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Objective:To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative gastrointestinal function in the patients undergoing lumbar spinal surgery.Methods:Fifty patients of both sexes, aged 50-75 yr, with body mass index of 18.5-28.0 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰor Ⅱ, undergoing elective lumbar spinal surgery under general anesthesia, were divided into 2 groups ( n=25 each) by a random number table method: control group (group C) and TEAS group. In group C, stimulating electrodes were placed at the non-acupoint parts of the limbs, but no electrical stimulation was applied. In group TEAS, bilateral Neiguan (PC6), Hegu (L14), Zusanli (ST36), Shangjuxu (ST37) and Xiajuxu (ST39) acupoints were stimulated using disperse-dense waves with a frequency of 2/100 Hz. The intensity of stimulation was the maximum current that patients could tolerate. Simulation lasting 30 min was performed once a day before induction of anesthesia and within 1-7 days after operation. The time to first flatus, time to first defecation, time for recovery of first bowel sounds and occurrence of abdominal distension were recorded. The occurrence and score of postoperative nausea and vomiting were recorded at 24, 48 and 72 h after operation. Peripheral venous blood samples were collected before operation and at 1 and 3 days after operation for determination of the concentrations of serum substance P and cholecystokinin before surgery and at 1 and 3 days after surgery using enzyme-linked immunosorbent assay. Results:Compared with group C, the time to first flatus, time to first defecation and time for recovery of first bowel sounds were significantly shortened, and the incidence of abdominal distension was decreased in group TEAS ( P<0.01). There was no significant difference in the incidence and score of postoperative nausea and vomiting and serum concentrations of substance P and cholecystokinin before surgery and at 1 and 3 days after surgery between the two groups ( P>0.05). Conclusions:TEAS can improve postoperative gastrointestinal function in the patients undergoing lumbar spinal surgery.
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Objective To investigate the effect of the intraoperative wake-up test on the postoperative delirium in patients undergoing scoliosis operation under analgesia with sufentanil. Methods Sixty ASA Ⅰ or Ⅱ patients , aged 12-60 yr, scheduled for scoliosis surgery, were randomly divided into 2 groups ( n = 30 each) : control group (group C) and intraoperative wake-up test group (group W) . The intraoperative wake-up test was not performed during operation in group C. Anesthesia was induced with target-controlled infusion of sufentanil with the target effect-site concentration set at 0.5 ng/ml and iv injection of propofol 1-2 nig/kg. As soon as the patients lost consciousness, tracheal intubation was facilitated with 0.15 mg/kg cisatracurium besylate. The patients were mechanically ventilated. Anesthesia was maintained with target-controlled inhalation of sevoflurane (target end-tidal concentration 0. 8%-1. 5%), target-controlled infusion of sufentanil (target effect-site concentration 0.2-0.3 ng/ml) and iv infusion of cisatracurium besylate 0.1 mg- kg-1·h-1 . In group W, the patients underwent the intraoperative wake-up test. Postoperative analgesia was provided with sufentanil. The occurrence of intraoperative awareness and postoperative delirium was recorded. Results No significant difference was found in the incidences of intraoperative awareness and postoperative delirium between the two groups. Conclusion The intraoperative wake-up test is not the risk factor for postoperative delirium in patients undergoing scoliosis surgery under analgesia with sufentanil, and inhibition of perioperative pain and intraoperative awareness by analgesia with sufentanil may be involved in the mechanism.
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Objective To explore the value of low resection of rectal carcinoma in pull-through anus operation and its influence factor with rectal carcinoma distant metastases along intestine wall.Method Clinical pathological and visited data of 43 patients with rectal carcinoma were analyzed prospectively.Resuits Forty--one cases were successfully accepted resection in pull-through anus (95.3%).No patient suffered from stoma leak,3 cases appeared recurrence after operation.Compared between high differentiation patients and mid differentiation patients,there was no significant difference, while the difference of comparing between high or mid differentiation patients and low differentiation patients respectively,there was significant difference.The difference of comparison among Dukes stage A,B or C was significant.Conclusions The right length of incising distant intestine tube is more than 2.0,3.0,4.0 cm respectively for rectal careinoma of high,mid and low differentiation or that of Dukes stage A,B or C.low resection of rectal carcinoma in puB-through anus should be considered as a regular operation.
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Objective Crossclamping of aorta causes a sudden increase in systemic vascular resistance. Spinal cord may suffer ischemic injury during aortic aneurysm surgery. This study was designed to evaluate the hemodynamic and and spinal cord protective effects of captopril during suprarenal aortic crossclamping in rabbits.Methods Twenty-four albino rabbits were randomly divided into three groups :sham operation group (A),control group (B) and captopril group (C). The descending aorta was crossclamped above the level of renal artery for 30 min and then declamped.In group C a bolus of captopril 2 mg?kg -1 was given intravenously 10 min before crossclamping followed by a 0.5mg?kg -1?min -1 infusion for 30 min. The same volume of normal saline was given in other 2 groups. The carotid artery pressure(BP 1) and femoral artery pressure(BP 2) were recorded before injection, 5, 20,30min after crossclamping and 5,60,180min after declamping. Spinal cord was examined at the level of T 10 and L 3 for morphological changes and MDA content 180 min after declamping.Results 1. BP 1 increased significantly after crossclamping in group B. In group C there was no significant change in BP 1 after crossclamping. In group C there was no significant change in BP 1 after crossclamping. In group B BP after declamping was significantly lower than that before crossclamping. In group C BP at 60 and 180 min after declamping was significantly higher than that at the same intervals in group B(P