Hypertrophic cardiomyopathy, a genetic hereditary disease, is highly regarded in clinical practice due to its unique pathophysiological changes, course characteristics, and hemodynamic features. With the continuous advance of treatment methods such as medications and surgeries, the prevention, treatment and prognosis of hypertrophic cardiomyopathy has gradually improved. However, inappropriate use of positive inotropic drugs may lead to serious consequences that are difficult to reverse. Therefore, how to smoothly navigate through the perioperative period and ensure clinical safety poses a great challenge for anesthesiologists. This paper discusses the perioperative management of patients with hypertrophic cardiomyopathy, with the hope of enhancing anesthesiologists' management capabilities for this type of disease.

Objective To investigate the relationship between C-reactive protein (CRP) and postoperative cognitive function of female patients underwent cardiopulmonary bypass (CPB) cardiac surgery.Methods Sixty female patients were scheduled for CPB surgery from January 2012 to May 2013,aged form 35 to 60 years,mean aged (47.5 ± 12.5) years,and in state of ASAⅡ ～ Ⅲ.All patients had general anesthesia and CPB cardiac surgery.Blood samples were taken from peripheral vein before induction and 6 days after surgery.The neuropsychology assessment was measured with Wechsler Adult Intelligence Scale RC 2 + 1 (WAIS-RC) and digital span the first day preoperative,the 7th day,and the first month postoperative.The postoperative cognitive dysfunction (POCD) was judged with Newman style.Results (1) The rate of POCD of the 7th day and first month postoperatively was 50％ and 25％,respectively.(2) The Pearsong correlation showed negative correlation between CRP preoperative at the 6th day and the 7th day,and the first month postoperative WAIS-RC score(P ＜ 0.05).(3) The Pearson's figure showed negative correlation between CRP at the 6th day postoperative with digital span (P ＜ 0.05).Conclusions The ratio of POCD after CPB surgery was higher.It is instructively significant to monitor the variations of concentration of serum CRP for the selection of cognitive impairment in patients with cardiac-pulmonary bypass surgery.

ObjectiveTo explore the clinical effect of transcatheter hepatic arterial chemoembolization and systemic chemotherapy on colorectal cancer with hepatic metastasis.Methods50 cases of colon cancer with hepatic metastasis according to treatment methods were divided into A,B group.A group treated by TACE plus intravenous chemotherapy,B group treated by intravenous chemotherapy alone.Side effects,changes in liver tumor size and survival rate were observed.ResultsThe incidence of side effects of two groups had no significant difference ( P ＞ 0.05 ).A group of liver lesions smaller in size or stable is more than in group B( P ＜0.05 ).A group of 1 year,3 years survival rate is 84％and 64％respectively,which is higher than B group 56％and 36％ ( all P ＜ 0.05 ).ConclusionTranscatheter hepatic arterial chemoembolization and systemic chemotherapy is a safe and effective treatment of colon cancer with hepatic metastasis,it can obviously raise the survival rate.

Objective To evaluate the effect of esmolol on bispectral index (BIS) in patients undergoing orotracheal intubation during induction of anesthesia and to investigate the mechanism of inhibiting the cardiovascular responses to tracheal intubation.Methode Forty patients in physical status of ASA Ⅰ or Ⅱ and aged 20-60 years were randomly divided into 2 groups ( n = 20 each): esmolol group (group E) and control group (group C). Anesthesia was induced with midazolam 0.1 mg/kg, fentanyl 5 μg/kg and vecuronium 0.1 mg/kg. In group E, esmolol 1 mg/kg was given intravenously before anesthesia induction and followed by an infusion of esmolol 250 μg· kg- 1·min-1, while a comparable volume of saline was given for group C. Mean arterial pressure (MAP), heart rate (HR) and BIS were recorded before esmolol administration, before induction of anesthesia, before orotracheal intubation, and at 1, 2 and 5 min after intubation, respectively.Results There were no significant differences in HR, MAP and BIS between the two groups before tracheal intubation. HR and MAP significantly increased after tracheal intubation in both groups, but BIS only in group C significantly increased after intubation.HR, MAP and BIS were significantly lower after intubation in group E than in group C ( P＜ 0.05).Conclusion Esmolol can decrease BIS during tracheal intubation and its antinociceptive property is related to the mechanism of inhibiting cardiovascular responses to tracheal intubation.

Objective To analyze the effect and safety of interventional therapy by trans uterine artery for treatment of tubal pregnancy. Methods Forty-two patients with tubal pregnancy were performed two side uterine arteries. MTX perfusion and embolization with gelfoam particles guided by DSA fluoroscopy. Results Forty patients obtained the decline of serum β-HCG value and 39 patients' ectopic mass absorption after treatment. Two patients occurred ectopic mass bleeding after interventional therapy and emergency surgical operation were done, but the amount of bleeding was low than 400ml. Conclusion Interventional therapy by trans uterine artery for treatment of tubal pregnancy could preserve the function of fallopian tubal, it was more benefit for patients who want normal pregnancy.

Clinical data of 21 pregnant women with scrub typhus were analyzed retrospectively.They all had fever,13 of them with lymph nodes enlargement,12 with skin rashes,11 with eschar or ulcer,and 20 positive with Weil-Felix reaction.Oxytetracycline was given in 17 of them and other four were treated by azithromycin,with all cured.Seven of them gave natural childbirth at the 37th week of gestation,nine were aborted inductively,three aborted spontaneously and two delivered premature births.Scrub typhus was harmful to both pregnant women and their fetuses,early diagnosis and treatment are necessary for patients with it for avoiding exacerbation and reducing fatality.

).The complication rate in RIVVH was lower than that in the control group (P<0.05).Conclusions Early RIVVH was effective in the treatment of SAP,and may be an option as adjuvant treatment measure.

Objective To determine the median effective dose of remifentanil for maintaining the tolerance to ProSeal laryngeal mask airway in awake and spontaneously breathing patients.Methods Sixty ASA Ⅰ orⅡpatients aged 20-55 years old were recruited.Sixty patients was randomized into six groups with 10 case each Remifentanil was infused in a dose of 0.061,0.048,0.039,0.03,0.025 or 0.02μg·kg~(-1) 5 minutes after inserting PLMA.Single dose of remifentanil 0.25/μg/kg was given before continuous intravenous infusion.Respiratory response subscore of comfort scale(CSRR)and Ramsay sedation scale(RSS)were recorded after 25 minutes.ED50 was calculated.Results The ED50 of remifentanil for ProSeal laryngeal mask airway tolerance was 0.027μg·kg~(-1)(95%CI:0.023-0.030μg·kg~(-1)·min~(-1)in awake and spontaneously breathing patients.Conclusion The patients tolerate stimulus of laryngeal mask with a low dose continuous intravenous infusion of remifentanil in awake.and can maintain the hemodynamics stable.

Objective To investigate the effects of esmolol and remifentanil on minimum alveolar concentration (MAC) of isoflurane in patients undergoing upper abdominal surgery. Methods One hundred ASAⅠorⅡpatients aged 18-60 yr undergoing upper abdominal surgery under general anesthesia were randomly divided into 5 groups (n=20 each):group A isoflurane alone; group B isoflurane + large dose esmolol; group C isoflurane + remifentanil; group D isoflurane + remifentanil + small dose esmolol and group E isoflurane + remifentanil + large dose esmolol. In group B and E esmolol was infused at 250 μg·kg-1·min-1 after a loading dose of 1 mg/kg (large dose esmolol). In group D esmolol was infused at 50 μg'kg-1·min-1 after a loading dose of 0.5 mg/kg (small dose esmolol). In group C, D and E remifentanil was infused at 0.05 μg·kg-1·min-1 after a loading dose of 0.25 μg/kg. As soon as the patients lost consciousness, tracheal intubation was facilitated with succinyl choline 1.5 mg/kg. The patients were mechanically ventilated (VT=8 ml/kg, RR 12 bpm, FiO2= 100% ). PET CO2 was maintained at 32-38 mm Hg and naso-pharyngeal temperature above 35.5℃. End-tidal isoflurane concentration was continuously monitored. If the patient moved his/her hand, foot, head or body within 60 seconds after skin incision was made the end-tidal isoflurane concentration was increased by 10% in the next patient; if the patient did not respond to skin incision the end-tidal concentration of isoflurane was decreased by 10% in the next patient. The initial end-tidal isoflurane concentration was 1.24% in group A and B, 0.78% in group C, D and E. Results The MAC of isoflurane was 1.24% ± O.14%, 1.22%±0.09%, 0.77%± 0.05%, 0.75% ±0.06%, 0.60%±0.05% in group A, B, C, D, E respectively. Remifentanil significantly reduced MAC of isoflurane in group C, D and E as compared with group A. The MAC of isoflurane was significantly lower in group E than in group C. Conclusion Remifentanil infusion at 0.05 μg·kg-1·min-1 combined with large dose esmolol can reduce MAC of isdlurane by 52% in patients undergoing upper abdominal surgery.

Objective To investigate the effect of milrinone on the gastric intramucosal pH (pHi), endotoxemia and systemic inflammatory response during cardiopulmonary bypass (CPB) Methods Twenty adult patients undergoing valve replacement were randomly divided into two equal groups of ten patients each: control group (C) and milrinone group (M) In group M milrinone 30?g?kg -1 was given as an intravenous bolus after induction of anesthesia followed by 0 5?g?kg -1 ?min -1 infusion, while in group C normal saline (NS) was given instead of milrinone Patients with ejection fraction (EF)