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The effect of dexmedetomidine alternative to propofol administered in general anesthesia on maintainance and recovery in patients undergoing gynecologic laparoscopy

Yanling FENG ; Wei GU ; Xiaoping GU

Chinese Journal of Postgraduates of Medicine.2013;36(27):1-4. doi:10.3760/cma.j.issn.1673-4904.2013.27.001

Objective To evaluate the effect of dexmedetomidine alternative to propofol administered in general anesthesia on maintainance and recovery in patients undergoing gynecologic laparoscopy.Methods One hundred and twenty patients undergoing gynecologic laparoscopy,were divided into group C,D1 and D2 with 40 cases each by random digits table method.Group C received propofol 100 μ g / (kg min) and remifentanil 0.10-0.25 μ g / (kg min) intravenous infusion,group D1 received propofol 100 μ g/(kg min),remifentanil 0.10-0.25 μ g/(kg min) and dexmedetomidine 0.2 μ g/(kg h) intravenous infusion,while group D2 received dexmedetomidine 2.0-3.0 μ g / (kg h) and remifentanil 0.10-0.25 μ g/ (kg min).Cis-atracurium was given on time to maintainance of anesthesia.The heart rate (HR),mean arterial pressure (MAP) were recorded at the following time points:arriving at operating room (To),anesthesia induction (T1),intubation (T2),skin incision (T3),pneumoperitoneum (T4),10 min after pneumoperitoneum (T5),20 min after pneumoperitoneum (T6),the end of operation (T7),discharge from post anesthesia care unit(T8) and the first postoperative day (T9).The time of emergence,extubation and duration in post anesthesia care unit were recorded too.Ramsay scale and Riker Sedation-Agitation Scale on emergence,extubation and discharge from post anesthesia care unit and post anesthesia recovery score at T9 were also recorded.Results The MAP in group D2 was higher at T3 to T7 time-points than that in group C and group D1 [(93 ± 10),(99 ± 11),(94 ± 13),(95 ± 10),(91 ± 10) mm Hg (1 mm Hg =0.133 kPa) vs.(88± 11),(90± 10),(87±9),(86±9),(83±8)mmHgand (87±9),(90± 10),(86±8),(85 ±7),(83 ± 7) mm Hg],there were significant difference (P ＜ 0.05).There were no significant difference among groups on the HR at each time point and the time of emergence,extubation and duration in post anesthesia care unit (P ＞ 0.05).Ramsay scale was lower on emergence and Riker Sedation-Agitation Scale was higher on emergence and extubation in group C than that in group D1 and group D2 [(3.7 ± 1.3) scores vs.(4.0 ± 0.9),(4.2 ±0.9) scores,(3.1 ± 1.0) scores vs.(2.8 ±0.6),(2.7 ±0.9) scores,(3.3 ±0.7) scores vs.(3.2 ± 0.4),(3.0 ± 0.5) scores],there were significant differences (P ＜ 0.05).Riker Sedation-Agitation Scale was higher on extubation in group D1 than that in group D2(P ＜ 0.05).Post anesthesia recovery score at T9 in group D2 was apparently increased compared with that in group C and group D1 [(108 ± 10) scores vs.(93 ± 13),(93 ± 15) scores] (P ＜ 0.05).Conclusions Dexmedetomidine 2.0-3.0 μ g/ (kg h) administered in general anesthesia on maintainance in gynecologic laparoscopy can improve the quality of extubation and promote postoperative recovery without prolonging extubation time,but have a influence on hemodynamic changes at early stage of pneumoperitoneum.

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The detection and clinical significance of eosinophil and eotaxin in the children with virus associated wheezing diseases

Qiuxia FAN ; Airong ZHANG

Chinese Journal of Postgraduates of Medicine.2013;36(27):5-7. doi:10.3760/cma.j.issn.1673-4904.2013.27.002

Objective To detect the levels of eosinophil and eotaxin in the children with virus associated wheezing diseases,and explore the role of both in virus correlation breathing occurrence and development.Methods Sixty-eight cases of children with virus associated wheezing diseases were selected as observation group,and the other 42 cases of healthy children were selected as control group.The peripheral eosinophil count and serum eotaxin level were detected and compared in observation group and control group on the acute stage and recovery stage.Results The eosinophil count in observation group on the acute stage was (1.12 ± 0.62) × 1099/L,the recovery stage was (0.34 ± 0.13) × 109/L,control group was (0.16 ± 0.07) ×109/L,the eosinophil count in observation group on the acute stage was higher than that on the recovery stage and control group,the eosinophil count in observation group on the recovery stage was higher than that in control group,there were statistically significant differences (P ＜ 0.05).The eotaxin level in observation group on the acute stage was (437.2 ±87.6) ng/L,the recovery stage was (182.4 ±56.2) ng/L,control group was (84.1 ± 39.7) ng/L,the eotaxin level in observation group on the acute stage was higher than that on the recovery stage and control group,the eotaxin level in observation group on the recovery stage was higher than that in control group,there were statistically significant differences (P ＜0.05).There were positively correlated between the eosinophil count and the eotaxin level in observation group on the acute stage,recovery stage and control group (r =0.579,0.593,0.581,P＜ 0.05).Conclusions The eosinophils and eotaxin may be involved in the children with virus associated wheezing diseases pathophysiological process,the levels of the eosinophils and eotaxin can monitor the course change,and be helpful for clinical diagnosis and treatment.

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The diagnostic value of Epworth sleepiness scale combined with portable sleep monitor in patients with obstructive sleep apnea syndrome

Jing TANG ; Zekui LI ; Shuangqiao SAI

Chinese Journal of Postgraduates of Medicine.2013;36(27):7-9. doi:10.3760/cma.j.issn.1673-4904.2013.27.003

Objective To evaluate the diagnostic value of Epworth sleepiness scale(ESS) combined with portable sleep monitor (PM) in patients with obstructive sleep apnea syndrome (OSAHS).Methods The questionnaire of ESS was used to evaluate 156 patients with snoring,and then line PM check,monitoring apnea hypoventilation index (AHI),oxygen reduction index (ODI),the lowest oxygen saturation (LSpO2),average blood oxygen saturation (MSpO2).Results One hundred and twenty-four patients were diagnosed to be OSAHS and 32 patients be simple snore by PM in 156 patients.A total of 124 cases,including mild 42 cases,moderate 47 cases,severe 35 cases.There were significant difference in ESS score,AHI,ODI,LSpO2 and MSpO2 between OSAHS in various degrees and patients with simple snore [simple snore:(5.8 ± 2.9) scores,(3.2 ± 1.3) times/h,(3.3 ± 2.6) times,0.911 ± 0.121,0.973 ± 0.132;mild OSAHS:(9.7 ± 3.5) scores,(12.8 ± 23.3) times/h,(14.2 ± 5.7) times,0.875 ± 0.083,0.902 ± 0.095 ; moderate OSAHS:(12.9 ±4.8) scores,(27.6 ± 4.5) times/h,(25.6 ± 6.1) times,0.816 ± 0.069,0.851 ± 0.071 ;severe:(16.1 ± 5.2)scores,(43.6 ± 7.6) times/h,(38.6 ± 7.8) times,0.701 ± 0.061,0.795 ± 0.063] (P ＜ 0.05).With the severity of OSAHS increased,ESS score,AHI,ODI increased gradually,LSpO2,MSpO2 gradually declined,there were statistically significant differences (P ＜ 0.05).ESS score was positively correlated with AHI and ODI (r =0.42,0.51,P ＜ 0.05),and negatively correlated with LSpO2 and MSpO2 (r =-3.70,-4.50,P ＜ 0.05).Conclusions There is a good relativity between ESS score and the monitoring index of PM.Combination of ESS with PM could be used as a primary diagnostic method in patients with OSAHS,especially in primary-care hospitals.

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The application comparison between one-site and two-site incision in glaucoma with cataract combined surgery

Xuqing LI ; Kang CHEN ; Hongwei WANG ; Yao TUO

Chinese Journal of Postgraduates of Medicine.2013;36(27):12-14. doi:10.3760/cma.j.issn.1673-4904.2013.27.005

Objective To compare the effect of one-site and two-site incision in glaucoma with cataract combined surgery.Methods Forty-two cases (58 eyes) of patients of glaucoma with cataract combined surgery were selected.One-site incision were 22 cases with 30 eyes (one-site incision group),and two-site incision were 20 cases with 28 eyes (two-site incision group).The postoperative intraocular pressure,ultrasound biomicroscope (UBM),filtering bleb and complications were compared in two groups.Results The postoperative visual acuity and intraocular pressure in two groups were better than preoperative [one-site incision group:0.82±0.11 vs.0.18±0.09,(17.32±4.52) mm Hg (1 mm Hg=0.133 kPa) vs.(31.98± 5.18) mm Hg,two-site incision group:0.79 ±0.20 vs.0.20 ±0.03,(16.98 ±4.65) mm Hg vs.(33.16 ±4.61) mm Hg],there were statistically significant differences (P ＜ 0.05),but there was no significant difference between two groups on postoperative (P＞ 0.05).There was no statistically significant difference in visibility of filtering routes under the scleral flap and reflectivity inside the blebs in two groups (P ＞ 0.05).Conclusions Ohe-site and two-site incision in glaucoma with cataract combined surgery has good intraoeular pressure control,can maintain a good filtering bleb function at the same time.The effects are similar between the two operative methods.

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The change of surgical route and range of hysterectomy in different periods

Zhilan CHEN ; Jing WANG ; Chengwen SONG ; Shouzhen XIE ; Shuang LI

Chinese Journal of Postgraduates of Medicine.2013;36(27):15-18. doi:10.3760/cma.j.issn.1673-4904.2013.27.006

Objective To analyze the change of surgical route and range of hysterectomy in the past 10 years.Methods From January 2000 to December 2010,the clinical data of patients with hysterectomy were analyzed retrospectively,including clinical features,surgical path and scope of operation.Results There were 1980 patients.The predominant reason for hysterectomy was leiomyomas (52.88％,1047/1980),adenomyosis (17.78％,352/1980),cervical intraepithelial neoplasia (12.17％,241/1980).The age of the patients with hysterectomy for abdominal,transvaginal and laparoscopic was (46.54 ± 7.35),(58.73 ± 10.49),(44.10 ±5.12) years.In 2000-2005,the proportion of abdominal,transvaginal and laparoscopic proportion were 81.78％ (615/752),8.64％ (65/752) and 9.57％ (72/752).In 2006-2010 were 64.50％ (792/1228),6.51％ (80/1228) and 28.99％ (356/1228).In 2006-2010,the proportion of abdominal significantly decreased and laparoscopic significantly rised compared with those in 2000-2005,there were statistically significant differences (P ＜ 0.01).In 2000-2005,unilateral and bilateral annex removal ratios were 15.43％ (116/752),12.23％ (92/752),in 2006-2010 were 8.63％ (106/1228),7.49％(92/1228).Unilateral and bilateral annex removal ratios in 2006-2010 were significantly lower than those in 2000-2005,there were statistically significant differences (P ＜ 0.01 or ＜ 0.05).Conclusions Over the past 10 years,hysterectomy route and range changed with the percentage of laparoscopic increasing,and concomitant unilateral or bilateral annex removal decreased.

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Investigation on the related factors of clinical incidence and the ultrasound diagnostic value of endometrial polyps

Jing CHEN ; Weiying WU ; Jun MENG ; Dan LIAN ; Liuyu JI

Chinese Journal of Postgraduates of Medicine.2013;36(27):18-20. doi:10.3760/cma.j.issn.1673-4904.2013.27.007

Objective To investigate the related factors of clinical incidence and the ultrasound diagnostic value of endometrial polyps (EMP).Methods A total of 278 patients with clinical abnormal vaginal bleeding,menorrhagia,infertility,cervical polyps or physical examination showing EMP received vaginal ultrasound and hysteroscopy.The related clinical factors were recorded and single factors and multivariate unconditional Logistic regression analysis were carried.Results The univariate analysis showed that the number of pregnancy,menopause,placing intrauterine device,oral comtraceptives,history of hormone therapy,chronic endometritis,cervical polyp,merger endometriosis and obesity were the statistically significant factors of EMP incidence (P ＜ 0.05 or ＜ 0.01),which were used as dependent variables for multivariate Logistic regression analysis,indicating that menopause,chronic endometritis,history of hormone therapy and cervical polyp significantly affecting EMP incidence (P ＜ 0.05),with OR values of 4.068,4.122,3.770 and 3.983 respectively.Conclusion Menopause,chronic endometritis,history of hormone therapy,cervical polyps are the related risk factors of EMP.

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The pathological state of metabolic syndrome and the expressions analysis of microRNA-205 in women with endometrial cancer

Chaorong LI ; Yongmei SHI ; Bimei WU ; Xue LI

Chinese Journal of Postgraduates of Medicine.2013;36(27):21-23. doi:10.3760/cma.j.issn.1673-4904.2013.27.008

Objective To detect the pathological state of metabolic syndrome and the expression of microRNA-205 in women with endometrial cancer.Methods Thirty-eight cases of patients with endometrial cancer were collected including waist circumference,weight,blood pressure.Collected preoperative fasting blood,postoperative endometrial lesions and endometrium tissue adjacent to carcinoma paraffin section.Analyzed the metabolic syndrome in patients with pathological state indicators,extracted the total RNA of endometrium tissue and the level of microRNA-205 was detected.Results The prevalence of metabolic syndrome was 44.74％ (17/38).The abnormal rate of high-density lipoprotein cholesterol,blood pressure,triglycerides,waist circumference,fasting blood sugar successively were 52.6％ (20/38),36.8％ (14/38),34.2％ (13/38),34.2％ (13/38) and 26.3％ (10/38).The expression level of microRNA-205 in endometrial carcinoma was higher than that in normal endometrium tissues,there was significant difference (P ＜ 0.01).Conclusions Metabolic syndrome is closely associated with the metabolic syndrome and its components.The expressions of microRNA-205 may participate in the occurrence and development of endometrial carcinoma,and it may be as an early screening of molecular markers.

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The effect of intranasal dexmedetomidine on preventing myoclonus induced by etomidate

Haoxing WANG ; Zhiping WANG ; Jun WANG ; Zhengfeng GU

Chinese Journal of Postgraduates of Medicine.2013;36(27):30-32. doi:10.3760/cma.j.issn.1673-4904.2013.27.011

Objective To observe the effect of intranasal dexmedetomidine on preventing myoclonus induced by etomidate.Methods One hundred patients who ASA classification Ⅰ-Ⅱ grades were divided into two groups by random digits table method with 50 cases each.Before anesthesia induction with dexmedetomidine 1 μ g/kg (dexmedetomidine group) or equivalent 0.9％ sodium chloride (control group) intranasal,30 min after two groups were injected etomidate 0.3 mg/kg.Mean artery pressure(MAP),heart rate (HR),oxygen saturation with pulse oximetry (SpO2) and respiratary rate were recorded before intranasal instillation of dexmedetomidine (T0),at l5 min (T1) and 30 min (T2) after intranasal dexmedetomidine,myoclonus was observed and graded.Results The MAP,HR at T2 was lower than that at T0 in dexmedetomidine group [(75.9 ± 8.1) mm Hg (1 mm Hg =0.133 kPa) vs.(81.4 ± 10.4) mm Hg,(80.9 ± 7.6) times/min vs.(85.9 ± 9.1) times/min],there was significant difference (P ＜ 0.05),but all within the normal range; other within the group at each time point had no statistical significance between two groups (P ＞ 0.05).The incidence of myoclonus was significantly reduced in dexmedetomidine group compared with that in control group [42％(21/50) vs.70％(35/50)],there was significant difference (P ＜ 0.01).Conclusion Intranasal instillation of dexmedetomidine can safely prevent myoclonus induced by etomidate.

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Clinical observation of low-dose dexmedetomidine combined with butorphanol tartrate for patient controlled intravenous analgesia after radical mastectomy

Daipeng ZHOU

Chinese Journal of Postgraduates of Medicine.2013;36(27):33-35. doi:10.3760/cma.j.issn.1673-4904.2013.27.012

Objective To observe the clinical effect of low-dose dexmedetomidine combined with butorphanol tartrate for patient controlled intravenous analgesia (PCIA) after radical mastectomy.Methods Seventy patients who ASA classification Ⅰ-Ⅱ grades with elective radical mastectomy were divided into the butorphanol tartrate PCIA group (group B),and the dexmedetomidine combined with butorphanol tartrate PCIA group (group DB) with 35 cases each by to random digits table method.To compare two groups of 24 h and 48 h after surgery in patients with pain score by visual analog scale (VAS) scores (0-10 scores).The Ramsay scores and the butorphanol consumption,intramuscular pethidine times were recorded in two groups.And the adverse events such as nausea and vomiting,dizziness and respiratory depression were observed.Results All patients got good analgesia in two groups,VAS scores ＜ 4 scores.VAS scores at 24,48 h after operation in group DB were lower than those in group B [(3.2 ± 0.3) scores vs.(3.8 ± 0.4) scores,(2.7 ± 0.3) scores vs.(3.2 ±0.2) scores],there were significant differences (P ＜0.05),while there was no significant difference of Ramsay scores between two groups(P＞ 0.05).And the butorphanol consumption and the intramuscular pethidine times in group DB were less than those in group B [(6.2±1.3)mgvs.(7.8± 1.6) mg,(2.3 ±1.8) times vs.(5.3 ±2.1) times],there were significant differences (P ＜0.05).Conclusion Low-dose dexmedetomidine may improve the effect of butorphanol tartrate PCIA after radical mastectomy,and help to reduce the butorphanol tartrate consumption and adverse effects.

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The expressive level and clinical significance of tumor necrosis factor ligands related molecule 1A in peripheral blood of patients with viral myocarditis

Yuqiang JI ; Mei XIE ; Peiyong LIU ; Zhao ZHAO

Chinese Journal of Postgraduates of Medicine.2013;36(28):8-9. doi:10.3760/cma.j.issn.1673-4904.2013.28.003

Objective To explore the expressive level and clinical significance of tumor necrosis factor ligands related molecule 1A (TL1A) in peripheral blood of patients with viral myocarditis.Methods In 70 patients with viral myocarditis (viral myocarditis group) and 70 normal controls (control group),the plasma level of TL1A was detected by enzyme linked immunosorbent assay and the mRNA level of TL1A was detected by real-time quantitative reverse transcription polymerase chain reaction.Results The plasma level of TL1A in viral myocarditis group was significantly higher than that in control group [(1.37 ± 0.41) μg/L vs.(0.85 ± 0.22) μg/L](P=0.000).The level of peripheral blood TL1A mRNA in viral myocarditis group was significantly higher than that in control group (0.39 ±0.17 vs.0.31 ±0.11,P =0.001).Conclusion The level of TL1A in patients with viral myocarditis is increased,and TL1A may participate in the occurrence of viral myocarditis.

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