1.Study on the elements of medical service value from the perspective of cancer patients based on free-form comment text analysis
Xiao CHEN ; Yuhong ZHANG ; Chun YANG ; Pengfei HAN ; Jianyou CHEN ; Yuxia ZHANG
Chinese Journal of Hospital Administration 2025;41(2):139-145
Objective:To explore the focus points and emotional tendencies of cancer patients regarding medical services from their free-form comments, and to analyze the elements of perceived medical service value by patients.Methods:A tertiary general hospital in Shanghai invited patients to evaluate inpatient services through the assessment module of a patient satisfaction management platform, which included open-ended questions in the patient satisfaction survey. This study extracted free-form comment texts from cancer patients regarding medical services collected from September 2022 to August 2023 from this platform, forming a corpus of patient opinions. A hybrid method combining manual coding and natural language processing techniques was used to conduct sentiment analysis and topic modeling on the free-form comment texts. Descriptive analysis was performed on the comment themes and emotions, and logistic regression analysis was used to explore the relationship between patient negative comments and patient satisfaction and loyalty.Results:A total of 10 446 comment texts provided by cancer patients were included. The most frequently targeted objects in the comments were nurses (2 223 cases), followed by doctors (1 125 cases) and nursing assistants (162 cases). The results of sentiment analysis showed that 7 058 patients made positive comments, 1 958 patients made negative comments, 1 114 patients made neutral comments, and 316 patients made mixed comments. The results of topic analysis showed that the five most frequently mentioned themes by cancer patients were humanistic care (1 327 times), information provision, communication, and education (589 times), diet (582 times), effectiveness of diagnosis and treatment (506 times), and medical staff responsibility (489 times). Logistic regression analysis showed that negative evaluations of humanistic care ( OR=0.306, P<0.001), professional technical level ( OR=0.425, P=0.010), information provision, communication, and education ( OR=0.475, P<0.001), and response to needs ( OR=0.412, P=0.026) were significantly associated with decreased patient satisfaction. Negative evaluations of humanistic care ( OR=0.407, P<0.001), professional technical level ( OR=0.466, P=0.009), and information provision, communication, and education ( OR=0.557, P<0.001) were significantly associated with decreased patient loyalty. Conclusions:Hospital managers should value the role of patient free-form comment texts in improving medical services and make full use of natural language processing techniques for information mining. In addition, the results of this study show that patient comments mainly involve the interpersonal and functional aspects of service, especially the interpersonal interactions, which are often the " critical moments" for patients to critically evaluate hospital services during their service experience.
2.A clinical study on the preventive and therapeutic effects of oxycodo-ne administered at different timings on rebound pain following the wearing off of intercostal nerve block in thoracic surgery
Luxiang JIANG ; Jianyou ZHANG ; Zhuan ZHANG ; Miao GUO ; Suhong TANG
Chinese Journal of Clinical Pharmacology and Therapeutics 2025;30(10):1312-1318
AIM:To evaluate the effect of intrave-nous oxycodone administration at different timing on rebound pain following the resolution of inter-costal nerve blockade after thoracoscopic surgery.METHODS:A total of 114 patients undergoing elec-tive thoracoscopic surgery under general anesthe-sia between January and July 2024 were selected.The patients were aged 18 to 64 years,regardless of gender,with a BMI of 18 to 30 kg/m2,and classi-fied as ASA Ⅰ-Ⅱ.The patients were randomly divided into three groups using a random number table:control group(Group C),oxycodone administration at the end of surgery group(Group Q1),and oxyco-done administration 6 hours postoperatively group(Group Q2),with 38 patients in each group.Group C received a normal saline injection at the end of surgery,Group Q1 received an intravenous injec-tion of oxycodone 0.04 mg/kg at the end of sur-gery,and Group Q2 received an intravenous injec-tion of oxycodone 0.04 mg/kg at 6 hours postoper-atively.Patients in the three groups were treated with a postoperative intravenous self-control anal-gesic pump(PCIA).The occurrence of rebound pain was recorded,the time of the first analgesic pump press,the number of presses,the dosage of sufent-anil,and the need for rescue analgesia were also recorded.Numerical Rating Scale(NRS)scores at rest and during movement were recorded at 6,8,12,24,48 and 72 hours postoperatively.The Pitts-burgh Sleep Quality Index(PSQI)was used to as-sess the sleep quality of patients the night before surgery and for two nights postoperatively.Adverse reactions such as respiratory depression,postoper-ative nausea and vomiting(PONV),and pruritus were recorded.RESULTS:Compared with group C and Q1,the incidence of rebound pain,postopera-tive sufentanil consumption,effective compression frequency of PCIA from 0-24 hours after surgery,and the rate of rescue analgesia were lower in Groups Q2(P<0.05);Compared to Group C,the NRS scores at rest and during movement at 8,12,and 24 hours postoperatively were significantly lower in Groups Q1 and Q2(P<0.05).However,compared to Group Q1,Group Q2 exhibited lower NRS scores at rest and during movement at 8,12,and 24 hours postoperatively(P<0.05).On the first postoperative night,the PSQI scores of patients in Group Q2 were significantly better than those in Groups C and Q1(P<0.05).There was no statistical-ly significant difference in the incidence of PONV among the three groups(P>0.05).No respiratory depression,drowsiness,or pruritus were observed postoperatively in any of the groups.CONCLUSION:Intravenous injection of 0.04 mg/kg oxycodone 6 hours after surgery can reduce the occurrence of rebound pain after intercostal nerve block resolu-tion in thoracoscopic surgery and improves pa-tients' sleep quality.
3.Changes in S100A8/9 and NLRP3/Caspase-1/interleukin-1β pathway in kidney-aging rats induced by D-galactose
Dandan FENG ; Ying ZHOU ; Ziyao PANG ; Yueqin CAI ; Chu CHEN ; Jianyou ZHANG ; Dejun WANG
Acta Laboratorium Animalis Scientia Sinica 2025;33(6):823-835
Objective To investigate changes in the pro-inflammatory mediator S100A8/9 and NLRP3/Caspase-1/IL-1β pathway in a rat kidney-aging model induced by D-galactose.Methods Twelve SD rats were divided into control and D-galactose groups,and injected subcutaneously in the back of the neck with D-galactose(150 mg/kg)to establish a rat model of kidney aging.Kidney samples were collected under anesthesia after 8 weeks.Kidneys were stained for senescence-associated beta-galactosidase(SA-β-Gal),mRNA expression levels of the aging-related genes p21,p16,and p53 were detected by quantitative reverse transcription-polymerase chain reaction(qRT-PCR),and histopathological changes were observed by hematoxylin-eosin(HE)and Masson staining.Serum urea nitrogen and creatinine,and catalase(CAT),glutathione peroxidase(GSH-PX),superoxide dismutase(SOD),and malondialdehyde(MDA)levels in the kidney tissues were detected.Reactive oxygen species(ROS)were detected by dihydroethdium staining and protein expression levels of collagen Ⅲ,α-smooth muscle actin(α-SMA),Protein expression of S100A8/9 was detected by immunofluorescence,and transforming growth factor(TGF)-β1 levels in kidney tissues and key factors in the NLRP3/Caspase-1/IL-1β inflammatory pathway were detected by Western Blot.A renal senescence model using HK-2 cells was constructed using H2O2 in vitro,and expression levels of the senescence proteins p21 and p16 and mRNA expression levels of the inflammatory factors IL-18 and tumor necrosis factor-α(TNF-α)were detected.Cell senescence was observed by SA-β-Gal staining.The effects of the S100A8/9 inhibitor paquinimod on expression levels of S100A8/9 and NLRP3/Caspase-1/IL-1β pathway-related proteins in the aging model were also detected.Results mRNA levels of the aging genes p21,p16,and p53 in kidney tissues were significantly increased in rats in the D-galactose group compared with the control group(P<0.01),and SA-β-Gal staining showed a significant increase in senescent cells(P<0.01).Serum blood urea nitrogen and creatinine levels increased(P<0.05),CAT,GSH-PX,and SOD activities decreased(P<0.01),while MDA activity increased in the D-galactose group(P<0.01).Collagen Ⅲ,α-SMA,and TGFβ1 expression and the ROS content in tissues increased(P<0.05).Glomeruli were atrophied or absent in the D-galactose group,the lumens of the renal sacs and renal tubules were enlarged,the nuclei were deeply stained and constricted,and numerous collagen fibers were deposited.Levels of S100A8 and S100A9 protein(P<0.01),as well as NLRP3,Caspase-1,and IL-1β increased(P<0.05).Paquinimod alleviated HK-2 cell senescence and decreased expression levels of the senescence proteins p21 and p16,and mRNA levels of the inflammatory factors IL-18 and TNF-α(P<0.05,P<0.01).The number of senile cells was also decreased,shown by SA-β-Gal staining(P<0.01).Paquinimod also inhibited the protein expression of S100A8 and S100A9(P<0.01)and NLRP3,Caspase-1,and IL-1β(P<0.05 or P<0.01).Conclusions S100A8/9 participates in the chronic inflammatory response by activating the NLRP3/Caspase-1/IL-1β pathway,thereby promoting D-galactose-induced renal aging.
4.A clinical study on the preventive and therapeutic effects of oxycodo-ne administered at different timings on rebound pain following the wearing off of intercostal nerve block in thoracic surgery
Luxiang JIANG ; Jianyou ZHANG ; Zhuan ZHANG ; Miao GUO ; Suhong TANG
Chinese Journal of Clinical Pharmacology and Therapeutics 2025;30(10):1312-1318
AIM:To evaluate the effect of intrave-nous oxycodone administration at different timing on rebound pain following the resolution of inter-costal nerve blockade after thoracoscopic surgery.METHODS:A total of 114 patients undergoing elec-tive thoracoscopic surgery under general anesthe-sia between January and July 2024 were selected.The patients were aged 18 to 64 years,regardless of gender,with a BMI of 18 to 30 kg/m2,and classi-fied as ASA Ⅰ-Ⅱ.The patients were randomly divided into three groups using a random number table:control group(Group C),oxycodone administration at the end of surgery group(Group Q1),and oxyco-done administration 6 hours postoperatively group(Group Q2),with 38 patients in each group.Group C received a normal saline injection at the end of surgery,Group Q1 received an intravenous injec-tion of oxycodone 0.04 mg/kg at the end of sur-gery,and Group Q2 received an intravenous injec-tion of oxycodone 0.04 mg/kg at 6 hours postoper-atively.Patients in the three groups were treated with a postoperative intravenous self-control anal-gesic pump(PCIA).The occurrence of rebound pain was recorded,the time of the first analgesic pump press,the number of presses,the dosage of sufent-anil,and the need for rescue analgesia were also recorded.Numerical Rating Scale(NRS)scores at rest and during movement were recorded at 6,8,12,24,48 and 72 hours postoperatively.The Pitts-burgh Sleep Quality Index(PSQI)was used to as-sess the sleep quality of patients the night before surgery and for two nights postoperatively.Adverse reactions such as respiratory depression,postoper-ative nausea and vomiting(PONV),and pruritus were recorded.RESULTS:Compared with group C and Q1,the incidence of rebound pain,postopera-tive sufentanil consumption,effective compression frequency of PCIA from 0-24 hours after surgery,and the rate of rescue analgesia were lower in Groups Q2(P<0.05);Compared to Group C,the NRS scores at rest and during movement at 8,12,and 24 hours postoperatively were significantly lower in Groups Q1 and Q2(P<0.05).However,compared to Group Q1,Group Q2 exhibited lower NRS scores at rest and during movement at 8,12,and 24 hours postoperatively(P<0.05).On the first postoperative night,the PSQI scores of patients in Group Q2 were significantly better than those in Groups C and Q1(P<0.05).There was no statistical-ly significant difference in the incidence of PONV among the three groups(P>0.05).No respiratory depression,drowsiness,or pruritus were observed postoperatively in any of the groups.CONCLUSION:Intravenous injection of 0.04 mg/kg oxycodone 6 hours after surgery can reduce the occurrence of rebound pain after intercostal nerve block resolu-tion in thoracoscopic surgery and improves pa-tients' sleep quality.
5.Changes in S100A8/9 and NLRP3/Caspase-1/interleukin-1β pathway in kidney-aging rats induced by D-galactose
Dandan FENG ; Ying ZHOU ; Ziyao PANG ; Yueqin CAI ; Chu CHEN ; Jianyou ZHANG ; Dejun WANG
Acta Laboratorium Animalis Scientia Sinica 2025;33(6):823-835
Objective To investigate changes in the pro-inflammatory mediator S100A8/9 and NLRP3/Caspase-1/IL-1β pathway in a rat kidney-aging model induced by D-galactose.Methods Twelve SD rats were divided into control and D-galactose groups,and injected subcutaneously in the back of the neck with D-galactose(150 mg/kg)to establish a rat model of kidney aging.Kidney samples were collected under anesthesia after 8 weeks.Kidneys were stained for senescence-associated beta-galactosidase(SA-β-Gal),mRNA expression levels of the aging-related genes p21,p16,and p53 were detected by quantitative reverse transcription-polymerase chain reaction(qRT-PCR),and histopathological changes were observed by hematoxylin-eosin(HE)and Masson staining.Serum urea nitrogen and creatinine,and catalase(CAT),glutathione peroxidase(GSH-PX),superoxide dismutase(SOD),and malondialdehyde(MDA)levels in the kidney tissues were detected.Reactive oxygen species(ROS)were detected by dihydroethdium staining and protein expression levels of collagen Ⅲ,α-smooth muscle actin(α-SMA),Protein expression of S100A8/9 was detected by immunofluorescence,and transforming growth factor(TGF)-β1 levels in kidney tissues and key factors in the NLRP3/Caspase-1/IL-1β inflammatory pathway were detected by Western Blot.A renal senescence model using HK-2 cells was constructed using H2O2 in vitro,and expression levels of the senescence proteins p21 and p16 and mRNA expression levels of the inflammatory factors IL-18 and tumor necrosis factor-α(TNF-α)were detected.Cell senescence was observed by SA-β-Gal staining.The effects of the S100A8/9 inhibitor paquinimod on expression levels of S100A8/9 and NLRP3/Caspase-1/IL-1β pathway-related proteins in the aging model were also detected.Results mRNA levels of the aging genes p21,p16,and p53 in kidney tissues were significantly increased in rats in the D-galactose group compared with the control group(P<0.01),and SA-β-Gal staining showed a significant increase in senescent cells(P<0.01).Serum blood urea nitrogen and creatinine levels increased(P<0.05),CAT,GSH-PX,and SOD activities decreased(P<0.01),while MDA activity increased in the D-galactose group(P<0.01).Collagen Ⅲ,α-SMA,and TGFβ1 expression and the ROS content in tissues increased(P<0.05).Glomeruli were atrophied or absent in the D-galactose group,the lumens of the renal sacs and renal tubules were enlarged,the nuclei were deeply stained and constricted,and numerous collagen fibers were deposited.Levels of S100A8 and S100A9 protein(P<0.01),as well as NLRP3,Caspase-1,and IL-1β increased(P<0.05).Paquinimod alleviated HK-2 cell senescence and decreased expression levels of the senescence proteins p21 and p16,and mRNA levels of the inflammatory factors IL-18 and TNF-α(P<0.05,P<0.01).The number of senile cells was also decreased,shown by SA-β-Gal staining(P<0.01).Paquinimod also inhibited the protein expression of S100A8 and S100A9(P<0.01)and NLRP3,Caspase-1,and IL-1β(P<0.05 or P<0.01).Conclusions S100A8/9 participates in the chronic inflammatory response by activating the NLRP3/Caspase-1/IL-1β pathway,thereby promoting D-galactose-induced renal aging.
6.Study on the elements of medical service value from the perspective of cancer patients based on free-form comment text analysis
Xiao CHEN ; Yuhong ZHANG ; Chun YANG ; Pengfei HAN ; Jianyou CHEN ; Yuxia ZHANG
Chinese Journal of Hospital Administration 2025;41(2):139-145
Objective:To explore the focus points and emotional tendencies of cancer patients regarding medical services from their free-form comments, and to analyze the elements of perceived medical service value by patients.Methods:A tertiary general hospital in Shanghai invited patients to evaluate inpatient services through the assessment module of a patient satisfaction management platform, which included open-ended questions in the patient satisfaction survey. This study extracted free-form comment texts from cancer patients regarding medical services collected from September 2022 to August 2023 from this platform, forming a corpus of patient opinions. A hybrid method combining manual coding and natural language processing techniques was used to conduct sentiment analysis and topic modeling on the free-form comment texts. Descriptive analysis was performed on the comment themes and emotions, and logistic regression analysis was used to explore the relationship between patient negative comments and patient satisfaction and loyalty.Results:A total of 10 446 comment texts provided by cancer patients were included. The most frequently targeted objects in the comments were nurses (2 223 cases), followed by doctors (1 125 cases) and nursing assistants (162 cases). The results of sentiment analysis showed that 7 058 patients made positive comments, 1 958 patients made negative comments, 1 114 patients made neutral comments, and 316 patients made mixed comments. The results of topic analysis showed that the five most frequently mentioned themes by cancer patients were humanistic care (1 327 times), information provision, communication, and education (589 times), diet (582 times), effectiveness of diagnosis and treatment (506 times), and medical staff responsibility (489 times). Logistic regression analysis showed that negative evaluations of humanistic care ( OR=0.306, P<0.001), professional technical level ( OR=0.425, P=0.010), information provision, communication, and education ( OR=0.475, P<0.001), and response to needs ( OR=0.412, P=0.026) were significantly associated with decreased patient satisfaction. Negative evaluations of humanistic care ( OR=0.407, P<0.001), professional technical level ( OR=0.466, P=0.009), and information provision, communication, and education ( OR=0.557, P<0.001) were significantly associated with decreased patient loyalty. Conclusions:Hospital managers should value the role of patient free-form comment texts in improving medical services and make full use of natural language processing techniques for information mining. In addition, the results of this study show that patient comments mainly involve the interpersonal and functional aspects of service, especially the interpersonal interactions, which are often the " critical moments" for patients to critically evaluate hospital services during their service experience.
7.Efficacy of hematoporphyrin monomethyl ether-mediated photodynamic therapy in the treatment of facial port-wine stains in 15 children with Sturge-Weber syndrome
Sheng ZHANG ; Xiuwei WANG ; Jianyou CHEN ; Wei DENG ; Haihua ZHANG ; Gaolei ZHANG ; Xiaoyan LIU ; Wei SU
Chinese Journal of Dermatology 2024;57(7):616-622
Objective:To evaluate the clinical efficacy and safety of hematoporphyrin monomethyl ether (HMME) -mediated photodynamic therapy (PDT) in the treatment of facial port-wine stains (PWS) in children with Sturge-Weber syndrome (SWS) .Methods:A retrospective analysis was conducted based on the clinical data from SWS children treated with HMME-PDT at the Department of Dermatology, Children's Hospital, Capital Institute of Pediatrics from December 2020 to January 2022. HMME was intravenously injected at a dose of 5 mg/kg, followed by the irradiation of SWS lesions with a 532-nm light-emitting diode light source, and the treatment interval was 8 weeks. The efficacy of HMME-PDT for SWS was evaluated based on the subsidence of erythema and changes in the number and density of blood vessels under a dermoscope before and after treatment; adverse events after treatment were recorded. Fisher's exact test was used to analyze differences in efficacy.Results:A total of 15 children with SWS were included, comprising 7 males and 8 females, with an average age of 4.74 years (range, 1 - 14 years). There were 10 cases of clinical phenotype Ⅰ and 5 cases of type Ⅱ; 10 patients were accompanied by glaucoma, 6 by epilepsy, and 10 showed abnormalities on craniocerebral imaging. After HMME-PDT treatment, 4 out of 15 patients achieved complete remission of SWS lesions, 3 showed marked improvement, and 5 achieved improvement. Among 8 cases receiving 2 sessions of treatment, 1 achieved marked improvement and 4 showed improvement; among 7 cases receiving 3 or more sessions of treatment, 4 achieved complete remission, 2 achieved marked improvement, and 1 showed improvement; the proportions of patients achieving complete remission and marked improvement were significantly higher among those receiving 3 or more sessions of treatment than those receiving 2 sessions (both P < 0.05). Among 7 patients with pink-type PWS, 1 recovered completely, 2 achieved marked improvement, and 4 showed improvement; among 4 patients with purplish-red-type PWS, 3 recovered completely and 1 showed marked improvement; among 4 patients with thickened-type PWS, 1 achieved improvement; there was a significant difference in the proportions of patients achieving marked improvement or improvement among the patients with different types of PWS (both P < 0.05). Among 14 patients with lesions involving the central face region, 4 achieved marked improvement and 2 showed improvement; among 15 with lesions involving the lateral face region, 5 recovered completely, 3 achieved marked improvement, and 4 showed improvement; the recovery rate of lesions was higher in the lateral face region than in the central face region ( P < 0.05). Under a dermoscope, the skin lesions showed 4 vascular patterns: short rod-shaped vessels in 3 cases, linear vessels in 4, reticular vessels in 5, and mixed-type vessels in 3. The 3 patients with short rod-shaped vessels all recovered completely; among the 4 patients with linear vessels, 2 achieved marked improvement, and 2 showed improvement; among the 5 patients with reticular vessels, 1 recovered completely, 1 achieved marked improvement, and 3 showed improvement; the 3 patients with mixed-type vessels all showed poor response to the treatment; the proportions of patients who recovered completely and those who achieved improvement significantly differed among the patients with 4 different vascular patterns (both P < 0.05). All the children experienced varying degrees of pain, swelling, purpura, and crusting after treatment, but none exhibited exacerbation of ocular or neurological complications. Conclusion:HMME-PDT was safe and effective in the treatment of PWS in children with SWS, and its efficacy was related to the number of treatment sessions, lesion types and locations.
8.Effect of intraoperative continuous infusion insulin on myocardial perfusion in patients after cardiac surgery under cardiopulmonary bypass
Zhuan ZHANG ; Jiajia YIN ; Ning LI ; Chao CHEN ; Kai ZHANG ; Rongrong MA ; Shiyu GUAN ; Jianyou ZHANG ; Qiang WANG ; Hu LI
The Journal of Clinical Anesthesiology 2024;40(5):497-502
Objective To investigate the effect of continuous intraoperative insulin infusion on my-ocardial blood perfusion after cardiac surgery under cardiopulmonary bypass(CPB).Methods Forty-eight patients,21 males and 27 females,aged 55-80 years,BMI 18-28 kg/m2,ASA physical status Ⅱ-Ⅳ,who underwent elective cardiac surgery with CPB were selected and randomly divided into two groups:the insulin group(group I,n = 25)and the control group(group C,n = 23).The same anesthesia protocol was implemented in both groups.After induction of anesthesia,group Ⅰ received intravenously infusion of in-sulin 30 mU·kg-1·h-1,glucose 0.12 g·kg-1·h-1,and potassium chloride 0.06 mmol·kg-1·h-1,and group C received saline 10 ml/h,all of which were infused until the end of surgery.The targeted blood glucose range for both groups was set at 6.1-11.1 mmol/L.Transesophageal echocardiography(TEE)was performed 10 minutes after induction of general anesthesia(T2)and before the end of surgery(T6)to ex-amine the coronary sinus(CS)flow spectrum and diameter,pulmonary venous flow spectrum,and calculate CS net antegrade flow velocity time integral(VTI).Femoral mean arterial pressure(MAP),central venous pressure(CVP),stroke volume(SV),cardiac index(CI)and peripheral vascular resistance index(SVRI)were recorded at T2,2 minutes before CPB(T3),the end of CPB(T5),and T6.The concentra-tions of blood glucose and lactate 5 minutes before anesthesia induction(T1),T3,30 minutes after CPB(T4),T5,T6,6 hours after surgery(T7),12 hours after surgery(T8),and 24 hours after surgery(T9)were recorded.The levels of high-sensitivity C-reactive protein(hs-CRP),high-sensitivity troponin I(hs-TnI),and creatine kinase isoenzyme(CK-MB)were recorded 1 day preoperatively,1 and 2 days post-operatively.Results Compared with group C,in group I,CS net antegrade flow VTI and blood flow per minute were significantly increased(P<0.05),and pulmonary venous peak atrial reversal wave velocity(ARp)was significantly reduced at T6(P<0.05),SV and CI were significantly increased and SVRI was significantly decreased at T5 and T6(P<0.05),lactate concentration was significantly decreased at T7 and T8(P<0.05),hs-CRP and CKMB were significantly decreased 1 and 2 days postoperatively(P<0.05),hs-TnI was significantly reduced 2 days postoperatively(P<0.05).Conclusion Continuous insulin admin-istration during cardiac surgery with CPB while maintaining blood glucose at 6.1-11.1 mmol/L can enhance myocardial blood perfusion,mitigate postoperative inflammatory response,and reduce myocardial injury.
9.Effect of acupoint pre-embedding thread on autonomic nervous system and gastrointestinal function in patients undergoing gynecological laparoscopic surgery under general anesthesia
Haiyan XIA ; Jianyou ZHANG ; Yingfei OU ; Naichao WANG ; Feifei LI ; Zhong ZHENG
The Journal of Clinical Anesthesiology 2024;40(7):699-703
Objective To explore the effects of multiple groups of acupoint pre-embedding thread on the autonomic nervous system and gastrointestinal function in patients undergoing gynecological laparo-scopic surgery under general anesthesia.Methods Sixty patients,aged 25-64 years,BMI 18.5-30.0 kg/m2,ASA physical status Ⅰ or Ⅱ,were selected for laparoscopic gynecological surgery under general anesthesia.Patients were divided into two groups using a random number table method:control group(group C)and acupoint thread embedding group(group M),30 patients in each group.Patients in group M received thread embedding at 10 acupoints in 5 groups,including Neiguan,Sanyinjiao,Geshu,Jueyin,and Weishu on the day before surgery.Patients in group C did not undergo thread embedding at acupoints before surgery.The HR,MAP,normalized unit of low frequency(LF),normalized unit of high frequency(HF)and LF/HF were recorded at 5 minutes before anesthesia induction,immediately after tracheal intu-bation,immediately after establishing pneumoperitoneum,10,20,and 30 minutes after pneumoperitoneum,and when tracheal intubation was removed.Motilin and gastrin concentrations in serum were measured on the day before surgery and 24 hours after surgery.The time of first postoperative exhaust and defecation,as well as the occurrence of nausea and vomiting within 48 hours after surgery were recorded.Results Compared with group C,the HR was significantly lower,and the MAP,the LF and LF/HF in group M were significant-ly reduced at 10,20,and 30 minutes after pneumoperitoneum,while HF was significantly increased(P<0.05).The first postoperative time of exhaust and defecation in group M was significantly shortened(P<0.05),and the incidence of nausea and vomiting within 24 hours after surgery was significantly reduced(P<0.05).The concentrations of motilin and gastrin in serum of group M were significantly increased 24 hours after surgery(P<0.05).Conclusion The combination of acupoints and pre-embedding thread can regu-late the autonomic nervous function of patients undergoing gynecological laparoscopic surgery under general anesthesia,which is beneficial for the recovery of postoperative gastrointestinal function and improves the quality of rehabilitation.
10.Effect of pressure-controlled volume-guaranteed ventilation on perioperative pulmonary function in patients undergoing thoracoscopic lobectomy
Jianyou ZHANG ; Ning GUO ; Dawei YANG ; Yixin WANG ; Suhong TANG ; Xianning DUAN
The Journal of Clinical Anesthesiology 2024;40(8):820-824
Objective To observe the effect of pressure-controlled ventilation volume-guaranteed(PCV-VG)mode on respiratory mechanics,lung injury markers and postoperative pulmonary complications(PPCs)in thoracoscopic patients.Methods Fifty-nine patients undergoing elective thoracoscopic lobecto-my,29 males and 30 females,aged 18-64 years,BMI 18.5-26.0 kg/m2,ASA physical status Ⅰ or Ⅱ,were divided into two groups using a random number table method:the PCV-VG mode group(group P,n=29)and the volume-controlled ventilation(VCV)mode group(group V,n=30).The PCV-VG mode was used for one-lung ventilation(OLV)in group P,and the VCV mode was used in group V.Anesthesia in-duction and maintenance medications were consistent in all patients.PaO2 was recorded before induction of anesthesia,5 minutes after intubation,15 minutes after OLV,30 minutes after OLV,and 3 days postopera-tively,and oxygenation index(OI)and intrapulmonary shunt rate(Qs/Qt)were calculated.Peak airway pressure(Ppeak),pulmonary dynamic compliance(Cdyn),and driving pressure(DP)were recorded 5 minutes after intubation,15 minutes after OLV,and 30 minutes after OLV.Clara cell secretory protein-16(CC-16)and interleukin-6(IL-6)concentration were measured before induction of anesthesia and after ex-tubation.Recording the occurrence of PPCs within 1 week after surgery.Results Compared with group V,Ppeak and DP were significantly reduced,Cdyn was increased significantly in group P 15 minutes and 30 minutes after OLV(P<0.05),PaO2 and OI were significantly increased in group P 3 days postoperatively(P<0.05),CC-16 and IL-6 concentrations were significantly reduced in group P after extubation(P<0.05).Compared with group V,the incidence of PPCs was significantly reduced in group P(P<0.05).Conclusion During one-lung ventilation for thoracoscopic surgery,the pressure-controlled ventilation vol-ume-guaranteed mode reduces peak airway pressure and driving pressure,improves pulmonary dynamic compliance and improves oxygenation,reduces the incidence of PPCs.

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