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Objective To compare the clinical outcomes of low-dose rabbit antithymocyte globulin (rATG ) vs basiliximab as induction therapy in recipients of ABO-incompatible kidney transplantation (ABOi-KT) .Methods Retrospective analysis was conducted for e the clinical data of 40 ABOi-KT recipients between March 2017 and March 2019 .17 recipients of them received induction therapy with basiliximab (basiliximab group) while another 23 recipients received low-dose rATG (rATG group ,rATG 25 mg/d × 3 d) .During a median follow-up period of 282 days , the data of serum creatinine and eGFR at 1 week and 1 month ,graft survival rate and complication rate of two groups were compared .Results No significant difference existed in age ,gender ,dialytic modality/ duration , blood groups of recipients , HLA mis-match , blood group antibody titers , dose of rituximab ,blood groups of donors or donor age ( P > 0 .05 ) . The times of double filtration plasmapheresis in Basiliximab group were more (P< 0 .05) .No significant difference existed in serum creatinine and eGFR at 1 week or 1 month ( P > 0 .05 ) . No significant difference existed in graft survival rate . No significant difference existed in rate of acute rejection ,parvovirus B19 infection , urinary tract infection or hematoma .Conclusions Low-dose of rATG is as effective as basiliximab for ABOi-KT recipients .And rATG does not increase the rate of infection .
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Objective To compare the effect of oxycodone,sufentanil and fentanyl on immune function in patients with colon cancer under postoperative analgesia,provide guidance and basis for clinical medication.Methods Ninety patients 49 males and 41 females,aged <65 years,ASA physi-cal status Ⅰ or Ⅱ,were enrolled and randomly divided into 3 groups using a random number table (n=30):oxycodone group (group O),sufentanil group (group SF)and fentanyl group (group F).All patients underwent the same way to maintain anesthesia.The PCIA pump recipe were as follows:group O,oxycodone 2 mg/kg+granisetron 3 mg,added normal saline to 100 ml;group SF,sufen-tanil 0.002 mg/kg+granisetron 3 mg,added normal saline to 100 ml;group F,fentanyl 0.02 mg/kg+granisetron 3 mg,added normal saline to 100 ml;The background volume of PCIA electronic pump was 2 ml/h,the amount of each press was 2 ml,the lock time was 1 5 min,the pump time lasted for 24 h and maintained for 2 days after operation.The percentage of CD4+,CD8+and NK cells in venous blood were recorded at the end of surgery,6 h,12 h,24 h and 48 h after surgery.Results In CD4+,in the time points of 6 h,12 h,24 h after surgery,it was significantly higher in group O than that in groups SF and F (P<0.05);CD8+in group O was higher than that of group F,and CD8+in group F was higher than group SF at the time of 6 h after surgery.The group O was significantly higher than that of the groups SF and F at the times of 12 h,24 h after surgery (P<0.05);In NK cells,at the time points of 12 h,24 h and 48 h after surgery,it was significantly higher in group O than in groups SF and F (P<0.05).Conclusion Three analgesic drugs caused decline in immune function.Sufentanil and fentanyl have the similar effects on immunity,but oxycodone have a relatively small effect on immunity.Oxycodone is a more appropriate analgesic drug for colon cancer under postoperative analgesia.
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Objective To evaluate the effect of awake tracheal intubation with intubating larynegeal mask airway (ILMA) on stress responses of hypertensive patients.Methods Sixty hypertensive patients,aged 45-64 yr,with body mass index of 20.3-27.5 kg/m2,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,undergoing elective abdominal surgery under general anesthesia,were divided into 2 groups (n=30 each) using a random number table:direct laryngoscope group (group D) and ILMA group (group I).At 3 min after topical anesthesia (T1),while epiglottis and glottis were exposed with direct laryngoscope in group D or during ILMA insertion in group I (T2),immediately after completion of intubation (T3),when the maximum change in hemodynamics after intubation appeared (at about 15 s after tracheal tubes were placed,T4),and at 5 min after completion of intubation (T5),mean arterial pressure (MAP) and heart rate (HR) were recorded,and blood samples were collected for determination of plasma epinephrine concentrations by radio-immunity method.Successful intubation at first attempt was recorded.Results Compared with the parameters at T1,the MAP,HR and plasma epinephrine concentrations were significantly increased at T2-4 in group D (P＜0.01),and no significant change was found in the parameters mentioned above at the other time point in group I (P＞0.05).Compared with group D,the MAP,HR and plasma epinephrine concentrations were significantly decreased at T2-4 (P＜0.01),and no significant change was found in the success rate of intubation at first attempt in group I (P＞0.05).Conclusion Awake tracheal intubation with ILMA does not induce strong stress responses and is helpful in avoiding the occurrence of cerebrovascular accidents,thus increasing the safty of awake tracheal intubation in hypertensive patients.
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Objective To evaluate the effect of age on the median-effective target plasma concentration (EC50) of propofol inhibiting body movement evoked by gastroscopy in the patients.Methods Ninety adult patients of both sexes,of ASA physical status Ⅰ or Ⅱ,with body mass index 19-25 kg/m2,scheduled for elective gastroscopy,were divided into 3 groups according to age (n =30 each):18-39 yr group (Ⅰ group),40-64 yr group (Ⅱ group) and 65-85 yr group (Ⅲ group).In Ⅰ,Ⅱ,Ⅲ groups,propofol was given by target-controlled infusion with the initial target concentrations of 2.5,2.0 and 1.5 μg/ml,respectively,and gastroscopy was performed when the target concentration was achieved.Body movement was defined as the directional movement in head or four extremities during gastroscopy.The target plasma concentration of propofol was determined by up-and-down sequential trial.Each time the plasma concentration of propofol increased/decreased by 0.5 μg/ml in the next patient depending on whether or not body movement developed.The EC50 and 95 ％ confidence interval of propofol inhibiting gastroscopy-evoked body movement were determined using Probit analysis.Results The EC50 (95 ％ confidence interval) of propofol was 4.2(3.8-4.5),4.1(3.7-4.4) and 2.4(1.8-2.7) μg/ml in Ⅰ,Ⅱ and Ⅲ groups,respectively.There was no significant difference in the EC50 of propofol between group Ⅱ and group Ⅰ.The EC50 of propofol was significantly lower in group Ⅲ than in Ⅰ and Ⅱ groups.Conclusion Age affects propofol-induced analgesia in patients with visceral pain,and the potency of propofol inhibiting visceral pain during gastroscopy in the elderly patients is significantly enhanced as compared with that in the young and middle-aged patients.
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Objective To evaluate the effects of different doses of fentanyl on the median effective target plasma concentration (EC50) of propofol inhibiting body movement evoked by gastroscopy in the elderly patients.Methods Ninety patients of both sexes,aged 75-89 yr,with a body mass index of 19-25 kg/m2,of ASA physical status Ⅱ or Ⅲ,scheduled for elective gastroscopy,were randomly divided into 3 groups (n =30 each):control group (group C) and different doses of fentanyl groups (F0.5 and F1.0 groups).Fentanyl 0.5 and 1.0 μg/kg were injected intravenously in F0.5 and F1.0 groups,respectively.Propofol was then administered by target-controlled infusion.The initial target plasma concentrations (Cps) of propofol were 2.0,1.5 and 1.0 μg/ml in C,F0.5 and F1.0 groups,respectively.Gastroscopy was performed after the target effect-site and plasma concentrations were balanced.Body movement was defined as movement in head or four extremities during gastroscopy.The target Cp of propofol was determined by up-and-down sequential trial.Each time the Cp increased/decreased by 0.5 μg/ml in the next patient depending on whether or not body movement developed.The EC50 and 95 ％ confidence interval (CI) of propofol inhibiting gastroscopy-evoked body movement were determined using Probit analysis.Results The EC50 (95 ％ CI) of propofol was 2.24 ng/ml (1.67-2.47 ng/ml) in group C,1.79 (1.55-1.95) μg/ml in group F0.5,and 1.13 (1.08-1.62) μg/ml in group F1.0.There was no significant difference in the EC50 of propofol between F0.5 and C groups.The EC50 of propofol was significantly lower in F1.0 group than in C and F0.5 groups.Conclusion When combined with propofol,fentanyl 1.0 μg/kg is recommended for gastroscopy in the elderly patients.