Objective To observe the influence of combined spinal and epidural anesthesia( CSEA) of different po-sitions on the anesthesia effect, anesthesia operation and hemodynamic index during cesarean section of obese par-turients. Methods Eighty obese parturients[BMI≥30] undergoing cesarean section were randomly divided into two groups, that was group A and B, with 40 cases each. In group A, the parturients were required to undergo lat-eral decubitus position with 0.5% ropivacaine hydrochloride of 2. 4 ml. In group B, the parturients were required to undergo sitting position with the same ropivacaine hydrochloride as group A. The following data was recorded, which were the percentage of one-attempt's successful epidural needle placement, the anesthesia level,the anesthe-sia effect and the hemodynamic change. All the complications were also observed,such as the supine hypotension syndrome during operation,headache after spinal anesthesia and postoperative spinal nerve stimulation. ResultsThe difference of anesthetic effect between the two groups was insignificant in statistics while group B's rate of one-attempt successful puncture was higher than gruop A ( P <0.05 ) . The difference of hemodynamic index between them was significant in statistics ( P<0.05 ) with group B's rate of supine hypotension syndrome lower than group A. Conclusion Both body positions have the same anesthtic effect for obese parturients during cesarean section while the puncture operation of sitting positon is easier than lateral decubitus position and the hemodynamic change is also more stable.

Objective To investigate the treatment of noninvasive ventilator in chronic obstructive pulmonary disease merge chronic type Ⅱ respiratory failure and to analysis its clinical efficacy and safety.Methods According to the random number table,115 cases were randomly divided into two groups,the observation group (n =59)and the control group(n =56).The control group received conventional symptomatic treatment,while the observation group therapy was combined with non -invasive ventilation in the basis of the control group.The changes of HR,RR, PaCO2 ,PaO2 ,Forced expiratory volume in one second 1 (FEV1 ),Forced expiratory volume in one second 1 (Forced expiratory volume in one second 1,FEV1 /FVC)were compared between the two groups before and after treatment 48h.Results Before treatment,there were no significant differences in HR,PaCO2 ,RR,FEV1 ,PaO2 ,FEV1 /FVC (P >0.05).After the treatment,in the control group,HR,RR,PaCO2 ,PaO2 ,FEV1 and FEV1 /FVC were respectively (90.16 ±4.15)beats/min,(23.17 ±1.63)beats/min,(59.68 ±5.85)mmHg,(69.16 ±5.26)mmHg,(2.65 ± 0.25)L and(65.47 ±1.97)%.In the observation group,HR,RR,PaCO2 ,PaO2 ,FEV1 and FEV1 /FVC were respectively (82.93 ±3.76)beats/min,(19.02 ±1.57)beats/min,(50.82 ±6.53)mmHg,(78.06 ±5.48)mmHg,(2.96 ± 0.31)L and (72.38 ±2.15)%.The difference was statistically significant(t =9.800,13.907,7.649,8.877,5.917, 17.942,all P <0.05).No adverse reactions occurred during the treatment.Conclusion The clinical efficacy of non-invasive ventilator in the treatment of COPD associated with chronic type Ⅱ respiratory failure is significant,safe and reliable,which has important research value,and is worthy of further application.

Objective To investigate the clinical efficacy of multidisciplinary integrated treatment and management model in the medical management of elderly patients.Methods 226 elderly patients treated in our hospital from October 2014 to December 2015 were randomly divided into observation group and control group,113 cases in each group.Patients in the control group were treated with traditional medical management model,while patients in the observation group were treated with multidisciplinary integrated treatment and management model.The therapeutic effect,hospital stay,incidence of complications,treatment satisfaction,MMSE score,FCA score and Tinetti score between the two groups were compared.Results The total effective rate (95.58%) in the observation group was significantly higher than that in the control group (79.65%) (χ2=13.21,P=0.000).The mortality rate in the observation group (1.77%) was significantly lower than 7.96% in the control group (χ2=4.68,P=0.004).The satisfaction rate of the observation group (92.04%) was significantly higher than 77.88% of the control group (χ2=8.86,P=0.003).The MMSE score[(25.17±4.43)points],FCA score[(77.35±8.35)points]and Tinetti score[(26.45±4.25)points]of the observation group were significantly higher than those in the control group[(20.13±3.07) points,(65.32±8.88) points and (21.03±3.30) points,t=-2.93,-3.11,-3.18;P=0.025,0.014,0.006].Conclusion Multidisciplinary integrated treatment management model can significantly increase the therapeutic effect,shorter hospital stay,reduce the incidence of complications,improve patients' satisfaction,and improve the quality of life,so it is a new type of efficient and rational therapeutic management model and worthy of clinical promoting.

Objective To investigate the effects of parecoxib pretreatment on the intrapulmonary shunt during one-lung ventilation in patients undergoing esophageal cancer resection.Methods Forty ASA Ⅰ or Ⅱ patients of both sexes,aged 25-64 yr,weighing 45-70 kg,with body height 156-178 cm,undergoing elective esophageal surgery,were randomly divided into 2 groups (n =20 each):normal saline group (group NS) and parecoxib group (group P).Parecoxib 40 mg (in normal saline 10 ml) was injected intravenously 30 min before anesthesia in group P,while the equal volume of normal saline was given instead of parecoxib in group NS.Anesthesia was induced with iv injection of propofol,fentanyl and rocuronium.Bronchial blocker was inserted after tracheal intubation and the correct position was confirmed by bronchoscopy.Anesthesia was maintained with iv infusion of propofol and remifentanil and intermittent iv boluses of atracurium.HR,MAP,SpO2 and mean airway pressure (Pmean)were determined at 5 min of two-lung ventilation,at 40 min of one-lung ventilation,and at 30 min after re-expansion of the collapsed lung (T0-2).Blood samples were taken simultaneously from jugular vein and radial artery for blood gas analysis.Intrapulmonary shunt (Qs/Qt) was calculated.Results There were no significant differences in hemodynamic parameters and Pmean between the two groups (P ＞ 0.05).PaO2 was significantly lower,while Qs/Qt was significantly higher at T1,2 than at T0 in groups NS and P (P ＜ 0.05).PaO2 was significantly higher,while Qs/Qt was significantly lower at T2 than at T1 in groups NS and P (P ＜ 0.05).Qs/Qt was significantly lower at T1,2 and PaO2 was significantly higher at T2 in group P than in group NS (P ＜ 0.05).Conclusion Parecoxib 40 mg injected intravenously at 30 min before anesthesia can reduce the intrapulmonary shunt during one lung ventilation in patients undergoing esophageal cancer resection.

Objective To observe the effect of body temperature protection on enhanced recovery after surgery of patients undergoing laparotomy radical gastrectomy.Methods Sixty of patients ASA physical status Ⅰ or Ⅱ,aged 45-76 years,scheduled for elective radical gastrectomy were ran domly divided into 2 groups (n=30 each):heating blanket group and control group.In the heating blanket group,patients were warmed up during the whole perioperative period using the warmblanket until discharge from PACU;exposed skin as covered with clean surgical dressing;infusion,irrigation fluids and blood transfusions were warmed to 40℃;the bacteriological and viral filters were placed between the Y-piece of the breathing circuit and the tracheal tube.In the control group,patients were not given special heat preservation measures.For temperature measurements,an infrared tympanic ear thermometer was used.The core temperature of two groups were recorded at the pre-operative period (T1),before induction (T2),1 h after induction (T3),closing (T4),extubation （T5),discharging from PACU (T6).The dosage of anesthetic drug,volume of fluids infused,peritoneal fluid flushing volume,operation time,anesthesia time,ambient temperature,amount of bleeding,intrao perative blood transfusion,shivering,extubation time,incision infection and hospitalization time were recorded.Results There was no statistical difference in terms of temperature at T1 between the two groups.Compared with the T1,the core temperature of two groups of patients in T2-T6 were signifi cantly decreased (P ＜0.05).The perioperative core body temperature at T2-T6 was significantly higher in the heating blanket group than in the control group.The amount of bleeding and blood transfusion in perioperative period was significantly less that in the heating blanket group (P＜0.05).The incidence of shivering and surgical-wound infection were significantly lower in the heating blanket group (P＜0.05).The extubation time and hospitalization time were shorter in the heating blanket group (P＜0.05).Conclusion Combined body temperature protection measures can significantly reduce the incidence of inadvertent perioperative hypothermia (IPH) and improve postoperative outcomes for patients undergoing laparotomy radical gastrectomy.

BACKGROUND: Existing evidence suggests that fruit consumption is a significant influencing factor for chronic obstructive pulmonary disease (COPD), but this is unclear in the Chinese population. We examined the association of fresh fruit consumption with the risk of COPD-related hospitalization and death in a nationwide, population-based prospective cohort from China. METHODS: Between 2004 and 2008, the China Kadoorie Biobank recruited >0.5 million adults aged 30 to 79 years from ten diverse regions across China. After excluding individuals diagnosed with major chronic diseases and prevalent COPD, the prospective analysis included 421,428 participants. Cox regression was used to calculate the hazard ratios (HRs) for the association between fresh fruit consumption and risk of COPD-related hospitalization and death, with adjustment for established and potential confounders. RESULTS: During a mean follow-up of 10.9 years, 11,292 COPD hospitalization events and deaths were documented, with an overall incidence rate of 2.47/1000 person-years. Participants who consumed fresh fruit daily had a 22% lower risk of COPD-related hospitalization and death compared with non-consumers (HR = 0.78, 95% confidence interval [CI]: 0.71-0.87). The inverse association between fresh fruit consumption and COPD-related hospitalization and death was stronger among non-current smokers and participants with normal body mass index (BMI) (18.5 kg/m 2 ≤ BMI < 24.0 kg/m 2 ); the corresponding HRs for daily fresh fruit consumption were 0.78 (95% CI: 0.68-0.89) and 0.69 (95% CI: 0.59-0.79) compared with their counterparts, respectively. CONCLUSIONS High-frequency fruit consumption was associated with a lower risk of COPD in Chinese adults. Increasing fruit consumption, together with cigarette cessation and weight control, should be considered in the prevention and management of COPD.