| Objective:It is difficult to predict the recovery time of elderly patients after general anesthesia.Delay of recovery is one of the common complications after general anesthesia,especially in elderly patients.It not only prolongs the recovery period of anesthesia,but also brings some safety risks to the elderly patients,and it is not advantaged to the recovery of organ function after operation.In order to shorten the recovery time,reduce the delayed recovery time and improve the recovery quality of the elderly patients during the recovery period of general anesthesia,the purpose of this study was to explore the effect of energy-supporting drug sodium phosphate on BIS value,recovery time,incidence of delayed recovery and restlessness after general anesthesia in elderly patients by a randomized,controlled,double-blind experiment,so as to provide reference for clinical practice.Methods:A total of 240 patients,ASA I or II,aged 65-80,undergoing selective abdominal cholecystectomy under general anesthesia were enrolled in this study.The patients were randomly divided into two groups:group creatine phosphate sodium?group P?and control group?group C?,with 60 cases in each group.A dose of100m L saline?containing 1.0 g creatine phosphate sodium?was infused intravenously at the time of skin incision in group P,and the same volume of saline was infused in group C for 30 minutes.The BIS values of before induction?T0?,cut skin?T1?,incision of gallbladder?T2?,sew peritoneum?T3?,sew skin?T4?,extubation?T5?,1min?T6?,5min?T7?,10min?T8?,15min?T9?after extubation were recorded.The steward scores were recorded at 1,5,10,15 min after extubation?T6-T9?.The time of anesthesia,operation,awake and extubation were also recorded.In addition,the incidence of delayed recovery and restlessness were observed during general anesthesia recovery period.Results:Compared with the time at T0,T8 and T9,the BIS values of the two groups decreased significantly at T5,T6 and T7?P<0.001?.Compared with group C,the BIS values of patients were significantly higher at T5,T6 and T7?P<0.001?,and the Steward scores of patients in group P at T6 and T7 were also increased?P<0.001?.Compared with group C,the time of awake and extubation in group P were significantly shorter?P<0.001?.There were three patients with delayed recovery and four patients with restlessness in different degrees occurring in group C.There was no cases of delayed recovery and restlessness occurring in group P.The incidence of delayed recovery and restlessness in group C?5%,6.7%?was higher than that in group P,respectively?0,0??P<0.001?.Conclusion:The results of this study suggested that intravenous infusion of 1.0g creatine phosphate sodium can significantly improve the BIS value and recovery time of the elderly patients undergoing abdominal cholecystectomy under general anesthesia,and can reduce the incidence of delayed recovery and restlessness during general anesthesia recovery period.Objective: When cerebral ischemia and hypoxia occurred,energy failure was one of the important causes of brain function damage.As the material of ATP synthesis,sodium creatine phosphate can directly provide energy for cells of brain,which has a certain brain protective effect.However,the specific mechanism is still unclear.In the case of cerebral ischemia and hypoxia injury,the key to the treatment is to save or reduce the neuron apoptosis in the ischemic penumbra region in time.The apoptosis pathway of the neuron is mainly the two: the death receptor pathway and the endogenous mitochondrial apoptosis pathway.In the mitochondrial apoptosis pathway,the apoptotic protein is released from the mitochondrial membrane gap to the cytoplasm,thus activating caspase protein,resulting in apoptosis.The second mitochondrial source caspase activator?Smac?is one of the apoptotic proteins,which inhibits its inhibitory effect on caspase by binding with X-linked apoptotic protein inhibitor?XIAP?.Therefore,the aim of this study was to observe the effects of sodium creatine phosphate on XIAP and Smac in ischemic penumbra after focal cerebral ischemia-reperfusion in rats,and to explore the mechanism of cerebral protection of sodium phosphate.Methods: Sixty male Sprague Dawley rats were randomly divided imo three groups?n= 20 each?: sham operation group?group A?,ischemia-reperfusion group?groupB?,sodium phosphate pretreatment group?group IC?.The rat model of middle cerebral artery occlusion?MCAO?was established in group B and C,and the rats were reperfused for 24 hours after occlusion for 2 hours.After the neurological deficit score?NDS?was evaluated at 24 h of reperfusion,the rats were sacrificed.The brains were immediately removed for microscopic examination and determination of caspase-9,XIAP,Smac protein and caspase-3 expression.Results: Compared with group B,the damage of nerve function and the number of apoptotic cells in ischemic penumbra were significantly alleviated in group C?P < 0.05?.Compared with group B,the expression of XIAP was increased in group C?P < 0.05?.Compared with group B,the expression of Smac and caspase-9,the number of caspase-3 positive cells were significantly decreased in group C?P < 0.05?.Conclusion: Sodium creatine phosphate can effectively alleviate focal cerebral ischemia-reperfusion injury in rats.The mechanism may be to inhibit the apoptosis of ischemic brain cells,promote the expression of XIAP,inhibit the expression of Smac and increase the ratio of XIAP/Smac,so as to play a protective role in the brain. |
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