Objective To observe the effect of combined continuous femoral nerve blockade (CFNB)with epidural morphine postoperative analgesia on total knee arthroplasty (TKA)in elderly patients.Methods Eighty elderly patients scheduled to undergo TKA were randomly divided into two groups:groups FN and FNM.Groups FNM and FN were received 0.1% morphine 2 ml and normal saline 2 ml through epidural space respectively at the end of surgery.After surgery,all patients were implanted catheter around femoral nerve guided by ultrasound,and were infused 0.2% ropivacaine 25 ml.Continuous infusion of 0.2% ropivacaine for femoral never block was administrated at a rate of 5 ml/h for 48 hours to all patients.VAS scores and bending degree during rest,active and passive exer-cise were recorded at time point of postoperative 24,48,72,96 h.Ambulation status on the fifth day after operation were observed.Satisfaction of hospitalization were graded before hospital discharge. Results Compared with group FN,VAS scores during rest,active and passive excercise were signifi-cantly decrease at 24 h in group FNM (P <0.05 or P <0.01).The bending degree of knee joints in group FNM were significantly greater compared with group FN at 24 h after surgery (P <0.01).Am-bulation status on the fifth day after surgery were significantly better in group FNM compared with group FN (P <0.05).The level of patient satisfaction was much higher in group FNM (P <0.05). Conclusion After TKA,CFNB combined with single epidural morphine injection can provide better analgesia and bending degree with a high level of satisfaction.

Objective To evaluate the effect of electro-acupuncture (EA) at Zusanli (ST36) acupoint on blood coagulation during intestinal ischemia-reperfusion (I/R) in rats.Methods Forty healthy male Sprague-Dawley rats,aged 6-8 months,weighing 250-300 g,were divided into 5 groups (n =8 each) using a random number table:sham operation group (group S),intestinal I/R group (group I/R),EA at Zusanli acupoint group (group EA),EA at non-acupoint group (group NE) and α7 nicotinic acetylcholine receptor antagonist α-bungarotoxin (α-BGT) group (group α-BGT).Intestinal I/R was induced by clamping the superior mesenteric artery for 4-5 min followed by 120 min of reperfusion.Bilateral Zusanli acupoints were stimulated with an electric stimulator (frequency 3 Hz,voltage 2-4 V,wave length 2 ms) for 30 min starting from the time point immediately after beginning of ischemia in group EA,while EA was performed at the points 5 mm lateral to the bilateral Zusanli instead in group NE.In group α-BGT,α-BGT 1 μg/kg was intraperitoneally injected at 45 min before ischemia,and the other treatments were similar to those previously described in group EA.Blood samples were collected from the abdominal aorta at 120 min of reperfusion for determination of the concentrations of tumor necrosis factor alpha (TNFα),tissue factor (TF),antithrombin (AT),tissue plasminogen activator (tPA),fiber plasminogen activator inhibitor-1 (PAl-l) and D-dimer in plasma (by enzyme-linked immunosorbent assay) and platelet count (PLT).The animals were sacrificed after blood sampling,the distal ileum specimens were removed for examination of the pathological changes with a light microscope,and the damage to the intestinal mucous membrane was assessed and scored according to Chin.Results Compared with group S,the concentrations of plasma TNFα,TF,tPA,PAI-1 and D-dimer were significantly increased,and the plasma AT concentration and PLT were decreased in I/R,NE and α-BGT groups,the concentrations of plasma TNFα and TF were significantly increased,and the plasma AT concentration was decreased in group EA,and Chiu's scores were significantly increased in I/R,EA,NE and α-BGT groups (P＜ 0.05).Compared with group I/R,the concentrations of plasma TNFα,TF,tPA,PAI-1 and D-dimer were significantly decreased,the plasma AT concentration and PLT were increased,and Chiu's scores were decreased in group EA (P＜0.05),and no significant change was found in the variables mentioned above in NE and α-BGT groups (P＞0.05).Compared with group EA,the concentrations of plasma TNFα,TF,tPA,PAI-1 and D-dimer were significantly increased,the plasma AT concentration and PLT were decreased,and Chiu's scores were increased in group NE (P＜0.05).Conclusion EA at Zusanli acupoint can improve blood coagulation during intestinal I/R in rats,and the mechanism is related to activating the cholinergic anti-inflammatory pathway.

Objective:To investigate the effects of dyclonine hydrochloride mucilage administered for oropharyngeal anesthesia on gag reflex in patients with chronic pharyngitis during gastroscopy.Methods:A total of 100 patients with chronic pharyngitis who met American Society of Anesthesiologists Classification I-II and received treatment in The First Affiliated Hospital of Ximen University from January to December 2020 were included in this study. Using the principle of voluntariness, these patients were divided into dyclonine hydrochloride mucilage (D) and control (C) groups, with 50 patients in each group. Ten minutes before anesthesia induction, patients in Group D took 10 mL of dyclonine hydrochloride mucilage in the mouth, but did not swallow it, and those in Group C were identically given equal volume of placebo. Ten minutes later, dyclonine hydrochloride mucilage or placebo was swallowed. For anesthesia induction, 20 μg Fentanyl and 2-4 mg/kg Propofol were intravenously administered. A gastroscopy examination was performed after the patient's consciousness disappeared. The patient's cough and body movement response scores during gastroscopy were recorded. Before anesthesia induction (T0), before endoscope insertion (T1), after endoscope insertion (T2), and after endoscope withdrawal (T3), mean arterial pressure and heart rate were recorded.Results:The incidence rate of cough and body movement in Group D were 20% (10/50) and 24% (12/50), which were significantly lower than 72% (36/50) and 68% (34/50) in Group C ( χ2 = 27.21, 19.49, both P < 0.001). At T1, mean arterial pressure in Group D and Group C was (62.21 ± 10.32) mmHg and (63.82 ± 10.51) mmHg(1 mmHg=0.133 kPa), respectively, which were significantly lower than (70.21 ± 13.13) mmHg and (70.91 ± 14.02) mmHg at T0 ( t = 3.15, 5.82, both P < 0.05). At T2, mean arterial pressure and heart rate in Group C were (80.13 ± 11.92) mmHg and (90.02 ± 15.63) beats/minute, respectively, which were significantly higher than (70.91 ± 14.02) mmHg and (78.75 ± 14.93) beats/minute at T0 in the same group ( t = 5.99, 4.03, both P < 0.05) and were also significantly higher than (66.21 ± 12.33) mmHg and (76.53 ± 10.31) beats/minute] at T2 in Group D ( t = 2.07, 2.67, both P < 0.05). Conclusion:Dyclonine hydrochloride mucilage administered for oropharyngeal anesthesia can effectively suppress gag reflex in patients with chronic pharyngitis and increase hemodynamic stability during gastroscopy.