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Objective To evaluate the feasibility and safety of tracheal extubation in operating room for patients with end-stage chronic obstructive pulmonary disease (COPD) after single-lung transplantation. Methods Clinical data of 57 recipients who underwent single-lung transplantation due to end-stage COPD were retrospectively analyzed. According to the evaluation indexes of tracheal extubation in operating room established by our hospital, 17 recipients eligible for tracheal extubation in operating room were assigned into the operating room extubation group (OR extubation group) and 40 recipients receiving tracheal extubation in intensive care unit (ICU) were allocated in the ICU extubation group. The evaluation results of intraoperative tracheal extubation and postoperative recovery were compared between two groups. Results Compared with the ICU extubation group, recipients in the OR extubation group had higher oxygenation index, lower arterial partial pressure of carbon dioxide (PaCO2), lower blood lactic acid level, less fluctuation range of blood pressure and fewer cases receiving extracorporeal membrane oxygenation (ECMO) during operation (all P < 0.05). Two recipients in the OR extubation group received repeated tracheal intubation at 6 and 8 h after returning to ICU, and tracheal extubation at postoperative 6 and 9 d. In the OR extubation group, time of postoperative mechanical ventilation, length of postoperative ICU and hospital stay of the recipients were shorter than those in the ICU extubation group (all P < 0.05). The incidence of grade 3 primary graft dysfunction (PGD), atrial tachyarrhythmia, continuous renal replacement therapy and 1-year survival rate did not significantly differ between two groups (all P > 0.05). Conclusions The tracheal extubation regimen in the operating room for COPD patients after single-lung transplantation established by our hospital is safe and feasible, which shortens the time of postoperative mechanical ventilation, the length of postoperative ICU and hospital stay, whereas does not increase the incidence of postoperative complications.
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Objective: To investigate the effects of buccal acupuncture on analgesia, immune indicators, and expression levels of Survivin and Livin proteins in patients with advanced-stage primary liver cancer. Methods: Eighty patients with advanced-stage primary liver cancer were selected and divided into control and treatment groups according to the difference in treatment modalities, with 40 patients in each group. The control group received transcatheter arterial chemoembolization (TACE), and the treatment group received buccal acupuncture in addition to TACE. The recent efficacy, analgesic effect, liver function, serum tumor markers, Survivin and Livin protein expression levels in liver cancer tissue, and immune indexes were analyzed and compared between the two groups. Results: The objective response rate (ORR) and disease control rate (DCR) of the treatment group were 37.5％ and 77.5％, respectively, which were significantly higher than those of the control group (22.5％ and 52.5％), and the recent efficacy of the treatment group was significantly better than that of the control group (P<0.05). The onset of analgesia in the treatment group was significantly faster than that in the control group (P<0.05), the duration of analgesia was significantly longer than that in the control group (P<0.05), and the numeric rating scale (NRS) score of pain after treatment was significantly lower than that in the control group (P<0.05). In the treatment group, the aspartate aminotransferase (AST), alanine aminotransferase (ALT), and albumin/globulin (A/G) were significantly lower than those in the control group (P<0.05), and the serum levels of alpha-fetoprotein (AFP), alpha-L-fucosidase (AFU), and carcinoembryonic antigen (CEA) were significantly lower than those in the control group (P<0.05), and the expression levels of Survivin and Livin in liver cancer tissue were significantly lower than those in the control group (P<0.05); CD4+ and CD4+/CD8+ in the treatment group were significantly higher than those in the control group, and CD8+ was significantly lower than that in the control group after treatment (P<0.05). Conclusion: Buccal acupuncture can reduce the degree of pain and liver function damage in patients with advanced- stage primary liver cancer and lower the serum tumor marker levels, and its mechanism of action may be related to the down-regulation of Survivin and Livin protein expression levels in the liver cancer tissue and the regulation of the immune function.
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Objective To investigate the hemodynamic and rheological effects of acute hypovolemic hemodilution with 6% hydroxyethyl starch (HES) at different infusion rates. Methods 20 ASA Ⅰ adult patients undergoing elective surgery were randomized to one of two groups with 10 patients each. The patients were premedicated with intramuscular midazolam 0.06 mg/kg and atropine 0.01 mg/kg 30 min before anesthesia. Before anesthesia an intravenous line was established and lacted ringer solution was infused at a rate of 5 ml. kg-1. h-1 . Anesthesia was induced with midazolam 0.2mg/kg , fentanyl 5μg/kg and vecuronium 0. lmg/kg and maintained with inhalation of 50 % N2O and 1% isoflurane. After tracheal intubation the patients were mechanically ventilated and PET CO2 was maintainted between 4.6-6.0 kPa.Swan-Ganz catheter was inserted via right internal jugular vein. The dorsalis pedis artery was cannulated for direct measurement of arterial pressure. 6% HES infusion rates were 10 ml.kg-1.h-1 in group Ⅰ and 20ml.kg-1 .h-1 in group Ⅱ respectively. ECG, heart rate (HR), arterial blood pressure (SBP, DBP and MAP), CO, CL, CVP, PAP, PCWP, SpO2, PET CO2 and inhalation concentrations of N2O and isoflurane were monitored before and 30, and 60 min after infusion was started. Arterial and venous blood samples were taken for blood gas analysis and rheological studies. Results The two groups were comparable with respect to demographic data. During HES infusion HR decreased and CL increased in both groups and there was no significant difference between the two groups. BP increased slightly at 60 min in group Ⅰ , whereas in group Ⅱ it tended to decrease. CVP, PAP and PCWP increased significantly in both groups especially at 60 min. Hct decreased from 36.2% ±4.5% to 30.4% ±4.1% in group Ⅰ and from 39.6%±8.0 % to 30.8% ± 5.9 % in group Ⅱ at 60 min. Hb and K value of erythrocyte sedimentation rate (ESR) equation decreased significantly in both groups especially at 60 min. Conclusions Intravascular volume expansion ismore efficient with increased infusion rate of HES but the influences on hemodynamics would be more significant. HES infused at 20 ml. kg-1 . h -1 is safe in healthy patient during operation with blood loss.[Key Words] Hemodilution; Hydroxyethyl starch; Hemodynamics; Hemorheology
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Objective: To study clinical pharmacodynamics and efficacy for endotracheal intubation of rocuronium and succinylcholine at different dosage. Method: Sixty adult patients under general anesthesia according to the different drugs and dosage, were randomly divided into four groups. In groupⅠorⅡ,2 or 3?ED_(95) rocuronium were administrated,and in group Ⅲ and Ⅳ, 2 or 3?ED_(95) succinylcholine were given respectively. The course of depression and recovery of twitch response of the adductor pollicis muscle were recorded, and intubating condition were assessed. Result:The intubation condition was excellent in all patients of group Ⅱ,but only in 20％ of group Ⅲ.The degree of twitch at maximal depression was similar between all groups. The lag time and the time of twitch reaching maximal depression were not significantly different between group Ⅱ,Ⅲ and Ⅳ, which were shorter than those of groupⅠ.The times of twitch recovery to 25％ and 95％ of baseline in groupⅠor Ⅳ were significantly longer than in groupⅠor Ⅲ, respectively. Conclusion: 3?ED_(95) rocuronium has similar onset time to 2 or 3?ED_(95) succinylcholine with the excellent intubation condition,but the clinical effective duration is more longer than that of 2?ED_(95) rocuronium.
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This study was concerned about comparing the degree and process of cardiopulmonary effect of propofol and midazolam. Forty-five adult patients,ASA grade Ⅱ, scheduled for elective operation, were randomly allocated to intravenously receiving midazolam 0.28mg?kg~(-1)(group Ⅰ,n=16), 0.40mg?kg~(-1) (group Ⅱ,n=16) ,or propofol 2.5mg?kg~(-1) (group Ⅲ,n=13) ,respectively. MAP ,HR, SpO_2 ,TV ,MV ,RR and P_(ET)CO_2 were monitored continuously before and in 30 minutes following the administration ,and the arterial blood gas analysises were performed before and 1,2,3,4,5,10,15,20 and 30 minutes after the administration. The results showed that in group Ⅰ, Ⅱ and Ⅲ after the administration separately,the maximal decrease of MAP were 20.0% ,22.8% and 22.20%, and occured in 10.8, 9.3 and 3.5 minutes;HR decreased maximally by 6.3% ,8.7% and 15.5%,TV by 76.6% ,81.3% and 91.3%/00 ,MV by 87.2%,91.6% and 93.6%,RR by 60.3%,67.5% and 83.6%; the incidences and durations of apnea were 37.5%vs 57.5 seconds,31.3%vs 68. O seconds and 76.9%vs 73.0 seconds. The MV recovered to the baseline 5 minutes in group Ⅲ and more than 10 minutes in group Ⅰ and Ⅱ following the administration. The arterial blood pH reduced and PaCO_2 increased significantly in three groups (P
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0.05) . The success rate of insertion at first attempt was similar (95%) in both groups. PLMA was placed in the correct position in 87.5% of the patients. The changes in BP and HR and the extubation or PLMA removal response were less in the PLMA group. Significantly less patients in PLMA group complained about sore throat after operation (P