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Neonatal mortality has been significantly decreased because of the development of neo-natal respiratory support techniques. Nevertheless,constant and high frequency ventilators have some limita-tions to solve all problems in neonatal respiratory failure. Special mechanical ventilation,mainly including he-liox and partial liquid ventilation,provides new respiratory support for newborn infants. The clinical signifi-cance of heliox and partial liquid ventilation need further investigation.
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Objective To investigate the clinical value of amplitude integrated electroencephalogram on early diagnosis and prognosis evaluation of brain injury caused by neonatal asphyxia.Methods A total of 34 full-term asphyxiated neonates(asphyxia group)hospitalized in NICU of our hospital from January 2015 to September 2015 were selected;meanwhile,34 full-term healthy infants(control group)of the same term were selected.All cases were monitored for the activities of aEEG background,sleep-awakening cycle(SWC)and epileptic activity(SA)within 6 hours after birth.Meanwhile,the relationships between various indexes and asphyxia degree and brain injury were analyzed.Results The electroencephalogram of the asphyxia group was 52.9％and the rate of SWC was 58.8％,which were lower than those of the control group,and the difference had statistic significance(P<0.05).Meanwhile,neonates with epileptic activity in asphyxia group accounted for 11.8％,which was higher than that of control group significantly(P<0.05).Conclusion The AEEG changes of neonates at early period after birth are closely related to perinatal asphyxia and brain injury after asphyxia.The application of amplitude integrated electroencephalogram has an important significance on early diagnosis of neonatal asphyxia.
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Objective To investigate the therapeutic effect and safety of the intratracheal instillation of sodium nitroprusside for treating persistent pulmonary hypertension of newborn (PPHN) .Methods The intratracheal instillation of sodium nitroprusside was used to 19 cases of PPHN under the mechanical ventilation ,and the pulmonary arterial mean pressure(PAMP) ,arterial mean pressure(AMP) ,transcutaneous oxygen saturation(TcSaO2 ) of the right upper and left lower limb at the basic state ,30 ,60 ,120min after intratracheal instillation of sodium nitroprusside were respectively measured and compared .Results Among 19 cases of PPHN ,17 cases had the primary lung disease .Of 17 cases ,14 cases(82 .35% ) had significant decrease of PAMP after intratracheal instillation of sodium nitroprusside ,which was most significant at 30min after therapy and the difference was statistically significant compared with before therapy [(21 .30 ± 4 .200)mm Hg vs .(30 .30 ± 4 .20)mm Hg ,P0 .05] .Conclusion The intratracheal instillation of sodium nitroprusside is the safe ,effective and economic method for treating PPHN .
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Objective To evaluate the effects of limited fluid resuscitation on systemic inflammatory responses in rats with traumatic hemorrhagic shock through comparing with unlimited fluid resuscitation.Methods Sixty pathogen-free male Sprague-Dawley rats,aged 2-3 months,weighing 250-290 g,were randomly divided into 6 groups (n =10 each) using a random number table:sham operation group (group S),no fluid resuscitation group (group NF),unlimited fluid resuscitation group (group ULF),limited crystalloid fluid resuscitation group (group LR),and limited colloid fluid resuscitation groups (group LSG and group LHES).Traumatic uncontrolled hemorrhagic shock was induced by withdrawal of blood from the femoral artery at 2.5 mL/100 g over a 20-minute period,followed by tail amputation at 10 min after the end of blood withdrawal.At 10 min after the end of blood withdrawal,fluid resuscitation was performed.Lactated Ringer's solution (ULF and LR groups),4 ％ succinylated gelatin (group LSG),or 6 ％ hydroxyethyl starch 130/0.4 (group LHES) was infused intravenously.The initial infusion rate was 2 ml · kg-1 · min-1.The target MAP was maintained at 50 mm Hg in rats with limited fluid resuscitation,while at 80 mm Hg in rats with unlimited fluid resuscitation.After 60 min of fluid resuscitation,bleeding in the tail was stopped by ligation and fluid infusion was replaced with blood resuscitation.After 60 min of blood resuscitation,180 main of observation was started.At 10 min after catheterization of the femoral artery and vein (T0),10 min after the end of blood withdrawal (T1),the end of fluid resuscitation (T2),the end of blood resuscitation (T3),and the end of observation (T4),arterial blood samples were collected to measure hematocrit (Hct)and concentrations of plasma tumor necrosis factor-alpha (TNF-α),interleukin (IL)-6,and IL-10.Blood samples were collected from the femoral artery at T2 for determination of the expression of Toll-like receptor 4 (TLR4) and myeloid differentiation factor 88 (MyD88) and activity of nuclear factor-kappaB (NF-κB) in monocytes.The amount of blood loss from the tail and volume of fluid infused were also recorded.Another 120 Sprague-Dawley rats were randomly divided into 6 groups (n =20 each) and resuscitation was performed according to the method previously described.The rats were observed for 72 h survival rate.Results Compared with group S,Hct was significantly decreased,the concentrations of plasma TNF-α,IL-6,and IL-10 and activity of NF-κB were increased,and the expression of TLR4,and MyD88 in monocytes was up-regulated in the other groups (P ＜ 0.05).Compared with group NF,the concentrations of plasma TNF-α and IL-6 and NF-κB activity were significantly increased,and the concentration of plasma IL-10 and Hct were decreased,and the expression of TLR4 and MyD88 in monocytes was up-regulated in ULF,LR and LSG groups,and the concentrations of plasma TNF-α and IL-6 were significantly increased,the concentration of plasma IL-10 and Hct were decreased in group LHES (P ＜ 0.05).Compared with group ULF,the concentrations of plasma TNF-α and IL-6 and NF-κB activity were significantly decreased,the concentration of plasma IL-10 and Hct were increased,the survival rate was higher,the expression of TLR4 and MyD88 in monocytes was down-regulated,and the amount of blood loss from the tail was decreased and the volume of fluid infused was reduced in LSG,LHES and LR groups (P ＜ 0.05).Compared with group LR,the concentrations of plasma TNF-α and IL-6 and NF-κB activity were significantly decreased and the expression of TLR4 and MyD88 in monocytes was down-regulated (P ＜ 0.05),and no significant change was found in the concentration of plasma IL-10 in group LHES (P ＞ 0.05),and the volume of fluid infused was reduced and the survival rate was increased (P ＜ 0.05),and no significant change was found in the amount of blood loss from the tail in LSG and LH-ES groups (P ＞ 0.05).Conclusion Compared with unlimited fluid resuscitation,limited fluid resuscitation exerts less effect on systemic inflammatory responses in rats with traumatic hemorrhagic shock,especially when resuscitation with 6％ hydroxyethyl starch 130/0.4 is performed,and inhibition of TLR4/NF-κB signaling pathway is involved in the mechanism.
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ObjectiveTo evaluate the effects of ketamine on the minimum alveolar concentration of scvoflurane for blunting adrenergic responses to skin incision (MAC_(BAR)) in patients undergoing abdominal surgery. Methods Forty-four ASA Ⅰ or Ⅱ patients aged 30-60 yr undergoing elective abdominal surgery were randomly divided into 2 groups (n=22 each) : control group (group K_0) and ketamine group (group K_1). Anesthesia was induced with propofol 2 mg/kg and fentanyl 3 μg/kg. Tracheal intubation was facilitated with cisatracurium 0.15 mg/kg. The patients were mechanically ventilated. Anesthesia was maintained with sevoflurane inhalation (the initial end-tidal concentration 3% ). Ketamine at 14 μg·kg~(-1)·min~(-1) was infused at the same time in group K,. The patients' response to skin incision was described as positive if MAP or HR increased by≥15%. If the response was positive, the end-tidal concentration of sevoflurane for the next patient was increased by 0.5%, while if negative, decreased by 0.5% . ResultsThe MAC_(BAR) of scvoflurane was 3.25 % (95 % confidence interval 3.05%-3.45%) in group K_0, and 2.20% (95% confidence interval 1.96%-2.44%) in group K~1. The MAC_(BAR) of sevoflurane was significantly lower in group K~1 than in group K_0 (P<0.05). Conclusion Ketamine infusion at 14 μg·kg~(-1)·min~(-1) can reduce MAC_(BAR) of sevoflurane and enhance the inhibitory effect of sevoflurane on the stress response.
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Aim To establish the model of oxidative damage in brain of Parkinsons disease(PD)rats induced by levodopa(L-DOPA)with microdialysis technique.Methods PD model rats were induced by intracerebral injection of 6-hydroxyl dopamine(6-OHDA)and were perfused in brain with L-DOPA by using microdialysis technique.Salicylic acid can capture hydroxyl radicals in brain,then yield 2,3-dihydroxy benzyl acid(2,3-DHBA)and 2,5-dihydroxy benzyl acid(2,5-DHBA).Extracelluler dopamine(DA)and its metabolites,2,3-DHBA and 2,5-DHBA in striatum of rats were measured by HPLC-ED before and after L-DOPA treatment.Results Both 2,3-DHBA and 2,5-DHBA in model group were significantly higher than those in control group at 6 and 7 time points respectively(P