Objective To explore the clinical application of Narcotrene Ineex( NI)on guieing the usage of propofol combinee with eifferent analgesic erugs at colonoscopy examination,in oreer to evaluate the application ane clinical safety of the eifferent analgesic erugs. Basee on NI guieance,propofol effect-site concentration was aejustee euring colonoscopy. Methods Two huneree ane forty patients with colonoscopy were selectee as our subjects. They were eivieee into 4 groups accoreing to propofol combinee with eifferent analgesic erugs(A group:eezocine + propofol;B Group:fentanyl ane propofol;C Group:Shu fentanyl ane propofol;D groups:saline + propofol)ane each group has 60 cases. At eifferent stages of surgery,NI was control within 56- 65 or 66 - 75 in terms of anesthesia eegree. The life ineices( mean arterial pressure( MAP),heart rate, respiratory rate(RR)ane oxygen saturation( SpO2 )),ineuction time,insert the mirror ane surgical time ane recovery time ane cases with boey movement,the cases of respiratory eepression were recoreee. The analysis of each group of patients with VAS scores ane the total amount of propofol the patients were recoreee at 5 time points(before anesthesia(T1)ane eyelash reflex time(T2),insertee through the anus mirror(T3),when insertee mirror up to the ileocecal(T4)ane the back mirror finish(T5)). Results MAP,heart rate,respiratory rate of patients in four groups at T2,T3 ane T4 time point were eecreasee than that in T1. Comparee with D group, MAP,heart rate,respiratory rate of patients in A,B ane C groups eecreasee at eifferent eegrees(MAP:F within group = 26. 793,P < 0. 05;F interaction = 6. 532,P < 0. 05;F between group = 7. 574,P < 0. 05;Heart rate:F within group = 21. 428,P < 0. 05;F interaction = 6. 316,P < 0. 05;F between group = 5. 431,P < 0. 05;Respiratory rate:F within group = 14. 226,P < 0. 05;F interaction = 5. 531,P < 0. 05;F between group= 7. 986,P < 0. 05). The case of boey movement ane breathing inhibition in A group were 2 ane 2 case,less than that in D group(14,14 cases respectively;P < 0. 01). VAS score ane the total amount of propofol in A,B, C groups were(1. 20 ± 0. 72)points ane(148. 40 ± 10. 53)mg;(1. 88 ± 0. 88)points ane(178. 85 ± 18. 59) mg;(1. 65 ± 0. 74)points ane(166. 68 ± 16. 22)mg,less than that in D group((2. 35 ± 1. 10)points ane (227. 33 ± 28. 66)mg),ane the eifferences was statistically significant( F = 18. 038,177. 399;P < 0. 05).Conclusion During colonoscopy,Narcotrene real-time monitoring of propofol combinee with eifferent analgesics can significantly reeuce the amount of narcotic erugs,shortee recovery time,reeuce the incieence of complications in patients,ane thus enhancing patient comfort .

Objective To investigate the effect of continuous thoracic paravertebral block anal-gesia guided by sonography on pulmonary function after thoracotomy.Methods Sixty patients,male 29 cases,female 31 cases,aged 18-60 years,BMI 1 6-28 kg/m2 ,ASA grade Ⅰ or Ⅱ,who had under-went thoracotomy were divided randomly into 2 groups,30 cases each:group G with general anesthe-sia and postoperative patient controlled intravenous analgesia (PCIA),whereas group GP with general anesthesia combined with continuous thoracic paravertebral block (CTPVB)and postoperative continuous CTPVB.CTPVB were performed before induction as the patient was conscious so that the effect of CTPVB could be tested by blocking range.Both resting and coughing visual analogue scales (VAS)were recorded at the points of 30 minutes after extubation (T1 ),2 hours after operation (T2 ),6 hours after operation (T3 ),24 hours after operation (T4 )and 48 hours after operation (T5 ). Forced vital capacity (FVC),forced expiratory volume in the first second (FEV1 )and maximal mid expiratory flow (MMF)were measured by spirometer and the three maximal values were recorded at time points of entry of operating room (T0 ),T4 and T5 .Blood gas analysis was employed at corre-sponding time points by a blood gas analyzer and oxygen inhalation was ceased 30 minutes before drawing blood from radial artery.PaCO 2 ,PaO 2 and alveolararterial oxygen difference (PA-a O 2 )were recorded.Adverse effects were observed.Results Compared with group G,VAS when resting and coughing in group GP at T1-T5 decreased significantly (P <0.05).Compared with T0 ,FVC,FEV1 , MMF and PaO 2 at T4 ,T5 in both groups decreased significantly (P <0.05),PA-a O 2 increased signifi-cantly (P <0.05 ).Compared with group G,PaO 2 in group GP at T4 ,T5 increased and PA-a O 2 in group GP at T4 ,T5 decreased significantly (P <0.05).Conclusion CTPVB guided by sonography had excellent effect.It can not only improve pulmonary function after thoracotomy significantly but also promote intrapulmonary oxygenation.

ObjectiveTo investigate the feasibility and safety of Proseal-laryngeal mask airway(PLMA) for anesthesia in endoscopic thyroidectomy.MethodsForty ASA class Ⅰ or Ⅱ patients underwent endoscopic thyroidectomy via breast approach were randomly divided into laryngeal mask venting group( Group P,n =20) and endotracheal tube venting group( Group T,n =20).Both groups were used the same anesthesia induction,maintenance and breathing parameter adjustment.The HR and MAP in both groups were recorded respectively before intubation,while intubation,2 min after intubation,before and after head back out center position,before extubation and 2 min after exbutation.The adverse effects of respiratory tract were recorded respectively.ResultsThere were no significant changes in HR and MAP in Group P before and after intubation,as well as before and after extubation( all P ＞ 0.05 ) ;In Group T,the HR and MAP while intubation,2 min after intubation are higher than that before intubation (all P ＞ 0.05).The HR and MAP in Group T,2 min after exbutation are higher than before extubation(all P ＞ 0.05 ).The incidence rate of sore throat and hoarse postoperatively were lower in Group P than in Group T( all P ＞ 0.05 ).ConclusionPLMA could be safely and effectively used in the anesthesia of endoscopic thyroidectomy.

@@

Objective　To study the value of comprehensive examination of visual electrophysiology in prognosis of visual function after cataract operation.Methods　315 patients with cataract(408 eyes) underwent preoperative routine examination with pattern reversal visual evoked potential(PVEP), red and blue flicker electroretinogram(ERG) and oscillatory potential (OPs). Normal control group included 162 cases (266 eyes). All of the ocular fundi were examined postoperatively and corrected visual acuities were obtained 3 months after operation. Results　Postoperative corrected visions ≥0.5(Ⅰ) and ＜0.5(Ⅱ) in case group compared with that in control group, amplitudes of PVEP P100-wave decreased significantly and PVEP P100-wave latency times prolonged significantly in group Ⅰ and Ⅱ. There was much more prominent changes in P100-wave of group Ⅱ due to other factors influencing visual function. There wasn't significant difference of the amplitudes and the latency times of a-wave and b-wave of Red-Blue ERG in group Ⅰ and the control group preoperatively. The amplitudes of a-wave and b-wave of Red ERG decreased, the latency times of a-wave and b-wave of Red ERG prolonged, the amplitudes of a-wave and b-wave of Blue ERG decreased but latency times didn' t prolong in group Ⅱ. The value of OPs decreased in groupⅡ compared with that of the control group, which was related to the retinopathy due to blood circulation obstruction.Conclusion　Combined examination of visual electrophysiology can estimate visual function thoroughly. The prognosis will be good if various examinations are normal before operation, but will not be good if PVEP P100 latency time prolong, the amplitudes of a-wave and b-wave of Red ERG decrease and the latency time prolong, the amplitudes of a-wave and b-wave of Blue ERG decrease and the value of OPs decrease.

Objective To compare the EC50 of Propofol for inhibiting intubation response. Methods 80 cases un-derwent tracheal intubation general anesthesia, all patients were randomly divided into two groups. The general situ-ation between the two groups showed no significant difference. Except for Propofol, other anesthesia drugs infusion method and dosage were the same. Sequential determination the EC50 of Propofol which for inhibiting intubation re-sponse of each groups by up-and-down. Propofol target concentration of the first patient was set to 4 μg/ml, and ad-justed according to intubation stress response disappeared or not, concentration of two adjacent patients with ratio of 1.2. Results A group inhibited the cardiovascular responses of Propofol EC50 and 95%CI was 5.19 μg/ml (95%CI:4.88 ~ 5.50 μg/ml). B group inhibited the cardiovascular responses of Propofol EC50 and 95 %CI was 4.15μg/ml (95%CI:3.80~4.40μg/ml). The EC50 and 95% confidence interval of the B group were significantly lower than those of the A group ( P< 0.05). The MAP and HR at T2 were higher than that of T1 in each group ( P< 0.05), and the MAP and HR of observe group were lower than that of control group ( P< 0.05). The MAP and HR at T3 were lower than that of T1 in control group ( P< 0.05), but there were no significant deference in observe group ( P> 0.05).Conclusion The EC50 and 95% confidence interval of Propofol for inhibiting intubation response under photopic laryngoscopes was significant lower than those of under direct laryngoscopes, the circulation during period of induc-tion and intubation was more stable.

Objective To investigate the reliability of Narcotrend for monitoring the depth of sedation [the observer's assessment of alterness/sedation(OAA/S) scale] with midazolam and correlation between the depth of sedation and Narcotrend index.Methods 0 ASA Ⅰ-Ⅱ status patients scheduled for elective lower limb operations underwent spinal anesthesia,who were given target-controlled infusion of midazolam.Target plasma concentration was 50ng/ ml at first and increased by 10 ng/ml each grade until OAA/S scale became 1 point.Each target concentration infusion was maintained for 5min.Observe the patient the OAA/S scale to be 5 points.If the operation was not over yet,regulated the appropriate depth of sedation until the end of operation.The Narcotrend index of different OAA/S scale and heart rate,mean arterial pressure,respiration were recorded.Results In the deepening or recovery phase of sedation,OAA/S scales were correlated with Narcotrend index (Spearman' s r =0.786,0.652,all P ＜ 0.05).Conclusion Narcotrend is a good index to guide target controlled infusion of midazolam,the index is closely related with the depth of sedation of midazolam.

Objective To compare the anesthetic effect of interscalene joint axillary brachial plexus block guided by nerve stimulator or conventional paresthesia in elderly patients with upper extremity surgery.Methods Sixty cases of ASA grade Ⅱ-Ⅲ elderly patients with upper extremity surgery were divided into two groups by random number table.Nerve stimulator group (30 cases) received interscalene joint axillary brachial plexus block guided by nerve stimulator.Paresthesia group (30 cases) received interscalene joint axillary brachial plexus block guided by conventional paresthesia.Both groups used the same local anesthetic:0.375％ ropivacaine,the dosage was 0.4 ml/kg.Anesthetic dose between interscalene and axillary in two groups in half.The operating time,block onset time,duration of analgesia,anesthetic effect [used by visual analogue scale (VAS) scores] and adverse reaction in two groups were observed and recorded.Results The operating time and block onset time in nerve stimulator group were significantly shorter than those in paresthesia group[(5.2 ± 1.7) min vs.(8.6 ± 2.2) min and (19.4 ± 3.2) min vs.(29.0 ± 3.9) min],VAS scores was lower than that in paresthesia group [(0.7 ± 0.4) scores vs.(2.3 ± 0.8) scores],there were significant differences (P ＜ 0.01).There was no significant difference in duration of analgesia between two groups [(12.4 ± 3.6) h vs.(13.1 ± 3.8) h,P ＞0.05].Nerve stimulator group without adverse reactions.Paresthesia group had 5 cases of adverse reactions,including local hematoma in 2 cases,laryngeal recurrent nerve paralysis in 1 case,horner syndrome in 2 cases.Conclusion Interscalene joint axillary brachial plexus block guided by nerve stimulator in elderly patients is accurate positioning,high success rate,good anaesthesia effect,less adverse reaction,and worth promoting in clinical.

ObjectiveTo evaluate the surgical techniques and 2-year follow-up results of Mast Quadrant-assisted modified transforaminal lumbar interbody fusion (TLIF).MethodsFrom September 2006 to October 2008,54 patients with single-level lumbar degeneration disease were treated by Mast Quadrantassisted modified TLIF.Under the guidance of C-arm,the Mast Quadrant's retractor was placed and the lower articular process of the upper vertebrae and 1/2-2/3 of the lamina,flavum ligament and hyperplastic cohesive part of the lower articular process were removed,the nerve roots and the central canal were decompressed.After cleaning up intervertebral disc space,bone grafting and pedicle screw fixation were achieved.Visual analogue scale(VAS) and Oswestry disability index(ODI) results,as well as the fusion rate at the last follow-up were analyzed.ResultsAll patients were treated by Mast Quadrant-assisted modified TLIF,in which 51 patients were followed up for 2 years.An average operating time was(178.7±63.2) min,and an average blood loss was (224.2±136.5) ml; an average postoperative drainage loss was (117.2±91.4) ml,and an average postoperative stay was(5.8±3.6) d.There were statistic significances between pre- and post-operative ODI and VAS scores,respectively.At last follow-up,51 patients were achieved radiographic fusion without internal fixation failure and other complications.ConclusionMast Quadrant-assisted modified TLIF had a good vision,was relatively safe and easy to be acceptable by surgeons,and which had a good clinical results for the patients with single-level lumbar degenerative disease.

Objective To investigate the risk factors and treatment strategy in treating adjacent segment diseases (ASD) after anterior cervical decompression and fusion.Methods Fourteen patients with ASD after anterior cervical decompression and fusion from December 2005 to August 2012 were analyzed.The overall curvature of the cervical spine,local curvature of surgical segments,and the distances between the plate and the upper and lower intervertebral space were measured and analyzed.10 males and 4 females,age at initial surgery was 36 to 68 years old,the mean was 52.0±11.0 years old.The secondary surgery was taken,according to the number of involved segments and other factors.Anterior decompression and fusion and internal fixation was taken to patients who segment number ≤2 without severe ossification of posterior longitudinal ligament or ossification of the ligamentum flava; posterior decompression and laminoplasty was conducted in patients whose segment number ≥3,but not accompanied with significant kyphosis,instability and serious ossification of the ligamentum flava; and posterior laminectomy and fusion was performed in patients with significant kyphosis,instability and not suitable for anterior decompression due to technical reasons,as well as patients with serious ossification of the ligamentum flava.Results The average time of occurrence of ASD after the initial surgery was 9.3±4.4 years,and the average age of reoperation was 61.3±12.4 years old.The overall curvature of the cervical spine,surgical segment local curvature after the initial surgical procedure were 12.4°± 10.8 o,1.5o±6.8o,respectively; and the distances between the plate and the upper and lower interyertebral space were:0.9± 1.8 mm,3.8±3.2 mm.The secondary surgeries were taken as follows:9 cases anterior decompression and fusion and internal fixation,3 cases posterior decompression and laminoplasty,and 2 cases posterior laminectomy and fusion.All 14 patients were followed up 30.4± 17.8 months,and the average improvement rate of Japanese Orthopaedic Association scores at the last follow up was 73.9％±9.7％.Conclusion The smaller distance between the plate and neighboring intervertebral space,and poorer local curvature of surgical segments might be the risk factors for ASD after anterior cervicad decompression and fusion.The appropriate secondary surgery was taken after comprehensive analysis of the number of adjacent segments,compression factors,cervical curvature and other factors.