With the advancement and development of computer technology, the medical decision-making system based on artificial intelligence (AI) has been widely applied in clinical practice. In the perioperative period of cardiovascular surgery, AI can be applied to preoperative diagnosis, intraoperative, and postoperative risk management. This article introduces the application and development of AI during the perioperative period of cardiovascular surgery, including preoperative auxiliary diagnosis, intraoperative risk management, postoperative management, and full process auxiliary decision-making management. At the same time, it explores the challenges and limitations of the application of AI and looks forward to the future development direction.
ObjectiveTo analyze the clinical outcomes of extended thymectomy for myasthenia gravis (MG) patients under different surgical approaches, and to determine the factors affecting the prognosis of MG. MethodsThe MG patients who underwent extended thymectomy from January 2014 to March 2021 in our hospital were retrospectively collected. According to the surgical approach, they were divided into a subxiphoid group and an intercostal group, and the perioperative results and prognosis were compared between the two groups. A “good outcome” was defined as complete stable remission (CSR), pharmacological remission (PR) or minimal manifestations state (MMS); a “poor outcome” was defined as outcomes worse than MMS. Univariate and multivariate logistic regression analyses were performed to assess the factors associated with the good outcomes. ResultsA total of 187 MG patients were included in the study, including 82 males and 105 females, with a median age of 50 (36, 60) years. There were 134 patients in the intercostal group and 53 patients in the subxiphoid group. Compared with the intercostal group, although the operation time of the subxiphoid group was longer [200.0 (172.0, 232.0) min vs. 141.0 (118.0, 169.0) min, P<0.001], the intraoperative blood loss was less [10.0 (10.0, 20.0) mL vs. 20.0 (10.0, 50.0) mL, P<0.001], the postoperative hospital stay was shorter [3.0 (2.5, 4.0) d vs. 5.0 (3.0, 7.0) d, P<0.001], and the incidence of complications was lower [1 (1.9%) vs. 26 (19.4%), P=0.001]. A total of 159 (85.0%) patients were followed up for a median period of 46 (13, 99) months, with a good outcome rate of 90.6% and CSR rate of 33.3%. There were no statistical differences in PR, MMS or overall good outcome rates between the two groups (P>0.05). Multivariate logistic analysis showed that age≤50 years was an independent predictor for "good outcome" of MG patients. ConclusionExtended thymectomy via subxiphoid for MG is a safe, feasible and effective surgical approach.
Objective To provide experience for clinical diagnosis and treatment through exploring the perioperative characteristics and short-term treatment outcomes of adult cardiac surgery in patients with prior coronavirus disease-2019 (COVID-19). MethodsA retrospective analysis was performed on patients undergoing coronary artery bypass grafting (CABG) or valve surgery in the Department of Cardiac Surgery of Beijing Anzhen Hospital from December 26, 2022 to December 31, 2022, and previously diagnosed with COVID-19 before surgery. ResultsFinally 108 patients were collected, including 81 males and 27 females, with an average age of 60.73±8.66 years. Two (1.9%) patients received emergency surgery, and the others received elective surgery. The 86.1% of patients had been vaccinated, and the duration of COVID-19 was 5.0 (4.0, 7.0) days. The time from COVID-19 to operation was 15.0 (12.0, 17.8) days. Eighty-nine patients received CABG, of which off-pump CABG was dominant (92.1%). Nineteen patients received valve surgery. The rate of delayed extubation of ventilator was 17.6%. The ICU stay was 21.0 (17.3, 24.0) hours, and the postoperative hospital stay was 7.0 (6.0, 8.0) days. Three (2.8%) patients were treated with intra-aortic balloon pump (IABP), one (0.9%) patient was treated with extracorporeal membrane oxygenation (ECMO), one (0.9%) patient was treated with continuous renal replacement therapy (CRRT) due to acute renal insufficiency, three (2.8%) patients were treated with temporary pacemaker, and one (0.9%) patient underwent rethoracotomy. In terms of postoperative complications, the incidence of cerebrovascular accident, acute renal insufficiency, gastrointestinal bleeding and septicemia was 0.9%, respectively, and the incidence of acute heart failure, lung infection, and liver insufficiency was 1.9%, respectively. All patients recovered and were discharged from hospital, and no in-hospital death occurred. Conclusion The utilization rate of postoperative IABP, ECMO, CRRT, temporary pacemaker and the incidence of serious complications in patients with prior COVID-19 are not higher than those of normal patients, and the short-term treatment outcome is good.
ObjectiveTo compare the perioperative outcomes between robot-assisted complex segmentectomy and simple segmentectomy for stage ⅠA non-small cell lung cancer (NSCLC). MethodsThe clinical data of 285 patients with NSCLC undergoing robot-assisted thoracic surgery (RATS) in our hospital from January 2015 to August 2021 were retrospectively analyzed. There were 105 males and 180 females aged 23-83 years. The patients were divided into a complex segmentectomy group (n=170) and a simple segmentectomy group (n=115) according to tumor location and surgical method. The clinical pathological baseline characteristics and perioperative outcomes between the two groups were compared, including operative time, blood loss volume, dissected lymph nodes, conversion rate, postoperative duration of drainage, postoperative hospital stay, the incidence of persistent air leakage and postoperative 30 d mortality. ResultsThere was no statistical difference in baseline data between the two groups (P>0.05). No postoperative 30 d death was observed. One patient in the complex segmentectomy group was transferred to thoracotomy. No statistical difference was observed between the two groups in the operative time (97.36±38.16 min vs. 94.65±31.67 min, P=0.515), postoperative duration of drainage (3.69±1.85 d vs. 3.60±1.90 d, P=0.679), postoperative hospital stay (4.07±1.85 d vs. 4.05±1.97 d, P=0.957), dissected lymph nodes (5.15±3.53 vs. 5.13±2.93, P=0.952), incidence of blood loss volume<100 mL (98.2% vs. 99.1%, P=0.650), and incidence of postoperative persistent air leakage (6.5% vs. 5.2%, P=0.661). ConclusionThe safety and effectiveness of robot-assisted complex segmentectomy and simple segmentectomy are satisfactory in the treatment of stage ⅠA NSCLC. The perioperative results of RATS complex segmentectomy and simple segmentectomy are similar.
The technique of transcatheter aortic valve implantation has become increasingly mature. Although the transapical approach has a certain degree of minimally invasive trauma, it still has the characteristics such as heart beating without cardiopulmonary bypass, and the low technical requirements of catheter guide wire. In particular, the valve path is short and coaxial, which is easy to manipulate, and pure regurgitation and stenosis can be easily operated and are not subject to the limit of peripheral artery stenosis. It is still one of China's main approaches for transcatheter aortic valve replacement. Its perioperative management still has specific features and differs from the femoral artery approach. In addition, there is little relevant literature abroad. Therefore, domestic experts in this field were organized to discuss the development of perioperative management specifications to provide reference and techniques support for developing this field in China and further improve the quality of clinical operation and perioperative management. It will provide more safe and more effective medical services to these patients.
摘要:目的: 探讨脊髓动静脉畸形患者科学的围手术期护理方法。 方法 :对31例脊髓动静脉畸形围术期患者进行了科学的护理,即心理,术前、术后以及特殊症状护理,并分析护理效果。 结果 :31例患者中治愈27例,好转4例。 结论 :脊髓动静脉畸形手术难度大,危险性高,科学的围手术期护理是促进治疗效果的重要保证。Abstract: Objective: To discuss the effectiveness of scientific perioperative nursing for the patients with spinal arteriovenous malformations. Methods : 31 patients with spinal arteriovenous malformations had got nursing, such as psychology nursing and special perioperative symptoms. The nursing effective is analysed. Results : 27 cases are cured and the other 4 cases improved. Conclusion : Spinal arteriovenous malformations is difficult and dangerous for operation.The scientific perioperative nursing is important guarantee for advancing the cure effective.
Objective To introduce the results and strategy of perioperative management undergo coronary artery bypass grafting (CABG) for patients older than 70. Methods One hundred and twenty one patients, 93.4%(113/121) of whom was complicated with other diseases, were retrospectively studied. Off-pump CABG (OPCAB) was used in 80 cases (66.1%). For the rest patients with severely compromised heart function or small target vessel with diffuse lesion, conventional CABG (CCABG) was selected. Left internal mammary artery (LIMA) was harvested leaving pleural cavity intact and grafted to left anterior descending artery (LAD). Saphenous vein(SV) was utilized for other anastomoses. Transit-time flowmeter (TTFM) was utilized to make sure that grafts were patent with satisfactory blood flow. Procedure of sternotomy and chest closure was carefully performed to decrease the complication of mediastinitis. Adequate nutrition and gradually increased physical activity were encouraged for "fast-track". Results Grafts were 3.08±0.75 for CCABG and 2.24±0.82 for OPCAB . LIMA was used in 90.9%(110/121) patients. One patient receiving emergency operation died of multiple organ failure syndrome resulting in mortality of 0.8%. The incidence of complication was 3.3%(4/121). The others recovered smoothly without any complication. Intubation time of OPCAB(10.04±5.68 h) was significantly shorter than that of CCABG(21.46±14.54 h). Patients were discharged within 12.22±5.56 days after operation. Conclusion Good short term result, namely low incidence of mortality and complication, could be obtained in patients older than 70 who underwent CABG through meticulous perioperative management.
ObjectiveTo explore the influence of enhanced recovery after surgery (ERAS) on intestinal flora in patients with colorectal cancer.MethodsBy convenient sampling method, 60 patients with colorectal cancer were selected from August 2018 to December 2019 in the Department of Gastrointestinal Surgery of West China Hospital of Sichuan University and randomly divided into ERAS group and traditional treatment group (traditional group). Among them, the perioperative clinical management was carried out according to the ERAS management and traditional treatment process in the the ERAS group and in the traditional group, respectively. The fresh fecal samples were collected within 24 h after admission and the first natural defecation after operation. The bacterial 16 Sr DNA V3–V4 region was sequenced by Illumina MiSeq sequencer, and the results were analyzed by bioinformatics.ResultsA total of 60 patients with colorectal cancer were included, 30 cases in the traditional group and 27 cases in the ERAS group (3 people temporarily withdrew from the study). There were no significant differences in the basic informations between the two groups (P>0.05). ① Before or after operation, there were no significant differences in Shannon index and Simpson index between the two groups. The difference between preoperative and postoperative comparison in the same group was also not statistically significant (P>0.05). ② Beta diversity analysis showed that there was no significant difference in community composition between the traditional group and the ERAS group before operation, and there was a clear boundary between the traditional group and the ERAS group after operation. ③ At the phylum level, compared with the preoperative abundance, the postoperative abundance Firmicutes decreased by 26.5% and 5.5% in the traditional and ERAS group, respectively; Bacteroidetes increased by 21.6% and 4.7% in the traditional and ERAS group, respectively; Proteobacteria increased by 7.2% and 2.2% in the traditional and ERAS group, respectively. At the genus level, compared with the preoperative abundance, the postoperative abundance of Bacteroides in the traditional group increased by 17.6% and in the ERAS group decreased by 1.6%; Bifidobacterium decreased by 1.8% and 1.3% in the traditional group and in the ERAS group, respectively.ConclusionsERAS does not affect species diversity of intestinal flora. Although ERAS has some damage to structure of intestinal flora, it is weaker than traditional process, so it is more conducive to reconstruction and restoration of intestinal microecological environment.