滋肾续骨汤联合鲑鱼降钙素对老年椎体压缩性骨折术后血清骨形态发生蛋白9及血管内皮生长因子水平的影响

目的观察滋肾续骨汤联合鲑鱼降钙素对老年椎体压缩性骨折术后血清骨形态发生蛋白9(BMP9)及血管内皮生长因子(VEGF)水平的影响。方法将80例老年椎体压缩性骨折术后患者按照随机数字表法分为2组。对照组39例予鲑鱼降钙素治疗;治疗组41例在对照组治疗基础上加用滋肾续骨汤治疗。2组均治疗24周后统计临床疗效,并观察2组治疗前后血清BMP9、VEGF水平及疼痛视觉模拟评分(VAS)、胸腰椎损伤分类及损伤程度评分系统(TLICS)、Oswestry功能障碍指数(ODI)评分、日本骨科协会(JOA)腰痛评分,以及椎体前缘丢失高度、伤椎Cobb角、伤椎骨密度水平及并发症发生情况。结果治疗组总有效率95.12%(39/41),对照组总有效率76.92%(30/39),治疗组临床疗效优于对照组(P<0.05)。2组治疗后血清BMP9、VEGF水平均升高(P<0.05),且治疗组高于对照组(P<0.05)。2组治疗后疼痛VAS、TLICS评分均降低(P<0.05),且治疗组低于对照组(P<0.05)。治疗后2组ODI评分均降低(P<0.05),且治疗组低于对照组(P<0.05);治疗后2组JOA腰痛评分均升高(P<0.05),且治疗组高于对照组(P<0.05)。治疗后2组椎体前缘丢失高度、伤椎Cobb角均降低(P<0.05),伤椎骨密度均升高(P<0.05),且治疗组改善均优于对照组(P<0.05)。治疗组并发症总发生率4.88%(2/41),对照组并发症总发生率20.51%(8/39),治疗组并发症总发生率低于对照组(P<0.05)。结论滋肾续骨汤治疗老年椎体压缩性骨折术后患者疗效显著,可有效改善临床症状及血清BMP9、VEGF水平。     

复发性脑梗死临床分析

目的 研究复发性脑梗死的危险因素及临床特点.方法 回顾性分析58例复发脑梗死和53例初发脑梗死患者的临床资料.结果 复发组心肌受损率显著增高(p＜0.01);女性、房颤、糖尿病、肥胖、高血压家族史和中风家族史者的发生率显著高于初发组(P＜0.05～0.01);复发组血TC、TG、BS、纤维蛋白原、全血粘度(高切)、全血还原粘度(高切)、血浆粘度明显高于初发组(P＜0.05～0.01),HDL-C则明显低于初发组(P＜0.05);复发组死亡率与初发组有明显差异(p＜0.05).结论 复发性脑梗死的治疗早期要注意预防心肌损伤.复发性脑梗死的可控危险因素主要是高血压病,血纤维蛋白原、TC水平、血浆粘度和全血高切还原粘度升高及HDL-C降低;而高血压病是复发与初发脑梗死患者共同的危险因素.     

《巴西肿瘤外科协会盆腔廓清术治疗宫颈癌指南》解读

2019年12月,巴西肿瘤外科协会(Brazilian Society of Surgical Oncology)针对放、化疗后局部持续或复发宫颈癌(PRCC)患者的补救性盆腔廓清术(PE)治疗,颁布《巴西肿瘤外科协会盆腔廓清术治疗宫颈癌指南》(Guidelines of the Brazilian Society o...     

沙滩椅体位及控制性降压下肩关节手术病人脑氧饱和度与脑部血流速度改变及其对术后神经认知的影响

目的 分析沙滩椅体位及控制性降压下肩关节手术中脑氧饱和度(r Sc O2)与脑部血流速度的变化,及其对病人术后神经认知的影响。方法 选取拟于本院以沙滩椅体位接受肩关节手术治疗的病人60例,均为美国麻醉医师协会(ASA)分级Ⅰ、Ⅱ级,在静脉全身麻醉及控制性降压干预下,于麻醉前、麻醉并转入沙滩椅体位后5 min、手术开始时以及手术开始后每隔20 min直至手术结束进行rScO₂、大脑中动脉血流速度(VMCA)和有创血压(心脏水平和耳道水平)的检测,并记录脑氧欠饱和事件(CDE)的发生。同时,于术前和术后24 h对病人进行神经认知能力测试。结果 转入沙滩椅体位后所有病人的rScO₂和VMCA相比麻醉前都有所下降。经历CDE的病人耳道水平平均动脉压、rScO₂和VMCA均显著低于未经历CDE的病人,并且术后24 h时连线测试成绩也更低,组间差异有统计学意义(P<0.05)。结论 对于ASA分级Ⅰ、Ⅱ级病人,沙滩椅体位及控制性降压下肩关节手术中部分病人的rScO₂和VMCA较麻醉前显著下降并发生CDE,...     

围术期氧疗的研究进展

目的氧疗是围术期麻醉管理的重要组成部分。氧疗是把双刃剑,氧浓度过高可产生肺不张、氧化应激,给机体造成损伤,过低又会导致低氧血症,影响氧合。因此,围术期氧疗如何选择合适的吸氧浓度一直是麻醉管理的热点问题。本文将围绕围术期氧疗对机体的影响、不同类型患者吸入氧浓度的选择作一综述,以期为围术期精准氧疗提供理论参考。     

肝癌动脉化疗栓塞致截瘫病例分析

目的探讨化疗栓塞术后发生截瘫的病因、临床特点和预防。方法2003年3月-2005年2月共有2758例肝肿瘤患者施行经导管动脉化疗栓塞术(TACE),术后发生截瘫4例。本研究详细回顾手术过程和术后病程。结果4例患者TACE术后4 h内出现截瘫症状,截瘫发生率为0.145%,并在24～48 h症状进行性加重,5～7 d后病情逐渐平稳,2个月后症状明显改善。结论肝肿瘤患者多次栓塞化疗后及远处转移瘤行供血动脉化疗栓塞时需慎重,尽量预防脊髓动脉栓塞。     

脾动脉栓塞与脾切除的对比分析

目的探讨脾动脉栓塞和脾切除治疗脾功能亢进的疗效及并发症,为临床治疗脾功能亢进方式提供选择依据。方法回顾分析我院近年部分性脾动脉栓塞46例和脾切除33例,比较两种方法治疗后血象改善及并发症发生情况。结果两种方法均能有效改善肝硬化继发脾肿大脾功能亢进患者血小板和白细胞计数(P<0.001),但两组患者中脾切除组术后血小板计数改善明显优于脾动脉栓塞组,而白细胞计数的改善两组无明显差异。脾动脉栓塞组术后并发症发生率明显高于脾切除组(P<0.001)。结论对于腹水较多、门脉高压明显、脾脏巨大的患者不宜行脾动脉栓塞治疗,行脾切除术较好;对于肝脏功能较差、凝血功能严重障碍、高龄和伴肝癌的脾功能亢进患者宜行脾动脉栓塞治疗。     

颈椎手术重要并发症研究进展

颈椎手术是目前用于治疗颈椎病、颈髓损伤、颈椎感染、颈椎肿瘤、颈椎不稳或畸形等的常见骨科手术.尽管颈椎手术的术式在不断地精进和完善,但并发症仍然是困扰脊柱外科医生和患者的临床难题,应予以重视.了解颈椎手术并发症的原因及预防或处理方法在临床实践中有着重大意义.与手术操作精细度相关的并发症 ( 如脑脊液漏、术中牵拉损伤、伤口...     

Does Risk Mitigation Reduce 90-Day Complications in Patients Undergoing Total Knee Arthroplasty?: A Cohort Study

BackgroundWith ever-increasing demand for total knee arthroplasty (TKA), most healthcare systems around the world are concerned about its socioeconomic burden. Most centers have universally adopted well-defined clinical care pathways to minimize adverse outcomes, maximize volume, and limit costs. However, there are no prospective comparative trials reporting benefits of these risk mitigation (RM) strategies.MethodsThis is a prospective cohort study comparing post-TKA 90-day complications between patients undergoing RM before surgery and those following a standard protocol (SP). In the RM group, we used a 20-point checklist to screen for modifiable risk factors and evaluate the need for optimizing non-modifiable comorbidities. Only when optimization goals were achieved, patients were offered TKA.ResultsTKA was performed in 811 patients in the SP group and in 829 in the RM group, 40% of which were simultaneous bilateral TKA. In both groups, hypertension was the most prevalent comorbidity (48%), followed by diabetes (20%). A total of 43 (5.3%) procedure-related complications were seen over the 90-day postoperative period in the SP group, which was significantly greater than 26 (3.1%) seen in the RM group (p = 0.039). The commonest complication was pulmonary thromboembolic, 6 in each group. Blood transfusion rate was higher in the SP group (6%) than in the RM group (< 1%).ConclusionsScreening and RM can reduce 90-day complications in patients undergoing TKA.     

Epidermal growth factor receptor (EGFR)—tyrosine kinase inhibitors as a first-line treatment for postoperative recurrent and EGFR-mutated non-small-cell lung cancer

 Open in a separate windowOBJECTIVESTo clarify survival outcomes and prognostic factors of patients receiving epidermal growth factor receptor (EGFR) - tyrosine kinase inhibitors (TKIs) as first-line treatment for postoperative recurrence.METHODSA retrospective chart review was performed to identify consecutive patients who received EGFR-TKIs as first-line treatment for postoperative recurrence of non-small-cell lung cancer (NSCLC) harbouring EGFR gene mutations at our institution between August 2002 and October 2020. Therapeutic response, adverse events, progression-free survival (PFS) and overall survival (OS) were investigated. Survival outcomes were assessed using the Kaplan–Meier analysis. The Cox proportional hazards model was used for univariable and multivariable analyses.RESULTSSixty-four patients were included in the study. The objective response and disease control rates were 53% and 92%, respectively. Grade 3 or greater adverse events were noted in 4 (6.3%) patients, including 1 patient (1.6%) of interstitial pneumonia. The median follow-up period was 28.5 months (range 3–202 months). The total number of events was 43 for PFS and 23 for OS, respectively. The median PFS was 18 months, and the median OS was 61 months after EGFR-TKI treatment. In multivariable analysis, osimertinib showed a tendency to prolong PFS [hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.12–1.1; P = 0.071], whereas the micropapillary component was significantly associated with shorter OS (HR 2.1, 95% CI 1.02–6.9; P = 0.045).CONCLUSIONSEGFR-TKIs as first-line treatment appeared to be a reasonable treatment option in selected patients with postoperative recurrent EGFR-mutated NSCLC. Osimertinib and the micropapillary component may be prognostic factors.