Revista espanola de anestesiologia y reanimacion最新文献

英文中文

Suzetrigine as a non-opioid analgesic: Between need and scientific evidence 舒三嗪作为一种非阿片类镇痛药：在需求和科学证据之间。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-10-01 DOI: 10.1016/j.redare.2025.501858

A. Alcántara Montero

引用次数: 0

Comparison of serratus plane and erector spinae plane blocks for postoperative analgesia in unilateral breast surgery 单侧乳房手术后锯肌平面与竖脊肌平面阻滞镇痛的比较。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-10-01 DOI: 10.1016/j.redare.2025.501830

K. Şahin , C. Sayman , S. Kına , A. Surhan Çınar

Objective

The use of interfascial plane blocks for postoperative analgesia is becoming more widespread because they are easier to perform and have fewer complications. This prospective, single-blind, randomized controlled study compares the efficacy of serratus plane block (SPB) and erector spinae plane block (ESPB) for postoperative analgesia in patients undergoing unilateral breast surgery.

Methods

Seventy-four ASA I–II patients aged 18–65 years who underwent elective unilateral breast surgery were included in the study. After exclusion, 70 patients were randomized to receive SPB (n = 35) or ESPB (n = 35). In both groups, nerve blocks were administered under ultrasound guidance with 25 ml of 0.25% bupivacaine. Postoperative pain (assessed using the visual analogue scale [EVA]), duration of analgesia, tramadol consumption, and incidence of complications were recorded.

Results

There were no significant differences in EVA scores between groups. However, duration of analgesia was significantly higher in the ESPB group (395.6 ± 141.9 min) vs the SPB group (290.3 ± 148.3 min) (p = 0.003). Total tramadol consumption over 24 h was similar between groups: 70.9 ± 48.6 mg in the SPB group and 70.3 ± 50.5 mg in the ESPB group. Minimal postoperative complications, including nausea and vomiting, were noted with no significant difference between groups.

Conclusion

Both SPB and ESPB were safe and provided similar postoperative analgesia in patients undergoing unilateral breast surgery. ESPB provides longer lasting analgesia, and therefore improves patient comfort in the early postoperative period.

目的：由于筋膜间平面阻滞术操作简单、并发症少，其在术后镇痛中的应用越来越广泛。这项前瞻性、单盲、随机对照研究比较了锯肌平面阻滞（SPB）和竖脊肌平面阻滞（ESPB）对单侧乳房手术患者术后镇痛的疗效。方法：74例ASA I-II型患者，年龄18-65岁，接受选择性单侧乳房手术。排除后，70例患者随机接受SPB （n = 35）或ESPB （n = 35）。两组患者均在超声引导下应用25 mL 0.25%布比卡因进行神经阻滞。记录术后疼痛（采用视觉模拟量表[EVA]评估）、镇痛持续时间、曲马多用量及并发症发生率。结果：两组患者EVA评分差异无统计学意义。然而，ESPB组的镇痛时间（395.6±141.9分钟）明显高于SPB组（290.3±148.3分钟）（p = 0.003）。两组间24小时曲马多总消耗量相似：SPB组为70.9±48.6 mg， ESPB组为70.3±50.5 mg。最小的术后并发症，包括恶心和呕吐，组间无显著差异。结论：SPB和ESPB对单侧乳房手术患者的术后镇痛效果相似，安全可靠。ESPB提供更持久的镇痛，因此提高了术后早期患者的舒适度。

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引用次数: 0

Poliomyelitis: The paradigm of an eliminated disease: Sequelae and challenges to eradication. 脊髓灰质炎：已消灭疾病的范例：后遗症和根除的挑战。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-09-15 DOI: 10.1016/j.redare.2025.500484

José Tuells, José Antonio Hurtado-Sánchez

Polio represents one of the most emblematic cases in the history of public health. Its greatest impact occurred during the first half of the 20th century, with devastating epidemic outbreaks that caused half a million cases annually with tens of thousands of deaths, in addition to leaving many survivors permanently paralyzed. The scientific community responded in an exemplary manner by studying polio until they developed two effective vaccines: an inactivated vaccine (Salk, 1955) and an attenuated vaccine (Sabin, 1962). A global response was immediately organized based on international cooperation, well-defined immunization strategies, and epidemiological surveillance. The mass vaccination effort carried out since 1988 through the Global Polio Eradication Initiative (GPEI) managed to reduce cases by 99.9%. Currently, the wild polio virus only persists in Afghanistan and Pakistan, and the GPEI's "Eradication Strategy 2022-2026" has been implemented with the hope of certifying its complete eradication in the coming years. Two significant challenges remain: controlling outbreaks caused by vaccine-derived polioviruses and increasing low immunization coverage in certain regions.

小儿麻痹症是公共卫生史上最具代表性的病例之一。它的最大影响发生在20世纪上半叶，毁灭性的流行病爆发，每年造成50万例病例，数万人死亡，此外还使许多幸存者永久瘫痪。科学界以模范的方式作出反应，研究小儿麻痹症，直到研制出两种有效的疫苗：一种灭活疫苗（Salk， 1955年）和一种减毒疫苗（Sabin， 1962年）。根据国际合作、明确的免疫战略和流行病学监测，立即组织了全球应对行动。1988年以来通过全球根除脊髓灰质炎行动开展的大规模疫苗接种工作使病例减少了99.9%。目前，野生脊髓灰质炎病毒仅在阿富汗和巴基斯坦存在，GPEI的“2022-2026年根除战略”已经实施，希望在未来几年内证明其完全根除。仍然存在两项重大挑战：控制由疫苗衍生脊髓灰质炎病毒引起的疫情，以及提高某些地区低免疫覆盖率。

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引用次数: 0

Clinical guidelines and strategic plan for the prevention, diagnosis and treatment of delirium: The zero delirium project 谵妄预防、诊断和治疗的临床指南和战略计划：零谵妄项目。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-08-01 DOI: 10.1016/j.redare.2025.501805

O. de la Varga-Martínez , R. Badenes , C. Gordaliza , S. de Miguel Manso , G.E. Landázuri Castillo , C. Armenteros Aragon , M. Fernández Castro , A.B. Martin Santos , R. Lopez Herrero , R. Navarro Pérez , A. Abad Gurumeta , M. Varela Duran , M. Heredia Rodriguez , E. Tamayo Gómez , external reviewers

The aim of this clinical practice guideline is to provide a rationale for the implementation of the Zero Delirium Project (ZDP) - a series of recommendations for patients in special critical care units (SCCU). The recommendations were developed by a group of anaesthesiologists from around Spain, and were reviewed by the Scientific Committee of the Spanish Society of Anaesthesiology, Resuscitation and Pain Therapy. Delirium is an acute, fluctuating, multifactorial syndrome characterised by inattention, disorganised thinking, and an altered level of consciousness. It may affect up to 56% in patients during their stay in critical care, and is important because many SCCUs have not yet introduced routine delirium screening, treatment and prevention strategies. Staff that are able to recognise and diagnose delirium can prevent it, treat it and reduce its incidence, which in turn reduces morbidity, mortality and costs. The ZDP was created with this aim in mind.

本临床实践指南的目的是为零谵妄项目（ZDP）的实施提供一个基本原理-对特殊重症监护病房（SCCU）患者的一系列建议。这些建议是由一组来自西班牙各地的麻醉师提出的，并由西班牙麻醉、复苏和疼痛治疗学会科学委员会进行了审查。谵妄是一种急性的、波动的、多因素的综合征，以注意力不集中、思维混乱和意识水平改变为特征。在重症监护期间，它可能影响高达56%的患者，这一点很重要，因为许多sccu尚未引入常规的谵妄筛查、治疗和预防策略。能够识别和诊断谵妄的工作人员可以预防、治疗谵妄并减少其发病率，从而降低发病率、死亡率和成本。ZDP是在这个目标下创建的。

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引用次数: 0

Factors associated with postoperative anastomotic leak and comparison of 4 prediction scales in colorectal surgery 结直肠手术术后吻合口瘘的相关因素及4种预测量表的比较。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-08-01 DOI: 10.1016/j.redare.2025.501852

J.M. Nieves-Alonso, L.A. Gómez Arredondo, P. Maestre Serantes, C. Martín Martín, F. Guitart de la Lastra, F. Ramasco Rueda

Introduction

Anastomotic leakage is a serious post-colorectal surgery complication, and has an incidence ranging from 2.8% to 30%. Identifying risk factors and evaluating prediction scores could optimize perioperative management. This study analyses factors associated with dehiscence and compares the predictive capacity of four scales: ASA, CCI, RCRI and AUB-HAS2.

Methods

Retrospective observational study in 182 patients undergoing colorectal surgery with anastomosis in a Spanish tertiary hospital (2018–2020). Clinical and perioperative data were collected, and the ASA, CCI, RCRI and AUB-HAS2 scores were calculated. Risk factors were analysed using multivariate logistic regression, and predictive capacity was assessed with ROC curves.

Results

Leakage occurred in 13.2% of cases. In the multivariate analysis, heart failure (OR: 4.14; 95% CI: 1.14−13.77) and laparotomy (OR: 2.67; 95% CI: 1.07–6.60) were significantly associated with dehiscence. None of the scales predicted this complication. The AUB-HAS2 and CCI scales were associated with 30-day mortality (AUC: 0.81 and 0.74, respectively), and the CCI predicted the need for organ support (AUC: 0.71).

Conclusion

Heart failure and laparotomy are independent risk factors for anastomotic leakage. Although none of the scales predicted this complication, the AUB-HAS2 and CCI were useful in stratifying postoperative mortality. This highlights the importance of personalized assessment.

吻合口瘘是结直肠术后严重的并发症，发生率为2.8% ~ 30%。识别危险因素并评价预测评分可优化围手术期管理。本研究分析了崩裂的相关因素，并比较了ASA、CCI、RCRI和AUB-HAS2四种量表的预测能力。方法：回顾性观察2018-2020年西班牙某三级医院182例结直肠吻合术患者。收集临床及围手术期资料，计算ASA、CCI、RCRI、AUB-HAS2评分。多因素logistic回归分析危险因素，ROC曲线评估预测能力。结果：13.2%的病例发生渗漏。在多变量分析中，心力衰竭(OR: 4.14；95% CI: 1.14-13.77)和剖腹手术(OR: 2.67；95% CI: 1.07-6.60)与裂裂显著相关。所有的量表都没有预测到这种并发症。AUB-HAS2和CCI量表与30天死亡率相关（AUC分别为0.81和0.74），CCI预测器官支持需求（AUC为0.71）。结论：心衰和剖腹手术是吻合口瘘的独立危险因素。虽然没有一种量表能预测这种并发症，但AUB-HAS2和CCI对术后死亡率分层是有用的。这突出了个性化评估的重要性。

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引用次数: 0

Usefulness of Point-of-Care Ultrasound in the differential diagnosis of postoperative cervical oedema after posterior cervical spine surgery 即时超声在后颈椎手术后颈椎水肿鉴别诊断中的价值。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-08-01 DOI: 10.1016/j.redare.2025.501666

B. Rodríguez Sánchez , I. Fuertes Arenal , J.J. Algaba Jaramillo , P. Morillas Sendin

引用次数: 0

Update on the treatment of neuropathic pain from the Neuropathic Pain Special Interest Group of International Association for the Study of Pain 国际疼痛研究协会神经性疼痛特别兴趣小组关于神经性疼痛治疗的最新进展。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-08-01 DOI: 10.1016/j.redare.2025.501856

A. Alcántara Montero

引用次数: 0

Postoperative delirium: From international evidence to clinical practice in Spain – a challenge yet to be addressed 术后谵妄：从国际证据到西班牙临床实践-一个尚未解决的挑战

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-08-01 DOI: 10.1016/j.redare.2025.501920

Aldana E.M. , C. Aldecoa

引用次数: 0

Postoperative acute kidney injury in major abdominal surgery. Utility of the urinary biomarker [TIMP-2] × [IGFBP7] (NephroCheck™) 腹部大手术术后急性肾损伤。尿生物标志物[TIMP-2] × [IGFBP7] （NephroCheck®）的应用

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-08-01 DOI: 10.1016/j.redare.2025.501853

A. Lara-Jiménez , P. Monedero , G. Echarri

Background

The urinary biomarker [TIMP-2] × [IGFBP7] enables the prediction of postoperative acute kidney injury (PO-AKI). Our study aimed to assess the incidence of PO-AKI in high-risk patients undergoing major abdominal surgery and to evaluate the impact of implementing KDIGO renal optimization measures in those with renal stress identified by [TIMP-2]×[IGFBP7].

Materials and methods

This was a prospective study including 182 patients who underwent major abdominal surgery. Perioperative data, [TIMP-2] × [IGFBP7] levels, and the implementation of KDIGO renal protection strategies in the ICU were collected. Predictors of PO-AKI were identified through multivariate analysis.

Results

The overall incidence of PO-AKI was 25.3%, reaching 42.7% in ICU patients. [TIMP-2] × [IGFBP7] showed moderate predictive ability (AUROC = 0.74), with a PO-AKI incidence of 47.5% in patients with elevated levels. Despite the implementation of KDIGO measures in the ICU, the incidence of PO-AKI in patients with elevated [TIMP-2] × [IGFBP7] was 65.6%. In multivariate analysis, the main predictors of PO-AKI were elevated [TIMP-2] × [IGFBP7] (OR = 6.3; 95% CI: 2.6–15.6; p < 0.001), male sex (OR = 6.1; 95% CI: 1.9–19.6; p = 0.002), and ICU admission (OR = 4.5; 95% CI: 1.5–13.6; p = 0.009).

Conclusions

PO-AKI is common after major abdominal surgery, particularly in ICU patients. The [TIMP-2] × [IGFBP7] biomarker allows for early identification of at-risk patients, although the implementation of KDIGO measures in the ICU did not significantly reduce its incidence.

背景：尿生物标志物[TIMP-2]×[IGFBP7]能够预测术后急性肾损伤（PO-AKI）。本研究旨在评估接受腹部大手术的高危患者PO-AKI的发生率，并评估实施KDIGO肾脏优化措施对[TIMP-2]×[IGFBP7]识别的肾应激患者的影响。材料和方法：这是一项前瞻性研究，包括182例接受腹部大手术的患者。收集围手术期数据、[TIMP-2]×[IGFBP7]水平及KDIGO肾保护策略在ICU的实施情况。通过多变量分析确定PO-AKI的预测因素。结果：PO-AKI总发生率为25.3%，在ICU患者中达到42.7%。[TIMP-2]×[IGFBP7]具有中等预测能力（AUROC = 0.74），升高的患者PO-AKI发生率为47.5%。尽管在ICU实施了KDIGO措施，但在[TIMP-2]×[IGFBP7]升高的患者中，PO-AKI的发生率为65.6%。在多因素分析中，PO-AKI的主要预测因子为[TIMP-2]×[IGFBP7]升高(OR = 6.3；95% ci: 2.6-15.6；结论：PO-AKI在腹部大手术后很常见，特别是在ICU患者中。[TIMP-2]×[IGFBP7]生物标志物允许早期识别高危患者，尽管在ICU实施KDIGO措施并没有显著降低其发生率。

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引用次数: 0

Exploring the role of flow cytometry to assess endothelial cells in human sepsis: A systematic review 探索流式细胞术在人类败血症中评估内皮细胞的作用：一项系统综述。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-08-01 DOI: 10.1016/j.redare.2025.501850

M. Bardají-Carrillo , M. Martín-Fernández , A. García-Concejo , Á. Tamayo-Velasco , D. Bernardo , E. Tamayo

Introduction

Given the key role of the endothelium in organ failure secondary to sepsis, we reviewed the available literature on the use of flow cytometry (FC) to analyse endothelial cells in human sepsis.

Methods

We systematically searched PubMed and Web of Science from inception until November 2024 to identify original research articles describing the use of FC to study human endothelial cells in sepsis.

Results

A total of 395 original articles were found; 36 met the inclusion criteria. Ten studied circulating mature (CEC) or progenitor (CEPC) endothelial cells. High CEC and/or CEPC counts correlated with higher mortality; CEC numbers were increased even before the onset of shock. Twenty-six manuscripts studied the phenotype of different human microvascular endothelial cells (HMEC), and showed that expression of adhesion molecules ICAM-1, VCAM-1 and E-selectin were increased in sepsis, but there was no evidence of their association with severity or mortality.

Conclusion

High CEC and CEPC counts correlate with sepsis severity and mortality, confirming that their assessment by FC can shed some light on early sepsis diagnosis.

鉴于内皮在脓毒症继发器官衰竭中的关键作用，我们回顾了利用流式细胞术（FC）分析人类脓毒症中内皮细胞的现有文献。方法：我们系统地检索PubMed和Web of Science从成立到2024年11月，以确定描述使用FC研究脓毒症中的人内皮细胞的原始研究文章。结果：共发现原创文章395篇；36例符合纳入标准。10个研究循环成熟（CEC）或祖（CEPC）内皮细胞。高CEC和/或CEPC计数与高死亡率相关；甚至在休克开始前CEC数就增加了。26篇文献研究了不同人微血管内皮细胞（HMEC）的表型，结果显示黏附分子ICAM-1、VCAM-1和e -选择素在脓毒症中表达增加，但没有证据表明它们与严重程度或死亡率相关。结论：高CEC和高CEPC计数与脓毒症的严重程度和死亡率相关，证实了FC对它们的评估有助于脓毒症的早期诊断。

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