ABSTRACT
Objective To compare the analgesic effect of the ultrasound-guided modified-fascia iliaca compartment block with ultrasound-guided fascia iliaca compartment block injection in the treat-ment of elderly patients with hip fracture.Methods Sixty elderly patients with hip fracture,17 males and 43 females,falling into ASA physical status Ⅱ or Ⅲ,were randomly divide into two groups (n=30 each):ultrasound-guided modified fascial iliaca compartment block group (group M)and ultra-sound-guided fascial iliaca compartment block group (group F).The patients in group M received M-FICB using ultrasound-guided injection of 0.4% ropivacaine 5 ml in obturator nerve,15 ml in the fas-cial iliac space.The patients in group F received ultrasound-guided injection of 0.4% ropivacaine 20 ml in the fascial iliac space.FICB or MFICB was performed 20 min before epidural anesthesia in group F or group M respectively.The time of ultrasound-guided nerve block was recorded,and the onset time of femoral nerve,lateral femoral cutaneous nerve and obturator nerve block were recorded in the two groups.Visual analogue pain scores (VAS)were recorded before nerve block (T0 ),after nerve block,10 min (T1 ),20 min (T2 ),placing spinal anesthesia position (T3 ),and postoperative 24 h (T4 ).Results The onset time of obturator nerve block in group M was significantly shorter than that in group F [(4.1±1.4)min vs (10.1 ±3.9)min,P <0.05].The time of ultrasound-guided nerve block has no difference between the two groups [(2.2 ± 0.5 )min vs (2.1 ± 0.5 )min].Compared with group F,the VAS scoress at T1-T3 were lower in group M (P <0.05).Compared with T0 ,the VAS scores at T1-T4 decreased in both groups (P < 0.05 ).Conclusion Ultrasound-guided fascia iliaca compartment block is more effective in reducing the VAS scores during the supine position and reducing postoperative pain.
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Objective To evaluate the blood-saving effect of combination of hemocoagulase artox for injection and tranexamic acid (TXA) in patients undergoing off-pump coronary artery bypass grafting (OPCABG).Methods Eighty ASA Ⅱ patients (NYHA Ⅰ or Ⅱ),aged 50-70 yr,weighing 50-100 kg,scheduled for elective OPCABG,were randomly divided into 4 groups (n =20 each):control group (group C),hemocoagulase atrox for injection group (group H,n =20),TXA group (group T) and hemocoagulase atrox for injection + ·TXA group (group HT).Hemocoagulase atrox 0.04 U/kg (the highest dose 4 U) was injected at 20 min before skin incision,and additional hemocoagulase atrox 2 U was given every 2 h starting from 15 min after administration of protamine until the end of operation in group H.TXA 20 mg/kg was injected intravenously at skin incision,followed by a continuous infusion of TXA at 10 mg· kg-1 · h-1 until the end of operation in group T.Hemocoagulase atrox and TXA were given as the method described in groups H and T.Venous blood samples were taken from the central vein before operation,at the end of operation,and 24 h after operation to determine the plasma D-Dimer concentration.The amount of blood loss,allogeneic red blood cells and plasma infused during operation,volume of drainage during 0-6 and 6-24 h after operation,total volume of drainage and volume of allogeneic blood transfused during operation were recorded.The deep vein thrombosis was recorded.Results Compared with group C,the amount of blood loss during operation was significantly decreased in groups T and HT,and the allogeneic red blood cells and plasma infused during operation,and volume of drainage during 0-6 and 6-24 h after operation,and total volume of drainage were significantly decreased in groups H,T and HT (P ＜ 0.05).Compared with groups H and T,the allogeneic red blood cells and plasma infused during operation,and volume of drainage during 0-6 and 6-24 h after operation,and total volume of drainage were significantly decreased in group HT (P ＜ 0.05).No deep vein thrombosis was observed in the 4 groups.Conclusion The combination of hemocoagulase artox for injection and TXA provides better blood-saving effect than either alone for the patients undergoing OPCABG without increasing the risk for thrombosis.
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Objective To investigate the effect of isoflurane anesthesia on the expression of amyloid β protein (Aβ) in hippocampus in aged rats.Methods Sixty-one healthy male SD rats,aged 18-19 months,weighing 400-500 g,were randomly divided into 3 groups:isoflurane group (group Ⅰ,n =31),control group (groupⅡ,n =20),and blank group (group Ⅲ,n =10).Group Ⅰ inhaled 1.4％ isoflurane for 2 h,and cognitive function was assessed at 5 d before and 2 d after anesthesia by Morris water maze.Group Ⅱ received Morris water maze text only.Group Ⅲ received no treatment.Group Ⅰ was divided into 2 subgroups according to whether the cognitive impairment occurred:cognitive impairment group (P subgroup) and no cognitive impairment group (NP subgroup).The animals were sacrificed immediately after the test.The hippocampus was isolated for determination of the levels of Aβ40 and Aβ42,β-secretase (BACE),insulin degrading enzyme (IDE)and neprilysin (NEP).Results There was no significant difference in the results of Morris water maze test before anesthesia among the 3 groups.There was no significant difference in the swimming velocity between group Ⅰ and group Ⅱ.The time of staying at the original platform quadrant was significantly shorter in P subgroup than in NP subgroup and Ⅱ group,and there was no significant difference in the time of staying at the original platform quadrant between NP subgroup and Ⅱ group.There was no significant difference in the levels of Aβ40 and Aβ42,BACE,NEP and IDE among the 5 groups,and between P subgroup and NP subgroup.Conclusion Isoflurane anesthesia has no effect on the expression of Aβ in the hippocampus,indicating that isoflurane-induced cognitive impairment is not related to Aβ pathway in aged rats.
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Objective To investigate the effect of batroxobin combined with tranexamic acid on the perioperative bleeding and blood coagulation in the patients undergoing adolescent idiopathic scoliosis.Methods Eighty ASA Ⅰ or Ⅱ patients,aged 15-26 yr,weighing 41-56 kg,scheduled for elective adolescent idiopathic scoliosis,were randomly divided into 4 groups (n =20 each):normal saline group (group A),batroxobin group (group B),tranexamic acid group (group C) and batroxobin combined with tranexamic acid group (group D).0.9 ％ normal saline was infused after admission to the operating room in group A.Batroxobin 0.02 U/kg was infused at 20 min before skin incision,an increment of 0.02 U/kg was given every 2 h until the end of operation and the maximal dose was less than 1 U in group B.Tranexamic acid 20 mg/kg was injected immediately before skin incision,followed by infusion at 10 mg· kg-1 · h-1 until the end of operation in group C.In group D,batroxobin and tranexamic acid were given as the method described in B and C groups.The intraoperative blood loss,volume of autologous and allogeneic blood transfused,transfusion of fresh frozen plasma (FFP),and volume of drainage within 24 h after operation were recorded.Blood routine,prothrombin time (PT),activated partial thromboplastin time (APTT),fibrinogen (Fbi),thrombin time (TT),activated clotting time (ACT),clot rate (CR) and platelet function (PF) were measured.Deep vein thrombosis was detected at 1 week after operation.Results Compared with group A,the intraoperative blood loss,volume of allogeneic blood transfused,transfusion of FFP,volume of autologous blood transfused and volume of postoperative drainage were significantly reduced,and Plt and Fib were significantly increased at T2,3 in groups B,C and D,and PF was increased at T2 in group C,Hct,Plt,Fib and PF were increased and PT was prolonged at T2,3 in group D (P ＜ 0.05).Compared with group B,the intraoperative blood loss,volume of allogeneic blood transfused,transfusion of FFP,volume of autologous blood transfused and volume of postoperative drainage were significantly decreased and Hct,Plt,Fib and PF were increased at T2,3 in group D,and the volume of postoperative drainage was increased and Plt increased at T2,3 was in group C (P ＜ 0.05).Compared with group C,the intraoperative blood loss,volume of allogeneic blood transfused,volume of autologous blood transfused,volume of postoperative drainage and transfusion of FFP were significantly decreased and Hct,Plt,Fib and PF were significantly increased at T2,3 in group D (P ＜ 0.05).No patients developed blood coagulation disorder and deep vein thrombosis.Conclusion Batroxobin combined with tranexamic acid can significantly reduce the intraoperative blood loss and volume of allogeneic blood transfused and improve the blood coagulation,and the efficacy is superior to that of either alone for the patients undergoing adolescent idiopathic scoliosis.