Objective To observe the therapeutic effect and safety of dexmedetomidine for sedation in ICU. Methods We selected 40 patients who transferred to the ICU with retained endotracheal intubation after abdominal surgery under general anesthesia in this study. 40 patients were randomly divided into the dexmedetomidine group (D group,20 cases) and midazolam group (M group,20 cases) . Patients in group D were treated with loading dose 1 μg/kg from central vein pump injection 20 min, 1h according to Ramsay score for each adjustment of drug dose is pumped into 0.2 ~ 0.7 μg/(kg.h). Patients in M group were given a loading dose of midazolam 0.05mg/kg intravenous injection 1 min, depending on the degree of sedation maintenance dose of 0.02 ~ 0.1 mg/(kg.h). Pain scores every 2 h (NRS),when the NRS score>4 sharing,plus fentanyl 1μg/kg. When the patients achieved the offline condition, the endotracheal tube was pulled out. The sedation efficiency, dosage of fentanyl, after discontinuation wake-up time, extubation time, duration of mechanical ventilation, the incidence of cardiovascular events and delirium were compared between two groups.Results The sedation efficacy in Group D sedation was significantly higher than in group M ( <0.05) . Compared with group M, the dosage of fentanyl in patients in D group was significantly reduced ( <0.05), the wake time after stopping, extubation time were significantly shorter ( <0.05) . The incidence of cardiovascular events has no significant difference between two groups during the treatment. The incidence of postoperative delirium in D group was significantly lower than in that in group M ( <0.05) . Conclusions Dexmedetomidine has good sedative effect, and can shorten the time of extubation with hemodynamic stability and low incidence of delirium for patients in the ICU. It is an ideal ICU sedative.

Aged ; China ; Confusion ; drug therapy ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Medicine in Literature

Animals ; Guanylate Cyclase ; metabolism ; Hypercapnia ; metabolism ; Hypoxia ; metabolism ; Lung ; metabolism ; physiopathology ; Male ; Rats ; Rats, Sprague-Dawley ; Receptors, Cytoplasmic and Nuclear ; metabolism ; Soluble Guanylyl Cyclase

Objective To investigate the effect of exogenous hydrogen sulfide (H 2 S) on H2 S concentration and cystathionine β-synthase (CBS) expression in hippocampus in a rat model of vascular dementia (VaD). Methods A rat model of VaD was induced by using the modified four -vessel occlusion. The rats were divided into sham operation, model, low -dose and high-dose NaHS groups using the random number table method. They were further redivided into one day, seven -day, and 30-day subgroups according to the time after modeling. After modeling respectively, NaHS 30 μmol/kg and 100 μmol/kg were injected intraperitoneally every day in the low -dose and high-dose NaHS groups. The normal saline was injected intraperitoneally every day in the sham operation group and the VaD model group. Morris water maze test was used to evaluate the learning and memory ability of the rats. The expression of CBS in hippocampus was detected by real-time fluorescent polymerase chain reaction. Western Blotting was used to detect expression of CBS protein in hippocampus. Results Morris water maze test showed that the escape latencies of the model group, low -dose and high-dose NaHS groups were prolonged significantly compared with the sham operation group (P <0.05); the times of crossing the platform were decreased significantly compared with the model group (P <0.05); and the escape latencies were shortened significantly in the low -dose and high-dose NaHS groups compared with the model group ( P <0.05). The H2 S content in hippocampus was decreased significantly in the model group, low -dose and high-dose NaHS groups compared with the sham operation group, but the low -dose and high-dose NaHS group was significantly higher than that in the model group (all P <0.05). The expression of CBS mRNA and protein in the model, low -dose and high-dose NaHS groups was significantly lower than that of the sham operation group (all P < 0.05), and there was no significant difference between the low -dose and high-dose NaHS groups and the model group. Conclusions Exogenous H2 S may improve the learning and memory ability of the VaD rats. It may be associated with the increased H2 S content in hippocampus. However, it has no effect on CBS expression.

Actins ; metabolism ; Adult ; Diagnosis, Differential ; Female ; Fibroma ; pathology ; Fibrosarcoma ; pathology ; Follow-Up Studies ; Humans ; Hysterectomy ; Inflammation ; Keratins ; metabolism ; Leiomyoma ; pathology ; Neoplasm Recurrence, Local ; Neoplasms, Muscle Tissue ; drug therapy ; metabolism ; pathology ; surgery ; Receptor Protein-Tyrosine Kinases ; metabolism ; Uterine Neoplasms ; drug therapy ; metabolism ; pathology ; surgery ; Young Adult

AIM:To investigate the effects of 1.8mm coaxial micro incision phacoemulsification on corneal endothelial injury and postoperative visual acuity.METHODS: Totally 145 eyes in 120 patients underwent phacoemulsification from July 2013 to July 2015 were randomly divided into observation group 60 cases (73 eyes) and control group 60 cases (72 eyes).The observation group 60 cases were given 1.8mm coaxial micro incision cataract phacoemulsification operation,while the control group were given traditional 3.2mm coaxial micro incision cataract surgery.The uncorrected visual acuity (UCVA),best corrected visual acuity (BCVA),corneal thickness of incision area,incision width,incision length,macular retinal thickness,surgically induced astigmatism,corneal endothelial cell counts and complications of the two groups were compared.RESULTS: The UCVA and BCVA on 1wk after surgery of the observation group were significantly higher than the control group (t=3.604,7.109;P<0.05);the width of incision on 1wk and 1mo after surgery of the observation group were significantly less than the control group (t=205.3,225.2;P<0.05).The length of incision in observation group was significantly greater than the control group (t=3.926,5.009;P<0.05).Macular retinal thickness 1wk after surgery of the observation group was significantly less than the control group (t=2.817,P<0.05).The surgically induced astigmatism was significantly less than the control group (t=19.43,22.16;P<0.01);the difference of corneal edema between the two groups was not significant (8.22% vs 11.11%) (x2=0.348,P>0.05).CONCLUSION: The 1.8mm micro incision phacoemulsification is helpful to improve the visual acuity of patients with cataract phacoemulsification,which may be related to the reduction of corneal cell injury,enhancement of corneal closure and decrease post-operation corneal original astigmatism.

BACKGROUND:Hand-foot-mouth disease has become a major public health issue in children in China. In the present prospective study we investigated the clinical characteristics and emergency management of children with severe encephalitis associated with NPE caused by enterovirus 71. METHODS:The study was conducted in 2 pediatric intensive care units (PICUs) over a 2-month period. Clinical records were reviewed of critically ill children with severe encephalitis associated with NPE caused by EV71 who were admitted to PICUs during the period of May to June 2008 in Fuyang. RESULTS:We reviewed the complete records of 36 children, of whom 23 (63.9％) were male and 13 (36.1％) female. Their age ranged from 4 to 48 months, with an average of 15.8 months. Al children except one were under 3 years of age. The overal mortality in these children was 19.4％. The average duration of critical life threatening signs and symptoms was 2.1 days (12 hours-5 days). Nervous system diseases included brainstem encephalitis in 27 children (75％), brainstem encephalitis associated with myelitis in 6 children (16.7％), and general encephalitis in 3 chidren (8.3％), respectively. In 12 patients of NPE (33.3％) pink or bloody bubble sputum and asymmetric pulmonary edema or hemorrhage was the primary manifestation but no typical exanthema was observed. Five children died of acute onset of NPE and / or pulmonary hemorrhage with rapid progression of cardiopulmonary failure within hours after admission. Therapeutic management consisted of mechanical ventilation and administration of mannitol, methylprednisolone, intravenous immunoglobulin (IVIG) and vasoactive drugs, associated with the need of fluid volume resuscitation in 9 (25％) of the 36 children. CONCLUSIONS:In children less than 3 years of age found to be affected by severe EV71 encephalitis associated with NPE, one fifth may die. The major organ systems infected by severe EV71 include the central nervous system, the respiratory system, and the cardiovascular system. Early diagnosis and evaluation, respiratory support, treatment of intracranial hypertension, and mainttenance of function of the cardiovascular system are the most important therapeutic measures.

Objective To investigate the effect of controlled hypotension with nitroglycerin on intraocular pressure(IOP)during gynecological laparoscopic surgery.Methods Forty ASA Ⅰ or Ⅱ patients,aged 25-55 yr,weighing 55-70 kg,undergoing gynecological laparoscopic surgery,were randomly divided into 2 groups(n =20 each):control group(group C)and controlled hypotension with nitroglycerin group(group N).Anesthesia was induced with iv injection of midaaolam 0.1 mg/kg,fentanyl 3 μg/kg,vecuronium 0.1 mg/kg and etomidate 0.3 mg/kg and maintained with iv infusion of propofol at 8 mg· kg-1 · h-1 and vecuronium at 0.1 mg· kg 1 · h-1.Additional fentanyl 2 μg/kg was injected intravenously at 3 min before the starting of surgery.The patients was tracheal intuhated and mechanically ventilation.PETCO2 was maintained at 35-40 mm Hg.BIS value was maintained at 50-60.Controlled hypotension was induced by infusion of nitroglycerin at 2-4 μg· kg-1 · min-1 after the starting of surgery.CVP was maintained at 12-14 cm H2 O.Controlled hypotension was stopped at the end of operation.IOP and CVP were recorded before induction(To),at 3 min after tracheal intubation(T1),at 10,30,60,90 and 120 m in of pneumoperitoneum(T2-6)and at 10 min after pneumoperitoneum(T7).Intraocular hypertension(IOP ＞ 21mm Hg)was also recorded.Results Compared with group C,IOP at T3-6 and CVP at T2-6 were significantly decreased,and the incidence of intraocular hypertension was also decreased in group N(P ＜ 0.01).Conclusion Controlled hypotesion with nitroglycerin can prevent the intraocular hypertension effectively during gynecological laparoscopic surgery.

AIM: To observe the effect of Ahmed glaucoma valve implantation intravitreal bevacizumab in the treatment of neovascular glaucoma ( NVG) .
METHODS:Twenty-two cases (22 eyes) who presented with NVG were first treated with intravitreal bevacizumab 0. 1mL ( 2. 5mg ), then with Ahmed glaucoma valve implantation after regression of iris neovessels. Cases were followed - up for 6 - 36 ( mean 24 ) mo with observation on visual acuity, IOP control, regression of iris neovessels, and complications during or after surgery.
RESULTS: Iris neovessels was regressed in different degree after injection within 1wk in 22 eyes. At final follow-up, the IOP of 18 eyes were all less than 21mmHg without any drugs and of 3 eyes with 1-3 kinds of anti-glaucoma drugs after combined Ahmed glaucoma valve implantation. The IOP of one eye was controlled after cryotherapy. The mean IOP dropped from 45. 36 ±8.13mmHg preoperatively to 15. 59 ± 3. 21mmHg postoperatively. IOP reduction was statistically significance between preoperative and postoperative ( P<0. 05) at final follow-up. Visual acuity was improved in 9 eyes (41%) and was no changed in 13 eyes. No serious complications were observed during or after intravitreous bevacizumab injection and Ahmed glaucoma valve implantation.
CONCLUSION: Ahmed glaucoma valve implantation and intravitreal bevacizumab in the treatment of NVG is useful and safe. It improves the success rate of surgery and preserves visual function, furthermore its complications are less.

AIM:To investigate the effect of vitrectomy in treatment of metal intraocular foreign bodies and the factors affecting visual prognosis.
METHODS:Fourty seven cases ( 48 eyes ) with foreign bodies from January 2010 to June 2013 in our hospital underwent vitrectomy combined with intraocular foreign body removal were retrospectively analyzed. The changes of visual acuity, the size of foreign body, the complications of preoperative, and the relationship between treatment time and visual acuity were recorded.RESULTS: Totally 46 eyes were successfully removed the complete foreign body, 2 eyes of orbital foreign bodies had not been removed. After 6mo of followed-up, the best corrected visual acuity were all improved in varying degrees (P<0. 05), intraocular foreign body size combined with retinal detachment was the risk factor for visual impact (P<0. 05).
CONCLUSION:Vitrectomy has obvious advantages in the treatment of metal intraocular foreign bodies. Timely and appropriate vitrectomy is very important to the recovery of visual function.