Protective effect of sevoflurane on lung function of elderly chronic obstructive pulmonary disease patients undergoing total hip arthroplasty.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a common respiratory disorder that affects the elderly population and increases the risk of postoperative pulmonary complications (PPCs) after major surgeries. Sevoflurane is a volatile anesthetic that has been shown to have anti-inflammatory and antioxidant properties and attenuate lung injury in animal models. AIM: To evaluate the protective effect of sevoflurane on the lung function of elderly COPD patients undergoing total hip arthroplasty (THA). METHODS: In this randomized controlled trial, we randomly assigned 120 elderly patients with COPD, who were scheduled for THA, to receive either sevoflurane (sevoflurane group) or propofol (propofol group) as the maintenance anesthetic. The primary outcome was the incidence of PPCs within seven days after surgery. The secondary outcomes were changes in the lung function parameters, inflammatory markers, oxidative stress markers, and postoperative pain scores. RESULTS: The results showed that the incidence of PPCs was significantly lower in the sevoflurane group than in the propofol group (10% vs 25%, P = 0.02). Furthermore, the decline in the forced expiratory volume in 1 s, forced vital capacity, and peak expiratory flow was significantly lesser in the sevoflurane group than in the propofol group at 24 h and 48 h after surgery (P < 0.05). The interleukin-6, tumor necrosis factor-alpha, malondialdehyde, and 8-hydroxy-2 α-deoxyguanosine levels were significantly lower in the sevoflurane group than in the propofol group at 24 h after surgery (P < 0.05). The sevoflurane group showed significantly lower postoperative pain scores than the propofol group at 6 h, 12 h, and 24 h after surgery (P < 0.05). CONCLUSION: Sevoflurane protects the lung function of elderly COPD patients undergoing THA under general anesthesia by reducing the incidence of PPCs, attenuating inflammatory and oxidative stress responses, and alleviating postoperative pain.

[Professor XIANG Xian-de's clinical experience of acupuncture and Chinese herbal medicine on functional dyspepsia].

Professor XIANG Xian-de's clinical experience of acupuncture and Chinese herbal medicine on functional dyspepsia is introduced. Inview of the treatment based on syndrome differentiation, professor XIANG uses acupuncture with Chinese herbal medicine, psychological counseling and regular diet, etc. to treat functional dyspepsia comprehensively. In terms of syndrome differentiation, six-meridian and visceral syndrome differentiation are selected;methods such as soothing liver and regulating qi, invigorating spleen and stomach are adopted as the treatment principle; meridians are mainly the conception vessel, stomach meridian of foot-yangming and spleen meridian of foot-taiyin; acupoints are mainly selected with "new ten needles" and both internal and external treatment are advocated; needling method is fast twisting needle insertion; manipulation is adopted with directional supplementation and draining method; and the combination of acupuncture and Chinese herbs is adopted on the treatment. Regular diet, standardized work and rest, five elements music therapy for psychological intervention, give patients positive psychological hints, to achieve the effect of both body and mind.