Objective To evaluate the effects of different blood-saving strategies on postoperative cellular immune function in patients undergoing resection for liver cancers.Methods Sixty-six ASA physical status Ⅰ or Ⅱ patients,aged 25-64 yr,with hepatocellular carcinoma classification G1-G3 and clinicopathological staging Ⅰ-Ⅳ,undergoing elective resection for liver cancers,were randomly divided into 3 groups (n =22 each) using a random number table:low central venous pressure group (L group),acutenormovolemic hemodilution group (A group),and acute normovolemic hemodilution combined with low central venous pressure group (AL group).Acute normovolemic hemodilution was performed after endotracheal intubation.Right jugular vein was cannulated for central venous pressure monitoring.Blood withdrawn from the radial artery at a rate of 25-40 ml/min was simultaneously replaced by iv infusion of the equal volume of 130/0.4 hydroxyethyl starch at the same rate until the target Hct (30％) was achieved.In A and AL groups,central venous pressure was maintained at 3-5 cm H2O during the procedure of liver parenchyma transection.Peripheral venous blood samples were taken before operation (T1,baseline) and on postoperative days 1,3 and 5 (T2-4) to determine the percentage of regulatory T-lymphocytes (CD4 + CD25 +,CD25 + Foxp3+),effective T-lymphocytes (CD8 +,CD4 + CD25-) and natural killer (NK) cells by flow cytometry.Results Compared with the baseline value at T1,the percentage of CD4 + CD25 +and CD25 + Foxp3+ was significantly decreased,and the percentage of CD8 + and CD4 + CD25-was increased at T3,4,and the percentage of NK cells was decreased at T2 in A and AL groups,and the percentage of CD4 + CD25 +and CD25 + Foxp3+ was decreased,and the percentage of CD8 + and CD4 + CD25-was increased at T4,and the percentage of NK cells was decreased at T2,3 in group L (P ＜ 0.05).Compared with L group,the percentage of CD4 + CD25 + and CD25 + Foxp3+ was significantly decreased at T3,the percentage of CD8 + was increased at T3,4,and the percentage of NK cells was increased at T3 in AL group (P ＜ 0.05).Conclusion Acute normovolemic hemodilution combined with low central venous pressure provides slighter inhibitory effect on the immune function of T-lymphocytes and NK cells in patients undergoing resection for liver cancers than either alone.

Objective To compare the efficacy of combined intravenous-inhalational anesthesia with propofol-fentanyl-sevoflurane in children undergoing minor surgery under spontaneous breathing with nasopharyngeal airway-face mask versus laryngeal mask airway (LMA).Methods Seventy-two children,scheduled for elective high ligation of indirect inguinal hernia,were randomly divided into 2 groups (n =36 each):nasopharyngeal airway-face mask group (group M) and LMA group (group L).Propofol 1.0 mg/kg and fentanyl 2.0μg/kg were injected intravenously.The spontaneous breathing was kept.After lass of consciousness,a face mask was placed for inhalation of pure oxygen at 2 L/min and 3 ％ sevoflurane.When BIS value reached 50-60,a size 2 LMA was inserted in group L and a nasopharyngeal airway was placed via the left nasal cavity and the face mask was held tightly and connected to the anesthesia machine in group M.Anesthesia was maintained with inhalation of 2％-4％ sevoflurane.Fentanyl 1 μg/kg was injected intravenously 5 min before skin incision.The concentration of sevoflurane was adjusted to maintain BIS value at 40-60 during surgery.Mean arterial pressure,heart rate,partial pressure of end-tidal carbon dioxide and pulse oxygen saturation were recorded before induction,at 3 min during induction,immediately after successful insertion of the airway,at skin incision,3 min after skin incision,and immediately after removal of the airway.The airway insertion time,success rate of insertion at first attempt,emergence time,and adverse reactions were recorded.Results Compared with group L,mean arterial pressure and heart rate were significantly decreased during airway insertion or removal,nasopharyngeal airway insertion time was shortened and the success rate of nasopharyngeal airway insertion at first attempt (100％) was increased,and the agitation score and incidence of obstruction of the upper respiratory tract were decreased in group M (P ＜ 0.05).Conclusion Combined inravenous-inhalational anesthesia with propofol-fentanyl-sevoflurane is easy to establish the airway,can maintain spontaneous breathing,has little influence on circulatory function and reduce complications during recovery from anesthesia in children undergoing minor surgery under spontaneous breathing with nasopharyngeal airway-face mask,and the efficacy is better than that with LMA.

Objective: To evaluate the efficacy of WEI NASAL JET for supraglottic ventilation before tracheal intubation in the patients with tooth loss. Methods: Sixty patients of both sexes with tooth loss (more than 8 teeth missing), aged 67-83 yr, of American Society of Anesthesiologists physical statusⅠ-Ⅲ, with Mallampati classificationⅠ-Ⅲ, with body mass index of 18-25 kg/m², undergoing surgery with general anesthesia, were divided into 2 groups (n=30 each) using a random number table method: WEI NASAL JET group (S group) and mask group (M group). After the end of anesthesia induction, WEI NASAL JET was inserted via the nasal cavity to perform supraglottic ventilation in group S, and two-hand buckle mask was performed in group M, and the patients were tracheally intubated after 5-min ventilation.At 5-min spontaneous breathing after nitrogen removal by oxygen supply, 1, 2, 3 and 4 min after no spontaneous breathing and immediately after intubation (T₅), ultrasound was used to measure the amplitude of diaphragm motion induced by respiratory movement, and blood gas analysis was performed to record the development of pH value<7.30, SpO₂<90% and fluctuation in mean arterial pressure and heart rate ≥30% of baseline before operation.The development of ventilation-related complications was also recorded. Results: Compared with group M, the amplitude of diaphragm motion induced by respiratory movement was significantly increased at T_1-5, PaO₂was increased at T_2-5, PaCO₂ and P_ETCO₂ were decreased at T_3-5, the incidence of sore throat and nasal mucosal bleeding was increased, the incidence of gingiva injury and flatulence was decreased (P<0.05), and no significant change was found in the incidence of fluctuation in mean arterial pressure and heart rate ≥30% of baseline in group S (P>0.05). The pH value<7.30 and SpO₂<90% were not found in two groups. Conclusion WEI NASAL JET can provide satisfactory supraglottic ventilation efficacy before tracheal intubation with good safety in the patients with tooth loss.