Objective To evaluate the efficacy of ultrasound-guided transversus abdominis plane (TAP) block for postoperative analgesia in patients undergoing inguinal hernia repair.Methods Forty ASA Ⅰ or Ⅱ patients,aged 18-79 yr,with body mass index ＜ 30 kg/m2,scheduled for elective unilateral inguinal hernia repair combined spinal-epidural anesthesia,were randomly divided into 2 groups (n =20 each):control group (group C) and ultrasound-guided TAP block group (group B).The ultrasound-guided TAP block was performed at the end of surgery and 20 ml of 0.375 ％ ropivacaine was injected in group B,while the equal volume of normal saline was given in group C.Tramadol was injected intravenously when VAS score ≥ 4 after surgery.VAS scores at rest and during activity were recorded at 4,6,24 and 48 h after surgery.The warm block plane on the blocked side was measured at 24 and 48 h after surgery.The overall satisfaction on analgesia was scored and the time when the patients passed the flatus was recorded.TAP block-related side effects were recorded.Results Four patients required tramadol in group C,while no patients required rescue analgesic in group B.Compared with group C,VAS scores were significantly decreased,the overall satisfaction scores were increased (P ＜ 0.05 or 0.01),and no significant change was found in the time when the patients passed the flatus in group B (P ＞ 0.05).The rate of warm plane block on the blocked side was 80％ at 24 h after surgery and there was not warm block plane in patients at 48 h after surgery in group B.There was not warm block plane in patients at 24 and 48 h after surgery in group C.TAP block-related side effects were not found in group B.Conclusion The efficacy of ultrasound-guided TAP block for postoperative analgesia is better in patients undergoing inguinal hernia repair and the safety is higher.

Animals ; Birds ; Disease Outbreaks ; prevention & control ; Hong Kong ; epidemiology ; Humans ; Influenza in Birds ; epidemiology ; prevention & control ; Poultry ; Public Health ; Public Health Administration

Objective　To explore the relationship of defense style and mental health in student of middle school. Method 203 middle student were investigated with Defense Style Questionnaire (DSQ) and Symptom Check List-90 (SCL-90). Results There were no significant difference for 4 factors of DSQ in man／female and advance middle school or not(P>0.05); there were significant difference for immature defense mechanism and middle type factor ,and conceal factor in high-symptom score team with that of low-symptom sore team(P<0.01) and it is positive-correlation with each factor-score and total score of SCL-90. Conclusion School and family need to pay attention to the higher correlation in the total score of SCL-90 with immature defense mechanism and middle type factor and conceal factor.

Factor Analysis, Statistical ; Health Policy ; Leadership ; Occupational Health Services ; organization & administration

Bone Density Conservation Agents ; therapeutic use ; Bone Neoplasms ; complications ; drug therapy ; secondary ; Breast Neoplasms ; pathology ; Diphosphonates ; therapeutic use ; Female ; Humans ; Male ; Pain ; drug therapy ; etiology ; Prostatic Neoplasms ; pathology ; Quality of Life

Objective To investigate the effects of L-Arginine(L-Arg) on microcirculation perfusion after banked-blood transfusion in rabbits with hypovolemia.Methods Thirty healthy male New Zealand white rabbits weighing 2.0-2.5 kg were randomly divided into 3 groups (n =10 each): groups Ⅰ-Ⅲ.Hypovolemia was induced by blood letting (20％ of blood volume) and the equal volume of banked-blood was transfused 30 min later in groups Ⅰ and Ⅲ.25％ L-Arg 300 mg/kg was injected iv 5 min before blood letting in group Ⅲ,and the equal volume of normal saline was injected in group Ⅰ.Group Ⅱ only received 25％ L-Arg 300 mg/kg.MAP,CVP and tip perfusion index (TPI) were recorded at before (T0) and after blood letting (T1),end of banked-blood transfusion (T2),1 h ( T3 ) and 2 h (T4) after banked- blood transfusion,and blood samples were taken for determination of plasma lactate and nitric oxide (NO) concentrations.Results TPI was higher at T2-T4,plasma lactate concentration lower at T1 -T4 and plasma NO concentration lower at T3,T4 in groups Ⅱ and Ⅲ than in group Ⅰ ( P ＜0.05).There was no significant difference in MAP between groups Ⅱ,Ⅲ and group Ⅰ ( P ＞ 0.05).MAP was lower at T1 in group Ⅲ than in group Ⅱ (P ＜ 0.05).There was no significant difference in CVP among the 3 groups( P ＞ 0.05).Conclusion Pretreatment with L-Arg can increase microcirculation perfusion,and has no effect on hemodynamics in rabbits with hypovolemia after banked-blood transfusion.

Objective To investigate the clinical application of laparoscopic adrenalectomy and summarize the experience in laparoscopie adrenalectomy.Methods From August 2002 to March 2007,21 cases of benign adrenal tumors were treated with retroperitoneal laparoscopy in this hospital.There were 9 cases of adrenocortical adenoma, 7 cases of primary aldosteronism,3 cases of adenocorticol macronodular hyperplasia,1 case of pheochromccytoma,and 1 case of adrenal gangliocytoma.Results Retroperitoneal laparoscopy was successfully applied in 21 cases.Operating time was between 65 and 130min with an average of 95 min.All patients did not receive blood transfusion and had no obvious complications.Conclusion Laparoscopic adrenalectomy had the advantages of minimal morbidity,mini- mal postoperative discomfort and a short hospital stay,whieh had a good prospect for application in the clinical prac- tice.

Objective To evaluate the intraoperative opioid-sparing effect of different frequency transcutaneous electrical acupoint stimulation (TEAS) in the patients undergoing video-assisted thoracoscopic pneumonectomy.Methods Eighty patients,aged 40-64 yr,weighing 50-90 kg,of ASA physical status Ⅰ-Ⅲ,scheduled for elective thoracoscopic pneumonectomy under general anesthesia,were randomly divided into 4 groups (n =20 each) using a random number table:control group (group Con),stimulation on Lieque (LU7)-Quchi (LI11)-Neiguan (PC6)-Hegu (LI4) at 2/100 Hz group (group 2/100 Hz),stimulation on LU7-LI11-PC6-LI4 at 2 Hz group (group 2 Hz),and stimulation on LU7-LI1 1-PC6-LI4 at 100 Hz group (group 100 Hz).The patients in group Con had the electrodes applied,but received no stimulation.In 2/100 Hz,2 Hz and 100 Hz groups,the patients received 2/100,2 and 100 Hz TEAS on LU7-LI11-PC6-LI4 acupoints ipsilateral to the surgery site,respectively,starting from 30 min before induction of anesthesia until the end of surgery,and the intensity was the maximum current that could be tolerated.Anesthesia was induced with iv midazolam,propofol,sufentanil and cisatracurim,and maintained with target-controlled infusion of remifentanil and propofol,continuous infusion of cisatracurim,and iv boluses of sufentanil when necessary.The target plasma concentration of propofol was adjusted to maintain BIS value at 40-60 during operation.The initial target effect-site concentration of remifentanil was 1 ng/ml,and adjusted to 4 ng/ml at skin incision.The concentration of remifentanil and consumption of sufentanil were adjusted to maintain Analgesia Nociception Index (ANI) at 50-70.When the concentration of remifentanil was increased to 4 ng/ml,ANI was still less than 50,and then 0.1 μg/kg sufentanil was given.The duration of operation and intraoperative consumption of remifentanil and sufentanil (the consumption of sufentanil was converted to the consumption of remifentanil producing the equivalent effect by 1:10) were recorded.Results The intraoperative consumption of remifentanil was significantly reduced in 2/100 Hz group as compared with Con,2 Hz and 100 Hz groups.There was no significant difference in the intraoperative consumption of remifentanil between Con group,2 Hz group and 100 Hz group.Conclusion The use of 2/100 Hz but not 2 and 100 Hz TEAS on LU7-LI11-PC6-LI4 significantly reduces intraoperative opioid consumption in the patients undergoing video-assisted thoracoscopic pneumonectomy.

Objective To observe reverse effect of anisodamine to the adverse effect of remifentanil during enteroscopy without pain for patients with bradycardia .Methods Sixty‐five patients with bradycardia were selected and divided randomly into group C (n=21 ,control group)、group A1 (n=22 ,anisodamine by instillation) and group A2 (n=22 ,anisodamine by continous infusion) .In‐duction :Intravenous etomidate 0 .08 mg/kg ,propofol 1 .00 mg/kg and remifentanil 0 .10μg/kg in 3 groups .Ten mg anisodamine in‐fused by instillation before induction in group A1 ,5 mg anisodamine infused by instillation before induction and continous infused by 0 .25 mg/min in group A2 .Maintenance:All group received propofol 4 mg · kg‐1 · h‐1 ,remifentanil 0 .05 μg · kg‐1 · min‐1 after un‐dergoing enteroscopy .stopping pumping propofol when colonoscopy reached ileocecal junction ,and we took off remifentanil when colonoscopy withdraw to decending colon .Then we observed and recorded HR ,SpO2 ,MAP ,dosage ,fluid infusion ,induction time , check time ,analepsia time ,degree and of enterospasm and numbers of cases and side effect at T0 (before induction) ,T1 (beginning of operation) ,T2 (into the transverse colon) ,T3 (to the ileocecal junction) ,T4 (exit) .Results There were no significant difference a‐mong 3 groups of induction time .Compared with group A1 and group A2 about check time and analepsia time ,group C was much shorter .The HR of group A1 and A2 were more stable than group C at T2 、T3 .At T1 、T2 ,the fluctuation of HR of group A2 was less than that of group A1 .There was obviously different among 3 groups of propofol′s dosage ,operation time and enterospasm ,the effect of group A1 and group A2 were better .There was statistically significant in number of cases of body movement between group A1 (1/22)and group C(4/21) ,there was also statistical significance between group A1 ,group A2 and group C(P<0 .05) .Conclusion There are no difference between 2 methods about relieving enterospasm ,refraining intestinal angina ,shortening operation time , saving anesthetic dosage .Effect of continous pumping to undulation of HR may be more stable .

Objective To evaluate the characteristics of quantitative monitoring of brain function during the perioperative period in elderly patients and its relationship with postoperative cognitive dysfunction (POCD).Methods Seventy ASA physical status Ⅰ or Ⅱ patients,aged ≥ 60 yr,scheduled for elective lumbar spine decompression and fusion surgery under general anesthesia,having an expected postoperative length of hospital stay ≥ 7 days,were enrolled in the study.The cognitive function was assessed by using Mini-Mental State Examination before operation and the results were normal.Fifty healthy elderly volunteers were chosen and served as control group.Cognitive function was assessed at l day before operation (D0) and 3 (D3) and 7 days after operation (D7).Z score was used to identify POCD.All the patients were then divided into POCD group or control group (group C) according to the results of diagnosis.Quantitative monitoring of brain function was carried out using a traction system,and the wavelet index (WLI),i_22 and i_20 were recorded.Results A total of 67 patients completed the study and were enrolled in the analysis,there were 9 cases in group C,and 58 cases in group POCD.The WLI was significantly decreased at D7,and no significant change was found in WLI at D3 as compared with the value at D0.The WLI was significantly lower at D7 than at D3.There was no significant difference in i_22 and i_20 between the three time points.Compared with group C,i_22 was significantly decreased at D0,and no significant change was found in i_22 at the other time points and in WLI at each time point in POCD group.Conclusion During quantitative monitoring of brain function during the perioperative period in the elderly patients,WLI is significantly decreased on 7th day postoperatively,and no significant change is found in i_20 and i_22,however,the pre-operative low i_22 value can predict the development of POCD.