Objective:To explore the effects of remimazolam versus dexmedetomidine combined with spinal-epidural anesthesia in elderly patients undergoing hip replacement.Methods:A total of 100 elderly patients who needed total hip replacement in the Nanjing Lishui People′s Hospital from March 2021 to March 2023 were selected and divided into two groups by dynamic randomization, with 50 cases in each group. Both groups underwent surgery under combined spinal-epidural anesthesia. The control group was given dexmedetomidine for anesthesia, and the observation group was given remimazolam for anesthesia. The depth of sedation [eye-opening time, post anesthesia care unit (PACU) stay time, awakening time], cognitive function at different time periods [Mini-Mental State Examination (MMSE) score], inflammatory factor indexes [interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)], and hemodynamic indexes [heart rate (HR), mean arterial pressure (MAP)] were compared between the two groups.Results:The eye-opening time and PACU stay time in the observation group were shorter than those in the control group (all P<0.05), and there was no significant difference in awakening time between the two groups ( P>0.05). The MAP of both groups at post-skin incision (T 1) and completion of internal fixation (T 2) was higher than that after anesthesia induction (T 0), and decreased at the end of surgery (T 3); the HR of both groups at T 1 was lower than that at T 0, but increased at T 2, and then decreased at T 3. There were no significant differences in MAP and HR between the two groups at each time point (all P>0.05). The MMSE scores of the observation group at 1, 4, and 7 days after surgery were significantly higher than those of the control group (all P<0.05). The serum levels of IL-1β, IL-6, and TNF-α in both groups at post-anesthesia (t 1), end of surgery (t 2), and post-surgery (t 3) were significantly higher than those at 1 day before surgery (t 0), and the serum levels of IL-1β, IL-6, and TNF-α in the observation group at t 1, t 2, and t 3 were lower than those in the control group (all P<0.05). Conclusions:Both remimazolam and dexmedetomidine can effectively maintain hemodynamic stability in elderly patients undergoing hip replacement surgery, while remimazolam can more effectively shorten the time to reach the required depth of sedation, reduce the occurrence of cognitive dysfunction, and decrease the secretion of inflammatory factors.

Objective To evaluate the effect of different doses of esketamine combined with propofol medium and long chain fat emulsion in painless gastroenteroscopy.Methods 144 patients who were scheduled to receive painless gastroenteroscopy from January 2022 to December 2023 were randomly divided into four groups with 36 cases in each group.The load dose of esketamine in group A,group B and group C was 0.2,0.3 and 0.4 mg/kg respectively,and group D was treated with equivalent normal saline instead of esketamine as the control.All the patients were administrated with propofol medium and long chain fat emulsion during the examination.Heart rate(HR),mean arterial pressure(MAP)and percutaneous arterial oxygen saturation(SpO2)were recorded immediately after electrocardiograph monitoring was established(T0),immediately before examination(T1),immediately after gastroscopy placement(T2),immediately before colonoscopy(T3),immediately after colonoscopy implantation(T4)and immediately after examination(T5).The dosage of propofol medium and long chain fat emulsion,recovery time and discharge time were compared among the four groups.Patients were assessed with quality of recovery-40 questionnaire(QoR-40)at T0 and at wake time(T6).The adverse reactions of the four groups were compared.Results There were statistically significant differences in the temporal effects of HR,MAP and SpO2 among the 4 groups(F=3.91,21.65,6.17,P＜0.05);There were statistically significant differences in the intergroup effects of HR,MAP and SpO2 among the 4 groups(F=14.57,7.14,30.34,P＜0.05).The variation trend of SpO2 in groups A,B,C and D was statistically significant(F=2.88,P＜0.05).The first and total dosage of propofol medium and long chain fat emulsion,and the recovery time of the four groups were statistically significant(P＜0.05).The initial dosage and total dosage of propofol medium and long chain fat emulsion in group A,group B and group C were significantly lower than those in group D(P＜0.05),and group B and group C were significantly lower than group A(P＜0.05),but there was no significant difference between group B and group C(P＞0.05).The recovery time of group A and group B were significantly shorter than that of group C and group D(P＜0.05),and group C was significantly longer than that of group D(P＜0.05),and there was no significant difference between group A and group B(P＞0.05).There was no significant difference in the time of get discharged from the hospital among the four groups(P＞0.05).The total scores of QoR-40 in four group at T6 were significantly lower than those at T0 respectively(P＜0.05).T6 QoR-40 total score:group B was significantly higher than group A,Group C and group D(P＜0.05),group A and group C were significantly higher than group D(P＜0.05),and there was no significant difference between group A and group C(P＞0.05).There were significant differences in the incidence of hypoxemia,hypotension,bradycardia,tachycardia,body movement and dizziness among the four groups(P＜0.05).The incidence of hypoxemia,hypotension and bradycardia in group B and group C was significantly lower than that in group D(P＜0.083),and the incidence of dizziness in group C was significantly higher than that in group D(P＜0.0083).Among them,1 case in group A and 3 cases in group D needed mask pressure ventilation due to hypoxemia.There was no significant difference in the incidence of nausea and vomiting among the four groups(P＞0.05).Conclusion During painless gastroenteroscopy,the application of 0.3 mg/kg esketamine combined with propofol medium and long chain fat emulsion can help maintain the hemodynamic stability,alleviate the respiratory and circulatory inhibition caused by propofol medium and long chain fat emulsion,accelerate recovery,and reduce adverse reactions in patients.

Objective:To explore the effects of remimazolam versus dexmedetomidine combined with spinal-epidural anesthesia in elderly patients undergoing hip replacement.Methods:A total of 100 elderly patients who needed total hip replacement in the Nanjing Lishui People′s Hospital from March 2021 to March 2023 were selected and divided into two groups by dynamic randomization, with 50 cases in each group. Both groups underwent surgery under combined spinal-epidural anesthesia. The control group was given dexmedetomidine for anesthesia, and the observation group was given remimazolam for anesthesia. The depth of sedation [eye-opening time, post anesthesia care unit (PACU) stay time, awakening time], cognitive function at different time periods [Mini-Mental State Examination (MMSE) score], inflammatory factor indexes [interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)], and hemodynamic indexes [heart rate (HR), mean arterial pressure (MAP)] were compared between the two groups.Results:The eye-opening time and PACU stay time in the observation group were shorter than those in the control group (all P<0.05), and there was no significant difference in awakening time between the two groups ( P>0.05). The MAP of both groups at post-skin incision (T 1) and completion of internal fixation (T 2) was higher than that after anesthesia induction (T 0), and decreased at the end of surgery (T 3); the HR of both groups at T 1 was lower than that at T 0, but increased at T 2, and then decreased at T 3. There were no significant differences in MAP and HR between the two groups at each time point (all P>0.05). The MMSE scores of the observation group at 1, 4, and 7 days after surgery were significantly higher than those of the control group (all P<0.05). The serum levels of IL-1β, IL-6, and TNF-α in both groups at post-anesthesia (t 1), end of surgery (t 2), and post-surgery (t 3) were significantly higher than those at 1 day before surgery (t 0), and the serum levels of IL-1β, IL-6, and TNF-α in the observation group at t 1, t 2, and t 3 were lower than those in the control group (all P<0.05). Conclusions:Both remimazolam and dexmedetomidine can effectively maintain hemodynamic stability in elderly patients undergoing hip replacement surgery, while remimazolam can more effectively shorten the time to reach the required depth of sedation, reduce the occurrence of cognitive dysfunction, and decrease the secretion of inflammatory factors.

Objective To evaluate the effect of different doses of esketamine combined with propofol medium and long chain fat emulsion in painless gastroenteroscopy.Methods 144 patients who were scheduled to receive painless gastroenteroscopy from January 2022 to December 2023 were randomly divided into four groups with 36 cases in each group.The load dose of esketamine in group A,group B and group C was 0.2,0.3 and 0.4 mg/kg respectively,and group D was treated with equivalent normal saline instead of esketamine as the control.All the patients were administrated with propofol medium and long chain fat emulsion during the examination.Heart rate(HR),mean arterial pressure(MAP)and percutaneous arterial oxygen saturation(SpO2)were recorded immediately after electrocardiograph monitoring was established(T0),immediately before examination(T1),immediately after gastroscopy placement(T2),immediately before colonoscopy(T3),immediately after colonoscopy implantation(T4)and immediately after examination(T5).The dosage of propofol medium and long chain fat emulsion,recovery time and discharge time were compared among the four groups.Patients were assessed with quality of recovery-40 questionnaire(QoR-40)at T0 and at wake time(T6).The adverse reactions of the four groups were compared.Results There were statistically significant differences in the temporal effects of HR,MAP and SpO2 among the 4 groups(F=3.91,21.65,6.17,P＜0.05);There were statistically significant differences in the intergroup effects of HR,MAP and SpO2 among the 4 groups(F=14.57,7.14,30.34,P＜0.05).The variation trend of SpO2 in groups A,B,C and D was statistically significant(F=2.88,P＜0.05).The first and total dosage of propofol medium and long chain fat emulsion,and the recovery time of the four groups were statistically significant(P＜0.05).The initial dosage and total dosage of propofol medium and long chain fat emulsion in group A,group B and group C were significantly lower than those in group D(P＜0.05),and group B and group C were significantly lower than group A(P＜0.05),but there was no significant difference between group B and group C(P＞0.05).The recovery time of group A and group B were significantly shorter than that of group C and group D(P＜0.05),and group C was significantly longer than that of group D(P＜0.05),and there was no significant difference between group A and group B(P＞0.05).There was no significant difference in the time of get discharged from the hospital among the four groups(P＞0.05).The total scores of QoR-40 in four group at T6 were significantly lower than those at T0 respectively(P＜0.05).T6 QoR-40 total score:group B was significantly higher than group A,Group C and group D(P＜0.05),group A and group C were significantly higher than group D(P＜0.05),and there was no significant difference between group A and group C(P＞0.05).There were significant differences in the incidence of hypoxemia,hypotension,bradycardia,tachycardia,body movement and dizziness among the four groups(P＜0.05).The incidence of hypoxemia,hypotension and bradycardia in group B and group C was significantly lower than that in group D(P＜0.083),and the incidence of dizziness in group C was significantly higher than that in group D(P＜0.0083).Among them,1 case in group A and 3 cases in group D needed mask pressure ventilation due to hypoxemia.There was no significant difference in the incidence of nausea and vomiting among the four groups(P＞0.05).Conclusion During painless gastroenteroscopy,the application of 0.3 mg/kg esketamine combined with propofol medium and long chain fat emulsion can help maintain the hemodynamic stability,alleviate the respiratory and circulatory inhibition caused by propofol medium and long chain fat emulsion,accelerate recovery,and reduce adverse reactions in patients.

Objective To investigate the expression and clinical significance of serum long non-coding RNA small nucleolar RNA host gene 16(lncRNA SNHG16)and mothers against decapentaplegic homolog 4(SMAD4)in elderly patients with chronic obstructive pulmonary disease(COPD)and pulmonary infection(PI).Methods A total of 237 elderly COPD patients admitted to the hospital from January 2021 to January 2023 were enrolled in the study.Among them,117 patients with concomitant PI were classified as the concur-rent group,and 120 patients without concomitant PI were classified as the COPD group.Real-time fluores-cence quantitative polymerase chain reaction(qRT-PCR)was applied to detect the expression level of serum lncRNA SNHG16 in two groups.Enzyme linked immunosorbent assay(ELISA)was applied to detect the lev-el of SMAD4 in patients'serum.Simplified clinical pulmonary infection scale(sCPIS)was used to evaluate the degree of PI of patients in the concurrent group.Multivariate Logistic regression was applied to analyze the in-fluencing factors of PI in elderly COPD patients.Correlation between serum lncRNA SNHG16,SMAD4 levels and sCPIS in elderly COPD patients with PI was analyzed by using Spearman correlation analysis.Receiver op-erating characteristic(ROC)curve was applied to analyze the diagnostic value of serum lncRNA SNHG16 and SMAD4 levels in elderly COPD patients with PI.Results The serum relative expression level of lncRNA SNHG16 in the concurrent group was higher than that in the COPD group,but the serum SMAD4 level was lower than that in the COPD group(P<0.05).In addition,the proportions of patients with age≥70 years,smoking history,complicated with diabetes and COPD course≥5 years and the levels of tumor necrosis fac-tor-α(TNF-α),interferon-γ(INF-γ)in the concurrent group were higher than those in the COPD group,and FEV1/FVC and the level of interleukin-10(IL-10)in concurrent group were lower than those in COPD group(P<0.05).Multivariate Logistic analysis showed that age≥70 years old,complicated with diabetes,COPD course≥5 years,high levels of TNF-α,INF-γ and lncRNA SNHG16 were risk factors for elderly patients with COPD complicated with PI(P<0.05),but high FEV1/FVC and high levels of SMAD4 and IL-10 were protective factors(P<0.05).Spearman correlation analysis showed that serum relative expression level of ln-cRNA SNHG16 was positively correlated with sCPIS in COPD patients with PI(r=0.505,P<0.001),while SMAD4 level was negatively correlated with sCPIS(r=-0.550,P<0.001).The area under the curve(AUC)of the combined diagnosis of serum lncRNA SNHG16 and SMAD4 for PI in elderly COPD patients was higher than those of individual diagnosis(Z=2.416,P=0.016;Z=2.375,P=0.018).Conclusion The serum relative expression level of lncRNA SNHG16 increases and SMAD4 level decreases in elderly COPD pa-tients with PI,both are influencing factors for elderly COPD patients complicated with PI,and both are related to the degree of PI in patients,and both have diagnostic value for elderly COPD patients complicated with PI,and the diagnostic efficacy of combined detection is better.