RESUMO
Objective:To identify the risk factors for postoperative delirium (POD) in frail elderly patients undergoing cardiac surgery and develop a ROC prediction model.Methods:The medical records of patients of either sex, aged ≥65 yr, of American Society of Anesthesiologists Physical Status classification Ⅲ or Ⅳ, with frailty index score>0.25, underwent open heart surgery under cardiopulmonary bypass (CPB) from January 2022 to June 2022, were collected retrospectively.The patients were divided into POD group and non-POD group according to POD occurred within 7 days after operation.Clinical information such as gender, age, Mini-mental State Examination score, past medical history, results of the laboratory test before surgery, operation time, cerebral oxygen saturation (rSO 2), rSO 2 baseline (rSO 2 baseline), lowest intraoperative rSO 2 value before, during and after CPB (CPB 1rSO 2 lowest, CPB 2rSO 2 lowest, CPB 3rSO 2 lowest) , the greatest decrease in intraoperative rSO 2 from the baseline value before, during and after CPB (CPB 1rSO 2 decrease, CPB 2rSO 2 decrease, CPB 3rSO 2 decrease) were recorded.Multivariate logistic regression analysis was used to identify the risk factors for POD, and the receiver operating characteristic (ROC) curve was drawn to evaluate the accuracy of the related risk factors. Results:A total of 130 patients were enrolled, with 32 cases in POD group and 98 cases in non-POD group, and the incidence of POD was 24.6%.The results of logistic regression analysis showed that the CPB 2rSO 2 decrease, CPB 2rSO 2 lowest and operation time were independent risk factors for POD ( P<0.05). The area under the ROC curve (95% confidence interval) of CPB 2rSO 2 decrease>11.2% predicting POD was 0.655 (0.533-0.778), sensitivity 68.9%, and specificity 62.9%.The area under the ROC curve (95% confidence interval) of operation time>237.5 min predicting POD was 0.751 (0.652-0.849), sensitivity 62.5%, and specificity 78.6%. Conclusions:CPB 2rSO 2 decrease, CPB 2rSO 2 lowest and operation time are independent risk factors for POD in frail elderly patients undergoing cardiac surgery; both CPB 2rSO 2 decrease and operation time can effectively predict the occurrence of POD in frail elderly patients undergoing cardiac surgery.
RESUMO
Objective:To compare the effects of different fractions of inspired O 2 (FiO 2) during general anesthesia induction on perioperative pulmonary function in patients undergoing gynecological laparoscopic surgery. Methods:A total of 100 patients, aged 30-64 yr, with body mass index<30 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective total laparoscopic hysterectomy, were divided into 4 groups ( n=25 each) using a random number table method: group A, group B, group C and group D. In A, B, C and D groups, FiO 2 was 40%, 60%, 80% and 100%, respectively.Immediately after the establishment of electrocardiogram monitoring after entering the operation room (T 0), immediately after tracheal intubation (T 1), immediately after creation of pneumoperitoneum (T 2), at 30 min of pneumoperitoneum (T 3), immediately before tracheal intubation (T 4) and at 15 min after tracheal intubation (T 5), ventral (ROIⅠ), middle ventral (ROIⅡ), middle dorsal (ROIⅢ) and dorsal (ROI Ⅳ) lung ventilation were recorded using electrical impedance tomography.The impedance ratio (IR) was calculated and the safety time without ventilation was recorded.Blood samples were collected from the radial artery at T 0-2 and T 5 for blood gas analysis, arterial oxygen partial pressure (PaO 2) and arterial carbon dioxide partial pressure (PaCO 2) were recorded, and oxygenation index (OI) was calculated.The occurrence of pulmonary complications within 3 days after operation was recorded. Results:Compared with group D, the ventilation in ROIⅠ and ROIⅡwas significantly increased, the ventilation in ROIⅢ and ROIⅣ was decreased, and IR was increased at T 1 and T 2 in A, B and C groups, PaO 2 and OI were decreased at T 1, and the safety time without ventilation was prolonged in A and B groups, and PaO 2 was decreased, OI was increased at T 1 ( P<0.05), and no significant was change in the safety time without ventilation in group C ( P>0.05). There was no significant difference in the incidence of pneumoperitoneum among the 4 groups ( P>0.05). Conclusion:During general anesthesia induction, 80% FiO 2 has the least effect on lung function in the patients undergoing gynecological laparoscopic surgery.
RESUMO
Objective To evaluate the accuracy of respiratory variations of internal jugular vein (IJV) in monitoring fluid responsiveness in patients undergoing radical gastrectomy for gastric cancer.Methods Fifty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 40-64 yr,scheduled for elective radical gastrectomy for gastric cancer,were enrolled in this study.Before induction of anesthesia,the hemodynamic parameters such as heart rate,central venous pressure,cardiac index,stroke volume index (SVI),stroke volume variation and respiratory variation of IJV were recorded after haemodynamics was stable and were recorded again at 10 min after endotracheal intubation,and a loading dose of 6％ 130/0.4 hydroxyethyl starch 7 ml/kg was infused over 15 min.The parameters mentioned above were recorded within 5 min after loading dose.Patients were divided into 2 groups according to the percentage of increase in SVI (△SVI) after volume expansion:△SVI≥ 15％ was considered to be a positive response (responder group) and △SVI＜15％ was considered to be a negative response after volume expansion (non-responder group).Results The area under the receiver operating characteristic curve of respiratory variations of IJV in monitoring fluid responsiveness and 95％ confidence interval were 0.852 (0.744-0.961).Respiratory variation of IJV 24.6％ was considered as the cut-off value and used to monitor fluid responsiveness,and the sensitivity and specificity were 67.6％ and 92.3％,respectively.Conclusion Respiratory variation of IJV can be considered as an effective index in monitoring fluid responsiveness in the patients undergoing radical gastrectomy for gastric cancer.
RESUMO
Objective To evaluate the accuracy of respirophasic variation in carotid artery blood flow peak velocity(ΔVpeak-CA)in predicting fluid responsiveness in the patients undergoing surgery in the prone position. Methods Forty-three American Society of Anesthesiologists physical status Ⅰ-Ⅲ pa-tients of both sexes, aged 45-75 yr, with body mass index of 20-25 kg∕m2, scheduled for elective posteri-or approach lumbar surgery, were enrolled in the study.After induction of anesthesia, hydroxyethyl starch 130∕0.4 sodium chloride injection 7 ml∕kg was intravenously infused over 20 min when the patients were in the prone position.Subjects were classified as responders if stroke volume index increased≥15% after vol-ume expansion.The receiver operating characteristic curve for ΔVpeak-CA in determining positive fluid re-sponsiveness was drawn. Results The results of receiver operating characteristic curve analysis showed that: the cut-off value of ΔVpeak-CA in predicting positive fluid responsiveness was 7.94%, sensitivity 81.8%, specificity 70.0%, and the area under the curve(95% confidence interval)was 0.818 (0.378-0.757). Conclusion Respirophasic ΔVpeak-CA can accurately predict fluid responsiveness in the patients undergoing surgery in the prone position.
RESUMO
Objective To investigate the effect of levosimendan on pulmonary artery pressure in patients with pulmonary hypertension undergoing mitral valve replacement.Methods Twenty-four ASA Ⅱ or Ⅲ and NY-HA class Ⅱ or Ⅲ patients,aged 35-60 yr,with mean pulmonary artery pressure (MPAP) ＞ 30 mm Hg,undergoing mitral valve replacement were randomly divided into 2 groups (n =12 each):control group (group C) and levosimendan group (group L).In group L,a loading dose of levosimendan 24 μg/kg was injected intravenously after aortic unclamping,followed by infusion of levosimendan at a rate of 0.2 μg· kg-1 · min-1 until 1 d after operation.Group C received the equal volume of normal saline.HR,MAP,MPAP,pulmonary capillary wedge pressure (PCWP),cardiac index (CI) were recorded at 5 min after induction (T0),at the end of CPB (T1) and at 1 h after operation (T2),and the pulmonary vascular resistance (PVR) and rate-pressure product (RPP) were calculated.The improvement in pulmonary hypertension was recorded.Results PCWP was significantly lower and CI higher at T1,2 in both groups,and HR was significantly higher at T1,2 and MPAP lower at T2 in group C,and MPAP and PVR were significantly lower at T1,2 in group L than at T0 (P ＜ 0.05).HR,MPAP and PVR were significantly lower and CI was significantly higher at T1,2,RPP was significantly lower at T2 and the improvement in pulmonary hypertension was higher in group L than in group C (P ＜ 0.05).Conclusion Levosimendan can improve pulmonary hypertension without increasing the myocardial oxygen consumption and with a significant increase in myocardial contractility in patients with pulmonary hypertension undergoing mitral valve replacement.