Oblective To define the median effective dose (ED50) and 95%effective dose of fentanyl for inhibition of emergence agitation after sevoflurane-remifentanil anesthesia in children.Methods Twenty six ASA ⅠorⅡchildren aged 5-8 yr weighing 15-30 kg undergoing adenoidectomy under general anesthesia were studied.The patients were unpremedicated.Anesthesia was induced with inhalation of 8%sevoflurane (fresh gas flow=6 L/min)and iv remifentanil 1μg/kg.The patients were mechanically ventilated after tracheal intubation.Fentanyl was injected iv to inhibit emergence agitation.The dose of fentanyl was determined by using modified Dixon's upand-down method (increment or decrement of 0.5μg/kg).The initial dose of fentanyl was 4 μg/kg.Anesthesia Sevoflurane inhalation and remifentanil infusion were terminated at the end of operation.The patients were transferred to the PACU.No alteration in the ventilatory settings was made.Stimulation of the patients was avoided during emergence.The emergence time and the occurrence of agitation,nausea and vomiting and respiratory depression within 4h after operation were recorded.ED50,ED95 and 95%confidence interval (CI) of fentanyl for inhibition of emergence agitation were calculated.Results ED50 was 3.01μg/kg (95%CI 2.52-3.40μg/kg) and ED95 3.81μg/kg(95%CI 3.41-6.22μg/kg).No nsusea and vomiting and respiratory depression occurred within 4h after operation.The emergence time was (11.3±2.6) min.Conclusion The ED50 and ED95 of fentanyl for inhibition of emergence agitation after sevoflurane-remifentanyl anesthesia were 3.01 and 3.81μg/kg respectively in children.

Through the comparative study on fostering mode of postgraduate education of public health between China and America,for example,the admission criteria and scale,the duration of study,fostering aims and hierarchy,curriculum structure and methods of management,etc.so as to seize the moment of reforming of university and health care institution to promote Chinese education reform of public health,provide reference for Chinese postgraduate education of public health.

In 87 ICU patients intramucosal pH (pHi) was measured, and the new simplified acute physiology score (SAPSⅡ) was calculated within the first 24h ICU admission. Eleven(12 6%) patients died in the ICU.The nonsurvivors had a relatively lower pHi(7 03?0 27) and a higher SAPSⅡ(45?11 77),while the svrvivors had a higher pHi (7 42?0 13) and a lower SAPSⅡ(19 58?10 32).The difference was statistically significant( P

It elaborates the importance of designing a patient-centered hospital environment, and presents the concept of such a design. The authors hold that such a concept is mostly composed of systematic, people-oriented, informationized and variability designs, and describe the design trends in contemporary hospitals. It is also pointed out that patient-centered principle should be dominant in building a contemporary hospital, as the guideline and development trend, as a satisfactory hospital environment makes a hospital more competitive.

ObjectiveTo investigate the feasibility of auxiliary orthotopic partial liver transplantation (APOLT) from a living donor for the treatment of Willson′s disease.MethodsThe patient was a 20-year-old girl with Willson′s disease, whose blood type was O. The donor was a man aged 21 and his blood type was A. The left lateral lobe (260?g) of patient′s liver was removed, the left lateral lobe (295?g) of donor′s liver was grafted to the patient in situ. Blood plasma exchange was carried out to the recipient before transplantation. FK506 adrenocortical hormones and cytoxan was administered after operation. ResultsThe recipient had a onset of hepatic artery thrombosis 15 days after operation, and ensuing intraabdominal hemorrhage caused by thrombolytic agent was successfully managed by laparotomy. Other postoperative complications such as hydroperitonia, pulmonary atelectasis and bile fistula were cured. Now the patient has survived 15 months with a normal copper-protein level, a mitigated extrapyramidal symptom and the grafted liver grows larger.ConclusionAPOLT is a feasible remedy for late-staged Willson′s disease.

Objective:To investigate the effect of ulinastatin(UTI) on the changes of IL-6,TNF-?,IL-10 and IL-4 expression during perioperative period of surgical correction of adolescent idiopathic scoliosis(AIS).Methods: Twenty patients with AISⅠ-Ⅱ scheduled to receive surgical correction of spinal deformities were equally randomized into 2 groups-UTI group and control group.Patients in UTI group received intravenous infusion of 10 000 U/kg UTI with 250 ml normal saline just before operation and every 4 h thereafter if necessary;patients in control group received same amount of normal saline.ECG,CVP,SpO_(2)and P_(ET)CO_(2) were continously monitored during operation in both group.Mean arteral pressure(MAP) was maintained at(60?5) mmHg(1 mmHg=0.133 kPa).Venous blood samples were collected immediately before induction of anaesthesia(T_(1)),10 min after induction(T_(2)),1 h after UTI administration(T_(3)),30 min after extubation(T_(4)) and 24 h postoperatively(T_(5)).The plasma levels of IL-6,TNF-?,IL-10 and IL-4 were measured by enzyme-linked immunosorbent assay(ELISA),and their mRNA expression was assayed by real-time quantitative reverse transcription polymerase chain reaction.Results: At T_(3),T_(4) and T_(5),plasma levels of IL-6 and TNF-? and their mRNA copies in control group were significantly higher than that at T_1(P

Objective To evaluate the effect of desflurane on emergency in patients undergoing suspension microlaryngoscopy surgery.Methods Forty adult patients with ASA Ⅰ-Ⅱ who underwent elective microlaryngoscopy surgery were randomly divided into desflurane group (group D,n =20) and sevoflurane group (group S,n =20).Time from end of the surgery to resume of spontaneous breathing,extubation,and discharge from postanesthesia care unit (PACU) were recorded.The extent of cough reflex during extubation and cough episode after extubation were recorded.Perioperative mean arterial pressure (MAP) and heart rate (HR) were recorded before anesthesia induction (T0),on suspension laryngoscope instrument (Ttary),the gas concentration reached 1.3 MAC (T1.3mac),1 min after 1.3 MAC (T1.3 1),on arrival at PACU (Tpacu),on extubation (Textu),1 min after extubation (T 1),5 min after extubation (T 5),and on discharge from PACU (Tdis).Results Time from end of the surgery to resume of spontaneous breathing was not significantly different between the two groups.Time to extubation in group D was 4.6 min,which was shorter than it was in group S (P＜0.05).Time to discharge from PACU was 5.0 min in group D,which was shorter than it was in group S (P＜0.05).Incidence of cough was 100％ in group D and 55％ in group S during extubation (P＜0.05).The episode of coughing after extubation was not significantly different between the two groups.Perioperatively,changes of MAP and HR between the two groups were not significantly different (P ＞ 0.05).Conclusions Desflurane for adult patients undergoing suspension microlaryngoscopy surgery was associated with fast emergence.The incidence of cough was higher in group D than it was in group S during extubation,but it continued a short duration.

Objective To investigate the effect of competitive N-methyl-D-aspartate (NMDA) receptor antagonist LY274614 [(?)-6-phosphonomethyl-decahydroisoquinolin-3-carboxylic acid] on the development of morphine tolerance and dependence.Methods Male Spraque-Dawley rats were rendered tolerant and dependent by subcutaneous injection of morphine(15mg/kg body weight) three times a day for 10 consecutive days. LY274614 (2, 4, 6 mg/kg body weight) was also given subcutaneously by subcutaneous injection. Antinociception was measured by tail-flick (TF) test. Tail was exposed to the heat source(a beam of high intensity light). The time from the beginning of exposure to removal of tail from the path of the heat source was taken as latency. The baseline TF latency without medication was 4-5 seconds. A ten-second maximum exposure to the heat source was used to minimize damage to tissue during the multiple measurements. Morphine prolonged TF latency. With the development of tolerance TF latency gradually returned to baseline value. Physical dependence on morphine was assessed by abstinence syndrome precipitated by subcutaneous injecting naloxone 10 mg/kg on the tenth day. According to method of Blasig, the number of jumping/30min after naloxone injection was recorded as an index pf abstinence syndrome. Rats were randomly divided into 8 groups (n=6-8). Each group received morphine 15 mg/kg or normal saline (NS) 1.5 ml/kg+LY274614 (2.0,4.0,6.0 mg/kg) or NS, group 1: morphine+NS; group 2: NS+NS; group 3:morphine+LY274614 (2mg/kg); group 4: NS+LY274614 (2mg/kg); group 5: morphine+LY274614 (4mg/kg); group 6: NS+LY274614 (4mg/kg); group 7: morphine+LY274614 (6mg/kg); group 4: NS+LY274614 (6mg/kg).Results LY274614 itself did not have analgesic action, but if used with morphine, it did inhibit the development of tolerance. In group 5 and 7 the decrease in TF latency was more gradual than that in morphine+saline group. 4 and 6 mg/kg LY274614 reduced the number of jumping/30min following naloxone injection.Conclusions LY274614 can inhibit morphine tolerance and dependence rendered by consecutive subcutaneous morphine injection.

Objective To investigate the risk factors of hyperamylasemia in patients with gastrointestinal minimally invasive surgery.Methods Two hundred and twenty cases with gastrointestinal were selected as our subjects who were hospitalized in General Surgery Department of the Center Hospital of Binzhou from Jan 2012 to Jan 2014.The patients were divided into normal group and hyperamylasemia group according to the postoperative serum amylase levels.The complications of two groups were recorded.The risk factors of hyperamylasemia were analyzed with univariate and Logistic multivariate.Results There were 98 cases (44.54％,98/220) of concurrent hyperamylasemia,45 cases (20.45 ％) of colon surgery,53 cases (24.09％) of stomach surgery.The complications of hyperamylasemia group and normal group were 28 cases (28.57％) and 8 cases (6.56％),and the difference was significant (x2 =4.869,P =0.006).Univariate analysis showed that there were significant differences in terms of the abdominal surgery,surgical approach,body mass index ＞ 25 kg/m2,operation time,position,CO2 insufflation pressure,pneumoperitoneum duration and pancreatic treatment between two groups(P ＜ 0.05).Logistic multivariate analysis showed that the abdominal surgery,CO2 insufflation pressure,pneumoperitoneum duration and operative time were independent risk factors with hyperamylasemia.Conclusion There is high incidence of hyperamylasemia after laparoscopic gastrointestinal surgery.Patients with pancreatitis and postoperative infection are easily to get hyperamylasemia complications.Upper abdominal surgery,CO2 insufflation pressure,pneumoperitoneum duration,operative time are independent risk factors for hyperamylasemia.

Objective:In order to improve the treatment methods of laryngotracheal atresia, several improved surgical procedures were used.Method:From 1986,the 48 patients with laryngotracheal atresia accepted surgical treatment in our hospital.Laryngo-fissure with laser cauterization of the glottis, laryngotracheal reconstruction using surgical flaps with or without particles, laryngo-tracheal reconstruction using itself′s cicatrices, tracheal end-to-end anastomosis, two-stage laryngotracheal reconstruction using aqueduct method, bronchotracheal reconstruction through the chest. Result:46/48 cases were cured breathing without tracheal cannula.Following-up survey is 1～12 years.Conclusion:The treatment of cicatriceal laryngotracheal atresia was difficult, but if the surgical methods were selected carefully according to the situation of each patient, we also can get a good result.