全麻下血管化游离皮瓣修复术后患者谵妄的危险因素

Objective To investigate the risk factors for postoperative delirium in patients after vascular free flap reconstruction performed under general anesthesia.Methods Two hundred and sixteen ASA Ⅰ-Ⅲ patients aged 18-80 yr undergoing vascular free flap reconstruction surgery were enrolled in this study.Patient characteristics before and during operation were recorded.The patients were followed up for 5 days after operation.Their level of consciousness,severity of pain and sleep quality were evaluated daily.The patients were divided into 2 groups according to the occurrence of delirium during the 5 days after operation:delirium group and non-delirium group.The method of CAM-ICU was reed in the diagnosis of postoperative delirium.Multivariate logistic regression was used to analyze the risk factors for postoperative delirium.Results logistic regression analysis showed that old age,history of alcohol abuse and sleep diacrder after operation were risk factors for delirium developed after free flap surgery.Conclusion Old age,history of alcohol abuse and sleep disorder after operation were the risk factors for postoperative delirium in patients after vascular free flap reconstruction performed under general anesthesia.     

Predictive values of neutrophil to lymphocyte ratio,monocyte to lymphocyte ratio and platelet to lym-phocyte ratio for delirium after hip fracture surgery in the elderly北大核心CSCD

Objective To explore the predictive values of neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR) and platelet to lymphocyte ratio (PLR) for postoperative delirium in the elderly patients with hip fracture. Methods The data of 1,278 elderly patients with hip fracture were analyzed retrospectively who had been admitted to Department of Orthopedics, The 7th Medical Center, General Hospital of Chinese People's Liberation Army from January 2012 to December 2018. There were 418 males and 860 females, with a median age of 81 (75, 90) years. There were 728 intertrochanteric fractures and 550 femoral neck fractures. The working characteristic curves (ROC) of NLR, MLR, and PLR used to predict postoperative delirium in the elderly patients with hip fracture were worked out to obtain the best cutoff points (sensitivity, specificity, and area under the curve) respectively. According to the best cutoff points, the NLR, MLR, and PLR were respectively divided into an increase group and a normal group. According to whether postoperative delirium occurred or not, the patients were divided into a delirium group and a delirium-free group. After univariable analysis was conducted to screen out the risk factors, binary logistic regression analysis was conducted of the factors with P<0.05 to determine the risk factors. Results The median values of NLR, MLR and PLR in the 1,278 elderly patients with hip fracture at admission were 5.43 (3.87, 7.88), 0.40 (0.29, 0.54) and 158.40 (118.00, 222.50), respectively. Postoperative delirium occurred in 153 patients (12.0%). In the study of the predictive values of NLR, MLR, and PLR using ROC curves for postoperative delirium in the elderly patients with hip fracture, the best cutoff points (sensitivity, specificity, and area under the curve) for prediction were 7.613 (57.5%, 77.1%, 0.726), 0.512 (52.3%, 74.0%, 0.663), and 201.125 (68.6%, 73.3%, 0.751), respectively. The risk factors for postoperative delirium were increased NLR (OR=2.046, 95% CI: 1.322 to 3.166, P<0.001), increased MLR (OR=1.568, 95% CI: 1.039 to 2.367, P=0.032), and increased PLR (OR=3.489, 95% CI: 2.290 to 5.317, P<0.001). Conclusion As NLR≥7.613, MLR≥0.512 and PLR≥201.125 may be risk factors for postoperative delirium in elderly patients with hip fracture, NLR, MLR and PLR may have a positive value in prediction of postoperative delirium. © 2023 Chinese Journal of Orthopaedic Trauma. All rights reserved.     

老年非心脏手术患者术前高敏C反应蛋白与术后心脏不良事件相关性的研究

Objective To investigate the relevance between level of preoperative high-sensitivity C-reactive protein(hsCRP) and the occurrence of postoperative adverse cardiac events in elderly patients underwent noncardiac surgery. Methods 49 patients of more than 65 years that had undergone elective noncardiac surgery were enrolled in the study. And all patients were conformed to the standards of "classification of risk factors for clinical history", content of "Guidelines on Preoperative Cardiovascular Evaluation for Noncardiac Surgery" established by the ACC/AHA .The patients were divided into two groups based on the preoperative hsCRP level:A group:hsCRP ≤ 3mg/L group (n=21) and B group: hsCRP>3mg/L group (n=28). General clinical characteristics of patients were recorded before operation, and 24 hours dynamic ECG was monitored a week prior to and after the operation. All patients taken measures of analgesia after surgery. The incidence of postoperative adverse cardiac events and the hospitalized days was recorded. The distinctions between two groups were analyzed regarding the occurrence of adverse cardiac events and hospitalized days after operation. Results 19 patients had postoperative myocardial ischemia; 4 cases in A group and 15 cases in B group. 7 patients suffered other postoperative adverse cardiac events, including 1 case in A group and the others in B group. There was statistically significant difference considering morbidity of myocardial ischemia in postoperation between the two groups, but there was no statistically significant difference about incidence of other adverse cardiac events and the length of stay in postoperation. Indexes about serious degree of myocardial ischemia:total depression time is(43.5±5.82 )min in A group, is( 135.0±81.2)min in B group. The depression times is(5.2±2.5 )in A group, is( 8.8±3.0)in B group.The longest depression time is( 23.7±9.2)min in A group, is( 84.3±54.1 )min in B group.Total ischemia burden is( 170.1 ±88.8 )mm· min-1 ·24h-1 in A group, is (311.3± 118.8 )mm· min-1 ·24h-1 in B group.There was statistically significant difference between the two groups. Conclusion Level of preoperative hsCRP>3 mg/L was relevant to the incidence of the most common postoperative adverse cardiac events--myocardial ischemia in elderly patients and level of preoperative hsCRP >3 mg/L was one of the risk factors of postoperative myocardial ischemia;Determination of preoperative hsCRP level may improve cardiovascular risk scoring system.     

Effect of retension sutures on abdominal pressure after abdominal surgery

Purpose: To evaluate the effect of retention sutures on abdominal pressure and postoperative prognosis in abdominal surgery patients. Methods: This prospective cohort study included patients who were admitted to Daping Hospital from May 15, 2014 to October 11, 2014. A total of 57 patients were enrolled, including 18 patients in the “U” type retention suture group, 17 patients in the intermittent retention suture group, and 22 patients in non-retention suture group. The demographic data, clinical data and risk factors for abdominal wound dehiscence were recorded. The bladder pressure (IVP) was monitored preoperatively, intraoperatively, and four days postoperatively. Additionally, the incidence of abdominal wound dehiscence and infection 14 days after the operation was recorded. Results: During the operation, the IVP decreased and then increased; it was at its lowest 1 h after the start of the operation (5.3 mmHg ± 3.2 mmHg) and peaked after tension-reducing (8.8 mmHg ± 4.0 mmHg). The IVP values in the “U” type retention suture group and intermittent retention suture group were higher than in the non-retention suture group 4 days after operation (p < 0.005). The Visual Analogue Scale (VAS) pain scores were 3.9 ± 2.2, 3.8 ± 2.0, and 3.0 ± 1.0 in the retention suture group, intermittent retention suture group and non-retention suture group, respectively. The VAS pain scores in the “U” type tension-reducing group and intermittent tension-reducing group were higher than in the non-tension-reducing group (p < 0.005). Conclusion: Although retention sutures may reduce the incidence of postoperative wound dehiscence in abdominal surgery patients, they can increase the IVP and postoperative pain.     

直肠癌术后吻合口瘘的危险因素及对预后的影响

Objective To identify risk factors for anastomotic leakage after low anterior resection (LAR) in rectal cancer patients and study its impact on patients'long-term prognosis.Methods Chnical data were analyzed from 720 patients who underwent low anterior resection(LAR) for rectal cancer between 1996 and 2006.Results Anastomotic leakage after anterior resection occurred in 44 cases(6.1%).The median time of anastomotic leakage after operation was 5.6 days.Muhivariate analysis showed male patients.history of preoperative chemoradiation therapy,diabetes,cancer distance from anus less than 7 cm and hand-sewed anastomosis were independent risk factors predisposing anastomosis leakage (P<0.05).Tumor local recurrence rate was 13.6% in patients suffering from leakage and 5.9% for those without leakage (χ2= 4.116,P<0.05).The distant metastasis rates were 25.0 and 14.1 percent for the leakage and noaleakage groups,respectively(χ2=3.943,P<0.05).The survival rates were 56.8 and 72.5 percent in the leakage and nonleakage groups,respectively(χ2=4.979,P<0.05).Conclusion Sex,preoperative chemoradiation therapy,diabetes,cancer distance from anus less than 7 cm and hand-sewed anastomosis were found to be independent risk factors for anastomotic leakage after rectal cancer surgery.Anastomotic leakage was associated with poor prognosis.     

直肠癌术后吻合口瘘的危险因素及对预后的影响

Objective To identify risk factors for anastomotic leakage after low anterior resection (LAR) in rectal cancer patients and study its impact on patients'long-term prognosis.Methods Chnical data were analyzed from 720 patients who underwent low anterior resection(LAR) for rectal cancer between 1996 and 2006.Results Anastomotic leakage after anterior resection occurred in 44 cases(6.1%).The median time of anastomotic leakage after operation was 5.6 days.Muhivariate analysis showed male patients.history of preoperative chemoradiation therapy,diabetes,cancer distance from anus less than 7 cm and hand-sewed anastomosis were independent risk factors predisposing anastomosis leakage (P<0.05).Tumor local recurrence rate was 13.6% in patients suffering from leakage and 5.9% for those without leakage (χ2= 4.116,P<0.05).The distant metastasis rates were 25.0 and 14.1 percent for the leakage and noaleakage groups,respectively(χ2=3.943,P<0.05).The survival rates were 56.8 and 72.5 percent in the leakage and nonleakage groups,respectively(χ2=4.979,P<0.05).Conclusion Sex,preoperative chemoradiation therapy,diabetes,cancer distance from anus less than 7 cm and hand-sewed anastomosis were found to be independent risk factors for anastomotic leakage after rectal cancer surgery.Anastomotic leakage was associated with poor prognosis.     

老年病人全麻术后颅内兴奋性氨基酸水平与术后认知功能障碍的关系

Objective To investigate the relationship between the changes in intracranial excitatory amino acid(EAA) levels and the incidence of postoperative cognitive dysfunction (POCD) in eldedy patients after general anesthesia. Methods Forty ASA Ⅰ-Ⅲ patients of both sexes aged 65-79 yr weighing 48-76 kg undergoing elective non-cardiac surgery under general anesthesia were studied.Anesthesia was induced with midazolam,fentanyl,etomidate and succinylcholine and maintained with continuous iv infusion of propofol,remifentanil,isoflurane inhalation and intermittent iv boluses of vecuronium.The right internal jugular vein was cannulated with a catheter which was advanced cephalad until jugular bulb.The jugular bulb venous blood samples were taken before (T0,baseline),at the end of (T1) and at 24,48 and 72h(T2-4) after operation for measurement of plasma concentrations of glutamate (Glu),aspartate (Asp) and glycine (Gly) by RP-HPLC.The cognitive function was evaluated by mini-mental state examination (MMSE) at T0 and T4.Results Eleven of the 40 patients developed POCD (28%).The plasma Gh,Asp and Gly concentrations were significantly increased after operation as compared with the baseline values in POCD patients and were significantly higher than in non-POCD patients.The plasma concentrations of Glu and Asp were negatively correlated with MMSE score(Glu:r=-0.86.P<0.01;Asp:r=-0.99,P<0.01).Conclusion Elderly patients may develop POCD after operation performed under general anesthesia through increase in intracranial EAA levels.     

老年病人全麻术后颅内兴奋性氨基酸水平与术后认知功能障碍的关系

Objective To investigate the relationship between the changes in intracranial excitatory amino acid(EAA) levels and the incidence of postoperative cognitive dysfunction (POCD) in eldedy patients after general anesthesia. Methods Forty ASA Ⅰ-Ⅲ patients of both sexes aged 65-79 yr weighing 48-76 kg undergoing elective non-cardiac surgery under general anesthesia were studied.Anesthesia was induced with midazolam,fentanyl,etomidate and succinylcholine and maintained with continuous iv infusion of propofol,remifentanil,isoflurane inhalation and intermittent iv boluses of vecuronium.The right internal jugular vein was cannulated with a catheter which was advanced cephalad until jugular bulb.The jugular bulb venous blood samples were taken before (T0,baseline),at the end of (T1) and at 24,48 and 72h(T2-4) after operation for measurement of plasma concentrations of glutamate (Glu),aspartate (Asp) and glycine (Gly) by RP-HPLC.The cognitive function was evaluated by mini-mental state examination (MMSE) at T0 and T4.Results Eleven of the 40 patients developed POCD (28%).The plasma Gh,Asp and Gly concentrations were significantly increased after operation as compared with the baseline values in POCD patients and were significantly higher than in non-POCD patients.The plasma concentrations of Glu and Asp were negatively correlated with MMSE score(Glu:r=-0.86.P<0.01;Asp:r=-0.99,P<0.01).Conclusion Elderly patients may develop POCD after operation performed under general anesthesia through increase in intracranial EAA levels.     

加速康复外科技术对肝肿瘤患者术后恢复的影响

Objective To investigate the effects of fast-track surgery on postoperative rehabilitation of patients with liver cancer. Methods Forty-one patients with liver cancer who had been admitted to Zhongshan Hospital of Fudan University from 9 to 30 in July 2008 were randomly divided into fast-track surgery group (n =20) and routine treatment group (n =21) according to the random number table. Patients in fast-track surgery group were preoperatively educated in order to lessen their anxiety. Bowel preparation was not applied before operation, and they were orally administered with 1000 ml of enteral nutrition emulsion (1300 kcal), then they were fasted for 4 hours before operation. Urethral catheter and gastric tube were removed after operation. They were orally administered with 1000 ml of enteral nutrition emulsion on postoperative day 2, and were encouraged to partake in off-bed activity shortly after the operation. The off-bed time, anus exhaust time, postoperative complica-tions, hospitalization time, expense, nutritional and metabolic indexes on postoperative day 1, 3 and 5, hepatic and renal function, immune and stress indexes between the 2 groups were compared by t test and chi-square test. Results There were significant differences in off-bed time, anus exhaust time, patients' weight, expense, total bilirubin level on postoperative day 1, 3 and 5, and level of serum TNF-α on postoperative day 3 between the 2 groups (t =7.065, 5.483, 3.754, 2.291,2.289, 3.218, 3.192, 2.434, 2.089, P <0.05). Conclusions Fast-track surgery can accelerate the postoperative rehabilitation of patients with liver cancer.     

A retrospective study to compare the treatment outcomes with and without surgical navigation for fracture of the orbital wall

Purpose To evaluate the outcomes with and without aid of a computer-assisted surgical navigation system(CASNS)for treatment of unilateral orbital wall fracture(OWF).Methods Patients who came to our hospital for repairing unilateral traumatic OWF from 2014 to 2017 were included in this study.The patients were divided into the navigation group who accepted orbital wall reconstruction aided by CASNS and the conventional group.We evaluated the surgical precision in the navigation group by analyzing the difference between actual postoperative computed tomography data and preoperative virtual surgical plan through color order ratios.We also compared the duration of surgery,enophthalmos correction,restoration of orbital volumes,and improvement of clinical symptoms in both groups systemically.Quantitative data were presented as mean±SD.Significance was determined by the two-sample t-test using SPSS Version 19.0 A p<0.05 was considered statistically significant.Results Seventy patients with unilateral OWF were included in the study cohort.The mean difference between preoperative virtual planning and actual reconstruction outcome was(0.869±0.472)mm,which means the reconstruction result could match the navigation planning accurately.The mean duration of surgery in the navigation group was shorter than it is in the control group,but not significantly.Discrepancies between the reconstructed and unaffected orbital-cavity volume and eyeball projection in the navigation group were significantly less than that in the conventional group.One patient had remnant diplopia and two patients had enophthalmos after surgery in the navigation group;two patients had postoperative diplopia and four patients had postoperative enophthalmos in the conventional group.Conclusion Compare with the conventional treatment for OWF,the use of CASNS can provide a significantly better surgical precision,greater improvements in orbital-cavity volume and eyeball projection,and better clinical results,without increasing the duration of surgery.