Perioperative Blood Loss after Preoperative Prostatic Artery Embolization in Patients Undergoing Simple Prostatectomy: A Propensity Score‒Matched Study

PurposeTo assess perioperative blood loss following prostatic artery embolization (PAE) before surgery in patients undergoing simple prostatectomy.MethodsA retrospective chart review was used to identify 63 patients (mean age, 65.3 ± 8.0 years) with prostatic hypertrophy and severe lower urinary tract symptoms who underwent prostatectomy from September 2014 to December 2019, 18 (28.5%) of whom underwent PAE before surgery. Demographic data, pertinent laboratory results, procedural or operative information, hospital course details, and pathology reports were obtained. A 2:1 propensity score‒matching analysis was performed to compare intraoperative blood loss in patients who underwent prostatectomy alone with intraoperative blood loss in those who first underwent bilateral PAE before surgery.ResultsSixteen (89%) of the 18 patients underwent bilateral PAE before surgery. Thirty-two patients who underwent prostatectomy without embolization before surgery were selected for the 2:1 propensity score‒matched analysis based on age, race, surgery type, prostate gland size, and comorbidities. The mean estimated blood loss (EBL) for prostatectomy alone was 545 ± 380 mL (mean ± standard deviation). There was a statistically significant reduction in the EBL for patients who underwent bilateral PAE (303 ± 227 mL, P < .01). The operative time was also significantly decreased for patients who underwent PAE before surgery (P < .05). For patients who underwent PAE, there were no complications related to the procedure.ConclusionsBilateral PAE before surgery appears to be safe and may be effective in reducing perioperative bleeding and operative time.     

阿托伐他汀对大脑中动脉栓塞大鼠尿激酶溶栓治疗的影响

目的研究阿托伐他汀联合尿激酶溶栓对大鼠大脑中动脉急性脑梗死的疗效。方法选择SD大鼠48只,采用血栓栓塞法制备大鼠大脑中动脉急性脑梗死模型,随机分为阿托伐他汀组、尿激酶组、联合治疗组和对照组,每组12只。缺血3h给予阿托伐他汀或生理盐水,缺血4h给予尿激酶或生理盐水治疗。治疗前和缺血24h行神经功能缺损评分,缺血24h取脑行2,3,5-氯化三苯基四氮唑染色检测脑梗死体积。结果与对照组比较,阿托伐他汀组缺血24h神经功能显著改善[(6.5±4.3)分vs(12.5±4.3)分],脑梗死体积明显降低[(13.8±7.5)%vs(30.5±23.4)%,P<0.05]。与阿托伐他汀组比较,尿激酶组和联合治疗组神经功能改善程度及脑梗死体积降低程度更显著(P<0.05)。与尿激酶组比较,联合治疗组神经功能改善、脑梗死体积减小,但差异无统计学意义(P>0.05)。结论阿托伐他汀对脑梗死组织有保护作用,阿托伐他汀与尿激酶联合治疗有进一步提高疗效的趋势。     

综合ICU导尿管相关性尿路感染目标性监测数据分析与探讨

目的分析重症监护病房（ICU）导尿管相关性尿路感染目标性监测数据,探讨ICU导尿管相关性尿路感染现状,分析发展趋势,为制订干预措施提供参考。同时,分析现行的导尿管相关性尿路感染（CAUTIs）诊断标准对ICU患者的临床适用性。方法 2012年9月~2013年8月所有收住ICU〉48h的留置导尿患者,进行导尿管相关性尿路感染目标性监测,收集临床资料,计算导尿管使用率及导管相关性感染发病率。结果 2012年9月~2013年8月综合ICU共收住患者357例,留置导尿患者336例;留置时间最长172d,最短2d;共留取386份尿培养标本,细菌培养结果阳性10份,阳性率2.59%;总住院天数2 969d,总留置导尿管日数2 831d,尿道插管使用率95.35%,千日感染率0.353%。结论尿培养结果阳性率与留置导尿管时间长短无相关性;重症监护病房导尿管相关性尿路感染目标性监测有助于规范医疗护理行为,按标准要求进行操作与护理,但使用目前推行的导尿管相关性尿路感染诊断标准（以生物学检查结果为准）会降低感染病例的诊断率,对重症监护病房患者的临床适用性有待进一步考量和验证。