Objective To investigate the causes and prevention of cardiopulmonary complications in elderly patients after thoracotomy. Methods Respiratory and circulatory status were monitored and postoperative complications were documented in 58 elderly patients either aged over 65 years, with major organ dysfunction or underwent highly invasive procedures （experimental group） during July 2001 to Dec. 2003. The results were compared with those from 56 young patients（〈65 years） receiving thoracotomy in the same period （control group）. Results Patients in experimental group had significantly more preoperative cardiopulmonary co-morbidities and poorer spirometry than those in control group （P〈0.05）. Four patients died after operation in experimental group. There were significantly more postoperative complications in experimental group than those in control group [58. 6% （34/58） vs. 17. 9% （10/56）, P=0. 000], especially functional complications [51.7% （30/58） vs. 12.5% （7/56）, P = 0. 000]. The rate of respiratory complications was also significantly higher in the experimental group . Multivariance logistic regression showed that preoperative pulmonary morbidity （OR=5.4） and obesity （OR=4. 9） were independent risk factors for pulmonary complications after thoracotomy in elderly patients. Conclusions Cardiopulmonary co-morbidities commonly seen are responsible for surgical morbidities, especially the functional complications in elderly patients underwent thoracotomy. Respiratory complications are the major causes of death in the elderly after thoracotomy. Pulmonary co-morbidity and obesity are independent risk factors for respiratory complications. Supraventricular tachycardia is the major type of cardiovascular complications after thoracotomy and is predicted by preoperative cardiovascular morbidity. Close monitoring of cardiopulmonary status of the elderly may identify patients at risk in developing functional complications and help improve surgical outcome.
ObjectiveTo investigate the risk factors of delirium in mechanical ventilation patients with chronic obstructive pulmonary disease (COPD).MethodsA total of 97 mechanically ventilated non-hypertensive patients with COPD who were admitted to this department from January 2018 to October 2018 were selected as subjects. The patients were divided into 49 cases with delirium and 48 cases non-delirium according to the Consciousness Assessment Method for the Intensive Care Uint. The examined data were collected in the patients such as pH, arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), neuron-specific enolase (NSE), and Acute Physiology and Chronic Health EvaluationⅡ (APACHEⅡ) scores were calculated in the pre-mechanical (d0) and mechanically ventilated 3rd (d3), 5th (d5) days. The mechanical ventilation days were recorded in the two groups. Logistic regression analysis was used to screen the risk factors influencing delirium of patients.ResultsThe PaCO2, NSE, APACHEⅡ scores and mechanical ventilation days were higher in the delirium group than in the non-delirium group ［(88.1±7.5) vs. (85.3±6.2) mm Hg; (28.4±5.8) vs. (26.1±3.3) μg/L; (23.7±3.9) vs. (21.7±2.6); (7.5±1.3) d vs. (6.6±1.2) d］ and PaO2 were lower than non-delirium group ［(54.9±5.5) vs. (57.2±3.1) mm Hg］, the differences were statistically significant (P<0.05). Multivariate logistic regression analysis showed that PaO2, NSE, APACHEⅡ scores and mechanical ventilation days were risk factors for delirium in mechanically ventilated patients with COPD (regression coefficients were –0.177, 0.163, 0.203, 0.597 respectively, P<0.05). The PaO2 and APACHEⅡ scores of mechanical ventilation on the 3rd and 5th day of the two groups ［d3 (88.3±5.3) vs. (89.1±6.9) mm Hg; d5 (90.3±9.0) vs. (91.3±6.4) mm Hg; d3 (21.7±3.0) vs. (21.4±2.2); d5 (20.9±2.8) vs. (20.7±2.1)］ were not statistically significant (P>0.05).The NSE changes on the 3rd and 5th day of mechanical ventilation ［d3 (30.0±5.3) vs. (26.8±3.6) μg/L; d5 (27.3±4.3) vs. (25.7±2.6) μg/L］ were statistically significant (P<0.05).ConclusionPaO2, NSE, APACHEⅡ score and mechanical ventilation days are risk factors for delirium in COPD patients with mechanical ventilation and NSE is one of the more important risk factors.