It is unclear whether desflurane, one of the most-used volatile anesthetics in clinical practice, is less likely to induce postoperative cognitive dysfunction (POCD). We here compared early postoperative cognitive function of the isoflurane and desflurane patients and explored the diagnostic performance of relative level of LINC01844 in peripheral blood for POCD. Eighty-five patients underwent lumbar surgery under general anesthesia were included in the study according to inclusion and exclusion criteria. Patients were randomly allocated to either isoflurane (I) or desflurane (D) study arms. A battery of 7-item neurocognitive tests was performed repeatedly on one day preoperatively and 1st, 3rd and 5th day postoperatively (POD1,3,5) and peripheral blood samples were drawn simultaneously. POCD was diagnosed using the Z-score method. The relative level of LINC01844 was decided by quantitative real-time polymerase chain reaction. The primary outcome was the incidence of POCD within 5 days postoperatively. Binary logistic regression analysis and receiver operating characteristic (ROC) curves were used for the analysis of diagnostic performance of LINC01844 level for POCD. The incidence of POCD within 5 days postoperatively was significantly lower in D group than in the I group (p = 0.001). Compared to I group, LINC01844 relative levels in D group were significantly lower on POD1(p < 0.001), POD3(p = 0.003) and POD5(p < 0.001). Patients diagnosed with POCD had higher LINC01844 relative level on POD1(p < 0.001), POD3(p = 0.003) and POD5(p < 0.001). Binary logistic regression analysis found that POCD was independently associated with LINC01844 relative level of POD1, POD3 and POD5(OR 14.862, 95

This study evaluated the effect of preoperative carbohydrate fluid intake on gastric volume (GV), blood glucose (BG), reflux aspiration, and postoperative nausea and vomiting (PONV) in patients with sellar tumors undergoing neuroendoscopic transnasal–sphenoidal sinus resection (NTSR). Fifty-eight patients scheduled for elective NTSR were randomly assigned to Group A (n = 29), who received 400 mL of 10

Background The sedative effects of remimazolam are well-established, but its impact on amnesia remains unclear. We compared the effects of remimazolam and propofol on memory before and after general anaesthesia. Methods This study included 110 patients scheduled for elective unilateral great saphenous vein surgery under general anaesthesia. Patients were assigned to either remimazolam or propofol groups (n = 55 each) based on the attending anaesthesiologist's preference and clinical judgement. Primary outcomes included the average proportion of patients experiencing complete amnesia (inability to recall any posters) across three assessment points (10, 20, and 30 min after awakening), evaluated 24 h postoperatively. Secondary outcomes included the total number of posters recalled within 30 min after recovery and the proportion of recalled posters shown at specific time points before anaesthesia induction and after awakening. Results After exclusions (n = 24), 86 patients (n = 43 per group) were included. The proportion of patients experiencing amnesia within 30 min of anaesthesia recovery was significantly higher, and the total number of posters recalled within the 30-min period post-recovery was significantly lower in the remimazolam group compared with the propofol group (P < 0.001). Memory of the posters shown before anaesthesia induction was similar in both groups. Awakening time was significantly longer in the remimazolam group than in the propofol group (P = 0.001). Conclusion Compared with propofol, remimazolam was associated with a more pronounced impairment of memory 30 min after anaesthesia recovery. These findings may help inform clinical selection of induction agents for general anaesthesia. Registration Chinese Clinical Trial Registry; Registration number: ChiCTR2400080979; URL: https://www.chictr.org.cn/showproj.html?proj=219722.

BACKGROUND:Neuroinflammation following peripheral surgery plays a key role in postoperative cognitive dysfunction (POCD) development and there is no effective therapy to inflammation-mediated cognitive impairment. Recent studies showed that rutin, a natural flavonoid compound, conferred neuroprotection. However, the effects and mechanisms of rutin on cognition of surgical and aged mice and LPS-induced BV2 need deeper exploration.METHODS:The effect of rutin in vivo and vitro were evaluated by Morris water maze test, HE stainin, Golgi-Cox staining, IF, IHC, RT-PCR, Flow Cytometer and Western blotting. In vivo, aged mice were treated with rutin and surgery. In vitro, rutin, Nrf2 knockdown, MAC-1 overexpression and VX765, a caspase-1 inhibitor, were administration on BV2 microglial cells.RESULTS:Surgery led to compensatory increase in nuclear Nrf2 and rutin could further increase it. Neural damage was accompanied with high level in MAC-1, caspase-1-mediated pyroptosis and M1 microglia, while rutin recovered the process. Nrf2 inhibition abolished the effect of rutin with the increase of MAC-1, caspase-1-mediated pyroptosis and M1 microglia. Activation of MAC-1 abrogated protection of rutin by increase in pyroptosis and M1 microglia. Finally, we found that treatment with VX765 improved injury and increased M2 microglia against overexpression of MAC-1.CONCLUSIONS:Our study indicated that rutin may be a potential therapy in POCD and exerted neural protection via Nrf2/ Mac-1/ caspase-1-mediated inflammasome axis to regulate pyroptosis and microglial polarization.

BACKGROUND:Neuroinflammation is crucial in the development of postoperative cognitive dysfunction (POCD), and microglial activation is an active participant in this process. SS-31, a mitochondrion-targeted antioxidant, is widely regarded as a potential drug for neurodegenerative diseases and inflammatory diseases. In this study, we sought to explore whether SS-31 plays a neuroprotective role and the underlying mechanism.METHODS:Internal fixation of tibial fracture was performed in 18-month-old mice to induce surgery-associated neurocognitive dysfunction. LPS was administrated to BV2 cells to induce neuroinflammation. Neurobehavioral deficits, hippocampal injury, protein expression, mitophagy level and cell state were evaluated after treatment with SS-31, PHB2 siRNA and an STING agonist.RESULTS:Our study revealed that SS-31 interacted with PHB2 to activate mitophagy and improve neural damage in surgically aged mice, which was attributed to the reduced cGAS-STING pathway and M1 microglial polarization by decreased release of mitochondrial DNA (mtDNA) but not nuclear DNA (nDNA). In vitro, knockdown of PHB2 and an STING agonist abolished the protective effect of SS-31.CONCLUSIONS:SS-31 conferred neuroprotection against POCD by promoting PHB2-mediated mitophagy activation to inhibit mtDNA release, which in turn suppressed the cGAS-STING pathway and M1 microglial polarization.

BACKGROUND The population of elderly patients with gastric cancer is increasing, which is a major public health issue in China. Malnutrition is one of the greatest risk factors for adverse clinical outcomes in elderly patients with gastric cancer. AIM To investigate the preoperative nutritional status and its association with delayed discharge of elderly gastric cancer patients following radical gastrectomy. METHODS A total of 783 patients aged 65 years and older harboring gastric adenocarcinoma and following radical gastrectomy were retrospectively analyzed from the prospectively collected database of Zhongshan Hospital of Fudan University between January 2018 and May 2020. RESULTS The overall rate of malnutrition was 31.8%. The incidence of postoperative complications was significantly higher in the malnourished group compared to the well-nourished group (P < 0.001). Nutritional characteristics in the malnourished group, including body mass index, prognostic nutritional index (PNI), albumin, prealbumin, and hemoglobin, were all significantly lower than those in the well-nourished group. The percentage of patients who received postoperative total nutrient admixture was lower in the malnourished group compared to the well-nourished group (22.1% vs 33.5%, P = 0.001). Age ≥ 70 years (HR = 1.216, 95%CI: 1.048-1.411), PNI < 44.5 (HR = 1.792, 95%CI: 1.058-3.032), operation time ≥ 160 minutes (HR = 1.431, 95%CI: 1.237-1.656), and postoperative complications grade III or higher (HR = 2.191, 95%CI: 1.604-2.991) were all recognized as independent risk factors associated with delayed discharge. CONCLUSION Malnutrition is relatively common in elderly patients undergoing gastrectomy. Low PNI is an independent risk factor associated with delay discharge. More strategies are needed to improve the clinical outcome of these patients.

The initiation time and formula for supplemental parenteral nutrition after surgery require optimization, especially in older patients undergoing major gastrointestinal surgery. This study aimed to assess the effect of early supplementation with a branched-chain amino acid (BCAA)-enriched formula (BAF) on short-term postoperative outcomes in older patients undergoing gastric surgery. This single-center, prospective, double-blinded, randomized clinical trial was conducted from March 10, 2020, to September 15, 2022. Patients aged 65–80 years with gastric cancer scheduled for curative resection were assessed for eligibility and randomly allocated to a high-proportion BCAA (HBCAA) (early supplementation with the BAF) or control (routine nutrition) group. The primary outcome was the standardized length of hospital stay (LOS). A total of 150 patients were randomized. Thirteen patients were excluded due to the resection of other organs, presence of metastasis, or withdrawal of consent. Finally, we included 70 and 67 patients in the HBCAA and control groups, respectively (mean age: 70.5 ± 4.2 years; 96 men [70.1

Peripheral surgery-induced neural inflammation is a key pathogenic mechanism of postoperative cognitive dysfunction (POCD). However, the mechanism underlying neuroinflammation and associated neural injury remains elusive. Surgery itself can lead to gut damage, and the occurrence of POCD is accompanied by high levels of TNF-α in the serum and blood‒brain barrier (BBB) damage. Reductions in stress, inflammation and protein loss have been emphasized as strategies for enhanced recovery after surgery (ERAS). We designed an amino acids and dipeptide (AAD) formula for injection that could provide intestinal protection during surgery. Through the intraoperative infusion of AAD based on the ERAS concept, we aimed to explore the effect of AAD injection on POCD and its underlying mechanism from the gut to the brain. Here, we observed that AAD injection ameliorated neural injury in POCD, in addition to restoring the function of the intestinal barrier and BBB. We also found that TNF-α levels decreased in the ileum, blood and hippocampus. Intestinal barrier protectors and TNF-α inhibitors also alleviated neural damage. AAD injection treatment decreased HMGB1 production, pyroptosis, and M1 microglial polarization and increased M2 polarization. In vitro, AAD injection protected the impaired gut barrier and decreased TNF-α production, alleviating damage to the BBB by stimulating cytokine transport in the body. HMGB1 and Caspase-1 inhibitors decreased pyroptosis and M1 microglial polarization and increased M2 polarization to protect TNF-α-stimulated microglia in vitro. Collectively, these findings suggest that the gut barrier–TNF-α–BBB–HMGB1–Caspase-1 inflammasome–pyroptosis–M1 microglia pathway is a novel mechanism of POCD related to the gut–brain axis and that intraoperative AAD infusion is a potential treatment for POCD. According to our findings, AAD injection, which is based on the ERAS concept, alleviates POCD by decreasing the activity of the gut barrier–TNF‐α–BBB–HMGB1–Caspase-1 inflammasome–pyroptosis–M1 microglial axis

This study aimed to investigate the impact of caloric restriction (CR) on cognitive function in aged C57BL/6 mice after surgery, as well as the underlying mechanisms. Forty 14-month-old male C57BL/6 mice were randomly assigned to the ad libitum (AL, n = 20) group and the CR (n = 20) group. After feeding for 12 weeks, they were subdivided into four groups: AL control (ALC, n = 10), AL with surgery (ALS, n = 10), CR control (CRC, n = 10), and CR with surgery (CRS, n = 10). The Morris Water Maze (MWM) test was used to assess learning and memory capacity. By using western blot and immunofluorescence, the expression of Sirt1, MeCP2, and BDNF in the hippocampus and hippocampal CA1 region was quantified. According to the behavioral test, the CRC and CRS groups had significantly better learning and memory abilities than the ALC and ALS groups, respectively. Sirt1, MeCP2, and BDNF expression in the hippocampus and CA1 region in the hippocampus of the ALC and CRC groups of mice were correlated with cognitive improvement. In conclusion, CR could enhance the postoperative cognitive function in aged mice, most likely by increasing the expression of Sirt1, MeCP2, and BDNF in the CA1 region of the hippocampus.

The purposes of this study were to explore the impact of obesity on postoperative cognitive dysfunction (POCD) and to investigate the underlying mechanism by which obesity exacerbates POCD. In this study, fifteen-month-old male C57BL/6 J mice were fed a High-fat diet for three months to establish obesity models. Internal fixation of tibial fractures under isoflurane inhalation was performed to construct a POCD animal model. Three days after surgery, mice were subjected to the Morris water maze (MWM) experiment to evaluate their learning and memory abilities. The findings from the MWM experiment revealed that in comparison to the Ad Libitum Surgical group (ALS), mice in the High-fat Surgical group (HFS) exhibited prolonged escape latencies and reduced platform crossings. These outcomes suggest the potential exacerbating role of obesity in cognitive impairment within the POCD mouse models. Immunofluorescence (IF) findings demonstrate that obesity intensifies anesthesia and surgery-induced oxidative stress levels within the hippocampus. Compared to the Ad Libitum Control group (ALC), an elevation in PARP1 expression and a reduction in the NAD+/NADH ratio and SIRT1 expression were observed in the hippocampus of mice from the ALS. Moreover, when contrasting the HFS group with the ALS group, increased PARP1 expression along with decreased NAD+/NADH ratio and SIRT1 expression were evident. In vitro studies found that compared with the Control group (CON), oil red staining and BODIPY probe staining showed significant lipid droplet aggregation in the palmitic acid (PA) group. IF results demonstrated that HT22 cells in the PA group experienced oxidative stress and activation of the PARP1/NAD+/SIRT1 axis in contrast to the CON group. Moreover, manipulation of PARP1 expression in HT22 cells through PARP1 lentivirus-based silencing or overexpression revealed a converse relationship between PARP1 expression levels and the NAD+/NADH ratio as well as SIRT1 expression levels. This study concludes that obesity may exacerbate POCD by triggering activation of the oxidative stress-induced PARP1/NAD+/SIRT1 axis.

Background: Total parenteral nutrition with the formula of amino acids enriched branched-chain amino acids (BCAAs) could promote patients' recovery after gastrointestinal surgery. Previous studies reported that vitamin B6 could promote amino acid metabolism and enhance protein synthesis. The aim of this study was to determine if the addition of vitamin B6 to BCAAs-enriched formula can enhance post-operative nutritional status and intestinal function in rats undergoing partial gastrectomy, and the appropriate compatibility concentration of vitamin B6.Methods: Fifty-six male rats were randomly divided into seven groups (n 1/4 8 per group): (I) Control, (II) BCAAs-enriched formula group (BCAA), (III) BCAA plus vitamin B6 (50 mg/L), (IV) BCAA plus vitamin B6 (100 mg/L), (V) BCAA plus vitamin B6 (200 mg/L), (VI) BCAA plus vitamin B6 (500 mg/L), and (VII) BCAA plus vitamin B6 (1000 mg/L). All animals were performed partial gastrectomy and placed a jugular vein catheter. During enteral nutrition, blood and urine samples were repeatedly collected. Gastrocnemius muscle and small intestine were also collected at the end of experiment.Results: The addition of vitamin B6 to BCAAs-enriched formula improved negative nitrogen balance after gastrectomy compared to the BCAAs-enriched formula group at POD1 (first postoperative day) and POD3 (third postoperative day), and 100 mg/L was an appropriate concentration of vitamin B6 to enhance the effects of BCAAs-enriched formula. The 3-methylhistidine/creatinine in BCAA plus vitamin B6 groups were significantly lower than that in the BCAA group at POD3. Moreover, BCAA plus vitamin B6 group significantly increased the cross-sectional area of the muscle fibers compared to the BCAA group. Transcriptome sequencing, GO and KEGG enhancement analysis also showed that BCAA plus vitamin B6 group showed muscle organ development and PI3K/AKT pathway enhancement compared to BCAA group. Moreover, AKT/mTOR/4EBP1 pathway was activated in BCAA plus vitamin B6 group. In addition, the results also showed that BCAA plus vitamin B6 decreased D-lactate, and exerted synergistic effects on intestinal morphology.Conclusion: The addition of vitamin B6 to BCAAs-enriched formula could improve nitrogen balance, promote muscle protein synthesis through AKT/mTOR/4EBP1 pathway, and alleviate intestinal mucosa damage after partial gastrectomy in rats. Overall, the results from this pre-clinical study support the use of vitamin B6 as an ingredient to BCAAs-enriched formula, and 100 mg/L may be an optimal concen-tration for rats.(c) 2023 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Objective. Preoperative malnutrition is an independent risk factor for postoperative complications and survival for gastric cancer patients. The study is aimed at investigating the prevalence of malnutrition, perioperative nutritional support, and the risk factors associated with delayed discharge of geriatric patients undergoing gastrectomy. Methods. A retrospective study of gastric cancer patients ( age ≥ 65 ) who underwent gastrectomy at Zhongshan Hospital from January 2018 to May 2020 was conducted. Clinical data, including demographic information, medical history, surgery-related factors, and perioperative nutritional management, were collected and analyzed. Postoperative complications were assessed according to the Clavien-Dindo grading system, and the prognostic nutritional index (PNI) was calculated. The risk factors affecting the prolongation of postoperative hospital stay were analyzed. Results. A total of 783 patients were reviewed. The overall frequency of malnutrition was 31.3% (249/783). The albumin, prealbumin, and hemoglobin levels were lower in the malnutrition group than in the well-nourished group. The proportion of patients who received preoperative total parenteral nutritional support in the malnutrition group was significantly higher than in the well-nourished group (12.4% vs. 3.7%, P < 0.001 ). All patients received postoperative parenteral nutrition (PN); the proportion of patients who received total nutrient admixture (TNA) in the malnutrition group was lower than in the well-nourished group (22.1% vs. 33.5%, P = 0.001 ). No significant difference was found in the duration of postoperative nutrition between groups ( P > 0.05 ). The malnutrition group was associated with a higher rate of postoperative complications ( P < 0.001 ). Univariate and multivariate regressions revealed that age > 70 years ( OR = 1.216 , 95% CI 1.048-1.411, P = 0.010 ), operation time > 180 min ( OR = 1.431 , 95% CI 1.237-1.656, P < 0.001 ), PNI < 44.5 ( OR = 1.792 , 95% CI 1.058-3.032, P = 0.030 ), and postoperative complications ( OR = 2.191 , 95% CI 1.604-2.991, P < 0.001 ) were significant risk factors associated with delayed discharge. Conclusion. Malnutrition is relatively common in elderly patients undergoing gastrectomy. Advanced age, duration of surgery, lower levels of PNI, and postoperative complications were risk factors associated with delay discharge. Elderly gastric cancer patients with risk factors urgently require specific attention for reducing hospital stay.

目的 分析术中输注复方氨基酸对在全麻复合硬膜外阻滞下接受胃癌根治术患者苏醒质量的影响.方法 选择2016年1月至2019年6月在复旦大学附属中山医院行开放胃癌根治术的患者,随机分为氨基酸组和对照组,分别于手术开始后经颈内静脉输注11.4％复方氨基酸(18AA-Ⅱ)、0.9％氯化钠液2 mL·kg-1·h-1,持续2 h.评估两组拔管时间、麻醉苏醒质量(QoR-15评分及Richmond躁动-镇静评分)和不良反应;比较术前、术中及术后鼻咽温度、血糖,以及术后第1天外周血中性粒细胞计数、淋巴细胞计数、白细胞介素6(IL-6)和C反应蛋白(CRP)水平;记录并发症情况和住院时间.结果 共入选78例患者,氨基酸组35例、对照组43例.氨基酸组拔管时间早于对照组[7(5,10)min vs 12.5(10,15)min,P<0.001],QoR-15评分和躁动镇静水平优于对照组(P<0.001).氨基酸组术中及术后鼻咽温度较对照组升高(P<0.001).两组术后第1天IL-6和CRP水平均较术前升高(P<0.001);与对照组相比,氨基酸组术后第1天IL-6水平更高(P=0.048).两组术后血糖水平、CRP、中性粒细胞及淋巴细胞水平差异无统计学意义.两组术后恶心呕吐、寒战、感染等并发症及住院时间差异无统计学意义.结论 胃癌根治术中输注复方氨基酸有助于加快苏醒,改善苏醒质量,改善围术期低体温,且对术后炎症水平、并发症及住院时间无明显影响.

Background Malnutrition is relatively common among elderly patients with gastric cancer. This study sought to analyze whether preoperative nutritional status, inflammatory cytokines, and intestinal permeability were correlated in elderly gastric cancer patients undergoing surgery, and their effects on postoperative recovery. Methods This study was a single-center prospective cohort study. Patients aged 65-90 years who underwent gastrectomy were included. Preoperative nutritional status was assessed by the Mini Nutritional Score (MNA), Nutritional Risk Screening-2002 (NRS2002), body mass index (BMI), free fatty acids (FFAs), albumin, and prealbumin concentrations. Intestinal permeability was assessed by D-lactate and intestinal fatty acid-binding protein (i-FABP). The inflammatory factors included interleukin (IL)-6, IL-10, neutrophil, and lymphocyte counts. The time to first defecation, time to first liquid diet, length of hospital stay (LOS), and postoperative complications were recorded. Results A total of 134 patients were included. According to the MNA, 50.7% and 32.1% of the cohort had mild to moderate malnutrition, and severe malnutrition, respectively. According to the NRS2002, 38.8% of the patients scored >4 points. I-FABP was significantly negatively correlated with albumin (r=-0.409, P<0.001) and prealbumin (r=-0.397, P<0.001), and significantly positively correlated with MNA (r=0.291, P=0.001), the NRS2002 (r=0.284, P=0.001), and LOS (r=0.245, P=0.004). D-lactate was significantly negatively correlated with BMI (r=-0.229, P=0.008), albumin (r=-0.426, P<0.001), and prealbumin (r=-0.358, P<0.001), and significantly positively correlated with the NRS2002 (r=0.187, P=0.030), time to first defecation (r=0.264, P=0.002), and LOS (r=0.409, P<0.001). There were significant differences in BMI, prealbumin, FFAs, i-FABP, time to first defecation, and time to first fluid diet (P<0.05) among groups based on MNA score. The multivariate logistic analysis showed that D-lactate was an independent risk factor of postoperative complications [odds ratio (OR) =1.354, 95% confidence interval (CI): 1.099-1.669, P=0.004]. Conclusions The preoperative intestinal permeability indicators (i.e., D-lactate and i-FABP) are significantly correlated with some nutritional indicators and postoperative recovery indicators. The preoperative D-lactate level is an independent risk factor of postoperative complications, suggesting that altered gut barrier function before surgery could to some extent influence postoperative recovery in the elderly.

Background: Opioid-sparing anesthesia may enhance postoperative recovery by reducing opioid-related side effects. The present study was to evaluate the effect of an opioid-sparing strategy in bariatric surgery.Methods: This study was conducted as a retrospective matched case-controlled (1:1) study. A total of 44 patients receiving either an opioid-based approach (OBA group) or an opioid-sparing strategy (OSA group) who under laparoscopic sleeve gastrectomy were included between May 2017 and October 2020. The primary outcome was the postoperative hospital length of stay (PLOS). Secondary outcomes were the hospital costs, operative opioid consumption, time to recovery, postoperative pain score at rest and rescue antiemetic administered in the PACU.Results: The clinical demographic and operative data in both groups were comparable. There were no significant differences between the two groups in the PLOS (OSA vs. OBA: 6.18 ± 0.23 days vs. 6.73 ± 0.39 days, p = 0.24). Compared to the OBA group, opioid consumption in the OSA group was significantly decreased (48.79 ± 4.85 OMEs vs. 10.57 ± 0.77 OMEs, p < 0.001). There were no significant differences in the hospital costs, time to recovery, and rescue antiemetic administered, the incidence of intravenous opioids and vasopressor use in the PACU.Conclusion: The opioid-sparing anesthesia for laparoscopic sleeve gastrectomy was feasible but did not decrease the PLOS.

目的:探索多学科团队(multidisciplinary team,MDT)诊疗模式对纵隔疾病的治疗策略.方法:回顾性分析在 2020 年 1-12 月复旦大学附属中山医院接受纵隔MDT讨论的纵隔疾病患者的临床资料,并与 2019 年未进行MDT讨论的胸腺肿瘤患者的临床资料进行对比.结果:共为 166 例患者进行 185 次MDT讨论,涉及的病种包括 112 例胸腺上皮肿瘤、12 例淋巴瘤、21 例生殖源性肿瘤、6 例后纵隔神经源性肿瘤,、12 例其他肿瘤、3 例非肿瘤性疾病.35 例首选手术治疗,35 例在放化疗后进行手术治疗.与既往未接受纵隔MDT讨论的胸腺肿瘤患者的临床资料进行比较,接受纵隔MDT讨论的胸腺肿瘤患者的中位诊断治疗间隔时间缩短(13 vs 7 d),接受手术治疗的比例提高(35.8％vs 45.7％),手术完全切除的比例提高(76.5％vs 79.1％),术后平均住院时间缩短(9 vs 7 d).结论:MDT讨论对于复杂纵隔疾病的治疗具有潜在优势,能够为患者制定安全合理的治疗策略.

目的 比较全麻诱导时持续气道内正压通气(continuous positive airway pressure,CPAP)模式与常规模式的预给氧效能.方法 纳入2020年5月1日至2021年12月31日复旦大学附属中山医院厦门医院收治的81例拟行全麻患者,分为诱导前自主呼吸组(n=27)、诱导后压力支持辅助通气PSV组(n=26)、诱导前CPAP组(n=28).比较3组预给氧后呼出氧浓度(FeO2)达到90％的时间;4 min无通气状态后的呼出氧浓度(FeO2)、动脉血氧分压(PaO2)、二氧化碳分压(PaCO2);插管时反流发生率;血流动力学变化.结果 CPAP组FeO2达到90％所需时间短于自主呼吸组(P=0.01),与PSV组比较差异无统计学意义.Cox比例风险回归显示,3组达到90％FeO2所需时间与性别、年龄、BMI无相关性,与自主呼吸模式相比,CPAP模式的HR=0.430(95％CI 0.243～0.761;P=0.04);与PSV模式相比,CPAP模式的HR=0.810(95％CI 0.474～1.383;P=0.44).CPAP组在4 min无通气状态下的PaCO2低于自主呼吸组(P=0.03),与PSV组比较差异无统计学意义;在4 min无通气状态下FeO2、PaO2、插管反流发生率、术前与插管后血流动力学变化差异均无统计学意义.结论 全麻诱导前CPAP模式预给氧较诱导前自主呼吸模式效能更高,所需时间更短,4 min无通气状态下PaCO2更低,值得临床推广.

目的 建立饮食诱导的肥胖小鼠模型,研究建立肥胖小鼠胃袖状切除术模型的可行性及有效性.方法 将40只4周龄雄性SPF级C57BL/6J小鼠随机分为普通饮食组(n=20)和高脂饮食组(n=20),均喂养20周.20周后随机分为4个亚组:普通饮食假手术组,普通饮食手术组,高脂饮食假手术组,高脂饮食手术组.定期测量体重及空腹血糖,喂养20周后检测葡萄糖耐量、血脂水平及肝组织病理学.结果 高脂饮食喂养4周后,高脂饮食组小鼠体重即开始显著高于普通饮食小鼠(P<0.05).喂养20周后,与普通饮食小鼠相比,高脂饮食小鼠平均体重[(42.71±2.30)g vs.(32.23±1.73)g]、血糖[(8.82±0.51)mmol/L vs.(6.74±0.31)mmol/L]及血脂水平[血清总胆固醇:(4.40±0.57)mmol/L vs.(2.31±0.35)mmol/L;血清三酰甘油:(2.26±0.25)mmol/L vs.(1.11±0.24)mmol/L]均明显升高(P均<0.01).高脂饮食及普通饮食假手术组小鼠存活率为100％,高脂饮食手术组存活率为70％(7/10),普通饮食手术组存活率为80％(8/10).术后第1周,各组小鼠体重均显著下降(P<0.01);术后第4周,高脂饮食及普通饮食手术组小鼠较术前体重下降约20％;术后第3周,高脂饮食及普通饮食假手术组小鼠体重恢复至术前水平.结论 高脂饮食喂养20周可诱导肥胖小鼠模型,进一步建立胃袖状切除术模型可行且有效.