静脉留置针行股静脉穿刺输液在神经外科脑疝患者术前抢救中的应用

目的 探讨静脉留置针行股静脉穿刺输液在神经外科脑疝患者术前抢救中的意义.方法 将我科334 例单侧瞳孔散大的脑疝患者采用随机数字表法随机分为三组.A 组(外周静脉输液组):静脉留置针行外周静脉穿刺输液120 例.B组(中心静脉输液组):中心静脉穿刺置管输液102 例.C 组(静脉留置针行股静脉输液组):静脉留置针行股静脉穿刺输液112 例.比较三组患者穿刺成功所需时间(T1 )、输注20%甘露醇250 ml 所需时间(T2 )、术前瞳孔回缩例数.结果 T1 :A 组为(2.16 ±0.82)min,B 组为(11.73 ±4.43)min,C 组为(2.29 ±0.92)min.经t 检验:PAB ＜0.05,PBC ＜0.05,PAC ＞0.05.T2 :A 组为(35.78 ±1.69)min ,B 组为(19.74 ±1.97)min,C 组为(19.81 ±2.03)min.经t 检验:PAB ＜0.05,PBC ＞0.05,PAC＜0.05.瞳孔回缩例数:A 组为18 例,B 组为20 例,C 组为36 例.经χ2 检验:χ2 ＝0.825,PAB ＞0.05,χ2 ＝4.341,PBC ＜0.05,χ2 ＝9.533,PAC ＜0.01.结论 静脉留置针行股静脉穿刺置管输液能快速建立输液通道,且输液速度快,能够快速有效输注20%甘露醇等高渗脱水降颅内压抢救药物,迅速降低颅内压,缓解脑疝,为进一步手术治疗赢得时间,效果优于外周静脉输液及中心静脉输液,且并发症低,在神经外科脑疝患者的抢救中意义明显.

Impact of neoadjuvant chemoradiotherapy on prognosis and surgery for esophageal carcinoma

Objective To evaluate the role of neoadjuvant chemoradiotherapy on prognosis and surgery for esophageal carcinoma by performing a meta-analysis of randomized controlled trials （RCTs） that compared neoadjuvant chemoradiotherapy and surgery with surgery alone for esophageal carcinoma.Methods PubMed and manual searches were done to identify all published RCTs that compared neoadjuvant chemoradiotherapy and surgery with surgery alone for esophageal cancer. According to the test of heterogeneity,a fixed-effects model or a random effects model was used and the relative risk （RR） was the principal measure of effect.Results Fourteen RCTs that included 1737 patients were selected with quality assessment ranging from A to C （Cochrane Reviewers＇ Handbook 4.2.2）. Relative risk （95% confidence interval CI]; P value）,expressed as chemoradiotherapy and surgery versus surgery alone chemoradiotherapy-surgery（CRTS） versus surgery alone（S）; value 1 favor CRTS）,was 1.06 （95% CI 0.99~1.13; P=0.1） for 1-year survival,1.18 （95% CI 1.04~1.33; P=0.01） for 2-year survival,1.39 （95% CI 1.23~1.58; P0.00001） for 3-year survival,1.27 （95% CI 1.04~1.55; P=0.02） for 4-year survival,1.41 （95% CI 1.18~1.69; P=0.0001） for 5-year survival,1.01 （95% CI 0.97~1.05; P=0.67） for rate of resection,1.44 （95% CI 1.23~2.74; P=0.008） for rate of complete resection,1.70 （95% CI 1.12～2.56; P=0.01） for operative mortality,1.12 （95% CI 0.89-2.48; P=0.503） for all treatment mortality,1.23 （95% CI 0.93~1.78; P=0.13） for the rate of adverse treatment,1.18 （95% CI 1.22~1.61; P=0.0001） for local-regional cancer recurrence,1.18 （95% CI 0.75~1.68; P=0.71） for distant cancer recurrence,and 1.07 （95% CI 0.76~1.56; P=0.18） for all cancer recurrence. A complete pathological response to chemoradiotherapy occurred in 10%~45.5% of patients. The 5-year survival benefit was most pronounced when chemotherapy and radiotherapy were given concurrently （RR 1.34,95% CI 1.06~1.89,P=0.013） instead of sequentially （RR 0.86,95% CI 0.67~1.38,P=0.29）.Conclusions Compared with surgery alone,neoadjuvant chemoradiotherapy and surgery improved 3-year,5-year survival and reduced local-regional cancer recurrence. It was associated with a higher rate of complete （R0） resection and operative mortality although no significance about the rate of esophageal resection,There was a nonsignificant trend toward increased all treatment mortality with neoadjuvant chemoradiotherapy. Concurrent administration of neoadjuvant chemotherapy and radiotherapy was superior.