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AIM: To evaluate the effect of remimazolam on early postoperative cognitive function in elderly patients with hip fracture based on a randomized controlled trial. METHODS: A total of 106 elderly patients, aged 65-90 years, ASA grade Ⅱ or III, who underwent hip fracture surgery under combined spinal-epidural anesthesia in the Sixth Affiliated Hospital of Wenzhou Medical University from December 2022 to June 2023 and met the inclusion criteria, were selected and randomized into remimazolam group (group R) and propofol group (group P) according to the random number table, with 53 cases in each group. Patients in group P received a slow intravenous injection of propofol at a dose of 0.3-0.5 mg / kg (injection time of 1min), followed by a pump infusion at 0.5-3 mg · kg
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Objective:To establish a prediction model of postoperative 1-year mortality risk in elderly patients undergoing hip fracture surgery and verify its efficacy.Methods:Patients of both sexes, aged ≥65 yr, of American Society of Anesthesiologists physical status Ⅰ-Ⅳ, who underwent an operation for traumatic hip fracture in the Second Affiliated Hospital of Wenzhou Medical University from January 2017 to December 2018, were enrolled and randomly assigned to model group and verification group in a ratio of 3∶1.The demographic characteristics, clinical data and results such as laboratory examinations were collected.In model group, the logistic regression analysis was used to recognize the independent risk factors for 1-year mortality after procedure, and the prediction model was established.In verification group, the prediction efficacy was analyzed using the receiver operating characteristic curve, and the degree of fitting was evaluated by Hosmer-Lemeshow goodness-of-fit test.Results:Multivariate logistic analysis indicated that age ≥84 yr, Charlson comorbidity index ≥2 points, Braden score on admission to hospital ≤16 points, preoperative urea nitrogen ≥8.8 mmol/L and postoperative albumin ≤ 29.6 g/L were the independent risk factors for 1-year mortality after hip fracture surgery in elderly patients ( P<0.05). The prediction model was established based on the risk factors mentioned above.The area under receiver operating characteristic curve was 0.870, and the sensitivity and specificity were 82.8% and 80.0%, respectively.The prediction model showed good fitting ( χ2=4.672, P=0.700). Conclusion:Age ≥84 yr, Charlson comorbidity index ≥2 points, Braden score on admission to hospital≤16 points, preoperative urea nitrogen ≥8.8 mmol/L and postoperative albumin ≤ 29.6 g/L are the independent risk factors for 1-year mortality after hip fracture surgery in elderly patients, and the prediction model established based on the above indicators has good efficacy.
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Objective To determine the risk factors for postoperative hyperactive-type delirium (PHTD) in elderly patients undergoing orthopedic surgery.Methods A total of 7 171 elderly patients of both sexes,aged more than or equal to 65 yr,of American Society of Anesthesiologists physical status Ⅰ-Ⅳ,who underwent orthopedic surgery from January 2008 to December 2012 in Second Affiliated Hospital of Wenzhou Medical University,were retrospectively analyzed.Data such as gender,age,preoperative electrolytes,blood glucose,hemoglobin,albumin,senile dementia and use of benzodiazepines,type of operation,anesthesia methods,operation time,intraoperative use of anticholinergic agents and benzodiazepines and hypotension (decrease more than 20％ of the baseline),and postoperative electrolyte,hemoglobin,albumin and hypotension were collected.The patients were divided into postoperative PHTD group (group PHTD) and postoperative non-PHTD group (group non-PHTD) according to whether PHTD developed within 7 days after operation.The risk factors of which P values were less than 0.05 would enter the multivariate logistic regression to stratify the risk factors for postoperative PHTD.Results Ninety-nine patients developed PHTD,and the incidence was 1.38％.The results of logistic regression analysis showed that age more than or equal to 80 yr,hip surgery and preoperative anemia were independent risk factors for postoperative PHTD (P＜0.05).Conclusion Age more than or equal to 80 yr,hip surgery and preoperative anemia are independent risk factors for postoperative PHTD in elderly patients undergoing orthopedic surgery.
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Objective To evaluate the accuracy of high-aensitivity C-reactive protein (hs-CRP) in the prediction of perioperative cardiovascular accidents (CVAS) in patients with diabetes mellitus. Methods Ninetyone type 2 diabetic patients undergoing elective non-cardiac surgery were divided into 3 groups according to their blood concentrations of hs-CRP: low-concentration group ＜ 1.0 mg/L ( group Ⅰ , n = 9); median-concentration group 1.0-2.9 mg/L (group Ⅱ ,n= 16) and high-concentration group 3.0-10.0 mg/L (group Ⅲ ,n =66). Risk factors for perioperative CVA were analyzed using Spearman rank correlation analysis. Various risk factors including sex, age, ASA physical status, BMI, NYHA claasification, smoking history ,preoperative ECG changes, duration,treatment and complications of diabetes mellitus, hypertension and blood lipids were correlated with perioperative CVA. The risk factors of which P values were less than 0.05 would enter the binary logistic regression analysis to stratify CVA-related risk factors. Area under the ROC curve was used to analyze the accuracy of the risk factors in prediction of perioperative CVA. Results The incidences of perioperative CVAs were 0, 31% and 35 % in Ⅰ ,Ⅱ and Ⅲ groups respectively. It was determined by Spearman rank correlation analysis that preoperative ECG,NYHA classification, age, preoperative cardiovascular color doppler ultrasound, blood hs-CRP concentration and ASA classification of physical status were important risk factors ( P ＜ 0.05 or 0.01 ). Binary logistic regression .malysis indicated that preoperative ECG, NYHA classification and age were highly related to perioperative CVA (P ＜0.05 or 0.01).The area under ROC curve of preoperative ECG, NYHA classification, age and blood hsCRP concentration was 0.855, 0.755, 0.702 and 0.605 respectively. Conclusion The accuracy of blood concentration of hs-CRP in prediction of perioperative CVA in patients with diabetes mellitus is lower than that of the preoperative ECG, NYHA classification or age.
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Objective To assess the effect of sodium nitroprusside (SNP)-induced hypotension on gastric intramucosal pH (pHi), gastric intramucosal PCO2 ( PgCO2 ) and the difference between PgCO2 and PaCO2 (PgCO2-PaCO2) .Methods Fifteen ASA I patients (11 male, 4 female) aged 22-43 yr8, weighing 51-68 kg undergoing laminectomy for decompression of spinal cord in prone position were enrolled in this study. The patients were intubated and mechanically ventilated with 100% O2 after induction of general anesthesia. Anesthesia was maintained with isoflurane (1.2-1.4%) . Radial artery was cannulated for BP monitoring and boood sampling. TRIP tonometry catheter 14 F was inserted into stomach and connected to Tonocap ( Datex-Ohmeda, Finland) . Controlled hypotension was induced with SNP infusion at 1-5 ?g kg-1 min-1 . MAP was reduced to (60 ?5) mm Hg in 5-7 min and maintained for 60 min. Blood samples were taken before induced hypotension (T, ) , at 30 min (T2 ) and 60 min of hypotension (T3) and 30 min after hypotension (T4) for blood gas analysis. pHi, PgCO2 -PaCO2 and PETCO2 were also determined.Results MAP decreased by 35% and 33% at T2 and T3 as compared with the baseline (T, ) . pHi decreased significantly and PgCO2, PgCO2-PaCO2 increased significantly at T, as compared with those at T( ( P 0.05). pH at T2 ,T3 and T4 and BE at T3 and T4 were significantly lower than the baseline value (T1). PaCO2 and PET CO2 were significantly higher at T4 than those at T, (P