Objective To evaluate the efficacy of thoracic paravertebral block for preemptive analgesia in the patients undergoing minimally invasive direct coronary artery bypass grafting (MIDCAB).Methods Sixty patients of both sexes,aged 54-75 yr,weighing 55-82 kg,of American Society of Anesthesiologists physical Ⅱ or Ⅲ,with New York Heart Association Ⅰ-Ⅲ,scheduled for elective MIDCAB,were randomly divided into 2 groups (n =30 each) by using a random number table:control group (group C) and thoracic paravertebral block group (group P).Thoracic paravertebral block was performed under the guidance of a nerve stimulator in group P.A paravertebral catheter was placed at T4,5 interspace,a test dose of 0.5％ ropivacacine 5 ml was injected through the catheter,and 5 min later a bolus dose of 0.5％ ropivacacine 15 ml was injected.Anesthesia was induced with intravenous etomidate,midazolam,fentanyl and vecuronium.All the patients were intubated with a double-lumen endobronchial tube and mechanically ventilated,and end-tidal pressure of carbon dioxide was maintained at 30-40 mmHg.Anesthesia was maintained with intravenous injection of fentanyl and vecuronium,intravenous infusion of propofol,and inhalation of sevoflurane.Bispectral index value was maintained at 40-60.When systolic blood pressure ＞ 160 mmHg,fentanyl 0.1 mg was injected intravenously.Both groups started to receive patient-controlled intravenous analgesia (PCIA) after extubation until 48 h after operation.PCIA solution contained morphine in 100 ml of normal saline.The PCIA pump was set up with a 2 mg bolus dose,a 10 min lockout interval and background infusion at a rate of 0.5 mg/h.Visual analogue scale was maintained ≤ 4.When visual analogue scale＞4,morphine 4 mg was injected intravenously as rescue analgesic.The consumption of intraoperative fentanyl was recorded.The consumption of morphine and requirement for rescue analgesics were recorded within 24 and 48 h after operation.The adverse reactions such as somnolence,nausea and vomiting,respiratory depression,pruritus,and atelectasis were recorded within 48 h after operation.The extubation time after operation,length of time in intensive care unit,and recovery time after operation were recorded.At 24 and 48 h after operation,pulmonary function was detected,the forced vital capacity (FVC) expressed as a percentage of the predicted value (FVC％),and forced expiratory volume in 1 second (FEV1)expressed as a percentage of the predicted value (FEV1 ％) were recorded,and the ratio of FEV1/FVC was calculated.Blood gas analysis was performed,and arterial oxygen partial pressure and partial pressure of arterial carbon dioxide were recorded at 24 and 48 h after operation.Results Compared with group C,the intraoperative consumption of fentanyl and consumption of morphine within 24 and 48 h after operation were significantly reduced,the extubation time and length of time in intensive care unit were shortened,FVC％ and FEV1％ were increased at 24 and 48 h after operation,the partial pressure of arterial carbon dioxide and incidence of somnolence were decreased (P＜0.05),and no significant change was found in the FEV1 / FVC,arterial oxygen partial pressure,requirement for rescue analgesics and recovery time after operation in group P (P＞0.05).Conclusion Thoracic paravertebral block analgesia can provide good preempive analgesia in the patients undergoing MIDCAB.

0.05). CONCLUSION: Lornoxicam can relief pain in patients after open heart surgery safely and efficiently, and reduce the morphine consumption.

To probe into the influence of transplantation of allogenic bone marrow mononuclear cells (BM-MNCs) on the left ventricular remodeling of rat after acute myocardial infarction (AMI), 60 male Wistar rats were evenly divided into three groups at random: control group 1, control group 2 and transplantation group. In control group 1, chest was opened without ligation of coronary artery; in control group 2 and transplantation group, the left anterior descending branch of coronary artery was ligated to establish AMI model. Prepared culture medium and allogenic BM-MNCs suspension were respectively implanted the surrounding area of infracted cardiac muscle via epicardium of control group 2 and transplantation group. Four weeks after the operation, the osteopontin gene (OPN mRNA, P<0.01), type I collagen (P<0.01) and angiotensin II (AngII, P<0.01) content in the left ventricular non-infracted myocardium, and the Ang II density in blood plasma (P<0.05) of transplantation group and control group 2 were all significantly higher than that of control group 1. In the transplantation group, the myocardial OPN mRNA, type I collagen and Ang II content of non-infracted zone in left ventricle, and the Ang II concentration in blood plasma were all significantly lower than those of control group 2 (P<0.05 for all). It is concluded that allogenic BM-MNCs transplantation may ease left ventricular remodeling after AMI by inhibiting the synthesis of type I collagen in the cardiac muscle and down-regulating the expression of Ang II and OPN gene.

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Objective To evaluate the effects of sevoflurane postconditioning on myocardial oxidative stress in the patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Fifty ASA physical status Ⅱ or Ⅲ patients (NYHA Ⅱ or Ⅲ) of both sexes,aged 36-59 yr,weighing 42-71 kg,with rheumatic heart disease undergoing cardiac valve replacement under CPB,were randomly divided into control group (group C,n =25) and sevoflurane postconditioning group (group S,n =25).In group S,4 ％ sevoflurane was infused for 10 min via the extracorporeal circulation machines starting from the time point immediately after aortic unclamping.Before aortic clamping and at 15 min,30 min,6 h,and 24 h after aortic unclamping (T1-5),blood samples were collected from the central vein for determination of the levels of cardiac troponin I (cTnI) in plasma.Myocardial specimens were taken from the left auricle before CPB and after termination of CPB for determination of malondialdehyde (MDA) content and superoxide dismutase (SOD) activity.The restoration of spontaneous heart beat,reperfusion arrhythmia scores,and requirement for vasoactive drugs were recorded.Results Compared with group C,MDA content was significantly decreased,and SOD activity was increased after termination of CPB,the plasma cTnI concentration was decreased at T2-5,the rate of restoration of spontaneous heart beat was increased,reperfusion arrhythmia scores were decreased,and the requirement for dopamine and nitroglycerin was reduced in group S.Conclusion Sevoflurane postconditioning provides myocardial protection by reducing myocardial oxidative stress injury in the patients undergoing cardiac valve replacement with CPB.

Objective To evaluate the role of Toll-like receptor 4 (TLR4) in non-medullary andmedullary cells in lung ischemia-reperfusion (I/R) injury in mice.Methods Ten healthy male TLR4+/+ in non-medullary cells/TLR4+/+ in medullary cells (WT/WT) mice,10 TLR4-/-in non-medullary cells/ TLR4-/-in medullary cells (KO/KO) homozygote mice,10 TLR4+/+ in non-medullary cells/TLR4-/-in medullary cells (WT/KO) mice,and 10 TLR4-/-in non-medullary cells/TLR4+/+ in medullary cells (KO/WT) heterozygote mice,aged 6-8 weeks,weighing 20-25 g,were used in the study.Lung I/R was induced by occlusion of the left hilum for 60 min followed by 240 min of reperfusion in anesthetized mice.Blood samples were obtained from the femoral artery at 240 min of reperfusion for blood gas analysis,and the oxygenation index (PaO2/FiO2) was calculated.The animals were then sacrificed and lung tissues were immediately removed for determination of wet/dry weight ratio,myeloperoxidase activity and contents of tumor necrosis factor-alpha,interleukin-1beta (IL-1β) and IL-6 (by enzyme-linked immunosorbent assay) and for microscopic examination of the pathological changes of lungs which were scored.Results Compared with WT/WT mice,the oxygenation index was significantly increased in sequence,and lung injury scores,wet/dry weight ratio,myeloperoxidase activity and contents of tumor necrosis factor-alpha,IL-1β and IL-6 were decreased in sequence in WT/KO,KO/WT and KO/KO mice (P＜0.05).Conclusion TLR4 in non-medullary cells plays a rnore important role in lung I/R injury than that in medullary cells of mice.

To probe into the influence of transplantation of allogenic bone marrow mononuclear cells (BM-MNCs) on the left ventricular remodeling of rat after acute myocardial infarction (AMD,60 male Wistar rats were evenly divided into three groups at random: control group 1, control group 2and transplantation group. In control group 1, chest was opened without ligation of coronary artery;in control group 2 and transplantation group, the left anterior descending branch of coronary artery was ligated to establish AMI model. Prepared culture medium and allogenic BM-MNCs suspension were respectively implanted the surrounding area of infracted cardiac muscle via epicardium of control group 2 and transplantation group. Four weeks after the operation, the osteopontin gene (OPN mRNA, P＜0.01), type Ⅰ collagen (P＜0.01) and angiotensin Ⅱ (AngⅡ, P＜0.01) content in the left ventricular non-infracted myocardium, and the Ang Ⅱ density in blood plasma (P＜0.05) of transplantation group and control group 2 were all significantly higher than that of control group 1. In the transplantation group, the myocardial OPN mRNA, type Ⅰ collagen and Ang Ⅱ content of non-infracted zone in left ventricle, and the Ang Ⅱ concentration in blood plasma were all significantly lower than those of control group 2 (P＜0.05 for all). It is concluded that allogenic BM-MNCs transplantation may ease left ventricular remodeling after AMI by inhibiting the synthesis of type Ⅰ collagen in the cardiac muscle and down-regulating the expression of Ang Ⅱ and OPN gene.

Humans ; Adult ; Serum Albumin, Human ; Consensus ; Cardiac Surgical Procedures ; Thoracic Surgery