吸烟对围术期患者病理生理和麻醉效果的影响

背景 每年都有成千上万的吸烟患者需要手术和麻醉,而大多数麻醉医师未充分认识到吸烟对围术期的危害.目的 为提高麻醉管理水平,改善围术期吸烟手术患者的预后,现将吸烟对围术期患者病理生理和麻醉效果的影响作一综述.内容 吸烟不仅能增加术后并发症(包括肺部并发症、心血管并发症和伤口相关并发症),还能增加麻醉相关并发症(譬如低氧血...     

围术期戒烟病理生理与国内外麻醉医师对戒烟干预研究进展

背景 吸烟患者在围术期均处于不同的戒烟期,麻醉医师在围术期承担重要角色,但戒烟对围术期病理生理的影响有多大,哪些因素影响患者的围术期戒烟及戒烟实施情况并不十分清楚. 目的 提高麻醉管理水平,改善围术期吸烟患者的预后. 内容 回顾当前关于短期(时间范围从数小时到数周)和长期戒烟病理生理方面的变化,尤其是与术后转归密切相关的几个方面.此外,还探讨围术期戒烟的影响因素、国内外麻醉医师在围术期戒烟中的作用与实践. 趋向 围术期戒烟还有很长的路要走,需要今后的临床研究和实验进一步探讨,以便更好地帮助患者围术期甚至长期戒烟,减少麻醉手术相关并发症.     

肝移植围手术期糖尿病防治的初步研究

目的研究肝移植围手术期糖尿病对患者的影响及防治措施。方法回顾性分析131例肝移植患者临床资料，观察患者围手术期糖尿病的发生及对术后并发症的影响，探讨移植术后新发糖尿病与原发疾病、术后免疫抑制药物等因素的关系。结果移植术后新发糖尿病发生率为19．3％（21／109），与糖尿病家族史和术后使用大剂量激素有关，与非糖尿病患者相比，围手术期糖尿病患者急性排斥反应、细菌感染、高血压等并发症的发生率显著升高（P〈0．05），术前及术后早期（2周内）将血糖降至正常可减少感染的发生。结论围手术期出现糖尿病会增加肝移植患者术后并发症的发生率，应该有效控制血糖以减少感染并发症的发生，同时肝移植术后早期应避免使用大剂量激素.     

合并糖尿病食管癌患者的围手术期综合护理

目的探讨合并糖尿病食管癌患者的围手术期综合护理方法及效果。方法对32例接受食管癌根治术的糖尿病患者行围手术期综合护理,回顾性分析患者的临床资料。结果经过围手术期综合护理措施,本组36例患者未发生低血糖、糖尿病酮症酸中毒、高渗性非酮症糖尿病昏迷及严重感染等并发症。未发生与护理措施不当有关的并发症。术后发生切口感染1例,经更换敷料后切口Ⅱ期愈合。其余患者均顺利康复出院。结论食管癌大多发生在高龄人群,故合并糖尿病的患者较多,术后易发生较多并发症,增加了手术的风险。加强围手术期综合护理,尤其是对糖尿病的护理,对患者的术后康复有重要意义。     

预防前列腺汽化电切术中低体温的保暖护理措施

目的探讨对前列腺汽化电切手术患者围术期实施复合保暖护理措施对防治术中低体温的疗效。方法回顾分析159例前列腺汽化电切手术患者围术期预防术中低体温的护理措施。结果 159例手术中145例患者体温保持正常,9例出现术中低体温,5例出现术中寒颤,均经对症处理后症状缓解。未出现严重感染、心功能异常等其他并发症病例。结论对于前列腺汽化电切术患者围术期复合保暖护理措施可降低术中低体温及寒颤的发生率,减少并发症发生。     

273例宫腔镜手术围术期护理体会

目的探讨宫腔镜围手术期的护理措施。方法对273例接受宫腔镜手术患者的临床资料进行回顾性分析。结果手术均顺利完成,经围术期护理配合未发生子宫穿孔、空气栓塞、TURP综合征、术后出血、感染等并发症。结论宫腔镜手术创伤小、出血少、恢复快、可保留患者的生育能力。护理人员要做好围手术期护理措施,与医师密切配合,以保障手术的顺利进行及患者的迅速康复。     

肥胖患者围术期通气策略的研究进展

肥胖患者在手术人群中所占的比例逐年上升.肥胖不仅影响了患者的生理功能,也给麻醉和手术带来不少难题.现就此讨论肥胖患者围手术期的呼吸管理,包括术前的呼吸治疗、术中的机械通气策略及术后的呼吸支持等问题.对肥胖患者围术期呼吸生理改变的了解,详尽的、个体化的通气设置和术中术后完善的通气管理有助于减少肥胖患者呼吸系统并发症的发生.     

食管癌手术围术期肺部感染的高危因素分析及预防

目的探讨食管癌手术围术期发生肺部感染的高危因素及其预防措施。方法回顾性分析2009～2012年广元市中心医院258例食管癌手术患者的临床资料,按食管癌术后是否发生肺部感染将258例食管癌手术患者分为两组,肺部感染组：86例,男62例、女24例,平均年龄65.1（45～84）岁,食管癌手术后均发生肺部感染;对照组：172例,男124例、女48例,平均年龄60.2（43～78）岁,为随机抽取的同期食管癌手术后未发生肺部感染者。比较两组患者的术前肺功能、年龄、吸烟量、吻合口位置、手术出血量、术前、术后其它合并症及管状胃代食管肺部感染发生率的差异,并采用logistic多因素回归分析食管癌手术围术期肺部感染的高危因素。结果单因素分析结果显示,肺部感染组肺功能中重度障碍、吸烟（≥400支/年）、高龄（≥65岁）、喉返神经损伤、围手术期失血量（术中出血＋术后24 h胸腔、腹腔引流量≥1 000 ml）、手术时间≥4 h、术前合并糖尿病的比率均高于对照组（P〈0.05）。Logistic多因素回归分析结果显示,肺功能中重度障碍（P=0.022）、吸烟（≥400支/年,P=0.000）、高龄（≥65岁,P=0.026）、喉返神经损伤（P=0.002）、围手术期失血量（术中出血＋术后24 h胸、腹腔引流量≥1 000 ml,P=0.020）是食管癌患者术后发生肺部感染最主要的危险因素。结论肺功能中-重度障碍、吸烟（≥400支/年）、高龄（≥65岁）、喉返神经损伤、围手术期失血量（≥1 000 ml）是食管癌术后发生肺部感染的高危因素;术前戒烟、加强呼吸功能锻炼、呼吸道准备、严密止血、注意保护喉返神经等措施可预防肺部感染的发生。     

糖尿病对胆道手术的影响及治疗对策

目的探讨糖尿病对胆道手术的影响及控制血糖的有效方法。方法通过设立严格的病例对照，比较40例糖尿病患者与非糖尿病患者、胰岛素强化治疗与非强化治疗胆道术后并发症的发生率。结果糖尿病显著增加胆道术后并发症的发生率，围手术期胰岛素强化治疗，可减少并发症的发生。结论高血糖是胆道病患者术后并发症高发生率的主要原因，严密监测血糖、尿糖，规范围手术期胰岛素强化治疗是预防术后并发症的关键。     

择期剖宫产术围术期人性化护理的体会

目的分析人性化护理在择期剖宫产围术期的应用体会。方法对56例行择期剖宫产术的产妇围术期实施人性化护理,观察术中出血量、手术时间、肛门排气时间、术后并发症发生率和对护理工作满意度等。结果本组产妇术中出血量(186±20.58)m L,手术时间(59±15.43)min,术后肛门排气时间(22±9.56)h。术后发生切口疼痛、尿储留等5例(8.93%),均经对症处理后缓解。未发生产后出血、便秘、切口感染等其他并发症。出院时发放护理工作满意调查表显示,患者及家属满意率98.21%。结论对行择期剖宫产手术产妇实施围术期人性化护理,能增加产妇舒适感,提高其治疗依从性,保证手术顺利进行,减少并发症,缩短恢复时间,提高护理质量。     

A multicenter study of cardiac events and anesthetic management of patients with ischemic heart diseases for noncardiac surgery--a follow-up report

We have conducted a joint research project to investigate the incidence of ischemic heart disease in patients for noncardiac surgery and to define the risk of perioperative cardiac complications in these patients. From September to November 1997 we had 7288 patients scheduled to undergo noncardiac surgery in the 8 departments of anesthesiology. Of these patients, 228 (3.1%) patients had ischemic heart disease, and 30 of them (13.2%) developed perioperative cardiac events. Critical cardiac events, including perioperative myocardial ischemia and lethal arrhythmia, occurred in 7 of these patients. In our region of Japan, 3-4% of surgical patients tend to develop ischemic heart disease and 3.1% of them demonstrated severe cardiac complications perioperatively. Compared with United States we encounter fewer surgical patients with ischemic heart disease, but the risk of developing perioperative cardiac complications in such patients is almost the same for both countries.     

The musculoskeletal effects of perioperative smoking

Although the carcinogenic consequences of smoking are well known, further research is needed on the effects of smoking on musculoskeletal health and surgical outcomes. Orthopaedic perioperative complications of smoking include impaired healing, increased infection, delayed and/or impaired fracture union and arthrodesis, and inferior arthroplasty outcomes. The incorporation of smoking cessation protocols such as transdermal patches, chewing gum, lozenges, inhalers, sprays, bupropion, and varenicline in the perioperative period may result in substantial benefits for patients' musculoskeletal and general health.     

Predictors of morbidity following free flap reconstruction for cancer of the head and neck

BACKGROUND: Free flap reconstruction of head and neck cancer defects is complex with many factors that influence perioperative complications. The aim was to determine if there was an association between perioperative variables and postoperative outcome. METHODS: We evaluated 185 patients undergoing free flap reconstruction following ablation of head and neck cancer between 1999 and 2001. Demographic, laboratory, surgical and anesthetic variables were analyzed using univariate and multivariable techniques. RESULTS: Ninety-eight patients (53%) developed complications, of which 74 were considered major, giving a major morbidity rate of 40%. Predictors of major complications were increasing patient age, ASA class, and smoking. Predictors of medical complications were ASA class, smoking, age and crystalloid replacement. Predictors of surgical complications were tracheostomy, preoperative hemoglobin, and preoperative radiotherapy. CONCLUSION: Patient age, comorbidity, smoking, preoperative hemoglobin, and perioperative fluid management are potential predictors of postoperative complications following free flap reconstruction for cancer of the head and neck.     

Efficacy of oncologic surgery. Does anesthesia influence the postoperative outcome?

Major surgical interventions in tumour surgery are still associated with perioperative cardiopulmonary, infectious, thromboembolic, cerebral, and gastrointestinal complications. There are different prophylactic and therapeutic possibilities to anticipate or counteract these perioperative complications. The most important, including beta blockers and alpha-2-agonists for patients at coronary risk, preoperative optimisation of oxygen transport in high risk surgical patients and the concept of multimodal perioperative therapy (analgesia, early mobilisation, early enteral nutrition, and others) combined with high perioperative inspiratory oxygen concentration and maintenance of normothermia to reduce wound infection and cardiac complications are described in this paper.     

Alcohol Drinking does not Affect Postoperative Surgical Site Infection or Anastomotic Leakage: A Systematic Review and Meta-analysis

Background

Alcohol abuse appears to increase postoperative complications, but clinical trials have reported conflicting results. The objective of this systematic review and meta-analysis is to clarify how alcohol drinking affects postoperative surgical site infection and anastomotic leakage and to determine the impact of perioperative alcohol intervention.

Material and Methods

The databases MEDLINE, EMBASE, and CENTRAL were searched. Observational studies assessing surgical site infection and anastomotic leakage for alcohol drinkers and randomized controlled trials (RCTs) studying perioperative alcohol interventions were included. Meta-analyses were performed with random effects models. Methodological quality was assessed by the Newcastle–Ottawa Scale and Cochrane methodology.

Results

Fifteen observational studies and 2 RCTs were identified. Meta-analyses were performed for alcohol drinkers vs nondrinkers and moderate drinkers (≤2 U/day), respectively. No difference between alcohol drinkers and nondrinkers was found. When drinkers and moderate drinkers were compared, a significantly higher incidence of surgical site infection and anastomotic leakage was found in unadjusted studies. In the meta-analysis of studies adjusting for smoking and age, alcohol drinking did not significantly affect surgical site infection and anastomotic leakage. The RCTs did not show any effect of perioperative alcohol abstinence or pharmacological withdrawal treatment on outcome.

Conclusions

Alcohol drinking is not an independent risk factor for surgical site infection and anastomotic leakage. Interventions which aim to make patients quit alcohol or treat withdrawal symptoms do not seem to affect the surgical outcomes of interest.     

Smoking increases the risk of postoperative wound complications: A propensity score-matched cohort study

Cigarette smoking is associated with surgical complications, including wound healing and surgical site infection. However, the association between smoking status and postoperative wound complications is not completely understood. Our objective was to investigate the effect of smoking on postoperative wound complications for major surgeries. Data were collected from the 2013 to 2018 participant use files of the American College of Surgeons National Surgical Quality Improvement Program database. A propensity score matching procedure was used to create the balanced smoker and nonsmoker groups. Multivariable logistic regression was used to calculate the odds ratios (ORs) with 95% confidence intervals (CIs) for postoperative wound complications, pulmonary complications, and in-hospital mortality associated with smokers. A total of 1 156 002 patients (578 001 smokers and 578 001 nonsmokers) were included in the propensity score matching analysis. Smoking was associated with a significantly increased risk of postoperative wound disruption (OR 1.65, 95% CI 1.56-1.75), surgical site infection (OR 1.31, 95% CI 1.28-1.34), reintubation (OR 1.47, 95% CI 1.40-1.54), and in-hospital mortality (OR 1.13, 95% CI 1.07-1.19) compared with nonsmoking. The length of hospital stay was significantly increased in smokers compared with nonsmokers. Our analysis indicates that smoking is associated with an increased risk of surgical site infection, wound disruption, and postoperative pulmonary complications. The results may drive the clinicians to encourage patients to quit smoking before surgery.     

老龄肠梗阻病人急诊手术并发症发生的危险因素分析及对策

目的探讨老龄肠梗阻病人急诊术后并发症发生的危险因素和处理策略。方法回顾性分析解放军第一〇五医院普外科2010年1月至2015年12月间行急诊手术干预57例老龄肠梗阻病人围手术期临床资料。结果 57例病人的年龄为70~105岁,平均(78.3±7.3)岁,其中24例病人(42.1%)发生了各种并发症48例次,包括肺部感染9例,术后肠梗阻3例,切口感染11例,急性肾损伤2例,低蛋白血症17例,心律失常6例。术前合并低蛋白血症、高血糖、贫血、营养不良及手术时间较长的病人术后容易出现常见手术并发症,而年龄、心脑血管疾病、水电解质紊乱及酸碱失衡则对此无明显影响。结论术前多种因素引起了病人术后并发症的出现,与病人术前各种合并疾病、病变本身因素以及手术方式的选择有关,没有单一的绝对因素决定术后并发症的出现。加强对老龄病人合并疾病的围手术期处理是减少老龄肠梗阻病人术后早期并发症的重要措施之一。     

The anesthetic risk of tobacco smoking

Tobacco smoking is one of the many factors that predispose to postoperative complications. Although smoking affects multiple organs (heart, lungs, blood, immune and nervous systems), the most prominent perioperative morbidity is of pulmonary origin. This article reviews the major effects of tobacco smoke constituents on organ functions and the management principles applying to anesthesia of smokers. It is pointed out that smoking should be discouraged in all patients but that a marked reduction in perioperative complications can already be obtained if cessation of smoking occurs at least 8 weeks before surgery. Such smoke-free interval will benefit the surgical patient by eliminating carboxyhemoglobin, improving ciliary function, decreasing both mucus secretion and small airway obstruction and restoring normal immune function.     

Smoking cessation: techniques and potential benefits

Smokers have a significantly greater risk of complications during and after operations. Cigarette smoke has significant effects on cardiac function, circulation, and respiratory function. Preliminary studies suggest that smoking cessation for a minimum of 6 to 8 weeks before surgery is required to reduce the perioperative and postoperative risks of smoking. Smoking cessation programs that employ advice, support groups, nicotine replacement therapy, or some anti-depressants have been used successfully in many situations and should be used to discourage smoking preoperatively. Further research is needed, however, to clarify the best approach to smoking cessation for surgical patients.