Objective To investigate the carotid atherosclerosis(AS) in hemodialysis(HD) patients.Methods Clinical index was measured and intma-media thickness(IMT) of extracranial common carotid artery and presence of atherosclerotic plaques were determined by high-resolution B-mode ultrasonography.Results The age,disease duration,HD duration,triglyceride(TG),low density lipoprotein(LDL),serum C-reactive protein(CRP),mean carotid artery IMT in HD with atherosclerotic plaque were significantly higher than HD without atherosclerotic plaque patients,however,the serum albumin(Alb) was significantly decreased.Mean carotid artery IMT is related to the disease duration,Alb,TG,LDL,CRP in HD patients.Conclusion The CRP,mean carotid artery IMT were increased in HD with atherosclerotic plaque.Mean carotid artery IMT is related to the disease duration,Alb,TG,LDL,CRP in HD patients.To improve malnutrition and decrease micro-inflammation,serum lipid might reduce the rate of AS in HD.

Objective:To observe the perioperative rehabilitation of children undergoing lingual frenoplasty under dexmedetomidine nasal drip combined with esketamine anesthesia.Methods:100 children who underwent lingual frenoplasty in Changsha Maternal and Child Health Hospital from 2020 to 2021 were randomly divided into two groups: the esketamine group (E group, 50 cases) and the dexmedetomidine nasal drip combined with esketamine group (DE group, 50 cases). The mean arterial pressure (MAP), heart rate (HR) , blood oxygen saturation (SpO 2) and respiratory rate (RR) were measured, and the patients were admitted to the post anesthesia recovery unit (PACU) after operation. The modified Aldrete score, Visual Analogue Score (VAS), Wake-up Restlessness Score, food intake (clear water) time and hospital leaving time were observed at 10 min, 30 min, 60 min and 120 min after operation. Results:There was no significant difference in SpO 2 and RR, MAP and HR at T 0 and T 6 between the two groups (all P>0.05). The MAP and HR at T 1, T 2, T 3, T 4 and T 5 in DE group were lower than those in E group (all P<0.05). The modified Aldrete score of DE group was higher than that of E group, and the VAS and Wake-up Restlessness Score were lower than that of E group (all P<0.05); The time of food intake (clear water) and leaving hospital were shorter than those in Group E, with statistically significant difference (all P<0.05). Conclusions:In children′s lingual frenoplasty, dexmedetomidine nasal drip combined with esmketamine can more effectively relieve postoperative pain and agitation than esmketamine alone, shorten children′s postoperative eating time, leave the hospital earlier, and enhance recovery of children.

Objective:To observe the effect of combination of esketamine and sufentanil on postoperative analgesia and postpartum depression after cesarean section.Methods:A total of 150 primiparous women who underwent lower segment cesarean section under spinal anesthesia and postoperative analgesia at Changsha Maternal and Child Health Hospital from February to October 2021 were selected and randomly divided into three groups: A, B, and C, with 50 cases in each group. All three groups underwent combined spinal epidural anesthesia and received patient-controlled intravenous analgesia (PCIA) after surgery. The group A received low-dose esketamine via intravenous pump after fetal delivery, with PCIA formula esketamine combined with sufentanil; After the delivery of fetuses in the group B and the group C, an equal dose of physiological saline was pumped into the vein. The PCIA formula of esketamine combined with sufentanil for the group B and Sufentanil for the group C. We compared the pain Visual Analogue Scale (VAS) and Edinburgh Postpartum Depression Scale (EPDS) scores of three groups of patients at different time points after surgery, as well as the postoperative pain relief rate and incidence of adverse reactions.Resultsl:There was a statistically significant difference in VAS between the group A and the group B within 48 hours after surgery compared to the group C (all P<0.05), while there was a statistically significant difference in VAS between the group A and the group B within 24 hours after surgery (all P<0.05). The postoperative pain relief rate in the group A and group B was significantly lower than that in the group C, and the incidence of postpartum depression within 7 days after surgery was significantly lower than that in the group C. Moreover, the incidence of postpartum depression in the group A was lower than that in the group B within 3 days after surgery, and the differences were statistically significant (all P<0.05). There was no statistically significant difference in the incidence of postpartum depression among the three groups 42 days after surgery (all P>0.05), and there was no statistically significant difference in the incidence of adverse reactions among the three groups ( P>0.05). Conclusions:Esketamine combined with sufentanil can synergistically enhance the analgesic effect after cesarean section and reduce the incidence of early postpartum depression after surgery.

Objective:To evaluate the effect of esmketamine for labor analgesia on the occurrence of postpartum depression (PPD).Methods:Two hundred and forty-two cases of nulliparous parturients who selected natural labor and agreed to receive labor analgesia were selected and divided into conventional labor analgesia group (C-LA group, n=119) and esmketamine-based labor analgesia group (E-LA group, n=123). The epidural labor analgesia solution contained ropivacaine 100 mg and sufentanil 30 μg in 100 ml of normal saline in C-LA group. The epidural labor analgesia solution contained ropivacaine 100 mg, sufentanil 30 μg and esketamine 50 mg in 100 ml of normal saline in E-LA group. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen parturients for depression on admission to the predelivery room and at 2 h and 1, 7 and 42 days after delivery, and EPDS scores were recorded. The patients were diagnosed as having PPD when EPDS score ≥ 9 at 7-42 days after delivery. Peripheral venous blood samples were collected on admission to the predelivery room and at 1 day after delivery to determine the concentrations of serum estrogen, progesterone, 5-hydroxytryptamine and cortisol by enzyme linked inmunosorbent assay. Results:Compared with group C-LA, the EPDS scores were significantly decreased on the 1 and 42 days after delivery( P<0.01), no significant change was found in the incidence of PPD (1.7%/0.8%, P>0.05), no significant change was found in the concentrations of serum estrogen, progesterone, 5-hydroxytryptamine and cortisol on admission to the delivery room ( P>0.05), and the concentrations of serum progesterone and cortisol were significantly increased on 1 day after delivery in group E-LA ( P<0.05). Conclusions:Combination of esketamine is helpful in reducing the risk of postpartum depression when used for epidural labor analgesia, and the mechanism is related to slowing the declines in blood levels of sex hormones and stress hormones after delivery.