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Objective To investigate the effect of anesthesia at different depths on postoperative cognitive disfunction (POCD) and inflammatory response in the elderly patients undergoing abdominal operation.Methods A total of 90 elderly patients who underwent abdominal operation in the Affiliated Hospital of Shaanxi University of Chinese Medicine from June 2014 to June 2016 were divided into observation group and control group according to the depth of anesthesia,45 cases in each group.The patients in the two groups were performed with combined intravenous and inhalation anesthesia,the bispeetral index (BIS) value was maintained at 30-39 during the operation in the observation group,and the BIS value was maintained at 50-59 during the operation in the control group.The mean arterial pressure (MAP) and heart rate(HR) of patients in the two groups were recorded at the time points of entering the operation room(T0),5 minutes after tracheal cannula(T1),opening abdominal cavity (T2),closing abdominal cavity (T3) and tracheal cannula extubation (T4).The mini-mental state examination (MMSE) score of the patients in the two groups was performed before operation and the first,third,seventh day after operation;and the incidence of POCD was recorded.The levels of serum interleukin-6(IL-6) and S-100β protein were detected at the time points of before operation,the end of the operation and the first,third day after operation in the two groups.Results Five cases in the control group and six cases in the observation group were eliminated,39 cases in the observation group and 40 cases in the control group were evaluated finally.The MAP at T1 and T2 was significantly lower than that at T0 in the two groups (P ＜ 0.05).There was no significant difference in the MAP between T3,T4 and T0 in the two groups(P ＜ 0.05).There was no significant difference in the HR each time point in each group(P ＜ 0.05).There was no significant difference in the MAP and HR between the two groups at each time point(P ＜ 0.05).There was no significant difference in the MMSE score between the two groups before operation(P ＜ 0.05).The MMSE score of patients at the first and third day after operation was significantly lower than that before operation and the seventh day after operation in the two groups (P ＜ 0.05).There was no significant difference in the MMSE score between before operation and the seventh day after operation in the two groups(P ＜0.05).The MMSE score in the observation group was significantly higher than that in the control group at the first and third day after operation (P ＜ 0.05).There was no significant difference in the MMSE score between the two groups at the seventh day after opera tion(P ＜ 0.05).The incidences of POCD at the first,third and seventh day after operation in the observation group were 28.21％ (11/39),15.38％ (6/39) and 7.69％ (3/39) respectively;and they were 50.00％ (20/40),37.50％ (15/40) and 20.00％ (8/40) respectively in the control group.The incidence of POCD in the observation group was significantly lower than that in the control group at the first and third day after operation (x =3.934,4.949;P ＜ 0.05).There was no significant difference in the incidence of POCD between the two groups at the seventh day after operation(x2 =2.496,P ＜ 0.05).There was no significant difference in the levels of serum IL-6 and S-100β protein between the two groups before operation (P ＜0.05).The levels of serum IL-6 and S-100β protein at the end of operation and the first,third day after operation were significantly higher than those before operation in the two groups(P ＜ 0.05).The levels of serum IL-6 and S-100β protein in the observation group were significantly lower than those in the control group at the end of operation and the first,third day after operation (P ＜ 0.05).Conclusion Deep anesthesia (BIS value is maintained at 30-39) can reduce the levels of inflammatory factors,the incidence of POCD after operation and the brain damage in the elderly patients with abdominal operation.
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Objective To evaluate the analgesic effect of oxycodone hydrochloride and morphine in preemptive analgesia for abdominal surgery.Methods The 200 patients who received abdominal operation were randomly divided into the oxycodone hydrochloride group (group O) and the morphine group(group M) with 100 patients in each group,and patients of the two groups were given oxycodone hydrochloride and morphine in preemptive analgesia respectively .The VAS, OAA/S and BCS 48 hours after surgery , the frequency of the use of PCIA in 24 hours,the satisfaction of patients ,and the occurrence rate of complications were compared between the two groups .Results There was no significant difference between the two groups in VAS ,BCS,OAA/S,frequency of the use of PCIA and patients satisfaction (P>0.05).The occurrence rate of nausea,vomit,and itch in group O were much lower than that in group M (P<0.05).The occurrence rate of drowsiness in group O was higher than that of group M(P<0.05).Conclusion Compared with morphine,oxycodone hydrochloride has the same analgesia efficiency and less side effect occurrence rate for patients with abdominal operation .
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Objective To construct nursing service quality evaluation index system for abdominal operation patients. Methods Based on the service quality(SERVQUAL)model, a total of 33 nursing experts were selected by Delphi method for two turns of consultation. All the consultation experts have got senior professional title and 90.9%(30/33) have been working for more than 20 years. Finally, we calculated the questionnaire response rates, the authority coefficient, the mean and standard deviation, the coefficient of variation and the harmony coefficient. Results The response rates of questionnaires was 91.89% and 100% respectively, while the authority coefficient of experts was 0.91. The harmony coefficient of first and second and third indictors was 0.43, 0.47 and 0.53 respectively in the second consultation. Combined with selection of indicators and expert opinion, the final evaluation index system includes 6 first grade indexes, 14 second grade indexes and 49 third grade indexes. Conclusions There is a high level of authority and team coordination in experts. The results of the study can provide a reference for evaluating the nursing service quality of abdominal operation patients.
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Pleural effusion is one of the common complications after abdominal surgery, which has a high incidence rate. It not only extends the length of hospital stay and increases the economic burden, but also may affect the prognosis of patients or even endanger lives. Therefore, early diagnosis and treatment of pleural effusion are important for postoperative rehabilitation. So far,the relationship between pleural effusion and clinical pathological factors of postoperation has not been revealed clearly and definitely. Preventive measures and the causes are summarized by reading a large number of literatures and combining with clinical experience to reduce incidence rate.
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To observe the clinical efficacy of Chinese compound Kaixiong Shunqi Capsule in the treament of early intestinal paralysis caused by gynecology abdominal operation. After gynecology abdominal operation, 100 cases with early intestinal paralysis symptoms were randomly divided into two groups, 50 cases in treatment group with oral Kaixiong Shuqi Capsule for 6 h by taking three capsules and 18 h by taking three capsules after the operation; 50 cases in control group with oral Trimebutine for 6 h by taking three tablets and 18 h by taking three tables after operation. After the operation, the first time of anal exhaust, the first cacation time, and the changes of abdominal distension and pain, nausea and vomiting of the patients between the two groups were observed. The patients in the treatment group are better than those in the control group (P < 0.05). In the treament of early intestinal paralysis caused by gynecology abdominal operation, Kaixiong Shunqi Capsule has the exact effect.
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Objective To investigate the effect of dexmedetomidine on sedation and cognitive function in elderly pa-tients after abdominal operation. Methods From January 2013 to January 2014 in our department,100 cases of abdominal operation were randomly divided into observation group (infusion of dexmedetomidine﹚ and control group (infusion of saline﹚,50 cases in each group, compared two groups of patients before treatment and 10 min after administration, 30 min after administration of Ramsay score changes,changes in the two groups before operation 1 days, 1 days after operation,postoperative 3 days,7 days after operation,MMSE score, the two groups before operation (T0﹚, 5 min after operation(T1﹚,before extubation 15 min T2﹚,extubation 30 min(T3﹚systolic blood pressure (SBP﹚,diastolic blood pres-sure (DBP﹚,heart rate(HR﹚ and oxygen saturation(SpO2﹚changes. Results Patients with 10 min after administration, 30 min Ramsay after administration scores were higher than those in the control group,there was significant difference (P<0.05﹚. The MMSE score of the patients in control group after operation 1 d, postoperative were lower than that of the observation group,there was significant difference (P<0.05﹚. 2 groups of patients with T2 in T3,SBP levels were significantly higher than T0,but the control group was significantly higher than those in the observation group,there was significant difference(P<0.05﹚. Patients in the control group DBP level was T0 increased significantly,and the level of DBP in patients with T2 group,T3 was significantly higher than that in the control group,and the observation of DBP level significantly changes in T0-T2 group were not significant (P>0.05﹚. Patients in control group and T1-T3 in HR were higher than that of the observation group,there was significant difference(P<0.05﹚. Conclusion Dexmedetomidine for sedation in elderly patients after abdominal operation,the cognitive function of patients recovered quickly,and can maintain the stability of hemodynamics.
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Objective To discuss curative effect of Octreotide on early inflammatory intestinal obstruction after abdomi-nal operation and its influence on serum LPS and High sensitive C-reactive protein (hs-CRP) levels. Methods All 64 cases of patients with early inflammatory intestinal obstruction after abdominal operation were selected and divided into observation group (n=32) and control group (n=32) at random. The patients in two groups were given routine medical treatment, such like fasting, instant gastrointestinal decompression, anti-infection, intravenous nutrition,maintenance of water-electrolyte and acid-base balance and etc. The patients in observation group were additionally given 0.1mg Octreotide by hypodermic injection,q8h,while the patients in control group were given the same medical treatment as that in observation group except for Octreotide. The changes of serum LPS and hs-CRP levels of patients in two groups before and 6 days after the medical treatment,and the curative effect and untoward effect was compared as well. Results After 6 days' medical treatment, serum LPS and hs-CRP levels of patients in two groups were obvi-ously declined than before(P<0.05 or P<0.01),and the declining rate of patients in observation group was much higher than that in control group (P<0.05), and the total clinical efficiency in observation group (93.75%) was much higher than that in control group (75.00%)(χ2=4.27,P<0.05). 1 and 3 cases of untoward effect were appeared on patients in control group and observation group during treatment with light symptom, and after comparing the occurrence rates of untoward effect of patients in two groups,no differences were appeared(χ2=0.27,P>0.05). Conclusion Octreotide has reliable curative effect on early inflammatory intestinal obstruction after abdominal operation with high security, whose mechanism of action has close effect on obvious reducing serum LPS and hs-CRP levels of patients.
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Objective:To study the effect of sufentanil combined with dezocine on the PCIA after abdominal operation. Methods:Totally 110 patients undergoing abdominal operation were randomly divided into the experimental group and the control group with 55 cases in each. The two groups were both treated with electronic analgesia pump for the PCIA after the operation. The control group was given dezocine 0. 3 mg·kg-1 ,and the experimental group was given sufentanil injections 0. 1 g·kg-1 plus dezocine 0. 3 mg·kg-1 . The VAS score,adverse drug reactions,Ramesay scores,press number of patient controlled analgesia,exhaust time,recovery time of bowel sounds and bowel audio rate index in the two groups were compared to evaluate the effect of PCIA. Results:All the observed in-dices in the experimental group were significantly better than those in the control group(P<0. 01). The incidence of adverse reactions in the experimental group was significantly higher than that in the control group(P<0. 01). Conclusion:Sufentanil combined with dezocine for the PCIA after abdominal operation shows significantly analgesic and sedative effects,and can notably improve the clinical symptoms,which is worthy of clinical application.
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Objective:To discuss the influence and curative effect of octreotide combined with potent purgative decoction with ad-ditions on serum inflammatory factors level in the patients with early postoperative inflammatory bowel obstruction ( EPISBO) after ab-dominal operation. Methods: Totally 78 cases of patients with EPISBO after abdominal operation were divided into the observation group and the control group with 39 ones in each. The patients in the two groups were given the basic medical treatment, such as fast-ing, water deprivation, gastrointestinal decompression, maintenance of water, electrolyte and acid-base balance, infection prevention, parenteral nutrition support and etc. The patients in the control group were given 0. 1mg octreotide via hypodermic injection, q8h, while the patients in the observation group were additionally given potent purgative decoction with additions, one dose per day comple-ted by twice or three times through mouth or nasogastric tube. The course of treatment was 1 week. The changes of serum hs-CRP and TNF-α levels in the two groups before the treatment and after the medical treatment were observed and compared, and the curative effect and adverse drug reactions ( ADR) were evaluated as well. Results: After the one-week medical treatment, the serum hs-CRP and TNF-α levels in the two groups were obviously declined (P0. 05). Conclusion:Octreotide combined with potent purgative decoction with additions has significant curative effect in the patients with EPISBO after abdominal operation with high security, and the mechanisms are related with such effects as reducing serum hs-CRP and TNF-α levels and inhibiting local inflammatory response in intestinal tract.
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Objective To evaluate the effect of wound protector on preventing incisional wound infection following class Ⅲ-Ⅳincision abdominal operation.Methods Patients who had undergone class Ⅲ-Ⅳincision abdominal opera-tion from January 2013 to December 2014 were divided into trial group and control group according to whether they had used wound protector ,incidence of postoperative incisional wound infection between two groups were com-pared.Results A total of 310 patients were monitored,150 cases in trial group,and 160 cases in control group. Incidence of incisional wound infection in trial group was significantly lower than control group (4.00% [n=6]vs 11 .88%[n=19],χ2 =6.48,P <0.05).The average operation time and length of hospital stay in trial group were both shorter than control group ([42.10±3.30]min vs [58.30±4.10]min,P <0.05;[7.00±2.20]d vs [10.00 ±3.50]d ,P <0.05),score of pain assessment of incision in trial group was lower than control group([2.00 ± 1 .70]vs [3.00±1 .80],P <0.05).Conclusion Wound protector can effectively reduce the incidence of incisional wound infection following class Ⅲ-Ⅳincision abdominal operation.
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Objective To investigate the high risk factors causing abdominal operation incision infection in department of general surgery as well as explore the treatment measures in order to reduce the rate of postoperative incision infection.Methods Retrospective analysis was conducted.Two thousand one hundred and eighteen patients underwent abdominal operation in the Tangshan Branch of Hebei Corps Hospital of China People's Armed Police from Jan.2006 to Mar.2013 were selected as our subjects.Of them,there were 89 cases infected incision after operation and served as the observation group.Selected 80 cases patients without incision infection in the same period served as control group.The difference between two groups related factors were compared.Results In observation group,cases with aged over 60 years old,body mass index (BMI) over 25 kg/m2,complicated with metabolism disease,Ⅲ incision,operation period over 2 h,antibiotics application before operation,malignant tumor and use of electric knife were 18 (20.22％),19 (21.35％),12 (13.48％),17 (19.10％),28 (31.46％),13 (14.61％),11 (12.36％) and 28 (31.46％),respectively;significant different from those in control group (5 (6.25％),4 (5.00％),3 (3.75％),4 (5.00),11 (12.75％),3 (3.75％),2 (2.50％),11 (13.75％);P＜0.05).Conclusion There are a lot of factors causing abdominal incision infection in department of general surgery.The indices of high age,high BMI,with basic diseases,incision type Ⅲ,operation period over 2 h,without antibiotics application,with malignant tumor,use of electric knife are risk factors.
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Objective To investigate the clinical effect of abdominal operation,laparoscopic operation and vaginal operation on treating ovarian cysts in order to summarize the characteristics of Yin type way operation. Methods Two hundreds and twenty-six patients with benign ovarian cysts were selected as our subjects and they were hospitalized from Jan. 2006 to Dec. 2012 in the First People's Hospital of Shangqiu. Of 226 patients,there were 77 cases with laparoscopic operation( laparoscopic group),75 cases with vaginal operation(transvaginal group),and 74 cases with traditional open operation(abdominal group). The information of operation periods,intraoperative blood loss volum,postoperative analgesia,postoperative exhaust time and hospitalization days,and the rate of postoperative complication were collected. All the patients were followed-up at 1 or 3 months after surgery. Results Operation periods and bleeding volume in vaginal group was(41. 71 ± 16. 92)min and(33. 11 ± 20. 19)ml,less than that in laparoscopic((50. 73 ± 18. 71)min,(38. 21 ± 18. 73)ml)and abdominal group((61. 81 ± 19. 75)min.(107. 29 ± 41. 27)ml)and the difference was significant. Meanwhile,gastrointestinal function recovery in vaginal group was(12. 19 ± 4. 17)h,less than that other two groups(15. 43 ± 4. 31)h and(30. 00 ± 6. 21)h). In addition,shorter hospitalization period was also less than that of other two groups((4. 38 ± 1. 30)d vs.(5. 60 ± 0. 50)d vs.(8. 50 ± 2. 00)d;P 0. 05 ). Conclusion The approaches of transvaginal operation and laparoscopy operation treating the ovarian cyst have their advantages and disadvantages. It is better to accurately understand the operation indications and then achieve the best therapeutic effect with minimal trauma.
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Objective To observe the anesthesia and recovery results of sevoflrane and remifentanil combined anesthesia in open or laparoscopic surgeries. Methods 60 cases of ordinary surgeries from the department of gynecology and general surgeries were included in this study with 30 cases in each group. (1)recording total sevoflurane inhalation time, muscular relaxant amount, end tidal sevoflurane concentration;(2)recording BP,HR at 10 min after induction,operation staring and ending,ventilation recovery, opening eye and extubation period;also sevoflurane concentration 5 min after stopping medicine and ventilation recovery;recording time period between surgery ending and autonomous respiration recovery , eye opening and extubation. Results No any adverse events happen in each patient.the sevoflurane inhalation time in open surgery group was (157.20 ± 47.28) min, longer than that of laparoscopic surgeries group (73.50 ± 11.23)min(P0.05). Conclusion Sevoflurane combined remifentanil anesthesia can achieve stable intra-operative maintenance and rapid postoperative recovery quality , we suggest the widespread usage of it in clinic.
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Objective To investigate the changes of electrolyte metabolism in patients undergoing moderate elective abdominal operation,and explore its relationship with postoperative complications.Methods The clinical data of 1117 inpatients (age ≥ 18 years) who had undergone moderate elective abdominal operation in the Department of General Surgery of Beijing Hospital from January 1,2011 to December 31,2011 were retrospectively analyzed.They received postoperative fasting for ≥ 3 days,and the preoperative liver function and renal function were normal.The perioperative electrolyte changes and clinical outcomes were recorded.For patients with normal preoperative electrolytes but abnormal postoperative electrolytes,its potential correlations with the postoperative infections and total complications were analyzed.Results The rates of abnormal postoperative electrolytes were as follows:potassium,24.1％ ; sodium,6.4％ ; chloride,27.6％ ; calcium,61.7％ ; magnesium,16.3％ ; and phosphorus,71％.The vast majority of ion levels were below the normal levels.The total complication rate was 19.7％ and the postoperative infection rate was 17.19％.Univariate logistic regression analysis showed that the postoperative total and infective complications were significantly associated with the increased (P =0.007) or decreased (P =0.007) serum potassium,the decreased serum sodium (P =0.016),the decreased serum phosphorus (P =0.004),and the decreased magnesium (P =0.049).Conclusions Electrolyte decrease is common after moderate elective abdominal operations.There is a certain correlation between postoperative electrolyte decrease and postoperative complications.Therefore,attention should be paid to maintain electrolyte balance during the perioperative period.
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Objective To analyze the effect of different anesthesia methods for postoperative patients with abdominal operation on cognitive function .Methods A total of 418 patients with abdominal operation in this hospital were randomly divided into 5 groups(A -E) according to random numbers table ,different anesthesia methods were used before and after operation in patients . The cognitive function were analyzed and evaluated by MMSE scale .Results The influence of different ways of anesthesia on cog-nitive function in patients persistent to operation after third days still existed .The cognitive scores of patients in group B 3 hours af-ter operation were highest ,the occurrence rate of cognitive dysfunction postoperative were minimum .Conclusion The compound general anesthesia method by remifentanil and sevoflurane have minimal effects for cognitive function postoperative on abdominal operation patients .
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@#Objective To investigate the related factors of postoperative pulmonary complications with abdominal operation. Methods 193 cases after abdominal operation were reviewed. The age, smoking history, surgery duration, surgical site, pulmonary function, artery blood gas analysis, and the incidence of post-operative pulmonary complications were analyzed. Results Pulmonary complications were found in 29 cases. The age was higher and surgery duration was longer in patients with pulmonary complications than those without pulmonary complications (P<0.05). The patients with abnormal forced expiratory volume in the first second (FEV1)%, FEV1/ forced vital capacity (FVC)%, maximum ventilatory volume (MVV)% and smoking history before operation were in higher risk for post-operative pulmonary complications (P<0.05). There was significant difference in artery blood gas analysis between the 2 groups (P<0.05). Conclusion The age,smoking history, surgery duration and pulmonary dysfunction may be the risk factors of pulmonary complications after abdominal operation,while it is important to monitor the blood gas analysis.
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PURPOSE: As patients who take immediate breast reconstructions with TRAM flap have increased, concomitant or delayed other elective intra-abdominal operations in these patients also have increased. There are few reports of concomitant or delayed intra-abdominal operation in TRAM flap patients. We report our experiences and outcomes of these operations which is safe and feasible. METHODS: We reviewed the charts and postoperative follow-up results of 11 patients among 471 consecutive patients who took immediate breast reconstruction with TRAM flap from December of 2002 to September of 2006. Four patients took concomitant intra-abdominal operation and 7 patients took delayed intra-abdominal operation between 1 to 52 months after TRAM flap RESULTS: There were no significant postoperative abdominal and systemic complications. One patient who took concomitant intra-abdominal operation presented partial skin necrosis of abdomen, but recovered completely with conservative treatments. Two patients took transfusion in peri-operative periods. CONCLUSION: Concomitant or delayed intra-abdominal operation in immediate breast reconstruction with TRAM flap could be performed safely and feasibly when it is necessary. Furthermore, it could be helpful to patients and surgeons.
Sujets)
Femelle , Humains , Abdomen , Région mammaire , Études de suivi , Mammoplastie , Nécrose , PeauRésumé
Objective To explore the effects of L-carnitine on the plasma lipid profile and liver function in elderly patients receiving total parenteral nutrition after abdominal operations.Methods In this prospective blinded randomized controlled trial,24 eligible elderly patients were given 6-day total parenteral nutrition.They were further equally divided into L-carnitine group(administered with L-carnitine 50 mg/kg)and control group(without L-carnitine).The changes of lipid profile and liver function and the clinical outcomes were recorded and compared.Results The plasma triglyeride levels were lower in L-carnitine group than in control group on the 4th and 7th post-operative day,but there were not significant difference(P>0.05);There was a significant difference between the two groups in the change of the 4th post-operative day and pre-operative day(P<0.05).However,the liver function indicators were not significantly different between these two groups.Conclusion Administration of L-carnitine during total parenteral nutrition can improve the triglyeride metabolism in elderly patients after abdominal operations and may benefit the recovery of liver function.
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Objective To evaluate the effects of carbohydrate-electrolyte solution(CES)on serum glucose,pancreas islet function,and safety in elderly patients after abdominal operation.Methods In this prospective,double-blinded,randomized,and controlled study,40 elderly patients who met the defined criteria were enrolled.Subjects in CES group were intravenously administered with 1 000 ml CES for consecutive three days beginning from the 1st and 2nd post-operative day,while subjects in the control group were administered with 10% glucose of the same volume under the same arrangement.The changes of serum glucose,insulin and insulin C-peptide,as well as lactic acid and uric acid and uric acid were determined before and after injection.Adverse events were recorded.Results All patients completed the study.The increase rate of serum glucose was significantly lower on the 2nd and 3rd day after injection in CES group than in control group(P=0.008,P:0.001).Blood insulin and insulin C-peptide levels showed increasing trends in both two groups,but were not significantly different between two groups(P=0.612,P=0.213).In the CES group,6 patients experienced systemic inflammatory response syndrome and 4 patients had infective complications after surgeries ;on the contrary,these two numerals were 8 and 6 in the control group(P=0.639,P=0.606).No increase in serum lactic acid or uric acid was detected.Conclusion Appropriate application of CES has minimal effect on the blood gluocse and pancreas islet function in elderly patients after abdominal surgery and may be helpful to improve clinical outcomes.
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Objective To discuss the influential factors of postoperative pulmonary complications in elder patients accepted abdominal operation. Methods The clinical data of 95 cases accepted abdominal operation were analyzed retrospectively,and all the patients aged over 60. These patients were divided into two groups based on whether they had pulmonary complications or not. Seven relative factors including the age,sex,smoking history,surgery duration ,operation place,pulmonary function,anesthesia were analyzed and the relationship between these factors and the incidence of postoperative pulmonary complications were explored,too. Results Among the 95 patients,19 cases had pulmonary complications. The surgery duration in patients with pulmonary complications ((3.4 ± 1.1)h)were significantly higher than in those without pulmonary complications ((2. 6 ± 0. 9)h)(P ＜0.05). We also found significant differences in the comparison of FEV1%(59.2 ±9.5),FEV1/FVC(61.3 ±7.7)% ,MVV%(59.3 ±8.6)% in the group with pulmonary complications,with FEV1%(79.7 ± 11.5)%、FEV1/FVC(73.2 ±8. 3)% 、MVV%(74. 2 ±6. 4)% in the group without pulmonary complications. The epigastric operation and general anesthesia before operation were risk factors for post-operative pulmonary comphcations(P ＜0. 05). Conclusions Surgery duration,operation place,pulmonary dysfunction and anesthesia may be the risk factors of pulmonary complications after abdominal operation.