Objective To investigate the effects of acute hypervolemic hemodilution (AHH) on cerebral O2 supply/consumption and energy metabolism in patients undergoing elective surgery under general anesthesia combined with continuous epidural block. Methods Fourteen ASA Ⅰ or Ⅱ patients of both sexes (9 male, 5 female) aged 44-62 yrs weighing 55-70 kg undergoing elective surgery under general anesthesia combined with epidural block were enrolled in this study. Lactated Ringer's solution 6-8 ml?kg-1 was infused before anesthesia. After correct placement of epidural catheter was confirmed radial artery was cannulated for BP monitoring and blood sampling. BP, EGG, SpO2 and PET CO2 were continuously monitored during anesthesia. General anesthesia was induced with fentanyl, midazolam, propofol and rocuronium and maintained with iaoflurane and intermittent i. v. boluses of vecuronium. The patients were intubated and mechanically ventilated. PET CO2 was maintained at 30-35 mm Hg. Epidural block was produced by a mixture of 1.33 % lidocaine + 0.167 % dicaine. Right internal jugular vein was retrogradely cannulated and advanced cephalad until jugular bulb for blood sampling. AHH was conducted by infusing 6% HES 20 ml?kg-1 at 50 ml?min-1 after induction of general anesthesia. Blood samples were taken from artery (a) and jugular venous bulb (jv) simultaneously before AHH (T0) at 15 min (T1) and 120 min (T2) after AHH was accomplished for blood gas analysis and determination of Hb, glucose and lactate concentrations. Cerebral O2 extraction rate (CERO2), glucose extraction rate (CMRglu) , arterial-jugular bulb venous O2 content difference (D a-jvO2) and arterial-jugular bulb venous lactate difference (VADL) were calculated. Results At the end of AHH Hct and Hb decreased by 20% as compared to the baseline values before AHH. S jvO2 was significantly higher, D a-jvO2 smaller and CERO2 lower at T1 than at T0. There were no significant differences in BP, HR, CMRglu and VADL at all time points. Conclusion AHH can increase cerebral O2 supply and has no significant effect on cerebral glucose metabolism during operation performed under general anesthesia combined with epidural block.

AIM:To evaluate the prophylactic effect of azasetron in different juncture injection on postoperative nausea and vomiting(PONV)during patients controlled intravenous ananlgesia(PCIA).METHODS:One hundred and twenty patients,scheduled for selective abdominal operations,were randomly divided into four groups:patients received an preoperative intravenous injection of 10 mg azasetron(Group A,n=30),patients received an intravenous injection of 10 mg azasetron during abdominal cavity(Group B,n=30),patients received an intravenous injection of 10 mg azasetron when the operation were finished(Group C,n=30),patients with no azasetron as control(Group D,n=30).The incidence rate and score of PONV,the visual analogue scales(VAS)and Ramsay scores were recorded at 4,8,12,24,48 h postoperatively.RESULTS:There was significant difference between the postoperative VAS during 12 to 48 h and that of 4 h postoperatively(?0.05).CONCLUSION:A preoperative intravenous injection of 10 mg azasetron can be used effectively to prevent PONV during PCIA.

Objective To investigate the effects of 3 different delivery methods on maternal and fetal complications during labor and determine better mode of delivery. Methods Sixty pregnant women with ASA class Ⅰ or Ⅱ were randomly divided into three groups with 20 cases each: the cesarean section group (group Ⅰ), the pain relief group (group Ⅱ) and normal delivery group (group Ⅲ). In group Ⅰ and Ⅱ, an epidural catheter was placed through L_(2-3) interval. 0.5% ropivacaine was injected via the epidural catheter for continuous epidural anesthesia in group Ⅰ. After a loading dose of 8-10 mL 0.125% ropivacaine+2 μg/mL fentany, the patient-controlled epidural analgesia (PCEA) during labor was started with bolus 5 mL, lockout interval 20 min and back ground infusion rate 6-8 mL/h in group Ⅱ. The level of block was controlled below T_(10). BP, HR and RR were continuously monitored during labor. Blood samples were taken from umbilical vein at delivery for blood gas analysis and determination of lactate concentration. Neonates were assessed by Apgar score and neurological and adaptive capacity score (NACS). Maternal postoperative complications were recorded. Results There was no statistical differences in plasma pH, PCO_2, PO_2, SO_2, Apgar score and NACS among 3 groups. The umbilical vein blood lactate concentration was significantly increased in group Ⅱ and Ⅲ compared to the group Ⅰ, while blood lactate concentration in group Ⅱ was lower than that in the group Ⅲ (P<0.05). Base excess (BE) was significantly higher in group Ⅲ than in group Ⅰ. Compared with group Ⅱ and Ⅲ, maternal postoperative complications such as urinary retention, postpartum hemorrhage and so on were increased significantly in group Ⅰ (P<0.05). PCEA provided satisfactory effect in group Ⅱ. Conclusions Epidural labor analgesia with 0.125% ropivacaine+2 μg/mL fentany can provide comparative and effective analgesia for pain relief during labor without adverse effects on the mothers and fetuses and may reduce the postoperative complications. It is a safer and more effective technique in pain relief during labor.

Objective To observe the changes of plasma calcitonin gene-related peptide (CGRP) and endothelin (ET) during propofol-induced anesthesia and intubationMethods Thirty-six patients were randomly allocated to receiving intravenous administration with propofol 2mg/kg ( group PP, n=20) or sodium thiopental group (SP, n=16) The venous bloos samples were taken to measure the plasma CGRP and endothelin (ET) concentrations, together with systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR), immediately before induction, 2min after P or SP administration, 2min, 7min, 15min after intubationResults SBP decreased immediately after induction in both groups (P005), increased markedly in group SP (P

Objective To investigate the effects of acute hypervolemic hemodilution (AHH) with hydroxyethyl starch (HES) 130/0.4 on intestinal mucosal barrier in a rat model of sepsis.Methods Thirty healthy New Zealand rabbits of both sexes weighing 2.0-3.0 kg were randomly divided into 3 groups (n=10 each):group I sham operation; group II sepsis and group III AHH+sepsis.Sepsis was produced by modified colon ascendens stent peritonitis(CASP).At 4 h after CASP group III meceived HES 130/0.4 20 ml/kg iv at a rate of 20 ml/min.The MAP and HR were monitored and recorded at 4 h (before AHH) and 5,6,7,8 h after CASP.Blood samples were taken from carotid artery and superior mesenterie vein (SMV) at 4 h and 8 h after CASP for blood gas analysis and determination of plasma D-lactate concentration and intestinal oxygen extraction ratio.The rabbits were sacrificed at 8 h after CASP and a segment of ileum of 3 cm in length,5 cm from ileocecal valve,was removed for determination of wet/dry ileum weight ratio and microscopic examination.The degree of damage to intestinal mucous membrane was scored according to Chiu score (0=normal,5=severe damage).Results Sepsis-induced hypotension and metabolic acidosis,increased plasma D-lactate concentration,decreased intestinal oxygen extraction ratio,increased wet/dry ileum weight ratio and Chiu score in group II as compared with group I.AHH with HES 130/0.4 20 ml/kg significantly attenuated the scpsis-induced changes in group III.Conclusion AHH with HES 130/0.4 can attenuate damage to intestinal mucosal barrier produced by sepsis.

Objective To investigate the effect of epidural morphine for analgesia on the number of interstitial cells of Cajal (ICC) in the rabbit colon.Methods Thirty healthy rabbits of either sex,weighing 2.0-2.5 kg,were randomly divided into 2 groups (n =15 each):control group (group C) and morphine group (group M).The animals were anesthetized with iv 20% urethane 4 ml/kg.The epidural analgesia was performed at L3,4 interspace.In group M morphine 9.2 ug· kg-1 · h-1 was infused into the epidural space for 7 consecutive days,while the equal volume of normal saline was infused instead in group C.The characteristics of excrement and constipation were recorded during morphine infusion.Normal saline or Chinese ink mixture 5 ml was administered via a gastric tube inserted through the mouth 1 day after the end of administration.The rabbits were sacrificed 30 min later and laparotomy was performed.The intestinal segment numbered from the pylorus to the ileocecal region of the bowel was removed and the length of the intestinal segment and propelled distance of the ink within the intestinal tract were measured in the tension-free state.The rate of propelled distance was calculated.The proximal and distal colon tissues were taken for measurement of the expression of c-kit (by immunohistochemisty) and ICC count,and stained with haematoxylin and eosin for examination of pathological changes.Results Compared with group C,the incidence of constipation was significantly increased,and the rate of propelled distance,and expression of c-kit and ICC count in proximal colon tissues were decreased at 3-7 days of morphine infusion (P ＜ 0.05),and no significant change was found in the expression of c-kit and ICC count in distal colon tissues in group M (P ＞ 0.05).Conclusion Epidural morphine for analgesia can inhibit the motor function of the intestinal tract in rabbits,and reduction in the number of ICC count in proximal colon is involved in the mechanism.

Objective To evaluate the effect of morphine exposure in the late pregnancy on the expression of 2B subunit-containing N-methyl-D-aspartate receptor (NR2B) in the nucleus accumbens of offspring rats.Methods Forty-eight Sprague-Dawley rats at 14 days of gestation,aged 16-20 weeks,weighing 400-600 g,were equally and randomly divided into control group (group C) and morphine group (group M).In group M,morphine was administered subcutaneously twice a day (9:00 a.m.and 5:00 p.m.) in the initial dose of 2 mg/kg followed by daily increment of 1 mg/kg until 6 mg/kg.The equal volume of normal saline was given instead of morphine in group C.Fifty offspring rats with similar body weight were selected from the two groups,and conventionally fed for 8 weeks.Thirty offspring rats were further selected,morphine 3 mg/kg was injected subcutaneously for 7 consecutive days,and then the rats underwent the conditioned place preference test to monitor the effect.The time spent in drug-paired side (gray area) was recorded at 24 h after the test.Ten offspring rats selected were sacrificed after the test,and the brain was removed.The nucleus accumbens was isolated for detection of the expression of NR2B by immunohistochemistry and Western blot.Results Compared with group M,the time spent in drug-paired side (gray area) was significantly prolonged,and the expression of NR2B in the nucleus accumbens was up-regulated in group C (P＜0.05).Conclusion The mechanism by which morphine exposure in the late pregnancy causes susceptibility to morphine addiction is associated with up-regulation of NR2B expression in the nucleus accumbens of offspring rats.

Objective To compare the time-course of relaxant effect of rocuronium between patients with ocular and generalized myasthenia gravis (MG).Methods Twenty-seven ASA physical status I or Ⅱ patients with MG of both sexes,aged 12-64 yr,with body mass index of 17-26 kg/m2,scheduled for elective extended thymectomy,were divided into 2 groups according to Osserman stage:ocular group (group O,n =10) and generalized group (group G,n =17).Anesthesia was induced with iv injection of fentanyl 2 μg/kg,midazolam 0.05 mg/kg,and propofol 1.5 mg/kg.All patients were tracheal intubated and mechanically ventilated.Anesthesia was maintained with iv infusion of propofol 4-8 mg· kg-1 · h-1 and remifentanil 0.2 μg· kg-1 · min-1.Twitch tension was monitored in the adductor pollicis muscle by train-of-four stimulation of the ulnar nerve (intensity 60 mA,interval 12 s,frequency 2 Hz,wave length 0.2 ms).Rocuronium 0.6 mg/kg was injected intravenously after calibration.Mean arterial pressure (MAP),HR,heart rate variability (HRV) and low frequency and high frequency (LF/HF) ratio was recorded.The onset time of muscle relaxation,time for T1 to recover to 25％,time for T1 to recover to 50％ and recovery index were recorded.Results Compared with the baseline value,there were no significant changes in MAP,HR,HRV,LF/HF ratio at all time points in the two groups (P ＞ 0.05).Compared with group O,there was no significant change in the onset time of muscle relaxation,and the time for T1 to recover to 25％,time for T1 to recover to 50％ and recovery index were significantly prolonged in group G (P ＜ 0.05).Conclusion The duration of rocuronium-induced neuromuscular block is significantly longer in patients with generalized MG than those with ocular MG,while the onset time is comparable between the two groups.

AIM: To investigate the effect of low concentration desflurane on hemodynamics and fibrinolysis in patients during general anesthesia. METHODS: Twenty eight ASA grade Ⅰ-Ⅱ patients during general anesthesia, scheduled for elective chest surgery, were studied, and hemodynamics and fibrinolysis were observed after inhalation of desflurane at 0.5 and 1.0 MAC , respectively. RESULTS: Compared with those before anesthesia, SBP, DBP, and MAP remarkably decreased and HR significantly increased at intubation. However, the changes were more remarkable than those of before anesthesia when inhalation of desflurane at 0.5 and 1.0 MAC ; blood pressure did not further decreased; and HR did not increased in comparison with intubation. The level of plasma tissue plasminogen activator (t PA) remarkably increased and the level of plasma plasminogen activitor inhibitor (PAI) significantly decreased when inhalation of desflurane. The level of plasma t PA further increased and the level of plasma PAI further decreased as inhalation of increased desflurane concentration. CONCLUSION: There are some effects of low concentration desflurane on hemodynamics and fibrinolysis in patients with chest surgery during general anesthesia.

Objective To explore the syphilis epidemiological characteristics of blood recipients in Xinyang ,reduce medical dis‐putes and prevent hospital infection .Methods The gender ,age ,occupation ,education and other data of 16 429 blood recipients in our hospital were collected .Then we performed statistical analysis on the test results of syphilis antibodies to all kinds of people . Results Out of 16 429 samples ,137 cases were detected positive ,the prevalence was 0 .83% .Among them ,there were 70 males ,ac‐counting for 0 .74% male patients ,67 females ,accounting for 0 .96% female patients ,and there was no significant difference be‐tween the male and female patients(P>0 .05) .Syphilis infection in different age groups had significant difference(P<0 .05) .Mean‐while ,linear trend test suggested that syphilis infection rate increased with age(P<0 .01) .Different cultural level also had different infection rate of syphilis ,the higher cultural level ,the lower infection rate .Among non‐employed persons and farmers the prevalence of syphilis was highest .In contrast ,the prevalence was lowest among students .Conclusion Syphilis infection rates were not the same among different kinds of people ,and the syphilis test should be strengthened to blood recipients .