Objective To observe the effect of general anesthesia induction with fentanil on parturient undergoing cessrean section and Apgar score of newborn. Methods Forty-two example cesarean section under general anesthesia were induced with fentanil 4μ/kg, propofol 1.5-2.0 mg/kg, atracurium 0.5mg/kg.Observed the change of hemodynamics parameter of parturientand 1 min,5 min Apgar score of newborn. Results Parturient woman blood stream dynamics Was stable. The premature delivery, the low body weight, the polyembryony or the anaesthesia had used the hypnotics group, its newborn 1 min Apgar score was obviously lower than that had not merged above situations(P＜0.01),but the newborn 5 min Apgar score was not significantly different(P＞0.05).Conclusions Fentanil used in cesarean section general anesthesia induction, parturient woman blood stream dynamics is stable, affects not obviously to newborn's Apgar scoure. But regarding the premature delivery, the polyembryony, the low body weight or the pregnant woman used the hypnotics, cegaresn section general anesthesia induction with fentanil should be supposed to use cautiously.

Objective:To compare the preventive effects of dezocine or parecoxib used alone or combination on emergence pain and agitation in the patients undergoing radical hysterectomy. Methods: Sixty ASA Ⅰ~Ⅱ patients undergoing radical hysterectomy were randomly divided into three groups. At the time of sewing incision, the dezocine group (group D, n=20) received dezocine in-travenous injection at the dosage of 0. 1 mg·kg-1, the parecoxib group (group P, n=20) received parecoxib intravenous injection at the dosage of 0.8 mg·kg-1, and the combination group (group DP, n=20) received 0.1 mg·kg-1dezocine and 0.8 mg·kg-1 parecoxib. When the operation was finished, the patients were transferred to the recovery room with endotracheal tubes, and recovered and extubated without the administration of reversal agents. Visual analogue scale ( VAS) for pain and Aono' s four-point scale for e-mergence agitation ( EA) were measured. The recovery time, extubation time, VAS, degree of EA and side effects such as nausea, vomiting, respiratory depression and hypersomnia during the emergence were also evaluated and recorded. Results:There were no sig-nificant differences in recovery time and extubation time among the three groups (P >0. 05). The VAS score and degree of EA in group DP were lower than that in group D (4. 65 ± 1. 69) and group P (5. 95 ± 1. 82) (P<0. 05), and the VAS score in group D was lower than that in group P (P<0. 05). The incidence of moderate and severe pain during the emergence in group DP (20%) was low-er than that in group D and group P (75% and 85%, respectively, P<0. 05), and that was lower in group D when compared with that in group P(P<0. 05). There were no significant differences in the incidence of degree of EA higher than 3 among the three groups (P>0. 05), and no side effects such as nausea, vomiting, respiratory depression and hypersomnia were detected during the emergence. Conclusion:Intravenous injection of 0. 1 mg·kg-1 dezocine combined with 0. 8 mg·kg-1 parecoxib at the time of sewing incision shows effective analgesia and emergence agitation reduction without obvious complications in the patients undergoing radical hysterecto-my.

Objective To study the relationship between the expressions of vascular endothelial growth factor-C (VEGF-C) and vascular endothelial growth factor receptor-2 (KDR) in cervical carcinoma and the formation of cervical cancer and lymph node metastasis.Methods We selected 72 cervical carcinoma tissues,their corresponding adjacent tissues and 36 normal cervical tissues which have been resected in the Maternal and Child Health Care Hospital of Baoji of Shaanxi Province from January 2010 to December 2013.The mRNA and protein expressions of VEGF-C and KDR were examined by semi-quantitative PCR and enzyme linked immunosorbent assay in these tissues.The relationships between the expressions of VEGF-C and KDR and the formation of cervical cancer and lymph node metastasis were analyzed.Results The mRNA levels of VEGF-C in 72 cases of cervical cancer tissues and its corresponding adjacent tissues were 4.67 ± 1.05 and 2.02 ± 0.65,which were significantly higher than those in normal cervical tissues (0.36 ± 0.06),with significant differences (t =2.247,P =0.025;t =1.379,P =0.027).The protein levels of VEGF-C in 72 cases of cervical cancer tissues and their corresponding adjacent tissues were 68.30 ± 17.10 and 48.20 ± 12.70,which were significantly higher than those in normal cervical tissues (18.40 ± 10.70),with significant differences (t =4.357,P =0.016;t =6.337,P =0.012).The mRNA levels of KDR in 72 cases of cervical cancer tissues and their corresponding adjacent tissues were 3.52 ± 0.95 and 1.92 ± 0.87,which were significantly higher than those in normal cervical tissues (0.72 ±0.36),with significant differences (t =3.127,P =0.023;t =1.214,P =0.028).The protein levels of KDR in 72 cases of cervical cancer tissues and their corresponding adjacent tissues were 47.20 ± 15.60 and 38.60 ± 11.30,which were significantly higher than those in normal cervical tissues (16.40 ± 9.40),with significant differences (t =3.667,P =0.020;t =0.986,P =0.032).The expression level of VEGF-C protein in 72 cases of cervical cancer tissues was not correlated with age (x2 =0.54,P =0.17),tissue type (x2 =0.34,P =0.25),depth of invasion (x2 =5.39,P =0.08),pathological grade (x2 =0.78,P =0.11),but was correlated with tumor size (x2 =22.34,P =0.02),clinical stage (x2 =32.14,P =0.01) and lymph node metastasis (x2 =15.58,P =0.03).The expression level of its receptor KDR was correlated with tumor size (x2 =13.78,P =0.04),tissue type (x2 =32.74,P =0.01),pathological grade (x2 =13.72,P =0.04),depth of invasion (x2 =10.27,P =0.04),clinical staging (x2 =20.25,P =0.02) and lymph node metastasis (x2 =19.52,P =0.02),but was not correlated with age (x2 =4.17,P =0.09).Conclusion The expression levels of VEGF-C and KDR are correlated with the growth,invasion and metastasis of cervical cancer,which are good indicators of the lymph node metastasis.

Objective To investigate the safety of autologous blood component transfusion during cesarean section in patients with Rh (D)-negative blood group.Methods Thirty ASA Ⅰ or Ⅱ patients of Rh (D)-negative blood group, aged 20-35 yr, weighing 50-80 kg, undergoing elective cesarean section, were enrolled in this study.After lactated Ringer' s solution 7 ml/kg was infused, blood was obtained from radial artery at a rate of 60-80ml/min, and blood volume was maintained by simultaneous infusion of 6% hydroxyethyl starch 130/0.4 at the same rate. The collected blood was subjected to two cycles of autologous blood component separation. Blood collecting during each cycle was stopped 15 s after red blood cells were separated. The autologous blood was infused when the blood loss≥20% of blood volume. The autologous blood was infused after suture of the uterus when the blood loss < 20% of blood volume. The parameters of maternal vital signs and fetal heart rate were monitored. Hypotension and tachycardia were recorded during autologous blood collecting. SpO2 was monitored routinely. Venous blood samples were taken before blood collecting (baseline), at the end of blood collecting, before autologous blood transfusion, 24 h after operation for determination of Hb, Hct, Plt, PT, APTT, INR and Fib. Umbilical arterial blood samples were obtained after delivery for blood gas analysis. Apgar score was recorded at 1 and 5 min after birth. Blood loss and allogeneic blood transfusion were also recorded. Results No hypotension and tachycardia occurred during the process of blood collecting and the fetal heart rate was within the normal range. Compared with the baseline value, there were no significant differences in SpO2 , Hb, Hct, Plt, PT, APTT, INR and FIB value at the other time points. The pH value and concentrations of base excess and lactate were within the normal range.The Apgar score was (9.0 ±0.8) and (9.2 ± 0.8) at 1 and 5 min after birth respectively. The blood loss during operation was (405 ± 28) ml and no patients received homologous blood transfusion. Conclusion The safety of autologous blood component transfusion is good during cesarean section in Rh (D)-negative blood group patients.

Objective To compare the development of gastric insufflation related to different peak inspiratory pressures (PIPs) during facemask ventilation in the pediatric patients.Methods Ninety male pediatric patients,aged 2-4 yr,of American Society of Anesthesiologists physical status Ⅰ,scheduled for elective surgery under general anesthesia,were randomly divided into 5 groups (n =18 each) using a random number table:PIP 8 cmH2O group (group P8),PIP 10 cmH2O group (group P10),PIP 12 cm H2O group (groupP12),PIP 14cmH2O group (group P14) and PIP 16 cmH2O group (group P16).Anesthesia was induced with fentanil,propofol and rocuronium in sequence.After loss of eyelash reflex,positive pressure facemask ventilation was performed for a 120 s period in pressure-controlled mode.Gastric insufflation was detected by real-time ultrasonography of the antrum,and cross-sectional antral area was measured using ultrasonography before facemask ventilation and at 120 s of facemask ventilation.The pulse oximetry (SpO2),tidal volume (VT),end-tidal pressure of carbon dioxide (PETCO2) and end-tidal oxygen concentration (ETO2) were recorded at 30,60,90,and 120 s of facemask ventilation.The development of gastric insufflation and hypoventilation was recorded.Results Compared with group P8,the incidence of gastric insufflation was significantly increased in group P16 (P＜0.01),and no significant change was found in the incidence of gastric insufflation in the other groups (P＞0.05),the incidence of hypoventilation was significantly decreased,VT and ETO2 were increased,and PET CO2 was decreased in P12,P14 and P16 groups,and PETCO2 was significantly decreased at 120 s of facemask ventilation (P＜ 0.05 or 0.01),and no significant change was found in the other parameters in group P10 (P＞0.05).Compared with P12 and P14 groups,VT was significantly increased,PEHTCO2 was decreased at 120 s of facemask ventilation (P＜0.05),and no significant change was found in the incidence of hypoventilation and ETO2 in group P16 (P＞0.05).There was no significant difference between group P12 and group P14 in the incidence of hypoventilation,VT,PETCO2 and ETO2 (P＞0.05).The pediatric patients showed a certain CO2 accumulation [PETCO2 (40.6±4.0) mmHg] at 120 s of facemask ventilation in group P8,and the pediatric patients showed excessive ventilation [PETCO2 (23.6± 1.4) mmHg],and cross-sectional antral area was not measured using ultrasonography in three cases because of excessive gastric insufflation in group P16.Conclusion PIP at 12-14 mmHg in pressure-controlled ventilation mode can not only ensure adequate preoxygenation and but also avoid excessive gastric insufflation during facemask ventilation in the pediatric patients.

Intraoperative cell salvage ( IOCS) was conducted during cesarean delivery from May 2011 to April 2016 in our hospital: when the volume of autologous blood collected from the surgical field≥800 ml during surgery and the parturients′hemoglobin≤100 g∕L after hemorrhage, the autologous blood was centrifuged, concentrated, washed and then filtered using a leucocyte depletion filter before reinfusion. IOCS was carried out in 1 085 cases during cesarean delivery within 5 yr. For the parturients who underwent IOCS, the percentage of patients who did not require transfusion of allogeneic red blood cells was 82.95%(900 cases), the percentage of patients who required plasma transfusion was 41.66% (452 cases), the percentage of patients who required platelet transfusion was 3.32% (36 cases), and no autologous blood transfusion?related adverse reactions were found during surgery and hospital stay. In conclusion, IOCS could be safely and effectively used for blood?saving effect in cesarean delivery.

Objective To determine the risk factors for autologous blood withdrawal-reinfusion in cesarean section. Methods Parturients who underwent cesarean section and autologous blood withdrawal from August 2012 to June 2015 in our hospital were selected. The preoperative, intraoperative and postop-erative data of the parturients were collected retrospectively from electronic medical records. The parturients were divided into reinfusion group and non-reinfusion group according to whether the parturients received au-tologous blood reinfusion. Logistic regression analysis was used to stratify the risk factors for autologous blood withdrawal-reinfusion in cesarean section. Results A total of 1604 parturients who received autolo-gous blood reinfusion were included in the study, with 757 cases in reinfusion group and 847 cases in non-reinfusion group. Placenta increta∕percreta, placenta previa with previous uterine surgery and complete pla-centa previa were the risk factors for autologous blood withdrawal-reinfusion in cesarean section (P<0. 05). The predictive model was exp( w) ÷ [1 + exp( w)],w = 1. 447 × placenta increta∕percreta ( corrected OR value)+0. 945×complete placenta previa (corrected OR value)+1. 361×placenta previa with previous uter-ine surgery (corrected OR value). The sensitivity and specificity of this model in predicting blood reinfusion were 56％ and 79％, respectively, the positive predictive value was 71％, and the negative predictive val-ue was 67％. Conclusion Placenta increta∕percreta, placenta previa with previous uterine surgery and complete placenta previa are high risk factors for autologous blood withdrawal-reinfusion in cesarean section, and routine preparation for autologous blood withdrawal-reinfusion is recommended.

Objective To investigate the clinical value and method of fetal tricuspid regurgitation in the first trimester.Methods Fetuses were performed ultrasonography at 11 to 14 gestational weeks,measuring crown rump length,nuchal translucency and acquiring tricuspid waveform.All the fetuses were followed up until 6 months after birth,including prenatal ultrasound examination,maternal serum biochemistry and karyotype test.Results A total of 262 fetuses were performed ultrasonography in the first trimester,the tricuspid waveform were acquired successfully in 249 (95%).Nine cases with tricuspid regurgitation were detected,including 3 cases of trisomy 21,3 cases with complex heart defects,one case with omphalocele,two resulted in intrauterine death and one case of normal chromosome and phenotype.Conclusions Tricuspid waveform is relatively easier to examine and assessment.Tricuspid regurgitation is a useful first-trimester ultrasound marker for the detection of chromosomal abnormalities,cardiac defects,and adverse pregnancy outcome.

Objective:To evaluate the effect of oxygen supply via the transnasal self-made pharyngeal oxygen catheter on the safe apnea time in pediatric patients undergoing tonsil surgery. Methods:Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of either sex, aged 2-6 yr, weighing 10-20 kg, scheduled for elective tonsillectomy under general anesthesia, were divided into 2 groups ( n=30 each) using a random number table method: transnasal self-made pharyngeal oxygen catheter for oxygen supply group (group NO) and control group (group C). Anesthesia was induced with intravenous midazolam, propofol, fentanyl and cis-atracurium, and then ventilation was performed with a mask, and the mask was removed when the exhaled oxygen concentration (C ETO 2) reached more than 90%.In group NO, the self-made oxygen catheter was implanted into the oropharynx through the nose, and the 100% oxygen at 10 L/min was aspirated through the humidification bottle until the intubation was successful.In group C, the transnasal self-made oxygen catheter was not implanted, and the rest of the protocol was similar to those previously described in group NO.The visual laryngoscope was implanted to simulate difficult airways.When SpO 2 ≤ 95% or the safe apnoea time reached 600 s, the observation of apnea was stopped, and mechanical ventilation was started after successful rapid endotracheal intubation.The safe apnea time (from removing the mask until SpO 2 decreased to 95%), value of C ETO 2 at the end of mask ventilation, and the minimum value of SpO 2 after stopping mask ventilation were recorded.Heat rate and mean arterial pressure were observed and recorded on admission to the operating room, immediately after onset of apnea and immediately after successful endotracheal intubation.The SpO 2, P ETCO 2 and cross-sectional area of gastric antrum were also recorded immediately after onset of apnea and immediately after successful endotracheal intubation, and the rate of increase in P ETCO 2 was calculated.The nasal bleeding, nasal dryness, postoperative pharyngeal discomfort and other adverse reactions were recorded when the self-made pharyngeal oxygen catheter was placed. Results:Compared with group C, the safe apnea time was significantly prolonged, the rate of increase in P ETCO 2 was decreased, the minimum value of SpO 2 after stopping mask ventilation was increased, and the heat rate, mean arterial pressure, SpO 2 and P ETCO 2 were increased immediately after successful intubation ( P<0.05), no significant change was found in C ETO 2 after stopping mask ventilation and cross-sectional area of gastric antrum at each time point in group NO ( P>0.05). No adverse reactions such as nasal bleeding, nasal dryness and postoperative pharyngeal discomfort were found when the self-made pharyngeal oxygen catheter was inserted in group NO. Conclusions:The oxygen supply with the transnasal self-made pharyngeal oxygen catheter technique can prolong the safe apnea time in the pediatric patients undergoing tonsil surgery.

Objective To determine the diagnostic value of two and three dimensional ultrasound in detecting fetal hand malformations. Methods In the retrospectively analysis,the severe fetal hand malformations detected by prenatal ultrasound during the recent three years in our hospital were classified according to the prenatal sonographic characteristics,family history,karyotype analysis and autopsy results,etc.Results Fourteen fetuses with hand-anomaly were detected during the 16-28th week of gestation,both hands were affected in 10 cases,with the same morphology bilaterally in 8 cases.Thirteen cases had other abnormal sonographic findings.They were detected and classified into three categories,Wrist deformity (9 cases),three fetuses were associated with total absence of radius and radial clubhand,and six fetuses had palmar deviated hands,with various etiologies including familial hereditary arthrogryposis multiplex congenita,distal type 1 (AMCD1),amniotic band syndrome,body stalk anomaly,trisomy18 and micromelia.Hand (figer) hypoplasia or aphasia (3 cases),one hand was absent in one fetus without associated anomaly,absence of five fingers with ipsilateral multicystic dysplastic kidney in the second fetus,and the third fetus had split hand/foot malformation (SHFM).Overlapping fingers (4 cases),three of them were trisomy18,and two fetuses had both wrist deformity and overlapping fingers.Conclusions Prenatal two and three dimensional ultrasound play an important role in detecting and diagnosing severe type of fetal hand malformations.