Hypernatremia increases the incidence of late delirium after cardiac surgery / 中国胸心血管外科临床杂志

@#Objective    To analyze whether hypernatremia within 48 hours after cardiac surgery will increase the incidence of delirium which developed 48 hours later after surgery (late-onset delirium). Methods    We conducted a retrospective analysis of 3 365 patients, including 1 918 males and 1 447 females, aged 18-94 ( 60.53±11.50) years, who were admitted to the Department of Cardiothoracic and Vascular Surgery of Nanjing First Hospital and underwent cardiac surgery from May 2016 to May 2019. Results    A total of 155 patients developed late-onset delirium, accounting for 4.61%. The incidence of late-onset delirium in patients with hypernatremia was 9.77%, the incidence of late onset delirium in patients without hypernatremia was 3.45%, and the difference was statistically different (P<0.001). The odds ratio (OR) of hypernatremia was 3.028 (95% confidence interval: 2.155-4.224, P<0.001). The OR adjusted for other risk factors including elderly patients, previous history of cerebrovascular disease, operation time, cardiopulmonary bypass time, lactate, hemoglobin≥100 g/L, prolonged mechanical ventilation, left ventricular systolic function, use of epinephrine, use of norepinephrine was 1.524 (95% confidence interval: 1.031-2.231, P=0.032). Conclusion    Hypernatremia within 48 hours after cardiac surgery may increase the risk of delirium in later stages.

Application of blind bedside non-spiral nasointestinal tubes in critically ill patients / 中华临床营养杂志

Objective To evaluate the effect of blind bedside non-spiral nasointestinal tubes in critically ill patients.Methods Patients requiring bedside nasointenstinal tubes in intensive care unit of Nanjing First Hospital from February 2017 to February 2018 were enrolled in this study.The placement of nasointenstinal tubes was conducted according to the reference procedure of our department,recording operation times,operation duration,position of the tube's tip,expense and complications.Results A total of 53 patients received the bedside non-spiral nasointenstinal tubes which were conducted for 64 times.51 patients (51/53,94.4％) were successful in tube placement,45 case-times (45/64,70.3％) were successful at the first attempt,and 50 case-times (50/64,78.1％) were successful at the second attempt in accumulation.The mean time of our procedure was (13.80±6.90) minutes,the mean insertion length was (99.55±8.35) cm,and the mean expense was (244.82±45.68) Yuan.No severe complications were observed.Conclusion Blind bedside placement of non-spiral nasointestinal tubes has high success rate and many advantages as short operation time,low expense and less complications,which is a good choice for early establishment of enteral feeding pathway and early supplement of enteral nutrition in critically ill patients.

α7nAchR in dexmedetomidine coordinate with mlelatonin attenuate delirium in rats / 临床麻醉学杂志

Objective To observe dexmedetomidine coordinate with mlelatonin attenuate the scopolamine-induced delirium in rats and its mechanism.Methods Thirty male adult SD rats aged 6-8 weeks were randomly divided into six groups:normal saline control group (group C),scopolamine-induced delirious model group (group S),dexmedetomidine group (group D),mlelaton group (group M),α-bungarotoxin antagonism group (group BM),joint protection group (group DM).A model of delirium was reproduced by intraperitoneal inj ection of scopolamine 1.8 mg/kg.The rats in group C was given equal sterile normal saline instead,the rats in group D was intraperitoneal injected of dexmedetomidine 40 μg/kg 15 minutes before scopolamine injection,the rats in group M was intrap-eritoneal injected of mlelaton 5 mg/kg in the contralateral abdominal at the same time with scopolamine injection,the rats in group BM was intraperitoneal injected ofα-BGT 1 μg/kg 15 minutes before scopolamine injection and mlelaton 5 mg/kg in the contralateral abdominal at the same time with scopolamine injection,the rats in group DM was intraperitoneal injected of dexmedetomidine 40 μg/kg 15 minutes before scopolamine injection and mlelaton 5 mg/kg in the contralateral abdominal at the same time with scopolamine injection.The rats were assigned for open field test 15 minutes before and 10 minutes after model reproduction for 15 minutes.The level ofα7nAchR in serum was deter-mined by enzyme linked immunosorbent assay.Results When compared with group C,rats in group S ran significant longer total distance and space distance,had faster total speed and space speed (P<0.05).When compared with group S,rats in group D,group M,group DM ran significant shorter total distance and space distance,had significant slower total speed and space speed (P<0.01 );when compared with group D,rats in group DM ran significant shorter total distance and space dis- tance (P<0.05 ),had slower total speed and space speed,however without significant statistical difference.When compared with that in group C,the level of α7nAChR in serum were significantly decreased in group S (P<0.05).When compared with group S,the level of α7nAChR were signifi-cantly increased in group D (P<0.01).There were no significant difference between group M and group S (P=0.96).When compared with group D,the level of α7nAChR had an elevated trend in group DM.Conclusion Dexmedetomidine can improve the symptoms of delirium,possibly by in-creasing the activity of alpha 7nAChR.Melatonin may improve the effect of dextromidine on delirium.

Correlation risk factors analysis of mortality of Tile C pelvic fracture / 临床麻醉学杂志

Objective To explore the significant risk factors in patients with Tile C pelvic frac-tures.Methods We conducted a retrospective review of all patients with Tile C pelvic fractures in Nanjing First Hospital from January 2010 to December 2014.The data gathered on each patient in-cluded:age,sex,mechanism of injury,visiting time after injury,shock index,Injury severity scale (ISS),Revised trauma score (RTS),Glasgowcoma scale (GCS),lowest PaO2/FiO2 ,6 h lactate clearance rate,concomitant injures and interventious of Tile C pelvic fractures.The data were tested using Student’t-test,χ2 test and logistic regression method.Results The study include 139 consecutive patients.The total mortality was 29.5%.Among them,36 (25.9%)patients died within 48 hours after admission.Multivariate regression analysis showed that shock index (OR=2.591,95%CI 1.041-4.216), ISS (OR = 47.96,95%,CI 15.89-147.23 ),RTS (OR = 6.917,95% CI 1.147-13.862 ),GCS (OR =4.172,95%CI 2.962-6.268),lowest PaO2/FiO2 (OR= 117.016,95% CI 51.011-176.032),6 h lactate clearance rate (OR=2.785,95%CI 1.191-4.892),concurrent head (OR=6.302,95%CI 2.270-13.175)or chest (OR=12.233,95%CI 5.193-33.985)injures were associated with high morality of Tile C pelvic frac-ture (P <0.01).The performing digital subtraction angiography with intravascular embolization can cut the mortality (OR=0.887,95%CI 0.875-0.899).Conclusion In our study,high trauma score,serious shock, coma,PaO2/FiO2 decreased and 6 h lactate clearance rate decreased,combined with the head and chest inju-ry are the important reasons of mortality in patients with Tile C pelvic fracture.It’s vital to control shock actively,use trauma scale and emphasize multidisciplinary cooperation to reduce mortality in patients with Tile C pelvic fractures.