限制性输血与开放性输血策略对髋关节置换术老年患者预后的影响

目的比较限制性输血与开放性输血对髋关节置换术老年患者预后的影响。方法择期在蛛网膜下腔麻醉下行髋关节置换术老年患者206例,年龄65~90岁,ASAⅠ~Ⅲ级,随机分为两组:限制性输血组(维持80g/L≤Hb100g/L,n=102)和开放性输血组(维持100g/L≤Hb120g/L,n=104)。记录羟乙基淀粉输注量、红细胞输注率、围术期Hb、术中低血压发生率、住院时间,以及术后患者脑梗死、急性肺栓塞、肺炎、心肌梗死、伤口感染发生率及90d死亡率。结果两组患者一般资料、术前Hb浓度、住院时间、脑梗死、急性肺栓塞、心肌梗死、伤口感染发生率及90d死亡率比较差异均无统计学意义。与开放性输血组比较,限制性输血组羟乙基淀粉输注量、术中低血压发生率明显增加(P0.05);而红细胞输注率、输血前及输血后Hb、肺炎发生率明显降低(P0.05)。结论对行髋关节置换术的老年患者,限制性输血是安全的治疗策略。     

限制性输血对直肠癌保肛术后并发症影响分析

目的探讨限制性输血和开放性输血对直肠癌保肛术后吻合口漏和感染性并发症的影响。方法行保肛手术的直肠癌病人289例。根据围手术期最低血红蛋白水平和输血状态分为4组。组1:血红蛋白≥100 g/L,未输血;组2:血红蛋白≥70 g/L但100 g/L,未输血;组3:血红蛋白≥70 g/L但100 g/L,输血;组4:血红蛋白70 g/L,输血。对4组病人的临床基本资料、术后30天内吻合口漏和感染并发症进行比较。结果 289例直肠癌病人平均年龄为(58. 2±10. 8)岁。组1、组2、组3、组4分别为121例、115例、32例、21例。4组间术前新辅助化疗、白蛋白水平、术中出血量、肿瘤大小以及TNM分期等指标有明显差异。4组病人总体感染性并发症发生率分别为16. 5%、28. 7%、40. 6%和52. 4%。结论对围手术期血红蛋白水平≥70 g/L的直肠癌病人进行输血治疗会增加术后手术部位感染、总体感染性并发症及术后吻合口漏的发生率。     

门静脉血栓形成对肝移植手术相关参数的影响

目的 探讨术前合并门静脉血栓(PVT)对原位肝移植(OLT)受者手术和术后相关参数的影响.方法 回顾性分析2002年2月至2007年2月武警总医院836例成人OLT病人中71例术前合并门静脉血栓(PVT组)和765例无门静脉血栓(对照组)病人的临床资料.比较两组手术时间、无肝期时间、输血量等手术参数以及ICU时间、住院时间、PVT复发、移植物功能、门静脉血流量、围手术期病死率和1、3、5年生存率等术后参数.结果 PVT组手术时间(min)和无肝期时间(min)明显长于对照组(分别为792.47±162.29和516.18±186.30,P<0.01;77.53±24.76和48.55±31.20;P<0.05).两组间术中输血量、平均ICU时间、住院时间没有显著差异(P>0.05).PVT组术后再栓塞率显著高于对照组(分别为9.86%和1.44%,P<0.01).除90 d时PVT组门静脉血流(PVF,cm/s)较高(41.43±17.19和19.85±11.39,P<0.05)外,两组间各随访时段移植物功能和PVF没有显著性差异.PVT组围手术期病死率略高于对照组而1、3、5年生存率稍低于对照组,但是差异均没有显著性.结论 术前PVT可能会增加肝移植手术复杂程度,但并不影响肝移植效果.     

不解剖肝门的半肝与全肝入肝血流阻断在肝细胞癌患者行肝切除术中的临床应用比较

目的探讨不解剖肝门的半肝入肝血流阻断(HIO)与全肝入肝血流阻断(TIO)在肝细胞癌患者行肝切除术中的临床应用效果。 方法回顾性分析肝细胞癌行肝切除术患者63例,并随机分为两组,HIO组(33例)行不解剖肝门的半肝入肝血流阻断联合控制性低中心静脉压肝切除,TIO组(30例)行全肝入肝血流阻断联合控制性低中心静脉压肝切除。比较两组手术时间、血流阻断时间、术中出血量、术中输血情况,以及术后住院时间、ICU时间、术后第1、3天肝功能。 结果两组手术时间、血流阻断时间、术后ICU时间、术中出血量、术中输血情况差异无统计学意义, HIO组术后住院时间显著短于TIO组[(14.1±5.5) d vs (17.2±5.8)d,t=-2.142,P=0.036];术后第1天HIO组患者血清白蛋白(Alb)水平显著高于TIO组[(34.2±3.5)g/L vs (31.6±3.8)g/L,t=2.784,P=0.007],其余肝功指标(ALT、AST、AKP、GGT、TB、DB)在术后第1天的水平差异无统计学意义,术后第3天两组间肝功指标水平差异无统计学意义。 结论两种肝血流阻断技术同样安全、有效,半肝入肝血流阻断在术后住院时间及早期Alb水平恢复上更优。     

肝移植术后早期呼吸系统并发症的危险因素

目的观察肝移植术后早期呼吸系统并发症类型及危险因素。方法观察2004年2月至2004年9月89例肝移植病人病情,包括原发病、术中输血情况、术前实验室检查、早期术后病死率。结果37例术后早期合并至少1种呼吸系统疾病,其中包括胸腔积液(25例,28%),肺不张(17例,19%),肺炎(15例,16.8%),急性呼吸功能衰竭(7例,7.8%),肺水肿(6例,6.7%),气胸(2例,2.2%)。合并并发症的病人年龄明显高于无并发症组[(53±13)岁vs(34±11)岁,P<0.05],术中输血的比例也明显高于无并发症组(P<0.05),合并肺炎的病死率明显高于总病死率(25%vs8%,P<0.05)。结论高龄及术中大量输血是发生呼吸系统并发症的危险因素,病死率与肺炎发生率升高有关。     

限制性输血在全膝关节置换患者术后的应用

目的探讨严格输血指征(Hb80 g/L)结合自体引流血回输的限制性输血在TKA患者术后应用的安全性和有效性。方法选取自2013-03—2014-12行单侧TKA的骨性关节炎120例,随机分为A组(Hb100 g/L时输血);B组(Hb80 g/L时输血);C组(Hb80 g/L时输血结合自体引流血回输)。观察记录各组手术时间、出血量、术后引流血量、回输血量、输注异体血量和输血不良反应例数;术前、术后2 d、5 d、出院时Hb、红细胞压积(Hct)、血浆凝血酶原时间测定(PT)、活化部分凝血活酶时间(APTT)、D-二聚体(D-Dimer)检测值。结果 C组回输引流血(330.5±61.4)ml,输异体血(70.0±195.1)ml,异体血输注率12.5%,低于B组和A组,差异有统计学意义(P0.05)。手术时间、术中失血量、术后引流量及输血不良反应率与B组和A组相比较差异无统计学意义(P0.05)。结论限制性输血对TKA患者是安全的,在达到预期手术治疗效果的同时,有效减少或杜绝了输注异体血的风险。     

消化道手术前患者PAL水平与手术预后的相关性分析

目的分析消化道手术前患者术前清蛋白(Preoperative albumin level,PAL)水平与手术预后的相关性。方法收集2014-02—2016-03间收治的108例实施消化道手术的患者,测定PAL水平后,进行分组,将PAL水平≤35 g/L作为对照组,PAL水平35 g/L作为观察组。分别比较2组术后并发症发生率、病死率、术后住院时间、入住ICU时间、恢复进食时间等。结果观察组并发症总发生率低于对照组,总病死率低于对照组,术后住院时间、入住ICU时间、恢复进食时间均少于对照组,差异均有统计学意义(均P0.05)。PAL水平与术后并发症、病死率及术后住院时间和入住ICU时间,恢复进食时间等之间呈现负相关(r=-0.386,-0.399,-0.423,-0.411,-0.389,P0.05)。结论实施消化道手术的患者,应在术前监测其PAL水平以推测预后情况,综合考虑该因素后方可视患者临床症状予以相应手术治疗。     

公民逝世后器官捐献供肝肝移植术后感染特点及危险因素分析

目的探讨公民逝世后器官捐献供肝肝移植受体术后感染特点及感染相关危险因素。方法回顾性分析接受公民逝世后器官捐献供肝肝移植68例受体的临床资料。根据受体术后是否合并感染分为感染组(33例)和非感染组(35例)。总结68例肝移植受体术后感染的主要特点;对受体发生肝移植术后感染的可能危险因素进行单因素分析;有统计学意义的危险因素再进行多因素分析,找出独立危险因素,并采用受试者工作特征(ROC)曲线分析其预测肝移植术后感染的准确度。结果肝移植术后33例受体发生感染,占总数的49%,以细菌感染和真菌感染为主,感染部位主要有肺部感染和腹腔感染。单因素分析发现,供体存在开放性损伤,受体术前血红蛋白水平、血小板计数、肝功能Child-Pugh分级、终末期肝病模型(MELD)评分,术中红细胞输注量,术后第1日γ-谷氨酰转肽酶(GGT)、重症监护室(ICU)停留时间共8个因素是器官捐献供肝肝移植术后感染的相关因素(均为P0.05)。多因素Logistic回归分析结果显示术前血红蛋白水平120 g/L和术后ICU停留时间96 h为器官捐献供肝肝移植术后感染的独立危险因素(均为P0.05)。ROC曲线分析显示,术前血红蛋白水平114 g/L和术后ICU停留时间102 h对预测术后感染准确度较高。结论公民逝世后器官捐献供肝肝移植术后感染发生率较高,以细菌感染和真菌感染为主,感染部位主要在肺部和腹腔。受体肝移植术前血红蛋白水平低及术后ICU停留时间长,会增加肝移植术后感染风险。     

红激光与等离子经尿道前列腺剜除术治疗大体积良性前列腺增生的疗效及安全性比较

目的比较经尿道前列腺红激光剜除术(diode laser enucleation of the prostate,Di LEP)和经尿道前列腺等离子剜除术(bipolar plasmakinetic enucleation of the prostate,PKEP)治疗大体积良性前列腺增生(benign prostatic hyperplasia,BPH)的疗效及安全性。方法回顾性分析2012年6月到2014年1月收治的70例大体积BPH患者,分别采用等离子或红激光行经尿道前列腺剜除术。比较两组手术时间、血红蛋白值下降值、手术前后国际前列腺症状评分(IPSS)、残尿量(PVR)、最大尿流率(Qmax)。结果两组手术均获成功;术后随访12个月,两组IPSS、Qmax、生活质量评分(Qo L)无差异。Di LEP组术后血红蛋白下降值、膀胱灌注时间、留置尿管时间及住院时间均显著低于PKEP组。两组手术时间[(123.5±27.2)min vs.(102.7±20.4)min]、切除组织重量[(64.7±16.8)g vs.(61.2±20.5)g]、术后血红蛋白下降值[(0.92±0.43)g/dl vs.(1.24±0.55)g/dl]、膀胱灌注时间[(28.9±14)h vs.(38.5±16.6)h]、导尿管留置时间[(2.6±1.8)d vs.(3.8±2.3)d]和住院时间[(4.84±1.8)d vs.(6.2±2.3)d]比较差异均有统计学意义(P0.05);刺激症状、逆行射精亦有差异(P0.05);但尿潴留、输血、压力性尿失禁发生率无差别;且术后均未发生经尿道电切综合征。PKEP组1例因术后出血给予输血治疗。结论与PKEP相比,Di LEP治疗大体积BPH出血风险更小,膀胱灌注、留置尿管及住院时间更短,具有良好的疗效及安全性。     

离体肝脏冷缺血时间对自体肝移植术后早期肝脏功能及并发症影响研究

目的 探讨离体肝脏冷缺血时间(CIT)对自体肝移植术后早期肝脏功能及并发症的影响。方法 回顾性分析2017年12月至2020年11月在新疆医科大学第一附属医院接受自体肝移植的89例病人资料,根据术中离体肝脏冷缺血时间长短将病人分为A组(CIT≤6 h)和B组(CIT>6 h),比较两组病人术后早期肝功能及早期并发症的发生率。结果 A组病人术后住院天数,术后带引流管时间,术后天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、总胆红素(TBIL)、直接胆红素(DBIL)降至正常范围的时间。术后大量腹腔积液发生率,术后血管并发症的发生率,术后胆道并发症的发生率均短/低于B组病人[(20.56±9.67)d vs.(30.58±22.81)d,(14.18±6.51)d vs.(23.78±20.61)d,(7.00±2.84)d vs.(9.22±4.66)d,(8.41±2.45)d vs.10.60±5.20)d,(10.68±5.81)d vs.15.00±9.76)d,(10.12±5.85)d vs.14.69±9.48)d,17.65%(6/34)vs.43.64%(24/...     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.