BACKGROUND:Traditional analgesia method can relieve the pain after total knee arthroplasty, but the prognosis is poor and drug dependence is strong. Therefore, it is of great significance to study the analgesic drugs in perioperative period of total knee arthroplasty. OBJECTIVE:To explore the analgesic effect of gabapentin combined with continuous femoral nerve block on total knee arthroplasty. METHODS: A total of 48 patients with knee osteoarthritis receiving total knee arthroplasty in the Department of Orthopedics, Affiliated Hospital of Inner Mongolia Medical University from October 2013 to October 2014 were enroled in this study. Using general anesthesia, femoral nerve block was conducted before anesthesia. Analgesia pump was connected after arthroplasty. Patients were randomized to two groups. The control group received multimodal analgesia, and the experimental group received gabapentin combined with continuous femoral nerve block analgesia. Patient’s pain was scored by using resting, activity visual analog scale. Postoperative quality of life, range of motion of knee joint and complications were observed. RESULTS AND CONCLUSION:No significant difference in preoperative resting pain and activity pain was detected between the two groups (P > 0.05). Visual analog scale scores were decreased with time prolonged after arthroplasty in both groups. Visual analog scale scores of resting pain and activity pain were significantly lower in the experimental group than in the control group at 1, 3 and 7 days and 1 month (P < 0.05). Range of motion was significantly larger in the experimental group than in the control group at 3-7 days after arthroplasty (P< 0.05). Activity of daily living score, physical function score, mental function score and social function score were significantly higher in the experimental group than in the control group (P < 0.05). The complication rate was significantly lower in the experimental group than in the control group (17%, 46%,P < 0.05). These data indicate that during perioperative period of total knee arthroplasty, analgesic effect of gabapentin combined with continuous femoral nerve block is ideal. In particular, in patients with acute pain within 48 hours, their combination can promote early rehabilitation of the patient’s knee, and few side effects are found.

An investigation of palmar patterns on 900 cases Han nationality of China wasmade.The main purpose of this paper is to provide the normal values of Chinese dermatoglyphics and human genetics.The main characters of palmar patterns of Han nationality are as follows:mainline A:type Ⅰ 7.89%,type Ⅲ 91%,type Ⅴ 1.11%;main line B:type Ⅴ 80.72%,type Ⅶ 16.78%,type Ⅸ0.67%,type Ⅺ0.06%,type O(absent)0.11%,typeⅢ 1.67%;main line C:type Ⅴ 38.78%,type Ⅶ 32.67%,type Ⅸ 16.06%,typeⅪ0.44%,type O(absent)12.06%;main line D:type Ⅶ and type Ⅸ all 40.61%,type Ⅺ 18.39%,type O(absent)0.39%.The average value of AD main line formula is 6.50?1.61(SD).There are sig-nificant difference between sexes and two hands(R.L.)(P0.05).The frequency of complicatedpalmar creases is 5.22%.The rate of symmetrical main lines between two hands is34.89%.The main type of A.B.C.D main line is 3.5′.5″.7(18.11%).

Objective To investigate the value and nursing of persistent balloon dilatation for anastomotic stricture after choledochojejunostomy. Methods The clinical data of 14 cases of anastomotic strictures after choledochojejunostomy accepted the treatment of persistent balloon dilatation were analyzed retrospectively. The effect, adverse reactions and approriate nursing were evaluated. Results Five patients were performed with persistent balloon dilatation thorough the output loop of intestine after choledochojejunostomy and 9 patients through percutaneous transhepatic cholangiography. There was no hemobilia, bile leak or other serious complications. There were 2 cases of balloon dilatation catheter damage, 5 cases of pressure pump damage and 4 cases of balloon migration with 25.0% (7/28) instrument damage rate and 4 cases of balloon migration. After persistent balloon dilation for 6 to 8 months, no anastomotic stricture was found by choledochoscopic examination. Follow up for 6 to 18 months, 2 cases had recurrent anastomotic stricture. Conclusions Persistent balloon dilatation by percutaneous transhepatic cholangiography is a simple, safe and effective method for anastomotic stricture after choledochojejunostomy. In the course of nursing, the balloon catheter and pressure pump damage, and balloon migration should be noted.

Objective To investigate the nursing points of endoscopic full-covered self-expanding removable metal stents (FCSERMS) implantation for bile duct anastomotic strictures after liver transplantation. Methods The clinical data of patients who were treated by endoscopic full-covered self-expanding removable metal stents implantation for bile duct anastomotic strictures after liver transplantation from January 2013 to July 2015 were retrospectively analyzed, and the nursing process were summarized. Results The group of 9 patients were successfully placed and removed with FCSERMS. There was no postoperative complication, such as stent migration, acute pancreatitis, biliary bleeding and intestinal leakage. All the bile duct strictures were relieved after FCSERMS removement. Followed up for 10-32 months, there was no symptom and sign of bile duct anastomotic stricture recurrent. Conclusions The key in nursing points of FCSERMS implantation for bile duct anastomotic strictures after liver transplantation are introducing the function of FCSERMS and therapeutic process to improve patient compliance, mastering the endoscopic operations, the placement and removal method of FCSERMS to short operation time, strengthening postoperative nasal bile duct care, paying attention to the observation, detection and treatment of postoperative complications after the metal stent placement and removement, as well as the continuing care during the period between placement and removment of FCSERMS.

Objective To explore the key points of graded nursing care to rectal cancer patients with radioactive proctitis induced by preoperative neoadjuvant chemoradiotherapy.Methods The clinical data of 162 rectal cancer patients undergoing neoadjuvant chemoradiotherapy were analyzed retrospectively. The experience of grading nursing care for patients with radioactive proctitis induced by neoadjuvant chemoradiotherapy was summarized.Results Of 162 patients,radioactive proctitis occurred in 110 patients(67.9%).Among the 110 patients with proctitis,62(38.3%)were grade I radioactive proctitis,29(17.9%)gradeⅡand 19(11.7%)gradeⅢ.The graded nursing was done to the patients with radioactive proctitis and achieved good effect.Conclusions Radioactive proctitis has a high incidence in rectal cancer patients with preoperative neoadjuvant chemoradiotherapy and graded nursing care can reduce the distress of patients with radioactive proctitis effectively and promote wound healing,thus to improve their quality of life.

A computerized stabilometer was used to evaluate the balance function of 31 subjects with healthy backs and 3l subjects with chronic low back pain. According to the difference of age and sex,they were divided into 2 groups equally. They were told that the feet stood side by side and stood separately with eyes opened and closed. The sensitivity and applying value of all of the test parameters were analyzed. The result showed that the stabilization of the subjects with chronic low back pain was poorer than the healthy subjects. The parameters, such as Sx, Sy, MS, PL, CA and AS, were sensitive, and feet stood side by side was more sensitive than feet stood separately.

ObjectiveTo investigate the effects of nasal continuous positive airway pressure (nCPAP) and intubation in very low birth weight preterm infants. Methods One hundred and twenty-three very low birth weight preterm infants with respiratory distress within 60 minutes after birth were randomly assigned to nCPAP (n=63) or intubation group (n=60).Outcomes at 7,28 days and 36 corrected gestational weeks were assessed with x2 or t-test. ResultsThere were no significant difference in fatality rate and incidence of bronchopulmonary dysplasia between nCPAP group and intubation group [7.9％ (5/63) vs 6.6％(4/60),4.8％(3/63) vs 3.3％(2/60),x2 =0.07and 0.16,P＞0.05].In nCPAP group,the use of pulmonary sulfactant was 27.0％ (17/63),lower than that (83.3 ％,50/60) in intubation group (x2 =39.34,OR=0.3,90 ％ CI:0.2-0.6,P＜0.05) ;The nCPAP group had fewer ventilation support in 28 days [17.5％ (11/63) vs 25.0％ (15/60),OR=0.7,90％ CI:0.4-1.4] and 36 weeks [6.3％ (4/63) vs 8.3％ (5/60),OR=0.8,90％ CI:0.2-2.4] than those in intubation group but without statistical difference (x2=1.05 and 0.01,P＞0.05,respectively).The incidence of air leak in nCPAP group were lower than intubation group [11.1％ (7/63) vs 33.3％ (20/60),x2 =8.86,OR=0.3,90％00 CI:0.2-0.7,P＜0.05].There was no significant difference for other complications between two groups. ConclusionsIn very low birth weight preterm infants,early nCPAP dose not significantly reduce the fatality rate and the incidence of bronchopulmonary dysplasia as compared with intubation ventilation,but shorten the time of ventilation and lower the incidence of air leak.

Objective To apply electrical impedance tnmography that is a new evaluation ap-proach to monitor the development of retroperitoneal injury. We used retroperitoneal inject blood model in pigs to study the feasibility on monitoring retroperitoneal bleeding and to provide premise in theory and practice for clinical application. Methods Five pigs were used on the experiment. We insert a vessel into the retroperitoneal and inject blood to simulate retroperitoneal bleeding. Sixteen electrodes were atta-ched on the abdominal region circumference of pigs and used for electrical current injection and surface voltage measurement. Then the monitoring images were performed by electrical impedance tomography. Results The images of electrical impedance tomography retroperitoneal inject blood model of five pigs were clear, the minimal impedance scale was decreasing significantly as the bleeding volume increasing and the images were changed significantly too. The computerized tomography and the dissecting results confirmed the blood was limited in retroperitoneal. Conclusions The establishments of pigs retroper-itoneal inject blood model was successful. The images of electrical impedance tomography retroperitoneal inject blood model were clear with significant contrast. It's feasible to use electrical impedance tomography system to monitor the retroperitoneal bleeding. This technique may become a useful tool for monitoring ret-roperitoneal injury in intensive care patients.

Objective:To investigate the effect of short single reverse-α fixation of nasobiliary tube after endoscopic nasobiliary drainage.Methods:From January 2019 to October 2019, the patients who performed with endoscopic nasolbiliary drainage in Tongji University Affiliated Shanghai East Hospital were randomly divided into experimental group (short single reverse-α fixation, 155 cases) and control group (routine reverse-α fixation, 137 cases). The incidences of the fixation time, prolapse rate, nursing time, scores of nasal comfort and bile flow rate of nasobiliary duct were evaluated between the two groups.Results:The average time of nasobiliary duct fixation was (18.31±1.67) s, the prolapse rate was 5.2% (8/155) and the time of nursing was (35.03±2.68) s, which were lower than those of the control group (46.50±5.50) s, 13.9% (19/137) and (72.07±7.63) s. The difference was statistically significant ( t or χ 2 values were 60.795, 6.570, 56.629, P<0.01 or 0.05). The comfort score of the experimental group was (4.61±1.06) points, the bile flow rate was (241.52±53.95) ml/days, which were higher than (5.76±0.76) points and (174.09±47.55) ml/days of the control group, the difference was statistically significant ( t values were 10.448, 11.265, P<0.01). Conclusions:Shortening the length of nasobiliary duct combined with single reaction "α" method has the advantages of simper operation and nursing, low prolapse rate, high comfort and good drainage effect. It is worthy of clinical application.