抗血小板和抗凝患者行脊柱介入和疼痛介入治疗指南(一)

疼痛介入治疗涵盖了较局部神经阻滞更为广泛的内容,两者具有不同的目的和治疗靶点。参加ASRA第11届疼痛医学年会的脊柱、疼痛科及介入科医师参与调查时表示:由于介入技术的发展,ASRA现有的、关于局部神经阻滞中有关抗血小板和抗凝患者的相关指南已经不能满足临床需要。受访者一致认为,由于介入治疗与局部神经阻滞在适应证和操作上存在差异,需针对疼痛介入治疗制订单独的临床指南。对此,ASRA成立了指南委员会,通过查阅脊柱和疼痛治疗相关并发症的文献,委员会根据潜在的出血风险将脊柱和疼痛介入治疗分为低、中、高三个级别。该指南主要适用于中、低风险治疗级别,而高风险操作需要进一步权衡患者安全和最佳预后。指南制订委员会采用极为全面的数据库检索方法收集最新的相关文献,尽可能为读者提供循证推荐。然而,由于许多原始文献缺乏针对疼痛介入治疗来设计的大型研究证据的支持,指南制订委员会难以提供这些证据的强度和级别,尽管有些指南或共识的制订不全基于随机对照研究或大样本患者数据库,但希望这些指南能提供良好的临床建议和类似指南的证据基础。

抗血小板和抗凝患者行脊柱介入和疼痛介入治疗指南(三)

长期服用抗血小板及抗凝药物的患者在介入操作期间如何使用这些药物，是微创医学界关注的焦点之一，《局部麻醉与疼痛医学》杂志编辑部组织专家编写了Interventional Spineand Pain Procedures in Patiems on Antiplatelet and Anticoagulant Medications（抗血小板和抗凝患者行脊柱介入和疼痛介入治疗指南），我刊委托华盛顿大学易晓彬教授洽谈版权并组织翻译，因篇幅较长，分三期刊出（22卷6～8期），参考文献请查阅原文（Doi：10．109711AAE0000000000000223，Reg Anesth Pain Med，2015，40：182～212）。

Change in management of predicted difficult airways following introduction of video laryngoscopes

AIM To determine if video laryngoscopy(VL) has significantly impacted management of difficult airways by decreasing the rate of awake fiberoptic intubation(FOI). METHODS Anesthetic records of 3723 patients who underwent general anesthesia at Rush University Medical Center were reviewed over a 2-mo period prior to the introduction of VLs in 2009("pre-VL" group) and over the same 2-mo period after the introduction of VLs in 2012("postVL" group). Patient records with predicted difficult air-ways based on pre-operative airway examination were analyzed. The primary outcome was rate of awake FOI.RESULTS To control for possible factors that may influence the FOI rate, a logistic regression was performed with these factors included as covariates. The rate of awake FOI was 13.1% in pre-VL group compared to 9.0% in post-VL group. Although this decrease was not statistically significant individually(P = 0.1768), it showed a trend toward significance when covariates were accounted for(P = 0.0910). Several factors predicting a higherlikelihood of awake FOI were found to be statistically significant: Morbid obesity(larger BMI P = 0.0154, OR = 1.5 per 10 point BMI increase), male gender(P = 0.0026, OR = 3.0) and a higher el-Ganzouri airway score(P = 0.0007, OR = 1.5). Although VLs were seen to be used to intubate 51% of predicted difficult airways, the rate of awake FOI has not significantly changed.CONCLUSION Although VL may continue to grow in popularity, the most difficult airways are still managed using awake FOI.

抗血小板和抗凝患者行脊柱介入和疼痛介入治疗指南(二)

疼痛介入治疗涵盖了较局部神经阻滞更为广泛的内容,两者具有不同的目的和治疗靶点。参加ASRA第11届疼痛医学年会的脊柱、疼痛科及介入科医师参与调查时表示:由于介入技术的发展,ASRA现有的、关于局部神经阻滞中有关抗血小板和抗凝患者的相关指南已经不能满足临床需要。受访者一致认为,由于介入治疗与局部神经阻滞在适应证和操作上存在差异,需针对疼痛介入治疗制订单独的临床指南。对此,ASRA成立了指南委员会,通过查阅脊柱和疼痛治疗相关并发症的文献,委员会根据潜在的出血风险将脊柱和疼痛介入治疗分为低、中、高三个级别。该指南主要适用于中、低风险治疗级别,而高风险操作需要进一步权衡患者安全和最佳预后。指南制订委员会采用极为全面的数据库检索方法收集最新的相关文献,尽可能为读者提供循证推荐。然而,由于许多原始文献缺乏针对疼痛介入治疗来设计的大型研究证据的支持,指南制订委员会难以提供这些证据的强度和级别,尽管有些指南或共识的制订不全基于随机对照研究或大样本患者数据库,但希望这些指南能提供良好的临床建议和类似指南的证据基础。