Objective To explore the effect of fast track rehabilitation in patients with gastric cancer during perioperative period. Methods Eighty patients were randomly divided into conventional method group （n=40） and fast track rehabilitation group （n=40）, and to compare the levels of total lymphocyte count （TLC） , C-reaction protein （CRP），IgG， IgM， IgA， CD3＋， CD4＋， CD8＋， and CD4＋/CD8＋ in serum on the days of 1 d before operation and 1 and 3 d after operation，and to record the duration of fever，first ventilation time of flatus， postoperative hospital stay time，and the postoperative complications. Results The first ventilation time after operation was advanced in patients of fast track rehabilitation group， and the postoperative fever time and hospital stay time after operation of patients was shorter in fast track rehabilitation group than that in conventional method group （P＜0.05）. The incidence difference of complications in two groups had not statistic significance （P＞0.05）. The TLC on 1 d after operation were lower than that on 1 d before operation in two groups, and the CRP values of 1 d after operation were higher than that of 1 d before operation in two groups （P＜0.01）. Compared with 1 d before operation, the CRP value on 3 day after operation in fast track rehabilitation group was lower than that in conventional method group, and the levels of IgG, IgM， IgA， CD3＋， CD4＋， CD8＋， and CD4＋/CD8＋ were higher than that in conventional group （P＜0.05）. Conclusions Fast track surgery applied to patients with gastric cancer during perioperative period is safe and efficient， which can mitigate the immunologic impairment of patients and accelerate postoperative rehabilitation．
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.
The great clinical efficacy of an enhanced recovery after surgery (ERAS) program has been illustrated by the decreased incidence of perioperative complications and the shortened length of in-hospital stay. Furthermore, the ERAS programs have their own key techniques and strategies in the clinical application to the unique diseases and operative modes. The key technology of an ERAS program is the minimally invasive surgery, which has been widely utilized in the surgical specialties. The main strategy in an ERAS program consists of the intensive pulmonary rehabilitation and optimal perioperative care that aim to improve the in-hospital outcomes of lung cancer patients who are considered at high surgical risk. Pulmonary rehabilitation is regarded as the mainstay of the ERAS strategies but its clinical protocols still remain less mature. The purpose of this overview is to summarize the current pulmonary rehabilitation programs in terms of the suitable crowd, the feasible protocols and the clinical significance.
ObjectiveTo summarize perioperative management experience of 16 patients undergoing surgical correction of anomalous origin of the left coronary artery from pulmonary artery (ALCAPA). MethodsWe performed a retrospective analysis of 16 patients who received surgical correction of ALCAPA between January 2005 and December 2013 in Cardiovascular Center of Children's Hospital of Fudan University. There were 6 males and 10 females with their age ranging from 2 months to 13 years (mean age of 23.25±0.63 months) and body weight ranging from 5 to 30 kg (mean body weight of 19.77±0.75 kg). All the patients underwent direct implantation of the anomalous coronary artery into the ascending aorta, and received comprehensive management regarding left ventricular ejection fraction (LVEF), heart rate, blood pressure, arterial blood gas, urinary volume, blood lactic acid and central venous pressure. ResultsPostoperative complications were low cardiac output syndrome (LCOS) in 9 patients (including intractable LCOS in 2 patients) and arrhythmia in 1 patient. One patient with intractable LCOS and arrhythmia died postoperatively with the mortality of 6.25%. Cardiopulmonary bypass time was 85-260 (135.61±35.01) minutes, aortic cross-clamping time was 40-97 (57.32±16.02) minutes, mechanical ventilation time was 34-187 (106.34±41.62) hours, length of CICU stay was 2-21 (8.13±5.02) days, and hospital stay was 12-51 (22.14±5.00) days. Postoperative LVEF and left ventricular fractional shortening were significantly higher than preoperative values (P < 0.05). ConclusionKey points for successful surgical correction of ALCAPA include meticulous perioperative management, preoperative heart function improvement, prevention of postoperative complications and use of new techniques.
Objective To explore the application effect of process optimization in perioperative venous access management. Methods A total of 205 general surgery patients in the Operating Room of Cheng Du Shang Jin Nan Fu Hospital, West China Hospital of Sichuan University from April to May 2018 were selected as the control group, and 205 general surgery patients from June to August 2018 were selected as the observation group. The traditional management process was used in the control group, and the process optimization management was performed in the observation group. The establishment of venous access and related complications between the two groups of patients, as well as the satisfaction of patients and staff before and after the process optimization were compared. Results There was no significant difference in gender, age, education level, operation type, anesthesia method, operation duration, or intraoperative intravenous infusion channels between the two groups of patients (P>0.05). There was no statistically significant difference in gender, age, educational background, job title, job nature, or working years of the staff participating in the satisfaction survey before and after the process optimization (P>0.05). The rate of repetitive venous puncture (15.61% vs. 58.05%) and the idelness ratio of the intraoperative indwelling needle approach (10.73% vs. 52.20%) in the observation group were lower than those of the control group, and the differences were statistically significant (P<0.05). There was no statistically significant difference in the incidence of tube blockage, detubation, or phlebitis/exudation between the two groups (P>0.05). After process optimization, patient satisfaction (22.91±3.43 vs. 17.44±4.90) and staff satisfaction (28.17±2.56 vs. 20.65±3.71) were higher than before optimization, and the differences were statistically significant (P<0.05). Conclusions The process optimization of venous access management for perioperative patients can effectively reduce the rate of venous repeated venipuncture and the idelness ratio of the intraoperative indwelling needle approach, reduce invasive operations on patients, reduce the ineffective work of nurses, avoid the waste of medical resources such as manpower and materials, and improve the satisfaction of patients and staff. It is worthy of promotion and application.
Objective To evaluate clinical effects of strict control vs. conventional control of blood glucose in perioperative cardiac surgery. Methods Databases including PubMed, EMbase, HighWire, The Cochrane Library, CBM and VIP were searched to collect the randomized controlled trials (RCTs) on strict control vs. conventional control of blood glucose in perioperative cardiac surgery, published from 2000 to 2011. Two reviewers independently screened articles according to the inclusion and exclusion criteria, extracted data, and assessed quality of the included studies. Then meta-analysis was performed using RevMan 5.1. Results A total of 8 RCTs involving 2 250 patients were included. The results of meta-analysis showed that compared with the conventional group, the strict control of blood glucose could reduce postoperative short-term mortality (OR=0.52, 95% CI 0.30 to 0.91, P=0.02) and postoperative incidence rate of both atrial fibrillation (OR=0.64, 95%CI 0.43 to 0.96, P=0.03) and incision infection (OR=0.30, 95%CI 0.15 to 0.57, P=0.000 2), and shorten hospital stay (MD=1.75, 95%CI –3.18 to –0.32, Plt;0.02) and time of mechanical ventilation (MD=–0.9, 95%CI –1.43 to –0.38, Plt;0.000 8). Conclusion Current evidence shows that the strict control of blood glucose in perioperative cardiac surgery can reduce postoperative short-term mortality and postoperative incidence rate of both atrial fibrillation and incision infection, shorten hospital stay and time of mechanical ventilation, and have important clinical values and social and economic significance. However, this conclusion has to be proved by more high-quality and large-scale RCTs for the limitation of quantity and quality of the included studies.
Objective To investigate the surgicalmethod and perioperative treatment for senile lumbar disease accompanied by internal disease. Methods From June 2000 to December 2003,the complete neurological and physical examinations were performed on the patients before operation, as treatment of internal diseases could improve the patients’ conditions. Lumbar operations were performed on 125 patients, among whom 23 had simple lumbardisc herniation, 13 had lumbar spine stenosis, 81 had lumbar disc herniation with lumbar spine stenosis, and 8 had spondylolisthesis.The JOA score was 116±2.5. There were 3 patients undergoing fenerstration+discectomy, 16 undergoing semilaminectomy+discectomy,82 undergoing total-laminectomy+disectomy, 5 undergoing total-laminectomy+disectomy+pedicle fixation, 11 undergoing lamina decompression+nerve-root pathyway decompression, and 8 undergoing pedicle screw fixation+bone graft and fusion in spondylolisthesis. Results With an effective medical treatment, the internal disease produced little effect on the operation. Improved functions and bone fusions were observed after- operation. According to the JOA standards, the average alleviation rate was 87.9%. Conclusion Early neurological examination and proper treatment of internal diseases are the keys to the successful operation on the senile patients with lumbar disease. Radiological data are important in avoidance of mistaken diagnosis.
【Abstract】 Objective To explore the cause of the perioprative period compl ication of scandinavian total anklereplacement(STAR) and to summarize the experience in the treatment and prevention. Methods From March 1999 toNovember 2006, 35 patients were given total ankle replacement(TAR) with STAR system. There were 19 males and 16 femaleswith an average age of 50.5 years (27 to 68 years), including 12 cases of posttraumatic arthritis, 8 cases of osteoarthritis and 15cases of rheumatoid arthritis. All patients had pain of ankle joint, swell ing and l imitation of joint motion. The disease coursewas 9-64 months. The curative effect was estimated by Kofoed total ankle scoring system. The mean preoperative ankle scorewas 29(6-48); the mean pain score was 18.3(0-35); the mean function score was 11.7(6-18); and the mean activity score was9.2(3-12). The type of all compl ications were record, and its cause, prevetion and treatment were analyszed. Results Thirtythreepatients achieved heal ing by first intention, 2 achieved delayed union because of infection. Twenty-eight patients werefollowed up 3-80 months (mean 43.5 months). Medial malleolus fracture occurred in 2 cases, unstable ankle joint introversion in2 cases, l imitation of ankle dorsiextension in 1 case and 1 case had hypoesthesia at intermediate dorsal skin of foot and 3rd-5thmetatarsal skin without obvious dysfunction; all were treated with symptomatic medication. The postoperative mean ankle scorewas 85.5 (58-95); the mean pain score was 48.3(35-50); the mean function score was 20.7(18-30); the mean activity score was17.2(16-20). There were statistically significant differences when compared with preoperative score(P lt; 0.01). The cl inical resultswere excellent in 16 patients, good in 9 patients and fair in 3 patients. The X-ray films showed no loosening and subsidence ofprosthesis. Conclusion Although STAR can retain the functions of the operated joint, it has its special compl ications. It isimportant to obey operation principle with proficient operative technique, to strictly control surgical indication and to intensifyperioperative period treatment so as to decrease the compl ications.
Objective To evaluate the effect of perioperative period clinical care mode through fast-track (FT) under nonminimal invasive operation on the inflammatory response of colorectal cancer resection. Methods Fifty-five patients underwent elective colorectal cancer resection were randomized divided into two groups: FT group (n=29) in which patients were performed FT perioperative care and tradition group (n=26) in which patients were received traditional perioperative care. The nonminimal invasive operations were performed in this study. The venous blood samples were respectively collected at 24 h before operation, at 24 h, 72 h, and 7 d after operation, and were used to detect the concentrations of serum C-reactive protein (CRP) and serum amyloid A protein (SAA).Results There was no complication such as infection, fistula of stoma and inflammatory ileus that was potential to influence the study results in two groups, and no patient died. The trend of changes in the concentrations of CRP and SAA of patients was accordant in each group. The peak concentrations of CRP and SAA of patients in FT group were respectively observed at 24 h after operation 〔CRP: (72.36±60.94) mg/L; SAA: (328.97±267.20) mg/L〕, while which were respectively delayed to 72 h after operation in tradition group 〔CRP: (112.71±63.92) mg/L; SAA: (524.18±331.03) mg/L〕. At the same time, the concentrations of CRP and SAA in FT group began to descend 〔CRP: (57.21±30.42) mg/L; SAA: (237.43±215.66) mg/L〕. The peak concentrations of CRP and SAA in tradition group were significantly higher than that in FT group (Plt;0.001) and the concentrations of CRP and SAA in FT group were significantly lower than those in tradition group at 72 h after operation (Plt;0.001). On 7 d after operation, the concentrations of CRP and SAA further decreased, but the difference between two groups was not significant (Pgt;0.05). Likewise, the concentrations of CRP and SAA at 7 d after operation were significant higher than those 24 h and 72 h after operation (Plt;0.001), lower than that 24 h before operation (Plt;0.001), respectively. Conclusion This study demonstrates that perioperative period clinical care mode through FT under non-minimal invasive operation can reduce the inflammatory response of colorectal carcinoma resections and scientific clinical care is an important means to promote quick rehabilitation.
Inherited retinal diseases (IRDs) are a group of severe retinal degenerative diseases leading to permanent visual impairment. IRDs are the major cause of irreversible blindness in children and working age groups. Gene therapy is a new clinical treatment method and currently the only clear and effective treatment for IRDs, while, there are still risks in clinical research and application. How to standardize perioperative management and reduce the potential risks of treatment is one of the keys to ensure the safety and effectiveness of treatment. However, there is no systematic and standardized guidance on the perioperative management for IRDs gene therapy. Therefore, in order to standardize the perioperative management, the Fundus Disease Group of Ophthalmology Society of Chinese Medical Association and Chinese Medical Doctor Association organized domestic experts to put forward standardized opinions on the perioperative management of IRDs gene therapy in China after repeated discussion and combined with domestic and foreign research experience, so as to provide clinicians with reference and application in clinical research and practice.