Objective To compare and analyze the application effects of ciprofol+remifentanil and remazolam+remifentanil in painless gastrointestinal gastroscopy in elderly overweight patients.Methods The subjects of this study,122 elderly overweight patients for painless gastrointestinal endoscopy from October 2023 to October 2024,were randomly divided into H group and R group,each with 61 cases.At the same time,122 elderly patients with normal body weight who planned to undergo painless gastrointestinal endoscopy during the same period were randomly divided into H1 group and R1 group,61 cases in each group.All subjects received a slow intravenous injection of remifentanil at a dose of 0.5 μg/kg,30 s later Group H and H1 group were administered with a slow intravenous injection of ciprofol at a dose of 0.4 mg/kg,while Group R and R1 group were given a slow intravenous injection of remazolam at a dose of 0.2 mg/kg.Anesthesia effect and perioperative indicators(examination time,induction time,etc.),and the hemodynamic parameters[mean arterial pressure(MAP),heart rate(HR)and percutaneous arterial oxygen saturation(SpO2)]were compared of the four groups immediately after the establishment of electrocardiogram monitoring(T0),upon completion of anesthesia induction(T1),when gastroscopy passed through the throat(T2),when enteroscopy passed through the hepatic flexure(T3),and immediately after completion of surgery(T4),as well as adverse reactions were compared of the four groups.Results Excellent anesthesia rate:group H and H1 group were higher than group R(96.72%,98.36%vs.86.89%,P<0.05).Induction time:no difference was found of the four groups(P>0.05).Examination time:group H and group R were significantly longer than that in group H1 and group R1(P<0.05),but there was no significant difference between group H and group R,and between group H1 and group R1(P>0.05).The time of awakening and moving out of postanesthesia care unit(PACU):group H,group R,group H1 and group R1 gradually decreased,and the differences between each two groups were statistically significant(P<0.05).There were statistically significant differences in MAP and HR of the four groups,time and interaction effects(P<0.05).The difference of SpO2 of the four groups was statistically significant(P<0.05),and the difference of time and interaction effect was not statistically significant(P>0.05).Incidence of injection pain:group H and group H1 were lower than group R and group R1(P<0.05).Incidence of other adverse reactions:no significant difference of four groups(P>0.05).Conclusion During painless gastrointestinal endoscopy of elderly overweight patients the application of ciprofol+remifentanil can achieve better anesthetic effect and lower incidence of injection pain as compared with remazolam+remifentanil.The anesthetic effect of the two anesthesia regimens is similar in elderly normal weight patients,but the elderly normal weight patients have a faster recovery from anesthesia than the elderly overweight patients.

Objective To observe the efficacy and safety of 3 D video-assisted thoracoscopic segmentectomy in patients with stage Ⅰ lung cancer treated with indocyanine green(ICG)fluorescence reverse-staining.Methods A total of 132 patients with stage Ⅰ lung cancer who were admitted from May 2022 to September 2024 all underwent three-dimensional video-assisted thoracoscopic segmental resection of the lung.They were divided into the observation group(63 cases)and the control group(69 cases)according to the method of intersegmental plane exposure.The control group was treated with the modified expansion and collapse method,while the observation group was treated with the ICG fluorescence backstaining method.The surgical conditions,pulmonary function,postoperative pain degree,quality of life and complications of the two groups were compared.Results The postoperative chest tube retention time,surgical time,postoperative hospitalization time,total postoperative thoracic drainage volume,and inter-segmental plane exposure time in the observation group were as follows(2.13±0.37)d,(145.12±25.26)min,(5.21±0.95)d,(261.41±28.57)ml and(9.15±1.73)s,respectively.The data of the control groups were(3.29±0.48)d,(178.31±30.45)min,(6.34±1.36)d,(352.03±36.74)ml and(1 651.28±179.84)s,respectively.There was a statistically significant difference between the two groups(P＜0.05).There was no statistically significant difference in the number of intraoperative blood loss and intraoperative lymph node dissections between the two groups(P＞0.05).There was no statistically significant difference in the levels of maximal expiratory flow(PEF),forced expiratory volume in one second(FEV1),and FEV1/forced vital capacity(FVC)between the two groups before the operation and one month after the operation(P＞0.05).The Visual Analogue Scale(VAS)scores of the observation group at 12 hours,48 hours and 72 hours after the operation were(3.25±0.46)points,(2.13±0.35)points and(1.02±0.24)points respectively.The control groups were(4.11±0.59)points,(2.98±0.42)points,and(1.73±0.30)points,respectively.There was a statistically significant difference between the two groups(P＜0.05).There was no statistically significant difference in the scores of negative and positive items between the two groups before the operation and one month after the operation(P＞0.05).There was no statistically significant difference in the total incidence of complications between the two groups(P＞0.05).Conclusion The modified dilatation collapse method and ICG fluorescence reverse staining method have no significant effects on lung function and complications in patients with stage Ⅰ lung cancer,and both can improve the quality of life.Compared with the modified dilatation collapse method,ICG fluorescence reverse staining method can shorten the plane exposure time between segments and the operation time,promote postoperative rehabilitation and alleviate postoperative pain.

Objective To compare and analyze the application effects of ciprofol+remifentanil and remazolam+remifentanil in painless gastrointestinal gastroscopy in elderly overweight patients.Methods The subjects of this study,122 elderly overweight patients for painless gastrointestinal endoscopy from October 2023 to October 2024,were randomly divided into H group and R group,each with 61 cases.At the same time,122 elderly patients with normal body weight who planned to undergo painless gastrointestinal endoscopy during the same period were randomly divided into H1 group and R1 group,61 cases in each group.All subjects received a slow intravenous injection of remifentanil at a dose of 0.5 μg/kg,30 s later Group H and H1 group were administered with a slow intravenous injection of ciprofol at a dose of 0.4 mg/kg,while Group R and R1 group were given a slow intravenous injection of remazolam at a dose of 0.2 mg/kg.Anesthesia effect and perioperative indicators(examination time,induction time,etc.),and the hemodynamic parameters[mean arterial pressure(MAP),heart rate(HR)and percutaneous arterial oxygen saturation(SpO2)]were compared of the four groups immediately after the establishment of electrocardiogram monitoring(T0),upon completion of anesthesia induction(T1),when gastroscopy passed through the throat(T2),when enteroscopy passed through the hepatic flexure(T3),and immediately after completion of surgery(T4),as well as adverse reactions were compared of the four groups.Results Excellent anesthesia rate:group H and H1 group were higher than group R(96.72%,98.36%vs.86.89%,P<0.05).Induction time:no difference was found of the four groups(P>0.05).Examination time:group H and group R were significantly longer than that in group H1 and group R1(P<0.05),but there was no significant difference between group H and group R,and between group H1 and group R1(P>0.05).The time of awakening and moving out of postanesthesia care unit(PACU):group H,group R,group H1 and group R1 gradually decreased,and the differences between each two groups were statistically significant(P<0.05).There were statistically significant differences in MAP and HR of the four groups,time and interaction effects(P<0.05).The difference of SpO2 of the four groups was statistically significant(P<0.05),and the difference of time and interaction effect was not statistically significant(P>0.05).Incidence of injection pain:group H and group H1 were lower than group R and group R1(P<0.05).Incidence of other adverse reactions:no significant difference of four groups(P>0.05).Conclusion During painless gastrointestinal endoscopy of elderly overweight patients the application of ciprofol+remifentanil can achieve better anesthetic effect and lower incidence of injection pain as compared with remazolam+remifentanil.The anesthetic effect of the two anesthesia regimens is similar in elderly normal weight patients,but the elderly normal weight patients have a faster recovery from anesthesia than the elderly overweight patients.

Objective To observe the efficacy and safety of 3 D video-assisted thoracoscopic segmentectomy in patients with stage Ⅰ lung cancer treated with indocyanine green(ICG)fluorescence reverse-staining.Methods A total of 132 patients with stage Ⅰ lung cancer who were admitted from May 2022 to September 2024 all underwent three-dimensional video-assisted thoracoscopic segmental resection of the lung.They were divided into the observation group(63 cases)and the control group(69 cases)according to the method of intersegmental plane exposure.The control group was treated with the modified expansion and collapse method,while the observation group was treated with the ICG fluorescence backstaining method.The surgical conditions,pulmonary function,postoperative pain degree,quality of life and complications of the two groups were compared.Results The postoperative chest tube retention time,surgical time,postoperative hospitalization time,total postoperative thoracic drainage volume,and inter-segmental plane exposure time in the observation group were as follows(2.13±0.37)d,(145.12±25.26)min,(5.21±0.95)d,(261.41±28.57)ml and(9.15±1.73)s,respectively.The data of the control groups were(3.29±0.48)d,(178.31±30.45)min,(6.34±1.36)d,(352.03±36.74)ml and(1 651.28±179.84)s,respectively.There was a statistically significant difference between the two groups(P＜0.05).There was no statistically significant difference in the number of intraoperative blood loss and intraoperative lymph node dissections between the two groups(P＞0.05).There was no statistically significant difference in the levels of maximal expiratory flow(PEF),forced expiratory volume in one second(FEV1),and FEV1/forced vital capacity(FVC)between the two groups before the operation and one month after the operation(P＞0.05).The Visual Analogue Scale(VAS)scores of the observation group at 12 hours,48 hours and 72 hours after the operation were(3.25±0.46)points,(2.13±0.35)points and(1.02±0.24)points respectively.The control groups were(4.11±0.59)points,(2.98±0.42)points,and(1.73±0.30)points,respectively.There was a statistically significant difference between the two groups(P＜0.05).There was no statistically significant difference in the scores of negative and positive items between the two groups before the operation and one month after the operation(P＞0.05).There was no statistically significant difference in the total incidence of complications between the two groups(P＞0.05).Conclusion The modified dilatation collapse method and ICG fluorescence reverse staining method have no significant effects on lung function and complications in patients with stage Ⅰ lung cancer,and both can improve the quality of life.Compared with the modified dilatation collapse method,ICG fluorescence reverse staining method can shorten the plane exposure time between segments and the operation time,promote postoperative rehabilitation and alleviate postoperative pain.

Objective:To evaluate the efficacy of visualized precise lung expansion for determining the intersegmental plane in thoracoscopic segmentectomy.Methods:Sixty-four American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients, regardless of gender, aged 33-77 yr, with body mass index of 16-34 kg/m 2, undergoing elective thoracoscopic segmentectomy under general anesthesia, were included. They were preoperatively reconstructed with 3D CT bronchovascularization to reconstruct the pulmonary vasculature, bronchus, and the virtual intersegmental planes of the lungs. The patients were divided into 2 groups ( n=32 each) using a random number table method: visualized precise lung expansion group (group V) and modified expansion and atrophy group (group E). Group V used visualized precision lung expansion to determine the intersegmental planes, and group E used the modified expansion and atrophy method to determine the intersegmental planes. The intraoperative intersegmental plane determination time, target segmental bronchus identification and treatment time, anesthesia time, operation time, postoperative air leakage, pulmonary atelectasis, fever, occurrence of lung infection, postoperative 24 h drainage volume, drain removal time and hospitalization time were recorded in the two groups. Results:Compared with group E, the intersegmental plane determination time, target segment bronchial identification and treatment time, anesthesia time and operation time were significantly shortened in group V( P<0.05).There were no significant differences between groups in the 24 h postoperative drainage volume, drain removal time, hospitalization time or incidence of postoperative pulmonary complications ( P>0.05). Conclusions:Compared with the modified expansion and atrophy method, visualized precise lung expansion can effectively shorten the intersegmental plane determination time in thoracoscopic segmentectomy.

Objective This study investigates the relationship of serum irfflammatory cytokine levels with intracranial pressure (ICP) in patients with severe traumatic brain injury (TBI) after surgery.Methods A total of 32 cases with severe TBI and placement of ICP monitor were prospectively enrolled.Serum was collected before surgery and every 12 h after surgery.Cytokines levels of interleukin (IL)-1β,IL-8,and tumor necrosis factor (TNF)-α were analyzed and compared with outcome of patients.Hourly values of ICP were recorded.The degree of ICP above treatment threshold (20 mm Hg) were calculated every 12 h as pressure times time dose(PTD-ICP20),which was compared with serum cytokine levels before (Pre) and after (Post) the 12-hour time period using linear regression method.Results Serum IL-1β (P＜0.05),IL-8 (P＜0.01) and TNF-a (P＜0.01) levels elevated dramatically after severe TBI and were significantly associated with outcome of patients.Mean PTD-ICP20 was (42.9 ± 60.2)mm Hg/h and was correlated with increased Pre-IL-8 (r=0.554,P＜0.001),Pre-TNF-α (r=0.597,P＜0.001),Post-IL-8 (r=0.629,P＜0.001) and Post-TNF-α (r=0.538,P＜0.001) levels.Conclusion Serum IL-8 and TNF-α demonstrated the most promising candidate bio.rnarkers of impending ICP elevation in this study.These findings indicate a feasible way of monitoring patients with severe TBI.