Association between intra-operative cardiac arrest and country Human Development Index status: a systematic review with meta-regression analysis and meta-analysis of observational studies*

Intra-operative cardiac arrests differ from most in-hospital cardiac arrests because they reflect not only the patient's condition but also the quality of surgery and anaesthesia care provided. We assessed the relationship between intra-operative cardiac arrest rates and country Human Development Index (HDI), and the changes occurring in these rates over time. We searched PubMed, EMBASE, Scopus, LILACS, Web of Science, CINAHL and SciELO from inception to 29 January 2020. For the global population, rates of intra-operative cardiac arrest and baseline ASA physical status were extracted. Intra-operative cardiac arrest rates were analysed by time, country HDI status and ASA physical status using meta-regression analysis. Proportional meta-analysis was performed to compare intra-operative cardiac arrest rates and ASA physical status in low- vs. high-HDI countries and in two time periods. Eighty-two studies from 25 countries with more than 29 million anaesthetic procedures were included. Intra-operative cardiac arrest rates were inversely correlated with country HDI (p = 0.0001); they decreased over time only in high-HDI countries (p = 0.040) and increased with increasing ASA physical status (p < 0.0001). Baseline ASA physical status did not change in high-HDI countries (p = 0.106), while it decreased over time in low-HDI countries (p = 0.040). In high-HDI countries, intra-operative cardiac arrest rates (per 10,000 anaesthetic procedures) decreased from 9.59 (95%CI 6.59–13.16) pre-1990 to 5.17 (95%CI 4.42–5.97) in 1990–2020 (p = 0.013). During the same time periods, no improvement was observed in the intra-operative cardiac arrest rates in low-HDI countries (p = 0.498). Odds ratios of intra-operative cardiac arrest rates in ASA 3–5 patients were 8.48 (95%CI 1.67–42.99) times higher in low-HDI countries than in high-HDI countries (p = 0.0098). Intra-operative cardiac arrest rates are related to country-HDI and decreased over time only in high-HDI countries. The widening gap in these rates between low- and high-HDI countries needs to be addressed globally.     

肛周坏死性筋膜炎术后热毒炽盛期应用解毒消痈饮的疗效观察

[目的] 探讨解毒消痈饮治疗肛周坏死性筋膜炎术后热毒炽盛期的临床效果。[方法] 将60例肛周坏死性筋膜炎患者随机分为对照组和观察组,各30例。对照组采用术后对症支持的常规治疗+痛痒消洗剂坐浴,观察组在对照组的基础上,术后口服解毒消痈饮治疗。[结果] 观察组治疗后第3、7、14天视觉模拟评分量表（VAS）评分均低于对照组,差异具有统计学意义（P<0.05）;两组治疗14 d后白细胞（WBC）、C-反应蛋白（CRP）、白细胞介素-6（IL-6）较治疗前显著减低,且观察组明显低于对照组（P<0.05）,而血红蛋白（Hb）较治疗前明显升高,且观察组优于对照组（P<0.05）;两组治疗14 d后坏死性筋膜炎实验室风险指数评分（LRINEC）、Fournier坏疽严重程度指数（FGSI）均较治疗前显著减低,且观察组明显低于对照组（P<0.05）;观察组治疗后第7、14天创面渗液和创面水肿情况评分均低于对照组,差异具有统计学意义（P<0.05）;观察组创面愈合时间较对照组短（P<0.05）;观察组的总有效率优于对照组（P<0.05）。[结论] 肛周坏死性筋膜炎术后热毒炽盛期应用解毒消痈饮疗效确切,能够有效缓解术后疼痛,降低炎症反应,提高血红蛋白含量,有利于评估患者术后病情及预后,减轻术后创面渗液和创面水肿,加速创面愈合。     

箭叶淫羊藿不同时期根际微生物群落组成及其与有效成分累积的相关性分

目的 通过分析箭叶淫羊藿Epimediumsagittatum不同生育期根际微生物群落结构及其与主要药用有效成分累积之间的相关性,探讨箭叶淫羊藿根际土壤微生物对其药材有效成分的影响,为箭叶淫羊藿的优质高产栽培提供科学依据。方法 以三年生箭叶淫羊藿的根际土为研究对象,采用高通量测序技术对根际细菌和真菌群落结构进行分析,同时测定根际土壤理化性质、酶活性及不同生育期药材总黄酮、淫羊藿苷等有效成分含量,通过皮尔逊相关性分析探究土壤生态因子与有效成分之间的关系。结果 高通量测序结果显示,箭叶淫羊藿根际细菌优势菌属包括Candidatus＿Solibacter、苔藓杆菌属、嗜酸栖热菌属、芽单胞菌属等,其中,Candidatus＿Solibacter属在5个生长时期的平均丰度值最高。根际真菌优势菌属中被孢霉属相对丰度占比最大,在花蕾期样品中的丰度值高达44.27%。UPGMA聚类和非度量多维标定法（NMDS）分析表明,花蕾期、盛花期、果实膨大期及盛果期的根际土壤细菌和真菌结构相似,而药材质量稳定期与前4个时期的根际微生物群落结构存在明显差异。同时,皮尔逊相关性分析结果显示：总黄酮含量与有效磷呈显著正...     

围术期肺保护策略的研究进展

术后肺部并发症(PPCs)是影响患者围术期预后的主要原因,需要麻醉科医师重点关注并有效防治。越来越多的证据表明,围术期实行肺保护策略可减少PPCs。近5年来,围术期肺保护策略研究已成为围术期医学关注的重点问题之一,围术期肺保护是加速康复外科的重要组成部分,其策略包括术前风险预测、术中肺保护性通气、术后镇痛及物理治疗等。本综述结合围术期肺保护策略最新进展进行阐述,以提高麻醉科医师对PPCs潜在风险的认识,为制定围术期个体化肺保护方案提供策略。未来还应进一步研究以阐明围术期肺保护策略对患者预后结局的影响。     

中医外治技术联合快速康复外科理念对肝胆外科术后患者的临床疗效

目的:探讨中医外治技术联合快速康复外科(ERAS)理念促进肝胆外科患者康复的临床疗效。方法:选择于2018 年8 月—2020 年10 月在我科行腹腔镜手术的患者308 例,随机分为外治组156 例,对照组152 例。对照组行腹腔镜手术+ERAS 理念,外治组在前者基础上加用中医外治技术,比较两组患者在术后肠鸣音恢复、肛门首次排气及排便时间、疼痛评分、住院天数、相关并发症等方面的差异。结果:外治组术后肠鸣音恢复、肛门首次排气排便时间均短于对照组(P <0.05),术后疼痛评分低于对照组(P <0.05),行肝脏手术及胰腺手术患者的住院时间均短于对照组(P <0.05)。但两组相关并发症发生率差异无统计学意义(P <0.05)。结论:中医外治技术联合ERAS 理念在肝胆外科围手术期的应用能减轻术后患者的疼痛,促进胃肠道功能的恢复,缩短住院时间,值得临床推广应用。     

兔急性心肌缺血时心肌非缺血区的电生理学变化

本研究通过结扎家免在位心脏冠状动脉左室支造成急性心肌缺血。结果显示不仅缺血区心肌有明显的电生理变化，在非缺血区亦有电生理变化，后者主要表现为广泛的非缺血区域有效不应期（ERP）呈普遍轻度延长，与缺血边缘带共同形成一个不应期离散和跃变带。这种电生理紊乱易于诱发折反性心律失常的产生。升高循环血中几条酚胺浓度并不能模拟非缺血区的电生理变化。刺激连走神经外周瑞虽可使自然心律情况下的ERP延长，但却不能使固定心律情况下的ERP延长。提示非缺血区的电生理学变化并非由于心肌缺血时交感或迷走神经张力增高所致，而可能有其它原因。     

Is there an abnormal fasting duodenogastric reflux in nonulcer dyspepsia?

A quantitatively and/or qualitatively abnormal duodenogastric reflux (DGR) could be involved in the pathogenesis of nonulcer dyspepsia (NUD). The aims of this prospective study were to look for (1) a pathological DGR profile during fasting and (2) an eventual correlation between DGR profile and clinical symptoms. Twenty-six NUD patients were investigated. Seven other operated patients with a surgical procedure facilitating DGR episodes and 27 healthy volunteers served as control groups. A clinical score was determined for each patient from a standardized questionnaire. Gastric aspiration was performed for 6 hr in fasting subjects. The aspirates were pooled into 17 samples. In each sample the concentration and the output of total bile acids was determined. If the concentration was larger than 30 mol/liter in pooled samples, the concentrations of free bile acids and the distribution of the conjugated bile acids was determined. The percentage of aliquots with a total bile acid concentration larger than 50 mol/liter (without upper limit), and the percentage with a concentration larger than 2500 mol/liter was also obtained. No significant difference was demonstrated between the healthy volunteers and NUD patients, whatever the parameter considered. However, there was a significant increase in each of the quantitative parameters for the group of operated patients in comparison with the NUD patient group. No significant correlation was found between the clinical score and the DGR profile in NUD patients. Apparently, DGR episodes do not play a primary role in the pathogenesis of NUD.Part of this work was presented at the 4th European Symposium on Gastrointestinal Motility, Krakow, Poland. September 22–24, 1988.Hepatogastroenterology, 35:178, 1988 (abstract).     

90例心脏病人剖宫产围手术期处理和麻醉观察

目的：探讨心脏病人施行剖宫术最佳围手术期的治疗及麻醉处理,有效地提高母婴生存率。方法：随机选择90例心脏病剖宫手术病人进行围手术治疗,麻醉处理及监测剖分病例进行术前,术后血动力学指标等项目监测,结果：硬膜外阻滞后33例出现低血压,平均收缩压下降2．7－4．0kPa,中心解脉压无明显影响;血流动力学指标改变,心律失常发生率与心脏病类型有关,结论：在适当纠正条件和心电监测下对心脏病人行剖部产术更为安全,可有效地防止急性心力衰竭的发生,硬膜外连续阻滞麻醉施行剖宫产术尤为适且于高危妊娠心脏病人的剖腹产,心脏病人剖宫术围手术期密切监测血流动力指标和心血管功能可有效地提高母婴安全。     

手术对淋巴细胞亚群细胞周期的影响

目的观察实验动物围手术期脾脏淋巴细胞亚群细胞周期改变,分析手术对机体免疫功能的影响及其意义。方法对Balb／c小鼠行截肢术,分别于术后第1、2、3、4d处死,分离脾脏淋巴细胞,单克隆荧光抗体标记,流式细胞检测各淋巴细胞亚群的细胞周期。结果术后第1天CD3+、CD4+细胞的(S＋G2)期明显增高,分别为43.5±3.4％和46.5±4.1％,维持至术后第4天。CD8+(S＋G2)期术后第2天62.7±5.7％较对照组41.3±1.9％明显升高。sIG(膜表面免疫球蛋白)术后第2天(S＋G2)期明显升高。结论手术及应激可影响小鼠机体免疫功能。