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Objective To evaluate the effect of intraoperative application of dexmedetomidine on acute post-traumatic stress disorder (PTSD) in female patients with lower limb fracture.Methods Ninety female patients with lower limb fractures caused by traffic accident,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,aged 20-35 yr,weighing 40-72 kg,scheduled for elective internal fixation,were divided into 3 groups (n =30 each) using a random number table:control group (group C),low-dose dexmedetomidine group (group D1) and high-dose dexmedetomidine group (group D2).Ropivacaine (0.75％) 10-15 ml was injected into the epidural space,and operation was started after pain disappeared at the plane T8-10.Two percent lidocaine 5-10 ml was intermittently injected to maintain the anesthetic plane at T10.After successful epidural anesthesia,dexmedetomidine 0.5 and 1.0 μg/kg were intravenously infused over 30 min in D1 and D2 groups,respectively,while the equal volume of normal saline was given in group C.Patient-controlled epidural analgesia was performed with 0.15％ ropivacaine after operation and lasted until 48 h postoperatively,maintaining visual analogue scale score ≤ 3 (baseline).Morphine 3 mg was intravenously injected for rescue analgesia when visual analogue scale score＞3.The requirement for rescue analgesia within 48 h after operation was recorded.Acute Stress Disorder Scale (ASDS),Self-Rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) scores were assessed at 1 h before operation and on 1,3 and 7 days after operation.The patients were followed up for 3 months by telephone,and the PTSD Checklist-Civilian Version score was evaluated.The occurrence of acute PTSD (PTSD Checklist-Civilian Version score ＞ 38) was recorded.Results Compared with group C,the ASDS,SAS and SDS scores were significantly decreased on 1,3 and 7 days after operation,and the incidence of acute PTSD was decreased in D1 and D2 groups (P＜0.05).Compared with group D1,the ASDS scores were significantly decreased on 1,3 and 7 days after operation,and the incidence of acute PTSD was decreased (P＜0.05),and no significant change was found in SAS or SDS scores at each time point in group D2 (P＞ 0.05).There was no significant difference in the requirement for rescue analgesia between the three groups (P＞0.05).Conclusion Intraoperative application of dexmedetomidine can reduce the occurrence of acute PTSD and it is dose-related in female patients.
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The stress response is a preexisting and adaptive behavioral mode of all living beings, which may bring deleterious consequences of dysfunction or failure of tissue and organ. This article aims to elaborate theories of stress response, summarize the manifestation and mechanism of acute stress response in critically burned patients, and help to improve clinical curative efficacy and prognosis of these patients by physiological, psychological and pharmacological methods.
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Objective To investigate the prevalence of traumatic event exposure and its relationship with major depressive disorder (MDD) in community population in Tianjin. Methods A multi-stage cluster random sampling method was used for the general health questionnaire (GHQ-12) in the population aged above 18 in 15538 families of 18 counties in Tianjin city. Among the 11748 subjects who completed the survey, they were divided into the high-risk group (100%), medium risk group (40%) and low risk group (10%) according to the risk level of mental disorders. Finally, 4438 residents were interviewed with the diagnostic and statistical manual of mental disorders Fourth Edition (DSM-Ⅳ) axisⅠdiagnostic clinical interview version (SCID-Ⅰ/P). The prevalence of respondents exposed to traumatic events and MDD was calculated. Logistic regression analysis was applied to obtain the risk factors of MDD. Results A total of 469 people experienced traumatic events in 4438 subjects, and the adjusted total exposure rate was 10.3%. Seventy-six people suffered from MDD in 469 cases with traumatic events, and the adjusted total exposure rate was 6.7%. The prevalence of MDD was 3.3% in people with no traumatic events. Logistic regression analysis showed that female (OR=1.77,95%CI:1.27-2.46), widowed/divorced and experienced a traumatic event (OR=2.21,95%CI:1.46-3.34) were the risk factors of MDD. Conclusion The total exposure rate of traumatic events is 10.3% in community residents in Tianjin, and the prevalence of MDD is related with the traumatic event exposure. It is suggested that the whole society should mobilize and participate extensively, and pay more attention to the psychological health problems of high risk population.
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OBJECTIVE: The aim of this study was to evaluate brain-derived neurotrophic factor levels in two patients, one with posttraumatic stress disorder and one with acute stress disorder, before and after treatment, and to compare those levels to those of healthy controls. METHOD: Brain-derived neurotrophic factor level, Davidson Trauma Scale, Beck Depression Inventory, Global Assessment of Functioning, and Clinical Global Impression were assessed before and after 6 weeks of treatment. RESULTS: Brain-derived neurotrophic factor levels were higher in patients than in matched controls before treatment. After 6 weeks, there was a reduction in symptoms and an improvement in functioning in both cases. At the same time, brain-derived neurotrophic factor levels decreased after treatment, even in case 2, treated with psychotherapy only. CONCLUSIONS: These results suggest that serum levels of brain-derived neurotrophic factor, as opposed to what has been described in mood disorders, are increased in posttraumatic stress disorder as well as in acute stress disorder.
OBJETIVO: O objetivo do estudo foi avaliar os níveis séricos do fator neurotrófico derivado do cérebro em um paciente com transtorno de estresse pós-traumático e em um paciente com transtorno de estresse agudo antes e após o tratamento, comparando esses níveis aos de controles saudáveis. MÉTODO: Os níveis do fator neurotrófico derivado do cérebro, a Escala Davidson de Trauma, o Inventário de Depressão de Beck, a Avaliação do Funcionamento Global e a Impressão Clínica Global foram medidos antes e após seis semanas de tratamento. RESULTADOS: Os níveis de fator neurotrófico derivado do cérebro foram maiores nos pacientes, quando comparados aos controles, antes do tratamento. Depois de seis semanas houve redução dos sintomas e melhora do funcionamento nos dois casos. Ao mesmo tempo, houve redução dos níveis de fator neurotrófico derivado do cérebro, mesmo no caso 2, tratado exclusivamente com psicoterapia. CONCLUSÕES: Esses resultados sugerem que o fator neurotrófico derivado do cérebro está aumentado tanto no transtorno de estresse pós-traumático quanto no transtorno de estresse agudo, de forma oposta às alterações até então descritas nos transtornos do humor.
Subject(s)
Female , Humans , Middle Aged , Young Adult , Brain-Derived Neurotrophic Factor/blood , Psychotherapy , Stress Disorders, Post-Traumatic/blood , Stress Disorders, Traumatic, Acute/blood , Biomarkers/blood , Case-Control Studies , Sex Offenses/psychology , Stress Disorders, Post-Traumatic/therapy , Stress Disorders, Traumatic, Acute/therapy , Young AdultABSTRACT
Objective To investigate the effects of cannabinoid 1 receptor (CB1R) on regulating visceral sensitivity in rats with acute partial restraint stress. Methods Thirty Sprague-Dawley rats were divided into blank control (sham stress), acute stress and CB1R groups with 10 each. The frequency of discharge of electromyogram (EMG) was recorded at the 1st, 2nd, 5th and 8th day to evaluate the visceral sensitivity to colorectal distension (CRD) in rats. The expression of the CB1R mRNA was determined by means of RT-PCR at day 8. Results There was no significant difference in baseline discharge frequency among three groups at the 1st day. But the discharge frequencies corresponding to CRD at 40,60,80 mm Hg at the 2nd day were significantly lower in CB1R group [(22.37±1.49)/min, (42.24±3.03)/min and (69.09±5.54)/min, respectively] than in acute stress group [(39.71±1.84)/min, (84.45±8.85)/min and (112.56±11.66)/min, respectively, P<0.05)]. The discharge frequencies corresponding to CRD at 40, 60,80 mm Hg in acute stress group [(104.12±6.77)/min, (158.07±18.68)/min, (193.58±25.69)/min,respectively] showed a significant elevation at the 5th day in comparison with blank control group[(36.33±5.42)/min, (74.07±8.25)/min, (102.94±7.95)/min, respectively, P<0.05] or CB1R group [(74.66±6.44)/min,(140.10±4.68)/min and (160.39±5.60)/min,respectively, P<0.05]. However, at the 8th day after stress, there was no significant difference in discharge frequency among three groups. The expressions of CB1R mRNA in ileocecal junction, proximal colonic and distal colonic tissues were significantly higher in acute stress group (2.53±0.52, 2.29±0.42, 2.54±0.29 respectively) than in blank control group(0.56±0.15, 0. 73±0.12, 0.82±0.09, respectively, P<0.05). There was no effect of CB1R agonist on CB1R mRNA expression in rats. Conclusion The visceral sensitivity in rats induced by stress can trigger the accommodation of endogenous cannabinoid system that plays an important role in modulation of visceral sensitivity.