1.Comparison of cellular immune function during postoperative analgesia with dezocine versus fentanyl in patients with gynecologic malignant tumors
Xiaolan GU ; Pengyi LI ; Lianbing GU
Chinese Journal of Anesthesiology 2015;35(11):1293-1295
Objective To compare the cellular immune function during postoperative analgesia with dezocine and fentanyl in the patients with gynecologic malignant tumors.Methods Fifty patients scheduled for elective surgery for gynecologic malignant tumors, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , were equally and randomly divided into either dezocine group (group D) or fentanyl group (group F) using a random number table.Total intravenous anesthesia was used for all the patients, and the intraoperatively administered anesthetics was the same.The patient-controlled intravenous analgesia (PCIA) was used for postoperative analgesia.PCIA solution contained dezocine 0.8 mg/kg and tropisetron 6 mg in 100 ml of normal saline in group D.PCIA solution contained fentanyl 0.01 mg/kg and tropisetron 6 mg in 100 ml of normal saline in group F.The PCA pump was set up to deliver a 1 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h after a loading dose of 2 ml in the two groups.Tramadol 100 mg was given intravenously as rescue analgesic to maintain visual analogue scale score ≤ 4.Before surgery (T0), at the end of surgery, and at 24 and 48 h after surgery (T2,3) , venous blood samples were collected for detection of T lymphocyte subsets CD3+, CD4+ , CD8+ and natural killer (NK) cell levels (by flow cytometry).CD4+/CD8+ ratio was calculated.The requirement for rescue analgesics and occurrence of adverse reactions such as nausea, vomiting, hypotension and respiratory expression were recorded after surgery.Results No patients required tramadol as rescue analgesic in either group.Compared with the value at T0, the levels of CD3+ , CD4+ and NK cells and CD4+/CD8+ ratio were significantly decreased at T1,2, and the CD8+level was increased at T1 in group D, and the levels of CD3+ cells at T1,2, CD4+ cells at T1 and NK cells at T1-3 were decreased (P<0.05) , and no significant change was found in CD8+ cell level and CD4+/CD8+ ratio in group F (P>0.05).Compared with group F, the levels of CD3+ and NK cell were significantly increased at T3 (P<0.05) , and no significant change was found in the incidence of adverse reactions after surgery in group D (P>0.05).Conclusion The inhibitory degree of the cellular immune function is reduced when postoperative analgesia is performed with dezocine as compared with that when fentanyl is used in the patients with gynecologic malignant tumors.
2.Effects of aerosolized prostaglandin E1 before one lung ventilation on lung protection in patients undergo-ing surgery for oesophageal cancer
Dian JIAO ; Lianbing GU ; Lijun WANG ; Pengyi LI
The Journal of Clinical Anesthesiology 2016;32(7):668-671
Objective To observe the effects of aerosolized prostaglandin E1 (PGE1 )via right lung before one-lung ventilation (OLV ) on shunt rate (Qs/Qt ) and oxygenation in patients undergoing surgery for oesophageal cancer.Methods Sixty patients scheduled for elective trans-left-thoracic esophagectomy for esophageal cancer were randomly and single-blindly located into two groups.Patients in each group received different therapy before OLV,namely inhaling PGE1 0.2μg/kg via right lung in group P and inhaling normal saline in group C.The PaO 2 and hemodynamic indicators of two groups were recorded at these points:before OLV(T1 ),OLV 10 min (T2 ),OLV 1 5 min (T3 ),OLV 30 min (T4 ),OLV 60 min (T5 ),OLV 120 min (T6 ),.Results PaO 2 in both groups were declined straightly since OLV and fell to the lowest point at T4 in group C.PaO 2 in group P at T2-T4 were significantly higher than that in group C (P <0.05),and the lowest point of which was recorded at T5 .Qs/Qt in group P was significantly lower than that in group C at T2-T4 (P <0.05).There were no significant differences in hemodynamics indicators between the two groups. Conclusion Inhalation of 0.2 μg/kg PGE1 before OLV via one lung can reduce pulmonary shunt and improve PaO 2 in thoracic surgery patients.
3.Empirical study of therapeutic effect of montelukast on acute lung injury induced by paraquat in rats
Jianbo SUN ; Pengyi GU ; Gang LI ; Qige QI ; Shuai JIN ; Dong JIA ; Zhenzhen SANG ; Min ZHAO
Chinese Journal of Emergency Medicine 2012;21(11):1198-1204
Objective To discuss the effect of Montelukast (Mont) on MDA,SOD,W/D,TNF-α,IL-10 and NF-κBp65 in lung tissue of Wistar rats poisoned by paraquat (PQ) and also to observe the pathological changes of the lung tissue.Methods A total of 104 Wistar rats were divided into 3 groups in random (random number),namely PQ group (n =40),Mont group (n =40) and control group (n =24).PQ (20 mg/kg) was administered by intra-peritoneal route to rats of PQ group and Mont group and narcotics were used for 2 hours.Mont in dose of 50 mg/kg was administered intra-gastrically to rats of Mont group per day and saline instead were administered to PQ group and control group per day until they were sacrificed for experiment.Of both PQ group and Mont group,10 rats were sacrificed at each interval of 1,3,5 and 7 days respectively after modeling,whereas 6 rats of control group were sacrificed at each interval.The levels of MDA and SOD in lung tissue and W/D of lung tissue,the levels of serum TNF-α and IL-10 and the level of NF-κBp65 in lung tissue were determined.Further,the specimen of lung tissue was prepared for electron microscopy observation.Results The level of MDA in lung tissue of PQ group was (8.19 ± 0.53) nmol/mg prot,which was significantly higher than that of control group on the 7th day.The level of SOD in lung tissue of PQ group was (128.76 ± 10.18) U/mg prot,which was significantly lower than that of control group.In PQ group,the W/D of lung tissue (6.62 ±0.42),level of serum TNF-α (156.16 ± 11.13) pg/ml,level of IL-10 (43.63 ±4.44) pg/ml and level of NF-κBp65 in lung tissue (0.23 ±0.02) were significantly higher than those in control group (P <0.01).In Mont group on the 7th day,the level of serum TNF-α (129.99 ±13.13) pg/ml,level of serum IL-10 (34.28 ± 3.80) pg/ml and level of NF-κBp65 in lung tissue (0.20 ±0.02) were significantly lower than those in PQ group (P < 0.01).In the PQ group,pathological changes of lung tissue under the light and electron microscopes were acute diffused lung injury manifested itself in hemorrhage,effusion and infiltration of inflammatory cells inside the alveolar space,and the necrosis and defluxion of Ⅰ type and Ⅱ type epithelia cells.The pathological changes in Mont group were localized with infiltration of scanty inflammatory cells,and Ⅰ type epithelia cells were intact and there was no obvious necrosis of Ⅱ type epithelia cells.Conclusions Mont has protective effects on acute lung injury caused by PQ poisoning in rats.
4.Preparation and Evaluation of Long-circulating Liposomes of Paraoxonase
Zhenkun HAN ; Jianbo SUN ; Dan LIU ; Haiyang HU ; Dawei CHEN ; Pengyi GU ; Min ZHAO
Journal of China Medical University 2010;(2):87-91
Objective To prepare the long-circulating liposomes of paraoxonase(PON).Methods The long-circulating liposomes of paraoxonase were prepared by film dispersion method.The encapsulation efficiency was determined by gel column.The effects of the factors on the encapsulation efficiency,such as the weight ratio of paraoxonase to phospholipid,cholesterol(Choi) to phospholipid,PEG-cholesterol (PEG-Chol) and the iron strength of water phase,were investigated respectively.Then the formulation was optimized by orthogonal design.Results The encapsulation efficiency of the paraoxonase liposomes was 87.66±3.46%,and the average diameter of the liposomes was about 126 nm.There was no significant change on encapsulation efficiency on 15 d at 4 ℃,and the activity of paraoxonase was maintained basically stable.Conclusion The preparation of PEG-modified paraoxonase liposomes was easy and practicable,and the property investigation in vitro showed that the paraoxonase liposomes were stable.
5.Effects of different doses of aerosolized prostaglandin E,inhalation on pulmonary shunt and oxygen-ation during one-lung ventilation
Pengxin LI ; Lei QIU ; Lijun WANG ; Pengyi LI ; Lianbing GU
The Journal of Clinical Anesthesiology 2023;39(11):1131-1136
Objective To investigate the effects of aerosolized inhalation of different doses of pros-taglandin E1(PGE1)on pulmonary shunt and oxygenation during one-lung ventilation(OLV)when the fraction of inspiration O2 was 40%.Methods A total of 156 patients undergoing radical operation of esophageal cancer,121 males and 35 females,aged 18-64 years and BMI 18-30 kg/m2,ASA physical status Ⅱ or Ⅲ were included in the study.The patients were randomly assigned into 4 groups using a random number table:PGE1 0.1 μg/kg group(group L,n=39),PGE1 0.2 μg/kg group(group M,n=38),PGE 0.3 μg/kg group(group H,n=39),and a saline control group(group C,n=40).Patients re-ceived different therapy before OLV,namely inhaling either PGE1 0.1,0.2,0.3 μg/kg,and saline into right lung for a duration of 10 minutes.Venous blood and arterial blood were drawn from right internal jugu-lar vein catheter and radial artery catheter for blood gas analysis at pre-anesthesia(T0),pre-nebulization(T1),OLV 10 minutes(T2),OLV 15 minutes(T3),OLV 30 minutes(T4),OLV 60 minutes(T5),and OLV 120 minutes(T6).HR,MAP,PaO2,oxygenation index(OI),pulmonary shunt fraction(Qs/Qt),PaCO2,and peak airway pressure(Ppeak)were also recorded at above time points.Intraoperative hypox-emia,intraoperative hypotension,clinical pulmonary infection score(CPIS)on the second postoperative day and postoperative pulmonary complications(PPCs)within 7 days were recorded.Results Compared with group C,groups L,M,and H showed a lower incidence of hypoxemia(P<0.05),group H demon-strated lower MAP at T2 and T3(P<0.05),groups L,M,and H displayed lower Qs/Qt and higher PaO2 and OI at T2-T4(P<0.05),group H had a lower CPIS on the second postoperative day(P<0.05).Compared with group L,group H exhibited lower Qs/Qt at T2-T4,and higher PaO2 and OI at T3 and T4.There were no significant differences in the incidence of hypotension,HR,PaCO2,Ppeak,and the occur-rence of PPCs within 7 days among the four groups.Conclusion Nebulized inhalation of PGE,0.1,0.2 and 0.3 μg/kg under FiO2 40%before OLV can effectively reduce Qs/Qt,improve oxygenation and de-crease the incidence of hypoxemia.However,it has no significant impact on PPCs.PGE,0.3 μg/kg exhibits the best improvement in oxygenation and can also reduce CPIS on the second postoperative day,close monitoring of circulatory fluctuations is still required.