Objective To compare the effectiveness of arthroscopy assisted percutaneous internal fixation and open reduction and internal fixation for Schatzker types II and III tibial plateau fractures. Methods Between August 2006 and April 2010, 58 patients with tibial plateau fractures of Schatzker types II and III were treated with arthroscopy assisted percutaneous internal fixation (arthroscopy group, n=38), and with open reduction and internal fixation (control group, n=20). There was no significant difference in gender, age, disease duration, fracture type, and compl ication between 2 groups (P gt; 0.05). The operation time, incision length, fracture heal ing time, and compl ications were compared between 2 groups. Knee function score and the range of motion were measured according to American Hospital for Special Surgery (HSS) scorestandard. Results All patients achieved primary incision heal ing. The arthroscopy group had smaller incision length andlonger operation time than the control group, showing significant differences (P lt; 0.05). The patients of 2 groups were followed up 12 to 14 months. At 6 months, the HSS score and the range of motion of the arthroscopy group were significantly greater than those of the control group (P lt; 0.05). The X-ray films showed bony union in 2 groups. The fracture heal ing time of the arthroscopy group was shorter than that of the control group, but no significant difference was found (t=2.14, P=0.41). Morning stiffness occurred in 2 cases (5.3%) of the arthroscopy group, joint pain in 6 cases (30.0%) of the control group (3 cases had joint stiffness) at 1 week, which were cured after symptomatic treatment. There was significant difference in the incidence of compl ications between 2 groups (χ2=6.743, P=0.016). Conclusion The arthroscopy assisted percutaneous internal fixation is better than open reduction and internal fixation in the treatment of tibial plateau fractures of Schatzker types II and III, because it has smaller incision length and shorter fracture heal ing time.
目的:探讨循证护理在气管切开术患者呼吸道管理中应用的效果及措施。方法:将104例患者随机分为观察组和对照组各52例。观察组重点从“气道湿化、肺部物理疗法、吸痰、气道感染的预防、口咽部护理”几个方面进行循证,获取最佳证据,指导临床护理,对照组按传统护理法。结果:观察组患者并发症的发生率、死亡率显著低于对照组,患者及家属对护理工作的满意率明显提高。结论:运用循证护理能减少患者并发症的发生,降低病死率,提高生存质量。
Abstract： Objective To find out goodness and weakness by comparing totally thoracoscopic surgery （TTS）and median sternotomy （MS）with cardiopulmonary bypass for pediatric open heart operation. Methods One hundred and fortyseven patients with ventricular septal defect(VSD) and atrial septal defect(ASD) were randomly divided into two groups according to operative methods, TTS group: patients were operated by totally thoracoscopy; MS group: patients were operated by median sternotomy with cardiopulmonary bypass. The clinical records from two groups were compared on operative effect, complications, hospitalization, ventilation time,variations of main data of blood routine test, drainage of pleura cavity, blood loss and transfusion, and pulmonary function. Results There were no death in two groups. There was VSD residual leak the same day after operation which was cured by TTS in one patient of TTS group. There was one case which bleeding was stopped by second operation in MS group. Followup visit were made to 41 patients for 3 months, no heart murmur was detected. The ultrasonic cardiography (UCG) showed that correcting of VSD and ASD were good and had no residual leak. The hospitalization,aortic clampping time, ventilation time and variations of main data of blood routine test, drainage of pleura cavity, blood transfusion and blood loss in TTS group had no significant difference to those in MS group (Pgt;0.05). Operating times was longer in TTS group than that in MS group, while stays in the intensive care unit were shorter in TTS group than that in MS group (Plt;0.01). Preoperative and 3 months postoperative pulmonary function of both teams had no statistically significant difference in two groups (Pgt;0.05). Conclusion TTS is a safe and effective method to pediatric VSD and ASD as MS is.
Objective To study the clinical feasibility of invasive mechanical ventilation with bilevel positive airway pressure（BiPAP） non-invasive ventilator in the stable patients needing prolonged mechanical ventilation.Methods Eleven patients with respiratory failure admitted in intensive care unit（ICU）of our department，who needed prolonged mechanical ventilation，between Jun 2004 and Nov 2007 were enrolled in the study and followed until death or Jan 2008.The arterial blood gas analysis data，length of stay(LOS)，LOS after changing to BiPAP non-invasive ventilator（Synchrony，Harmony，RESPIRONICS，VPAP III ST-A，RESMED），survival time after discharge(or fulfilled the discharge standards) were reviewed retrospectively.Results The settings of inspiratory pressure，expiratory pressure and respiratory rate of non-invasive ventilation were 21.3 (16-26) cm H2O，4 cm H2O，and 16 min-1，respectively.The LOS (or up to the discharge standard) was (91.5±50.2) days.The LOS (or up to the discharge standard) after changing to BiPAP ventilator was (23.5±12.2) days.The mean survival time after discharge (or up to the discharge standard) was (353.1±296.5) days.Four patients were still alive up to the end of the study.The arterial pH，PaCO2，PaO2，and SaO2 were not significant different before and after changing to BiPAP ventilator.Conclusion The mechanical ventilation with BiPAP non-invasive ventilator via tracheotomy tube is an alternative choice for stable patients needing prolonged mechanical ventilation.
ObjectiveTo explore the risk factors for tracheal stenosis caused by tracheotomy or intubation.MethodsFrom July 2010 to July 2020, a total of 44 patients were suffered with tracheal stenosis caused by tracheotomy or intubation at the First Affiliated Hospital of Hunan Normal University as case group (n=44), and 34 patients were suffered tracheotomy or intubation without tracheal stenosis as control group (n=34). The clinical application of intratracheal tube cuff diameter was investigated by univariate comparison, ROC analysis and multivariate logistic regression analysis.ResultsUnivariate analysis showed intratracheal tube cuff diameter (C)/transverse diameter at the level of the clavicle >150%, intubation time>7d, tracheal intubations/tracheostomy ≥2, recurrent respiratory tract infections and replacement of tracheal tube≥ 2 were the influence factors of posttracheostomy tracheal stenosis (PTTS) and postintubation tracheal stenosis (PITS) (P<0.005). Multivariate Logistic regression analysis showed C/T>150% (OR=6.681, 95%CI: 1.164 - 38.363), intubation time>7d (OR=4.723, 95%CI: 1.413 - 15.779), tracheal intubations/tracheostomy ≥2 (OR=4.526, 95%CI: 1.133 - 18.083) and recurrent respiratory tract infections (OR=3.681, 95%CI: 1.177 - 11.513) were positively correlated with PTTS and PITS. The area under the ROC curve (AUC) of C/T>150% was 0.665 with the sensitivity of 0.364 and the specificity of 0.033 (95%CI: 0.555 - 0.775). AUC of intubation time>7 d was 0.717 with the sensitivity of 0.568 and the specificity of 0.133 (95%CI: 0.613 - 0.821). AUC of tracheal intubations/tracheostomy ≥2 was 0.683 with the sensitivity of 0.432 and the specificity of 0.067 (95%CI: 0.574 - 0.791). AUC of recurrent respiratory tract infections was 0.707 with the sensitivity of 0.614 and the specificity of 0.200 (95%CI: 0.603 - 0.811). However, there was no statistically significant difference C/T>150% and those clinical data in Z test (Z=0.839, P=0.402; Z=0.302, P=0.763; Z=0.751, P=0.453).ConclusionIntubation time>7 d, tracheal intubations/tracheostomy ≥2, recurrent respiratory tract infections, replacement of tracheal tube≥ 2 and C/T>150% are risk factors for PTTS and PITS.
Objective To compare the efficacy and safety of different airway humidification methods in patients with tracheotomy in weaning process. Methods Twelve patients with tracheotomy in the medical intensive care unit ( MICU) of the First Affiliated Hospital of Sue Yat-sen University fromSeptember 2008 to August 2009 were enrolled in which 45 case /times weaning tests in three different humidification ways were performed( 15 cases in each group) . Wet square gauze method was used in group A and traditional intermittent wet fluid drip method was used in group B. In group C, MR850 humidifier device, RT200 Venturi tube and T tube device were used to perform humidification. Comparisons were carried out between the three groups on sputum viscosity, comfort of patients before and after humidification, length of weaning time, frequencies of irritating coughs and phlegm formation during test period. Sputum viscosity was evaluated by airway secretion score ( AWSS) .Results There was no significant difference of sputum viscosity assessed by AWSS in group A before and after humidification( P gt; 0. 05 ) while AWSS was significantly increased in group B and group C ( P lt;0. 01) , implied that sputum viscosity was significantly lower than that of group A ( P lt;0. 05) . The scores of patients’comfortwere 3. 0 ±0. 4, 5. 0 ±1. 2, and 8. 0 ±1. 7 in groups A, B, and C respectively which mean that the patients in group C felt more comfortable than those in group A and group B ( P lt;0. 01) . Cough frequencies of groups A, B and C per hour were 0. 8,2. 6,and 0. 4 times/hour respectively in which the frequency of group B was significantly higher than those of group A and group C ( P lt;0. 01) . The frequency of phlegm formation in group A was 7 times in 15-times offline record, which was significantly higher than those in group B and group C ( P lt;0. 01) . Conclusions For the patients with tracheotomy in weaning process, MR850 humidifier device, RT200 Venturi tube and T tube device for humidification is superior in reducing sputum viscosity and phlegm formation, improving patient comfort, and reducing the occurrence of irritating cough.
Objective To explore the oxygen therapy effects of high-flow T-tube oxygen therapy on neurointensive care patients who have undergone tracheostomy and are undergoing mechanical ventilation while meeting the criteria for weaning from mechanical ventilation, especially in terms of controlling airway temperature and humidity, promoting mucus dilution, and reducing postoperative complications. MethodsCollected data from 50 neurointensive care patients who underwent tracheostomy and were on mechanical ventilation, meeting the criteria for weaning from mechanical ventilation, treated at West China Hospital of Sichuan University from September 2019 to September 2021. The three groups of patients had different weaning methods: a high-flow T-tube for weaning, a heat and moisture exchanger (artificial nose) for weaning, and a high-flow tracheal joint for weaning. The vital signs, dyspnea and blood gas analysis before and three days after weaning were collected. The primary outcomes were mechanical sputum excretion, postural drainage, phlegm-resolving drugs use, airway-related events (artificial airway blockage, artificial nose blockage, lung infection), stay in ICU (days), and death in ICU. Results Among the 50 patients, 28 were males and 22 were females. There were no significant differences in age, weight, height, gender, finger pulse oxygen saturation, heart rate, APACHEII score, sequential organ failure assessment, or Glasgow coma scale among the three groups (P>0.05). There was no statistical difference in the number of 72-hour mechanical sputum excretion or the use of phlegm-resolving drugs in the three groups (P=0.113, P=1.00). Conclusion The use of high-flow T-tube oxygen therapy in neurointensive care patients who have undergone tracheostomy, are on mechanical ventilation, and meet the criteria for weaning from mechanical ventilation can effectively control airway temperature and humidity, promote mucus dilution for better drainage, thereby reducing post-tracheostomy complications.
目的 比较经皮扩张气管切开术（PDT）和开放式气管切开术（OT）在成批吸入性损伤患者中的应用效果。 方法 采用前瞻性随机性研究方法，将2006年1月－2010年12月收入三峡大学人民医院重症医学科的4批34例吸入性损伤患者，分为PDT组（n=17）和OT组（n=17），比较两组的手术时间、出血量、并发症，观察手术前后的平均动脉压（MAP）、心率（HR）、呼吸频率（R）、动脉血氧分压（PaO2）和动脉血二氧化碳分压（PaCO2）。 结果 PDT组与OT组手术时间分别为（7.0 ± 1.9）、（18.0 ± 11.4）min，差异有统计学意义（P=0.000）；PDT组与OT组出血量分别为（7.0 ± 4.4）、（19.0 ± 12.1）mL，差异有统计学意义（P=0.001）；两组患者气管切开前及切开后的MAP、HR、R、PaO2和PaCO2差异无统计学意义（P＞0.05）；PDT组发生出血并发症1例，OT组发生出血、皮下气肿、纵隔气肿及切口感染等并发症共6例，PDT组并发症发生率低于OT组，差异有统计学意义（P=0.034）。 结论 PDT在救治成批吸入性损伤患者时比OT更快地建立人工气道，而出血量、并发症发生率均低于OT，值得推广应用。
目的 探讨胆源性肝脓肿的诊治方法。方法 对我院2000~2004年期间收治并确诊为胆源性肝脓肿的12例患者进行分析，在应用抗生素和全身支持的前提下，再依据其病变发生、发展的不同阶段采用不同手段治疗。结果 4例急性期患者中2例行急诊胆道引流手术后治愈，另2例转为亚急性期（脓肿融合期）； 6例亚急性期患者均经B超导向下行脓肿穿刺抽脓后注入抗生素治疗后治愈； 4例慢性期患者行脓肿切开引流后治愈。结论 本病在应用广谱抗生素（二联抗生素）和全身支持治疗的前提下，再根据病变不同时期采用不同方法治疗，可获得良好效果。