<span style="font-family:Verdana;"> <strong>Background: </strong></span><span><span><span style="font-family:;" "=""><span style=&qu...<span style="font-family:Verdana;"> <strong>Background: </strong></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">Femoral and pelvic osteotomies are potential hemorrhagic interventions where transfusion requirements can be necessary. </span><b><span style="font-family:Verdana;">Objective: </span></b><span style="font-family:Verdana;">We undertook a secondary analysis of patients who underwent femoral and pelvic osteotomy in the initial cohort. The objective of this secondary analysis was to describe intraoperative and postoperative outcomes and to describe intraoperative management in these patients in terms of blood product management and fluid and hemodynamic therapy with the aim of implementing optimization management protocols for postoperative outcome improvement. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> A secondary analysis of patients who underwent femoral and pelvic osteotomy surgery was included in the initial retrospective study. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">There were eighteen patients with a mean age of 104 ± 47.1 months. Four (22.2%) patients had intraoperative and/or postoperative complications. One patient (5.6%) had an intraoperative hemorrhagic shock, two patients (11.1%) had postoperative neurologic failure, and one patient (5.6%) had postoperative wound sepsis. The transfusion rate was 50% in nine patients. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Femoral and pelvic osteotomies are interventions where blood, transfusion and fluid requirements can be increased;thus, this implies the necessity of a global patient blood management protocol with point-of-care tests and fluid- and hemodynamic-guided protocols with validated tools in children for intraoperative and postoperative outcome optimization.</span></span></span></span>展开更多
Purpose: We investigated whether the simplified intraoperative Goal-Directed Therapy (GDT) could improve the factors affecting medical costs, and contribute in standardizing intraoperative fluid management. Methods: T...Purpose: We investigated whether the simplified intraoperative Goal-Directed Therapy (GDT) could improve the factors affecting medical costs, and contribute in standardizing intraoperative fluid management. Methods: The enrolled patients underwent esophagectomy, pancreatoduodenectomy, or aortic stent grafting in 2012, and between March 2013 and October 2014. We conducted a comparison study on the effects of GDT, between the before-GDT historical control group (n = 100) and GDT group (n = 100). The hemodynamic indices used for control group patients were conventional: Blood pressure, heart rate, and urine output. For GDT group, additionally, we used stroke volume variation (SVV) and stroke volume index (SVI). The primary outcomes were the length of intensive care unit (ICU) stay and hospital stay (LOS). Regression analysis was used to identify factors affecting LOS. The secondary outcomes were the albumin use, the fluid amount administered, and the variation in the fluid administration rate. Results: The control and GDT groups comprised 96 and 99 patients, respectively. The patient characteristics were similar. The length of ICU stay was significantly shorter (2.1 ± 2.1 days vs. 2.8 ± 1.9 days, P = 0.0009) and LOS was shorter but without statistical significance (24.5 ± 17.7 days vs. 27.7 ± 20.1 days, P = 0.21) in the GDT group than in the control group. The fluid amount administered and the presence/ absence of albumin use were factors affecting LOS. The variation of the fluid administration rate was significantly lower in the GDT group. Conclusion: The simplified GDT may contribute to the improvement of medical economics and standardize the fluid management.展开更多
目的分析加速康复外科(ERAS)联合目标导向液体管理对老年肺癌患者围手术期血流动力学及认知功能的影响。方法选取2020年1月至2021年6月邯郸市中医院收治的拟择期行开胸肺叶切除术的128例老年肺癌患者为研究对象,并根据不同处置方法分为...目的分析加速康复外科(ERAS)联合目标导向液体管理对老年肺癌患者围手术期血流动力学及认知功能的影响。方法选取2020年1月至2021年6月邯郸市中医院收治的拟择期行开胸肺叶切除术的128例老年肺癌患者为研究对象,并根据不同处置方法分为研究组和对照组,每组64例。研究组患者围手术期行ERAS联合目标导向液体管理,对照组患者围手术期行ERAS联合常规液体管理。比较两组患者手术时间、麻醉时间,血流动力学指标(心率、平均动脉压、氧合指数)、认知功能[蒙特利尔认知评估量表(MoCA)]以及并发症发生情况。结果两组患者手术时间、麻醉时间比较差异无统计学意义(P>0.05)。心率、平均动脉压、氧合指数不时点间和组间的主效应差异有统计学意义(P<0.01),组间和时点间存在交互作用(P<0.01),两组心率、氧合指数均先降低后升高(P<0.05),平均动脉压均逐渐升高(P<0.05),但研究组患者气管拔管后1、3、12 h的心率、平均动脉压明显低于对照组(P<0.05),气管拔管即刻及1、3、12 h的氧合指数明显高于对照组(P<0.05)。MoCA评分时点间和组间的主效应差异有统计学意义(P<0.01),组间和时点间存在交互作用(P<0.01),两组MoCA均呈先降低后升高趋势(P<0.05),但研究组患者术后1、3、5 d MoCA评分高于对照组(P<0.05)。研究组总并发症发生率明显低于对照组[14.06%(9/64)比34.38%(22/64)](P<0.01)。结论在ERAS基础上行目标导向液体管理,有利于维持老年肺癌患者围手术期血流动力学稳定性,提高患者认知功能,降低并发症发生风险。展开更多
文摘<span style="font-family:Verdana;"> <strong>Background: </strong></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">Femoral and pelvic osteotomies are potential hemorrhagic interventions where transfusion requirements can be necessary. </span><b><span style="font-family:Verdana;">Objective: </span></b><span style="font-family:Verdana;">We undertook a secondary analysis of patients who underwent femoral and pelvic osteotomy in the initial cohort. The objective of this secondary analysis was to describe intraoperative and postoperative outcomes and to describe intraoperative management in these patients in terms of blood product management and fluid and hemodynamic therapy with the aim of implementing optimization management protocols for postoperative outcome improvement. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> A secondary analysis of patients who underwent femoral and pelvic osteotomy surgery was included in the initial retrospective study. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">There were eighteen patients with a mean age of 104 ± 47.1 months. Four (22.2%) patients had intraoperative and/or postoperative complications. One patient (5.6%) had an intraoperative hemorrhagic shock, two patients (11.1%) had postoperative neurologic failure, and one patient (5.6%) had postoperative wound sepsis. The transfusion rate was 50% in nine patients. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Femoral and pelvic osteotomies are interventions where blood, transfusion and fluid requirements can be increased;thus, this implies the necessity of a global patient blood management protocol with point-of-care tests and fluid- and hemodynamic-guided protocols with validated tools in children for intraoperative and postoperative outcome optimization.</span></span></span></span>
文摘Purpose: We investigated whether the simplified intraoperative Goal-Directed Therapy (GDT) could improve the factors affecting medical costs, and contribute in standardizing intraoperative fluid management. Methods: The enrolled patients underwent esophagectomy, pancreatoduodenectomy, or aortic stent grafting in 2012, and between March 2013 and October 2014. We conducted a comparison study on the effects of GDT, between the before-GDT historical control group (n = 100) and GDT group (n = 100). The hemodynamic indices used for control group patients were conventional: Blood pressure, heart rate, and urine output. For GDT group, additionally, we used stroke volume variation (SVV) and stroke volume index (SVI). The primary outcomes were the length of intensive care unit (ICU) stay and hospital stay (LOS). Regression analysis was used to identify factors affecting LOS. The secondary outcomes were the albumin use, the fluid amount administered, and the variation in the fluid administration rate. Results: The control and GDT groups comprised 96 and 99 patients, respectively. The patient characteristics were similar. The length of ICU stay was significantly shorter (2.1 ± 2.1 days vs. 2.8 ± 1.9 days, P = 0.0009) and LOS was shorter but without statistical significance (24.5 ± 17.7 days vs. 27.7 ± 20.1 days, P = 0.21) in the GDT group than in the control group. The fluid amount administered and the presence/ absence of albumin use were factors affecting LOS. The variation of the fluid administration rate was significantly lower in the GDT group. Conclusion: The simplified GDT may contribute to the improvement of medical economics and standardize the fluid management.
文摘目的分析加速康复外科(ERAS)联合目标导向液体管理对老年肺癌患者围手术期血流动力学及认知功能的影响。方法选取2020年1月至2021年6月邯郸市中医院收治的拟择期行开胸肺叶切除术的128例老年肺癌患者为研究对象,并根据不同处置方法分为研究组和对照组,每组64例。研究组患者围手术期行ERAS联合目标导向液体管理,对照组患者围手术期行ERAS联合常规液体管理。比较两组患者手术时间、麻醉时间,血流动力学指标(心率、平均动脉压、氧合指数)、认知功能[蒙特利尔认知评估量表(MoCA)]以及并发症发生情况。结果两组患者手术时间、麻醉时间比较差异无统计学意义(P>0.05)。心率、平均动脉压、氧合指数不时点间和组间的主效应差异有统计学意义(P<0.01),组间和时点间存在交互作用(P<0.01),两组心率、氧合指数均先降低后升高(P<0.05),平均动脉压均逐渐升高(P<0.05),但研究组患者气管拔管后1、3、12 h的心率、平均动脉压明显低于对照组(P<0.05),气管拔管即刻及1、3、12 h的氧合指数明显高于对照组(P<0.05)。MoCA评分时点间和组间的主效应差异有统计学意义(P<0.01),组间和时点间存在交互作用(P<0.01),两组MoCA均呈先降低后升高趋势(P<0.05),但研究组患者术后1、3、5 d MoCA评分高于对照组(P<0.05)。研究组总并发症发生率明显低于对照组[14.06%(9/64)比34.38%(22/64)](P<0.01)。结论在ERAS基础上行目标导向液体管理,有利于维持老年肺癌患者围手术期血流动力学稳定性,提高患者认知功能,降低并发症发生风险。
