ABSTRACT
Objective To investigate the effect of ulinastatin on the renal function during perioperative period in infants undergoing open heart surgery under CPB.Methods Forty ASA Ⅱ infants (25 male, 15 female)aged 3-5 months weighing 5.3-6.8 kg undergoing open heart surgery under CPB were randomly divided into 2 groups (n = 20 each): control group (group C) and ulinastatin group (group U). Ulinastatin 20 000 U/kg in normal saline 20 ml was infused iv in 3 parts (1/3 was infused via CVP line when the catheter was successfully placed in the internal jugular vein; 1/3 at the beginning of CPB and 1/3 at aortic unclamping). Blood and urine samples were collected at 30 min before incision ( T1 ), 5 min before aortic clamping (T2 ), 5 min after aortic unclamping (T3 ), at the end of operation (T4) and 24 and 48 h after operation (T5, T6 ) for determination of serum urea nitrogen (BUN) and creatinine (Cr) and urinary N-acetyl-β-D-glucosaminidase (NAG) and β2-microglubin (β2-MG) levels. Results There was no significant difference in serum BUN and Cr concentrations between the two groups. The urinary β2-MG concentration and NAG activity were significantly increased at T2-6 as compared with baseline values at T1 in both groups. The urinary β2-MG concentration and NAG activity were significantly lower in group U than in group C at T3-5 . Conclusion Ulinastatin can protect the renal function during perioperative period in infants undergoing open heart surgery under CPB.
ABSTRACT
Objective To investigate the effect of tramadol on the expression of 5-HT1A receptor in the distal'cerebrospinal fluid contacting neurons (CSF-CNs) in mid-brain in a rat model of neuropathic pain. Methods Forty male SPF SD rats weighing 220-280 g were randomly divided into 5 groups (n = 8 each): group Ⅰ normal control (group C); group Ⅱ normal saline (group NS); group Ⅲ tramodol (group T); group Ⅳ neuropathic pain + normal saline (group NP+ NS) and group Ⅴ neuropathic pain + tramadol (group NP + T). Neuropathic pain was induced by chronic constrictive injury (CCI) in group Ⅳ and Ⅴ . Four silk ligatures were placed on the sciatic nerve at 1 mm intervals. In group Ⅱ (NS) and group Ⅲ (T) the sciatic nerve was exposed but not ligated and NS 2 ml/kg and tramadol 10 mg/kg were injected IP respectively, while in group Ⅳ and Ⅴ NS 2 ml/kg and tramadol 10 mg/kg were injected IP respectively on the 7th day after CCI. Paw withdrawal threshold (PWT) to von Frey filament stimulation and paw withdrawal latency (PWL) to noxious thermal stimuli were measured before (T1) and after IP NS or tramadol injection (T2) in group Ⅱ-Ⅴ. The distal CSF-CNs in the mid-brain was labelled with 30% cholera toxin subunit B and horseradish peroxidase compound (CB-HRP) 3 μl injected in left lateral cerebral ventricle. The expression of 5-HT1A receptors was measured by immuno-histochemistry. Results PWT and PWL were significantly decreased after CCI in group Ⅳ (NP + NS) and tramadol significantly inhibited the mechanical and thermal hyperalgesia in group Ⅴ (NP + T). There was no significant difference in the number of distal CSF-CNs among the 5 groups. CCI significantly down-regulated the expression of 5-HT1A in distal CSF-CNs in group Ⅳ(NP+ NS) as compared with group Ⅰ , Ⅱ and Ⅲ and tramadol significantly inhibited the CCI-induced downregulation of 5-HT1A receptor expression. Conclusion Tramadol can ease neuropathic pain by down-regulating the expression of 5-HT1A receptor in distal CSF-CNs in mid-brain.
ABSTRACT
Objective To compare the therapeutic effect of inhaled aerosolized and intravenous milrinone (a phosphodiesteraee-3 inhibitor) on postoperative pulmonary artery hypertension (PAH) in children with congenital heart disease (CHD).Methods Forty CHD complicated with PAH children aged 5-14 yr weighing 15-38 kg with pulmonary artery pressure (PAP) 30-90 mm Hg were randomly divided into 2 groups (n = 20 each): Ⅰ milrinone inhalation group and Ⅱ intravenous milrinone group. At the end of CPB, aerosolized milrinone 1 ml/kg was inhaled for 12 h at 30 min intervals, and each time milrinone was inhaled for 10 min in group Ⅰ . In group Ⅱ , a bolus of 10 g/kg milrinone was given iv followed by 12 h milrinone infusion at 0.5 μg·kg-1 ·min-1 . Blood samples were taken from aorta and pulmonary artery for blood gas analysis at the end of administration and venous oxygen saturation (S(-v)O2) was recorded. MAP, PAP, pulmonary vascular resistance index (PVRI) and systemic vascular resistance index (SVRI) were recorded every 2 h during milrinone administration. The duration of endotracheal tube, PAH, lung infection and postoperative hyoxemia were recorded during milrinone administration. Results PAP, PVRI and the incidence of lung infection and PAH were significantly lower, while MAP, SVRI and S(-v)O2higher in group Ⅰ than in group Ⅱ (P ＜ 0.05), but there was no significant difference in the duration of endotracheal tube and incidence of hyoxemia between the two groups(P ＞ 0.05). Conclusion Inhaled aerosolized milrinone has better therapeutic effect than intravenous milrinone on PAH in children with CHD.