目的探讨术后早期肠梗阻的临床特点、诊断及治疗。方法对10例术后早期肠梗阻患者进行回顾性分析。结果10例均为机械性肠梗阻。保守治疗6例，其中治愈5例，死亡1例； 手术治疗4例，其中3例术中有绞窄性肠梗阻征象，均治愈。1例术中发现为广泛癌性粘连，行部分粘连松解术，术后第8天再发肠梗阻，保守治疗1天无效，患者自动出院。结论术后早期肠梗阻诊断并不困难； 保守治疗多数有效，故宜先行保守治疗； 可疑肠绞窄时应及时中转手术。
【摘要】 目的 观察丙泊酚在重症监护室（ICU） 外科术后对患者的镇静效果及作用。 方法 2006年7月-2008年7月，对行外科手术后在ICU观察室采用丙泊酚镇静的45例患者的镇静效果、停药苏醒时间及给药前后呼吸、循环参数的变化进行观察，并与治疗前进行比较。 结果 丙泊酚镇静起效快，镇静治疗后大多数患者开始血压有所下降（Plt;0.05）但不久恢复正常，所有患者心率、呼吸频率、血氧饱和度无明显变化（Pgt;0.05），停药后苏醒快。 结论 丙泊酚是外科术后患者较理想的镇静剂，但应根据患者情况调整给药速度、剂量及时间。 【Abstract】 Objective To observe the sedative effect of propofol on the patients after surgical operations in intensive care unit (ICU). Methods Forty-five patients underwent the injection with propofol after surgical operations in ICU from July 2006 to July 2008. The sedative efficacy, recovery time after the propofol administration, and changes of respiratory, circulate parameter before and after medication were observed, which were compared with those before the treatment. Results The sedative reactive time of propofol was short. Most of the patients had decreased blood pressure after injection with propofol (Plt;0.05) but recovered soon. The heart rate, respiratory rate, and pulse oxygen saturation did not significantly changed (Pgt;0.05). The recovery time was short after propofol administration was stopped. Conclusion Propofol is an effective sedative for the patients after surgical operations in ICU, but the medicated speed, amount and time according to state of the patients should be adjusted.
Objective To approach the clinical characters and therapeutic methods of retinal detachment(RD) after extracapsular catarat extraction(ECCE)with posterior chamber intraocular lens(PCIOL). Methods Sixty eight cases(68 eyes) of RD after ECCE with PCIOL were treated with sclerel buckling,microvitreo retinal surgery and intraocular gas,silicone oil injection and were reviewed. Results The retinas were totally reattached in 65 eyes(95.59%) which dropped to 94.12% in 6-60 months postoperatively.The resultant rate of visual acuity of the eyes with 0.1 or better was 79.41%,with 0.3 or better was 26.47%. Conclusion The main causes of RD after ECCE with PCIOL are similar to those of general RD,and most cases of RD after ECCE with PCIOL can be cured by surgical treatment. (Chin J Ocul Fundus Dis,1998,14:167-169)
ObjectiveTo investigate the predictive value of prognostic nutritional index (PNI) in complications after thoracoscopy-assisted radical resection of esophageal cancer.MethodsWe collected the clinical data of patients who underwent thoracoscopy-assisted esophagectomy in the First Affiliated Hospital of Xinjiang Medical University from January 2015 to June 2020. The predictive value of PNI for postoperative complications was evaluated by establishing receiver operating characteristic (ROC) curve and the optimal cut-off point was determined. The patients were divided into a high PNI group and a low PNI group according to the cut-off point. The differences of baseline data and perioperative complications-related indicators between the two groups were compared and analyzed. Univariate and multivariate analyses were used to investigate the influence of PNI and other related indexes on postoperative complications.ResultsA total of 116 patients were enrolled in this study, including 75 males and 41 females, aged 65 (58-69) years. The area under ROC curve was 0.647, and the optimal cut-off point was 51.9. According to the cut-off point, there were 45 patients in the high PNI group and 71 patients in the low PNI group. The overall complication rate (χ2=10.437, P=0.001) and the incidence of postoperative pulmonary infection (χ2=10.811, P=0.001) were statistically different between the two groups. The results of univariate analysis showed that the duration of ventilator use (Z=–3.136, P=0.002), serum albumin value (t=2.961, P=0.004), and PNI value (χ2=10.437, P=0.001) were the possible risk factors for postoperative complications after thoracoscopy-assisted esophagectomy. The results of multivariate analysis suggested that the duration of ventilator use (OR=1.015, P=0.002) and the history of drinking (OR=5.231, P=0.013) were independent risk factors for postoperative complications, and high PNI was the protective factor for postoperative complications (OR=0.243, P=0.047).ConclusionPNI index has a certain value in predicting postoperative complications, which can quantify the preoperative nutritional and immune status of patients. Drinking history and duration of ventilator use are independent risk factors for postoperative complications of thoracoscopy-assisted esophagectomy, and high PNI is a protective factor for postoperative complications.
Objective To analyze the clinical risk factors of the occurrence of severe proliferative vitreoretinopathy (PVR) after scleral reattachment surgery. Methods A total of 4031 eyes of 4031 consecutive patients with reghmatogenous retinal detachment (RRD) and PVR (grade C1 or less), on whom the scleral buckling was performed, were retrospectively studied. Twenty-two clinical charac teristics of the patients (including the ocular tension, condition of lens and vitreous, characte ristics of retinal detachment, whether or not with choroidal detachment, et al) were recorded.In 4031 patients, 2660 were followed up for more than 3 months, and 72 (in PVR group) of the 2660 patients underwent the second surgery (vitre oretinal surgery) because of the occurrence of postoperative seve re PVR; in the other 2588 patients, 72 (72 eyes) with retinal reattachment for more than 3 months were selected randomly as the control. The data were analyzed in SPSS (10.0) software. Results Logistic regression analysis revealed that the significant risk factors for PVR were incomplete posterior vitreous detachment ( P＜0.001), intraocular pressure lt;7 mm Hg（1 mm Hg=0.133 kPa, P＜0.002）, and large retinal tear (gt;2 DD,P＜0.005). Conclusion Incomplete posterior vitreous detachment, intraocular pressure lt;7 mm Hg and large retinal tear of the patient with RRD may be the major risk factors for PVR. (Chin J Ocul Fundus Dis，2003，19：141-143)
ObjectiveTo evaluate the association of intraoperative ventilation modes with postoperative pulmonary complications (PPCs) in adult patients undergoing selective cardiac surgery under cardiopulmonary bypass (CPB).MethodsThe clinical data of 604 patients who underwent selective cardiac surgical procedures under CPB in the West China Hospital, Sichuan University from June to December 2020 were retrospectively analyzed. There were 293 males and 311 females with an average age of 52.0±13.0 years. The patients were divided into 3 groups according to the ventilation modes, including a pressure-controlled ventilation-volume guarantee (PCV-VG) group (n=201), a pressure-controlled ventilation (PCV) group (n=200) and a volume-controlled ventilation (VCV) group (n=203). The association between intraoperative ventilation modes and PPCs (defined as composite of pneumonia, respiratory failure, atelectasis, pleural effusion and pneumothorax within 7 days after surgery) was analyzed using modified poisson regression. ResultsThe PPCs were found in a total of 246 (40.7%) patients, including 86 (42.8%) in the PCV-VG group, 75 (37.5%) in the PCV group and 85 (41.9%) in the VCV group. In the multivariable analysis, there was no statistical difference in PPCs risk associated with the use of either PCV-VG mode (aRR=0.951, 95%CI 0.749-1.209, P=0.683) or PCV mode (aRR= 0.827, 95%CI 0.645-1.060, P=0.133) compared with VCV mode. ConclusionAmong adults receiving selective cardiac surgery, PPCs risk does not differ significantly by using different intraoperative ventilation modes.
ObjectiveTo explore the clinical value of three early predictive scale of lung injury (ALI) in patients with high risk of acute lung injury (ALI) after lung cancer surgery.MethodsA convenient sampling method was used in this study. A retrospective analysis was performed on patients with lung cancer underwent lung surgery. The patients were divided into an ALI group and a non-ALI group according to ALI diagnostic criteria. Three kinds of lung injury predictive scoring methods were used, including lung injury prediction score (LIPS), surgical lung injury prediction (SLIP) and SLIP-2. The differences in the scores of the two groups were compared. The correlation between the three scoring methods was also analyzed. The diagnostic value was analyzed by drawing receiver operating characteristic (ROC) curves.ResultsA total of 400 patients underwent lung cancer surgery, and 38 patients (9.5%) developed ALI after operation. Among them, 2 cases progressed to acute respiratory distress syndrome and were treated in intensive care unit. There were no deaths. The predictive scores of the patients in the ALI group were higher than those in the non-ALI group, and the difference was statistically significant (all P<0.001). There was a good correlation between the three scoring methods (allP<0.001). The three scoring methods had better diagnostic value for early prediction of high risk ALI patients after lung cancer surgery and their area under ROC curve (AUC) were larger than 0.8. LIPS score performed better than others, with an AUC of 0.833, 95%CI (0.79, 0.87).ConclusionThree predictive scoring methods may be applied to early prediction of high risk ALI patients after lung cancer surgery, in which LIPS performs better than others.
ObjectiveTo understand the impact of preoperative nutritional status on the postoperative complications for patients with low/ultra-low rectal cancer undergoing extreme sphincter-preserving surgery following neoadjuvant therapy. MethodsThe patients with low/ultra-low rectal cancer who underwent extreme sphincter-preserving surgery following neoadjuvant therapy from January 2009 to December 2020 were retrospectively collected using the Database from Colorectal Cancer (DACCA), and then who were assigned into a nutritional risk group (the score was low than 3 by the Nutrition Risk Screening 2002) and non-nutritional risk group (the score was 3 or more by the Nutrition Risk Screening 2002). The postoperative complications and survival were analyzed for the patients with or without nutritional risk. The postoperative complications were defined as early-term (complications occurring within 30 d after surgery), middle-term (complications occurring during 30–180 d after surgery), and long-term (complications occurring at 180 d and more after surgery). The survival indicators included overall survival and disease-specific survival. ResultsA total of 680 patients who met the inclusion criteria for this study were retrieved from the DACCA database. Among them, there were 500 (73.5%) patients without nutritional risk and 180 (26.5%) patients with nutritional risk. The postoperative follow-up time was 0–152 months (with average 48.9 months). Five hundreds and forty-three survived, including 471 (86.7%) patients with free-tumors survival and 72 (13.3%) patients with tumors survival. There were 137 deaths, including 122 (89.1%) patients with cancer related deaths and 15 (10.9%) patients with non-cancer related deaths. There were 48 (7.1%) cases of early-term postoperative complications, 51 (7.5%) cases of middle-term complications, and 17 (2.5%) cases of long-term complications. There were no statistical differences in the incidence of overall complications between the patients with and without nutritional risk (χ2=3.749, P=0.053; χ2=2.205, P=0.138; χ2=310, P=0.578). The specific complications at different stages after surgery (excluding the anastomotic leakage complications in the patients with nutritional risk was higher in patients without nutritional risk, P=0.034) had no statistical differences between the two groups (P>0.05). The survival curves (overall survival and disease-specific survival) using the Kaplan-Meier method had no statistical differences between the patients with and without nutritional risk (χ2=3.316, P=0.069; χ2=3.712, P=0.054). ConclusionsFrom the analysis results of this study, for the rectal cancer patients who underwent extreme sphincter-preserving surgery following neoadjuvant therapy, the patients with preoperative nutritional risk are more prone to anastomotic leakage within 30 d after surgery. Although other postoperative complications and long-term survival outcomes have no statistical differences between patients with and without nutritional risk, preoperative nutritional management for them cannot be ignored.