Objective To investigate the causes and remedial measures of the failure of continuous epidural for labor analgesia. Methods Nine hundred and fifty-two primiparas who received voluntary labor analgesia were selected. They received epidural block in the L2-3 interspace, and epidural catheter was inserted 4 cm into the epidural space. The method of labor analgesia was continuous intravenous injection combined with self controlled analgesia. The visual analogue score (VAS) >5 scores was analgesia failure. Withdrawing the epidural catheter 1 to 2 cm and replacement of the catheter or changing to subarachnoid space combined with epidural block was used to rescue the analgesia failure. The production process progress and satisfaction rate of postpartum 24 h were recorded. Results The analgesia failure was in 144 cases, and the analgesia failure rate was 15.1%(144/952), among which the epidural catheter was inserted into blood vessels in 47 cases, the epidural catheter was blocked by a blood clot in 13 cases, the epidural catheter bent in 9 cases, the unilateral block or partial block was in 31 cases, the epidural catheter migrated in 37 cases, the catheters left the epidural cavity in 5 cases, and dural puncture was in 2 cases. Eighty-seven cases were treated by withdrawing the epidural catheter 1 to 2 cm, 48 cases were treated by replacement of the catheter, and 9 cases were treated by changing to subarachnoid space combined with epidural block. The satisfaction rate of postpartum 24 h was 96.7%(921/952). Conclusions The failure of continuous epidural block for labor analgesia is higher. According to the different causes, the most of the failures could be rescued by withdrawing the epidural catheter 1 to 2 cm, replacement of the catheter or changing to subarachnoid space combined with epidural block.

Objective To investigate the analgesic effect and the safety assessment of intravenous injection of flurbiprofen axetil and sufentanil combined with epidural morphine for post-cesarean analgesia.Methods One hundred and eighty parturients (ASA Ⅰ-Ⅱ) undergoing elective cesarean section with combined spinal and epidural anesthesia were divided into morphine group (group A),sufentanil + morphine group(group B),flurbiprofen axetil+sufentanil+ morphine group(group C) with 60 cases in each group.All patients were used subarachnoid epidural anesthesia,at the end of the surgery,1.5 mg morphine diluted to 5 ml saline was injected into the epidural space of each patient.Additional,group B and group C received patient-controlled intravenous analgesia after cesarean section.Flurbiprofen axetil and sufentanil were diluted to 100 ml with saline.The visual analog scale (VAS) of rest and dynamic incisional pain and uterine contraction pain,Ramsay sedation scale (RSS),and adverse events were recorded at 6,12,24 h after operation.Results At 6,12,24 h after operation,the VAS scores of rest and dynamic incisional pain and uterine contraction pain in group B and group C were statistically lower than those in group A [rest incisional pain:(2.6 ± 0.6),(2.7 ± 0.4),(2.8 ± 0.3)scores in group A; (2.3 ± 0.3),(2.3 ± 0.4),(2.2 ± 0.3) scores in group B; (1.8 ± 0.4),(1.7 ±0.5),(1.9 ±0.4) scores in group C; dynamic incisional pain:(5.7 ±0.9),(5.5 ± 0.8),(5.6 ± 1.0) scores in group A; (3.8 ± 0.4),(3.7 ± 0.5),(3.7 ± 0.4) scores in group B ; (2.7 ± 0.4),(2.4 ± 0.5),(2.4 ± 0.6) scores in group C ; uterine contraction pain:(5.7 ± 1.2),(5.9 ± 0.9),(5.8 ± 1.1) scores in group A; (3.0 ± 0.5),(3.1 ± 0.6),(3.2 ± 0.7)scores in group B; (2.5 ± 0.5),(2.5 ± 0.6),(2.4 ± 0.4) scores in group C],and group C were lower than group B,and there were significant differences (P＜0.05).At 6,12,24 h after operation,Ramsay score in group B and group C was higher than that in group A [(1.8 ± 0.5),(1.7 ± 0.4),(1.9 ± 0.5) scores in group A; (3.4 ± 0.8),(3.2 ± 0.7),(3.3 ± 0.6) scores in group B; (2.7 ±0.7),(2.7 ±0.5),(2.6 ± 0.4)scores in group C],and group C was higher than group B,and there were significant differences (P ＜ 0.05).The incidence of adverse events in group A and group C was lower than group B [8.3％(5/60) and 23.3％(14/60) vs.40.0％(24/60)],and group A was lower than group C,and there were significant differences (P ＜ 0.05).Condusion Intravenous injection of flurbiprofen axetil and sufentanil combined with epidural morphine could perform better analgesic on postoperative incisional and uterine contraction pain after cesarean section and the incidence of adverse events is less than sufentanil combined with morphine.

Objective To evaluate the effect of dexmedetomidine on apoptosis in myocardial cells in rats with severe scald.Methods Eighteen healthy male Sprague-Dawley rats,weighing 220-280 g,were randomly divided into 3 groups (n =6 each) using a random number table:control group (group C),scald group (group B)and scald + dexmedetomidine 30 μg/kg group (group D).Thirty percent of the total body surface was shaved and then exposed to 94 ℃ water for 12 s.Rats were resuscitated with isotonic saline according to Parkland formula immediately after burn.Sham burn was produced in C group.In group D,the rats received inraperitoneal injection of dexmedetomidine 30 μg/kg immediately after burn,and the equal volume of normal saline was injected in group B.The left ventricle was removed at 12 h after burn to observe the pathological changes of myocardial tissues with light microscope and to detect the apoptosis in myocardial cells (TUNEL assay) and expression of glucose-regulated protein 78 (GRP78) and C/EBP-homologous protein (CHOP) (using Western blot).The apoptosis index was calculated.Results Compared with group C,the apoptosis index was significantly increased and the expression of GRP78 and CHOP was up-regulated in B and D groups (P ＜ 0.05).Compared with group B,the apoptosis index was significantly decreased and the expression of GRP78 and CHOP was down-regulated in group D (P ＜ 0.05).The pathological changes were obvious in group B and were significantly attenuated in group D.Conclusion Dexmedetomidine can protect myocardium through inhibiting endoplasmic reticulum stress-mediated apoptosis in myocardial cells in rats with severe scald.

Objective: To investigate the methods for qualitative pathological assessment of dynamic changes in liver fibrosis/cirrhosis after antiviral therapy in patients with chronic hepatitis B (CHB), since antiviral therapy can partially reverse liver fibrosis and cirrhosis caused by hepatitis B and semi-quantitative, rather than qualitative, pathological assessment is often used for the research on liver fibrosis regression. Methods: Previously untreated CHB patients with liver fibrosis and cirrhosis were enrolled, and liver biopsy was performed before treatment and at 78 weeks after the antiviral therapy based on entecavir. The follow-up assessment was performed once every half a year. Based on the proportion of different types of fibrous septum, we put forward the new qualitative criteria called P-I-R classification (predominantly progressive, predominantly regressive, and indeterminate) for evaluating dynamic changes in liver fibrosis. This classification or Ishak fibrosis stage was used to evaluate the change in liver fibrosis after treatment and Ishak liver inflammation score was used to evaluate the change in liver inflammation after treatment. Results: A total of 112 CHB patients who underwent liver biopsy before and after treatment were enrolled, and among these patients, 71 with an Ishak stage of ≥3 and qualified results of live biopsy were included in the final analysis. Based on the P-I-R classification, 58% (41/71) were classified as predominantly progressive, 29% (21/71) were classified as indeterminate, and 13% (9/71) were classified as predominantly regressive; there were no significant differences between the three groups in alanine aminotransferase, aspartate aminotransferase, albumin, HBeAg positive rate, HBV DNA, and liver stiffness (P < 0.05). After treatment, the proportion of predominantly progressive, indeterminate, or predominantly regressive patients changed to 11% (8/71), 11% (8/71), and 78% (55/71), respectively. Among the 35 patients who had no change in Ishak stage after treatment, 72% (25/35) were classified as predominantly regressive and had certain reductions in the Laennec score, percentage of collagen area, and liver stiffness. Conclusion This new P-I-R classification can be used to assess the dynamic changes in liver fibrosis after antiviral therapy in CHB patients.