BackgroundDespite recent advancements in blood conservation strategies, perioperative allogeneic red blood cell (RBC) transfusion remains common in pediatric patients undergoing scoliosis surgery. This study aimed to develop a simplified preoperative risk score to predict allogeneic RBC transfusion requirements in this population.MethodsWe conducted a retrospective cohort study of 1,992 pediatric patients (<18 years) who underwent scoliosis surgery at two tertiary care centers between January 2018 and May 2023. The primary outcome was perioperative allogeneic RBC transfusion. Missing data were addressed via multiple imputation, generating 10 imputed datasets. Predictor variables were screened through univariate and least absolute shrinkage and selection operator (LASSO) regression. Multivariable logistic regression was used to develop the prediction model, followed by stepwise variable selection to identify a parsimonious set of predictors without compromising model performance. A simplified risk score and corresponding risk stratification system were derived from the final model coefficients.ResultsThe overall perioperative RBC transfusion rate was 32.9% (655/1,992). After variable selection and model optimization, the final prediction model included four preoperative variables: American Society of Anesthesiologists (ASA) physical status grade, Cobb angle, diagnosis, and weight. The resulting risk score ranged from 0 to 20 points and exhibited strong discriminative ability, with an area under the receiver operating characteristic curve (AUC) of 0.818 [95% confidence interval (CI): 0.793–0.843] in the training set and 0.814 (95% CI: 0.764–0.864) in the validation set. Three risk categories were established: low risk (0–4 points), medium risk (5–10 points), and high risk (≥11 points). Transfusion rates exhibited a progressive increase across risk categories in both training (9.6, 37.3, 76.3%) and validation (7.3, 32.1, 74.1%) sets.ConclusionWe developed a simplified risk score based on four readily available preoperative variables (diagnosis, weight, Cobb angle, and ASA grade) to predict perioperative allogeneic RBC transfusion in pediatric scoliosis surgery. This tool facilitates preoperative transfusion risk assessment and stratification, serving as a practical clinical aid that may contribute to optimized perioperative blood management strategies.

OBJECTIVE:Deep learning-based automated analysis of transgastric short-axis view (TSV) transesophageal echocardiography (TEE) remains under-explored. In this study, we propose a deep learning-based method for fully automated left ventricular segmentation and ejection fraction (EF) prediction in TSV TEE videos. METHODS:We built upon the U-Net network and proposed an Echo Efficient U-Net (Echo-EU-Net) segmentation model by replacing the original standard convolutions with depth-wise separable convolutions and by introducing the Multi-Efficient Channel Attention (MECA) and Enhanced Atrous Spatial Pyramid Pooling (EASPP) modules. We also incorporated automatic cardiac phase tracking and EF calculation. Experiments were performed on a TSV TEE dataset containing 694 videos from 451 patients, with expert manual segmentations and manual EF measurements as the reference standard. RESULTS:The proposed Echo-EU-Net, with an average Dice similarity coefficient of 92.91% and a Jaccard similarity coefficient of 87.23%, outperformed U-Net and its variants for left ventricular segmentation in TSV TEE, particularly in challenging cases. The model parameter size of Echo-EU-Net was 1.30 million, compared with 7.79 million for U-Net. The proposed EF prediction method had a satisfying agreement with the manual EF measurements (Pearson's r=0.84), with a mean absolute error of 6.44%. An ablation study demonstrated the effectiveness of the MECA and EASPP modules. CONCLUSION:The feasibility of the proposed Echo-EU-Net-based method in automatically segmenting the left ventricle and measuring EF in TSV TEE has been demonstrated. The findings of this study may shed light on lightweight deep learning-based fully automated left ventricular segmentation and EF quantification in TSV TEE.

In recent years, with the gradual and extensive application of digital medical treatment in the field of medica anesthesia, its role in the postoperative pain management of children has attracted increasing attention. It provides new ideas for the preoperative prediction, postoperative monitoring and evaluation, and treatment management of postoperative pain in children, as well as a new scheme for anesthesiologists to formulate the best postoperative pain management strategy for children. This article reviews digital medical treatment and its application in clinical anesthesia, and reviews the application prospects of this therapy in postoperative pain in children, in order to deepen clinicians' knowledge.

Segmenting the left ventricle from the transgastric short-axis views (TSVs) on transesophageal echocardiography (TEE) is the cornerstone for cardiovascular assessment during perioperative management. Even for seasoned professionals, the procedure remains time-consuming and experience-dependent. The current study aims to evaluate the feasibility of deep learning for automatic segmentation by assessing the validity of different U-Net algorithms. A large dataset containing 1388 TSV acquisitions was retrospectively collected from 451 patients (32% women, average age 53.42 years) who underwent perioperative TEE between July 2015 and October 2023. With image preprocessing and data augmentation, 3336 images were included in the training set, 138 images in the validation set, and 138 images in the test set. Four deep neural networks (U-Net, Attention U-Net, UNet++, and UNeXt) were employed for left ventricle segmentation and compared in terms of the Jaccard similarity coefficient (JSC) and Dice similarity coefficient (DSC) on the test set, as well as the number of network parameters, training time, and inference time. The Attention U-Net and U-Net++ models performed better in terms of JSC (the highest average JSC: 86.02%) and DSC (the highest average DSC: 92.00%), the UNeXt model had the smallest network parameters (1.47 million), and the U-Net model had the least training time (6428.65 s) and inference time for a single image (101.75 ms). The Attention U-Net model outperformed the other three models in challenging cases, including the impaired boundary of left ventricle and the artifact of the papillary muscle. This pioneering exploration demonstrated the feasibility of deep learning for the segmentation of the left ventricle from TSV on TEE, which will facilitate an accelerated and objective alternative of cardiovascular assessment for perioperative management.

Epidural labor analgesia aims to provide effective medical services to alleviate labor pain in parturients, while adhering to the principles of voluntary participation and clinical safety. In 2018, Peking Union Medical College Hospital(PUMCH)became one of the first pilot units for labor analgesia in China, and has achieved satisfactory results in high-quality development of labor analgesia. This article mainly introduces the achievements and experience of labor analgesia at PUMCH, including: (1) prioritizing maternal and infant safety, arranging personnel rationally, and developing standardized treatment processes through multidisciplinary collaboration to ensure safe and comfortable childbirth; (2) leveraging the hospital's comprehensive capabilities in emergency treatment, and improving collaborative rescue plans for critically ill parturients and newborns; (3) implementing advanced teaching methods to effectively train and conduct simulated drills for labor analgesia and rescue of critically ill parturients; (4) conducting patient education and informative lectures to help parturients acquire a scientific understanding of labor analgesia. We hope that this experience can provide reference and inspiration for other hospitals.

本研究以情景模拟教学在八年制医学生麻醉科实习阶段医院感染知识学习中的应用为目的,选取 2022 年 3 月至 9月于中国医学科学院北京协和医院麻醉科轮转的医学生,随机分成两组,分别采用传统教学方式和情景模拟教学方式进行培训.培训前、后采用网络问卷方式对学生进行医院感染相关知识考核,同时对教学效果进行满意度问卷调查.在教学效果评估方面,除教学内容外,其他项目情景模拟教学组学生的满意度均高于传统教学组;与培训前相比,培训后两组学生的成绩均提高.情景模拟教学组学生在手术部位感染的核心预防方法、导管相关血流感染的核心预防方法、呼吸道传染病的预防原则、医院内血源性感染的常见种类及预防策略、围手术期抗菌药物管理 5 个方面的培训成绩均高于传统教学组的学生,其余知识点组间比较差异无统计学意义.本研究显示两种教学方法对八年制医学生感染控制的培训均有明显的提高效果.

Abstract Background Postoperative residual curarization (PORC) may be a potential risk factor of postoperative pulmonary complications (PPCs), and both of them will lead to adverse consequences on surgical patient recovery. The train-of-four ratio (TOFr) which is detected by acceleromyography of the adductor pollicis is thought as the gold standard for the measurement of PORC. However, diaphragm function recovery may differ from that of the peripheral muscles. Recent studies suggested that diaphragm ultrasonography may be useful to reveal the diaphragm function recovery, and similarly, lung ultrasound was reported for the assessment of PPCs in recent years as well. Sugammadex reversal of neuromuscular blockade is rapid and complete, and there appear to be fewer postoperative complications than with neostigmine. This study aims to compare the effects of neostigmine and sugammadex, on PORC and PPCs employing diaphragm and lung ultrasonography, respectively. Methods/design In this prospective, double-blind, randomized controlled trial, patients of the American Society of Anesthesiologists Physical Status I–III, aged over 60, will be enrolled. They will be scheduled to undergo arthroplasty under general anesthesia. All patients will be allocated randomly into two groups, group NEO (neostigmine) and group SUG (sugammadex), using these two drugs for reversing rocuronium. The primary outcome of the study is the incidence of PPCs in the NEO and SUG groups. The secondary outcomes are the evaluation of diaphragm ultrasonography and lung ultrasound, performed by an independent sonographer before anesthesia, and at 10 min and 30 min after extubation in the post-anesthesia care unit, respectively. Discussion Elimination of PORC is a priority at the emergence of anesthesia, and it may be associated with reducing postoperative complications like PPCs. Sugammadex was reported to be superior to reverse neuromuscular blockade than neostigmine. Theoretically, complete recovery of neuromuscular function should be indicated by TOFr > 0.9. However, the diaphragm function recovery may not be the same matter, which probably harms pulmonary function. The hypothesis will be proposed that sugammadex is more beneficial than neostigmine to reduce the incidence of PPCs and strongly favorable for the recovery of diaphragm function in our study setting. Trial registration ClinicalTrials.gov NCT05040490. Registered on 3 September 2021

Objective To evaluate and compare the incidence of postoperative residual curarisation (PORC) after administration of neostigmine or sugammadex by diaphragmatic ultrasonography.Methods A total of 100 patients with American Society of Anesthesiologists grade Ⅰ or Ⅱ who underwent elective joint replacement surgery from March to August in 2021 were randomly enrolled into the neostigmine+atropine group(N+A group,n=51) and sugammadex group(SUG group,n=49) according to a random number table.Muscle relaxation was monitored by train of four(TOF) stimulation of adductor pollicis muscle during anesthesia.The patients in N+A group were administrated with neostigmine 50 μg/kg + atropine 15 μg/kg and those in SUG group with sugammadex 2 mg/kg for reversing muscle relaxation.Endotracheal tube was removed only when TOF ratio≥0.9. Diaphragmatic ultrasonography was performed before surgery,10 min and 30 min after extubation.The right diaphragm excursion during deep breathing(DE-DB) and the diaphragm movement velocity during sniffing(V-S) were measured,with the low-frequency probe placed at the intersection of the right midclavicular line and the right costal margin.The diaphragmatic thickening fraction during deep breathing(TF-DB) was measured with the high-frequency probe placed at zone of apposition.The incidence of PORC was taken as the primary outcome,and DE-DB,TF-DB,and V-S as the secondary outcomes.Results When PORC was defined as TF-DB≤36%,the incidence of PORC in the SUG group was lower than that in the N+A group 10 min(4.3% vs.31.1%;χ2=11.541,P=0.001) and 30 min(0 vs.17.6%;P=0.001) after extubation.When PORC was defined as TF-DB≤36% or DE-DB≤4 cm,the incidence of PORC in the SUG group was also lower than that in the N+A group 10 min(8.2% vs.33.3%;χ2=9.543,P=0.002) and 30 min(0 vs.19.6%;χ2=8.608,P=0.003) after extubation.The DE-DB in the SUG group was higher than that in the N+A group 10 min[(6.5±1.6) cm vs.(5.6±1.4) cm;t=-3.185,P=0.002] and 30 min[(6.9±1.5) cm vs.(6.1±1.4) cm;t=-2.712,P=0.008] after extubation.The TF-DB in the SUG group was also higher than that in the N+A group 10 min[(60.1±18.8)% vs.(49.1±20.0)%;t=2.739,P=0.007] and 30 min[(65.0±20.1)% vs.(49.9±19.1)%,t=-3.686,P<0.001] after extubation.Conclusion Compared with neostigmine,sugammadex can significantly improve the postoperative diaphragm movement and decrease the incidence of PORC.

Objective To investigate the degree of difficult intubations for patients with ankylosing spondylitis (AS) and to predict the related factors influencing the selection of intubation methods. Methods A total of 347 patients(276 males, 71 females), aged 15-77 years, ASA Ⅰ-Ⅲwith AS underwent surgical procedure from January 2008 to January 2017 were included. During general anesthesia induction, patients were divided into two groups according to the application of non-visual devices (179 cases) and visual devices (168 cases). Patient data were collected, including gender, age, kyphosis, degree of mouth opening, Mallampatti classification, neck mobility and the duration of the AS. Multivariate regression analysis of variables was conducted to find the relevant predictors of intubations method selection in AS patients with difficult endotracheal airway. Results The older patients, kyphosis, limited mouth opening, limited neck range of motion, and longer duration of AS, the utilization rate of the visual group was significantly higher than that of the non-visual group (P＜0.05). Multi-factor Logistic regression analysis suggested that moderate limitation of neck range of motion(OR=5.41,95% CI: 2.32-13.10,P＜0.001)and severe limitation of neck range of motion (OR=9.22,95% CI: 4.37-20.25,P＜0.001) were related factors for tracheal intubation with visual devices in patients with difficult airway. Conclusions Neck mobility has a great influence on whether or not to use visual intubation tools. When neck mobility decreases, anesthesiologists are more likely to use visual devices such as video laryngoscope, McCoy laryngoscope, visual rigid and fiberoptic bronchoscope.

目的 研究情景模拟教学在麻醉科院感知识学习中的应用.方法 选取2021年1月至3月北京协和医院麻醉科3年内的住院医师共计96名进行培训.根据随机数字表将其分为两组,每组各48人,分别采用传统教学方式和情景模拟教学方式进行培训,即传统教学组和情景模拟教学组.培训前后采用网络问卷的方式对所有住院医师进行院感相关的知识点考核.主要结局指标为考核后两组成绩,次要结局指标为培训前后的组内成绩比较及培训后两组人员在不同考点的成绩正确率.结果 与培训前成绩比较,两组培训后考试成绩升高,且情景模拟教学组高于传统教学组,差异有统计学意义(P＜0.05).情景模拟教学组标准预防的含义与选择、医院感染定义常见类型与诊断标准、手术部位感染的核心预防方法、导管相关血流感染的核心预防方法、医院内血源性感染的常见种类及预防策略、医疗废物管理、环境相关医院感染及防控策略及安全注射共计8个知识点正确率高于传统教学组,差异有统计学意义(P＜0.05).结论 相较于传统教学方法,情景模拟教学对院内感染的预防措施知识的学习有提高作用.

Objective To investigate the understanding of the head and face protection of the health care workers in operating room of Peking Union Medical College Hospital during the corona virus disease-19(COVID-19) pandemic.Methods The knowledge of head and face protection of health care workers in the operating room was evaluated based on the non-registered questionnaires for protection measures collected on-line.Results The survey was conducted in two phases.In the first phase(COVID-19 outbreak),153 questionnaires were collected.In the second phase(when Beijing lowered the emergency response to level 3 and normalized the epidemic prevention and control),101 questionnaires were collected.The results showed that 98% of health care workers had used any form of protective devices during the pandemic and anesthesiologists had the highest usage rate(93.0%)of ear-loop face mask with eye shield.During the pandemic,health care workers mainly used goggles(71.2%)for protection to diagnose and treat the patients with fever and ear-loop face mask with eye shield(56.2%)for protection to diagnose and treat the non-fever patients.In the first-and second-phase survey,43% and 68% of health care workers still used protection,and they mainly used face shield(50.0% and 56.5%)and ear-loop face mask with eye shield(56.1% and 68.1%).Conclusions During the pandemic,more than 90% of the health care workers in the operating room of Peking Union Medical College Hospital were aware of head and face protection.Different healthcare workers in the operating room had different choices of head and face protection,and more than 40% of them would still keep such protection during the normalized stage of pandemic prevention and control.

目的 比较全身麻醉(GA)和区域阻滞麻醉(RA)对下肢缺血行手术治疗的老年患者术后转归的影响.方法 回顾性分析2013年1月至2021年3月中国医学科学院北京协和医院血管外科收治的下肢缺血行手术治疗的56例老年患者的临床资料,根据麻醉方法分为GA组(n=28)和RA组(n=28).记录患者性别、年龄、改良心脏风险指数(RCRI)、麻醉方法、术中血流动力学指标、术后住院时间(LOS)及术后并发症.采用SPSS 19.0统计软件进行数据分析.应用多因素logistic回归或线性回归分析不同麻醉方法对下肢缺血行手术治疗老年患者非心脏手术后心肌损伤(MINS)、术中血压波动及术后LOS的影响.结果 56例患者中18例(32.1％)发生MINS,RA组12例(42.9％),GA组6例(21.4％).2组患者MINS发生率及术后LOS比较,差异无统计学意义(均P>0.05).RA组患者术中血压波动显著低于GA组,差异有统计学意义(P<0.05).女性是下肢缺血老年患者术后发生MINS的独立危险因素(OR=0.191,95％CI 0.051～0.720;P=0.015),麻醉方式不是影响MINS及LOS的危险因素,RA组术中血流动力学较GA组更加稳定.结论 女性是下肢缺血患者术后发生MINS的独立危险因素,麻醉方式对MINS的发生和术后LOS无显著影响,但RA组患者术中血流动力学更加平稳.

[目的]回顾性比较羟考酮和吗啡用于妇科开腹肿瘤细胞减灭术后患者静脉自控镇痛(patient-controlled analgesia,PCA)的效果.[方法]选择于2017年12月至2018年8月行妇科肿瘤细胞减灭术患者.羟考酮组(O组)镇痛泵使用羟考酮注射液,吗啡组(M组)镇痛泵使用吗啡注射液.采用视觉模糊评分(visual analogue scale,VAS)评分和改良镇静-躁动评分(richmond agitation-sedation scale,RASS)评价患者术后1、4、8、12、24、48 h的疼痛和镇静程度.并记录睡眠评分,副作用,PCA有效按压数/总按压数,患者满意度进行评估.[结果]与M组相比较,O组患者术后1h、术后4h的静息痛及术后8h的活动后疼痛评分有显著降低(P=0.043,P=0.007,P=0.049).术后1hO组的RASS评分与M组相比较有显著统计学差异(P=0.04),M组的恶心呕吐明显高于O组患者,引起的不适及患者满意度也相应地降低.[结论]与吗啡镇痛泵相比较,羟考酮镇痛泵对妇科开腹肿瘤细胞减灭术的术后短期镇痛效果更好,长期镇痛效果相似的情况下,不良反应更少,患者满意度更高.

Objective To evaluate the emergence agitation and recovery quality of patients with 3 endocrine types of pituitary tumor after transnasal transsphenoidal hypophysectomy. Methods Patients who received pituitary adenoma resection under general anesthesia were enrolled and categorized into three groups: growth hormone group (GH), adrenocorticotropic hormone group (ACTH) and non-functional group (control). Riker Sedation-Agitation Scale (RSAS), the severity of the emergence coughing, headache (by VAS), medical staff satisfaction were recorded in the post-anesthesia care unit. QoR-40 score, headache(by VAS), nausea score (by VRS) and vomiting score, and patient satisfaction were recorded at 24 h postoperatively. Results 163 cases were enrolled in the analysis, including 51 in GH group, 44 in ACTH group and 68 in control group. No significant difference was found regarding the emergence agitation among 3 groups. The ACTH group showed significantly higher nausea VRS score at 24 h after surgery than control group (P＜0.01). The headache VAS score of ACTH group was significantly higher than that in control group (P＜0.001). The incidence of postoperative sore throat in ACTH group was significantly higher than that in control group (P＜0.05). The postoperative QoR-40 score of ACTH group was significantly lower than that of control group (P＜0.01). Conclusions The incidences of postoperative nausea, headache and sore throat are significantly increased and the score of QoR-40 is significantly reduced in patients with ACTH pituitary adenoma.

嗜铬细胞瘤是一种起源于肾上腺髓质能够产生儿茶酚胺的嗜铬细胞肿瘤,在所有分泌儿茶酚胺的肿瘤中占85％～90％,在高血压患者中的发生率为0. 2％～0. 6％. 由于大多数患者临床症状不典型,故术前诊断、鉴别诊断及充分的术前准备尤为重要. 目前手术切除肿瘤是治疗嗜铬细胞瘤的一线方案,但嗜铬细胞瘤患者易出现围术期血流动力学不稳定,甚至发生高血压危象、恶性心律失常、多器官功能衰竭等致死性并发症,故麻醉风险较高. 近年来仍有多个病例报道围术期出现恶性高血压及儿茶酚胺危象[1-4]. 本文总结整理近年来对诊断及未诊断的嗜铬细胞瘤麻醉术中管理及相关措施的决策.

Objective To investigate the predictors for rapid postoperative recovery from general anesthesia ( GA) in children less than three-year old receiving repair of cleft lip or palate. Methods Totally 314 children less than three years old, who received repair of cleft lip or palate under GA in Peking Union Medical Collegc Hospital from Jan 2013 to Dec 2016, were divided into two groups according to the time from extubation to discharge from operation room and back to ward. Rapid recovery from GA were defined as the recovery time less than 30 min. All the records, inclu-ding demographics, preoperative coexist diseases, the parameters of anesthesia and operation, were compared between these two groups. The multivariate logistic regression analysis was used to survey the potential risk factors. Results When compared with the rapid recovery group, children in the non-rapid recovery group had significantly smaller age, lower body weight, smaller tracheal tube ID, less proportion of cleft palate repairment, and higher rate of preoperative respiratory coexist diseases ( P<0. 01) . The multivariate logistic regression analysis showed that preoperative respiratory coexist diseases was the independent predictors for non-rapid recovery from GA ( OR=5. 622, 95％ CI=1. 650～19. 158) . Conclusion Preoperative respiratory coexist diseases is an independent predic-tors for non-rapid recovery from GA in children <3 years old receiving repair of cleft lip or palate.

手术部位感染(SSI)是危害患者安全的重要原因之一,也导致了沉重的经济和社会负担.作为围术期医生,预防SSI,我们义不容辞.首先,应采取有效的预防性抗感染治疗,第一、二代头孢菌素类药物是清洁手术和清洁-污染手术预防性抗感染治疗的首选,推荐在切皮前120 min内预防性使用抗生素,并根据药物半衰期具体考虑.其次,需遵从无菌原则,严格执行个人手卫生,注意注射安全,维护设备及环境的清洁,并在有创性操作中注意无菌规范.最后,需完善术中管理,采取体温保护措施,加强围术期血糖控制,倡导限制性输血.

麻醉学是推动人类文明和社会进步的重要学科, 历经百余年发展, 现已成为保障医疗安全的关键学科, 是医院发展的重要平台. 现代麻醉学科的发展和成熟, 离不开19世纪麻醉领域开疆拓土的前辈们, 正是其不懈的努力, 使得诸多手术可以安全实施, 患者免受疼痛之苦. 麻醉学科的发展史, 如同人类文明进化的镜子, 印证着人类不断追求更高生活质量的发展历程.

作为手术室的重要成员，麻醉医师在决定手术麻醉方式、维持患者术中生命体征的稳定以及实施术后镇痛方面起着决定性的作用。由于患者病情程度不同，实施麻醉的同时，有些患者也需行动静脉穿刺、纤维支气管镜、经食管超声心动图等操作辅助手术的平稳进行。众多操作均与患者的体液/血液有直接或间接触碰。在对职业暴露进行自我保护的同时，如何减少患者间、医疗环境及医护人员间的交叉传染成为另一需关注重点。近年来，随着围术期患者之家概念的提出，麻醉医师也成为患者围术期多学科协作管理团队的重要成员[1]。但在手术室感染控制、自我手卫生监控方面麻醉医师的意识还较为欠缺。本文针对近年来麻醉医师手卫生现状及手术间感染控制进行综述分析并提出相应可完善方案及策略。