术后恶心、呕吐的防治

术后恶心、呕吐(PONV)的发病机制不明确,目前没有标准的防治措施.个体因素、麻醉与手术均可影响PONV的发生,青春期后的女性、非吸烟病人、晕动症或PONV史、挥发性麻醉气体、氧化亚氮、围术期应用阿片类药物等都是明确的PONV危险因素.不同个体发生PONV的危险因素各异,发生PONV的几率也不相同,常规地给所有病人预防用药是没有必要的,而且总体效果不理想.应采用个体化的综合防治措施,以求安全、有效、经济,具体策略为:评估病人发生PONV的危险性、尽可能减少PONV的危险因素、合理的预防用药、积极治疗已发生PONV的病人.     

术后恶心呕吐相关基因多态性的研究现状

背景 术后恶心呕吐(postoperative nausea and vomiting,PONV)是临床上常见的并发症,受多种因素的影响.尽管有多种类型的止吐药物用于控制PONV的发生,但效果并不理想,且患者对药物的反应存在很大的差异性. 目的 探讨基因多态性对PONV发生的影响,为预防PONV提供预警作用. 内容 多种基因多态性与PONV的发生具有关联性,其中涉及对止吐药物疗效的影响. 趋向 目前已发现多个PONV的易感基因,期待根据基因分型进行个体化治疗以优化PONV的药物防治效果.     

静脉麻醉药与吸人麻醉药对术后恶心呕吐的影响

术后恶心呕吐（PONV）是最常见的麻醉后不良反应之一。PONV增加了术后患者的不适，且严重时会引起其他并发症，同时增加了患者的医疗费用，因此防止PONV的发生对患者十分重要。在引起PONV的众多原因中，麻醉是十分重要的因素。虽有报道称使用吸入麻醉药会显著增加PONV的发生率，但为了减少大剂量单一用药的不良反应，作者仍推荐在全身麻醉中采用静吸复合麻醉的方法。这篇文章综述了PONV的病理生理机制，并对各种静脉和吸入麻醉药物引起PONV的作用进行比较，希望能使麻醉医生对各种麻醉药物的致吐性有较全面的了解，更加合理的选择药物，有效降低患者PONV的发生。     

术后恶心呕吐研究进展

背景 术后恶心呕吐(post-operative nausea and vomiting,PONV)是手术麻醉后的一种常见并发症,发生率较高,严重影响患者术后恢复及满意度.PONV的具体发生机制仍在研究.目的 旨在总结PONV研究进展,尤其是PONV评分方面.内容 现已知与PONV相关的递质主要包括5-羟色胺、多巴胺、组胺、乙酰胆碱、P物质等.现有的PONV危险因素评分系统具有一定的预测能力,但是仍然存在其局限性. 趋向 麻醉医师应当足够重视PONV,积极进行预防性用药,以获得更好的满意度.     

中西医结合防治术后恶心呕吐进展

术后恶心呕吐(postoperative nausea and vomiting,PONV)是最为常见的麻醉并发症之一.尽管有关防治研究取得了进展,但是其平均发生率为20%～30%[1,2],具有高危因素的患者其发生率最高可达70%[3].PONV会给患者带来不安、痛苦、窘迫、疲劳、对再次外科手术恐惧等精神方面的影响,同时可发生伤口裂开、电解质紊乱和脱水、活动延迟、吸入性肺炎等并发症而导致一定的死亡率.对PONV的预防治疗主要包括药物和非药物两种方法,其中非药物方法主要依据中医穴位刺激原理.本文利用有关文献,总结目前中西医结合防治PONV进展.……     

甲强龙在围手术期的使用范围及效果

背景 术后不良反应至今仍无较好的防治策略;甲强龙是肾上腺糖皮质激素类药物,具有抗炎、免疫抑制、抗休克等作用,目前主要应用于严重感染、自身免疫性疾病及抗休克治疗;现在越来越多的麻醉医师在围手术期应用甲强龙管理术后恶心呕吐(postoperative nausea and vomiting,PONV)、疼痛、维持气道稳定和减轻炎症反应等.目的 为临床围手术期应用甲强龙预防术后副作用提供临床参考.内容 综述甲强龙对PONV、疼痛、气道稳定和炎症反应等的影响.趋向 甲强龙联合用药在临床麻醉应用中具有广阔前景.     

异丙酚与恶心呕吐

异丙酚用于麻醉诱导和维持能够降低术后恶心呕吐(PONV)的发生率。本文对异丙酚抗吐作用的临床、实验及 其机制研究的进展及如何合理应用异丙酚的抗吐作用予以综述。     

异丙酚与恶心呕吐

异丙酚用于麻醉诱导和维持能够降低术后恶心呕吐（PONV）的发生率，本文对异丙酚抗吐作用的临床，实验及其机制研究的进展及如何合理应用异丙酚的抗吐作用予以综述。     

压迫环状软骨对术后恢复期恶心呕吐发生率的影响

影响妇科手术术后恶心呕吐（PONV）发生率的因素有年龄、体重、手术类型、麻醉药物及麻醉技术,面罩加压给氧引起胃扩张也是PONV重要原因之一.     

门诊手术麻醉协会关于手术后恶心呕吐的处理指南

本指南是在门诊手术麻醉协会发起下，由国际专家组编撰而成。该专家组成员涉及与手术后恶心、呕吐（PONV）相关的多个学科，他们审慎的评估了当前关于PONV的医学文献，为PONV高风险的成年及儿童外科手术患者提供了循证医学的参考工具。指南的重点是识别成人及儿童患者中发生PONV的危险因素；推荐降低PONV基础风险的方法；甄别出对PONV进行预防性治疗最为有效的单一药物及联合用药方案；推荐对已发生的PONV的治疗方法；并为具有较高PONV风险的患者提供了处理流程。     

Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty

BackgroundAbsenteeism is costly, yet evidence suggests that presenteeism—illness-related reduced productivity at work—is costlier. We quantified employed patients’ presenteeism and absenteeism before and after total joint arthroplasty (TJA).MethodsWe measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization’s Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.ResultsIn total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).ConclusionAmong employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery.     

The German emergency and disaster medicine and management systemdhistory and present

As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach.     

Tendon and Ligament Healing and Current Approaches to Tendon and Ligament Regeneration

Ligament and tendon injuries are common problems in orthopedics. There is a need for treatments that can expedite nonoperative healing or improve the efficacy of surgical repair or reconstruction of ligaments and tendons. Successful biologically-based attempts at repair and reconstruction would require a thorough understanding of normal tendon and ligament healing. The inflammatory, proliferative, and remodeling phases, and the cells involved in tendon and ligament healing will be reviewed. Then, current research efforts focusing on biologically-based treatments of ligament and tendon injuries will be summarized, with a focus on stem cells endogenous to tendons and ligaments. Statement of clinical significance: This paper details mechanisms of ligament and tendon healing, as well as attempts to apply stem cells to ligament and tendon healing. Understanding of these topics could lead to more efficacious therapies to treat ligament and tendon injuries. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:7–12, 2020     

肝内胆管囊腺瘤和囊腺癌的CT、MRI及病理表现

目的探讨肝内胆管囊腺瘤和囊腺癌的CT、MRI和病理特点。方法回顾性分析经手术病理证实的6例肝内胆管囊腺瘤和2例肝内胆管囊腺癌的影像及临床病理资料，将病变的影像表现与其病理大体形态及组织学表现作对照分析。结果6例肝内胆管囊腺瘤，女4例、男2例；2例肝内胆管囊腺癌均为女性病人；8例病人平均年龄55岁。所有病灶均表现为多房囊性肿块，肿瘤囊腔各分房内常为多种液体成分，在CT上可表现为不同密度、在MRI上可表现为不同信号强度。囊内出现多发大小不等的壁结节在胆管囊腺癌内更常见，囊内有分隔但无壁结节只见于胆管囊腺瘤。在7例CT扫描中，4例胆管囊腺瘤和1例胆管囊腺癌可见囊壁或分隔上钙化，囊壁、囊内分隔及囊内结节均为轻、中度延迟增强。肿瘤中出现卵巢样间质见于3例胆管囊腺瘤和1例胆管囊腺癌，且均为女性病人。结论肝内胆管囊腺瘤和囊腺癌是肝脏不常见的囊性肿瘤，影像上多房、囊内有分隔且各分房囊内密度或信号不一致，高度提示肝内胆管囊腺瘤或囊腺癌的诊断，如囊内伴有多发大小不等的结节，则进一步提示囊腺癌的可能。但影像学表现不能区分肿瘤中有无卵巢样间质。