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@#Objective To systematically evaluate the risk factors for hypoxemia after Stanford type A aortic dissection (TAAD) surgery. Methods Electronic databases including PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP and CBM were searched by computer to collect studies about risk factors for hypoxemia after TAAD published from inception to November 2021. Two authors independently assessed the studies' quality, and a meta-analysis was performed by RevMan 5.3 software. Results A total of 19 case-control studies involving 2 686 patients and among them 1 085 patients suffered hypoxemia, included 21 predictive risk factors. The score of Newcastle-Ottawa scale≥7 points in 16 studies. Meta-analysis showed that: age (OR=1.10, 95%CI 1.06 to 1.14, P<0.000 01), body mass index (OR=1.87, 95%CI 1.49 to 2.34, P<0.000 01), preoperative partial pressure of oxygen in arterial blood/fractional concentration of inspiratory oxygen (PaO2/FiO2)≤300 mm Hg (OR=7.13, 95%CI 3.48 to 14.61, P<0.000 01), preoperative white blood cell count (OR=1.34, 95%CI 1.18 to 1.53, P<0.000 1), deep hypothermic circulatory arrest time (OR=1.33, 95%CI 1.14 to 1.57, P=0.000 4), perioperative blood transfusion (OR=1.89, 95%CI 1.49 to 2.41, P<0.000 01), cardiopulmonary bypass time (OR=1.02, 95%CI 1.00 to 1.03, P=0.02) were independent risk factors for hypoxemia after TAAD surgery. Preoperative serum creatinine, preoperative myoglobin, preoperative alanine aminotransferase were not associated with postoperative hypoxemia. Conclusion Current evidence shows that age, body mass index, preoperative PaO2/FiO2≤300 mm Hg, preoperative white blood cell count, deep hypothermic circulatory arrest time, perioperative blood transfusion, cardiopulmonary bypass time are risk factors for hypoxemia after TAAD surgery. These factors can be used to identify high-risk patients, and provide guidance for medical staff to develop perioperative preventive strategy to reduce the incidence of hypoxemia. The results should be validated by higher quality researches.
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@#Objective To analyze the changes of perioperative thyroid hormone in patients undergoing cardiac surgery under cardiopulmonary bypass, and to provide guidance for postoperative cardiac management. Methods The clinical data of 72 patients receiving cardiac surgery under cardiopulmonary bypass in our hospital from January to May 2019 were collected, including 35 males and 37 females, aged 19-72 (52.35±10.40) years. The changes of thyroid hormones before operation, 2 hours and 24 hours after operation were analyzed. Results There was a statistical difference in thyroid stimulating hormone (TSH), triiodothyronine (T3), tetraiodothyronine (T4) and free tetraiodothyronine (FT4) between postoperative 2 hours and preoperation (P<0.05). There was a statistical difference in TSH, T3, free triiodothyronine (FT3), T4 and FT4 between postoperative 24 hours and preoperation (P<0.05). There was a statistical difference in TSH, T3, FT3 and T4 between postoperative 24 hours and 2 hours (P<0.05). Postoperatively T3 and FT3 decreased, TSH increased and then decreased while T4 and FT4 were within the normal range. Repeated measures analysis of variance showed a statistical difference of time effect in TSH, T3, FT3, T4 and FT4. Conclusion Patients with cardiac surgery under cardiopulmonary bypass have different thyroid hormones postoperatively compared with preoperatively. T3 and FT3 decrease, TSH increases and then decreases, while T4 and FT4 are in the normal range. The results require further large-scale, multi-center, high-quality clinical studies to be confirmed.
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@#Objective To systematically evaluate the risk factors for hypoxemia after coronary artery bypass grafting (CABG). Methods Eight electronic databases including PubMed, EMbase, CENTRAL, Web of Science, CNKI, CBM, VIP and Wanfang data were searched by computer to collect cochort and case-control studies about CABG and hypoxemia published from inception to March 2020. Two authors independently assessed the quality using the Newcastle-Ottawa Scale (NOS), and a meta-analysis was performed by RevMan 5.3 software. Results A total of 15 studies involving 4 277 patients were included in this study and among them 1 273 patients suffered hypoxemia. Meta-analysis showed that age (OR=1.55, 95%CI 1.22 to 1.96, P=0.000 3), smoking (OR=3.22, 95%CI 2.48 to 4.17, P<0.000 01), preoperative chronic pulmonary diseases (OR=4.75, 95%CI 3.28 to 6.86, P<0.000 01), diabetes (OR=2.49, 95%CI 1.86 to 3.33, P<0.000 01), left ventricular ejection fraction (OR=3.15, 95%CI 2.19 to 4.52, P<0.000 01), number of coronary artery lesions (OR=2.20, 95%CI 1.63 to 2.97, P<0.000 1) were independent risk factors for hypoxemia after CABG; body mass index (OR=1.31, 95%CI 0.97 to 1.77, P=0.08) and cardiopulmonary bypass time (OR=3.40, 95%CI 0.72 to 15.94, P=0.12) were not associated with hypoxemia. Conclusion Current evidence shows that age, preoperative chronic pulmonary diseases, smoking, diabetes, left ventricular ejection fraction, number of coronary artery are risk factors for hypoxemia after CABG, which can be used to identify high-risk patients and provide guidance for medical staff to develop perioperative preventive strategies to reduce the incidence of hypoxemia. The results should be validated by large-scale standard studies in the future.
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Objective To systematically evaluate the association between frailty and risk of postoperative delirium.Methods Systematic review of literature was conducted using eight electronic databases:PubMed,Embase,CENTRAL,Web of Science,CNKI,CBM,VIP and Wanfang Data,and prospective cohort studies about association between frailty and postoperative delirium published before March 2017 were included.Two authors independently screened the literature,extracted the data,and assessed the quality using NOS Scale,and meta-analysis was conducted by RevMan 5.3 software.Results A total of eight studies involving 846 patients were included in this review.Meta-analysis showed that:frailty was associated with higher risk of postoperative delirium [OR=3.63,95％CI (2.06,6.40),P＜0.001].Subgroup analysis showed that:①Frailty assessment tool:Fried frailty criteria and other frailty assessment were associated with increased risk of postoperative delirium[OR=5.81,95％CI(3.54,9.77),P＜0.001],[OR=1.76,95％CI(1.06,2.92),P=0.03].②Age:frailty patients aged 60～74 had increased risk of postoperative delirium [OR=5.05,95％CI (3.14,8.12),P＜0.001],but for patients aged ≥ 75,frailty wasn't associated with postoperative delirium [0R=1.73,95％CI (0.99,3.00),P=0.05].③Type of surgery:for cardiovascular and non-cardiovascular surgery patients,frailty was associated with increased risk of postoperative delirium [OR=3.40,95％CI (1.64,7.05),P＜0.001],[OR=4.95,95％CI (2.41,10.16),P＜0.001].Conclusion Frailty can increase the risk of postoperative delirium.In consideration of quantity and quality of included studies,the conclusion needs to be validated by multi-centered prospective cohort studies with large sample size.
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Objective To investigate the prevalence and influencing factors associated with frailty among institutional older adults and to provide evidence for intervention study.Methods A total of 237 older adults living in four welfare homes from Chengdu in Sichuan Province were recruited by convenience sampling.A cross-sectional survey was conducted,and frailty was assessed by the frailty phenotype;general information was collected by selfmade general information questionnaire;functional capacity was assessed by Barthel questionnaire;depressive status was assessed by GDS-15;cognitive function was assessed by clock drawing test and nutritional status was assessed by short form mini nutritional scale questionnaire (MNA-SF).Results The reported rate of frailty was 55.69％ among institutional older adults,and 44.31％ reported no frailty;grip weakness (207,87.3％),slow walking speed (172,72.6％) and low physical activity(131,55.3％) were the main frailty problems.Univariate analysis showed that the elderly'frailty conditions were different in the pre-retirement occupations,smoking,alcohol consumption,physical exercise,chronic diseases,medication,acute events (last year),self-reported health,using assisted walking devices,ability of daily life,depression,cognitive ability and nutritional status,and the differences were statistically significant(P＜0.05).Conclusion The status of frailty is not optimistic among institutional older adults and many factors are associated with frailty.Healthcare providers should pay more attention to the frailty issue and take timely intervention strategies to prevent or delay the frailty.
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<p><b>OBJECTIVE</b>To compare the clinical efficacy differences between acupoint plaster therapy with midnight-noon ebb-flow hour-prescription method and traditional acupoint plaster therapy for senile osteoporosis (SOP).</p><p><b>METHODS</b>With randomized controlled blind design, 76 SOP patients with deficiency of liver and kidney syndrome were randomly divided into an observation group and a control group, 38 cases in each one. Based on oral administration of caltrate D, the patients in the observation group were treated with acupoint plaster therapy with midnight-noon ebb-flow hour-prescription method at Yingu (KI 10), Taixi (KI 3), Dazhong (KI 4), Fuliu (KI 7) and Zhiyin (BL 67), while the patients in the control group were treated with traditional acupoint plaster therapy. Each plaster therapy lasted for 6 h, once a day; there was an interval of 2 d after consecutive 5-day treatment; 4 weeks were taken as one course, and totally 2 courses were given. Visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the pain and dysfunction before intervention, after 4 weeks and 8 weeks intervention. Osteoporosis symptom rating sale and quality of life questionnaire of the European foundation for Osteoporosis (QUALEFFO-41) were adopted to evaluate the TCM syndrome and quality of life before and after 8-week intervention.</p><p><b>RESULTS</b>All the outcomes were significantly improved after treatment in the two groups (<0.01,<0.05); after 4 weeks and 8 weeks of treatment, the VAS and ODI in the observation group were lower than those in the control group (all<0.05). Repeated ANOVA indicated the VAS and ODI were significant in group effect, time effect and interaction effect (all<0.01). Further comparison showed that VAS and ODI at later time points were lower than those in the early time points (all<0.01). After the treatment, the scores of TCM syndrome and QUALEFFO-41 in the observation group were lower than those in the control group (all<0.05). The effective rate was 85.7% (30/35) in the observation group, which was superior to the effective rate in the control group[74.3%(26/35),<0.05].</p><p><b>CONCLUSIONS</b>The acupoint plaster therapy with midnight-noon ebb-flow hour-prescription method is superior to traditional acupoint plaster therapy in improving pain, dysfunction, TCM syndrome and quality of life in SOP patients; in addition, its clinical efficacy is significant.</p>