INTRODUCTION:Open elbow arthrolysis effectively treats post-traumatic elbow stiffness, but severe postoperative pain during early rehabilitation impedes recovery. Continuous brachial plexus blocks, though effective, face limitations such as catheter displacement and infection risks. Liposomal bupivacaine, an ultra-long-acting local anaesthetic, offers prolonged analgesia and may circumvent these challenges. This study aims to compare the analgesic efficacy of a single-dose liposomal bupivacaine supraclavicular block versus continuous ropivacaine infusion in patients undergoing open elbow arthrolysis. METHODS AND ANALYSIS:This single-centre, randomised, double-blind, non-inferiority trial will enrol 72 adults (ASA I-III，the American Society of Anesthesiologists physical status classification for preoperative risk) scheduled for open elbow release surgery. Participants will be randomised (1:1) to receive either a single supraclavicular block with 10 mL liposomal bupivacaine plus 10 mL 0.5% ropivacaine followed by saline infusion (liposomal bupivacaine group) or continuous catheter infusion with 20 mL 0.5% ropivacaine followed by 0.2% ropivacaine infusion (control group). The primary outcome is the weighted area under the curve (AUC) of Numerical Rating Scale (NRS) pain scores during functional exercises within 72 hours postoperatively. Secondary outcomes include resting NRS scores, sleep quality (Pittsburgh Sleep Quality Index), rehabilitation metrics (range of motion, grip strength), recovery quality (Quality of Recovery -15) and long-term functional outcomes (Quick Disabilities of the Arm, Shoulder and Hand scores, Quick-DASH scores) at 2 weeks, 6 weeks and 12 weeks. Non-inferiority will be established if the upper 95% confidence limit of the AUC difference is ≤1.3. Statistical analyses will employ intention-to-treat principles with SPSS V.24.0. ETHICS AND DISSEMINATION:Ethical approval was granted by Beijing Jishuitan Hospital Ethics Committee (K2025-213-00). The trial is registered with the Chinese Clinical Trial Registry (ChiCTR2500103911). Results will be disseminated via peer-reviewed journals, contributing evidence on liposomal bupivacaine's role in perioperative analgesia and rehabilitation for elbow surgery. TRIAL REGISTRATION NUMBER:Chinese Clinical Trial Registry (ChiCTR ID provided on acceptance).

Abstract Background Postoperative delirium is the most common complication in older patients and is associated with surgery-induced inflammation. Although inflammation plays a key role in delirium, the potential benefits of a comprehensive anti-inflammatory approach to managing perioperative systemic inflammation remain underexplored. This study evaluated whether a perioperative anti-inflammatory bundle strategy, combining dexmedetomidine, glucocorticoids, ulinastatin, and nonsteroidal anti-inflammatory drugs, reduces the risk of postoperative delirium in older patients undergoing hip fracture surgery. Methods This dual-center, double-blind, placebo-controlled, parallel-group, pilot study was conducted from August 2023 to January 2024 at two tertiary university hospitals. A total of 132 patients aged ≥ 65 years with an American Society of Anesthesiologists physical status of 2 or 3 scheduled for elective hip fracture surgery were screened and randomized to receive either an anti-inflammatory drug bundle or a placebo. The primary outcome was postoperative delirium, identified within the first three postoperative days. Postoperative blood inflammatory markers and acute pain were measured for mediation analysis. Results Of the 132 patients randomized, 123 (93%) completed the trial (mean age, 82 years; 75% women). The prevalence of postoperative delirium was significantly lower in the anti-inflammatory bundle group (15%, 9/62) compared to the placebo group (44%, 27/61) (risk difference, − 30 percentage points [95% CI, − 45 to − 15]; relative risk [RR], 0.33 [95% CI, 0.17 to 0.64]; P = 0.001). No major adverse events were reported in either group. The postoperative CRP level in the anti-inflammatory bundle group was significantly lower (predicted mean difference: − 29.4 [95% CI: − 46.5, − 12.2] mg·L−1; adjusted P < 0.001). Mediation analysis showed a significant indirect association between the anti-inflammatory bundle and postoperative delirium through reduced systemic inflammation (odds ratio [OR], 0.61 [95% CI, 0.26 to 0.87]). Conclusions This study demonstrates that a perioperative anti-inflammatory bundle significantly reduces the prevalence of postoperative delirium in older patients undergoing hip fracture surgery, without major side effects. Systemic inflammation mediates the protective effect of the intervention. These findings provide preliminary evidence supporting the anti-inflammatory bundle strategy, paving the way for large-scale multicenter trials to optimize postoperative delirium prevention strategies. Trial registration This study was registered in the Chinese Clinical Trial Registry (ChiCTR2300074303) by Ayixia Nawan on August 3, 2023, prior to patient enrollment.

Introduction It is appealing to accurately predict postoperative delirium (POD) before surgeries. In this study, it was hypothesized that a novel electroencephalogram-derived index, the delirium index (DELi), could extract latent information regarding the predisposing factors of POD preoperatively. This study was aimed at developing a concise model that incorporated this DELi score to predict the early POD of elderly patients after hip surgeries. Materials and Methods Elderly patients scheduled for elective hip fracture surgeries were prospectively enrolled in a tertiary care hospital from November 2020 to June 2022. DELi scores and patient characteristics (age, sex, types of fracture and surgery, the time interval between fracture and surgery, cognitive function assessed using the Montreal Cognitive Assessment (MoCA), and frailty status assessed using the FRAIL scale) were collected preoperatively as candidate predictors. POD diagnosed using the confusion assessment method (CAM) was the outcome. Least absolute shrinkage and selection operator (LASSO) regression analysis was used to select predictors. Then, these predictors were entered into a backward logistical regression analysis to develop a prediction model. Discrimination, calibration and clinical utility were validated using the bootstrapping method. Results All data (144 qualified patients of 170) were used for development. POD was observed in 71 patients (49.3%). Preoperative DELi scores predicted early POD (the area under the curve (AUC) = .786, 95% confidence interval (CI): .712, .860, in internal validation). A nomogram with MoCA, FRAIL scale and DELi score was constructed with excellent discrimination (AUC = .920, 95% CI: .876, .963, in internal validation), accredited calibration ( P = .733, Hosmer‒Lemeshow test), and a wide range of threshold probabilities (5% to 95%). Conclusions Preoperative DELi scores predicted the early POD of elderly patients after hip surgeries. A concise prediction model was developed and demonstrated excellent discrimination.

ImportancePostpartum depression (PPD) is emerging as a major public health problem worldwide. Although the particular period and context in which PPD occurs provides an opportunity for preventive interventions, there is still a lack of pharmacologic prevention strategies for PPD. ObjectiveTo assess the efficacy and safety of dexmedetomidine for prevention of PPD among women with prenatal depression undergoing cesarean delivery. Design, Setting, and ParticipantsThis randomized clinical trial enrolled 338 women who screened positive for prenatal depression at 2 hospitals in Hunan, China from March 28, 2022, to April 16, 2023. Women with an Edinburgh Postnatal Depression Scale score of more than 9 who were 18 years of age or older and were scheduled for elective cesarean delivery were eligible. InterventionsEligible participants were randomly assigned in a 1:1 ratio to either the dexmedetomidine group or the control group via centrally computer-generated group randomization. Dexmedetomidine, 0.5 mu g/kg and 0.9% saline were intravenously infused for 10 minutes after delivery in the dexmedetomidine and control groups, respectively. After infusion, sufentanil or dexmedetomidine plus sufentanil was administered via patient-controlled intravenous analgesia for 48 hours in the control group and dexmedetomidine group, respectively. Main Outcomes and MeasuresThe primary outcome was positive PPD screening results at 7 and 42 days post partum, defined as a postpartum Edinburgh Postnatal Depression Scale score of more than 9. Analysis was on an intention-to-treat basis. ResultsAll 338 participants were female, with a mean (SD) age of 31.5 (4.1) years. Positive PPD screening incidence at 7 and 42 days post partum in the dexmedetomidine group vs the control group was significantly decreased (day 7, 21 of 167 [12.6%] vs 53 of 165 [32.1%]; risk ratio, 0.39 [95% CI, 0.25-0.62]; P < .001; day 42, 19 of 167 [11.4%] vs 50 of 165 [30.3%]; risk ratio, 0.38 [95% CI, 0.23-0.61]; P < .001). The dexmedetomidine group showed no significant difference in adverse events vs the control group (46 of 169 [27.2%] vs 33 of 169 [19.5%]; P = .10), but the incidence of hypotension increased (31 of 169 [18.3%] vs 16 of 169 [9.5%]; risk ratio, 2.15 [95% CI, 1.13-4.10]; P = .02). Conclusions and RelevanceDexmedetomidine administration in the early postpartum period significantly reduced the incidence of a positive PPD screening and maintained a favorable safety profile. Trial RegistrationChinese Clinical Trial Registry Identifier: ChiCTR2200057213

BACKGROUND:This randomized controlled trial explored whether bilateral 2-level erector spinae plane block could accelerate postoperative gastrointestinal function and rehabilitation in patients undergoing posterior lumbar surgery. METHODS:A total of 80 adult patients undergoing posterior lumbar surgery between March 2021 and August 2021 were randomized to either ultrasound-guided bilateral 2-level erector spinae plane block (group E) or not (group C). General anesthesia was routinely performed. The primary outcome was the time of the first flatus after surgery. We also recorded the first food and liquid intake, first off-bed activity, days of hospital stay, and postoperative complications. Postoperative visual analog scale score and opioid consumption were also recorded. A venous blood sample was taken to measure the serum concentration of lipopolysaccharides, c-reactive protein, tumor necrosis factor-alpha, interleukin-6, and blood glucose before induction of anesthesia, immediately after, and 24 and 48 hours after surgery. RESULTS:Seventy-seven patients, 39 in group C and 38 in group E, finished the trial. Patients in group E had a significantly shorter time to first flatus (16.2 ± 3.2 vs 19.7 ± 3.0 hours, P < .05), earlier liquid intake (1.7 ± 0.2 vs 1.9 ± 0.3 hours, P < .05), earlier food intake (1.9 ± 0.2 vs 2.1 ± 0.3 hours, P < .05), and first off-bed activity (27.9 ± 3.2 vs 31.4 ± 3.3 h, P < .05). Patients in group E had shorter postoperative hospital stay (4.6 [4.2-5.5] d vs 5.4 [4.5-6.3], P < .05). We found that patients in group E had less pain and total sufentanil consumption (129 [120-133] vs 138 [132-147] μg, P < .05) within 24 hours after surgery. At 24 hours after surgery, the serum concentrations of lipopolysaccharides, tumor necrosis factor-alpha, interleukin-6, and C-reactive protein in group E were significantly decreased compared to group C (P < .05). CONCLUSION:Bilateral 2-level erector spinae plane block can accelerate gastrointestinal function recovery and shorten the length of hospital stay in patients undergoing open posterior lumbar surgery. The potential mechanism may attribute to the opioids-sparing effects and anti-stress-related anti-inflammatory effects of bilateral 2-level erector spinae plane block.

Background Spinal surgery causes severe postoperative pain. An erector spinae plane (ESP) block can relieve postoperative pain, but the optimal blocking method has not been defined. The aim of this study is to compare the feasibility of a one-level and a two-level lumbar ESP block and their effect on intraoperative and postoperative analgesia in lumbar spinal surgery. Methods A total of 83 adult patients who were scheduled for posterior lumbar interbody fusion were randomly divided into two groups. Patients in Group I ( n = 42) received an ultrasound-guided bilateral one-level ESP block with 0.3% ropivacaine, while patients in Group II ( n = 41) received a bilateral two-level ESP block. Blocking effectiveness was evaluated, including whether a sensory block covered the surgical incision, sensory decrease in anterior thigh, and quadriceps strength decrease. Intraoperative anesthetic dosage, postoperative visual analogue scale scores of pain, opioid consumption, rescue analgesia, and opioid-related side effects were analyzed. Results Of the total number, 80 patients completed the clinical trial and were included in the analysis, with 40 in each group. The time to complete the ESP block was significantly longer in Group II than in Group I (16.0 [14.3, 17.0] min vs. 9.0 [8.3, 9.0] min, P = 0.000). The rate of the sensory block covering the surgical incision at 30 min was significantly higher in Group II than in Group I (100% [40/40] vs. 85.0% [34/40], P = 0.026). The rate of the sensory block in the anterior thigh was higher in Group II (43.8% [35/80] vs. 27.5% [22/80], P = 0.032), but the rate of quadriceps strength decrease did not differ significantly between the groups. The mean effect–site remifentanil concentration during intervertebral decompression was lower in Group II than in Group I (2.9 ± 0.3 ng/ml vs. 3.3 ± 0.5 ng/ml, P = 0.007).There were no significant differences between the groups in terms of intraoperative analgesic consumption, postoperative analgesic consumption, and postoperative VAS pain scores at rest and with movement within 24 h. There were no block failures, block-related complications, and postoperative infection. Conclusions Among patients undergoing posterior lumbar interbody fusion, the two-level ESP block provided a higher rate of coverage of the surgical incision by the sensory block when compared with the one-level method, without increasing the incidence of procedure-related complications. Clinical Trial Registration www.chictr.org.cn , identifier: ChiCTR2100043596

Objective:To evaluate the effects of language awakening nursing and thermal insulation nursing on anesthesia in elderly patients undergoing spinal fracture surgery. Methods:Randomized control method was used in this study, 200 elderly patients who underwent spinal fracture surgery under general anesthesia between January and December 2022. Among the patients, 100 cases were selected as the observation group, and the other 100 cases were included in the control group by the random number table method. The control group was treated with thermal insulation nursing, and the observation group was given language arousal nursing (a type of care that helps patients regain consciousness after surgery or anesthesia) combined with thermal insulation nursing (A nursing method for maintaining a patient's body temperature in a medical setting). Results:After the intervention, the observation group showed shorter extubation time, awaking time, eye-opening time, and respiratory recovery time compared to the control group (P < .05). Systolic, diastolic, and MAP decreased in both groups after the intervention, with the observation group showing lower values (P < .05). Heart rate at 5 and 10 minutes after extubation decreased in both groups, with the observation group having a lower heart rate than the control group (P < .05). There were no significant differences in SPO2 between the groups after intervention (P > .05). The observation group reported milder pain and a lower incidence of anesthesia-related adverse reactions (P < .05). These findings suggest that language arousal nursing combined with heat preservation nursing improves anesthesia recovery in elderly patients undergoing spinal fracture surgery, leading to better outcomes and reduced adverse events. Conclusion:Combining language arousal and thermal insulation nursing enhances anesthesia recovery in elderly spinal fracture surgery patients, leading to optimized blood pressure, heart rate, reduced pain, and fewer anesthesia-related adverse events.

目的 分析超声引导下肢神经阻滞复合右美托咪定(DEX)在老年股骨颈骨折术中的应用价值.方法 选取2020年7月～2022年7月北京积水潭医院住院的123例老年股骨颈骨折手术患者进行回顾性分析,根据麻醉方法的不同分组,接受全身麻醉复合DEX的61例为全麻组,接受超声引导下肢神经阻滞复合DEX的62例为超声组,比较两组入室时(T0)、神经阻滞操作前(T1)、手术切皮即刻(T2)、手术开始15 min(T3)、手术开始30 min(T4)、手术结束(T5)各时间点的心率(HR)、平均动脉压(MAP)、血氧饱和度(SaO2),比较两组术后2 h、4 h、8 h的视觉模拟自评量表(VAS)评分、Ramsay镇静评分,DEX用量、按压镇痛泵次数及不良反应发生情况.结果 超声组T2、T3、T4时的HR、MAP均低于全麻组、T1、T5时的HR、MAP均高于全麻组(P＜0.05),两组T1～T5各时间点的SaO2比较,差异均无统计学意义(P＞0.05).超声组术后2 h、4 h、8 h的VAS评分均低于全麻组、Ramsay镇静评分均高于全麻组(P＜0.05).超声组DEX用量、按压镇痛泵次数均低于全麻组(P＜0.05).两组不良反应总发生率比较,差异无统计学意义(P＞0.05).结论 老年股骨颈骨折手术中通过超声引导下肢神经阻滞复合DEX麻醉效果好,安全性较高.

患者女,71岁,因"右侧髋部外伤致疼痛伴活动功能障碍14 d"于2022年6月22日就诊于北京积水潭医院,X线检查后诊断为"右侧股骨假体周围骨折、骨质疏松",拟行"陈旧股骨干骨折切开复位内固定术、髂骨取骨术、股骨植骨术".既往史:高血压13年,规律口服硝苯地平;腔隙性脑梗死10年,无明显后遗症;不稳定性心绞痛2年,近半年未发作,服用阿司匹林治疗;2012年因病态窦房结综合征于外院行心脏永久起搏器植入术;2013年因股骨颈骨折于外院行人工股骨头置换术;2021年11月因摔伤致股骨假体周围骨折于我院行股骨干切开复位内固定术;既往严重骨质疏松病史,否认其他慢性疾病史.

Abstract Background: This paper attempts to compare the effect of a co-management care model with a traditional orthopedic model on perioperative neurocognitive disorders complications in elderly hip fracture patients. Methods: In this study, elderly hip fracture patients attending six hospitals in Beijing from November 31, 2018 to November 31, 2020 were divided into co-management care model and traditional orthopedic model according to the intention-to-treat principle. Beijing Jishuitan Hospital implemented a rapid co-management care model (OGC group), and five Beijing hospitals, including Beijing Anzhen Hospital, implemented a traditional orthopedic model (TOC group). The study used the Confusion Assessment Method (CAM) and a modified telephone interview method targeting patients' cognitive status to assess the incidence of delirium in elderly patients. Results: A total of 2071 elderly hip surgery patients were included in the study, excluding 128 patients who received conservative treatment and 119 patients who were withdrawn from follow-up. Ultimately, 995 patients in the OGC group and 829 patients in the TOC group were included in the follow-up analysis. The incidence of perioperative neurocognitive disorders was significantly lower in the OGC group than in the TOC group (20.5% vs 69.5%, OR 0.59, 95% CI:0.53~0.65, P=0.000); the incidence of preoperative delirium was significantly lower in the OGC group than in the TOC group (10.5% vs 16.9%, OR 0.64, 95% CI:0.47-0.70, P=0.000); the incidence of postoperative delirium was also lower in the OGC group than in the TOC group (19.1% vs. 22.6%, OR 0.67, 95% CI:0.58 ~ 0.77, =0.001). Our logistic multivariate analysis also showed that the rapid fast-track co-management care model may be a protective factor against the development of neurocognitive impairment in patients in the perioperative period. Conclusion: The fast-track co-management care model can reduce the occurrence of perioperative neurocognitive disorders in elderly patients, which is worth being promoted in clinical treatment. Key words: hip fracture, fast track, co-management care model, delirium, perioperative neurocognitive disorders.

Purpose: To explore the risk factors associated with perioperative blood transfusion among elderly patients with trochanteric femur fracture who receive intramedullary nail (IMN) fixation and establish a nomogram prediction model. Patients and methods: A retrospective study was conducted on elderly patients with trochanteric femur fracture treated by IMN under single injection spinal anesthesia with nerve blocks from January 2020 to July 2020. Medical records were retrieved to collect demographic data, comorbidities, and laboratory results at admission. Univariate and multivariate regression analyses were performed to identify independent risk factors for perioperative blood transfusion. The performance and consistency of the nomogram prediction model were assessed by the consistency coefficient (C-index) and the calibration curve. Results: In total, 202 patients met the inclusion criteria and were enrolled, and of these, 130 patients (64.4%) received a blood transfusion during the operative period. Multivariate analysis demonstrated that the body mass index (BMI) (OR: 0.890; 95% CI: 0.811–0.977), preoperative hemoglobin (Hb) (OR: 0.905; 95% CI: 0.877–0.934), and intraoperative blood loss (IBL) (OR:1.008; 95% CI: 1.002–1.013) were independent risk factors for perioperative blood transfusion. The nomogram model showed good discrimination with an area under the curve of 0.885, a C-index of 0.885 (95% CI, 0.838–0.932), and good calibration. Conclusion: We constructed a nomogram prediction model, which can be used to help identify high-risk patients who require perioperative blood transfusion among elderly patients with trochanteric femur fracture. This model may facilitate the efficiency of blood product management and the delivery of safe and effective care.Funding Information: This work was supported by grants from the Capital Health Research and Development of Special (2020-2-1122).Declaration of Interests: The authors report no conflicts of interest in this work Ethical Approval Statement: This study was approved by the Ethics Committee of the Jishuitan Hospital in Beijing.

Developing a new type of CO gas sensor with high response, good reproducibility, and short response/recovery time is of great significance in medical fields, especially during anesthesia. During mechanical ventilation, CO gas will be produced by CO 2 absorbent. Herein, novel interconnected CeO 2 nanofibers with an average diameter of 150 nm are firstly prepared by electrospinning. The results show that the received nanofibers are mainly composed of fluorite-structured CeO 2 crystals with oxygen vacancies as well as the adsorbed oxygen species on the fiber surface. It is found that there is no agglomeration and sintering for the nanofibers even after annealing at 1000°C. The interconnected nanofibers exhibit excellent gas sensing performance to CO gas at an optimum operating temperature of 450°C, where the gas sensing response value is 2.82. And the nanofibers also exhibit excellent gas sensing reproducibility, fast response/recovery rate (2 s/4 s), and high response value-concentration correlation toward CO. This study provides a simple approach to interconnected CeO 2 nanofibers for potential gas sensor application.

(1) Background: Previous evidence demonstrates that tight glycemic control and good physical function could reduce the risk of delirium. This study aimed to investigate whether the occurrence of postoperative delirium (POD) in older hip fracture surgery patients is associated with preoperative glycemic control factors or pre-injury physical performance. (2) Methods: Three-hundred and nine individuals aged over 65 years and scheduled for hip fracture surgery were included at a single center. Glycemic control factors and pre-injury physical performance were assessed preoperatively. The presence of delirium was assessed using the Confusion Assessment Method on postoperative hospitalization days. Univariate and multivariable logistic regression models and a risk prediction model of POD were established. (3) Results: Among the 309 patients, 52 (16.83%) experienced POD during the hospital stay. The numbers of pre-injury physical performance and type 2 diabetes mellitus (T2DM) patients were significantly different in the POD and non-POD groups. The multivariable model showed that development of delirium was significantly explained by preoperative fasting blood glucose (FBG) (OR 0.804, p = 0.004), stair climbing (OR 0.709, p = 0.003), T2DM (odds ratio (OR) 3.654, p = 0.001), and age-adjusted Charlson comorbidity index (ACCI) (OR 1.270, p = 0.038). The area under the receiver operating characteristic curve (AUROC) of the risk prediction model including those covariates was 0.770. (4) Conclusions: More older T2DM patients develop POD after hip fracture surgery than patients without T2DM. A simple assessment of preoperative FBG and pre-injury stair climbing capacity may identify those at high risk for the development of POD. Higher preoperative FBG and good pre-injury stair climbing capacity are protective factors for POD.

Background: Emergence delirium (ED) occurs immediately after emergence from general anesthesia, which may have adverse consequences. This cross-sectional survey assessed Chinese physicians’ and nurses’ knowledge of, attitudes towards, and practice regarding ED in adults. Methods: Electronic questionnaires were sent to 93 major academic hospitals across mainland China and both attending anesthesiologists and anesthesia nurses were recommended to complete them. Results: A total of 243 anesthesiologists and 213 anesthesia nurses participated in the survey. Most of the participants considered it a very important issue; however, less than one-third of them routinely assessed ED. In terms of screening tools, anesthesiologists preferred the Confusion Assessment Method, while anesthesia nurses reported using multiple screening tools. Divergence also appeared with regard to the necessity of monitoring the depth of anesthesia. Anesthesiologists considered it only necessary in high-risk patients, while the nurses considered that it should be carried out routinely. No unified treatment strategy nor medication was reported for ED treatment during the recovery period. Conclusions: This study illustrated that there are high awareness levels among both Chinese anesthesiologists and anesthesia nurses regarding the importance of ED. However, a specific practice in terms of routine delirium assessment, anesthesia depth monitoring, and a standardized treatment algorithm needs to be implemented to improve ED management.

目的 探讨不同麻醉方式对髋关节置换术患者血流动力学指标及下肢深静脉血栓(DVT)的影响.方法 收集2021年1月至2022年1月北京积水潭医院收治的96例髋关节置换术患者的临床资料,根据麻醉方式的不同将其分为全麻组(n=43)和神经阻滞麻醉组(n=53).记录两组患者的手术相关指标[手术时间、拔管时间、首次下床活动时间、住院时间、术后24 h视觉模拟评分法(VAS)评分],比较两组患者术前(T0)、术中(T1)、术毕(T2)、术后30 min(T3)时的血流动力学指标[心率(HR)、平均动脉压(MVP)],比较两组患者T0、T2时的凝血功能指标[凝血酶时间(TT)、凝血酶原时间(PT)、纤维蛋白原(FIB)水平、D-二聚体(D-D)水平],分析两组患者术后下肢DVT发生率及安全性指标.结果 神经阻滞麻醉组患者拔管时间、首次下床活动时间、住院时间均短于全麻组患者,术后24 h VAS评分低于全麻组患者,差异均有统计学意义(P<0.05).T1、T2、T3时,全麻组患者HR、MVP均低于本组T0,但神经阻滞麻醉组患者HR、MVP均高于全麻组患者,差异均有统计学意义(P<0.05).T2时,全麻组患者血清FIB水平、D-D水平均高于本组T0,TT、PT均长于本组T0,但神经阻滞麻醉组患者血清FIB水平、D-D水平均低于全麻组患者,TT、PT均短于全麻组患者,差异均有统计学意义(P<0.05).全麻组患者下肢DVT发生率为16.3％(7/43),高于神经阻滞麻醉组患者的3.8％(2/53),差异有统计学意义(P<0.05).两组患者术后安全性指标比较,差异均无统计学意义(P>0.05).结论 超声引导下的神经阻滞麻醉在髋关节置换术患者中的血流动力学稳定性较高,早期镇痛效果显著,减少了首次下床活动及出院时间,下肢DVT发生率较低,安全性较高,值得临床推广应用.

BackgroundVisfatin is considered to be a “novel pro-inflammatory cytokine.” Neuroinflammatory response is one of the important mechanisms of postoperative delirium (POD). The relationship between preoperative plasma visfatin and POD is unclear.ObjectiveTo investigate the relationship between preoperative plasma visfatin concentrations and POD (primary outcome) in older hip fracture patients and to explore whether it affects POD through inflammatory factors.Materials and methodsThis prospective cohort study enrolled 176 elderly patients who were scheduled for hip fracture surgery. Preoperative plasma was collected on the morning of surgery, and visfatin levels were measured. Interleukin (IL)-1 and IL-6 were measured using patients’ plasma collected on the first day after surgery. We used the 3-min diagnostic interview for Confusion Assessment Method-defined delirium (3D-CAM) twice daily within the 2 days after surgery to assess whether POD had occurred. Restricted cubic splines and piecewise regression were used to explore the relationship between preoperative plasma visfatin concentrations and POD, and further mediation analysis was used to verify whether visfatin plays a role in POD through regulating inflammatory factors.ResultsThe incidence of POD was 18.2%. A J-shaped association was observed between preoperative plasma visfatin levels and POD. The risk of POD decreased within the lower visfatin concentration range up to 37.87 ng/ml, with a hazard ratio of 0.59 per 5 ng/ml [odds ratio (OR) = 0.59, 95% confidence interval (CI) = 0.37–0.95], but the risk increased above this concentration (P for non-linearity < 0.001, with a hazard ratio of 1.116 per 10 ng/ml; OR = 1.10, 95% CI = 1.02–1.23). Mediation effect analysis showed that when the plasma visfatin concentration was higher than 37.87 ng/ml, the effect of visfatin on POD was mediated by IL-6 (p < 0.01). A significant indirect association with postoperative plasma IL-6 was observed between preoperative plasma visfatin and POD (adjusted β = 0.1%; 95% CI = 4.8∼38.9%; p < 0.01).ConclusionVisfatin is the protective factor in POD when the preoperative plasma visfatin concentration is below 37.87 ng/ml, but when it exceeds 37.87 ng/ml, the visfatin concentration is a risk factor for POD, which is mediated by postoperative plasma IL-6. The results suggest that preoperative visfatin may have a dual effect on the POD occurrence.Clinical trial registration[www.ClinicalTrials.gov], identifier [ChiCTR21 00052674].

AimThe purpose of this study was to analyze the potential risk factors for mortality 1 year after hip fracture surgery in critically ill older adults.MethodsWe reviewed 591 critically ill older adults who underwent hip surgery at our institution from January 2018 to April 2021. We collected baseline demographics, clinical information, and 1-year survival status of the sample patients by means of medical record systems and follow-up phone calls. Patients were divided into survival and mortality groups based on survival within 1 year after surgery.ResultsBased on the results of the 1-year postoperative follow-up of patients, we obtained 117 cases in the death group and 474 cases in the survival group, and this led to a 1-year mortality rate of 19.8% (117/591) after hip fracture in critically ill older adults at our hospital. The risk factors that influenced the 1-year postoperative mortality were identified as advanced age (HR:1.04, 95%, 1.01–1.06), preoperative arrhythmia (HR: 1.95, 95%, 1.26–2.70), high level of NLR (HR:1.03, 95%, 1.01–1.06), respiratory failure (HR: 2.63, 95%, 1.32–5.23), and acute cardiovascular failure. 5.23) and acute cardiovascular events (HR: 1.65, 95%, 1.05–2.59).ConclusionAdvanced age, preoperative arrhythmias, high levels of NLR, postoperative respiratory failure, and acute cardiovascular events were independent risk factors for survival of critically ill older adults with hip fracture at 1 year after surgery. Therefore, laboratory tests such as high levels of preoperative NLR can be an important indicator of patient prognosis.

目的 探讨上午/下午手术对老年髋部骨折患者术后睡眠质量的影响.方法 选取北京积水潭医院2019年4月～2020年6月年龄≥65岁的髋部骨折患者40例,按手术开始时间分为上午组及下午组,每组20例.比较2组术后睡眠及疼痛情况.结果 与下午组相比,上午组手术当晚总睡眠时长、快动眼睡眠及浅睡眠均显著增加[(341.3±127.9)min vs.(214.7±89.9)min,t=2.326,P=0.027;48.5(23.5,59.8)min vs.34.0(21.0,49.8)min,Z=-2.109,P=0.035;(246.3±85.9)min vs.(157.9±72.5)min,t=2.221,P=0.034],术后第一晚快动眼睡眠、深睡眠显著增加[71.0(34.3,87.3)min vs.36.0(19.0,53.3)min,Z=-2.600,P=0.009;47.5(39.0,69.3)min vs.34.5(19.5,51.0),Z=-2.538,P=0.011].结论 对于老年髋部骨折患者,上午接受手术较下午手术可增加术后睡眠时长.

Objective To evaluate the risk of bleeding in elderly patients undergoing early hip fracture surgery with/without clopidogrel administration. Methods This was a retrospective study, and patients over 65 years with fresh hip fracture were enrolled. For the patients taking clopidogrel, early surgical treatment was performed without 5–7 days waiting time. The patients were divided into groups according to their fracture type and the surgical method. Within each fracture/surgery group, the patients were further divided into subgroups according to whether they had clopidogrel administration. The patients' age, gender, American Society of Anesthesiologists (ASA) score, hemoglobin level at admission, and the time from admission to surgery were compared in the different groups. The bleeding outcomes, such as intraoperative blood loss and blood transfusion status, as well as secondary outcomes, such as operation duration and length of hospital stay, were also compared in these groups. Results There were no statistically significant differences in patients' baseline characteristics and outcomes, including intraoperative blood loss, blood transfusion rate, operation duration and length of hospital stay, between the clopidogrel‐administrated patients and the control patients. However, the percentage of patients taking general anesthesia was significantly higher in clopidogrel group than that in control group (P = 0.01). Similar intraoperative blood loss was found in the subgroups of hemi‐hip replacement, internal fixation for intertrochanteric fracture of the femur (fracture type A1‐2, short pin), and internal fixation of femoral neck fracture with cannulated nails. For the internal fixation of femoral neck fracture with cannulated nails, the blood loss is significantly less in both subgroups than that with other two surgical methods. Moreover, the total hip arthroplasty, with the highest bleeding risk among all the surgical methods involved, was rarely chosen to treat geriatric hip fracture in this study. Conclusion This study indicated that compared with patients without clopidogrel administration, elderly patients with hip fractures who receive clopidogrel as long‐term anti‐platelet therapy are relatively safe for surgery in less than 5–7 days after discontinuation of clopidogrel.