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Objective:To evaluate the effect of remote ischemic preconditioning (RIPC) combined with postconditioning (RIPostC) on postoperative pulmonary complications in elderly patients undergoing thoracoscopic radical surgery for lung cancer.Methods:Eighty American Society of Anesthesiologists physical status Ⅱ or Ⅲ elderly patients, aged 65-79 yr, with height 155-180 cm, weighing 45-80 kg, were divided into 2 groups ( n=40 each) by the random number table method: control group (group C) and RIPC combined with RIPostC group (group R). RIPC was induced by 3 cycles of 5 min ischemia (cuff inflation to 200 mmHg) followed by 5 min reperfusion (cuff deflation to 0 mmHg) though applying a mercury sphygmomanometer adult cuff to the right upper extremity at 30 min before one-lung ventilation and 30 min before the end of one-lung ventilation in group R. The adult cuff was only bound to the right upper extremity without inflation and deflation in group C. The occurrence of pulmonary complications was recorded within 72 h after operation in both groups.The Quality of Recovery-15 score was used to assess the early postoperative quality of recovery on 1 and 2 days after operation.The number of white blood cells and neutrophils and percentage of neutrophils were recorded at 1 day before surgery and 1 and 3 days after surgery.The postanesthesia care unit stay time and hospital stay time were recorded. Results:Compared with group C, the incidence of pulmonary complications was significantly decreased within 72 h after operation, Quality of Recovery-15 scores were increased at 1 and 2 days after operation, the number of white blood cells and neutrophils and percentage of neutrophils were decreased at 1 and 3 days after operation, and the postanesthesia care unit stay time and postoperative hospital stay time were shortened in group R ( P<0.05). Conclusion:RIPC combined with RIPostC can decrease the risk of postoperative pulmonary complications and is helpful for early postoperative rehabilitation in elderly patients undergoing thoracoscopic radical surgery for lung cancer.
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Objective To evaluate the effects of remote ischemic preconditioning (RIPC) on occurrence of postoperative delirium in elderly patients undergoing radical mastectomy.Methods Sixty elderly patients,aged 65-78 yr,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,scheduled for elective radical mastectomy,were allocated into 2 groups (n =30 each) using a random number table method:control group (group C) and RIPC group.Three cycles of 5-min ischemia/5-min reperfusion induced by a blood pressure cuff placed on the upper arm of the right upper arm served as RIPC treatment at 5 min after induction of anesthesia in RIPC group.The blood pressure cuff was only placed on the upper arm of the right upper arm without inflation and deflation in group C.Jugular bulb venous blood samples were obtained at 10 min before anesthesia induction (T0) and 1,12,24,48 and 72 h after the end of operation (T1-5) for determination of S-100β protein and neuron-specific enolase (NSE) concentrations in serum.The occurrence of delirium within 72 h after operation was estimated using Confusion Assessment Method for the Intensive Care Unit.The occurrence of hypotension,sinus bradycardia and reintubation was recorded.The Quality of Recovery-15 (QoR-15) was used to evaluate the early postoperative quality of recovery at 1 and 2 days after operation.Results Compared with group C,the concentrations of S-100β protein and NSE in serum and incidence of delirium within 72 h after operation were significantly decreased at T1-T5,and the Quality of Recovery-15 scores were increased at 1 and 2 days after operation in group RIPC (P＜0.05).There was no significant difference in the duration of delirium or incidence of hypotension,sinus bradycardia and reintubation between the two groups (P＞0.05).Conclusion RIPC can decrease the development of postoperative delirium and is helpful for the early postoperative recovery of elderly patients undergoing radical mastectomy.
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Objective@#To evaluate the effects of remote ischemic preconditioning (RIPC) on occurrence of postoperative delirium in elderly patients undergoing radical mastectomy.@*Methods@#Sixty elderly patients, aged 65-78 yr, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective radical mastectomy, were allocated into 2 groups (n=30 each) using a random number table method: control group (group C) and RIPC group.Three cycles of 5-min ischemia/5-min reperfusion induced by a blood pressure cuff placed on the upper arm of the right upper arm served as RIPC treatment at 5 min after induction of anesthesia in RIPC group.The blood pressure cuff was only placed on the upper arm of the right upper arm without inflation and deflation in group C. Jugular bulb venous blood samples were obtained at 10 min before anesthesia induction (T0) and 1, 12, 24, 48 and 72 h after the end of operation (T1-5) for determination of S-100β protein and neuron-specific enolase (NSE) concentrations in serum.The occurrence of delirium within 72 h after operation was estimated using Confusion Assessment Method for the Intensive Care Unit.The occurrence of hypotension, sinus bradycardia and reintubation was recorded.The Quality of Recovery-15 (QoR-15) was used to evaluate the early postoperative quality of recovery at 1 and 2 days after operation.@*Results@#Compared with group C, the concentrations of S-100β protein and NSE in serum and incidence of delirium within 72 h after operation were significantly decreased at T1-T5, and the Quality of Recovery-15 scores were increased at 1 and 2 days after operation in group RIPC (P<0.05). There was no significant difference in the duration of delirium or incidence of hypotension, sinus bradycardia and reintubation between the two groups (P>0.05).@*Conclusion@#RIPC can decrease the development of postoperative delirium and is helpful for the early postoperative recovery of elderly patients undergoing radical mastectomy.
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Objective To investigate the clinical value of laparoscopic hysteromyomectomy.Methods The clinical data of 98 cases of laparoscopic hysteromyomectomy(LM)and 76 cases of transabdominal Myomectomy(TAM)were retrospectively analyzed and comparison was made on the operative time,operative blood loss,postoperative blind enema time,body temperature recovery time,the rate of postoperative complicating disease and hospitalization after operation.Result Though the mean opertative time is the same,the mean operative blood loss,the mean body temperature recovery time,postoperative blind enema time,and the mean hospitalization was smaller in LM group than in TAM group(P＜0.05).Conclusion Laparoscopic hysteromyomectomy has the advantage of minimal invasion,short in-hospital days,fast recovery and low complication rate,which is an ideal treatment of hysteromyoma.
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Objective To assess the value of laparoscopy in the diagnosis and treatment of abdominal emergency during pregnancy.Methods Clinical data of 40 cases of abdominal emergency at 7~17 gestational weeks(mean,13.2 weeks) from June 1997 to October 2004 were retrospectively reviewed.There were 16 cases of uterine with ectopic pregnancy,3 cases of twisted ovary,5 cases of pedicel torsion of ovarian cyst,5 cases of acute cholecystitis,and 11 cases of acute appendicitis.The diagnosis and treatment were conducted under laparoscope. Results The confirmative diagnosis was clarified under laparoscope in all the cases.Except 1 case of conversion to open surgery,the operation was accomplished laparoscopically in all cases. The operation time was 25~70 min(mean,38.2 min).Surgical complications occurred in 1 case.During postoperative follow-up observations,there were 3 cases of threatened abortion,3 cases of inevitable abortion,and 1 case of premature delivery. Conclusions Laparoscopic operation is safe and effective for acute abdominal emergency during early-to-middle pregnancy.