Objective To explore the influencing factors for pulmonary infection after radical resection of colon cancer. Methods A cohort study included 56 patients who underwent radical resection of colon cancer in People’s Hospital of Daye City from Oct. 2014 to Oct. 2016 were followed-up prospectively, to observe the occurrence of pulmonary infection, and collectting the related factors for pulmonary infection in addition. Results The clinical data of 53 patients were finalized and the clinical data of these patients were complete. Among them, 13 patients suffered from pulmonary infection after radical resection of colon cancer, and 40 patients had no obvious exacerbation and no complicated pulmonary infection. Results of logistic regression showed that, value of forced expiratory volume in1 second/forced vital capacity (OR=1.174, P=0.033), operative time (OR=1.638, P=0.012), levels of postoperative copeptin (OR=1.328, P=0.032), and procalcitonin (OR=1.465, P=0.042) were risk factors for pulmonary infection after radical resection of colon cancer. Receiver operating characteristic curve (ROC) showed that, operative time was 6.207-hour, postoperative copeptin level was 10.420 pmol/L, and the postoperative procalcitonin level was 3.676 ng/mL, which had the best predictive effect on predicting pulmonary infection after radical resection of colon cancer. Conclusions Value of forced expiratory volume in 1 second/forced vital capacity, operative time, levels of copeptin and procalcitonin after operation are the independent influencing factors for pulmonary infection after radical resection of colon cancer, and it has best prognostic outcome when the operative time is 6.207-hour, postoperative copeptin level is 10.420 pmol/L, and the postoperative procalcitonin level is 3.676 ng/mL.
目的 探討纖維膽道鏡下微爆破碎石治療肝內外膽管難取性結石的療效和安全性。方法 對筆者所在醫院2007年4月至2011年12月期間收治的58例肝內外膽管難取性結石患者，行纖維膽道鏡下體內微爆破碎石治療，對其治療效果進行回顧性分析。結果 58例肝內外膽管難取性結石患者的碎石成功率為100%（58/58）。27例膽總管結石患者的取石成功率為100%（27/27），31例肝內膽管結石患者的取石成功率為93.5%（29/31）。術后均無竇道穿孔、膽道大出血及膽瘺發生，術后出現膽管黏膜滲血6例，出現畏寒、發熱3例，出現一過性腹瀉2例。42例患者獲訪，隨訪時間3～38個月，平均21個月。2例患者分別于術后6個月和9個月出現膽管炎，行B超及磁共振胰膽管成像（MRCP）檢查，均未發現肝內外膽管結石及膽管狹窄；1例患者于術后3年行B超檢查，發現膽總管下端有1枚直徑為0.5cm的結石；其余患者均無腹痛、發熱、黃疸等癥狀，均未發生結石復發及膽管狹窄。結論 纖維膽道鏡下微爆破碎石可有效治療術中及術后膽管難取性結石，安全性好。
ObjectiveTo investigate influencing factors of postoperative cognitive dysfunction (POCD) in elderly patients underwent laparoscopic surgery. MethodsThe elderly patients underwent laparoscopic surgery were collected in the Daye City People's Hospital and Yangxin County People's Hospital from September 14, 2014 to January 1, 2016 and the Traditional Chinese Medicine Hospital of Daye City from June 19, 2014 to January 1, 2016. Factors included in the registration of patients in general and a variety of influencing factors during perioperative period were recorded. The independent factors associated with POCD were analyzed by multivariate logistic regression analysis. ResultsThree hundred and seventy-eight elderly patients underwent laparoscopic surgery were included according to the inclusion and exclusion criteria, of which 43 patients with POCD and 335 patients without POCD within 3 days after laparoscopic surgery. The baseline data had no significant differences between the patients with POCD and without POCD. The cerebral infarction, preoperative fear, preemptive analgesia, use of dexmedetomidine before laparoscopic surgery, general anesthesia combined with epidural anesthesia, operation time, low SpO2 during anesthesia induction, PaCO2 after pneumoperitoneum, postoperative patient controlled epidural analgesia (PCEA), postoperative VAS score on day 3 were associated with the POCD (P < 0.05). The results of logistic regression analysis showed that the preemptive analgesia, use of dexmedetomidine before laparoscopic surgery, general anesthesia combined with epidural anesthesia, and postoperative PCEA were the independent protective factors of the POCD (P < 0.05). The operation time and PaCO2 after pneumoperitoneum were the independent risk factors of the POCD (P < 0.05). ConclusionFor elderly patients underwent laparoscopic surgery, clinicians should be alert to occurrence of POCD according to the influence factors of it, and timely screen relevant scale so as to early diagnose and early intervent and effectively delay progress of patient's POCD.