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Objective:To systematically review and evaluate the effect of intraoperative regional cerebral oxygen saturation (rSO 2) monitoring on perioperative neurocognitive disorders (PNDs) in elderly patients undergoing non-cardiac surgery. Methods:China National Knowledge Infrastructure, Wanfang Database, China Biomedical Literature Database, China Science and Technology Journal Database, PubMed, Cochrane Library, Embase and Web of Science databases were searched from inception to October 2022 for randomized controlled trials involving the effects of intraoperative rSO 2 monitoring on PND in elderly patients underwent non-cardiac surgery. The primary outcome measure was the incidence of PND (1-7 days after surgery), and secondary outcome measures were intraoperative minimum rSO 2 (rSO 2min), intraoperative mean rSO 2 (rSO 2mean), maximum percentage of decrease (rSO 2% max) in rSO 2 from baseline (rSO 2baseline), and the Montreal Cognitive Assessment Scale was used to evaluate the quality of references that met the inclusion criteria, and data were extracted for meta-analysis using RevMan5.4 software. Results:Thirteen randomized controlled trials were enrolled, involving 1 134 patients with 557 patients in experimental group (anesthesia under rSO 2 monitoring) and 577 patients in control group. The results of meta-analysis showed that the incidence of PND was significantly lower in experimental group than in control group ( RR=0.32, 95% confidence interval [ CI] 0.25-0.41, P<0.001), the intraoperative rSO 2min was significantly higher in experimental group than in control group ( MD=7.46, 95% CI 5.05-9.86, P<0.001), and the intraoperative rSO 2mean was significantly higher in experimental group than in control group ( MD=5.49, 95% CI 3.97-7.02, P<0.001), the intraoperative rSO 2% max was significantly lower in experimental group than in control group ( MD=-6.55, 95% CI-9.03--4.07, P<0.001), and the postoperative Montreal Cognitive Assessment Scale score was significantly higher in experimental group than in control group ( MD=1.37, 95% CI 0.74-1.99, P<0.001). Conclusions:Intraoperative application of rSO 2 monitoring can reduce the occurrence of PND in elderly patients undergoing non-cardiac surgery.
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Objective To explore the influence of dexmedetomidine combined with sufentanil on postoperative analgesia effect and immune function for patients undergoing lower limb fracture surgery. Methods One hundred cases patients of lower limb fracture undergoing open reduction and internal fixation of elective surgery in our hospital from January 2016 to November 2016 were selected ( ASAⅠ-Ⅱgrade, male 51 cases and female 49 cases, 30-65 years old, 50-75 kg). All cases were randomly divided into sufentanil group (Group S) and dexmedetomidine combined with sufentanil group (Group DS) according to the random number table, who used patient-controlled intravenous analgesia (PCIA). The PCIA drug formulations of two groups were as followings: sufentanil group (Group S) used 3 μg/h sufentanil+ondansetron 16 mg, dissolved in 0.9%sodium chloride injection 100 ml;dexmedetomidine combined with sufentanil group (Group DS) used dexmedetomidine 0.1μg/(kg · h)+sufentanil 2μg/h+ondansetron 16 mg, dissolved in 0.9%sodium chloride injection 100 ml;background infusion rate was 2 ml/h, and loading dose was 2 ml. Dose for patient-controlled analgesia (PCA) was 0.5 ml, and locking time was 15 min. The changes of pain, MAP, HR , sedation scores were recorded at 4 h (T1), 8 h (T2), 24 h (T3) and 48 h (T4) after operation; nausea and vomiting, hypotension, bradycardia, respiratory depression and other adverse reactions were aslo recorded at the same time. At 10 min before induction of anesthesia (T0) and T1-T4 after operation, the CD3+, CD4+, CD8+and NK cell activity of peripheral blood T lymphocyte subsets were determined using flow cytometry, and CD4 +/CD8 + ratio was calculated. Results The levels of MAP and HR in DS group at each time point after operation were lower than those in group S (P<0.05), the level of visual analogue score (VAS) in DS group at different time points were significantly lower than those of s group: (1.8 ± 0.3) scores vs. (2.5 ± 0.5) scores, (1.1 ± 0.5) scores vs. (1.9 ± 0.3) scores, (1.0 ± 0.5) scores vs. (1.8 ± 0.5) scores, (0.8 ± 0.3) scores vs. (1.5 ± 0.6) scores (P < 0.05), Ramsay Sedation score was significantly higher than that of s group: (3.5 ± 0.3) scores vs. (2.4 ± 0.6) scores, (3.3 ± 0.5) scores vs. (2.5 ± 0.3) scores, (3.5 ± 0.6) scores vs. (2.3 ± 0.5) scores, (3.2 ± 0.4) scores vs. (2.2 ± 0.5)scores (P<0.05);nausea and vomiting occurred in two patients after the operation of group DS , which was significantly lower than that of S group (P<0.05);compared with those at T0, CD3+, CD4+, CD4+/CD8+and NK cells in the two groups of patients decreased significantly at the time of T1-T4 (P<0.05);The levels of CD3+, CD4+, CD4+/CD8+and NK cells were significantly higher in group DS at T1- T4 than those in group S(P < 0.05). Conclusions Dexmedetomidine combined with sufentanil for analgesia in patients with lower limb fracture surgery has better effect. It decreases the incidence of nausea and vomiting, and improves the cellular immune function of patients.
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Objective To study the effect of target controlled infusion of etomidate and propofol during general anesthesia induction period on haemodynamics and stress by cerebral state index (CSI) in elderly hypertensive patients. Methods Forty ASAⅠor Ⅱelderly hypertensive patients undergoing selective laparoscopic cholecystectomy were randomly divided into two groups by random digits table method with 20 cases each: propofol group and etomidate group. CSI, mean arterial pressure (MAP), heart rate, blood glucose, concentration of plasma cortisol in the two groups were observed before induction of anesthesia, at 1 min before intubation, and at 1 min, 3 min and 5 min after intubation. Results The level of CSI, MAP, heart rate, blood glucose, cortisol between two groups at before induction of anesthesia had no significant difference (P>0.05).The levels of CSI in two groups at 1 min before intubation, and at 1 min, 3min after intubation were significantly lower than that at before induction of anesthesia, but compared with that at 1 min before tracheal intubation, CSI was significantly higher in two group at 1 min, and 3 min after intubation, and there was significant difference (P0.05). Compared with before induction of anesthesia, the concentrations of blood glucose and cortisol at 1min before intubation in patients of the two groups decreased significantly, while glucose and cortisol concentrations at 1 min, 3 min and 5 min after intubation in two group significantly increased , and there was significant difference (P<0.05);cortisol concentration in etomidate group at 1 min before intubation and 1 min, 3 min, 5 min after intubation was significantly lower than that at the same period in propofol group:(260.6 ± 39.6) nmol/L vs. (290.2 ± 35.6) nmol/L, (380.3 ± 37.6) nmol/L vs.(410.8 ± 46.6) nmol/L, (361.2 ± 25.2) nmol/L vs. (392.6 ± 31.6) nmol/L, (352.3 ± 25.6) nmol/L vs. (370.3 ± 28.8) nmol/L, and there were significant differences (P < 0.05). Conclusions During induction of general anesthesia with the guidance of cerebral state index, target controlled infusion of etomidate has more stable hemodynamics, and also attenuates the stress response to tracheal intubation in elderly hypertensive patients.
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Object To provide the theoretical basis for the artificial planting of Hypericum perforatum L., the effects of light, gibberellin and ethephon on the germination of H. perforatum seeds were studied. Methods The method of direct germination was used. Results The seeds germinated to 79% in the light, while didn't germinate in the dark. Gibberellin and ethephon not only promoted the germination in the light, but also induced the germination in the dark. But ethephon inhibited the growth of seedling radicals severely. Conclusion The seed of H. perforatum is light-dependent seed, its light-dependence is related to gibberellin and ethephon.
