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Objective@#To evaluate the effect of multidisciplinary cooperative pain management on the rapid recovery of patients with total hip and total knee arthroplasty.@*Methods@#A total of 120 patients, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 20-64 yr, with body mass index of 18-25 kg/m2, were divided into 2 groups using a random number table method: test group (group T, n=66) and control group (group C, n=54). Multidisciplinary cooperative pain management mode was adopted for pain management in the perioperative period in group T, while traditional pain management was used in group C. Numeric rating scale scores were recorded at 4 h and 1, 2, 3 and 7 days after surgery and on discharge from hospital.The postoperative joint recovery time, length of hospital stay and satisfaction were recorded in two groups.@*Results@#Compared with group C, the numeric rating scale scores were significantly decreased at 4 h and 1, 2, 3 and 7 days after surgery and on discharge from hospital, the postoperative joint recovery time and length of hospitalization were shortened, and the degree of satisfaction was increased in group T (P<0.05).@*Conclusion@#Multidisciplinary cooperative pain management can effectively promote the rapid recovery of patients with total hip and total knee replacement.
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Objective To evaluate the predictive value of ultrasonography of the respiratory variability index of inferior vena cava internal diameter (IVC-RVI) in preoperative fluid responsiveness evaluation of hip fracture in geriatric patients.Methods A retrospective case-control study was used to analyze 39 cases of elderly hip fractures admitted to the Daping Hospital of Army Medical Center from August 2017 to February 2018,including 15 males and 24 females,aged 65-92 years [(80.9 ±7.9)years].The heart rate (HR),mean arterial pressure(MAP),cardiac output (CO),and cardiac stoke volume (SV)were recorded five minutes after the patient entered the operating room and within 5 minures after capacity load test.The inferior vena cave during expiration (IVCe) and inferior vena cave during inspiration (IVCi) were measured by ultrasound before and after volume load test and the difference in IVC-RVI was calculated.Volumetric positive group were the cases of SV change (△SV) ≥15％ (positive group,n =21),and volume negative group were the cases of △SV ＜ 15％ (negative group,n=18).The correlations between various ultrasonic parameters and SV were analyzed by comparing HR,MAP,CO,SV,SV,IVCe,IVCi and IVC-RVI before and after the capacity load test.The predictive value of IVC-RVI for preoperative volumetric reactivity in elderly patients with hip fractures was evaluated by using the receiver operative characteristic (ROC) curve and Pearson correlation analysis.Results Prior to the volumetric load test,no significant difference was observed between the two groups concerning HR,MAP,CO,SV,and IVCe (P ＞ 0.05),IVCi in the positive group was significantly smaller than that in the negative group (P ＜ 0.05),and IVC-RVI in the positive group was significantly larger than that in the negative group (P ＜ 0.05).After the volumetric load test,there was no statistically significant difference between the two groups in CO,IVCe,IVCi,and IVC-RVI (P ＞ 0.05),HR in the positive group was smaller than that in the negative group (P ＜ 0.05),and MAP and SV in the positive group were significantly larger than that in the negative group (P ＜ 0.05).Compared with that before capacity load test,MAP,CO,and SV in the positive group increased after the capacity load test (P ＜ 0.05),while the HR difference was not statistically significant (P ＞ 0.05).HR,MAP,CO,and SV showed no significant difference in the negative group before and after capacity test (P ＞ 0.05).IVC-RVI assessed the area under the curve (AUC) was 0.80 ± 0.08 for preoperative volumetric responsiveness in elderly hip fractures (P ＜ 0.05),with a critical point of 20.69％,sensitivity of 77.78％,and specificity of 76.19％.After Pearson correlation analysis,IVC-RVI was positively related to △SV (OR =0.367,P ＜ 0.05).Conclusion Ultrasonography of the respiratory variability of IVC can predict the preoperative fluid responsiveness of hip fracture in geriatric patients and guide for clinical rehydration.
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Objective To evaluate the effect of multidisciplinary cooperative pain management on the rapid recovery of patients with total hip and total knee arthroplasty.Methods A total of 120 patients,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,aged 20-64 yr,with body mass index of 18-25 kg/m2,were divided into 2 groups using a random number table method:test group (group T,n=66) and control group (group C,n=54).Multidisciplinary cooperative pain management mode was adopted for pain management in the perioperative period in group T,while traditional pain management was used in group C.Numeric rating scale scores were recorded at 4 h and 1,2,3 and 7 days after surgery and on discharge from hospital.The postoperative joint recovery time,length of hospital stay and satisfaction were recorded in two groups.Results Compared with group C,the numeric rating scale scores were significantly decreased at 4 h and 1,2,3 and 7 days after surgery and on discharge from hospital,the postoperative joint recovery time and length of hospitalization were shortened,and the degree of satisfaction was increased in group T (P＜0.05).Conclusion Multidisciplinary cooperative pain management can effectively promote the rapid recovery of patients with total hip and total knee replacement.
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Objective To study the correlation between early cognitive function and severity of pain in elderly patients after operation. Methods Selective open abdominal operation was performed in 30 elderly patients admitted to our department from January 2009 to June 2009. Severity of pain was assessed using visual analogue scale ( VAS) and cognitive function was scored with Mini-Mental State Examination ( MMSE) ,animal fluency test ( AFT) and clock drawing test ( CDT) ,respectively,in 24 and 48 h after operation. Cognitive function of the patients was assessed from the view of neurophysiology. Pain was scored after operation with VAS. Variables were analyzed with the linear correlation analysis. Correlation between early cognitive function and severity of pain in elderly patients was observed after operation. Results No linear correlation was observed between scores on MMSE,VAS and AFT scales in 24 and 48 h after operation ( r = -0. 053,P = 0. 786; and r = -0. 052,P = 0. 783; and r = -0. 323,P = 0. 082; and r = -0. 038,P = 0. 841). A negative linear correlation was found between scores on CDT and VAS scales in 24 and 48 h after operation ( r = -0. 731,P =0. 000; and r = -0. 636,P = 0. 001). Conclusion Cognitive function including visual space structure function and implementing function in elderly patients after operation is correlated with the pain scores on VAS scale.
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Clinical practice of anesthesia is an important phase for interns to be professional physicians.In order to improve teaching quality of anesthesiology,we should attach great importance to following three aspects:stressing medical ethics and standardize medication,inspiring activity of the students,reinforcing self-construction of the teachers.Mutual action between teaching and learn-ing can only bring about the improvement of teaching quality in anesthesiology.