Purpose:Propofol and remimazolam monotherapy have their own limitations for general anesthesia in elderly patients. Optimizing anesthesia protocols is essential to enhance recovery and postoperative outcomes. This study aimed to evaluate the effects of combined sub-anesthetic doses of remimazolam and propofol on anesthesia recovery and sleep quality in this population. Patients and Methods:This single-center, single-blind, prospective, randomized controlled trial enrolled 92 patients aged 65-80 years scheduled for elective laparoscopic colorectal cancer surgery. Patients were randomly allocated to either group P (propofol alone, 4-12 mg/kg/h) or group PR (propofol 2-4 mg/kg/h combined with remimazolam 0.3 mg/kg/h). The primary outcome was awakening time. The secondary outcomes included sedation scores, intraoperative hemodynamics, postoperative Pittsburgh Sleep Quality Index (PSQI) scores, Visual Analogue Scale (VAS) scores, Quality of Recovery-15 (QoR-15) scores, and the incidence of adverse events. Results:Awakening time was significantly reduced in group PR compared with group P (14.8 ± 4.8 min vs 18.9 ± 5.1 min, P < 0.001). Group PR showed higher QoR-15 scores at 24 h postoperatively (129 [124.3-133] vs 121.5 [118-128], P = 0.002), a lower incidence of sleep disturbances on postoperative days 1 and 3 (P < 0.001), and more stable intraoperative hemodynamics with a lower incidence of hypotension (19.6% vs 54.4%, P < 0.001). No significant differences were observed in VAS scores or other adverse events. Conclusion:Anesthesia maintenance using a sub-anesthetic dose of remimazolam combined with propofol was associated with shorter awakening time and improved postoperative recovery quality. This combination may represent a promising anesthetic strategy, but further research with objective sleep monitoring is warranted to confirm these findings.

Objective To compare the postoperative 24-hour opioid consumption and pain relief between unilateral single-shot lateral and posterior quadratus lumborum block (QLB) in robot-assisted partial nephrectomy (RAPN). Design: A retrospective cohort study. Setting: A tertiary hospital. Interventions: Quadratus lumborum block. RAPN was performed under general anesthesia plus lateral QLB (n = 219) or posterior QLB (n = 201) for analgesia. Primary and secondary outcome measures: The primary outcome was postoperative cumulative sufentanil consumption at 24 and 48 hours. The secondary outcomes were visual analog scale (VAS) scores, time to first rescue analgesia, and intraoperative sufentanil consumption. Adverse effects and complications were also assessed. Results The postoperative 24-hour cumulative sufentanil consumption was significantly lower in the posterior QLB group 54.315[50.306–58.140](54.8 [51.7–59.5]) compared to the lateral QLB group (56.9 [49.1–65.8]) 55.913[48.675–62.595]( P = 0.042). However, this difference was not noticed at for the 48-hour cumulative consumption. There were also no significant differences in postoperative VAS scores and time to first rescue analgesia between the two groups, although the postoperative BCS scores were significant higher in the lateral QLB group. Posterior QLB had a higher incidence of intraoperative ephedrine use, while lateral QLB was associated with a higher proportion of ipsilateral lower limb weakness. No significant differences were found in adverse effects or complications. Conclusions Posterior QLB was associated with modestly lower postoperative opioid consumption compared to lateral QLB in RAPN, although the difference was modest. Both techniques provided comparable pain relief.

Chronic post-surgical pain (CPSP) represents a pain syndrome that interferes with postoperative daily activities and affects recovery of body functions, posing a heavy social and economic burden. Its pathogenesis is complex and unclear, which causes difficulties in treatment. Current research suggests that CPSP is influenced by genetic, psychosocial, emotional, and cognitive factors and is associated with complex neurological modulation. This review briefly introduces the definition and epidemiology of CPSP. Based on the genetic susceptibility and the interaction of epigenetic factors, gut microbes, environment, and neuro-modulatory system, we mainly addressed the pathogenesis of CPSP. The aim of this review is to provide new ideas for basic medical research and clinical practice.

Objective:To explore the risk factors of postoperative pulmonary complication (PPC) in adult patients with pancreatic cancer.Method:A total of 1 162 patients were selected according to the inclusion and exclusion criteria. Retrospective retrieval was conducted using the clinical electronic system database to collect their clinical data during the perioperative period. The systemic inflammatory index (SII), prognostic nutritional index (PNI), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) were calculated to determine the inflammatory and nutritional conditions of patients before operation. Logistic regression analysis was performed to determine risk factors. A receiver operating characteristic (ROC) curve was plotted to evaluate its predicting value. Multivariate Cox regression was used to explore the survival of patients 30 days after surgery.Result:According to the presence of PPC, the patients were divided into two groups: a PPC group ( n=39, 3.4%) and a Non-PPC group ( n=1 123, 96.6%). Compared with the Non-PPC group, patients in the PPC group had increased age ( P<0.05), with an elevated proportion of male patients ( P<0.05). The PPC group presented increases in the duration of anesthesia and operation, the time to withdraw gastric tube after surgery, postoperative feeding time, the total length of hospitalization stay, the length of intensive care unit (ICU) treatment and the total duration of postoperative treatment ( P<0.05). The PPC group presented increases the proportion of re-insertion after gastric tube withdrawal, the proportion of re-stop after postoperative feeding, the proportion of abandonment of treatment (no death in hospital) and the proportion of in-hospital death ( P<0.05), as well as decreases in the proportion of exhaust and defecation within 2 days after surgery, and the proportion of recovery and discharge and the survival rate 30 days after surgery ( P<0.05). The PPC group consumed increased volumes of colloidal liquid ( P<0.05), with elevated blood loss ( P<0.05), and an increased proportion of patients underwent blood transfusion ( P<0.05). The PPC group showed decreases in pre-operative albumin and albumin, low density lipoprotein cholesterol, LMR and PNI ( P<0.05), as well as increases in neutrophil percentage, neutrophil count, monocyte count, lymphocyte count, erythrocyte distribution width, serum procalcitonin, CEA, SII, NLR, alkaline phosphatase, cystatin C and creatinine (Cr) ( P<0.05). There was no statistical difference in other indexes between the two groups ( P>0.05). The risk factors of PPC were modeled through logistic regression analysis. The results indicated that blood loss, SII, NLR, PLR, neutrophils count and percentage were independent risk factors. ROC curve analysis showed that the area under curve (AUC) was 0.948 [95% confidence interval (CI) 0.919, 0.978], the sensitivity was 0.846, the specificity was 0.914, and the Yoden index was 0.760. Cox survival analysis showed that blood loss [odds ratio ( OR) 1.616 (95%CI 1.045, 2.500), P=0.031], SII [ OR 1.004 (95%CI 1.000, 1.007), P=0.047], and PLR [ OR 0.961 (95%CI 0.931, 0.993), P=0.016] and postoperative pulmonary complications [ OR 0.018 (95%CI 0.002, 0.138), P<0.001] were positively correlated with the mortality 30 days after surgery. Conclusions:Intraoperative blood loss, preoperative SII, preoperative NLR, preoperative PLR, and preoperative neutrophil count and percentage are the independent risk factors for PPC.

Study objectivePostoperative pulmonary complications (PPCs) are common and associated with adverse outcomes impairing long-term survival and quality of recovery. This single-centered retrospective study aimed to examine factors associated with PPCs in patients receiving elective colorectal surgery aged ≥60 years.MethodsBetween January 2019 and December 2019, 638 patients at the Shanghai Changhai Hospital who had received elective surgery for colorectal cancer were enrolled in this study. Patients were divided into the PPC group (n=38) and non-PPC group (n=600). Neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), red blood cell distribution width (RDW), and systemic inflammatory index (SII) were selected and caculated to indicate preoperative and postoperative inflammatory status. Receiver operating characteristic curve and bivariate correlation analyses were performed to evaluate the identified risk factors.Main resultsThe overall incidence of PPCs was approximately 5.96%. Multivariate regression analysis identified age (OR = 1.094, 95%CI 1.038–1.153, P = 0.001), preoperative RDW (OR = 1.159, 95%CI 1.025–1.309, P = 0.018), and preoperative SII (OR = 1.001, 95%CI 1.000–1.003, P = 0.035) as independent risk factors for PPCs. The cut-off values of age, preoperative RDW, and preoperative SII for predicting PPCs were 69.5 (sensitivity 0.658, specificity 0.653), 13.2 (sensitivity 0.789, specificity 0.552) and 556.1 (sensitivity 0.579, specificity 0.672), respectively.ConclusionsAge, preoperative RDW, and preoperative SII were identified as independent risk factors for PPC occurrence in elderly patients receiving elective colorectal surgery. Further studies are warranted to evaluate whether normalization of preoperative RDW and SII, as modifiable risk factors, are associated with improved surgical outcomes.

OBJECTIVES Neuro-inflammation induced by microglia is crucial in the pathogenesis of sepsis-associated encephalopathy (SAE). The endogenous lipid mediator, Resolvin D1 (RvD1), which is synthesized from docosahexaenoic acid, has been extensively reported to attenuate inflammation in various diseases by its anti-inflammation and pro-resolving functions. However, the effect of RvD1 on SAE remains unclear. In this study, we aimed to ex the function and mechanism of RvD1 on SAE mice. METHODS In our study, the SAE mice model was established by the method of cecal ligation and perforation (CLP). C57BL/6J mice were randomly divided into three groups: the Sham group, the CLP group and the CLP+RvD1 group. Cognitive impairment of the mice was assessed by Morris water maze. Iba1 immunohistochemistry was conducted to observe the activation of microglia in hippocampus of the mice from different groups. The production of cytokines, including TNF-α, IL-6 and IL-1β, and their mRNA levels were evaluated by ELISA and Q-PCR. The expression of the molecules from inflammatory signaling pathways was assessed by Western blot. RESULTS xaRvD1 treatment significantly improved the learning and cognitive ability of SAE mice. The activation of microglia and the production of inflammatory cytokines in hippocampal tissues were inhibited in CLP+RvD1 group. We also found that the inflammation of microglia was attenuated by RvD1 treatment both in vivo and in vitro. Moreover, the activation of NF-κB, MAPK and STAT signaling pathways were inhibited by RvD1 treatment, which partly explained the anti-inflammation function of RvD1 on SAE mice. CONCLUSIONS RvD1 could improve the learning and cognitive ability of SAE mice by inhibiting the systemic and local inflammation. It could attenuate the inflammation in microglia by inhibiting the activation of inflammatory signaling pathways and then decreasing the production of cytokines. These findings are helpful to better understand the pathophysiology of SAE, which also provide a novel therapeutic method in clinic.

目的 探讨老年结直肠肿瘤患者根治性切除术后肺部并发症的危险因素.方法 回顾性收集2019年1～12月首次行结直肠肿瘤根治性切除术老年患者的病历资料.收集患者一般资料、合并症、围术期监测指标及术后肺部并发症等.采用单因素分析及多因素Logistic回归分析法筛选此类患者术后肺部并发症的危险因素.结果 共纳入资料完整患者662例,其中45例(6.80％)发生术后肺部并发症(并发症组).单因素分析显示,与非并发症组比较,并发症组患者年龄较大、术前血中性粒细胞百分比较高(P<0.05),术中胶体液、红细胞悬液及血浆静脉滴注量较多(P<0.05),术前及术后血红蛋白、血白蛋白较低(P<0.05).Logistic回归分析显示,年龄>80岁(OR=4.433,95％CI:1.963～10.007,P=0.000)、术前血白蛋白<30g/L(OR=7.305,95％CI:1.606～33.214,P=0.010)是老年结直肠肿瘤患者根治性切除术后肺部并发症的独立危险因素.结论 年龄>80岁、术前血白蛋白<30g/L是老年结直肠肿瘤患者根治性切除术后肺部并发症的独立危险因素.

目的 探讨全身麻醉妇科手术患者术后恶心呕吐(PONV)与体内性激素水平的相关性.方法 纳入择期全身麻醉下行妇科手术患者81例.记录术前、术中一般情况,术后出苏醒室前留存静脉血测定体内性激素的浓度,记录术后24 h患者恶心呕吐情况.根据是否发生PONV,将患者分为恶心呕吐组(P组)和非恶心呕吐组(N组).统计分析2组患者一般情况和术后体内性激素浓度的差异,进一步分析PONV发生的危险因素.结果 在11种所检测的性激素中,P组患者孕烯醇酮显著高于N组(P=0.017),而17?羟基孕烯醇酮则显著低于N组(P=0.038).多因素回归分析发现患者的年龄、晕动病史、术中瑞芬太尼用量、术后孕烯醇酮和17?羟基孕烯醇酮水平与术后24 h内PONV密切相关,其中孕烯醇酮[HR(95％CI)=1.01(1.00,1.01)]为危险因素,而17?羟基孕烯醇酮[HR(95％CI)=0.99(0.99,0.99)]为保护因素).结论 择期全身麻醉下行妇科手术术后,患者的年龄、晕动病史、术中瑞芬太尼用量、术后血中孕烯醇酮和17?羟基孕烯醇酮水平与术后24 h内PONV密切相关.

妊娠期母体内分泌系统的生理状态及激素水平发生改变,从而为胎儿的生长发育提供适宜的环境.这些变化对母体的麻醉生理、麻醉药理及麻醉管理方式等均产生重要影响.随着妊娠时间的推移,垂体、甲状腺、胰岛、肾上腺等内分泌器官的变化更加显著,并可能由此引起相应的内分泌急症.产科手术多为急诊手术,任何一种内分泌急症对母体与胎儿来说都可能是致命打击.本文概述了常见的妊娠期内分泌急症及其麻醉处理要点,旨在帮助麻醉医师更好地了解此类问题、掌握相关急症的处理方法 与麻醉管理要点.

目的 探讨腹横肌平面(TAP)阻滞联合氟比洛芬酯对腹腔镜胆囊切除手术患者术后苏醒和疼痛的影响.方法 择期行腹腔镜胆囊切除术的患者80例,年龄35～65岁,美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级,按照随机数字表法将患者分为TAP阻滞组、氟比洛芬酯组、联合组和对照组,每组20例.TAP阻滞组于术前20 min在超声引导下行双侧TAP阻滞,每侧予0.375％罗哌卡因20 mL;氟比洛芬酯组于术前20 min静脉缓慢注射氟比洛芬酯1 mg/kg;联合组于术前20 min同TAP阻滞组行双侧TAP阻滞,同时同氟比洛芬酯组给予氟比洛芬酯;对照组给予等容量的0.9％氯化钠溶液.观察并记录患者的手术时间(切皮至缝合完成的时间)、自主呼吸恢复时间(停药至自主呼吸恢复时间)和拔管时间(停药至拔除气管导管时间),分别于拔除气管导管后1 h(T1)、6 h(T2)、12 h(T3)和24 h(T4)评估患者咳嗽时的疼痛VAS评分,并观察苏醒期间的躁动情况.结果 4组患者的手术时间、自主呼吸恢复时间和拔管时间的差异均无统计学意义(P值均＞0.05).TAP阻滞组和联合组T1至T4时间点、氟比洛芬酯组T1至T3时间点的疼痛VAS评分均显著低于对照组同时间点(P值均＜0.05),TAP阻滞组和联合组T1至T4时间点的疼痛VAS评分均显著低于氟比洛芬酯组同时间点(P值均＜0.05).联合组轻、中、重度苏醒期躁动的发生率均显著低于对照组(P值均＜0.05);TAP阻滞组和氟比洛芬酯组重度苏醒期躁动的发生率均显著低于对照组(P值均＜0.05),轻、中度苏醒期躁动的发生率均显著高于联合组(P值均＜0.05).结论 TAP阻滞可减轻腹腔镜胆囊切除术患者的术后疼痛,TAP阻滞联合氟比洛芬酯不仅提供了良好的术后镇痛,而且改善了患者的苏醒质量.

Background NOD-like receptor pyrin domain containing 3 (NLRP3) inflammasomes are multimeric protein that consists of NLRP3,apoptosis-associated speck-like protein containing a CARD (ASC) and cysteinyl aspartate specific proteinase-1 (caspase-1).NLRP3 is an important regulator of caspase-1,the enzyme that processes the immature form of IL-1β into the active protein.IL-1β act as a receptor of exogenous microorganisms and endogenous danger signas.Objective The purpose of this review is to focus on how NLRP3 inflammasomes regulate inflammatory disease through negative regulation.Content To explain the roles of pyrin domains,ubiquitination,nitric oxide,interferon,reactive oxygen species in regulating effect of NLRP3 inflammasomes.Trend To provide some new ideas of the diagnosis and therapy for NLRP3 inflammasomes-related diseases.

Hydrogen is a kind of noble gas with the character to selectively neutralize reactive oxygen species. Former researches proved that low-concentration of hydrogen can be used to ameliorating cerebral ischemia/reperfusion injury. Hydrogen electrolyzed from water has a hydrogen concentration of 66.7%, which is much higher than that used in previous studies. And water electrolysis is a potential new hydrogen resource for regular clinical use. This study was designed and carried out for the determination of safety and neuroprotective effects of water electrolysis-derived hydrogen. Sprague-Dawley rats were used as experimental animals, and middle cerebral artery occlusion was used to make cerebral ischemia/reperfusion model. Pathologically, tissues from rats in hydrogen inhalation group showed no significant difference compared with the control group in HE staining pictures. The blood biochemical findings matched the HE staining result. TTC, Nissl, and TUNEL staining showed the significant improvement of infarction volume, neuron morphology, and neuron apoptosis in rat with hydrogen treatment. Biochemically, hydrogen inhalation decreased brain caspase-3, 3-nitrotyrosine and 8-hydroxy-2-deoxyguanosine-positive cells and inflammation factors concentration. Water electrolysis-derived hydrogen inhalation had neuroprotective effects on cerebral ischemia/reperfusion injury in rats with the effect of suppressing oxidative stress and inflammation, and it is a possible new hydrogen resource to electrolyze water at the bedside clinically.

The number of regulatory T cells (Treg cells) and the expression of ectonucleoside triphosphate diphosphohydrolase 1 (ENTPD1; also known as CD39) and 5'-ectonucleotidase (NT5E; also known as CD73) on the Treg cell surface are increased during sepsis. In this study, to determine the factors leading to the high expression of CD39 and CD73, and the regulation of the CD39/CD73/adenosine pathway in Treg cells under septic conditions, we constructed a mouse model of sepsis and separated the Treg cells using a flow cytometer. The Treg cells isolated from the peritoneal lavage and splenocytes of the mice were treated with adenosine or the specific adenosine A2A receptor agonist, CGS21680, and were transfected with specific siRNA targeting E2F transcription factor 1 (E2F-1) or cyclic adenosine monophosphate (cAMP) response element-binding protein (CREB), which are predicted transcription regulatory factors of CD39 or CD73. The regulatory relationships among these factors were then determined by western blot analysis and dual-luciferase reporter assay. In addition, changes in adenosine metabolism were measured in the treated cells. The results revealed that adenosine and CGS21680 significantly upregulated CD39 and CD73 expression (P<0.01). E2F-1 and CREB induced CD39 and CD73 expression, and were upregulated by adenosine and CGS21680. Adenosine triphosphate (ATP) hydrolysis and adenosine generation were inhibited by the knockdown of E2F-1 or CREB, and were accelerated in the presence of CGS21680. Based on these results, it can be inferred that adenosine, the adenosine A2A receptor agonist, E2F-1 and CREB are the possible factors contributing to the high expression of CD39 and CD73 on the Treg cell surface during sepsis. Adenosine and its A2A receptor agonist served as the signal transducer factors of the CD39/CD73/adenosine pathway, accelerating adenosine generation. Our study may benefit further research on adenosine metabolism for the treatment of sepsis.

OBJECTIVES:Forkhead/winged helix transcription factor p3 (Foxp3) increases in CD4(+)CD25(+)Treg cells during sepsis; however, related mechanisms are unclear. Our study aimed to explore the possible molecular mechanisms of high expression of Foxp3 in Treg cells during sepsis.METHODS:Sepsis was induced by cecal ligation and puncture (CLP) method. CD4(+)CD25(+)Treg cells were isolated from peripheral blood and identified by flow cytometry (FCM). Treg cells were cultured with or without adenosine, adenosine agonist, adenosine antagonist, SMAD family member 3 (Smad3) agonist (transforming growth factor (TGF)-β1), or C-Jun N-Terminal Kinase (JNK) inhibitor. Expression levels of Foxp3 and activator protein 1 (AP-1) were determined. The binding of c-Fos or c-Jun to the Foxp3 promoter was then evaluated by the chromatin immunoprecipitation (ChIP) assay and quantified by quantitative real-time PCR (qRT-PCR). The mRNA and protein levels of Foxp3 were determined after transfection with siRNA against c-Fos, Fra-2, c-Jun or JunD.RESULTS:Pharmacological inhibition of both adenosine and JNK reduced Foxp3 protein levels. JNK/AP-1 activation was involved in increased levels of Foxp3 protein in CD4(+)CD25(+)Treg cells. AP-1 regulated activity of Foxp3 promoter in Treg cells, and the induction of c-Fos or c-Jun activity leads to elevated transcription of Foxp3 gene. Knockdown of c-Fos, Fra-2, c-Jun, or JunD levels also reduced Foxp3 expression.CONCLUSION:We confirm that adenosine plays significant roles in the high expression of Foxp3. Adenosine promotes Foxp3 expression in Treg cells during sepsis via JNK/AP-1 pathway.

腹腔镜手术具有创伤较小、恢复较快等优点,但是术后常伴随切口疼痛,少数病例由于术后急性疼痛未经制止可能会进一步演变为慢性痛。腹横筋膜(Transversus abdominis plane,TAP)阻滞是一种区域麻醉技术,它可以通过局麻药阻滞腹内斜肌与腹横肌之间腹壁传入神经纤维,有效阻断腹壁前侧的痛觉传入[1~3]。自2001年 Rafi 博士将经 TAP 阻滞应用于临床以来,已有大量文献证实 TAP 阻滞可为腹部手术提供有效的术后镇痛[4]。右美托咪定是α2肾上腺素受体激动药,具有镇静、镇痛、抗焦虑、催眠作用,且无明显呼吸抑制,能维持术中血流动力学稳定[5]。本研究拟评价 TAP阻滞联合右美托咪定对妇科腹腔镜手术患者术后恢复的影响。

目的：：探讨不同剂量右美托咪定在高血压患者全身麻醉诱导的麻醉效果。方法：2014年1月至6月共94例全身麻醉下择期腹部手术的原发性高血压患者,随机分为2组( n=47),DEX高剂量组( DH组)与DEX低剂量组( DL组),比较两组患者术中血流动力学状态、术中及麻醉恢复期不良事件发生情况。结果：DH组患者分别于T3、T4、T5、T6心率低于DL组患者(P<0.05),于T5、T6时刻SBP、DBP 低于DL组患者(P<0.05)。两组患者窦性心动过缓发生率最高(DH 组12例,DL组11例),但所有不良反应(恶心、呛咳、躁动、喉痉挛、窦性心动过缓)均未有差异( P>0.05)。结论：对于高血压患者,术前采用右美托咪定1ug/kg负荷,术中以0.5ug·kg-1· h-1的剂量维持,可有效减少患者心率、血压的波动,并且不增加不良反应的发生情况。

Objective To investigate the effect of carbon dioxide pneumoperitoneum on pharmacodynamics of rocuronium(ROC)in gynecological laparoscopic surgery.Methods Patients of ASA Ⅰ-Ⅱscheduled for elective gynecological laparoscopic surgery(Group L,n=29)or open gynecological surgery(Group C,n=29)were given total intravenous anesthesia(TIVA)with propofol and remifentanil.All patients initially received ROC 0.6mg·kg-1 by 1.8μg·kg-1·min-1 through closed-loop muscle relaxation injection system.ROC(30μg·kg-1·min-1)was given to maintain muscle relaxation when T1 reached 15%of control.The onset time of ROC(T1down to 0%),the first time of ROC injection(T1reach 15%),recovery index of muscle relaxation(T1increase from 25% to 75%),frequency of ROC injection and injection dosage per unit time were recorded.The hemodynamic parameters including heart rate(HR),mean arterial pressure(MAP),cardiac output(CO),PaCO2,pH and depth of anesthesia(bispectral index,BIS)were also recorded before intubation(P0),after intubation(P1),5min after pneumoperitoneum(P2),30 min after pneumoperitoneum(P3),1hafter pneumoperitoneum(P4),the end of pneumoperitoneum(P5)and time of removal of intubation(P6).Results The first time of ROC injection in group L was significantly longer than that in group C([42.1±10.7]min vs[27.7±9.5]min,P0.01),and the recovery index of muscle relaxation in group L was significantly longer than that in group C([13.8±6.0]min vs[9.6±3.9]min,P0.01).The total dosage per unit time of ROC in group L was significantly less than that in group C([5.4±0.8]μg·kg-1·min-1 vs[6.3±0.5]μg·kg-1·min-1,P0.05).The frequency of ROC injection in group L was significantly less than that in group C([2.1±1.0]per hour vs[2.8 ±0.9]per hour,P0.05).Hemodynamically,CO in group L was found significantly lower than that in group C during P2-P4(P0.01).Conclusion The duration and recovery time of ROC in patients undergoing laparoscopic surgery under carbon dioxide pneumoperitoneum are prolonged,and smaller dosage is required compared to opengynecological surgery,which is likely due to the lower CO caused by carbon dioxide pneumoperitoneum.

目的 探讨右美托咪定对下肢手术患者的血流动力学和术后恢复的影响.方法 选取上海长海医院2012年1-6月间300例行下肢手术患者为研究对象,将其按照随机数字法分入观察组和对照组,观察组患者在麻醉诱导成功后静脉注射1.0 μg/kg右美托咪定,10 min后以0.5 μg·kg-1·h-1的速度经静脉泵持续注射;对照组患者静脉注射等量的0.9％氯化钠溶液.观察两组患者的血流动力学和术后恢复指标的变化.结果 观察组在止血带充气前,止血带充气后15、30、45、60 min,以及止血带放气后5 min各时间点的心率均显著慢于对照组同时间点(P值均＜0.05);止血带充气后45、60 min和止血带放气后5 min各时间点的心输出量、心指数、每博输出量,以及止血带放气后5 min时的每博输出指数均显著高于对照组同时间点(P值均＜0.05).两组间苏醒时间、拔除气管导管时间、离开手术室的时间的差异均无统计学意义(P值均＞0.05).两组患者均发生恶心、呕吐、寒战、脉搏血氧饱和度异常、上呼吸道梗阻等并发症,但除对照组呕吐发生率显著高于观察组(P＜0.05)外,两组间其他不良反应发生率的差异均无统计学意义(P值均＞0.05).观察组不良反应总发生率为5.3％(8/150),显著低于对照组的20.6％(31/150,P＜0.05).结论 临床中对于下肢手术患者术中应用右美托咪定麻醉是可行的,患者的血流动力学稳定,术后不良反应发生率也相对较低.