不同肺保护性通气策略对肺切除术术中通气和术后肺部并发症的影响

目的:评估小潮气量联合不同水平呼气末正压(positive end-expiratory pressure,PEEP)对胸腔镜下肺切除术患者通气氧合和术后肺部并发症(postoperative pulmonary complications,PPCs)的影响.方法:选取空军军医大学唐都医院2019年12月至2020年12月择期行胸腔镜下肺切除患者100例,采用随机数字表法分为两组:低水平PEEP组(LP组)和高水平PEEP组(HP组);LP组于单肺通气(one lung ventilation,OLV)时设置潮气量(tidal volume,VT)6 mL/kg,PEEP≤5 cmH2O,HP组于相同时间点设置VT 6 mL/kg,PEEP 6～10 cmH2O.分别于OLV前(T1)、OLV 60 min(T2)、手术结束(T3)采取桡动脉血液行血气分析;记录T1、T2、T3的心率(heart rate,HR)、脉搏血氧饱和度(pulse oxygen saturation,SpO2)、收缩压/舒张压(systolic blood pressure/diastolic blood pressure,SBP/DBP)、呼气末二氧化碳分压(partial pressure of end-expiratory carbon dioxide,PETCO2)、VT、吸气峰压(peak pressure,Ppeak)、平台压(plateau pressure,Pplat);记录术后7 d内PPCs、胸腔引流管拔除时间、术后3 d内胸腔引流管引流量及术后住院时间.结果:与T1时比较,T2、T3时两组患者HR无明显变化;T2时平均动脉压(mean arterial pressure,MAP)明显降低(P<0.05);两组Ppeak、Pplat明显升高,动态肺顺应性(dynamic compliance,Cdyn)明显降低(P<0.05);两组患者氧合指数(oxygenation index,OI)明显降低,肺泡气-动脉血氧分压差(alveolar gas-arterial oxygen partial pressure difference,A-aDO2)明显升高;T2时两组呼吸指数(respiratory index,RI)明显升高,T3时LP组RI明显升高(P<0.05).与LP组比较,T2时HP组Ppeak明显升高;T2、T3时,HP组Pplat明显升高,驱动压(driving pressure,DP)明显降低,Cdyn明显增高(P<0.05);T2、T3时HP组OI明显升高,A-aDO2、RI明显降低(P<0.05).两组术后7 d PPCs及住院时间差异无统计学意义.结论:小潮气量6 mL/kg联合较高水平PEEP 6～10 cmH2O可改善胸腔镜下肺切除术患者OLV时通气氧合情况,利于术中麻醉管理.     

肺复张对ARDS患者呼吸力学的影响

目的 观察呼气未正压(PEEP)递增法肺复张联合保护性通气对急性呼吸窘迫综合征(ARDS)肺换气功能及血流动学的影响.方法 对35例ARDS患者行PEEP递增法肺复张;测定肺复张前及肺复张后10mim、30min、1h、4h、24h时患者的氧合、呼吸力学和循环指标变化.结果 肺复张后的脉搏血氧饱和度(SpO2)、动脉血氧饱和度(SaO2)、动脉血氧分压(PaO2)、氧合指数(PaO2/FiO2 )呈进行性升高,气道平台压 (Pplat)呈进行性降低,与肺复张前比较,差异有统计学意义( P<0.01或 P<0.05).实施肺复张前后二氧化碳分压(PaCO2)、PH值、气道峰压(PIP)、心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)均无明显变化,差异无统计学意义(P>0.05).结论 PEEP递增法肺复张结合肺保护通气策略是治疗ARDS的安全有效措施.     

心脏手术患者输血策略的系统评价

为了系统地评价心脏手术患者输血策略对临床结果的影响。按照Cochrane系统评价方法,计算机检索PubMed、Medline、Cochrane Library等数据库,并手工检索相关文献,查找限制性输血组与开放性输血组比较的随机对照试验(RCT)。检索时间从1980年1月年~2012年10月。采用RevMan 5.1软件进行Meta分析。结果共纳入6个RCT,1 203例患者。结果显示,与开放性输血组相比,限制性输血组患者输血量更少(MD=-1.46,95%CI-1.18~-1.1)和输血人数更少(RR=0.69,95%CI 0.53~0.89);两组在30d死亡率、住院时间、术后并发症等方面差异无统计学意义。由此可见,限制性输血可明显减少患者输血量,降低输血暴露风险。同时,不增加患者的30d内的死亡率和术后并发症,不延长住院时间。     

单肺通气对小儿围手术期炎性细胞因子的影响

目的:观察单肺通气 (OLV) 方式对小儿围手术期炎性细胞因子影响.方法:选择 40 例ASAⅠ～Ⅱ级肺部手术小儿, 随机分为长时间组(Ⅰ组)和间断双肺通气组 (Ⅱ组), 每组20例.两组患者分别在麻醉诱导后(T1)、 OLV 30 min(T2)、 60 min(T3)及术后 2 h(T4)采取静脉血, 测定血清肿瘤坏死因子α(TNF-α)、白细胞介素(IL-6、 IL-8、 IL-10)浓度.用Datex-Ohmeda Anesttesia Delivery Unit(ADU)监测呼吸力学参数: 气道锋压(Ppeak)、气道平台压(Pplat)、气道阻力(Raw)、分钟通气量(MV)等.结果:两组TNF-α、 IL-6、 IL-8和 IL-10于 T3时明显上升(P<0.05), Ⅱ组T3、 T4时TNF-α和IL-8均明显低于Ⅰ组(P<0.05), 而 IL-10高于Ⅰ组(P<0.05).两组患儿呼吸动力学参数比较无统计学差异.结论:单肺通气期间间断双肺通气可减轻小儿围手术期炎性反应.     

非通气侧肺持续中低流量给氧在老年胸腔镜肺癌根治术中的应用

目的 探讨非通气侧肺持续中低流量给氧在老年胸腔镜肺癌根治术中的临床应用效果。方法 选择广西医科大学附属武鸣医院接受胸腔镜治疗的老年肺癌患者80例,按照随机数字表法将其分为观察组和对照组,每组40例。观察组单肺通气过程中非通气侧肺持续中低流量给氧,对照组非通气侧肺未进行特殊给氧。比较2组单肺通气过程中丙二醛(MDA)、超氧化物歧化酶(SOD)、超敏C反应蛋白(hs-CRP)等氧化应激与炎症指标。比较2组麻醉前、单肺通气时、干预15 min时、给氧干预1 h时及停止单肺通气时动脉血氧分压变化情况。比较2组单肺通气过程中气道平台压(Pplat)、气道峰压(Ppeak)及肺顺应性Cldyn20水平。统计2组麻醉苏醒相关指标和围术期呼吸相关并发症发生情况。结果 单肺通气过程中,观察组SOD水平高于对照组(P<0.05),MDA、hs-CRP水平低于对照组(P<0.05),观察组干预15 min时、给氧干预1 h时及停止单肺通气时动脉血氧分压均高于对照组(P<0.05)。单肺通气过程中观察组Pplat、Ppeak低于对照组(P<0.05),Cldyn20水平高于对照组(P&...     

同步悬空俯卧位对稳定期慢性阻塞性肺疾病患者肺通气功能的影响

探讨同步悬空俯卧位对稳定期慢性阻塞性肺疾病(COPD)患者肺通气功能情况的影响。方法 2009年6月至10月本院门诊就诊的12例稳定期COPD患者,在人工呼吸床上随机采用仰卧位、悬空俯卧位、托平俯卧位、同步悬空俯卧位4种不同体位,每个体位观察10 min,通过NICO无创心肺功能监测系统连续测定患者在不同体位时的心率、动脉血氧饱和度、呼气末二氧化碳分压等一般生命体征和呼吸频率、潮气量、肺泡潮气量、生理无效腔(Vd/Vt)、吸气峰流速(PIF)、呼气峰流速(PEF)等呼吸动力学指标。根据患者的肺功能按美国胸科协会(ATS)和欧洲呼吸学会(ERS)制定的肺功能共同指南标准划分不同阻塞程度,并分析存在通气功能障碍患者的潮气量和呼吸频率等肺功能变化情况。结果 4种体位对心率、动脉血氧饱和度、呼气末二氧化碳分压无明显的影响。呼吸频率在4种体位中由慢至快呈现同步悬空俯卧位＜仰卧位＜托平俯卧位＜悬空俯卧位的趋势[(14.8±3.2)次/min＜(17.6±4.5)次/min ＜(18.4±3.4)次/min＜(19.5±3.4)次/min,均P＜0.05],潮气量和肺泡潮气量由高至低呈现同步悬空俯卧位＞仰卧位＞托平俯卧位＞悬空俯卧位的趋势。生理无效腔、PIF、PEF各组差异无统计学意义。3例重度和5例极重度阻塞通气功能障碍的患者潮气量在各体位间差异均无统计学意义,呼吸频率则在同步悬空俯卧位时最低,分别为(15.3±1.8)次/min、(16.6±1.8)次/min,且与悬空俯卧位时的呼吸频率差异有统计学意义[(19.4±3.4)次/min、(21.4±3.6)次/min,均P＜0.05]。结论 同步悬空俯卧位与其他两种俯卧呼吸体位一样,经短时间观察是安全稳定的,同步悬空俯卧位显著降低患者的呼吸频率、增加潮气量。在阻塞性通气功能障碍的情况下,对潮气量的影响不明显,但仍能降低患者的呼吸频率。     

肺保护性通气策略在早产儿呼吸窘迫综合征机械通气治疗中的应用

目的探讨肺保护性通气策略在早产儿呼吸窘迫综合征（RDS）机械通气治疗中的意义。方法将需进行机械通气治疗的80例早产儿RDS患儿,根据是否应用肺保护性通气策略,随机分成保护通气组（PV组）40例和传统通气组（CV组）40例,对二组呼吸机参数、血气分析结果、呼吸机相关性肺损伤（VALI）发生率及上机时间、氧疗时间、病死率等进行分析。结果（1）PV组呼吸机参数吸气峰压、平均气道压和氧浓度显著低于CV组（P均〈0.05）;呼气末正压高于CV组（P〈0.01）;两组通气频率（RR）差异无显著性（P〉0.05）。（2）PV组PaCO2高于CV组（P〈0.01）;pH低于CV组（P〈0.01）;两组Pa02差异无显著性（P〉0.05）。（3）PV组呼吸机相关性肺损伤的发病率低于CV组（P〈0.05）。（4）两组脑室内出血（IVH）、动脉导管开放（PDA）、慢性肺疾病（CLD）的发生率差异无显著性（P〉0.05）;PV组上机时间、氧疗时间均明显低于CV组（P均〈0.05）。结论实施肺保护性通气策略可改善肺部气体氧合,维持适当血氧分压,显著降低VALI的发生率,缩短上机时间,并不增加IVH、PDA和CLD的发生率,PaCO2维持在可耐受的范围且无副作用。     

术侧不同通气方式对单肺通气期间肺保护作用的研究进展

良好的肺隔离技术是胸科手术顺利进行的保障,单肺通气可导致低氧血症和肺内分流及急性肺损伤。目前,改善低氧血症和肺内分流及急性肺损伤的方法主要有药物应用、麻醉方式、容量治疗和通气模式等方面。对非通气侧肺的研究较少,非通气侧实施持续正压通气或高频喷射通气是胸部手术的一种气道管理策略。该文将对非通气侧行持续正压通气和高频喷射通气两种不同的辅助通气方式对改善肺部并发症的最新研究进展做一综述。     

氧化亚氮在单肺通气时对肺内氧合和动脉血乳酸水平的影响

目的:探讨应用氧化亚氮持续气道内正压在单肺麻醉时对病人氧合、肺内分流和动脉血乳酸水平的影响。方法:择期行肺癌手术病人22例,美国麻醉医生协会(ASA)Ⅰ-Ⅲ级,随机分为对照组(A组)和N₂O组(B组),每组11例。A组在单肺麻醉期间非通气侧肺的支气管导管直接开口于大气中,B组单肺麻醉期间非通气侧持续给予N₂O(压力2cmH₂O),并在仰卧双肺通气20min,仰卧单肺通气20min,侧卧单肺通气20min、40min和关胸时,分别采取动脉血做血气分析并计算分流率(Qs/Qt),同时监测乳酸含量的变化。结果:在单肺麻醉后20min、40min时,B组氧合明显高于A组(P＜0.01),B组分流率(Qs/Qt)明显低于A组(P＜0.05),单肺麻醉后40min时B组乳酸含量明显低于A组(P＜0.05)。结论:单肺麻醉期间,非通气侧持续给予N₂O(压力2cmH₂O),有助于提高氧合,减少肺内分流,可减少低氧血症的发生率。     

右支气管封堵器在胸科单肺通气手术中的应用

目的　评估胸科行右侧肺叶单肺通气手术时,支气管封堵器应用的可行性及安全性。 方法　收集术中需要行右侧肺叶单肺通气的择期胸科手术患者36例,随机分为A、B两组,每组18例,A组插管方法采用传统双腔支气管法,B组采用支气管封堵器法。通过观察插管时间、插管前后生命体征变化、术中肺萎陷的质量、记录插管后、单肺通气20、40、60 min酸碱度（pH）、氧分压（pO2）、二氧化碳分压（pCO2）、及气道压Paw、患者术中出现低氧血症的例数及术后并发症等指标比较两种方法的安全性。 结果　单肺通气后所有患者Paw均升高,但随着时间的延长,B组明显低于A组（P＜0.05）;B术中发生低氧血症及术后发生声音嘶哑等并发症的例数均明显降低（P＜0.05）,差异有统计学意义。 结论　在行右侧肺叶单肺通气的胸科手术中,支气管封堵器法可以解决术中因双腔支气管对位不良而导致术中患者血氧降低的问题,且对气道刺激较小,是一种安全、有效的单肺通气方法。     

血嗜酸性粒细胞计数与冠状动脉旁路移植手术后肺炎风险（英文）

目的:研究血嗜酸性粒细胞计数与冠状动脉旁路移植手术患者术后肺炎风险的关系。方法:收集2008年~2017年在我院进行冠状动脉旁路移植手术的613例患者资料进行分析,比较不同血嗜酸性粒细胞计数患者术后肺炎发生率及住院死亡率,采用多因素回归分析明确患者术后肺炎的危险因素。结果:研究共纳入582例患者,其中220例患者血嗜酸性粒细胞比例2%(低血嗜酸性粒细胞组),362例患者血嗜酸性粒细胞比例≥2%(高血嗜酸性粒细胞组)。低血嗜酸性粒细胞组术后肺炎发生率(14.1%,31/220)明显高于高血嗜酸性粒细胞组(6.4%,23/362,P=0.002),而2组患者住院死亡率无明显差异。多因素回归分析结果显示低血嗜酸性粒细胞计数(OR=3.521,95%CI:1.213~10.223,P=0.021)、鼻胃管(OR=6.490,95%CI:2.757~15.280,P0.001)和机械通气时间≥24 h(OR=3.496,95%CI:1.156~10.178,P=0.035)为术后发生肺炎的独立危险因素。结论:低血嗜酸性粒细胞计数患者冠状动脉旁路移植手术后发生肺炎的风险升高。     

Da-Cheng-Qi Decoction,A Traditional Chinese Herbal Formula,for Intestinal Obstruction: Systematic Review and Meta-Analysis

Background

This study was aimed at determining the effects and safety of Da-Cheng-Qi decoction (DCQD) or DCQD combined with conservative therapy in patients with intestinal obstruction.

Materials and Methods

PubMed, EMBASE, Cochrane Controlled Trials Register, and several other databases were searched. Randomised controlled trials (RCTs) of DCQD or DCQD plus conservative therapy in patients with intestinal obstruction were eligible. Therapeutic effect was estimated by the improvement of clinical manifestations and diagnostic imaging; dichotomous/ordinal data assessment of overall response to therapy, adverse effects; or continuous variable were identified, including time to first bowel movement, time to first flatus, length of hospital stay.

Results

Sixty eligible RCTs including 6,095 patients were identified. Response rate: (1) DCQD versus conservative therapy (6 RCTs, 361 patients, RR of respond =1.13; 95% CI 0.97 to 1.31). (2) DCQD plus conservative therapy versus conservative therapy (48 RCTs, 4,916 patients, RR of respond =1.25 which favoured DCQD plus conservative therapy; 95% CI 1.20 to 1.30). Treatment effect remained similar when RCTs at high risk of bias were excluded. Time to first flatus postoperatively: (1) DCQD versus conservative therapy (2 RCTs, 240 patients, SMD=-3.65; 95% CI −8.17 to 0.87). (2) DCQD plus conservative therapy versus conservative therapy (11 RCTs, 1,040 patients, SMD=−2.09 which favoured DCQD plus conservative therapy; 95% CI −3.04 to −1.15).

Conclusion

DCQD combined with conservative therapy may increase the success rate of conservative therapy for intestinal obstruction significantly and can shorten the duration of postoperative ileus in patients undergoing abdominal surgery compared with conservative therapy alone.     

Assessment of Perioperative Atelectasis Using Lung Ultrasonography in Patients Undergoing Pneumoperitoneum Surgery in the Trendelenburg Position: Aspects of Differences according to Ventilatory Mode

BackgroundDuring robotic gynecologic pneumoperitoneum surgery in the Trendelenburg position, aeration loss leads to perioperative atelectasis. Recently developed ventilator mode pressure-controlled ventilation volume-guaranteed (PCV-VG) mode could provide adequate ventilation with lower inspiratory pressure compared to volume-controlled ventilation (VCV); we hypothesized that PCV-VG mode may be beneficial in reducing perioperative atelectasis via low tidal volume (V_T) of 6 mL/kg ventilation during robotic gynecologic pneumoperitoneum surgery in the Trendelenburg position. We applied lung ultrasound score (LUS) for detecting perioperative atelectasis. We aimed to compare perioperative atelectasis between VCV and PCV-VG with a low V_T of 6 mL/kg during pneumoperitoneum surgery in the Trendelenburg position using LUS.MethodsPatients scheduled for robotic gynecologic surgery were randomly allocated to the VCV (n = 41) or PCV-VG group (n = 41). LUS, ventilatory, and hemodynamic parameters were evaluated at T1 (before induction), T2 (10 minutes after induction in the supine position), T3 (10 minutes after desufflation of CO₂ in the supine position), and T4 (30 minutes after emergence from anesthesia in the recovery room).ResultsEighty patients (40 with PCV-VG and 40 with VCV) were included. Demographic data showed no significant differences between the groups. The total LUS has changed from baseline to T4, 0.63 (95% confidence interval [CI], 0.32, 0.94) to 1.77 (95% CI, 1.42, 2.21) in the VCV group and 0.86 (95% CI, 0.56, 1.16) to 1.43 (95% CI, 1.08, 1.78) in the PCV-VG group (P = 0.170). In both groups, total LUS increased significantly compared to the baseline values.ConclusionUsing a low V_T of 6 mL/kg during pneumoperitoneum surgery in the Trendelenburg position, our study showed no evidence that PCV-VG ventilation was superior to VCV in terms of perioperative atelectasis.Trial RegistrationClinical Research Information Service Identifier: KCT0006404     

Epsilon aminocaproic acid reduces blood transfusion and improves the coagulation test after pediatric open-heart surgery: a meta-analysis of 5 clinical trials

Background: Excessive postoperative blood loss after cardiopulmonary bypass is a common problem, especially in patients suffering from congenital heart diseases. The efficacy of epsilon aminocaproic acid (EACA) as a prophylactic treatment for postoperative bleeding after pediatric open-heart surgery has not been determined. This meta-analysis investigates the efficacy of EACA in the minimization of bleeding and blood transfusion and the maintenance of coagulation tests after pediatric open-heart surgery. Methods: A comprehensive literature search was performed to identify all randomized clinical trials on the subject. PubMed, Embase, the Cochrane Library, and the Chinese Medical Journal Network were screened. The primary outcome used for the analysis was postoperative blood loss. Secondary outcomes included postoperative blood transfusion, re-exploration rate and postoperative coagulation tests. The mean difference (MD) and risk ratio (RR) with 95% confidence intervals (CI) were used as summary statistics. Results: Five trials were included in this meta-analysis of 515 patients. Prophylactic EACA was associated with a reduction in postoperative blood loss, but this difference did not reach statistical significance (MD: -7.08; 95% CI: -16.11 to 1.95; P = 0.12). Patients treated with EACA received fewer postoperative blood transfusions, including packed red blood cells (MD: -8.36; 95% CI: -12.63 to -4.09; P = 0.0001), fresh frozen plasma (MD: -3.85; 95% CI: -5.63 to -2.08; P < 0.0001), and platelet concentrate (MD: -10.66; 95% CI: -18.45 to -2.87; P = 0.007), and had a lower re-exploration rate (RR: 0.46; 95% CI: 0.23 to 0.92; P = 0.03). Prophylactic EACA also improved coagulation tests 6 hours after open-heart surgery. Conclusions: Prophylactic EACA minimizes postoperative blood transfusion and helps maintain coagulation in pediatric patients undergoing open-heart surgery. Therefore, the results of this study indicate that adjunctive EACA is a good choice for the prevention of postoperative blood transfusion following pediatric cardiac surgery.     

Efficacy and harms of convalescent plasma for treatment of hospitalized COVID-19 patients: a systematic review and meta-analysis

IntroductionWe systematically reviewed benefits and harms of convalescent plasma (CP) in hospitalized COVID-19 patients.Material and methodsRandomized controlled trials (RCTs) and observational studies assessing CP effects on hospitalized, adult COVID-19 patients were searched until November 24, 2020. We assessed risk of bias (RoB) using Cochrane RoB 2.0 and ROBINS-I tools. Inverse variance random effect meta-analyses were performed. Quality of evidence was evaluated using GRADE methodology. Primary outcomes were all-cause mortality, clinical improvement, and adverse events.ResultsFive RCTs (n = 1067) and 6 cohorts (n = 881) were included. Three and 1 RCTs had some concerns and high RoB, respectively; and there was serious RoB in all cohorts. Convalescent plasma did not reduce all-cause mortality in RCTs of severe (RR = 0.60, 95% CI: 0.33–1.10) or moderate (RR = 0.60, 95% CI: 0.09–3.86) COVID-19 vs. standard of care (SOC); CP reduced all-cause mortality vs. SOC in cohorts (RR = 0.66, 95% CI: 0.49–0.91). Convalescent plasma did not reduce invasive ventilation vs. SOC in moderate disease (RR = 0.85, 95% CI: 0.47–1.55). In comparison to placebo + SOC, CP did not affect all-cause mortality (RR = 0.75, 95% CI: 0.48–1.16) or clinical improvement (HR = 1.07, 95% CI: 0.82–1.40) in severe patients. Adverse and serious adverse events were scarce, similar between CP and controls. Quality of evidence was low or very low for most outcomes.ConclusionsIn comparison to SOC or placebo + SOC, CP did not reduce all-cause mortality in RCTs of hospitalized COVID-19 patients. Convalescent plasma did not have an effect on other clinical or safety outcomes. Until now there is no good quality evidence to recommend CP for hospitalized COVID-19 patients.     

Efficacy and safety of treatment with biologicals for severe chronic rhinosinusitis with nasal polyps: A systematic review for the EAACI guidelines

This systematic review evaluates the efficacy and safety of biologicals for chronic rhinosinusitis with nasal polyps (CRSwNP) compared with the standard of care. PubMed, Embase, and Cochrane Library were searched for RCTs. Critical and important CRSwNP-related outcomes were considered. The risk of bias and the certainty of the evidence were assessed using GRADE. RCTs evaluated (dupilumab-2, omalizumab-4, mepolizumab-2, and reslizumab-1) included 1236 adults, with follow-up of 20–64 weeks. Dupilumab reduces the need for surgery (NFS) or oral corticosteroid (OCS) use (RR 0.28; 95% CI 0.20–0.39, moderate certainty) and improves with high certainty smell evaluated with UPSIT score (mean difference (MD) +10.54; 95% CI +9.24 to +11.84) and quality of life (QoL) evaluated with SNOT-22 (MD −19.14; 95% CI −22.80 to −15.47), with fewer treatment-related adverse events (TAEs) (RR 0.95; 95% CI 0.89–1.02, moderate certainty). Omalizumab reduces NFS (RR 0.85; 95% CI 0.78–0.92, high certainty), decreases OCS use (RR 0.38; 95% CI 0.10–1.38, moderate certainty), and improves high certainty smell (MD +3.84; 95% CI +3.64 to +4.04) and QoL (MD −15.65; 95% CI −16.16 to −15.13), with increased TAE (RR 1.73; 95% CI 0.60–5.03, moderate certainty). There is low certainty for mepolizumab reducing NFS (RR 0.78; 95% CI 0.64–0.94) and improving QoL (MD −13.3; 95% CI −23.93 to −2.67) and smell (MD +0.7; 95% CI −0.48 to +1.88), with increased TAEs (RR 1.64; 95% CI 0.41–6.50). The evidence for reslizumab is very uncertain.     

Influence of perioperative opioid-related patient education: A systematic review and meta-analysis

ObjectiveTo determine the role of perioperative protocolized opioid-specific patient education on opioid consumption for individuals undergoing surgical procedures.MethodsWe searched Medline, Embase, and the Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs) that compared protocolized perioperative opioid-specific patient education to the usual care for adult individuals undergoing surgical interventions. The standardized mean difference (SMD) was used to represent continuous outcomes while the risk ratio (RR) was used to represent dichotomous outcomes.ResultsIn total, 15 RCTs that enrolled 2546 participants were deemed eligible. Protocolized opioid-specific patient education showed a significant reduction in postoperative opioid consumption and postoperative pain score compared to usual care (SMD= –0.15, 95% confidence interval [CI]: –0.28 to –0.03 and SMD= –0.17, 95% CI: –0.28 to –0.06, respectively). No significant difference was found between the protocolized opioid-specific patient education and the usual care in terms of the number of refill requests (RR=0.82, 95% CI: 0.50–1.34), patients with opioid leftovers (RR=0.92, 95% CI: 0.78–1.08), and patients taking opioids after hospital discharge.ConclusionsThis meta-analysis demonstrated that protocolized opioid-specific patient education significantly reduces postoperative opioid consumption and pain score but has no influence on the number of opioid refill requests, opioid leftovers, and opioid use after hospital discharge.Practice implicationsHealthcare professionals may offer opioid-related educational sessions for the surgical patients during the perioperative period through a video-based material that emphasizes the role of alternative analgesics to opioids, patients’ expectations about the post-operative pain, and the potential side effects of opioid consumptions.     

Negative pressure wound therapy for surgical site infections: a systematic review and meta-analysis of randomized controlled trials

ObjectivesPrevious studies showed the effectiveness of negative pressure wound therapy (NPWT) in preventing surgical site infections (SSIs), but current guidelines do not recommend its routine use for surgical wounds. The aim was to compare the effectiveness and safety of NPWT with standard surgical dressing or conventional therapy for preventing SSIs.MethodsPubmed, Embase and the Cochrane Library were systematically searched on 10 April 2019. Also, we searched clinicaltrials.gov and references of relevant studies. Eligibility criteria were randomized controlled trials (RCTs) and adult surgical patients were included. The effectiveness of NPWT versus standard surgical dressing or conventional therapy was investigated. Relative risks (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were used to estimate the pooled effect of dichotomous outcomes and continuous outcomes respectively. The primary outcome was surgical site infections. The quality of included studies and the certainty of the evidence were assessed using the risk of bias tool and the GRADE approach.ResultsA total of 45 RCTs with 6624 surgical patients were included. NPWT reduced SSIs (RR 0.58; 95% CI 0.49–0.69) and wound dehiscence(17 RCTs; RR 0.80; 95% CI 0.65–1.00). NPWT did not increase the risk of hematoma (9 RCTs; RR 0.91; 95% CI 0.40–2.07) and hospital readmission(9 RCTs; RR 0.77; 95% CI 0.52–1.12) or prolong length of hospital stay(15 RCTs; MD –0.38; 95% CI, –0.78 to 0.02). NPWT significantly increased the risk of all adverse event-related outcomes (10 RCTs; RR 3.21; 95% CI, 1.17–8.78). The level of certainty was identified as low for the primary outcome and very low for all the secondary outcomes.ConclusionsCompared with standard wound care, NPWT may reduce the risk of SSIs. We are uncertain whether NPWT reduces or increases the risk of wound dehiscence, haematoma, hospital readmission and all adverse event-related outcomes or if it shortens or prolongs length of hospital stay.     

俯卧位通气在复杂先天性心脏病患儿延迟关胸术后低氧血症的应用

目的 探讨俯卧位通气在复杂先心病患儿延迟关胸术后低氧血症的应用效果。方法 回顾性分析2017年1月~2018年12月我院行延迟关胸的34例复杂先天性心脏病患儿的临床资料，对低氧血症患儿实行俯卧位通气，比较第1次俯卧位通气前（T1）、俯卧位0.5 h（T2）、俯卧位1 h（T3）、俯卧位2 h（T4）患儿血气指标[氧分压（PaO2）、二氧化碳分压（PaCO2）、动脉血氧饱和度（SaO2）、乳酸（Lac）]变化及生命体征[心率（HR）、动脉血压（ABP）、中心静脉压（CVP）、呼吸频率（RR）、血氧饱和度（SpO2）]变化。结果 T2~T4时间点PaO2、SaO2均较T1升高，PaCO2、Lac均较T1下降，差异有统计学意义（P＜0.05）。不同时间点HR、ABP、CVP、RR比较，差异无统计学意义（P＞0.05）；T2~T4时间点SpO2较T1升高，差异有统计学意义（P＜0.05）。结论 俯卧位通气可改善复杂先天性心脏病患儿的低氧血症，改善血气指标，是临床可行的支持治疗手段。     

经皮肾镜碎石术术中肾盂内压对预测术后感染的影响

目的 探讨经皮肾镜碎石术（PCNL）术中肾盂内压对术后感染的影响。方法 回顾性分析2017年12月~2018年2月我院79例行PCNL患者的临床资料,根据PCNL术后感染情况分为术后感染组（14例）和术后正常组（65例）,比较两组临床特点及术中肾盂内压力变化对术后感染的影响。结果 两组年龄、性别、高血压病史、糖尿病病史、体重指数、结石大小及术中失血量比较,差异无统计学意义（P＞0.05）;两组手术时间、IPP比较,差异有统计学意义（P＜0.05）。多因素Logistic分析结果显示,手术时间和IPP是PCNL术后感染的危险因素。ROC曲线分析结果显示,IPP最佳截断值为37.5 mmHg,敏感性为56.92%,特异性为96.89%,曲线下面积为0.865,95%CI:0.704~0.946;手术时间最佳截断值为59.92 min,敏感性为52.31%,特异性为92.86%,曲线下面积为0.821,95%CI:0.738~0.984。结论 术中肾盂内压及手术时间是PCNL术后感染的独立危险因素,因此需监控IPP,避免因IPP过高引起术后感染。