基于快速康复理念下腹腔镜胆囊切除手术患者的麻醉管理研究

目的:探讨快速康复外科理念在腹腔镜胆囊切除术麻醉管理中的应用效果。方法:将2019年1月—2019年12月收治的80例进行腹腔镜胆囊切除术的患者均分为观察组和对照组,每组40例。对照组患者采用传统麻醉管理,观察组患者采用基于快速康复理念下腹腔镜胆囊切除手术麻醉管理,观察对比两组患者的应激反应、术后麻醉苏醒时间、排气时间及并发症发生率。结果:麻醉前两组血糖和血清皮质醇比较差异无统计学意义(P>0.05)。在气腹成功时、术中以及手术结束时,观察组血糖和血清皮质醇均明显低于对照组,差异有统计学意义(P<0.05)。观察组麻醉苏醒时间、首次排气时间均明显短于对照组,差异有统计学意义(P<0.05)。观察组的并发症发生率明显低于对照组,差异有统计学意义(P<0.05)。结论:加速康复外科理念应用于腹腔镜胆囊切除术麻醉管理,能够有效缓解围术期的应激反应,缩短术后麻醉苏醒时间和排气时间,降低并发症发生率,有助于患者快速恢复。     

竖脊肌平面阻滞与前锯肌平面阻滞对胸腔镜手术术后急性疼痛的影响#br#

目的　回顾性分析竖脊肌平面阻滞与前锯肌平面阻滞对胸腔镜术后急性疼痛的影响。 方法　选取2018年1月至2018年12月于我院行择期单孔胸腔镜手术患者87例,其中对照组29例（全凭静脉麻醉）、竖脊肌平面阻滞组30例（T5平面阻滞联合全凭静脉麻醉）和前锯肌平面阻滞组28例（T5平面阻滞联合全凭静脉麻醉）。麻醉期间常规监测患者心率、血压、脉搏氧饱和度,分别于术前,术后2 h、8 h、12 h、24 h和48 h对患者进行VAS评分。记录患者术中和术后PCIA阿片类药物消耗情况及术后48 h内恶心呕吐、瘙痒和呼吸抑制等并发症发生情况。 结果　竖脊肌平面和前锯肌平面阻滞组患者VAS评分在术后2 h、8 h、12 h显著低于对照组,而竖脊肌平面阻滞组又低于前锯肌平面组,差异具有统计学意义（P<0.05）。与对照组相比,竖脊肌平面阻滞组和前锯肌平面阻滞组术中和术后PCIA阿片类药物消耗均显著减少,且竖脊肌平面组少于前锯肌平面组,差异具有统计学意义（P<0.05）。 结论　在单孔胸腔镜手术围术期镇痛中,超声引导下竖脊肌平面阻滞较前锯肌平面阻滞具有更好的镇痛效果,减少围术期阿片类药物用量。     

A multicenter, multinational analysis of mitomycin C in refractory metastatic colorectal cancer

BackgroundA considerable number of metastatic colorectal cancer (mCRC) patients who progress on standard treatment with 5-fluorouracil (5FU), oxaliplatin, irinotecan and monoclonal antibodies, still have adequate performance status and desire further treatment. Mitomycin C (MMC) has been widely used in this context, and despite good tolerability, there are doubts regarding its true benefit.MethodsIn order to assess the activity of MMC in the refractory mCRC setting, we retrospectively evaluated 109 heavily pre-treated patients who received MMC as single agent or in combination for mCRC at three different institutions in two countries.ResultsMedian patient’s age was 54 years old, 57% were male and 94% had performance status ECOG 0 or 1. MMC was used in second line in 11%, third line in 38% and fourth line or beyond in 51% of patients. 58% received MMC combinations, mainly with capecitabine. Grade 3 or 4 toxicity was observed in 5% of patients and 6% required dose reductions. Median time to treatment failure (TTF) was 1.7 months with MMC and 3.6 months on the regimen prior to MMC, with a ratio between these TTF below 1 in 82% of patients. Median survival was only 4.5 months (95% confidence interval (CI) of 3.48–5.56).ConclusionsThis retrospective data represent the largest reported series of unselected refractory mCRC patients treated with MMC. The median survival of 4.5 months is similar to the survival expected for best supportive care. This lack of activity strongly suggests that MMC should not be routinely used in refractory mCRC.     

生殖医学特色专科护理管理和服务模式研究

目的研究生殖医学特色专科护理管理与服务模式的临床应用效果。方法摘选2019年2月至2020年2月期间,我院接收的不孕女性患者936例,先随机抽取出468例作为A组,开展传统生殖医学专科护理管理,其余468例设为B组,采用生殖医学特色专科护理管理与服务模式,总结分析两组患者的临床护理结果。结果护理后,B组患者的妊娠率与A组相比明显更高(P<0.05),B组患者的辅助生殖技术有关知识掌握度、护理满意度与A组相比均明显更高(P<0.05)。结论生殖医学特色专科护理管理与服务模式的应用可有效提升生殖医学护理管理与服务的质量,得到了患者的高度认可,值得推广。     

联合ICGR15与CT测量残肝体积在原发性肝癌病人的临床应用

目的探讨联合ICGR15与CT测量残肝体积在原发性肝癌病人的临床应用价值。方法研究对象为2014年9月至2017年6月在我院肝胆外科住院确诊为原发性肝癌并且进行手术治疗的48例病人。术前完成病人的生化、凝血功能检查、腹水B超,测定体表面积和肝体积,进行ICGR15检测,术后根据病人有否出现肝功能衰竭分为肝功能衰竭组(A组)9例,以及无肝功能衰竭组(B组)39例。对两组临床资料以及对三种评估方法进行比较。结果 48例病人肝癌术后出现肝功能衰竭9例,无肝功能衰竭39例,发生率为18.75%,两组病人的年龄、ALT、AST、TBIL、ALB、PT、术前Child-Pugh评分、手术时间、术中输血量等指标的差异均无统计学意义(P0.05);而术前ICGR15、SRLV、肝门阻断时间以及术中出血量等指标差异均有统计学意义(P0.05);ICGR15和残肝体积占比分别与Child-Pugh分级比较,差异有统计学意义(P0.05);ICGR15和残肝体积占比的比较,差异无统计学意义(P0.05)。结论 ICGR15与CT测量残肝体积可以作为评估原发性肝癌病人肝切除术后肝功能衰竭的准确指标,且联合应用两者可以互补优势。     

磁共振动态增强检查对宫颈癌的诊断价值

〔摘 要〕 目的：探究磁共振动态增强（DCE–MRI）检查对宫颈癌的临床诊断价值。 方法：选取湛江中心人民医院 2019 年 3 月至 2020 年 4 月收治的 60 例疑似宫颈癌患者为研究对象,利用随机数表法将其分为对照组和观察组,每组 30 例。对照 组患者进行常规磁共振成像（MRI）诊断,观察组患者进行 DCE–MRI 诊断,以病理学诊断结果为标准,比较两组方法与 病理检查的结果。 结果：以病理学诊断结果为标准,对照组常规 MRI 检查出现 1 例误诊宫颈癌患者,观察组 DCE–MRI 检 查对 Ⅰa 期、Ⅲa 期和 Ⅲb 期的宫颈癌患者诊断检查正确率高达 100.0 %,且对照组患者 Ⅱb 期诊断准确率低于观察组,差异 具有统计学意义（P ＜ 0.05）。 结论：对宫颈癌患者进行 DCE–MRI 检查,相较于常规 MRI,可以明显提高诊断准确率, 并对各病理分期进行明确。     

Label-free fluorescent aptasensor for chloramphenicol based on hybridization chain reaction amplification and G-quadruplex/N-methyl mesoporphyrin IX complexation

The use of the broad-spectrum antibiotic chloramphenicol (CAP) in food is strictly regulated or banned in many countries. Herein, for the sensitive, rapid, and specific detection of CAP in milk, a label-free fluorescence strategy was established based on guanine (G)-quadruplex/N-methyl mesoporphyrin IX (NMM) complex formation and hybridization chain reaction (HCR) amplification. In this system, CAP can specifically bind to an aptamer (Apt) to release an Apt-C sequence from double-stranded DNA (Apt·Apt-C). Apt-C, can further hybridize with a functional hairpin DNA probe to release a primer sequence. The released primer sequence causes HCR and the formation of a nicked double-helix polymer, which contains G-quadruplex DNA. The recognition of G-quadruplex DNA by the NMM fluorochrome results in fluorescence enhancement. Consequently, CAP can be quantitatively detected by measuring the fluorescence intensity at 612 nm. The reliability of the aptasensor method was confirmed by comparison with an enzyme-linked immunosorbent assay. The proposed aptasensor was found to have a limit of detection of 0.8 pg mL⁻¹ for CAP. Moreover, when the aptasensor was applied to the detection of CAP in milk samples, the average recoveries were 99.8–108.3% with relative standard deviations of 4.5–5.2%. Thus, this CAP detection method, which is rapid with high sensitivity and selectivity, has considerable potential for a wide range of food analysis applications.

For the sensitive and specific detection of CAP in milk, a label-free fluorescence strategy was established based on guanine (G)-quadruplex/N-methyl mesoporphyrin IX (NMM) complex formation and hybridization chain reaction (HCR) amplification.     

胃黄色瘤与根治幽门螺旋杆菌后早期胃癌的相关性分析

目的 通过胃黄色瘤与根治幽门螺旋杆菌后早期胃癌相关性的回顾性、单中心观察性研究,最终确定胃黄色瘤对诊断根治幽门螺旋杆菌后早期胃癌发生的预测价值。方法 选择2018~2021年在我院成功根治幽门螺旋杆菌且进行胃镜随访的病人,收集相关病例资料。所有病例。根据胃镜下检查并经病理最终证实为早期胃癌,归为病例组,其余归为对照组,分析胃黄色瘤与根治幽门螺旋杆菌后早期胃癌的相关性。结果 病例组胃黄色瘤患者比例显著高于对照组（71.1% vs. 13.9%;P < 0.05）。logistic回归分析发现,萎缩、肠上皮化生和胃黄色瘤是幽门螺旋杆菌根治后早期胃癌检测的独立预测因素。萎缩匹配对照分析也确定胃黄色瘤为独立预测因子。结论 胃黄色瘤可作为幽门螺旋杆菌根治后早期胃癌的预测指标。