Objective To observe the effect of total intravenous anesthesia (TIVA) on intrapulmonary shunt fraction and arterial oxygenation during one-lung ventilation (OLV) for thoracoscope surgery.Methods Forty patients scheduled for thoracoscope surgery were randomly assigned to two groups ( n =20),group of TIVA (A) and group of intravenous anesthesia combined with inhalational anesthesia(B).After inducing and intubating,patients were assigned to maintenance of anesthesia with propofol ( group A)or with sevoflurane ( group B) in order to maintain a BIS between 40 and 60.Mean arterial pressure (MAP),heart rate (HR),SpO2 and Paw were measured in four phases,always in the lateral position,10min after beginning two-lung ventilation (TLV),15 min after beginning OLV (OLV + 15 ),30 rain after beginning OLV ( OLV + 30) and 60 min after beginning OLV ( OLV + 60).Blood samples were drawn simultaneously and analyzed within 5 min.The Qs/Qt at each phase was calculated.Adverse events including hypotension,bradycardia,hypoxemia,delayed emergence and restlessness in recovery period were recorded.Results In all patients,a decrease in PaO2 and an increase in the Qs/Qt occurred during OLV were observed.But PaO2 values in group A were significantly higher than those in group B ( 177 ±88 vs 125 ±63;150 ±65 vs 110 ±67;188 ±69 vs 128 ±52) ( P ＜0.05).The Qs/Qt in group B was significantly higher than those in group A (34.2 ±5 vs 28.8 ±2;38.4 ±8 vs 32.1 ±6;37.1 ±2 vs 29.5 ±2,P ＜0.05).MAP values in group A were significantly lower than those in group B at the phase:OLV + 15 and OLV +30(72 ± 10 vs 88 ± 14;74 ± 12 vs 89 ± 10) ( P ＜ 0.05 ).The incidence of hypotension and delayed emergence in group A was higher than those in group B ( 10 case vs 4 case;9 case vs 2 case).The incidence of restlessness in recovery period in group B was more than those in group A (9 case vs 3 case).The differences between two groups were significant ( P ＜ 0.05).Conclusions Compared with sevoflurane-sufentanyl combined anesthesia,TIVA with propofol can efficiently decrease intrapulmonary shunt fraction and improve arterial oxygenation during OLV for thoracoscope surgery,which is good for the prevention of hypoxemia.

Objective To assess potential suitability of the intercostal artery as a conduit in coronary bypass graft.Methods Collected 36 cases of chinese adult thoracic aorta CTA original cross-sectional images,the images were retrospectively reconstructed under volume rendering technology (VR),multi-planar reconstruction (MPR),curved planar reformation (CPR) and maximum intensity projection(MIP).Observed and measured the data of the 8th,9th and 10th bilateral intercostal arteries and internal thoracic arteries.Results Toshiba 320-slice volume scanning CT can clearly display the intercostal arteries.The average length and diameter at corresponding point of the left and right 8-10th intercostal artery is similar,all the length is longer than 180 mm,and the diameter at axillary line is all bigger than 2.1 mm,the mean length of right intercostal arteries is slightly longer than the left intercostal arteries,the diameter at each corresponding point of left and right intercostal artery is similar,and equivalent to approximately 85％-90％ of internal thoracic artery.Conclusion Intercostal artery can be used as an ideal alternative vessel in coronary artery bypass grafting.

Objective To observe the effect of one-lung ventilation (OLV) on cerebral oxygen balance and energy metabolism during total intravenous anesthesia for thoracoscopic surgery.Methods Thirty patients scheduled for thoracoscopic surgery were selected.After inducing and intubating,patients were assigned to maintenance of anesthesia with propofol by target controlled infusion in order to maintain a bispectral index(BIS) between 40 and 60,and end-tidal partial pressure of carbon dioxide (PETCO2) between 30mmHg and 35mmHg.Mean arterial pressure (MAP),heart rate (HR),SpO2,PetCO2,cerebral blood flow velocity (CBFv),BIS value and nasopharyngeal temperature(NPT) were measured,always with the patients in the lateral position,in four phases:10min after beginning twolung ventilation (TLV),15 min after beginning OLV (OLV + 15),30min after beginning OLV (OLV + 30) and 60 min after beginning OLV(OLV + 60).Blood samples were drawn simultaneously and analyzed within 5min.The Da-jvO2,CERO2,CMRO2,Da-jvLac and Da-jvGlu at each phase were calculated.Results In all patients,a decrease in PaO2 [(172±85) vs (428±42);(162±54) vs (428±42);(185±61) vs (428±42)] and MAP [(70±10) vs (81 ±11) ; (71 ± 12) vs (81 ± 11)] occurred during OLV (t =15.02,13.14,23.25,20.16,18.02,all P ＜ 0.05).SjvO2 at the phase:OLV + 15 and OLV + 30 were significantly lower than those at TLV [(54.0 ± 1.2) ％ vs (65.0 ± 0.8) ％ ;(55.0±1.5)％ vs (65.0 ±0.8)％] (t =3.12,2.14,all P＜0.05).Ca-jvO2[(50 ± 12)％ vs(40 ± 12)％ ;(54±11)％ vs (40 ± 12)％],CMRO2 [(186 ±40) vs (162 ± 35);(191 ±24) vs (162 ±35)]and CERO2 [(36 ± 12) vs (30 ± 1 1) ; (35 ± 10) vs (30 ± 11)] atthephase:OLV + 15 andOLV + 30weresignificantlyhigher than those at TLV (t =5.23,4.28,1.86,2.01,8.21,10.11,all P ＜ 0.05).After OLV,Da-jvGlu [(0.45 ± 0.10) vs (0.22 ± 0.30) ; (0.52 ± 0.20) vs (0.22 ± 0.30) ; (0.40 ± 0.20) vs (0.22 ± 0.30)] significantly increased (t =6.45,12.03,15.10,all P ＜ 0.05).The differences of Da-jvLac and CBFv at every phase were not significant (P ＞0.05).Conclusion During total intravenous anesthesia,OLV resulted in an increase of consumption of cerebral oxygen and energy.It may be not good for cerebral oxygen balance and energy metabolism.The efficient prevention is necessary clinically.

Objective To investigate the effects of subglottic secretion drainage at different intervals on ventilator- associated pneumonia(VAP). Methods A total of 150 patients receiving tracheostomy during January 2015 to December 2016 were divided into A, B, C group according to the order of intubation time. The subglottic secretion drainage was attracted at intervals of 2, 4, and 6 h respectively.The differences in balloon secretion on occult blood test(after intubation,intubation time,3 d, 5 d,7 d), the content of airborne bacteria in the air sac, the number of VAP and the time of VAP occurrence between the 3 groups were analyzed. Results The 3 groups that group A had 78 positive cases,group B had 46 cases and group C had 38 cases had statistical significance differences compared with balloon retentate occult blood test(χ2=28.23,P=0.00);there were statistical significance differences between the 3 groups of bacteria (Z=11.91, P =0.00 ), there were statistically significant differences between group A and group C (Z=-3.01, P=0.00), between group B and group C (Z=-2.19, P=0.01). There were statistical significance differences between the 3 groups of the number of VAP cases(χ2=7.50, P =0.00) that there were 12 cases happening in group A, 13 cases in group B and 23 cases in group C. There were statistical significance differences between group A and group C(χ2=5.32,P=0.02),between group B and group C (χ2=4.34, P =0.04). The occurrence time of VAP which was (169.25 ± 20.80) h in group A,(168.35±18.04)h in group B and(129.47±18.13)h in group C,there was significantly different between the 3 groups(F=2 788.19,P=0.00),the differences between group A and group C(t=3.19,P=0.00),group B and group C(t=68.40,P=0.00)were statistically significant. Conclusions The subglottic secretion drainage at intervals of 4 hours will not only reduce the damage to the airway mucosa,but also reduce the incidence of airway bacteria and the incidence of VAP and delay the occurrence of late VAP.

Objective To compare the effects of propofol and midazolam on the prognosis of patients treated with noninvasive positive pressure ventilation.Methods A prospective,single-blind,randomized controlled trial (RCT) was conducted in 90 patients who were treated with noninvasive ventilation for acute dyspnea in the ICU of the Sixth People's Hospital Affiliated to Shanghai Jiaotong University from October 2014 to December 2016.They were randomly divided into three groups according to the digital table,with 30 cases in each group.The control group was not given sedation treatment.The propofol group was given propofol 0.5 ～ 1 mg/kg,and then administered by intravenous infusion of 1 mg · kg-1 · h-1 with a micropump.The midazolam group was given midazolam 0.05-O.1 mg/kg,and then with intravenous infusion of 0.05-0.1 mg · kg-1 · h-1 maintaining the patients'sedation goals(Ramsay score of 2).The vital signs and blood gas analysis indicators were recorded.The incidence of tracheal intubation,the incidence of hospital infection,length of ICU and hospital stay,mortality and sedation-related complications were compared.Results The tracheal intubation rate in the propofol group was similar to that in the midazolam group (20.0％ vs.23.3％,x2 =2.65,P ＞ 0.05),while the tracheal intubation rate (46.7％) in the control group was significantly higher (x2 =4.21,4.17,all P ＜ 0.05).The length of ICU and hospital stay in the pmpofol group [(7 ± 3)d and (15 ± 5) d] and midazolam treatment group[(8 ± 4) d and (16 ± 4) d] were significantly shorter than those in the control group[(13 ± 4) d and (20 ± 6) d] (t =2.384,2.371,2.392,2.389,all P ＜ 0.05).The mortality rates of 30d (20.0％,6/30) and 90d (30.0％,9/30) in the control group were higher than those in the propofol group(10.0％,3/30;20.0％,6/30),and the midazolam group (13.3％,4/30;23.3％,7/30),but the differences were not statistically significant(P ＞ 0.05).The incidence rates of hospital infection in the pmpofol group and midazolam group were 6.6％ (2 cases) and 10.0％ (3 cases),which were significantly lower than 33.3％ (10 cases) in the control group (x2 =4.32,4.23,all P ＜ 0.05).Conclusion The use of mild sedation in patients of acute dyspnea treated with noninvasive positive pressure ventilation can improve the patients' tolerance rate,reduce the rate of tracheal intubation and the incidence of hospital infection,and decrease the length of ICU and hospital stay,without significant adverse reactions.There was no significant difference between propofol and midazolam.

Objective: To investigate the effect of early intervention on the prevention of delirium in patients undergoing elective surgery. Methods: Totally 200 patients scheduled for surgery and admitted to ICU during Oct. 2016 to Jun. 2018 were assigned to two groups (n=100). Both the observation group (group A) and the control group (group B) received routine nursing care from wards, operating room and ICU nurses. In addition, the observation group (group A) were intervened by ICU nurses by means of nursing measures to prevent delirium the day before surgery. The differences of delirium incidence, delirium duration, and length of stay in ICU, satisfaction and anxiety scores between the two groups were measured. Results: The incidence and duration of delirium, length of stay in ICU, satisfaction rate of ICU, S-AI scores between group A and B were 16% (16/100) vs. 29% (29/100), 4(3.1, 10.6) h vs. 12(9.2, 14.6) h, (33.06 ±16.06) h vs. (39.96±25.47) h and (56.25 ±5.74) vs. (41.59 ±4.94), (50.17±1.56) vs.(52.37±3.52) respectively (χ²=4.129, Z=-2.757, t=2.291,-19.349, 5.718, all P < 0.05). Conclusion Early intervention can effectively prevent and reduce the incidence of ICU delirium in patients undergoing elective surgery.