Objective:To explore the related factors influencing the length of hospital stay(LOS) of pregnant women with heart disease (PWHD) after cesarean section.Methods:A total of 306 patients with PWHD who underwent cesarean section from January 2012 to March 2019 were collected. Among them, 203 patients had not undergone heart surgery (uncorrected group) and 103 patients who had undergone heart surgery (corrected group) during the same period. Demographic, perioperative and postoperative data were recorded. Predictors associated with postoperative LOS were determined using univariate and multivariate linear regression analysis models.Results:(1) The median LOS after cesarean section in the uncorrected group was 6 days (5-8 days). The results of univariate linear regression analysis showed that 38 parameters had significant impact on LOS ( P<0.05). The results of multivariate linear regression analysis showed that 5 parameters were independent risk factors for prolonged LOS in the uncorrected group; among them, the median LOS in uncorrected group with hypertensive disorders of pregnancy was 3 days longer than that in patients with PWHD alone [7 days (5-8 days) vs 4 days (4-5 days), β=0.195, P=0.001]; the median LOS in uncorrected group with high serum creatinine was 3 days longer than normal patients [7 days (5-13 days) vs 4 days (4-5 days), β=0.145, P=0.015]; the LOS of patients who chose general anesthesia was 2 days longer than that of patients who chose spinal anesthesia [6 days (4-8 days) vs 4 days (4-5 days), β=0.154, P=0.007]; the LOS of patients with postoperative pulmonary infection was 4 days longer than that of patients without pulmonary infection [8 days (5-15 days) vs 4 days (4-5 days), β=0.269, P<0.01]; the LOS of patients who admitted to ICU after surgery was 2 days longer than that not admitted patients [6 days (5-8 days) vs 4 days (4-5 days), β=0.268, P<0.01]. (2) The median LOS after cesarean section in corrected group was 4 days (4-5 days). The results of univariate linear regression analysis showed that 8 parameters had significant impact on the LOS (all P<0.05). The results of multivariate linear regression analysis showed that 2 parameters, which were American Society of Anesthesiologists (ASA) grade ( β=0.198, P=0.028) and intraoperative blood loss ( β=0.285, P=0.003), were the independent risk factors for prolonged LOS in corrected group. Conclusion:Preoperative with hypertensive disorders of pregnancy, preoperative creatinine increase, intraoperative general anesthesia, postoperative pulmonary infection, and postoperative admission to ICU are independent predictors of prolonged LOS in uncorrected patients with PWHD; ASA classification and intraoperative bleeding are independent predictor of prolonged postoperative LOS in patients with corrected PWHD.

Objective:To evaluate the effect of nicorandil on cardiac function in the patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB).Methods:Forty patients of both sexes, aged 18-64 yr, of American Society of Anesthesiologists physical status Ⅱ-Ⅳ, with New York Heart Association class Ⅱ or Ⅲ, with body mass index of 18-25 kg/m 2, scheduled for elective cardiac valve replacement under general anesthesia and CPB, were divided into conventional group( n=20) and nicorandil group( n=20) according to a randomized number table method.In nicorandil group, nicorandil 10-60 μg·kg -1·h -1 was intravenously infused starting from the end of anesthesia induction until the the end of operation.Mean arterial pressure was maintained at 60-80 mmHg in two groups.Venous blood samples were collected before induction of anesthesia (T 0) and at 6, 12, 24, 48 and 72 h after operation (T 1-5) and at the time of discharge (T 6) to determine the serum amino-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations.The occurrence of myocardial ischemic events or arrhythmia before and after operation was recorded.The defibrillation during intraoperative restoration of spontaneous heart beat, restoration of spontaneous heart beat, medication during restoration of spontaneous heart beat, and cardiac rhythm after restoration of spontaneous heart beat were recorded.The intra- and post-operative requirements for cardiovascular drugs were recorded.The mechanical ventilation time and intensive care unit stay time were also recorded. Results:Compared with conventional group, the serum NT-proBNP concentration was significantly decreased at T 5 and T 6, the mechanical ventilation time and intensive care unit stay time were shortened, the consumption of intraoperative norepinephrine and postoperative dobutamine was decreased ( P<0.05), and no significant change was found in the incidence of postoperative myocardial ischemic events or arrhythmias, defibrillation rate during restoration of spontaneous heart beat, rate of spontaneous recovery of heart beat, cardiac rhythm after restoration of spontaneous heart beat or medication during restoration of spontaneous heart beat in nicorandil group ( P>0.05). Conclusion:Intravenous infusion of nicorandil can improve the cardiac function and is helpful in improving short-term prognosis in the patients undergoing cardiac valve replacement under CPB.

Objective To evaluate the relationship between sevoflurane-induced cognitive impairment and α1B adrenoceptors (ADRA1B) and ADRA1D in the cerebral cortex of rats.Methods Forty-eight SPF adult Sprague-Dawley rats (half male,half female),weighing 220-260 g,were divided into control group (C group,n =24) and sevoflurane group (S group,n =24) using a random number table method.Group C and group S inhaled air and 3％ sevoflurane,respectively,for 5 h.Eight rats in each group were sacrificed immediately after anesthesia,and the cerebral cortex was removed.Eight rats in each group were selected on days 1 and 7 after anesthesia and underwent Barnes maze test.The rats were then sacrificed,and the cerebral cortex was removed.The expression of ADRA1B and ADRA1D protein and mRNA in cerebral cortex tissues was detected by Western blot and fluorescent quantitative real-time polymerase chain reaction,respectively.Results Compared with group C,the number of entering incorrect holes was significantly increased at 1 and 7 days after anesthesia,the latency and total distance to enter the target hole were prolonged,and the expression of ADRA1B and ADRA1D protein and mRNA in cerebral cortex was down-regulated immediately after anesthesia and at 1 and 7 days after anesthesia in group S (P＜0.05).Conclusion The mechanism underlying sevoflurane-induced cognitive impairment may be related to the down-regulated expression of ADRA1B and ADRA1D in cerebral cortex of rats.

Objective: To investigate the incidence and risk factors of postoperative acute renal injury (AKI) in patients after primary unilateral hip and knee replacement. Methods: Between January 2016 and July 2018, A total of 1 490 patients underwent hip and knee arthroplasty were enrolled. There were 507 male and 983 female with a median age of 66 years (range: 18 to 95 years). There were 201 patients underwent femoral head replacement, 897 total hip arthroplasty and 392 total knee arthroplasty, respectively. The creatinine value was 68.79 μmol/L preoperatively. Demographic, perioperative and postoperative data were recorded. The development of AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. The demographic information, comorbidities, preoperative medication, type of surgery, type of anesthesia, intraoperative anesthetics, operation time, intravenous fluid type and dose, amount of bleeding and postoperative creatinine values were recorded. Predictors associated with AKI and postoperative creatinine was determined by multiple regressions. Results: There were 80 cases developed AKI with the incidence of AKI 5.4%. Among the AKI patients, there were 69 cases (4.6%) in AKI stage 1, 7 cases (0.5%) in AKI stage 2, and 4 cases (0.3%) in AKI stage 3. The creatinine value was 72.03 μmol/L after surgery. The length of postoperative hospital stay was 9 days. There were 5 patients died in hospital. The independent risk factors of AKI after hip and knee arthroplasty included old age, a higher American Society of Anesthesiologists (ASA) grade and preoperative diabetes (P<0.05). The risk of postoperative AKI in patients aged 60-69 years, 70-79 years, and older than 80 years was 2.259, 2.798, and 6.049 times than that of patients under 60 years of age, respectively. The risk of postoperative AKI in patients with ASA grade II, III, and IV was 3.749, 9.023, and 21.595 times than that of ASA grade I patients, respectively. The risk of AKI in patients with diabetes before surgery was 2.377 times higher than that in non-diabetics. Age, diabetes, hypertension and preoperative serum creatinine were positively correlated with postoperative creatinine values (P<0.05). Intensive care unit admissions were greater in AKI patients than that in non-AKI patients (25.0%, 5.6%, χ²=-6.774, P<0.001). Compared with non-AKI patients, the postoperative length of hospital stay was longer in AKI patients (Z=-3.904, P<0.001). Conclusion The incidence of postoperative AKI after primary hip and knee replacement was 5.4%. The older age, ASA grade, and diabetes were independently associated with risk of AKI. Old age, male, preoperative diabetes, hypertension and a higher preoperative creatinine value can predict postoperative increased creatinine levels at postoperation. The risk factors for AKI included old age, a higher ASA grade and diabetes. The postoperative length of hospital stay was longer in AKI patients.

Objective To compare the effects of isoflurane compare sevoflurane on postoperative cognitive function and the level of serum β-amyloid in elder patients at 12 months after surgery.Methods Seventy-seven patients undergoing abdominal surgery,43 males and 34 females,aged 65-75 years,ASA physical status Ⅰ-Ⅲ,were divided into two proups:isoflurane group (group Ⅰ,n =32) and sevoflurane group (group S,n =45).The patients' cognitive function were assessed using mini-mental state examination (MMSE) 1 d before operation,3 d and 12 months after opertion.Blood samples were taken before operation,3 d and 12 monthes after operation for determination of serum Aβ42 and Aβ40 concentrations.Results The MMSE scores of the two groups 3 d after operation were significantly lower than those before operation (P＜0.05).The MMSE score 3 d after operation in group Ⅰ was significantly lower than that in group S (P＜0.05).The incidence of cognitive dysfunction 12 months after operation had no significant difference between two groups [13 (40.6％) cases vs 15 (33.3％) cases].There was no significant difference in the serum Aβ42 and Aβ40 concentration between groups.Conclusion Sevoflurane has less effect on postoperative cognitive function in short time than isoflurane,but its long-term effect seemed to be similar.The levels of Aβ42 and Aβ40 showed no difference between two groups.

Objective To evaluate the effect of sevoflurane anesthesia on the expression of hippocampal α4 subunit-containing nicotinic acetylcholine receptor (α4nAChR) in rats.Methods One hundred and forty-four Sprague-Dawley rats of both sexes,aged 3-4 months,weighing 220-270 g,were divided into 4 groups (n =36 each) using a random number table:control group (group C),sevoflurane anesthesia for 1 h group (group S1),sevoflurane anesthesia for 3 h group (group S2) and sevoflurane anesthesia for 5 h group (group S3).Group C inhaled air,and S1,S2 and S3 groups inhaled 3％ sevoflurane for 1,3 and 5 h,respectively.Twelve rats in each group were selected at 1 and 7 days after emergence from anesthesia to undergo spatial probe test.Rats were then sacrificed immediately after anesthesia and at 1 and 7 days after emergence from anesthesia,and hippocampi were removed for determination of the expression of α4nAchR protein and mRNA in hippocampal neurons (by Western blot or real-time polymerase chain reaction).Results Compared with group C,the duration of staying at the target quadrant was significantly shortened,and the ratio of duration of staying at the original platform quadrant to the total duration and ratio of swimming distance in the original platform quadrant to the total distance were decreased on 1 and 7 days after emergence from anesthesia,the expression of α4nAchR protein and mRNA was down-regulated,and the number of positive cells was reduced in S1,S2 and S3 groups (P＜0.05).Compared with S1 and S2 groups,the duration of staying at the target quadrant was significantly shortened,the ratio of duration of staying at the original platform quadrant to the total duration and ratio of swimming distance in the original platform quadrant to the total distance were decreased on 1 day after emergence from anesthesia in group S3 (P＜0.05).There was no significant difference in the expression of α4nAchR protein and mRNA or number of positive cells at each time point between group S1,group S2 and group S3 (P＞0.05).Conclusion The mechanism by which sevoflurane anesthesia induces cognitive dysfunction may be partially related to down-regulating the expression of hippocampal α4nAchR in rats.

Objective To evaluate the relationship between sevoflurane-induced cognitive decline and α1A norepinephrine receptor (ADRA1A) in the cerebral cortex of rats.Methods Forty-eight cleangrade healthy adult Sprague-Dawley rats (24 male,24 female),weighing 220-260 g,aged 3-4 months old,were divided into 2 groups (n =24 each) using a random number table method:control group (group C) and sevoflurane group (S group).Group S inhaled 3％ sevoflurane for 5 h.Rats underwent the Barnes maze test on days 1 and 7 after anesthesia.Rats were sacrificed immediately after anesthesia and on days 1 and 7 after anesthesia,and the cerebral cortex was removed for determination of the expression of ADRA1A protein and mRNA (by Western blot or fluorescent quantitative real-time polymerase chain reaction).Results Compared with group C,the number of entering incorrect holes was significantly increased,and the latency of entering the target hole and the distance were prolonged,and the expression of ADRA1A protein and mRNA in cerebral cortex was down-regulated at each time point in group S (P＜0.05).Conclusion The mechanism of sevoflurane-induced cognitive decline is related to down-regulated expression of ADRA1A in the cerebral cortex of rats.

Objective To evaluate the effect of nicorandil on early prognosis in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Forty American Society of Anesthesiologists physical status Ⅱ or Ⅳ patients,aged 18-64 yr,with New York Heart Association grade Ⅱ or Ⅲ,scheduled for elective cardiac valve replacement with CPB,were divided into 2 groups (n =20 each) using a random number table method:control group and nicorandil group.Nicorandil was intravenously infused at 10-60 μg · kg-1 · h-1 (3-15 ml/h) after anesthesia induction until the end of surgery in nicorandil group.Before anesthesia induction (To) and at 6,12,24,48 and 72 h after surgery (T1-5),and when the patients were discharged from hospital (T6),venous blood samples were obtained for determination of the concentrations of serum cardiac troponin I (cTnI) and brain natriuretic peptide.The events of myocardial ischemia or development of arrhythmia before and after surgery,development of defibrillation during restoration of heart beat,spontaneous heart beat,drug administration during restoration of heart beat,heart rhythm after restoration of heart beat,and the requirement for cardiovascular drugs during and after surgery were recorded.The mechanical ventilation time,duration of intensive care unit stay,and length of postoperative hospital stay were also recorded.Results Compared with control group,the concentrations of serum cTnI at T2,3 and brain natriuretic peptide at T2-6 were significantly decreased,the consumption of intraoperative norepinephrine and postoperative dobutamine was reduced,and the ventilation time and duration of intensive care unit stay were shortened (P＜0.05),and no significant change was found in the rate of defibrillation,restoration of spontaneous heart beat,requirement for drugs during restoration,heart rhythm after restoration or duration of postoperative hospital stay in nicorandil group (P ＞ 0.05).Conclusion Continuously infusing nicorandil during surgery can reduce myocardial injury and improve early prognosis in patients undergoing cardiac valve replacement with CPB.

Objective To evaluate the effect of electroacupuncture (EA) on postoperative outcome in the patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Forty-four patients of both sexes,aged 18-55 yr,with body mass index of 18-25 kg/m2,of American Society of Anesthesiologists physical status Ⅲ,with New York Heart Association Ⅱ[or Ⅲ,scheduled for elective cardiac valve replacement with CPB,were divided into 2 groups (n =22 each) using a random number table:control group (group C) and group EA.In group EA,patients received EA stimulation with needles at bilateral Neiguan,Ximen,Shenmen and Baihui acupoints (disperse-dense waves,frequency 2 Hz,intensity 1.0-1.2 mA) from 20 min before anesthesia induction to the end of surgery.After induction of general anesthesia,the patients were endotracheally intubated and mechanically ventilated,and combined intravenous-inhalational anesthesia was used to maintain anesthesia.Quality of Recovery 9 and Minimum Mental State Examination scores were assessed on the day before surgery and 1 and 3 days after surgery.The development of nausea and vomiting,postoperative cognitive dysfunction,requirement for rescue analgesics and ventricular arrhythmia was recorded within 3 days after surgery.The consumption of sufentanil in surgery,extubation time,the first flatus time,the first postoperative off-bed time,duration of stay in the intensive care unit and length of hospital stay after sugery were recorded.Results Compared with group C,the consumption of sufentanil in surgery was significantly decreased,Quality of Recovery 9 scores were increased at 1 and 3 days after surgery,the incidence of nausea and vomiting,postoperative cognitive dysfunction and ventricular arrhythmia was decreased within 3 days after surgery,and the extubation time,the first flatus time,the first postoperative off-bed time and length of hospital stay after surgery were significantly shortened in group EA (P＜0.05).Conclusion EA can promote postoperative outcome in the patients undergoing cardiac valve replacement with CPB.

Objective To evaluate the effect of sevoflurane on the expression of α7 nicotinic acetylcholine receptor (α7nAChR) in hippocampal neurons of rats.Methods Forty-eight pathogen-free healthy adult Sprague-Dawley rats of both sexes,weighing 210-280 g,aged 3-4 months,were divided into 4 groups (n=12 each) using a random number table:control group (group C) and 1%,3% and 5% sevoflurane groups (S1,S2 and S3 groups).In S1,S2 and S3 groups,1%,3% and 5% sevoflurane were inhaled for 1 h,respectively.Morris water maze test was performed at 1 and 7 days after anesthesia to assess the cognitive function.Six rats in each group were sacrificed after the end of the test.The brains were then removed and the hippocampi were isolated for detection of the expression of α7nAChR (by Western blot) and contents of tumor necrosis factor-alpha and interleukin-1 (by enzyme-linked immunosorbent assay).Results Compared with group C,the number of crossing the platform was significantly decreased at 1 and 7 days after anesthesia in group S1,the time of staying at the target quadrant was significantly shortened,the number of crossing the platform was decreased,and the rate of time of staying at the original platform quadrant and rate of swimming distance at the original platform quadrant were decreased at 1 and 7 days after anesthesia in S2 and S3 groups,and the contents of tumor necrosis factor-alpha and interleukin-1 were significantly increased,and the expression of α7nAChR was down-regulated at 1 and 7 days after anesthesia in S1,S2 and S3 groups (P<0.05).Compared with group S1,the expression of α7nAChR was significantly down-regulated at 1 and 7 days after anesthesia in S2 and S3 groups (P<0.05).Compared with group S2,the expression of α7nAChR was significantly down-regulated at 1 day after anesthesia in group S3 (P<0.05).There was no significant difference in each parameter of Morris water maze test among group S1,group S2 and group S3 (P>0.05).Conclusion The mechanism by which sevoflurane induces inflammatory responses in hippocampi is related to down-regulation of α7nAChR expression in hippocampal neurons of rats.