ObjectiveTo evaluate the effect of perioperative nebulization of ipratropium bromide on preoperative pulmonary function and incidence of postoperative pulmonary complications as well as safety in chronic obstructive pulmonary disease (COPD) patients who underwent lung resection in thoracic surgery. MethodsDuring November 18, 2013 to August 12, 2015, 192 COPD patients with a necessity of selective surgical procedures of lobectomy or right bilobectomy or segmentectomy under general anaesthesia in 10 centers were 1 : 1 randomized to an ipratropium bromide group (96 patients) and a placebo group (96 patients), to compare the effect on preoperative pulmonary function and incidence of postoperative pulmonary complications. The average age of treated patients was 62.90±6.50 years, with 168 male patients and 22 female patients. Results The demographic and baseline characteristics were well-balanced between the two groups. The adjusted mean increase of forced expiratory volume in one second (FEV1) in the ipratropium bromide group was significantly higher than that in the placebo group (169.90±29.07 mL vs. 15.00±29.35 mL, P<0.05). The perioperative use of ipratropium bromide significantly decreased incidence of postoperative pneumonia (2.6% vs. 14.1%, P<0.05). There was no ipratropium bromide related adverse event (AE) observed in this trial. ConclusionThis trial indicates that perioperative nebulization of ipratropium bromide significantly improves preoperative lung function and reduces postoperative pneumonia in COPD patients undergoing lung resection in thoracic surgery, and has good safety profile.
ObjectiveTo investigate the effect of early enteral nutrition (EEN) support in the perioperative period of children with perforated appendicitis based on the enhanced recovery after surgery (ERAS). MethodsThe children with perforated appendicitis were collected as an observation group, who underwent EEN support treatment based on the ERAS mode from January 2021 to December 2022 in the Xuzhou Children’s Hospital. At the same time, the children with perforated appendicitis received conventional nutrition support from January 2019 to December 2020 were matched as a control group according to the principle of balanced and comparable baseline data such as the gender, age, disease course, pathological type, and body mass index with the observation group. The time of first exhaust or defecation and the hospital stay after surgery were compared. Meanwhile, the nutritional indexes [prealbumin (PA), albumin (ALB), hemoglobin (Hb)], immune indexes [immunoglobulin (Ig) A, IgM, IgG], serum inflammatory factors [C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)] before surgery, on day 1 and 7 after surgery were compared. And the adverse effects were observed. ResultsThere were 40 children with perforated appendicitis in the observation group and the control group, respectively. There were no statistical differences in the baseline data such as the gender, age, course of disease, pathological type, and body mass index between the two groups (P>0.05). The time of first exhaust or defecation and the hospital stay after surgery in the observation group were shorter than in the control group (t=3.234, P=0.002; t=5.582, P<0.001). The levels of PA, ALB, Hb, IgA, IgM, and IgG in the observation group were higher than in the control group on day 7 after surgery (P<0.05). The levels of CRP, IL-6, and TNF-α in the observation group were lower than in the control group on day 7 after surgery (P<0.05）. The incidence of adverse reactions in the observation group was lower than that in the control group [5.0% (2/40) vs. 22.5% (9/40), χ2=5.165, P=0.023]. ConclusionsFrom on the results of this study, EEN support based on ERAS during perioperative period of children with perforated appendicitis contributes to recover gastrointestinal function, correct nutritional status, improve immune function, and reduce inflammation, and which has a higher safety for children with perforated appendicitis.
Objective To study the effect of perioperative nutritional support on protein metabolism and immunity in patients underwent liver transplantation. Methods A total of 80 patients who underwent liver transplantation in our hospital from March 2015 to March 2016 were collected retrospectively, and then the 80 patients were divided into control group (n=40) and observation group (n=40) according to the type of perioperative nutritional support. Patients of control group didn’t receive preoperatively nutritional support, and received total parenteral nutrition support before postoperative exhaust, then received enteral nutrition support after anal exhaust. Patients of observation group receive preoperatively nutritional support before surgery, and received parenteral nutrition and enteral nutrition support before postoperative exhaust. The several parameters about nutritional status and immune function were observed on 7 days and 14 days after liver transplantation, and comparison of the 2 group in these parameters was performed. Results On the protein metabolism, the levels of serum transferrin, prealbumin, and nitrogen balance on 14 days after liver transplantation were higher than those of other time points (before liver transplantation and 7 days after liver transplantation),P<0.05, both in control group and observation group. There was no significant difference in the levels of serum transferrin, prealbumin, and value of nitrogen balance between the 2 groups before liver transplantation (P>0.05). But on 7 days and 14 days after liver transplantation, the levels of serum transferrin, prealbumin, and value of nitrogen balance of the observation group were higher than those of control group (P<0.05). On the immunity, the total number of lymphocytes, value of IgG and CD4/CD8 on 14 days after liver transplantation, were superior to other time points (before liver transplantation and 7 days after liver transplantation),P<0.05, both in control group and observation group. There was no significant difference in the total number of lymphocytes, value of IgG and CD4/CD8 between the 2 groups before liver transplantation (P>0.05). But on 7 days and 14 days after liver transplantation, the levels of the total number of lymphocytes, value of IgG and CD4/CD8 in the observation group were superior to those of control group (P<0.05). Conclusion Perioperative nutritional support can improve the nutritional status and immune function in patients underwent liver transplantation.
ObjectiveTo systematically evaluate the risk factors for perioperative blood transfusion in patients undergoing coronary artery bypass grafting (CABG).MethodsPubMed, Web of Science, The Cochrane Library, EMbase, CNKI, WanFang and VIP Database were electronically searched to collect case-control and cohort studies about the risk factors for perioperative blood transfusion in patients undergoing CABG from inception to February 2020. Two reviewers screened and evaluated the literatures according to the inclusion and exclusion criteria, and meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 26 articles were collected, involving 84 661 patients. The results of meta-analysis showed that age (OR=1.06, 95%CI 1.03 to 1.08, P<0.001), age≥70 years (OR=2.14, 95%CI 1.77 to 2.59, P<0.001), female (OR=1.85, 95%CI 1.55 to 2.22, P<0.001), body mass index (OR=0.94, 95%CI 0.90 to 0.98, P=0.003), weight (OR=0.95, 95%CI 0.93 to 0.96, P<0.001), body surface area (OR=0.19, 95%CI 0.10 to 0.39, P<0.001), smoking (OR=0.80, 95%CI 0.69 to 0.93, P=0.003), diabetes (OR=1.15, 95%CI 1.09 to 1.20, P<0.000 01), chronic heart failure (OR=1.59, 95%CI 1.26 to 1.99, P<0.001), number of diseased coronary arteries (OR=1.17, 95%CI 1.01 to 1.35, P=0.030), reoperation (OR=2.12, 95%CI 1.79 to 2.51, P<0.001), preoperative hemoglobin level (OR=0.60, 95%CI 0.43 to 0.84, P=0.003), preoperative ejection fraction <35% (OR=2.57, 95%CI 1.24 to 5.34, P=0.010), emergency surgery (OR=4.09, 95%CI 2.52 to 6.63, P<0.001), urgent operation (OR=2.28, 95%CI 1.25 to 4.17, P=0.007), intra-aortic balloon pump (OR=3.86, 95%CI 3.35 to 4.44, P<0.001), cardiopulmonary bypass (OR=4.24, 95%CI 2.95 to 6.10, P<0.001), cardiopulmonary bypass time (OR=1.01, 95%CI 1.01 to 1.01, P<0.000 01) and minimum hemoglobin during cardiopulmonary bypass (OR=0.42, 95%CI 0.23 to 0.77, P=0.005) were the risk factors for perioperative blood transfusion in patients undergoing CABG.ConclusionCurrent evidence shows that age, age≥70 years, female, body mass index, weight, body surface area, smoking, diabetes, chronic heart failure, number of diseased coronary arteries, reoperation, preoperative hemoglobin level, preoperative ejection fraction<35%, emergency surgery, urgent operation, intra-aortic balloon pump, cardiopulmonary bypass, cardiopulmonary bypass time and minimum hemoglobin during cardiopulmonary bypass are risk factors for perioperative blood transfusion in patients who undergo CABG. Medical staff should formulate and improve the relevant perioperative blood management measures according to the above risk factors, in order to reduce the perioperative blood utilization rate and improve the clinical prognosis of patients.
The apical displacement of tricuspid valve lea?ets complicated with significantly enlarged, thin and fibrotic wall of the right ventricle is prone to dysfunction of right heart. Therefore, the myocardial protection for the right ventricle is important. Based on the pathological changes, an algorithm of perioperative myocardial protection strategy is summarized. Firstly, we should clearly know that the right ventricular myocardium with severe lesions is much different from the unimpaired myocardium, because it is now on the margin of failure; secondly, right heart protection should be regarded as a systematic project, which runs through preoperative, intraoperative and postoperative periods, and requires close collaboration among surgeons, perfusionists, anesthesiologists and ICU physicians. In this article, we try to introduce the systematic project of the right heart protection, in order to improve the outcome of this population.
In recent years, day surgery has developed rapidly in China, but there is still a certain gap between domestic and international fields. The whole-process perioperative analgesia management standard is one of the necessities to ensure the rapid recovery and timely discharge of patients undergoing day surgery, and it is also an effective driving force to narrow the gap between domestic and international day surgery management. Based on the clinical experience of perioperative analgesia management for day surgery patients in West China Hospital of Sichuan University, this paper summarizes the implementation strategies, quality control of perioperative analgesia management and the construction of painless day surgery ward, and formulates the perioperative analgesia management standard for day surgery, which will provide a reference for the perioperative analgesia management for day surgery in China.
Patients with thoracic malignancy have a high incidence of perioperative venous thromboembolism (VTE), but its onset is insidious, often asymptomatic or atypical, and is easily overlooked. Early identification and standardized prevention of VTE can effectively reduce the risk of VTE. "Guideline for the prevention and management of perioperative venous thromboembolism in thoracic malignancies in China (2022 version)" has been officially released recently. This article closely follows the context, significance, core implications, and the impact of future VTE prevention in thoracic surgery. It is hoped that through our joint efforts, we can reduce the incidence of perioperative VTE and mortality of thoracic surgery, and strive to improve the long-term survival of patients with lung cancer and esophageal cancer.
ObjectiveTo evaluate the efficacy and safety of a loading high-dose tranexamic acid (TXA) followed by postoperative 5 doses in total hip arthroplasty (THA) by a randomized controlled trial.MethodsSeventy-two patients who underwent primary unilateral THA between December 2017 and March 2018 were randomly divided into two groups (36 patients in each group). A single dose of 20 mg/kg TXA was administered intravenously before 5-10 minutes of operation in group A; and a single dose of 40 mg/kg TXA was administered intravenously in group B at the same time point. All patients received 5 doses of 1 g TXA at 3, 6, 12, 18, and 24 hours after the first dose. There was no significant difference in gender, age, weight, height, body mass index, disease type, and combined medical diseases between the two groups (P>0.05). Total blood loss (TBL), lowest postoperative hemoglobin (Hb) level, fibrinolysis parameters [fibrin (ogen) degradation products (FDP), D-dimer], inflammatory factors [C-reaction protein (CRP), interleukin-6 (IL-6)], adverse events (thrombosis, pulmonary embolism) were recorded and compared between groups.ResultsThe TBL was significantly lower in group B than in group A (P<0.05). Furthermore, the lowest postoperative Hb level was significantly higher in group B than in group A (P<0.05). There was no significant difference in FDP and D-dimer before operation between the two groups (P>0.05). The levels of FDP and D-dimer were significantly lower in group B than in group A at 12 and 36 hours postoperatively (P<0.05). There was no significant difference in CRP and IL-6 before operation between the two groups (P>0.05). The levels of CRP and IL-6 were significant lower in group B than in group A at 12, 24, and 36 hours postoperatively (P<0.05). There was no significant difference at 14 days (P>0.05). There were 2 patients with intramuscular venous thrombosis in group A and 1 in group B after operation, and there was no significant difference in the incidence of embolic events (P>0.05). No deep venous thrombosis or pulmonary embolism occurred in all groups.ConclusionA loading high-dose TXA followed by postoperative 5 doses can further reduce the blood loss, provide additional fibrinolysis and inflammation control in THA, without increasing the risk of embolic events.
Anxiety is a strong behavioral and psychological reaction with fear components, while depression is a mental disorder dominated by high or low mood, both of which are accompanied by cognitive and behavioral changes, and are common comorbidities in patients with heart disease. Cardiac surgery is one of the important factors which trigger specific emotional and physiological reactions of patients. Persistent or initial depression and anxiety after surgery will not only increase surgical complications, short- or long-term mortality and medical costs, but also seriously affect patients' social function and quality of life. With the transformation of bio-psycho-social medical model, it is necessary to evaluate the perioperative psychological state and biological risk of patients undergoing cardiac surgery. This article reviews the characteristics, related mechanisms and therapeutic interventions of anxiety and depression in patients undergoing cardiac surgery.
Objective To explore the impact of anemia on the incidence of perioperative lower limb deep vein thrombosis (DVT) in patients undergoing total hip arthroplasty (THA). Methods A retrospective analysis was conducted on clinical data of 1 916 non-fracture patients who underwent THA between September 2015 and December 2021, meeting the selection criteria. Among them, there were 811 male and 1 105 female patients, aged between 18 and 94 years with an average of 59.2 years. Among the patients, 213 were diagnosed with anemia, while 1 703 were not. Preoperative DVT was observed in 55 patients, while 1 861 patients did not have DVT preoperatively (of which 75 patients developed new-onset DVT postoperatively). Univariate analysis was performed on variables including age, gender, body mass index (BMI), diabetes, hypertension, history of tumors, history of thrombosis, history of smoking, revision surgery, preoperative D-dimer positivity (≥0.5 mg/L), presence of anemia, operation time, intraoperative blood loss, transfusion requirement, and pre- and post-operative levels of red blood cells, hemoglobin, hematocrit, and platelets. Furthermore, logistic regression was utilized for multivariate analysis to identify risk factors associated with DVT formation. Results Univariate analysis showed that age, gender, hypertension, revision surgery, preoperative levels of red blood cells, preoperative hemoglobin, preoperative D-dimer positivity, and anemia were influencing factors for preoperative DVT (P<0.05). Further logistic regression analysis indicated that age (>60 years old), female, preoperative D-dimer positivity, and anemia were risk factors for preoperative DVT (P<0.05). Univariate analysis also revealed that age, female, revision surgery, preoperative D-dimer positivity, anemia, transfusion requirement, postoperative level of red blood cells, and postoperative hemoglobin level were influencing factors for postoperative new-onset DVT (P<0.05). Further logistic regression analysis indicated that age (>60 years old), female, and revision surgery were risk factors for postoperative new-onset DVT (P<0.05). Conclusion The incidence of anemia is higher among patients with preoperative DVT for THA, and anemia is an independent risk factor for preoperative DVT occurrence in THA. While anemia may not be an independent risk factor for THA postoperative new-onset DVT, the incidence of anemia is higher among patients with postoperative new-onset DVT.