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Objective:To compare the effects of dexmedetomidine combined with propofol on anesthesia and thromboelastography in patients undergoing radical gastrectomy.Methods:From September 2017 to December 2019, 120 patients undergoing radical gastrectomy in Chaoyang Central Hospital were prospectively selected and divided into control group and observation group according to random number table method, with 60 cases in each group.The two groups used the same drugs before induction and the same way of anesthesia induction. During the maintenance of anesthesia, remifentanil and propofol were injected intravenously in the control group, and dexmedetomidine was injected in the observation group on the basis of the control group. The indexes of thromboelastography, preoperative and postoperative cellular immune function, postoperative analgesic effect [Visual Analogue Scale (VAS)], Ramsay sedation score, and postoperative adverse reactions were compared between the two groups at different times.Results:The reaction time of coagulation factor (R) and fibrinogen (K) in the two groups decreased 3 hours after operation, and those in the observation group were lower than those in the control group (all P<0.05); The maximum thrombus amplitude (MA) of the two groups increased 3 hours after operation, and MA in the observation group was higher than that in the control group (all P<0.05). Compared with that before operation, the VAS scores and Ramsay sedation scores in the control group and the observation group at 24 h and 48 h after operation were significantly lower (all P<0.05), and the VAS scores and Ramsay sedation scores in the observation group at 24 h and 48 h after operation were significantly lower than those in the control group (all P<0.05). Compared with that before operation, the CD4 +, CD8 +, CD4 + /CD8 + in the control group and the observation group were improved at 6 h and 48 h after operation (all P<0.05), and the improvement in the observation group was significantly better than that in the control group at 6 h and 48 h after operation (all P<0.05). The incidence of adverse reactions in the control group was 6.67%(4/60), which was slightly higher than that in the observation group of 5.00%(3/60), but the difference was not statistically significant ( P>0.05). Conclusions:Compared with propofol and remifentanil alone, combined application of dexmedetomidine can help patients undergoing radical gastrectomy for gastric cancer to achieve better analgesic effect, improve the blood coagulation state of patients, and play a better regulatory role on cellular immune function, which is worthy of further promotion in clinic.
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Objective To investigate the efficacy of neoadjuvant chemotherapy combined with radical resection of cervical cancer in the treatment of stage IB2-ⅡB cervical cancer.Methods According to the treatment plan from October 2012 to October 2016 in the People′s Hospital of Luohu District of Shenzhen in 80 cases of stage IB2-II B cervical cancer patients were divided into observation group(n=43) and control group(n=37),the observation group was treated with neoadjuvant chemotherapy combined with radical surgery for cervical cancer,patients in the control group directly treated for radical resection of cervical cancer.Chemotherapy effect,operation time,intraoperative blood loss,postoperative pathological risk factor differences of two groups of patients were compared.Results (1)Evaluated the curative effect of neoadjuvant chemotherapy,squamous cell carcinoma group complete remission(CR) 4 cases,partial remission(PR) 22 cases,stable disease(SD),6 cases of disease progression(PD) in 0 cases,in adenocarcinoma group CR 1 cases,PR 3 cases,SD 5 cases,PD 2 cases of squamous cell carcinoma group adjuvant chemotherapy was significantly better than that of adenocarcinoma group,the difference was statistically significant(z=2.4968,P=0.0063).(2)The operation time((215±57) min) and intraoperative blood loss((682±145) ml) in the observation group were significantly lower than those in the control group(((259±62) min,(758±193) ml)),the difference was statistically significant(t=3.8780,2.2528,P=0.0002,0.0263).(3)The two groups of patients with ureteral fistula(P=0.5039),vesicovaginal fistula(P=0.3639),wound healing(P=0.5182),lower extremity deep venous thrombosis(P=0.4818) complications had no significant difference.(4)The positive rate of the observation group of lymph nodes(χ2=8.2005,P=0.0000),parametrial infiltration rate(χ2=8.1553,P=0.0000) was significantly lower than the control group,the difference was statistically significant.Two groups of patients with deep myometrial invasion rate(χ2=0.0991,P=0.7516),the incidence of cancer embolus(χ2=0.0130,P=0.9176) compared to no statistical significance.Conclusion The effect of neoadjuvant chemotherapy on cervical squamous cell carcinoma is better than that of adenocarcinoma.Compared with the direct for radical resection of cervical cancer,neoadjuvant chemotherapy combined with radical resection of cervical cancer patients for the treatment of stage IB2-ⅡB cervical cancer,operation time and blood loss are lower,node positive and parametrial invasion and postoperative pathologic risk factors in lymph node also can get better effect.
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Objective To observe the effects and safety of oxycodone hydrochloride combined with parecoxib sodium in preventing postoperative hyperalgesia induced by remifentanil. Methods Eighty-eight ASA Ⅰ or Ⅱ patients undergoing elective laparoscopic myomectomy surgery were randomly divided into four groups (C,O,P,PO) with 22 cases in each group. Patients in group C,O,P,PO were given with 10 mL saline, 0.1 mg?kg-1 oxycodone hydrochloride, 40 mg parecoxib sodium, 0.1 mg?kg-1 oxycodone hydrochloride and 40 mg parecoxib sodium 30 min before the end of the surgery, respectively. The VAS scores were recorded at the end of surgery 30 min, 1 h, 2 h, 4 h, 8 h, and the cases of agitation, rigor, vomiting and increasing of analgesics were recorded. Results Compared with group C, the VAS scores in group O, P,PO were significantly lower(P<0.05). The VAS scores in group PO were lower than those in group O,P(P<0.05). The cases of agitation and rigor in group PO (0.0%, 5.0%) were less than those in group C (45.0%,23.0%) (P<0.05). The increased doses of analgesics in group PO(0) were less than those in groups C (12), group P (5), and group O (5)(P<0.05). Conclusion Oxycodone hydrochloride combined with parecoxib sodium can effectively prevent postoperative hyperalgesia induced by remifentanil, and reduce the incidence of postoperative agitation.
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Objective To evaluate the effects of dexmedetomidine on the activity of nuclear factor kappa B (NF-κB) in neutrophil granulocytes during one-lung ventilation in the patients undergoing pulmonary lobectomy.Methods Thirty-eight ASA physical status Ⅰ or Ⅱ patients,aged 40-64 yr,weighing 50-75 kg,scheduled for elective pulmonary lobectomy,were randomized into 2 groups (n =19 each) using a random number table:control group (group C) and dexmedetomidine group (group D).In group D,dexmedetomidine 1.0 μg/kg was infused intravenously over 15 min before induction of anesthesia,followed by infusion at a rate of 0.5 μg· kg-1 · h-1 until 30 min before the end of operation.The equal volume of normal saline was given in group C.At 5 min after intubation,0,30 and 60 min of one-lung ventilation,0 and 30 min of two-lung ventilation,and 30 min after operation,blood samples were taken from the radial artery for blood gas analysis and for measurement of plasma concentrations of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6).The oxygenation index and respiratory index were calculated.The nuclear protein of neutrophil granulocytes was extracted for measurement of NF-κB DNA-binding activity.Results Compared with group C,the respiratory index,plasma concentrations of TNF-α and IL-6 and NF-κB DNA-binding activity were significantly decreased,and no significant difference was found in the oxygenation index in group D.Conclusion Dexmedetomidine can inhibit the activation of NF-κB in neutrophil granulocytes and is helpful in reducing the systemic inflammatory responses during one-lung ventilation in the patients undergoing pulmonary lobectomy.
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Objective To determine the median effective plasma concentration of remifentanil (EC50) inhibiting cardiovascular response to tracheal intubation and skin incision when combined with propofol in patients of Uighur nationality.Methods Thirty ASA Ⅰ or Ⅱ Uighurs aged 20-60 yr with body mass index of 18-30 kg/m2 undergoing elective laparoscopic cholecystectomy were enrolled in this study.Anesthesia was induced and maintained with propofol infusion.BIS value was maintained at 40-50.TCI of remifentanil was then started.The initial target plasma concentration (Cp) was 6.0 ng/ml.EC50 of remifentanil was determined by modified Dixon' s upand-down sequential experiment.Each time Cp increased/decreased by 0.5 ng/ml.Tracheal intubation was facili.tated with cisatracurium 0.2 mg/kg at 2 min after a new Cp was set when target effect-site concentration (Ce) was balanced with Cp.Positive cardiovascular response was defined as increase in SBP by 15％ and/or HR ＞ 90 bpm lasting＞15 s.The EC50 (95％ confidence interval) of remifentanil blunting responses to tracheal intubation and skin incision was calculated.Results EC50 (95 ％ confidence interval) of remifentanil inhibiting cardiovascular response to tracheal intubation and skin incision when combined with propofol was 3.4 (2.3-4.5) ng/ml and 3.8 (2.8-4.9) ng/ml respectively.Conclusion When depth of anesthesia was maintained at BIS value 40-50 with propofol infusion,the EC50 of remifentanil inhibiting cardiovascular response to tracheal intubation and skin incision is 3.4 and 3.8 ng/ml respectively.