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Tranexamic acid in patients with traumatic brain injury: a meta-analysis 氨甲环酸在脑外伤患者中的应用:荟萃分析
Pub Date : 2024-05-01 DOI: 10.1016/j.redare.2024.02.013
R.M. Sarhan, M.S. Boshra, M.E.A. Abdelrahim, H. Osama

Background

We performed a meta-analysis to assess the effectiveness and safety of tranexamic acid in patients with traumatic brain injury (TBI).

Methods

We searched the literature for articles evaluating the effectiveness and safety of tranexamic acid (TXA) in TBI published between January 2012 and January 2021, and identified 8 studies with a total of 10860 patients: 5660 received TXA and 5200 served as controls. We used a dichotomous or continuous approach with a random or fixed-effect model to assess the efficacy and safety of TXA in TBI, and calculated the mean difference (MD) and odds ratio (OR) with the corresponding 95% confidence interval.

Results

In patients with TBI, early administration of TXA was associated with a greater relative benefit (MD −2.45; 95% CI = −4.78 to −0.12; p = 0.04) and less total haematoma expansion (MD - 2.52; 95% CI = −4.85 to −0.19; p = 0.03) compared to controls.

There were no statistically significant differences in mortality (OR 0.94; 95% CI = 0.85–1.03; p = 0.18), presence of progressive haemorrhage (OR 0.75; 95% CI = 0.56–1.01; p = 0.06), need for neurosurgery (OR 1.15; 95% CI = 0.66–1.98; p = 0.63), high Disability Rating Scale score (OR 0.90; 95% CI = 0.56–1.45; p = 0.68), and incidence of ischaemic or thromboembolic complications (OR 1.34; 95% CI = 0.33–5.46; p = 0.68) between TBI patients treated with TXA and controls.

Conclusions

Early administration of TXA in TBI patients may have a greater relative benefit and may inhibit haematoma expansion. There were no significant differences in mortality, presence of progressive haemorrhage, need for neurosurgery, high Disability Rating Scale score, and incidence of ischaemic or thromboembolic complications between TBI patients treated with TXA and controls. Further studies are needed to validate these results.

背景:我们进行了一项荟萃分析,以评估氨甲环酸对创伤性脑损伤(TBI)患者的有效性和安全性:我们检索了2012年1月至2021年1月期间发表的评估氨甲环酸(TXA)对创伤性脑损伤的有效性和安全性的文献,并确定了8项研究,共计10860名患者:其中 5660 名患者接受了氨甲环酸治疗,5200 名患者作为对照组。我们采用随机或固定效应模型的二分法或连续法评估了TXA在TBI中的疗效和安全性,并计算了平均差(MD)和几率比(OR)以及相应的95%置信区间:在创伤性脑损伤患者中,与对照组相比,早期给予 TXA 有更大的相对益处(MD -2.45;95% CI = -4.78 至 -0.12;p = 0.04),且血肿扩大的程度较小(MD -2.52;95% CI = -4.85 至 -0.19;p = 0.03)。在死亡率(OR 0.94;95% CI = 0.85-1.03;p = 0.18)、进行性出血(OR 0.75;95% CI = 0.56-1.01;p = 0.06)、神经外科手术需求(OR 1.15;95% CI = 0.66-1.98;p = 0.63)、残疾评定量表评分高(OR 0.90;95% CI = 0.56-1.45;p = 0.68)、缺血或血栓栓塞并发症的发生率(OR 1.34;95% CI = 0.33-5.46;p = 0.68):结论:对创伤性脑损伤患者及早使用TXA可能具有更大的相对益处,并可抑制血肿扩大。接受 TXA 治疗的创伤性脑损伤患者与对照组患者在死亡率、进行性出血、神经外科手术需求、高度残疾评定量表评分以及缺血性或血栓栓塞并发症的发生率方面没有明显差异。需要进一步研究来验证这些结果。
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引用次数: 0
Influence of lymphopenia on long-term mortality in septic shock, a retrospective observational study 淋巴细胞减少症对脓毒性休克长期死亡率的影响,一项回顾性观察研究。
Pub Date : 2024-05-01 DOI: 10.1016/j.redare.2024.02.014
J. Rico-Feijoó , J.F. Bermejo , A. Pérez-González , S. Martín-Alfonso , C. Aldecoa

Background and objective

The diagnosis of infection, to diagnose septic shock, has been qualified by leukocyte counts and protein biomarkers. Septic shock mortality is persistently high (20%–50%), and rising in the long term. The definition of sepsis does not include leukocyte count, and lymphopenia has been associated with its mortality in the short term. Immunosuppression and increased mortality in the long term due to sepsis have not been demonstrated. The aim is to relate the occurrence of lymphopenia and its lack of recovery during septic shock with mortality at 2 years.

Patients and methods

Cohort of 332 elderly patients diagnosed with septic shock. Mortality at 28 days and 2 years was analysed according to leukocyte, neutrophil, and lymphocyte counts, and the ability to recover from lymphopenia (LRec).

Results

A total of 74.1% of patients showed lymphopenia, and 73.5% did not improve during ICU stay. Mortality was 31.0% and 50.3% at 28 days and 2 years, respectively. Lymphopenia was a predictor of early mortality (OR 2.96) and LRec of late mortality (OR 3.98). Long-term mortality was associated with LRec (HR 1.69).

Conclusions

In elderly patients with septic shock, 28-day mortality is associated with lymphopenia and neutrophilia, and LRec with 2-year mortality; this may represent 2 distinct phenotypes of behaviour after septic shock.

背景和目的:感染诊断,即脓毒性休克诊断,一直由白细胞计数和蛋白质生物标志物来定性。脓毒性休克的死亡率一直居高不下(20%-50%),并且长期呈上升趋势。脓毒症的定义不包括白细胞计数,而淋巴细胞减少症在短期内与脓毒症的死亡率有关。免疫抑制和败血症导致的长期死亡率增加尚未得到证实。本研究的目的是将脓毒性休克期间发生的淋巴细胞减少症及其未恢复情况与患者两年后的死亡率联系起来:患者和方法:332 名被诊断为脓毒性休克的老年患者。根据白细胞、中性粒细胞和淋巴细胞计数以及淋巴细胞减少症恢复能力(LRec)分析28天和2年后的死亡率:结果:74.1%的患者出现淋巴细胞减少症,73.5%的患者在重症监护室住院期间病情未见好转。28天和2年后的死亡率分别为31.0%和50.3%。淋巴细胞减少可预测早期死亡率(OR 2.96),LRec可预测晚期死亡率(OR 3.98)。长期死亡率与淋巴细胞减少症相关(HR 1.69):结论:在老年脓毒性休克患者中,28 天死亡率与淋巴细胞减少和中性粒细胞增多有关,而 LRec 与 2 年死亡率有关;这可能代表了脓毒性休克后两种不同的行为表型。
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引用次数: 0
Association between different corticosteroid regimens used in severe SARS-CoV-2 infection and short-term mortality: retrospective cohort study 严重 SARS-CoV-2 感染者使用的不同皮质类固醇治疗方案与短期死亡率之间的关系:回顾性队列研究。
Pub Date : 2024-05-01 DOI: 10.1016/j.redare.2024.02.012
A. González-Castro, A. Fernandez, E. Cuenca-Fito, Y. Peñasco, J. Ceña, J.C. Rodríguez Borregán

Introduction

During the SARS-CoV-2 pandemic, several corticosteroid regimens have been used in the treatment of the disease, with disparate results according to drug and regimen used. For this reason, we wanted to analyze differences in early mortality derived from the use of different regimens of dexamethasone and methylprednisolone in SARS-CoV-2 infection in critically ill patients requiring admission to an ICU.

Method

Observational, analytical and retrospective study, in an intensive care unit of a third-level university hospital, (March 2020 and June 2021). Adult patients (>18 years old) who were admitted consecutively for proven SARS-CoV-2 infection were included. The association with mortality in ICU at 28 days, different corticosteroid regimens used, was analyzed using a Cox proportional risk regression model.

Results

Data from a cohort of 539 patients were studied. Patient age (RR: 1.06; 95% CI: 1.02–1.10; P = <0.01) showed a significant association with 28-day mortality in the ICU. In the comparison of the different corticosteroid regimens analyzed, taking as a reference those patients who did not receive corticosteroid treatment, the dose of dexamethasone of 6 mg/day showed a clear trend towards statistical significance as a protector of mortality at 28 days in the ICU (RR: 0.40, 95% CI: 0.15–1.02, p = 0.05). The dose of dexamethasone of 6 mg/day and low doses of methylprednisolone show a similar association with survival at 28 days (OR: 1.19; 95% CI: 0.63–2.26).

Conclusions

The use of corticosteroids has been associated with better mortality outcomes in severe cases of SARS-CoV-2 infection. However, the therapeutic benefits of corticosteroids are not limited to dexamethasone alone.

导言:在 SARS-CoV-2 大流行期间,有多种皮质类固醇疗法被用于治疗该疾病,但不同药物和疗法的治疗效果各不相同。因此,我们希望分析在需要入住重症监护室的重症患者感染 SARS-CoV-2 时,使用地塞米松和甲基强的松龙的不同方案所导致的早期死亡率的差异:观察、分析和回顾性研究,在一所三级大学医院的重症监护病房进行(2020 年 3 月至 2021 年 6 月)。研究对象包括因证实感染 SARS-CoV-2 而连续入院的成年患者(18 岁以上)。采用 Cox 比例风险回归模型分析了不同皮质类固醇治疗方案与重症监护病房 28 天死亡率的关系:结果:共研究了 539 例患者的数据。患者年龄(RR:1.06;95% CI:1.02-1.10;p=结论:在感染 SARS-CoV-2 的严重病例中,使用皮质类固醇可改善死亡率。然而,皮质类固醇的治疗效果并不仅限于地塞米松。
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引用次数: 0
In reply to “Negative preoperative RT-PCR screening is no guaranty of no SARS-CoV-2 infection” 回复 "术前 RT-PCR 筛查阴性并不能保证没有感染 SARS-CoV-2"。
Pub Date : 2024-05-01 DOI: 10.1016/j.redare.2024.02.022
M. de la Matta , J.M. Delgado-Sánchez , G. Martín-Gutiérrez
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引用次数: 0
Pre-anaesthesia assessment in cataract surgery: Recommendations from the SEDAR Working Group 白内障手术麻醉前评估:SEDAR 工作组的建议。
Pub Date : 2024-05-01 DOI: 10.1016/j.redare.2024.02.029
L. Quecedo Gutierrez , E. Alsina , B. del Blanco Narciso , A. Vazquez Lima , M. Zaballos Garcia , A. Abad Gurumeta

Introduction and objectives

Cataract surgery is one of the most common procedures in outpatient surgery units. The use of information and communication technologies (ICT) in clinical practice and the advent of new health scenarios, such as the Covid pandemic, have driven the development of pre-anaesthesia assessment models that free up resources to improve access to cataract surgery without sacrificing patient safety. The approach to cataract surgery varies considerably among public, subsidised and private hospitals. This raises the need for guidelines to standardise patient assessment, pre-operative tests, management of background medication, patient information and informed consent.

Results

In this document, the SEDAR Clinical Management Division together with the Major Outpatient Surgery Division SEDAR Working Group put forward a series of consensus recommendations on pre-anaesthesia testing based on the use of ITCs, health questionnaires, patient information and informed consent supervised and evaluated by an anaesthesiologist.

Conclusions

This consensus document will effectivise pre-anaesthesia assessment in cataract surgery while maintaining the highest standards of quality, safety and legality.

导言和目标:白内障手术是门诊手术室最常见的手术之一。信息和通信技术(ICT)在临床实践中的应用以及新的健康状况(如 Covid 大流行病)的出现,推动了麻醉前评估模式的发展,从而在不牺牲患者安全的前提下释放资源,改善白内障手术的可及性。公立医院、受资助医院和私立医院的白内障手术方法大相径庭。这就需要制定指导方针,对患者评估、术前检查、背景药物管理、患者信息和知情同意进行标准化:在这份文件中,SEDAR 临床管理部门与主要门诊手术部门 SEDAR 工作组共同提出了一系列关于麻醉前检测的共识建议,这些建议基于 ITC、健康问卷、患者信息和知情同意书的使用,并由一名麻醉师进行监督和评估:该共识文件将有效促进白内障手术的麻醉前评估,同时保持最高的质量、安全和合法性标准。
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引用次数: 0
Before diagnosing a SARS-CoV-2-related PRES, alternative diagnoses must be ruled out 在诊断与sars - cov -2相关的PRES之前,必须排除其他诊断。
Pub Date : 2024-05-01 DOI: 10.1016/j.redare.2023.11.004
J. Finsterer
{"title":"Before diagnosing a SARS-CoV-2-related PRES, alternative diagnoses must be ruled out","authors":"J. Finsterer","doi":"10.1016/j.redare.2023.11.004","DOIUrl":"10.1016/j.redare.2023.11.004","url":null,"abstract":"","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138441916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Post-traumatic pleuro-pulmonary hernia 创伤后胸肺疝。
Pub Date : 2024-05-01 DOI: 10.1016/j.redare.2024.02.017
S. Esquivel Ramírez, L. Charro Hidalgo, U. Caballero Flores, C. Hernández Gamito
{"title":"Post-traumatic pleuro-pulmonary hernia","authors":"S. Esquivel Ramírez,&nbsp;L. Charro Hidalgo,&nbsp;U. Caballero Flores,&nbsp;C. Hernández Gamito","doi":"10.1016/j.redare.2024.02.017","DOIUrl":"10.1016/j.redare.2024.02.017","url":null,"abstract":"","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139998755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
SARS-CoV-2 RT-PCR in the absence of reference standards cannot warrant for a reliable analytical performance 在没有参考标准的情况下,SARS-CoV-2 RT-PCR 无法保证可靠的分析性能。
Pub Date : 2024-05-01 DOI: 10.1016/j.redare.2023.12.008
Salvatore Chirumbolo
{"title":"SARS-CoV-2 RT-PCR in the absence of reference standards cannot warrant for a reliable analytical performance","authors":"Salvatore Chirumbolo","doi":"10.1016/j.redare.2023.12.008","DOIUrl":"10.1016/j.redare.2023.12.008","url":null,"abstract":"","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139038365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effectiveness of a specific follow up program for the management of the mental components of post-intensive care syndrome and chronic pain after COVID-19: results from the PAIN-COVID randomized clinical trial 针对 COVID-19 感染后重症监护室后综合征和慢性疼痛的精神因素的特定随访计划的效果:PAIN-COVID 随机临床试验的结果。
Pub Date : 2024-05-01 DOI: 10.1016/j.redare.2023.12.009
A. Ojeda , A. Calvo , T. Cuñat , R. Mellado-Artigas , A. Costas-Carrera , M.M. Sánchez-Rodriguez , O. Comino-Trinidad , J. Aliaga , M. Arias , G. Martínez-Pallí , C. Dürsteler , C. Ferrando

Background

Critical COVID-19 survivors are at risk of developing Post-intensive Care Syndrome (PICS) and Chronic ICU-Related Pain (CIRP). We determined whether a specific care program improves the quality of life (QoL) of patients at risk of developing PICS and CIRP after COVID-19.

Methods

The PAIN-COVID trial was a parallel-group, single-centre, single-blinded, randomized controlled trial. The intervention consisted of a follow up program, patient education on PICS and pain, and a psychological intervention based on Rehm’s self-control model in patients with abnormal depression scores (≥8) in the Hospital Anxiety and Depression Scale (HADS) at the baseline visit. QoL was evaluated with the 5-level EQ 5D (EQ 5D 5 L), mood disorders with the HADS, post-traumatic stress disorder (PTSD) with the PCL-5 checklist, and pain with the Brief Pain Inventory short form, the Douleur Neuropathique 4 questionnaire, and the Pain Catastrophizing Scale. The primary outcome was to determine if the program was superior to standard-of-care on the EQ visual analogue scale (VAS) at 6 months after the baseline visit. The secondary outcomes were EQ VAS at 3 months, and EQ index, CIRP incidence and characteristics, and anxiety, depression, and PTSD at 3 and 6 months after baseline visits.

Conclusions

This program was not superior to standard care in improving QoL in critical COVID-19 survivors as measured by the EQ VAS. However, our data can help establish better strategies for the study and management of PICS and CIRP in this population.

Trial registration

# NCT04394169, registered on 5/19/2020.

背景:COVID-19危重症幸存者有患重症监护后综合征(PICS)和慢性重症监护病房相关疼痛(CIRP)的风险。我们确定了一项特定护理计划是否能改善 COVID-19 病后有可能患重症监护后综合征和慢性重症监护相关疼痛的患者的生活质量(QoL):PAIN-COVID 试验是一项平行组、单中心、单盲、随机对照试验。干预措施包括随访计划、PICS和疼痛方面的患者教育,以及基于雷姆自我控制模型的心理干预,干预对象为基线访问时医院焦虑抑郁量表(HADS)中抑郁评分异常(>=8)的患者。质量生活以 5 级 EQ 5D (EQ 5D 5 L) 进行评估,情绪障碍以 HADS 进行评估,创伤后应激障碍(PTSD)以 PCL-5 核对表进行评估,疼痛以简明疼痛量表简表、Douleur Neuropathique 4 问卷和疼痛灾难化量表进行评估。主要结果是确定该计划在基线访问后 6 个月的 EQ 视觉模拟量表(VAS)上是否优于标准护理。次要结果是 3 个月后的 EQ VAS,基线访问后 3 个月和 6 个月的 EQ 指数、CIRP 发生率和特征,以及焦虑、抑郁和创伤后应激障碍:结论:根据 EQ VAS 测量,该计划在改善 COVID-19 危重症幸存者的 QoL 方面并不优于标准护理。然而,我们的数据有助于为研究和管理该人群中的 PICS 和 CIRP 制定更好的策略:# NCT04394169,注册日期:2020年5月19日。
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引用次数: 0
Association between early manifestations of infection or sepsis and prognosis in a high complexity hospital in the city of Medellín 麦德林市一家高度复杂医院的感染或败血症早期表现与预后之间的关系。
Pub Date : 2024-05-01 DOI: 10.1016/j.redare.2024.04.001
J.A. Albarracin Duarte , J. Chaparro Hernández , J.A. Rojas Aceros , J.E. Valoyes Gélvez , J. Ascuntar , F. Jaimes

Objective

To identify the first symptoms and signs of patients with suspected infection or sepsis and their association with the composite outcome of admission to the Intensive Care Unit (ICU) or mortality.

Design

Prospective cohort study between June 2019 and March 2020.

Setting

Hospital Universitario San Vicente Fundación, Colombia.

Patients

Over 18 years of age with suspicion or confirmation of sepsis, which required hospitalization.

Interventions

None.

Main variables of interest

Symptoms and signs associated with infection, with their time of evolution, specified in the study.

Results

From 1005 eligible patients, 261 were included. After multivariable adjustment with a logistic regression model, the main factors for ICU admission or mortality were heart rate (OR 1.04 with 95% CI 1.04–3.7), respiratory rate (OR 1.19 with 95% CI 1.0−1.4) and capillary refill time (OR 3.4 with 95% CI 1.9−6.1).

Conclusions

Heart rate, respiratory rate, and capillary refill may behave as early predictors of ICU admission and mortality in cases of sepsis.

目的 确定疑似感染或败血症患者的首发症状和体征及其与重症监护病房(ICU)入院或死亡的综合结果之间的关系.设计 2019年6月至2020年3月期间的前瞻性队列研究.地点 哥伦比亚圣维森特基金大学医院.患者年龄在18岁以上,怀疑或确认患有败血症,需要住院治疗。干预措施无。主要关注变量与感染相关的症状和体征,以及研究中规定的演变时间。结论心率、呼吸频率和毛细血管再充盈时间可能是脓毒症患者入住 ICU 和死亡的早期预测因素。
{"title":"Association between early manifestations of infection or sepsis and prognosis in a high complexity hospital in the city of Medellín","authors":"J.A. Albarracin Duarte ,&nbsp;J. Chaparro Hernández ,&nbsp;J.A. Rojas Aceros ,&nbsp;J.E. Valoyes Gélvez ,&nbsp;J. Ascuntar ,&nbsp;F. Jaimes","doi":"10.1016/j.redare.2024.04.001","DOIUrl":"10.1016/j.redare.2024.04.001","url":null,"abstract":"<div><h3>Objective</h3><p>To identify the first symptoms and signs of patients with suspected infection or sepsis and their association with the composite outcome of admission to the Intensive Care Unit (ICU) or mortality.</p></div><div><h3>Design</h3><p>Prospective cohort study between June 2019 and March 2020.</p></div><div><h3>Setting</h3><p>Hospital Universitario San Vicente Fundación, Colombia.</p></div><div><h3>Patients</h3><p>Over 18 years of age with suspicion or confirmation of sepsis, which required hospitalization.</p></div><div><h3>Interventions</h3><p>None.</p></div><div><h3>Main variables of interest</h3><p>Symptoms and signs associated with infection, with their time of evolution, specified in the study.</p></div><div><h3>Results</h3><p>From 1005 eligible patients, 261 were included. After multivariable adjustment with a logistic regression model, the main factors for ICU admission or mortality were heart rate (OR 1.04 with 95% CI 1.04–3.7), respiratory rate (OR 1.19 with 95% CI 1.0−1.4) and capillary refill time (OR 3.4 with 95% CI 1.9−6.1).</p></div><div><h3>Conclusions</h3><p>Heart rate, respiratory rate, and capillary refill may behave as early predictors of ICU admission and mortality in cases of sepsis.</p></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140768186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Revista espanola de anestesiologia y reanimacion
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