Perioperative Medicine最新文献

{"title":"Comparative study of the efficacy and safety of remimazolam and midazolam for general anesthesia in elderly patients: a randomized controlled trial.","authors":"Yang Wan-Jun, Geng Zhi-Long, Gao Yuan-Yuan, Cui Chao-Yuan, Chen Zheng-Ze, Tian Zi-Wei, Guo Xi-Lin, Zhang Ya-Nan, Wang Lu, Huo Rui, Ma Chen-Wei, Niu Jing","doi":"10.1186/s13741-025-00525-9","DOIUrl":"https://doi.org/10.1186/s13741-025-00525-9","url":null,"abstract":"<p><strong>Background: </strong>Elderly patients are a vulnerable group with high perioperative risks. Thus, reducing the duration of anesthesia is important. Remimazolam is a benzodiazepine sedative commonly used for the induction and maintenance of general anesthesia given its rapid induction and rapid recovery. Most reports have focused on nonelderly patients.</p><p><strong>Aim: </strong>To compare the time to loss of consciousness, length of PACU stay and incidence of adverse events in patients older than 65 years who received remimazolam for general anesthesia with those of patients who received midazolam.</p><p><strong>Methods: </strong>This study was conducted at a university hospital between February 2022 and March 2023. We included 100 patients aged 65 years or older who were scheduled for surgery under general anesthesia. Patients were divided into 2 groups, namely, the midazolam group and the remimazolam group, with 50 patients in each group. The primary outcome was the time to loss of consciousness. The secondary outcomes included the time to extubation and length of PACU stay. We also recorded the percentage of flumazenil used and incidence of adverse events.</p><p><strong>Results: </strong>Clinical data from 96 patients who were scheduled for surgery under general anesthesia were included in the final analysis, with 46 patients in the remimazolam group and 50 patients in the midazolam group. The time to loss of consciousness was 304 (222, 330) s in the remimazolam group and 95 (67, 25) s in the midazolam group, and the difference was significant (p = 0.000). The time to extubation was 24.93 ± 11.617 min in the remimazolam group and 34.88 ± 19.740 min in the midazolam group, revealing a significant difference (p = 0.003). The length of PACU stay was 55 (48, 64) min in the remimazolam group and 65 (55, 85) min in the midazolam group, and the difference was significant (p = 0.001). The percentage of flumazenil used was 6% in the remimazolam group and 20% in the midazolam group, and the difference was significant (p = 0.003).</p><p><strong>Conclusion: </strong>General anesthesia with remimazolam has been shown to be effective and safe for surgery in elderly patients. The time to extubation was significantly shorter, length of PACU stay was shorter, and percentage of flumazenil used was lower in the remimazolam group than in the midazolam group.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"53"},"PeriodicalIF":2.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dosage of epidural morphine analgesia after lower abdominal cancer surgery: a randomized clinical trial among the older adults.","authors":"Muhammad Shawqi, Sahar Abdel-Baky Mohamed, Essam Sharkawy, Diab Hetta","doi":"10.1186/s13741-025-00521-z","DOIUrl":"https://doi.org/10.1186/s13741-025-00521-z","url":null,"abstract":"<p><strong>Background: </strong>Epidural morphine is considered one of the most potent drugs used for postoperative analgesia; however, its side effects are dose-related and exaggerated in elderly people. In this study, we aimed to determine which of three doses within that range (1.5 mg, 3 mg, or 4.5 mg) can provide adequate pain relief.</p><p><strong>Methods: </strong>A total of 102 patients were assessed for allocation into one of four groups to receive either placebo (group Morphine 0, N = 22), 1.5 mg of epidural morphine (Morphine 1.5, N = 22), 3 mg of epidural morphine (Morphine 3, N = 22), or 4.5 mg of epidural morphine (Morphine 4.5, N = 22) before skin incision, 24 h after surgery and 48 h after surgery. Cumulative intravenous IV-PCA morphine consumption, VAS pain scores, modified Ramsay Sedation Scores, nausea, vomiting, and pruritus were evaluated.</p><p><strong>Results: </strong>The VAS pain scores at activity of patients who received epidural morphine at doses of 3 mg and 4.5 mg were significantly lower than the placebo and 1.5 mg groups, VAS Score at 72 h was (2 ± 0.8) and (1.7 ± 1) vs (4.3 ± 1.1) and (4 ± 1) respectively, p value = 0.000. The mean total IV-PCA morphine consumption (mg) was significantly higher in patients who received received epidural 0.9% sodium chloride alone compared to 1.5 mg, 3 mg and 4.5 mg epidural morphine groups (38.1 ± 4.8 mg vs 27.2 ± 5.6 mg, 9.2 ± 3.5 mg, and 6.3 ± 3.3 mg respectively), p value = 0.000). However, the difference between the 3 mg and the 4.5 mg groups was not statistically significant in both of VAS scores and IV-PCA morphine consumption (P value > 0.05 for 3 mg vs. 4.5 mg). Patients who received 4.5 mg of epidural morphine experienced a significant increase in the level of sedation, measured by the Ramsay sedation scale, in comparison with 1.5 mg, 3 mg and placebo epidural morphine groups in the first 24 h, the Scale for this group was (2.5 ± 0.5) vs (2.1 ± 0.2, 2.1 ± 0.2, and 2.2 ± 0.5 respectively); p value = 0.000. No relationship between postoperative nausea and the dosage of epidural morphine was found.</p><p><strong>Conclusion: </strong>Epidural morphine 3 mg as a bolus every 24 h with add on IV patient control analgesia (PCA) morphine, set to deliver 1.5 mg boluses on demand without background infusion with a lockout period of 45 min, could achieve effective and adequate analgesia lasting up to 72 h postoperatively without increasing in the level of sedation or other side effects in older adults after a lower abdominal cancer surgery.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"52"},"PeriodicalIF":2.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Higher rate of undetected intraoperative damage of latex-free surgical gloves worn by scrub nurses.","authors":"Leon Euler-Schmidt, Artur Barsumyan, Jan Adriaan Graw, Christian Soost, Yvonne Stephan, Rene Burchard","doi":"10.1186/s13741-025-00539-3","DOIUrl":"https://doi.org/10.1186/s13741-025-00539-3","url":null,"abstract":"<p><strong>Background: </strong>Surgical gloves are a medical product and a cornerstone of prevention from surgical site infections and staff injury. This study aimed to investigate the integrity of surgical gloves worn by scrub nurses during selected procedures in both general and trauma surgery. The frequency of defects such as perforations or tears was identified. Furthermore, differences in durability between latex and latex-free gloves were analyzed.</p><p><strong>Methods: </strong>In a 3-month period, a total of 139 surgical glove pairs, both latex and latex-free, used during general or trauma surgery in an academic teaching hospital were collected immediately after procedures. The gloves were subjected to watertightness testing following European norm ISO EN 455:2022 standards. Only gloves visually presumed to be intact were tested for any concealed perforations.</p><p><strong>Results: </strong>The number of perforated glove pairs was similar in both departments (general surgery 25% (n = 14 of 57) vs. trauma surgery 28% (n = 23 of 82), p = 0.79). However, differences in perforation rates by glove models (latex vs. latex-free) were noticed. The likelihood of perforation was increased by a factor of 4.24 with the use of latex-free gloves (χ^2 = 8.48, p = 0.004).</p><p><strong>Conclusions: </strong>Perforation of surgical gloves worn by scrub nurses is a common event during various surgical procedures in general and trauma surgery. In several cases, members of the surgical team do not notice a perforation of a glove. The risk of undetected damage to a surgical glove is significantly higher when latex-free gloves are used. Further research is needed to investigate if the use of a second layer of gloves could reduce this perioperative risk for surgical staff and patients.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"51"},"PeriodicalIF":2.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12054052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global research trends in perioperative care for diabetic patients: a bibliometric and visualized study.","authors":"Jiangru Kang, Xin Chai, Tao Jia, Huiru Hu, Rong Fu, Huang Nie","doi":"10.1186/s13741-025-00532-w","DOIUrl":"https://doi.org/10.1186/s13741-025-00532-w","url":null,"abstract":"<p><p>Perioperative management in diabetic patients is important since their postoperative mortality and morbidity are higher than that of non-diabetic patients, which will exacerbate the burden on public health. We selected relevant publications from the WoSCC-SCIE between 2007 and 2024, utilizing VOSviewer and CiteSpace to analyze the collected information and generate knowledge maps. A total of 3167 articles from 792 journals and 83 countries/regions were included for analysis. Overall, there has been a continuous increase in publication volume. From the result of academic collaboration between different countries/regions and institutions, the USA occupies a central position in research strength. A total of 18,101 authors participated in research on \"perioperative management in diabetic patients\" with Dr. Guillermo E. Umpierrez from Emory University School of Medicine being the most productive author. We conclude that perioperative adverse clinical outcomes in diabetic patients and perioperative blood glucose management have consistently been research hotspots in this field. Additionally, continuous glucose monitoring and insulin administration under computer guidance, as well as the use of merging medications are likely to be frontier directions for future research. Research on perioperative care for diabetic patients has been further deepened worldwide, which will be crucial in further improving perioperative care for diabetic patients and enhancing postoperative recovery.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"50"},"PeriodicalIF":2.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12042523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of ciprofol on respiratory-related adverse incidence in patients with obesity during painless gastroscopy: a prospective, randomized clinical trial.","authors":"Yanjing Zhang, Danru Xie, Feifei Li, Mengjiao Che, Yaoheng Yang, Geng Li, Yiwen Zhang","doi":"10.1186/s13741-025-00529-5","DOIUrl":"https://doi.org/10.1186/s13741-025-00529-5","url":null,"abstract":"<p><strong>Background: </strong>Ciprofol is an intravenous anesthetic agent which in low doses produces sedation. It was developed via structural modification of propofol. Ciprofol is claimed to reduce respiratory depression. The object of the present study was to investigate whether or not ciprofol did actually reduce respiratory depression or not in patients with obesity undergoing gastroscopy.</p><p><strong>Methods: </strong>A total of 84 patients with obesity scheduled for gastroscopy were enrolled. The participants were randomly allocated to receive sedation with ciprofol (group C) or propofol (group P). The primary outcome was the incidence of respiratory-related adverse events (AEs), whereas the secondary outcomes were the incidence of further intraoperative and postoperative AEs; procedure and anesthesia success rates; Narcotrend index (NI); induction dosage; procedure time; recovery time; discharge time; and satisfaction ratings from the patients, anesthesiologists, and endoscopists.</p><p><strong>Results: </strong>The incidence of respiratory-related AEs was significantly lower in group C than in group P (17.5% vs. 57.5%; P < 0.001). The occurrence of hypotension and movement during procedural events in group C was markedly reduced compared with that in group P (P = 0.024 and 0.007, respectively). No notable differences were observed in the occurrence of additional AEs or in the success rates of the procedure and anesthesia between the two groups (P > 0.05). The three-point satisfaction levels were comparable between the groups (P > 0.05).</p><p><strong>Conclusions: </strong>0.4 mg/kg of ciprofol provides anesthesia comparable with 2.0 mg/kg of propofol. However, it is related to reduced respiratory-related AEs and hypotension during gastroscopy in patients with obesity; thus, ciprofol is preferred to propofol for anesthesia in obese patients.</p><p><strong>Trial registration: </strong>This study was registered in the Chinese Clinical Trial Registry (KYLS20230625; first registration date: 29/06/2023).</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"49"},"PeriodicalIF":2.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12038989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of prolonged time to tracheal extubation and its associated factors among adult patients undergoing elective surgery at Jimma Medical Center, Jimma, Oromia, Ethiopia, 2024.","authors":"Gemechisa Akuma Wayesa, Mitiku Berhanu Wedajo, Wondu Reta Demissie, Admasu Belay Gizaw, Assefa Hika Gudeta, Guteta Gudina Gula","doi":"10.1186/s13741-025-00520-0","DOIUrl":"https://doi.org/10.1186/s13741-025-00520-0","url":null,"abstract":"<p><strong>Purpose: </strong>Extubation refers to removing the breathing tube from the patient's airway after surgery under general anesthesia with tracheal intubation. Extubation procedures typically take less than 15 min, and if they take more, they are prolonged. Whether or not to extubate a patient depends on several factors, including the patient's preoperative status, the type of surgery, anesthetic methods, and expected recovery after the procedure. Thus, the study's objective was to determine the incidence of prolonged extubation and its associated factors among adult patients undergoing surgery at Jimma Medical Center.</p><p><strong>Methods: </strong>A prospective observational study through a consecutive sampling technique was conducted. Ethical clearance and approval were obtained from the institutional review board of Jimma University. Data on the extubation time and possible associated factors for a prolonged extubation time were collected using a data collection checklist. After being entered into EpiData 4.6 and exported into SPSS 25, descriptive analyses and logistic regression were carried out. In multivariate variables, p ≤ 0.05 was declared as statistical significance.</p><p><strong>Result: </strong>Three-hundred eight adult patients were enrolled in the current study. Of these, the incidence of prolonged extubation was 24.7% (95% CI [20.0-29.9]). The identified associated factors were age ≥ 55 years (AOR = 5.7, 95% CI [2.62, 12.69], p ≤ 001); ASAPS > II (AOR = 4.27, 95% CI [1.59, 11.45], p = 004); BMI ≥ 30 kg/m² (AOR = 6.6, 95% CI [2.37, 18.36], p ≤ 001); the use of benzodiazepine (AOR = 3.43, 95% CI [1.42, 8.25], p = 0.006); using of isoflurane (AOR = 0.35, 95% CI [0.15, 0.78], p = 0.011); prone position (AOR = 4.68, 95% CI [1.56, 14.07], p = 0.006); extubation in afternoon (AOR = 2.69, 95% CI [1.26, 5.74]; p = 0.011); and duration of surgery ≥ 210 min (AOR = 5.2, 95% CI [2.32, 11.72], p ≤ 0.001).</p><p><strong>Conclusions: </strong>The study found that prolonged time to extubation occurred in one-fourth of the patients. The independent factors statistically associated with prolonged extubation were older ages, higher ASA class, obesity (≥ 30 kg/m²), the use of benzodiazepine, halothane for maintenance, prone position, extubation in the afternoon, and longer procedures (≥ 210 min).</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"48"},"PeriodicalIF":2.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of frailty on functional recovery after cardiac surgery-a case control study.","authors":"M Abdelmonem, M Elsayed, D Awadallah, O Don, R H Bennett, O G Mackay, S Pookayil, C Archer, M Mahgoub, M J Bennett","doi":"10.1186/s13741-025-00526-8","DOIUrl":"https://doi.org/10.1186/s13741-025-00526-8","url":null,"abstract":"<p><strong>Background: </strong>Good functional recovery after cardiac surgery can be reported as 'days alive and out of hospital' in the first 30 days after a procedure (DAOH₃₀) and 'days at home' in the first year (DAH₃₆₅), which integrate several clinically important outcomes, including death, hospital length of stay, quality of recovery and hospital readmission. They depend on the preservation or early recovery of physiological and functional capacity, both of which may be lost in patients living with frailty.</p><p><strong>Case presentation: </strong>We measured frailty with a multidimensional approach, incorporating 30 variables spanning comorbidity, sensory, cognitive, psychosocial, disability and pharmaceutical domains, which together make up the Patient Frailty Index (pFI). We further explored the impact of socioeconomic factors on functional recovery using the Welsh Index of Multiple Deprivation (WIMD). The outcome measures included duration of level 3 and level 2 care, duration of hospital stay, readmission and both short- and longer-term mortality. A total of 669 patients were included in the final analysis. A total of 224 (33.5%) of the patients were 'frail'. They were more likely to have chronic obstructive pulmonary disease, heart failure and diabetes and to be in the lowest decile for deprivation. Frailty was not associated with either sex or advanced age. Patients deemed to be 'frail' had a longer stay in intensive care, required level 3 cardiovascular and respiratory support for longer and stayed longer in the hospital. They spent fewer days at home in the first 30 days, largely due to days requiring advanced cardiovascular support, and fewer days at home in the first year, with most days lost to patients who died in the first year following their surgery. A moderation analysis examined whether the WIMD modified the effect of frailty on recovery after cardiac surgery. The interaction term, after confirming there were no collinearity concerns, was not significant, either for DAOH₃₀ or DAH₃₆₅, indicating no evidence of moderation.</p><p><strong>Conclusions: </strong>Short- and medium-term measures of good functional recovery were lower in 'frail' patients, and longer-term survival was also significantly reduced. An accumulation of deficits assessment of frailty, incorporating multiple domains, builds a more accurate picture of increasing vulnerability and can be acquired from patients' electronic health records. In a surgical population that is increasingly comorbid, these findings should inform decisions on preoperative priority setting, prehabilitation, postoperative resources and discharge planning.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"46"},"PeriodicalIF":2.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12016124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global trends in artificial intelligence research in anesthesia from 2000 to 2023: a bibliometric analysis.","authors":"Yi Ou, Xiaoyi Hu, Cong Luo, Yajun Li","doi":"10.1186/s13741-025-00531-x","DOIUrl":"https://doi.org/10.1186/s13741-025-00531-x","url":null,"abstract":"<p><strong>Background: </strong>Interest in artificial intelligence (AI) research in anesthesia is growing rapidly. However, there is a lack of bibliometric analysis to measure and analyze global scientific publications in this field. The aim of this study was to identify the hotspots and trends in AI research in anesthesia through bibliometric analysis.</p><p><strong>Methods: </strong>English articles and reviews published from 2000 to 2023 were retrieved from the Web of Science Core Collection (WoSCC) database. The extracted data were summarized and analyzed using Microsoft Excel, and bibliometric analysis were conducted with VOSviewer software.</p><p><strong>Results: </strong>AI research literature in anesthesia has exhibited rapid growth in recent years. The United States leads in the number of publications and citations, with Stanford University as the most prolific institution. Hyung-Chul Lee is the author with the highest number of publications. The journal Anesthesiology is highly recognized and authoritative in this field. Recent keywords include \"musculoskeletal pain\", \"precision medicine\", \"stratification\", \"images\", \"mean arterial pressure\", \" enhanced recovery after surgery\", \"frailty\", \"telehealth\", \"postoperative delirium\" and \"postoperative mortality\" indicating hot topics in AI research in anesthesia.</p><p><strong>Conclusions: </strong>Publications on AI research in the field of anesthesia have experienced rapid growth over the past two decades and are likely to continue increasing. Research areas such as depth of anesthesia (DOA) and drug infusion (including electroencephalography and deep learning), perioperative risk assessment and prediction (covering mean arterial pressure, frailty, postoperative delirium, and mortality), image classification and recognition (for applications such as ultrasound-guided nerve blocks, vascular access, and difficult airway assessment), and perioperative pain management (particularly musculoskeletal pain) have garnered significant attention. Additionally, topics such as precision medicine, enhanced recovery after surgery, and telehealth are emerging as new hotspots and future directions in this field.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"47"},"PeriodicalIF":2.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12016147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical value of NT-proBNP, MPO, and NLR combined with echocardiography in prediction of malignant arrhythmia in elderly patients with valvular heart disease.","authors":"Jianping Liu, Apei Zhou, Meiduan Zheng, Ling Wang, Ping Zeng","doi":"10.1186/s13741-025-00527-7","DOIUrl":"https://doi.org/10.1186/s13741-025-00527-7","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to probe the clinical value of N-terminus pro-brain natriuretic peptide (NT-proBNP), myeloperoxidase (MPO), and neutrophil lymphocyte ratio (NLR) combined with echocardiography in the prediction of malignant arrhythmias (MA) in elderly patients with valvular heart disease (VHD).</p><p><strong>Methods: </strong>MPO, NT-proBNP, and NLR were detected in blood samples. After 1 year of follow-up, receiver operating characteristic curves were analyzed to determine the clinical value of NT-proBNP, MPO, NLR, and echocardiography for predicting MA in patients with VHD.</p><p><strong>Results: </strong>MPO, NT-proBNP, and NLR were higher in the VHD group. MPO, NT-proBNP, and NLR were higher with severe cardiac dysfunction. MPO, NT-proBNP, NLR, and LVESV in the MA group were higher. NT-proBNP was an independent factor influencing the occurrence of MA in elderly patients with VHD. The AUC for predicting MA in elderly patients with VHD using NT-proBNP, MPO, NLR, and echocardiography were 0.782 (sensitivity 61.50%, specificity 94.60%, 95% CI 0.630-0.934), 0.759 (sensitivity 69.20%, specificity 81.10%, 95% CI 0.579-0.938), 0.736 (sensitivity 76.90%, specificity 64.90%, 95% CI 0.562-0.910), and 0.782 (sensitivity 76.90%, specificity 75.70%, 95% CI 0.646-0.918), respectively. The AUC for the combined prediction using NT-proBNP, MPO, NLR, and echocardiography was 0.913 (sensitivity 76.90%, specificity 94.60%, 95% CI 0.820-1.000), higher than that of each parameter alone (P < 0.05).</p><p><strong>Conclusion: </strong>The combination of NT-proBNP, MPO, NLR, and echocardiography has a predictive value in detecting MA in elderly VHD patients.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"44"},"PeriodicalIF":2.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12016093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between the preoperative N-terminal pro-B-type natriuretic peptide and acute kidney injury in gastrointestinal surgery patients managed with enhanced recovery strategy: a retrospective cohort study.","authors":"Zefei Zhang, Ziyu Zheng, Huang Nie, Hailong Dong, Chong Lei","doi":"10.1186/s13741-025-00528-6","DOIUrl":"https://doi.org/10.1186/s13741-025-00528-6","url":null,"abstract":"<p><p>Importance Previous evidence has indicated that N-terminal pro-B-type natriuretic peptide (NT-proBNP) is associated with postoperative acute kidney injury (AKI). However, the association between preoperative NT-proBNP level and postoperative AKI in surgeries managed with enhanced recovery after surgery (ERAS) strategy requires further clarification.Objective To explore the association between preoperative NT-proBNP and the incidence of postoperative AKI in patients who underwent gastrointestinal surgeries and managed with ERAS strategy.Design A retrospective cohort study.Setting A review of documented cases of elective gastrointestinal surgeries managed with ERAS strategy occurred at Xijing Hospital from 01 May 2017 to 30 June 2022.Participants A total of 629 patients aged 18 years or older who were scheduled for elective gastrointestinal surgeries and subjected to the ERAS strategy with preoperative NT-proBNP and creatinine measurements were included in the analysis.Exposure Preoperative serum concentrations of NT-proBNP.Main outcomes and measures The primary outcome was the incidence of postoperative AKI. Preoperative NT-proBNP was divided into high- or low-level groups based on the median (165 pg/ml). Logistic regression was used to explore the association between increased preoperative NT-proBNP level and risk of AKI.Results After screening 1932 case records, 629 cases were included in the final analyses. The average age was 63.5 (15.3) years old and 197 (31.3%) of them were female. Among them, 112 (17.8%) developed postoperative AKI. The incidence of AKI was 21% in the high NT-proBNP group, and 14.6% in the low NT-proBNP group. Patients with higher preoperative NT-proBNP levels (≥ 165 pg/mL) have significant higher risk of postoperative AKI as compared to those in the lower group (adjusted OR 1.75; 95% CI 1.12 to 2.73).Conclusions and relevance Increased preoperative NT-proBNP is associated with an elevated risk of postoperative AKI in patients who underwent gastrointestinal surgery and managed with ERAS strategy.Trial registry number Clinical trial registry number: NCT06145347.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"45"},"PeriodicalIF":2.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12016297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}