目的探讨老年肺癌根治术中脑组织氧饱和度(SctO_(2))与术后神经认知障碍(PNCD)的相关性。方法选择120例接受肺癌根治术的老年患者,根据PNCD的发生情况将其分为PNCD组、非PNCD组,比较2组患者不同时间点的SctO_(2)水平。采用受试者工作特...目的探讨老年肺癌根治术中脑组织氧饱和度(SctO_(2))与术后神经认知障碍(PNCD)的相关性。方法选择120例接受肺癌根治术的老年患者,根据PNCD的发生情况将其分为PNCD组、非PNCD组,比较2组患者不同时间点的SctO_(2)水平。采用受试者工作特征(ROC)曲线分析术中SctO_(2)对患者出现PNCD的预测价值。采用Logistic回归模型分析老年肺癌根治术后出现PNCD的危险因素。结果2组患者麻醉前、麻醉后手术开始前SctO_(2)水平比较,差异无统计学意义(P>0.05)。PNCD组患者手术开始30 min及60 min的SctO_(2)水平低于非PNCD组(P<0.05)。ROC曲线显示,手术开始30 min SctO_(2)水平预测患者出现PNCD的最佳截断值为63.29%,曲线下面积为0.812(95%CI0.718~0.906),灵敏度和特异度分别为71.43%、65.22%;手术开始60 min SctO_(2)水平预测患者出现PNCD的最佳截断值为62.35%,曲线下面积为0.822(95%CI0.722~0.923),灵敏度和特异度分别为76.84%、69.57%。Logistic回归模型分析结果显示年龄>70岁、麻醉时间及手术时间较长、超敏C反应蛋白(hs-CRP)水平较高、手术开始30 min SctO_(2)<63.29%、手术开始60 min SctO_(2)<62.35%是患者出现PNCD的独立危险因素(P<0.05)。结论术中SctO_(2)水平较低是PNCD发生的独立危险因素之一,其水平可用于预测老年肺癌根治术后出现PNCD的情况。展开更多
Objective: To investigate the underlying neurobiological mechanism of the protective effect of electroacupuncture (EA) during cerebral ischemia-reperfusion (CI-R). Methods: In the first part of the study, 15 SD rats w...Objective: To investigate the underlying neurobiological mechanism of the protective effect of electroacupuncture (EA) during cerebral ischemia-reperfusion (CI-R). Methods: In the first part of the study, 15 SD rats were evenly randomized into control group, CI-R-48h model group and CI-R-48h+EA group. The cortical apoptosis and expression of Bcl-2 and Bax proteins in each group were detected by flow cytometer (FCM). In the second part of the study, 75 SD rats were evenly randomized into control, CI-R-3min, CI-R-3min+EA, CI-R-48h and CI-R-48h+EA groups. Cortical norepinephrine (NE) concentration was detected by fluorescence spectrometer. CI-R model was established by occlusion of the bilateral common carotid arteries and reperfusion. EA (4～16 Hz, 1～3 V) was applied to “Shuigou”(水沟 GV 26) and “Chengjiang”(承浆 CV 24) for 30 min before CI and after reperfusion respectively. Results: In the first part of this study, results indicated that the number of the apoptotic neurons and the apoptosis rate of CI-R-48h group were significantly higher than those of control group; while comparison between CI-R-48h+EA and CI-R-48h groups showed that the number of the apoptotic neurons and the apoptosis rate of the former group were significantly lower than those of the later group (P<0.05). In comparison with control group, after CI-48h, Bax expression was up-regulated significantly and Bcl-2 down-regulated markedly (P<0.05). Comparison between CI-R-48h and CI-R-48h+EA group indicated that Bax expression of the later group was significantly lower than that of the former group, while Bcl-2 expression of CI-R-48h+EA group was significantly higher than that of CI-R-48h group (P<0.05), suggesting that EA could reverse CI induced reactions of these two indexes. In the second part of the study, in comparison with control group, NE concentration in cerebral cortex of CI-R-3min group increased significantly (P<0.05); while NE content of CI-R-3min+EA group was significantly lower than that of CI-R-3min group (P<0.05). No significant difference was found between CI-R-3min group and control group in cortical NE levels; and no significant changes were found about NE levels in CI-R-48h and CI-R-48h+EA groups, suggesting that EA could inhibit the increase of cortical NE level in the early stage of CI. Conclusion: Changes of NE concentration in the cerebral cortex during the earlier period of CI-R is possibly related to the incidence of cortical apoptosis. EA can reduce the increase of NE due to CI and thus may inhibit CI-induced cortical apoptosis.展开更多
文摘目的探讨老年肺癌根治术中脑组织氧饱和度(SctO_(2))与术后神经认知障碍(PNCD)的相关性。方法选择120例接受肺癌根治术的老年患者,根据PNCD的发生情况将其分为PNCD组、非PNCD组,比较2组患者不同时间点的SctO_(2)水平。采用受试者工作特征(ROC)曲线分析术中SctO_(2)对患者出现PNCD的预测价值。采用Logistic回归模型分析老年肺癌根治术后出现PNCD的危险因素。结果2组患者麻醉前、麻醉后手术开始前SctO_(2)水平比较,差异无统计学意义(P>0.05)。PNCD组患者手术开始30 min及60 min的SctO_(2)水平低于非PNCD组(P<0.05)。ROC曲线显示,手术开始30 min SctO_(2)水平预测患者出现PNCD的最佳截断值为63.29%,曲线下面积为0.812(95%CI0.718~0.906),灵敏度和特异度分别为71.43%、65.22%;手术开始60 min SctO_(2)水平预测患者出现PNCD的最佳截断值为62.35%,曲线下面积为0.822(95%CI0.722~0.923),灵敏度和特异度分别为76.84%、69.57%。Logistic回归模型分析结果显示年龄>70岁、麻醉时间及手术时间较长、超敏C反应蛋白(hs-CRP)水平较高、手术开始30 min SctO_(2)<63.29%、手术开始60 min SctO_(2)<62.35%是患者出现PNCD的独立危险因素(P<0.05)。结论术中SctO_(2)水平较低是PNCD发生的独立危险因素之一,其水平可用于预测老年肺癌根治术后出现PNCD的情况。
文摘Objective: To investigate the underlying neurobiological mechanism of the protective effect of electroacupuncture (EA) during cerebral ischemia-reperfusion (CI-R). Methods: In the first part of the study, 15 SD rats were evenly randomized into control group, CI-R-48h model group and CI-R-48h+EA group. The cortical apoptosis and expression of Bcl-2 and Bax proteins in each group were detected by flow cytometer (FCM). In the second part of the study, 75 SD rats were evenly randomized into control, CI-R-3min, CI-R-3min+EA, CI-R-48h and CI-R-48h+EA groups. Cortical norepinephrine (NE) concentration was detected by fluorescence spectrometer. CI-R model was established by occlusion of the bilateral common carotid arteries and reperfusion. EA (4～16 Hz, 1～3 V) was applied to “Shuigou”(水沟 GV 26) and “Chengjiang”(承浆 CV 24) for 30 min before CI and after reperfusion respectively. Results: In the first part of this study, results indicated that the number of the apoptotic neurons and the apoptosis rate of CI-R-48h group were significantly higher than those of control group; while comparison between CI-R-48h+EA and CI-R-48h groups showed that the number of the apoptotic neurons and the apoptosis rate of the former group were significantly lower than those of the later group (P<0.05). In comparison with control group, after CI-48h, Bax expression was up-regulated significantly and Bcl-2 down-regulated markedly (P<0.05). Comparison between CI-R-48h and CI-R-48h+EA group indicated that Bax expression of the later group was significantly lower than that of the former group, while Bcl-2 expression of CI-R-48h+EA group was significantly higher than that of CI-R-48h group (P<0.05), suggesting that EA could reverse CI induced reactions of these two indexes. In the second part of the study, in comparison with control group, NE concentration in cerebral cortex of CI-R-3min group increased significantly (P<0.05); while NE content of CI-R-3min+EA group was significantly lower than that of CI-R-3min group (P<0.05). No significant difference was found between CI-R-3min group and control group in cortical NE levels; and no significant changes were found about NE levels in CI-R-48h and CI-R-48h+EA groups, suggesting that EA could inhibit the increase of cortical NE level in the early stage of CI. Conclusion: Changes of NE concentration in the cerebral cortex during the earlier period of CI-R is possibly related to the incidence of cortical apoptosis. EA can reduce the increase of NE due to CI and thus may inhibit CI-induced cortical apoptosis.
