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Objective:To evaluate the accuracy of serum surfactant protein concentration in predicting postoperative pulmonary complications (PPCs) in the patients at moderate risk for PPCs undergoing abdominal surgery.Methods:Fifty-eight patients of both sexes, with the predicted ARISCAT score of 26-44 points, scheduled for elective abdominal gastrointestinal surgery, were studied.Central venous blood samples were collected before operation (T 0), at 30 min after extubation (T 1) and at 1 day after surgery (T 2) for determination of serum surfactant protein A (SP-A) and surfactant protein B (SP-B) in serum by enzyme-linked immunosorbent assay.The occurrence of PPCs during the postoperative hospitalization was recorded.The patients were divided into PPCs group and non-PPCs group according to whether PPCs occurred. The receiver operating characteristic curve was used to analyze the accuracy of serum SP-A and SP-B concentrations in predicting PPCs. Results:Compared with the baseline value at T 0, the serum SP-B concentrations were significantly increased at T 1 in group PPCs, and the concentrations of serum SP-A and SP-B were significantly decreased at T 2 in both groups ( P<0.05). The concentrations of serum SP-A and SP-B were significantly decreased at T 2 than at T 1 in both groups ( P<0.05). Compared with non-PPCs group, the serum concentrations of SP-A at T 0 and SP-B at T 1 were significantly increased in group PPCs ( P<0.05). The area under the receiver operating characteristic curve of serum SP-B concentrations in predicting PPCs at T 1 was 0.908 (95% confidence interval 0.821-0.996), and the cut-off value was 26.3 ng/ml, sensitivity 0.90, and specificity 0.81. Conclusion:The accuracy of serum SP-B concentrations measured at 30 min after extubation in predicting PPCs is higher in the patients at moderate risk for PPCs undergoing abdominal surgery.
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Objective To observe the effects of three doses of dexmedetomidine hydrochloride on stress and myalgia in patients before conventional modified electroconvulsive therapy (MECT).Methods Seventy-nine patients scheduled for the first time of MECT with schizophrenia,depression or mania patients,38 males and 41 females,aged 18-65 years,ASA physical status Ⅰ or Ⅱ,were randomly divided into four groups.The patients received intravenous drip infusion of dexmedetomidine 0.4 μg/kg (group D1,n=20),0.7μg/kg (group D2,n=19),1.0 μg/kg (group D3,n=20) and saline 20 ml (group N,n =20) within 10 min before conventional MECT treatment.The mean arterial pressure (MAP) and heart rate (HR) were recorded before anesthesia (T0),drug pump (dexmedetomidine or saline) after 10 min (T1),30 s after MECT shock (T2) and 5 min after MECT shock (T3);the blood glucose and the concentration of serum cortisol (Cor) were recorded at T0 and T2;visual analogue scores (VAS) 30 min after electric shock (T1) and 6 h after shock (T5),the recovery time,recovery time of spontaneous breathing were also recorded.Results Compared with group N,the concentration of Cor and MAP at T2 were decreased significantly,the HR was increased significantly in groups D1-D3;the blood glucose at T2 were decreased significantly in groups D2,D3 (P＜0.05).The degree in group D3 was larger than that in group D2,and the degree in group D2 was larger than that in group D1 (P＜0.05).Compared with group N,the VAS score at T5 were decreased significantly in groups D1-D3;the recovery time was prolonged significantly in groups D2,D3.The degree in group D3 was larger than that in group D2,and the degree in group D2 was larger than that in group D1 (P＜0.05).The spontaneous breathing recovery time had no difference in three groups.Conclusion Dexmedetomidine pretreatment before modified electroconvulsive therapy can dose-dependently reduce stress response and treatment related myalgia and prolong the recovery time.
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Objective To study the application effects of timely regional vascular occlusion in primary liver cancer(PLC) surgery. Methods Eighty-eight patients with PLC who underwent surgery in the Department of General Surgery of Yan'an University Affiliated Hospital from January 2014 to December 2016 were selected for prospective study, and they were divided into the experimental group and the control group by the random number table method, 44 cases of each group. In the experimental group, the blood supply was blocked with timely regional vascular occlusion while in the control group, the blood supply was blocked with half hepatic vascular occlusion. The occurrence of postoperative complications, and surgical indexes(surgical time, intraoperative blood loss, the time of hepatic portal occlusion, blood transfusion volume, abdominal drainage volume and hospital stay), levels of alanine aminotransferase, albumin and total bilirubin, levels of CD3+, CD4+, CD8+ and CD4 + /CD8 +, effective rate, control rate, and clinical efficacy were compared between the two groups. Measurement data with normal distribution were represented as (x) ± s and analyzed using the independent-sample t test between the two groups; within the groups, paired t-tests were used. Comparison of count data were represented as n(％ ), and analyzed using the chi-square test. Results The intraoperative blood loss, time of hepatic portal occlusion, blood transfusion volume and hospital stay of the experimental group were(331. 48 ±30.65) ml, (14.78土2.27) min, (132.61 ±13.87) ml, (9.29土1.19) d, and the control group were (500.61 ±50.62) ml, (23.96±2.89) min, (305.76 ± 30.64) ml, (12.10 ± 1.22) d, with statistically significant differences in above indexes between the two groups(all P< 0.05). The operation time and abdominal drainage volume in the experimental group were(146.86 ± 15.87) min and(321.77 ±33.65) ml respectively, while those in the control group were (143.07土15.35) min and(335.18 ±33.82) ml respectively, there was no significant difference between the two groups(P> 0.05 ). After surgery, the levels of alanine aminotransferase, total bilirubin and albumin of the experimental group were(54.86 ±5.61) U/L, (20.65 ± 2.32) U/L, (41.95土4.32) ng/ml, and the control group were(120.75 ± 13.03) U/L, (35.42+3.21) U/L, (70.25 ±7.45) ng/ml, with statistically significant differences in above indexes between the two groups(all P <0.05). After surg;ery, the levels of CD3 +, CD4+, CD8 + and CD4 + /CD8 + of the experimental group were 0.63 ±0.16, 0.52 ± 0.11, 0.20 ±0.04, 1.70 ±0.17 and the control group were 0.56 ±0.14, 0.45±0.12, 0.26 ± 0.05, 1.46土0.22, with statistically significant differences in above indexes between the two groups (all P< 0.05 ). There were no differences between the experimental group and the controlg roup in the response rate and the control rate(75.00％ vs.79.55％; 88. 64％ vs.90.91％ ) (P>0.05). Conclusions The application of timely regional vascular occlusion in PLC surgery can reduce the intraoperative blood loss, the time of hepatic portal occlusion, blood transfusion volume and hospital stay, improve the immune level and liver function. And there is no difference in response rate and control rate compared with half hepatic vascular occlusion, therefore it is worthy of clinical application.
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Objective To evaluate the protective effect of apneic oxygen insufflation on the operated lung of patients undergoing one-lung ventilation (OLV).Methods Fifty-four American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes,aged 50-75 yr,scheduled for elective pulmonary tumorectomy,were divided into 2 groups using a random number table method:conventional group (group C,n=27) and apneic oxygen insufflation group (group A,n=27).The patients were intubated with a double-lumen tube after induction of anesthesia.Apneic oxygen insufflation was performed on the operated lung immediately after OLV by continuously administrating oxygen at 5 L/min with inspiratory oxygen fraction of 100％.Blood samples were taken from the radial artery at 1 min before OLV (T1) and 3 and 33 min after OLV (T2,3) for blood gas analysis,pulmonary oxygenation index and intrapulmonary shunt rate were calculated,and the occurrence of oxygen index less than 200 and 300 mmHg was recorded.Blood samples of the internal jugular vein were collected to detect the concentrations of surfactant protein B (SPB) and surfactant protein C (SP-C) in serum.The lung on the operated side was lavaged at T3,and the broncho-alveolar lavage fluid was collected for determination of the concentrations of SP-B and SP-C by enzyme-linked immunosorbent assay.Results Compared with group C,the oxygenation index was significantly increased at T2,3,the intrapulmonary shunt rate was decreased,the concentrations of SP-B and SPC in serum were decreased,and the concentrations of SP-B and SP-C in broncho-alveolar lavage fluid were increased in group A (P＜0.05).Conclusion Giving apneic oxygen insufflation 5 L/min to the operated lung during OLV can reduce the damage to the operated lung.
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The accuracy of preoperative staging diagnosis of colorectal cancer directly determines the accuracy of treatment and prognosis.Endoscopic ultrasonography,CT,MRI and positron emission tomography/computed tomography (PET/CT) imaging have their own advantages and disadvantages in preoperative staging of colorectal cancer.According to the actual situation of patients,choosing the best method of examination,when necessary,several effective methods combined,can improve the accuracy of preoperative staging diagnosis of colorectal cancer.
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Objective To investigate the protective effects of dexmedetomidine on lung injury during one lung ventilation in patients undergoing lobectomia pulmonalis.Methods Sixty-four patients undergoing lobectomy in our hospital from May 2014 to February 2017 were selected.There were 38 males and 26 females,aged 42-75 years,ASA physical status Ⅱ or Ⅲ.Patients were divided into two groups according to different treatments,n=32 in each group.The patients in the observation group were given dexmedetomidine 0.5 μg· kg-1 · h-1 at 20 min before the induction of anesthesia,and adjusted to 0.2-0.5 μg·kg-1 ·h-1 after 10 min.The control group was given equal volume normal saline.The changes of polymorphonuclear neutrophil (PMN),myeloper oxidase (MPO),intra-pulmonary shunt rate(Qs/Qt),xanthine oxidase (XOD),vascular endothelial growth factor (VEGF) and nitric oxide (NO) concent ration were recorded at 10 min before induction (T0),beginning of OLV (T1),OLV for 60 min (T2),90 min (T3),postoperative 24 h (T4).Results Compared with T0,the PMN counts increased significantly at T2-T4 and the serum MPO and XOD concentrations were significantly increased (P＜0.05).The PMN counts,serum MPO and XOD concentration in the observation group were significantly lower than those in the control group (P＜0.05).Compared with T0,the serum VEGF concentration was significantly increased at T2 and T3,and the serum VEGF concentration in the observation group was significantly lower than that in control group at T3 (P＜0.05).The serum NO concentration at T2 and T3 in observation group was significantly higher than that in control group (P＜0.05).Conclusion Dexmedetomidine can reduce the inflammatory response of the lungs and has a protective effect on ischemia-reperfusion and injury in patients with single lung ventilation,and reduce the degree of oxidative stress,which plays a protective effect on lung.
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The accuracy of preoperative staging diagnosis of colorectal cancer directly determines the accuracy of treatment and prognosis.Endoscopic ultrasonography,CT,MRI and positron emission tomography/computed tomography (PET/CT) imaging have their own advantages and disadvantages in preoperative staging of colorectal cancer.According to the actual situation of patients,choosing the best method of examination,when necessary,several effective methods combined,can improve the accuracy of preoperative staging diagnosis of colorectal cancer.