Objective To investigate the effect of perioperative individualized nutritional intervention on the changes of nutritional indicators and prognosis of elderly patients with nutritional risk after posterior lumbar interbody fusion. Methods From January 2018 to December 2019,a total of 181 elderly patients over 75 years old with posterior lumbar interbody fusion in Xuanwu Hospital Capital Medical University were included in this study.85 patients with≥3 points of NRS2002 were included in the intervention group,and 96 patients with<3 points of NRS2002 were included in the control group.The control group was given routine diet education,and the patients ordered meals according to their own dietary patterns and preferences.The intervention group was given further nutritional assessment and individualized nutritional treatment plan was developed.Nutritional indices(serum total protein,albumin,prealbumin and hemoglobin),potential risk factors for postoperative hypoproteinemia(whether diabetes mellitus,frailty,operative time and intraoperative blood loss) and postoperative infection were compared between the two groups. Results There were no significant differences in gender,course of disease,proportion of combined diabetes and frailty between the two groups(P>0.05).The age of the intervention group was higher than that of the control group,the body mass index,intraoperative blood loss,preoperative serum total protein,albumin,prealbumin and hemoglobin levels were lower than those of the control group,and the operation time was shorter than that of the control group,with statistical significance(P<0.05).The levels of serum total protein,albumin,prealbumin and hemoglobin in both groups were decreased after operation,but the levels of all indexes in the intervention group were lower than those in the control group,with statistical significance(P<0.05).There was no significant difference in length of hospital stay and postoperative infection between the two groups(P>0.05). Conclusion For elderly patients with nutritional risk,preoperative nutritional intervention can reduce the decline of postoperative nutritional indicators.

Purpose: We aimed to identify the risk factors for postoperative cognitive decline (POCD) by evaluating the outcomes from preoperative comprehensive geriatric assessment (CGA) and intraoperative anesthetic interventions. Patients and Methods: Data used in the study were obtained from the Aged Patient Perioperative Longitudinal Evaluation-Multidisciplinary Trial (APPLE-MDT) cohort recruited from the Department of Orthopedics in Xuanwu Hospital, Capital Medical University between March, 2019 and June, 2022. All patients accepted preoperative CGA by the multidisciplinary team using 13 common scales across 15 domains reflecting the multi-organ functions. The variables included demographic data, scales in CGA, comorbidities, laboratory tests and intraoperative anesthetic data. Cognitive function was assessed by Montreal Cognitive Assessment scale within 48 hours after admission and after surgery. Dropping of >1 point between the preoperative and postoperative scale was defined as POCD. Results: We enrolled 119 patients. The median age was 80.00 years [IQR, 77.00, 82.00] and 68 patients (57.1%) were female. Forty-two patients (35.3%) developed POCD. Three cognitive domains including calculation (P = 0.046), recall (P = 0.047) and attention (P = 0.007) were significantly worsened after surgery. Univariate analysis showed that disability of instrumental activity of daily living, incidence rate of postoperative respiratory failure (PRF) >= 4.2%, STOP -Bang scale score, Caprini risk scale score and Sufentanil for maintenance of anesthesia were different between the POCD and non-POCD patients. In the multivariable logistic regression analysis, PRF >= 4.2% (odds ratio [OR] = 2.343; 95% confidence interval [CI]: 1.028-5.551; P = 0.046) and Sufentanil for maintenance of anesthesia (OR = 0.260; 95% CI: 0.057-0.859; P = 0.044) was independently associated with POCD as risk and protective factors, respectively. Conclusion: Our study suggests that POCD is frequent among older patients undergoing elective orthopedic surgery, in which decline of calculation, recall and attention was predominant. Preoperative comprehensive geriatric assessments are important to identify the high-risk individuals of POCD.

Abstract Background: The effectiveness of comprehensive geriatric assessment (CGA) has been confirmed to reduce perioperative complications of geriatric patients. But there is no universally accepted standardization of CGA for orthopedic surgery. In this study, a novel CGA strategy was applied to evaluate the conditions of elderly patients undergoing orthopedic surgery from a broad view and to identify potential risk factors for postoperative complications. Methods: A prospective cohort study was conducted from March 2019 to December 2020.The study enrolled patients for elective or confined orthopedic surgery if they were over the age of 75 years old. All patients were enrolled and treated with help from a multidisciplinary team. A structured CGA was conducted to identify high-risk elderly patients and to facilitate coordinated multidisciplinary team care by a geriatric team. The basic patient characteristics and CGA results were collected in addition to postoperative complication and mortality rates. Multivariate logistic regression analysis was used to identify risk factors for postoperative complications. Results: A total of 214 patients with an age of 81.07 ± 4.78 (range, 75–100) years were prospectively enrolled in this study. In total, 66 (30.8%) complications were registered, including one death from myocardial infarction (mortality rate, 0.5%). Poor ADL and IADL were accompanied by frailty, worse American Society of Anesthesiologists (ASA) score, visual analogue scale score, and nutritional status. Poor ADL was also associated with higher risks of falling, polypharmacy, and cardiac and respiration complications. Poor IADL was associated with higher risk of cardiac and respiration complications. Higher stroke risk was accompanied by higher risks of cardiac complications, delirium, and hemorrhage. Worse ASA scale was associated with worse ADL, IADL, and frailty, and higher delirium risk. Multivariate logistic regression analysis showed that spinal fusion (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.65 to 0.83; p = 0.0214), blood loss(OR, 1.68; 95% CI, 1.31 to 2.01; p = 0.0168), ADL (severe dysfunction or worse) (OR, 1.45; 95% CI, 1.16 to 1.81; p = 0.0413), IADL (serious dependence) (OR, 1.08; 95% CI, 1.33 to 1.63; p = 0.0436), renal function (CKD ≥ stage 3a) (OR, 2.01; 95% CI, 1.54 to 2.55; p = 0.0133), and malnutrition(OR, 2.11; 95% CI, 1.74 to 2.56; p = 0.0101) were independent risk factors for postoperative complications. All P <0.05.Conclusion: Spinal fusion, blood loss, ADL (severe dysfunction or worse), IADL (serious dependence), renal function (CKD ≥ stage 3a) and nutrition MNA (malnourished) were independent risk factors of postoperative complications following orthopaedic surgery in elderly patients.

Background The comprehensive geriatric assessment (CGA) has been proposed as a supplementary tool to reduce perioperative complications of geriatric patients, however there is no universally accepted standardization of CGA for orthopedic surgery. In this study, a novel CGA strategy was applied to evaluate the conditions of older patients undergoing orthopedic surgery from a broad view and to identify potential risk factors for postoperative complications. Methods A prospective cohort study was conducted from March 2019 to December 2020.The study enrolled patients (age > 75 years) for elective or confined orthopedic surgery. All patients were treated by a multidisciplinary team. A structured CGA was conducted to identify high-risk older patients and to facilitate coordinated multidisciplinary team care by a geriatric team. The basic patient characteristics, CGA results, postoperative complication and mortality rates were collected. Multivariate logistic regression analysis was used to identify risk factors for postoperative complications. Results A total of 214 patients with an age of 81.07 ± 4.78 (range, 75–100) years were prospectively enrolled in this study. In total, 66 (30.8%) complications were registered, including one death from myocardial infarction (mortality rate, 0.5%). Poor Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) were accompanied by frailty, worse perioperative risk, pain, and nutritional status. Poor ADL was also associated with higher risks of falling, polypharmacy, and cardiac and respiration complications. Poor IADL was associated with a higher risk of cardiac and respiration complications. Higher stroke risk was accompanied by higher risks of cardiac complications, delirium, and hemorrhage. Worse American Society of Anesthesiologists (ASA) score was associated with worse ADL, IADL, frailty, and higher delirium risk. Multivariate logistic regression analysis showed that spinal fusion (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.65 to 0.83; p = 0.0214), blood loss(OR, 1.68; 95% CI, 1.31 to 2.01; p = 0.0168), ADL (severe dysfunction or worse) (OR, 1.45; 95% CI, 1.16 to 1.81; p = 0.0413), IADL (serious dependence) (OR, 1.08; 95% CI, 1.33 to 1.63; p = 0.0436), renal function (chronic kidney disease (CKD) ≥ stage 3a) (OR, 2.01; 95% CI, 1.54 to 2.55; p = 0.0133), and malnutrition(OR, 2.11; 95% CI, 1.74 to 2.56; p = 0.0101) were independent risk factors for postoperative complications. Conclusion The CGA process reduces patient mortality and increases safety in older orthopedic surgery patients. Spinal fusion, blood loss, ADL (severe dysfunction or worse), IADL (serious dependence), renal function (CKD ≥ stage 3a) and nutrition mini nutritional assessment (MNA) (malnourished) were independent risk factors of postoperative complications following orthopaedic surgery in older patients.

目的 回顾脓毒症患者入院时血清CRP/PA,了解其对脓毒症预后的评估价值,寻找早期判断患者预后情况的有效指标. 方法 采用回顾性队列研究,收集首都医科大学宣武医院2017-05 ～2018-04收治的脓毒症住院患者.根据患者住院期间转归情况分为生存组和死亡组.收集患者的完整临床资料,分析两组间临床资料差异,临床指标与APACHEⅡ评分、SOFA评分的相关性,应用ROC曲线分析各因素对脓毒症患者预后的预测价值. 结果 共纳入患者65例,年龄(67.06±16.51)岁.生存组患者44例,年龄为(63.82±16.84)岁,死亡组患者21例,年龄为(73.86±13.80)岁,两组年龄比较差异存在统计学意义(P =0.021).住院患者脓毒症的死亡率为32.3％.与死亡组比较,生存组PA水平高,CRP/PA比值小,APACHEⅡ评分和SOFA评分低,差异均有统计学意义(P＜0.05).CRP、CRP/PA与APACHE Ⅱ存在弱相关(r=0.308,0.397,P＜0.05),PA与SOFA存在弱相关(r=-0.268,P＜0.05).应用ROC曲线评价CRP/PA、APACHE Ⅱ评分、SOFA评分对预后的评估价值,APACHEⅡ评分的AUC最大,为0.893.CRP/PA的AUC为0.669,其敏感度、特异度、阳性预测值(PPV)、阴性预测值(NPV)分别为80.0％,50.0％,76.2％,51.3％. 结论 CRP/PA对于评价脓毒症患者预后简单便捷,有望作为快速评价脓毒症预后的指标.

Objective To investigate the effect of full nutrition management on cancer patients with chemotherapy, and to support theory bases for the standardized clinical nutrition of cancer patients. Methods From January 2016 to December 2017, a total of 88 patients with the first chemotherapy were recruited and randomly divided into experimental group and control group, with 44 patients in each group. These patients all complied with the inclusion and exclusion criteria, and volunteered for the study. The two groups all received the same of anti-tumor treatment and the same conventional nutritional support (according to the results of nutrition screening and nutrition assessment, the nutritional support was formulated and patients′dietary guidance was given), while only patients of the experimental group were given full nutritional management, including regularly following up the patient′s condition changes, gastrointestinal reactions, and the feed. According to the five-step treatment model of malnutrition, nutritional support was improved in a timely manner, and appropriate nutritional support was provided. At the end of chemotherapy, the change of weight, albumin, prealbumin, hemoglobin was compared with that before treatment in the two groups. Results After chemotherapy, albumin, prealbumin, hemoglobin had no obvious drop compared with that before treatment in two groups (P>0.05). The patients of experimental group showed stable weight after chemotherapy: (53.39 ± 9.24) kg vs. (54.66 ± 9.41) kg, P>0.05. Weight loss in the control group after chemotherapy was statistically significant:(54.61 ± 10.76) kg vs. (56.52 ± 10.46) kg, P<0.05. Conclusions The full nutritional management can help maintain nutrition status during chemotherapy, especially can prevent the weight loss.

Objective To retrospectively analyze the serum calcium level in sepsis patients, understand the influencing factors of abnormality calcium metabolism, and analyze the effect of serum calcium level on sepsis prognosis. Methods From January 1, 2017 to January 31, 2018, clinical data about sepsis patients admitted hospital were collected. The patients were divided into 2 groups according the levels of serum calcium measured in patients admitted in 24 h: normal serum calcium group (serum calcium 2.03-2.67 mmol/L), and low serum calcium group (serum calcium<2.03 mmol/L). And this study did not find hypercalcemia patients. The data about laboratory test index were compared between two groups. Results Fifty-two cases were included in this study, including 14 cases of normal serum calcium and 38 cases of hypocalcemia, and the incidence rate of hypocalcemia was 73.1%(38/52). The level of serum calcium in hypocalcemia group was (1.78 ± 0.17) mmol/L, and was (2.16 ± 0.14) mmol/L in normal serum calcium group. The main position of infections in patients with sepsis were digestive system, respiratory system and urinary system. Compared with that in the normal serum calcium group, the number of malnutrition patients in the hypocalcemia group was more. The total protein (TP), albumin (ALB), prealbumin (PAB) and total cholesterol (TCH) in the nutritional status of the patients were lower, the sequential organ failure assessment (SOFA) scores was higher, the prothrombin activity (PTA) was lower, the prothrombin time (PT) was prolonged, and international normalized ratio (INR) was increased. The differences were statistically significant (P<0.05 or <0.01). Pearson correlation test was used to screen the tests and scores related to the concentration of serum calcium. The results showed that the serum calcium concentration was negatively correlated with the level of SOFA scores, procalcitonin (PCT), PTA, thrombin time (PT), activated partial thromboplastin time (APTT) and INR (r=- 0.431, - 0.361, - 0.441, - 0.431, - 0.427, - 0.420, P<0.01 or<0.05), and the serum calcium concentration was positively correlated with TCH, TP, ALB and PAB (r=0.442, 0.475, 0.463, 0.419, P<0.01). Conclusions Hypocalcemia is related to the nutritional status of the body, and is related to coagulation function, serum protein level, PCT concentration and SOFA scores. The decrease of serum calcium indicates that multiple organ dysfunction syndrome may occur, and should be paid more attention to. Key words: Sepsis; Hypocalcemia; Sequential organ failure assessment; Multiple organ dysfunction syndrome