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Objective:To investigate the application of non-intravenous dexmedetomidine(DEX)in the pediatric patients underwent lower abdomen and limb surgery,and to observe the sedative effect of DEX in this procedure. Methods:Sixty patients undergoing the general anesthesia for lower abdomen and limb surgery were selected and randomly devided into ropivacaine sacral block(RS)group,intranasal DEX+ ropivacaine sacral block(ID)group, ropivacaine + DEX sacral block(DS)group,20 cases in each group.The children in ID group received intranasal DEX 1 μg·kg-130 min before operation and the children in RS and DS groups received physiological saline. 1 mL·kg-1propofol was infused intravenously in the children who could not smoothly enter into the operating room as well as the intolerance to oxygen mask or sevoflurane inhalation while induction.The children in RS and ID groups received 0.25% ropivacaine 1 mL·kg-1,and the children in DS group received the same dose of ropivacaine mixed with 1 μg·kg-1DEX,and the total volume of drugs was 20 mL.The general information of each child was recorded;the sedation status when separated from their parents and induction period mask and sevoflurane acceptance scores were assessed;the satisfaction of separation with parents,oxygen mask and sevoflurane inhalation were recorded;the time of operation,induction,extraction of laryngeal mask and anesthesia awake were recorded;delayed awakening,laryngismus and awakening period agitation score were recorded.The scores of anesthesia recovery and the dosage of propofol were recorded;the sedation scores 4,8,12,16,20,and 24 h after operation were recorded.Results:Compared with RS and DS groups,the sedation scores of the children when they were separated from their parents and mask induction and sevoflurane inhalation acceptance,the satisfaction degree of separation,mask and sevoflurane acceptance in ID group were increased(P<0.05);the dosage of propofol in ID group were decreased(P<0.05).The time of operation,extraction of laryngeal mask and anesthesia awake had no significant differences between three groups(P>0.05),the induction time of children in ID group was shorter than those in RS and DS groups(P<0.05).There was no delayed awakening in three groups,and the laryngismus and the awakening period agitation score in RS group were higher than those in ID and DS groups(P<0.05).There was no differences in the consciousness,respiration,activity scores and the scores of anethesia recovery between three groups(P>0.05).The sedation scores in the three groups were less than 3 points 4 h after operation. Compared with RS group,the sedation scores in ID and DS groups were decreased 8 h after operation(P<0.05). Compared with RS and ID groups,the sedation scores in DS group 12,16 and 20h after operation were decreased (P<0.05).There were no significant differences in the sedation scores between three groups 24 h after operation (P>0.05).Conclusion:When non-intravenous DEX is used in the pediatric patients underwent lower abdomen and limb surgery,the children can quietly and co-operationly enter into the operating room and quickly and smoothly complete the induction process;the incidence of revival restlessness is significantly reduced,and it can play a role in the early postoperative sedation.
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Objective To investigate the influence of pure intercostal nerve block combined with hydromorphone hydrochlo-ride intravenous analgesia on the occurrence of postoperative cognitive function and analgesia in elder patients with thoracic surger-y.Methods Ninety-six ASA I?Ⅱ elder patients with elective thoracic operation were divided into intercostal nerve block group (A),intercostal nerve block combined with hydromorphone hydrochloride intravenous analgesia group (B)and hydromorphone hydrochloride intravenous analgesia group(C)according to the random number table method,32 cases in each group.The patient-controlled intravenous analgesia(PCIA)with sufentanyl was postoperatively performed in all cases.When analgesia effect was poor, dezocine 0.1mg/kg was intravenously injected.The mean artery pressure(MAP),heart rate(HR),respiratory rate(RR),visual ana-logue scale (VAS)score and mini mental state examination (MMSE)score were recorded at postoperative 2,6,24,48 h in 3 groups.Results The MMSE score in the group B was higher than that in the group A and C,the VAS score was lower than that in the group A and C,the difference was statistically significant(P <0.05).Postoperative MAP and HR in the group B were more sta-ble than those in the group A and C,the difference was statistically significant(P <0.05).RR in the group C was more fast and had smaller range than those in the group A and B,the difference was statistically significant(P <0.05).Conclusion Intercostal nerve block combined with hydromorphone hydrochloride intravenous analgesia can achieve better postoperative analgesic effect with sta-ble postoperative blood dynamics and low occurrence rate of early postoperative cognitive dysfunction.
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Objective To investigate the effects of preemptive analgesia with nalbuphine on inflammatory factors in elderly patients undergoing thoracotomy. Methods Eighty elderly patients with ASA I or Ⅱ undergoing thoracotomy were randomly allocated into control group (group C:n=40) and Nalbuphine group (group N:n=40). Each patient received 20 mg of Nalbuphine intravenously before induction of anesthesia in group N and same volume of normal saline in group C. Plasma levels of IL-10, TNF-α and IL-6 were measured at different time points. The VAS was recorded and the MAP, HR, SpO2 and PaCO2 were monitored. Results Compared with group C, the levels of TNF-α and IL-6 were lower, while IL-10 was higher at T2, T3, T4 in group N(P < 0.05). The VAS, MAP, HR and PaCO2 in group N were lower than those in group C at T2, T3 and T4 (P < 0.05). Conclusion Preemptive analgesia with Nalbuphine can improve the efficacy of postoperative analgesia and effectively reduce inflammatory reaction in the old patients undergoing thoracotomy.
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Objective To investigate the influence of preemptive analgesia with Hydr- omorphone Hy-drochloride on postoperative cognitive function and inflammation cytokines in the elderly patients. Methods Ninety ASA I orⅡ elder patients were randomly divided in control group (C)and Hydromorphone Hydrochloride group(H) with 45 cases each. Hydromorphone Hydrochloride 2 mg was injected iv before induction of anesthesia in group H. Observed plasma concentrations of the CRP、 TNF-α and IL-6 at different time. Cognitive function was assessed by minimental state examination. Results Plasma the CRP、 TNF-a and IL-6 concentrations were lower and MMSE scales were higher in group H than in group C. Conclusion Preemptive analgesia with Hy-dromorphone Hydrochloride 2 mg can reduce the incidence of postoperative cognitive dysfunction in the elderly patients.
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Objective To explore the anticoagulation effect of low molecular weight heparin (LMWH) combination with warfarin at the early stage at the treatment of intracranial venous sinus thrombosis.Methods 80 cases of intracranial venous sinus thrombosis patients in people's hospital of Xinjiang Uygur autononous region from January 2010 to December 2014 were chosen to be analyzed retrospectively.37 cases in observation group were treated with low molecular heparin (LMWH) in combination with warfarin, and 43 cases in control group were treated with warfarin.The clinical curative effect between two groups was compared post-treatment.Results The effective rate in observation group was 91.89%, which was significantly higher than 67.44% in control group (P<0.05) .The recanalization rate of involved intracerebral venous in observation group was 89.19%, which was significantly higher than 67.29% in control group(P<0.05).After treatment, the prothrombin time (PT), thrombin time (TT) and activated partial thromboplastin time (APTT) were higher and fibrinogen (FBG) in both groups was lower than those pre-treatment(P<0.05).The PT and APTT was higher and FBG was lower in observation group than those in control group(P<0.05).Conclusion Low molecular weight heparin in combination with warfarin worked well than single warfarin in the treatment of intracranial venous sinus thrombosis.
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Objective To study the changes of arterial blood lactate(ABL) and serum enzymes activities and thier correlation.Method Lactate dehydrogenase(LDH),alkaline phosphatase(AKP) and creatine kinase(CK) in serum were determined in sixty-four critical patients in the intensive care unit(ICU) at admission immediately,following 24h,48h and 72h,respectively.The patients was divided into three groups:favorable,survival and death groups.Results Before treatment,ABL level was(3.9?2.5,2.9?1.3 and 3.8?2.3)mmol/L in favorable,survival and death groups respectively.Although ABL in favorable and survival groups were decreased gradually to normal level during 24～72h,the death group showed that the decline was very slowly it still persistent elevated in 72h.There was significanct difference between the death group and the favorable and survival groups(P