Objective:To investigate the clinical efficacy of electroacupuncture therapy for critical ill patients with acute gastrointestinal injury (AGI).Methods:77 patients were randomly allocated to the treatment group (38 cases) and control group(39 cases).The control group received conventional medical treatment.In the treatment group,electroacupuncture therapy combined with conventional medical treatment was adopted.Treatment was given for seven days.The clinical therapeutic effects were evaluated using the quantity of enteral nutrition (EN) and abdominal cavity pressure changes in 1,3,5,7 days.After the treatment,the percentage of patients with early enteral nutrition (EEN),total enteral nutrition (TEN),parenteral nutrition (PN) supplementedas and the length of ICU stay were also observed.Results:The amount of daily EN in treatment group was significantly higher than that in control group(P ＜ 0.05) and the abdominal cavity pressure was significantly lower in the treatment group (P ＜ 0.05).After treatment,the proportion of EEN and TEN of the treatment group were both higher than control group (P ＜ 0.05) and the percentage of combined EN and PN therapy in the treatment group decreased significantly (P ＜ 0.05).Meanwhile,the mechanical ventilation period and the length of ICU stay in the treatment group were shortened (P ＜ 0.05).Conclusion:Electroacupuncture therapy can effectively improve the intestinal function and have remarkable therapeutic effect in treating critical illpatients with AGI.

Objective To investigate the effect of dexmedetomidine on protein kinase RNA-like endoplasmic reticulum kinase (PERK) signaling pathway in cardiomyocytes of the rats with severe scald.Methods Twenty-four healthy adult male Sprague-Dawley rats,weighing 220-280 g,were randomly divided into 3 groups (n =8 each) using a random number table:control group (group C),severe scald group (group S),and scald + dexmedetomidine group (group D).Thirty percent of the total body surface area was shaved on the back and then exposed to 94 ℃ water for 12 s to establish the model of 3rd degree scald.Dexmedetomidine 30 μg/kg (2 μg/ml) was intraperitoneally injected immediately after scald in group D.Myocardial specimens were obtained at 12 h after scald for examination of the pathological changes and for determination of cell apoptosis and expression of C/EBP-homologous protein (CHOP),PERK,and phosphorylated PERK (p-PERK) by Western blot.The apoptosis index and p-PERK/PERK ratio were calculated.Results Compared with group C,the apoptosis index was significantly increased,the expression of CHOP,PERK and p-PERK was significantly up-regulated,and the p-PERK/PERK ratio was significantly increased in S and D groups (P＜0.05).Compared with group S,the apoptosis index was significantly decreased,the expression of CHOP,PERK and p-PERK was significantly down-regulated,and the p-PERK/PERK ratio was significantly decreased (P＜0.05),and the pathological changes of myocardium were significantly attenuated in group D.Conclusion The mechanism by which dexmedetomidine inhibits apoptosis in cardiomyocytes is related to inhibition of PERK signaling pathway in the rats with severe scald.

In order to evaluate the clinical significance of the acid-base disturbance complicating hepatic encephalopathy, arterial blood gas and electrolyte levels were determined in 33 patients with encephalopathy due to various hepatic disorders. It was found the respiratory alkalosis occurred in 31 cases(93.9%) and respiratory acidosis complicated with metabolic acidosis in 2 cases (6.06%). In the 31 cases of respiratory alkalosis, there were 4 cases(12.12%) of simple respiratory alkalosis, 18 cases(54.55%) complicated with metabolic alkalosis, 3 cases(9.09%) complicated with metabolic acidosis, and 6 cases complicated with both metabolic alkalosis and acidosis. In addition, the arterial blood pH of 29 cases (87.87%) was above the normal value of 7.45. The main type of acid-base disturbance found in hepatic encephalopathy was alkalosis. Its occurrence was closely related to hypoxemia, hyperammonemia, and elevated blood level of progesterone in the case of respiratory alkalosis and to salt-limited diet and improper administration of diuretics and alkalite drugs in the case of metabolic alkalosis. Metabolic acidosis was usually the result of severe complitions. In alkalosis, there was frequently an elevation of blood free ammonia, which could penetrate the blood-brain barrier easily and induce coma and encephalopathy. Therefore energetic correction of alkalosis would be valuable to prevent hepatic encephalopathy. Effective treatment of the primary disease, correction of hyperventilation.correction of disturbances of blood electrolytes, and administration of arginine hydrochloride and potasium chloride would be appropriate measures in dealing with alkalosis.

Objective To study anesthesia management in the laparoscopic excision of pheochromocytoma. Methods Thirty-seven cases of the epidural associated general anesthesia cured with diazepam 10 mg and scopolamine 0.3 mg administered 30 min before operation , anesthesia was induced with fentanyl 2?g ?kg -1 ,propofol 2mg?kg -1 , vecuronium 0.12mg?kg -1 and maintained with isoflurane,propofol and fentanyl. Vasoactive drugs were used to maintain blood pressure. All cases were sent into surgery intensive care unit after operation, ropivacaine and morphine for analgesia. Results The anesthetic effects and analgesia were satisfactory; all patients were cured. Conclusion Approach of anesthesia management in the laparoscopic excision of pheochromocytoma is feasible.

Objective To investigate the effect of rocuronium of on the function of acetylcholine receptor (AchR)/channel in cone neurons of hippocampal cortex in rats.Methods SD rats of both sexes (2-5 days old) were killed by decapitation. Brain was immediately removed and hippocampal cortex was cut into slices which were incubated in decalcified and magnesium-free artificial cerebro-spinal fluid (CSF) and mechanically dissociated and then digested in artificial CFS containing 2.5% trypsin. Cell suspension was prepared. The AchR/channel function was studied in the absence and presence of various concentrations of rocuronium (0, 0.05, 0.1, 0.2, 0.4mmol? L-1) and/or atropine 0.1 mmol ?L-1 using patch clamp technique.Results (1) The conductance, open probability (P0) and short term open constant (?01) were significantly higher in R-0.05 group than those in the control group (R-0) , but there was no significant difference in long term open constant (?02) , short term close constant( (?c1) and long term close constant(?c2) between the two groups. The conductance, P0 ,?01 ,?02 , ?c1, and ?c2 were significantly longer or higher in R-0.0, 0.2 and 0.4 groups than those in control group. (2) There was no significant difference in the conductance, P0 , ?01 , ?02 , ?c1 , and ?c2, between R-0.5 and control group but those in R-0.0, 0.2 and 0.4 groups were significantly higher or longer than control group, when rocuronium was used with atropine. Conclusions AchR/channel ( muscarinic and nicotinic ) in cone neuron of hippocampal cortex were excited by different concentrations of rocuronium. The results suggest that adverse effect may be induced on CNS by rocuronium in case it permeates the injured blood-brain barrier.

Local anesthetics have neurotoxicity, which can lead to temporary or permanent sensory and motor dysfunction.And regional anesthesia is commonly used in diabetics undergoing limbs or lower abdominal surgery, so that local anesthetics were widely used in them.However local anesthetics sensitivity in patients with diabetics is not yet clear.In this paper, we will discuss the problem and make a summary.

Objective To observe and analyze the clinical effect of cefuroxime combined with methylprednisolone in the treatment of elderly patients with chronic obstructive pulmonary disease(COPD) complicated with pulmonary emphysema.Methods 92 COPD patients complicated with pulmonary emphysema were selected as study objects,and they were randomly divided into observation group and control group.46 cases in the control group were treated with antibiotic treatment, and 46 cases in the observation group were treated with cefuroxime combined with methylprednisolone.The clinical curative effect, pulmonary function, blood gas index and incidence of adverse reactions were compared between the two groups.Results The total effective rate of the observation group was 91.30%, which was significantly higher than 76.09% of the control group (x2=8.476,P<0.05).The pulmonary function indices including FVC%,FEV1,FEV1%,MVV levels in the observation group were higher than those in the control group (t=2.657,3.610,2.413,2.359,all P<0.05).The PaO2 level in the observation group [(80.3±2.8)mmHg] was higher than (74.1±3.8)mmHg in the control group, the PaCO2 level in the observation group [(34.0±1.1)mmHg] was significantly lower than (40.2±2.2)mmHg in the control group, the differences were statistically significant (t=3.021,3.952,all P<0.05).The incidence rate of adverse reactions of the observation group was 6.52%,which of the control group was 10.87%, the difference was not significant (x2=1.363,P>0.05).Conclusion In elderly COPD patients with emphysema, using cefuroxime combined with methylprednisolone therapy can effectively alleviate the clinical symptoms, improve lung function and blood gas index, and has less adverse reactions, higher safety and high clinical application value.

Objective To study the microsurgical excision of large and giant pituitary adenomas via transeyebrow supraorbital keyhole approach and discuss the advantages of this approach Methods Forty four patients were treated with microneurosurgery via transeyebrow supraorbital keyhole approach Transverse incision was made about 5 cm,include external two third of eyebrow The skull window was about 3 cm in diameter The operative space was between subdual and epiarachnoid Under the microscope,border of tumor and its capsule could be found and dissected step by step Tumor was removed piece by piece and could be removed totally The follow up survey after 6 month, includes MRI examination,endocrine changes,visual power and visual field Result Total excision of pituitary adenomas was achieved in 40 patients;2 patients subtotal excision,and large part was removed in another 2 patients There was no mortality in this group The clinical symptoms were improved in all patients Conclusion The transeyebrow supraorbital keyhole technique is a minimally invasive technique and can be used in excision of large and giant pituitary adenomas,it can reduce the operative injury and morbidity

Objective To investigate whether the perfusion of the solitary pulmonary nodules (SPNs) is homogeneous derived with 16-slice spiral CT and 64-sliee spiral CT. Methods Eight-five patients with. SPNs (diameter≤4 cm; 57 maliagnant;15 active inflammatory; 13 benign)underwent multi- location dynamic contrast material-enhanced serial CT. One scan was obtained every 1 seconds during 11- 41 seconds without scanning interval after injection, one scan was obtained at 90 seconds. TOSHIBA AquilionMerconi 16 : The section thickness was 8.0 mm for lesions 3.0-4.0 cm, 6. 0 mm for 2.0- 3.0 cm,4.0 mm for 1.5-2.0 cm,3.0 mm for 1.0-1.5 cm and 2.0 mm for lesions <1.0 cm. GE Lightspeed 64:The section thickness was 8.0 mm for lesions3.0-4.0 cm and 2.5 mm for <3.0 cm. Precontrast and posteontrast attenuation on every scan was recorded. The peak height , perfusion, ratio of peak height of the SPNs to that of the aorta and mean transit time of three central valid sections were calculated. The significance of the difference among groups was analyzed by means of ANOVA. Results The peak heights in three sections were ( 30.95±14.53 ), ( 25.10±13.32), (32.37±15.85) HU, respectively, the perfusions (33.01±21.35), (23.70±12.87), ( 29.00±15.47) ml·min-1·100 g-1, the ratios of peak height of the SPN to that of the aorta (13.58±6.41) %, (10.95±5.76) %, (13.64± 6.20)% and the mean transit times (11.61±5.74),(11.97±3.55), (13.44±3.74) s. Statistically significant differences were found among three sections in the peak height(F= 5.913,P=0.003), perfusion (F=6.464, P=0.002), ratio of peak height of the SPN to that of the aorta (F=5.333, P=0.005) and mean transit time (F= 3.837, P = 0.023). No statistically significant differences were found among three sections in precontrast attenuation ( F =0.032, P = 0.968). Conclusion The volume perfusion of the SPNs is inhomogeneous,it is suggested to evaluate blood flow patterns of the solitary pulmonary nodules with CT volume perfusion imaging.

70% . The patients were mechanically ventilated. VT was set at 10 ml? kg-1 and respiratory rate at 12 bpm. End-tidal PCO2 was maintained at 30-35 mm Hg. End-tidal PCO2, SpO2, ECG and BP were continuously monitored. The respiratory function and mechanics were measured using respiratory monitor CP-100 (BICORE) before and after pneumoperitoneum (intra-abdominal pressure reached 15 mm Hg) and 5,10,15,20,25,30,35 min after vecuronium. The respiratory parameters measured included inspiratory and expiratory VT ( VTi, VTe) , minute ventilation (VE), respiratory rate (RR), peak inspiratory and expiratory flow rate (PIFR,PEFR), PEEP, auto-PEEP, pressure-time product (PTP), inspiratory-time ratio (TI/TTOT ), rate/VT ratio, average airway pressure (PAWM), esophageal pressure (PES), peak inspiratory pressure (PIP), dynamic compliance (CDyn), airway resistance (RAw ) and work of breathing. Results There was no significant difference in the effect of different doses of vecuronium on respiratory function and mechanics including all parameters measured at all time points among the three groups. Mean airway pressure, esophageal pressure peak inspiratory pressure, airway resistance and work of breathing increased significantly but dynamic compliance decreased significantly after CO2 penumoperitoneum. Conclusion Intra-abdominal CO2 insufflation significantly attect respiratory mecnanics. me effect of pneumoperitoneum on respiratory mechanics can not be prevented or attenuated by increasing the dose of muscle relaxant.