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.

Objective To investigate the effect of ulinastatin on postoperative cardiac troponin I ( cTnI) in patients underwent carotid endarterectomy ( CEA) under general anesthesia. Methods Forty patients with severe symptomatic carotid artery stenosis underwent unilateral CEA under general anesthesia from January 2011 to March 2012 were divided into either a ulinastatin group or a control group according to a random number table ( n=20 in each group) . Patients in the ulinastatin group received 500 000 U of ulinastatin via veins before induction of anesthesia. The patients in the control group were given the same amount of isotonic saline. The serum concentrations of cardiac troponin I ( cTnI ) were detected before surgery and at day 1,2,and 3 after procedure. Myocardial injury was defined as the cTnI peak concentration>0. 04μg/L . Results The levels of serum cTnI before procedure and at day 1,2,and 3 after procedure in the ulinastatin group were median (M) 0. 00 (0. 00-0. 03) μg/L,0. 07 (0. 00-1. 45) μg/L,0. 01 (0. 00-1. 21)μg/L,and 0. 05 (0. 00-0. 89)μg/L,respectively;those in the control group were 0. 00 (0. 00-0. 01)μg/L,0. 00 (0. 00-1. 42)μg/L,0. 00 (0. 00-1. 39)μg/L,and 0. 00 (0. 00-1. 24)μg/L, respectively. At day 1 after procedure,6 patients ( 30%) in the control group and 11 ( 55%) in the ulinastatin group occurred myocardial injury. There was no significant difference between the two groups (P<0. 05). In all the patients with the increased cTnI levels,the peak cTnI occurred at the first day after procedure,however,they did not reach the level ( >1. 5μg/L) of indicating patients occurring myocardial infarction. Conclusion Ulinastatin may not decrease the postoperative serum cTnI levels in CEA patients under general anesthesia. For whether to the CEA patients have myocardial protective effect,more samples are needed to be confirmed.

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 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

Objective To assess the influences of cardiopulmonary bypass (CPB) on energy matabolism and the effect of nicardipine pretreatment. Methods Sixteen patients with valvlar heart disease undergoing valve replacement were chosen and randomly allocated into control group (group C, n=8) and nicardipine pretreatment group (group N,n=8). In group N, nicardipine 0.5?g?kg -1?min -1 was continuously infused after induction of anesthesia and terminated before CPB. The total dose given was 0.5mg?kg -1. If the total dose was not reached before CPB, the rest dose was given immediately after the beginning of CPB. Arterial and coronary sinus blood samples were taken immediately before CPB,at 5,30min after the aortic declamping , the end of operation, 6 and 18h after operation.Blood lactate and glucose concentrations were measured. Blood gas was checked simultaneously. Then myocardial lactate extraction rate (LER) and myocardial glucose extraction rate(GER) and myocardial oxygen extraction index(MOEI) were calculated. Results In group C GER and LER decreased signficantly after aortic declamping as compared with those before CPB (P

Objective To investigate the feasibility of inducing controlled hypotension (CH) with nicardipine and low dose esmolol and its influence on blood catecholamine, blood beta 2-microlobulin (?2-mG) and tissue aerobic metabolism. Methods Thirty patients undergoing elective surgery for bone tumor were randomly divided into 3 groups: control group (C, n = 10); nicardipine group (N, n = 10) and nicardipine + esmolol group (N + E, n= 10). Controlled hypotension (CH) was started 15 min after incision. In group N nicardipine was infused at 2.5?g?kg-1?min-1 initially and in group N + E nicardipine (2.5?g?kg-1?min-1 ) and esmolol (12. 5?g?kg-1?min-1) were infused initially. When MAP was reduced to 60-70mm Hg nicardipine infusion rate was adjusted to maintain MAP at this level in both groups. In control group no CH was induced. The patients were premedicated with pethidine 25-50mg and scopolamine 0.3?g im. Anesthesia was induced with fentanyl 3?g?kg-1, propofol 1.2-2.5mg?kg-1 and vecuronium 0. 12mg?kg-1 iv and maintained with isoflurane inhalation (end-tidal concentration 1.0%-2.0%) and intermittent iv boluses of vecuronium . Radial artery was cannulated for continuous BP monitoring and internal jugular vein was cannulated for CVP monitoring. ECG , SpO2 and end-tidal CO2 concentration were continuously monitored . Blood samples were taken before CH (T0) , when MAP was reduced to 60-70mm Hg (T1), 30 min after CH had been maintained for 30min(T2 ), at the end of CH (T3) and at the end of operation (T4 ) for determination of concentrations of catecholamine ,?2-mG , lactate and Hb. Results The demographic data including age, body weight and height were comparable among the three groups. There was no significant difference in preoperative Hb and ALT, AST, Cr andBUN levels. There was also no significant difference in the duration of CH between group N and group N + E . In group C and N norepinephrine (NE) level gradually increased during CH whereas in group N + E NE level increased only slightly during CH as compared with the baseline value (T0) , and was maintained at this low level.?2-mG level was not significantly elevated during CH but lactate level increased significantly during CH in all three groups . There was no significant difference in urine output during CH among the three groups. Conclusion Hypotension with nicardipine does not result in tissue anaerobic metabolism and renal damage. Its combination with low dose esmolol has stress-inhibiting effect.

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