Background With the popularisation of video laryngoscopy, the difficulty of tracheal intubation has greatly reduced. This study explored the suitability of traditional airway assessment methods for tracheal intubation using video laryngoscopy. Methods A total of 1047 patients undergoing general anaesthesia were enrolled. Before anaesthesia, body mass index (BMI) was measured. Traditional airway assessment methods such as the modified Mallampati classification (MMC), upper lip bite test (ULBT), thyromental distance (TMD), mouth opening (MO), and neck movement (NM) been rigorously evaluated. During tracheal intubation, the grading of glottis exposure (Cormack-Lehane) was recorded, along with the intubation duration and one-time intubation success rate. Additionally, the use of other improvement methods, such as applying pressure to the laryngeal node or utilising alternative intubation positions, was observed. Results The proportion of Cormack-Lehane ≤ 2 in MMC with 1 or 2, ULBT with 1, TMD with 1, and NM with 1 were much higher than that of Cormack-Lehane ≥ 3 (P < 0.05). However, there were no significant differences in MO or BMI between different glottic exposure grades (P > 0.05). Multiple logistic regression analysis showed that MMC, ULBT, TMD, and NM were independent risk factors for glottic exposure grading (P < 0.05). With the increase in variable grading, the intubation duration prolonged, and there were significant differences in MMC with 1 or 2 vs. 3 or 4, ULBT with 1 vs. 2 or 3, TMD with 1 vs. 2 or 3, MO with 1 vs. 2 or 3, and NM with 1 vs. 2 (P < 0.05). Conclusion Traditional airway assessment indicators continue to provide guidance for tracheal intubation under video laryngoscopy, and there is currently no necessity to develop new methods for airway evaluation. Trial registration Chinese Clinical Trial Register: ChiCTR2200057603) on 15 March 2022.

ObjectiveTo analyze the correlation between the lung allocation score (LAS) and the risk of early death in patients with idiopathic pulmonary fibrosis (IPF) after lung transplantation. MethodsClinical data of 275 patients with IPF were retrospectively analyzed. The correlation between LAS and the risk of early death in IPF patients after lung transplantation and the correlation between LAS and complications at postoperative 1 year was assessed by univariate and multivariate Cox regression analyses. ResultsAmong 275 recipients, 62, 83, 95 and 108 cases died within postoperative 30, 90, 180 and 365 d, respectively. LAS was significantly correlated with 30-, 90-, 180- and 365-d fatality of IPF patients (all P<0.05), whereas it was not correlated with the incidence of primary graft dysfunction (PGD) and acute kidney injury (AKI) at 365 d after lung transplantation (both P>0.05). ConclusionsLAS is correlated with the risk of early death of IPF patients after lung transplantation. However, it is not correlated the incidence of PGD and AKI early after lung transplantation. Special attention should be paid to the effect of comprehensive factors upon PGD and AKI.

Opioid-reduced multimodal analgesia has been used clinically for many years to decrease the perioperative complications associated with opioid drugs. We aimed to assess the clinical effects of opioid-reduced anesthesia during thoracoscopic sympathectomy. Surgical patients (n = 151) with palmar hyperhidrosis were randomly divided into control (Group C, 73 patients) and test (Group T, 78 patients) groups. All patients were administered general anesthesia using a laryngeal mask. In Group C, patients received propofol, fentanyl, and cisatracurium for anesthesia induction, and maintenance was achieved with propofol and remifentanil, along with mechanical ventilation during the operation. In Group T, anesthesia was induced with propofol, dezocine, and dexmedetomidine (DEX) and maintained with propofol, DEX, and an intercostal nerve block, along with spontaneous breathing throughout the operation. Perioperative complications related to opioid use include hypotension, bradycardia, hypertension, tachycardia, hypoxemia, nausea, vomiting, urine retention, itching, and dizziness were observed. To assess the impact of these complications, we recorded and compared vital signs, blood gas indices, visual analogue scale (VAS) scores, adverse events, and patient satisfaction between the two groups. Perioperative complications related to opioid use were similar between groups. There were no significant differences in the type of perioperative sedation, analgesia index, respiratory and circulatory indicators, blood gas analysis, postoperative VAS scores, adverse reactions, propofol dosage, postoperative recovery time, and patient satisfaction. In minimally invasive surgeries such as thoracoscopic sympathectomy, opioid-reduced anesthesia was found to be safe and effective; however, this method did not demonstrate clinical advantages. Chinese Clinical Trial Register: ChiCTR2100055005, on December 30, 2021.

OBJECTIVETo investigate the risk factors of early death after lung transplantation in patients with idiopathic pulmonary fibrosis (IPF) complicated with pulmonary arterial hypertension (PAH).METHODSA retrospective cohort study was conducted. The clinical data of 134 patients with IPF and PAH who underwent lung transplantation at Wuxi People's Hospital Affiliated to Nanjing Medical University from January 2017 to December 2020 were collected. The donor's gender, age, duration of mechanical ventilation, and cold ischemia time, the recipient's gender, age, body mass index (BMI), smoking, history of hypertension and diabetes, preoperative usage of hormones, mean pulmonary arterial pressure (mPAP), cardiac echocardiography and cardiac function, serum creatinine (SCr), N-terminal pro-brain natriuretic peptide (NT-proBNP) as well as surgical type, extracorporeal membrane oxygenation (ECMO) treatment, duration of operation, and plasma and red blood cell infusion ratio were collected. The cumulative survival rates of patients at 30, 60, and 180 days after lung transplantation were calculated by Kaplan-Meier method. The univariate and multivariate Cox proportional hazards regression models were used to analyze the effects of donor, recipient, and surgical factors on early survival in donors after lung transplantation.RESULTSThe majority of donors were male (80.6%). There was 63.4% of the donors older than 35 years old, 80.6% of the donors had mechanical ventilation duration less than 10 days, and the median cold ischemia time was 465.00 (369.25, 556.25) minutes. The recipients were mainly males (83.6%). Most of the patients were younger than 65 years old (70.9%). Most of them had no hypertension (75.4%) or diabetes (67.9%). The median mPAP of recipients was 36 (30, 43) mmHg (1 mmHg ≈ 0.133 kPa). There were 73 patients with single lung transplantation (54.5%), and 61 with double lung transplantation (45.5%). The survival rates of 134 IPF patients with PAH at 30, 60, 180 days after lung transplantation were 81.3%, 76.9%, and 67.4%, respectively. Univariate Cox proportional risk regression analysis showed that recipient preoperative use of hormone [hazard ratio (HR) = 2.079, 95% confidence interval (95%CI) was 1.048-4.128], mPAP ≥ 35 mmHg (HR = 2.136, 95%CI was 1.129-4.044), NT-proBNP ≥ 300 ng/L (HR = 2.411, 95%CI was 1.323-4.392), New York Heart Association (NYHA) cardiac function classification III-IV (HR = 3.021, 95%CI was 1.652-5.523) were the risk factors of early postoperative death in patients with IPF complicated with PAH (all P < 0.05). In the multivariable Cox proportional risk regression analysis, recipient preoperative hormone usage (model 1: HR = 2.072, 95%CI was 1.044-4.114, P = 0.037; model 2: HR = 2.098, 95%CI was 1.057-4.165, P = 0.034), NT-proBNP ≥ 300 ng/L (HR = 2.246, 95%CI was 1.225-4.116, P = 0.009) and NYHA cardiac function classification III-IV (HR = 2.771, 95%CI was 1.495-5.134, P = 0.001) were independent risk factors of early postoperative death in patients with IPF.CONCLUSIONSPreoperative hormone usage, NT-proBNP ≥ 300 ng/L, NYHA cardiac function classification III-IV are independent risk factors for early death in patients with IPF and PAH after lung transplantation. For these patients, attention should be paid to optimize their functional status before operation. Preoperative reduction of receptor hormone usage and improvement of cardiac function can improve the early survival rate of such patients after lung transplantation.

The incidence of breast cancer has exhibited an annually increasing trend, and the disease has become the most common malignant tumour worldwide. Currently, the primary treatment for breast cancer is surgical resection. However, metastatic recurrence is the main cause of cancer-related death in this patient population. Various factors are associated with breast cancer prognosis, and anaesthesia-induced changes in the tumour microenvironment have attracted increasing attention. To date, however, it remains unclear whether anaesthetic drugs have a positive or negative impact on cancer outcomes after surgery. The present article reviews the effects of different anaesthetics on the postoperative prognosis of breast cancer surgery to guide the choice of anaesthetic technique(s) and agents for such patients.

We aimed at exploring the role and mechanism of METTL3-mediated m6A modification in neuropathic pain. Male Sprague-Dawley rats were randomly divided into four groups: Sham operation group (Sham group), chronic constriction injury (CCI) of the sciatic nerve model group (NPP group), intrathecal injection of virus down-regulated METTL3 + CCI model group (M3 + NPP group) and intrathecal injection of negative control virus + CCI model group (Scr + NPP group). The M3 + NPP group and the Scr + NPP group were intrathecally injected with virus nineteen days before operation. The paw withdrawal mechanical thresholds and paw withdrawal latency were respectively recorded one day before operation, three days, five days and seven days after oper-ation. The rats were sacrificed on the seventh day after operation, and their spinal cord tissues were taken. The frozen sections of rats were performed to observe the expression of green fluorescent protein of the virus. The methylation level of RNA, the protein expression of m6A-related enzyme (METTL3) and mu opioid receptor (MOR) in spinal cord tissues of the four groups were measured. Downregulation of METTL3 had no effect on the overall methylation level of the spinal cord, but it could regulate the methylation level of the OPRM1 gene RNA encoding MOR, partially restore the expression of MOR, and relieve pain in rats. In the process of NPP, METTL3 may inhibit the expression of MOR by regulating the methylation level of OPRM1 gene RNA encoding MOR, and ultimately promote the occurrence and development of NPP.

目的 观察改良式胸外按压在预防支气管结核患者无痛支气管镜诊疗期间低氧血症的临床效果.方法 选取2022年5-10月在深圳市第三人民医院行支气管镜诊疗的支气管结核患者200例,随机数表法分为对照组(C组)和试验组(T组),每组100例.麻醉方法均为静脉注射咪达唑仑+瑞芬太尼,患者意识消失后置入支气管镜,围手术期患者如发生呼吸停止达10s以上,C组予手动托下颌,T组行改良式胸外按压.如果血氧饱和度(SpO2)持续低于90%超过60s时,暂停支气管镜下操作,行面罩通气治疗.观察两组患者麻醉前(T0)、过声门时刻(T1)、诊疗结束时刻(T2)、离室时刻(T3)的心率(HR)、平均动脉压(MAP)、SpO2变化、麻醉药用量、苏醒时间、低氧血症及诊疗中断发生情况.结果 与麻醉前相比,两组术中均有MAP升高、HR增快及SpO2下降,术后逐渐恢复至基础水平,但两组患者不同时点MAP、HR的比较差异无统计学意义(P＞0.05).与C组相比,T组T1、T2时点SpO2维持于较高水平(P＜0.05),T组低氧血症及诊疗中断的发生率明显降低(P＜0.05).两组呼吸暂停的发生率、SpO2最低值和其他不良反应无明显差异(P＞0.05).T组中未出现胸痛、肋骨骨折、气胸等胸外按压相关不良反应.结论 改良式胸外按压在支气管结核患者无痛支气管镜诊疗期间安全可行,可有效预防低氧血症,减少诊疗中断次数.

Objective To study the clinical effects of dexmedetomidine（DEX） on patient controlled intravenous analgesia（PCIA） in patients with acquired immunodeficiency syndrome（AIDS） underwent perianal surgery. Methods Ninety AIDS patients with perianal surgery under combined spinal epidural anesthesia were randomly divided into observation group（Group O） and control group（Group C）. In Group O, sufentanil 1.5 μg/kg + DEX 2.5 μg/kg + flurbiprofen 200 mg + ondansetron 8 mg were diluted to 200 mL with normal saline in PCIA; the background infusion rate was 3 mL/h; an additional dose of 3 mL/h was permitted under a locking time of 15 min; and the total infusion time was 48 h. In Group C, DEX was not used in PCIA, the rest were the same as Group O. The degree of pain, sedation at rest 4, 12, 24 and 48 hours after surgery, and PCIA cumulative additional drugs were recorded. The changes of plasma T lymphocyte subsets in the two groups before anesthesia and 24 and 48 hours after operation were observed, and the occurrence of perioperative adverse reactions and patients′ satisfaction were recorded. Results Compared with Group C, the pain score after surgery and cumulative additional drugs in Group O were significantly reduced; while the patients′ satisfaction was significantly improved（P＜0.05）. However, there was no significant difference in postoperative sedation score, perioperative T lymphocyte subsets or adverse reactions between two groups（P＞0.05）. Conclusion DEX is safe and effective in PCIA of patients with AIDS after perianal surgery. It can reduce the degree of pain and improve patients′ satisfaction, but has no significant effect on T lymphocyte subsets.

目的 探讨结核病患者胸膜剥脱手术中的加速康复外科模式下目标导向液体治疗对减轻患者术后肺水肿的治疗价值.方法 选取2021年1月至2022年5月拟行胸膜剥脱手术的结核病患者60例作为研究对象,随机将60例患者分为试验组(S组)和对照组(C组),每组各30例,S组采用目标导向液体治疗策略,根据每搏量变异(SVV)调整液体量,C组采用常规液体治疗方案,根据有创平均动脉压、中心静脉压及尿量等参数调整补液量,在术前、术后第1天、术后第3天采用肺水肿影像学评分(Rale评分)系统对患者胸部正位片进行评分,评估患者术后肺水肿发生情况,分别在麻醉诱导前5min(T1)、气管插管后5min(T2)、手术开始(T3)、手术1h(T4)、手术结束(T5)记录的平均动脉压(MAP)、心率(HR)、指尖脉氧饱和度(SPO2)和气道峰压(PEAK)的变化,记录术后并发症发生的情况;分别于手术前ld、术后第1天和术后第3天对患者进行全身麻醉术后恢复质量评分(QoR-15),评估患者术后恢复情况.结果 与C组相比,S组术后第1天Rale评分较低(P＜0.05),术后第3天两组患者Rale评分无明显差异;两组术中生命体征差异无统计学意义;S组输液量较C组少(P＜0.01);拔管时间、术后住院时间、尿量、QoR-15评分均无明显差异.结论 目标导向液体治疗可以在结核病患者胸膜剥脱手术中减轻术后急性肺水肿严重程度,维持稳定的循环同时减少术中输液量.

目的 筛选肝癌(hepatocellular carcinoma,HCC)患者行经皮肝穿刺射频消融(radiofrequency ablation,RFA)术后中重度疼痛的危险因素.方法 择期行全麻下CT引导经皮肝穿刺RFA的HCC患者102例,根据术后24 h内视觉模拟评分(visual analogue scale,VAS)情况分为中重度疼痛组(VAS≥3分)和非中重度疼痛组(VAS＜3分).收集患者性别、年龄、ASA分级、肝硬化及肝脏手术情况、术前疼痛情况、肿瘤病灶大小、肿瘤位置、与肝包膜的距离、肿瘤数量、消融病灶数量、消融时间及手术时间,采用多因素logistic回归分析筛选术后中重度疼痛的独立危险因素.结果 56例患者术后24 h内发生了中重度疼痛.与非中重度疼痛组比较,中重度疼痛组术前合并疼痛、病灶＞1.5 cm及消融时间＞12 min比例较高,组间比较差异有统计学意义(P＜0.05);多因素logistic回归分析结果显示:病灶＞1.5 cm及消融时间＞12 min是患者术后中重度疼痛的独立危险因素(P＜0.05).结论 HCC患者肿瘤病灶＞1.5 cm或RFA消融时间＞12 min时术后易发生中重度疼痛,术后应注意及时给予镇痛治疗.

目的 观察湿化高流量鼻导管通气(humidified high flow nasal cannula,HFNC)在肝硬化患者胃镜治疗中的临床效果.方法 肝硬化患者择期行无痛胃镜下食管-胃底曲张静脉治疗40例,所有患者术前均无活动性上消化道出血,随机分为气管插管组(I组)和HFNC组(H组),每组20例.所有患者均采用全凭静脉麻醉,I组围术期行机械通气,H组保留自主呼吸.记录两组患者麻醉药用量、苏醒时间、麻醉相关并发症发生情况及患者满意度.结果 与I组相比,H组丙泊酚、芬太尼用量明显减少,术后苏醒时间缩短,围术期低血压及鼻出血的发生率较低,但轻度低氧血症发生率较高(P<0.05).两组患者围术期其他并发症发生情况及满意度的比较差异无统计学意义(P>0.05).结论 采用HFNC可减少肝硬化患者胃镜治疗期间全麻药用量,缩短术后苏醒时间,降低低血压及鼻出血发生率,但围术期需加强气道管理.

Objective:To explore the early prognosis on patient of idiopathic pulmonary fibrosis (IPF) combined with different degrees of pulmonary arterial hypertension (PAH) undertake lung transplantation (LTx).Methods:From January 2017 to December 2020, the clinical data of 134 patients with IPF who underwent LTx in Wuxi People's Hospital were analyzed retrospectively. According to the average pulmonary artery pressure detected by right cardiac catheter before operation, the patients were divided into mild PAH group (63 cases), moderate PAH group (47 cases) and severe PAH group (24 cases). The donor data and the recipient's preoperative, intraoperative and postoperative data were collected; the postoperative survival curve to analyze early survival among the three patient groups.Results:With the increase of pulmonary artery pressure, the rate of abnormal right ventricular function increased, the end diastolic diameter of left ventricle decreased before operation, and the rate of using veno-arterial extracorporeal membrane oxygenation (V-A ECMO) increased during the surgery ( P<0.05). Multivariate analysis found that combined severe PAH had significant effects on primary graft dysfunction (Primary graft dysfunction, PGD), retracheal intubation or tracheotomy, hypovolemic shock within 72 h, and 6-month survival after LTx. The survival surve showed that 30-day survival rates of patients with IPF complicated with mild, moderate and severe PAH were 85.7%, 80.8% and 66.7% respectively, and the 6-month survival rates were 80.9%, 74.0% and 62.2%, respectively. Conclusion:Patient of IPF combined with different degrees of PAH had a significant impact on cardiac function and intraoperative ECMO selection of LTx, and severe PAH could significantly reduce the early survival rate after LTx.

随着精准医疗及加速康复外科理念的推广,越来越多胸科手术要求患者术后快速清醒、快速出院,围术期多模式镇痛和非插管麻醉策略应运而生.这篇综述无阿片保留自主呼吸麻醉技术在胸科日间手术中的现状,供临床参考.

目的 观察每博变异度(stroke volume variation,SVV)在指导肾移植手术中输液管理的临床效果.方法 全麻下行同种异体肾移植术40例,随机分为观察组和对照组,每组20例.观察组在SVV指导下进行输液治疗,对照组采用经典4-2-1液体疗法.观察两组患者围术期并发症及术后早期恢复情况.结果 与对照组相比,观察组围术期总输液量明显减少(P<0.01),但两组术中呼吸循环并发症、主要血气指标、出血量、尿量、术后拔管时间、离室时间、住院时间、术后14 d内恢复质量评分和30 d内肺部感染、胸腔积液、肺水肿、心功能衰竭、淋巴瘘及重度贫血发生率的比较差异无统计学意义(P>0.05).结论 肾移植术中采用SVV指导容量管理可明显减少术中输液量,但并不能改善患者早期预后,传统输液策略仍可安全用于肾移植术.

目的 观察右美托咪定(dexmedetomidine,DEX)预处理对结核病(tuberculosis,TB)大鼠CD3+T淋巴细胞、CD4+T淋巴细胞、CD8+T淋巴细胞、自然杀伤细胞(natural killer cell,NK细胞)、γ-干扰素(interferon gamma,IFN-γ)表达及肺损伤的影响,为TB患者手术期间免疫保护提供参考.方法 取SD大鼠30只,随机分为非结核对照组(C组)、结核+生理盐水对照组(T组)、结核+DEX 5μg/kg组(D1组)、结核+DEX 10μg/kg组(D2组)和结核+DEX 15μg/kg组(D3组),每组6只.采用流式细胞仪检测麻醉前30min(T0),手术后1h(T1)、4h(T2)及8h(T3)眼眶静脉血CD3+T淋巴细胞、CD4+T淋巴细胞、CD8+T淋巴细胞、CD4+T淋巴细胞/CD8+T淋巴细胞比值、NK细胞及IFN-γ表达水平的变化;术后12h处死大鼠,观察肺组织的病理学改变.结果 与T0比较,各组术后T淋巴细胞亚群、NK细胞及IFN-γ均出现抑制,但同一时点各组间T淋巴细胞亚群、NK细胞及IFN-γ的变化差异无统计学意义(P>0.05),且TB大鼠术后肺部炎症反应程度相似.结论 TB大鼠围术期采用DEX预处理无明显免疫保护及肺保护作用,该药在TB患者中使用需谨慎.

艾滋病(AIDS)是人体感染免疫缺陷病毒(HIV)引起的一种危害性极大的传染病,HIV主要侵犯CD4+T淋巴细胞,引起人体免疫功能障碍,易合并各种感染,病死率较高 [1-2].慢加急性肝衰竭是指各种急性损伤因素作用下,肝功能原本相对稳定的慢性肝病患者迅速恶化的肝衰竭综合征,合并HIV感染者更易加速疾病进展,肝移植为治疗该类患者的主要选择 [3].然而,该类患者肝移植手术难度大、风险高,对手术护理配合及感染防护提出了极高的要求,现就4例HIV患者肝移植围术期护理配合方法报告如下.

艾滋病(AIDS)疼痛是由艾滋病病毒(HIV)感染引起的疼痛综合征,可见于AIDS的各个阶段,具有发病率高、病程长、临床表现复杂及难根治等特点,严重干扰患者的生活质量.本文综述HIV感染者/AIDS患者疼痛的诊疗现状,供临床参考.

目的 观察湿化高流量鼻导管通气(humidified high flow nasal cannula,HFNC)在纤维支气管镜(以下简称纤支镜)检查静脉全麻中的应用效果.方法 选择拟择期行纤支镜检查患者60例,随机分为对照组(C组)和HFNC组(H组),每组30例.所有患者均采用丙泊酚复合瑞芬太尼全凭静脉麻醉,C组采用普通鼻导管吸氧,H组采用湿化高流量鼻导管通气.记录两组患者的一般情况、手术期间的氧合情况、生命体征、麻醉药物总用量、苏醒时间及患者满意度,记录相关并发症和不良反应.结果 两组患者的一般情况、手术时间、麻醉时间、丙泊酚和瑞芬太尼用量、苏醒时间的比较均差异无统计学意义(P>0.05).H组轻度缺氧和重度缺氧的发生率明显低于C组(P<0.001).两组患者其他并发症及满意度的比较差异无统计学意义(P>0.05).结论 HFNC可有效改善静脉全麻下行纤支镜检查术患者的氧合情况,提高手术麻醉的安全性.

BACKGROUND Extracorporeal membrane oxygenation (ECMO) is widely used for cardiopulmonary assistance during lung transplantation (LTx). However, the optimal timing for ECMO removal remains controversial. This study aimed to evaluate the risk factors and early prognosis of delayed withdrawal ECMO after LTx. METHODS 267 patients who underwent LTx supported by ECMO were included in this study. Based on whether or not ECMO was completely stopped in the operating room, patients were divided into early ECMO withdrawal group (group E, 107 cases) and delayed withdrawal group (group D, 160 cases). Peri-operative data of the donors and recipients, including the suspected risk factors for delayed removal of ECMO, post-operative complications, and hospital survival rate, were retrospectively analyzed. RESULTS Preoperative New York Heart Association (NYHA) cardiac function for recipient and mechanical ventilation time for donor were independent risk factors for delayed weaning of ECMO in veno-arterial ECMO (V-A-ECMO) patients. Compared with group E, the odds of post-operative pulmonary infection, primary graft dysfunction, renal dysfunction, blood transfusion volume and mechanical ventilation time were significantly higher in group D (all P < 0.05). Delayed withdrawal ECMO was decisive factor for early post-operative death, as the risk of early post-operative death in the group D was 1.99 (95% confidence interval: 1.13-3.54) times as that in the group E. CONCLUSIONS During the period of LTx, NYHA grade III/IV for recipient and mechanical ventilation time ≥ 5 days for donor are suggestive of delayed V-A-ECMO removal, and clinicians should minimize the post-operative bypass time of ECMO when conditions permit.

非去极化肌松药(NDMR)是目前临床应用最为广泛的骨骼肌松弛药.NDMR的药效学特征与多种因素有关,结核病患者因其病理生理特点和患者长期服药治疗可引起肝功能及神经-肌肉系统受损,影响该类药物的阻滞时效.了解结核病患者NDMR的药效学特点,对该类患者围术期个体化用药具有重要意义.