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Objective:To explore the correlation between intraoperative regional cerebral oxygen saturation(rScO 2) and nerve damage markers with postoperative neurological dysfunction(PND) in patients undergoing acute Stanford type A aortic dissection surgery. Methods:A total of 57 patients undergoing acute Stanford type A aortic dissection surgery under cardiopulmonary bypass(CPB) in the operating room of Henan Provincial Hospital from July 2020 to May 2021 were enrolled, regardless of gender, aged 35-64 years old, weighed 58.0-90.0 kg and with American Association of Anesthesiologists(ASA) classification status with Ⅱ-Ⅲ. A near infrared spectrometer(NIRS) was used to continuously monitor the bilateral rScO 2 of the patients during the surgery. Central venous blood was drawn 10 min before induction of anesthesia(T0), 10 min after induction of anesthesia(T1), immediately after CPB started(T2), when CPB ended(T3), at the end of the operation(T4), and when exiting ICU(T5), 1 day(T6), 2 days(T7) and 3 days(T8) after operation, and the levels of nerve injury marker S100 calcium binding protein(S100β protein) and neuron-specific enolase(NSE) in serum were measured. Follow up was performed on postoperative 3 to evaluate the occurrence of PND.The value of intraoperative rScO 2 and the concentrations serum S100β protein and NSE were compared between the PND group and the NND(NPND) group. The changes of intraoperative rScO 2 value, the concentrations of serum S100β protein and NSE between the PND group and NPND group were compared. The risk factors of PND and its correlation with the intraoperative rScO 2 value, and the concentrations of serum S100β protein and NSE were analyzed. The prognostic indicators of the two groups of patients were statistically analyzed. Results:Three patients were excluded from the study. A total of 12 patients(22.2%) developed PND(PND group), and 42 patients(77.8%) did not develop PND(NPND group) on postoperative 3 day. Compared with the NPND group, the minimum mean arterial pressure and the minimum rScO 2 during CPB were significantly decreased( P<0.05), the maximum da-rScO 2 during CPB was significantly increased( P<0.05), and duration of da-rScO 2>0.50, duration of da-rScO 2>0.40, duration of rScO 2 reduction >25%, rScO 2<0.50, rScO 2<0.40, during CPB were significantly prolonged( P<0.05) in the PND group. The levels of serum S100β and NSE in the PND group were significantly increased, compared with the NPND group at T2-8, respectively. Logistic regression analysis showed that the reduction of rScO 2 more than 25%( P=0.033), during of rScO 2<0.40( P=0.007) and duration of da-rScO 2>0.50( P=0.001) during CPB were risk factors of PND. Conclusion:Compared with the NPND group, the postoperative mechanical ventilation time, duration of ICU stay, postoperative hospital stay and PND recovery time were significantly prolonged( P<0.05), and the medical expenses were increased significantly( P<0.05) in the PND group. The duration of the reduction of rScO 2>25%, the duration of rScO 2<0.40 and the duration of da-rScO 2>0.50 during CPB are the risk factors of PND in patients with acute Stanford type A aortic dissection under CPB. Significantly increased levels of serum nerve injury markers S100β and NSE are related to the occurrence of PND. The occurrence of PND has a significant adverse effect on the early clinical prognosis of patients.
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Objective:To evaluate the effect of remote ischemic preconditioning (RIPC) combined with postconditioning (RIPostC) on postoperative pulmonary complications in elderly patients undergoing thoracoscopic radical surgery for lung cancer.Methods:Eighty American Society of Anesthesiologists physical status Ⅱ or Ⅲ elderly patients, aged 65-79 yr, with height 155-180 cm, weighing 45-80 kg, were divided into 2 groups ( n=40 each) by the random number table method: control group (group C) and RIPC combined with RIPostC group (group R). RIPC was induced by 3 cycles of 5 min ischemia (cuff inflation to 200 mmHg) followed by 5 min reperfusion (cuff deflation to 0 mmHg) though applying a mercury sphygmomanometer adult cuff to the right upper extremity at 30 min before one-lung ventilation and 30 min before the end of one-lung ventilation in group R. The adult cuff was only bound to the right upper extremity without inflation and deflation in group C. The occurrence of pulmonary complications was recorded within 72 h after operation in both groups.The Quality of Recovery-15 score was used to assess the early postoperative quality of recovery on 1 and 2 days after operation.The number of white blood cells and neutrophils and percentage of neutrophils were recorded at 1 day before surgery and 1 and 3 days after surgery.The postanesthesia care unit stay time and hospital stay time were recorded. Results:Compared with group C, the incidence of pulmonary complications was significantly decreased within 72 h after operation, Quality of Recovery-15 scores were increased at 1 and 2 days after operation, the number of white blood cells and neutrophils and percentage of neutrophils were decreased at 1 and 3 days after operation, and the postanesthesia care unit stay time and postoperative hospital stay time were shortened in group R ( P<0.05). Conclusion:RIPC combined with RIPostC can decrease the risk of postoperative pulmonary complications and is helpful for early postoperative rehabilitation in elderly patients undergoing thoracoscopic radical surgery for lung cancer.
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In order to solve the problem that the early onset of paroxysmal atrial fibrillation is very short and difficult to detect, a detection algorithm based on sparse coding of Riemannian manifolds is proposed. The proposed method takes into account that the nonlinear manifold geometry is closer to the real feature space structure, and the computational covariance matrix is used to characterize the heart rate variability (RR interval variation), so that the data is in the Riemannian manifold space. Sparse coding is applied to the manifold, and each covariance matrix is represented as a sparse linear combination of Riemann dictionary atoms. The sparse reconstruction loss is defined by the affine invariant Riemannian metric, and the Riemann dictionary is learned by iterative method. Compared with the existing methods, this method used shorter heart rate variability signal, the calculation was simple and had no dependence on the parameters, and the better prediction accuracy was obtained. The final classification on MIT-BIH AF database resulted in a sensitivity of 99.34%, a specificity of 95.41% and an accuracy of 97.45%. At the same time, a specificity of 95.18% was realized in MIT-BIH NSR database. The high precision paroxysmal atrial fibrillation detection algorithm proposed in this paper has a potential application prospect in the long-term monitoring of wearable devices.
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Humanos , Algoritmos , Fibrilación Atrial , Bases de Datos Factuales , Electrocardiografía , Dispositivos Electrónicos VestiblesRESUMEN
Objective@#To evaluate the effects of remote ischemic preconditioning (RIPC) on occurrence of postoperative delirium in elderly patients undergoing radical mastectomy.@*Methods@#Sixty elderly patients, aged 65-78 yr, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective radical mastectomy, were allocated into 2 groups (n=30 each) using a random number table method: control group (group C) and RIPC group.Three cycles of 5-min ischemia/5-min reperfusion induced by a blood pressure cuff placed on the upper arm of the right upper arm served as RIPC treatment at 5 min after induction of anesthesia in RIPC group.The blood pressure cuff was only placed on the upper arm of the right upper arm without inflation and deflation in group C. Jugular bulb venous blood samples were obtained at 10 min before anesthesia induction (T0) and 1, 12, 24, 48 and 72 h after the end of operation (T1-5) for determination of S-100β protein and neuron-specific enolase (NSE) concentrations in serum.The occurrence of delirium within 72 h after operation was estimated using Confusion Assessment Method for the Intensive Care Unit.The occurrence of hypotension, sinus bradycardia and reintubation was recorded.The Quality of Recovery-15 (QoR-15) was used to evaluate the early postoperative quality of recovery at 1 and 2 days after operation.@*Results@#Compared with group C, the concentrations of S-100β protein and NSE in serum and incidence of delirium within 72 h after operation were significantly decreased at T1-T5, and the Quality of Recovery-15 scores were increased at 1 and 2 days after operation in group RIPC (P<0.05). There was no significant difference in the duration of delirium or incidence of hypotension, sinus bradycardia and reintubation between the two groups (P>0.05).@*Conclusion@#RIPC can decrease the development of postoperative delirium and is helpful for the early postoperative recovery of elderly patients undergoing radical mastectomy.
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Objective To evaluate the effects of remote ischemic preconditioning (RIPC) on occurrence of postoperative delirium in elderly patients undergoing radical mastectomy.Methods Sixty elderly patients,aged 65-78 yr,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,scheduled for elective radical mastectomy,were allocated into 2 groups (n =30 each) using a random number table method:control group (group C) and RIPC group.Three cycles of 5-min ischemia/5-min reperfusion induced by a blood pressure cuff placed on the upper arm of the right upper arm served as RIPC treatment at 5 min after induction of anesthesia in RIPC group.The blood pressure cuff was only placed on the upper arm of the right upper arm without inflation and deflation in group C.Jugular bulb venous blood samples were obtained at 10 min before anesthesia induction (T0) and 1,12,24,48 and 72 h after the end of operation (T1-5) for determination of S-100β protein and neuron-specific enolase (NSE) concentrations in serum.The occurrence of delirium within 72 h after operation was estimated using Confusion Assessment Method for the Intensive Care Unit.The occurrence of hypotension,sinus bradycardia and reintubation was recorded.The Quality of Recovery-15 (QoR-15) was used to evaluate the early postoperative quality of recovery at 1 and 2 days after operation.Results Compared with group C,the concentrations of S-100β protein and NSE in serum and incidence of delirium within 72 h after operation were significantly decreased at T1-T5,and the Quality of Recovery-15 scores were increased at 1 and 2 days after operation in group RIPC (P＜0.05).There was no significant difference in the duration of delirium or incidence of hypotension,sinus bradycardia and reintubation between the two groups (P＞0.05).Conclusion RIPC can decrease the development of postoperative delirium and is helpful for the early postoperative recovery of elderly patients undergoing radical mastectomy.
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Objective To observe the clinical efficacy of Tiao Shen Ding Zhi (mind-regulating) needling method in treating anxious neurosis. Method Fifty-eight patients with anxious neurosis were randomized into a treatment group and a control group, 29 in each group. The treatment group was intervened by Tiao Shen Ding Zhi needling method, while the control group was by conventional needling. The total effective rates of the two groups were observed. Result The total effective rate was 96.5% (28/29) in the treatment group versus 82.8% (24/29) in the control group, and the difference was statistically significant (P<0.05). Conclusion Tiao Shen Ding Zhi needling method can produce a higher total effective rate than conventional acupuncture in treating anxious neurosis.
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Objective To investigate the Sedative effect and safety of intravenous Sufentanil combined with Propofol in painless gastroscopy.Methods 270 patients with ASA Ⅰ-Ⅱ were randomly divided into three groups:Group A (the Propofol group),Group B (the Fentanyl combined with Propofol group) and Group C (the Sufentanil combined with Propofol group).HR,MAP and SpO2 were monitored at three different time points:before placement of the gastroscope,during and 5 minutes after gastroscopy.The time required for consciousness recovery,the time required for regaining orientation,the operating time for gastroscopy and the dosage of Propofol were recorded.Results HR,MAP and SpO2 were obviously lower during operation than before or after operation in each group (P＜0.05) and were significant different among the groups (P＜ 0.05).The times required for consciousness recovery and for regaining orientation,respectively,were significantly longer in Group A than in Group B or C,and there was a significantly difference between Group B and Group C (P＜0.05).The total dose of Propofol in Group A was significantly larger than that in Group B or C (P＜0.05).Conclusions Compared with Propofol alone or Fentanyl combined with Propofol,Sufentanil can be used in combination with lower does of Propofol in painless gastroscopy to produce rapid and effective Sedation,with fewer side effects and higher patient satisfaction.
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AIM: To investigate the effect of volatile anesthetics on function,metabolism,ATPase activity and free radicals in isolated ischemia /reperfusion(I/R) rat hearts.METHODS: 136 SD rats were anesthetized with pentobarbital and randomly divided into six groups and 17 sub-groups(n=8),according to the given drug.In a normal thermal isolated Langendorff rat heart model,four volatile anesthetics in 1.5 MAC concentration were given before global ischemia 25 min and during reperfusion 30 min.Coronary flow(CF),LVEDP,left ventricular developed pressure(LVDP),?dp/dt were monitored at 15 min of equilibrium,15 min of drug treatment,the end of reperfusion.Myocardial adenosine triphosphate(ATP),malodialdehyde(MDA),activity of Ca2+-ATPase and Na+-K+-ATPase,and superoxide dismutase(SOD) were determined at 15 min of equilibrium,15 min of drug treatment or absence,10 min global ischemia and the end of reperfusion.RESULTS: CF and LVEDP were iocreased significantly after exposured to volatile anesthetics 15 min,and LVDP,+dp/dtmax were significantly decreased.However,LVDP and +dp/dtmax were increased at the end of reperfusion in the treated groups.HR in halothane and isoflurane groups was decreased before ischemia and after reperfusion.The myocardial ATP content was significantly increased before and after ischemia in the treated groups.At the end of reperfusion,the activity of SOD was significantly higher and myocardial MDA content was significantly lower in the treated groups than those in control group.The activity of Ca2+-ATPase,compared with the control group,was markedly decreased before ischemia in halothane,enflurane and isoflurane group.Nonetheless,the activity of Ca2+-ATPase was clearly increased in the treated groups during ischemia and at the end of reperfusion.The activity of Na+-K+-ATPase was only enhanced in halothane group at the end of reperfusion among groups.CONCLUSION: The volatile anesthetics depress myocardial systolic function.There are markedly protective effects against myocardial I/R injury.Meanwhile,the volatile anesthetics improve the recovery of function and metabolism,and increase CF and the activity of Ca2+-ATPase and Na+-K+-ATPase in rats.
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AIM: To study the effects of 1.5 MAC halothane and sevoflurane on ischemic myocardium. METHODS: The isolated rat heart were perfused with halothane and sevoflurane and HR, LVEDP, LVDP, +d p /d t , -d p /d t , coronary flow (CF), the myocardial ATP content and Ca 2+ -ATPase activity were determined before and 10 min and 25 min after ischemia. In the meantime, LVP was recorded during 25 min ischemia. RESULTS: 1.5MAC sevoflurane significantly increased CF in normal isolated rat hearts. Both halothane and sevoflurane depressed myocardial contractile function, increased normal myocardial energy storage. After 10 min ischemia, the decrease of myocardial ATP content were slowed down by halothane and sevoflurane, especially halothane. During 25 min of ischemia, the onset time of contracture was significantly delayed, and the contracture intensity was alleviated by halothane, but not sevoflurane. CONCLUSION: Halothane has better protective effect on ischemic myocardium than sevoflurane through preventing the decrease of myocardial ATP content and Ca 2+ -ATPase activity during ischemia.