Objective To observe the effects of propofol and enflurane on intrapulmonary shunt and the changes of plasma endothelin ( ET ) and nitric oxide ( NO ) in the pulmonary artery and vein during one lung ventilation ( OLV ) Methods Thirty patients undergoing elective thoracotomy with OLV were randomly allocated to receiving enflurane at an inspired concentration of 1 8%(enflurane group) or an intravenous infusion of propofol at rate of 6 mg?kg -1 ?h -1 The arterial and mixed venous blood gas analysis and the plasma concentrations of ET and NO in the pulmonary artery and vein were measured 30 min after beginning of two lung ventilation ( TLV ) , 30 min and 60 min after of beginning OLV Results In both groups , the venous admixture percentage(Qs/Qt) increased significantly 30 and 60 min after beginning of OLV compared with that 30 min after beginning of TLV (P0 05) ET concentration in the pulmonary vein increased significantly following OLV in propofol group (P0 05) Conclusion Propofol at clinical dosage does not inhibit hypoxic pulmonary vasoconstriction The atelectasis and hypoxic stimulus during OLV can make pulmonary endothelium release ET or inhibit pulmonary elimination of ET Enflurane can suppress the above process

Aim To investigate the effects of L-type calcium channel blockers on tramadol-induced analgesia.Methods Hot-plate test and writhing test were used to measure the analgesia induced by tramadol. Verapamil, nimodipine or nifedipine was co-administrated with tramadol to determine its effects on tramadol analgesia.Results Tramadol (10, 20, 40 mg?kg -1 in hot-plate test or 2, 5,10 mg?kg -1 in writhing test) produced significantly analgesia in hot-plate test and writhing test. Co-administration of verapamil and tramadol prolonged the latency of pain response of mice in hot-plate test.In writhing test, verapamil, nimodipine and nifedipine could potentiate the analgesic effect of tramadol in a dose-dependent manner.Conclusion L-type calcium channel blockers can potentiate tramadol-induced analgesia. Calcium influx mediated by L-type calcium channels may be involved in tramadol-induced analgesia.

[Objective]To investigate the clinical treatments of perioperative complications in patients with cervical cord injury.[Method]Totally 155 cases of cervical cord injury associated with fracture of the cervical spine were enrolled in this study from January 1997 to December 2007.Eighty-five cases were treated with anterior internal fixation,66 with expansive open-door laminoplasty of the cervical spine,and 4 with one stage anterior and posterior approach operations.[Result]Forty-five cases were complicated with hyperpyrexia,31 with respiratory dysfunction,43 with pulmonary infection,70 with hyponatremia,25 with urinary system infection,3 with stress ulcer,10 with deep venous thrombosis,5 with palsy of the C5 nerve root,3 with injury of superior laryngeal nerve or recurrent nerve,1 with leakage of cerebrospinal fluid,2 with cervical hematoma,1 with loosening of interal fixation,1 with esophageal fislula,and 10 died.[Conclusion]There are many perioperative complications from cervical cord injury.To pay attention to the treatments of perioperative complications will bring a satisfactory clinical effect.

Objective To investigate the effect of dexmedetomidine on the cerebral injury in patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB).Methods Forty ASA Ⅱ or Ⅲ patients of both sexes,aged 43-64 yr,scheduled for elective cardiac valve replacement,were randomly divided into 2 groups (n =20 each):control group (group C) and dexmedetomidine group (group D).Dexmedetomidine 0.6 μg/kg was injected intravenously over 15 min before induction of anesthesia,followed by infusion at 0.2μg· kg-1 · h-1 until the end of operation in group D.While the equal volume of normal saline was given in group C.Blood samples were obtained from the radial artery and jugular bulb for blood gas analysis before CPB,immediatelv after declamping of the ascending aorta,at the end of CPB and at 6 h after operation (T1-4).The arteriovenous blood O2 difference (Da-jvO2) and cerebral O2 extraction rate (CERO2) were calculated.The plasma concentrations of S-100β and neuron-specific enolase (NSE) in the blood samples obtained from the jugular bulb were measured at T1-4 and 24 h after operation.Results Compared with group C,the jugular venous oxygen saturation was significantly increased and Da-jvO2 and CERO were decreased at T2,3,and the plasma concentrations of S100β and NSE were decreased at T2-4 in group D (P ＜ 0.05).Conclusion Dexmedetomidine can decrease the cerebral O2 metabolic rate and reduce the cerebral injury in patients undergoing cardiac valve replacement under CPB.

Objective To investigate the effects of penehyclidine hydrochloride combined with ulinastatin on lung injury in patients undergoing cardiac valve replacement with cardiopulmonary bypass(CPB).Methods Sixty ASA Ⅱ or Ⅲ patients of both sexes,aged 33-64,weighing 47-81 kg,NYHA class Ⅱ or Ⅲ ,scheduled for cardiac valve replacement,were randomly divided into 4 groups(n = 15 each): control group(group C),ulinastatin group(group U),penehyclidine hydrochloride group(group P)and penehyclidine hydrochloride + ulinastatin group(group PU).Group U,P and PU received iv injection of ulinastatin 20 000 U/kg,penehyclidine hydrochloride 0.05 mg/kg and ulinastatin 20 000 U/kg + penehyclidine hydrochloride 0.05 mg/kg 30 min after the end of CPB,respectively,while group C received equal volume of normal saline.Then PEEP was increased to 8 cm H2O in all groups.Blood samples were taken at 30 min,3 and 6 h after the end of CPB and 12 and 24 h after operation for determination of PaO2 and serum concentrations of TNF-α,IL-6,IL-8 and IL-10.Airway peak pressure and airway plateau pressure were recorded at the corresponding time points.Oxygen index(OI)and pulmonary compliance(CL)were calculated.Lung injury was scored at 6 h after the end of CPB and 12 and 24 h after operation.Results OI and CL were significantly increased and lung injury score was significantly decreased in group U,P and PU compared with group C(P ＜ 0.05 or 0.01),and in group PU compared with group U and P (P ＜ 0.05).Serum concentrations of TNF-α,IL-6 and IL-8 were significantly lower and the serum IL-10 concentration was significantly higher in group U,P and PU than in group C(P ＜ 0.05 or 0.01),and in group PU than in group U and P(P ＜ 0.05).There was no significant difference in the indices mentioned above between group U and P(P ＞ 0.05).Conclusion Penehyclidine hydrochloride combined with ulinastatin can attenuate lung injury by inhibiting inflammatory response in patients undergoing cardiac valve replacement with CPB.

Objective To explore the differences between the conservative treatment and the operative treatment in the management of cervical spinal cord injury, and the timing of the operation. Methods The therapeutic effectiveness o f the 45 cases who were treated from October 1996 to January 2002 was analyzed. 21 of them underwent conservative treatment and 24 operative treatment. The corr elation between the therapeutic effects of the operation and its timing was expl ored. Results The myeloid functional recovery was poor in the patients who had b een treated with conservative means but good in those who had been given an oper ation. The earlier the operation, the more effective it could be, and the higher the probability of the myeloid functional recovery. Conclusions The operative treatment promises better outcome than the conservative treatment. To get the be st effects, the operation should be done within one month after the injury, for the longer the lapse between the injury and the operation, the worse the effect.

Objective To investigate the efficiency and safety of agkistrodon hemocoagulase on coagulation function in pa?tients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB). Methods In this prospective,randomized controlled trial,80 eligible patients accepted valve replacement were assigned to control group (n=20) and agkistrodon hemoco?agulase groups (H1, H2, H3) according to the different timing of administration. Twenty patients were given treatment 20 minutes before anesthesia induction (H1 group), 20 patients were given treatment 20 minutes after CBP (H2 group) and 20 patients were given treatment after CBP (H3 group). Coagulation parameters including prothrombin time (PT), activated partial thromboplas?tin time (APTT), thrombin time (TT), fibrinogen (Fib) and platelet (PLT) were detected 20 minutes before surgery (T0), immedi?ately after surgery (T1) and 24 hours after surgery(T2). Data of 24-h postoperative drainage of mediastinal and pericardial, dura?tion of mechanical ventilation, stay time of intensive care unit (ICU), the actual days of hospitalization and hospital costs were recorded. The clinical parameters were also recorded including blood transfusion after surgery, secondary thoracotomy, aller?gies, liver and kidney dysfunction, deep vein thrombosis and neuropsychiatric symptoms. Results Compared with control group, values of PT, APTT and TT at T1 and T2 were significantly lower in H1, H2 and H3 groups (P<0.05). Compared with T0, values of PT, APTT and TT at T1 and T2 were significantly higher in all groups of patients (P<0.05). Values of PT and TT at T1 and T2 were significantly decreased in H3 group than those of H1 group (P<0.05). The pericardial and mediastinal drainage, the duration of ventilation support within 24-h after surgery were significantly lower in H1, H2 and H3 groups than those of control group (P<0.05). There was no significant difference in the incidence of adverse events between groups. Conclusion Agkis?trodon hemocoagulase is safe and effective in patients undergoing cardiac valve replacement with cardiopulmonary bypass.

Objective To investigate the effects of sevoflurane postconditioning on lung function in patients undergo-ing heart valve prosthesis implantation with cardiopulmonary bypass (CPB). Methods Thirty patients, scheduled for heart valve prosthesis implantation, were randomly divided into control group (C, n=15) and sevoflurane postconditioning group (S, n=15). Anesthesia was maintained by intermittent intravenous injection of midazolam, fentanyl and pipecuronium. In group S, 2%sevoflurane was inhaled continuously for 15 min , 2 min before aortic unclamping. Blood samples were taken at 30 min before CPB (T2), 30 min after CPB (T3), 6 h (T4), 12 h (T5) and 24 h (T6) after operation. The values of p(O2), SaO2, airway peak pressure (Ppeak) and airway plateau (Pplat) pressure during the time of mechanical ventilation were recorded. Oxygen index (OI), alveolar arterial oxygen tension difference (AaDO2), dynamic pulmonary compliance (Cdyn) and static pulmonary compli-ance (Cstat) were calculated. Results Compared with group C, the values of SaO2 and Cdyn were significantly higher in group S after 30 min of CPB. The values of OI, p(O2), Cdyn and Cstat were significantly higher in group S than those of group C after 6 h of operation. The value of AaDO2 was significantly lower 12 h and 24 h after operation than that of group C (P＜0.05). Conclusion CPB led to the lung injury. The sevoflurane postconditioning has a protective effect on lung function in pa-tients undergoing cardiac valve replacement with CPB.

Objective To observe the analgesic and sedative effects of oxycodone combined with dexmedetomidine and its effects on respiratory and cardiovascular functions during endotracheal intubation guided by fiberoptic bronchoscope at conscious state.Methods Forty patients with endotra-cheal intubation difficulty were randomly divided into sulfentanil group and oxycodone group.An initial induction dose of 1 μg/kg dexmedetomidine was given followed by an maintaining infusion of 0.2 μg·kg-1 ·h-1 in sulfentanil group,additionally,0.2 μg/kg sulfentanil was given intravenously. Patients in oxycodone group received intravenous infusion of oxycodone 0.08 mg/kg instead.The changes of HR,MAP and SpO 2 were monitored during medication and intubation.The Ramsay scores before intubation, the PET CO 2 and comfort degree after intubation were recorded. Results There were no statistically significant differences in hemodynamic changes,Ramsay scores and comfort level between the two groups during drug-injection and intubation.SpO 2 of patients in oxycodone group was higher than that of sulfentanil group after injection of drugs,but PET CO 2 of oxycodone group after endotracheal intubation was lower.Conclusion The combination of oxycodone and dexmedetomidine can be safely used in awake tracheal intubation,for it shows effective sedation and analgesia,less respiratory depression and other side-effects compared with sufentanil.

Objective This study is to investigate the protective effect of creatine phosphate so-dium on circulatory function in unilateral total knee replacement surgery using bone cement implanta-tion.Methods Forty patients undergoing unilateral total knee replacement surgery with bone cement were randomly assigned into 2 groups:test group (group CP,n=20)and control group (group NS, n=20).The easophageal doppler ultrasound probe was placed at the level of the third rib transorally after induction in each patient.In group CP,creatine phosphate sodium (2 g in 100 ml normal saline) was infused (within 30 min)at 30 min before the operation,as well as normal saline 100 ml in group NS.SBP,DBP,HR,SpO2 ,PET CO2 and BIS were monitored and recorded before (T0 )and 1 (T1 ),3 (T2 ),5 (T3 ),10 (T4 )min after insertion of bone cement.Cardiac output (CO),stroke volume (SV)and left ventricular end-diastolic volume (LVEDV)were simultaneously monitored and recorded with esophageal doppler ultrasound.WhileⅡ-lead electrocardiogram were recorded to monitor ven-tricular arrhythmia perioperatively.Results SBP,DBP and HR decreased at T2 and T3 in group NS, and were lower than those in group CP (P <0.05 );Meanwhile,compared with group CP,CO and SV were significantly lower,while LVEDV was significantly higher in group NS (P <0.05 ).Com-pared with T0 ,CO and SV decreased and LVEDV increased at T2 and T3 in group NS (P <0.05 ). After insertion of bone cement,the incidence of arrhythmia in group CP was obviously lower than that in group NS (P < 0.05 ).Conclusion Pretreatment with creatine phosphate sodium can effectively prevent the incidence of bone cement implantation syndrome (BCIS)by stabilizing hemodynamic in elderly patients undergoing total knee replacement with bone cement.