Objective To analyze the current situations of nosoeomial infection tumor and correlated factors,comlnon pathogens and resistance,to provide reference for reasonable clinical use of antibiotics.Methods The specimens of pathogens cultured from 398 Cases of patients with tumor were retrospectively analyzed.Results The rate of the hospital infection oftumor patients was 12.3%,significantly higher than 5.1%,the average infection rate in the 881ne period.The mest common nosocomial infection was in respiratory system.Of the 57 pathogens,Gˉ accounted for 66.7%;G+ 22.8%,and fungus,10.5%.The main bacteria were pseudomonas aeruginosa,Klebsiellapneumonlae,escherichia coli bacteria.Conclusion After nesocomial infections occurred,pathogens should he routinely checked,drugs,susceptibility tested and antibiotics,rationally used.

Objective To explore the clinical effect of intranasal dexmedetomidine as premedication on sedation and analgesia during painless electronic colonoscopy in children, and to investigate its optimal dose. Methods Ninety children scheduled for painless electronic colonoscopy were divided into three groups by using a computer?generated randomization schedule, 30 per group. Children were pretreated with 0. 2 mg/kg midazolam ( group A) , 1. 0μg/kg dexmedetomidine ( group B) or 2. 0μg/kg dexmedetomidine ( group C) by nasal drip 30 min before operation. The anesthesia protocol was programmed by propofol in the three groups. After eyelash reflex disappeared, the examination was performed. Mean artery blood pressure ( MAP ) , heart rate (HR), respiratory rate (RR) and oxygen saturation (SPO2) of children were recorded at 10 min before intranasal administration ( T0 ) , 30 min after intranasal administration ( T1 ) , at the onset of eyelash reflex disappearance ( T2 ) and the onset of examination initiating( T3 ) , at lens passing through splenic flexure ( T4 ) , or through hepatic flexure ( T5 ) , at the end of examination ( T6 ) and when patients were fully awake ( T7 ) , respectively. Bispectral index ( BIS) and the observer's assessment of alertness/sedation scale ( OAA/S) were performed at 10 min before intranasal administration ( T0 ) , 10 min, 20 min and 30 min after intranasal administration in the three groups. Mood score at parent?children separation and venipuncture acceptance score were also recorded. The adverse reactions during examination were analyzed. The above observed indices were compared among the three groups. If there was statistical difference ( P<0. 05 ) , pairwise comparison was performed ( P<0. 017) . Results The children's haemodynamics were all stable in the three groups. Compared with group A and group B at the same time point, BIS and OAA/S were all lower ( P<0. 017) in 10 to 30 min after intranasal administration in group C. Compared with group A and group B, mood score at parent?children separation and venipuncture acceptance score were both higher ( P<0. 017) in group C. Compared with group A and B, anesthetic revival time and consumption of propofol were shorter or lower in group C (P<0. 017). Compared with group A and group B, the incidences of intraoperative adverse reactions including hypertension, sinus tachycardia, restless moving and postoperative restlessness were all lower in group C(P<0. 017). The rate of intranasal stimulus in group B and group C were both lower than that of group A( P<0. 017) . The rate of injection pain of group C was lower ( P<0. 017 ) than that of group A and B. Conclusion Intranasal administration of dexmedetomidine can be safely applied to children receiving painless electronic colonoscopy, and it can improve children's compliance effectively and yield to satisfactory anesthetic effect. Moreover, the administering efficacy of dexmedetomidine with the dose of 2. 0μg/kg was superior to 1. 0μg/kg.

Objective To explore the effects of dexmedetomidine(DEX) on the changes of patient' s cognitive function after undergoing cardiac valve replacement with cardiopulmonary bypass(CPB).Methods Sixty patients to selectively receive cardiac valve replacement with CPB were randomly divided into two groups:DEX group(n =30) and normal saline group(NS group,n =30).DEX (0.5 μ.g/kg bolus and infusion at a rate of 0.5 μg · kg-1 · h-1) was administered to the patients of DEX group,and the patients of NS group were given with equivalent normal saline at the same time.Aortic clamped time,CPB time,duration of anesthesia and PaO2 at 10 min before CPB were recorded.Heart rate(HR),mean arterial pressure(MAP),jugular venous oxygen saturation(SJvO2) and jugular venous oxygen partial pressure(PJvO2) of anesthesia induction(T0),10 min after induction(T1),CPB re-warmed to 36℃ (T2),and 1 h(T3),6 h(T4),24 h (T5),48 h (T6),72 h (T7) after CPB were performed.MMSE were performed 3 days after surgery,the incidence of POCD was calculated.Results There was no statistical significance in aortic clamped time,duration of CPB,anesthesia time and PaO2 at 10 min before CPB (P ＞ 0.05) between both of groups.Compared to TO,SJvO2 and PJvO2 of NS group from T1 to T2,T4 to T7 and DEX group at T1,T4 to T7 were decreased(P＜0.05,P＜0.01).Compared to NS group,SJvO2 and PJvO2 of DEX group from T2 to T3 were increased(P ＜ 0.01).MMSE evaluation and the incidence of POCD of DEX group were better than those of NS group 3 days af ter surgery(P ＜0.05,P ＜ 0.01).Conclusion Cardiac valve replacement with CPB can lead to cognitive impairment in pa tients,dexmedetomidine can ameliorate cognitive function by decreasing oxygen consumption in brain tissue.

Objective To determine the optimum dose of dexmedetomidine through evaluating the effects of different doses of dexmedetomidine combined with propofol and remifentanil for anesthesia during laparotomy in patients with mild liver dysfunction.Methods Sixty ASA physical status Ⅱ patients of both sexes,aged 18-60 yr,with body mass index 20-26kg/m2,Child-Pugh grade A,undergoing radical resection for stomach or colon cancer,were randomly assigned into 3 groups (n=20 each):propofol and remifentanil group (group Ⅰ),low-dose dexmedetomidine combined with propofol and remifentanil group (group Ⅱ) and high-dose dexmedetomidine combined with propofol and remifentanil group (group Ⅲ).In Ⅱ and Ⅲ groups,dexmedetomidine was infused at a rate of 0.2 μg·kg-1 · h-1 and 0.4 μg·kg 1 · h-1,respectively,until 30 min before the end of surgery after a loading dose of dexmedetomidine 0.4 μg/kg and 0.8 μg/kg,respectively,was infused at 10 min before induction of anesthesia.The patients were mechanically ventilated after tracheal intubation.Anesthesia was maintained with target-controlled infusion of propofol (target plasma concentration 2-4 μg/ml),iv infusion of remifentanil 0.2 μμg·kg-1 · h-1 and intermittent iv boluses of rocuronium 0.15 mg/kg.BIS value was maintained at 40-60.Before dexmedetomidine infusion (T0),at 2 min before intubation (T1),at 1 min after intubation (T2),immediatay after zskin incision (T3),and at 30 min of surgery (T4),arterial blood samples were taken for measurement of concentrations of plasma norepinephrine (NE) and epinephrine (E).The emergence time,adverse cardiovascular events,and the development of nausea and vomiting and restlessness during recovery from anesthesia were recorded.Results Compared with group Ⅰ,the plasma concentration of propofol was significantly decreased,and the incidence of tachycardia and restlessness during recovery from anesthesia were significantly decreased in Ⅱ and Ⅲ groups,and the incidence of bradycardia during operation was significantly increased,and the incidence of hypertension during recovery from anesthesia was significantly decreased,and the emergence time was prolonged in group Ⅲ (P ＜ 0.05).Compared with group Ⅱ,the plasma concentration of propofol was significantly decreased,the incidence of bradycardia during operation was increased,and the emergence time was prolonged in group Ⅲ (P ＜0.05).The plasma NE and E concentrations were significantly higher at T2.3 in group Ⅰ,and were lower at T1-4 in Ⅰ and Ⅲ groups than those at T0 (P ＜ 0.05).Conclusion 0.4 μg/kg injected before induction of anesthesia followed by infusion at 0.2 μg·kg-1 · h-1 is the recommended optimum method for application of dexmedetomidine when combined with propofol and remifentanil for anesthesia during laparotomy in patients with mild liver dysfunction.

Objective To evaluate the effect of dexmedetomidine combined with continuous positive airway pressure (CPAP) on the oxidative stress and inflammatory responses during one-lung ventilation (OLV) in the elderly patients undergoing radical surgery for esophageal carcinoma.Methods One hundred and twenty ASA physical status Ⅱ or Ⅲ patients,aged 65-80 yr,with body mass index 18-25 kg/m2,scheduled for radical surgery for esophageal carcinoma,were randomly divided into 4 groups (n =30 each) using a random number table:control group (group C),dexmedetomidine group (group D),CPAP group (group P) and dexmedetomidine combined with CPAP group (group DP).After induction of anesthesia,the patients were endotracheally intubated and then mechanically ventilated.At the beginning of skin incision,OLV was performed instead.In D and DP groups,a loading dose of dexmedetomidine 0.3 μg/kg was infused starting from 10 min before incision,followed by infusion at a rate of 0.3 μg·kg-1 ·h-1 untill the chest was closed.CPAP 2 cmH2O was used on the non-ventilated side during OLV in P and DP groups.Immediately before incision,at 90 min of OLV,at the end of operation and on 1 day after operation,venous blood samples were obtained for determination of the serum malondialdehyde (MDA),interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) concentrations.The development of complications was recorded at 1 and 7 days after operation.Results Compared with group C,the incidence of hyoxemia during operation and pulmonary atelectasis and infection after operation was significantly decreased in the other three groups,the incidence of hyoxemia and pulmonary atelectasis and infection after operation was decreased,and the serum concentrations of MDA,IL-6 and TNF-α were decreased in group DP (P ＜ 0.05).Compared with D and P groups,the serum concentrations of MDA,IL-6 and TNF-α were significantly decreased,and the incidence of pulmonary atelectasis and infection after operation was decreased in group DP (P ＜ 0.05).The incidence of hyoxemia during operation was significantly lower in group DP than in group D (P ＜ 0.05).Conclusion Dexmedetomidine combined with CPAP can alleviate the oxidative stress and inflammatory responses more effectively and is more helpful in improving prognosis than either alone during OLV in elderly patients.

Objective To study and evaluate the feasibility and clinical effects of the treatment of premature ejaculation with modified Masters-Johnson sensate focus exercise.Methods 100 male outpatients with premature ejaculation were divided randomly into two equal groups randomly.The experiment group was treated with the modified Masters-Johnson sensate focus exercise and oral sertraline 50 mg/day for 8 weeks.The control group was given oral sertraline 50 mg/day for 8 weeks.The scores were evaluated with CIPE-5 and compared between the groups before and after the treatment and after the flown-up for 6 moths.Results After treatment,the score of CIPE-5 were better in experiment group than that in control group (P＜0.01).The effective rate 92％ (46/50) in experiment group was significantly higher than that in control group 68％ (34/50) (P＜0.01).The relapse cases (6 cases) were significantly lower than that in the control group (22 cases) (P＜0.01).Conclusions The method of Masters-Johnson sensate focus exercise for treatment of premature ejaculation has a good curative effect,and low recurrence rate,which is worth the clinical promotion.

Objective To evaluate the efficacy of intermittent ventilation performed in lungs on the operated side for prevention of reexpansion pulmonary edema after pulmonary resection.Methods Forty patients of both sexes,aged 16-32 yr,with body mass index of 18-25 kg/m2,of ASA physical status Ⅰ or Ⅱ,scheduled for elective thoracoscope-assisted pulmonary resection,were randomly divided into 2 groups (n =20 each) using a random number table:control group (group C) and intermittent ventilation performed in lungs on the operated side group (group Ⅴ).After induction of anesthesia,the patients were tracheally intubated and mechanically ventilated.After correct positioning was confirmed by fiberoptic bronchoscopy,one-lung ventilation was performed instead.One-lung ventilation was performed routinely in group C.In group Ⅴ,the lung on the operated side was ventilated intermittently for 30 s with the tidal volume set at 2 ml/kg and respiration rate at 20 bpm,the bronchial tube was then opened,and the process was repeated at 10 min intervals until the diseased tissues were removed.After resection of diseased tissues,the specimens of normal tissues around the area were obtained for determination of the expression of aquaporin 1 (AQP-1) and AQP-5 in lung tissues.The development of pulmonary atelectasis,hyoxemia and reexpansion pulmonary edema was recorded within 24 h after surgery.Results Compared with group C,AQP-1 and AQP-5 expression was significantly up-regulated,the incidence of atelectasis and reexpansion pulmonary edema was decreased within 24 h after surgery,while no significant change was found in the incidence of hyoxemia in group Ⅴ.Conclusion Intermittent ventilation performed in lungs on the operated side can effectively prevent the development of reexpansion pulmonary edema during one-lung ventilation in the patients undergoing pulmonary resection.

Objective To evaluate the effect of creatine phosphate on the myocardial injury induced by lung ischemia-reperfusion (I/R) in rats.Methods Twenty-four male Sprague-Dawley rats,aged 8-10 weeks,weighing 250-350 g,were randomly divided into 3 groups (n =8 each) using a random number table:sham operation group (group S),I/R group,and I/R+creatine phosphate group (group CP).Lung I/R was induced by clamping the left hilum of lung for 0.5 h with a non-invasive microvascular clip followed by mechanical ventilation and 2.0 h of reperfusion.Creatine phosphate 6.6 mg · kg-1 · min-1 were infused intravenously at 30 min before ischemia in group CP,while the equal volume of normal saline was administered in group I/R.At 2.0 h of reperfusion,blood samples were obtained from the right ventricle for determination of the serum concentration of cardiac troponin I (cTnI).Myocardial specimens were obtained from the apex for microscopic examination and for determination of the levels of myocardial superoxide dismutase (SOD),malondialdehyde (MDA),and myeloperoxidase (MPO).Results Compared with group S,the serum cTnI concentrations,MDA content,and MPO activity were significantly increased,and the SOD activity was significantly decreased in I/R and CP groups (P＜0.05).Compared with group I/R,the serum cTnI concentrations,MDA content,and MPO activity were significantly decreased,and the SOD activity was significantly increased in group CP (P＜0.05).Myocardial injury was significantly attenuated in group CP as compared with group I/R.Conclusion Creatine phosphate can attenuate the myocardial injury induced by lung I/R in rats,and the mechanism is related to decrease in damage caused by lipid peroxidation.

Objective To investigate the effect of dexmedetomidine pretreatment on the expression of caspase-12 in lung tissues undergoing one-lung ventilation (OLV) in rats.Methods Thirty male Sprague-Dawley rats, aged 6-8 weeks, weighing 180-220 g, were randomly allocated into 3 groups (n=10 each) using a random number table: two-lung ventilation (TLV) group, OLV group and dexmedetomidine group (Dex group).Bilateral lungs were ventilated for 2 h in group TLV.In OLV and Dex groups, unilateral lung was ventilated for 1.5 h followed by 0.5 h TLV.In group Dex, dexmedetomidine was infused intravenously at a rate of 3.0 μ g · kg-1 · h-1 over 60 min starting from 60 min prior to OLV.The equal volume of normal saline was given instead of dexmedetomidine in OLV and TLV groups.Peak airway pressure (Ppeak) and mean airway pressure (Paw) were recorded at 45 min of OLV and 15 min of TLV in OLV and Dex groups, and at 15 min of TLV in group TLV.The rats were then sacrificed, and left lungs were removed for microscopic examination of the pathologic changes (using HE staining) and the ultrastructure of lung tissues (with transmission electron microscope) and for determination of wet to dry lung weight ratio (W/D ratio), cell apoptosis in lung tissues (by TUNEL), caspase-12 mRNA expression (using real-time reverse transcriptase-polymerase chain reaction), and caspase-12 expression (by Western blot).Results Ppeak and Paw were significantly lower at 15 min of TLV than at 45 min of OLV in OLV and Dex groups (P＜0.05).Compared to group TLV, W/D ratio and AI were significantly increased, and the expression of caspase-12 protein and mRNA was up-regulated in OLV and Dex groups (P＜0.01).Compared to group OLV, W/D ratio and AI were significantly decreased, and the expression of caspase-12 protein and mRNA was down-regulated in group Dex (P ＜ 0.01).The pathologic changes of lung tissues were significantly alleviated in group Dex as compared with group OLV.Conclusion The mechanism by which dexmedetomidine pretreatment alleviates acute lung injury caused by OLV is associated with down-regulated expression of caspase-12 and inhibited cell apoptosis in rats.

This study was carried out to observe the hemodynamic changes in patients with BuddChiari syndrome(BCS) during venoauricular bypass. Twenty-one patients with BCS,ASA grade Ⅱ-Ⅲ, aged 33.4 years on average, were involved. The anesthesia was induced with intravenous midazolam, fentanyl and atracurium. The hemodynamic parameters were measured by Swan-Ganz catheter at various times during whole procedures. As cdmpared with those before anesthesia. CO, CI, SI, LVSWI and RVSWl reduced significantly following general anesthesia(P