Objective To analyze the incidence and risk factors of hypothermia in elderly patients with malnutrition during proximal femoral nail antirotation(PFNA)internal fixation under general anesthesia.Methods A total of 139 elderly patients underwent PFNA internal fixation under general anesthesia were selected,and the nutritional status scores 1 day before surgery ranged from 0 to 11 points.Univariate and multivariate Logistic binary regression analysis was performed to analyze the related factors that may lead to intraoperative hypothermia.Results Among 139 elderly patients with preoperative nutritional scores of 0 to 11 points,79 cases(56.83%)developed intraoperative hypothermia.The results of univariate and multivariate Logistic binary regression analysis suggested that age≥75 years old,mini nutritional assessment short form(MNA-SF)nutritional score 0 to 7 points,BMI<18.5 kg/m2,duration of general anesthesia≥2 hours,intraoperative flushing fluid volume≥1 000 mL and intraoperative fluid volume≥1 000 mL were the risk factors for the occurrence of intraoperative hypothermia in elderly patients(OR>1,P<0.05).The use of warm blanket insulation was the protective factor against the occurrence of intraoperative hypothermia(OR<1,P<0.05).Conclusion The incidence of intraoperative hypothermia during PFNA internal fixation under general anesthesia in elderly patients with mainutrition before operation is high,and patients with poor nutritional status are more likely to develop intraoperative hypothermia.Patients with older age,poor nutritional status,lower BMI,longer duration of general anesthesia,and more intraoperative flushing fluid volume and intraoperative fluid volume are likely to lead to intraoperative hypothermia.The use of warm blanket can reduce the incidence of intraoperative hypothermia.

Objective To explore the effects of preoperative anxiety on intraoperative body temperature,adverse reactions during recovery and incision healing in elderly patients undergoing radical mastectomy under general anesthesia.Methods A total of 139 elderly patients who underwent radical mastectomy under general anesthesia in the Fourth Affiliated Hospital of Nanjing Medical University from January 2020 to December 2022 were selected as the study objects,and they were divided into the non-anxiety group(87 cases)and the anxiety group(52 cases)according to whether they were complicated with anxiety before surgery.The nasopharyngeal temperature before surgery,after 30 minutes,60 minutes,90 minutes of surgery and at the end of surgery,the ratio of intraoperative nasopharyngeal temperature<36.0℃,the ratio of perioperative blood loss>300 mL,the occurrence of adverse reactions during the recovery period and the incision healing of patients in the two groups were compared.Results There was no statistically significant difference in the nasopharyngeal temperature before surgery and after 30 minutes of surgery of patients between the two groups(P>0.05).After 60 minutes,90 minutes of surgery and the end of surgery,the nasopharyngeal temperatures of patients in the anxiety group were lower than those in the non-anxietey group,and the differences were statistically significant(P<0.05).There were statistically significant differences in the nasopharyngeal temperature at different times of patients in the two groups(P<0.05).The ratios of patients with intraoperative nasopharyngeal temperature<36.0℃and perioperative blood loss>300 mL in the anxiety group were higher than those in the non-anxiety group,and the differences were statistically significant(P<0.05).The incidence of delayed awakening,shivering reaction,and poor postoperative incision healing in the anxiety group were higher than those in the non-anxiety group,with statistically significant differences(P<0.05).Conclusion Elderly patients undergoing radical mastectomy under general anesthesia combined with anxiety show obvious temperature drop after 60 minutes of surgery,and perioperative blood loss has significantly increased,with a higher incidence of intraoperative hypothermia,adverse reactions during recovery and poor postoperative incision healing,which should arouse clinical attention.

Objective To investigate the effect of erector spinae plane block on postoperative delirium and cognitive function in elderly patients with lung cancer undergoing thoracoscopic radical surgery.Methods A total of 90 elderly patients with lung cancer underwent thoracoscopic radical surgery were selected and randomly divided into the control group and the observation group,with 45 cases in each group.The patients in the control group were given general anesthesia,while the patients in the observation group were given erector spinae plane block before general anesthesia.The vital signs at different time points,opioid dosage,number of analgesic pump compressions,incision pain visual analogue scale(VAS)score,cognitive function and postoperative delirium of patients between the two groups were compared.Results At the end of anesthesia,the mean arterial pressure(MAP)and heart rate of patients in the observation group were significantly lower than those in the control group(P<0.05).The dosage of remifentanil during operation,sufentanil during perioperative period and number of analgesia pumps compressions of patients in the observation group were significantly less than those in the control group(P<0.05).The incision pain VAS scores 6 hours,12 hours,24 hours and 48 hours after surgery of patients in the observation group were significantly lower than those in the control group(P<0.05).The scores of cognitive function 6 hours and 24 hours after surgery of patients in the observation group were significantly higher than those in the control group(P<0.05);and the incidence of delirium 6 hours and 24 hours after surgery in the control group was significantly higher than those in the observation group(P<0.05).Conclusion Erector spinae plane block can significantly relieve the perioperative pain of elderly patients with lung cancer undergoing thoracoscopic radical surgery,reduce the dosage of opioids and the incidence of postoperative delirium,improve the postoperative cognitive function of patients,which provides a new idea for reducing the incidence of postoperative mental diseases.

Objective To investigate the effects of pulsed radiofrequency(PRF)with intercostal nerve block on analgesia analgesia effect,cognitive function and postoperative delirium in elderly patients undergoing thoracoscopic lung surgery.Methods Ninety elderly patients undergoing thoracoscopic lung surgery in our hospital were randomly divided into the control group(intercostal nerve block with local anesthetic drugs)and the PRF group(PRF with intercostal nerve block).The pain score,analgesic effect,cognitive function,postoperative delirium and neurological dysfunction of the two groups were compared.Results The pain scores of resting and coughing state 48 hours and 72 hours after surgery in the PRF group were significantly lower than those in the control group(P<0.05).The number of analgesic pump compression and proportion of supplemental analgesia within 72 hours after surgery and perioperative sufentanil dosage in the PRF group were significantly less than those in the control group(P<0.05).The cognitive function scores 48 hours and 72 hours after surgery in the PRF group were significantly higher than those in the control group(P<0.05).The incidence of delirium 72 hours after surgery in the PRF group was significantly lower than that in the control group(P<0.05).There was no significant difference in the incidence of intercostal nerve dysfunction 1 month,2 months and 3 months after surgery between the two groups(P>0.05).Conclusion PRF with intercostal nerve block can effectively relieve pain after elderly thoracoscopic lung surgery,reduce postoperative opioid consumption,improve postoperative cognitive function,and decrease postoperative delirium incidence without affecting the intercostal nerve function,which is safe and reliable.

Objective To investigate the effect of intravenous infusion of low-dose remifentanil on obese scarred uterine puerperae undergoing cesarean section under epidural anesthesia.Methods A total of 87 obese scarred uterine puerperae undergoing cesarean section under epidural anesthesia were selected as the study subjects,and they were randomly divided into the conventional group(n=43)and the remifentanil group(n=44).From the beginning of skin incision,puerperae of the conventional group and the remifentanil group were intravenously injected with normal saline and low-dose remifentanil respectively until the end of the operation.The vital signs,pain and comfort scores,intraoperative complications of puerperae,and status of newborns were compared between the two groups at different points during the operation.Results During fetal extraction and peritoneal exploration,the heart rate,mean arterial pressure and pain scores of puerperae in the remifentanil group were lower than those in the conventional group,and the differences were statistically significant(P<0.05);the intraoperative comfort score of puerperae in the remifentanil group was higher than that in the conventional group,and the difference was statistically significant(P<0.05).The incidence of nausea and vomiting of puerperae in the remifentanil group was lower than that in the conventional group,and the difference was statistically significant(P<0.05).There was no significant difference in the Apgar score at 1 minute and 5 minutes after delivery,requiring initial resuscitation or pH value of umbilical vein blood between newborns delivered by puerperae of the two groups(P>0.05).Conclusion Intravenous infusion of 0.05 μg·kg-1·min-1 low-dose remifentanil not only significantly reduces intraoperative pain and improves comfort of obese scarred uterine puerperae undergoing cesarean section under epidural anesthesia,but also helps to reduce the incidence of adverse reactions and ensure maternal and infant safety.

Objective To explore the effects of different sevoflurane elution methods on awakening quality and cognitive function of elderly obese patients undergoing hip joint replacement.Methods A total of 90 elderly obese patients underwent hip joint replacement under intravenous inhalation combined with general anesthesia and maintained anesthesia with sevoflurane during surgery were selected as the research subjects,and randomly divided into group A and group B,and sevoflurane was eluted by closed elution method and decreasing concentration elution method,respectively.The concentration of sevoflurane exhaled and cognitive function scores at different time points of patients between the two groups were compared,and the awakening quality and the occurrence of adverse reactions during the awakening period of patients between the two groups were compared.Results At the end of the surgery,the concentration of sevoflurane exhaled by patients in group B was significantly lower than that in group A(P<0.05),and the recovery time,awakening time,tracheal extubation time,and anesthesia recovery room stay time of patients in group B were significantly shorter than those in group A(P<0.05).The incidence of agitation during the awakening period of patients in group B was significantly lower than that in group A(P<0.05),and the cognitive function score at the time of 2 hours after awakening of patients in group A was significantly lower than that in group B(P<0.05).Conclusion For elderly obese patients undergoing hip joint replacement with intravenous inhalation combined with general anesthesia,sevoflurane can be eluted by decreasing concentration elution method before the end of surgery,and the patient wakes up smoothly and in a shorter time,with fewer adverse reactions and less impact on postoperative cognitive function.

Objective To observe the clinical efficacy and safety of flupentixol and melitracen tablets combined with psychological intervention in the treatment of cerebral infarction with anxiety disorder.Methods Eighty patients with cerebral infarction and anxiety disorders were randomly divided into control group and treatment group with 40 cases per group.Control group was treated with antiplatelet aggregation,activating blood stasis and brain protectant and so on.Treatment group was treated with flupentixol and melitracen tablet 10 mg per group,bid,orally,and psychological intervention once every 3-5 days,on the basis of control group.Two groups were treated for 6 weeks.The self rating scale (SAS)scores,depression self rating scale (SDS) scores,the United States national institutes of health stroke scale (NIHSS) scores and adverse drug reactions were compared between two groups.Results After treatment,the main indexes in treatment and control groups were compared:SAS scores were (40.07 ± 3.02) and (52.07 ± 6.94) points,SDS scores were (40.03 ±3.38) and (51.48 ± 7.22) points,NIHSS scores were (6.04 ± 1.51) and (8.92 ± 4.12) points,the differences were statistically significant (all P ＜ 0.05).No adverse drug reactions in two groups occurred during the treatment.Conclusion Flupentixol and melitracen tablets combined with psychological intervention have a definitive clinical efficacy and safety in the treatment of cerebral infarction with anxiety disorder,which can significantly reduce the NIHSS scores and improve prognosis.

Objective To explore the effects of sulfentanil on the per-centage of β1 -band power of quantitative pharmaco-electroencephalo-graphy ( QPEEG ) in rabbits, and its relationship with opioid recep-tor.Methods Thirty-six healthy rabbits were divided randomly into six groups(n=6):normal group (0.9%NaCl 1 mL? kg-1), low, medium, high doses sulfentanil groups ( 1.5 , 3 , 6 μg? kg -1 ) , naloxone group (400 μg? kg-1 ) and naloxone and sulfentanil group ( naloxone 400μg? kg -1 and sulfentanil 3 μg? kg-1 ) .The percentage of each band power was respectively noted down 30 s before administration and 1, 3, 5, 10, 20, 25 min after administration.Results Compared with the baseline, the percentage ofβ1 -band power was decreased in the groups of medium, high doses sulfentanil ( P <0.05 ) , which had a negative correlation with sulfentanil dose ( P <0.05 ) . There was no obvious change in the percentage of β1 -band power in the group of naloxone compared with the baseline ( P >0.05 ) .Conclusion Sulfentanil de-creases the percentage ofβ1 -band power in a dose-dependent manner, and this effect is mediated by the opioid receptor.

Objective To observe the effects of diazepam on the percen-tage of δ -band power of quantitative pharmaco -electroencephalogram ( QPEEG ) in rabbits and the relation with benzodiazepine receptor.Methods Thirty-six healthy rabbits were randomly divided into 6 groups (each n=6),where rabbits in each group were intravenously injected with 1 mL· kg-1 0.9%NaCl (blank group), 0.12 mg· kg-1 , 0.25 mg· kg-1 or 0.50 mg· kg-1 diazepam groups, 0.1 mg· kg-1 flumazenil group and 0.1 mg· kg-1 flumazenil +0.5 mg· kg-1 diazepam ( combined group ).Then a digital EEG system was adopted to record the changes of QPEEG in eight encepha-lic regions before and after injection at each time point.Results The per-centage of δband power in eight encephalic regions of 0.25, 0.50 mg· kg-1 diazepam groups are noted increase within 0.5 to 30 min.The change of the percentage of δ band power has a positive correlation with diazepam dose.Compared with the 0.5 mg· kg-1 diazepam group,the percentage of δ-band power in combined group was lower at same time point.Conclusion Diazepam increases the percentage ofδ-band power of QPEEG in the way of dose dependence in rabbits.It indicates that benzodiazepine receptor mediates the effect of diazepam and the percentage of δ-band power may become an index that reflects the degree of sedation and hypnosis.

Objective To compare the antiarrhythmic effects and safety of landiolol and esmolol .Methods The sequential method was used to detect the median lethal dose ( LD50 ) and 50%effective dose ( ED50 ) of the two drugs.Treatment index were calculated by LD 50/ED50 .Several of arrhythmia models were used to study the antiarrhythmic effects of landio-lol and esmolol in the equivalent dose .Results ED50 and LD50 of landio-lol and esmolol were 14.4 , 17.3 mg? kg -1 and 347 , 100 mg? kg -1 re-spectively , TI were 24.1 and 5.8.The ratio of equivalent dose between landiolol and esmolol on anti -chloroform induced arrhythmia was 0.83∶1.Landiolol and esmolol have similar anti -arrythmia effect on va-rious arrhythmia models.Esmolol has a stronger inhibition function on the heart rate than that of landiolol .Conclusion Compared with esmolol , landiolol has similar antiarrhythmic effect , gentle and slow effect on heart rate, higher treatment index and safety in equivalent dose .