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IntroductionOur aim was to describe practices in multimodal pain management at US children's hospitals and evaluate the association between non-opioid pain management strategies and pediatric patient-reported outcomes (PROs).MethodsData were collected as part of the 18-hospital ENhanced Recovery In CHildren Undergoing Surgery (ENRICH-US) clinical trial. Non-opioid pain management strategies included use of preoperative and postoperative non-opioid analgesics, regional anesthetic blocks, and a biobehavioral intervention. PROs included perioperative nervousness, pain-related functional disability, health-related quality of life (HRQoL). Associations were analyzed using multinomial logistic regression models.ResultsAmong 186 patients, 62 (33%) received preoperative analgesics, 186 (100%) postoperative analgesics, 81 (44%) regional anesthetic block, and 135 (73%) used a biobehavioral intervention. Patients were less likely to report worsened as compared to stable nervousness following regional anesthetic block (relative risk ratio [RRR]:0.31, 95% confidence interval [CI]:0.11–0.85), use of a biobehavioral technique (RRR:0.26, 95% CI:0.10–0.70), and both in combination (RRR:0.08, 95% CI:0.02–0.34). There were no associations of non-opioid pain control modalities with pain-related functional disability or HRQoL.ConclusionUse of postoperative non-opioid analgesics have been largely adopted, while preoperative non-opioid analgesics and regional anesthetic blocks are used less frequently. Regional anesthetic blocks and biobehavioral interventions may mitigate postoperative nervousness in children.Level of evidenceIII.  相似文献   
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BackgroundPerianal abscesses and anal fistulas are common. The principle of intention-to-treat has not been considered in previous systemic reviews. Thus, the comparison between primary and post-recurrence management was confused, and the recommendation of primary treatment is obscure. The current study aims to identify the optimal initial treatment for pediatric patients.MethodsUsing PRISMA guidelines, studies were identified from MEDLINE, EMBASE, PubMed, Cochrane Library, and Google Scholar without any language or study design restriction. The inclusion criteria include original articles or articles with original data, studies of management for a perianal abscess with or without anal fistula, and patient age of <18 years. Patients with local malignancy, Crohn's disease, or other underlying predisposing conditions were excluded. Studies without analyzing recurrence, case series of <5, and irrelevant articles were excluded in the screening stage. Of the 124 screened articles, 14 articles had no full texts or detailed information. Articles written in a language other than English or Mandarin were translated by Google Translation first and confirmed with native speakers. After the eligibility process, studies that compared identified primary managements were then included in the qualitative synthesis.ResultsThirty-one studies involving 2507 pediatric patients met the inclusion criteria. The study design consisted of two prospective case series of 47 patients and retrospective cohort studies. No randomized control trials were identified. Meta-analyses for recurrence after initial management were performed with a random-effects model. Conservative treatment and drainage revealed no difference (Odds ratio [OR], 1.222; 95% Confidential interval [CI]: 0.615–2.427, p = 0.567). Conservative management had a higher risk of recurrence than surgery without statistical significance (OR 0.278, 95% CI: 0.109–0.707, p = 0.007). Compared with incision/drainage, surgery can prevent recurrence remarkably (OR 4.360, 95% CI: 1.761–10.792, p = 0.001). Subgroup analysis of different approaches within conservative treatment and operation was not performed for lacking information.ConclusionStrong recommendations cannot be made due to the lack of prospective or randomized controlled studies. However, the current study based on real primary management supports initial surgical intervention for pediatric patients with perianal abscesses and anal fistula to prevent recurrence.Level of evidenceType of study: Systemic review; Evidence level: Level II.  相似文献   
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ObjectiveThe use of mechanical circulatory support (MCS) in lung transplantation has been steadily increasing over the prior decade, with evolving strategies for incorporating support in the preoperative, intraoperative, and postoperative settings. There is significant practice variability in the use of these techniques, however, and relatively limited data to help establish institutional protocols. The objective of the AATS Clinical Practice Standards Committee (CPSC) expert panel was to review the existing literature and establish recommendations about the use of MCS before, during, and after lung transplantation.MethodsThe AATS CPSC assembled an expert panel of 16 lung transplantation physicians who developed a consensus document of recommendations. The panel was broken into subgroups focused on preoperative, intraoperative, and postoperative support, and each subgroup performed a focused literature review. These subgroups formulated recommendation statements for each subtopic, which were evaluated by the entire group. The statements were then developed via discussion among the panel and refined until consensus was achieved on each statement.ResultsThe expert panel achieved consensus on 36 recommendations for how and when to use MCS in lung transplantation. These recommendations included the use of veno-venous extracorporeal membrane oxygenation (ECMO) as a bridging strategy in the preoperative setting, a preference for central veno-arterial ECMO over traditional cardiopulmonary bypass during the transplantation procedure, and the benefit of supporting selected patients with MCS postoperatively.ConclusionsAchieving optimal results in lung transplantation requires the use of a wide range of strategies. MCS provides an important mechanism for helping these critically ill patients through the peritransplantation period. Despite the complex nature of the decision making process in the treatment of these patients, the expert panel was able to achieve consensus on 36 recommendations. These recommendations should provide guidance for professionals involved in the care of end-stage lung disease patients considered for transplantation.  相似文献   
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Background

Glutamate plays a key role for post-ischaemic recovery of myocardial metabolism. According to post hoc analyses of the two GLUTAMICS trials, patients without diabetes benefit from glutamate with less myocardial dysfunction after coronary artery bypass surgery (CABG). Copeptin reflects activation of the Arginine Vasopressin system and is a reliable marker of heart failure but available studies in cardiac surgery are limited. We investigated whether glutamate infusion is associated with reduced postoperative rises of plasma Copeptin (p-Copeptin) after CABG.

Methods

A prespecified randomised double-blind substudy of GLUTAMICS II. Patients had left ventricular ejection fraction ≤0.30 or EuroSCORE II ≥3.0 and underwent CABG ± valve procedure. Intravenous infusion of 0.125 M L-glutamic acid or saline at 1.65 mL/kg/h was commenced 10–20 min before the release of the aortic cross-clamp and then continued for another 150 min P-Copeptin was measured preoperatively and postoperatively on day one (POD1) and day three. The primary endpoint was an increase in p-Copeptin from the preoperative level to POD1. Postoperative stroke ≤24 h and mortality ≤30 days were safety outcomes.

Results

We included 181 patients of whom 48% had diabetes. The incidence of postoperative mortality ≤30 days (0% vs. 2.1%; p = .50) and stroke ≤24 h (0% vs. 3.2%; p = .25) did not differ between the glutamate group and controls. P-Copeptin increased postoperatively with the highest values recorded on POD1 without significant inter-group differences. Among patients without diabetes, p-Copeptin did not differ preoperatively but postoperative rise from preoperative level to POD1 was significantly reduced in the glutamate group (73 ± 66 vs. 115 ± 102 pmol/L; p = .02). P-Copeptin was significantly lower in the Glutamate group on POD1 (p = .02) and POD 3 (p = .02).

Conclusions

Glutamate did not reduce rises of p-Copeptin significantly after moderate to high-risk CABG. However, glutamate was associated with reduced rises of p-Copeptin among patients without diabetes. These results agree with previous observations suggesting that glutamate mitigates myocardial dysfunction after CABG in patients without diabetes. Given the exploratory nature of these findings, they need to be confirmed in future studies.  相似文献   
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目的研究全身麻醉联合椎管内麻醉对冠心病患者行骨科手术容量负荷及左室功能影响情况。方法选取骨科2016年12月~2019年12月80例冠心病骨科手术患者,将其随机分为观察组与对照组,每组40例患者,对照组患者手术之前给予全身麻醉,观察组患者给予全身麻醉联合椎管内麻醉,分析两组患者的情况。结果对比两组患者不同时间点血流动力学指标发现,两组患者CVP在三个时间段无明显差异(P>0.05);SVV指标三个时间段无明显差异(P>0.05);SVI指标麻醉后观察组患者数值明显高于对照组(P<0.05);CI指标三个时间段对比无明显差异(P>0.05);MAP指标在麻醉后出现显著差异(P<0.05);HR指标手术1 h后出现显著差异,观察组数值高于对照组(P<0.05)。通过对比两组患者的心肌酶谱发现,在麻醉后和手术1 h后CK-MB数值低于对照组(P<0.05);观察组患者在手术1 h后的LDH指标低于对照组(P<0.05)。对比两组患者的并发症情况,观察组并发症的发生率明显低于对照组(P>0.05)。结论全身麻醉联合椎管内麻醉对冠心病骨科手术患者手术期容量负荷比较小,血流动力学指标也更加稳定,安全性好。  相似文献   
8.
陈晓亮 《中国校医》2022,36(9):687-690
目的 探讨调强放射治疗对乳腺癌保乳术后患者的影响。方法 选取2015年3月—2019年10月在本院接受保乳术治疗的98例乳腺癌患者作为研究对象,按随机数字表法分为观察组与对照组,每组各49例。对照组采用常规放射治疗,观察组采用调强放射治疗。比较2组疗效、计划靶区剂量学、肌钙蛋白水平、预后情况。结果 观察组疗效总有效率为83.67%,高于对照组的65.31%,差异具有统计学意义(χ2=4.350,P=0.037);观察组计划靶区V100%、V105%分别为(9.68±0.65)%、(1.03±0.06)%,分别低于对照组的(42.02±4.87)%、(24.51±2.54)%,差异具有统计学意义(t=46.076、64.691,P值均<0.001);放疗后,观察组和对照组肌钙蛋白分别为(0.116±0.012)ng/mL、(0.260±0.019)ng/mL,分别高于放疗前的(0.059±0.010)ng/mL、(0.057±0.009)ng/mL,差异具有统计学意义(P<0.05),但观察组肌钙蛋白较对照组低,差异有统计学意义(t=44.855,P<0.001);观察组的无瘤生存率为97.96%,高于对照组的83.67%,差异具有统计学意义(χ2=4.405,P=0.036)。结论 对乳腺癌保乳术后患者辅以调强放射治疗,可提高临床疗效,调节靶区照射剂量均匀性、适应性,避免心肌及其他周围组织损伤,并提高无瘤生存率,改善预后。  相似文献   
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BackgroundGastroesophageal reflux may be associated with the worsening of asthma by increasing cough reflex sensitivity. Hull Airway Reflux Questionnaire (HARQ) consists of 14 prevalent reflux-related symptoms. It may be useful in predicting the presence of cough reflex hypersensitivity in asthma.MethodsFrom August 2018 to July 2020, 266 asthmatic patients completed the HARQ. They underwent blood analysis, spirometry, fraction of exhaled nitric oxide (FeNO) measurement, and the capsaicin cough challenge test. Patients were considered to have reflux-related symptoms if their HARQ scores were 13 points or higher. We evaluated the association between reflux-related symptoms and clinical asthma outcomes. Finally, we performed a multivariate analysis to determine the clinical significance of the HARQ for asthma. This study was registered in the University Hospital Medical Information Network (UMIN000040732).ResultsThe mean HARQ scores were 13.1 (standard deviation 12.0). Patients in the high HARQ scores group (HARQ ≥13, n = 105) showed a lower prevalence of atopic predisposition, lower levels of FeNO, heightened capsaicin cough reflex sensitivity, poorer asthma control, and more frequent admissions due to asthma than those in the low HARQ groups (all p values < 0.05). The HARQ was useful in selecting patients with poor controlled asthma and those with severe cough when the cut-off value was set at 13. Multivariate analysis revealed that heightened capsaicin cough reflex sensitivity affected reflux-related symptoms, as well as lower levels of FeNO and younger age.ConclusionsHigher HARQ scores (≥13) may be useful in predicting not only poor asthma condition but also the presence of airway neuronal dysfunction in patients with asthma to some extent.  相似文献   
10.
黎淑玲  刘俊杰  蒋邦好  罗劲根 《安徽医学》2022,43(11):1264-1267
目的 观察痔上动脉结扎(HAL)术对中重度混合痔患者的手术效果及对术后并发症的影响。方法 选取2019年6月至2020年6月广州市番禺区中心医院收治的148例混合痔合并出血性内痔患者作为研究对象,采用随机数字表法分为对照组与观察组,每组74例。对照组行痔上黏膜环切术(PPH)术,观察组行PPH联合HAL。观察比较两组患者手术时间、住院时间、住院费用,术后急性尿潴留,术后3个月内出血、脱垂、水肿、肛门狭窄、视觉疼痛模拟评分(VAS)、Wexner肛门失禁评分、疗效等指标的差异。结果 观察组手术时间较对照组更长,住院时间较对照组更短,住院费用较对照组更低,差异有统计学意义(P<0.05)。观察组术后出血比例为5.41%、水肿发生率为9.46%、Wexner肛门失禁评分为(2.32±1.25)分,均低于对照组,差异有统计学意义(P<0.05);观察组有效率为94.59%,高于对照组,差异有统计学意义(P<0.05)。手术后,两组VAS评分均降低,术后观察组VAS低于对照组,差异有统计学意义(P<0.05)。观察组术后急性尿潴留、脱垂、肛门狭窄发生情况与对照组比较,差异无统计学意义(P>0.05)。结论 PPH联合直视下HAL治疗出血性中重度混合痔安全有效,并发症发生率更低,具有临床应用价值。  相似文献   
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