肥胖对胃癌患者术后短期结局的影响

目的探讨肥胖对胃癌患者手术操作及术后短期结局的影响。方法将2006年1月至2008年6月青岛大学医学院附属医院经手术治疗的胃癌患者426例,按入院时人体质量指数（BMI）分为肥胖组（127例,BMI大于或等于25）与非肥胖组（299例,BMI小于25）,予以CT测量脐水平腹部皮下脂肪（SCF）厚度、腹部前后径（APD）和腹部横径（TD）,记录手术时间、术中出血量、术后发热天数、术后腹腔引流量、术后并发症发生率、住院死亡率和住院时间及住院费用．并进行统计学分析。结果胃癌患者中肥胖并发率为29．8％。肥胖组和非肥胖组SCF分别为（21．8±7．1）mm和（14．4±7．5）mm;APD分别为（223．2±24．6）mm和（181．8±23．5）mm,TD分别为（323．6±23．8）mm和（285．8±24．4）mm,差异均具有统计学意义（P=0．000）。肥胖组和非肥胖组的手术时间分别为（182．6±100．4）min和（157．1±46．2）min（P=0．007）;淋巴结清扫数目分别为（17．0±9.3）枚和（21．7±10．9）枚（P=0．000）;术后发热时间分别为（3．0±1．4）d和（2．4±1．4）d（P=0．000）：术后并发症发生率分别为22．8％和12．0％（P=0．005）;住院时间分别为（17．4±12．9）d和（15．0±9．0）d（P=0．029）。两组住院死亡率差异无统计学意义（P=0．702）。结论CT扫描可直观显示胃癌患者的腹部形态．有助于判断手术的难度。肥胖可使胃癌手术操作难度和术后并发症发生率增加．影响其术后短期结局。     

体质指数与腰椎间盘突出症术后疗效的关系

目的探讨体质指数(bodymassindex,BMI)与腰椎间盘突出症手术疗效的关系。方法研究对象为住院行腰椎间盘突出症手术治疗的患者,共448例。术前记录患者身高、体重,并计算BMI(体重/身高2,kg/m2)。根据BMI将患者分为三组:正常组BMI<24,超重组BMI为24～28,肥胖组BMI>28。根据北美脊柱协会制定的60项指标结合临床实际制定出疗效评价量表,调查术后症状、体征、术后生活能力及术后恢复工作情况。结果全部病例均获随访,随访时间2.08～5.16年,平均2.48年。正常组较肥胖组的术后改善率好,差异有显著性(P<0.01或P<0.05);三组间术后腰部疼痛程度和下肢麻木程度比较差异无显著性(P>0.05);术后恢复工作能力方面正常组较肥胖组好(P<0.05);生活能力方面三组间差异无显著性(P>0.05);男女患者在改善率、术后腰部疼痛和术后下肢麻木程度上差异有显著性(P<0.05或P<0.01)。结论BMI过高,即肥胖是腰椎间盘手术的不利因素,特别对于女性患者,减轻体重可能是术后康复的重要内容之一。     

Late outcome after surgical management of carotid body tumors from a 20-year single-center experience

Background and aims  Surgical resection is the treatment of choice for carotid body tumors. The aim of this study was to assess not only the perioperative, but also the long-term outcome after surgical treatment. Patients/methods  All patients that were operated on a carotid body tumor at our institution between 1986 and 2006 were reviewed. Data collection included patient profile, intraoperative findings and postoperative outcome. Results  Seventeen patients (11 female, six male) with 17 carotid body tumors (12 right, five left sided) were identified. Mean patient age at treatment was 49 years (range 19 to 76 years). Eight patients (47.1%) had large Shamblin type III tumors. Complete tumor resection was achieved in 16 of 17 cases (94.1%). Malignacy could not be proven in any patient. The 30-day mortality and stroke rates were 0. The incidence of temporary and permanent cranial nerve deficit was 41.2% and 11.8%, respectively. Patients with type III tumors had significantly higher risk of neurologic complications than patients with smaller tumors (p = 0.0152). The median postoperative follow-up was 6.4 years (range 1.5 to 20 years). The overall survival rate was 82.4%; the disease-specific survival rate was 94.1% (16 of 17 patients). One patient (5.6%) died of local tumor recurrence 3 years after a R1 resection. All the other patients showed no signs of local recurrence or metastases. Conclusions  The surgical therapy of carotid body tumors shows low long-term morbidity, mortality, and recurrence rates. Cranial nerve injury is mostly temporary but a relevant procedure-related complication. Surgical resection is indicated also for small, asympomatic tumors, because of the uncomplicated resectability of these tumors. Presented at the Annual Scientific Congress of the German, Swiss and Austrian Societies for Vascular Surgery, Basel Switzerland, September 2007.     

Relationship of shuttle walk test and lung cancer surgical outcome

Objective: Surgery remains the treatment of choice in patients with potentially resectable lung carcinoma. Both the British Thoracic Society and American Chest Physician guidelines for the selection of patients with lung cancer surgery suggest the use of a shuttle walk test to predict outcome in patients with borderline lung function. The guidelines suggest that if the patient is unable to walk 250 m during a shuttle walk test, they are high risk for surgery. However, there is no published evidence to support this recommendation. Therefore, we undertook a prospective study to examine the relationship between shuttle walk test and surgical outcome in 139 patients undergoing assessment for possible lung cancer surgery. Methods: The shuttle walk test was performed in 139 potentially resectable patients, recruited over a 2 year period, prior to surgery. One hundred and eleven patients underwent surgery. Outcome of surgery, including duration of hospital stay, complication and mortality rates was recorded. Student's t-test was used to compare the shuttle walk distance in patients with good and poor outcome from surgery. Results: Mean age of patients undergoing surgery was 69 years (42–85). Mean shuttle walk distance was 395 m (145–780), with a mean oxygen desaturation of 4% (0–14) during the test. Sixty nine patients had a good surgical outcome and 34 had a poor outcome. The shuttle walk distance was not statistically different in the two outcome groups. Conclusion: Shuttle walk distance should not be used to predict poor surgical outcome in lung cancer patients, contrary to current recommendations. It is therefore advisable to perform a formal cardiopulmonary exercise test if at all possible. The usefulness of a shuttle walk test might be improved. It could be compared to a predicted value, as for a formal cardiopulmonary exercise test.     

Increased skin autofluorescence after colorectal operation reflects surgical stress and postoperative outcome

Background

Abdominal surgery is a major oxidative stress effector. The increase in oxidative stress has been related to postoperative complications. Oxidative stress leads to the formation and accumulation of oxidation protein end products, which exhibit autofluorescence (AF) and induce inflammatory reactions.

Methods

Skin AF was assessed perioperatively in 40 consecutive colorectal surgery patients until discharge. Duration of surgery, estimated blood loss, and urinary production per hour were analyzed as measures of surgical stress. The clinical occurrence of anastomotic leakage, systemic infections, and cardiopulmonary complications within 30 days of surgery were analyzed.

Results

A perioperative increase in skin AF of 19 ± .2% was observed. Duration of operation and blood loss were independently associated with the perioperative increase in skin AF. Skin AF correlated with C-reactive protein levels postoperatively. American Society of Anesthesiologists classification, duration of operation, and preoperative and perioperative increases in AF were independently associated with postoperative complications.

Conclusions

This is the first study to demonstrate an association between skin AF and surgical stress and outcomes, which may rate the condition of a patient after operation.     

Obesity does not adversely affect the outcome of laparoscopic antireflux surgery (LARS)

Background: Because it has been suggested that obesity adversely affects the outcome of LARS, it is unclear how surgeons should counsel obese patients referred for antireflux surgery. Methods: A prospective database of patients undergoing LARS from 1992 to 2001 was used to compare obese and nonobese patients. Patients were surveyed preoperatively and annually thereafter. Questionnaires were completed regarding global symptoms and overall satisfaction. Results: Of the 505 patients, the body mass index (BMI) was <25 (normal) in 16%, 25–29 (overweight) in 42%, and >30 (obese) in 42%. Although the operative time was longer in the obese group than in the normal weight group (137 ± 55 min vs 115 ± 42 min, p = 0.003), the time to discharge and rate of complications did not differ. At a mean follow-up of 35 ± 25 months, there were no differences in symptoms, overall improvement, or patient satisfaction. Further, the rates of anatomic failure were similar among the obese, overweight, and normal weight groups. Conclusions: Although the operative time is longer in the obese, complication and anatomic failure rates are similar to those in the nonobese at long-term follow-up. Obese patients have equivalent symptom relief and are equally satisfied postoperatively. Therefore, obesity should not be a contraindication to LARS. Presented at the annual meeting of the Association of Academic Surgeons, Boston, MA, USA, November 2002     

门静脉高压症外科手术治疗的疗效评估

目的 分析和评价外科手术治疗门静脉高压症并发食管胃底曲张静脉破裂出血的疗效.方法 对1996年1月至2007年10月收治的149例门静脉高压症患者的临床资料进行回顾性分析,其中男性119例,女性30例,男女比例为3.97:1;年龄19～73岁,平均(48.0±10.6)岁.Child-Pugh分级A级110例,B级39例.根据手术方式不同分为断流组(n=85)和分流组(n=64).结果 115例患者获得随访(随访率78.8%),平均随访时间(46.3±30.4)个月.术后1、3、5和10年生存率分别为95.6%、88.7%、83.4%和65.1%,其中断流组术后1、3、5和10年生存率分别为95.4%、87.7%、80.6%和56.3%,分流组则为95.8%、90.1%、86.8%和72.6%,两组差异无统计学意义(P>0.05).多元回归分析结果显示,Child-Pugh分级是影响术后生存时间的重要因素,Child A级患者与Child B级患者的术后生存时间的差异有统计学意义(P<0.01).随访期间再出血率为20.9%,其中断流组22.7%,分流组18.4%,分流组1、3、5年再出血率明显好于断流组(P<0.05).全组肝性脑病发生率为7.0%,其中断流组6.9%,分流组6.1%,两组差异无统计学意义(P>0.05).脾肾分流手术后门静脉压力、内径、流量均有显著下降(P<0.05),但仍保持向肝性血流.结论 分流术和断流术并不影响患者术后长期生存时间,惟一影响因素是术前肝功能Child-Pugh分级;个体化脾肾分流控制食管胃底静脉曲张破裂出血的疗效明显好于断流手术.     

A contemporary evaluation of surgical outcome in neonates and infants undergoing lung resection

Background/Purpose

The timing and need of resection of asymptomatic congenital lung lesions are controversial. The morbidity of such surgery needs to be considered in the decision analysis. We analyzed the contemporary outcome of infants and neonates undergoing lung resection.

Methods

With institutional review board approval, all patients 12 months or younger undergoing lung resection between 1995 and 2004 in 2 hospitals were reviewed. Demographic data, indications for surgery, operative procedure, complications, use of regional anesthesia, length of stay (LOS), and follow-up were assessed.

Results

Forty-five patients (28 male, 17 female) with a median age of 4 months (2 days-12 months) were evaluated. Congenital lesions (42) were the most frequent indication for surgery. Twenty-two (48.9%) patients had cardiorespiratory symptoms or infection preoperatively. Lobectomy was the most common operation (40/45). Three patients had intraoperative difficulty (bleeding, hypotension, desaturation). Significant postoperative complications occurred in 7 patients: prolonged air leak or chest tube drainage (4), anemia or bleeding (2), respiratory distress requiring reintubation (1). Fewer complications occurred in asymptomatic vs symptomatic patients (1/23 vs 6/22). Of 12 patients, 7 (58%) requiring 24 hours of ventilation or longer were 3 months or younger. Increasing age did significantly influence the chance of successful extubation (P = .01; odds ratio, 1.5; 95% confidence interval, 1.0-2.0), as did the use of epidural anesthesia (P < .001). Median LOS was 6 days (2-89 days). Asymptomatic patients had shorter LOS (median, 4 days; range, 2-20 days; P = .024) vs symptomatic patients (median, 8 days; range, 4-89 days). The only death occurred from underlying heart disease. Mean follow-up at 35 months (12-132 months) revealed no subjective reduction in cardiopulmonary function.

Conclusions

Lung resection is safe and well tolerated in infancy. Surgery should be scheduled before the development of symptoms but likely after 3 months of age to improve the chances of postoperative extubation. The use of regional anesthesia may facilitate this.     

不同麻醉方法对行腹腔镜前列腺癌根治术患者认知功能的影响

目的比较靶控输注丙泊酚瑞芬太尼全凭静脉麻醉、七氟醚和瑞芬太尼静吸复合麻醉及七氟醚加芬太尼复合腰硬联合麻醉对行腹腔镜前列腺癌根治术患者术后认知功能的影响。方法选择ASAⅠ～Ⅱ级,年龄60-75岁行择期腹腔镜前列腺癌根治术患者60例,随机分为靶控输注丙泊酚瑞芬太尼全凭静脉麻醉组（PR组）,七氟醚和瑞芬太尼静吸麻醉组（SR组）和七氟醚加瑞芬太尼复合腰硬联合麻醉组（CS组）,每组20例。在麻醉诱导前、术后1h、3h、5h和24h应用简易智力状态检查（MMS）测试方法评定其认知功能。结果三组患者各时间点MMS评分组间比较差异无统计学意义（P〉0．05）：三组患者在术后1h均较术前显著降低（P〈0．05）,PR组、SR组和CS组分别有4例（20％）、有7例（35％）,3例（15％）患者有明显的认知功能降低;术后3hPR组和SR组分别有2例（10％）和有3例（15％）MMS分值较低,CS组基本恢复至术前水平;术后5h和24h三组MMS评分恢复至术前水平。结论在腹腔镜前列腺癌根治术后均可引起一过性的术后认知功能障碍,三种麻醉方法的影响相似。     

七氟醚麻醉通过c-fos和神经振荡影响小鼠苏醒期恐惧记忆

目的 探讨c-fos和神经振荡在七氟醚麻醉小鼠苏醒期恐惧记忆中的作用。
方法 选择SPF级雄性成年C57BL/6小鼠270只,8～10周龄,体重18～24 g。将小鼠随机分为三组：A组吸入2.5%七氟醚麻醉2 h;B组吸入2.5%七氟醚麻醉6 h;C组吸入2.5%七氟醚麻醉2 h,连续3 d,每组90只。所有小鼠先进行恐惧条件实验训练,训练后1 d进行相应的七氟醚麻醉处理,记录麻醉停止到翻正反射出现（苏醒）的时间。于麻醉前30 min（T₀）、翻正反射出现后5 min（T₁）、30 min（T₂）和60 min（T₃）对小鼠进行恐惧条件实验测试,记录冻结时间百分比。于T₀、T₁时进行旷场试验,记录小鼠运动总路程和在中心区域停留时间。A组随机另取6只小鼠于麻醉前1周在海马组织植入微电极,后将小鼠放回原来的笼子恢复1周,于T₀—T₃时记录Delta、Theta、Alpha、Beta和Gamma波相对能量值。于T₀—T₃时采用免疫荧光法检测海马组织c-fos阳性细胞数,采用Western blot法记录海马组织c-fos蛋白相对含量。
结果 与T₀时比较,T₁时A组和B组冻结时间百分比明显升高（P＜0.05）,B组中心区域停留时间明显缩短（P＜0.05）。B组停止麻醉到翻正反射出现的时间明显长于A组（P＜0.05）,T₁时冻结时间百分比明显低于A组（P＜0.05）,T₁时中心区域停留时间明显短于A组（P＜0.05）。C组停止麻醉到翻正反射出现的时间明显短于B组（P＜0.05）,T₁时冻结时间百分比明显低于A组和B组（P＜0.05）,T₁时中心区域停留时间明显长于B组（P＜0.05）。与T₀时比较,A组T₁时Theta波和T₁、T₂时Gamma波相对能量值明显升高（P＜0.05）,T₁时海马CA1区c-fos阳性细胞数明显增多（P＜0.05）,T₁时海马组织c-fos蛋白相对含量明显升高（P＜0.05）。与T₁时比较,A组T₃时Theta波和T₂、T₃时Gamma波相对能量值明显降低（P＜0.05）,T₂、T₃时海马CA1区c-fos阳性细胞数明显减少（P＜0.05）。
结论c-fos表达上调和神经振荡增强参与单次短时间吸入七氟醚增强小鼠苏醒短时间内恐惧记忆的过程,但这一效应随着苏醒后时间的延长而逐渐消失。     

Higher preoperative Oswestry Disability Index is associated with better surgical outcome in upper lumbar disc herniations

To evaluate the surgical outcome in terms of functional and subjective recovery, patients who needed discectomies at L1–L2, L2–L3 and L3–L4 levels were compared with an age and sex-matched group of patients who required L4–L5 and L5–S1 discectomies. We prospectively enrolled 50 consecutive patients, referred to our center, who had L1–L2, L2–L3 and L3–L4 herniations and required surgical intervention. Likewise, a comparative group of 50 consecutive patients with herniations at L4–L5 and L5–S1 were selected. All 100 patients were treated and followed for a 1 year period. Physical examination findings as well as Oswestry Disability Questionnaire before surgery were recorded. After 1 year, patients were requested to fill the same questionnaire. Significant decline in the Oswestry Disability Index (ODI) scores was considered to be a measure of functional improvement and recovery. The mean age of patients with upper lumbar disc herniation (L1–L2, L2–L3, L3–L4) was 45.7 years and patients with lower lumbar disc herniation (L4–L5, L5–S1) had a mean age of 41.2 years. There was no statistically significant difference in age between the two groups. The preoperative Oswestry Disability (ODI) Index score had a statistically significant impact on ODI score improvement after surgery in both lower and upper lumbar disc groups. All 100 patients with either lower or upper lumbar disc herniation had statistically significant ODI change after surgical intervention (P < 0.0001 for both groups). However, patients with upper disc herniations and moderate preoperative disability (ODI of 21–40%) did not show significant improvement, while patients with ODI greater than 40% had significant reduction (P = 0.018). Surprisingly, as many as 25% of the former had even an increase in ODI scores after surgery. Gender was also a conspicuous factor in determining the surgical outcome of patients with upper lumbar disc herniation, and male patients had more reduction in ODI score than female patients (P = 0.007). Since the functional recovery in patients with herniated lumbar disc, especially upper lumbar herniation, is influenced by preoperative ODI scores, the use of ODI or any other standard pain assessment tool is a sensible consideration as an inherent investigative method to preclude unfavorable surgical outcome.     

Obesity as defined by waist circumference but not body mass index is associated with higher renal mass complexity

Objectives

Obesity, typically defined as a body mass index (BMI)≥30 kg/m², is an established risk factor for renal cell carcinoma (RCC) but is paradoxically linked to less advanced disease at diagnosis and improved outcomes. However, BMI has inherent flaws, and alternate obesity-defining metrics that emphasize abdominal fat are available. We investigated 3 obesity-defining metrics, to better examine the associations of abdominal fat vs. generalized obesity with renal tumor stage, grade, or R.E.N.A.L. nephrometry score.

手术去毛法的实验及临床研究

目的观察去除多厚的真皮组织及其内的毛囊毛发才不至于再生。方法以五指山小型猪为实验对象,去除不同厚度的真皮组织及其内的毛囊观察猪毛的再生情况,并根据其结果在临床上去除一定厚度的头皮真皮组织及毛囊。结果去除２／３的真皮组织及其内的毛囊可阻止猪毛再生。１９９５年１月至１９９６年１２月,对６２例患者,根据不同年龄去除１／４～２／５的真皮组织及相应的毛囊达到满意的临床效果。结论手术去毛法是一简单、有效、可靠的方法。     

Percutaneous stone surgery in the obese: outcome stratified according to body mass index

OBJECTIVE: To report our experience of percutaneous surgery for treating renal pelvicalyceal stones over 6 years, to show that this approach is feasible and safe in obese and morbidly obese patients, as the prevalence of obesity and stone disease has risen in the last 20 years. PATIENTS AND METHODS: We retrospectively reviewed the results of 223 percutaneous nephrolithotomies (PCNLs) by one urologist between 1995 and 2001. Patients were stratified into four groups according to the World Health Organization classification of body mass index (BMI), i.e. <25, 25-29.9 (overweight), 30-39.9 (obese) and > 40 kg/m(2) (morbidly obese). The outcomes of surgery in these four groups were compared. RESULTS: There were no statistically significant differences in operative duration, decrease in haemoglobin concentration, postoperative analgesic use, hospital stay and stone-free rates; nor was there a higher complication rate in patients who were obese. CONCLUSION: The outcome of PCNL is independent of the patients' BMI and results can be favourable in most patients. We therefore advocate treating obese patients with symptomatic stone disease based on individual status, using percutaneous surgery where appropriate.     

不同麻醉药物诱导用于小儿气管镜检异物取出术的比较

目的比较七氟醚、丙泊酚和氯胺酮麻醉诱导用于小儿支气管镜检异物取出术的效果。方法急诊支气管镜检异物取出术患儿30例,年龄9~58个月,采用随机数字表法将患儿分为三组:七氟醚组(S组),丙泊酚组(P组)和氯胺酮组(K组),每组10例。S组采用8%七氟醚吸入诱导;P组采用丙泊酚2.5mg/kg缓慢静脉注射诱导;K组采用氯胺酮5mg/kg肌肉注射诱导;三组诱导至意识消失后均以保留自主呼吸为准则,喉镜开口实施利多卡因咽喉部表面麻醉;术中采用靶控输注丙泊酚和瑞芬太尼维持麻醉,面罩吸氧后置入气管镜。记录一次置入气管镜成功率,置入气管镜前后即刻HR和SpO2,置入气管镜时间、气管镜检时间和术后苏醒时间,置入气管镜和术中不良反应发生情况。结果 S组和P组成功置入气管镜的时间、术后苏醒时间明显短于K组(P0.05);S组一次置管成功率明显高于K组(P0.05)。三组患儿不良反应发生率差异无统计学意义。结论与丙泊酚静脉注射和氯胺酮肌肉注射麻醉诱导比较,七氟醚诱导麻醉在婴幼儿气管镜检异物取出术中具有诱导快、苏醒快等优点。     

手术去毛法的实验及临床研究

目的观察去除多厚的真皮组织及其内的毛囊毛发才不至于再生。方法以五指山小型猪为实验对象,去除不同厚度的真皮组织及其内的毛囊观察猪毛的再生情况,并根据其结果在临床上去除一定厚度的头皮真皮组织及毛囊。结果去除2/3的真皮组织及其内的毛囊可阻止猪毛再生。1995年1月至1996年12月,对62例患者,根据不同年龄去除1/4～2/5的真皮组织及相应的毛囊达到满意的临床效果。结论手术去毛法是一简单、有效、可靠的方法。     

Functional outcome after surgical treatment of perilunate injuries: A series of 12 cases

PurposePerilunate injuries (PLIS) are complex injuries, which are frequently missed in the initial setting, and delayed presentation leads to poor functional outcomes. In this study, we are presenting our experience of treating these injuries by surgical treatment and the effect of neglect on their outcome.Materials and methodsIn this retrospective study, 11 patients with 12 PLIS, which presented to our center from January 1, 2000 to December 31, 2012 were included. They were managed surgically as open reduction and internal fixation. Function was documented by using Mayo score. To ascertain the effect of the delay/neglect on the outcome, the patients were divided into two groups according to time between day of injury and final surgery (group I – operated within 6 weeks of injury and group II – treated after 6 weeks of injury).ResultsAverage postoperative Mayo score was 76.4. Average Mayo score in group I was 93.7 (90–95). Average Mayo score in group II was 67.1 (60–75). Although functional result as Mayo score was significantly better in group I (p value <0.5) even chronic or delayed group patients also had good to fair results.ConclusionEarly diagnosis and treatment of such injuries should be emphasized as delay in treatment leads to progressive poor results. Well-planned surgical management gives good functional results even in delayed cases.     

手术体积描计指数联合熵指数监测对关节镜肩袖修补术中循环及早期转归的影响

目的探讨手术体积描计指数(SPI)联合熵指数麻醉深度监测对关节镜肩袖修补患者术中循环及早期转归的影响。方法选择择期行关节镜肩袖修补手术患者60例,男31例,女29例,年龄18～65岁,BMI 18～28 kg/m~2,ASAⅠ或Ⅱ级。采用随机数字表法分为两组:标准组(S组)和多模式组(M组),每组30例。S组术中采用常规监测;M组在S组的基础上联合SPI和熵指数监测[以状态熵(SE)为主要监测参数]。记录瑞芬太尼和丙泊酚用量和调控次数。记录麻醉诱导前(T_1)、插管前10 s(T_2)、插管完成时(T_3)、切皮时(T_4)、缝皮时(T_5)和拔管时(T_6)M组SPI、SE值和两组HR、MAP。记录自主呼吸恢复时间、拔管时间、首次下床活动时间、首次进流食时间和住院时间。记录术后6 h(T_7)、12 h(T_8)、24 h(T_9)、48 h(T_(10))、1周(T_(11))及1个月(T_(12))的加州大学肩关节(UCLA)评分和NRS评分。记录术中知晓、苏醒延迟、术后躁动、术后喉痉挛、术后寒颤、术后恶心呕吐和伤口愈合不良等并发症的发生情况。结果与T_1时比较,T_2—T_6时M组SPI和SE值明显降低(P0.01);T_2、T_5时两组HR明显减慢(P0.05),T_3时两组HR明显增快(P0.05),T_6时S组HR明显增快(P0.05);T_2、T_4、T_5时两组MAP明显降低(P0.05),T_3时S组MAP明显升高(P0.05)。与S组比较,M组T_2时HR明显增快,MAP明显升高(P0.05),T_3、T_6时HR明显减慢,MAP明显降低(P0.05),T_5时MAP明显升高(P0.05);M组瑞芬太尼和丙泊酚用量明显减少(P0.01),调控次数明显增加(P0.01),自主呼吸恢复时间、拔管时间、首次下床活动时间、首次进流食时间和住院时间明显缩短(P0.01);T_9—T_(10)时M组UCLA评分明显升高(P0.01),T_9—T_(11)时M组NRS评分明显降低(P0.01)。两组并发症发生率差异无统计学意义。结论 SPI联合熵指数能有效监测全麻镇痛和镇静深度,利于指导术中用药,促进肩关节镜手术患者早期康复,不增加并发症。     

Understanding the reliability of trial outcome measures: The example of angiographic results of surgical or endovascular treatments of aneurysms

BackgroundThe reliability of outcome measures is of central importance in clinical research. Studies of reliability remain rare in the neurovascular field.MethodsA narrative review of the history (1997–2021) of reporting angiographic results of the surgical or endovascular treatments of aneurysms serves to illustrate the importance of precisely defining outcome measures. We also review how the reliability of an angiographic classification system was studied.DiscussionOutcome measures are commonly used without precise definitions. When definitions or classification systems exist, they are rarely verified for their reliability. Twenty-five years following its introduction, a classification of angiographic results of aneurysm treatments is still being studied and modified.ConclusionThe reliability of outcome measures should be made a research priority if we are to practice outcome-based medical or surgical care.