Pub Date : 2020-04-15DOI: 10.3760/CMA.J.CN321761-20190926-00007
Hai-yan Wei, Hong-wei Shi, Ying Li, Jie Shi, Y. Ge, Tao Shi, Hongguang Bao
Objective To investigate the relationship between plasma P-selectin level and acute lung injury (ALI) in patients with acute type A aortic dissection (ATAAD) during the perioperative period. Methods Forty-six ATAAD patients were enrolled. According to the perioperative diagnostic criteria of ALI, the patients were divided into two groups: a preoperative ALI group (group A, n=24) and a preoperative non-ALI group (group NA, n=22). All the patients underwent total aortic arch replacement combined with stented elephant trunk implantation (the Sun's procedure) under general anesthesia and deep hypothermic circulatory arrest (DHCA). Arterial blood was collected before anesthesia induction (T0), at the end of operation (T1) and 12 h after operation (T2) for blood gas analysis, and oxygenation index (OI) was calculated. At the same time, venous blood was taken to detect plasma P-selectin level, platelet count (PC), mean platelet volume (MPV), and platelet distribution width (PDW). Results Patients in group A presented a lower OI than those in group NA at each time point (P<0.05). Compared with those at T0, OI decreased at T1 but increased at T2 for patients in group A, while OI decreased at T1 and T2 for patients in group NA (P<0.05). Compared with those in group NA, patients in group A produced an increased level of plasma P-selectin at each time point (P<0.05), and a decreased PC at T0 (P<0.05). Compared with those at T0, both groups produced increased levels of plasma P-selectin and PDW as well as decreased PC and MPV at T1 (P<0.05); and increased levels of plasma P-selectin and decreased PC at T2 (P<0.05). There was a negative correlation between plasma P-selectin level and OI (r=-0.793, P<0.05). Conclusions Many factors lead to platelet activation and an increased level of plasma P-selectin in ATAAD patients during the perioperative period, which is an important factor for ALI during the perioperative period. Perioperative measures to weaken platelet activation and reduce plasma P-selectin level may contribute to prevention and treatment of ALI. Key words: Dissection of aortic; P-selectin; Acute lung injury; Oxygenation index; Platelet
{"title":"Relationship between plasma P-selectin level and acute lung injury in patients with acute type A aortic dissection during the perioperative period","authors":"Hai-yan Wei, Hong-wei Shi, Ying Li, Jie Shi, Y. Ge, Tao Shi, Hongguang Bao","doi":"10.3760/CMA.J.CN321761-20190926-00007","DOIUrl":"https://doi.org/10.3760/CMA.J.CN321761-20190926-00007","url":null,"abstract":"Objective \u0000To investigate the relationship between plasma P-selectin level and acute lung injury (ALI) in patients with acute type A aortic dissection (ATAAD) during the perioperative period. \u0000 \u0000 \u0000Methods \u0000Forty-six ATAAD patients were enrolled. According to the perioperative diagnostic criteria of ALI, the patients were divided into two groups: a preoperative ALI group (group A, n=24) and a preoperative non-ALI group (group NA, n=22). All the patients underwent total aortic arch replacement combined with stented elephant trunk implantation (the Sun's procedure) under general anesthesia and deep hypothermic circulatory arrest (DHCA). Arterial blood was collected before anesthesia induction (T0), at the end of operation (T1) and 12 h after operation (T2) for blood gas analysis, and oxygenation index (OI) was calculated. At the same time, venous blood was taken to detect plasma P-selectin level, platelet count (PC), mean platelet volume (MPV), and platelet distribution width (PDW). \u0000 \u0000 \u0000Results \u0000Patients in group A presented a lower OI than those in group NA at each time point (P<0.05). Compared with those at T0, OI decreased at T1 but increased at T2 for patients in group A, while OI decreased at T1 and T2 for patients in group NA (P<0.05). Compared with those in group NA, patients in group A produced an increased level of plasma P-selectin at each time point (P<0.05), and a decreased PC at T0 (P<0.05). Compared with those at T0, both groups produced increased levels of plasma P-selectin and PDW as well as decreased PC and MPV at T1 (P<0.05); and increased levels of plasma P-selectin and decreased PC at T2 (P<0.05). There was a negative correlation between plasma P-selectin level and OI (r=-0.793, P<0.05). \u0000 \u0000 \u0000Conclusions \u0000Many factors lead to platelet activation and an increased level of plasma P-selectin in ATAAD patients during the perioperative period, which is an important factor for ALI during the perioperative period. Perioperative measures to weaken platelet activation and reduce plasma P-selectin level may contribute to prevention and treatment of ALI. \u0000 \u0000 \u0000Key words: \u0000Dissection of aortic; P-selectin; Acute lung injury; Oxygenation index; Platelet","PeriodicalId":13847,"journal":{"name":"国际麻醉学与复苏杂志","volume":"41 1","pages":"350-354"},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48716695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-15DOI: 10.3760/CMA.J.CN321761-20190730-00016
Fei Wang, Xuechao Hao, Tao Zhu
With the growth of the world's older population and the improvement of anesthetic and surgical techniques, an increasing number of elderly patients would like to undergo non-cardiac surgery. Perioperative cardiovascular adverse events are still the one of most commonly reasons to increase mortality and complications. Elderly patients have an obviously higher risk of cardiovascular adverse events than young and middle-aged patients, due to degraded physiological function and increased diseases, in addition to the influence of anesthesia and operation. With respect to patient general condition, comorbidity, anesthetic method and other factors, it is a hot research topic at home and abroad to construct an accurate and feasible assessment tool or predictive model to evaluate the risk of cardiovascular adverse events in elderly patients during the perioperative period. The current paper reviews the advantages, disadvantages, clinical application and research progress of domestic and oversea assessment tools to evaluate cardiovascular risks of elderly patients with non-cardiac surgery. Key words: Non-cardiac surgery; Cardiovascular events; Aged; Perioperative period; Risk assessment
{"title":"Progress in the application of perioperative cardiac risk assessment tools in elderly patients with non-cardiac surgery","authors":"Fei Wang, Xuechao Hao, Tao Zhu","doi":"10.3760/CMA.J.CN321761-20190730-00016","DOIUrl":"https://doi.org/10.3760/CMA.J.CN321761-20190730-00016","url":null,"abstract":"With the growth of the world's older population and the improvement of anesthetic and surgical techniques, an increasing number of elderly patients would like to undergo non-cardiac surgery. Perioperative cardiovascular adverse events are still the one of most commonly reasons to increase mortality and complications. Elderly patients have an obviously higher risk of cardiovascular adverse events than young and middle-aged patients, due to degraded physiological function and increased diseases, in addition to the influence of anesthesia and operation. With respect to patient general condition, comorbidity, anesthetic method and other factors, it is a hot research topic at home and abroad to construct an accurate and feasible assessment tool or predictive model to evaluate the risk of cardiovascular adverse events in elderly patients during the perioperative period. The current paper reviews the advantages, disadvantages, clinical application and research progress of domestic and oversea assessment tools to evaluate cardiovascular risks of elderly patients with non-cardiac surgery. \u0000 \u0000Key words: \u0000Non-cardiac surgery; Cardiovascular events; Aged; Perioperative period; Risk assessment","PeriodicalId":13847,"journal":{"name":"国际麻醉学与复苏杂志","volume":"41 1","pages":"396-400"},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47733272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-15DOI: 10.3760/CMA.J.CN321761-20190226-00019
L. Cai, Kaimin Zhu, Meihua Shen, Hongpeng He
With the rapid development and huge progress of surgery, more and more patients choose to undergo surgery. Post- operative delirium is a common complication which has attracted increasing attention. However, the pathogenesis of postoperative delir- ium remains unclear, and it is still not easy to diagnose the disease. Postoperative delirium has diverse manifestations and is easy to be misdiagnosed, without specific biochemical markers. The treatment of postoperative delirium is still difficult, especially the lack of effective drugs. This paper summarized the diagnosis, pathogenesis, prevention and treatment of postoperative delirium, so as to facilitate future research. Key words: Postoperative delirium; Cognitive disorder
{"title":"Research progress on the perioperative application of lung ultrasound in pulmonary disease","authors":"L. Cai, Kaimin Zhu, Meihua Shen, Hongpeng He","doi":"10.3760/CMA.J.CN321761-20190226-00019","DOIUrl":"https://doi.org/10.3760/CMA.J.CN321761-20190226-00019","url":null,"abstract":"With the rapid development and huge progress of surgery, more and more patients choose to undergo surgery. Post- operative delirium is a common complication which has attracted increasing attention. However, the pathogenesis of postoperative delir- ium remains unclear, and it is still not easy to diagnose the disease. Postoperative delirium has diverse manifestations and is easy to be misdiagnosed, without specific biochemical markers. The treatment of postoperative delirium is still difficult, especially the lack of effective drugs. This paper summarized the diagnosis, pathogenesis, prevention and treatment of postoperative delirium, so as to facilitate future research. \u0000 \u0000Key words: \u0000Postoperative delirium; Cognitive disorder","PeriodicalId":13847,"journal":{"name":"国际麻醉学与复苏杂志","volume":"41 1","pages":"411-416"},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46898623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-15DOI: 10.3760/CMA.J.CN321761-20191122-00008
Chen Xie, Yueyang You, K. Sun, M. Yan
Objective To investigate the incidence of hypoxemia in the anesthesia recovery period after thoracoscopic surgery and explore the risk factors of hypoxemia and its predictive efficiency. Methods A total of 841 patients, aged 18-90 years, American Society of Anesthesiologists (ASA) physical status of Ⅰ‒Ⅲ , who were scheduled for thoracoscopic surgery from October 2017 to May 2019 in the Second Affiliated Hospital of Zhejiang University School of Medicine, were retrospectively analyzed in the current study. They were divided into a hypoxemia group and a non-hypoxemia group, according to the presence of hypoxemia in the anesthesia recovery period. Both groups were compared for their clinical data before and during surgery to evaluate the condition of hypoxemia in the recovery period. Their risk factors were analyzed by multivariate Logistic regression. A receiver operating characteristic (ROC) curve was established to examine its predictive efficiency towards hypoxemia. Results Among the 841 patients, 239 patients (28.4%) presented hypoxemia during the anesthesia recovery period. The risk factors of hypoxemia included age [odds ratio (OR)=1.028, 95% confidence interval (CI) 1.006-1.050], body mass index (BMI) (OR=1.217, 95%CI 1.111-1.333), hypertension (OR=2.462, 95%CI 1.564-3.875), mediastinal surgery (OR=2.756, 95%CI 1.605-6.873) and supine position (OR=2.230, 95%CI 0.936-5.314). For hypoxemia in the anesthesia recovery period, its area under the receiver operating characteristic curve (AUC) was 0.723 (95%CI=0.685-0.761, P<0.01), with a sensitivity of 63.6% and a specificity of 69.4%. Conclusions Extensive attention towards blood pressure control and body weight management before surgery, and comprehensive understanding the mechanism of hypoxemia caused by surgery at the supine position and active prevention, may reduce the incidence of hypoxemia during the anesthesia recovery period after thoracoscopic surgery. Key words: Thoracoscopy; Anesthesia recovery period; Hypoxemia; Risk factor
{"title":"Analysis of the risk factors of hypoxemia in the anesthesia recovery period after thoracoscopic surgery","authors":"Chen Xie, Yueyang You, K. Sun, M. Yan","doi":"10.3760/CMA.J.CN321761-20191122-00008","DOIUrl":"https://doi.org/10.3760/CMA.J.CN321761-20191122-00008","url":null,"abstract":"Objective \u0000To investigate the incidence of hypoxemia in the anesthesia recovery period after thoracoscopic surgery and explore the risk factors of hypoxemia and its predictive efficiency. \u0000 \u0000 \u0000Methods \u0000A total of 841 patients, aged 18-90 years, American Society of Anesthesiologists (ASA) physical status of Ⅰ‒Ⅲ , who were scheduled for thoracoscopic surgery from October 2017 to May 2019 in the Second Affiliated Hospital of Zhejiang University School of Medicine, were retrospectively analyzed in the current study. They were divided into a hypoxemia group and a non-hypoxemia group, according to the presence of hypoxemia in the anesthesia recovery period. Both groups were compared for their clinical data before and during surgery to evaluate the condition of hypoxemia in the recovery period. Their risk factors were analyzed by multivariate Logistic regression. A receiver operating characteristic (ROC) curve was established to examine its predictive efficiency towards hypoxemia. \u0000 \u0000 \u0000Results \u0000Among the 841 patients, 239 patients (28.4%) presented hypoxemia during the anesthesia recovery period. The risk factors of hypoxemia included age [odds ratio (OR)=1.028, 95% confidence interval (CI) 1.006-1.050], body mass index (BMI) (OR=1.217, 95%CI 1.111-1.333), hypertension (OR=2.462, 95%CI 1.564-3.875), mediastinal surgery (OR=2.756, 95%CI 1.605-6.873) and supine position (OR=2.230, 95%CI 0.936-5.314). For hypoxemia in the anesthesia recovery period, its area under the receiver operating characteristic curve (AUC) was 0.723 (95%CI=0.685-0.761, P<0.01), with a sensitivity of 63.6% and a specificity of 69.4%. \u0000 \u0000 \u0000Conclusions \u0000Extensive attention towards blood pressure control and body weight management before surgery, and comprehensive understanding the mechanism of hypoxemia caused by surgery at the supine position and active prevention, may reduce the incidence of hypoxemia during the anesthesia recovery period after thoracoscopic surgery. \u0000 \u0000 \u0000Key words: \u0000Thoracoscopy; Anesthesia recovery period; Hypoxemia; Risk factor","PeriodicalId":13847,"journal":{"name":"国际麻醉学与复苏杂志","volume":"41 1","pages":"355-359"},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49358506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-15DOI: 10.3760/CMA.J.CN321761-20191125-00003
Jia Li, Jianwei Wang, Meng Wang, Bo Ren, Chang-sheng Li, Xihua Lu, C. Miao
Objective To discuss the effects of hippocampal Na+-K+ -2C1- cotransporter (NKCC1) on sevoflurane-induced neurobehavioral impairments in neonatal rats. Methods Thirty six 6-day-old male Sprague-Dawley rats were divided into three groups (n=12), according to the random number table method: a control group (group C), a sevoflurane group (group S), and a sevoflurane + bumetanide group (group SB). Group C inhaled 30% oxygen for 6 h, while groups S and SB inhaled 2.1% sevoflurane+30% oxygen for 6 h. Group SB was intraperitoneally injected with bumetanide (1.82 mg/kg) 15 min before sevoflurane inhalation. Then, 4 weeks later, the elevated plus maze and prepulse inhibition (PPI) tests were performed. One week after behavior tests, the hippocampus was harvested. Quantitative real time PCR and Western blot were used to detect the levels of NKCC1 mRNA and protein. Results In the elevated plus maze test, no significant difference was observed in total movement distance among the three groups (P<0.05). Compared with group C, group S spent shortened time of stay in the open arms, presented decreased PPI% corresponding to PP3 and PP6 (P<0.05), and produced increased amounts of hippocampal NKCC1 mRNA and protein (P<0.05). Compared with group S, group SB presented extended time in the open arms, increased PPI% corresponding to PP3 and PP6, and declined amounts of hippocampal NKCC1 mRNA and protein (P<0.05). Conclusions Sevoflurane may cause neurobehavioral damages in neonatal rats, which may be associated with NKCC1. Key words: Sevoflurane; Na+-K+ -2C1- cotransporter; Hippocampus; Neuroethology; Neonatal rats
{"title":"Effects of hippocampal Na+-K+-2C1- cotransporter on sevoflurane-induced neurobehavioral impairments in neonatal rats","authors":"Jia Li, Jianwei Wang, Meng Wang, Bo Ren, Chang-sheng Li, Xihua Lu, C. Miao","doi":"10.3760/CMA.J.CN321761-20191125-00003","DOIUrl":"https://doi.org/10.3760/CMA.J.CN321761-20191125-00003","url":null,"abstract":"Objective \u0000To discuss the effects of hippocampal Na+-K+ -2C1- cotransporter (NKCC1) on sevoflurane-induced neurobehavioral impairments in neonatal rats. \u0000 \u0000 \u0000Methods \u0000Thirty six 6-day-old male Sprague-Dawley rats were divided into three groups (n=12), according to the random number table method: a control group (group C), a sevoflurane group (group S), and a sevoflurane + bumetanide group (group SB). Group C inhaled 30% oxygen for 6 h, while groups S and SB inhaled 2.1% sevoflurane+30% oxygen for 6 h. Group SB was intraperitoneally injected with bumetanide (1.82 mg/kg) 15 min before sevoflurane inhalation. Then, 4 weeks later, the elevated plus maze and prepulse inhibition (PPI) tests were performed. One week after behavior tests, the hippocampus was harvested. Quantitative real time PCR and Western blot were used to detect the levels of NKCC1 mRNA and protein. \u0000 \u0000 \u0000Results \u0000In the elevated plus maze test, no significant difference was observed in total movement distance among the three groups (P<0.05). Compared with group C, group S spent shortened time of stay in the open arms, presented decreased PPI% corresponding to PP3 and PP6 (P<0.05), and produced increased amounts of hippocampal NKCC1 mRNA and protein (P<0.05). Compared with group S, group SB presented extended time in the open arms, increased PPI% corresponding to PP3 and PP6, and declined amounts of hippocampal NKCC1 mRNA and protein (P<0.05). \u0000 \u0000 \u0000Conclusions \u0000Sevoflurane may cause neurobehavioral damages in neonatal rats, which may be associated with NKCC1. \u0000 \u0000 \u0000Key words: \u0000Sevoflurane; Na+-K+ -2C1- cotransporter; Hippocampus; Neuroethology; Neonatal rats","PeriodicalId":13847,"journal":{"name":"国际麻醉学与复苏杂志","volume":"41 1","pages":"331-334"},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45732139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-15DOI: 10.3760/CMA.J.CN321761-20190401-00011
Ran Xia, Xingyu Tong, Chengmi Zhang, Weiwei Li, Xueyin Shi
Postoperative pulmonary complication (PPC) has drawn increasing attention due to high incidence and mortality in surgical patients. However, there are many debates its diagnosis and treatment. This review summarized the pathogenesis, diagnosis, predictive risk indicators, and strategy of lung protective ventilation, as well as surgical, anesthesiological, nursing care and other preventative measures that can be taken in the perioperative period. It also introduces the progress on domestic and oversea researches. In the new era when the concept of enhanced recovery after surgery is widely accepted, close multi- disciplinary cooperation is required to cope with PPC and reduce its severity. Key words: Lung; Postoperative complications; Perioperative period; Lung protective ventilation
{"title":"Research progress on the perioperative strategy of prevention and treatment of postoperative pulmonary complications","authors":"Ran Xia, Xingyu Tong, Chengmi Zhang, Weiwei Li, Xueyin Shi","doi":"10.3760/CMA.J.CN321761-20190401-00011","DOIUrl":"https://doi.org/10.3760/CMA.J.CN321761-20190401-00011","url":null,"abstract":"Postoperative pulmonary complication (PPC) has drawn increasing attention due to high incidence and mortality in surgical patients. However, there are many debates its diagnosis and treatment. This review summarized the pathogenesis, diagnosis, predictive risk indicators, and strategy of lung protective ventilation, as well as surgical, anesthesiological, nursing care and other preventative measures that can be taken in the perioperative period. It also introduces the progress on domestic and oversea researches. In the new era when the concept of enhanced recovery after surgery is widely accepted, close multi- disciplinary cooperation is required to cope with PPC and reduce its severity. \u0000 \u0000Key words: \u0000Lung; Postoperative complications; Perioperative period; Lung protective ventilation","PeriodicalId":13847,"journal":{"name":"国际麻醉学与复苏杂志","volume":"41 1","pages":"370-376"},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47656662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-15DOI: 10.3760/CMA.J.CN321761-20190715-00018
Huijie Zhu, Yue Liu, Zhengliang Ma
Postoperative delirium (POD) is an acute neuropsychiatric syndrome characterized by attention deficit and cognitive dysfunction after surgery, and commonly seen in elderly patients. It is known that aging, surgical anesthesia and sleep disorders are related to the occurrence of POD, and one of the mechanisms may be blood-brain-barrier (BBB) damage. This paper summarized the role of BBB damage in the occurrence and development of POD in the recent years, and discusses the detection of BBB damage markers related to POD, so as to provide new ideas for clinical diagnosis, prevention and treatment of POD. Key words: Postoperative delirium; Blood brain barrier; Pathogenesis
{"title":"Research progress on blood-brain barrier damage in the pathogenesis of postoperative delirium","authors":"Huijie Zhu, Yue Liu, Zhengliang Ma","doi":"10.3760/CMA.J.CN321761-20190715-00018","DOIUrl":"https://doi.org/10.3760/CMA.J.CN321761-20190715-00018","url":null,"abstract":"Postoperative delirium (POD) is an acute neuropsychiatric syndrome characterized by attention deficit and cognitive dysfunction after surgery, and commonly seen in elderly patients. It is known that aging, surgical anesthesia and sleep disorders are related to the occurrence of POD, and one of the mechanisms may be blood-brain-barrier (BBB) damage. This paper summarized the role of BBB damage in the occurrence and development of POD in the recent years, and discusses the detection of BBB damage markers related to POD, so as to provide new ideas for clinical diagnosis, prevention and treatment of POD. \u0000 \u0000Key words: \u0000Postoperative delirium; Blood brain barrier; Pathogenesis","PeriodicalId":13847,"journal":{"name":"国际麻醉学与复苏杂志","volume":"41 1","pages":"406-410"},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42291095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-15DOI: 10.3760/CMA.J.CN321761-20191129-00009
Maohong Zhao, Shuqian Han, Yan Li, Weizhi Wang
Objective To evaluate the accuracy of invasive systolic pressure variation (SPV) in monitoring the volume responsiveness of patients under pneumoperitoneum. Methods A total of sixty patients, aged 50-70 years, American Society of Anesthesiologists (ASA) Ⅱ , with body mass index (BMI) of 19-25 kg/m2, who were scheduled for laparoscopic radical resection of gastric cancer, were enrolled. Artificial pneumoperitoneum was established after endotracheal intubation under general anesthesia. Then, 3 min later, the volume loading test was performed, while 6% hydroxyethyl starch 130/0.4 injection was infused at 7 ml/kg over 15 min. Heart rate, mean arterial pressure (MAP), cardiac output (CO), cardiac index (CI), stroke volume index (SVI) and stroke volume variability (SVV) were recorded before pneumoperitoneum (T0), 3 min after pneumoperitoneum (T1), 3 min after the volume loading test (T2) and 2 h after surgery (T3). SPV was calculated after the title of invasive arterial pressure was changed. The patients were divided into two groups according to the increased percentage in SVI after the volume loading test (∆SVI): a positive volume responsiveness group (group R, n=29, ∆ SVI≥10%), and a negative volume responsiveness group (group N, n=31, ∆ SVI<10%). The receiver operator characteristic (ROC) curves of SPV and SVV were plotted, and the area under the receiver operator characteristic curve (AUC) and 95% confidence interval (CI) were calculated to determine the accuracy and diagnostic thresholds of SPV and SVV in monitoring the volume responsiveness of patients under pneumoperitoneum. Results Compared with those at T0, both groups presented increases in heart rate, MAP, SVI, CO and CI at T1 (P 0.05). Compared with those at T1, both groups presented decreases in SPV and SVV at T2 (P 0.05). Compared with group N, group R produced reduced SVI, and increased SPV and SVV at T0; increased SPV and SVV at T1; and increased SVI, CO and CI at T2 (P 0.05). The AUC and 95%CI of SPV and SVV were 0.88 (0.77-0.98) and 0.93 (0.87-1.00), respectively. When SPV= 6.5% was set as the cutoff value to monitor volume responsiveness, the sensitivity was 89.7% and the specificity was 87.1%. When SVV=10.5% was set as the cutoff value to monitor volume responsiveness, the sensitivity was 93.1% and the specificity was 80.6%. Conclusions SPV can be used to monitor the volume changes of patients under pneumoperitoneum. Key words: Invasive systolic pressure variation; Stroke volume variability; Pneumoperitoneum; Volume responsiveness
目的评价有创收缩压变化(SPV)监测气腹病人容量反应性的准确性。方法选择60例年龄50 ~ 70岁，体重指数(BMI) 19 ~ 25 kg/m2，美国麻醉医师学会(ASA)Ⅱ会员，行腹腔镜胃癌根治术的患者。全麻下气管插管后建立人工气腹。3 min后进行容量负荷试验，同时以7 ml/kg注射6%羟乙基淀粉130/0.4，持续15 min输注。记录气腹前(T0)、气腹后3 min (T1)、容量负荷试验后3 min (T2)、术后2 h (T3)的心率、平均动脉压(MAP)、心输出量(CO)、心脏指数(CI)、脑卒中容积指数(SVI)和脑卒中容积变异性(SVV)。改变有创动脉压标题后计算SPV。根据容积负荷试验后SVI升高百分比(∆SVI)将患者分为两组:正容积反应性组(R组，n=29，∆SVI≥10%)和负容积反应性组(n组，n=31，∆SVI <10%)。绘制SPV和SVV的受试者操作者特征曲线(ROC)，计算受试者操作者特征曲线下面积(AUC)和95%置信区间(CI)，确定SPV和SVV监测气腹下患者体积反应性的准确性和诊断阈值。结果与T0时比较，两组患者T1时心率、MAP、SVI、CO、CI均升高(P < 0.05)。与T1时比较，两组患者T2时SPV、SVV均降低(P < 0.05)。与N组比较，R组在T0时SVI降低，SPV和SVV升高;T1时SPV和SVV升高;T2时SVI、CO、CI升高(P < 0.05)。SPV和SVV的AUC和95%CI分别为0.88(0.77 ~ 0.98)和0.93(0.87 ~ 1.00)。以SPV= 6.5%为临界值监测体积反应性时，灵敏度为89.7%，特异度为87.1%。当SVV=10.5%作为监测体积反应性的临界值时，灵敏度为93.1%，特异性为80.6%。结论SPV可用于监测气腹患者的体积变化。关键词:有创性收缩压变化;行程容量变异性;气腹;体积响应能力
{"title":"Accuracy of invasive systolic pressure variation in monitoring the volume responsiveness of patients under pneumoperitoneum","authors":"Maohong Zhao, Shuqian Han, Yan Li, Weizhi Wang","doi":"10.3760/CMA.J.CN321761-20191129-00009","DOIUrl":"https://doi.org/10.3760/CMA.J.CN321761-20191129-00009","url":null,"abstract":"Objective \u0000To evaluate the accuracy of invasive systolic pressure variation (SPV) in monitoring the volume responsiveness of patients under pneumoperitoneum. \u0000 \u0000 \u0000Methods \u0000A total of sixty patients, aged 50-70 years, American Society of Anesthesiologists (ASA) Ⅱ , with body mass index (BMI) of 19-25 kg/m2, who were scheduled for laparoscopic radical resection of gastric cancer, were enrolled. Artificial pneumoperitoneum was established after endotracheal intubation under general anesthesia. Then, 3 min later, the volume loading test was performed, while 6% hydroxyethyl starch 130/0.4 injection was infused at 7 ml/kg over 15 min. Heart rate, mean arterial pressure (MAP), cardiac output (CO), cardiac index (CI), stroke volume index (SVI) and stroke volume variability (SVV) were recorded before pneumoperitoneum (T0), 3 min after pneumoperitoneum (T1), 3 min after the volume loading test (T2) and 2 h after surgery (T3). SPV was calculated after the title of invasive arterial pressure was changed. The patients were divided into two groups according to the increased percentage in SVI after the volume loading test (∆SVI): a positive volume responsiveness group (group R, n=29, ∆ SVI≥10%), and a negative volume responsiveness group (group N, n=31, ∆ SVI<10%). The receiver operator characteristic (ROC) curves of SPV and SVV were plotted, and the area under the receiver operator characteristic curve (AUC) and 95% confidence interval (CI) were calculated to determine the accuracy and diagnostic thresholds of SPV and SVV in monitoring the volume responsiveness of patients under pneumoperitoneum. \u0000 \u0000 \u0000Results \u0000Compared with those at T0, both groups presented increases in heart rate, MAP, SVI, CO and CI at T1 (P 0.05). Compared with those at T1, both groups presented decreases in SPV and SVV at T2 (P 0.05). Compared with group N, group R produced reduced SVI, and increased SPV and SVV at T0; increased SPV and SVV at T1; and increased SVI, CO and CI at T2 (P 0.05). The AUC and 95%CI of SPV and SVV were 0.88 (0.77-0.98) and 0.93 (0.87-1.00), respectively. When SPV= 6.5% was set as the cutoff value to monitor volume responsiveness, the sensitivity was 89.7% and the specificity was 87.1%. When SVV=10.5% was set as the cutoff value to monitor volume responsiveness, the sensitivity was 93.1% and the specificity was 80.6%. \u0000 \u0000 \u0000Conclusions \u0000SPV can be used to monitor the volume changes of patients under pneumoperitoneum. \u0000 \u0000 \u0000Key words: \u0000Invasive systolic pressure variation; Stroke volume variability; Pneumoperitoneum; Volume responsiveness","PeriodicalId":13847,"journal":{"name":"国际麻醉学与复苏杂志","volume":"41 1","pages":"360-364"},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42154673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-15DOI: 10.3760/CMA.J.CN321761-20190415-00001
Ya-Nan Wang, Jia Liu, L. Zhang, Qin Zhao, Shilei Wang
Objective To explore the regulation of Kelch-like ECH-associated protein 1 (Keap1)/nuclear factor-E2-related factor 2 (Nrf2)/antioxidant response element (ARE) signaling pathway on mitochondrial fission after cerebral ischemia/reperfusion (I/R) injury. Methods The extracted primary hippocampal neurons of rats were divided into four groups according to the random number table method: a control group (group C), an oxygen-glucose deprivation/reperfusion group (group OGD/R), an OGD/R+Nrf2 inhibitor group (group OGD/R+N) and an OGD/R+vehicle group (group OGD/R+V). The mitochondrial morphology was observed by electron microscopy. The expression of dynamin-related protein 1 (Drp1), mitochondrial fission protein 1 (Fis1), Keap1 and Nrf2 were detected by Western blot. The nuclear translocation of Nrf2 protein was observed by immunofluorescence, and the apoptosis rate of each group was detected by flow cytometry. Results Compared with group C, group OGD/R presented reduced levels of Keap1 and increased levels of nuclear Nrf2 protein, Drp1 and Fis1; through immunofluorescence, the nuclear translocation of Nrf2 was found during OGD/R, with an increased apoptosis rate (P 0.05). Conclusions During cerebral I/R, the Keap1/Nrf2/ARE signaling pathway can regulate mitochondrial fission, reduce apoptosis and relieve brain damage. Key words: Brain; Ischemia/reperfusion; Kelch-like ECH-associated protein 1; Nuclear factor-E2-related factor 2; Antioxidant response element; Mitochondria
{"title":"Effects of Kelch-like ECH-associated protein 1/nuclear factor-E2-related factor 2/antioxidant response element signaling pathway on the regulation of mitochondrial fission in cerebral ischemia/reperfusion injury","authors":"Ya-Nan Wang, Jia Liu, L. Zhang, Qin Zhao, Shilei Wang","doi":"10.3760/CMA.J.CN321761-20190415-00001","DOIUrl":"https://doi.org/10.3760/CMA.J.CN321761-20190415-00001","url":null,"abstract":"Objective \u0000To explore the regulation of Kelch-like ECH-associated protein 1 (Keap1)/nuclear factor-E2-related factor 2 (Nrf2)/antioxidant response element (ARE) signaling pathway on mitochondrial fission after cerebral ischemia/reperfusion (I/R) injury. \u0000 \u0000 \u0000Methods \u0000The extracted primary hippocampal neurons of rats were divided into four groups according to the random number table method: a control group (group C), an oxygen-glucose deprivation/reperfusion group (group OGD/R), an OGD/R+Nrf2 inhibitor group (group OGD/R+N) and an OGD/R+vehicle group (group OGD/R+V). The mitochondrial morphology was observed by electron microscopy. The expression of dynamin-related protein 1 (Drp1), mitochondrial fission protein 1 (Fis1), Keap1 and Nrf2 were detected by Western blot. The nuclear translocation of Nrf2 protein was observed by immunofluorescence, and the apoptosis rate of each group was detected by flow cytometry. \u0000 \u0000 \u0000Results \u0000Compared with group C, group OGD/R presented reduced levels of Keap1 and increased levels of nuclear Nrf2 protein, Drp1 and Fis1; through immunofluorescence, the nuclear translocation of Nrf2 was found during OGD/R, with an increased apoptosis rate (P 0.05). \u0000 \u0000 \u0000Conclusions \u0000During cerebral I/R, the Keap1/Nrf2/ARE signaling pathway can regulate mitochondrial fission, reduce apoptosis and relieve brain damage. \u0000 \u0000 \u0000Key words: \u0000Brain; Ischemia/reperfusion; Kelch-like ECH-associated protein 1; Nuclear factor-E2-related factor 2; Antioxidant response element; Mitochondria","PeriodicalId":13847,"journal":{"name":"国际麻醉学与复苏杂志","volume":"41 1","pages":"321-325"},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47632750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-15DOI: 10.3760/CMA.J.CN321761-20191224-00006
Kun Liu, Meiying Xu, Chengya Huang, C. Tong, Jingxiang Wu
Objective To discuss the effects of individualized setting of positive end-expiratory pressure (PEEP) based on electrical impedance tomography (EIT) on the respiratory mechanics and oxygenation in elderly patients during the recovery period after lobectomy. Methods Eighty-two elderly patients who were scheduled for thoracoscopic lobectomy were divided into two groups (n=41), according to the random number table method: a control group and an individualized PEEP group. After surgery, synchronized intermittent mandatory ventilation was adopted in the postanesthesia care unit (PACU), with a tidal volume of 8 ml/kg. The PEEP value of the control group was set at 5 cmH2O (1 cmH2O=0.098 kPa). The PEEP value of the individualized PEEP group was determined based on EIT; the optimal PEEP value was considered as the crossing of the curves representing lung hyperinflation and collapse in the EIT monitoring chart. The oxygenation index (OI) at the time points of entering into PACU (T1), mechanical ventilation over 0.5 h (T2), and going out of PACU (T3), as well as dynamic respiratory system compliance (Cdyn) and driving pressure (ΔP) at T1 and T2 were recorded for analysis. The primary outcome measures included OI, Cdyn and ΔP. The secondary outcome measures were the peak airway pressure (Ppeak), mean airway pressure (Pmean), mean arterial pressure (MAP), the use of vasoactive agents, pH, PaCO2, the incidence of hypoxia, extubation time and the length of stay in PACU. Results The EIT-titrated PEEP (with a median of 9 cmH2O) was significantly higher than that of the control group. Compared with the control group, the individualized PEEP group had increased OI and Cdyn and decreased ΔP at T2 (P 0.05). Conclusions Individualized PEEP setting in elderly patients after lobectomy can effectively improve OI, reduce ΔP and improve Cdyn in the recovery period, without significant effects on extubation time, the incidence of hypoxia and the length of stay in PACU. Key words: Pulmonary lobectomy; Lung protective ventilation; Positive end-expiratory pressure; Electrical impedance tomography
{"title":"Effects of individualized ventilation on the respiratory mechanics and oxygenation in elderly patients during the recovery period after lobectomy","authors":"Kun Liu, Meiying Xu, Chengya Huang, C. Tong, Jingxiang Wu","doi":"10.3760/CMA.J.CN321761-20191224-00006","DOIUrl":"https://doi.org/10.3760/CMA.J.CN321761-20191224-00006","url":null,"abstract":"Objective \u0000To discuss the effects of individualized setting of positive end-expiratory pressure (PEEP) based on electrical impedance tomography (EIT) on the respiratory mechanics and oxygenation in elderly patients during the recovery period after lobectomy. \u0000 \u0000 \u0000Methods \u0000Eighty-two elderly patients who were scheduled for thoracoscopic lobectomy were divided into two groups (n=41), according to the random number table method: a control group and an individualized PEEP group. After surgery, synchronized intermittent mandatory ventilation was adopted in the postanesthesia care unit (PACU), with a tidal volume of 8 ml/kg. The PEEP value of the control group was set at 5 cmH2O (1 cmH2O=0.098 kPa). The PEEP value of the individualized PEEP group was determined based on EIT; the optimal PEEP value was considered as the crossing of the curves representing lung hyperinflation and collapse in the EIT monitoring chart. The oxygenation index (OI) at the time points of entering into PACU (T1), mechanical ventilation over 0.5 h (T2), and going out of PACU (T3), as well as dynamic respiratory system compliance (Cdyn) and driving pressure (ΔP) at T1 and T2 were recorded for analysis. The primary outcome measures included OI, Cdyn and ΔP. The secondary outcome measures were the peak airway pressure (Ppeak), mean airway pressure (Pmean), mean arterial pressure (MAP), the use of vasoactive agents, pH, PaCO2, the incidence of hypoxia, extubation time and the length of stay in PACU. \u0000 \u0000 \u0000Results \u0000The EIT-titrated PEEP (with a median of 9 cmH2O) was significantly higher than that of the control group. Compared with the control group, the individualized PEEP group had increased OI and Cdyn and decreased ΔP at T2 (P 0.05). \u0000 \u0000 \u0000Conclusions \u0000Individualized PEEP setting in elderly patients after lobectomy can effectively improve OI, reduce ΔP and improve Cdyn in the recovery period, without significant effects on extubation time, the incidence of hypoxia and the length of stay in PACU. \u0000 \u0000 \u0000Key words: \u0000Pulmonary lobectomy; Lung protective ventilation; Positive end-expiratory pressure; Electrical impedance tomography","PeriodicalId":13847,"journal":{"name":"国际麻醉学与复苏杂志","volume":"41 1","pages":"344-349"},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47853366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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