ProSeal喉罩对老年乳腺癌根治术患者全身麻醉苏醒期的影响

Objective To explore the effect of ProSeal laryngeal mask airway and endotracheal tube on analepsia stage of general anesthesia in geriatric patients undergoing radical mastectomy.Methods Thirty geriatric females with breast cancer of American Standards Association (ASA)Ⅰ-Ⅱscheduled for selective radical mastectomy under general anesthesia were randomly allocated to two groups: ProSeal laryngeal mask airway group(PLMA group, n=15) and endotracheal tube group (ET group, n=15). The patients were put on PLMA or were intubated with ET under general anesthesia in the two groups, respectively. The heart rate (HR), systolic blood pressure(SBP)and diastolic blood pressure (DBP) were recorded at the time points of 5 min after entering operation room (T0), end of surgery (T1), opening eyes (T2), after extubation (PLMA) immediately (T3) and 3 min after extubation (PLMA) (T4). The numbers of patients who were given antihypertensive agent,showed bucking, agitation or sore throat, nausea and vomiting after extubation were recorded during the analepsia stage of general anesthesia. Results The blood pressure (BP) and HR were mildly.increased in PLMA group at T2, and there was no significant difference compared with T0(P＞0.05). But the BP and HR were significantly higher at T3 than at T0 (P＜0.05). In ET group, the BP and HR were both significantly elevated at T2 and T3 than at T0 (P＜0.05), and reached the peak at T3. The increased levels of BP and HR were significantly lower in PLMA group than in ET group at T2 and T3 (P＜0.05). The quantities of patients who were given antihypertensive agent, showed bucking and sore throat were less in PLMA group than in ET group(P＜0.05). No differences in incidence rate of agitation, nausea and vomiting after extubation between the two groups were observed(P＞0.05). Conclusions PLMA can obviously reduce the occurrence of complications in analepsia stage of general anesthesia in geriatric patients scheduled for selective radical mastectomy,and is beneficial to provide much safer anesthesia.     

Is there any difference in anesthetic management of different post-OLT stage patients undergoing nontransplant organ surgery?

BACKGROUND: Little information is available about anesthesia management of nontransplant organ surgery of recipients after adult liver transplantation. The aim of this study was to discuss the anesthesia management of recipients for different stages after liver transplantation. METHODS: The medical records of 16 patients were reviewed after OLT scheduled for elective nontransplant organ surgery at our institution from September 2002 to October 2005. The patients were divided into perioperative stage (group A) and mid-term and long-term stage (group B) groups according to post-OLT time. The data of 16 patients preoperation, intraoperation and postoperation were analyzed. RESULTS: The measurements of alanine transaminase (ALT), total bilirubin (TB), prothrombin time (PT), and lung infection were significantly higher in group A than in group B (P<0.05). The incidence of hyperglycaemia was significantly higher in group B than in group A (P<0.05). During operation the incidence of hypotension was significantly higher in group A than in group B (P<0.05). After operation, the number of patients in ICU was significantly larger and the extubation time was longer in group A than in group B. General anesthesia was induced in 14 patients, and regional anesthesia in 2 patients. CONCLUSIONS: Regional or general anesthesia can be safely delivered to adult OLT recipients except for contraindications. Special considerations include protection of the function of important organs, correction of hemodynamic instability in perioperative stage patients after OLT, and measurement of the side-effects of immunosuppression in mid-term and long-term stage patients.     

Effect of acupoint stimulation on the quality of recovery in patients with radical thyroidectomy under the concept of enhanced recovery after surgery:a randomized controlled trial

正Objective To observe the effect of acupoint stimulation on the quality of recovery in patients with radical thyroidectomy under the concept of enhanced recovery after surgery (ERAS).Methods A total of 62 patients with radical thyroidectomy were randomized into an observation group and a control group,31 cases in each one.In both of the two groups,general anesthesia with tracheal intubation was applied,the same anesthesia induction and maintenance medication were given.In the observation     

Effects of 7.5% hypertonic saline on fluid balance after radical surgery for gastrointestinal carcinoma

AIM: To investigate the effects of 7.5% hypertonic saline on positive fluid balance and negative fluid balance, after radical surgery for gastrointestinal carcinoma. METHODS: Fifty-two patients with gastrointestinal carcinoma undergoing radical surgery were studied. The patients were assigned to receive either Ringer lactate solution following 4 mL/kg of 7.5% hypertonic saline (the experimental group, n = 26) or Ringer lactate solution (the control group, n = 26) during the early postoperative period in SICU. Fluid infusion volumes, urine outputs, fluid balance, body weight change, PaO2/FiO2 ratio, anal exhaust time as well as the incidence of complication and mortality were compared between the two groups. RESULTS: Urine outputs on the operative day and the first postoperative day in experimental group were significantly more than in control group (P<0.000001, P=0.000114). Fluid infusion volumes on the operative day and the first postoperative day were significantly less in experimental group than in control group (P= 0.000042, P= 0.000415). The volumes of the positive fluid balance on the operative day and during the first 48 h after surgery, in experimental group, were significantly less than in control group (P<0.000001). Body weight gain post-surgery was significantly lower in experimental group than in control group (P<0.000001). The body weight fall in experimental group occurred earlier than in control group (P<0.000001). PaO2/FiO2 ratio after surgery was higher in experimental group than in control group (P= 0.000111). The postoperative anal exhaust time in experimental group was earlier than in control group (P= 0.000006). The overall incidence of complications and the incidence of pulmonary infection were lower in experimental group than in control group (P= 0.0175, P= 0.0374). CONCLUSION: 7.5% hypertonic saline has an intense diuretic effect and causes mobilization of the retained fluid, which could reduce fluid infusion volumes and positive fluid balance after radical surgery for gastrointestinal carcinoma, as well as, accelerate the early appearance of negative fluid balance after the surgery, improve the oxygen diffusing capacity of the patients' alveoli, and lower the overall incidence of complications and pulmonary infection after the surgery.     

The scoring system for patients with severe sepsis after orthotopic liver transplantation

BACKGROUND: Because of the complicated pathological features after liver transplantation, severe sepsis is difficult to treat and often leads to death. This study was undertaken to analyze the role of orthotopic liver transplantation (OLT) in patients with severe sepsis and to evaluate the effect of the scoring system. METHODS: Fifty-six patients conformed to the inclusion criteria. They were divided into two groups: non-OLT group (group A) and OLT group (group B). Besides the general data of the patients, the surveillance of blood lactate, the number of failed organs, acute physiology and chronic health evaluationⅡ(APACHEⅡ) and mutiple organ dysfunction score (MODS) were evaluated at the 1st, 3rd and 7th day after OLT. RESULTS: The mortality during hospitalization was 30% in the non-OLT group and 57.6% in the other group. The level of blood lactate at the 1st day of OLT increased more significantly in the OLT group than in the non-OLT group (P<0.01). It was decreased but higher than that in the non-OLT group in the seven days after OLT. The number of failed organs in the OLT group was greater than that in the non-OLT group (P<0.01). The continuous score of APACHEⅡwas not significantly different in the two groups. But the continuous MODS in the OLT group was higher than that in the non-OLT group (P<0.01), which was consistent with the number of failed organs. CONCLUSIONS: The persistently higher level of blood lactate during 7 days may be a dependent risk factor. Immunosuppression may be another risk factor for OLT patients. The mortality of OLT in patients with severe sepsis in 28 days is almost double that in non-OLT patients. The MODS score is better than the APACHEⅡscore in the assessment of organ failure in OLT patients with severe sepsis. The standard scoring system could be improved or a new scoring system that includes the blood lactate score should be established for liver transplantation.     

围手术期无创双水平正压通气治疗对中、重度慢性阻塞性肺疾病患者上腹部手术疗效观察

Objective To investigate the treatment effects of noninvasive bi-level positive airway Dressure(BiPAP)in elder chronic obstructive pulmonary disease(COPD)patients with upper abdominal surgery in postoperative period.Methods To divide 59 moderate-severe elder stable COPD patients into two groups randomly.Thirty cases in treatment group,intermittent noninvasive BiPAP was added on the basis of general treatment,began to use one week before the surgery and continued to use after the surgery for one week(to use immediately in general anesthesia patients after extubation).Twenty-nine cases in control group,to cure with the general method of removing sputum,relieving caugh and stopping dyspnea in postoperative period.Results PaO2,FEV1,PEFR increased obviously before the surgery in treatment group [PaO2:(77.3±4.2)mm Hg vs(86.4±4.7)mm Hg,FEV1:(1.02±0.11)L/s vs(1.37±0.21)L/s,PEFR:(3.47±0.29)L/s vs(4.84±0.34)L/s](P＜0.05).PaO2,PEFR decreased in varying degrees in both groups after the surgery,and the degree was more obvious in control group than in treatment group (P＜0.05).Parameters began to recover in the second day after the surgery in treatment group,and reached to the normal level in the fifth day,but got tO the normal level in the seventh day in control group.The incidence rate of pulmonary complications was more obvious in control group than in treatment group(20%vs 37.9%),the duration of hospitalization was shorter in treatment group than in control group(9.46 days vs 13.36 days)(P＜0.05).Conclusions The restricted air-flow and hypoxemia can be improved significantly in elder COPD patients with upper abdominal surgery in postoperative period after treatment with nonin-vasive BiPAP increases ventilation,decreases complications after surgery.     

Efficacy of perioperative parecoxib injection on postoperative pain relief after laparoscopic cholecystectomy： A prospective, randomized study

AIM： To determine the efficacy of perioperative parecoxib injection on postoperative pain relief after laparoscopic cholecystectomy. METHODS： A prospective, double-blind, randomized, placebo-controlled study was conducted on 70 patients who underwent elective laparoscopic cholecystectomy under general anesthesia at Siriraj Hospital, Bangkok, from January 2006 to December 2007. Patients were randomized to receive either 20 mg parecoxib infusion 30 min before induction of anesthesia and at 12 h after the first dose （treatment group）, or normal saline infusion, in the same schedule, as a placebo （control group）. The degree of the postoperative pain was assessed every 3 h in the first 24 h after surgery, and then every 12 h the following day, using a visual analog scale. The consumption of analgesics was also recorded. RESULTS： There were 40 patients in the treatment group, and 30 patients in the control group. The pain scores at each time point, and analgesic consumption did not differ between the two groups. However,there were fewer patients in the treatment group than placebo group who required opioid infusion within the first 24 h （60% vs 37%, P = 0.053）. CONCLUSION： Perioperative administration of parecoxib provided no significant effect on postoperative pain relief after laparoscopic cholecystectomy. However, preoperative infusion 20 mg parecoxib could significantly reduce the postoperative opioid consumption.     

The changes of intraoperative body temperature in adult liver transplantation: A retrospective study

Background: Body temperature is poorly regulated in patients with end-stage liver disease. Due to the prolonged surgery time and anhepatic time as well as the complex surgical procedures performed in liver transplantation, the body temperature fluctuates greatly. This study investigated the effect of intraoperative body temperature fluctuations on the prognosis of liver recipients. Methods: The body temperatures of liver recipients recorded from the induction of anesthesia(T 0) until the end of surgery(T 14) were retrieved. The patients were divided into two groups: the hypothermia group( 35 °C and ≥ 5 min) and the normothermia group( ≥ 35 °C or 35 °C but 5 min). Intraoperative and postoperative variables were compared between the two groups, and the correlations between the duration of hypothermia and the medical variables were analyzed. Results: Of the 107 patients, 67 patients were in the normothermia group, and 40 in the hypothermia group. The lowest body temperature was at 5 min after reperfusion for the whole cohort. Compared with the normothermia group, patients in the hypothermia group were more prone to bleeding, had a longer intubation time and increased rates of bacterial infection and acute pulmonary edema after liver transplantation( P 0.05). Hypothermia time was positively correlated with bleeding volume, intubation time, units of blood transfusions and intensive care stay, but negatively correlated with urine output. Conclusions: The intraoperative body temperature exhibited a graphical "V" trend, and the lowest temperature was at 5 min after reperfusion. The longer the duration of hypothermia, the more unfavourable the prognosis.     

Hybrid artificial liver support system for treatment of severe liver failure

AIM: To construct a novel hybrid artificial liver support system (HALSS) and to evaluate its efficacy in patients with severe liver failure. METHODS: Hepatocytes were isolated from suckling pig by the modified Seglen's method. Isolated hepatocytes were cultured in a spinner flask for 24 h to form spheroids before use and the functions of spheroids were detected. HALSS consisted of a plasma separator, a hemo-adsorba and a bioreactor with hepatocytes spheroids in its extra-fiber space. HALSS was applied to 10 patients with severe liver failure. The general condition and the biochemical indexes of the patients were studied just before and after the treatment. RESULTS: The number of cells per liver was about 2-4×1010 (mean, 3.1±1.5×1010). The cell viabilities were more than 95%. After 24 h of spheroid culture, most hepatocytes formed spheroids. The levels of albumin and urea in the medium of spheroid culture were higher than those in supernatant of petri dish culture (P= 0.0015 and 0.0001, respectively). The capacity of albumin production and urea synthesis remained stable for more than one wk and declined rapidly after two weeks in vitro. In HALSS group, the duration of HALSS treatment was 6-10 h each time. All patients tolerated the treatment well without any fatal adverse reaction. After HALSS treatment, the general condition, psychic state, encephalopathy and hepatic function of the patients were improved. The survival rate of the HALSS group, Plasmapheresis group and control group was 30% (3/10), 20% (2/10) and 0% (0/10), respectively (P = 0.024). Two weeks after treatment, Tbil and ALT decreased and the PTA level elevated in HALSS group and pasmapheresis group (Pvalue: 0.015 vs0.020, 0.009 vs 0.012 and 0.032 vs 0.041, respectively). But there was no significant change of blood albumin concentration before and after treatment in HALSS group and Plasmapheresis group. CONCLUSION: The HALSS established by us is effective in supporting liver function of patients with severe liver failure.     

Capsule oxymatrine in treatment of hepatic fibrosis due to chronic viral hepatitis:A randomized,double blind,placebo-controlled,multicenter clinical study

AIM:To evaluate the efficacy and safety of oxymatrine capsule in treatment of hepatic fibrosis in patients with chronic viral hepatitis. METHODS:It was a randomized,double blind,placebo- controlled,multicenter clinical study.One hundred and forty- four patients were divided into oxymatrine capsule group (group A)and placebo group(group B).The course was 52 wk.Patients were visited once every 12 wk and the last visit was at 12 wk after cessation of the treatment.All patients had liver biopsy before treatment,part of them had a second biopsy at the end of therapy.Clinical symptoms,liver function test,serum markers of hepatic fibrosis were tested.Ultrasound evaluation was performed before,during and at the end of therapy. RESULTS:One hundred and forty-four patients enrolled in the study.Of them 132 patients completed the study according to the protocol,49 patients had liver biopsy twice(25 patients in group A and 24 in group B).At the end of therapy,significant improvements in hepatic fibrosis and inflammatory activity based on Semi-quantitative scoring system(SSS)were achieved in group A.The total effective rate of the treatment was 48.00%,much higher than that of 4.17% in group B (P<0.05).Significant improvement in serum markers of hepatic fibrosis such as hyaluronic acid(HA)and type Ⅲ procollagenic peptide(P Ⅲ P)in group A was seen(P<0.05).The total effective rate of serum markers at the end of therapy in group A was 68.19%,much higher than that of 34.85% in group B(P<0.05).The total effective rate of noninvasive markers at the end of therapy in group A was 66.67%,much higher than that of 30.30% in group B(P<0.05).The rate of adverse events was similar in two groups. CONCLUSION:Oxymatrine capsule is effective and safe in treatment of hepatic fibrosis due to chronic viral hepatitis.     

State of knowledge of helminth fauna of freshwater fishes of Poland

A total 89 fish and lamprey species has been recorded from Polish freshwater habitats. Twenty-seven of them (30.3%) have not been surveyed for parasitic helminthes. Some of the latter fishes are either rare or not easily accessible. Other live only in specific habitats in scattered localities. An important obstacle for studying parasite faunas of some fishes may be their status on an endangered species. Among the non-surveyed fishes, are those which have been relatively recently introduced to Poland or migrated there on their own. The present paper attempts to review all hitherto not studied helminthologically fish species, their habitats, localities and current protection status.