A 60-years-old(85 kg,178 cm) coronary arterial disease patient having had acute myocardial infarction for several times received liver transplantation successfully.He had a previous episode of acute myocardial infarction associated with entire obstruction of right coronary 6 years ago,and was inserted a bracket then.One year ago the patient got chest pain again,and was diagnosed as inferior wall myocardial infarction.Then he received expectant treatment in internal medical department for several days.A 774HF75 PAC catheter(Edwards Lifescience,USA) was inserted into an internal jugular vein,and cardiac output,right ventricular end diastolic volume index,right ventricular ejection fraction,stroke volume index,system vascular resistance,pulmonary vascular resistance,left ventricular-stroke work index and right ventricular-stroke work index were calculated.During the operation,cardiovascular medications such as dopamine,norepinephrine,dobutamine were infused and adjusted by steps carefully.Electrolytes and acid-base balance were maintained normal.With these hemodynamic parameters,BGA and systemic management,the anesthesia was managed safely and successfully.

Objective:To explore the feasibility of guiding the volume management during orthotopic liver transplantation by right ventricular end-diastolic volume index(RVEDVI).Methods:Thirty-two patients who accepted OLT were studied during operation.A modified pulmonary artery catheter equipped with a fast response thermistor(774HF75)was used to determine RVEDVI,EF,CCI,CVP,MPAP,PAOP and SVI.The above-mentioned hemodynamic measures were taken in 9 phases:T0,before induction of anesthesia;T1,before operation;T2,pre-anhepatic phase;T3,30 minutes after PV occlusion;T4,10 minutes after graft reperfusion;T5,30 minutes after graft reperfusion;T6,60 minutes after graft reperfusion;T7,120 minutes after graft reperfusion;and T8,at the end of surgery.The linear regression analyses of SVI and CVP,SVI and PAOP,SVI and RVEDVI in each phase were calculated,and the best measure of representing the volume of the OLT patient was selected.Results:The variation of the RVEF value was(42.04?9.40)%.Linear regression analyses showed a significant correlation between RVEDVI and stroke volume index(SVI) in each phase(P

Objective To observe the effects of trunk and ankle dorsiflexion training on the motor function of the hemiplegics affected lower limb. Methods 36 cases with hemiplegia were divided into two groups: treatment group (n=22) and control group (n=14). The treatment group accepted trunk and ankle dorsiflexion training, while the control group not. They were assessed with Ueda Assessment 2 months after treatment. Results 22 cases (100%) in the treatment group were grade 8 or higher, while 7 cases (50%) in the control group. Conclusion Trunk and ankle dorsiflexion training are important for the recovery of motor function in the hemiplegics.

ve To investigate the mechanism of myocardial ischemia-reperfusion injury during cardiac surgery and the protective effect of low dose nicardipine. Methods Sixteen patients undergoing valve replacement under cardiopulmonary bypass (CPB) were randomized to one of the two groups: control group (group C, n = 8) and nicardipine group (group N, n = 8) . In group N low dose nicardipine (O.5?g?kg-1 ?min-1) was infused after induction of anesthesia until beginning of CPB, a total dose of 0.05 mg?kg-1 was given. All patients were premedicated with intramuscular morphine 0.1-0.2 mg?kg-1 and scopolamine 0.3 mg 30 min before surgery. Anesthesia was induced with midazolam 0.05-0.1 mg?kg-1, fentanyl 15-20 ?g?kg-1 and pipecuronium 0.1 mg?kg-1 and maintained with intermittent boluses of midazolam 0.05 mg? kg-1, fentanyl 10-30?g?kg-1 and pipecuronium 2 mg. After induction of anesthesia Swan-Ganz catheter was placed for hemodynamic monitoring. Moderate hypothermia (26℃-28℃) was maintained and Hct was diluted to 20%-24% during CPB. Hyperkalemic cardioplegia was used for myocardial protection. Arterial blood (a) and coronary sinus (cs) blood were taken simultaneously for determination of tumor necrosis factor a (TNF-a), superoxide dismutase (SOD), lipid peroxide (LPO), creative kinase(CK-MB) before CPB and at 5 and 30 min after release of aortic cross-clamp (RACC), at the end of operation (EO) and at 6h and 18h after operation. Myocardial net release of TNF-a (TNF-anr) and LPO (LPOnr) and net consumption of SOD (SODnc) were calculated. The number of defibrillation after RACC, weaning index from CPB and dopamine requirement after CPB were recorded simultaneously. Results In group C LPOa and LPOcs increased significantly after RACC until the end of operation as compared with the baseline (P

Objective To study the influence of pulmonary ischemia-reperfusion (I/R) induced by cardio-pulmonary bypass (CPB) on pulmonary function and the preventive effect of nicardipine.Methods Sixteen patients scheduled for cardiac valve replacement were randomly divided into two groups : control group ( n = 8) and nicardipine group ( n = 8) . In nicardipine group nicardipine 0.02 mg kg-1 was given at the beginning of CPB; while in control group normal saline was given instead of nicardipine. All patients were operated upon under TIVA with large doses of fentanyl. Swan-Ganz catheter was placed via internal jugular vein after induction of anesthesia. Mean pulmonary arterial pressure (MPAP), pulmonary vascular resistance index (PVRI) and lung compliance were measured and calculated before CPB (T0 ), 5min after declamping of vena cava (T1 ), at tennination of CPB (T2) and at the end of operation (T3 ). At the same time points arterial and mixed venous blood samples were taken for determination of TNF-a, SOD and LPO concentrations and polymorphonuclear leukocyte (PMN) count, intrapulmonary PMN trapping (PMNa-PMNv) and blood gases and calculation of PaO2/FiO2 , P(A-2,)O2 difference and Qs/Qt. The vena cava cross-clamping time was defined as pulmonary ischemia time. Results (1) In control group MPAP, PVRI, PaO2/FiO2 and Qs/Qt were significantly deteriorating after vena cava declamping (T1-T3) as compared with the baseline valves (T0) (P

Objective To assess the mechanisms that contribute to lung injury in patients undergoing heart valve replacement with cardiopulmonary bypass (CPB) .Methods Eight HYHA grade Ⅱ-Ⅲ patients (4 males, 4 females) aged 47-67 years weighing 49.4-68.6 kg undergoing heart valve replacement with CPB were studied. The patients were premedicated with intramuscular morphine 0.1-0.2 mg?kg-1 and scopolamine 0.3 tng. Anesthesia was induced with midazolam 0.05-0.1 mg? kg-1 , fentanyl 15-20 ?g?kg-1 and pipecuronium 0.1 mg?kg-1 and maintained with intermittent Ⅳ boluses of midazolam 0.05 mg?kg-1 , fentanyl 10-30?g?kg-1 and pipecuronium 2 mg. Swan-Ganz catheter was placed via internal jugular vein after induction of anesthesia. Operation was performed under mild hypothermic (28-32℃) CPB. Blood samples were taken from radial and pulmonary artery for blood gas analysis and determination of neutrophil (PMN) counts, plasma TNFa and LPO concentrations and SOD activity prior to CPB (T0), 5 min after venae cava declamping (T1) and at the end of CPB (T2) and operation (T3 ) . The differences in the variables measured between pulmonary artery and vein were calculated to show the PMN entrapped, TNFa produced, SOD depleted and LPO released in the lungs. The alveolar-arterial oxygen tension difference (PA-aDO2) and intrapulmonary shunt( QS/QT)were calculated. Lung ischemia time was defined as the duration between occlusion and release of vena cava superior and inferior. Results The mean lung ischemia time was (97?21)min. MPAP, PVRI, PA-a.DO2 and QS/QT significantly increased after CPB, while PaO2/FiO2 and lung compliance significantly decreased compared with those before CPB (P

Objective To investigate the changes of stress responses and fibrinolysis under three anesthesia techniques undergoing elective hysterectomy during perioperative period. Methods Thirty ASA Ⅰ or Ⅱ patients aged 31-57yr weighing 45-70 kg undergoing elective hysterectomy were divided randomly into 3 groups ( n = 10 each): group Ⅰ continuous epidural anesthesia (E); group Ⅱ general anesthesia combined with continuous epidural anesthesia (G + E) and group Ⅲ general anesthesia (G) . The patients in the 3 groups were all premedicated with midazolam 0.05 mg?kg-1 i.v. . In group G and G + E the patients received an additional scopolamine 0.3 mg i.v. . In group E and G + E an epidural catheter was placed through L1-2 interspace and 2% lidocaine 5 ml was given as test dose. The spinal segments blocked was extended from L3 to T6 using 0.75 % bupivacaine. In group G and G + E general anesthesia was induced with fentanyl 2-3 ?g ? kg-1, propofol 1.5-2.0 mg?kg-1 and vecuronium 0.1 mg?kg-1 and maintained with isoflurane inhalation and intermittent i.v. boluses of vecuronium. The patients were mechanically ventilated after tracheal intubation. BIS, ECG, BP, HR, SpO2 , PETCO2 and end-tidal isoflurane concentration were continuously monitored during operation. BIS value was maintained below 60. PCEA or PCIA was started as soon as the patients were awake. VAS scores were maintained below 3-4. Venous blood samples were taken before anesthesia (T0 baseline) at the end of operation (T1) and 24 and 72 h after operation (T2 , T3) for determination of plasma adrenaline (A) and noradrenaline (NA), D-dimer level (DD), tissue type plasminogen activator (t-PA ) and plasminogen activator inhibitor ( PAI-1) concentrations. Results The plasma NA and A concentrations in group G were significantly increased at T1-3 as compared to the baseline value at T0 and were significantly higher than those in group E and G + E. There was no significant difference in plasma NA concentration between group E and G + E. The DD level was significantly increased at T2 as compared to the baseline value at T0 in all 3 groups and remained high at T3 in group E and G + E. The t-PA and PAI-1 activities were significantly increased at T1 as compared to the baseline values at T0 in all three groups and then gradually decreasing at T2 and T3 . In group E the PAI-1 activity returned to baseline level at T3 . Conclusion Epidural anesthesia helps in maintaining fibrinolytic activity by attenuating the responses to surgical stress and inhibiting the increase in PAI-1 activity.

Objective: To observe the efficacy of controlled hypotention with nicardipine and influences on endocrine system. Method: Twenty adult patient, ASA grade Ⅰ-Ⅱ, scheduled for bone tumour operation, were selected. After the operation begining, Nicar of 0.01-0.02mg/kg was given at central venous bolus, was infused at 1-4?g?kg?min~(-1). Result: Hemodynamics was very stable during controlled hypotension, regulating frequency of Niear dosage was 1.5?0.7 time/h, reaching time of aim blood pressure was 47?31s, BP recovery time from discontinuating Nicar intusion to pre-hypotention level was 40?11min and no hypertention rebound occurred after discontinuation of Nicar. Fifteen min following controlled hypotension, plasma catecholamine (CA) level increased (P0.05). During mass bleeding and subsequent malignant hypotension, serious arrhythmia and oliguria did not occur. Conclusion: Controlled hypotension with Niear is rapid, stable and easy without hypertension rebound. The influences of Nicar on plasma CA are only very obvious. Nicar has considerable protective effects on heart and kidney during mass bleeding.

Objective To determine perioperative changes of tumor necrosis factor alpha (TNF ?),superoxide dismutase(SOD),lipid peroxides(LPO) and creatine kinase MB (CK MB) in patients undergoing cardiopulmonary bypass (CPB) Methods Thirteen patients undergoing heart valves surgery were studied Blood samples were taken from artery and coronary sinus for measurement of plasma TNF ? and LPO concentrations, and plasma SOD and CK MB activities prior to CPB, 5min,30min after aorta declamping, at the end of operation, 6h and 18h after surgery respectively Blood gas analysis was done at various intervals and alveolar arterial oxygen gradient (P A a DO 2) was calculated The net myocardial release of TNF ? (coronary sinus plasma level minus arterial level) was recorded Results Arterial and coronary sinus TNF? levels increased significantly following aortic declamping as compared with those before CPB and were kept at the higher level till the end of operation (P