Objective To explore the clinical effect and complications of lumbar plexus block through different approaches on perioperative analgesia in aged proximal femur surgery, and find the best method for analgesia in these patients. Methods From January to December 2015, 150 elderly patients scheduled for proximal femur surgery were randomly divided into three groups: psoas compartment block (PCB group, n=50), Winnie " 3 in 1” block (Winnie group, n=50), and fascia iliaca compartment block (FICB group, n=50). Twelve hours before surgery, guided by ultrasound and nerve stimulator, lumbar plexus blocks were performed in all the patients, then patient-controlled analgesia (the formula and the usage were the same) was done. All patients received epidural anesthesia, and were maintained postoperative analgesia for 72 hours. If Rest Visual Analogue Scale>3 or Initiative Movement Visual Analogue Scale>4, sufentanyl 10 μgi.m. was given. Muscle strength grades and complications were recorded. Anesthetic effect of sensory block of femoral, lateral femoral cutaneous, and obturator nerves were measured and recorded too. Results There were two cases of epidural block, and one case of puncture point bleeding in group PCB; no complication in the other groups was found. There was no remedy for inadequate analgesia in the three groups. Compared with group PCB, the muscle strength grades during postoperative 24–72 hours in group FICB were higher (P<0.05). The successful rate of the block of lateral femoral cutaneous nerves was 64%, 91% and 96% in group Winnie, group PCB and group FICB, respectively, and the differences between the three groups were all statistically significant (P<0.05). The successful rate of the block of obturator nerves in group FICB (62%) was lower than that in group PCB (89%) and Winnie group (84%) (P<0.05). Conclusion Continuous fascia iliaca compartment block on perioperative analgesia in aged proximal femur surgery, with exact effect, less complications and simple operation, is better than the psoas compartment block and Winne " 3 in 1” nerve block.
ObjectiveTo analyze the clinical characteristics of coronavirus disease 2019 (COVID-19), identify the high-risk factors which promoted the disease progression into severe or critical cases, and provide clinical guidance.MethodsNinety-six cases of clinically diagnosed coronavirus disease 2019 were collected and analyzed from General Hospital of the Yangtse River Shipping from January 20 to February 14, 2020. According to clinical classification, those cases were divided into two groups: mild group, including common and mild cases, and severe group including severe and critical cases.ResultsThere were more than half of patients ages>60 years old and severe or critical illness (61.5%, 56.3%), and obese patients accounts for 45.8%, the complication of hypertension accounts for 52.1%. The average time from onset to hospitalization was (6.1±2.6) days, and the average hospitalization days were (15.7±6.3) days. Compared with the mild group, the number of male patients in the severe group was more (57.4% vs. 35.7%, P<0.05), the numbers of elderly patients were larger (77.8% vs. 40.5%, P<0.01), and more obese peoples (55.6% vs. 33.3%, P<0.05). Cough symptom was more common in clinical presentation in the severe group (81.5% vs. 61.9%, P< 0.05). Patients with the complication of hypertension or diabetes occupied a higher proportion in the severe group, which were 64.8% vs. 35.7% and 35.2% vs. 14.3% (P< 0.05), respectively. And the rate of hypoxemia in admission of the severe group was significantly higher (79.6% vs. 9.5%, P< 0.01).ConclusionsThe cases of ages>60 years old and severe or critical illness in coronavirus disease 2019 occupy a higher proportion, and the complication of hypertension accounts for high proportion. Men, ages>60 years old, obese, coughing symptoms, with hypertension and / or diabetes, hypoxemia upon admission are high risk factors for progression into severe and critical cases.
ObjectiveTo investigate the clinical effect of Maze Ⅳ in the treatment of elderly patients with valvular heart disease and persistent atrial fibrillation (AF).MethodsWe retrospectively analyzed the clinical data of 78 elderly patients with cardiac valve disease combined with persistent AF in our hospital from 2017 to 2018. The patients were allocated to two groups including a trial group (n=37) and a control group (n=41). There were 21 males and 16 females aged 61 to 74 (65.2±2.5) years in the trial group. There were 23 males and 18 females aged 62 to 76 (64.8±3.3) years in the control group. The clinical effects of the two groups were compared.ResultsThere was no statistical difference in baseline data between the two groups (P>0.05). The aortic occlusion time, extracorporeal circulation time, and operation time of the trial group were longer than those of the control group with statistical differences (P<0.05). There was no statistical difference in postoperative ventilator assistance time, complication rate, mortality, ICU retention time, perioperative drainage, red blood cell transfusion volume, or length of hospital stay between the two groups (P>0.05). At the time of discharge, postoperaive 1-month, 3-month, 6-month, and 12-month, the maintenance rates of sinus rhythm in the control group were statistically different from those of the trial group (P<0.05). Compared with the control group, left atrial diameter, left ventricular end diastolic diameter and the decrease of pulmonary artery systolic blood pressure were statistically different (P<0.05).ConclusionMaze Ⅳ is safe and effective in the treatment of elderly patients with valvular heart disease and persistent AF, which is conducive to the recovery and maintenance of sinus rhythm, and is beneficial to the remodeling of the left atrium and left ventricle and the reduction of pulmonary systolic blood pressure with improvement of life quality of the patients.