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Objective:To investigate the application effect of dexmedetomidine combined with propofol and remifentanil in fiberoptic bronchoscopy in elderly patients with chronic obstructive pulmonary disease(COPD).Methods:From October 2018 to November 2019, 112 elderly patients with COPD who were examined by fiberoptic bronchoscopy in the Affiliated Hospital of Medical College of Ningbo University were divided into control group and observation group, with 56 cases in each group.Propofol and remifentanil were used for anesthesia induction in both two groups.Dexmedetomidine (0.5μg/kg) was injected intravenously into observation group, and later 0.5μg·kg -1·h -1 continuous infusion, the control group was given the same dose of 0.9% sodium chloride injection.The OAA/S scores, propofol dosage, remifentanil dosage, wake-up time, heart rate, oxygen saturation, mean arterial pressure, pulmonary function changes and adverse reactions were compared between the two groups. Results:At the fiberbronchoscope entered immediately and 10 min after examination, the OAA/S scores in the observation group were (1.03±0.35)points, (4.42±0.28)points, respectively, which in the control group were (1.22±0.22)points, (3.01±0.22)points, respectively, the differences between the two groups were statistically significant( t=3.439, 29.631, all P<0.05). The dosages of propofol and remifentanil in the observation group were (3.00±0.28)μg/kg and (1.65±0.29)μg/kg, respectively, which were less than those in the control group [(3.70±0.39)μg/kg, (2.42±0.45)μg/kg], the recovery time was (8.40±1.58)min, which was shorter than that in the control group [(13.31±2.02)min], the differences were statistically significant( t=10.911, 10.763, 14.327, all P<0.05). The heart rate, oxygen saturation, mean arterial pressure, pulmonary function(FEV 1, MVV) in the observation group were significantly better than those in the control group( t=9.757, 11.981, 11.486, 11.913, 40.189, all P<0.05). The incidence of adverse reactions in the observation group was 7.14%(4/56), which was lower than 19.64%(11/56) in the control group(χ 2=6.737, P<0.05). Conclusion:Dexmedetomidine(0.5μg/kg, followed by 0.5μg·kg -1·h -1 continuous infusion) and target controlled infusion of propofol and remifentanil are safe for elderly patients with COPD, and the use of anesthetic drugs is small, which can shorten the recovery time after operation, and will not have a great impact on respiratory circulation.
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Aim To establish insulin resistance cell model on HepG2 cells (human embryonic liver tumor cells )and investigate the effect of berberine hydro-chloride on insulin-resistant HepG2 (IR-HepG2 ) cells.Methods ① IR model was induced by respec-tively using 10 -9 ,10 -8 ,10 -7 ,10 -6 ,10 -5 ,10 -4 mol ·L-1 insulin with 25 mmol · L-1 glucose in HepG2 cells.② HepG2 cells were incubated with 2-NBDG (fluorescent labeled glucose)in a series of concentra-tion:50,100,200,400,600,800 μmol·L-1 and a series of incubation time:20,40,60,80,100 min, to select the optimum concentration of insulin and the optimum incubation concentration and time of 2-NBDG in HepG2 cells.The success of the model was deter-mined by detecting the consumption of glucose in the cell supernatant and the uptake of glucose in HepG2 cells.③To study the effect of berberine hydrochloride on improving insulin resistance on the cell level,met-formin and berberine hydrochloride were used in the IR cells.Results Six concentrations of insulin induced the IR model in different degrees.Although 10 -4, 10 -5 mol·L-1 insulin was significant,a large amount of cells died.10 -6 mol·L-1 insulin was effective and had high survival rate of HepG2 cells,which had sta-tistical significance compared with the normal group. When the incubation concentration of 2-NBDG was more than 100 mol·L-1 ,the fluorescence intensity of the cells was significantly different from the normal group.When the incubation time of 2-NBDG was more than 20 min,fluorescence intensity was significantly different from the normal group.When the incubation time of 2-NBDG was more than 100 min,the fluores-cence quenching phenomenon was obvious in the cells. Berberine hydrochloride and metformin significantly in-creased the glucose consumption and glucose uptake in cell supernatant, which had statistical significance compared with the model group.Conclusions Using 10 -6 mol · L-1 insulin induced IR model in HepG2 cells,the optimum incubation concentration and incu-bation time of 2-NBDG is 200 μmol·L-1 and 80 min, respectively.Berberine hydrochloride and metformin have obvious effect on improving IR in HepG2 cells.
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Objective To evaluate the effects of early and late tracbeostomy on patients with acute severe cerebral trauma.Methods In the retrospective study,167 patients with severe brain trauma ( GCS ＜ 9 ) requiring prolonged mechanical ventilation ( MV ) were managed by percutaneous dilational tracheostomy (PDT) from May 2001 to December 2010.According to the transoral incubation MV duration,the patients were divided into the early tracheostomy (ET) group ( MV duration≤7 d,81 cases)and late tracheostomy (LT) group (MV duration ＞ 7 d,86 cases).The basic clinical characteristics,pre-and post-PDT MV period,total MV duration,length of post-PDT ICU stay,length of ICU stay,length of hospital stay and mortality were compared between the two groups.Results The two groups showed no statistical differences in aspects of age,sex,acute physiology and chronic health evaluation Ⅱ (A-PACHE Ⅱ ) score,GCS,trauma index and craniotomy rate (P＞0.05).Compared with LT group,ET group significantly shortened the pre-PDT MV period [ (5.16 ± 1.33 ) d∶ ( 1 1.64 ± 4.25 ) d,P ＜ 0.01 ],post-PDT MV period ( median:15.0 d∶ 17.0 d,P ＜ 0.05 ),total MV duration ( median:18.0 d∶26.0 d,P＜0.05),length of post-PDT ICU stay (median:16.0 d∶21.0 d,P＜0.01 ) and length of ICU stay (median:21.0 d∶32.0 d,P ＜0.01 ).But the two groups had no statistical differences concerning the length of hospital stay ( P ＞ 0.05 ),ICU mortality ( 17％ ∶ 14％,P ＞ 0.05 ) and in-hospital mortality (25％∶28.4％,P ＞0.05).Kaplan-Meier curves showed that the frequency of MV and ICU stay rate within 60 days in ET group were significantly lower than those in LT group.Conclusions For patients with severe brain trauma,early tracheostomy shortens the duration of MV and length of ICU stay without affecting their prognosis.Thereby,tracheostomy can be performed at early stage when managing acute severe brain injury.