الملخص
Objective To observe the effects of thoracic paravertebral nerve block(TPVB)combined with preserved spontaneous respiratory anesthesia on intraoperative local cerebral oxygen saturation(SrcO2)and postoperative delirium(POD)in elderly patients undergoing thoracoscopic surgery.Methods A total of 80 elderly patients who planned to undergo thoracoscopic wedge resection of lung were randomly divided into the control group and the observation group,and finally 76 patients completed the study,with 39 cases in the control group and 37 cases in the observation group.The control group was given general anesthesia under single lung ventilation,while the observation group was given TPVB combined with preserved spontaneous respiratory anesthesia.Patients'SrcO2 was monitored by a near infrared spectrometer,and the decrease of SrcO2 from baseline by≥10%was considered as cerebral oxygen desaturation(COD).The preoperative baseline value of SrcO2,intraoperative lowest value of SrcO2,the incidence and duration of COD of the two groups were compared.The operation situation,the incidence of hypotension,hypoxemia,delayed awakening and analgesic recovery rate were counted.The incidence of POD and pain visual analogue scale(VAS)score 2 hours,24 hours and 72 hours after surgery were evaluated.The hospitalization time was recorded,and the quality of recovery-40(QoR-40)scores at admission and discharge were evaluated.Results There was no significant difference in operative time,intraoperative blood loss,preoperative baseline value of SrcO2,VAS score 2 hours after surgery and QoR-40 score at admission between the two groups(P>0.05).Compared with the control group,the observation group had higher intraoperative lowest value of SrcO2(P<0.05),lower incidence and shorter duration of COD(P<0.05),lower incidence of POD 2 hours,24 hours and 72 hours after surgery(P<0.05),lower VAS scores 24 hours and 72 hours after surgery and analgesic recovery rate(P<0.05),lower/shorter incidence of intraoperative hypotension,delayed awakening and hospitalization time(P<0.05),and higher QoR-40 scores at discharge(P<0.05).Conclusion TPVB combined with preserved spontaneous respiratory anesthesia can improve the level of cerebral oxygenation and reduce the occurrence of POD in elderly patients undergoing thoracoscopic surgery.
الملخص
<p><b>BACKGROUND</b>Appropriate antimicrobial therapy of community-acquired pneumonia (CAP) is mainly based on the distribution of etiology and antimicrobial resistance of major pathogens. We performed a prospective observational study of adult with CAP in 36 hospitals in China.</p><p><b>METHODS</b>Etiological pathogens were isolated in each of the centers, and all of the isolated pathogens were sent to Zhongshan Hospital for antimicrobial susceptibility tests using agar dilution.</p><p><b>RESULTS</b>A total of 593 patients were enrolled in this study, and 242 strains of bacteria were isolated from 225 patients. Streptococcus pneumoniae (79/242, 32.6%) was the most frequently isolated pathogen, followed by Haemophilus influenzae (55/242, 22.7%) and Klebsiella pneumoniae (25/242, 10.3%). Totally 527 patients underwent serological tests for atypical pathogens; Mycoplasma pneumoniae and Chlamydia pneumoniae infections were identified in 205 (38.9%) and 60 (11.4%) patients respectively. Legionella pneumophila infections were identified in 4.0% (13/324) of patients. The non-susceptibility rate of isolated Streptococcus pneumoniae to erythromycin and penicillin was 63.2% and 19.1% respectively. Six patients died from the disease, the 30-day mortality rate was 1.1% (6/533).</p><p><b>CONCLUSIONS</b>The top three bacteria responsible for CAP in Chinese adults were Streptococcus pneumonia, Haemophilus influenza and Klebsiella pneumonia. There was also a high prevalence of atypical pathogens and mixed pathogens. The resistance rates of the major isolated pathogens were relatively low except for the high prevalence of macrolide resistance in Streptococcus pneumoniae.</p>