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Objective To investigate the clinical application of remifentanil in awake state for removal of tumors in functional brain area. Methods Twenty-four patients with tumors in functional brain area were divided into two groups by random digits table with 12 cases each:control group and remifentanil group. Infiltration anesthesia was used in all patients with 0.2% ropivacaine. Remifentanil was injected intravenously with micropump in 0.05-0.10 μg/ (kg·min) in remifentanil group and 0.9% sodium chloride was instead of remifentanil in control group. Patients remained awake during surgery in both groups. The hemodynamic changes and complications during operation were monitored. The satisfaction for surgical procedure was evaluated. Results The patients in two groups could be completed in awake state with surgery;mean artery pressure, heart rate in remifentanil group during opening or closing skull or intracranial period were significantly higher than those in control group(P< 0.05). There were no conspicuous complication in two groups such as respiratory depression, nausea, vomitting and dysphoria. The satisfaction score in remifentanil group[(3.3 ?0.6) scores] was higher than that in control group[(2.4 ?0.5) scores],there was significant difference between two groups (P<0.05). Conclusion Awake brain tumor surgery could be completed in rational use of remifentanil on the base of good local anesthesia, and hemodynamics are stable and the patients are well tolerated.
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Objective To study the effects of patient-controlled intravenous analgesia (PCIA) on plasma endothelin-1 (ET-1) of patients after mitral valve replacement.Methods One hundred and twenty ASA Ⅱ -Ⅲ patients undergoing mitral valve replacement were randomly divided into four groups, 30 cases in each group. The patients were given PC IA with lornoxicam 16 μ g/(kg·h ) in group L, fentanyl 0.2 μ g/( kg·h) in group F, tramadol 0.2 mg/(kg·h) in group T,and without PCIA in group D. VAS score and Ramsay score were recorded at 8,12,24 and 48 h after operation.The plasma ET-1 levels were detected using radioimmunoassay before anesthesia induction,at 8,12 and 24 h after operation.Results VAS scores in group L, F,T were lower at 8,12 h after operation than those in group D,Ramsay scores in group L, D were lower than those in group F,T.ET-1 levels in group L,F and T were significantly lower than those in group D at 8,12 and 24 h after operation (P <0.05).The numbers of dizziness, nausea,vomiting after operation in group L[3.3%(1/30) ,3.3%( 1/30),0]and group D(0)were significantly less than those in group F[13.3% (4/13), 13.3%(4/13), 10.0%(3/30)]and group T[10.0%(3/30), 26.7%(8/30), 16.7%(5/30)](P < 0.05).Conclusion PCIA with lornoxicam is a better method of suppressing the increase of plasma ET-1 levels with less side effects in the patients after mitral valve replacement.
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Objective To investigate the application of repeated myocardial perfusion on difficult cardiac resuscitation after aortic unclamping under open heart operation. Methods Fifteen cases met difficult cardiac resuscitation after release of aortic cross-clamping under open heart operation were analyzed retrospectively. They were perfused with or without repeated aortic clamping, with warm blood cardioplegic solution until electric activity of cardiac muscle stop. Results All cases got cardiac resuscitation and detached from-cardiopulmonary bypass (CPB) successfully,9 cases perfused with warm blood cardioplegic solution without repeated aortic clamping got cardiac resuscitation automatically(7 cases) or after defibrillation for one time (2 cases),5 cases experiencing repeated aortic clamping and perfused with warm blood cardioplegic solution for two times got cardiac resuscitation automatically (3 cases) or after defibrillation for one time (2 cases) and another one experiencing for four times. Conclusion Application of repeated perfusion on difficult cardiac resuscitation after aortic unclamping under open heart operation is effective.
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Objective To observe the effects of different hypothermia on cerebral oxygen metabolism during cardiopulmonary bypass(CPB).Methods 20 patients undergoing valvular replacements were randomly divided in two groups:shallow hypothermia group(30℃) and middle hypothermia group(26℃).Blood gas analysis and lactate concentration in arterial and internal jugular vein blood were monitored at 3 time points during operation,from which the arterial-internal jugular venous oxygen content difference(Ca-jvO 2),cerebral oxygen extraction ratio(ERO 2),cerebral lactate production(ADVL) were calculated.Results CaO 2,Ca-jvO 2 and ERO 2 of the two groups were significantly reduced(P0 05) at the same time points.Ca-jvO 2 at the T 3 time point was both lower(P