翻译：钮阳 徐州医科大学2024级硕士研究生
审校：赵林林 徐医附院麻醉科
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《Anesthesiology》2024年1月刊，第140卷第1期
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《Anesthesiology》2024年11月刊，第141卷第5期Science, Medicine, and the AnesthesiologistInfographics in Anesthesiology1.The Many Worlds of Patient Safety in Anesthesiology2.Keeping the Patient at the Center of Conscientious Objection while Respecting Our Colleagues3.Routine Innovation in Perioperative Clinical Trials: The Best Chance to Answer Our Most Important Questions?围手术期临床试验的常规创新：回答我们最重要问题的最佳机会？4.From Notes to Knowledge: Deciphering Perioperative Risky Substance Use through Natural Language Processing从笔记到知识：通过自然语言处理解析围手术期危险物质使用Perioperative Medicine: Clinical Science1.Dexamethasone for Cardiac Surgery: A Practice Preference – Randomized Consent Comparative Effectiveness Trial地塞米松用于心脏手术：实践偏好-随机同意比较有效性试验High-dose corticosteroids have been used to attenuate the inflammatory response to cardiac surgery and cardiopulmonary bypass, but patient outcome benefits remain unclear. The primary aim was to determine whether using dexamethasone was superior to not using dexamethasone to increase the number of home days in the first 30 days after cardiac surgery.The secondary aim was to evaluate efficiency, value, and impact of the novel trial design.背景：大剂量皮质类固醇已被用于减轻心脏手术和体外循环后的炎症反应，但患者的预后益处尚不清楚。主要目的是确定在心脏手术后的前30天内，使用地塞米松是否优于不使用地塞米松来增加家庭天数。第二个目的是评估新试验设计的效率、价值和影响。This pragmatic, international trial incorporating a prerandomized consent design favoring local practice enrolled patients undergoing cardiac surgery across seven hospitals in Australia and The Netherlands. Patients were randomly assigned to dexamethasone 1 mg/kg or not (control). The primary outcome was the number of days alive and at home up to 30 days after surgery (“home days”). Secondary outcomes included prolonged mechanical ventilation (more than 48 h), sepsis, renal failure, myocardial infarction, stroke, and death.这项实用的国际试验采用了支持当地实践的预随机同意设计，纳入了澳大利亚和荷兰七家医院接受心脏手术的患者。患者随机分配地塞米松1 mg/kg组或非1 mg/kg组（对照组）。主要观察指标是术后30天的存活和在家天数（“在家天数”）。次要结局包括延长机械通气时间（超过48小时）、败血症、肾衰竭、心肌梗死、中风和死亡。Of 2,562 patients assessed for eligibility, 1,951 were randomized (median age, 63 yr; 80% male).The median number of home days was 23.0 (interquartile range, 20.1 to 24.1) in the no dexamethasone group and 23.1 (interquartile range, 20.1 to 24.6) in the dexamethasone group (median difference, 0.1; 95% CI, –0.3 to 0.5; P = 0.66). The rates of prolonged mechanical ventilation (risk ratio, 0.72; 95% CI, 0.48 to 1.08), sepsis (risk ratio, 1.02; 95% CI, 0.57 to 1.82), renal failure (risk ratio, 0.94; 95% CI, 0.80 to 1.12), myocardial infarction (risk ratio, 1.20; 95% CI, 0.30 to 4.82), stroke (risk ratio, 1.06; 95% CI, 0.54 to 2.08), and death (risk ratio, 0.72; 95% CI, 0.22 to 2.35) were comparable between groups (all P > 0.10). Dexamethasone reduced intensive care unit stay (median, 29 h; interquartile range, 22 to 50 h vs. median, 43 h; interquartile range, 24 to 72 h; P = 0.004). The authors’ novel trial design was highly efficient (89.3% enrollment).结果在2562例入选患者中，1951例被随机分组(中位年龄63岁；80%的男性)。无地塞米松组的家中天数中位数为23.0（四分位数范围为20.1 ~ 24.1），地塞米松组的家中天数中位数为23.1（四分位数范围为20.1 ~ 24.6）(中位数差异为0.1；95% CI, -0.3 ~ 0.5；P = 0.66)。延长机械通气率(风险比，0.72；95% CI, 0.48 ~ 1.08)，脓毒症(风险比，1.02；95% CI, 0.57 ~ 1.82)，肾功能衰竭(风险比，0.94；95% CI, 0.80 ~ 1.12)，心肌梗死(风险比，1.20；95% CI, 0.30 ~ 4.82)，卒中(风险比，1.06；95% CI, 0.54 ~ 2.08)和死亡(风险比，0.72；95% CI, 0.22 ~ 2.35)组间比较具有可比性（P均> 0.10）。地塞米松减少重症监护病房住院时间(中位数，29小时；四分位数间距为22 - 50小时，中位数为43小时；四分位数间距24 ~ 72 h；P = 0.004)。作者新颖的试验设计非常有效（入组率为89.3%）。Among patients undergoing cardiac surgery, high-dose dexamethasone decreased intensive care unit stay but did not increase the number of home days after surgery.结论：在接受心脏手术的患者中，大剂量地塞米松减少了重症监护病房的住院时间，但未缩短术后住院天数。2.Cannabis Use and Inhalational Anesthesia Administration in Older Adults: A Propensitymatched Retrospective Cohort Study老年人大麻使用和吸入麻醉：一项倾向匹配的回顾性队列研究Cannabis use is associated with higher intravenous anesthetic administration. Similar data regarding inhalational anesthetics are limited. With rising cannabis use prevalence, understanding any potential relationship with inhalational anesthetic dosing is crucial.Average intraoperative isoflurane or sevoflurane minimum alveolar concentration equivalents between older adults with and without cannabis use were compared.背景：大麻的使用与较高的静脉麻醉剂量有关。关于吸入麻醉剂的类似数据是有限的。随着大麻使用率的上升，了解与吸入麻醉剂剂量的任何潜在关系至关重要。比较了使用和不使用大麻的老年人术中异氟烷或七氟烷最低肺泡浓度当量的平均值。The electronic health records of 22,476 surgical patients 65 yr or older at the University of Florida Health System between 2018 and 2020 were reviewed. The primary exposure was cannabis use within 60 days of surgery, determined via (1) a previously published natural language processing algorithm applied to unstructured notes and (2) structured data, including International Classification of Diseases codes for cannabis use disorders and poisoning by cannabis, laboratory cannabinoids screening results, and RxNorm codes. The primary outcome was the intraoperative time-weighted average of isoflurane or sevoflurane minimum alveolar concentration equivalents at 1-min resolution. No a priori minimally clinically important difference was established. Patients demonstrating cannabis use were matched 4:1 to non–cannabis use controls using a propensity score.方法 回顾2018年至2020年佛罗里达大学卫生系统65岁及以上22476例外科患者的电子健康记录。主要接触对象是手术后60天内的大麻使用情况，这是通过(1)以前发表的一种应用于非结构化笔记的自然语言处理算法和(2)结构化数据确定的，包括大麻使用障碍和大麻中毒的国际疾病分类代码、实验室大麻素筛选结果和RxNorm代码。主要结果是术中异氟醚或七氟醚最低肺泡浓度当量在1分钟分辨率下的时间加权平均值。没有先验的最小临床重要差异。使用倾向评分将证明使用大麻的患者与不使用大麻的对照组进行4:1匹配。Among 5,118 meeting inclusion criteria, 1,340 patients (268 cannabis users and 1,072 nonusers) remained after propensity score matching. The median and interquartile range age was 69 (67 to 73) yr; 872 (65.0%) were male, and 1,143 (85.3%) were non-Hispanic White. The median (interquartile range) anesthesia duration was 175 (118 to 268) min. After matching, all baseline characteristics were well-balanced by exposure. Cannabis users had statistically significantly higher average minimum alveolar concentrations than nonusers (mean ± SD, 0.58 ± 0.23 vs. 0.54 ± 0.22, respectively; mean difference, 0.04; 95% confidence limits, 0.01 to 0.06; P = 0.020).结果 在5118例符合纳入标准的患者中，倾向评分匹配后剩余1340例患者（268例大麻使用者和1072例非大麻使用者）。年龄中位数和四分位数范围为69（67 ~ 73）岁；872例（65.0%）为男性，1143例（85.3%）为非西班牙裔白人。麻醉持续时间中位数（四分位数范围）为175（118至268）分钟。匹配后，所有基线特征均通过暴露得到良好平衡。大麻使用者的平均最低肺泡浓度显著高于非使用者(平均±SD，分别为0.58±0.23比0.54±0.22；平均差值为0.04；95%置信限，0.01 ~ 0.06；P = 0.020)。Cannabis use was associated with administering statistically significantly higher inhalational anesthetic minimum alveolar concentration equivalents in older adults, but the clinical significance of this difference is unclear. These data do not support the hypothesis that cannabis users require clinically meaningfully higher inhalational anesthetics doses.结论：在老年人中，大麻使用与给予更高的吸入性麻醉最低肺泡浓度当量相关，但这种差异的临床意义尚不清楚。这些数据不支持大麻使用者需要临床上有意义的更高吸入麻醉剂剂量的假设。Critical Care Medicine: Clinical Science1.Correction of Trauma-induced Coagulopathy by Goal-directed Therapy: A Secondary Analysis of the ITACTIC Trial目标导向疗法纠正创伤性凝血病：ITACTIC试验的二次分析2.Calcium-activated Potassium Channels as Amplifiers of TRPV4-mediated Pulmonary Edema Formation in Male Mice钙激活钾通道作为雄性小鼠中TRPV4介导的肺水肿形成的放大器Pain Medicine: Clinical Science1.Platelet-derived Growth Factor Receptor-α Induces Contraction Knots and Inflammatory Pain–like Behavior in a Rat Model of Myofascial Trigger Points血小板源性生长因子受体-α在肌筋膜触发点大鼠模型中诱发收缩结节和炎症性疼痛样行为2.Neuropeptide Y Y2 Receptors in Sensory Neurons Tonically Suppress Nociception and Itch but Facilitate Postsurgical and Neuropathic Pain Hypersensitivity中文：感觉神经元中的神经肽YY2受体持续抑制伤害感受和瘙痒，但会促进术后和神经病理性疼痛的超敏反应Education: Images in Anesthesiology1.Sublingual Hematoma: A Rare Anesthetic(al) Complication2.Heart under Pressure: Intrathoracic Impact of Large Hiatal HerniaEducation: Clinical Focus Review1.Identification and Treatment of Pediatric Perioperative Anxiety2.Diagnosis and Treatment of Perioperative Anemia: A Society for Perioperative Assessment and Quality Improvement Collaborative Review围手术期贫血的诊断与治疗：围手术期评估与质量改进协会合作审查Correspondence: Letters to the Editor1.Perioperative Care for Spine Surgery: Comment2.Perioperative Care for Spine Surgery: Reply3.Intraoperative Mechanical Power: Comment
