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Objective To compare the scalp nerve block versus local infiltration of incision for in-tracranial aneurysm clipping under general anesthesia. Methods Fifty-seven American Society of Anesthe-siologists physical statusⅠorⅡpatients of both sexes, aged 18-64 yr, scheduled for elective intracranial aneurysm clipping under general anesthesia, were divided into 3 groups ( n=19 each) using a random num-ber table method:control group ( group C) , scalp nerve block group ( group S) and local infiltration of in-cision group ( group I) . Anesthesia was induced by intravenously injecting propofol, sufentanil and cisatra-curium. Bilateral supraorbital nerve (2 ml), supratrochlear nerve (2 ml), zygomaticotemporal nerve (2 ml), auriculotemporal nerve (2 ml), greater occipital nerve (3 ml), lesser occipital nerve (3 ml) and the third occipital nerve ( 1 ml) blocks were performed with 0. 75％ ropivacaine after tracheal intubation in group B. Local infiltration of incision was carried out with 0. 75％ ropivacaine 15 ml in group I. Anesthesia was maintained by intravenously infusing propofol and remifentanil to maintain bispectral index value at 40-60. The fluctuation range of mean arterial pressure and heart rate was not more than 20％ of the baseline, and vasoactive agents were administered when necessary. Oxycodone 0. 1 mg∕kg was intravenously injected at 30 min before the end of surgery to perform preemptive analgesia. When visual analogue scale score>3 with-in 48 h after surgery, oxycodone 2 mg was intravenously injected as rescue analgesic, and administration was repeated when necessary ( at an interval>15 min) . The intraoperative consumption of propofol, remifen-tanil and vasoactive agents was recorded. Arterial blood samples were collected before anesthesia induction and at 3, 12, 24, 48 and 72 h after surgery for determination of serum interleukin-6 ( IL-6) , IL-10 and C-reactive protein ( CRP ) concentrations by enzyme-linked immunosorbent assay. The time of the first postoperative requirement for oxycodone and consumption of oxycodone within 48 h after surgery were recor-ded. The development of adverse reactions such as postoperative fever, nausea and vomiting, dizziness, respiratory depression, pruritus, local anesthetic intoxication, subcutaneous hematoma, and scalp infec-tion was also recorded. Results Compared with group C, the intraoperative consumption of remifentanil and requirement for nicardipine were significantly decreased, the concentration of serum IL-6 was decreased at 3 h after surgery, the concentration of serum CRP was decreased at 12 h after surgery, the concentration of serum IL-10 was increased at 12 and 24 h after surgery, the time of the first postoperative requirement for rescue analgesia was prolonged, the consumption of oxycodone was reduced, and the incidence of nausea and vomiting was decreased in group B, and the intraoperative consumption of remifentanil was significantly reduced in group I (P<0. 05). Compared with group I, the intraoperative consumption of remifentanil was significantly reduced, the requirement for nicardipine was decreased, the concentration of serum IL-6 was decreased at 3 h after surger-y, the concentration of serum CRP was decreased at 12 h after surgery, the concentration of serum IL-10 was in-creased at 12 and 24 h after surgery, the time of the first postoperative requirement for rescue analgesia was pro-longed, the consumption of oxycodone was reduced, and the incidence of nausea and vomiting was decreased in group B (P<0. 05). Conclusion Compared with local infiltration of incision, scalp nerve block is helpful in carrying out anesthetic model of low-consumption opioids and in maintaining intraoperative hemodynamics stable and is more helpful in inhibiting perioperative inflammatory and pain responses when used for the patients under-going intracranial aneurysm clipping under general anesthesia.
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Objective To investigate the relationship between levels of mean platelet volume (MPV) and carotid atherosclerosis in patients with acute cerebral infarction.Methods A total of 99 patients were chosen for the observation group.Another 30 healthy people were for control group.The level of mean platelet volume in all subjects was detected bby enzymatic cycling assay and the carotid intimamedia thickness(IMT) of all patients was checked using color Doppler echocardiography.According to IMT degree,the patients in observation group were divided into IMT nomal group,IMT mild stenosis group and IMT moderate,severe stenosis group.According to the size of area of skull CT or MRI brain infarction,groups can be divided into a small area of cerebral infarction group,middle area of cerebral infarction group,the large area cerebral infarction group.The level of mean platelet volume between observation group and control group as well each subgroup of observation group was compared,and its correlation with IMT was also analyzed.Results The level of mean platelet volume in observation group was higher than in healthy control group (P ＜ 0.05).Cerebral infarction patients with different degree of carotid stenosis group of peripheral blood MPV comparative difference was statistically significant(P =0.000).Pearson correlation analysis displayed that the level of mean platelet volume was positively correlated with IMT(r =0.331,P =0.000),and positively correlated with Cerebral infarction volume.The optimal cut-off value of MPV was 11.45,with a sensitivity of 41.4％ and a specificity of 86.7％ for predicting ischemic stroke.Conclusion Increased MPV is closely associated with carotid artery stenosis and its degree in cerebral infarction patients.
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Objective To observe and analyze the characteristics and trends of the liver and gallbladder damage caused by long-term use of anti schizophrenia drugs through the observation of the abdominal ultrasound. Methods From August 2013 to April 2016, the patients diagnosed as schizophrenia and met criterions were enrolled in our hospital. The observation group I included patients taking anti schizophrenia drug for 3 to 5 years. The observation group II included patients taking anti schizophrenia drug more than 5 years. In addition, the control group recruited healthy person who were over 30 years old and had never taken anti-schizophrenia drug. The change in ultrasound of liver and gallbladder were recorded and analyzed. Results The rate of cholecystolithiasis, chronic cholecystitis in observation group II were higher than those in the other two groups (P<0.05), while there had no significant difference between observation group I and control group. The rate of pure fatty liver in observation group II were higher than those incontrol group (P<0.05), while there had no significant difference between observation group I and observation group II, and there had no significant difference between observation group I and control group. There had no significant difference among three groups regarding as the rate of hepatic cyst and hepatic cavernous hemangioma. Conclusion Long-term use of anti-schizophrenia drugs could increase the risk ofcholecystolithiasis, chronic cholecystitis and pure fatty liver .
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Objective To evaluate the efficacy of nalmefene in preventing sufentanil-induced cough during induction of general anesthesia.Methods One hundred American Society of Anesthesiologists physical status Ⅰ orⅡ patients of both sexes,aged 21-62 yr,weighing 45-82 kg,undergoing elective laparoscopic cholecystectomy under general anesthesia,were divided into 2 groups (n =50 each) using a random number table:nalmefene group (group N) and control group (group C).Nalmefene 0.25 μg/kg was injected intravenously at 2 min before anesthesia induction in group N,and the equal volume of normal saline was given instead in group C.Anesthesia was induced with target-controlled infusion of propofol,and sufentanil 0.5 μg/kg was injected over 5 s when bispectral index value reached 55.The number of patients who developed cough within 2 min after sufentanil injection and severity of cough were observed.Other iv anesthetics were given for induction after the end of observation.Results The incidence of sufentanil-induced cough was 8％ in group N and 48％ in group C.Compared with group C,the incidence and severity of cough were significantly decreased in group N (P＜0.05).Conclusion Nalmefene 0.25 μg/kg injected at 2 min before induction of anesthesia can effectively decrease the development of sufentanil-induced cough during induction of general anesthesia.