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Massive transfusion protocol (MTP) is a programmatic procedure for massive blood transfusions, which is an important means of patient blood management (PBM) for trauma and massive hemorrhage patients. MTP can be initiated in a variety of modes, including the McLaughlin, ABC and TASH scoring systems and the mode depending on the patient′s hemorheology. After MTP has been activated, blood components should be injected as soon as possible. Generally, red blood cells should be injected first, followed by plasma and platelets injected proportionally. MTP should be based on good damage control measures and good hemostatic treatment, and should try to avoid the waste of blood components.This article reviews the progress of research on MTP in the above aspects.
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Advanced intrahepatic cholangiocarcinoma(ICC) is one of the most common hepatic malignant tumors besides hepatocellular carcinoma, with occult onset, limited treatment and poor prognosis. Systemic treatment is a recommendable solution for advanced unresectable ICC. The authors reported the clinical experience of an ICC patient who underwent transarterial chemoembolization combined with immunotherapy plus target therapy.
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Objective To compare the bispectral index ( BIS) values at loss of consciousness in-duced by etomidate and propofol given by target-controlled infusion (TCI). Methods A total of 120 Amer-ican Society of Anesthesiologists physical statusⅠ-Ⅲ patients, aged 18-64 yr, scheduled for elective ca-rotid endartrectomy under total intravenous anesthesia, were divided into R0e, R1e, R2e, R0p, R1p and R2p groups (n＝20 each) using a random number table method. R1e and R1p groups received remifentanil at an target effect-site concentration (Ce) of 1 ng∕ml, and R2e and R2p groups received remifentanil at an target Ce of 2 ng∕ml. At the beginning of anesthesia induction, remifentanil was given by TCI until the pre-set effect-site concentration was achieved, and etomidate was given by TCI at an initial target plasma con-centration of 0. 6 μg∕ml followed by an increase by 0. 1 μg∕ml every minute until loss of consciousness in R0e, R1e and R2e groups, and propofol was given by TCI at an initial target plasma concentration of 2 μg∕ml followed by an increase by 0. 1 μg∕ml every minute until loss of consciousness in R0p, R1p and R2p groups. BIS values were recorded immediately after pasting the BIS electrode, when the preset Ce of remifentanil was achieved and at loss of consciousness. Results Compared with group R0p, BIS values were significantly decreased at loss of consciousness in group R0e ( P＜0. 05) . Compared with group R1p, BIS values were significantly decreased at loss of consciousness in group R1e ( P＜0. 05) . BIS values were significantly lower at loss of consciousness in group R2e than in group R2p ( P＜0. 05) . Conclusion BIS values are significantly lower at loss of consciousness induced by TCI of etomidate than propofol.
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Objective To investigate the application of preoperative autologous blood donation (PABD) in selective operation.Methods Retrospective investigations and analysis were carried out in clinical datas of 1 026 patients of PABD in selective operation from January 2016 to may 2017,comparing with those who had not performed PABD in the same time.Results ①The surgeries of PABD were mainly neurosurgery,urology,orthopedics,gynecology and hepatobiliary surgery,respectively,which accounted for 5.97％,4.90％,3.78％,3.76％ and 3.55％ of the patients in the same period;②The rate of transfusion of allogeneic red blood cells of selective operation in PABD group of neurosurgery,urology,orthopedics,gynecology and hepatobiliary surgery were 5.66％,2.51％,4.89％,0 and 4.88％,respetively,while not performed PABD group were 25.46％,28.58％,24.77％,10.62％ and 17.54％,respetively;③The rate of transfusion of the group of hemoglobin (Hb)＜ 120 g/L is significantly higher than those Hb is (120-129.9) g/L,(130-139.9)g/L and ≥ 140 g/L(7.65％vs 2.44％,3.66％ and 2.70％,P＞0.05).Conclusion ①PABD is mainly carried out in neurosurgery,urology,orthopedics,gynecology and hepatobiliary surgery;②The group of Hb＜ 120 g/L has a high rate transfusion of allogeneic erythrocyte in selective operations;③Only the PABD is improved can patients make benefit from it.
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Objective To investigate the effects of different anesthesia methods on oxidative stress in elderly patients undergoing neurosurgery.Methods Totally 60 patients undergoing neurosurgery were randomly divided into 3 groups:propofol group,isoflurane group and sevoflurane group (n-20 each group),heart rate(HR) and mean artery pressure(MAP) in all patients were recorded at the time points of pre anesthesia (T0),incision of skin (T1),incision of dura (T2),end of operation (T3).The activity of superoxide dismuase (SOD),catalase (CAT),and glutathione peroxidase (GSH-Px) were measured at the time of T0,6 h (T4),24 h (T5),48 h (T6),72 h (T7)after operation.The efficacy of anesthesia was evaluated by Glasgow Outcome Score (GOS) at 3 months after operation.Results The activity of SOD,CAT and GSH Px in 3 groups were lower at T5and T6 than at T0 (P＜0.05).The SOD activity at T4,T5,T5and TTwere higher in propofol group [(87.2±11.8) U/ml,(75.1±12.4) U/ml,(84.6±9.3) U/ml,(92.5±12.5) U/ml,respectively]than in isoflurane group [(75.0±12.2) U/ml,(63.8±8.9) U/ml,(70.3±9.0) U/ml,(82.5±13.5) U/ml,respectively] and in sevoflurane group [(79.4±10.4) U/ml,(68.7±10.5) U/ml,(72.0±10.9) U/ml,(85.17±8.41) U/ml,respectively] (all P＜0.05).The CAT activity at T5 was higher in propofol group [(66.59±7.21) U/ml] than in isaflurane group [(51.58±8.19) U/ml] and in sevoflurane group [(58.49±7.27) U/ml] (both P＜0.05).The GSH-Px activity was higher at T4,T5and T6 in group propofol[(159.2 ± 20.8) U,(140.7 ± 16.2) U,(152.3 ± 19.1) U,respectively] than in isoflurane group [(129.4±17.9) U,(108.3±15.9) U,(118.4±14.1) U,respectively] and in sevoflurane group [(140.1±15.8) U,(125.2± 17.1) U,(137.9±10.7) U,respectively] (all P＜0.05).The outcome of neurosurgery had no significant differences among the 3 groups (P＞0.05).Conclusions Propofol has a better effect on oxidative stress than isoflurane and sevoflurane in elderly patients undergoing neurosurgery.
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Objective To investigate the effect of different target effect-site concentrations (Ces) ofremifentanil on the median effective concentration (EC50 ) of etomidate required for loss of consciousness and disappearance of nociceptive stimuli-induced body movement. Methods Eighty ASA Ⅰ orⅡ patients aged 18-64 yr scheduled for elective gynecological surgery under general anesthesia were randomly divided into 4 groups ( n = 20 each): group R0 received no remifentanil and R1-3 groups received remifentanil at 3 predetermined target Ces of 1,2 and 3 ng/ml respectively. At the beginning of anesthesia induction, remifentanil was given by target-controlled infusion (TCI) until the predetermined Ces were achieved, TCI of etomidate was then started at a target plasma concentration of 0.6 μg/ml and then the target plasma concentration of etomidate increased by 0.1 μg/ml every 1 min until the patients lost consciousness and the body movement induced by the nociceptive stimuli disappeared. The Ce of etomidate required for loss of consciousness and disappearance of nociceptive stimuli-induced body move-ment was recorded and the EC50 was calculated by Probit method. Results With the increase in the target Ces of remifentanil, the EC50 of etomidate required for loss of consciousness and disappearance of nociceptive stimuli-induced body movement decreased gradually (P < 0.05) .Conclusion Remifentanil given by TCI can enhance the sedative and analgesic effect of etomidate concentration-dependently.