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Objective:To investigate the independent influencing factors of wound drainage tube time delay in patients with breast cancer and establish a predictive model.Methods:Patients admitted to Tianjin Medical University Cancer Hospital from January to November 2021 were selected as the research objects. They were divided into sword modeling group (156 cases) and verification group (86 cases) according to the admission time. Delayed time to postoperative wound drainage and extubation in breast cancer patients was the end point, 95 cases of 156 patients in the modeling group whose extubation time was less than or equal to 7 days were set as the normal group, 61 cases whose extubation time were more than 7 days were set as delayed group, and the influencing factors of the two groups were compared to establish the prediction model, Hosmer-Lemeshow test was conduct to verify the fitting effect, used the ROC curve to verify the prediction model performance.Results:Univariate and multivariate Cox proportional hazards regression analysis showed that patients' high BMI, related basic disease history, operation mode, axillary lymph node dissection, breast tumor size (T3, T4) and drainage fluid volume 48 hours (≥50 ml) after operation were independent influencing factors for wound drainage tube time delay ( P<0.05). The prediction model was P=0.822, and the area under the ROC curve was 0.877, and the Youden index was 0.605, the sensitivity was 0.736, and the specificity was 0.869. The research data of 86 cases in the validation group were used as the test set for internal and external validation of the model, and the model verification was 96.51%. Conclusion:This prediction model has a good effect, providing a reference basis for clinical medical workers.
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Objective:To investigate the effects of sentinel lymph node biopsy utilization on operative time, intraoperative blood loss and extubation time.Methods:Sixty-two patients with breast cancer who received treatment in the First Hospital of China Medical University from January to December 2019 were included in this study. They were randomly assigned to receive either conventional breast cancer surgery (control group, n = 31) or sentinel lymph node biopsy combined with breast cancer surgery (study group, n = 31). Extubation time, operative time, intraoperative blood loss, drainage volume, breast cosmetic effect, upper limb function and complications were compared between the two groups. Results:Extubation time and operative time in the study group were (16.3 ± 1.1) hours and (61.6 ± 11.3) minutes, respectively, and they were (28.2 ± 6.4) hours and (124.2 ± 28.5) minutes, respectively in the control group. There were significant differences in extubation time and operative time between the two groups ( t = 14.922 and 16.479, both P < 0.05). Intraoperative blood loss and postoperative drainage volume in the study group were (68.7 ± 17.9) mL and (105.9 ± 19.5) mL respectively, and they were (122.4 ± 23.1) mL and (257.2 ± 36.4) mL respectively in the control group. There were significant different differences in intraoperative blood loss and postoperative drainage volume between the two groups ( t = 15.928 and 18.797, both P < 0.05). The excellent and good rate of breast cosmetic effect in the study group was significantly higher than that in the control group (93.6% vs. 83.8% , χ2 = 5.584, P < 0.05). After treatment, the difference in the upper arm circumference between the healthy and affected sides, and shoulder abduction and shoulder function score in the study group were (0.5 ± 0.1) cm, (123.7 ± 6.6) ° and (75.9 ± 4.9) points respectively, and they were (0.7 ± 0.1) cm, (120.1 ± 6.1) °, (73.5 ± 4.4) points, respectively in the control group. There were significant differences in these indices between the two groups ( t = 11.432, 12.450, 12.647, all P < 0.05). The incidence of complications in the study group was significantly lower than that in the control group (12.9% vs. 38.8%, χ2 = 6.309, P < 0.05). Conclusion:Sentinel lymph node biopsy can help improve therapeutic effects, shorten the operative time, reduce the amount of intraoperative bleeding, shorten the extubation time, and reduce the incidence of complications in breast cancer patients.
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Objective Discuss the anesthetic effect ofremifentanil and fentanyl on interventional surgery for children with congenital heart disease.Methods 80 patients with congenital heart disease were selected,they were divided into two groups randomly.The control group (40 cases) was given fentanyl anesthesia.The observation group (40 cases) was given remifentanil anesthesia.Observe and record SDP,DBP,HR at different time of anesthesia,extubation time,recovery time and dosage of anesthesia and adverse reaction during anesthesia to evaluate the anesthetic effect of remifentanil and fentanyl on interventional surgery for children with congenital heart disease.Results Compared with the basic value before induction of anesthesia,the SDP,DBP of two groups were decreased after induction (P ＜ 0.05).There was no significant difference on HR level between two groups before and after induction.The extubation time,recovery time of observation group was shorter than that of the control group.However,the amount of anesthesia drug in the observation group was higher than that of the control group (P ＜ 0.05).During anesthesia,there was no significant difference on adverse reactions between two groups.Conclusion The anesthetic effect of remifentanil on interventional surgery for children with congenital heart disease is good,and it has little effect on cardiac function with early extubation and less side effect.
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Objective To compare the postoperative extubation time and length of PACU retention between patients who had undergone retroperitoneal laparoscopic unilateral adrenal pheochromocytoma resection and other adrenal tumor resection.Methods A retrospective study of 57 hypertensive patients who had undergone retroperitoneal laparoscopic unilateral adrenal tumor resection under the general anesthesia was conducted.Nineteen patients with adrenal pheochromocytoma were assigned to group S,and other 38 patients were assigned to group D.We recorded and compared the gender ratio,ASA grade,age,weight,height,duration of operation and anesthesia,dosage of anes thetics,extubation time,and length of PACU retention between the two groups.Results There were no significant differences in gender ratio,ASA grade,age,weight,height,duration operation and anesthesia,as well as doses of propofol,midazolam,fentanyl and muscle relaxants between the two groups.As to extubation time and length of PACU retention,those of group S were both significantly longer than those of group D [30.0(25.0-42.5)min vs 20.0(15.0-20.0)min;70.0(57.5-82.5)min vs 45.0(33.5-55.0) min,P＜0.05,respectively].Conclusion Retroperitoneal laparoscopic unilateral adrenal pheochromocytoma resection might lead to postoperatively longer extubation time and length of PACU retention.It does not relate to the dosage of anesthetics used perioperatively.
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Objective Discuss the anesthetic effect ofremifentanil and fentanyl on interventional surgery for children with congenital heart disease.Methods 80 patients with congenital heart disease were selected,they were divided into two groups randomly.The control group (40 cases) was given fentanyl anesthesia.The observation group (40 cases) was given remifentanil anesthesia.Observe and record SDP,DBP,HR at different time of anesthesia,extubation time,recovery time and dosage of anesthesia and adverse reaction during anesthesia to evaluate the anesthetic effect of remifentanil and fentanyl on interventional surgery for children with congenital heart disease.Results Compared with the basic value before induction of anesthesia,the SDP,DBP of two groups were decreased after induction (P ＜ 0.05).There was no significant difference on HR level between two groups before and after induction.The extubation time,recovery time of observation group was shorter than that of the control group.However,the amount of anesthesia drug in the observation group was higher than that of the control group (P ＜ 0.05).During anesthesia,there was no significant difference on adverse reactions between two groups.Conclusion The anesthetic effect of remifentanil on interventional surgery for children with congenital heart disease is good,and it has little effect on cardiac function with early extubation and less side effect.
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BACKGROUND: Remifentanil is a useful opioid, but it induces postoperative hyperalgesia and acute tolerance associated N-methyl-D-aspartate (NMDA) receptor. This study was aimed to investigate whether small dose ketamine, NMDA receptor antagonist, prevent remifentanil induced postoperative hyperalgesia or acute tolerance after combined anesthesia with propofol and remifentanil using target controlled infusion (TCI) in patients undergoing mastectomy. METHODS: Fourty ASA physical status 1 or 2 women, undergoing mastectomy were randomly assigned to two groups to receive intraoperative infusion of ketamine at 3microgram/kg/min rate after injection of ketamine 0.3 mg/kg as a loading dose (Group K) or saline infusion after saline loading at the same rate and dose (Group C). All the patients were anesthetized with propofol and remifentanil to maintain bispectral index (BIS) 40-60, mean arterial pressure within 20% of basal values. Remifentanil was infused with target controlled infusion (TCI) to the effect site (concentration: 2.0 ng/ml). Postoperative paine scores (visual analog scale: VAS), morphine requirements, and sedation scores were recorded for 48 hours postoperatively. RESULTS: The VAS scores and morphine requirements of the Group K were significantly lower than those of the Group C at the postanesthetic care unit and at the ward for 24 hours postoperatively. The extubation time was delayed in Group K compared with Group C. CONCLUSIONS: Intraoperative infusion of small dose ketamine reduced postoperative pain and morphine requirements after combined anesthesia with propofol and remifentanil in patients undergoing mastectomy.
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Femenino , Humanos , Anestesia , Presión Arterial , Hiperalgesia , Ketamina , Mastectomía , Morfina , N-Metilaspartato , Dolor Postoperatorio , Piperidinas , PropofolRESUMEN
Objective This research aimed to compare two regimens of anesthesia(vecuronium-fentanyl and cisatracurium-remifentanil)for kidney transplantation patients.Methods 108 patients were studied,45 patients(Group Ⅰ)received balanced anesthesia with vecuronium and fentanyl,to the others 63(Group Ⅱ),cisatracurium and remifentanyl was given.Comparison of the difference between the two groups was made on the extubation time,intraoperative hemodynamics,postoperative urine output,serum creatinine and anesthesia complications.Results Extubation time of the Group Ⅰ was significantly longer than that of Group Ⅱ(33.5min ±17.5min,P＜0.05),but there was no difference between two groups on intraoperative hemodynamics,postoperative urine output,serum creatinine and anesthesia complications.Conclusions Both of the two regimens can provide safe anesthesia for kidney transplantation.Patients received regimen of cisatracurium and remifentanil experienced shorter extubation time.This regimen may be a better anaesthesic regimen for renal transplantation.