group A)(P0.05).In all the 3 groups,the BIS decreased to the lowest level at T2,and then increased at T3 and T4,and the BISs at T2,T3,and T4 were significantly different from that at T1(P

Objective To evaluate the effects of the domestic wire-reinforced epidural catheter on complications related to anesthesia during labor analgesia.Methods A total of 2 407 parturients,aged 18-40 yr,weighing 50-100 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective operations under combined spinal-epidural anesthesia for labor analgesia,were divided into 2 groups using a random number table:comnon epidural catheter group (group Ⅰ,n=1 203) and wirereinforced epidural catheter group (group Ⅱ,n=1 204).After successful epidural puncture,the appropriate amount of local anesthetics was injected into the subarachnoid space,and the corresponding epidural catheter was then inserted,and the depth was 3 em.Paresthesia during catheterization,unexpected catheter displacement,difficult extubation,catheter bending,epidural bleeding,successful insertion at first attempt,successful insertion time,the number of successfully delivered doses and consumption of patientcontrolled analgesia solution were recorded.The patients were followed up after operation for nerve damage.Results Compared with group Ⅰ,the incidence of paresthesia during catheterization,unexpected catheter displacement and catheter bending was significantly decreased,the occurrence of epidural bleeding was reduced,the success rate of insertion at first attempt was increased,successful insertion time was shortened,the incidence of difficult extubation was increased (P＜0.05 or 0.01),and no significant change was found in the number of successfully delivered doses,consumption of patient-controlled analgesia solution or incidence of nerve damage after operation in group Ⅱ (P＞0.05).Conclusion Complications related to anesthesia are reduced when the domestic wire-reinforced epidural catheter is used for labor analgesia.

The human sphincter of Oddi has been known for more than a century.The sphincter regulates periodic discharge of bile and pancreatic juice and their directional flow.Research on the sphincter is still inadequate,especially on how to accurately evaluate its function,dysfunction and effective treatment.In recent years,advances in anatomy,regulation and improvements in investigation have deepened our understanding of diagnosis and treatment of sphincter of Oddi dysfunction. This paper summarizes the new developments in this field.

Objective To evaluate the clinical effects of continuous spinal anesthesia (CSA) with sufentanil for labor analgesia when compared with the effects of combined spinal-epidural analgesia (CSEA) and continuous epidural analgesia (CEA).Methods One hundred ASA Ⅰ or Ⅱ nulliparous patients who were at full term and who requested labor epidural analgesia,were randomly divided into 3 groups (n =40 each):continuous spinal analgesia group (group S),combined spinal-epidural analgesia group (group C) and continuous epidural analgesia group (group E).Labor analgesia was performed when the cervical dilation was 2-3 cm.In group S,the spinal catheter was placed at L3,4 interspace,and patient-controlled analgesia (PCA) with sufentanil was performed after a loading dose of sufentarnil 8 μg.PCA solution contained sufentanil 100 μg in 100 ml of normal saline.The PCA pump was set up with a 2 ml bolus dose,a 10 min lockout interval (volume was limited to 14 ml/h) and background infusion at a rate of 2 ml/h.In group C,CSEA was performed at L2,3 interspace,the patients received intrathecal sufentanil 8 μg via a spinal needle,the PCA solution contained 0.1％ ropivacaine 200 mg and 0.5 μg/ml sufentanil 100 μg in 200 ml of normal saline.The CSEA pump was set up with a 6 ml bolus dose,a 10 min lockout interval (volume was limited to 40 ml/h) and background infusion at a rate of 6 ml/h.In group E,CEA was performed at L2,3 interspace and the method was the same as in group C.The systolic pressure,diastolic pressure,HR,fetal heart rate (FHR) and intensity of uterine contraction were recorded beforeanalgesia and 5,10,15,30,60 and 120 min after beginning of analgesia,when the cervical dilation was 7-8 cm,and when the uterine cervix dilated absolutely.The side effects were recorded.Bromage scale was assessed at 10 min of analgesia.Apgar scores of the neonates were recorded at 1,5 and 10 min after birth.The analgesic effect was evaluated 24 h after birth.Results In group S,the hemodynamic parameters,FHR and intensity of uterine contraction were within the normal range,the analgesic effect was excellent or good,Bromage scale was 0,two cases had post-dural puncture headache,the incidence of pruritus was 42 ％ and pruritus was mild,Apgar scores of the neonates were 9.1 ± 0.4,9.6 ± 0.4 and 10 at 1,5 and 10 min after birth,respectively,no cardiovascular events occurred.There was no significant difference in the parameters mentioned above between groups C and S and between groups E and S (P ＞ 0.05).Conclusion CSA with sufentail is effective and suitable for labor analgesia and the efficacy is comparable with that of CSEA and CEA.

Objective To compare the continuous subarachnoid block with ropivacaine or sufen?tanil either alone or in combination for labor analgesia. Methods Ninety nulliparous parturients who re?quired labor analgesia voluntarily, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 23-35 yr, with a body height of 155-170 cm, were included in this study. When regular uterine contrac?tion appeared, labor analgesia was performed in the first stage of labor. The parturients were divided into 3 groups ( n=30 each ) using a random number table: ropivacaine group ( group R ) , sufentanil group (group S), and combination of ropivacaine and sufentanil group ( group RS). The spinal catheter was placed at L3,4 interspace. In group R, ropivacaine was given as an initial bolus of (0.6 mg∕ml) 5 ml fol?lowed by an infusion of 0.2 mg∕ml after the analgesia pump was connected. In group S, sufentanil was given as an initial bolus of (1.6 μg∕ml) 5 ml followed by an infusion of 0.2μg∕ml after the analgesia pump was connected. In group RS, the mixture of ropivacaine 0. 3 mg∕ml plus sufentanil 0. 8 μg∕ml was given as an initial bolus of 5 ml, followed by an infusion of the mixture of ropivacaine 0. 1 mg∕ml plus sufentanil 0.1 μg∕ml after the analgesia pump was connected. The analgesia pump was programmed to deliver a 5 ml bolus dose with a 15 min lockout interval, background infusion at a rate of 5 ml∕h, and the total volume of 100 ml in the three groups. The analgesia pump was connected at 30 min after the initial bolus was given, and the infusion was stopped at 2 h after delivery in the three groups. Visual analog scale ( VAS) scores were maintained ≤3. VAS scores were recorded before analgesia and at 5, 10 and 30 min after the initial bolus was given. The interval and duration of uterine contraction were recorded before analgesia, in 0-30 min, 30-60 min and 90-120 min of analgesia periods, and in the second stage of labor. The development of nausea and vomiting, pruritus, lateral episiotomy, assisted vaginal delivery, cesarean section, and post?dural puncture headache and requirement for oxytocin were recorded. Apgar scores at 1, 5 and 10 min after birth were recorded. Results The Apgar score of the newborn was more than or equal to 7 at 1, 5 and 10 min after birth in the three groups. Compared with the value before analgesia, the interval of uterine contraction was significantly prolonged, and the duration of uterine contraction was significantly shortened in the 0-30 min of analgesia period in group R ( P<0.05) , and no significant change was found in the inter?val and duration of uterine contraction in each analgesia period in S and RS groups ( P>0.05) . Compared with group R, the VAS scores were significantly increased at 5 and 10 min after the initial bolus was given, the interval of uterine contraction was significantly shortened, and the duration of uterine contraction was significantly prolonged in S and RS groups, and the incidence of pruritus was significantly decreased in group S ( P<0.05 or 0.01) . Compared with group S, the incidence of pruritus was significantly decreased ( P<0.01) , and no significant change was found in the VAS scores at each time point and interval and du?ration of uterine contraction in each analgesia period in group RS ( P>0.05) . Conclusion Continuous sub?arachnoid block with combination of ropivacaine and sufentanil provides better efficacy for labor analgesia than ei?ther alone.

Objective To assess the related risk factors of endoscopic retrograde cholangiopancreatography(ERCP)on postoperative pancreatitis.To improve the level of diagnostic and therapeutic ERCP,to reduce the incidence of postoperative pancreatitis.Methods A total of 346 patients in our hospital referred to diagnostic and therapeutic ERCP(399 frequency)were divided into 8 groups;the differences of postoperative serum amylase in 24 hour as well as clinical symptoms were compared among different groups.Results The incidence of postoperative hyperamylasaemia was 12.5 %.The incidence of postoperative acute pancreatitis was 1.5 %.ERCP+STENT therapeutic group(38.9%)had the highest incidence of postoperative hyperamylasaemia and postoperative acute pancreatitis among the groups.(respectively 38.9%,11.1%).There was the different incidence of postoperative actcte pancreatitis between the period from June 2003 to June 2005 and from July 2005 to July 2007,respectively 3.3%,0.4%.Conclusion Pancreatic duct contrast filling and deficient experience of doctor during ERCP manipulation are the main risk factors for postoperative pancreatitis.

Objective To investigate the effect of ultrasound-guided transversus abdominis plane (TAP)block on the efficacy of postoperative analgesia in parturients undergoing selective cesar-ean delivery.Methods Eighty ASA Ⅰ or Ⅱ parturients recruited for selective cesarean delivery under combined spinal-epidural anesthesia were randomly divided into two groups(n =40 each):TAP group (group T)and control group(group C).After cesarean delivery,bilateral of ultrasound-guided TAP block were performed,20 ml of 0.5% ropivacaine was injected in each side in group T,while TAP was not done in group C.Both groups received patient-controlled intravenous analgesia (PCIA)after cesarean delivery.The resting and exercise visual analogue scale (VAS)scores,Ramsay sedation score and the Bruggrmann comfort scale(BCS)score were evaluated at 2,4,6,8 and 24 h after operation. The consumption of sufentanil within 24 h after operation,the number of successfully delivered doses (D1 )and the number of attempts (D2 )within 24 hr after operation were recorded.D1/D2 was calculated.The parturients satisfaction and the adverse reactions were also recorded.Each parturient was assessed postoperatively by a blinded investigator.Results The consumption of sufentanil within 24 hr after operation,the resting and exercise VAS scores at 2,4,6 hr after surgery were significant-ly lower,while the BCS score,the value of Dl/D2 and the degree of satisfaction were higher in group T than those in group C (P <0.05).There were no adverse reactions in both groups.Conclusion Ultra-sound-guided TAP block reduces the postoperative sufentanil consumption,enhances the efficacy of post-cesarean analgesia of the parturients.Comfort and satisfaction are achieved in the parturients of the group T.

Objective To investigate blood flow dynamics adjacent to regional myocardial segments in coronary artery disease(CAD) patients and to explore the association of the two CAD features.Methods In 43 CAD patients,velocity vector imaging (VVI) was used to evaluate the wall motion and classify normal myocardial segments (NS),relatively abnormal and obviously abnormal wall motion segments (RS and OS) by systolic peak strain (Ss).Vector flow mapping (VFM) was used to show blood flow dynamics in the heart chamber,including blood flow (Q) heading towards or away from the apex during a heart beat and time to every peak flow (T).Results Compared with NS,both RS and OS showed a higher systole Q + (blood flow heading towards the apex during systole) and lower diastole Q + (blood flow heading towards the apex during diastole) and shortened T2 (adjusted time interval between E and A peaks).Systole Q + was positively correlated with Ss but negatively with segmental ejection fraction (SEF).Diastole Q + was negatively correlated with early and late diastolic peak velocity (Ve and Va) but positively with Ve/Va.T2 was negatively correlated with Ve but positively with Ve/Va and early diastolic peak strain rate (SRe).Conclusions VFM might be a new tool to quantitatively assess change in regional blood flow dynamics in patients with CAD.

BACKGROUND: Microglia is the immune effect cell in central nervous system, if it is activated, it will release neuron poisoning factors and inflammatory factors, and bring fatal injury.OBJECTIVE: To investigated the effect of focal cerebral reperfusion on activation of microglia and the effect of the regulation of electroacupuncturing Shuigou and Baihui.DESIGN: A randomized and controlled study.SETTING: The department of Physioltherapy, the 458 Hospital of Chinese PLA; Dongfang Hospital Affiliated to Shanghai Tongji University; The department of Histology-embryology, Tongji Medical College of Huazhong University of Science and Technology.MATERIALS: This experiment was processed at Histology-embryology Center of Tongji Medical College of Huazhong University of Science and Technology in March 2002. Total 80 Wistar rats were randomly divided into 8 groups with 10 in each group.METHODS: ① Normal control group: The rats were not given any treatment and killed next day. ② Sham operation group: Only artery was separated, no suture inserted, killed next day. ③ 6, 12 and 24-hour reperfusion groups: The rats' right middle cerebral artery (MCA) ischemia-reperfusion model was made by embolus suture technique, then the rat was killed after 30 minutes' occlusion at MCA and reperfusing respectively 6, 12, 24hours. ④ 6-hour reperfusion + electroacupuncture group: Electroacupuncture was carried out immediately after the model was made, then the rat was killedafter 30 minutes' occlusion at MCA and reperfusion 6 hours (The frequency was 4 Hz-16 Hz. Stimulus intensity increased 1 V per 10minutes and the final intensity was 3V. The stimulus was lasted 30 minutes). ⑤ 12-hour reperfusion + electroacupuncture B group: Electroacupuncture was carried out immediately after the model was made and 8 hours later, then the rat was killed after 30 minutes' occlusion at MCA and reperfusion 12 hours. ⑥ 24-hour reperfusion + electroacupuncture group: Electroacupuncture was carried out immediately after the model was made and 8, 16 hours later, then the rat was killed after 30 minutes' occlusion at MCA and reperfusion 24 hours.MAIN OUTCOME MEASURES: To calculate numbers of microglia and to observe its morphological changes.RESULTS: Data of totally 67 rats was entered the results analysis. No microglia was seen in the normal and sham operation groups. Large quantity of microglia was activated at the border of ischemic area in 6, 12 and 24reperfusion group, their quantity was largely increased, reaching apex at reperfusion 12 hours [(35.38±1.77), (54.25±1.67), (49.29±2.21)/200sights]. The quantity in every 6, 12 and 24 reperfusion + electroacupuncture group was less than that in model group [(32.11±2.80), (50.88±2.64),(45.45±3.95)/200 sights, P ＜ 0.05].CONCLUSION: The microglia in brain is activated after the cerebral ischemia-reperfusion and induces toxic effect on neurons. The electroacupuncture can decrease activation of microglia so as to protect the neurons.

Objective To evaluate the effect of labor analgesia on the development of postpartum depression.Methods Seventy nulliparous parturients who were at full term with a singleton fetus in vertex presentation,aged 20-35 yr,with body mass index＜27 kg/m2,at 38-41 weeks of gestation,of ASA physical status Ⅰ,were enrolled and divided into 2 groups (n =35 each) using a random number table:vaginal delivery group (group VD) and labor analgesia group (group LA).In LA group,the epidural catheter was placed at L2,3 interspace for combined spinal-epidural analgesia when their cervical dilations were in 2-3 cm.VAS score was maintained below 3 after the analgesia.Parturients completed Edinburgh Postnatal Depression Scale questionnaires 42 days after the labor.The development of depression was recorded.Results The incidence of postnatal depression was significantly lower in LA group (17％) than in VD group (40％).Conclusion Labor analgesia can decrease the development of postpartum depression.