Research progress in hip-preserving modalities for early osteonecrosis of the femoral head in young and middle-aged patients / 中华创伤杂志

Osteonecrosis of the femoral head (ONFH) is one of the common and difficult-to-treat orthopedic diseases caused by a variety of factors that lead to abnormal blood flow to the femoral head, which in turn leads to deformation and collapse of the femoral head and eventually results in severe hip joint dysfunction. The key to the treatment is early diagnosis and correct treatment according to the stage classification and active prevention of further aggravation of ONFH aiming to delay or avoid hip replacement surgery in young and middle-aged patients. At present, there are various non-surgical and surgical hip-preserving modalities for early ONFH, designed to slow down the progression of the disease, prevent the femoral head from collapsing and stop the mild collapse. In recent years, with the emergence and development of bone reconstruction biomaterials, artificial bone reconstruction after scraping of ONFH lesions has shown great potential in the treatment of early ONFH. The authors review the research progress in hip-preserving modalities for early ONFH in young and middle-aged patients from non-surgical and surgical perspectives, hoping to provide a reference for clinical treatment of early ONFH.

Influence of once pre-injection dexmedetomidine on clinical effects in general anesthesia induction / 重庆医学

Objective To observe the influence of once pre-injection dexmedetomidine(DEX) on clinical effect in general anesthesia induction.Methods Sixty patients,ASA Ⅰ-Ⅲ,no sex limitation,undergoing elective laparoscopic cholecystectomy under general anesthesia were selected and divided into the 1ug/kg DEX group(D) and normal saline control group(C),30 cases in each group.The BIS values were recorded after medication infusion.Then the target controlled infusion(Marsh mode) of propofol was performed according to the plasma concentration.The plasma concentration was gradually increased until BIS value reaching 40.Then the effect-site concentration(Ce) of propofol was recorded at this time and sufentanil 0.5ug/kg was injected within 10 s.The bucking incidence rate within 1 min after injection of sufentanil was recorded and cisatracurium was injected again.The tracheal intubation was performed when the TOF value was 0.The time of train-of-four stimulation(TOF) to 0(effect onset time) and intubation time were recorded.The hemodynamic indexes were recorded at pre-administration(T0),post-administration(T1),after induction(T2),and after intubation(T3).The incidence rate of intraoperative awareness was recorded.Results The bucking incidence rate at 1 min after sufentanil injection in the group D was significantly lower than that in the group C(3.33％ vs.13.3％,P＜0.01).Ce of propofol in the group D was lower than that in the group C(P＜0.01).HR af T1 in the group D was decreased;HR and MAP at T2 in the group C were decreased,which at T3 were increased.No intraoperative awareness occurred in all cases.Conclusion Pre-injection of DEX 1ug/kg before induction can decrease the propofol dose and maintains hemodynamic stability.

Effects of dexmedetomidine plus ropivacanie on lumbar plexus-sciatic nerve blocks and sedation / 临床外科杂志

Objective To investigate the effects of dexmedetomidine plus ropivacanie on lumbar plexus-sciatic nerve blocks and sedation. Methods One hundred and twenty patients( ASA Ⅰ-Ⅲ) scheduled for unilateral arthroscopy of the knee received lumbar plexus-sciatic nerve blocks. The patients were randomly divided into 4 groups(n = 30 in each). In group R,dexmedetomidine was not used for nerve. In group RLD,dexmedetomidine was only used for lumbar-plexus block. In group RSD,dexmedeto-midine was only used for sciatic nerve block. In group RD,dexmedetomidine was used for both lumbar-plexus block and sciatic nerve block. Onset time and maximum time of sensory and motor block,duration of analgesia,Ramsay scores,HR,and the incidence of anesthetic toxicity were recorded at different time points(T0-T4). Results There were no significant differences in the onset time of sensory and motor block among the groups(P > 0. 05). However,there were significant differences in the maximum time of sensory and motor block for the lumbar plexus among the RLD group[(1008. 00 ± 104. 99)min and (800. 00 ± 97. 56)min],RD group[(922. 00 ± 149. 05)min and(732. 00 ± 139. 52)min],RSD group [(768. 00 ± 108. 48)min and(602. 00 ± 84. 09)min],and R group[(742. 00 ± 129. 44)min and (612. 00 ± 109. 62)min]. There were significant differences in the maximum time of sensory and motor block for the sciatic nerve among the RLD group[(1006. 00 ± 117. 58)min and(810. 00 ± 105. 41) min],RD group[(932. 00 ± 144. 18)min and(744. 00 ± 136. 09)min],RSD group[(738. 00 ± 120. 16)min and(582. 00 ± 96. 04)min],and R group[(708. 00 ± 126. 45)min and(548. 00 ± 111. 12)min]. Compare with the R group,the Ramsay scores of at the time point of T1-T4 were higher and the HRs were lower in the RLD group,RSD group and RD group. There were significant differences in the analgesia duration among the RLD group[(1006. 00 ± 117. 58)min],RD group[(918. 00 ± 83. 60)min],RSD group[(898. 00 ± 131. 34)min],and R group[(808. 00 ± 119. 72)min]. No local anesthetic intoxication was noticed. Conclusion Perineural dexmedetomidine plus ropivacaine increase the effects of lumbar plexus-sciatic nerve blocks in a dose-dependent manner. Dexmedetomidine provides a good sedative effect,however,it may lead to bradycardia.

Leading effect of PETCO2 on mechanical ventilation in New Zealand white rabbits / 局解手术学杂志

Objective To observe the leading effect of end-tidal pressure of carbon dioxide in artery ( PET CO2 ) on mechanical ventila-tion in New Zealand white rabbits, and to establish parameters for medical animal experiments in terms of hemodynamics, blood gas, blood glucose, electrolyte. Methods 31 anesthetized New Zealand rabbits were practiced tracheostomy tube and mechanical ventilation. Respira-tion rate was 40 breaths/min and tidal volume was adjusted so that PET CO2 was 29 mmHg. Invasive blood pressure, electrocardiogram and PET CO2 were monitored. Blood gas analysis, electrolyte, hemoglobin and blood glucose were tested. Results When PET CO2 was maintained at 29 mmHg, the results were as follows:PH (7.42 ±0.07), 95% confidenceinterval (7.40~7.45);PaCO2(38.5 ±5.8) mmHg, 95%confidenceinterval (36. 4~40. 6) mmHg;BE (1. 45 ± 2. 80) mmol/L,95% confidenceinterval (0. 43~2. 48) mmHg. Conclusion Moni-toring of PET CO2 is good to guide mechanical ventilation in New Zealand white rabbits.

Effects of ulinastatin on hemorrhagic shock and resuscitation-induced acute lung injury in rats / 中华麻醉学杂志

Objective To evaluate the effects of ulinastatin on hemorrhagic shock and resuscitation ( HS∕R)?induced acute lung injury in rats. Methods Fifteen SPF adult Sprague?Dawley rats, aged 2-3 months, weighing 300-400 g, were divided into 3 groups ( n=5 each) using a random number table:sham operation group ( group S ) , HS∕R group and ulinastatin group ( group U ) . Carotid arteries were cannulated for blood pressure monitoring and blood?letting. HS∕R was induced by blood?letting and maintained for 1 h, followed by resuscitation with autologous blood transfusion and infusion of normal saline. After cannulation of carotid arteries ( T0 ) , at 5 min after hemorrhagic shock ( T1 ) , before resuscitation ( T2 ) , at 5 min after the expected blood pressure was achieved following resuscitation ( T3 ) , and at 30 min, 1?5 h and 2?5 h after resuscitation ( T4?6 ) , arterial blood samples were collected for determination of interleukin?6 ( IL?6 ) and tumor necrosis factor?α ( TNF?α) concentrations ( by enzyme?linked immunosorbent assay) . Arterial blood samples were collected at T0 , T2 and T6 for blood gas analysis. The pH value, partial pressure of arterial carbon dioxide ( PaCO2 ) , HCO-3 and base excess ( BE) value were recorded, and oxygenation index ( PaO2∕FiO2 ) was calculated. Lungs were removed at T6 , and pulmonary specimens were obtained for examination of pathological changes which were scored, and nucleus was extracted for determination of nuclear factor?kappa B ( NF?κB ) p65 expression by enzyme?linked immunosorbent assay. Results Compared with group S, the pH values, HCO-3 , BE values and OI were significantly decreased, and PaCO2 , plasma IL?6 and TNF?α concentrations, expression of NF?κB p65 in lung tissues, and pathological scores were increased in U and HS∕R groups. Compared with group HS∕R, the plasma concentrations of IL?6 and TNF?α, expression of NF?κB p65 in lung tissues, and pathological scores were significantly decreased, and no significant changes were found in parameters of blood gas analysis in group U. Conclusion Although ulinastatin can alleviate HS∕R?induced acute lung injury, it is insufficient to improve lung oxygenation in rats.

Clinical efficacy of dexmedetomidine combined with ropivacaine in brachial plexus block / 临床麻醉学杂志

Objective To investigate the clinical effect of dexmedetomidine combined with ropi-vacanie in brachial plexus block (BPB)through modified coracoid approach.Methods Sixty patients scheduled for selective upper extremity surgery were randomly divided into two groups,30 patients in each group.BPB was performed at the point of 2 cm below coracoid directed by nerve stimulator. Ropivacaine (200 mg)was diluted into 40 ml in group R (n=30)and ropivacaine (200 mg)+1 μg/kg dexmedetomidine diluted into 40 ml in group RD (n=30).Motor and sensory block onset times and blockade durations were recorded.HR,SBP,DBP and SpO2 were recorded before drug administration and 1 5,30,60,90 and 120 min after drug administration.Visual Analog Scale (VAS)of normal up-per extremity in group RD was recorded before drug administration and 30 min after drug administra-tion.Side effects were recorded in both groups.Results Sensory and motor block onset time was sig-nificantly longer in group R than those in group RD;Sensory and motor blockade durations in group R was significantly shorter than in those group RD (P <0.01).Compared with group RD,MAP,HR at 30,60,90,120 minutes after drug administration were significantly higher in group R(P <0.05 ). VAS of normal upper extremity in group RD before drug administration and 30 min after drug admin-istration had no statistical significance.7 patients were treated with atropine for bradycardia in group RD.Conclusion Dexmedetomidine combined with ropivacaine for BPB shortens the sensory and motor block onset time and prolongs the duration of sensory and motor blockade.

A comparison of dexmedetomidine and midazolam in patients during combined spinal and epidural anesthesia / 中国医师进修杂志

Objective To compare the influence for intravenous dexmedetomidine and midazolam during combined spinal and epidural anesthesia (CSEA) on sedation,respiratory and circulatory.Methods Ninety patients with lower extremity fractures and internal fixation,were divided into dexmedetomidine group,midazolam group and control group by random digits table with 30 cases each.CSEA was performed at L3-4 interspace.After block reached T8 level,dexmedetomidine,midazolam and 0.9％ sodium chloride were given to the three groups.Ramsay score,mean arterial pressure (MAP),heart rate (HR),partial pressure of carbon dioxide in end expiratory gas (PErCO2),respiratory rate (RR) were recorded before anesthesia(T0),after CSEA (T1),and 10,15,30,45,60 min after giving drug (T2-T6),and intraoperative awareness was recorded.Results Ramsay score in dexmedetomidine group and midazolam group at T2-T6 were higher than those in the group T0,T1 and concurrent control group (P ＜ 0.05),MAP were lower than those in the group T0,T1 and concurrent control group (P ＜ 0.05).HR in dexmedetomidine group at T2-T6 were lower than those in concurrent midazolam group and control group (P ＜ 0.05).PETCO2 in midazolam group at T2-T6 were higher than those in concurrent dexmedetomidine group and control group (P ＜ 0.05),RR were lower than those in concurrent dexmedetomidine group and control group (P ＜ 0.05).The rate of intraoperative awareness in dexmedetomidine group and midazolam group was lower than that in control group [16.7％(5/30) and 13.3％(4/30) vs.93.3％(28/30),P＜0.05].Conclusions Dexmedetomidine and midazolam provide good sedation to reduce intraoperative awareness,slight inhibition of blood pressure.Dexmedetomidine can decrease HR,but it does not influence respiratory function.Midazolam restrains respiratory function.

Application of parecoxib sodium for preemptive analgesia in patients undergoing cerebral angiography / 中国医师进修杂志

Objective To evaluate the effects of parecoxib sodium for preemptive analgesia in patients undergoing cerebral angiography. Methods Sixty patients undergoing cerebral angiography were divided into two groups by random digits table with 30 cases in each : group P and group F. Patients in group P received parecoxib sodium 40 mg 30 min before operation, while group F received fentanyl 1 μ g/kg 2 min before operation. The changes of hemodynamics were observed before operation (To), immediately right internal carotid artery angiography during operation (T1), immediately right vertebral artery angiography (T2),immediately left internal carotid artery angiography(T3), immediately left vertebral artery angiography(T4), 10min after operation (T5). The mean arterial pressure (MAP), heart rate (HR), pulse oxygen saturation (SpO2)and visual analogue score (VAS) were recorded at different times during the whole operation. Results There were no significantly differences on MAP, HR and VAS between group P and group F (P ＞ 0.05 ). But the SpO2 at T1 ,T2,T3 in group F (0.94±0.03,0.95±0.02,0.95±0.02) were significantly lower than those in group P (0.98 ± 0.01,0.98 ± 0.02,0.98 ± 0.02 )(P＜0.05 ), and 2 cases SpO2 ＜ 0.90 at Ti. Conclusion Parecoxib sodium administered preemptively provides a nice analgesic effect in patients undergoing cerebral angiography, and is more safe than fentanyl.

Clinical studies on the protective effect of propofol in surgery of acute cranial trauma / 解放军医学杂志

Objective To investigate the changes in neuron-spe ci fic enolase (NSE) and S100B in patient′s serum before, during and after surgery of acute cerebral trauma, and to examine the influence of propofol, a venous an esthetic, on these changes, so as to evaluate the brain-protective effects of t his agent. Methods Ten patients with no cerebral injury and sch eduled for urological operation served as control group. Thirty patients with ce rebral trauma were randomly allocated to either propofol group (n=15) or iso flurane group (n=15). NSE and S100B were measured by ELISA in both propofol and isoflurane groups before surgery, 2 hours after cranial surgery started, and after surgery. The same measurement was done in the control group only before s urgery. Glasgow scores of patients with cerebral trauma were estimated and recor ded. Results Before surgery, the NSE and S100B in the patients with cerebral trauma were significantly higher than that in the control group ( P