摘要信息：【摘 要】 目的 观察西维来司他钠联合气道压力释放通气(APRV)治疗创伤所致重度急性呼吸窘迫综合征(ARDS)的疗效及对血气指标、炎性因子和预后的影响。方法选取2020年4月一2021年4月徐州仁慈医院重症医学科收治创伤所致重度 ARDS 患者 80 例,随机数字表法分为观察组(40 例)和对照组(40 例)。2 组均予基础治疗,对照组加用 APRV 治疗,观察组加用 APRV 治疗和西维来司他钠治疗。比较2组治疗期间血清炎性因子、血气和血流动力学指标、急性生理和慢性健康状况(APACHEⅡ)评分、序贯器官衰竭评估(SOFA)评分变化,以及机械通气时间.ICU 住院时间、病死率差异。结果 2组治疗7d后血清 PCT、IL6、CRP水平、APACHEⅡ评分、SOFA 评分较治疗前降低(P<0.05),且观察组血清 PCT、IL6、CRP水平低于对照组(t/P =9.309/0.000、12.221/0.000、5.471/0.000)。2 组患者治疗期间 Pa0,、Pa0,/ Fi0,增高,PaC0,降低(P<0.05),HR、CVP、MAP 下降后又回升(P<0.05),观察组患者治疗24 h、72h时 PaO,、PaO, /FO,、HR、CVP、MAP 高于对照组,PaC0,低于对照组(治疗24 h:t/P=2.092/0.0405.931/0.000、2.854/0.006、3.683/0.002、3.978/0.000、2.063/0.042;治疗72 h: t/P = 2.202/0.031、3. 177/0.0025.380/0.000、10.125/0.000、5.993/0.000、4.314/0.000)。2 组患者机械通气时间、ICU 住院时间、病死率比较差异均无统计学意义(P均>0.05)。结论 西维来司他钠联合 APRV 可降低血清炎性因子水平,提高氧合指数,但不能缩短机械通气时间和住院时间、降低病死率。

摘要信息：Thoracic trauma in China was scarcely reported. This study aimed to summarize the clinical profiles and to analyze the management approaches of patients with traumatic thoracic injury.Data for consecutive patients with thoracic trauma from January 2003 to January 2018 were retrospectively collected and analyzed. Patients' profiles and clinical outcomes were compared between those patients treated with a dedicated thoracic trauma team and those without.The study included 4168 patients with mean age of 49.0 years, of whom 82.1% were male. Traffic accident accounted for 42.7% of the injuries. Most of the patients (66.8%) had rib fractures. Associated injuries were present in 48.3% of the patients; of them 86.0% were extremity fractures. Majority of the patients were managed without surgical procedures other than tube thoracostomy (33.2%). ICU service was needed in 12.0% of the patients. Patients treated with thoracic trauma team were older (53.59 ± 16.8 year vs 45.1 ± 18.0 year, P < .001), less male (78.3% vs 85.2%, P < .001), with higher injury severity scores (17.5 ± 10.1 vs 13.7 ± 8.2, P < .001), required more ventilator support (48.3% vs 25.3%, P < .001) and underwent more tube thoracostomy and other surgeries (43.8% vs 24.2%, and 34.4% vs 14.1%, respectively, all P < .001), yet with a shorter hospital stay (11.7 ± 9.0 days vs 12.7 ± 8.8 days, P < .001), and numerically lower ICU usage and mortality when compared to those without.Thoracic trauma in China usually affects mid-age males. Traffic accident is the top one etiology. The most common type of thoracic injuries is rib fracture. Associated injuries occur frequently. Nonoperative treatment and tube thoracostomy are effective for majority of the patients. A multidisciplinary approach with a dedicated thoracic trauma team could improve the treatment for these patients.

摘要信息：【摘要】 目的 系统评价创伤性脊髓损伤(spinal cord injury,SCI)在中国的流行病学特征和疾病经济负担。方法 计算机检索 PubMed、EMbase、WanFang Data、VIP 和 CNKI数据库,搜集有关中国 SCI流行病学和疾病经济负担的研究,检索时限均从1978年1月1日至2017年8月30日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后，采用 Stata12.0软件进行合并分析。结果 共纳人 32篇文献。Meta 分析结果显示:我国 SCI年患病率为 37人次/100万[95%CI(21,53)],平均年龄范围 34.7~54.4岁,男性高于女性。汽车碰撞和高空坠落是 SCI的主要原因。SCI严重程度从 A~E级(ASIA 分级)不等,以A级为主,E级比例最低。结论，当前证据显示，我国 SCI发病率较高,具有较高的社会和医疗负担,SCI主要由汽车碰撞和高空坠落弓起。受纳入研究数量和质量的限制，上述结论尚待更多高质量研究予以验证。

摘要信息：Background:This study reports a 10-year retrospective analysis of multiple trauma complicated by pulmonary contusion. The purpose of this study is to ascertain the risk factors for mortality due to trauma in patients with pulmonary contusion, the impact of various treatment options for prognosis, and the risk factors for concurrent Acute Respiratory Distress Syndrome (ARDS). Methods:We retrospectively analyzed 252 trauma patients with lung contusion admitted to the General Hospital of Guangzhou Command from January 2000 to June 2011 by using the statistical processing system SPSS 17.0 for Windows. Results:We included 252 patients in our study, including 214 males and 38 females. The average age was 37.1 ± 14.9 years. There were 110 cases admitted to the ICU, of which 26 cases with ARDS. Nine of the 252 patients died. We compared those who survived with those who died by gender and age, the difference was not statistically significant (P = 0.199, P = 0.200). Separate univariate analysis of those who died and those who survived found that shock on admission (P = 0.000), coagulation disorders (P = 0.000), gastrointestinal bleeding (P = 0.02), the need for emergency surgery on admission (P = 0.000), pre-hospital intubation (P = 0.000), blood transfusion within 24 hours (P = 0.006), the use of mechanical ventilation (P = 0.000), and concurrent ARDS (P = 0.000) are poor prognosis risk factors. Further logistic analysis, including the admission GCS score (OR = 0.708, 95% CI 0.516-0.971, P = 0.032), ISS score (OR 1.135, 95% CI 1.006-1.280, P = 0.039), and concurrent ARDS (OR = 15.814, 95% CI 1.819-137.480, P = 0.012), identified the GCS score, ISS score and concurrent ARDS as independent risk factors of poor prognosis. Shock (OR = 9.121, 95% CI 0.857-97.060, P = 0.067) was also related to poor prognosis. Patients with injury factors such as road accident, falling injury, blunt injury and crush injury, et al.(P = 0.039), infection (P = 0.005), shock (P = 0.004), coagulation disorders (P = 0.006), emergency surgery (P = 0.01), pre-hospital intubation (P = 0.000), chest tube insertion (P = 0.004), blood transfusion (P = 0.000), usage of hormones (P = 0.002), phlegm (P = 0.000), ventilation (P = 0.000) were at a significantly increased risk for ARDS complications. Conclusions:Those patients with multiple trauma and pulmonary contusion admitted to the hospital with shock, coagulopathy, a need for emergency surgery, pre-hospital intubation, and a need for mechanical ventilation could have a significantly increased risk of mortality and ARDS incidence. A risk for poor prognosis was associated with gastrointestinal bleeding. A high ISS score, high APACHE2, and low GCS score were independent risk factors for poor prognosis. If patients developed an infection or were given drainage, hormones, and phlegm treatment, they were at higher risk of ARDS. Pre-hospital intubation and drainage were independent risk factors for ARDS. In patients with ARDS, the ICU stay, total length of stay, and hospital costs might increase significantly. A GCS score < 5.5, APACHE 2 score > 16.5, and ISS score > 20.5 could be considered indicators of poor prognosis for patients with multiple trauma and lung contusion.

摘要信息：Gastric aspiration is the major cause of acute lung injury (ALI) and acute respiratory distress syndrome. Aspiration-induced ALI is believed to be, at least in part, facilitated by neutrophil-derived mediators and toxic molecules. We conducted a prospective cohort study based on the hypothesis that sivelestat, a specific neutrophil elastase inhibitor, is effective for treating ALI following gastric aspiration. Forty-four ALI patients who showed evidence of aspiration were observed within 12 h before intensive care unit admission and who had been mechanically ventilated within 12 h after admission were included in this study. Lung injury score (LIS) and PAO2/FiO2 (P/F) ratio on day 7 were defined as the primary outcomes of the study. Twenty-three patients were assigned to the sivelestat group and 21 to the control group. In univariate analyses, the proportions of patients with LIS lower than 1.0 on day 7 and a P/F greater than 300 on day 7 were significantly higher in the sivelestat group than in the control group (60.9% vs. 26.3%, P = 0.03; 87.0% vs. 36.8%, P = 0.001). In the logistic regression model, the use of sivelestat was an independent predictor for LIS lower than 1.0 on day 7 (relative risk, 7.4; 95% confidence interval [CI], 1.51-36.48) and for a P/F ratio higher than 300 on day 7 (relative risk, 18.5; 95% CI, 2.72-126.46). In the Cox proportional hazards model, the use of sivelestat was associated with a lower cumulative proportion of patients who received mechanical ventilation during the initial 14 days (hazard ratio, 2.6; 95% CI, 1.17-5.55).

摘要信息：Background:There are conflicting views on the of sivelestat sodium (sivelestat-Na) on acute lung injury. Methods:The efficacy of sivelestat-Na on aspiration-related acute lung injury was analyzed by reviewing case reports published before or after the appearance of the drug on the clinical practice in Japan. Data were analyzed from the 23 sivelestat-treated cases and 5 non-sivelestat cases. Results:Sivelestat-Na was administered by 0.2 mg x kg(-1) x hr(-1) for 10 +/- 4 (mean +/- SD) days. PaO2/ ratio increased significantly from 124 +/- 59 mmHg of baseline to 253 +/- 79 mmHg on the third and to 361 +/- 84 mmHg on the termination of the therapy. Significantly better response was observed if the drug was administered within 24 hours after aspiration for patients with background of neurological disease, in which the increases in the P/F ratio were greater and the duration of the drug administration was shorter compared with other patients. In comparison with the non-sivelestat cases, sivelestat-Na therapy appears to be associated with shorter ventilator days or higher P/F increase, although sivelestat-Na costs higher. Conclusions:These results suggest the possibility of conducting prospective clinical trials to assess the efficacy of early sivelestat-Na therapy for aspiration-related acute lung injury.

摘要信息：摘要:目的 探讨西维来司他钠对急性: Stanford A型主动脉夹层(ATAAD)患者术后谵妄(POD)的预防作用及其机制。方法 纳入急诊行ATAAD手术患者80例,跟据随机数字表法分为西维来司他钠组及对照组各40例。西维来司他钠组于手术麻醉诱导前10 min静脉泵注西维来司他钠直至手术结束,对照组以相同的速率静脉泵注相同体积的生理盐水直至手术结束。术后3d内采用3min谵妄诊断量表(3D-CAM)对患者POD发生情况进行评估;于术后24h时采集患者外周静脉血,采用改良的Ficoll密度梯度离心法提取外周血单个核细胞(PBMCs),比色法检测PBMCs内铁离子(Fe”)浓度、丙二醛(MDA)含量及超氧化物歧化酶(SOD)活性,Westem bloting法检测PBMCs内长链脂酰辅酶A合成酶(ACSL4)及谷胱甘肽过氧化物酶4(GPX4)蛋白。记录围手术期情况及不良反应发生情况。结果 西维来司他钠组POD发生率低于对照组(P<0.05),两组POD严重程度评分及POD持续时间比较差异均无统计学意义。西维来司他钠组PBMCS内Fe”浓度及MDA含量低于对照组,SOD活性高于对照组(P均<0.05)。西维来司他钠组 PBMCS内ACSL4蛋白表达低于对照组,GRX4蛋白表达高于对照组(P均<0.05)。西维来司他钠组ICU人住时间及术后住院时间少于对照组(P均<0.05):两组不良反应发生率差异均无统计学意义。结论，西维来司他钠可预防急性ATAAD手术患者POD的发生,其机制可能与抑制铁死亡从而减轻神经损伤有关。

摘要信息：摘要:目的 观察西维来司他钠对行体外循环心脏瓣膜置换术老年患者肺功能的保护作用,探讨其可能机制。方法 2021年10月-2022年10月河南省人民医院行体外循环心脏膜置换术老年患者 76例,38 例麻醉诱导前10 min静脉泵注西维来司他钠 0.2 mg/(kg·h)至机械通气脱机者为观察组,38 例以相同速率静脉泵注生理盐水至机械通气脱机者为对照组。2组分别于切皮前(T)、术毕即刻(T,)、术后 24 h(T)、术后 48 h(T,)采集颈内静脉血,采用Ficoll密度梯度离心法分离外周血单个核细胞(PBMC),采用实时荧光定量 PCR 法检测 PBMCs 中白细胞介素(IL)-18.IL-1β mRNA 相对表达量,采用 Western blot 法检测 PBMCS NLRP3,caspase-1、消皮素 D(GSDMD)蛋白相对表达量,观察 T, 时 PBMCs形态变化。2 组分别于 T、T、T,、T,时采集桡动脉血行血气分析,测定 a(O,)、pa(CO,),计算肺泡-动脉血氧分压差(PDO2)、氧合指数(OI)和呼吸指数(RI)。记录2组体外循环时间、主动脉阻断时间、手术时间、麻醉时间、术中失血量及液体人量,术后机械通气时间、CU 治疗时间、首次下床活动时间、住院时间等;比较2组术中窦性心动过缓/过速、低血压/高血压、呯吸抑制及术后皮肤瘙痒、恶心呕叶、感染等发生情况。结果 观察组,时 pa(0,)pa(CO,)、血氧饱和度、P. DO,、RI、0I与对照组比较差异均无统计学意义(P>0.05),T、T、T;时 PDO,、RI 均低于对照组(P<0.05),01均高于对照组(P<0.05):2 组 T、T、T,时 PDO,,RI均高于 T 时(P<0.05),O1均低于T时(P<0.05)。T,时对照组 PBMCs 肿胀、变圆,气泡状突出物形成,形态大小不一,细胞膜裂解形成碎片,细胞间隙增宽、排列紊乱;观察组 PBMCs形态改变较对照组明显减轻。观察组 PBMCSIL-18、IL-1βmRNA 及 NLRP3、caspase-1.GSDMD蛋白相对表达量 T,时与对照组比较差异均无统计学意义(P>0.05),T、T、T;时均低于对照组(P<0.05);2 组T 、T,、T,时 IL-18、IL-1β mRNA 及 NLRP3,caspase-1、GSDMD 蛋白相对表达量均高于 T,时(P<0.05)。观察组术后机械通气时间[(33.3±8.0)h]、ICU 治疗时间[(51.9±7.8)h]均短于对照组[(39.9±9.6)、(61.7±8.4)h(t=3.256,P=0.002;t=5.270,P<0.001),体外循环时间、主动脉阻断时间、手术时间、麻醉时间、术中失血量及液体入量、围手术期悬浮红细胞及血浆输注量、首次下床活动时间,术后住院时间与对照组比较差异均无统计学意义(P>0.05)。2组术中均无呼吸抑制和深静脉血栓发生,术中窦性心动过缓、窦性心动过速、低血压、高血压及术后恶心呕吐、皮肤瘙痒、感染发生率比较差异均无统计学意义(P>0.05)。结论 西维来司他钠通过调控 NLRP3 炎性信号通路抑制 PBMCs 细胞焦亡保护行体外循环心脏瓣膜置换术老年患者术后肺功能,不增加围手术期不良事件的发生。

摘要信息：【摘要】 目的 探讨西维来司他钠对体外循环(CPB)下心脏瓣膜置换术老年患者术后早期康复的影响。方法 招募于本院手术室接受择期 CPB下心脏瓣膜置换术的患者 80 例,依据随机数字表法将其分成对照组(C组)和西维来司他钠组(S组),每组 40 例。记录术中及术后任何不良事件包括实性心动过缓或低血压/高血压、术后感染等。记录住院时间及 90 天死亡率。3个月后,使用问卷收集与睡眠有关的数据、生活质量、焦虑和疼痛。结果 C组共有 13 例患者(32.5%)在术后3d内发生术后谵妄(POD),S组共有5例患者(12.5%)在术后3d内发生POD,组间比较有显著差异(P、0.05)，两组术后13d时白细胞计数,中性粒细胞计数和中性粒细胞百分比较术前1d均增高,但S组均显著低于C组(P<0.05)。与C组比较,S组患者术后机械通气时间及 ICU入住时间均显著缩短(P<0.05)。术后 90d随访时,MMSE评分与基线相比无差异(P>0.05)。术后共有4例(10.0%)患者出现神经认知功能障碍(POCD)。两组间POCD发生率无差异(P>0.05)。术中心动过缓或低血压/高血压,术后感染等不良事件发生率在两组间均接近,差异无统计学意义(P>0.05)。在术后 90d的随访期内,两组均无患者死亡。两组在术后住院时间上无显著差异(P>0.05)。使用EQ5D问卷对两组患者的生活质量进行评估,结果显示,两组患者在统计学上无显著差异(P>0.05)。术后3个月,两组间的睡眠质量无显著差异(P>0.05)。结论 西维来司他钠可降低 CPB下心脏瓣膜置换术老年患者 POD发生率,缩短术后机械通气时间及 ICU入住时间,有益于术后早期康复。

摘要信息：Background:Despite advances in surgical techniques, the incidence of stroke following acute type A aortic dissection (ATAAD) repair remains markedly high, with substantial immediate and long-term adverse outcomes such as elevated mortality, extended hospital stays, and persistent neurological impairments. The complexity of managing ATAAD extends beyond the operation itself, highlighting a crucial gap in research concerning modifiable preoperative patient conditions and perioperative anesthetic management strategies. Objectives:This investigation aimed to elucidate the incidence, consequences, and perioperative determinants of stroke following surgical intervention for acute type A aortic dissection (ATAAD). Methods:In a multicenter retrospective analysis, 516 ATAAD surgery patients were evaluated. The data included demographic information, clinical profiles, surgical modalities, and outcomes. The primary endpoint was postoperative stroke incidence, with hospital mortality and other complications serving as secondary endpoints. Results:Postoperative stroke occurred in 13.6% of patients (70 out of 516) and was associated with significant extension of the ICU (median 10 vs. 5 days, P < 0.001) and hospital stay (median 18 vs. 12 days, P < 0.001). The following key independent stroke risk factors were identified: modified Frailty Index (mFI) ≥ 4 (odds ratio [OR]: 4.18, 95% confidence interval [CI]: 1.24-14.1, P = 0.021), common carotid artery malperfusion (OR: 3.76, 95% CI: 1.23-11.44, P = 0.02), pre-cardiopulmonary bypass (CPB) hypotension (mean arterial pressure ≤ 50 mmHg; OR: 2.17, 95% CI: 1.06-4.44, P = 0.035), ≥ 20% intraoperative decrease in cerebral regional oxygen saturation (rSO2) (OR: 1.93, 95% CI: 1.02-3.64, P = 0.042), and post-CPB vasoactive-inotropic score (VIS) ≥ 10 (OR: 2.24, 95% CI: 1.21-4.14, P = 0.01). Conclusions:Postoperative stroke significantly increases ICU and hospital durations in ATAAD surgery patients. These findings highlight the critical need to identify and mitigate major risks, such as high mFI, common carotid artery malperfusion, pre-CPB hypotension, significant cerebral rSO2reductions, and elevated post-CPB VIS, to improve outcomes and reduce stroke prevalence.