《麻醉、重症监护与疼痛医学》2023年2月刊，第42卷第1期

本文由“麻醉新超人”授权转载

翻译：刘郁鋆 徐医2022级麻醉学研究生

审校：赵林林 徐医附院麻醉科

Anaesthesia Critical Care & Pain Medicine February 2023 Volume 42, Issue 1

Table of Contents

目录

Covid Corner

新冠资讯角

1.Protecting science in times of crises

在危机时刻保护科学

2.COVID-19 pneumonia: Therapeutic implications of its atypical features

COVID-19肺炎:其非典型特征的治疗意义

3.COVID-19: Brief overview of therapeutic strategies

COVID-19:治疗策略概述

Editorials

社论

1.Validation of mechanical thrombectomy for patients with Basilar-Artery occlusion

基底动脉闭塞患者机械取栓术疗效的验证

2.Periprocedural management of patients with acute ischemic stroke caused by large vessel occlusion

大血管闭塞致急性缺血性脑卒中患者的围手术期管理

Original Articles

原创文章

1.Median effective dose of 0.2% ropivacaine for ultrasound-guided median nerve block in young children

0.2%罗哌卡因用于小儿超声引导下正中神经阻滞的半数有效剂量研究

2.Erector spinae plane block versus subcostal transversus abdominis plane block in patients undergoing open liver resection surgery: A randomized controlled trial

竖脊平面阻滞与肋缘下腹横肌平面阻滞对开腹肝切除术患者的镇痛疗效:一项随机对照试验

ABSTRACT

Background：The aim of this study was to compare the analgesic efficacy of erector spinae plane block (ESPB) in relation to subcostal transversus abdominis plane block (TAPB) in patients undergoing open liver resection surgery.

Methods：In this randomized controlled trial, we included adult patients undergoing open liver resection surgery. After induction of general anaesthesia, the included patients were randomized to receive either ESPB (n = 30) or subcostal TAPB (n = 30). Postoperative pain was assessed using the numeric rating scale (NRS) at rest and during cough. Intravenous morphine boluses were used for management of breakthrough pain intra- and postoperatively. The study’s primary outcome was morphine consumption during the first 24 h postoperatively. Secondary outcomes included intraoperative morphine consumption, time to first postoperative morphine requirement, incidence of complications, and patient satisfaction.

Results：Sixty patients were included and were available for the final analysis in this study. The intra-and postoperative morphine consumption were less in the ESPB group than the subcostal TAPB group (median [quartiles] morphine dose: 0 [0−0] vs 2 [0−5] mg, p = 0.007 and 20 [15–20] vs 25 [20−30] mg, p = 0.006, respectively). The time to first morphine requirement was longer in the ESPB group (median [quartiles]: 6.5 [5.5−6.5] h) than the subcostal TAPB group (median [quartiles]: 4.3 [1.0−6.5] h), P = 0.013. Patients in the ESPB group had lower incidence of sedation and higher level of satisfaction than the subcostal TAPB group.

Conclusion：In patients undergoing open liver resection surgery, ESPB provided superior analgesic properties than subcostal TAPB.

本文摘要：

背景：本研究的目的是比较竖脊肌平面阻滞(ESPB)与肋缘下腹横肌平面阻滞(TAPB)在开腹肝切除术患者中的镇痛效果。

方法：在这项随机对照试验中，我们纳入了接受开放式肝脏切除手术的成年患者。全麻诱导后，纳入的患者随机接受ESPB (n = 30)或肋下TAPB (n = 30)。术后休息时和咳嗽时使用数字疼痛评分量表((NRS)评估疼痛。静脉注射吗啡用于治疗术中和术后的爆发性疼痛。该研究的主要结果是术后24小时内吗啡的使用情况。次要结局包括术中吗啡用量、术后第一次需要使用吗啡的时间、并发症发生率和患者满意度。

结果：本研究共纳入60例患者，可供最终分析。与肋下TAPB组相比，ESPB组术中及术后吗啡消耗量更低(吗啡剂量中位数:0[0−0]vs 2[0−5]mg, p = 0.007; 20 [15 - 20] vs 25[20−30]mg, p = 0.006)。ESPB组首次需要使用吗啡的时间(中位数[四分位数]:6.5[5.5−6.5]h)比肋下TAPB组(中位数[四分位数]:4.3[1.0−6.5]h)长，P = 0.013。与肋下TAPB组相比，ESPB组患者镇静发生率较低，满意度较高。

结论：在接受开腹肝切除术的患者中，ESPB比肋下TAPB具有更好的镇痛效果。

3.Association between driving pressure and postoperative pulmonary complications in patients undergoing lung resection surgery: A randomised clinical trial

肺切除术患者驱动压与术后肺部并发症的相关性:一项随机临床试验

ABSTRACT

Background：It is uncertain whether an association exists for decreases in driving pressure and the occurrence of postoperative pulmonary complications (PPCs) in patients undergoing selective lung resection surgery. Thus, we designed this study to determine whether the positive end-expiratory pressure (PEEP) titration to the lowest driving pressure compared with conventional low PEEP level during one-lung ventilation (OLV) in patients undergoing selective lung resection surgery decreases PPCs.

Methods：This single-centre, randomised trial approved by the Ethical Committee of the Sun Yat-Sen University Cancer Center involved patients who signed written consent. Patients were randomised to the PEEP titration to the lowest driving pressure group (n = 104), or to the conventional low level of PEEP group (n = 103), consisting a PEEP level of 4 cm H2O during OLV. All patients received volume-controlled ventilation with a tidal volume of 6 mL/kg of predicted body weight. The primary outcome was defined as positive if 4 or more of eight Melbourne Group Scale (MGS) variables developed within the first 3 days after surgery. The incidence of major PPCs occurring during postoperative 7 days was also recorded.

Results：Among 222 patients who were randomised, 207 (93%) completed the trial (109 men [53%]; mean age, 56.9 years). The primary outcome occurred in 4 of 104 patients (4%) in the PEEP titration to the lowest driving pressure group compared with 13 of 103 patients (13%) in the conventional low level of PEEP group (risk ratio, 0.32 [95% CI, 0.10−0.90]; P = 0.021).

Conclusion：Among patients undergoing selective lung surgery, intraoperative OLV with PEEP titration to the lowest driving pressure compared with conventional low PEEP level (4 cm H2O) significantly reduced PPCs within the first 3 postoperative days, however, did not significantly reduce PPCs within the first 7 postoperative days.

本文摘要：

背景：在接受择期肺切除术的患者中，驱动压的降低与术后肺并发症(PPCs)的发生是否存在相关性尚不确定。因此，我们设计了这项研究，以确定择期肺切除术患者在单肺通气(OLV)期间，呼气末正压(PEEP)滴定至最低驱动压(与传统的低PEEP水平相比)是否能降低术后肺部并发症的发生率。

方法：这项由中山大学癌症中心伦理委员会批准的单中心随机试验涉及签署书面同意书的患者。患者被随机分为最低驱动压组(n = 104)和常规低水平PEEP组(n = 103)，包括单肺通气期间的PEEP水平为4cm H2O 。所有患者均接受容量控制通气模式，潮气量以预测体重计算，为6 mL/kg。如果术后3天内出现8个MGS评分量表变量中的4个或更多，则主要结局被定义为阳性。同时记录术后7天内主要术后肺部并发症的发生率。

结果：在随机分组的222例患者中，207例(93%)完成了试验(109例男性[53%];平均年龄56.9岁)。最低驱动压组104例患者中有4例(4%)发生主要结局，而常规低驱动压组103例患者中有13例(13%)发生主要结局(风险比，0.32 [95% 可信区间, 0.10−0.90];P = 0.021)。

结论：在择期肺切除术患者中，与常规低PEEP水平(4 cm H2O)相比，术中单肺通气与PEEP滴定至最低驱动压可显著降低术后前3天的肺部并发症发生率，但术后前7天的肺部并发症发生率无明显降低。

4.Intraoperative Optic Nerve Sheath Diameter as a Predictor of Early Tacrolimus Neurotoxicity after Living Donor Liver Transplantation

术中视神经鞘直径是活体肝移植术后早期他克莫司神经毒性的预测因素

5.Transient ischemic attack after indirect revascularization surgery for pediatric patients with moyamoya disease: A retrospective study of intraoperative blood pressure

烟雾病儿童患者间接脑血运重建手术后的短暂性脑缺血发作:一项对术中血压的回顾性研究

6.Effects of ferric carboxymaltose on hemoglobin level after cardiac surgery: A randomized controlled trial

羧基麦芽糖铁对心脏手术后血红蛋白水平的影响:一项随机对照试验

7.A new machine learning algorithm to predict veno-arterial ECMO implantation after post-cardiotomy low cardiac output syndrome

一种新的机器学习算法：用于预测心脏手术后发生低心排血量综合征的患者对静脉-动脉体外膜肺氧合植入的需求

8.Epidemiology, risk factors and prognosis of ventilator-associated pneumonia during severe COVID-19: Multicenter observational study across 149 European Intensive Care Units

重症COVID-19期间呼吸机相关肺炎的流行病学、危险因素和预后:横跨149个欧洲重症监护病房的多中心观察性研究

Review

综述

1.Mesenteric traction syndrome — Incidence, impact, and treatment: A systematic scoping review of the literature

肠系膜牵拉综合征的发生率，影响和治疗:相关文献的系统性综述

Letters to the editor

编辑推荐

1.Mini-invasive anaesthetic approach for laparoscopic kidney and upper urinary tract surgery: A new strategy — A retrospective analysis of 5 cases

腹腔镜肾、上尿路手术的微创麻醉入路:一种新策略——5例回顾性分析

2.Pain research: beyond the planes

疼痛研究:超越平面

3.Analgesia for open liver resection surgery

开腹肝切除术的镇痛

Guidelines

指南

1.Anaesthetic and peri-operative management for thrombectomy procedures in stroke patients

脑卒中患者取栓手术的麻醉和围手术期管理

免责声明：

文中所涉及药物使用、疾病诊疗等内容仅供医学专业人士参考。

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编辑：MiLu.米鹭

校对：Michel.米萱  

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