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Objective To evaluate the effects of dexmedetomidine combined with subanesthetic dose of ketamine on the emergence agitation in the patients undergoing thoracotomy.Methods Eighty ASA physical status Ⅱ or Ⅲ patients,aged 55-75 yr,weighing 50-75 kg,scheduled for elective esophageal cancer resection,were randomly divided into 4 groups (n =20 each) using a random number table:normal saline group (NS group),dexmedetomidine group (group D),subanesthetic dose of ketamine group (group K),and dexmedetomidine combined with ketamine group (group DK).In DK and K groups,ketamine 0.5 mg/kg was injected intravenously (within 1 min) at 10 min before the end of the operation.In DK and D groups,dexmedetomidine 0.5 μg/kg was infused intravenously over 10 min starting from 10 min before the end of operation.In group NS,the equal volume of normal saline was infused intravenously over 10 min starting from l0 min before the end of operation.The emergence time,extubation time,duration of ICU stay,occurrence and degree of agitation,and development of cardiovascular events and hypoxemia within 24 h after operation were recorded.Ramsay sedation scores were recorded before induction of anesthesia (T1),immediately after completion of administration at the end of surgery (T2),and at 0,5,10 and 30 min after extubation (T3-6).Results There was no significant difference in the emergence time,extubation time,and duration of ICU stay between the four groups.Compared with group NS,Ramsay sedation scores were significantly increased at T3-6,the incidence and degree of agitation were decreased,and the incidence of cardiovascular events and hyoxemia was decreased in D,K and DK groups.Compared with D or K group,Ramsay sedation scores were significantly increased at T3-6,the incidence and degree of agitation were decreased,and the incidence of cardiovascular events and hyoxemia was decreased in group DK.Conclusion Dexmedetomidine combined with subanesthetic dose of ketamine can prevent the emergence agitation in the patients undergoing thoracotomy,which provides better efficacy than either alone.
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Objective To evaluate the effects of sub anesthetic dose of ketamine combined with sufentanil on postoperative patient-controlled intravenous analgesia (PCIA)in patients undergoing radical resection of esophageal cancer.Methods Ninety patients,ASAⅠorⅡ,aged 55-75 years old,se-lected for radical resection of esophageal cancer were randomly divided into three groups:group S1,group S2,group SK,30 patients in each group were treated with PCIA.Group S1,2 μg/kg sufentanyl;group S2,2.5 μg/kg sufentanyl;group SK 2 μg/kg sufentanyl+90 μg·kg-1·h-1 ketamine.6 mg of granisetron was added to each group,and then diluted into 100 ml of normal saline.All patients were administered load-ing doses of 5 ml analgesics 30 min before the end of the operation.The VAS score,Ramsay sedation score, SBP,DBP,HR,SpO2 and adverse effects were recorded respectively at 4,8,24 and 48 hours after opera-tion.The total times of pressing PCIA were also recorded in 48 h after operation.Results There was no statistically significant difference in Ramsay sedation score,SBP,DBP,HR and SpO2 at 4,8,24,48 hours after operation in the three groups.Compared with group S1,the VAS score and total number of pressing PCIA times in groups SK and S2 were significantly lower in 48 h after operation (P <0.05).Compared with group S2,VAS score and the total number of pressing PCIA times in group SK were significantly de-creased in 48 h after operation (P <0.05).Two patients from group SK occurred respiratory depression 48 h after operation.There was no statistically significant difference in incidence of adverse effects in the three groups.Conclusion Sub anesthetic dose of ketamine combined with sufentanil on PCIA can reduce postoper-ative sufentanil consumption and significantly relieve the postoperative pain in patients undergoing radical re-section of esophageal cancer.The analgesic effect is better than using sufentanil alone.
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ObjectiveTo investigate the relationship between the expression of ER,PR,HER-2,Ki-67 and the effective rate of neoadjuvant chemotherapy (NAC) and to study the influence of NAC on expression of ER,PR,HER-2 and Ki-67 in breast cancer.Methods41 patients of breast cancer were performed 2 to 6 cycles of CAF chemotherapy.The expression of ER,PR,HER-2 and Ki-67 was detected by SP immunohistochemical method before and after NAC.ResultsThe effective rate of NAC was 73.17％ (30/41).The positive and negative efficiency rate was 67.86％ (19/28) vs 84.62％ ( 11/13 ) for ER,64.29％ (9/14) vs 77.78％ (21/27 ) for HER-2,70.00％ (14/20) vs 76.19％ ( 16/21 ) for Ki-67.The difference had no statistical significance (P ＞0.05).The positive and negative efficiency rate was 66.67％ (16/24) vs 82.35％ (14/17) for PR.The difference had statistical significance (P ＜ 0.05 ).The expression of ER,PR,HER-2 and Ki-67 before and after NAC changed in 10,8,3 and 9 cases respectively.The difference had no statistical significance (P ＞ 0.05).ConclusionsNAC has no influence on the expression of ER,PR,HER-2 and Ki-67.Patients with PR negative are more sensitive to NAC.The expression state of PR can be used to predict the curative effect of NAC.The expression state of ER,HER-2 and Ki-67 has no significant correlation with NAC.
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Objective To further control the indications and to improve the effect of intra-esophageal metallic stents.Methods 83 metallic stents were be planted into esophageal through endoscopy and under X-ray TV guiding using two kinds of stent meterials in 72 cases with benign or maligant stenosis(esophageal,cardiac orifice).Results The operation of planting stents was successful in all patients and the effect of treatment of esophageal stenosis with stents covered by dacron kint membrane was best.The clinical symptoms and food intaking ablities of all patients were improved.Conclusion Home-made nitinol stents can be plant in treatment of malighent esophageal stenosis.It should be first choice for the patients without indications of surgery or after operation.
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Objective To improve the level of CT in diagnosing LDH and to provide the proof for selecting method of clinical treatment in lumbar disc herniation (LDH). Methods 218 cases of LDH showed by CT and operative exploration were analysed retrospectively.Results The accurate rats of CT diagnosis of LDH were 95.4%. According to CT findings it may be divided into 5 types: Ⅰ was central type, Ⅱ was postero-lateral type, Ⅲ was forminal type, Ⅳ was extreme lateral type, was nucleus pulposus type. Conclusion CT plays an important role in diagnosis and selecting methods of clinical treatment of LDH; It is signficance to enhance the accurate rats of CT diagnosis and the effect of treatment by distinguish nucleus pulposus and fibrous scar tissue from CT finding of LDH.
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Objective To prospectively study the sensitivity and specificity of 99m Tc Methoxyisobutyl Isonitrile( 99m Tc MIBI) scintimammorgaphy in the detection of both primary breast cancer and axillary lymph node metastasis. Methods Eighty four consecutive women suspicious of breast cancer under clinical examination were checked by the scintimammorgaphy of planar prone imaging in three planar views(5～8?min/view). The entire breast and ipsilateral axillary region were included in the field of view. Biopsy of resectional breast and lymph node were performed within 10 days after scintimammography. Results There were 51 primary breast cancer(7 different histologic types) and 33 benign breast lesion(4 histologic types) in this series. The sensitivity of scintimammography for detecting primary breast cancer was 90.20%(46/51) and the specificity was 93.93%(31/33). Metastatic axillary lymph nodes were seen in 25 of the 51 patients. The sensitivity of scintimammography to detect metastatic lymph node was 84.0%(21/25) and the specificlty was 88.46%(23/26). Conclusions The results of this study indicate that the scintimammography has high diagnosis rate in detecting breast cancer and axillary lymph node metastasis.