双侧肺同期手术中不同体位和单肺通气对病人呼吸力学的影响

目的观察双侧肺同期手术中体位改变和单肺通气时对病人呼吸力学的影响。方法选取我院2007年6月至2010年12月双侧肺同期手术病人142例,经气道旁路采用旁气流通气连续监测病人PIP、Pplat、Raw、Cdyn等呼吸力学指标,监测SpO2、PETCO2指标,分别在双腔支气管导管定位后,平卧改侧卧,单肺通气及改换通气方式后10 min抽取动脉血进行血气分析。结果病人双肺通气改变体位和单肺通气后,病人PIP、Pplat、Raw升高,Cdyn减少,PH值降低,PETCO2、PaCO2升高、SpO2、PaO2降低(P<0.05);双肺通气改换通气方式后,病人PIP、Pplat、Raw降低,Cdyn增加,PH值降低,PaO2、SpO2、PaCO2、PETCO2升高(P<0.05)。单肺通气38例病人改换通气方式后,病人PIP、Pplat、Raw降低,Cdyn增加,PH值、PaO2、SpO2升高,PaCO2、PETCO2降低(P<0.05)。结论双侧肺同期手术麻醉中不同体位和单肺通气对病人的呼吸力学影响较大,改换通气方式可改变病人呼吸力学指标。     

情商与全麻苏醒期躁动的相关性探讨

目的探讨情商(emotional quotient,EQ)与全麻苏醒期躁动(emergence agitation,EA)的相关性。方法选取2017-05～2018-03行全麻手术患者78例,全麻诱导前采用巴昂情商量表(Baron emotional quotient inventory,EQ-I)测试EQ。全麻苏醒期采用Ricker镇静-躁动量表(Ricker sedation-agitation scale,SAS)进行评分。采用SPSS21. 0统计软件分析EQ与SAS相关性。结果 EQ与SAS呈负相关,Pearson相关系数r=-0. 626(P 0. 01)。结论 EQ高者全麻苏醒期躁动程度较低,EQ低者全麻苏醒期躁动程度较高。     

全麻开胸手术苏醒期风险因素及护理对策

全麻苏醒期由于麻醉药、肌松药的残留作用,患者意识及机体保护性反射尚未完全恢复,加之开胸手术创伤大、麻醉时间长,苏醒期低氧血症、麻醉诱导后导尿等因素,极易发生苏醒期躁动、坠床、脱管及一系列机体应激反应,若处理不当会危及患者生命,需引起护理同行的重视,现分析总结如下。     

单孔胸腔镜同期治疗双肺多发肺结节的效果分析

［摘要］　目的　分析单孔胸腔镜同期治疗双肺多发肺结节的效果。方法　回顾性分析2020年1月至2021年12月在东营市中医院（东营市胜利医院）胸心外科实施单孔胸腔镜下肺叶/亚肺叶切除同期治疗双肺多发肺结节24例患者的临床资料。其中男15例,女9例;年龄51～79（64.5±8.4）岁。一侧肺叶+一侧亚肺叶切除3例,双侧亚肺叶切除21例。结果　所有患者顺利完成手术并出院。手术时间90～254（162.1±50.9）min,术后住院时间4～13（7.1±2.3）d,术后胸腔引流带管时间2～4（2.8±0.8）d。术后并发症肺部感染2例,刀口愈合不良1例,咳嗽不适4例,术后憋喘不适4例。结论　单孔胸腔镜同期治疗双肺多发肺结节可行性良好,治疗效果满意。     

地佐辛防治全麻苏醒期躁动的效果分析

目的探讨地佐辛在防治全麻苏醒期躁动的临床效果。方法将2013-02~2014-12该院择期在气管插管全麻下进行手术治疗的94例患者按随机数字表法分为两组,观察组(48例)在手术结束前15 min静注地佐辛0.1 mg/kg,对照组(46例)在手术结束前15 min静注相同容积生理盐水,观察两组患者自主呼吸恢复时间、唤醒时间、拔管时间等,以及两组患者躁动发生率、不良反应发生情况。结果观察组躁动发生率和躁动程度明显低于和轻于对照组(P0.05);观察组自主呼吸恢复时间和拔管时间比对照组明显缩短(P0.01);观察组不良反应发生率低于对照组,但比较差异无统计学意义(P0.05)。结论地佐辛能有效预防全麻苏醒期躁动,并能缩短自主呼吸恢复时间和拔管时间。     

手术室预见性护理干预对妇科腹腔镜手术患者全麻苏醒期躁动及血压、心率的影响

目的探讨手术室预见性护理干预在妇科腹腔镜手术患者全麻苏醒期躁动中的应用效果。方法选择2018年6月-2019年8月于我院行全麻妇科腹腔镜手术的患者216例,按照随机数字表法分为两组,各108例。对照组实施常规手术室护理干预,观察组在此基础上给予手术室预见性护理。对比两组全麻苏醒期躁动及血压、心率水平。结果观察组苏醒期收缩压、舒张压与心率水平分别为(139.01±11.66)mmHg、(85.29±9.64)mmHg、(77.63±9.17)次/min,均低于对照组;观察组苏醒期躁动发生率为8.33%,低于对照组的27.78%,差异均有统计学意义(P<0.05)。结论手术室预见性护理干预能够有效降低妇科腹腔镜手术患者全麻苏醒期躁动发生率,利于促进全麻恢复期血压、心率指标相对稳定,保证安全度过复苏期。     

小儿五官科手术全麻苏醒期不同卧位对呼吸的影响

小儿全麻后苏醒期，尤其是五官科手术全麻后气管内插管及手术操作的直接刺激、术后创面水肿及渗血，加上患儿烦躁、哭闹，极易诱发上呼吸道阻塞如舌后坠、喉痉挛、误吸、窒息等并发症。自2001年以来，我院在对此类患儿拔出气管导管前即改变其体位，使呼吸道分泌物得到有效引流，并相应减少     

同期肺切除联合不停跳冠状动脉搭桥手术围手术期治疗经验

目的分析22例肺切除同期冠状动脉搭桥手术治疗肺肿瘤合并冠心病的临床资料。方法2003～2011年共完成同期手术22例,男性20例,女性2例,平均年龄66．11岁。肺叶切除18例,局部切除4例。患者平均搭桥2．3根。围手术期监测心肺功能并进行相应治疗。结果所有患者围手术期无死亡及新发心肌梗塞。常见并发症是：心律失常、肺不张、肺部感染,对症处理均好转。结论同期手术后围手术期心肺功能良好的维护对术后整体安全性非常重要。     

舒芬太尼对全麻开胸手术患者苏醒期躁动的预防效果观察

选择全麻下择期行开胸手术的80例患者,随机分为A、B两组,各40例.A组在术毕前10min用静脉镇痛泵输注舒芬太尼0.06μg/(kg·h);B组为对照组,常规处理.记录麻醉苏醒期患者躁动发生率及苏醒期操作配合程度.认为全麻开胸手术患者术毕前应用舒芬太尼可有效预防全麻苏醒期躁动的发生率,并能明显降低躁动程度.     

不同雾化吸入方案对老年腹部手术后肺部并发症影响的疗效观察

目的观察布地奈德混悬液联合氨溴索氧气驱动雾化吸入治疗老年腹部手术患者术后肺部行发症的效果,方法将2011年1月至2013年7月上海市安亭医院外科收治的老年腹部手术患者202例随机分为2组,每组101例所有患者均于气管内插管全凭静脉麻醉下行腹部手术治疗。治疗组采用布地奈德混悬液联合氨溴索雾化吸入,对照组采用地塞米松加糜蛋白酶、庆大霉素雾化吸入,记录和比较2组术后血常规、C反应蛋白（CRP）、血气分析、痰液量及患者的咳嗽咳痰症状评分。结果术后连续3d内2组的白细胞计数、中性粒细胞比例和CRP差异无统计学意义。术后第3天治疗组的氧分压高于对照组（P=0．000）,治疗组在痰液量、咳嗽咳痰症状改善方面优于对照组,治疗组的术后肺部并发症发病率（9．90％）比对照组（22．77％）低,两者差异有统计学意义（P=0．026）。结论布地奈德混悬液联合氨溴索雾化吸入治疗老年患者术后肺部并发症的效果优于传统的地塞米松加糜蛋白酶、庆大毒素。能改善患者术后咳嗽、咳痰症状,改善老年患者术后肺部氧合功能,能降低术后肺部行发症发病率,值得进一步推广。     

老年肝胆外科手术患者术后肺部并发症与膈肌功能的相关性

目的 分析老年肝胆外科手术患者术后肺部并发症(PPCs)与膈肌功能的关系。方法 收集解放军总医院第二医学中心综合外科行肝胆外科手术的16例老年患者的临床资料。根据术后是否出现肺部并发症分为PPCs组(6例)和非PPCs组(10例)。应用床旁超声分别于术前1天、术后当天、术后第1天、术后第3天及术后第7天监测患者右侧膈肌移动度(DE)。比较2组患者术前DE、术后最小DE、ΔDE、手术时间及手术方式的差异。采用SPSS 23.0统计软件进行数据分析。采用多因素logistic回归分析影响PPCs的危险因素,并绘制受试者工作特征(ROC)曲线评价其对PPCs的预测价值。结果 2组患者术前DE及手术方式比较,差异无统计学意义(P＞0.05)。与非PPCs组相比,PPCs组患者手术时间更长[(247.500±68.099)和(162.300±66.111)min]、术后最小DE更小[(1.071±0.202)和(1.414±0.236)cm]、ΔDE更大[(0.536±0.106)和(0.343±0.139)cm],差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示,手术时间及术后最小DE是影响PPCs的独立危险因素。手术时间及术后最小DE预测PPCs的ROC曲线下面积分别为0.825(95%CI 0.670～0.980)和0.867(95%CI 0.693～0.974),最佳截断点分别为210min和1.19cm,灵敏度分别为83.33%和90.00%,特异度分别为80.00％和83.33％。结论 术后膈肌功能下降及长时间手术是影响老年肝胆外科手术患者PPCs的危险因素,可通过膈肌超声监测膈肌功能对PPCs进行预测。     

Enhanced recovery after surgery programs in patients undergoing hepatectomy: A meta-analysis

AIM:To evaluate the impact of enhanced recovery after surgery(ERAS) programs in comparison with traditional care on liver surgery outcomes.METHODS:The Pub Med,EMBASE,CNKI and Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials(RCTs) comparing the ERAS program with traditional care in patients undergoing liver surgery. Studies selected for the meta-analysis met all of the following inclusion criteria:(1) evaluation of ERAS in comparison to traditional care in adult patients undergoing elective open or laparoscopic liver surgery;(2) outcome measures including complications,recovery of bowel function,and hospital length of stay; and(3) RCTs. The following exclusion criteria were applied:(1) the study was not an RCT;(2) the study did not compare ERAS with traditional care;(3) the study reported on emergency,non-elective or transplantation surgery; and(4) the study consisted of unpublished studies with only the abstract presented at a national or international meeting. The primary outcomes were complications. Secondary outcomes were length of hospital stay and time to first flatus.RESULTS:Five RCTs containing 723 patients were included in the meta-analysis. In 10/723 cases,patients presented with benign diseases,while the remaining 713 cases had liver cancer. Of the five studies,three were published in English and two were published in Chinese. Three hundred and fifty-four patients were in the ERAS group,while 369 patients were in the traditional care group. Compared with traditional care,ERAS programs were associated with significantly decreased overall complications(RR = 0.66; 95%CI:0.49-0.88; P = 0.005),grade?Ⅰ?complications(RR = 0.51; 95%CI:0.33-0.79; P = 0.003),and hospitallength of stay [WMD =-2.77 d,95%CI:-3.87-(-1.66); P 0.00001]. Similarly,ERAS programs were associated with decreased time to first flatus [WMD =-19.69 h,95%CI:-34.63-(-4.74); P 0.0001]. There was no statistically significant difference in grade Ⅱ-Ⅴ complications between the two groups.CONCLUSION:ERAS is a safe and effective program in liver surgery. Future studies should define the active elements to optimize postoperative outcomes for liver surgery.     

Risk factors of delayed recovery from general anesthesia in patients undergoing radical biliary surgery: What can we prevent

Delayed recovery (DR) is very commonly seen in the patients undergoing laparoscopic radical biliary surgery, we aimed to investigate the potential risk factors of DR in the patients undergoing radical biliary surgery, to provide evidences into the management of DR.Patients who underwent radical biliary surgery from January 1, 2018 to August 31, 2020 were identified. The clinical characteristics and treatment details of DR and no-DR patients were compared and analyzed. Multivariable logistic regression analyses were conducted to identify the potential influencing factors for DR in patients with laparoscopic radical biliary surgery.We included a total of 168 patients with laparoscopic radical biliary surgery, the incidence of postoperative DR was 25%. There were significant differences on the duration of surgery, duration of anesthesia, and use of intraoperative combined sevoflurane inhalation (all P < .05), and there were not significant differences on American Society of Anesthesiologists, New York Heart Association, tumor-lymph node- metastasis, and estimated blood loss between DR group and control group (all P > .05). Multivariable logistic regression analyses indicated that age ≥70 years (odd ratio [OR] 1.454, 95% confidence interval [CI] 1.146–1.904), body mass index ≥25 kg/m² (OR 1.303, 95% CI 1.102–1.912), alcohol drinking (OR 2.041, 95% CI 1.336–3.085), smoking (OR 1.128, 95% CI 1.007–2.261), duration of surgery ≥220 minutes (OR 1.239, 95% CI 1.039–1.735), duration of anesthesia ≥230 minutes (OR 1.223, 95% CI 1.013–1.926), intraoperative combined sevoflurane inhalation (OR 1.207, 95% CI 1.008–1.764) were the independent risk factors for DR in patients with radical biliary surgery (all P < .05).It is clinically necessary to take early countermeasures against various risk factors to reduce the occurrence of DR, and to improve the prognosis of patients.     

Comparison of pre- and postoperative pulmonary function in obese and non-obese female patients undergoing coronary artery bypass graft surgery

OBJECTIVE AND BACKGROUND: Various studies have suggested that body size and in-hospital mortality are related. However, only a few analysed the effects of obesity on pulmonary complications following coronary artery bypass graft surgery (CABG). The purpose of the present study was to assess early changes in lung volumes, respiratory complications and arterial blood gas tension following CABG in obese women. METHODS: Pulmonary function tests (PFTs), treadmill exercise capacity tests (TM), arterial blood gases and pulmonary complications were studied in 124 obese (mean age 57.2+/-5.8 years) and 108 non-obese (mean age 58.6+/-5.9 years) female patients undergoing elective CABG. PFT, TM tests, arterial blood gas analyses and CXR were performed in the preoperative and postoperative periods and pulmonary complications were recorded. Breathing and coughing exercises, early ambulation and pulmonary clearing techniques were used by physical therapists to prevent pulmonary complications after CABG surgery. RESULTS: Postoperative PFT and TM tests deteriorated significantly in both groups (P<0.0001). The deterioration in the obese group was highly significant. The postoperative deterioration of blood gas measurements in obese patients was also statistically significant compared to non-obese patients. Early pulmonary complications developed in 21 (16.94%) of the obese patients and in 10 (9.25%) of non-obese patients. Duration of mechanical ventilation, intensive care unit and hospital stays were longer compared to the non-obese patients (P=0.008, P<0.0001, P=0.0386, respectively). CONCLUSION: Obesity has a detrimental effect on pulmonary function, exercise capacity, blood gas measurements and complications rates in postoperative period following CABG surgery.     

Comparison between a general and a disease-specific health-related quality-of-life questionnaire in patients after pancreatic surgery

Background/Purpose

The aim of this study was to compare the short-form (SF-) 36 as a general instrument and the gastrointestinal quality of life index (GIQLI) as a disease-specific instrument in patients after pancreatic surgery.

Methods

The questionnaires were sent to patients receiving pancreatic surgery over a time period of three years. Patients were compared with a normal population completing the SF-36 or reported normal-population values for the GIQLI. Agreement between the instruments was analyzed using Bland Altman plots.

Results

A total of 98 patients were included, most of them undergoing a Whipple procedure (86%). The most frequent complaints were meteorism, obstipation, stool urgency, and stress incontinence in 9% of the patients. Whereas in almost every domain of the SF-36 the HRQL was impaired in comparison to the normal population, the GIQLI showed differences in only the domain emotions. Neither the SF-36 nor the GIQLI was different between patients with early and advanced cancer stages. The SF-36 had no agreement with the GIQLI.

Conclusions

The results of HRQL studies depend on the instruments which were used. Whereas a general instrument may detect factors such as comorbidity more accurately, disease-specific instruments have the advantage of better clinical interpretability.     

The feasibility of sugammadex for general anesthesia and facial nerve monitoring in patients undergoing parotid surgery

The use of neuromuscular blocking agent (NMBA) during anesthesia may interfere with facial nerve monitoring (FNM) during parotid surgery. Sugammadex has been reported to be an effective and safe reversal of rocuronium-induced neuromuscular block (NMB) during surgery. This study investigated the feasibility and clinical effectiveness of sugammadex for NMB reversal during FNM in Parotid surgery.Fifty patients undergoing parotid surgery were randomized allocated into conventional anesthesia group (Group C, n = 25) and sugammadex group (Group S, n = 25). Group C did not receive any NMBA. Group S received rocuronium 0.6 mg/kg at anesthesia induction and sugammadex 2 mg/kg at skin incision. The intubating condition and influence on FNM evoked EMG results were compared between groups. The intubation condition showed significantly better in group S patients than C group patients (excellent in 96% v.s. 24%). In group S, rapid reverse of NMB was found and the twitch (%) recovered from 0 to >90% within 10 min. Positive and high EMG signals were obtained in all patients at the time point of initial facial nerve stimulation in both groups. There was no significant difference as comparing the EMG amplitudes detected at the time point of initial and final facial nerve stimulation in both groups. Implementation of sugammadex in anesthesia protocol is feasible and reliable for successful FNM during parotid surgery.     

Factors associated with failure of enhanced recovery after surgery program in patients undergoing pancreaticoduodenectomy

Background: The enhanced recovery after surgery (ERAS) protocol is an evidence-based perioperative care program aimed at reducing surgical stress response and accelerating recovery. However, a small propor- tion of patients fail to bene t from the ERAS program following pancreaticoduodenectomy. This study aimed to identify the risk factors associated with failure of ERAS program in pancreaticoduodenectomy. Methods: Between May 2014 and December 2017, 176 patients were managed with ERAS program fol-lowing pancreaticoduodenectomy. ERAS failure was indicated by prolonged hospital stay, unplanned read- mission or unplanned reoperation. Demographics, postoperative recovery and compliance were compared of those ERAS failure groups to the ERAS success group. Results: ERAS failure occurred in 59 patients, 33 of whom had prolonged hospital stay, 18 were readmitted to hospital within 30 days after discharge, and 8 accepted reoperation. Preoperative American Society of Anesthesiologists (ASA) score of ≥III (OR = 2.736;95% CI: 1.276 6.939;P=0.028) and albumin (ALB) level of <35g/L (OR=3.589;95% CI: 1.403 9.181;P=0.008) were independent risk factors associated with prolonged hospital stay. Elderly patients (>70 years) were on a high risk of unplanned reoperation (62.5% vs. 23.1%, P=0.026). Patients with prolonged hospital stay and unplanned reoperation had delayed intake and increased intolerance of oral foods. Prolonged stay patients got off bed later than ERAS success patients did (65h vs. 46h, P =0.012). Unplanned reoperation patients tended to experience severer pain than ERAS success patients did (3 score vs. 2 score, P =0.035). Conclusions: Patients with high ASA score, low ALB level or age >70 years were at high risk of ERAS failure in pancreaticoduodenectomy. These preoperative demographic and clinical characteristics are important determinants to obtain successful postoperative recovery in ERAS program.