Postoperative delirium is one of the most common postoperative complications in elderly patients, affecting the outcome of approximately half of surgical patients. The pathogenesis of postoperative delirium is still unclear, but multivariate models of the etiology of postoperative delirium are well-validated and widely accepted, and 40% of postoperative delirium can be effectively prevented by targeting predisposing factors. Benzodiazepines have long been considered as predisposing factors for postoperative delirium. Although benzodiazepines are widely used in clinical practice, most relevant guidelines recommend avoiding the use of benzodiazepines in the perioperative period to reduce the incidence of postoperative delirium. Controversy exists regarding the association of benzodiazepine use with postoperative delirium. This article discusses the results of studies on perioperative benzodiazepines and postoperative delirium.
【Abstract】 Objective To review the recent progress of hi p resurfacing arthroplasty. Methods Literatureconcerning hip resurfacing arthroplasty and current achievements was extensively and comprehensively reviewed. Results The new metal-on-metal hip resurfacing arthroplasty made much progress especially in materials and technology, and the results were satisfactory for short-term follow-up. This was increasingly widely used especially in treating young patients. But there were still some problems such as elevation of metal ions which had already aroused publ ic attention. Conclusion The new metal-onmetal hip resurfacing arthroplasty is an efficient method in the treatment of adult hip joint disease and has an encouraging future, but long-term follow-up is still needed.
Objective To investigate the effect of recombinant human erythropoietin (rhEPO) on the expression of glutamine synthetase (GS) of cultured rat retinal Müller cells in high glucose environment in vitro. Methods Müller cells were isolated from retinas of 10 Sprague-Dawley rats at postnatal day three to five by trypsin digestion, and were randomly divided into six groups, including normal control group, high glucose group, high glucose +5 U/ml rhEPO group, high glucose+10 U/ml rhEPO group, high glucose +20 U/ml rhEPO group, high glucose+40 U/ml rhEPO groups. After 48 hours, the apoptosis of retinal Müller cells were assayed by terminal transferase-mediated DNA end labelling assay, and the expression levels of GS protein were detected with semi-quantitative immunocytochemistry. Results Compared with the normal control group, the cell viability and GS protein were reduced while the cell death increased in Müller cells cultured in high glucose, the difference was statistically significant (t=27.4,P＜0.01). Compared with the high glucose group, rhEPO treatment reduced the apoptotic Müller cells (t=857.2, 2 374.6, 2 473.2, 2 537.7;P＜0.01), induced the expression of GS proteins (t=3.2, 18.0, 22.5, 26.4; P＜0.05). Conclusions rhEPO can protect Müller cells from apoptosis under high glucose condition. The mechanism may be related to its function to up-regulate the GS protein expression, promote glutamic acid cycle, and reduce the excitotoxicity effects of high concentration of glutamate.
目的 评价地佐辛配伍丙泊酚联合喉罩用于无痛纤维支气管镜检查的效果。 方法 将2012年10月－12月拟行纤维支气管镜检查，且按美国麻醉医师协会分级Ⅰ或Ⅱ级的60例患者，随机分为芬太尼组（F组）、地佐辛组（D组）、生理盐水组（N组）,每组20例。采用双盲法给药，静脉注射芬太尼（10 μg/mL）或地佐辛（1 mg/mL）或生理盐水0.1 mL/kg，5 min后3组缓慢静脉注射丙泊酚2 mg/kg诱导后置入喉罩，术中保留自主呼吸，持续泵入丙泊酚4～6 mg/（kg·h）维持麻醉，观察3组患者诱导前（T0）、诱导后时（T1）、纤维支气管镜操作时（T2）、术毕时（T3）及拔除喉罩时（T4）的生命体征，记录丙泊酚总用量、苏醒时间、苏醒时的呼吸道疼痛视觉模拟评分（VAS），记录术中及术后有关并发症的发生情况。 结果 与N组相比，D、F两组丙泊酚总用量减少、苏醒时间缩短，头昏及术中体动发生率、VAS评分明显降低（P＜0.05）；呼吸暂停的发生率D组最低（P＜0.05）；恶心、呕吐的发生率F组最高（P＜0.05）。 结论 地佐辛配伍丙泊酚联合喉罩用于无痛纤维支气管镜检查，麻醉效果满意，术后镇痛效果好，值得临床推广。
Hyperprolactinemia is the common clinical syndrome; the causes of hyperprolactinemia are physiological, pharmacological, and pathological, in which prolactinoma is the most common cause. In drug therapy, dopamine agonists are the first choice, but there are 10%–20% of the patients who are resistant to drug therapy. This paper mainly summarized the causes, treatments, mechanisms of drug resistance, treatment during pregnancy, and progresses in the treatment of prolactinoma, so as to provide some theoretical basis to further research of hyperprolactinemia.
Postoperative delirium (POD) is a serious postoperative complication, which is significantly correlated with poor prognosis such as prolonged hospital stay and increased rate of readmission. POD is the result of multiple factors, and intervention targeting at its risk factors can significantly reduce the incidence of POD. At present, POD prevention tends to be multidisciplinary and cluster-oriented, aiming at forming a process-oriented, whole-perioperative assessment and intervention path. However, at present, there are few studies on POD peri-anesthetic period intervention, and there are many controversies. All guidelines and expert consensus are also blank in this part, and further studies are needed to fill the gaps. This paper discusses the current prevention strategies for POD during peri-anesthetic period, guiding future studies and further improving the intervention strategies for POD during peri- anesthetic period, so as to reduce the occurrence of POD.
Objective To investigate the safety and feasibility of preoperative non-indwelling catheter in primary unilateral total knee arthroplasty (TKA) without tourniquet . Methods From January 2016 to January 2017, a total of 60 patients undergoing primary unilateral TKA surgery were randomly divided into preoperative non-indwelling catheter group (group NIC, n=30) and indwelling catheter group (group IC, n=30) . The patients in group NIC were not retained catherter, and the patients in group IC were retained catherter. All patients did not use tourniquet. The time of first urination, the volume of first urination, and the occurrence of urine retention, urinary irritation symptoms and urinary tract infection of patients in two groups were analyzed. The incidence of venous thrombosis of the lower extremity was also recorded. Results There were statistical differences (P<0.05) between group NIC and group IC in the time of first urination [(3.2±0.6) vs. (4.5±1.8) hours] and urine volume [(262.5±29.4) vs. (391.6±50.2) mL], but there was no significant difference (P>0.05) between the two groups in urinary retention (6.7% vs. 16.7%), urinary tract irritation (33.3% vs. 23.3%), or urinary tract infection (0.0% vs. 16.7%). Conclusion Preoperative non-indwelling catheter in primary unilateral TKA without tourniquet is safe and feasible.
目的 调查规范化培训护士的职业自我概念现状，以期为其培训方案提供参考依据。 方法 2010年10月－11月采用护理专业自我概念量表对某三甲综合医院2009级、2010级175名规范化培训护士进行面对面问卷调查。 结果 88.37%规范化培训护士职业自我概念积极，5个维度得分从高到低分别是沟通交流、技能、灵活性、领导、满意度。2010级规范化培训护士职业自我概念总得分（t=?2.027，P=0.044）及领导维度得分（t=?3.258，P=0.001）高于2009级者，而技能（t=2.120，P=0.036）、灵活性（t=2.054，P=0.042）维度得分低于2009级；有职业兴趣的规范化培训护士其领导维度得分高于无职业兴趣的规范化培训护士（t=2.063，P=0.043）。 结论 护士规范化培训中除注重技能培训外还应加入情感教育课程，建立领导能力评价体系等。