ABSTRACT
Objective To investigate the relationship between the occurrence of adverse events during operation and postoperative complications in emergency general surgery patients, and to analyze the risk factors of postoperative complications.Methods We retrospectively analyzed 689 e-mergency general patients undergoing general anesthesia emergency surgery during the period of Sep 1,2015 to Sep 1,2016 in the First Affiliated Hospital of Nanjing Medical University.The clinical fac-tors that may influence the outcomes and postoperative complications were collected and analyzed using univariate analysis and multivariate Logistic regression analysis.Results Among the 689 patients enrolled in the study,there were 165 (23.9%)patients who had major complications within 30 days after surgery.The most common postoperative complications were respiratory complications (40.6%).The inde-pendent risk factors of postoperative complications including age (OR 1.880,95%C I 1.448-2.440),ASA classification (OR 3.303,95%C I 2.303-4.736),intraoperative hypotension duration more than 20 minutes (OR 2.501,95%C I 1.387-4.510),intraoperative rapid arrhythmia (OR 2.173,95% C I 1.002-4.711) and surgical level (OR 1.814,95% C I 1.060-3.103).Conclusion Emergency general surgery in patients with intraoperative hypotension duration more than 20 minutes and the occurrence of rapid arrhythmia are independent risk factors for postoperative complications.During the circulation man-agement of emergency surgical patients,the reduction of systolic blood pressure in the operation should be controlled within 20% of the base value to reduce the risk of postoperative complications.
ABSTRACT
Objective To compare the impact of patient controlled epidural analgesia with patient controlled intravenous analgesia on postoperative recovery and complications in patients undergoing laparotomy pancreatic surgeries.Methods Forty patients undergoing pancreatic surgeries, 27 males and 13 females, aged 18-70 years, ASA physical status Ⅰ or Ⅱ, were randomly divided into two groups (n=20 each).Patients in group E received T8-9 or T9-10 epidural block, 2% lidocaine test dose was given to ensure the location of epidural catheter, after that, each patient in group E was given 0.375% ropivacaine 5 ml into epidural space before skin incising and incision closures.Meanwhile, patients in groups E and V received propofol-sevoflurane combined intravenous inhalation anesthesia.After surgery, patients in group E received patient controlled epidural analgesia while patients in group V received patient controlled vein analgesia.Length of hospital stay, time to ambulation and exhaust defecation were recorded.Other complications were compared.Results Compared to group V, patients in group E showed earlier ambulation [(50.4±4.2) h vs (64.2±5.0) h, P<0.01], shorter hospital stays [(18.5±8.5) d vs (21.5±6.8) d, P<0.05].There was no statistically significant difference in flatus time between the two groups [(39.7±4.1) h vs (39.5±8.4) h].There was no significant difference in complications between the two groups.Conclusion The present study shows that for patients undergoing pancreatic surgeries, patient controlled epidural analgesia could effectively release post-operative pain, shorten the ambulation time and length of hospital stay with no extra complications.