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Objective:To investigate the effect of conducting general anesthesia with sevoflurane combined with remifentanil on the anesthetic effect and stress indexes in patients undergoing laparoscopic hysterectomy.Methods:A total of 80 patients undergoing laparoscopic hysterectomy in the Affiliated Hospital of Jining Medical College from April 2020 to August 2020 were selected and divided into the observation group and the control group according of the number table method, with 40 cases in each group. In the control group, sufentanil, propofol and rocuronium were used to induce anesthesia, and propofol and remifentanil were intravenously administered during anesthesia maintenance.The observation group received the same induction anesthesia, followed by 2% sevoflurane inhalation combined with remifentanil to maintain anesthesia. The anesthetic effect, stress indexes at different postoperative time points and adverse reaction between the two groups were compared.Results:The scores of mini mental state evaluation (MMSE) at 0.5, 1 and 2 h after the surgery and the scores of observer′sassessment of alertness/sedation scale (OAA/S) atimmediately after extubation, 1 and 2 h after surgery in the observation group were higher than those in the control group, there were statistical differences ( P<0.05). The wake up time and extubation time in the observation group were shorter than those in the control group: (9.22 ± 1.67) min vs. (15.94 ± 1.44) min, (10.34 ± 1.46) min vs. (17.11 ± 1.33) min, there were statistical differences ( P<0.01). The systolic blood pressure, diastolic blood pressure, epinephrine and cortisol at 10 min after intubation and at the end of surgery in the observation group were lower than those in the control group, there were statistical differences ( P<0.05). Conclusions:Sevoflurane combined with remifentanil conducting anesthesia can better improve the cognitive function of patients, shorten the recovery time of postoperative consciousness, and reduce the intraoperative stress response.
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Objective:To investigate the effect of ultrasound-guided continuous saphenous nerve block on preemptive analgesia in elderly patients undergoing unilateral total knee arthroplasty(TKA) under general anesthesia.Methods:A total of 120 elderly patients who received unilateral TKA in the Affiliated Hospital of Jining Medical College from June 2020 to October 2020 were enrolled and they were divided into group A (saphenous nerve block + general anesthesia), group B (femoral nerve block + general anesthesia) and group C (simple general anesthesia) by random numbering method, with 40 cases in each group. The visual analogue pain (VAS) scores, knee range of motion, RS agitation scores and Ramsay sedation scores at different time points after surgery and postoperative recovery and analgesia were compared among the three groups.Results:The static state and dynamic state VAS scores in the group A and group B at 6, 12, 24, 48 h after the surgery had no significant differences ( P>0.05). The knee range of motion in the group A at 6, 12, 24, 48 h after the surgery were higher than that in group B and group C: (74.8 ± 8.1)° vs. (68.4 ± 8.2)°and (63.2 ± 7.0)°, (77.4 ± 10.9)°vs.(73.0 ± 10.0)° and (68.6 ± 8.3)°, (82.6 ± 10.4)° vs. (77.4 ± 9.6)°and (73.2 ± 8.3)°, (91.8 ± 6.1)° vs. (86.8 ± 6.6)° and (82.8 ± 5.3)°, the differences were statistically significant ( P<0.05). The RS agitation scores and Ramsay sedation scores in the group A and group B had no significant differences ( P>0.05). The first time to the ground in the group A was shorter than that in the group B : (20.9 ± 3.0) h vs. (27.4 ± 3.5) h; the walking distance in the group A was longer than that in the group B: (7.1 ± 1.6) m vs. (5.2 ± 1.3) m, the differences were statistically significant ( P<0.05). Conclusions:Ultrasound-guided continuous saphenous nerve block has a good postoperative analgesic effect in elderly patients with unilateral TAK under general anesthesia. It can promote the recovery of directional force and knee range of motion in patient.
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Objective To compare the clinical outcomes between open reduction and fixation with cannulated screws via the modified Burks-Schaffer approach versus arthroscopic EndoButton plating for avulsion fracture of the tibial attachment of the posterior cruciate ligament(PCL).Methods From February 2013 to August 2017,41 patients with acute displaced avulsion fracture of the tibial PCL attachment were treated operatively at Department of Trauma Surgery,The Affiliated Hospital to Qingdao University.They were 24 men and 17 women,aged from 18 to 65 years (average,39 years).The lefi knee was injured in 22cases and the right knee in 19.They were divided into 2 groups according to their different fixation methods.The open reduction and fixation group (23 cases) received open reduction and fixation with cannulated screws via the modified Burks-Schaffer approach while the arthroscopic group (18 cases) arthroscopic Endobutton plating.The 2 groups were compared in terms of operation time,bleeding,objective knee scores and knee range of motion (ROM) after operation.Results All the 41 patients were followed up from 23 to 40months (average,27.2 months).Their follow-up revealed no incision infection,malunion,nonunion or loosening of the implants.Their knee X-ray films at the final follow-ups showed bony union of all the avulsion fractures.There were significant differences between the open reduction and fixation group and the arthroscopic group in operation time (52.6±7.3 min versus 86.8±9.2 min) and bleeding (63.9±12.7 mL versus 19.7 ± 10.2 mL) (P ＜ 0.05).There was no significant difference in the objective knee scores or knee ROM between the 2 groups (P ＞ 0.05).Conclusions Both open reduction and cannulated screw fixation via the modified Burks-Schaffer approach and arthroscopic EndoButton plating can achieve satisfactory clinical outcomes in the treatment of avulsion fracture of the tibial PCL attachment.Although the 2 methods make no significant differences in stability of the knee joint or in clinical scores,the latter leads to less bleeding and the former shorter operation time.
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Objective of the present work was to study the effect and significance of the combined therapy of methotrexate and immune adsorption in the treatment of rheumatoid arthritis disease. 56 patients with rheumatoid arthritis disease who have received treatment in "The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China" during the period from May, 2016 to May, 2017 were selected as study objects and were randomized into control group and experimental group according to different therapies. Control group was given conventional therapy while experimental group was treated with the combined therapy of methotrexate and immune adsorption with 28 patients in each group. After a period of time, clinical symptoms, the experimental index, treatment effectiveness and the occurrence rate of adverse reactions were all compared between the two groups. Results revealed that the clinical symptoms and the experimental index of experimental group were less than those of control group and the occurrence rate of adverse reactions in experimental group was lower than that in control group. Additionally, the effective rate of experimental group was higher than that of control group and statistically significant difference was observed and revealed that the combined therapy of methotrexate and immune adsorption in the treatment of rheumatoid arthritis disease had vital significance in alleviating related symptoms, lowering adverse reactions occurrence rate and improving treatment effectiveness, being worthy of clinical application and promotion
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Objective To evaluate the effect of dexmedetomidine on cell apoptosis during spinal cord ischemia-reperfusion(I∕R)in rats. Methods Forty-eight adult male Wister rats, weighing 200-260 g, were divided into 4 groups(n=12 each)using a random number table: sham operation group (Sham group), I∕R group, prophylactic dexmedetomidine use group(DPro group)and dexmedetomidine postconditioning group(DPost group). The model of spinal cord I∕R was established by temporary occlu-sion of the abdominal aorta using the modified Zivin′s method. Dexmedetomidine 5 μg·kg-1·h-1was in-travenously infused at 1 h before occlusion of the abdominal aorta in group DPro. Dexmedetomidine 5 μg·kg-1·h-1was intravenously infused for 1 h starting from the time point immediately after beginning of reperfusion in group DPost. The equal volume of normal saline was given instead in Sham and I∕R groups. The motor nerve function of the hindlimb was assessed and scored at 4, 12 and 24 h of reperfusion. The rats were sacrificed at 24 h of reperfusion, and L2-5segments of the spinal cords were removed for microscopic examination and for determination of Bcl-2 and Bax positive cells(by immuno-histochemistry)and cell ap-optosis(by flow cytometry). The apoptosis rate was calculated. Results Compared with group Sham, motor nerve function scores were significantly decreased at 4-12 h of reperfusion, and the apoptosis rate of nerve cells and Bcl-2 and Bax positive cells were increased in group I∕R, and motor nerve function scores were significantly decreased at 4 h of reperfusion, and the apoptosis rate of nerve cells and Bcl-2 and Bax positive cells were increased in DPro and DPost groups(P<005 or 001). Motor nerve function scores were significantly higher, and the apoptosis rate of nerve cells was lower, Bcl-2 positive cells were higher, and Bcl-2 and Bax positive cells were lower in DPro and DPost groups than in group I∕R(P<005 or 001). Conclusion The mechanism by which dexmedetomidine reduces spinal cord I∕R injury is related to inhibiting cell apoptosis in rats.