Role of NLRP3 inflammasome activation-mediated macrophage polarization in myocardial injury after ischemic stroke in diabetic mice / 中华麻醉学杂志

Objective:To evaluate the role of NOD-like receptor 3 (NLRP3) inflammasome activation-mediated macrophage polarization in myocardial injury after ischemic stroke in diabetic mice.Methods:Wild-type C57BL/6J mice and NLRP3 -/- mice, aged 4-6 weeks, were fed a high fat diet combined with streptozotocin administration to develop the diabetic model. Twenty-four diabetic wild type C57BL/6J mice and 23 diabetic NLRP3 -/- mice were divided into wild type sham operation group (WT D-SHAM group, n=9) , wild type ischemic stroke group (WT D-MCAO group, n=15) , NLRP3 -/- sham operation group (NLRP3 -/-D-SHAM group, n=9) and NLRP3 -/- ischemic stroke group (NLRP3 -/-D-MCAO group, n=14). The ischemic stroke model was developed by middle cerebral artery occlusion in the animals anesthetized with isoflurane. Echocardiography and electrocardiography were carried out at 3, 7, 14 and 28 days after developing the model. Mice were sacrificed under deep anesthesia, and myocardial tissues were taken at 28 days after surgery for determination of the expression of macrophage marker F4/80 and M2 type macrophage marker CD206 mRNA (by real-time fluorescence quantitative polymerase chain reaction). Results:Compared with WT D-SHAM group, the cardiac output, mass of left ventricle and corrected mass of left ventricle were significantly decreased at 28 days after surgery, and QT interval and QTc interval were prolonged at 14 and 28 days after developing the model in WT D-MCAO group ( P<0.05). Compared with NLRP3 -/-D-SHAM group, the cardiac output, mass of left ventricle and corrected mass of left ventricle were significantly decreased, and QT interval and QTc interval were prolonged at 3 days after surgery in NLRP3 -/-D-MCAO group ( P<0.05). There was no significant difference in CD206 and F4/80 mRNA expression between WT D-SHAM group and WT D-MCAO group and between NLRP3 -/-D-SHAM group and NLRP3 -/-D-MCAO group ( P>0.05). Compared with WT D-MCAO group, the QT interval and QTC interval were significantly shortened at 14 and 28 days after developing the model, and the expression of F4/80 mRNA was down-regulated and the expression of CD206 mRNA was up-regulated at 28 days after developing the model in NLRP3 -/-D-MCAO group ( P<0.05). Conclusions:NLRP3 inflammasome activation-mediated polarization of macrophages to M2 phenotype is involved in myocardial injury after ischemic stroke in diabetic mice.

Accuracy of mini-fluid challenge test in predicting fluid responsiveness in elderly patients undergoing surgery in prone position / 中华麻醉学杂志

Objective:To evaluate the accuracy of mini-fluid challenge test in predicting fluid responsiveness in elderly patients undergoing surgery in prone position.Methods:Forty-eight elderly patients, aged ≥ 65 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective spinal surgery, were enrolled.Patients were mechanically ventilated using a volume-controlled mode with a tidal volume of 6 ml/kg of ideal body weight during operation.A radial arterial catheter was inserted and connected to FloTrac/Vigileo system to monitor hemodynamic parameters.At 5 min after prone position, volume expansion was started when the hemodynamics was stable: lactated Ringer′s solution 1 ml/kg was intravenously infused over 1 min, 1 min later lactated Ringer′s solution 1 ml/kg was intravenously infused over 1 min, 1 min later lactated Ringer′s solution 1 ml/kg was intravenously infused over 1 min, and 1 min later operation was started.After tracheal intubation and before prone position (T 1), 5 min of prone position (T 2), 1 min after 1st infusion of 1 ml/kg liquid (T 3), and 1 min after 2nd infusion of 1 ml/kg liquid (T 4) and 1 min after infusion of 3 ml/kg fluid (T 5), heart rate, mean arterial pressure, cardiac output, cardiac index, stroke volume, stroke volume index (SVI), stroke volume variability (SVV), pulse pressure variability (PPV), and changes in SVI induced by rapid infusion of 1, 2 and 5 ml/kg crystalloid (ΔSVI 1 ml/kg, ΔSVI 2 ml/kg, ΔSVI 5 ml/kg) were calculated.Positive fluid challenges were defined as an increase in SVI of 10% or more from baseline, and the patients were divided into responder group (R) and non-responder group (NR). Receiver operating characteristic curves predicting fluid responsiveness were generated for ΔSVI 1 ml/kg, ΔSVI 2 ml/kg, SVV and PPV, and areas under the receiver operating characteristic curves (AUC) were calculated. Results:Thirty patients were enrolled in group R and 18 cases in group NR.The AUC of ΔSVI 1 ml/kg in predicting fluid volume responsiveness was 0.87 with a diagnostic threshold of 7%, a sensitivity of 80%, and a specificity of 83%.The AUC of ΔSVI 2 ml/kg in predicting fluid responsiveness was 0.928 with a diagnostic threshold of 8%, a sensitivity of 78%, and a specificity of 89%.The AUC of SVV and PPV in predicting fluid responsiveness was 0.65 and 0.53, respectively. Conclusion:Mini-fluid challenge test guided by ΔSVI can predict fluid responsiveness in elderly patients undergoing surgery in prone position, and rapid infusion of 2 ml/kg crystalloid provides better accuracy than 1 ml/kg.

Effects of pregnancy associated with diabetes on the duration of subarachnoid block with Ropivacaine in the parturient / 实用医学杂志

Objective To make comparison of duration of subarachnoid block with intrathecal ropivacaine between gravidas with diabetes mellitus and non-diabetic pregnancy, to evaluate the sensitivity of parturient with diabetes to ropivacaine. Methods 75 parturients who were presenting for elective cesarean section were randomly divided into pregestational diabetes mellitus group (group P, n=15) , gestational diabetes mellitus group (group G, n=30) and non-diabetic parturients group (group N, n=30). After entering the operating room, parturients were given spinal anesthesia spinal at the L3～4 interspace with 0.5％ hyperbaric ropivacaine 3 ml with left lateral decubitus position. To determine the level of sensory block by 10 g monofilament and evaluate the motor block with modified Bromage score. To record the time T6 sensory level was obtained, the onset time of sensory block, motor block, the duration of the motor block and sensory block. Results The time T6 sensory level was obtained of Group P were significantly shortened (P < 0.001). Compared with Group N and Group G, the duration of sensory (P < 0.001) and motor (P < 0.001) block were significantly prolonged. Conclusion Parturients with pregestational diabetes mellitus are more sensitive to 0.5％ hyperbaric ropivacaine compared to non-diabetic parturients. Compared with non-diabetic parturients, there are no difference in the sensitivity of parturient with gestational diabetes mellitus to 0.5％hyperbaric ropivacaine.

Optimum compatibility of nabufine mixed with flurbiprofen for patient-controlled intravenous analgesia after gynecological laparoscopic surgery: a multicenter, randomized, controlled clinical trial / 中华麻醉学杂志

Objective To evaluate the optimum compatibility of nabufine mixed with flurbiprofen for patient-controlled intravenous analgesia (PCIA) after gynecological laparoscopic surgery.Methods A total of 210 patients,aged 18-64 yr,with body mass index of 18-30 kg/m2,of American Society of Anesthesiologist physical status Ⅰ or Ⅱ,scheduled for gynecological laparoscopic surgery under general anesthesia,were divided into 4 groups using a random number table method:sufentanil 2.0 μg/kg+flurbiprofen axetil 2.0 mg/kg group (SF group,n =55),nalbuphine 1.5 mg/kg+flurbiprofen axetil 2.0 mg/kg group (N1 F group,n=49),nalbuphine 2.0 mg/kg+flurbiprofen axetil 2.0 mg/kg group (N2F group,n =55) and nalbuphine 3.0 mg/kg +flurbiprofen axetil 2.0 mg/kg group (N3F group,n=51).PCIA solution was prepared correspondingly after surgery in each group.The PCA pump was set up to deliver a 1 ml bolus dose with a 15-min lockout interval and background infusion at 2.0 ml/h.Nalbuphine 5 mg or sufentanil 5 μg was intravenously injected as a rescue analgesic to maintain visual analogue scale score at rest ＜4 at 48 h after surgery in SF and N1 F-N3F groups.Ramsay sedation scores were recorded on admission to post-anesthesia care unit (T1),at the time of post-anesthesia care unit discharge (T2) and at 6,24 and 48 h after surgery (T3-5).The total pressing times of PCIA in 0-6 h,6-24 h and 24-48 h periods after surgery and requirement for rescue analgesics were recorded.The incidence of adverse reactions such as nausea and vomiting,drowsiness and shivering within 48 h after surgery was also recorded.Results Compared with group SF,the incidence of nausea and vomiting was significantly decreased in N1 F and N2F groups,the requirement for rescue analgesics was significantly decreased,and the total pressing times of PCIA was reduced in N2F and N3 F groups,and Ramsay sedation scores at T3,4 were significantly increased in group N3F (P＜0.05).Compared with group N1 F,the requirement for rescue analgesics was significantly decreased,and the total pressing times of PCIA was reduced in N2F and N3F groups,and the incidence of nausea and vomiting and Ramsay sedation scores at T3,4 were significantly increased in group N3F (P＜0.05).Compared with group N2F,the incidence of nausea and vomiting was significantly increased (P＜ 0.05),and no significant change was found in the requirement for rescue analgesics,total pressing times of PCIA or Ramsay sedation scores in group N3F (P＞0.05).Conclusion Nabufine 2.0 mg/kg mixed with flurbiprofen 2.0 mg/kg is the optimum compatibility when used for PCIA after gynecological laparoscopic surgery.

Changes in expression of gamma-aminobutyric acid receptor subunit genes in dorsal root ganglia in a mouse model of neuropathic pain / 中华麻醉学杂志

Objective To evaluate the changes in the expression of gamma-aminobutyric acid (GABA) receptor subunit genes in the dorsal root ganglia (DRG) in a mouse model of neuropathic pain. Methods Experiment Ⅰ Twenty-four male C57BL6 mice, aged 8 weeks, weighing 25-30 g, were di-vided into sham operation group (group Sham, n=12) and neuropathic pain group (group NP, n=12) by using a random number table method. Neuropathic pain was produced by bilateral L4 spinal nerve ligation in anesthetized mice in group NP . The mechanical pain threshold of bilateral hindpaws was measured at 1 day before establishing the model and 7 days after establishing the model. Mice were then sacrificed and DRGs of the bilateral L4 were removed to perform transcriptome sequencing and to analyze the expression of GABA receptor subunit genes. Experiment Ⅱ Twenty-four male C57BL6 mice, aged 8 weeks, weighing 25-30 g, were studied. Neuropathic pain was produced by the left L4 spinal nerve ligation in anesthetized mice. Six mice were selected at 1 day before establishing the model and 3, 7 and 14 days after establishing the model, and the mechanical pain threshold of the left hindpaw was measured. Mice were then sacrificed and DRGs of the left L4 were removed to verify the expression of differentially expressed GABA receptor subunitgenes described in experiment Ⅰby quantitative real-time polymerase chain reaction. Results ExperimentⅠ Compared with group Sham, the mechanical pain threshold was significantly increased, the expression of Gabra1, Gabra2, Gabrb3, Gabrg2, Gabbr1 and Gabbr2 in DRGs was down-regulated, and the expres-sion of Gabrg1 in DRGs was up-regulated at 7 days after establishing the model in group NP ( P<0. 05 or 0. 01) . Experiment Ⅱ Compared with the baseline at 1 day before establishing the model, the mechanical pain threshold was significantly increased, and the expression of Gabra1, Gabra2, Gabrb3, Gabrg2, Gab-br1 and Gabbr2 in DRGs was down-regulated at each time point after establishing the model ( P<0. 05 or 0. 01) , and no significant change was found in the expression of Gabrg1 in DRGs at each time point after establishing the model ( P>0. 05) . Conclusion The expression of GABA receptor subunit genes Gabra1, Gabra2, Gabrb3, Gabrg2, Gabbr1 and Gabbr2 in DRGs is down-regulated, and the expression of Gabrg1 in DRGs is up-regulated in a mouse model of neuropathic pain.

Role of poly(ADP-ribose) polymerases-1-mediated blockade of autophagy in ischemia/reperfusion injury of rat cardiomyocytes / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the role of poly(ADP-ribose) polymerases-1 (PARP-1)-mediated blockade of autophagic flow in myocardial ischemia-reperfusion injury.</p><p><b>METHODS</b>H9c2 cells, a rat cardiac myocyte line, were divided into control group, hypoxia/ reoxygenation model group (H/R group), PARP-1 inhibitor (PJ34) group, and PJ34 + H/R group. The total protein was extracted from the cells in each group to detect the expressions of pADPr, Bax, the DNA damage marker protein p-YH2ax, and autophagic flow-associated proteins LC3BⅡ/LC3Ⅰ, Beclin-1, and P62 using Western blotting.</p><p><b>RESULTS</b>Compared with the control cells, the cells with H/R exhibited significantly increased expressions of pADPr, Bax and p-YH2ax ( < 0.05). The expressions of LC3B Ⅱ, beclin-1 and p62 were also increased significantly in the cells with H/R ( < 0.05), indicating the block of the autophagic flow. The application of PARP-1 inhibitor PJ34 in the cells with H/R significantly inhibited the expressions of pADPr ( < 0.05) and Bax ( < 0.01), and alleviated DNA damage in the cells. PJ34 treatment did not cause significant changes in the expressions of LC3B Ⅱ and beclin-1 but significantly decreased the expression of p62 ( < 0.05) in the cells with H/R.</p><p><b>CONCLUSIONS</b>Block of autophagic flow mediated by PARP-1 activation plays a role in myocardial ischemiareperfusion injury, and inhibition of PARP-1 activity can reverse autophagic flow block to reduce the injury.</p>

Effect of goal-directed fluid therapy on the tissue perfusion of elderly patients undergoing laparoscopic radical cystectomy / 临床麻醉学杂志

Objective To evaluate the effects of goal-directed fluid therapy on the tissue perfusion of elderly patients undergoing Laparoscopic Radical Cystectomy.Methods Thirty patients aged 60-82 years with ASA physical status Ⅰ or Ⅱ who were presenting for elective laparoscopic radical cystectomy were randomly divided into routine fluid replacement group (group C,n=15) and GDFT group (group G,n=15).Patients in group C received routine fluid replacement.Patients in group G were treated under goal-directed fluid infusion strategy with a target of SVV≤13%,CI≥2.5 L·min-1·m-2 and ScvO2≥73% under the monitoring of PiCCO.The indexes of hemodynamics and tissue perfusion were collected and recorded at 7 time points: before induction of anesthesia (T1),5 minutes after intubation (T2),5 minutes after pneumoperitoneum and change positions (T3),1 hour after pneumoperitoneum (T4),5 minutes after the abdomen was opened (T5),1 hour after the abdomen was opened (T6) and the end of surgery (T7).Results Compared with group C,group G received less fluid.MAP and SVV between two groups were no statistical significance.The CI in group G in time point T4,T6 and T7 was significantly higher than that in group C (P<0.05).The HR in group G in time point T5 and T6 was significantly higher than that in group C (P<0.05).The aLac in group G in time point T4 and T5 was significantly lower than that in group C (P<0.05).Pcv-aCO2,DO2I and O2ERe between the two groups were not statistically different.Postoperative rehabilitation indexes between the two groups were not statistically significant.Conclusion The GDFT guided under SVV,CI and ScvO2 can keep the effective circulatory volume and pressure to ensure the whole body perfusion,reduce aLac and improve microcirculation without affecting the balance of oxygen supply and demand and the postoperative complication.

The characteristics of peripheral neuropathy in type 2 diabetic rats induced by low dose STZ / 中国医师杂志

Objective To prepare the rat model of type 2 diabetes mellitus (T2DM), and to ob-serve the characteristics of peripheral neuropathy. Methods High fat and high sugar diets were fed for 8 weeks to induce insulin resistance and then low dose streptozotocin ( STZ) was injected intraperitoneally to induce type 2 diabetes mellitus models in Sprague Dawley rats. Blood glucose and serum insulin levels con-tinuous were monitored. Tactile allodynia in response to von Frey ( VF) filament stimulation of the plantar hind paws and paw withdrawal thermal latency ( PWTL) to plantar test were used as the criterion for diabetic neuropathy. Instruments AD was used to detect nerve conduction velocity ( NCV) of sciatic nerve in rat and the morphological and pathological changes of sciatic nerve were detected by electron microscope. Results The characteristics of T2DM rats by peripheral neuropathy in this method were that 50％ force withdrawal threshold and PWTL were measured. Both values of diabetic rats were decreased from the day of STZ injec-tion until 4 weeks after STZ injection, and then increased 8 weeks after STZ injection (50％ force withdraw-al threshold values, (11.8 ±0.8)g, (8.4 ±0.7)g and (16.2 ±1.4)g; PWTL (10.2 ±0.9)s, (8.3 ± 1. 2)s and (13. 2 ± 1. 0)s. These results indicated that tactile sensation changed from hypersensitive to hy-posensitive. Compared to the NC group, the sciatic nerve motor and sensory conduction velocity were signifi-cantly decreased at 4 and 8 weeks in DM group, respectively. Compared to DM group at 4 weeks, the sciat-ic nerve motor and sensory conduction velocities were further decreased in the DM group at 8 weeks. Con-clusively, sciatic nerve showed obvious demyelination and axonal collapse. Conclusions T2DM rat model was successfully induced by high fat and sugar diet combined with small dose of STZ injection. The rat mod-el has typical pathological change of peripheral nerve. It might provide a particularly advantageous tool for investigations of diabetes and its chronic complications.

Role of NOX2 in bupivacaine-induced production of reactive oxygen species in nerve cells / 中华麻醉学杂志

Objective To evaluate the role of NOX2 in bupivacaine-induced production of reactive oxygen species (ROS) in nerve cells.Methods SH-SY5Y cells were seeded in culture plates and divided into 4 groups (n =11 each) using a random number table:small interfering RNA (siRNA) negative control group (group NC),siRNA negative control plus bupivacaine group (group NC +B),NOX2 siRNA group and NOX2 siRNA plus bupivacaine group (group NOX2 siRNA + B).In NC and NOX2 siRNA groups,the cells were transfected with negative siRNA and NOX2 siRNA,respectively,and then incubated in the culture medium for 24 h.In NC+B and NOX2 siRNA+B groups,cells were transfected with negative siRNA and NOX2 siRNA,respectively,new plates were used,the cells were incubated for 3 h with bupivacaine at the final concentration of 1.5 mmol/L,the culture medium was then replaced,and the cells were incubated until 24 h.The level of intracellular ROS was measured using the fluorogenic probe dihydroethidium,the cell apoptosis was determined by TUNEL,and the expression of activated caspase-3 and caspase-9 was detected using Western blot.Apoptosis rate was calculated.Results Compared with group NC,the level of ROS and apoptosis rate were significantly increased,and the expression of activated caspase-3 and caspase-9 was up-regulated in group NC+B (P＜ 0.05),the level of ROS was significantly increased,and the expression of activated caspase-3 and caspase-9 was up-regulated (P＜0.05),and no significant change was found in apoptosis rate in group NOX2 siRNA+B (P＞0.05),and no significant change was found in the level of ROS or apoptosis rate (P＞0.05),and the expression of activated caspase-3 and caspase-9 was significantly up-regulated in group NOX2 siRNA (P＜ 0.05).Compared with group NC+B,the level of ROS and apoptosis rate were significantly decreased,and the expression of activated caspase-3 and caspase-9 was down-regulated in group NOX2 siRNA+B (P＜0.05).Conclusion NOX2 is involved in the pathophysiological mechanism of bupivacaine-induced burst production of ROS in nerve cells.

Effect of dexmedetomidine on PERK signaling pathway in cardiomyocytes of rats with severe scald / 中华麻醉学杂志

Objective To investigate the effect of dexmedetomidine on protein kinase RNA-like endoplasmic reticulum kinase (PERK) signaling pathway in cardiomyocytes of the rats with severe scald.Methods Twenty-four healthy adult male Sprague-Dawley rats,weighing 220-280 g,were randomly divided into 3 groups (n =8 each) using a random number table:control group (group C),severe scald group (group S),and scald + dexmedetomidine group (group D).Thirty percent of the total body surface area was shaved on the back and then exposed to 94 ℃ water for 12 s to establish the model of 3rd degree scald.Dexmedetomidine 30 μg/kg (2 μg/ml) was intraperitoneally injected immediately after scald in group D.Myocardial specimens were obtained at 12 h after scald for examination of the pathological changes and for determination of cell apoptosis and expression of C/EBP-homologous protein (CHOP),PERK,and phosphorylated PERK (p-PERK) by Western blot.The apoptosis index and p-PERK/PERK ratio were calculated.Results Compared with group C,the apoptosis index was significantly increased,the expression of CHOP,PERK and p-PERK was significantly up-regulated,and the p-PERK/PERK ratio was significantly increased in S and D groups (P＜0.05).Compared with group S,the apoptosis index was significantly decreased,the expression of CHOP,PERK and p-PERK was significantly down-regulated,and the p-PERK/PERK ratio was significantly decreased (P＜0.05),and the pathological changes of myocardium were significantly attenuated in group D.Conclusion The mechanism by which dexmedetomidine inhibits apoptosis in cardiomyocytes is related to inhibition of PERK signaling pathway in the rats with severe scald.

Effect of ropivacaine-induced convulsion on hippocampal synaptic development in neonatal rats / 中华麻醉学杂志

Objective To evaluate the effect of ropivacaine-induced convulsion on hippocampal synaptic development in neonatal rats.Methods Sixty 21-day-old Sprague-Dawley neonatal rats,weighing 40-41 g,were randomly divided into 3 groups (n=20 each) using a random number table:control group (group C),single convulsion group (group SC),and recurrent convulsion group (group RC).Normal saline 0.1 ml was intraperitoneally injected in group C.Group SC received single intraperitoneal injection of 0.5％ ropivacaine 33.8 mg/kg.In group RC,0.5％ ropivacaine 33.8 mg/kg was intraperitoneally injected once a day for 5 consecutive days.The rats developed convulsion were included in the study.Five rats were selected at 24 h,3 days and 7 days after convulsion and at the age of 60 days in C and SC groups,and at 24 h,3 days and 7 days after the last convulsion and at the age of 60 days in group RC,the rats were sacrificed,and the hippocampus was removed for examination of the ultrastructure of neurons (with a electron microscope) and for determination of the number of synapses,synaptic space and thickness of synaptic density.Results Compared with group C,the number of synapses was significantly decreased,and the synaptic space was widened at 24 h and 3 days after convulsion,and the thickness of synaptic density was thinned at 24 h after convulsion in group SC,and the number of synapses was significantly decreased,and the synaptic space was widened,and the thickness of synaptic density was thinned at 24 h,3 days and 7 days after convulsion in group RC (P＜0.05).Compared with group SC,the number of synapses was significantly decreased,the synaptic space was widened,and the thickness of synaptic density was thinned at 24 h,3 days and 7 days after convulsion in group RC (P＜0.05).There was no significant difference in the parameters mentioned above at the age of 60 days between the three groups (P＞0.05).Neurons exhibited nuclear swelling,mitochondria showed edema,and disrupted mitochondrial cristae and vacuoles were observed at 24 h and 3 days after convulsion,and these changes mentioned above were significantly attenuated at 24 h,3 days and 7 days after convulsion.Conclusion Ropivacaine-induced convulsion exerts no effects on hippocampal synaptic development in neonatal rats.

Comparison pharmacodynamics of continuous or intermittent cisatracurium infusion during laparoscopy for deep neuromuscular blockade / 临床麻醉学杂志

Objective To investigate continuous infusion and inermittent injection of cisatra-curium for deep neuromuscular blockade during laparoscopic surgery and to compare the effectiveness and safety.Methods Sixty ASA Ⅰ or Ⅱ patients,aged from 18 to 65,undergoing selective laparo-scopic gastrointestinal surgery with general anesthesia were randomly divided into 2 groups:group A (n =30)received cisatracurium 0.1 5 mg/kg for intubation,and then continuous infusion of cisatra-curium with micropump at an original rate of 0.2 mg·kg-1 ·h-1 when post tetanic count (PTC)≥3;group B(n =30)was given cisatracurium 0.1 5 mg/kg for intubation,and then intermittent infusion of cisatracurium of 0.05 mg/kg when PTC≥ 3.The cisatracurium consumption,duration of neuro-muscular blocking agent used in group A from induction to the end of infusion and in group B from in-duction to the last infusion,satisfaction of neuromuscular blockade (grade 0-10)of the surgeons,the time of T1 recovered to 25%,75%,TOFr recovered to 0.7,0.9,fulfillment of tongue depressor test,the incidence of hyoxemia after extubation,pneumonia,atelectasis were recorded.Results In comparison with group B,the cisatracurium consumption in group A was significantly more (P <0.05),and the satisfaction of the surgeons was significantly higher at the beginning,1 h,2 h of the operation (P <0.05).The satisfaction of the surgeons respectively showing no significant differences between the two groups at the end of the operation.Recovery index (T1 from 25% to 75%),time of TOFr recovery to 0.7,0.9 in group A was increased,but not statistically.Two patients (7.1%)in group A had hyoxemia after extubation while 1 (4.2%)in group B,the incidence rate was not signifi-cant;3 patients (10.7%)in group A was unable to perform sustained tongue depressor test while 4 (1 6.7%)in group B,the incidence was not significant;all of the patients did not suffer pneumonia and atelectasis.Conclusion Continuous infusion cisatracurium during laparoscopic procedures for deep neuromuscular blockade is effective and safe.The dose of cisatracurium is bigger,and muscular relax-ation would be deeper compared to intermittent infusion.Continuous infusion may prolong the working time of muscle relaxant,but have on influence on the residual effect of muscle relaxant.

Effect of ulinastatin on serum concentration of S100βprotein and NSE in patients undergoing supratento-rial tumor resection / 临床麻醉学杂志

Objective To observe the serum concentration of S100βprotein (S100β)and neuron specific enolase (NSE)in patients undergoing supratentorial tumor resection with ulinastatin treat-ment.Methods Twenty-four patients with supratentorial tumor resection,aged 18-65 years,ASA Ⅰor Ⅱ,were randomly divided into the control group (group A,n =12)and ulinastatin group (group U,n =12).Patients in group U received ulinastatin (2 kU/kg)at the beginning of the surgery,with the continuous dose of 1 kU·kg-1 ·h-1 till the end of the operation.Group A received equivalent volume of saline solution as the vehicle control.Blood samples were taken from the artery and jugular venous bulb before induction of anesthesia (T1 ),skin incision (T2 ),1 h after dura openning (T3 ),at the closure of dura (T4 ),at the end of operation (T5 )and 24 h after operation (T6 )to analyze the concentration of S100β and NSE.The concentration of S100β and NSE were determined by ELISA. Results The concentration of serum S100β and NSE increased more significantly higher at T3-T6 in group A than group U (P <0.01).The concentration of serum S100βand NSE in group U were lower than those in group A at T3-T5 (P < 0.01 ).Conclusion Ulinastatin reduces the concentration of serum S100βand NSE during surgery,indicating it alleviates brain injury during supratentorial tumor resection.

The effects of preoperative anxiety on postoperative pain and opioid consumption in patients undergoing laparoscopic hysterectomy / 临床麻醉学杂志

Objective To evaluate the effect of preoperative anxiety on the dosage of opioid drugs in perioperative period.Methods Fourty female patients who aged 18-65 years,ASA Ⅰ or Ⅱ, undergoing laparoscopic hysterectomy were enrolled during November 2014 to August 2015.Demo-graphic characteristics of the patients were recorded.The patients were separated into two groups ac-cording to their state anxiety inventory (SAI).The patients with SAI>37 score were included in the high-anxious patients group (group H,n=22)while the other patients with SAI≤37 were enrolled in the low-anxious patients group (group L,n=18).All patients received the SAI test at the day be-fore surgery.The anesthesia time,intraoperative remifentanil consumption,duration of the first time giving analgesia after surgery,consumption of sufentanil at 1(T1 ),2(T2 ),4(T3 ),6(T4 ),24(T5 ) and 48 hours(T6 )after operation were recorded.Visual analogue scale (VAS)scores,the times of pressing PCIA and the side effects of opioid 48 h after the surgery were recorded.Results In group H, the time for first dose of opioid after surgery was significantly shorter than group L (P <0.05).The con-sumption of sufentanil in group H was significantly more than group L at T1-T6 (P <0.05).The times of pressing PCIA at the T5 time point after operation in group H was more than group L (P<0.05).No sta-tistically difference was found in the incidence of nausea or vomit between the two groups.There were no re-spiratory depression, pruritus or urinary retention in all patients.Conclusion Patients with high preoperative anxiety level perceive needed more opioids in postoperative pain control.

Effect of diabetic peripheral neuropathy on peripheral neurotoxicity induced by local anesthetics in rats / 中华麻醉学杂志

Objective To evaluate the effect of diabetic peripheral neuropathy on peripheral neurotoxicity induced by local anesthetics in rats.Methods Sixty healthy adult male SPF Sprague-Dawley rats,aged 6 weeks,weighing 150-180 g,were divided into either control group (n =18) or diabetic peripheral neuropathy group (n=42) using a random number table.The rats were fed a high-fat and high-sucrose diet for 8 weeks,and streptozotocin (STZ) 30 mg/kg was injected intraperitoneally to induce diabetes mellitus which was confirmed by blood glucose level≥ 16.7 mmol/L.The mechanical paw withdrawal threshold to yon Frey filament stimulation and thermal paw withdrawal threshold were measured.The decrease in reaction thresholds to thermal and mechanical stimuli (changing from sensitivity to insensitivity) was observed after STZ injection.At 4 weeks after STZ injection,the rats showing a marked hyperalgesia served as early diabetic group.At 8 weeks after STZ injection,the rats showing a marked insensitivity to pain served as late diabetic group.Experiments were carried out in early or late diabetic rats,and ordinary Sprague-Dawley rats of the same age were used as control group.Left sciatic nerve block was performed with 2％ lidocaine 0.2 ml.Before the sciatic nerve block and at 1 week after the sciatic nerve block,the nerve conduction velocity of the left sciatic nerve and F-wave minimal latency were measured,and the sciatic nerve block time was recorded.Results Compared with the baseline before block,the nerve conduction velocity was significantly decreased,and the F-wave minimal latency was prolonged in late diabetic rats (P＜0.05).Compared with control group,the sciatic nerve block time was significantly prolonged in late diabetic group (P＜0.05).Conclusion Diabetic peripheral neuropathy aggravates peripheral neurotoxicity induced by local anesthetics in rats.

Review of sensitivity of diabetics to local anesthetics / 中国生化药物杂志

Local anesthetics have neurotoxicity, which can lead to temporary or permanent sensory and motor dysfunction.And regional anesthesia is commonly used in diabetics undergoing limbs or lower abdominal surgery, so that local anesthetics were widely used in them.However local anesthetics sensitivity in patients with diabetics is not yet clear.In this paper, we will discuss the problem and make a summary.

Prevalence and risk factors of chronic low back pain in puerperas after childbirth / 中国医师进修杂志

Objective To observe the prevalence and risk factors of chronic low back pain in puerperas after childbirth.Methods Eight hundred and eighty-one puerperas were selected,among whom 459 cases had uterine-incision delivery,and 422 cases had spontaneous delivery.The age,height and weight of pregnant women,birth weight of newborn,history of preoperative low back pain,parity and mode of delivery were recorded.The rate of chronic low back pain occurring within 1 month after childbirth and continuing for 3 months was recorded by telephone.The factors with P values less than 0.05 would enter the Logistic regression analysis to screen the risk factors of chronic low back pain.Results Two hundred and fifty-nine puerperas (259/881,29.4％) appeared chronic low back pain,of whom 157 puerperas (157/459,34.2％)delivered by uterine-incision and 102 puerperas (102/422,24.2％) delivered spontaneously,and the difference was statistically significant (P ＜ 0.01).Six hundred and fifty-eight puerperas had no history of preoperative low back pain,and 150 puerperas (150/658,22.8％) appeared newly developed chronic low back pain.Logistic regression analysis showed that mode of delivery,parity and history of preoperative low back pain were the risk factors of chronic low back pain.Condusions The rate of chronic low back pain in puerperas after childbirth is 29.4％,and the newly developed chronic low back pain is 22.8％.Uterineincision delivery,multiparity and history of preoperative low back pain are the risk factors of chronic low back pain for puerperas after childbirth.

Effects of penehyclidine hydrochloride combined with ulinastatin on brain injury in patients undergoing cardiac valve replacement with cardiopulmonary bypass / 中华麻醉学杂志

Objective To evaluate the effects of penehyclidine hydrochloride combined with ulinastatin on brain injury in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Forty-eight patients of both sexes,aged 20-64 yr,weighing 40-66 kg,of ASA physical status Ⅱ (NYHA Ⅱ),scheduled for elective cardiac valve replacement with CPB,were randomly divided into 4 groups (n =12 each) using a random number table:control group (group C),penehyclidine hydrochloride group (group P),ulinastatin group (group U),and penehyclidine hydrochloride and ulinastatin group (group PU).Penehyclidine hydrochloride 0.02 mg/kg was injected via the right internal jugular vein at 15 min before induction of anesthesia in group P.In group U,the total amount of ulinastatin was 2× 104 U/kg,30％ of the total amount was given via the right internal jugular vein after induction and before surgery,40％ was added to the priming solution,and the remaining 30％ was injected via the right internal jugular vein while the aorta was opened.In group PU,penehyclidine hydrochloride or ulinastatin was given according to the method previously described in group P or U.The equal volume of normal saline was given instead in group C.After induction and before surgery (T1),at 30 min of CPB (T2),and at 30 min and 6 h after termination of CPB (T3,4),blood samples were taken from the left internal jugular bulb and radial artery for blood gas analysis and determination of jugular venous oxygen saturation,jugular venous O2 content,arterial O2 content,and plasma concentrations of S-100β protein and neuron-specific enolase (NSE) (by ELISA).Arteriovenous oxygen content difference (Ca-jrO2) and cerebral O2 extraction rate (CERO2) were calculated.Results Compared with group C,SjvO2 was significantly increased,and CERO2 was decreased at T2.3 in P and U groups and at T2.4 in group PU,and Ca-jvO2 and plasma concentrations of S-100β protein and NSE were decreased at T2,3 in P,U and PU groups.The plasma concentrations of S-100β protein and NSE were significantly lower at T2,3 in group PU than in P and U groups.Conclusion The combination of penehyclidine hydrochloride and ulinastatin produces better efficacy than either alone in attenuating brain injury in patients undergoing cardiac valve replacement with CPB.

Effect of Astragalus injection on serum SOD and MDA in patients during supratentorial tumor resection / 实用医学杂志

Objective To evaluate the effect of Astragalus injection on serum SOD and MDA in patients during supratentorial tumor resection. Methods Twenty-four patients with ASAⅠorⅡ degree, aged 20~55 years old, undergoing supratentorial tumor resection were randomized into the control group (group C) and the Astragalus group (group R), with 12 cases in each group. Patients in group R received 250 mL 0.9% sodium chloride in addition with 20 mL Astragalus injection. Patients in group C received the same amount of 0.9%sodium chloride. Blood samples were taken from jugular venous bulb before induction of anesthesia (T1), intubation (T2), open dura instantly (T3), 1 h after the dura opened (T4), 24 h after the dura opened (T5), and 48 h after the dura opened (T6). The levels of serum SOD and MDA were determined. Results The serum SOD in both group R and group C was lower at T3~6 than that at T1 , but the serum SOD in group R reduced significantly compared with group C (P < 0.05); The serum MDA in both group R and group C at T4~6 was higher than that at T1, but the serum MDA in group R increased significantly compared with group C (P <0.05). Conclusion Astragalus injection can enhance the serum SOD activity and reduce MDA output in patients during supratentorial tumor resection.

Intravenous injection of flurbiprofen axetil and sufentanil combined with epidural morphine for post-cesarean analgesia / 中国医师进修杂志

Objective To investigate the analgesic effect and the safety assessment of intravenous injection of flurbiprofen axetil and sufentanil combined with epidural morphine for post-cesarean analgesia.Methods One hundred and eighty parturients (ASA Ⅰ-Ⅱ) undergoing elective cesarean section with combined spinal and epidural anesthesia were divided into morphine group (group A),sufentanil + morphine group(group B),flurbiprofen axetil+sufentanil+ morphine group(group C) with 60 cases in each group.All patients were used subarachnoid epidural anesthesia,at the end of the surgery,1.5 mg morphine diluted to 5 ml saline was injected into the epidural space of each patient.Additional,group B and group C received patient-controlled intravenous analgesia after cesarean section.Flurbiprofen axetil and sufentanil were diluted to 100 ml with saline.The visual analog scale (VAS) of rest and dynamic incisional pain and uterine contraction pain,Ramsay sedation scale (RSS),and adverse events were recorded at 6,12,24 h after operation.Results At 6,12,24 h after operation,the VAS scores of rest and dynamic incisional pain and uterine contraction pain in group B and group C were statistically lower than those in group A [rest incisional pain:(2.6 ± 0.6),(2.7 ± 0.4),(2.8 ± 0.3)scores in group A; (2.3 ± 0.3),(2.3 ± 0.4),(2.2 ± 0.3) scores in group B; (1.8 ± 0.4),(1.7 ±0.5),(1.9 ±0.4) scores in group C; dynamic incisional pain:(5.7 ±0.9),(5.5 ± 0.8),(5.6 ± 1.0) scores in group A; (3.8 ± 0.4),(3.7 ± 0.5),(3.7 ± 0.4) scores in group B ; (2.7 ± 0.4),(2.4 ± 0.5),(2.4 ± 0.6) scores in group C ; uterine contraction pain:(5.7 ± 1.2),(5.9 ± 0.9),(5.8 ± 1.1) scores in group A; (3.0 ± 0.5),(3.1 ± 0.6),(3.2 ± 0.7)scores in group B; (2.5 ± 0.5),(2.5 ± 0.6),(2.4 ± 0.4) scores in group C],and group C were lower than group B,and there were significant differences (P＜0.05).At 6,12,24 h after operation,Ramsay score in group B and group C was higher than that in group A [(1.8 ± 0.5),(1.7 ± 0.4),(1.9 ± 0.5) scores in group A; (3.4 ± 0.8),(3.2 ± 0.7),(3.3 ± 0.6) scores in group B; (2.7 ±0.7),(2.7 ±0.5),(2.6 ± 0.4)scores in group C],and group C was higher than group B,and there were significant differences (P ＜ 0.05).The incidence of adverse events in group A and group C was lower than group B [8.3％(5/60) and 23.3％(14/60) vs.40.0％(24/60)],and group A was lower than group C,and there were significant differences (P ＜ 0.05).Condusion Intravenous injection of flurbiprofen axetil and sufentanil combined with epidural morphine could perform better analgesic on postoperative incisional and uterine contraction pain after cesarean section and the incidence of adverse events is less than sufentanil combined with morphine.