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Objective To observe the effect of multiple monitoring of total intravenous anes-thesia on postoperative cognitive function in elderly patients.Methods Elective 100 patients undergo-ing general anesthesia for abdominal operation,56 males,44 females,aged 65-80 years,ASA physi-cal status Ⅱ or Ⅲ.All patients were divided into multiple monitoring group (group M)and routine monitoring group (group R)by random digital table method,n =50 each.In group M,the anesthesi-ologists modulated anesthetic drugs to make NTI of 37-56 and rSO 2 higher than 50% or not lower than the baseline value by 20%,while in group R the infusion rate of propofol,remifentanil and cisa-tracurium was adjusted by anesthesiologists according to anesthesiologist’s experiences by the pa-tients’monitoring index.Cognitive function of patients in the two groups were evaluated using MMSE 1 d before surgery and 1 d,3 d,7 d,1 month and 3 months after surgery.The occurrence of cognitive dysfunction 7 d,1 month and 3 months after surgery,the postoperative recovery and the dosage of propofol,remifentanil and cisatracurium were recorded.Blood was randomly selected from each group to determine the serum content of S100βand Aβ1-42 by ELISA method at the time point of before surgery (T0 ),one hour after starting surgery (T1 ),the end of surgery (T2 )and postopera-tive 24 hours (T3 ).Results The incidence of postoperative cognitive decline in group M on 1 d (8%vs.22%),3 d (2% vs.1 6%)after surgery were significantly lower than that in group R (P <0.05). Postoperative cognitive dysfunction between the two groups 7 d and 1 month,3 months after surgery has no statistical significance.The dose of propofol [(3.3 ± 0.8)mg · kg-1 · h-1 vs.(3.7 ± 0.7 ) mg·kg-1 ·h-1 ,P < 0.05 ] and cisatracurium [(104 ± 47 )μg · kg-1 · h-1 vs.(124 ± 68 )μg·kg-1 ·h-1 ,P <0.05]in group M was less than that in group R.The time of eye-opening [(10 ±3)min vs.(1 6±6)min,P <0.01],extubation [(13±3)min vs.(22±7)min,P <0.01]and lo-cation [(1 7±4)min vs.(27 ±9)min,P <0.01 ]was shorter in group M.Compared with T0 ,the serum level of S100βprotein was significantly increased in group M at T1 ,T2 and group R at T1-T3 (P <0.05);The level of serum S100βprotein in group M was significantly lower than that in group R (P <0.05).Compared with T0 ,Aβ1-42 protein level was significantly reduced in two groups at T1 and T2 (P <0.05),but there was no significant difference between the two groups.Conclusion Total intravenous anesthesia with multiple monitoring can reduce neural injury and reduce the incidence of early postoperative cognitive decline in elderly patients with abdominal surgery,but has no significant effect on the incidence of POCD.
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OBJECTIVE:To observe the effects of remifentanil-induced controlled hypotension (CH) on postoperative cogni-tive dysfunction (POCD) and serum S100β protein in elderly patients underwent spinal surgery,and to investigate their relation-ship. METHODS:Sixty elderly patients undergoing selective laminectomy decompression internal fixation of lumbar or thoracic fractures under general anesthesia were selected prospectively from orthopedics department of our hospital during Jan. 2014-Dec. 2015,and then divided into CH group and non-CH group in accordance with random number table,with 30 cases in each group. Both groups received general anesthesia of injection and inhalation via endotracheal intubation. Mean arterial pressure (MAP) of CH group were reduced to 70%-80%of the basic values by adjusting remifentanil infusion rate;those of non-CH group were main-tained at basic level. Surgery duration,anesthesia duration,intraoperative blood loss,the incidence of POCD and serum concentra-tion of S100β protein were observed in 2 groups. The relationship of serum concentration of S100β protein with POCD was ana-lyzed,and the occurrence of ADR was recorded. RESULTS:The intraoperative blood loss of CH group was significantly less than that of non-CH group,with statistical significance (P0.05). The incidence of POCD and serum concentration of S100β protein in CH group were significantly higher than in non-CH group on the 2nd and 3rd day after surgery,with statistical significance(P<0.05). The serum concentration of S100β protein may be related to the incidence of POCD (r=0.992 7,P=0.001 3). CONCLU-SIONS:Remifentanil CH used in elderly patients underwent spinal surgery can reduce intraoperative blood loss,but increase the se-rum concentration of S100βprotein and the incidence of POCD at early stage.
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Objective To investigate clinical evaluation of Kudiezi injection in treatment of acute cerebral infarction and its effects on serum vascular endothelial growth factor(VEGF), S-100β, matrix metalloproteinases(MMP)-9 levels.Methods 98 patients of acute cerebral infarction who received therapy from October 2014 to October 2016 in our hospital were selected.Those patients were randomly divided into the observation group and the control group with 48 cases in each group.The control group was treated with routine treatment, while the observation group was treated with Kudiezi injection.After treatment of 14 days, the clinical curative effect, serum VEGF, S-100β, MMP-9, National institutes of health stroke scale (NIHSS) and Barthel index were compared.Results After treatment, the total effective rate in the observation group 87.75%(43/49) was significantly higher than that of the control group 65.31%( 32/49 ) , the difference was statistically significant ( P<0.05 ) , the level of VEGF in the observation group was significantly higher than that of the control group, and the S-100βand MMP-9 were significantly lower than that of the control group, the difference was statistically significant (P<0.05), the NIHSS score in the observation group was significantly lower than that of the control group, the difference was statistically significant (P<0.05), the Barthel index in the observation group was significantly higher than that of the control group, the difference was statistically significant (P<0.05).Conclusion Kudiezi injection is well for acute cerebral infarction, which can effectively improve the serum levels of VEGF, S-100β, MMP-9, and can improve the therapeutic effect, promote the recovery of neurological function and improve the quality of life.
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Objective To observe the serum concentration of S100βprotein (S100β)and neuron specific enolase (NSE)in patients undergoing supratentorial tumor resection with ulinastatin treat-ment.Methods Twenty-four patients with supratentorial tumor resection,aged 18-65 years,ASA Ⅰor Ⅱ,were randomly divided into the control group (group A,n =12)and ulinastatin group (group U,n =12).Patients in group U received ulinastatin (2 kU/kg)at the beginning of the surgery,with the continuous dose of 1 kU·kg-1 ·h-1 till the end of the operation.Group A received equivalent volume of saline solution as the vehicle control.Blood samples were taken from the artery and jugular venous bulb before induction of anesthesia (T1 ),skin incision (T2 ),1 h after dura openning (T3 ),at the closure of dura (T4 ),at the end of operation (T5 )and 24 h after operation (T6 )to analyze the concentration of S100β and NSE.The concentration of S100β and NSE were determined by ELISA. Results The concentration of serum S100β and NSE increased more significantly higher at T3-T6 in group A than group U (P <0.01).The concentration of serum S100βand NSE in group U were lower than those in group A at T3-T5 (P < 0.01 ).Conclusion Ulinastatin reduces the concentration of serum S100βand NSE during surgery,indicating it alleviates brain injury during supratentorial tumor resection.
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Objective To investigate traditional Chinese medical emotional intervention on the cognition function of senile patients after abdominal surgery. Methods Seventy senile patients having elective abdominal operation were randomized into intervention group and control group, 35 cases in each group. The control group received routine peri-operative nursing, and the intervention group was given routine peri-operative nursing and emotional intervention based on the theory of traditional Chinese medicine. The cognition function was evaluated with mini-mental state examination (MMSE) on preoperative day 1, postoperative day 3 and 7, and serum S100βprotein level was detected before operation and on postoperative day 7. Results (1)Time for recovery from general anesthesia in the intervention group was much shortened as compared with that of the control group(P0.05). (3) On postoperative day 7, serum S-100β protein level in the two groups was increased as compared with that before treatment(P0.05). Conclusion Traditional Chinese medical emotional intervention has an effect on shortening time for recovery from general anesthesia and decreasing POCD incidence, but has no effect on POCD incidence and serum S100βprotein level on postoperative day 7.
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Objective To evaluate whether S-100β protein could be a serum marker for traumatic spinal cord injury (SCI). Methods From June, 2013 to October, 2014, 24 patients with complete SCI were measured the serum S-100β protein concentrations with en-zyme-linked immunosorbent assay, one week, three and six months after SCI. Serum from ten healthy persons was as normal control. Re-sults The serum S-100βprotein concentrations increased one week and 3 months after SCI (Z>4.273, P<0.001). Conclusion The increase of serum S-100βprotein may help assessing early impairment after complete SCI.
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Objective To investigate the effects of different BIS values on postoperative cogni-tive dysfunction (POCD)and S100βprotein(S100β)in the early stage of postoperation.Methods Fifty patients who were scheduled for selective abdominal surgery under general anesthesia (male 34 cases, female 1 6 cases,aged 65 to 75 years,ASA Ⅰ or Ⅱ)were randomly divided into two groups:light anesthesia group (group L,n =25,BIS value was maintained at 50 to 59)and deep anesthesia group (group D,n =25,BIS value was maintained at 30 to 39).BP,HR,SpO 2 ,ECG,PET CO 2 ,inhaled anes-thetic concentration and BIS values were recorded on time points of 5 minutes after the patients ente-ring the operating room (T0 ),before endotracheal (T1 ),intubation (T2 ),incision (T3 ),two hours after incision (T4 ),three hours after incision (T5 )and at the end of surgery (T6 ).The procedure du-ration,anesthesia time,dosages of propofol,fentanyl,midazolam and VAS scores on 1 d after sur-gery were also recorded.Blood samples were collected on time points of 10 min before anesthesia,im-mediately after surgery and 24,48 h after operation.S100β concentration were detected.Mini-mental State Examination (MMSE)score and Trail Making Test (TMT)completion time were recorded on 1 d before surgery and 1,3,7 d after surgery.Results BIS value of group D were lower than group L on T2 ,T3 and T4 .The propofol dosage of group D was significantly greater than that in group L (P <0.05 ).The concentration of serum S100βincreased significantly immediate and 48 h after operation in both groups compared with 10 min before anesthesia(P < 0.05).It was still higher 24 hours after op-eration than before anesthesia.But there was no statistic difference.Compared with the end of surger-y,the concentration of serum S100βin two groups on 24 h after surgery were significantly decreased (P < 0.05 ).The concentration of serum S100β in group L on the end of surgery and 24 h after surgery were higher than that in group D significantly (P <0.05).Compared with 1 d before surgery, postoperative 1 d MMSE scores in two groups and postoperative 3 d MMSE score in group L de-creased significantly (P <0.01).Compared with postoperative 3 d,postoperative 7 d MMSE score in group L increased significantly (P <0.01).Postoperative 1,3 d MMSE score in group D were signifi-cantly higher than group L (P <0.05).Compared with 1 d before surgery,TMT completion time in two groups on 1 d after surgery were significantly prolonged (P <0.01 ).Compared with 1 d after surgery,TMT completion time in two groups on 3 d after surgery were significantly shortened (P <0.01).Compared with 3 d after surgery,TMT completion time in group L on 7 d after surgery was significantly shortened (P <0.01 ).TMT completion time in group D on 1,3 d postoperative were significantly shorter than group L (P <0.05).POCD incidence of group D on 1 d after surgery was lower than that in group L (P < 0.05).Conclusion Different depth of anesthesia can ensure hemo-dynamic balance in old patients during surgery and after surgery.When BIS value was maintained at 30 to 39,it had lower S100βprotein levels,lower incidence of early POCD and a lesser degree of post-operative cognitive dysfunction.
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OBJECTIVE:To observe the cerebral protective effects of dexmedetomidine in brain aneurysm surgery. METH-ODS:48 patients with intracranial aneurysm were randomly divided into observation group and control group,with 24 cases in each group. Observation group was given dexmedetomidine 1 μg/kg,pump time 10 min,at rate of 0.5 μg/kg;control group re-ceived constant volume of normal saline. Hemodynamic changes,the levels of S100β protein and neuron specific enolase (NSE) were compared between 2 groups. RESULTS:The heart rate and mean arterial blood pressure were more stable in the observation group after medication,with statistical significance(P<0.05). The serum level of S100β protein at the end of operation(T5),6 h after operation(T6),12 h after operation(T7),24 h after operation(T8)were(1.52±0.35)μg/L,(1.69±0.33)μg/L,(1.72±0.42)μg/L,(2.08±0.57)μg/L;the serum level of NSE were(10.9±1.2)ng/L,(13.5±1.5)ng/L,(16.8±2.8)ng/L and(19.7±4.3)ng/L in observation group;those were all lower than in control group,with statistical significance(P<0.05). CONCLUSIONS:Dexme-detomidine for cerebral aneurysm operation is helpful for hemodynamics stability,and result in lower S100β protein and NSE. So it is important for cerebral protection.
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Objective To analyze clinical efficacy of nimodipine combined with compound danshen solution in treating patients with subarachnoid hemorrhage.Methods 60 patients with acute subarachnoid hemorrhage were randomly divided into observation group and control group from January 2010 to January 2015, 30 cases in each group.Control group was treated with reduce intracranial pressure, symptomatic and supportive treatment, stable pH and electrolyte balance and other conventional treatment, observation group was given conventional therapy basis on the use of nimodipine combined with compound danshen solution, the situation of S100-βin cerebrospinal fluid,clinical efficacy and the incidence of complications of two groups were recorded and analyzed before and after treatment.Results Treatment 5, 7, 14d after S100-βprotein were observed in patients (0.095 ±0.014,0.072 ±0.011,0.022 ±0.010) μg/L, were better than control group (1.120 ±0.012,0.098 ±0.013,0.052 ±0.009) μg/L (P<0.05).Treatment observation group total effective rate was 90.0%,higher than 63.3% of control group(P<0.05).Rebleeding, cerebral ischemia, hydrocephalus and other complications of treatment group were similar to control group, the difference was not significant.Conclusion Clinical efficacy of nimodipine combined with compound danshen solution in treating subarachnoid hemorrhage is effective , precise, which compares with conventional therapy, there is no significant adverse reactions.It can significantly improve the cure rate in patients with subarachnoid hemorrhage , reducing mortality, and it is worthy of further research and applications.
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Objective To analyse the effect of dual-antiplatelet drugs on S100β,IL-1β, adiponectin(ADPN)and NIHSS score in patients with acute cerebral infarction.Methods 58 patients diagnosed with acute cerebral infarction in first hospital of Qinhuangdao.All patients were collected and randomly divided into experimental group and control group according to random number table , 29 cases in each group.Both group were given the treatrnent of improvng the cerebral vascular circulation, protect brain cells, control blood pressure, blood glucose, oxygen when necessary.On the basis of conventional treatment, control group was treated with aspirin 200 mg, one time per day,orally.And experimental group was treated with clopidogrel 75 mg/d on the basis of control group,one time per day,orally.After treatment, the serum levels of S100β, IL-1β, ADPN and NIHSS score were detected in all patients.ResuIts After treatment, compared with control group,the serum S100βprotein level was significantly lower in the experimental group (P<0.05); the serum IL-1βlevel in experimental group was significantly lower (P<0.05);ADPN level in experimental group was significantly higher (P<0.05); NIHSS score of patients in experimental group was significantly lower (P<0.05).ConcIusions Dual antiplatelet drugs can reduce serum S100βprotein,IL-1βin serum of patients with acute cerebral infarction, increase the level of serum adiponectin, decrease NIHSS score, can effectively improre neurological function in patients with acute cerebral infarction.
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Objective There is a lack objective methods for the diagnosis of postoperative cognitive dysfunction (POCD).This study aimed to investigate the influence of propofol or etomidate anes-thesia on the postoperative cognitive function and serum S 100βprotein level in infants . Methods This study included 100 hernia infants aged 1-3 years treated by laparoscopic herniorrhaphy under propofol (n=50) or etomidate anesthesia (n=50).At 1 day before and 3 days after surgery, we assessed the cognitive function of the patients using Bayley Scales of Infant and Toddler Development ( BSID-Ⅲ) and further divided each group into a POCD and a non-POCD sub-group based on the results of diagnosis made according to the Z-scores.Using ELISA, we measured the levels of the serum S100βpro-tein in the iliac venous blood drawn preoperatively ( T0 ) and before PACU ( T1 ) and compared them between the POCD and non-POCD groups. Results At 3 days after operation, POCD was observed in 10 cases (20.0%) in the propofol group and 9 cases (18.0%) in the etomidate group, with no statistically significant differences between the two (P>0.05).The level of the serum S100βprotein was markedly elevated in both the propofol and etomidate groups at T 1 as compared with that at T0(P0.05).A significant correlation was found between the postoperative S 100βlevel and POCD at 3 days after surgery in both the propofol (r=0.842, P=0.001) and the etomidate group (r=0.821, P=0.001). Conclusion Propofol and etomidate anes-thesia can induce different degrees of postoperative decline of cognitive function in 1-3 years old infants .The post-anesthesia elevation of the serum S100βprotein level is positively correlated with early postoperative POCD and indicates various degrees of brain damage .
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Objective To investigate the effect of sodium nitroprusside sustained release on cognitive function, S-100βprotein and VILIP-1 in pituitary tumor surgery patients.Methods 156 cases of pituitary tumor patients were selected and divided into two groups according to random number table method,78 patients in each group.All patients underwent general anesthesia induction,the experimental group treated with 0.5~6 μg ( kg· min) infusion of sodium nitroprusside induced hypotension by micro pump at the beginning of operation.MMSE was used to determine the cognitive function of 2 groups of patients 1 day before operation and 2 days after operation,S-100βand VILIP-1 content were determined by ELISA before anesthesia,after surgery,and 0,12,24,48 h after operation.Results There was no statistical significance between the 2 groups in the incidence of postoperative cognitive dysfunction.Compared with control group, the operation time, bleeding volume and the recovery time of the experiment group were lower(P<0.05).S-100βprotein and VILIP-1 showed increased at first and then decreased at the peak of 24h;compared with the normal group, the levels of S-100βprotein and VILIP-1 of the cognitive impairment were higher ( P <0.05 ).Compared with the control group, the levels of S-100βprotein and VILIP-1 of the experiment group were lower(P <0.05).Conclusion Sodium nitroprusside sustained release controlled hypotension can reduce the level of cognitive disorder, patients of S-100βprotein and visinin-like protein 1 and has certain directive significance to the clinical.