Objective. To probe into the influence of dexmedetomidine (DEX) on diaphragm function and postoperative outcomes of mechanically ventilated patients in the intensive care unit (ICU). Methods. 84 patients with mechanical ventilation (MV) in the ICU of our hospital were selected as the research participants, including 38 patients in the control group (CG) sedated with midazolam (MZ) and 46 patients in the research group (RG) with DEX sedation. Ramsay sedation score, visual analogue scale (VAS), and restlessness score (RS) were used to evaluate their state before sedation (T0), as well as 2 h (T1), 6 h (T2), and 24 h (T3) after sedation, and the alterations of mean arterial pressure (MAP) and heart rate (HR) were recorded. Serum cortisol (Cor), adrenocorticotropic hormone (ACTH), superoxide dismutase (SOD), malondialdehyde (MDA), interleukin- (IL-) 1β, IL-6, and tumor necrosis factor-α (TNF-α) were measured before and 24 h after sedation. The end-inspiratory diaphragm thickness (DTei) and end-expiratory diaphragm thickness (DTee) were measured within 2 h after the initiation of MV and 5 min after the spontaneous breathing test (SBT), and the diaphragm thickening fraction (DTF) was calculated. Finally, the ventilator weaning, MV time, and the incidence of adverse reactions (ADs) of the two groups were counted. Results. T0 and T3 witnessed no distinct difference in Ramsay, VAS, and RS scores between the two arms ( P > 0.05 ), but at T1 and T2, RG had better sedation state and lower VAS and RS scores than CG ( P < 0.05 ), with more stable vital signs ( P < 0.05 ). After sedation, the contents of oxidative stress and inflammatory factors in RG were lower, while DTee, DTei, and DTF were higher, versus CG ( P < 0.05 ). Moreover, RG presented higher success rate of first ventilator weaning, less MV time, and lower incidence of ADs than CG ( P < 0.05 ). Conclusions. DEX is effective in mechanically ventilated patients in the ICU, which can protect patients against diaphragm function damage, improve the success rate of ventilator weaning, and benefit the postoperative outcome, with excellent and rapid sedation effect and less stress damage to patients.
Background: Ischemia-reperfusion injury (IRI) is the main cause of perioperative organ injury, and the morbidity increase constantly in population. Due to a lack of effective treatment, IRI is associated with a high mortality rate. Thus, we need to discover an effective means to alleviate IRI.Methods: HUVECs were treated with different concentrations of H2O2 alone and in combination with Dex to explore the dose-effect relationship of different concentrations of H2O2 and Dex on HUVEC. In order to explore the relationship between Dex and p38MAPK signal pathway, HUVEC was treated with SB202190, an inhibitor of p38MAPK signal pathway. Cell viability was detected by CCK-8 method. ELISA kit was used to detect lactate dehydrogenase (LDH). Fluorescence probe DCFH-DA staining was used to detect ROS level. Flow cytometry analysis with Propidium Iodide (PI) was used to determine the rate of cell apoptosis. And the protein expression of p-p38MAPK, total p38MAPK, p-ERK1/2 and caspase9 was detected by western blot.Results: 1)H2O2 could damage HUVEC and lead to the release of LDH. The higher the concentration of H2O2, the more severe the injury. 2)Dex pretreatment attenuated H2O2-induced oxidative stress injury and apoptosis of HUVEC. The cell activity of HUVEC increase as Dex concentration increase, the release of LDH decreased, the intracellular ROS level and apoptosis rate decreased, the protein expression of p-p38MAPK and caspase9 decreased, while the protein expression of p-ERK1/2 increased. 3)Dex had the same effect as SB202190, an inhibitor of p38MAPK signaling pathway. After the application of SB202190, the activity of HUVECs increased significantly, while LDH, intracellular ROS and apoptosis rate decreased significantly. Western blot showed that the protein expression of p-p38MAPK and caspase9 decreased significantly, while the protein levels of p-ERK1/2 increased significantly.Conclusion: 1)Dex attenuates H2O2-induced oxidative stress injury and apoptosis of HUVEC in a concentration-dependent. 2)Dex may attenuate H2O2-induced oxidative stress injury and apoptosis of HUVEC by inhibiting p38MAPK signal pathway.
Objective. To investigate the effects of different doses of hydromorphone under the guidance of ultrasound on ropivacaine blocking the superior inguinal iliac fascia and postoperative analgesia. Methods. From January 2020 to June 2021, 90 American Society of Anesthesiologists (ASA) I-II patients undergoing elective total hip arthroplasty (THA) were selected and randomly divided into 3 groups, 30 patients in each one. Ultrasound-guided superior inguinal iliac fascia block was performed in the patients of the 3 groups before operation. The L group: 0.3% ropivacaine 30 ml; the H1 group: 0.3% ropivacaine + 25 μg/kg hydromorphone 30 ml; the H2 group: 0.3% ropivacaine + 50 μg/kg hydromorphone 30 ml. The time until the occurrence of pain, pain intensity, sufentanil remedial dose, the number of PCIA presses, and effective times were compared among the 3 groups. The VAS and Ramsay scores of 3 groups were recorded at 12 h, 24 h, 36 h, and 48 h after operation. Results. The time from the end of surgery to the appearance of pain in the H2 group was higher than that in the H1 group and the L group, and the time in the H1 group was higher than that in the L group ( P < 0.05 ). The VAS score in the H2 group was lower than that in the H1 group and the L group, and the VAS score in the H1 group was lower than that in the L group ( P < 0.05 ). The VAS scores of 12 h, 24 h, 36 h, and 48 h after operation in the H2 group were lower than those of the H1 group and the L group, and the H1 group was lower than the L group ( P < 0.05 ). The Ramsay scores at 12 h, 24 h, 36 h, and 48 h after operation in the H2 group and the H1 group were higher than those in the L group ( P < 0.05 ), and the difference was not statistically significant in the H2 group and the H1 group ( P > 0.05 ). The remedial dosage of sufentanil, times of PCIA compression, and effective times in the H2 group were lower than those in the H1 group and the L group, and the level in the H1 group was lower than that in the L group ( P < 0.05 ). The incidence rates of adverse reactions in the L group, the H1 group, and the H2 group were 13.33%, 23.33%, and 30.00%, respectively. There was no significant difference in the incidence rate of adverse reactions among the 3 groups ( P > 0.05 ). Conclusion. 25 μg/kg and 50 μg/kg hydromorphone used in the ultrasound-guided superior inguinal iliac fascia block can enhance the time effect of ropivacaine and improve analgesic effects, with good safety. In addition, time effect and analgesic effect of 50 μg/kg hydromorphone in enhancing ropivacaine were more obvious.
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