BACKGROUND:Ropivacaine and dexmedetomidine are two commonly used local anesthetic agents and adjuvants in elderly total hip arthroplasty. They provide sedation and analgesic effects during peripheral hip nerve blocks.OBJECTIVE:To explore the dose-effect relationship between dexmedetomidine and ropivacaine in continuous sedation during pericapsular nerve group block in elderly patients undergoing total hip arthroplasty.METHODS:A total of 120 elderly patients who received total hip arthroplasty in Dongguan Hospital,Guangzhou University of Chinese Medicine from January 2021 to January 2023 were selected as study subjects and randomly divided into two groups 1∶1 matching according to propensity matching method. The observation group (n=60) received pericapsular nerve group block by giving 20 mL mixture of ropivacaine and 1 μg/kg dexmedetomidine. The control group (n=60) received received pericapsular nerve group block by giving 20 mL of ropivacaine. The general data,perioperative indexes,postoperative analgesia,hemodynamic indexes,inflammatory factors,stress indexes,postoperative adverse reactions,length of hospital stay,and the occurrence of postoperative complications were compared and analyzed between the two groups. The median effective dose and 95％ effective dose concentrations of ropivacaine pericapsular nerve group block were calculated by the Probit method.RESULTS AND CONCLUSION:(1) The postoperative analgesia of the observation group was better than that of the control group,and the visual analog scale score at 6-hour dynamic,12-hour static,12-hour dynamic,24-hour static,24-hour dynamic,48-hour static,48-hour dynamic,as well as the time of first patient-controlled analgesia compression and the number of patient-controlled analgesia compression at 24 and 48 hours postoperatively were statistically different (P<0.05). (2) There were significant differences between the two groups in mean arterial pressure and heart rate at extubation and 12 hours after extubation (P<0.01). (3) The levels of interleukin-6,tumor necrosis factor-α,epinephrine,and noradrenaline in the observation group were significantly lower than those in the control group at 24 and 48 hours after surgery (P<0.01). (4) There was significant difference in the length of hospital stay between the two groups (P<0.01),and no difference was detected in the occurrence of postoperative complications (P>0.05). (5) The median effective dose and 95％ effective dose values of dexmedetomidine combined with ropivacaine were 0.164％ and 0.188％,respectively,while the median effective dose and 95％ effective dose values of ropivacaine alone were 0.194％ and 0.276％,respectively. (6) It is concluded that using dexmedetomidine combined with ropivacaine in pericapsular nerve group block can effectively alleviate postoperative analgesia in elderly patients with total hip arthroplasty,help maintain the hemodynamic stability of patients,reduce postoperative inflammation and stress response,and shorten the length of hospital stay. In addition,dexmedetomidine can reduce the dosage of ropivacaine under the condition of effective pericapsular nerve group block reaction.

BACKGROUND:Ropivacaine and dexmedetomidine are two commonly used local anesthetic agents and adjuvants in elderly total hip arthroplasty. They provide sedation and analgesic effects during peripheral hip nerve blocks.OBJECTIVE:To explore the dose-effect relationship between dexmedetomidine and ropivacaine in continuous sedation during pericapsular nerve group block in elderly patients undergoing total hip arthroplasty.METHODS:A total of 120 elderly patients who received total hip arthroplasty in Dongguan Hospital,Guangzhou University of Chinese Medicine from January 2021 to January 2023 were selected as study subjects and randomly divided into two groups 1∶1 matching according to propensity matching method. The observation group (n=60) received pericapsular nerve group block by giving 20 mL mixture of ropivacaine and 1 μg/kg dexmedetomidine. The control group (n=60) received received pericapsular nerve group block by giving 20 mL of ropivacaine. The general data,perioperative indexes,postoperative analgesia,hemodynamic indexes,inflammatory factors,stress indexes,postoperative adverse reactions,length of hospital stay,and the occurrence of postoperative complications were compared and analyzed between the two groups. The median effective dose and 95％ effective dose concentrations of ropivacaine pericapsular nerve group block were calculated by the Probit method.RESULTS AND CONCLUSION:(1) The postoperative analgesia of the observation group was better than that of the control group,and the visual analog scale score at 6-hour dynamic,12-hour static,12-hour dynamic,24-hour static,24-hour dynamic,48-hour static,48-hour dynamic,as well as the time of first patient-controlled analgesia compression and the number of patient-controlled analgesia compression at 24 and 48 hours postoperatively were statistically different (P<0.05). (2) There were significant differences between the two groups in mean arterial pressure and heart rate at extubation and 12 hours after extubation (P<0.01). (3) The levels of interleukin-6,tumor necrosis factor-α,epinephrine,and noradrenaline in the observation group were significantly lower than those in the control group at 24 and 48 hours after surgery (P<0.01). (4) There was significant difference in the length of hospital stay between the two groups (P<0.01),and no difference was detected in the occurrence of postoperative complications (P>0.05). (5) The median effective dose and 95％ effective dose values of dexmedetomidine combined with ropivacaine were 0.164％ and 0.188％,respectively,while the median effective dose and 95％ effective dose values of ropivacaine alone were 0.194％ and 0.276％,respectively. (6) It is concluded that using dexmedetomidine combined with ropivacaine in pericapsular nerve group block can effectively alleviate postoperative analgesia in elderly patients with total hip arthroplasty,help maintain the hemodynamic stability of patients,reduce postoperative inflammation and stress response,and shorten the length of hospital stay. In addition,dexmedetomidine can reduce the dosage of ropivacaine under the condition of effective pericapsular nerve group block reaction.

Objective To establish a scientific and sensitive evaluation index system of nursing quality for cancer hospital. Methods The evaluation index system of nursing quality for cancer hospital was formulated based on literature,semi- structured interviews and expert group discussion. Then, developing the evaluation index system of nursing quality for cancer hospital by two rounds of Delphi consultation. Results The experts′ authority coefficient was 0.862. The nursing quality indicators included 5 first-level indicators,9 second-level indicators and 73 third-level indicators. The Kendall coordination coefficients of the importance of the three level indicators were 0.354,0.217,and 0.243, The Kendall coordination coefficients of the feasibility of the three level indicators were 0.234,0.313,and 0.339. Conclusions Scientific nature and concentration indicator system of nursing quality for cancer hospital was developed. It will be used to provide quantitative basis for the control of nursing quality in cancer hospital.

Objective To investigate high risk human papillomavirus(HR-HPV)prevalence among married women in Beijing and to study the high risk flactors.nethods During March 2007 to September 2008.a total of 6185 married women sampled from 137 communities in 12 districts were screened bv HR-HPV DNA test and cytogical test.The interview was carried out with unified questionnaires.The databage was set up and twice entered in EpiDam 3.0.After checked up,the data were analyzed in SPSS 15.0.Results (1) The HR-HPV infection rate was 9.89%.The HR-HPV infection rate of the city zone,the suburb and the exurb were 9.34%,10.51% and 9.51% (P>0.05).The HR-HPV infection rate of the native and the oudander were 9.53%,11.30% (P<0.05).(2) The age distribution of HR-HPV infection was that the rate was around 10% among 25 to 44 age groups,which was the highest(11.21%) in 30 to 34 age group;then the rate was descended as the age raising,the rate of 50 to 54 age group was the lowest(7.78%).(3) Multiple logistic regression showed that the related risk factors of HR-HPV infection mainly included 1000 RMB and above of family income per person per month.possessing more than 1 sexual partner of her husband,outlander and hish levels of education.(4) The prevalence of cervical intraepithelial neoplasia(CIN)in HR-HPV positive group wag significantly higher than that in HR-HPV negative group(29.76% vs 3.32%,P<0.01).Conclusions(1)The HR-HPV infection rate among aged 25 to 54 years was 9.9% and there was no significant difference in area distribution.(2)The hish risk population which should strengthen screening was the married bearing-age women with high level of family income,outlander,high levels of education and her husband possessing more than 1 sexual partner.(3)HR-HPV infection is the main risk factor for CIN and cervical cancer.while does not provide a causal relationship with them.The high risk population should be checked regularly to understand the development of HR-HPV infection and CIN incidence.

[Objective]To search for a good way for complex total hip arthroplasty(THA) and hip reconstruction.[Method]From February 1995 to June 2007,THA was done 95 hips in 86 patients with good preoperative preparation,full evaluatibn and complete simulation the details occurring at operation.[Result]Eighty one patients were followed up from 6 months to 10 years(average 3.5 years).All patients were measured by Harris score.The preoperative Harris score in the patients ranged from 35 to 50(average 42.1).The postperative score ranged from 70 to 90(average 82.3).Leg length discrepancy ranged from 1 to 12 cm preoperative.(average 4 cm),but from 0 to 5 cm postperative(average 1.5 cm).Two with serious leg length discrepancy,one is 6 cm,the other is 12 cm,after the operation,one is 2 cm,the other is 5 cm.Two had poor incision healing,upper femur split occurred in 3,one with hip prothesis dislocate,nerve injury happened in 2 and two had venous embolism.[Conclusion]Anatomic structure in complex total hip arthroplasty changes so much that it is hard to rebuild and replace a normal hip anatomic structure.Excellent clinical outcome can be achieved with full preparation and evaluation before operation and careful management at opertation.