每搏量变异度指导的目标导向液体治疗对脑膜瘤切除术患者术后恶心呕吐的影响

目的探讨FloTrac/Vigileo提供的每搏量变异度(SVV)指导的目标导向液体治疗(GDT)与传统静态参数指导的液体治疗对脑膜瘤切除术患者术后恶心呕吐(PONV)的影响。方法择期行脑膜瘤切除术患者50例,随机分为两组:C组和G组,每组25例。两组麻醉诱导前按照3ml/kg输注6%羟乙基淀粉(130/0.4),术中通过输注6%羟乙基淀粉(130/0.4)或静脉注射血管活性药物(麻黄素或去氧肾上腺素)分别达到以下要求,C组:中心静脉压(CVP)≥8mmHg或平均动脉压(MAP)>80%基础值;G组:SVV≤12%且MAP>70%基础值。观察两组患者术中及术后24h液体出入情况。观察患者术后1～3d恶心呕吐程度,记录止吐药物使用情况。结果两组患者一般资料、手术及麻醉时间比较差异均无统计学意义(P>0.05)。与C组比较,G组术中胶体液量[(710±61)mlvs.(464±45)ml]和总液量[(1427±76)mlvs.(1171±54)ml]均增加(P<0.05),G组患者术毕SVV值[(10.6±0.4)%vs.(13.4±1.0)%]降低(P<0.05)。与C组比较,G组患者术后第2、3天恶心评分均降低(P<0.05),术后第1天呕吐评分降低(P<0.05)。与C组比较,G组术后追加止吐药物的患者例数较少(10例vs.3例,P<0.05)。结论 FloTrac/Vigileo提供SVV指导的术中GDT,可以减轻脑膜瘤切除术患者PONV的程度,减少止吐药物的使用。     

Age-related changes in auditory temporal processing in the rat

Presbycusis, as the deterioration of hearing ability occurring with aging, can be manifested not only in a shift of hearing thresholds, but also in a deterioration of the temporal processing of acoustical signals, which may in elderly people result in degraded speech comprehension. In this study we assessed the age-related changes in the temporal processing of acoustical signals in the auditory system of pigmented rats (Long Evans strain). The temporal resolution was investigated in young adult (3-4 months) and old (30-34 months) rats by behavioral and electrophysiological methods: the rats' ability to detect and discriminate gaps in a continuous noise was examined behaviorally, and the amplitude-rate function was assessed for the middle latency response (MLR) to clicks. A worsening of the temporal resolution with aging was observed in the results of all tests. The values of the gap detection threshold (GDT) and the gap duration difference limen (GDDL) in old rats increased about two-fold in comparison with young adult rats. The MLR to a click train in old rats exhibited a significantly faster reduction in amplitude with an increasing stimulation rate in comparison with young adult rats. None of the age-related changes in the parameters characterizing temporal resolution (GDT, GDDL and MLR to a click train) correlated with the degree of the age-related hearing loss. However, the age-related changes in MLR amplitude-rate function correlated with the age-related changes in GDDL, but not with the changes in GDT. The behavioral and electrophysiological data clearly show that aging in rats is accompanied with a pronounced deficit in the temporal processing of acoustical signals that is associated with the deteriorated function of the central auditory system.     

酒精依赖患者的风险决策功能损害和危险因素分析

目的：探讨酒精依赖患者的实验室决策功能特点及其影响因素。方法：对30例酒精依赖患者和30例健康对照进行宗氏焦虑自评量表（SAS）、宗氏焦虑自评量表（SDS）评估和爱荷华赌博试验（IGT）、骰子博弈试验测试（GDT）。结果：1）酒依赖组在SAS、SDS量表评分中的得分高于对照组,差异具有统计学意义（P<0.05）;2）在IGT的第五模块测试中,酒依赖组的冒险得分高于对照组,两组有统计差异（P<0.05）;酒依赖组的GDT结果显示,安全选项的得分低于对照组,风险选项的得分高于对照组,两组存在统计学差异（P<0.05）;3）IGT净分数的影响因素是SDS总分、受教育年限、SAS总分（P<0.001）;IGT冒险分数的影响因素是年龄、受教育年限和入院次数（P<0.001）;GDT风险选项的影响因素是成瘾时间（P=0.011）。结论：本研究发现酒精依赖患者存在风险决策功能损伤,其危险因素包括焦虑、抑郁情绪,年龄、受教育年限、入院次数和成瘾时间。     

目标导向液体管理用于老年患者开胸手术的临床研究

目的 观察以心指数(cardiac index,CI)/每搏指数(stroke volume index,SVI)/每搏量变异度(stroke volume variation,SVV)为目标导向的液体管理策略对行开胸肺叶切除术的老年患者术后转归的影响.方法 30例行择期肺叶切除术的患者,年龄≥65岁,美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级,采用随机数字表法随机分为以CI/SVI/SVV为导向的S组(n=15)和常规液体管理组(routine group,R组)(n=15),监测围术期两组指标,包括心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)、动脉血氧饱和度(arterial oxygen saturation,SpO2)、呼气末二氧化碳分压(end-tidal carbon dioxide partial pressure,PETCO2)、气道压力(airway pressure,Pmax)、脑电双频指数(bispectral index,BIS)等,评价以CI/SVI/SVV为导向的围术期液体管理策略在改善患者术后转归方面是否优于常规液体管理策略.结果 S组患者术中不同观察时间点HR、MAP、SpO2、PETCO2、Pmax、BIS与R组比较,差异无统计学意义.S组患者术后脱离呼吸机时间4±2h、术中输液量1310±310ml、术后液体输入的正平衡量516±212ml明显小于R组患者9±3h,1920土646ml,859±335ml(P ＜0.05),术后ICU驻留时间、氧合指数等指标S组较R组呈现良好的转归趋势.两组患者的术后并发症发生率比较差异无统计学意义.结论 以CI/SVI/SVV为目标导向的老年开胸手术围术期液体管理策略较常规液体管理策略更严格限制液体的摄入量,缩短患者呼吸机支持时间,不增加心肺并发症的发生率,有助于改善老年患者的术后转归.     

The impact on postoperative outcomes of intraoperative fluid management strategies during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

BackgroundThe impact of intraoperative fluid management during cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) on postoperative outcomes has been poorly investigated. This study aimed to retrospectively evaluate the impact of intraoperative fluid management strategy on postoperative outcomes and survival.Methods509 patients undergoing CRS and HIPEC at Uppsala University Hospital/Sweden 2004–2017 were categorized into two groups according to the intraoperative fluid management strategy: pre-goal directed therapy (pre-GDT) and goal directed therapy (GDT), where a hemodynamic monitor (CardioQ or FloTrac/Vigileo) was used to optimize fluid management. Impact on morbidity, postoperative hemorrhage, length-of-stay and survival was analyzed.ResultsThe pre-GDT group received higher fluid volume compared to the GDT group (mean 19.9 vs. 16.2 ml/kg/h, p < 0.001). Overall postoperative morbidity Grade III-V was higher in the GDT group (30% vs. 22%, p = 0.03). Multivariable adjusted odds ratio (OR) for Grade III-V morbidity was 1.80 (95%CI 1.10–3.10, p = 0.02) in the GDT group. Numerically, more cases of postoperative hemorrhage were found in the GDT group (9% vs. 5%, p = 0.09), but no correlation was observed in the multivariable analysis 1.37 (95%CI 0.64–2.95, p = 0.40). An oxaliplatin regimen was a significant risk factor for postoperative hemorrhage (p = 0.03). Mean length of stay was shorter in the GDT group (17 vs. 26 days, p < 0.0001). Survival did not differ between the groups.ConclusionWhile GDT increased the risk for postoperative morbidity, it was associated with shortened hospital stay. Intraoperative fluid management during CRS and HIPEC did not affect the postoperative risk for hemorrhage, while the use of an oxaliplatin regimen did.