Background:Postoperative delirium (POD) is an acute and common postoperative complication that can increase morbidity and mortality. The evidence regarding the association between preoperative chronic pain and POD is inconsistent. This study aims to explore the relationship between preoperative chronic pain and POD. Methods:This prospective cohort study consecutively enrolled 200 elderly patients undergoing elective orthopedic surgery. POD occurring within 7 days was assessed using the 3-min Diagnostic Interview for Confusion Assessment Method (3D-CAM). Chronic pain was defined as pain lasting ≥ 3 months, with intensity assessed by VAS preoperatively. Demographic and perioperative baselines were compared between delirium and non-delirium groups. Univariate and multivariate logistic regression were used to identify POD risk factors. Subgroup analyses focus on chronic pain patients were performed to explore the risk factors of developing POD among them. Results:Among the 200 enrolled patients (median age, 69 years; ASA II/III, 106/94), POD occurred in 33% (66/200) and preoperative chronic pain occurred in 58.5% (117/200). Univariate and multivariable logistic regression analyses showed significant association between preoperative chronic pain and POD among elder population (unadjusted OR = 2.039, 95% CI: 1.090-3.811; adjusted OR = 2.488, 95% CI: 1.282-4.837, P = 0.007). A subgroup analysis of chronic pain patients revealed that current pain intensity (VAS scores) was associated with the increased risk of POD (OR = 1.858, 95% CI: 1.291-2.675, P < 0.001). Conclusion:Preoperative chronic pain is associated with the increased risk of POD in the elderly patients undergoing elective orthopedic surgery. Furthermore, a significant association between current pain intensity assessed by VAS and POD was found among older adults with chronic pain.

Abstract Background Postoperative delirium (POD) represents a frequent complication among patients undergoing joint replacement surgery. While sleep disturbance is prevalent during the perioperative period, its relationship with POD has not been fully clarified. To this end, the present study was conducted to investigate the association between preoperative sleep disturbance and POD in elderly patients undergoing joint replacement. Methods This prospective cohort study recruited 200 patients undergoing elective knee or total hip replacement surgery between April 10th and July 15th, 2025, retrospectively registered with the Chinese Clinical Trial Registry (ChiCTR2500113120) on November 25, 2025. Specifically, preoperative subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) on the day of admission. POD was assessed twice daily using the Chinese version of the 3-Minute diagnostic assessment for delirium based on the Confusion Assessment Method (3D-CAM) within the first postoperative week. Multivariable logistic regression was performed to examine the association between preoperative sleep disturbance and POD, adjusting for age, sex, American Society of Anesthesiologists (ASA) classification, alcohol consumption, smoking,comorbidity, education level, type of anesthesia and PCIA. Results Preoperative sleep disturbance was observed in 69 of 200 patients (35%), with POD present in28 patients (14%). Followingmultivariable adjustment, preoperative sleep disturbance was independently associated with the occurrence of POD (OR: 2.84, 95% CI: 1.24–6.50, P = 0.013). The RCS curve revealed a significant positive linear association: as the PSQI score increased, POD risk increased gradually (P for overall = 0.036, P for nonlinear = 0.190). Exploratory subgroup analyses indicated a significant association between preoperative sleep disturbance and POD among patients under 80 years of age, females, patients with a normal BMI, and those with an ASA Ⅱ. Conclusion In elderly patients undergoing elective knee or total hip replacement surgery, preoperative sleep disturbance is independently associated with an increased risk of POD.

In this research, a novel coordination polymer (CP) based on Zn(II) ions as nodes [Zn2(1,4-NDC)2(py)2(H2O)] (1, py = pyridine and 1,4-NDCH2 = 1,4-naphthalenedicarboxylic acid) has been produced under hydrothermal reaction condition and then structurally characterized. Furthermore, Zn-complex reveals high sensitivity (with the detection limit of 1.97 × 10−6 M) and fast test time for the Al3+ in the water phase through the fluorescence enhancement method which is rare example in the reported Al3+ detection sensors. The compound was designed for hypotension treatment after anesthesia. First of all, the hypotension animal model was constructed; then, the compound’s protective was evaluated. The real-time reverse transcription-polymerase chain reaction (RT-PCR) was performed, and the α receptor expression on the vascular endothelial cells was determined. In addition to this, the western blot was also conducted for the α receptor expression assessment.

Postoperative recurrence, distant metastasis, and chemotherapy resistance in breast cancer present significant challenges in clinical treatment. Improving perioperative intervention strategies is crucial for enhancing patient prognosis. Lidocaine, a commonly used local anesthetic, has recently been shown to possess potential anti-breast cancer effects, offering a novel therapeutic direction through its drug repurposing potential. This review explores the multifaceted mechanisms by which lidocaine exerts anti-cancer effects, including nuclear regulation, membrane receptor channel inhibition, tumor microenvironment reprogramming, autophagy activation, and synergistic effects when combined with chemotherapy agents. Furthermore, the review discusses the limitations of current research, incorporating clinical evidence. This article provides a theoretical foundation for the perioperative application of lidocaine in breast cancer and the development of combination therapies, while also outlining future research directions to promote the clinical translation of “old drugs, new uses.”

OBJECTIVES:The effect of esketamine on perioperative neurocognitive dysfunction (PND) remains controversial. This systematic review and meta-analysis aimed to evaluate the impact of perioperative esketamine administration on PND. DESIGN:Systematic review and meta-analysis. DATA SOURCES:PubMed, EMBASE, Web of Science and Cochrane Library were searched from their inception to 25 April 2024. ELIGIBILITY CRITERIA FOR SELECTING STUDIES:We included the randomised controlled trials (RCTs) that compared single or continuous intravenous infusion of esketamine to saline among adult surgical patients without pre-existing neurocognitive disorders. DATA EXTRACTION AND SYNTHESIS:Two reviewers independently extracted pertinent information from the included studies. Risk of bias was assessed using Cochrane's risk of bias criteria. Risk ratios (RRs) and their corresponding 95% CIs were synthesised using a random-effects model. The overall evidence quality was appraised using the Grading of Recommendations Assessment, Development and Evaluation framework. RESULTS:10 RCTs were included in our meta-analysis, involving 854 surgical patients. Perioperative esketamine was associated with a reduced risk of postoperative delirium (POD) (relative risk (RR): 0.46, 95% CI: 0.30 to 0.71, p<0.001) and delayed neurocognitive recovery (dNCR) (RR: 0.41, 95% CI: 0.21 to 0.78, p<0.001). However, no statistically significant difference was found in the risk of postoperative neurocognitive disorder (post-NCD) at 3 months postsurgery between the esketamine and control groups (RR: 0.57, 95% CI: 0.19 to 1.73, p=0.40). Additionally, pain severity was reduced on postoperative day 1, with no difference in the risk of adverse events or length of hospital stay. CONCLUSION:Perioperative esketamine reduces the risk of short-term PND, including POD and dNCR, without significantly affecting the incidence of adverse events or length of hospital stay. However, no significant differences were observed in the risk of post-NCD at 3 months following surgery. This systematic review and meta-analysis offers valuable data for PND research and clinical drug intervention strategies. PROSPERO REGISTRATION NUMBER:CRD42024538438.

Traumatic brain injury (TBI) often leads to significant damage to the blood-brain barrier (BBB), contributing to the progression of neurological dysfunction and exacerbating inflammatory responses. BBB disruption is a critical factor in TBI pathology, as it facilitates neuroinflammation and edema, thereby worsening brain injury. For the first time, this study investigates the neuroprotective role of Human Pituitary Adenylate Cyclase Activating Peptide (PACAP) in mitigating the progression of TBI by addressing BBB dysfunction. Using a murine TBI model, the research demonstrates a significant reduction in PACAP levels in both serum and cortical tissues post-injury. Administration of PACAP was found to ameliorate neurological deficits, as evidenced by improved modified Neurological Severity Scores (mNSS) and enhanced motor coordination. Furthermore, PACAP treatment attenuated neutrophil infiltration and pro-inflammatory cytokine secretion, including TNF-α and IL-6, while reducing endothelial inflammation markers VCAM-1 and ICAM-1. PACAP also preserved BBB integrity by decreasing brain water content and Evans blue dye extravasation, alongside upregulating tight junction protein ZO-1. In vitro studies on human brain microvascular endothelial cells (HBMVECs) corroborated these findings, showing PACAP's efficacy in reducing endothelial permeability and enhancing transendothelial electrical resistance (TEER). The protective effects were mediated through the upregulation of ELF3, as its silencing negated PACAP's benefits. Collectively, these findings underscore PACAP's potential as a therapeutic agent in TBI management by fortifying BBB integrity and curtailing inflammatory responses.

Colonoscopy is essential for diagnosing colon lesions but is often associated with discomfort. Painless colonoscopy techniques are being increasingly used to improve the patient experience."However, in the case of painless colonoscopy, anesthesia is performed outside the operating room, which requires more significant peri-examination of hemodynamic changes and adverse postoperative reactions. This requires a more careful selection of narcotic analgesics, and there needs to be optimal analgesic drug guidance in clinical practice. This study compared the efficacy and safety of nalbuphine and hydromorphone in improving patient comfort and maintaining hemodynamic stability during elective colonoscopy. This prospective, randomized, double-blinded controlled trial included 72 adult patients (aged 18–65) who underwent sedation colonoscopy. The 72 patients were randomly divided into two groups using a computer-generated random sequence. Body mass index 18.5–28.0 kg/m2; American Society of Anesthesiologists (ASA) grade I to II. Then, the nalbuphine group was given 0.13 mg/kg nalbuphine, the hydromorphone group was given 0.016 mg/kg hydromorphone, and during the operation, 10–20 mg/time propofol could be appropriately injected according to the patient's examination and cooperation. All patients were continuously monitored for oxygen saturation, heart rate, and noninvasive mean arterial blood pressure. The colonoscopy time and anesthesia time were recorded. Adverse reactions such as hypotension, decreased oxygen saturation, nausea, and vomiting were recorded. Anesthesiologist satisfaction, gastroenterologist (operator), and patient satisfaction were recorded. Both nalbuphine and hydromorphone effectively maintained hemodynamic stability, with no significant differences in vital signs observed between the groups (P > 0.05). However, nalbuphine significantly reduced the incidence of postoperative nausea, vomiting, dizziness, and headache compared to hydromorphone (P < 0.05). The reduced side effects of nalbuphine were marked, suggesting a better postoperative comfort profile. While nalbuphine and hydromorphone effectively maintain intraoperative vital signs, nalbuphine offers superior postoperative comfort. This makes nalbuphine a preferable analgesic choice in outpatient colonoscopy settings. Further research is warranted to determine the optimal dosages for both drugs and to explore their mechanisms of action in procedural pain management. ChiCTR2300077446,November 9, 2023.

Existing evidence supports a connection between the atherogenic index of plasma(AIP) and increased stroke risk, however, few investigations have specifically examined this relationship among Chinese adults aged ≥ 45 with depression. This research utilized a comprehensive, nationally representative dataset collected from 2011 to 2018. The cross-sectional analysis included 4,055 samples. In the retrospective cohort study, 2,861 participants who had no stroke at baseline were selected and followed up for the development of stroke. Variables including age, AIP, gender, place of residence, marital condition, education, smoking, alcohol intake, diabetes, heart problem, and hypertension were compared between stroke patients and non-stroke patients among depressed individuals. Multivariable logistic regression modeling is used to further assess the association between AIP and stroke in individuals with depression after adjusting for confounding factors. Subgroup analysis was conducted to observe the connection between AIP and stroke among specific lifestyle habits (smoking, drinking) groups, and further threshold analysis was performed to test for any non-linear relationship. The cross-sectional results show that when comparing those with stroke to those without stroke, a notable disparity in AIP levels is observed (p < 0.001). Results from multiple regression analysis demonstrated a remarkable positive association between AIP and the likelihood of stroke. This association persisted in the final multivariable-adjusted model (adjusting for 6 covariates), where AIP retained significance(p = 0.016). In the retrospective cohort study, AIP was positively correlated with the risk of stroke in the depressed population (OR = 1.83, 95

Objective:To evaluate the efficacy of transcranial direct current stimulation (tDCS) in reducing the incidence of postoperative delirium (POD) in elderly patients undergoing hip fracture surgery. Methods and analysis:This single-center, double-blind, randomized controlled trial will enroll 160 participants aged 65 years and older, scheduled for elective hip surgery under spinal anesthesia. Participants will be randomly assigned to either the active-tDCS group or the sham-tDCS group. The active-tDCS group will receive two sessions: one pre-surgery and one post-surgery, with electrodes positioned over the left dorsolateral prefrontal cortex and the right supraorbital area. Each session includes 15-second ramp-up phase at the start, 20 min simulation with 2 mA current and 15-second ramp-down phase at the end. The sham-tDCS group will receive two sham procedures with no actual current delivered. Functional brain activity will be monitored before and after each session or sham procedure to assess changes in cortical activation and connectivity using functional near-infrared spectroscopy (fNIRS). The primary outcome measure will be the incidence of POD, assessed using the 3-Min Diagnostic Interview for Confusion Assessment Method (3D-CAM). Secondary outcomes include the severity of delirium, postoperative pain, anxiety, depression, cognitive function, and sleep quality. Trial registration:The trial was registered at ClinicalTrials.gov (NCT06678529) on Oct 22, 2024.

Excessive activation of microglia contributes to neuronal damage and astrocytic activation during cerebral ischemia and hypoxia. Poliumoside (Pol) is a caffeoylated phenylpropanoid glycoside with significant anti-inflammatory and antioxidant functions. However, whether Pol can mediate microglia-mediated neurotoxicity in the ischemic brain remains nebulous. Here, a cerebral ischemia-reperfusion injury (CI/RI) mouse model was conducted to investigate Pol's role in microglial activation and neurotoxicity. We found that Pol significantly reduced neurological deficits, cerebral infarction volume, and neuronal damage in the CI/RI mouse model. Pol inhibited proinflammatory cytokines and microglial and astrocytic activation, while enhancing anti-inflammatory cytokines. Mechanistically, Pol markedly suppressed Fstl1, NF-κB phosphorylation, and the Nlrp3-Asc-Caspase1 inflammasome. In the oxygen-glucose-deprivation (OGD)-mediated BV2 microglia, Fstl1 overexpression significantly enhanced microglial activation. The conditioned medium of Fstl1-overexpressed microglia promoted astrocytic activation and neuronal injuries. However, Pol treatment or NF-κB pathway inhibition reversed Fstl1-mediated effects. In conclusion, Pol restrained microglia-modulated neuroinflammation and neurotoxicity in the cerebral hypoxic-ischemic model by restraining the Fstl1-NF-κB pathway.

Background: Colonoscopy is essential for diagnosing colon lesions but is often associated with discomfort. Painless colonoscopy techniques are being increasingly used to improve the patient experience." However, in the case of painless colonoscopy, anesthesia is performed outside the operating room, which requires more significant peri-examination of hemodynamic changes and adverse postoperative reactions. This requires a more careful selection of narcotic analgesics, and there needs to be optimal analgesic drug guidance in clinical practice. This study compared the efficacy and safety of nalbuphine and hydromorphone in improving patient comfort and maintaining hemodynamic stability during elective colonoscopy. Methods: This prospective, randomized, double-blinded controlled trial included 72 adult patients (aged 18-65) who underwent sedation colonoscopy. The 72 patients were randomly divided into two groups using a computer-generated random sequence. Body mass index 18.5-28.0 kg/m2; American Society of Anesthesiologists (ASA) grade I to II. Then, the nalbuphine group was given 0.13 mg/kg nalbuphine, the hydromorphone group was given 0.016 mg/kg hydromorphone, and during the operation, 10-20 mg/time propofol could be appropriately injected according to the patient's examination and cooperation. All patients were continuously monitored for oxygen saturation, heart rate, and noninvasive mean arterial blood pressure. The colonoscopy time and anesthesia time were recorded. Adverse reactions such as hypotension, decreased oxygen saturation, nausea, and vomiting were recorded. Anesthesiologist satisfaction, gastroenterologist (operator), and patient satisfaction were recorded. Results: Both nalbuphine and hydromorphone effectively maintained hemodynamic stability, with no significant differences in vital signs observed between the groups (P > 0.05). However, nalbuphine significantly reduced the incidence of postoperative nausea, vomiting, dizziness, and headache compared to hydromorphone (P < 0.05). The reduced side effects of nalbuphine were marked, suggesting a better postoperative comfort profile. Conclusions: While nalbuphine and hydromorphone effectively maintain intraoperative vital signs, nalbuphine offers superior postoperative comfort. This makes nalbuphine a preferable analgesic choice in outpatient colonoscopy settings. Further research is warranted to determine the optimal dosages for both drugs and to explore their mechanisms of action in procedural pain management. Register Number: ChiCTR2300077446

Abstract Aims: Pulmonary vein isolation (PVI) is the main treatment of atrial fibrillation (AF), which can be performed under general anesthesia or conscious analgesia. The use of general anesthesia may improve contact force (CF) and mapping system accuracy compared to conscious sedation, but its influence on catheter swing and ablation index (AI) during PVI has not previously been investigated. Methods: The study population included 20 patients with Af who first underwent PVI procedure:10 patients adopted general anesthesia (GA) and 10 patients adopted conscious sedation (CS). We retrospectively analyzed the difference of catheter swing, CF, AI and distance between ablation points during PVI in two groups. Results: The swing of catheter was significantly higher in the CS group than in the GA group. On the contrary, CF increased in GA group. The AI and the distance between ablation points has no difference between the groups. In addition, GA was associated with lower pulmonary vein reconnection, total ablation points and supplemental ablation points. Conclusion: GA reduced catheter swing and improves CF during PVI compared with CS.

Abstract Caloric restriction (CR) has been shown to improve cardiac function, especially to restore cardiac tolerance during ischemia-reperfusion(I/R). However, evidence about the effects of caloric restriction on the myocardium of aged mice during I/R and mechanisms remain scarce. Our aim was to fill the gap by establishing a mouse model. We determined the effects of CR on fat content, adiponectin and leptin by ELISA. Blood glucose, insulin-related indexes, intraperitoneal glucose tolerance test (IP-GTT) and ultrastructure were also recored and analyzed in aged mice and young mice after I/R. In addition, we also examined the related proteins expression levels of AKT-mTOR pathway in mouse cardiac tissue by Western blot. The results showed that the fat content, the blood glucose and insulin levels decreased after CR, the adiponectin and leptin increased after CR. Besides, CR relieved myocardial injury in mice induced by I/R. Additionally, compared with the elderly ad libitum (AL) group, the expression levels of p-Akt, p-ULK1, and p-FoxO1 proteins in the elderly CR group increased, while the protein levels of p-raptor and p-mTOR decreased. Overall, our results suggested that Akt-mTOR-induced autophagy was involved in the relief of myocardial injury in aged mice on I/R after CR.

Background:Due to the global prevalence of opioid drugs, postsurgical prescriptions can lead to substantial opioid consumption, highlighting the increasing need for alternative medications. Alternative medicines can markedly lessen the usage of opioids after surgery, but the variety and notable side effects of these alternatives require meticulous experimental support. Objective:This study explored the efficacy and safety of ulinastatin for alleviating postsurgical pain, for reducing the need for opioids, and for inclusion in conventional treatment methods. Methods:A total of 108 patients undergoing elective hip replacement were randomly allocated into either the experimental group (56 cases, standard pain relief treatment plus 60 IU ulinastatin) or the control group (40 cases, standard pain relief treatment). The main outcomes measured were the total consumption of opioids at 24, 48, and 72 h postoperatively. Secondary outcomes comprised patient-reported pain indices and levels of satisfaction with pain control. The frequency of adverse events evaluated medication safety. Results:There were no statistically significant differences in age, sex, or underlying diseases between the two groups. Over 24 hours, opioid consumption was higher in the standard treatment group (66.6 mg; mean difference [MD]: 4.43 mg; 95% CI: 57.6-75.5) than in the intervention group (54.5 mg; MD: 1.91 mg; 95% CI: 50.7-58.3). The standard treatment group exhibited a notably higher incidence of adverse reactions. However, there was no disparity in post-discharge satisfaction between the groups, with an odds ratio of 1.058 (95% CI: 0.62-1.82; P > 0.05). Additionally, significant differences in C-reactive protein levels were observed immediately and 6 h after surgery between the two groups. Conclusion:Within 72 h post-surgery, ulinastatin was effective in substantially reducing the use of opioids while maintaining adequate pain control. Ulinastatin may be beneficial for postoperative pain management and for reducing the risks associated with opioid use. Registered:ClinicalTrials.gov ChiCTR2300072126.

BACKGROUND:The comparison between sedation and general anesthesia (GA) in terms of all-cause mortality remains a subject of ongoing debate. The primary objective of our study was to investigate the impact of GA and sedation on all-cause mortality in order to provide clarity on this controversial topic. METHODS:A systematic review and meta-analysis were conducted, incorporating cohort studies and RCTs about postoperative all-cause mortality. Comprehensive searches were performed in the PubMed, EMBASE, and Cochrane Library databases, with the search period extending until February 28, 2023. Two independent reviewers extracted the relevant information, including the number of deaths, survivals, and risk effect values at various time points following surgery, and these data were subsequently pooled and analyzed using a random effects model. RESULTS:A total of 58 studies were included in the analysis, with a majority focusing on endovascular surgery. The findings of our analysis indicated that, overall, and in most subgroup analyses, sedation exhibited superiority over GA in terms of in-hospital and 30-day mortality. However, no significant difference was observed in subgroup analyses specific to cerebrovascular surgery. About 90-day mortality, the majority of studies centered around cerebrovascular surgery. Although the overall pooled results showed a difference between sedation and GA, no distinction was observed between the pooled ORs and the subgroup analyses based on RCTs and matched cohort studies. For one-year all-cause mortality, all included studies focused on cardiac and macrovascular surgery. No difference was found between the HRs and the results derived from RCTs and matched cohort studies. CONCLUSIONS:The results suggested a potential superiority of sedation over GA, particularly in the context of cardiac and macrovascular surgery, mitigating the risk of in-hospital and 30-day death. However, for the longer postoperative periods, this difference remains uncertain. TRIAL REGISTRATION:PROSPERO CRD42023399151; registered 24 February 2023.

BackgroundDiabetic foot ulcer (DFU) is a chronic and challenging condition, addressed through various treatments including photodynamic therapy (PDT) and standard of care (SOC), yet lacking consensus on the optimal approach. This study presents a comprehensive meta-analysis of randomized controlled trials to evaluate the efficacy and safety of PDT versus SOC in managing DFU.MethodsAn extensive literature search was conducted across PubMed, Embase, and the Cochrane Library databases to identify RCTs that compared the effectiveness of PDT with SOC in treating DFU. The primary metrics evaluated included changes in ulcer area, wound healing indices, and pain levels experienced by the patients.ResultsThis meta-analysis incorporated data from 6 RCTs, encompassing 458 patients with 467 DFUs. The analysis indicated that while PDT led to a faster reduction in ulcer size compared to SOC, the difference was not statistically significant [mean difference (MD): 2.73cm², 95% Confidence Interval (CI) -2.98 to 8.44; p>0.05]. However, a notable improvement was observed in the wound healing rate in the PDT group [MD: 29.26%, 95% CI 7.24 to 51.28; p=0.01]. Based on the Visual Analog Scale (VAS), pain assessment revealed no significant difference between the two treatment groups [MD: 2.35, 95% CI -2.36 to 7.06; p=0.33].ConclusionThe study suggests that PDT might offer an enhanced healing rate for DFUs compared to SOC alone, potentially leading to improved patient outcomes. Importantly, our findings highlight the superiority of photodynamic therapy in accelerating ulcer healing without an associated increase in complications.PROSPERO2023 CRD42023493930

Background:Previous reports have demonstrated post-operative dementia and Alzheimer's disease (AD), and increased amyloid-β levels and tau hyperphosphorylation have been observed in animal models post-anesthesia. Objective:After surgical interventions, loss in memory has been observed that has been found linked with genes modulated after anesthesia. Present study aimed to study molecular pattern present in genes modulated post anesthesia and involved in characters progressing towards AD. Methods:In the present study, 17 transcript variants belonging to eight genes, which have been found to modulate post-anesthesia and contribute to AD progression, were envisaged for their compositional features, molecular patterns, and codon and codon context-associated studies. Results:The sequences' composition was G/C rich, influencing dinucleotide preference, codon preference, codon usage, and codon context. The G/C nucleotides being highly occurring nucleotides, CpGdinucleotides were also preferred; however, CpG was highly disfavored at p3-1 at the codon junction. The nucleotide composition of Cytosine exhibited a unique feature, and unlike other nucleotides, it did not correlate with codon bias. Contrarily, it correlated with the sequence lengths. The sequences were leucine-rich, and multiple leucine repeats were present, exhibiting the functional role of neuroprotection from neuroinflammation post-anesthesia. Conclusions:The analysis pave the way to elucidate unique molecular patterns in genes modulated during anesthetic treatment and might help ameliorate the ill effects of anesthetics in the future.

目的 探讨亚麻醉剂量艾司氯胺酮对髋关节置换术老年患者围术期应激与炎性反应的影响.方法 选择2021 年9 月至2022 年12 月在山西医科大学第一医院行全麻下髋关节置换术的老年患者60 例,随机分为对照组和试验组,各30 例.对照组给予舒芬太尼诱导、瑞芬太尼维持的镇痛方式,试验组在切皮前额外给予艾司氯胺酮0.25 mg/kg,术中以0.15 mg/(kg?h)的给药速率持续泵注.记录患者术前(T0)、术后12 h(T2)、术后24 h(T3)血清中应激激素皮质醇(Cor)、肾上腺素(NE)的含量和疼痛介质前列腺素E2(PEG2)、P物质(SP)的含量.记录患者术前(T0)、术后4 h(T1)、术后12 h(T2)、术后24 h(T3)、术后48 h(T4)的静态与动态视觉模拟评分(VAS评分).记录患者术中阿片类药物使用量、术后 24h 内的有效按压次数和阿片类药物使用量.记录不良反应发生情况.结果 试验组在T2 的Cor、NE、PGE2 和SP含量均低于对照组[(287.30±32.94)ng/ml vs.(321.76±34.79)ng/ml,(221.73±36.57)pg/ml vs.(252.58±42.20)pg/ml,(42.57±5.17)pg/ml vs.(54.33±4.94)pg/ml,(178.47±7.80)pg/ml vs.(199.53±8.59)pg/ml](P＜0.05);试验组在T3 的Cor、NE、PGE2 和SP含量均低于对照组[(326.68±34.29)ng/ml vs.(378.91±38.08)ng/ml,(258.58±42.20)pg/ml vs.(287.98±45.57)pg/ml,(53.11±8.23)pg/ml vs.(67.93±9.60)pg/ml,(200.11±10.13)pg/ml vs.(222.23±13.16)pg/ml](P＜0.05);试验组 T1～T3 的静态 VAS 评分和 T1～T2 的动态 VAS 评分均低于对照组(P＜0.05);试验组在术中的阿片类药物使用量、术后24h内有效按压次数和阿片类药物使用量明显低于对照组(P＜0.05);两组患者不良反应的发生情况差异无统计学意义(P＞0.05).结论 围术期应用艾司氯胺酮可减少髋关节置换术后老年患者的应激与炎性反应,具有充分的镇痛效果,有助于减少阿片类药物的使用,有望成为髋关节置换术患者多模式镇痛的重要组成部分.

Objective:To explore the effect of spontaneous breathing during induction of general anesthesia on atelectasis in patients undergoing laparoscopic resection of gastrointestinal tumors.Methods:A total of 60 patients aged 18-60 years scheduled for laparoscopic resection of gastrointestinal tumors under general anesthesia in the First Hospital of Shanxi Medical University from October 2021 to August 2022 were selected. The body mass index was 18.5-28.0 kg/m 2 and the American Society of Anesthesiology grade wasⅠ-Ⅱ. All patients were divided into the spontaneous breathing group (group S, 30 cases) and the controlled breathing group (group C, 30 cases) according to the random number table method. Patients in group S received 0.2-0.3 mg/kg etomidate (pumping at the speed of 200 ml/h) and 2 μg/kg remifentanil (slowly injected more than 30 s) for anesthesia induction; patients in group C received 0.2-0.3 mg/kg etomidate and 2 μg/kg remifentanil (slowly injected more than 30 s) and 0.2 mg/kg cisatracurium. After bispectral index (BIS) decreased to 80, the patients had no response to the language stimulation; and then the mask was used to closely fit the face and maintain spontaneous breathing in group S; patients in group C received manual positive pressure ventilation. Atelectasis scores were collected immediately after endotracheal intubation (T 1) and 15 min after transferring to the recovery room (T 3), and oxygenation index (OI) was collected 5 min after endotracheal intubation (T 2) and at T 3. The postoperative pulmonary complication (PPC) on the 3rd day after the operation was recorded. Results:A total of 56 patients were finally enrolled, 27 cases in group S and 29 cases in groups C. Compared with group C, the atelectasis score of group S at T 1 and T 3 decreased [T 1: (2.4±0.8) scores vs. (4.2±0.7) scores, t = -9.12, P < 0.001; T 3: (8.2±1.8) scores vs. (10.5±1.6) scores, t = -4.96, P < 0.001]. The OI increased at T 2 and T 3 in group S [T 2: (334±11) mmHg (1 mmHg = 0.133 kPa) vs. (323±13) mmHg, t = 3.45, P = 0.001; T 3: (362±23) mmHg vs. (347±25) mmHg, t = 2.31, P = 0.025]. The incidence of PPC was 20.7% (6/29) and 18.5% (5/27), respectively in group C and group S on the 3rd day after the operation, and the difference was statistically significant ( χ2 = 0.04, P = 0.838). Conclusions:Maintaining spontaneous breathing during induction of general anesthesia can reduce atelectasis caused by general anesthesia and improve oxygenation for patients undergoing laparoscopic resection of gastrointestinal tumors.