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Objective To investigate effects of goal-directed fluid therapy on inflammatory cytokines under combined anesthesia.Methods 60 patients undergoing colorectal cancer surgery,aged 60 to 85 years old,which were classified as American Society of Anesthesiology(ASA)classⅡ~Ⅲ,were randomly assigned to Goal-directed fluid therapy group(group G,n = 30)and central venous pressure liquid management group(group C,n = 30). Life sign and BIS indexes were collected at the time points,before surgery(T1),after the start of the operation (T2),one hour after surgery(T3),after the operation(T4).Hemodynamic indexes were recorded.Two milliliter blood sample were phlebotomized for evaluation of TNF-α and IL-6 from each patient at T1,T3,T4.The infusion volume, the amount of bleeding,the operation time,anal exhaust time,and length of postoperative hospital stay were recorded. Results Comparing information between the two groups,infusion volume and colloid had an obvious decrease than that of group C(P<0.05).SVV and CVP of group G were much stable than group C.The levels of TNF-α and IL-6 of group G were lower than those of group C(P<0.01).The length of anal exhaust time and post-operative hospital stay group G were faster than that of group C(P<0.01).Conclusions Goal-directed fluid ther-apy is superior on fluid administration. It can reduce the release of IL-6 and TNF-α. It is beneficial to elderly colorectal cancer patients with hypertension.
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OBJECTIVE:To investigate the effects of different doses of tanshinone ⅡAon hemodynamics in patients underwent non-extracorporeal circulation coronary artery bypass grafting(NECCABG). METHODS:A total of 66 patients underwent selective NECCABG during Nov. 2016-Apr. 2017 were selected and divided into control group(33 cases)and observation group(33 cases) according to random number tablet. Both groups were given Tanshinone ⅡAsodium sulfonate injection with loading dose of 0.4 μg/kg for 10 min at the beginning of surgery. Control group was given Tanshinone ⅡAsodium sulfonate injection 0.2 μg/(kg·h) continuously till the end of surgery;observation group was given 0.4 μg/(kg·h)continuously till the end of surgery. HR,MAP, central venous pressure(CVP),mean pulmonary arterial pressure(MPAP),pulmonary capillary wedge pressure(PCWP),cardiac index(CI),systemic vascular resistance index(SVRI),pulmonary circulation resistance index(PVRI)and the occurrence of ADR were observed in 2 groups before anesthesia induction(T0),5 min after tracheal intubation(T1),at the moment of sternum cut(T2),at the end of anastomosis of anterior descending branch(T3),at the end of anastomosis of right coronary artery(T4),at the end of operation(T5). RESULTS:At T0,there was no statistical significance in HR,MAP,CVP,MPAP,PCWP, CI,SVRI or PVRI between 2 groups(P>0.05). At T1-T5, HR,MAP,CVP,MPAP,PCWP,SVRI and PVRI of control group were significantly higher than at T0,with statistical significance(P<0.05). There was no statistical significance in CI of control group among at T1-T5and with at T0;there was no statistical significance in HR,MAP,CVP,MPAP,PCWP,SVRI or PVRI of observation group between at T1-T5with at T0 (P>0.05). At T1-T5,CI of observation group was significantly higher than at T0and than control group;HR,MAP,CVP, MPAP,PCWP,SVRI and PVRI were significantly lower than control group,with statistical significance(P<0.05). No obvious ADR was found in 2 groups during medication. CONCLUSIONS:Tanshinone ⅡA0.4 μg/(kg·h)is helpful to keep hemodynamics stable and improve heart function in patients with NECCABG with good safety.
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Objective To investigate the effects of different depth of anesthesia on ScvO2 and ABL in elderly patients with gastrointestinal cancer. Methods Totally 55 elderly patients undergoing gastrointestinal sur-gery were randomly divided into deep anesthesia group(BIS40-49)(group D,n=27)and light anesthesia group (BIS50-59)(group S,n = 28). While SVV value was fixed,fluid management was conducted while monitoring CVP. HR,MAP,the change of central venous oxygen saturation and lactic acid index were recorded in different time points. Results Propofol dosage in group D and group S indicated statistical significance(P0.05). There was no significant difference between and within ABL groups in each time period(P>0.05). There was no significant difference in terms of other indicators between 2 groups. Conclusions For elderly patients with gastrointestinal surgery,shallow anesthesia can improve tissue oxygenation and reduce the amount of anesthetics.
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Objective:To explore the effect of sulforaphane (SFN) preconditioning on the cold myocardial ischemia-reperfusion injury (IRI) in the rats through PI3K/Akt signaling pathway.Methods:Sixty-four health male Sprague-Dawley (SD) rats were randomly divided into cold IRI group,SFN group,LY (LY294002) + cold IRI group,and LY+SFN group (n=16).The allogeneic heterotopic heart transplantation model was established by donor heart into recipient abdomen.The myocardium tissue was taken 24 h after reperfusion for the detection of histological changes using HE staining.The expression levels of Akt,p-Akt,Bax and Bcl-2 proteins were detected by immunohistochemistry and Western boltting methods.Results:The morphological results showed that the myocardium tissue damage was serious in cold IRI group and LY+cold IRI group,it was light in SFN group;the myocardium tissue damage of the rats in SFN+ LY group was ranged between cold IRI group and SFN group.Compared with IRI group,the expression levels of p-Akt protein and Bcl-2 protein in SFN group were increased (P＜0.05),and the expression level of Bax protein was decreased (P＜0.05).After treatment of blockage LY294002,compared with LY-+-cold IRI group,the expression level of p-Akt protein in LY-+-SFN group was not statistically significant (P＞0.05),the expression level of Bcl2 protein was increased (P＜0.05),the expression levels of Bax protein was decreased),and the ratio of Bcl-2/Bax was also increased (P＜0.05).Conclusion:SFN may attenuate cold IRI of heart transplantation through PI3K/Akt signaling pathway in the rats.
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Objective:To explore the effect of sulforaphane (SFN) preconditioning on the cold myocardial ischemia-reperfusion injury (IRI) in the rats through PI3K/Akt signaling pathway.Methods:Sixty-four health male Sprague-Dawley (SD) rats were randomly divided into cold IRI group,SFN group,LY (LY294002) + cold IRI group,and LY+SFN group (n=16).The allogeneic heterotopic heart transplantation model was established by donor heart into recipient abdomen.The myocardium tissue was taken 24 h after reperfusion for the detection of histological changes using HE staining.The expression levels of Akt,p-Akt,Bax and Bcl-2 proteins were detected by immunohistochemistry and Western boltting methods.Results:The morphological results showed that the myocardium tissue damage was serious in cold IRI group and LY+cold IRI group,it was light in SFN group;the myocardium tissue damage of the rats in SFN+ LY group was ranged between cold IRI group and SFN group.Compared with IRI group,the expression levels of p-Akt protein and Bcl-2 protein in SFN group were increased (P＜0.05),and the expression level of Bax protein was decreased (P＜0.05).After treatment of blockage LY294002,compared with LY-+-cold IRI group,the expression level of p-Akt protein in LY-+-SFN group was not statistically significant (P＞0.05),the expression level of Bcl2 protein was increased (P＜0.05),the expression levels of Bax protein was decreased),and the ratio of Bcl-2/Bax was also increased (P＜0.05).Conclusion:SFN may attenuate cold IRI of heart transplantation through PI3K/Akt signaling pathway in the rats.
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Objective To investigate the effects of different doses of dexmedetomidine combined with sufentanil for postoperative pain management in elderly patients with femoral head replacement (FHR).Methods Between January 2016 and August 2016,160 elderly patients(＞ 65 years and BMI 20-28 kg/m2) with American Society of Anesthesiologists (ASA)physical classification Ⅰ-Ⅲ scheduled for elective FHR under spinal anesthesia were randomly allocated into four groups(n=40 for each group).Forty patients,who received patient-controlled intravenous analgesia (PCIA)with sufentanil(1.5 μg/kg) and tropisetron(5 mg) diluted by normal saline to 100 ml,were assigned to the control group.The other 120 patients who received Dexmedetomidine in addition to PCIA were allocated to the experimental group.Based on the dose of dexmedetomidine used in PCIA,the experimental group was divided into three subgroups:Group D1 (1.0 μg/kg),D2 (1.5 μg/kg) and D3 (2.0 μg/kg).The background infusion rate was 2 ml/h,demand dose 0.5 ml and lockout interval 15 min.Pain scores at rest were evaluated with a visual analogue scale(VAS)and Ramsay sedation scores were recorded at 4 h,8 h and 24 h after surgery.Effects of post-operative analgesia and sedation,supplementary doses of analgesics,and adverse events were also recorded and compared.Results Compared with Control group,VAS was significantly lower at 4 h,8 h and 24 h after surgery in Group D1,D2,and D3(P＜0.05 for all),except that there was no difference between Control group and Group D1 at 24 h(P＞0.05).Meanwhile,there were no significant differences in Ramsay scores among the four groups.Doses of supplementary analgesics and rates of adverse events were markedly lower in Group D1,D2 and D3 than in Control group(P＜0.05 for all).Conclusions Dexmedetomidine may enhance the analgesic effects of PCIA with sufentanil and reduce the side effects of opioids in elderly patients with FHR.
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Objective To evaluate the effects of two fluid therapy methods guided by SVV and CVP re-spectively on intestinal barrier of colon cancer surgery with elderly patients. Methods 50 elderly patients with ASA Ⅱ~Ⅲ level were randomly divided into Group S (fluid therapy guided by SVV) and Group C (convention-al fluid therapy). Each group has 25 cases. Patients in group S were treated under goal-directed fluid infusion strategy with target of 10%≤SVV≤12%. Group C received conventional infusion characterized by monitoring central venous pressure (CVP) and mean arterial pressure (MAP). Fluid volume, surgery time, urine volume, blood loss, exhausting time, post-operative hospitalization days in Group S and Group C were recorded. MAP, HR, CVP, SVV, HCO3- of patients were recorded at the same time before anesthesia (T0), beginning of surgery (T1), one hour after surgery (T2) and ending of surgery (T3) respectively. Venous blood samples were collected at the time points of T0, T1, T2 and T3 to detect DAO and D-lactic acid levels. Results MAP and CVP at time points of T2 and T3 in Group S were obviously lower than that in Group C; total intraoperative fluid volume in Group S was obviously less than that in Group C (P < 0. 05); postoperative exhausting time and hospitalization days in Group S decreased significantly (P < 0.05) and the content of DAO and D-lactic acid in Group S were lower than that in Group C (P < 0.05). Conclusion For elderly patients with colon cancer surgery, fluid thera-py guided by SVV is better than conventional fluid therapy guided by CVP in protecting intestinal barrier.
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Objective Radical surgery is extensively used in the treatment of lung cancer in elderly patients .This study aimed to investigate the effects of acute hypervolemic hemodilution (AHVHD) on the cognitive function and plasma S100βof elderly people following radical surgery for lung cancer . Methods A total of 112 lung cancer patients treated by radical surgery were equally randomized to an AHVHD and a non-AHVHD control group .Using the Mini-Mental State Examination scale ( MMSE) , we evaluated the cognitive function of the patients .We made comparisons between the two groups in the cerebral oxygen metabolism indexes and plasma S100βlevels at T0(immediately after anesthesia induction), T1(15 min after hemodilution), T2(60 min after hemodilution), T3(60 min before the end of surgery ) and T4 ( at the end of surgery ) as well as MMSE scores before and after operation . Results At T1 , T2, T3, and T4, the values of jugular venous oxygen saturation in the AHVHD group were (75.1 ±4.3), (78.5 ±3.1), (79.1 ± 4.4), and (79.6 ±2.8) %, respectively, with time-dependent decreases in Da-jvO2 and cerebral oxygen extraction , and significantly higher than that at T0 (P<0.05) and those in the control group ([63.4 ±2.0], [63.9 ±1.8], [64.2 ±3.0], and [64.7 ±3.2]%) (P<0.05).The levels of plasma S100βat T1, T2, T3, and T4 were remarkably lower in the AHVHD group ([0.53 ±0.04], [0.52 ±0.07], [0.51 ±0.06], and [0.50 ±0.08] μg/L) than in the control ([0.64 ±0.06], [0.64 ±0.04], [0.65 ±0.05], and [0.67 ±0.06] μg/L), with statistically significant differences between the two groups at the same time point (P<0.05).At 1, 3, 5, and 7 days after surgery, the MMSE scores were markedly higher in the AHVHD group (24.3 ±1.7, 26.5 ±1.9, 27.8 ±1.3, and 28.1 ±1.0) than in the control (21.1 ±1.6, 24.0 ±2.1, 25.9 ±1.8, and 26.4 ±1.7) (P<0.05). Conclusion AHVHD can significantly improve cognitive function and reduce plasma S 100βin elderly patients following radical surgery for lung cancer , which may be related to cerebral oxygen metabolism .