OBJECTIVE: To confirm the feasibility of target-controlled infusion of midazolam on conscious sedation for patients undergoing combined spinalepidural anesthesia and the needed target-controlled blood concentration.METHODS: Sixty patients undergoing combined spinal-epidural anesthesia were subjected to target-controlled infusion of midazolam.The level of sedation of midazolam was evaluated applying OAA/S score and bispectral index(BIS).The correlation between target-controlled blood concentration(Cp) and BIS was determined.The Cp,BIS,MAP,HR and SpO2 at different OAA/S were observed. RESULTS: When OAA/S score was 3,the required target-controlled blood concentration of midazolam was(122.8? 20.8) ng? mL-1 in midazolam sedation patients.There was a good correction between BIS and Cp,and BIS=— 3.28Cp+ 355.22(r=— 0.862 5,P

Objective To explore the effect of group psychological training on the mental health and self consistency of nurses from operating rooms.Methods 52 nurses of an operating room were randomized into the treatment group(n=25)and the control group(n=27): The latter received humane care and instructions for mental self care and the former received group psychological training for 8 weeks based on the same treatment as in the control group.Symptom checklist 90(SCL-90)and self consistency and congruence scale(SCCS)were used to assess and compare the difference of the two groups before and after training.Results The intra-and inter-group comparisons between pre-and post-intervention showed statistical differences in terms of the total score by SCL,interpersonal sensitivity,depression and hostility,total score by SCCS and the score on the subscale of inconsistency between themselves and their experience(all P<0.05 or P<0.01).Conclusion Group psychological training can effectively improve the level of mental health and self consistency of OR nurses and thus can improve the total psychological status of the OR nurses.

Objective To explore the effects of pneumoperitioneal on respiratory function and haemodynamic and liver function in laparoscopic hcpatectomy under general anesthesia. Methods changes of pneumoperitioneal on respiratory function and haemodynamic were analyzed retrospectively in 15 LH.Results SBP、DBP、HR were higher significant after C02 insufflation(P＜0.05).SpO2 were lower significant after CO2 insufflation(P＜0.05),there was significant difference between after 30 min after deflation and before CO2 insufflation(P＞0.05);VT were lower significant after CO2 insumation(P＜0.05),there was no significant difference between after 30 min after deflation and before CO2 insufflation (P＞0.05);Ppeak were higher significant after CO2 insufflation(P＜0.05),there was no significant difference between after 30 min afterdefiation anal before CO2 insufflation (P＞0.05). Conclusion there were significant effects of pneumoperitioneal on respiratory function and haemodynamic in laparoscopic hepatectomy under general anesthesia,there weren,t significant effects of liver function.

OBJECTIVE:To observe the clinical effects of interstitial implantation of 125 I particles together with5-FU slow-release particles for advanced pancreatic cancer.METHODS:A total of12patients with advanced pancreatic cancer whose tumors were unsuitable to be resected were implanted with5-FU slow-releasing particles and then 125 I particles.The intensity of radioactive 125 I particles was0.4mCi～0.5mCi,the matched peripheral dose was60Gy～100Gy,and an average of16 125 I particles and1000mg5-FU were used for each patient.RESULTS:Relief of pain was achieved in all the subjects,with the effective rates of odynolysis at91.7%.The tumor size in all the subjects was diminished to some degree,with local control rate at83.3%.1y survival rate was25%.CONCLUSION:Interstitial implantation of 125 I particles and5-FU slow-release particles for advanced pancreatic cancer is simple,safe and effective.

Objective To explore effect of eptazocine hydrobromide combined with sufentanil on postoperative analgesia after trans-urethral resection prostate ( TURP ). Methods One hundred and twenty adult patients undergoing TURP were randomly divided into three groups ( n＝40): eptazocine hydrobromide group ( group E), dezocine combined with sufentanyl group (group DS) and eptazocine hydrobromide combined with sufentanyl group (group ES).All patients received postoperative patient controlled intravenous analgesia (PCIA).The patients in the group E were given eptazocine hydrobromide with dose of 1 mg·kg-1;group DS patients were given with dezocine of 0. 3 mg·kg-1combined with sufentanil 1. 5 μg·kg-1;group ES patients were given eptazocine hydrobromide 0.2 mg·kg-1combined with sufentanil 1.5 μg·kg-1.The VAS scores and Ramsay scores were recorded at 1 h (t1), 4 h (t2),8 h (t3), 12 h (t4), 24 h (t5) and 48 h (t6) postoperatively.Total analgesic consumption of PCIA pump and total need of remedial drugs, the incidences of postoperative dizziness, nausea and vomiting, and other adverse reactions during postoperative 48 h were also documented. Results Compared with group E, VAS scores at each time point postoperatively in group DS and group ES were lower (P<0.05);and total analgesic consumption of PCIA pump and total need of remedial drugs were also lower than group E(P<0.05);the incidence of vertigo, nausea and vomiting, dysphoria, drowsiness in group DS were higher(P<0.05);while only the incidence of nausea and vomiting in group ES was higher than group E (P<0.05).Compared with group DS, no statistical significances of VAS scores were found at each time point postoperatively between group DS and group ES (P>0.05);but total analgesic consumption of PCIA pump and the need of remedial drugs in group ES were lower (P<0.05);patients in group ES with lower incidence of respiratory depression, vertigo, dysphoria and drowsiness ( P< 0. 05 ). No statistical significances were found when comparing the Ramsay scores at each time point postoperatively among three groups (P>0.05). Conclusion Eptazocine hydrobromide combined with sufentanyl can effectively alleviate the postoperative pain in patients with TURP, reduce the consumption of postoperative analgesics and incidence of analgesic related adverse reactions.

Objective To study the antidepressant effect of subanesthestic dose ketamine in anesthesia after cesarean section. Methods One hundred and twenty-six parturients who had underwent cesarean section were divided into ketamine group and control group with 63 cases each, The parturients in control group were given intravenous 0.9%sodium chloride 20 ml after childbirth, and the parturients in ketamine group were given subanesthetic dose ketamine after childbirth (0.5 mg/kg + 20 ml 0.9%sodium chloride). The parturients were evaluated by hospital anxiety and depression scale (HADS) and postpartum depression screening scale (PDSS). Results The scores of HADS and PDSS 5 and 10 d after parturition in ketamine group were significantly lower than those in control group, HADS:(7.67 ± 2.53) scores vs. (10.48 ± 2.48) scores and (7.96 ± 2.61) scores vs. (11.24 ± 2.74) scores, PDSS:(52.58 ± 13.36) scores vs. (71.34 ± 15.19) scores and (53.73 ± 13.28) scores vs. (73.41 ± 15.37) scores, and there were statistical differences (P<0.01). The incidences of depression 5 and 10 d after parturition in ketamine group were significantly lower than those in control group:4.8%(3/63) vs. 15.9%(10/63) and 4.8%(3/63) vs. 17.5% (11/63), and there were statistical differences (P<0.05). There were no serious adverse reactions in the 2 groups. Only 2 cases had mild nausea in control group, and the symptoms disappeared after adjustment. Conclusions The use of subanesthestic dose ketamine can significantly reduce the incidence of postoperative depression in cesarean section, and it has a good antidepressant effect.

Objective To investigate the effect of eptazocine hydrobromide on emergence agitation (EA) of patients undergoing video-assisted thoracoscopic surgery at recovery period. Methods One hundred and twenty patients with ASA I or II,scheduled to undergo video-assisted thoracoscopic surgery vats under general anesthesia, were randomly allocated to three groups(n = 40): eptazocine hydrobromide injection group (group E) , dezocine injection group (group D) and sodium chloride injection group (group NS) . Eptazocine hydrobromide injection 0. 3 mg· kg-1, dezocine injection 0. 1 mg· kg-1 and sodium chloride injectionin equal volume were administrated to group E, group D and group NS, respectively, 15 min before the termination of surgery. The operation time,awakening time,extubation time and postanesthesia care unit (PACU) staying time of all patients were recorded. Riker sedation-agitation scores, MAP and HR were documented at the time of awakening (t0) and 10 min (t1) ,20 min (t2) and 30 min (t3) after awakening,and the incidence of EA was also recorded. Results There were no significant differences in operation time,awakening time, extubation time, PACU staying time among three groups(P>0.05) . Compared with the group NS,the riker sedation-agitation scores and MAP in group E and D at t0– t3 were lower, as well as the incidence of EA. HR of group E was lower at t1– t3,while HR of group D was lower at t2 and t3(P<0.05) . Compared with group D,riker sedation-agitation scores and MAPs in group E were lower at t1 and t2, while HR was lower at t2(P<0.05) . However, there was no difference in incidence of EA between group D and group E (P>0.05) . Conclusion Administration 0.3 mg· kg-1 eptazocine hydrobromide,15 min before the termination of surgery, could effectively reduce the incidence of EA in patients undergoing video-assisted thoracoscopic surgery after general anesthesia. Simultaneously, awakening time, extubation time and PACU staying time could not prolonged.

Objective To investigate the effect of subanesthetic dose of esketamine on remifentanil-in-duced hyperalgesia after cesarean section under general anesthesia,and its effect on serum homocysteine(Hcy)level and postpartum depression.Methods A total of fifty patients undergoing cesarean section under general anesthesia were randomly divided into the esketamine group and the control group(25 cases in each group).The two groups were given esketamine 0.2 mg/kg and the same amount of normal saline by slow in-jection 10 min after fetal delivery.Then,the extubation time,visual analogue scale(VAS)score within two hours after operation,and consumption of morphine while in the post-anaesthesia care unit(PACU)were compared between the two groups.The Edinburgh Postnatal Depression Scale(EPDS)scores were compared at one day before surgery,one day,four days,and one month after surgery.Serum Hcy levels were measured at one day before surgery,one day and four days after surgery.Results There was no significant difference in extubation time between the two groups(P>0.05).Compared with the control group,it took a longer time for patients in the esketamine group to have a VAS score≥4 for the first time,but the time from morphine injection to a VAS score<4 was shortened(P<0.05).The amount of morphine used in the esketamine group was lower than that in the control group in PACU(P<0.05).Compared with the control group,the VAS scores of the esketamine group decreased at 15 min,30 min,45 min,one hour,and 90 min after surgery(P<0.05),while there was no statistical significance difference in VAS scores at two hours after surgery(P<0.05).EPDS scores in the esketamine group were lower than those in the control group at one day and four days after surgery(P>0.05),but there was no statistically significant between the two groups at one month after surgery(P>0.05).Serum Hcy level in the esketamine group was lower than that in the control group at one day and four days after surgery(P<0.05).Conclusion The subanesthetic dose of esketamine during caesarean section under general anesthesia can effectively relieve remifentanil-induced postoperative hy-peralgesia and prevent the occurrence of postpartum depression.

Objective:To investigate the factors affecting the application of systemic glucocorticoids in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with carbon dioxide (CO 2) retention, and to guide the formulation of a strategy to reduce systemic glucocorticoid exposure. Methods:The AECOPD patients with CO 2 retention admitted to the Ningde Municipal Hospital of Fujian Medical University from January 2017 to December 2019 were enrolled. The general information, past history, times of acute exacerbations within 1 year, pneumonia on admission, causes of COPD, heart failure, blood gas analysis, eosinophil count (EOS), albumin (Alb) and apolipoprotein E (ApoE) levels, exhaled nitric oxide (FeNO) level, inhaled glucocorticoid and non-invasive mechanical ventilation treatment at acute exacerbation were collected. The patients were divided into recommended dosage group (exposure levels in the recommended dosage range, cumulative prednisone dosage ≤ 200 mg) and exceeded group (exposure levels exceeded the recommended dose, cumulative prednisone dosage > 200 mg) according to cumulative systemic glucocorticoid exposure dosage of the patients during hospitalization. The clinical data of patients between the two groups were compared, and possible factors with P < 0.1 in univariate analysis were included in multivariate Logistic regression analysis to screen the related factors of systemic glucocorticoid exposure level in AECOPD patients with CO 2 retention. Results:According to the order of hospitalization, 151 AECOPD patients with CO 2 retention were enrolled, 8 patients were excluded, and 143 patients were enrolled in the analysis. Of the 143 patients, 68 received the recommended dose of systemic glucocorticoid, and 75 received excessive systemic glucocorticoid. Age, percentage of forced expiratory volume in 1 second (FEV1%) at stable phase, frequency of acute exacerbation within 1 year, heart failure ratio, oxygen index (PaO 2/FiO 2), arterial partial pressure of carbon dioxide (PaCO 2), serum EOS and ApoE levels at admission, the ratio of aerosolized inhaled glucocorticoids and non-invasive mechanical ventilation showed statistical differences between the two groups. Multivariate Logistic regression analysis showed that related factors affecting systemic glucocorticoid exposure levels of AECOPD patients with CO 2 retention were FEV1% at stable phase [odds ratio ( OR) = 0.957, 95% confidence interval (95% CI) was 0.921-0.994, P = 0.023], acute exacerbation frequency within 1 year ( OR = 1.530, 95% CI was 1.121-2.088, P = 0.007), heart failure ( OR = 3.022, 95% CI was 1.263-7.231, P = 0.013), PaCO 2 ( OR = 1.062, 95% CI was 1.010-1.115, P = 0.018) and EOS at admission ( OR = 0.103, 95% CI was 0.016-0.684, P = 0.019), aerosolized inhaled glucocorticoids ( OR = 0.337, 95% CI was 0.145-0.783, P = 0.011) and non-invasive mechanical ventilation at acute exacerbation ( OR = 0.422, 95% CI was 0.188-0.948, P = 0.037), of which high FEV1% at stable phase, high EOS at admission, aerosolized inhaled glucocorticoid and non-invasive mechanical ventilation at acute exacerbation were protective factors, while high frequency of acute exacerbation within 1 year, heart failure and high PaCO 2 were risk factors. Conclusions:For AECOPD patients with CO 2 retention, high FEV1% at stable phase, high EOS level at admission, aerosolized inhaled glucocorticoid and non-invasive mechanical ventilation at acute exacerbation can reduce systemic glucocorticoid exposure. In addition, high frequency of acute exacerbation within 1 year, heart failure, and high PaCO 2 can increase systemic glucocorticoid exposure.

OBJECTIVETo explore the effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative analgesia of ureteroscopic holmium laser lithotripsy.

METHODSOne hundred and twenty adult patients, American Association of Anesthesiologists (ASA) Class Ⅰ or Ⅱ, scheduled to ureteroscopic holmium laser lithotripsy, were randomly assigned into an observation group and a control group, 60 cases in each one. The patients in the observation group were treated with TEAS for postoperative analgesia. TEAS was implemented at bilateral Shenshu (BL 23) and Yinlingquan (SP 9) at the time of back ward and postoperative 4 h, 8 h, 12 h. TEAS at 7:00, 11:00 and 15:00 at the above acupoints were used on the second and third days; while placebo (twice a day, 100 mg a time) was used. Tramadol hydrochloride tablets for postoperative analgesia were applied in the contnol group, twice a day, 100 mg a time, and electrode sheets without stimulation were put on Shenshu (BL 23) and Yinlingquan (SP 9). When analgesia was insufficient with the score of visual analogue scale (VAS)≥3, the patients were treated with tramadol tablets for remedy analgesia. The VAS score, the concentrations of serotonin (5-HT) and substance P (SP) in 3 mL venous blood at the time of back ward (T), postoperative 4 h (T), 12 h (T), 24 h (T), and 48 h (T) were detected respectively. The total amount of medication for remedy analgesia and the incidence of adverse reactions, such as nausea and vomiting within postoperative 48 h were compared between the two groups.

RESULTSThe VAS scores at T through T were lower than those at T in the two groups (all <0.05). Compared with the control group, the VAS scores at T through T in the observation group were lower (all <0.05). The total dose of remedy analgesic medicine within 48 h after operation in the observation group was lower than that in the control group (<0.05). Compared with the control group, the concentrations of 5-HT at T, T, T and SP at T through T were lower (all <0.05). The numbers of constipation, nausea and vomiting in the observation group were less than those in the control group (both <0.05).

CONCLUSIONTEAS can relieve the pain and reduce the total amount of analgesic medicine, the levels of substance causing pain and the incidence of adverse reactions after ureteroscopic holmium laser lithotripsy.