Safety of mTOR inhibitor continuation in pediatric heart transplant recipients undergoing surgical procedures

mTOR inhibitors have been associated with SWC when used in the perioperative period. Limited literature is available to guide providers in managing chronic mTOR inhibitor use in the perioperative period, especially in the pediatric setting. The primary aim of this study was to describe the prevalence of SWC with mTOR inhibitor continuation during the perioperative period for major surgeries. Heart transplant recipients ≤25 years old at the time of primary heart transplant receiving sirolimus maintenance therapy during a surgical procedure and within the study period were included. Surgeries identified within the study period included otolaryngology procedures (46.2%), such as tonsillectomies with or without adenoidectomies, cardiac surgeries (30.8%) including a sternal revision, pulmonary vein repair, and pacemaker placement in two patients, orthopedic surgeries (15.4%) including a posterior spinal fusion and an Achilles tendon lengthening with ankle and subtalar joint release, and a neurosurgery (7.7%), which was a ventriculoperitoneal shunt revision. Thirteen surgical encounters were examined. One SWC was observed, an infected pacemaker requiring systemic antibiotics and removal of the device. The results of this study suggest that sirolimus may be continued in the perioperative period based on the low rate of SWC observed.     

剖宫术后瘢痕妊娠经腹部及经阴道彩色多普勒联合应用的误诊分析

目的：经手术及病理证实的67例剖宫术后瘢痕妊娠经腹部彩色多普勒（TAS）及经阴道彩色多普勒（TVS）超声表现及对其中12例误诊原因进行回顾分析,提高超声对其诊断准确率。方法：对67例本院经手术及病理证实的剖宫产术后瘢痕妊娠经腹部及经阴道彩色多普勒检查结果进行回顾性对比分析,并查找其中12例误诊原因。结果：剖宫术后瘢痕妊娠（Caesarean Scar Pregnancy,cps）,TAS＋TVS诊断符合率81％,TAS＋TVS检查诊断符合率较TAS诊断符合率显著提（P〈0．01）。结论：TAS＋TVS可提高剖宫术后瘢痕妊娠的早期诊断准确率,同时能动态观察病灶及血供情况,对指导临床治疗方案及监测治疗效果等方面具有重要意义,停经时间短、妊娠囊占据宫腔、妊娠囊过小及只贴着瘢痕表面、混合包块型者、血供多少以及结合临床不紧密是误诊的重要原因。     

盐酸右美托咪定联合七氟烷对小儿眼科手术术后镇静的影响

目的 探讨右美托咪定联合七氟烷对小儿眼科手术术后镇静的影响。方法 选择2014年1月-2016年8月在安康市中医医院进行眼科手术的患儿200例,将其随机分为两组,每组100例,A组患儿接受七氟烷联合生理盐水术后镇静,B组患儿接受七氟烷联合右美托咪定术后镇静,比较两组患儿的手术情况以及术后VAS疼痛评分、Ramsay镇静评分以及PAED躁动评分,记录两组患儿术后不良反应的发生情况并进行统计学分析。结果 两组患儿的手术时间差异不显著,B组患儿术后清醒较A组晚,差异有统计学意义（P<0.05）。B组患儿术后拔管质量评分低于A组,差异有统计学意义（P<0.05）;且B组术后使用镇痛剂的患儿明显较A组少,差异有统计学意义（P<0.05）。T1、T2及T3时刻,B组患儿的VAS评分显著小于A组患儿,差异有统计学意义（P<0.05）;T1及T2时B组患儿的Ramsay评分显著高于A组患儿,差异有统计学意义（P<0.05）;B组患儿PAED评分明显低于A组,差异有统计学意义（P<0.05）。B组患儿术后恶心呕吐、呼吸抑制、术后躁动的发生率显著低于A组患儿,差异有统计学意义（P<0.05）;且B组患儿术后发生不良反应的总发生率显著低于A组患儿,差异有统计学意义（P<0.05）。结论 右美托咪定联合七氟烷用于小儿眼科手术术后镇静的临床疗效显著且安全性较好,可以显著缓解患儿苏醒期的躁动程度,降低患儿术后发生不良反应的发生率,值得临床推广应用。     

中医药治疗肺癌VATS术后咳嗽的一项单臂临床研究

目的:中医药治疗肺癌术后咳嗽的临床疗效评价及用药规律分析。方法:收集2020年7月20日至2021年2月3日在我院就诊的肺癌术后1周内的患者32例,通过莱塞斯特咳嗽量表(Mandarin Chinese version of the Leicester cough quality of life questionnaire, LCQ-MC)调查及外周血采集,评价中药治疗肺癌术后咳嗽疗效,分析用药规律。结果:32例患者治疗后CRP、IL-6显著低于治疗前(P<0.05),其中22例术后咳嗽患者治疗后LCQ-MC总分、生理和心理领域评分高于治疗前(P<0.05),最后通过聚类分析将35种高频药物聚成6类。结论:肺癌术后患者咳嗽的发生及转归与CRP密切相关,中药干预对咳嗽的改善具有积极作用,治疗用药上要兼顾肺脾,标本同治。     

Is faster better? Impact of operative time on postoperative outcomes after VATS anatomical pulmonary resection

BackgroundVideo-assisted thoracic surgery (VATS) is now the preferred approach for standard anatomical pulmonary resections. This study evaluates the impact of operative time (OT) on post-operative outcomes after VATS anatomical pulmonary resection for non-small cell lung cancer (NSCLC).MethodsWe retrospectively reviewed all consecutive patients undergoing VATS lobectomy or segmentectomy for NSCLC between November 2010 and December 2019. Postoperative outcomes were compared between short (<150 minutes) and long (≥150 minutes) OT groups. A multivariable analysis was performed to identify predictors of long OT and overall post-operative complications.ResultsA total of 670 patients underwent lobectomy (n=496, 74%) or segmentectomy (n=174, 26%) for NSCLC. Mediastinal lymph node dissection was performed in 621 patients (92.7%). The median OT was 141 minutes (SD: 47 minutes) and 387 patients (57.8%) were operated within 150 minutes. Neoadjuvant chemotherapy was given in 25 patients (3.7%). Conversion thoracotomy was realized in 40 patients (6%). Shorter OT was significantly associated with decreased post-operative overall complication rate (30% vs. 41%; P=0.003), shorter median length of drainage (3 vs. 4 days; P<0.001) and shorter median length of hospital stay (6 vs. 7 days; P<0.001). On multivariable analysis, long OT (≥150 minutes) (OR 1.64, P=0.006), ASA score >2 (OR 1.87, P=0.001), FEV₁ <80% (OR 1.47, P=0.046) and DLCO <80% (OR 1.5, P=0.045) were significantly associated with postoperative complications. Two predictors of long OT were identified: neoadjuvant chemotherapy (OR 3.11, P=0.01) and lobectomy (OR 1.5, P=0.032).ConclusionsA prolonged OT is significantly associated with postoperative complications in our collective of patients undergoing VATS anatomical pulmonary resection.     

Comparison of the effects of inhalational and total intravenous anesthesia on quality of recovery in patients undergoing endoscopic transsphenoidal pituitary surgery: a randomized controlled trial

Background: Endoscopic transsphenoidal pituitary surgery has shown promising results. However, fast and high-quality recovery after this procedure remains a challenge for neuroanesthesiologists. This study aimed to compare the quality of recovery after transsphenoidal pituitary surgery between patients who received inhalational anesthesia with sevoflurane and patients who received propofol-based total intravenous anesthesia (TIVA).Methods: Eighty-two patients undergoing transsphenoidal pituitary surgery were randomized to receive either sevoflurane inhalation with manual infusion of remifentanil (sevoflurane group) or effect-site target-controlled infusion of propofol and remifentanil (TIVA group). The primary outcome was the 40-item Quality of Recovery (QoR-40) score on postoperative day 1. The QoR-40 questionnaire was completed by patients the day before surgery and on postoperative days 1 and 2. Emergence agitation and recovery characteristics were also assessed.Results: There were no significant differences between the groups in the global QoR-40 scores on both postoperative days 1 and 2 (difference -8.7, 95% CI -18.0 to 0.7, and P = 0.204; -3.6, 95% CI -13.0 to 5.8, and P > 0.999, respectively). The time to verbal response and time to extubation were significantly shorter in the sevoflurane group than in the TIVA group (P < 0.001 and P < 0.001, respectively). However, the incidence of emergence agitation was lower in the TIVA group than in the sevoflurane group (P < 0.001).Conclusions: Both inhalational anesthesia with sevoflurane and propofol-based TIVA were appropriate anesthetic techniques for patients undergoing endoscopic transsphenoidal pituitary surgery in terms of the quality of recovery up to 2 days postoperatively. Rapid emergence was observed in the sevoflurane group, while smooth emergence was observed in the TIVA group.     

情绪释放疗法对腹腔镜子宫肌瘤剔除术病人疼痛程度、不良情绪、术后恢复及满意度的影响

目的:探讨情绪释放疗法对腹腔镜子宫肌瘤剔除术病人疼痛程度、不良情绪及术后恢复的影响。方法:选择2019年11月—2021年6月医院c4病区收治的腹腔镜子宫肌瘤剔除术病人80例,随机分为对照组与观察组,各40例。对照组行常规干预,观察组行情绪释放疗法干预。比较两组病人手术后疼痛程度、不良情绪、术后恢复效果及满意度。结果:干预后观察组病人术后6 h、24 h的视觉模拟评分法(VAS)评分明显低于对照组(P<0.05);观察组病人术后2 d的汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评分明显低于对照组(P<0.05);观察组病人术后肛门首次排气时间、腹胀消失时间、术后首次排便时间、肠鸣音恢复时间、首次下床时间、术后住院时间均明显短于对照组(P<0.05);观察组病人术后满意度明显高于对照组(P<0.05)。结论:情绪释放疗法能明显缓解腹腔镜子宫肌瘤剔除术病人疼痛程度,减轻其不良情绪,提升满意度,促进术后早日康复。     

西沙必利促进妇科和产科手术后胃肠蠕动的恢复

目的 :观察西沙必利对妇科和产科手术后胃肠蠕动恢复的疗效。方法 :妇科和产科的手术后病人 2 81例分为 2组 ,西沙比利组 116例 ,年龄 35a±s 11a ,于术后 6h给予西沙比利 ,首次 10mg ,po ,以后 5mg ,po ,q 6h ,直至肛门排气 ;对照组 16 5例 ,年龄 33a± 9a ,口服安慰剂 ,服法同西沙必利组。通过肛门排气时间观察疗效。结果 :西沙必利组术后排气时间 15h± 4h较对照组排气时间 4 4h± 5h ,差异有非常显著意义 (P <0 .0 1)。结论 :西沙比利能促进妇科和产科手术后胃肠蠕动的恢复     

A型主动脉夹层术后谵妄的发生率和危险因素研究

目的研究A型主动脉夹层术后谵妄的发生率和相关危险因素。方法以A型主动脉夹层术后患者为研究对象,以意识错乱评估方法作为谵妄诊断工具,分析术后谵妄的发生率和危险因素。结果共有84例患者纳入研究,发生术后谵妄28例,发生率为33.3%。21例(75%)为一过性谵妄(<24 h);7例(25%)为持续性谵妄。Logistic多因素回归分析结果表明,脑梗死、深低温停循环时间、重症监护病房时间是术后谵妄的危险因素。结论既往脑梗死、深低温停循环时间、重症监护病房持续时间是术后谵妄的独立危险因素。     

奥硝唑治疗口腔颌面部整形术后厌氧菌感染的疗效观察

目的 :评价奥硝唑氯化钠注射液治疗口腔颌面部整形术后厌氧菌感染的疗效。方法 :以甲硝唑氯化钠注射液为对照 ,采用多中心随机对照方法 ,对两组间临床疗效和细菌清除率进行比较。结果 :奥硝唑氯化钠注射液与甲硝唑氯化钠注射液的临床治愈率分别为65 %和40 % (P<0 01) ,总有效率和细菌清除率无显著性差异(P>0 05)。结论 :奥硝唑氯化钠注射液治疗口腔颌面部整形术后厌氧菌感染效果显著。