Objective To evaluate the efficacy of thoracic paravertebral block for preemptive analgesia in the patients undergoing minimally invasive direct coronary artery bypass grafting (MIDCAB).Methods Sixty patients of both sexes,aged 54-75 yr,weighing 55-82 kg,of American Society of Anesthesiologists physical Ⅱ or Ⅲ,with New York Heart Association Ⅰ-Ⅲ,scheduled for elective MIDCAB,were randomly divided into 2 groups (n =30 each) by using a random number table:control group (group C) and thoracic paravertebral block group (group P).Thoracic paravertebral block was performed under the guidance of a nerve stimulator in group P.A paravertebral catheter was placed at T4,5 interspace,a test dose of 0.5％ ropivacacine 5 ml was injected through the catheter,and 5 min later a bolus dose of 0.5％ ropivacacine 15 ml was injected.Anesthesia was induced with intravenous etomidate,midazolam,fentanyl and vecuronium.All the patients were intubated with a double-lumen endobronchial tube and mechanically ventilated,and end-tidal pressure of carbon dioxide was maintained at 30-40 mmHg.Anesthesia was maintained with intravenous injection of fentanyl and vecuronium,intravenous infusion of propofol,and inhalation of sevoflurane.Bispectral index value was maintained at 40-60.When systolic blood pressure ＞ 160 mmHg,fentanyl 0.1 mg was injected intravenously.Both groups started to receive patient-controlled intravenous analgesia (PCIA) after extubation until 48 h after operation.PCIA solution contained morphine in 100 ml of normal saline.The PCIA pump was set up with a 2 mg bolus dose,a 10 min lockout interval and background infusion at a rate of 0.5 mg/h.Visual analogue scale was maintained ≤ 4.When visual analogue scale＞4,morphine 4 mg was injected intravenously as rescue analgesic.The consumption of intraoperative fentanyl was recorded.The consumption of morphine and requirement for rescue analgesics were recorded within 24 and 48 h after operation.The adverse reactions such as somnolence,nausea and vomiting,respiratory depression,pruritus,and atelectasis were recorded within 48 h after operation.The extubation time after operation,length of time in intensive care unit,and recovery time after operation were recorded.At 24 and 48 h after operation,pulmonary function was detected,the forced vital capacity (FVC) expressed as a percentage of the predicted value (FVC％),and forced expiratory volume in 1 second (FEV1)expressed as a percentage of the predicted value (FEV1 ％) were recorded,and the ratio of FEV1/FVC was calculated.Blood gas analysis was performed,and arterial oxygen partial pressure and partial pressure of arterial carbon dioxide were recorded at 24 and 48 h after operation.Results Compared with group C,the intraoperative consumption of fentanyl and consumption of morphine within 24 and 48 h after operation were significantly reduced,the extubation time and length of time in intensive care unit were shortened,FVC％ and FEV1％ were increased at 24 and 48 h after operation,the partial pressure of arterial carbon dioxide and incidence of somnolence were decreased (P＜0.05),and no significant change was found in the FEV1 / FVC,arterial oxygen partial pressure,requirement for rescue analgesics and recovery time after operation in group P (P＞0.05).Conclusion Thoracic paravertebral block analgesia can provide good preempive analgesia in the patients undergoing MIDCAB.

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Objective:To compare the efficacy of different concentrations of ropivacaine for interscalene brachial plexus block in patients undergoing arthroscopic shoulder surgery under general anesthesia.Methods:Ninety American Society of Anesthesiologists physical statusⅠor Ⅱ patients (NYHA classⅠorⅡ) of both sexes, aged 18-64 yr, with body mass index of 18.0-26.9 kg/m 2, undergoing elective arthroscopic shoulder surgery were selected, and were divided into 3 groups ( n=30 each) using a random number table method: 0.25% ropivacaine group (group A), 0.375% ropivacaine group (group B) and 0.5% ropivacaine group (group C). Interscalene brachial plexus block was performed with 0.25%, 0.375% and 0.5% ropivacaine 20 ml in A, B and C groups, respectively.Before operation (T 0) and at 30 min (T 1), 4 h (T 2), 6 h (T 3), 8 h (T 4), 10 h (T 5) and 12 h (T 6) after administration, the diaphragmatic mobility was measured and recorded using M-mode ultrasound and forced expiratory volume in the first second (FEV 1) and forced vital capacity (FVC) were measured using portable spirometer.The occurrence of phrenic paralysis was recorded at T 1-6.The duration of sensory and motor block was recorded.When visual analogue scale score>3 within 24 h after operation, flurbiprofen axetil 50 mg was injected intravenously for analgesia and the consumption was recorded.The adverse reactions such as cardiovascular events, local anesthetic intoxication, Horner syndrome, pneumothorax, and nausea and vomiting within 24 h after administration were recorded. Results:Compared with group A, the diaphragmatic mobility was significantly decreased during quiet breathing at T 1-3 and was decreased during deep breathing at T 2-5, and the diaphragmatic paralysis rate was increased during quiet and deep breathing at T 2-3 in group B, diaphragmatic mobility was decreased during quiet and deep breathing at T 1-6, diaphragmatic paralysis rate was increased during quiet and deep breathing at T 1-4, FEV 1% and FVC% were decreased at T 1 and FVC% was decreased at T 2 in group C, and the duration of sensory and motor block was prolonged in B and C groups ( P<0.05 or 0.01). Compared with group B, the diaphragmatic mobility was significantly decreased during quiet breathing at T 4-6 and was decreased during deep breathing at T 1-6, the diaphragmatic paralysis rate during quiet breathing was increased at T 2-4 ( P<0.05) was increased during deep breathing at T 3-4, and FEV 1 % and FVC % at T 1 were decreased in group C ( P<0.05). There was no significant difference in the postoperative requirement for flurbiprofen axetil and the incidence of adverse reactions within 24 h after administration among the 3 groups ( P>0.05). Conclusion:0.25% ropivacaine 20ml provides better efficacy when used for interscalene brachial plexus block in the patients undergoing arthroscopic shoulder surgery.

Objective To evaluate the effects of sevoflurane postconditioning on myocardial oxidative stress in the patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Fifty ASA physical status Ⅱ or Ⅲ patients (NYHA Ⅱ or Ⅲ) of both sexes,aged 36-59 yr,weighing 42-71 kg,with rheumatic heart disease undergoing cardiac valve replacement under CPB,were randomly divided into control group (group C,n =25) and sevoflurane postconditioning group (group S,n =25).In group S,4 ％ sevoflurane was infused for 10 min via the extracorporeal circulation machines starting from the time point immediately after aortic unclamping.Before aortic clamping and at 15 min,30 min,6 h,and 24 h after aortic unclamping (T1-5),blood samples were collected from the central vein for determination of the levels of cardiac troponin I (cTnI) in plasma.Myocardial specimens were taken from the left auricle before CPB and after termination of CPB for determination of malondialdehyde (MDA) content and superoxide dismutase (SOD) activity.The restoration of spontaneous heart beat,reperfusion arrhythmia scores,and requirement for vasoactive drugs were recorded.Results Compared with group C,MDA content was significantly decreased,and SOD activity was increased after termination of CPB,the plasma cTnI concentration was decreased at T2-5,the rate of restoration of spontaneous heart beat was increased,reperfusion arrhythmia scores were decreased,and the requirement for dopamine and nitroglycerin was reduced in group S.Conclusion Sevoflurane postconditioning provides myocardial protection by reducing myocardial oxidative stress injury in the patients undergoing cardiac valve replacement with CPB.

ObjectiveTo investigate the feasibility of applying electronic nose technology to rapidly identify Bletillae Rhizoma and its approximate decoction pieces. MethodA total of 134 batches of Bletillae Rhizoma and its approximate decoction pieces， including 45 batches of Bletillae Rhizoma， 30 batches of Gastrodiae Rhizoma， 30 batches of Polygonati Odorati Rhizoma and 29 batches of Bletillae Ochraceae Rhizoma， were collected as test samples. The olfactory sensory data of the samples were collected by PEN3 electronic nose as the independent variable（X）. Based on the identification results of the 2020 edition of Chinese Pharmacopoeia and local standards， as well as the high performance liquid chromatography（HPLC） fingerprint and original purchase information of 134 batches of the decoction pieces， the benchmark data Y of the identification model were obtained， and four chemometric methods of principal component analysis-discriminant analysis（PCA-DA）， partial least squares-discriminant analysis（PLS-DA）， least square-support vector machine（LS-SVM） and K-nearest neighbor（KNN） were used to establish the binary identification model for 45 batches of Bletillae Rhizoma and 89 batches of non-Bletillae Rhizoma and the quadratic identification model of the four kinds of decoction pieces， that is， Y=F（X）. ResultAfter leave-one-out cross validation， the positive discrimination rates of the above four models were 97.01%， 97.01%， 98.51% and 97.01% in the binary identification， and 97.76%， 89.55%， 98.51% and 97.01% in the quadratic identification， respectively. The highest positive discrimination rate could reach 98.51% for the binary and quadratic identification models， and LS-SVM algorithm is both the optimal one， the most suitable kernel functions were chosen as radial basis function and linear kernel function， respectively. The optimal models discriminated well with no unclassified samples. ConclusionElectronic nose technology can accurately and rapidly identify Bletillae Rhizoma and its approximate decoction pieces， which can provide new ideas and methods for rapid quality evaluation of other decoction pieces.

In order to standardize the quality control of traditional Chinese medicine（TCM） dispensing granules， the Chinese Pharmacopoeia Commission has promulgated and implemented 200 national drug standards for TCM dispensing granules， but there are still varieties of TCM dispensing granules without unified standards. Many provinces have actively invested in the formulation of provincial standards for TCM dispensing granules to make up for the gaps in standards for varieties of traditional Chinese medicine dispensing granules other than the national standards. By the end of July 2022， 29 provincial-level administrative regions have successively promulgated and implemented a total of 5 602 provincial standards for TCM dispensing granules， involving more than 400 varieties. In order to better understand the formulation and characteristics of provincial standards， this study took 105 provincial standards that have been promulgated and implemented in Henan province as an example， and comprehensively analyzed the formulation and characteristics through quality control indicators such as dry extract rate of raw materials， contents of index components and their transfer rates， specifications and so on. The formulation and characteristics of the same TCM dispensing granules in the provincial standards of different provinces were further analyzed， in order to provide reference for the formulation of provincial standards of TCM dispensing granules and the implementation of national standards.