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Anesthesiology：麻醉学相关研究进展一瞥

2014-04-24 南粤麻医 新青年麻醉论坛

麻醉学进展
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2014年2月出版的Anesthesiology杂志上刊登主编精选的与麻醉学科相关的8篇科学、医学最新进展，值得推荐学习：一、JAMA：冠脉支架患者接受非心脏手术的主要心脏不良事件的风险JAMA. 2013 Oct 9;310(14):1462-72. doi: 10.1001/jama.2013.278787该研究发现，近期有冠脉支架置入手术的患者在非心脏手术后发生重大心脏不良事件（MACE）的

2014年2月出版的Anesthesiology杂志上刊登主编精选的与麻醉学科相关的8篇科学、医学最新进展，值得推荐学习：

一、JAMA：冠脉支架患者接受非心脏手术的主要心脏不良事件的风险

JAMA. 2013 Oct 9;310(14):1462-72. doi: 10.1001/jama.2013.278787

该研究发现，近期有冠脉支架置入手术的患者在非心脏手术后发生重大心脏不良事件（MACE）的风险主要有：与缺血性心脏疾患相关的非特异性外科症状与体征。

冠脉支架植入与非心脏手术的时间间隔并无多大意义。支架植入6月以上，支架类型与实施非心脏手术MACE并无显著相关。

围术期完全停用抗血小板药物也与MACE并不相关。

关于药物洗脱支架患者抗血小板治疗药物的使用指南应重新评估。


二、JAMA：外科手术医生疲劳对日间择期腔镜胆囊切除术患者并发症的影响

JAMA. 2013 Nov 6;310(17):1837-41. doi: 10.1001/jama.2013.280372

该研究观察外科手术医生疲劳对日间择期腔镜胆囊切除术患者并发症的影响。结果发现：外科医生术前日夜间是否手术与LC转开腹比例、医源性并发症发生率及死亡率之间并无统计学意义。

虽然该研究并未有证据发现外科医生术前疲劳对手术安全的影响，但是也可从一个侧面表明麻醉医生在手术患者术中安全保护的重要作用。

三、JAMA：艾司洛尔用于脓毒症休克患者中控制心率对血流动力学及临床预后的影响

JAMA. 2013 Oct 23;310(16):1683-91. doi: 10.1001/jama.2013.278477

仍然是来自JAMA 2013年10月期刊的一篇研究，该随机临床试验观察了艾司洛尔用于脓毒症休克患者中控制心率对血流动力学及临床预后的影响。【原文下载】



该研究观察使用去甲肾上腺素维持MAP于65mmHg的患者使用艾司洛尔将HR控制在95Bpm以下。

结果发现：脓毒症休克患者使用艾司洛尔可降低HR至目标水平，与标准治疗相比并不增加不良事件的发生，然而死亡率及ICU住院时间明显降低。

四、JAMA：晶体液与胶体液用于ICU容量治疗的不同效果




同样是来自JAMA 2013年11月期刊的文章，这篇可是一石再次激起千层浪。

该国际多中心、前瞻性、随机、临床试验通过多种病例（脓毒症、创伤或低血容量休克）比较晶体液与胶体液用于ICU容量治疗的不同效果，研究选取了近10年的2857例患者。主要结果为28天死亡率，组间无明显差异；90d死亡率胶体组低于晶体组，需要进一步研究。

胶体组：1414例，使用明胶、右旋糖酐、羟乙基淀粉、4%或20%白蛋白。晶体组：1443例，使用等张或高张盐水、乳酸林格液。

液体干预，而非容量维持。

主要结果：28d死亡率；次要结果：90d死亡率、存活天数、未接受肾脏替代治疗的时间、机械通气或升压药物治疗情况。


五、JAMA：辛伐他汀不能改善呼吸机相关性肺炎患者第28天时的生存率


为了探讨他汀类药物治疗是否可以降低呼吸机相关性肺炎（VAP）患者的死亡率，来自法国马赛市艾克斯-马赛大学附属医院北院的Laurent Papazian及其同事进行了一项研究，研究结果在线发表于2013年10月9日的《美国医学会杂志》（JAMA）上。研究结果显示：对于怀疑有VAP的成年患者而言，添加辛伐他汀治疗与安慰剂相比不能改善其第28天时的生存率。

该研究是一项多中心、随机、双盲、安慰剂对照、平行组别的临床试验。共有来自法国的26个重症监护病房参与了该研究，研究的起止时间为2010年1月至2013年3月。

该研究发现，抑制素（辛伐他汀）与安慰剂相比用于治疗呼吸机相关性肺炎，并不改善ICU患者存活率。


六、JGME：以患者为中心的沟通能改善预后

来自2013年9月JGME的一篇综述，强调注重与患者沟通的重要性，提示以患者为中心的沟通交流可以很好的改善预后

J Grad Med Educ. 2013 Sep;5(3):385-393.



There is a consensus about what constitutes “best practice” for physician communication in medical encounters:

(1) fostering the relationship,  

(2) gathering information, 

(3) providing information, 

(4) making decisions, 

(5) responding to emotions, and 

(6) enabling disease- and treatment-related behavior.


七、PLoS Biol：HIF1A具有肺保护作用

来自2013年9月PLoS Biol杂志的研究发现，HIF1A具有肺保护作用。






树皮蝎已知会造成动物界最疼痛的蜇伤，而沙居食蝗小鼠对此却丝毫不知。现在，来自德克萨斯州大学奥斯汀分校等机构的科学家们揭开了其中奥妙，他们对树皮蝎毒液对食蝗小鼠及普通的家鼠的作用进行了研究。

研究发现，这些食蝗小鼠已经演化出了一种针对该蝎子毒液的独特抵抗力，使得它们能够大啖该蛛形纲动物而不会感觉到被蜇痛。这种类型的演化是罕见的，因为疼痛信号一般来说在警示动物组织损伤或其它健康问题中扮演着如此重要的角色。这就是为什么如此少的捕食动物会费力演化出针对它们的猎物所用的致痛性防御毒液的抵抗力。

研究人员表示，这些特别的毒素会抑制食蝗小鼠的感觉神经元进行放电，而其在家鼠中则会强烈地激活其感觉神经元的放电。




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    2015-12-26 hixiaoluo

    值得收藏，学习，谢谢分享

    0

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    2015-12-26 hixiaoluo

    值得收藏，学习，谢谢分享

    0

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    2015-06-18 xiaozhu1126

    都是出自麻醉学吗？

    0

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    2014-11-14 shenxlcyp

    #相关研究#

    0

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    2014-07-17 xiangyuzhou971

    #EST#

    0

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    2014-07-26 kuangxin

    能下载原文就好！

    0

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    2015-03-06 ms3875500703114551

    #麻醉学#

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=48098, encodeId=67d148098f7, content=值得收藏，学习，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bc301610909, createdName=hixiaoluo, createdTime=Sat Dec 26 15:13:00 CST 2015, time=2015-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=48099, encodeId=398c48099ea, content=值得收藏，学习，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bc301610909, createdName=hixiaoluo, createdTime=Sat Dec 26 15:13:00 CST 2015, time=2015-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=28124, encodeId=05932812485, content=都是出自麻醉学吗？, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5ff132690, createdName=xiaozhu1126, createdTime=Thu Jun 18 15:01:00 CST 2015, time=2015-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1800371, encodeId=fa3f18003e197, content=<a href='/topic/show?id=cbf9e254051' target=_blank style='color:#2F92EE;'>#相关研究#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72540, encryptionId=cbf9e254051, topicName=相关研究)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a9de34, createdName=shenxlcyp, createdTime=Fri Nov 14 18:15:00 CST 2014, time=2014-11-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2050400, encodeId=aaad205040081, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Thu Jul 17 16:15:00 CST 2014, time=2014-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=10634, encodeId=a54f106340d, content=能下载原文就好！, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bfc575775, createdName=kuangxin, createdTime=Sat Jul 26 09:42:00 CST 2014, time=2014-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1635075, encodeId=fcd416350e5a6, content=<a href='/topic/show?id=e4b210305576' target=_blank style='color:#2F92EE;'>#麻醉学#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103055, encryptionId=e4b210305576, topicName=麻醉学)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=612f22405513, createdName=ms3875500703114551, createdTime=Fri Mar 06 22:15:00 CST 2015, time=2015-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1380419, encodeId=91d313804196a, content=<a href='/topic/show?id=9281e34519b' target=_blank style='color:#2F92EE;'>#研究进展#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73451, encryptionId=9281e34519b, topicName=研究进展)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=21015, createdName=heli0118, createdTime=Sat Apr 26 07:15:00 CST 2014, time=2014-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1588157, encodeId=146f158815ee2, content=<a href='/topic/show?id=1cb8e014e0' target=_blank style='color:#2F92EE;'>#ESI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7014, encryptionId=1cb8e014e0, topicName=ESI)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f4f817593223, createdName=skhzy, createdTime=Sat Apr 26 07:15:00 CST 2014, time=2014-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=9127, encodeId=669f912e95, content=内容再具体点更好。, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=222.129.192.111, createdTime=Fri Apr 25 07:18:00 CST 2014, time=2014-04-25, status=1, ipAttribution=)]
    2014-04-26 heli0118

    #研究进展#

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=48098, encodeId=67d148098f7, content=值得收藏，学习，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bc301610909, createdName=hixiaoluo, createdTime=Sat Dec 26 15:13:00 CST 2015, time=2015-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=48099, encodeId=398c48099ea, content=值得收藏，学习，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bc301610909, createdName=hixiaoluo, createdTime=Sat Dec 26 15:13:00 CST 2015, time=2015-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=28124, encodeId=05932812485, content=都是出自麻醉学吗？, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5ff132690, createdName=xiaozhu1126, createdTime=Thu Jun 18 15:01:00 CST 2015, time=2015-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1800371, encodeId=fa3f18003e197, content=<a href='/topic/show?id=cbf9e254051' target=_blank style='color:#2F92EE;'>#相关研究#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72540, encryptionId=cbf9e254051, topicName=相关研究)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a9de34, createdName=shenxlcyp, createdTime=Fri Nov 14 18:15:00 CST 2014, time=2014-11-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2050400, encodeId=aaad205040081, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Thu Jul 17 16:15:00 CST 2014, time=2014-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=10634, encodeId=a54f106340d, content=能下载原文就好！, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bfc575775, createdName=kuangxin, createdTime=Sat Jul 26 09:42:00 CST 2014, time=2014-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1635075, encodeId=fcd416350e5a6, content=<a href='/topic/show?id=e4b210305576' target=_blank style='color:#2F92EE;'>#麻醉学#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103055, encryptionId=e4b210305576, topicName=麻醉学)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=612f22405513, createdName=ms3875500703114551, createdTime=Fri Mar 06 22:15:00 CST 2015, time=2015-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1380419, encodeId=91d313804196a, content=<a href='/topic/show?id=9281e34519b' target=_blank style='color:#2F92EE;'>#研究进展#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73451, encryptionId=9281e34519b, topicName=研究进展)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=21015, createdName=heli0118, createdTime=Sat Apr 26 07:15:00 CST 2014, time=2014-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1588157, encodeId=146f158815ee2, content=<a href='/topic/show?id=1cb8e014e0' target=_blank style='color:#2F92EE;'>#ESI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7014, encryptionId=1cb8e014e0, topicName=ESI)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f4f817593223, createdName=skhzy, createdTime=Sat Apr 26 07:15:00 CST 2014, time=2014-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=9127, encodeId=669f912e95, content=内容再具体点更好。, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=222.129.192.111, createdTime=Fri Apr 25 07:18:00 CST 2014, time=2014-04-25, status=1, ipAttribution=)]
    2014-04-26 skhzy

    #ESI#

    0

  10. [GetPortalCommentsPageByObjectIdResponse(id=48098, encodeId=67d148098f7, content=值得收藏，学习，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bc301610909, createdName=hixiaoluo, createdTime=Sat Dec 26 15:13:00 CST 2015, time=2015-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=48099, encodeId=398c48099ea, content=值得收藏，学习，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bc301610909, createdName=hixiaoluo, createdTime=Sat Dec 26 15:13:00 CST 2015, time=2015-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=28124, encodeId=05932812485, content=都是出自麻醉学吗？, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5ff132690, createdName=xiaozhu1126, createdTime=Thu Jun 18 15:01:00 CST 2015, time=2015-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1800371, encodeId=fa3f18003e197, content=<a href='/topic/show?id=cbf9e254051' target=_blank style='color:#2F92EE;'>#相关研究#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72540, encryptionId=cbf9e254051, topicName=相关研究)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a9de34, createdName=shenxlcyp, createdTime=Fri Nov 14 18:15:00 CST 2014, time=2014-11-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2050400, encodeId=aaad205040081, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Thu Jul 17 16:15:00 CST 2014, time=2014-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=10634, encodeId=a54f106340d, content=能下载原文就好！, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bfc575775, createdName=kuangxin, createdTime=Sat Jul 26 09:42:00 CST 2014, time=2014-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1635075, encodeId=fcd416350e5a6, content=<a href='/topic/show?id=e4b210305576' target=_blank style='color:#2F92EE;'>#麻醉学#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103055, encryptionId=e4b210305576, topicName=麻醉学)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=612f22405513, createdName=ms3875500703114551, createdTime=Fri Mar 06 22:15:00 CST 2015, time=2015-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1380419, encodeId=91d313804196a, content=<a href='/topic/show?id=9281e34519b' target=_blank style='color:#2F92EE;'>#研究进展#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73451, encryptionId=9281e34519b, topicName=研究进展)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=21015, createdName=heli0118, createdTime=Sat Apr 26 07:15:00 CST 2014, time=2014-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1588157, encodeId=146f158815ee2, content=<a href='/topic/show?id=1cb8e014e0' target=_blank style='color:#2F92EE;'>#ESI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7014, encryptionId=1cb8e014e0, topicName=ESI)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f4f817593223, createdName=skhzy, createdTime=Sat Apr 26 07:15:00 CST 2014, time=2014-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=9127, encodeId=669f912e95, content=内容再具体点更好。, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=222.129.192.111, createdTime=Fri Apr 25 07:18:00 CST 2014, time=2014-04-25, status=1, ipAttribution=)]
    2014-04-25 222.129.192.111

    内容再具体点更好。

    0

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