Objective To observe the clinical effect and safety of subanesthetic doses of ketamine and fentanyl assisted regional anesthesia.Methods 90 children received abdominal operation or limbs operation were selected in our hospital.They were randomly divided into A,B and C group with 30 children in each group.The children in group A received sub-anesthetic doses of ketamine and fentanyl in nerve block anesthesia; the children in group B received sub-anesthetic doses of ketamine and fentanyl anesthesia aided;while the children in group C accepted traditional ketamine anesthesia.The indexes of respiratory frequency,mean arterial pressure,heart rate and oxygen saturation and other basic vital signs as well as anesthesia adverse events of situation were compared.Results The respiratory frequency,mean arterial pressure and heart rate in group A and B were lower than those in group C,the difference was statistically significant(all P ＜0.05),whereas no difference was observed on the oxygen saturation between two groups(P ＞0.05).The respiratory rate,mean arterial pressure and heart rate in group A and B showed no significant difference (all P ＞ 0.05).In adverse reactions,the muscle relaxants was in good condition in group A and B,no obvious body movement and gastrointestinal adverse events observed either.Group C with muscle relaxants in good condition,but body movement and some gastrointestinal adverse reaction can be observed occasionally.Conclusion Subanesthetic doses of ketamine and fentanyl has good anesthetic effect on regional anesthesia,and can effectively reduce the occurrence of adverse reactions,which is worthy of clinical application.

Objective To study the resistance status of helicobacter pylori (HP) to commonly used antibacterial drugs as well as clinical effects of quadruple therapy in the patients with chronic obstructive pulmonary disease (COPD) infected by Hp.Methods A total of 180 cases of patients with Hp infection in the inpatient department and outpatient department of our hospital from August 2012 to December 2014 were collected,including 90 cases of COPD (COPD group) and 90 cases of non-COPD (control group).The gastric antrum mucosal tissues in all cases were taken for conducting Hp culture and identification.The resistance situation to clarithromycin,metronidazole,amoxicillin,levofloxacin and furazolidone in each group was observed.In addition,the two groups were equally divided into subgroup A,B and C according to different medication schemes:which were given 3 kinds of quadruple medication scheme containing amoxicillin and clarithromycin (group A),amoxicillin and levofloxacin (group B) and amoxicillin and furazolidone (group C).Then the clinical effects were compared.Results The resistance rate of infected Hp strains to clarithromycin in the control group was 21.11%;which to metronidazole was 55.56%;which to amoxicillin was 3.33%;which to levofloxacin was 5.56%,while which in the COPD group were in turn 26.67%,57.78%,7.78% and 16.67% respectively.No strain was found to be resistant to furazolidone in the two groups.There was statistically significant difference in the resistance to levofloxacin and double antibiotic resistance between the two groups (P<0.05).The eradication rates for using 3 kinds of quadruple therapy in 3 subgroups of control group were 90.0% in the group A,96.7% in the group B and 100.0% in the group C,while which in the COPD group were 86.7%,80.0% and 96.7% respectively;the Hp eradication rate for adopting the group B scheme had statistical difference between the two groups (P<0.05).Conclusion The resistance rate of COPD patient affected by Hp to levofloxacin has an increasing trend,so its use should be cautious.The quadruple scheme containing amoxicillin+furazolidone can serve as the preferred scheme for the initial Hp eradication therapy in COPD patients affected by Hp.

Objective To compare medical students' learning curve between Macintosh laryngoscope and optical laryngoscope in endotracheal intubation and to decide which one is more suitable for novice personnel.Methods Totally 26 interns after being trained by experienced anesthesiologists were enrolled in this study.They performed intubation on 6 patients by using both Macintosh laryngoscope and optical laryngoscope ( each laryngoscope for 3 patients) under the supervision of experienced anesthesiologists.The sequence of laryngoscope was determined by computer-generated random number list.Results Totally 149 patients who were ready to receive surgery under general anesthesia were enrolled in this randomized crossover controlled study.Duration of intubation was significantly shorter in Airtraq group (78 -± 33 ) s than in Macintosh group (114 ± 32) s,P ＜ 0.001.Intubation success rate was significantly higher in Airtraq group than in Macintosh group ( 87.8％ vs.66.7％,P ＜ 0.05 ).Conclusions With the advantages of rapid learning curve,higher intubation success rate and shorter intubation duration,Airtraq laryngoscope is easier to master for novice personnel.

Objective To investigate the pathogenesis of diagnosis and treatment for delayed gastric emptying(DGE) after pancreaticoduodenectomy(PD).Methods The clinical data of 226 patients admitted between 1983 and 2001 undergoing PD were retrospectively analysed.Results In 226 PD cases DGE was observed in 62 patients(27.4%). Patients with DGE had longer duration of nasogastric tube drainage(21 days vs. 5.6 days).All patients were treated by non-operative methods. The average recovery time was 21 days.Conclusions It is emphasized that DGE has been associated with several factors, including preoperative status of diabetes, bowel obstruction, and jaundice,and postoperative pancreatic fistula, intra-abdominal abscess. Octreotide administration had no relation with the occurrence of DGE.

Objective: According to the relevant principles of blood volume monitoring and monitoring methods, to apply online monitoring data information management in the blood volume monitoring for hemodialysis patients. Methods:through the relevant technical form and its function of monitoring data to study and analyze of treatment parameters of hemodialysis patients described in online blood volume monitor, to achieve data analyzed by using information management system. Results: the blood volume can be visually monitored during the hemodialysis to understand changes in the blood volume of hemodialysis patients, it helps to avoid the occurrence of hypotension and evaluation of patients with dry weights during the hemodialysis. The data can be downloaded, exported, and edited at the same the while fully access to treatment data by effective using of blood volume monitoring data management system (BVMS), in order to achieve data analyzed by using information management system. Conclusion:by understanding the correlation betweenΔBV and blood pressure screen composition can help to speculate the reasons for drop in blood pressure;by combining the examination data can help to control dry weight management, by fully accessing to data can help to manage hemodialysis patient data information management system, and according to patients expression and display of blood volume monitoring to determine the appropriate amount of ultrafiltration, adjust dry weight and develop an appropriate treatment plan.

To investigate the effects of preoperative intravascular embolization on treatment of intracranial giant arteriovenous malformations (AVMs), 27 patients with intracranial giant AVMs were successfully treated from August, 1997 to April 1998 every patient was treated with preoperative intravascular embolization. Compared with single surgical resection, it was found that surgical resection after intravenous embolization can greatly reduce the intraoperative hemorrhage, diminish postoperative mortality and morbidity, and prevent normal perfusion pressure breakthrough (NPPB) significantly. The present study suggested that combination of surgical resection and intravascular embolization was an effect way in the treatment of giant cerebral AVMs.

Objective To evaluate the optimal degree of neuromuscular blockade for inhibiting obturator nerve-muscle responses induced by transurethral resection of bladder tumor (TURBT) with general anesthesia.Methods Ninety American Society of Anesthesiologists physical status Ⅰ-Ⅲ patients of both sexes,aged 26-64 yr,weighing 50-80 kg,scheduled for elective TURBT for lateral bladder wall tumors with general anesthesia,were divided into 3 groups (n =30 each) using a random number table:low-dose mivacurium group (group L),medium-dose mivacurium group (group M) and high-dose mivacurium group (group H).After mivacurium 0.15 mg/kg was injected intravenously during anesthesia induction,mivacurium was continuously infused at a rate of 0.2,0.3 and 0.4 mg · kg-1 · h-1 in L,M and H groups,respectively,until the end of operation.Neuromuscular blockade was continuously monitored during operation.When T1％ and TOF count (TOFC) disappeared,post tetanic count (PTC) was used.ROC curve was applied to analyze the relationship between the occurrence of obturator nerve-muscle responses and degree of neuromuscular blockade.Results T1％ and TOFC were recorded in 16 patients (15 cases in group L,1 case in group M) during the resection of tumor,and the obturator nerve-muscle response was observed in all of these patients.In the other 74 patients,T1％ and TOFC disappeared,and PTC recorded was 10.0±3.1 (group L,n=15),6.0± 3.5 (group M,n=29) and 4.0±2.2 (group H,n=30).Among the 74 patients,the obturator nerve-muscle response was found in 18 patients (8 cases in group L,10 cases in group M).The area under the ROC curve of PTC value in predicting the occurrence of obturator nerve-muscle responses was 0.882 with a PTC cut-off of 9 (P＜0.05).The sensitivity and specificity were 87.3％ and 72.2％,respectively.Conclusion In order to inhibit the obturator nerve-muscle response during TURBT with general anesthesia,the optimal degree of neuromuscular blockade should be kept not more than 9 for PTC.

Objective To investigate the relationship between single nucleotide polymorphism (677C→T) of methylenetetrahydrofolate reductase and Alzheimer′s disease(AD) in south China Han people. Methods By applying polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP), MTHFR 677C→T mutation was detected in 45 AD patients and 48 healthy controls. Results The frequency of MTHFR 677C→T mutation of patients showed no significant difference to that of healthy controls (P > 0.05). There is no statistic significance between AD group and controls in C, T gene frequency(P>0.05). But T gene frequency is higher in AD group than in control group. Conclusion MTHFR C 677T is not the pathogenic factor for AD, but could have some effects on AD.

Objective To investigate the nursing points of the mechanical ventilated patients after percutaneous endoscopic gatrostomy (PEG). Methods The nursing approaches of 28 mechanical ventilated patients after percutaneous endoscopic gatrostomy in our department was analyzed retrospectively. Results The nutritional status of the 28 patients was improved to different degree after enteral nutrition (EN) support by PEG. Thereby, the nutritional requirement of the mechanical ventilated patients was ensured effectively. Among these patients, 4 patients could take food by mouth after taking off ventilator and extubation and stoma tube was pulled out, 15 patients were discharged carrying with stoma tube and convalescent care was continued, 3 patients died of primary diseases. Conclusions The PEG is a simple,safe and cost-effective approach of nutritional support for EN of mechanical ventilated patients. The key point of insuring EN of severe patients is intensive nursing and to prevent and reduce the complication of PEG.

Objective To evaluate the safety and efficacy of hepatectomy in combination with portal azygous disconnection for primary hepatocellular carcinoma (HCC) complicated with severe portal hypertension (PHT). Methods Clinical data of 30 cases of HCC complicated with PHT treated in our hospital from April 2005 to April 2008 were retrospectively analyzed. All 30 cases were randomly divided into the single operation group (group Ⅰ ) and combined group (group Ⅱ ). Results After operation, there were no significant statistical differences in rates of complications such as hepatic encephalopathy, ascites, stress ulcer, etc. and recovery of liver function between the 2 groups. The WBC and PLT counts in the blood samples of group Ⅱ were higher than those in group Ⅰ after operation. The postoperative 1- and 2-year hemorrhagic rates were lower in group Ⅱ than in group Ⅰ .Conclusion Hepatectomy in combination with portal azygous disconnection is safe and feasible for treatment of HCC complicated with PHT.