AIM: To study the altion of aminophylline or doxapram attenuate somnolence induced by postoperative intravenous analgesia with butorphanol.METHODS: One hundred and five adult patients were randomly divided into three groups under epidural blockade.0.01% butorphanol and 0.25% aminophylline analgesia-pump(groupⅠ,n=35),0.01% butorphanol and 0.15% doxapram analgesia-pump(groupⅡ,n=35),and 0.01% butorphanol analgesia-pump(group Ⅲ,n=35).Lethargy and analgesia effect were compared.RESULTS: The analgesia effects were satisfactory in the three groups after operation.conscious-sedation score(OAA/S)(at 8-24 h after operation)in groupⅢ was higher than those in groupⅠand Ⅱ(P

Objective To investigate the role of fiberoptic bronchoscopy (FOB) in the positioning of ProSeal laryngeal mask airway (PLMA). Methods Sixty ASA Ⅰ or Ⅱ patients undergoing general anesthesia using PLMA were randomly divided into two groups with 30 cases each: inserted PLMA group (group A)and FOB positioning group (group B). After the routine intravenous anesthesia induction,the PLMA inflated to an intracapsular pressure of 50 cm H2O (1 cm H2O =0.098 kPa) with the positive airway pressure by the anesthesia apparatus, the airway seal pressure, airway peak voltage of intermittent positive pressure ventilation and tidal volume were evaluated. Results Patients from two groups achieved adequate lung ventilation (SpO2 ＞0.97,PETCO2 was normal), the operations were all smooth. There were 5 cases adjusted the position two times,and 1 case adjusted 3 times. Patients in group B were all PLMA insertion under FOB and airway seal pressure was higher,but airway peak voltage was lower than in group A (P＜0.05). Conclusion FOB elevates accurate allocation of PLMA,enhances the isolated function from the surrounding tissue of glottis, improves the lung ventilation, and increases the safety of PLMA.

Objective To evaluate the effectiveness of epidural saline washout on regression of sensory and motor block after epidural anesthesia in elderly patients.Methods A total of 70 males with ASA Ⅰ or Ⅱ who were subjected lumbar epidural anesthesia with 10 ml of 1.73% bicarbonate-lidocaine and fentanyl 50 μg (1 ml).At the end of transurethral surgery,the washout group (35 cases) received an epidural bolus of 20 ml saline while the control group(35 cases) did not,extracted the epidural catheter after 10 minutes.Results Mean times of 3-dermatomal sensory regression for pinpric, 1-grade of motor block, and the rate of 1 h motor block were significantly shorter in the washout group than those in the control group [(24.6 ± 15.9) min vs(32.8 ± 16.7) min, (32.7 ± 13.4) min vs(47.9 ± 22.6) min,5 cases (14.3%) vs 14 cases (40.0%)](P < 0.05 or < 0.01 ).There was no difference in pain-killer utilization, postoperative pain scores no more than 3 scores and side effects between the two groups (P > 0.05).Conclusion It suggests that epidural washout facihtates regression of both sensory and motor block following epidural anesthesia without reducing the postoperative analgesic benefit.

Objective To evaluate the effect of remifentanil on mean arterial pressure (MAP), heart rate (HR) and QTc interval during tracheal intubation of general anesthesia patients. Methods Seventy-five ASA Ⅰ -Ⅱ grade patients were selected and allocated to receive either saline (group C), remifentanil 0.50 μg/kg (group R1) or remifentanil 0.75 μg/kg(group R2) by random digits table with 25 cases in each, they were administrated as a bolus intravenous, followed by a continuous infusion at 0.10 μg/ (kg·min), 1 min before laryngoscopy. All patients received fentanyl 3 μg/kg,propofol 1.0 - 1.5 mg/kg and vecuronium 0.1 mg/kg. The ECG.MAP and HR were recorded prior to induction of anesthesia (T0), 2 min following the start of drug intravenous of fentanyl and propofol with vecuronium (T1), 1 min following remifentanil or saline (T2), before laryngoscopy(T3), 30 s (T4), 2 min (T5) and 4 min (T6) after intubation. Results The QTc interval was significantly prolonged immediately following intubation in group C and group R1, but it remained stable in group R2, compared with the QTc interval just before laryngoscopy. In group R2, QTc interval was significantly shorter at T4-T6 compared to group C(P＜ 0.05 or ＜ 0.01). QTc interval significantly increased from baseline at T4 in group R1 and T4-T6 in group C (P＜ 0.05 or ＜ 0.01). The number of patients with QTc interval ＞ 440 ms were significantly greater immediately following tracheal intubation in group C than that in group R2 [44% (11/25) vs. 12% (3/25)] (P ＜ 0.05). Conclusions QTc interval increases following tracheal intubation during induction of anesthesia using fentanyl and propofol. Intravenous of remifentanil attenuates the QTc interval prolongation associated with tracheal intubation. In addition, remifentanil decreases the hemodynamic responses to tracheal intubation.

Objective To evaluate the effect of oxytocin on Tp-e and QTc interval during caesarean section under spinal anesthesia in healthy puerperas. Methods Forty ASA Ⅰ puerperas were selected and allocated to receive oxytocin intravenous bolus group (group-IB) or oxytocin continuous infusion group (group-CI) with 20 puerperas in each by random digits table. An intravenous bolus of 5% glucose 5 ml and 5 U oxytocin was administered after delivery a 55-60 s period. A continuous infusion of 5% glucose 5 ml and 5U oxytocin was administered after delivery a 10 min period. Measured the QTc interval,Tp-e interval,mean arterial pressure (MAP) and beart rate ( HR ) pre-operatively, then 1,3 and 5 ain after spinal anesthesia, and at least 1,3,5 and 10 min after oxytocin injection. Results In group-IB:HR was fast 1 min after oxytocin injection compared with pre-operatively [(89 ± 13) beats/min vs. (73 ± 12) beats/min] ,MAP was decreased [(69 ± 12 ) mm Hg ( 1 mm Hg= 0. 133 kPa ) vs. ( 82 ± 13 ) mm Hg] and QTc interval was prolonged [(426 ±21 ) ms vs. (405 ± 18 ) ms] (P ＜ 0.01 ); but Tp-e interval was prolonged 1,3,5 min after oxytocin injection compared with pre-operatively (P ＜ 0.01 or ＜ 0.05 ). Conclusions Single large dose of oxytocin intravenous bolus (5 U) can prolong QTc interval and Tp-e interval in healthy puerperas, and Tp-e interval can exact predict the occurrence of ventricular arrhythmias. The risk-benefit balance of oxytocin bolus during caesarean delivery should be discussed with women with a history of long QT syndrome.

Objective:To gain an insight into the immunological mechanism of tuberculosis by observing the variation of T lymphocyte subgroups in endobronchial tuberculosis(EBTB) patients.Methods:The variation of T lymphocyte subgroups was determined by flow cytometry in 23 EBTB patients and 25 physical examinees and results were compared.Results:The value of CD8 T lymphocytes was significantly lower in the EBTB patients than in healthy controls(P0.05).Conclusion:The pathogenesis of tuberculosis is associated with the changes in the immune system.CD4 and CD8 T lymphocytes play an important role in the cell-mediated immune response.

Objective To study the effect of paeonol (PAE) and panax notoginseny saponins (PNS) on the expressions of collagenⅠandⅢprotein and mRNA in rats with acute myocardial infarction (AMI), and to explore the molecular mecha?nism of improving myocardial fibrosis. Methods The rat model of AMI was made using the left anterior descending coro?nary branch ligation.According to the intervention rats were divided into model group, PAE (8 mg/kg) group, PNS (40 mg/kg) group, PAE (4 mg/kg)+PNS (20 mg/kg) group, PAE (8 mg/kg)+PNS (40 mg/kg) group and captopril positive control group (10 mg/kg). Sham operation group, only wear line without ligation. The left ventricular mass index (LVMI) was detected after treatment for 28 d. Masson staining was used to observe changes of myocardial fibrosis. Western blot assay and RT-PCR technique were used to detect protein and mRNA expression levels of collagenⅠandⅢ. Results The values of LVMI were increased in model group compared with those of sham operation group and treatment groups. Compared with PAE group and PNS group, values of LVMI were significantly decreased in PAE (4 mg/kg)+PNS (20 mg/kg) group and PAE (8 mg/kg)+PNS (40 mg/kg) group. There was a more significant decrease in formula high dose group (P < 0.01). The model group showed pathological change. There were different degrees of improvement in pathological structure in all treatment groups, more sig?nificant improvement was found in formula low dose group, formula high dose group and captopril positive control group. There were different degrees of increase in expressions of collagenⅠandⅢprotein and mRNA in model group compared with those of sham operation group and treatment groups. Compared with PAE group and PNS group, the protein and mRNA expression levels of collagenⅠandⅢwere significantly decreased in formula low dose group and formula high dose group,more significant decreased was found in formula high dose group (P<0.05). Conclusion Compound of paeonol and PNS can improve myocardial fibrosis in myocardial infarction rats, which may be related with reduced expressions of collagenⅠandⅢprotein and mRNA.

Objective To study the effect of paeonol (PAE) and PNS on the expression of transforming growth factor (TGF)- beta 1/ Smad2/3 pathway in rats with acute myocardial infarction (AMI), and the possible molecular mechanism thereof. Methods Model of AMI was made using left anterior descending coronary branch ligation. According to the inter?vention methods rats were divided into model group, PAE group (8 mg·kg-1), PNS group (40 mg·kg-1), PAE (4 mg·kg-1)+PNS (20 mg·kg-1) low dose group, PAE (8 mg·kg-1)+PNS (40 mg·kg-1) high dose group and captopril positive control group (10 mg · kg-1). Rats without ligation were used as Sham operation group. Left ventricular systolic blood pressure (LVSP), left ventricular diastolic pressure (LVEDP) and the maximum rise and fall rate (/dtmax DP) were detected after 28-day treat?ment. HE staining was used to observe changes of myocardial tissue. The protein expression levels of TGF-β1 and Smad2/3 were detected by Western blot assay. Results There were significant differences in parameters used for detecting treatment group and model group, formula group and single drug group, formula high dose group and formula low dose group (P <0.01). The model group showed pathological changes. All treatment groups showed different degrees of pathological improve?ment. There was the most significant improvement in formulae group and captopril group. Compared with the model group, TGF-β1 and Smad2/3 protein expressions were decreased in treatment group. The expression levels of TGF-β1 and Smad2/3 were significantly decreased in formula group than those of PAE group and PNS group, and lower levels in formula high dose group than those of formula low dose group (P<0.05). Conclusion Paeonol and PNS can inhibit the expressions of TGF-β/Smad 2/3 protein in rats with AMI, by blocking TGF-β/Smad pathway.

Objective To investigate the relationship between uncertainty in illness and recovery quality. Methods A cross sectional study was conducted from June to December 2015. The Chinese version Mishel Uncertainty in Illness Scale was used to assess uncertainty in illness of 168 patients with unconfirmed breast tumor undergoing general anesthesia. The following datarecovery time, time stay in postanesthesiacar unit, modified Observer′s Assessment of Alertness/Sedation Scale score etc were recorded. Results The breast tumor patients had a medium degree of illness uncertainty (81.11 ± 12.57) points. Educational background, marital status, family medical history, the severity of disease affect scores of illness uncertainty (P<0.05 or 0.01). Uncertainty in illnesswas negative correlated with recovery quality (P<0.05 or 0.01). Conclusions Uncertainty in illness of patients isrelated to recovery quality. Nursesshould instruct breast tumor patients to manage symptoms to decrease uncertainty in illness.

Objective To summarize the clinical and laboratory characteristics of patients with severe fever with thrombocytopenia syndrome (SFTS ) and to identify the related risk factors for mortality .Methods Clinical features and laboratory parameters were collected from 40 SFTS patients (7 deaths and 33 survivors) .Dynamic changes of laboratory data were compared between the two groups , including white blood cell count (WBC ) , platelet count (PLT ) , alanine aminotransferase (ALT ) , aspartate aminotransferase (AST) ,creatine kinase (CK) ,lactate dehydrogenase (LDH) ,prothrombin time (PT) ,activated partial thromboplastin time (APTT) and thrombin time (TT) .Continuous variables with normal distribution were compared with t test ,and those with non‐normal distribution were compared with nonparametric test ;categorical variables were compared with χ2 test .Univariate Logistic regression was used to evaluate the risk factors associated with death .Results For the deceased patients and the survivors ,the APTT were 56 .40 s and 44 .45 s ,respectively (Z=5 .419 ,P=0 .04) at day 1—7 .Those were 66 .25 s and 36 .85 s ,respectively (Z=10 .112 ,P=0 .009) at day 8—10 ,and (125 .06 ± 11 .88) s and (33 .44 ± 6 .50) s ,respectively (t=45 .760 ,P<0 .01) at day 11—13 .At day 11—13 ,the ALT levels in deceased patients and survivors were (783 .00 ± 210 .12) U/L and (137 .33 ± 89 .59) U/L ,respectively (t=7 .989 ,P=0 .016) ,AST levels were 890 U/L and 99 U/L ,respectively (Z=60 .248 ,P <0 .01) , CK levels were 2 315 U/L and 314 U/L ,respectively (Z= 122 .065 , P< 0 .01) ,LDH levels were 1 075 U/L and 509 U/L ,respevtively (Z=44 .642 ,P<0 .01) ,PT were 16 s and 11 s ,respectively (Z=7 .917 ,P=0 .031) ,and TT were 120 s and 20 s ,respectively (Z=1 361 .674 ,P<0 .01) .Day 11—13 after the onset of illness was the critical stage for SFTS .Consciousness alteration (OR=6 .60 ,95% CI:2 .94—14 .80) ,bleeding (OR=9 .29 ,95% CI:1 .48—58 .47) ,PT> 15 s (OR= 24 .00 ,95% CI:1 .99—289 .60) ,APTT>70 s (OR= 42 .67 ,95% CI:3 .54—514 .85) and TT > 120 s (OR= 0 .14 ,95% CI:0 .02—0 .88) were risk factors for the death of SFTS patients (all P< 0 .05) .Conclusion Prolonged APT T ,T T and PT at early stage and progressively increasing during the disease course suggest poor prognosis of SFTS .