膝关节置换手术产生的创伤刺激常使患者术后承受着中到重度疼痛,这不仅使患者术后体验不佳,疼痛应激还会加重机体的内环境紊乱,对患者的术后康复产生不利的影响。现在多模式镇痛理念越来越多被应用到术后镇痛中,即将多种不同机制的镇痛药物和镇痛方法进行合理有效的结合,发挥最佳的镇痛效应。布比卡因脂质体作为一种具有稳定性和长效性特点的新型缓释局麻药在术后多模式镇痛中得到越来越多的应用,尤其是应用在膝关节置换术后镇痛。文章综述了布比卡因脂质体应用于膝关节置换手术后镇痛的应用进展情况。The traumatic stimulus produced by knee replacement surgery often causes patients to suffer from moderate to severe pain after surgery, which not only makes the patient’s postoperative experience poor, but also aggravates the internal environmental disorders of the body, which adversely affects the patient’s postoperative recovery. Nowadays, the concept of multimodal analgesia is more and more often applied to postoperative analgesia, which is to reasonably and effectively combine multiple analgesic drugs and analgesic methods with different mechanisms to exert the best analgesic effect. Liposomal bupivacaine, as a new type of sustained-release local anesthetic with stability and long-acting characteristics, has been increasingly used in postoperative multimodal analgesia, especially in postoperative analgesia after knee arthroplasty. This article reviews the progress of liposomal bupivacaine application for postoperative analgesia after knee replacement surgery.
目的探讨低病毒载量乙肝肝癌人群发生肝切除术后肝衰(post-hepatectomy liver failure,PHLF)的影响因素,并构建风险预测模型。方法选择2015年1月1日至2023年3月1日在陆军军医大学第一附属医院麻醉科首次接受肝切除术的403例低病毒载量乙肝肝癌患者作为研究对象,按照7:3比例采用简单随机抽样法分为训练集和验证集,通过Lasso回归和多因素Logistic回归分析筛选PHLF发生的影响因素并建立列线图预测模型。通过多种指标对模型的性能进行评估,包括受试者工作特征曲线下面积(area under the receiver operating characteristic curve,AUC)、校准曲线、决策曲线分析和临床影响曲线分析。结果本研究确定抗病毒治疗史、饮酒史、乙肝表面抗原值及国际标准化比值为低病毒载量乙肝肝癌人群发生PHLF的独立影响因素。基于上述指标建立的预测模型在训练集和验证集中表现出卓越的区分能力,AUC值分别为0.744(95%CI:0.671~0.818)和0.737(95%CI:0.599~0.876)。校准曲线显示出模型的高准确性(训练集:P=0.995;验证集:P=0.701),决策曲线分析和临床影响曲线分析均表明模型提供了更大的临床益处。结论本研究建立的预测模型能够有效评估低病毒载量乙肝肝癌人群发生PHLF的风险,具有良好的预测性能,对及时识别高危人群具有一定的指导意义。
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