ABSTRACT
Objective To evaluate the effects of parecoxib on cellular immune function during patientcontrolled intravenous analgesia (PCIA) with butorphanol after modified radical mastectomy in patients.Methods Sixty ASA physical status Ⅰ or Ⅱ patients,aged 36-60 yr,weighing 48-82 kg,scheduled for elective modified radical mastectomy,were randomly divided into 2 groupe (n =30 each):control group (group C) and parecoxib group (group P).PCIA with butorphanol 10μg/kg was used at the end of operation.The PCIA pump was set up to deliver a 0.5 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h.In group P,parecoxib 40 mg was injected intravenously at the end of operation and 12,24 and 36 h after surgery,while in group C,the equal volume of normal saline was injected.VAS score was maintained at ≤4.When VAS score≥5,butorphanol was injected intravenously as a rescue analgesic.Blood samples were obtained from the right internal jugular vein at 5 min before induction of anesthesia,2 h after skin incision,and 6 h and 1,3,7 days after surgery for determination of the levels of T lymphocyte subsets (CD3+,CD4+,CD8+,CD4+/CD8+) and natural killer (NK) cells (by flow cytometry).CD4+/CD8+ was calculated.The number of attempts,the number of successfully delivered doses and requirement for rescue analgesics were recorded at 2,6,12,24 and 48 h after surgery.Adverse effects were also recorded after surgery.Results Compared with group C,the number of attempts and requirement for rescue analgesics were significantly decreased,the number of successfully delivered doses was increased,and the levels of CD3+,CD4+,CD4+/CD8+ and NK cells were decreased at 1 day after surgery (P ＜ 0.05).There was no significant difference in adverse effects between the two groups (P ＞ 0.05).Conclusion Parecoxib can enhance the efficacy of postoperative PCIA with butorphanol and reduce the consumption of butorphanol thus improving cellular immune function after modified radical mastectomy in the patients.
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Objective To explore the influence of autologous blood salvage on the gastric intramucosal pH(pHi)in operation for orthopedic patients.Methods 40 patients nnderwent orthopedic surgery were randomly divided into two groups(n=20 each).Salvage group received autologous blood transfusion.The pHi was measured by a nasogastric tube air carbon dioxide tension instrument.The blood samples were collected before operation(T0),1 h after operation(T1),2h after operation(T2)and the end of surgery(T3)for the measurement of pHi.The volume of blood recovery,erythrocyte suspension and plasma were counted.Results The volume of erythrocyte suspension and plasma were significantly higher in control group than in salvage group during operation(P＜0.05).There was no obviously different in blood gas indexes in the two groups(P＞0.05).The phi was significantly higher in salvage group[(7.381±0.023),(7.386±0.025)]than those in control group[(7.361±0.022),(7.375±0.024)]at T2 and T3(all P＜0.05).Conclusion Autologous blood salvage could recover loss blood in time,and make pHi decline,and maintain effective circulation,and significantly improved visceral microcirculatory perfusion and oxygenation in patients under went orthopedic surgery.
ABSTRACT
Objective To investigate the effects of continuous stellate ganglion block (SGB) on serum thyroid hormone and cortisol levels in patients with severe brain injury.Methods Eighty ASA Ⅱ or Ⅲ patients with severe brain injury aged 22-61 yr undergoing emergency craniotomy were randomly divided into 2 groups ( n = 40 each): control group (group C) received routine treatment only and continuous SGB group (group SGB) received continuous SGB with 0.2% ropivacaine besides routine treatment. SGB was performed on the operated side after induction of general anesthesia and tracheal intubation. An epidural catheter was placed. A bolus of 0.2% ropivacaine 7 ml was followed by continuous infusion of 0.2% ropivacaine at a rate of 2 ml/h. Continuous SGB was maintained for 48 h. Successful SGB was confirmed by increase in skin temperature by ≥1.5℃ behind earlobe on the operated side.Venous blood samples were obtained at 30 min before and 3 and 7 day after operation for determination of serum thyroid stimulating hormone (TSH), triiodothyronine (T3) ,thyroxine (T4) , reverse triiodothyronine(rT3) and cortisol concentrations. Glasgow prognosis score was used to evaluate the clinical results at 3 months after operation. Results Serum T4 , rT3 , TSH and cortisol concentrations were significantly lower while the serum T3 concentration was higher in the SGB group than in group C at 3 and 7 d after operation. The clinical results were significant better in SGB group than in group C according to Glasgow prognosis scores at 3 months after operation. Conclusion Continuous SGB can inhibit the stress response, and improve hypothalamus-pituitary-thyroid gland axis function and is helpful to patient's recovery from injury.