Zhonghua yi xue za zhi
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Zhonghua yi xue za zhi · Nov 2016
[Intestinal barrier dysfunction and its related factors in patients with sepsis].
Objective: To investigate the relationship between related factors of intestinal barrier dysfunction in patients with sepsis or septic shock and severity of the condition. Methods: A prospective observational study was conducted in 31 sepsis patients, 28 septic shock patients, and 21 postoperative patients without sepsis (control group) who were admitted to intensive care unit (ICU) of General Hospital of Ningxia Medical University between November 2015 and June 2016. Blood samples were collected from the patients within 24 hours following admission to ICU. ⋯ There were no statistically significant differences in levels of serum D-lactic acid and endotoxin between the survival group and the death group [21.65(15.11, 39.00) vs 19.78(14.41, 80.93)mg/L; 17.09(12.62, 20.42) vs 19.26(13.22, 26.27)U/L, both P>0.05]. (2) In the sepsis and septic shock patients, serum D-lactate level was significantly related to mean arterial blood lactate concentration, APACHE Ⅱ score, and SOFA score in the first 24 hours after admission to ICU (r=0.499, 0.447, 0.469, all P<0.01); serum endotoxin level was correlated with hsCRP, APACHE Ⅱ score, and SOFA score (r=0.224, 0.388, 0.393, all P<0.05). (3) Multivariate linear regression analysis showed that D-lactic acid level was independently associated with average arterial blood lactate concentration as well as with SOFA score(R2=0.34, F=19.91, P<0.01), and endotoxin was independently associated with only SOFA score(R2=0.14, F=12.68, P<0.01). Conclusions: Regardless of the site of infection, patients with sepsis or septic shock often have intestinal barrier injury, which is correlated with the severity of disease, but does not independently affect patient outcome. Tissue hypoperfusion in the early stage of sepsis may be one of the causes of intestinal barrier injury.
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Zhonghua yi xue za zhi · Nov 2016
Randomized Controlled Trial[The application of conscious sedation with a small dose of dexmedetomidine and sufentanil in elderly patients undergoing multiple intestinal polyps resection].
Objective: To explore the effectiveness and feasibility of conscious sedation with a low dose of dexmedetomidine and sufentanil during multiple intestinal polyps resection in elderly patients. Methods: Sixty elderly patients who underwent multiple intestinal polyps resection in Peking University Third Hospital from Janurary to May 2016 were randomly divided into dexmedetomidine group (D group, n=30) and propofol group (P group, n=30). There were 28 males and 32 females with a mean age of (70.4±4.5) years old (range: 65-80 years old). ⋯ The emergency time and duration of stay in the PACU (post anesthesia care unit) were (2.0±1.2) and (22.0±7.4) min in group D, and they were (4.9±2.4) and (35.8±11.6) min in group P (t=-5.839, t=-5.472, P<0.05). There was no difference in surgery time, patient satisfaction and acceptance rate of reexamination (t=-3.031, t=-7.322, t=2.069, P>0.05). Conclusion: Conscious sedation with dexmedetomidine and sufentanil is effective and feasible in elderly patients undergoing multiple intestinal polyps resection.
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Zhonghua yi xue za zhi · Nov 2016
Randomized Controlled Trial[Effect of goal-directed haemodynamic management on the postoperative outcome in elderly patients with fragile cardiac function undergoing abdominal surgery].
Objective: To investigate the effect of goal-directed haemodynamic management based on stroke volume variation (SVV), cardiac index (CI) and mean arterial blood pressure (MAP) on the postoperative outcome in elderly patients with fragile cardiac function undergoing gastrointestinal surgery. Methods: Ninety patients with fragile cardiac function, aged 65-90 years old, ASAⅡ or Ⅲ, NYHA Ⅱor Ⅲ, scheduled for abdominal surgery were enrolled in this study. The patients were randomly assigned to two groups: Experience anesthesia group (group E, n=45) and goal-directed hemodynamic management group (G group, n=45). ⋯ The length of hospitalization of group G was shorter than that of group E [(12.21±2.20) d vs (13.16±3.84) d, t=-1.341, P<0.05]. The incidence of total complication in hospital and in 30-days after surgery of group G were 10.26% and 5.13%, while these of group E were 29.73% and 24.32%, (χ2=4.545, 4.520, all P<0.05). ΔNT-proBNP1 (the base value of NT-proBNP's minus the value of NT-proBNP's at the end of the operation) and ΔNT-proBNP2 (the base value of NT-proBNP's minus the value of NT-proBNP's 24 hours postoperatively) of group G were 12.0(-291.0, 1 517.0) and 0(-6 770.0, 291.0), both higher than these of group E [0(-440.0, 200.0) and -12.0(-7 200, 22.0), (Z=-2.412, -2.163, all P<0.05)]. Conclusion: Goal-directed haemodynamic management based on SVV, CI and MAP could improve the outcome of the elderly patients with fragile heart function undergoing abdominal surgery.
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Zhonghua yi xue za zhi · Nov 2016
[Ultrasound imaging increases first-attempt success rate of neuraxial block in elderly patients].
Objective: To verify whether preprocedural ultrasound of the lumbar spine could improve first-attempt success rate (defined as a successful neuraxial anesthesia with only one skin puncture) of neuraxial block in elderly patients. Methods: From septemble 2015 to February 2016, 200 elderly patients undergoing lower-limb surgery with neuraxial block at the Peking Universty Third Hospital were enrolled in this study. RandA 1.0 software was used to randomize patients into two groups: conventional surface landmark-guided group (group LM) and ultrasound-assisted group (group US). ⋯ The paramedian sagittal oblique scanning image was superior to that of the transverse median plane. Conclusions: For elderly patients, ultrasound imaging before neuraxial block increases first-attempt success rate, decreases puncture time. The strengths of prepuncture ultrasound scanning outweighs its longer total time.
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Zhonghua yi xue za zhi · Nov 2016
Randomized Controlled Trial Comparative Study[Effect comparison of ultrasound-guided lower extremity nerve block and spinal anesthesia in ankle surgery].
Objective: To compare the anesthesia effect between ultrasound-guided lower extremity nerve block and spinal anesthesia in ankle surgery. Methods: Upon the approval of institutional Ethics Committee and informed consent, 80 patients American Society of Anesthesiology (ASA)Ⅰ-Ⅱaged 18-70 yr, undergoing ankle surgery from December 2014 to May 2015 in the Fifth Affiliated Hospital of Wen Zhou Medical College, were randomly divided by random numbers into two groups (n=40): nerve block group (group N) and spinal anesthesia (group S). The group N was combined with ultrasound-guided femoral nerve, obturator nerve, lateral femoral cutaneous nerve and sacral plexus block; group S was selected spinal anesthesia in the gap of L3-L4. ⋯ The incidence of 24 hours postoperatively analgesic in group N were significantly lower than that in group S (45.0% vs 77.5%, P<0.05). Compared with group S, there was no significant difference in the percentage of anesthetic effect reached gradeⅠ(95% vs 100%, P>0.05) in group N. Conclusion: Ultrasound-guided nerve block could be safe and effective in patients undergoing ankle surgery, and postoperative analgesia time of nerve block is longer than that of spinal anesthesia.