Objective To evaluate the effects of different doses of dexmedetomidine on lung injury in pediatric patients undergoing open heart surgery under cardiopulmonary bypass (CPB).Methods Forty-eight pediatric patients,aged 7 months-3 yr,of ASA physical status Ⅱ or Ⅲ,scheduled for elective repair of ventricular septal defect under CPB,were randomly divided into 4 groups (n =12 each) using a random number table:control group (group C) and 3 different doses of dexmedetomidine groups (D1-3 groups).Anesthesia was induced with midazolam,fentanyl and vecuronium.The patients were endotracheally intubated and mechanically ventilated.In D1-3 groups,dexmedetomidine 0.5μg/kg (initial dose) was given over more than 10 min,followed by continuous infusion at 0.1,0.3 and 0.5 μg· kg-1 · h-1,respectively,until the end of operation.The equal volume of normal saline was given instead of dexmedetomidine in group C.Before administration (T1),and at 2,6 and 12 h after termination of CPB (T2-4),blood samples were collected for determination of plasma tumor necrosis factor-α (TNF-α),interleukin-6 (IL-6) and IL-8 concentrations and for blood gas analysis.Respiratory index (RI),oxygenation index (OI) and lung compliance (CL) were calculated.Results The plasma concentrations of TNF-α and IL-8 at T2-4 and IL-6 at T3,4 were significantly lower in D2,3 groups than in group C.Compared with group D1,the plasma concentrations of TNF-α,IL-8 and RI were significantly decreased,and OI and CL were increased at T2-4 in D2-3 groups,and the plasma IL-6 concentrations at T3,4 in group D2 and at T2-4 in group D3 were decreased.The plasma concentrations of TNF-α and IL-6 were significantly lower,while OI and CL were higher at T2,3,and the plasma concentrations of IL-8 and RI were lower at T2-4 in group D3 than in group D2.Conclusion Dexmedetomidine can reduce lung injury in pediatric patients undergoing open heart surgery under CPB and promote the lung function after CPB possibly through inhibiting inflammatory responses to CPB dosedependently.

Objective To investigate the effect of ultrasound-guided oblique subcostal trans versus abdominis plane (OSTAP) block with different concentration of ropivacaine in combined anesthesia for upper abdominal surgery.Methods One hundred forty-seven patients underwent upper abdominal surgery,85 males and 62 females,aged 18-80 years,ASA physical status Ⅰ or Ⅱ,were recruited and randomly divided into four groups.Bilateral ultrasound-guided OSTAP block were performed in each group.Ropivacaine hydrochloride injection of 2.5 mg/kg were performed in each of group A (n =41),B (n =55),C (n =37) while concentration was 0.375％,0.5％,0.75％,respectively.Group D (n =14) was received 20 ml of saline solution for each side.Intravenous-inhalation combined anesthesia was conducted during the surgery,with sevoflurane 0.8-1.0 MAC,dexmedetomidine 0.5 μg/kg iv,remifentanil 0.1μg·kg-1 ·min-1 iv.Each group was received patient-controlled intravenous analgesia (PCIA) after surgery which contained butorphanol tartrate and flurbiprofen axetil.The consumption of opioids and vasoactive drugs,hemodynamic parameters in operation were recorded.The visual analogue scale (VAS) scores were evaluated at 12 and 24 h after operation,the location and degree of abdominal pain,fentanyl used for acute pain during the first 12 h after operation,the postoperative intestinal exhaust time and hospitalization time were also recorded.Results There was no difference in basic states,duration of operation or blood loss in each group.The consumption of sufentanil in operation in groups A,B and C was (30.5±9.4)μg,(27.4±7.4) μg,(30.9±8.8) μg,respectively,which were significantly lower than that in group D [(47.1±9.3) μg] (P＜0.05).There was no difference in vasoactive drugs between the four groups.There was no difference in hemodynamic indexes in the TAP block groups.There was no significant difference in intraoperative blood loss between the four groups the VAS scores.There was no difference in the location and degree of abdominal pain,fentanyl used for acute pain,the postoperative intestinal exhaust time and hospitalization time.Conclusion Intraoperative opioids consumption in combined general anesthesia was reduced by ultrasound-guided OSTAP block.There is no difference between the effect of OSTAP block with different concentration of ropivacaine in combined anesthesia for upper abdominal surgery.

Objective     To investigate the risk factors for postoperative complications Clavien-Dindo classification≥grade Ⅱ after lung cancer surgery. Methods     The patients who underwent lung cancer surgery in a multicenter observational study from November 2017 to January 2020 were included. The Clavien-Dindo classification of postoperative complications was analyzed. Logistic regression was used to identify the risk factors for complications≥ gradeⅡ. Results     A total of 388 patients were enrolled, including 203 males and 185 females with a mean age of 56.14±10.36 years. The incidence of postoperative complications was 25.52% (99/388) after lung cancer surgery and the incidence of complications≥gradeⅡ was 20.10% (78/388). The five most common postoperative complications were pneumonia (6.96%), prolonged pulmonary air leak (>7 days, 5.67%), incision dehiscence (4.64%), arrhythmia (3.87%), and postoperative pleural effusion (3.35%). Multivariate analysis showed that open surgery [reference: uniportal thoracoscopic surgery, OR=2.18, 95%CI (1.01, 4.70), P=0.047], extended resection [reference: sublobar resection, OR=2.86, 95%CI (1.11, 7.19), P=0.030; reference: lobectomy, OR=2.20, 95%CI (1.10, 4.40), P=0.026] and operative time≥3 h [OR=2.07, 95%CI (1.12, 3.85), P=0.021] were independent risk factors for postoperative complications≥gradeⅡ after lung cancer surgery. Conclusion     Surgical approach, extent of resection and operative time are independent influencing factors for postoperative complications≥gradeⅡ after lung cancer surgery.

Objective    To investigate the use of opioid analgesics during the postoperative hospitalization in patients undergoing lung resection and analyse its influencing factors. Methods    The clinical data of 450 patients undergoing lung resection in Sichuan Cancer Hospital among a multicenter symptom research database (CN-PRO-Lung 1) between November 2017 and January 2020 were analyzed. There were 248 males and 202 females with an average age of 54.7±10.3 years. Results    A total of 448 (99.6%) patients used opioid analgesics. The average daily morphine equivalent dose during the postoperative hospitalization was 48.9 mg. There were statistical differences in postoperative morphine equivalent dose across patients with different sex, age, highest level of education, Charlson Comorbidity Index score, surgical approach, surgical type, operative time, postoperative hospital stay and grade of postoperative complications (all P<0.05). Multivariate analysis showed that sex, surgical approach and postoperative hospital stay were independent influencing factors for morphine use during the postoperative hospitalization in patients undergoing lung resection (all P<0.05). Conclusion    In clinical practice, attention should be paid to postoperative pain for male patients, as well as to promote the application of minimally invasive surgery, and to shorten the length of postoperative hospital stay, in order to ultimately reduce the use of opioids.