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AIM: To observe the efficacy of moderate and high myopia patients with vault greater than 1 000μm after implantation of phakic posterior chamber implantable contact lens(ICL).METHODS: A total of 42 patients(73 eyes)who received ICL implantation in the hospital and had postoperative vault greater than 1 000 μm between January 2014 and January 2017 were selected and retrospectively studied. Changes in visual acuity, intraocular pressure, corneal endothelial cell density, anterior chamber-related parameters(chamber angle, central anterior chamber depth, anterior chamber volume)and vault were compared among patients before surgery, at 1, 3, 6mo and 1a after surgery and at the last follow-up.RESULTS: The uncorrected visual acuity(UCVA)at 1, 3, 6mo and 1a after surgery and at the last follow-up was better than that before surgery(all P<0.05), and the chamber angle, central anterior chamber depth and anterior chamber volume were smaller or lower than those before surgery(all P<0.05), but there were no statistical differences in UCVA, chamber angle, central anterior chamber depth and anterior chamber volume at each time point after surgery(all P>0.05). The intraocular pressure at 1mo after surgery was lower than that before surgery(P<0.05), but the intraocular pressure at 3, 6mo and 1a after surgery and at the last follow-up was not statistically different from that before surgery(all P>0.05). There was no statistical significance in the corneal endothelial cell density at 1, 3, 6mo and 1a after surgery and at the last follow-up compared with that before surgery(all P>0.05). The vault at 1, 3, 6mo and 1a after surgery and at the last follow-up showed a decreasing trend, and the difference was statistically significant at each time point after surgery(all P<0.05).CONCLUSION: The short-term and long-term efficacy are better in moderate and high myopia patients with vault greater than 1 000 μm after ICL implantation, and there are no significant effects on the intraocular pressure and corneal endothelial cell. The postoperative anterior chamber structure is relatively stable and the vault tends to decrease over time. In most cases, close observation is sufficient and intraocular lens replacement is generally not required.
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Objective:To analyze the effect of Croton leaf on ERK1/2 pathway in hippocampal of rats with cerebral ischemia-reperfusion.Methods:A total of 216 SD male rats were divided into sham operation group, model group, nimodipine group, low-dose, medium-dose and high-dose groups of croton leaf according to random nubmer table method, with 36 rats in each group. The MACO model of rats was prepared by the method of wire embolization. The high, medium and low dose groups were intragastrated with the water decoction 0.06 g/ml, 0.12 g/ml and 0.18 g/ml of Croton leaf; nimodipine group was intragastrated with nimodipine suspension 1.08 g/L; sham operation group and model group were intragastrated with equal volume of normal saline. Garcia JH score was used to conduct neurological function score, and HE staining was used to observe the morphology of hippocampal neurons after 7 days of continuous administration. Apoptosis of hippocampal CA3/DG region was detected by TUNEL assay. Western Blot was used to detect the expression of ERK1/2 and p-ERK1/2 proteins.Results:Compared with the model group at simultaneous point, the neurological function scores of low-dose, medium-dose and high-dose groups of Croton leaf increased ( P<0.01), the number of apoptotic cells decreased ( P<0.01), the expression of p-ERK1/2 / ERK1/2 [1 d: (0.22±0.03, 0.34±0.02, 0.46±0.01 vs. 0.19±0.02); 3 d: (0.38±0.02, 0.50±0.02, 0.68±0.02 vs. 0.27±0.02); 7 d: (0.29±0.03, 0.43±0.02, 0.59±0.02 vs. 0.21±0.03)] in hippocampus of the low-dose, medium-dose and high-dose groups of Croton leaf significantly increased ( P<0.01). Conclusion:Croton leaf could regulate the expression of ERK1/2 pathway protein upward, effectively improve the neural function and resist the apoptosis of hippocampal CA3/DG area of rats with cerebral ischemia-reperfusion injury.
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Femtosecond laser small incision lenticule extraction(SMILE)is one of the most advanced corneal refractive operations at present. Different from other traditional corneal refractive operations, SMILE achieves minimally invasive and valveless operation. Therefore, the evaluation of postoperative visual quality of SMILE also has its own characteristics, at present, the latest research at home and abroad has confirmed that the naked eye vision can be significantly improved and the refractive status is stable after SMILE. However, there are different understandings of the objective visual quality indexes and their influencing factors, such as higher-order aberration, modulation transfer function cut off(MTF cut off)and objective scatter index(OSI)after SMILE. This paper reviews the postoperative visual quality and its influencing factors after SMILE to provide clinical help.
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@#【Objective】 We sought to compare ultrasound superb micro- vascular imaging （SMI） and contrast- enhanced ultrasound（CEUS）in the evaluation of carotid plaque neovascularization，and to understand the feasibility of SMI as a method to screen neovascularization of plaque.【Methods】A total of 60 cases，with a total of 109 plaques underwent SMI and CEUS to detect neovascularization of plaque.【Results】SMI and CEUS examination results were consistent in 101 of 109 plaques. The cost of SMI was less than CEUS（￥150 vs. ￥900）. There was significant difference in examination time between SMI and CEUS［（5.0 ± 1.4 vs. 18.5 ± 2.2）min，P < 0.05］.【Conclusion】Preliminary results showed that these two methods have good consistency. SMI also has advantages ：simple ，less time-consuming ，cheap and low risk. It indicates that SMI may be an effective screening method for neovascularization in plaques.
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Objective To compare the efficacy of ultrasound-guided lumbar epidural access using paramedian transverse scanning (PMTS) versus paramedian saggital scanning (PMSS) with the needle inplane.Methods Fifty American Society of Anesthesiologists physical status Ⅰ-Ⅲ patients,aged 50-75 yr,weighing 55-85 kg,undergoing lower extremity surgery under combined spinal-epidural anesthesia,were divided into PMSS group (n=25) and PMTS group (n=25) using a random number table.The realtime ultrasound-guided lumbar epidural access (L3,4) was performed using PMTS and PMSS in PMTS and PMSS groups,respectively.The visibility of ligamentum flavum,posterior and anterior dura maters,posterior epidural space on the prepuncture ultrasound images,imaging quality score,time for puncture and depth of puncture were recorded.The development of air ultrasonic contrast sign and backflow of cerebrospinal fluid from the spinal needle were recorded.The development of adverse reactions such as paresthesia and hypokinesia was also recorded on 2 days after operation.Results Compared with group PMSS,the time for puncture was significantly shortened,the depth of puncture was shallower (P＜0.05),and no significant change was found in the visibility of spinal structure,imaging quality score or air ultrasonic contrast sign and incidence of backflow of cerebrospinal fluid in group PMTS (P＞0.05).No significant change was found in adverse reactions such as paresthesia or hypokinesia between the two groups (P＞0.05).Conclusion PMTS provides clear imaging and simple and convenient operation in guiding lumbar epidural access with the needle in-plane when compared with PMSS,and it is worthy of clinical application.
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Aim To investigate the effects of IcarisideⅡ ( ICS Ⅱ) on myocardial fibrosis in spontaneously hypertensive rat( SHR) . Methods Twenty male SHR rats were randomly divided into the model group (group SHR) , ICS Ⅱ low ( ICS Ⅱ-L) , middle ( ICSⅡ-M) and high ( ICS Ⅱ-H) group, and male WKY rats were set as control group ( group WKY) . ICS Ⅱ-L, ICSⅡ-M and ICSⅡ-H groups were intragastrically administered with ICS Ⅱ for 12 weeks. After that the blood pressure was measured in rats. Then, the rats were sacrificed and the left ventricles were separated in order to calculate the left ventricular mass index. Mas-son staining was used to detect the occurrence of inter-stitial fibrosis in cardiac tissues. Real time PCR was used to observe the gene expression of MMP-2, MMP-9 and TIMP-1 in the left ventricle in SHRs. The protein expression levels of MMP-2, MMP-9, TIMP-1, Colla- gen Ⅰ and Collagen Ⅲ were measured by Western blot. Results Compared with SHR group, the myo-cardial fibrosis was reduced after ICS Ⅱ (8, 16 mg· kg-1) treatment. The blood pressure and left ventricu-lar mass index decreased(P<0.05). The expressions of MMP-2, MMP-9, CollagenⅠand CollagenⅢwere down-regulated in left ventricular tissues( P <0.05 ) , while the expression of TIMP-1 was up-regulated( P<0.05) . Conclusion Icariside Ⅱ ameliorates myocar-dial fibrosis in SHR, and the mechanisms might be re-lated to the decrease of blood pressure and down-regu-lation of MMP-2, MMP-9 expression and up-regulation of TIMP-1 expression.
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<p><b>Background</b>As a major complication after orthotopic liver transplantation (OLT), the occurrence of acute kidney injury (AKI) is frequently defined by serum creatinine (Cr); however, the accuracy of commonly used blood urea nitrogen (BUN), uric acid (UA), and β-microglobulin (β-MG) remains to be explored. This retrospective study compared the accuracy of these parameters for post-OLT AKI evaluation.</p><p><b>Methods</b>Patients who underwent OLT in three centers between July 2003 and December 2013 were enrolled. The postoperative AKI group was diagnosed by the Kidney Disease Improving Global Outcomes (KDIGO) criteria and classified by stage. Measurement data were analyzed using the t-test or Wilcoxon rank-sum test; enumerated data were analyzed using the Chi-square test or Fisher's exact test. Diagnostic reliability and predictive accuracy were evaluated using receiver operating characteristic (ROC) curve analysis.</p><p><b>Results</b>This study excluded 976 cases and analyzed 697 patients (578 men and 119 women); the post-OLT AKI incidence was 0.409. Compared with the no-AKI group, the AKI group showed very significant differences in Model for End-stage Liver Disease score (14.74 ± 9.91 vs. 11.07 ± 9.54, Z = 5.404; P < 0.001), hepatic encephalopathy (45 [15.8%] vs. 30 [7.3%], χ = 12.699; P < 0.001), hemofiltration (28 [9.8%] vs. 0 [0.0%], χ = 42.171; P < 0.001), and 28-day mortality (23 [8.1%] vs. 9 [2.2%], χ = 13.323; P <0.001). Moreover, mean values of Cr, BUN, UA, and β-MG in the AKI group differed significantly at postoperative days 1, 3, and 7 (all P < 0.001). ROC curve area was 0.847 of Cr for the detection of AKI Stage 1 (sensitivity 80.1%, specificity 75.7%, cutoff value 88.23 μmol/L), 0.916 for Stage 2 (sensitivity 87.6%, specificity 82.6%, cutoff value 99.9 μmol/L), and 0.972 for Stage 3 (sensitivity 94.1%, specificity 88.2%, cutoff value 122.90 μmol/L).</p><p><b>Conclusion</b>The sensitivity and specificity of serum Cr might be a high-value indicator for the diagnosis and grading of post-OLT AKI.</p>
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Adult , Female , Humans , Male , Middle Aged , Acute Kidney Injury , Blood , Blood Urea Nitrogen , Creatinine , Blood , Liver Transplantation , Retrospective Studies , Uric Acid , Blood , beta 2-Microglobulin , BloodABSTRACT
Aim To observe the effect of icariside Ⅱ(ICS Ⅱ)on cardiomyocyte apoptosis in spontaneously hypertensive rats (SHR)and to explore its possible mechanism. Methods Thirty male 13-week-old SHRs were randomly divided into model group,ICS Ⅱ low, medium,high and positive drug group (n = 6),ho-mologous male Wistar-Kyoto rats as control group (n =6). After a week of adaptive feeding,ICS Ⅱ low,me-dium and high dose groups were given ICS Ⅱ 4,8,16 mg · kg - 1 (ig,qd),and the positive drug group was given losartan 20 mg·kg - 1 . At the same time,the WKY and SHR group were given equal volume double distilled water. After 12 weeks of administration,the blood pressure was measured in rats. Then,the rats were sacrificed and the left ventricles were separated in order to calculate the left ventricular mass index. HE staining was used to observe the pathological changes of the left ventricle,and the apoptosis of the left ventricu-lar myocardium was detected by TUNEL staining. The expressions of Bcl-2 and Bax mRNA in left ventricle were detected by real time RT-PCR,and Bcl-2,Bax and cleaved-caspase-3 protein expressions were detec-ted by Western blot. Results Compared with WKY group,the blood pressure and left ventricular mass in-dex increased in SHR group (P < 0. 05),and the my-ocardial cell arrangement was disordered and the cell hypertrophy and apoptosis were obvious,accompanied by rupture of filament ;the level of Bax mRNA was up-regulated (P < 0. 05),and Bcl-2 mRNA was down-regulated (P < 0. 05 );the expressions of Bax and cleaved-caspase-3 protein were up-regulated (P <0. 05),and the level of Bcl-2 protein was down-regu-lated (P < 0. 05 ),and the ratio of Bax / Bcl-2 in-creased (P < 0. 05). Compared with SHR group,the blood pressure and left ventricular mass index de-creased in ICS Ⅱ middle,high group and the positive drug group (P < 0. 05);moreover,the arrangement of myocardial cells became more orderly,the cell hyper-trophy and the apoptosis of myocardial cells were im-proved;the level of Bax mRNA was down-regulated and Bcl-2 mRNA was up-regulated (P < 0. 05);the expression of Bax and cleaved-caspase3 protein were down-regulated and the level of Bcl-2 protein was up-regulated (P < 0. 05 );the ratio of Bax / Bcl-2 de-creased (P < 0. 05). Conclusions ICS Ⅱ can im-prove the left ventricular cardiomyocytes apoptosis in SHR,and its mechanism is related to the decrease of blood pressure and the inhibition of mitochondrial ap-optosis pathway.
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Objective To evaluate the effect of zinc deficiency factor on cognitive function after isoflurane anesthesia in mice with Alzheimer's disease (AD).Methods One hundred and forty-four APP/ PS1 transgenic mice with AD,weighing 22-28 g,aged 8-10 months,were divided into 6 groups (n=24 each) using a random number table:zinc adequate group (group ZA),zinc adequate plus isoflurane anesthesia group (group ZA+Iso),zinc deficiency group (group ZD),zinc deficiency plus isoflurane anesthesia group (group ZD+Iso),zinc treatment group (group ZT) and zinc treatment plus isoflurane anesthesia group (group ZT+Iso).The mice were fed a diet adequate in zinc and deionized water for 2 months in ZA and ZA+Iso groups.The mice were fed a diet low in zinc (0.01‰ zinc) and deionized water for 1 month in ZD and ZD+Iso groups.The mice were fed a diet adequate in zinc and 0.12‰ ZnSO4 · 7H2O water for 2 months in ZT and ZT+Iso groups.The mice underwent 2 h of anesthesia with 1.4％ isoflurane starting from the end of feeding in ZA+Iso,ZD+Iso and ZT+Iso groups.At 24 h after anesthesia,the mice were sacrificed and hippocampal tissues were obtained for determination of the contents of soluble amyloid beta protein 40 (Aβ40) and Aβ42 and insoluble Aβ40 and Aβ42 (using enzyme-linked immunosorbent assay) and expression of total Aβ,Aβ40,Aβ42,tau pSer396,tau pSer262 and tau pThr231 (by Western blot).Morris water maze test was performed at 24 h after anesthesia.Results There was no significant difference in each parameter between group ZA and group ZA+Iso and between group ZT and group ZT+Iso (P＞0.05).Compared with group ZD or group ZT+Iso,the escape latency was significantly prolonged,the space exploration time was shortened,the expression of hippocampal Aβ42,tau pSer396,tau pSer262 and tau pThr231 was up-regulated,and the contents of soluble and insoluble Aβ42 were increased in group ZD+Iso (P＜0.05 or 0.01).Conclusion Zinc deficiency can aggravate the impairment of cognitive function after isoflurane anesthesia in mice with AD,and the mechanism is related to the promotion of hippocampal Aβ aggregation and tau protein phosphorylation.
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Objective To assess the efficacy and safety of smoking intervention by anesthesiol-ogists in surgical patients.Methods A total of 182 male patients,aged 18-79 years,ASA grade Ⅰ-Ⅲ,scheduled for elective noncardiovascular and nonthoracic surgery,were assessed preoperatively. Patients were randomized to either the control group or the intervention group,n =91 each.The con-trol group did not receive specific smoking cessation intervention.The intervention group received brief counseling by the anesthesiologist,leaflets on smoking cessation,including pictorial health warning labels,smoking cessation clinic’s smokers’hot line and WeChat public number.Anesthesia methods,operation time,treatment time in PACU,the rate of smoking cessation at 30 days postop-eratively,perioperative complications and smoking status at 30 days postoperatively were recorded. Results One hundred and sixty-six patients were included in the analysis finally.There was no signif-icant difference between two groups in 30 days of follow-up postoperatively.Self-reported smoking re-duction in the postoperative 30 days the intervention group was significantly lower than that in the control group (36.9% vs.22.0%,P <0.05).For smokers,there was a relationship between the lev-el of eCO and the smoking cessation rate,it was 83.3% in the intervention group and 40.0% in the control group (P <0.05).There was no significant difference of overall rate of combined intraopera-tive and immediate postoperative complications between two groups.Conclusion Smoking cessation intervention launched by anesthesiologists promotes 30 days of abstinence postoperatively.
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Objective To evaluate the effect of pretreatment with botulinum toxin A injected intrath?ecally or locally at the incision site on the neurokinin?1 ( NK?1) receptor internalization in the spinal dorsal horn in a rat model of incisional pain. Methods Male Sprague?Dawley rats, weighing 280-300 g, aged 6-8 weeks, were used in the study. The experiment was performed in two parts. ExperimentⅠ Twenty?seven rats with no sign of nerve injury at day 7 after successful catheterization were selected and divided into 3 groups (n=9 each) using a random number table: control group (C1 group), incisional pain group (IP1 group) and intrathecal botulinum toxin A group (BoNT∕A1 group). At 24 h before operation, botulinum tox?in A 0.5 U ( in 10μl of normal saline) was injected intrathecally in group BoNT∕A1, and normal saline 10μl was injected intrathecally in group IP1. ExperimentⅡ Twenty?seven rats were selected and divided into 3 groups (n=9 each) using a random number table: control group (group C2), incisional pain group (IP2 group) and locally injected botulinum toxin A at the incision site group (BoNT∕A2 group). At 24 h before op?eration, botulinum toxin A 2 U ( in 0.4 ml of normal saline) was injected subcutaneously at the incision site and into the plantar surface, and normal saline 0.4 ml was injected subcutaneously at the incision site and into the plantar surface in group IP2. Six rats in each group were selected, and the cumulative pain score (CPS) was recorded, and the mechanical paw withdrawal threshold ( MWT) in the right hindpaw was measured be?fore administration, before operation, and at 3 h and 1, 3, 5 and 7 days after operation. At 3 h after opera?tion, 3 rats in each group were selected and sacrificed, and the lumbar segment ( L4,5 ) of the spinal cord was removed for determination of the expression of NK?1 receptors in the spinal dorsal horn by immunofluores?cence. Results ExperimentⅠ Compared with group C1, the CPS was significantly increased at 3 h and 1, 3, 5 and 7 days after operation, the MWT was significantly decreased at 3 h and 1 and 3 days after opera?tion, and the expression of NK?1 receptors in the spinal dorsal horn was significantly up?regulated in group IP1, and the CPS was significantly increased at 3 h and 1, 3 and 5 days after operation, the MWT was sig?nificantly decreased at 3 h after operation ( P0.05). Compared with group IP1, the CPS was significantly decreased, and the MWT was significantly increased at 3 h and 1, 3, and 5 days after oper?ation, and the expression of NK?1 receptors in the spinal dorsal horn was significantly down?regulated in group BoNT∕A1 (P0.05) . Compared with group IP2, the CPS was significantly decreased at 3 h and 1, 3, and 5 days after operation, the MWT was signifi?cantly increased at 3 h and 1 and 3 days after operation, and the expression of NK?1 receptors in the spinal dorsal horn was significantly down?regulated in group BoNT∕A2 (P<0.05). Conclusion Pretreatment with botulinum toxin A injected intrathecally or locally at the incision site can inhibit the internalization of NK?1 re?ceptors in the spinal dorsal horn in a rat model of incisional pain.
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Objective To evaluate the clinical efficacy of “Shamrock” ultrasound images?guided lumbar sympathetic ganglion blockade ( LSGB) . Methods Sixty patients of both sexes, aged 18-60 yr, weighing 50-70 kg, of American Society of Anesthesiologists physical statusⅠorⅡ, undergoing unilater?al LSGB, were divided into groupⅠ ( n=30) and group Ⅱ ( n=30) using a random number table. In group Ⅰ, unilateral LSGB was performed at the L2 level under ultrasound guidance with paramedian trans?verse scanning. In groupⅡ, unilateral LSGB was performed at the L2 level under ultrasound guidance with“Shamrock” ultrasound images. After final needle position was confirmed, 2% lidocaine 6?0 ml was ad?ministered in each patient. At 20 min before and after LSGB, the visual analogue scale scores and skin temperature of the big toe of the affected foot were recorded, and the successful blockade and visibility of important paravertebral structures on ultrasound images were recorded during puncture. Results The visu?al analogue scale scores were significantly lower, and the skin temperature on the affected side was signifi?cantly higher after LSGB than before LSGB in both groups ( P<0?05) . The important paravertebral struc?tures such as erector spinae, quadratus lumborum, psoas major, transverse process of L2 vertebrae, and the curved edge of L2 vertebrae were visible in both groups. The visibility rate of the inferior vena cava or ab?dominal aorta on ultrasound images and the success rate of blockade were significantly lower in group Ⅰthan in group Ⅱ (P<0?01). Conclusion Compared with paramedian transverse scanning, LSGB has some advantages such as real?time monitoring, higher success rate of blockade, better efficacy and avoiding damage to great vessels when performed under “Shamrock” ultrasound image guidance.
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<p><b>BACKGROUND</b>Bispectral index (BIS) is considered very useful to guide anesthesia care in elderly patients, but its use is controversial for the evaluation of the adequacy of analgesia. This study compared the BIS changes in response to loss of consciousness (LOC) and loss of somatic response (LOS) to nociceptive stimuli between elderly and young patients receiving intravenous target-controlled infusion (TCI) of propofol and remifentanil.</p><p><b>METHODS</b>This study was performed on 52 elderly patients (aged 65-78 years) and 52 young patients (aged 25-58 years), American Society of Anesthesiologists physical status I or II. Anesthesia was induced with propofol administered by TCI. A standardized noxious electrical stimulus (transcutaneous electrical nerve stimulation, [TENS]) was applied (50 Hz, 80 mA, 0.25 ms pulses for 4 s) to the ulnar nerve at increasing remifentanil predicted effective-site concentration (Ce) until patients lost somatic response to TENS. Changes in awake, prestimulus, poststimulus BIS, heart rate, mean arterial pressure, pulse oxygen saturation, predicted plasma concentration, Ce of propofol, and remifentanil at both LOC and LOS clinical points were investigated.</p><p><b>RESULTS</b>BISLOCin elderly group was higher than that in young patient group (65.4 ± 9.7 vs. 57.6 ± 12.3) (t = 21.58, P < 0.0001) after TCI propofol, and the propofol Ce at LOC was 1.6 ± 0.3 μg/ml in elderly patients, which was significantly lower than that in young patients (2.3 ± 0.5 μg/ml) (t = 7.474, P < 0.0001). As nociceptive stimulation induced BIS to increase, the mean of BIS maximum values after TENS was significantly higher than that before TENS in both age groups (t = 8.902 and t = 8.019, P < 0.0001). With increasing Ce of remifentanil until patients lost somatic response to TENS, BISLOSwas the same as the BISLOCin elderly patients (65.6 ± 10.7 vs. 65.4 ± 9.7), and there were no marked differences between elderly and young patient groups in BISawake, BISLOS, and Ce of remifentanil required for LOS.</p><p><b>CONCLUSION</b>In elderly patients, BIS can be used as an indicator for hypnotic-analgesic balance and be helpful to guide the optimal administration of propofol and remifentanil individually.</p><p><b>TRIAL REGISTRATION</b>CTRI Reg. No: ChiCTR-OOC-14005629; http://www.chictr.org.cn/showproj.aspx?proj=9875.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Electroencephalography , Movement Disorders , Pain , Piperidines , Pharmacology , Propofol , Pharmacology , Transcutaneous Electric Nerve Stimulation , UnconsciousnessABSTRACT
Objective To evaluate the feasibility of using stroke volume variation (SVV) as the left ventricular preload to draw the cardiac function curve.Methods Twenty-seven patients of both sexes,aged 18-64 yr,with body mass index of 18-30 kg/m2,of American Society of Anesthesiologists physical status Ⅱ (New York Heart Association Ⅱ),with abnormal cardiac function,scheduled for elective offpany coronary artery byp grafting,were enrolled in this study.Twenty-five patients,aged 18-64 yr,with body mass index of 18-30 kg/m2,of American Society of Anesthesiologists physical status Ⅰ (New York Heart Association Ⅰ),with normal cardiac function,scheduled for elective non-cardiac surgery,were also enrolled in this study.SVV and SV were monitored by using a FloTrac/VigileoTM system.The patients were in the supine position from the end of anesthesia induction to the beginning of surgery.After the hemodynamics was kept stable for 5 min,SVV and SV were recorded.6％ hydroxyethyl starch 130/0.4 500 ml was intravenously infused over 20 min.SVV and SV were recorded after volume expansion.Spearman rank-order correlation was used to analyze the relationship between SVV and SV.The quadratic regression analysis was used to draw the SVV-SV curve,and the SVV-SV curve was compared with the Frank-Starling curve.Results Compared with the value before volume expansion,SVV and HR were significantly decreased,and SV was increased after volume expansion in the patients with normal cardiac function,and SVV was decreased after volume expansion in the patients with abnormal cardiac function (P＜0.01).SVV was negatively correlated with SV in the patients with normal cardiac function,and r=-0.467 (P＜0.05).SVV was negatively correlated with SV in the patients with abnormal cardiac function,and r=-0.378 (P＜0.05).The mirror symmetry was found between the SVV-SV curve in the patients with normal cardiac function and the normal Frank-Starling curve,and the general trend was close.The symmetry was not detected between the SVV-SV curve in the patients with abnormal cardiac function and the Frank-Starling curve in the patients with decreased myocardial contractility,and the general trend was not close.Conclusion For the patients with normal cardiac function,SVV can be used as the left ventricular preload to draw the cardiac function curve.
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Objective To investigate the predictive value of spontaneous cough in extubation patients with craniocerebral in‐jury in ICU .Methods Totally 78 cases of patients with severe craniocerebral injury in ICU was divided into successful exbuation group (53 cases) and failing exbuation group (25 cases) according to the exbuation outcome .With the permission of patients ,the general clinical data ,glasgow coma scale (GCS) scores and spontaneous cough of patients were recorded .Results There were 53 cases suceed ;25 cases of patients failing in exbuation ,accounting for 32 .05% .There were no significant difference between ages , gender ,medical history ,hospital acquired pneumonia (HAP) ,disease kind between two groups (P> 0 .05) ,while had significant difference between smoking ,body mass index (BMI)、GCS scores and spontaneous cough of two groups (P 0 .05) .Receiver operating characteristic curve (ROC) analysis showed that ,GCS scoresarea under the curve (AUC) was 0 .822 ,BMI AUC was 0 .674 ,spontaneous cough AUC was 0 .914 ,and smoking AUC was 0 .856 .Conclusion Smoking ,BMI and GCS scores and spontaneous cough times were all meaningful indices for evaluating exbuation of patients with craniocerebral injury in ICU ,in which spontaneous cough times was an important predictive factor and the most accurate one .
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Objective To evaluate the effects of lidocaine in combination with sevoflurane on myocardial protection in patients undergoing off-pump coronary artery bypass grafting (OPCABG).Methods One hundred ASA physical status Ⅱ or Ⅲ and NYHA class Ⅰ or Ⅱ patients of both sexes,aged 45-70 yr,weighing 63-82 kg,scheduled for elective OPCABG,were randomly assigned into 4 groups (n=25 each):control group (group C),lidocaine group (group L),sevoflurane group (group S),sevoflurane combined with lidocaine group (group SL).Tracheal intubation was performed after induction of anesthesia.Anesthesia was maintained with iv infusion of propofol and intermittent iv boluses of sufentanil and pipecuronium.Bispectral index value was maintained at 45-55.Lidocaine 1.5 mg/kg was injected after intubation,followed by infusion at 2 mg/min until the end of surgery in L and SL groups.Sevoflurane was inhaled with end-tidal concentration of 2.2％-2.5％ starting from the end of intubation until the end of operation in S and SL groups.Before induction of anesthesia,at skin incision,immediately after transsection of internal mammary artery,after completion of anastomosis of the proximal aortovein and distal coronary artery,at the end of operation and at 24 h during operation,venous blood samples were obtained to detect the levels of plasma creatine kinase (CK),creatine kinase isoenzyme-MB (CK-MB) and cardiac troponin Ⅰ (cTnI).Lidocaine-related side effects such as arrhythmia,bradycardia or cardiac arrest were recorded during operation and within 24 h after operation.Results Compared with group C,the plasma CK,CK-MB and cTnI levels were decreased in the S,L and SL groups.The plasma CK-MB and cTnI levels were significantly lower in SL group than in L group.The plasma CK,CK-MB and cTnI levels were significantly lower in SL group than in S group.In L and SL groups,no patient developed lidocainerelated side effects.Conclusion Lidocaine 1.5 mg/kg injected intravenously after intubation,followed by infusion at 2 mg/min in combination with sevoflurane end-tidal concentration about 2.2％ ～2.5％ provides myocardial protection in patients undergoing OPCABG,the efficacy is stronger than that of either alone.
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Objective To determine the median effective dose ( ED50 ) of 0?5% ropivacaine for ul?trasound?guided adductor canal saphenous nerve block. Methods Twenty?three patients of both sexes, aged 18-45 yr, weighing 50-85 kg, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, scheduled for elective arthroscopic meniscectomy, received an ultrasound?guided adductor canal saphenous nerve block. After successful location, 0?5% ropivacaine was injected. The sensory block of the area in?nervated by the saphenous nerve was assessed by pin?prick test. The dose of ropivacaine was determined by up?and?down technique. The initial dose of ropivacaine was set at 18 ml. Each time the dose increased∕de?creased in the next patient according to whether or not the sensory block of the area innervated by the saphe?nous nerve was complete, and the ratio between the two successive doses was 1 ∶ 1?2. The ED50 and 95%confidence interval of 0?5% ropivacaine for adductor canal saphenous nerve block were calculated by probit analysis. Results The ED50 (95% confidence interval) of 0?5% ropivacaine for ultrasound?guided adduc?tor canal saphenous nerve block was 10?7 ( 8?8-12?2) ml. Conclusion The ED50 of 0?5% ropivacaine for ultrasound?guided adductor canal saphenous nerve block is 10?7 ml.
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<p><b>BACKGROUND</b>In this prospective randomized study, we compared the predicted blood and effect-site C 50 for propofol and remifentanil target-controlled infusion (TCI) and the bispectral index (BIS) values at loss of consciousness (LOC) and response to a standard noxious painful stimulus (LOS) in elderly and young patients, respectively. We hypothesized that the elderly patients will require lower target concentration of both propofol and remifentanil at above two clinical end-points.</p><p><b>METHODS</b>There were 80 American Society of Anesthesiologists (ASA) physical status I-II unpremedicated patients enrolled in this study, they were divided into elderly group (age ≥65 years, n = 40) and young group (aged 18-64 years, n = 40). Propofol was initially given to a predicted blood concentration of 1.2 μg/ml and thereafter increased by 0.3 μg/ml every 30 s until Observer's Assessment of Alertness and Sedation score was 1. The propofol level was kept constant, and remifentanil was given to provide a predict blood concentration of 2.0 ng/ml, and then increased by 0.3 ng/ml every 30 s until loss of response to a tetanic stimulus. BIS (version 3.22, BIS Quattro sensor) was also recorded.</p><p><b>RESULTS</b>In elderly group, the propofol effect-site C 50 at LOC of was 1.5 (1.4-1.6) μg/ml, was significantly lower than that of young group, which was 2.2 (2.1-2.3) μg/ml, the remifentanil effect-site C 50 at LOS was 3.5 (3.3-3.7) ng/ml in elderly patients, was similar with 3.7 (3.6-3.8) ng/ml in young patients. Fifty percent of patients lost consciousness at a BIS value of 57.3 (56.4-58.1), was similar with that of young group, which was 55.2 (54.0-56.3).</p><p><b>CONCLUSION</b>In elderly patients, the predicted blood and effect-site concentrations of propofol at LOC were lower than that of young patients. At same sedation status, predicted blood and effect-site concentrations of remifentanil required at LOS were similar in elderly and young patients. BIS were not affected by age. Low-propofol/high-opioid may be optional TCI strategy for elderly patients.</p>
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Age Factors , Anesthetics, Intravenous , Therapeutic Uses , Piperidines , Therapeutic Uses , Propofol , Therapeutic Uses , Prospective Studies , UnconsciousnessABSTRACT
Objective We aimed to explore the value of Servperf model in evaluation of nursing service quality of obstetrics.Methods This survey was conducted by modified Servperf model.A total of 315 maternal in obstetrics of a certain hospital in Xinjiang province were studied.Results The total scores of nursing service quality in obstetrics were (117.78±17.60) and score index was 81.2％.The score index from high to low for each dimension turned out as:the score of assurance was (37.09 ± 5.15),and score index was 82.4％; the score of reliability was (12.19 ± 2.08) and score index was 81.3％; the score of care was (32.27 ± 5.13) and score index was 80.7％; the score of responsiveness was (36.24 ± 6.13) and score index was 80.5％.The maternal who had different occupations,hospitalization days,education levels and perceived health status had significant difference in perception of nursing service quality.Conclusions On the basis of ensuring assurance and reliability,nursing managers should give priorities to responsiveness and empathy care in terms of nursing service quality.In addition,nursing interventions should be given accoming to influencing factors in order to effectively improve nursing service quality of obstetrics.
ABSTRACT
Objective To compare the clinical value of nerve stimulator-versus ultrasound-guided continuous femoral nerve block for analgesia after laparoscopic surgery.Methods Forty patients,aged 18-60 yr,with body mass index of 18-30 kg/m2,of ASA physical status Ⅰ or Ⅱ,scheduled for elective laparoscopic surgery,were randomly assigned into 2 groups (n =20 each) using a random number table:nerve stimulator group (group S) and ultrasound group (group U).Epidural anesthesia was performed with 1.73 ％ carbonated lidocaine in both groups.0.2％ ropivacaine 5 ml/h was infused continuously after surgery to perform femoral nerve block for analgesia.VAS score at rest was assessed at 2,6,24 and 48 h after surgery.At 24 and 48 h after surgery,VAS scores during active and passive movement were assessed.The time for catheter placement near the femoral nerve and development of subcutaneous hematoma at the puncture site,local anesthetic intoxication and nausea and vomiting were recorded.The postoperative requirement for analgesics was also recorded.Results There was no significant difference in the VAS scores and puncture for femoral nerve block-and local anesthetics-related adverse events between the two groups.The time for catheter placement near the femoral nerve was 8.0 ± 1.4 and (6.7 ± 0.9) min in S and U groups,respectively,and the time was significantly longer in group S than in group U.No patients required rescue analgesic after surgery in both groups.Conclusion Nerve stimulator-guided continuous femoral nerve block provides higher clinical value than ultrasound-guided continuous femoral nerve block for analgesia after laparoscopic surgery and it is more suitable for clinical application.