This study was set up to observe the changes in stress and immune functions in upper abdominal surgery after general anesthesia.In thirty elective upper abdominal operation patients,general anesthesia was induced with propofol,fentanyl,scoline and maintained with isoflane and atrumium. Catecholamines(CA),cortisol,interleukin-2(IL-2) and soluble interleukin-2 receptor(sIL-2R) were measured before anesthesia,after induction of anesthesia,at the end of operation,and on the first and third postoperative days.The results showed that epinephrine(E),norepinephrine(NE) concentration increased at the end of operation and on the first postoperative day(P<0.01)，Cortisol concentration decreased after anesthesia induction(P<0.05)，IL-2 concentration decreased at the end of operation(P<0.05)，and sIL-2R lever did not change.The investigation suggested that general anesthesia with propofol,fentanyl and isoflane can suppress CA and cortisol increase resulting from induction of anesthesia. There was no change in IL-2 level.However it can not suppress the increase of stress hormones and decrease of IL-2 due to operation.The stress response correlate with immune functions.

Objective:To study the therapeutic value of Xueshuantong injection combined atorvastatin in patients with coronary heart disease (CHD)complicated diabetes mellitus (DM).Methods:A total of 100 CHD+DM patients, who were treated in our hospital from Jan 2012 to Jan 2014,were selected.According to random number method, they were randomly and equally divided into routine treatment group (including atorvastatin treatment)and Xue-shuantong combined atorvastatin group (combined treatment group).Clinical therapeutic effect,change of blood lipid level and safety were observed in two groups.Results:Total effective rate of combined treatment group was significantly higher than that of routine treatment group (96.0% vs.68.0%,P =0.032).Compared with routine treatment group,after treatment,there were significant reductions in levels of total cholesterol [(4.38 ± 0.50) mmol/L vs.(4.09±0.47)mmol/L],triglyceride [(2.23±0.35)mmol/L vs.(1.79±0.28)mmol/L]and low density lipoprotein cholesterol [(2.45±0.29)mmol/L vs.(2.23±0.28)mmol/L],and significant rise in level of high density lipoprotein cholesterol [(1.11 ±0.12)mmol/L vs.(1.37± 0.25)mmol/L]in combined treatment group,P <0.05 all.Incidence rate of adverse reaction was 6.0% and 4.0% in combined treatment group and rou-tine treatment group respectively,but there was no significant difference between two groups,P =0.436. Conclu-sion:Xueshuantong combined atorvastatin treatment can significantly improve blood lipid levels and raise clinical therapeutic effect in CHD+DM patients.

Objectives To study the effects of anesthesia, head-up position and CO 2 pneumoperitoneum on cardiac autonomic nerve evaluated by heart rate variability (HRV) during laparoscopic cholecystectomy. Methods 20 patients undergoing elective laparoscopic cholecystectomy were anesthetized with balanced anesthesia. Pneumoperitoneum was introduced by inflation of CO 2. Intra-abdominal pressure was maintained at (11～13) mmHg. HRV was measured in supine and head-up tilt (15?～20?) positions while the patients were awake, in the stable state of anesthesia and CO 2 pneumoperitoneum at 10 minute and 20 minute respectively. Power spectral analysis of HRV was conducted on 256-beat R-R interval segments of interpolated heart rate by using the fast Fourier transformation. Total spectral power (TP), low frequency power (LF) and high frequency power (HF) were calculated by integrating the power spectra between (0～0 5) Hz, (0 03～0 15)Hz and ( 0 15～0 35)Hz. Results The change of positions did not significantly influence HRV. Decreases in LF, HF and TP were noted during the maintenance of anesthesia. The power of LF, the normalized unit of LF and LF/HF ratio increased during inflation period. LF/HF increased from 2 15?1 16 to 4 61?2 04 ( q =4 491, P

Objective To study pharmacodynamic changes of combined anesthesia with remifentanil at different target plasma concentrations and isoflurane at different minimal alveolar concentrations(MAC) in laparoscopic operations. Methods Forty-five patients with ASA status Ⅰ~Ⅱ,receiving selective laparoscopic cholecystectomy or laparoscopic oophorocystectomy,were included.The patients were randomly divided into three groups with 15 patients in each group.In the Group A,anesthesia was maintained with isoflurane inhalation at the MAC of 1.3;in the Group B,anesthesia was maintained with both isoflurane inhalation at the MAC of 0.6 and remifentanil target-controlled infusion at 4 ng/L;and in the Group C,anesthesia was maintained with both isoflurane inhalation at the MAC of 0.4 and remifentanil target-controlled infusion at 6 ng/L.Pharmacodynamic parameters and recovery characteristics,including bispectral index(BIS),heart rate variability(HRV),mean arterial pressure(MAP),heart rate(HR),time to additional administration of muscle relaxants,time to the recovery of spontaneous breathing,time to eye opening,time to endotracheal extubation,time to the recovery of orientation,and follow-up survey of "awareness during operation",were compared among the 3 groups.Results ①The BIS value was lower in the Group A than in the Group B and C at the time of pneumoperitoneum for 2 min and removal of the gallbladder or the ovarian cyst.The measures of HRV were higher in the Group A than in the Group B and C at the time of pneumoperitoneum for 2 min and removal of the gallbladder or the ovarian cyst.The measures of MAP and HR in the Group A were higher than those in the Group C at the time of pneumoperitoneum for 2 min,and were lower than those in the Group C at the time of the endotracheal extubation and the recovery of consciousness.②Either isoflurane inhalation at the MAC of 0.6 combined with remifentanil target-controlled infusion at 4 ng/L or isoflurane inhalation at the MAC of 0.4 combined with remifentanil target-controlled infusion at 6 ng/L provided satisfactory anesthetic maintenance.③Significantly shorter time to endotracheal extubation,to eye opening,and to the recovery of orientation were recorded in the Group B and C than in the Group A.Conclusions Anesthesia with target-controlled infusion of remifentanil combined with inhalation of isoflurane can be used for laparoscopic surgery.Pharmarcodynamic parameters and recovery characteristics show that combined use of remifentanil infusion at 4 ng/L and isoflurane inhalation at the MAC of 0.6 provides optimal anesthetic maintenance.

This study was set up to observe the changes in stress and immune functions in upper abdominal surgery after general anesthesia.In thirty elective upper abdominal operation patients,general anesthesia was induced with propofol,fentanyl,scoline and maintained with isoflane and atrumium. Catecholamines(CA),cortisol,interleukin-2(IL-2) and soluble interleukin-2 receptor(sIL-2R) were measured before anesthesia,after induction of anesthesia,at the end of operation,and on the first and third postoperative days.The results showed that epinephrine(E),norepinephrine(NE) concentration increased at the end of operation and on the first postoperative day(P

0.05).A similar amount of propofol was used in each group.A significantly higher dose of sufentanil was administered in the Group C(73.9?13.6 ?g)than in the Group A(24.3?4.9 ?g)and the Group B(35.4?8.1?g)(qC-A=237.924,P=0.000;qC-B=119.385,P=0.000).The expected time of recovering consciousness was shorter in the Group A and B than in the Group C.Conclusions Administered by target-controlled infusion with propofol,sufentanil dose-dependently reduces BIS and modifies hemodynamic responses during anesthesia induction.The target effect-site sufentanil concentration of 0.6 ng/ml combined with plasma propofol concentration of 3 ?g/ml is suitable for anesthesia induction for short-time laparoscopic operation.

Objective To evaluate the prophylactic effect of continuous epidural block combined with desflurane anesthesia on increase of sympathetic neural activity induced by desflurane Methods Thirty patients were randomly allocated to two groups: desflurane anesthesia (DA) group (n=15) and epidural block combined with desflurane anesthesia (ECDA) group (n=15) After rapid induction with fentanyl propofol scoline, in DA group 2% desflurane in oxygen was inhaled firstly, then imposed with successive 1% increase of desflurane until balance and in ECDA group epidural blockade at T 9 10 or T 10 11 was firstly performed with 2% lidocain and other procedures were same as DA group The central venous blood samples were taken before induction, 30 min following desflurane inhalation(T 1), 60 min after operation beginning(T 2) and at the end of operation(T 3), to measure the plasma conentrations of catecholamine with high performance liquid chromatography Results Compared with baseline, following desflurane inhalation, MAP increased in DA group, but decreased in ECDA group, with significant difference between both groups As compared with the baselines, plasma epinephrine (EPI) and norepinephrine (NE) concentrations increased significantly in DA group at T 1, T 2 and T 3, but in ECDA group remained unsignificant changes at T 1, rose markedly at T 2 and T 3 EPI and NE levels were evidently higher in DA group at T 1 and T 2 than those in ECDA group Conclusions Continuous epidural blockade can effectively prevent the increasing in sympathetic neural activity induced by desflurane

ve To evaluate the performance of the target controlled infusion (TCI) system of midazolam for sedation during operation in terms of safety and ease of use in the elderly and the young. Methods Forty-four unpremedicated ASA I - II patients scheduled for elective surgery under epidural or combined spinal-epidural (CSE) anesthesia were included in this study. The patients were divided into two age groups: the elderly group aged 61-82 yr ( n = 22) and the young group aged 19-43 yr (n = 22) . Patients with neurological or severe cardiopulmonary diseases or abnormal liver or kidney function were excluded. The block height was maintained below T4. The TCI system consisted of Intel Pentium III 450 MHz computer and Graseby 3500 computerized infusion pump. The software we used was Stelpump Version 1.05 written by Pina and Coetzee and the pharmacokinetic model and parameter were described by Arram and Buhrer. The effect site concentration of midazolam was targeted and started from 50ng?ml-1, then increased in increment of 50 ng?ml-1 (in the young group) or 25ng?ml-1 (in the elderly group) until the patient did not respond to light shaking (defined as unconsciousness) . Each incremental increase was maintained for 15 min. Arterial blood samples were taken in ten patients randomly selected from each group at 10 and 15min after each incremental increase of midazolam concentration for determination of plasma midazolam concentration by high performance liquid chromatography ( HPLC) .Results The bias (median performance error) of the TCI system of midazolam was 7.9% in the elderly group and 11.6% in young groups. The precision (median absolute performance error) was 20.0% in both groups. They were clinically acceptable. Conclusions The TCI system of midzolam can provided sedation for patients undergoing surgery under spinal and/or epidural anesthesia safely and efficiently in both the old and young.

Objective To assess the changes in heart rate variability (HRV) during midazolam sedation with TCI in the elderly and young patients. Methods Thirty-eight ASA I - Ⅱ patients scheduled for elective surgery on lower abdomen or lower extremities under epidural or combined epidural-spinal anesthesia were divided into two groups of 19 patients each: the young group (18-40 yr) and the elderly group (60-89 yr). Radial artery was cannulated for intra-arterial pressure monitoring and blood sampling. HRV was monitored by HXD-1 monitoring system. HRV parameters included total power (TP), low frequency(LF), high frequency(HF), LF/HF, nuLF(LF/TP ?100%) and NuHF(HF/TP ? 100%) . The height of block was maintained below T5. TCI was used to achieve a rapid induction and maintenance of a stable target blood midazolam concentration. Target blood midazolam concentration was started from 50 ng/ml and gradually increased with increment of 25 ng/ml in elderly group or 50ng/ml in the young group until loss of consciousness (OAA/S =1). Arterial blood samples were taken at each target blood midazolam concentration for determination of blood midazolam concentration. HRV parameters were recorded at different OAA/S scores during both the induction of and recovery from sedation. Results With increasing depth of sedation, most of the HRV parameters (LF, nuLF, LF/HF and TP) decreased progressively, while nuHF increased and HF remained unchanged. During recovery from midazolam-induced sedation, HRV parameters returned gradually to the baseline values. OAA/S scores and HRV parameters were well correlated(r = 0.502-0.719). The trend of changes in HRV was consistent in both groups. At the same OAA/S score, most values of HRV parameters were not significantly different between the two groups. Only during deep sedation (OAA/S=1), values of all HRV parameters were significantly lower in the elderly group than those in the young group, except LF/HF. Conclusions During profound sedation (OAA/S=1) midazolam depresses the activity of the autonomic nervous system more markedly in the elderly than in the young, but the elderly without cardiovascular and autonomic nervous system disorders has the same ability to keep the balance between the sympathetic and parasympathetic nervous system as theyoung.

0.05). Conclusions Following retroperitoneal laparoscopy, the cerebral blood flow is increased and no cerebral anoxia is found.