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The risk of developing perioperative acute kidney injury (AKI) in elderly patients increases with age. The combined involvement of aging kidneys, coexisting multiple underlying chronic diseases, and increased exposure to potential renal stressors and nephrotoxic drugs or invasive procedures constitute susceptibility factors for AKI in elderly patients. The perioperative AKI in elderly patients undergoing noncardiac surgery has its own specific population characteristics, so it is necessary to further explore the characteristics of AKI in elderly patients in terms of epidemiology, clinical diagnosis, risk factors, and preventive and curative measures to provide meaningful clinical advice to improve prognosis, accelerate recovery, and reduce medical burden in elderly patients. Since AKI has the fastest-growing incidence in older patients and is associated with a worse prognosis, early detection, early diagnosis, and prevention of AKI are important for elderly patients in the perioperative period. Large, multicenter, randomized controlled clinical studies in elderly non-cardiac surgery patients with AKI can be conducted in the future, with the aim of providing the evidence to reduce of the incidence of AKI and to improve the prognosis of patients.
Subject(s)
Humans , Aged , Acute Kidney Injury/prevention & control , Kidney , Risk Factors , Prognosis , Incidence , Postoperative Complications/prevention & controlABSTRACT
Objective To investigate the perioperative complications of stenting with symptomatic intracra-nial artery stenosis and study the mechanism and prevention of complications. Methods 63 patients were collect-ed from Stroke Center of Guangxi. They were proved intracranial artery stenosis and performed intracranial stents. Patients′ age,with hypertension,diabetes and hyperlipidemia or not,smoking or not,types and occurrence time of complications were registered. Results 63 patients were registered and 2 patients terminated operation due to blood vessels circuity or serious vessel spasm. Operation success rate reached 96.83％. 5 patients had complications among 63 cases,with complication incidence of 8.20％. 3 patients experienced cerebral hemorrhage and two cere-bral infarction in peri-operation period. 2 patients died of complications and mortality rate was 3.28％. Conclu-sions The incidence rate of complications of intracranial stenting with symptomatic intracranial artery stenosis is relatively high and it can be reduced by preoperative sufficient assessment and prudent selection ,careful operation and strict management after operation.
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Objective To investigate the perioperative complications of stenting with symptomatic intracra-nial artery stenosis and study the mechanism and prevention of complications. Methods 63 patients were collect-ed from Stroke Center of Guangxi. They were proved intracranial artery stenosis and performed intracranial stents. Patients′ age,with hypertension,diabetes and hyperlipidemia or not,smoking or not,types and occurrence time of complications were registered. Results 63 patients were registered and 2 patients terminated operation due to blood vessels circuity or serious vessel spasm. Operation success rate reached 96.83％. 5 patients had complications among 63 cases,with complication incidence of 8.20％. 3 patients experienced cerebral hemorrhage and two cere-bral infarction in peri-operation period. 2 patients died of complications and mortality rate was 3.28％. Conclu-sions The incidence rate of complications of intracranial stenting with symptomatic intracranial artery stenosis is relatively high and it can be reduced by preoperative sufficient assessment and prudent selection ,careful operation and strict management after operation.
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Objective To observe the effect of pre-intervention with electroacupuncture at Neiguan (PC 6) plusα2-adrenoceptor (α2AR) agonist on peri-operative heart rate variability (HRV).Method A total of 120 patients going to receive lower limb orthopedic surgery were randomized into four groups by using the random number table, namely a control group (group A), an electroacupuncture group (group C), anα2AR agonist group (group D) and an electroacupuncture plus medication group (group N), 30 cases in each group. The indicators of heart rate variability (HRV), including the standard deviation of normal-to-normal (N-N) intervals (SDNN), standard deviation of the average of N-N intervals (SDANN), root mean square successive differences (rMSSD), percentage of adjacent N-N intervals>50 ms apart (pNN50), low-frequency power (LF), high-frequency power (HF), LF/HF and total power (TP) were recorded 1 d prior and 1 d after the operation; meanwhile, the mean arterial pressure (MAP) and heart rate (HR) were recorded before incubation (T0), right after incubation (T1), 5 min after incubation (T2), right afterextubation (T3), 5 min after extubation (T4), 60 min after extubation (T5), and 180 after extubation (T6).Result In group N, the HR and MAP at the other time points were insignificantly different from those at T0 (P>0.05); in group A, the HR and MAP at T1-T6 were significantly different from those at T0 (P<0.05); in group C and D, the HR and MAP at T1-T4 were significantly different from those at T0 (P<0.05); the HR and MAP in group N were significantly lower than those in group A at T1-T6 (P<0.05) and were significantly lower than those in group C and D at T1-T4 (P<0.05); the HR and MAP in group C and D were significantly lower than those in group A at T5 and T6 (P<0.05). In group A, the LF, HF, LF/HF and TP 1 d after the operation were significantly increased compared to those 1 d prior to the operation (P<0.05); in group A and D, the SDNN, SDANN, rMSSD, and pNN501 d after the operation were significantly lower than those 1 d prior to the operation (P<0.05); the LF, HF, LF/HF, and TP in group C, D and N were significantly lower than those in group A 1 d after the operation (P<0.05); the SDNN, SDANN, rMSSD, and pNN50 in group C and N were significantly higher than those in group A and D 1 d after the operation (P<0.05). Conclusion Pre-intervention electroacupuncture plusα2AR agonist can improve the balance of cardiac sympathetic and vagus nerves, and better maintain the peri-operative hemodynamic stability.
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Objective To observe the effect of integrative Chinese and western medicine fast-track rehabilitation in surgery (FTS) for patients during peri-operation period of gynecological laparoscopy. Methods A total of 226 patients receiving gynecological laparoscopic surgery were randomized into observation group and control group, 113 cases in each group. The observation group received integrative Chinese and western FTS treatment, and the control group received routine non-surgery treatment. After operation, time for the first post-operation anal gas evacuation, time for out-of-bed activity, hospitalization time, and incidence of post-operation complications were compared between the two groups. Results In the observation group, time for the first post-operation anal gas evacuation and time for out-of-bed activity were earlier, and hospitalization time was shorter than those in the control group (P<0.05). The incidence of post-operation complications was 0.9%, lower than 4.4% in the control group ( P<0.05). Conclusion Integrative Chinese and western medicine fast-track rehabilitation in surgery shows certain effect on promoting enterokinesia, shortening time for the anal gas evacuation, reducing post-operation complica-tions, promoting post-operation recovery of gastrointestinal function of patients receiving gynecological la-paroscopy .
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Objective To investigate the clinical efficiency of Huayu Xiaozhong Decoction (HXD) on preventing peri-operative deep venous thrombosis (DVT) in lower limbs following artificial total hip replacement. Methods Ninety cases following artificial total hip replacement were randomized into blank control group, Rivaroxaban group and HXD group, 30 cases in each group, and were treated with brown sugar water, Rivaroxaban, HXD respectively. Before operation, and one, 3 and 14 days after operation, we monitored the changes of bleeding volume, DVT incidence, hemoglobin, prothrombin time ( PT) , activated partial thromboplastin time ( APTT) , international normalized ratio (INR), and D-dimer (DD) in the three groups. Results (1) Fifteen cases had DVT, with a total incidence rate of 16.67%. Of the 15 cases, 10 were from blank control group, 2 from Rivaroxaban group, and 3 from HXD group. ( 2) The amount of bleeding volume of Rivaroxaban group was larger than that of the blank control group and HXD group (P<0.05), but the bleeding was mild. (3) One, 3 and 14 days after operation, PT and APTT were shortened in blank control group (P<0.01 compared with those before operation). PT, APTT and INR were prolonged, and coagulation function was improved in Rivaroxaban group and HXD group, the differences being significant as compared with the blank control group ( P<0.05). HXD group had better effect on improving INR than Rivaroxaban group ( P<0.05). ( 4) In the three groups, hemoglobin level began to decrease on postoperative day one, arrived to the bottom on postoperative day 3 (P<0.05), and rose up near to the normal level on postoperative day 14; HXD group had higher hemoglobin level than blank control group and Rivaroxaban group on postoperative day 3 and 14 ( P<0.05). The 3 groups had higher plasma DD level than the normal level before the operation, arrived to the highest level on postoperative day one and 3 ( P<0.05) , and fell down near to the normal level on postoperative day 14. The inter-group comparison results showed that Rivaroxaban group and HXD group had lower DD level than the blank control group on postoperative day 3 and 14 ( P<0.05). Conclusion HXD is effective on preventing DVT in the peri-operation period through reducing bleeding, increasing hemoglobin level and improving postoperative anemia. The efficiency and safety of HXD are similar to Rivaroxaban.
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Objective To investigate the efficacy and safety of multimodal analgesia and patients controlled intravenous analgesia (PCIA) on peri-operative pain in open chest radical operation patients with esophageal carcinoma .Methods Eighty patients with e-sophageal carcinoma underwent open chest radical operation were randomly divided into 2 groups :multimodal analgesia group (group A ,n=40) and simple PCIA group(group B ,n=40) .Patients in group A were injected dexmedetomidine 1 μg/kg through vein by a micro-infusion pump within 10 min before incision ,and blocked the intercostal nerves at the cut and the chest tube places and the upper and lower intercostal nerves of the cut .Patients in group B were injected equal amount of saline as a control in the same way .Patients in both groups were undertaken sufentanil PCIA immediately at the end of the operation .Observation of the VAS score ,sedative and comfortable state ,patients controlled analygesia(PCA) pressing times ,using dosage and side effects of sufentanil on these patients at 2nd ,4th ,6th ,12th ,24th ,48th hour after operation were taked .Results Compared with group B , VAS score ,the dosage of sufentanil ,PCA pressing times ,nausea ,vomiting ,pruritus ,abdominal distension ,respiratory depression and side effects of sufentanil in group A significantly decreased ,and the comfortable score significantly increased .The differences have statistically significant(P0 .05) .Con-clusion Compared with PCIA ,the multimodal analgesia is more effective ,and has less adverse reaction after open chest radical op-eration in patients with esophageal carcinoma .
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Objective To investigate the early post-operative nutritional support for kidney transplant recipients.Methods Totally 67 patients who received early post-operative nutrition supports were randomly divided into three groups:group A (n = 24,relatively high nitrogen intake),group B (n = 25,intermediate nitrogen intake) and group C (n = 18,relatively low nitrogen intake).Two weeks after operation,albumin,hemoglobin,the nutrition indieators,serum lipids,and renal function 1 day before operation and 2 weeks after operation were evaluated. Results Body weight was significantly different among three groups;the nitrogen balance in group A was significantly better than those in groups B and C (P ＜0.05);albumin and hemoglobin were not significantly different between group A and group B (P ＞ 0.05),but were significantly higher than those in group C (P ＜ 0.05).The renal function in group C was significantly better than those in group A and group B (P ＜ 0.05).The triglyceride level was not significantly different among three groups,while the cholesterol level in group A was significantly higher than those in group B and group C (P ＜ 0.05),but not between group B and group C.Conclusion Proper nitrogen intake in early post-operative nutrition support can improve the recovery of renal function and nutritional status in kidney transplant recipients.
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OBJECTIVE To explore the method to prevent 203 patients after liver transplantation from infection.METHODS According to infective reason after liver transpantation,the strict management in every step was performed,including establishing standard of infection control,strengthening the staff management,and separating the different area.RESULTS Multi-organs dysfunction sydrome was found in 4 patients after liver transplantation because of fungal infection,and the total mortality of patients after transplantation was 1.97%.CONCLUSIONS Strengthening the nursing management can take a significant effect for patients after transplantation to control infection and decrease mortality rate.
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[Objective]To observe the effect and the safety of the COX-2 inhibitor Celecoxib as the analgesia in orthopaedic post-operative patients.[Method]Sixty-four operative patients were selected in all between 2004～2005 in hospital,and divided into two groups randomly.Celecoxib was used as the postoperative analgesia in the experiment group and the "Patient-controlled analgesia" in the control group.The administration of Celecoxib: 8-12 hours before operation generally,just before the abrosia,and 6 hours after operation when patients can take food.drug withdrawal was depended on the complex of the operation and the severety of pain in 3 to 5 days.Dosage:400 mg first time,if a complicated operation,larger dose would be given.VAS score,adverse reaction and the satisfaction of patients were observed.[Result]The effect of Celecoxib is similar as the PCA,with less adverse reaction and more satisfaction.[Conclusion]Celecoxib has a satisfactory effect and safety as a postoperative analgesia,and is suitable to be a peri-operative analgesia of orthopaedic patients.
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Forty-seven patients with congenital heart disease and pulmonary hypertension were treated surgically. Among them, 31 were male and 16 female. The age ranged from 2 to 47(13. 7? 11. 2) years. Gongenital heart abnormalities included ventricular septal defect (VSD) in 20, huge atrial septal defect (ASD) in 1, VSD+ASI) in 12, VSD with patent ductus arteriosus (PDA) in 6, endocardial cushion in 2, VSD with aortopulmonary septal defect (APSD) in 1, double outlet right ventricle with PDA in 1 and total anomalous pulmonary venous connection in 1. Right heart catheterization was performed in 15 cases. The mean pulmonary artery pressure was (73 ? 24)mmHg, total pulmonary resistance was (78. 0 ?61. 2)kPa/(L/s). There were 7 cases examined in operation. Their mean pulmonary artery pressure was (55?13)mmHg. The others were examined by echocardiography. The mean pulmonary artery pressure was (49?15)mmHg. All patients were treated pre-op-eratively with oxygen inhalation therapy, hyperbaric oxygenation, prostaglandin E1 , respectively according to the degree of pulmonary hypertension. During cardiopulmonary bypass, pulmonary artery perfusion was performed with protective solution containing aprotinin for lung protection. Vasoactive drugs were routinely administrated postoperatively. There were 2 operative deaths with hospital mortality rate of 4. 3%. The cause of deaths was severe low cardiac output syndrome. The postoperative morbidity rate was 4. 3%. Our conclusion is proper peri-operative management could reduce post-operative mortality and morbidity for congenital heart disease with pulmonary hypertension.
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Objective To explore reasonable application of antibiotics in the peri-operative period of the general surgery.Methods 121 cases who were admitted from Nov. 1998 to Jun. 2000 were divided into three groups including deep-vein group, biliary culture group and drainage-rube group. The antibiotics were Cefradine, Cefuroxime, Cefoperazone, Ceftriaxone, Imipenem, Ciprofloxacin and Metronidazole. We recorded the dosages and applying-time of the antibiotics. We also carried out the culture of the blood, cut-secreta and drainage tube at the same time.Results The clinical doctors applied the antibiotics with excess of indications and applying-time. That brought about more and more drug-fast bacteria, even multiple drug-fast bacteria.Conclusion We must apply the antibiotics reasonable in the peri-operation.
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Objective To explore the feasibility of laparoscopic cholecystectomy(LC) in patients over 85 years old.Methods Three-port LC was performed in 79 patients aged over 85 years old from October 1996 to October 2006.Patients' co-morbidities were effectively controlled before operation.The operation was conducted under continuous epidural anesthesia,and the CO2 pneumoperitoneum pressure was set at 8～10 mm Hg.Results The LC was successfully completed in 70 patients,while conversions to open surgery were required in 9 patients(11.4%).Causes of conversions included severe intraperitoneal adhesion in 6 patients,uncontrolled bleeding in 1 patient,and suspicion of gallbladder carcinoma in 2 patients.Postoperative complications occurred in 10 patients(12.7%,10/79).Of them,1 patient died of acute myocardial infarction,and the remaining 9 patients were cured(including left heart failure in 1 patient,pulmonary infection in 2 patients,ileus in 1 patient,wound haematoma in 1 patient,fungal enteritis in 1 patient,and effusion in the gallbladder bed in 3 patients).Conclusions Proper peri-operative management,effective control of co-morbidities,and careful surgical performance are essential for a safe LC in patients over the age of 85.
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Objectives:To observe the role of peri operational nutritional support in the old patients with gastrointestinal carcinoma. Methods: One hundred and seventeen cases of aged patients with gastrointestinal carcinoma were divided into two groups: nutritional support (NS) group and normal therapy(NT) group. The therapeutic effects of peri operational nutritional support were studied. Results: All patients survived. The rate of complication in group of NT was higher than that of NS group. The recovering time of the gut function after operation and average duration in the hospital of the NT group were longer than that in the NS group. The recovery of body weight, level of plasma albumen and nitrogen balance in NS group was faster than that of NT group. Conclusions:Peri operational nutritional support in the aged patients with gastroenterological carcinoma is of significance, improving the nutritional condition,enhancing the endurance from the surgical trauma and decreasing the rate of postoperative complication.