ABSTRACT
Objective To evaluate the effect of the combination of dexmedetomidine and sufentanil on monitoring anesthesia care during burr-hole surgery for patients with chronic subdural hematoma. Methods 96 pa-tients underwent burr-hole surgery for chronic subdural hematoma with MAC were randomly divided into two groups:Group D and Group DS (n=48 in each group). Local anesthetic block was started at least 10 min after DEX and sufentanil infusion. Ramsay sedation scale of the two groups was maintained to 3. Anesthesia onset time, hemo-dynamics, the amount of rescue midazolam or fentanyl, the time to first dose of rescue midazolam or fentanyl, the to-tal number of intraoperative patient movements, postoperative recovery time, patient and surgeon satisfaction scores, and the adverse events were recorded. Results Compared with group D, anesthesia onset time was significantly less in group DS (13.68 ± 3.13 vs. 11.82 ± 2.43 min, P=0.002). More patients in group D required rescue midazol-am to achieve RSS=3 compared with group DS (31.25%15/48 vs. 12.50%6/48, P=0.023). Compared with group D, significantly fewer patients in group DS required rescue fentanyl to relieve pain (10.42%5/48 vs. 27.08%13/48, P = 0.036). Additionally, the total dose of rescue fentanyl in group DS was significantly higher (89.48 ± 23.27 vs. 125.28 ± 33.52μg, P=0.000), and the time to first dose of rescue fentanyl was longer than group D(18.34 ± 4.45 vs. 14.34 ± 3.63 min, P=0.000). The total number of patient movements during the burr-hole surgery was higher in group D than group DS (35.42%17/48 vs. 16.67%8/48, P=0.036). The time to recovery for discharge from the PA-CU (time to an Aldrete score ≥ 9) was significantly shorter in group DS compared with group D (17.54 ± 5.92 vs. 12.57 ± 5.28 min, P=0.000). Results from the patient and surgeon satisfaction scores showed significant differenc-es favoring group DS (P<0.05). More patients in group D showed higher levels of the overall incidence of bradycar-dia (37.50% 18/48 vs. 18.75% 9/48, P = 0.041) and hypotension(37.50%18/48 vs. 14.58%79/48, P=0.011)com-pared with group DS. Conclusions Compared with DEX alone, DEX-sufentanil associated with fewer number of in-traoperative patient movements, less amount of rescue scheme, could be safely and efficiently used for MAC during burr-hole surgery for patients with chronic subdural hematoma.
ABSTRACT
Objective To explore the relationship between the serum anticardiolipin antibody (ACA),vascular endothelial grow factor (VEGF) concentration and cognitive impairment in patients with ischemic stroke.Methods Totally 128 cases with acute ischemic stroke were admmitted in stroke unit ward of our hospital during June 2014 to December 2014.According to the score of Montreal cognitive assessnent (MoCA),128 patients with ischemic stroke were divided into groups A (53 cases with cognitive impairment) and group B (75 cases without cognitive impairment).The concentrations of serum ACA,VEGF were quantitatively determinated by ELISA.The differences of serum ACA,VEGF concentrations were compared between the two groups.Results Compared with normal cognitive function group,the cognitive impairment patients had significantly higher ACA concentration ((0.86±0.16) mg/L vs (0.52±0.08) mg/L,P＜0.01),and lower VEGF concentration ((197.60±7.48) pg/ml vs (205.80±8.52) pg/ml,P＜0.05).Logistic regression revealed that ACA and VEGF were independent effect factors for cognitive impairment (ACA:B =2.841,OR =0.33,95 ％ CI =0.118-0.926,P=0.025.V EGF:B =-1.674,OR =4.99,95％ CI =1.688-4.741,P=0.034).Conclusion ACA and VEGF may play an important role in cognitive impairment after ischemic stroke.
ABSTRACT
Objective To analyze the operation methodes and effects of cataract complicated with acute angle-closure glaucoma . Methods Phacoemusification combined with intraocular lens implantation and phacoemusification ,intraocular lens implantation combined with trabeculectomy were choosed to be performed on 40 eyes(38 patients) which were diagnosed with cataract compli-cated combined with acute angle-closure glaucoma ,according to the intraocular pressure and the opening level of the angle of anteri-or chamber of patients .All cases were been followed-up from 6-24 months after the operation .Results For postoperative correc-ted vision ,20 eyes were greater than 0 .6 ,17 eyes were between 0 .3-0 .6 and 3 eyes were less than 0 .3;For postoerative intraocu-lar pressure ,38 eyes were in normal range ,2 eyes were in normal range with drug control .Conclusion Phacoemusification combined with intraocular lens implantation prefer to be choosed for cataract complicated with acute angle-closure glaucoma with opening lev-el of the angle of anterior chamber greater than the half .Phacoemusification ,intraocular lens implantation combined with trabeculec-tomy prefer to be choosed for cataract complicated with acute angle-closure glaucoma with opening level of the angle of anterior chamber less than the half .Choosing proper operation methodes for the patients who were diagnosed with cataract complicated with acute angle-closure glaucoma ,according to patients′situation ,benefit to improve patients′vision and control intraocular pressure .