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Objective:To identify the risk factors for postoperative cognitive dysfunction (POCD) and develop the prediction model in elderly patients undergoing lumbar surgery under general anesthesia.Methods:The elderly patients undergoing elective lumbar surgery under general anesthesia in our hospital from July 2021 to July 2022 were enrolled. Cognitive function was assessed at 7 days after surgery using Mini-Mental State Examination and Montreal Cognitive Assessment. When the decrease in both scales≥ 1 standard deviation, the patients were considered as having POCD. The patients were divided into POCD group and non-POCD group according to whether POCD developed. The propensity score matching was used to balance the confounding bias between two groups. The multivariate logistic regression analysis was used to identify the risk factors for POCD. The prediction model was constructed, and a nomogram was drawn for visualization of the model. The receiver operating characteristic curve, calibration plot and decision curve analysis (DCA) were drawn to evaluate the differentiation, consistency and clinical validity of the model, respectively.Results:A total of 159 patients were enrolled in this study, and the incidence of POCD was 31.4%. There were statistically significant differences in the ratio of intraoperative blood transfusion, cumulative time of hypotension, total infusion volume and operation time between two groups ( n=32 each) after propensity score matching ( P<0.05). The results of multivariate logistic regression showed that age, educational levels, diabetes mellitus, previous two or more operations under general anesthesia, APTT and cumulative time of hypotension were independent risk factors for POCD in elderly patients undergoing lumbar surgery under general anesthesia ( P<0.05). A model was developed based on the risk factors mentioned above: LogitP=-15.878+ 0.263 × Age (years) - 0.122 × Educational Level (years)+ 1.601 × Diabetes Mellitus+ 1.468 × History of General Anesthesia for 2 or more times+ 0.608 × Cumulative Time of Hypotension(min) - 0.140 × APTT (s). The area under the receiver operating characteristic curve was 0.930 (95% CI 0.887-0.973), the sensitivity was 0.920, specificity was 0.798 and Youden index was 0.718. After visualizing the model via nomogram, the model was verified by Hosmer-Lemeshow test, P=0.403, C index was 0.930, and corrected C index was 0.914. Conclusions:Age, educational levels, diabetes mellitus, previous multiple operations under general anesthesia, APTT and cumulative time of hypotension are independent risk factors for POCD in elderly patients undergoing lumbar surgery under general anesthesia, and the established risk prediction model can effectively predict the occurrence of POCD in elderly patients undergoing lumbar surgery under general anesthesia.
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Objective:To determine the median effective dose (ED 50) and the 95% effective dose (ED 95) of remifentanil inhibiting responses to endotracheal intubation without neuromuscular relaxant when combined with dexmedetomidine in patients undergoing thyroid surgery. Methods:American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of either sex, aged 18-64 yr, with body mass index of 18-28 kg/m 2, scheduled for elective thyroid surgery under intraoperative neuromonitoring, were enrolled in this study.Dexmedetomidine was intravenously injected in a loading dose of 0.8 μg/kg at 10 min before anesthesia induction.Anesthesia was induced by intravenously injecting midazolam 0.1 mg/kg, etomidate 0.4 mg/kg and the preset dose of remifentanil.The dose of remifentanil was determined using up-and-down sequential method.The initial dose was set at 3.7 μg/kg.The dose of remifentanil in the next case was determined according to whether responses to endotracheal intubation occurred, and the ratio between the two successive doses was 1.1.The ED 50, ED 95 and 95% confidence interval (CI) were calculated by Probit analysis. Results:when combined with dexmedetomidine for anesthesia induction, the ED 50 (95% CI) of remifentanil inhibiting responses to endotracheal intubation without neuromuscular relaxant was 3.39 (3.29-3.50) μg/kg, and the ED 95 (95% CI) was 3.52 (3.48-3.64) μg/kg. Conclusion:when combined with dexmedetomidine, the ED 50 of remifentanil inhibiting responses to endotracheal intubation without neuromuscular relaxant is 3.39 μg/kg, and the ED 95 is 3.52 μg/kg.
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Objective:To evaluate the effects of CD34 + cell transplantation on radiation-induced brain injury (RIBI) and the relationship with the activity of astrocytes in rats. Methods:Healthy adult male Sprague-Dawley rats, weighing 210-230 g, were divided into 3 groups ( n=36 each) using a random number table method: control group (C group), RIBI group, and CD34 + group.RIBI model was established by computed tomography (CT) scanning in anesthetized rats.Another 6 rats were selected, and CD34 + cells were eluted by flow cytometry and labeled with BrdU.CD34 + cells were transplanted at day 7 after establishing the model.Brain tissues were obtained at 7, 14 and 28 days after establishing the model in C and RIBI groups and at 14 and 28 days after establishing the model in CD34 + group for determination of Evans blue (EB) extravasation ratio and expression of GFAP (by immuno-histochemistry). Results:Compared with group C, the EB extravasation ratio was significantly increased after establishing the model, and the expression of GFAP was up-regulated in group RIBI ( P<0.05), and no significant change was found in EB extravasation ratio after establishing the model in group CD34 + ( P>0.05). Compared with group RIBI, the EB extravasation ratio was significantly decreased after establishing the model, and the expression of GFAP was down-regulated in group CD34 + ( P<0.05). Conclusion:CD34 + cell transplantation can reduce RIBI, and the mechanism may be related to inhibiting the activity of astrocytes in rats.
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Objective To evaluate the effect of dexmedetomidine on postoperative cognitive function in the patients with mild hyperbilirubinemia caused by choledocholithiasis.Methods One hundred and twenty patients of both sexes with mild hyperbilirubinemia (serum total bilirubin levels 21-170μ mol/L) caused by choledocholithiasis,aged 51-63 yr,with body mass index of 20-28 kg/m2,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,with preoperative Mini-Mental State Examination (MMSE) scores ≥ 20,scheduled for elective cholecystectomy and choledocholithotomy,were divided into 3 groups (n =40 each) using a random number table method:control group (C group) and dexmedetomindine 0.4 μg · kg-1 · h-1 group (D1 group) and dexmedetomindine 0.6 μg · kg1 · h-1 group (D2 group).After induction of anesthesia,dexmedetomidine was intravenously infused for 10 min in a loading dose of 0.5 μg/kg,followed by an infusion of 0.4 and 0.6 μg · kg-1 · h-1 until the end of operation in D1 and D2 groups,respectively.The equal volume of normal saline was given instead in group C.with preoperative scores ≥ 20,MMSE and Montreal Cognitive Assessment (MoCA) were used to assess the cognitive function at 1 day before operation (T0) and 1,3,5 and 7 days after operation (T1-4).The occurrence of cognitive dysfunction within 7 days after operation was recorded.Venous blood samples were collected at the time points mentioned above,and the plasma concentrations of β-amyloid (Aβ) 42 were determined by enzymelinked immunosorbent assay.Results Compared with group C,MoCA scores were significantly increased at T1 in group D1,and MMSE scores at T1 and MoCA scores at T1 and T2 were significantly increased,and the plasma concentrations of Aβ42 were decreased at T2-4 in group D2,and the incidence of cognitive dysfunction was significantly decreased in D1 and D2 groups (P＜0.05).Compared with group D1,MoCA scores were significantly increased at T1,and the plasma concentrations of Aβ42 were decreased at T2-4 in group D2 (P＜0.05).Conclusion Dexmedetomidine can improve postoperative cognitive function,and intravenous infusion at a rate of 0.6 μg · kg-1 · h-1 provides better efficacy for the patients with mild hyperbilirubinemia caused by choledocholithiasis.
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Objective@#To evaluate the effect of dexmedetomidine on postoperative cognitive function in the patients with mild hyperbilirubinemia caused by choledocholithiasis.@*Methods@#One hundred and twenty patients of both sexes with mild hyperbilirubinemia (serum total bilirubin levels 21-170 μmol/L) caused by choledocholithiasis, aged 51-63 yr, with body mass index of 20-28 kg/m2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with preoperative Mini-Mental State Examination (MMSE) scores≥20, scheduled for elective cholecystectomy and choledocholithotomy, were divided into 3 groups (n=40 each) using a random number table method: control group (C group) and dexmedetomindine 0.4 μg·kg-1·h-1 group (D1 group) and dexmedetomindine 0.6 μg·kg-1·h-1 group (D2 group). After induction of anesthesia, dexmedetomidine was intravenously infused for 10 min in a loading dose of 0.5 μg/kg, followed by an infusion of 0.4 and 0.6 μg·kg-1·h-1 until the end of operation in D1 and D2 groups, respectively.The equal volume of normal saline was given instead in group C. with preoperative scores≥20, MMSE and Montreal Cognitive Assessment (MoCA) were used to assess the cognitive function at 1 day before operation (T0) and 1, 3, 5 and 7 days after operation (T1-4). The occurrence of cognitive dysfunction within 7 days after operation was recorded.Venous blood samples were collected at the time points mentioned above, and the plasma concentrations of β-amyloid (Aβ) 42 were determined by enzyme-linked immunosorbent assay.@*Results@#Compared with group C, MoCA scores were significantly increased at T1 in group D1, and MMSE scores at T1 and MoCA scores at T1 and T2 were significantly increased, and the plasma concentrations of Aβ42 were decreased at T2-4 in group D2, and the incidence of cognitive dysfunction was significantly decreased in D1 and D2 groups (P<0.05). Compared with group D1, MoCA scores were significantly increased at T1, and the plasma concentrations of Aβ42 were decreased at T2-4 in group D2 (P<0.05).@*Conclusion@#Dexmedetomidine can improve postoperative cognitive function, and intravenous infusion at a rate of 0.6 μg·kg-1 · h-1 provides better efficacy for the patients with mild hyperbilirubinemia caused by choledocholithiasis.
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Objective To compare the efficacy of different doses of intrathecal administration of morphine and fentanyl before operation for postoperative analgesia in patients undergoing abdominal hysterectomy.Methods Forty ASA Ⅰ or Ⅱ patients,aged 19-60 yr,undergoing abdominal hysterectomy under combined spinal-epidural anesthesia,were randomly divided into Ⅰ and Ⅱ groups (n =20 each).Morphine 0.5 mg+ fentanyl 15 μg and morphine 0.2 mg+ fentanyl 25 μg were injected intrathecally in groups Ⅰ and Ⅱ respectively.VAS score ≤2was considered as effective analgesia.When VAS score≥ 3,morphine 0.05 mg/kg was given intravenously as rescue analgesic.The incidence of nausea and vomiting and pruritus was recorded after operation.Results Compared with group Ⅰ,no significant change was found in the percentage of patients requiring rescue morphine after operation (P ＞ 0.05),the incidence of nausea and vomiting and pruritus was significantly decreased after operation and the time when the patients passed the flatus was significantly shortened after operation in group Ⅱ (P ＜ 0.05).Conclusion Intrathecal administration of morphine 0.2 mg and fentanyl 25.μg before operation is safer and more helpful to recovery of gastrointestinal function than intrathecal administration of morphine 0.5 mg and fentanyl 15 μg before operation if they can provide the equivalent postoperative analgesia.
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Objective To compare the severity of hepatic ischemidreperfusion(I/R)injury caused by partial hepatectomy performed under propofol-remifentanil and isoflurane-fentanyl anesthesia.Methods Thirty ASA Ⅰ or Ⅱ patients aged 41-64 yr weighing 58-86 kg undergoing elective partial hepatectomy were randomly divided into 2 groups(n=15 each):propefol-remifentanil group(PR)and isoflurane-fentanyl group(IF).Anesthesia was induced with midazolam,fentanyl,etomidate and vecuronium.The patients were mechanically ventilated after tracheal intubation.Anesthesia was maintained with TCI of propofol(Cp=3.5μg/ml)and remifentanil(Cp=4.2 ng/ml)in group PR or 1.5%-2.5% isoflurane and intermittent iv boluses of fentanyl in group IF.Muscle relaxation was maintained with intermittent iv boluses of vecuronium in both groups.Blood samples were taken before occlusion of hepatic portal(T1)immediately(T2)and 30,60 min after release of portal occlusion(T3,4)and 1 d after operation(T5),for determination of sernm levels of ALT,AST,γ-GGT,LDH,TBIL,T-SOD and MDA.Specimens were obtained from the liver left intact after partial hepatectomy for ultrastructural examination with electron microscope.ResultsSerum levels of ALT at T5,γ-GGT at T3,4,and MDA at T4,5 were significandy lower while T-SOD at T5 were significantly higher in group PR than in group IF.Electron microscopic examination showed that tissue damages were significantly aRenuated in PR group as compared with IF group.Conclusion Propofol-remifentanil anesthesia can to some extent pmtect the liver against I/R injury during partial hepatectomy by reducing oxygen free radicals.