琥珀酰胆碱与罗库溴铵用于麻醉诱导对甲状腺手术患者术中喉返神经监测的影响[论著]

目的　比较常规剂量琥珀酰胆碱与小剂量罗库溴铵用于麻醉诱导对甲状腺手术患者术中喉返神经监测的影响。方法　选取2019年4月至2019年7月本院120例同一外科医师团队甲状腺手术喉返神经监测患者，随机分为A组：麻醉诱导肌松药物为琥珀胆碱1.5 mg/kg；B组：麻醉诱导肌松药物为罗库溴铵0.3 mg/kg。麻醉医师待肌松监测显示到最大抑制后，通过气管插管条件评分评估两组患者气管插管条件。记录各组插管时间、等待时间；迷走神经和喉返神经电信号基础值；以及术中血压波动、术后咽痛、声音嘶哑、低氧血症、苏醒延迟等并发症。外科医师通过神经肌电监测仪进行喉返神经刺激评估两组患者喉返神经监测情况。结果　A组患者气管插管条件优于B组，A组插管时间、肌松监测时间小于B组，两组手术监测时间差异无统计学意义。A组首次神经监测信号值大于B组，A组首次监测例数多于B组，两组患者术中无体动，血压下降差异无统计学意义。麻醉术后并发症，A组咽痛少于B组，A组有少量患者发生肌痛，差异无统计学意义。结论　1.5 mg/kg琥珀酰胆碱用于甲状腺手术患者的麻醉诱导，可以提供较好的插管条件，不影响外科医师术中行喉返神经监测，同时减少患者术后咽痛的发生。     

Evaluation of polyethylene glycol precipitation as screening test for macroprolactinemia using Architect immunoanalyser

We performed the polyethylene glycol (PEG) precipitation test to determine the prevalence of macroprolactinemia in 172 hyperprolactinemic subjects with prolactin (PRL) levels > 700 mIU/l. PRL was measured by Architect i2000 (Abbott Diagnostics) both in serum and in supernatant obtained after PEG. We used the PRL recovery percentage (R%) as interpretative criterion of PEG test and we estimated a prevalence of macroprolactinemia of 21.5% (R% ≤ 40%), whereas 74.4% of subjects showed a true hyperprolactinemia (R% ≥ 60%). In true hyperprolactinemic subjects PRL levels obtained before and after PEG showed a good correlation (Pearson coefficient, R = 0.995); in macroprolactinemic individuals no correlation was found. The PEG test was also performed in 50 normoprolactinemic subjects and a new PRL reference interval was obtained: 64–453 mIU/l. In this case the macroprolactinemic subjects (hyperprolactinemic presenting a normal PRL value after PEG) were 20.3% whereas 79.7% showed still elevated PRL levels. In 35 females we were also able to evaluate the symptoms and the pituitary imaging findings: no significant differences between macroprolactinemic (N = 11) and true hyperprolactinemic (N = 24) subjects were found. In conclusion, the PEG test appears to be simple, reproducible and absolutely necessary for diagnostics of hyperprolactinemia.     

Nutritional assessment and risk factors associated to malnutrition in patients with esophageal cancer

Introduction: Esophageal cancer is the fourth most common cause of cancer death in China. Patients with esophageal cancer are more likely to suffer from malnutrition. The purpose of this study is to assess nutritional status of patients with esophageal cancer from multiple perspectives and analyze the risk factors. Methods: A total of 1482 esophageal cancer patients were enrolled in the study. We investigated the Scored Patient Generated Subjective Global Assessment (PG-SGA) scores, NRS-2002 scores, Karnofsky performance status scores, anthropometric, and laboratory indicators of patients. Unconditional logistic regression analysis was applied to identify the risk factors of nutritional status. Results: PG-SGA (≥4) and NRS-2002 (≥3) showed the incidence of malnutrition were 76% and 50%, respectively. In the patients with PG-SGA score ≥4, the proportion of patients who did not receive any nutritional support was 60%. The incidence of malnutrition in females was significantly higher than that in males. Besides, abnormality rates of Red blood cell (P < 0.001), MAC (P = 0.037), and MAMC (P < 0.001) in males was significantly higher than that in females, while abnormality rates of TSF (P < 0.001) was lower than that in females. After adjusted with the other potential risk factors listed, unconditional logistic regression analysis indicated smoking (odds ratio: 2.868, 95% confidence interval: 1.660-4.954), drinking (OR: 1.726, 95% CI: 1.099-2.712), family history (OR: 1.840, 95% CI: 1.132-2.992), radiotherapy or chemotherapy (OR: 1.594, 95% CI: 1.065-2.387), and pathological stage (OR: 2.263, 95% CI: 1.084-4.726) might be the risk factors of nutritional status, while nutritional support can reduce the risk of malnutrition. Conclusion: Effective nutritional risk assessment methods and nutritional intervention measures can be adopted according to the research data to improve quality of life of esophageal cancer patients.