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Objective:Analyze the perioperative data of children undergoing cardiopulmonary bypass(CPB) for congenital heart disease under the management of ultra-fast track anesthesia(UFTA), the factors of CPB are discussed.Methods:1 034 children who underwent CPB from May 2018 to August 2019 were analyzed retrospectively. According to the success of anesthesia, they were divided into two groups: UFTA group and UFTA failure group. Propensity score matching was used to screen the children with preoperative baseline data matching. Finally 346 cases in each group. The possible CPB factors of the two groups were analyzed by single factor analysis, and the statistically significant factors were analyzed by logistic regression analysis. Results:Univariate analysis showed that the CPB and aortic occlusion time, the lowest temperature and lowest hematocrit in CPB, the dosage of crystalloid and suspended erythrocytes, the second or more times of CPB, and the blood lactate after CPB were the factors influencing the ultra-fast track anesthesia. Logistic regression analysis showed that the time of CPB and aortic occlusion, the value of blood lactate, the dosage of suspended erythrocytes, and the second or more times of CPB were the independent influencing factors of ultra-fast track anesthesia. In the UFTA failure group, the postoperative hospitalization time, the length of stay in the ICU and the hospitalization cost were all higher than those in the ultra-fast track group. Conclusion:CPB time, aortic occlusion time, blood lactate after CPB, the dosage of suspended erythrocytes, secondary or multiple CPB were independent risk factors for UFTA.UFTA is beneficial to shorten the postoperative hospital stay, the ICU stay and the cost of hospitalization.
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Objective@#To evaluate the severity of median nerve damage in patients with carpal tunnel syndrome (CTS) , and to analyze its relationship with body mass index (BMI) and wrist joint index.@*Methods@#From May 2016 to January 2017, 23 patients with mild CTS (mild group) and 35 patients with moderate to severe CTS (moderate to severe group) were enrolled in this study. And 22 healthy volunteers matched for sex and age were selected as control group. The neuroelectrophysiological monitor was used to measure the median nerve movement and sensory nerve conduction in the subjects. The BMI and wrist joint index were calculated. The relationship of neuroelectrophysiological parameters with BMI and wrist joint index was analyzed in the CTS patients.@*Results@#Compared with the control group, the mild group and the moderate to severe group had significantly higher wrist joint index, significantly longer distal motor latency (DML) of the median nerve, and significantly lower sensory nerve conduction velocity (SNCV) and sensory nerve action potential (SNAP) amplitude of the finger 1-wrist and finger 3-wrist (P<0.01) ; the moderate to severe group had significantly higher BMI and significantly lower composite muscle action potential (CMAP) amplitude (P<0.01) . The wrist joint index and BMI were positively correlated with DML of the median nerve and negatively correlated with SCV and SNAP amplitude of the finger 1-wrist and finger 3-wrist (all P<0.05) . The patients with a wrist joint index of >0.73 had a significantly higher risk of CTS than those with a wrist joint index of <0.73 (odd ratio=30.67, 95% confidence interval: 3.79-248.36) .@*Conclusion@#A wrist joint index of >0.73 is an independent risk factor for CTS in manual laborers. CTS should be prevented in the manual laborers with high wrist joint index and BMI.
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Objective To evaluate the relationship of the plasma levels of osteopontin(OPN),lipoprotein (a) [Lp (a)] and apolipoproteinA/apolipoproteinB (ApoB/ApoA1) ratio with atherosclerosis.Methods 120 elderly patients with atherosclerosis (observation group) and another 120 healthy elderly subjects (control group) from Health Check Department in Tianjin Third Center Hospital were enrolled from Mar.2014 to Nov.2015.The levels of plasma OPN,Lp(a) and ApoB / ApoA1 ratio were measured and their relationship with atherosclerosis was analyzed.Results In observation group versus control group,the levels of plasma OPN[(33.2±10.1) μg/L vs.(30.6± 9.1) μg/L],ApoB/ApoA1 ratio[(0.8±0.7) vs.(0.6±0.1)]and Lp(a)[(357.6±66.5) mg/L vs.(120.5±35.7) mg/L] were increased with statistically significant differences (t =8.91,8.43,6.01;P=0.021,0.035,0.041).The concentrations of plasma OPN,ApoB/ApoA1 ratio and Lp (a) were increased along with aggravation of artery lesion,with statistically significant differences (F =8.50,7.38,6.41;P=0.031,0.039,0.037).Conclusions The plasma levels of OPN,Lp(a) and ApoB/ ApoA1 ratio are increased in patients with atherosclerosis and increased along with the lesion aggravation.
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Objective To investigate the relationship between the plasticity of dendritic spines in entorhinal cortical neurons and mechanism of low-dose ketamine-induced reduction of cognitive dysfunction following sevoflurane anesthesia in aged rats.Methods Thirty-six pathogen-free healthy male SpragueDawley rats,aged 18 months,weighing 500-600 g,were divided into 3 groups (n=12 each) using a random number table:control group (group C),sevoflurane anesthesia group (group Sev) and ketamine group (group K).Group C received no treatment.Group Sev inhaled the mixture of air (flow rate 1 L/min) and 3.6％ sevoflurane for 3 h.In group K,ketamine 10 mg/kg was injected intraperitoneally,and 5 min later the mixture of air (flow rate 1 L/min) and 3.6％ sevoflurane was inhaled for 3 h.Open field test and Morris water maze test were performed 3 days after anesthesia.After the behavioral tests,the animals were sacrificed,and their brains were removed and cut into sections for determination of the density of neurons,density of dendritic spines,and expression of postsynaptic density protein-95 (PSD-95) and synaptophysin (SY38) in superficial laminaes (Ⅱ-Ⅲ) of entorhinal cortex using Nissl's staining,Golgi staining and immunohistochemistry,respectively.Results Compared with group C,the time of staying at the central region was significantly shortened,the escape latency was prolonged,the density of dendritic spines was decreased,and the expression of PSD-95 and SY38 was down-regulated in group Sev (P＜0.05).Compared with group Sev,the time of staying at the central region was significantly prolonged,the escape latency was shortened,the density of dendritic spines was increased,and the expression of PSD-95 and SY38 was upregulated in group K (P＜0.05).There were no significant differences in the density of neurons in entorhinal cortex between the three groups (P＞0.05).Conclusion The mechanism by which low-dose ketamine attenuates cognitive dysfunction induced by sevoflurane anesthesia may be related to the enhanced plasticity of dendritic spines in entorhinal cortical neurons of aged rats.
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Objective:To compare the clinical effects of high volume zero-balanced ultraifltration (ZBUF) with different replacement lfuid in infant patients. Methods: A total of 40 infant patients who received aortic coarctation with deep hypothermic circulatory arrest operation in our hospital from 2012-11 to 2014-02 were summarized. The patients were randomized into 2 groups, Group A, the patients had ZBUF with plasmalyte A, n=21 and Group B, the patients had ZBUF with modiifed replacement lfuid n=19. All patients received ZBUF (15-20) ml/kg during re-warming period until the temperature reached 34°C at rectum. Blood gas analysis were conducted at 4 time points as T1 (before CPB), T2 (open ascending aorta and 5 min after calcium perfusion), T3 (ifnishing ZBUF) and T4 (end of CPB). The intra-operative CPB time and the post-operative recovery with the complication were recorded in all patients. Results: For blood gas analysis, the calcium concentration was higher in Group B than that in Group A at T3 time point, P0.05. The other indexes were similar between 2 groups, P>0.05 and the post-operative recovery was similar between 2 groups, P>0.05. Conclusion: ZBUF with modiifed replacement lfuid could avoid decreased calcium concentration and acidosis, therefore, provide a relative stable homeostasis in infant patients.
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Objective To determine the minimum alveolar concentration (MAC) of sevoflurane in Chinese neonates.Methods Thirty ASA Ⅰ or Ⅱ neonates,aged ≤ 28 days,with normal body weight,scheduled for elective surgery under general anesthesia,were enrolled in the study.Anesthesia was induced with inhalation of 6.00％ sevoflurane in oxygen.The infants were tracheal intubated and mechanically ventilated.The inhaled concentration of sevoflurane was adjusted to achieve the preset end-tidal concentration and maintained at this level for 20 min.Skin incision was then performed.The concentration of sevoflurane was determined by modified Dixon's up-and-down method.The initial end-tidal concentration of sevofluren was 3.00％.Each time the concentration increased/decreased by 0.25 ％ in the next infant according to the infant's response.Successful skin incision was defined as no body movement during skin incision.The MAC,ED95 and 95 ％ confidence interval of sevoflurane were calculated using logistic regression analysis.Results The MAC and ED95 (95 ％ confidence interval) of sevoflurane required for successful skin incision were 2.82％ (2.66％-2.98％) and 3.39％ (2.89％-3.89％),respectively,in neonates.Conclusion The MAC of sevoflurane is 2.82 ％ in Chinese neonates and lower than the present reference values previously described in foreign reports.
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Objective To evaluate the relationship between extracellular signal-regulated kinase (ERK)and ketamine-induced apoptosis in rat hippocampal neurons.Methods Sprague-Dawley rats at 18 days of gestation were anesthetized.The fetal rats were obtained under the sterile condition and decapitated.The hippocampal neurons were isolated and primarily cultured for 5 days,and were seeded in 6-well plates (2 ml/well) or in 96-well plates (100μl/well) at a density of 5 × 105/ml.The cells were randomly divided into 4 groups (n =18 each):control group (group C),fibroblast growth factor (FGF-2,an ERK agonist) group (group F),ketamine group (group K) and FGF-2 + ketamine group (group FK).The cells were cultured in the plain culture medium in group C.FGF-2 50 ng/ml was added to the culture medium in group F.Ketamine was added to the culture medium in group K.FGF-2 50 ng/ml was added to the culture medium at 20 min before ketamine 100 μmol/L was added in group FK.The phosphorylation of ERK in hippocampal neurons was detected by Western blot at 10 min after treatment.At 24 h after treatment,the neuronal apoptosis was detected by Hoechst33342/PI staining,and the cell survival rate was detected by MTT assay.The apoptosis rate was calculated.Results Compared with group C,the phosphorylation of ERK in hippocampal neurons and the cell survival rate was significantly decreased and the apoptosis rate was increased in K and FK groups (P ＜ 0.05).There was no significant difference in the parameters mentioned above between F and C groups (P ＞ 0.05).The phosphorylation of ERK in hippocampal neurons and the cell survival rat was significantly higher and the apoptosis rate was lower in group FK than in group K (P ＜0.05).Conclusion Ketamine induces apoptosis in rat hippocampal neurons by inhibiting activation of ERK in hippocampal neurons.
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Objective To investigate the effect of perioperative fluid therapy on blood glucose in the neonates undergoing gastrointestinal operation. Methods Sixty-four ASA Ⅰ or Ⅱ neonates undergoing gastrointestinal operation were randomly divided into 4 groups ( n = 16 each). Group Ⅰ received water orally 2 h before operation and iv infusion of acetated Ringer's solution during operation. Group Ⅱ received water orally 2 h before operation and iv infusion of 2% glucose (in normal saline) during operation. Group Ⅲ received 10% glucose 5 ml/kg orally 2 h before operation and iv infusion of acetated Ringer's solution during operation. Group Ⅳ received 10% glucose 5 ml/kg orally 2 h before operation and iv infusion of 2 % glucose (in normal saline) during operation. Blood sam ples were collected from radial artery for determination of blood glucose concentrations at the beginning of fluid therapy (T0), immediately after induction of anesthesia (T1), at the beginning of operation (T2), and at 20,40and 60 min (T3-5) and 2 h after operation ( T6 ). MAP and HR were also recorded simultaneously. The blood lactic acid concentration was determined at T0 . Results There was no significant difference in MAP and HR among the 4 groups. Compared with group Ⅰ , blood glucose concentrations were significantly increased at T4-6 in group Ⅱand Ⅳ, but no significant change was found in blood glucose concentrations at each time point in group Ⅲ. There was no significant difference in blood glucose concentrations between group Ⅱ and Ⅳ. The blood lactic acid concentration was significantly higher in group Ⅲ than in group Ⅰ , and in group Ⅳ than in group Ⅱ . Conclusion Oral 10% glucose 5 ml/kg before operation and iv infusion of 2% glucose (in normal saline) during operation is beneficial for the stabilization of blood glucose levels in neonates undergoing gastrointestinal operation.