Objective:To investigate the effect of dexmedetomidine combined with parecoxib sodium on multimode analgesia during total knee arthroplasty (TKA) and its effect on cognitive function.Methods:One hundred and eighty-eight patients who underwent TKA from January 2017 to December 2019 in People′s Hospital of Xuyi County were divided into the multimode analgesia (MA) group and the postoperative patient-controlled intravenous analgesia (PCIA) group by the method of random number table, each group with 94 patients. Patients in the MA group were injected with parecoxib sodium and dexmedetomidine hydrochloride half an hour before anesthesia induction and PCIA after the operation, while PCIA was only given after the operation in the PCIA group. Visual analogue scale (VAS) and sedation Ramsay scores were performed at the time of entry into the operation room (T 0), 12 h (T 1), 24 h (T 2) and 48 h (T 3) postoperatively; simple mental state scale (MMSE) score, serum S-100β, and neuron-specific enolase (NSE) levels were measured at 24 h before the operation (T 01), T 2, and 72 h after the operation (T 4). The incidence of adverse reactions within 48 h after surgery and postoperatively cognitive dysfunction (POCD) in the two groups within 72 h after surgery were recorded and compared. Results:The VAS scores and sufentanil dosage at T 1, T 2 and T 3 in the MA group were significantly lower than those in the PCIA group ( P<0.05), and Ramsay scores were significantly higher than those in the PCIA group ( P<0.05). The total incidence of adverse reactions and POCD in the MA group were significantly lower than that in the PCIA group: 5.32% (5/94) vs. 20.21%(19/94), 8.51%(8/94) vs. 27.66%(26/94), there were significant differences ( P<0.05). At T 2 and T 4, the MMSE scores in the MA group were significantly higher than that in the PCIA group: (26.42 ± 1.68) scores vs. (25.30 ± 1.74) scores, (27.06 ± 1.93) scores vs. (26.49 ± 1.87) scores; the S-100β level in the MA group were significantly lower than that in the PCIA group: (1.35 ± 0.17) μg/L vs. (1.43 ± 0.19) μg/L, (1.26 ± 0.13) μg/L vs. (1.40 ± 0.16) μg/L; the NSE level in the MA group were significantly lower than that in the PCIA group: (0.88 ± 0.05) μg/L vs. (0.94 ± 0.06) μg/L, (0.83 ± 0.06) μg/L vs. (0.91 ± 0.04) μg/L, there were significant differences ( P<0.05). Conclusions:Dexmedetomidine combined with parecoxib sodium multimode analgesia has clear analgesia effect after TKA, can significantly reduce the occurrence of POCD and has high safety.

Objective To observe and compare the effect of remimazolam combined with nalbuphine and midazolam combined with nalbuphine on postoperative recovery in elderly patients undergoing fibrobronchoscopy.Methods A total of 112 elderly patients undergoing fibrobronchoscopy,56 males and 56 females,aged ≥ 65 years,BMI 18.5-28.0 kg/m2,ASA physical status I or Ⅱ,were ran-domly divided into two groups:midazolam group and remimazolam group,56 patients in each group.The midazolam group received midazolam 0.03 mg/kg combined with nalbuphine 0.1 mg/kg for anesthesia.The remimazolam group received remimazolam 0.1 mg/kg combined with nalbuphine 0.1 mg/kg for anesthesia.HR,MAP,SpO2,and RR were recorded after entering room,before anesthesia induction,5 minutes after anesthesia induction,and at the end of the operation.The onset time of anesthesia,the time of awakening,the time of operation,the time of discharge,the number of successful cases of sedation,the number of suc-cessful cases of endoscopy,and the occurrence of adverse events were recorded.The satisfaction of the pa-tient,anesthesiologist,and endoscopist were also recorded.Results Compared with the midazolam group,HR and MAP were significantly increased 5 minutes after induction and the end of operation in the remima-zolam group(P＜0.05),the onset time of anesthesia and the time of awakening were significantly short-ened(P＜0.05),the incidence of hypotension,respiratory depression and nausea and vomiting were sig-nificantly reduced(P＜0.05),and the rae of very satisfaction of the operating physician was significantly increased(P＜0.05).There were no significant differences in the time of separation,the success rate of sedation and the success rate of endoscopy between the two groups.Conclusion Compared with midazolam,remimazolam combined with nalbuphine can be safely used for flexible bronchoscopy in elderly patients,reduce recovery time and adverse reactions,which is conducive to rapid postoperative recovery.

Objective:To explore the application of metagenomic next-generation sequencing (mNGS) in critically ill children with hematological disorders and evaluate its diagnostic value.Methods:A retrospective analysis was conducted on the clinical data of children with hematological diseases, tumors, and hematopoietic stem cell transplantation who underwent traditional culture and mNGS testing in the pediatric intensive care unit of the Xiangya Hospital, Central South University from September 2019 to June 2022. The detection rate and diagnostic value of traditional culture and mNGS for pathogens were analyzed and compared.Results:Among the 50 patients, there were 29 males and 21 females, with a median age of 9.00(4.75-13.00) years. A total of 60 samples were sent for mNGS testing, including 40 blood samples, 10 bronchoalveolar lavage fluid samples, 7 cerebrospinal fluid samples, and 1 bone marrow, 1 skin, and 1 pleural fluid sample each. 49 positive samples were detected by mNGS, including 20 cases of viruses, 14 cases of bacteria, 8 cases of mixed samples, and 7 cases of fungi. The detection rate of mNGS in this study was significantly higher than that in traditional pathogen culture (81.7% vs 16.7%), and the difference was statistically significant ( P<0.01). Based on clinical diagnostic cases, the sensitivity of mNGS was significantly higher than that of traditional culture (85.2% vs 29.6%), with a statistically significant difference ( P<0.01), while its specificity was not statistically significant ( P>0.05) compared to traditional culture (50.0% vs 83.3%). Conclusions:mNGS has a higher detection rate and sensitivity than traditional pathogen culture, and can early identify viral, fungal, and mixed infections, providing strong assistance for precise treatment of critically ill children with hematological conditions.