ABSTRACT
Objective To investigate the risk factors that cause arterial blood lactate (Lac) elevation in patients after gastrointestinal operation.Methods The data of 216 patients who had undergone gastrointestinal operation, and transferred to intensive care unit (ICU) of Ningxia Medical University General Hospital from November 2013 to November 2014 were retrospectively analyzed.According to the initial level of blood Lac after operation,the patients were divided into two groups: high Lac group (Lac ＞ 2 mmol/L, n =100) and normal Lac group (Lac ≤ 2 mmol/L, n =116).The baseline data of two groups were recorded as follows: ① baseline data: gender, age, preoperative acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, previous diseases, initial Lac level after operation;② preoperative risk factors: 24-hour total amount of fluid, and the amount of colloid for resuscitation;③ intraoperative risk factors: the proportion of emergency operation, operation time, site of operation, usage of antibacterial drug, the highest and lowest mean arterial pressure and its difference (MAPmax, MAPmin, A MAP),total amount of fluid and colloid for resuscitation.The risk factors of increasing Lac post gastrointestinal operation was evaluated using multiple linear regression analysis.Results ① There were no significant differences in baseline data such as gender, age, preoperative APACHE Ⅱ score and previous diseases between the two groups (all P ＞ 0.05).Initial Lac level in high Lac group was significantly higher than that of normal Lac group (mmol/L: 5.1 ± 3.6 vs.1.3 ±0.4,t =10.584,/P =0.000).② There were no significant differences in 24-hour amount of fluid and colloid for resuscitation before operation, and intraoperative MAPmax between two groups.Compared with normal Lac group, intraoperative A MAP [mmHg (1 mmHg =0.133 kPa): 35.8 ± 14.4 vs.28.7 ± 13.7, t =3.727, P =0.000], the proportion of emergency operations (19.0％ vs.9.5％, x 2 =9.869, P =0.007), intraoperative transfusion volume [mL: 4 500 (3 500, 5 800) vs.3 700 (2 812, 5 075), Z =-3.244, P =0.001], intraoperative colloid volume [mL: 1 000 (1 000, 1 900) vs.1 000 (1 000, 1 787), Z =-2.347, P =0.019], and operation time (minutes: 222.0±91.5 vs.187.0±75.9, t =3.026,P =0.003) in high Lac group were significantly increased, and the levels of intraoperative MAPmin (mmHg: 68.7 ± 11.6 vs.75.9± 10.6, t =-4.716, P =0.000) and intraoperative antibiotics usage (62.0％ vs.86.2％, x 2 =18.318, P =0.000)were significantly decreased.③The patients undergoing operation of esophagus, stomach, duodenal and intestine,and colon accounted for 6.9％, 22.7％, 16.7％, and 53.7％, respectively, their Lac was 2.8 (1.6, 5.4), 2.3 (1.2, 5.8),2.5 (1.5, 5.2), 1.7 (1.1, 2.9) mmol/L, respectively, indicating that surgical site had an influence on the occurrence of postoperative hyperlactacidemia (x 2 =11.032, P =0.012).④ It was showed by multiple linear regression analysis that the operation site (t =-2.725, P =0.007), MAPmin (t =-4.533, P =0.000), non-antibiotics usage during operation (t =2.441, P =0.016) were the risk factors of Lac increase in patients after gastrointestinal operation.⑤ The incidence of postoperative incipient procalcitonin (PCT) increase (PCT ＞ 0.5 μg/L) in patients and usage of antibiotics was significantly lower than that in patients who did not receive antibiotics during operation [17.89％ (17/95) vs.67.74％ (21/31), x 2 =27.572, P =0.000].Conclusions The surgical site showed an influence on the occurrence of hyperlactacidemia in patients after gastrointestinal operation, and the lowest occurrence rate was found in the colonic operation.In patients suffering from gastrointestinal operation, antibiotics should be routinely used to improve MAP.Excessive preoperative and intraoperative fluid infusion cannot reduce the occurrence of hyperlactacidemia.
ABSTRACT
Objective To explore the best plan of perioperative individualized fluid therapy in the elderly patients with coronary heart disease undergoing gastrointestinal surgery.Methods Eighty elderly patients with coronary heart disease undergoing gastrointestinal surgery were divided into experimental group and control group by random digits table method with 40 cases each.Conventional capcity treatment was given during surgery and postoperative period in control group.Individualized fluid therapy was used during surgery and postoperative period in intensive care unit of 24 h in experimental group,which was determined based on target controlled fluid therapy according to the cardiac index,stroke volume,and stroke volume variation.Traditional fluid therapy was used in control group in the intraoperative and postoperative period.The two groups were compared in terms of postoperative hemodynamic parameters,total fluid volume,incidence of adverse cardiac events,and recovery of gastrointestinal function.Results The mean arterial pressure at the beginning of the operation,the cardiac index at operation begining 1 h and at the end of operation were (80.4 ± 6.4) mmHg (1 mmHg =0.133 kPa),(4.0 ± 0.6) L/(min ·m2),(4.1 ± 0.8) L/(min ·m2) in experimental group and (76.9 ± 8.0) mmHg,(3.5 ± 0.4) L/(min· m2),(3.6 ± 0.3) L/(min · mè) in control group,and there were significant differences between two groups (P ＜ 0.05).During surgery and 24±hour stay in intensive care unit,the total fluid volume,crystal usage,urine and colloid usage were (2 915 ± 650),(2 715 ± 415),(1 515 ± 315),(1 225 ± 385),(419 ± 233),(619 ± 285),(1 015 ± 220),(1 535 ± 455) ml in experimental group and (3 645 ±770),(3 355 ±750),(2 315 ±320),(1 855 ±325),(602 ±31),(875 ±423),(805 ±250),(1 135 ± 205) ml in control group,and there were significant differences between two groups (P ＜ 0.05).The perioperative adverse cardiac events rate was 30％ (12/40) in experimental group,lower than 45％ (18/40) in control group,but the difference was no statistically significance (P ＞ 0.05).Conclusion In the elderly patients with coronary artery disease undergoing gastrointestinal surgery,individualized fluid therapy can effectively decrease adverse cardiac events,improve postoperative gastrointestinal function,and reduce length of hospital stay.
ABSTRACT
Objective To study the influence of carbon dioxide (CO2)gas temperature on recovery of patients after laparoscopic gastrointestinal operation.Methods 100 cases with gastrointestinal operation patients were selected and randomly divided into the experimental group and the control group with 50 patients in each.In the experimental group,pneumoperitoneum was established with CO2 gas heated to 37 ℃,and the control group used routine method to establish pneumoperitoneum.The items such as postoperative tracheal extubation time,anal exhaust time and extubation time were observed in two groups of patients.Results The endotracheal tube extubation time,anal exhaust time and extubation time in the experimental group were earlier than those in the control group.Conclusions Using CO2 gas heated to 37 ℃ to establish pneumoperitoneum during laparoscopic gastrointestinal operation can effectively promote the rehabilitation of patients after operation.
ABSTRACT
Objecltive To intensify the coordination and nursing in the operation room in order to prevent surgical site infection after gastrointestinal operation. Methods 337 medical history of patients received gastrointestinal operation and third rate healing from 1999 to 2006 were collected. A series of intensified measures were applied to surgical site infection from 2003 gradually, including invocation of new surgical handwashing method, modified skin disinfection manner, adoption of degreasing with ethanol first before disinfection with iodophor, placement of incision protector and clean bag for incision protection after entering abdomen, changing to use new gastrointestinal anastomofic thimerosal,standardization of operation order and clean manage-ment in operation room. The incidence rate of surgical site infection after gastrointestinal operation of patients from 1999 to 2002 and from 2003 to 2006 underwent χ2 test. Results The incidence rate of surgical site in-fection after gastrointestinal operation greatly decreased after adoption of intensified nursing intervention, Signifi-cant difference existed in rate of patients with third rate healing between the year 1999 to 2002 and 2003 to 2006. Conclusions Modified nursing intervention for surgical incision after gastrointestinal operation can de-crease incision infection rate evidently.
ABSTRACT
PURPOSE: The risk factors of pseudomembranous colitis (PMC) are well known. However, there have been no studies of PMC after gastrointestinal operation. The aim of this study was to evaluate the risk factors and to establish the guiding principles for PMC after gastrointestinal operation. METHODS: We performed a retrospective study of 39 PMC patients after gastrointestinal operation from January 2004 to December 2008. A control group of one hundred and seventeen matched to a PMC group by date of operation was chosen in a random fashion. Preoperative, operative, and postoperative factors of PMC were evaluated. RESULTS: The incidence of PMC after gastrointestinal operation was 0.63%. On univariate analysis, among preoperative factors, albumin, PT-INR and neutropenia were significant risk factors for PMC. There was no difference in the operative factors. Among postoperative factors, duration of cephalosporin, aminoglycoside, H2 blocker administration were significant risk factors for PMC after gastrointestinal operation. And transfusion, duration of NPO, length of stay in intensive care unit (ICU) and postoperative intraabddominal abscess, pneumonia were also significant risk factors. On multivariate analysis, the independent risk factors for PMC after gastrointestinal operation were duration of aminoglycoside administration, transfusion volume and length of stay in ICU. When period of study was divided by three months, incidence of PMC at a specific period was high. After limiting of prophylactic antibiotics, incidence of PMC fell to 0.36%. CONCLUSION: To prevent PMC after gastrointestinal operation, we need sustained efforts to establish stricter guidelines about prophylactic antibiotics and transfusion, and to minimize length of stay in ICU.
Subject(s)
Humans , Abscess , Anti-Bacterial Agents , Enterocolitis, Pseudomembranous , Incidence , Intensive Care Units , Length of Stay , Multivariate Analysis , Neutropenia , Pneumonia , Retrospective Studies , Risk FactorsABSTRACT
OBJECTIVE:To investigate the safety and efficacy of alanyl-glutamine dipeptide administered via peripheral vein total parenteral nutrition(TPN)in patients after gastrointestinal operation.METHODS:64cases after gastrointestinal operations were randomly divided into routine TPN group(control group)and TPN plus alanyl-glutamine dipeptide group(therapeautic group),all of which were treated with the corresponding medicines from the first day to the7th day after oper?ation.RESULTS:The levels of both seralbumin and prealbumin rebounded on the8th day after operation with those of the control group rebound more slowly,significant differences were noted between the2groups(P
ABSTRACT
The surgical nutrition puts emphasis on the regulation of postoperative patients recently.The artical reviewed the effects of recombinant human growth hormone on metabolism, defence and wound healing of postoperative patients.
ABSTRACT
Objectives: To study the effect of early enteral nutrition using Fresubin after gastrointestinal operation. Methods:78 postoprative patients were divided into two groups. The jejunostic tube group(A group, n=50) received the enteral nutrition(Fresubin) 6h after operation, and the control group(B group, n=28)received the intravenous infusion and then the oral liquid diet after the bowel movement recovery.The clinical findings,operative complications,blood glucose,the function of liver and kidney,electrolytes and nutritional status were observed. Results:The recovery of bowel movement in group A was much earlier than that in group B(P