Objective To explore the effects and indications of physical cooling in fever patients after bone fracture surgery.Methods 450 fever patients after bone fracture surgery were selected.They were divided into different groups according to ~e main influencing factors which affected the effect of physical cooling,including the temperature of sponge bathing,the degree of fever,clinical phases of fever.The influence of above factors on physical cooling was observed.Results The temperature for sponge bathing maintaining at 38～40 ℃(the experimental group) achieved better results than that at 32～34 ℃(the control group).Physical cooling at constant peak period of fever had better effect than that during the fervescence period,and the effect of sponge bathing treatment was better in mild fever patients than in high fever patients.Conclusions The single physical hypothermia only fit the patients following bone fracture surgery who had a fever below 38.5 ℃.Patients who had an infectious high fever should receive drug combination.Temperature of sponge bathing maintaining at 38～40 ℃,bathing timing at constant peak period of fever may get best cooling effect.

Objective: To summarize the clinical experience of cardiopulmonary bypass(CPB) in acute type A aortic dissection received aortic arch reconstruction on age over 70 years patients. Methods: From April 2013 to December 2017, 35 elderly patients aged over 70 who were involved the aortic arch, brachiocephalic trunk, left common carotid artery and left subclavian artery and severe arch lesions, large false lumen and large rupture risk of acute A aortic dissection were reconstructed by triple-branched stent graft in emergency extracorporeal circulation. During the period of cardiopulmonary bypass, selective cerebral perfusion and discontinuous arrest under moderate hypothermia(25 degrees C) were used to reduce the time of cerebral ischemia and hypoxia, and to strengthen the management of the protection of important organs. Results: Cardiopulmonary bypass time was(144.85±32.98)minutes, and aortic cross clap time was(51.82±17.59)minutes, and selective cerebral perfusion time was(12.17±4.70)minutes, discontinuous arrest time was(4.50±3.54) minutes, the lower body arrest time was(16.6±7.49)minutes. All patients were smoothly weaned from cardiopulmonary bypass.35 patients resuscitated within 48 hours, of which 3 patients had transient mental disorders in the early stage and recovered before hospital discharge; 2 patients had cerebral infarction. Hospital mortality in this group was 17.1%(6/35). Conclusion Advanced age is not a contraindication to the reconstruction of the arch of the aortic dissection. Reasonable management of cardiopulmonary bypass can provide an important guarantee for the reconstruction of the elderly patients with acute type A aortic dissection.