Objective To identify the influence of early postoperative delirium on long-term morbidity ,mortality and quality of life(QoL) .Methods 261 patients admitting to SICU after noncardiac surgery were prospectively included .The clinical data were collected .Delirium was diagnosed clinically by Confusion Assessment Method-Intensive Care Unit(CAM-ICU) .The patients were followed 2 years after the surgery and the quality of life was assessed by three scales .Results The incidence of early PD was 21 .8% .Multivariate logistic regression analysis showed that increasing age ,shorter educational time ,preoperative diabetes melli-tus ,high ASA grades and high APACHE II score on SICU admission were the independent predictors for early PD .The cumulative survival in 24 months was 66 .5% in patients without delirium and 57 .3% in patients with delirium ,there was no statistical differ-ence between two groups(P=0 .187) .Multivariable Cox model showed that male patients ,tumor stage ≥3 and high ASA grades were the independent predictors for postoperative death .The long-term QoL in delirious patients were significant poorer than that in non-delirious patients in mainly four domains :physical function ,role-physical ,social function and cognitive function .Conclusion Early postoperative delirium significantly deteriorate the long-term quality of life in severe patient after noncardiac surgery in mainly four domains :physical function ,role-physical ,social function and cognitive function .

OBJECTIVE To evaluate the clinical efficacy and safety of extending the administration time of meropenem in the treatment of moderate and severe bacterial infections in surgical intensive care uint(SICU) patients.METHODS Fifty patients with moderate and severe bacterial infections admitted to SICU were randomized to two groups: meropenem 30 min infusion group(n=25) and meropenem 3 h infusion group(n=25),the clinical efficacy and side-effects were observed between two groups.RESULTS Twenty-five patients were enrolled in meropenem 30 min infusion group with an effective rate of 48%,bacterial clearance rate of 26.9%.On the other hand,twenty-five patients were enrolled in meropenem 3 h infusion group with an effective rate of 60%,bacterial clearance rate of 43.5%.There were no significant differences between two groups(P=0.375,P=0.224,separately).CONCLUSIONS There are no significant differences between two groups on effective rate and bacterial clearance rate.

Objective To investigate the relationship between preoperative albumin level and postoperative acute kidney injury(AKI)following off-pump coronary artery bypass(OPCAB)surgery;to confirm albumin cut-off value associated with AKI. Method This was a retrospective cohort study. data from patients who accepted OPCAB surgery in last two years in our hospital and AKI was diagnosed according to KIDGO-AKI criteria. Results Generalized additive model and multivariable logistic regression analysis have shown that the higher preoperative albumin level is related with the lower the incidence of AKI after OPCAB surgery. By generalized additive model,multivariable logistic regression analysis and ROC curve,we confirmed the albumin cut-off value associated with AKI between 39~40 g/L. Conclusion For patients undergoing OPCAB surgery,the higher preoperative albumin level ,the lower the incidence of AKI. In order to reduce the incidence of AKI in OPCAB surgery patients,preoperative albumin level higher than 40 g/L should be maintained.

ObjectiveTo determine the median effective dose (ED50) of intrathecal (IT) hyperbaric and hypobaric ropivacaine for elective cesarean section.MethodsForty parturients aged 20-40 yr at full term undergoing elective cesarean section under combined spinal-epidural anesthesia were randomized to receive IT 0.5 ％ hyperbaric (group HR) and hypobaric ropivacaine (group LR) ( n =20 each).The initial dose was 9 mg and the dose was increased/decreased by 1 mg in the next parturient using an up-and-down sequential allocation technique.Analgesia was considered acceptable if adequate analgesia reached T7 or higher in response to pin prick until 20 min after IT ropivacaine and no supplemental epidural analgesic was required during the operation.ED50 and 95％confidence interval (CI) were calculated.ResultsThe ED50 and 95 ％ CI were 9.34 mg (95 ％ CI 8.34-10.46mg) for 0.5％ hyperbaric ropivacaine and 9.64 mg (95％ CI 8.90-10.44 mg) for 0.5％ hypobaric ropivacaine.ConclusionBaricity has no effect on the efficacy of IT ropivacaine for cesarean section.

Objective To analyze the diagnosis and treatment of cervical spinal cord injury without fracture or dislocation.Methods 38 patients were analyzed retrospectively.Results and Conclusion According to the manifestation of MRI and the symptoms,6 cases accepted conservation treatment,and the other 32 cases accepted surgery with different styles.All the patients recovered in some degrees.

Objective To explore the diagnosis and treatment of supinator syndrome.Methods 11 patients with supinator syndrome definitely diagnosed were treated with conservation treatment, 4 ineffective cases with conservation treatment were treated with operation. The following-up was performed for 6～12 months to evaluate the therapeutic effect.Results Among the total 7 patients received conservation treatment, 5 cases recovered completely, the other 2 cases recovered partially; among the total 4 patients who received operations, 3 cases recovered completely, and the other one recovered partially.Conclusion At present, supinator syndrome can be diagnosed definitely according to the clinical symptom, and the examination with electromyogram is beneficial to diagnose this disease, but it has not specificity. Most patients of supinator syndrome often get satisfactory effects after conservation treatment, and the ones who are failed can get the improvement from surgical treatment timely.

Objective:To observe the effects of 0.4 μg/(kg·h)dose of dexmedetomidine on intra-operative wake-up test in children patients undergoing scoliosis surgery.Methods:Sixty patients for pos-terior scoliosis correction (ASA Ⅰ -Ⅱ,aged 5 -16 years)from March 2013 to April 2015 were en-rolled in this prospective,double-blinded,randomized,placebo-controlled study,The patients were ran-domly classified into two groups to receive dexmedetomidine (group RD,n =30)or saline solution (group R,n =30).In group RD,dexmedetomidine [0.4 μg/(kg·h)]was administered after tracheal intubation,while the equal volume saline solution was given instead in group R.Anesthesia was induced with midazolam,propofol,sufentanyl and cisatracurium,and anesthesia was maintained with sevoflurane inhalation and a continuous intravenous infusion of remifentanil in the both groups.BIS(bispectral index, BIS)value was maintained at 40 -60,and mean arterial pressure (MAP)was maintained at ≥ 60 mm-Hg before the wake-up test.When the wake-up test was performed,immediately the dexmedetomidine and remifentanil infusion were stopped,and the end-tidal concentration of sevoflurane was adjusted to 0. Mean arterial pressure,and heart rate (HR)were recorded before anesthesia and at 5-minute intervals during the wake-up test.The wake-up test time,arousal quality and sedation scores were recorded also. In addition,the data were also gathered on the dosage of ephedrine and atropine were used,as well as the intraoperative awareness in the patients who were followed up on the first day after the operation.Re-sults:There were no differences between group RD and group R with regard to HR and MAP at getting into the operation room (t =-1.460,P =0.150; t =-1.015,P =0.315 ).In group RD,no evi-dence was found for a difference in HR and MAP at awakening up versus at getting into the operation room (t =0.974,P =0.340;t =-1.449,P =0.161),while in group R,an increase in HR and MAP occurred at awakening versus at getting into the operation room (t =-2.106,P =0.044;t =-2.352, P =0.026).There were no significant differences in sedation scores and wake-up test time between the two groups(t =1.986,P =0.052;t =0.392,P =0.697).The wake-up test quality was significantly bet-ter in group RD than in group R (t =-2.098,P =0.041).HR in group RD was significantly lower than that in group R at any time point during the wake-up test (P <0.05).Four patients had awareness oc-currence during the operation in group R,and no awareness occurrence in group RD.Conclusion:Dexmedetomidine,when administered at a rate of 0.4 μg/(kg·h)as an adjuvant of sevoflurane inhala-tional anesthesia,could improve the wake-up test quality,and maintain hemodynamic stability during scoliosis surgery.

Audiology ; methods ; Hearing Tests ; methods ; Humans ; Time Factors

Objective To investigate the relationship of apolipoprotein E ?4 allele to early cognitive dysfunction after cardiac surgery and to identify the predictors of cognitive decline after cardiac operation. Methods Two hundred and thirty patients aged over 18 yr undergoing coronary artery bypass grafting (CABG) were studied. They were capable of completing the preoperative cognitive function tests in terms of the education they had received. Patients with neurological or mental disease and those with serious hepato-renal or cardiac dysfunction were excluded. Cognitive function was evaluated using a battery of nine neuro-psychologieal tests before operation, at one week and 3 months after operation. Cognitive decline was defined as ≥20% decrement in 20% or more of the completed tests. The changes in the Z-based scores were used to evaluate the severity of cognitive decline. Logistic regression and multiple linear regression were used to determine the relationship of ApoE genotype to cognitive decline and identify the predictors of postoperative cognitive decline ( POCD) after cardiac operation. Results The incidence of cognitive decline was as high as 51.9 % and 21.0% at 1 week and 3 months after operation respectively. The ?4 allele was present in 7.4 % , ?3 allele in 86.1 % and ?2 allele in 6.5 % of the 230 patients. The cognitive decline was not significantly associated with the presence or absence of the ?4 allele. The ?4 allele was associated with poor baseline performance. Age, the use of cardiopulmonary bypass (CPB), duration of endotracheal intubation were predictors of cognitive impairment after cardiac operation. There was positive correlation between the neuro-psychological test scores at 1 week and 3 months after operation. Conclusion The results suggest that age, the use of CPB and duration of endotracheal intubation are the predictors of POCD. The ?4 allele is not associated with POCD after cardiac operation. The cognitive dysfunction at 3 months after operation is positively correlated with the level of cognitive decline at 1 week after operation.

Objective To compare the degree of inflammatory response and changes in pulmonary function in patients undergoing coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass (CPB) Methods Elective CABG was performed in twenty-two patients with CPB (n = 11) or off-pump (n = 11). The patients were premedicated with oral midazolam 7.5 mg and intramuscular morphine 10 mg. Anesthesia was induced with fentanyl 5-10 ?g?kg-1 , midazolam 0.05 mg?kg-1 , etomidate 0.15 mg?kg-1 and rocuronium 0.6 mg?kg-1 and maintained with intermittent i.v. boluses of fentanyl and rocuronium. All patients had pulmonary artery catheter and arterial line placed. ECG, SpO2, PET CO2 , body temperature and urine output were monitored. In CPB group aprotinin was given. The patients were transferred to ICU after operation and mechanically ventilated. Extubation was performed when standard extubation criteria were met. The length of ICU stay and hospitalization were recorded. CI, PVRI, SVRI, PA-aO2 , PaO2/FiO2 and QS/QT were measured and calculated before and at the end of operation and 4, 12, 24, 36 h after operation. Blood samples were taken from radial artery and pulmonary artery (mixed venous blood) before and at the end of operation and 4, 12, 36 h after operation for determination of plasma levels of IL-6, IL-8 and neutrophil elastance, the numbers of WBC and neutrophil, the numbers of WBC and neutrophil segregated in the lungs (the number of WBC/neutrophil in mixed venous blood - the number of WBC/neutrophil in arterial blood) .Results The two groups were comparable with respect to age, sex, duration of anesthesia and surgery and the number of grafts. CI was significantly increased while SVRI significantly decreased after operation as compared to the baseline values before operation. There was no significant difference in CI and SVRI after operation between the two groups. The postoperative PVRI and PA-a O2 were significantly lower while postoperative PaO2/FiO2 was significantly higher in the off-pump group than in the CPB group ( P