Objective To explore the safety and feasibility of controlled hypotension with urapidil and nitroglycerin esmolol-three drugs combination in endoscopic surgery. Methods Forty patients who were received endoscopic surgeries were randomly divided into two groups, 20 cases in each group, urapidil-esmolol-nitroglycerin controlled hypotension group (A group) and non controlled hypotension group (B group). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded at the following points: before anesthesia (basal, T1), immediate before surgery (T2), 30 minutes after the start of surgery (T3), end of the operation (T4), 10 minutes after the end of surgery (T5). We recorded blood loss, operative time, transfusion volume, urine. At last the parameters were compared between the two groups. Results The difference of SBP, DBP, MAP at the points of T2, T3, T4 in the two groups was statistically significant (P < 0.05) comparing with the control group (group B). The vital signs of patients during anesthesia in A group had more stable than that of the B group , and the operation time of the A group was significantly shorter than that of the B group. Meanwhile, the blood loss in A group was significantly decreased(P < 0.05). Conclusion It has synergistic antihypertensive effect, and can reduce both side effects and the risk of anesthesia and surgery for us to use urapidil-esmolol-nitroglycerin three antihypertensive drugs in combination. It is a safe and reliable method for clinical application.

Objective To discuss effects of anti-inflammatory mechanism of amygdalin on rats with type II collagen-induced arthritis (CIA). Methods Wistar rats were randomized into normal group, model group, amygdalin group, and tripterygium group. Type II CIA rat models were established. From the 15th day after the modeling establishment, each administration group was given corresponding dose of medicine for continuous 28 days. Levels of TNF-αand sICAM-1 were detected by ELISA in serum of rats, and expression of TNF-α was detected by immuno-histochemical method. Results TNF-α positive expression in amygdalin group and tripterygium group was similar and significantly reduced compared with model group. Levels TNF-α and sICAM-1 in amygdalin group and tripterygium group significantly decreased compared with those in model group (P<0.05), without significant difference compared with normal group (P>0.05). Conclusion Amygdalin can inhibit the expression of TNF-α and levels of TNF-α and sICAM-1, in order to treat rheumatoid arthritis.

Objective To evaluate the clinical effects of the artificial humeral head prosthesis in the treatment of proximal humerus bone tumors. Methods Fifteen patients with proximal humerus bone tumor had excision of bone tumor and application of artificial humeral head prosthesis were analyzed retrospectively. Among them,8 patients had osteosarcoma,4 patients had giant cell tumor of bone,2 patients had chondrosarcoma, 1 patient had fibrosarcoma. Results All cases were followed up for average (39 ± 5 ) months after the surgery.The duration time of operation were( 110 ± 10) minutes in average. The bleeding volume during operation were (600 ± 41 ) ml in average. One patient with osteosarcoma died of recurrence and metastasis 20 months after the surgery. The functions of the other 14 patients were assessed by Enneking system and the average score was 23.3 ± 3.7. The overall rate of excellent or good results was 84.6% ( 11/15 ). Conclusion Limb salvage surgery with the artificial humeral head prosthesis is an efficacious treatment for proximal humerus bone tumors,which can improve short-term clinical outcome.

Objective:To follow up the hepatitis B recurrence post liver transplantation using the combination of lamivu dine and high-dose intravenous/intramuscular hepatitis B immunoglobulin.Methods:Fifty-two consecutive patients who underwent liver transplantation were included in this analysis.All patients were administered lamivudine combined with hepatitis B immunoglobulin intravenous(V group)or intramuscular(M group)injection prophylaxis.Dosages of hepatitis B immunoglobulin were 4 000 U during anhepatic phase,2 000 U/d during the first six days after operation,2 000 U/week at 2-4 weeks after operation and 2 000 U/month at 2-6 months after operation.The dosages of hepatitis B immunoglobulin were decided by blood concentrations at 6 months after transplantation in both groups(HBsAb titer≥200 U/L during the 6-12 months after operation;100-200 U/L one year after operation).The negative-conversion rates of serum HBsAg,serum HBsAb levels and hepatitis B recurrence rate at the 6th month,1 year after transplantation and at the end of this study were investigated.Results:The daily average negative-conversion rate of serum HBsAg was significantly faster in V group than that of M group within the first 4 postoperative days(P ＜ 0.05).The 100% of serum HBsAg negative-conversion rate was obtained in two groups after one week of operation.No recurrence was found in two groups.And the ease of death was independent on HBV recurrent during the follow-up.Conclusion:Lamivudine combined with hepatitis B immunoglobulin intravenous/intramuscular injection prophylaxis was effective protocol for the hepatitis B recurrence after the liver transplantation.

ObjectiveTo study the safety and effectiveness of acute hypervolemic hemodilution (AHH) combined with tranexamic acid(TA) in neurosurgical operation. Methods Forty patients underwent selective neurosurgical operation were divided into two groups by radom digits table with 20 cases each, both groups were infused HES(130/0.4) 20 ml/kg for AHH after anesthesia, TA intravenous injection of loading 10 mg/kg, 1 mg/(kg·h) continuous infusion until the end of surgery in experimental group,only for AHH in control group. The mean arterial blood pressure(MAP), central venous pressure(CVP), heart rate (HR), pulse oxygen saturation (SpO2) were measured before AHH (T0), A HH immediately (T1), 1 h after AHH (T2), at the end of operation (T3), and in the corresponding time hemoglobin (Hb), hematocrit (Hct),prothrombin time (PT), activated partial thromboplastin time (APTT), platelet ( Plt ), fibrinogen ( FIB ) were measured; the intraoperative bleeding, blood transfusion and transfusion rate were counted in both groups.ResultsThere was no significant difference in HR and MAP at different time between two groups (P ＞0.05),compaued with T0,CVP at T1,T2 was increased (P＜0.05),Hb and Hct at T1,T2,T3 were decreased (P＜ 0.05 ). PT and APTT at T2,T3 were longer than that at T0 in control group (P＜ 0.05 ) ;Plt at T1 ,T2,T3 was lower in control group than that at T0 in two groups (P ＜ 0.05 ), Plt at T2, T3 was obviously increased in control group compared with experimental group (P ＜ 0.01 ) ; FIB at T2, T3 was lower than that at T0 in control group (P ＜0.05). The intraoperative bleeding, blood transfusion and transfusion rate in experimental group [(650 ±560) nl, (150 ± 50)ml,30％(6/20)]were lower than those in control group [(820 ±410) ml,(380 ±290) ml,60％ (12/20)],there were significant differences between two groups(P ＜0.05).ConclusionAHH combined with TA has obvious effect of saving blood and hemodynamic stability with less influence on coagulation in neurosurgical operation.

Objective To study the effect of acute non-isovolemic hemodilution (ANIH) plus tranexamic acid on bleeding and coagulation factors. Methods Forty-two patients with brain tumor under general anesthesia were randomly divided into group N and group T with 21 patients in each group. Group N was given ANIH , while group T was given tranexamic acid and ANIH. Bleeding, transfusion, urine volume were recorded. Coagulation factors and D-dimer were detected one day before and after surgery. Hemoglobin was recorded before and after ANIH and after auto-blood was transfused. Results There was less bleeding in group T. Hemoglobin in group T was higher after transfusion. No significant difference was found in Group T and group N in terms of urine volume and transfusion rate. Both the two groups had no difference on variation of coagulation factors. Conclusion ANIH with tranexamic acid has no significant effect on coagulation but produces synergetic effect on decreasing bleeding. They can be applied in surgery of brain tumor safely.

Objective To summarize and explore the clinical characteristics,treatment and outcome of measles in pediatric liver transplant recipients.Method A total of 56 recipients underwent pediatric liver transplantation from June 2013 to April 2014,and 4 recipients suffered from measles post-liver transplantation with the incidence being 7.1％.The data of 4 recipients were retrospectively analyzed.All of the 4 cases were subjected to liver transplantation at our center for biliary atresia and cholestasis liver cirrhosis.All the patients received the combined immunosuppressive regimen on the basis of tacrolimus.All the patients did not accept the immunization with measles vaccine because of the primary liver diseases.All the cases presented the clinical manifestations of cough,high fever (T ＞38.5℃C) and conjunctiva congestion before the rashes came out.Maculopapular rashes appeared about 4 days after the fever.The rashes first appeared from the skine post aurem,face,neck,and then spread to trunk and extremities.Koplik's spots on the buccal mucosa were observed in all the 4 cases.The serological test of IgM antibodies to measles was done.The treatment was adjusted as soon as the diagnosis of measles was clear.Immunosuppressants were decreased or stopped,intravenous immunoglobulin (IVIG) combined with anti-infection drugs was given.Result The clinical manifestation of measles in pediatric liver transplant recipients was serious.There were 3 cases complicated with pneumonia,and one case with laryngitis.Two cases presented severe measles pneumonia and developed into severe respiratory failure requiring mechanical ventilation.Three eases recovered from the therapy and 1 case died of respiratory failure.Conclusion Pediatric liver transplant recipients who suffered from measles are at high risk of severe pneumonia.Measles pneumonitis is frequently fatal in immunocompromised pediatric patients.The treatment shoule be given as soon as possible.

Objective To observe the effects of acute hypervolemic hemodilution(AHH)with dif-ferent plasma substitutes on blood gas analysis and plasma electrolytes in neurosurgieal patients.Methods Sixty ASA Ⅰ-Ⅱpatients undergoing elective neurosurgery were divided into 3 groups(n=20 each)：voluven group(group V),polygeline group(group P)and lactated Ringer solution group(group R).After in-duetion of anesthesia the patients were randomized to receive 20 ml/kg of either 6% voluven,5% polygeline or lactated Ringer solution within 30 min.Blood samples were taken before(T1),immediately(T2)and 30 min after the end fluid infusion(T3)for determination of blood gas analysis including Hct and Hb,the plas-ma electrolytes.And during the hemodilution the heart rate(HR),mean arterial pressure(MAP) and central venous pressure(CVP) were continuously monitored.Results Group R was significantly lower in fluid ex-pansion rate than group P and group V,but there was no significant difference between group P.In the HH procedure three groups of patients MAP and HR maintained stable relatively,CVP increased signifieantly af-ter AHH compared with the baseline value before AHH in group V and group P(P<0.01).Compared with T1,plasma potasgium concentration significantly increased in group P in T3 and plasma sodium concentra-tion signitieantly increased in group V in T2(P<0.01),while plasma calcium concentration significantly de-creased in group V in T2(P<0.05).Compared with T2,plasma potassium oncentration signitleantly in-creased in group V and group P in T3(P<0.05 or 0.01).Compared with group P,plasma potassium con-centration decreased in group V in T2,while plasma calcium concentration significantly decreased in group V in T3(P<0.05).but they were still within normal range.Conclusions Voluven and polygeline are compa-rable in expanding blood volume and more efficient than lactated Ringer solution,hemodynamics is stable.Voluven and polygeline are small influence to the blood gas analysis and plasma electndytes,and safety han-dling in neurosurgical pafients.

Child ; Humans ; Liver Transplantation ; adverse effects ; Measles ; etiology ; Pneumonia, Viral ; etiology ; Transplant Recipients

Objective To investigate the effect of acute non-isovolemic hemodilution in combination with tranexamic acid on cycle function blood gas and electrolytes with brain tumor surgery. Methods Forty-two patients undergoing brain tumor were randomly divided into two groups. Patients in group A received ANIH plus tranexamic acid , while patients in group B received ANIH alone. Collected blood was transfused before the end of surgery. HR、CVP、MAP,hemoglubin, blood gas and plasma electrolytes were respectively recorded before ANIH(T1), at 0 min (T1) and 1 h (T2) after ANIH, and at the end of operation (T4). Results There were no significant changes in HR, CVP, MAP. At T2, T3, T4, Hb, Hct in both two groups lower than those at T1(P <0.05); at T4, Hb, Hct in group A were higher than those in group B. There were no significant changes in pH , PaO2, PaCO2, BE between the both two groups. There were no significant changes in Na +, Cl-, Ca2+and K+between the both two groups. Conclusion ANIH has little effect on the cycle function and blood gas electrolyte. ANIH in combination with TA has a section blood effect. It can be used in the brain tumor operation with TA security.