Objective To evaluate the relationship between emergence agitation (EA) during recovery from general anesthesia and postoperative cognitive dysfunction (POCD).Methods Two hundred and eighty ASA Ⅰ or Ⅱ patients,aged 18-70 yr,weighing 52-80 kg,undergoing elective surgery,were included.Anesthesia was induced with midazolam,fentanyl,propofol and cisatracurium.The patients were tracheal intubated and mechanically ventilated.Anesthesia was maintained with remifentanil,propofol and cisatracurium.EA was assessed at 15-40 min after extubation by using Post-operative Quality Recovery Scale and the cognitive function was assessed at day 1 before operation and days 1-7 after operation.Patients were divided into POCD or nonPOCD group according to the occurrence of POCD.The general data of patients,preoperative complications and types of surgery were recorded.If there was significant difference between the 2 groups,the factor was analyzed using multi-factor logistic regression to select the risk factor for incidence of POCD.Results The incidence of POCD was 40.7 ％.The results of logistic regression analysis showed that the dangerous degree of the risk factors for POCD in order from high to low were emergence agitation,duration of anesthesia and age.Conclusion EA during recovery from general anesthesia is an independent risk factor for POCD.

Objective: To analyze the risk factors on acute respiratory dysfunction caused death in patients after type A aortic dissection surgery.
Methods: A total of 223 patients who received aorta replacement surgery in our hospital from 2010-01 to 2012-12 were retrospectively studied. 80 patients suffered from post-operative acute respiratory dysfunction including 61 male and 19 female with the mean age of (49.2 ± 11.6) years. Those patients were divided into 2 groups as Death group, n=18 and Survival group, n=62. We analyzed the most relevant risk factors for death, such as gender, age, histories of smoking, diabetes, hypertension, Marfan syndrome;pre-operative acute or chronic dissection, hypoxemia, mal-perfusion, LVEDD and LVEF;CPB time, aortic-clamping time;post-operative ICU retention time, mechanical ventilation time, permanent neurologic dysfunction, pulmonary infection, MACE, renal failure, hypohepatia, septicemia and wound mal-healing, et al.
Results: The early post-operative (< 3 days) respiratory dysfunction rate was 35.8% and the mortality was 22.5%(18/80). The relevant risk factors of death included female gender (P=0.019), haemorrhage (P<0.01), mechanical ventilation time (P=0.011), permanent neurologic dysfunction (P=0.013), pulmonary infection (P=0.001), MACE (P=0.022), renal failure (P<0.01), hypohepatia (P<0.01) and septicemia (P=0.001). Female gender and renal failure were the independent risk factors for respiratory dysfunction caused death in patients after type A aortic dissection surgery.
Conclusion: The occurrence and mortality were high in patients after type A aortic dissection surgery especially in those with female gender and post-operative renal failure.

Objective To analyze the risk factors of postoperative acute renal injury (AKI) for acute Stanford type A aortic dissection in 137 cases.Methods From January 2010 to December 2011,137 patients with acute Stanford type A aortic dissection were received surgical operations in our hospital.There were 106 males and 31 females with their mean age of(46.8 ± 13.1)years and mean weight of (69.9 ± 18.0) kg.The postoperative acute renal injury diagnosis was according to AKIN diagnosis standard of acute kidney injury network working group in 2005.All patients were received surgical repair with cardiopulmonary bypass,including 120 patients with deep hypothermic circulatory arrest and selective cerebral perfusion.Among them,there were 54 cases with total arch replacement and 66 with right half arch replacement.The postoperative managements were include control the patients' mean arterial blood pressure at 80 to 90 mmHg (1 mmHg =0.133 kPa),supplement the blood volume timely,and correction of hypoxia and hypoproteinemia.The patients were received renal replacement therapy if still oliguria after medical treatments,or their blood creatinine raising continually more than 500 μmol/L.Results A total of 12 patients died in hospitalization with a total in-hospital mortality of 8.74％ (12/137).76 cases had AKI in the first day after operations,including 38 cases (27.7％) with stage Ⅰ and 21 cases (15.3％) with stage Ⅱ and 17 cases (12.4％) with stage Ⅲ.There were 36 patients have acute renal failure (ARF) with morbility of 26.3％ (36/137),and 34 patients among them were received renal replacement therapy.Single factor analysis showed that preoperative creatinine,total arch replacement,cardiopulmonary bypasstime,intraoperative day transfusion of concentrated red cells are risk factors of ARF.Logistic regression was used for multivariate analysis showed that total arch replacement and preoperative creatinine abnormalities are independent risk factors for postoperative AFR.Conclusion Total arch replacement and preoperative creatinine abnormalities were independent risk factors of AFR for acute type A dissection after operation.

Exposure therapy is a kind of behavior therapy that exposes patients to certain stimulating situations to make them tolerate and adapt. Based on the ethical perspective, this paper introduced the ethical disputes in exposure therapy from three aspects that safety and tolerance, patient rights and humanistic care, as well as professional ethics and moral risks of psychotherapists. This paper also put forward three ethical norms and requirements, including earnestly implementing the principle of informed consent, adhering to the principle of no harm in the whole process, and obeying the principle of confidentiality, in order to improve the professional level of exposure therapy and protect the rights and interests of patients and psychotherapists.

Objective     To analyze the surgical effect of total aortic arch replacement and stented elephant trunk (Sun’s procedure) for acute or chronic Stanford type A aortic dissection, and to investigate the optimal surgical timing for Stanford type A aortic dissection involving aortic arch. Methods     We retrospectively reviewed the clinical data of 327 patients with acute or chronic Stanford type A aortic dissection treated by Sun's procedure from June 2010 to June 2014 in Guangdong Cardiovascular Institute. Patients were divided into two groups according to whether the time from onset to operation was longer than 2 weeks: an acute group with 229 patients (≤2 weeks, the average time of onset to operation 5.70±3.50 d) and a chronic group with 98 patients (>2 weeks, the average time of onset to operation 21.60±15.70 d). There were 186 males and 43 females with a mean age of 47.47±11.19 years in the acute group, and 76 males and 22 females with a mean age of 45.62±12.92 years in the chronic group. The patients discharged from hospital were followed up for one year. Results     There was no significant difference between the two groups in preoperative data. The rate of coronary artery bypass grafting, cardiopulmonary bypass time, aortic cross-clamping time, intraoperative and postoperative 24 h red blood cell intake were higher or more in the acute group than those in the chronic group (P<0.05).  The in-hospital morality, ICU stay, mechanical ventilation time, the incidence of neurological dysfunction, low cardiac output syndrome, acute renal failure with continuous renal replacement therapy, hepatic insufficiency, poor wound healing were higher or more in the acute group than those in the chronic group (P<0.05). During one year follow-up, the survival rate of the acute and chronic groups was 97.0% and 97.6% respectively (P>0.05). No new complications were found in the two groups. The irreversible neurological dysfunction, paraplegia and renal failure showed no significant difference between the two groups. Conclusion     The short-term mortality and complications of acute Stanford A aortic dissection involving aortic arch treated by Sun’s procedure are significantly higher or more than those of chronic Stanford type A aortic dissection. The risk of surgical treatment in acute phase is high.

Objective    To explore the correlation between perioperative blood transfusion and acute kidney injury (AKI) after heart transplantation. Methods    A retrospective study was performed on 67 patients who underwent heart transplantation in the Department of Cardiac Surgery, Guangdong Provincial People's Hospital from January 2016 to December 2018, and finally 63 patients were included according to the exclusion criteria. There were 53 males and 10 females with an average age of 44.3±12.9 years. Twenty patients who adopted continuous renal replacement therapy (CRRT) after heart transplantation were divided into a RT group and the other 43 patients who did not use CRRT were divided into a non-RT group. Baseline characteristics, perioperative blood transfusion data and clinical prognosis were compared between the two groups. Results    The preoperative baseline characteristics of the two groups were basically the same. There were significant differences in perioperative infusion of red blood cells and plasma, postoperative 24 h bleeding and re-exploration (P<0.05) between the two groups. The area under the receiver operating characteristic (ROC) curve was 0.923 (95%CI 0.852 to 0.995, P<0.001). The ROC curve showed that perioperative infusion of red blood cells more than 18 mL/kg would increase the incidence of AKI after heart transplantation. Conclusion    Perioperative blood transfusion is closely related to AKI after heart transplantation. The more blood transfusion is in clinics, the higher incidence of renal injury is and the worse prognosis is. It is suggested that various blood-saving measures can be carried out.