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Objective:To evaluate the value of implementing strict aseptic operation procedures in preventing central venous catheter-related infections.Methods:This retrospective cohort study consisting of non-surgical patients who underwent central venous catheterization from 2015 to 2019 were conducted.The patients were divided into 2 groups according to routine aseptic procedures and strict aseptic procedures, the patients between 2015 and 2017 served as routine aseptic procedure group (group C), and the patients between 2017 and 2019 served as strict aseptic procedure group (group E ). The occurrence of central venous catheter-related infections (local infection, bloodstream infection) was recorded within 6 days after catheterization.Results:Compared with group C, the incidence of central venous catheter-related local infection was significantly decreased (1.79% vs. 0.48%, P<0.001; the rate ratio being 0.27 ranged in 0.10-0.30), while no significant change was found in the incidence of central venous catheter-related bloodstream infection in group E (0.29% vs. 0.19%, P>0.05). The cumulative incidence of central venous catheter-related infections was 0.67%(<1.00%) in group E. Conclusions:Implementation of strict aseptic procedures during central venous catheterization can further reduce the occurrence of central venous catheter-related infections, which has significant clinical value.
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Objective:To investigate the effect of sevoflurane anesthesia on electroencephalographic (EEG) seizures and long-term behavior and possible mechanism in neonatal rats.Methods:A total of 141 postnatal days 4-6 Sprague-Dawley rats (66 male, 75 female) were divided into 3 groups ( n=47 in each group) according to random number table method: control group, sevoflurane group, and NKCC1 inhibitor group, with 22 males and 25 females in each group. Rats in the control group were fed in normal cage without anesthesia; rats in the sevoflurane group were anesthetized with 2.1% sevoflurane for 6 hours; rats in the NKCC1 blocker group received intraperitoneal injection of 1.82 mg / kg bumetanide 30 minutes before anesthesia with 2.1% sevoflurane. The rats in the control group and sevoflurane group were injected subcutaneously with the same dose of DMSO at the same time when the NKCC1 blocker group received the drug intervention, so as to eliminate the influence caused by the solvent. The rats were observed for 30 minutes after recovery from anesthesia and then continued to breastfeed normally. Some of the new born rats received EEG monitoring from 9 to 11 days after being raised; the other rats received EPM and PPI respectively at 60 and 70 days after being raised. Results:The results of EEG showed that, compared with the control group, the number of epileptic waves((0.429±0.787), (1.571±0.787), t=2.753, P<0.01), the average duration of single epileptic wave ((1.575±2.349), (6.392±3.374), t=3.880, P< 0.01), the total duration increased significantly ((1.800±3.617), (10.957±6.028), t= 3.929, P<0.01) were all increased, the differences were statistically significant. Compared with sevoflurane group, the number of epileptic waves in EEG of male rats in NKCC1 blocker group decreased, the average duration of single epileptic wave decreased, and the total duration of epileptic wave shortened significantly, with statistical significance ((0.286±0.756), (0.925±1.733), (1.043±2.759), t=3.097, 4.404, 4.254, all P<0.01). There were no significant differences in female rat among the three groups (all P>0.05). Compared with male rats, the average duration of female rats in sevoflurane group decreased ((6.392±3.374), (2.515±2.992), t=3.044, P<0.01), the total duration shortened ((10.957±6.028), (3.270±5.883), t=2.626, P<0.01), the difference was statistically significant.The behavioral results showed that, compared with the control group, the open arm dwell time of male rats in sevoflurane group was significantly shorter ( P<0.05), and the panic response in PPI group was significantly lower ( P<0.05), the difference was statistically significant.Compared with the sevoflurane group, the open arm dwell time in NKCC1 blocker group was significantly longer ( P<0.05), and the panic response in PPI group was significantly increased.The difference was statistically significant ( P<0.05). The change trend in female rats of each group was similar to that of male rats, but there was no significant difference (all P>0.05). Comparison between male and female rats: compared with male rats in sevoflurane group, the female rats in sevoflurane group had a longer open arm stay time in EPM experiment ( P<0.05), the difference was statistically significant. Conclusion:Sevoflurane anesthesia for 6 hours can significantly increase the generation of epileptic waves in EEG of male newborn rats, and cause behavioral abnormalities in adult male rats, which may be related to NKCC1.And male rats are more vulnerable to the negative effects of sevoflurane anesthesia on brain nerve development.
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Objective:To evaluate the role of hypothalamic aromatase in sevoflurane anesthesia-induced epileptic waves in neonatal rats.Methods:Thirty clean-grade healthy neonatal Sprague-Dawley rats of both sexes, aged 5 days, weighing 10-15 g, were divided into 3 groups ( n=10 each) according to a random number table method: control group (group C), sevoflurane group (group S), and aromatase inhibitor formestane plus sevoflurane group (group F). The electroencephalogram (EEG) in the neonatal rat cortex was monitored, 30 min later formestane 2 mg/kg was subcutaneously injected in F group, while the equal volume of normal saline was given instead in C and S groups.At 30 min after subcutaneous administration, 6% sevoflurane was inhaled to induce anesthesia for 3 min, and then the concentration was adjusted to 2.1% to maintain anesthesia for 57 min in S and F groups.The total duration and single duration of epileptic waves and the number of seizure during sevoflurane anesthesia were recorded.After the end of EEG recording, the laparotomy was performed, the left ventricular puncture was performed, and blood samples were collected for blood gas analysis and for determination of corticosterone levels (by enzyme-linked immunosorbent assay). Brain tissues were obtained, and then the hypothalamus was rapidly isolated for determination of the expression of aromatase mRNA, Na + -K + -2Cl - cotransporter-1 (NKCC1) mRNA and K + -Cl - cotransporter-2 (KCC2) mRNA (by polymerase chain reaction). Results:No epileptic waves were found in group C. Compared with group C, the total duration and single duration of cortical epileptic waves were significantly prolonged, and the number of seizures was increased, the serum corticosterone concentration was increased, the expression of aromatase mRNA was up-regulated, and NKCC1/KCC2 mRNA ratios were increased in S and F groups ( P<0.05). Compared with group S, the total duration and single duration of cortical epileptic waves were significantly shortened, and the number of seizures was decreased, the serum corticosterone concentration was decreased, the expression of aromatase mRNA was down-regulated, and NKCC1/KCC2 mRNA ratios were decreased in group F ( P<0.05). Conclusion:Up-regulation of hypothalamic aromatase expression is involved in the development of sevoflurane anesthesia-induced epileptic waves in newborn rats.
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Objective To investigate the effect of estradiol on sevoflurane-induced epileptiform cor-tical EEG waves in neonatal rats. Methods Forty neonatal rats,aged 4-6 days,weighting 8-15 g,were di-vided into 5 groups according to random number table:normal saline control group (group C),estradiol group (group E),ICI182780 (group I),Formestane group (group O) and estradiol +ICI182780 (group EI). Af-ter establishing the monitoring model of cortical electroencephalogram in neonatal rats, EEG was recorded continuously for 30 minutes, then different treatment drugs were given according to different groups. After 30 minutes of continuous recording of EEG, anesthesia induction was started with inhalation of 6% sevoflurane for 3 minutes, followed by inhalation of 2. 1% sevoflurane to maintain anesthesia. Sevoflurane anesthesia las-ted for 1 hour. The righting reflex disappearance time was recorded after sevoflurane anesthesia. The total du-ration,single duration and frequency of EEG convulsion waves were recorded. Spike frequencies were recor-ded at different periods. Animal respiratory rate was recorded after sevoflurane induction. Results One rat in group I and one rat in group EI showed convulsion wave before treatment,which were excluded from the study. The righting reflex disappearance time of group S,group E,group I,group O and group EI were (24. 4 ±2. 5)s,(16. 4±4. 2)s,(31. 8±5. 2) s,(29. 8±1. 8) s,(24. 8±2. 7) s respectively,and there were statisti-cally significant differences among the 5 groups (F=16. 693,P<0. 01). There were no significant difference in respiratory frequency among the 5 groups (F=0. 276,P>0. 05). Compared with group S,the total dura-tion,single duration and frequency of convulsion wave were significantly increased in group E during anesthe-sia,and the differences were statistically significant (P<0. 05). Compared with group E and group S,the total duration,single duration and frequency of convulsion wave during anesthesia were significantly reduced in group I,group O and group EI,and the differences were statistically significant (P<0. 05). Compared with group S,the spike frequency of group E increased significantly in each period,and the differences were statis-tically significant (P<0. 05). The frequency of spike wave in group I,group O and group EI at 65-70 min and 90-95 min were lower than that in group S,and the differences were statistically significant (P<0. 05). The frequency of spike wave between group O and group EI during 115-120 min was statistically different with group S and group E(P<0. 05). Conclusion The mechanism of epileptiform EEG wave induced by sevoflu-rane anesthesia may be related with neuroactive steroidal estradiol.
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Objective To evaluate the efficacy of different doses of dexmedetomidine mixed with ropivacaine used for thoracic paravertebral nerve block (TPVB) combined with general anesthesia in the pa-tients undergoing radical resection of lung cancer. Methods One hundred patients of both sexes, aged 18-64 yr, with body mass index of 18-25 kg∕m2, of American Society of Anesthesiologists physical statusⅡorⅢ, scheduled for elective radical resection of lung cancer, were divided into 5 groups (n＝20 each) using a random number table method: general anesthesia group ( group G), TPVB with ropivacaine com-bined with general anesthesia group (group R), TPVB with 0. 5 μg∕kg dexmedetomidine mixed with ropiva- caine combined with general anesthesia group (group RD0. 5), TPVB with 1. 0 μg∕kg dexmedetomidine mixed with ropivacaine combined with general anesthesia group (group RD1. 0), and TPVB with 2. 0 μg∕kg dexmedetomidine mixed with ropivacaine combined with general anesthesia group ( group RD2. 0). Two-point TPVB was performed, and anesthetic 10 ml was injected into each puncture site. Zero point five per-cent ropivacaine was administered in group R. Dexmedetomidine 0. 5, 1. 0 and 2. 0 μg∕kg mixed with ropi-vacaine at the final concentration of 0. 5% were injected in group RD0. 5, group RD1. 0 and group RD2. 0, respectively. Anesthesia was maintained by intravenously infusing propofol and remifentanil and cisatracuri-um was intermittently injected to maintain muscle relaxation. The occurrence of intraoperative hypotension and bradycardia was recorded. The emergence time, extubation time, duration of postanesthesia care unit (PACU) stay and requirement for rescue analgesia during emergence from anesthesia were also recorded. Small marginal lung samples next to the tumor were harvested immediately after removing the tumor tissues. The expression of caspase-3 and Bcl-2 was determined by Western blot, the content of IL-1β in lung tissues was determined by enzyme-linked immunosorbent assay, the cell apoptosis was evaluated by TUNEL, and apoptosis index ( AI) was calculated. The injury to lung tissues was observed with a light microscope and scored. Results Compared with G and R groups, AI, IL-1β content and lung injury score were signifi-cantly decreased, the expression of caspase-3 was down-regulated, and the expression of Bcl-2 was up-regulated in the other three groups, the incidence of hypotension and bradycardia was significantly in-creased in group RD1. 0, the incidence of bradycardia was significantly decreased in group RD0. 5, and the incidence of hypotension and bradycardia was significantly increased, and the emergence time, extu-bation time and duration of PACU stay were prolonged in group RD2. 0 ( P＜0. 05). Compared with group RD0. 5, IL-1β content was significantly decreased, and the incidence of hypotension and bradycardia was increased in group RD1. 0, and IL-1β content was significantly decreased, the incidence of hypoten-sion and bradycardia was increased, and the emergence time, extubation time and duration of PACU stay were prolonged in group RD2. 0 ( P＜0. 05). Compared with group RD1. 0, the incidence of hypotension and bradycardia was significantly increased, and the emergence time, extubation time and duration of PACU stay were prolonged in group RD2. 0 ( P＜0. 05). There was no significant difference in the AI, expression of caspase-3 and Bcl-2, lung injury score, or requirement for rescue analgesia among RD0. 5, RD1. 0 and RD2. 0 groups ( P＞0. 05). Conclusion Dexmedetomidine 0. 5 μg∕kg mixed with ropiva-caine for TPVB combined with general anesthesia provides better efficacy in the patients undergoing radical resection of lung cancer.
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Nine pediatric patients (4 females,5 males) with huge hemangioma of head and neck complicated with Kasabach-Merritt phenomenon,aged 15-135 days,undergoing elective radical resection for huge hemangioma of head and neck,were selected from June 2012 to June 2016 in our hospital.Two pediatric patients were sensitive to preoperative hormone treatment,the platelet count almost increased to the normal value,7 pediatric patients were not sensitive to preoperative hormone treatment,and the increase in platelet count was not obvious.When the platelet count ＜ 40× 109/L,platelet was infused at 12 h before operation until the platelet count ＞ 100× 109/L.Two pediatric patients with larger haemangioma in maxillofacial region kept spontaneous breathing,and anesthesia was induced by inhaling high-concentration of sevoflurane.Anesthesia was induced with intravenous midazolam,sufentanil and cisatracurium in the other seven pediatric patients.Pediatric patients were mechanically ventilated in pressure-controlled mode after endotracheal intubation with airway pressure of 9-12 cmH2O.All pediatric patients inhaled sevoflurane,and anesthesia was maintained by infusing remifentanil.Heart rate and systolic blood pressure were maintained within the normal range during operation.Fluid and blood products were infused according to the blood loss,urine volume,physiological requirement and central venous pressure,etc.Pediatric patients were transferred to pediatric intensive care unit (PICU) at the end of operation,and the endotracheal tube was removed after the patients were completely awake.One pediatric patient developed pulmonary infection after operation,was discharged from PICU on day 7 after operation,then cured and discharged from hospital after healing on day 20 after operation.The other eight pediatric patients were discharged from PICU on day 2 after operation,then cured and discharged from hospital on days 5-10 after operation.After a followup period of 1 yr,the pediatric patients recovered well,the platelet count was normal,and the tumor recurrence was not found.
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Objective To evaluate the effect of dexmedetomidine on the cell apoptosis during the acute lung injury induced by blunt chest trauma in rats.Methods Thirty pathogen-free male SpragueDawley rats,weighing 240-270 g,aged 8 weeks,were divided into 3 groups (n=10 each) using a random number table:shan operation group (group Sham),blunt chest trauma group (group T) and blunt chest trauma plus dexmedetomidine group (group TD).The model of acute lung injury was induced by dropping a 300 g weight onto a precordium in anesthetized rats.After the model was established,dexmedetomidine was intravenously infused at a rate of 5 μg · kg 1 · h-1 for 6 h in group TD.At 6 h after the model was established,blood samples were collected from the femoral artery for determination of concentrations of serum tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6).The rats were sacrificed after blood sampling,and lungs were removed for examination of the pathological changes (with light microscope) and for determination of Bax and Bcl-2 expression in lung tissues (by immuno-histochemistry) and cell apoptosis (by TUNEL).Bcl-2/Bax ratio and apoptosis index (AI) were calculated.Results Compared with group C,the serum TNF-α and IL-6 concentrations and AI were significantly increased,the expression of Bax and Bcl-2 was up-regulated,and Bcl-2/Bax ratio was decreased in T and TD groups (P＜ 0.01).Compared with group T,the serum TNF-α and IL-6 concentrations and AI were significantly decreased,the expression of Bax in lung tissues was down-regulated,the expression of Bcl-2 in lung tissues was up-regulated,Bcl-2/Bax ratio was increased (P＜0.05),and the pathological changes of lung tissues were significantly attenuated in group TD.Conclusion The mechanism by which dexmedetomidine mitigates the acute lung injury induced by blunt chest trauma is related to inhibition of cell apoptosis in rats.
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Objective To investigate the effects of penehyclidine hydrochloride (PHCD) on acute lung injury (ALI) induced by blunt chest trauma and Toll-like receptor 4 (TLR4) expression in the lung tissues in rats.Methods Ninety-six male SD rats weighing 250-300 g were randomly divided into 3 groups ( n = 32 each):control group (group C), ALI group and PHCD group. ALI was induced by dropping a 300 g weight onto a precordial protective shield to direct the impact force away from the heart and toward the lungs in anesthetized rats according to the method described by Raghavendran et al. PHCD 2 mg/kg was injected intraperitoneally immediately after ALI was induced in group PHCD. Eight rats were selected at 2, 8, 12 and 24 h after ALI was induced, and arterial blood samples were collected for determination of the serum TNF-α concentration. Eight rats were selected at 8 h after ALI was induced, arterial blood samples collected for blood gas analysis and then the rats sacrificed. The lungs were immediately removed for determination of W/D lung weight ratio, myeloperoxidase (MPO) activity and TLR4 expression, and microscopic examination. Results The pH value and PaO2 were significantly lower, and the PaCO2, lactic acid level, MPO activity, W/D ratio, TLR4 expression and serum TNF-α concentration higher in groups ALI and PHCD than in group C (P ＜ 0.01 ). The pH value and PaO2 were significantly higher, and the PaCO2, lactic acid level, MPO activity, W/D ratio, TLR4 expression and serum TNF-α concentration lower in group PHCD than in group ALI ( P ＜ 0.05). The lung histopathologic damage was significantly ameliorated in PHCD group as compared with ALI group. Conclusion PHCD can protect the lungs against blunt chest trauma-induced ALI, and the down-regulation of TLR4 expression in lung tissues and reduction of inflammatory response are involved in the mechanism.
