Effect of acute normovolemic hemodilution autologous blood transfusion on the EEG bispectral index and muscle relaxation in elderly patients undergoing orthopedic surgery / 中国临床药理学与治疗学

AIM: To observe the effect of acute normovolemic hemodilution (ANH) autologous blood transfusion on the EEG bispectral index and muscle relaxation in elderly patients undergoing orthopedic surgery to explore the influence of autologous blood transfusion containing anesthetic components on the quality and safety of postoperative anesthesia recovery. METHODS: Forty patients, aged 65-75, weighing 55-80 kg, ASA grade I-II, with an estimated intraoperative blood loss of more than 600 mL, were selected for elective orthopedic surgery. The patients were randomly divided into two groups (n=20): group A was given acute normovolemic hemodilution (ANH), and the target value of Hct was 28%-30% after induction of anesthesia; group B was the control group which was given routine fluid infusion during operation without ANH. Bispectral index (BIS), TOF values and plasma concentrations of propofol and cisatracurium were measured at the beginning of autotransfusion (T

Effectiveness of Simplified Airway Risk Index score in predicting difficult airway in Chinese patients / 中华麻醉学杂志

Objective:To evaluate the effectiveness of Simplified Airway Risk Index (SARI) score in predicting difficult airway in Chinese patients.Methods:One thousand and three hundred patients of both sexes, aged 18-90 yr, with American Society of Anesthesiologists physical status Ⅰ-Ⅲ, undergoing tracheal intubation with the laryngoscope under general anaesthesia, were enrolled in this study.SARI scores (including 7 evaluation items: mouth opening, thyromental distance, Mallampati classification, neck mobility, mandibular protrusion, body weight, and history of difficulty in tracheal intubation) were determined before anesthesia induction.The receiver operating characteristic curve and area under the curve (AUC) were used to evaluate the effectiveness of SARI scores in predicting difficult tracheal intubation and difficult laryngoscopy.Results:The AUC and 95% confidence interval of the SARI score, mouth opening, modified Mallampati classification and thyromental distance in predicting difficult tracheal intubation were 0.91 (0.89-0.93), 0.84 (0.82-0.86), 0.81 (0.79-0.83) and 0.83 (0.80-0.85), respectively.The AUC and 95% confidence interval of the SARI score, mouth opening, modified Mallampati classification and thyromental distance in predicting difficult laryngoscopy were 0.90 (0.88-0.91), 0.79 (0.76-0.81), 0.76 (0.74-0.78) and 0.73 (0.70-0.75), respectively.The AUC of SARI scores in predicting difficult tracheal intubation and difficult laryngoscopy was significantly larger than that of the mouth opening, modified Mallampati classification and thyromental distance ( P<0.05). Conclusion:The SARI score produces better efficacy in predicting tracheal intubation and difficult laryngoscopy in Chinese patients.

Application of micellar electrokinetic capillary chromatography for identification, quantitative detection and unfolding analysis of interleukin-12 / 南方医科大学学报

OBJECTIVE@#To establish a micellar electrokinetic capillary chromatography-based method for identification and quantitative detection of interleukin-12 (IL-12) and analysis of its unfolding process.@*METHODS@#An uncoated fused-silica capillary (inner diameter 50 μm) with a total length of 48.5 cm (40 cm to the detector) was used for the experiment. The factors influencing the separation efficiency of IL-12 were analyzed, and a standard curve of IL-12 concentration was established. The mixture of IL-12 and anti-IL-12 antibody was incubated in a water bath at 38 ℃ for 40 min, and capillary electrophoresis was then performed under the same conditions. The results were compared with those of IL-12 and anti-IL-12 antibody to identify IL-12. IL-12 and dithiothreitol (DTT) were incubated at 60 ℃ in water bath for different lengths of times, and the unfolding process of IL-12 was analyzed based on electrophoresis results of IL-12 in different states.@*RESULTS@#A micellar capillary electrophoresis on-line sweep method was established with 80 mmol/L borate (pH=9.3) containing 30 mmol/L sodium dodecyl sulfate (SDS) as the buffer solution. This system showed a good linear relationship between the peak area and the mass concentration of IL-12 with a linear correlation coefficient of 0.9991 within the linear range of 2 to 120 ng/L. As the incubation time of IL-12 and DTT prolonged, the disulfide bond of IL-12 gradually opened and resulted in distinct changes in the protein peak.@*CONCLUSIONS@#This capillary electrophoresis-based method is simple and sensitive for IL-2 analysis and allows rapid detection of changes in IL-12 content in the setting of tumors and analysis of the possible causes.

The application of SimMan 3G situational simulation method in anesthesiology teaching / 中华医学教育探索杂志

Objective To evaluate the application value of situational simulation method based on SimMan 3G in anesthesiology teaching. Methods 5-years anesthesiology under-graduates of 2012 grade and 2013 grade in Wannan Medical Colloge anticipating in clinical practice of anesthesia were selected as observation group. All students were divided into two groups: control group (teachers demonstrated cases, 2012 grade, n=35) and observation group (students role-played simulation cases, 2013 grade, n=36). In control group, teachers firstly applied a multimedia courseware, and then demonstrated the cases to adopt the SimMan 3G simulated system. In observation group, SimMan 3G situational simulation method was used to teach the course , and then the students played roles and videotaped the whole course in the simulated operating room. After training, the students discussed their performance in the simulated training (by the playback of the simulated video), and the teachers commented and summarized the case. The effect of teaching was evaluated by questionnaire and examination. The date were analyzed through Chi-square and t-test test. Results There was no significant difference in essential characteristics, including age, gender, the scores of specialized theory at routine examination between two groups (P>0.05). Statistical difference was found in the theoretical assessment between observation group and control group [(79.44±5.41) vs. (73.46± 4.62), P=0.001]. Meanwhile, questionnaire survey of teaching effect showed that in observation group 31 students (86.1％) were satisfied with the teaching contents, 33 students (91.7％) had consolidated clinical thinking, and 34 students (94.4％) believed it improved their teamwork and communication ability (P=0.031, P=0.018, P=0.013). Conclusion Using SimMan3G for role-playing situational simulation teaching can significantly improve student's comprehensive theoretical scores, facilitate the exercise of clinical thinking, and improve their teamwork and communication skills.

Effects of different hemoglobin concentrations on lung injury in a rabbit model of hemorrhagic shock and resuscitation / 中华麻醉学杂志

Objective@#To evaluate the effect of different hemoglobin (Hb) concentrations on the lung injury in a rabbit model of hemorrhagic shock and resuscitation (HS-R).@*Methods@#Fifty healthy male New Zealand rabbits, aged 2 months, weighing 1.9-2.4 kg, were divided into 5 groups (n=10 each) using a random number table method: control group (group C), HS-R group (group H), and three HS-R plus infusion of concentrated red blood cell groups group R1 (60 g/L≤Hb<80 g/L), group R2 (80 g/L≤Hb<100 g/L) and group R3 (100 g/L≤Hb<120 g/L). The animals were sacrificed at 3 h after resuscitation, lung tissues were obtained for examination of the pathological changes with a light microscope, and lung tissues were obtained again for determination of wet to dry weight ratio (W/D ratio), neutrophil myeloperoxidase (MPO), NO level and cell apoptosis (by TUNEL).@*Results@#Compared with group C, the levels of MAP and NO, W/D ratio and apoptosis index were significantly increased in the other groups (P<0.05). Compared with group H, the levels of MAP and NO, W/D ratio and apoptosis index were significantly decreased in R2 and R3 groups (P<0.05). Compared with group R2, the apoptosis index was significantly increased at T5(P<0.05), and no significant change was found in the other parameters in group R3 (P>0.05).@*Conclusion@#Maintaining Hb 80-100 g/L after HS-R reduces acute lung injury in rabbits.

Effects of different hemoglobin concentrations on lung injury in a rabbit model of hemorrhagic shock and resuscitation / 中华麻醉学杂志

Objective To evaluate the effect of different hemoglobin(Hb)concentrations on the lung injury in a rabbit model of hemorrhagic shock and resuscitation(HS-R).Methods Fifty healthy male New Zealand rabbits,aged 2 months,weighing 1.9-2.4 kg,were divided into 5 groups(n＝10 each)u-sing a random number table method: control group(group C),HS-R group(group H),and three HS-R plus infusion of concentrated red blood cell groups group R1(60 g/L≤Hb＜80 g/L),group R2(80 g/L≤Hb＜100 g/L)and group R3(100 g/L≤Hb＜120 g/L).The animals were sacrificed at 3 h after resuscita-tion,lung tissues were obtained for examination of the pathological changes with a light microscope,and lung tissues were obtained again for determination of wet to dry weight ratio(W/D ratio),neutrophil my-eloperoxidase(MPO),NO level and cell apoptosis(by TUNEL).Results Compared with group C,the levels of MAP and NO,W/D ratio and apoptosis index were significantly increased in the other groups(P＜0.05).Compared with group H,the levels of MAP and NO,W/D ratio and apoptosis index were signifi-cantly decreased in R2 and R3 groups(P＜0.05).Compared with group R2,the apoptosis index was signif-icantly increased at T5(P＜0.05),and no significant change was found in the other parameters in group R3(P>0.05).Conclusion Maintaining Hb 80-100 g/L after HS-R reduces acute lung injury in rabbits.

Accuracy of Wilson risk score in predicting difficult tracheal intubation / 中华麻醉学杂志

Objective To evaluate the efficacy of Wilson risk score in predicting difficult tracheal intubation. Methods American Society of Anesthesiologists physical statusⅠ-Ⅲ patients of both sexes, aged≥18 yr, undergoing elective surgery with general anesthesia, were enrolled in the study. All the pa-tients were evaluated by the special researchers for assessment of the preoperative airway. The assessment i-tems included the Wilson risk score ( 5 risk factors: weight, jaw movement, head and neck movement, mandible receding, buck teeth), modified Mallampati classification, thyromental distance, inter-incisor distance, etc. After the airway assessment was completed, anesthesia induction was conducted, and tra-cheal intubation was performed after 3 min of pressure ventilation under the mask. The primary outcome was difficult tracheal intubation. The receiver operating characteristic curve and area under the curve ( AUC) were used to analyze the efficacy of the corresponding parameters in diagnosing difficult tracheal intubation. The optimal predictive cut-off value and corresponding sensitivity and specificity of the parameters were de-termined by using the Youden index. Results A total of 1544 patients were enrolled in this study, and difficult intubation was found in 37 cases. The analysis of receiver operating characteristic curve showed that the AUC of the modified Mallampati classification was 0. 65, and the AUC of the thyromental distance was 0. 81, and the AUC of the Wilson risk score was 0. 91. Compared with the modified Mallampati classifica-tion and thyromental distance, the AUC of Wilson risk score was significantly increased when used for pre-dicting difficult tracheal intubation (P<0. 05). Compared with the inter-incisor distance, no significant change was found in the AUC of Wilson risk score in predicting difficult tracheal intubation ( P>0. 05) . The optimal predictive cut-off value of the Wilson risk score was more than 1, which was determined by the Youden index. Conclusion Wilson risk score provides better efficacy than the modified Mallampati classi-fication and thyromental distance in predicting difficult tracheal intubation.

Effect of the LEMON method in predicting patients with difficult airway / 临床麻醉学杂志

Objective To evaluate the effect of the LEMON method in predicting difficult air-way.Methods A total of 1 528 patients scheduled for elective surgery requiring tracheal intubation under general anaesthesia,680 males and 848 females,aged 18-83 years,ASA physical status Ⅰ orⅡ,were enrolled in the study.We used the LEMON method to assess airway conditions before an-aesthesia and recorded the scores.The primary end point was difficult tracheal intubation.The sec-ondary end point was difficult laryngoscopy.Receiver operating characteristic (ROC)curve analysis and the area under the curve (AUC)were used to evaluate the clinical effect of the LEMON mothod. Results There were 37 cases with difficult tracheal intubation and 106 cases with difficult laryngosco-py.The incidence of difficult tracheal intubation and difficult laryngoscopy were 2.4% and 6.9%,re-spectively.The area under the curve of the LEMON method for predicting difficult laryngoscopy and difficult tracheal intubation were 0.884 (95% CI 0.867-0.899)and 0.934 (95% CI 0.921-0.946), respectively.Conclusion The LEMON method has good clinical effect in predicting difficult airway.

Effects of dexmedetomidine on early postoperative cognitive function after non-cardiac surgery in elderly patients:a meta-analysis / 临床麻醉学杂志

Objective To explore the effects of dexmedetomidine on postoperative cognitive function after non-cardiac surgery in elderly patients by meta-analysis.Methods We searched Co-chrane Library,MEDLINE,EMbase,Ovid,Springer,China Biology Medicine,CNKI,VIP and WanFang Data for controlled clinical trials.All randomized controlled trials (RCT)that meet their standards of dexmedetomidine on postoperative cognitive function after non-cardiac surgery in elderly patients were collected. The meta-analysis was performed by Review Manager 5.3. Results Twenty-two trials with 1 713 patients were included in this meta-analysis.The results of me-ta-analysis showed that:Mini-mental state examination (MMSE)MD=2.99,95%CI (2.25,3.74) one day before operation,MD=1.66,95%CI (0.68,2.64)three days after operation,MD=1.52, 95%CI (0.55,2.49)seven days after operation,respectively (P <0.05);Perioperative dexmedeto-midine treatment was significantly associated with better neurocognitive performance in comparison with saline.Compared with normal saline group,the serum concerntrations of neuron-specificenolase, S100β protein, TNF-α and IL-6 were significantly decreased in dexmedetomidine group. Conclusion The present meta-analysis indicates that dexmedetomidine shows superiority over placebo in early postoperative neurocognitive function after non-cardiac surgery in elderly patients.

Effect of morphine exposure in late pregnancy on expression of NR2B in nucleus accumbens of off-spring rats / 中华麻醉学杂志

Objective To evaluate the effect of morphine exposure in the late pregnancy on the expression of 2B subunit-containing N-methyl-D-aspartate receptor (NR2B) in the nucleus accumbens of offspring rats.Methods Forty-eight Sprague-Dawley rats at 14 days of gestation,aged 16-20 weeks,weighing 400-600 g,were equally and randomly divided into control group (group C) and morphine group (group M).In group M,morphine was administered subcutaneously twice a day (9:00 a.m.and 5:00 p.m.) in the initial dose of 2 mg/kg followed by daily increment of 1 mg/kg until 6 mg/kg.The equal volume of normal saline was given instead of morphine in group C.Fifty offspring rats with similar body weight were selected from the two groups,and conventionally fed for 8 weeks.Thirty offspring rats were further selected,morphine 3 mg/kg was injected subcutaneously for 7 consecutive days,and then the rats underwent the conditioned place preference test to monitor the effect.The time spent in drug-paired side (gray area) was recorded at 24 h after the test.Ten offspring rats selected were sacrificed after the test,and the brain was removed.The nucleus accumbens was isolated for detection of the expression of NR2B by immunohistochemistry and Western blot.Results Compared with group M,the time spent in drug-paired side (gray area) was significantly prolonged,and the expression of NR2B in the nucleus accumbens was up-regulated in group C (P＜0.05).Conclusion The mechanism by which morphine exposure in the late pregnancy causes susceptibility to morphine addiction is associated with up-regulation of NR2B expression in the nucleus accumbens of offspring rats.

Value of hyomental distance measured when the hyoid is located using ultrasound in predicting difficult airway / 中华麻醉学杂志

Objective To evaluate the value of hyomental distance (HMD) measured when the byoid was located using ultrasound in predicting the difficult airway.Methods Two hundred and thirteen patients of both sexes,aged 18-64 yr,with body mass index of 14-34 kg/m2,with interincisor distance ＞3 cm,with atlanto-axial joint mobility ＞ 90°,of Mallampati class Ⅰ-Ⅳ,of American Society of Anesthesiologists physical status Ⅰ-Ⅲ,scheduled for elective surgery requiring endotracheal intubation under general anesthesia,were enrolled in the study.The HMD was measured by fingers (finger breaths in width,HMDf) and by rulers (HMDr) when the hyoid was located artificially and when the hyoid was viewed on ultrasound (HMDu) before anesthesia induction.After anesthesia induction,the difficult airway was defined as Cormack-Lehane grade 3 or 4 assessed under direct laryngoscope during intubation.The hyoid viewed on ultrasound was considered as the criterion,and the error rate was calculated when the hyoid was located artificially.Youden Index was used to determine the optimal value in predicting difficult airway,and the specificity and sensitivity of HMDf,HMDr and HMDu in predicting difficult airway were calculated based on this criterion.Results The error rate was 18.8％ when the hyoid was located artificially.The specificity and sensitivity of HMDu in predicting difficult airway were 64.6％ and 91.5％,respectively.The specificity and sensitivity of HMDr in predicting difficult airway were 62.5％ and 84.8％,respectively.The specificity and sensitivity of HMDf in predicting difficult airway was 29.2％ and 98.2％,respectively.Conclusion The HMD measured when the hyoid is located using ultrasound can accurately predict the difficult airway.

Clinical value of MGFA classification and QMG score on predicting late extubation after thymectomy in patients with myasthenia gravis / 临床麻醉学杂志

Objective To evaluate clinical value of MGFA classification and QMG score on pre-dicting late extubation after thymectomy for myasthenia gravis(MG).Methods Total of 61 patients with MG received extended thymectomy from January 2007 to February 2012 were enrolled.Patients were divided into two groups:normal extubation group contained the other 47 patients without pro-longed postoperative mechanical ventilation and delayed extubation group included 14 patients with prolonged postoperative mechanical ventilation.The following factors were evaluated:gender,age, weight,MGFA classification,QMG score,history of steroid hormones or anticholinesterase drugs be-fore operation,the function of liver and kidney before operation,preoperative electrolyte,preoperative hemoglobin content,etc.Receiver operator characteristic curve (ROC)was plotted,and the predictive value, sensitivity and specificity of preoperative MGFA clinical classification and QMG score predicting postoperative ventilation in MG were calculated.Results Fourteen patients(22.95%)de-veloped breathing support after the anaesthetic or endotracheal intubation again in 48 hours.the area under ROC curve(AUC)for preoperative MGFA clinical classification predicting postoperative ventila-tion was 0.723 in MG,it had the sensitivity of 78.5% and specificity of 63.8%.The AUC for QMG score predicting postoperative ventilation was 0.866,the QMG score threshold value of 8.5 had the sensitivity of 78.6% and specificity of 87.2%.Conclusion MGFA classification and QMG score can predict late extubation after thymectomy in patients with myasthenia gravis.

Analysis of risk factors of delirium in critically ill patients / 临床麻醉学杂志

Objective To investigate the risk factors of ICU delirium in critically ill patients. Methods A total of 1 74 critically ill patients in ICU who were older than 18 yrs and stayed in ICU exceeding 24 hs from January 201 5 to June 201 5 were enrolled.Patients were divided into delirium group and non delirium group.Delirium was assessed twice daily with the Confusion Assessment Method for the ICU (CAM-ICU)during the first 7 days.The factors such as history of alcoholism and other 12 factors were analyzed by univariate and multivariate logistic regression analysis to identify those risk factors associated with delirium.Results With 22 cases of delirium in 1 74 patients,the in-cidence of delirium was 12.64% (delirium group).Variables associated with delirium were coronary heart history,operation,tracheal intubation,clinical use of mechanical ventilation,hypoxemia and Benzodiazepine.Multivariate logistic regression analysis showed that coronary heart disease (OR 3.932,95%CI 1.225-12.61 7),surgery(OR 9.691,95%CI 2.103-44.657),hypoxemia(OR 6.595, 95%CI 1.377-31.585),Benzodiazepine use (OR 7.620,95%CI 1.713-33.899)was independent risk factors of delirium in critically ill patients (P < 0.05 or P < 0.01 ).Conclusion Coronary heart disease,surgery,hypoxemia and Benzodiazepine are independent risk factors of ICU delirium in criti-cally ill patients.Early screening and prevention of delirium should be given to reduce the occurrence of delirium for patients in ICU.

Effect of esmolol on fluid responsiveness and hemodynamic parameters in patients with septic shock / 中华危重病急救医学

Objective To study the effects of esmolol on fluid responsiveness and hemodynamic parameters in patients with septic shock.Methods A prospective self-control study was conducted.Fifteen septic shock patients undergoing mechanical ventilation admitted to Department of Critical Care Medicine of Yijishan Hospital from January 2015 to August 2015 were enrolled.All patients enrolled in this study were given the treatment based on American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) Consensus 2012.Esmolol was intravenously injected at a beginning rate of 6 mg·kg-1·h-1, and then the dose was adjusted to reduce heart rate by 10％ from baseline.The changes in hemodynamic and systemic oxygen metabolism indexes were monitored by pulse indicator continuous cardiac output (PiCCO) before and 2 hours after the esmolol administration, and the fluid responsiveness was evaluated by stroke volume variation (SVV).SVV ≥ 10％ was considered to be a positive fluid responsiveness.Results In 15 patients, 9 were male and 6 female, with an age of 65 ± 16.Among them 10 patients suffered from pulmonary infection, and 5 patients with abdominal infection.Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was 21 ±9;sequential organ failure score (SOFA) was 8 ±4.28-day mortality was 40.0％.SVV was significantly decreased after esmolol infusion as compared with baseline [(14 ± 5)％ vs.(17 ±7)％, t =2.400, P =0.031].Heart rate [HR (bpm): 100±4 vs.112±8, t =8.161, P =0.000], cardiac output [CO (L/min):6.13 ± 1.45 vs.7.88 ± 1.82, t =4.046, P =0.001], cardiac index [CI (mL·s-1·m-2): 51.51 ± 11.00 vs.66.18 ± 11.48, t =4.131, P =0.001], stroke volume index [SVI (mL/m2): 31.0 ± 6.4 vs.35.4 ± 6.5, t =2.577, P =0.020], the maximum rate of left ventricular pressure rise [dp/dt max (mmHg/s): 927±231 vs.1 194±294, t =3.775, P =0.002], global ejection fraction (GEF: 0.21 ±0.05 vs.0.24±0.06, t =3.091, P =0.008), cardiac function index (CFI: 5.03 ± 1.37 vs.6.59 ± 1.92, t =4.769, P =0.000) showed significant decrease during esmolol infusion.On the other hand, central venous pressure [CVP (mmHg, 1 mmHg =0.133 kPa): 9±3 vs.8±3, t =-3.617, P =0.003], diastolic blood pressure (DBP, mmHg: 69± 15 vs.66± 13, t =-2.656, P =0.019), systemic vascular resistance index (SVRI, kPa·s·L-1·m-2:206.8±69.8 vs.206.8±69.8, t =-3.255, P =0.006) were significantly increased during esmolol infusion.No significant difference was found in systolic blood pressure [SBP (mmHg): 120 ± 25 vs.123 ± 18, t =0.678, P =0.509],mean arterial pressure [MAP (mmHg): 86 ± 18 vs.85 ± 14, t =-0.693, P =0.500], global end diastolic volume index [GEDVI (mL/m2): 614 ± 84 vs.618 ± 64, t =0.218, P =0.830], extravascular lung water index [EVLWI (mL/kg):5.99±1.50 vs.5.73±1.14, t =-1.329, P =0.205], central venous oxygen saturation (ScvO2: 0.711±0.035 vs.0.704 ± 0.048, t =-0.298, P =0.773), arterial blood lactate [Lac (mmol/L): 3.1± 0.3 vs.3.0 ± 0.4, t =-0.997, P =0.345],and difference of central venous-arterial carbon dioxide partial pressure [Pcv-aCO2 (mmHg): 4.1 ± 0.9 vs.4.7 ± 0.5,t =1.445, P =0.182] as compared with those before esmolol treatment.Conclusion Heart rate control with esmolol infusion may reduce fluid responsiveness, cardiac function, heart rate and cardiac output without adverse effect on systemic perfusion in septic shock patients.

Study on the feasibility of establishing the critical care specialty in the medical undergraduate course / 中华医学教育探索杂志

As an important component of modern medicine , the critical care medicine has sprung up for years. Nevertheless, based on the postgraduate education and the further education like 5C training, the existing talent training pattern has been unable to solve the serious problem of the deficiency in the human capital of critical care medicine in hospitals of different levels. With the eco-nomic development of the society and the constant emergence of the new medical technologies , the critical care medical specialty should be quickly established in medical colleges, especially facing the modern demand on curriculum reformation in the undergraduate course. As the “National Compre-hensive Reforms Pilot Unit of Anesthesiology”, the School of Anesthesiology of Wannan Medical Col-lege is obliged to cater for the social need and respond to the national policy. Despite of the insuffi-ciency of teaching and cases, the school endeavors to build up the reformed “2+1+2” curriculum system on the basis of strengthening the major advantages. With the core of the teaching mold reform, the new system aims to enhance the clinical training and introduce the teaching mold reforms of “or-ganic system-based”, PBL and CBL, etc. Therefore, the sound training mold of critical care medicine could be further explored significantly.

Effect of stellate ganglion block on reconstruction of the left ventricle in spontaneously hypertensive rats / 中南大学学报(医学版)

OBJECTIVE@#To determine the effect of stellate ganglion block on reconstruction of the left ventricle in spontaneously hypertensive rats (SHRs).@*METHODS@#Thirty-two 10-week-old male SHRs were randomly assigned into 4 groups: a left stellate ganglion block group (group LS), a right stellate ganglion block group (group RS), a captopril group (group D) and a control group (group C). The arterial systolic blood pressure (SBP) was measured by ALC-NIBP measuring system. After 10 weeks, we observed the left ventricular mass index (LVMI), myocardial pathologic changes, and detected the endothelin (ET-1) and endothelial nitric oxide synthase (eNOS) level in the left ventricle by radioimmunoassay and the collagen protein level in the left ventricle by immunohistochemical method.@*RESULTS@#Compared with group LS and group C, the LVMI in group RS was lowered most notably (P<0.05) and pathological changes were improved obviously. The expression of eNOS in group RS was significantly increased and ET-1 significantly decreased (P<0.05) compared with that in group C and group LS. The expression of type I collagen fibers in group RS was significantly lower and type III collagen fibers significantly higher (P<0.05) when compared with that in group C and LS.@*CONCLUSION@#Right stellate ganglion block can not only decrease the arterial pressure but also reverse the reconstruction of the left ventricle.

Effect of stellate ganglion block on cardiomyocyte apoptosis and expression of Bcl-2/Bax protein in spontaneously hypertensive rats / 中南大学学报(医学版)

OBJECTIVE@#To investigate the relationship between apoptosis of myocardial cells in spontaneously hypertensive rats (SHRs) and the expressions of Bcl-2 and Bax protein, and the protective effect of stellate ganglion block on apoptosis of myocardial cells.@*METHODS@#A total of 32 ten-week-old male SHRs were assigned randomly into 4 groups: a left stellate ganglion block group (group LS), a right stellate ganglion block group (group RS), a captopril group (group D) and a control group (group C). The arterial systolic blood pressure was measured by ALC-NIBP system. After 10 weeks, all rats were anaesthetized by 3% pentobarbital sodium, cardiomyocyte apoptosis index of left ventricle was assessed by TUNEL, and the localization of myocardium Bcl-2, Bax was investigated by immunohistochemistry.@*RESULTS@#Compared with group LS and C, the apoptotic index decreased (P<0.05). SHR myocardial expression of Bcl-2 significantly increased (P<0.05), Bax expression significantly decreased (P<0.05) and Bcl-2/Bax was significantly higher (P<0. 05) in group RS.@*CONCLUSION@#Bcl-2 and Bax play an important role in the apoptosis of myocardial cells in SHRs. Right stellate ganglion block can reduce the apoptosis of myocardial cells and reverse the reconstruction of the left ventricle in SHRs via regulation of apoptosis-related gene proteins.

Difference in time-course of relaxant effect of rocuronium between patients with ocular and generalized myasthenia gravis / 中华麻醉学杂志

Objective To compare the time-course of relaxant effect of rocuronium between patients with ocular and generalized myasthenia gravis (MG).Methods Twenty-seven ASA physical status I or Ⅱ patients with MG of both sexes,aged 12-64 yr,with body mass index of 17-26 kg/m2,scheduled for elective extended thymectomy,were divided into 2 groups according to Osserman stage:ocular group (group O,n =10) and generalized group (group G,n =17).Anesthesia was induced with iv injection of fentanyl 2 μg/kg,midazolam 0.05 mg/kg,and propofol 1.5 mg/kg.All patients were tracheal intubated and mechanically ventilated.Anesthesia was maintained with iv infusion of propofol 4-8 mg· kg-1 · h-1 and remifentanil 0.2 μg· kg-1 · min-1.Twitch tension was monitored in the adductor pollicis muscle by train-of-four stimulation of the ulnar nerve (intensity 60 mA,interval 12 s,frequency 2 Hz,wave length 0.2 ms).Rocuronium 0.6 mg/kg was injected intravenously after calibration.Mean arterial pressure (MAP),HR,heart rate variability (HRV) and low frequency and high frequency (LF/HF) ratio was recorded.The onset time of muscle relaxation,time for T1 to recover to 25％,time for T1 to recover to 50％ and recovery index were recorded.Results Compared with the baseline value,there were no significant changes in MAP,HR,HRV,LF/HF ratio at all time points in the two groups (P ＞ 0.05).Compared with group O,there was no significant change in the onset time of muscle relaxation,and the time for T1 to recover to 25％,time for T1 to recover to 50％ and recovery index were significantly prolonged in group G (P ＜ 0.05).Conclusion The duration of rocuronium-induced neuromuscular block is significantly longer in patients with generalized MG than those with ocular MG,while the onset time is comparable between the two groups.

Effect of epidural morphine for analgesia on the number of interstitial cells of Cajal in rabbit colon / 中华麻醉学杂志

Objective To investigate the effect of epidural morphine for analgesia on the number of interstitial cells of Cajal (ICC) in the rabbit colon.Methods Thirty healthy rabbits of either sex,weighing 2.0-2.5 kg,were randomly divided into 2 groups (n =15 each):control group (group C) and morphine group (group M).The animals were anesthetized with iv 20% urethane 4 ml/kg.The epidural analgesia was performed at L3,4 interspace.In group M morphine 9.2 ug· kg-1 · h-1 was infused into the epidural space for 7 consecutive days,while the equal volume of normal saline was infused instead in group C.The characteristics of excrement and constipation were recorded during morphine infusion.Normal saline or Chinese ink mixture 5 ml was administered via a gastric tube inserted through the mouth 1 day after the end of administration.The rabbits were sacrificed 30 min later and laparotomy was performed.The intestinal segment numbered from the pylorus to the ileocecal region of the bowel was removed and the length of the intestinal segment and propelled distance of the ink within the intestinal tract were measured in the tension-free state.The rate of propelled distance was calculated.The proximal and distal colon tissues were taken for measurement of the expression of c-kit (by immunohistochemisty) and ICC count,and stained with haematoxylin and eosin for examination of pathological changes.Results Compared with group C,the incidence of constipation was significantly increased,and the rate of propelled distance,and expression of c-kit and ICC count in proximal colon tissues were decreased at 3-7 days of morphine infusion (P ＜ 0.05),and no significant change was found in the expression of c-kit and ICC count in distal colon tissues in group M (P ＞ 0.05).Conclusion Epidural morphine for analgesia can inhibit the motor function of the intestinal tract in rabbits,and reduction in the number of ICC count in proximal colon is involved in the mechanism.

Effects of different modes of delivery on arterial oxygen saturation in the fetus / 中华麻醉学杂志

Objective To compare the effects of different modes of delivery on arterial oxygen saturation in the fetus.Methods One hundred and twenty ASA Ⅰ or Ⅱ parturients aged 22-32 yr with a single fetus at full term lying in normal headdown position were divided into 3 groups according to the modes of delivery (n =40 each):group cesarean section (group CS) ; group labor analgesia (group LA) and group spontaneous labor (group SL).In group CS cesarean section was performed under epidural anesthesia with 0.5％ ropivacaine.Epidural catheter was placed at L2,3 interspace in groups CS and LA.In group LA labor analgesia was started from the first stage and maintained until complete cervical dilatation.The patients received epidural PCA (PCEA) with O.125 ％ropivacaine plus fentanyl 2 μg/ml.PCEA setting was as follows:a loading dose of 8-10 ml; demand bolus 5 ml;20 min lockout; background infusion 6-10 ml/h.Blood samples were taken from umbilical artery at delivery for blood gas analysis and determination of serum concentrations of lactate,β-endorphin (β-EP) and neuropeptide Y (NP-Y).Apgar score and neurological and adaptive capacity score (NACS) were recorded.Results There was no significant difference in Apgar score,NACS and NP-Y and β-EP concentrations in umbilical arterial blood among the 3 groups.The lactate concentration and the absolute value of BE were significantly higher while pH was lower in group SL than in groups CS and LA.PO2 was significantly higher while PCO2 was lower in group LA than in groups SL and CS,and the lactate concentration and absolute value of BE were significantly lower while pH was higher in group LA than in group SL.Conclusion The 3 modes of delivery have significant effects on arterial oxygenation in fetus but have no clinical significance.