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Objective:To investigate the analgesic efficacy of dexmedetomidine combined with dizosine after lumbar internal fixation and its effects on hyperalgesia.Methods:Seventy-two patients who underwent lumbar internal fixation in General Hospital of Armed Police and Marine Police between April 2018 and June 2019 were included in this study. They were randomly assigned to undergo either flurbiprofen axetil and dizosine administration (control group) or dexmedetomidine and dizosine (observation group) for postoperative analgesia. Mechanical pain, degree of postoperative pain, and incidence of complications were recorded in each group.Results:At 6, 24 and 48 hours after surgery, peri-wound pain threshold in the observation group was (119.52 ± 20.42) points, (120.19 ± 17.44) points, (120.94 ± 20.73) points, respectively, which were significantly higher than (108.42 ± 15.24) points, (107.63 ± 16.83) points, (108.47 ± 17.82) points in the control group ( t = 0.01, 0.00, 0.01, all P < 0.05). At 24 and 48 hours after surgery, forearm pain threshold in the observation group was (109.93 ± 15.87) points and (110.79 ± 22.85) points, respectively, which were significantly higher than (97.07 ± 16.49) points and (95.63 ± 24.06) points ( t = 3.37, 2.74, both P < 0.05). There was no significant difference in Ramsay Sedation Scale score between the two groups ( P > 0.05). There was no significant difference in the dose of dizosine used within 48 hours after surgery between the two groups ( P > 0.05). The incidence of postoperative complications in the observation group was significantly lower than that in the control group [8.33% (3/36) vs. 27.78% (10/36), χ2 = 4.60, P < 0.05]. Conclusion:Dexmedetomidine combined with dizosine exhibits obvious analgesic efficacy after lumbar internal fixation. The combined therapy can effectively prevent hyperalgesia with a low incidence of comphications.
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Objective:To investigate the effect of two different withdrawal sequences on the quality of recovery in patients undergoing nasal endoscopic surgery under combined intravenous and inhalation anesthesia.Methods:Seventy patients scheduled for endoscopic sinus surgery in The First Affiliated Hospital of Xiamen University, China from January to June 2019 were included in this study and randomly assigned to undergo intravenous anesthesia alone (Group A, n = 35) or combined intravenous and inhalation anesthesia (Group B, n = 35). Propofol 2-4 mg/kg, fentanyl 3-4 μg/kg, cisatracurium besylate 0.2 mg/kg were used to induce anesthesia. Propofol 4-6 mg/kg/h, remifentanil 6.5-13.0 mg/kg/h, sevoflurane ≥ 0.30 minimum alveolar concentration were used to maintain anesthesia. At 30 minutes before the end of surgery, inhalational sevoflurane administration and pump propofol administration were stopped in the groups A and B respectively. At 10 minutes before the end of surgery, pump propofol administration and inhalational sevoflurane administration were stopped in the groups A and B respectively. At the end of surgery, pump remifentanil administration was stopped in both groups A and B. The time to spontaneous breathing recovery, the time to consciousness recovery, and the time to tracheal extubation were recorded. Mean arterial pressure and heart rate were recorded at the time of entering the operation room (T0), at the end of anesthesia (T1), at the time of spontaneous breathing recovery (T2), consciousness recovery (T3) and tracheal extubation (T4), 5 minutes (T5) and 10 minutes after tracheal extubation (T6). Agitation score was recorded at T2-T6 and at 20 minutes after tracheal extubation (T7). Cough score was recorded at T4. Results:The time to spontaneous breathing recovery, the time to consciousness recovery, and the time to tracheal extubation in group A were (16.0 ± 4.6) minutes, (18.0 ± 5.3) minutes, (19.0 ± 5.5) minutes, respectively, which were significantly longer than (8.8 ± 3.5) minutes, (9.5 ± 4.1) minutes, (10.7 ± 4.5) minutes, respectively in the group B ( t = 9.554, 8.881, 9.011, all P < 0.05). There were no significant differences in mean arterial pressure and heart rate recorded at T0-T6 between groups A and B (all P > 0.05). There was no significant difference in agitation score measured at T3-T6 between groups A and B (all P > 0.05). There was no significant difference in cough score recorded at T4 between groups A and B ( P > 0.05). Conclusion:Two different withdrawal sequences can maintain stable hemodynamics and reduce agitation during recovery period and cough during extubation. The recovery time of remifentanil combined with propofol is longer than that of remifentanil combined with sevoflurane.
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Objective@#To investigate the effects of remifentanil combined with propofol on hemodynamics, inflammatory stress response and immune function in patients with acute abdomen complicated with septic shock.@*Methods@#From June 2017 to August 2018, 112 patients with acute abdomen complicated with septic shock who admitted to the First Affiliated Hospital of Xiamen University were enrolled in the study.They were randomly divided into observation group and control group according to the digital table, with 56 cases in each group.The control group was anesthetized with sevoflurane combined with propofol.The observation group was anesthetized with remifentanil combined with propofol.The hemodynamic parameters of the patients entering the operating room(T0), 0.5h(T1), 1h(T2) and awake(T3) after anesthesia were recorded.The intraoperative norepinephrine dosage was recorded.The inflammatory response, stress response and immune function indicators at T0, T2 and T3 were recorded.@*Results@#Compared with T0, T1 and T2, the MAP of the two groups was higher at T3, and the differences were statistically significant(tcontrol group=4.834, 4.484, 5.378, tobservation group=6.420, 7.006, 6.152, all P<0.05). Compared with T0, the HR of the two groups was higher at T3, and the differences were statistically significant(tcontrol group=5.943, tobservation group=7.722, all P<0.05). Compared with T1 and T2, CO of the two groups was higher at T3, and the differences were statistically significant(tcontrol group=4.276, 2.262, tobservation group=6.318, 5.132, all P<0.05). There were no statistically significant differences in MAP, HR and CO between the two groups at T0, T1, T2 and T3(all P>0.05). The doses of norepinephrine in the observation group and the control group were (1 587.7±287.5)μg and (1 937.9±397.6)μg, respectively, and the difference was statistically significant(t=5.341, P<0.05). The serum levels of C reactive protein(CRP), tumor necrosis factor alpha(TNF-α) and interleukin 6(IL-6) increased with time in the two groups, and the differences were statistically significant(tcontrol group=17.06, 36.13, 19.07, 3.822, 9.466, 2.874, 14.18, 26.87, 16.21, tobservation group=11.72, 20.79, 11.01, 2.810, 6.559, 3.716, 10.52, 24.56, 17.64, all P<0.05). At T2 and T3, the serum levels of CRP, TNF-α and IL-6 in the observation group[T2: CRP (89.63±17.65)mg/L, TNF-α (51.16±10.16)ng/L, IL-6 (34.26±6.25)ng/L, T3: CRP (136.15±26.25)mg/L, TNF-α (58.64±11.12)ng/L, IL-6 (67.56±12.67)ng/L]were lower than those in the control group[T2: CRP (112.15±22.34)mg/L, TNF-α (59.56±11.58)ng/L, IL-6 (42.65±8.37)ng/L, T3: CRP (175.16±34.75)mg/L, TNF-α (65.79±11.35)ng/L, IL-6 (79.02±14.56)ng/L], the differences were statistically significant(t=5.919, 6.703, 4.080, 3.367, 6.010, 4.443, all P<0.05). Compared with T0, serum levels of epinephrine(E), cortisol(Cor) increased in two groups at T2 and T3, and the differences were statistically significant(tcontrol group=10.03, 8.096, 8.679, 7.029, tobservation group=6.473, 4.728, 6.330, 4.727, all P<0.05). Compared with T2, serum levels of E and Cor in two groups at T3 were decreased, and the differences were statistically significant(tcontrol group=2.400, 2.638, tobservation group=2.260, 2.162, all P<0.05). At T2 and T3, the serum levels of E, Cor in the observation group[T2: E (286.36±41.02)ng/L, Cor (262.52±29.89)μg/L, T3: E (270.35±33.59)ng/L, Cor (253.23±30.28)μg/L]were lower than those in the control group[T2: E (312.56±38.75)ng/L, Cor (287.56±38.76)μg/L, T3: E (295.79±35.12)ng/L, Cor (270.25±30.15)μg/L], the differences were statistically significant (t=3.457, 3.917, 3.828, 2.981, all P<0.05). At T0, T2 and T3, there were no statistically significant differences in CD3+, CD4+, CD8+ and CD4+/CD8+ between the two groups(all P>0.05).@*Conclusion@#Remifentanil combined with propofol anesthesia can make hemodynamics more stable in patients with acute abdomen complicated with septic shock, and can alleviate inflammation and stress response.
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Objective To investigate the effects of remifentanil combined with propofol on hemodynamics,inflammatory stress response and immune function in patients with acute abdomen complicated with septic shock.Methods From June 2017 to August 2018,112 patients with acute abdomen complicated with septic shock who admitted to the First Affiliated Hospital of Xiamen University were enrolled in the study.They were randomly divided into observation group and control group according to the digital table,with 56 cases in each group.The control group was anesthetized with sevoflurane combined with propofol.The observation group was anesthetized with remifentanil combined with propofol.The hemodynamic parameters of the patients entering the operating room(T0),0.5h(T1),1h (T2) and awake (T3) after anesthesia were recorded.The intraoperative norepinephrine dosage was recorded.The inflammatory response,stress response and immune function indicators at T0,T2 and T3 were recorded.Results Compared with T0,T1 and T2,the MAP of the two groups was higher at T3,and the differences were statistically significant(tcontrol group =4.834,4.484,5.378,tobservation group =6.420,7.006,6.152,all P ＜0.05).Compared with T0,the HR of the two groups was higher at T3,and the differences were statistically significant (tcontrol group =5.943,tobservation group =7.722,all P ＜ 0.05).Compared with T1 and T2,CO of the two groups was higher at T3,and the differences were statistically significant (tcontrol group =4.276,2.262,tobservation group =6.318,5.132,all P ＜ 0.05).There were no statistically significant differences in MAP,HR and CO between the two groups at T0,T1,T2 and T3 (all P ＞0.05).The doses of norepinephrine in the observation group and the control group were (1 587.7 ± 287.5) μg and (1 937.9 ±397.6) μg,respectively,and the difference was statistically significant(t =5.341,P ＜0.05).The serum levels of C reactive protein(CRP),tumor necrosis factor alpha(TNF-α) and interleukin 6 (IL-6) increased with time in the two groups,and the differences were statistically significant(tcontrol group =17.06,36.13,19.07,3.822,9.466,2.874,14.18,26.87,16.21,tobservation group =11.72,20.79,11.01,2.810,6.559,3.716,10.52,24.56,17.64,all P ＜ 0.05).At T2 and T3,the serum levels of CRP,TNF-α and IL-6 in the observation group [T2:CRP (89.63 ±17.65) mg/L,TNF-α (51.16 ± 10.16) ng/L,IL-6 (34.26 ± 6.25) ng/L,T3:CRP (136.15 ±26.25) mg/L,TNF-α (58.64 ± 11.12)ng/L,IL-6 (67.56 ± 12.67)ng/L] were lower than those in the control group[T2:CRP (112.15 ±22.34) mg/L,TNF-α (59.56 ± 11.58) ng/L,IL-6 (42.65 ± 8.37) ng/L,T3:CRP (175.16 ±34.75) mg/L,TNF-α (65.79 ± 11.35) ng/L,IL-6 (79.02 ± 14.56) ng/L],the differences were statistically significant (t =5.919,6.703,4.080,3.367,6.010,4.443,all P ＜ 0.05).Compared with T0,serum levels of epinephrine(E),cortisol(Cor) increased in two groups at T2 and T3,and the differences were statistically significant(tcontrol group =10.03,8.096,8.679,7.029,tobservation group =6.473,4.728,6.330,4.727,all P ＜ 0.05).Compared with T2,serum levels of E and Cor in two groups at T3 were decreased,and the differences were statistically significant (tcontrol group =2.400,2.638,tobservation group =2.260,2.162,all P ＜ 0.05).At T2 and T3,the serum levels of E,Cor in the observation group [T2:E (286.36 ± 41.02) ng/L,Cor (262.52 ± 29.89) μg/L,T3:E (270.35 ±33.59)ng/L,Cor (253.23 ±30.28)μg/L]were lower than those in the control group[T2:E (312.56 ±38.75)ng/L,Cor (287.56 ± 38.76) μg/L,T3:E (295.79 ± 35.12) ng/L,Cor (270.25 ± 30.15) μg/L],the differences were statistically significant (t =3.457,3.917,3.828,2.981,all P ＜ 0.05).At To,T2 and T3,there were no statistically significant differences in CD3+,CD4+,CD8+ and CD4+/CD8+ between the two groups (all P ＞ 0.05).Conclusion Remifentanil combined with propefol anesthesia can make hemodynamics more stable in patients with acute abdomen complicated with septic shock,and can alleviate inflammation and stress response.
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Objective To explore and analyze the anesthetic effects of different doses of ropivacaine combined with lidocaine for epidural anesthesia in elderly patients undergoing hysterectomy.Methods A total of 100 elderly patients who required hysterectomy in our hospital from April 2009 to June 2012 were randomly divided into the low dose group and the high dose group (n=50,each group).The low dose group was given 10 mg ropivacaine combined with lidocaine for lumbar epidural anesthesia,and the high dose group was given 15 mg ropivacaine combined with lidocaine for lumbar epidural anesthesia.The anesthetic effects in the two groups were observed.Results The onset time of sensory block and highest plane time were significantly shorter in high dose group than in low dose group [(159±21) s vs.(225±23) s,(7.3±1.3) min vs.(9.2±1.5) min,respectively,t=3.412 and 2.877,both P＜0.05)].The maintenance time of highest plane was significantly longer in high dose group than in low dose group [(57.3±8.1) min vs.(45.3±7.2)min,t=2.623,P＜0.05].The onset time of movement block was shorter in high-dose group than in low dose group[(4.3±1.2) min vs.(6.9±1.3) min,t=3.109,P＜0.05],while the maintenance time of movement was longer in high-dose group than in low dose group[(161 ± 16) min vs.(133 ±14) min,t=2.793,P＜0.05].There were no significant differences in modified Bromage Score between the two groups (P＞0.05).The excellent anesthetic effect was significantly higher in high dose group than in low dose group (90％ vs.80％,x2 =4.33,P＜0.05).There were no significant differences in the incidence of adverse reactions between the two groups (P＞0.05).Conclusions The application of 15 mg ropivacaine combined with lidocaine has a better anesthetic effect for lumbar epidural anesthesia in elderly patients undergoing hysterectomy.It can provide a reference for the clinical practice.
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Objective To investigate the effect of propofol combined with remifentanil or sufentanil on cognitive function in patients undergoing awake craniotomy. Methods Sixty ASA Ⅰ or Ⅱ neurosurgical patients undergoing resection of glioma in cerebral cortical functional area were divided into 2 groups by random digits table: propofol + remifentanil (group RF, 30 cases) and propofol + sufentanil (group SF, 30 cases). Scalp nerve block and local infiltration of incision and dura mater were performed in both groups with 0.5% ropivacaine. Propofol, remifentanil and sufentanil were administered by target controlled infusion. The target plasma concentration of remifentanil was set at 1-2 ng/ml and that of sufentanil at 0.1-0.2 ng/ml,propofol was set at 3-6 μg/ml at open skull stage. The patients were inserted laryngeal mask and mechanically ventilated. Bispectral index (BIS) was monitored as the depth of anesthesia. Mini-mental scale examination (MMSE) was investigated at the time of preoperative,intraoperative wake-up after the patients had been targeted capacity. Results Blood concentration of propofol in group RF was (1.10 ± 0.06)μg/ml, group SF was (0.98 ± 0.05)μ g/ml in patients during intraoperative wake-up. BIS in group RF changed from 46.4 ± 2.5 to 90.8 ± 3.2 during wake-up, group SF from 44.8 ± 2.1 to 89.9 ± 3.2. The cognitive function score was not significantly different at the time of preoperative and intraoperative assessment. Conclusion Propofol combined with remifentanil or sufentanil has no effect on cognitive function for the patients undergoing awake craniotomy.
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Objective To assess the efficacy and safety of target-controlled infusion of propofol and remifentanil in geriatric patients with hepatocellular carcinoma undergoing percutaneous radiofrequency ablation. Methods Thirty geriatric patients with primary hepatocellular carcinoma of ASA Ⅱ-Ⅲ scheduled for percutaneous radiofrequency ablation under monitored anesthesia care (MAC) were randomly allocated to two groups: target-controlled infusion of propofol and remifentanil group (PR group, n= 15) and intravenous injection of midazolam and fentanyl group (MF group. n= 15). The mean arterial blood pressure (MAP), heart rate (HR) and pulse oxygen saturation (SpO2) of patients were recorded during the treatment. The Ramsay Score, Patient Cooperation Score, VAS Score and postoperative Patient Satisfaction Score were recorded as well. Results The Ramsay Score, Patient Cooperation Score, VAS Score and Patient Satisfaction Score were all higher in PR group than in MF group (all P<0.05). The maximum values of MAP and HR [( 108.7± 8.6) mm Hg, (83.8±7.1) times/min] were significantly higher than the baseline values [( 99.3 ± 8.5) mm Hg, (76.3±7.1) times/min] in MF group, and the degree of increment of MAP and HR were significantly greater in MF group than in PR group (both P<0.05). The minimum values of MAP and HR [(84.5±6.5) mm Hg, (66.6 ± 6.6) times/min] were significantly lower than the baseline values [(97.7±6.5) mm Hg, (75.4±7.3) times/min] in PR group, and the degree of decrement of MAP and HR were significantly greater in PR group than in MF group (both P<0.05). SpO2 of both groups decreased significantly (the minimum values of PR and MF groups were 95.1±2.0 and 95.5± 2.2, respectively), but there was no statistical difference between two groups (P>0.05) . Conclusions MAC with target-controlled infusion of propofol and remifentanil is more suitable for geriatric patients with hepatocellular carcinoma undergoing percutaneous radiofrequency ablation, as it can provide ideal analgesia and sedation, but the respiration and the change of hemodynamics of patients must be observed seriously.