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Objective:To evaluate the effect of novel erythrocyte preservation solution on the quality of erythrocytes in stored blood of type 2 diabetes mellitus (T2DM) rats.Methods:Forty SPF male Sprague-Dawley rats, aged 8 weeks, weighing 180-220 g, were used in this study. Ten rats randomly selected served as conventional erythrocyte preservation solution group (group A). T2DM model was prepared in the remaining 30 rats. Twenty T2DM rats were divided into 2 groups ( n=10 each) using a random number table method: T2DM conventional erythrocyte preservation solution control group (group C) and T2DM novel erythrocyte preservation solution observation group (group Y). Erythrocyte preservation solution was prepared to simulate the preoperative autologous blood donation process, and blood was collected from the tail vein to isolate the red blood cells, and then the corresponding preservation solution was added. Immediately after blood collection (T 0) and at 7, 14 and 21 days of preservation (T 1-3), the morphological structure of erythrocytes was observed with a light microscope, and the concentrations of 2, 3-diphosphoglycerate (2, 3-DPG) and reactive oxygen species (ROS) were also determined by enzyme-linked immunosorbent assay at T 0-T 3 and 28 days of preservation (T 4). PKH26 was used to label the erythrocytes stored in vitro for 28 days, and then the erythrocytes were transfused back into rats. The survival rate of erythrocytes was detected by flow cytometry at 1, 7, 13 and 18 h after retransfusion. Results:The erythrocyte damage was aggravated at different time points of preservation in group C when compared with group A. Compared with group C, the damage to erythrocytes was significantly alleviated at different time points of preservation in group Y. Compared with group A, the concentration of 2, 3-DPG in erythrocytes was significantly decreased at T 0 and T 2-T 4, the concentration of ROS was increased at T 0-T 4, and the survival rate of erythrocytes was decreased at 1, 7 and 18 h after retransfusion in group C ( P<0.05). Compared with group C, the concentration of 2, 3-DPG in erythrocytes was significantly increased at T 0-T 4, the content of ROS was decreased at T 1, T 3 and T 4, and the survival rate of erythrocytes was increased at 1, 7 and 18 h after retransfusion in group Y ( P<0.05). Conclusions:The novel erythrocyte preservation solution can improve the quality of stored erythrocytes and increase the survival rate of erythrocytes in vivo after retransfusion in T2DM rats.
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Esketamine is an antagonist of the N-methyl-D-aspartate (NMDA) receptor and exerts antianxiety, hypnotic, sedative, and analgesic effects by interacting with NMDA receptors, opioid receptors, M - choline receptors, monoamine receptors, adenosine receptors, and other purine receptors. As the more potents isomer of ketamine, it is about twice as potent as ketamine. Compared with ketamine, esketamine has the characteristics of rapid onset and metabolism, strong analgesia, slight respiratory depression, rapid recovery of cognitive function, and low incidence of psychiatric side effects. It has become a new choice of pediatric anesthesia drugs. This article reviews the pharmacological properties of esketamine and its recent application in pediatric anesthesia, and provides reference for the safe use of esketamine in pediatric perioperative period.
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AIM: To observe the effect of RBC preservation solution with sodium pyruvate on the morphology, structure and function of RBC stored in vitro in type 2 diabetes rats. METHODS: Thirty SPF male SD rats, were randomly divided into 3 groups (n=10): non-T2DM conventional RBC preservation solution (group A), T2DM conventional RBC preservation solution (group B) and T2DM sodium pyruvate RBC preservation solution (group C). The leukoreduced RBC from the tail vein and stored for 0 d (T0), 7 d (T1), 14 d (T2), 21 d (T3) and 28 d (T4) to detect the morphology, structure and the contents of 2, 3-DPG, reactive oxygen species (ROS), malondialdehyde (MDA) and lactic acid (LA) of RBC in group A, B and C. The RBC stored for 14 days in vitro were labeled with PKH26, and its survival rate were tested in vivo at 1, 4, 10 and 16 hours after intravenous infusion. RESULTS: At T0, the RBC morphology of group A was intact, which was better than that of group B and group C. With the extension of storage time, the morphology of RBC in each group gradually transformed into a spindle-spherical shape. Compared with group A, the incidence of acanthocytes in group B and group C was higher, and the incidence of acanthocytes in group C was lower than that in group B. Compared with group A, the content of 2, 3-DPG in group B and group C decreased, while ROS and MDA increased at different time points (P<0.05). The content of 2,3-DPG in group C was higher than that in group B (P<0.05), and the contents of ROS and MDA were lower than those in group B (P<0.05). LA content in group B was higher than that in group A and group C (P<0.05). At T2-T4, the LA content in group C was lower than that in group A (P<0.05). The survival rate of RBC in group A was higher than that in group B and C, and the survival rate of RBC in group B was lower than that in group C (P<0.05). CONCLUSION: Sodium pyruvate added RBC preservation solution has a certain protective effect on RBC stored in vitro in type 2 diabetic rats, and its mechanism may be related to its antioxidant effect.
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Objective To establish a method for the determination of cisatracurium besylate in human plasma by UPLC-MS/MS which could be used in the monitoring of drug residual in plasma of elderly patients after operation. Methods The samples were precipitated with 0.1% formic acid-acetonitrile solution and separated by an SHISEIDO ADME column(3.0 mm×100 mm, 2.7 μm) for isocratic elution with the mobile phase of water containing 0.1% formic acid with 2 mmol/L ammonium acetate and acetonitrile (30:70, V/V). MS condition was optimized in the positive ion detection mode by multiple reaction monitoring (MRM), along with the Agilent jet stream electrospray source interface (AJS-ESI). The precursors to the product ion transitions were m/z 464.3→358.2 for cisatracurium besylate and m/z 557.4→356.3 for vecuronium bromide (the internal standard, IS). Plasma samples of elderly patients undergoing spinal surgery were collected after anesthesia induction, at the end of surgery, 0.5 h and 1 h after surgery, and from the blood bags while autologous blood transfusion, and stored in cryopreservation tubes with 2% formic acid solution. Then the contents of cisatracurium besylate were determined. The effects of autogenous blood transfusion on plasma concentration of cisatracurium besylate in elderly patients after surgery evaluated. Results The calibration curve was linear in the range of 20-5 000 ng/ml for cisatracurium besylate in human plasma, r=0.999 7. The intra-day and inter-day precision and accuracy were good (RSD<10%, RE<±10%). The matrix effect of different concentrations was 71.88%~80.64%. The recovery of different concentrations was 83.62%~88.87%. The recovery of vecuronium bromide (IS) was 125.91%, which conformed with the requirement of methodological validation. There was a certain degree of residual cisatracurium besylate in the plasma of elderly patients, so the extubation time should be strictly controlled and the stay time of patients in the anesthesia recovery room should be appropriately extended. Conclusion The method is sensitive, accurate, and efficient, which could be used for the determination of cisatracurium besylate in human plasma of elderly patients after operation.
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Objective:To evaluate the effect of intraoperative cell salvage (ICS) on the number and viability of cancer cells in salvaged autologous blood from the patients undergoing liver cancer surgery.Methods:Twenty patients undergoing open radical primary hepatocellular carcinoma were selected, and blood from the operative field was collected after exposing the liver and treated with ICS. Blood specimens 20 ml from the surgical field (S 1), blood specimens 20 ml before ICS treatment-leukocyte depletion filter (LDF) filtration (S 2) and blood specimens 20 ml after LDF filtration (S 3) were collected and enriched, of which the blood sample 10 ml was used for cancer cell identification and count by immunofluorescence staining, and the remaining blood sample 10 ml was continuously cultured for 3 weeks, and then cell viability was observed by immunofluorescence method. Results:Hepatocellular carcinoma(HCC) cells were identified in 19 S 1 specimens, 18 S 2 specimens, and 16 S 3 specimens, but there was no significant difference in the detection rate among the three specimens ( P>0.05). Compared with S 1 specimens, HCC cell count was significantly reduced in S 2 and S 3 specimens ( P<0.05). There was no significant difference in the HCC cell count between S 3 specimens and S 2 specimens ( P>0.05). After 3 weeks of culture, the results of light microscopy showed that: hepatocellular carcinoma cell clusters were found in S1 specimens, and no hepatocellular carcinoma cell cluster was found in S 2 and S 3 specimens; the results of fluorescence microscopy showed that: 400 and 14 mixed epithelial-mesenchymal HCC cells and 100 and 21 mesenchymal HCC cells were found in S 1 and S 2 specimens, respectively, while no HCC cells were identified in S 3 specimens, among which HCC cells mainly presented as clusters of hepatocellular carcinoma cells in S 1 specimen, while no clusters of hepatocellular carcinoma cells were found in S 2 and S 3 specimens. Conclusions:After treatment with ICS or ICS-LDF, the number and viability of hepatocellular carcinoma cells in salvaged autologous blood are significantly reduced, and hepatocellular carcinoma cells exist as single cells and fail to develop clusters of hepatocellular carcinoma cells; LDF can reduce the risk of hepatocellular carcinoma cell autotransfusion to a certain extent, although it can not effectively filter out hepatocellular carcinoma cells continuously.
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To investigate the changes of anesthetic drug concentration in plasma during isolation of autologous blood with acute normovolemic hemodiluti-on and its influence on the depth of anesthesia, muscle relaxant effect and blood drug concentration after reinfusion. METHODS: Forty patients of both sexes, aged 20-60 yr, American Society of Anesthesiologists physical status or Ⅱ, hemoglobin (Hb) >120 g / L, hematocrit (Hct) >35%, undergoing eletive multilevel spinal surgery were included, were divided into 2 groups (n=20 each) using a random number table. ANH group (group A): ANH was performed after stable induction of anesthesia, the target Hct value was 28%-30%, and autologous blood was reinfused after the main operation steps. Control group (group C): routine transfusion and infusion treatment. The bispectral index (BIS) and Train-of-Four stimulation (TOF) were observed and recorded at the stable induction of anesthesia (T1), 30 minutes of stable induction (T2), the end of operation (T3), 30 minutes after the end of the operation (T4), 1 hour after the end of the operation (T5) and 2 hours after the end of the operation (T6). The concentrations of propofol and cisatracurium besylate in plasma at T1-T6, stored blood at 1 h (TS1), 2 h (TS2), and before reinfusion (TS3) were detected by Liquid Chromatography-tandem Mass Spectrometry. The extubation time and recovery score at T4-6 hours were recorded. RESULTS: There was no significant difference in propofol between the two groups at each time point (P > 0.05). The plasma concentration of cisatracurium besylate in group A was higher than that in group C at T3 (P0.05). The BIS value at T4 and TOF value at T3 in group A were significantly lower than those in group C. The recovery score of group A was lower than that of group C at T4 (P0.05). CONCLUSION: The plasma concentrations of propofol and cisatracurium besylate were basically unchanged during the in vitro isolation of ANH autologous blood. The plasma concentrations of cisatracurium besylate were only temporarily affected after the main operation steps, but the postoperative muscle relaxation recovery and recovery quality were not significantly affected.
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Patients with malignant tumour often require massive transfusion. Intraoperative cell salvage(IOCS) was initially limited in cancer surgery by concerns about the possibility of dissemination of tumor cells into circulation. However, as supportive literature concerning IOCS research and application in cancer surgery are increasing, it is necessary to reassess the perioperative application of IOCS in patients with malignancy. This review summarizes the application, risks and value of IOCS during cancer operations.
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AIM: To observe the effects of cyclooxygenase-2 (COX-2) inhibitors on the levels of inflammatory factors, nerve damage-related factors and antioxidant factors, as well as pain and delirium scores in the plasma of elderly patients with orthopaedic surgery, to clarify the role of COX-2 inhibitors in the prevention and treatment of POD and explore its possible mechanism. METHODS: Eighty patients undergoing elective hip arthroplasty were randomly divided into parecoxib sodium group (P group, n =40) and control group (C group, n = 40). Group C was injected with the same volume of normal saline at the same time point, and the preoperative cognitive function was screened 1 d (T
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Objective:To evaluate the relationship between the mechanism of promoting wound healing by modified autologous blood transfusion and metastasis-associated lung adenocarcinoma transcript 1 ( MALAT1) in diabetic mice. Methods:Twenty SPF ICR mice, weighing 21-25 g, in which the diabetic model was successfully established, were divided into 2 groups ( n=10 each) using a random number table method: modified preservation group (group I) and ordinary preservation group (group O). Peripheral venous blood samples were collected and stored in the corresponding preservation solution for 7 days.The platelet aggregation rate, blood glucose, serum glycosylated hemoglobin (GHB) and phosphodiesterase (DPG) concentrations and WBC were measured.Autologous blood was transfused back immediately after the wound model was established.The percentage of wound healing area was calculated at 7, 10 and 14 days after autologous blood transfusion.The expression of hypoxia-inducible factor-1α, vascular endothelial growth factor, matrix metalloproteinase-9, β-actin, type Ⅰ collagen (Col Ⅰ), Col Ⅲ protein and mRNA and MALAT1 was determined by Western blot, immunohistochemistry and quantitative real-time polymerase chain reaction respectively, at 14 days after transfusion. Results:Compared with group O, the blood glucose, serum concentrations of GHB and DPG, and WBC were significantly decreased, platelet aggregation rate was increased, the percentage of wound healing area was increased, the positive staining rate of Col Ⅰ and Col Ⅲ was increased, and the expression of hypoxia-inducible factor-1α, vascular endothelial growth factor, matrix metalloproteinase-9, ColⅠ, Col Ⅲ and β-actin protein and mRNA and MALAT1 was up-regulated in group I ( P<0.05). Conclusion:The mechanism by which modified autologous blood transfusion promotes wound healing may be related to up-regulating MALAT1 expression in diabetic mice.
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Remimazolam is a new ultra-short-acting sedative, with rapid onset and recovery, metabolism independent of liver and kidney function, light respiratory inhibition, stable hemodynamics, long time application without accumulation. Carboxylic acid metabolites have no pharmacological effects, and can be rapidly reversed by antagonist flumazenil, which is expected to become a new choice of clinical sedative. In this paper, pharmacological characteristics and recent research progress of remimazolam are reviewed, which can provide reference for clinical safe drug use.
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AIM: To observe the effect of acute normovolemic hemodilution (ANH) autologous blood transfusion on the EEG bispectral index and muscle relaxation in elderly patients undergoing orthopedic surgery to explore the influence of autologous blood transfusion containing anesthetic components on the quality and safety of postoperative anesthesia recovery. METHODS: Forty patients, aged 65-75, weighing 55-80 kg, ASA grade I-II, with an estimated intraoperative blood loss of more than 600 mL, were selected for elective orthopedic surgery. The patients were randomly divided into two groups (n=20): group A was given acute normovolemic hemodilution (ANH), and the target value of Hct was 28%-30% after induction of anesthesia; group B was the control group which was given routine fluid infusion during operation without ANH. Bispectral index (BIS), TOF values and plasma concentrations of propofol and cisatracurium were measured at the beginning of autotransfusion (T
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Alfentanil is a synthetic fentanyl derivative acting on μ opioid receptors. It is a short-acting strong analgesic. Compared with similar anesthetic drugs such as fentanyl and sufentanil, alfentanil had the lowest titer, the fastest effect, and shorter action time. The effect reached the peak 1.4 min after intravenous injection, and the maintenance time was 10-15 min. The distribution volume was small, which was in line with the three-compartment model, and was excreted through urine after liver metabolism inactivation. Alfentanil, one of the earliest drugs in the fentanyl family, has been widely used in analgesia, sedation, anti-anxiety, induction and maintenance of anesthesia. In recent years, the use of alfentanil has tended to be short procedure, daytime surgery, reserved breathing, and outpatient anesthesia. With the recent successful development of domestic alfentanil and its gradual application in anesthesia, alfentanil is expected to become a new choice for clinical analgesia, but its clinical application experience and related studies are very limited at present. In this paper, the pharmacological characteristics of alfentanil and its application at home and abroad were reviewed in order to provide reference for the rational clinical application of alfentanil.
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Objective:To evaluate the effect of stored autologous blood transfusion on the function of bone marrow hematopoietic stem cells and the recovery of reticulocytes in peripheral blood of rabbits.Methods:Thirty healthy male New Zealand rabbits, aged 3-6 months, weighing 2.5-3.0 kg, were divided into 5 groups ( n=6 each) using a random number table method: control group (C group), operation group (O group), blood collection group (O+ B group), stored autologous whole blood group (O+ WB group) and stored autologous component blood group (O+ CB group). In O+ B group, O+ WB group and O+ CB group, blood was collected via the right femoral artery at a rate of 3-5 ml/min at 7 days before surgery, the blood volume was 10% of the total blood volume, and blood was stored at 4-6 ℃.In O+ CB group, blood was centrifuged to remove plasma and white blood cells, and red blood cell suspension was prepared and placed in a blood storage bag.In O, O+ B, O+ WB and O+ CB groups, hepatectomy was performed, and bleeding was performed through the right femoral artery at a rate of 3-5 ml/min, and the blood volume was 10% of the total blood volume.Lactated Ringer′s solution 1 ml/min was intravenously infused during surgery in O and O+ B groups, stored autologous whole blood was intravenously infused during surgery in group O+ WB, and stored autologous red blood cell suspension 1 ml/min was intravenously infused during surgery in group O+ CB.Bone marrow blood samples were collected immediately before the start of surgery (T 2) and at 6 and 24 h after surgery (T 3, 4) to determine the percentage of CD34 + cells, cell cycle and relative expression of telomere DNA.Peripheral venous blood samples were collected before storage (T 1) and at T 4 for determination of the percentage of reticulocytes. Results:Compared with group C, the percentage of CD34 + cells was significantly increased at T 3 and T 4, the percentage of CD34 + cells in G1 phase was decreased, and the expression of telomere DNA in CD34 + cells was up-regulated in group O, and the percentage of reticulocyte in peripheral blood was increased at T 4 in the remaining 4 groups ( P<0.05). Compared with group O, the percentage of CD34 + cells was significantly increased at T 2-4, the percentage of CD34 + cells in G1 phase was decreased, and the expression of telomere DNA in CD34 + cells was up-regulated in O+ B, O+ WB and O+ CB groups, and the percentage of reticulocyte in peripheral blood was increased at T 4 in O+ WB and O+ CB groups ( P<0.05). Compared with group O+ B, the percentage of CD34 + cells was significantly increased at T 3 and T 4, the percentage of CD34 + cells in G1 phase was decreased, and the expression of telomere DNA in CD34 + cells was up-regulated in O+ WB and O+ CB groups, and the percentage of reticulocyte in peripheral blood was decreased at T 4 in O+ WB and O+ CB groups ( P<0.05). Compared with O+ WB group, the percentage of CD34 + cells was significantly decreased at T 3 and T 4, the percentage of CD34 + cells in G 1 phase was increased, the expression of telomere DNA in CD34 + cells was down-regulated, and the percentage of reticulocytes in peripheral blood was increased at T 4 in group O+ CB ( P<0.05). Conclusion:Stored autologous blood transfusion can inhibit the function of bone marrow hematopoietic stem cells and is not helpful for recovery of reticulocytes in peripheral blood of rabbits; stored autologous component blood transfusion has less effect on the hematopoietic function of bone marrow than stored autologous whole blood transfusion.
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Perioperative autotransfusion and blood protection has become a hot issue in modern medicine. Hemodilution, as an effective method of saving blood, has been widely used in clinical practice. It can reduce the clinical demand for allogeneic blood source and relieve the tension of clinical blood use to a certain extent. However, hemodilution itself will also have a certain impact on human physiological functions; especially it can affect the pharmacokinetics and pharmacodynamics of anesthetics and the depth of anesthesia. This paper focuses on the effects of hemodilution on anesthetics and anesthesia depth.
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Objective@#To evaluate the effect of different hemoglobin (Hb) concentrations on the lung injury in a rabbit model of hemorrhagic shock and resuscitation (HS-R).@*Methods@#Fifty healthy male New Zealand rabbits, aged 2 months, weighing 1.9-2.4 kg, were divided into 5 groups (n=10 each) using a random number table method: control group (group C), HS-R group (group H), and three HS-R plus infusion of concentrated red blood cell groups group R1 (60 g/L≤Hb<80 g/L), group R2 (80 g/L≤Hb<100 g/L) and group R3 (100 g/L≤Hb<120 g/L). The animals were sacrificed at 3 h after resuscitation, lung tissues were obtained for examination of the pathological changes with a light microscope, and lung tissues were obtained again for determination of wet to dry weight ratio (W/D ratio), neutrophil myeloperoxidase (MPO), NO level and cell apoptosis (by TUNEL).@*Results@#Compared with group C, the levels of MAP and NO, W/D ratio and apoptosis index were significantly increased in the other groups (P<0.05). Compared with group H, the levels of MAP and NO, W/D ratio and apoptosis index were significantly decreased in R2 and R3 groups (P<0.05). Compared with group R2, the apoptosis index was significantly increased at T5(P<0.05), and no significant change was found in the other parameters in group R3 (P>0.05).@*Conclusion@#Maintaining Hb 80-100 g/L after HS-R reduces acute lung injury in rabbits.
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Objective To evaluate the effect of different hemoglobin(Hb)concentrations on the lung injury in a rabbit model of hemorrhagic shock and resuscitation(HS-R).Methods Fifty healthy male New Zealand rabbits,aged 2 months,weighing 1.9-2.4 kg,were divided into 5 groups(n＝10 each)u-sing a random number table method: control group(group C),HS-R group(group H),and three HS-R plus infusion of concentrated red blood cell groups group R1(60 g/L≤Hb＜80 g/L),group R2(80 g/L≤Hb＜100 g/L)and group R3(100 g/L≤Hb＜120 g/L).The animals were sacrificed at 3 h after resuscita-tion,lung tissues were obtained for examination of the pathological changes with a light microscope,and lung tissues were obtained again for determination of wet to dry weight ratio(W/D ratio),neutrophil my-eloperoxidase(MPO),NO level and cell apoptosis(by TUNEL).Results Compared with group C,the levels of MAP and NO,W/D ratio and apoptosis index were significantly increased in the other groups(P＜0.05).Compared with group H,the levels of MAP and NO,W/D ratio and apoptosis index were signifi-cantly decreased in R2 and R3 groups(P＜0.05).Compared with group R2,the apoptosis index was signif-icantly increased at T5(P＜0.05),and no significant change was found in the other parameters in group R3(P>0.05).Conclusion Maintaining Hb 80-100 g/L after HS-R reduces acute lung injury in rabbits.
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Objective To compare the effect of storage autologous blood component transfusion versus storage autologous whole blood transfusion on the cellular immune function and hemorheology in the patients undergoing spinal surgery.Methods Forty patients of both sexes,aged 32-60 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,undergoing elective multilevel spinal surgery,were divided into 2 groups (n =20 each) using a random number table:stored autologous whole blood transfusion group (group A) and stored autologous blood component transfusion group (group B).Before blood sampling (T0),immediately after blood sampling (T1) and at the end of surgery (T2),arterial blood samples were collected for determination of red blood cell count (RBC),hemoglobin (Hb),hematocrit (Hct),erythrocyte aggregation index (EAI) and erythrocyte rigidity index (ERI).Venous blood samples were collected at T0,T2 and on day 6 after surgery (T3),the distribution of T lymphocyte subsets (percentage of CD3+,CD4+ and NK cells) was measured,and CD4+/CD8+ ratio was calculated.Results Compared with the baseline at T0,the percentage of CD3+,CD4+ and NK cells and CD4+/CD8+ ratio were significantly decreased at T2,3 in group A and at T2 in group B,and RBC,Hb and Hct were significantly decreased at T1,and EAI and ERI were decreased at T1,2 in two groups (P＜0.05).Compared with group A,the percentage of CD3+,CD4+ and NK cells and CD4+/CD8+ ratio were significantly increased at T3 (P＜0.05),and no significant change was found in RBC,Hb,Hct,EAI or ERI at each time point in group B (P＞0.05).Conclusion The effect of storage autologous blood component transfusion on cellular immune function is mitigated than that of storage autologous blood transfusion and the effects on hemorheology are comparable in the patients undergoing spinal surgery.
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Objective To investigate the effect of allogeneic transfusion and preoperative autologous blood donation on perioperative cellular immunity and humoral immunity in patients with gastrointestinal neoplasms.Methods Sixty gastrointestinal cancer patients undergoing radical surgery,33 males and 27 females,aged 53 69 years,weighing 47-70 kg,ASA physical status Ⅰ or Ⅱ,were included in this study.Blood transfusion was started when the blood loss was more than 200～400 ml,Hb＜70 g/L,and the patients were randomly divided into the preoperative autologous blood donation group (group P,n =30):intraoperative blood transfusion using the stored autologous blood transfusion;allogeneic blood transfusion group (group A,n =30):allogeneic blood transfusion.The levels of T lymphocyte subsets,NK cells and IL-2,IL-10,TNF-α,perforin (PF) concentration and plasma immunoglobulin IgG,IgA and IgM levels.Results The percentage of CD3+,CD4+,NK cells and the ratio of CD4+/CD8+ in group A at the end of surgery to 7 d after operation were significantly lower than those at the time of admission (P＜0.05).The percentage of CD3+,CD4+ (P＜ 0.05).The level of IL-2 in group A was significantly lower than that in group P (P＜0.05) 1-7 d after operation,and the level of IL-10 in group A was significantly higher than that in group P (P＜ 0.05).The levels of IgG and IgA 3 d after operation in group A were significantly lower than those in group P (P＜0.05).The levels of IgG and IgA in group P were significantly decreased at the end of operation and recovered to preoperative levels 1-3 d after operation (P ＜ 0.05).Conclusion Allogeneic blood transfusion can reduce the percentage of T-cell subsets and NK cells in cancer patients and delay their recovery,and also can transiently reduce the content of immunoglobulin IgG and IgA in plasma and thus affect the immune function of patients.However,the preoperative autologous blood donation has a slight effect on postoperative immune function in cancer patients.
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Objective To investigate the effect of acute normovolemic hemodilution (ANH) combined with controlled hypotension (CH) on the extravascular lung water (EVLW) and oxygenation in elderly orthopaedic surgery patients.Methods Forty-five elderly orthopaedics surgery patients,23 males,22 females,aged 65-75 years old,ASA grade Ⅰ or Ⅱ,were randomly divided into 3 groups (n=15 each).Group A,served as control,received regular routine transfusion and intraoperative crystalloid fluids and colloidal liquid to add volume.Group B,namely ANH group,received normovolemic hemodilution till Hct reaching 30% after induction of anesthesia.Group C,ANH combined with CH group,received ANH with Hct reaching 30% after induction of anesthesia,and the patients were continuously pumped nitroglycerin combined with esmolol for controlled hypotension.The target mean arterial pressure controlled and cut by 30% below the basic value.We collected arterial blood for blood gas analysis at 5 points: before before induction of anesthesia (T1),immediately after ANH (T2),30 min after ANH (T3),30 min after CH (T4),immediately after surgery (T5).Meanwhile the MAP,HR,PaO2,SpO2,Hct,HCO3-,pH,cardiac index (CI),stroke volume variation (SVV),stroke volume index (SVI),extravascular lung water index (EVLWI) and intrathoracic blood volume index (ITBVI) were recorded.Blood loss,urine output after surgery and the operation time were also recorded.Results The volumes of autoblood removed had no significant difference between group B and group C,and no autoblood was removed in group A.The volume of blood loss in group C was significantly less than that in group A and group B (P<0.05).Six cases in group A,one case in group B and none in group C needed homologous allogeneic blood transfusion.Compared with T1,MAP,HR,CI,SVI and Hct were significantly decreased at T2-T5 (P<0.05),but all those are stable in the normal range.Compared with T1,SVV was significantly decreased at T2-T4 (P<0.05).Compared with T1,ITBVI,PaO2 and SpO2 were increased at T2-T5 (P<0.05),but all those are stable in the normal range.CI and SVI at T2 in group A was significantly lower than that in group B and C.Compared with group A and B,MAP at T4 in group C were significantly decreased and SVV at T4 in group C were significantly increased(P<0.05).Urine output,the operation time,EVLWI,HCO3-and pH in three groups had no significant difference.Conclusion Acute normovolemic hemodilution combined with controlled hypotension has an effect of saving blood in elderly patients,without any influence on the extravascular lung water and oxygenation,which can be used safely in elderly patients which they are monitored.
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Objective To investigate the impact of a single sub-anesthetic dose of ketamine on postoperative emotional reactions of anxiety and depression during colorectal tumors surgery. Methods A total of 42 patients undergoing selective colorectal surgery,aged 18 to 65 years,were randomly divided into ketamine group (group K)and control group (group C).After induction of an-esthesia,a single intravenous injection of 0.3 mg/kg ketamine and saline were used in Group K and group C 5 minutes before the operation respectively.The intravenous analgesia program was identical between the two groups.The patients??emotional reactions (anxiety,depression)were assessed using the Hospital Anxiety and Depression Scale (HAD),the quality of recovery was assessed using the QoR-40 questionnaire on the day before operation and within postoperative 48 hours respectively.Pain was estimated by the visual analog scale (VAS)and sedation was assessed with Ramsay score 30 mi-nutes after extubation.The time of anesthetic end and extubation were recorded.The complications during anesthesia and recovery such as cough, agitation 30 minutes extubation were recorded. Results The HAD-A and HAD-D scores of group K were lower than group C (P <0.05)48 h post-operatively.There was no difference on the QoR-40 score postoperative 48 h between the two groups. The patients??emotional state QoR-40 score of group K were higher than group C (P <0.05 ).The VAS scores 30 minutes after extubation of group K were lower than group C (P <0.05).There was no significant difference on sedation score 30 minutes postoperatively between the two groups.There was no significant difference in extubation time,cough,agitation and delirium between the two groups.There was no dizziness, nausea, vomiting or diplopia 30 minutes after extubation. Conclusion A single subanesthetic dose of ketamine can significantly reduce the scores of postopera-tive anxiety and depression,improve the quality of recovery,and no postoperative adverse reactions increased.