Objective To determine the incidence of pre- and postoperative myocardial ischemia (MI) in patients undergoing noncardiac surgery and to identify the predictors of perioperative MI. Methods One hundred and fifty patients (99 male, 51 female) aged 42-89 yr, weighing 35-87 kg undergoing elective noncardiac surgery were enrolled in this study. Patients with left or right bundle branch block, left ventricular hypertrophy, low voltage on ECG using limb leads, being treated with digoxin or on artificial pacemaker were excluded from the study. The patients were premedicated with intramuscular atropine 0.5 mg and phenobarbital sodium 0.1 g, and were monitored continuously with dynamic ECG (DMS Holler 5.0 USA) for at least 12 h before surgery and 48 h after surgery. The incidence of MI, the number of ischemic episodes, the duration of MI and the area under the ST curve per hour were computed pre- and postoperatively. Factors that could affect MI including age, sex, weight, ASA class, history of cardiac disease, cardiac risk factors, cardiac medication, anesthesia, surgery, laboratory and other physiological data were also recorded. The potential predictors of perioperative MI were identified by univariate model and were then entered into multivariate logistic models. Results The incidence of preoperative MI was 4.7% and postoperative MI was 22.7 % . The incidence of MI and number of ischemia episodes achieved peak levels at 12-24 h after operation, while the duration of MI and the area under the ST curve peaked at 0-12 h after operation. Predictors of postoperative MI were : preoperative MI identified by ECG, age ≥ 65 yr, ASA class ≥ Ⅲ , history of angina, or hypertension or diabetes and high VAS score. Conclusion Postoperative MI usually develops on the first day after surgery. The patients at high risk for developing postoperative MI can be identified by predictors.

To explore the relationship between the perioperative change in erythrocytic pyruvate kinase (PK) activity and surgical hyperglycemia in the patients undergoing upper abdominal surgery under intravenous procaine balanced anesthesia. Seventeen patients with ASA grade Ⅰ～Ⅱ, being scheduled for selective cholecystectomy or subtotal gastrectomy, were randomly enrolled in our study. PK activity of erythrocytes and its pertinent modulators, such as adenosine triphosphate (ATP), adenosine diphosphate (ADP), inorganic phosphate (Pi), magnesium, plasma glucose and serum insulin were dynamically assayed in the surgical patients receiving intravenous procaine balanced anesthesia. The results showed that PK activity was decreased significantly at 10 min and 24 hours after operation as compared with that of preoperative period. Changes in PK activity were positively correlated with ATP/ADP ratio( r =0 680, P 0 05). It is our supposition that the decreased PK activity and the disturbance of glycolytic pathway might be directly or indirectly induced by anesthesia and surgical trauma, leading to hindrance of utilization of glucose and Pi, as well as synthesis of ATP. Therefore, an inhibition of glycolytic reaction is one of the important mechanisms of "surgical hyperglycemia".

Objective To investigate the activity of autonomic nervous system (ANS) in elderly patients with diabetes mellitus ( DM) after non-cardiac surgery. Mehtods Thirty ASA Ⅰ-Ⅲ patients aged ≥ 60 yrs undergoing elective abdominal surgery or operation on the lower limbs were assigned to one of 2 groups ( n =15 each) : DM group and non-DM group. The patients were monitored with Holter (DMS Co, U.S. A) the day before and on the 1st and 2nd day after operation. Heart-rate variability (HRV) including total power (TP), high frequency (HF), low frequency (LF), very low frequency (VLF) and LF/HF ratio were recorded. Results TP and HF were significantly lower in DM group than in non-DM group before operation ( P

Objective To observe the effects of shenfu injection (SFI) on the awakening quality of the patients with hepatitis B cirrhosis undergoing splenectomy under general anethesia. Methods Forty patients with hepatitis B cirrhosis and hepatic insufficiency (ASA classⅡ~Ⅲ) underwent splenectomy by general anesthesia. Patients were all sent into the post-anesthesia care unit (PACU) shortly after the operation with unconscious and no spontaneously breathing. They were randomly divided into two groups: SFI treatment group (Group SFI, n =20) and normal saline controlled group (Group NSC, n = 20). SFI group were treated with SFI (1 mL/kg, i. v.) in 10 minutes, and NSC group were treated with normal saline (1 mL/kg,i.v.). The time of eyes opening, extubation of tracheal catheter and the detention time of PACU were recorded. The heart rate (HR) and the average artery presses (MAP) were monitored at 4 time points: before SFI and normal saline administration, 5 min, 15 min, and 45 min after administration. The incidence of restlessness during the patients awakening period was also recorded. Results The time of eyes opening, extubation and the detention time of PACU of SFI group show no significant difference compared with the NSC group (P > 0.05). SFI and normal saline intravenous injection did not cause significant changes on HR and MAP at the time of 5 min , 15 min and 45 min compared to the time of before administration (P > 0.05). The incidence of restlessness during the patients resuscitation period in SFI group were lower than in NSC group (P < 0.05). Conclusion Shenfu injection can effectively improve the awakening quality and decrease the incidence of restlessness of the patients with hepatitis B cirrhosis undergoing splenectomy under general anesthesia during the awakening period in PACU.

ObjectiveTo investigate the effects of combination of dexmedetomidine and sufentanil preconditioning on ischemia-reperfusion (I/R) injury in isolated rat hearts.MethodsForty male SD rats weighing 180-220 g, aged 8-10 weeks, were anesthetized with intraperitoneal 3％pentobarbital 60 mg/kg and heparin 3000 U/kg.The hearts were excised and perfused in a Langendorff apparatus with K-H solution saturated with 95％O2-5％CO2 at 36.5-37.5 ℃.Forty isolated rat hearts were randomly divided into 5 groups ( n =8 each):control group (group C),I/R group,dexmedetomidine preconditioning group (group DP),sufentanil preconditioning group (group SP),and dexmedetomidine + sufentanil preconditioning group (group DS).I/R injury was induced by 30 min of ischemia followed by 120 min of reperfusion.Groups DP,SP and DS received 30 min of perfusion with K-H solution containing dexmedetomidine 2.3 ng/ml,sufentanil 3.77 ng/ml and dexmedetomidine 2.3ng/ml + sufentanil 3.77 ng/ml respectively at 30 min before ischemia.Coronary flow (CF),left ventricular developed pressure (LVDP),± dp/dtmax and HR were measured at 15 min of equilibration,immediately before ischemia,at 30 min of ischemia and at 120 min of reperfusion.The superoxide didmutase (SOD) and myeloperoxidase (MPO) activities and the malondialdehyde (MDA) content in myocardial tissues and infarct size were determined at 120 min of reperfusion.Results Compared with group C,CF,LVDP, ± dp/dtmax,HR and SOD activity were significantly decreased,and MPO activity,MDA concent and infarct size were significantly increased in the other 4 groups ( P ＜ 0.05).Compared with group I/R,CF was significantly decreased in groups DP and DS,HR was significantly decreased in groups SP and DS,and LVDP, ± dp/dtmax and SOD activity were significantly increased,and MPO activity,MDA content and infarct size were significantly decreased in groups DP,SP and DS ( P ＜0.05).Compared with group DS,CF was significantly decreased and HR increased in group DP,and SOD activity was significantly decreased,CF,MPO activity,MDA content and infarct size were significantly increased in group SP (P ＜ 0.05 ),and no significant change was found in SOD and MPO activities,MDA content and infarct size in group DP ( P ＞ 0.05).Conclusion Dexmedetomidine combined with sufentanil preconditioning can reduce I/R injury in isolated rat hearts,but the myocardial protection is not further enhanced.

Objective To discuss Extracorporeal Membrane Oxygenation(ECMO) management method and effect during inter-hospital transport of potential cardiac death donors after cardiac death (DCD).Methods 8 potential donors after cardiac death with brain injury were supported by ECMO for inter-hospital transport.All donors were inserted Medtronic overall cannula into one side femoral artery and venous.The position of catheters were guided by ultrasound.The front-end of venous catheter located in the junction of atrium and inferior vena cava,meanwhile the front-end of artery catheter was below renal artery.100 IU/kg heparin was injected before inserting cannulas.Flow of ECMO maintained at 2.0～3.0 L/min,and oxygen flow was 2～3 L/min during ECMO supporting.When hemodynamics of potential donors were stable,patients were moved into ambulance with ECMO for inter-hospital transport.Results A total of 8 ECMO transports were performed for central circulatory collapse caused brain injury.Patients were previously cannulated and on ECMO prior to transport and transported a distance of more than 100 kilometer from our institution by ambulance.ECMO running times were 120 min,and operation process circulatory stable.Conclusion ECMO can ensure inter-hospital transport of potential donors after cardiac death safety.

Objective To investigate the effects of target-controlled infusion (TCI)of dexme-detomidine on the median effective concentration of effect-site (Ce50 )of propofol at loss of conscious-ness (LOC)in patients.Methods Sixty-four patients,28 males and 36 females,aged 20-60 years, ASA physical status Ⅰ or Ⅱ,scheduled for elective surgery,were randomly allocated to receive dexmedetomidine of 0 ng/ml (group P),dexmedetomidine of 0.4 ng/ml (group D1),dexmedetomi-dine of 0.6 ng/ml (group D2)and dexmedetomidine of 0.8 ng/ml (group D3)for 1 5 min before TCI of propofol,n =1 6 in each group.The propofol infusion was started to provide an effect-site concen-tration of 1.0 μg/ml,and increased by 0.2 μg/ml when propofol effect-site concentration and target concentration were equilibrium until LOC.Results The Ce50 (95%CI )at loss of consciousness in groups P,D1,D2 and D3 were 2.30 (2.24-2.36)μg/ml,1.92 (1.87-1.96 )μg/ml,1.60 (1.55-1.65)μg/ml and 1.41 (1.35-1.45 )μg/ml,respectively.There was a negative correlation between the effect-site concentration of propofol-induced LOC and target concentration of dexmedetomidine (r=-0.84,P <0.01).Compared with groups P,D1 and D2,the incidence of bradycardia was higher in group D3 (P <0.05).Conclusion The Ce50 of propofol-induced LOC gradually decreases with in-creasing target concentration of dexmedetomidine.Combining propofol with dexmedetomidine of 0.4 or 0.6 ng/ml that can reduce the Ce50 of propofol-induced LOC,which is suitable for induction of an-esthesia with a lower incidence of bradycardia.

Objective To evaluate the sedative interaction between dexmedetomidine and propofol.Methods Sixty-four American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients,aged 20-60 yr,with body mass index of 19.0-25.0 kg/m2,scheduled for elective surgery under general anesthesia,were allocated into 4 groups (n =16 each) using a random number table:different target concentrations of dexmedetomidine groups (D1-4 groups).Dexmedetomidine was administered by target-controlled infusion (TCI) with the Markku model.The target plasma concentrations of dexmedetomidine were 0,0.4,0.6 and 0.8 ng/ml in D1-4 groups,respectively.At 15 min of dexmedetomidine TCI,propofol was given by TCI with Schnider model,and the initial target effect-site concentration was set at 1.0 μg/ml.After the target effect-site and plasma concentrations were balanced,the target effect-site concentration of propofol was gradually increased in increments of 0.2 μg/ml until loss of consciousness (Observer's Assessment of Alertness/Sedation Scale score was 1).The model of pharmacodynamic interaction was used to analyze the sedative interaction between the two drugs.Results There was no statistically significant difference in residual sums of squares fitted by using the model of pharmacodynamic interaction between the target effect-site concentration of propofol and target plasma concentration of dexmedetomidine at loss of consciousness (P＞0.05).The linear dimensionless parameter of pharmacodynamic interaction was 0.The median effective effect-site concentration of propofol was 2.38 μg/ml at loss of consciousness,and the median effective plasma concentration of dexmedetomidine was 2.03 ng/ml at loss of consciousness.Conclusion Dexmedetomidine and propofol interact additively in terms of sedation.

Objective To observe the effects of the preconditioning of ulinastatin on GES-1 cell injury induced by oxygen and glucose deprivation (OGD). Methods GES-1 cells were cultured in vitro and divided into three groups: normal control group (group N), oxygen and glucose deprivation group (group O), and ulinastatin preconditioning group (group U). The OGD model of GES-1 cells were established by glucose-free medium and three-gas incubator for 6h. Ulinastatin was added to group U 12h before the deprivation of oxygen and glucose. The cell viability and apoptosis were determined by cck-8 and flow cytometry respectively. Western Blot was used to examine the protein expression of Caspase-3 and Cleaved Caspase-3. The TRPV1 mRNA expression was measured by quantitative real-time PCR. Results As compared with group N, the viability of GES-1 was decreased, the apoptotic rate and the expression of Caspase-3 and Cleaved Caspase-3 were increased, and the TRPV1 mRNA expression decreased greatly in group O (P < 0.05). As compared with group O, the aforementioned changes were significantly inhibited in group U. Conclusions Ulinastatin preconditioning could effectively inhibit GES-1 cell injury induced by OGD, which may be related to the inhibition of apoptosis and the upregulation of TRPV1 mRNA expression.

Objective To investigate the effect of preoperative single target administrating of fibrinogen(FIB)on the intraop-erative bleeding and coagulation function in posterior lumbar interbody fusion (PLIF)operation.Methods 60 cases of lumbar inter-vertebral disc herniation(LDH)undergoing elective PLIF operation were divided into two groups according to the preoperative FIB levels:normal control group(NC,FIB≥3.0 g/L,n=20)and low FIB group(FIB<3.0 g/L,n=40).The low FIB group was ran-domly re-divided into 2 groups:the low HIB control group(LC,n=20)and the preoperative single FIB administrating group(PF, n=20).After anesthesia induction,the PF group was given FIB;the LC and NC groups were given the same volume of saline solu-tion as solvent volume required by administrating FIB dose.The change of blood coagulation 4 indexes were detected and the activa-ted clotting time(ACT),coagulation time(CR)and platelet function(PF)were detected by the sonoclot analyzer before and after drug administrating.The bleeding amount was weighed after ending operation.Results The FIB concentration after administrating in the PF group was (3.75±0.23)g/L,which was significantly higher than (2.62±0.33)g/L in the NC group and (2.23±0.22) g/L in the LC group,the differences among 3 groups were statistically significant(P <0.05);the CR value after administrating in the PF group was (21.42±7.15)U/min,which was higher than (18.21±5.62)U/min in the NC group and (15.21±5.63)U/min in the LC group.The bleeding amount in the PF group was (516.74±135.53)g,which was lower than (660.71±119.34)g in the NC group and (726.72±160.47)g in the LC group,the difference among 3 groups had statistical significance(P <0.05).Conclusion Preoperative single target administrating of fibrinogen can effectively increase the FIB level,improve the blood coagulation func-tion and reduce the periaoperative bleeding amount.