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Objective:To explore the effects of dexmedetomidine (DEX) on intestinal stress response and cellular immune function in patients with gynecologic malignancies undergoing laparoscopic surgery.Methods:A total of 60 patients with gynecologic malignancies who scheduled to undergo laparoscopic surgery under general anesthesia in the Second Hospital of Shanxi Medical University from March 2021 to March 2022 were selected. All patients were divided into the DEX group and the control group according to the random number table method, with 30 cases in each group. The DEX group included 12 cases of cervical cancer, 10 cases of endometrial cancer and 8 cases of ovarian cancer; the control group included 14 cases of cervical cancer, 9 cases of endometrial cancer and 7 cases of ovarian cancer. The DEX group: intravenous anesthesia was induced with a dose of DEX 0.5 μg/kg (infusion was completed within 10 min), general anesthesia was maintained with DEX 0.2 μg·kg -1·h -1 pumped intravenously, and the drug was stopped 30 min before surgery. The control group: equal amount of 0.9% sodium chloride solution was pumped intravenously. The venous blood was drawn at the time points of 10 min before general anesthesia (T 0), at the end of operation (T 1) and 1 d after the operation (T 2) to detect the stress response indicators such as cortisol (COR), epinephrine (E), norepinephrine (NE) levels, and immune indicators such as CD4 +, CD8 + proportions and CD4 +/CD8 + at T 0, T 1,and T 2. In addition, the pneumoperitoneum time, general anesthesia time, operation time and intestinal function recovery time were recorded. Results:At T 0, there were no statistically significant differences in the levels of COR, E and NE between the DEX group and the control group (all P > 0.05). At T 1, the levels of COR, E and NE were (146±12) μg/L, (158±14) ng/L, (265±12) ng/L, respectively in the control group, and (136±18) μg/L, (149±15) ng/L, (158±12) ng/L, respectively in the DEX group; the levels of COR, E and NE in the DEX group were lower than those in the control group ( t values were -2.51, -2.37, -2.08, all P < 0.05). At T 2, the levels of COR, E and NE were (124±12) μg/L, (131±16) ng/L, (234±8) ng/L, respectively in the control group, and (116±15) μg/L, (123±12) ng/L, (228±10) ng/L, respectively in the DEX group; the levels of COR, E and NE in the DEX group were also lower than those in the control group ( t values were -2.35, -2.23, -2.17, all P < 0.05). At T 0, there were no statistically significant differences in the proportions of CD4 +, CD8 + and CD4 +/CD8 + between the DEX group and the control group (all P > 0.05). At T 1, the proportions of CD4 +, CD8 + and CD4 +/CD8 + were (23±3)%, (20±3)%, 1.12±0.16, respectively in the control group, and (27±4)%, (23±4)%,1.22±0.19, respectively in the DEX group; the proportions of CD4 +, CD8 + and CD4 +/CD8 + in the DEX group were higher than those in the control group ( t values were -3.43, -2.29, 2.13, all P < 0.05). At T 2, the proportions of CD4 +, CD8 + and CD4 +/CD8 + were (26±3)%, (23±4)%, 1.17±0.16, respectively in the control group, and (31±5)%, (25±4)%, 1.26±0.19, respectively in the DEX group; the proportions of CD4 +, CD8 + and CD4 +/CD8 + in the DEX group were higher than those in the control group ( t values were -4.32, -2.02, 2.02, all P < 0.05). In addition, the time of first exhaust in the DEX group was shorter than that in the control group ( P<0.05). Conclusions:DEX can reduce the intestinal stress response of gynecologic malignancies patients undergoing laparoscopic surgery, thereby improving the immunosuppression of patients. It is also of great significance to protect intestinal mucosal barrier and recover the intestinal function, and DEX has a high safety.
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Objective:To explore the effects of different doses of dexmedetomidine (DEX) on inflammatory factors and immune function in patients with gynecological malignant tumors who underwent laparoscopic surgery.Methods:A total of 60 patients with gynecological malignant tumors who underwent laparoscopic surgery from January 2021 to December 2021 in the Second Hospital of Shanxi Medical University were selected as the research objects. All patients were divided into the control group, low-dose DEX group (group D1) and high-dose DEX group (group D2) by using random number table method, 20 cases in each group. Patients in D1 and D2 groups were intravenously pumped DEX 0.5 μg/kg and 1.0 μg/kg 10 minutes before induction of anesthesia, and then maintained with DEX 0.5 μg·kg -1·h -1 and 1.0 μg·kg -1·h -1 until 30 minutes before the end of operation; and patients in the control group were given the same amount of Nacl solution. The 10 ml peripheral venous blood were collected at 10 minutes before induction of anesthesia (T 1), 1 h after pneumoperitoneum relief (T 2) and 24 h after pneumoperitoneum relief (T 3). The changes of interleukin-6 (IL-6), interleukin-10 (IL-10), the proportion of CD4 +, the proportion of CD8 + and CD4 +/CD8 + ratio of the three groups were compared, and the cases of bradycardia and hypotension in perioperative period and the time of first exhaust after operation were recorded. Results:At T 1,T 2 and T 3, the expression level of IL-6 in the control group was (7.95±0.26) pg/ml, (8.30±0.24) pg/ml and (8.35±0.28) pg/ml, respectively, and the difference was statistically significant ( F = 14.14, P < 0.001); the expression level of IL-10 in the control group was (38.9±2.6) pg/ml, (44.5±6.6) pg/ml and (46.3±4.6) pg/ml, respectively, and the difference was statistically significant ( F = 12.45, P < 0.001); the proportion of CD4 + in the control group was (38.5±2.1)%, (29.5±4.6)% and (29.6±3.5)%, respectively, and the difference was statistically significant ( F = 40.82, P < 0.001); the ratio of CD8 + in the control group was (30.1±3.7)%, (35.1±6.3)% and (40.3±8.2)%, respectively, and the difference was statistically significant ( F = 13.02, P < 0.001); the CD4 +/CD8 + ratio in the control group was 1.29±0.14, 0.84±0.09 and 0.75±0.14, respectively, and the difference was statistically significant ( F = 99.94, P < 0.001). The expression level of IL-6 in group D1 and group D2 was (8.10±0.32) pg/ml and (8.01±0.30) pg/ml at T 2, and (8.12±0.35) pg/ml and (8.05±0.34) pg/ml at T 3,which were lower than those in the control group, and the differences were statistically significant (all P < 0.05). The expression level of IL-10 in group D2 was (40.6±3.5) pg/ml at T 2, which was lower than that in the control group, and the difference was statistically significant ( P < 0.05). At T 3, the expression level of IL-10 in group D1 and group D2 was (43.7±3.5) pg/ml and (42.4±3.9) pg/ml, which were lower than those in the control group, and the differences were statistically significant (all P < 0.05). At T 2, the proportion of CD4 + in group D2 was (34.5±4.3)%, which was higher than that in the control group, and the difference was statistically significant ( P < 0.05). At T 3, the proportion of CD4 + in group D1 and group D2 was (32.1±4.2)% and (33.7±2.8)%, which were higher than those in the control group, and the differences were statistically significant (all P < 0.05). At T 2, the proportion of CD8 + in group D2 was (30.7±5.5)%, which was lower than that in the control group, and the difference was statistically significant ( P < 0.05). At T 3, the proportion of CD8 + in group D1 and group D2 was (35.4±5.8)% and (32.5±5.1)%, which were lower than those in the control group, and the differences were statistically significant (all P < 0.05). The CD4 +/CD8 + ratio in group D1 and D2 was 0.99±0.17 and 1.14±0.16 at T 2, 0.93±0.19 and 1.05±0.16 at T 3, which were higher than those in the control group, and the differences were statistically significant (all P < 0.05). Meanwhile, 1 case of hypotension occurred in the the control group and group D1, respectively; 3 cases of bradycardia and 2 cases of hypotension occurred in the group D2. The time of exhaust in the control group was later than that in group D1 and D2, and the difference was statistically significant ( P < 0.05). Conclusions:DEX can inhibit the inflammatory reaction during laparoscopic surgery in patients with gynecological malignant tumors, reduce immune damage. The anti-inflammatory action and immune protection of high-dose of DEX is more significant compared with low-dose of DEX, while high dose of DEX is more likely to cause hemodynamic fluctuations in perioperative period.
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Objective:To explore the effect of different doses of dexmedetomidine (Dex) on levels of tight-junction protein claudin-1 and diamine oxidase (DAO) in patients undergoing laparoscopic radical resection of gynecological malignant tumors.Methods:A total of 60 patients with gynecological malignant tumors who were scheduled to undergo laparoscopic radical resection under general anesthesia from January 2019 to January 2020 in the Second Hospital of Shanxi Medical University were selected, including 43 cases of cervical cancer (stageⅠ-Ⅱ A), 9 cases of ovarian cancer (stageⅠ A-Ⅲ C), and 8 cases of endometrial carcinoma (stageⅠ). Accroding to the random number table method, the patients were divided into control group (group C), low-dose Dex group (group D 1) and high-dose Dex group (group D 2), with 20 cases in each group. Patients in group D 1 were given Dex 0.5 μg·kg -1·h -1 by constant rate intravenous infusion pump after induction until 30 min before the end of operation. Patients in group D 2 were given Dex 1.0 μg·kg -1·h -1 by constant rate intravenous infusion pump after induction until 30 min before the end of operation. Group C adopted the same calculation method and received the same amount of 0.9% sodium chloride solution by infusion pump. At 10 min before induction (T 1), 1 hour after pneumoperitoneum (T 2) and 12 hours after pneumoperitoneum (T 3), 5 ml of brachial vein blood was collected from the patients, and the levels of claudin-1 protein, DAO and blood glucose were measured. Results:At T 1, T 2 and T 3, the expression levels of claudin-1 in group C were (77.05±17.61) pg/ml, (66.76±12.97) pg/ml and (55.93±12.71) pg/ml, and the difference was statistically significant ( F = 10.449, P<0.05); the expression levels of DAO in group C were (4.83±0.93) ng/ml, (5.62±1.01) ng/ml and (5.98±1.21) ng/ml, and the difference was statistically significant ( F = 6.139, P < 0.05); the levels of blood glucose in group C were (4.82±0.66) mmol/L, (7.55±0.94) mmol/L and (6.51±0.54) mmol/L, and the difference was statistically significant ( F = 70.197, P < 0.05). At T 2, the expression level of claudin-1 in group D 1 was (69.12±13.02) pg/ml, which was not significantly different from group C ( t = -0.575, P > 0.05); the expression level of claudin-1 in group D 2 was (76.36±14.89) pg/ml, which was higher than that in group C, and the difference was statistically significant ( t = -2.175, P < 0.05). At T 3, the expression levels of claudin-1 in group D 1 and group D 2 were (66.14±14.36) pg/ml and (73.37±16.93) pg/ml, which were higher than that in group C, and the differences were statistically significant ( t values were -2.380 and -3.682, both P < 0.05). The expression levels of DAO in group D 1 and group D 2 were (5.02±0.84) ng/ml and (4.91±0.93) ng/ml at T 2, and (5.29±0.86) ng/ml and (5.20±0.98) ng/ml at T 3, which were lower than those in group C, and the differences were statistically significant ( t values were 2.051, 2.295, 2.079 and 2.285, all P < 0.05). The levels of blood glucose in group D 1 and group D 2 were (7.10±0.66) mmol/L and (6.77±0.97) mmol/L at T 2, and (5.95±0.94) mmol/L and (5.93±0.74) mmol/L at T 3, which were lower than those in group C, and the differences were statistically significant ( t values were 2.565, 5.374, 2.293 and 2.765, all P < 0.05). Conclusion:Continuous infusion of Dex can inhibit the stress response caused by long-term CO 2 pneumoperitoneum in laparoscopic radical resection of gynecological malignant tumors, and adjust the changes of expression levels of claudin-1 protein and DAO, reduce the damage of intestinal mucosal cells, facilitate the recovery of intestinal function, and the effect of high-dose Dex is better than low-dose Dex.
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Objective:To explore the effects of dexmedetomidine (Dex) on perioperative intrapulmonary shunt rate (Qs/Qt), inflammatory factors and Claudin-4 in patients with esophageal cancer undergoing radical operation.Methods:Sixty patients with thoraco-laparoscopic combined esophageal cancer radical resection under general anesthesia were selected from the Second Hospital of Shanxi Medical University from March to August 2018. The patients were divided into Dex group (observation group) and 0.9% sodium chloride injection group (control group) according to the random number table method, and both groups were given the same anesthesia. In the observation group, Dex was injected intravenously before the anesthesia induction, the infusion was first performed at the loading dose of 1.0 μg/kg (the infusion was completed in 10 minutes) and then the infusion was performed at the rate of 0.4 μg·kg -1·h -1 until 30 minutes before the end of the operation. The control group was injected with the same dose of 0.9% sodium chloride injection. The radial artery blood and the subclavian venous blood was collected from the two groups at four time points of double lung ventilation for 15 minutes (T 0), 30 minutes (T 1) and 1 hour (T 2) after one-lung ventilation and 30 minutes (T 3) after the restoration of bipulmonary ventilation. The blood gas was analyzed, and Qs/Qt was calculated. The blood samples from subclavian vein were collected, and the serum levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and Claudin-4 were measured by enzyme-linked immunosorbent assay. Results:The Qs/Qt in the control group at T 0, T 1, T 2 and T 3 were (13.6±3.6)%, (36.1±2.9)%, (31.8±2.4)%, and (15.3±3.2)%, the difference was statistically significant, ( F = 397.273, P < 0.01), and the Qs/Qt in the observation group were (12.5±1.8)%, (27.4±3.0)%, (27.7±4.2)%, and (13.9±3.4)%, the difference was statistically significant, ( F = 205.124, P < 0.01); the Qs/Qt in the observation group at T 1 and T 2 were significantly lower than those in the control group ( t values were 178.011 and 23.791, both P < 0.05). The concentrations of TNF-α in the control group at T 0, T 1, T 2 and T 3 were (12.4±2.4) pg/ml, (20.5±3.0) pg/ml, (24.8±4.1) pg/ml, and (34.3±8.0) pg/ml, the difference was statistically significant, ( F = 109.749, P < 0.01), and the concentrations of TNF-α in the observation group were (11.4±3.0) pg/ml, (17.6±2.8) pg/ml, (17.4±3.2) pg/ml, and (26.2±5.0) pg/ml, the difference was statistically significant, ( F = 87.653, P < 0.01); the concentrations of TNF-α in the observation group at T 1, T 2 and T 3 were significantly lower than those in the control group ( t values were 10.471, 44.730 and 24.132, all P < 0.05). The concentrations of IL-6 in the control group at T 0, T 1, T 2 and T 3 were (18.4±4.0) pg/ml, (28.5±5.4) pg/ml, (40.1±6.0) pg/ml, and (43.1±6.0) pg/ml, the difference was statistically significant, ( F = 200.151, P < 0.01), and the concentrations of IL-6 in the observation group were (17.7±4.8) pg/ml, (21.9±3.9) pg/ml, (24.8±4.6) pg/ml, and (24.0±3.8) pg/ml ( F = 14.655, P < 0.01); the concentrations of IL-6 in the observation group at T 1, T 2 and T 3 were significantly lower than those in the control group ( t values were 38.983, 120.110 and 594.878, all P < 0.01). The concentrations of Claudin-4 in the control group at T 0, T 1, T 2 and T 3 were (5.9±0.8) ng/ml, (13.6±1.8) ng/ml, (14.7±4.5) ng/ml, and (16.8±2.5) ng/ml, the difference was statistically significant, ( F = 89.332, P < 0.01), the concentrations of Claudin-4 in the observation group were (5.5±0.7) ng/ml, (16.8±1.8) ng/ml, (18.0±4.8) ng/ml, and (21.2±4.4) ng/ml, the difference was statistically significant, ( F = 120.367, P < 0.01), the concentrations of Claudin-4 in the observation group at T 1, T 2 and T 3 were significantly higher than those in the control group ( t values were 54.619, 7.112 and 18.766, all P < 0.05). Conclusion:Dex can improve the intrapulmonary shunt to some extent, inhibit the inflammatory response during the operation, and increase the level of Claudin-4, which plays an active role in perioperative lung protection.
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Aim To investigate the effects of 17β-es-tradiol on the apoptosis induced by ketamine in primary cultured cortical neurons. Methods Primary cultured cortical neurons were treated with different concentra-tions of ketamine or 17β-estradiol respectively. 24 hours after various treatments, neuron viability was measured by MTT assay. The structure of neurons was analyzed using microscope. Apoptotic neurons were de-termined by the TUNEL assay. The level of pAkt ex-pression was analyzed by Western blot. ResultsCompared with the control group, ketamine decreased neuron viability in a dose-dependent manner. Com-pared with ketamine group, 17β-estradiol increased neuron viability in a dose-dependent manner. Lack of three-dimensional sense,faded color,uncleared outline were observed, and fractured neuron axons or neurons death were also observed in neurons treated by 100μmol · L-1 ketamine. 100 μmol · L-1 ketamine in-creased the number of apoptotic neurons and decreased the expression of pAkt. 0.1 μmol · L-1 17β-estradiol decreased the number of apoptotic neurons and in-creased the expression of pAkt. LY294002 inhibited the protective effects of 17β-estradiol, the number of apoptotic neurons increased, and the level of pAkt de-creased significantly. Conclusion 17β-estradiol ex-erts the neuroprotective effects against ketamine-in-duced neuroapoptosis by activating the PI3 K/Akt sig-naling pathway.
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Objective To investigate the changes in the expression of mitochondrial transcription factor A (mtTFA) during one-lung ventilation (OLV)-induced lung injury in rabbits.Methods Sixty healthy male New Zealand white rabbits,weighing 2.5-3.0 kg,were randomized into 2 groups (n =8 each):two-lung ventilation (TLV) group and OLV group.The animals were anesthetized with iv 3％ pentobarbital sodium 30 mg/kg and tracheostomized.A self-made double lumen catheter was then intubated.Bilateral lungs were ventilated for 3 h in group TLN.In group OLV the left lung was ventilated for 2 h followed by 1 h TLV.Arterial blood samples were taken for blood gas analysis immediately after the beginning of ventilation,at 1 and 2 h of ventilation,and immediately after the end of ventilation.The oxygenation index was calculated.The animals were sacrificed after the end of ventilation and the apex of the left lung was removed and then cut and stained with HE for microscopic examination.The pathological changes of the lung were scored.The expression of mtTFA in lung tissues was measured by Western blot.Results Oxygenation index was significantly decreased,lung injury score was increased,the expression of mtTFA was down-regulated in group OLV compared with group TLV (P ＜ 0.05).The pathological changes of the lung were aggravated in group OLV.Conclusion OLV induces lung injury by down-regulation of mtTFA expression in rabbit lung tissues.
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Objective To investigate the effects of different doses of dexmedetomidine on the minimum alveolar concentration (MAC) of sevoflurane required to inhibit the body movement evoked by skin incision.Methods ASA Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,with body mass index of 21-27 kg/m2,undegoing elective lower abdominal surgery under general anesthesia,were randomly divided into 4 groups:control group (group C) and different doses of dexmedetomidine groups (groups D1,D2 and D3 ).Dexmedetomidine 0.2,0.4 and 0.6 μg/kg in 15 ml of normal saline was infused over 30 min before induction of anesthesia in groups D1,D2 and D3 respectively.While 15 ml of normal saline was given instead in group C.Anesthesia was induced with inhalation of 8％ sevoflurane.The patients were mechanically ventilated after tracheal intubation.Anesthesia was maintained with inhalation of sevoflurane.The initial end-tidal concentration of sevoflurane was set at 3.0％,3.0％,2.5％,2.0％ in groups C,D1,D2 and D3 respectively.The ratio between the two successive concentrations was 0.9.Skin incision was made after 15 min of equilibratiton.At least 7 independent crossover pairs were observed in each group.The MAC of sevoflurane was the mean of the end-tidal concentration of sevoflurane of each crossover pair,and 95 ％ confidence interval (CI) was calculated.Results In groups C,D1,D2 and D3,18,20,20 and 22 patients were enrolled respectively.The MAC (95 ％ CI) of sevoflurane was 2.5 ％ (2.3 ％-2.8 ％ ),1.5 ％ ( 1.3 ％-1.7％),1.3％ (1.0％-1.6％) and 1.1％ (0.7％-1.5％) in groupsC,D1,D2 and D3 respectively.The MAC of sevoflurane was significantly lower in groups D1,D2,D3 than in group C,and in groups D2 and D3 than in group D1 ( P ＜ 0.05).There was no significant difference in the MAC of sevoflurane between groups D2 and D3 ( P ＞0.05).Conclusion Dexmedetomidine 0.2,0.4,0.6 μg/kg can significantly decrease the MAC of sevoflurane required to inhibit the body movement evoked by skin incision in a dose-dependent manner.