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Objective:To evaluate the relationship between preoperative malnutrition and postoperative pulmonary complications (PPCs) in elderly patients undergoing thoracoscopic and laparoscopic radical esophagectomy.Methods:The elderly patients who underwent elective thoracoscopic and laparoscopic radical esophagectomy in the Affiliated Hospital of Jiangnan University were enrolled.The general clinical data and nutritional status, Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score, tumor pathological stage and operation-related variables based on the Gobal Leader Initiative on Malnutrition criteria were recorded.The patients were divided into 2 groups according to whether PPCs occurred during hospitalization, and the differences between the variables were compared.Logistic regression analysis was used to identify the risk factors for PPCs in elderly patients undergoing thoracoscopic and laparoscopic radical esophagectomy.The accuracy of the ARISCAT score and ARISCAT score combined with malnutrition in predicting the occurrence of PPCs was evaluated by receiver operating characteristic curve.Results:A total of 256 elderly patients undergoing thoracoscopic and laparoscopic radical esophagectomy were included, and the incidence of PPCs was 23.8%.There were no significant differences between patients with and without PPCs in FEV 1/FVC, age, American Society of Anesthesiologists physical status, chronic obstructive pulmonary disease ratio, malnutrition ratio and ratio of patients with high ARISCAT score ( P<0.05). The results of logistic regression analysis showed that increasing age, chronic obstructive pulmonary disease, malnutrition and high ARISCAT score were independent risk factors for PPCs.The area under the receiver operating characteristic curve of ARISCAT score and malnutrition combined with ARISCAT score in predicting the occurrence of PPCs was 0.722 and 0.777, respectively, and the difference was statistically significant ( P<0.05). Conclusions:Preoperative malnutrition is an independent risk factor for the occurrence of PPCs in elderly patients undergoing thoracoscopic and laparoscopic radical esophagectomy, which is helpful in improving the accuracy of ARISCAT score in predicting the occurrence of PPCs.
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Objective:To evaluate the relationship between preoperative frailty and postoperative pulmonary complications (PPCs) in elderly patients undergoing thoracoscopic lobectomy.Methods:The elderly patients with non-small cell lung cancer who underwent thoracoscopic lobectomy in the Affiliated Hospital of Jiangnan University were collected.The general data, frailty status, parameters of blood and operation-related parameters were recorded.The patients were divided into PPC group and non-PPC group according to whether PPCs occurred during hospitalization, and the differences between the parameters were compared.Logistic regression analysis was used to analyze the independent risk factors for PPCs.Stratification analysis and interaction test were used to further analyze the relationship between frailty and PPCs.Results:A total of 298 elderly patients with non-small cell lung cancer undergoing thoracoscopic lobectomy were included in this study, and the incidence of PPCs was 22.8%.Compared with non-PPC group, the albumin and FEV 1/FVC were decreased, and age, blood creatinine, ratio of diabetes mellitus, ratio of chronic obstructive pulmonary disease (COPD) and rate of preoperative frailty were significantly increased in PPC group ( P<0.05). The results of logistic regression analysis showed that COPD and preoperative frailty were independent risk factors for PPCs.After adjusting all the risk variables, the frail patients had a 171% increased risk of PPCs compared with non-frail patients ( OR value=2.71, 95%CI: 1.18-4.73, P<0.05). The results of subgroup analysis showed that body mass index and operation time had effect modification on the association between frailty and PPCs (interaction P<0.05). Conclusion:COPD and preoperative frailty are independent risk factors for PPCs in elderly patients undergoing thoracoscopic lobectomy, and the frail patients with obesity or long operation time are at higher risk of PPCs.
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Objective:To determine whether dexmedetomidine (Dex) improves oxygenation and lung mechanics in patients with moderate chronic obstructive pulmonary disease (COPD) during lung cancer surgery.Methods:Fifty-six patients with moderate COPD were randomly allocated to a control group and a Dex group (n=28 each).In the Dex group,dexmedetomidine was given as an initial loading dose at 1.0 μg/kg lasting for 10 min followed by a maintenance dose at 0.5 μg/(kg-h) during OLV while the control group was administered an equal volume of 0.9％ saline accordingly.Results:Patients in the Dex group had a significantly higher oxygenation index (P＜0.05) and higher dynamic lung compliance at Dex-30 and Dex-60 (P＜0.05) compared with those in the control group.In the Dex group,oxygenation index in the postoperative period was significantly higher (P=0.025) and postoperative complications were lower than those in the control group.Conclusion:Dex administration may provide dinically relevant benefits by improving oxygenation index and lung mechanics,and reducing postoperative pulmonary complications in patients with moderate COPD underwent lung cancer surgery.
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Objective To investigate the effect of dexmedetomidine versus sevoflurane to perioperative myocardial ischemia in coronary heart disease patients undergoing noncardiac surgery.Methods A total of 135 patients (90 males,45 females,aged 45-82 years,ASA grade Ⅱ or Ⅲ) with coronary heart disease,undergoing endoscopic thoracic and abdominal surgery,were divided into control group (group C),dexmedetomidine group (group D) and sevoflurane group (group S) by random number table.Anesthesia induction and maintenance were adopted by etomidate 0.2 mg/kg,propofol 0.5 mg/kg,atracuronium sulfonate 0.2-0.3 mg/kg and fentanyl 5.0-6.0 μg/kg.Dexmedetomidine was given the continuous injection from 10 min before the start of the operation to the end in group D.Equal volume of saline was given in group C.Sevoflurane was inhaled from the induction of anesthesia 30 min before the end of surgery.ST segment changes of electrocardiogram were recorded for diagnosis of myocardial ischemia during the operation and postoperative 72 hours.Results The incidence of myocardial ischemia in group C,group D and group S were 26.7% (12 cases),6.7% (3 cases),8.9% (4 cases) during the operation and 13.3% (6 cases),8.9% (4 cases) and 8.9% (4 cases) postoperative 72 hours.Conclusion Dexmedetomidine and sevoflurane can improve the balance of blood oxygen supply and demand to reduce cardiovascular complications of non-cardiac surgery in patients with coronary heart disease.
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Objective To study the protective effects of sevoflurane at different anesthesia depths on periperative myocardial ischemia in coronary heart disease patients undergoing noncardiac surgery.Methods 96 patients with coronary undergoing noncardiac surgery were randomly divided into three groups:control group (Group C),high-concentration sevoflurane group (Group S 1) and low-concentration sevoflurane group (Group S2).Etomidate,Propofol,Cisatracurium Besilate and Fentanyl were used for intravenous anesthetic induction and maintenance of anesthesia.In addition,B ispectralindex (BIS) remained between 35 ～ 45 and 45 ～ 55 in groups S1 and S2,re spectively.BIS remained between 40 ～ 50 in group C.Perioperative hemodynamic changes,ECG ST-segment before induction of anesthesia,endotracheal immediate intubation and extubation were recorded.Plasma concentrations of cTnT,high sensitive cardiac troponin (hs-cTnT) and high sensitive ereaetive protein (hs-CRP) were detected with central venous blood before anesthesia induction and immediate extubation.Results Compared with group C,the incidences of hypertension,tachycardia,myocardial ischemia,proiosystole and atrial fibrillation were significantly reduced in groups S1 and S2 (P ＜ 0.05);The incidences of bradycardia and hypotension groups were significantly higher in group S1 (P ＜ 0.05).Compared with group S1,the incidences of hypotension,bradycardia,myocardial ischemia were significantly reduced in group S2 (P ＜ 0.05).Compared with group C,plasma concentrations of cTnT,hs-cTnT and hs-CRP were significantly reduced after endotracheal extubation in group S1 and S2 (P ＜ 0.05).Conclusion Myocardial protective effect is better and less risky for patients with coronary artery disease undergoing noncardiac surgery by inhalation of 1.0％ to 2.5％ sevoflurane to maintain BIS between 45 to 55.