Objective To investigate the effects of different doses of dexmedetomidine on the anesthetic efficacy of propofol and remifentanil in patients undergoing plastic surgery.Methods Sixty ASA Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,weighing 45-75 kg,scheduled for elective plastic surgery,were randomly assigned into 3 groups (n =20 each):control group (C group),low loading dose dexmedetomidine group (D1 group) and high loading dose dexmedetomidine group (D2 group).Dexmedetomidine was infused at a rate of 0.4 μg· kg-1 · h-1 until 30 min before the end of surgery after a loading dose of dexmedetomidine 0.6 (group D1) or 1.0 μg/kg (group D2) was infused at 10 min before induction of anesthesia in groups D1 and D2.Anesthesia was induced with target-controlled infusion of propofol (target plasma concentraiton 4.0 μg/ml) and remifentanil (target effect-site concentraiton 2.0 ng/ml).After the patients lost consciousness,rocuronium 0.6 mg/kg was injected intravenously.The patients were mechanically ventilated after tracheal intubation.Anesthesia was maintained with target-controlled infusion of propofol (target plasma concentraiton 2.0-3.5 μg/ml) and remifentanil (target effectsite concentraiton 1.5-2.5 ng/ml).Narcotrend index was maintained at Class D.Narcotrend index,systolic pressure (SP),diastolic pressure (DP) and HR were recorded before anesthesia (baseline),at 10 min of dexmedetomidine infusion,at 0,1 and 5 min after tracheal intubation,at the end of dexmedetomidine infusion,and at 0,1and 5 min after removal of the endotracheal tube.The induction time,consumption of propofol and remifentanil,time for recovery of spontaneous breathing and orientation,extubation time,and Richmond Agitation Sedation Scale score at 10 min after removal of the endotracheal tube were recorded.The development of sinus bradycardia during operation and complications during recovery from anesthesia were also recorded.Results Compared with group C,the total consumption of propofol and remifentanil,Richmond Agitation Sedation Scale score at 10 min after removal of the endotracheal tube,and incidences of nausea,bucking and agitation during recovery from anesthesia,and Narcotrend index and HR at 10 min of dexmedetomidine infusion were significantly decreased in groups D1 and D2,and induction time was shortened in D2 group (P ＜ 0.05 or 0.01).The incidence of sinus bradycardia during operation was significantly higher in group D2 than in groups C and D1 (P ＜ 0.05).There was no significant difference in the time for recovery of spontaneous breathing and orientation,and extubation time between the three groups (P ＞ 0.05).There was no significant difference in SP,DP and HR before and after tracheal intubation and before and after removal of the endotracheal tube between groups D1 and D2 (P ＞ 0.05).Conclusion Infusion of dexmedetomidine at a rate of 0.4μg·kg-1 · h-1 after a loading dose of 0.6 μg/kg infused before induction of anesthesia can shorten the induction time,reduce the consumption of propofol and remifentanil,effectively inhibit the stress responses to tracheal intubation or removal of the endotracheal tube,and decrease the occurrence of side effects in patients undergoing plastic surgery.

Objective:To retrospectively analyze the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) accompanied with diarrhea.Methods:From January 11 to February 6 in 2020, the clinical data of 663 patients diagnosed with COVID-19 admitted to Renmin Hospital of Wuhan University were collected and divided into diarrhea group and non-diarrhea group according to whether they had diarrhea or not. The differences in baseline characteristics, basic disease history, clinical manifestations, chest computed tomography (CT), laboratory findings, disease severity and mortality between the two groups were compared. Chi-square test and Fisher exact test were used for statistical analysis.Results:Among 663 COVID-19 patients, 70 (10.6%) patients accompanied with diarrhea. The proportion of fatigue and increased lactate dehydrogenase (LDH) levels of diarrhea group were higher than those of non-diarrhea group (58.6%, 41/70 vs. 28.2%, 167/593; and 64.2%, 43/67 vs. 50.4%, 277/550), and the differences were statistically significant ( χ2=26.891 and 4.566, both P<0.05). There was no statistically significant difference in the proportion of pneumonia in chest CT between diarrhea group and non-diarrhea group (100.0%, 62/62 vs. 99.4%, 529/532) ( P>0.05). There were no statistically significant differences in the proportions of mild and normal type, severe type and critical type between diarrhea group and non-diarrhea group (35.7%, 25/70 vs. 38.6%, 229/593; 50.0%, 35/70 vs. 47.2%, 280/593; and 14.3%, 10/70 vs. 14.2%, 84/593, respectively) (all P>0.05). There were no statistically significant differences in the mortality of mild and normal type, severe type and critical type between diarrhea group and non-diarrhea group (0 vs. 0.5%, 3/593; 0 vs. 0 and 1.4%, 1/70 vs. 3.5%, 21/593) (all P>0.05). Conclusions:Patients with COVID-19 accompanied with diarrhea are more likely to have fatigue and increased LDH level. Diarrhea is not significantly correlated with the disease severity of patients with COVID-19.

Objective:To investigate the clinical characteristics of asymptomatic carriers with 2019 novel coronavirus (2019-nCoV), and to provide clinical guidance for the management of asymptomatic infection with 2019-nCoV.Methods:The clinical data of 663 patients with confirmed coronavirus disease 2019 (COVID-19) admitted to Renmin Hospital of Wuhan University from January 11 to February 6, 2020 were collected. Patients were divided into asymptomatic group (21 cases) and symptomatic group (642 cases) according to the diagnostic criteria. General conditions, clinical classification, death, chest computed tomograph (CT) and laboratory results of patients were retrospectively collected. Mann-Whitney U test, chi-square test and Fisher exact test were used for statistical analysis. Results:All 663 patients were positive for 2019-nCoV nucleic acid tests. The age of patients in the asymptomatic group were significantly younger than those in symptomatic group (35.0 (31.5, 58.0) years old vs 58.5 (45.0, 69.0) years old, U=4 234.500, P=0.002). The proportion of patients <30 years old in the two groups was significantly different (19.0%(4/21) vs 6.1%(39/642), Fisher exact test, P=0.047). There were 15 women (71.4%) in the asymptomatic group and 327 women (50.9%) in the symptomatic group, while the difference of gender distributions was not statistically significant ( χ2=3.420, P=0.064). In addition, among patients with asymptomatic infection, the proportions of mild/ordinary, severe and critical patients were 10 cases (47.6%), 10 cases (47.6%), and one case (4.8%), respectively, which were not significantly different from those in symptomatic group (244 cases (38.0%), 305 cases (47.5%) and 93 cases (14.5%), respectively, χ2=1.847, P=0.397). As of February 9, one(4.8%) mild/ordinary patient in the asymptomatic group died who had malignant tumor. Twenty-four (3.7%) patients in the symptomatic group died including two mild/ordinary and 22 critical patients. There was no significant difference in mortality between the two groups(Fisher exact test, P=0.560). CT examination was performed on 594 patients, and 591 cases (99.5%) showed unilateral or bilateral pneumonia, and three cases (0.5%) showed normal. Conclusions:Patients with asymptomatic infection with 2019-nCoV are younger than symptomatic patients, and there are more patients under 30 years old in the asymptomatic group. The absence of clinical symptoms is not significantly associated with clinical classifications and mortality in COVID-19 patients.

Objective To compare the effect of postoperative between total intravenous anesthesia(TIVA)use of alfentanil and remifentanil undergoing endoscopic sinus surgery.Methods A total of 130 and thirty patients scheduled for endoscopic sinus surgery,62 males and 68 females,aged 18-64 years,BMI 18-30 kg/m2,ASA physical status Ⅰ or Ⅱ,were randomly divided into two groups:alfentanil group(group A)and remifentanil group(group R).Midazolam 0.02 mg/kg,propofol target-controlled infusion(TCI)3 μg/ml,alfentanil 20 μg/kg,and rocuronium 0.6 mg/kg were injected intravenously in group A,and target-controlled infusion of propofol combined with alfentanil was used to maintain anesthesia.Midazo-lam 0.02 mg/kg,propofol TCI 3 μg/ml,remifentanil 1 μg/kg,and rocuronium 0.6 mg/kg were injected intravenously in group R,and target-controlled infusion of propofol combined with remifentanil was used to maintain anesthesia.The number of intraoperative hemodynamic adverse reactions such as hypertension,tachycardia,hypotension,bradycardia during operation,and pain degree at 30 minutes,60 minutes,24 hours after operation,extubation time,and rescue analgesia and adverse reactions such as nausea and vomi-ting,skin pruritus,respiratory depression within 24 hours after operation were recorded.Results Compared with group R,the incidence of intraoperative hypotension in group A was significantly lower(P＜0.05),the incidence of painless in group A 30 and 60 minutes after operation was significantly higher(P＜0.05),the incidence of mild and moderate pain was significantly decreased(P＜0.05),and the recovery time was significantly prolonged(P＜0.05).There was no significant difference in rescue analgesia within 24 hours after operation.There were no significant differences in the incidence of postoperative nausea and vomiting,postoperative skin pruritus,and respiratory depression between the two groups.Conclusion In endoscopic sinus surgery,the effect of total intravenous anesthesia with alfentanil on postoperative analgesia is better than that of remifentanil,and the incidence of perioperative and postoperative adverse reactions in alfentanil is lower than that of remifentanil,while the recovery time of alfentanil is slightly longer than that of remifentanil.