Effect of High-frequency Repetitive Transcranial Magnetic Stimulation on Hand Function in Patients after Stroke / 中国康复理论与实践

@#Objective To observe the effect of high-frequency repetitive transcranial magnetic stimulation(rTMS)on hand function in patients after stroke. Methods From June,2016 to September,2017,30 stroke patients were randomly divided into control group(n=30)and experimental group(n=30).Both groups received routine training after sham rTMS or 3 Hz rTMS.Fugl-Meyer Assessment(FMA),modified Ashworth Scale(MAS)and modified Barthel Index(MBI)were used to evaluate the hand function and the activities of daily living before and after treatment. Results Finally 27 patients completed the experiment.After treatment, the FMA score increased in both groups (Z>2.070, P<0.05), and the difference value was higher in the experimental group than in the control group (Z=-2.296,P<0.05);the MAS score improved in the experimental group(Z=-2.456,P<0.05),no difference was found in the control group(Z=-0.816,P>0.05),and the difference value was higher in the experimental group than in the control group(Z=-2.792,P<0.01);the MBI score improved in both groups(t>3.085,P<0.01),howev-er,no difference was found in the MBI score and the difference value between two groups(t<0.246,P>0.05). Conclusion High-frequency rTMS could promote the hand function in patients after stroke.

Anesthesia management in robotic-assisted esophagectomy with triple incisions: analysis of 53 cases / 南方医科大学学报

Between March, 2016 and January, 2017, 53 patients underwent robotic-assisted esophagectomy with triple incisions. All the patients were intubated with Double lumen endotracheal tub with one-lung ventilation and COpneumoperitoneum, and COpneumothorax was used in 7 cases. Most of the patients could tolerate OLV and COpneumoperitoneum, and 4 patients with COpneumothorax had hypoxemia and required double-lung ventilation or high frequency ventilation; 15 patients developed postoperative pulmonary complications and were transferred to ICU. These results suggest that COpneumothorax during robotic-assisted esophagectomy with triple incision seriously disturbs pulmonary function, and careful anesthesia management is essential for preventing complications.

Effect of sevoflurane versus propofol-remifentanil anesthesia on neuromuscular blockade by continuous cisatracurium infusion / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the effects of sevoflurane and propofol-remifentanil anesthesia on neuromuscular blockade produced by continuous cisatracurium infusion.</p><p><b>METHODS</b>Forty ASA I or II patients undergoing selective surgery were randomly divided into sevoflurane and propofol-remifentanil anesthesia groups (n=20). Neuromuscular blockade was monitored using train-of-four (TOF) stimulation by recording the contraction force of the adductor pollicis muscle with a muscle relaxation monitor. A bolus dose of cisatracurium of 0.15 mg/kg was administered to facilitate endotracheal intubation, followed by continuous infusion adjusted manually to maintain the first twitch (T1) < or = 5% of the control level. The following variables were recorded including the infusion rate, total amount of cisatracurium, spontaneous recovery index (RI), and the time interval from termination of infusion cisatracurium to recovery of TOF ratio (TOFR) to 0.9.</p><p><b>RESULTS</b>With the maintenance of a 95%-99% neuromuscular blockade, the infusion rate was significantly lower in sevoflurane group than in propofol-remifentanil group (P<0.05), and stabilized in both groups after 120 min. No significant differences were found in RI or the time to TOFR of 0.9 between the two groups (P>0.05).</p><p><b>CONCLUSION</b>During the maintenance of stable neuromuscular blockade by continuous cisatracurium infusion, both sevoflurane and propofol-remifentanil anesthesia can time-dependently enhance the effect of cisatracurium without producing significant differences in the recovery properties.</p>

Comparison of sevoflurane and propofol in combined anesthesia induction with remifentanil for tracheal intubation with fiberoptic bronchoscope / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the effect and hemodynamics of sevoflurane(SEV) and propofol (PRO) in combined anesthesia induction with remifentanil for tracheal intubation fibreoptic bronchoscope (FOB).</p><p><b>METHODS</b>Twenty-four patients without difficult airway undergoing elective surgery with tracheal intubation general anesthesia were randomly divided into SEV and PRO group. FOB intubation was performed with sevoflurane or propofol administration combined with remifentanil induction. Blood pressure (BP), heart rate (HR), SPO2 and Narcotrend index (NI) were monitored to evaluate the anesthetic depth during the induction. The time to loss of consciousness (LOC), intubation time, intubation score, anesthetic dosage and adverse effects were recorded.</p><p><b>RESULTS</b>No significant difference was found between the two groups in the time to LOC, intubation time, intubation score, remifentanil dosage. Intubation was performed successfully in both groups. BP and HR of both groups decreased after the induction and did not increase after the intubation, with variation within the normal range. No significant difference in BP and HR was found between the two groups. NI of both groups decreased after the induction and during intubation. NI of SEV group 2 min after intubation was higher than that of PRO group. There was no significant difference in NI between the two groups at the other time points. No significant adverse effects or recall of the intubation procedure were reported.</p><p><b>CONCLUSION</b>Anesthesia induction FOB intubation with sevoflurane and propofol, both in combination with remifentanil, can be applied in surgical patients without contraindications to general anesthesia, and both methods can provide fast induction and good intubation condition with stable hemodynamics.</p>

Postoperative analgesia with fentanyl combined with flurbiprofen axetil following gynecologic surgery for turnor / 南方医科大学学报

<p><b>OBJECTIVE</b>a To observe the analgesic effect of fentanyl combined with flurbiprofen axetil for postoperative analgesia after gynecologic surgery.</p><p><b>METHODS</b>One hundred and forty patients undergoing gynecologic surgery were randomized equally into two groups to receive postoperative patient controlled intravenous analgesia (PCIA) with fentanyl (1.6-1.8 mg) plus tropisetron (5 mg/100 ml) (group I), or with fentanyl (0.8-1.0 mg) and flurbiprofen axetil (200 mg) plus tropisetron (5 mg/100 ml) (group II), at the PCIA rate of 2 ml/h, bolus dose of 1 ml, and lock time of 15 min. At 6 h (T1), 12 h (T2), 24 h (T3), and 48 h (T4) after the operation, the analgesic effect was evaluated with the Prine-Henry score (PHS), and the side effects were recorded. The coagulation function of the patients was assessed with thrombelastography before (T0) and 48 h (T4) after the operation, and the time of gastrointestinal function recovery was recorded.</p><p><b>RESULTS</b>The fentanyl dose was significantly less in group II than in group I (P<0.05). At the time points of T1 and T2, the PHS in group II was significantly lower than that in group I (P<0.05), but comparable between the two groups at T3 and T4 (P>0.05). Significant higher incidences of the adverse effects such as nausea, dizziness and lethargy was noted in group I than in group II (P<0.05). Compared with that at T0, the parameter K was significantly delayed at T4 in both groups (P<0.05). The two groups showed similar time of gastrointestinal function recovery after the operation (P>0.05).</p><p><b>CONCLUSION</b>Flurbiprofen axetil combined with fentanyl for postoperative analgesia can significantly reduce fentanyl dose and the incidence of adverse effects associated with fentanyl without obviously affecting the coagulation and gastrointestinal functions.</p>

Effect of ulinastatin on inflammatory responses induced by oesophagectomy / 南方医科大学学报

<p><b>OBJECTIVE</b>To examine the effect of ulinastatin (UTI) on the inflammatory responses induced by oesophagectomy.</p><p><b>METHODS</b>Forty patients with esophageal cancer (without serious hypertension, heart disease, or respiratory function impairment, including 34 men and 6 women aged 46 to 70 years) scheduled for oesophagectomy via left thoracotomy were randomly divided into control group (n=20) and UTI group (n=20). Anesthesia induction and perioperative management followed the same protocols in the two groups, and in UTI group, patients received 5000 U/kg UTI while those in the control group were given the same volume of saline. Before operation (T(1)), 10 min after recovery of two-lung ventilation (T(2)), and 24 h (T(3)) and 48 h (T(4)) after operation, the venous blood sample was taken from the internal jugular vein and the plasma was separated and stored at -70 degrees C for later analysis of IL-6 and IL-8 with enzyme-linked immunosorbent assay (ELISA). The bronchoalveoar lavage fluid (BAFL) was also collected at T(1) and T(2) for IL-6 and IL-8 detection.</p><p><b>RESULTS</b>IL-6, IL-8 levels in the plasma and BALF collected at T(2)-T(4) increased significantly as compared with those in samples collected at T(1), and their peak concentration inplasma and BALF samples were similar. IL-6 and IL-8 levels in the UTI group were significantly lower than those in the control group during the time points of T(2)-T(4).</p><p><b>CONCLUSION</b>Inflammatory responses occur during and after oesophagectomy, which can be inhibited with UTI.</p>