0.05),but the total of propofol was different(P

Objective:To study the clinical benefit of propofol anesthesia with target-controlled influsion technic modulated by cerebral state index in the elderly patients with tumor. Methods:A total of 126 ASA Ⅰ or Ⅱ aged65 yrs or older patients underwent gastrectomy and rectal surgery were randomly divided into tow groups(n=63 each):group by target-controlled influsion technic modulated(groupⅠ)and group by target-controlled influsion(groupⅡ). CSI of groupⅠwas 50. Propofol of two groups was administered by TCI at a target blood concertration of 2?g/ml during induction of anesthesia and maintenance of anesthesia,sufentanil of two groups was administered by TCI at a target blood concertration of 1.5?g/ml during induction of anesthesia and of 0.3ng/ml during maintenance of anesthesia. MAP,HR,HRV and CSI of the foundation(T1),intubation(T2),five minutes after intubation(T3),chip(T4),the tumor excision(T5) and the end of surgery(T6) were recorded. And the total of propofol was recorded. Results:MAP at T3,T4 and T5 of groupⅡdecreased obviously compared to that of groupⅠ(P

OBJECTIVE:To find out a cost-efficient antibiotic prophylaxis of p ul monary and esophageal surgery by way of pharmacoeconomic analysis METHODS:To c ompare the efficacy and cost between short-term and long-term of prophylactic uses of ceftriaxone in pulmonary and esophageal surgery by randomized controlled study and cost-effectiveness analysis RESULTS:Single-dose ceftriaxone regim en and four-dose ceftriaxone regimen were equally effective in preventing posto perative infections in pulmonary and esophageal surgery,the average cost per pa tients for single-dose ceftriaxone regimen(1 257 84?769 67)yuans was signi ficantly lower than that for four-dose ceftriaxone regimen(1 786 69?652 83 ) yuans,P

The present study was performed to investigate the relationship between the countercurrent of portal vein and intrahepatic cancerometastasis in patients with hepatic carcinoma under color Doppler flow imaging.To display the situation of portal carcinomatous thrombosis and intrahepatic cancerometastasis, two dimensional ultrasound was carried out in patients with hepatitis hepatocarcinoma and non hepatitis hepatocarcinoma. Also, color Doppler flow imaging was employed to examine the incidence of the pylic countercurrent and the portal vein hepatic artery fistula in four groups: hepatitis hepatocarcinoma group, non-hepatitis hepatocarcinoma group, hepatocirrhosis group and control group. The results showed that the incidences of portal carcinomatous thrombosis,intrahepatic cancerometastasis and the incidences of the countercurrent in portal vein were higher in hepatitis hepatocarcinoma group than those in non hepatitis hepatocarcinoma group ( P

Objective To investigate the curative effect of Quadrant channel transforaminal lumbar interbody fusion(TLIF) in the treatment of recurrent lumbar disc herniation(RLDH).Methods Seventy-six cases patients with RLDH were divided into traditional TLIF group(36 cases) and Quadrant group(40 cases) by the different operation modes.The operation,VAS scores and ODI scores were compared between the two groups.Results Operation time((98.2±18.1) min vs.(118.5±27.2) min,t=3.79,P<0.05),incision length((2.7±0.6) cm vs.(5.5±1.0) cm,t=14.97,P<0.05),intraoperative blood loss((90.7±20.1) ml vs.(170.3±33.5) ml,t=12.71,P<0.05) and intraoperative drainage((43.8±12.4) ml vs.(117.1±28.9) ml,t=14.62,P<0.05) in Quadrant group were less than that in traditional TLIF group.The ambulation time((2.8±0.6) d vs.(6.8±1.1) d,t=19.95.P<0.05) and hospitalization time((7.1±2.0) d vs.(14.2±2.7) d,t=13.11,P<0.05) of Quadrant group were shorter than those of TLIF group.VAS scores in both groups were significantly decreased.VAS in Quadrant group was significantly lower than that in traditional TLIF group from 3 d to 6 months after operation((4.4±1.0,3.9±1.2,3.4±0.8,1.9±0.6,1.3±0.4) points vs.(5.0±1.4,4.5±1.1,4.1±0.9,3.6±0.7,2.5±0.6) points,P<0.05).ODI scores in both groups were significantly decreased.ODI in Quadrant group was significantly lower than that in traditional TLIF group from 1 d to 6 months after operation((36.7±7.1,33.4±6.2,30.7±4.1,27.8±5.3,24.5±5.4,18.4±4.7) points vs.(39.8±6.0,36.8±5.8,33.5±6.6,31.3±5.1,28.9±6.6,22.3±5.2) points,P<0.05).Conclusion The treatment of RLDH by Quadrant channel TLIF has obvious curative effect,short operation time,less trauma,faster recovery and shorter hospital stay.

ObjectiveTo investigate the changes in stroke volume variation (SVV) monitored by FloTrac/Vigileo system during mechanical ventilation in patients undergoing pulmonary lobectomy.MethodsForty-four ASA Ⅰ or Ⅱ patients aged 44-64 yr weighing 47-86 kg undergoing elective pulmonary lobectomy performed under general anesthesia were studied.Blood volume was maintained by fluid (crystalloid∶ colloid 1∶1) infusion at a rate of 6-8 ml·kg-1 ·h-1.Cardiac output index (CI),stroke volume index (SVI) and SVV were measured based on arterial pressure wave form analysis by FloTrac/Vigileo System (Edwards Co.,USA) and recorded at following time points:at 5 min of two-lung ventilation (TLV) in supine position,2 min TLV in lateral position,during one-lung ventilation (OLV) before thoracotomy,at 5 and 30 min of OLV after thoracotomy,1 and 15 min OLV + PEEP of 5cm H2 O,before and immediately and 1 min after reflation of the remaining lobes.The normal value for SVV is less than 13％.ResultsThe hemodynamic parameters were stable during lobectomy.CI and SVI were within normal range.SVV was less than 13％ at all time points except that at immediately after reflation of the remaining lobes.ConclusionSVV obtained with FloTrac/Vigileo system can be used to guide fluid therapy during OLV in mechanically ventilated patients undergoing pulmonary lobectomy.

Objective To investigate the role of ileocecal valve in children patients with intussus-ceptions by colonoscopy after pneumatic air enema reduction. Methods A total of 106 intussusceptions chil dren patients, who recovered with pneumatic air edema reduction, were recruited to the study. They underwent colonoscopy within 12 hours after reduction. The control group was composed of 103 children patients with both diarrhea and hematochezia. There was no significant difference in age, sex or weight between the two groups.Colonoscopic findings were recorded in terms of slack, swelling, prolapsus, lymphoid hyperplasia and mucosal lesions in ileocecal valve. Results In patients with intussusceptions, the rates of ileocecal valve slack, swelling including prolapsus, lymphoid hyperplasia and mucosal lesions were 61.3%, 33. 9%, 100. 0% and 31.1%, respectively, which were significantly different with those of the control group (P ＞ 0. 05 ). When further divided intussusceptions patients into groups with age more than 1 yr or less, significant differences were also observed in regarding of these features. Conclusion There is a close relationship between morphological and functional changes in ileocecal valve and intussusceptions in children. Ileocolic intussusceptions in patients younger than 1yr is more likely to be due to slack of ileocecal valve, while that in patients older than 1yr is mainly due to swelling or prolapse of ileocecal valve, represented by ileocecal intussuception.

ObjectiveTo retrospectively analyze the experience in the treatment of cardiac rupture caused by blunt chest trauma and to explore the approaches and methods to improve patient survival.Methods From 2004 to 2010,16 cases of closed chest trauma caused by cardiac rupture,who were treated in our hospital,were treated by heart repair using median sternotomy incision approach.Results Except for 1 patient occurred cardiac arrest before the establishment of CPB,who was failed for cardiopulmonary resuscitation after surgical repair,the remaining 15 patients were all successfully treated.Conclusion The diagnosis of cardiac rupture should be made as soon as possible once it occurs.Timely and decisive rescue and emergency surgery should be given.Heart repair can greatly improve the patient's survival.

Objective To study causes of deterioration of sudden mydriasis in craniocerebral trauma patients with normal intracranial pressure and verify the efficiency of specific treatments.Methods A retrospective analysis was performed on causes of four cases of accidental mydriasis in normal intracranial pressure among 473 cases of craniocerebral trauma treated from June 2008 to March 2012.Changes of patients' condition and monitoring indices were observed after specific treatments.Results Abnormal mydriasis with synchronously normal intracranial pressure was largely due to sufficient decompression after a certain period of intracranial hypertension and persistence of brain perfusion pressure to more than 110 mm Hg or due to high cerebral perfusion pressure caused by redundant drainage of cerebrospinal fluid or low intracranial pressure (＜ 10 mm Hg),together with factors like low plasma osmotic pressure and carbon dioxide accumulation.The study showed that the intracranial pressure was maintained normal,that the brain swelling took a turn for better,that medical condition were stabilized and that pupil returned to normal in the four cases after treatment with specific protocol.GOS was four points in three cases and five points in one during follow-up at six months postoperatively.Conclusion Incidence of mydriasis with normal intracranial pressure in craniocerebral trauma patients can be efficiently declined through reduction of peripheral blood pressure,perfusion pressure controlling,hypertonic remedy maintenance and brain edema relief.

To explore the value of acoustic radiation force impulse (ARFI) technique in the differential diagnosis of benign and malignant hepatic neoplasms.Retrospective analysis of touch tissue quantification (VTQ) and general ultrasonic examination of interesting region were performed for hepatocellular carcinoma (HCC),hepatic hemangioma,focal nodular hyperplasia (FNH) and controls.Significant differences existed between HCC and hepatic hemangioma,hepatic FNH and controls (all P ＜0.01).No significant difference existed between primary and metastatic HCC (P ＞ 0.05).There was no significant difference between hepatic hemangioma,FNH and controls (all P ＞ 0.05).With a cut-off VTQ value of 1.95 m/s,the sensitivity and accuracy rate in the differentiation of benign and malignant hepatic neoplasms was 90％ and 83％ respectively.The sensitivity and accuracy rate in general ultrasound examination of hepatic neoplasms was 88％ and 70％ respectively.Significant differences existed in accuracy rate between two methods (P ＜ 0.01).It was confirmed that ARFI could reflect the stiffness of liver neoplasm noninvasively.Compared with general ultrasonography,ARFI is better at differentiating benign and malignant hepatic neoplasms.