Infusion Research Articles

Comparison of effect of total intravenous anesthesia with propofol and combined intravenous-inhalational anesthesia with sevoflurane on postoperative sleep quality in elderly female patients

Objective To compare the effect of total intravenous anesthesia with propofol and combined intravenous-inhalational anesthesia with sevoflurane on postoperative sleep quality in elderly female patients. Methods One hundred and twenty patients, aged 65-80 yr, with body mass index of 18.5-25.0 kg/m2, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, scheduled for elective gynecological laparoscopic operation, were divided into 2 groups (n=60 each) by a random number table method: total intravenous anesthesia with propofol group (group P) and combined intravenous-inhalational anesthesia with sevoflurane group (group S). Anesthesia was induced with intravenous etomidate 0.2-0.3mg/kg, sufentanil 0.2-0.4 μg/kg and cisatracurium 0.10-0.15 mg/kg.Anesthesia was maintained as follows: propofol was given by target-controlled infusion with the target plasma concentration set at 2-4 μg/ml in group P, 1.2-2.3% sevoflurane was inhaled in group S, and sufentanil 0.2-0.3 μg/kg and cisatracurium 0.04-0.06 mg/kg were intermittently injected in two groups.The patients were followed up at 7-8 a. m.on the day of hospitalization, the day of operation and 1, 3, 7 and 30 days after operation.The Pittsburgh Sleep Quality Index (PSQI) was recorded, PSQI > 7 points was considered as sleep disorders, and the occurrence of sleep disorders was recorded.The morning urine was collected at the time points mentioned above, and the concentrations of melatonin sulfate and free cortisol were determined by enzyme-linked immunosorbent assay. Results Compared with group S, the PSQI was significantly decreased on 3 and 7 days after operation, the incidence of sleep disorder was decreased on 7 days after operation, the concentrations of melatonin sulfate in urine were increased (P 0.05). Conclusion The effect of total intravenous anesthesia with propofol on postoperative sleep quality is less than that of combined intravenous-inhalational anesthesia with sevoflurane in elderly female patients. Key words: Propofol; Anesthetics, inhalation; Anesthesia, general; Aged; Femininity; Sleep quality

Accuracy of aortic valve velocity time integral in assessing fluid responsiveness during general anesthesia in elderly patients

Objective To evaluate the accuracy of aortic valve velocity time integral (VTI) in assessing fluid responsiveness during general anesthesia in elderly patients. Methods Forty-four elderly patients of both sexes, aged 65-80 yr, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, with New York Heart Association classⅠ or Ⅱ, undergoing elective surgery with general anesthesia in our hospital from February 2018 to August 2018, were enrolled in this study.All the patients underwent tracheal intubation after general anesthesia induction, and then volume expansion was carried out (6% hydroxyethyl starch 250 ml was intravenously infused for 30 min). The heart rate (HR), mean arterial pressure (MAP), VTI and stroke volume (SV) were recorded before and after volume expansion, and ΔHR, ΔMAP, ΔVTI and ΔSV were calculated.Patients were divided into 2 groups according to ΔSV: response group (R group, ΔSV≥15%) and non-response group (NR group, ΔSV<15%). The receiver operating characteristic curve (with the area under the standard ΔSV curve was 1) was used to analyze the ΔHR, ΔMAP and ΔVTI, and the Youden index at its best was calculated.The Person test was used to analyze the correlation between ΔVTI and ΔSV. Results There were 25 cases in R group and 19 cases in NR group.Compared with group NR, ΔHR was significantly decreased, and ΔVTI and ΔSV were increased in group R (P<0.05). The area under the ROC curve of ΔHR, ΔMAP and ΔVTI in assessing fluid responsiveness was 0.509 (95% confidence interval 0.314-0.689, P=0.415), 0.558 (95% confidence interval 0.379-0.737, P=0.515) and 0.905 (95% confidence interval 0.812-0.999, P<0.01), respectively. When Youden index was at its best, ΔVTI was 15.28%, with the sensitivity 88.0% and specificity 94.7%.There was a positive correlation between ΔSV and ΔVTI (r=0.936, P<0.05). Conclusion ΔVTI can accurately assess the fluid responsiveness during general anesthesia in elderly patients. Key words: Aortic valve; Aged; Fluid therapy

Effects of different hemoglobin concentrations on lung injury in a rabbit model of hemorrhagic shock and resuscitation

Objective To evaluate the effect of different hemoglobin (Hb) concentrations on the lung injury in a rabbit model of hemorrhagic shock and resuscitation (HS-R). Methods Fifty healthy male New Zealand rabbits, aged 2 months, weighing 1.9-2.4 kg, were divided into 5 groups (n=10 each) using a random number table method: control group (group C), HS-R group (group H), and three HS-R plus infusion of concentrated red blood cell groups group R1 (60 g/L≤Hb<80 g/L), group R2 (80 g/L≤Hb<100 g/L) and group R3 (100 g/L≤Hb<120 g/L). The animals were sacrificed at 3 h after resuscitation, lung tissues were obtained for examination of the pathological changes with a light microscope, and lung tissues were obtained again for determination of wet to dry weight ratio (W/D ratio), neutrophil myeloperoxidase (MPO), NO level and cell apoptosis (by TUNEL). Results Compared with group C, the levels of MAP and NO, W/D ratio and apoptosis index were significantly increased in the other groups (P 0.05). Conclusion Maintaining Hb 80-100 g/L after HS-R reduces acute lung injury in rabbits. Key words: Shock, hemorrhagic; Cardiopulmonary resuscitation; Hemoglobins; Acute lung injury

Effect of perioperative allogeneic red blood cell infusion on T cell subsets and natural killer cells in peripheral blood of patients with gastric cancer

Objective To investigate the effect of allogeneic red blood cell transfusion on T lymphocyte subsets and natural killer (NK) cells in peripheral blood of patients with gastric cancer during perioperative period. Methods 50 patients with gastric cancer in our hospital from January 2017 to December 2017 were randomly divided into control group (n=25) and observation group (n=25). Perioperative allogeneic erythrocyte transfusion was performed in the observation group, while no allogeneic erythrocyte transfusion was performed in the control group. Blood samples were taken from two groups before and after operation 3 d, and serum T lymphocyte subsets (CD3+, CD4+, CD8+, CD4+ /CD8+ ) and NK cell levels were measured. T cell subsets and NK cell levels of patients in observation group, control group and observation group at different clinical stages before and after operation were counted. According to blood transfusion volume, the patients in the observation group were divided into <4 U group and <4 U group. T cell subsets and NK cell levels before and after operation were compared between the two groups. Results There was no significant difference in CD3+, CD4+, CD8+, CD4+ /CD8+, NK cells between the two groups before operation (P>0.05). The levels of CD3+, CD4+, CD4+ /CD8+, NK cells in the two groups after operation were lower than those before operation and CD8+ levels were higher than those before operation. The levels of CD3+, CD4+, CD4+ /CD8+, NK cells in the observation group were lower than those in the control group, and the levels of CD8+ in the observation group were higher than those in the control group (P 0.05). After operation, the levels of CD3+, CD4+, CD4+ /CD8+, NK cells in the two groups were lower and CD8+ levels were higher than those before operation. The levels of CD3+, CD4+, CD4+ /CD8+, NK cells in stage Ⅰ-Ⅱ patients were higher than those in stage Ⅲ-Ⅳ patients, and CD8+ levels were lower than those in stage Ⅲ-Ⅳ patients (P 0.05). After operation, the levels of CD8+ in the two groups were higher than those before operation, while the levels of CD3+, CD4+, CD4+ /CD8+, NK cells were lower than those before operation; The levels of CD3+, CD4+, CD4+ /CD8+, NK cells in the 4 U group, and CD8+ levels were lower than those in >4 U group (P<0.05). Conclusions Perioperative allogeneic red blood cell transfusion can affect T cell subsets and NK cell content in peripheral blood of patients with gastric cancer, and there are some differences in the effects of different clinical stages of gastric cancer patients, which can cause the suppression of cellular immune function. Key words: Stomach neoplasms; Perioperative period; Erythrocyte transfusion; T-lymphocyte subsets; Killer cells, natural

Venous injury caused by peripheral intravenous indwelling catheter and recovery

Objective To observe the correlation factors of venous injury caused by peripheral intravenous indwelling catheter, so as to guide the rational use of clinical intravenous indwelling catheter, so as to avoid venous injury and promote vascular recovery. Methods This study was carried out in five Class Ⅲ Grade A hospitals. In each hospital, we randomly selected one of the departments: Digestive Internal Medicine, Nephrology, Hepatobiliary Surgery, Extraglandular Surgery and Respiratory Medicine as the research departments. The inpatients admitted from March to June 2018 were selected and included in the study as a whole with the consent of the patients. In this study, 81 qualified patients were successfully injected with the peripheral intravenous indwelling catheter infusion and observed. According to the prescription of the doctors and hospital department policies, peripheral intravenous indwelling catheter was used for infusion. Specialists were arranged to record the patients' infused solution, evaluate the puncture site of the indwelling catheter before puncture and the results of venous blood vessel evaluation before puncture. Observe and record the reasons for the removal of indwelling catheter, the patency during the removal, the indwelling time, the marking of indwelling vein, evaluate and record the condition of the puncture site of indwelling catheter and the grade of phlebitis. The elasticity and filling degree of venous vessels were evaluated and recorded on the 14th day after catheter removal. Results (1) The severity of local phlebitis was positively correlated with the severity of vascular injury when removing intravenous indwelling catheter; the incidence of moderate and severe vascular injury was 9.09% when local symptoms were grade Ⅰ phlebitis; the incidence of moderate and severe vascular injury was 95.83% when local symptoms were grade Ⅱ and Ⅲ phlebitis when removing intravenous indwelling catheter; and there was statistical difference in the incidence of moderate and severe vascular injury between the two groups (P 0.05) . Conclusions Phlebitis after peripheral intravenous indwelling catheter infusion is the main cause of vascular injury and hinders venous recovery. Preventive measures should be taken in clinical puncture and use of venous indwelling needles; the removal of indwelling catheters should not be based only on indwelling time; the symptoms of puncture sites and patients' reactions should be evaluated in accordance with the regulations to avoid phlebitis above grade Ⅱ; in order to avoid vascular injury caused by infusion of peripheral intravenous indwelling catheters, asymptomatic removal of intravenous indwelling catheter is recommended. Key words: Phlebitis; Peripheral intravenous indwelling catheters; Blood vessel recovery; Vascular injury; Indwelling time; Indicators for removal of catheter

Status of nursing quality and management about intravenous therapy in Class II and above hospitals of Hu'nan Province

Objective To investigate the current situation of intravenous therapy in 38 ClassⅡ and above hospitals in Hu'nan Province and analyze the existing problems. Methods A questionnaire survey was conducted in 38 hospitals in Hu'nan Province in November 2018 using the Nursing Situation of Intravenous Therapy in Hospitals at All Levels designed by the Professional Committee of Intravenous Therapy and Chinese Nursing Association. To understand the status quo of intravenous therapy, quality management of intravenous therapy, and the status of specialist nurses in intravenous therapy. Results In 38 hospitals, totally 36 hospitals provided continuous intravenous therapy services through intravenous therapy/peripherally inserted central catheter (PICC) clinics and a designated hospital department; 21 hospitals had established intravenous therapy/PICC clinics; the outpatient service was flexible in form, but the qualification certification of outpatient nurses needed further regulation. The proportion of hospitals carrying out medium and long-term catheter infusion and hospitals carrying out PICC transfusion with Modified Sedinger Technique (MST) puncture guided by ultrasound was 100.00% and 72.22%, respectively. In vascular visualization technology, hospitals using infrared, ultrasound and X-ray technology were 2.63%, 63.16% and 34.21% respectively. There were some gaps in the skin disinfectant and disinfection scope, concentration of flushing and sealing fluid and maintenance frequency between the hospitals and the national standards in peripheral and central venipuncture and catheter maintenance. In terms of quality management of intravenous therapy, 34 hospitals had established intravenous therapy teams, whose quality evaluation criteria are different. In terms of specialist nurses team construction, there were 505 specialist nurses in venous therapy/PICC in 38 hospitals. The structure of specialist nurses had been continuously optimized in terms of education, title and length of service. However, hospitals needed to pay more attention to the development of specialist nurses. Conclusions The contents of continuous nursing of intravenous therapy need to be further expanded, the management of PICC clinic needs to be strengthened, the standardized use of infusion devices and connectors needs to be improved, the knowledge and practice gap between puncture nursing and catheter maintenance of intravenous therapy exists, and the quality control standards of hospitals need to be standardized and regulated, more attention should be paid to the development of specialist nurses. Key words: Intravenous therapy; Quality management; Specialist clinic; Specialist nurse; PICC

Effects of pentazocine on postoperative cardiac troponin I in diabetic patients undergoing lower limb surgery

Objective To evaluate the changes of cardiac troponin I (cTnI) in diabetic patients undergoing lower limb surgery and the effect of pentazocine on the changes. Methods Ninety-three patients who were scheduled for orthopedic surgery in the lower extremity under intrathecal anesthesia were enrolled. They were divided into three groups (n=31): a non-diabetic patient group (group NDM), a diabetic group without treatment of pentazocine (group DM) and a diabetic group with treatment of pentazocine (group DM-P). Patients in group DM-P were intravenously infused with 0.5 mg/kg pentazocine 30 min before operation, while the same volume of normal saline was given in groups DM and NDM. Blood samples were collected 30 min before surgery and 24 h after operation. The serum concentrations of cTnI and calcitonin gene-related peptide (CGRP) were determined through enzyme-linked immunosorbent assay (ELISA). Intraoperative adverse cardiovascular events were recorded. Results Compared with group NDM, groups DM and DM-P showed remarkable increases in the concentration of serum cTnI 30 min before operation and 24 h after operation (P<0.05). Group DM presented marked higher levels of cTnI 24 h after operation than group DM-P (P<0.05). A remarkable increased level of cTnI in groups NDM and DM and a marked decreased level of cTnI in group DM-P were found 24 h after surgery, in comparison with those before surgery (P<0.05). Meanwhile, group NDM presented significantly higher levels of serum CGRP than groups DM and DM-P 30 min before operation (P<0.05). Compared with group DM, groups NDM and DM-P showed remarkable increased levels of CGRP 24 h after operation (P<0.05). The incidence of intraoperative adverse cardiovascular events was significantly increased in group DM (58.1%), compared with 22.6% in group NDM (P<0.05). Conclusions The level of serum cTnI is significantly increased in diabetic patients. Pentazocine can reduce the serum concentration of cTnI in diabetic patients 24 h after lower extremity surgery, which may be associated with the up-regulation of CGRP. Key words: Pentazocine; Diabetes mellitus; Cardiac troponin I; Calcitonin gene-related peptide; Adverse cardiovascular events

Desmopressin for Antiplatelet-Associated Intracranial Hemorrhage?

Patients with intracranial hemorrhage (ICH) who are on antiplatelet agents have poor outcomes, and platelet infusions almost certainly don't help (NEJM

Relevant factors of intravenous infusion among thyroid disease patients after operation

Objective To explore the relevant factors of intravenous infusion among thyroid disease patients after operation. Methods From June to December 2017, we selected 600 thyroid disease patients with operation in Peking Union Medical College Hospital by convenience sampling. We analyzed the intravenous therapy aims, rates of infusion and influencing factors of intravenous therapy among patients after thyroid operation. SPSS 21.0 was used to data analysis. Results The main aims of intravenous therapy after thyroid operation were the calcium supplement and to reduce local edema. The rate of infusion was 14.67% (88/600) one day after operation. Single factor analysis showed that there were statistical differences in intravenous infusion among patients after thyroid operation with history of thyroid operation and neck dissection or not, different extents of lymph node dissection as well as operation (P<0.05) . Logistic regression was used by taking intravenous infusion as the dependent variable and taking variables with statistical differences in single factor analysis as independent variables. The results showed that the influencing factors of intravenous infusion among patients after thyroid operation included being with history of thyroid operation or not, different extents of lymph node dissection as well as operation. Conclusions Intravenous infusion among patients after thyroid operation may be related to be with history of thyroid operation or not, different extents of lymph node dissection as well as operation. Medical staff should make clear the aims of intravenous therapy and make suitable plans for intravenous infusion therapy to reduce the incidence of complications and improve nursing quality. Key words: Thyroid diseases; Postoperative care; Infusions, intravenous; Influencing factors

Effect of sequential therapy of antibacterial drugs on acute mesenteric lymphadenitis caused by bacterial infection in children

Objective To investigate the effect of cephalosporin sequential therapy on acute mesenteric lymphadenitis caused by bacterial infection. Methods From December 2015 to December 2018, 66 patients with acute mesenteric lymphadenitis caused by bacterial infection in Shaoxing Central Hospital were randomly selected.The control group(33 cases) received intravenous infusion of cefuroxime.The observation group(33 cases) was treated with intravenous infusion of cefuroxime, after the abdominal pain disappeared and the peripheral blood cell count returned to normal, the cefuroxime axetil tablet was given orally.The clinical efficacy of the two groups was evaluated, and the treatment costs and adverse reactions of the two groups were counted. Results The total effective rate of the observation group was 96.97%(32/33), compared with 90.91%(30/33) of the control group, the difference was not statistically significant(χ2=1.26, P=0.53). The total cost of treatment in the observation group was (326.85±51.88)CNY, which was lower than that of the control group[(576.82±72.17)CNY], the difference was statistically significant(t=16.15, P=0.00). There were no significant adverse reactions in the two groups during treatment periods. Conclusion Sequential therapy with cefuroxime and venous infusion of cefuroxime for the treatment of acute mesenteric lymphadenitis in children with bacterial infection is safe, but sequential therapy is less expensive and therefore recommended. Key words: Bacterial infection; Lymphadenitis; Mesentery; Sequential therapy; Anti-bacterial agents; Blood cell count; Infusions, intravenous; Child; Cefuroxime

Effect of acetazolamide on lithium reabsorption and lithium-induced GSK3β phosphorylation in rat kidney.

Lithium promotes the phosphorylation of glycogen synthase kinase-3β (GSK3β), and this reaction protects against acute kidney injury mediated by renal apoptosis. Lithium is considered to be reabsorbed by sodium-phosphate cotransporters and sodium-proton exchanger NHE3. This study evaluated the relation between the lithium reabsorption and the phosphorylation of GSK3β, by using acetazolamide, an NHE3 inhibitor. In rats infused with lithium chloride, the plasma concentration of lithium was 4.77 mEq/l, and the renal clearance of lithium and its fractional excretion were calculated to be 2.29 ml/min/kg and 0.405, respectively. Coadministration of acetazolamide decreased creatinine clearance and the reabsorption rate of lithium, increased the fractional excretion of lithium, and did not affect its plasma concentration. Western blot analysis exhibited the facilitation of GSK3β phosphorylation in the kidney cortex by lithium infusion, and acetazolamide inhibited the lithium-induced phosphorylation of GSK3β. Lithium did not affect GSK3β phosphorylation in the liver and did not affect Akt in the kidney cortex and liver. These data show that lithium reabsorption contributes to GSK3β phosphorylation in the kidney cortex.

Effect of dexmedetomidine on stress response and immune balance in mechanical ventilation patients with acute respiratory distress syndrome

Objective To investigate the effect of dexmedetomidine on stress response and immune balance in patients with acute respiratory distress syndrome(ARDS) undergoing mechanical ventilation. Methods From March 2016 to September 2018, 90 ARDS patients with mechanical ventilation in Chongqing Three Gorges Center Hospital were randomly divided into dexmedetomidine group(D group, 30 cases), propofol group(P group, 30 cases), midazolam group(M group, 30 cases) by random number table method.Another 30 healthy workers in our hospital were selected as normal control group(C group). In M, P and D groups, the sedative drugs were infused by micro-pump on the basis of analgesic treatment(fentanyl citrate). The heart rate(HR), mean arterial pressure(MAP), Murray score, acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score, plasma norepinephrine(NS), plasma cortisol(Cor), and blood T lymphocyte subsets(CD4+, CD8+, CD4+/CD8+) were observed in all patients at T0(the beginning of sedation), T1 (6h after sedation), T2 (24h after sedation), T3(48h after sedation). The levels of NS and Cor in plasma and blood T lymphocyte subsets(CD4+, CD8+, CD4+/CD8+) in C group were measured at 8∶00 a. m.the next day. Results The plasma NS and Cor at T0 in M, P and D group were higher than those in C group (all P 0.05). The levels of CD8+ at T2 and T3 in P and D groups were higher than that of M group (all P<0.05). The level of CD4+/CD8+ at T3 in D group were higher than that in M and P group[(1.46±0.30) vs.(1.26±0.33), (1.46±0.30) vs.(1.32±0.34)](t=0.21, 0.15, all P<0.05). Conclusion Sedation with dexmedetomidine or propofol can alleviate stress response and improve immune function in ARDS patients undergoing mechanical ventilation, and dexmedetomidine is better than propofol. Key words: Respiratory distress syndrome, Adult; Ventilators, mechanical; T-Lymphocytes; Dexmedetomidine; Propofol; Midazolam

Efficacy observation of thalidomide combined with TP regimen in treatment of advanced gastric cancer

Objective To analyze the clinical efficacy of thalidomide combined with TP regimen (taxol+cisplatin) in treatment of advanced gastric cancer. Methods A total of 60 patients with advanced gastric cancer in the Affiliated Cancer Hospital of Zhengzhou University from February 2016 to March 2018 were enrolled. The patients were divided into two groups by using random number table method: the observation group (32 cases) taking thalidomide, oral administration 100 mg based on TP regimen before going to bed; the control group (28 cases) taking TP regimen chemotherapy only. Both groups received 75 mg/m2 doses of cisplatin, intravenous infusion, 25 mg/m2 per day, for 3 d. Paclitaxel dose was 150 mg/m2, intravenous infusion for 1 day, 3-week was one course, and the efficacy was evaluated after at least 2 course of treatment. Results The incidence of gastrointestinal adverse reactions including nausea and vomiting was 21.8% (7/32) in the observation group, and was 64.3% (18/28) in the control group, and the difference was statistically significant (χ 2 = 11.051, P = 0.001), but there were no statistically significant differences in the incidence of morning faint, constipation, bone marrow suppression, liver and kidney injury and other adverse reactions between the two groups (all P > 0.05). The effective rates in the observation group and the control group were 43.8% (14/32) and 39.3% (11/28), respectively, and the disease control rates in the observation group and the control group were 84.4% (27/32) and 78.6% (22/28), respectively. There were no significant differences in the effective rates and the disease control rates between the two groups (χ 2 = 0.122, P = 0.726; χ2 = 0.336, P = 0.562). The improvement and significant improvement rate of sleeping quality, pain, Eastern Cooperative Oncology Group (ECOG) score was 71.9% (23/32), 53.1% (17/32), 56.2% (18/32), respectively in the observation group, and 17.9% (5/28), 14.3% (4/28), 21.4% (6/28), respectively in the control group, and the difference between the two groups was statistically significant (all P < 0.05). Conclusions Thalidomide combined with TP regimen in treatment of advanced gastric cancer patients can improve the efficacy of chemotherapy and the quality of life. It also has a good tolerance to side effects. Key words: Stomach neoplasms; Thalidomide; Antineoplastic combined chemotherapy protocols; Comparative effectiveness research

The value of contrast-enhanced ultrasonography in differential diagnosis of orbit tumors in extraconal compartment

Objective To provide a reference for differential diagnosis of orbit tumors in extraconal compartment by analyzing the parameters of contrast-enhanced ultrasonography (CEUS). Methods A total of 76 patients with orbit tumors in extraconal compartment who underwent CEUS examination were retrospectively analyzed. These patients were divided into two groups depending on histological diagnosis including 27 cases with malignant tumor and 49 cases with benign tumor. CEUS images were analyzed using Sonoliver software. The time-intensity curve (TIC) and dynamic vascular pattern curve (DVPC) were acquired and the characteristics of the arterial flow infusion of these were analyzed. The related parameters such as time of arrival time(AT), rise time (RT), time to peak(TTP), mean transit time(mTT), slope of rise(K1), the absolute value for slope of down (K2) were also obtained. The differences of DVPC, TIC and quantitative parameters between the two groups were compared. Receiver operating curve analysis was used to acquire the cut-off values of these parameters for differential diagnosis. Results ①TICs of the benign tumors were mainly fast rise and slow drop and DVPCs were mainly positive biphasic, while TICs of the malignant tumors were mainly fast rise and fast drop and DVPCs were mainly biphasic. ②The differences of quantitative parameters IMAX, K1, K2, mTT and RT of TICs were statistically significant between the two groups (P 0.05). ③IMAX=456.2%, K1=109.6, K2=35.2, RT=7.9 s, mTT=28.1 s were the best cut-off values for differential diagnosis. Among these parameters, mTT with 28.1 s had the highest diagnostic value(sensitivity: 81%, specificity: 77%). Conclusions The quantitative CEUS parameters can provide effective reference for differential diagnosis of orbit tumors in extraconal compartment. Key words: Contrast-enhanced ultrasonography; Orbit tumors in extraconal compartment; Time-intensity curve; Dynamic vascular pattern

Nursing experience in the process of diagnosing and treating post-transplantation lymphoproliferative disorder

Objective To explore the key points of nursing in the process of diagnosing and treating the common complication--- post-transplantation lymphoproliferative disorder (PTLD) after pediatric liver transplantation. Methods The clinical data of 21 children with PTLD after liver transplantation. The key point of nursing in the process of prevention, onset, diagnosis and treatment was summarized. Results With the individual and combined treatments 18 patients gained remission except for 1 patient died because of perforation and sequent intractable haemorrhage and 2 patient died for the development of lymphoma. In terms of nursing, during the prevention stage, it is critical to insist the regular follow-up to make early diagnosis. More efforts should be made to obtain the children′s cooperation to complete the examination. During the infusion of rituximab, strengthened monitoring is necessary and more attention should be paid to the special nursing when other complications such as intractable haemorrhage, intestinal obstruction or perforation occurs. Conclusions The nursing care of PTLD is complicated. Individual and careful nursing regimens should be made based on the specific situations in different stages. Key words: Nursing care; Post-transplantation lymphoproliferative disorder; Pediatric liver transplantation; Rituximab; Epstein-Barr virus

Primary Raynaud's phenomenon in premature infant: a case report

This is a case report of preterm female neonate with Raynaud's phenomenon, who was born at 30+3 weeks of gestation. Her right upper limb completely turned pale from wrist to fingers with undetermined cause five days after birth, with weakened radial artery pulsation and lower skin temperature than the other side. After several treatment steps including right upper limb massage, keeping warm, intravenous infusion of Alprostadil and application of tropical mucopolysaccharide polysulfate cream, the affected limb gradually turned to purple and then ruddy. No abnormality was detected in the examinations for secondary Raynaud's phenomenon, therefore a primary Raynaud's phenomenon was considered. No similar symptoms recurred during hospitalization or follow-ups. Though rare, Raynaud's phenomenon should be considered if patients' hands suddenly turn to pale and then purple. The main treatments involve removing the causative factors, keeping warm and massage of the affected limb. Medications can be used to improve peripheral circulation if necessary. Long-term follow-up is needed for neonates suffered from Raynaud's phenomenon. Key words: Raynaud's phenomenon; Infant, premature; Treatment

Retrospective study on the timing of termination of erythrocyte infusion in patients with severe postpartum hemorrhage

Objective To evaluate the appropriate time and reasonable indicator of ending the erythrocyte transfusion in patients with severe postpartum hemorrhage. Methods A retrospective study was performed, where the hemoglobin (Hb) and hematocrit (Hct) values were taken as test variables and the infusion of erythrocytes was stopped, and the Hb>70 g/L of 24 h after the infusion of erythrocytes was taken as the state variable, and the receiver operating characteristic (ROC) curve was drawn to calculate area under receiver operating characteristic curve(AUC) and cut-off value. Based on the AUC area in the ROC curve, the study was conducted. Patients with severe postpartum hemorrhage whose test variables were less than or equal to cut-off value were divided into group A(n=34), and the rest were divided into group B(n=53). Bleeding volume, blood transfusion volume, hemoglobin content after red blood cell infusion were stopped, and heart rate (HR), mean arterial pressure (MAP) and pulse oxygen saturation (SpO2) were compared 24 h after red blood cell infusion was stopped. The damage of new organs, length of stay and total cost of hospitalization were compared in the two groups. Results The AUC area of Hb was calculated as 0.825 [95%confidence interval (CI) 0.725-0.925] when the infusion was stopped, and the cut-off value of Hb when the infusion was stopped was 86.5 g/L (sensitivity 72.5%, specificity 87.5%). The AUC area of Hct was 0.780 (95%CI 0.665-0.895) when the infusion was stopped, and the cut-off value of Hct when the infusion was stopped was 27.65% (sensitivity 65.2% and specificity 71.2%). There was no significant difference in bleeding volume between the two groups (P>0.05). The mean Hb values of the patients in the two groups were (79±6) g/L in group A and (100±10) g/L in group B, respectively, after the transfusion of erythrocytes was stopped. The difference between the two groups was statistically significant (P 0.05). The incidence of oxygenation index 0.05). Conclusions Hb is better than Hct in evaluating the indicators of stopping transfusion of red blood cells in patients with severe postpartum hemorrhage. When the body Hb reached 86.5 g/L, it was possible the appropriate time for ending erythrocyte transfusion, with beneficial effects on the body. It was also found that the occurrence of organ injury rises with the increase of erythrocyte transfusion. Key words: Postpartum hemorrhage; Erythrocyte infusion; Terminating time; Receiver operating characteristic curve

Effects of combined ultrasound-guided erector spinae plane block and patient controlled intravenous analgesia on postoperative pain in patients undergoing radical resection of esophageal carcinoma

Objective To observe the effects of one time erector spinae plane block (ESPB) combined with patient controlled intravenous analgesia(PCIA) on postoperative pain and satisfactory extent of patients undergoing radical resection of esophageal carcinoma by thoracotomy operation. Methods Forty patients[20 males and 20 females, American Society of Anesthesiologists (ASA) status Ⅰ or Ⅱ], scheduled for radical resection of esophageal carcinoma by open chest surgery, were randomly assigned into two groups: ESPB combined with PCIA group(group EP) and PCIA only group (group IA). ESPB was performed in group EP before anesthesia induction. The effect was evaluated by detecting the area of block after 20 min. The patients in both group used PCIA after surgery. Visual Analogue Scale (VAS) scores were recorded at 1, 6, 12, 24 h and 48 h after operation both in the resting and the coughing state. The times of pressing analgesic pump, the total volume of analgesic drugs infused by analgesic pump, the frequency and extent of adverse reaction and satisfactory extent of patients were recorded as well. Results Twenty min after EPSB, pain sense of patients in group EP was successfully blocked in the skin area innervated by spinal nerve between T3 to T9. The VAS scores both at rest and during coughing in group EP were lower than those in group IA(P<0.05). The times of pressing analgesic pump and the volume of infused analgesic drugs were significantly less in group EP than the times and volume in group IA (P<0.05). Meanwhile, the frequencies of nausea and vomiting in group EP were significantly lower than those in group IA (P<0.05). Also, the degree of satisfaction in group EP was significantly higher than the degree in group IA(P<0.05). Conclusions For radical resection of esophageal carcinoma by thoracotomy, ESPB combined with PCIA is a more effective method for postoperative analgesia than PCIA only. Also, the gross satisfactory extent is significantly higher in group EP than that in group IA. Less adverse effects were observed in patients of group EP. Key words: Erector spinae plane block; Patient controlled intravenous analgesia; Radical resection of esophageal carcinoma; Analgesic effect; Degree of satisfaction

Impact of comfortable nursing on penetration success rate, dispute occurrence rate and nursing satisfaction in children's infusion

目的 观察舒适护理用于儿童输液中对穿刺成功率、纠纷发生率及护理满意度的影响。 方法 采用方便抽样的方法回顾性收集2016年6月至2017年5月舟山市妇幼保健院门诊急诊输液室收治患儿240例为研究对象，120例患儿作为常规护理组，120例患儿作为舒适护理组。常规组患儿采用常规护理，舒适护理组患儿在对照组护理的基础上，采用舒适护理。比较两组患儿输液过程中的一次穿刺成功率、等候输液时间、不良事件的发生率、纠纷发生率及护理满意度。 结果 常规护理组患儿中一次穿刺成功103例(85.88%)，舒适护理组患儿中一次穿刺成功116例(98.33%)，舒适护理组显著高于常规护理组(χ2=8.819，P=0.003)；常规护理组患儿输液等候时间为(42.39±12.68)min，舒适护理组患儿的输液等候时间为(15.67±5.47)min，差异有统计学意义(t=21.196，P=0.000)；常规护理组患儿输液期间出现给药错误等不良事件的发生率为11.67%(14/120)，显著高于舒适护理组的0.83%(1/120)，差异有统计学意义(χ2=8.604，P=0.003)；常规护理组患儿近亲属与护理人员纠纷发生率为10.83%(13/120)，显著高于舒适护理组的1.67%(2/120)(χ2=8.604，P=0.003)；与常规护理组比较，舒适护理组护理满意度为100.00%(120/120)，显著高于常规护理组的86.67%(104/120)(χ2=17.143，P=0.000)。 结论 舒适护理能够显著减少等待时间，增加穿刺成功率，减少不良事件及纠纷的发生并提高护理满意度。

Effect of XELOX regimens plus combination of endostar and thalidamide as first-line treatment for advanced colorectal cancer

Objective To investigate the efficacy and safety of two antiangiogenic drugs (recombinant human endostatin endostar and thalidomide) combined with capecitabine and oxaliplatin(XELOX) regimens in the treatment of advanced colorectal cancer. Methods From January 2015 to May 2018, 40 patients of advanced metastatic colorectal cancer with organ metastasis and non-resectable were selected from the first people′s hospital of Hefei and Anhui Provincial Hospital, and they were randomly divided into treatment and control group, with 20 cases in each group.The treatment group received intravenous infusion (IV) of endostar for continuous 7 days (day 1~7) combined with oral administration of thalidomide for continuous 14 days (day 1~14) plus XELOX regimens after the fifth dose of endostar (day 6~19), and the control group was treated with XELOX regimen (day6~19). Results The objective response rate (ORR) was 50% (10/20) and 20% (4/20) respectively (χ2=3.956, P 0.05), and the median progression free survival (mPFS) was 6.8 in both groups.There was no significant difference in Karnofsky performance score (KPS) and incidence of adverse reactions between the two groups before and after treatment (P>0.05). Conclusion Combination of endostar and thalidamide plus XELOX regimen as first-line treatment have better antitumor activity and are well-tolerated in patients with advanced colorectal cancer. Key words: Recombinant human endostatin; Endostar; Thalidomide; Advanced colorectal cancer