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Objective:To evaluate the value of systematic education for primiparas undergoing epidural labor analgesia.Methods:A total of 240 primiparas who were suitable and voluntarily requested epidural labor analgesia, aged 20-35 yr, at 37-41 + 6 weeks gestation, with a singleton fetus, in vertex presentation without fetal abnormality, were selected.According to whether the primiparas and their accompanying family members had received systematic education on epidural labor analgesia during pregnancy, the primiparas were divided into 2 groups ( n=120 each): education group and control group.When the uterine contraction was regular and the diameter of the uterine orifice reached 2 cm or more, epidural labor analgesia was carried out.Before the begining of epidural puncture, the degree of anxiety of pregnant women was evaluated using the self-rating anxiety scale.The time of communication before analgesia, time of placing body position, and satisfaction of puerperae and their family members with labor analgesia were observed and recorded. Results:Compared with control group, the self-rating anxiety scale score was significantly decreased, the time of communication before analgesia and time of placing body position were shortened, and the rate of satisfaction of puerperae and their family members with labor analgesia was increased in education group ( P<0.05). Conclusions:Systematic education is helpful in relieving the anxiety of primiparas during epidural labor analgesia, increasing the efficiency of analgesia implementation and improving the delivery experience of puerperae.
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Objective:To explore the behavior and influencing factors of mobile health (m-Health) information searching among patients with cancer, aiming to provide evidence for the provision of medical health information.Methods:A cross-sectional survey was conducted.A total of 535 patients with cancer were recruited from a cancer hospital in Zhejiang Province from September to December 2017.Measurement tools included the demographic information questionnaire, mobile health information search behavior questionnaire, mobile health information search environment questionnaire, cancer needs questionnaires-short form and ehealth literacy scale.SPSS 26.0 was used for descriptive statistical analysis, one-way analysis of variance, Pearson correlation analysis and multiple linear regression analysis.Results:The total score of mobile health information search behavior of cancer patients was (60.84±9.60), and 66.5% of participants reported that they "never" or "occasionally" searched health information via mobile.The total score of information needs was (80.99±27.86), electronic health literacy was (26.54±7.85), mobile health information search environment was (8.00±2.86). m-Health information search behavior was positively correlated with information needs ( r=0.251, P<0.01), ehealth literacy ( r=0.538, P<0.01), and m-Health information search environment ( r=0.267, P<0.01). The stepwise regression analysis revealed that the place of residence, working status, income level, ehealth literacy, mobile health information search environment and information needs were statistically significant associated with the m-Health information searching behavior among cancer patients, which accounted for 39.3% of the total variance ( F=12.151, P<0.01). Compared with patients living in the central cities, those living in the small and medium-sized cities( β=0.092, P=0.031) had higher score in m-Health information behavior.Compared with patients working on normal schedule, those took sick days ( β=0.156, P=0.017) and working fewer hours ( β=0.138, P=0.002) had higher score m-Health information behavior.Compared with patients with monthly income of 1 000-3 000 yuan ( β=-0.194, P=0.002), those with monthly income less than 1 000 yuan had higher score in m-Health information behavior.The ehealth literacy ( β=0.425, P=0.000), mobile health information search environment ( β=0.179, P=0.000) and information needs ( β=0.091, P=0.027) were positive influencing factors of m-Health information search behavior. Conclusion:Patients with cancer did not report high m-Health information search behavior.Place of residence, working status, income level, ehealth literacy, m-Health information search environment and information demand were the influencing factors of m-Health information search behavior among patients with cancer.
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Objective:To evaluate the accuracy of surgical pleth index (SPI) in monitoring the depth of anesthesia in elderly patients undergoing general anesthesia.Methods:Thirty-five patients, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 65-80 yr, with body mass index of 18-30 kg/m 2, scheduled for elective gynecological laparoscopic surgery, were studied.Combined intravenous-inhalational anesthesia was used to maintain bispectral index value at 45-60.SPI was recorded within 2 min before and after skin incision, before and after pneumoperitoneum, and before and after the most intense stimulation of skin incision.The maximum value (SPI max) within 2 min after noxious stimulation was recorded, and the difference between SPI max and baseline value (ΔSPI) was calculated.The receiver operating characteristic curve (ROC) was used to evaluate the accuracy of the above indicators in monitoring the depth of anesthesia. Results:Thirty patients were finally included in this study.The area under the curve of SPI max was 0.887, the diagnostic threshold was 57, the sensitivity was 68.9%, and the specificity was 92.9%.The area under the curve of ΔSPI was 0.988, diagnostic threshold was 12, the sensitivity was 88.0%, and the specificity was 98.7%. Conclusion:SPI can accurately determine the depth of anesthesia in elderly patients with general anesthesia, and using ΔSPI has more clinical significance.
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Objective To evaluate the effect of neoadjuvant chemotherapy for ovarian cancer on the sedative potency of propofol and oxycodone for anesthesia induction.Methods Sixty-eight American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients,aged 40-64 yr,with body mass index of 20-30 kg/m2,scheduled for elective radical resection of ovarian cancer with general anesthesia,were divided into into 2 groups (n =34 each) according to whether the patients received neoadjuvant chemotherapy before surgery:neoadjuvant chemotherapy group (group Ⅰ) and non-chemotherapy group (group Ⅱ).Patients received 3 cycles of chemotherapy (21 days for 1 cycle),chemotherapy regimen was paclitaxel and carboplatin,and patients underwent surgery after 3 weeks of chemotherapy in group Ⅰ.Anesthesia was induced with Ⅳ oxycodone 0.2 mg/kg.Propofol was given by target-controlled infusion 4 min later,and the effectsite concentration (Ce) of propofol was determined by up-and-down technique,with the initial Ce 1.0 μg/ml and the ratio between the two successive Ces 1.09.The median-effective target plasma concentration (EC50) and 95％ confidence interval of propofol causing loss of consciousness were calculated using Probit analysis.Results The EC50 and 95％ confidence interval of propofol causing loss of consciousness were 1.22 μg/ml (1.14-1.30 μg/ml) and 1.74 μg/ml (1.57-3.19 μg/ml) in group Ⅰ and group Ⅱ,respectively.Compared with group Ⅱ,the EC50 of propofol causing loss of consciousness was significantly decreased in group Ⅰ (P＜0.05).Conclusion Neoadjuvant chemotherapy for ovarian cancer can enhance the sedative potency of propofol and oxycodone for anesthesia induction.
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Objective To evaluate the effects of different doses of dexmedetomidine on stress responses of the hypertensive patients undergoing thoracic surgery and find the uptimal infusion rate of dexmedetomidine in decreasing stress responses.Methods Sixty hypertensive patients of both sexes,aged 45-64 yr,weighing 65-80 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,were divided into 4 groups (n =15 each) using a random number table:control group (group C) and 3 different doses of dexmedetomidine groups (D1-3 groups).In D1,D2 and D3 groups,dexmedetomidine 0.2,0.3 and 0.4 μg · kg 1 · h 1 were intravenously infused until 30 min before the end of surgery,respectively,starting from 15 min before induction of anesthesia.The equal volume of normal saline was given instead of dexmedetomidine in group C.Before administration of dexmedetomidine (T0),at 1 min after endotracheal intubation (T1),at skin incision (T2) and immediately after extubation (T3),venous blood samples were collected for determination of epinephrine and norepinephrine concentrations in plasma (using high-performance liquid chronatography) and blood glucose concentrations.The development of adverse effects such as bradycardia,hypotension and respiratory depression was recorded.Results Compared with group C,epinephrine and norepinephrine concentrations in plasma and blood glucose concentrations were significantly decreased at T1-3 in D1,D2 and D3 groups,the incidence of bradycardia and hypotension was significantly increased in group D3 (P＜0.05),and no significant change was found in the incidence of bradycardia or hypotension in D1 and D2 groups (P＞0.05).There were no significant differences in epinephrine and norepinephrine and concentrations in plasma and blood glucose concentrations at each time point between group D1,group D2 and group D3 (P ＞ 0.05).Conclusion The optimal infusion rates of dexmedetoinidine are 0.2 and 0.3μg · kg-1 · h-1 in decreasing stress responses of the hypertensive patients undergoing thoracic surgery.
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Objective To compare the cost-effectiveness of closed-loop versus open-loop infusion of propofol guided by bispectral index (BIS) in elderly patients undergoing abdominal surgery.Methods Sixty American Society of Anesthesiologists physical status Ⅱ patients of either sex,aged 65-75 yr,with body mass index of 18 25 kg/m2,undergoing elective open gastrointestinal tumor resection with general anesthesia,were allocated into closed-loop target-controlled infusion (TCI) group (group C) and open-loop TCI group (group O) using a random number table.Propofol was given using closed-loop TCI,and the target BIS value was set at 45-55 in group C.In group O,the target plasma concentration (2.0-3.5 μg/ml)of propofol was adjusted to maintain the BIS value at 45-55.Remifentanil was given by TCI with the target plasma concentration of 2-8 ng/ml in both groups.The total consumption of propofol and remifentanil,time rate of maintaining BIS value within the target range,development of intraoperative hypertension and hypotension,emergence time,tracheal extubation time,time for recovery of orientation,first ambulation time,time to first flatus and length of postoperative hospital stay were recorded.The development of nausea and vomiting and delirium within 3 days after operation and intraoperative awareness was recorded.The cost of anesthetics and total cost of anesthesia were calculated.Results Compared with group O,the total consumption of propofol was significantly decreased,the total consumption of remifentanil was increased,the time rate of maintaining BIS value within the target range was increased,the emergence time,tracheal extubation time and time for recovery of orientation were shortened,the cost of propofol and total cost of anesthesia were decreased (P＜0.05),and no significant change was found in the cost of remifentanil,incidence of postoperative delirium and nausea and vomiting,first ambulation time,time to first flatus or length of postoperative hospital stay in group C (P＞0.05).Intraoperative awareness was not found in two groups.Conclusion Compared with open-loop infusion of propofol guided by BIS,closed-loop infusion of propofol guided by BIS is a cost-effective method of anesthesia in elderly patients undergoing abdominal surgery.
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OBJECTIVE To investigate the change of tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),intercellular adhesion molecules(ICAM-1),matrix metalloproteinases 2 (MMP-2) and MMP-9 contents in cultured pulmonary microvascular endothelial cells (PMVECs) in rats after perfluoroisobutylene (PFIB) exposure. METHODS PMVECs were separated and purified using a modified method of implantation of pulmonary tissues. After identification,PMVECs were divided into the normal control group and the PFIB-exposed groups(n=3). The PFIB-exposed groups inhaled PFIB at the concentration of 200 mg · m-3 for 5 min in a flow-past header,while the normal control group were PMVECs in quiescent condition. The supernatants and lysates of PMVECs were harvested at 0.5,1,2,4 and 8 h,respec?tively, after execution. The contents of TNF-α,IL-1β,ICAM-1,MMP-2 and MMP-9 were measured by ELISA,and the activity of MMP-2 and MMP-9 was measured by gelatin zymography. RESULTS① According to the morphologic characteristics of cell growth and the expression of specificity antigens and the bind experiment of phytohemagglutinin,the cells separated and purified by modified method shared the characteristics of PMVECs.②TNF-αwas rapidly expressed by PMVECs at 0.5 h post PFIB stimulation and the maximum value was achieved at 2 h post PFIB stimulation(P<0.05). The newly synthesized TNF-α was slowly released out of the cells. The maximum TNF-α in the supernatant was achieved at 4 h post stimulation.③Within 2 h of stimulation,PMVECs synthesized a large amount of IL-1β and peaks at 2 h. However,IL-1βwas never released to the extracellular milieu.④The amount of ICAM-1 was rapidly synthesized by PMVECs after PFIB stimulation,but at a low level.⑤After stimulation with PFIB,MMP-2 in the supernatant of PMVECs culture was gradually increased,peaked at 2 h and then decreased subsequently. The biological activity of MMP-2 in the supernatant was also enhanced after PFIB stimulation. PFIB did not stimulate synthesis or secretion of MMP-9,indicating that PMVECs were not the main source of MMP-9 during PFIB inhalation-induced acute lung injury. CONCLUSION PFIB stimulates the surviving PMVECs to synthesize a large amount of TNF-α,IL-1β, MMP-2 and conjunctive ICAM-1.
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Objective To investigate the optimum ratio of medicine dosage for dexmedetomidine mixed with oxycodone used for patient-controlled intravenous analgesia (PCIA) after gastrointestinal surgery.Methods Eighty patients of both sexes, aged 35-64 yr, weighing 55-75 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , undergoing elective gastrointestinal surgery, were randomly divided into 4 groups (n=20 each) using a random number table: oxycodone group (group O), and different ratios of medicine dosage when dexmedetomidine was added to sufentanil groups (OD1-3 groups).At 15 min before the end of surgery, oxycodone 0.1 mg/kg was injected intravenously, and PCIA pump was connected simultaneously.In group O, the PCIA solution contained oxycodone 1.00 mg/kg in 100 ml of normal saline.In group OD1, the PCIA solution contained oxycodone 1.00 mg/kg and dexmedetomidine 2.5 μg/kg in 100 ml of normal saline.In group OD2 , the PCIA solution contained oxycodone 0.75 mg/kg and dexmedetomidine 2.5 μg/kg in 100 ml of normal saline.In group OD3, the PCIA solution contained oxycodone 0.50 mg/kg and dexmedetomidine 2.5 μg/kg in 100 ml of normal saline.The PCIA pump was set up to deliver a 0.5 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h.Oxycodone 0.05 mg/kg was injected intravenously as a rescue analgesic, and visual analogue scale score was maintained ≤ 4.The requirement for rescue analgesics was recorded.The requirement for the rescue analgesic was recorded within 48 h after surgery.The number of successfully delivered doses, and occurrence of adverse reactions such as bradyeardia, hypotension, nausea, vomiting, over-sedation, somnolence, pruritus, and respiratory depression were recorded.Patient's satisfaction with analgesia was recorded at 72 h after surgery.Results No patients required the rescue analgesic or developed over-sedation, vomiting, respiratory depression and hypotension in the four groups.Compared with group O, the incidence of somnolence was significantly increased in group OD1, the incidence of nausea, somnolence, bradycardia and pruritus was decreased in OD2 and OD3 groups, and the degree of patient's satisfaction with analgesia was increased in OD1-3 groups (P＜0.05).Compared with group OD1, the incidence of nausea, somnolence, bradycardia and pruritus was significantly decreased in OD2 and OD3 groups, the degree of patient's satisfaction with analgesia was increased in group OD3 (P＜0.05) , and no significant was found in the degree of patient's satisfaction with analgesia in group OD2 (P＞0.05).Compared with group OD2, no significant was found in the incidence of adverse reactions (P＞0.05) , and the degree of patient's satisfaction with analgesia was significantly decreased in group OD3 (P＜0.05).The number of successfully delivered doses was significantly larger in group OD3 than in O, OD1 and OD2 groups (P＜0.05).Conclusion Dexmedetomidine 2.5 μg/kg added to oxycodone 0.75 mg/kg is the optimum ratio of medicine dosage when used for PCIA after gastrointestinal surgery.
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One of the most promising antimalarial drugs which are widely used throughout the world is the artemisinin (ARS)and its derivatives,e.g.,artemether,arteether,and artesunate.Their true potential lies in broader anti-disease applications.The mechanism of action of these compounds appears to involve the endoperoxide bridge to produce carbon-centred free radicals.Large clinical studies did not show serious side effects,however,there is a paucity of large-scale clinical trials suitable to detect rare but significant toxicity.Therefore,a final and definitive statement on the safety of artemisinins still cannot be made.In contrast,animal experiments at high doses shown considerable toxicity upon application of artemisinins.In the present review,the authors give a comprehensive overview on toxicity studies in cell culture and in animals (mice,rats,rabbits,dogs,and monkeys)as well as on toxicity reported in human clinical trials.The authors emphasize the current knowledge on neurotoxicity,embryotoxicity, genotoxicity,hemato-and immunotoxicity and cardiotoxicity.Rapid elimination of artemisinins after oral intake represents a relatively safe route of administration compared to delayed drug release after intra-muscular (im ) injection. There are drug-related differences, i.e., intramuscular application of artemether or arteether,but not to artesunate,which is safe and gives good profiles after im administra-tion in severe malaria.It might also be important in determining dose limitations for treatment of other diseases such as cancer.Questions about dosing regimens,safety of long-term use and possible inter-actions with existing therapies and toxicities that might be related to the treatment of tumors should be answered by appropriate clinical and preclinical studies.
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Objective To evaluate the protective effects of different modes of ventilation on the lungs on the operated side during one-lung ventilation (OLV ) in patients undergoing thoracic surgery .Methods Forty-five ASA physical status Ⅰ or Ⅱ patients of both sexes ,aged 45-64 yr ,weighing 65-80 kg ,were randomly divided into 3 groups (n=15 each) using a random number table :group A ,group B and group C .After induction of anesthesia ,the patients were intubated with double-lumen tube and OLV was performed .During OLV ,the lung on the operated side was collapsed naturally in group A ,positive pressure ventilation (FGF 2 L/min) was applied in the lung on the operated side in group B ,and high-frequency jet ventilation (frequency 100 beats/min ,driving pressure 0.5 kg/cm2 ) was used in the lung on the operated side in group C .Immediately after intubation (T0 ) , and at 1.5 h (T1 ) and 2 h (T2 ) of OLV ,blood samples were taken from the central vein and radial artery for determination of the serum interleukin-6 (IL-6 ) and IL-8 concentrations .The net release of IL-6 and IL-8 was calculated .Blood samples were taken from the radial artery at T0-2 for blood gas analysis and for determination of surfactant protein A (SP-A) concentration in the serum .Respiratory index (RI) was calculated .The non-cancer tissues 1.0 cm × 1.0 cm × 1.0 cm which were extracted from the lung cancer specimens were used for microscopic examination of the pathological changes of lungs which were scored .Results Compared with group A ,the net release of IL-6 and IL-8 ,serum SP-A concentration ,RI and pathological scores were significantly decreased at T1 ,2 in B and C groups ( P<0.05) .Compared with group B ,the serum SP-A concentration and RI were significantly decreased at T1 ,2 , and the net release of IL-6 was increased at T2 in group C ( P< 0.05 ) .Conclusion Continuous positive ventilation and high-frequency jet ventilation both can effectively protect the lungs on the operated side during OLV in patients undergoing thoracic surgery ,and the efficacy of high-frequency jet ventilation is better .
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Objective To investigate tentatively the role of angiotensionⅡ( AngⅡ) in perfluoroisobutylene ( PFIB)-in-duced acute lung injury ( ALI) in rats.Methods Twenty-eight male Wistar rats were randomly divided into one control group(0 h) and six PFIB-exposed groups which were executed at 1, 2, 4, 8, 16 and 24 h after PFIB exposure (n=4). The PFIB-exposed groups inhaled PFIB at a concentration of 145 mg/m3 for 8 min in a flow-past header while the control group was exposed to the filtered air in a similar manner .After execution at the corresponding time-point, the samples of the lung, serum and brochoalveolar lavage fluid (BALF) were harvested.The measurement of the lung wet-to-dry weight ratio ( W/D) and total protein content in BALF , and the histopathological examination of the lung were carried out to evalu -ate the degree of lung injury .The over-time changes in the content of AngⅡin the lung homogenates and blood plasma and the activity of angiotensin converting enzyme ( ACE) in the lung tissue were observed .Results The lung W/D and total protein content in BALF were increased significantly at 16 h after PFIB exposure with severe acute lung edema and abun-dant neutrophil exudation to the alveoli , which were alleviated dramatically at 24 h after PFIB exposure .The content of AngⅡin the lung homogenate showed a tendency of increase during the first 8 hours with significant decrease at 16 and 24 h after exposure.However, the content of AngⅡin the plasma and the activity of ACE in the lung experienced of fluctuations , but without significant difference compared to the control group .Conclusion There is no obvious correlation between the extent of lung injury and that of AngⅡin the lung.The pathological significance of AngⅡin PFIB-induced ALI needs to be further clarified.
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Objective To evaluate the correlation between stroke volume variation (SVV) and blood volume during one-lung ventilation (OLV).Methods Forty ASA Ⅱ male patients,aged 50-60 yr,with body mass index 20-25 kg/m2,scheduled for elective resection of esophageal cancer,were studied.Anesthesia was induced with fentanyl 4 μg/kg,propofol 2 mg/kg,and rocuronium 0.6 mg/kg.Double-lumen tube was inserted.Correct position was verified by fiberoptic bronchoscopy.The patients were mechanically ventilated (VT 8 ml/kg,RR 15 bpm,Ⅰ ∶ E 1 ∶ 2).6％ hydroxyethyl statch (HES) 130/0.4 was infused intravenously at a rate of 0.67 ml· kg-1 · min-1 starting from 30 min of OLV.SVV,cardiac output (CO),SV and cardiac index (CI) were monitored and recorded using the FloTrac/Vigileo (Edwards Lifesciences,USA) system before HES was infused and when the dose of HES reached 2,4,6,8,10 and 12 ml/kg.Spearman rank sum correlation coefficient was used to analyze the data.Results SVV was negatively correlated with the blood volume during OLV and the correlation coefficient was rSVV =-0.249.CI,CO and SV were positively correlated with the blood volume during OLV and the correlation coefficients were rCO =0.570,rSV =0.552 and rCI =0.550,respectively.Conclusion SVV is poorly correlated with the blood volume during OLV and can not reflect the blood volume accurately.
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Objective To investigate the effect of carbon dioxide ( CO2 ) pneumoperitoneum on the neuromuscular block of cisatracurium in patients undergoing laparoscopic operation.Methods Sixty ASA Ⅰ or Ⅱ patients,aged 35-60 yr,with body mass index of 18-24 kg/m2,scheduled for elective hysterectomy,were randomly divided into 2 groups ( n =30 each ):pneumoperitoneum group ( group P) and control group ( group C ).Each group was further divided into 2 subgroups according to the use of the antagonist of neuromuscular block ( n =15 each):no neostigmine group ( group P0 or C0 ) and neostigmine group (group P1 or C1 ).Anesthesia was induced with fentanyl,propofol and cisatracurium and maintained with target-controlled infusion of propofol and remifentanil.Tracheal intubation was performed and the patients were mechanically ventilated.Neuromuscular function was monitored by TOF-Watch SX accelerography (Organon Co.,Organon).A train of four (TOF) stimulation of the ulnar nerve was used.When T,returned to 5％ of control height after CO2 pneumoperitoneum was established,cisatracurium 0.05 mg/kg was injected intravenously in group P.When T1 returned to 25％ of control height after the end of operation,neostigmine was injected intravenously in groups P1 andC1.The clinical duration and recovery index were recorded after CO2 pneumoperitoneum was established.Arterial blood samples were obtained immediately before induction,at 30 and 60 min of pneumoperitoneum,and at the end of operation for blood gas analysis.Results The clinical duration and recovery index were significantly longer in group P0 than in group C0,and in group P1 than in group C1 ( P ＜ 0.05).Compared with group C0,the pH value was significantly decreased and PaCO2 was significantly increased at 30 and 60 min of pneumoperitoneum,and at the end of operation in group P0 ( P ＜ 0.05).Compared with group C1,the pH value was significantly decreased and PaCO2 was significantly increased at 30 and 60 min of pneumoperitoneum,and at the end of operation in group P1 ( P ＜ 0.05).Conclusion CO2 pneumoperitoneum can strengthen the neuromuscular block induced by cisatracurium and prolong the recovery time following antangonism by neostigmine administration in patients undergoing laparoscopic operation.
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Objective To investigate the effects of different methods of volume therapy on the inflammatory response in patients undergoing liver cancer resection.Methods Forty ASA Ⅰ or Ⅱ patients,aged 40-60 yr,with body mass index 20-25 kg/m2,undergoing liver cancer resection,were randomly divided into 2 groups ( n =20 each):routine fluid replacement group (group Ⅰ ) and goal-directed fluid replacement group (group Ⅱ ).The fluid replacement regime in group Ⅰ =compensatory volume expansion (CVE) + physiological requirements + cumulative loss + confinued loss + the third space losses.CVE was replaced with lactated Ringer's (LR) solution 5 mg/kg before anesthesia induction.The physiological requirements and cumulative loss were replaced with LR solution according to the principle of 4-2-1.The continued loss equal to the intraoperative blood loss was replaced with the equal volume of 6％ hydroxyethyl s tarch ( HES 130/0.4).The 3rd space losses were replaced with LR solution 5 ml·kg-1 ·h-1.In group Ⅱ,CVE was replaced with LR sol6ution as in group Ⅰ.LR solution was infused after anesthesia induction at 5 ml·kg-1 ·h-1.6％ HES was infused to maintain left ventricular ejection time (LVETc) between 350-400 ms.When 350 ms ＜ LVETc ＜ 400 ms and the amplitude of stroke volume ( SV ) increased by ＞ 10％,6％ HES was infused continuously until the amplitude of SV increased by ≤ 10％.Blood samples were taken before anesthesia induction and at the end of operation for measurement of serum TNF-α,IL-2,IL-4,IL-6 and IL-8 concentrations.The adverse cardiovascular reactions were recorded.Results Compared with group Ⅰ,the serum TNF-α,IL-6,IL-8 concentrations were significantly decreased,the serum IL-2 and IL-4 concentrations were significantly increase,and the incidence of hypotension and tachycardia was significantly decreased in group Ⅱ ( P ＜ 0.05).No adverse cardiovascular reactions were found in both groups.Conclusion LVETc and SV-guided volume therapy can maintain the blood volume and inhibit the inflammatory response and is suitable for the patients undergoing liver cancer resection.
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OBJECTIVE To investigate whether the pulmanary fibrosis formed after a single PFIB exposure.METHODS A total of 70 male mice were exposed to PFIB 130 mg·m-3 for 5 min.Pulmonary edema of 10 mice was evaluated by lung indices at 24 h after PFIB exposure.Pathological changes and collagen deposition were detected by hematoxylin and eosin (HE) and Sirius red stainings in the other mice,changes in collagen content in lungs and plasma by measuring the respective hydroxyproline content at 2,4,6,8,12 and 16 weeks after PFIB exposure.RESULTS Severe pulmonary edema was observed at 24 h after PFIB exposure.At day 14 after PFIB exposure,inflammatory cell infiltration,alveolar septum thickening,interstitial and alveolar edema and protein leakage were noticed.Collagens types Ⅰ and Ⅲ on the wall of vessel and bronchi were severely damaged,but considerable amount of collagen type Ⅲ deposited on the alveolar wall.The content of hydroxyproline considerably decreased in the lungs but increased significantly in the plasma up to six weeks.Hydroxyproline in lungs and plasma began to recover at the end of 8 weeks,and then returned to normal.At 16 weeks,they recovered to normal level.At the end of 4 weeks,the lung lesions and the collagens at the wall of vessel and bronchi began to recover gradually; collagen typeⅢ at the alveolar wall was gradually absorbed,too.At 16 weeks,the lungs almost recovered to normal level.CONCLUSION At earlier phase after PFIB exposure,the excessive collagens destruction in lungs is observed,but no pulmonary fibrosis forms at the later phase.
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Objective To analyze the ostomy patients' demands, resolve the common problems after discharge by telephone consultation, and supplement the content of specialized health education. Methods The data of 256 telephone consultations from 186 patients with ostomy were retrospectively analyzed. Results Most of the consultations came from patients aged from 61 to 80 years old (64.5%) and patients within one year after surgery (85%). The contents focused on information about ostomy products, care of skin around the stoma and leakage of defecation, which accounted to 32.8%,30.1%,24.6%,respectively.The problems were solved by telephone interview in 201 consultations (78.5%). Conclusion Consultation by telephone is useful to find out the demands of discharged ostomy patients, resolve their problems in time and improve their quality of life. It has great significance for improving health education and extensive services of ostomy patients.
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Objective To evaluate the correlation between stroke volume variation (SVV) and the blood volume. Methods Forty-eight ASA Ⅱ male patients, aged 50-60 yr, scheduled for elective radical operation for gastric cancer, were studied. Anesthesia was induced with fentanyl 4 μg/kg, propofol 2 mg/kg and cis-atracurium 0.15 mg/kg and maintained with inhalation of 2%-3% sevoflurane. 6% HES 130/0.4 was infused intravenously at a rate of 0.67 ml· kg - 1 · min - 1 30 min after induction. SVV,cardiac output (CO),SV and cardiac index (CI) were monitored and recorded using the FloTrac/Vigileo (Edwards Lifesciences, USA) system before HES was infused and when the dose of HES reached 2, 4, 6, 8, 10, 12, 14, 16 and 18 ml/kg. CVP was also recorded at the corresponding time points. Spearman's rank sum correlation coefficient was used to analyze the data. Results Correlation coefficients between the amount of HES infused and CO, SV, CI or CVP were rSVV = - 0.91 ± 0.06,rCO = 0.83 ± 0.04, rSV = 0.86 ± 0.09, rCI = 0.86 ± 0.09 and rCVP = 0.90 ± 0.03. Among the 5 correlation coefficients, rSVV was the highest, rCVP was significantly higher than rCO, rSV and rCI (P ＜ 0.05), and there was no significant difference among rCO, rSV and r CI (P ＞ 0. 05). Conclusion SVV is highly correlated with the blood volume and can be used to guide volume therapy.