Delirium is a common acute brain dysfunction in the intensive care unit (ICU) that correlates strongly with poor patient outcomes. The glucose-to-lymphocyte ratio (GLR), as a novel marker reflecting metabolic stress and immune status, may represent a distinct biological signal of homeostatic disruption. This study aims to investigate the relationship between GLR, ICU delirium, and mortality. Using the MIMIC-IV database, we included 16,055 adult patients during their first ICU admission. A multivariable logistic regression with a nested modeling strategy (Models A–F) was applied to examine the association between GLR and delirium, adjusting for a broad range of clinical confounders and multiple established severity indices. The robustness of these findings was validated through 1:1 propensity score matching (PSM) and extensive subgroup analyses. Restricted cubic spline (RCS) analysis explored potential non-linear relationships. Cox proportional hazards models and mediation analysis with the bootstrap method were employed to evaluate mortality risks and the mediating role of delirium. Patients in the highest GLR quartile (Q4) had a 2.51-fold higher risk of delirium compared to those in the lowest quartile (Q1) (95% CI: 2.12–2.98; P < 0.001), with a significant dose-response relationship (P for trend < 0.001). In the fully saturated model (Model F), this significant association between GLR and delirium persisted (OR = 2.51, P < 0.001). These findings remained consistent after 1:1 PSM and across all pre-specified subgroups. ROC analysis demonstrated that GLR had superior discriminative performance (AUC = 0.626) compared with blood glucose alone (AUC = 0.587) or lymphocyte count (AUC = 0.603). Survival analysis indicated significantly increased 28-day (HR = 1.17), 90-day (HR = 1.22), and 1-year (HR = 1.22) mortality for high GLR (all P < 0.05). Mediation analysis confirmed that delirium partially mediated the relationship between GLR and 28-day mortality (proportion: 15.235%–19.133%). Elevated GLR is independently associated with increased risks of delirium and mortality in ICU patients. As a composite marker of metabolic-immune dysregulation, GLR provides incremental predictive value beyond established severity scores, offering a robust biological signal for early risk stratification in critical care.

Background Perioperative hypotension is highly prevalent and associated with adverse postoperative outcomes. The relationship between intraoperative hypotension (IOH) and postoperative hypotension (POH) remains understudied. The objective of this retrospective study is to investigate the association between intraoperative and postoperative hypotension in patients undergoing abdominal surgery. Methods Patients undergoing abdominal surgery under general anesthesia were identified through the perioperative medical database (INSPIRE 1.3), with IOH and POH events determined by measuring the perioperative mean arterial pressure (MAP). The exposure was IOH (time-weighted average [TWA] of MAP below 65 mmHg). The primary outcome was the incidence of POH within 24 hours after surgery, with secondary outcomes comprising the frequency of POH within 24 hours after surgery, 30-day postoperative mortality, and length of stay (LOS). A directed acyclic graph (DAG) was used to identify potential confounding factors. Logistic regression analysis was used to investigate the association between IOH and the risk of POH. A zero-inflated negative binomial (ZINB) model was used to determine the relationship between IOH and the number of postoperative hypotensive episodes. The Accelerated Failure Time (AFT) model was used to estimate the effect of IOH on patients' survival time. The LOS was evaluated using generalized linear models with a gamma distribution. Results A total of 21,145 patients (median age, 60.0 years) were included. The incidence of IOH (TWA>0) was 30.6%, and the rate of POH was 9.9%. After adjusting for all identified confounding factors, IOH was significantly correlated with an elevated risk of POH (OR 1.70, 95% CI 1.60–1.81). Furthermore, RCS analysis demonstrated a significant nonlinear relationship between TWA and POH (P for overall < 0.001; P for nonlinear < 0.001). When TWA was classified into three categories, taking the low group as the reference, the odds ratio (95% confidence interval [CI]) for the medium group was 1.63 (1.42-1.87), and 2.75 (2.41-3.13) for the high group in the fully adjusted model. TWA was also significantly associated with the frequency of POH, with an incidence rate ratio (IRR) of 1.29 (95% CI: 1.19-1.40). Sixty-one patients died within 30 days of surgery. Conclusions Among patients undergoing abdominal surgery, a greater IOH burden was associated with both the incidence and frequency of POH.

BACKGROUND:Postoperative shivering may lead to severe side effects during postoperative care, particularly in patients with impaired cardiopulmonary function. The efficacy of oral gabapentin as a preventive strategy for postoperative shivering has not been quantitatively analyzed. In this meta-analysis, we aimed to evaluate the effectiveness of gabapentin as a drug for treating postoperative shivering. METHODS:A review of the Cochrane Library, PubMed, and Embase was conducted by 2 researchers for randomized controlled trials (RCTs). In this meta-analysis, Review Manager was used to analyze these RCTs on oral gabapentin for postoperative shivering. RESULTS:Six trials with 544 patients were included in our meta-analysis. Prophylactic oral gabapentin reduced postoperative shivering compared with placebo (pooled risk ratio [RR]: 0.38, 95% confidence interval [CI]: 0.25-0.57). The anti-shivering effect could be achieved after both general anesthesia (pooled RR of 3 trails: 0.28, 95% CI: 0.14-0.56) and orthopedic surgery (pooled RR of 4 trails: 0.38, 95% CI: 0.24-0.58). Meanwhile, gabapentin also could decrease postoperative vomiting (POV; pooled RR 0.35, 95% CI 0.16-0.77). CONCLUSION:Our current meta-analysis shows that compared with placebo, oral gabapentin can reduce the incidence of postoperative shivering. This result also provides new evidence to strengthen the clinical application value of gabapentin in the conventional treatment of POV. PROSPERO REGISTRATION NUMBER:CRD42022340734.

BACKGROUND:Muscle strength positively correlates with cognitive function, with the bidirectional causal link between hand grip strength and cognition posing a significant but incompletely understood public health challenge. This study aimed to explore the causal relationship between hand grip strength and cognition and its effect on dementia. METHODS:A two-sample Mendelian randomization analysis used genome-wide significant single nucleotide polymorphisms (SNPs) (P < 5×10-8, at least P < 5×10-6) linked to hand grip strength (right or left), cognition/dementia risk from the IEU Open GWAS project with 42,484 GWAS summary data sets. The primary analysis employed the inverse variance weighted method, while sensitivity analyses were conducted using the weighted mode and MR-Egger. These analyses aimed to assess the causal relationships between hand grip strength and cognition/dementia risk. RESULTS:The inverse variance weighted (IVW) analysis indicated a directional positive causal effects of hand grip strength on cognition (Left-hand grip strength on cognitive function (OR (95% Cl): 1.23 (1.02-1.48), P = 0.026)/performance (OR (95% Cl): 1.16 (1.04-1.30), P = 0.009); Right-hand grip strength on cognitive function (OR (95% Cl): 1.23 (1.02-1.48), P = 0.031)/performance (OR (95% Cl): 1.10 (1.02-1.19), P = 0.018), with almost no reverse causality between cognitive function/performance and hand grip strength. Based on the results above, we then researched the directional causal effects of hand grip strength on neurodegenerative diseases (like dementia) with cognitive decline as the main clinical manifestation. However, the IVW methods yielded no evidence to support a causal effect of left-hand grip strength on dementia (P > 0.05). CONCLUSIONS:This MR study indicates a positive directional causal relationship between hand grip strength and cognition, with no observed causal link to dementia. These results hold implications for the development of public health measures and strategies for preventing cognitive decline.

OBJECTIVES:This study aimed to identify risk factors for sleep disorders in gastrointestinal cancer patients undergoing chemotherapy and to construct a predictive nomogram model, validated both internally and externally. METHODS:A prospective study was conducted (ChiCTR2400085854), involving 308 patients from Jiangnan University Affiliated Central Hospital (Oct 2023-Aug 2024) for model development. Sleep quality and symptom burden were assessed using the Pittsburgh Sleep Quality Index (PSQI) and the Memorial Symptom Assessment Scale-Chinese version (MSAS-Ch). Independent risk factors were identified by multivariate logistic regression. A nomogram was constructed using R software and validated internally with 1000 bootstrap resamples and externally with 103 patients (Aug-Dec 2024). Model performance was evaluated by AUC, calibration curves, and decision curve analysis (DCA). RESULTS:The incidence of sleep disorders was 53.8%. Significant influencing factors included longer disease duration, more severe depression, pain, fatigue, and diarrhea, as well as lower social support and physical activity (all P < 0.05). Internal validation showed good discrimination (AUC = 0.897, 95% CI: 0.862-0.931) and calibration. External validation confirmed robust performance (AUC = 0.896, 95% CI: 0.837-0.954) with consistent calibration. DCA demonstrated favorable clinical value. CONCLUSIONS:Sleep disorders are prevalent among gastrointestinal cancer patients undergoing chemotherapy. The developed nomogram demonstrates high predictive accuracy and is a practical tool to identify high-risk patients.

Sepsis is a life-threatening syndrome caused by an imbalanced host response to infection and remains one of the leading causes of death worldwide. The neutrophil percentage-to-albumin ratio (NPAR) has recently emerged as a novel biomarker that integrates information on systemic inflammation and nutritional status. However, its role in predicting outcomes among septic patients has yet to be fully clarified. This study aimed to investigate the association between NPAR and all-cause mortality at 28-day, 90-day, and 365 day in patients diagnosed with sepsis. Using the medical information mart for intensive care-IV v3.1 database, we identified 6242 patients meeting the Sepsis-3.0 definition. Participants were categorized into tertiles based on NPAR values ( Q 1 < 23.8; 23.8 ≤ Q 2 < 30.1; Q 3 ≥ 30.1). Multivariable Cox proportional hazards regression was employed to analyze associations between NPAR and mortality. Restricted cubic spline models assessed nonlinear trends, while receiver operating characteristic curves evaluated discriminative ability. Kaplan–Meier survival analyses were performed to visualize survival differences across NPAR groups. Patients in the highest NPAR tertile ( Q 3 ) exhibited significantly greater disease severity and higher mortality at 28 days (34.03% vs 22.28%), 90 days (43.54% vs 28.93%), and 365 days (52.33% vs 37.72%) compared to those in the lowest tertile ( Q 1 ; all P < .001). After adjusting for confounders, elevated NPAR remained an independent predictor of mortality at 28 days (HR = 1.22, 95% CI: 1.06–1.39), 90 days (HR = 1.24, 95% CI: 1.10–1.40), and 365 days (HR = 1.21, 95% CI: 1.09–1.35). Restricted cubic spline analyses revealed a U-shaped nonlinear relationship between NPAR and mortality ( P for nonlinearity < .001). Integrating NPAR with the sequential organ failure assessment score significantly enhanced predictive accuracy compared to sequential organ failure assessment alone (area under the curve: 0.624 vs 0.599, P < .001). Subgroup analysis indicated a more pronounced association in patients with congestive heart failure ( P for interaction = .002). High NPAR levels are independently associated with increased short- and long-term mortality in sepsis. Given its simplicity and cost-effectiveness, NPAR could be a useful marker for early risk assessment and clinical decision-making in septic populations.

OBJECTIVES:There is some debate about the link between vitamin C and depressive risk. This study utilized data from the National Health and Nutrition Examination Survey (NHANES) and Mendelian randomization (MR) methodology to investigate the association between the two. METHODS:We obtained serum vitamin C levels through laboratory data and determined the intake of vitamin C through a 24-hour dietary recall method on the first day from NHANES 2017 to 2018. Assessment of depressive risk was employed by the 9-item Patient Health Questionnaire (PHQ-9). The association between serum vitamin C levels and depressive risk was examined using logistic regression. Furthermore, the research utilized a two-sample MR methodology to investigate the potential causal connection between vitamin C and depressive risk. RESULTS:Three thousand four hundred and thirty-four participants aged 20+ with serum vitamin C levels and depressive risk data was included. Among the participants, 18.7% had low serum vitamin C levels and 25.2% had self-reported depressive risk. Serum vitamin C levels were associated with depressive risk [OR 1.64, (95% CI: 1.36-1.97), P < 0.01], which remained significant [OR 1.32, (95% CI: 1.08-1.61), P < 0.01] after adjustments. Distinct genetic SNPs were identified for serum vitamin C levels and depressive risk, allowing detailed analysis. No additional influences were observed between genetic variations. IVW and MR Egger analysis showed a non-causal association between vitamin C levels and depressive risk (All P > 0.05). CONCLUSIONS:Our findings of the nationally representative survey revealed a strong correlation between serum levels, intake as a supplement or medication of vitamin C and depressive risk, however, without a unidirectional causal association.

Acute lung injury is a common complication of sepsis and characterized by a high mortality rate during hospitalization. Proanthocyanidin, which are abundant compounds found in various plants, have shown promising effects in preventing chronic diseases, and their oligomers have attracted attention for their high bioavailability and strong antioxidant activity. In recent years, there have been suggestions that oligomeric proanthocyanidin may possess lung-protective properties, however, the specific mechanisms involved have not been fully elucidated. This study reveals that the therapeutic efficacy of oligomeric proanthocyanidin in mitigating lung injury during sepsis, achieved through the reduction of neutrophil extracellular traps accumulation and the attenuation of inflammation, can be attributed to the capacity to safeguard the integrity of the intestinal mucus layer and the intestinal barrier. This protective action results in a decrease in endotoxin entry into the bloodstream and bacterial translocation, both of which can trigger neutrophil extracellular traps causing further lung injury.

OBJECTIVES:To systematically investigate the expression, prognostic value, genetic alterations, immune infiltration, and molecular function of Nck-associated protein 1 (NCKAP1) in a pan-cancer analysis, with a specific focus on its association with kidney renal cell carcinoma (KIRC). METHODS:We analyzed the role of NCKAP1 across various tumor types using data from The Cancer Genome Atlas (TCGA). The Gene Expression Profiling Interactive Analysis version 2 (GEPIA2) database was used to assess the correlation between NCKAP1 expression levels and overall survival (OS) and disease-free survival (DFS) across different cancers, as well as its association with cancer stage. Genetic alterations of NCKAP1 were explored using CBioPortal, and their prognostic implications were assessed. NCKAP1 was further analyzed through Gene Ontology and protein interaction network analyses. Immunohistochemistry (IHC) staining from the Human Protein Atlas (HPA) database evaluated NCKAP1 levels in KIRC tissues. Functional assays, including Cell Counting Kit-8 (CCK-8), colony formation, transwell, and wound healing assays, were conducted to determine the effects of NCKAP1 overexpression on cell growth rate and their ability to invade, proliferate, migrate in a KIRC (786-O) cell line. The relationship between NCKAP1 expression and immune infiltration in KIRC was systematically examined using the Tumor Immune Estimation Resource. RESULTS:NCKAP1 expression was significantly altered in most tumor types compared to corresponding non-tumor tissues. Survival analysis indicated that low NCKAP1 expression was associated with poor OS, DFS, and advanced cancer stage (P < 0.05) specifically in KIRC. Genetic alterations in NCKAP1 were linked to clinical outcome in cancer patients, and a positive correlation was observed between NCKAP1 expression and cancer-associated fibroblast infiltration (P < 0.05). Gene Ontology analysis revealed that NCKAP1 regulates the actin cytoskeleton and interacts with proteins such as CYFIP1, ABI2, WASF2, and BRK1. IHC staining showed significantly lower NCKAP1 levels in KIRC tissues compared to normal tissues. Overexpression of NCKAP1 in KIRC cell lines reduced cell proliferation, invasion, and migration (P < 0.05). NCKAP1 was also positively correlated with macrophage, neutrophil, and CD4+ T cell infiltration (P < 0.001). CONCLUSION:NCKAP1 may serve as a prognostic and immunological marker and may be a therapeutic target for KIRC.

AIMS:Residual neuromuscular blockade has been linked to pulmonary complications in the postoperative period. This study aimed to determine whether sugammadex was associated with a lower risk of postoperative pulmonary complications (PPCs) compared with neostigmine. METHODS:This retrospective cohort study was conducted in a tertiary academic medical center. Patients ≥18 year of age undergoing noncardiac surgical procedures with general anesthesia and mechanical ventilation were enrolled between January 2019 and September 2021. We identified all patients receiving rocuronium and reversal with neostigmine or sugammadex via electronic medical record review. The primary endpoint was a composite of PPCs (including pneumonia, atelectasis, respiratory failure, pulmonary embolism, pleural effusion, or pneumothorax). The incidence of PPCs was compared using propensity score analysis. RESULTS:A total of 1786 patients were included in this study. Among these patients, 976 (54.6%) received neostigmine, and 810 (45.4%) received sugammadex. In the whole sample, PPCs occurred in 81 (4.54%) subjects (7.04% sugammadex vs. 2.46% neostigmine). Baseline covariates were well balanced between groups after overlap weighting. Patients in the sugammadex group had similar risk (overlap weighting OR: 0.75; 95% CI: 0.40 to 1.41) compared to neostigmine. The sensitivity analysis showed consistent results. In subgroup analysis, the interaction P-value for the reversal agents stratified by surgery duration was 0.011. CONCLUSION:There was no significant difference in the rate of PPCs when the neuromuscular blockade was reversed with sugammadex compared to neostigmine. Patients undergoing prolonged surgery may benefit from sugammadex, which needs to be further investigated.

目的:探讨亚麻醉剂量艾司氯胺酮对舒芬太尼复合丙泊酚行无痛内镜逆行胰胆管造影术(ERCP)麻醉效果的影响.方法:选取 2021 年 1 月—2022 年 10 月在无锡市第二人民医院择期行无痛ERCP的 60 例患者为研究对象.按入院时间先后顺序的不同,将 60 例手术患者分为观察组和对照组,各 30 例.两组均缓慢静注舒芬太尼、丙泊酚进行全麻诱导,在此基础上,观察组予艾司氯胺酮,对照组予氯化钠注射液.待患者入睡、睫毛反射消失后开始进行ERCP.观察记录两组在不同时间点生命体征的变化;记录两组手术时间、苏醒时间、丙泊酚总用量及不良反应发生情况.结果:入室后 5 min(T0)至术毕撤镜(T3)时,两组心率(HR)比较,差异无统计学意义(P>0.05).内镜操作开始(T1)、ERCP术中 20 min(T2)时,观察组平均动脉压(MAP)高于对照组,差异有统计学意义(P<0.05);T1 时,观察组血氧饱和度(SpO2)高于对照组,差异有统计学意义(P<0.05).两组手术时间、苏醒时间比较,差异无统计学意义(P>0.05);观察组丙泊酚总用量少于对照组,差异有统计学意义(P<0.05).观察组术中体动、呼吸抑制、低血压的发生率均低于对照组,差异有统计学意义(P<0.05);两组术后头晕、恶心呕吐发生率比较,差异无统计学意义(P>0.05);两组术后均未见幻觉、噩梦等精神症状的发生.结论:亚麻醉剂量艾司氯胺酮可进一步优化舒芬太尼复合丙泊酚用于无痛ERCP的麻醉效果,提高术中循环、呼吸稳定性.

Purpose: Type 2 diabetes mellitus (T2DM) is a persistent metabolic condition with an unknown pathophysiology. Moreover, T2DM remains a serious health risk despite advances in medication and preventive care. Randomised controlled trials (RCTs) have provided evidence that probiotics may have positive effects on glucolipid metabolism. Therefore, we performed a meta-analysis of RCTs to measure the effect of probiotic therapy on glucolipid metabolism in patients with T2DM. Methods: With no constraints on the language used in the literature, Excerpta Medica Database, PubMed, the Cochrane Library, and the Web of Science were searched for pertinent RCTs published between the date of creation and 18 August 2022. Stringent inclusion and exclusion criteria were applied by two reviewers to independently examine the literature. The risk of bias associated with the inclusion of the original studies was assessed using the Cochrane risk-of-bias tool, and Stata 15.0 was used to perform the meta-analysis. Results: Thirty-seven publications containing a total of 2502 research participants were included in the meta-analysis. The results showed that after a probiotic intervention, the experimental group showed a significant decrease in body mass index (standardised mean difference (SMD) = −0.42, 95% confidence interval (CI) [−0.76, −0.08]), fasting glucose concentration (SMD = −0.73, 95% CI [−0.97, −0.48]), fasting insulin concentration (SMD = −0.67, 95% CI [−0.99, −0.36]), glycated haemoglobin concentration (SMD = −0.55, 95% CI [−0.75, −0.35]), Homeostatic Model Assessment for Insulin Resistance score (SMD = −0.88, 95% CI [−1.17, −0.59]), triglyceride concentration (SMD = −0.30, 95% CI [−0.43, −0.17]), total cholesterol concentration (SMD = −0.27, 95% CI [−0.43, −0.11]), and low-density lipoprotein concentration (SMD = −0.20, 95% CI [−0.37, −0.04]), and an increase in high-density lipoprotein concentration (SMD = 0.31, 95% CI [0.08, 0.54]). Moreover, subgroup analyses showed that patients with a longer intervention time, or those who were treated with multiple strains of probiotics, may benefit more than those with a shorter intervention time or those who were treated with a single probiotic strain, respectively. Conclusion: Probiotic supplementation improves glucolipid metabolism in patients with T2DM, offering an alternative approach for the treatment of these patients.

目的:观察不同剂量右美托咪定静脉维持在重型颅脑损伤患者中的应用价值.方法:选取2018年9月～2020年9月期间江苏大学附属宜兴市人民医院麻醉与重症医学科接收的重型颅脑损伤患者96例,根据随机数字表法分为三组:A组(右美托咪定剂量为0.3 μg/kg·h)、B组(右美托咪定剂量为0.5 μg/kg·h)和C组(右美托咪定剂量为0.7 μg/kg·h),各32例.观察三组患者不同时间点的生命体征、免疫功能、镇静镇痛情况、血清神经细胞因子,记录三组不良反应发生情况.结果:B组、C组术后24h、术后72 h的心率(HR)、呼吸频率(RR)、平均动脉压(MAP)低于A组(P＜0.05).B组、C组术后24 h、术后72 h的Ramsay镇静评分、视觉模拟评分法(VAS)评分低于A组(P＜0.05).B组、C组术后24 h、术后72 h的CD3+、CD4+/CD8+高于A组(P＜0.05).B组、C组术后24 h、术后72 h的神经元特异性烯醇化酶(NSE)、中枢神经特异性蛋白(S100β)低于A组(P＜0.05).C组的不良反应总发生率高于A组、B组(P＜0.05).结论:重型颅脑损伤患者术中给予右美托咪定剂量为0.5 μg/kg·h、0.7 μg/kg·h维持,可有效维持患者生命体征平稳,促进患者免疫功能和血清神经细胞因子水平改善,但0.7 μg/kg·h剂量的右美托咪定使用后不良反应发生率相对更高.

The prevalence of diabetes mellitus is increasing globally. Probiotics have been shown to be an effective intervention for diabetes. This study focused on the relieving effects and possible mechanisms of 16 strains of two dominant Bifidobacterium species (B. bifidum and B. adolescentis, which exist in the human gut at different life stages) on type 2 diabetes (T2D). The results indicated that more B. adolescentis strains appeared to be superior in alleviating T2D symptoms than B. bifidum strains. This effect was closely related to the ability of B. adolescentis to restore the homeostasis of the gut microbiota, increase the abundance of short-chain fatty acid-producing flora, and alleviate inflammation in mice with T2D. In addition, compared with B. bifidum, B. adolescentis had a higher number of core genes, and these genes were more evolutionarily stable, including unique environmental tolerance, carbon and nitrogen utilization genes, and a blood sugar regulation gene, glgP. This may be one of the reasons why B. adolescentis is more likely to colonize in the adult gut and show a superior ability to relieve T2D. This study provides insights into future studies aimed at investigating probiotics for the treatment of metabolic diseases.

Patients with IgA nephropathy with minimal proteinuria(proteinuria <1 g/24 h) were previously believed to have good long-term prognosis and a low proportion of renal biopsy, and they generally did not receive active and effective treatment. However, in recent years more and more studies have shown that the long-term prognosis of patients with IgA nephropathy with minimal proteinuria is not optimistic, so it is necessary to improve the understanding about IgA nephropathy with minimal proteinuria. This article reviews the clinical manifestations, renal pathology, treatment and prognosis of IgA nephropathy with minimal proteinuria.

目的 研究小潮气量肺保护通气在老年肺功能不全患者行腹腔镜胃肠手术中的应用价值.方法 纳入2017年5月至-2019年9月于无锡第二医院治疗的老年肺功能不全行腹腔镜下胃肠手术患者80例,采用随机数字表法分为观察组(n=40)和对照组(n=40).观察组行小潮气量肺保护性通气,对照组行常规大潮气量通气.观察并比较2组患者围术期肺氧合功能指标水平,评估并比较2组白介素-8(IL-8)、白介素-1(IL-1)、肿瘤坏死因子α(TNF-α)和肺泡灌洗液中肺表面活性蛋白D (SP-D)水平,以及术后并发症发生率.结果 观察组术后并发症发生率明显低于对照组(P＜0.05).2组患者气管插管时(T1)、插管后5 min(T2)、拔管时(T3)及术后30 min (T4)时动脉血二氧化碳分压(PaCO2)和肺内分流率(Qs/Qt)水平差异均有统计学意义(P＜0.01);T2、T3及T4时,观察组氧分压(PaO2)和Qs/Qs均显著高于对照组,PaCO2显著低于对照组(P＜0.01);IL-8、IL-1、TNF-α水平均显著低于对照组,而SP-D水平显著高于对照组(P＜0.01).结论 小潮气量肺保护性通气策略用于肺功能不全的老年胃肠手术患者,有助于降低术后并发症,保护肺功能,提高手术安全性,具有一定的应用价值.

目的:观察羟考酮静脉自控镇痛(PCIA)联合肋间神经阻滞用于胸腔镜术后镇痛的临床效果.方法:将60例择期胸腔镜手术患者随机分为A组和B组,每组30例.A组术后予羟考酮PCIA,B组予羟考酮PCIA+肋间神经阻滞.比较两组镇痛效果.结果:B组术后4、12 h平静时VAS评分均明显低于A组,差异有统计学意义(P<0.05).B组术后4、12、24 h的PHPS评分均明显低于A组,差异有统计学意义(P<0.05).B组PCIA泵按压次数与曲马多追加例数均明显少于A组,差异有统计学意义(P<0.05).A组恶心、呕吐、嗜睡发生率高于B组,但两组比较差异无统计学意义(P>0.05).B组镇痛质量主观评分明显高于A组,差异有统计学意义(P<0.05).结论:胸腔镜术后采用羟考酮PCIA+肋间神经阻滞可提高镇痛效果,患者镇痛满意度更高.

目的 研究老年肺癌患者在手术治疗过程中应用两种不同麻醉用药方法 的效果.方法 选取2017年8月至2019年8月本院接收的40例老年肺癌患者,采用随机抽签法将所有患者分为七氟烷组与丙泊酚组,每组20例.七氟烷组应用七氟烷复合瑞芬太尼、顺式阿曲库铵进行麻醉维持;丙泊酚组应用丙泊酚复合瑞芬太尼、顺式阿曲库铵来进行麻醉维持.比较两组患者的术后疼痛感、认知功能、S100β血清蛋白水平.结果 手术前,两组患者的认知功能MMSE评分比较差异无统计学意义;手术后,七氟烷组患者的认知功能水平优于丙泊酚组,两组比较差异具有统计学意义(P<0.05).手术前,两组患者的疼痛感评分比较差异无统计学意义;手术后,七氟烷组患者的疼痛感评分低于丙泊酚组,两组比较差异具有统计学意义(P<0.05).手术前,两组患者的S100β血清蛋白水平比较差异具有统计学意义;手术后,七氟烷组患者的S100β血清蛋白水平优于丙泊酚组,两组比较差异具有统计学意义(P<0.05).结论 不同的用药麻醉方法 对患者的麻醉效果存在一定的差异,老年肺癌患者在手术治疗过程中应用七氟烷药物进行麻醉效果更佳,可以有效的改善患者的认知功能,改善患者的S100β血清蛋白水平,减轻患者的术后疼痛感,值得临床推广应用.

纤维连接蛋白肾小球疾病(FNG)是一种罕见的常染色体显性遗传性疾病,以大量纤维连接蛋白沉积于肾小球内皮下及系膜区为其特征,临床表现为蛋白尿、不同程度的血尿、高血压及进展缓慢的肾功能减退,少数患者有肾小管酸中毒.其诊断主要依据肾穿刺结果纤维连接蛋白荧光染色阳性,目前无特异性治疗,多给予对症治疗.FNG发病罕见,合并具有肾脏意义的单克隆免疫球蛋白血症(MGRS)极少报道.本文报道1例FNG合并MGRS,并进行相关文献的复习.