【罂粟摘要】应用彩色多普勒超声评价桡动脉穿刺置管拔管后桡、尺动脉血流的变化

应用彩色多普勒超声评价桡动脉穿刺置管拔管后桡、尺动脉血流的变化

贵州医科大学     麻醉与心脏电生理课题组

翻译：吴学艳  编辑：陈锐 审校：曹莹

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摘要

背景：关于桡动脉拔管后血流变化的文献报道较少；本研究目的是通过彩色多普勒超声观察桡动脉拔管后桡动脉和尺动脉血流变化，探讨影响桡动脉血流恢复的因素。

方法：采用彩色多普勒超声测量桡动脉置管患者在置管前(T0)、拔管后30min(T1)、拔管后24h(T2)、拔管后7d(T3)4个时间点的桡动脉横截面积(S_R)、尺动脉横截面积(S_U)、桡动脉收缩峰值流速((PSV_R)和尺动脉收缩峰值流速(PSV_U)。采用重复测量方差分析和Logistic回归分析进行数据分析。

结果：本研究共纳入120例患者；与T0组相比，T1组和T2组PSV_U/PSV_R比值显著升高(p<0.01)；与T1组相比，T2组和T3组PSV_U/PSV_R比值显著降低(p<0.01)；与T2组相比，T3组PSV_U/PSV_R比值显著降低(p<0.01)。女性患者(OR 2.76 ；95%CI（1.01-7.57；p=0.048)和局部血肿(OR 3.04；95%CI（1.12-8.25）；p=0.029)为拔管后7天影响桡动脉血流恢复的相关显著因素。

结论：桡动脉拔管后，同侧尺动脉血流代偿性增加；女性患者和局部血肿形成是影响导管拔出后7天桡动脉血流恢复的因素。

原始文献来源：Liu LJ, Zhou HM, Tang HL,et al. Evaluation of radial and ulnar artery blood flow after radial artery decannulation using colour Doppler ultrasound [J].BMC Anesthesiol. 2021 Dec 10;21(1):312. DOI: 10.1186/s12871-021-01538-9. 

英文原文

Dexmedetomidine for prevention of postoperative

delirium in older adults undergoing oesophagectomy

with total intravenous anaesthesia A double-blind, randomised clinical trial

Abstract

BACKGROUND：Dexmedetomidine is known to be a sedative. Recent studies suggest that administration of dexmedetomidine can prevent postoperative delirium (POD) which has been confirmed as a common complication after major surgery. However, its effects in patients undergoing oesophagectomy are scarce.

OBJECTIVE：To investigate the efficacy and safety of dexmedetomidine in reducing POD in elderly patients after transthoracic oesophagectomy with total intravenous anaesthesia (TIVA).

DESIGN A：randomised, double-blind, placebo-controlledtrial.

SETTING：Single-centre, tertiary care hospital, November 2016 to September 2018.

PATIENTS：Eligible patients (n=177) undergoing transthoracic oesophagectomy were randomly assigned to receive total intravenous anaesthesia (TIVA, n=87) or dexmedetomidine with TIVA (DEX-TIVA, n=90).

INTERVENTIONS：Patients receiving DEX-TIVA received a loading dose of dexmedetomidine (0.4ug/kg), over 15 min,followed by a continuous infusion at a rate of 0.1ug/kg/h until 1 h before the end of surgery. Patients receiving TIVA received physiological saline with a similar infusion rate protocol.

OUTCOME MEASURES：The primary outcome was the incidence of POD. The secondary endpoints were the incidence of emergence agitation, serum interleukin-6 (IL-6) levels and haemodynamic profile.

RESULTS：All randomised patients were included with planned intention-to-treat analyses for POD. Delirium occurred in 15 (16.7%) of 90 cases given dexmedetomidine,and in 32 (36.8%) of 87 cases given saline (P =0.0036).The DEX-TIVA group showed less frequent emergence agitation than the TIVA group (22.1 vs. 48.0%,P=0.0058). The incremental change in surgery-induced IL-6 levels was greater in the TIVA group than DEX-TIVA

group (P < 0.0001).

CONCLUSION：Adding peri-operative dexmedetomidine to a total intravenous anaesthetic safely reduces POD and emergence agitation in elderly patients undergoing open transthoracic oesophagectomy. These benefits were associated with a postoperative reduction in circulating levels of the proinflammatory cytokine IL-6 and stabilisation of the haemodynamic profile.

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