Résumé
Objective:To study the effects of low-dose dexmedetomidine via nasal spray on preoperative anxiety and tracheal intuba-tion induced stress response in elderly patients with maxillofacial surgery using heart rate variability(HRV).Methods:60 elderly pa-tients underwent maxillofacial surgery were randomly divided into the dexmedetomidine group(group D)and the control group(group C).Patients in the group D were treated with nasal spray of dexmedetomidine at 45 min preoperatively.Those in the group C were giv-en the same dose of normal saline spray at the same time.All patients were given intravenous combined with inhalation general anes-thesia.The hemodynamics,HRV index,sedation score and BIS value of the 2 groups of patients were compared at 3 time points,be-fore operation(T0),entrance(T1)and tracheal intubation(T2)respectively.Results:At T1,the average score of Ramsay in group D and group C was 2.8±0.7 and 1.1±0.39,BIS 87.3±6.1 and 97.4±0.5,SD1 20.9±7.0 and 15.4±5.4,SDNN 30.9±6.6 and 37.1±7.0,LF/HF 1.3±0.3 and 2.6±0.4,respectively(P＜O.01).At T2,the average score of SD1 in group D and group C was 10.4±3.5 and 7.7±3.1,SDNN 59.2±6.5 and 70.1±7.1,LF/HF 5.l±0.5 and 7.5±0.5,respectively(P＜0.01).Conclusion:Low-dose dexmedetomidine nasal spray can effectively relieve the preoperative anxiety of elderly patients in maxillofacial surgery and reduce the stress response of tracheal intubation.
Résumé
To establish an animal model of acute-on-chronic liver failure (ACLF) that would replicate the pathological process of ACLF in humans, rats were administered porcine serum (PS) for 11 weeks. Liver fibrosis was determined by pathological and biochemical assessments. The animals then were injected with d-galactosamine (d-gal) and lipopolysaccharide (LPS). The survival times of animals with cirrhosis and ACLF were determined over 48 h. Other animals were killed at 0, 4, 8 and 12 h after administration of d-gal/LPS. Liver injury was assessed by histopathological analysis and biochemical indices, and apoptosis was detected by Western blot and TUNEL analysis. After PS administration for 11 weeks the serum levels of hyaluronic acid and N-procollagen type III peptide increased significantly, and serious fibrosis and cirrhosis was observed at weeks 10 and 11. Cirrhotic rats were injected with d-gal/LPS to induced ACLF; the rate of mortality over 48 h was 80%. ALT and AST levels increased markedly at 4 h, but decreased significantly at 8 and 12 h post-treatment. The total bilirubin, direct bilirubin, and total bile acids levels increased markedly at 8 and 12 h. Clotting times, TNF-and IL-6 levels increased significantly, except for 12 h post-treatment. Apoptosis, inflammation and necrosis were elevated as determined by hematoxylin-eosin staining and TUNEL assays. BCL-2 levels decreased significantly, While BAX levels increased significantly. Cytochromeexpression peaked at 8 h post-d-gal/LPS treatment. In conclusion, an ACLF model induced by PS and d-gal/LPS was established and the underlying mechanisms of ACLF development were explored.