In order to improve the accuracy of blood pressure measurement in wearable devices, this paper presents a method for detecting blood pressure based on multiple parameters of pulse wave. Based on regression analysis between blood pressure and the characteristic parameters of pulse wave, such as the pulse wave transit time (PWTT), cardiac output, coefficient of pulse wave, the average slope of the ascending branch, heart rate, etc. we established a model to calculate blood pressure. For overcoming the application deficiencies caused by measuring ECG in wearable device, such as replacing electrodes and ECG lead sets which are not convenient, we calculated the PWTT with heart sound as reference (PWTTPCG). We experimentally verified the detection of blood pressure based on PWTTPCG and based on multiple parameters of pulse wave. The experiment results showed that it was feasible to calculate the PWTT from PWTTPCG. The mean measurement error of the systolic and diastolic blood pressure calculated by the model based on multiple parameters of pulse wave is 1.62 mm Hg and 1.12 mm Hg, increased by 57% and 53% compared to those of the model based on simple parameter. This method has more measurement accuracy.
Objective To investigate the effects of one-lung ventilation time on the concentration of tumor necrosis factor (TNF)-α and interleukin (IL)-6 in the bronchoalveolar lavage fluid (BALF), serum inflammatory markers and early pulmonary infection after radical resection of esophageal cancer. Methods Ninety patients with thoracoscope and laparoscopic radical resection of esophageal carcinoma were chosen. According to the thoracoscope operation time, the patients were divided into 3 groups including a T1 (0.5–1.5 hours) group, a T2 (1.5–2.5 hours) group and a T3 (>2.5 hours) group. Immediately after the operation, the ventilated and collapsed BALF were taken. Enzyme-linked immunosorbent assay (ELISA) method was used to determine the concentration of IL-6 and tumour necrosis TNF-α. The concentrations of procalcitonin (PCT), C-reactive protein (CRP), and white blood cell (WBC) were measured on the first, third, fifth day after operation. The incidence of pulmonary infection was observed within 3 days after operation. Result The IL-6 values of the right collapsed lung in all groups were higher than those in the left ventilated lung. The TNF-α value of the right collapsed lung in the T2 group and T3 group was higher than that in the left ventilated lung (P<0.05). Compared with in the right collapsed lung, the TNF-α and IL-6 values gradually increased with the the duration of one-lung ventilation (P<0.05). Compared with the left ventilated lung groups, the IL-6 value increased gradually with the duration of one-lung ventilation time (P<0.05). The TNF-α value of the T3 group was higher than that of the T1 and T2 groups (P<0.05). The PCT value of the T3 group was higher than that of the T1 group and T2 group on the third, fifth day after operation (P<0.05). But there was no significant difference in CRP and WBC among the three groups at different time points. The incidence of pulmonary infection in the T3 group was significantly higher than that in the T1 group within 3 days after operation (P<0.05). Conclusion With the extension of one-lung ventilation time, the release of local and systemic inflammatory mediators is increased, and the probability of pulmonary infection is higher.
ObjectiveTo discuss the reason and treatment strategy of gallbladder muddy stones after cholecysto-lithotomy. MethodsThe clinical data of 62 patients with gallbladder muddy stones after cholecystolithotomy who were treated in our hospital from December 2008 to December 2014 was analyzed retrospectively. ResultsThere were 43 patients without any symptom and 19 patients with acute cholecystitis in 62 patients. Four patients were diagnosed with septation gallbladder, 6 patients with long and tortuous cystic duct, 3 patients with calculus of cystic duct, 4 patients with common bile duct stones, 39 patients with periampullary diverticula, 18 patients with pancreaticobiliary maljunction, 6 patients with duodenal papilla stenosis, 29 patients with duodenal papillitis, and 3 patients with duodenal papilla adenocarcinoma. Two patients were treated with laparoscopic cholecystectomy (LC), 1 patient with endoscopic sphincterotomy (EST) /endoscopic balloon dilation (EPBD) and LC, 1 patient with percutaneous transhepafic gallbladder drainage (PTGD) and open cholec-ystectomy, 14 patients with PTGD and EST/EPBD, 1 patient with PTGD and hepatocholangioplasty with the use of gallbladder (HG), 34 patients with EST/EPBD, 3 patients with EST/EPBD and endoscopic biliay metal stent drainage (EBMSD), 5 patients with HG, and 1 patient with EST/EPBD and HG. The gallbladder muddy stones disappeared after operations in 55 patients with gallbladder reserved, and gallbladder ejection fraction increased from (42±12) % to (59±16) %. Of the 62 patients, 53 patients were followed up for 6 months to 6 years (the median time was 3.6-year). During the follow-up period, 3 patients were diagnosed with gallbladder stones, 2 patients with common bile duct stones, and 2 patients with intrahepatic and extrahepatic bile duct stones. ConclusionBile efferent tract obstruction is the important reason for the formation of gallbladder stones. HG, EST, and balloon expansion are the efficient methods to resolve the bile efferent tract obstruction.
Objective To evaluate the clinical efficacy of dexmedetomidine in perioperative management of on-pump cardiac surgery. Methods Randomized controlled trials (RCTs) were identified through a systematic literature search of PubMed, EBSCO, Web of Science, Cochrane Library, CBM, CNKI, Wanfang Database (up to December 2016). RevMan 5.3 software was used for meta-analysis. Results Sixteen studies with 1 432 patients were included. Dexmedetomidine significantly decreased the risk of postoperative delirium (RR=0.28, 95% CI 0.18 to 0.44, P<0.000 01) and postoperative atrial fibrillation (RR=0.65, 95% CI 0.44 to 0.98, P=0.04) compared with the controls. The duration of intubation (RR=–1.96, 95% CI –2.07 to –1.86, P<0.000 01), length of ICU stay (RR=–0.49, 95% CI –0.74, –0.24, P=0.000 1) and hospital stay (RR=–1.24, 95% CI –2.26 to –0.22, P=0.02) in the dexmedetomidine group were significantly shorter than those of the control group. In addition, dexmedetomidine was shown to improve the score of the the Montreal Cognitive Assessment (RR=0.88, 95% CI 0.42 to 1.35, P=0.000 2) compared to the control group. Conclusion Dexmedetomidine can reduce the complications after cardiac surgery, which is safe and effective. However, more studies with good methodologic quality and large samples are still needed to make further assessment.
ObjectiveTo analyze the perioperative safety and the short-term prognosis of non-small cell lung cancer (NSCLC) patients with preoperative arrhythmia. MethodsThe clinical data of NSCLC patients treated in the Department of Cardiothoracic Surgery, the First Affiliated Hospital of Chongqing Medical University from August 2020 to March 2021 were collected and observed. The patients were divided into an arrhythmia group and a control group according to whether there was arrhythmia in the 24 h ambulatory electrocardiogram examination report before operation. The incidence of intraoperative and postoperative cardiovascular events and short-term prognosis were compared between the two groups. Results A total of 466 patients were included in this study, including 338 patients in the arrhythmia group, 176 males and 162 females, with a median age of 68.0 (63.0, 72.0) years, and 128 patients in the control group, 59 males and 69 females, with a median age of 66.5 (60.0, 72.0) years. A total of 26 patients (7.7%) in the arrhythmia group were placed with temporary pacemakers before operation. There was no significant difference in the incidence of cardiovascular related events between the two groups [100 (29.6%) vs. 28 (21.9%), P=0.096]. The incidence of postoperative arrhythmia events in the arrhythmia group was higher than that in the control group [112 (33.1%) vs. 11 (8.6%), P<0.001]. The average postoperative ICU stay in the arrhythmia group was longer than that in the control group (1.1±0.7 d vs. 1.0±0.6 d, P=0.039). ConclusionPreoperative arrhythmia does not increase the risk of intraoperative cardiovascular events in NSCLC patients, but increases the incidence of postoperative arrhythmia events and prolongs ICU stay.
ObjectiveTo compare the effectiveness of different β-blockers for preventing postoperative atrial fibrillation (POAF) after cardiac surgery. Methods Databases of PubMed, Science Direct, Web of Science, The Cochrane Library, SinoMed, CKNI, VIP, WanFang were searched by the computer from inception to April 31, 2022 to collect randomized controlled studies on the comparison of the effectiveness of different β-blockers for preventing POAF. Two investigators independently screened the literature and extracted information. The quality of the literature was evaluated using Cochrane bias risk tool, and RevMan 5.3 and STATA 17.0 were used for meta-analysis. Results A total of 17 randomized controlled studies with 3 290 patients were included. Direct meta-analysis showed that landiolol and metoprolol were more effective than placebo (P≤0.001), and carvedilol was more effective than metoprolol in preventing the development of POAF (P<0.001). Network meta-analysis showed that landiolol, carvedilol and metoprolol were more effective than placebo in preventing the incidence of POAF (P<0.05). Landiolol and carvedilol were more effective than metoprolol, and carvedilol were more effective than nebivolol (P<0.05). The surface under the cumulative ranking curve from high to low were carvedilol, landilol, propranolol, atenolol, metoprolol, and nebivolol. Conclusion Carvedilol and landilol have different degrees of improvement in the occurrence of POAF, and carvedilol has the best preventive effect. More studies are required to verify the strength of evidence due to the limited sample size.
ObjectiveTo discuss the clinical effects of T-tube with side holes in the gallbladder-common hepatic duct anastomosis. MethodsThe clinical data of 60 cases that performed gallbladder-common hepatic duct anastomosis from Jul. 2009 to Jul. 2012 were retrospectively analyzed. The contractile functions and mucosal recovery of gallbladder were compared between the conventional T-tube and T-tube with side holes. ResultsTwenty-four cases of gallbladder-common hepatic duct anastomosis used conventional T-tube, the gallbladder were not developing in 6-8 weeks after operation by T-tube cholangiography, the gallbladder mucosa of 17 cases were normal without edema, congestion and edema were observed in 6 cases, and the normal gallbladder mucosa structure disappeared in 1 case. The gallbladder were developing in 6-8 weeks after operation by T-tube cholangiography in 36 cases that used T-tube with side holes, the gallbladder mucosa structure had not congestion, edema, and erosion. The gallbladder contractile function were normal. ConclusionsThe floc, blood clots, and inflammatory substances in gallbladder can be discharged into the intestine or drainage in vitro, and the bile can go into gallbladder and can be concentrated through the T-tube with side holes. Physiological flow of bile can return to normal and the function of gallbladder can recover early.
目的总结1例非肝移植胆管铸型患者的诊治过程。 方法对1例非肝移植胆管铸型患者的临床资料、辅助检查资料及治疗效果进行分析，并进行文献复习。 结果1例非肝移植胆管铸型患者经生化检查、胆胰管水成像（MRCP）、上腹部CT等检查诊断为胆囊结石伴胆囊炎、胆总管结石伴低位胆管梗阻。采取开腹胆道探查、胆道镜检查取石、胆囊切除、T管引流手术治疗。术中见胆囊缩小，与周围大网膜膜性粘连，肝十二指肠韧带水肿，胆总管扩张呈充盈状态。胆道镜下见肝内外胆管轻度扩张，肝外胆管壁炎性水肿较重，大量纤维素附着；胆总管末端通畅，可见胰管开口，进而诊断为胆胰合流异常。以胆道镜从胆总管内取出1枚结石，约2.0 cm×1.5 cm×1.0 cm大，质硬，表面光滑；另取出1枚胆管铸型，约3.5 cm×0.3 cm×0.3 cm大，质脆易碎，表面粗糙。该患者的手术顺利，切除胆囊术后病理学检查示慢性胆囊炎改变。术后恢复良好，未出现胆汁漏、出血等并发症。术后随访1年，复查上腹部CT提示无结石复发，肝功能各项指标均正常。 结论非肝移植胆管铸型较少见，胆胰合流异常是非肝移植胆管铸型和胆管结石形成的原因之一。胆道镜是清除胆管铸型和观察胆管内结构的重要工具。
ObjectiveTo discuss the relation between bile duct anastomotic stricture and bile duct injury by endo-scopic observation following liver transplantation and it, s efficacy of endoscopic treatment. Method The clinical data of 24 cases of bile duct anastomotic stricture following liver transplantation diagnosed by cholangiography were analyzed retro-spectively. Results①Twenty-four cases of bile duct anastomotic strictures were included in 3 cases of typeⅠa, 2 cases of typeⅠb, 4 cases of typeⅡ, 1 case of typeⅢa, 5 cases of typeⅢb, and 9 cases of typeⅢc.②The redness of intrahepatic bile duct mucosa, banding erosion, ulcer and fusion of anastomotic stricture mucosa could be seen in typeⅠa andⅢa. The redness of intrahepatic bile duct and anastomotic stricture mucosa could be seen in typeⅡwithout ulcer and fusion. The extensive erosion and ulcer of intrahepatic bile duct and redness of anastomotic stricture mucosa could be seen in typeⅢb. The extensive erosion, ulcer and partial necrosis of intrahepatic bile duct and anastomotic stricture mucosa could be seen in typeⅠb andⅢc.③Seventeen cases were cured by choledochoscopy through T tube, the biliary casts were moved out and the anastomotic strictures were relieved by balloon dilatation and placement of plastic stenting for 2 to 6 months, no recurrence happened. One case of typeⅠb treated by percutaneous transhepatic cholangial drainage(PTCD) and percuta-neous transhepatic cholangioscopy(PTCS) was developed into the stricture of typeⅡduring following-up for 19 months. Two cases of typeⅠa were treated by ERCP, the biliary casts were moved, one of which was cured, another 1 case was developed into the stricture of typeⅡduring following-up for 5 months. Two cases of typeⅡwere treated by ERCP, the biliary casts were moved, balloon dilatation and placement of plastic stent were performed, one of which was cured, another 1 case was recurrent during following-up for 1 months. The strictures were not relieved by multiple plastic stents for 4 to 6 months in 3 patients with recurrence and progress, but which was relieved by full-covered self-expanding removable metal stents for 4 to 7 months, there was no recurrence during following-up. One case of typeⅢb and one case of typeⅢc received the secondary open operation or choledochoscopy and placement of plastic stent for biliary infection and jaundice after the treatment of ERCP were cured. ConclusionsBiliary stricture following liver transplantation accompanies different degree biliary injury. The slightest is typeⅡand typeⅠa, typeⅢa is the second, typeⅢb is more serious, and typeⅠb and typeⅢc are the worst. Choledochoscopy is a better choose for anastomotic strictures. ERCP is not a better choose for anastomotic strictures of typeⅠb, Ⅲb, andⅢc.