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Objective To explore the predictive effect of American Society of Anesthesiologists (ASA) classification on prognosis of elderly patients with hip fracture.Methods A retrospective casecontrol study was conducted to analyze the clinical data of 814 elderly patients with hip fracture admitted to the 7th Medical Center of the General Hospital of the PLA from January 2012 to December 2015.There were 272 males and 542 females,with the age range of 60-99 years [(80.0 ± 8.0) years].According to ASA classification,the patients were divided into four groups:23 cases (2.8％) of ASA grade Ⅰ,380 cases (46.7％) of ASA grade Ⅱ,389 cases (47.8％) of ASA grade Ⅲ and 22 cases (2.7％) of ASA grade Ⅳ.Data compared among the groups included gender,age,comorbidities,fracture type,anesthesia methods,surgical methods,length of hospital stay,complications,and 30-day and 1-year mortality rates.Multiple Logistic analysis was conducted to seek independent risk factors for 1-year mortality.Results There were no significant difference among the four groups with regards to gender,fracture type,surgical methods (P ＞ 0.05).With the improvement of ASA classification,the age of patients increased gradually,the length of hospital stay increased,and the rate of nerve block anesthesia increased (allP ＜ 0.01).Incidence of complications of ASA grade Ⅳ patients was the highest [59％ (13/22)],followed by 31.4％ (122/389) of ASA grade Ⅲ patients,17.6％ (67/380) of ASA grade Ⅱ patients,4％ (1/23) of ASA grade Ⅰ patients (all P ＜ 0.01).The 30-day and 9-0day mortality of ASA grade Ⅳ patients were 32％ (7/22),64％ (14/22),ASA grade Ⅲ patients were 4.6％ (18/389),17.0％ (66/389),ASA grade Ⅱ patients were 3.4％ (13/380),12.1％ (46/380),and ASA grade Ⅰ patients were 0 and 4％ (1/23),respectively.The differences between these groups were significantly different (allP ＜0.01).Univariate analysis showed that male,advanced age,coronary heart disease,pulmonary infections,chronic obstructive pulmonary diseases (COPD),renal insufficiency,ASA classification,anesthesia methods,and length of hospital stay were related to postoperative 1-year death (P ＜0.05 or 0.01).A total of 127 patients (15.6％) died within 1 year after operation.Multivariate Logistic regression analysis showed age (OR =1.037,95％ CI 1.007-1.068),ASA grade(ASA grade Ⅱ:OR =1.851,95 ％ CI 1.238-14.386;ASA grade Ⅲ:OR =2.092,95％ CI 1.266-16.482;ASA grade Ⅳ:OR =15.368,95％ CI 1.626-145.283),length of hospital stay (OR =1.038,95％ CI 1.015-1.061) were independent risk factors for 1-year mortality.Conclusions The outcome of the elderly hip fracture is poor.The ASA classification is closely related to the incidence of complications,30-day mortality,and 1-year mortality.Advanced age,ASA grade Ⅱ,Ⅲ and Ⅳ,hospital length of stay are the independent risk factors for poor prognosis of hip fractures.The ASA classification can be used as a screening tool to intervene for the high-risk population as early as possible.
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Objective@#To explore the predictive effect of American Society of Anesthesiologists (ASA) classification on prognosis of elderly patients with hip fracture.@*Methods@#A retrospective case-control study was conducted to analyze the clinical data of 814 elderly patients with hip fracture admitted to the 7th Medical Center of the General Hospital of the PLA from January 2012 to December 2015. There were 272 males and 542 females, with the age range of 60-99 years [(80.0±8.0)years]. According to ASA classification, the patients were divided into four groups: 23 cases (2.8%) of ASA grade I, 380 cases (46.7%) of ASA grade II, 389 cases (47.8%) of ASA grade III and 22 cases (2.7%) of ASA grade IV. Data compared among the groups included gender, age, comorbidities, fracture type, anesthesia methods, surgical methods, length of hospital stay, complications, and 30-day and 1-year mortality rates. Multiple Logistic analysis was conducted to seek independent risk factors for 1-year mortality.@*Results@#There were no significant difference among the four groups with regards to gender, fracture type, surgical methods (P>0.05 ). With the improvement of ASA classification, the age of patients increased gradually, the length of hospital stay increased, and the rate of nerve block anesthesia increased ( allP<0.01). Incidence of complications of ASA grade IV patients was the highest [59%(13/22)], followed by 31.4%(122/389) of ASA grade Ⅲ patients, 17.6%(67/380) of ASA grade II patients, 4%(1/23) of ASA grade I patients (all P<0.01). The 30-day and 9-0day mortality of ASA grade IV patients were 32% (7/22), 64% (14/22), ASA grade III patients were 4.6% (18/389), 17.0% (66/389), ASA grade II patients were 3.4% (13/380), 12.1% (46/380), and ASA grade I patients were 0 and 4% (1/23), respectively. The differences between these groups were significantly different ( allP<0.01). Univariate analysis showed that male, advanced age, coronary heart disease, pulmonary infections, chronic obstructive pulmonary diseases (COPD), renal insufficiency, ASA classification, anesthesia methods, and length of hospital stay were related to postoperative 1-year death (P<0.05 or 0.01). A total of 127 patients (15.6%) died within 1 year after operation. Multivariate Logistic regression analysis showed age (OR=1.037, 95%CI 1.007-1.068), ASA grade(ASA grade II : OR=1.851, 95%CI 1.238-14.386; ASA grade III : OR=2.092, 95%CI 1.266-16.482; ASA grade IV: OR=15.368, 95%CI 1.626-145. 283), length of hospital stay (OR=1.038, 95%CI 1.015-1.061) were independent risk factors for 1-year mortality.@*Conclusions@#The outcome of the elderly hip fracture is poor. The ASA classification is closely related to the incidence of complications, 30-day mortality, and 1-year mortality. Advanced age, ASA grade II, III and IV, hospital length of stay are the independent risk factors for poor prognosis of hip fractures. The ASA classification can be used as a screening tool to intervene for the high-risk population as early as possible.
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Objective To investigate the preventive action of Gongxuening capsule combined with oxytocin in treatment of bleeding after medical abortion.Methods 71 casess with medical abortion from March 2014 to May 2015,were randomly divided into observation group of 34 patients and control group of 37 patients.Conventional medical abortion forpregnant women as a control group, giving Gongxuening capsule drug for pregnant women in observation group.After medical abortion, the efficacy of the drug flow between two groups of patients, pregnant women, complete abortion drug flow vaginal bleeding, incomplete abortion pregnant drug flow duration and recovery time of menstruation comparative analysis.Results After medical abortion,medical abortion effect of the two groups of pregnant women were analyzed, the results showed that the proportion of complete abortion patients in the observation group, the proportion of incomplete abortion, abortion failure rates and the control group was not significant.Vaginal bleeding after two complete abortion drug flow comparing pregnant women in observation group and less than an amount equal to the total number of menstruation was significantly lower than control group (χ2 =5.318,P<0.05).Observation group after the drug flow vaginal bleeding lasted significantly phrases in the control group (P<0.05); the recovery time of menstruation after medical abortion were compared two groups of patients.Observation group completely abortion menstrual period the number of days than the control group (P<0.05);similar to the menstrual cycle days, the difference was not statistically significant.Conclusion Gongxuening capsule combined with oxytocin on bleeding after medicinal abortion has a significant preventive effect, can effectively reduce the amount of bleeding and bleeding time in patients after the drug flow, which is a safe and effective medical abortion methods should be promoted and used in clinical.
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Objective To examine the gene expression levels of matrix metalloproteinase-1(MMP-1), tissue inhibitor of metalloproteinase-1 ( TIMP-1) in peripheral blood mononuclear cells (PBMC) and sera in the patients with chronic hepatitis B (CHB) and to investigate the value of message RNA(mRNA) expression of MMP-1 and TIMP-1 for diagnosing liver fibrosis. Methods PBMC and sera samples were collected from 37 CHB patients and 20 healthy controls. The total RNA isolated from PBMC was reversely transcribed into cDNA. The mRNA levels of MMP-1 and TIMP-1 in PBMC were examined by real-time fluorescence quantitative reverse transcription polymerase chain reaction (FQ-RT-PCR). The serum levels of MMP-1 and TIMP-1 were determined by sandwich enzyme-linked immunosorbent assay (ELISA). Liver tissues were obtained from all these patients by biopsy and subsequently used for evaluating liver fibrosis stages (S). Intergroup comparison was performed by non parametric test. The correlation analysis was performed by Spearman. Results The MMP-1 and TIMP-1 mRNA levels in PBMC from healthy controls were low. The MMP-1 mRNA levels in PBMC from CHB patients were not significantly different from those in healthy controls,while the TIMP-1 mRNA levels were remarkably higher in CHB patients' PBMC compared to healthy controls. Both the MMP-1 mRNA levels in PBMC and the MMP-1 protein levels in sera were not significantly different among CHB patients at different disease stages and healthy controls (χ~2 =8. 960,P=0.111l ;χ~2 =7. 898, P = 0.211). However, the TIMP-1 mRNA levels in PBMC and the TIMP-1 protein levels in sera increased gradually along with the disease progressed from S1 to S4. The TIMP-1 mRNA levels in PBMC were (1.67±0. 84) lg copy/μL, (3. 48±2. 08) lg copy/μL,(5. 86±3. 47) lgcopy/μL and (8. 14 ± 6. 48) lg copy/μL from stage 1 to 4 respectively, while the protein levels of TIMP-1 in sera were (233. 73±64. 84) ,μg/L, (262. 10±71. 12) μg/L, (301. 15±62. 74)μg/L and(381. 15 ± 152. 75)μg/L, respectively. The differences between each stages were statistically significant (χ~2'= 14. 290, P=0.002,χ~2 = 12.209, P=0. 007). The TIMP-1 mRNA levels in PBMC and the TIMP-1 serum levels were positively correlated with liver fibrosis stage (r=0. 752, P<0. 01;r=0. 530, P=0. 008). Conclusions The TIMP-1 mRNA level in PBMC and TIMP-1 protein level in serum are closely related with liver fibrosis stages. These two parameters, especially the TIMP-1 mRNA level in PBMC, can be potentially new markers for diagnosing liver fibrosis.