目的:探讨七氟烷吸入麻醉对老年肿瘤患者认知功能的影响.方法:选取2017年5月-2018年5月笔者所在医院收治的80例老年肿瘤患者,随机分为两组,对照组使用丙泊酚进行麻醉,观察组使用七氟烷作为麻醉药物.比较两组患者的手术情况、血液流变学、不良反应情况及手术前后认知功能恢复状况.结果:观察组患者的诱导时间及苏醒时间均短于对照组(P＜0.05);两组患者血液流变学的各项指标比较差异无统计学意义(P＞0.05);观察组的不良反应率低于对照组(P＜0.05);术后观察组患者认知功能评分显著优于对照组(P＜0.05).结论:对老年肿瘤患者使用七氟烷作为麻醉,不仅效果理想,而且安全性高,能够显著降低患者的诱导时间及术后的苏醒时间,具备稳定的血流动力学,同时有效降低患者发生不良反应情况,有助于提高患者的治疗效果,具有安全、可靠性,利于在临床中推广应用.

目的 研究超声引导下胸椎旁神经阻滞联合全麻对食管癌根治术患者应激状况及苏醒质量的影响,为临床治疗提供指导.方法 选择深圳市人民医院2016年5月至2018年5月收治的100例行食管癌根治术患者进行研究.根据随机数表法将患者均分为对照组和观察组各50例.对照组采取单纯全麻,观察组采取超声引导下胸椎旁神经阻滞联合全麻.比较两组患者麻醉诱导前(T0)、气管插管即刻(Tl)、手术2 h(T2)、术毕(T3)和术后24 h(T4)的应激状况、苏醒质量和血流动力学,以及T3、T4和术后48 h(T5)的疼痛评分.结果 观察组患者T4的血糖、肾上腺素(E)、去甲肾上腺素(NE)、多巴胺(DA)水平分别为(7.53±1.32)mmol/L、(170.12±68.53)pg/mL、(318.54±42.53)pg/mL、(51.45±21.51)pg/mL,明显低于对照组的(8.15±1.23)mmol/L、(210.22±71.53)pg/mL、(451.51±41.53)pg/mL、(67.62±21.03)pg/mL,差异均有统计学意义(P<0.05);观察组患者的苏醒时间和拔管时间分别为(16.54±3.26)min、(22.36±3.55)min,明显短于对照组的(18.64±3.39)min、(25.54±3.68)min,苏醒期躁动评分为(0.89±0.18)分,明显低于对照组的(2.43±0.57)分,差异均有统计学意义(P<0.05);观察组患者T1、T2的收缩压、舒张压和心率水平明显高于对照组,差异均有统计学意义(P<0.05);两组不同时刻的血氧饱和度比较差异均无统计学意义(P>0.05);观察组患者T3、T4、T5的疼痛评分分别为(0.25±0.03)分、(0.61±0.12)分、(0.51±0.13)分,明显低于对照组的(1.26±0.57)分、(2.52±0.34)分、(2.25±0.16)分,差异均有统计学意义(P<0.05).结论 与单纯全麻相比,超声引导下的胸椎旁神经阻滞能够有效抑制食管癌根治术患者的应激反应,提高其苏醒质量,值得临床推广应用.

目的 探讨氨甲环酸局部注入和静脉应用对膝关节置换术患者术后失血量和凝血功能的影响.方法 选取2017年2月至2018年5月深圳市人民医院收治的120例拟行膝关节置换术患者为研究对象,根据随机数表法将患者分为局部应用组38例、静脉应用组42例和对照组40例.局部应用组患者在行膝关节置换术成功后放置引流管并缝合关节囊,夹闭引流管4 h后通过引流管注入氨甲环酸;静脉应用组患者在术毕缝合切口前静脉滴注氨甲环酸10 mg/kg;对照组在术毕缝合切口前静脉滴注同等剂量的0.9％氯化钠溶液并不夹闭引流管.比较三组患者术后血红蛋白(Hb)水平和纤维蛋白原浓度以及凝血酶原时间、活化部分凝血活酶时间,并通过容积法计算患者术中出血量、术后引流量、隐性失血量、总失血量,于术后1周行双下肢静脉超声检查是否存在下肢深静脉血栓(DVT),于术后1个月、3个月、6个月复查有无下肢DVT.应用WOMAC指数比较三组治疗前后膝关节功能.结果 局部应用组、静脉应用组和对照组患者术后引流量[(182.54±41.05)mL vs(265.77±50.61)mL vs(355.64±52.06)mL]及总失血量[(891.04±151.28)mL vs(1006.33±157.91)mL vs(1121.28±162.42)mL]比较,局部应用组、静脉应用组明显低于对照组,差异均有统计学意义(P<0.05);局部应用组、静脉应用组和对照组患者第1天[(113.54±11.72)g/L vs(105.72±10.08)g/L vs(90.82±9.88)g/L]、第3天[(107.05±10.66)g/L vs(94.77±9.62)g/L vs(85.38±9.24)g/L]、第5天[(119.04±10.71)g/L vs(112.42±10.08)g/L vs(100.15±9.52)g/L]Hb水平比较,局部应用组和静脉应用组均明显高于对照组,并且局部应用组在第1天、第3天Hb水平明显高于静脉应用组,差异均有统计学意义(P<0.05);局部应用组、静脉应用组和对照组患者纤维蛋白原[(3.73±0.28)g/L vs(3.64±0.21)g/L vs(3.48±0.22)g/L]比较,局部应用组明显高于静脉应用组和对照组,静脉应用组明显高于对照组,差异均有统计学意义(P<0.05);三组患者术后行下肢静脉超声未查出深静脉血栓发生,随访6个月同样未查出下肢静脉血栓;局部应用组、静脉应用组和对照组患者术后WOMAC指数分别为37.5±2.6、36.7±2.2和35.8±3.4,差异无统计学意义(P>0.05).结论 局部应用氨甲环酸较静脉滴注更能够有效地减少患者手术失血量,阻止纤维蛋白原的降解,且不会增加下肢深静脉血栓发生,相对于静脉滴注效果更好.

目的 比较胸科手术单肺通气中七氟烷与丙泊酚对患者肺损伤的保护作用.方法 将200例胸科手术患者按随机数字表法分为丙泊酚组与七氟烷组,每组100例,术中均行单肺通气.2组患者麻醉诱导相同,麻醉维持时丙泊酚组静脉泵入丙泊酚,七氟烷组吸入七氟烷.比较2组麻醉诱导前(T0)、单肺通气前(T1)、单肺通气后0.5 h(T2)和手术结束时(T3)肺功能指标[包括潮气量(VT)、气道均压(Pmean)、气道峰压(Ppeak)、动态肺顺应性(Cydn)]、炎症因子[包括白细胞介素-6(IL-6)、白细胞介素-10(IL-10)]及氧化应激因子[包括丙二醛(MDA)、超氧化物歧化酶(SOD)]水平.结果 2组VT和Cydn均在T2时降低,T3时增高,但均显著低于T1时,差异均有统计学意义(P<0.05);2组Ppeak与Pmean均在T2时增高,T3时降低,但均显著高于T1时,差异均有统计学意义(P<0.05);2组肺功能指标各时点比较差异均无统计学意义(P>0.05).2组T1—T3时IL-6与IL-10水平均较T0时明显增高,其中T2、T3时水平与T0时比较差异均有统计学意义(P<0.05);T2、T3时丙泊酚组IL-6水平显著低于七氟烷组,IL-10水平显著高于七氟烷组,差异均有统计学意义(P<0.05).2组T1—T3时MDA水平较T0明显增高,SOD水平明显降低,其中T2、T3时水平与T0时比较差异均有统计学意义(P<0.05);T2、T3时丙泊酚组SDO水平显著高于七氟烷组,MDA水平显著低于七氟烷组,差异均有统计学意义(P<0.05).结论 丙泊酚对胸科手术单肺通气中炎症反应和氧化应激反应的抑制作用优于七氟烷,能够在一定程度上起到肺损伤保护作用.

目的 探讨肿瘤坏死因子-α(T N F-α)在体-肺分流性肺动脉高压大鼠肺组织和血浆中的表达变化.方法 40只雄性SD大鼠随机分为假手术组(n=10)和手术模型组(n=30).术后8周和12周右心导管法评估各组大鼠肺血流动力学变化,计算右心室肥厚指数并检测肺组织中TNF-α的mRNA表达变化、血浆中TNF-α浓度的变化及肺血管重构情况.结果 手术组大鼠TNF-α的血浆浓度随肺动脉高压的严重程度而逐渐升高,且其与肺血流动力学指标及右室肥厚指数均呈正相关[RVSP(r=0.7666,P<0.01),PASP(r=0.7667,P<0.01),mPAP(r=0.7424,P<0.01)及RVHI(r=0.6846,P<0.01)].TNF-α的mRNA表达在术后8周[(1.60±0.52)倍]和12周[(2.29±0.60)倍]较假手术组均显著升高(均P<0.01),且呈时间依赖性,同时手术组大鼠肺血管呈现明显的病理重构.结论 TNF-α在先天性体-肺分流性肺动脉高压大鼠的血浆和肺组织中表达显著升高,其可能在肺血管重构发生发展过程中发挥着重要作用,并可能是反映先天性体-肺分流性肺动脉高压严重程度的生物标志物.

目的:探讨加速康复外科(ERAS)联合全胸腔镜在肺癌根治术中的应用. 方法:将41例拟行胸腔镜肺癌根治手术的病人分为两组,即对照组采用单纯全胸腔镜治疗(n=21)和ERAS组采用ERAS联合胸腔镜治疗(n=20),并对两组病人各项指标进行统计学比较. 结果:两组病人术前一般情况无统计学差异.ERAS组病人在术后首次进食时间、术后住院天数、胸腔引流管拔除时间等指标明显优于对照组(P＜0.05),而两组胸腔引流管重置率无显著性差异(P＞0.05).ERAS组病人术后并发症和全身性炎症反应综合征发生率有减少的趋势,但与对照组比无显著性差异(P＞0.05);术后第3天,C反应蛋白(CRP)值明显低于对照组(P＜0.01).ERAS组病人在术后早期疼痛评分、术后曲马多用量均优于对照组,差异有显著性统计学意义(P＜0.05). 结论:全胸腔镜肺癌根治术在ERAS理念指导下可有效地减轻手术创伤和术后应激反应、缩短住院天数、促进病人康复.

Objective To evaluate a new operation of Occlusion of trans-jugular venous minimal invasive surgery on atrial septal defect with curve-controllable sheath catheter. Methods From December 2015 to March 2016, 7 patients with atrial septal defect (ASD) underwent trans-jugular vein closure using the curve-controllable sheath catheter were analyzed retrospective. These patients were 23-47years old and weighed 39.6-64.5kg,male and female 2 and 5 cases. Results All patients were performed minimal invasive surgery successfully. The average procedure time was 22-40 minutes. The ventilator was used for 2-4.5h.The patients stayed in ICU for 6-32h,and the postoperative hospitalization stay was 2-3days. All patients survived and were discharged. The one week and 1, 3month follow up examination with the postoperative echocardiography and ECG indicate that no residual shunt, no occluder dislocation and noⅢstage atrioventricular block. Conclusion It is a new surgical method with simple operation, mild damage. It has advantages over traditional percutaneous and transtrhoracic closure of ASD.

目的：探讨胸椎旁阻滞镇痛在肺叶切除术后镇痛的效果。方法拟行胸腔镜肺叶切除的患者40例，分为静脉镇痛组（A组）和椎旁阻滞镇痛组（B组）。两组患者均在全麻下完成手术，于手术结束前分别行静脉和胸椎旁间隙穿刺置管用于术后自控镇痛。记录术后不同设计时点患者视觉模拟评分，并观察镇痛泵按压次数和并发症发生情况。结果术后6、12、24、48 h B组患者的VAS评分及镇痛泵按压次数均明显低于A组（ P＜0.05）；B组患者术后并发症明显少于A组（ P＜0.05）。结论胸腔镜肺叶切除术后胸腔镜引导下椎旁阻滞镇痛效果优于静脉镇痛，且具有创伤小、安全高效、并发症少的优点。

目的 分析患者在麻醉恢复期并发症的发生情况、原因以及所采取的护理措施,探索麻醉恢复室安全护理的方法.方法 对本院麻醉恢复室所收治的5 156例术后患者进行病情记录、分析,统计麻醉恢复期常见并发症的发生例数.结果 麻醉恢复期患者发生并发症1 093例(21.20％),其中呼吸系统并发症441例(8.55％),循环系统并发症504例(9.77％),神经系统并发症25例(0.48％),其他123例(2.39％).结论 护理人员应加强对麻醉恢复期患者的观察,针对患者的不同护理需要,与其建立和谐的互动关系并有针对性的实施护理措施,将并发症的危险程度降低,保证患者安全平稳的度过麻醉恢复期.

Objective To analyze tje current status of caring ability among nurses in operating room. to compare caring ability among nurses witj different professional titles and working times,to put forward training strategies for enjancing nurses′caring ability. Method A total of 100 nurses in operating room were investigated using Caring Ability Inventory( CAI ). Results Tje gross score on CAI was 188. 82 ± 19. 47. Tje nurses sjowed lower level of caring ability tjan foreign norms of CAI. tje nurse witj different professional titles,work-ing times,professional titles jad significant difference in tje total of caring ability,courage and patience dimensions(P<0. 05). tje nurse-in-cjarge,working time more tjan 16 years,and age > 36 jad tje jigjest score. Conclusion Tje caring ability among nurses in tje operating room is not enougj. Tje nursing managers sjould strengtjen training for nurses to improve tjeir caring ability.

Objective To observe the safety and feasibility of dexmedetomidine and fentanyl for conscious sedation in endoscopic retrograde cholangio-pancreatography(ERCP).Methods Sixty patients of American Society of Anesthesiologists classification gradeⅠ-Ⅱ who planed to received ERCP were divided into dexmedetomidine group and propofol group,thirty cases in each group.The patients in the two groups were treated with anisodamine 10.0 mg and fentanyl 1.0 μg·kg-1 by intravenous injection before ERCP.The patients in dexmedetomidine group were treated with dexmedetomidine 0.5 μg·kg-1 by intravenous injection within 15 minutes,then the dexmedetomidine was infused continuously at the speed of 0.5-1.0 μg·kg-1·h-1 by micro-pump to the end of operation.The patients in propofol group were treated with propofol 1.0 mg·kg-1 by intravenous injection within 2 minutes,then the propofol was infused continuously at the speed of 4.0-6.0 mg·kg-1·h-1 by micro-pump to the end of operation.The blood pressure,heart rate(HR) and saturation of blood oxygen(SpO2) were recorded at the time points of before anesthesia(T0),before inserting endoscope(T1),while inserting endoscope(T2),20 minutes after inserting endoscope(T3) and 10 minutes after the end of examination(T4).The intubation process and cooperation of patients were scored;and the patients′ satisfaction for examination was evaluated next day.Results There was no significant difference in the SBP,DBP,HR and SpO2 between the two groups before anesthesia(P0.05).In dexmedetomidine group,the HR of patients at the time points of T1,T2,T3 and T4 was significantly lower than that at the time point of T0(P0.05);but there was no significant difference in the SBP and DBP among the time points of T0,T1,T2,T3 and T4(P0.05).The SBP,DBP and HR at the time points of T1,T2,T3 and T4 were significantly lower than those at the time point of T0 in propofol group(P0.05).There was no significant difference in the SpO2 among the all time points in the two groups(P0.05).The SBP at the time point of T1 and the DBP at the time points of T1,T2,T3,T4 in propofol group were significantly lower than those in dexmedetomidine group(P0.05);but there was no significant difference in the SBP at the time points of T2,T3 and T4 between the two groups(P0.05).The HR at the time points of T1,T2,T3 and T4 in propofol group was significantly higher than that in dexmedetomidine group(P0.05).The score of intubation process and cooperation of patients in dexmedetomidine group was significantly higher than that in propofol group(P0.05).There was no significant difference in the satisfactory degree of patients for examination between the two groups(P0.05).Conclusion Dexmedetomidine and fentanyl for conscious sedation in ERCP is safe and feasible,which can meet the test needs of sedation,and can obtain better cooperation of patients;but some patients with decreased HR need some intervention measures.

Objective To investigate the clinic effect and security of butorphanol preemptive analgesia with different administration methods in the elderly undergoing radical mastectomy surgery.Methods 100 elective radical mastectomy patients(ASAⅠ~Ⅱ) over 60 years old,were randomly divided into the group BV1,group BV2,group BM1,group BM2 and group C(control group).10 minutes before incision,group BV1 receives butorphanol 10μg/kg iv,group BV2 receives butorphanol 15μg/kg iv,group BM1 receieves butorphanol 10μg/kg im,group BM2 receives butorphanol 15μg/kg im,group C receieves 2ml of saline iv.Record the time from stopping drugs to open eyes,VAS score at 4 hours(T1),8 hours(T2),12 hours(T3) and 24 hours(T4) after operation,Ramsay score after extubation,the frequency of use of analgesics within 24 hours after operation.The occurrence of adverse reactions like nausea,vomiting,chills,respiratory and circulatory depression were also recorded.Results The time from stopping drugs to open eyes: group BV2 was significantly longer than group BV1,BM1,BM2 and C(P<0.05).At time T1~T4,VAS score of group BV1,BV2,BM1,BM2 was significantly lower than group C(P<0.01),and the VAS score of group BV1,BV2,BM2 was lower than group BM1(P<0.05).The Ramsay score after extubation of group BV2 was higher than group BV1,BM1,BM2 and C(P<0.05).The frequency of use of analgesics within 24 hours after operation: group BV1,BV2,BM1 and BM2 was significantly lower than group C(P<0.01),group BV1,BV2 and BM2 was lower than group BM1(P<0.05).There was no significant differences about the occurrence of adverse reactions among all groups(P>0.05).Conclusions Butorphanol preincisional used in surgery has the effect of preemptive analgesia,the administration methods of intravenous 10μg/kg and intramuscular 15μg/kg can achieve satisfactory analgesia without affecting the wake of the patients under general anesthesia,thus can be effectively and safely used for the elderly radical mastectomy surgery.

Objective To observe the analgesic efficacy and safety of non-steroidal anti-inflammatory drugs in multimodal analgesia after video-assisted thoracic surgery( VATS) lobectomy. Methods Sixty ASA I-II patients undergoing VATS lobectomy were included in the study. They were randomly divided into 3 groups: group P,group F and group C( n= 20). Patients in group P received 40 mg parecoxib sodium before skin incision and the same dose 24 hours after surgery.Patients in group F received 50mg flurbiprofen axetil before skin incision and 200 mg flurbiprofen axetil was added to PCIA.Patients in group C received 5mL normal saline before skin incision and the same dose 24 hours after surgery. All patients were administered an intercostal nerve block before chest closure and connected to PCIA pump after extubation. The visual analogue scale( VAS) at rest and coughing and the effective button-pressing times in PCIA were recorded at 2 h( T1),4h( T2),8 h( T3),12 h( T4),24 h( T5),48 h( T6) and 72 h( T7) after the start of PCIA. Patients' evaluation of analgesic efficacy was recorded at time T6 and T7. Respiratory monitoring parameters( RR,SpO2,P ET CO2),vital sign and side effects were also recorded. Results At time T1 and T2,three groups showed no significant difference in the effective press times of PCIA; the effective press times of PCIA decreased from time T3 to T6,in group P and F compared with those of group C( all P < 0. 05),with no significant difference between group P and F. The three groups showed no significant difference in resting VAS and coughing VAS at time T1 and T2,resting VAS and coughing VAS were significantly lower in group P and F than those of group C at different time points from T3 to T6( all P < 0. 05),with no significant difference between group P and F. At time T7,three groups showed significant difference in both resting VAS and coughing VAS( all P <0. 05). The three groups showed no significant differences in respiratory monitoring parameters at each time point.Group P and F showed a better evaluation of analgesic efficacy than that of group C( all P < 0. 05). No severe adverse reactions were observed in any group. Conclusion When used in multimodal analgesia after VATS lobectomy,non-steroidal anti-inflammatory drugs enhance analgesic effect,do not increase incidence of adverse reactions,have little impact on breathing,and are conducive to expectoration.

?Objective?To observe treatment effect and adverse reactions of using tramadol and metoclopramide to treat shivering in cesarean section. Methods One hundred ASA I~II parturient patients, who were undergoing elective cesarean section, were included in the study. They were randomly assigned to one of two groups – Group T and Group MT. Group T receives 1mg/kg tramadol iv after delivery. Group MT receives 10mg metoclopramide iv followed by 1mg/kg tramadol iv. Monitor scale of shivering, incidence of nausea and vomiting, dizziness, respiratory depression and incidence of extrapyramidal reactions. Results 97% remission rate and 82% cure rate of shivering was observed after tramadol was given. Group T showed 70% incidence of nausea and vomiting. Group MT showed 86% less incidence of nausea and vomiting compared to Group T. Conclusion 1mg/kg tramadol is effective in preventing and treating shivering in cesarean section. Metoclopramide is effective in reducing nausea and vomiting caused by tramadol.

Objective To investigate the effects of dexmedetomidine on hemodynamics in patients undergoing neurosurgery.Methods Forty patients undergoing selective posterior fossa surgery were randomly divided into two groups (twenty patients in each group):the control group (group C) and the dexmedetomidine group (group D).After induction and tracheal intubation,group D was administrated with dexmedetomidine 0.8 μg·kg-1·h-1 during the anesthesia,group C was administrated with saline.Anesthesia was maintained with propofol,remifentanil and vecuronium.BIS value was controlled at 40~55 during the whole operation.Heart rate (HR),systolic blood pressure (SBP),diastolic blood pressure (DBP) and bispectral (BIS) were recorded at the moment of before induction (T0),induction (T1),15 minutes after induction (T2),skin incision (T3),10 minutes after skin incision (T4),drilling skull (T5) and at end of operation (T6).The dosage of propofol and remifentanil was recorded.Results SBP in the two groups was significantly decreased at T1 and T2 compared with T0,and HR was significantly decreased at T2 compared with T0 (P0.05).At T3,HR of group C was significantly higher than that of group D (P 0.05),and SBP in both groups were increased,with no statistically significant difference between the two groups (P0.05).At T5,HR and SBP of group C were significantly higher than those of group D (P 0.05).At T6,HR of both groups was increased,and the increase in group C was more profound than that in group D (P 0.05).SBP of group C was increased and SBP of group D was decreased at T6 compared with T0,with statistically significant difference between the two groups (P0.05).The dosage of propofol and remifentnil in group D was decreased 30.93% (P 0.01) and 7.69% (P 0.05) respectively compared with group C.Conclusion Administration with demedetomidinecan 0.8 μg·kg-1·h-1 during maintenance of anesthesia decrease the hemodynamical fluctuations in patients undergoing neurosurgery and reduce the dosage of propofol and remifentanil.

Objective: To compare the effect of remifentanil with sevoflurane on oxygenation and intrapulmonary shunt during one-lung ventilation for senile patients.Methods: Forty senile patients with esophageal cancer were randomly divided into remifentanil group(group R: n=20) and sevoflurane(group S: n=20).When anesthesia was induced right-sided double-lumen endobronchial tube(R-DLT) was intubated orally.Then anesthesia was maintained with remifentanil 0.1～0.15μg/(kg·min) in group R,and with 2%～3% sevoflurane inhalation in group S respectively.The other drugs used in both groups for anesthesia maintenance were target-controlled infusion of propofol 2～6 mg/L(plasma concentration).The arterial and mixed venous blood samples were drawn for blood gas analysis and intrapulmonary shunt calculations were taken at the following time: 15 min after two-lung ventilation,15,30,60 and 90 min after one-lung ventilation and 15 min after returning to two-lung ventilation in both groups.Result: The shunt fraction(Qs/Qt) and Ppeak were significantly higher and PaO2 was significantly lower in one-lung ventilation than in two-lung ventilation(P0.05).There was no statistical difference in Ppeak,Qs/Qt,PaO2,recovery time,extubation time and complications between two groups.Conclusion: There was no statistical difference between remifentanil and sevoflurane in oxygenation and intrapulmonary shunt during one-lung ventilation for senile patients.Anesthesia with remifentanil can provide stable hemodynamics and fast consciousness for elderly patients undergoing thoracic surgery.

Objective To investigate the effects of spinal anesthesia with low dose bupivacaine in the hemorrhoidectomy. Methods 150 patients,ASA physical status Ⅰ～Ⅱ,scheduled for the hemorrhoidectomy with spinal anesthesia,were randomly divided into 3 groups,50 in each group:0.5% bupivacaine 1ml for Group A,0.5% bupivacaine 1.5 ml for Group B,0.5% bupivacaine 2ml for Group C as control.All the patients were received certain concentrations of bupivacaine in subarachnoid space,respectively.The several data,such as onset time,extent and duration of sensory block,the time reached maximum extent of sensory block,degree of motor block,recovery of motor block and urination function,the incidence of urinary retention,blood dynamic changes and other side effects were recorded,respectively. Results The anesthetic effects were satisfactory in all patients.The significantly differences in onset time,and the time reached the maximum extent of sensory block were observed among 3 groups,the longest in group A,the shortest in group C,p0.05.The degree of motor block in group A were significantly less than that in group B and C,p0.05.The duration of analgesia,the recovery of motor function,and the recovery of urination function,which were effected in dose-dependent manner,were significantly different among 3 groups,and the shortest in group A,the longest in group C,p0.05.The incidence of urinary retention in group A and B were significantly lower than that in group C,p0.05. Conclusion The selective spinal anesthesia with the 5mg or 7.5mg bupivacaine for the hemorrhoidectomy,showed satisfactory anesthetic effect,and the less degree of motor block,and the lower incidence of post-operation urinary retention.The best anesthetic effect was observed in Group A.

Objective To observe the clinic effect of Conscious Sedation with dexmede-tomidine on spinal anesthesia. Methods Forty ASA Ⅰ～Ⅱ patients who received operation of lower limbs after spinal anesthesia were randomly divided into five groups(n=8):Group Ⅰ,Ⅱ,Ⅲ,Ⅳ,Ⅴ(the dexmedetomidine was given intravenous injection of 0.1,0.2,0.3,0.4,0.5μg·kg-1·h-1 respectively).The level of sedation was registered through observer's Assessment of alertness sedation scale(OAA/S) and bispectral index(BIS) After infusion of dexmedetomidine 30,60,90mins.The level of oblivion and satisfaction were registered. Results The OAA/S and BIS in group Ⅱ~Ⅴ were less than group I statistically(p0.05).The forgetting rate of anesthesia with dexmedetomidine in groups Ⅱ,Ⅲ,Ⅳ,Ⅴ were 50%,87.5%,100%,100%.The groups Ⅲ,Ⅳ,Ⅴ were satisfied with anesthesia. Conclusion The conscious Sedation with dexmedetomidine on spinal anesthesia was effective and safe.The dose of dexmedetomidine of 0.3 μg·kg-1·h-1 is better.

Aim:To investigate the effects and mechanisms of oxygenation at high concentration on rat brain injury.Methods: Forty-nine adult male Wistar rats weighting 230~280 g were randomly divided into seven equal groups with seven animals each.Group 1 was normal controls;group 2,3,4 were exposed to oxygen(50% O2) for 15,30,60 min respectively;group 5~7 was exposed to oxygen(100% O2) for 15,30,60 min respectively.The expression of Nuclear FactorκB(NF-кB),induce Nitric Oxide Synthase(iNOS)and Mn-Superoxide Dismutase(Mn-SOD)of rat brains by Western blotting analysis,immunohistochemistry and xanthine oxidase analysis after oxygenation were examined.And the histological injury of rat brains by light microscope simultaneity was also examined.Results: The expression of NF-кB all decreased in oxygenation groups compared with that in the controlled group.The numbers of iNOS positive cells all increased as compared with that in the controlled group.But that only significantly increased in oxygenation(50% O2) for 15,30 min and oxygenation(100% O2) for 15 min groups.The activity of Mn-SOD all increased but that only oxygenation(100% O2) for 60 min group increased significantly.Pathology results: The harm of neurons in oxygenation(100% O2) groups was more serious than in oxygenation(50% O2) groups.The neurons had severe edema and eosinophilic degeneration and so on.Pathology change grade had not relations with oxygenation times.Conclusion:50% oxygenation can lead to slightly reversible injury,but 100% oxgen can lead to serious unreversible injury.oxygenation can not activate NF-κB,those expression all decreased on the contrary.

Objective To investigate the effects and mechanisms of oxygenation on rat cerebral antioxidant ability.Methods 49 adult male Wistar rats weighting 230~280 g were randomly divided into seven equal groups with seven animals each.1 group was normal controls;2、3、4 group was exposed to oxygenation(50% O2)for 15、30 、60min;5~7 group was exposed to oxygenation(100% O2)for 15、30、60 min.We examined the expression of Nuclear FactorκB,induce Nitric Oxide Synthase and Mn-Superoxide Dismutase at protein level in the brain of rat by Western blotting analysis,immunohistochemistry and xanthine oxidase analysis.All the brains of rats were examination using light microscope to determine the degree of neuronal damage.Results The expression of NF-кB all decreased in oxygenation groups compared with that in the control group;The numbers of iNOS positive cells all increased as compared with that in the control group.But that only significantly increased in oxygenation(50% O2)for 15、30 min and oxygenation(100% O2)for 15min groups.The activity of Mn-SOD all increased but that only oxygenation(100% O2)for 60min group increased significantly.Pathology results:The harm of neurons in oxygenation(100% O2)groups was more serious than in oxygenation(50% O2)groups.The neurons were severe edema and eosinophilic degeneration and so on.Pathology change grade had not relations with oxygenation times.Conclusion 50% oxygenation can lead to slightly reversible injury,but 100% oxygenation can lead to serious unreversible injury.Oxygenation can not activate NF-κB,those expression all decreased on the contrary.