RESUMO
Objective To evaluate the effect of dexmedetomidine on high-mobility group box 1 protein (HMGB1)/Toll-like receptors (TLRs) signaling pathway during lung injury in septic rats.Methods Twenty-four SPF healthy adult male Wistar rats,aged 15-18 weeks,weighing 200-250 g,were divided into 3 groups (n =8 each) using a random number table:sham operation group (group S),sepsis group (group Sep) and dexmedetomidine group (group D).Dexmedetomidine 25 μg/kg was intraperitoneally injected in D group,while the equal volume of normal saline was given instead in S and Sep groups.Sepsis was produced by cecal ligation and puncture in Sep and D groups.The rats were sacrificed at 24 h after operation,and the right lung was removed for examination of the pathological changes which were scored and for determination of myeloperoxidase (MPO) activity,content of interleukin-1β (IL-1β),IL-6 and tumor necrosis factor-α (TNF-α) in lung tissues (by enzyme-linked immunosorbent assay),wet to dry weight ratio (W/D ratio) and expression of HMGB1,TLR2 and TLR4 in lung tissues (by Western blot).Results Compared with group S,the MPO activity,lung injury score,W/D ratio,content of IL-1β,IL-6,TNF-α and expression of HMGB1,TLR2 and TLR4 were significantly increased in Sep and D groups (P＜0.05).Compared with group Sep,the MPO activity,lung injury score,W/D ratio,content of IL-1β,IL-6,TNF-α and expression of HMGB1,TLR2 and TLR4 were significantly decreased in group D (P＜0.05).Conclusion Dexmedetomidine reduces lung injury through inhibiting HMGB1/TLRs signaling pathway in septic rats.
RESUMO
Objective To evaluate the optimized efficacy of thoracic paravertebral block (TPVB) combined with general anesthesia via the research on the postoperative cellular immune function in the patients undergoing radical resection for esophageal cancer.Methods Forty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 45-64 yr,with body mass index of 20-25 kg/m2,scheduled for elective radical resection for esophageal cancer,were divided into 2 groups (n =20 each) using a random number table:general anesthesia group (G group) and TPVB combined with general anesthesia group (TPVB+G group).In group TPVB+G,TPVB was performed at T4 and T6 on the operated side under ultrasound guidance with 0.5％ ropivacaine 15 ml before anesthesia induction.Anesthesia induction was started after the level of block was confirmed.Anesthesia was maintained with propofol given by target-controlled infusion at the target plasma concentration of 1-4 μg/ml,and bispectral index value was maintained at 40-50.Patient-controlled intravenous analgesia was performed after operation,and visual analog scale score was maintained ≤ 3.Before anesthesia induction,at the end of operation and at 24 and 48 h after operation,blood samples were collected from the central vein for determination of the levels of T lymphocyte subsets CD3+,CD4+ and CD8+ and CD4+/CD8+ ratio.Ricker Sedation-Agitation Scale scores were recorded at 10 min,20 min,30 min and 1 h after extubation and 6,24 and 48 h after operation.The consumption of intraoperative remifentanil,requirement for vasoactive agents during recovery from anesthesia,the number of unsuccessfully delivered doses and the total number of attempts were also recorded.Results Compared with group G,Ricker Sedation-Agitation Scale scores were significantly decreased at 10 min after extubation,the consumption of intraoperative remifentanil,requirement for vasoactive agents during recovery from anesthesia and the number of unsuccessfully delivered doses were decreased,and the postoperative CD4+ level and CD4 +/CD8 + ratio were increased in group TPVB+G (P＜0.05).Conclusion TPVB combined with general anesthesia can improve the postoperative cellular immune function and is an optimal anesthesia regimen in the patients undergoing radical resection for esophageal cancer.
RESUMO
Objective To evaluate the relationship between the anesthesia factor and myocardial injury in the patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).Methods Eightyeight patients of both sexes,aged 42-71 yr,weighing 59-83 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ (New York Heart Association Ⅱ or Ⅲ),scheduled for elective coronary artery bypass grafting with CPB,were divided into 4 groups (n =22 each) using a random number table:routine anesthesia control group (group C),dexmedetomidine-based anesthesia group (group D),sevofluranebased anesthesia group (group S) and dexmedetomidine combined with sevoflurane anesthesia group (group DS).After tracheal intubation,0.2％-2.1％ sevoflurane was inhaled until the beginning of CPB in S and DS groups.In D and DS groups,dexmedetomidine was intravenously infused as a loading dose of 1 μg/kg over 10 min before induction of anesthesia,followed by an infusion of 0.4 μg · kg-1 · h-1 until the end of surgery.Before induction of anesthesia,before CPB,after the end of CPB,immediately after the end of surgery and at 24 h after surgery,venous blood samples were collected for determination of plasma creatine kinase-MB (CK-MB) and cardiac troponin I (cTnI) concentrations by immunofluorescence.The restoration of spontaneous heart beat and adverse events such as hypotension,malignant arrhythmia,cardiac arrest and respiratory depression during surgery and within 24 h after surgery were recorded.Results Compared with group C,the plasma concentrations of CK-MB and cTnI were significantly decreased in the other three groups (P＜0.05).The plasma eoncentrations of CK-MB and eTnl were significantly lower in group DS than in S and D groups (P＜0.05).There were no significant differences in the rate of restoration of spontaneous heart beat among the four groups (P＞ 0.05).No adverse events were found during surgery and within 24 h after surgery in the four groups.Conclusion Dexmedetomidine combined with sevoflurane anesthesia is helpful in reducing myocardial injury and provides better efficacy than either alone in the patients undergoing cardiac surgery with CPB and is more suitable for cardiac surgery with CPB.
RESUMO
Objective To evaluate the effect of hydrogen on the postoperative cognitive function in aged mice.Methods Sixty aged male Kunming mice,aged 12-14 months,weighing 35-45 g,were assigned into 3 groups (n=20 each) using a random number table:sham operation group (group Sham),partial hepatectomy group (group PH) and partial hepatectomy plus hydrogen-enriched saline group (group PH-H).On preoperative day 3,during operation and on postoperative day 3,hydrogen-enriched saline 10 ml/kg was intraperitoneally injected once a day in group PH-H,and the equal volume of normal saline was intraperitoneally injected once a day in S and PH groups.The spatial probe test was performed on postoperative day 7 to evaluate the cognitive function.Ten mice were selected on postoperative days 3 and 7 (after the end of the spatial probe test),and blood samples were collected for determination of serum tumor necrosis factor-alpha (TNF-α),interleukin-lbeta (IL-1β) and high-mobility group box 1 protein (HMGB1) concentrations by enzyme-linked immunosorbent assay.The animals were sacrificed after blood sampling,brains were removed and hippocampi were isolated for detection of the expression of TNF-α,IL-1β and HMGB1 by Western blot.Results Compared with group S,the percentage of time of staying at the target quadrant and the number of crossing the platform within 1 min were significantly decreased,the serum concentrations of TNF-α,IL-1β and HMGB1 were increased,and the expression of hippocampal TNF-α,IL-1β and HMGB1 was up-regulated in group PH (P＜0.05),and no significant change was found in the variables mentioned above in group PH-H (P＞0.05).Compared with group PH,the percentage of time of staying at the target quadrant and the number of crossing the platform within 1 min were significantly increased,the serum concentrations of TNF-α,IL-1β and HMGB1 were decreased,and the expression of hippocampal TNF-α,IL-1β and HMGB1 was down-regulated in group PH-H (P＜0.05).Conclusion Hydrogen can improve the postoperative cognitive function in aged inice.