Objective To evaluate the probability that strong ion gap was selected as predictive factor of mortality in patients with a -cute respiratory failure.Methods SIG was calculated with the Stewart -Figge model, after determination of blood gas ,blood pH,serum electrolytes.Results ①The incidence of acute respiratory distress syndrome and source pulmonary edema was 26% respectively in pa-tients with ARF.②There was a significant difference in the values of K +、Cl-、HCO3-、AG、pH、ALB、SIG、Cr,lactic acid,PaCO2 and PaO2 between group T 1 and control .However , there was no significant difference between recovery group T 2 and control .③There was a signifi-cant difference in the value of AG and SIG between the recovery group T 1 and death group T 1 from the patients with ARF .④SIG was a better predictor than AG by the evaluation of ROC curve .Conclusions AG and SIG can reflect the worse condition of acid -base disturb-ance in patients with ARF sensitively at the first beginning .Meanwhile , SIG may be served as a predictor for risk of mortality in patients with ARF better than AG .

This paper affirms that physician-patient relationship is the most important and fundamental relationship in medical activities.But nowadays there are some unpleasant factors arising in the physician-patient relationship,which have become severe intractable problems and heated social issues to be resolved as soon as possible in the development of Chinese society and healthcare career.Traditional Chinese Medicine contains a lot of information about medical ethics and humanism spirit of medicine.There are also many theories on how to build up a harmonious physician-patient relationship and many viable methods to solve the problems.Analysis of the physician-patient relationship nowadays and exploration of the T.C.M quintessence will help to build up a harmonious physician-patient relationship with Chinese characteristics for the construction of a harmonious society.

Researching and discussing the significance,principle,method and ethical conception of triage of casualties during earthquake.In particular,explaining the relationship between triage efficiency and aid impact;Pointing principles in Triage.At last,affirming the exigent importance of education of triage and giving some advie.

Objective To discuss the feasibility of minimally invasive drainage tube placement and tee-junctions irrigation for the treatment of chronic subdural hematoma. Methods Transcranial drainage and closed tee-junctions irrigation was carried out under local anesthesia in 31 cases of chronic subdural hematoma by using self-made trocar and osteotome. Results All the patients had been completely freed of the disease, without pneumocephalus. Follow-up for 3～6 months revealed no recurrence. Conclusions Minimally invasive tube placement and tee-junctions irrigation for chronic subdural hematoma is feasible. It not only clears away the lesions thoroughly, but also prevents the pneumocephalus effectively.

Objective To evaluate the early kindney injury by means of urinary protein/creatinine ratio(TPCR,200mg/g Cr)through group-discrimination in mellitus diabetes patients. Methods Qualitative analysis was carried out with urine 5~6 item indexes in 113 cases of diabetes mellitus ,61 cases of heallthy people and other 67 cases of diabetes mellitus patients. 2 groups were divided by means of urinary protein/creatinine ratio(TPCR,200mg/g Cr).Results In 113 cases of diabetes mellitus ,urine TPCR,mAlb,?2-MG,LAP and AFU of 38 cases in TPCR≥200mg/g Cr group were significantly higher than those of 75 cases in TPCR

Objective To compare the changes of serum levels of heme oxygenase‐1(HO‐1) ,C‐reactive protein(CRP) and Chitinase‐3‐1ike protein 1(YKL‐40) in patients with rectal cancer after laparoscopic‐assisted radical operation versus open radical surgery .Methods According the integration and elimination standard ,60 cases of patients with rectal cancer were selected and di‐vided into laparoscopic group (30 cases) and open group (30 cases) ,the concentrations of HO‐1 ,YKL‐40 and CRP in peripheral blood of patients were detected on the first and third postoperative day and preoperative day(P<0 .05) ,and were compared between the two groups .Results The serum levels of HO‐1 ,YKL‐40 and CRP in the laparoscopic group were significantly lower than those in the open group on the first and third postoperative day(P<0 .05) .The serum levels of HO‐1 ,YKL‐40 and CRP were significant‐ly increased after surgery ,and serum levels of HO‐1 and CRP on third postoperative day were significantly increased compared with that on the first postoperative day in the two groups after surgery ,while serum level of YKL‐40 on the third postoperative day was significantly lower than that on the first postoperative day in the two groups after surgery .Conclusion The stress reaction is com‐paratively mild in patients with rectal cancer after laparoscopic assisted radical operation ,and the postoperative period may be shor‐ter in patients treated with laparoscopic assisted radical operation than those treated with open radical surgery .

Objective To Investigate the application value of strong ion gap(SIG),anion gap(AG)and other four indicators in the trauma disease.Methods Blood was taken from trauma patients admitted to hospital immediately,with the heparin anticoagulation,misce bene.Blood gas was measured.Creatinine(Cr),phosphorus and albumin(ALB)was measured simultaneously.Results Betwean traumatic group and control group,there was signifrcant difference in SIG,AG,potential HCO3-,and other 5 item(P4mmol/L.

Objective To evaluate the efficacy of ultrasound-guided obturator nerve block using proximal interfascial technique.Methods Seventy ASA physical status Ⅰ or Ⅱ patients of both sexes, aged 43-82 yr, with body mass index of 18.0-30.5 kg/m2, scheduled for elective trans-urethral resection of bladder tumor, were randomly divided into 2 groups (n =35 each) using a random number table: remote interfascial technique group (group R) and proximal interfascial technique group (group P).In group R, interfascial injections at 2 planes, lateral and deep to the adductor brevis muscle, were carried out with 0.375％ ropivacaine 7.5 ml to block each obturator nerve branch separately.In group P, 0.375％ ropivacaine 15.0 ml was injected under ultrasound guidance at the interfascial plane inferior to the superior pubic ramus (between the pectineus and obturator externus).The strength of thigh adduction was measured before injection (baseline) and at 5, 10, and 15 min after injection.Then combined spinal-epidural anesthesia was performed at L3,4 interspace.The 50％ strength reduction indicated a successful block.The block performance time was recorded.The success rate of block at 15 min after injection was calculated.It was considered clinically effective when obvious muscle twitching interfering with the surgical procedure did not appear.The clinical outcome was assessed, and the effective rate of clinical outcome was calculated.Results Compared with group R, the block performance time was significantly shortened, the success rate of block, strength reduction at 10 and 15 min after injection, and clinical outcome were increased in group P.There were no significant differences in the effective rate of clinical outcome.Conclusion Compared with remote interfascial technique, ultrasound-guided obturator nerve block using proximal interfascial technique provides easier and rapid procedure, higher success rate of block and better clinical outcome of block.

Objective To evaluate the outcome of patients using intra-aortic balloon pump IABP undergoing coronary artery bypass grafting and to assess the results.Methods From December 2001 to December 2011,eighty-two consecutive patients,who used IABP undergoing coronary artery bypass grafting were studied.The out-come of early complication,mortality,LVEF were analyzed.Results Fourteen patients died.Forty-three patients,who used IABP,no serious complications (malignant arrhythmia,renal insufficience),preoperative LVEF was (46.0 ± 1.8) ％,LVEDD was (66.0 ± 4.1) mm,early postoperative LVEF was (50.0 ± 2.7) ％,LVEDD was (53.0 ± 2.8) mm (P ＜ 0.05).Conclusion Use of IABP decreased early mortality,and postopertive respiratory tract infections,renal insufficiency were the main complication.Positive use of IABP postoperatively can decrease early mortality.