Objective To evaluate the cerebral protection of dexmedetomidine during craniotomy under general anesthesia in the patients with craniocerebral injury.Methods Sixty patients with craniocerebral injury,aged 30-50 yr,with body mass index of 18-25 kg/m2,of ASA physical status Ⅱ or Ⅲ,with Glasgow Coma Scale score of 6-12,scheduled for elective craniotomy under general anesthesia,were randomized into 2 groups (n =30 each) using a random number table:control group (group C) and dexmedetomidine group (group Dex).Anesthesia was induced with iv midazolam,propofol,cisatracurium and sufentanil.The patients were endotracheally intubated and mechanically ventilated.In group Dex,dexmedetomidine 1 μg/kg was infused intravenously over 10 min before induction of anesthesia,followed by infusion at a rate of 0.5 μg · kg-1 · h-1 until the end of operation.The equal volume of normal saline was given in group C.Immediately before beginning of surgery (T0),at the moment when the duramater was opened (T1),at 2 h after beginning of surgery (T2),at the duramater closing (T3) and at the end of surgery (T4),blood samples were obtained from the radial artery and jugular venous bulb for blood gas analysis,arteriovenous blood O2 difference and cerebral O2 extraction rate were calculated.The serum concentrations of S-100β were measured by ELISA.Results The serum concentrations of S-100β were significantly increased at T2-4 than at T0 in both groups.The serum concentrations of S-100β were significantly decreased at T2-4 in group Dex than in group C.The parameters of cerebral oxygen metabolism were all within the normal range in both groups.Conclusion Dexmedetomidine (1 μg/kg infused intravenously before induction of anesthesia,followed by infusion at a rate of 0.5 μg · kg-1 · h-1 until the end of operation) provides cerebral protection to some extent during craniotomy under general anesthesia in the patients with craniocerebral injury.

Objective To compare the pharmacokinetics of remifentanil during general anesthesia in children and adults.Methods Eight children(4 male,4 female)and 8 adults(4 male,4 female),undergoing elective operation under general anesthesia,were randomly divided into 2 groups(n=8 each):group adults(aged 19-60 yr,weighing 45-81 kg)and group children(aged 10 months-7 yr,weighins 7.2-21.0 kg).Remifentanil 5μg/kg was injected intravenously during induction of anesthesia.Arterial blood samples 1.0 ml were taken at 1,2,3,5,7,10,15,20,25,30,45 and 60 min after injection for determination of the plasma concentrations of remifentanil.The pharmacokinetic parameters were calculated using software 3P97.Results Elimination half-life was significantly shorter and apparent volume of distribution and clearance were significantly greater in children than in adults(P<0.05),while no significant change was found in the other pharmacokinetic parameters between the two groups(P>0.05).Conclusion There is difference in the pharmacokineties of remifentanil during general anesthesia between children and adults.The plasma concentration of remifentanil is lower in children than in adults after using the same dose,and the dose should be increased appropriately.

Objective To study the age difference of remifentanil in pharmacokinetics. Methods ASA class Ⅰ or Ⅱ patient,s undergoing selective operation under general anestesia were assigned into group A (65 to 82 years old) and group B(18 to 64 years old) with 60 cases each. Remifentanil 4 μg/kg was infused during induction. Arterial blood samples 1 ml were taken at 1,2,3,5,7,10,15,20,25,30,45,60 min after injection and the concentrations of remifentanil were detected using liquid-liquid extraction and capillary GC-MS-SIM. Results The values of elimination half-tirne(t_(1/2β)), volume distribution(Vd) and clearance(CL) were significantly higher in group A than those in group B[t_(1/2β), (18. 1±9. 2) min vs. (9. 4±4. 6) min, Vd, (60.7±18.2) L vs. (45.3±10.6)L, CL, (2.1±0.3) L/min vs. (3.8±0.4) L/min](P<0.05). Conclusion The t_(1/2β),Vd and CL are significantly higher in the elderly than those in the younger.

ObjectiveTo study the clinical applications value of tuberculous cavity resection in cavitary tuberculosis.MethodsForty-three cases of patients with cavitary tuberculosis were selected and divided into 2 groups by mechanical sampling method,15 cases in group Ⅰ were given standard chemotherapy regimen,28 cases in group Ⅱ were given standard chemotherapy regimen combined with tuberculous cavity resection.ResultsAfter treatment,the proportion of haemoptysis ending in group Ⅱ was85.7％(24/28),the proportion of negative sputum bacteria was 96.4％(27/28),and the proportion of antfebrile was 92.9％(26/28),which were higher than those in group Ⅰ [13.3％(2/15),33.3％(5/15),26.7％(4/15)].There were significant differences between two groups(P＜ 0.01 ).But after treatment,the time needed for improving symptoms in group Ⅰ [( 10.2 ± 1.1 ),(8.3 ± 1.2 ),(9.1 ± 1.1 ) months]were significantly longer than those in group Ⅱ [(6.3 ± 1.2 ),(4.5 ± 1.3 ),( 5.3 ± 1.2) months],and there were significant differences between two groups (P＜0.05).Conclusion The tuberculous cavity resection in treatment for cavitary tuberculosis can significantly improve the curative effect,and shorten the period of treatment.

Objective To integrative the effect of ulinastatin on postoperative cognitive function in elderly gastric cancer surger-y.Methods Two hundred elderly patients with gastric cancer surgery were randomly divided into observed group (100 cases)and control group (100 cases).Patients in observed group received the intravenous drip of ulinastatin before and after the surgery,while others only received the intravenous drip of physiological saline before and after the surgery.Results The urine output of observed group was (441.7±78.5)mL,which was significantly lower than that in control group as the result was (613.2±81.2)mL(P <0.05).After the treatment,the score of MMSE,visual regeneration and association learning in both observed group and control group were significantly lower than that before the treatment(P <0.05).The scores of MMSE,visual regeneration and association learning in observed group were 24.4±1.5,9.7±1.7 and 12.4±1.8,which were significantly higher than that in control group as the scores were 21.1±1.0,8.7±1.5 and 11.3±1.7 (P <0.05).The level of S100βin serum of observed group at the end of sur-gery,1 day and 3 day after the surgery were (0.099±0.024)μg/L,(0.074±0.026)μg/L and (0.061±0.022)μg/L,which were significantly lower than that in control group as the results were (0.138±0.042)μg/L,(0.110±0.034)μg/L and (0.075±0.031)μg/L (P < 0.05).Conclusion Ulinastatin can not only improve the postoperative cognitive dysfunction in elderly patients with postoperative,but can also reduce the level of S100βin serum.It provides brain protection for patients.

Objective To evaluate the hemodynamic responses of esmolol to nasotracheal intubation with fiberbronchoscope(FOB). Methods Thirty-five ASAⅠorⅡpatients undergone stomatology and otorhinolaryngology surgery were randomly divided into fiberoptic nasotracheal intubation esmolol group (esmolol group) and fiberoptic nasotracheal intubation group (control group). The intravenous administration of esmolol 1mg?kg-1 was performed 2 min before tracheal intubation in esmolol group. Noninvasive SBP,DBP,MBP,HR and SpO2 were recorded before and after anesthetic induction,at intubation and 1,2,3,4,5 min after intubation. Results The SBP,DBP and MBP 1 min after intubation in esmolol group were significantly lower than those in control group(P

ObjectiveTo explore the clinical application of video-assisted mini-thoracotomy lobectomy for radical resection of lung cancer.MethodsThirty-five patients with lung cancer treated with video-assisted mini-thoracotomy lobectomy as experiment group,40 patients with lung cancer treated with open thoracic operation as control group.The length of incision,operation time,lymph node number,peri-operative bleeding,drainage time,postoperative analgesia time,length of hospital stay were observed and compared between two groups.ResultsThe length of incision,operation time,lymph node number,peri-operative bleeding,drainage time,postoperative analgesia time,length of hospital stay were(5.8 ± 1.5) cm,( 146.5 ± 26.4) min,7.8 ± 0.6,(257.5 ± 79.5) ml,(3.2 ± 0.6) d,(2.0 ± 0.4) d,(9.5 ± 2.6) d in experiment group,and (28.7 ± 3.1 ) cm,( 142.3 ± 28.6) min,8.2 ± 0.7,(495.3 ± 97.6) ml,(5.7 ± 1.0) d,(3.6 ± 0.8) d,(16.3 ± 2.7) d in control group.There was no significant difference in the operation time,lymph node number between two groups(P ＞ 0.05).There were significant differences in the length of incision,peri-operative bleeding,drainage time,postoperative analgesia time,length of hospital stay between two groups (P ＜ 0.01 or ＜ 0.05).ConclusionsThe radical resection of lung cancer under video-assisted mini-thoracotomy lobectomy is safe,effective,microinvasive.It can achieve the better efficacy under the similar operation time as open thoracic operation,thus it is worthy of being widely used in the clinic and promotion.

ObjectiveTo investigate the association between homocysteine and cerebral infarction, as well as between different subtypes of cerebral infarction.Methods105 cases with cerebral infarction were divided into two subgroups, according to TOAST criteria, large-artery disease and small-artery disease.In addition,50 normal persons were selected as control group.Fasting blood samples were drawn from antecubital vein for measurement of plasma total homocysteine,glucose and lipids.Enzyme conversion immunoassay was applied to detect plasma total homocysteine (tHcy) levels.ResultsThe mean tHcy of cerebral infarction, which was (24.85±24.56) μmol/L, was significantly higher than that of control group, which was (16.18±6.97) μmol/L(P<0.05).There was a significant difference of homocysteine between large-artery disease,which was (30.46±31.16) μmol/L, and small-artery disease,which was (18.43±10.73) μmol/L,or the control group(P<0.05),but there was no significant difference between small-artery disease and the control group. ConclusionThe mean tHcy significantly elevated in large-artery disease,which indicated that elevated plasma homocysteine levels is an independent risk factor for atherosclerotic vascular disease.

Objective To evaluate the changes in noxious stimulation intensity at different periods of pneumoperitoneum in gynecological laparoscopic surgery. Methods Forty-five ASA Ⅰ orⅡ patients, aged 25-36 yr, with body mass index 18-23 kg/m2 , undergoing elective gynecological laparoscopic surgery, were randomly divided into 3 groups ( n = 15 each) . In group Ⅰ , anesthesia was maintained with TCI of remifentanil (target plasma concentration 4-6 ng/ml) and propofol (target plasma concentration 2 μg/ml) , and the concentrations were ad-justed according to the changes in BP and HR to maintain hemodynamics stable. Ⅱ and Ⅲ groups received inhala-tion of isoflurane (end-tidal concentration 1%-2%) and TCI of remifentanil (target plasma concentration 2-4ng/ml) . TCI of remifentanil was then stopped at 5 min before pneumoperitoneum (group Ⅱ ) or at 5 min after theend of rapid inflation (group Ⅲ ) , and isoflurane was inhaled (end-tidal concentration 1%-2% ) to maintain anes-thesia until the end of operation in Ⅱ and Ⅲ group. Before anesthesia (T0 ), 5 min before pneumoperitoneum (T1), 5 and 15 min of pneumoperitoneum (T2,3), HR and MAP were monitored and venous blood samples were taken for determination of plasma cortisol (Cor) , norepinephrine ( NE) and epinephrine ( E) concentrations. Results HR, MAP and NE and E concentrations at T2,3 , and Cor concentrations at T3 were significantly higher than those at T0 ingroup Ⅱ , and in group Ⅱ than in group Ⅰ (P<0.05). HR, MAP and NE and E concentrations at T2,3 ,and Cur concentrations at T3 were significantly lower in group Ⅲ than in group Ⅱ ( P < 0.05). Conclusion The intensity of noxious stimulation is strongest during rapid inflation among the different periods of pneumoperitoneum in gynecological laparoscopic surgery and the depth of anesthesia should be regulated.

Objective To evaluate the changes in noxious stimulation intensity at different periods of pneumoperitoneum in patients undergoing gynecological laparoscopic surgery.Methods Forty-five ASA Ⅰ or Ⅱ patients,aged 25-36 years,with body mass index of 18-23 kg/m2,undergoing elective gynecological laparoscopic surgery,were randomly divided into three groups (n =15 each).In group Ⅰ,anesthesia was maintained with target-controlled infusion (TCI) of remifentanil (with target plasma concentration of 4-6 ng/ml) and propofol (with target plasma concentration of 2 μg/ml),and the concentrations were adjusted according to the changes in blood pressure (BP) and heart rate (HR) to maintain hemodynamics stable.Group Ⅱ and group Ⅲ received inhalation of isoflurane (with the end-tidal concentration of 1％-2％) and TCI of remifentanil (with target plasma concentration of 2-4 ng/ml).TCI of remifentanil was then stopped at 5 minutes before pneumoperitoneum (group Ⅱ) or at 5 minutes after the end of rapid inflation (group Ⅲ),and isoflurane was inhaled (with the end-tidal concentration of 1％-2％) to maintain anesthesia until the end of operation in groups Ⅱ and Ⅲ.Before anesthesia (T0),5 minutes before pneumoperitoneum (T1),after 5 and 15 minutes of pneumoperitoneum (T2,3),HR and mean arterial blood pressure (MAP) were monitored and venous blood samples were taken for determination of plasma concentrations of cortisol (Cor),norepinephrine (NE) and epinephrine (E).Results HR,MAP,and NE and E concentrations at T2,3,and Cor concentrations at T3 were significantly higher than those at T0 in group Ⅱ.They were significantly higher in group Ⅱ than in group Ⅰ (P ＜ 0.05),but were significantly lower in group Ⅲ than in group Ⅱ (P＜0.05).Conclusion The intensity of noxious stimulation is strongest during rapid inflation among the different periods of pneumoperitoneum in patients undergoing gynecological laparoscopic surgery and the depth of anesthesia should be regulated.