Therapeutics and Clinical Risk Management最新文献

Purpose: The high incidence of postoperative delirium (POD) among patients undergoing lumbar spine surgery presents a significant barrier to achieving enhanced postoperative recovery. Accordingly, a thorough understanding and precise identification of common risk factors for POD in this surgical context are crucial to mitigating its occurrence and facilitating improved recovery outcomes. This study is the first to assess the predictive value of the Prognostic Nutritional Index (PNI) for POD in elderly patients undergoing transforaminal lumbar interbody fusion (TLIF) for degenerative lumbar spine disease.

Methods: We conducted a retrospective analysis of the outcomes of TLIF surgery in elderly patients with degenerative lumbar spine disease between 2020 and 2024. The diagnosis of POD was based on postoperative medical records during hospitalization, using the Confusion Assessment Method. The PNI was calculated based on preoperative serum albumin levels and total lymphocyte counts. Multivariate logistic regression analysis was performed to evaluate the relationship between preoperative PNI scores and the occurrence of POD. Finally, the optimal PNI cut-off point for predicting POD was determined using the receiver operating characteristic curve.

Results: POD was observed in 61 of 370 patients, with PNI being significantly lower in the delirium group. The mean PNI values were 43.02±3.44 in the non-delirium group and 48.53±3.72 in the delirium group. Multivariate logistic regression analysis revealed that low PNI (OR: 0.743; 95% CI: 0.597-0.924; p = 0.008), low serum albumin levels (OR: 0.759; 95% CI: 0.584-0.987; p = 0.040), and advanced age (OR: 1.096; 95% CI: 1.030-1.166; p = 0.004) were independent predictors of POD following TLIF. The area under the curve (AUC) for PNI on the receiver operating characteristic curve was 0.864±0.025. The cutoff value for PNI, determined using the Youden index, was 45.825, with a sensitivity of 82.0% and a specificity of 74.4%.

Conclusion: The preoperative use of PNI holds promise as a valuable tool for assessing the risk of POD in elderly patients undergoing TLIF.

Background: Enhanced Recovery After Surgery (ERAS) principles have gained widespread recognition for optimizing recovery across various surgical specialties. Effective management of postoperative pain plays a pivotal role in facilitating early rehabilitation and enhancing patient outcomes, particularly in ankle fracture surgery. This study investigated the effectiveness of rehabilitation therapies rooted in ERAS protocols in alleviating postoperative wound pain and improving recovery for patients undergoing ankle fracture surgery.

Methods: A total of 376 patients who underwent ankle fracture surgery between December 2022 and December 2023 were included in this retrospective analysis. Of these, 190 patients received ERAS-guided rehabilitation, while 186 underwent standard rehabilitation care. The ERAS program encompassed tailored interventions such as multimodal pain control, prompt mobilization, and personalized physical therapy regimens. Pain intensity was evaluated using the Visual Analog Scale (VAS) at 24 hours, 48 hours, and 7 days postoperatively. Additional metrics, including the duration of hospital stay, complication rates, and patient satisfaction, were also assessed.

Results: Patients in the ERAS group experienced significantly lower VAS scores than the standard care group at 24 hours (4.2 ± 1.1 vs 5.6 ± 1.4, P<0.001), 48 hours (3.1 ± 0.9 vs 4.4 ± 1.2, P<0.001), and 7 days post-surgery (2.0 ± 0.7 vs 3.1 ± 0.9, P<0.001). Furthermore, those receiving ERAS care had a shorter average hospital stay (5.1 ± 1.6 days vs 6.7 ± 2.1 days, P<0.001) and reported higher levels of satisfaction (92.1% vs 78.4%, P<0.001). However, there were no statistically significant differences in overall complication rates between the two groups (3.7% vs 4.3%, P=0.712).

Conclusion: Rehabilitation therapies incorporating ERAS principles demonstrate substantial benefits in reducing postoperative wound pain and expediting recovery in ankle fracture surgery patients. These findings underscore the value of integrating ERAS-driven protocols into clinical practice to enhance patient experiences and postoperative outcomes.

Background: Enhanced Recovery After Surgery (ERAS) principles have gained widespread adoption in perioperative care to optimize recovery and reduce complications. Total knee arthroplasty (TKA) patients benefit significantly from ERAS-guided strategies, which minimize surgical stress and accelerate postoperative recovery. This study evaluates the application of perioperative nursing care based on ERAS principles and its impact on TKA patients.

Methods: A retrospective analysis was conducted on prospectively maintained data of 312 patients who underwent TKA between January 2023 and December 2023. Of these, 158 patients received perioperative nursing care based on ERAS principles, while 154 received standard nursing care. The ERAS-based perioperative nursing protocol included preoperative education, intraoperative fluid optimization, postoperative pain management, and early mobilization strategies. Clinical data, including postoperative complications, length of hospital stay, and patient satisfaction, were collected and compared between the two groups using statistical methods.

Results: Patients in the ERAS-based nursing group exhibited significantly better outcomes compared to the standard care group. Postoperative complications, such as deep vein thrombosis and infections, were reduced (4.4% vs 11.7%, P<0.05), and the average length of hospital stay was shorter (5.6 ± 1.8 days vs 8.3 ± 2.4 days, P<0.001). Patient satisfaction scores were notably higher in the ERAS group (94.3% vs 78.6%, P<0.001). Multivariate analysis identified perioperative nursing based on ERAS principles as an independent factor for improved recovery.

Conclusion: Perioperative nursing care guided by ERAS principles significantly improves clinical outcomes in TKA patients, reducing complications and hospital stay while enhancing patient satisfaction. This study supports the broader implementation of ERAS protocols in perioperative nursing to optimize surgical care outcomes.

Background: Hip fractures in elderly patients represent a significant healthcare challenge, with substantial morbidity and mortality rates. This study investigated the efficacy of continuous fascia iliaca compartment block (CFICB) in perioperative management.

Methods: A retrospective analysis was conducted on elderly patients (≥65 years) with intertrochanteric fractures treated between January 2020 and December 2023. Eligible patients were initially divided into CFICB (n=46) and routine analgesia (RA, n=64) groups. Propensity score matching with a caliper width of 0.21 was performed, yielding 40 patients in each group for final analysis. Matching variables included age, gender, BMI, and ASA score. Primary outcomes were Visual Analog Scale pain scores, cognitive function assessed through a two-tier protocol (Montreal Cognitive Assessment [MoCA©] screening followed by confirmatory Mini-Mental State Examination-2 [MMSE-2Ⓡ] for positive screens), and functional recovery evaluated using the Harris Hip Score.

Results: The CFICB group showed significantly lower VAS scores during the early postoperative period (≤ 72h). This was most notable at 24 hours postoperatively (2.43 ± 0.72 vs 3.45 ± 0.87, P < 0.001). Postoperative cognitive dysfunction rates were significantly lower in the CFICB group. The differences were evident at 6h (10% vs 30%, P = 0.025), 24h (15% vs 35%, P = 0.039), and 72h (5% vs 20%, P = 0.043). Multivariable analysis identified CFICB as an independent protective factor against postoperative cognitive dysfunction (adjusted OR = 0.41, 95% CI: 0.26-0.65, P < 0.001). Harris Hip Scores at one month postoperatively were significantly higher in the CFICB group (78.56 ± 8.12 vs 72.39 ± 7.65, P = 0.008). Complication rates were comparable between groups (22.5% vs 17.5%, P = 0.576).

Conclusion: CFICB effectively improves postoperative pain management, reduces cognitive dysfunction incidence, and enhances early functional recovery in elderly patients with intertrochanteric fractures, while maintaining a favorable safety profile.

Purpose: Postoperative fatigue (POF) is a common occurrence following colonoscopy, primarily attributed to bowel preparation and endoscopic probe stimulation, and is associated with worse postoperative outcomes. Esketamine, an antidepressant anesthetic, has shown the potential to enhance postoperative recovery through various mechanisms. We hypothesized that the low-dose esketamine could alleviate POF in outpatients undergoing colonoscopy.

Methods: 200 participants scheduled for painless colonoscopy were enrolled, with 151 patients included in the primary endpoint analysis. Patients were randomly received 0.15 mg/kg esketamine or 0.1 μg/kg sufentanil before anesthesia induction. The primary outcome was the incidence of POF, assessed using the Identity-Consequence Fatigue Scale-10 (ICFS-10) scores at 30 min after colonoscopy. Secondary outcomes included ICFS-10 scores at baseline and 1 day post-colonoscopy, time to discharge and patients' satisfaction.

Results: The incidence of POF was significantly lower in the esketamine group (Group E) compared to the sufentanil group (Group S) (28% vs 44%, P = 0.036). There were no significant differences in ICFS-10 scores between the two groups at baseline and 1 day post-colonoscopy. However, discharge time was significantly shorter in Group E than in Group S (25 min vs 30 min, P = 0.001). In Group E, there was improved hemodynamic stability and greater patients' satisfaction.

Conclusion: The administration of esketamine significantly reduced the incidence of POF and shortened discharge time in patients undergoing colonoscopy. A regimen of 0.15 mg/kg esketamine combined with propofol proved to be an effective anesthesia strategy for painless colonoscopy.

Purpose: Cerebrovascular autoregulation (CVA) is a homoeostatic regulatory function to maintain constant cerebral blood flow (CBF) despite changes in systemic blood pressure. The CVA-based optimal mean arterial pressure (MAPopt) refers to the MAP level at which the CVA mechanism reaches its lowest degree of pressure passiveness, allowing for optimal autoregulation. This study aimed to determine MAPopt by analyzing existing CVA data from patients undergoing non-cardiac surgery.

Methods: This single-center investigation is a secondary analysis of prospectively recorded CVA data of patients undergoing oncologic prostate surgery. Intraoperative CVA was assessed using the cerebral oxygenation index (COx) derived from the simultaneous measurement of MAP and regional cerebral oxygen saturation (rSO₂). Patient-specific MAPopt values were calculated using a second-order polynomial formula, in which the MAP related to the lowest COx was considered to be the intraoperative MAPopt.

Results: A total of 180 patients were enrolled into the study. The average age was 63 years, 83.9% of patients had no or mild systemic disease. MAPopt determination was feasible in 128 patients, while 52 patients exhibited no U-shaped correlation between MAP and COx. The average intraoperative MAPopt was 81.7 mmHg ranging from 60.2 to 101.4 mmHg. The mean duration of intraoperative CVA measurement was 178 min.

Conclusion: This study demonstrates a wide range of individual intraoperative MAPopt values and underscores that CVA-based MAPopt during non-cardiac surgery may differ from commonly accepted intraoperative MAP thresholds in clinical practice (ie 65 mmHg).

Purpose: This study evaluated the effects of 12 months of NBP treatment on stroke recurrence and examined the influence of age and gender on its efficacy.

Methods: A prospective cohort of 1109 patients with non-cardioembolic ischemic stroke (IS) within six months was divided into NBP (n = 538) and control (n = 571) groups. The NBP group received NBP plus standard treatment, while the control group received standard treatment alone. Primary outcomes were recurrent ischemic and hemorrhagic stroke over 12 months. Secondary outcomes included functional status (modified Rankin Scale, m-RS) and all-cause mortality.

Results: NBP reduced recurrent IS by 39% compared to controls (RR:0.61,95% CI:0.40-0.93, P=0.022) and total stroke events by 39.6% (RR:0.60,95% CI:0.40-0.91,P=0.016). Protective effects were more significant in males (RR:0.52,95% CI:0.30-0.91, P=0.021 vs RR:0.53,95% CI:0.40-0.91,P=0.021) and in patients under 70 years (P<0.05). Functional outcomes (modified Rankin Scale and Barthel index) and all-cause mortality did not differ significantly between groups (all P>0.05).

Conclusion: NBP significantly reduces stroke recurrence and overall vascular events, especially in males and younger patients. While it does not improve functional outcomes or mortality, NBP demonstrates substantial preventive value for recurrent strokes.

Background: Cerebral infarction is a prevalent disabling condition among the elderly, often leading to limb dysfunction and psychological challenges that significantly impair quality of life. Traditional nursing approaches have primarily focused on physical rehabilitation; however, growing evidence highlights the importance of psychological factors-such as emotional well-being and rehabilitation confidence-in influencing recovery outcomes. Positive collaboration in rehabilitation nursing, which involves coordinated efforts among patients, healthcare providers, and family members, has emerged as a holistic approach to enhance both physical and psychological recovery.

Objective: To analyze the effects of positive collaboration concept rehabilitation nursing on elderly patients with cerebral infarction, focusing on fall efficacy and rehabilitation confidence.

Methods: A retrospective analysis was conducted on clinical data from 106 elderly patients with cerebral infarction, admitted from October 2022 to April 2024. Patients were divided into a control group (n=53, receiving routine care) and an observation group (n=53, receiving positive collaboration rehabilitation nursing). Neurological function (NIHSS), negative emotions (SAS, SDS), fall efficacy (MFES), activities of daily living (ADL), quality of life (SS-QOL), rehabilitation confidence (CaSM), and nursing satisfaction (NSNS) were compared between the two groups.

Results: The observation group showed significantly lower NIHSS scores at 2 weeks and 1 month post-intervention (P<0.05). Both groups demonstrated reduced SAS and SDS scores, with the observation group showing greater improvement (P<0.05). A higher proportion of patients in the observation group (56.60%) showed excellent fall efficacy compared to the control group (37.74%) (P<0.05). The observation group also had greater improvements in ADL, SS-QOL, and rehabilitation confidence, with higher patient satisfaction (90.57% vs 71.70%, P<0.05).

Conclusion: Positive collaboration rehabilitation nursing significantly improves neurological function, emotional well-being, fall efficacy, and quality of life in elderly patients with cerebral infarction. This approach increases patient and family satisfaction, highlighting the potential benefits of integrating collaborative care into clinical practice.

Background: Traumatic brain injury (TBI) is a leading cause of both disability and death, frequently necessitating treatment in emergency departments (ED). Integrated nursing interventions are critical in the management of TBI patients, but limited research has been conducted to evaluate their effectiveness in this setting. The aim of this article is to investigate and evaluate the impact of integrated nursing interventions on the management of TBI patients in the ED.

Method: A retrospective study was conducted among 216 patients with TBI who came to the ED between January 2022 and December 2022, of whom 120 were treated with nursing interventions and 96 were not treated with nursing interventions. The integrated interventions included rapid triage, continuous monitoring of neurological status, early rehabilitation involvement, patient and family education, and interdisciplinary care coordination. The medical records were reviewed to assess the utilization of nursing interventions and analyze the impact of these interventions on the short-term and long-term prognosis of TBI patients. Patient demographics, clinical characteristics, and outcomes were analyzed using descriptive statistics and logistic regression analysis.

Result: Among the 216 TBI patients, 96 (44.4%) received nursing interventions as part of their ED care. These patients had significantly lower rates of adverse events such as intracranial hemorrhage (3.3% vs 12.5%, P=0.018) and hospital stays (7 ± 2 days vs 10 ± 4 days, P<0.001). Logistic regression analysis showed that nursing interventions were significantly associated with a decreased risk of adverse events (OR=0.25, 95% CI=0.10-0.63, P=0.003).

Conclusion: Integrated nursing interventions are essential in the care of TBI patients in the emergency department. Early detection, swift treatment, continuous monitoring, assessment, and education for both patients and their families can enhance recovery and minimize the likelihood of complications. Implementation of nursing interventions should be encouraged in EDs to improve the quality of TBI care. Further studies are needed to investigate the optimal strategies and cost-effectiveness of nursing interventions in TBI management in the ED.

Objective: Esketamine and dexmedetomidine are commonly used sedatives in surgery, which can result in minimal respiratory depression and analgesic activity. This study investigated the sedative effect of esketamine combined with dexmedetomidine on patients undergoing spinal tumor (ST) surgery.

Methods: We did a retrospective analysis at the Anesthesiology Department of Ningbo City's the sixth Hospital. They studied 75 ST surgery patients who got esketamine in combination with dexmedetomidine (Group ED) between April 2022 and June 2024. In a 1:1 cohort, compare these individuals to those who only received dexmedetomidine at the same time period (Group D). The primary outcome is perioperative hemodynamic status. The secondary outcomes were pain intensity, intraoperative neurophysiological monitoring (IONM), and the occurrence of adverse responses.

Results: Compared with group E, the group ED had lower mean arterial pressure (MAP), heart rate (HR), and visual-analogue scale (VAS) scores after the start of surgery (all P<0.05). There was no significant difference in the waiting time for perioperative motor evoked potential (MEP) and the intensity of the first induced MEP current between the two groups (all P>0.05); The Group ED first induced MEP amplitude, somatosensory evoked potential (SEP) amplitude, and MEP amplitude greater than the Group D, while SEP latency and MEP latency were smaller than the Group D (all P<0.05). There was no significant difference in the incidence of perioperative adverse events between the two groups (P>0.05).

Conclusion: Compared with dexmedetomidine alone, the combination of esketamine and dexmedetomidine during ST surgery can demonstrated superior sedation and pain control without increasing adverse event risk, making it a viable alternative for ST surgery anesthesia.