Postoperative gastrointestinal disorder (POGD) was a common complication after surgery under anesthesia. Strategies in combination with Traditional Chinese Medicine and Western medicine showed some distinct effects but standardized clinical practice guidelines were not available. Thus, a multidisciplinary expert team from various professional bodies including the Perioperative and Anesthesia Professional Committees of the Chinese Association of Integrative Medicine (CAIM), jointly with Gansu Province Clinical Research Center of Integrative Anesthesiology/Anesthesia and Pain Medical Center of Gansu Provincial Hospital of Traditional Chinese Medicine and WHO Collaborating Center for Guideline Implementation and Knowledge Translation/Chinese Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Center/Gansu Provincial Center for Medical Guideline Industry Technology/Evidence-based Medicine Center of Lanzhou University, was established to develop evidence-based guidelines. Clinical questions (7 background and 12 clinical questions) were identified through literature reviews and expert consensus meetings. Based on systematic reviews/meta-analyses, evidence quality was analyzed and the advantages and disadvantages of interventional measures were weighed with input from patients' preferences. Finally, 20 recommendations were developed through the Delphi-based consensus meetings. These recommendations included disease definitions, etiologies, pathogenesis, syndrome differentiation, diagnosis, and perioperative prevention and treatment.
目的 探讨复方苦参注射液联合六味补气方对肿瘤患者癌因性疲乏(cancer-related fatigue,CRF)的临床疗效.方法 选取2022年1-8月安徽中医药大学第一附属医院气虚型恶性肿瘤伴CRF患者60例,随机分为对照组和观察组,每组30例.对照组采用常规治疗,观察组采用常规治疗联合复方苦参注射液和六味补气方治疗,治疗1个疗程(7d),比较治疗前后两组生活状况、疲乏状况和中医证候评分.结果 60例患者中男32例,女28例,年龄28～83岁,平均(62.9±1.5)岁.与治疗前相比,治疗后观察组生活状况评分较高[(71.00±7.59)分比(60.00±7.88)分]、疲乏状况评分[(2.73±0.69)分比(5.73±0.98)分]和中医证候评分[(5.03±1.21)分比(16.80±1.18)分]较低,差异均有统计学意义(P＜0.05).治疗后与对照组相比,观察组生活状况评分较高[(71.00±7.59)分比(62.00±6.64)分]、疲乏状况评分[(2.73± 0.69)分比(5.53±0.94)分]和中医证候评分[(5.03±1.21)分比(15.40±1.37)分]较低,差异均有统计学意义(P＜0.05).结论 复方苦参注射液联合六味补气方可以有效减轻肿瘤患者的CRF程度,改善患者身体状况,提高生活质量.
Objective To explore the status and influencing factors of postoperative anxiety in patients undergoing non-cardiac surgery.Methods A total of 299 non-cardiac surgery patients from Beijing Chaoyang Hospital,Capital Medical University from August 2019 to January 2020 were selected,the perioperative data were collected,and multivariate logistic regression equation was used to analyze the influencing factors of postoperative anxiety in patients undergoing non-cardiac surgery.Results Among the 299 patients,there were 134 males and 165 females,aged from 20 to 85 years,with an average age of(55.2±14.0)years.The incidence of postoperative anxiety was 12.70％(38/299).Multivariate logistic regression analysis showed that preoperative anxiety(OR=5.512,95％CI:2.206-13.776,P=0.001),preoperative depressive symptoms(OR=3.523,95％CI:1.436-8.644,P=0.006)and first day postoperative pain(OR=1.405,95％CI:1.125-1.756,P=0.003)were risk factors for postoperative anxiety in patients undergoing non-cardiac surgery.Conclusions In non-cardiac surgery,pre-screening and intervention for patients with preoperative anxiety and depression,and actively relieving postoperative pain can significantly reduce the incidence of postoperative anxiety.
Objective To explore the clinical observation of multi-frequency vestibular function examination for rehabilitation evaluation of vestibular neuritis(VN).Methods A total of 25 atients with unilateral acute VN in the Second Affiliated Hospital of Henan University of Science and Technology from July 2021 to February 2022 were selected.Temperature test(CT),velocity step test(VST),video head impulse test(video impulse test,vHIT)and dizziness handicap inventory(DHI)were used to evaluate the vestibular function of patients at admission,one month and three months after medications and vestibular rehabilitation training.Results There were 20 males and five females among the 25 patients,aged from 18 to 76 years,with an average age of(46.9±4.9)years.The highest abnormal rate was DHI(100.00％),followed by vHIT(96.00％)and CT(96.00％),and VST(84.00％)was the lowest before treatment.The effective rates of CT(52.00％,88.00％)and VST(48.00％,80.00％)were higher than those of vHIT(16.00％,56.00％)and DHI(20.00％,60.00％)after rehabilitation treatment for one month and three months,and the differences were statistically significant(P＜0.05).Conclusions CT,VST,vHIT and DHI are of great significance in the clinical evaluation of VN patients during the rehabilitation period,among which CT and VST are more effective in evaluating long term rehabilitation of VN vestibula function.The different vestibular rehabilitationin results of the process of the four tests can be used as a complement.
Objective To explore the status and influencing factors of complications after cytoreductive surgery(CRS)combined with hyperthermic intraperitoneal chemotherapy(HIPEC)for pseudomyxoma peritonei(PMP).Methods A total of 344 patients who were transferred to intensive care unit(ICU)after CRS combined with HIPEC in Peking University Aerospace Center Hospital from May 2015 to December 2022 were selected.The grading situation of postoperative complications were analyzed according to the Clavien-Dindo classification system,and the influencing factors of postoperative complications were analyzed by multivariate logistic regression equation.Results Among the 344 patients,there were 110 males and 234 females,aged from 32 to 85,with a median age of 61(54,68)years old.A total of 133 patients(38.7％)developed at least one complication during hospitalization,including 42 cases of pulmonary infection(12.2％),41 cases of abdominal infection(11.9％)and 31 cases of intestinal fistula(9.0％).There were 209 complications in 133 patients,including 3.8％(8/209)of grade Ⅰ,53.1％(111/209)of grade Ⅱ,43.1％(90/209)of serious complication(≥ Ⅲ a).Logistic regression analysis showed that patients with history of chronic lung disease(OR=6.410,95％CI:2.037-20.408,P=0.001)and CRS history(OR=3.425,95％CI:2.004-5.848,P＜0.001),and high-grade tumor pathologic classification(OR=1.704,95％CI:1.007-2.882,P=0.047)had higher risk of postoperative complications after CRS and HIPEC.Conclusions PMP patients with CRS+HIPEC has a higher incidence of postoperative serious complications which should be alert to the occurrence of postoperative complications in PMP patients with chronic lung diseases,CRS history and high-level pathological classification of tumors.
患者男,58岁,因"左耳听力减退伴眩晕1d"于2022年11月24日入院.患者入院前1d晨醒后出现左侧听力减退伴耳闷,中午出现伴头晕、行走欠稳、无视物旋转,当晚出现右侧肢体活动不利.急诊头颅CT未见异常,以"突发性耳聋、脑梗死待排"收住入院.既往史:高血压病史、糖尿病史、BP和血糖均控制不佳,否认心房颤动疾病史及耳科疾病史,长期吸烟饮酒史.
为维护北京医学杂志的声誉和读者的权益,本刊特对一稿多投问题的处理声明如下. 1.作者向本刊投寄的文稿,经审稿专家、本刊编辑委员会和编辑部审阅,发现已在他刊(其他文种期刊除外)发表,或审稿专家已为他刊审过此稿,尽管文稿在文题、文字的表达和讨论的叙述方面略有不同,但其主要数据和图表相同,本刊则认定此文稿为一稿多投.
急性单侧前庭病(acute unilateral vestibulopathy,AUVP),也称前庭神经炎(vestibular neuritis,VN),是一种急性外周前庭综合征.2022年6月巴拉尼协会首次发布《急性单侧前庭病/前庭神经炎诊断标准》,包含4个亚型的诊断标准,即急性单侧前庭病、演变中的急性单侧前庭病、可能的急性单侧前庭病和既往急性单侧前庭病.该诊断标准对临床有重要指导意义,本文对这一诊断标准进行解读.
Objective To explore the clinical efficacy of transcatheter closure guided by transesophageal ultrasound in the treatment of elderly patient with patent foramen ovale(PFO).Methods A total of 64 elderly patients diagnosed as PFO complicated with migraine in Yongchuan Hospital affiliated to Chongqing Medical University and treated with transcatheter closure guided by transesophageal ultrasound from January 2020 to December 2021 were included,and were divided into control group(without ischemic stroke,36 cases)and observation group(with ischemic stroke,28 cases)according to the MRI results.After six months of follow-up,the scores of headache impact test-6(HIT-6)and surgical complications were compared between the two groups.Results Among the 64 patients,four cases lost follow-up during the follow-up period(three cases in the control group and one case in the observation group),with a total follow-up rate of 6.25％.Finally 60 cases were included,including 25 males and 35 females,aged from 60 to 88 years,with an average age of(65.2±4.7)years,and the success rate of surgical occlusion was 100％.Six months after operation,the complete occlusion rate was 88.33％(53/60),and 11.67％(7/60)patients had different degrees of residual shunt.During the follow-up period,except for one patient with new atrial fibrillation,the other 59 cases had no serious complications such as occluder shedding,displacement,occluder thrombosis,new arrhythmia,pericardial effusion,and no new stroke in imaging.The HIT-6 scores of the two groups at six months after operation were lower than those before operation,and the difference was statistically significant(P＜0.05).There was no significant difference in HIT-6 scores between the two groups before and six months after operation(P＞0.05).Conclusions Transcatheter closure guided by transesophageal ultrasound has a significant effect on elderly patients with PFO complicated with migraine,and the incidence of thromboembolism during follow-up is low.
Objective To explore the clinical effect of the same quality of different concentrations and volumes of analgesia solution in dural puncture epidural(DPE)combined with programmed intermittent epidural blous(PIEB)for labor analgesia and its effect on infants.Methods A total of 94 cases of primiparas who requested labor analgesia in Beijing Obstetrics and Gynecology Hospital,Capital Medical University from May 2021 to March 2022 were selected,and were randomly divided into group C(46 cases)and group T(48 cases).Both groups were given DPE combined with PIEB for labor analgesia,but group C was given high concentration and low volume analgesic solution,while group T was given the same quality but low concentration and high volume analgesic solution.The analgesia efficacy,safety and birth conditions of the fetus were compared between the two groups.Results The age of the 94 patients ranged from 25 to 36 years,with an average of(28.8±3.0)years.The dosage of ropivacaine and sufentanyl in group T were lower than those in group C[(54.5± 14.8)mg vs.(65.9±15.7)mg,(26.6±7.5)μg vs.(32.2±7.9)μg],and the differences were statistically significant(P＜0.05).There were no significant differences in visual analogue scale(VAS)at different time points,second stage of labor time,analgesia onset time,analgesia block plane,incidence of breakthrough pain,instrumental midwifery rate,the rate of modified Bromage score ≥ 1 score and neonatal Apgar score(l min,5 min)＜7 score,and the incidence of analgesia adverse reactions between the two groups(all P＞0.05).Conclusions In the mode of DPE combined with PIEB for labor analgesia,low-concentration and high-volume analgesic solution can achieve the same labor analgesia effect as high-concentration and low-volume analgesic solution with the same quality,without affecting the labor process and delivery mode of the parturient,and can reduce the dosage of analgesic drugs without affecting the birth of the fetus.
Objective To explore the changes of left atrial structure and function in patients with atrial fibrillation before and after left atrial appendage clipping(LAAC).Methods Patients who underwent LAAC surgery in Beijing Tiantan Hospital affiliated to Capital Medical University from October 2018 to October 2022 were selected,and the changes of left atrial size,serum potassium and sodium,troponin Ⅰ(TNⅠ),myoglobin,creatine kinase-myocardial band(CK-MB),and brain natriuretic peptide(BNP)before and after surgery were compared.Results A total of 52 patients with LAAC were selected,including 37 males and 15 females,aged from 57 to 84 years,with an average age of(68.4±6.2)years.There were no significant differences in left ventricular end-diastolic diameter,anteroposterior left atrial diameter,and ejection fraction before surgery,at discharge and three months after surgery(all P＞0.05).Serum potassium at discharge and three months after surgery was higher than that at preoperative[(4.0±0.5)mmol/L,(3.9±0.4)mmol/L vs.(3.8±0.4)mmol/L],serum sodium was lower than that at preoperative[(138.7±3.1)mmol/L,(138.5±2.5)mmol/L vs.(142.2±2.8)mmol/L].The postoperative peak TNⅠ,myoglobin,CK-MB and BNP were higher than those before surgery[0.712(0.443,1.113)ng/ml vs.0.005(0.002,0.014)ng/ml,442.6(280.7,551.6)ng/ml vs.40.5(32.4,66.3)ng/ml,3.42(2.17,5.19)ng/ml vs.1.67(1.00,2.40)ng/ml,379.15(268.85,524.53)pg/ml vs.195.65(71.48,219.33)pg/ml],TNⅠ at discharge was higher than that before surgery[0.194(0.084,0.310)ng/ml vs.0.005(0.002,0.014)ng/ml],the differences were statistically significant(all P＜0.05).There were no significant differences in myoglobin,CK-MB,and BNP between the time at discharge and preoperative(all P＞0.05).Conclusions After LAAC,no obvious changes in cardiac structure and systolic function are found in the early stage,but myocardial enzymes and BNP increase temporarily,and both of them decline after discharge,the long-term effects should continue to be observed.
目的 探讨速度阶跃试验(velocity step test,VST)、视频头脉冲试验(video head impulse test,vHIT)各项参数与年龄的相关性.方法 选取2022年1-12月辽宁中医药大学附属医院耳鼻咽喉头颈科眩晕诊疗中心受试者284例,根据年龄分为 11～20岁(19例)、＞20～30岁(22例)、＞30～40岁(34例)、＞40～50岁(43 例)、＞50～60岁(51 例)、＞60～70岁(50例)、＞70～80岁(48例)、＞80岁(17例)8组,分析VST、vHIT各项参数与年龄的相关性.结果 284例受试者中男141例,女143例,年龄10～88岁,平均(52.5±19.2)岁.不同年龄组VST顺时针、逆时针旋转急停后30 s水平眼震平均慢相速度及不对称比、衰减时间的不对称比,和vHIT左、右水平半规管60 ms瞬时增益值、6个半规管的回归增益值、每对半规管回归增益值不对称比的比较,差异均无统计学意义(P＞0.05).结论 不同年龄段VST、vHIT各项参数无相关性,结果判定时无需考虑患者年龄,可设定单一正常范围参考值.
Objective To explore the validity and accuracy of the measurement results of DBA-550 body composition analyzer based on bioelectrical impedance analysis(BIA).Methods A total of 30 college students were selected from Beijing from June to July 2018,the total body water(TBW)and fat free mass(FFM)were measured by isotope dilution method and BIA respectively,and the accuracy of the two methods was compared.Results Among the 30 participants,there were 15 males and 15 females,aged from 18 to 25 years,with an average age of(23.8±1.67)years.The TBW and FFM measured by BIA were higher than those measured by isotope 18O[(34.49±6.47)kg vs.(32.33±6.14)kg,(47.12±8.85)kg vs.(44.17±8.39)kg],and the differences were statistically significant(both P＜0.05).Pearson correlation coeffiicients of TBW and FFM measured by the two methods were both 0.873(P＜0.05).The Bland-Altman consistency analysis showed that the range of difference between BIA and isotope dilution method(18O)in TBW and FFM was(2.2±6.2)kg and(-2.9± 8.5)kg,respectively,which showed a good consistency.Conclusions The measurement of TBW by DBA-550 body composition analyzer based on BIA is equivalent to the"gold standard"isotope dilution method,which is suitable for rapid evaluation of human TBW,FFM and other indicators.
Objective To explore the clinical efficacy of endorectal advancement flap(ERAF)combined with ligation of the intersphincteric fistula tract(LIFT)in the treatment of high simple anal fistula.Methods A total of 84 patients with high simple anal fistula in Beijing Anorectal Hospital(Beijing Erlong Road Hospital)from March to September 2022 were selected,and were randomly divided into the observation group and the control group,with 42 patients in each group.The observation group was treated with ERAF combined with LIFT,while the control group was treated with traditional incision and thread-drawing surgery.The visual analogue scale(VAS),clinical efficacy and complications were compared between the two groups.Results Among the 84 patients,there were 58 males and 26 females,aged from 27 to 59 years,with an average of(32.6±6.8)years.The VAS of the observation group on the 1st,3rd and 7th day after operation was lower than those of the control group[(5.24±1.08)score vs.(7.19±1.35)score,(4.76±1.11)score vs.(6.21±1.09)score,(2.34± 0.54)score vs.(2.98±0.61)score],the blood loss,hospitalization time and wound healing time were lower than those in the control group[(7.83±1.62)ml vs.(12.66±2.46)ml,(3.75±1.66)d vs.(4.55±1.71)d,(28.15±8.65)d vs.(39.12± 10.23)d],Wexner score and anal systolic blood pressure two month after operation were lower than those in the control group[(3.28±0.63)score vs.(4.46±0.75)score,(178.49±8.82)mmHg vs.(186.22±10.29)mmHg,1 mmHg=0.133 kPa],the anal resting pressure was higher than that in the control group[(45.88±2.87)mmHg vs.(43.85±1.74)mmHg],and incidence of complications were lower than that of the control group(11.90％vs.33.33％),the differences were statistically significant(all P＜0.05).There was no significant difference in operation time between the two groups(P＞0.05).Conclusions Compared with the traditional incision and thread-drawing surgery for high simple anal fistula,ERAF combined with LIFT has an advantage of less bleeding,less pain,shorter course of disease,faster recovery,which is worthy of clinical promotion.
目的 探讨手术前后甲状腺相关眼病(thyroid associated ophthalmopathy,TAO)患者的生活质量.方法 选取2022年4-11月解放军总医院第三医学中心接受手术治疗的TAO患者54例,比较患者手术前后的生活质量(quali-ty of life,QOL).结果 54例患者中,男22例、女32例;年龄18～77岁,平均(44.0±15.3)岁.其中,眶减压手术18例,斜视手术11例,眼睑手术25例.与术前相比,术后患者的视觉功能和社会心理评分增加;术后患者在骑自行车、开车、房间里散步、看书、看电视等视觉功能评分均增加;自我感觉容貌变化、走在大街上其他人会注视、其他人不友好等社会心理评分均增加,以上差异均有统计学意义(P＜0.05).结论 手术治疗可以显著改善TAO患者的生活质量.
目的 探讨单侧全聋型突发性耳聋(profound idiopathic sudden sensorineural hearing loss,PISSNHL)患者前庭功能损伤的频率特点和预后.方法 选取2020年10月至2022年3月东南大学附属江阴市人民医院耳鼻咽喉头颈外科PISSNHL患者,按诊疗指南完成治疗,住院10 d后完成温度试验(caloric test,CT)和视频头脉冲试验(ideo head im-pulse test,vHIT),分析患者频率特点和治疗有效率.结果 共纳入单侧PISSNHL患者50例,其中男27例,女23例,年龄18～71岁,平均(48.2±11.2)岁.伴眩晕患者22例(44.0％),CT检查结果异常23例(46.0％).眩晕组CT结果异常率高于非眩晕组(90.9％比10.7％),差异有统计学意义(P＜0.05).vHIT检查结果显示,水平半规管异常13例(26.0％),后半规管异常8例(16.0％),上半规管异常8例(16.0％).治疗后听力疗效等级评估,治愈11例(22.0％)、显效15例(30.0％)、有效10例(20.0％)、无效14例(28.0％).眩晕组、CT异常组治疗有效率分别低于非眩晕组和CT正常组,差异均有统计学意义(P＜0.05).结论 伴有眩晕症状的患者前庭功能和CT异常率更高.与反应高频前庭功能的vHIT检查相比,反应低频前庭功能的CT检查异常率更高,且治疗有效率更低.完善的前庭功能检测能更全面反映PISSNHL患者病变累及范围及治疗效果.
日间手术作为一种新型医疗模式正处于快速发展阶段,智能化移动医疗随访方式可以使日间手术术后管理更加精细,使医疗资源使用率和日间手术患者围术期的医疗服务质量得到提升.现从日间手术的概念、日间手术术后随访的必要性、传统随访方式及效果、智能化随访方式及效果进行综述,以期为移动医疗在日间手术术后随访的应用与发展提供参考.
Objective To explore the effect of multiple intracranial and extracranial artery stenosis on the risk of one-year recurrence of acute mild stroke.Methods A total of 2 390 patients with acute mild stroke admitted to the Department of Neurology,Renqiu Kangjixintu Hospital from January 2014 to November 2018 were selected.Multivariate logistic regression equation was used to analyze the effect of multiple intracranial and extracranial artery stenosis on the risk of one-year recurrence of acute mild stroke.Results Among the 2 390 patients,there were 886 males and 1 504 females,aged from 23 to 95 years,with an average age of(62.6±11.1)years.A total of 70 cases of stroke recurred within one year,and the recurrence rate was 2.93％.The incidence of intracranial and extracranial artery stenosis was 41.05％,of which 20.33％were multiple intracranial and extracranial artery stenosis.Multivariate logistic regression analysis results showed that patients with higher Hcy(OR=1.015,95％CI:1.006-1.024,P=0.001)and multiple intracranial and extracranial artery stenosis(OR=3.292,95％CI:1.925-5.631,P=0.000)had higher one-year stroke recurrence risk.Conclusions Hyperhomocysteinemia and multiple intracranial and extracranial artery stenosis are independent risk factors for one-year recurrence of minor stroke.
目的 探讨热射病中枢神经系统损害临床特点及治疗效果.方法 选取2012年1月至2022年10月中国康复研究中心北京博爱医院神经康复病房的热射病恢复期患者11例.分析患者临床和影像学表现和治疗效果.结果 11例患者中,男10例、女1例;年龄15～68岁,平均(34.7±19.0)岁;病程0.5～7个月,平均病程(2.86±2.13)个月.存在多种功能障碍,包括认知障碍(7例)、构音障碍(5例,其中3例不能发声)、吞咽障碍(2例)、肢体运动功能障碍(11例)、感觉障碍(5例)、平衡障碍(11例)、尿便障碍(2例)、情绪障碍(9例)、废用综合征(2例),日常生活活动能力均需外界帮助,社会参与能力均减退.经系统、规范化康复治疗后,患者功能障碍改善,平衡功能和日常生活活动能力显著提高(P＜0.05).结论 热射病中枢神经系统损害患者存在多种功能障碍,综合康复治疗能减轻热射病患者的功能障碍,显著提高平衡功能和日常生活活动能力.
儿童低级别胶质瘤(pediatric low grade glioma,pLGG)是儿童最常见的中枢神经系统肿瘤类型,与成人相比表现出不同的生物学和临床特征.发育中的儿童大脑更容易受到肿瘤及其治疗毒性的影响,胶质瘤放化疗导致的神经认知功能下降、耳毒性、内分泌毒性和细胞学毒性等,对于维持患者生活质量和生理功能是巨大的挑战,临床急需研发新的药物.在pLGG临床研究中,由于肿瘤对药物的反应缓慢,治疗过程中从影像学角度观察,缓解并不明显,完全缓解(complete response,CR)和部分缓解(partial response,PR)发生率不高.多个指南在pLGG的研究中引入了轻微缓解(minor response,MR)的概念,即在T2/FLAIR序列上按二维扫描标准测量肿瘤相关径线,其乘积大小较基线检查时减少25％～＜50％.肿瘤进展缓慢,无进展生存(progression free survival,PFS)和总生存(overall survival,OS)时间长,终点随访周期过长,难以用PFS或OS作为临床研究的主要终点.为了更好地推动pLGG的药物研发,本共识汇集了神经肿瘤学、临床肿瘤学、神经影像学、神经外科学和神经病理学等多学科专家的意见,给出了中国pLGG临床研究试验终点选择的专家意见和建议,基于中枢神经系统肿瘤评价标准(response assessment in neuro-oncology criteria,RANO),推荐客观缓解率(objective response rate,ORR)(定义为CR+PR+MR)作为主要终点,指导中国pLGG靶向治疗的临床研究和药物研发.现从pLGG的分型、影像学表现和临床表现,pLGG化疗和放疗治疗的局限性,pLGG的药物研发进展,pLGG临床研究试验终点的选择,运动、神经心理学和患者自报告终点,pLGG疗效评估标准进行综述.
