Anxiety is a strong behavioral and psychological reaction with fear components, while depression is a mental disorder dominated by high or low mood, both of which are accompanied by cognitive and behavioral changes, and are common comorbidities in patients with heart disease. Cardiac surgery is one of the important factors which trigger specific emotional and physiological reactions of patients. Persistent or initial depression and anxiety after surgery will not only increase surgical complications, short- or long-term mortality and medical costs, but also seriously affect patients' social function and quality of life. With the transformation of bio-psycho-social medical model, it is necessary to evaluate the perioperative psychological state and biological risk of patients undergoing cardiac surgery. This article reviews the characteristics, related mechanisms and therapeutic interventions of anxiety and depression in patients undergoing cardiac surgery.
ObjectiveTo summarize perioperative management experience of 16 patients undergoing surgical correction of anomalous origin of the left coronary artery from pulmonary artery (ALCAPA). MethodsWe performed a retrospective analysis of 16 patients who received surgical correction of ALCAPA between January 2005 and December 2013 in Cardiovascular Center of Children's Hospital of Fudan University. There were 6 males and 10 females with their age ranging from 2 months to 13 years (mean age of 23.25±0.63 months) and body weight ranging from 5 to 30 kg (mean body weight of 19.77±0.75 kg). All the patients underwent direct implantation of the anomalous coronary artery into the ascending aorta, and received comprehensive management regarding left ventricular ejection fraction (LVEF), heart rate, blood pressure, arterial blood gas, urinary volume, blood lactic acid and central venous pressure. ResultsPostoperative complications were low cardiac output syndrome (LCOS) in 9 patients (including intractable LCOS in 2 patients) and arrhythmia in 1 patient. One patient with intractable LCOS and arrhythmia died postoperatively with the mortality of 6.25%. Cardiopulmonary bypass time was 85-260 (135.61±35.01) minutes, aortic cross-clamping time was 40-97 (57.32±16.02) minutes, mechanical ventilation time was 34-187 (106.34±41.62) hours, length of CICU stay was 2-21 (8.13±5.02) days, and hospital stay was 12-51 (22.14±5.00) days. Postoperative LVEF and left ventricular fractional shortening were significantly higher than preoperative values (P < 0.05). ConclusionKey points for successful surgical correction of ALCAPA include meticulous perioperative management, preoperative heart function improvement, prevention of postoperative complications and use of new techniques.
【摘要】 目的 探讨小儿外科围手术期抗菌药物应用情况，为儿外科临床合理、规范使用抗菌药物提供参考。 方法 随机抽取儿外科2008年1月-2009年10月出院手术病历763份，对抗菌药物的应用情况进行分析。 结果 763份病历显示，患儿均使用了抗菌药物，应用率高达100%。抗菌药物品种应用最多的是青霉素类518例（48.05%），其次为头孢菌素类336例（31.17%），其他抗菌药物（林可霉素类、硝基咪唑类、大环内酯类等）224例（20.78%）。一联用药574例（75.00%），二联用药147例（19.00%），三联及以上用药42例（6.00%）。其中， 99例（12.98%）做过病原学检测，39例有药敏试验依据（5.11%），以G+中的葡萄球菌为主。 结论 小儿外科围手术期抗菌药物目前应用存在一定的不合理，临床应当严格按照《抗菌药物临床应用指导原则》合理、规范使用抗菌药物。【Abstract】 Objective To investigate the perioperative use of antibiotics in children’s surgery of our hospital to guide it’s reasonable and normal use. Methods A total of 763 patients who discharged from our hospital between January 2008 and October 2009 were sampled randomly for statistical analysis regarding the utilization. Results Of the 763 cases reviewed, all cases (100%) received antibiotics. In terms of the application of antibiotics, penicillins were predominantly used in 518 patients (48.05%), followed by cephalosporins in 336 patients (31.17%) and other antibiotics such as lincomycins nitroimidazoles and macrolides in 224 patients (20.78%). 574 patients (75.00%) received one antibiotic, 147 (19.00%) received two antibiotics and 42(6.00%) received at least three antibiotics concomitantly. Only 99 patients (12.98%) received etiological test and 39 patients (5.11%) received susceptibility test during antibiotic ues, most of them are G+ staphylococcus infected. Conclusion The perioperative use of antibiotics in our hospital is somewhat unreasonable, thus monitoring closely on which should be performed to promote their reasonable and normal use.
Objective To investigate the perioperative outcome of robot-assisted pulmonary lobectomy in treating pathological stage Ⅰ non-small cell lung cancer (NSCLC). Methods We retrospectively analyzed the clinical data of 333 consecutive p-T1 NSCLC patients who underwent robotic-assisted pulmonary lobectomy in our hospital between May 2013 and April 2016. There were 231 females (69.4%) and 102 males (30.6%) aged from 20–76 (55.01±10.46) years. Cancer was located in the left upper lobectomy in 37 (11.1%) patients, left lower lobectomy in 71 (21.3%) patients, right upper lobectomy in 105 (31.5%) patients, right middle lobectomy in 32 (9.6%) patients, right lower lobectomy in 88 (26.4%) patients. Adenocarcinoma was confirmed in 330 (99.1%) patients and squamous cell cancer was confirmed in 3 (0.9%) patients. Results Total operative time was 46–300 (91.51±30.80) min. Estimated intraoperative blood loss was 0–100 ml in 319 patients (95.8%), 101–400 ml in 12 patients (3.6%), >400 ml in 2 patients (0.6%). Four patients were converted to thoracotomy, including 2 patients due to pulmonary artery branch bleeding and 2 due to pleural adhesion.No patient died within 30 days after surgery. And no perioperative blood transfusion occurred. Postoperative day 1 drain was 0–960 (231.39±141.87) ml. Chest drain time was 2–12 (3.96±1.52) d.And no patient was discharged with chest tube. Length of hospital stay after surgery was 2–12 (4.96±1.51) d. Persistent air leak was in 12 patients over 7 days. No readmission happened within 30 days. All patients underwent lymph node sampling or dissection with 2–9 (5.69±1.46) groups and 3–21 (9.80±3.43) lymph nodes harvested. Total intraoperative cost was 60 389.66–134 401.65 (93 809.23±13 371.26) yuan. Conclusion Robot-assisted pulmonary lobectomy is safe and effective in treating p-Stage Ⅰ NSCLC, and could be an important supplement to conventional VATS. Regarding to cost, it is relatively more expensive compared with conventional VATS. RATS will be widely used and make a great change in pulmonary surgery with the progressive development of surgical robot.
ObjectiveTo prospective study the effectiveness and safety of multimodal analgesia (MA) in treatment of avascular necrosis of the femoral head with free vascularized fibular grafting (FVFG).MethodsSixty patients with avascular necrosis of the femoral head, who were scheduled to unilateral primary FVFG between February 2016 and December 2016 and met the selection criteria, were included in the study. All patients were allocated to two groups according to the method of random number table: MA group (n=30) and control group (n=30). There was no significant difference in gender, age, body mass index, side, duration and stage of avascular necrosis of the femoral head, preoperative visual analogue scale (VAS) scores under quiescent and active states, and range of motion (ROM) of hip flexion and abduction before operation (P>0.05). The patients in the MA group were treated with MA therapy, including oral administration of celecoxib before operation, local anesthetic wound infiltration during operation, and ice compression and oral administration of celecoxib after operation. The patients in control group were only treated with patient-controlled intravenous analgesia pump. The postoperative VAS scores under quiescent and active states, ROM of hip flexion and abduction, prescription of Tramadol and adverse reaction were recorded and compared.ResultsThe operations were completed successfully in both groups without obvious complications and adverse reaction. The Tramadol was used in 4 cases (13.3%) of MA group and in 11 cases (36.7%) of control group, but no significant difference was found between the two groups (χ2=4.356, P=0.072). The VAS scores under quiescent state at 6 and 24 hours postoperatively were significantly lower in MA group than in control group (P<0.05), while VAS scores under active state at 48 hours postoperatively and on the day of discharge were significantly lower in MA group than in control group (P<0.05). There was no significant difference in VAS score between two groups at other time points (P>0.05). The ROM of hip flexion in MA group was better than that in control group at 1 day postoperatively and the day of discharge (P<0.05), while no significant difference was found at 2 and 3 days postoperatively (P>0.05). The ROM of hip abduction in MA group was superior to the control group at 1, 2, and 3 days postoperatively and the day of discharge (P<0.05).ConclusionThe MA can effectively relieve the pain following FVFG and facilitate early functional exercises of the hip. The usage of opioids was also relatively fewer for MA protocol.
Objective To investigate the effect of perioperative body temperature on the survival of skin flap grafting. Methods From July 2005 to November 2006, 50 cases of Ⅰ-Ⅱ grade patients undergoing elective skin flap grafting were randomly divided 2 groups. Pharyngeal temperature (PT) and skin temperature(ST) were monitored and recorded every 15 minutes. Operativetime, anesthetic time, time from the end of operation to extubation, the volume of blood transfusion, the volume of fluid transfusion and the flap survival 7 days after operation were recorded. In the experimental group, the body temperature was maintained in normal range with water market and forced air heater. In the control group， the body temperature was only monitored without any treatment. Results There were no significant differences in operating room temperature, operative time, anesthetic time, the volume of blood transfusion and fluid transfusion between 2 groups(Pgt;0.05). After induction, PT decreased gradually inboth groups during the first 45 minutes, compared with the time point of intubation(Plt;0.05),but there were no significant differences between the 2 groups(Pgt;0.05); and ST rose in both groups during the first45 minutes, compared with the time point of intubation (Plt;0.05). After 45 minutes of induction, in the experimental group, PT was in the normal range(36℃), and ST didn’t change compared with that of the timepoint of induction(Pgt;0.05). In the control group, both PT and ST decreasedgradually and timedependently compared with the time point of intubation (Plt;0.05). In the experimental group, PT and ST at each time point were higher than those in the control group (Plt;0.05). All the skin flap grafts survived in the experimental group, and skin flap grafts necrosed in 2 cases in the control group.Conclusion Keeping normal body temperature can improve the survival ofskin flap grafting. Therefore, the body temperature should be monitored and maintained in a normal range.