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Objective To investigate the clinical effect of perioperative electroacupuncture intervention on postoperative delirium (POD) in hip replacement surgery patients.Method One hundred and twenty-eight patients who would undergo hip replacement surgery were randomly allocated to treatment and control groups, 64 cases each. The treatment group received perioperative electroacupuncture and the control group, routine preoperative preparation and postoperative treatment. Serum S100β protein concentration was measured in the two groups of patients at one day before, the end of and one day after surgery. The incidences of POD were compared between the two groups at one, two and three days after surgery.Result There was a statistically significant difference in the incidence of POD between at one day after surgery and recovery from anesthesia in the two groups (P<0.01). In the treatment group, the incidence of POD was significantly lower at two and three days than at one day after surgery (bothP<0.05) and at three days than at two days after surgery (bothP<0.05). There was a statistically significant difference in the incidence of POD between the treatment and control groups at different time points (recovery from anesthesia, and one, two and three days after surgery) (P<0.01). In the treatment group, there was a statistically significant difference in S100β protein concentration between at one day after and the end of surgery (P<0.05). There was a statistically significant difference in S100β protein concentration between the treatment and control groups at the end of and one day after surgery (P<0.05).Conclusions Perioperative electroacupuncture treatment can effectively decrease postoperative incidence of delirium and its duration in hip replacement surgery patients.
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Objective To investigate the effect of rivaroxaban on prevention from deep venous thrombosis after hip replacement surgery .Methods 80 patients with lower limb parallel arthroplasty were randomly divided into observation group and control group from January 2014 to January 2015.40 cases in each group.Control group was given aspirin treatment, observation group was given rivaroxaban treatment, indicators changes were followed up and recorded.Results PT, APTT values of observation group one week after treatment were (35.79 ±2.16),(15.84 ±2.11) s, which were better than control group (45.64 ±2.12),(18.72 ±2.02) s (P<0.05).TT, D-dimer of observation group(13.48 ±2.10)s,(2.34 ±0.33)g/L after a week were better,than control group (16.38 ±1.79)s, (1.42 ±0.21)g/L (P<0.05) respectively.Conclusion Effect of rivaroxaban in prevent deep venous thrombosis after hip replacement surgery is exact without obvious adverses reaction, it is worthy of further research and application.
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Objective To investigate the effect of dezocine combined with sufentanil on postop-erative analgesia and side effects in the upper-abdominal surgery and hip replacement surgery,and ex-plore the potential mechanisms.Methods One hundred patients scheduled for selective upper-abdomi-nal operation and hip replacement surgery were randomly divided into group dezocine (group D), dezocine 0.3 mg/kg combined with sufentanil 1 μg/kg group(group DS1),dezocine 0.3 mg/kg com-bined with sufentanil 1.5 μg/kg group(group DS2)and dezocine 0.3 mg/kg combined with sufentanil 2 μg/kg group(group DS3).Analgesia was maintained by remifentanil 6-8 μg·kg-1·h-1 under total intravenous anesthesia.Patients were administered 5 μg sufentanil during sewing the skin.Visual Analogue Score (VAS)of both silence and 90°turn over situation,Ramsay score,and adverse effects at 1 h (T1 ),4 h (T2 ),8 h (T3 ),12 h (T4 ),24 h (T5 ),36 h (T6 ),48 h (T7 )after the operation were recorded respectively.Results The total amount of sufentanil and dezocine of group DS1 group showed a significant higher than the other three groups (P <0.05).The VAS in silence of group DS1 were higher than group DS3 at T1-T3 (P <0.05).There was no significant difference in VAS under 90°turn over situation.The side effect of group DS3 were higher than the other three groups (P <0.05).Conclusion Dezocine combined with sufentanil for postoperative patient-controlled intravenous analgesia(PCIA)is effective and safe in patients undergoing upper-abdominal surgery and hip replace-ment surgery,and while dezocine 0.3 mg/kg combined with sufentanil 1.5 μg/kg,it has the best effect of postoperative analgesia and least side effects.
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Objective To investigate the relationship between postoperative cognitive dysfunc-tion and plasma cortisol levels in aged patients undergoing total hip replacement surgery. Methods Ninety patients aged 65-75 years old,scheduled for total hip replacement surgery under general anesthesia were enrolled in the present study.Cognitive state was tested by mini-mental state examination (MMSE).The patients were divided into two groups,POCD group and non-POCD group.Perioperative plasma levels of cortisol were determined on 2 d preoperative,2 d postoperative and 7 d postoperative.Results Incidence of POCD after 7 d in aged patients undergoing total hip re-placement surgery was 37.8%.Compared with day 2 d preoperative,plasma cortisol levels in POCD patients significantly increased on 2 d and 7 d post operation (P <0.01 or P <0.05).Compared with non-POCD patients,cortisol levels on the 2 d and 7 d postoperative day significantly increased in POCD patients (P <0.05).Plasma cortisol levels showed a negative correlation with MMSE scores on postoperative 2 d and 7 d(P <0.01).Conclusion Elderly patients have a relatively higher incidence of POCD after hip replacement surgery.POCD may be caused by high plasma cortisol levels in elderly patients following hip replacement surgery under general anesthesia.
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Objective To observe the effect and adverse reaction of sufentanil combined with lornoxicam in venous controlled analgesia after hip arthroplasty. Methods Fifty patients with general anesthesia orthopaedic hip arthroplasty were randomly divided into sufentanil group (group S) and finnan fluoride group ( F) , group S sufentanil 2μg/kg,lornoxicam 40mg, physiological saline diluted to 100ml canister, Group F fentanyl 20μg/kg, lomoxicam 40mg, physiological saline diluted to 100ml canister. After operation connected intravenous infusion pump analgesia. Results Group S postoperative analgesia was obviously better than the group F,48h abnormal sweating and nausea and vomiting incidence was less than the group F( all P ＜ 0.05). Conclusion The effect of sufentanil combined lornoxicam for hip arthroplasty after intravenous analgesia was better than that of fentanyl combined lornoxicam group and had fewer side effects.
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PURPOSE: The purpose of this study was to validate the value of Duplex Color Doppler Ultrasonography (DDU) in post-operative deepvein thrombosis (DVT) after hip replacement surgery. MATERIALS AND METHODS: From September 1998 to June 2000, 138 cases (130 patients) were eligible for a minimal one-year follow-up.DDU was carried out between the 7th and 10th postoperative in all cases, patients wore a compressive stocking on the lower extremity. RESULTS: DVT occurred in five cases (4%), four cases occurred at 10th postoperative day and one case was occurred after one month. DVT occurred in the femoral vein in all cases. Three cases had clinical symptoms such as pain and localized edema. However, no case complained of systemic pulmonary symptoms. CONCLUSION: The incidence of DVT obtained from DDU after replacement hip surgery was very low (4%) with early mobilization and acompressive stocking. No case of DVT progressed to symptomatic pulmonary embolism. DDU was valuable for detecting DVT in the proximal thigh as a screening test.
Subject(s)
Humans , Early Ambulation , Edema , Femoral Vein , Hip , Incidence , Lower Extremity , Mass Screening , Pulmonary Embolism , Thigh , Thrombosis , Ultrasonography, Doppler, Color , Ultrasonography, Doppler, Duplex , Venous ThrombosisABSTRACT
BACKGROUND: The high incidence of deep vein thrombosis (DVT) of lower extremities and a subsequent pulmonary embolism (PE) makes it the most common cause of death following total hip replacement surgery. Therefore, the authors measured the perioperative changes in the blood coagulation activity with a thromboelastography (TEG) in the patients treated with fluid and packed red cells (PRC). METHODS: Hemodilution was estimated with a measurement of hemoglobin (Hb), hematocrit (Hct), and platelet count. The changes in the coagulation factor activities were measured with TEG. Samples were obtained before skin incision (step 1); at the period that Hb and Hct ranged from about 10 g/dl to 30% (step 2); in the postanesthetic care unit (step 3); and on the postoperative first and third day (step 4, 5). RESULTS: Although Hct and Hb decreased to 9.4% statistically at step 2 only, platelet counts were significantly decreased in step 2 (10.6%), 3 (34.5%), 4 (32.5%), and 5 (33.6%) compared with step 1 (P < 0.05). At step 2, there were no significant changes in TEG parameters except r time, which decreased (21.5%) (P < 0.05). At step 3, r time, alpha angle, and maximum amplitude (MA) decreased, and k time and lysis 60 increased (P < 0.05). CONCLUSIONS: In spite of consumption and dilution of coagulation factors after massive fluids and PRC therapy during total hip replacement surgery, the increased activities of procoagulants and decreased fibrinolytic activities predisposed the body to initiate and maintain the thrombus.