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围术期神经肌肉阻滞的管理:欧洲麻醉和重症监护学会临床指南

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中华麻醉学杂志 2024年第6期44卷 641-656页

作者： Thomas Fuchs-buder Carolina S.Romero Heidrun Lewald Massimo Lamperti Arash Afshari Ana-Marjia Hristovska Denis Schmartz Jochen Hinkelbein Dan Longrois Maria Popp Hans Dde boer Massimiliano Sorbello Radmilo Jankovic peter Kranke 法国南锡大学医学院附属医院麻醉学、重症监护与围术期医学科法国南锡54000 巴伦西亚大学综合医院麻醉与重症监护科西班牙巴伦西亚46014 慕尼黑工业大学麻醉学与重症监护科德国慕尼黑80333 克利夫兰阿布扎比诊所麻醉学研究所阿联酋阿布扎比31250 哥本哈根大学医院小儿和产科麻醉科丹麦哥本哈根2100 哥本哈根大学医院麻醉学与重症监护科丹麦赫维德2650 布鲁塞尔自由大学Erasme医院麻醉科比利时布鲁塞尔1070 科隆大学医院麻醉学与重症监护科德国科隆50937 巴黎大学附属比查特克劳德伯纳德医院麻醉学与重症监护医学科法国巴黎75018 维尔茨堡大学医院麻醉学、危重病医学、急诊医学和疼痛医学科德国维尔茨堡97080 格罗宁根大学医院麻醉学、疼痛医学与程序性镇静与镇痛科荷兰格罗宁根9713 GZ 卡坦尼亚大学医院麻醉与重症监护科意大利卡坦尼亚95123 尼什大学医学院尼什临床中心麻醉学与重症治疗科塞尔维亚尼什18000

近来的研究表明,由于围术期神经肌肉阻滞管理不当,肌肉松弛药(肌松药)残留阻滞及其术后并发症的发生率居高不下。需要重视神经肌肉功能监测仪、肌松药及其拮抗剂的合理应用,以利于改善神经肌肉阻滞管理。欧洲麻醉和重症监护学会(Europea... 详细信息

近来的研究表明,由于围术期神经肌肉阻滞管理不当,肌肉松弛药(肌松药)残留阻滞及其术后并发症的发生率居高不下。需要重视神经肌肉功能监测仪、肌松药及其拮抗剂的合理应用,以利于改善神经肌肉阻滞管理。欧洲麻醉和重症监护学会(European Society of Anaesthesiology and Intensive Care,ESAIC)首次发布围术期神经肌肉阻滞管理临床指南,旨在为临床医生提供最佳医疗管理的循证建议,以提高围术期患者安全。本指南主要聚焦在3个临床问题:肌松药是否有助于成人气管插管?神经肌肉阻滞深度是否影响腹部手术患者的预后?肌松药残留阻滞的诊断和治疗策略有哪些?根据PICO原则(患者、干预、对照、结局;patient,intervention,comparator,outcome;PICO)构建临床问题并进行文献检索。初始纳入的临床研究为24 000篇,采用逐步筛选策略,最终临床研究88篇纳入指南分析。应用GRADE方法学(Grading of Recommendations,Assessment,Development and Evaluation,GRADE)对结局指标证据、质量等级进行评价。运用两轮德尔菲法收集专家组建议并形成统一推荐:R1推荐应用肌松药辅助气管插管(1A)。R2推荐应用肌松药以减少气管插管导致的咽部和(或)喉部损伤(1C)。R3推荐在快速顺序诱导插管(rapid sequence induction intubation,RSII)时使用短效肌松药,例如琥珀胆碱1 mg/kg或罗库溴铵0.9~1.2 mg/kg(1b)。R4推荐在需要改善外科手术条件时,加深神经肌肉阻滞深度(1b)。R5尚无足够的证据推荐深度神经肌肉阻滞可减轻术后疼痛或降低围术期并发症的发生率(2C)。R6推荐在拇内收肌处刺激尺神经,定量监测神经肌肉阻滞深度以排除肌松药残留阻滞(1b)。R7推荐应用舒更葡糖钠逆转甾体类肌松药(罗库溴铵、维库溴铵)诱导的深、中及浅度神经肌肉阻滞(1A)。R8推荐在使用新斯的明前,TOFr自行恢复至>0.2,并继续定量监测神经肌肉功能,直至TOFr超过0.9(1C)。

关键词：神经肌肉阻滞神经肌肉功能肌松药临床指南罗库溴铵琥珀胆碱外科手术定量监测

TIPSS for variceal hemorrhage after living related liver transplantation:A dangerous indication

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World Journal of Gastroenterology 2006年第3期12卷 493-495页

作者： peter Schemmer boris Radeleff Christa Flechtenmacher Arianeb Mehrabi Gtz M Richter Markus W büchler Jan Schmidt Department of General Surgery Ruprecht-KarlsUniversity69120 HeidelbergGermany Department of RadiologyRuprecht-Karls-University69120 HeidelbergGermany Department of PathologyRuprechtKarls-University69120 HeidelbergGermany

The introduction of transjugular intrahepatic portalsystemic stent-shunt （TIPSS） has been a major breakthrough in the treatment of portal hypertension, which has evolved to a large extent, into a routine procedure. A 21-year-old male patient with progressive graft fibrosis/cirrhosis requiring TIPSS for variceal hemorrhage in the esophagus due to portal hypertension was unresponsive to conventional measures two years after living related liver transplantation （LDLT）. Subsequently, variceal hemorrhage was controlled, however, liver function decreased dramatically with consecutive multi organ failure. CT scan revealed substantial necrosis in the liver. The patient underwent successful ＂high urgent＂ cadaveric liver transplantation and was discharged on postoperative d 20 in a stable condition.

关键词： Portal hypertension Liver necrosis Fibrosis Cirrhosis

Heart rate variability and the influence of craniosacral therapy on autonomous nervous system regulation in persons with subjective discomforts:a pilot study

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Journal of Integrative Medicine 2014年第3期12卷 156-161页

作者： Wanda Girsberger Ulricke bnziger Gerhard Lingg Harald Lothaller peter-Christian Endler Interuniversity College for Health and Development Castle of Seggau8042 GrazAustria Practice for Craniosacral Therapy Kronenstrasse 488006 ZurichSwitzerland

bACKGROUND： Subjective discomforts in a preclinical range are often due to imbalanced autonomic nervous system activity, which is a focus of craniosacral therapy. ObJECTIVE： The aim of this work was to determine any changes in heart rate variability （HRV） in a study on craniosacral therapy. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS： This is a quasi-experimental （controlled） study with cross-over design. In a private practice, measurements were performed on 31 patients with subjective discomforts before and after a control and an intervention period. HRV was determined using a device that requires a measuring time of 140 s and electrode contact only with the fingertips. Main PRIMARY OUTCOME MEASURES： HRV change under the influence of a defined onetime intervention （test intervention） with craniosacral therapy versus control （defined rest period）. RESULTS： Standard deviation of all RR-intervals （ms） and total power of RR-interval variability in the frequency range （ms2） were together interpreted as an indicator of test subjects＇ autonomic nervous activity and as a measure of their ability to cope with demands on their health. Neither of these parameters increased during the control period （P〉0.05）, whereas during the test intervention period there was an increase in both （P〈0.05, P〈0.01）. Nevertheless, interactions between treatment and the increase were statistically not significant （P〉0.05）. No changes were observed in the low frequency/high frequency ratio （sympathetic-vagal balance） in the course of the control or the test intervention period （P〉0.05）. CONCLUSION： Craniosacral treatment had a favourable effect on autonomic nervous activity. This in itself is an interesting result, but further research will be needed to distinguish specific effects of craniosacral therapy technique from less specific therapist-client interaction effects.

关键词： massage autonomic nervous system electrocardiography adult complementarytherapies pilot projects

Target blood pressure in diabetes patients with hypertension——What is the accumulated evidence in 2011?

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Journal of Zhejiang University-Science b(biomedicine & biotechnology) 2011年第8期12卷 611-623页

作者： peter M.NILSSON Department of Clinical Sciences Lund UniversityUniversity Hospital

There is overwhelming evidence that hypertension is an important risk factor for both macrovascular and microvascular complications in patients with diabetes,but the problem remains to identify appropriate goals for preventive therapies.A number of guidelines (the European Society of Cardiology (ESC)/European Association for the Study of Diabetes (EASD) 2007,the Joint National Committee (JNC)-Ⅶ 2003,the American Diabetes Association (ADA) 2011) have for example advocated a blood pressure goal of less than 130/80 mmHg,but this suggestion has been challenged by findings in recent trials and meta-analyses (2011).The European Society of Hypertension (ESH) therefore recommends a systolic blood pressure goal of "well below" 140 *** on evidence from both randomized controlled trials (hypertension optimal treatment (HOT),action in diabetes and vascular disease:preterax and diamicron MR controlled evaluation (ADVANCE),action to control cardiovascular risk in diabetes (ACCORD)) and observational studies (ongoing telmisartan alone and in combination with ramipril global endpoint trial (ONTARGET),international verapamil-trandolapril study (INVEST),treat to new targets (TNT),and the National Diabetes Register (NDR)),it has been shown that the benefit for stroke reduction remains even at lower achieved blood pressure levels,but the risk of coronary events may be uninfluenced or even increased at lower systolic blood pressure *** a recent meta-analysis,it was therefore concluded that the new recommended goal should be 130-135 mmHg systolic blood pressure for most patients with type 2 *** risk factors should also be controlled with a more ambitious strategy applied in the younger patients with shorter diabetes duration,but a more cautious approach in the elderly and frail patients with a number of vascular or non-vascular *** patients from East Asia,such as China,the stroke risk is relatively higher than the risk of coronary *** must al

关键词： blood pressure Cardiovascular Diabetes Goal Hypertension Treatment

Electrical Tracking,Erosion and Fire Retardancy Performance of Silicone Rubber Insulation Containing Aluminum Trihydrate,Graphene and Glass Fiber Additives

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CSEE Journal of Power and Energy Systems 2023年第5期9卷 1918-1925页

作者： M.Tariq Nazir Arslan Khalid b.Toan Phung Arup K.Das peter Cheetham Ashish Paramane Shakeel Akram Khoi Loon Wong School of Engineering RMIT UniversityMelbourneVIC 3000Australia. the Center for Advanced Power Systems(CAPS) Florida State UniversityFL 32310USA the Flame Security International Pty Limited Australia the School of Electrical Engineering and Telecommunications University of New South Wales SydneyNSW 2052Australia Department of Electrical Engineering National Institute of TechnologySilcharAssam 788010India the College of Electrical Engineering and Control Science Nanjing Tech UniversityNanjingJiangsu 211816China

Silicone rubber composite is a priority electrical insulating material used in high-voltage outdoor insulation *** electrical tracking/erosion and poor flame resistance performance of silicone rubber once ignited,substantially reduce its working *** paper attempts to investigate tracking/erosion performance of room temperature vulcanized(RTV)silicone rubber along with flame retardant parameters using aluminum trihydrate(ATH),graphene nanosheets(GN)and milled glass fiber(GF)*** inclined plane test(IPT)was performed in line with criteria defined in IEC 60587 using step-up tracking voltage method while flame retardancy is evaluated according to ASTM E 1354.0 using a cone *** suggest 30% of ATH assists in improving physical tracking/erosion resistance of pristine silicone elastomer rubber by impeding development of leakage current and a great reduction in maximum average temperatures on the surface of *** improvement in performance of RTV2 is achieved through introduction of 1%of GN and 5% of GF as seen in ***,30% of ATH reduces heat release rate and smoke production rate,and this trend is improved with the introduction of GN/***4 has pop up as the most promising silicone rubber composite with excellent electrical tracking,erosion,and flame resistance performance relative to its counterparts in this study.

关键词： Dry band arcing electrical tracking heat release rate leakage current silicone rubber smoke production rate

Unfolded p53 in non-neuronal cells supports bacterial etiology of Alzheimer’s disease

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Neural Regeneration Research 2022年第12期17卷 2619-2622页

作者： peter W.French Innlanz Limited SydneyNSWAustralia

Alzheimer’s disease has proven to be largely intractable to treatment,despite years of research,and numerous trials of therapies that target the hallmarks of the disease-amyloid plaques and neurofibrillary *** etiology of Alzheimer’s disease remains *** is a growing body of evidence for an infectious trigger of Alzheimer’s disease,and,in particular,the focus has been on the oral pathogen Porphyromonas gingivalis(***).Reports of the expression of a misfolded form of p53 in non-neuronal cells(fibroblasts,peripheral blood mononuclear cells,and b cells)and serum,which appears several years before clinical symptoms manifest,may provide further support for the role of bacteria in general,and *** in particular,in the initiation of the *** review presents a model of the pathway from initial oral infection with *** to amyloid plaque formation and neuronal degeneration,via the steps of chronic periodontitis;secretion of the inflammagens lipopolysaccharide and gingipains into the bloodstream;induction of an inflammatory response in both peripheral cells and tissues;disruption of the blood-brain barrier,and entry into the central nervous system of the inflammagens and the *** bacteria *** this model,the misfolded p53(or“unfolded p53”;up53)is induced in non-neuronal cells and upregulated in serum as a result of oxidative stress due to lipopolysaccharide from ***53 is therefore a potential biomarker for early diagnosis of the presence of a causative agent of Alzheimer’s *** dental hygiene and aggressive antibiotic treatment may prevent the patient progressing to clinical Alzheimer’s disease if serum up53 is detected at this pre-symptomatic stage.

关键词： Alzheimer’s disease gingipains lipopolysaccharide P.gingivalis periodontitis unfolded p53

Idempotent Completions of Operator Partial Matrices

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Acta Mathematica Sinica,English Series 1999年第3期15卷 333-346页

作者： Heydar Radjavi peter Rosenthal Department of Mathematics Shanxi Teachers University Linfen 041004 P. R. ChinaDepartment of Mathematics Statistics and Computing Science Dalhousie University Halifax N.S. B3H 3J5 Canada Department of Mathematics University of Toronto Toronto On M5S 1A1 Canada

Necessary and sufficient conditions are obtained for operator partial 2×2 matrices to have an idempotent completion, and all such completions are parametrically represented.

关键词： Hilbert space Operator matrix Idempotent operator

Phytochrome-regulated Gene Expression

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Journal of Integrative Plant biology 2007年第1期49卷 11-20页

作者： peter H. Quail Department of Plant and Microbial biology University of Cafifomia Berkeley CA 94720 USA U.S. Department of Agriculture/Agriculture Research Service-Plant Gene Expression Center 800 Buchanan Street Albany CA 94710 LISA

Identification of all genes involved in the phytochrome （phy）-medieted responses of plants to their light environment is an important goal in providing an overall understanding of light-regulated growth end development. This article highlights end integrates the central findings of two recent comprehensive studies in Arabidopsis that have identified the genome-wide set of phy-reguleted genes that respond rapidly to red-light signals upon first exposure of dark-grown seedlings, and have tested the functional relevance to normal seedling photomorphogenesis of an Initial subset of these genes. The data：（a） reveal considerable complexity in the channeling of the light signals through the different phy-femily members （phyA to phyE） to responsive genes; （b） identify a diversity of transcription-factor-encoding genes as major early, if not primary, targets of phy signaling, end, therefore, as potentially important regulators in the transcriptional-network hierarchy; and （c） identify auxin-related genes as the dominant class among rapidly-regulated, hormone-related genes. However, reverse-genetic functional profiling of a selected subset of these genes reveals that only a limited fraction are necessary for optimal phy-induced seedling deetioletion.

关键词： expression profiling phytochrome signaling transcriptional networks microarrays reverse genetics functional profiling transcription factors auxin-related genes

Drought Responses of Leaf Tissues from Wheat Cultivars of Differing Drought Tolerance at the Metabolite Level

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Molecular Plant 2012年第2期5卷 418-429页

作者： Jairus b. bowne Tim A. Erwin Juan Juttner Thorsten Schnurbusch peter Langridge Antony bacic Ute Roessner Australian Centre for Plant Functional Genomics School of Botany The University of Melbourne 3010 Victoria Australia Australian Centre for Plant Functional Genomics University of Adelaide Waite Campus Glen Osmond 5064 SA Australia Metabolomics Australia Bio21 Molecular Science and Biotechnology Institute 30 Flemington Rd The University of Melbourne 3010 Victoria Australia ARC Centre for Excellence for Plant Cell Walls School of Botany The University of Melbourne 3010 Victoria Australia Metabolomics Australia School of Botany The University of Melbourne 3010 Victoria Australia

Drought has serious effects on the physiology of cereal crops. At the cellular and specifically the metabolite level, many individual compounds are increased to provide osmoprotective functions, prevent the dissociation of enzymes, and to decrease the number of reactive oxygen species present in the cell. We have used a targeted GC-MS approach to identify compounds that differ in three different cultivars of bread wheat characterized by different levels of tolerance to drought under drought stress （Kukri, intolerant; Excalibur and RAC875, tolerant）. Levels of amino acids, most notably proline, tryptophan, and the branched chain amino acids leucine, isoleucine, and valine were increased under drought stress in all cultivars. In the two tolerant cultivars, a small decrease in a large number of organic acids was also evident. Excalibur, a cultivar genotypically related to Kukri, showed a pattern of response that was more similar to Kukri under well-watered conditions. Under drought stress, Excalibur and RAC875 had a similar response; however, Excalibur did not have the same magnitude of response as RAC875. Here, the results are discussed in the context of previous work in physiological and proteomic analyses of these cultivars under drought stress.

关键词： abiotic/environmental stress metabolomics drought wheat.