目的:观察依托咪酯持续输注用于麻醉诱导和维持对肾上腺皮质功能的抑制程度以及评价是否会造成严重不良后果。方法:择期行普外手术患者60例,随机分成依托咪酯组(E组)和异丙酚组(P组)。两组患者常规麻醉诱导后,E组和P组分别采用瑞芬太尼0.1～0.4 μg/kg·min,复合依托咪酯或异丙酚维持,据BIS值调整依托咪酯或异丙酚的输注速率。分别测定麻醉前,手术结束时,术后24 h,术后48 h患者血清皮质醇浓度,记录各组的血压,心率,睁眼时间,拔管时间和术后不良反应。结果:与麻醉前比较,E组和P组患者在手术结束时皮质醇浓度均降低,但E组降低更明显(Plt;0.05),48 h后恢复正常甚至高于麻醉前水平;与诱导前相比,异丙酚组患者诱导后平均动脉压(MAP)明显低于诱导前,而依托咪酯组无明显变化;E组的拔管时间比P组长(Plt;0.05),而睁眼时间无明显差异(Pgt;0.05).结论:1依托咪酯和异丙酚均能抑制患者肾上腺皮质功能,且依托咪酯组更为明显,在术后48 h基本恢复正常,甚至高于术前水平。2依托咪酯在麻醉诱导和维持中比异丙酚具有血流动力学稳定性。3依托咪酯持续输注用于全身麻醉维持并不造成围术期严重不良后果。
ObjectiveTo understand the adverse effects of perioperative red blood cells (RBC) transfusion on patients after pancreaticoduodenectomy (PD) so as to provide ideas for reducing postoperative complications and improving prognosis. MethodThe relevant literatures at home and abroad in recent years about studies of perioperative RBC transfusion on postoperative complications (focusing on pancreatic fistula and infection) and prognosis of patients with PD were reviewed. ResultsThe rates of postoperative complications and perioperative RBC transfusion after PD were still higher. The perioperative RBC transfusion might increase the rate of postoperative complications, promote early tumor recurrence, and shorten the disease-free survival and overall survival. At present, with the progress of technology, the perioperative RBC transfusion rate was decreasing. At the same time, with the accelerated development of new blood transfusion technologies such as freeze-drying and refrigeration, the decline rate was still expected to be increased. ConclusionsPerioperative RBC transfusion in PD might have adverse effects on postoperative complications and prognosis. Although further research is still needed to explore its necessary connection, this adverse effect needs to be paid enough attention in clinical practice. Early identification of risk factors, strict transfusion indications and minimizing amount or concentration of RBC transfusion might help to avoid or reduce RBC transfusion and minimize its adverse effects.
目的:观察阿霉素持续静脉输注联合国产长春瑞滨(盖诺 NVB)治疗晚期乳腺癌的疗效及毒副反应,探讨治疗方式改变在化疗中的价值。方法:32例晚期乳腺癌患者,用NA方案:NVB 25 mg/m2 ivgtt d1,8、ADM 50 mg/ m2 civ 96h d1~4。每28天为一周期,至少2周期后评价疗效。观察疗效及毒副反应。结果:32例患者均随访。总共用药170周期,平均5.3周期。CR 5例,PR 18例,RR(CR+PR)71.9% 。初治、复治有效率分别为73.3%、70.6%,二者间无显著性差异(Pgt;0.05)。中位缓解期8.2个月。主要毒副反应为白细胞降低,发生率100%(32/32),32例中Ⅲ～Ⅳ度下降15例(46.9%);恶心、呕吐23例(71.9%),Ⅲ～Ⅳ度4例(12.5%);均发生脱发,Ⅲ～Ⅳ度5例(156%);口腔炎16例(50.0%),Ⅲ～Ⅳ度4例(12.5%);静脉炎2例(6.2%),均为Ⅰ度;心脏毒性发生3例(9.4%),为Ⅰ、Ⅱ度不等。无治疗相关性死亡。结论:阿霉素持续静脉输注与盖诺联合治疗晚期转移性乳腺癌疗效明确,毒副反应可以耐受,远期疗效值得进一步研究。
Objective Historically, perioperative hemoglobin monitoring has relied on calculated saturation, using blood gas devices that measure plasma hematocrit (Hct). Co-oximetry, which measures total hemoglobin (tHb), yields a more comprehensive assessment of hemodilution. The purpose of this study was to examine the association of tHb measurement by co-oximetry and Hct, using conductivity with red blood cell (RBC) transfusion, length of stay (LOS) and inpatient costs in patients having major cardiac surgery. Methods A retrospective study was conducted on patients who underwent coronary artery bypass graft (CABG) and/or valve replacement (VR) procedures from January 2014 to June 2016, using MedAssets discharge data. The patient population was sub-divided by the measurement modality (tHb and Hct), using detailed billing records and Current Procedural Terminology coding. Cost was calculated using hospital-specific cost-to-charge ratios. Multivariable logistic regression was performed to identify significant drivers of RBC transfusion and resource utilization. Results The study population included 18 169 cardiovascular surgery patients. Hct-monitored patients accounted for 66% of the population and were more likely to have dual CABG and VR procedures (10.4% vs. 8.9%, P=0.006 9). After controlling for patient and hospital characteristics, as well as patient comorbidities, Hct-monitored patients had significantly higher RBC transfusion risk (OR=1.26, 95%CI 1.15-1.38,P<0.000 1), longer LOS (IRR=1.08, P<0.000 1) and higher costs (IRR=1.15, P<0.000 1) than tHb-monitored patients. RBC transfusions were a significant driver of LOS (IRR=1.25, P<0.000 1) and cost (IRR=1.22, P<0.000 1). Conclusion tHb monitoring during cardiovascular surgery could offer a significant reduction in RBC transfusion, length of stay and hospital cost compared to Hct monitoring.
ObjectiveTo systematically review the efficacy and safety of extended or continuous intravenous infusion (EI/CI) versus short-term intravenous infusion (STI) of imipenem/meropenem in adult patients with severe lung infection. MethodsWe electronically searched databases including PubMed, EMbase, The Cochrane Library (Issue 6, 2015) and CBM from inception to June, 2015, to collect random controlled trials (RCTs) about EI/CI versus STI of imipenem/meropenem for severe infection. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 6 RCTs involving 442 patients were included. The results of meta-analysis showed that, compared with the STI group, the EI/CI could significantly improve the microbiological success rate (RR=1.16, 95%CI 1.02 to 1.32, P=0.02) without increasing adverse drug reaction (RR=0.99, 95%CI 0.65 to 1.52, P=0.97). There were no significant differences in clinical effective rate (RR=1.12, 95%CI 0.97 to 1.28, P=0.13), survival rate (RR=1.03, 95%CI 0.92 to 1.16, P=0.62) and hospital stays (MD=-0.43, 95%CI-1.29 to 0.42, P=0.32) between the two groups. Conclusions There is no significant difference in clinical effect between EI/CI and STI for severe lung infection. While, the infections caused by gram-negative bacteria with high MIC could benefit more from EI/CI. Due to the limited quantity and quality of the included studies, the above conclusion still need to be further verified by more high quality studies.
Objective To evaluate the effect of intraoperative fluid infusion volume on postoperative pulmonary complications (PPCs) in patients after minimally invasive endoscopic esophageal carcinoma resection. Methods From June 2019 to August 2021, 486 patients undergoing elective minimally invasive endoscopic esophagectomy for esophageal cancer were retrospectively screened from the electronic medical record information management system and anesthesia surgery clinical information system of West China Hospital of Sichuan University. There were 381 males and 105 females, with a median age of 64.0 years. Taking the incidence of pulmonary complications within 7 days after operation as the primary outcome, the correlation between intraoperative fluid infusion volume and the occurrence of PPCs within 7 days was clearly analyzed by regression analysis. ResultsThe incidence of pulmonary complications within 7 days after surgery was 33.5% (163/486). Regression analysis showed that intraoperative fluid infusion volume was correlated with the occurrence of PPCs [adjusted OR=1.089, 95%CI (1.012, 1.172), P=0.023], especially pulmonary infection [adjusted OR=1.093, 95%CI (1.014, 1.178), P=0.020], and pleural effusion [adjusted OR=1.147, 95%CI (1.007, 1.306), P=0.039]. Pulmonary infection was significantly less in the low intraoperative fluid infusion group [<6.49 mL/(kg·h), n=115] compared with the high intraoperative fluid infusion group [≥6.49 mL/(kg·h), n=371] (18.3% vs. 34.5%, P=0.023). Intraoperative fluid infusion volume was positively associated with death within 30 days after surgery [adjusted OR=1.442, 95%CI (1.056, 1.968), P=0.021]. Conclusion Among patients undergoing elective minimally invasive endoscopic esophageal cancer resection, intraoperative fluid infusion volume is related with the occurrence of PPCs within 7 days after the surgery, especially pulmonary infection and pleural effusion, and may affect death within 30 days after the surgery.
目的:研究糖尿病围手术期应用胰岛素泵持续皮下输注胰岛素的临床疗效。方法:68例糖尿病围手术期患者随机分为33例采用胰岛素泵持续皮下输注胰岛素治疗(CSII组),对照组35例采用常规多次皮下注射胰岛素治疗(MSII组),分别对术前、术后的相关指标进行对比研究。结果:治疗后两组各时点血糖均较治疗前显著下降(Plt;0.01)。CSII组达到目标血糖所用的时间明显少于MSII组(2.9比7.2天)(Plt;0.05),血糖达标率优于MSII组(93.%比77.1%)(Plt;0.05),低血糖发生率低于MSII组(9.1%比34.3%)(Plt;0.01)。待手术时间(4.2比9.4天)和住院时间(16比24天)明显缩短(Plt;0.05),但两组住院总费用无差异(Pgt;0.05)。〖结论:CSII在糖尿病患者围手术期中应用疗效及安全性方面优于MSII。