Objective To investigate the efficiency and safety of Dexmedetomidine as adjuvant to local anesthetics in elderly patient undergoing transurethral resection of the prostate.Methods Sixty elderly patients undergoing selective transurethral resection of the prostate were randomly divided into the Dexmedetomidine group and the Propofol group(n =30,each).After block level of spinal anesthesia was determined,Dexmedetomidine(a bolus dose of 0.5 μg/kg for 10 minutes,then continuous injection of 0.2-0.4 μg· kg-1 · h-1)or Propofol(initial plasma concentration of 0.5 mg/L,after getting equal to an effect compartment drug concentration,plasma concentration was gradually increased by 0.1 mg/L)was injected with an infusion pump.Observation items were recorded,including the onset time [observer's assessment of alertness/sedation (OAA/S) ≤ 3 points],blood pressure,heart rate,respiratory rate,pulse oxygen saturation,end-tidal carbon dioxide partial pressure,bispectral index value(BIS),and OAA/S score as well as adverse events and patients' satisfaction to sedation.Results The OAA/S score after 20 minutes of drug injection was lower in the Propofol group than in the Dexmedetomidine group(3.0 ± 0.5 scores vs.3.5 ± 0.6 scores,t =2.300,P =0.030).The systolic pressure levels were lower in the Propofol group than in the Dexmedetomidine group after 30 minutes and 40 minutes of drug injection(107.6 ± 11.2 mmHg vs.119.2 ± 16.4 mmHg,106.7±9.6 mmHg vs.121.2±18.3 mmHg,1 mmHg=0.133 kPa,t =2.151 and 2.555,P=0.041 and 0.017).The diastolic pressure was lower in the Propofol group than in the Dexmedetomidine group after 10 minutes of drug injection(69.8±6.7 mmHg vs.78.0±10.1 mmHg,t =2.462,P =0.021).The incidence of bradycardia was higher in the Dexmedetomidine group than in the Propofol group(20.0％ or 6/30 vs.0.0％ or 0/30,x2 =6.667,P=0.010).The incidences of respiratory depression and involuntary movement were lower in the Dexmedetomidine group than in the Propofol group(0.0％ or 0/30 vs.13.3％ or 4/30,0.0％ or 0/30 vs.30.0％ or 9/30,x2 =4.286 and 10.588,P =0.038 and 0.001).Conclusions Compared with the conventional Propofol,Dexmedetomidine has a definite sedative effect in elderly patients undergoing transurethral resection of the prostate under spinal anesthesia,with peace and cooperation,greater stability of blood pressure,without breath depression,but with higher incidence of bradycardia.

Objective:To explore the effect and mechanism of intracellular Zn2+ concentration ([Zn2+ ]i) in hypoxia‐induced regulation of metalloproteinases (MMPs) and extracellular matrix (ECM) expression in nucleus pulposus (NP) cells .Methods:NP cells from SD rats received plate culture at first and then three‐dimensional culture with sodium alginate gel .[Zn2+ ]i was assayed by FluoZin‐3 AM staining .Proteoglycan was assayed by Alcian blue staining .Glycosaminoglycan was detected by 1 ,9‐dimethylmethylene blue (DMMB) assay .And real‐time PCR were used to assay the mRNA expression of α1 type II collagen (COL2A1) ,matrix metalloproteinase 13 (MMP‐13) and a disintegrin and metalloproteinase with a thrombospondin motif 5 (ADAMTS‐5) .The expression of ZRT ,IRT‐like protein 8(ZIP8) was assayed by immunohistochemistry and Western blotting .Results:Interleukin (IL)‐1βand ZnCl2 could significantly increase the [Zn2+ ]i of NP cells ,however ,the effect could be inhibited by hypoxia .Hypoxia did significantly attenuate the decrease of proteoglycan ,glycosaminoglycan ,and COL2A1 mRNA ,which was induced by IL‐1βand ZnCl2 treatment ,in sodium alginate three‐dimensional culture . However ,ZnCl2 inhibited the protective effect of hypoxia .Both an intracellular Zn2+chelator and hypoxia could inhibit the increase of MMP‐13 mRNA expression .IL‐1βand ZnCl2 treatment promoted the increase of ZIP8 expression in NP cells ,however ,hypoxia inhibited ZIP8 expression .Conclusions:Hypoxia may regulate the Zn2+ influx in NP cells . Zn2+ mediates the regulation effect of hypoxia on ECM and MMP‐13 .Perhaps the changes of [Zn2+ ]i are involved in the process of intervertebral disc degeneration .

Objective:To analyze the incidence of postoperative pulmonary complications and related factors in elderly patients after major abdominal surgery.Methods:Clinical data of elderly patients undergone major abdominal surgeries at Beijing Hospital were retrospectively analyzed.The incidence of postoperative pulmonary complications was studied, and related factors were analyzed using Logistic regression analysis.Results:A total of 96 cases were included.The incidence of postoperative pulmonary complications was 53.1%(51/96)in elderly patients after major abdominal surgery.Logistic regression analysis showed laparoscopy was a protective factor for postoperative pulmonary complications( OR=0.293, 95% CI: 0.100-0.865, P=0.026), while driving pressure > 18 cmH 2O(1 cmH 2O=0.098 kPa)( OR=3.300, 95% CI: 1.148-9.434, P=0.027)and intraoperative bleeding volume > 500 ml( OR=4.444, 95% CI: 1.091-18.180, P=0.037)were risk factors for postoperative pulmonary complications. Conclusions:Attention should be paid to the incidence of postoperative pulmonary complications in elderly patients after major abdominal surgery.Laparoscopy is a protective factor for postoperative pulmonary complications, while driving pressure more than 18 cmH 2O and intraoperative bleeding volume more than 500 ml can increase the risk of postoperative pulmonary complications.