This study was designed to determine the effects of different anaesthesia on the postoperative gastrointestinal motility after cholecystectomy. Postoperative gastrointestinal motility were recorded continuously by means of gastrointestinal manometry in 20 patients subject to cholecystectomy (general anaesthesia 10, epidural anaesthesia 10). Normal migrating motor complex (MMC) was abolished during the early postoperative period in all patients. The time of reappearance of intestinal MMC varied from 0.5 to 2 hours . Gastric MMC recurred 5.5 to 14 hours postoperatively and the normal MMC completely recovered 22 to 43 hours after the operations. Ingestion of food changed the MMC into a fed pattern during the early postoperative period. There was no difference between the general anaesthesia group and epidural anaesthesia group in terms of gastrointestinal motility. The results indicate that postoperative gastrointestinal motility recovers faster than that was thought conventionally. Cholecystectomy under general anaesthesia or under epidural anaesthesia makes no difference in postoperative gastrointestinal motility.
ObjectiveTo observe the clinical characteristics, the characteristics of organ dysfunction and death related factors in the natural course of severe acute pancreatitis (SAP). MethodsThe data of 302 cases of SAP from January 1999 to June 2007 in our hospital were retrospective analyzed. The APACHEⅡscore, state of each organ, and death related factors were recorded and analyzed according to the admission and on 1, 3, 5, 7, 14, and 28 d after admission, a total of 7 time points. ResultsIn natural course of SAP, the APACHEⅡscore took on a double-peak type distribution, the peaks appearing nearly about one week and two weeks after the onset of SAP. Systemic inflammatory response syndrome (SIRS), hypoxemia, metabolic acidosis, hyperglycemia, and abdominal compartment syndrome were the main causes of early organ failure. Incidence of organ failure and infection increased significantly for patients with intestinal paralysis lasting longer than five days. The most affected organ failure was followed by respiratory organs, peripheral circulation, kidneys, and gastrointestinal tract. The mortality rate increased significantly for patients with organ failure more than 48 hours. Four cases of death (9.5%) caused by severe shock and cardiac arrest within 24 h after admission; 6 deaths (14.3%) led by persistent shock with ARDS or acute renal failure within 24-72 h; 14 cases of death (33.3%) arose from 3-10 d after onset, mainly for acute respiratory distress syndrome (ARDS), acute renal failure associated with multiple organ dysfunction syndrome (MODS); 18 cases (42.8%) of the death arose on 10 d after the onset, mainly for the MODS caused by intra-abdominal infections, bleeding, pancreatic fistula, and biliary fistula. ConclusionsThe natural course of SAP can be divided into three phases:systemic inflammation, systemic infection, and recovery. Duration of intestinal paralysis is an important factor affecting the natural history of SAP. Early complications in patients with organ failure appeared as SIRS, metabolic acidosis, hyperglycemia, and abdominal hypertension. MODS led by SIRS is the leading cause in early death of SAP; MODS caused by pancreas and peripancreatic tissue infections, abdominal bleeding, pancreatic fistula, and biliary fistula are the main death factor in the late phase. Early recovery of gastrointestinal function can reduce the incidence of MODS.
Objective To evaluate the association between intraoperative fluid management and prolonged postoperative ileus (PPOI) after colorectal surgery. Methods We reviewed the data of 980 patients who underwent elective colorectal surgery in West China Hospital of Sichuan University between July and December 2016. The primary outcome was PPOI. The association of intraoperative fluid volume and fluid balance with PPOI were analyzed. Results Nine hundred and eighty patients undergoing elective colorectal surgery were included, and the incidence of PPOI was 31.1% (305/980). Compared with non-PPOI patients, patients with PPOI had longer postoperative hospital stay and increased total hospital cost (P<0.05). Multivariate logistic regression analysis did not find intraoperative fluid volume and fluid balance were associated with PPOI in patients undergoing colorectal surgery (P>0.05). Conclusions There is no clinically relevant association between intraoperative fluid management and PPOI in adult patients underwent colorectal surgery. However, the occurrence of PPOI may prolong postoperative hospital stay and increase hospitalization cost.