The incidence of complications after radical resection of esophageal carcinoma is high up to about 20%-50%. The incidence of pneumonia, pleural effusion, tracheal intubation, anastomotic fistula and cardiac events is relatively high. Among them, pulmonary complications are the most common complications after esophageal cancer operation and cause the most perioperative deaths. Among the factors that influence the occurrence of postoperative complications of esophageal cancer, the amount of fluid infusion during and after the operation is closely related to the occurrence of postoperative complications. Moreover, in the environment of enhanced recovery after surgery (ERAS), it is more important to optimize the postoperative fluid management of esophageal cancer. Restricted fluid therapy plays a more and more important role in patients undergoing esophagectomy. This review integrated the relevant research results and discussed the advantages of the restricted fluid therapy compared with other fluid therapy, how to control the restricted infusion volume and infusion speed and how to monitor and evaluate the infusion process and the selection of infusion types, so as to provide reference for clinical practice test.
目的:研究糖尿病围手术期应用胰岛素泵持续皮下输注胰岛素的临床疗效。方法:68例糖尿病围手术期患者随机分为33例采用胰岛素泵持续皮下输注胰岛素治疗(CSII组),对照组35例采用常规多次皮下注射胰岛素治疗(MSII组),分别对术前、术后的相关指标进行对比研究。结果:治疗后两组各时点血糖均较治疗前显著下降(Plt;0.01)。CSII组达到目标血糖所用的时间明显少于MSII组(2.9比7.2天)(Plt;0.05),血糖达标率优于MSII组(93.%比77.1%)(Plt;0.05),低血糖发生率低于MSII组(9.1%比34.3%)(Plt;0.01)。待手术时间(4.2比9.4天)和住院时间(16比24天)明显缩短(Plt;0.05),但两组住院总费用无差异(Pgt;0.05)。〖结论:CSII在糖尿病患者围手术期中应用疗效及安全性方面优于MSII。
ObjectiveTo summarize the individualized selection of surgical treatment strategies and the key points of perioperative management for patients with heart valve disease complicated with severe chronic heart failure.MethodsThe clinical characteristics of 5 male patients with valvular heart disease complicated with severe chronic heart failure (CHF) were analyzed retrospectively from June 2017 to October 2018 in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, with an average age of 60.21 years.ResultsFive patients were given angiotensin receptor and neprilysin inhibitor (ARNI)-based anti-heart failure treatment after admission. The operation mode of these patients was decided to be valve replacement under cardiopulmonary bypass after individualized evaluation of patients’ improving symptoms. Three patients were treated with intra-aortic balloon pump (IABP) and continuous renal replacement therapy (CRRT) early after operation to assist patients in improving cardiac function. Five patients recovered oral anti-heart failure after awakening. All patients were discharged smoothly 2 weeks after operation.ConclusionIndividualized evaluation is needed for the choice of operation timing and mode, standardized preoperative treatment for heart failure, shortening the aortic blocking time during cardiopulmonary bypass, and early application of left ventricular adjuvant drugs or instruments are all important measures to help patients recover smoothly.
目的:探讨脊柱结核一期内固定手术的围手术期处理方法。方法:一期手术治疗脊柱结核患者68例。围手术期处理主要包括正规化疗、围手术期营养支持、选择正确的手术时机、术后支具保护下逐步功能锻炼、定期随访、监测药物副作用等。结果:68例患者切口均一期愈合,无窦道形成。平均2.2 年随访,结核治愈、后凸畸形纠正,10 例患者出现化疗相关的并发症对症或调整药物后症状控制。结论:正确的围手术期处理是脊柱结核手术成功的重要保证。.
目的了解腹腔镜肝切除术（laparoscopic hepatectomy，LH）与开腹肝切除术（open hepatectomy，OH）治疗原发性肝癌的围手术期状况的变化。 方法回顾性分析2012年1月至2013年6月期间青岛大学医学院附属医院肝胆外科收治的40例原发性肝癌患者的临床资料，其中20例行LH，20例行OH，比较2组患者的术前一般情况、术中情况和术后恢复情况。 结果2组患者术前一般情况的差异均无统计学意义（P＞0.05）；在切口长度、术中出血量、术后肝功能指标、胃肠功能恢复情况和术后住院时间方面LH具有明显的优势（P＜0.05），而在手术时间、术后并发症和住院总费用方面2组间差异无统计学意义（P＞0.05）。 结论LH较传统的OH可明显改善肝癌患者的围手术期状况，值得在有条件的情况下开展推广。
There is increasing evidence that microorganisms play a complex and important role in human health and disease, and that the in vivo microbiome can directly or indirectly affect the host’s immune system, endocrine system, and nervous system. Therefore, a relatively stable equilibrium between the host and the microbiome is crucial in human health. However, in the special pathophysiological state of the perioperative period, preoperative anxiety and sleep deprivation, anesthesia intervention and surgical injury, postoperative medication and complications may all have different effects on the microbial composition of various organs in the body, resulting in pathogenic microorganisms, and the balance between beneficial microorganisms is altered. This may affect patient the outcomes and prognosis in a direct or indirect manner. This paper will provide a systematic review of key studies to understand the impact of perioperative stress on the commensal microbiome, provide a fresh perspective on optimizing perioperative management strategies, and discuss possible potential interventions to restore microbiome-mediated steady state.