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Objective To observe the efficacy and safety of the etomidate target controlled in-fusion (TCI)in the total thoracoscopic mitral valve replacement surgery.Methods One hundred and ten patients,aged 29-55 years,48 males and 62 females with ASA grade Ⅱ or Ⅲ rheumatic mitral valve disease planned to be corrected with total thoracoscopic mitral valve replacement surgery were randomly divided into group E and group P,55 cases in each group.In group E,etomidate-sufentanil target controlled infusion was used for induction (the initiate plasma concentration of etomidate was 0.2 ng/ml and increased 0.1 ng/ml per minute according to the bispectral index and the effect-site concentration of sufentanil was maintained at 1.0 ng/ml)and maintenance.In group P,using propo-fol-sufentanil target controlled infusion for induction (the initiate plasma concentration of propofol was 1.0 ng/ml and increased 0.3 ng/ml per minute according to the bispectral index and the effect-site concentration of sufentanil was maintained at 1.0 ng/ml)and maintenance.We documented the incidence of hypotension during the induction phase, recorded the basic clinical parameters of patients,the dosage of vasopressors during induction and sufentanil during anesthesia,time of eyelash reflex absence,operation time,CPB time,clamping time,APACHE Ⅱ score when enter CCU,pos-itive inotropic score 24 h postoperatively,wakening time,mechanical ventilation time,CCU stay,in-hospital stay,blood glucose and lactic acid preoperatively,2,6,24 h postoperatively,cortisol,aldo-sterone and adrenocorticotropin preoperatively and 24 h postoperatively and postoperative complications in both groups.Results The incidence of hypotension during induction in group E was much lower than that in group P (P<0.05).The dosage of norepinephrine during the induction in group E were much less than group P (P <0.05).The wakening time,mechanical ventilation time,CCU stay and in-hospital stay in group E were significantly shorter than group P (P <0.05).The blood glucose and lactic acid at postoperative 2,6,24 h were much higher than the preoperative value within each group (P <0.05).They reached the maxim at 6 h postoperatively and began to decline at 24 h postoperatively. Blood glucose and lactic acid at all the time points between two groups were similar.Cortisol at 24 h postoperatively was much higher than the preoperative value in group P (P <0.05).The dosage of cortisol and aldosterone 24 h postoperatively in group E were much less than that in group P (P <0.05).The incidence of postoperative lung infection in hospital in group E was remarkably lower than that in group P (P <0.05).Conclusion Etomidate target controlled infusion can maintain stable he-modynamics during the induction period, shorten postoperative recovery time and reduce postoperative lung infection obviously,which can be safely used in total thoracoscopic mitral valve re-placement surgery.
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<p><b>OBJECTIVE</b>To investigate the expression and clinical significance of phosphatase and tensin homology deleted on chromosome ten (PTEN) and hypoxia-inducible factor 1 alpha (HIF-1α) in sinonasal inverted papilloma (SNIP) of different pathological grades.</p><p><b>METHODS</b>Fifty-five paraffin samples from patients with SNIP and a control group of 10 paraffin samples of patients with normal nasal cavity mucosa (NM) who underwent inferior turbinectomy were consisted in this study. Among the 55 cases of SNIP, 30 cases were without dysplasia subtypes, 11 cases were with dysplasia subtypes, and 14 cases with canceration to squamous cell carcinoma (SCC) subtypes. PTEN and HIF-1α expression in SNIP was detected by immunohistochemistry. The differences between NM and SNIP, and among the three subtypes were analyzed, and the relationship between PTEN, HIF-1α expression and SNIP recurrence and the correlation between PTEN expression and HIF-1α expression were also analyzed. SPSS 16.0 software was used to analyze the data.</p><p><b>RESULTS</b>The positive expression rate of PTEN in NM and SNIP was 100% and 65.5%, the difference was significant (U = 147, P = 0.014), while HIF-1α was 0 and 30.9%, the difference was significant (U = 190, P = 0.045). The positive expression rate of PTEN in SNIP without dysplasia, SNIP with dysplasia and NSCC was 83.3%, 63.6%, 28.6%, respectively, the difference was significant (H = 12.644, P = 0.002); while HIF-1α was 16.7%, 45.5%, 50.0%, respectively, the difference was significant (H = 8.292, P = 0.016). A total of 22 SNIP patients recurred. PTEN had lower expression in recurrent SNIP (45.5%) than that in non-recurrent SNIP (82.8%), and the difference was significant(χ² = 7.834, P = 0.005). However, the expression of HIF-1α had no significant difference between recurrent SNIP and the SNIP which had no recurrence (χ² = 0.901, P = 0.343). The expression of PTEN protein was negatively correlated with that of HIF-1α protein (r = -0.503, P = 0.001).</p><p><b>CONCLUSIONS</b>PTEN expression decreased graduately with the severity of malignancy of SNIP, but HIF-1α increased. The expression of HIF-1α was induced by hypoxia, which may negatively effect the expression of PTEN, and both HIF-1α and PTEN may play critical roles in the progress of SNIP. PTEN is one of the factors responsible for the postoperative recurrence of SNIP.</p>