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.

Objective To investigate the postoperative epidural analgesia and adverse reactions in total abdominal hysterectomy with dezocine and ropivacaine.Methods Sixty elective transabdominal hysterectomy patients with American Society of Anesthesiologists (ASA) Ⅰ-Ⅱ grade were randomly divided into two groups,dezocine group and morphine group,there were 30 cases in each group.Dezocine group:dezocine (6 mg) + 0.75％ ropivacaine hydrochloride(20 ml) + saline dilution,diluted to 100 ml.Morphine group:morphine(6 mg) + 0.75 ％ hydrochloride ropivacaine (20 ml) + saline dilution,diluted to 100 ml,for postoperative epidural analgesia.Both two groups were adopted in LCP mode with a loading dose:dezocine group,dezocine(2 mg) +saline dilution,diluted to 5 ml; morphine group,morphine (2 mg) + saline dilution,diluted to 5 ml.Continuous infusion of 2 ml/h,a bolus dose of 2 ml,and a lockout interval of 15 min.The analgesia duration was 48 h.Visual analogue scales (VAS) evaluation was employed to assess the analgesic effect,and the postoperative epidural analgesia adverse reaction were also recorded.Results The analgesic effect was both satisfied in the two groups.Comparing the VAS scores postoperative at different time point (4 h,8 h,12 h,24 h,36 h,48 h),dezocine group(2.7 ± 0.4,2.5 ± 0.6,2.2 ± 0.5,1.5 ± 0.5,1.3 ± 0.5,1.1 ± 0.3) were slightly lower than morphine group (2.8 ± 0.5,2.6 ± 0.7,2.3 ± 0.6,1.6 ± 0.7,1.5 ± 0.6,1.2 ± 0.4),but the difference was not significant (within the group:F =2414.96,P ＜ 0.01 ; between the group:F =0.63,P ＞ 0.05 ; interactive:F =2.42,P ＞0.05).Comparison of VAS scores at different time points after operation in two groups,the difference was not statistically significant; And within the group,there was not,the difference was not significant at the time point at 12,24,36,48 h compare to postoperative at 4 h (P ＜ 0.01).the Adverse reaction like nausea and vomiting,skin itching occur rate is lower in dezocine group (3.3 ％ (1/30),0 (0/30)) than that of in morphine group(26.7％ (8/30),20.0％ (6/30)),and there were signficant differences between the two groups (P =0.026,0.024,P ＜ 0.05).Conclusion Dezocine composed with ropivacaine is safe and effective,and with few adverse reactions in total abdominal hysterectomy postoperative epidural analgesia,it is worth of widely use in clinical.

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 investigate the feasibility of Narcotrend-guided application of small dose of dexmedetomidine ( DEX) for sedation during combined spinal-epidural anesthesia for elderly patients. Methods Fifty cases of ASA II or Ⅲelderly patients were randomly divided into treatment group and control group (25 patients of each group). After combined spinal-epidural anesthesia, both groups received continuous intravenous infusion of DEX, at 0. 4 μg·kg-1 in 10 min, and then the rate was lowered to 0. 4 μg·kg-1 per hour. For the treatment group, infusion rate was adjusted to reach a Narcotrend Index (NTI) of 75-85, and for the control group, infusion rate was adjusted to reach an OAA/S score of level 3-4. MAP, HR, RR, SpO2 , NTI and OAA/S score were recorded at the beginning of DEX treatment ( t0 ) , 10 min ( t1 ) , 20 min ( t2 ) , 30 min ( t3 ) , and 60 min ( t4 ) after the beginning of DEX treatment, and at the end of surgery ( t5 ) . The incidence rates of adverse events including bradycardia, hypotension, low oxygenation, and respiratory depression were also recorded. The patients were followed up until 24 h after surgery to record loss of memory about the surgical events. Results In comparison with t0 , NTI and MAP of both groups significantly decreased at t1-t5(P<0. 01). Comparison between the two groups showed no difference in MAP at each time point, and NTI of treatment group was higher than that of control group at t2-t5(P<0. 05). In comparison with t0, OAA/S of both groups significantly decreased at t1-t5(for t1, P<0. 05;for t2-t5, P<0. 01). Comparison between the two groups showed no difference in OAA/S at each time point (P>0. 05). Follow-up at 24 h after surgery observed total amnesia in 72. 0% of DEX group patients and in 76. 0% of the control group, without significant difference (P>0. 05). Conclusion Sedating elderly patients undergoing spinal-epidural anesthesia with DEX under the guidance of Narcotrend is safe and feasible, and the patients can be sedated properly.

Objective To determine the random spot albuminuria to creatinine ratio (ACR) of normal pregnant women , to track the pregnancy outcome , and to discuss the predictive value of ACR in women with hy-pertensive disorders complicating pregnancy (HDCP). Methods Except for 87 pregnant women suffering from HDCP, 2 038 pregnant women were enrolled in this study. ACR, routine examinations of blood and urine, blood biochemical, 24-hr urinary protein were determined. Results ACR, but not 24-hr urinary protein level,was sig-nificantly higher in women with HDCP. There was positive correlation between the ACR and 24-hr urinary protein quantitation. Age, gestational weeks, ACR, red blood cells, fasting plasma glucose, serum creatinine, total pro-tein were the independent risk factors for HDCP. The sensitivity , specificity and optimal cut off value of ACR for predicting HDCP were 0.78, 0.63, 1.46 mg/mmol. Conclusions There was positive correlation between ACR and 24-hr urinary protein quantitation , and ACR provided a more sensitive pathway for early predictionof HDCP.

Objective To investigate the effects of mesenchymal stem cells(MSCs)on the pathological structure and cytokine expression of lung tissue in septic model of diabetic rats. Methods Diabetic rats were ran-domly divided into control,sham-operation,sepsis and MSC-treated groups. The diabetic model was induced by high-sucrose and high-fat diet combined with streptozotocin and cecal ligation and puncture. The pathological changes of lung tissue were observed at 6,12,18 and 24 hours after operation respectively,and the expression of SP-D,TNF-α,IFN-γ and IL-10 in lungs were measured.Results The levels of SP-D,TNF-α and IFN-γ in lung tissue increased gradually with the elongation of time after CLP. The expression of IL-10 in lung tissue increased and then decreased. The trend of MSC intervention increased the content of SP-D,TNF-α and IL-10 in the lung tissue of non-diabetic septic rat model and reduced the content of IFN-γ.MSC intervention reduced the SP-D and TNF-α content.The intervention of MSC had no effect on the content of IFN-γ in the lung tissue of diabetic septic rats.However,it increased and then decreased the content of IL-10.Conclusions The model of sepsis in diabetic rats can be established by feeding combined high-sugar and high-fat diet and streptozotocin combined with cecal ligation and puncture. Mesenchymal stem cells affect sepsis inflammation and organ damage. But its specific role depends on the immune status and the timing of mesenchymal stem cell selection.

Objective To establish the quality standards of Hirtula Roses for the quality control of production, supervision, circulation and application. Methods The moisture content, total ash, ethanol extract content and characteristic chromatogram of Rosa roxburghii Tratt. were determined according to the related determination method in Ⅳ-Part of Chinese Pharmacopeia 2020. Results There should be 6 characteristic peaks in the characteristic chromatogram of Rosa roxburghii Tratt., which should correspond to the retention time of 5 characteristic peaks in the reference chromatogram of the standard herbs, and another peak should correspond to the retention time of the reference chromatogram of isoquercitrin. The moisture content of Rosa roxburghii Tratt. should be less than 14.0%; the total ash content should be less than 5.0%; the ethanol extract content should be more than 20.0%. Conclusion According to the experimental results, the quality standard of Rosa roxburghii Tratt. is conformed to the national requirements of quality standards for traditional Chinese medicine, which could provide a reference for the quality control of Hirtula Roses.

Objective To investigate the relationship between interventricular septum thickness(IVS) and renal function in patients with diabetes mellitus.Methods Two hundred and sixty-five patients of type 2 diabetes without dialysis were enrolled in a cross-sectional study.According to their IVS,the patients were divided into normal group (IVS≤ 11 mm) and higher IVS group (IVS ＞ 11 mm).All patients according to evaluated glomerular filtration rate (eGFR) level were divided into eGFR≥60 ml· min-1 · (1.73 m2) 1 group and eGFR ＜ 60 ml· min-1 · (1.73 m2)-1 group.The demographic characteristic,biochemical examination,eGFR,and proteinuria of different groups were compared.Pearson or spearman correlation was used to analyze the relationship between eGFR,IVS and other parameters.eGFR ＜ 60 ml · min-1 · (1.73 m2)-1 and IVS thickening were analyzed by binary logistic regression.Risk factors affect the prognosis of renal function in patients with diabetes mellitus were analyzed by Cox regression analysis.Results Compared with normal group,patients in the higher IVS group had higher systolic pressure (P=0.002),their level of Scr,BUN,24 h urinary protein were increased (all P ＜ 0.05),while the level of eGFR,albumin (ALB),hemoglobin (Hb) and fasting blood glucose were decreased (all P ＜ 0.05).The prevalence of hypertension was increased (81.16％ vs 58.67％,x2=11.273,P=0.001),and there was also a difference in the proportion of patients in each stage of CKD (x2=34.593,P ＜ 0.001).Correlation analysis showed that IVS was positively correlated with BMI,systolic BP,Scr,BUN,24 h urinary albumin,24 h urinary protein (all P ＜ 0.05),while negative correlation was observed between the thickened degree of IVS and Hb,albumin,eGFR and total calcium (all P ＜ 0.05).It's worth noting that IVS also correlated with history of hypertension and degree of renal injury (all P ＜ 0.01).Logistic regression analysis showed that longer duration of diabetes,higher systolic pressure and BUN were independent risk factors for eGFR ＜ 60 ml·min-1·(1.73 m2)-1 (all P ＜ 0.05),while higher Hb and Alb were independent protective factors for eGFR ＜ 60 ml· min-1· (1.73 m2)-1 (all P ＜ 0.05).Logistic regression analysis also showed that the baseline increased Scr was independent risk factor for interventricular thickening (P ＜ 0.05),while the increase of fasting blood-glucose was independent protective factor for interventricular thickening (P ＜ 0.05).Cox regression analysis showed that interventricular thickening was an independent risk factor in predicting the progression of type 2 diabetes (HR=1.396,95％ CI=1.098-1.774,P=0.006).Conclusion Interventricular septum thickness is closely related to the state of renal function,as well as is an independent risk factor to predict kidney function decline in patients with type 2 diabetes.