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Objective:To explore the effect of enhanced recovery after surgery (ERAS) protocols in patients undergoing laparoscopic radical cystectomy (LRC) and intracorporeal urinary diversion (ICUD).Methods:A total of 83 patients who received LRC+ ICUD in Beijing Chaoyang Hospital from March 2014 to September 2020, were divided into 2 groups based on different perioperative management, including 29 ERAS cases and 54 conventional recovery after surgery (CRAS) cases. The ERAS group included 26 males and 3 females , with an average age of (62.07 ± 9.26) years. There were 26 patients with ASA class Ⅰ-Ⅱ, 3 patients with ASA class Ⅲ, 4 patients received neoadjuvant chemotherapy, and 7 patients had a history of abdominal surgery in ERAS group. The CRAS group included 44 males and 10 females , with an average age of (61.59 ± 10.16) years. There were 50 patients with ASA class Ⅰ-Ⅱ, 4 patients with ASA class Ⅲ, 9 patients received neoadjuvant chemotherapy, and 10 patients had a history of abdominal surgery in CRAS group. There were no statistically significant differences in the baseline characteristics between the two groups. The patients in both groups underwent LRC+ ICUD procedures. The perioperative results and complications between the two groups were compared.Results:In the ERAS group, there were 20 patients who underwent Bricker ileal conduit surgery and 9 patients who underwent Studer orthotopic ileal neobladder surgery. Pathological staging included 3, 3, 7, 7, 5 and 4 cases in stage T a, T is, T 1, T 2, T 3 and T 4a, respectively. There were 23, 2, 3 and 1 patient with pathological stage N 0, N 1, N 2 and N 3, respectively. Pathological diagnosis included 3 cases of low-grade urothelial carcinoma, 24 cases of high-grade urothelial carcinoma, and 2 cases of other histological subtypes. In the CRAS group, there were 31 patients who underwent Bricker ileal conduit surgery and 23 patients who underwent Studer orthotopic ileal neobladder surgery. Pathological staging included 5, 3, 12, 9, 15 and 10 patients in stage T a, T is, T 1, T 2, T 3 and T 4a, respectively. There were 35, 6, 7 and 6 patients with pathological stage N 0, N 1, N 2, and N 3, respectively. Pathological diagnoses included 6 cases of low-grade urothelial carcinoma, 45 cases of high-grade urothelial carcinoma, and 3 cases of other histological subtypes. There were no statistically significant differences ( P>0.05) in surgical methods, pathological staging, or pathological types between the ERAS and CRAS groups. ERAS group presented less albumin loss [(25.73±8.63)% vs. (32.63±9.05)%, P=0.001], shorter hospital stay [9(7, 13)d vs. 12(9, 16)d, P=0.006], less 30-day overall complications [55.2% (16/29) vs. 83.3% (45/54), P=0.009]. In multivariable analysis, maximum albumin loss≥20% was independently associated with 30-day minor complications ( P=0.049), and maximum albumin loss ≥25% was independently associated with hospital of stay≥10 days ( P=0.038), respectively. Conclusions:For patients who received LRC+ ICUD, ERAS was associated with reduced perioperative albumin loss, shorter length of stay, less 30-day complications, accelerated recovery time, improved clinical outcome and less albumin injection.
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Objective:To construct the prediction model for the prolonged length of postoperative hospital stay in the patients undergoing thoracoscopic lobectomy.Methods:The patients of both sexes, aged ≥18 yr, of American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ, who received elective thoracoscopic lobectomy with general anesthesia from March 2016 to February 2019 in our hospital, were selected, their clinical data were collected, and the patients were pathologically diagnosed with non-small-cell lung cancer after operation.Basic information (sex, age, smoking history), previous history (dyslipidemia, hypertension, diabetes, cardiovascular and cerebrovascular diseases, peripheral vascular diseases, chronic obstructive pulmonary diseases), allergy history, other tumor history, surgical resection site, anesthetic factors (intraoperative use of non-steroidal anti-inflammatory drugs and glucocorticoids, duration of anesthesia, intraoperative epidural anesthesia + postoperative epidural analgesia) and postoperative complications (pleural effusion, pneumothorax, atelectasis) was collected.The patients were divided into 2 groups according to whether the length of postoperative hospital stay was prolonged: normal group (≤ 7 days) and prolonged group (>7 days).Logistic regression analysis was used to identify the predictors for prolonged length of postoperative hospital stay.The regression model for prediction of prolonged length of postoperative hospital stay was constructed based on the TensorFlow deep learning framework, and the efficacy of prediction was evaluated.A deep neural network was further established based on the TensorFlow framework to construct a classification prediction model for prolonged length of postoperative hospital stay, and the efficacy of prediction was assessed, further comparing it with the prediction model constructed by the traditional machine learning method.Results:A total of 428 patients were finally enrolled in the study.The results of multivariate logistic regression analysis showed that age and anesthesia duration were the risk factors for the prolonged length of postoperative hospital stay, and female, other tumor history and resection of right middle lobe were the protective factors ( P<0.05).The performance of the regression model proved ineffective, getting 2.16 mean absolute error and 11.05 mean square error on the training set, 2.14 mean absolute error and 11.73 mean square error on the test set.The classification model achieved better score with accuracy 75.58%, F1-measure 0.553 and area under the receiver operating characteristic curve 0.702 on the test set, however, it showed no better performance than that of 4 other prediction models established by 4 traditional machine learning methods, specifically Logistic Regression, Random Forest, Gradient Boosting and Support Vector Machine. Conclusions:Sex, age, surgical resection site, other tumor history and duration of anesthesia can serve as the predictors, and a classification prediction model for prolonged length of postoperative hospital stay is constructed based on a deep neural network in the patients undergoing thoracoscopic lobectomy.
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The postoperative nervous system and neurocognition-related complications have become an important issue of research focus with the gradual increase of the survival rate after liver transplantation. Compared to other solid organ transplantation, the incidence of nervous system complications after liver transplantation is higher and closely related to death. This paper mainly overviewed the nervous system complications, neurocognition-related complications after liver transplantation and the risk factors inducing these complications. It also discussed how to evaluate, monitor, and prevent these complications in order to provide reference for future studies.
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Objective To investigate the effect of low platelet (PLT) count on the early fatality rate of liver transplant recipients without intraoperative PLT transfusion. Methods Clinical data of 180 recipients undergoing orthotopic liver transplantation were retrospectively analyzed. The critical value of PLT count on postoperative 7 d to predict the early postoperative fatality rate was evaluated by the receiver operating characteristic(ROC) curve. All recipients were divided into the low PLT count group and control group according to the critical value. Relevant clinical data including perioperative PLT count, preoperative general conditions and intraoperative conditions of the recipients were included. The independent risk factors of the early fatality rate of liver transplant recipients were analyzed by Logistic regression analysis. The early prognosis of the recipients between two groups was observed and compared by the postoperative length of intensive care unit (ICU) stay, postoperative length of hospital stay, early allograft dysfunction and fatality rate on postoperative 30 d. Results The PLT count < 32×109/L on 7 d after liver transplantation was an independent risk factor of the fatality rate on postoperative 30 d (P < 0.05). The postoperative length of ICU stay of the recipients in the low PLT count group was 9 (5, 14) d, significantly longer than 5 (3, 6) d in the control group (P < 0.05). In the low PLT count group, the early allograft dysfunction rate was 55.0%, significantly higher than 20.6% in the control group (P < 0.05). In the low PLT count group, the fatality rate on postoperative 30 d was 40.0%, significantly higher than 2.5% in the control group (P < 0.05). The length of hospital stay did not significantly differ between two groups (P > 0.05). Conclusions The PLT count < 32×109/L on postoperative 7 d is an independent risk factor for the fatality rate on postoperative 30 d of liver transplant recipients. It can prompt the early allograft dysfunction and contribute to predict the early clinical prognosis of liver transplant recipients.
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Objective To compare the accuracy of three acute kidney injury (AKI) criteria of RIFLE, Acute Kidney Injury Network (AKIN) and Kidney Disease: Improving Global Outcomes (KDIGO) in predicting the early (30 d) postoperative death of liver transplant recipients. Methods Clinical data of 173 liver transplant recipients were retrospectively analyzed. The incidence of postoperative AKI was calculated according to the three criteria of RIFLE, AKIN and KDIGO. The all-cause fatality rate and cause of death at postoperative 30 d were analyzed. The risk factors of death within 30 d after operation were analyzed by binary Logistic regression. The prediction accuracy of three criteria for death within 30 d after operation was compared by the receiver operating characteristic (ROC) curve. Results According to the RIFLE, AKIN and KDIGO criteria, the incidences of postoperative AKI were 48.0%, 51.4% and 53.8%, respectively. Thirteen patients died within 30 d after operation and the fatality rate was 7.5%. RIFLE, AKIN and KDIGO stages were the independent risk factors for death within 30 d after operation (all P < 0.05). The area under the curve (AUC) of RIFLE, AKIN and KDIGO stages to predict death within 30 d after liver transplantation were 0.828, 0.766 and 0.844, respectively. There was a statistically significant difference between AKIN and KDIGO (P < 0.05). Conclusions KDIGO criterion is better for predicting early death after liver transplantation. However, as a tool, the comparative selection among these three criteria still needs the evidence support from a large multicenter sample.
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Objective:To compare the sedative efficacy of bispectral index (BIS)-guided dexmedetomidine and propofol in the elderly patients undergoing percutaneous kyphoplasty (PKP).Methods:Sixty elderly patients of both sexes, aged 70-90 yr, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, scheduled for elective PKP with local infiltration anesthesia, were divided into 2 groups ( n=30 each) using a random number table method: dexmedetomidine group (group D) and propofol group (group P). In group D, dexmedetomidine was infused for 10 min in a loading dose of 0.5 μg/kg followed by an infusion of 0.2-0.7 μg·kg -1·h -1 for maintanence.In group P, propofol was injected in a loading dose of 1.0 mg/kg followed by an infusion of 1-2 mg·kg -1·h -1 for maintanence.Local infiltration anesthesia was performed with 1% lidocaine 20-30 ml after disinfection and layering.The target BIS value was mainatined at 80-90.On admission to the operating room (T 0), at puncture (T 1), after balloon dilation (T 2), at the end of bone cement injection (T 3), and at the end of surgery (T 4), Ramsay sedation score was recorded, and the occurrence of adverse reactions such as hypotension, respiratory depression, bradycardia, nausea and vomiting was recorded during operation. Results:Compared with group P, the Ramsay score was significantly decreased, the incidence of bradycardia was increased, and the incidence of respiratory depression was decreased at T 1-4( P<0.05), and no significant change was found in hypotension and nausea and vomiting in group D ( P>0.05). Conclusion:Dexmedetomidine provides better sedative efficacy than propofol, but the occurrence of bradycardia should be prevented in the elderly patients undergoing PKP.
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Objective:To identify the risk factors for mortality after laparotomy for hemorrhage in the patients with bleeding after liver transplantation.Methods:The patients who underwent re-laparotomy for hemorrhage after liver transplantation, aged>18 yr, from June 2005 to June 2013, were selected.The preoperative clinical characteristics of patients, time of liver transplantation, mode of operation, intraoperative massive hemorrhage, intraoperative use of vasoactive drugs, atropine, lidocaine and immunosuppressive agents, and postoperative tracheotomy and renal failure were collected.Patients were divided into survival group (group S) and death group (group D) according to the survival outcome at 3 months after surgery.Factors of which P values were less than 0.05 would enter the multiple logistic regression analysis to stratify the risk factors for mortality of patients with bleeding after liver transplantation. Results:A total of 128 patients were included in this study , with 117 cases in group S and 11 cases in group D. Postoperative renal failure was the independent risk factor for mortality of patients with bleeding after liver transplantation, and OR value (95% confidence interval) was 11.307 (1.992-64.188) ( P<0.05). The area under the curve of postoperative renal failure (95% confidence interval) was 0.849 (0.712-0.986), and the sensitivity and specificity were 81.8% and 12.0%, respectively. Conclusion:Postoperative renal failure is an independent risk factor for mortality after laparotomy for hemorrhage in the patients with bleeding after liver transplantation.
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Objective@#To evaluate the role of hippocampal CD200 receptor 1 (CD200R1) in perioperative neurocognitive disorders (PND) in mice.@*Methods@#Sixty clean-grade male C57BL/6 mice, aged 9-10 months, weighing 32-38 g, were used in the study.The experiment was performed in two parts.Experiment Ⅰ Thirty-six mice were divided into 2 groups (n=18 each) using a random number table method: control group (group C) and PND group.Group C only received isoflurane anesthesia.Partial left lobectomy of the liver was performed under isoflurane anesthesia in group PND.Contextual fear conditioning test was performed at 1, 3 and 7 days after surgery, and the freezing time was recorded.The mice were then sacrificed, and the hippocampus was isolated for determination of interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) contents (by enzyme-linked immunosorbent assay) and CD200 and CD200R1 expression (by Western blot). Experiment Ⅱ Twenty-four mice were divided into 2 groups (n=12 each) using a random number table method: CD200-Fc group and IgG1-Fc group.Recombinant proteins CD200-Fc and human IgG1-Fc were injected into the lateral cerebral ventricle in CD200-Fc group and IgG1-Fc group, respectively.Partial left lobectomy of the liver was performed after the end of injection.Contextual fear conditioning test was performed at 1 and 3 days after surgery, and the freezing time was recorded.@*Results@#Experiment Ⅰ Compared with group C, the freezing time in the contextual fear conditioning test was significantly shortened, and the contents of IL-1β were increased at 1 and 3 days after surgery, the contents of TNF-α were increased at 3 and 7 days after surgery, and the expression of CD200 and CD200R1 was up-regulated at 1 day after surgery in group PND (P<0.05). Experiment Ⅱ Compared with IgG1-Fc group, the freezing time in the contextual fear conditioning test was significantly prolonged at 1 day after surgery in CD200-Fc group (P<0.05).@*Conclusion@#Up-regulated expression of hippocampal CD200R1 is the endogenous protective mechanism of PND in mice.
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Objective To evaluate the role of hippocampal CD200 receptor 1(CD200R1)in peri-operative neurocognitive disorders(PND)in mice.Methods Sixty clean-grade male C57BL/6 mice,aged 9-10 months,weighing 32-38 g,were used in the study.The experiment was performed in two parts.Ex-periment Ⅰ Thirty-six mice were divided into 2 groups(n＝18 each)using a random number table meth-od: control group(group C)and PND group.Group C only received isoflurane anesthesia.Partial left lo-bectomy of the liver was performed under isoflurane anesthesia in group PND.Contextual fear conditioning test was performed at 1,3 and 7 days after surgery,and the freezing time was recorded.The mice were then sacrificed,and the hippocampus was isolated for determination of interleukin-1β(IL-1β)and tumor necrosis factor-α(TNF-α)contents(by enzyme-linked immunosorbent assay)and CD200 and CD200R1 expression(by Western blot).ExperimentⅡ Twenty-four mice were divided into 2 groups(n＝12 each)using a random number table method: CD200-Fc group and IgG1-Fc group.Recombinant proteins CD200-Fc and human IgG1-Fc were injected into the lateral cerebral ventricle in CD200-Fc group and IgG1-Fc group,respectively.Partial left lobectomy of the liver was performed after the end of injection.Contextual fear conditioning test was performed at 1 and 3 days after surgery,and the freezing time was recorded.Re-sults Experiment Ⅰ Compared with group C,the freezing time in the contextual fear conditioning test was significantly shortened,and the contents of IL-1β were increased at 1 and 3 days after surgery,the contents of TNF-α were increased at 3 and 7 days after surgery,and the expression of CD200 and CD200R1 was up-regulated at 1 day after surgery in group PND(P＜0.05).ExperimentⅡ Compared with IgG1-Fc group,the freezing time in the contextual fear conditioning test was significantly prolonged at 1 day after surgery in CD200-Fc group(P＜0.05).Conclusion Up-regulated expression of hippocampal CD200R1 is the endogenous protective mechanism of PND in mice.
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Objective To compare the accuracy of lactate concentration and model for end-stage liver disease (MELD) to predict early mortality after liver transplantation, and to provide a convenient and timely predictive tool for clinical work. Methods A total of 121 patients who underwent Allograft liver transplantation in 2017 in our hospital, 92 males and 29 females, aged 25-78 years old, ASA physical status Ⅲ or Ⅳ, were selected to the retrospective study. Patients were divided into survival group and non-survival group, according whether survived within 30 days after the surgery. The preoperative and postoperative lactate concentrations were gotten and the preoperative and postoperative MELD scores were calculated. The preoperative lactate concentrations, postoperative lactate concentrations, preoperative MELD scores and postoperative MELD scores were compared between survival group and non-survival group, respectively. The predictive accuracy about early mortality (30 days) of lactate concentration and MELD score were compared at preoperation and postoperation through receiver operating characteristic, respectively. Results There were 109 patients (90.0％) survived and 12 patients (10.0％) non-survived within 30 days after the surgery. Compared with survival group, the preoperative lactate concentrations, postoperative lactate concentrations, preoperative MELD scores and postoperative MELD scores in the non-survival group were significantly increased (P ＜ 0.05). According to the ROC analysis, the area under the curve (AUC) of ROC of preoperative lactate concentration was 0.78 (95％ CI 0.62-0.93) with a cutoff value of 2.43 mmol/L, the AUC of preoperative MELD score was 0.70 (95％ CI 0.53-0.87) with a cutoff value of 24.50 scores. There was not statistically significant between the AUC of preoperative MELD score and lactate concentration. The AUC of postoperative lactate concentration was 0.85 (95％ CI 0.70-0.99) with a cutoff value of 9.57 mmol/L, the AUC of postoperative MELD score was 0.74 (95％ CI 0.61-0.88) with a cutoff value of 25.42 scores. The AUC of postoperative lactate concentration was statistically higher than that of MELD score (P ＜ 005). Conclusion The predictive capability of lactate concentration, especially that of postoperative lactate concentrations, was better than the predictive capability of MELD score.
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Objective To evaluate the effect of different approaches to thoracolumbar interfascial plane (TLIP) block on the analgesic efficacy after lumbar spinal fusion.Methods Seventy-five patients of both sexes,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,aged 40-70 yr,with body mass index ≤40 kg/m2,undergoing posterior median approach to lumbar spinal fusion,were divided into 3 groups (n =25 each) using a random number table method:patient-controlled intravenous analgesia (PCIA) group (group P),medial approach to TLIP combined with PCIA group (group MP) and lateral approach to TLIP combined with PCIA group (group LP).TLIP block was performed by advancing the block needle in a lateral to medial direction and injecting 0.5％ ropivacaine 20 ml locally between the bilateral multifidus and longissimus muscles in group MP.TLIP block was performed by advancing the block needle in a medial to lateral direction and injecting 0.5％ ropivacaine 20 ml locally between the bilateral longissimus and iliocostalis muscles in group LP.The identification rate and distinction score between multifidus and iliocostalis muscles obtained from ultrasonic images were recorded before block in MP and LP groups.All the patients received PCIA until 48 h after surgery.PCIA solution contained sufentanil 100 μg and tropisetron 10 mg diluted to 100 ml with 0.9％ normal saline.The PCA pump was set up with a 2 ml bolus dose,a 15-min lockout interval and background infusion at a rate of 1 ml/h.When visual analogue scale score at rest ＞4 after surgery,parecoxib 40 mg was intravenously injected for rescue analgesia.The development of adverse reactions such as nausea and vomiting was recorded within 48 h after surgery.Results The identification rate and distinction score of the iliocostalis was significantly higher than that of the multifidus (P＜0.05).Compared with group P,the intraoperative consumption of propofol and remifentanil was significantly decreased,the pressing times of PCA,amount of drugs consumed in PCA and consumption of parecoxib were decreased within 48 h after surgery (P＜0.05),and no significant change was found in the incidence of nausea or vomiting in MP and LP groups (P＞0.05).There was no significant difference in the parameters mentioned above between group MP and group LP (P＞0.05).Conclusion Ultrasound-guided medial and lateral approaches to TLIP block is helpful in achieving low-dose opioid anesthesia mode and more helpful in enhancing the efficacy of PCIA when used for lumbar spinal fusion.
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Objective To compare the efficacy of ultrasound-guided lumbar epidural access using paramedian transverse scanning (PMTS) versus paramedian saggital scanning (PMSS) with the needle inplane.Methods Fifty American Society of Anesthesiologists physical status Ⅰ-Ⅲ patients,aged 50-75 yr,weighing 55-85 kg,undergoing lower extremity surgery under combined spinal-epidural anesthesia,were divided into PMSS group (n=25) and PMTS group (n=25) using a random number table.The realtime ultrasound-guided lumbar epidural access (L3,4) was performed using PMTS and PMSS in PMTS and PMSS groups,respectively.The visibility of ligamentum flavum,posterior and anterior dura maters,posterior epidural space on the prepuncture ultrasound images,imaging quality score,time for puncture and depth of puncture were recorded.The development of air ultrasonic contrast sign and backflow of cerebrospinal fluid from the spinal needle were recorded.The development of adverse reactions such as paresthesia and hypokinesia was also recorded on 2 days after operation.Results Compared with group PMSS,the time for puncture was significantly shortened,the depth of puncture was shallower (P＜0.05),and no significant change was found in the visibility of spinal structure,imaging quality score or air ultrasonic contrast sign and incidence of backflow of cerebrospinal fluid in group PMTS (P＞0.05).No significant change was found in adverse reactions such as paresthesia or hypokinesia between the two groups (P＞0.05).Conclusion PMTS provides clear imaging and simple and convenient operation in guiding lumbar epidural access with the needle in-plane when compared with PMSS,and it is worthy of clinical application.
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Objective To explore the perioperative outcomes and safety of enhanced recovery after surgery (ERAS) in laparoscopic radical cystectomy (LRC).Methods We retrospectively evaluated outcome of 10 LRC patients on ERAS protocol from May 2017 to October 2017,and 39 LRC patients on conventional recovery after surgery(CRAS) protocol from July 2015 to November 2016.There were (60.9 ±11.4) years and (63.7 ± 12.1) years in ERAS group and CRAS group respectively(P =0.514);(25.5 ±2.7) kg/m2 and (24.4 ± 3.6) kg/m2 with body mass index (P =0.375).Both of the median of charlson comorbidity index (P =0.931) and American Society of Anesthesiologists score (P =0.254) were 2 There was no statistical significance between the two groups for type of urinary diversion and preoperative laboratory studies (P ＞ 0.05).Patients' perioperative outcomes,early (30-day) complications and postoperative readmission rate were compared.Results The ERAS group had less intraoperative crystalloid infusion [(950.0 ± 474.3) ml vs.(1 797.4 ± 448.1) ml,P ＜ 0.001],faster removed gastric tube (0 d vs.4 d,P ＜0.001),and shorter passing flatus time [(1.6 ± 0.8) d vs.(2.9 ± 1.4) d,P =0.006] than the CRAS group;however,no difference was found in terms of intraoperative colliod infusion [(1 110.0 ± 331.5)ml vs.(1 117.9 ± 397.9) ml,P =0.954].No patients from either group required conversion to open surgery.There was no significant difference between the two groups for operative time (P =0.311),estimated blood loss (P =0.073),drain days (P =0.681),postoperative hospital stay (P =0.509),overall blood transfusion (P =1.000),intensive care unit stay (P =1.000) and tumor characteristics (pathological stage,histology,nodes removed,positive nodes,lymph node-positive patients,positive surgical margins).The 30-day postoperative complications were documented in 5 (50％)and 23 (59％)patients in groups ERAS and CRAS (P =0.878),respectively.And the most common complication were minor complications (Clavien-Dindo grade 1 and 2) in both groups (100.0％ vs.86.9％,P =0.729).The 30-day readmission rate was 20.0％ (2 patients) in ERAS group and 10.3％ (4 patients) in CRAS group with no statistical significance(P =0.588).Conclusions Our ERAS protocol expedited bowel function recovery after RC and urinary diversion without increasing in 30-day complications compared with CRAS.The key of implement ERAS pathway is to explore and develop their own protocol conformed to their medical treatment enviroment.
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Objective To observe the effect of ultrasound-guided single erector spinae plane (ESP ) block combined with patient-controlled intravenous analgesia (PCIA ) on postoperative analgesia in patients undergoing lobectomy performed via video-assisted thoracoscope. Methods Forty patients (20 males and 20 females,ASA physical status Ⅰ or Ⅱ),scheduled for e-lective video-assisted thoracoscopic lobectomy,were randomly assigned into two groups,ESP block combined with PCIA group (group EP)and PCIA only group (group P).ESP block was given to pa-tients in group EP before operation,and its effect was evaluated by testing the area of block.VAS scores were recorded at 1,6,18,24 and 48 h after operation.The frequency for compress PCIA,the volume of analgesic drugs,the consumption of flurbiprofen axetil and the side-effects were recorded as well.Results ESP block was accomplished in group EP with sensory loss from T2-T8 or T3-T7 over the entire posterolateral aspect of the hemithorax.And there were no puncture-related complications. The VAS scores both at rest and coughing in group EP were lower than those in group P (P <0.05). The compress PCA numbers,the volume of analgesic drugs and the consumption of flurbiprofen axetil were significantly less in group EP than those in group P (P <0.05).Only nausea and vomiting were observed as postoperative side effects,and there were no significant differences between the two groups.Conclusion Ultrasound-guided single erector spinae plane block combined with PCIA is a sa-fer and more effective method for the analgesia of thoracic operation than PCIA only.
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Objective To evaluate the effect of pretreatment with botulinum toxin A injected intrath?ecally or locally at the incision site on the neurokinin?1 ( NK?1) receptor internalization in the spinal dorsal horn in a rat model of incisional pain. Methods Male Sprague?Dawley rats, weighing 280-300 g, aged 6-8 weeks, were used in the study. The experiment was performed in two parts. ExperimentⅠ Twenty?seven rats with no sign of nerve injury at day 7 after successful catheterization were selected and divided into 3 groups (n=9 each) using a random number table: control group (C1 group), incisional pain group (IP1 group) and intrathecal botulinum toxin A group (BoNT∕A1 group). At 24 h before operation, botulinum tox?in A 0.5 U ( in 10μl of normal saline) was injected intrathecally in group BoNT∕A1, and normal saline 10μl was injected intrathecally in group IP1. ExperimentⅡ Twenty?seven rats were selected and divided into 3 groups (n=9 each) using a random number table: control group (group C2), incisional pain group (IP2 group) and locally injected botulinum toxin A at the incision site group (BoNT∕A2 group). At 24 h before op?eration, botulinum toxin A 2 U ( in 0.4 ml of normal saline) was injected subcutaneously at the incision site and into the plantar surface, and normal saline 0.4 ml was injected subcutaneously at the incision site and into the plantar surface in group IP2. Six rats in each group were selected, and the cumulative pain score (CPS) was recorded, and the mechanical paw withdrawal threshold ( MWT) in the right hindpaw was measured be?fore administration, before operation, and at 3 h and 1, 3, 5 and 7 days after operation. At 3 h after opera?tion, 3 rats in each group were selected and sacrificed, and the lumbar segment ( L4,5 ) of the spinal cord was removed for determination of the expression of NK?1 receptors in the spinal dorsal horn by immunofluores?cence. Results ExperimentⅠ Compared with group C1, the CPS was significantly increased at 3 h and 1, 3, 5 and 7 days after operation, the MWT was significantly decreased at 3 h and 1 and 3 days after opera?tion, and the expression of NK?1 receptors in the spinal dorsal horn was significantly up?regulated in group IP1, and the CPS was significantly increased at 3 h and 1, 3 and 5 days after operation, the MWT was sig?nificantly decreased at 3 h after operation ( P0.05). Compared with group IP1, the CPS was significantly decreased, and the MWT was significantly increased at 3 h and 1, 3, and 5 days after oper?ation, and the expression of NK?1 receptors in the spinal dorsal horn was significantly down?regulated in group BoNT∕A1 (P0.05) . Compared with group IP2, the CPS was significantly decreased at 3 h and 1, 3, and 5 days after operation, the MWT was signifi?cantly increased at 3 h and 1 and 3 days after operation, and the expression of NK?1 receptors in the spinal dorsal horn was significantly down?regulated in group BoNT∕A2 (P<0.05). Conclusion Pretreatment with botulinum toxin A injected intrathecally or locally at the incision site can inhibit the internalization of NK?1 re?ceptors in the spinal dorsal horn in a rat model of incisional pain.
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Objective To evaluate the feasibility of using stroke volume variation (SVV) as the left ventricular preload to draw the cardiac function curve.Methods Twenty-seven patients of both sexes,aged 18-64 yr,with body mass index of 18-30 kg/m2,of American Society of Anesthesiologists physical status Ⅱ (New York Heart Association Ⅱ),with abnormal cardiac function,scheduled for elective offpany coronary artery byp grafting,were enrolled in this study.Twenty-five patients,aged 18-64 yr,with body mass index of 18-30 kg/m2,of American Society of Anesthesiologists physical status Ⅰ (New York Heart Association Ⅰ),with normal cardiac function,scheduled for elective non-cardiac surgery,were also enrolled in this study.SVV and SV were monitored by using a FloTrac/VigileoTM system.The patients were in the supine position from the end of anesthesia induction to the beginning of surgery.After the hemodynamics was kept stable for 5 min,SVV and SV were recorded.6％ hydroxyethyl starch 130/0.4 500 ml was intravenously infused over 20 min.SVV and SV were recorded after volume expansion.Spearman rank-order correlation was used to analyze the relationship between SVV and SV.The quadratic regression analysis was used to draw the SVV-SV curve,and the SVV-SV curve was compared with the Frank-Starling curve.Results Compared with the value before volume expansion,SVV and HR were significantly decreased,and SV was increased after volume expansion in the patients with normal cardiac function,and SVV was decreased after volume expansion in the patients with abnormal cardiac function (P＜0.01).SVV was negatively correlated with SV in the patients with normal cardiac function,and r=-0.467 (P＜0.05).SVV was negatively correlated with SV in the patients with abnormal cardiac function,and r=-0.378 (P＜0.05).The mirror symmetry was found between the SVV-SV curve in the patients with normal cardiac function and the normal Frank-Starling curve,and the general trend was close.The symmetry was not detected between the SVV-SV curve in the patients with abnormal cardiac function and the Frank-Starling curve in the patients with decreased myocardial contractility,and the general trend was not close.Conclusion For the patients with normal cardiac function,SVV can be used as the left ventricular preload to draw the cardiac function curve.
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Objective To evaluate the effects of lidocaine in combination with sevoflurane on myocardial protection in patients undergoing off-pump coronary artery bypass grafting (OPCABG).Methods One hundred ASA physical status Ⅱ or Ⅲ and NYHA class Ⅰ or Ⅱ patients of both sexes,aged 45-70 yr,weighing 63-82 kg,scheduled for elective OPCABG,were randomly assigned into 4 groups (n=25 each):control group (group C),lidocaine group (group L),sevoflurane group (group S),sevoflurane combined with lidocaine group (group SL).Tracheal intubation was performed after induction of anesthesia.Anesthesia was maintained with iv infusion of propofol and intermittent iv boluses of sufentanil and pipecuronium.Bispectral index value was maintained at 45-55.Lidocaine 1.5 mg/kg was injected after intubation,followed by infusion at 2 mg/min until the end of surgery in L and SL groups.Sevoflurane was inhaled with end-tidal concentration of 2.2％-2.5％ starting from the end of intubation until the end of operation in S and SL groups.Before induction of anesthesia,at skin incision,immediately after transsection of internal mammary artery,after completion of anastomosis of the proximal aortovein and distal coronary artery,at the end of operation and at 24 h during operation,venous blood samples were obtained to detect the levels of plasma creatine kinase (CK),creatine kinase isoenzyme-MB (CK-MB) and cardiac troponin Ⅰ (cTnI).Lidocaine-related side effects such as arrhythmia,bradycardia or cardiac arrest were recorded during operation and within 24 h after operation.Results Compared with group C,the plasma CK,CK-MB and cTnI levels were decreased in the S,L and SL groups.The plasma CK-MB and cTnI levels were significantly lower in SL group than in L group.The plasma CK,CK-MB and cTnI levels were significantly lower in SL group than in S group.In L and SL groups,no patient developed lidocainerelated side effects.Conclusion Lidocaine 1.5 mg/kg injected intravenously after intubation,followed by infusion at 2 mg/min in combination with sevoflurane end-tidal concentration about 2.2％ ～2.5％ provides myocardial protection in patients undergoing OPCABG,the efficacy is stronger than that of either alone.
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Objective To investigate the effect of batroxobin combined with tranexamic acid on the perioperative bleeding and blood coagulation in the patients undergoing adolescent idiopathic scoliosis.Methods Eighty ASA Ⅰ or Ⅱ patients,aged 15-26 yr,weighing 41-56 kg,scheduled for elective adolescent idiopathic scoliosis,were randomly divided into 4 groups (n =20 each):normal saline group (group A),batroxobin group (group B),tranexamic acid group (group C) and batroxobin combined with tranexamic acid group (group D).0.9 ％ normal saline was infused after admission to the operating room in group A.Batroxobin 0.02 U/kg was infused at 20 min before skin incision,an increment of 0.02 U/kg was given every 2 h until the end of operation and the maximal dose was less than 1 U in group B.Tranexamic acid 20 mg/kg was injected immediately before skin incision,followed by infusion at 10 mg· kg-1 · h-1 until the end of operation in group C.In group D,batroxobin and tranexamic acid were given as the method described in B and C groups.The intraoperative blood loss,volume of autologous and allogeneic blood transfused,transfusion of fresh frozen plasma (FFP),and volume of drainage within 24 h after operation were recorded.Blood routine,prothrombin time (PT),activated partial thromboplastin time (APTT),fibrinogen (Fbi),thrombin time (TT),activated clotting time (ACT),clot rate (CR) and platelet function (PF) were measured.Deep vein thrombosis was detected at 1 week after operation.Results Compared with group A,the intraoperative blood loss,volume of allogeneic blood transfused,transfusion of FFP,volume of autologous blood transfused and volume of postoperative drainage were significantly reduced,and Plt and Fib were significantly increased at T2,3 in groups B,C and D,and PF was increased at T2 in group C,Hct,Plt,Fib and PF were increased and PT was prolonged at T2,3 in group D (P ＜ 0.05).Compared with group B,the intraoperative blood loss,volume of allogeneic blood transfused,transfusion of FFP,volume of autologous blood transfused and volume of postoperative drainage were significantly decreased and Hct,Plt,Fib and PF were increased at T2,3 in group D,and the volume of postoperative drainage was increased and Plt increased at T2,3 was in group C (P ＜ 0.05).Compared with group C,the intraoperative blood loss,volume of allogeneic blood transfused,volume of autologous blood transfused,volume of postoperative drainage and transfusion of FFP were significantly decreased and Hct,Plt,Fib and PF were significantly increased at T2,3 in group D (P ＜ 0.05).No patients developed blood coagulation disorder and deep vein thrombosis.Conclusion Batroxobin combined with tranexamic acid can significantly reduce the intraoperative blood loss and volume of allogeneic blood transfused and improve the blood coagulation,and the efficacy is superior to that of either alone for the patients undergoing adolescent idiopathic scoliosis.
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Objective To investigate the changes in trafficking of GluRl-containing AMPA (GluR1-AMPA) receptor and GluR2-AMPA receptor from cytoplasm to cell membrane in the spinal cord dorsal horn in a rat model of incisional pain.Methods Thirty-two adult male SD rats aged 6-8 weeks weighing 280-300 g were randomly divided into 2 groups:control group (group C,n =8) and incisional pain group (group Ⅰ,n =24).An 1 cm long incision was made in the plautar surface of right hindpaw according to Brennan et al.in group Ⅰ.Cumulative pain score (CPS) and paw-withdrawal threshold to yon Frey stimuli (PWT) were measured at 3 h and day 1 and 3 afar incision ( T1,2,3 ).The animals were sacrificed after pain behavior assessment.Their lumbar segments of the spinal cord (L3-6) were removed.The expression of GluR1 and GluR2 in cell membrane and cytoplasm in spinal cord dorsal horn was determined by Western blot analysis.The co-expression of Stargazing with GluR1 and GluR2 in the spinal cord dorsal horn was examined by co-immuno-precipitation.Results The CPS was increased and PWT decreased; the GluR1 expression in cytoplasm was decreased while the expression of GluR1 in cell membrane and the co-expression of Stargazing with GluR1 were up-regulated in group Ⅰ as compared with group C.There was no significant change in the expression of GluR2 in cytoplasm and cell membrane and the co-expression of Stargazing with GluR2 in group Ⅰ as compared with group C.Conclusion GluR1-AMPA receptor transfers from cytoplasm to cell membrane but GluR2-AMPA receptor does not in rats with incisional pain.
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Objective To investigate the effects of propofol on the phosphoryhtion of α-amino-3-hydroxy5-methyl-4-isoxazolepropionate(AMPA)receptor GluR1 subunits at Serine-831 and Serine-845 sites in the spinal cord dorsal horn in a rat model of visceral pain.Methods Thirty male SD rars,aged 6-8 weeks,weighing 200300 g,in which intrathecal catheters were successfully placed without complications,were randomly divided into 3 groups(n-=10 each):sham operation group(group Ⅰ),visceral pain group(group Ⅱ)and propofol group (group Ⅲ).Visceral pain was induced by injection of 10％ capsaicin 50μl via the rectum in groups Ⅱ and Ⅲ.While the equal volume of normal saline was given instead in group Ⅰ.Group Ⅲ received intrathecal injection of propofol 20 tg at 10 min before injection of capsaicin.While the equal volume of dimethyl sulfoxide was given instead of propofol in groups Ⅰ and Ⅱ.The cumulative pain score was recorded during 30 min after capsaicin injection.The rats were then sacrificed,and the lumbar segment(L3-6)of the spinal cord was removed for determination of the expression of GluR1 subunits and phosphorylation of GluR1 subunits at Serine-831 and Serine-845 sites in the spinal cord dorsal horn.Results Compared with group Ⅰ,the cumulative pain score and phosphorylation of GluR1 subunits at Serine-831 sites and Serine-845 in the spinal cord dorsal horn were significantly increased(P ＜0.05 or 0.01),but there were no significant differences in the expression of GluR1 subunits in groups Ⅱ and Ⅲ (P ＞ 0.05).Compared with group Ⅱ,the cumulative pain score and phosphorylation of GluRl subunits at Serine831 and Serine-845 sites in the spinal cord dorsal horn were significantly decreased in group Ⅲ(P ＜ 0.05 or 0.01).Conclusion Propofol can attenuate the visceral pain through the inhibition of the phosphorylation of AMPA receptor GluR1 subunits at Serine-831 and Serine-845 sites in tte rat spinal cord dorsal horn.