Peri-operative Management and Result of Pulmonary Endarterectomy in 56 Patients / 中国循环杂志

Objective: To summarize the peri-operative management experience of pulmonary endarterectomy (PEA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Methods: A total of 56 CTEPH patients received PEA in our hospital from 2015-01 to 2016-11 were retrospectively analyzed. Our study was focused on the medication in respiratory and circulatory system during ICU stay, peri-operative application of vasoactive drug and target drug to pulmonary hypertension (HP), usage of ventilators, mechanical assisted devices and other management experiences. Results: No peri-operative death occurred. There were 2/56 (3.6%) patients with lung reperfusion, 2 (3.6%) with PH crisis. Compared with pre-operation, the post-operative pulmonary artery hemodynamics parameters were improved as right heart catheter measured pulmonary artery systolic pressure (PASP) decreased from (85.05±22.40) mmHg to (36.83 ±17.21) mmHg and pulmonary vascular resistance decreased from (773.84±342.95) dyn·s·cm-5 to (293.59±214.95) dyn·s·cm-5. Post-operative oxygen saturation was maintained at (95-100) % in all patients. Echocardiography found that PASP from pre-operation (85.03±25.78) mmHg decreased to (39.44±19.24) mmHg at follow-up period, P<0.01.Conclusion: A comprehensive peri-operative management of PEA was helpful to improve pulmonary hemodynamics in CTEPH patients; meanwhile, effective prevention and treatment of severe complication could obviously reduce peri-operative mortality.

Factors Influencing Intra-Operative Body Temperature in Laparoscopic Colectomy Surgery under General Anesthesia: An Observational Cohort

PURPOSE: This study aimed to identify factors influencing intra-operative core body temperature (CBT), and to develop a predictive model for intra-operative CBT in laparoscopic abdominal surgery. METHODS: The prospective observational study involved 161 subjects, whose age, weight, and height were collected. The basal pre-operative CBT, pre-operative blood pressure, and heartbeat were measured. CBT was measured 1 hour and 2 hours after pneumoperitoneum. RESULTS: Explanatory factors of intra-operative hypothermia (<36℃) were weight (β=.361, p<.001) and pre-operative CBT (β=.280, p=.001) 1 hour after pneumoperitoneum (Adjusted R2=.198, F=7.56, p<.001). Weight was (β=.423, p<.001) and pre-operative CBT was (β=.206, p=.011) 2 hours after pneumoperitoneum (Adjusted R2=.177, F=5.93, p<.001). The researchers developed a predictive model for intra-operative CBT (℃) by observing intra-operative CBT, body weight, and pre-operative CBT. The predictive model revealed that intra-operative CBT was positively correlated with body weight and pre-operative CBT. CONCLUSION: Influence of weight on intra-operative hypothermia increased over time from 1 hour to 2 hours after pneumoperitoneum, whereas influence of pre-operative CBT on intraoperative hypothermia decreased over time from 1 hour to 2 hours after pneumoperitoneum. The research recommends pre-warming for laparoscopic surgical patients to guard against intra-operative hypothermia.

Factors Affecting Intraoperative Body Temperature in Surgical Patients with Laparotomy under General Anesthesia

PURPOSE: The study was conducted to identify factors affecting the intraoperative core body temperature (CBT) of surgical patients under general anesthesia. METHODS: This study was performed through a prospective descriptive research design. The sample consisted of 138 patients who had undergone elective laparotomy surgery. Age, weight, height, the basal preoperative CBT, blood pressure, and heart rate were collected. CBT was again measured at induction of anesthesia, 1 hour, 2 hours, and 3 hours following induction of general anesthesia. RESULTS: Factors affecting intraoperative hypothermia <36degrees C at 1 hour following induction, were CBT at induction and total body fat (TBF) (R2=.569, p<.001); at 2 hours after induction, CBT at induction and TBF (R2=.507, p<.001); at 3 hours after induction, CBT at induction (beta=0.34), TBF, age and the ambient temperature in the operating room (R2=.449, p<.001). CONCLUSION: CBT at induction and TBF appear to be factors affecting intraoperative CBT within 2 hours after induction of anesthesia; CBT at induction, TBF, advanced age and the ambient temperature after 3 hours following induction. We recommend keeping surgical patients warm before induction of anesthesia and providing intraoperative warming for surgical patients of advanced age with low TBF and when the duration of general anesthesia will last more than 3 hours.

Application of high quality nursing service in perioperative treatment of patients with coronary heart disease / 中国实用护理杂志

Objective The study was to find the application effect of high quality nursing service in perioperative treatment of patients with coronary heart disease.Methods Eighty patients were randomly divided into the comfort nursing group and the routine nursing group with 40 patients in each group.The comfort nursing group was given high quality nursing service,and the routine nursing group received the conventional care.The effect in two groups was compared after rehabilitation.The statistical software of SPSS 17.0 was used to analyze the data.Results The degree of anxiety was lower,the number of patients with complication was less,the degree of satisfaction was higher and the time in hospital was less in the comfort nursing group.Conclusions The comfortable nursing care should be used in peri-operative treatment of coronary heart disease,which can make patients keep the best mental state to accept and cooperate with the surgical treatment.It also can improve the care quality and patients' satisfaction degree and shorten the hospital stay.

Influência da lesão carotídea no pós-operatório de revascularização miocárdica e sua evolução tardia / Influence of carotid injury in post-myocardial revascularization surgery and its late evolution

FUNDAMENTO: Cerca de 30% dos AVE perioperatórios da cirurgia de revascularização do miocárdio (CRM) são decorrentes de lesões carotídeas, sem redução de risco confirmada por intervenção perioperatória. OBJETIVOS: Avaliar o impacto da doença carotídea e a intervenção perioperatória nos pacientes submetidos à CRM. MÉTODOS: Estudo retrospectivo observacional, avaliando 1.169 pacientes com idade > 65 anos submetidos à CRM entre janeiro de 2006 e dezembro de 2010, acompanhados, em média, por 49 meses. Todos foram submetidos à ultrassonografia de carótidas prévia à CRM. Definiu-se doença carotídea quando lesão > 50%. O desfecho primário foi composto pela incidência de AVE, acidente isquêmico transitório (AIT) e óbito por AVE. RESULTADOS: A prevalência da doença carotídea foi de 19,9% dos pacientes. A incidência do desfecho primário entre portadores e não portadores foi de 6,5% e 3,7%, respectivamente (p = 0,0018). Nos primeiros 30 dias, ocorreram 18,2% dos eventos. Relacionaram-se a doença carotídea: disfunção renal (OR 2,03, IC95% 1,34-3,07; p < 0,01), doença arterial periférica (OR 1,80, IC95% 1,22-2,65; p < 0,01) e infarto do miocárdio prévio (OR 0,47, IC95% 0,35-0,65; p < 0,01). Quanto ao desfecho primário, foram associados AIT prévio (OR 5,66, IC95% 1,67-6,35; p < 0,01) e disfunção renal (OR 3,28, IC95% 1,67-6,45; p < 0,01). Nos pacientes com lesão > 70%, a intervenção carotídea perioperatória apresentou incidência de 17% no desfecho primário contra 4,3% na conduta conservadora (p = 0,056) sem diferença entre abordagens percutânea e cirúrgica (p = 0,516). CONCLUSÃO: A doença carotídea aumenta o risco para AVE, AIT ou morte por AVE na CRM. Entretanto, a intervenção carotídea não foi relacionada à redução do desfecho primário.

BACKGROUND: Approximately 30% of perioperative CVA of myocardial revascularization surgery (MRS) are a result of carotid injuries, without reduction of risk confirmed by perioperative intervention. OBJECTIVES: Evaluate the impact of carotid disease and perioperative intervention in patients subjected to MRS. METHODS: Observational, retrospective study, evaluating 1169 patients aged > 69 years undergoing MRS from January, 2006 and December, 2010, monitored, on average, for 49 months. All patients were subjected to ultrasonography of carotids before MRS. It was defined as carotid disease when lesion > 50%. The primary outcome was composed of CVA incidence, transitory ischemic accident (TIA) and death due CVA. RESULTS: Prevalence of carotid disease was of 19.9% of patients. The incidence of primary outcome between unhealthy and healthy patients was of 6.5% and 3.7%, respectively (p = 0.0018). In the first 30 days, there were 18.2% of events. Were related to carotid disease: renal dysfunction (OR 2.03, IC95% 1.34-3.07; p < 0.01), peripheral arterial disease (OR 1.80, IC95% 1.22-2.65; p < 0.01) and previous myocardial infarction (OR 0.47, IC95% 0.35-0.65; p < 0.01). Regarding the primary outcome, were associated the previous TIA (OR 5.66, IC95% 1.67-6.35; p < 0.01) and renal dysfunction (OR 3.28, IC95% 1.67-6.45; p < 0.01). In patients with lesion >70%, perioperative carotid intervention demonstrated an incidence of 16% in primary outcome compared to 4.3% in conservatory treatment (p = 0.056) with no difference between percutaneous and surgical approaches (p = 0.516). CONCLUSION: Carotid disease increases the risk of CVA, TIA or death due to CVA in MRS. However, the carotid intervention was not related to reduction of primary outcome.

A influência da ansiedade nas estratégias de enfrentamento utilizadas no período pré-operatório / The influence of anxiety in coping strategies used during the pre-operative period

O presente estudo tem como objetivos: identificar o estado de ansiedade dos pacientes no período pré-operatório; identificar as estratégias de enfrentamento utilizadas pelos pacientes nesse período; verificar a relação entre o estado de ansiedade e as estratégias de enfrentamento utilizadas pelos pacientes, no período pré-operatório. A amostra foi composta por 40 pacientes cirúrgicos. Para a coleta dos dados foram utilizados dois instrumentos auto-aplicáveis: o questionário de estado de ansiedade de Spielberger e o inventário de estratégias de coping de Lazarus e Folkman. A amostra compôs-se, em sua maioria, por pacientes do sexo feminino com uma idade média de 46 anos, com baixo grau de escolaridade, com experiência cirúrgica anterior e sem intercorrências anteriores. As estratégias de enfrentamento mais comumente utilizadas foram as de suporte social e a de resolução de problemas. Em relação à ansiedade e às estratégias de enfrentamento, obteve-se uma correlação negativa entre o estado de ansiedade e o suporte social e a resolução de problemas.

This study aims at characterizing the population analyzed regarding socio-demographic aspects, identifying the anxiety level of patients undergoing surgery and the most used coping strategies during the pre-operative period, as well as observing the relation between anxiety level and coping strategies over the same period. The population was comprised of 40 patients undergoing surgery. For data collection, two self-applicable instruments were employed: Spielberger's anxiety level inventory and Lazarus, Folkman's coping strategies inventory. Data were collected over the pre-operative period. Most patients were women averaging 46-years old, with low level of schooling, previous surgery experience set before, and no previous intercurrence. The coping strategies more commonly used were social support and problem resolution. In regards to anxiety and coping strategies there was found a negative correlation between anxiety level, social support and problem resolution.

En el presente estudio se tuvo por objetivos: identificar el estado de ansiedad de los pacientes en el período pre-operatorio; identificar las estrategias de enfrentamiento utilizadas por los pacientes en ese período; verificar la relación entre el estado de ansiedad y las estrategias de enfrentamiento utilizadas por los pacientes, en el período pre-operatorio. La muestra estuvo compuesta por 40 pacientes quirúrgicos. Para la recolección de los datos fueron utilizados dos instrumentos auto-aplicables: el cuestionario de estado de ansiedad de Spielberger y el inventario de estrategias de coping de Lazarus y Folkman. La muestra se compuso, en su mayoría, por pacientes del sexo femenino con una edad media de 46 años, con bajo grado de escolaridad, con experiencia quirúrgica anterior y sin incidencias anteriores. Las estrategias de enfrentamiento común-mente utilizadas fueron las de soporte social y la de resolución de problemas. En relación a la ansiedad y a las estrategias de enfrentamiento, se obtuvo una correlación negativa entre el estado de ansiedad y el soporte social y la resolución de problemas.

Peri-operative care in elderly acute abdomen patients / 临床外科杂志

Objective The experiences of peri-operative management in senile acute abdominal patients were summarized in order to raise the successful rate.Method We analysed retrospectively 575 cases who were senile acute abdominal patients from 1990 to 2000.Results Among 575 cases,540 cases(93.9%)were cured.423 cases(73.5%) were with other chronic diseases and dysfunctions before operation.Various complications occurred in 168 cases(29.2%)and 35 cases(6.1%) died.The death causes mainly were correlated with accompanied chronic diseases.Conclusion Strengthen peri operative care,active management of other chronic diseases and adequate operation time are important significantly for senile acute abdomen to get satisfied outcome.