Objective Discuss the anesthetic effect ofremifentanil and fentanyl on interventional surgery for children with congenital heart disease.Methods 80 patients with congenital heart disease were selected,they were divided into two groups randomly.The control group (40 cases) was given fentanyl anesthesia.The observation group (40 cases) was given remifentanil anesthesia.Observe and record SDP,DBP,HR at different time of anesthesia,extubation time,recovery time and dosage of anesthesia and adverse reaction during anesthesia to evaluate the anesthetic effect of remifentanil and fentanyl on interventional surgery for children with congenital heart disease.Results Compared with the basic value before induction of anesthesia,the SDP,DBP of two groups were decreased after induction (P ＜ 0.05).There was no significant difference on HR level between two groups before and after induction.The extubation time,recovery time of observation group was shorter than that of the control group.However,the amount of anesthesia drug in the observation group was higher than that of the control group (P ＜ 0.05).During anesthesia,there was no significant difference on adverse reactions between two groups.Conclusion The anesthetic effect of remifentanil on interventional surgery for children with congenital heart disease is good,and it has little effect on cardiac function with early extubation and less side effect.

OBJECTIVETo investigate the risk factors of mortality in patients with severe chest trauma (SCT).

METHODSThe clinical data of 777 SCT [abbreviated injury scale (AIS) ≥3] patients who were treated in the Chongqing Emergency Medical Center from January 2006 to April 2009 were retrospectively reviewed. Stepwise logistic regression analysis was used to explore 15 possible mortality-related risk factors.

RESULTSSeven factors were found to be correlated with the mortality of SCT: age, hemorrhagic shock, multiple organ dysfunction syndrome (MODS), pulmonary infection, abdominal organ injury, Glasgow coma scale (GCS) score, and thorax AIS score. Among them five factors were the independent factors that might increase the mortality of SCT: hemorrhagic shock (B=1.710, OR=1.291, P=0.001), MODS (B=3.453, OR=1.028, P<0.001), pulmonary infection (B=2.396, OR=10.941, P<0.001), abdominal organ injury (B=1.542, OR=1.210, P=0.005), and thorax AIS score ≥4 (B=0.487, OR=1.622, P<0.001). Two factors showed protective effects: age ≤60 years (B=-0.035, OR=0.962, P=0.01) and GCS score ≥12 (B=-0.635, OR=0.320, P<0.001).

CONCLUSIONSAge, disease severity, and complications (hemorrhagic shock, MODS, and pulmonary infection) are independent risk factors of the mortality of SCT. Effective treatment programs targeting these risk factors may improve the outcomes of SCT patients.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Thoracic Injuries ; mortality ; Young Adult

OBJECTIVETo analyze the epidemiological features of severe chest trauma (SCT) and investigate the risk factor of its mortality in the Three Gorges Area of China.

METHODSThe clinical data of 1834 SCT patients who were admitted in three hospitals in this area from January 1990 to December 2009 were retrospectively reviewed. Th epidemiological features of SCT were analyzed using a database. Stepwise logistic regression analysis was used to analyze 15 possible risk factors affecting mortality.

RESULTSThe morbidity rates of blunt trauma (68.5% vs. 74.7%,p=0.006) and sharp instrument injury (12.2% vs. 15.9%,p=0.039) showed significant differences before and after 2000. The pre-hospital time [(3.45±2.38)h vs. (2.20±4.39)h,p<0.01] and transfer rate (32.39% vs. 36.80%,p=0.01) significantly improved. The thoracic Abbreviated Injury Scale (AIS)(3.56±0.71vs. 3.43±0.58,p<0.01)score and Revised Trauma Score (RTS)(7.14±2.18 vs. 6.93±1.07,p<0.01) significantly increased. Treatment for pulmonary infection (12.63±4.79 vs. 17.16±6.41,p=0.019) and hemorrhagic shock (2.4±0.75 vs. 3.4±1.34,p=0.008 )was significantly improved. The leading cause of death was hypovolemic shock (59.41%). The independent rik factors of death among these SCT patients included: hemorrhagic shock (B=1.710,OR=1.291,p=0.001), multiple organ dysfunction syndrome (B=3.453,OR=1.028,p<0.001), pulmonary infection(B=2.396,OR=10.941,p<0.001), abdominal organ injury(B=1.542,OR=1.210,p=0.005), and thorax AIS(B=0.487,OR=1.622,p<0.001).

CONCLUSIONSThe prevalence of SCT shows an increasing trend in the Three Gorges Area in recent years, but with a decreased rate of complications and improved treatment. Age, complications, thorax AIS, and GCS are useful prognostic indicators.

China ; epidemiology ; Humans ; Logistic Models ; Retrospective Studies ; Thoracic Injuries ; epidemiology ; mortality

Objective To study the clinical manifestations and treatment methods of hyperprolactinemia (HPRL), a common disorder encountered in clinical practice, and explore its association with prolactinomas. Methods The clinical data, hormone profile and imaging data of 166females with documented HPRL, admitted to our hospital from January 2005 to January 2010, for over a period of 5 years, including 4 years of retrospective analysis and 1 year of prospective study, were retrospectively analyzed. Results Most patients aged 20-40 with abnormal menstruation as their most common symptom; 141 patients (84.9％) appeared abnormal menstruation and 1 14 (68.7％) with galactorrhea. Microadenoma was noted in 62 patients (37.3％), nonfunctioning pituitary macroadenoma involved stalk occurred in 26 patients (15.7％). As compared with that in patients with idiopathic HPRL ([93.9±20.4]ng/mL), the level ofprolactin in patients with microprolactinoma ([161.2±60.6]ng/mL) was significantly higher (P＜0.05); as compared with that in patients with prolactin microadenoma, the level of prolactin in patients with domperidone caused drug-induced HPRL ([240.2±29.4]ng/mL) was obviously increased (P＜0.05). Conclusion We cannot confirm whether a HPRL patient has prolactinomas only through detecting the level of prolactin. Microprolactinoma is the most common cause of HPRL, followed by idiopathic cause.

BACKGROUNDSince January 2002, adult-to-adult living donor liver transplantation (AALDLT) has gained increasing popularity in China in response to the shortage of cadaveric donor livers. This study presents a detailed analysis of the outcomes of AALDLT in a single center.

METHODSA total of 70 patients underwent AALDLT at our center between January 2002 and January 2007. Among these, 67 patients received a right lobe graft without the middle hepatic vein and 3 patients received dual grafts. Three-dimensional volumetric computed tomography, magnetic resonance imaging with angiography and cholangiography were performed preoperatively. Recipient operation time, intraoperative transfusion requirement, length of intensive care unit stay, length of hospital stay, liver function tests, coagulation tests and surgical outcomes were routinely investigated throughout this study.

RESULTSAll donors survived the procedure with an overall complication rate of 15.3%. Overall recipient 1-year survival and complication rates were 87.1% and 34.2%, respectively. Among the 70 cases, average graft recipient weight ratio was 0.94% (0.72% - 1.43%) and average graft volume/standard liver volume ratio was 46.42% (31.74% - 71.68%). All residual liver volumes exceeded 35%. Liver function and coagulation recovered rapidly within the first 7 days after transplantation.

CONCLUSIONSAALDLT is a safe procedure for the donors and an effective therapy for patients with end-stage liver disease. Patient selection and timely decision-making for transplantation are essential in achieving good outcomes. With accumulation of experience in surgery and clinical management, timely feedback and proper modification, we foresee better outcomes in the future.

Adolescent ; Adult ; Aged ; Female ; Humans ; Liver Transplantation ; methods ; Living Donors ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

Objective:To explore the effects of robot-assisted therapy combined with mirror therapy (MT) on upper limbs in patients with hemiplegia after stroke. Methods:From January, 2017 to June, 2018, 56 patients with hemiplegia after stroke were randomly divided into control group (n = 28) and observation group (n = 28). The control group received conventional therapy, and the treatment group received robot-assisted therapy combined with MT, additionally. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Wolf Motor Function Test (WMFT), Functional Independence Measure (FIM) and modified Barthel Index (MBI) before and four weeks after treatment. Results:Four weeks after treatment, the scores of FMA-UE, WMFT and MBI were better in both groups (t > 2.959, P < 0.05), and were better in the observation group than in the control group (t > 4.732, P < 0.001). Conclusion:Robot-assisted therapy combined with MT could improve the function of upper limb and activities of daily living in patients with hemiplegia after stroke.