were put for-ward,including optimizing resource allocation of inspection and testing,enhancing facility and capacity,improving the utilization of existing resources,improving management mechanism,process and standard.
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Objective To evaluate the effects of sevoflurane on right ventricular systolic function after cardiopulmonary bypass in patients undergoing coronary artery bypass grafting(CABG). Methods Eighteen patients with coronary heart disease,13 males,5 females,ASA Ⅱ or Ⅲ,aged 50-80 years,measuring 1 50-182 cm in height,weighing 5 1-96 kg,scheduled for CABG under CPB were enrolled in this study.Anesthesia was maintained with intravenous anesthesia, and 1 MAC sevoflurane inhalation lasted for 60 min after CPB.Hemodynamic indicators such as HR,MAP, CVP,cardiac output (CO),Systemic vascular resistance (SVR)and right ventricular parameters in-cluding tricuspid annular plane systolic excursion (TAPSE)and velocity (TAPSV)were recorded be-fore sternotomy (T2 ),30 min after CPB (T3 ),60 min after CPB (T4 ).Results Compared with T1 , CO was increased at T2 (P <0.05);compared with T2 ,CO was decreased at T3 and T4 (P <0.05 or P <0.01),with a statistical significance;compared with T1 ,TAPSE and TAPSV were increased at T2 (P <0.05 or P <0.01);compared with T2 ,TAPSE and TAPSV were decreased at T3 and T4 (P<0.05);with a statistical significance in TAPSE and TAPSV.Conclusion For the patients undergo-ing CABG under CPB,1 MAC sevoflurane inhalation after CPB can reduce right ventricular systolic function,which,however,is within the normal ranges.
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Objective:To investigate the value of 64-slice spiral computed tomography (64SCT) in preoperative evaluation of spinal vascular intervention.Methods: Seventeen patients with spinal vascular malformations(SVM) scheduled for spinal vascular interventional therapy in our hospital between January 2012-December 2014 were collected, all received 64-detector spiral CT angiography (64-MDCTA) before surgery, image postprocessing technologies such as volume rendering (VR), maximum intensity projection(MIP) and multiplanar reconstruction(MPR) were applied to conduct three-dimensional reconstruction, the traveling case of spinal cord feeding artery was analyzed and were compared with DSA test results.Results: All of the 17 patients clearly showed the abnormality of spinal cord blood vessels and lesions scope, the SVM classification and lesions scope were exactly the same as that of DSA and intraoperative performance, the coincidence rate was 100%;1 case of patient was not shown fistula, the rest of the patients clearly shown the draining veins around the spinal cord, open position and flow tendency of radiculomedullary artery, the coincidence rates were 100.00%, 94.12%%, 100.00%.Conclusion: 64-MDCTA is important for SVM patients to preoperative evaluation of spinal vascular intervention, for it can fully and accurately reflect the open position and flow tendency of radiculomedullary artery, spatial relationship with the surrounding vessels, spinal cord and vertebral situation, should be widely applied.
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Objective To evaluate the effect of transcatheter arterial chemoembolization(TACE)together with portal vein chemoembolization(PVCE)for the treatment of advanced liver carcinomas.Methods Forty-eight patients with liver carcinoma were randomly divided into two groups.Patients in study group(n=22)were treated with TACE together with PVCE,and patients in control group(n=26)were treated with TACE alone.Results Based on the postoperative CT findings and AFP levels,the effective rate of the study group was markedly higher than that of control group and the difference between two groups was statistically significant(P＜0.05).The volume of un-embolized liver tissue in the patients of study group was obviously increased after treatment. Conclusion TACE together with PVCE is superior to TACE alone in treating advanced hepatic carcinomas.The combination of TACE and PVCE can effectively increase the successful rate of surgical resection for the advanced hepatic carcinomas.
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Preoperative portal vein embolization(PVE)has become an important tool in the management of selected patients with hepatic cancer before the major hepatic resection is carried out.PVE can redirect the portal flow to the intended future remnant liver tissue in order to induce the hypertrophy of the non-diseased portion of the liver and thereby may reduce the occurrence of complications and shorten the hospitalization days after surgery.This article aims to review the technical and clinical considerations in performing PVE and to discuss the PVE-related practical points,including the relevant anatomy,the access approach,the choosing of embolic agents and the pathophysioiogy of PVE.In addition,the indications and contraindications for performing PVE,the use of combination therapies and the concern for tumor growth after PVE are also discussed.
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Objective To observe the effect of inferior vena cava filter (IVCF) on prevention of bone cement implantation syndrome (BCIS). Methods Ten sheep were divided into 2 even groups, BCIS and LVCF intervention ones. First IVCF was implanted into the inferior vena cava through cervical vena-right atrium pathway under fluoroscopic monitoring to observe the influence of IVCF on BCIS. Then BCIS was es-tablished in the same sheep by compressing 10 mL of bone cement into a sheep medullary canal after mutilation of the left femur. Arterial blood pressure, heart rate, central venous pressure (CVP) and blood gas were monitored, while an ultrasonic device was utilized to monitor fat embolisms in the right atriums of the sheep. Oil red staining was performed to detect fat embolisms in pulmonary arteries after the sheep were executed. Results In BCIS group, dotted uneven resonances were found in the right atrium and right ventricle when the medullary canal pressure was increased to 120 mm Hg, indicating embolisms in the right chambers. The dotted resonances were increased to ponderous, snowflake-like ones as the medullary canal pressure climbed up. At the same time, blood pressure and Pa02 dropped significantly, the systolic blood pressure dropped to (80±11) mm Hg and PaO<.2> to the minimum 25 minutes after cone cement implantation. The heart rate and CVP increased continuously. The blood gas assay indicated respiratory and metabolic acidosis. The oil red staining showed bulk fat embolus in pulmonary arteries. But in IVCF group, the similar resonances were not observed throughout the surgery and the medullary canal pressure climbed to 400 mm Hg, reaching the maximum of our pressure gage range. The blood pressure, PaO2, heart rate and CVP did not change much compared to those before implantation. The blood gas and pulmonary oil red staining showed few changes either. Conclusion IVCF implantation can prevent the genesis of BCIS.
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<p><b>OBJECTIVE</b>To investigate relationship between apoptosis of the cardiac myocytes and myocardial dysfunction in severely scalded rats.</p><p><b>METHODS</b>Wistar rats inflicted by 40% TBSA III degree scalding were employed as the model. The myocardial tissue was obtained from the left ventricle at different postburn time points. Apoptosis was determined by the determination of myocardial tissue Caspase-3 activity and TUNEL staining (terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-biotin nick end labeling). The LVSP (left ventricular systolic pressure), LVEDP (left ventricular end-diastolic pressure) and +dp/dtmax (the rate of the rise of left ventricular pressure) and -dp/dtmax (the rate of the fall of left ventricular pressure) were all monitored by four-channel physiological recorder. In addition, myocardial activities of MPO and SOD were detected.</p><p><b>RESULTS</b>The TUNEL staining of rat myocardial cells was positive at 6 postburn hour (PBH) and reached top level at 12 PBH. The change in Caspase-3 activity was earlier than that of apoptotic morphology and reached peak values at 3 and 6 PBHs. The left ventricular function (systolic and diastolic function) was significantly impaired after the scalding and dropped to the lowest levels at 12 PBHs. The increase in myocardial tissue MPO activity was accompanied by the decrease in SOD activity.</p><p><b>CONCLUSION</b>Myocardial cellular apoptosis was one of the reasons of postburn myocardial injury in scalded rats. Caspase protease cascade pathway might be involved in the process of apoptosis, which suggested that the initiation of apoptosis was closely related to the infiltration of neutrophils and to the release of large amounts of oxygen free radicals in myocardial tissue.</p>
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Animals , Female , Male , Rats , Apoptosis , Burns , Pathology , Caspase 3 , Caspases , Metabolism , Myocytes, Cardiac , Pathology , Peroxidase , Metabolism , Rats, Wistar , Superoxide Dismutase , Metabolism , Ventricular Function, LeftABSTRACT
Objective To investigate the X-ray characteristics and differential points of intra-thoracic malignant lymphoma-Hodgkin’s disease(HD) and Non-Hodgkin’s lymphoma(NHL).Methods The X-ray manifestations of intra-thoracic malignant lymphoma in 66 cases(including HD in 20 and NHL in 46) with complete clinical informations and pathologic results were retrospectively analysed.The lymphadenopathy of the hilar and mediastinum,the changes of the intra-lung and pleura were mainly observed and compared with the pathological results.Try to find the characteristic X-ray appearance of the HD and NHL.Results (1)48 cases had enlargement of lymph nodes of the hilar with/or mediastinum,and common seen in NHL,and the lymphopathy appeared as unilateral or asymmetry in NHL,bilateral or symmetry in HD.(2)The involvement of lymph nodes was mostly the anterior mediastinum and retrosternal in HD,the posterior mediastinum in NHL and to cause the paraspinal line widening.(3)Intra-pulmonary lesions always were interstitial changes and common seen in NHL,and seldom seen in HD.(4)NHL was often accompanied with pleural lesions,and HD not.Conclusion Both HD and NHL have its own X-ray characteristics .Carefully observing and analyzing these characteristics are helpful in diagnosing and differentiating HD and NHL.
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Objective To study the X-ray signs of lung injury in acute ammonia poisoning.Methods The X-ray features of lung in ammonia poisoning in 37 cases were analysed and all patients were followed up for one year.Results The X-ray signs of lung in early of ammonia poisoning in 35 cases included increase of lung markings,lobular pneumonia,pulmonary interstitial emphysema and pneumonedema.In advanced stage in 15 cases,chronic bronchitis,pulmonary interstitial fibrosis and pulmonary bullae.Conclusion It's irreversible of injury that caused by acute ammonia poisoning in lung.
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Objective To study the diagnostic value of imageology for pyelic carcinoma.Methods The accuracy of qualitative diagnosis and sensitivity were analyzed by comparing various imaging examinations in 19 patients with pathologically proved pyelic carcinomas.Results Irregular filling defect and hydronephrosis were seen in the renal pelvis and calyces on intravenous pyelography(IVP).On CT scan,when the tumor was small,soft tissue mass was in the renal pelvis and the calyces.When the renal parenchyma involved by tumors,the soft tissue masses with unhomogeneous density,liquefaction necrosis in the renal pelvis and the parenchyma were seen.On contrast-enhanced CT scan,enhancement from slight to moderate was found in the lesion.The lesions were detected by IVP in 9/12 cases,by BUS in 10/16 cases,by CT in 18/19 cases and by MRI in 3/3 cases.Conclusion IVP and CT are the first method of choice to diagnose the pyelic carcinoma,BUS can be used as a screening method.While in evaluating the tumor involving the parenchyma of the ren or distant metastasis,CT and MRI are superior to IVP.
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The dynamica changes of the activity of serum tumor necrosis factor(TNF)was determined in 24 patients with severe burns,and the changes of cardiac and hepatic enzymes,plasma lactate and glucose,serum protein,WBC count etc were determined as well.It was found that TNF was produced in large amounts to damage and degenerate the vascular endothe-lium.Consequently intravascular emboli were more liable to occur to result in tissue hypoxia.TNF could also induce the release of polymorphonuclear neutrophils(PMNs)from the bone marrow.PMNs by chemotacsis accumulated in the inflammatory tissues to produce large amounts of toxic products,which could damage the cells and tissues directly to result in multiple organ failure.Furthermore,TNF,through the mediation of pyrogen and cachectin,could induce febrile reaction,exhaustion of glycogen reserve,and increment of muscular protein catabolism.Eventually the energy consumption of the host would be incresed and his defensive function weakened.
