ABSTRACT
Objective To investigate the effects of different DO2-directed hemodynamic man-agement on postoperative prognosis of orthotopic liver transplantation (OLT)patients with different degrees of liver function insufficiency.Methods Seventy patients (male 48 cases,female 22 cases, aged 37-66 years,ASA grade Ⅲ or Ⅳ)scheduled non veno-venous bypass OLT were divided into two groups (n = 35 each ).The oxygen delivery (DO2 )maintained respectively between 350 ml·min-1 ·m-2 and 500 ml·min-1 ·m-2 (group control)and more than 500 ml·min-1 ·m-2 (group study).After induction of anesthesia,the left radial artery was cannulated,allowing continu-ous blood pressure monitoring as well as serial blood sampling,then the Swan-Ganz catheter was in-serted via the right internal jugular vein to continuously monitor CI and S-vO2 .After anesthesia induc-tion and before operation (T1 ),10 min before anhepatic phase (T2 ),30 min after onset of anhepatic phase (T3 ),30 min after neohepatic phase (T4 )and the end of surgical procedure (T5 ),the SaO2 , PaO2 ,Hb,CI and S-vO2 were recorded to calculate the DO2 ,VO2 and ERO2 .Postoperatively,ICU and hospital length of stay,quality of life (QOL)and 1-5 year survival rate were recorded.Results In the two groups,CI,DO2 and VO2 declined at T3 to a statistically significant degree in comparison with T1 (P <0.05).CI,DO2 and VO2 in group study significantly higher than those of group control (P <0.05).ERO2 in group study was lower than that of group control significantly (P <0.05).ICU and hospital length of stay were significantly shorten in group study in comparison with group control (P <0.05).Survival rate and QOL in group study tended to be slightly higher than those of group control until the end of study period,but there was no significant difference.Conclusion The DO2-directed hemodynamic management can improve prognosis with enhanced DO2 in OLT patients with different degrees of hepatic insufficiency.It has a positive impact on their outcome of shortening ICU stay and the hospitalization days.
ABSTRACT
Objective To investigate the effect of mild hypothermia preconditioning against ischemia/ reperfusion (I/R) injury of cultured primary cortical rats neurons,and to compare the protective effect of mild hypothermia only and with its combination with drugs.Methods Cortical neurons of neonatal Sprague-Dawley (SD) rat within 24 hours after birth were harvested and cultured in vitro.On the 3rd day,the cells were cultured in a medium containing 2.5 mg/L cytosine arabinoside to inhibit the growth of glial cells and fibroblast.Having cultured for 6 days they were randomly divided into blank control group,glutamate damaged group (cultured with 200 μmol/L glutamate for 0.5 hour after washing),mild hypothermia preconditioning group (cultured under 33.5 ℃ for 24 hours before injury induced by glutamate),mild hypothermia combining with edaravone preconditioning group,and the hypothermia combining with propofol preconditioning group (medium containing 100 μmol/L edaravone and 3 mg/L propofol).They were cultured under 33.5 ℃ for 24 hours before injury induced by glutamate.After 24 hours of culturing in various medium,apoptosis ratio was observed by flow cytometry.Cell surviving rate was determined with methylthiazolete trazolium (MTT),c-fos protein expression was assayed,and morphologic change of cells with hematoxylin-eosin (HE) staining under the microscope,and uhrastructure changes were observed after uranyl acetate and lead citrate staining under transmission electron microscope.Results The apoptosis ratio and c-fos protein in glutamate damaged group were significantly higher than those in blank control group [apoptosis ratio:(9.85 ± 0.76)％ vs.(0.94 ± 0.20)％,c-fos (ng/L):6.96 ± 0.75 vs.1.65 ± 0.59,both P＜0.01],the cell surviving rate was significantly lower than that in blank control group [(0.20 ± 0.02)％ vs.(0.97 ± 0.03)％,P＜0.01].Mild hypothermia preconditioning reversed surviving rate,apoptosis ratio and c-fos protein,and the effect of hypothermia combining with propofol preconditioning was obviously better [cell surviving rate:(0.80 ± 0.04)％ vs.(0.20 ± 0.02)％,apoptosis ratio:(2.26 ± 0.54)％ vs.(9.85 ± 0.76)％,c-fos (ng/L):2.98 ± 0.46 vs.6.96 ± 0.75,all P＜0.01].The morphology of cortical neurons in blank control group was normal.Most of the cells in glutamate damaged group showed bluish black cytoplasm with pyknic nuclei,with crimpled axons and of them were fractured,and cell number was obviously decreased.In each pre-conditional groups,decrease in cell number was unconspicuous,and only a few cells showed apoptosis.Under transmission electron microscope,it was found that cell membrane,mitochondria and rough endoplasmic reticulum were intact in blank control group,but with reduction in organelles,severely swollen mitochondria,even with formation of vacuole or pyknosis,serious dilation of rough endoplasmic reticulum,with loss of cristac with loss of vacuoles or pyknosis,and marked dilatation of intemal reticular endoplasm,and loss of cristac with vacuolation and chromatin were observed under electron microscope in glutamate damaged group.Compared with the glutamate damaged group,these pathologic changes were markedly alleviated in protected groups.Conclusions Mild hypothermia preconditioning can inhibit glutamate-induced injury to cortical neurons.The protective effect of mild hypothermia combined with propofol is better.