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Objective@#To investigate the effects of remifentanil combined with propofol on hemodynamics, inflammatory stress response and immune function in patients with acute abdomen complicated with septic shock.@*Methods@#From June 2017 to August 2018, 112 patients with acute abdomen complicated with septic shock who admitted to the First Affiliated Hospital of Xiamen University were enrolled in the study.They were randomly divided into observation group and control group according to the digital table, with 56 cases in each group.The control group was anesthetized with sevoflurane combined with propofol.The observation group was anesthetized with remifentanil combined with propofol.The hemodynamic parameters of the patients entering the operating room(T0), 0.5h(T1), 1h(T2) and awake(T3) after anesthesia were recorded.The intraoperative norepinephrine dosage was recorded.The inflammatory response, stress response and immune function indicators at T0, T2 and T3 were recorded.@*Results@#Compared with T0, T1 and T2, the MAP of the two groups was higher at T3, and the differences were statistically significant(tcontrol group=4.834, 4.484, 5.378, tobservation group=6.420, 7.006, 6.152, all P<0.05). Compared with T0, the HR of the two groups was higher at T3, and the differences were statistically significant(tcontrol group=5.943, tobservation group=7.722, all P<0.05). Compared with T1 and T2, CO of the two groups was higher at T3, and the differences were statistically significant(tcontrol group=4.276, 2.262, tobservation group=6.318, 5.132, all P<0.05). There were no statistically significant differences in MAP, HR and CO between the two groups at T0, T1, T2 and T3(all P>0.05). The doses of norepinephrine in the observation group and the control group were (1 587.7±287.5)μg and (1 937.9±397.6)μg, respectively, and the difference was statistically significant(t=5.341, P<0.05). The serum levels of C reactive protein(CRP), tumor necrosis factor alpha(TNF-α) and interleukin 6(IL-6) increased with time in the two groups, and the differences were statistically significant(tcontrol group=17.06, 36.13, 19.07, 3.822, 9.466, 2.874, 14.18, 26.87, 16.21, tobservation group=11.72, 20.79, 11.01, 2.810, 6.559, 3.716, 10.52, 24.56, 17.64, all P<0.05). At T2 and T3, the serum levels of CRP, TNF-α and IL-6 in the observation group[T2: CRP (89.63±17.65)mg/L, TNF-α (51.16±10.16)ng/L, IL-6 (34.26±6.25)ng/L, T3: CRP (136.15±26.25)mg/L, TNF-α (58.64±11.12)ng/L, IL-6 (67.56±12.67)ng/L]were lower than those in the control group[T2: CRP (112.15±22.34)mg/L, TNF-α (59.56±11.58)ng/L, IL-6 (42.65±8.37)ng/L, T3: CRP (175.16±34.75)mg/L, TNF-α (65.79±11.35)ng/L, IL-6 (79.02±14.56)ng/L], the differences were statistically significant(t=5.919, 6.703, 4.080, 3.367, 6.010, 4.443, all P<0.05). Compared with T0, serum levels of epinephrine(E), cortisol(Cor) increased in two groups at T2 and T3, and the differences were statistically significant(tcontrol group=10.03, 8.096, 8.679, 7.029, tobservation group=6.473, 4.728, 6.330, 4.727, all P<0.05). Compared with T2, serum levels of E and Cor in two groups at T3 were decreased, and the differences were statistically significant(tcontrol group=2.400, 2.638, tobservation group=2.260, 2.162, all P<0.05). At T2 and T3, the serum levels of E, Cor in the observation group[T2: E (286.36±41.02)ng/L, Cor (262.52±29.89)μg/L, T3: E (270.35±33.59)ng/L, Cor (253.23±30.28)μg/L]were lower than those in the control group[T2: E (312.56±38.75)ng/L, Cor (287.56±38.76)μg/L, T3: E (295.79±35.12)ng/L, Cor (270.25±30.15)μg/L], the differences were statistically significant (t=3.457, 3.917, 3.828, 2.981, all P<0.05). At T0, T2 and T3, there were no statistically significant differences in CD3+, CD4+, CD8+ and CD4+/CD8+ between the two groups(all P>0.05).@*Conclusion@#Remifentanil combined with propofol anesthesia can make hemodynamics more stable in patients with acute abdomen complicated with septic shock, and can alleviate inflammation and stress response.
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Objective To investigate the effects of remifentanil combined with propofol on hemodynamics,inflammatory stress response and immune function in patients with acute abdomen complicated with septic shock.Methods From June 2017 to August 2018,112 patients with acute abdomen complicated with septic shock who admitted to the First Affiliated Hospital of Xiamen University were enrolled in the study.They were randomly divided into observation group and control group according to the digital table,with 56 cases in each group.The control group was anesthetized with sevoflurane combined with propofol.The observation group was anesthetized with remifentanil combined with propofol.The hemodynamic parameters of the patients entering the operating room(T0),0.5h(T1),1h (T2) and awake (T3) after anesthesia were recorded.The intraoperative norepinephrine dosage was recorded.The inflammatory response,stress response and immune function indicators at T0,T2 and T3 were recorded.Results Compared with T0,T1 and T2,the MAP of the two groups was higher at T3,and the differences were statistically significant(tcontrol group =4.834,4.484,5.378,tobservation group =6.420,7.006,6.152,all P ＜0.05).Compared with T0,the HR of the two groups was higher at T3,and the differences were statistically significant (tcontrol group =5.943,tobservation group =7.722,all P ＜ 0.05).Compared with T1 and T2,CO of the two groups was higher at T3,and the differences were statistically significant (tcontrol group =4.276,2.262,tobservation group =6.318,5.132,all P ＜ 0.05).There were no statistically significant differences in MAP,HR and CO between the two groups at T0,T1,T2 and T3 (all P ＞0.05).The doses of norepinephrine in the observation group and the control group were (1 587.7 ± 287.5) μg and (1 937.9 ±397.6) μg,respectively,and the difference was statistically significant(t =5.341,P ＜0.05).The serum levels of C reactive protein(CRP),tumor necrosis factor alpha(TNF-α) and interleukin 6 (IL-6) increased with time in the two groups,and the differences were statistically significant(tcontrol group =17.06,36.13,19.07,3.822,9.466,2.874,14.18,26.87,16.21,tobservation group =11.72,20.79,11.01,2.810,6.559,3.716,10.52,24.56,17.64,all P ＜ 0.05).At T2 and T3,the serum levels of CRP,TNF-α and IL-6 in the observation group [T2:CRP (89.63 ±17.65) mg/L,TNF-α (51.16 ± 10.16) ng/L,IL-6 (34.26 ± 6.25) ng/L,T3:CRP (136.15 ±26.25) mg/L,TNF-α (58.64 ± 11.12)ng/L,IL-6 (67.56 ± 12.67)ng/L] were lower than those in the control group[T2:CRP (112.15 ±22.34) mg/L,TNF-α (59.56 ± 11.58) ng/L,IL-6 (42.65 ± 8.37) ng/L,T3:CRP (175.16 ±34.75) mg/L,TNF-α (65.79 ± 11.35) ng/L,IL-6 (79.02 ± 14.56) ng/L],the differences were statistically significant (t =5.919,6.703,4.080,3.367,6.010,4.443,all P ＜ 0.05).Compared with T0,serum levels of epinephrine(E),cortisol(Cor) increased in two groups at T2 and T3,and the differences were statistically significant(tcontrol group =10.03,8.096,8.679,7.029,tobservation group =6.473,4.728,6.330,4.727,all P ＜ 0.05).Compared with T2,serum levels of E and Cor in two groups at T3 were decreased,and the differences were statistically significant (tcontrol group =2.400,2.638,tobservation group =2.260,2.162,all P ＜ 0.05).At T2 and T3,the serum levels of E,Cor in the observation group [T2:E (286.36 ± 41.02) ng/L,Cor (262.52 ± 29.89) μg/L,T3:E (270.35 ±33.59)ng/L,Cor (253.23 ±30.28)μg/L]were lower than those in the control group[T2:E (312.56 ±38.75)ng/L,Cor (287.56 ± 38.76) μg/L,T3:E (295.79 ± 35.12) ng/L,Cor (270.25 ± 30.15) μg/L],the differences were statistically significant (t =3.457,3.917,3.828,2.981,all P ＜ 0.05).At To,T2 and T3,there were no statistically significant differences in CD3+,CD4+,CD8+ and CD4+/CD8+ between the two groups (all P ＞ 0.05).Conclusion Remifentanil combined with propefol anesthesia can make hemodynamics more stable in patients with acute abdomen complicated with septic shock,and can alleviate inflammation and stress response.
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Objective To evaluate the effect of dexmedetomidine on acute kidney injury (AKI) and the relationship between the mechanism and expression of high mobility group protein B1 (HMGBl) mRNA in renal tissues of septic rats.Methods Fort-eight healthy adult male Sprague-Dawley rats,aged 8-12 weeks,weighing 240-270 g,were divided into 3 groups (n =16 each) using a random number table method:control group (C group),sepsis group (S group) and dexmedetomidine group (D group).AKI was induced by cecal ligation and puncture.The concentrations of serum cystatin C (Cys C) were measured by immunoturbidimetry at 24 and 48 h after operation.The rats were sacrificed after blood sampling,and kidney tissues were removed for determination of the expression of HMGB1 mRNA (by fluorescent quantitative real-time polymerase chain reaction) and for examination of the pathological changes.The damage to the renal tubules was scored.Results Compared with group C,the renal tubular damage score and serum Cys C concentrations were significantly increased,and the expression of HMGB1 mRNA was up-regulated in S and D groups (P＜0.05).Compared with group S,the renal tubular damage score and serum Cys C concentrations were significandy decreased,the expression of HMGB1 mRNA was down-regulated (P＜0.05),and the pathological changes of renal tissues were significantly attenuated in group D.Conclusion Dexmedetomidine can attenuate AKI in septic rats and the mechanism may be related to inhibiting the expression of HMGB1 mRNA in renal tissues.
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Objective To observe the effect of combined continuous femoral nerve blockade (CFNB)with epidural morphine postoperative analgesia on total knee arthroplasty (TKA)in elderly patients.Methods Eighty elderly patients scheduled to undergo TKA were randomly divided into two groups:groups FN and FNM.Groups FNM and FN were received 0.1% morphine 2 ml and normal saline 2 ml through epidural space respectively at the end of surgery.After surgery,all patients were implanted catheter around femoral nerve guided by ultrasound,and were infused 0.2% ropivacaine 25 ml.Continuous infusion of 0.2% ropivacaine for femoral never block was administrated at a rate of 5 ml/h for 48 hours to all patients.VAS scores and bending degree during rest,active and passive exer-cise were recorded at time point of postoperative 24,48,72,96 h.Ambulation status on the fifth day after operation were observed.Satisfaction of hospitalization were graded before hospital discharge. Results Compared with group FN,VAS scores during rest,active and passive excercise were signifi-cantly decrease at 24 h in group FNM (P <0.05 or P <0.01).The bending degree of knee joints in group FNM were significantly greater compared with group FN at 24 h after surgery (P <0.01).Am-bulation status on the fifth day after surgery were significantly better in group FNM compared with group FN (P <0.05).The level of patient satisfaction was much higher in group FNM (P <0.05). Conclusion After TKA,CFNB combined with single epidural morphine injection can provide better analgesia and bending degree with a high level of satisfaction.
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An electrochemical aptasensor for Pb2+ was constructed based on the layer-by-layer assembly of graphene (GR) and anthraquinone -2-sulfonic acid sodium salt (AQMS) on the surface of Pb2+ aptamer. The mercapto-modified Pb2+ aptamer was first anchored on a gold electrode. Then the highly conductive material of GR was adsorbed on apt through the unique π-π stacking interaction, which was further used for the assembly and signal amplification of the electroactive AQMS. Upon interaction with Pb2+ ions, the apt on the aptasensor undergone conformational switch from a single-stranded form to the G-quadruplex structure, causing the GR assembled with AQMS releasing from the electrode surface into solution. As a result, the electrochemical signal of AQMS on the aptasensor was substantially reduced. Base on this concept, a useful platform for detection of Pb2+ ions was constructed. Under the optimal experimental conditions, the attenuation of peak currents (△Ipa ) showed linear relationship with the logarithm of Pb2+ concentrations (lgCPb2+) over the range from 5. 0×10-10 to 5. 0×10-8 mol/ L. The detection limit was estimated to be 6. 0×10-11 mol/ L.