Objective To evaluate the effects of dexmedetomidine combined with subanesthetic dose of ketamine on the emergence agitation in the patients undergoing thoracotomy.Methods Eighty ASA physical status Ⅱ or Ⅲ patients,aged 55-75 yr,weighing 50-75 kg,scheduled for elective esophageal cancer resection,were randomly divided into 4 groups (n =20 each) using a random number table:normal saline group (NS group),dexmedetomidine group (group D),subanesthetic dose of ketamine group (group K),and dexmedetomidine combined with ketamine group (group DK).In DK and K groups,ketamine 0.5 mg/kg was injected intravenously (within 1 min) at 10 min before the end of the operation.In DK and D groups,dexmedetomidine 0.5 μg/kg was infused intravenously over 10 min starting from 10 min before the end of operation.In group NS,the equal volume of normal saline was infused intravenously over 10 min starting from l0 min before the end of operation.The emergence time,extubation time,duration of ICU stay,occurrence and degree of agitation,and development of cardiovascular events and hypoxemia within 24 h after operation were recorded.Ramsay sedation scores were recorded before induction of anesthesia (T1),immediately after completion of administration at the end of surgery (T2),and at 0,5,10 and 30 min after extubation (T3-6).Results There was no significant difference in the emergence time,extubation time,and duration of ICU stay between the four groups.Compared with group NS,Ramsay sedation scores were significantly increased at T3-6,the incidence and degree of agitation were decreased,and the incidence of cardiovascular events and hyoxemia was decreased in D,K and DK groups.Compared with D or K group,Ramsay sedation scores were significantly increased at T3-6,the incidence and degree of agitation were decreased,and the incidence of cardiovascular events and hyoxemia was decreased in group DK.Conclusion Dexmedetomidine combined with subanesthetic dose of ketamine can prevent the emergence agitation in the patients undergoing thoracotomy,which provides better efficacy than either alone.

Objective To evaluate the effects of sub anesthetic dose of ketamine combined with sufentanil on postoperative patient-controlled intravenous analgesia (PCIA)in patients undergoing radical resection of esophageal cancer.Methods Ninety patients,ASAⅠorⅡ,aged 55-75 years old,se-lected for radical resection of esophageal cancer were randomly divided into three groups:group S1,group S2,group SK,30 patients in each group were treated with PCIA.Group S1,2 μg/kg sufentanyl;group S2,2.5 μg/kg sufentanyl;group SK 2 μg/kg sufentanyl+90 μg·kg-1·h-1 ketamine.6 mg of granisetron was added to each group,and then diluted into 100 ml of normal saline.All patients were administered load-ing doses of 5 ml analgesics 30 min before the end of the operation.The VAS score,Ramsay sedation score, SBP,DBP,HR,SpO2 and adverse effects were recorded respectively at 4,8,24 and 48 hours after opera-tion.The total times of pressing PCIA were also recorded in 48 h after operation.Results There was no statistically significant difference in Ramsay sedation score,SBP,DBP,HR and SpO2 at 4,8,24,48 hours after operation in the three groups.Compared with group S1,the VAS score and total number of pressing PCIA times in groups SK and S2 were significantly lower in 48 h after operation (P <0.05).Compared with group S2,VAS score and the total number of pressing PCIA times in group SK were significantly de-creased in 48 h after operation (P <0.05).Two patients from group SK occurred respiratory depression 48 h after operation.There was no statistically significant difference in incidence of adverse effects in the three groups.Conclusion Sub anesthetic dose of ketamine combined with sufentanil on PCIA can reduce postoper-ative sufentanil consumption and significantly relieve the postoperative pain in patients undergoing radical re-section of esophageal cancer.The analgesic effect is better than using sufentanil alone.

Objective:To evaluate the effect of patient-controlled intravenous analgesia (PCIA) with dexmedetomidine mixed with subanesthetic dose of ketamine on anxiety and depression in the patients with advanced cancer pain.Methods:Sixty patients of either gender with advanced cancer pain, aged 24-82 yr, with poor analgesic effect or obvious adverse reactions after three-step analgesic treatment, were selected and randomly divided into 2 groups ( n=30 each) using a random number table method: routine treatment group (group R) and dexmedetomidine mixed with ketamine group (group DK). The initial dose of morphine for PCIA was 1/3 of the oral dose in group R. In group DK, ketamine 5.4 mg/kg (90 μg·kg -1·h -1) and dexmedetomidine 6 μg/kg (0.1 μg·kg -1·h -1) were added on the basis of group R. Tropisetron 8 mg was added to analgesics and diluted to 200 ml with normal saline in both groups.The analgesic pump was programmed to deliver 4 ml with an initial dose of 4 ml, lockout interval of 15 min and background infusion at 4 ml/h.The numerical rating scale score, Ramsay sedation score, Chinese version of State-Trait Anxiety Inventory score and Beck Depression Inventory-Ⅱ score were recorded before PCIA and at 4, 12, 24 and 48 h of PCIA.The development of effective analgesia and satisfactory sedation, occurrence and degree of depression, score for patient's quality of life and satisfaction score, consumption of morphine and adverse reactions such as constipation, nausea and vomiting, agitation and respiratory depression were recorded within 48 h of PCIA. Results:Compared with group R, the NRS score was significantly decreased, the rate of effective analgesia was increased, Beck Depression Inventory-Ⅱscore and Chinese version of State-Trait Anxiety Inventory score were decreased, the incidence and degree of depression were decreased, incidence of nausea and vomiting and constipation, consumption of morphine and pressing times of PCIA pump were decreased, and the score for patient's quality of life and satisfaction score were increased in group DK ( P<0.05). Conclusion:PCIA with dexmedetomidine mixed with subanesthetic dose of ketamine can significantly enhance the analgesic effect, improve anxiety and depression, and raise the quality of life when used for the patients with advanced cancer pain.

Objective To analyze the precision and stability of optical surface imaging system for patients who received radiotherapy with active breath control. Methods Eighteen radiotherapy patients with lung metastasis were managed by active breath control (ABC).The difference error detected by optical surface imaging system and CBCT were defined as the precision of optical surface imaging system. The variation among the error of optical surface imaging positioning the value of correction of treatment position and the error detected by optical surface imaging again were defined as the stability of optical surface imaging system. Intrafractional errors were analyzed by optical surface imaging system through whole treatment process (including breath hold and free breath). Results The optical surface imaging system had precision (systematic (Σ) and random errors (σ)) of 1.78/3.42 mm 2.54/6.57 mm and 2.79/3.22 mm respectively and stability of2.12/2.54 mm 3. 09/4.02 mm and 1.37/3.55 mm respectively in lateral-medial superior-inferior and anterior-posterior directions. The intrafractional errors (Σ and σ) were 0.42/0.85 mm 0.41/1.47 mm and 0.41/1.47 mm respectively for breath hold duration and 4.76/4.16 mm 6.54/7.78 mm and 3.13/5.92 mm for free breath duration in lateral-medial superior-inferior and anterior-posterior directions. Conclusions As an effective method for validate breath hold;Optical surface imaging system can improve the precision and safety of active breath control. However,the factors that affect the accuracy and stability of the optical surface imaging system in patients undergoing radiotherapy with ABC are not clear;it cannot replace the CBCT for positioning verification.

OBJECTIVE：To provide method reference for scientifically eva luating the rationality of the use of saxagliptin . METHODS：Based on the drug instructions ，clinical guidelines ，clinical pathways ，related references ，clinical endocrinology department and pharmaceutical experts of a hospital jointly discussed and formulated the evaluation criteria for the rationality of the use of saxagliptin. AHP method was used to assign weights to various indexes of evaluation criteria ；TOPSIS method was used to analyze the use of saxagliptin of 106 cases in the hospital during Nov. 2018-Apr. 2019 retrospectively and evaluate rational drug use. RESULTS ：A total of 6 primary indicators and 12 secondary indicators were established. The first three indicators with a relatively high index weight were indications （with a weight of 0.25），dose and adjustment of administration （with a weight of 0.21）and frequency of administration （with a weight of 0.15）. Among 106 cases，39.6％ of drug use were reasonable ，51.0％ were basically reasonable and 9.4％ were unreasonable. Evaluation results made by weighted TOPSIS were consistent with the actual situation. CONCLUSIONS ：TOPSIS method weighted by AHP is reasonable and feasible for evaluating the rationality of saxagliptin use.