TCD value for evaluating the intracranial hypertension and nerve injury in patients with hypertensive cerebral hemorrhage

Objective: To evaluate the assessment of intracranial hypertension and nerve injury in patients with hypertensive cerebral hemorrhage by transcranial Doppler (TCD). Methods: The patients who were hospitalized for hypertensive cerebral hemorrhage between August 2014 and February 2017 were selected as the cerebral hemorrhage group and healthy subjects who received physical examination during the same period were selected as the control group;TCD was used to determine the PI of affected-side and unaffected-side middle cerebral artery in cerebral hemorrhage group and lumbar puncture was done to measure intracranial pressure. The serum was collected from the two groups to detect the levels of inflammatory cytokines and nerve injury markers. Results: PI level in affected-side middle cerebral artery of cerebral hemorrhage group was significantly higher than that in the unaffected-side and positively correlated with intracranial pressure level;serum IL-1β, TNF-α, ICAM-1, MMP9, YKL-40, Asp, Glu, NPY, NSE and GFAP levels of cerebral hemorrhage group were significantly higher than those of control group, and serum IL-1β, TNF-α, ICAM-1, MMP9, YKL-40, Asp, Glu, NPY, NSE and GFAP levels of cerebral hemorrhage group of patients with high PI level were significantly higher than those of cerebral hemorrhage group of patients with low PI level. Conclusion: TCD parameters can evaluate the degree of intracranial pressure increase and nerve injury in patients with hypertensive cerebral hemorrhage.

Effect of dexmedetomidine on immune function, hemodynamics and stress response in elderly patients undergoing thoracoscopic radical resection of lung cancer

Objective:To investigate the effects of dexmedetomidine on immune function, hemodynamics and stress response in elderly patients undergoing thoracoscopic radical resection of lung cancer Methods: 80 elderly patients who was underwent radical thoracoscopic lung cancer surgery from September 2016 to February 2018 were selected. According to the anesthesia method, it was divided into the conventional group and the observation group, 40 cases in each group. The conventional group was anesthetized with propofol, midazolam, sufentanil, and atracurium sulfonate. The observation group was anesthetized with dexmedetomidine on the basis of the conventional group. The changes of vascular dynamics were compared between the two groups before induction (T0), induction 5 min (T1), surgery (T2), extubation immediately (T3) and 5 min after extubation (T4). The changes of immune function, inflammation and stress index in T0, T2 and 24h (T5) were compared between the two groups.Results: There were no significant differences in T0 vascular kinetics, immune function and inflammation stress between the two groups (P<0.05). Compared with T0, MAP, HR and CVP were significantly increased in the conventional group at T3 and T4 (P<0.05), and MAP, HR and CVP were significantly increased in the observation group at T3 (P<0.05). Compared with the conventional group in T3, T4, the MAP, HR, and CVP levels in the observation group at T3 and T4 were significantly lower than the conventional group (P<0.05). Compared with T0, the levels of immune function IgG, IgA, IgM and NK in T2 and T5 were significantly lower in the two groups (P<0.05). There was no significant difference in IgG, IgA, IgM and NK levels between T2 and T5 in the two groups (P>0.05). Compared with T0, the stress levels of NE and E were significantly increased at T2, and the levels of inflammatory factors TNF-αand Cor were significantly increased at T2 and T5 (P<0.05). Compared with the conventional group at T2, the NE and E levels in the observation group were significantly lower than those in the conventional group (P<0.05), and the levels of TNF-α and Cor in the observation group were significantly lower than those in the conventional group at T2 and T5 (P<0.05).Conclusions: Dexmedetomidine anesthesia has little effect on perioperative hemodynamics in elderly patients undergoing thoracoscopic lung cancer radical resection, and can relieve stress response, so it is worthy of clinical application.