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Objective To investigate effects of intrathecal injection of sufentanil combined with bupivacaine on postoperative analgesia and immunity function in elderly patients under lower extremity orthopaedic surgery.Methods Totally 60 elderly patients with ASA Ⅰ or Ⅲ under lower extremity orthopaedic surgery were randomly divided into two groups:bupivacaine and sufentanil group (each n =30).3 ml bupivacaine (2 ml 0.75％ bupivacaine plus 1 ml 0.9％ normal saline) were given in bupivacaine after successful spinal anesthesia and 3 ml sufentanil (1 ml 0.75 ％ bupivacaine plus 1 ml 0.9％ normal saline and 1 ml with 5 μg sufentanil) were used in sufentanil group respectively.The anesthetic feeling and block level before operation recovery time were recorded postoperation.Visual analogue scale (VAS) and adverse reaction were recorded at 1,6,12,24 and 48 h after surgery.Cellular and humoral immunity function were recorded at the following time points:T0,the day before surgery; T1,the day after surgery; T2,the first 5 postoperative days; T3,the first 10 postoperative days; T4,the first 15 postoperative days.Results The sensory and motor block levels in sufentanil group were T9～～T10 and T11～T12 respectively,which were higher than in bupivacaine (T7～T8 and T8～T10).The recovery time in sufentanil group was shorter than in the bupivacaine (P＜0.05).There were no significant differences in VAS scale between the two groups at any postoperative time points (P＜0.05).The incidence of skin pruritus was higher in sufentanil group (6 cases) than in bupivacaine (P＜0.05).There were significant differences in the indexes for the immune condition including CD3+,CD4+/CD3+,CD4/HLADR,CD8/HLADR,B-cell,NK-cell between time points of T2[(48.7±2.3)％,(33.4±1.8)％,(10.2±1.8)％,(0.75±0.07)％,(1.02±0.16)％,(3.12 ±0.19) ％,(2.53±0.14)％,respectively] and T0 in bupivacaine (P＜0.05).There were significant differences in the indexes for the immune condition including CD3+,CD4+/CD3+,CD4/HLADR,CD8/HLADR,B-cell,NK-cell at T2 between sufentanil group [(54.5 ± 2.4) ％,(36.3 ± 1.7) ％,(15.1±1.6)％,(1.32±0.11)％,(1.25±0.14)％,(4.96±0.25)％,(4.17±0.10)％,respectively] and bupivacaine (P＜0.05).Conclusions Intrathecal injection of 5 μg sufentanil combined with low concentration bupivacaine can be safely and effectively applied in elderly patients under lower extremity orthopaedic surgery,and can reduce local anesthetic concentration,shorten recovery time of anesthesia and accelerate the recovery of postoperative immunity function.
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Objective To investigate the risk factors and treatment of postoperative delirium in patients with benign prostatic hyperplasia(BPH). Methods For 256 postoperrative BPH patients in our department,the clinical parameters including age,hypoxemia,preoperative infection,postoperative pain,and introvert were analyzed,and the treatment were summarized. Results The incidence of postoperative delirium was higher in patients aged≥75 years than＜75 years[17.4%(19/109)vs.5.4%(8/147),X2=8.307,P=0.0043,higher in patients with preoperative infection (pulmonary or urinary)versus without the infection[15.0%(17/113)vs.7.0%(10/143),X2=4.337,P=0.037],higher in patients with hypoxia versus without hipoxia[16.5%(16/97).vs.6.9%(111159),X2=4.885,P=0.027]and higher in patients with post-operative pain versus without the pain(16.9%(10/59)vs.1.2%(1/85),X2=10.146,P=0.0014].Hematocrit and hemoglobin in patients with postoperative delirium were lower after operation versus pre-operation[(0.29±0.04)vs.(0.42±0.04),t=12.2314,P＜0.001;(102.39±6.58)g/L vs.(114.58±8.36)g/L,t=5.9537,P＜0.001].All delirium patients were recovered after sedation treatment,improving the quality of sleep,controlling the infection and correcting electrolyte turbulence. Conclusions Advanced age,hypoxemia,preoperative infection,postoperative pain are important risk factors for delirium.
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Objective To establish the determination method of Tubeimoside Ⅰ in Jiazhongxiao preparation and serum of rat. Methods RP-HPLC/UV method was used as follows:Diamonsil C18 column (250 mm?4.6 mm, 5 ?m) and Easyguard column, methanol-water (65∶35) as mobile phase with flow rate of 1.0 mL/min, UV detection at 214 nm. Results The mean recovery rates of Tubeimoside Ⅰ in preparation and serum of rat were (103.49?3.49)% and (104.70?4.69)% respectively. The linearity of Tubeimoside Ⅰ was shown in the range of 1.18～88.5 ?g/mL. Tubeimoside Ⅰ in preparation and serum of rat were 995.3 ?g/g and 3.19 ?g/mL. Conclusion The method was simple, reliable and rapid. It’s quite suitable to be used in the analysis of Tubeimoside Ⅰ in Jiazhongxiao preparation and serum of rat.
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Objective To evaluate the influences of artifical plasma substitutes on blood coagulation and fibrinoglysisMethods Forty adult patients, ASA grade Ⅰ-Ⅱ, scheduled for selective surgery ,were randomly allocated to receiving intravenous infusion of hydroxyethylh starch(HES group), polygeline (Haemaccel,HAE group), succinylated gelatin (Gelofusine,GEL group), or normal saline (control group) at the rate of 20ml?kg -1?h -1in 60 min ,respectively, with 10 cases in each groupThe venous blood samples were taken before and 1h following the infusion to determine platelet count(PLC),platelet agglutgtination test(PAG), platelet factor 3 availability test(PF 3at), activated partial thromboplastin time(APTT), prothrombin time(PT), thrombin time(TT), fibrinogen(FIB), tissue plasminogen(t-PA) and plasminogen activator inhibitor(PAI:A)Results In HAE group PAG decreased significantly, and PT was prolonged markedly after the infusion(P005)In GEL group only FIB reduced obviously after the infusion ,additionally was remarkably lower than that in control group(P