The clinical application of diagnostic and therapeutic gastrointestinal endoscopy under sedation and anesthesia is rapidly expanding,currently accounting for approximately 60%of all procedures.However,sedation and anesthesia during gastrointestinal endoscopy are accompanied by nonnegligible risks of safety.At present,there is a relative shortage of personnel and equipment dedicated to sedation and anes-thesia management in endoscopy unit.Substantial variability exists in the implementation and management of sedation and anesthesia across different regions and medical institutions,and deficiencies remain in docu-mentation of anesthesia records.Therefore,improving the overall standardization and safety of sedation and anesthesia during gastrointestinal endoscopy is urgently needed.To address these issues,the National Gas-troenterology Quality Improvement System and the National Center of Anesthesia Quality Assurance identified 24 key clinical questions related to sedation and anesthesia management in gastrointestinal endoscopy through online interviews,questionnaire surveys,and expert voting.Based on systematic evidence retrieval,critical appraisal of evidence quality,and a structured recommendation formulation process,a total of 41 recommendations were ultimately developed.This guideline aims to provide standardized,evidence-based guidance for the implementation and management of sedation and anesthesia in gastrointestinal endoscopic procedures,so as to improve the safety and quality of the overall healthcare.
IntroductionSelective posterior rhizotomy (SPR) is a preferred procedure for relieving spastic children with cerebral palsy, but it is associated with severe pain and significant emergence agitation (EA). The thoracolumbar interfascial plane (TLIP) block provides an effective blockade to the dorsal branch of the spinal nerve. We hypothesise that the TLIP block may be an effective tool to alleviate EA and postoperative pain scores in children with cerebral palsy undergoing SPR.Methods and analysisThis study is a single-centre, randomised, parallel-controlled trial being conducted in Beijing, China. A total of 50 paediatric patients with cerebral palsy scheduled for SPR are randomised in a 1:1 ratio to receive bilateral TLIP block with 0.2% ropivacaine 0.5 mL/kg or control. Patients in the TLIP group receive general anaesthesia combined with TLIP block, while patients in the control group receive only general anaesthesia, without a TLIP block. The primary outcome is the Paediatric Anaesthesia Emergence Delirium Score. The secondary outcomes are the incidence of EA, the Wong-Baker Faces Pain-rating Scale, the perioperative haemodynamics, the intraoperative remifentanil and propofol dosage, the extubation time and recovery time, and adverse reactions.Ethics and disseminationThis study was approved by the Ethics Committee of Dongzhimen Hospital, Beijing University of Chinese Medicine on 21 September 2023 (2023DZMEC-379–02). Written informed consent is obtained from the legal guardian of each patient. The results of this study will be published in peer-reviewed international journals.Trial registration numberChiCTR2300076397
目的 探讨无背景剂量羟考酮静脉自控镇痛联合髋关节囊周神经(PENG)阻滞用于老年患者全髋关节置换术(THA)术后镇痛的效果.方法 选择择期在蛛网膜下腔阻滞下行单侧THA老年患者99 例,男38 例,女61 例,年龄65～85 岁,BMI 18～30 kg/m2,ASAⅡ或Ⅲ级.采用随机数字表法将患者分为两组:有背景剂量羟考酮静脉自控镇痛组(P组,n=49)和无背景剂量羟考酮静脉自控镇痛+PENG阻滞组(N组,n=50).麻醉开始前,N组在髋关节囊周围注射 0.375％罗哌卡因20 ml.两组术后均连接静脉自控镇痛,镇痛泵配方:羟考酮 40 mg+托烷司琼 4mg用生理盐水稀释至100 ml.P组设置背景剂量2 ml/h,PCA剂量2.5 ml.N组设置为无背景剂量,PCA剂量5 ml.记录术后 48h羟考酮累积消耗量、镇痛泵总按压次数、有效按压次数以及补救镇痛情况,术后 4、12、24、48、72 h的静息和活动时VAS疼痛评分,术前1d、术后1、2、3 d的匹兹堡睡眠质量指数(PSQI)和术后 48h不良反应的发生情况.结果 与P组比较,N组术后 48h羟考酮累积消耗量以及补救镇痛比例明显降低(P＜0.05),总按压次数和有效按压次数明显增加(P＜0.05),术后 4、12、24 h的静息和活动时VAS疼痛评分明显降低(P＜0.05),术后 1、2、3 d PSQI评分明显降低(P＜0.05),术后恶心、呕吐发生率明显降低(P＜0.05).结论 无背景剂量羟考酮静脉自控镇痛联合PENG阻滞用于老年患者THA的术后镇痛,镇痛效果满意,可减少术后镇痛药物用量,且能够提高术后睡眠质量,减少术后不良反应的发生.
目的 基于机器学习算法建立心脏外科手术患者术后谵妄(POD)风险预测模型,并验证其有效性.方法 选择2021年5—12月择期行心脏外科手术患者710例,男468例,女242例,年龄≥18岁,ASAⅠ—Ⅳ级.采用医疗电子信息系统收集患者资料.记录术前抑郁筛查量表(PHQ-9)评分、广泛性焦虑障碍量表(GAD?7)评分以及简易精神状态检查量表(MMSE).将采集的整个数据集按照训练集(75％)和测试集(25％)的比例进行划分,其中训练集和测试集中POD发生率相同.建立6种机器学习模型,包括梯度提升决策树(GBDT)、支持向量机(SVM)、随机森林(RF)、逻辑回归(LogR)、K最邻近法(KNN)、深度神经网络(DNN),基于这6种算法以5折交叉验证的方式对训练数据集的数据进行模型的学习训练,通过测试数据集的数据对模型性能进行验证.基于准确率、精确率、召回率、F1分数、受试者工作特征曲线(ROC)及ROC曲线下面积(AUC)比较不同模型的有效性,并找出适合本研究数据框架的最佳模型.结果 有151例(21.3％)心脏外科手术患者中发生POD.本研究进行了6个机器学习模型的性能比较,在使用全部特征作为潜在风险因素的条件下,GBDT的AUC为0.86(95％CI 0.82～0.89),SVM的AUC为0.79(95％CI 0.76～0.83),RF的AUC为0.85(95％CI 0.83～0.87),LogR的AUC为0.67(95％CI 0.63～0.70),KNN的AUC为0.67(95％CI 0.63～0.69),DNN的AUC为0.78(95％CI 0.74～0.82).结论 机器学习算法开发的预测模型可用于心脏外科手术后POD的预测,其中GBDT和RF表现出了较好的机器学习效能,适合于本研究数据框架,更有可能提高POD预测的准确性.特征工程可进行患者数据的可视化处理,以筛选心脏外科手术发生POD的风险因素.
围术期神经认知障碍(PND)是一种常见于老年患者的术后并发症,其特征是患者出现认知功能下降、记忆受损、注意力不能集中等改变.随着老年患者手术数量的持续增长,出现PND的患者数量也将随之上升.PND的危险因素及诱发因素十分复杂,具体机制尚不清楚,且无统一的诊断标准.本文总结近年来各类PND脑源性生物标志物的研究进展,以期为PND的预测和诊断提供参考.
