Objective:To construct an evidence-based practice plan for perioperative nutritional optimization in esophageal cancer patients.Methods:By systematically searching relevant guidelines at home and abroad,two experts in...Objective:To construct an evidence-based practice plan for perioperative nutritional optimization in esophageal cancer patients.Methods:By systematically searching relevant guidelines at home and abroad,two experts independently assessed the quality of the guidelines,extracted valuable evidence and recommendations,and initially formed a draft nursing program.Subsequently,an expert panel was organized to conduct a detailed discussion to review the practicality and effectiveness of the recommendations one by one,and the program was finally revised and improved.Results:The protocol covered four stages of patients’admission,preoperative,postoperative,and discharge,involving specific contents such as nutritional assessment,risk screening,dysphagia assessment,nutritional therapy,enteral and parenteral nutritional support,symptom management,and health education.The program included a total of 61 entries,with 33 class A recommendations and 28 class B recommendations.Conclusion:The constructed perioperative nutritional care program for esophageal cancer patients is scientific and practical,and can provide practical guidance for clinical care.展开更多
Objective:To investigate the usefulness of the descending aortic retrograde flow area to forward flow area(dAO RF)ratio using echocardiography in managing pulmonary blood flow during the perioperative period following...Objective:To investigate the usefulness of the descending aortic retrograde flow area to forward flow area(dAO RF)ratio using echocardiography in managing pulmonary blood flow during the perioperative period following Blalock-Thomas-Taussig shunt(BTTS)surgery.Methods:This retrospective study analyzed patient characteristics,surgical procedures,and perioperative courses.The dAO RF ratio was measured upon admission to the pediatric intensive care unit(PICU)and 12,24,48,and 72 h post-surgery.Blood pressure,percutaneous oxygen saturation,arterial blood gas values,and lactate levels were measured at the same time as the dAO RF ratio.Results:Seventy-one cases were analyzed.Excessive and low pulmonary blood flow occurred in 17 and two patients,respectively.Four patients required resuscitation within 72 h post-surgery,due to excessive pulmonary blood flow.No deaths occurred within 72 h.The dAO RF ratio was significantly higher in patients with excessive pulmonary blood flow at PICU admission and at its maximum(p=0.049 and p<0.01,respectively).The maximum dAO RF ratio was significantly correlated with lactate levels when measured concurrently;however,there was clinical variability in the resuscitation cases.The dAO RF ratio cutoff of 0.61 was highly accurate(area under the receiver operating characteristic curve:0.91[95%confidence interval:0.82-1.00]),sensitive(82.4%),and specific(94.4%)for detecting excessive pulmonary blood flow.Conclusions:Measuring the dAO RF ratio postoperatively can prevent deterioration in patients with BTTS by accurately detecting excessive pulmonary blood flow,offering a minimally invasive and accurate assessment of perioperative pathophysiology.展开更多
Cancer,potentially the second leading cause of mortality globally,poses a significant health challenge.The conventional treatment for solid tumors typically involves surgical intervention,followed by chemotherapy,radi...Cancer,potentially the second leading cause of mortality globally,poses a significant health challenge.The conventional treatment for solid tumors typically involves surgical intervention,followed by chemotherapy,radiotherapy,and targeted therapies.However,cancer recurrence and metastasis remain major issues.Anesthesia is essential for ensuring patient comfort and safety during surgery.Despite its crucial role in surgery,the precise effect of anesthesia on cancer patients'outcomes has not been clearly understood.This comprehensive review aims to elucidate perioperative anesthesia strategies for cancer patients and their potential effects on prognosis.Given the complexity of cancer treatments,understanding the relationship between anesthesia and cancer outcomes is crucial.By examining potential implications of anesthesia strategies for cancer prognosis,this review may help better understand treatment efficacy and risk factors for cancer recurrence and metastasis.Ultimately,a detailed analysis of anesthesia practices in cancer surgery may provide insights to refine existing anesthesia protocols and reduce risk factors for poor patient outcomes.展开更多
Continuously increasing reports in the international medical literature,along with current guidelines from international societies,support the view that perioperative enteral nutrition(EN)and immunonutrition offer sig...Continuously increasing reports in the international medical literature,along with current guidelines from international societies,support the view that perioperative enteral nutrition(EN)and immunonutrition offer significant benefits to patients with benign and/or malignant digestive disorders,including reduction of postoperative infections and hospital stay.A vital component of the rehabilitation of patients after major gastrointestinal surgery is a comprehensive nutritional rehabilitation program.It has been shown that implementing an integrated nutritional support program significantly improves patients’immune responses,accelerates wound healing processes,reduces pain and accompanying anxiety,and decreases hospital length of stay.It appears that,in addition to the efforts of rehabilitation,prehabilitation,i.e.the return to the presurgery level of physical fitness,is or should be a vital objective of the team responsible for rehabilitating patients undergoing gastrointestinal surgery.The present review summarized the most up-to-date data on the role of perioperative nutritional support(EN and immune EN)in the rehabilitation and prehabilitation of patients undergoing major digestive surgery.Systematic and comprehensive perioperative nutritional support for these patients should become a daily clinical practice element of paramount importance.展开更多
Colorectal cancer(CRC)is a prevalent malignancy,with surgery playing a key role in its treatment.However,perioperative complications,such as anastomotic leaks,infections,and mortality,can significantly affect surgical...Colorectal cancer(CRC)is a prevalent malignancy,with surgery playing a key role in its treatment.However,perioperative complications,such as anastomotic leaks,infections,and mortality,can significantly affect surgical outcomes,extend hospital stays,and increase healthcare costs.Traditional risk prediction models often lack precision,leading to increased interest in artificial intelligence(AI)for improving risk stratification.This review examines the application of AI,particularly machine learning and deep learning,in predicting perioperative complications in CRC surgery.AI models have been employed to predict a variety of postoperative complications,including readmissions,surgical-site infections,anastomotic leakage,and mortality,by analyzing diverse data sources such as electronic health records,medical imaging,and preoperative markers.Despite the promising results,several challenges remain,including data quality,model generalizability,the complexity of clinical data,and ethical and regulatory concerns.The review emphasizes the need for multicenter,diverse datasets and the integration of AI into clinical workflows to improve model performance and adoption.Future efforts should focus on enhancing the transparency and interpretability of AI models to ensure their successful implementation in clinical practice,ultimately improving patient outcomes and surgical decision-making in CRC surgery.展开更多
The nutritional situation of the elderly is closely related to the occurrence and development of many diseases.How to reduce the damage of surgery,and improve the postoperative survival rate and quality of life in mal...The nutritional situation of the elderly is closely related to the occurrence and development of many diseases.How to reduce the damage of surgery,and improve the postoperative survival rate and quality of life in malnourished elderly patients is very important.Through the elderly malnutrition perioperative risk factors analysis,we make strategies for risk factors of perioperative-related prevention,from preoperative,intraoperative,and postoperative management of patients,to improve the patient’s life.展开更多
BACKGROUND Enhanced recovery after surgery(ERAS)represents an innovative,protocoldriven perioperative care program designed to optimize patient outcomes.However,its application and efficacy in infants and children wit...BACKGROUND Enhanced recovery after surgery(ERAS)represents an innovative,protocoldriven perioperative care program designed to optimize patient outcomes.However,its application and efficacy in infants and children with Hirschsprung disease(HD)remain underexplored.AIM To delve into the impact of ERAS on perioperative recovery and the overall medical experience in HD infants and children.METHODS Thirty-eight infants and children with HD who received the Soave surgical procedure were enrolled in this case-control study.According to age-and sexstratified single-blind randomized tables,20 cases received ERAS treatment(ERAS group)and 18 cases received conventional treatment(control group).The two treatments were then compared in terms of perioperative recovery and medical experience.RESULTS Significant differences were observed in pain scores at awakening(4.2±1.3 vs 5.2±1.2,t=2.516,P=0.017)and pain duration(85.69±7.46 hours vs 67.00±8.56 hours,t=7.139,P<0.001)between the ERAS and control group.The recovery of bowel movement was earlier in the ERAS group than in the control group(borborygmus time:33.63±9.83 hours vs 44.69±16.85 hours,t=2.501,P=0.017;feeding time:36.63±9.55 hours vs 49.36±16.99 hours,t=2.884,P=0.007;anal catheter indwelling time:75.83±13.80 hours vs 93.36±20.65 hours,t=3.104,P=0.004),and fever duration(40.73±14.42 hours vs 52.63±18.69 hours,t=2.211,P=0.034).In the ERAS group,hospital stay was shorter(7.5±0.9 days vs 8.3±1.2 days)and the cost was lower(14203±2381 yuan vs 16847±3558 yuan).During the 1-month follow-up period,of the multiple postoperative complications observed,the occurrence of perianal dermatitis(PFisher=0.016)and defecation dysfunction(PFisher=0.027)were lower in the ERAS group than in the control group.CONCLUSION The ERAS protocol has the potential to profoundly enhance postoperative recovery and significantly elevate the overall comfort and quality of the medical experience,making it an indispensable approach that warrants widespread adoption.Continuous refinement through evidence-based practices is anticipated to further optimize its efficacy.展开更多
BACKGROUND Heart rate variability(HRV)represents efferent vagus nerve activity,which is suggested to be related to fundamental mechanisms of tumorigenesis and to be a predictor of prognosis in various cancers.Therefor...BACKGROUND Heart rate variability(HRV)represents efferent vagus nerve activity,which is suggested to be related to fundamental mechanisms of tumorigenesis and to be a predictor of prognosis in various cancers.Therefore,this study hypothesized that HRV monitoring could predict perioperative complication(PC)in colorectal cancer(CRC)patients.AIM To investigate the prognostic value of HRV in hospitalized CRC patients.METHODS The observational studies included 87 patients who underwent CRC surgical procedures under enhanced recovery after surgery programs in a first-class hospital.The HRV parameters were compared between the PC group and the non PC(NPC)group from preoperative day 1 to postoperative day(Pod)3.In addition,inflammatory biomarkers and nutritional indicators were also analyzed.RESULTS The complication rate was 14.9%.HRV was markedly abnormal after surgery,especially in the PC group.The frequency-domain parameters(including pNN50)and time-domain parameters[including high-frequency(HF)]of HRV were significantly different between the two groups postoperatively.The pNN50 was significantly greater at Pod1 in the PC group than that in the NPC group and returned to baseline at Pod2,suggesting that patients with complications exhibited autonomic nerve dysfunction in the early postoperative period.In the PC group,HFs were also enhanced from Pod1 and were significantly higher than in the NPC group;inflammatory biomarkers were significantly elevated at Pod2 and Pod3;the levels of nutritional indicators were significantly lower at Pod1 and Pod2;and the white blood cell count was slightly elevated at Pod3.CONCLUSION HRV is independently associated with postoperative complications in patients with CRC.Abnormal HRV could predicted an increased risk of postoperative complications in CRC patients.Continuous HRV could be used to monitor complications in patients with CRC during the perioperative period.展开更多
Objective To evaluate the changes in postoperative plasmaβ-endorphin(β-EP)levels in patients who had received perioperative electroacupuncture(EA)treatment in 10 randomized controlled trials(RCTs)and examine the imp...Objective To evaluate the changes in postoperative plasmaβ-endorphin(β-EP)levels in patients who had received perioperative electroacupuncture(EA)treatment in 10 randomized controlled trials(RCTs)and examine the impact of EA on postoperative pain.Methods This meta-analysis evaluated the changes in plasmaβ-EP levels and visual analog scale(VAS)12,24 and 48 hours after surgery in patients receiving perioperative EA.It also assessed the changes in plasma serotonin(5-hydroxytryptamine,5-HT)and prostaglandin E2(PGE2)levels at 24 hours postsurgery.A comprehensive search was conducted in the China National Knowledge Infrastructure(CNKI),Wanfang,Chongqing VIP database,Chinese Biomedical Database(CBM),Web of Science,and PubMed databases.RCTs on perioperative EA andβ-EP published from the inception of the websites up to July 25,2023,were retrieved.Effect size aggregation,literature quality assessment,and bias analysis were performed using RevMan 5.3 software,and sensitivity analysis was conducted via R 4.3.1.Results A total of 10 RCTs involving 706 patients were included.EA in conjunction with conventional anesthesia significantly increased plasmaβ-EP levels at 12 hours postsurgery[standard mean difference(SMD)=2.79,95%CI(1.85,3.72),Z=5.81,P<0.00001],24 hours postsurgery[SMD=1.87,95%CI(0.9,2.83),Z=3.79,P=0.0001],and 48 hours postsurgery[SMD=2.02,95%CI(1.49,2.54),Z=7.50,P<0.00001].EA reduced plasma PGE2 levels at 24 hours postsurgery and plasma 5-HT levels at 24 hours postsurgery,and the VAS at 12,24 and 48 hours after surgery also decreased.Conclusion These findings suggest that perioperative EA markedly elevates plasmaβ-EP levels,reduces pain-inducing factors in plasma,and effectively alleviates acute postoperative pain.展开更多
Objective:To analyze the positive impact of pharmaceutical care in the ophthalmology perioperative period on the rational use of antibiotics.Methods:A total of 115 patients who underwent ophthalmological surgery betwe...Objective:To analyze the positive impact of pharmaceutical care in the ophthalmology perioperative period on the rational use of antibiotics.Methods:A total of 115 patients who underwent ophthalmological surgery between March and June 2023 were selected as the control group,receiving routine medication management.Another 115 patients who underwent ophthalmological surgery between July and October 2023 were selected as the observation group,receiving pharmaceutical care.The rationality of medication use,mastery of medication knowledge,medication compliance,and adverse reaction rates were compared between the two groups.Results:The observation group had higher rationality of medication use,higher scores for mastery of medication knowledge,higher medication compliance,and a lower adverse reaction rate compared to the control group(P<0.05).Conclusion:The combination of antibiotic therapy and pharmaceutical care in the ophthalmology perioperative period can improve the rationality of medication use,enhance patients’mastery of medication knowledge,increase their medication compliance,and prevent adverse reactions to antibiotics.展开更多
Kidney transplant is the treatment of choice for patients with end-stage kidneydisease. Meticulous anaesthetic management is the cornerstone of good postoperativepatient and graft outcomes. Over the decades, the perio...Kidney transplant is the treatment of choice for patients with end-stage kidneydisease. Meticulous anaesthetic management is the cornerstone of good postoperativepatient and graft outcomes. Over the decades, the perioperative strategiesfor preoperative optimization, fluid management, immunosuppression, haemodynamicmonitoring, and pain management keep changing with the inclusionof newer studies. The aim of this review is to update anaesthesia colleagues forrecent advancements in perioperative care of patients undergoing kidney transplantation.展开更多
BACKGROUND Surgery is the gold standard for gallstone treatment.Nevertheless,the complications associated with the surgical procedure can exert diverse and adverse impacts on patients’health and quality of life to va...BACKGROUND Surgery is the gold standard for gallstone treatment.Nevertheless,the complications associated with the surgical procedure can exert diverse and adverse impacts on patients’health and quality of life to varying extents.Hence,it is essential to offer perioperative care to patients undergoing gallstone surgery.AIM To examine the impact of perioperative comprehensive nursing on pain intensity,complication rates,and patient comfort in individuals undergoing gallstone surgery.METHODS From February 2022 to February 2024,195 patients who underwent gallstone surgery at Sanmen People’s Hospital were selected and divided into two groups:A control group receiving routine nursing care(95 patients)and a research group receiving perioperative comprehensive nursing(100 patients).Key postoperative recovery indicators,including time to first postoperative anal exhaust,oral food intake,and ambulation,were observed,along with pain intensity(measured by the numeric rating scale),complication rate(bleeding,incision infection,recurrence),patient comfort(assessed using the visual analogue scale),and quality of life(measured by the World Health Organization Quality of Life-BREF).RESULTS The research group showed significantly shorter times to first postoperative anal exhaust,oral intake,and ambulation.Moreover,numeric rating scale pain scores in the research group were markedly lower post-nursing,and the total complication rate was significantly reduced compared to the control group.Furthermore,comfort levels improved considerably in the research group,and World Health Organization Quality of Life-BREF scores across the physical,psychological,social,and environmental domains were significantly higher compared to the control group following nursing care.CONCLUSION Perioperative comprehensive nursing effectively enhances postoperative recovery in patients undergoing gallstone surgery,reducing pain,lowering complications,and improving patient comfort and quality of life,which deserves clinical application.展开更多
BACKGROUND Elderly patients undergoing laparoscopic colorectal cancer surgery are at high risk for hypothermia-related complications.This study explores the efficacy of periop-erative composite insulation intervention...BACKGROUND Elderly patients undergoing laparoscopic colorectal cancer surgery are at high risk for hypothermia-related complications.This study explores the efficacy of periop-erative composite insulation interventions in maintaining normothermia and reducing postoperative risks in this vulnerable group.AIM To evaluate the efficacy of perioperative composite insulation in older patients undergoing colorectal cancer surgery.METHODS We selected 100 older patients who underwent laparoscopic surgery for colorectal cancer at Huzhou Central Hospital from September 2023 to April 2024.Using a random number table,patients were divided into a control group and inter-vention group of 50 patients each.After returning to the regular ward,the con-ventional group received traditional insulation intervention measures,while the intervention group received composite insulation nursing intervention.We ob-served and recorded postoperative blood pressure and heart rate changes,as well as postoperative anesthesia recovery time and incidence of complications.RESULTS The statistical results showed significant differences(P<0.05)in heart rate changes and systolic blood pressure between the two groups.There was a sig-nificant change in heart rate between the groups immediately after surgery and at 15 and 30 minutes after surgery(P<0.05).The heart rate and systolic blood pressure of the intervention group were significantly lower than those of the control group at 15 and 30 minutes after surgery(P<0.05).The rewarming time of the intervention group was shorter than that of the control group,and the overall incidence of postoperative complications was significantly lower than that of the control group(P<0.05).CONCLUSION For elderly patients undergoing laparoscopic colorectal cancer surgery,a composite insulation intervention during the perioperative period can maintain body temperature,reduce postoperative stress,and significantly reduce the incidence of hypothermia and related complications.展开更多
BACKGROUND The application of perioperative disinfection and isolation measures to patients undergoing gastrointestinal surgery with postoperative infection can provide a data reference for reducing the postoperative ...BACKGROUND The application of perioperative disinfection and isolation measures to patients undergoing gastrointestinal surgery with postoperative infection can provide a data reference for reducing the postoperative infection rate,improving post-operative biochemical markers,and enhancing postoperative recovery outcomes.AIM To explore the effectiveness of perioperative disinfection and isolation measures in controlling postoperative infection following gastrointestinal surgery.It also sought to compare infection rates and biochemical markers between the obser-vation and control groups and evaluate the impact of disinfection and isolation measures on reducing postoperative complications.METHODS A retrospective analysis was conducted.Ninety-six patients who underwent gastrointestinal surgery between January 2022 and December 2023 were selected and divided into an observation group and a control group,with 48 cases in each.The observation group received disinfection and isolation measures during the perioperative period,whereas the control group received standard nursing care.The incidence of infection,white blood cell count,C-reactive protein levels,hemoglobin levels,and liver function markers(alanine aminotransferase,aspartate aminotransferase,creatinine,and blood urea nitrogen)were monitored postoperatively in both groups.RESULTS The postoperative infection rate in the observation group was significantly lower than that in the control group(P<0.05).White blood cell and C-reactive protein levels decreased significantly after surgery in the observation group and were significantly lower than those in the control group(P<0.05).Alanine aminotransferase,aspartate aminotransferase,creatinine,and blood urea nitrogen levels in the observation group were lower than those in the control group on postoperative days 1 and 3,showing a significant difference(P<0.05).CONCLUSION Perioperative disinfection and isolation measures effectively reduce postoperative infection rates in gastrointestinal surgery patients and improve biochemical markers,thereby enhancing recovery outcomes.This study provides a valuable basis for postoperative infection control and has significant clinical applications.展开更多
BACKGROUND The risk and mortality rate of venous thromboembolism(VTE)following gastrointestinal surgery remain high,and the symptoms are atypical.Therefore,it is necessary to identify the risk factors associated with ...BACKGROUND The risk and mortality rate of venous thromboembolism(VTE)following gastrointestinal surgery remain high,and the symptoms are atypical.Therefore,it is necessary to identify the risk factors associated with the occurrence of VTE following gastrointestinal surgery and to implement appropriate prevention and treatment measures.AIM To assess the efficacy of perioperative anticoagulation for the prevention of postoperative VTE.METHODS This retrospective study enrolled 205 patients who underwent gastrointestinal surgery.In the observation group(n=101),prophylactic anticoagulation was administered via hypodermic injection of low-molecular-weight heparin during the perioperative period,whereas the control group(n=104)only received lowmolecular-weight heparin treatment postoperatively.Blood coagulation parameters and the incidence of VTE of the bilateral lower limbs pre-and post-surgery were compared between groups.Postoperative VTE was transformed into a dichotomous variable,and influencing factors were explored using multivariate logistic regression analyses.RESULTS On the 7th day postoperatively,the incidence of VTE of the bilateral lower limbs was significantly lower in the observation group than in the control group,as were the D-dimer levels(P<0.05).At 1 month postoperatively,the incidence of VTE was significantly lower in the observation group than in the control group(P<0.05).An age≥65 years,a body mass index≥24 kg/m^(2),and malignant diseases of the digestive system were identified as risk factors for the occurrence of postoperative VTE in patients undergoing gastrointestinal surgery.CONCLUSION The incidence of VTE in patients who underwent gastrointestinal surgery peaked within 1 week postoperatively.The findings confirmed perioperative anticoagulation can safely and effectively reduce the incidence of postoperative VTE.展开更多
Cardiac arrest(CA)is considered a state of clinical death in which the heart suddenly loses its ability to effectively expel blood,resulting in circulatory and respiratory arrest.CA is often catastrophic for patients,...Cardiac arrest(CA)is considered a state of clinical death in which the heart suddenly loses its ability to effectively expel blood,resulting in circulatory and respiratory arrest.CA is often catastrophic for patients,as it can cause serious long-term cardiovascular and cerebrovascular complications that affect their quality of life[1].Survey data indicate that the overall incidence rate of intraoperative CA in patients undergoing thoracic surgery in China is currently 0.138%[2].This rate is expected to increase because of the increasing proportion of older individuals(age>60 years)in the population,as well as the increasing pulmonary surgery rates.However,the incidence rate during the perianesthetic period in older patients undergoing thoracic surgery has not yet been comprehensively reported.展开更多
BACKGROUND Esophageal cancer constitutes one of the most aggressive malignant neoplasms associated with poor clinical outcomes.While surgical resection remains the cornerstone of curative intervention,optimization of ...BACKGROUND Esophageal cancer constitutes one of the most aggressive malignant neoplasms associated with poor clinical outcomes.While surgical resection remains the cornerstone of curative intervention,optimization of perioperative care protocols has emerged as an essential strategy to reduce postoperative complications and potentially improve long-term survival rates in patients undergoing esophagectomy.However,substantial debate persists regarding the relative importance of various perioperative risk factors and their impact on post-resection outcomes.AIM To identify perioperative factors affecting prognosis after radical esophagectomy,aiming to improve patient outcomes through targeted interventions.METHODS A retrospective study analyzed 378 patients with esophageal cancer who underwent radical esophagectomy(McKeown,Sweet,or Ivor-Lewis procedures)from January 2022 through December 2023.All operations were performed by experienced surgeons following standardized perioperative protocols.The investigation gathered data on patient demographics,surgical parameters,tumor pathology(using the 8th edition American Joint Committee on Cancer staging system),and survival outcomes.Statistical analyses utilized Kaplan-Meier estimates and Cox proportional hazards modeling,with adjustment for confounding variables.RESULTS Multivariate Cox proportional hazards analysis identified three independent predictors of survival:Tumor-nodemetastasis staging[Hazard ratio(HR)=2.31,95%confidence interval(CI):1.72-3.10,P<0.001],tumor differentiation(moderate:HR=1.46,95%CI:1.02-2.09,P=0.038;poor:HR=2.15,95%CI:1.47-3.14,P<0.001),and extended postoperative analgesic use(>5 days)(HR=1.43,95%CI:1.08-1.89,P=0.012).Kaplan-Meier analysis demonstrated significantly lower overall survival rates in patients requiring analgesics for>5 days compared to≤5 days(P=0.003),with consistent patterns observed for both opioid(P=0.019)and nonsteroidal anti-inflammatory drug use(P=0.028).The extended analgesic group exhibited a higher proportion of elderly patients(48.47%vs 35.57%,P=0.015),while other baseline characteristics and tumor features remained comparable between groups.CONCLUSION Tumor-node-metastasis staging,tumor differentiation,and duration of postoperative analgesic use independently predict survival following radical esophagectomy,underscoring the significance of optimal pain management protocols.展开更多
BACKGROUND Hepatobiliary and pancreatic cancers are among the most lethal malignancies due to late-stage diagnosis and limited treatment options.Liquid biopsy has emerged as a minimally invasive tool for early cancer ...BACKGROUND Hepatobiliary and pancreatic cancers are among the most lethal malignancies due to late-stage diagnosis and limited treatment options.Liquid biopsy has emerged as a minimally invasive tool for early cancer detection,prognosis,and therapeutic monitoring.AIM To concise the available data on liquid biopsy and establish its role in hepato-biliary surgeries.METHODS This systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 guidelines.A comprehensive lite-rature search was performed using PubMed,Scopus,Web of Science,and EMBASE for studies published up to March 2025.Studies assessing the role of circulating tumor DNA,circulating tumor cells,exosomes,and other liquid biopsy markers in hepatobiliary and pancreatic cancers were included.The risk of bias was evaluated using the Newcastle-Ottawa Scale for observational studies and the Cochrane Risk of Bias Tool for clinical trials.RESULTS Liquid biopsy demonstrated significant potential for early cancer detection,perioperative risk stratification,intraoperative surgical decision-making,and postoperative monitoring of minimal residual disease.However,challenges remain regarding standardization,sensitivity,and clinical validation.CONCLUSION Liquid biopsy represents a paradigm shift in hepatobiliary and pancreatic cancer management.Advancements in next-generation sequencing and artificial intelligence may enhance its clinical utility.Further large-scale studies are needed to establish standardized protocols for routine implementation.展开更多
BACKGROUND The use of an ultrasound-guided quadratus lumborum block(QLB)combined with general anesthesia for patients undergoing colorectal cancer surgery serves as a model for reducing the postoperative stress respon...BACKGROUND The use of an ultrasound-guided quadratus lumborum block(QLB)combined with general anesthesia for patients undergoing colorectal cancer surgery serves as a model for reducing the postoperative stress response,preserving metabolic stability,protecting renal function,and alleviating postoperative pain.AIM To compare QLB combined with general anesthesia vs general anesthesia alone in the perioperative stress response,metabolic and renal function,postoperative pain,and recovery outcomes among patients undergoing colorectal cancer surgery.METHODS Clinical data of 116 patients who underwent colorectal cancer surgery at our hospital between July 2023 and August 2024 were collected for retrospective analysis.According to the anesthesia protocol,the patients were divided into the control(general anesthesia,n=58)and experimental groups(QLB combined with general anesthesia,n=58).Physiological indicators such as blood glucose(GLU),lactic acid(LAC),blood urea nitrogen(BUN),and creatinine(CRE)were measured at T0(pre-surgery),T1(post-surgery),T2(6 hours post-surgery),T3(24 hours post-surgery),and T4(48 hours post-surgery).The differences between the two groups for each indicator were evaluated using repeated-measures analysis of variance.RESULTS The GLU levels from T1 to T4 in the experimental group were significantly lower than those in the control group(P<0.001),and the LAC levels were also significantly reduced(P<0.001).The experimental group exhibited superior renal protection based on postoperative BUN and CRE levels(P<0.05).Furthermore,the postoperative pain score in the experimental group was significantly lower than that in the control group[visual analogue scale(VAS)]scores differed significantly from T2 to T4,P<0.05.CONCLUSION Research has shown that QLB combined with general anesthesia can decrease postoperative GLU and LAC by 8%-15%and 10%-20%(P<0.001),respectively.It also enhances renal function markers(BUN,CRE,P<0.05)and lowers VAS scores by 15%-30%(P<0.05).Ultrasound-guided lumbar muscle block with general anesthesia outperforms general anesthesia alone in diminishing stress response,preserving metabolic balance and renal function,and alleviating postoperative pain.This approach offers a more efficient perioperative management strategy for patients undergoing colorectal cancer surgery.It is particularly advantageous for individuals with stress sensitivity,renal impairment,and heightened pain susceptibility.展开更多
Objective:To analyze the effect of pharmacist-led rational drug use management of antibiotics during the perioperative period in gynecology.Methods:Two hundred patients who underwent gynecological surgery between Marc...Objective:To analyze the effect of pharmacist-led rational drug use management of antibiotics during the perioperative period in gynecology.Methods:Two hundred patients who underwent gynecological surgery between March 2023 and December 2023 were selected and randomly divided into two groups.In the experimental group,the pharmacist led the medication management during the perioperative use of antibiotics,while the control group received routine antibiotic management.The management effects were compared between the two groups.Results:The irrational drug use rate,the incidence of adverse drug reactions,the cost of antibiotics,and the incidence of postoperative infection were all lower in the experimental group compared to the control group(P<0.05).Conclusion:Implementing pharmacist-led medication management during the perioperative period of gynecological surgery can prevent irrational drug use,reduce adverse drug reactions,control drug costs,and lower the risk of postoperative infection.展开更多
文摘Objective:To construct an evidence-based practice plan for perioperative nutritional optimization in esophageal cancer patients.Methods:By systematically searching relevant guidelines at home and abroad,two experts independently assessed the quality of the guidelines,extracted valuable evidence and recommendations,and initially formed a draft nursing program.Subsequently,an expert panel was organized to conduct a detailed discussion to review the practicality and effectiveness of the recommendations one by one,and the program was finally revised and improved.Results:The protocol covered four stages of patients’admission,preoperative,postoperative,and discharge,involving specific contents such as nutritional assessment,risk screening,dysphagia assessment,nutritional therapy,enteral and parenteral nutritional support,symptom management,and health education.The program included a total of 61 entries,with 33 class A recommendations and 28 class B recommendations.Conclusion:The constructed perioperative nutritional care program for esophageal cancer patients is scientific and practical,and can provide practical guidance for clinical care.
文摘Objective:To investigate the usefulness of the descending aortic retrograde flow area to forward flow area(dAO RF)ratio using echocardiography in managing pulmonary blood flow during the perioperative period following Blalock-Thomas-Taussig shunt(BTTS)surgery.Methods:This retrospective study analyzed patient characteristics,surgical procedures,and perioperative courses.The dAO RF ratio was measured upon admission to the pediatric intensive care unit(PICU)and 12,24,48,and 72 h post-surgery.Blood pressure,percutaneous oxygen saturation,arterial blood gas values,and lactate levels were measured at the same time as the dAO RF ratio.Results:Seventy-one cases were analyzed.Excessive and low pulmonary blood flow occurred in 17 and two patients,respectively.Four patients required resuscitation within 72 h post-surgery,due to excessive pulmonary blood flow.No deaths occurred within 72 h.The dAO RF ratio was significantly higher in patients with excessive pulmonary blood flow at PICU admission and at its maximum(p=0.049 and p<0.01,respectively).The maximum dAO RF ratio was significantly correlated with lactate levels when measured concurrently;however,there was clinical variability in the resuscitation cases.The dAO RF ratio cutoff of 0.61 was highly accurate(area under the receiver operating characteristic curve:0.91[95%confidence interval:0.82-1.00]),sensitive(82.4%),and specific(94.4%)for detecting excessive pulmonary blood flow.Conclusions:Measuring the dAO RF ratio postoperatively can prevent deterioration in patients with BTTS by accurately detecting excessive pulmonary blood flow,offering a minimally invasive and accurate assessment of perioperative pathophysiology.
基金Innovative and Entrepreneurial Team of Jiangsu Province(Grant No.JSSCTD202144)Nanjing Postdoctoral Program(Grant No.BSHNJ2023006)National Natural Science Foundation of China(Grant No.82201380)。
文摘Cancer,potentially the second leading cause of mortality globally,poses a significant health challenge.The conventional treatment for solid tumors typically involves surgical intervention,followed by chemotherapy,radiotherapy,and targeted therapies.However,cancer recurrence and metastasis remain major issues.Anesthesia is essential for ensuring patient comfort and safety during surgery.Despite its crucial role in surgery,the precise effect of anesthesia on cancer patients'outcomes has not been clearly understood.This comprehensive review aims to elucidate perioperative anesthesia strategies for cancer patients and their potential effects on prognosis.Given the complexity of cancer treatments,understanding the relationship between anesthesia and cancer outcomes is crucial.By examining potential implications of anesthesia strategies for cancer prognosis,this review may help better understand treatment efficacy and risk factors for cancer recurrence and metastasis.Ultimately,a detailed analysis of anesthesia practices in cancer surgery may provide insights to refine existing anesthesia protocols and reduce risk factors for poor patient outcomes.
文摘Continuously increasing reports in the international medical literature,along with current guidelines from international societies,support the view that perioperative enteral nutrition(EN)and immunonutrition offer significant benefits to patients with benign and/or malignant digestive disorders,including reduction of postoperative infections and hospital stay.A vital component of the rehabilitation of patients after major gastrointestinal surgery is a comprehensive nutritional rehabilitation program.It has been shown that implementing an integrated nutritional support program significantly improves patients’immune responses,accelerates wound healing processes,reduces pain and accompanying anxiety,and decreases hospital length of stay.It appears that,in addition to the efforts of rehabilitation,prehabilitation,i.e.the return to the presurgery level of physical fitness,is or should be a vital objective of the team responsible for rehabilitating patients undergoing gastrointestinal surgery.The present review summarized the most up-to-date data on the role of perioperative nutritional support(EN and immune EN)in the rehabilitation and prehabilitation of patients undergoing major digestive surgery.Systematic and comprehensive perioperative nutritional support for these patients should become a daily clinical practice element of paramount importance.
文摘Colorectal cancer(CRC)is a prevalent malignancy,with surgery playing a key role in its treatment.However,perioperative complications,such as anastomotic leaks,infections,and mortality,can significantly affect surgical outcomes,extend hospital stays,and increase healthcare costs.Traditional risk prediction models often lack precision,leading to increased interest in artificial intelligence(AI)for improving risk stratification.This review examines the application of AI,particularly machine learning and deep learning,in predicting perioperative complications in CRC surgery.AI models have been employed to predict a variety of postoperative complications,including readmissions,surgical-site infections,anastomotic leakage,and mortality,by analyzing diverse data sources such as electronic health records,medical imaging,and preoperative markers.Despite the promising results,several challenges remain,including data quality,model generalizability,the complexity of clinical data,and ethical and regulatory concerns.The review emphasizes the need for multicenter,diverse datasets and the integration of AI into clinical workflows to improve model performance and adoption.Future efforts should focus on enhancing the transparency and interpretability of AI models to ensure their successful implementation in clinical practice,ultimately improving patient outcomes and surgical decision-making in CRC surgery.
基金supported by Emerging Industry Leading Talent Project of Shanxi Province(No.2020587).
文摘The nutritional situation of the elderly is closely related to the occurrence and development of many diseases.How to reduce the damage of surgery,and improve the postoperative survival rate and quality of life in malnourished elderly patients is very important.Through the elderly malnutrition perioperative risk factors analysis,we make strategies for risk factors of perioperative-related prevention,from preoperative,intraoperative,and postoperative management of patients,to improve the patient’s life.
基金Supported by the Project of Mianyang Central Hospital,School of Medicine,University of Electronic Science and Technology of China,No.2021YJ005the Science&Technology Department of Sichuan Province,China,No.2019YJ0701。
文摘BACKGROUND Enhanced recovery after surgery(ERAS)represents an innovative,protocoldriven perioperative care program designed to optimize patient outcomes.However,its application and efficacy in infants and children with Hirschsprung disease(HD)remain underexplored.AIM To delve into the impact of ERAS on perioperative recovery and the overall medical experience in HD infants and children.METHODS Thirty-eight infants and children with HD who received the Soave surgical procedure were enrolled in this case-control study.According to age-and sexstratified single-blind randomized tables,20 cases received ERAS treatment(ERAS group)and 18 cases received conventional treatment(control group).The two treatments were then compared in terms of perioperative recovery and medical experience.RESULTS Significant differences were observed in pain scores at awakening(4.2±1.3 vs 5.2±1.2,t=2.516,P=0.017)and pain duration(85.69±7.46 hours vs 67.00±8.56 hours,t=7.139,P<0.001)between the ERAS and control group.The recovery of bowel movement was earlier in the ERAS group than in the control group(borborygmus time:33.63±9.83 hours vs 44.69±16.85 hours,t=2.501,P=0.017;feeding time:36.63±9.55 hours vs 49.36±16.99 hours,t=2.884,P=0.007;anal catheter indwelling time:75.83±13.80 hours vs 93.36±20.65 hours,t=3.104,P=0.004),and fever duration(40.73±14.42 hours vs 52.63±18.69 hours,t=2.211,P=0.034).In the ERAS group,hospital stay was shorter(7.5±0.9 days vs 8.3±1.2 days)and the cost was lower(14203±2381 yuan vs 16847±3558 yuan).During the 1-month follow-up period,of the multiple postoperative complications observed,the occurrence of perianal dermatitis(PFisher=0.016)and defecation dysfunction(PFisher=0.027)were lower in the ERAS group than in the control group.CONCLUSION The ERAS protocol has the potential to profoundly enhance postoperative recovery and significantly elevate the overall comfort and quality of the medical experience,making it an indispensable approach that warrants widespread adoption.Continuous refinement through evidence-based practices is anticipated to further optimize its efficacy.
基金Supported by The Natural Science Foundation of Nanjing University of Chinese Medicine,No.XZR2021019The Outstanding Young Doctor Program of Jiangsu Province of Chinese Medicine,No.2023QB0140+1 种基金Project of National Clinical Research Base of Traditional Chinese Medicine in Jiangsu Province,No.JD2022SZ18The Natural Science Foundation of Nanjing University of Chinese Medicine,No.KYCX21_1710.
文摘BACKGROUND Heart rate variability(HRV)represents efferent vagus nerve activity,which is suggested to be related to fundamental mechanisms of tumorigenesis and to be a predictor of prognosis in various cancers.Therefore,this study hypothesized that HRV monitoring could predict perioperative complication(PC)in colorectal cancer(CRC)patients.AIM To investigate the prognostic value of HRV in hospitalized CRC patients.METHODS The observational studies included 87 patients who underwent CRC surgical procedures under enhanced recovery after surgery programs in a first-class hospital.The HRV parameters were compared between the PC group and the non PC(NPC)group from preoperative day 1 to postoperative day(Pod)3.In addition,inflammatory biomarkers and nutritional indicators were also analyzed.RESULTS The complication rate was 14.9%.HRV was markedly abnormal after surgery,especially in the PC group.The frequency-domain parameters(including pNN50)and time-domain parameters[including high-frequency(HF)]of HRV were significantly different between the two groups postoperatively.The pNN50 was significantly greater at Pod1 in the PC group than that in the NPC group and returned to baseline at Pod2,suggesting that patients with complications exhibited autonomic nerve dysfunction in the early postoperative period.In the PC group,HFs were also enhanced from Pod1 and were significantly higher than in the NPC group;inflammatory biomarkers were significantly elevated at Pod2 and Pod3;the levels of nutritional indicators were significantly lower at Pod1 and Pod2;and the white blood cell count was slightly elevated at Pod3.CONCLUSION HRV is independently associated with postoperative complications in patients with CRC.Abnormal HRV could predicted an increased risk of postoperative complications in CRC patients.Continuous HRV could be used to monitor complications in patients with CRC during the perioperative period.
基金Supported by Beijing Natural Science Foundation(7232130)Fundamental Research Funds for the Central Universities(2024-JYB-JBZD-024)CZ015-High Level Traditional Chinese Medicine Hospital SM Project(DZMG-LJRC0006)。
文摘Objective To evaluate the changes in postoperative plasmaβ-endorphin(β-EP)levels in patients who had received perioperative electroacupuncture(EA)treatment in 10 randomized controlled trials(RCTs)and examine the impact of EA on postoperative pain.Methods This meta-analysis evaluated the changes in plasmaβ-EP levels and visual analog scale(VAS)12,24 and 48 hours after surgery in patients receiving perioperative EA.It also assessed the changes in plasma serotonin(5-hydroxytryptamine,5-HT)and prostaglandin E2(PGE2)levels at 24 hours postsurgery.A comprehensive search was conducted in the China National Knowledge Infrastructure(CNKI),Wanfang,Chongqing VIP database,Chinese Biomedical Database(CBM),Web of Science,and PubMed databases.RCTs on perioperative EA andβ-EP published from the inception of the websites up to July 25,2023,were retrieved.Effect size aggregation,literature quality assessment,and bias analysis were performed using RevMan 5.3 software,and sensitivity analysis was conducted via R 4.3.1.Results A total of 10 RCTs involving 706 patients were included.EA in conjunction with conventional anesthesia significantly increased plasmaβ-EP levels at 12 hours postsurgery[standard mean difference(SMD)=2.79,95%CI(1.85,3.72),Z=5.81,P<0.00001],24 hours postsurgery[SMD=1.87,95%CI(0.9,2.83),Z=3.79,P=0.0001],and 48 hours postsurgery[SMD=2.02,95%CI(1.49,2.54),Z=7.50,P<0.00001].EA reduced plasma PGE2 levels at 24 hours postsurgery and plasma 5-HT levels at 24 hours postsurgery,and the VAS at 12,24 and 48 hours after surgery also decreased.Conclusion These findings suggest that perioperative EA markedly elevates plasmaβ-EP levels,reduces pain-inducing factors in plasma,and effectively alleviates acute postoperative pain.
文摘Objective:To analyze the positive impact of pharmaceutical care in the ophthalmology perioperative period on the rational use of antibiotics.Methods:A total of 115 patients who underwent ophthalmological surgery between March and June 2023 were selected as the control group,receiving routine medication management.Another 115 patients who underwent ophthalmological surgery between July and October 2023 were selected as the observation group,receiving pharmaceutical care.The rationality of medication use,mastery of medication knowledge,medication compliance,and adverse reaction rates were compared between the two groups.Results:The observation group had higher rationality of medication use,higher scores for mastery of medication knowledge,higher medication compliance,and a lower adverse reaction rate compared to the control group(P<0.05).Conclusion:The combination of antibiotic therapy and pharmaceutical care in the ophthalmology perioperative period can improve the rationality of medication use,enhance patients’mastery of medication knowledge,increase their medication compliance,and prevent adverse reactions to antibiotics.
文摘Kidney transplant is the treatment of choice for patients with end-stage kidneydisease. Meticulous anaesthetic management is the cornerstone of good postoperativepatient and graft outcomes. Over the decades, the perioperative strategiesfor preoperative optimization, fluid management, immunosuppression, haemodynamicmonitoring, and pain management keep changing with the inclusionof newer studies. The aim of this review is to update anaesthesia colleagues forrecent advancements in perioperative care of patients undergoing kidney transplantation.
基金Supported by Science and Technology Program of Sanmen County Public Technology Social Development Project,No.24227.
文摘BACKGROUND Surgery is the gold standard for gallstone treatment.Nevertheless,the complications associated with the surgical procedure can exert diverse and adverse impacts on patients’health and quality of life to varying extents.Hence,it is essential to offer perioperative care to patients undergoing gallstone surgery.AIM To examine the impact of perioperative comprehensive nursing on pain intensity,complication rates,and patient comfort in individuals undergoing gallstone surgery.METHODS From February 2022 to February 2024,195 patients who underwent gallstone surgery at Sanmen People’s Hospital were selected and divided into two groups:A control group receiving routine nursing care(95 patients)and a research group receiving perioperative comprehensive nursing(100 patients).Key postoperative recovery indicators,including time to first postoperative anal exhaust,oral food intake,and ambulation,were observed,along with pain intensity(measured by the numeric rating scale),complication rate(bleeding,incision infection,recurrence),patient comfort(assessed using the visual analogue scale),and quality of life(measured by the World Health Organization Quality of Life-BREF).RESULTS The research group showed significantly shorter times to first postoperative anal exhaust,oral intake,and ambulation.Moreover,numeric rating scale pain scores in the research group were markedly lower post-nursing,and the total complication rate was significantly reduced compared to the control group.Furthermore,comfort levels improved considerably in the research group,and World Health Organization Quality of Life-BREF scores across the physical,psychological,social,and environmental domains were significantly higher compared to the control group following nursing care.CONCLUSION Perioperative comprehensive nursing effectively enhances postoperative recovery in patients undergoing gallstone surgery,reducing pain,lowering complications,and improving patient comfort and quality of life,which deserves clinical application.
文摘BACKGROUND Elderly patients undergoing laparoscopic colorectal cancer surgery are at high risk for hypothermia-related complications.This study explores the efficacy of periop-erative composite insulation interventions in maintaining normothermia and reducing postoperative risks in this vulnerable group.AIM To evaluate the efficacy of perioperative composite insulation in older patients undergoing colorectal cancer surgery.METHODS We selected 100 older patients who underwent laparoscopic surgery for colorectal cancer at Huzhou Central Hospital from September 2023 to April 2024.Using a random number table,patients were divided into a control group and inter-vention group of 50 patients each.After returning to the regular ward,the con-ventional group received traditional insulation intervention measures,while the intervention group received composite insulation nursing intervention.We ob-served and recorded postoperative blood pressure and heart rate changes,as well as postoperative anesthesia recovery time and incidence of complications.RESULTS The statistical results showed significant differences(P<0.05)in heart rate changes and systolic blood pressure between the two groups.There was a sig-nificant change in heart rate between the groups immediately after surgery and at 15 and 30 minutes after surgery(P<0.05).The heart rate and systolic blood pressure of the intervention group were significantly lower than those of the control group at 15 and 30 minutes after surgery(P<0.05).The rewarming time of the intervention group was shorter than that of the control group,and the overall incidence of postoperative complications was significantly lower than that of the control group(P<0.05).CONCLUSION For elderly patients undergoing laparoscopic colorectal cancer surgery,a composite insulation intervention during the perioperative period can maintain body temperature,reduce postoperative stress,and significantly reduce the incidence of hypothermia and related complications.
文摘BACKGROUND The application of perioperative disinfection and isolation measures to patients undergoing gastrointestinal surgery with postoperative infection can provide a data reference for reducing the postoperative infection rate,improving post-operative biochemical markers,and enhancing postoperative recovery outcomes.AIM To explore the effectiveness of perioperative disinfection and isolation measures in controlling postoperative infection following gastrointestinal surgery.It also sought to compare infection rates and biochemical markers between the obser-vation and control groups and evaluate the impact of disinfection and isolation measures on reducing postoperative complications.METHODS A retrospective analysis was conducted.Ninety-six patients who underwent gastrointestinal surgery between January 2022 and December 2023 were selected and divided into an observation group and a control group,with 48 cases in each.The observation group received disinfection and isolation measures during the perioperative period,whereas the control group received standard nursing care.The incidence of infection,white blood cell count,C-reactive protein levels,hemoglobin levels,and liver function markers(alanine aminotransferase,aspartate aminotransferase,creatinine,and blood urea nitrogen)were monitored postoperatively in both groups.RESULTS The postoperative infection rate in the observation group was significantly lower than that in the control group(P<0.05).White blood cell and C-reactive protein levels decreased significantly after surgery in the observation group and were significantly lower than those in the control group(P<0.05).Alanine aminotransferase,aspartate aminotransferase,creatinine,and blood urea nitrogen levels in the observation group were lower than those in the control group on postoperative days 1 and 3,showing a significant difference(P<0.05).CONCLUSION Perioperative disinfection and isolation measures effectively reduce postoperative infection rates in gastrointestinal surgery patients and improve biochemical markers,thereby enhancing recovery outcomes.This study provides a valuable basis for postoperative infection control and has significant clinical applications.
文摘BACKGROUND The risk and mortality rate of venous thromboembolism(VTE)following gastrointestinal surgery remain high,and the symptoms are atypical.Therefore,it is necessary to identify the risk factors associated with the occurrence of VTE following gastrointestinal surgery and to implement appropriate prevention and treatment measures.AIM To assess the efficacy of perioperative anticoagulation for the prevention of postoperative VTE.METHODS This retrospective study enrolled 205 patients who underwent gastrointestinal surgery.In the observation group(n=101),prophylactic anticoagulation was administered via hypodermic injection of low-molecular-weight heparin during the perioperative period,whereas the control group(n=104)only received lowmolecular-weight heparin treatment postoperatively.Blood coagulation parameters and the incidence of VTE of the bilateral lower limbs pre-and post-surgery were compared between groups.Postoperative VTE was transformed into a dichotomous variable,and influencing factors were explored using multivariate logistic regression analyses.RESULTS On the 7th day postoperatively,the incidence of VTE of the bilateral lower limbs was significantly lower in the observation group than in the control group,as were the D-dimer levels(P<0.05).At 1 month postoperatively,the incidence of VTE was significantly lower in the observation group than in the control group(P<0.05).An age≥65 years,a body mass index≥24 kg/m^(2),and malignant diseases of the digestive system were identified as risk factors for the occurrence of postoperative VTE in patients undergoing gastrointestinal surgery.CONCLUSION The incidence of VTE in patients who underwent gastrointestinal surgery peaked within 1 week postoperatively.The findings confirmed perioperative anticoagulation can safely and effectively reduce the incidence of postoperative VTE.
基金supported by the Regional Science Foundation Project of the National Natural Science Foundation of China(Project No:82160157)the Beijing High-Level Public Health Technology Talent Construction Project(Project No.:Leading Talents-03-10).
文摘Cardiac arrest(CA)is considered a state of clinical death in which the heart suddenly loses its ability to effectively expel blood,resulting in circulatory and respiratory arrest.CA is often catastrophic for patients,as it can cause serious long-term cardiovascular and cerebrovascular complications that affect their quality of life[1].Survey data indicate that the overall incidence rate of intraoperative CA in patients undergoing thoracic surgery in China is currently 0.138%[2].This rate is expected to increase because of the increasing proportion of older individuals(age>60 years)in the population,as well as the increasing pulmonary surgery rates.However,the incidence rate during the perianesthetic period in older patients undergoing thoracic surgery has not yet been comprehensively reported.
文摘BACKGROUND Esophageal cancer constitutes one of the most aggressive malignant neoplasms associated with poor clinical outcomes.While surgical resection remains the cornerstone of curative intervention,optimization of perioperative care protocols has emerged as an essential strategy to reduce postoperative complications and potentially improve long-term survival rates in patients undergoing esophagectomy.However,substantial debate persists regarding the relative importance of various perioperative risk factors and their impact on post-resection outcomes.AIM To identify perioperative factors affecting prognosis after radical esophagectomy,aiming to improve patient outcomes through targeted interventions.METHODS A retrospective study analyzed 378 patients with esophageal cancer who underwent radical esophagectomy(McKeown,Sweet,or Ivor-Lewis procedures)from January 2022 through December 2023.All operations were performed by experienced surgeons following standardized perioperative protocols.The investigation gathered data on patient demographics,surgical parameters,tumor pathology(using the 8th edition American Joint Committee on Cancer staging system),and survival outcomes.Statistical analyses utilized Kaplan-Meier estimates and Cox proportional hazards modeling,with adjustment for confounding variables.RESULTS Multivariate Cox proportional hazards analysis identified three independent predictors of survival:Tumor-nodemetastasis staging[Hazard ratio(HR)=2.31,95%confidence interval(CI):1.72-3.10,P<0.001],tumor differentiation(moderate:HR=1.46,95%CI:1.02-2.09,P=0.038;poor:HR=2.15,95%CI:1.47-3.14,P<0.001),and extended postoperative analgesic use(>5 days)(HR=1.43,95%CI:1.08-1.89,P=0.012).Kaplan-Meier analysis demonstrated significantly lower overall survival rates in patients requiring analgesics for>5 days compared to≤5 days(P=0.003),with consistent patterns observed for both opioid(P=0.019)and nonsteroidal anti-inflammatory drug use(P=0.028).The extended analgesic group exhibited a higher proportion of elderly patients(48.47%vs 35.57%,P=0.015),while other baseline characteristics and tumor features remained comparable between groups.CONCLUSION Tumor-node-metastasis staging,tumor differentiation,and duration of postoperative analgesic use independently predict survival following radical esophagectomy,underscoring the significance of optimal pain management protocols.
文摘BACKGROUND Hepatobiliary and pancreatic cancers are among the most lethal malignancies due to late-stage diagnosis and limited treatment options.Liquid biopsy has emerged as a minimally invasive tool for early cancer detection,prognosis,and therapeutic monitoring.AIM To concise the available data on liquid biopsy and establish its role in hepato-biliary surgeries.METHODS This systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 guidelines.A comprehensive lite-rature search was performed using PubMed,Scopus,Web of Science,and EMBASE for studies published up to March 2025.Studies assessing the role of circulating tumor DNA,circulating tumor cells,exosomes,and other liquid biopsy markers in hepatobiliary and pancreatic cancers were included.The risk of bias was evaluated using the Newcastle-Ottawa Scale for observational studies and the Cochrane Risk of Bias Tool for clinical trials.RESULTS Liquid biopsy demonstrated significant potential for early cancer detection,perioperative risk stratification,intraoperative surgical decision-making,and postoperative monitoring of minimal residual disease.However,challenges remain regarding standardization,sensitivity,and clinical validation.CONCLUSION Liquid biopsy represents a paradigm shift in hepatobiliary and pancreatic cancer management.Advancements in next-generation sequencing and artificial intelligence may enhance its clinical utility.Further large-scale studies are needed to establish standardized protocols for routine implementation.
文摘BACKGROUND The use of an ultrasound-guided quadratus lumborum block(QLB)combined with general anesthesia for patients undergoing colorectal cancer surgery serves as a model for reducing the postoperative stress response,preserving metabolic stability,protecting renal function,and alleviating postoperative pain.AIM To compare QLB combined with general anesthesia vs general anesthesia alone in the perioperative stress response,metabolic and renal function,postoperative pain,and recovery outcomes among patients undergoing colorectal cancer surgery.METHODS Clinical data of 116 patients who underwent colorectal cancer surgery at our hospital between July 2023 and August 2024 were collected for retrospective analysis.According to the anesthesia protocol,the patients were divided into the control(general anesthesia,n=58)and experimental groups(QLB combined with general anesthesia,n=58).Physiological indicators such as blood glucose(GLU),lactic acid(LAC),blood urea nitrogen(BUN),and creatinine(CRE)were measured at T0(pre-surgery),T1(post-surgery),T2(6 hours post-surgery),T3(24 hours post-surgery),and T4(48 hours post-surgery).The differences between the two groups for each indicator were evaluated using repeated-measures analysis of variance.RESULTS The GLU levels from T1 to T4 in the experimental group were significantly lower than those in the control group(P<0.001),and the LAC levels were also significantly reduced(P<0.001).The experimental group exhibited superior renal protection based on postoperative BUN and CRE levels(P<0.05).Furthermore,the postoperative pain score in the experimental group was significantly lower than that in the control group[visual analogue scale(VAS)]scores differed significantly from T2 to T4,P<0.05.CONCLUSION Research has shown that QLB combined with general anesthesia can decrease postoperative GLU and LAC by 8%-15%and 10%-20%(P<0.001),respectively.It also enhances renal function markers(BUN,CRE,P<0.05)and lowers VAS scores by 15%-30%(P<0.05).Ultrasound-guided lumbar muscle block with general anesthesia outperforms general anesthesia alone in diminishing stress response,preserving metabolic balance and renal function,and alleviating postoperative pain.This approach offers a more efficient perioperative management strategy for patients undergoing colorectal cancer surgery.It is particularly advantageous for individuals with stress sensitivity,renal impairment,and heightened pain susceptibility.
文摘Objective:To analyze the effect of pharmacist-led rational drug use management of antibiotics during the perioperative period in gynecology.Methods:Two hundred patients who underwent gynecological surgery between March 2023 and December 2023 were selected and randomly divided into two groups.In the experimental group,the pharmacist led the medication management during the perioperative use of antibiotics,while the control group received routine antibiotic management.The management effects were compared between the two groups.Results:The irrational drug use rate,the incidence of adverse drug reactions,the cost of antibiotics,and the incidence of postoperative infection were all lower in the experimental group compared to the control group(P<0.05).Conclusion:Implementing pharmacist-led medication management during the perioperative period of gynecological surgery can prevent irrational drug use,reduce adverse drug reactions,control drug costs,and lower the risk of postoperative infection.
