Optimization Control of Multi-Mode Coupling All-Wheel Drive System for Hybrid Vehicle

The all-wheel drive(AWD)hybrid system is a research focus on high-performance new energy vehicles that can meet the demands of dynamic performance and passing ability.Simultaneous optimization of the power and economy of hybrid vehicles becomes an issue.A unique multi-mode coupling(MMC)AWD hybrid system is presented to realize the distributed and centralized driving of the front and rear axles to achieve vectored distribution and full utilization of the system power between the axles of vehicles.Based on the parameters of the benchmarking model of a hybrid vehicle,the best model-predictive control-based energy management strategy is proposed.First,the drive system model was built after the analysis of the MMC-AWD’s drive modes.Next,three fundamental strategies were established to address power distribution adjustment and battery SOC maintenance when the SOC changed,which was followed by the design of a road driving force observer.Then,the energy consumption rate in the average time domain was processed before designing the minimum fuel consumption controller based on the equivalent fuel consumption coefficient.Finally,the advantage of the MMC-AWD was confirmed by comparison with the dynamic performance and economy of the BYD Song PLUS DMI-AWD.The findings indicate that,in comparison to the comparative hybrid system at road adhesion coefficients of 0.8 and 0.6,the MMC-AWD’s capacity to accelerate increases by 5.26%and 7.92%,respectively.When the road adhesion coefficient is 0.8,0.6,and 0.4,the maximum climbing ability increases by 14.22%,12.88%,and 4.55%,respectively.As a result,the dynamic performance is greatly enhanced,and the fuel savings rate per 100 km of mileage reaches 12.06%,which is also very economical.The proposed control strategies for the new hybrid AWD vehicle can optimize the power and economy simultaneously.

Anesthesia Management at Fuwai Hospital:Practice,Evidence and Outcomes

Fuwai Hospital was established in 1956 and the Anesthesia Department of Fuwai Hospital was one of the earliest anesthesia departments then in China.Under the leadership of several department directors and with the concerted efforts of all generations of colleagues,the Anesthesia Department of Fuwai Hospital has dramatically transformed,upgraded and modernized.For more than six decades,the Anesthesia Department has been providing high-quality peri-operative anesthesia care for cardiovascular surgeries,conducting innovative experimental and clinical researches,and offering comprehensive training on cardiovascular anesthesiology for professionals across China.Currently,Fuwai Hospital is the National Center for Cardiovascular Diseases of China and one of the largest cardiovascular centers in the world.The present review introduces the Anesthesia Department of Fuwai Hospital,summarizes its current practice of anesthesia management,the outcomes of cardiovascular surgeries at Fuwai Hospital,accumulates relevant evidence,and provides prospects for future development of cardiovascular anesthesiology.

The effect of intraoperative goal-directed fluid therapy in patients under anesthesia for gastrointestinal surgery

BACKGROUND Intraoperative fluid management is an important aspect of anesthesia mana-gement in gastrointestinal surgery.Intraoperative goal-directed fluid therapy(GDFT)is a method for optimizing a patient's physiological state by monitoring and regulating fluid input in real-time.AIM To evaluate the efficacy of intraoperative GDFT in patients under anesthesia for gastrointestinal surgery.METHODS This study utilized a retrospective comparative study design and included 60 patients who underwent gastrointestinal surgery at a hospital.The experimental group(GDFT group)and the control group,each comprising 30 patients,received intraoperative GDFT and traditional fluid management strategies,respectively.The effect of GDFT was evaluated by comparing postoperative recovery,com-plication rates,hospitalization time,and other indicators between the two patient groups.RESULTS Intraoperative blood loss in the experimental and control groups was 296.64±46.71 mL and 470.05±73.26 mL(P<0.001),and urine volume was 415.13±96.72 mL and 239.15±94.69 mL(P<0.001),respectively.The postoperative recovery time was 5.44±1.1 days for the experimental group compared to 7.59±1.45 days(P<0.001)for the control group.Hospitalization time for the experimental group was 10.87±2.36 days vs 13.65±3 days for the control group(P<0.001).The visual analogue scale scores of the experimental and control groups at 24 h and 48 h INTRODUCTION Gastrointestinal surgery is one of the most common procedures in the field of general surgery[1],involving the stomach,intestines,liver,pancreas,spleen,and other internal abdominal organs[2,3].With advancements in surgical technology and anesthesia methods,the safety and success rates of surgery have significantly improved[4,5].However,intraop-erative fluid management remains a critical challenge[6].Traditional fluid management strategies often rely on experience and basic physiological parameters,which may lead to excessive or insufficient fluid input,thereby affecting postoperative recovery and complication rates.Intraoperative goal-directed fluid therapy(GDFT)is an emerging fluid management strategy that dynamically adjusts fluid input volume by monitoring the patient's hemodynamic parameters in real-time to optimize the patient's physiological state[7,8].GDFT has shown superiority in many surgical fields;however,its application in gastrointestinal surgery requires further research and verification[9,10].The application of intraoperative GDFT in clinical settings has gradually increased in recent years[11,12].Studies have demonstrated that GDFT can optimize tissue perfusion and oxygenation by precisely controlling fluid input and reducing the occurrence of postoperative complications[13,14].For example,in cardiac and major vascular surgeries,GDFT significantly reduced the incidence of postoperative acute kidney injury and cardiovascular events[15,16].Similarly,in abdominal surgery,GDFT effectively reduced postoperative infections and expedited recovery[17].However,studies on the utilization of GDFT in gastrointestinal surgery are relatively limited and they are confounded by contradictory findings[18].Traditional fluid management strategies typically rely on estimating fluid input volume based on the patient's weight,preoperative status,and basic physiological parameters[19].However,this method lacks real-time dynamic adjustment,which may result in either insufficient or excessive fluid input,consequently affecting postoperative recovery.Insufficient fluid input can lead to hypovolemia and inadequate tissue perfusion,whereas excessive fluid input can cause tissue edema and postoperative complications,such as pulmonary edema and heart failure.GDFT involves dynamically adjusting fluid input volume by monitoring the patient's hemodynamic parameters in real-time,such as cardiac output,pulse pressure variability,and central venous pressure.Commonly used monitoring equipment include esophageal Doppler and pulse wave profile analyzers[20].These devices provide real-time hemo-dynamic data to assist anesthesiologists in tailoring fluid therapy to a patient's specific condition.Firstly,the patient's volume responsiveness is assessed by preloading fluid;secondly,fluid input volume is dynamically adjusted based on real-time monitoring data;finally,vasoactive and inotropic drugs are administered in combination to further optimize the patient’s hemodynamic status.Through personalized fluid management,GDFT can more accurately maintain intraop-erative hemodynamic stability and reduce complications[21].Gastrointestinal surgery involves procedures on multiple organs,often requiring prolonged operative times and extensive tissue trauma,which presents challenges for intraop-erative fluid management.Surgical procedures can lead to significant bleeding and fluid loss,requiring prompt and effective fluid replenishment.In addition,the slow recovery of gastrointestinal function after surgery and susceptibility to complications such as intestinal obstruction and delayed gastric emptying elevate the necessity for postoperative fluid management.

Emergency treatment and anesthesia management of internal carotid artery injury during neurosurgery:Four case reports

BACKGROUND During skull base surgery,intraoperative internal carotid artery(ICA) injury is a catastrophic complication that can lead to fatal blood loss or secondary cerebral ischemia.Appropriate management of ICA injury plays a crucial role in the prognosis of patients.Neurosurgeons have reported multiple techniques and management strategies;however,the literature on managing this complication from the anesthesiologist’s perspective is limited,especially in the aspect of circulation management and airway management when patients need transit for further endovascular treatment.CASE SUMMARY We describe 4 cases of ICA injury during neurosurgery;there were 3 cases of pathologically proven pituitary adenoma and 1 case of cavernous sinus endothelial meningioma.After the onset of ICA injury,all four patients were immediately transferred for endovascular therapy under general anesthesia with vital signs monitored and mechanical ventilation.Three patients were transferred to the hybrid operating room,and one patient was transferred to the catheter operating room.Three patients underwent covered stent implantation,and one patient underwent embolization.All four patients experienced hypovolemic shock and received blood products infusion and vasoactive drugs to maintain stable circulation.After the neurosurgery,one patient was extubated and returned to the ward,and the other three were delayed tracheal extubation and returned to the intensive care unit.One patient died from serious neurological complications after 62 d in the hospital,but the other three showed good clinical outcomes.CONCLUSION ICA injury imposes a high risk of massive hemorrhage and subsequent infarction.Immediate treatment is critical and requires interdisciplinary collaboration among neurosurgeons,anesthesiologists,and interventional neuroradiologists.Effective hemostatic methods,stable hemodynamics sufficient to ensure perfusion of vital organs,airway safety during transit,rapid localization and implementation of appropriate measures to occlude the damaged vessel are strong guarantees of patient safety.

Regional anesthesia for acute pain management in elderly patients

Normal aging is a process that involves loss of functional reserve of most organ systems of the human body, most significantly: cardiovascular, pulmonary, renal and nervous systems. Advancements in both surgery and anesthesia have made it possible to operate more safely on the elderly population and those older patients with multiple severe co-morbidities that were not routinely possible in the recent past. Regional anesthesiologist have proven to be instrumental in this regard as regional anesthetic/analgesic techniques may now permit surgeons to operate on the elderly who were not ideal surgical candidates or unable to tolerate general anesthesia. In addition, regional techniques provide alternatives that may optimize acute pain control and reduce the incidence of devastating side effects during the perioperative period such as: myocardial infarction, pulmonary embolism, pneumonia, and also increases the opportunity to allow for early ambulation and shorter hospital stays. These anesthetic options now provide the elderly patient with better medical care alternatives, but also can show a significant financial impact on health care system resources. Further understanding on aging molecular biology, physiology and pathophysiology, together with technical improvements of regional anesthetic techniques will continue to make it safer and more efficacious to operate on the elderly population with evidence of reduced morbidity and mortality. Although there is only anecdotal evidence that regional anesthesia(RA) improves survival, there is little doubt that RA plays an important role in perioperative optimization of pain control and decreases pain management complications as well as a reduction in healthcare costs. Beyond traditional operating rooms, elderly patients may increasingly benefit from RA and acute pain management in Emergency Rooms, medical clinics and even within a patient's home. Therefore, the focus of this review is directed toward geriatric patients and beneficial effects of RA on outcomes in the elderly.

Management of procedural pain in the intensive care unit

Pain is a common experience for inpatients,and intensive care unit(ICU)patients undergo more pain than other departmental patients,with an incidence of 50%at rest and up to 80%during common care procedures.At present,the management of persistent pain in ICU patients has attracted considerable attention,and there are many related clinical studies and guidelines.However,the management of transient pain caused by certain ICU procedures has not received sufficient attention.We reviewed the different management strategies for procedural pain in the ICU and reached a conclusion.Pain management is a process of continuous quality improvement that requires multidisciplinary team cooperation,painrelated training of all relevant personnel,effective relief of all kinds of pain,and improvement of patients'quality of life.In clinical work,which involves complex and diverse patients,we should pay attention to the following points for procedural pain:(1)Consider not only the patient's persistent pain but also his or her procedural pain;(2)Conduct multimodal pain management;(3)Provide combined sedation on the basis of pain management;and(4)Perform individualized pain management.Until now,the pain management of procedural pain in the ICU has not attracted extensive attention.Therefore,we expect additional studies to solve the existing problems of procedural pain management in the ICU.

The Crucial Role of Bilateral Infraclavicular Nerve Blocks in the Anesthetic Management of a Trauma Patient

Bilateral brachial plexus blocks and regional anesthesia in trauma patients are rarely performed due to potential complications when using these techniques. We illustrate a case in which bilateral infraclavicular nerve blocks were placed as part of a multimodal approach to pain management in a trauma patient. We discuss potential hazards, important considerations, and rationale for attempting this procedure. Ultimately, performing bilateral brachial plexus nerve blocks in trauma patients is a viable option when choosing pain management techniques.

Patient Blood Management:Single Center Evidence and Practice at Fuwai Hospital

Blood loss and blood transfusion requirement are important quality control indicators of cardiovascular surgery and cardiovascular anesthesia.Patient blood management(PBM)is an evidence-based,multidisciplinary approach to optimizing the care of patients who may need transfusion,which encompasses anemia management,hemodilution,cell salvage,hemostatic treatment,and other approaches to reducing bleeding and minimizing blood transfusion.PBM in cardiovascular surgery is a"team sport"that involves cardiac and vascular surgeons,anesthesiologists,perfusionist,intensivists,and other health care providers.The current work provides an overview of evidence and practice of PBM at Fuwai Hospital.Implementation of PBM should also take local resource availability and costeffectiveness of different devices,drugs,technologies,and techniques into consideration.

Swine model in transplant research: Review of anaesthesia and perioperative management

Pigs are one of most common animal species to be used in biomedical models due to their many anatomical visceral similarities with humans, particularly with regards to transplantation. Despite this use, in many of the researches in which pigs are selected for transplantation, the anaesthesia used is an adaptation of human anaes-thesia and presents some limitations such as a reduced analgesia a limited control in perioperative period. In this review we show some of the most important conditions in the preanaesthetic management and of swine as well as we review of anaesthetic protocols for the most common types of swine model of transplantation.

Pheochromocytoma Anesthetic Management

Pheochromocytomas are catecholamine producing tumors and although uncommon present a great challenge to the anesthesiologist since it has nonspecific clinical symptoms and risk of critical events, including death when not previously diagnosed. Clinical manifestation is variable, unspecific and depends on the catecholamine production profile. The classic triad of headache, palpitation and diaphoresis is present in up to 70% of the cases and only 50% have sustained hypertension. The best approach for pheochromocytoma treatment is surgical excision of the affected adrenal gland. The introduction of alpha adrenergic blockade medication, such as phentolamine and phenoxybenzamine had the highest impact in perioperative mortality reduction due to inhibition of the deleterious effect of vasoconstriction. The majority of anesthetic techniques and drugs are considered safe. Post-operative care in intensive care unit is advisable since patients may present instability of blood pressure and hypoglycemia. Genetic testing should be done in first-degree relatives of confirmed cases or when a genetic syndrome is suspected.

Anaesthesia and pancreatic surgery:Techniques, clinical practice and pain management

Pancreatic cancer continues to pose a major public health concern. The incidence of the disease is nearly equivalent to the death rate associated with the diagnosis of pancreatic cancer. Thus, there exists a need for continued improvement in the diagnostic, therapeutic and palliative care of these patients. There have been significant advances made over the years in the areas of critical care, anesthesia, and surgical technique, which have led to improved mortality rates and survival after resection for pancreatic cancer. Resections are performed with the goals of negative margins and minimal blood loss and referral to high-volume centers and surgeons is encouraged. However, 5-year survival rate after curative resection still remains at less than 20%. Perioperative management of pancreatic and periampullary cancer poses a considerable challenge to the pancreatic surgeon, anesthesiologist and the intensive care team. Major morbidity is often secondary to pancreatic anastomotic leakage and fistula or infection. The anesthesiologist plays a crucial role in the perioperative management of such patients and in the pain control. Pancreatic ductal adenocarcinoma has a high rate of neural invasion(80%-100%) and can be associated with moderate to severe pain. In the recent past, new information has emerged on many issues including preoperative biliary drainage, nutritional support, cardiovascular assessment, perioperative fluid therapy and hemodynamic optimization. Careful patient selection and appropriate preoperative evaluation can greatly contribute to a favorable outcome after major pancreatic resections.

Complex Inpatient Pain Management in a Critically Ill Lung Transplant Recipient: A Case Report

Thoracic surgery is known to cause severe pain that may not subside during the course of hospitalization. Early pain control is important in these patients because it improves ventilation and promotes mobility. Lung transplant recipients can experience post-operative complications that lead to extended hospital stays. This increases the time a patient is sedentary, which further deconditions patients;therefore, rehabilitation should be initiated early post-operatively. We present a unique case of a critically ill double lung transplant recipient whose rehabilitation post-operatively was hindered by severe vasopressor-induced ischemic pain. Due to debilitating pain, he was unable to regain mobility. His pain management course was challenging due to sensitivity to opioids, renal failure, and anticoagulation.

快速康复外科理念下日间手术的麻醉与围术期质量控制

日间手术模式是一种加速康复理念下的手术诊疗康复体系,我国的日间手术正处于高速发展状态中,日间手术医疗质量管理也越来越受到重视。本文围绕日间手术的围术期管理进行了阐述,从患者选择、手术麻醉选择、术中管理、术后镇痛、术后恶心呕吐管理和出院随访等方面探讨了日间手术的管理细节,旨在建立统一的日间手术麻醉质量管理模式、进行全面的质量改进,为临床日间手术管理提供更恰当的日间手术管理方法,才能更好地促进日间手术的健康、快速、高效的发展。

手术室外麻醉工作单元麻精药品同质化管理的探讨

目的探索运用同质化管理模式在手术室外麻醉工作单元麻精药品管理中的作用。方法从2021年7月开始运用同质化管理模式对手术室外麻醉工作单元麻精药品进行管理,通过制定同质化管理流程,比较和分析同质化管理模式实施后每季度麻精药品质量管理指标的比值率。结果每季度管理指标评分均有明显提升。结论运用同质化管理模式在手术室外麻醉工作单元麻精药品管理中,能有效提高麻精药品的管理质量,达到药品规范化、精细化、安全化管理的目的,值得推广。

分娩镇痛:舒适与安全并行,教学与质控并举

分娩镇痛是以遵循产妇自愿和临床安全为原则,通过实施有效的分娩镇痛技术,以最大程度减轻产妇产痛的医疗服务。2018年,北京协和医院成为我国分娩镇痛首批试点单位,近年来在分娩镇痛高质量发展的各项工作中取得了满意成果。本文主要介绍北京协和医院分娩镇痛相关经验,具体包括:(1)合理调配人员安排,多学科联动制定标准化诊疗流程,为安全分娩提供舒适度保障;(2)完善危重孕产妇、新生儿救治方案,为安全分娩保驾护航;(3)传递先进的教学理念,将分娩镇痛培训与救治演练落到实处;(4)开展教育与科普讲座,帮助产妇树立科学分娩镇痛观。希望该经验分享可为我国各级诊疗机构提供参考和借鉴。

手术麻醉医疗文书无纸化归档应用实践

目的:对手术麻醉系统医疗文书进行无纸化归档改造,优化相关流程,满足医院对病案管理的要求。方法:实现医、护、患的电子签名,对所有医疗文书进行电子化改造,明确无纸化归档范围,重塑手术麻醉系统的病历归档流程。结果:通过一系列改造,实现了手术麻醉系统医疗文书的无纸化归档,归档流程严谨、顺畅,无纸化归档率达到100%。结论:手术麻醉系统医疗文书无纸化归档满足了医院对患者病历统一管理的需求,提升了临床的工作效率,保障了病历的完整性,为医院节省了运营成本,提升了医院精细化管理水平。

北京市麻醉科电子病历信息化及药品管理智能化系统建设现状分析

目的探究北京市麻醉科电子病历信息化及药品管理智能化系统的建设现状。方法选取2021年1~12月北京市辖区内109家二级及以上医院上报的质控数据进行分析,对麻醉科电子病历信息化及药品管理智能化系统相关的质控指标实行动态管理,探讨其在临床麻醉及质控管理中的应用现状。结果截至2021年12月,64家医院(58.7%)启用麻醉科电子记录系统,63家(57.8%)医院启用电子化麻醉记录单,45家(41.3%)医院启用电子化术前访视记录单,49家(45.0%)医院启用电子化术后随访记录单,32家(29.4%)医院启用电子化麻醉恢复室记录单,23家(21.1%)医院配备智能药柜,68家(62.4%)医院配备彩色药品标签。朝阳区、海淀区、东城区、西城区麻醉科电子病历信息化医院数量较多,顺义区、门头沟区、通州区、平谷区上报的医院中只有1~2家医院启用麻醉信息管理系统,麻醉科电子病历信息化程度较低,怀柔区、密云区上报的医院中尚未启用麻醉信息管理系统。结论北京市部分区域麻醉电子病历信息化及药品管理智能化仍偏低、麻醉信息化建设滞后,需进一步加强麻醉质控管理标准化和医疗服务同质化建设。

rSO2-BIS监测在儿童肱骨髁上骨折手术中的应用研究

目的 探讨局部脑氧饱和度(regional cerebral oxygen saturation,rSO2)-脑电双频指数(bispectral index,BIS)监测麻醉方式在儿童肱骨髁上骨折手术中的应用。方法 选取江西省儿童医院骨科2020年1月至2022年12月收治的60例肱骨髁上骨折手术患儿,按随机数字表法分为对照组和观察组,每组30例。观察组患儿麻醉后给予rSO2-BIS监测,对照组患儿给予常规麻醉管理。结果 观察组患儿的丙泊酚中/长链脂肪乳和瑞芬太尼注射液用量明显少于对照组(P<0.05);患儿苏醒时各时间点的心率、血氧饱和度及平均动脉压比较,差异无统计学意义(P>0.05);术后镇痛药补救率低于对照组,拔管时间短于对照组(P<0.05);术后不良反应发生率及不良行为率低于对照组(P<0.001)。多因素分析结果发现丙泊酚中/长链脂肪乳和瑞芬太尼注射液的用量是诱发患儿术后出现不良反应和不良行为的独立危险因素,rSO2-BIS监测是减少患儿术后出现不良行为和不良反应的关键因素(P<0.05)。结论 儿童肱骨髁上骨折术中采用rSO2-BIS监测可降低手术患儿术后不良行为和不良反应的发生率,进而改善术后疗效。

日间手术麻醉规范化管理策略

日间手术具有床位周转快、患者满意度高、医疗费用少、院内感染率低等优势,是目前国内外大力探索和发展的一种手术模式。安全是日间手术开展的底线,舒适是日间手术的核心追求,二者的保障均离不开对高质量的围术期麻醉管理。因此,在快速周转的日间手术模式下,本文就如何实施规范化的麻醉管理策略,分别从日间手术麻醉临床路径的制定、硬件设施以及人员的配备,麻醉术前评估与术前准备,麻醉方式的选择,围术期疼痛管理,术后恶心呕吐(postoperative nausea and vomiting,PONV)管理,麻醉后监测治疗,术后随访几方面加以阐述。

OSA可能是引发麻醉意外的一种尚未被认识的原因

临床上对于麻醉意外的认识以往并未包括睡眠呼吸暂停问题。特别是全麻患者发生术中和术后合并症时,一般认为所涉及的原因大多是麻醉期间发生的反流、误吸、缺氧、吸氧、呼吸抑制、急性呼吸衰竭、术后苏醒延迟,很少涉及阻塞性睡眠呼吸暂停(OSA)问题。近年来,随着人们对于睡眠呼吸暂停危害认识的逐渐深入和扩展,发现外科麻醉时产生的问题可能与OSA有关。本研究在长期临床实践经验的基础上,推测OSA可能是造成麻醉意外(主要是全麻)的一种尚未被认识和重视的原因。本研究按照顺序逐层剖析和阐述其推测过程,在梳理导致OSA高危因素和发病条件的基础上,重点阐述OSA与麻醉意外之间的关系,分析OSA引发麻醉意外的原因,强调应充分认识OSA引发麻醉意外的危害,指出OSA患者术前若未进行必要的筛查诊断和干预处理,可能会出现系列不良后果;麻醉医生应时刻加强OSA患者围手术期的管理。