Objective To investigate the safety and efficacy of Remimazolam combined with nalbuphine in painless endoscopic mucosal resection(EMR)of colorectal polyps.Methods A total of 100 patients who undergo painless colorectal polyp EMR were randomly divided into nalbuphine combined with remimazolam(NR)and nalbuphine combined with propofol(NP),with 50 patients in each group.The mean arterial pressure,heart rate and oxygen saturation were recorded after entry(T0),1min after administration(T1),1min at the beginning of surgery(T2),3min(T3),5min(T4),and at the end of surgery(T5).The frequency of application of vasoactive drugs,their operation time,consciousness vanishing time,recovery time,the times of supplementary sedation,dosage of incidence of nalbuphine,adverse reactions,The satisfaction of doctors and patients were compared.Results The mean arterial pressure of T1,T2,T3,T4 and T5 in the NR group was higher than that in the NP group(P<0.05),and the heart rate of T1 in the NR group was higher than that in the NP group(P<0.05).The incidence of respiratory depression,hypotension,injection pain,the recovery time and the frequency of application of vasoactive drugs in the NR group was lower than that in the NP group(P<0.05).The satisfaction of doctors in the NR group was higher than that in the NP group(P<0.05).There was no significant difference between the two groups in the operation time,oxygen saturation,the times of supplementary sedation,the dosage of incidence of nalbuphineincidence of dizziness,nausea and vomiting,and other adverse reactions(P>0.05).Conclusion Nalbuphine combined with remimazolam can be used safely in the EMR,has few perioperative adverse effects,and is a good choice for painless EMR.

Objective:To compare two different methods for the harvest of the costal cartilage cortical slice with perichondrium preserved for rhinoplasty patients, and to explore a simple and less invasive method for the costal cartilage cortical slice.Methods:From September 2019 to December 2020, the rhinoplasty patients using the techniques of nasal tip "double arch" stent combined with prosthesis were selected in Shanghai Time Plastic Surgery Hospital, they were randomly divided into observation group and control group. In the observation group, only the cortical slice of costal cartilage with perichondrium was cut and the continuity of costal cartilage was preserved. While in the control group, with the superficial perichondrium preserved, the whole costal cartilage was dissected first, and then pruned it and harvested the cortical slice of costal cartilage with perichondrium. The operation were performed by the same clinicians in both groups. Different variables were compared between the two groups, including the operation time, intraoperative blood loss, length of incision, the degree of chest pain after postoperative 6, 24, 72 h, 1 week, the incidence of intraoperative complications and so on. The severity of chest pain was assessed by visual analogue scale (VAS). The measurement data of the two groups were analyzed by t-test, and the enumeration data were analyzed by χ2 test. Results:For both observation group and the control group, 61 patients were included. In the observation group, there were 3 males (4.9%) and 58 females (95.1%), aged (28.6±5.4) years old, and BMI (21.76±1.65) kg/m 2. In the control group, there were 2 males (3.3%) and 59 females (96.7%), aged (45.8±5.7) years old, and BMI (22.25±1.47) kg/m 2. There were no significant differences in gender composition, age and BMI between the two groups ( P>0.05). The double arch stent of nasal tip could be made by the costal cartilage cortical slices obtained in the two groups. In the control group, two cases of pleural rupture occurred and their prognosis was good after effective treatment, with no complications such as hematoma, infection or pleural injury. In the observation group, there were no complications such as hematoma, infection or pleural injury. The operation time, incision length and intraoperative blood loss in the observation group were significantly lower than those in the control group [(18.54±3.62) min vs. (25.75±3.75) min; (1.68±0.26) cm vs. (2.16±0.32) cm; (16.79±7.86) ml vs. (25.46±8.49) ml; P<0.05]. The VAS score in the observation group was lower than that in the control group after postoperative 6, 24, 72 h, 1 week [(2.76±0.62) vs. (3.87±0.68)scores; (2.37±0.45) vs. (3.12±0.55) scores; (1.76±0.45) vs. (2.57±0.53) scores; (1.17±0.44) vs. (1.85±0.51) scores; P<0.05]. Conclusions:Compared with the conventional method of whole costal cartilage harvest, the method of harvesting the costal cartilaginous cortical slice with the costal perichondrium preserved and preserving the continuity of the costal cartilage can reduce the trauma and bleeding, shorten the operation time, simplify the operation process, and significantly reduce the postoperative chest pain.

Objective:To compare two different methods for the harvest of the costal cartilage cortical slice with perichondrium preserved for rhinoplasty patients, and to explore a simple and less invasive method for the costal cartilage cortical slice.Methods:From September 2019 to December 2020, the rhinoplasty patients using the techniques of nasal tip "double arch" stent combined with prosthesis were selected in Shanghai Time Plastic Surgery Hospital, they were randomly divided into observation group and control group. In the observation group, only the cortical slice of costal cartilage with perichondrium was cut and the continuity of costal cartilage was preserved. While in the control group, with the superficial perichondrium preserved, the whole costal cartilage was dissected first, and then pruned it and harvested the cortical slice of costal cartilage with perichondrium. The operation were performed by the same clinicians in both groups. Different variables were compared between the two groups, including the operation time, intraoperative blood loss, length of incision, the degree of chest pain after postoperative 6, 24, 72 h, 1 week, the incidence of intraoperative complications and so on. The severity of chest pain was assessed by visual analogue scale (VAS). The measurement data of the two groups were analyzed by t-test, and the enumeration data were analyzed by χ2 test. Results:For both observation group and the control group, 61 patients were included. In the observation group, there were 3 males (4.9%) and 58 females (95.1%), aged (28.6±5.4) years old, and BMI (21.76±1.65) kg/m 2. In the control group, there were 2 males (3.3%) and 59 females (96.7%), aged (45.8±5.7) years old, and BMI (22.25±1.47) kg/m 2. There were no significant differences in gender composition, age and BMI between the two groups ( P>0.05). The double arch stent of nasal tip could be made by the costal cartilage cortical slices obtained in the two groups. In the control group, two cases of pleural rupture occurred and their prognosis was good after effective treatment, with no complications such as hematoma, infection or pleural injury. In the observation group, there were no complications such as hematoma, infection or pleural injury. The operation time, incision length and intraoperative blood loss in the observation group were significantly lower than those in the control group [(18.54±3.62) min vs. (25.75±3.75) min; (1.68±0.26) cm vs. (2.16±0.32) cm; (16.79±7.86) ml vs. (25.46±8.49) ml; P<0.05]. The VAS score in the observation group was lower than that in the control group after postoperative 6, 24, 72 h, 1 week [(2.76±0.62) vs. (3.87±0.68)scores; (2.37±0.45) vs. (3.12±0.55) scores; (1.76±0.45) vs. (2.57±0.53) scores; (1.17±0.44) vs. (1.85±0.51) scores; P<0.05]. Conclusions:Compared with the conventional method of whole costal cartilage harvest, the method of harvesting the costal cartilaginous cortical slice with the costal perichondrium preserved and preserving the continuity of the costal cartilage can reduce the trauma and bleeding, shorten the operation time, simplify the operation process, and significantly reduce the postoperative chest pain.

Comprehensive scoring models are one of the main methods for liver function evaluation and an important part of the treatment strategy for hepatocellular carcinoma. This article summarizes the value and limitations of traditional scoring models (Child-Turcotte-Pugh score and Model for End-Stage Liver Disease score) and new scoring models (albumin-bilirubin score, platelet-albumin-bilirubin score, and albumin-indocyanine green score) in radiofrequency ablation for hepatocellular carcinoma and points out that the new scoring models, especially platelet-albumin-bilirubin score, are advantageous.

Objective To evaluate the effect of dexmedetomidine on the postoperative pulmonary function in patients undergoing laparoscopic operation.Methods Eighty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients,aged 45-64 yr,weighing 45-70 kg,undergoing laparoscopic radical resection of rectal cancer,were divided into 2 groups (n =40 each) using a random number table:control group (group C) and dexmedetomidine group (group Dex).General anesthesia combined with epidural anesthesia was used.In group Dex,dexmedetonidine was intravenously infused as a bolus of 0.3 μg/kg over 10 min after epidural catheterization and before induction of general anesthesia,followed by an infusion of O.4 μg · kg-1 · h-1 starting from the end of tracheal intubation until 30 min before the end of operation.The equal volume of normal saline was given instead in group C.After epidural catheterization and before infusion of dexmedetomidine (T0),immediately before termination of pneumoperitoneum (T1) and at 1,6 and 24 h after operation (T2-4),blood samples were taken from the peripheral vein for determination of concentrations of serum interleukin-6 (IL-6),IL-10,tumor necrosis factor-alpha and malondialdehyde,and arterial blood gas analysis was performed simultaneously.Respiratory index and oxygenation index (OI) were calculated,and the occurrence of OI ≤ 300 mmHg was recorded.Results Compared with group C,the serum IL-6 and tumor necrosis factor-alpha concentrations and respiratory index were significantly decreased,and IL-1O concentrations and OI were increased at T1-4,and malondialdehyde concentrations were decreased at T1-3,and the incidence of OI ≤ 300 mmHg was decreased in group Dex (P＜0.05).Conclusion Dexmedetomidine can inhibit inflammatory responses and improve the postoperative pulmonary function in patients undergoing laparoscopic operation.

Objective To investigate the effects of positive end-expiratory pressure (PEEP) after recruitment maneuvers (RM) on respiratory mechanics and gas exchange during laparoscopy in obese patients.Methods Sixty-three ASA physical status Ⅱ or Ⅲ patients,aged 42-64 yr,with body mass index 30-40kg/m2,were randomly allocated into 3 groups (n=21 each):PEEP0 group,PEEP5 group and PEEP10 group.PEEP was not given after RM in PEEP0 group.In PEEP5 and PEEP10 groups,a recruiting maneuver was followed by PEEP 5 and 10 cm H2 O,respectively,until the end of pneumoperitoneum.The intraabdominal pressure was set at 12mmHg in the three groups.Parameters of respiratory mechanics including peak airway pressure (Ppeak),airway plateau pressure (Peat),chest wall plateau pressure (PplatCW),airway resistance (Raw),elastance of respiratory system (ERS),elastanc of chest wall (ECW) and elastance of lung (EL) and parameters of gas exchange including oxygenation index (PaO2/FiO2),arterial to end-tidal difference in carbon dioxide (Da-ETCO2),alveolar-arterial oxygen tension difference (DA-aO2),and dead space/tidal volume ratio (VD/VT) were measured before pneumoperitoneum (T0),at 20 min of pneumoperitoneum (T1),at 10 min after the end of recruitment (T2),and at the end of pneumoperitoneum (T3).Results Da-ETCO2,ERS and Raw were decreased at T2,ECW and EL were decreased at T3 in PEEP5 group,and Da-ETCO2,VD/VT,DA-aO2,Pplatcw Raw and EL were decreased at T2.3,and PaO2/FiO2 was increased at T2,ECW was decreased at T3 in group PEEP10 as compared with that in group PEEP0 (P ＜ 0.05).Da-ETCO2 and VD/VT were decreased and PaO2/FiO2 was increased at T2,3,Raw was increased and EL was decreased at T2 in group PEEP10 as compared with that in group PEEP5 (P ＜ 0.01).Conclusion PEEP after RM can improve respiratory mechanics and gas exchange during laparoscopy in obese patients and PEEP maintained at 10 cm H2O after RM provides better efficacy than PEEP at 5 cm H2 O.

ObjectiveTo investigate the effect of dexmedetomidine on postoperative intracranial pressure (ICP) in patients with severe brain injury.MethodsNinety ASA Ⅱ or Ⅲ patients with severe brain injury,aged 19-64 yr,with Glasgow coma scale 3-7,undergoing emergency craniotomy,were randomly divided into 3 groups (n =30 each):control group (group C) and 2 different doses of dexmedetomidine groups (groups D1,D2 ).Anesthesia was induced with propofol 1.5-2.0 mg/kg,fentanyl 4 μg/kg and vecuronium 0.1 mg/kg and maintained with iv infusion of propofol and remifentanil and intermittent iv boluses of vecuronium.The patients were mechanically ventilated after tracheal intubation.Dexmedetomidine 0.3 and 0.7 μg· kg- 1· h- 1 were infused after tracheal intubation in groups D1 and D2 respectively and the infusion was maintained for 48 h.ICP was monitored after operation and maintained ＜ 30 mm Hg by iv injection of hexadecadrol,mannitol and glycerol fructose within 2 d after operation.Venous blood samples were obtained from peripheral vein after anesthesia induction and at 6,12 and 24 h after operation (T0-3) for determination of sertum IL-1β and TNF-α concentrations by ELISA.The clinical results were evaluated using Glasgow prognosis score at 3 months after operation.The amount of hexadecadrol,mannitol and glycerol fructose consumed during 2 d after operation was recorded.ResultsCompared with T0,serum IL-1βand TNF-α concentrations were significantly higher at T1-3 in the three groups ( P ＜ 0.05).The serum IL-1β and TNF-α concentrations at T1-3 and the amount of hexadecadrol,mannitol and glycerol fructose consumed were significantly lower,and the clinical results were significant better in groups D1 and D2 than in group C,and in group D2 than in group D1 ( P ＜ 0.05).ConclusionDexmedetomidine can reduce postoperative ICP in patients with severe brain injury in a dose-dependent manner which is helpful for improving prognosis.The decrease in IL-1β and TNF-α levels and inhibition of inflammatory response may be involved in the mechanism.

Objective To investigate the effect of preemptive analgesia with parecoxib sodium on postoperative cognitive junction in the elderly patients.Methods Sixty ASA ⅠorⅡ patients aged 69-83 yr weighing 47-73 kg undergoing elective operation on the femoral head or hip joint were randomly divided into 2 groups (n=30 each):control group (group C) and parecoxib group (group P).Their preoperative mini-mental state examination scores were more than 23.Parecoxib sodium 40 mg in 5 ml normal saline was injected iv before induction of anesthesia in group P. Patient-controlled intravenous analgesia with fentanyl and tramadol was used in all patients. VAS score was maintained ≤3. If VAS score was more than 3, a bolus of fentanyl 0.2 μg/kg was given iv.Venous blood samples were taken at 1 day before and 1, 4, 24 and 72 h after operation for determination of plasma concentrations of cortisol.Cognitive function was assessed by mini-mental state examination. The total amount of fentanyl and tramadol consumed was recorded. Results Plasma cortisol concentrations and incidence of postoperative cognitive dysfunction were significantly lower and the total amount of fentanyl and tramadol consumed was smaller in group P than in group C.Conclusion Preemptive analgesia with parecoxib sodium 40 mg can reduce the incidence of postoperative cognitive dysfunction in the elderly patients.

Objective To evaluate the incidence of postanesthetic shivering in patients undergoing radical operation for lung cancer under dexmedetomidine-assisted anesthesia.Methods Eighty ASA Ⅰ or Ⅱ patients,aged 50-75 yr,height 158-180 cm,weighing 48-79 kg,scheduled for radical operation for lung cancer under general anesthesia combined with epidural anesthesia,were randomly divided into 2 groups ( n =40 each): normal saline control group (group C) and dexmedetomidine group(group D).Anesthesia was induced with midazolam,fentanyl,propofol and rocuronium.The patients were tracheal intubated and mechanically ventilated.Anesthesia was maintained with sevoflurane inhalation and intermittent epidural ropivacaine.BIS was maintained at 40-55.Group D received dexmedetomidine intravenous infusion at 0.5 μg · kg- 1· h- 1 from immediately after tracheal intubation until 1 h before the end of operation,and group C received the equal volume of normal saline.The shivering within 1 h after operation was scored and recorded.Results The incidence rate of postanesthetic shivering was 50％ in group C and 10％ in group D.Compared with group C,the incidence rate and degree of shivering were decreased in group D( P ＜ 0.05).Conclusion Dexmedetomidine-assisted anesthesia can reduce the incidence of postanesthetic shivering in patients undergoing radical operation for lung cancer.

Objective To observe the effects of Shenfu injection on intestinal mucosal barrier of rats with hepatic ischemia-reperfusion.Method Ninety SD male rats and weight from 230 to 270g were randomly divided into three groups( 30 rats in each),and 30 rats in each group divided again into 6h and 12h group( 15 rats in each):(1)SO group received sham operation(SO);(2) IR + NS group received so and 0.9 normal saline intravenously imediately before the ischemia reperfusion injury;(3) IR + SF group received Shenfu injection intravenously imediately before the ischemia reperfusion injury,IR + NS group and IR + SF group occlusion of the hepatoduodenal ligament,and endotoxin,ALT and MDA were detected.Results The levels of ALT,MDA in IR + NS group were higher than those in IR + SF group,and the rate of bacterial translocation( BT)group.