良性前列腺增生患者术后谵妄的临床分析

目的:探讨良性前列腺增生(BPH)患者术后发生谵妄的影响因素。方法:分析我院198例60～83岁BPH手术患者的年龄与术后疼痛、低氧血症和睡眠时间减少发生的关系,判定患者术后发生谵妄的危险因素。结果:198例患者术后发生谵妄13例(6.5%),≥70岁的患者与<70岁患者相比,术后谵妄发生率增加(1.6%vs14%,P<0.05)。结论:高龄患者前列腺术后疼痛和睡眠障碍是发生谵妄的重要原因,镇痛及良好的睡眠对预防术后谵妄有积极的意义。     

TURP治疗良性前列腺增生的临床分析(附912例报告)

目的总结经尿道前列腺电切术(TURP)治疗良性前列腺增生症的疗效、安全性及围手术期处理的经验。方法回顾性分析我院近11年来应用TURP治疗的912例良性前列腺增生症患者的临床资料。结果平均手术时间73min(30～115min);58例术后发生低钠血症,其中52例为初期手术病例,5例术后出血膀胱填塞行开放手术治疗,均为初期手术病例。术后输血19例,术后5～7d拔除尿管。无死亡病例,无真性尿失禁。结论TURP是治疗良性前列腺增生症的理想选择。     

前列腺、精囊

耻骨后解剖性根治性前列腺切除术的技术改进;同期手术治疗良性前列腺增生并膀胱结石27例报告;良性前列腺增生症与阴茎勃起功能障碍的相关性研究;伽玛刀治疗高危前列腺增生症的临床应用;经尿道前列腺电切术患者转开放手术的危险因素分析     

棒状水囊前列腺扩裂联合动脉栓塞治疗前列腺增生的临床研究

目的探讨经尿道棒状水囊前列腺扩裂联合前列腺动脉栓塞术治疗高危患者良性前列腺增生症的临床效果。方法随机选取2017年8月至2019年8月本院高危良性前列腺增生症患者40例,均接受经尿道棒状水囊前列腺扩裂联合前列腺动脉栓塞术治疗,然后统计分析患者的术前、手术及术后的相关指标,包括手术出血量、前列腺体积(PV)、Qmax、PVR、IPSS评分、QOL评分、术后并发症发生情况。结果患者的术中出血量为(78.3±10.0)ml。患者手术后的PV、IPSS评分、QOL评分均显著低于手术前(P0.05),Qmax显著高于手术前(P0.05)。在术后并发症发生率方面,会阴部栓塞后阵痛4例为10.0(4/40)。结论经尿道棒状水囊前列腺扩裂联合前列腺动脉栓塞术治疗高危患者良性前列腺增生症的效果好。     

手术治疗良性前列腺增生症合并膀胱结石的体会

目的总结手术治疗良性前列腺增生症合并膀胱结石的效果。方法对21例良性前列腺增生症合并膀胱结石的患者,先行耻骨上小切口膀胱切开取石,然后行经尿道前列腺汽化电切术,对患者的临床资料进行回顾性分析。结果手术时间60～135 min,术后1周左右除去导尿管后排尿通畅,未发生膀胱穿孔及电切综合征等并发症。20例患者得到1～2 a随访,前列腺症状评分明显降低,最大尿流率平均>15.0 mL/s。结论对良性前列腺增生症合并膀胱结石患者,行耻骨上小切口膀胱切开取石、经尿道前列腺汽化电切术,是一种痛苦小、费用低、效果满意的治疗方法。     

经膀胱单孔腹腔镜手术治疗大体积良性前列腺增生症的初步体会

目的探讨经膀胱单孔腹腔镜手术治疗大体积良性前列腺增生症的手术技巧,总结该术式的临床经验。方法对4例大体积BPH患者（95ml、83ml、150ml、143ml）实施经膀胱单孔腹腔镜下良性前列腺摘除术。记录手术时间、失血量、术后尿管留置时间,拔管时间,控尿情况和术后下尿路症状（LUTS）。结果 4例手术均顺利完成,手术时间分别为75min、60min、120min、95min。术中出血分别为50ml、45ml、120ml、300ml。术后无需膀胱持续冲洗,留置尿管时间分别为9d、8d、12d、9d。所有患者术中、术后无并发症发生,拔除尿管后排尿情况均较前明显改善,无尿失禁发生。结论经膀胱单孔腹腔镜手术治疗大体积良性前列腺增生症安全、有效,并发症少,恢复快,对于大体积良性前列腺增生症患者具有良好的临床应用前景。     

同期经尿道切除膀胱肿瘤和前列腺的安全性和疗效观察（附16例报告）

目的：探讨同期经尿道切除膀胱肿瘤和前列腺治疗表浅性膀胱癌合并良性前列腺增生症的手术安全性和临床疗效.方法：16例表浅性膀胱癌合并良性前列腺增生症患者,先行经尿道膀胱肿瘤电切术（TURBT）切除膀胱肿瘤后同期行经尿道前列腺电切术（TURP）切除前列腺.结果：患者均顺利完成手术,无膀胱穿孔和电切综合征发生,术后随访6～36个月,平均22个月,6例发生膀胱肿瘤复发,平均复发时间14个月,复发部位均不在膀胱颈口和前列腺尿道,全部再次行TURBT.结论：同期经尿道切除膀胱肿瘤和前列腺治疗表浅性膀胱癌合并良性前列腺增生症手术安全、短期疗效确切,可适用于一部分年龄较大伴有严重的下尿路梗阻的且肿瘤分期、分级低的表浅性膀胱肿瘤患者.     

经尿道前列腺电切术后尿道狭窄发生的危险因素

目的 探讨经尿道前列腺电切术(TURP)后尿道狭窄发生的危险因素。方法 对200例诊断为良性前列腺增生症病人行经尿道前列腺电切术后随访12月～18月,对可能影响术后尿道狭窄的因素以Lo-gistic回归模型做单因素分析以及用逐步回归法行多因素分析。结果 本组共155例患者获完整随访,其中12例术后出现尿道狭窄,发生率为7.74%。术前尿路感染、术后留置尿管时间长短、手术切除前列腺重量三因素与术后尿道狭窄相关,相对危险度分别为9.305、2.973和5.587,有统计学意义(P<0.05)。结论 术前尿路感染、术后尿管留置时间的长短、手术切除前列腺的重量依次是TURP术后出现尿道狭窄的主要危险因素。     

经尿道前列腺电切术后谵妄诊治的临床分析

目的探讨经尿道前列腺电切术（TURP）后出现谵妄的相关因素，提高对该病的诊治水平。方法总结我院110例良性前列腺增生（BPH）患者行TURP术的临床资料，分析TURP术后发生谵妄的危险因素。年龄55-86岁，平均71．5岁，其中55-69岁57例，70岁以上53例。合并糖尿病者27例，高血压76例，冠心病29例，慢性支气管炎13例。所有患者无精神障碍和颅脑外伤病史。结果110例患者术后发生谵妄6例，表现为知觉障碍、语句不连贯、睡眠、清醒节律失调、定向失调和记忆力减退等。70岁以上的患者术后谵妄发生率明显增加，55-69岁及70岁以上患者谵妄发生率分别为1，7％和9．4％。结论高龄、疼痛和睡眠障碍是TURP术后发生谵妄的重要因素，术后良好的镇痛及充足的睡眠可有效预防术后谵妄的发生。     

经尿道前列腺电切术治疗良性前列腺增生症的临床疗效分析

目的观察经尿道前列腺电切术治疗良性前列腺增生症的临床效果。方法对60例前列腺增生症患者实施经尿道前列腺电切术,观察治疗效果。结果 60例患者均顺利完成手术,平均手术时间52.95 min。平均术中出血量72.20 m L,术后出现3例并发症(5.00%)。未出现尿道狭窄、电切综合征等其他严重并发症。与治疗前比较,患者术后国际前列腺症状评分、最大尿流率和残余尿量等均明显改善,差异有统计学意义(P0.05)。结论采用经尿道前列腺电切术治疗良性前列腺增生症,并发症少、安全性高、疗效确切。     

老年患者脊柱手术术后谵妄危险因素分析的回顾性研究

目的:探讨老年患者脊柱手术术后谵妄的发生率及相关危险因素。方法:采用回顾性分析2016年1月至2018年11月收治的老年脊柱手术病例436例,根据术后是否发生谵妄分为谵妄组和非谵妄组。记录患者的性别、年龄、身体质量指数,糖尿病史,冠心病史,慢性阻塞性肺疾病史,术前白细胞计数,术前红细胞比容,术前血红蛋白水平,手术方式,手术时间,麻醉时间,美国麻醉医师协会(ASA)评分,心功能分级,术中失血量,术中输血量,术中芬太尼、异丙酚和地佐辛的用量,术后白细胞计数,术后红细胞比容,术后血红蛋白水平,术后电解质(钠离子、钾离子),采用单因素Logistic回归分析有统计学意义的危险因素后进行多元Logistic回归分析进一步探讨独立危险因素。结果:纳入436例中112例老年患者术后出现谵妄,发生率25.68%。谵妄组与非谵妄组在年龄、术前白细胞计数、术前红细胞比容、术后红细胞比容、术后血红蛋白水平、术后钠离子浓度、麻醉时间、ASA评分、心功能评分、术中失血量、术后地佐辛使用量、糖尿病史、冠心病史、慢性阻塞性肺疾病史方面差异有统计学意义(P0.05),通过多因素Logistic回归分析显示年龄、ASA评分、术后地佐辛量、慢性阻塞性肺疾病史是老年患者脊柱手术术后谵妄发生的独立危险因素。结论:患者高龄72岁、ASA评分2分、地佐辛镇痛药物的使用以及患者合并慢性阻塞性肺疾病史是术后谵妄发生的独立危险因素。     

骨科常见手术术后谵妄的危险因素分析

 目的 分析骨科常见手术术后发生谵妄的相关危险因素。方法 回顾性分析2011年1月至2013年12月行股骨转子间骨折内固定术（155例）、人工股骨头置换术（64例）、全髋关节置换术（169例）、膝关节置换术（65例）和肩关节周围手术（72例）患者525例,根据是否发生术后谵妄分为谵妄组（56例）和非谵妄组（469例）。记录谵妄组和非谵妄组患者年龄、性别、血型以及住院天数、手术方式、麻醉方式、术前准备时间、术前基础疾病状况、术前及术后白蛋白、术前及术后血红蛋白水平、术后电解质是否紊乱、术中出血量、手术持续时间、术后是否ICU监护和输血量等围手术期因素共17项。采用单因素和多因素Logistic回归分析术后发生谵妄的相关危险因素。结果 单因素Logistic回归分析结果显示,可能与术后谵妄相关的因素有年龄、手术方式、术前准备时间、术前白蛋白水平、术前血红蛋白水平、术后电解质是否紊乱、手术持续时间、是否术后ICU监护和输血量等9项。多因素Logistic回归分析显示：年龄70~80岁和>80岁组术后谵妄发生率高于年龄<70岁组,OR值分别为12.998（95%CI：2.829,59.713）和36.210（95%CI：8.222,159.476）;术前准备时间4~6 d组术后谵妄发生率高于术前准备时间≥7 d组,OR值为3.903（95%CI：1.658,9.188）;术后电解质紊乱组术后谵妄的发生率高于电解质正常组,OR值为2.160（95%CI：1.065,4.382）。结论 高龄、术前准备时间不充分和术后电解质紊乱是骨科术后发生谵妄的高危因素。     

非心脏手术患者术后谵妄的危险因素

目的 筛选非心脏手术患者发生术后谵妄的危险因素.方法 择期围术期有可疑危险因素的非心脏手术患者480例,年龄18～92岁,根据术后3 d内是否发生谵妄分为术后谵妄组和非术后谵妄组.可疑危险因素进行组间比较后,将差异有统计学意义的因素进行logistic回归分析,筛选发生术后谵妄的危险因素.结果 79例术后发生谵妄,发生率为16.5%.logistic回归分析结果显示,老龄、全身麻醉、手术时间≥3 h、术后Price-Henry疼痛评分为4分、合并肺气肿、饮酒≥3次/周是发生术后谵妄的独立危险因素(P＜0.05),相对危险度依次为1.924、0.188、2.251、1.752、18.954、1.779.结论 老龄、全身麻醉、长时间手术、术后剧烈疼痛、合并肺气肿、长期饮酒是非心脏手术患者发生术后谵妄的危险因素.     

全凭静脉麻醉下脊柱手术患者术后谵妄的危险因素

目的 筛选全凭静脉麻醉下脊柱手术患者发生术后谵妄的危险因素.方法 择期行脊柱手术患者200例,年龄18～70岁,根据术后3 d内是否发生谵妄分为术后谵妄组和非术后谵妄组.可疑危险因素进行组间比较后,将差异有统计学意义的因素进行logistic回归分析,筛选发生术后谵妄的危险因素.结果 39例患者术后发生谵妄,发生率为19.5%.logistic回归分析结果显示,年龄、术中失血量、经常饮酒是发生术后谵妄的独立危险因素(P＜0.05).相对危险度依次为1.882、0.999、1.715.结论 老龄、术中大量失血、长期饮酒是全凭静脉麻醉下脊柱手术患者发生术后谵妄的危险因素.     

Durchgangssyndrome nach gefäßchirurgischen Operationen

INTRODUCTION: Postoperative delirium is a common psychic disturbance occurring acutely after various surgical procedures and typically presenting with a fluctuating course. These patients' recovery takes longer. In this study we analyze the incidence of postoperative delirium in patients undergoing vascular surgery and try to identify risk factors for its development. METHODS: Patients undergoing elective arterial operations were included. Their medical history, the specific vascular diagnosis and operation performed, the medication and laboratory data were monitored. Additionally the patients were preoperatively interviewed by a psychiatrist. Intraoperatively the drugs, infusions, possible transfusions, blood gases and pressures were monitored, as were the times of surgery and anesthesia. Postoperatively patients were seen daily by the psychiatrist and the surgeon for at least 7 days. Postoperative delirium was diagnosed according to DSM IV criteria, and mild, moderate and severe delirium were distinguished. RESULTS: Fifty-four patients entered the study. Twenty-one (38.9%) developed postoperative delirium (11 mild, 2 moderate, 8 severe). Patients with aortic operations developed delirium more frequently than those with non-aortic procedures(55.5 vs 22.2%, n = 27 each). Some preexisting diseases (hearing disturbance) increased the probability of postoperative delirium, while age was not identified as a risk factor. General psychopathological and depressive disturbances increased the likelihood of postoperative delirium. Patients who had a severe intraoperative course developed postoperative delirium more frequently. This was not seen in the absolute time of surgery or anesthesia nor in the intraoperative development of blood pressure or intraarterial gases, which did not differ between patients with and without postoperative delirium. More reliable parameters were an increased intraoperative need for crystalloid volume, intra- or postoperatively decreased hemoglobin values (Hb < 10 g/dl) and the development of acidosis that had to be treated. Patients with delirium had serious complications more often (8/21 = 38.1% vs 6/33 = 18.2%) and needed Intensive Care treatment longer (2.7 vs 2.1 days, only aortic surgery 3.2 vs 2.4 days). CONCLUSIONS: Postoperative delirium after vascular surgery is frequent. Patients undergoing aortic surgery, with specific concomitant medical disease, psychopathological disturbances and a severe intraoperative course, are at risk of developing postoperative delirium.     

Durchgangssyndrome nach gefäßchirurgischen Operationen Zwischenergebnisse einer prospektiven Untersuchung

Introduction: Postoperative delirium is a common psychic disturbance occurring acutely after various surgical procedures and typically presenting with a fluctuating course. These patients' recovery takes longer. In this study we analyze the incidence of postoperative delirium in patients undergoing vascular surgery and try to identify risk factors for its development. Methods: Patients undergoing elective arterial operations were included. Their medical history, the specific vascular diagnosis and operation performed, the medication and laboratory data were monitored. Additionally the patients were preoperatively interviewed by a psychiatrist. Intraoperatively the drugs, infusions, possible transfusions, blood gases and pressures were monitored, as were the times of surgery and anesthesia. Postoperatively patients were seen daily by the psychiatrist and the surgeon for at least 7 days. Postoperative delirium was diagnosed according to DSM IV criteria, and mild, moderate and severe delirium were distinguished. Results: Fifty-four patients entered the study. Twenty-one (38.9%) developed postoperative delirium (11 mild, 2 moderate, 8 severe). Patients with aortic operations developed delirium more frequently than those with non-aortic procedures(55.5 vs 22.2%, n=27 each). Some preexisting diseases (hearing disturbance) increased the probability of postoperative delirium, while age was not identified as a risk factor. General psychopathological and depressive disturbances increased the likelihood of postoperative delirium. Patients who had a severe intraoperative course developed postoperative delirium more frequently. This was not seen in the absolute time of surgery or anesthesia nor in the intraoperative development of blood pressure or intraarterial gases, which did not differ between patients with and without postoperative delirium. More reliable parameters were an increased intraoperative need for crystalloid volume, intra – or postoperatively decreased hemoglobin values (Hb <10 g/dl) and the development of acidosis that had to be treated. Patients with delirium had serious complications more often (8/21=38.1% vs 6/33=18.2%) and needed Intensive Care treatment longer (2.7 vs 2.1 days, only aortic surgery 3.2 vs 2.4 days). Conclusions: Postoperative delirium after vascular surgery is frequent. Patients undergoing aortic surgery, with specific concomittant medical disease, psychopathological disturbances and a severe intraoperative course, are at risk of developing postoperative delirium.     

老年股骨转子间骨折患者内固定术后发生谵妄的危险因素分析

目的探讨老年股骨转子间骨折患者内固定术后发生谵妄的相关危险因素。方法回顾性分析2010年12月至2018年4月期间保定市第二中心医院骨科接受闭合复位股骨近端防旋髓内钉固定治疗的423例股骨转子间骨折患者资料。男205例,女218例;年龄为70~98岁,平均78.6岁;骨折AO分型:31-A1型239例,31-A2型141例,31-A3型43例;362例患者合并内科疾病。受伤至手术时间为4~72 h,平均46.6 h。统计患者术后发生谵妄的情况。对患者的隐性失血量、性别、年龄、体重指数、并发症情况、麻醉方式、术前准备时间及电解质紊乱情况等进行单因素分析筛选危险因素,对于P<0.05的因素再采用多因素logistic回归分析确定主要的独立危险因素。结果423例患者中49例(11.58%)术后发生谵妄,其中29例发生于术后第1天,20例发生于术后第2天;374例(88.42%)患者未发生谵妄。单因素分析结果显示:发生谵妄患者与未发生谵妄患者在受伤至手术时间、隐性失血量及电解质紊乱方面比较差异均有统计学意义(P<0.05)。多因素logistic回归分析显示:受伤至手术时间>48 h(OR=3.386,95%CI:1.362~6.638)、隐性失血量>600 mL(OR=10.292,95%CI:1.244~35.091)、术后电解质紊乱(OR=4.157,95%CI:1.595~7.626)是老年股骨转子间骨折患者内固定术后发生谵妄的独立危险因素。结论受伤至手术时间长、隐性失血量多与术后发生电解质紊乱是老年股骨转子间骨折患者内固定术后发生谵妄的独立危险因素。     

Apolipoprotein E e4 allele increases the risk of early postoperative delirium in older patients undergoing noncardiac surgery

BACKGROUND: Whether patients who subsequently develop early postoperative delirium have a genetic predisposition that renders them at risk for postoperative delirium has not been determined. METHODS: The authors conducted a nested cohort study to include patients aged > or = 65 yr who were scheduled to undergo major noncardiac surgery requiring anesthesia. A structured interview was conducted preoperatively and for the first 2 days postoperatively to determine the presence of delirium, defined using the Confusion Assessment Method. Blood was drawn for measurement of the apolipoprotein genotypes. Bivariate tests of association were conducted between delirium and apolipoprotein genotypes and other potentially important risk factors. Variables that had significant bivariate association with postoperative delirium were entered in a forward multivariable logistic regression model. RESULTS: Of the 190 patients studied, 15.3% developed delirium on both days 1 and 2 after surgery. Forty-six patients (24.2%) had at least one copy of the apolipoprotein e4 allele. The presence of one copy of the e4 allele was associated with an increased risk of early postoperative delirium (28.3% vs. 11.1%; P = 0.005). Even after adjusting for covariates, patients with one copy of the e4 allele were still more likely to have an increased risk of early postoperative delirium (odds ratio, 3.64; 95% confidence interval, 1.51-8.77) compared with those without the e4 allele. CONCLUSIONS: Apolipoprotein e4 carrier status was associated with an increased risk for early postoperative delirium after controlling for known demographic and clinical risk factors. These results suggest that genetic predisposition plays a role and may interact with anesthetic/surgical factors contributing to the development of early postoperative delirium.