静脉留置针行股静脉穿刺输液在神经外科脑疝患者术前抢救中的应用  

Impact of neoadjuvant chemoradiotherapy on prognosis and surgery for esophageal carcinoma

作　　者：段军伟[1] 谭敏[1] 唐晓平[1] 王远传[1] 罗仁国[1] 漆建[1] 唐文国[1] 冯凌[1] 李舜[1] 彭华[1] 张涛[1] 张静[1] 王惠君[1] 

机构地区：[1]川北医学院附属医院神经外科,四川南充637000

出　　处：《中华临床医师杂志（电子版）》2011年第1期159-160,共2页Chinese Journal of Clinicians(Electronic Edition)

基　　金：四川省医学重点建设学科基金资助(川卫办发[2007]407号)

摘　　要：目的探讨静脉留置针行股静脉穿刺输液在神经外科脑疝患者术前抢救中的意义。方法将我科334例单侧瞳孔散大的脑疝患者采用随机数字表法随机分为三组。A组(外周静脉输液组):静脉留置针行外周静脉穿刺输液120例。B组(中心静脉输液组):中心静脉穿刺置管输液102例。C组(静脉留置针行股静脉输液组):静脉留置针行股静脉穿刺输液112例。比较三组患者穿刺成功所需时间(T1)、输注20%甘露醇250ml所需时间(T2)、术前瞳孔回缩例数。结果 T1:A组为(2.16±0.82)min,B组为(11.73±4.43)min,C组为(2.29±0.92)min。经t检验:PAB<0.05,PBC<0.05,PAC>0.05。T2:A组为(35.78±1.69)min,B组为(19.74±1.97)min,C组为(19.81±2.03)min。经t检验:PAB<0.05,PBC>0.05,PAC<0.05。瞳孔回缩例数:A组为18例,B组为20例,C组为36例。经χ2检验:χ2=0.825,PAB>0.05,χ2=4.341,PBC<0.05,χ2=9.533,PAC<0.01。结论静脉留置针行股静脉穿刺置管输液能快速建立输液通道,且输液速度快,能够快速有效输注20%甘露醇等高渗脱水降颅内压抢救药物,迅速降低颅内压,缓解脑疝,为进一步手术治疗赢得时间,效果优于外周静脉输液及中心静脉输液,且并发症低,在神经外科脑疝患者的抢救中意义明显。Objective To evaluate the role of neoadjuvant chemoradiotherapy on prognosis and surgery for esophageal carcinoma by performing a meta-analysis of randomized controlled trials （RCTs） that compared neoadjuvant chemoradiotherapy and surgery with surgery alone for esophageal carcinoma.Methods PubMed and manual searches were done to identify all published RCTs that compared neoadjuvant chemoradiotherapy and surgery with surgery alone for esophageal cancer. According to the test of heterogeneity,a fixed-effects model or a random effects model was used and the relative risk （RR） was the principal measure of effect.Results Fourteen RCTs that included 1737 patients were selected with quality assessment ranging from A to C （Cochrane Reviewers＇ Handbook 4.2.2）. Relative risk （95% confidence interval [CI]; P value）,expressed as chemoradiotherapy and surgery versus surgery alone chemoradiotherapy-surgery（CRTS） versus surgery alone（S）; value 1 favor CRTS）,was 1.06 （95% CI 0.99~1.13; P=0.1） for 1-year survival,1.18 （95% CI 1.04~1.33; P=0.01） for 2-year survival,1.39 （95% CI 1.23~1.58; P0.00001） for 3-year survival,1.27 （95% CI 1.04~1.55; P=0.02） for 4-year survival,1.41 （95% CI 1.18~1.69; P=0.0001） for 5-year survival,1.01 （95% CI 0.97~1.05; P=0.67） for rate of resection,1.44 （95% CI 1.23~2.74; P=0.008） for rate of complete resection,1.70 （95% CI 1.12～2.56; P=0.01） for operative mortality,1.12 （95% CI 0.89-2.48; P=0.503） for all treatment mortality,1.23 （95% CI 0.93~1.78; P=0.13） for the rate of adverse treatment,1.18 （95% CI 1.22~1.61; P=0.0001） for local-regional cancer recurrence,1.18 （95% CI 0.75~1.68; P=0.71） for distant cancer recurrence,and 1.07 （95% CI 0.76~1.56; P=0.18） for all cancer recurrence. A complete pathological response to chemoradiotherapy occurred in 10%~45.5% of patients. The 5-year survival benefit was most pronounced when chemotherapy and radiotherapy were given concurrently （RR 1.34,95% CI 1.06~1.89,P=0.013） instead of

关 键 词：脑疝 静脉切开术 股静脉 输注 静脉内 

分 类 号：R473.6[医药卫生—护理学]