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Objective To investigate the effects of phenylephrine and norepinephrine on tissue oxygen metabolism in elderly patients undergoing fluid restriction. Methods Eighty elderly patients who had underwent elective colorectal surgery were selected, with ASA of Ⅰ-Ⅱ grade. The patients were divided into restricted fluid administration combined with phenylephrine group (group Ⅰ) and restricted fluid administration combined with norepinephrine group (groupⅡ) by random digits table with 40 cases each. The compound recipe sodium lactate was given at a rate of 5 ml/(kg · h). Small dose of phenylephrine was infused intravenously at 0.1-0.3μg/(kg · min) simultaneously during the surgery in group Ⅰ, or norepinephrine 0.01-0.03 μg/(kg · min) in group Ⅱ. Mean arterial pressure (MAP) was maintained ≥ 65 mmHg (1 mmHg = 0.133 kPa). The intraoperative blood loss was replaced with the equal volume of 6% hydroxyethyl starch 130/0.4. The blood gas analysis, hemoglobin and so on were determined before the surgery (T0), 1 h after beginning of surgery (T1), 2 h after beginning of surgery (T2) and at the time of leaving operation room (T3). The complications were recorded. Results There were no statistical differences in MAP, central venous pressure (CVP), heart rate, lactic acid, arterial partial pressure of oxygen, central venous oxygen pressure, central venous blood oxygen saturation, oxygen uptake rate, hemoglobin, albumin, blood urea nitrogen, creatinine and incidence of complication between 2 groups (P>0.05). The T1-3 hemoglobin and arterial oxygen content (CaO2), T1 and T3 venous oxygen content (CcvO2) and T2 atrerial venous oxygen content differences (Da-cvO2) in groupⅠwere significantly higher than those in groupⅡ, hemoglobin:(103.8 ± 7.9) g/L vs. (110.8 ± 8.6) g/L, (101.7 ± 7.7) g/L vs. (107.3 ± 7.8) g/L and (101.6 ± 6.9) g/L vs. (106.8 ± 5.6) g/L; CaO2: (140.6 ± 9.7) mmol/L vs. (149.6 ± 10.5) mmol/L, (137.5 ± 9.3) mmol/L vs. (144.9 ± 10.2) mmol/L and (137.2 ± 9.2) mmol/L vs. (143.1 ± 8.9) mmol/L;CcvO2:(119.8 ± 10.2) mmol/L vs. (126.4 ± 10.8) mmol/L and (102.3 ± 8.6) mmol/L vs. (108.5 ± 8.9) mmol/L;Da-cvO2:(19.6 ± 3.9) mmol/L vs. (23.0 ± 4.5) mmol/L, and there were statistical differences (P<0.05). Conclusions Phenylephrine has more effect on tissue oxygen metabolism in the elderly patients undergoing fluid-restricted abdominal surgery.
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Objective To evaluate 11C-MDA,a cardiac sympathetic nerve presynaptic molecular probe,in acute myocardial ischemia (AMI) and to compare with 13N-Ammonia myocardial perfusion imaging.Methods Twelve Bama miniature pigs were used to establish AMI models.11C-MDA and 13N-Ammonia PET/CT were performed before and after model establishment.The defect fraction,ratio of defect to normal region,defect volume of 11C-MDA and 13N-Ammonia PET/CT were calculated.Paired-t test and twosample t test were used.Results Eight models were established successfully and 4 pigs died.The defect fractions on 11C-MDA and 13N-Ammonia myocardial imaging were significantly different (13.4±3.3 vs 7.4±1.0,18.8±4.4 vs 4.8±1.0,10.5±4.2 vs 4.4±0.9;t values:4.901,8.864,4.030,all P＜0.001) at the first,third and sixth month post-model establishment.The ratios of defect to normal region on 11C-MDA and 13N-Ammonia PET/CT myocardial images were significantly different (0.47±0.14 vs 0.59±0.10,0.43±0.13 vs 0.61±0.09;t values:-2.166,-3.415,both P＜0.05) at the first and third month post-model establishment.The defect volumes on 11C-MDA and 13N-Ammonia PET/CT were significantly different ((4.20±0.34) vs (2.55±0.11) cm3,(10.66±0.71) vs (2.46±0.12) cm3,(5.95±0.50) vs (2.44±0.11) cm3;t values:12.925,32.149,19.440,all P＜0.001) at the first,third and sixth month post-model establishment.Conclusions Myocardial ischemia-reperfusion and cardiac sympathetic restoration might occur at different times.The recovery of myocardial ischemia-reperfusion is earlier than that of the cardiac sympathetic nerve.
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Objective To compare the effects of phenylephrine and norepinephrine in patients with restrictive transfusion.Methods 65 patients undergoing laparoscopic resection of rectal cancer were selected.According to the random number table method,the patients were randomly divided into 32 cases of observation group (phenylephrine composite restriction infusion) and 33 cases of control group(norepinephrine combined restrictive transfusion).The operation and hemodynamics of the two groups at different time points were compared.At T0,T1,T2,the central venous blood and arterial blood were collected,the central venous blood saturation (ScvO2),arterial blood lactate (Lac),central venous oxygen partial pressure (PcvO2),PaO2,Hb concentrations,venous oxygen content (CcvO2),arterial oxygen content(CaO2),arteriovenous oxygen content difference (Ca-cvO2) and oxygen uptake rate (ERO2) were compared between the two groups.Results The ASA levels (Ⅰ / Ⅱ grade) of the observation group and the control group were 11 cases/21 cases and 13 cases/20 cases,respectively,the difference was not statistically significant(x2 =5.298,P =0.052).The BMI of the observation group and the control group were (20.61 ± 1.65) kg/m2,(21.57 ± 1.42) kg/m2,respectively,the difference was not statistically significant (t =0.652,P =1.980).The fluid replacement of the observation group and the control group were (1 162 ± 113) mL,(1171 ± 104) mL,respectively,the difference was not statistically significant (t =1.734,P =0.065).The blood loss of the observation group and the control group were (276 ± 41) mL,(294 ± 42) mL,respectively,the difference was not statistically significant (t =0.083,P =1.023).The urine volume of the observation group and the control group were (524 ± 113) mL,(532 ± 109) mL,respectively,the difference was not statistically significant(t =1.834,P =0.053).The operation time of the observation group and the control group were (192 ± 24) min,(197 ± 21) min,respectively,the difference was not statistically significant(t =1.367,P =0.073).The MAP at T1-T2 of the two groups increased,the CVP of the two groups was significantly higher at T1,the HR of the two groups was significantly higher at T2.The MAP,CVP,HR between the two groups had no significant differences (all P ＞ 0.05).The levels of ScvO2,PcvO2 and PaO2 at T1 were significantly higher than those at T0,on the contrary,the levels of ScvO2,PcvO2 and PaO2 at T2 were significantly lower than those at T0,and the Hb in the observation group was significantly lower at T1-T2,the Hb in the control group was significantly lower at T,-T2,which in the observation group was lower than the control group,the differences were statistically significant(all P ＜ 0.05).There was no statistically significant difference in Lac between the two groups (P ＞ 0.05).There were statistically significant differences in CcvO2,CaO2,Ca-cvO2 and ERO2 between the two groups at different time points (all P ＜ 0.05).Conclusion Phenylephrine is more effective than norepinephrine in limiting infusion in elderly patients,and it has more obvious effects on tissue oxygen metabolism.
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OBJETIVO: Avaliar o efeito da ibopamina a 2 por cento tópica e comparar a variação na pressão intraocular (PIO) em olhos com glaucoma primário de ângulo aberto assimétrico (GPAA). MÉTODOS: Quinze pacientes (30 olhos) com GPAA com evolução assimétrica da neuropatia entre os dois olhos, onde comparamos em cada paciente a resposta a ibopamina e o defeito perimétrico, caracterizado por uma diferença de pelo menos 5dB de MD entre os olhos. O teste estatístico utilizado foi o t Student bicaudal e para significância estatística estabeleceu-se p <0,05. RESULTADOS: Em 80 por cento dos casos, (12/15 pacientes) o olho mais afetado pelo defeito perimétrico apresentou um aumento da PIO e/ou uma variaçã da PIO pós-ibopamina maior, sendo o resultado estatisticamente significativo (p<0,0001 e p = 0,0006), respectivamente. CONCLUSÃO: Este estudo mostrou que o defeito perimétrico no GPAA é significativamente relacionado com a positividade do teste de ibopamina sendo que olhos com maior defeito no campo visual apresentam maiores picos de PIO (max-PIO) pós-ibopamina e/ou uma maior variação em relação a sua PIO prévia ao teste (v-PIO).
OBJECTIVE: To evaluate the topic 2 percent ibopamine effect in the intraocular pressure (IOP) of eyes with assimetric primary open-angle glaucoma (POAG). METHODS: 15 patients (30 eyes) with primary open-angle glaucoma showing assimetric nerve disease evolution were assessed. We compared in all patients, the ibopamine response and the visual field defect between both eyes. The visual field, to be considered, should have at least 5 dB in MD difference between them. The statistical analysis was done with the Two-Tailed Student Test, with a Statistics significance of p<0.05. RESULTS: In 80 percent of the cases, (12/15 patients), the most affected eye in the visual field presented a greater variation and/or higher intraocular pressure after the ibopamine provocative test. The difference was statistically significant (p<0.00001 and p= 0.0006) respectively. CONCLUSION: This study showed that the visual field defect in GPAA is significantly connected with the positivity of the ibopamine test. The most affected eyes in the visual field presented a higher intraocular pressure (max-PIO) and/or a greater variation (v-PIO) after the ibopamine provocativetest.
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Humans , Male , Female , Adult , Middle Aged , Aged, 80 and over , Deoxyepinephrine/administration & dosage , Deoxyepinephrine/analogs & derivatives , Glaucoma, Open-Angle/drug therapy , Intraocular Pressure , Mydriatics , Ophthalmic Solutions/administration & dosage , Visual FieldsABSTRACT
Objective To investigate the changes in auditory evoked potential index(AAI)value and bispectral index(BIS)value produced by treatment of hypotension with ephedrine or phenylephrine during induction of general anesthesia.Methods Seventy-five ASA Ⅰ or Ⅱ patients of both sexes aged 30-50 yr with body mass index ＜ 30 kg/m2 underwent elective abdominal surgery under general anesthesia.Anesthesia was induced with 8%sevoflurane,midazolam 0.1 mg/kg and fentanyl 3 μg/kg.Tracheal intubation was facilitated with succinylcholine 2 mg/kg.Anesthesia was maintained with sevoflurane inhalation.BIS value was maintained at 40-50 and AAI value at 20-30 by adjusting the concentration of sevoflurane.When the desired level of BIS value and AAI value was reached during induction of anesthesia,hypotension(MAP ＜ 80 % of the baseline)was treated with intravenous ephedrine 0.1 mg/kg(group E,n = 25)or phenylephrine 2 mg/kg(group P,n = 25)or 6% HES(130/0.4)10 ml/kg(group C,n = 25)at random.MAP,HR,BIS value and AAI value value were recorded before(T0)and at 2,5,7,10 min after fluid or vasoactive agent administration(T1-4).Results MAP significantly increased after treatment at T1-4 as compared with MAP at To in all 3 groups.BIS and AAI values were significantly increased after administration of ephedrine at T3,4 as compared with MAP at To in group E.There were no significant differences in BIS and AAI values before and after administration of phenylephrine and 6% HES in group P and C.Con-clusion Treatment of hypotension with ephedrine during induction of general anesthesia can increase BIS and AAI and decrease the depth of anesthesia but phenylephrine cannot.
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OBJECTIVE: To establish a RP-HPLC method for the simultaneous determination of chloramphenical,dexamethsone sodium phosphate and deoxyepinephrine in luxindi eye drops.METHODS: The determination was performed on Kromasil C18 column and the mobile phase consisted of methanol-water(containing 0.2% triethylamine and 0.15% octane sulfonic acid sodium,pH was adjusted to 3.8 with phosphoric acid,40∶60) with flow rate at 1.0 mL?min-1.The detective wavelength was set at 230 nm;the sample size was 20 ?L and the column temperature was set at room temperature.RESULTS: The linear ranges of chlormphenical,dexamethasone sodium phosphate and deoxyepinephrine were 125～1 000(r=0.999 3),25～200(r=0.999 6) and 12.5～100(r=0.999 2) mg?L-1,respectively,with the average recoveries rate at 99.53%,100.0% and 99.24%,and RSD at 0.51%,0.90% and 0.72%,respectively.CONCLUSIONS: This method is simple,rapid and accurate,and it is applicable for the content determination of this preparation.