Objective To evaluate the predictive effects of Narcotrend(NT) monitor on laryngeal mask intubation and consciousness recovery in propofol-laryngeal mask total intravenous anesthesia of gynecilogical surgery.Methods Thirty ASA I patients undergoing elective gynecilogical surgery under general anesthesia with laryngeal mask intubation were anesthetized with propofol by target-controlled infusion (TCI).NT monitor was used to monitor the anesthesia depth.The ventilation was used on the closed circuit breathing mode of ZEUS anesthesia machine.The values of NT stage (NTS),NT index (NTI),the effect compartment concentration (Ce) and hemodynamic parameters were recorded during the time of sleeping,laryngeal mask intubation,propofol stopping pumping,recovery of spontaneous respiration and eyes opening.The incidence rate of intraoperative awareness was recorded.Results The NTI (77±23,30±9) (Z =5.561,P =0.001),Ce [(1.1±0.4) μg/ml vs (2.2±0.4) μg/ml] (Z=6.38,P=0.006),MAP [(92±14) mm Hg (1 mm Hg =0.133 kPa)vs (83±14) mm Hg] (t =2.490,P =0.016) and HR [(74±15) bpm vs (65±10) bpm] (t =2.688,P =0.009) of the time of intubation were significantly decreased compared to the time of sleeping.The NTI (37±7 vs 71±14)of the time of recovery of spontaneous respiration was significantly increased compared to the time of propofol stopping pumping (Z =6.34,P =0.005).The NTI (37±7 vs 83±13) (Z =6.668,P =0.003),Ce [(3.1±0.4) μg/ml vs (1.6±0.2) μg/ml] (Z =6.414,P =0.002) and HR[(59±7) bpm vs (64±8) bpm] (t =-2.825,P =0.006) of the time of eyes opening were statistically significant compared to the time of propofol stopping pumping.None of patients experienced intraoperative awareness.Conclusion NT monitor can effectively guide the intubation and extubation of laryngeal mask in total intravenous anesthesia of gynecilogical surgery.

Objective To explore the clinical characteristics of patients during recovery period in low flow and circulation closed pattern anesthesia by ZEUS with isoflurane.Methods During elective gynecologic surgery,35 ASA Ⅰ or Ⅱ patients were anesthetized with isoflurane under general anesthesia with tracheal intubation.The ventilation was used with the closed circuit breathing mode (Autocontrol) of ZEUS anesthesia machine.The time of inhale drug,exhale drug and eyes-opend,consumption of drug and complication were recorded during the process.The values of NT stage (NTS),NT index (NTI),the final endexpiratory concentration of isoflurane (EXP),MAC and hemodynamic parameters were recorded during the time of isoflurane stopping inhale,recovery of spontaneous respiration,eyes opening.Results The values of NTI (50±7,74±12,86±10,t =-9.382,t =-16.682,P ＜ 0.01),the EXP [(0.9±0.0)％,(0.1±0.1)％,0,z =-7.262,z =-7.835],MAC [(1.2±0.1)％,(0.2±0.2)％,0,z =-7.186,z =-7.728,P ＜ 0.01] and hemodynamic parameters (SBP,DBP,MAP,HR) [(108.1±13.4) mm Hg (1 mm Hg =0.133 kPa),(66.3±12.1) mm Hg,(84.3± 12.5) mm Hg,(69.8±12.5) /min and (124.6±17.9) mm Hg,(75.7±14.5) mm Hg,(96.0±14.6) mm Hg,(82.8±15.0)/min and (128.0±16.3) mm Hg,(77.1±15.0) mm Hg,(99.8±15.3) mm Hg,(85.2±18.5) bpm] (t =-4.365,t =-2.951,t =-3.574,t =-3.921; t =-5.554,t =-3.309,t =-4.642,t =-4.085,P ＜0.01) during the time of recovery of spontaneous respiration and tracheal extubation were statistically significant compared to the time of isoflurane stopping (P＜ 0.01).None of patients experienced intraoperative was awareness.Conclusion Isoflurane can be used for closed circuit breathing mode of ZEUS anesthesia machine,but consciousness recovery need a long time.

Objective To investigate the infection status and clinical features of common viruses in acute lower respiratory infection (ALRI) among the hospitalized children 0 to 7 years old in Nantong of Jiangsu.Methods 1 376 swab samples from pharynx nasalis in the ALRI inpatients 0 to 7 years old were collected.The human respiratory syncytial virus (RSV),adenovirus (ADV),influenza virusA,B (IVA,B),parainfluenza virus Ⅰ ～ Ⅲ (PIV Ⅰ ～ Ⅲ)were detected by direct immunofluorescence assay,and the results were analyzed.Results In 1 376 respiratory tract samples,there were 577 cases(41.93％) of positive samples.In all positive samples,there were 376 cases of RSVpositive (65.16％),42 ADV-positive (7.28％),63 IVA-positive (10.92％),24 IVB-positive (4.16％),20 PIV Ⅰ-positive(3.47％),19 PIV Ⅱ-positive (3.29％),108 PIV Ⅲ-positive (18.72％),68 cases with mixed infection (11.79％) [two virus-positive ones in 59 cases (86.76％),three virus-positive ones in 9 cases (13.24％)].In different age group,the highest positive rate was in 0 ～ 6-month-old group(53.32％),with the lowest in 5-7 years old group(6.90％).Virus detection rate was higher in March 2012 (58.67％),December 2012 (53.33％),and January 2013(53.63％)than the rest months,including the lowest June 2012(33.33％).Bronchiolitis virus detection rate was the highest(69.23％)among ALRI.Conclusion The virus is major pathogen of children 0 to 7 years old with ALRI in Nantong of Jiangsu,and with difference among different ages,seasons and diseases.Infants and young children are the main affected population.

Objective:To explore the application value of asthma prediction index (API) in the management of young wheezing children in primary hospitals.Methods:From July 2014 to December 2016, 137 children with recurrent wheezing diagnosed and treated in the People's Hospital of Qidong were selected for API evaluation.Forty-six children with positive API (treatment group) were given standardized treatment for childhood asthma, 43 patients with API positive (observation group) and 48 patients with API negative (control group) were given routine treatment (intermittent anti-inflammatory and antiasthmatic treatment). All children were given breathing nursing education and management, followed up to observe breathing control.Results:One child in the treatment group was withdrawn from the cohort, and the complete remission rates in the treatment group, observation group and control group were 86.7% (39/45), 9.3% (4/43) and 43.8% (21/48), respectively.The complete response rate in the treatment group and control group was higher than that in the observation group, and the differences were statistically significant (χ 2=53.39, 14.78, all P<0.05). Conclusion:API can effectively help pediatricians in primary hospitals to manage young wheezing children and improve the complete remission rate.

Objective: To examine the effectiveness and safety of application of the ureteral access sheath in the treatment of middle or lower ureteral calculi in patients with large-volume benign prostatic hyperplasia above grade Ⅲ, which is expected to avoid the simultaneous or staged treatment of benign prostatic hyperplasia via eliminate the difficult angle and resistance of ureteroscopy caused by severe prostatic hyperplasia. Methods: From April 2018 to December 2020, the clinical data of 27 patients with massive benign prostatic hyperplasia above grade Ⅲ and middle and lower ureteral calculi treated with indwelling ureteral access sheath plus ureteroscopy holmium laser lithotripsy at Department of Urology, Zhejiang Quhua Hospital were retrospectively analyzed and followed up. All the patients were male, aged (69.7±12.8) years (range: 55 to 87 years). Prostate volume measured by transrectal ultrasound was (94.8±16.2) cm³ (range: 85 to 186 cm³). The ureteral access sheath was indwelled in advance, and then the semirigid ureteroscopy was introduced through the working channel of the sheath. Holmium laser lithotripsy was performed, and intraoperative and postoperative complications were recorded. Urinary abdominal plain X-ray or CT urography were performed at 1-and 2-month postopaerative to evaluate the residual stones and clinical efficacy. Results: The ureteral access sheath was placed and holmium laser lithotripsy under a semirigid ureteroscopy was performed successfully in all the 27 patients. In 2 patients, a second session of auxiliary procedure was required due to the large load of preoperative stones and residual stones after surgery, among whom 1 patient received extracorporeal shock wave lithotripsy and 1 patient underwent extracorporeal shock wave lithotripsy plus ureteroscopic lithotripsy. The stone free rate at 1-and 2-month postoperative were 92.6% (25/27) and 100% (27/27), respectively. There were no severe complications such as ureteral avulsion and perforation, perirenal hematoma, septic shock, severe hematuria, urinary retention, iatrogenic ureteral stricture occurred during and after the surgery. The ureteral calculus was wrapped by polyps heavily in 1 patient, he was diagnosed as ureteral stenosis 1 month postoperative, receiving laparoscopic resection of ureteral stricture plus anastomosis 3 months postoperative. Conclusions: In the operations of middle and lower ureteral calculi in patients with large-volume prostatic hyperplasia above grade Ⅲ, the ureteral access sheath can be placed first to effectively eliminate the difficult angle and resistance of ureteroscopy caused by severe prostatic hyperplasia, and then semirigid ureteroscopic lithotripsy can be safely performed. It could avoid the treatment of benign prostatic hyperplasia at the same time or by stages.
Aged ; Aged, 80 and over ; Humans ; Lithotripsy ; Lithotripsy, Laser ; Male ; Middle Aged ; Prostatic Hyperplasia/complications* ; Retrospective Studies ; Treatment Outcome ; Ureteral Calculi/surgery* ; Ureteroscopy