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Objective:To evaluate the effect of Mongolian medicine Eerdun Wurile on postoperative cognitive function in elderly patients undergoing thoracoscopic lobectomy.Methods:Sixty elderly patients of either gender, aged ≥60 yr, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, with body mass index≤28 kg/m 2, with preoperative Mini-Mental State Examination (MMSE) score ≥27 points, undergoing thoracoscopic lobectomy under general anesthesia, were divided into 2 groups ( n=30 each) using the random number table method: control group (group C) and Eerdun Wurile group (group E). Eerdun Wurile 15 capsules per day were taken for 7 consecutive days starting from 3 days before surgery in group E, and placebo was given instead in group C. The peripheral venous blood samples were collected before medication at 3 days before surgery (T 1) and 24 and 72 h after surgery (T 2, 3) for determination of the concentrations of serum brain-derived neurotrophic factor (BDNF), interleukin-1beta (IL-1β), tumor necrosis factor-alpha (TNF-α) and Tau proteins by enzyme-linked immunosorbent assay. The patients′ cognitive function was assessed by MMSE at T 1 and 5 days after surgery (T 4), and the occurrence of cognitive decline (MMSE score < 27) was recorded. Results:Compared with group C, the serum BDNF concentration was significantly increased at T 2 and T 3, and the concentrations of IL-1β, TNF-α and Tau protein were decreased, the MMSE score was increased at T 4, and the incidence of cognitive decline was decreased in group E ( P<0.05). Conclusions:Mongolian medicine Eerdun Wurile can improve postoperative cognitive function in elderly patients undergoing thoracoscopic surgery, and the mechanism may be related to reduction of systemic inflammatory responses and promotion of nerve cell repair and regeneration.
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Objective To evaluate the risk-benefit of aspirin discontinuation during the perioperative period in elderly patients undergoing laparoscopic surgery.Methods Eighty-eight patients of both sexes,aged ≥65 yr,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,scheduled for elective laparoscopic cholecystectomy,taking aspirin to prevent cardiovascular diseases,were divided into 2 groups (n =44 each) using a random number table method:non-discontinuation group (N group) and discontinuation group (D group).No aspirin was discontinued during the perioperative period in group N.Aspirin was discontinued at 7 days before surgery and resumed at 3 days after surgery.Venous blood samples were collected at 24 h before surgery (To) and 30 min and 24 h after surgery (T1.2) for measurement of blood coagulation by thromboelastography,and clot reaction time,coagulation time,angle oα,maximal amplitude,and coagulation index were recorded.The occurrence of TEG parameters below/above normal values of clinical significance was recorded.The intraoperative blood loss,postoperative drainage,reoperation due to hemorrhage within 48 h,perioperative blood transfusion and fluid infused,and adverse cardiovascular events (myocardial ischemia,venous thrombosis of lower extremity,pulmonary embolism,etc.)within 30 days after surgery were also recorded.Results Compared with group N,no significant change was found in the intraoperative blood loss,intraoperative fluid infused,postoperative drainage rate and drainage volume,reoperation due to hemorrhage within 48 h,or length of hospitalization (P＞0.05),angle α,maximal amplitude and coagulation index were increased,clot reaction time was shortened,the incidence of clot reaction time below normal values of clinical significance was increased in group D (P＜0.05).There was no significant difference in the incidence of adverse cardiovascular events between group D (7％) and group N (0) (P＞0.05).Conclusion Perioperative discontinuation of aspirin does not reduce the perioperative blood loss with no clinical benefit,induces blood hypercoagulation and increases the risk of adverse cardiovascular events,and thus it is recommended not to discontinue aspirin in the perioperative period in elderly patients undergoing laparoscopic surgery.
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Objective To observe the effect of intraoperative 5 cm H2O positive end expiratory pressure on vascular endothelial function in patients with uvulopalatopharynplasty (UPPP ). Methods Forty patients with obstructive sleep apnea-hypopnea syndrome (OSAHS)scheduled for UPPP were selected,including 25 males and 15 females,fully met the following conditions as age<60 years,BMI<30 kg/m2and ASA physical status Ⅰ or Ⅱ.Patients were divided into two groups, 20 in each group using random number table method.The observation group was given the intermit-tent positive pressure ventilation (IPPV)with 5 cm H2O PEEP,while the controls group were given IPPV.3 ml of arterial blood was drawn at the time of 5 min of pure oxygen Inhalation (T0),intuba-tion (T1),extubation (T2),and 20 min after extubation (T3).Vascular endothelium expansion fac-tors such as nitric oxide (NO),endothelin (ET),and soluble cell adhesion molecule (CAMs)were detected by ELISA.Results There was no significant difference in plasma ET concentrations between the two groups at different time points.Plasma NO concentration in the observation group was signif-icantly higher than that in the control group at T2and T3(P<0.05).Compared with T0,the concen-trations of CAMs in the control groups from T1to T3,and in the observation group at T2and T3in-creased significantly (P<0.05).In the perioperative period,the plasma CAMs of the control group increased along with the prolongation of the operation time,but the plasma CAMs concentrations in the observation group decreased in the same observation time (P<0.05).Conclusion Low level of PEEP 5 cm H2O may improve endothelial function in general anesthesia patients with OSAHS.
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Objective To explore the feasibility of FloTrac/Vigileo System in hemodynamic monitoring during the surgery of single-lung ventilation patients.Methods Twenty-five patients with thoracoscopic lobectomy under general anesthesia,aged 35-65 years,ASA physical status Ⅰ or Ⅱ, preoperative showed no application taboo of FloTrac/Vigileo system or transesophageal echocardio-graphy (TEE).The radial artery puncture catheter was inserted after getting into the operating room, then connect the FloTrac/Vigileo system,after that the TEE was inserted following the induction of general anesthesia.Using the FloTrac/Vigileo system to record the stroke volume (SVF),cardiac output (COF),stroke volume variation (SVV),at the moment of after turning over (T0),opening chest and single-lung ventilation(T1),single-lung ventilation for 15 minutes (T2),single-lung venti-lation for 30 minutes (T3),single-lung ventilation for 45 minutes (T4)single-lung ventilation for 60 minutes (T5).Using TEE to monitor the index and record the the stroke volume (SVT)cardiac out-put(COT)and inferior vena cava collapse index(cIVC)of the same patient at same time as Group F. Results There was no statistically significant different between SVFand SVTat T0-T5in both groups,Overall correlation analysis,r=0.84,P<0.01.There is no statistically significant different between COFand COTat T0-T5in both groups,Overall correlation analysis,r=0.92,P<0.01. Correlation analysis of SVV of group F and cIVC of group T,the results were positively correlate,r=0.80,P<0.01.Conclusion FloTrac/Vigileo system can be used as a monitoring method for mo-nitoring hemodynamics in thoracic surgery.
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Objective To investigate the relationship between anesthetic factors and intestinal injury in the patients undergoing elective cardiac surgery with cardiopulmonary bypass (CPB).Methods Ninety American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes,aged 18-64 yr,with New York Heart Association grade Ⅱ or Ⅲ,undergoing elective cardiac surgery with CPB,were divided into 2 groups (n =45 each) using a random number table:propofol-based anesthesia group (group P) and sevoflurane-based anesthesia group (group S).CPB was established routinely after anesthesia induction.Before induction (T0),immediately after aortic unclamping (T1),at 30 min after aortic unclamping (T2) and at 2 h after discontinuation of CPB (T3),blood samples were collected from the radial artery for determination of the plasma endotoxin,D-lactic acid,diamine oxidase (DAO) and intestinal fatty acid-binding protein (Ⅰ-FABP) concentrations (by enzyme-linked immunosorbent assay) and plasma interleukin-6 (IL-6),IL-8 and tumor necrosis factor-alpha (TNF-o) concentrations (using radio-immunity method).Results Compared with the baseline at T0,the concentrations of plasma endotoxin,D-lactic acid,DAO,TNF-α,IL-6,IL-8 and I-FABP were significantly increased at T1-T3 in both groups (P＜0.05).Compared with group P,the concentrations of plasma endotoxin,D-lactic acid,DAO,TNF-α,IL-6,IL-8 and I-FABP were significantly decreased at T1-T3 in group S (P＜0.05).Conclusion Anesthetic factors are related to intestinal injury in patients undergoing cardiac surgery with CPB.Compared with propofol-based anesthesia,sevoflurane-based anesthesia is helpful in reducing the inflammatory response and in decreasing the degree of intestinal injury and is more suitable for the cardiac surgery with CPB.
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Objective To investigate the effects of ABO blood group factors on erythrocyte suspension ( RCS) transfusion reactions in patients. Methods TestⅠA total of 12 600 patients in whom RCS was transfused during operation at the department of anesthesiology of 11 hospitals of Inner Mongolia from January 2006 to January 2014 were selected. The occurrence of transfusion reactions ( fever [ an increase in body temperature>1 ℃ than that before transfusion] , allergy, hemolysis) was recorded in the patients. Test Ⅱ A total of 120 RCS?transfused patients of both sexes, aged 18-55 yr, weighing 45-75 kg, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, who underwent surgical operation, were divided into 4 groups ( n=30 each) according to the blood group: blood group A group ( group A) , blood group B group ( group B ) , blood group O group ( group O ) and blood group AB group ( group AB) . The standard for RCS transfusion was defined as hemoglobin ( Hb) 10 g∕L. Before induction of anesthesia ( T1 ) , before blood transfusion ( T2 ) , and at 5 min, and 1, 6 and 24 h after blood transfusion ( T3?6 ) , blood samples were collected from the central vein for determination of the plasma tumor necrosis factor?alpha ( TNF?α) , interleukin?4 ( IL?4 ) and IL?10 concentrations by enzyme?linked immunosorbent assay. Results Among the 12 600 RCS?transfused patients, 216 cases developed transfusion reactions, and the incidence of transfusion reactions was 1.714%. For the patients of different blood groups, the incidence of transfusion reactions from the high to the low was blood group B, blood group AB, blood group A, and blood group O in turn ( P<0. 05 or 0.01) . Compared with group B, the plasma TNF?α and IL?10 concentrations were significantly decreased, and the plasma IL?4 concentrations were increased at T3?T6 in the other three groups ( P<0.05) . Compared with group AB, the plasma TNF?α and IL?10 concentrations were significantly decreased, and the plasma IL?4 concentrations were increased at T3?T6 in A and O groups (P<0.05). Compared with group O, the plasma TNF?α and IL?10 concentrations were significantly decreased, and the plasma IL?4 concentrations were increased at T3?T6 in group A ( P<0. 05 ) . Conclusion ABO blood group factors affect RCS transfusion reactions in the patients, and the incidence of transfusion reactions from the high to the low is blood group B, blood group AB, blood group A, and blood group O in turn.
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Objective To evaluate the efficacy of parecoxib sodium for prevention of post-thoracotomy pain syndrome.Methods Ninety ASA physical status Ⅰ or Ⅱ patients,aged 40-64 yr,weighing 50-80 kg,scheduled for elective thoracotomy,were equally and randomly divided into 3 groups using a random number table:control group (group C) and two different treatments with parecoxib sodium groups (P1 and P2 groups).At 20 min before skin incison,parecoxib sodium 40 mg was injected intravenously in P1 and P2 groups,while the equal volume of normal saline was given in group C.An increment of parecoxib sodium 40 mg was given every 12 h for 6 times after surgery in group P2.General anesthesia combined with epidural anesthesia was used during surgery and patient-controlled epidural analgesia was used for postoperative analgesia in the three groups.Morphine was used as rescue analgesic to maintain VAS score ≤ 3.The consumption of morphine within 72 h after operation,development of adverse effects and development and duration of pain (VAS score ＞ 3) within 6 months after operation were recorded.The blood coagulation was measured at 72 h after operation.Results Morphine was not used within 72 h after operation in P2 group.The abnormality of blood coagulation at 72 h after operation was not observed in the three groups.Compared with group C,no significant changes were found in the incidence and duration of pain within 6 months after operation in P1 group (P ＞ 0.05),the incidence of pain was significantly decreased and duration of pain was shortened within 6 months after operation in P2 group,and the incidence of nausea,vomiting and pruritus was decreased in P1 and P2 groups (P ＜ 0.05 or 0.01).The incidence of nausea,vomiting and pruritus was significantly lower in P2 group than in P1 group (P ＜ 0.01).Conclusion Continuous application of parecoxib sodium for 72 h can decrease the development of post-thoracotomy pain syndrome without increasing the incidence of adverse effects.