ABSTRACT
ObjectiveTo observe the changes of the respiratory dynamics during expand thymectomy,and to explore the protection of ulinastatin on pulmonary function.MethodsSixty patients with myasthenia gravis( Ossermann Ⅰ,Ⅱ b)undergoing expand thymectomy were randomly divided into control group( group C,n =30)and ulinastatin group( group U,n =30).Patients in ulinastatin group received intravenous injection of ulinastatin 4000 U/kg in 20 ml physiological saline immediately after entering operating room and pumped ulinastatin 2000 U/( kg · h)to the end of the operation continuously.Patients in control group received the same volume of normal saline.Heart rate ( HR ),mean arterial pressure ( MAP ),lung compliance,airway peak pressure,plateau airway pressure,inspiratory and expiratory resistance were monitored before induction of anesthesia( T1 ),during skin incision ( T2),at 30 min after operation ( T3 ) and at 60 min after operation (T4),at the end of operation before extubation(T5).ResultsCompared with T1,HR and MAP at T2 in two groups were increased obviously [ group U HR:( 90.2 ± 13.5 ) bpm vs ( 78.6 ± 10.4 ) bpm,MAP:( 15.5 ± 2.3 ) kPa vs ( 12.1 ± 1.5)kPa;group C HR:(94.3 ± 15.4)bpm vs(81.6 ± 12.2)bpm,MAP:( 16.8 ± 2.6) kPa vs( 12.6 ±1.8)kPa,P ＜ 0.05 )].There was no significant difference on HR,MAP at each time between the two groups (P ＞0.05).At T3,T4,T5,the lung compliance was significantly decreased when compared with T1 [ group U:T3,T4,TS(51.23 ± 12.33) ml/cm H2O,(50.35 ± 13.29) ml/cm H2O and(50.65 ± 13.16) ml/cm H2O vs T1 (53.69 ± 14.34) ml/cm H2O;group C:T3,T4,T5(41.56 ± 11.20)ml/cm H2O,(42.02 ± 10.12) ml/cm H2O and(39.85 ± 10.31 ) ml/cm H2O vs T1 ( 53.45 ± 15.21 ) ml/cm H2O; P ＜ 0.05 ) ].Airway peak pressure,plateau airway pressure,inspiratory and expiratory resistance at T3,T4,T5 were obviously increased compared with T1 in two groups [ airway peak pressure:group U:( 13.04 ± 2.14 ) cm H2O,( 13.12 ± 2.42 ) cm H2O,(13.22±2.48)cm H2O,vs(12.04 ±2.12)cm H2O;group C:(16.25 ±3.27)cm H2O,(15.56 ±4.34)cm H2 O,( 16.64 ± 3.45 ) cm H2O,vs ( 13.12 ± 2.32 ) cm H2O; plateau airway pressure:group U:( 10.54 ±2.46) cm H2O,( 11.76 ± 3.11 ) cm H2O,( 12.02 ± 3.25 ) cm H2 O,vs ( 9.48 ± 2.13 ) cm H2O; group C:(15.02 ±3.87)cm H2O,( 15.51 ± 3.13) cm H2O,( 15.67 ± 3.02) cm H2O,vs (9.25 ± 1.26) cm H2O;inspiratory resistance:group U:( 8.56 ± 2.52 ) cm H2O,( 9.31 ± 3.06 ) cm H2O,( 8.44 ± 2.45 ) cm H2O,vs (8.25 ±2.20)cm H2O;group C:(11.52 ±3.06)cm H2O,(12.16 ±3.02)cm H2O,(12.83 ±3.14)vs ( 8.31 ± 2.24 ) cm H2O ; expiratory resistance:group U:( 10.22 ± 2.24 ) cm H2O,( 10.34 ± 2.66 ) cm H2O,(10.27 ± 2.22) cm H2O,vs(8.46 ± 2.37) cm H2O; group C:(14.43 ±3.18)cm H2O,(14.56 ±3.32)cm H2O,( 14.46 ± 3.52 ) cm H2O,vs ( 8.55 ± 2.18 ) cm H2O; P ＜ 0.05 ) ].The increased degree of lung compliance and the decreased degree of airway peak pressure,plateau airway pressure,inspiratory and expiratory resistance at the time of T3,T4,T5 and T1 in ulinastatin group were all significantly higher than those in control group(F=6.167,3.138,4.137,5.217,4.361,respectively,P ＜0.05).ConclusionUlinastatin can improve respiratory dynamics,reduce lung injury,and play a protective role in patients with myasthenia gravis.
ABSTRACT
Objective To explore the two different anesthesia methods on hemodynamics and inflammatory cytokines in elderly patients during peroperative period.MethodsFifty elderly patients with Knee Replacement( ASA Ⅰ,Ⅱ )were randomly divided into general anesthesia group( group A,n =25 ) and combined general and epidural anesthesia group( group B,n =25 ).The changes of mean arterial pressure(MAP) and heart rate ( HR ) were monitored before induction of anesthesia ( T1 ),at intubation ( T2 ),during skin incision ( T3 ) and at the time of extubation ( T4 ),at 30 min after extubation ( T5 ).Blood samples were taken from artery for determination of plasma TNF-α,IL-6,IL-10 concentrations before tourniquet inflation ( T5 ),10 min after tourniquet deflation(T6),30 min after tourniquet deflation (T7)and 30 min after operation (T8)by enzymelinked immunosorbent assay(ELISA).ResultsThe MAP and HR of patients in two groups at T2,T3,T4 were all increased when compared with T1 [ group A:HR:( 94.3 ± 10.4 ) bpm,( 96.4 ± 12.7 ) bpm,(93.3 ± 11.1 )bpm vs(62.6 ±7.3)bpm;MAP:( 18.8 ±3.4)kPa,( 19.6 ±3.4)kPa,( 17.8 ±2.0)kPa vs ( 14.5 ± 1.5)kPa,P＜0.05;group B:HR(76.2 ±6.5)bpm,(70.1 ± 9.7) bpm,(71.5 ± 8.3) bpm vs(64.6 ± 8.4) bpm;MAP:( 16.3 ± 2.5 ) kPa,( 15.3 ± 1.2) kPa,( 14.8 ± 1.4) kPa vs ( 14.1 ± 1.3 ) kPa,P ＜ 0.05 ].There was significant difference on MAP and H R between group A and group B( F =11.957,9.745;P ＜ 0.05 ).The level of plasma TNF-α,IL-6 and IL-10 were significantly increased at T6 to T8 compared with T5 in both groups[ groupA:TNF-α:(4.36 ±0.18) ng/L,(7.54 ± 1.23) ng/L,(10.35 ±2.21 )ng/L vs (2.26 ±0.16) ng/L; groupA:IL-6:(4.32 ±0.21 ) ng/L,( 8.35 ± 1.26 ) ng/L,( 10.23 ± 2.23 ) ng/L vs ( 1.36 ± 0.08 ) ng/L; groupA:IL-10:(5.32±1.10) ng/L,(7.56 ± 1.36) ng/L,(8.63 ± 2.21) ng/L vs (1.25 ± 0.03) ng/L; groupB:TNF-α:(3.43 ±0.06)ng/L,(5.24 ±2.10) ng/L,(7.68 ± 1.43) ng/L vs(2.22 ±0.15) ng/L;groupB:IL-6:(3.41 ±0.08 ) ng/L,(5.34 ± 1.34 ) ng/L,( 8.54 ± 2.03 ) ng/L vs ( 1.28 ± 0.04 ) ng/L; groupB:IL-10:( 7.28 ± 1.22 )ng/L,( 10.53 ± 2.14)ng/L,( 12.45 ± 2.03 )ng/L vs( 1.31 ± 0.04)ng/L,P ＜ 0.05 ].And there was significant difference on TNF-α,IL-6 and IL-10 between group A and group B( F =7.889,3.554,5.443,respectively,P ＜0.05).ConclusionCompared with general anesthesia group,combined general and epidural anesthesia group can ensure hemodynamic stability of elderly patients during peroperative period very well and can reduce the releasing of inflammatory cytokins,it is a viable and an ideal method.