摘要:目的:总结巨大垂体腺瘤水钠代谢紊乱的围手术期处理经验。方法:对71例巨大垂体腺瘤患者术前及术后1周内每日检测血、尿电解质水平,以及血、尿渗透压,判断失钠及失水类型。总结不同瘤体大小与手术入路和水钠紊乱发生率、程度、时间之间的关系。结果:71例巨大垂体腺瘤患者中,出现水钠代谢紊乱52例,发生率73.2%。肿瘤大小与水钠紊乱发生率、严重程度、发生时间成正比,而手术入路选择与水钠代谢紊乱发生无明显相关。结论:巨大垂体腺瘤患者术后水钠代谢紊乱的发生与瘤体大小成正相关,其出现时间和表现形式复杂。对水钠代谢紊乱严重患者可适当予以预防性治疗,以减少临床症状和不良后果。Abstract: Objective: To summarize the preioperative management experience of metabolic disturbance of water and natrium for patients with giant pituitary adenomas. Methods: The electrolyte and osmotic pressure of blood and urine in patients with giant pituitary adenomas were detected within preoperative and postoperative one week and the type of the metabolic disturbance of water and natrium were determined. The correlation of the different tumor size and surgical approach with the incidence rate, extent and time of the metabolic disturbance was summarized. Results: There were 52 cases with different extent metabolic disturbance of water and natrium in 71 cases of giant pituitary adenomas(73.2%). There were a positive correlation of tumor size with the incidence rate, extent and time of the metabolic disturbance, and a negative correlation of surgical approach with that of the metabolic disturbance. Conclusion: The metabolic disturbance of water and natrium in giant pituitary adenomas was positive correlation with the tumor size, which. is various in emergence time and pattern of manifestation. To reduce the clinical symptoms and adverse consequences, prophylactic treatment may be used in patients with serious metabolic disorder of water and natrium.
摘要:目的:探讨老年人梗阻性大肠癌的围手术期处理。方法:回顾性分析2003年至2008年间71例60岁以上老年人梗阻性大肠癌的围手术期处理情况。 结果:术前发现并存病者43例,术中出现并发症19例,术后发生并发症37例得,除5例死亡外,均得到有效控制,死亡原因与并存疾病有关。结论:加强围手术期处理,积极治疗并存疾病,老年人梗阻性大肠癌的治疗同样能取得满意的效果。Abstract: Objective:To study the perioperative measures for the aged patients with Obstructive Colorectal Cancer. Methods: Seventyone cases above 60 years with Obstructive Colorectal Cancer were analysed retrospectively on their individual accompanied diseases and perioperative treatments, from 2003 to 2008.Results: Fortythree cases of them had suffered from other diseases. Midoperative complications occurred in 19 cases. Postoperative complications occurred in 37 cases. Except 5 cases of death, complications occurring in others cases were well controlled. The death causes mainly were correlated with accompanied chronic diseases. Conclusion: Strengthen care, active management of other chronic diseases are important significantly for senile patients with colorectal carcinoma to get satisfied outcome.
摘要:目的：评价围手术期预防性应用抗菌药物现状及合理性。方法：采用回顾性调查的方法，随机抽查2009年度Ⅰ类切口手术围手术期病案500份，设计外科围手术期预防性应用抗生素调查表，对预防用药的适应证、用药种类、联合用药、给药时机及持续时间进行统计分析。结果：未使用抗生素5例，预防性使用抗生素495例，其中不合理80例（16.00％）。预防性使用抗生素总品规数为540，其中头孢菌素类453例（83.89%），青霉素类（包括加酶抑制剂）26例（4.81%），喹诺酮类44例（8.15%）。选用头孢唑啉钠178例（32.96%）居第一位，头孢替唑钠第二，151例（2796%）。结论：Ⅰ类切口手术患者围手术期预防性使用抗菌药物较为合理，但仍存在用药指征把握不严，抗菌药物的选择、抗菌药物使用时间较长等问题，有待进一步规范化管理。Abstract: Objective: To understand the current application of perioperative preventive antibiotics, and their rationality. Methods: Five hundred perioperative records of patients with incision Ⅰ were randomly chosen and surveyed in 2009. A questionnaire for prophylactic use of antimicrobial was designed. The indication of antimicrobial use, the species, combination, timing and drug duration were analyzed. Results: Our of 500, 495 used antimicrobial and 80 were unreasonable; 540 kinds of antimicrobial were used, included cephalosporin 453 cases (83.89%), penicillin class (including plus enzyme inhibitors) in 26 cases (4.81%), quinolone 44 cases (8.15%). Cefazolin sodium (178 patients, 32.96%) ranked first, second was cefazolin sodium (151, 27.96%). Conclusion: Perioperative use of antimicrobial prophylaxis in patients with incision Ⅰ is reasonable, but standardization management should be strengthened in the indication, species, and duration.
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.
Objective To systematically evaluate effects of enhanced recovery after surgery (ERAS) programme on clinical outcomes of liver resection during perioperative period. Methods The randomized controlled trials (RCTs) of comparing ERAS programme with traditional care programme in patients underwent liver resection were searched by Wanfang, VIP, CNKI, PubMed, Embase, and Cochrane Library databases from inception to January 2016. The quality of the included RCT was assessed independently according to the Cochrane handbook–version 5.1.0 by two reviewers. Meta-analysis was conducted for the eligible RCTs by using RevMan 5.3.0. Results Seven RCTs containing 844 patients were included in this meta-analysis. There were 35 cases of benign tumor, 809 cases of malignant tumor. The ERAS programmes were performed in 415 patients, while the traditional care programmes were performed in 429 patients. Compared with the traditional care programme, the overall complications rate and the Dindo-Clavien grade Ⅰ complications rate were significantly lower〔OR=0.59, 95%CI (0.41, 0.87),P=0.007;OR=0.45, 95%CI (0.27, 0.76),P=0.002〕, the hospital stay and the first anal exhaust time were significantly shorter〔WMD=–2.66, 95%CI (–3.64, –1.69),P<0.000 01;WMD=–20.25, 95%CI (–32.08, –8.42),P=0.000 8〕 in the ERAS programme, but there was no statistically significant difference of the Dindo-Clavien grade Ⅱ–Ⅳ complications rate between these two groups〔OR=0.93, 95%CI (0.53, 1.63),P=0.80〕. Conclusions ERAS is a safe and effective programme in liver resection during perioperative period. Future studies should define active elements to optimize postoperative outcomes for liver resection.
Objective To investigate the perioperative outcome of robot-assisted pulmonary lobectomy in treating pathological stage Ⅰ non-small cell lung cancer (NSCLC). Methods We retrospectively analyzed the clinical data of 333 consecutive p-T1 NSCLC patients who underwent robotic-assisted pulmonary lobectomy in our hospital between May 2013 and April 2016. There were 231 females (69.4%) and 102 males (30.6%) aged from 20–76 (55.01±10.46) years. Cancer was located in the left upper lobectomy in 37 (11.1%) patients, left lower lobectomy in 71 (21.3%) patients, right upper lobectomy in 105 (31.5%) patients, right middle lobectomy in 32 (9.6%) patients, right lower lobectomy in 88 (26.4%) patients. Adenocarcinoma was confirmed in 330 (99.1%) patients and squamous cell cancer was confirmed in 3 (0.9%) patients. Results Total operative time was 46–300 (91.51±30.80) min. Estimated intraoperative blood loss was 0–100 ml in 319 patients (95.8%), 101–400 ml in 12 patients (3.6%), >400 ml in 2 patients (0.6%). Four patients were converted to thoracotomy, including 2 patients due to pulmonary artery branch bleeding and 2 due to pleural adhesion.No patient died within 30 days after surgery. And no perioperative blood transfusion occurred. Postoperative day 1 drain was 0–960 (231.39±141.87) ml. Chest drain time was 2–12 (3.96±1.52) d.And no patient was discharged with chest tube. Length of hospital stay after surgery was 2–12 (4.96±1.51) d. Persistent air leak was in 12 patients over 7 days. No readmission happened within 30 days. All patients underwent lymph node sampling or dissection with 2–9 (5.69±1.46) groups and 3–21 (9.80±3.43) lymph nodes harvested. Total intraoperative cost was 60 389.66–134 401.65 (93 809.23±13 371.26) yuan. Conclusion Robot-assisted pulmonary lobectomy is safe and effective in treating p-Stage Ⅰ NSCLC, and could be an important supplement to conventional VATS. Regarding to cost, it is relatively more expensive compared with conventional VATS. RATS will be widely used and make a great change in pulmonary surgery with the progressive development of surgical robot.
Objective To summarize the general situation of perioperative venous thromboembolism (VTE) and summarize the perioperative antithrombotic strategies. Methods Domestic and international literatures and guidelines on antithrombotic therapy were collect and reviewed. Results VTE was common during the perioperative period. Reasonable assessment of each patient’s condition during the perioperative period, as well as reasonable use of anticoagulant, antiplatelet drugs, and hemostatic agents could reduce the incidence of VTE events during the perioperative period. Conclusions Clinicians need to properly assess the timing of the usage and discontinuation of antithrombotic drugs, weigh the risk of thrombosis and bleeding, develop a rational and scientific antithrombotic strategy based on the specific circumstances of each patient. Simultaneously, hemostatic agents need to be prescribed perioperatively to reduce the incidence of thromboembolic complications.
Objective To identify the relationship between preoperative left ventricular dysfunction and perioperative risk factors in coronary artery bypass grafting (CABG). Methods The clinical data of 192 patients who underwent CABG from November 2015 to October 2016 were analyzed retrospectively. The patients were divided into three groups by preoperative left ventricular ejection fraction (LVEF) in echocardiography: a serious left ventricular dysfunction group (LVEF≤35%, 23 patients, 15 males and 8 females at age of 63.91±5.36 years), a moderate left ventricular dysfunction group (35%<LVEF<50%, 24 patients, 20 males and 4 females at age of 66.29±6.03 years) and a normal left ventricular function group (LVEF≥50%, 145 patients, 86 males and 59 females at age of 66.60±6.41 years). Results The overall mortality was 4.16% (8/192), 17.39% (4/23) in patients with LVEF≤35% and 2.76% (4/145) in those with LVEF≥50%. Preoperative LVEF≤35%, hypoxia, assisted circulation, acute kidney injury (AKI) and postoperative continuous renal replacement therapy (CRRT) were risk factors of perioperative mortality in coronary artery surgery. LVEF≤35% and CRRT were independent preditors of mortality. There were significant differences in mortality and postoperative complications between the serious left ventricular dysfunction group and other two groups. Conclusion Postoperative mortality and complications are obviously serious in the patients with LVEF≤35%. We should pay more attention to preoperative risk factors. Postoperative individual manipulation, intra-aortic balloon pump and CRRT can enhance survival of those patients.
Objective To evaluate the efficacy and safety of perioperative comprehensive management in non- small cell lung cancer (NSCLC) with chronic obstructive pulmonary disease (COPD). Methods Clinical studies about effect of different perioperative comprehensive management on patients with early NSCLC combined with COPD were searched from PubMed, EMbase, The Cochrane Library, CBM, CNKI and WanFang databases from inception to November 1st, 2017. Two researchers independently screened literature, extracted data and evaluated the risk of bias of included studies, and then meta-analysis was conducted by RevMan 5.3 and Stata 14.0 softwares. Results A total of 20 articles were identified including 1 079 patients. The results of meta-analysis showed that perioperative comprehensive management improved the forced vital capacity (FVC), maximum minute ventilation (MVV), predictive value of postoperative one-second rate (ppoFEV1%), carbon monoxide diffusing capacity (DLCO) and percent forced expiratory volume in one second (FEV1%) (MD=–0.47, 95%CI –0.62 to –0.32, P<0.000 01; MD=–0.17, 95%CI –0.22 to –0.11, P<0.000 01; MD=–4.24, 95%CI –5.37 to –3.11, P<0.000 01; MD=–7.54, 95%CI –8.33 to –6.76, P<0.000 01; MD=–1.33, 95%CI –2.16 to –0.50, P=0.002; MD=–6.93, 95%CI –9.45 to –4.41, P<0.000 1, respectively). However, there was no significant difference in the rate of DLCO (DLCO%) and ventilation at maximal workload (VEmax) between pre- and post-management (MD=–2.91, 95%CI –11.31 to 5.50, P=0.5; MD= 0.18, 95%CI –2.23 to 2.58, P=0.89, respectively). With regard to cardiac function, perioperative comprehensive management improved the maximal oxygen consumption (VO2max), 6-minute walk distance (6MWD) and anaerobic threshold (AT) (MD=–2.28, 95%CI –3.41 to –1.15, P<0.000 1; MD=–57.77, 95%CI –77.90 to –37.64, P<0.000 1; MD=–2.71, 95%CI –3.30 to –2.12, P<0.000 1, respectively). As to complications, compared with conventional treatment group, perioperative comprehensive management group had fewer postoperative short-term complications (OR=0.39, 95%CI 0.26 to 0.58, P<0.000 01). Besides, perioperative comprehensive management also shortened hospital stay (MD=–2.38, 95%CI –3.86 to –0.89, P=0.002). Conclusion Perioperative comprehensive management can significantly improve lung function in patients with NSCLC combined with COPD, reduce short-term postoperative pulmonary complications and shorten the hospital stay with good efficacy and safety.
Objective To review the progress of perioperative treatments for patients of Parkinson’s disease and hip fractures. Methods The related literature of treatments for patients of Parkinson’s disease and hip fractures were reviewed and analyzed from the aspects such as the perioperative management, selection of operation ways, and prognosis. Results The patients of Parkinson’s disease are more likely to sustain hip fractures because of postural instability and osteoporosis. The perioperative treatments for patients of Parkinson’s disease and hip fractures should be determined by orthopedists, neurologist, anesthesiologist, and physical therapist. There is still controversy about the selection of operation and surgical approach. And the prognosis of patients of Parkinson’s disease and hip fractures are associated with the severity of Parkinson’s disease. Conclusion There are few clinical studies about the patients of Parkinson’s disease and hip fractures. The mid-term and long-term functional outcomes of patients of Parkinson’s disease and hip fractures are unsufficient. And the best treatments of patients of Parkinson’s disease and hip fractures need to be further explored.