RESUMEN
Objective To explore the risk factors for perioperative myocardial infarction(PMI) in aged patients undergoing nonneurologic and noncardiac surgery.Methods A total of 9285 inpatients aged 65 or above receiving nonneurologic and noncardiac surgery at Peking University People's Hospital from November 2012 to May 2016 were retrospectively recruited to our study.Patients who had suffered PMI were assigned to a myocardial infarction group(MI group)and others were allocated to a nonmyocardial infarction group(non-MI group).Clinical manifestations,comorbidities,preoperative laboratory test results,polypharmacy,characteristics of operation and anesthesia,and prognosis were analyzed and compared between the two groups.A multivariate logistic regression model was built to evaluate risk factors for PMI in aged patients undergoing nonneurologic and noncardiac surgery.Results PMI occurred in 12 patients(0.13％).Previous stroke or transient ischemic attack(TIA) history (OR =159.254,P ＜ 0.001),cardiovascular heart disease (CHD) history (OR=33.645,P ＜0.001),and chronic kidney disease(CKD) (OR =19.393,P =0.003) were independent risk factors for PMI in aged patients undergoing nonneurologic and noncardiac surgery.PMI was associated with longer hospitalization[29 (15 59) days vs.9 (6-15) days,P ＜ 0.001] and higher mortality(58.3 ％).Conclusions Previous stroke or TIA history,CHD history,and CKD are independent risk factors for PMI in aged patients undergoing nonneurologic and noncardiac surgery.The incidence of PMI in patients with these risk factors is not high,but the mortality will be high and hospitalization will be prolonged once PMI occurs.Patients with these characteristics need more careful perioperative care.
RESUMEN
Objective To develop a risk index scoring for predicting perioperative mortality risk in aged patients undergoing non-neurologic and non-cardiovascular surgery.Methods A total of 11 144 inpatients aged ＞65 years old undergoing non-neurologic and non-cardiovascular surgery in the People's Hospital of Peking University from December 2012 to March 2016 were selected and divided into the death group and survival group.The following variables were compared between the 2 groups:general data,comorbidities,preoperative laboratory tests and operation anesthesia.A multivariate Logistic regression analysis was performed on the risk factors for perioperative death in this group.The Bootstrapping method was performed for conducting internal validation.The parameters weighing of risk index scoring was established by correcting the partial regression coefficient of equation.Results The perioperative mortality was 1.0％ (111 cases).Eight independent predicting factors were obtained by the regression analysis.Then the risk index scoring was defined:classification of the Association of American Physicians (grade Ⅰ:0 point;grade 1:3 points;grade Ⅲ or 1:4 points),BMI(＜24 kg/m2:0 point;＞24 kg/m2:-1 point),renal insufficiency(1 point),chronic obstructive pulmonary disease(3 points),diabetes needing insulin treatment(2 points),preoperative hypoalbuminemia (1 point),preoperative hyponatremia (1 point) and general anesthesia (1 point).The patients with risk scores＜6 points were classified as low risk,patients with risk score 6-7 points were classified as intermediate risk and those with risk score＞ 7 were classified as high risk.The actual predicting risk of perioperative death in high risk patients ＞10％.The perioperative mortality risk index exhibited better diagnostic recognition ability (c-statistic=0.878).Conclusion The perioperative mortality risk of aged patients undergoing non-neurologic and non-cardiovascular surgery can be predicted by the risk index scoring,which can help to screen the high-risk individuals of perioperative death in order to give more carefully perioperative management.
RESUMEN
Objective To develop a risk index scoring for predicting perioperative mortality risk in aged patients undergoing non-neurologic and non-cardiovascular surgery.Methods A total of 11 144 inpatients aged ＞65 years old undergoing non-neurologic and non-cardiovascular surgery in the People's Hospital of Peking University from December 2012 to March 2016 were selected and divided into the death group and survival group.The following variables were compared between the 2 groups:general data,comorbidities,preoperative laboratory tests and operation anesthesia.A multivariate Logistic regression analysis was performed on the risk factors for perioperative death in this group.The Bootstrapping method was performed for conducting internal validation.The parameters weighing of risk index scoring was established by correcting the partial regression coefficient of equation.Results The perioperative mortality was 1.0％ (111 cases).Eight independent predicting factors were obtained by the regression analysis.Then the risk index scoring was defined:classification of the Association of American Physicians (grade Ⅰ:0 point;grade 1:3 points;grade Ⅲ or 1:4 points),BMI(＜24 kg/m2:0 point;＞24 kg/m2:-1 point),renal insufficiency(1 point),chronic obstructive pulmonary disease(3 points),diabetes needing insulin treatment(2 points),preoperative hypoalbuminemia (1 point),preoperative hyponatremia (1 point) and general anesthesia (1 point).The patients with risk scores＜6 points were classified as low risk,patients with risk score 6-7 points were classified as intermediate risk and those with risk score＞ 7 were classified as high risk.The actual predicting risk of perioperative death in high risk patients ＞10％.The perioperative mortality risk index exhibited better diagnostic recognition ability (c-statistic=0.878).Conclusion The perioperative mortality risk of aged patients undergoing non-neurologic and non-cardiovascular surgery can be predicted by the risk index scoring,which can help to screen the high-risk individuals of perioperative death in order to give more carefully perioperative management.
RESUMEN
Objective To explore effects of monitored anesthesia care (MAC) on gastrointestinal endoscopy.Methods All patients who underwent gastrointestinal endoscopy in Peking University People's Hospital from September 2010 to September 2015 were analyzed retrospectively and divided into two groups:the MAC group and control group by usage of MAC.Success rates of removal of foreign bodies by upper gastrointestinal endoscopy were compared between two groups during this period.Detection rates of ectopia of gastric mucosa in upper esophagus were compared between two groups from September 2014 to September 2015 when esophagogastroduodenoscopy was performed.The monthly cases of gastrointestinal endoscopies were compared between the two groups,which were separately collected from one MAC operating table and one routine operating table from September 2014 to September 2015.Results The success rate of removal of foreign bodies in the MAC group was higher than that in the control group (100.0％ VS 89.7％,x2 =11.737,P=0.001).The detection rate of ectopia of gastric mucosa in upper esophagus in the MAC group was higher than that in the control group(4.3％ VS 1.7％,x2 =58.751,P＜0.001).The monthly cases of gastrointestinal endoscopies in the MAC group was higher than that in the control group(350.2±36.2 cases VS 213.2±27.9 cases,t =17.591,P＜0.001).Conclusion The use of MAC for gastrointestinal endoscopy improves operating success rate,accuracy and operating time.MAC in gastrointestinal endoscopy can be recommended.
RESUMEN
Objective To compare the efficacy and efficiency of simulation-based training of flexible fibreoptic intubation in novices with virtual reality simulator.Methods A total of 46 anaesthesia residents in their first stage of training in anaesthesiology with no experience in flexible fibreoptic intubation at Peking University People's Hospital were enrolled in the study,and were divided into 2 groups randomly,which were virtual reality simulator group (group S,n=23) and manikin group (group M,n=23).The group S was then trained for 25 times on simulator,while the group M did the same processes on manikin.After training,participants in both groups had their performance assessed with the fibrescope evaluated through the oral route using a simulation manikin,who were instructed to attempt to advance the fibrescope 5 consecutive times to view the carina in the shortest amount of time.The time required to view the carina of each practice during training in both groups were recorded as pooled data to construct group learning curves with the application of SPSS 20.0.By using repeated measures analysis of variance and Ttest,the procedure time and global rating scale (GRS) of fibreoptic bronchoscope manipulation ability were compared between groups,so did the participant's confidence between before and after the training both within-subjects and between-subjects.Results The plateaus in the learning curves were achieved after 19 (15,26) practice sessions in group S and 24 (19,31) in group M,respectively.There was no significant difference in the procedure time [(13.7 ± 6.6) s and (11.9 ±4.1) s] and GRS [(3.9 ±0.4) vs.(3.7 ±0.3)]between groups.There were significant increases in participant's confidences in both groups after training [group S:(1.8 ± 0.5) vs.(3.9 ± 0.6),t=10.928,P=0.000;group M:(2.0 ± 0.7) vs.(3.9 ± 0.5),t=15.306,P=0.000],but there was no significant difference between groups.Conclusion The simulation-based training of flexible fibreoptic intubation in novices with virtual reality simulator is more efficient than the one with manikin,but the similar effects can be achieved in both modalities,after adequate trainings.In the related training a balance between time cost and economic cost should be considered and the appropriate teaching methods and forms should be taken.