Objective To observe the effect of application of dexmedetomidine on cerebral injury in infants after cardiopulmonary bypass.Methods 60 cases of congenital heart disease were divided into 3 groups,each group 20 infants,namely D1,D2 and N group.Group D1 dexmedetomidine 1.0μg/kg,in 0.2μg · kg-1 · h-1 intravenous infusion,until the end of operation; group D2 with dexmedetomidine 0.5 μg/kg,in 0.1 μg · kg-1 · h-1,drug concentration and injection speed was the same as the group D1.Group N intravenous normal saline in the whole operation process,infusion speed was the same as the experimental group,anesthesia and experimental group agreement.Take blood samples sent to laboratory before the operation (T1),at the end of CPB (T2),after CPB 2 h (T3),6 h (T4),24 h (T5) respectively,colleced records of perioperative data.Results There were no significant in 3 groups,for infant's age,weight,operation time,CPB time difference (P ＞0.05).In T1,there was no statistical difference between the 3 groups in S-100β protein and NSE (P ＞ 0.05).In group N,S-100β protein and NSE in T2,T3,T4,T5 were increased significantly than the level in T1 (P ＜ 0.05).In T2,compared with group D2,S-100β and NSE increased significantly in group N and D1 (P ＜ 0.01),and there were more in D2 than D1 group.Differences in heart rate,blood pressure and hemodynamics were observed in infant during perioperative period was not significant (P ＞ 0.05).Conclusion Dexmedetomidine can reduce the ascensional range of S-100β and NSE in infant after cardiopulmonary bypass,and relieve the cerebral injury.

Objective To investigate the optimum concentration and dose of ropivacaine for caudal block in the neonates undergoing laparotomy under general anesthesia.Methods One hundred pediatric patients of both sexes,aged 9-30 days,weighing 2.5-4.5 kg,scheduled for elective pyloromyotomy,were randomly divided into 5 groups (n =20 each) using a random number table:control group (group C),0.10％ ropivacaine 1.0 ml/kg group (group 0.1％ L1),0.15 ％ ropivacaine 1.0 ml/kg group (group 0.15 ％ L1),0.10 ％ ropivacaine 1.2 ml/kg group (group 0.10 ％ L2),and 0.15 ％ ropivacaine 1.2 ml/kg group (group 0.15 ％ L2).Anesthesia was induced with sevoflurane and cisatracurium.The pediatric patients were tracheally intubated and mechanically ventilated.Remifentanil was infused intravenously at 0.2-0.3 μg· kg-1 · min-1 in group C.In 0.10 ％ L1,0.15 ％ L1,0.10 ％ L2 and 0.15％L2 groups,the corresponding concentrations and doses of ropivacaine were injected into the sacral canal under the guidance of ultrasound.The operation was started at 15 min after administration and sevoflurane was inhaled and the end-tidal concentration of sevoflurane was maintained at 0.8-1.0 MAC.Before induction (T1),at pyloric muscle retraction (T2),and at 4,8,12 and 24 h after operation (T3-6),blood samples were collected from the central vein for determination of plasma concentrations of cortisol and interleukin-6 (IL-6).Pain was assessed using CRIES score at T3-6.When CRIES scores ＞ 3,10％ chloral hydrate 0.5 ml/kg was given by retention enema for analgesia,and the requirement for chloral hydrate was recorded.The emergence time,extubation time,duration of stay in post-anesthesia care unit (PACU) and hospital discharge time were recorded.Bradycardia and hypotension during operation,and development of motor block of lower extremities,infection and dehiscence of incision,vomiting,and urinary retention after operation were also recorded.Results Compared with group C,no significant changes were found in the emergence time,extubation time,duration of stay in PACU,hospital discharge time,plasma concentrations of cortisol and IL-6,the requirement for chloral hydrate,and the incidence of bradycardia,hypotension,motor block of lower extremities,and infection and dehiscence of incision in 0.10％ L1 and 0.15 ％ L1 groups,the emergence time,extubation time,duration of stay in PACU,hospital discharge time were significantly shortened,and the plasma concentrations of cortisol and IL-6,requirement for chloral hydrate,and the incidence of hypotension and infection of incision were decreased in 0.10％ L2 and 0.15％ L2 groups,and the incidence of vomiting and urinary retention was increased in 0.15％ L1 and 0.15％ L2 groups.Compared with group 0.10％ L2,the incidence of vomiting and urinary retention was significantly decreased,and no significant changes were found in the other parameters mentioned above in 0.15％ L2 group.Conclusion The optimum concentration and dose of ropivacaine are 0.10％ and 1.2 ml/kg,respectively,for caudal block in the neonates undergoing laparotomy under general anesthesia.

Objective To compare the effect and safety of propofol with intranasal dexmedetomidine in analgesic enteroscopy for children.Methods Ninety children undergoing analgesic enteroscopy were ran-domly assigned to 3 groups.Intranasal dexmedetomidine followed by propofol was administered in the observ-ing group;sufentanil and followed by propofol was intravenously given to the control group A;propofol was given to the control group B.The scale of anesthetic effect,HR,RR,MAP and SpO2 30 min after intranasal administration were monitored.The intranasal sedation satisfaction rate,the dose of propofol,wake-up time, hospitalization,hemodynamics,adverse reaction and complication after anesthesia were recorded.Results Intranasal sedation satisfaction rate of the observing group was 83.3%(25 /30).The anesthetic effect in ob-serving group(excellent/good /bad:24 /6 /0)showed no significant difference from that in the control group A (excellent/good /bad:25 /5 /0),but better than that in the control group B(excellent/good /bad:12 /14 /4) (P <0.05).The amount of propofol in the observing group(96.2 ±5.3)mg showed no significant difference from that of group A(93.7 ±4.6)mg,but less than group B[(121.1 ±4.9)mg,P <0.05].The time of re-covery of infants in the control group A[(14.2 ±5.5)min]and the control group B[(13.7 ±3.9)min] were longer than that in observing group[(7.9 ±4.1)min,P <0.05].The hospitalization time of observing group[(14.3 ±5.4)min]was shorter than those of group A[(27.5 ±3.7)min,P <0.05]and group B [(26.3 ±6.6)min,P <0.05].The incidences of breath suppression,glossoptosis,nausea and dizziness were the lowest in the observing group,compared with the two others (all P <0.05).Conclusion In-tranasal dexmedetomidine combined with propofol,increasing children compliance,decreasing the adverse reaction,is satisfactory and safe for children anesthesia.

One hundred and fifty ASA Ⅰ-Ⅱ infants scheduled to undergo surgery on unilateral inguinal region,were randomly assigned to 3 groups with 50 in each group.In groups Ⅰ and Ⅱ puncture was performed at traversus abdominis plane under ultrasound-guidance,0.4 or 0.5/kg of 0.25％ ropivacaine was injected respectively.In group Ⅲ the triangle of Petit was positioned through palpating and then 0.5 ml/kg of 0.25％ ropivacaine was injected.HR,RR,SpO2,PETCO2,expired sevoflurane concentration and BIS value at the time of entering the operation room (T1),incision of skin (T2),pulling hernia sac (T3),ending the surgery (T4),waking (T5),the number of pressing the analgesia pump after operation were recorded.The results showed that HR at T2 and T3 of groups Ⅰ and Ⅱ was lower than group Ⅲ (P ＜ 0.05).The were significant differences in case numbers of insufficient intraoperative analgesia among 3 groups(x2 =10.500,P =0.005).The CHEOPS scores and the number of pressing analgesia pump after operation in groups Ⅰ and Ⅱ were lower than those in group Ⅲ (x2 =7.230,P =0.027).Results indicate that ultrasound-guided transversus abdominis plane block is safer and more effective than conventional method for operations of inguinal region in infants; it may reduce dose of local anesthetics and postoperative use of analgesics.

Objective: To evaluate the efficacy of ultrasound-guided caudal epidural block for postoperative analgesia in the infants undergoing lobectomy under general anesthesia. Methods: Sixty American Society of Anesthesiology physical status Ⅱ or Ⅲ pediatric patients of both sexes, aged 1-3 yr, weighing 10-16 kg, scheduled for elective lobectomy under general anesthesia, were divided into 2 groups (n=30 each) using a random number table method: control group (group C) and epidural block group (group E). Caudal epidural block was performed under ultrasound guidance after induction of general anesthesia and at 15 min before surgery in group E. An epidural catheter was inserted at T_{6, 7} interspace, 0.1% ropivacaine 1 mg/kg was injected at 5 min after injecting 1% lidocaine 3 ml, the diffusion of epidural fluid was controlled at T_3-10, and the epidural catheter was then removed.An analgesia pump was connected at the end of the surgery in two groups.Pain was evaluated using Face Legs Activity Cry Consolability scale.When Face Legs Activity Cry Consolability scale score>3, the pump was pressed.When pain was still unrelieved 5 min later, sufentanil 0.1-0.2 μg/kg was intravenously injected.The patients were followed up for 48 h after operation, and the requirement for additional remifentanil and sufentanil, and the occurrence of postoperative nausea and vomiting, respiratory depression, hypoxemia and over-sedation was recorded.The number of pressing times, extubation time and duration of intensive care unit stay were also recorded.Pain at 1 and 2 days after operation was evaluated using the Postoperative Pain Measure for Parents. Results: Compared with group C, the consumption of remifentanil, the number of pressing times and requirement for additional sufentanil were significantly decreased, the incidence of each index of the Postoperative Pain Masure for Patients was decreased at 1 day after surgery, the extubation time and duration of intensive care unit stay were shortened, and the incidence of nausea and vomiting and over-sedation was decreased in group E (P<0.05). Conclusion Ultrasound-guided caudal epidural block provides better efficacy and fewer side effects for postoperative analgesia in the infants undergoing lobectomy under general anesthesia.

Objective:To study the timeliness incentive nursing intervention applied to rectal cancer postoperative rehabilitation of colostomy.Methods:A total of 120 cases of permanent rectal cancer patients who were treated with colostomy in Dalian University affiliated Xinhua Hospital during February 2016 to February 2019 were evenly divided into observation group and control group by random number table method. The control group were caught out by conventional postoperative rehabilitation nursing. The control group were caught out by the timeliness incentive nursing intervention. Two groups of patients were compared before and after continuous care for 3 months in many ways which included the pain degree, the time to get out of bed, the time of first eating, length of hospital stay, negative emotions, compliance, self-management ability and postoperative complications.Results:The pain degree, the first activity time away from the bed, the first time to eat and the hospital stay were 1.9±0.5, (14.36±2.43) h, (21.39±3.08) h, (8.78±0.82) d in the observation group, and 3.5±1.1, (20.02±2.97) h, (27.14±3.96) h, (11.01±1.43) d in the control group. The difference was statistically significant ( t values were 5.369- 9.539, P<0.05). The negative emotions such as anxiety and depression in the observation group scored 41.4±2.3 and 39.9±2.0 after nursing. However, the control group scored 47.6±3.8 and 45.9±2.2 after nursing, respectively. The difference was statistically significant ( t values were 3.509, 3.519, P<0.05). The self-management abilities of patients in the observation group, including emotional cognition management, general life management, disease cognitive management and colostomy nursing management were 23.43±2.12, 24.04±0.96, 23.02±3.22, and 21.43±1.75, significantly higher than those in the control group (18.96±2.82,18.89±1.69, 17.95±2.61, 16.87±2.12). The difference was statistically significant ( t values were 17.712-18.879, P<0.05). The compliance of the observation group in nursing, rehabilitation and reexamination was 0.79±0.19, 0.98±0.23 and 0.87±0.35, significantly higher than those of the control group (1.02±0.26, 1.58±0.36, 1.46±0.43). The difference was statistically significant ( t values were 5.532, 5.221, 5.645, P < 0.05). The incidence of postoperative complications in the observation group was significantly lower than that in the control group. The incidence of observation group was 8.33% (5/60), and the incidence of control group was 23.33% (14/60). The difference was statistically significant ( χ 2 values were 5.065, P<0.05). Conclusions:Timeliness incentive can obviously shorten the postoperative recovery time of colostomy patients in getting out of bed and capacity to eat, length of hospital stay. It can relieve the postoperative pain and the negative emotions, and also improve compliance and relieve self-management ability, and reduce the occurrence of postoperative complications.

Objective To evaluate the role of necroptosis in hyperoxia-induced acute lung injury(ALI)in preadolescent rats.Methods A total of 72 clean-grade healthy male Sprague-Dawley rats,aged 14 days,weighing 40-50 g,were divided into 3 groups(n＝24 each)by using a random number table method: control group(group C),hyperoxia-induced ALI group(group ALI)and hyperoxia-induced ALI and necrostatin-1 group(group ALI+N).The rats of group ALI+N was intraperitoneally injected with ne-crostatin-1 1.0 mg/kg once a day for 3 consecutive days.The rats were intraperitoneally injected with dime-thyl sulfoxide 0.2 ml/kg once a day for 3 consecutive days in C and ALI groups.The animals were sacrificed at 72 h after inhaling oxygen,and bronchoalveolar lavage fluid(BALF)was collected for determination of interleukin-6(IL-6)and IL-8 concentrations(by enzyme-linked immunosorbent assay),superoxide dis-mutase(SOD)activity(by xanthine oxidase method),and malondialdehyde(MDA)concentration(by thiobarbituric acid method).Lung tissues were taken for measurement of wet/dry weight ratio(W/D ratio)and for examination of the pathological changes(with a light microscope)and ultrastructure of lung tissues(with an electron microscope).The injured alveolus rate(IAR)was calculated.The expression of recep-tor-interacting protein kinase 1(RIPK1),RIPK3 and mixed-lineage kinase domain-like protein(MLKL)in lung tissues was detected by Western blot.Results Compared with group C,the concentrations of IL-6,IL-8 and MDA in BALF were significantly increased,the activity of SOD in BALF was decreased,the W/D ratio and IAR of lung tissues were increased,the expression of RIPK1,RIPK3 and MLKL in lung tis-sues was up-regulated(P＜0.05),and the pathological damage was accentuated in group ALI.Compared with group ALI,the concentrations of IL-6,IL-8 and MDA in BALF were significantly deceased,the ac-tivity of SOD in BALF was increased,the W/D ratio and IAR of lung tissues were decreased,the expres-sion of RIPK1,RIPK3 and MLKL in lung tissues was down-regulated(P＜0.05),and the pathological damage was significantly attenuated in group ALI+N.Conclusion Necroptosis is involved in the patho-physiological process of hyperoxia-induced ALI in preadolescent rats.

Objective:To investigate the relationship between the mechanism of ulinastatin reducing perioperative myocardial injury and ferroptosis in peripheral blood mononuclear cells (PBMCs) in pediatric patients undergoing heart surgery under cardiopulmonary bypass (CPB).Methods:A total of 60 pediatric patients of either sex, aged 4-8 yr, of American Association of Anesthesiologists physical status Ⅱ or Ⅲ, undergoing elective repair of ventricular septal defect under CPB, were divided into 2 groups by a random number table method: control group (C group) and ulinastatin group (UTI group), with 30 cases in each group.Combined intravenous-inhalational anesthesia was used.In UTI group, ulinastatin 20 000 U/kg was diluted to 100 ml in normal saline, 50 ml was infused through the central vein over 15 min starting from 20 min before skin incision, and the remaining 50 ml was instilled through the CPB pipeline over 15 min starting from 10 min of CPB.The equal volume of normal saline was given instead in C group.Blood samples from the internal jugular vein were collected after anesthesia induction and before skin incision (T 1), at 30 min after start of CPB (T 2), immediately after termination of CPB (T 3) and at 24 h after termination of CPB (T 4) for determination of the levels of amino-terminal B-type pro-brain natriuretic peptide (NT-proBNP), cardiac troponin I (cTnI) and creatine kinase isoenzymes (CK-MB) in plasma by enzyme-linked immunosorbent assay.PBMCs were extracted by modified Ficoll density gradient centrifugation method for determination of the concentrations of Fe 2+ and malondialdehyde (MDA) and activity of superoxide dismutase (SOD) in PBMCs (by colorimetric method) and expression of long-chain acyl-CoA synthase 4 (ACSL4) and glutathione peroxidase 4 (GPX4) in PBMCs (by Western blot). Results:Compared with the baseline at T 1, the levels of NT-proBNP, cTnI and CK-MB in plasma were significantly increased, the concentrations of Fe 2+ and MDA in PBMCs were increased, the expression of ACSL4 in PBMCs was up-regulated, and the activity of SOD was decreased, and the expression of GPX4 was down-regulated at T 2-4 in two groups ( P<0.05). Compared with C group, the plasma levels of NT-proBNP, cTnI and CK-MB were significantly decreased, the concentrations of Fe 2+ and MDA in PBMCs were decreased, the expression of ACSL4 in PBMCs was down-regulated, the activity of SOD was increased, and the expression of GPX4 was up-regulated at T 2-4 in UTI group ( P<0.05). Conclusion:The mechanism by which ulinastatin reduces perioperative myocardial injury may be related to inhibition of ferroptosis in PBMCs in the pediatric patients undergoing open heart surgery under CPB.

Female ; Humans ; Infant, Newborn ; Thoracic Surgical Procedures ; methods ; Twins, Conjoined ; surgery

Objective To discuss the effect of Quality Control Circle activity optimize Traditional Chinese Medicine (TCM) nursing program in improving the recovery of gastrointestinal function after cesarean section. Methods In the management of applying QCC method to optimize TCM nursing program to promote the recovery of gastrointestinal function after cesarean section. The study was conducted on patients with cesarean section of the department of obstetrics and gynecology of shenzhen hospital of Guangzhou university of traditional chinese medicine (Futian). 36 cases of the control group were patients before the optimization of TCM nursing program by QCC on February 13-26, 2017, and 36 cases of the intervention group were patients after that on July 2 to 15, 2017. Before and after the QCC program, the time of postoperative of cesarean section patients' first anus exhaust, anal exhaust rate in 18 hours and lactation time were compared. The postoperative of cesarean section patients′first anus exhaust time, 18 hours anal exhaust rate and lactation time were investigated , and essential factors and really causes of the anal exhaust rate in 18 hours were analyzed, and a corresponding countermeasures were made. Results After TCM nursing program, the postoperative of cesarean section patients′ first anus exhaust time and lactation time were significant reduced (P<0.05);anal exhaust ratein 18 hours wasrise from 22.2％(8/36) to 86.1％(31/36). The patients after cesarean sectionwhose anal exhaust rate in 18 hours was increased significantly. The target success rate was as high as 116％, and the recovery rate was as high as 287.8％. Conclusions QCC activity optimize TCM nursing program can improve the recovery of gastrointestinal function after cesarean section. It enriched the connotation of TCM nursing programs, promote the implementation and standardizes the operation process of it. It also improved the clinical efficacy of TCM nursing program, and indeed promoted the patients′ gastrointestinal function after cesarean section, so that it is worthy of clinical application.