Plasma MMP-2 and MMP-7 levels are elevated first month after surgery and may promote growth of residual metastases

BACKGROUND MMP-2 also known as gelatinase A and MMP-7(matrilysin)are members of the zinc-dependent family of MMPs(Matrix metalloproteinase).MMP-2 and MMP-7 are remodeling enzymes that digest extracellular matrix;MMP-2 is extensively expressed during development and is upregulated at sites of tissue damage,inflammation,and in stromal cells of metastatic tumors.MMP-7 is expressed in the epithelial cells and in a variety of cancers including colon tumors.Plasma MMP-2 and MMP-7 levels were assessed before and after minimally invasive colorectal resection for cancer pathology.AIM To determine plasma MMP-2 and MMP-7 levels before and after minimally invasive colorectal resection for cancer pathology.METHODS Patients enrolled in a plasma bank for whom plasma was available were eligible.Plasma obtained from preoperative(Preop)and postoperative blood samples was used.Only colorectal cancer(CRC)patients who underwent elective minimally invasive cancer resection with preop,post-operative day(POD)1,3 and at least 1 late postop sample(POD 7-34)were included.Late samples were bundled into 7 d blocks(POD 7-13,14-20,etc.)and treated as single time points.Plasma MMP-2 and MMP-7 levels were determined via enzyme-linked immunosorbent assay in duplicate.RESULTS Total 88 minimally invasive CRC resection CRC patients were studied(right colectomy,37%;sigmoid,24%;and LAR/AR 18%).Cancer stages were:1,31%;2,30%;3,34%;and 4,5%.Mean Preop MMP-2 plasma level(ng/mL)was 179.3±40.9(n=88).Elevated mean levels were noted on POD1(214.3±51.2,n=87,P<0.001),POD3(258.0±63.9,n=80,P<0.001),POD7-13(229.9±62.3,n=65,P<0.001),POD 14-20(234.9±47.5,n=25,P<0.001),POD 21-27(237.0±63.5,n=17,P<0.001,)and POD 28-34(255.4±59.7,n=15,P<0.001).Mean Preop MMP-7 level was 3.9±1.9(n=88).No significant differences were noted on POD 1 or 3,however,significantly elevated levels were noted on POD 7-13(5.7±2.5,n=65,P<0.001),POD 14-20(5.9±2.5,n=25,P<0.001),POD 21-27(6.1±3.6,n=17,P=0.002)and on POD 28-34(6.8±3.3,n=15 P<0.001,)vs preop levels.CONCLUSION MMP-2 levels are elevated for 5 wk and MMP-7 levels elevated for weeks 2-6.The etiology of these changes in unclear,trauma and wound healing likely play a role.These changes may promote residual tumor growth and metastasis.

Time Course of Elevations in Plasma Olprinone Concentration during Pediatric Cardiac Surgery

Purpose: Little research has been reported to date on the usefulness of olprinone in pediatric cardiac surgery, and no standard pediatric infusion protocol is currently established. Our study sought to confirm that the regimen described herein rapidly achieves the requisite plasma olprinone concentrations. Methods: For the purposes of our study, we enrolled 13 patients: 7 biventricular repair candidates and 6 Fontan-type operation candidates. We administered a continuous infusion of olprinone to our study subjects at 0.3 μg/kg/min with no loading dose starting approximately 30 minutes (min) before weaning from cardiopulmonary bypass (CPB). We performed blood sampling at 15, 30, 45, 60, 90, and 120 min after the start of infusion and at the same elapsed intervals after separation from CPB. We measured plasma olprinone concentrations using ultra-fast liquid chromatography. Results: We observed effective plasma olpri-none concentrations (>20 ng/ml) at 30 min after weaning from CPB, or at 60 min after the start of infusion. Conclusion: We conclude that continuous olprinone infusion at 0.3 μg/kg/min without a loading dose initiated immediately after the release of aortic cross-clamping or immediately after the completion of all surgical procedures quickly and reliably achieves effective plasma concentrations.

Risk factors for endophthalmitis after cataract surgery in diabetic patients: a case control study

AIM: To identify risk factors associated with post-cataract surgery endophthalmitis(PCE) in type 2 diabetic patients.METHODS: A hospital-based retrospective case-control study was conducted on 194 type 2 diabetic patients undergoing cataract surgery in Rajavithi Hospital from January 2007 to December 2015. Fifteen patients with PCE were included as the case group and 179 patients without PCE were included as the control group. Potential factors associated with PCE among both groups including demographics, pre-operative characteristics, surgical settings and complications, were statistically analyzed using Chi-square testing and a logistic regression model.RESULTS: Within the case group, 53% were females and the median age was 68 y. Univariate analysis of pre-operative characteristics, surgical settings and complications revealed that recent pre-operative fasting plasma glucose, insulin therapy, presence of diabetic retinopathy, and severe non-proliferative or proliferative diabetic retinopathy were significantly associated with PCE. In a multivariate analysis adjusting for blood glucose level, insulin treatment was the only significant factor associated with an increased risk of PCE(OR 3.9, 95%CI 1.0-15.0, P=0.04) compared to patients without insulin treatment. The most common causative organisms were gram-positive bacteria(89%). Staphylococcus species represented the most common group(67%). Median best corrected visual acuity at 1-month and 3-month follow-up was equal at 0.7 logMAR(20/100).CONCLUSION: The authors identify insulin treatment as the only risk factor associated with endophthalmitis after cataract surgery in type 2 diabetic patients. Further studies with serum levels of pre-operative glycated hemoglobin(HbA_(1c)) and post-operative fasting plasma glucose level are essential to truly demonstrate the role of peri-operative glycemic markers as a risk factor for PCE.

Fresh frozen plasma transfusion does not affect outcomes following hepatic resection for hepatocellular carcinoma

AIM:To investigate whether fresh frozen plasma (FFP) transfusion affects outcomes following hepatic resection for hepatocellular carcinoma (HCC) in terms of liver function,postoperative complications and cancer prognosis.METHODS:We retrospectively compared the incidence of postoperative complications between 204 patients who underwent hepatectomy for HCC with routine FFP transfusion in an early period (1983-1993,Group A) and 293 with necessity for FFP transfusion during a later period (1998-2006,Group B),and also between two subgroups of Group B [22 patients with FFP transfusion (Group B1) and 275 patients without FFP transfusion (Group B2)].Additionally,only in limited patients in Group B1 and Group B2 with intraoperative blood loss≥ 2000 mL (Group B1 ≥ 2000 mL and Group B2 ≥ 2000 mL),postoperative complications,liver function tests,and cancer prognosis were compared.RESULTS:No mortality was registered in Group B,compared to 8 patients (3.9%) of Group A.The incidence of morbidity in Group B2 [23.2% (64/275)] was not significantly different from Group B1 [40.9% (9/22)] and Group A [27.0% (55/204)].The incidence of complications and postoperative liver function tests were comparable between Group B1 ≥ 2000 mL vs Group B2 ≥ 2000 mL.Postoperative prognosis did not correlate with administration of FFP,but with tumor-related factors.CONCLUSION:The outcome of hepatectomy for HCC is not influenced by FFP transfusion.We suggest FFP transfusion be abandoned in patients who undergo hepatectomy for HCC.

Plasma-Lyte 148: A clinical review

AIM To outline the physiochemical properties and specific clinical uses of Plasma-Lyte 148 as choice of solution for fluid intervention in critical illness, surgery and perioperative medicine.METHODS We performed an electronic literature search from Medline and Pub Med(via Ovid), anesthesia and pharmacology textbooks, and online sources including studies that compared Plasma-Lyte 148 to other crystalloid solutions. The following keywords were used: "surgery", "anaesthesia", "anesthesia", "anesthesiology", "anaesthesiology", "fluids", "fluid therapy", "crystalloid", "saline", "plasma-Lyte", "plasmalyte", "hartmann's", "ringers" "acetate", "gluconate", "malate", "lactate". All relevant articles were accessed in full. We summarized the data and reported the data in tables and text. RESULTS We retrieved 104 articles relevant to the choice of Plasma-Lyte 148 for fluid intervention in critical illness, surgery and perioperative medicine. We analyzed the data and reported the results in tables and text.CONCLUSION Plasma-Lyte 148 is an isotonic, buffered intravenous crystalloid solution with a physiochemical composition that closely reflects human plasma. Emerging data supports the use of buffered crystalloid solutions in preference to saline in improving physicochemical outcomes. Further large randomized controlled trials assessing the comparative effectiveness of PlasmaLyte 148 and other crystalloid solutions in measuring clinically important outcomes such as morbidity and mortality are needed.

Plasma and wound fluid levels of eight proangiogenic proteins are elevated after colorectal resection

BACKGROUND Colorectal resection is associated with 3-5 wk long elevations in the plasma levels of at least 11 proangiogenic proteins that may stimulate tumor angiogenesis postsurgery.The increases during the first week after surgery may be related to the acute inflammatory response;the cause(s)of the week 2-5 increases is unknown.The wounds are a possible source because of the important role that angiogenesis plays in the healing process.The main hypothesis of the study is that wound fluid levels of the proteins studied will be elevated well beyond plasma levels which,in turn,are elevated from preoperative baseline levels.AIM To determine plasma and wound fluid levels of 8 proangiogenic proteins after colorectal resection for cancer and benign pathology.METHODS Blood and wound fluid samples were taken simultaneously on postoperative(postop)day 1,3,and later time points until wound drain removal in 35 colorectal cancer patients and 31 benign disease patients undergoing colorectal resection in whom closed wound drains had been placed in either the pelvis or the subcutaneous space of the abdominal incision.Postop plasma levels were compared to preop plasma and postop wound fluid levels(separate analyses for cancer and benign groups).RESULTS Sixty-six colorectal disease patients were studied(35 cancer,31 benign pathology).Most patients underwent minimally invasive surgery(open surgery in 11%of cancer and 6%of benign patients).The majority in the cancer group had rectal resections while in the benign group sigmoid or right colectomy predominated.Plasma levels of all 8 proteins were significantly elevated from baseline (P<0.05) at all post-operative time points in the cancer group and at 90% of time points(29/32) in the benign group.Wound levels of all 8 proteins were 3-106 times higher (P<0.05) than plasma levels at 87-90 percent of postop time points;of note,wound levels were more than 10 times higher at 47-50% of time points.CONCLUSION Plasma protein levels were elevated for 3 weeks after surgery;wound fluid levels were much greater than corresponding blood levels.Healing wounds may be the source of the plasma increases.

Extracellular Fluid Accumulation Predicts Fluid Responsiveness after Hydroxyethyl Starch 70/0.5 Bolus Infusion during Major Abdominal Surgery

Objective: The purpose of this study was to test the hypothesis that extracellular fluid accumulation predicts fluid responsiveness after hydroxyethyl starch (HES) solution bolus infusion during major abdominal surgery. Methods: Twenty patients who underwent elective pancreaticoduodenectomy under general anesthesia were studied. Patients received 4 mL/kg boluses of Ringer’s acetate or 6% HES 70/0.5 solution over 15 min in random order when urine output decreased below 1.0 mL/kg/h. Stroke volume variation (SVV) and stroke volume index (SVI) were measured using the FloTracTM/VigileoTM system at pre-bolus, 15, 30, and 60 min after initiating bolus infusion. The percent change in pre-bolus extracellular fluid volume relative to that at the skin incision for arm (ΔVECF) was measured by bioelectrical impedance. Prediction of fluid responsiveness (an increase in SVI of ≥5%) by pre-bolus SVV or pre-bolus ΔVECF was tested by calculating the area under the receiver operating characteristic curve (AUC). Results: Fluid bolus infusions in this study consisted of 61 Ringer’s acetate infusions and 62 HES infusions. The best AUCs for identifying fluid responsiveness were seen with pre-bolus ΔVECF for HES at 30 min and 60 min (AUC = 0.74, P = 0.022;AUC = 0.74, P = 0.0054, respectively). Optimal threshold values of pre-bolus ΔVECF for predicting fluid responsiveness were 6.5% for 30 min (sensitivity: 78%, specificity: 58%) and 7.7% for 60 min (sensitivity: 56%, specificity: 76%). Conclusion: Extracellular fluid volume predicts fluid responsiveness after HES solution bolus infusion during major abdominal surgery. Substantial fluid responsiveness is observed upon increased accumulation of extracellular fluids.

Platelet rich plasma effectiveness in bowel anastomoses:A systematic review

BACKGROUND Anastomotic leak constitutes a major problem in abdominal surgery.Technical insufficiency,topical or systemic factors contribute to disrupted healing of the performed bowel anastomosis and result in anastomosis leakage,with detrimental effects on patient postoperative outcomes.Despite the investigation of several factors and the invention of protective materials,the ideal agent to prevent anastomotic leaks is yet to be determined.AIM To study the effect of platelet rich plasma(PRP)on the healing of bowel anastomoses.METHODS A systematic literature search was performed in PubMed,EMBASE,and Scopus databases to identify studies investigating the effect of PRP application on bowel anastomosis.RESULTS Eighteen studies were eligible with a total population of 712 animals including rats(14 studies),rabbits(2 studies)and pigs(2 studies).No postoperative complications were reported following PRP application.Fourteen out of 18 studies reported a statistically significant higher anastomosis bursting pressure in PRP groups compared to control either in healthy animals or animal models with underlying condition or intervention,such as intraperitoneal chemotherapy or peritonitis.Similar results were reported by ten studies in terms of tissue hydroxyproline levels.One study reported significant increase in collagen deposition in PRP groups.PRP application resulted in significantly decreased inflammatory cell infiltration in the presence of peritonitis or intraperitoneal chemotherapy(6 studies).CONCLUSION The application of PRP is associated with improved bowel anastomosis outcomes,especially in animal models having an underlying condition affecting the normal healing process.PRP application seems to augment the normal healing process under these circumstances.However,further studies are needed to investigate the potential role of PRP on bowel anastomosis healing,especially in clinical settings.

Detecting plasma Epstein-Barr virus DNA to diagnose postradiation nasopharyngeal skull base lesions in nasopharyngeal carcinoma patients:a prospective study

The diagnosis of postradiation nasopharyngeal skull base lesions in petients with nasopharyngeal carcinoma(NPC) is still a tough problem in clinical practice.An early and accurate diagnosis is important for subsequent management.We prospectively evaluated the diagnostic value of plasma Epstein-Barr virus(EBV) DNA in detecting postradiation nasopharyngeal skull base lesions in NPC patients.From July 2006 to September 2010,90 patients with postradiation NPC(34 women and 56 men;median age:42 years) met the selection criteria and were recruited in this study.All postradiation nasopharyngeal skull base lesions were found in the latest magnetic resonance imaging(MRI) examinations before endoscopic surgery,and the nasopharyngeal cavity was normal under flexible nasopharyngoscopy.Plasma EBV DNA detection was performed within 2 weeks before endoscopic surgery.A total of 90 endoscopic operations were successfully performed without any postoperative complications.Recurrences confirmed by postoperative pathology were found in 30 patients.The specificity,positive and negative predictive values of plasma EBV DNA detection were better than those of MRI.In addition,combining plasma EBV DNA detection with MRI improved the specificity and positive predictive values of MRI.Plasma EBV DNA detection followed by MRI would help to diagnose recurrence whereas MRI was unable.These results indicate that plasma EBV DNA is an effective and feasible biomarker for detecting postradiation nasopharyngeal skull base lesions in NPC patients.

3种灭菌方式对磁外科器件磁通量的影响及灭菌成本分析

目的 分析压力蒸汽、低温等离子及环氧乙烷3种灭菌方式对磁外科器件磁通量的影响及其灭菌成本。方法234件不同规格型号磁外科器件-磁环,配对编号标记后随机分为A组、B组和C组,每组78件(39对),其中A组使用压力蒸汽灭菌,B组使用低温等离子灭菌,C组使用环氧乙烷灭菌,每对器件按灭菌规范进行包装;测量3组磁环灭菌前后磁通量,对单包灭菌成本和灭菌时间比较分析。结果 3种灭菌方式对磁外科器件磁通量的影响差异无统计学意义(P>0.05),每种灭菌方式灭菌前后的磁通量有统计学差异(P<0.001);灭菌成本:A组为(1.96±0.16)元,B组(23.17±0.32)元、C组(8.16±0.18)元,差异有统计学意义(P<0.01);灭菌时间:A组为(65.21±3.36)min, B组(45.46±1.39)min, C组(1 020.38±12.21)min,差异具有统计学意义(P<0.01)。结论 3种灭菌方式对磁外科器件的磁通量没有影响。压力蒸汽灭菌法单包成本最低,低温等离子单包灭菌成本最高,环氧乙烷灭菌时间最长。压力蒸汽应为磁外科手术器件的首选灭菌方法。

改良血浆置换装置在血浆置换术中的应用研究

分析改良血浆置换装置在血浆置换术中的应用效果.选取梧州市红十字会医院2021年2月-2023年10月收治的90例行血浆置换术的患者为研究对象,采用随机数字表法将患者分为3组,分别为对照1组、对照2组、研究组.对照1组应用透析机进行血浆置换,对照2组应用连续肾脏替代治疗机进行血浆置换,研究组应用改良血浆置换装置在灌流机上进行血浆置换.对比3组患者相关指标.结果显示,研究组患者的低血压发生率低于对照1组、对照2组,医疗费用少于对照1组和对照2组(P<0.05);研究组患者的焦虑总发生率低于对照1组和对照2组(P<0.05);研究组患者躯体功能评分、社会功能评分、心理功能评分、物质生活状态评分均高于对照1组、对照2组(P<0.05).研究发现,应用改良血浆置换装置在灌流机上进行血浆置换可显著降低患者低血压的发生率,减少治疗费用,可减轻患者焦虑程度,提高患者生活质量,辅助治疗效果显著.

加速康复外科在低温等离子下扁桃体切除患者中的护理效果

目的探究加速康复外科在低温等离子下扁桃体切除患者中的护理效果。方法选取2021年1—12月于丰城市人民医院行低温等离子下扁桃体切除术的40例患者作为研究对象,以入院日期单双号为标准分为对照组与观察组,每组20例。对照组采用常规护理,观察组采用加速康复外科护理,比较两组术期相关指标、疼痛程度、临床症状消失时间、手术相关并发症。结果观察组术后正常进食时间、白膜形成时间、白膜脱落时间、住院时间均短于对照组,差异有统计学意义(P<0.05)。术后1、3、5、7d,观察组视觉模拟评分法(visual analogue scale,VAS)评分均低于对照组,差异有统计学意义(P<0.05)。观察组术后睡眠呼吸粗重、鼻翼煽动、流鼻涕、鼻塞症状消失时间均短于对照组,差异有统计学意义(P<0.05)。观察组手术相关并发症发生率为5.00%,低于对照组的30.00%,差异有统计学意义(P<0.05)。结论加速康复外科理念对低温等离子下扁桃体切除护理效果显著,能减轻患者术后疼痛,提高术后舒适度,缩短住院时间,值得临床推广应用。

血浆基质在牙髓根尖周病治疗中的应用

血浆基质作为一种自体血液离心产物,具有再生修复的功能,已被广泛应用于口腔颌面部软硬组织再生修复、皮肤美容等领域,并取得了较好的效果。目前,牙髓再生治疗和根尖手术已成为保存牙髓以及保存患牙的主要方法,生物活性材料的应用至关重要,血浆基质作为一种自体生物活性材料,较易获取,可塑性强,具有天然优势。血浆基质可应用于以下情况:①无法刺激根尖出血的根尖孔未闭合年轻恒牙的牙髓血运重建术;②存在骨缺损的根尖屏障术及大面积穿孔髓室底或根侧壁修补术;③大面积根尖病变,伴或不伴随牙周疾病患牙的根尖手术。因血浆基质为自身血液来源制品,使用方面无明显禁忌。虽然已有系统综述表明,相比传统血凝块,血浆基质作为天然再生支架,可有效促进牙髓根尖周病的再生性修复。然而,由于血浆基质的特性受不同制备方式的影响,其适用范围有所差异。此外,目前尚缺乏血浆基质长期的临床研究结果,且组织学证据较难获取,仍然需要大量的体内外研究进一步探索。本文将对不同血浆基质在牙髓再生、根尖手术中的骨组织再生等方面的应用进行阐述,以期为临床医生在适应证选择及预后评估时提供参考。

新型等离子针状电极在膀胱癌整块切除手术中的应用效果及安全性分析

目的 观察新型等离子针状电极在膀胱癌整块切除手术中的应用效果及安全性。方法 本研究为前瞻性研究,选择洛阳市东方人民医院2020年5月~2022年6月期间收治的90例膀胱癌患者为研究对象,以计算机随机分组法将其分为常规组和试验组,各45例。常规组实施经尿道膀胱肿瘤切除术(TURBT)治疗,试验组实施新型等离子针状电极精准切除术(ATUNER)治疗,所有患者术后开展为期1年随访,比较两组患者的手术情况、术后并发症发生情况、术后泌尿功能恢复情况及短期生存情况。结果 联合组的CRP、IL-6、IL-8,术后2周、4周的伤椎后凸角、Cobb角、ODI评分均低于手术组,JOA评分均高于手术组;联合组的住院时间、卧床时间、骨折愈合时间,术后并发症发生率均低于手术组(P<0.05)。结论 ATUNER能加快膀胱癌患者的术后康复进程,对降低术后并发症发生风险、促进膀胱功能恢复,并改善术后短期预后均有积极意义。

经皮椎间孔镜椎间盘切除联合富血小板血浆治疗腰椎间盘突出症

背景:富血小板血浆具有促进椎间盘组织修复再生的作用,经皮椎间孔镜椎间盘切除被广泛应用于治疗腰椎间盘突出症,近年来越来越多的学者聚焦于两种技术联合治疗腰椎间盘突出症,以期取得更佳的患者预后。目的:探讨经皮椎间孔镜椎间盘切除联合富血小板血浆治疗腰椎间盘突出症的临床安全性及有效性。方法:回顾性分析2017年6月至2018年5月解放军总医院第六医学中心收治的腰椎间盘突出症患者的临床资料,共纳入58例,其中29例接受经皮椎间孔镜椎间盘切除联合自体富血小板血浆治疗(观察组),另29例接受经皮椎间孔镜椎间盘切除治疗(对照组)。术前及术后3,6,12个月、末次随访时,评估腰腿部目测类比评分、腰椎JOA评分及Oswestry残疾指数;术前及术后6,12个月、末次随访时,通过影像学检查测量两组的椎间隙高度、髓核与脑脊液信号强度比值及椎间盘Pfirrmann分级;末次随访时,采用改良MacNab标准评估疗效优良率。结果与结论:①与术前比较,两组患者术后的腰腿部目测类比评分、腰椎JOA评分及Oswestry残疾指数均明显改善(P<0.05);观察组患者术后3,6个月的目测类比评分与Oswestry残疾指数均低于对照组(P<0.05),术后3,6个月的腰椎JOA评分高于对照组(P<0.05);②观察组患者末次随访的髓核与脑脊液信号强度比值高于对照组(P<0.05),椎间盘Pfirrmann分级情况优于对照组(P<0.05);观察组优良率为93%,对照组优良率为83%,组间比较差异无显著性意义(P>0.05);③结果表明,经皮椎间孔镜椎间盘切除联合富血小板血浆治疗腰椎间盘突出症的临床疗效满意,在一定程度上可延缓椎间盘的退变。

术中高血浆输注剂量对围手术期输血患者预后的影响

目的探讨术中血浆输注剂量、凝血指标的变化与外科手术患者的临床预后之间的关系,为指导术中合理用血提供理论依据。方法收集孙逸仙纪念医院2017年1月—2020年12月术中接受血浆输注的556例外科手术患者的临床资料,并根据术中血浆输注剂量分为低输注剂量(<15 mL/kg)组和高输注剂量(≥15 mL/kg)组,通过单因素、Logistic多因素回归分析以及线性回归分析,探讨血浆输注剂量、凝血指标的变化与术后患者预后之间的关系。结果共有556例外科手术患者纳入研究,所有患者术后血浆输注剂量的中位数(四分位间距)为10.5(8.5~14.0)mL/kg。在多变量回归分析中,术中血浆输注剂量每增加1 mL/kg导致术后24 h内输注红细胞悬液的风险增加[OR(95%CI)1.16(1.01,1.33),P<0.05]、ICU住院天数增加[Mean(95%CI)0.19(0.03,0.35),P<0.05]以及医院住院天数增加[Mean(95%CI)0.55(0.27,0.81),P<0.05];术前INR的异常程度增加术后24 h内输注红细胞悬液的风险[OR(95%CI)1.82(1.33,2.50),P<0.05],增加术后患者的住院死亡率[OR(95%CI)2.15(1.09,4.24),P<0.05];术中血浆输注前后INR的下降幅度降低术后24 h患者输注红细胞的风险[OR(95%CI)0.47(0.27,0.84),P<0.05]以及减少住院死亡率[OR(95%CI)0.23(0.13,0.50),P<0.05]。结论在术中接受血浆输注的外科手术患者中,术前异常的INR值和术中高血浆输注剂量与较差的临床预后有关;而INR(输血前—输血后)较大的变化值与较好的临床结果有关。

术中血浆输注剂量对心脏外科手术患者临床预后的影响

【目的】评估术中血浆输注剂量,凝血实验测试值INR对心脏外科手术患者临床预后的影响,为指导心脏外科手术术中合理用血提供依据。【方法】收集中山大学孙逸仙纪念医院2014年1月至2022年12月期间术中输注新鲜冰冻血浆的305例心脏外科手术患者的临床资料,并根据术中血浆输注剂量分为低剂量组(血浆输注剂量<15 mL/kg,n=214)和高剂量组(血浆输注剂量≥15 mL/kg,n=91),并通过单因素,相关性以及Logistic多因素回归分析,探讨血浆输注量,血浆输注前后INR的变化情况与心脏外科手术患者临床预后之间的关系。【结果】最终共有305例心脏外科手术患者纳入研究分析,所有患者术中血浆输注剂量的中位数(四分位间距)为11.11(8.17~19.05)mL/kg,其中高剂量组与低剂量组患者术中血浆输注剂量的中位数(四分位间距)分别为17.78(15.69~20.91)mL/kg和9.52(7.77~11.43)mL/kg,两者差异具有统计学意义(P<0.001)。高低剂量组血浆输注前后INR变化值中位数(四分位间距)分别为0.98(0.60~1.26)和0.50(0.35~0.76),两者差异具有统计学意义(P<0.001)。Logistic多因素回归分析显示,术前INR值的异常升高导致心脏外科手术患者术后24 h内输注红细胞的风险增加(P<0.001),OR 95%CI为6.757(3.068,14.822),同时也增加手术患者术后住院死亡风险(P<0.001),OR 95%CI为5.441(2.193,13.499);术中血浆输注前后INR的改变值降低了心脏外科手术患者术后24 h内输注红细胞的风险(P=0.001),OR 95%CI为0.244(0.107,0.558)。相关性分析显示,术中血浆剂量与心脏外科手术患者术后ICU时间(rs=0.569,P<0.001)和住院时间(rs=0.302,P<0.001)呈正相关。【结论】在接受术中血浆输注的心脏外科手术患者中,高血浆输注剂量和术前异常高的INR值与较差的临床预后有关,而输注血浆后INR值校正程度更高的手术患者显示出较好的临床结果。

低温等离子手术治疗早期喉鳞状细胞癌整体预后及复发的相关因素研究

目的探讨低温等离子手术治疗早期喉鳞状细胞癌(简称喉癌)的整体预后情况,并评估相关风险因素对患者无病生存期(DFS)的影响,从而分析影响手术疗效的因素,总结临床经验。方法回顾性分析2013年4月—2020年12月接受经口内镜下低温等离子手术治疗、有完整随访资料的患者369例早期喉癌患者的临床资料。随访时间为32~124个月,中位随访时间72个月。并统计分析获得患者各项肿瘤学结果,包括DFS、总生存期(OS)、局部控制率(LC)、保喉率(LP)。结果术后共计70例患者出现复发,40例死亡。所有患者总的1、2、5年DFS分别为89%(95%CI:86%~92%)、85%(95%CI:82%~89%)、80%(95%CI:76%~84%),中位DFS未到达。1、2、5年OS分别为97%(95%CI:96%~99%)、92%(95%CI:89%~95%)、89%(95%CI:85%~92%),中位OS未到达。且累及前连合显著影响患者DFS,但对OS没有影响。而ACI患者1、2、5年DFS分别为87%(95%CI:82%~92%)、82%(95%CI:77%~88%)、76%(95%CI:70%~82%)。而未侵犯患者1、2、5年DFS分别为92%(95%CI:87%~96%),89%(95%CI:84%~93%),85%(95%CI:79%~91%)。结论等离子手术与CO_(2)激光手术或是单纯放疗的疗效较为接近。累及前连合与术后肿瘤切缘也是影响患者术后DFS的重要因素,并且术后复发患者的二次等离子手术并非禁忌。术前做好相应评估,在确认前连合区域外侧甲状软骨没有明显侵犯并且术前判断可以获得阴性切缘的情况下再考虑行等离子手术治疗,才能使患者获得最佳疗效。

凝胶型富血小板血浆联合关节镜下微骨折术对距骨骨软骨损伤的临床疗效

目的探讨凝胶型富血小板血浆(PRP)联合关节镜下微骨折术(AMS)对距骨骨软骨损伤(OLT)的早期疗效。方法前瞻性研究2020年2月—2022年2月无锡市第九人民医院足踝外科收治的踝关节创伤后OLT患者45例,男性28例,女性17例;年龄18~43岁,平均28.0岁;病程17~32个月,平均23.0个月。按随机数字表法分为玻璃酸钠联合组(22例)、PRP联合组(23例)。玻璃酸钠联合组行玻璃酸钠(2 mL,注射,术后1次/周,共治疗6周)联合AMS治疗,PRP联合组行凝胶型PRP(3 mL,注射,术后1次/周,共治疗6周)联合AMS治疗。比较治疗前及治疗后6个月两组患者骨髓水肿(BME)程度、VAS、踝关节活动度(ROM)、美国足踝关节外科协会(AOFAS)评分,并统计并发症发生情况。结果治疗后6个月PRP联合组软骨下骨BME体积(0.37±0.11)cm 3、VAS(2.0±0.6)分低于玻璃酸钠联合组(0.46±0.15)cm 3、(3.1±1.0)分(P<0.05);PRP联合组跖屈ROM、背伸ROM(25.49±3.72)°、(15.43±2.54)°大于玻璃酸钠联合组(22.88±2.83)°、(13.57±2.03)°(P<0.05);PRP联合组疼痛、功能、对线及AOFAS总分(34.7±5.6)分、(39.8±7.4)分、(7.7±1.6)分、(87.2±4.8)分高于玻璃酸钠联合组(29.7±5.9)分、(32.1±4.4)分、(6.0±1.5)分、(80.6±5.1)分(P<0.05);PRP联合组跖屈软骨修复组织观察评分(35.4±8.2)分低于玻璃酸钠联合组(42.3±9.5)分(P<0.05)。PRP联合组踝关节功能优良率87.0%(20/23)高于玻璃酸钠联合组54.5%(12/22)(P<0.05)。PRP联合组并发症发生率(8.7%,2/23)低于玻璃酸钠联合组(36.4%,8/22),差异有统计学意义(P<0.05)。结论凝胶型PRP联合AMS治疗距骨骨软骨损伤,可改善患者的足、踝关节功能,缓解BME及疼痛,增加踝关节ROM,减少并发症。

鼻内镜手术联合低温等离子鼻甲射频消融术治疗慢性鼻窦炎患者的效果及对术后鼻通气功能及变态反应的影响

目的探讨鼻内镜手术联合低温等离子鼻甲射频消融术治疗慢性鼻窦炎患者的效果。方法选取2020年1月至2022年1月我院收治的80例慢性鼻窦炎患者为研究对象,按手术方式的差异将其分为对照组和观察组,各40例。对照组采用鼻内镜手术,观察组采用鼻内镜手术联合低温等离子鼻甲射频消融术。比较两组的治疗效果。结果观察组的治疗总有效率高于对照组(P<0.05)。术后1 d,观察组的鼻腔容积大于对照组,鼻阻力小于对照组(P<0.05)。术后1 d,观察组的总免疫球蛋白E(TIgE)、嗜酸性粒细胞阳离子蛋白(ECP)水平均低于对照组(P<0.05)。术后3个月,观察组的糖精清除时间短于对照组,黏液纤毛清除率高于对照组,黏液纤毛清除速度大于对照组(P<0.05)。两组的并发症总发生率无显著差异(P>0.05)。结论鼻内镜手术联合低温等离子鼻甲射频消融术治疗慢性鼻窦炎的效果显著,可促进术后鼻通气功能及鼻腔黏液纤毛清除功能改善,减轻变态反应,且安全性高,值得推广。