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Background:In the clinical setting, the effect of intra-abdominal hypertension on the human body is dependent on time, but its role is not yet clear.Objective:To investigate the effect of the duration of intra-abdominal hypertension (IAH) on the prognosis of critically ill patients.Methods:This prospective cohort study enrolled 256 IAH patients who were admitted to the Surgical ICU of 10 Grade A hospitals in Fujian Province from January 2018 to December 2020. The duration of IAH (DIAH) was obtained after monitoring IAP, and ICU length of stay, duration of mechanical ventilation, duration of continuous renal replacement therapy (CRRT) and average daily energy intake from enteral nutrition during ICU stay were observed and recorded. The correlation was analyzed by Spearman rank correlation. The patients were divided into the survival group and the death group according to their survival state at 60 days after enrollment. Thereafter, clinical characteristics between the two groups were compared. Multivariable logistic regression was used to study and validate the relationship between DIAH and 60-day mortality. The receiver operating characteristics (ROC) curve was established to evaluate the predictive abilities of DIAH on the mortality risk.Results:In critically ill patients, DIAH was positively correlated with duration of mechanical ventilation ( r=0.679, P<0.001), duration of CRRT ( r=0.541, P<0.001) and ICU length of stay ( r=0.794, P<0.001), respectively. In addition, there was a negative correlation between DIAH and average daily energy intake from enteral nutrition ( r=-0.669, P<0.001). After multivariable adjustment, DIAH was an independent risk factor for 60-day mortality in critically patients with IAH ( OR=1.05, 95% CI: 1.01-1.12; P = 0.012), and exhibited a linearity change trend relationship with mortality risk. The ROC curve analysis of DIAH showed that the area under ROC curve (AUC) was 0.825 (95% CI: 0.763~0.886, P<0.01). When the cut-off value was 16.5 days, the sensitivity was 78.4% and the specificity was 75.4%. Conclusions:DIAH is an important risk factor for prognosis in critically ill patients. Early identification and rapid intervention for the etiology of IAH should be performed to shorten DIAH.
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Objective:To investigate the clinical efficacy and prognostic influencing factors of open abdomen technique for acute pancreatitis with abdominal compartment syndrome (ACS).Methods:The retrospective cohort study was conducted. The clinical data of 186 patients of acute pancreatitis with ACS who were admitted to 6 hospitals, including 65 cases in the 910th Hospital of Joint Logistics Support Force of Chinese People′s Liberation Army, 46 cases in the First Affiliated Hospital of Wenzhou Medical University, 33 cases in the Fujian Provincial Hospital, 31 cases in the Second Affiliated Hospital of Fujian Medical University, 7 cases in the People′s Hospital Affiliated to Quanzhou Medical College, 4 cases in the Shishi General Hospital, from January 2013 to December 2020 were collected. There were 142 males and 44 females, aged (43±8)years. Observation indica-tors: (1) patients conditions after being treatment with open abdomen technique; (2) analysis of clinical characteristics in patients with different treatment outcomes; (3) changing trend of the volume of urine output, levels of lactic acid, levels of enteral nutrient intake and the sequential organ failure score in patients with different treatment outcomes; (4) influencing factors for prognosis of patients. Measurement data with normal distribution were represented as Mean± SD, and compari-son between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test or the continuity correction chi-square test. Repeated measurement data were analyzed using the repeated ANOVA. Spearman correlation analysis was used for correlation analyses. The COX regression model was used for univariate analysis and COX regression model with forward regression was used for multivariate analysis. Results:(1) Patients conditions after being treatment with open abdomen technique. Intra-abdominal pressure, oxygena-tion index, levels of lactic acid and sequential organ failure score of the 186 patients were (23.3±1.9)mmHg (1 mmHg=0.133 kPa), (121±24)mmHg, (5.0±3.4)mmol/L and 10.4±3.6 before the treatment with open abdomen technique and (11.2±2.9)mmHg, (222±38)mmHg, (3.2±2.1)mmol/L and 4.4±2.3 at postoperative 168 hours, showing significant differences in time effects before and after the treatment ( Ftime=855.26,208.50, 174.91,208.47, P<0.05). (2) Analysis of clinical characteristics in patients with different treatment outcomes. Of the 186 patients, 166 cases survived and were discharged, and 20 cases died during hospitalization. Age, sequential organ failure score, duration of ACS and levels of lactic acid during hospitalization before the treatment with open abdomen technique were (41±7)years, 9.4±3.4, 13(10,21)hours and (4.2±0.6)mmol/L in surviving patients, versus (45±6)years, 11.5±2.4, 65(39,84)hours and (5.2±0.5)mmol/L in dead patients, respectively, showing significant differences between them ( t=-2.10, -2.71, Z=-5.36, t=-7.16, P<0.05). Duration of postoperative acute gastro-intestinal injury, duration of continuous renal replacement therapy, time to liberation from mech-anical ventilation, duration of vasoactive drugs therapy, cases undergoing early abdominal closure, cases without intestinal fistula or with postoperative high-order intestinal fistula and low-order intestinal fistula during hospitalization after the treatment with open abdomen technique were 4(2,6)days, 4(3,7)days, 34(21,41)days, 3(2,6)days, 126, 131, 23, 12 in surviving patients, versus 13(10,17)days, 10(8,18)days, 0(0,3)days, 8(6,12)days, 1, 2, 15, 3 in dead patients, respectively, showing significant differences between them ( Z=-5.60, -3.75, -3.64, -3.06, χ2=41.43, 45.86, P<0.05). (3) Changing trend of the volume of urine output, levels of lactic acid, levels of enteral nutrient intake and the sequential organ failure score in patients with different treatment outcomes. The volume of urine output, levels of lactic acid, levels of enteral nutrient intake and the sequential organ failure score in surviving patients during hospitalization were (0.29±0.10)mL/(kg·h), (4.2±0.6)mmol/L, 0.0 kcal/(kg·d) and 9.4±3.4 before the treatment with open abdomen technique and (2.22±0.15)mL/(kg·h), (1.9±0.7)mmol/L, (20.7±2.9)kcal/(kg·d) and 3.7±2.2 at postoperative 168 hours. The above indicators in dead patients during hospitalization were (0.28±0.08)mL/(kg·h), (5.2±0.5)mmol/L, 0.0kcal/(kg·d) and 11.5±2.4 before the treatment with open abdomen technique and (0.28±0.09)mL/(kg·h), (7.7±0.8)mmol/L, (4.6±1.8)kcal/(kg·d) and 12.4±2.1 at postoperative 168 hours. There were significant differences in time effects in the above indicators in surviving patients and dead patients before and after the treatment with open abdomen technique ( Ftime=425.57, 188.59, 394.84, 37.52, P<0.05). There were interactive effects between the above indicators and the treatment outcome at different time points ( Finteraction=383.14, 233.04, 169.83, 36.61, P<0.05). There were signifi-cant differences in the change trends of the above indicators between the surviving patients and the dead patients during hospitalization ( Fgouprs=2 739.56, 877.98, 542.05, 240.85, P<0.05). (4) Influen-cing factors for prognosis of patients. Results of univariate analysis showed that age, sequential organ failure score, duration of ACS before surgery, procalcitonin, lactic acid, postoperative high-order intestinal fistula, abdominal hemorrhage, duration of postoperative acute gastrointestinal injury, duration of continuous renal replacement therapy, duration of vasoactive drugs therapy, early abdominal closure were related factors influencing prognosis of patients under-going treatment with open abdomen technique ( hazard ratio=1.07, 1.18, 1.39, 1.16, 8.25, 12.26, 2.83, 1.29, 1.56, 1.41, 0.02, 95% confidence interval as 1.00-1.15, 1.45-2.27, 1.22-1.57, 1.02-1.32, 1.75-38.90, 7.37-41.23, 1.16-6.93, 1.22-1.37, 1.23-1.99, 1.08-1.84, 0.00-0.16, P<0.05). Results of multivariate analysis showed that extended duration of ACS before surgery, postoperative high-order intestinal fistula and extended duration of postoperative acute gastrointestinal injury were independent risk factors influencing prognosis of patients undergoing treatment with open abdomen technique ( hazard ratio=1.05, 7.95, 1.17, 95% confidence interval as 1.01-1.32, 2.05-30.87, 1.13-1.95, P<0.05) and early abdominal closure was an independent protective factor ( hazard ratio=0.10, 95% confidence interval as 0.01-0.89, P<0.05). Results of Spearman correlation analysis showed that duration of ACS was positively correlated with sequential organ failure score before surgery ( r=0.71, P<0.05). Conclusions:Open abdomen technique is effective for acute pancreatitis with ACS. Extended duration of ACS before surgery, postoperative high-order intestinal fistula and extended duration of postoperative acute gastrointestinal injury are independent risk factors for prognosis of patients during hospitalization and early abdominal closure is an independent protective factor.
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Objective Early identification of deep vein thrombosis(DVT) risk in patients with joint arthroplasty helps to reduce the incidence of DVT.The study aimed to investigate the effectiveness of Autar risk assessment model in assessing DVT risk in patients with joint arthroplasty.Methods 72 patients with DVT from 10 hospitals from November 2014 to February 2016 were selected as the case group, and 144 non-DVP patients who hospitalized during the same period served as the control group.The medical history, laboratory tests and other related clinical data of the patients were collected, and Autar risk assessment scale was used to evaluate the patients.Multiple logistic regression was applied to analyze the relationship between the risk scale of DVT and the risk of DVT formation.Results 216 patients were included in the research.The Autar score of DVT patients (17.09±2.83) in case group was higher than that of control group (14.25±2.46) and the difference is of statistical significance(P<0.05).The area under the ROC curve of Autar scale in case group was 0.789 (95％CI: 0.719, 0.858,P<0.05).When the ROC curve cutoff point was 15, the sensitivity and the specificity of Autar scale were 88.57％ and 57.90％ respectively.In Autar scale, the main risk factors of DVT incidence were age≥70 years old, BMI≥30, strict bed rest, varicose veins, lower limb injuries and orthopedic surgery.The result of logistic regression analysis showed the difference of Autar risk rating between these two groups was of statistical significance(P<0.05).In comparison with low risk group, the DVT risk of patients with joint arthroplasty at medium risk was of no significant difference (OR=1.178, 95％ CI: 0.733-1.490, P=0.053) while that of patients with joint arthroplasty at high risk was of significant difference (OR=5.536, 95％ CI:3.577-7.132, P<0.001).Conclusion Autar DVT risk assessment scale assessed patients with joint arthroplasty at high risk are high risk group of DVT.The risk of DVT increases with the risk rating in patients with joint arthroplasty.Therefore, Autar risk assessment scale can be applied in the assessment of DVT risk in patients with joint arthroplasty.
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Objective To investigate the effect of dexmedetomidine on the serum concentrations of S-100 β protein and neurone specific enolase (NSE) in elderly patients undergoing surgery.Methods One hundred ASA Ⅱ or Ⅲ patients,aged 65 ～75 yr with a body mass index of ＜25 kg/m2,scheduled for elective hip joint replacement surgery under general anesthesia,were randomly divided into 2 groups (n =50):control group (group C) and dexmedetomidine group (group D).Dexmedetomidine 0.5 μg/kg was infused intravenously over 15 min before anesthesia induction in group D and was maintained 0.4 μg/(kg·h) until 30 min before operation end,while the same volume of normal saline was infused in group C.Anesthesia was induced by iv injection of sufentanil 0.4 μg/kg and propofol 1 ～ 2 mg/kg until loss of consciousness.Tracheal intubation was facilitated with 0.6 mg/kg rocuronium bromide and the patients were mechanically ventilated.Anesthesia was maintained with sevoflurane by target controlled inhalation (TCI) (end-tidal concentration set at 1％～3％) and sufentanil 0.2 μg/(kg·h) in both groups.BIS was maintained at 40～60 during operation.Venous blood samples were obtained for determination of serum concentrations of S-100β protein and NSE before anesthesia (baseline),operation end and at 12h after operation.Patients were sent to Intensive Care Unit when operation end.All the patients were assessed for the development of delirium by experience research staff using Confusion Assessment Method for Intensive Care Unit.The incidence of postoperative delirium within 24h after operation were recorded,and compared between the two groups.Results The serum concentrations of S-100β protein and NSE was significantly increased at T1～2 than at T0 in two groups.The total dose of each anesthetic (propofol,sevoflurane),the serum concentrations of S-1005 protein and NSE,and the incidence of postoperative delirium were significantly lower in group D than in group C (P＜0.05).Conclusions Dexmedetomidine can reduce the serum concentrations of S-100 β protein and NSE,and can also reduce the occurrence of postoperative delirium in elderly patients undergoing hip joint replacement surgery.Dexmedetomidine can provides cerebral protection in elderly patients undergoing surgery.
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ObjectiveTo investigate the risk factors for postoperative pulmonary infection in patients with primary liver cancer through a retrospective analysis, and to provide a reference for appropriate preventive measures in clinical treatment. MethodsA total of 286 patients with liver cancer who visited Department of Hepatology, 180 Hospital of PLA, from May 2011 to December 2015 were enrolled, and according to the presence or absence of postoperative pulmonary infection, these patients were divided into infection group (36 patients) and non-infection group (250 patients). The factors for postoperative pulmonary infection were analyzed. The t-test was used for comparison of continuous data between groups, the chi-square test was used for comparison of categorical data between groups, and logistic multivariate regression analysis was used to analyze the risk factors for postoperative pulmonary infection. ResultsThe univariate analysis showed that age distribution, smoking history, diabetes, intraoperative blood transfusion volume, and the indwelling time of abdominal drainage tube showed significant differences between the two groups (all P＜0.05). The multivariate analysis showed that smoking history, diabetes, intraoperative blood transfusion volume, and the indwelling time of abdominal drainage tube were independent risk factors for postoperative pulmonary infection in patients with primary liver cancer (all P＜0.05). Among the anesthesia-related factors, application of single-use medical devices and perioperative antibacterial agents significantly reduced the incidence rate of postoperative pulmonary infection (both P＜0.05). ConclusionSmoking history, diabetes, intraoperative blood transfusion volume, the indwelling time of abdominal drainage tube, no use of single-use medical devices during anesthesia, and no use of perioperative antibacterial agents are risk factors for postoperative pulmonary infection in patients with primary liver cancer. Corresponding preventative and treatment methods can effectively prevent the development of postoperative pulmonary infection.
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Objective To explore the application of a three-dimensional simulation system in extended liver resections.Methods A three-dimensional surgical simulation system was used for preoperative assessment and for computer simulation to estimate the resected liver volume,the residual liver volume,and the surgical resection margins.The software virtual liver resection was used to choose the most optimal surgical option.The actual resection,the postoperative liver volume and the actual surgical resection margins were compared.Results 1 patient was diagnosed by ultrasound to develop ascites on post-operative day 2.Another patient was diagnosed by transthoracic ultrasound to have moderate pleural effusion on postoperative day 1.Postoperative liver failure developed in 1 patient.There was no patient who developed bile leakage.The average length of stay was 6 ～ 85 days (average 22 d).There was no recurrence within 1 month after surgery and there was no postoperative deaths.Condusions The three-dimensional surgery simulation system was effective.It gave an accurate evaluation and simulation of the liver surgery.In extended liver resection,it gave good guidance and help.
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Objective To profile the types of bacteria in bile culture and study their antibiotic sensitivity pattern in patients with varying de-grees of acute cholangitis and to provide data guidance for the prevention and treatment of bacterial infection.Methods The clinical data of 230 patients with acute cholangitis who were admitted to our hospital from April 2010 to April 2014 were retrospectively analyzed.Classifica-tion of pathogenic bacteria and the antibiotic sensitivity test in bile cultures were performed using VITEK 2 Compact Biomerieux microbiologi-cal system.Results Within the 230 patients,172 tested positive for biliary bacteria,and the positive rate was 74.78%(172/230).There were 237 strains of pathogenic bacteria,including 135 strains of Gram-positive bacteria (56.96%),comprised mainly of Enterococcus and Staphylococcus aureus,96 strains of Gram-negative bacteria (40.5 1%),comprised mainly of Pseudomonas aeruginosa,Escherichia coli, and Klebsiella pneumonia,and 6 strains of fungi (2.53%),comprised mainly of yeast.Significant difference in the positive rate of bacteria was detected between patients with mild and severe cholangitis (χ2 =4.58,P =0.028).Gram-negative bacteria were the predominant i-solates in patients with mild and moderate acute cholangitis,while multiple bacterial infection was more common in patients with severe cholangitis.Biliary bacteria had a higher rate of susceptibility to vancomycin,imipenem,and amikacin compared with other antibiotics. Conclusion Gram-positive bacteria are the predominant pathogens in acute cholangitis.Early detection,immediate intervention,and ac-curate drug susceptibility test should be implemented at regular intervals to direct effective clinical therapy.
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Objective To investigate the clinical effect of different nutritional therapies on the immune function of patients with malignant obstructive jaundice after percutaneous transhepatic cholangiodrainage (PTCD).Methods A total of 50 patients with malignant obstructive jaundice who were admitted to our hospital from January 2009 to March 2013 were randomly divided into two groups according to the admis-sion order.The patients in group A (n=25 )received enteral nutritional support after PTCD,and those in group B (n=25 )received total parenteral nutritional support after PTCD.Intra-group and inter-group comparisons were made in terms of jaundice clearance,nutritional indices,and body’s immune function on preoperative day 1 and postoperative day 7;comparison between the two groups was made by t test. Results Among the 50 patients who underwent PTCD,39 (78%)had good drainage,while 1 1 (22%)did not reach the expectation,of which,5 (10%)were in group A and 6 (12%)in group B.In both groups,the nutritional indices on postoperative day 7 were significantly higher than those on preoperative day 1(P0.05).The immune function of patients in both groups was significantly improved following PTCD and nutrition-al support (P0.05).Although the same scheme of nutritional support was used,there were 1 1 patients who did not achieve the expected jaundice clearance after PTCD and had limited improvement in immune function compared with those who had complete jaundice clearance (all P<0.05).Conclusion Jaundice clearance is closely re-lated to PTCD in patients with malignant obstructive jaundice,but not markedly associated with the ways of nutritional support.
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Objective To investigate the effects of splenectomy on peripheral immune cells including Th17 cells in patients with portal hy-pertension and to analyze the influence of splenectomy on their immune function.Methods Twenty-five portal hypertension patients trea-ted with splenectomy in No.180 Hospital of PLA from June 2012 to June 2014 were selected as observation group,and 25 healthy controls who underwent physical examination in the same period as control group.Flow cytometry was used to determine the percentages of CD3 , CD4,and CD8 T lymphocytes,CD4/CD8 ratio,and percentage of Th17 cells in the peripheral blood of portal hypertension patients (1 day before operation and at 7 days,1 month,and 3 months after operation)and healthy controls.ELISA was used to evaluate the changes in ser-um interleukin-6 (IL-6),interleukin-17 (IL-17),and interleukin-23 (IL-23).Comparison between groups was made by one-way ANOVA and LSD-t test.Results Before splenectomy,the portal hypertension patients had significantly lower percentages of CD3, CD4,and CD8 T lymphocytes and CD4/CD8 ratio (P0.05 for all).At 7 days,1 month,and 3 months after operation,the percentage of Th17 cells and levels of their associated inflammatory cytokines (IL-6,IL-17,and IL-23)in portal hypertension patients decreased gradually (P<0.05 for all).Conclusion Th17 cells and their associated inflammatory cytokines (IL-6,IL-17,and IL-23)are reduced in portal hy-pertension patients treated with splenectomy,so their immune function can be improved.
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Objective To compare the efficacy of combined intravenous-inhalational anesthesia with propofol-fentanyl-sevoflurane in children undergoing minor surgery under spontaneous breathing with nasopharyngeal airway-face mask versus laryngeal mask airway (LMA).Methods Seventy-two children,scheduled for elective high ligation of indirect inguinal hernia,were randomly divided into 2 groups (n =36 each):nasopharyngeal airway-face mask group (group M) and LMA group (group L).Propofol 1.0 mg/kg and fentanyl 2.0μg/kg were injected intravenously.The spontaneous breathing was kept.After lass of consciousness,a face mask was placed for inhalation of pure oxygen at 2 L/min and 3 ％ sevoflurane.When BIS value reached 50-60,a size 2 LMA was inserted in group L and a nasopharyngeal airway was placed via the left nasal cavity and the face mask was held tightly and connected to the anesthesia machine in group M.Anesthesia was maintained with inhalation of 2％-4％ sevoflurane.Fentanyl 1 μg/kg was injected intravenously 5 min before skin incision.The concentration of sevoflurane was adjusted to maintain BIS value at 40-60 during surgery.Mean arterial pressure,heart rate,partial pressure of end-tidal carbon dioxide and pulse oxygen saturation were recorded before induction,at 3 min during induction,immediately after successful insertion of the airway,at skin incision,3 min after skin incision,and immediately after removal of the airway.The airway insertion time,success rate of insertion at first attempt,emergence time,and adverse reactions were recorded.Results Compared with group L,mean arterial pressure and heart rate were significantly decreased during airway insertion or removal,nasopharyngeal airway insertion time was shortened and the success rate of nasopharyngeal airway insertion at first attempt (100％) was increased,and the agitation score and incidence of obstruction of the upper respiratory tract were decreased in group M (P ＜ 0.05).Conclusion Combined inravenous-inhalational anesthesia with propofol-fentanyl-sevoflurane is easy to establish the airway,can maintain spontaneous breathing,has little influence on circulatory function and reduce complications during recovery from anesthesia in children undergoing minor surgery under spontaneous breathing with nasopharyngeal airway-face mask,and the efficacy is better than that with LMA.
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Objective To investigate the effect of dexcedetomidine on the postoperative delirium in adolescent idiopathic scoliosis undergoing spine surgery. Methods 160 patients (7-16 years of age) with idiopathic scoliosis undergoing posterior spinal fusion were randomly divided in to two groups. Group SS (n=80) included patients anesthetized with sevorane and sufentanil, group SSD (n=80) included patients anesthetized with sevorane,sufentanil and dexcedetomidine. In the latter group, dexcedetomidine was administered as a continuous infusion of 0.2 ug/h started after the induction of anesthesia without a loading dose. Sevorane was adjusted to maintain the bispectral index (BIS) number at 40-60 and vasoactive drugs was adjusted to maintain the mean arterial pressure (MAP) at 65-75 mmHg. The amount of anesthetic, the time of anesthesia recovery,restlessness during recovery and postoperative delirium were recorded. Results The amount of sevorane, the incidence of restlessness during recovery and the incidence of postoperative delirium were significantly lower in the group SSD than in group SS ( <0.05) . Conclusion The perioperative infusion of 0.2 ug/h dexcedetomidine can decrease the incidence of postoperative delirium in adolescent idiopathic scoliosis undergoing spine surgery.
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Objective To determine the median effective target effect-site concentration (EC50) of sufentanil when intraoperative wake-up test was successful in patients undergoing scoliosis surgery.Methods Ninety ASA Ⅰ or Ⅱ patients,aged 18-64 yr,with body mass index ＜ 30 kg/m2,scheduled for scoliosis surgery under sevoflurane and sufentanil anesthesia,were randomly divided into Ⅰ-Ⅵ groups (n =15 each).Anesthesia was induced with sufentanil,etomidate and cisatracurium,and maintained with sevoflurane,sufentanil and cisatracurium.The patients were tracheal intubated and mechanically ventilated.Before the wake-up test,infusion of cisatracurium was stopped and the end-tidal concentration of sevoflurane was adjusted to 0.The EC50 was determined by the K(a)rber method.The target effect-site concentration of sufentanil was set at 0.19 ng/ml in group Ⅰ,0.18 ng/ml in group Ⅱ and gradually decreased in decrements of 0.01 ng/ml.The wake-up test was performed 5 min later.The EC50 and 95 ％ confidence interval of sufentanil were calculated by the K(a)rber method.Results EC50 of sufentanil obtained was 0.164 ng/ml and 95％ confidence interval of sufentanil obtained was 0.157-0.172 ng/ml when the wake-up test was successful.Conclusion The EC50 of sufentanil is 0.164 ng/ml when the intraoperative wake-up test is successful in the patients undergoing scoliosis surgery.
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Objective To investigate the effect of dexmedetomidine combined anesthesia on postoperative delirium in the elderly patients undergoing hip joint replacement.Methods One hundred and sixty ASA Ⅱ or Ⅲ patients,aged 75-85 yr,with a body mass index of 20-25 kg/m2,scheduled for elective total hip joint replacement under general anesthesia,were randomly divided into 2 groups (n =80 each):sevoflurane-fentanyl control group (group C) and dexmedetomidine-sevoflurane-fentanyl group (group D).Dexmedetomidine was intravenously infused at 0.2 μg· kg-1 · h-1 until the end of operation after a loading dose of 0.6μg/kg over 15 min before induction of anesthesia in group D,while the equal volume of normal saline was infused in group C.Anesthesia was induced with iv injection of fentanyl 2-4 μg/kg and etomidate 0.1-0.3 mg/kg at 5 min after the end of administration of the loading dose.Tracheal intubation was facilitated with cisatracurium 0.15 mg/kg and the patients were mechanically ventilated.Anesthesia was maintained with target-controlled inhalation of sevoflurane (the end-tidal concentration 1％-3％) and intermittent iv boluses of fentanyl 0.05 mg.BIS was maintained at 40-60 during operation.The consumption of etomidate,fentanyl,and sevoflurane,agitation during emergence from anesthesia,and postoperative delirium within 24 h after operation were recorded.Results Compared with group C,the consumption of etomidate,fentanly,and sevoflurane was significantly reduced and the incidences of agitation during emergence from anesthesia and postoperative delirium within 24 h after operation were significantly decreased in group D (P ＜0.05).Conclusion Dexmedetomidine combined anesthesia can reduce the occurrence of postoperative delirium in the elderly patients undergoing hip joint replacement.
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ObjectiveTo observe the effect of donor liver pretreated by breviscapine on liver transplantation ischemia/reperfusion injury in rats. Methods SD rats served as liver donors and recipients (n =48 each).The recipients were divided into four groups by random number table.The donors in groups A and C were not pretreated with breviscapine,but those in groups B and D were pretreated with 20 mg/L Breviscapine.The cold ischemia time in donor livers of groups A and B was 30-40 min,and that in groups C and D was 12 h. Clotting function, liver function, serum thrombomodulin,caspase3,and relative activity of NF-kB after liver transplantation were assessed,and the pathological changes and TUNEL apoptosis staining were observed.ResultsThe mortality in groups C and D was 40.0％ (8/20) and 29.4％ (5/17),respectively (P＞0.05).There were no significant changes in coagulation function in all groups after operation. The liver function was improved,pathological lesions were alleviated,and apoptosis rate,serum TM,caspase3 expression and activity of NF-kB in the liver tissues of group D were significantly decreased as compared with group C at 3rd day after operation (P＜0.01),but all these parameters in group B had no significant change compared to group A.ConclusionPretreatment of donor livers with breviscapine can reduce the ischemia/reperfusion injury and apoptosis after liver transplantation in rats probably by inhibiting the apoptosis-related pathway and alleviating the damage to the endothelial cells of the liver microcirculation.
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Objective To evaluate the effect of dexmedetomidine on intraoperative wake-up test in patients undergoing scoliosis surgery.Methods Sixty ASA Ⅰ patients,aged 13-18 yr,scheduled for elective scoliosis surgery,were randomly divided into 2 groups (n =30 each) ∶ sufentanil group (group S) and dexmedetomidine combined with sufentanil group (group DS).Anesthesia was induced with sufentanil,etomidate and cisatracurium,and maintained with target-controlled inhalation of sevoflurane combined with target-controlled infusion of sufentanil in both groups.In group DS,dexmedetomidine 0.2 μg·kg-1 · h-1 was infused during operation,while the equal volume of normal saline was given instead in group S.Before the wake-up test,cisatracurium infusion was stopped,the end-tidal concentration of sevoflurane was adjusted to 0,and the target effect-site concentration of sufentanil was adjusted to 0.1 and 0.08 ng/ml in groups S and DS,respectively.The wake-up test was performed 5 min later.The wake-up time and bucking/restlessness and cardiovascular events during the wake-up test were recorded.The occurrence of intraoperative awareness was recorded in the patients who were followed up after operation.Results No cardiovascular events occurred during the wake-up test in group DS.The wake-up time was significantly shorter and the incidences of cardiovascular events and bucking/restlessness were significantly lower in group DS than in group S (P ＜ 0.05).No intraoperative awareness occurred in the patients.Conclusion Dexme-detomidine can be used for intraoperative wake-up test in patients undergoing scoliosis surgery,with shorter wakeup time,stable hemodymamics and fewer adverse reactions.
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Objective To investigate the effect of the intraoperative wake-up test on the postoperative delirium in patients undergoing scoliosis operation under analgesia with sufentanil. Methods Sixty ASA Ⅰ or Ⅱ patients , aged 12-60 yr, scheduled for scoliosis surgery, were randomly divided into 2 groups ( n = 30 each) : control group (group C) and intraoperative wake-up test group (group W) . The intraoperative wake-up test was not performed during operation in group C. Anesthesia was induced with target-controlled infusion of sufentanil with the target effect-site concentration set at 0.5 ng/ml and iv injection of propofol 1-2 nig/kg. As soon as the patients lost consciousness, tracheal intubation was facilitated with 0.15 mg/kg cisatracurium besylate. The patients were mechanically ventilated. Anesthesia was maintained with target-controlled inhalation of sevoflurane (target end-tidal concentration 0. 8%-1. 5%), target-controlled infusion of sufentanil (target effect-site concentration 0.2-0.3 ng/ml) and iv infusion of cisatracurium besylate 0.1 mg- kg-1·h-1 . In group W, the patients underwent the intraoperative wake-up test. Postoperative analgesia was provided with sufentanil. The occurrence of intraoperative awareness and postoperative delirium was recorded. Results No significant difference was found in the incidences of intraoperative awareness and postoperative delirium between the two groups. Conclusion The intraoperative wake-up test is not the risk factor for postoperative delirium in patients undergoing scoliosis surgery under analgesia with sufentanil, and inhibition of perioperative pain and intraoperative awareness by analgesia with sufentanil may be involved in the mechanism.
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ObjectiveTo compare the intraoperative wake-up test in patients undergoing scoliosis surgery with different anesthesia methods.MethodsForty ASA Ⅰ patients aged 13-18 yr with body mass index ＜ 30 kg/m2 scheduled for scoliosis surgery were randomly divided into 2 groups ( n =20 each): propofol combined sufentanil anesthesia group (group P) and sevoflurane combined sufentanil anesthesia group (group S).Anesthesia was induced with target-controlled infusion of sufentanil(target effect-site concentration 0.5 ng/ml),and iv injection of etomidate 0.3 mg/kg in both groups.Tracheal intubation was facilitated with 0.15 mg/kg cisatracurium when patients lost consciousness.The patients were mechanically ventilated.Anesthesia was maintained with target-controlled inhalation of sevoflurane (target end-tidal concentration 0.8％-1.5％ ) in group S,and target-controlled infusion of propofol (target plasma concentration 3-5 μg/ml) in group P,and target-controlled infusion of sufentanil (target effect-site concentration 0.2-0.3 ng/ml),and iv infusion of cisatracurium 0.1 mg· kg-1· h-1 in both groups.BIS value was maintained at 40-60.Cisatracurium administration was terminated and target effect-site concentration of sufentanil decreased to 0.1 ng/ml before wake-up test,5 min later,sevoflurane and propofol administration were terminated,and 5 min later wake-up test was performed.MAP and HR were recoreded during wake-up test.The wake-up time and advers effect (bucking,restlessness and awareness)were recorded.Results The wake-up time was significantly shorter in group S than in group P( P ＜ 0.05).MAP and HR were in normal range during wake-up test in both groups,and bucking,restlessness and awareness were not found in both groups.ConclusionTarget-controlled inhalation of ssvoflurane combined with sufentanil can be safely and effectively used for intraoperative wake-up test in patients undergoing scoliosis surgery,and the wake-up time is shorter than that with propofol combined sufentanil,and it is an apporiate anesthetic technique for the intraoperative wake-up test.
الملخص
Objective To investigate the risk factors for postoperative delirium in patients undergoing spine operation under total intravenous anesthesia. Methods Two hundred patients undergoing elective spine operation were included in this study. Patients' perioperative informations were recorded. The diagnosis of delirium was based on Confusion Assessment Method (CAM). The patients were divided into 2 groups according to the occurrence of delirium within 3 days after operation: postoperative delirium group and no postoperative delirium group. Multivariate logistic regression was used to analyze the risk factors for postoperative delirium. Results Postoperative delirium developed in 39 patients during the first three postoperative days. The incidence of postoperative delirium was 19.5%. The logistic stepwise regression analysis indicated that the risk factors for delirium included age, intraoperative blood loss and alcohol abuse. Conclusion Age, large amount of intraoperative blood loss and alcohol abuse are risk factors for postoperative delirium in patients undergoing spine operation under total intravenous anesthesia.
الملخص
Objective To investigate the risk factors for postoperative delirium in patients undergoing noncardiac surgery. Methods From September-December 2009, 480 patients undergoing elective noncardiac surgery were included in this study. The criteria for enrolment of the patients in this study were (1) age ≥ 65 yr,(2) age ＜ 65 yr if associated with coronary artery disease, hypertension, diabetes mellitus, brain injury, cerebral hemorrhage, cerebral infarct, emphysema, chronic bronchitis; duration of operation ≥ 3 h and intraoperative blood loss was expected to exceed 20% of blood volume. The diagnosis of delirium was based on Confusion Assessment Method (CAM). Multivariate logistic regression was used to analyze the risk factors for postoperative delirium.Results Postoperative delirium developed in 79 patients during the first three postoperative days. The incidence of postoperative delirium was 16.5%. The logistic stepwise regression analysis indicated that the risk factors for delirium included advanced age, method of anesthesia, long operation, postoperative pain, emphysema and alcholic. Conclusion Age, method of anesthesia, long operation, postoperative pain, emphysema and alcholic are risk factors for postoperative delirium in patients undergoing noncardiac surgery.
الملخص
Objective To investigate the clinical significance of intra-abdominal pressure measure in patients with liver transplantation by summarizing the data of 143 cases.Methods Intra-abdominal pressure was indirectly measured by urinary bladder pressure.Intra-abdominal pressure over 10 cm H2O (1 cm H2O=0.098 kPa) was regarded as intra-abdominal hypertension (IAH),and 10