Effectiveness of lanthanum carbonate treatment used in combination with calcium carbonate in hemodialysis patients with hyperphosphatemia

Objective To evaluate the effect and safety of the combination of lanthanum carbonate and calcium carbonate in controlling the phosphate level of hemodialysis patients with hyperphosphatemia. Methods Seventy-three patients who developed hyperphosphatemia after hemodialysis were involved, and of which twelve patients complicated with hypercalcemia were put in the group without calcium. The other patients were divided into 3 groups: 21 patients in calcium carbonate group, 32 patients in lanthanum carbonate group and 20 patients in combination group. All the subjects took blood test every month. Results The level of phosphorus decreased in all the subjects participated in the trial (P＜0.01). The level of phosphatemia in combination group decreased dramatically (P＜0.01) and had little effect on calcium and parathyroid hormone. Osteoporosis and valvular calcification were the same as the begin of the trial. Conclusions The combination of lanthanum carbonate and calcium carbonate is more effective than alone. The incidences of adverse effects such as gastrointestinal, hypercalcemia, nausea, vomiting and constipation are low.     

Association between nutrition and peripheral artery disease in continuous ambulatory peritoneal dialysis patients

Objective To investigate the association between nutrition and peripheral artery disease (PAD) in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods One hundred and two stable CAPD patients from a single center were enrolled in this cross-sectional study. Automatic ankle-brachial index (ABI) measuring system was applied to examine ABI. Patients were divided into PAD group (ABI＜0.9) and non-PAD group (ABI≥0.9). Clinical data were collected. Biochemical parameters were detected. Nutritional status was evaluated by serum albumin, handgrip strength (HGS) and subjective global assessment (SGA). Logistic regression analysis was performed to estimate the association of PAD with each nutritional marker as well as other potential risk factors. Results The incidence of PAD was 23.53% (24/102). ABI was significantly lower in patients with malnutrition as compared to those without malnutrition [(0.72±0.21) vs (1.04±0.14), P＜0.01]. Compared with non-PAD patients, serum albumin (P＜0.01), HGS (P＜0.01), diastolic blood pressure (P＜0.05), serum creatine (P＜0.05)、blood urine nitrogen (P＜0.01) were significantly decreased, but age (P＜0.01), the incidence of malnutrition [SGA, P＜0.01], diabetic status (P＜0.01), cardiovascular disease history (P＜0.01) were significantly increased in PAD patients. Logistic regression analysis showed that serum albumin (OR=0.762, 95％CI：0.611-0.948, P=0.015), HGS (OR=0.988, 95％CI：0.979-0.997, P=0.013) were independent protective factors for PAD, malnutrition [(SGA), OR=21.101, 95％CI：5.008-88.901, P＜0.01] was independent risk factor for PAD in CAPD patients. Conclusions The PAD incidence of CAPD patients in our center is 23.53%. Nutrition is independent factor associated with PAD in CAPD patients.     

Supplemental oxygen for the prevention of postoperative nausea and vomiting: a meta-analysis of randomized clinical trials

OBJECTIVE: Despite the development of antiemetic drugs, the incidence of postoperative nausea and vomiting remains between 20% and 30%. This meta-analysis examines the hypothesis that perioperative administration of supplemental oxygen reduces the incidence of these complications. METHODS: We performed a systematic search of the literature through MEDLINE, EMBASE, the Cochrane Library, reference lists, and a manual search, with no language restrictions, up to September 2007 to identify randomized clinical trials evaluating the effect o f supplemental oxygen on postoperative nausea and vomiting. The data were extracted and analyzed using the RevMan program, version 4.2.9 (Cochrane Collaboration, Oxford, UK). RESULTS: The study included 9 randomized clinical trials with a total of 1661 enrolled patients (824 assigned to the group with a higher oxygen concentration and 837 assigned to the group with a lower oxygen concentration). Perioperative supplemental oxygen has no effect on the incidence of nausea (relative risk [RR], 0.94; 95% confidence interval [CI], 0.82 to 1.08), postoperative nausea and/or vomiting (RR, 0.93; 95% CI, 0.74 to 1.17), or the need for rescue antiemetic drugs (RR, 0.90; 95% CI, 0.70 to 1.15). The incidence of vomiting, however, is reduced (RR, 0.77; 95% CI, 0.62 to 0.97). Significant differences were not found in the incidence of atelectasis (RR, 1.23; 95% CI, 0.50 to 3.00) or postoperative PaCO2 (weighted mean difference, -4.0; 95% CI, -12.3 to 4.3). CONCLUSIONS: Supplemental oxygen reduces the incidence of postoperative vomiting. Administration of supplemental oxygen could be an effective method of reducing postoperative vomiting but does not replace current indications for pharmacologic prophylaxis.     

Perspectives on transdermal scopolamine for the treatment of postoperative nausea and vomiting

Transdermal scopolamine, a patch system that delivers 1.5 mg of scopolamine gradually over 72 hours following an initial bolus, was approved in the United States in 2001 for the prevention of postoperative nausea and vomiting (PONV) in adults. Scopolamine (hyoscine) is a selective competitive anatagonist of muscarinic cholinergic receptors. Low serum concentrations of scopolamine produce an antiemetic effect. Transdermal scopolamine is effective in preventing PONV versus placebo [relative risk (RR)=0.77, 95% confidence interval (CI), 0.61-0.98, P = 0.03] and a significantly reduced risk for postoperative nausea (RR=0.59, 95% CI, 0.48-0.73, P < 0.001), postoperative vomiting (RR=0.68, 95% CI, 0.61-0.76, P < 0.001), and PONV (RR 0.73, 95% CI, 0.60-0.88, P = 001) in the first 24 hours after the start of anesthesia.     

腹横肌平面阻滞用于剖宫产术后镇痛的效果评价:Meta分析

目的 采用Meta分析的方法评价腹横肌平面阻滞(transversus abdominis plane block,TAPB)在剖宫产术后镇痛的安全性及有效性. 方法 检索PubMed 、OVID、EMBASE、Cochrane图书馆,检索时间从建库至2015年3月.收集剖宫产术后镇痛使用TAPB的随机对照临床试验.采用Cochrane协作网系统评价法评价纳入文献的质量,采用RevMan5.2软件进行Meta分析. 结果 共纳入12项研究,包括663例患者,其中TAPB组342例,对照组321例.与对照组比较,TAPB组患者术后12h活动时VAS评分明显降低[加权均数差(weighted mean difference,WMD)=-0.61,95％置信区间(confidence interval,CI):-1.13～-0.09,P＜0.05]、术后24 h吗啡累积消耗量减少(WMD=-22.78,95％CI:-24.49～-21.07,P＜0.05)以及TAPB组患者需首次给予补救镇痛的时间延长(WMD=148.22,95％CI:86.57～209.86,P＜0.05),并且TAPB组患者恶心呕吐[比值比(OR)=0.23,95％CI:0.12～0.44,P＜0.05]及过度镇静(OR=0.29,95％CI:0.12～0.67,P＜0.05)的发生率较低. 结论 TAPB可能是剖宫产患者术后镇痛的一种较好的选择.     

The efficacy of 5-HT3 receptor antagonists for the prevention of postoperative nausea and vomiting after craniotomy: a meta-analysis

The purpose of this meta-analysis was to assess the efficacy of prophylactic administration of 5-HT3 receptor antagonists for postoperative nausea and vomiting in neurosurgical patients at 24 and 48+ hours. After a systematic search, 7 published randomized placebo controlled trials involving 448 craniotomy patients (222 treatment, 226 control) were included in the meta-analysis. Study drugs included ondansetron, granisetron, and tropisetron. The cumulative incidence of emesis was significantly reduced in the treatment group at 24 hours [relative risk (RR)=0.50, 95% confidence interval (CI): 0.38-0.66] and 48+ hours (RR=0.52, 95% CI: 0.36-0.75). There were no differences between the treatment and control groups in the cumulative incidence of nausea at 24 hours (RR=0.76, 95% CI: 0.54-1.06) and 48+ hours (RR=0.81, 95% CI: 0.62-1.06). The cumulative incidence of both nausea and vomiting continued to increase after 24 hours in both groups. Despite the ability of 5-HT3 receptor antagonists to reduce emetic episodes, future investigations should seek to address the control of postoperative nausea and to reduce further postoperative emesis in this population.     

胃切除术后留置胃肠减压必要性的Meta分析

目的 评价胃切除术后留置胃肠减压的必要性.方法 以Medline、Embase、the Cochrane Library数据库作为已发表国外文献的主要来源,以万方数据知识服务平台和中国知网数据出版平台作为已发表国内文献的主要来源;检索时间:2011年4月20日.收集1990-2011年公开发表的有关胃切除术后放置胃肠减压必要性的中文和英文文献.结果 筛选出符合纳入标准的前瞻性随机对照试验8项(975例).减压组和非减压组在术后排气时间相比差异无统计学意义(WMD=0.31,95%CI:-0.07～0.69,P＞0.05),而在进食时间和住院时间相比差异有统计学意义(WMD=0.61,95%CI:0.17～1.05,P＜0.05;WMD=1.20,95%CI:0.05～2.36,P＜0.05),非减压组的进食时间、住院时间短于减压组;减压组和非减压组发热的发生率之间相比差异有统计学意义(OR=1.76,95%CI:1.11～2.78,P＜0.05),减压组的发热发生率高于非减压组;其他并发症包括恶心、呕吐、肺部感染、吻合口瘘或十二指肠残端瘘、腹腔脓肿、切口裂开的发生率之间相比差异均无统计学意义(OR=1.43,95%CI:0.61～3.31,P＞0.05;OR=1.43,95%CI:0.82～2.49,P＞0.05;OR=1.17,95%CI:0.54～2.49,P＞0.05;OR=1.08,95%CI:0.50～2.34,P＞0.05;OR=1.47,95%CI:0.43～4.95,P＞0.05).结论 胃切除术后常规留置胃肠减压并不能加快胃肠功能的恢复,不能减少手术后并发症的发生,甚至增加术后发热的发生率,延长住院周期.     

股神经阻滞用于全膝关节置换术患者术后镇痛的Meta分析

目的 采用Meta分析的方法评价股神经阻滞(femoral nerve block,FNB)对全膝关节置换术(total knee arthroplasty,TKA)患者术后镇痛的效果. 方法 检索PubMed、OVID、EMBASE、Cochrane图书馆,检索时间从建库至2014年11月.收集在TKA术后使用FNB与患者自控静脉镇痛(patient-controlled intravenous analgesia,PCIA)或患者自控硬膜外镇痛(patient-controlled epidural analgesia,PCEA)的临床随机对照实验(randomized controlled trial,RCT).采用Cochrane协作网系统评价法评价纳入文献的质量,采用RevMan5.2软件进行Meta分析评价. 结果 共纳入14项研究,包括1 157例患者,其中FNB组616例,PCIA组380例,PCEA组161例.与PCIA组比较,FNB有效减少了患者术后24 h[加权均数差(weighted mean difference,WMD)=-17.93,95％置信区间(confidence interval,CI)=-27.38～-8.49]及48 h(WMD=-25.70,95％CI:-41.67～-9.74)的吗啡累计消耗量,降低患者术后24 h活动时VAS(WMD=-1.99,95％CI:-3.14～-0.85)(P＜0.05);且FNB组患者术后恶心呕吐比值比(odds ratio,OR)(0.31,95％CI:0.22～0.44)、尿潴留(OR=0.24,95％CI:0.13～0.43,P＜0.05)及头晕的发生率(OR=0.27,95％CI:0.14～0.52)都较低(P＜0.05). 结论 比较PCIA及PCEA,FNB可能是TKA患者术后镇痛的一种更好的选择.     

Methylprednisolone reduces pain, emesis, and fatigue after breast augmentation surgery: a single-dose, randomized, parallel-group study with methylprednisolone 125 mg, parecoxib 40 mg, and placebo

We compared methylprednisolone 125 mg IV (n = 68) and parecoxib 40 mg IV (n = 68) with placebo (n = 68) given before breast augmentation surgery in a randomized, double-blind parallel group study. Surgery was performed under local anesthesia combined with propofol/fentanyl sedation. Methylprednisolone and parecoxib decreased pain at rest and dynamic pain intensity from 1 to 6 h after surgery compared with placebo (mean summed pain intensity(1-6 h): methylprednisolone [17.25; 95% confidence interval [CI], 14.85-19.65] versus placebo [21.7; 95% CI, 19.3-24.1]; P < 0.03; parecoxib [15.25; 95% CI, 13.25-17.25] versus placebo; P < 0.001; mean summed dynamic pain intensity(1-6 h): methylprednisolone [22.7; 95% CI, 20.1-23.3] versus placebo [28.4; 95% CI, 26.0-30.8]; P < 0.01; parecoxib [20.9; 95% CI, 18.6-23.2] versus placebo; P < 0.001). Both rescue drug consumption and actual pain (all observations before and after rescue) during the first 6 h were similar in the two active drug groups and significantly reduced compared with placebo. Using a composite score of actual pain intensity and rescue analgesic use, the active drugs were significantly superior to placebo (P < 0.001 for both active drugs). Postoperative nausea and vomiting was reduced after methylprednisolone administration (incidence, 30%), but not after parecoxib (incidence, 37%), during the first 24 h compared with placebo (incidence, 60%; P < 0.001). Fatigue was reduced by methylprednisolone (incidence, 44%), but not by parecoxib (incidence, 59%), compared with placebo (incidence, 66%; P < 0.05). In conclusion, methylprednisolone 125 mg IV given before breast augmentation surgery had analgesic and rescue analgesic-sparing effects comparable with those of parecoxib 40 mg IV. Methylprednisolone, but not parecoxib, reduced nausea, vomiting, and fatigue.     

碳酸镧与传统磷结合剂治疗维持性血液透析患者高磷血症的Meta分析

目的 评价碳酸镧与传统磷结合剂治疗维持性血液透析患者高磷血症的疗效和安全性.方法 计算机检索MEDLINE(1996-2012.12)、EBCO (1996-2012.12)、Cochrane图书馆临床对照试验资料库和中文万方数据库(1996-2012.12).手工检索已发表或未发表的相关文献,包括会议摘要等.检索无语种限制.纳入碳酸镧与传统磷结合剂比较治疗维持性血液透析患者高磷血症的随机对照试验.由两名评价员独立评价纳入研究的质量和提取资料,并用RevMan 5.0软件进行Meta分析.结果 共纳入10项研究.Meta分析结果显示,碳酸镧与传统磷结合剂相比,降低血磷水平的疗效差异无统计学意义[WMD=-0.06,95％ CI(-0.27～0.15),P=0.57],但碳酸镧治疗组血钙水平低于含钙磷结合剂,两组间因不良反应退出情况差异无统计学意义,碳酸镧治疗组高钙血症发生率低于传统磷结合剂.结论 碳酸镧治疗对终末期肾脏疾病维持性血液透析患者高磷血症有效,且其高钙血症发生率低于传统磷结合剂.     

Efficacy and safety of lanthanum carbonate for reduction of serum phosphorus in patients with chronic renal failure receiving hemodialysis

BACKGROUND: Lanthanum carbonate is a highly effective phosphate binder with significant potential as a treatment for hyperphosphatemia in patients with end-stage renal disease (ESRD). Here, the results of a placebo-controlled, dose-ranging study are presented. METHODS: 196 patients (> or = 18 years) receiving hemodialysis for at least 6 months entered a 1- to 3-week, single-blind, placebo run-in phase. Of these, 145 patients were randomized to a double-blind phase in which they received placebo or lanthanum carbonate in daily lanthanum doses of 225, 675, 1,350 or 2,250 mg for 6 weeks. Serum levels of phosphorus, calcium and parathyroid hormone, and adverse events were monitored throughout the study. RESULTS: The intent-to-treat analysis (n = 144) showed significant dose-related reductions in serum phosphorus at lanthanum doses of 675, 1,350 and 2,250 mg. After 6 weeks of treatment, phosphorus levels were significantly lower in the lanthanum groups receiving 1,350 mg/day and 2,250 mg/day, compared with the placebo group (respective changes from randomization: -0.95 +/- 1.39 mg/dl (-0.31 +/- 0.45 mmol/l), -1.13 +/- 2.01 mg/dl (-0.36 +/- 0.65 mmol/l), 0.75 +/- 1.47 mg/dl (0.24 +/- 0.47 mmol/l), p < 0.001). Significant reductions in serum phosphorus, compared with placebo, occurred in the lanthanum 1,350 mg/day group from the second week of treatment and in the 2,250 mg/day group from the first week of treatment. Adverse events were mainly gastrointestinal (e.g. nausea and vomiting). Treatment-related adverse events occurred in 39% of patients treated with lanthanum carbonate and 44% of the placebo group. CONCLUSION: Lanthanum carbonate is an effective and well-tolerated agent for the short-term treatment of hyperphosphatemia in patients with ESRD.     

老年人腹股沟疝腹腔镜与开腹手术的疗效及安全性评价:Meta分析

目的分析腹腔镜与开腹手术对于治疗老年人腹股沟疝的疗效与安全性。方法检索万方、中国知网、PubMed、EMBASE、Cochrane Library等电子数据库,并人工检索相关电子期刊,针对筛选出的临床随机对照试验,运用Meta分析的方法综合比较相关指标并做综合评价。结果最终纳入8篇文献,共计818例老年病人。腹腔镜组与开腹组相比,在手术时间上差异无统计学意义(SMD=0.00,95%CI:-1.41~1.41,P=0.99);但住院时间更短(SMD=-1.64,95%CI:-2.06~-1.22,P0.01);并发症数量也较少(RR=0.31,95%CI:0.19~0.50,P0.01);治疗有效率更高(OR=3.17,95%CI:1.06~9.49,P=0.04)。结论腹腔镜治疗老年人腹股沟疝具有明显优势,应成为主要术式。     

围术期经皮穴位电刺激对术后胃肠功能影响的Meta分析

目的：系统评价经皮穴位电刺激（TEAS）促进术后胃肠功能恢复的效果。
方法：计算机检索中国知网、万方、维普、Embase、PubMed等数据库,纳入有关TEAS对术后胃肠功能影响的随机对照试验（RCT）,采用Cochrane系统评价手册5.1推荐的RCT质量评价工具进行方法学质量评价。采用RevMan 5.3、Stata 15进行Meta分析。
结果：共纳入34篇RCTs,患者3 593例,TEAS组1 781例,非TEAS组1 812例。与非TEAS组比较,TEAS组术后24 h内恶心发生率（RR=0.46,95%CI 0.36～0.59,P<0.001）、术后24 h内呕吐发生率（RR=0.47,95%CI 0.37～0.59,P<0.001）明显降低,术后肠鸣音恢复时间（MD=-6.42 h,95%CI -8.53～-4.32 h,P<0.001）、术后首次肛门排气时间（MD=-8.72 h,95%CI-10.64～-6.80 h,P<0.001）、术后首次排便时间（MD=-11.83 h,95%CI -14.67～-8.98 h,P<0.001）明显缩短。
结论：TEAS可促进术后胃肠功能恢复,明显降低术后24 h内恶心、呕吐发生率,缩短术后首次肛门排气、排便时间。     

The use of nonpharmacologic techniques to prevent postoperative nausea and vomiting: a meta-analysis.

We assessed the efficacy of nonpharmacologic techniques to prevent postoperative nausea and vomiting (PONV) by systematic review. These studies included acupuncture, electroacupuncture, transcutaneous electrical nerve stimulation, acupoint stimulation, and acupressure. Of the 24 randomized trials retrieved by a search of articles indexed on the MEDLINE and EMBASE databases (1980-1997), 19 were eligible for meta-analysis. The primary outcomes were the incidence of nausea, vomiting, or both 0-6 h (early efficacy) or 0-48 h (late efficacy) after surgery. The pooled relative risk (RR) and numbers needed to treat (NNT) were calculated. In children, no benefit was found. Some results in adults were significant. Nonpharmacologic techniques were similar to antiemetics in preventing early vomiting (RR = 0.89 [95% confidence interval 0.47-1.67]; NNT = 63 [10-infinity]) and late vomiting (RR = 0.80 [0.35-1.81]; NNT = 25 [5-infinity]) in adults. Nonpharmacologic techniques were better than placebo at preventing early nausea (RR = 0.34 [0.20-0.58]; NNT = 4 [3-6]) and early vomiting in adults (RR = 0.47 [0.34-0.64]; NNT = 5 [4-8]). Nonpharmacologic techniques were similar to placebo in preventing late vomiting in adults (RR = 0.81 [0.46-1.42]; NNT = 14 [6-infinity]). Using nonpharmacologic techniques, 20%-25% of adults will not have early PONV compared with placebo. It may be an alternative to receiving no treatment or first-line antiemetics. IMPLICATIONS: This systematic review showed that nonpharmacologic techniques were equivalent to commonly used antiemetic drugs in preventing vomiting after surgery. Nonpharmacologic techniques were more effective than placebo in preventing nausea and vomiting within 6 h of surgery in adults, but there was no benefit in children.     

Lanthanum carbonate (Fosrenol) efficacy and tolerability in the treatment of hyperphosphatemic patients with end-stage renal disease

AIMS: High serum phosphorus levels are a common problem in patients receiving long-term dialysis treatment. Lanthanum carbonate (Fosrenol) is a new non-aluminum, non-calcium phosphate binder developed for the treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD). We report data from a recent trial, which, for the first time, assessed the efficacy and tolerability of lanthanum carbonate treatment, compared with placebo, in Chinese patients with ESRD. PATIENTS AND METHODS: Following a one- to three-week washout phase and a four-week, open-label lanthanum carbonate dose-titration phase, male and female hemodialysis patients were randomized (1:1) to receive either lanthanum carbonate or placebo for four weeks. The primary efficacy parameter of the study was the control of serum phosphorus levels (< or =1.8 mmol/l [< or = 5.6 mg/dl]). Secondary endpoints included the profile of serum phosphorus during titration and parathyroid hormone, calcium, and calcium x phosphorus (Ca x P) product levels. The safety and tolerability of lanthanum carbonate were assessed by monitoring adverse events throughout the study. RESULTS: Mean serum phosphorus level at the end of washout was 2.5 +/- 0.5 mmol/l (7.7 +/- 1.5 mg/dl; n=73), and there was no evidence of a difference in levels between the treatment groups pre-randomization. At the end of the study, lanthanum carbonate-treated patients had significantly lower phosphorus levels (1.6 +/- 0.5 mmol/l [5.1 +/- 1.5 mg/dl]; n=30) than those receiving placebo (2.3 +/- 0.4 mmol/l [7.2 +/- 1.3 mg/dl]; n=31; p < 0.001). In addition, a significantly higher proportion of patients receiving lanthanum carbonate had controlled serum phosphorus levels (60%) compared with the placebo group (10%; p < 0.001). Ca x P product levels were also significantly lower in the lanthanum carbonate group at the end of randomized treatment (p < 0.001). Lanthanum carbonate was well tolerated; only one serious adverse event was reported, which was unrelated to treatment. CONCLUSIONS: Lanthanum carbonate was shown to be an effective and well-tolerated phosphate binder for the treatment of hyperphosphatemia in Chinese patients with ESRD. This finding supports the results of previous US and European studies, which have also shown that lanthanum carbonate treatment effectively controls serum phosphorus levels.     

5-羟色胺受体拮抗剂用于剖宫产患者鞘注吗啡后瘙痒和恶心呕吐的预防与治疗：系统回顾和荟萃分析

背景5-羟色胺受体拮抗剂用于剖宫产患者鞘内吗啡镇痛后瘙痒和恶心呕吐的预防和治疗,本文对其总体疗效进行了系统回顾。方法本文对一系列有关剖宫产患者应用任何一种5-羟色胺受体拈抗剂或安慰剂以预防和治疗瘙痒、恶心、呕吐的随机对照研究进行了回顾分析。所涉及的文章均真实有效,资料均由作者独立收集并以95％可信区间的相对危险度（relativerisks,RR）概括。结果本综述包括9项随机对照研究,涉及1152例患者,其中539例接受5-羟色胺受体拮抗剂治疗,413例接受安慰剂治疗,另外200例患者因接受其他止吐药治疗而未参与分析。与安慰剂组相比,5-羟色胺受体拮抗剂组瘙痒发生率并未降低[80．7％VS85．8％,RR（95％CI）=0．94（0．81—1．09）],然而5-羟色胺受体拮抗剂的应用降低了剧烈瘙痒发生率和瘙痒的治疗需求[需治疗数（number-needed-to—treat,NNT）分别为12和15]。5-羟色胺受体拮抗剂对于已出现的瘙痒疗效强于安慰剂,NNT差别为3。5-羟色胺受体拈抗剂组与安慰剂组相比,术后恶心[22．0％VS33．6％,RR（95％CI）=0．75（0．58。0．96）]和呕吐[7．7％VS16．8％,RR（95％CI）=0．49（0．30—0．81）]的发生率显著降低,术后需应用5．羟色胺受体拮抗剂进行补救性止吐治疗的发生率也明显降低[9％VS23％,RR（95％CI）=0．38（0．21—0．68）]。结论剖宫产的产妇鞘内给予吗啡镇痛,尽管预防性应用5一羟色胺受体拈抗剂不能降低瘙痒的发生率,但是却明显降低了剧烈瘙痒和需要治疗的瘙痒、术后恶心和呕吐的发生率以及术后补救性止吐治疗的需要。对于已发生的瘙痒治疗也同样有效。虽然需更多的研究加以证实,但目前的研究资料表明,在这类患者群体中常规预防性使用此类药物是值得推崇的。     

The relative renal safety of iso -osmolar contrast media compared with low -osmolar contrast media in intravenous contrast-enhanced CT: a Meta-analysis

Objective To compare the nephrotoxicity of the iso ? osmolar contrast media (iodixanol) to low?osmolar contrast media (LOCM) in intravenous contrast?enhanced CT. Methods Randomized controlled trials (RCTs) of iodixanol or low?osmolar contrast media in intravenous contrast?enhanced CT were searched in the database of VIP, CBM, CNKI, Wanfang, PubMed, EMBASE, Web of Science, Cochrane Library from their start year to July 2012. Screening and information extracted were did by two researchers independently. The quality of the included documents was evaluated by the criterion of Cochrane handbook. Revman software (version 5.0) of the Cochrane collaboration was used in data analysis. Results There was no significant difference in the incidence of contrast?induced nephropathy (CIN) among 6 trials recruited 907 patients between the iodixanol group and the LOCM group [RR=0.64, 95%CI (0.31 ? 1.32), P=0.22] by using serum creatinine increased by more than 44 μmol/L (0.5 mg/dl) as the diagnostic criteria. No considerable difference was existed by using serum creatinine increased by more than 25% as the diagnostic criteria between the two groups [RR=0.79, 95%CI (0.48?1.30), P=0.35]. Subgroup analysis showed there was no obvious difference [RR=0.57, 95%CI (0.30 ? 1.10), P=0.09] between the two groups in patients with increased baseline of serum creatinine. No obvious difference were gained in normal baseline group [RR=1.28, 95%CI (0.57?2.86), P=0.55] . Conclusion Compared with low?osmolar contrast media, iodixanol is not associated with less CIN in intravenous contrast?enhanced CT.     

直肠癌腹腔镜与开腹手术肿瘤清除及远期疗效的随机对照试验荟萃分析

目的探讨腹腔镜手术治疗直肠癌的肿瘤清除情况及长期疗效。方法利用电子数据库和手工检索等方法检索Pubmed,Embase。WebofScience及CochraneLibrary截止至2010年6月30日的所有随机对照试验（RCT）文献。评价指标为淋巴结获取数、肿瘤长期疗效（局部复发、切口复发、总体复发、总体生存率及无病生存率）。采用固定效应模型和随机效应模型对直肠癌腹腔镜手术与开腹手术的肿瘤清除情况及长期疗效指标进行荟萃分析。结果符合入选标准的RCT文献有6项共计1033例患者．腹腔镜手术组与开腹手术组分别为577例和456例。两组的淋巴结获取数差异无统计学意义（WMD=-0．38,95％CI：-1．35～0．58,P=0．43）。腹腔镜组环周切缘阳性率（7．94％）高于开腹手术组（5．37％）,但差异无统计学意义[风险比（RR）=1．13,95％CI：0．69-1．85,P=0．63]。局部复发率比较。差异无统计学意义（RR=O．55,95％CI：0．22-1．40,P=0．21）。两组3年总体生存率比较[危险比（HR）=O．76,95％CI：0．54-1．07,P=0．11]。差异无统计学意义;两组3年无病生存率比较（HR=1．16,95％CI：0．61-2．20,P=0．64）,差异亦无统计学意义。结论直肠癌腹腔镜手术在肿瘤清除及长期疗效方面至少与开腹手术相当。     

Metoclopramide for nausea and vomiting prophylaxis during and after Caesarean delivery: a systematic review and meta-analysis

Nausea and vomiting occur commonly during and after Caesarean delivery (CD) performed under neuraxial anaesthesia. Metoclopramide is a prokinetic agent reported to be safe in parturients. This meta-analysis assesses the efficacy of metoclopramide for prophylaxis against intra- and postoperative nausea and vomiting (IONV and PONV) in parturients undergoing CD under neuraxial anaesthesia. We performed a literature search of MEDLINE (1966-2011), Cochrane Central Register of Controlled Trials, EMBASE (1947-2011), Google scholar, and CINAHL for randomized controlled trials which compared metoclopramide with placebo in women having CD under neuraxial anaesthesia. Eleven studies with 702 patients were included in the analysis. Administration of metoclopramide (10 mg) resulted in a significant reduction in the incidence of ION and IOV when given before block placement [relative risk (RR) (95% confidence interval, 95% CI)=0.27 (0.16, 0.45) and 0.14 (0.03, 0.56), respectively] or after delivery [RR (95% CI)=0.38 (0.20, 0.75) and 0.34 (0.18, 0.66), respectively]. The incidence of early (0-3 or 0-4 h) PON and POV [RR (95% CI)=0.47 (0.26, 0.87) and 0.45 (0.21, 0.93), respectively] and overall (0-24 or 3-24 h) PON (RR 0.69; 95% CI 0.52, 0.92) were also reduced with metoclopramide. Extra-pyramidal side-effects were not reported in any patient. In conclusion, this review suggests that metoclopramide is effective and safe for IONV and PONV prophylaxis in this patient population. Given the quality of the studies and the infrequent use of neuraxial opioids, these results should be interpreted with caution in current practice and further studies are needed to confirm those findings.     

Efficacy and safety of calcium acetate on hyperphosphatemia in patients undergoing hemodialysis

Objective To evaluate the efficacy and safety of calcium acetate in treating hemodialysis(HD) patients with hyperphosphatemia. Methods A randomized, controlled multicenter study was performed. Phosphate binders were discontinued during a two-week washout period． A total of 171 hemodialysis patients from 10 sites with serum phosphorus during 1.94-2.75 mmol/L after two-week washout period were randomized to calcium acetate or calcium carbonate for 8 - week treatment period. Patients with serum phosphorus between 1.94-2.26 mmol/L were given elemental calcium 1000 mg/d and between 2.27- 2.75 mmol/L were given elemental calcium 1500 mg/d. The dose was constant during the 8 - week treatment period. Results All of 171 patients entered the safety analysis set, including 123 cases who completed the study into effect analysis set. In terms of efficacy: compared with the baseline, serum phosphorus, calcium - phosphorus products, parathyroid hormone (iPTH) levels were significantly decreased (all P＜0.05) and serum calcium levels increased slightly in both groups; compared with the calcium carbonate group, calcium acetate group had a significant advantage in the change of serum phosphorus content [(1.73 ± 1.85) vs (0.99 ± 1.60) mmol/L, P＜0.05] and drug response ratio (compared with the baseline serum phosphorus level fell more than 25%) (51.6% vs 32.8%, P＜0.05). In safety aspects, calcium acetate group and the control group had no significant differences in the incidence of adverse events (19.8% vs 18.8%) and adverse reactions (8.1% vs 4.7%), all P＞0.05. The main adverse reactions of calcium acetate were mild to moderate gastrointestinal reactions, including nausea, vomiting. Conclusions In hemodialysis patients with hyperphosphatemia, calcium acetate can decrease serum phosphorus and reduce the levels of calcium - phosphorus product and iPTH. In the phosphate binding capacity, calcium acetate is superior to calcium carbonate. Mild to moderate gastrointestinal reactions are most common after administration.