Objective To investigate the effect of different doses of dexmedetomidine combined with intercostal nerve block in regional adenomammectomy.Methods 112 patients receiving regional adenomammectomy and meeting criterions were selected from Oct.2013 to Oct.2016.And they were divided into control group and low,medium,and high dose group according to table of random number,with 28 cases in each group.Patients of the control group only received intercostal nerve block.Patients of low dose group received low dose of dexmedetomidine (0.7 μg/kg load dose and 0.25μg· kg-1·h-1 maintenance doses) combined with intercostal nerve block.Patients of medium dose group received medium dose of dexmedetomidine (0.7 μg/kg load dose and 0.5 μg·kg-1·h-1 maintenance doses) combined with intercostal nerve block.Patients of high dose group received high dose of dexmedetomidine (0.7 μg/kg load dose and 1 μg· kg-1·h-1 maintenance doses) combined with intercostal nerve block.Mean arterial pressure,heart rate,VAS score and sedation score of the four groups were detected and compared at T0,T1,T2,T3 and T4.Results The mean arterial pressure and heart rate of medium and high dose group were lower than those of the control group and low dose group at T1,T2,T3 (P＜0.05).The mean arterial pressure and heart rate of high dose group were lower than those in medium dose group at T1,T2,T3 (P＜0.05).VAS score of medium and high dose group were lower than those of the control group and low dose group (P＜0.05),while the difference was not statistically significant between medium and high dose group(P＞0.05).The sedation scores of low,medium and high dose groups were higher than those of the control group at T1,T2,T3 and T4 (P＜0.05),while the sedation score of high dose group were higher than those of low and medium dose groups at T1,T2,T3 and T4 (P＜0.05).Conclusion Medium and high dose of dexmedetomidine combined intercostal nerve block can effectively relieve pain for patients undergoing regional adenomammectomy,while high dose of dexmedetomidine is likely to cause bradycardia,hypotension and excessive sedation.Appropriate dosage should be chosen in clinical practice.

Objective:To investigate the factors contributing to frailty in very elderly patients with multimorbidity.Methods:This cross-sectional study enrolled 119 very elderly patients with multimorbidity who were hospitalized in the Department of Geriatrics of Huadong Hospital Affiliated to Fudan University from August 2022 to March 2023.The study aimed to understand the basic status of multimorbidity by collecting general information, the number and types of diseases, and frailty status.The subjects were divided into frail and non-frail groups through comprehensive geriatric assessment.Various factors including gender, age, Tinetti balance gait score, risk of sarcopenia, dementia, depression, risk of deep vein thrombosis, dysphagia, comorbidity index, medication count, Basic Activities of Daily Living(BADL)score, Instrumental Activities of Daily Living(IADL)score, Nutritional Risk Screening 2002(NRS-2002)score, Norton pressure injury risk assessment score, and Social Support Rating Scale(SSRS)score were compared.The correlation between each factor and the occurrence of frailty was analyzed using univariate analysis and multivariate Logistic regression analysis.Results:A total of 119 elderly inpatients with multimorbidity, with an average age of 90.8±5.9 years old, were included in the study.The incidence of frailty was 68.9%(82 cases).Univariate analysis revealed significant statistical differences between the frail group and the non-frail group in various factors including age( t=-3.131, P=0.002), Tinetti score( Z=-5.544, P<0.001), risk of sarcopenia( χ2=39.205, P<0.001), dysphagia( χ2=5.937, P=0.015), Charlson comorbidity index( Z=-2.565, P=0.010), medication count( Z=-3.325, P<0.001), BADL( Z=-5.871, P<0.001), IADL( Z=-5.062, P<0.001), Norton score( Z=-5.922, P<0.001), and SSRS social support( Z=-2.637, P=0.008).Multivariate logistic regression analysis showed that the Tinetti score( OR=0.843, 95% CI: 0.737-0.966, P=0.014), decreased muscle strength( OR=11.226, 95% CI: 2.157-58.432, P=0.004), sarcopenia( OR=18.084, 95% CI: 2.041-106.211, P=0.009), Norton score( OR=0.462, 95% CI: 0.254-0.838, P=0.011), and medication count( OR=1.153, 95% CI: 1.000-1.329, P=0.049)were independently associated with frailty. Conclusions:In very elderly patients with multimorbidities, the occurrence of frailty is notably increased.Frailty is linked to multiple risks including falls, muscle weakness/sarcopenia, pressure ulcer risk, and polypharmacy, and these risks are independent of other factors.