Objective To evaluate the effect of CPB with or without cardioplegia on hemodynamics and myocardial function. Methods Thirty NYHA class III patients undergoing mitral valve replacement were randomly divided into three groups of ten each: group Ⅰ received no blood cardioplegia; group Ⅱ received tepid blood cardioplegia solution and group Ⅲ received cold blood cardioplegia solution. The patients were premedicated with pethidine 50mg and scopolamine 0.3mg. Swan-Ganz catheter was inserted via right interval jugular vein into pulmonary artery and radial artery was cannulated under local anesthesia before anesthesia. Anesthesia was induced with midazolam 0.05-0.01 mg.kg-1, fentanyl 15-20?g. kg-1 and pancuronium 0.12mg.kg-1 and maintained with fentanyl, midazolam and pancuromium. Patients in group Ⅰ received no cardioplegic solution. Ascending aorta was not cross-clamped. Body temperature was reduced to 32℃-33 ℃ (naso-pharyngeal T) . The empty heart was beating at 40-60 bmp. In group D and Ⅲ cardioplegic solution (modified St. Thomas solution) was added to blood from oxygenator (in the proportion of 1:4).In group Ⅱ body temperature was reduced to 32℃-33℃.Tepid (32℃ ) hyperkalemia blood cardioplegic solution was infused at 200-250ml.min-1 after ascending aorta was cross-clamped. After cardioplegic arrest hypokalemic blood cardioplegia solution was infused. In group Ⅲ body temperature was reduced to 28℃-29℃. Cold (8℃) hyperkalemic blood cardioplegic solution was infused at 200-250ml. min-1, after ascending aorta was cross-clamped. After cardioplegia arrest cold hypokalemic blood cardioplegia solution was infused every 20 min. Hemodynamic parameters (MAP, MPAP, CO, CI, SVRI, PVRI, LVSWI and RVSWI) were recorded before anesthesia (T0), before CPB (T1), 10, 30, 60 min after termination of CPB (T2-T4 ) and at the end of surgery (T5 ) . Results Demographic data including age, gender, body weight and body surface area were comparable between the three groups. CI in group 1 and Ⅱ was significantly higher at T2 -T5 than that in group Ⅲ . SVRI after CPB in group Ⅰ was significantly lower than that in group Ⅲ . Conclusion The myocardial function after CPB without cardioplegia is better than that after CPB with cold cardioplegia, but is not significantly different from that after CPB with tepid blood cardioplegia.

Objective To investigate the clinical efficacy of lumbar-sacurm-iliac screws fixation in the treatment of complicated sacral fractures.Methods From January 2012 to October 2012,18 complicated sacrum fracture patients with unstable pelvic fractures and cauda equina dysfunctionwere retrospectively studied,which Gibbons score were all 4 points.Surgical treatment was performed by posterior lumbar-sacurm-iliac screw fixation combined with sacral decompression.The fixation stage can be extended to L4,S2 level by fracture.According to the patient's nerve injury and fracture displacement surgery sacral decompression and observation of nerve root injury.Ater full decompression,correct the vertical displacement and rotate the displacement,and then place the cross further fixed.The first 3 months after surgery,the patient reviewed once a month,3 months after the patient review once every six months.Results 18 patients underwent surgery for 2-21 d after injury,with an average of 10.2 d.The operation time is 150-240 min,an average of 180 min.Intraoperative blood loss of 600-2 000ml,an average of 1 100ml.The time of follow-up was 13-34 months,with an average of 23.4 months.Gibbons score averaged 4 points from preoperative to 2.78 points,the difference was statistically significant.Preoperative patients with an average angle of 42.89,postoperative 21.94,the difference was statistically significant.Postoperative Majeed scores averaged 64.5 points.Excellent in 3 cases,good in 3 cases,can be 7 cases,poor in 5 cases,excellent rate was 33.33％.Preoperative visual analogue scale (VAS) score averaged from 8.78 points before surgery to 2.22 points,this difference was statistically significant.The results of Tometta and Matto method were excellent in 5 cases,3 cases were good,7 cases were available,5 cases were poor,excellent and good rate was 44.44％.Conclusion Lumbarsacurm-iliac screw fixation in the treatment of complex sacral fractures can achieve a good reduction of fracture and attain satisfied nerve decompression,and more conducive to oatients faster and better recovery.

With the continuously exploration,in recent years,further understanding of anatomical characteristics of the cervical pedicle brings great breakthrough in cervical pedicle screw implantation.In addition,pedicle screw implantation in cervical spine is considered as a technique with high safety and reliability,which can be widely used in cervical trauma fracture,cervical instability,degenerative,inflammatory,benign or malignant tumor,deformity and other neck diseases.Because of the tremendous differences between upper cervical spine (C1,C2) and lower cervical spine (C3-7) in anatomical morphology,cervical pedicle screw implantation in C1 and C2 differs from in lower cervical spine.Due to the similar structure of C3-7,pedicle screw implantation methods are based on the same principle and sharing a few points in common.The pedicle screw technique can be classified in two groups according to the practice methods:navigation technology and manual placement of cervical pedicle screw.Navigation nailing is considered as reliable,easy handing,and with clear operative vision,however,with disadvantages as complex procedures,highly cost operation equipment,and risk in navigation draft.Therefore,manual placement of pedicle screw is more reasonable and practical comparing with the former.In this study,it analyzed anatomical characteristics of lower cervical pedicle and the measurement of pedicle structure,discussed technique of manual placement of pedicle screw in lower cervical spine and biomechanical study of pedicle screw,and summed up the comparison of the advantages and disadvantages of current representative manual placement technology.

Objective To evaluate the professional competency of the clinicians with DRGs indexes. Methods The homepages of medical records of the hospital from January to June in 2018 were extracted, and the conventional evaluation indexes ( i. e. percentage of drug expenditure, percentage of medical consumables expenditure, and percentage of antimicrobials application ) of each clinician were obtained. " CN-DRGs" burster was used to calculate the DRGs indexes. The weighted RSR was applied to evaluate the professional competency of the resident physicians. Results A comprehensive evaluation of the professional competency of 438 resident clinicians was conducted. 218, 190, and 30 clinicians fell into excellent, medium and poor categories respectively. The results of ANOVA showed that the differences of the 3 categories were significant ( F =664. 863, P <0. 001 ). Conclusions The evaluation of clinicians′professional competency based on DRGs was reasonable, objective and feasible, proving its importance for the establishment of a scientific and standardized clinicians evaluation system.

Objective To evaluate the efficacy of one stage anterior debridement combined with posterior pedicle screw fixation in the treatment of cervical intervertebral space infection.Methods From June 2010 to June 2016,28 cases were fixed by anterior debridement combined with the posterior vertebral pedicle screws for the cervical intervertebral space infection,19 males and 9 females.The average age was 45-74 years (58±14.5 years old).21 cases (75％) were spontaneous infection,of which 6 cases were diabetes mellitus,15 cases were over 60 years old.The remaining 7 cases (25％) were intervertebral space infection after radiofrequency ablation of the cervical spine.All patients were excluded from tuberculosis and Brucella infection.All patients underwent hematological examination,with emphasis on WBC,ESP and CRP.All patients received JOA score before operation,applied antibiotic according to blood culture and drug sensitive test.All patients underwent one stage anterior debridement combined with posterior pedicle screw fixation,and the operative time and bleeding volume were recorded.After the operation,intravenous antibiotic therapy was continued,and the application of antibiotics was guided according to the results of ESP and CRP,and the time for the application of antibiotics was recorded.Follow up was performed at 3 months,6 months and 1 years after operation respectively.The JOA score and postoperative cervical lordosis Cobb angle were recorded.Results All operations were successfully completed in this group.The operation time was 130-225 min,with an average of 145.5±12.7 min.The intraoperative blood loss was 40-100 ml,with an average of 67±35.2 ml.The incision was healed in one stage.The time of application of antibiotics in 28 patients was 21-87 days,with an average of 30.8±8.7 days.The longest application time of antibiotics was 87 days,and no relapse was found during follow-up.The postoperative JOA score increased from 11.3± 1.2 to three months 14.9 ± 1.96 postoperatively and 6 months 15.1 ± 1.55 and 1 years 16.5±0.48 after operation.The JOA score was significantly higher than that before operation.No significant loss and change of the Cobb angle in the cervical spine surgery were found.All cases had good bone graft fusion at 1 years.Conclusion One stage anterior debridement combined with posterior pedicle screw fixation is a safe and effective method for the treatment of cervical vertebra instability and nerve function injury caused by cervical intervertebral space infection.It provides a new way for the treatment of cervical intervertebral space infection.

Objective To explore the scientificity and feasibility of using weighted rank-sum ratio (RSR) method based on diagnosis-related groups ( DRGs) indicators in nursing performance evaluation. Methods Homepage data of medical records were extracted from inpatients discharged in 2017, and " CN-DRGs" burster was used to obtain the DRGs data. Data of medical safety were obtained from the nursing adverse event management system, while data of nursing grading information and medical expenses were obtained from the hospital information system, and the patient satisfaction was obtained in a questionnaire survey. Based on the indicators available, the weighted RSR was applied to evaluate the nursing performance from the 11 dimensions, namely workload, nursing competence, nursing quality, nursing personnel allocation, patient satisfaction, etc. Results The results of the weighted RSR showed that 43, 39, and 6 wards of total 88 wards of the hospital were rated as excellent, medium and poor grades respectively. The results of ANOVA showed that the difference of the 3 grades was significant (F=170. 391, P<0.001). The nursing performance evaluation results were consistent with the actual situation. Conclusions The evaluation of nursing performance with weighted RSR method based on DRGs indicators prove its practical application value, as this method can not only provide data support for nursing personnel allocation, but also provide reference for nursing quality evaluation and supervision.