Objective To observe the effect of propofol of dento-anaesth dosage on prevention of emergence ngitatian(EA). Methods Forty ASA Ⅰ-Ⅱ patients, aged 32-56 years old and undergoing elective laparoscopic cholecystectomy, were randomly divided into two groups, propofol group (group P, 20 cases) and control group (group C, 20 cases). Anesthesia was induced intravenously with 0.1 mg/kg midaxolam, 1.0 mg/kg propofol, 2 μg/kg fentanyl and 0.15 mg/kg vecuronium. Anesthesia was maintained by intravenous and inhalation combined anesthesia. Vecuronium was discontinued about 15 min before the end of sur gery. After entered the postoperative care unit, patients in group P received propofol (0.5 mg/kg) and those in group C were administrated with normal saline (0.05 ml/kg). Time to recovery of spontaneously breathing, duration of opening eyes on verbal command, extubation time were recorded. Incidence of EA in both groups was calculated. Results Time to recovery of spontaneously breathing, duration of opening eyes on verbal com-mand and extubatian time in group P [(15.6±4.5), (18.2±6.5), (22.6±5.5) min, respectively] were sig-nificantly longer than those in group C[(13.2±5.4), (15.7±6.2), (18.4±6.8) min, respectively ]. In-cidence of EA in group P(5% ) was significantly less than that in group C(30%). Conclusion The propofol of dento-anaesth dosage can obviously decrease the incidence of EA in patients undergoing elective laporo-scopic cholecystectomy.

Objective To analyze the clinical effect of treating adjacent multi-vertebral tuberculosis by anterior radical debridement, titanium mesh bone fusion and internal fixation. Methods Twenty-four patients with adjacent multi-vertebral tuberculosis were treated by anterior radical debridement, titanium mesh bone fusion and internal fixation from April 2002 to May 2004. There were different types of tuberculosis symptoms in all the cases, including local pain and preoperative kyphosis deformity, and paraplegia in 6 cases. The preoperative kyphosis angle was 27.5??3.5?. After intensive anti-tuberculosis medication for 2 to 4 weeks before operation, 24 patients were reconstructed with Ti-Mesh filled with autograft rib and anterior internal fixation. After operation, the anti-tuberculosis medication was continued for one year. Results All the patients were followed up for 1.5 to 2.5 years postoperatively, with the average of 1.9 years. Their focus was eliminated completely, all the wounds healed in the first stage. The postoperative kyphosis angle was 5??2.5?. The average subsidence of Ti-Mesh was (3.5?0.5) mm at 8th weeks postoperation and the loss angle of kyphosis correction was 4.1??1.0? at lastest follow-up. Ti-Mesh began to fuse 3 to 6 months after operation. No looseness and dislocation were found during follow-up period. 6 patients with paraplegia recovered completely after 6 months, and kyphosis was rectified. ESR of these patients reduced a month after operation and reached to normal level after 6 months. Conclusion Anterior radical debridement, titanium mesh bone fusion and internal fixation show good results in treatment of adjacent multi-vertebral tuberculosis. The large bone deficit in the spine after debridement can be successfully reconstructed and kyphosis can be rectified. As the result of a better stability of the spine, secondary paraplegia can be avoided, and there is no need for iliac bone harvest, so without any relative complications.

Objective To investigate the relationship between noninvasive brachial artery blood pressure (B) and radial artery blood pressure (R) of the right arm.Methods Two hundred and ninetyfive patients with 149 males and age of (47 ± 16) years were studied.The height of patients was 163 ± 8 cm,and weight of patients was (61.2 ± 7.8) kg.The patients with peripheral vascular disease,wounds of arm skin or subcutaneous tissue infection were all excluded.Their B (with adult cuffs) and R (with infant cuffs) of the right arm were measured and analyzed after the patients under general anesthesia and stable hemodynamics.The relationships between B and R were analyzed by linear regression,the differences between B and R of each interval were compared using one-way ANOVA and then followed by SNK procedure.Results Right brachial artery blood pressure was significantly lower than radial artery blood pressure.The differences between the two varied from 13 to 18 mmHg in systolic BP (SBP),diastolic BP (DBP) and mean blood pressure (MAP).And linear regression was most applicable to describe their correlation [r=0.841 (SBP),0.808 (DBP),0.833 (MAP),all P＜0.01].Conclusions Radial artery blood pressure measured with infant cuffs can well reflect the variation of brachial artery blood pressure.

Objective To evaluate the effects of peritoneal jet ventilation on peritoneal oxygenation in pigs.Methods Twenty-four pigs of both sexes (12-16 weeks,35-45 kg) were randomly divided into 3 groups (n=8 each): sham operation group (group S) ; peritoneal regular frequency jet ventilation group (16 bpm)(group N) and peritoneal high-frequency jet ventilation group (150 bpm) (group H).Oral tracheal intubation was performed.The animals were mechanically ventilated (VT 8-12 ml/kg,RR 12-16 bpm,I:E 1.0:1.5,FiO2 100％) via airway.Endotracheal tubes were inserted into abdomen through the incisions in the left lower (for peritoneal jet ventilation) and right upper quadrant (for outlet of air).Arterial blood PaO2 and PaCO2 were measured before (baseline) and at 30,60,90,120,150,180,210 and 240 s of peritoneal jet ventilation.Peritoneal jet ventilation was started after the lungs being mechanically ventilated for 35 min.Peritoneal jet ventilation was terminated when SpO2 dropped to SpO2 ＜ 90 ％.The duration of safe apnea (DSA,from the moment of begging of peritoneal jet ventilation to the time when PaO2 ＜ 60 mm Hg).Results PaO2 was significandy higher and DSA longer in group H than in groups S and N.But there was no significant difference in PaCO2 among the 3 groups.Conclusion Peritoneal high-frequency jet ventilation can significantly enhance the efficiency of peritoneal oxygenation and prolong DSA,while peritoneal regular frequency jet ventilation has no effect on peritoneal oxygenation.

Objective To explore multi-causes and therapy of massive hemothorax after thoracic operation.Methods Sixty-six patients suffered from massive hemothorax after thoracic operation.All of them were executed conservative treatments for postoperative hemothorax.The noneffeetive cases were executed re-exploration.The relationship of area of residual cavity,fluctuation of intrapleural pressure and volume of hemothorax were analyzed between lobectomy in 30 eases and wedge,segmental or no excision of lung in 24 cases in 24 h postoperation.Results Thirty-two of 66 cases being executed conservative treatments were suteessful,2 cases were dead,while 32 cases were executed re-exploration,and 29 of them were cured.but 1 case of them dead,and 2 cases suffered from bronchial fistula,who were cured by thoracoplasty.The operations of wedge,segmental or no excision of lung in 24 cases were compared with lobectomy in 30 cases.It Was proved that the former had the smaller area of residual cavity,the lower intrapleural pressure.and the less volume of hemothorax(P＜0.05).Conclusions The multiplicity analysis of massive hemothorax after thoracic operation are flucmafion of intrapleural pressure after operation,intracavitary suction with negative pressure,rise of pressure in microcirculation at wound,abnormality of blood coagulation function and so on.It can reduce complications that proper therapy is timely performed,and even avoid of re-exploration.

Objective To investigate the characteristics of sagittal anatomic structure of the upper airway in patients with ankylosing spondylitis using three-dimensional reconstruction based on computed tomography (CT).Methods Thirty-one male patients with ankylosing spondylitis,aged 20-60 yr (AS group),and 41 common patients (male) without difficult airways,aged 20-60 yr (control group),who underwent spiral CT scan of the head and neck using Helical CT from January 2007 to February 2011 in our hospital,were enrolled in the study.Reconstructed images of the upper airway were obtained using AW4.4 workstation and six distances (D1-D6) and four angles (α-δ) were recorded and analyzed:(1)D1,the arc distance between the upper central incisor and root of epiglottis; D2,the distance between the upper central incisor and root of epiglottis; D3 and D4,the lengths of maxilla and mandible ; D5,the distance between the root of epiglottis and midpoint of glottis; D6,the distance between the end of mandible and midpoint of glottis; (2) angle α,the angle of line D2 and D5; angle β,the angle of line D2 and the lower edge of the upper central incisor to the midpoint of glottis; angle γ,the angle of line D4 and D6; angle δ,the angle of the point of the lower edge of the upper central incisor to the trailing edge of the hard palate and then to the root of epiglottis.Results Compared with control group,no significant change was found in D1,D2,D3,D4 and D5 (P ＞ 0.05),and D6,angle α and angle δ were significantly increased,whereas angle β and angle γ were decreased in AS group (P ＜ 0.05).Conclusion The anatomic structure of the upper airway has the characteristics of specific changes and a laryngoscope blade with a large degree of curvature may be helpful for successful tracheal intubation in patients with ankylosing spondylitis.

Objective To prospectively investigate the neurological complications(NC)after offpump coronary artery bypass grafting(OPCABG),including the kinds of NC and their mobility,risk factors.prevetion and treatment.Methods A total of 55 consecutive patients with undergoing OPCABG were evaluated from March to June 2006 at the Department of Cardiosurgery in Beijing Anzhen Hospital.Risk factors of NC were collected before operation.Nervous system physical examination,The NIH Stroke Scale(NIHSS)score evaluation,cognitive tests,imaging examination(MRI,MRA and f-MRI),anxious and depression scale were performed before and after OPCABG.NC and their kinds were identified after surgery.According to the presence or absence of NC after the operation,the patients were divided into two groups,and univariate analysis was used between the two groups.P＜0.05 was considered of statistically significant difference.Results (1)2 cases of ischemic stroke developed after surgery(2/55),but there no case of mortality.The risk factors were not statistically different between the two groups(P＞0.05):(2)For all the patients,cognitive evaluation was normal and unchanged before and after surgery(P＞0.05),including Mini-Mental State Examination(MMSE),Clinical dementia rating(CDR)and Global Deterioration Scale (GDS);(3)Except the 2 cases of stroke,the others were normal and had no change on MRI,MRA,and f-MRI(P＞0.05)before and after surgery;(4)7 patients with slight anxiety and one with sight depression before operation recovered completely after surerty without treatment.Both the Self-rating Anxiety Scale (SAS)and Self-rating Depression Scale(SDS)were normal and unchanged before and after surgery (P＞0.05).Conclusions 2 cases of ischemic stroke were found among 55 patients undergoing OPCABG (2/55)and there was no mortality.There was no obvious change of cognitive function,imaging finding,anxiety and depression before and after the operation(P＞0.05).OPCABG is relatively safe for nervous system,but more exploratory work andclinical data are needed.

AIM To develope a reversed phase high performance liquid chromatography method to determine free concentrations of morphine (M) in the solution of human haemoglobin (Hb). To study the binding of M to haemoglobin, and evaluate the binding parameters of M to Hb. METHODS An ultrafiltration technique was used to recover morphine from the samples. Morphine was analyzed using a kromasil column (150 mm?4 6 mm) and a mobile phase of 0 1% tyiethylamine methanol (75∶25,v/v). The mobile phase pH was adjusted to 7 0 by phosphoric acid. The detection was set at 283 nm. RESULTS The ultrafiltration recovery of morphine was 98 5%. The Hb binding of M was concentration dependent of Hb and M. There were single typed binding sites for M to human Hb. The parameters determined were 4 1 for N and 340 mol?L -1 for K when the concentration of M and Hb were added from 8 50?10 -5 ～1 17?10 -2 mol?L -1 and 1 29?10 -4 ～8 57?10 -4 mol?L -1 respectively. CONCLUSION An ultrafiltration technique has proved to be simple and rapid for free drug determination. It is suitable for drug protein binding study.

BACKGROUND:It has been confirmed that carboxymethylated chitosan has an promoting effect on Schwann cel proliferation and secretion, but its impact on the cyclic adenosine monophosphate-mediated protein kinase A signaling pathway in schwann cel stil needs further study. OBJECTIVE:To investigate the effect of carboxymethylated chitosan on cyclic adenosine monophosphate/ protein kinase A signaling pathway in rat schwann cels. METHODS:The Schwann cels of the second generation neonatal rats were obtained and seeded in 6-wel plate at a concentration of 1×109/L. These Schwann cels were cultured and divided into four groups. The Schwann cels in the control group were cultured by adding PBS. The Schwann cels in the experimental groups were cultured by adding 50, 100 and 200 mg/L of carboxymethyl chitosan solution, respectively. After 24 hours, the concentration of cyclic adenosine monophosphate, protein kinase A activity and cyclic adenosine monophosphate response element binding protein mRNA expression were detected. RESULTS AND CONCLUSION:Compared with the control group, carboxymethyl chitosan increased cyclic adenosine monophosphate concentrations, the activity of protein kinase A and cyclic adenosine monophosphate response element binding protein mRNA expression within the Schwann cels in a dose-dependent manner (P < 0.05). These results demonstrate that carboxymethyl chitosan can increase the concentration of cyclic adenosine monophosphate within the Schwann cels and promote protein kinase A activity, thereby activating cyclic adenosine monophosphate/protein kinase A signaling pathway.