ObjectiveTo investigate the situation of off-label drug use in dose (OLDUD) of ambroxol hydrochloride injection (AHI) in perioperative period among patients for stanford type A aortic dissection in Guangdong General Hospital, so as to provide references for the rational application of AHI in clinical practice.
MethodsAll medical orders of AHI for patients had aortic arch replacement for Stanford type A aortic dissection in Guangdong General Hospital between January 2005 and December 2014 were included. The patients were divided into a mild OLDUD ( < 450 mg) group, a moderate OLDUD (450 mg≤OLDUD < 900 mg) group, and a high OLDUD (≥900 mg)group. The preoperative and postoperative features, incidence of PPCs, mortality, incidence of reintubation, time of mechanical ventilation, time stay in ICU, time stay in hospital and the overall costs among three groups were compared by SPSS 22.0 software.
Resultsa) A total of 549 patients were included. The incidence of OLDUD was 99.82%. The most common PMDDs were 450 mg (n=358) and 900 mg (n=88). b) The three groups were well matched for perioperative and operative variables. c) The incidence of preoperative drug use was 8.6%. The incidences (5.5% vs. 7.7% vs. 15.7%, P=0.022) and maximum doses (180 mg vs. 300 mg vs. 450 mg, P=0.014) of preoperative drug use were statistically different in mild OLDUD, moderate OLDUD and high OLDUD groups. The days of preoperative drug use were not different (3 d vs. 2.5 d vs. 2 d, P=0.307). The days of postoperative drug use (9.5 d vs. 13 d vs. 19 d, P < 0.001) and postoperative drug use in maximum doses (7 d vs. 8 d vs. 7 d, P=0.005) were different. d) The incidence of PPCs was 100%, and the mortality (8.2% vs. 6.6% vs. 9.0%, P=0.696) was not statistically different among mild OLDUD, moderate OLDUD and high OLDUD groups. However the incidence of reintubation (14.3% vs. 13.8% vs. 27%, P=0.009), time of mechanical ventilation (37 h vs. 50 h vs. 114 h, P < 0.001), time stay in ICU (138 h vs. 178.5 h vs. 316 h, P < 0.001), time stay in hospital (25 d vs. 27 d vs. 34 d, P=0.001) and the overall costs (￥ 0.17 million vs. ￥ 0.19 million vs. ￥ 0.25 million, P < 0.001) were different among three groups. Moreover, they were all increasing along with the dose of AHI.
ConclusionAHI cannot improve the prognosis of patients having aortic arch replacement for Stanford Type A Aortic Dissection in a dose-dependent manner. Further well-designed prospective studies should be conducted to verification or falsification.
ObjectiveTo summarize the perioperative blood management strategies for joint arthroplasty.
MethodsThe literature concerning preoperative, intraoperative, and postoperative blood management was reviewed and summarized.
ResultsAt present, a variety of blood management and conservation strategies are available. Preoperative strategies include iron supplementation, erythropoietin (EPO), and preoperative autologous donation (PAD). Intraoperative options include acute normovolemic hemodilution (ANH), antifibrinolytics, and the use of a tourniquet. Postoperative strategies include the use of reinfusion systems and guided transfusion protocols. Preoperatively, administration of either simple EPO or a combination of EPO and PAD can be efficacious in anemic patients. Intraoperatively, tourniquet use and tranexamic acid can effectively control bleeding. Postoperatively, appropriate transfusion indications can avoid unnecessary blood transfusions.
ConclusionPerioperative blood management strategies for joint arthroplasty should be integrated for the individual patient using a variety of ways to reduce perioperative blood loss and blood transfusion, and promote the rehabilitation of patients.
OBJECTIVE: To investigate the efficacy of different flaps in the treatment of skin defect of hell. METHODS: Forty-six patients with skin defect of hell were adopted in this study. There were 39 males and 7 females, 29 years old in average. Six different flaps were applied in the reconstructive operation, 14 plantaris medialis flaps, 4 flexor digitorum brevis muscle flaps, 3 abductor hallucis flaps, 7 latissimus dorsi flaps, 16 distal medialis flaps of leg pedicled with the cutaneous branch of posterior fibial artery, 2 foot dorsum flaps. RESULTS: All the flaps survived, primary healing of the wound in 45 cases and secondary healing in 1 case. Followed up for 3 months to 4 years, 43 patients obtained good flap sensation, the function of weight bearing were satisfied in 43 patients. CONCLUSION: The six different flaps should be applied according to patient’s condition individually. The sensation of flap is very important to the function of weight bearing.
ObjectiveTo evaluate rational use of antibiotics for hernioplasty in perioperative period by intervention-control study in order to provide a foundation for the clinical antibiotic use and management.
MethodsThe data of the preventive use of antibiotics for hernia patients from January to October, 2010 in perioperative period were collected and compared. Interventions on patients from January to October, 2011 were carried out.
ResultsIn the intervention group, the first three antibiotics used were changed from azlocillin, mezlocillin and aztreonam before intervention to cefazolin, clindamycin and azlocillin after intervention. Before intervention, antibiotics were first used after surgery for surgical prophylaxis, while after intervention, antibiotics were first used within 30 minutes before surgery or at the start of induction of anesthesia. The preventive medication time decreased from (3.50±2.07) days to (0.88±1.07) days (t'=14.601, P=0.000), the hospitalization days of post-surgery decreased from (5.17±1.90) days to (3.77±1.61) days (t'=7.313, P=0.000), the cost of antibiotics decreased from (342.39±415.50) yuan to (54.08±80.83) yuan (t'=8.831, P=0.000), the percentage of the cost of antibiotics in expenses for medicine declined from (47.53±25.51)% to (12.49±13.46)% (t'=15.776, P=0.000), and the percentage of the cost of antibiotics in hospitalization expenses declined from (6.59±5.49)% to (1.07±1.35)% (t'=12.662, P=0.000). The difference in inappropriate use of antibiotic drugs before and after prevention, such as choice of preventive drugs, preoperative medication occasion, course of postoperative medication and no indication of drug combination, had statistical significances (P<0.05).
ConclusionThe intervention-control study shows that the rational use of antibiotics for hernioplasty in perioperative period can be improved, and the average hospitalization days and the cost of antibiotics can be reduced by intervention.
Objective To investigate the protection of renal function and the prevention of acute renal failure （ARF） in patients with malignant obstructive jaundice in perioperative period of radical resection. Methods A series of clinical interventions had been taken since 2004 in our treatment team, including control of endotoxemia, depression of biliary tract before operation, maintenance of adequate effective blood volume, nutritive support, administration of mannitol and low dose of furosemide, and avoidance of disseminated intravascular coagulation. The incidence of perioperative ARF in 206 patients with malignant obstructive jaundice who had been radically resected from 2000 to 2007 was retrospectively studied, and the RIFLE criteria was used for ARF classification. This study was progressed in two periods. The first one was from Jan. 2000 to Dec. 2003, and the second one was from Jan. 2004 to Dec. 2007. Results After 2003, the proportion of radical resection rose from 44.8% to 57.1% （P＜0.05), and the rate of perioperative ARF dropped from 15.1% to 6.7%（P＜0.05), among which the proportion in the RIFLE-R (Risk) stage had no significant change, while in the RIFLE-F (Failure) stage it dropped from 10.5% to 2.5% (P＜0.05). Finally, perioperative mortality rate dropped from 16.3% to 5.8% (P＜0.05). Therefore, the reduction of ARF was mainly attributed to the reduction in RIFLE-F stage. Conclusion By using the latest RIFLE criteria to classify ARF, it illustrates that our perioperative interventions have effectively decreased ARF, limited ARF in its early and reversible stage, and prevented advancing.
ObjectiveThis study aimed to revise the perioperative recovery scale for integrative medicine (PRSIM) based on item response theory (IRT). MethodsUnder the guidance of IRT, a total of 349 patient data collected during the development of the original version of PRSIM at Guangdong Provincial Hospital of Chinese Medicine were used. Principal component analysis was performed using SPSS 18.0 software to test the unidimensionality. The R language was utilized for parameter estimation, including discrimination coefficient, difficulty parameters and information content, as well as drawing item characteristic curves to assess item quality and estimate item functioning differences. A comprehensive screening process was carried out by combining expert consultations, patient evaluations, and discussions within a core group. ResultsThe degree of discrimination of all items ranged from ?0.535 to 2.195. The difficulty coefficient ranged from ?10.343 to 5.461, and the average information content of all items ranged from 0.043 to 1.075. Based on the criteria for parameter selection, nine items were retained. The results of expert consultations indicated the removal of 5 items and the modification of 7 items. After discussion within the core group, a final decision was made to remove 5 items. ConclusionBased on a synthesis of IRT and expert consultation feedback, and following discussions within the core group, a revised version comprising 15 items is retained and modified from the original 20 items.
ObjectiveTo systematically evaluate the benefits and harms of intraoperative positive end-expiratory pressure (PEEP) to all adult patients suffered surgery, especially on the postoperative mortality and pulmonary outcomes.
MethodsWe electronically searched PubMed, EMbase, The Cochrane library (Issue 3, 2012), CBM, CNKI from inception to January 2013, for randomized controlled trials (RCTs) about PEEP for the prevention of pulmonary complications. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted the data, and evaluated the quality of the included studies. Then meta-analysis was conducted using RevMan 5.1 software.
ResultsA total of 8 RCTs involving 336 patients were finally included. The results of meta-analysis showed that there was no difference between two groups in mortality (OR=0.95, 95%CI 0.13 to 6.92, P=0.96). However, the PEEP group had a higher PaO2/FiO2 the first day after surgery (MD=22.98, 95%CI 4.40 to 41.55, P=0.02), while there was no difference 2-3 days after surgery (MD=12.59, 95%CI-6.78 to 31.96, P=0.31). Meanwhile, postoperative atelectasis was less in the PEEP group (OR=0.27, 95%CI 0.08 to 0.9, P=0.03).
ConclusionChoosing PEEP mode during general anaesthesia may improve postoperative oxygenation index in the first day after surgery, and reduce pulmonary complications, which has a protective effect on patients pulmonary function. However, it has no marked influence on the prognosis. Because of the limited quality and sampling size of the induced studies, this conclusion still needs to be further proved by more large-scale, multicenter and perspective RCTs.
Objective To investigate the changes of renal medulla aquaporin 2 expression and morphological changes of epithelia of collecting tube after bile duct recanalizaiton operation. Methods Thirty rats were divided into two groups randomly. Common bile duct ligation was performed on 20 experimental rats with silicon tubes 2 mm in extre-diameter, and sham operation on the other 10 rats. Seven days later, bile duct recanalizaiton was performed on obstructive jaundice group and sham operation on contrast group. Experimental rats were divided into two subgroups randomly. Half of them were killed immediately and the others would be killed 24 hours later. Serum of each rat was collected to detect hepatic function and renal function. Renal medulla was fixed for microscopic examination and was kept in the -80 ℃ refrigerator for aquaporin 2 expression measurement by Western blot technique. Results All of the animals accomplished the experiment smoothly. Golden ascites were found in the rats of obstructive jaundice group. Twenty-four hours after recanalization, serum bilirubin levels decreased 〔(45.95±8.39) μmol/L〕, P＜0.01, and there was no significant change in blood urine and creatine level. Compared with sham operation group (21 966.20±1 544.70), expression of aquaporin 2 decreased significantly after common bile duct ligation in obstructive jaundice group (15 665.30±1 181.85), P＜0.01. After recanalizaion, the expression of aquaporin 2 in obstructive jaundice group increased (19 490.80±4 239.32), P＜0.01. Conclusion Common bile duct obstruction would lead to epithelium injury of renal collecting tube, and down regulate the aquaporin 2 expression.
Objective To explore the perioperative management of the coexisting diseases for the elderly patients with gastric cancer. Methods The clinical data of perioperative management for coexisting diseases in 528 patients with gastric cancer over 70 years old treated in the First Affiliated Hospital of China Medical University from March 1980 to November 2008 were analyzed retrospectively. Results The main coexisting diseases included cardiovascuclar disease (259 cases, 49.05%), respiratory disease (161 cases, 30.49%), diabetes (72 cases, 13.64%). Adjusting blood pressure and blood glucose, improving cardiopulmonary function, and hepatic and renal function were mainly given. The common postoperative complications included intestinal obstruction (10 cases), pneumonia (10 cases), reflux esophagitis (9 cases), functional evacuation disorder of gastric remnant (7 cases), and anastomotic leakage (5 cases). Ten patients died during perioperative period: 6 died of heart and lung failure, 2 of acute myocardial infarction, 1 of anastomotic leakage, 1 of intestinal obstruction. Conclusions The common coexisting diseases in the elderly patients with gastric cancer are hypertension， bronchitis and diabetes. Complete assessment of the patient’s general health before operation and intensive perioperative management of the coexisting diseases not only can decrease the risk of surgical procedures， but also decrease the incidence of complication and perioperative mortality.
ObjectiveTo investigate effect of application of thymopentin during perioperative period on immune function of patients undergoing laparoscopic assisted radical resection for rectal carcinoma.
MethodsForty-two patients undergoing laparoscopic assisted radical resection for rectal carcinoma from January 2015 to April 2015 in this hospital were collected. These patients were divided into study group and control group. The patients were received routine treatment in the control group. In addition to routine treatment same as the control group, the patients were received 2 mg thymopentin every day for a week in the study group. The changes of lymphocyte count, T lymphocyte subsets (CD3+, CD4+, CD8+, and CD4+/CD8+), and immunoglobulin (IgG, IgA, and IgM) were compared on the 1st day before surgery and on the 1st day and 5th day after surgery.
ResultsThe lymphocyte count, T lymphocyte subsets, and immunoglobulin on the first day after surgery were significantly lower than those on the 1st day before surgery in these two groups (P < 0.05). The lymphocyte count, T lymphocyte subsets (except for CD4+/CD8+), and immunoglobulin (except for IgA) in the study group were significantly higher than those in the control group on the 5th day after surgery (P < 0.05). The changes of lymphocyte count, T lymphocyte subsets, and immunoglobulin in the study group had no significant differences between on the 5th day after surgery and on the 1st day before surgery (P > 0.05), but which on the 5th day afer surgery were significantly lower than those on the 1st day before surgery (P < 0.05) in the control group.
ConclusionApplication of thymopentin during perioperative period could accelerate recovery of immune function after operation in patients undergoing laparoscopic assisted radical resection for rectal carcinoma.
