To study the effects of electroacupuncture on sympathetic adrenomedullary(SA) system and renin angiotensin aldosterone (RAA) system in open heart surgical patients undergoing cardiopulmonary bypass (CPB), 30 patients ...To study the effects of electroacupuncture on sympathetic adrenomedullary(SA) system and renin angiotensin aldosterone (RAA) system in open heart surgical patients undergoing cardiopulmonary bypass (CPB), 30 patients with atrial septal defect were randomly divided into general anesthesia (GA) group, acupuncture anesthesia (AA) group and acupuncture with general anesthesia (AGA) group. Peripheral blood samples were taken before anesthesia and 30 min after CPB. The plasma concentrations of norepinephrine (NE), epinphrine (E) and angiotensinⅡ(AⅡ) were detected. Results: Plasma NE and E of post CPB increased significantly in GA group and AA group, but decreased significantly in AGA group. Plasma AⅡ of post CPB increased significantly in GA group, but no marked changes were found in AA group and AGA group. Conclusions: Acupuncture can improve the AⅡ response to cardiac surgery and CPB. AGA but not AA can inhibit the catecholamine (CA) response to cardiac surgery and CPB.展开更多
Objective To investigate the roles of sympathetic and vagus nerves in hypotension and bradycardia induced by fentanyl. Methods Fourteen rabbits were divided into 2 groups: normal and vagotomized rabbits. Rabbits were ...Objective To investigate the roles of sympathetic and vagus nerves in hypotension and bradycardia induced by fentanyl. Methods Fourteen rabbits were divided into 2 groups: normal and vagotomized rabbits. Rabbits were anesthetized, paralyzed, and artificial ventilated. Right renal sympathetic nerve was exposed and prepared for recording electrical activity. Fentanyl was injected intravenously in incremental doses of 1, 4, 15, 30, and 50 μg/kg at 10 minutes intervals. Results Fentanyl significantly reduced the spontaneous activity of renal sympathetic nerve, mean arterial pressure, and heart rate above a total dose of 20 μg/kg in both normal and vagotomized rabbits. However, normal rabbits spontaneous sympathetic nerve activity and mean arterial pressure were more depressed than vagotomized rabbits at total doses of 50 and 100 μg/kg. There were no significant difference in the reduction of heart rate between normal and vagotomized rabbits. Conclusion Fentanyl induction of bradycardia and hypotension in rabbits is mainly due to depression of sympathetic nerve activity.展开更多
背景：齐考诺肽(ziconotide，以前称为SN-111)可选择性阻断N型电压敏感性钙通道，该药可能对鸦片治疗无效或不能耐受鸦片类药物不良作用的疼痛患者有效。目的：在常规治疗无效的疼痛患者中评估鞘内注射ziconotide的效果和安全性。设计...背景：齐考诺肽(ziconotide，以前称为SN-111)可选择性阻断N型电压敏感性钙通道，该药可能对鸦片治疗无效或不能耐受鸦片类药物不良作用的疼痛患者有效。目的：在常规治疗无效的疼痛患者中评估鞘内注射ziconotide的效果和安全性。设计、地点和病例：1996年3月12日至1998年6月11日于美国、澳大利亚和荷兰32个研究中心进行的随机、双盲、安慰剂对照试验。参试者为111例24～85岁癌症或AIDS患者，疼痛强度视觉模拟评分(Visual Analog Scale of Pain Intensity，VASPI)平均为≥50mm。以2：1的比例随机分配患者接受ziconotide或安慰剂治疗。干预：鞘内注射ziconotide 5—6天，有效者继续维持5天，无效者转至安慰剂组。主要观察指标：与基线比较，初始滴定结束时VASPI评分变化百分率的平均值。结果：在评估人群中，68例接受ziconotide的患者和40例接受安慰剂的患者中分别有67例(98．5％)和38例(95％)在基线时使用了鸦片类药物(吗啡中位当量ziconotide组300mg／d，安尉剂组600mg／d；根据平均值计算P=0．63)，36例曾鞘内注射吗啡。Ziconotide组VASH评分均数(SD)为73．6(1．8)mm，而安慰剂组则为77．9(2．3)mm(P=0．18)。Ziconotide组VASPI评分均值下降了53．1％(95％可信区间[CI]，44．0％-62．2％)，而安慰剂组均值下降了18．1％(95％CI，4．8％-31．4％)(P<0．001)，维持阶段ziconotide组效果无减弱。Ziconotide组52．9％的患者疼痛中度至完全缓解，而安慰剂组的比例为17．5％(P<0．001)。接受ziconotide的患者中5例疼痛完全缓解，50％的患者ziconotide治疗有效，而安慰剂组则仅为17．5％(P=0．001)。结论：对于癌症或AIDS疼痛患者而言，鞘内注射ziconotide可起到显著的镇痛效果，具有统计学和临床意义。展开更多
Background Awareness under general anesthesia is a serious complication which leads to psychiatric disorders. The incidence of awareness in patients undergoing cardiac surgery has been reported in as many as 1.5%-23% ...Background Awareness under general anesthesia is a serious complication which leads to psychiatric disorders. The incidence of awareness in patients undergoing cardiac surgery has been reported in as many as 1.5%-23% in foreign countries. But so far, medical literature about awareness during cardiac surgery is still rare in China. Therefore, we investigated the incidence of awareness in patients undergoing different kinds of cardiac surgery, the phases when awareness occured and the effect of cardiopulmonary bypass on the incidence of awareness in coronary artery bypass grafting in Beijing.Methods Patients' recall of awareness during cardiac surgery was assessed. One hundred patients undergoing coronary artery bypass grafting (CABG) in Chaoyang Hospital, Beijing, one hundred patients undergoing CABG and one hundred patients undergoing valve replacement or septal defect repair in Fuwai Hospital, Beijing, were interviewed 3-6 days after surgery. Every report obout patients on recall of awareness was recorded. An independent research team, blinded to patients' surgery and anesthesia, assessed every report of awareness.Results The incidence of awareness of patients received CABG under cardiopulmonary bypass (CPB), off -pump CABG, septal repair or valve replacement under CPB was 4.7% (5 of 106 cases), 9.6% (9 of 94 cases) and 4% (4 of 100 cases), respectively. CPB did not greatly affect the incidence of awareness during the period of CABG (P>0.05). The incidence of awareness of patients who received CABG under CPB did not increase significantly, in comparison with that of patients who received septal repair or valve replacement under CPB in Fuwai Hospital (P>0.05). Awareness easily occurred before bypass grafting or CPB.Conclusions Awareness mainly occurs before bypass grafting or CPB in cardiac surgery. Most cases with awareness have auditory perceptions. CPB is not a main factor which affects the incidence of awareness of CABG. Surgical types do not affect the incidence of awareness of patients under CPB.展开更多
Background The hemodynamics and oxygenation severely fluctuated during the offpump coronary artery bypass grafting (OPCABG) This study aimed at investigating whether or not nicardipine combined with esmolol (1∶10) ca...Background The hemodynamics and oxygenation severely fluctuated during the offpump coronary artery bypass grafting (OPCABG) This study aimed at investigating whether or not nicardipine combined with esmolol (1∶10) can maintain systemic and tissue oxygenation during OPCABGMethods Twenty patients scheduled for OPCABG were divided ramdomly into Group nicardipine (N) and Group nitroglycerine (X) respectively combined with esmolol (E) (Dosage ratio: 1 to 10) (Group N+E and Group X+E) with 10 patients in each group The mixed solution of N+E or X+E were titrated to maintain mean arterial blood pressure between 70 and 80 mmHg following anesthesia induction The variables of hemodynamics, arterial blood lactate content (Lac) and gastric intramucosal partial pressure of carbon dioxide were measured at the following time points: after induction of anesthesia (T1), prerevascularization (T2), grafting of left anterior descending (T3), right coronary descending (T4) and left coronary circumflexus branches (T5), postrevascularization (T6), the end of operation (T7) The delivery of oxygen (DO2), consumption of oxygen (VO2) and gastric intramucosal pH (pHi) were calculatedResults The cardiac index (CI) in Group N+E was significantly increased (P<005) as compared with T1 during OPCABG, while it was mildly decreased in Group X+E The stroke volumes at T4, T5 in Group N+E and at T3T6 in Group X+E were significantly decreased (P<005) The systemic vascular resistance indices in Group N+E were significantly decreased as compared with T1 (P<005) The heart rates in these two Groups were significantly elevated intraoperatively (P<005) The DO2 after the infusion of N+E was significantly increased (P<005) or leveled to T1, and the Lac were within the normal range But the DO2 in Group X+E was decreased throughout the procedure, reaching significant level at T5 (P<005), and the Lac was significantly increased beyond normal range (P<005) The pHi in Group N+E was maintained above 735 during OPCABG, while it was less than 735 from T4 to T7 in Group X+EConclusion Nicardipine combined with esmolol (1∶10) regimen may maintain systemic and tissue oxygenation during OPCABG展开更多
基金ThisstudywassupportedbyagrantfromtheNationalScienceFoundationofChina (No .96-90 6-1 1 -0 1 )
文摘To study the effects of electroacupuncture on sympathetic adrenomedullary(SA) system and renin angiotensin aldosterone (RAA) system in open heart surgical patients undergoing cardiopulmonary bypass (CPB), 30 patients with atrial septal defect were randomly divided into general anesthesia (GA) group, acupuncture anesthesia (AA) group and acupuncture with general anesthesia (AGA) group. Peripheral blood samples were taken before anesthesia and 30 min after CPB. The plasma concentrations of norepinephrine (NE), epinphrine (E) and angiotensinⅡ(AⅡ) were detected. Results: Plasma NE and E of post CPB increased significantly in GA group and AA group, but decreased significantly in AGA group. Plasma AⅡ of post CPB increased significantly in GA group, but no marked changes were found in AA group and AGA group. Conclusions: Acupuncture can improve the AⅡ response to cardiac surgery and CPB. AGA but not AA can inhibit the catecholamine (CA) response to cardiac surgery and CPB.
文摘Objective To investigate the roles of sympathetic and vagus nerves in hypotension and bradycardia induced by fentanyl. Methods Fourteen rabbits were divided into 2 groups: normal and vagotomized rabbits. Rabbits were anesthetized, paralyzed, and artificial ventilated. Right renal sympathetic nerve was exposed and prepared for recording electrical activity. Fentanyl was injected intravenously in incremental doses of 1, 4, 15, 30, and 50 μg/kg at 10 minutes intervals. Results Fentanyl significantly reduced the spontaneous activity of renal sympathetic nerve, mean arterial pressure, and heart rate above a total dose of 20 μg/kg in both normal and vagotomized rabbits. However, normal rabbits spontaneous sympathetic nerve activity and mean arterial pressure were more depressed than vagotomized rabbits at total doses of 50 and 100 μg/kg. There were no significant difference in the reduction of heart rate between normal and vagotomized rabbits. Conclusion Fentanyl induction of bradycardia and hypotension in rabbits is mainly due to depression of sympathetic nerve activity.
文摘背景：齐考诺肽(ziconotide，以前称为SN-111)可选择性阻断N型电压敏感性钙通道，该药可能对鸦片治疗无效或不能耐受鸦片类药物不良作用的疼痛患者有效。目的：在常规治疗无效的疼痛患者中评估鞘内注射ziconotide的效果和安全性。设计、地点和病例：1996年3月12日至1998年6月11日于美国、澳大利亚和荷兰32个研究中心进行的随机、双盲、安慰剂对照试验。参试者为111例24～85岁癌症或AIDS患者，疼痛强度视觉模拟评分(Visual Analog Scale of Pain Intensity，VASPI)平均为≥50mm。以2：1的比例随机分配患者接受ziconotide或安慰剂治疗。干预：鞘内注射ziconotide 5—6天，有效者继续维持5天，无效者转至安慰剂组。主要观察指标：与基线比较，初始滴定结束时VASPI评分变化百分率的平均值。结果：在评估人群中，68例接受ziconotide的患者和40例接受安慰剂的患者中分别有67例(98．5％)和38例(95％)在基线时使用了鸦片类药物(吗啡中位当量ziconotide组300mg／d，安尉剂组600mg／d；根据平均值计算P=0．63)，36例曾鞘内注射吗啡。Ziconotide组VASH评分均数(SD)为73．6(1．8)mm，而安慰剂组则为77．9(2．3)mm(P=0．18)。Ziconotide组VASPI评分均值下降了53．1％(95％可信区间[CI]，44．0％-62．2％)，而安慰剂组均值下降了18．1％(95％CI，4．8％-31．4％)(P<0．001)，维持阶段ziconotide组效果无减弱。Ziconotide组52．9％的患者疼痛中度至完全缓解，而安慰剂组的比例为17．5％(P<0．001)。接受ziconotide的患者中5例疼痛完全缓解，50％的患者ziconotide治疗有效，而安慰剂组则仅为17．5％(P=0．001)。结论：对于癌症或AIDS疼痛患者而言，鞘内注射ziconotide可起到显著的镇痛效果，具有统计学和临床意义。
文摘Background Awareness under general anesthesia is a serious complication which leads to psychiatric disorders. The incidence of awareness in patients undergoing cardiac surgery has been reported in as many as 1.5%-23% in foreign countries. But so far, medical literature about awareness during cardiac surgery is still rare in China. Therefore, we investigated the incidence of awareness in patients undergoing different kinds of cardiac surgery, the phases when awareness occured and the effect of cardiopulmonary bypass on the incidence of awareness in coronary artery bypass grafting in Beijing.Methods Patients' recall of awareness during cardiac surgery was assessed. One hundred patients undergoing coronary artery bypass grafting (CABG) in Chaoyang Hospital, Beijing, one hundred patients undergoing CABG and one hundred patients undergoing valve replacement or septal defect repair in Fuwai Hospital, Beijing, were interviewed 3-6 days after surgery. Every report obout patients on recall of awareness was recorded. An independent research team, blinded to patients' surgery and anesthesia, assessed every report of awareness.Results The incidence of awareness of patients received CABG under cardiopulmonary bypass (CPB), off -pump CABG, septal repair or valve replacement under CPB was 4.7% (5 of 106 cases), 9.6% (9 of 94 cases) and 4% (4 of 100 cases), respectively. CPB did not greatly affect the incidence of awareness during the period of CABG (P>0.05). The incidence of awareness of patients who received CABG under CPB did not increase significantly, in comparison with that of patients who received septal repair or valve replacement under CPB in Fuwai Hospital (P>0.05). Awareness easily occurred before bypass grafting or CPB.Conclusions Awareness mainly occurs before bypass grafting or CPB in cardiac surgery. Most cases with awareness have auditory perceptions. CPB is not a main factor which affects the incidence of awareness of CABG. Surgical types do not affect the incidence of awareness of patients under CPB.
文摘Background The hemodynamics and oxygenation severely fluctuated during the offpump coronary artery bypass grafting (OPCABG) This study aimed at investigating whether or not nicardipine combined with esmolol (1∶10) can maintain systemic and tissue oxygenation during OPCABGMethods Twenty patients scheduled for OPCABG were divided ramdomly into Group nicardipine (N) and Group nitroglycerine (X) respectively combined with esmolol (E) (Dosage ratio: 1 to 10) (Group N+E and Group X+E) with 10 patients in each group The mixed solution of N+E or X+E were titrated to maintain mean arterial blood pressure between 70 and 80 mmHg following anesthesia induction The variables of hemodynamics, arterial blood lactate content (Lac) and gastric intramucosal partial pressure of carbon dioxide were measured at the following time points: after induction of anesthesia (T1), prerevascularization (T2), grafting of left anterior descending (T3), right coronary descending (T4) and left coronary circumflexus branches (T5), postrevascularization (T6), the end of operation (T7) The delivery of oxygen (DO2), consumption of oxygen (VO2) and gastric intramucosal pH (pHi) were calculatedResults The cardiac index (CI) in Group N+E was significantly increased (P<005) as compared with T1 during OPCABG, while it was mildly decreased in Group X+E The stroke volumes at T4, T5 in Group N+E and at T3T6 in Group X+E were significantly decreased (P<005) The systemic vascular resistance indices in Group N+E were significantly decreased as compared with T1 (P<005) The heart rates in these two Groups were significantly elevated intraoperatively (P<005) The DO2 after the infusion of N+E was significantly increased (P<005) or leveled to T1, and the Lac were within the normal range But the DO2 in Group X+E was decreased throughout the procedure, reaching significant level at T5 (P<005), and the Lac was significantly increased beyond normal range (P<005) The pHi in Group N+E was maintained above 735 during OPCABG, while it was less than 735 from T4 to T7 in Group X+EConclusion Nicardipine combined with esmolol (1∶10) regimen may maintain systemic and tissue oxygenation during OPCABG
