Objective To analyze the risk factors for the development of chronic critical illness(CCI)in septic shock patients in the intensive care unit(ICU).Methods A retrospective analysis was conducted on 102 sepsis shock patients admitted to the ICU of the hospital from August 2018 to May 2023.According to their clinical dates,they were divided into CCI group(n=60)and rapid recovery(RR)group(n=42).Multi-ple logistic regression analysis was perform to identify independent risk factors for developing CCI in septic shock patients,and construct their receiver operating characteristic(ROC)curves to evaluate their predictive value for CCI.Results The prolonged duration of hypernatremia(OR=1.770,95％CI:1.147-2.731,P=0.010)and low acute physiology and chronic health(APACHEⅡ)scores(OR=1.212,95％CI:1.025-1.433,P=0.025)were independent risk factors for CCI in ICU septic shock patients.The occurrence of acute gastrointestinal injury(OR=0.060,95％CI:0.011-0.341,P=0.002)and peak blood sodium levels during ICU(OR=0.812,95％CI:0.662-0.995,P=0.044)were protective factors.Conclusion For septic shock pa-tients,special attention should be paid to its related independent risk factors and protective factors to improve the prognosis of septic shock patients.

Objective To evaluate the added value of ciprofol and to provide the reference for clinical selection of ciprofol and propofol in patient individualized anesthesia and sedation program.Methods The relative safety,relative effectiveness,innovation/suitability,and economy of propofol and ciprofol were compared and scored according to the Guidelines for Drug Added Value Evaluation based on Health Technology Evaluation.Results Compared with the value of propofol,the total value of ciprofol was 57 points,which was reflected as a small increase.The sedation effect of the two drugs was similar,but propofol had more economic cost advantages,and ciprofol was better than propofol in injection pain,hypotension,and other adverse reactions.Conclusion Propofol and ciprofol should be used reasonably in anesthesia and sedation,considering the health status and economic condition of patients.

Objective:To investigate the application effect of teaching rounds with problem-based learning (PBL) and clinical teaching unit (CTU) in standardized residency training for anesthesiology.Methods:A total of 40 resident trainees in Department of Anesthesiology, The First Affiliated Hospital of Soochow University, were randomly divided into research group and control group, with 20 trainees in each group. In the first stage (1-4 months), the trainees in the research group received PBL-CTU teaching rounds, and those in the control group received conventional teaching rounds; in the second stage (5-8 months), both groups received the PBL-CTU teaching rounds. The two groups were compared in terms of general information, assessment results of theoretical knowledge and skill operation in the first and second stages, and questionnaire survey of the degree of satisfaction with teaching. SPSS 24.0 was used for statistical analysis; the t-test was used for continuous data, and the chi-square test was used for categorical data. Results:There were no significant differences between the two groups in terms of age, sex, educational level, residency grade, and comprehensive ability assessment before the study. After the first stage of training, compared with the control group, the research group had significantly better theoretical assessment score [(85.30±3.39) vs. (81.15±4.66), P=0.003], skill assessment score [(83.95±4.37) vs. (79.70±6.20), P=0.017], and effective communication ability (95.00% vs. 65.00%, P=0.048) and team collaboration ability (100.00% vs. 65.00%, P=0.013) in questionnaire survey of the degree of satisfaction with teaching. After the second stage of training, both groups had significant increases in theoretical assessment score [the research group: (89.30±4.12) vs. (85.30±3.39), P=0.002; the control group: (88.90±3.49) vs. (81.15±4.66), P<0.001] and skill assessment score [the research group: (88.40±4.84) vs. (83.95±4.37), P=0.004; the control group: (86.20±4.98) vs. (79.70±6.20), P=0.001], and the questionnaire survey showed that a relatively high degree of satisfaction (95.00%-100.00%) was achieved for teaching effect, while there were no significant differences in each indicator between the two groups. Conclusions:Compared with conventional teaching rounds, PBL-CTU teaching rounds significantly improve the levels of theoretical knowledge and clinical operation ability and enhance the quality of teaching rounds. All residents have achieved satisfactory learning outcomes and progress after the two stages of teaching activities.

Objective To evaluate the added value of ciprofol and to provide the reference for clinical selection of ciprofol and propofol in patient individualized anesthesia and sedation program.Methods The relative safety,relative effectiveness,innovation/suitability,and economy of propofol and ciprofol were compared and scored according to the Guidelines for Drug Added Value Evaluation based on Health Technology Evaluation.Results Compared with the value of propofol,the total value of ciprofol was 57 points,which was reflected as a small increase.The sedation effect of the two drugs was similar,but propofol had more economic cost advantages,and ciprofol was better than propofol in injection pain,hypotension,and other adverse reactions.Conclusion Propofol and ciprofol should be used reasonably in anesthesia and sedation,considering the health status and economic condition of patients.

Objective:To investigate the application effect of teaching rounds with problem-based learning (PBL) and clinical teaching unit (CTU) in standardized residency training for anesthesiology.Methods:A total of 40 resident trainees in Department of Anesthesiology, The First Affiliated Hospital of Soochow University, were randomly divided into research group and control group, with 20 trainees in each group. In the first stage (1-4 months), the trainees in the research group received PBL-CTU teaching rounds, and those in the control group received conventional teaching rounds; in the second stage (5-8 months), both groups received the PBL-CTU teaching rounds. The two groups were compared in terms of general information, assessment results of theoretical knowledge and skill operation in the first and second stages, and questionnaire survey of the degree of satisfaction with teaching. SPSS 24.0 was used for statistical analysis; the t-test was used for continuous data, and the chi-square test was used for categorical data. Results:There were no significant differences between the two groups in terms of age, sex, educational level, residency grade, and comprehensive ability assessment before the study. After the first stage of training, compared with the control group, the research group had significantly better theoretical assessment score [(85.30±3.39) vs. (81.15±4.66), P=0.003], skill assessment score [(83.95±4.37) vs. (79.70±6.20), P=0.017], and effective communication ability (95.00% vs. 65.00%, P=0.048) and team collaboration ability (100.00% vs. 65.00%, P=0.013) in questionnaire survey of the degree of satisfaction with teaching. After the second stage of training, both groups had significant increases in theoretical assessment score [the research group: (89.30±4.12) vs. (85.30±3.39), P=0.002; the control group: (88.90±3.49) vs. (81.15±4.66), P<0.001] and skill assessment score [the research group: (88.40±4.84) vs. (83.95±4.37), P=0.004; the control group: (86.20±4.98) vs. (79.70±6.20), P=0.001], and the questionnaire survey showed that a relatively high degree of satisfaction (95.00%-100.00%) was achieved for teaching effect, while there were no significant differences in each indicator between the two groups. Conclusions:Compared with conventional teaching rounds, PBL-CTU teaching rounds significantly improve the levels of theoretical knowledge and clinical operation ability and enhance the quality of teaching rounds. All residents have achieved satisfactory learning outcomes and progress after the two stages of teaching activities.

Objective To explore the effects of low-dose esketamine on the median effective dose(ED50)of ciprofol for sedation in elderly patients undergoing ultrasound-guided transperineal prostate biopsy.Methods Forty-nine elderly male patients,aged 65-75 years,BMI 18.5-30.0 kg/m2,ASA physical stutas Ⅰ-Ⅲ,who underwent ultrasound-guided transperineal prostate biopsy,were randomly as-signed into the esketamine-ciprofol group(group E,n=23)and the ciprofol group(group C,n=26).After intravenous administration of sufentanil 0.1 μg/kg,patients in group E received esketamine 0.2 mg/kg,while patients in group C received the same volume of normal saline.The up-and-down sequential allocation method was used to calculate the effective dose of ciprofol.The initial dose of ciprofol was 0.2 mg/kg in group E and 0.3 mg/kg in group C,and the dose gradient was 0.05 mg/kg for both groups.If there was no body movement during the first puncture of prostate after the loss of eyelash reflex,the ciprofol dose in the next patient was reduced by 0.05 mg/kg.Otherwise,the ciprofol dose in the next patient was in-creased by 0.05 mg/kg.The study was completed until 7 inflection points alternating between non-body movement and body movement achieved.The total amount of ciprofol,surgical time,recovery time,stay in recovery room,hypotension,bradycardia,respiratory depression,injection pain,nausea and vomiting,and adverse reaction of the mental system were recorded.The Probit method was used to calculate the ED50 and 95%effective dose(ED95)with 95%confidence interval(CI)of ciprofol for inhibition of body movement.Results Compared with group C,the total amount of ciprofol in group E was significantly reduced(P＜0.05).There were no significant differences between the two groups in surgical time,recovery time,stay in recovery room,and adverse events.The ED50 of ciprofol in group E was 0.22 mg/kg(95%CI 0.19-0.26 mg/kg),and the ED50 in group C was 0.38 mg/kg(95%CI 0.31-0.46 mg/kg).Compared with group C,the ED50 in group E was significantly reduced(P＜0.05).The ED95 of ciprofol in group E was 0.28 mg/kg(95%CI 0.25-0.49 mg/kg),and the ED95 in group C was 0.51 mg/kg(95%CI 0.44-1.25 mg/kg).Compared with group C,the ED95 in group E was significantly reduced(P＜0.05).Conclusion The ED50 of ciprofol for inhibition of body movement in elderly patients undergoing ultrasound-guided transperi-neal prostate biopsy was 0.38 mg/kg,which was reduced to 0.22 mg/kg by using lose-dose esketamine 0.2 mg/kg as an adjuvant.

Objective:To investigate the effect of bupivacaine liposome for erector spinae plane block on the quality of postoperative recovery in patients undergoing thoracoscopic lung resection.Methods:From July 2023 to January 2024, 128 American Society of Anesthesiologists Physical Status classification ⅠorⅡ patients of either sex, aged 18-75 yr, with body mass index of 18-32 kg/m 2, scheduled for elective thoracoscopic lung resection at the First Affiliated Hospital of Soochow University, were assigned to either bupivacaine liposome group (BL group) or bupivacaine hydrochloride group (BH group) using a random number table method, with 64 patients in each group. Patients received an ultrasound-guided erector spinae plane block following anesthesia induction. BL group received an injection of bupivacaine liposome 20 ml (266 mg) plus normal saline 10 ml, while BH group received an injection of bupivacaine hydrochloride 20 ml (100 mg) plus normal saline 10 ml. The primary outcome was the Quality of Recovery-15 (QoR-15) score at 24 h postoperatively. Secondary outcomes included the QoR-15 score at 3 days postoperatively, time to first patient-controlled analgesia press, and total opioid consumption within the first 3 days postoperatively. Other outcomes assessed were the time to ambulation, duration of chest tube placement, length of hospital stay, patient satisfaction scores at discharge, and development of adverse reactions during hospitalization. Results:Compared to BH group, QoR-15 scores were significantly increased at 24 h and 3 days postoperatively, the time to first patient-controlled analgesia press was significantly prolonged, the consumption of opioid was reduced within the first 3 days postoperatively, the time to ambulation was shortened, and patient satisfaction scores at discharge were increased in BL group ( P<0.05). There were no statistically significant differences between the two groups in terms of the chest tube duration, length of hospital stay, and incidence of adverse reactions during hospitalization ( P>0.05). Conclusions:Bupivacaine liposome for erector spinae plane block can improve the quality of postoperative recovery in patients undergoing thoracoscopic lung resection.

【Objective】 To investigate the correlation between perioperative zero red blood cell(RBC) transfusion and the prognosis of patients with acute Stanford type A aortic dissection. 【Methods】 A retrospective analysis was made on 96 patients who underwent one-stop Hybrid surgery for acute Stanford type A aortic dissection in our hospital from May 2021 to May 2022. The patients were divided into two groups according to whether they received perioperative RBC transfusion: zero RBC transfusion group (group A, n=26) and RBC transfusion group (group B, n=70). The preoperative general data and laboratory indexes were recorded and the propensity score matching method was used to screen the patients with the same preoperative baseline data, with comparison of operation-related indicators, intraoperative and postoperative blood component dosage and prognostic indicators. 【Results】 With BMI index, hemoglobin, platelet count, and troponin T as co variables, 48 patients were included in the study after matching according to 1∶1 propensity score: Group A (n=24) and Group B (n=24). Compared with group A, hemoglobin and hematocrit in group B decreased significantly at the end of operation and 24 h after operation, with a statistically significant difference (P<0.05). There was no significant difference between the two groups in operation-related indicators, intraoperative and postoperative blood component dosage, in-hospital mortality, continuous renal replacement therapy, incidence of infection and cerebral infarction (P>0.05). 【Conclusion】 The perioperative hemoglobin of patients with acute Stanford type A aortic dissection with zero RBC transfusion did not significantly decrease, and the postoperative complications and mortality did not increase.

Objective:To identify the effective concentrations of Ropivacaine in the modified fascial iliac compartment block(FICB)that would not affect the movement of the affected limb but would offer effective pain relief after total knee arthroplasty(TKA)in elderly patients.In addition, adverse reactions within 24 hours of FICB were examined.Methods:This study was a prospective, single-arm sequential trial.Forty-five elderly patients treated with TKA at the First Affiliated Hospital of Soochow University between September 2021 and March 2022 were selected, with an American Society of Anesthesiologists(ASA)score of Ⅰ or Ⅱ.All patients were given ultrasound-guided FICB on the surgical side under general anesthesia and 10 minutes before the operation, and the injection volume was 30 ml.According to preliminary experiments and relevant literature, the initial concentration of Ropivacaine was 0.1%, and the concentration for the next patient was determined using a modified Dixon sequential method.If the quadriceps femoris muscle strength score of the first patient was ≥4, there was no resting pain[visual analogue scale(VAS)score ≤1], and the VAS score during activity was ≤3, the concentration for the next patient would be reduced.Conversely, the concentration would be increased.The Ropivacaine concentration was increased or decreased by 0.01% each time and the trial would be stopped after 12 reentries.The median effective concentration(ED50), 95% effective concentration(ED95)and corresponding 95% confidence interval(CI)of ropivacaine were calculated using the probit model.Meanwhile, adverse reactions within 24 hours of FICB were monitored.Results:Of 43 elderly patients who completed the trial, the intervention was effective in 23 and ineffective in 20.While ensuring that postoperative limb movement in elderly patients was not affected, a single injection of 30 ml ropivacaine through FICB was able to effectively inhibit postoperative pain, and the ED50 and ED95 of ropivacaine were 0.072%(95% CI: 0.065%-0.078%)and 0.093%(95% CI: 0.084%-0.124%), respectively.Within 24 hours of FICB, 2 patients had lower limb weakness and could not get out of bed and walk, and 5 patients had severe pain and needed additional analgesics.No other adverse reactions were found. Conclusions:The effective ED50 and ED95 of Ropivacaine for postoperative pain relief in elderly patients after TKA are 0.072% and 0.093%, respectively.And the incidence of adverse reactions is low.

【Objective】 To investigate the effects of dexmedetomidine (DEX) intervention on the expressions of chondrocytes and related factors in vitro and its possible molecular mechanisms. 【Methods】 C28/I2 normal human chondrocyte lines were cultured in vitro, and dexmedetomidine at the concentration of 1 μmol/L was selected to intervene for 24 h and 48 h, respectively. The morphology and cell density of chondrocytes were observed after DEX culture at different time points. Immunofluorescence technique was used to detect the expression levels of disintegrin and metalloproteinase with thrombospondin motifs 5 (ADAMTS5) in chondrocytes in each group. The expression levels of Adamts5, aggrecan (Acan), versican (Vcan), Furin, proprotein convertase subtilisin/kexin type 6 (Pcsk6), collagen type Ⅰ alpha 1 (Col1a1), collagen type Ⅱ alpha 1 (Col2a1), collagen type X alpha 1 (Col10a1), and SRY2 related high mobility group box gene9 (Sox9) were detected by RT-PCR. Adamts5 gene knockout chondrocytes were constructed by lentivirus transfection technology and treated with DEX; RT-PCR was used to detect the effects of DEX on the expression levels of Acan, Vcan, Furin, Pcsk6 and Sox9 after Adamts5 gene knockout. 【Results】 After 24 and 48 h of intervention with 1 μmol/L DEX, the morphology and size of chondrocytes did not change significantly, but the cell density increased slightly. Immunofluorescence assay showed that the expression of ADAMTS5 increased at first and then decreased after DEX treatment for 24 and 48h, respectively (P=0.032). RT-PCR results showed that with the extension of intervention time, the expression of Adamts5 first increased and then decreased. The expression difference between 48 and 24 h after culture was statistically significant (P=0.032). The change trend of Pcsk6 was the same as that of Adamts5, while the change trend of Acan expression was opposite that of Adamts5. Chondrocytes knocked out Adamts5 gene and intervened with DEX for 24 and 48 h. The results of RT-PCR showed that the expression of Pcsk6 decreased while that of Acan increased and the changes were significant. 【Conclusion】 Dexmedetomidine may activate ADAMTS5 zymogen through Pcsk6, thereby promoting proteoglycan degradation in chondrocytes.