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Objective To investigate influence of dexmedetomidine on postoperative cognitive function in elder patients after hip re-placement surgery under spinal anesthesia. Methods Forty elderly patients with ASAⅠ~Ⅲ,undergoing hip replacement with spinal anesth-sia,were randomly divided into dexmedetomidine group( group A) and normal saline group( group B) ,with 20 patients in each group. Dexme-detomidine was given with 1 μg/kg after anesthesia and followed with 0. 5 μg·kg-1 ·h-1 in group A. The equal volume of normal saline was infused in group B. Cognitive function was evaluated before anesthesia,3 and 7 days after surgery by mini-mental state examination( MMSE) . The intraoperative concentration of TNF-α,IL-6,MDA were detected at the time of before surgery(T0),end of surgery(T1),3 days after sur-gery(T2),7 days after suegery. Results There was no significant difference in MMSE score before anesthesia between the two groups (P>0. 05). The difference of MMSE score at postoperative 3 days between two groups was statistical significance (P0. 05). Compared with T0,the concentration of TNF-α,IL-6,MDA at T1,T2 in group B increased,the difference was significant. And the concentration of IL-6 at T1 in group A decreased,compared with that at T0,the difference was significant(P<0. 05). The concentra-tion of TNF-α,IL-6 at T1,T2 and MDA at T2 in group A were lower than those in group B,the difference was significant. (P<0. 05). Con-clusion Dexmedetomidine can decreased the concentration of TNF-α,IL-6,MDA,and improve the postoperative cognitive dysfunction of eld-erly patients who finished the hip replacement surgery under spinal anesthesia.
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Objective To explore the effects of sedationand hemodynamics on different ages patients with the same concentration of dexmedetomidine under general anesthesia.Methods A total of 264 patients (ASAⅠ-Ⅱ)with orthopaedic surgery under general anesthesia in our hospital from April 2013 to May 2015 were divided into 3 groups by age,the young group (group Y,n =76),middle age group (group M, n =107),and old age group (group O,n =81 ).Fifteen minutes before anesthesia,patients were infused dexmedetomidine with 1 μg/kg, maintain the concentration of 0.5 μg·kg-1 ·h-1 and stop at 30 minutes before surgery finished.The SBP、DBP、BIS、HR before anesthesia (T1),pump injection start(T2),tracheal intubation(T3),1 minute after intubation(T4),5 minutes after skin incision(T5),endotracheal ex-tubation(T6)were observed.The dosage of propofoland remifentanil in anesthesia,duration from stop infusion to endotracheal extubation, Ramsay score and adverse reactions 5 minutes after PACU also need to be recorded.Results The level of SBP and DBP were significantly increased at T2,T3 in all groups.Compared with group O,both group Y and group M increased significantly,the difference was statistically significant(P 0.05).Compared with T1,the level of HR and BIS were signifi-cantly decreased at T2-T5,the difference was statistically significant(P 0.05). There was no significant difference in the total adverse reaction between group Y and group M(P >0.05),but it was significantly lower than that of group O(P <0.05).Conclusion Dexmedetomidine has good sedative effect in all groups,but older group have more adverse reac-tions and wake up time is extended.The concentratiuon of dexmedetomidine should be adjusted according to the age of patients.
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Objective To evaluate the efficiency of dezocine combined with sufentanil on postoertive analgesia for spinal deformity sur-gery.Methods Divided the 90 patients who were admitted into our hospital from January 2013 to September 2015 into three groups by ran-dom single blind method,namely the dezocine group,the sufentanil group and the combined group,with 30 cases in each group.All the pa-tients underwnet propofol and sevoflurane static absorption compound anesthesia,and they were given continuous intravenous analgesia with different drugs after the surgery.Their visual analogue scale (VAS)score,sedation scale (SS)score,adverse reaction,total PCIA times,ef-fective PCIA times,respiratory rate and arterial blood gas were measured at 2,6,24,48 hours after operation.Results The VAS score of the combined group was lower than that of the dezocine group (P <0.05).The combined group was significantly superior to the dezocine group and the sufentanil group in SS score and adverse reactions.At 24 and 48 hours after surgery,SaO2 and PaO2 in the combined group were higher than those in sufentanil group (P <0.05).PaCO2 in the combined group was lower than that in the dezocine group and the sufentanil group(P <0.05).Conclusion Dezocine combined with sufentanil is a more efficiency way with less adverse reaction on postoperative anal-gesia for spinal deformity surgery,and it is an ideal way of analgesia.
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Objective To compare and analyze the clinical application of lumbar plexus combined with sciatic nerve block and spinal anesthesia for elderly patients with knee joint surgery.Methods A total of 77 elderly patients with ASAⅠ ~Ⅲ undergoing single knee re-placement surgery were randomly divided into combined group which recieved lumbar plexus combined with sciatic nerve block and spinal an-esthesia group.The baseline values,blood pressure and heart rate at multiple time points,the block area and duration,the volume of intraoper-ative fluid,and other indexes of adverse reaction were observed.Results The MAP,SBP and DBP in the spinal anesthesia group after the op-eration have changed significantly at the time of T1,T2 and T3.The operating of anesthesia in the combined group was shorter than that of spi-nal anesthesia group.The rate of adverse reactions in combined group was significantly lower than that inspinal anesthesia group.Conclusion The spinal anesthesia can be satisfied for operation requirements,but it will cause the unstable circulation and varied adverse reactions.Lum-bar plexus combined with sciatic nerve block is safe and effective with less adverse reactions,less disturbance of hemodynamics,which is much better for the old or the patients with coagulation abnormalities combined heart and lung disease.
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Objective To analyze the clinical experience of double lumen endobronchial tube intubation in 41 cases of whole lung lavage .Methods Forty‐one patients with whole lung lavage in our hospital from February 2010 to February 2015 were retro‐spectively analyzed .The effect of bronchoscopy and auscultation location method were explored after double‐lumen endobronchial intubation in whole‐lung lavage .Results Among 41 cases ,39 cases were successfully located by using the auscultation location ,and other 2 cases were successfully positioned by using the bronchoscopy position after repeatedly auscultation location method resulting in lung isolation failure .The catheter depth in 19 cases was adjusted after using bronchoscopy ,and then double lung was isolated well and lavage was successfully conducted .Conclusion The prerequisite for success of whole lung lavage is accurate position of double‐lumen endobronchial tube .Bronchoscopy look positioning has become the gold standard of double‐lumen endobronchial tube position .
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Objective To observe the expression of pannexin1(PX1) in the dorsal horn of spinal cord in model ratwith neu-ropathipain afteselective ligation of sciatinerve branche.Method50 male SD ratwere randomly divided into 3 group,inclu-ding the control group(Wgroup ,n= 10) ,sham operation group(sham group ,n= 10) and sciatinerve branch selective injury group(SNI group ,n=30) .30 ratwere killed on postoperative 3 ,5 ,7 ,14 d and the lumbasegmenof the spinal cord wataken fodetecting the expression of PX1 by using Western blo.Othe20 ratwere killed on 7 d afteSNI and the expression of glial fibril-lary acidiprotein(GFAP) in the spinal cord wadetected with immunohistology .Among them ,10 ratin the SNI group were trea-ted with intrathecal intubation before operation and administrated with saline 20 μL ocarbenoxolone(CBX) 20 μL by intrathecal injection on postoperative 7 d fodetermining the expression of GFAP by the immunohistology .ResultThe expression of PX1 in the SNI group waincreased and enhanced with time ,which wasignificantly highethan thain the Wgroup and the sham group (P＜0 .05);the GFAP expression on 7 d in the SNI group waobviously increased compared with the Wgroup and the sham group(P＜0 .05);afteintrathecal injection of CBX ,the expression of GFAP wasignificantly decreased compared with thain the normal saline group(P＜0 .05) .No statistically significandifferencein the expression of PX1 and GFAP were found in the Wgroup and the sham group .Conclusion PX1 may be involved in the activation of astrocyte,prompting thaPX1 playan importanrole in the neuropathipain caused by the peripheral nervel injury .
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Objective To observe the effects of propofol on the hippocampal astrocytes and microglia in the nenotal mice . Methods 15 healthy mice from the same litters on postnatal 7 d were randomized into 3 groups:high dose propofol group ,low dose propofol group and 10% intralipid control group .All mice were treated with drugs on postnatal 7 d by intraperitoneal injection and were sacrificed at 24 h after drugs treatment .The high dose group was injected with propofol 60mg · kg -1 ;the low dose group was injected with propofol 30mg · kg -1 ;the control group was injected with the equal volume of 10% intralipid .The immunohistochem‐istry assay was used to detect the expression of glial fibrillary acidic protein (GFAP) and ionized calcium binding adapter molecular 1 (Iba1) for observing the effect of propofol on the astrocytes (AST ) and microglia in the hippocampus .Results Compared with the control group ,the number of GFAP‐labeled AST in the dentate gyms (DG) molecular layer of hippocampus in P7 mice of the high dose propofol group was significantly reduced (P<0 .01) ,while no obvious effect of the low‐dose propofol on the number of AST was observed ;high dose and low dose propofol all significantly decreased the number of Iba1‐labeled microglia .Conclusion Propofol can inhibit the growth of the hippocampal AST and microglia in a dose‐dependent manner .
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Objective To construct the recombinant adenovirus vector containing ubiquinol-cytochrome C reductase core protein 1(UQCRC1) and to investigate the protective role of UQCRC1 against hypoxia/reoxygenation injury in H9c2 cardiac myocytes . Methods UQCRC1 gene was obtained from the cDNA library by PCR ,then was double-digested with restriction endonucleases SalⅠand XbaⅠand inserted into pAd Track-CMV .The identified plasmid of pAd Track-UQCRC1 was transfected into BJ 5183 contai-ning pAdEasy-1 .After screening the positive clone ,the plasmid was transfect into 293T cells with liposome to integrate and package the recombinant adenovirus .Finally ,these adenoviruses were transfected into H9c2 cardiac myocytes .The expressions of green fluo-rescence protein(GFP) ,UQCRC1 gene and protein were observed by RT-PCR and Western blot analysis .The cell viability and the LDH release were detect .Results The recombinant adenovirus-UQCRC1 was constructed successfully .The overexpression of UQCRC1 increased the cell viability(P<0 .05) and decreased the LDH release(P<0 .05) from H9C2 cardiac myocytes after suf-fering hypoxia/reoxygenation injury .Conclusion UQCRC1 has the protective effect on hypoxia/reoxygenation injury in H9c2 car-diac myocytes ,and the construction of recombinant adenovirus vector will lay the foundation for further studying the role of UQCRC1 in cardioprotection .
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Objective To establish a method to isolate,culture and identify cardiomyocytes from neonatal mouse,estimate the cardiomyocytes survival rate,and identify the purity of cardiomyocytes.Methods Neonatal C5 7 mouse heart(within 3 days)was di-gested using trypsin and collagenase.Cardiomyocytes survival rate was estimated by trypan blue staining,and cardiomyocytes purity was identified byα-actin immunofluorescence staining.Results Mouse cardiomyocytes could be successfully isolated and cultured using neonatal mouse within 3 days.Trypan blue staining showed cardiomyocytes survival rate was>95%,and cardiomyocytes pu-rity was more than 95% demonstrated byα-actin immunofluorescence staining.Conclusion Under the strict experimental condi-tions,mouse cardiomyocytes can be successfully isolated and cultured with high survival rate and high purity.
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Objective To observe the effect of ketamine on apoptosis and synaptophysin expression in 7-day-old infant SD rat hippocampal neural cells. Methods Thirty SD rats of 7 days old were randomly assigned to receive the injection of 25 mg/kg ketamine (K_ 1 group)or 50 mg/kg (K_ 2 group) or 50 ml/kg normal saline (K_ 0 group). In 24 h after injecton, all rats were killed and the synaptophysin was tested by using immunhistochemistry and Western blotting, the apoptosis of neuronal cell by Tunel. Results In 24 h after injection of ketamine,the number of apoptotic neural cells increased,which of K_ 0 group was (5.3?1.7), K_ 1 group (9.5?4.2), K_ 2 group (23.4?7.6), and the grey values of synaptophysin by immunhistochemistry of K_ 0 group was (174.11?4.68), K_ 1 group (181.36?4.17), K_ 2 group (198.25?3.06), and the OD values of synaptophysin piece decreased, which of K_ 0 group (4 007?758), K_ 1 group (2 621?465), K_ 2 group (987?183). Conclusion In 24 h after treatment with ketamine, the expression of synaptophysin was decreased in hippocampl neural cells, the number of apoptotic neuronal cells were increased, which may be involved in neurotoxicity caused by ketamine.
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Objective To study the effect of stellate ganglion blocking (SGB) during cardiopulmonary bypass (CPB) on inflammatory reaction.Methods Twenty patients undergoing mitral valve replacement were randomly allocated to 2 matched groups,control group and SGB group (n=10).The control group only received conventional anesthesia,while the SGB group was blocked with 1% lidocaine in addition before the operation for SBG.Blood glucose (BG),Cortisol (Col),IL-1?,IL-6 and TNF-? in the venous blood samples were detected in following 5 time points,20 min before anesthesia,20 min after anesthesia,20 min after operation,20 min afer the start of CPB and 20 min after the end of CPB.Results Col level of the control group (353.09?129.34 ng/ml) was significantly higher than that of the SGB group (486.84?152.20 ng/ml) in 20 min after the end of CPB (P
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Objective To investigate influence of amitriptyline on astrocytic activation in spinal cord of rats after spared nerve injury(SNI).Methods A total of 120 male SD rats were randomly divided into 4 groups with 30 rats in each group:control(A),SNI(B),amitriptyline(C),and SNI+amitriptyline(D)groups,which respectively were treated with intraperitoneal injections of 0.2 ml normal saline(A and B),10 mg/kg amitriptyline(C and D),bid.The L3 to L6 segment of the spinal cord was isolated respectively at 1,3 and 5 d after surgery.Expression of glial fibrillary acidic protein(GFAP),marker of astrocytes,was determined by immunofluorescence,Western blot assay and semiquantitative RT-PCR.The changes of mechanical pain threshold were measured.Results Compared with control,group B had a markedly decreased rat mechanical pain threshold(P
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Objective To investigate the effect of preconditioning with mitochondrial ATP-sensitive potassium channel opener on the mitochondrial functions.Methods Thirty SD rats were used.Isoproterenol was used to induce myocardial ischemic injury in 20 rats,ten of which were pretreated with diazoxide.Rhodamine123(Rh123)was used as fluorescent prober to measure mitochondrial membrane potential.The activities of mitochondrial Na+-K+-ATPase and Ca2+-ATPase were detected.The mitochondrial respiratory parameters were recorded with a Clark electrode.The effect of diazoxide on mitochondrial membrane potential and mitochondrial respiration was investigated.Results Compared with the controls,the levels of state 3(ST3),respiratory control rate(RCR),mitochondrial membrane potential content and the activities of mitochondrial ATPase were decreased in the rats that received isoproterenol,while diazoxide pretreatment alleviated the changes of ST3,RCR,mitochondrial membrane potential and the activities of mitochondrial ATPase.Conclusion Preconditioning with diazoxide enhances the activities of mitochondrial ATPase and protects the myocardial mitochondrial function after isoproterenol induced myocardial ischemic injury.
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Objective To explore a space craft precooling temperature at which excessive thermal stress on the crew member could be prevented or reduced in an overheated launch or reentry module. Method Five young male volunteers wearing a space suit participated in 25 tests at sea level.The space suit was either ventilated in a volume air flow rate of 100 L/min (STPD) with ambient air at temperatures (Ta) of 15℃,10℃,and 5℃,respectively,or not ventilated. Rectal (Tr),mean skin (Tsk) and mean body (Tb) temperatures were measured. Result At Ta 15℃,Tr decreased without significance (from 37.0±0.2℃to 36.7±0.3℃) in 120-min tests,whereas Tsk and Tb decreased significantly,and subjects had local cold strain whether the space suit was ventilated or not; while at Ta 10℃,Tr decreased from 37.0±0.3℃ to 36.3±0.3℃(P<0.05),subjects had a whole body cold strain,and both Tsk and Tb dropped continuously and significantly. Conclusion Ambient temperature 15℃,at which the thermal comfort states of crew was not significantly degraded,was acceptable after precooling in a space craft.
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With the change in the modes of medicine, the traditional educational mode of clinical medicine is unable to meet the development demands of modern medicine. Evidence based medicine, a new mode of medical treatment, reflects the development trends of modern medicine and represents the direction of modern medical advancement. Judging from the perspective of medical education, evidence based medicine is a learning method which differs from the traditional educational mode and represents a new concept of education in clinical medicine. The rise of evidence based medicine demonstrates the direction of reform in medical education in the world today and will also bring about great changes in the mode of medical education in China. It is imperative for us to follow the trend in clinical medical education, update concepts on medical education in line with the basic ideas of evidence based medicine, and push forward reform in the mode of medical education.
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Objective It has been shown that fluorinated inhalational anesthetics have various adverse effects on the lungs. The aim of this study was to investigate the effects of different concentrations of isoflurane (ISO) on the lungs in rats.Methods Ninety Wistar rats of both sexes weighing 140-200 g were randomly divided into two groups : (A) control group received only oxygen inhalation ( n = 30) and (B) isoflurane group (n = 60) which was farther divided into 2 subgroups (n = 30):0.6% and 1.4% isoflurane. In each subgroup isoflurane was inhaled for 2 h ( n = 10), 4h (n = 10) or 8 h ( n = 10) . The animals were placed in a glass container and isoflurane was delivered from ISO vaporizer into the container through the inlet. The end-tidal ISO concentration was checked at the outlet. The animals were sacrificed at the end of ISO inhalation. The lungs were immediately removed and blood was collected for determination of (1) lung water content, (2) protein content and neutrophil ratio in broncho-alveolar lavage fluid (BALF) , (3) serum and BALF surfactant protein-A (SP-A) content and (4) microscopic examination. Results There was no significant difference in all variables between control group and 0.6% ISO subgroup. Exposure to 1.4% ISO for 8 h caused an increase in neutrophil ratio and protein content in BALF, and serum SP-A content but a decrease in BALF SP-A content. There was no significant difference in lung water content between control group and 1.4% ISO (8 h) subgroup. Conclusion Isoflurane (1 MAC) inhalation over 8 h may impair the function of alveolar epithelium.
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Objective To explore the effect of isoflurane on Na-K-ATPase activity in cultured primary alveolar type Ⅱ(ATⅡ) cells with or without being injured by H 2O 2.Methods ATⅡcells were isolated from adult rat lungs and incubated for 24h and divided into six groups. Group 1 served as control and received no treatment. Group 2 and 3 ATⅡ cells were exposed to 0.28 or 2.8mmol/L isoflurane. In group 4 cells were exposed to 75?mol/L H 2O 2. In group 5 and 6 cells were exposed to both 75?mol/L H 2O 2 + 0.28 or 2.8mmol/L isoflurane. Each group was incubated for another 2h after the addition of isoflurane and /or H 2O 2. The Na-K-ATPase activity of ATⅡcells ,the LDH activity and the MDA concentration of fluid culture medium were measured by biochemical methods.Results Isoflurane markedly decreased Na-K-ATPase activity in normal ATⅡ cells, but aggravated the decrease in Na-K-ATPase activity induced by H 2O 2. Isoflurane had no effect on LHD activity and MDA concentration of fluid culture medium of normal ATⅡ cells ,but significantly increased LHD activity and the MDA concentration of of fluid culture medium of ATⅡ cells injured by H 2O 2.Conclusions Isoflurane can inhibit Na-K-ATPase activity of ATⅡ cells in vitro, and aggravate the damage of ATⅡ cells caused by oxidants.
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Objective: To evaluate the effect of partial liquid ventilation with perfluorocarbon on the static lung compliance in rat with smoke inhalation injury. Method: Partial liquid ventilation (PLV)and mechanical ventilation (MV)were set up on rat's model,total static lung compliance (C_(2.94))and low volume static lung compliance (C_(0.49))were measured with hydraulic pressometer,the expansion index(EI)of lung was calculated. Result: There were significant decrease in C_(2.94),C_(0.49) and EI after 6 hours of smoke inhalation injury as compared with control values (P0.05), but in partial liquid ventilation group C_(2.94).C_(0.49) and EI increased obviously compared with those in smoke inhalation injury and MV groups (P
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Objective Blood lactic acid(LA) and glucose(Glu) level are important parameters of anaerobic glycolysis and can be used to assess the severity of brain injury and cerebral metabolism. The purpose of this study was to evaluate effect of propofol on traumatic brain injury by measuring blood and CSF level of LA and Glu in addition to microscopic and NSE immunohistochemical examination of brain tissue. Methods Ninety New Zealand rabbits weighing 2.6-3.0 kg were used . Traumatic brain injury model was established according to Wang's method. Part Ⅰ . Twenty rabbits were divided into two groups of ten animal each. Blood and CSF samples were taken before and 4h, 24h, 48h, 72h and 1 week after trauma for determination of LA and Glu levels. Propofol group received propofol 30mg' kg-1?h-1 infusion for 30 min in addition to ketamine 1mg/kg before each collection of samples. PartⅡ . Seventy rabbits were divided into seven groups with ten animals in each group. Brain tissues were taken before and 24h, 72h, and 1 week after trauma for microscopic and NES immunohistochemical examination. Propofol group received infusion of 30 propofol mg kg-1 h-1 for 30 mm every day. In control group animals received same amount of normal saline. Results Blood and CSF levels of LA increased significantly after trauma in both groups but were significantly higher in control group than those in propofol group at corresponding intervals. Blood and CSF Glu levels decreased significantly in control group after trauma but in propofol group blood Glu level decreased only at 4h and 24h after trauma and CSF Glu level at 24h after trauma. There was significant difference in blood and CSF levels of Glu after trauma between the two groups. In both groups microscopic examination of brain tissue showed hemorrhage, degeneration, decrease in glial cells and vacuolization of some neuron in brain tissue of injured and surrounding areas at 24h after trauma, infiltration of neutrophils at 72h after trauma and cerebral interstitial edema and glial cell proliferation at 1 week after trauma. Neurons showed no NSE expression. In propofol group the above mentioned changes were relatively slight. Conclusions Propofol can significantly reduce blood and CSF LA levels after trauma and protect the animal from traumatic brain injury. Further studies are needed on the dosage and method of administration of propofol.
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Objective To explore the change of alveolar epithelial liquid clearance capacity in lung edema following acute lung injury induced by oleic acid.Methods Forty-eight Wistar rats were randomly divided into 6 groups: the control(C), injury(I), amiloride(A), ouabain(O),amiloride plus ouabain(AO), and terbutaline(T) groups. Acute lung injury was induced with intravenous oleic acid 0.25 mlkg -1. 24h after injury, 5% albumin solution (5 ml?kg -1) was delivered into both lungs via the trachea in C and I groups. In A, O, AO and T groups, amiloride (2?10 -3 mol/L),ouabain (5?10 -4 mol/L), amiloride (2?10 -3mol/L) and ouabain (5?10 -4 mol/L)mixture and terbutaline(10 -4 mol/L),added respectively to the albumine solution,at 5ml.kg -1 were administered intratracheally to both lungs separately. One hour later, the alveolar liquid clearance rate(ALC), total lung water content(TLW), extravascular lung water content(EVLW) and arterial blood gases were measured.Results As compared with those in C group, severe hypoxemia, hypercapnia and acidosis appeared, ALC was reduced by 49.2% ,TLW and EVLW markedly increased in I group(P