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Objective To investigate the safety and effectiveness of ultrasound-guided paravertebral anaes-thesia combined with propofol in the thoracoscopic sympathectomy. Methods Total 63 male and 59 female patients with hyperhidrosis were recruited. The patients were equally divided into two groups:group A and C. Patients in group A received ultrasound-guided paravertebral anaesthesia combined with propofol. Patients in group C received general intravenous anesthesia with endotracheal intubation. The heart rate (HR),mean arterial pres-sure(MAP)and the oxygen saturation(SpO2)at the time of entering the operating room(T0),completing anesthe-sia(T1),incising the skin(T2),cutting the T4 sympathetic trunk(T3),completing the operation were record-ed. The awake time after operation ,VAS score after operation and postoperative throat discomfort were also record-ed. Results The two groups successfully completed the surgery. There were no significant differences of the HR , MAP and SpO2 at T0-T4 between the two groups. There were significant differences of the awake time after opera-tion,postoperative feeding time and hospitalization expenses. The VAS score after operation of group A were better than group C(P<0.05)at T2 h,T4 h,T8 h,and T12 h. There was no significant difference of VAS score at T24 h between the two groups. Conclusion Ultrasound-guided paravertebral anaesthesia combined with propofol can pro-vide a safe and effective approach for patients receiving the thoracoscopic sympathectomy.
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Objective To compare the prognosis effect of different Helicobacter pylori (Hp)eradication methods in patients with chronic gastritis.Methods One hundred and twenty patients with chronic gastritis diagnosed by gastroscopy and pathology examination were divided into sequential therapy group (36 cases),triple-combined therapy group (34 cases),Hp positive without eradication group (30cases) and Hp negative group (20 cases) according to the Hp infection status.All patients were followed up by gastroscopy,biopsy and rapid urease test before and after therapy.Results The Hp eradication rate in sequential therapy group was 94.44％ (34/36),in triple-combined therapy group was 73.53％ (25/34),and there was statistical difference (x2 =5.775,P =0.016).The symptoms scores and gastroscopy scores after therapy in the four groups were significantly lower than those before therapy,and there were statistical differences (P ＜ 0.05).The symptoms scores and gastroscopy scores after therapy in sequential therapy group were significantly lower than those in triple-combined therapy group,and there were statistical differences (P ＜0.05).The symptoms scores and gastroscopy scores after therapy in sequential therapy group,triple-combined therapy group and Hp negative group were significantly lower than those in Hp positive without eradication group [(0.84 ± 0.60),(1.34 ± 0.59),(1.49 ± 0.62) scores vs.(2.98 ± 0.54) scores,(0.47 ± 0.37),(0.83 ± 0.35),(0.96 ± 0.75) scores vs.(1.22 ± 0.40) scores],and there were statistical differences (P ＜ 0.05).Conclusions The Hp eradication rate of sequential therapy is higher than that of triple-combined therapy.The two therapy methods can both improve the symptoms score and gastroscopy score,but the symptoms after sequential therapy are relieved faster compared with triple-combined therapy.
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Objective To investigate the feasibility of Narcotrend-guided application of small dose of dexmedetomidine ( DEX) for sedation during combined spinal-epidural anesthesia for elderly patients. Methods Fifty cases of ASA II or Ⅲelderly patients were randomly divided into treatment group and control group (25 patients of each group). After combined spinal-epidural anesthesia, both groups received continuous intravenous infusion of DEX, at 0. 4 μg·kg-1 in 10 min, and then the rate was lowered to 0. 4 μg·kg-1 per hour. For the treatment group, infusion rate was adjusted to reach a Narcotrend Index (NTI) of 75-85, and for the control group, infusion rate was adjusted to reach an OAA/S score of level 3-4. MAP, HR, RR, SpO2 , NTI and OAA/S score were recorded at the beginning of DEX treatment ( t0 ) , 10 min ( t1 ) , 20 min ( t2 ) , 30 min ( t3 ) , and 60 min ( t4 ) after the beginning of DEX treatment, and at the end of surgery ( t5 ) . The incidence rates of adverse events including bradycardia, hypotension, low oxygenation, and respiratory depression were also recorded. The patients were followed up until 24 h after surgery to record loss of memory about the surgical events. Results In comparison with t0 , NTI and MAP of both groups significantly decreased at t1-t5(P0. 05). Follow-up at 24 h after surgery observed total amnesia in 72. 0% of DEX group patients and in 76. 0% of the control group, without significant difference (P>0. 05). Conclusion Sedating elderly patients undergoing spinal-epidural anesthesia with DEX under the guidance of Narcotrend is safe and feasible, and the patients can be sedated properly.
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Objective To compare the effects of five different target-controlled concentrations of propofol combined with finite concentration of remifentanil on intraoperative awareness,so as to determine the safer and more effective concentration of propofol which could decrease explicit memory and reduce the incidence of intraoperative awareness. Methods One hundred and fifty patients ( ASAⅠ-Ⅱ) were randomly divided into five groups. There was no significant difference between each group in general condition. Before awaking,the target controlled concentration of remifentanil was adjusted to 2. 4 μg·L-1 in all five groups. Groups R1,R2,R3,R4 and R5 also received 0. 9%normal saline,0. 5 mg·L-1,1. 0 mg·L-1,1. 5 mg·L-1 and 2. 0 mg·L-1 of target controlled infusion ( TCI) of propofol, respectively. Narcotrend index ( NI), mean arterial pressure (MAP),heart rate (HR) and t [the time from t1(the time of awareness beginning) to the end of awareness] at t0(the time of adjusting propofol),t1,t2(the period of awareness),t3(wake period end 5 min) were recorded. Elimination of explicit memory after surgery was followed up. Results There were no significant differences in t and NI between groups R1,R2 and R3(P>0. 05). NI of groups R4 and R5 was significantly lower than that in groups R1,R2 and R3(P0. 05). Conclusion Target controlled infusion of remifentanil 2. 4μg·L-1 combined with TCI propofol 1. 0 mg·L-1 does not affect the wakening controllability. The circulation was steadier and explicit memory could be eliminated during intraoperative awakening.
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Objective To evaluate the feasibility of using single lumen tube intubation technique in bronchial intubation with Robertshaw double-lumen tube .Methods 80 patients with ASA Ⅰ - Ⅱ level who need to accept bronchial intubation were ran-domly divided into two groups .Group A(n=40) accepted bronchial intubation using single lumen tube intubation technique .Group B(n=40) accepted bronchial intubation using traditional intubation technique .The single success rates and intubation complication rates were observed .Results The single success rates of group A was obviously higher than group B (P0 .05) .Conclusion The single suc-cess rates of single lumen tube intubation technique in bronchial intubation with Robertshaw double-lumen tube is higher than tradi-tional intubation technique ,at the same time ,the complication rate of intubation is low ,safe and feasible .
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Objective To investigate the postoperative epidural analgesia and adverse reactions in total abdominal hysterectomy with dezocine and ropivacaine.Methods Sixty elective transabdominal hysterectomy patients with American Society of Anesthesiologists (ASA) Ⅰ-Ⅱ grade were randomly divided into two groups,dezocine group and morphine group,there were 30 cases in each group.Dezocine group:dezocine (6 mg) + 0.75％ ropivacaine hydrochloride(20 ml) + saline dilution,diluted to 100 ml.Morphine group:morphine(6 mg) + 0.75 ％ hydrochloride ropivacaine (20 ml) + saline dilution,diluted to 100 ml,for postoperative epidural analgesia.Both two groups were adopted in LCP mode with a loading dose:dezocine group,dezocine(2 mg) +saline dilution,diluted to 5 ml; morphine group,morphine (2 mg) + saline dilution,diluted to 5 ml.Continuous infusion of 2 ml/h,a bolus dose of 2 ml,and a lockout interval of 15 min.The analgesia duration was 48 h.Visual analogue scales (VAS) evaluation was employed to assess the analgesic effect,and the postoperative epidural analgesia adverse reaction were also recorded.Results The analgesic effect was both satisfied in the two groups.Comparing the VAS scores postoperative at different time point (4 h,8 h,12 h,24 h,36 h,48 h),dezocine group(2.7 ± 0.4,2.5 ± 0.6,2.2 ± 0.5,1.5 ± 0.5,1.3 ± 0.5,1.1 ± 0.3) were slightly lower than morphine group (2.8 ± 0.5,2.6 ± 0.7,2.3 ± 0.6,1.6 ± 0.7,1.5 ± 0.6,1.2 ± 0.4),but the difference was not significant (within the group:F =2414.96,P ＜ 0.01 ; between the group:F =0.63,P ＞ 0.05 ; interactive:F =2.42,P ＞0.05).Comparison of VAS scores at different time points after operation in two groups,the difference was not statistically significant; And within the group,there was not,the difference was not significant at the time point at 12,24,36,48 h compare to postoperative at 4 h (P ＜ 0.01).the Adverse reaction like nausea and vomiting,skin itching occur rate is lower in dezocine group (3.3 ％ (1/30),0 (0/30)) than that of in morphine group(26.7％ (8/30),20.0％ (6/30)),and there were signficant differences between the two groups (P =0.026,0.024,P ＜ 0.05).Conclusion Dezocine composed with ropivacaine is safe and effective,and with few adverse reactions in total abdominal hysterectomy postoperative epidural analgesia,it is worth of widely use in clinical.
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Objective To investigate the impact and significance of the vagus nerve intervention on the atrial electrical emodeling.Methods 30 mongrel dogs were given metoprolol in order to eliminate the effects of sympathetic nerve on atrial electrical remodeling;observe the atrial effective refractory period (ERP) and atrial fibrillation susceptible window(VW) in the high right atrial(SA) and coronary sinus (CS) by the vagus nerve stimulation(VS) or vagus nerve stimulation(Non-VS) before and after using atropine and after atrial electrical remodeling was observed.Results Before using vagus nerve blocking agents atropine,ERP shortened significantly [(54.83 ± 46.23) ms] and VW increased significantly [(19.86±13.23) ms] after VS,this time with atrial fibrillation-prone ; After using atropine,ERP increased significantly [(112.33 ± 9.63) ms] under VS,did not induce atrial fibrillation; After atrial electrical remodeling,the value of ERP was no significant difference under basis and VS (t =2.116,0.853,all P ＞0.05).Conclusion VS can increase the atrial electrical remodeling,an increase of atrial fibrillation susceptibility;vagus nerve block can reduce atrial electrical remodeling and atrial fibrillation susceptibility decreased.