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.
ObjectiveTo summarize the efficacy of different anticoagulation methods during perioperative period of non-cardiac surgery after cardiac valve replacement and to compare the postoperative bleeding-related complications and embolization-related complications.MethodsRetrospective analysis of clinical data of 56 patients who underwent non-cardiac surgery after cardiac valve replacement in our hospital from January 2016 to January 2018 was conducted. There were 27 males and 29 females, aged 19-75 (53.56±13.94) years. According to different anticoagulation methods during perioperative period, the patients were divided into a bridging group (32 patients) and a non-bridging group (24 patients). The postoperative hospital stay, the number of patients needing postoperative blood transfusions, bleeding-related complications and embolization-related complications were compared between the two groups. According to the patient’s perioperative embolization risk, each group of patients were divided into a high-risk subgroup, middle-risk subgroup, and low-risk subgroup, and the bleeding-related complications and embolization-related complications in each subgroup were compared.ResultsThe postoperative hospital stay in the bridging group was significantly longer than that in the non-bridging group (P<0.05), but there was no significant difference in the number of patients needing postoperative blood transfusions, overall bleeding-related complications and embolization-related complications between the two groups (P>0.05). Subgroup analysis was performed according to the degree of embolization risk in the perioperative period. The incidence of bleeding-related complications of the non-bridging group in the high-risk subgroup was significantly higher than that in the high-risk subgroup of the bridging group (P<0.05). The incidence of bleeding-related complications in the bridging group was similar to that of embolization-related complications, while the rate of bleeding-related complications in the non-bridging group was 7 times higher than that of embolization-related complications.ConclusionBridging anticoagulation increases the length of postoperative hospital stay, but for patients with high risk factors for embolization, it is more beneficial than continuing oral warfarin during the perioperative period. The incidence of bleeding-related complications associated with continued warfarin therapy is significantly higher than that of embolization-related complications, and hemostatic drugs can be given necessarily.
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.
Objective To investigate the 30-day mortality risk factors in elderly patients (≥70 years) with heart failure with reduced ejection fraction (HFrEF) after isolated coronary artery bypass grafting (CABG) and to construct a nomogram for predicting mortality risk. Methods A retrospective analysis of elderly HFrEF patients undergoing isolated CABG at Tianjin Chest Hospital from 2010 to 2024. Simple random sampling in R was used to divide the dataset into training and validation sets in a 7 : 3 ratio. The training set was further divided into survivors and non-survivors. Univariate logistic regression was performed to identify differences between groups, followed by multivariate logistic stepwise regression to select independent risk factors for death and to establish a death-risk nomogram, which underwent internal validation. The predictive value of the nomogram was assessed by plotting receiver operating characteristic (ROC) curves, calibration curves, and decision-curve analyses for both the training and validation sets. ResultsA total of 656 patients were included. The training set consisted of 458 patients (survivors 418, deaths 40); the validation set consisted of 198 patients (survivors 180, deaths 18). In the training cohort, univariate analysis showed significant differences between survivors and deaths for creatinine (Cr) level, brain natriuretic peptide (BNP), maximum Cr, intra-aortic balloon pump (IABP) use, assisted ventilation, reintubation, hyperlactatemia, low cardiac output syndrome, and renal failure (P<0.05). After multivariable logistic regression with stepwise selection, five independent risk factors were identified: IABP use (OR=3.391, 95%CI 1.065–11.044, P=0.038), reintubation (OR=15.991, 95%CI 4.269–67.394, P<0.001), hyperlactatemia (OR=8.171, 95%CI 2.057–46.089, P=0.007), Cr (OR=4.330, 95%CI 0.997–6.022, P=0.024), and BNP (OR=1.603, 95%CI 1.000–2.000, P=0.010). Accordingly, a nomogram predicting mortality risk was constructed. The ROC and calibration analyses indicated good predictive value: training set AUC was 0.898 (95%CI 0.831–0.966); validation set AUC 0.912 (95%CI 0.805–1.000). Calibration and decision-curve analyses showed good agreement and clinical utility. Conclusion The nomogram incorporating IABP use, reintubation, hyperlactatemia, creatinine, and BNP provides good predictive value for 30-day mortality after CABG in elderly patients with HFrEF and demonstrates potential clinical utility.
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.
Giant thoracic tumor is currently one of the diagnostic and therapeutic challenges of thoracic surgery, with no established guideline or standard for diagnosis and treatment. The quality control of individualized surgical strategy and perioperative management with multi-disciplinary participation is the key to ensure the safety and improve the prognosis of patients. Based on the clinical experience of our institution and others, we hereby discussed and summarized the basic principles, surgical strategies and perioperative management of giant thoracic tumor, aiming to provide a reference of quality control.
Enhanced recovery after surgery (ERAS) has been proven to reduce surgical injuries, promote recovery, and improve postoperative outcomes in different types of surgeries. A core principle of ERAS is to provide programmatic evidence-based perioperative interventions. An international multidisciplinary expert group provided a statement on clinical practice in each thematic area of ERAS by obtaining a list of potential ERAS elements, and reviewing literature. The version 2024 of "Perioperative care in cardiac surgery: A joint consensus statement by the Enhanced Recovery After Surgery (ERAS) Cardiac Society, ERAS International Society, and the Society of Thoracic Surgeons (STS)" is developed from the version 2019 of "Guidelines for perioperative care in cardiac surgery: Enhanced Recovery after Surgery Society recommendations". The consensus statement group was composed of multidisciplinary experts such as cardiac surgeons, anesthesiologists, intensive care physicians, and nurses, based on personal ERAS knowledge and experience. This article interprets the changes and new statements in the 2024 consensus, which can provide a foundation for the best perioperative practices for adult cardiac surgery patients.
ObjectiveTo explore the efficacy and safety of intravenous injection of tranexamic acid (TXA) combined with local use of TXA cocktail in intertrochanteric fracture fixation with proximal femoral nail antirotation (PFNA).MethodsPatients with intertrochanteric fractures who underwent close reduction and internal fixation with PFNA between February 2018 and March 2019 were enrolled in the study. Among them, 45 patients who met the selection criteria were included in the study and randomly allocated into 3 groups (n=15). The patients in group A were not received TXA during perioperative period. The patients were intravenously injected of 1.0 g TXA before operation in group B and combined with local use of TXA cocktail during operation in group C. There was no significant difference in the age, gender, body mass index, fracture classification, disease duration, and complications between groups (P>0.05). The perioperative blood loss and blood transfusion rate, the visual analogue scale (VAS) score before operation and at 12, 24, and 48 hours after operation, the levels of prostaglandin E2 (PGE2) and bradykinin (BK) before operation and at 1 and 3 days after operation, postoperative complications, and the maximum amplitude (MA) of thromboelastogram were recorded and compared between groups.ResultsThe total blood loss, hidden blood loss, and visible blood loss were significantly lower in groups B and C than those in group A (P<0.05), and the total blood loss and hidden blood loss were significantly lower in group C than those in group B (P<0.05). There was no significant difference in the blood transfusion rate, preoperative VAS scores and the levels of PGE2 and BK between groups (P>0.05). The postoperative VAS scores and the levels of PGE2 and BK were significantly lower in group C than in groups A and B (P<0.05). There was no significant difference in pre- and post-operative MA of thromboelastogram between groups (P>0.05). The incidences of postoperative complications were 33.33% (5/15), 20.00% (3/15), and 13.33% (2/15) in groups A, B, and C, respectively, with no significant difference between groups (χ2=1.721, P=0.550).ConclusionFor intertrochanteric fractures, application of intravenous injection of TXA combined with local use of TXA cocktail in PFNA fixation can reduce perioperative blood loss, relieve pain after operation, and do not increase the risk of complications.
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.
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.