Objective To investigate the risks and anesthetic management of scar uterus undergoing cesarean section.MethodsOne hundred pregnant women(aged 24-43 years old)with scar uterus underwent cesarean section.Epidural anesthesia was used in 90 cases(group A)and general anesthesia in 10 cases(group B).The monitorings included ECG,BP,HR and SpO_2.CVP was measured in the high risk cases.The time from skin incision tO neonatal delivery(I-D).the time from uterine incision to delivery(U-D),and Apgar scores of neonates were recorded.Results Incomplete blockade was seen in 20 cases(22％).The I-D time was shorter in group B than that in group A[(7.5±2.0)min vs.(12.3±2.6)min](P<0.01).Intraoperative hypotension occurred in 32 cases (32％).Neonatal asphyxia happened in 21 cases(21%).Apgar scores of 11 neonatals werc less than 3,of whom 5 neonates died.Apgar scores were 4 to 7 in 10 cases,8 to 10 in 79 cases.Subtotal uterectomy was performed in 2 cases.Repair of injuried bladder had to be done in one case.Intraoperative huge bleeding took place in 15 cases.Conclusion The scar uterus undergoing cesarean section has a high risk for mothers and neonates.The incidence of incomplete epidural blockade is higher.Effectively preventing and managing the risk factors are the keys for reducing maternal and neonatal complications and mortality.

The new round of medical and health system reform proposed the need to explore effective ways to gradually reform the mechanism of “using medicine costs to supply medical care”, through the implementation of “medical separation”, solve patients’ problem of “difficult and expensive”. While implementing the mode of the “medical separation”, according to exploring and practicing the actual situation of the region, it describes on the main mode of “medical separation”, analyzes the advantages and disadvantages, and proposes policy recommendations of “medical separeation” according to analysis of different modes.

AIM: To study the effectiveness of urapidil and nitroglycerine on controlling the cardiovascular responses to tracheal intubation/extubation in patients with essential hypertension. METHODS: 45 patients with essential hypertension undergoing general anesthesia were divided randomly into control (C, without depressor, n=15), urapidil (U, 0.5 mg?kg -1 , n=15), and nitroglycerine (N, 1 ?g?kg -1 , n=15) groups. The SBP, DBP, MAP, HR and RPP were measured during intubation and extubation and at the induction of anesthesia and the end of operation respectively. RESULTS: The SBP, DBP, MAP, HR and RPP increased markedly (P

Objective:To explore the changes of serum cholinesterase(ChE)and its clinical significance in patients with sepsis.Methods:Serum cholinesterase concentration,acute physiology and chronic health evaluation(APACHE)Ⅱ scores were estimated in patients.The patients in this study were divided into the sepsis group and the non-sepsis group.The patients with sepsis were further divided into the death group and the survival group.The influence of altered serum ChE levels on prognosis was compared between the groups.Results:(1)Serum ChE was significantly lower in patients of sepsis group than that of control group(P ＜ 0.01).(2)In patients with sepsis,the serum ChE level was significantly lower in the death group compared with that of survival group(P ＜ 0.05).(3)In patients with sepsis the serum ChE levels were significantly negatively correlated with APACHE Ⅱ scores(r=-0.280,P ＜ 0.05),positively correlated with serum albumin and body mass index(r=0.458 and 0.287,P ＜ 0.05).Conclusion:Serum ChE levels can be used to determine the prognosis and severity of illness in patients with sepsis.

Objective To evaluate whether it can prevent Frey's syndrome by reserving parotid fascia or reconstructing parotid fascia with sternocleidomastoid muscle and remaining of parotid fascia in parotidectomy. Methods Fifty-two patients undergoing parotidectomy with maintained and reconstructed parotid fascia were followed up. A test of chewing vitamin C slice guidance and iodine-amylum pilot was conducted for observing the incidence of postoperative Frey's syndrome. Results Flush with perspires was found only in 5 out of the 52 patients (9.61%), which was lower than the incidence after traditional parotidectomy. Conclusion The method of reserving and reconstructing parotid fascia with sternocleidomastoid muscle and remaining of parotid fascia in parotidectomy can efficiently prevent Frey's syndrome, and can also repair the hollow abnormity of the face.

Objective:To evaluate the possibility of prevention of Frey's syndrome by reservation and reconstruction of parotid fascia in parotidectomy.Methods:Parotidectomy with parotid fascia reservation and reconstruction was conducted in 31 cases. 12 months-12 years after operation the patients were examined by Minor test.Result:Positive reaction of Minor test was observed in 3 out of the 31 cases(9.67%).Conclusion:A parotidectomy with reservation and reconstruction of parotid fascia can efficiently prevent Frey's syndrome.

This article summarizedthe influencing factors of the outcomeof postoperative pain management from structure and process aspects,based on the structure - process - outcome model, so as to provide reference for hospitals to improve the quality of postoperative pain management.

Objective:To report the results of neurocutaneous axial island flaps in the forearm in clinical application.Methods:12 patients with soft tissue defects around the elbow and the wrist were treated with proximally or distally based island flaps based on the lateral and medial forearm cutaneous nerves.The flaps measured 9cm?8cm to 4cm?3cm.Results:The flaps totally survived in 11 pa- tients,the other was patially survived.The color and texture of the flaps were good.Their appearance and function were satisfactory after 12～18 months follow—up.Conclusions:On the basis of the vascu- larization of the lateral and medial cutaneous nerves of the forearm,some reliable island flaps were raised successfully.These flaps are easy to dissection and have a large arc of rotaion.They were satisfac- tory in repairing the soft tissue defects around the elbow,the distalone of third of the forearm and the wrist.

Objective To report the improved operative technique and clinical results of sural nerve nutritional vessel axial flap Methods Based on anatomical studies,the sural nerve nutritional vessel flap pedicle with the lowest perforating branch of the peroneal artery were performed to repair the soft tissue defects of the lower leg,the ankle and the foot Results The modified flaps were applied in 7 cases,all flaps survived completely The size of the flap ranged from 30 cm?10 cm to 23 cm?8 cm The length of pedicles were 1 6～3 0 cm The colour and texture of flaps were excellent,the outline and functional results were satisfactory after 6～12 months follow up Conclusions This new procedure can enlarge the survival and repairing area of the flap,it can also solve the distortion problem of fasciocutaneous pedicle The blood supply of this flap is reliable Flap elevation is easy and quick It is very useful in repairing large skin defects of the lower leg,the ankle and the foot

Objective To investigate the nasal endoscope Television Co-line self-retaining laryngoscope vo-cal polyps surgery treatment. Methods 121 cases diagnosed of vocal cord polyp (of which 54 cases of bilateral, u-nilateral 67 cases), in the serf-retaining laryngoscope and surveillance camera system of vocal cord polyp removed and opened Lacunar Reinke and will preoperative laryngoscopy and laryngoscopy after surgery and review the results of the video and retain. Results 4 weeks to review 70° nasal endoscope, and 116 cases of vocal sounds close to nor-mal, the cure rate reached 95.9 percent, and the remaining five cases because of vocal hypertrophy or incomplete closure of the vocal cords, sounds worse than normal shoots. Follow-up 3～18 months without recurrence, no serious complications. Conclusion The nasal endoscope and television surveillance camera system of amplification, in par-ticular, Reinke Lacunar throat image more clearly, so that lesions can be completely removed, and the vocal cords can be a very good organization had to protect, and by retaining the video can be pre-operative, during and after vo-cal dynamic comparative situation.