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Perioperative stroke is cerebral infarction occurring in the perioperative period.The incidence of perioperative stroke in non-cardiac,and non-neurologic surgery is about 0.7％,but the mortality can be as high as 26％ to 40％.The outcome of the patients with perioperative stroke can be disastrous.Here we report a case of perioperative ischemic stroke that occurred after surgery of lumbar decompression and pedical screw fixation.A 76-year-old female admitted to our hospital because of lumbar spinal stenosis.Her medical history included hypertension and diabetes for ten years.Her personal history included a smoking history of 60 years by 2 cigarettes per day,not quitting.Her carotid artery ultrasound showed multiple low echo plaques on the right side and multiple high echo plaques on the left side of the carotid artery,but without distinct stenosis.Other examinations and tests showed no distinct abnormality.She went on a lumbar decompression and pedical screw fixation uneventfully.The blood loss was 400 mL and autologous blood transfusion 150 mL.The arterial blood pressure (ABP) maintained during 100-130 mmHg/60-80 mmHg (1 mmHg =0.133 kPa).Sixty minutes after she recovered from general anesthesia,the patient developed symptoms of slurred speech and right limbs weakness.The anesthesiologist evaluated the patient immediately with National Institute of Health Stroke Scale (NIHSS).The NIHSS score was 11 and a stroke was highly suspected.The acute stroke team was therefore initiated and fast responded.Within 4 h,digital subtraction angiography (DSA) was proceeded,which showed the M1 segment of the left middle cerebral artery was occluded and the local stenosis of her right middle cerebral artery was up to 80％.After the successful embolectomy by Solitaire stent,the left middle cerebral artery reflowed and the forward blood flow was thrombolysis in myocardial infarction (TIMI) grade 3.The patient was discharged after 33 days after the surgery with a NIHSS of 9.Our case provides an example that an acute stroke team that included the department of anesthesiology can be beneficial to the patients' perioperative strokes.During the perioperative period,anesthesiologists should be included into the acute stroke team,because anesthesiologists and anesthesia nurses might be first observers of those early onset strokes.Our case also put forward this thought that a standard peri-operative stroke evaluation tool,like NIHSS,should be discussed and applied to facilitate and accelerate the initiation of perioperative acute stroke team.
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[ABSTRACT]OBJECTIVE To summarize the clinical related factors and prognostic influence factors of perioperative pulmonary embolism of head and neck malignant tumor.METHODSFrom 2010-2014, our hospital carried out a total of 2736 cases of head and neck malignant tumor surgical operations, of which, 10 cases were clinically diagnosed as postoperative pulmonary embolism, retrospectively analyzed the process of clinical treatment of the patients of pulmonary embolism with head and neck malignant tumors, and summarized their etiological factors, clinical manifestations, diagnosis and treatment. RESULTS The preoperative period incidence of pulmonary embolism in patients with head and neck malignant tumor was 0.37%(10/2736). Their clinical manifestations were mainly of asthma and breathing difficulty, and 3 cases of asymptomatic hypoxemia. 8 cases of patients showed pulmonary artery and branch filling defects after pulmonary artery angiography (CTA), 7 cases of patients got cured and were discharged from the hospital after comprehensive treatment such as anticoagulation etc; 3 cases of patients died after emergency treatment. 2 cases of patients suffered cavity bleeding, and there was no anticoagulant drug adjustment.CONCLUSIONThe mortality of head and neck cancer patients with perioperative pulmonary embolism is high, and therefore, preventive measures and timely treatments are important to reduce the incidence of pulmonary embolism.
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Objective To explore the change of cellular immune function in renal cancer patients adopting thymopetidum (TP-5) combined with cytokine-induced killer cells (CIK) in peroperative period,and evaluate its curative effect.Methods Forty-one cases of Ⅰ-Ⅲ stage renal cancer patients adopting CIK treatment postoperatively were enrolled in this study for retrospective analysis.According to applicating condition of TP-5,the patients were divided into two groups:16 cases of combination group (TP-5+CIK) and 25 cases of CIK group.The patients in combination group were given TP-5 intramscular injection everyday from preoperative 1 d to postoperative 3 weeks,once a day.Peripheral blood mononuclear cell was collected in the patients of two groups,which was cultivated for 2 weeks and then transfused.Fasting peripheral blood 1 week (before collected peripheral blood mononuclear cell),3 weeks (before CIK retransfusion),4 weeks(after CIK retransfusion for 1 week) and 5 weeks(after CIK retransfusion for 2 weeks) after operation were examined,the peripheral blood T cell subgroups (CD3+,CD4+,CD8+) and nature killer cell (NK cell) levels were detected using flow cytometry.Results At 1 week and 3 weeks (before CIK) after operation,the levels of CD3+,CD4+/CD8+ and NK cell in combination group were significantly higher than those in CIK group:1 week after operation:0.542 ± 0.063 vs.0.491 ± 0.054,0.94 ± 0.09 vs.0.90 ± 0.12,0.247 ± 0.025 vs.0.223 ± 0.033;3weeks after operation:0.641 ±0.058 vs.0.587 ±0.062,1.71 ±0.13 vs.1.02 ±0.07,0.319 ±0.038 vs.0.264 ± 0.047).There were significantly differences (P＜ 0.05).At 4 weeks after operation,the levels of CD3+,CD4+/CD8+ and NK cell in combination group were significantly higher than those in CIK group:0.698 ± 0.041vs.0.649 ± 0.050,2.01 ± 0.11 vs.1.64 ± 0.09,0.331 ± 0.029 vs.0.289 ± 0.034.There were significantly differences (P ＜ 0.05).At 5 weeks after operation,the levels of CD3+,CD4+/CD8+ and NK cell in two grotups were no significant difference (P ＞ 0.05).At 4 and 5 weeks after operation,the levels of CD3+,CD4+/CD8+ and NK cell in two groups were significantly higher than those of 3 weeks after operation (P ＜ 0.05).None of patients occurred acratia,hyperpyrexia,shivering and so on.Conclusions The application of TP-5 treatment in peroperative period can promote the recovery of cellular immune function,which has synergistic effect with CIK.The value of TP-5 is worthy of promotion.
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Objective To summarize the perioperative nursing of undergoing radical cystectomy with ileal neobladder for the treatment of bladder cancer? Method The nursing measures included preoperative psychological care,bowel and body preparation as well as postoperative nursing of drainage tube,ileal bladder irrigation,bladder functional exercise and basic nursing care? Results No patients suffered from postoperative complications such as infections,urinary fistula and anastomotic leakage? Twenty patients recovered autonomous urination within 3-6 months after the operation? One patient got minor urinal incontinence? Conclusions Cystectomy with orthotopic ileal neobladder trauma contributes to more complications due to large surgical trauma? Therefore,good perioperative care is important for the successful operations?
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Objective To review the experience in perioperalive management of 324 consecutive cases of pancreatico-duodenectomy(PD).Methods The clinical data of 324 cases of PD were analyzed retrospectively.All underwent PD successfully,275 cases received the standard PD,while,49 cases had pylorus preserving PD.Digestive tract reconstruction was done by Child method.Pancreatointestinal anastomosis was performed by pancreas stump intussussception in 303 cases,and end-to-side anastomosis in 21 cases.Results The 30 day mortality rate was 0.3%(1/324).Complicalion rate was 8.0%,included one case of liver dysfunction,7 cases with pancreatic fistula and intraabdomind bleeding,1 case of stenosis of pancreaticoenteral anastomosis,3 cases with pancreatic dysfunction,4 cases with gastroenteral anastomosis ulcer,6 cases with delayed gastric emptying,1 with reflux of bile and 3 with lymphatic fistula.Conclusions Perioperative managemen for pancreaticoduodenectomy is crucial for patient prognosis.Carful perioperative management can decrease postoperative complications and ensure smooth recover of these patients.