Objective:To investigate the protective role of extracellular signal-regulated kinase (ERK) signaling pathway in the process that vasonatrin peptide (VNP) reduces hepatic ischemia-reperfusion injury in rats.Methods:Twenty SD rats, weighting 200-250 g, were randomly divided into four groups and each group has five rats. The four groups were sham operation group (S group), ischemia-reperfusion group (I/R group), VNP group (V group) and PD98059+ VNP group (P+ V group). In the rat model of hepatic warm ischemia and reperfusion, the hepatic artery and portal vein of the left lobe and middle lobe of the liver were clamped with arterial clamp for 45 min followed by reperfusion for 120 min. In the V group, VNP (50 μg/kg) was injected 10 minutes before ischemia. In the P+ V group, PD98059 (2 mg/kg) was injected 20 min before VNP injection followed by VNP administration and I/R treatment. The serum levels of alanine amino transaminase (ALT), aspartate amino transferase (AST), tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and the superoxide dismutase (SOD) in liver tissue homogenate and malondialdehyde (MDA) were measured. The histopathology of liver tissue was observed. The contents of p-ERK1/2 were detected by Western blot.Results:Compared with S group, in I/R group and P+ V group the serum levels of ALT [(489.65±11.22), (333.05±24.77) vs. (33.78±4.88) U/L], AST [(651.43±14.99), (503.18±21.48) vs. (154.84±12.32) U/L], TNF-α [(12.83±1.09), (9.64±0.57) vs. (2.11±0.11) ng/L], IL-1β [(7.19±0.62), (5.12±0.22) vs. (1.10±0.49) ng/L], MDA [(8.00±0.88), (5.60±1.01) vs. (2.76±1.29) μmol/mg] increased, while SOD [(54.89±10.60), (68.85±8.33) vs. (126.10±15.63) nmol/mg]decreased (all P<0.05). The histopathology of liver tissue revealed that liver structure damaged more seriously in I/R group and P+ V group. Western blot analysis showed that p-ERK1/2 decreased significantly in I/R group and P+ V group. Compared with I/R group, ALT, AST, MDA, TNF-α and IL-1β decreased significantly and SOD increased significantly in V group (all P<0.05). The histopathology of liver tissue revealed that liver structure was damaged slightly, and p-ERK1/2 increased significantly in V group compared with I/R group ( P<0.05). Conclusion:VNP can significantly reduce hepatic ischemia-reperfusion injury through activation of p-ERK1/2 signaling pathway and inhibition of hepatocyte inflammatory response.

目的 探讨微助教(micro-teachermate)辅助基于问题的(problem-based learning,PBL)翻转课堂(flipped classroom)在医学本科麻醉教学中的应用效果.方法 本研究选取西安交通大学临床医学本科五年制2015级两个班作为研究对象,其中一班为实验组(n=53),另一班为对照组(n=56).实验组采用微助教辅助PBL联合翻转课堂教学模式,对照组采用传统PBL联合翻转课堂模式.期末对两组进行理论考试和教学满意度、学习意愿和专业意愿进行调查分析.结果 实验组理论成绩显著高于对照组(P<0.05),实验组教学满意度和学习意愿显著高于对照组(P<0.05),两组专业意愿差异无统计学意义(P>0.05).结论 微助教辅助PBL翻转课堂可显著提高医学本科的麻醉教学效果.

目的 探讨微助教辅助教学在麻醉科住院医师规范化培训中的应用效果.方法 研究选取2018年1月—2019年11月在医院进行初次麻醉科住院医师规范化培训的45名麻醉科住院医师作为研究对象.随机分为普通微信辅助教学(A)组(n=23)和微助教辅助教学(B)组(n=22),共45名;A组采用普通微信辅助传统教学模式,B组采用微助教辅助教学模式,规培结束后对两组理论和临床操作、教学满意度进行调查分析.结果 规范化培训后B组理论成绩显著高于A组(P<0.05),两组临床操作成绩差异无统计学意义(P>0.05);B组教学满意度显著高于A组(P<0.05).结论 微助教辅助教学可显著提高麻醉科住院医师规范化培训的理论教学效果教学满意度.

目的 探讨翻转课堂结合CBL在麻醉专业住院医师规范化培训教学中的应用.方法 选取2017年1月—2019年6月西安交通大学第一附属医院麻醉专业住院医师规范化培训学员48名,采用随机数字表法对住院医师分为对照组和研究组.对照组采用传统教学模式,研究组采用翻转教学结合CBL教学模式.比较两组住院医师理论笔试、临床思维能力和临床技能操作成绩、教学方法满意度及学习兴趣评分.结果 与传统教学模式相比较,翻转课堂结合CBL教学模式的住院医师基本理论成绩、临床思维能力成绩、临床技能操作成绩都明显提高(P<0.05);教学模式调查问卷表结果也显著优于传统教学方法(P<0.05).结论 与传统教学模式相比较,翻转课堂结合CBL教学模式能显著提高麻醉住院医师规范化培训教学质量,提高学习兴趣.

目的 探讨缺血再灌注损伤对肝大部切除后残肝组织TNF-a/IL-6/STAT-3信号通路的影响.方法 选取健康、清洁级、雄性SD大鼠60只,体重230～280 g,随机分为单纯肝切除组(SH组)和缺血再灌注组(IR组).将两组大鼠肝左、中叶切除,残肝(右、尾叶)作不同处理:SH组不阻断其血流,IR组阻断血流30min后恢复灌注.术后1、6、12、24、48h时取各组大鼠残肝组织,测定残肝组织TNF-α、IL-6水平、CyclinD1、Cdk4、STAT-3 mRNA表达及CyclinD1、Cdk4蛋白表达水平.结果 与SH组比较,IR组各时点IL-6表达降低,TNF-α于1～12h明显升高,24h、48h时CyclinD1、Cdk4、STAT-3 mRNA及CyclinD1、Cdk4蛋白表达水平降低(均P＜0.05).结论 缺血再灌注损伤下调了肝大部切除后残肝组织TNF-α/IL-6/STAT-3信号通路的表达,最终可能抑制了肝细胞的增殖.

[目的]观察硫酸镁对剖宫产产妇行舒芬太尼复合布比卡因腰硬联合麻醉(CSEA)的效果及术后镇痛的影响.[方法]90例行剖宫产术的单胎足月初产妇随机分为两组,两组均输注布比卡因 10 mg和舒芬太尼 10 μg进行CSEA,腰麻给药后即刻,观察组产妇静脉泵入硫酸镁50 mg/kg,并以 10 mg/(kg·h)维持输注至术毕,对照组产妇在相同时间段泵入等量生理盐水.观察比较各时间点无创平均动脉压(MAP)和心率(HR)变化情况,术后 6 h、12 h、24 h 和 48 h 时间点疼痛评分(VAS)、药物使用情况和不良反应发生率.[结果]两组产妇在不同时间点 MAP、HR及下肢运动恢复时间比较差异均无显著性(P ＞0.05).观察组麻黄碱用量、镇痛药物使用量均低于对照组(P ＜0.05);观察组产妇术后 6 h、12 h、24 h和48 h VAS评分均显著低于对照组(P ＜0.05).观察组恶心呕吐和寒战等不良反应发生率显著低于对照组(P ＜0.05).[结论]硫酸镁能够改善CSEA下剖宫产妇女术后疼痛,减少术后镇痛药物使用量和降低术后不良反应发生率,值得临床推广使用.

目的 探讨模拟教学在麻醉专业本科生临床实习教学中的应用效果.方法 将2011级麻醉系本科实习生40名,随机分为两组:M组(n=20)和L组(n=20).分别进行医学模拟教学(M组)和教师讲授为主的教学(L组).实习半年结束后通过理论考核、临床技能考核和调查问卷的方法进行综合评价观察教学效果.结果 M组学生理论考核成绩、临床技能操作成绩和综合成绩均显著高于L组;调查问卷结果也显示M组在增加教学满意度、提高临床技能、培养临床思维能力、促进同学间交流沟通方面均较L组效果更优.结论 在麻醉专业本科生实习教学中模拟教学较传统教师讲授为主的教学具有明显优势.可以增强麻醉实习学生的沟通能力、思维能力以及运用知识解决实际临床问题的能力,最终提高教学质量.

Objective To investigate the protective effect of propotol against hepatic ischemiareperfusion injury in rats on mitochondrial permeability transition pore (MPTP) and the mechanism of GSK-3β.Methods Thirty SD rats were randomly assigned into five groups (n =6):sham operation group (S group),ischemia reperfusion group (I/R group),CsA pretreatment group (C group),propofol pretreatment group (P group),and propofol plus atractyloside pretreatment group (A + P group).Nauta liver ischemia-reperfusion rat model was used.Liver lobes were subjected to warm ischemia for 60min and then reperfusion for 120 min.In P group,propofol [12 mg/(kg · h)] was administered in the femoral vein for 30 min before ischemia until the end of reperfusion.In C group,CsA (2 mg/kg) was administered in the femoral vein for 20min before ischemia.In A + P group,20 μmol/kg of atractyloside was given through the femoral vein 10min before the injection of propofol.Rats were sacrificed at the end of reperfusion,and venous blood and hepatic tissue specimens from the same part of ischemia were obtained from different groups.Results Compared with S group,the AST and ALT levels were increased significantly,mitochondrial swelling were increased and mitochondrial membrane potential were decreased significantly in I/R group and A + P group.Casepase-3 were increased significantly and p-GSK3β Ser9 were decreased significantly in I/R group and A + P group.Compared with I/R group,the content of AST and ALT were decreased significantly,mitochondrial swelling were decreased and mitochondrial membrane potential were increased significantly,casepase-3 release were decreased significantly and p-GSK3β Ser9 were increased significantly in P group and C group.GSK-3β in each group displayed no significant difference.Conclusions Propofol can significantly reduce hepatic ischemia-reperfusion injury.The protective effect of propofol may be achieved via the inhibition of GSK-3β activation,increased p-GSK-3β Ser9 level,suppressing MPTP opening and decreasing hepatocytes apoptosis.

Objective To evaluate the efficacy and safety of PECS block under ultrasound guidance in multimodal analgesia after modified radical mastectomy.Methods Sixty female patients aged 18-65 years, ASA grade Ⅰ or Ⅱ, undergoing elective unilateral modified radical mastectomy were enrolled.Patients were randomly divided into PECS group (group P, n=30) or control group (group C, n=30).Two groups of patients were given flurbiprofen axetil 1 mg/kg via intravenous injection before operation.After general anesthesia induction, patients in group P received ultrasound guided pectoral nerves block with 30 ml of 0.375% ropivacaine.Patients in group C didn`t receive nerve block.Anesthesia maintenance was performed by combined intravenous-inhalation Anesthesia.Postoperative VAS pain scores (at 0, 3, 6, 12, and 24 postoperative hours), does of intraoperative remifentanil, rescue analgesic requirements in the first 24 h after surgery, adverse reactions were recorded.Results VAS score in group P was lower than that in group C at 0, 3, 6 and 12 h after surgery (P<0.05), there was no difference at 24 h.The dose of remifentanil and the rescue analgesic requirements in group P were lower than those in group C (P<0.05).There was no significant difference in postoperative adverse reactions between the two groups.Conclusion As a supplementary mode of multimodal analgesia, PECS block is a safe and reliable technique that provide better analgesia effect for modified radical mastectomy.

神经阻滞麻醉在临床中得到重新审视,尤其是超声影像辅助的兴起,使区域麻醉得到了进一步广泛应用.熟练掌握区域阻滞麻醉操作技术也是麻醉专业住院医师培训的一项基本要求.我们围绕住院医师规范化培训目标的要求,针对超声教学中的特点难点,灵活运用多种教学方法、将基础知识与临床实践很好的结合起来,为快速提高住院医师熟练掌握超声引导区域阻滞麻醉摸索出了一套有效的方法.

肝移植手术的麻醉极具挑战性,许多学生面对如此复杂疾病的患者通常手足无措,目前也缺少相关内容的教材.西安交通大学第一附属医院每年实施肝移植麻醉100余例,作为教学医院,笔者也积累了丰富的临床带教经验,本文从肝移植手术的麻醉前评估、术中各个阶段的麻醉以及体温监测方面对麻醉专业住院规范化培训的住院医师或研究生的教学做一总结.

Objective To investigate the protective effect of propofol pretreatment against hepatic ischemia-reperfusion injury and oxidative stress in rats and the mechanism of the role of GSK-3 β.Methods Sixty SD rats were randomly divided into four groups:sham operation group (S group),ischemia-reperfusion group (I-R group),propofol pretreatment group (P group),TDZD-8 pretreatment group (T group).The hepatic ischemia-reperfusion rat models were established by the method of Nauta.Rats were subjected to 30-min,60-min and 90-min 70％ warm ischemia of liver followed by reperfusion for 120 min,respectively.Propofol (12 mg/kg · h) was injected via femoral vein 30 min before ischemia till the end of reperfusion in P group and TDZD-8 (1 mg/kg) were injected via femoral vein 20 min before ischemia in T group.The animals were killed at 120 min after reperfusion.Blood samples and the liver tissue were obtained.The levels of alanine aminotransferase (ALT),aspartate aminotransferase (AST),lactate dehydrogenase (LDH),malondialdehyde (MDA) and superoxide dismutase (SOD) were analyzed.Liver morphological changes were observed using optical microscopy.p-GSK-3β Ser9 and total GSK-3 β expression was determined by Western blot.Results Compared with S group,AST,ALT,LDH and MDA level was increased,SOD level was reduced,and p-GSK-3 β Ser9 expression was significantly reduced in I-R group.Compared with I-R group,the content of AST,ALT,LDH and MDA was reduced significantly,SOD increased significantly,and the content of p-GSK-3β Ser9 increased significantly in P group and T group.There were no significant differences between P group and T group.The hematoxylin-eosin staining of hepatic tissues revealed in I-R group had severe structural damage and periportal inflammatory cells infiltrated,hepatocyte necrosis and sinusoidal congestion.In P group and T group,liver tissues had normal structure,less cell death,edema and inflammatory cell infiltration.Conclusions Propofol can significantly reduce hepatic ischemia reperfusion injury by reducing oxidative stress and lipid hydroperoxides.This protective effect of Propofol may be associated with the inhibition of GSK-3 β by GSK-3 β Ser9 phosphorylation.

目的:探究不同浓度右美托咪啶对小儿麻醉后肌钙蛋白I、C反应蛋白以及补体变化的影响.方法:收集我院下腹股沟斜疝、急性阑尾炎以及肠套叠手术患儿75例,根据治疗方法不同分为三组,每组25例,其中A组实施0.5 μg/kg负荷剂量右美托咪啶治疗,B组实施0.25 μg/kg负荷剂量右美托咪啶治疗,C组实施右美托咪啶0.2～0.7 μg/kg/h持续泵入.对比三组患者苏醒情况、血清肌钙蛋白I、C反应蛋白、补体水平、镇定及躁动评分.结果:手术后,B组自主呼吸恢复时间、气管导管拔管时间、解除监护时间明显缩短,且与其他两组比较,差异有统计学意义(P＜0.05);与A、C两组相比,B组手术后C反应蛋白及血清肌钙蛋白I水平较低,而C3及C4水平较高,差异具有统计学意义(P＜0.05);B组镇静、躁动评分明显降低,差异有统计学意义(P＜0.05).结论:0.25 μg/kg负荷剂量右美托咪啶能够有效减轻患儿术后炎性反应,缓解麻醉后神经损伤,有助于脏器功能的恢复.

Objective To evaluate the effect of recombinant human erythropoietin (rHuEPO) on lung injury induced by hepatic ischemia-reperfusion (I/R) in rats.Methods Sixty healthy male SpragueDawley rats, aged 6-8 weeks, weighing 220-280 g, were randomly divided into 3 groups (n=20 each) using a random number table: sham operation group (group S) , hepatic I/R group (group I/R), and rHuEPO group (group E).I/R and E groups underwent I/R of 70 percent of the liver.The rHuEPO 4 000 U/kg was injected intraperitoneally at 24 h before I/R in group E, while the equal volume of normal saline was given in S and I/R groups.The rats were sacrificed at 3 h of reperfusion, and lungs were removed and cut into sections which were stained with haematoxylin and eosin and examined under light microscope.Wet to dry lung weight ratio (W/D ratio) was calculated.The expression of heme oxygenase-1 (HO-1) and inducible nitric oxide synthase (iNOS) in lung tissues was determined by immunohistochemistry.The content of malondialdehyde (MDA), and activities of superoxide dismutase (SOD) and myeloperoxidase (MPO) in lung tissues were detected.Results Compared with group S, the W/D ratio, MDA content, and MPO activity were significantly increased, the SOD activity was decreased, the expression of HO-1 and iNOS was up-regulated (P＜0.05) , and the pathological changes of lung tissues were obvious in E and I/R groups.Compared with group I/R, the W/D ratio, MDA content, and MPO activity were significantly decreased, the SOD activity was increased, the expression of HO-1 was up-regulated, the expression of iNOS was down-regulated (P＜0.05) , and the pathological changes of lung tissues were reduced in group E.Conclusion The rHuEPO can alleviate hepatic I/R-induced lung injury in rats, and the mechanism may be related to up-regulated expression of HO-1 and down-regulated expression of iNOS.

Objective: To investigate the effect of ulinastatin (UTI) pretreatment on liver regeneration and energy metabolism after 70% hepatectomy combined with ischemia reperfusion injury in rats. Methods: Totally 120 healthy clean grade male Sprague-Dawley rats weighting 230~280 g were selected and assigned into three groups randomly: simple partial hepatectomy (PH) group, partial hepatectomy combined with ischemia reperfusion (PHIR) group and ulinastatin (UTI) group, with forty rats in each. Rats in each group had the left and middle liver lobes resected, but the remnant lobes (right and caudate lobes) were treated differently as follows: the blood flow to the reserved lobes was not occluded in PH group, but occluded for 30 minutes in PHIR group, and then reperfused. UTI group had the same liver resection and blood flow occlusion as PHIR group except for administration of ulinastatin 50000 U/kg by i.v. injection via caudal vein. Inferior vena cava blood and the reserved liver tissue were collected to measure serum alanine transaminase (ALT) and aspartate aminotransferase (AST), apoptosis index (AI), regenerated liver weight, PCNA staining as well as ATP, ADP and AMP contents. Results: Serum ALT and AST activities and AI level were lower, and the regenerated liver weight and positive PCNA staining as well as ATP content and energy charge were significantly higher in UTI group than in PHIR group (P<0.05). Conclusion: Ulinastatin can promote liver regeneration after major hepatectomy combined with ischemia reperfusion injury, which is possibly related to maintaining energy metabolism.

Objective To evaluate the effect of propofol on liver injury in mice with acute liver failure (ALF).Methods Eighty adult male ICR mice,aged 1 months,weighing 20-25 g,were randomly divided into 3 groups (n =20 each) using a random number table:control group (group Ⅰ),ALF group (group Ⅱ),and ALF + propofol group (group Ⅲ).ALF model was established with intra-peritoneal D-galactosamine (D-GaIN) and lipopolysaccharide (LPS).Propofol 5 mg/kg was injected via the tail vein every 1 h within 6 h after injection of DGaIN and LPS in group Ⅲ,while the equal volume of normal saline was given instead in the other groups.Venous blood samples were taken from the tail vein at 1,3 and 6 h after injection of D-GaIN and LPS (T1-3) to detect the activities of serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) and serum tumor necrosis factor-alpha (TNF-α),interleukin-1β (IL-1β) and IL-10 concentrations (by ILISA).The survival within 12 h after injection of D-GaIN and LPS was observed and the survival rates were calculated.The mice were sacrificed and livers were removed for microscopic examination of pathologic changes.Results Compared with group Ⅰ,the activities of AST and ALT were significantly increased at each time point in Ⅱ and Ⅲ groups and the serum TNF-α concentrations at T1,2 and IL-1β and IL-10 concentrations at each time point were significantly increased in group Ⅱ,and the serum TNF-α concentrations at T1,and IL-1β and IL-10 concentrations at T2,3 were significantly increased in group Ⅲ (P ＜ 0.05).Compared with group Ⅱ,the activities of AST and ALT at each time point,serum TNF-α concentrations at T1,2 and IL-1β and IL-10 concentrations at T2,3 were significantly decreased and the survival rate within 12 h after injection of D-GaIN and LPS was increased in group Ⅲll (P ＜ 0.05).The pathologic changes of liver tissues were gradually attenuated in Ⅱ and Ⅲ groups.Conclusion Propofol can reduce the liver injury in mice with ALF through inhibiting inflammatory responses.

Background: It was previously reported that propofol, an intravenously administered hypnotic and anesthetic agent, protects organs from ischemia-reperfusion (I/R) injury. However, the underlying mechanisms are largely unknown. Glycogen synthase kinase 3 beta (GSK-3 beta) is known to play an important role in the oxidative stress-induced apoptosis. In this study, we investigated the role of GSK-3 beta and mitochondrial permeability transition pore (MPTP) in the protective effects of propofol against hepatic I/R injury.Materials and methods: The left and median hepatic artery and the portal vein branches were blocked by no-damage artery clips to create the model of partial ischemia (70%), and liver lobes were subjected to warm ischemia for 30, 60, 90 min, respectively. Reperfusion of 120 min was then initiated by the removal of clamp. The MPTP opening was assessed by measuring mitochondrial large amplitude swelling and mitochondrial membrane potential.Results: Pretreatment with propofol in conditions of hepatic I/R inhibits the apoptosis of hepatocytes as evidenced by decreased terminal deoxynucleotidyl transferase dUTP nick end labeling-positive cells. Importantly, propofol suppressed the mitochondrial GSK-3 beta by promoting or preserving its phosphorylation at Ser9, thus restraining the opening of MPTP and preventing the mitochondrial swell and mitochondrial membrane potential collapse.Conclusions: Propofol protects liver from I/R injury by sustaining the mitochondrial function, which is possibly involved with the modulation of MPTP and GSK-3 beta. (C) 2013 Elsevier Inc. All rights reserved.

Objective:To investigate the efficacy and safety of dezocine combined with sufentanil on patient controlled intravenous analgesia(PCIA) in elderly patients undergoing thoracic surgery.Methods:Ninety ASA class Ⅰ or Ⅱ elderly patients scheduled to undergoing thoracic surgery were randomly divided into 3 groups(n=30 each):dezocine(D),sufentanil(S),dezocine combined with sufentanil(DS).Group D:dezocine 0.75mg·kg-1+tropisetron 4 mg and physiological saline to 100 ml;Group S:sufentanil 2.5μg·kg-1+tropisetron 4 mg and physiological saline to 100 ml;Group DS:dezocine 0.25mg·kg-1+sufentanil 1.25μg·kg-1+ tropisetron 4 mg and physiological saline to 100 ml.VAS score,Ramsay sedation score,number of attempts,number of successful deliveries,side-effects and the satisfaction of analgesia were recorded at 3,6,12,24 and 48h after the operation.Results:In group DS the VAS score and Ramsay score were significantly better than that in group D and S(P<0.05).The side-effects(postoperative nausea and vomiting,sleepiness,respiratory depression) in group DS was significantly lower than that in group D and S(P<0.05).The number of actual press and effective press in group DS was significantly lower than that in group D and S(P<0.05).The score of the satisfaction of analgesia in group DS was significantly higher than that in group D and S(P<0.05).Conclusion:Dezocine combined with sufentanil for PCIA in elderly patients undergoing thoracic surgery can provide good postoperative analgesia,fewer side-effects and higher satisfaction of analgesia.

Objective To observe the impact of Parecoxib combined with Tramadol on peri-operative pain and inflammatory cytokines in lung cancer patients undergoing video-assisted lung lobectomy.Methods Totally 48 patients of elective lung lobectomy via video-assisted thoracic surgery under general anesthesia were randomly divided into observation group(P group)and control group(C group).The drugs for induction and maintenance of anesthesia were used identically in the two groups.In P group,Parecoxib(40 mg)was given intravenously 30 min before surgery;Parecoxib(20 mg)and Tramadol(2 mg/kg)were given intravenously 30 min before the end of surgery.In C group,normal saline(4 mL)was given intravenously 30 min before surgery;normal saline(2 mL)and Tramadol(2 mg/kg)were given intravenously 30 min before the end of surgery.Anesthesia time,operation time,recovery time and dosage of analgesic during operation were recorded;heart rate(HR)and mean arterial pressure(MAP)during recovery were noted;serum IL-6 and IL-8 levels were measured in each group perioperatively;postoperative pain was assessed using visual analog scales(VAS).Meanwhile,adverse events were observed.Results There was no significant difference between the two groups regarding anesthesia time,operation time or recovery time(P0.05).Remifental used during operation was significantly less in P group than in C group(P 0.05).HR and MAP were significantly higher immediately at extubation,5 min and 10 min after extubation in C group than in P group(P0.05).Serum IL-6 and IL-8 levels were increased 6 h,12 h and 24 h after surgery in C group,having significant difference from those in P group(P0.05).VAS was significantly lower 15 min,1 h,2 h,4 h,8 h and 12 h after surgery in P group than in C group(P0.05).The two groups did not differ significantly in adverse events(P0.05).Conclusion Parecoxib used in video-assisted thoracic surgery for lung lobectomy can decrease analgesic dosage during operation,provide satisfactory pain control and suppress inflammatory cytokines after surgery,without increasing adverse events.

BACKGROUND:Intravenous and inhalation anesthesia are commonly used in the clinical setting. Recovery of cognitive function in elderly patients after surgery has received increased attention. In this study, the authors compared recovery of cognitive function in patients after different anesthesia techniques, and investigated which technique is safer. The authors also explored association between apolipoprotein E4 and postoperative cognitive dysfunction in patients undergoing general anesthesia.METHODS:A total of 2,000 patients were equally and randomly divided into intravenous and inhalation anesthesia groups. Total intravenous and inhalation anesthesia were used. Within 10 days after surgery, cognitive function was assessed daily using the Mini-Mental State Examination (MMSE). Restriction fragment length polymorphism of apolipoprotein E gene was analyzed. The primary outcome was MMSE score, frequency distribution of apolipoprotein E alleles and genotypes. P < 0.01 was used as statistically significant.RESULTS:MMSE score in inhalation preoperative baseline group significantly decreased at day 3 after surgery compared with the preoperational and intravenous anesthesia group. The proportion of patients scoring less than 25 points was significantly greater in the inhalation anesthesia group than in the intravenous anesthesia group at 3 days after surgery. In the inhalation anesthesia group, the decrease in MMSE score was closely related with apolipoprotein E ε4 allele. In the intravenous anesthesia group, the decrease in MMSE score was not correlated with apolipoprotein E ε4 allele.CONCLUSIONS:There was a strong association between the apolipoprotein E ε4 and postoperative cognitive dysfunction in elderly patients undergoing inhalation anesthetics.