Evaluation of the Efficacy of Subcostal Transversus Abdominis Plane Block for Patients Undergoing Open Liver Carcinoma Resection / 中山大学学报(医学科学版)

@#【Objective】To evaluate the efficacy of three different methods of subcostal transversus abdominis plane（TAP）block for patients undergoing open liver carcinoma resection.【Methods】A total of 60 adult patients，undergoing elective open liver carcinoma resection through a“reverse L”incision below the rib bow，were enrolled. The subjects were randomly divided into three groups（20 cases in each），including Group A，B and C，according to the position of local anesthetic injection. All patients underwent ultrasound- guided bilateral subcostal TAP block under local anesthesia. The TAP injection was injected at the middle line of the clavicle in Group A；Two separate injections were at the parasternal line and at the anterior axillary line in Group B；Multiple injections were proformed between the anterior median line and the middle axillary line in Group C. After completion of TAP block，the onset time，duration，blocking extent，hemodynamics and abdominal muscle thickness were evaluated. The operating time of TAP block and incidence of complications were recorded.【Results】The blocking extent of Group B or Group C was greater than that of Group A（P < 0.05），with no significant difference between Group B and Group C. The duration of TAP block in Group B or Group C was longer than that of Group A，while the onset time was not significantly different between the three groups. The mean arterial pressure and heart rate during laparotomy were higher than the base value in Group A，while there were no evident changes in Group B and Group C. The rectus abdominis became thinner after TAP block in all patients，but there was no significant difference in muscle thickness change among the three groups. The operating time of TAP block in the three groups was （8.4±1.9），（13.8±3.1），（23.3±4.2）min，respectively，with significant difference between any two groups（P < 0.05）. None of the patients enrolled showed such complications as local anesthetic poisoning，abdominal wall hematoma，nerve injury， abdominal viscera injury，and puncture point infection.【Conclusion】The outcome of subcostal TAP block for patients undergoing open liver surgery is related to injecting position of anesthetics. Two- point-injection method is superior to one- point-injection method or multiple-point-injection method，for adequate analgesic extent as well as less operating time.

The significance, development and prospects of healthcare data integration in new drug clinical trials / 药学学报

With the deployment of electronic medical records systems, more and more routine clinical data are recorded electronically, which become a potential data source for new drug clinical trials. In this paper, we summarized the opportunities, challenges, obstacles and the latest development in this field.

Efficacy of modified Roux-en-Y gastric bypass in the treatment of non-obese type 2 diabetes mellitus:one year follow-up / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the one year effect of modified Roux-en-Y gastric bypass (RYGP) in the treatment of non-obese type 2 diabetes and to investigate the reasonable indications for surgery.</p><p><b>METHODS</b>Totally 72 patients diagnosed as type 2 diabetes underwent RYGP from May 2009 to June 2010. There were 45 male and 27 female patients, with an average age of (47 ± 10) years. Preoperative body mass index (BMI) of the patients was 18.69 to 31.22 kg/m(2), average (26 ± 4) kg/m(2). The follow-up data included fasting plasma glucose (FPG), 2 h plasma glucose after oral glucose challenge (2hPG), weight, BMI and medication usage in 1, 3, 6 and 12 months postoperative; hemoglobin A1c (HbA1c), fasting C-peptide (C-P), fasting serum insulin (Fins) and homeostasis model assessment of insulin resistance index (HOMA-IR) in 6 and 12 months postoperative, respectively.</p><p><b>RESULTS</b>Compared with the preoperative, FPG, 2hPG, weight and BMI in 1, 3, 6 and 12 months after surgery were improved (t = 7.014 to 10.254, P = 0.000), while HbA1c, C-P and HOMA-IR in 6 and 12 months after surgery were improved (t = 1.782 to 7.789, P = 0.000 to 0.103) and there was no significant difference in Fins (P > 0.05). The rates of complete remission in 1, 3, 6 and 12 months after surgery were gradually improved to 22.2%, 27.8%, 36.1% and 60.6%, respectively, and the rate of remission in 1 year was 94.3%. The complete remission of 1 year after surgery was associated with normal C-P, insulin antibody and oral antidiabetic drugs (χ(2) = 11.730, P = 0.003; χ(2) = 7.131, P = 0.028;χ(2) = 6.149, P = 0.046).</p><p><b>CONCLUSIONS</b>Modified RYGP is safely and effectively in the treatment of no-obese type 2 diabetes patients. The function of islet cells is significantly improved after operation. Especially for the patients of whom C-P is normal, insulin antibody is negative before surgery, the rate of complete remission after 1 year is better.</p>

Effect of intravenous lornoxicam at different doses on the immune function in patients undergoing total abdominal hysterectomy / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of intravenous lornoxicam (LOR) at different doses given preoperatively on the immune function of patients undergoing total abdominal hysterectomy (TAH).</p><p><b>METHODS</b>Forty-five patients undergoing TAH were randomly divided into 3 groups, namely NS group, L8 group and L16 group with intravenous injection of 4 ml saline, 8 mg LOR, and 16 mg LOR before the induction of anesthesia respectively. Venous blood samples were taken before anesthesia (T0), at 30 min during the operation (T1), at the end of the operation (T2), and at 24 h and 48 h after the operation (T3 and T4, respectively) to determine the serum levels of regulated upon activation normal T cell expressed and secreted (RANTES), monocyte chemotactic protein-1 (MCP-1), and stromal cell-derived factor 1 alpha (SDF-1alpha) by enzyme-linked immunosorbent assay (ELISA).</p><p><b>RESULTS</b>The serum RANTES levels in NS group and L8 group at T1-T3 were significantly lower than those at T0 (P<0.05), but the levels in L8 group at each time point were all higher than those in NS group NS (P<0.05). The serum RANTES levels in L16 group L16 only decreased at T1-T2 as compared to those at T0, and were significantly higher than those in NS group and L8 group (P<0.05). The expressions of MCP-1 and SDF-1alpha in the 3 groups all increased at T1 and reached the peak levels after the operation. In L8 group and L16 group, MCP-1 expression at T2-T3 and SDF-1alpha at T1-T2 were both significantly lower than those in NS group (P<0.05). SDF-1alpha expression at T1-T2 was significantly lower in L16 group than in L8 group (P<0.05). The decrements of MCP-1 and SDF-1alpha were more obvious in L16 group than L8 group.</p><p><b>CONCLUSIONS</b>Preoperative intravenous LOR injection may increase serum RANTES level and decrease MCP-1 and SDF-1alpha expressions to effectively relieve the perioperative immune disorders caused by TAH, and the effect is more potent at the dose of 16 mg.</p>

Effect of controlled hypotension with different drugs combined with acute hypervolemic hemodilution on bleeding volume and gastrointestinal perfusion in nasal endoscopic surgery / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of controlled hypotension using different drugs on gastrointestinal perfusion and bleeding volume in nasal endoscopic surgery.</p><p><b>METHODS</b>Thirty ASA class I or II patients scheduled for nasal endoscopic surgery were randomized into three groups, including a routine general anesthesia group (group A) and two controlled hypotension groups (groups B and C). After anesthesia induction, anesthesia was maintained with 1%-2% isoflurane and vecuronium. ECG, mean arterial blood pressure (MAP), heart rate (HR), SpO(2) and PETCO(2) were continuously monitored. TRIP tonometry catheter 14 F was inserted into the stomach and connected to Tonocap (Datex-Ohmeda, Finland ). In groups B and C, hypotension was induced with isoflurane (1%-2%) and sodium nitroprusside (0.3-3 microg.kg(-1).min(-1)), and with isoflurane (1%-2%) and glonoine (0.5-5 microg.kg(-1).min(-1)), respectively, and the MAP was reduced to 50-55 mmHg in 10-15 min. In groups B and C, blood samples were taken for blood gas analysis after anesthesia (T(0)), after acute hypervolemic hemodilution (T(1)), at 30 and 60 min after controlled hypotension (T(2) and T(3)), and 30 min after recovery from hypotension (T(4)). In group A, blood samples were taken at different time points in the perioperative period.</p><p><b>RESULTS</b>The patients in groups B and C had smaller bleeding volume than those in group A. HR was decreased after moderate acute hypervolemic hemodilution, and increased after controlled hypotension (T(2) and T(3)) in comparison with that at T(1) to a level similar to that at T(0). No significant changes were found in pHi at T(2) and T(3) in comparison with that at T(1) in the three groups.</p><p><b>CONCLUSION</b>When appropriate measures are taken, induced hypotension at 50-55 mmHg does not necessarily produce disturbance in gastrointestinal perfusion. Induced hypotension with glonoin can decrease the bleeding volume better than sodium nitroprusside in nasal endoscopic surgery.</p>

Epidural anesthesia with ropivacaine by computerized infusion pump / 中南大学学报(医学版)

OBJECTIVE@#To explore the feasibility of epidural anesthesia with ropivacaine by computerized infusion pump.@*METHODS@#Sixty patients scheduled for obstetric operation were divided into a continuous pump infusion group (Group A, n=30) and a conventional injection group (Group B, n=30). The initial doses of 0.75% ropivacaine 12 mL and 15 mL were respectively injected into the patient's epidural space in Group A and Group B. The dose of 6 mL of 0.75% ropivacaine per hour was continuously pumped to maintain the anesthesia till the end of the operation in Group A, and 6 mL of 0.75% ropivacaine was injected 80 min later in Group B.@*RESULTS@#Blood pressure in some patients markedly decreased at 90 min after the first injection in Group B while it is relatively stable in Group A (P0.05).@*CONCLUSION@#Epidural anesthesia with ropivacaine by computerized infusion pump is safe, which can not only provide an excellent anesthetic effect but also keep the hemodynamics stable.

Effect of mechanical ventilation with different tidal volumes on the respiratory function during general anesthesia / 中南大学学报(医学版)

OBJECTIVE@#To determine the effect of mechanical ventilation with different tidal volumes on the respiratory function during general anesthesia and to seek optimum way and parameters of mechanical ventilation during general anesthesia.@*METHODS@#Forty ASA I-II patients scheduled for elective craniotomies in the supine position were included in this study. According to latin square design, the patients were randomly divided into 4 groups. Every group has its own tidal volume sequence. Each patient used 4 tidal volumes in turn. Every tidal volume maintained 30 minutes. The rate of mechanical ventilation was 15. But ECG, blood pressure, heart rate, SPO2, ETCO2, airway pressure, lung compliance, and blood gas analysis were continuously monitored.@*RESULTS@#A-aDO2, P(a-ET)CO2, P(PEAK), P(MEAN), P(PLAT), C(DYN), and C(STAT) significantly increased as the tidal volume increased (P0.05).@*CONCLUSION@#The optimum tidal volume of mechanical ventilation is not 4 mL/kg at the rate of 15 respiratory rate during general anesthesia in the supine position because of a high arterial carbon dioxide tension. Yet 6-8 mL/kg is better for neurosurgical anesthesia. Increasing the tidal volume alone may not improve the respiratory function impairment during general anesthesia.

Effect of different tidal volume ventilations on atelectasis in patients during general anesthesia by CT scan / 中南大学学报(医学版)

OBJECTIVE@#To investigate the effect of different tidal volume ventilations on the amount of atelectasis during general anesthesia.@*METHODS@#Twenty adults, ASA physical status I and status II patients, who were scheduled for elective excision of intracranial lesion were randomly divided into 2 groups: Group TV (traditional tidal volume ventilation, 10 mL/kg) and Group LV (low tidal volume ventilation, 6 mL/kg). Atelectasis, as determined by CT and artery blood gas (ABG) analysis, was measured before the anesthesia, after the tracheal intubation, and at the end of the operation, respectively. Respiratory mechanical parameters were measured at 30, 120, and 240 min after the intubation.@*RESULTS@#After the tracheal intubation, CT scan showed obvious atelectasis in both groups. The atelectasis area was(4.35+/-2.15)cm2 (3.12%+/-1.94%) in the TV group and (4.80+/-2.45)cm2 (3.89%+/-2.11%) in the LV group, with a nonsignificant difference between the 2 groups. At the end of the operation, there was no significant increase in the amount of atelectasis between and within the 2 groups. Artery blood gas analysis showed no difference after the tracheal intubation and at the end of the operation in either group. Ppeak, Pplat, Pmean and lung compliance(Cst)were significantly higher in the TV group than those in the LV group.@*CONCLUSION@#Low tidal volume(6 mL/kg) ventilation is more feasible during general anesthesia in patients with healthy lungs, and it does not increase the atelectasis and impairment of gas exchange.

Influences of perioperative metoprolol on hemodynamics and myocardial ischaemia in elderly patients undergoing noncardiac surgery / 中南大学学报(医学版)

OBJECTIVE@#To observe the influences of metoprolol on hemodynamics and myocardial ischaemia in elderly patients undergoing noncardiac surgery.@*METHODS@#Thrity patients (60 approximately 75 years) undergoing elective noncardiac surgery were randomly divided into a metoprolol group (n = 15) and a control group (n = 15). In the metoprolol group, metoprolol (0. 5 mg and 1.5 mg) was slowly injected into the vein of patients before the induction of intravenous anesthesia and after the tracheal intubation. The hemodynamic indice (invasive BP, HR and rate pressure product-RPP), the myocardial ischaemia indice (reversible ST segment depression of ECG II, V5 leads more than 0.1 mv or reversible ST segment elevation more than 0.2 mv from the baseline, ST segment depression or elevation over 1 min), the myocardial damage indice (serum cardiac troponin I, cTn I), and the indice of metoprolol cardiac and the respiratory adverse effects (incidence of HR below 50 beats/min, average doses of atropine, airway peak pressure) were observed intraoperatively.@*RESULTS@#The HR and RPP were lower before the tracheal induction than the baseline (before anesthesia) in all patients, but there is no significant difference between the two groups (P > 0.05). During the tracheal intubation, the HR and RPP of the control group significantly increased, compared with the baseline (P 0.05).@*CONCLUSION@#Intravenous administration of 0.5 mg and 1. 5 mg metoprolol before the induction of anesthesia and after the tracheal intubation has several advantages, including the decrease of myocardial oxygen consumption, the improvement of hemodynamic stability, and the lowering perioperative incidence of myocardial ischeamia and damage, but the tendency of high bradycardia incidence caused by peritoneal traction should be noticed.