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Objective To evaluate the changes in the status of macrophages during the non-ventilated lung injury in the patients undergoing long-time one-lung ventilation (OLV).Methods Thirty patients of both sexes,aged 35-64 yr,weighing 50-80 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective pulmonary lobectomy for lung cancer,were divided into 2 groups (n=15 each) according to the time of OLV:short-time OLV group (＜30 min,group S) and long-time OLV group (＞2 h,group L).Anesthesia was routinely induced and maintained.Normal lung tissues around the cancer tissues from the lobe of the lung excised were obtained for microscopic examination of pathologic changes which were scored.The activated macrophages (CD68 positive),polarized M1 macrophages (CD86 positive) and polarized M2 macrophages (CD206 positive) in lung tissues were detected using immunofluorescence.The ratio of CD86 positive cells to CD206 positive cells was calculated.Results Compared with group S,lung injury scores on the non-ventilated side were significantly increased,the number of CD68,CD86 and CD206 positive cells in lung tissues was increased,and the ratio of CD86 positive cells to CD206 positive cells was increased in group L (P＜0.05).Conclusion Long-time OLV (＞2 h) can result in increased number of activated macrophages,especially the polarized M1 macrophages,which may be one of the mechanisms underlying lung injury on the non-ventilated side.
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Objective To compare the difference between crystalloids and colloids under goal-directed fluid therapy (GDFT) in elective hepatectomy.Methods Seventy patients undergoing hepatectomy, 42 males and 28 females, aged 18-65 years, ASA physical status Ⅱ or Ⅲ, were included and randomly divided into three groups base on fluid treatment: conventional fluid therapy (group C, n=24), goal-directed fluid therapy filled with colloids (group G1, n=23) and goal-directed fluid therapy filled with crystalloids (group G2, n=23).Group C received conventional fluid therapy mainly based on MAP while group G1 and group G2 received goal-directed fluid therapy based on MAP, stroke volume variation (SVV) and cardiac index (CI), and the Flotrac/Vigileo system was used to obtain SVV and CI in group G1 and group G2.250 ml colloids were administered if SVV>13% in group G1 while 250 ml crystalloids were administered in group G2.If CI<2.5 L·min-1·m-2, dobutamine 2.0-10.0 μg·kg-1·min-1 was given until CI≥2.5 L·min-1·m-2.The ScvO2, Lac and Glu were tested at 5 min before anesthesia induction (T1), 5 min before hepatectomy (T2), 5 min after hepatectomy (T3) and the end of operation (T4).The duration of operation, fluid requirement, urinary output, bleeding volume, and the use of vasoactive agent were recorded.The exhaust time, ambulation time and postoperative hospital stay were recorded.Preoperative and postoperative liver and kidney function tests and postoperative complications were followed up.Results Compared with group C, the total volume was lower, flatus time, ambulation time and postoperative hospital stay were shorter, ScvO2 at T3 and T4 were higher, Lac at T2-T4 were lower, Glu at T3 and T4 were lower, ALT and AST on the third day and the fifth day after surgery were lower in group G1 (P<0.05).Compared with group G1, the amount of crystalloids was increased, the incidences of postoperative nausea and vomiting were significantly higher in group G2 (P<0.05).There was no significant difference in flatus time, ambulation time and postoperative hospital stay between group G1 and group G2.Conclusion GDFT in hepatectomy propably improves the microcirculation and tissue oxygenation, protects liver function, promotes gastrointestinal function recovery and shortens postoperative hospital stay.GDFT using colloids bolus contribute to a much lower incidence of postoperative nausea and vomiting.There is no significant difference in tissue perfusion and postoperative recovery between colloids and crystalloids.
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Objective To evaluate the safety and effectively of transfusion plan guided by POTTS in gynecological patients with Hb level ranged from 60 to 100 g/L. Methods 114 gynecological patients with perioperative Hb level ranged from 60 to 100 g/L were randomly divided into POTTS group ( n=57 ) and control group ( n=57 ) . Patients in POTTS group received transfusion under the guidance of POTTS. Patients in control group received transfusion according to doctor's experience. The proportion of injecting RBCs,the amount of RBCs, the incidence of serious complications and mortality,ICU occupancy rate, postoperative Hb recovery, incision healing, hospitalization time, blood transfusion related costs and costs of hospitalization were observed and compared. Results The transfusion rate and volume in POTTS group were significantly lower than the control group ( P<0. 01 ) . Neither severe com-plications nor any mortality were found in each group. The transfusion costs in POTTS group were significantly less than the control group (P<0. 01). Two groups had no postoperative ICU admission;the postoperative Hb recovery, incision healing, hospitalization time and costs of hospitalization in two groups were not statistically significant. Conclusion POTTS could be safety and effectively used in gynecological patients with Hb level ranged from 60 to 100 g/L, also effectively save the blood, reduce the costs of blood transfusion, not increase perioperative mortality and the incidence of various complications.
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The teaching team of undergraduates of anesthesiology in Anhui Medical University applied the primary trauma care system of encourage, heuristic teaching and practical teaching to further deepen the educational reform and improve teaching quality for undergraduate education.They designed the diversified section such as drills, discussion, teaching, questions, feedback and so on, implemented the simulation training of anesthesia crisis management skills and completed the feedback evaluation of comprehensive ability before and after the teaching, and then achieved the effect of improving the actual operation ability and clinical thinking capacity of students.So it is a good method and worth extending.
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Objective To retrospectively analyze the influence of perioperatively transfusing different ratios of fresh frozen plasma (FFP) to red blood cell (RBC) on prognosis of patients receiving massive transfusion.Methods From January 2010 to September 2012,139 surgical patients with transfusion of ≥ 10 RBC units within 24 hours were included in the study.Patients were categorised into three groups based on the FFP ∶ RBC scale:high scale group (FFP ∶ RBC ＞ 1 ∶ 1,n =19),middle scale group (FFP ∶ RBC =1 ∶ 2-1 ∶ 1,n =43) and low scale group (FFP ∶ RBC ＜ 1 ∶ 2,n =77).Comparison among the groups was made in aspects of transfusion of different blood products in hospital,blood routine index before and after massive transfusion,blood coagulation index,electrolyte index,hospital stay,ICU stay,cure rate and mortality.Results FFP transfusion was the most in high scale group (2 600 ± 1 582) ml,followed by (1 390 ± 1 043) ml in middle scale group and (318 ± 342) ml in low scale group (P ＜0.05).Platelet (PLT) transfusion was more in high scale group (0-1.4 units) and middle scale group (0-1.0 units) compared with that in low scale group (0-0.0 units,P ＜ 0.05).Volume of RBC and cryoprecipitate transfused revealed no significant differences among the groups (P ＞ 0.05).Before blood transfusion prothrombin time (PT) [(20.2 ± 10.7) s] and activated partial thromboplastin time (APTT) [(57.2±45.8) s] in middle scale group were significantly prolonged than those in high scale group [(14.3 ±4.4) s and (35.3 ± 10.0) s] and low scale group[(12.5 ± 1.7) s and (31.5 ± 5.9) s] (P ＜ 0.05),but the differences were insignificant in indices of hemoglobin (Hb),PLT,international normalized ratio (INR),K +,and Ca2 + (P ＞ 0.05).After blood transfusion Hb [(106.8 ± 31.7) g/L] and Ca2+[(1.99 ± 0.24)mmol/L] in low scale group were higher than these in middle scale group [(82.5 ± 32.2) g/L and (1.76 ± 0.38) mmol/L] and in high scale group [(91.3 ± 19.1) g/L and (1.96 ±0.25) mmol/L] (P ＜0.05),but there were no significant differences in PLT,PT,INR,APTT and K+(P ＞ 0.05).Moreover,hospital stay,ICU stay,cure rate and mortality were not differed significantly among the groups (P ＞ 0.05).Conclusion For massive transfusion patients,transfusion of FFP and RBC at a 1 ∶ 2 to 1 ∶ 1 ratio is beneficial to preventing coagulation dysfunction and reducing plasma total infusion volume,and exerts no effect on the prognosis.
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Objective To evaluate the role of different opioid receptors in sufentanil postconditioning-induced attenuation of myocardial ischemia-reperfusion (I/R) injury in rats.Methods Fifty adult male Sprague-Dawley rats,aged 4-6 months,weighing 200-330 g,were randomly divided into 9 groups:I/R group (n =7),ischemic postconditioning (IPC) group (n =7),sufentanil postconditiong (SP) group (n =6),κ-opioid receptor antagonist nor-binaltorphimine (nor-BNI) + SP group (group BNI + SP,n =5),δ-opioid receptor antagonist naltrindole + SP group (group NTD + SP,n =5) and μ-opioid receptor antagonist CTOP + SP group (group CTOP +SP,n =5).Myocardial I/R was produced by 30 min occlusion of left anterior descending branch of coronary artery followed by 120 min reperfusion.IPC was induced by 3 episodes of 10 s reperfusion followed by 10 s ischemia at the end of 30 min myocardial ischemia.Sufentanil 1 μg/kg was injected intravenously at 5 min before reperfusion in SP group.In groups BNI + SP,NTD + SP and CTOP + SP,nor-BNI 5 mg/kg,naltrindole 5 mg/kg and CTOP 1 mg/kg were injected intravenously,respectively,before SP and the corresponding doses of nor-BNI,naltrindole and CTOP were injected intravenously,respectively,at 5 min before reperfusion.Arterial blood samples were collected at 120 min of reperfusion for measurement of the plasma cardiac tropnin I (cTnI) concentration.The rats were then sacrificed and hearts removed for determination of myocardial infarct size (IS) and area at risk (AAR).IS/AAR was calculated.Results Compared with I/R group,the plasma cTnI concentration and IS/AAR were significantly decreased in groups IPC,SP,BNI + SP and NTD + SP (P ＜ 0.05),and no significant change was found in the plasma cTnI concentration and IS/AAR in groups CTOP + SP,NTD,BNI and CTOP (P ＞ 0.05).Compared with SP group,IS/AAR was increased in NTD + SP and BNI + SP groups and the plasma cTnI concentration and IS/AAR were significantly increased in CTOP + SP group (P ＜ 0.05).Conclusion The μ-,κ-and δ-opioid receptors mediate sufentanil postconditioning-induced attenuation of myocardial I/R injury in rats.
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Objective To investigate the role of inducible nitric oxide synthase (iNOS) in reduction of myocardial ischemia-reperfusion (I/R) injury by sufentanil preconditioning in rats. Methods Thirty adult male SD rats, weighing 250-330 g, were randomly divided into 5 groups ( n =6 each): sham operation group (group S),I/R group, sufentanil preconditioning group (group SF), sufentanil preconditioning + a specific inhibitor of iNOS S-methyl thiourea (SMT) group (group SF+ SMT) and S-methyl thiourea group (group SMT). In I/R,SF,SF+SMT and SMT groups, myocardial I/R was produced by occlusion of left anterior descending coronary artery for 30 min followed by 120 min reperfusion. Group SF received 30 min infusion of sufentanil 120 μg/kg via caudal vein 24 h before ischemia. Group SF + SMT received infusion of sufentanil 120 μg/kg via caudal vein 24 h before ischemia and then SMT 10 mg/kg was injected 10 min before ischemia. In group SMT, SMT 10 mg/kg was injected 10min before ischemia. MAP and HR were recorded at 30 min before ischemia, at 30 min of ischemia and at the end of reperfusion. The rate-pressure product (RPP) was calculated. Arterial blood samples were obtained immediately at the end of reperfusion to determine the plasma concentration of NO. Then the animals were sacrificed and myo cardial tissues were obtained to determine the area at risk (AAR), infarct size (IS) and iNOS expression. IS/AAR was calculated. Results Compared with group S, MAP and RPP were significantly decreased, while IS/AAR was significantly increased at 120 min of reperfusion in the other four groups, and MAP and RPP were significantly decreased at 30 min of ischemia in I/R and SMT groups ( P ＜ 0.05). Compared with group I/R, no significant change was found in HR, MAP and RPP in SF, SF + SMT and SMT groups, and in IS/AAR and plasma NO concentrations in SF + SMT and SMT groups ( P ＞ 0.05), but IS/AAR was significantly decreased, and the plasma NO concentration and iNOS expression were significantly increased in group SF ( P ＜ 0. 05). Conclusion iNOS is involved in reduction of myocardial I/R injury by sufentanil preconditioning in rats.
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Objective To investigate effect of diabetes mellitus factor on attenuation of myocardial ischemia-reperfusion injury by sufentanil postconditioning in rats.Methods Diabetes mellitus was established by intraperitoneal streptozotocin 50 mg/kg and was confirmed by blood glucose ≥ 16.7 mmol/L.Thirty healthy adult male SD rats,weighing 250-300 g which diabetes mellitus model was successfully established were randomly divided into 3 groups ( n =10 each):diabetic mellitus sham operation group (group DM-S),diabetic mellitus ischemia-reperfusion group (group DM-IR) and diabetic meltitus sufentanil postconditioning group (group DM-SP).Another 30nondiabetic mellitus rats were also randomly divided into 3 group ( n =10 each):nondiabetic mellitus sham operation group (group NDM-S),nondiabetic mellitus ischemia-reperfusion group (group NDM-IR) and nondiabetic mellitus sufentanil postconditioning group (group NDM-SP).Myocardial ischemia-reperfusion was induced by 30 min occlusion of left anterior descending branch of coronary artery followed by reperfusion.Sufentanil postconditioning was induced by iv injection of sufentanil 1.0 μg/kg at 5 min before reperfusion.MAP,SBP,HR and RPP (HR × SBP) were recorded before ischemia,30 min of ischemia and 120 min of reperfusion.Arterial blood samples were collected at 120 min of reperfusion for measurement of plasma cardiac troponin 1 (cTnI) concentration.The animals were then sacrificed for determination of total areas of right and left ventricles ( LV + RV),infarct area (IS),area at risk (AAR) and IS/AAR.Results MAP and RPP were significantly lower,while plasma cTnI concentration was higher during myocardial ischemia reperfusion in diabetic and nondiabetic rats.Sufentanil postconditioning significantly decreased IS,IS/AAR and plasma cTnI concentration in nondiabetic rats during myocardial ischemia reperfusion but had no effect on IS,IS/AAR and plasma cTnI concentration in diabetic rats.The IS,IS/AAR and plasma cTnI concentration were significantly higher in DM-SP group than in NDM-SP gnoup ( P ＜ 0.05).Conclusion Diabetes mellitus factor can negate sufentanil postconditioning induced protection against myocardial ischemia-reperfusion injury in rats.
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Objective To discuss the possibility of ultrasonic superficial spray anesthesia applied to bronchoscopy in children with intratracheal foreign bodies. Methods 50 cases with intratracheal foreign body were divided into two groups: surface anesthesia group (S group) and intravenous anesthesia group (Ⅰ group). 2% Lidocain by ultrasonic spraying inhalation for 8～10 min and r-OH 80 mg*kg-1+Ketamine 1 mg.kg-1 intravenous injection were adminstered respectively. Results In S group perioperative the MAP and HR were stable， the complications were fewer and the SpO2 was >95%，the awaking time was shorter (70.1±15.3) min after operation；In I group the MAP and HR were descendent (P<0.05)， the complications were more and the SpO2 was <95% (P<0.05)， the awaking time was longer(P<0.01). Conclusion The surface anesthesia is effective.The MAP and HR are stable，the complications are fewer and the awaking time is shorter.