Prognostic Factors in the Surgical Treatment of Ruptured Abdominal Aortic Aneurysms

Although the operative mortality following elective aneurysmectomy has achieved satisfactory results, that following surgery for ruptured abdominal aortic aneurysms (AAAs) remains high. The purpose of this study was to identify the factors affecting the mortality rate associated with the treatment of ruptured AAAs. Between 1978 and 1999, 33 patients underwent emergency surgery for a ruptured AAA. The operative mortality was 33.3% and in-hospital mortality was 6.0%. Hypotension, defined as a systolic blood pressure <80 mmHg, was seen in 19 patients at the time of presentation, 9 of whom underwent surgery in this state. In the remaining 10 patients, it was possible to increase the systolic blood pressure to ≥80 mmHg preoperatively. Of the 11 patients who died within 30 days of surgery, 9 had hypotension at the time of induction of anesthesia and only 2 had a systolic blood pressure of ≥80 mmHg. A satisfactory outcome was achieved in patients whose condition met the following criteria: a systolic blood pressure ≥80 mmHg at the time of operation, minimal aortic cross-clamping time, less blood loss and blood transfusions, and a shorter operation time to repair the ruptured AAA. Concomitant heart disease was also found to be an important prognostic factor. Received: June 16, 1999 / Accepted: March 24, 2000     

右美托咪啶在心脏术后患者中应用的临床研究

目的：研究右美托咪啶用于ICU心脏术后患者的镇静效果及安全性。方法：选择收住我院重症监护病房（ICU）心脏术后需机械通气的患者13例,随机分为右美托咪啶组（n=6）和丙泊酚组（n=7）,两组分别给予右美托咪啶和丙泊酚镇静治疗并同时给予吗啡镇痛,镇静目标为Ramsay评分2-4分。监测用药期间呼吸频率、心率、血压、脉搏血氧饱和度,并记录镇静药物剂量、机械通气时间、停药后唤醒时间、意外拔管情况以及镇静药物相关并发症（谵妄、低血压、心动过缓）。结果：两组患者镇静达标时间的比例无显著差异（P〉0.05）,右美托咪啶组停药后躁动的比例明显少于丙泊酚组（0%比28.57%,P〈0.05）,右美托咪啶组谵妄发生率明显少于丙泊酚组（0%比14.28%,P〈0.05）,两组机械通气时间无明显差异[（10.51±5.11）h比（11.07±4.91）h,P〉0.05],两组意外拔管率无明显差异（0%比0%,P〉0.05）。两组患者低血压发生率（33.33%比42.86%,P〉0.05）、需要干预的低血压比例（16.67%比28.57%,P〉0.05）均无显著差异,两组心动过缓发生率（33.33%比28.57%,P〉0.05）无显著差异。结论 ：右美托咪啶用于心脏术后患者能够实现镇静目标,对呼吸、循环无显著影响,可安全使用。     

急性ANH 联合低中心静脉压对肝癌手术患者凝血功能的影响

目的：观察急性等容血液稀释（ANH）联合低中心静脉压（ANH+LCVP）在肝癌手术中对患者凝血功能的影响。 方法：40例ASA I~II级拟行肝癌切除手术患者随机均分为观察组与对照组,观察组于全麻后行ANH,入室到肝实质横断分离完成前行控制性LCVP,对照组按常规处理。记录患者术中、术后的出血量和术后因腹腔出血需再次手术的患者例数,以及不同时间点患者的血红蛋白（Hb）、红细胞压积（HCT）、血小板（PLT）、纤维蛋白原（FIB）、活化部分凝血酶时间（APTT）、凝血酶原时间（PT）、国际标准化比例（INR）,凝血时间（ACT）、血块凝结速率（CR）、血小板功能（PF）等。 结果：观察组患者术中出血量明显少于对照组（P<0.05）,而术后出血量两组间差异无统计学意义（P>0.05）,两组均无因继发性出血而再次手术的患者;观察组在采血后、肝癌切除后、恢复容量后Hb、HCT、PLT、FIB、CR、PF较术前均明显下降,APTT、PT、INR、ACT较术前均明显升高,但恢复容量后比肝癌切除前各指标均明显改善（P<0.05）;对照组患者从手术开始至结束,Hb、HCT、PLT、FIB、CR、PF呈进行性降低,APTT、PT、INR、ACT呈进行性升高;手术结束后观察组各项指标明显较对照组改善（P<0.05）。 结论：ANH+LCVP能够减少术中出血,对患者的凝血功能有一定的影响,但是不会导致异常出血,可以安全应用肝癌手术中。

     

轻密度布比卡因与重密度布比卡因用于下肢手术的临床麻醉效果对比研究

[目的]对比研究轻密度布比卡因和重密度布比卡应用于下肢手术的临床麻醉效果。[方法]选取2010年1～12月在某院因行下肢手术而实施腰麻-硬膜外联合麻醉的患者120例作为研究对象,将所有患者按照使用布比卡因的比重不同分为轻密度组和重密度组,分别向下腔蛛网膜注射轻密度和重密度布比卡因。比较两组患者的麻醉效果、麻醉时间、术中低血压发生率、BCS舒适评分及并发症情况,综合评价轻密度布比卡因和重密度布比卡因在下肢手术患者中的临床效果。[结果]两组患者麻醉效果、麻醉时间及并发症比较差异无统计学意义,P值均﹥0.05;BCS舒适度评分及低血压发生率比较,轻密度组患者较重密度组患者有明显优势,P值均﹤0.05,均具有统计学意义。[结论轻密度布比卡因和重密度布比卡因在下肢手术患者中的麻醉效果及麻醉时间方面大致相当,但使用轻密度布比卡因较重密度布比卡因在麻醉舒适度和麻醉过程中低血压发生率及舒适度比较,有明显优势。     

Perioperative hypotension and discharge outcomes in non-critically injured trauma patients,a single centre retrospective cohort study

BackgroundThere is a lack of information on the effect of age on perioperative care and outcomes after minor trauma in the elderly. We examined the association between perioperative hypotension and discharge outcome among non-critically injured adult patients.MethodsWe conducted a retrospective study of non-critically ill patients (ISS <9 or discharged within less than 24 h) who received anaesthesia care for surgery and Recovery Room care at a level-1 trauma centre between 5/1/2012 and 11/30/2013. Perioperative hypotension was defined as systolic blood pressure (SBP) <90 mmHg (traditional measure) for all patients, and SBP <110 mmHg (strict measure) for patients ≥65 years. Poor outcome was defined as death or discharge to skilled nursing facility/hospice.Results1744 patients with mean ISS 4.4 across age groups were included; 169 (10%) were ≥65 years. Among patients ≥ 65 years, intraoperative hypotension occurred in >75% (131/169, traditional measure) and in >95% (162/169, strict measure); recovery room hypotension occurred in 2% (4/169) and 29% (49/169), respectively. Mean age-adjusted anaesthetic agent concentration (MAC) was similar across age groups. Opioid use decreased from 9.3 (SD 5.7) mg/h morphine equivalents in patients <55 years to 6.2 (SD 4.0) mg/h in patients over 85 years. Adjusted for gender, ASA score, anaesthesia duration, morphine equivalent/hr, fluid balance, MAC and surgery type, and using traditional definition, older patients were more likely than patients <55 to experience perioperative hypotension: aRR 1.21, 95% CI 1.11–1.30 for 55–64 and aRR 1.19, 95% CI 1.07–1.32 for ages 65–74. Perioperative hypotension was associated with poor discharge outcome (aRR 1.55; 95% CI 1.04–2.31 and aRR 1.87; 95% CI 1.17–2.98, respectively).ConclusionDespite age related reduction in doses of volatile anaesthetic and opioids administered during anaesthesia care, and regardless of hypotension definition used, non-critically injured patients undergoing surgery experience a large perioperative hypotension burden. This burden is higher for patients 55–74 years and older and is a risk factor for poor discharge outcomes, independent of age and ASA status.     

Changes of some amino acid concentrations in the medial vestibular nucleus of conscious rats following acute hypotension

Microdialysis and high performance liquid chromatography (HPLC) were used to measure the changes of certain amino acids in the medial vestibular nucleus (MVN) of conscious rats in order to understand whether those amino acids are involved in the regulation of blood pressure. Acute hypotension was induced by infusing sodium nitroprusside (SNP) into the femoral vein. In the control group, glutamate (Glu) release increased, though γ-aminobutyric acid (GABA) and taurine (Tau) release decreased in the MVN following acute hypotension. In the unilateral labyrinthectomy group, the levels of Glu, GABA, and Tau were unchanged in the ipsilateral MVN to the lesion following acute hypotension. Furthermore, in the contralateral MVN to the lesion, Glu release increased, and GABA and Tau release decreased following acute hypotension. These results suggest that SNP-induced acute hypotension can influence the activity of neurons in the MVN through afferent signals from peripheral vestibular receptors, and that certain amino acid transmitters in the MVN are involved in this process.     

腰麻联合硬膜外麻醉剖宫产患者仰卧位低血压综合征体位干预的护理效果观察

目的 探讨护理干预对剖腹产仰卧位低血压综合征的预防机制.方法 将120例剖宫产患者随机分为对照组(60例)和实验组(60例).对照组除麻醉前静脉滴注复方平衡盐水500 ml和胶体(羟乙基淀粉130/0.4氯化钠注射液)500 ml外不作任何干预措施.实验组麻醉前30 min内快速输入与对照组相同的液体,同时给予体位干预...     

血液透析患者低血压的临床研究

目的探讨血液透析中低血压的发生机制及防治措施。方法收集40例长期血液透析患者的临床资料，按有无透析低血压分为低血压组（17例）及对照组（23例），比较两组病因、年龄、透析间期体重增长率；透析中超滤量（UFV）、超滤率（UFR）；血钠（Na^＋）、白蛋白（Alb）、血红蛋白（Hb）、尿素氮（BUN）、血肌酐（Scr）。结果与对照组相比，合并糖尿病、左室肥厚及动脉硬化的老年人易发生透析低血压（P〈0．01）；透析间期体重增长率（％），透析中UFV、UFR有统计学差异（P〈0．01）；Na^＋、Alb、Hb有统计学差异（P〈0．05）；BUN、Scr差异无统计学意义（P〉0．05）。结论控制透析间期体重增长、减慢超滤速度，改变血液净化方法，采用序贯钠透析、低温透析，适当用药，改善心功能，纠正贫血、低蛋白血症及营养不良等可防治透析中低血压。