OBJECTIVE To investigate the classification and antibiotics resistance of Staphylococcus in children with septicemia in recent two years and to provide data for clinical treatment. METHODS All the blood specimens delivered by pediatrics were identified and detected the antibiotic resistance with Microscan Auto SCAN4. RESULTS Totally 268 Staphylococcus strains were collected. Among them,S. aureus was 114 strains (42.5%),coagulase-negative Staphylococcus were 154 srains. Among 114 S. aureus strains,meticillin-resistant Staphylococcus aureus (MRSA) were 79 strains (69.3%). Among 154 coagulase-negative Staphylococcus strains,meticillin-resistant coagulase-negative Staphylococcus aureus (MRCNS) were 102 strains (66.2%). The drug sensitivity results showed that meticillin-resistant staphylococcus (MRS) were highly resistant to 15 commnly used antibiotics than meticillin-sensitive Staphylococcus (MSS) and showing multi-drug resistance. No vancomycin-resistant strains were found.CONCLUSIONS Children with septicemia infected by Staphylococcus are increasing recently. Identification and antibiotic resistance of clinical isolated Staphylococcus must be strengthened,and give the effective data for clinicians.

Objective To compare the analgesic efficacy and safety of the sole local anesthetic ropivacaine with the combination of both local anesthetic ropivacaine and opioidergic analgesic sufen-tanil given epidurally on the labor pain control.Methods After institutional review board approval and patient consent,a total of 481 nulliparas requesting epidural labor analgesia were randomized into two groups:a sole local anesthetic group (0.125% ropivacaine,group R)and a combination of local anesthetic and opioidergic analgesic group (0.125% ropivacaine+0.3 μg/ml sufentanil,group RS). Analgesic efficacy was measured using numerical rating scale (NRS)of pain and maternal visual ana-logue scale (VAS)analgesia satisfaction with regard to the first and the second stage of labor.Anal-gesic safety was measured with the Bromage scale of maternal safety and epidural labor analgesia re-lated side effects,as well as fetal safety including Apgar scoring and umbilical cord artery blood gas a-nalysis.Results A total of 346 participants completed the study,with 1 64 and 182 women in each group R and RS,respectively.The median NRS pain score during the first stage of labor was signifi-cantly lower in the combination group (2.2,IQR:1.8-2.7 )comparing to the sole local analgesic group (2.4,IQR:2-2.8)(P <0.001).No significant difference was observed in NRS pain score dur-ing the second stage of labor.Patients in both groups were rated the same VAS satisfaction of analge-sia.Patients in the sole local analgesic group experienced fewer side effects than those in the combina-tion group (37.7% versus 47.2%,P =0.082).The incidence of 1-min Apgar≤7 was lower in the sole local analgesic group 2 (1.2%) than the combination group 10 (5.5%) (P < 0.05 ). Conclusion The sole local anesthetic ropivacaine produces a comparable labor analgesic effect as the combination of both local anesthetic ropivacaine and opioidergic analgesic sufentanil but the former has less maternal side effects,and less incidence of lower 1-min Apgar scoring.

Objective To evaluate the efficacy of programmed intermittent epidural bolus ( PIEB) for labor analgesia in parturients and the effect on neonates. Methods Two hundred primiparae with a sin?gleton fetus in vertex presentation, who requested labor analgesia, aged 21-36 yr, at 37 to 40 week gesta?tion, with cervical dilatation 1-3 cm, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, were divided into 2 groups ( n=100 each) using a random number table: PIEB group and continuous epi?dural infusion ( CEI) group. PIEB regimens were programmed as 10 ml∕h starting from 1 h after the initial bolus. The programmed bolus dose was fixed at 5 ml with the lock?out interval set at 30 min. The drugs used in the analgesic pump were 0?08% ropivacaine and 0?4μg∕ml sufentanil in both groups. From the on?set of labor analgesia until 1 h after delivery, visual analog scale score was used to evaluate the uterine con?traction pain every hour. The modified Bromage score was used to assess the degree of motor block. The up?per spread of sensory block, total consumption of drugs, the number of attempts, duration of every stage, delivery mode, postpartum hemorrhage volume, and occurrence of adverse reactions ( dyspnea, hypoten?sion, pruritus, nausea, vomiting and urinary retention) were recorded. Apgar scores of the neonates were recorded, and the degree of primiparae′satisfaction with the analgesic efficacy was scored. Results Com?pared with group CEI, visual analog scale scores at T2?5 , the total consumption of drugs and the number of
attempts were significantly decreased, and the satisfaction score was significantly increased in group PIEB ( P<0?05) . The height of sensory block in the thoracic vertebra was significantly higher, and the height of sensory block in the lumbosacral spine was significantly lower in group PIEB than in group CEI ( P<0?05) . There were no significant differences between the two groups in the duration of every stage, delivery mode, postpartum hemorrhage volume, incidence of adverse reactions and Apgar scores of neonates (P>0?05). Conclusion PIEB provides reliable efficacy for labor analgesia in parturients, the degree of primiparae′satisfaction is high without increasing the occurrence of adverse reactions, and it exerts no effect on the neonates.

Objective To investigate the effect of wire?reinforced epidural catheters on the success rate of epidural catheterization for labor analgesia. Methods A total of 200 nulliparous parturients who re?ceived labor analgesia voluntarily, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 20-45 yr, with body mass index<35 kg∕m2, were divided into 2 groups (n=100 each) using a random number table: common catheter group ( group Ⅰ) and reinforced catheter group ( group Ⅱ) . After suc?cessful epidural puncture, the corresponding catheter was inserted inⅠandⅡgroups. The development of difficult insertion, intravascular catheter insertion or paresthesia during insertion was defined as a failure of epidural catheterization. The occurrence of the failure of epidural catheterization was recorded. Results Compared with group Ⅰ, the failure rate of epidural catheterization was significantly decreased in groupⅡ( P<0.05) . Conclusion Wire?reinforced epidural catheters can raise the success rate of epidural catheter?ization for labor analgesia.

Objective To study the effects of remifentanil with propofol and no positive pressure ventilation induction of anesthesia in 5 minutes-cesarean section on parturients and neonates. Methods Sixty pregnant women were randomly divided into ketamine anesthesia group (group L) and remifentanil anesthesia group (group R).In group L,anaesthesia was induced with ketamin 0.5 mg/kg+propofol 2 mg/kg and group R with remifentanil 1 μg/kg+propofol 2 mg/kg.Blood pres-sure,heart rate,oxygen saturation and pulse rate of maternal were recorded at intubation (T1 ),inci-sion (T2 ),and cutting the umbilical cord (T3 ).The infant Apgar scores at 1 minute and 5 minute af-ter birth,the delivery time of the fetus and umbilical blood gas values were recorded.Results The systolic blood pressure (SBP)and heart rate (HR)were significantly higher at T1 and T2 in group L than those in group R (P <0.05).The SBP,DBP and HR had not significant difference at T3 .The delivery time of the fetus and the infant Apgar scores at 1 minute and 5 minute between the two groups had no statistically significant differences.Conclusion Remifentanil combined with propofol and without positive pressure ventilation induction of anesthesia can be safely used in 5 minutes-cesar-ean section.The maternal hemodynamics is more stable without increasing the risk of neonatal respira-tory depression.

OBJECTIVE:To observe the anesthetic effect of dexmedetomidine in pelvic floor reconstructive surgery of elderly patients with pelvic organ prolapse(POP). METHODS:60 elderly patients with pelvic floor reconstructive surgery were randomly di-vided into observation group and control group. Observation group was treated with 0.5 μg/kg dexmedetomidine by pumping and control group was treated with 0.125 ml/kg 0.9% sodium chloride injection by pumping 15 min before anesthesia,and conventional intravenous induction was conducted after 15 min. MAP,HR and bispectral index(BIS)in entering the room(T0),5 min after ad-ministration(T1),immediate intubation(T2),1 min after intubation(T3),5 min after intubation(T4),surgical skin incision(T5), immediate extubation(T6)and 5 min after extubation(T7),restlessness score,sedation score,recovery time and incidence of ad-verse reactions in 2 groups were observed. RESULTS:MAP and HR in observation group in T1-7 were significantly lower than T0 and control group,MAP and HR in control group in T2-7 were significantly high than T0 except that T1 was significantly lower than T0,the differences were statistically significant(P<0.05);BIS in 2 groups T1-7 was significantly lower than T0,the differences were statistically significant(P<0.05),however,there was no significant difference between 2 groups(P>0.05). Restlessness score in observation group was significantly lower than control group,sedation score was significantly higher than control group,the differ-ence was statistically significant(P<0.05),there was no significant difference in the recovery time between 2 groups(P>0.05). There were no obvious adverse reactions in 2 groups during treatment. CONCLUSIONS:Dexmedetomidine can effectively reduce the stress response and maintain cycle stability in the treatment of elderly patients with pelvic floor reconstructive surgery,with good safety.

Objective To investigate the effect of preemptive parecoxib on blood coagulation in patients undergoing abdominal hysterectomy. Methods This was a randomized, double-blind controlled study. Seventy ASA Ⅰ or Ⅱ patients aged 38-56 yr weighing 50-75 kg undergoing abdominal hysterectomy under combined spinal-epidural anesthesia were randomized to one of 2 groups (n=35 each): parecoxib group (group P) received intravenous parecoxib 40 mg/2 ml at 20 min before anesthesia and control group (group C) received normal saline 2 ml instead of parecoxib. Both groups received patient-controlled intravenous analgesia (PCIA) with butorphanol after surgery. The PCIA solution contained butorphanol 0.2 mg/kg and ondansetron 4 mg in normal saline 100 ml.The PCIA was set up with background infusion 2 ml/h, incremental dose 2 ml, and lockout interval 15 min. VAS score was used to assess the intensity of pain (O= no pain, 10 = worst pain). Venous blood samples were taken before and at 30 min and 2 h after parecoxib or normal saline administration for coagulation test and platelet count.The postoperative ambulation time and adverse response were recorded. Butorphanol consumption per hour during postoperative analgesia and total consumption of butorphanol within 24 h after operation were also recorded. Results Compared with those before parecoxib administration, prothrombin time and thrombin time in group C and thrombin time in group P were significantly prolonged and fibrinogen concentration was significantly lower in group C at 30 min after parecoxib administration (P＜ 0.05), but no significant difference was found in the other parameters of blood coagulation and platelet count at 30 min after parecoxib administration in group P ( P＞0.05).The fibrinogen concentration was significantly higher, the incidence of postoperative nausea and vomiting was significantly lower, the postoperative ambulation time was significantly shorter, and butorphanol consumption per hour during postoperative analgesia and total consumption of butorphanol within 24 h after operation were significantly lower in group P than in group C ( P＜0.05 ), but there was no significant difference in the other parameters of blood coagulation and platelet count between group P and group C ( P ＞ 0.05 ). Conclusion Preemptive parecoxib 40 mg can enhance blood coagulation in patients undergoing abdominal hysterectomy.

Objective To investigate the effects of programmed intermittent epidural bolus (PIEB) with continuous epidural infusion (CEI) at different time intervals for epidural labor analgesia.Methods One hundred and eighty-six nulliparous parturients were randomized to the groups P1, P2 and C.Epidural infusion was given initial loading dose: 10 ml (0.125% ropivacaine with 0.4 μg/ml sufentanil), followed by maintaining dose: 0.08% ropivacaine with 0.4 μg/ml sufentanil.Group P1 was given basal infusion 5 ml per 30 min, 30 min after the initial dose;group P2 was given basal infusion of 10 ml per 60 min, 60 min after the initial dose;CEI basal infusion of 10 ml/h immediately after the initial dose;PCEA (patient-controlled epidural analgesia dose) 5 ml (lockout interval: 30 min).The baseline maternal heart rate, noninvasive arterial blood pressure, SpO2, respiratory rate, and fetal heart rate tracing were recorded.The visual analog scale (VAS) was recorded during the first stage of labor and at full cervical dilation.The degree of motor block was assessed in both lower extremities using the modified Bromage score (MBS).The maximum blocked segment, the consumption of anesthetic, delivery mode, amount of oxytocin, The number of cases of motor block and intrapartum fever, the fetal Apgar scores,adverse reactions,maternal satisfaction score were recorded.Results The VAS obviously decreased in the three groups since receiving labor analgesia (P<0.05).The ratio of VAS score more than 3 scales in group PIEBⅡ was significantly lower than that in groups P1 and C (P<0.05).The maximum blocked segment increased in group P1, while The incidence of unilateral block was significantly decreased in group P2 (P<0.05).The total drug consumption.And the toatal number of PCA were decreased obviously in group PIEB (P<0.05).The initial PCA time was significantly prolonged in group P2 (P<0.05).The number of instrumental midwifery and intrapartum fever in group P2 were significantly lower than that in group C (P<0.05).Conclusion Programmed intermittent epidural bolus at the beginning 60 min intervals after the initial dose for epidural labor analgesia is scientific and effective.

Objective To observe the analgesic efficacy of epidural morphine for postpartum perineal pain in patients undergoing episiotomy.Methods After institutional reviewing board approval and patient consent,a total of 145 parturients requesting epidural labor analgesia and under-going episiotomy were randomized into three groups:M1,M2,and C,where in morphine 1 mg dis-solved in saline 10 ml,morphine 2 mg dissolved in saline 10 ml,or sole saline 10 ml was epidurally given immediately after umbilical cord clamp,respectively.Perineal pain at rest and movement within 24 hours after vaginal delivery were evaluated with present pain intensity (PPI).Further,the time in-terval between a moderate or severe PPI and epidural drug treatment were recorded.Besides,epidural morphine related side effects including nausea,vomiting,pruritus,and urinary retention were ob-served as well.Results The proportion of patients with moderate or severe pain at rest was signifi-cantly lower in group M2 (2.1%)compared to group M1 (15.7)and group C (19.1%)(P <0.05). Further,the time interval between a moderate or severe PPI and epidural drug treatment was signifi-cantly longer in group M2 (15.7±1.4 h)compared to group M1 (11.0±0.9 h)and group C (11.0 ±1.0 h)(P <0.05).No significant difference was found between groups M1 and group C with regard to morphine efficacy.However,the accumulated side effects including nausea,vomiting,pruritus, and urinary retention prominently increased in group M2 (102.1%)compared to group M1 (43.1%) and group C (12.8%)(P <0.05).Conclusion Although epidural morphine 2 mg may significantly decrease and postpone the occurrence of moderate or severe postpartum perineal pain,however,it de-serves consideration before clinical use owing to the increased side effects.

Objective:To describe the trends of loss of muscle fiber thickness of the arm and calf.Methods:From April 2019 to July 2019, 58 patients admitted to ICU of Qinghai Provincial People's Hospital were enrolled. During ICU stay, the muscle fiber thickness in bilateral upper arm (biceps brachii) and bilateral calf (gastrocephus muscle) were measured by bedside color ultrasound every day.Results:The muscle fiber thickness of biceps and gastrocnemius on the left and right were (1.52 ± 0.37), (1.50 ± 0.34), (1.53±0.39), (1.51 ± 0.37) mm, respectively. The thickness of muscle fibers were (1.45 ± 0.35), (1.46 ± 0.37), (1.44±0.33), (1.41 ± 0.32) mm, which were significantly decreased in 48 h admitted to ICU ( t values were 2.106-4.711, P<0.05 or 0.01); and (1.43 ± 0.36), (1.44 ± 0.36), (1.44±0.32), (1.39 ± 0.32) mm in 72 h, which were significantly decreased than 24 h admitted to ICU ( t values were2.029-4.504, P<0.05 or 0.01). During 1 week admission to ICU , the muscle fiber thickness showed a continuous trend of decline, and the muscle fiber thickness of the left biceps, right biceps, left gastrocnemius and right gastrocnemius decreased by 8.38% (0.13/1.55), 10.19% (0.16/1.57), 9.87% (0.15/1.52), 11.11% (0.17/1.53), respectively compared with the ICU admission. The muscle fiber thickness of the left biceps, right biceps, left gastrocnemius and right gastrocnemius decreased by 9.87% (0.15/1.52), 9.33% (0.14/1.50), 9.15% (0.14/1.53), 11.26% (0.17/1.51), respectively. Conclusion:Muscle attenuation can be observed within 48h after ICU entry, and it tends to decrease with the extension of the length of hospital stay.