Objective To determine the effect of epidural block on the incidence of postoperative complications in the patients undergoing video-assisted thoracoscopic surgery for non-small cell lung cancer (NSCLC).Methods A total of 396 NSCLC patients undergoing radical thoracoscopic surgery in our hospital from January 2014 to November 2015 were subjected in this study.They were randomly given general anesthesia and postoperative intravenous analgesia (GA group, n=198) and combined epidural-general anesthesia and postoperative epidural analgesia (EGA group, n=198).Except epidural block, the 2 groups received general anesthesia with same drugs intraoperatively and intravenous or epidural patient-controlled analgesia postoperatively for 3 d.The severities of pain at rest and with cough were assessed during the first 3 postoperative days with numeric rating scale (NRS).The patients were followed up from the 4th day postoperatively until hospital discharge for postoperative complications, hospital length of stay and in-hospital mortality.The primary end point was the incidence of postoperative complications during hospitalization.Results All 396 patients were included in the intention-to-treat analysis.The NRS pain scores both at rest and with cough were significantly lower in the EGA group than the GA group during the first 3 postoperative days (all P<0.0001).Compared with the GA group, the EGA group had significant lower incidences of atelectasis [1.0%(2/198) vs 4.5%(9/198), P=0.032], atrial fibrillation [2.0%(4/198) vs 5.1%(14/198), P=0.016], and overall cardiovascular complications [2.5%(5/198) vs 8.1%(16/198), P=0.014].But there was no significant difference in the overall incidence of complications after surgery [15.2%(30/198) vs 12.6%(25/198), P=0.468].The incidence of hypotension requiring intervention was obviously higher (P=0.021), whereas that of hypertension requiring intervention was lower (P<0.0001) in the EGA group than in the GA group during the perioperative period.Conclusion For the patients undergoing video-assisted thoracoscopic surgery for lung cancer, epidural block provides better analgesia and reduced the incidences of atelectasis and atrial fibrillation after surgery.However, it increases the occurrence of perioperative hypotension.

肾移植后妊娠是高危妊娠,较为罕见.了解肾移植术后的治疗和管理,有助于做出更好的临床决策,保证母婴安全. 患者,女,31岁,因"孕30+1周,胸闷、浮肿半月"急诊入院.孕24周时,BP150/100mmHg,加用硝苯地平缓释片30mg,后改为氨氯地平5mg,孕28周时,BP160/100mmHg,自觉胸闷、浮肿,于当地医院测得BP180/120mmHg,尿蛋白+++,血清肌酐(Scr)240μmol/L,白蛋白(ALB)26.9g/L,脑钠肽(BNP)232pg/ml.患者2005年体检时发现血尿、蛋白尿,未治疗.2006年孕期BP升高至180/110mmHg,Scr360μmol/L,顺娩后Scr升高至800μmol/L,后于2008年行肾移植术.2011年因BP不高自行停用降压药,目前口服甲强龙、吗替麦考酚酯和他克莫司.

Objective To study the effects of isoflurane anesthesia on the medium- and longterm cognitive function in mice at different months of age. Methods Male C57BL/6J mice at ages of 4 month (n =45)and 20 month (n 45) were randomly assigned to control group,short- term anesthesia and long term anesthesia groups,respectively (n=15 per group).Inhalation anesthesia was applied with 3％ isoflurane for induction and 1.2 ％ isoflurane for maintain in 30 ％ oxygen,and control group received 30％ oxygen only for 60 min.Short- and long- term anesthesia group anesthesia was maintained for 30 min and 60 min,respectively.Cognitive function was determined by alternative behavior and water maze.Alternative behavior was assessed at 1 d before ancsthesia and 7,14 and 28 d after anesthesia,and water maze was assessed from 7 d to 8 d,9 d,10 d,11 d and 28 d after anesthesia. Results The correct rate of alternative behavior at age of 4 month in long-term anesthesia group [(58=6)％] was lower than relative control [(69±9)％] (t=4.26,P＜0.01) at 28 d.The number of arm entries at age of 20 month in short- term anesthesia group (31 ± 6) was increased than control(24±6) and long-term anesthesia group (24±8)(F=5.34,P＜0.01) at 14 d after anesthesia,while the number in long-term anesthesia group (24± 6) was decreased than control (29±7) and short term anesthesia group(30±6)(F=3.29,P＜0.05) with no significant difference in correct rate at 28 d after anesthesia.There was no difference in latent time of water maze between groups at age of 4 month.The ratios of spent time in the target quadrant to the whole time at age of 4 month at 11 d and 28 d after anesthesia in short-term anesthesia group[( 36.6 ± 14.4)％,(34.7 ±9.5)％] and long term anesthesia group [( 36.8 ± 16.4)％ ,(31.8± 12.0)％] were reduced as compared with control [(49.5±8.8) ％,(42.8±12.2) ％] (F=3.31,3.30,all P＜0.05).The latent time of mice at age of 20 month at 11 d after anesthesia in short-term anesthesia[(31±6)s] and longterm anesthesia group [(30±7)s ] were longer than control [(23±6)s](F =3.34,P＜0.05).There were no differences in the ratios of spent time in the target quadrant to the whole time and the number of cross -platform among the groups. Conclusions Isoflurane anesthesia may impact the mediumand long- term cognitive funclion in mice at ages of 4 month and 20 month.