Objective To evaluate the effects of different doses of ephedrine combined with hydroxyethyl starch as a volume preload for preventing hypotension in caesarean section before combined spinal and epidural anesthesia.Methods 250 pregnant wemen undergoing cesarean section were randomly allocated into the control group (n =50) and the observation group(n =200)(group was divided into A,B,C,D group,each group 50 cases).Control group preloaded Lactated Ringer's solution 250ml before CSEA.A group preloaded hydroxyethyl starch combined with 5mg ephedrine; B group preloaded hydroxyethyl starch combined with 10mg ephedrine.C group preloaded hydroxyethyl starch combined with 15mg ephedrine; D group preloaded hydroxyethyl starch combined with 15mg ephedrine.The parturient SBP,HR and untoward reaction were monitored in five experimental groups.Results Compared with T0 A group parturient SBP was lower at T1,T2,T5 [(111.8 ± 17.18)mm Hg,(114.58 ± 19.80)mm Hg,(115.06 ± 10.39) mum Hg vs (120.88 ± 13.24) mm Hg,all P ＜ 0.05)].Compared with B,C,D group,statistical differences were found at T1,T4,T6[(111.8 ± 17.18)mm Hg vs (120.78 ± 14.47)mm Hg,(118.56 ± 14.25)mm Hg,(118.42 ± 18.71)mm Hg.(125.58 ± 14.45) mm Hg vs (120.02 ±21.15)mm Hg,(115.92 ± 17.56)mm Hg,(119.00 ±12.49)mm Hg.(118.08 ±9.09)mm Hg vs (121.52 ± 10.92) mm Hg,(116.04 ± 11.61)mm Hg,(124.98 ± 9.16) mm Hg,all P ＜ 0.05].Compared with T0 parturient HR was undulation at T1,T5 (P ＜ 0.05).Compared with C,D group,statistical differences were found at T1,T3,T4,T6 [(82.92 ± 19.55) times/min vs (98.86 ±17.82)times/min,(96.72 ± 17.91) times/min.(89.04 ± 16.68) times/min vs (92.10 ± 16.55) times/min,(98.46 ± 19.49) times/min.(87.56 ± 17.13) times/min vs (98.86 ± 16.76) times/min,(88.58 ± 19.22) times/min.(93.20 ± 14.07) times/min vs (98.80 ± 11.69) times/min,(90.98 ± 10.93) times/min.all P ＜ 0.05].In B and C group,parturient SBP and HR were steady and the untoward reaction was very few.Although parturient SBP of D group was steady,but HR obviously fast during operation (P ＜ 0.05).Compared with B,C group,statistical differences were found at T4,T6 (P ＜ 0.01).Conclusion The optimum dose is 10 ～ 15 mg of ephedrine.It combined with hydroxyethyl starch as a volume preload can keep the stable of blood circulation.

Objective To study the effect of dexmedetomidine hydrochloride injection ( Dex) on awakening quality in Pediatric Patients with congenital heart disease undergoing fast_track anesthesia and whole Video_assisted thoracoscoPic surgery. Methods One hundred and twenty Pediatric Patients ( ASA I orIIleVel) with congenital heart diseases were randomly chosen for this study. They receiVed femoral artery and Vein cannulation to establish cardioPulmonary byPass and three small holes were obtained in the right chest for the PurPose of undergoing the whole Video_assisted thoracoscoPic surgery on rePairmen of atrial sePtal defect or simPle Ventricular sePtal defect. They were randomly diVided into two grouPs: Dex_assisted fast_track anesthesia grouP (D grouP,n=60) and general fast_track anesthesia grouP (C grouP,n=60). Each one in grouP D was injected with loading dose of Dex (1 μg·kg-1),then was intraoPeratiVely infused with maintenance dose of 0. 5 μg·kg-1·h-1. Children in grouP C were giVen the same dose of saline in the same way. Hemodynamic changes in the two grouPs at each time Point:before anesthesia ( t0 ) ,at the time of extubation ( t1 ) ,5 min Post_extubation ( t2 ) ,10 min Post_extubation ( t3 ) ,15 min Post_extubation ( t4 ) , 30 min Post_extubation (t5) and at the time of transferring out of CICU (t6),resPectiVely,were obserVed. Restlessness extent, incidence,time of eye oPening after calling, fully awaking time, extubation time, the time of transferring out of CICU and VAS scores,were also recorded. Results From t0 to t2-t5 ,SBP in D grouP was decreased from (114. 2±10. 5) mmHg to (107. 2±10. 3) -(105. 3±11. 3) mmHg,DBP decreased from (61. 3±9. 2) mmHg to (58. 8±7. 8) -(57. 3±6. 3) mmHg,and HR gradually decreased from (95. 2±15. 7) time·min-1 to (85. 7±13. 7)-(83. 3±12. 6) time·min-1,with significant differences (P<0. 05). ComPared with C grouP,SBP and DBP at t2-t5 were decreased significantly (P<0. 01),and HR at t1-t5 decreased significantly (P<0. 01). OVerall incidence of agitation was significantly higher in grouP C than in grouP D (48. 3%vs. 16. 7%,P<0. 01). Incidence of moderate and seVere agitation were significantly higher in grouP C than in grouP D (18. 3%vs. 6. 7%,and 20%vs. 1. 7%,resPectiVely,P<0. 01). In grouP D,time of eye oPening after calling,fully awaking time,extubation time,and the time of transferring out of CICU were Prolonged,without significant difference as comPared with grouP C (P>0. 05). VAS at 30 min after extubation was significantly higher in grouP C than in grouP D(4. 7±0. 7 vs. 2. 4±0. 6,P<0. 05). Conclusion Injection of Dex with loading dose (1 μg·kg-1) and intraoPeratiVe infusion of maintenance dose of 0. 5 μg·kg-1·h-1 in children with congenital heart disease undergoing fast_track anesthesia and whole Video_assisted thoracoscoPic surgery could be conduciVe to maintain hemodynamic stability, reduce restlessness occurrence, enhance security during awakening Process, and alleViate Post_oPeratiVe Pain.

Objective To compare the clinical outcomes between conventional percutaneous vertebroplasty (PVP) and targeted PVP in the treatment of osteoporotic vertebral compression fractures (OVCFs).Methods A retrospective cohort study was designed to review 215 cases of single level OVCFs hospitalized between January 2014 and December 2015.According to the procedure techniques,the patients were assigned to targeted PVP group (89 cases) and conventional PVP group (126 cases) which was further divided into sufficient filled subgroup (110 cases) and insufficient filled subgroup (16 cases) on basis of cement distribution.Key techniques of targeted PVP included accurate needle insertion to fractured area and cement injection using a push rob with a side opening.Operating time,cement injection volume,rate and types of cement leakage,cement distribution in the fractured area and visual analogue score (VAS) of back pain were compared between the two groups.Results Operating time in targeted PVP group was longer than that in conventional PVP group (P ＜ 0.05).There were no significant differences in cement injection volume and rate and types of cement leakage between the two groups (P ＞ 0.05).None in targeted PVP group showed insufficient cement distribution in fractured area,while 16 cases (12.7％) in conventional PVP group (P ＜ 0.05).No significant differences in preoperative VAS of back pain existed among targeted PVP group,sufficient subgroup and insufficient subgroup (P ＞ 0.05).VAS of back pain was significantly decreased after PVP in three groups (P ＜ 0.05).Difference in postoperative VAS of back pain between targeted PVP group and sufficient filled subgroup was insignificant (P ＞0.05).However,postoperative VAS of back pain in insufficient filled subgroup was significantly increased compared with targeted PVP group and sufficient filled subgroup (P ＜ 0.05).Conclusion Targeted PVP provides sufficient cement to fill the fractured area and decreases incidence of unsatisfactory clinical outcome compared with traditional PVP,indicating a secure and effective new technique in the treatment of OVCFs.