الملخص
Objective:To evaluate the relationship between the severity of preoperative brain injury and postoperative delirium (POD) in elderly patients using latent class analysis based on markers of brain injury.Methods:One hundred and thirty-one American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ patients, aged 65-84 yr, with a body mass index of 18-28 kg/m 2, scheduled for elective unilateral total hip arthroplasty in our hospital, were selected. Cognitive function was assessed using the Mini-Mental State Examination before surgery. Arterial blood samples were collected before anesthesia to measure the plasma concentrations of brain-derived neurotrophic factor, inducible nitric oxide synthase, prostaglandin E2, central nervous system-specific protein (S100β), glial fibrillary acidic protein, neurofilament light chain, matrix metalloproteinase-9, fibroblast growth factor 23, complement 3, complement 3a, complement 5a and irisin using enzyme-linked immunosorbent assay. POD was evaluated using the Confusion Assessment Method within 3 days after operation, and the patients were divided into POD group and non-POD group. The patients were divided into different injury severity subtypes based on the levels of brain injury markers using latent class analysis, and logistic multivariate regression was used to analyze the independent risk factors for POD. Results:Compared with non-POD group, the concentrations of neurofilament light chain, glial fibrillary acidic protein, S100β and prostaglandin E2 were significantly different in POD group ( P<0.05). Using these four brain injury markers for latent class analysis, patients were divided into a high severity of brain injury group (91.51%) and a low severity of brain injury group (8.49%). The results of logistic multivariate regression analysis showed that subtypes of brain injury ( OR=8.31, 95% confidence interval [ CI] 1.77-38.90, P=0.007), age ( OR=1.14, 95% CI 1.03-1.24, P=0.007), and plasma irisin concentrations ( OR=0.99, 95% CI 0.98-0.99, P=0.027) were independent risk factors for POD. Conclusions:Higher severity of preoperative brain injury is an independent risk factor for POD in elderly patients.
الملخص
Objective To evaluate the efficacy of dexmedetomidine mixed with ropivacaine for thoracic paravertebral nerve blocks by multiple injections for preemptive analgesia on postoperative analgesia of patients undergoing thoracotomy. Methods Ninety patients, all genders, ASA Ⅰ or Ⅱ, aged 35-64, BMI 18-24 kg/m2, undergoing radical operation for esophageal carcinoma were randomly divided into three groups (each group 30 patients): group C received general anesthesia, group R received ropivacaine for thoracic paravertebral nerve block and group RD received dexmedetomidine mixed with ropivacaine for thoracic paravertebral nerve block.Three groups all used intravenous infusion of propofol, refentanyl and inhalation sevoflurane for anesthesia maintenance, and PCIA pump started before the end of surgery in 3 groups.Meanwhile, group R and group RD received ultrasound-guided T4-T8thoracic paravertebral nerve blocks by multiple injections on operation side preoperatively.In group R, the mixture of 0.5% ropivacaine 19 ml and 1ml of normal saline was injected, and in group RD, the mixture of dexmedetomidine 1 μg/kg and 19 ml of 0.5% ropivacaine was injected.The analgesia process lasted 48 h after surgery of these 3 groups, and the VAS score was maintained<4 points.When the VAS score was 4 or more points, intravenous injection of morphine 5- 10 mg was delivered. Postoperative PCIA liquid and morphine consumption, somnolence, nausea, vomiting, respiratory depression, itching and urinary retention was recorded. Additionally, the occurrences of adverse events about thoracic paravertebral nerve blocks were recorded.Results The dosages of propofol, refentanyl in group R and group RD were lower than those in group G:(7.2 ± 0.6),(6.1 ± 0.5)mg/(kg·h)vs.(8.1 ± 0.5)mg/(kg·h), and there were significant differences(P<0.05).The dosage of propofol in group RD was lower than that in group R: (6.1 ± 0.5) mg/(kg·h) vs. (7.2 ± 0.6) mg/(kg·h), and there was significant difference (P <0.05). Compared with group G, the consumption of PCIA liqud and the usage rate of morphine was reduced in group R and group RD (P < 0.05); the consumption of PCIA liqud and the usage rate of morphine was lower in group RD than that in group R(P<0.05).The rate of nausea and vomiting and itch in group R and group RD was lower than that in group G,and there were significant differences(P<0.05). No significant difference in somnolence showed between three groups (P > 0.05). Conclusions Ropivacaine combined with dexmedetomidine for target thoracic paravertebral nerve blocks by multiple injections for preemptive analgesia can significantly improve the efficacy of postoperative analgesia after thoracotomy, meanwhile,it can also save the dosage of anesthetic drugs during the operation.
الملخص
Electronic medical records (EMR) is the clinical diagnosis, guiding intervention and digital medical service record of outpatient, hospital patients (or care object) in medical institution. And it is the complete, detailed clinical information resource which has produced and recorded in all previous medical treatments. Radiotherapy electronic medical records contain texts, images and graphics, therefore the information is more complicated. This paper proposes an EMR information system based on DICOM-RT standard, through the use of seven objects of DICOM-RT to achieve the information exchange and sharing between different systems, equipments, convenient radiotherapy treatment data management, improve the efficiency of radiation treatment.