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Objective:To evaluate the relationship between postoperative delirium and preoperative frailty in elderly patients undergoing non-cardiac surgery.Methods:Elderly patients undergoing non-cardiac surgery at our hospital from March 2019 to July 2022 were collected and their age, comorbidities, gender, smoking history, type of surgery, preoperative albumin, duration of surgery, duration of anesthesia, postoperative hypotension, educational level, nutritional status, American Society of Anesthesiologists (ASA) Physical Status classification, postoperative admission to ICU or not, intraoperative bleeding and preoperative frailty status were collected. The patients were divided into delirium group and non-delirium group according to whether postoperative delirium occurred. The risk factors for postoperative delirium were analyzed by multivariate logistic regression analysis, and the receiver operating characteristic curve was drawn to analyze the value of risk factors in predicting postoperative delirium.Results:There were 74 cases in delirium group and 321 cases in non-delirium group, and the incidence of postoperative delirium was 18.7%. There were statistically significant differences in terms of age ≥70 yr, education level of junior high school and below, poor nutritional status, ASA Physical Status classification Ⅲ, postoperative admission to ICU, proportion of frailty and intraoperative bleeding volume between delirium group and non-delirium group ( P<0.05). The results of logistic regression analysis showed that age, educational level, nutritional status, ASA Physical Status classification, intraoperative bleeding and frailty were all independent risk factors for delirium ( P<0.05). The area under the receiver operating characteristic curve of preoperative frailty predicting postoperative delirium was 0.672 (95% confidence interval 0.605-0.740). Conclusions:Preoperative frailty is an independent risk factor for postoperative delirium in elderly patients undergoing noncardiac surgery, which can predict the occurrence of postoperative delirium to some extent.
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Kawasaki disease ( KD) is an acute febrile illness that preferentially affects children youn-ger than 5 years old and the primary cause of acquired heart disease during childhood. Coronary artery aneu-rysms ( CAA) is a serious complication of KD, leading to ischemic heart disease, myocardial infarction, and sudden cardiac death. Timely initiation of treatment with intravenous immunoglobulin ( IVIG) has reduced the incidence of CAA from 25％ to 4％. Nitrogen-terminal B-type natriuretic peptide ( NT-proBNP ) , originally used for the management of adults with heart disease, was shown to be useful in the diagnosis and management of patients with KD. NT-proBNP is released by cardiomyocytes in response to mechanical factors, such as the dilation of cardiac chambers, and to pro-inflammatory cytokines. Patients with KD have higher NT-proBNP at the time of diagnosis than febrile controls. Moreover, patients with resistance to IVIG treatment and CAA were found to have higher levels of NT-proBNP, suggesting a prognostic role. This review summarizes the signifi-cance of NT-proBNP in the diagnostic value of KD in recent years.
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Objective Evaluate the interaction between dexmedetomidine and propofol for seda-tion induction.Methods Seventy-five patients who undergoing elective surgery under general anesthe-sia,36 males and 39 females,aged 18-65 years,BMI 20-25 kg/m2,ASA physical status Ⅰ or Ⅱwere randomly divided into three groups (n=25 ):propofol group (group A),dexmedetomidine group (group B),propofol combined dexmedetomidine group(group C),each group was divided into 5 groups according to different drug doses,the dose ratio of the adjacent two groups was 1.25,and the median effective dose (ED50)value was calculated by the point oblique method.Results The hyp-notic dose of propofol ED50in group A was 1.25 mg/kg (0.90-1.45 mg/kg),and the anesthetic induction dose of dexmedetomidine ED50in group B was 1.35 μg/kg (0.95-1.50 μg/kg),and the hypnotic dose of propofol and dexmedetomidine ED50in group C was 0.65 mg/kg (0.50-0.90 mg/kg)and 0.40 μg/kg (0.34-0.65 μg/kg)respectively.Conclusion Dexmedetomidine combined with propofol can produce a sig-nificant hypnotic effect,while reducing the impact on the circulation.
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Objective:To study the curative efficacy of budesonide combined with huaiqihuang granules in the treatment of children with asthma and its effects on the serum leukotriene D4(LTD4),nerve growth factor (NGF),tissue inhibitor of metalloproteinase-1 (TIMP-1) levels.Methods:90 cases of children with asthma who were treated from March 2014 to March 2015 in our hospital were selected and divided into the observation group (n=45) and the control group (n=45) according to the random number table.Both groups of children were given bronchial antispasmodic agent,oxygen,antibiotics,glucocorticoid and other conventional treatment after admission,the control group was given budesonide atomization inhalation treatment on the basis of conventional treatment,0.5 mg budesonide were add in 3ml saline for continuous inhalation,twice a day,while the observation group was treated with Huaiqihuang Granules on the basis of the control group,twice a day.After 12 weeks of treatment,the curative effect,disappearance time of wheezing,cough relief,pulmonary rales,wheezing and other symptoms,forced vital capacity (FVC),serum LTD4,NGF,TIMP-1 levels,CD3+,CD4+,CD8+ of both groups were compared.Results:After treatment,the total effective rate of observation group was significantly higher than that of the control group [93.33％(42/45) vs 77.77％(35/45)](P＜0.05);disappearance time of breath,cough,moist rales and wheezes were significantly shorter than those of the control group[(4.32± 1.03)d vs (6.08± 1.24)d,(5.60± 1.12)d vs (7.21± 1.30)d,(3.19± 0.98)d vs (4.98± 1.02)d,(3.25± 1.03)d vs (5.89± 1.35)d](P＜0.05);the FEV1,FEV1/FVC were significantly higher than those of the control group [(92.63± 10.01)L/s vs (78.36± 9.19)L/s,(95.37± 11.72)％ vs (80.19± 10.23)％](P＜0.05);the serum LTD4,NGF,TIMP-1 levels were significantly lower than those of the control group [(7.24± 0.86)ng/mL vs (12.68± 1.01vng/mL,(68.18± 9.01)pg/mL vs (80.78± 10.24)pg/mL,(34.16 ± 5.06)ng/mL vs (49.76 ± 5.47)ng/mL] (P ＜0.05);the CD3+,CD4+ were significantly higher than those of the control group [(66.15± 7.20)％ vs (62.03± 6.85)％,(45.13± 7.90)％ vs (37.42± 7.06)％],CD8+ was significantly lower than that of the control group[(34.16± 5.06)％ vs (49.76± 5.47)％] (P＜0.05).Conclusion:Budesonide combined with Huaiqihuang granules was effective for children with asthma,which could enhance the immune function,improve the lung function,reduce the serum levels of LTD4,NGF,TIMP-1.
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Objective To explore the clinical efficacy and safety of Hydromorphone combined with Propofol therapy in painless gastroscopy combined with colonoscopy examination in elder patients.Methods Sixty-one patients aged 65-80 years underwent a painless gastroscopy combined with colonoscopy examination in the Affiliated Tumor Hospital of Zhengzhou University from June 2015 to January 2016.The patients were randomly divided into the Hydromorphone combined with Propofol group (Group H,n=31) and the Fentanyl combined with propofol group (Group F,n=30).Results The levels (H vs F group) of VAS at 5,15,30 min after anesthetic recovery were lower in H group thanin F group[(2.4±0.5) vs (3.4±0.6),(2.0±0.5) vs (3.2±0.6),(1.6±0.4) vs (2.6±0.7) respectively,(all P＜0.05)],and those of ramsay sedation scores at 5,15,30,45,and 60 min after anesthetic recovery were lower in H group than in F group[(2.6 ± 0.4) vs (3.3 ± 0.5),(2.3±0.5) vs (2.9±0.4),(2.1±0.3) vs (2.6±0.3),(1.9±0.3) vs (2.2±0.3),(1.8±0.3) vs (2.0±0.3) (all P＜0.05)] respectively.Additionally,the incidence rates (H vs F group) of nausea and vomit (3.2％ vs.26.7％),respiratory depression (0.0％ vs.33.3％) and restlessness (6.5％ vs.30.0％) within 60 min after anesthetic recovery were lower in the group H than in the group F (all P＜ 0.05).However,there were no statistical differences in the indexes of postoperative gastrointestinal function between two groups (all P＞0.05).Conclusions The clinical efficiency of hydromorphone combined with propofol used in painless gastroscopy combined colonoscopy examination is favourable and safe without increasing postoperative adverse reactions in elder patients.Hydromorphone combined with propofol is superior to fentanyl combined with propofol as a general intravenous anesthesia.
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OBJECTIVE@#To determine the short and mid-term effect of paravertebral adriamycin injection under CT guidance on intractable postherpetic neuralgia (PHN).@*METHODS@#From January 2010 to May 2012, 68 patients with intractable PHN receiving paravertebral adriamycin injection under CT guidance were enrolled. The outcome included the Quality of Life Score (QLS), Visual Analogue Score (VAS) (average, the worst and the least VAS), pain relief rate at the time before and after the injection, and 1 year after discharge.@*RESULTS@#Lower VAS was observed after the injection than that before the injection [(3.5 ± 1.5) vs (7.9 ± 1.3) on average; (2.1 ± 0.9) vs (6.5 ± 1.7) at least and (4.5 ± 1.4) vs (9.2 ± 1.1) at worst, P<0.05]. Lower VAS at 1 year after discharge was found than that before the injection [(2.2 ± 1.8) vs (7.9 ± 1.3) on average; (1.5 ± 0.8) vs (6.5 ± 1.7) at least; (3.2 ± 1.6) vs (9.2 ± 1.1) at worst ] and that after the injection [(3.5 ± 1.5) vs (2.2 ± 1.8) on average; (1.5 ± 0.8) vs (2.1 ± 0.9) at least and (3.2 ± 1.6) vs (4.5 ± 1.4) at worst, P<0.05]. The pain relief rate after the injection was (68 ± 23)%. The pain relief rate at 1 year after discharge (81 ± 22)% was higher than that at discharge (68 ± 23)% (P<0.05). The quality of life evaluation index scale after the injection (daily life, diet, general activities, sleep, work and social activities) was significantly improved than that before the injection [(10.1 ± 2.2) vs (14.2 ± 1.9), P<0.05]. The quality of life evaluation index scale at 1 year after discharge was significantly improved than that before the injection [(7.0 ± 2.1) vs (14.2 ± 1.9)] and that after the injection [(7.0 ± 2.1) vs (10.1 ± 2.2), P<0.05]. No complication was observed when the patients were discharged and 1 year after discharge.@*CONCLUSION@#Paravertebral adriamycin injection under CT guidance for intractable PHN can effectively relieve the patient's pain, improve the quality of sleep and life without obvious complications. It is safe and effective for intractable PHN.
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Humans , Doxorubicin , Therapeutic Uses , Neuralgia, Postherpetic , Drug Therapy , Pain Measurement , Quality of LifeABSTRACT
OBJECTIVE@#To investigate the effect of pre-amputation pain block on the N-methyl-D-aspartate receptor activation in the central nervous system of amputated rats, and the association between pre-amputation pain block and chronic amputation-related pain.@*METHODS@#Thirty-six adult male SD rats were randomly assigned to an NA group (n=12), a PA group (n=12) and a PAB group (n=12). Group NA was intraplantarly injected saline l00 μL while group PA and group PAB were intraplantarly injected complete Freund adjuvant (CFA) 100 μL. The sciatic nerve of group NA and group PA were freed from surrounding tissue, and that of group PAB was blocked by bupivacaine under pentobarbital sodium anesthesia 5 days after the injection. Thermal withdrawal latency (TWL) was measured before and after the injection. All rats were amputated at the scheduled survival time. The expression of N-methyl-D-aspartate receptor (NR2B) was measured by immunohistochemistry in L4-6 of the spinal cord and the anterior cingulated cortex 7 days after the amputation procedure.@*RESULTS@#The TWL after intraplantar administration of CFA in group PA and group PAB decreased significantly compared with the baseline value (P<0.05), while the saline treated control group remained unchanged. Besides the basic value, the TWL of group PA was shorter than that of group NA at the above-mentioned time-points (P<0.05). Compared with the basic value and group NA, the TWL of group PAB after the block increased significantly (P<0.05). Compared with group NA and group PAB, group PA had a remarkably high expression of NR2B (P<0.05), while there was no difference between group PA and group PAB.@*CONCLUSION@#Pre-amputation pain may activate N-methyl-D-aspartate receptor of the central nervous system, which may lead acute postoperative pain to chronic pain. It is necessary to treat pre-amputation pain.