Objective To improve theoretical levels and war wound treatment skills of the trainees in field medical station and form initial medical support capabilities in short time.Methods Modularized training method was introduced to the yearly field training of our field medical station.The trainees were divided into 7 groups and 1 platoon,who were trained either alone or in combination with other groups.Result Training with this method significantly improved the trainees theoretical levels and abilities to treat war wounds in short time.These trainings achieved ideal effects,which strengthened the capability and training quality of field medical station.

<正>婴幼儿因解剖标志不清,造成中心静脉穿刺置管术难度较大。目前,超声定位技术已广泛应用于成人中心静脉穿刺置管术中[1～3],然而在婴幼儿中的应用报道较少。本文将超声定位技术应用于婴幼儿中心静脉穿刺置管术中,效果较好,现报道如下。

Objective To investigate the effect of the intraoperative wake-up test on the postoperative delirium in patients undergoing scoliosis operation under analgesia with sufentanil. Methods Sixty ASA Ⅰ or Ⅱ patients , aged 12-60 yr, scheduled for scoliosis surgery, were randomly divided into 2 groups ( n = 30 each) : control group (group C) and intraoperative wake-up test group (group W) . The intraoperative wake-up test was not performed during operation in group C. Anesthesia was induced with target-controlled infusion of sufentanil with the target effect-site concentration set at 0.5 ng/ml and iv injection of propofol 1-2 nig/kg. As soon as the patients lost consciousness, tracheal intubation was facilitated with 0.15 mg/kg cisatracurium besylate. The patients were mechanically ventilated. Anesthesia was maintained with target-controlled inhalation of sevoflurane (target end-tidal concentration 0. 8%-1. 5%), target-controlled infusion of sufentanil (target effect-site concentration 0.2-0.3 ng/ml) and iv infusion of cisatracurium besylate 0.1 mg- kg-1·h-1 . In group W, the patients underwent the intraoperative wake-up test. Postoperative analgesia was provided with sufentanil. The occurrence of intraoperative awareness and postoperative delirium was recorded. Results No significant difference was found in the incidences of intraoperative awareness and postoperative delirium between the two groups. Conclusion The intraoperative wake-up test is not the risk factor for postoperative delirium in patients undergoing scoliosis surgery under analgesia with sufentanil, and inhibition of perioperative pain and intraoperative awareness by analgesia with sufentanil may be involved in the mechanism.

Objective To observe the analgesic effect of low-dose ketamine on chronic neuropathic pain.Methods 11 selected patients with chronic refractory neuropathic pain were intravenously injected with ketamine at 0.1 mg/kg during pain relief followed by continuous intravenous infusion of ketamine at 6 μg /(kg·min) for 4 successive days.If the pain disappeared or alleviated,the infusion would stop;if it recovered to the level before infusion,the same usage and dosage of ketamine as described above would be administered again.Visual analogue score(VAS) and tactile allodynia were recorded before infusion,at 24,48,72,96 h during infusion,once a week after infusion,and once a month after 4 w.In addition,adverse reactions and blood oxygen saturation were observed during infusion.Results All the patients were infused at least twice,and 8 patients three times.The average interval between the first and second infusion was 4.2 w,and that between the second and third infusion was 6.9 months.The VAS and tactile allodynia were significantly improved after the infusion compared with pre-infusion(P<0.05).No significant change of blood oxygen saturation was found and the side effects were slight during the infusion.Conclusion Continuous intravenous infusion of low-dose ketamine is effective and safe for patients with chronic refractory neuropathic pain.

Objective To compare the effects of propofol-ketamine combination intravenous anesthesia with propofol or ketamine separately in transcatherer closure of congenital heart disease of children.Methods 90 childrens with congenital heart disease for transcatherer closure were randomly divided in to 3 groups:group PK (propofol-ketamine combination,n=30),group P (propofol,n=30) and group K (ketamine,n=30).The changes of MAP,HR,SpO2 and RR before operation,at time of femoral vein and artery puncture and transcather closure placement,wake-up time,side effects,dosage of narcotic were recorded respectively for the three groups.Results MAP and HR during operation were lower in group PK,and higher in group K,but remained statistically unchanged in group PK.SpO2 were more than 93% in 3 groups,and without significant difference among them.As for the wake-up time,there was no significant difference between group PK and group K,but it was much longer in group K than in group PK and group P.The dosage of ketamine of group K or group P was more than that of group PK(P<0.05).Conclusion Propofol-ketamine combination intravenous anesthesia is effective,controllable and stable with less side effect,being superior to propofol or ketamine separately in transcatherer closure of congenital heart disease of children.

Objective: To investigate the effect of sodium nitroprusside and sodium nitroprusside combined with esmolol in controlled hypotension on endovascular exclusion of abdominal aortic anearysm.Methods: Twenty patients scheduled for endovascular exclusion of abdominal aortic aneurysm were divided randomly into two groups.Group Ⅰ receiving sodium nitroprusside,group Ⅱ receiving sodium nitroprusside combined with esmolol.The hemodynamics were recorded before controlled hypotension,5min,10min,15min after controlled hypotension and stopping controlled hypotension 5min,10min,15min.The time of getting to the target blood pressure were recorded.Results: The time of getting to the targeted blood pressure was shorter in group Ⅱ [(3.7±0.8)min] than that of group Ⅰ [(4.9±1.1)min],P<0.05.HR and RPP in group Ⅱ were lower than that of group Ⅰ at 5min,10min and 15min of controlled hypotension.After stop controlled hypotension 5min,HR was lower in group Ⅱ than that of group Ⅰ.Conclusion: Hemodynamics could be maintained stable during controlled hypotension of the patients undergoing endovascular exclusion of abdominal aortic aneurysm.

Objective To observe the effects of total intra-venous anesthesia and combined epidural-subarachnoid block on perioperative rectal temperature of patients.Methods Fifty patients with ASA I or II undergoing elective laparoscopic cholecystectomy under total intra-venous anesthesia and fifty patients undergoing elective tibia-fibula operation under combined epidural-subarachnoid block were divided into 2 groups.The changes of rectal temperature and vital signs were consecutively monitored from induction of anesthesia to 2 hours after operation.Results The rectal temperature of two groups decreased gradually after anesthesia.There was a significant difference in temperature before and after surgery.Decreasing amplitude of rectal temperature in patients with total intra-venous anesthesia was significant higher than that in combined epidural-subarachnoid block patients(P0.05).The vital sings of two grougs were stable.Conclusions Both total intra-venous anesthesia and combined epidural-subarachnoid block can reduce rectal temperature of patients,but the former is more than the later.

AIM: To study the effects of propofol on long-term potentiation (LTP) in the CA1 area of rat hippocampus in vivo and to elucidate the possible underlying mechanisms. METHODS: 63 pentobarbitone-anaesthetized rats were used to investigate the effects of propofol (20 mg/kg, i.p.) alone and with NMDA or AMPA receptor antagonists (APV or CNQX) on excitatory post-synaptic potential (EPSP) and LTP expression of the CA1 stratum radiatum of the rat hippocampus by using stereotaxic technology and extracellular recording. RESULTS: Baseline EPSP amplitudes of all groups were stable. During treatment with propofol before high frequency stimulation (HFS), LTP amplitude was the same as that of control (P0.05), whereas when given after HFS,propofol significantly lowered the amplitude of LTP compared with control (P0.01). On the other hand, LTP could not be induced after treatment of propofol with APV, however, the amplitude of LTP increased transiently and decreased to baseline rapidly after treatment with propofol and CNQX (P0.05). CONCLUSION: Propofol did not affect the induction of LTP which is dependent on NMDA receptors in the CA1 area of the rat hippocampus but propofol did inhibit the LTP maintenance, which may be attributed to blockade of AMPA receptors but not to NMDA receptors.

General anesthesia mechanism of propofol is unclear in spite of wide use in clinic.In the present review,the authors summarized the effect and mechanism of propofol on postsynaptic receptor reactivity of central nervous system.