超声引导下连续隐神经阻滞联合多模式镇痛在膝关节置换术中的应用

目的观察超声引导下连续隐神经阻滞(SNB)联合多模式镇痛在膝关节置换术中的应用效果。方法择期行单侧膝关节置换术患者60例,男23例,女37例,年龄50~75岁,采用数字表法随机分为两组:连续隐神经阻滞组(A组)和连续股神经阻滞组(B组)。两组术前均行超声引导,神经阻滞单次给药0.5%罗哌卡因25 ml,置入导管,接镇痛泵持续输入0.2%罗哌卡因。诱导后插入喉罩,术中静-吸复合全麻维持,术毕局部浸润麻醉。记录首次下地时间,行走距离,术后12、24、48 h膝关节活动度及住院天数;记录补救镇痛药物用量及不良反应。结果 A组首次下地时间明显早于B组[(25.4±2.1)h vs(34.0±2.7)h],行走距离明显多于B组[(7.6±1.8)步vs(3.7±1.3)步,P0.05];术后膝关节活动度A组明显大于B组[12 h:(75.8±4.3)°vs(65.4±4.7)°,24 h:(93.3±4.2)°vs(81.8±4.3)°,48 h:(102.1±4.1)°vs(95.1±2.6)°,P0.05];且A组住院时间明显短于B组[(5.3±1.2)d vs(7.4±1.4)d,P0.05];补救镇痛药物及恶心呕吐发生情况两组差异无统计学意义。结论超声引导下连续隐神经阻滞联合多模式镇痛可以促进膝关节置换术后患者早期康复。     

肘关节“恐怖三联征”的治疗:成组病例报告

目的观察手术及术后早期功能锻炼治疗肘关节"恐怖三联征"的临床效果。方法回顾性分析2010年1月至2015年6月重庆市人民医院收治的16例肘关节"恐怖三联征"病例,采用Herber钉、钉板系统或螺钉、克氏针等内固定伴锚钉或单纯韧带修复术治疗,术后活动支具保护下行早期功能锻炼,观察患者骨愈合、肘关节活动及Mayo肘关节功能评分(Mayo elbow performance score,MEPS)情况。结果经过6~12个月随访,16例患者在末次随访时骨折均获得良好愈合。伸肘角度范围为-20°~10°,平均(-2.19±10.16)°,屈肘角度范围为65°~135°,平均(102.19±16.02)°,旋前角度范围为25°~60°,平均(47.19±10.48)°,旋后角度范围为35°~70°,平均(50.63±11.53)°。MEPS评分为51~95分,平均(84.9±10.4)分,其中优6例、良8例、差2例。结论对肘关节骨与软组织稳定结构的固定、修补及术后早期功能锻炼治疗肘关节"恐怖三联征",能够获得满意效果。     

开胸术后持续肋间神经阻滞镇痛效果的临床研究

目的评价开胸术后持续肋间神经阻滞的镇痛效果。方法纳入2017年11月至2018年10月于我院进行开胸手术的120例患者,其中男60例、女60例,年龄40～77(58.10±7.00)岁。按照入院先后顺序,采用随机数表产生随机序列分成三组,各组在基础镇痛(阿片类联合非甾体消炎镇痛药)方案上,根据联合镇痛方案不同,分为持续肋间神经阻滞组(A组,n=40)、单纯肋间神经阻滞组(B组,n=40)及持续硬膜外镇痛组(C组,n=40),比较各组术后疼痛程度及追加镇痛药物的差异。结果术后第0 d,三组方案联合基础镇痛均能有效控制疼痛,视觉模拟疼痛评分A组(2.02±0.39)分,B组(2.13±0.75)分,C组(2.03±0.69)分,组间差异无统计学意义(P0.05)。术后第0～2 d与术后第3～4 d(停止基础镇痛),A组与C组患者疼痛评分差异无统计学意义[(2.08±0.28)分vs.(1.93±0.53)分,(3.20±0.53)分vs.(3.46±0.47)分,P0.05]。术后第0～2 d与术后第3～4 d相比,各组内疼痛评分差异有统计学意义[A组(2.08±0.28)分vs.(3.20±0.53)分,B组(2.42±0.73)分vs.(5.45±0.99)分,C组(1.93±0.53)分vs.(3.46±0.47)分,P0.05]。追加镇痛药物剂量A组与C组差异无统计学意义[(220.00±64.08)mg vs.(225.38±78.85)mg,P0.05],B组高于A组和C组[(343.33±119.56)mg vs.(220.00±64.08)mg,(343.33±119.56)mg vs.(225.38±78.85)mg,P0.05]。结论多模式镇痛是开胸术后早期控制疼痛的理想方案。持续肋间神经阻滞可有效减轻患者术后疼痛。     

连续锁骨下臂丛神经阻滞导管留置长度对术后镇痛的影响

目的 评价不同锁骨下置管深度对上肢手术术后镇痛效果的影响.方法 选取上肢手术患者60例,随机均分为A、B两组.A组在锁骨下入路臂丛神经阻滞后导管留置的长度1 cm,B组为3 cm.导管内注入造影剂,C臂机摄片评价导管位置.术后6、12、18、24 h行VAS评分.结果 造影剂在锁骨下区域向腋部与锁骨上区域双向扩散.A组成功率大于B组(P＜0.05).两组患者均得到良好的镇痛,但A组镇痛效果更好(P＜0.05).结论 在连续锁骨下臂丛神经阻滞中,药液由锁骨下区域向腋部与锁骨上区双向扩散.导管留置1 cm置管的成功率较高.     

铰链式外固定架在肘关节恐怖三联征治疗中的应用

目的探讨肘关节"恐怖三联征"切开复位内固定后铰链式外固定架固定对肘关节功能恢复的影响。方法回顾性分析自2012-01—2015-06采用切开复位内固定治疗的22例肘关节"恐怖三联征",12例术后石膏外固定(石膏组),10例安装铰链式外固定架(外固定架组)。结果 22例均获得随访,随访时间平均18.5(12~26)个月。末次随访时,石膏组肘关节屈伸(68.5±16.5)°,前臂旋转(85.6±16.1)°,肘关节功能Mayo评分(71.4±4.2)分;外固定架组肘关节屈伸(118.5±22.7)°,前臂旋转(151.3±18.4)°,Mayo评分(92.8±3.6)分。外固定架组肘关节屈伸活动度、前臂旋转活动度、肘关节功能Mayo评分均优于石膏组,差异有统计学意义(P0.05)。结论肘关节"恐怖三联征"切开复位内固定术后铰链式外固定架固定可靠,其牵开作用可维持关节高度,患者可早期主动进行功能锻炼,从而恢复良好的肘关节功能及活动度。     

前内侧肌间隙入路松解治疗退变性肘关节僵硬的临床探索

目的探讨前内侧肌间隙入路松解治疗退变性肘关节僵硬的临床疗效。方法 2016年8月至2019年8月期间,我科经肘关节前内侧旋前圆肌、桡侧腕屈肌间隙入路进行松解治疗退变性肘关节僵硬19例。其中男15例,女4例;年龄43～62岁,平均(53.6±1.2)岁。右肘13例,左肘6例;15例为主力侧;合并尺神经卡压症状11例。病程4个月～5年,平均(3.5±0.5)年。术后指导康复锻炼,使用Mayo肘关节功能评分(mayo elbow performance score,MEPS)、视觉模拟评分(visual analogue scale,VAS)进行疗效评价。结果 19例均获得随访,随访时间3～24个月,平均(11.3±0.8)个月。19例切口均Ⅰ期愈合。术后3个月的MEPS及VAS评分与术前比较,差异有统计学意义(P0.001)。MEPS评分优11例,良6例,可2例,优良率89.47%。肘关节屈曲角度增至(127.63±5.79)°,伸直受限改善至(9.74±3.90)°,与术前(101.21±12.45)°、(27.63±8.72)°比较差异有统计学意义(P0.001)。所有患者的前臂旋转也明显改善。屈伸弧度平均增加(44.37±12.09)°,所有患者运动功能都可满足日常生活。除1例术前无尺神经症状的患者,术后出现短暂尺神经麻痹,经保守治疗已治愈外,无其他严重的并发症发生。结论经肘前内侧肌间隙入路治疗退变性肘关节僵硬,是一种安全、有效的方法。而且学习曲线短,手术风险低,较易于在各级医院开展。     

超声引导下选择性颈神经根阻滞在肩关节镜术后镇痛中的应用

目的比较超声引导下选择性颈神经根阻滞与传统肌间沟臂丛阻滞在肩关节镜术后镇痛的应用效果。方法择期行肩关节镜手术全麻患者70例,男25例,女45例,年龄18~75岁,随机分为两组,选择性颈神经根阻滞组(S组)和传统肌间沟臂丛阻滞组(ISB组),每组35例。S组在超声引导下分别给予C5、C6神经根0.5%罗哌卡因各5ml;ISB组在超声引导下给予0.5%罗哌卡因10ml。记录神经阻滞起效时间;记录术后4、12、24h的VAS评分和前臂(屈肘、屈腕、屈指)MBS运动评分;记录术后24h曲马多用量,以及患者满意度和不良反应发生情况。结果 S组起效时间明显短于ISB组[(8.24±2.96)min vs(13.85±7.45)min,P0.01];S组术后12h的VAS评分明显低于ISB组[(1.7±0.8)分vs(3.6±0.7)分,P0.05],术后4h前臂(屈肘、屈腕、屈指)MBS运动评分明显高于ISB组[(3.5±0.6)分vs(0.8±0.3)分,(3.4±0.5)分vs(0.9±0.4)分,(3.6±0.6)分vs(0.7±0.4)分,P0.01];术后24h曲马多用量明显少于ISB组[(37.5±35.9)mg vs(112.5±43.5)mg,P0.05],患者满意率明显高于ISB组(88%vs 56%,P0.05),术后不良反应两组差异无统计学意义。结论在肩关节镜手术后镇痛中,超声引导下选择性颈神经根阻滞优于臂丛神经阻滞。     

松解术治疗陈旧性肘部损伤“三联征”的疗效分析

目的 探讨采用松解术治疗陈旧性肘部损伤“三联征”的疗效. 方法 对2010年9月至2012年8月收治的12例陈旧性肘部损伤“三联征”患者资料进行回顾性分析,男11例,女1例；年龄22～ 56岁,平均35岁.采用外侧和后内侧联合入路,彻底清除关节周围的粘连组织及异位骨化,松解至最大正常功能.术后应用塞来昔布预防异位骨化,并在铰链式外固定支架辅助下进行早期功能康复锻炼.末次随访时记录肘关节相关活动度、并发症恢复情况、采用Mayo肘关节功能评分系统(MEPS)评定肘关节功能并与行松解术前进行比较. 结果 本组患者手术时间为120 ～ 180 min(平均160 min).所有患者术后获90～385 d(平均210 d)随访,切口均一期愈合.术后(平均210 d)肘关节屈伸活动度和旋转活动度(122°±28°和142°±38°)均较术前(27°±22°和45°±50°)明显增大,差异均有统计学差异(P＜0.05).末次随访时按MEPS评分评定疗效:优6例,良3例,可3例.12例患者MEPS评分术后[75 ～100分,平均(90±11)分]明显高于术前[5～65分,平均为(41±20)分],差异有统计学意义(P＜0.05).无再次脱位发生. 结论 通过手术松解肘关节,清除异位骨化,恢复肘关节稳定性,并配合铰链式外固定支架早期行康复锻炼,可明显改善陈旧性肘部损伤“三联征”患者的关节功能.     

改良手术方法治疗肘关节恐怖三联征的短期疗效分析

目的观察改良手术方法治疗肘关节"恐怖三联征"的短期疗效。方法回顾性分析自2013-10—2015-09采用改良手术方法治疗的10例肘关节"恐怖三联征"。术中对桡骨头、外侧副韧带复合体以及内侧副韧带复合体重建,而未修复尺骨冠状突。结果本组手术时间65~160(100.10±32.32)min,术中失血量150~500(287.20±132.17)ml。10例均获得随访6~15(10.90±2.77)个月,无切口感染、尺神经麻痹表现、肘关节再脱位、骨化性肌炎等并发症。X线片显示骨折均在术后3个月内愈合。末次随访肘关节屈曲活动度110°~130°(118.53±6.11)°,伸展活动度为0°~20°(13.40±6.33)°,前臂旋前活动度45°~80°(63.20±11.46)°,旋后活动度25°~75°(52.91±15.31)°。Mayo肘关节功能评分80~94(87.12±4.01)分,优8例,良2例。结论在不固定Regan-MorreyⅠ、Ⅱ型冠状突骨折的情况下,通过手术固定或修补肘关节其他结构,也能恢复"恐怖三联征"患者的肘关节稳定性,且短期疗效良好。     

肘关节三联征非手术治疗的临床疗效分析

[目的]探讨极少数肘关节三联征患者非手术治疗的临床疗效。[方法]回顾性分析2010年9月~2014年6月在急诊就诊行非手术治疗的肘关节三联征患者8例。急诊闭合复位后,予以肘关节正侧位X线片和重建CT检查,对照非手术治疗适应证,采取非手术治疗和康复训练。[结果]所有患者均获得随访,随访时间12~38个月,平均18.5个月。肘关节活动度屈曲(121.8±10.5)°,伸直(13.8±6.3)°,旋前(76.3±9.6)°,旋后(80.1±14.8)°,患肢肌力与健侧相比平均减少12.1%。末次随访时MEPS(90.8±12.6)分;优6例,良2例。1例患者术后随访X线片显示有创伤性关节炎表现,Broberg-Morrey分级1级。4例患者有轻度异位骨化。[结论]对于极少数符合非手术治疗适应证的肘关节三联征患者,非手术治疗临床疗效较好,是一种可以接受的方法。     

维生素D受体在糖尿病肾病足细胞损伤及蛋白尿缓解中的作用

目的探讨维生素D受体(VDR)在糖尿病肾病(DKD)足细胞中的表达水平及在足细胞损伤及蛋白尿缓解中的作用。方法(1)本研究纳入了65例诊断患有2型糖尿病(伴或不伴蛋白尿)的患者,并纳入了25例年龄和性别相匹配的健康体检者为对照组。根据白蛋白/肌酐(ACR)的尿排泄比例对2型糖尿病患者进行分组,分别为无蛋白尿(ACR<30 mg/g,n=24)、微量白蛋白尿(ACR 30~300 mg/g,n=18)和临床蛋白尿(ACR>300 mg/g,n=23)。另选择25例经肾活检确诊的DKD患者作为DKD组。正常肾脏组织标本均取自泌尿外科同一时期肾脏肿瘤切除患者10例。将各组检测指标进行对比,同时采用实时定量PCR、ELISA法和免疫组化法检测VDR在各组患者的血液、尿液样本和肾脏组织中的表达情况,以及使用Pearson相关分析分析VDR与尿蛋白的相关性。(2)在2型糖尿病肾病小鼠模型中对上述结果进行验证,将遗传背景均为C57BLKs/J的雄性db/db小鼠及同窝出生的db/m小鼠,随机分为正常对照组(A组)、DKD对照组(B组)、DKD二甲基亚砜处理组(C组)、DKD帕立骨化醇(VDR激动剂)处理组(D组),C、D组连续腹腔注射处理8周,对照组不做任何处理。小鼠10周龄时开始连续干预8周,在小鼠22周龄(开始干预后12周)检测各组小鼠体重、血、尿生化指标对比;Western印迹法检测β⁃catenin、VDR的变化;免疫荧光观察足细胞标志蛋白podocin及足细胞损伤蛋白α⁃SMA的表达变化。结果(1)与正常健康对照组相比,无蛋白尿组、微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿组的糖尿病患者相比,微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05)。(2)与正常健康对照组相比,无蛋白尿糖尿病组和DKD组患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿糖尿病组患者相比,DKD组患者血浆中VDR的mRNA和蛋白水平亦较低(均P<0.05)。(3)免疫组化结果显示,DKD组肾组织中VDR的表达明显少于正常对照组。(4)DKD患者血浆中VDR mRNA相对水平与ACR呈负相关(r=-0.342,P<0.05)。(5)各组尿液上清液中VDR的水平与血浆中的水平呈相反趋势。(6)Western印迹结果显示,B组、C组肾小球足细胞β⁃catenin蛋白表达高于D组(均P<0.05),VDR蛋白的表达低于D组(均P<0.05);免疫荧光结果显示,B组、C组肾小球足细胞podocin的表达低于D组(均P<0.05),α⁃SMA的表达高于D组(均P<0.05)。结论VDR高表达缓解DKD足细胞损伤及蛋白尿。     

Comparison of University of Wisconsin and University of Pittsburgh solutions for heart transplantation

The effectiveness of University of Wisconsin (UW) and University of Pittsburgh (UP) solutions for the preservation of rat hearts was compared. Lewis rat hearts were preserved with UW (group A, n=45) or UP (group B, n=45) solution for 0 or 24 h and then transplanted heterotopically into the recipients' abdomen. Ten recipients in each group were observed to obtain 1-week graft survival rates. Tissue water content and tissue content of adenine nucleotides were measured 2 h after transplantation in six grafts from each group. Six hearts preserved for 0 h and seven hearts preserved for 24 h were taken from each group 24 h after grafting for histopathology. The 1-week graft survival rates of groups A24 and B24 were 60% and 10%, respectively. In the 24-h preserved grafts, adenosine triphosphate (ATP) and energy charge [(ATP+adenosine diphosphate/2)/(ATP+adenosine diphosphate+adenosine monophosphate)] of groups A and B were 0.972±0.165 and 0.200±0.123 mg/g wet tissue (P<0.05) and 74.4% and 61.1% (P<0.05), respectively. The tissue water content of group A24 was 71.7%, whereas that of group B24 was 74.1% (P<0.05). Histopathology revealed more severe muscle edema and necrosis and infiltration of polymorphonuclear cells in group B24 than in group A24. We conclude that UW solution is more appropriate for rat heart preservation than UP solution.     

Role of Conventional and Diffusion-Weighted Magnetic Resonance Imaging of Spinal Treatment Protocol for Hydatid Disease

Objective:

To demonstrate the role of magnetic resonance imaging (MRI) in determining the treatment protocol for hydatid disease of the spine.

Design:

Case report; literature review.

Findings:

Diffusion-weighted MRI can help differentiate complicated infected hydatidosis from abscesses, epidermoid cysts from arachnoid cysts, and benign from malignant vertebral compression fractures. It is also helpful in differentiating between abscesses and necrotic tumors.

Conclusion:

Diffusion-weighted MRI can help differentiate between infections requiring immediate surgery and those that can be treated medically with antihelmintic treatment.     

Long-term follow-up of callotasis lengthening of the capitate after resection of the lunate for the treatment of stage III lunate necrosis

The callotasis lengthening technique was used to gradually lengthen the capitate after resection of the lunate in stage IIIa necrosis in 23 patients. Results of ten patients with a follow-up of at least 5 years showed rapid and sufficient callus formation in every patient regardless of age. The callotasis lengthening modification of the Graner II operation provides all advantages and avoids the major inconvenience of the traditional Graner II operation. There was no increased rate of disturbed fracture healing. Results of the DTPA-gadolinium MRI study did not show any significant impairment of vascularization within the region of the capitate bone. With the “intrinsic bone formation,” contrary to every other intercarpal arthrodesis at the wrist, there is no need for an additional bone graft.     

罗伊适应模式对腹股沟疝无张力疝修补术后恢复情况的影响

目的探讨罗伊适应模式对患者腹股沟疝无张力疝修补术后恢复情况的影响。 方法将2016年1月至2019年5月在秦皇岛市第二医院择期进行无张力修补术治疗的120例腹股沟疝患者，按照随机数字法分为对照组和观察组，每组各60例。对照组采用常规护理治疗，观察组在对照组的基础上采用罗伊适应模式。比较2组患者的术后临床指标、心理状态、围手术期并发症发生情况及满意度。 结果术后观察组患者的首次排气时间、恢复正常饮食时间、离床活动时间和术后住院时间均低于对照组（P<0.05）；术后观察组患者的抑郁自评量表（SDS）和焦虑自评量表（SAS）评分显著低于对照组（P<0.05）；术后2组患者均无切口感染发生，2组患者尿潴留、急性疼痛、认知功能障碍、发热、血肿等发生率相比无统计学差异（P>0.05）；术后观察组患者护理满意度为96.67%，显著高于对照组的83.33%（P<0.05）。 结论在常规护理的基础上，罗伊适应模式用于患者腹股沟疝无张力修补围手术期，能有效改善术后患者的焦虑/抑郁情绪，不增加围手术期并发症，促进术后患者的恢复及提高治疗满意度。     

Safety and tolerability of single intravenous doses of sugammadex administered simultaneously with rocuronium or vecuronium in healthy volunteers

BACKGROUND: Sugammadex rapidly reverses rocuronium- and vecuronium-induced neuromuscular block. To investigate the effect of combination of sugammadex and rocuronium or vecuronium on QT interval, it would be preferable to avoid the interference of anaesthesia. Therefore, this pilot study was performed to investigate the safety, tolerability, and plasma pharmacokinetics of single i.v. doses of sugammadex administered simultaneously with rocuronium or vecuronium to anaesthetized and non-anaesthetized healthy volunteers. METHODS: In this phase I study, 12 subjects were anaesthetized with propofol/remifentanil and received sugammadex 16, 20, or 32 mg kg(-1) combined with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1); four subjects were not anaesthetized and received sugammadex 32 mg kg(-1) with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) (n=2 per treatment). Neuromuscular function was assessed by TOF-Watch SX monitoring in anaesthetized subjects and by clinical tests in non-anaesthetized volunteers. Sugammadex, rocuronium, and vecuronium plasma concentrations were measured at several time points. RESULTS: No serious adverse events (AEs) were reported. Fourteen subjects reported 23 AEs after study drug administration. Episodes of mild headache, tiredness, cold feeling (application site), dry mouth, oral discomfort, nausea, increased aspartate aminotransferase and gamma-glutamyltransferase levels, and moderate injection site irritation were considered as possibly related to the study drug. The ECG and vital signs showed no clinically relevant changes. Rocuronium/vecuronium plasma concentrations declined faster than those of sugammadex. CONCLUSIONS: Single-dose administration of sugammadex 16, 20, or 32 mg kg(-1) in combination with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) was well tolerated with no clinical evidence of residual neuromuscular block, confirming that these combinations can safely be administered simultaneously to non-anaesthetized subjects. Rocuronium and vecuronium plasma concentrations decreased faster than those of sugammadex, reducing the theoretical risk of neuromuscular block developing over time.     

Magnetic resonance imaging for the evaluation of rejection of a kindney allograft in the rat

Orthotopic DA (RT1^a) into Lewis (RT1¹) rat kidney allografts and control Lewis-into-Lewis grafts were assessed by magnetic resonance imaging (MRI) and perfusion measurement after intravenous injection of a superparamagnetic contrast agent. MRI anatomical scores (range 1–6) and perfusion rates were compared with graft histology (rank of rejection score 1–6). Not only acute rejection, but also chronic events were monitored after acute rejection was prevented by daily cyclosporine (Sandimmune) treatment during the first 2 weeks after transplantation. In acute allograft rejection (n=11), MRI scores reached the maximum value of 6 and perfusion rates were severely reduced within 5 days after transplantation; histology showed severe acute rejection (histologic score 5–6). In the chronic phase (100–130 days after transplantation), allografts (n=5) manifested rejection (in histology cellular rejection and vessel changes), accompanied by MRI scores of around 2–3 and reduced perfusion rates. Both in the acute and chronic phases, the MRI anatomical score correlated significantly with the histological score (Spearman rank correlation coefficient r _s 0.89, n=30, P<0.01), and perfusion rates correlated significantly with the MRI score or histological score (r _s values between-0.60 and -0.87, n=23, P<0.01). It is concluded that MRI represents an interesting tool for assessing the anatomical and hemodynamical status of a kidney allograft in the acute and chronic phases after transplantation.     

Cost-effectiveness of three combinations of antiemetics in the prevention of postoperative nausea and vomiting

Background. This study compares the cost-effectiveness of threecombinations of antiemetics in the prevention of postoperativenausea and vomiting (PONV). Methods. We conducted a prospective, double-blind study. NinetyASA I–II females, 18–65 yr, undergoing general anaesthesiafor major gynaecological surgery, with standardized postoperativeanalgesia (intrathecal 0.2 mg plus i.v. PCA morphine), wererandomly assigned to receive: ondansetron 4 mg plus droperidol1.25 mg after induction and droperidol 1.25 mg 12 h later (Group1); dexamethasone 8 mg plus droperidol 1.25 mg after inductionand droperidol 1.25 mg 12 h later (Group 2); ondansetron 4 mgplus dexamethasone 8 mg after induction and placebo 12 h later(Group 3). A decision analysis tree was used to divide eachgroup into nine mutually exclusive subgroups, depending on theincidence of PONV, need for rescue therapy, side effects andtheir treatment. Direct cost and probabilities were calculatedfor each subgroup, then a cost-effectiveness analysis was conductedfrom the hospital point of view. Results. Groups 1 and 3 were more effective (80 and 70%) thanGroup 2 (40%, P=0.004) in preventing PONV but also more expensive.Compared with Group 2, the incremental cost per extra patientwithout PONV was €6.99 (95% CI, –1.26 to 36.57) forGroup 1 and €13.55 (95% CI, 0.89–132.90) for Group3. Conclusion. Ondansetron+droperidol is cheaper and at least aseffective as ondansetron+ dexamethasone, and it is more effectivethan dexamethasone+droperidol with a reasonable extra cost. Br J Anaesth 2003; 91: 589–92     

不同尿钙水平的Gitelman综合征患者临床特点比较

目的观察不同尿钙水平Gitelman综合征(GS)患者的临床特点,探讨尿钙在GS疾病临床分型中的价值。方法收集2016—2018年来自中国国家罕见病注册系统(NRSC)、在北京协和医院行SLC12A3基因检测诊断为GS患者的临床资料,分析其尿钙特点,比较不同尿钙水平患者的临床和实验室检查指标。氢氯噻嗪试验按照标准操作流程进行,测定患者基线和用药后3 h内氯离子排泄分数改变量的最大值(ΔFECl)。结果共有83例GS患者被纳入研究,其中低尿钙患者53例(63.86%)。低尿钙组尿钙/肌酐比明显低于非低尿钙组[(0.085±0.058)mmol/mmol比(0.471±0.284)mmol/mmol,t=7.349,P<0.001]。两组患者在年龄、性别、估算肾小球滤过率、血压、血尿电解质水平、代谢性碱中毒方面差异均无统计学意义。低尿钙组患者乏力(χ2=4.595,P=0.032)及多尿(χ2=5.778,P=0.016)发生比例低于非低尿钙组,两组患者在其他临床症状方面差异无统计学意义。低尿钙和非低尿钙组各有16例患者行氢氯噻嗪试验,中位ΔFECl结果分别为0.539%(0.430%,1.283%)和0.829%(0.119%,1.298%),均提示对氢氯噻嗪无反应,组间差异无统计学意义(U=130.000,P=0.956)。结论GS患者中低尿钙比例为63.86%,尿钙水平与疾病临床表型、NCC功能损伤严重程度之间均无明确相关性。     

Fibrinogen-thrombin collagen patch reinforcement of highrisk colonic anastomoses in rats

AIM To evaluate the effectiveness of human fibrinogenthrombin collagen patch(TachoSil~?) in the reinforcement of high-risk colon anastomoses.METHODS A quasi-experimental study was conducted in Wistar rats(n = 56) that all underwent high-risk anastomoses(anastomosis with only two sutures) after colectomies. The rats were divided into two randomized groups: Control group(24 rats) and treatment group(24 rats). In the treatment group, high-risk anastomosis was reinforced with TachoSil~? (a piece of Tacho Sil? was applied over this high-risk anastomosis, covering the gap). Leak incidence, overall survival, intra-abdominal adhesions, and histologic healing of anastomoses were analyzed. Survivors were divided into two subgroups and euthanized at 15 and 30 d after intervention in order to analyze the adhesions and histologic changes. RESULTS Overall survival was 71.4% and 57.14% in the TachoSil~? group and control group, respectively(P = 0.29); four rats died from other causes and six rats in the treatment group and 10 in the control group experienced colonic leakage(P 0.05). The intra-abdominal adhesion score was similar in both groups, with no differences between subgroups. We found non-significant differences in the healing process according to the histologic score used in both groups(P = 0.066).CONCLUSION In our study, the use of TachoSil~? was associated with a non-statistically significant reduction in the rate of leakage in high-risk anastomoses. TachoSil~? has been shown to be a safe product because it does not affect the histologic healing process or increase intra-abdominal adhesions.