Objective To investigate the effect of dynamic lung compliance(Cdyn)-guided indi-vidualized positive end-expiratory pressure(PEEP)on postoperative atelectasis in children undergoing craniofacial reconstruction.Methods Eighty children under general anesthesia undergoing craniofacial re-construction were selected,52 males and 28 females,aged≤1 year,ASA physical status Ⅰ or Ⅱ,anes-thesia duration≥2 hours.According to the random number table method,the children were divided into two groups:Cdyn-guided individualized PEEP group(group Ⅰ)and fixed PEEP group(group P),40 chil-dren in each group.PEEP titration was performed in group Ⅰ after assessing the lung ultrasound(LUS)score 5 minutes after intubation,and the PEEP corresponding to the highest value of Cdyn was an individualized PEEP.In group P,PEEP was fixed 6 cmH2O.The parapleural consolidation score,the B-line score,the total score of LUS,and the incidence of atelectasis were recorded 5 minutes after intubation and at the end of the operation.Cdyn,Ppeak,HR and MAP were recorded 5 minutes after intubation and after PEEP was established.Oxygenation index(OI)was recorded 5 minutes after intubation and at the end of the operation.The incidence of postoperative pulmonary complications within 72 hours after operation were recorded.Results Median individualized PEEP with highest dynamic compliance during titration was 9 cmH2O in group Ⅰ.Compared with 5 minutes after intubation,the total parapleural consolidation score,posterior tho-racic parapleural consolidation score,total B-line score and anterior lateral posterior chest B-line score,and total score of LUS were significantly decreased in both groups at the end of the operation(P＜0.05).Com-pared with group P,the total score of parapleural consolidation,posterior chest parapleural consolidation score,total score of B-line and posterior chest B-line score,and total score of LUS,the incidence of atelec-tasis were significantly decreased in group I at the end of the operation(P＜0.05).Compared with group P,Cdyn and Ppeak in group Ⅰ were significantly increased after PEEP establishment(P＜0.05),OI at the end of the operation was significantly increased(P＜0.05),and the incidence of postoperative pulmonary complications within 72 hours after operation was significantly decreased in group Ⅰ(P＜0.05).Conclusion Intraoperative application of Cdyn-guided individualized PEEP can effectively reduce LUS score and atelectasis at the end of craniofacial reconstruction in children,improve oxygenation function,and reduce the incidence of postoperative pulmonary complications.

【Objective】 To explore the effect of lactate and alkali deficiency on the need for red blood cell transfusion in emergency of patients with traumatic hemorrhagic shock. 【Methods】 A total of 126 patients with traumatic hemorrhagic shock in our hospital from January 2019 to December 2021 were retrospectively analyzed, and the 99 cases with effective treatment were divided into two groups according to the outcome of blood transfusion within 24 hours after admission: non-transfusion group (n=36) and transfusion group (n=63). The changes of lactic acid (Lac), alkali deficiency (BE), hemoglobin (Hb), hematocrit (Hct) at admission, hemoglobin (Hb), hematocrit (Hct) 24 hours after admission and the length of stay in ICU were compared between the two groups. The binary logistic regression was used to analyze the risk factors of whether there was a need for blood transfusion at the time of emergency admission. The correlation between individual and combined indicators of each risk factor and the need for blood transfusion were analyzed by the receiver operating curve (ROC). 【Results】 The mean level of Lac (2.90±1.82) in the non-transfusion group at admission was lower than that in the transfusion group (5.80±2.83) (P<0.05), while BE、Hb and Hct (-1.76±3.24, 120.78±20.83, 35.76±6.11) were higher than those in the transfusion group (-5.91±4.69, 101.32±29.68, 29.97±8.48) (P<0.05). The mean levels of Hb and Hct in the two groups 24 hours after admission (92.75±16.66, 78.49±15.91) and (27.62±5.24, 22.60±4.74) were lower than those at admission (P<0.05). Binary logistic statistical analysis confirmed that Lac (OR=1.74, 95% CI 1.493-2.927, P<0.01), BE (OR=0.77, 95% CI 0.676-0.883, P<0.01), Hb (OR=0.97, 95% CI 0.954-0.989, P<0.01), Hct (OR=0.90, 95% CI 0.844=0.96, P<0.01) had guiding significance for patients with traumatic hemorrhagic shock to have red blood cell transfusion demand, and the increase of blood lactic acid was an independent risk factor (P<0.05), while age and gender had no significant effect on it(P>0.05)The maximum AUG of Lac and BE(0.875, 0.766) in predicting the need for emergency red blood cell transfusion in patients with traumatic hemorrhagic shock was significantly better than that of Hb and Hct (0.692, 0.682); the optimal threshold for Lac was >3.6 mmol/L, while the optimal threshold for Hb is ≤106 g/L; the maximum AUG obtained by ROC curve analysis combined with Lac, BE, Hb and Hct was 0.910, which was higher than that of the sole virable. Comparative predictive value using the optimal thresholds of Lac and Hb as indications for transfusion showed that Lac had better predictive value than Hb. 【Conclusion】 Lac and be can be instructive for patients with traumatic hemorrhagic shock as to whether they need red blood cell transfusion in an emergency setting, and combination of Lac, BE, Hb and Hct may help to determine the transfusion needs of patients more timely and accurately and optimize the transfusion management of emergency patients.

Background:In the clinical setting, the effect of intra-abdominal hypertension on the human body is dependent on time, but its role is not yet clear.Objective:To investigate the effect of the duration of intra-abdominal hypertension (IAH) on the prognosis of critically ill patients.Methods:This prospective cohort study enrolled 256 IAH patients who were admitted to the Surgical ICU of 10 Grade A hospitals in Fujian Province from January 2018 to December 2020. The duration of IAH (DIAH) was obtained after monitoring IAP, and ICU length of stay, duration of mechanical ventilation, duration of continuous renal replacement therapy (CRRT) and average daily energy intake from enteral nutrition during ICU stay were observed and recorded. The correlation was analyzed by Spearman rank correlation. The patients were divided into the survival group and the death group according to their survival state at 60 days after enrollment. Thereafter, clinical characteristics between the two groups were compared. Multivariable logistic regression was used to study and validate the relationship between DIAH and 60-day mortality. The receiver operating characteristics (ROC) curve was established to evaluate the predictive abilities of DIAH on the mortality risk.Results:In critically ill patients, DIAH was positively correlated with duration of mechanical ventilation ( r=0.679, P<0.001), duration of CRRT ( r=0.541, P<0.001) and ICU length of stay ( r=0.794, P<0.001), respectively. In addition, there was a negative correlation between DIAH and average daily energy intake from enteral nutrition ( r=-0.669, P<0.001). After multivariable adjustment, DIAH was an independent risk factor for 60-day mortality in critically patients with IAH ( OR=1.05, 95% CI: 1.01-1.12; P = 0.012), and exhibited a linearity change trend relationship with mortality risk. The ROC curve analysis of DIAH showed that the area under ROC curve (AUC) was 0.825 (95% CI: 0.763~0.886, P<0.01). When the cut-off value was 16.5 days, the sensitivity was 78.4% and the specificity was 75.4%. Conclusions:DIAH is an important risk factor for prognosis in critically ill patients. Early identification and rapid intervention for the etiology of IAH should be performed to shorten DIAH.

Objective:To investigate the clinical efficacy and prognostic influencing factors of open abdomen technique for acute pancreatitis with abdominal compartment syndrome (ACS).Methods:The retrospective cohort study was conducted. The clinical data of 186 patients of acute pancreatitis with ACS who were admitted to 6 hospitals, including 65 cases in the 910th Hospital of Joint Logistics Support Force of Chinese People′s Liberation Army, 46 cases in the First Affiliated Hospital of Wenzhou Medical University, 33 cases in the Fujian Provincial Hospital, 31 cases in the Second Affiliated Hospital of Fujian Medical University, 7 cases in the People′s Hospital Affiliated to Quanzhou Medical College, 4 cases in the Shishi General Hospital, from January 2013 to December 2020 were collected. There were 142 males and 44 females, aged (43±8)years. Observation indica-tors: (1) patients conditions after being treatment with open abdomen technique; (2) analysis of clinical characteristics in patients with different treatment outcomes; (3) changing trend of the volume of urine output, levels of lactic acid, levels of enteral nutrient intake and the sequential organ failure score in patients with different treatment outcomes; (4) influencing factors for prognosis of patients. Measurement data with normal distribution were represented as Mean± SD, and compari-son between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test or the continuity correction chi-square test. Repeated measurement data were analyzed using the repeated ANOVA. Spearman correlation analysis was used for correlation analyses. The COX regression model was used for univariate analysis and COX regression model with forward regression was used for multivariate analysis. Results:(1) Patients conditions after being treatment with open abdomen technique. Intra-abdominal pressure, oxygena-tion index, levels of lactic acid and sequential organ failure score of the 186 patients were (23.3±1.9)mmHg (1 mmHg=0.133 kPa), (121±24)mmHg, (5.0±3.4)mmol/L and 10.4±3.6 before the treatment with open abdomen technique and (11.2±2.9)mmHg, (222±38)mmHg, (3.2±2.1)mmol/L and 4.4±2.3 at postoperative 168 hours, showing significant differences in time effects before and after the treatment ( Ftime=855.26,208.50, 174.91,208.47, P<0.05). (2) Analysis of clinical characteristics in patients with different treatment outcomes. Of the 186 patients, 166 cases survived and were discharged, and 20 cases died during hospitalization. Age, sequential organ failure score, duration of ACS and levels of lactic acid during hospitalization before the treatment with open abdomen technique were (41±7)years, 9.4±3.4, 13(10,21)hours and (4.2±0.6)mmol/L in surviving patients, versus (45±6)years, 11.5±2.4, 65(39,84)hours and (5.2±0.5)mmol/L in dead patients, respectively, showing significant differences between them ( t=-2.10, -2.71, Z=-5.36, t=-7.16, P<0.05). Duration of postoperative acute gastro-intestinal injury, duration of continuous renal replacement therapy, time to liberation from mech-anical ventilation, duration of vasoactive drugs therapy, cases undergoing early abdominal closure, cases without intestinal fistula or with postoperative high-order intestinal fistula and low-order intestinal fistula during hospitalization after the treatment with open abdomen technique were 4(2,6)days, 4(3,7)days, 34(21,41)days, 3(2,6)days, 126, 131, 23, 12 in surviving patients, versus 13(10,17)days, 10(8,18)days, 0(0,3)days, 8(6,12)days, 1, 2, 15, 3 in dead patients, respectively, showing significant differences between them ( Z=-5.60, -3.75, -3.64, -3.06, χ2=41.43, 45.86, P<0.05). (3) Changing trend of the volume of urine output, levels of lactic acid, levels of enteral nutrient intake and the sequential organ failure score in patients with different treatment outcomes. The volume of urine output, levels of lactic acid, levels of enteral nutrient intake and the sequential organ failure score in surviving patients during hospitalization were (0.29±0.10)mL/(kg·h), (4.2±0.6)mmol/L, 0.0 kcal/(kg·d) and 9.4±3.4 before the treatment with open abdomen technique and (2.22±0.15)mL/(kg·h), (1.9±0.7)mmol/L, (20.7±2.9)kcal/(kg·d) and 3.7±2.2 at postoperative 168 hours. The above indicators in dead patients during hospitalization were (0.28±0.08)mL/(kg·h), (5.2±0.5)mmol/L, 0.0kcal/(kg·d) and 11.5±2.4 before the treatment with open abdomen technique and (0.28±0.09)mL/(kg·h), (7.7±0.8)mmol/L, (4.6±1.8)kcal/(kg·d) and 12.4±2.1 at postoperative 168 hours. There were significant differences in time effects in the above indicators in surviving patients and dead patients before and after the treatment with open abdomen technique ( Ftime=425.57, 188.59, 394.84, 37.52, P<0.05). There were interactive effects between the above indicators and the treatment outcome at different time points ( Finteraction=383.14, 233.04, 169.83, 36.61, P<0.05). There were signifi-cant differences in the change trends of the above indicators between the surviving patients and the dead patients during hospitalization ( Fgouprs=2 739.56, 877.98, 542.05, 240.85, P<0.05). (4) Influen-cing factors for prognosis of patients. Results of univariate analysis showed that age, sequential organ failure score, duration of ACS before surgery, procalcitonin, lactic acid, postoperative high-order intestinal fistula, abdominal hemorrhage, duration of postoperative acute gastrointestinal injury, duration of continuous renal replacement therapy, duration of vasoactive drugs therapy, early abdominal closure were related factors influencing prognosis of patients under-going treatment with open abdomen technique ( hazard ratio=1.07, 1.18, 1.39, 1.16, 8.25, 12.26, 2.83, 1.29, 1.56, 1.41, 0.02, 95% confidence interval as 1.00-1.15, 1.45-2.27, 1.22-1.57, 1.02-1.32, 1.75-38.90, 7.37-41.23, 1.16-6.93, 1.22-1.37, 1.23-1.99, 1.08-1.84, 0.00-0.16, P<0.05). Results of multivariate analysis showed that extended duration of ACS before surgery, postoperative high-order intestinal fistula and extended duration of postoperative acute gastrointestinal injury were independent risk factors influencing prognosis of patients undergoing treatment with open abdomen technique ( hazard ratio=1.05, 7.95, 1.17, 95% confidence interval as 1.01-1.32, 2.05-30.87, 1.13-1.95, P<0.05) and early abdominal closure was an independent protective factor ( hazard ratio=0.10, 95% confidence interval as 0.01-0.89, P<0.05). Results of Spearman correlation analysis showed that duration of ACS was positively correlated with sequential organ failure score before surgery ( r=0.71, P<0.05). Conclusions:Open abdomen technique is effective for acute pancreatitis with ACS. Extended duration of ACS before surgery, postoperative high-order intestinal fistula and extended duration of postoperative acute gastrointestinal injury are independent risk factors for prognosis of patients during hospitalization and early abdominal closure is an independent protective factor.

Objective:To explore the risk factors and regularity of pediatric primary Epstein-Barr virus (EBV) infection accompanied with elevated transaminase.Methods:Clinical data of 399 children diagnosed as primary EBV infection in the outpatient department, Children′s Hospital of Fudan University from September 2016 to October 2017 were analyzed retrospectively. Logistic regression analysis was performed to determine the potential correlations between elevated alanine transaminase (ALT) or aspartate transaminase (AST) and age, gender, course of fever and plasma EBV-DNA load. The cumulative rates of elevated transaminase recovery to nomal at different times were caculated.Results:Among 399 children diagnosed with primary EBV infection, there were 219 males and 180 females. The age was (4.2±2.7) years. Among all cases, 51.9% (207/399) had elevated transaminase. In patients who had elevated ALT, 74.5% (149/200), 21.0% (42/200) and 4.5% (9/200) had mild (40-160 U/L), moderate (160-400 U/L) and severe (>400 U/L) elevation of ALT, respectively. In patients who had elevated AST, 83.8% (155/185), 11.9% (22/185) and 4.3% (8/185) had mild (40-160 U/L), moderate (160-400 U/L) and severe (>400 U/L) elevation of AST, respectively. Only age was correlated with the occurrence of elevated transaminase ( OR=1.13, 1.10, both P<0.05). A total of 167 repeated tests were ordered in patients with elevated ALT and/or AST, including 113 cases with elevated ALT and 104 cases with elevated AST. The time of ALT and AST returned to normal were (24±13) days and (25±18) days respectively. The cumulative rates for ALT returned to normal within 1, 1-<4, 4-<8 weeks and more than 8 weeks were 2.7% (3/113), 54.0% (61/113), 79.6% (90/113) and 81.4% (92/113) respectively, and were 1.9% (2/104), 48.1% (50/104), 71.2% (74/104) and 74.0% (77/104) for AST. Conclusions:Age is a risk factor for transaminase elevation associated with primary EBV infection in children. The transaminases returned to normal within 3 weeks in half of the cases, and within 8 weeks in most cases.

OBJECTIVETo investigate the clinical effects of arthroscopic repair and arthroscopic-assisted small incision repair for the treatment of rotator cuff injury.

METHODSThe clinical data of 86 patients with rotator cuff injury from January 2012 to January 2015 were analyzed retrospectively. All the patients were divided into two groups: arthroscopic assisted small incision repair group(group A) and arthroscopic repair group(group B). There were 46 patients in group A, including 25 males and 21 females, with an average age of (52.8±7.8) years old. And there were 40 patients in group B, including 23 males and 17 females, with an average age of (53.2±9.5) years old. Several indexes such as shoulder joint activity, muscle strength and ASES, UCLA and VAS scores were examined before and after operation to compare therapeutic effects between these two groups.

RESULTSAll the patients were followed up, and the mean time was 20.8 months (ranged, 18 to 35 months). The results of patients in group A as follows: range of abduction motion of shoulder joint was (131.4±18.8)°, external rotation was (64.9±8.8)°, and internal rotation was(63.7±7.3)°. Results of patients in group B as follows: range of abduction motion of shoulder joint was(132.3±16.9), external rotation was(65.1±9.4)°, and internal rotation was(64.4±8.1)°. All the patients had better shoulder mobility than those before operation, but there were no significant differences between two groups after operation. Postoperative scores of patients in group A: ASES was 88.4±8.9, UCLA score was 29.6±3.6, VAS was 1.4±0.3; and in group B, the above scores were 89.5±9.6, 30.8±4.1 and 1.3±0.4 respectively. All the patients had better scores than those before operation, but there were no significant differences between two groups after operation.

CONCLUSIONSArthroscopic repair and arthroscopic-assisted small incision for repair of rotator cuff injury has clinical curative effects to some extent, and these two methods could improve the safety and reliability of surgical treatment.

Objective To evaluate the effect of dexmedetomidine on the damage to intestinal mu-cous membrane of rats with obstructive jaundice. Methods Thirty pathogen-free healthy male Sprague-Dawley rats, aged 4-6 months, weighing 200-250 g, were divided into 3 groups(n=10 each)using a random number table: control group(group C), obstructive jaundice group(group OJ)and dexmedeto-midine group(group D). Obstructive jaundice was induced by double ligation of common bile duct in anes-thetized rats. In group D, dexmedetomidine was intraperitoneally injected in a loading dose of 100 μg∕kg at 3 days after establishment of the model, followed by intraperitoneal infusion of 50 μg·kg-1·h-1for 5 h. The equal volume of normal saline was given instead in C and OJ groups. At 5 h after administration of dexmedetomidine, blood samples were collected from the heart for determination of serum concentrations of diamine oxidase(DAO)and tumor necrosis factor-alpha(TNF-α)by enzyme-linked immunosorbent as-say. Then the rats were sacrificed and colon tissues were removed for microscopic examination of the patho-logical changes. Results Compared with group C, the serum DAO and TNF-α concentrations were signifi-cantly increased in OJ and D groups(P<0.05).Compared with group OJ, the serum DAO and TNF-α concentrations were significantly decreased in group D(P<0.05).The pathological changes were signifi-cantly attenuated in group D when compared with group OJ. Conclusion Dexmedetomidine can reduce the damage to intestinal mucous membrane of rats with obstructive jaundice.

Objective To analyze the correlation between serum lipoprotein associated phospholipase A 2(Lp‐PLA2) with five traditional inflammatory factors of TC ,TG ,LDL‐C ,hs‐CRP and Hcy in the patients with coronary heart disease(CHD) ,and to in‐vestigate the relationship between its concentration with the lesions and severity of CHD .Methods Two hundreds cases of CHD were selected as the lesion group(which was subdivide into single vessel lesion ,double vessel lesion and three vessel lesion) ,at the same time ,100 persons undergoing physical examination were selected as the control group .The correlation between Lp‐PLA2 with five traditional inflammatory factors of TC ,TG ,LDL‐C ,hs‐CRP and Hcy was analyzed .The differences of Lp‐PLA2 in the lesion group and the control group were compared and the relation between Lp‐PLA2 level with lesion vessels number was analyzed .Re‐sults Lp‐PLA2 was significantly correlated with LDL‐C ,Hcy ,TC and hs‐CRP(P<0 .05) and had no relation with TG(P>0 .05) , the level of Lp‐PLA2 in the lesion group was significantly higher than that in the control group (P<0 .01) ,the Lp‐PLA2 level was elevated with the number of coronary lesion vessels ,but the correlation is unobvious(P>0 .05) .Conclusion High concentration of Lp‐PLA2 is a risk factor for coronary atherosclerosis ,but the correlation between the Lp‐PLA2 level and the severity of coronary arterial lesion needs further study .

Objective To investigate the effects of ABO blood group factors on erythrocyte suspension ( RCS) transfusion reactions in patients. Methods TestⅠA total of 12 600 patients in whom RCS was transfused during operation at the department of anesthesiology of 11 hospitals of Inner Mongolia from January 2006 to January 2014 were selected. The occurrence of transfusion reactions ( fever [ an increase in body temperature>1 ℃ than that before transfusion] , allergy, hemolysis) was recorded in the patients. Test Ⅱ A total of 120 RCS?transfused patients of both sexes, aged 18-55 yr, weighing 45-75 kg, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, who underwent surgical operation, were divided into 4 groups ( n=30 each) according to the blood group: blood group A group ( group A) , blood group B group ( group B ) , blood group O group ( group O ) and blood group AB group ( group AB) . The standard for RCS transfusion was defined as hemoglobin ( Hb) <7 g∕L, and Hb was maintained>10 g∕L. Before induction of anesthesia ( T1 ) , before blood transfusion ( T2 ) , and at 5 min, and 1, 6 and 24 h after blood transfusion ( T3?6 ) , blood samples were collected from the central vein for determination of the plasma tumor necrosis factor?alpha ( TNF?α) , interleukin?4 ( IL?4 ) and IL?10 concentrations by enzyme?linked immunosorbent assay. Results Among the 12 600 RCS?transfused patients, 216 cases developed transfusion reactions, and the incidence of transfusion reactions was 1.714%. For the patients of different blood groups, the incidence of transfusion reactions from the high to the low was blood group B, blood group AB, blood group A, and blood group O in turn ( P<0. 05 or 0.01) . Compared with group B, the plasma TNF?α and IL?10 concentrations were significantly decreased, and the plasma IL?4 concentrations were increased at T3?T6 in the other three groups ( P<0.05) . Compared with group AB, the plasma TNF?α and IL?10 concentrations were significantly decreased, and the plasma IL?4 concentrations were increased at T3?T6 in A and O groups (P<0.05). Compared with group O, the plasma TNF?α and IL?10 concentrations were significantly decreased, and the plasma IL?4 concentrations were increased at T3?T6 in group A ( P<0. 05 ) . Conclusion ABO blood group factors affect RCS transfusion reactions in the patients, and the incidence of transfusion reactions from the high to the low is blood group B, blood group AB, blood group A, and blood group O in turn.

Objective To explore the clinical significance of perioperative serum N-terminal pro-BNP(NT-proBNP)testing in patients with cardiac valve replacement.Methods The content of perioperative plasma NT-proBNP in 296 patients with cardiac valve replacement was detected,the relationship between preoperative plasma NT-proBNP content and heart function classification was analyzed,the postoperative changes were observed and the plasma NT-proBNP levels were compared among the death cases, the patients with complications and without complications.Results The left ventricular ejection fraction(LVEF)and plasma NT-proBNP content had statistical differences among different cardiac functional classifications(F =5.268,8.173,P <0.05),preopera-tive serum NT-proBNP level was positively proportional to the cardiac function classification(r =-0.776,P <0.01)and inversely proportional to LVEF(r=-0.472,P <0.05);on postoperative 1 d,plasma content of NT-proBNP reached the peak,there was sta-tistically significant difference compared with before treatment,(t=20.913,P <0.05),then which was gradually declined on post-operative 3,5,7 d.The preoperative plasma NT-proBNP content and postoperative plasma NT-proBNP peak levels in the death pa-tients and the patients with complications were higher than those in the patients without complications(P <0.05 ),the difference was statistically significant(P <0.05 ).Conclusion Preoperative plasma NT-proBNP concentration in the patients with cardiac valve replacement can reflect the cardiac function condition,the postoperative plasma NT-proBNP content is increased at the early stage,then gradually decreased,The increase of plasma NT-proBNP concentration before and after operation has a certain clinical value in predicting prognosis of the patients.