Morbidity of adjuvant hepatic arterial infusion pump chemotherapy in the management of colorectal cancer metastatic to the liver

BACKGROUND: Surgical resection remains the treatment of choice for patients with colorectal cancer metastatic to the liver. Hepatic arterial infusion pump (HAIP) chemotherapy in combination with surgical resection has been demonstrated in a recent study to improve disease-free and overall survival for patients with colorectal cancer metastatic to the liver. Other reports, however, have indicated significant toxicity related to HAIP chemotherapy in the form of biliary sclerosis. Thus, the value of adjuvant HAIP chemotherapy following hepatic resection or ablation remains controversial. The aim of this study was to examine the survival and toxicity in a single institutional experience with adjuvant HAIP chemotherapy. METHODS: Review of a prospective hepatobiliary database was performed. HAIP were placed in the standard technique following resection and/or radiofrequency ablation (RFA) of all liver metastases. Patients received floxuridine (FUDR) via the HAIP at standard doses. Complications were graded according to a standard 5-point grading scale. Statistical analysis was performed by chi(2) test. RESULTS: Thirty-four of 86 patients underwent placement of HAIP at the time of hepatic resection or ablation between January 1999 and November 2002. The HAIP group demonstrated a significantly greater (P <0.05) number (median 5 vs. 2) and size (median 5 cm vs. 3 cm) of hepatic lesions compared to the group without HAIP. The HAIP group experienced a greater frequency of complications (53% vs. 33%), with 6 (18%) patients in the HAIP group demonstrating biliary sclerosis. There were no deaths within 30 days of surgery. Median survival was similar in both groups (HAIP 20 months, no HAIP 24 months). CONCLUSIONS: Patients in the HAIP group had significantly worse overall predictors of outcome in metastatic colorectal cancer, yet the median overall survival in both groups was similar. However, adjuvant HAIP chemotherapy was associated with significantly greater morbidity. Given the availability of newer active systemic agents and regimens, the value of adjuvant HAIP chemotherapy remains controversial.     

Anaesthesia for carotid endarterectomy: comparison of hypnotic- and opioid-based techniques

Background. Although the synergistic interaction between hypnoticsand opioids for total i.v. anaesthesia has been repeatedly demonstrated,questions about different dose combinations of hypnotics andopioids remain. The optimal combination would be based on maximalsynergy, using the lowest dose of both drugs and having thelowest incidence of side-effects. Methods. The major goal of this prospective randomized studywas to compare two different dose combinations of propofol andremifentanil (both administered by target controlled infusion(TCI)) in respect of haemodynamics during surgery and recovery,and the need for cardiovascular treatment in the recovery room.A secondary goal was to compare pain scores (VAS) and morphineconsumption in the recovery room. Anaesthesia was induced inboth groups using TCI propofol, adjusted to obtain a bispectralindex score (BIS) value between 40 and 60. TCI for remifentanilcommenced at an initial effect-site concentration of 0.5 ng ml^–1,and was adjusted according to haemodynamics. Patients were dividedinto one of two groups during anaesthesia: (i) Group H, hypnoticanaesthesia (n=23), propofol effect-site concentration maintainedat 2.4 µg ml^–1; and (ii) Group O, opioidanaesthesia (n=23), propofol effect-site concentration maintainedat 1.2 µg ml^–1. In both groups, remifentanileffect-site concentration was adjusted according to haemodynamicsand changes in BIS value. Results. In Group O, more episodes of intraoperative hypotension(P<0.02) and hypertension (P<0.01), and fewer episodesof tachycardia were observed. More patients in Group O requirednicardipine administration for postoperative hypertension (8patients in Group H vs 15 patients in Group O, P<0.04). Duringrecovery, morphine titration was necessary in     

一种新型低温静脉输液装置对中枢性高热患者的降温效果及安全性研究

背景　物理降温方法是中枢性高热患者的主要降温方法,目前临床上常用的物理降温方法效果报道不一,且存在较明显的并发症。目的　探讨一种新型低温静脉输液装置（国家实用新型专利,专利号：ZL 2014 2 0070586.4）对中枢性高热患者进行物理降温治疗的效果及安全性。方法　选取2015-2019年佛山市中医院重症医学科收治的中枢性高热患者93例,采用随机数字表法将其分为对照组（n=29）、普通静脉降温组（n=32）和应用降温装置组（n=32）。对照组给予基础治疗及体表物理降温,普通静脉降温组在对照组的基础上予以静脉输注低温液体（由冰箱冷藏4 ℃）,应用降温装置组则在对照组的基础上采用新型低温静脉输液装置输注室温液体。检测三组患者治疗前、治疗24 h及治疗48 h后的凝血功能指标：纤维蛋白原（FbgC）、活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）及血小板计数（PLT）;观察寒战、心律失常、皮肤受损等并发症发生率;测量治疗前及治疗2、4、8、12、24、48 h的肛温;评估治疗1周后格拉斯哥昏迷量表（GCS）评分;电话随访患者治疗28 d病死率。结果　治疗方法和时间对FbgC、APTT、PT及PLT不存在交互作用（P>0.05）;治疗方法和时间对FbgC、APTT、PT及PLT主效应均不显著（P>0.05）。应用降温装置组寒战发生率低于对照组和普通静脉降温组,皮肤受损发生率低于对照组（P<0.017）。治疗方法和时间对肛温存在交互作用（P<0.05）;治疗方法和时间对肛温主效应均显著（P<0.05）;其中应用降温装置组治疗2、4、8、12、24、48 h的肛温均低于对照组和普通静脉降温组（P<0.05）。治疗1周后应用降温装置组GCS评分高于对照组和普通静脉降温组（P<0.05）。三组患者治疗28 d病死率比较,差异无统计学意义（P>0.05）。结论　采用新型低温静脉输液装置对中枢性高热患者进行物理降温治疗具有快速且稳定的降温效果,且其并发症发生率低,可广泛应用于临床降温治疗。     

右美托咪定靶控输注在冠状动脉搭桥术中的作用

【摘要】 目的 研究右美托咪定靶控输注在冠状动脉搭桥术 (CABG) 中的作用。方法 纳入2015年1 月~2017年10月于我院行CABG治疗的94例冠心病患者,数字法随机分为观察组与对照组,每组各47例。两组均采用常规气管插管全麻,观察组在此基础上进行右美托咪定靶控输注,对照组输注等量生理盐水。将麻醉诱导前、麻醉后、插管前、插管后及插管后5min设为T0、T1、T2、T3、T4,比较各时间点两组动脉舒张压（DBP）、收缩压（SBP）、平均动脉压（MAP）、心率（HR）、HR与SBP乘积（RPP）以及手术时间、拔管时间、苏醒时间。结果 两组T0、T1、T2 HR、RPP比较差异均无统计学意义（P＞005）,T3、T4观察组HR低于对照组,差异具有统计学意义（P＜005）; 两组T0、T1、T2DBP、SBP、MAP比较差异均无统计学意义（P＞005）,T3、T4观察组DBP、SBP、MAP均低于对照组,差异具有统计学意义（P＜005）;两组手术时间比较差异无统计学意义（P＞005）;观察组苏醒时间、拔管时间低于对照组,差异具有统计学意义（P＜005）。结论 冠心病冠状动脉搭桥术治疗运用右美托咪定靶控输注能够降低插管后血压与心率,即减轻气管插管时心血管反应及心肌耗氧。     

吴茱萸热熨联合术前区域动脉灌注化疗改善直肠癌患者术后胃肠蠕动功能的效果

目的:观察吴茱萸热熨联合术前区域动脉灌注化疗改善直肠癌患者术后胃肠蠕动功能的临床疗效。方法:选取2016年10月至2018年8月普外科收治的100例直肠癌患者,根据随机数字表法分为治疗组和对照组,每组50例。两组均接受直肠癌术后常规西医治疗及术前区域动脉灌注化疗,治疗组在此基础上予吴茱萸热熨足三里,比较两组患者治疗后的临床疗效及其他临床指标。结果:治疗组总有效率96.0%,显著高于对照组82.0%(P=0.025)。治疗组肠鸣音恢复时间、首次进食时间、首次肛门排气时间及排便时间均明显短于对照组(P0.01)。术后第5天,治疗组腹胀分级评分与呕吐分级评分明显低于对照组(P0.01);治疗组血清胃动素水平显著高于对照组(P0.01);生长抑素水平明显低于对照组(P0.01);治疗组生活质量评分显著高于对照组,差异有统计学意义(P=0.000);治疗组整体营养状况明显优于对照组,差异有统计学意义(P0.05)。结论:吴茱萸热熨联合术前区域动脉灌注化疗能促进直肠癌术后患者胃肠蠕动功能的恢复,有效缓解术后胃肠功能紊乱状态,预防并发症,且安全性高。     

依托咪酯靶控输注在全胸腔镜二尖瓣置换术中的应用

目的观察依托咪酯靶控输注(TCI)在全胸腔镜二尖瓣置换术中的使用效果及安全性。方法选择拟在全胸腔镜下行二尖瓣置换术的风湿性二尖瓣病变患者110例,男48例,女62例,年龄29~55岁,ASAⅡ或Ⅲ级,随机分为依托咪酯TCI组(E组)和丙泊酚TCI组(P组),每组55例。E组使用依托咪酯-舒芬太尼TCI(依托咪酯初始血浆靶浓度为0.2μg/ml,根据BIS值以0.1μg/ml梯度逐步增加,舒芬太尼效应室靶浓度1.0ng/ml)进行麻醉诱导与维持,P组使用丙泊酚-舒芬太尼TCI(丙泊酚初始血浆靶浓度为1.0μg/ml,根据BIS值以0.3μg/ml梯度逐步增加,舒芬太尼效应室靶浓度1.0ng/ml)进行麻醉诱导与维持。记录两组患者诱导期低血压发生情况、诱导期血管活性药物用量、诱导期睫毛反射消失时间、麻醉期舒芬太尼用量、手术时间、体外循环时间、升主动脉阻断时间、入CCU时APACHE II评分、术后24h正性肌力药物评分、术后清醒时间、机械通气时间、CCU停留时间、术后住院时间、记录术前、术后2、6、24h血浆中血糖、乳酸浓度,术前及术后24h血浆皮质醇、醛固酮、ACTH浓度以及术后并发症情况。结果 E组患者诱导期低血压发生率明显低于P组,诱导期去甲肾上腺素用量明显少于P组(P0.05);E组清醒时间、机械通气时间、CCU停留时间、术后住院时间明显短于P组(P0.05);与术前比较,术后2、6、24h两组患者血糖和乳酸浓度明显升高(P0.05),6h达到高峰,24h开始下降,两组患者各时点血糖、乳酸浓度差异无统计学意义;与术前比较,术后24hP组皮质醇浓度明显升高(P0.05);术后24hP组皮质醇和醛固酮浓度明显高于E组(P0.05);两组ACTH浓度差异无统计学意义;E组院内肺部感染发生率明显低于P组(P0.05)。结论依托咪酯靶控输注可以维持麻醉诱导期血流动力学平稳,患者术后恢复时间明显缩短,术后肺部感染发生率明显降低,能安全应用于全胸腔镜二尖瓣置换术。     

基于IPAD的移动静脉输液质量管理系统的研发与应用

目的开发与使用基于IPAD的移动静脉输液质量管理系统,加强医院信息化建设,提高静脉输液护理质量。方法成立静脉输液管理小组,设计并应用基于IPAD的移动静脉输液质量管理系统,每月对临床静脉输液进行质量督导。结果应用移动静脉输液质量管理系统后,静脉输液操作规范执行率、静脉输液工具选择正确率、使用刺激性药物静脉通路选择正确率、血管通路固定正确率及患者满意率显著提升,静脉输液相关并发症发生率显著下降(均P0.01)。结论应用移动静脉输液质量管理系统对静脉输液进行过程质量管理,可规范静脉输液流程、减少导管相关性并发症的发生、提高静脉输液的安全性及患者满意度。     

靶控输注丙泊酚复合芬太尼静脉麻醉在老年患者腹腔镜切除术中的应用

目的:比较TC I输注丙泊酚复合芬太尼静脉麻醉与静吸复合全麻在老年患者腹腔镜手术中血液动力学的改变。方法:选择择期进行腹腔镜胆囊切除术(LC)60岁以上的患者60例,ASAⅠ~Ⅱ级,随机分为TC I(A)组和静吸复合(B)组,每组各30例。A组采用TC I丙泊酚复合芬太尼静脉麻醉,B组采用静脉复合吸入异氟醚维持麻醉。分别于各时点记录患者的HR、SBP、DBP、PETCO2。结果:A、B两组患者各时点PETCO2逐渐增加,T2、T3时与T0时相比差异有显著性(P<0.01)。组间比较各时点差异无显著性。A组SBP最低下降了21%,B组则最低下降了40%,两者比较有显著性差异(P<0.05);DBP则A、B两组分别下降了18%和20%。TC I丙泊酚A组的血压波动明显小于静吸复合B组。A组的HR由(77.4±9.5)次/分下降至(70.6±7.7)次/分,下降了10%;B组的HR由(82.4±14.6)次/分降至(61.0±4.4)次/分,下降了25%。组间相比有显著性差异(P<0.05)。结论:靶控输注能够很好的抑制应激反应,维持血液动力学的稳定。     

皮下植泵灌注药物预防原发性肝癌术后复发

目的: 对比分析皮下植泵灌注化疗药物降低原发性肝癌术后肝内复发率,提高生存率的效果.方法: 95例原发性肝癌切除术后,同时皮下植泵,泵导管植入肝动脉、门静脉,术后定期通过药泵灌注化疗药物至肝脏(A组);行单纯肝癌切除术72例(B组);肝癌切除术加静脉化疗65例(C组).随访3年,比较3组的术后复发率和生存率.结果: 原发性肝癌术后皮下植泵组与对照组比较,术后3年的肝内复发率显著降低(P<0.01),生存率显著提高(P<0.01).结论: 皮下植泵定期灌注化疗是防止原发性肝癌术后肝内复发,提高生存率的有效方法.