ABSTRACT
Objective To evaluate the concordance on cardiac index (CI) measured with arterial pressure based cardiac output (APCO) and pulmonary artery catheter (PAC) during cesarean section in parturients with congenital heart disease combined with severe pulmonary hypertension.Methods Forty-five congenital heart disease combined with severe pulmonary hypertension parturient who scheduled for cesarean section were selected,APCO and PAC were used for cardiac output and other parameters of hemodynamics monitoring during operation in all patients.Continuous epidural anesthesia was performed.CI was recorded immediately before epidural administration (T1),at 5 and 10 min after epidural administration (T2,T3),immediately before delivery (T4),and at 2 and 5 min after delivery (T5,T6).The correlation of CI between APCO and PAC (A-CI and P-CI,respectively) was tested by Pearson correlation analysis and agreement test.Results The P-CI was significantly higher than A-CI,there was statistical difference (P ＜ 0.05).Compared with T1,no significant differences between A-CI and P-CI were found at T2-T4 and T6 (P ＞ 0.05),The A-CI at T5 [(4.5 ± 1.1) L/(min·m2) vs.(4.2 ± 0.8) L/(min ·m2)] and P-CI [(6.2 ± 1.5) L/(min·m2) vs.(5.4 ± 1.2) L/ (min· m2)] were significantly higher,there were statistical differences (P ＜ 0.05).The correlation analysis showed that there was positive correlation between A-CI and P-CI at T1-6 (r =0.931,0.955,0.945,0.892,0.960,0.913 ; P ＜ 0.05).Bland-Altman analysis showed poor agreement between CI measured with the two methods.Conclusion CI value obtained with APCO agrees poorly with that obtained with PAC during cesarean section in parents with congenital heart disease combined with severe pulmonary hypertension,but agrees well in monitoring the changing trend of CI.
ABSTRACT
Objective To study of improved laryngeal mask airway of painless fiber endoscopy in elderly patients with painless bronchoscopy.Methods To choose 108 cases of elderly patients who were treated with painless fiber endoscopy in our hospital from January 2012 to May 2013 as the research objects, and were randomly divided into the local anesthesia group and the improved laryngeal mask group, each group was 54 cases.Observed and compared the laryngeal mask insertion, patients′basic situation and adverse reactions of patients in two groups .Results The blood pressure and heart rate in surgery and postoperative of patients in the local anesthesia group were significantly higher, and the intraoperative blood oxygen satu-ration was significantly lower, but the blood pressure and heart rate in surgery and postoperative of patients in the improved la-ryngeal mask group were significantly lower than that of preoperative, and it showed no significant change in the aspect of blood oxygen saturation.The indicators of patients in two groups in surgery and after surgery, had significant difference (p<0.05), none of the patients in the improved laryngeal mask group had adverse reactions, and its incidence was significantly reduced comparing with the local anesthesia group, and the patient satisfaction scores of the improved laryngeal mask group were obviously better than that of the local anesthesia group (p<0.05), the difference was statistically significant.And the completion time of inserting improved laryngeal mask was 3 min or less, a one-time placement success rate was 98.15%. Conclusion The improved laryngeal mask airway of painless fiber endoscopy can effective stabilize the blood pressure , heart rate and blood oxygen saturation of elderly patients, at the same time also can avoid choking cough, laryngospasm and pulling hypoxemia and other adverse reactions after laryngeal mask, shorten the operation time of laryngeal mask insertion and in-crease the one-time success rate, so it is worthy of clinical use.
ABSTRACT
Objective To research the effect of perioperative thermal preservation on hemostatic function in elderly patients with laparoscopic rectal cancer resection.Methods Eighty-six elderly patients with laparoscopic rectal cancer resection with ASA Ⅰ-Ⅱ were randomly divided into control group (43 patients) and test group(43 patients).Control group was given routine operation,test group was given routine operation and thermal preservation.The nose pharynx temperature was monitored and recorded respectively on preanesthesia,30,60,90 min post-anesthesia and after operation.The level of prothrombin time (PT),activated partial thromboplastin time (APTT),thrombin time (TT),platelets (PLT),D-dimer(DD),fibrinogen (FBG),yon Willebrand factor (vWF) were detected on preanesthesia,30,60,90 min post-anesthesia and 24,48 h post-operation.Results The temperature in control group on 30,60,90 min pest-anesthesia and after operation [(36.1 ± 0.2),(36.0 + 0.1),(35.7 + 0.1),(35.6 ± 0.2) ℃] was significantly lower than that on preanesthesia [(36.8 ± 0.2) ℃] and the same time in test group [(36.8 ± 0.0),(36.7 ± 0.1),(36.7 +0.2),(36.8 ±0.2) ℃] (P ＜0.05).The level of PT,APTT and TT in control group on 30,60,90 min post-anesthesia and after operation were significantly longer than those on preanesthesia and the same time in test group (P ＜0.05).The level of PLT in control group after operation and on 24,48 h post-operation were significantly lower than preanesthesia and the same time in test group(P ＜ 0.05).The level of DD and vWF in control group on 24,48 h post-operation were significantly higher than preanesthesia and the same time in test group (P ＜ 0.05).The level of FBG in control group on 24,48 h post-operation were significantly lower than preanesthesia and the same time in test group (P ＜ 0.05).The hemostatic function had no significant change in test group (P ＞0.05).Conclusion The perioperative thermal preservation in elderly patients with laparoscopic rectal cancer resection can alleviate hemostatic function suppression and promote recovery.