As a novel analgesic method, erector spinae plane block is increasingly widely used during perioperative period. This technique mainly injects local anesthetic drugs into the connective tissue between the deep fascia of the erector muscle and the transverse process of the vertebral body to achieve a blocking effect. Its role in postoperative analgesia in adult patients has been verified. Currently, case reports have shown that it also has a certain analgesic effect in pediatric patients, which can reduce postoperative pain scores and opioid consumption. Therefore, this article explores the application of erector spinae plane block in pediatric patients from various aspects, summarizes existing research results, and aims to provide more evidence for clinicians to reasonably use this block technique in the pediatric population.
ObjectivesTo systematically review the efficacy and safety of controlled hypotension for total hip or knee replacement.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and CBM databases were electronically searched to collect randomized controlled trials (RCTs) on controlled hypotension for total hip or knee replacement from inception to September 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by RevMan 5.3 software.ResultsA total of 15 RCTs involving 854 patients were included. The results of meta-analysis showed that compared with no controlled hypotension during surgery, controlled hypotension could reduce intraoperative blood loss (MD=−267.35, 95%CI −314.54 to −220.16, P<0.000 01), allogeneic blood transfusion (MD=−292.84, 95%CI −384.95 to −200.73, P<0.000 01), and 24 h postoperative mini-mental state examination (MMSE) score (MD=−1.08, 95%CI −1.82 to −0.34, P=0.004). However, there were no significant differences in 96 h postoperative MMSE score (MD=−0.11, 95%CI −0.50 to 0.28, P= 0.57) and intraoperative urine volume (MD=57.93, 95%CI −152.57 to 268.44, P=0.59).ConclusionsThe current evidence shows that controlled hypotension during total hip or knee replacement can reduce intraoperative blood loss and allogeneic blood transfusion. Furthermore, there is no obvious effect on the maintenance of blood perfusion in important organs, despite certain effects on the postoperative cognitive function, which can be recovered in short term. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
呼吸道感染在感染性疾病中占有重要地位，细菌性肺炎是呼吸道感染中的主要代表性疾病，最重要的治疗措施是抗菌治疗，用药选择及方法正确与否直接影响治疗的成败。同时如何降低医疗费用也是临床医生需要考虑的棘手问题。据国外文献报道在英国每年约有5亿张以上的抗微生物药物处方，其中住院处方中约40％为静脉制剂，而我国住院静脉制剂的处方比例则更高。医疗费用的增加部分与静脉用药过多有关。为寻求解决临床治疗与医疗费用之间的矛盾，选择高效、低毒、廉价的抗菌药物，1987年Quintiliani等[1]首先提出了抗生素序贯疗法（sequential therapy）的概念，即在经过相对短疗程（48～72 h）静脉抗菌药物治疗，临床症状基本稳定或改善后，改为口服抗菌药物治疗。口服的抗菌药物可以是与前者完全相同的口服剂型，也可以是同一类或抗菌谱相似的同一级药物，后也有人称之为"转换治疗"（switch therapy）、"降级治疗"（step-down therapy）。据国外文献报道，住院的社区获得性肺炎（CAP）应用序贯疗法者因早期出院每位患者节约费用293~1393美元[2-4]。
目的 比较预注射利多卡因和局部加温缓解罗库溴铵注射痛效果。 方法 选取2011年3月－8月择期行腹腔镜下胆囊切除术的150例患者，按照完全随机的方法分为利多卡因组（L组）、局部加温组（W组）、对照组（C组）,每组各50例患者。W组患者在留置针部位用Bair Hugger以40 °C加温1 min；L组患者用橡胶止血带在静脉近端加压直至静脉输液停止走行，推注1%利多卡因2 mL，1 min后松开止血带。随后3组患者均在2 s内静脉推注1 mL罗库溴铵注射液（含罗库溴铵10 mg）。观察在注射罗库溴铵前预先注射利多卡因及局部加温缓解注射痛的效果。 结果 罗库溴铵注射痛的发生率在W组、L组、C组中分别为62%、34%、82%。C组的疼痛发生率最高（P＜0.05）；W组的疼痛率高于L组（P＜0.05）；与W、L组相比，C组的重度疼痛率最高（P＜0.05）；L组的中、重度疼痛率低于W组（P＜0.05）。 结论 预注射利多卡因和局部加温均能有效缓解罗库溴铵引起的注射痛，预注射利多卡因对于缓解罗库溴铵引起的注射痛更为有效。
ObjectiveTo present the application of mini-health technology assessment (Mini-HTA) method in configuration management of anti-magnetic anesthesia machine.MethodsFrom February to March 2019, the specialist operation assistant used Mini-HTA method to analyze and evaluate the anti-magnetic anesthesia machine applied by the department from basic situation and four dimensions, including technical dimension, patient dimension, hospital dimension, and economic dimension.ResultsA hospital health technology assessment report was prepared based on the evaluation of the specialist operation assistant, the suggestion of which was adopted by the hospital. As a result, an anti-magnetic anesthesia machine was arranged in the MRI room.ConclusionMini-HTA method can provide decision support for hospital equipment configuration and is conducive to the scientific and rational allocation of resources in hospitals.
Objective To evaluate the sedative effects of fentanyl on ventilated patients in intensive care unit (ICU ).Methods Thirty orotracheal intubated and mechanical ventilated medical patients in ICU were randomly divided into two groups，ie.Midazolam group (group M) and midazolam combined with fentanyl group with a proportion of 100∶1 (group M+F) The sedatives were continuously intravenously infused to achieve a target motor activity assessment scale (MAAS) of 3 and ventilator synchrony score of adaptation to the intensive care environment (ATICE) ≥3 after loading dose of midazolam.The sedation level was evaluated and the infusion rate was adjusted to maintain the target sedation goal every 2 h and the hemodynamic，respiratory and sedative parameters were recorded simultaneously.The oxygenation index were measured at 12 and 24 h.The infusion were ceased after 24 h,then the sedative degree was assessed every 30 min until MAAS ≥3 and the recover time were recorded.Results There were no significant differences in blood pressure，oxygenation index and adjustive frequency of drugs between the two groups (all Pgt;0.05).The heart rate，respiratory rate and airway pressure in group M+F decreased significantly than those in Group M (Plt;0.05).The amount of midazolam used and cost of sedatives were lower than those in group M (Plt;0.05).Satisfactory degree of sedation or ventilator synchrony and awakeness score of ATICE in group M+F were higher than those in group M.The recover time was shorter in groupM+F (Plt;0.05).Conclusion In medical ventilated patients, fentanyl improves the sedative effect of midazolam and reduces the dose of midazolam,hence,reduce the total cost of sedatives.
ObjectiveTo explore the technique of preoperative evaluation of video electroencephalography (VEEG) electrode fixation method.MethodsThe electrode fixation method was modified using a simple and easy-to-manufacture 3M decompression sticker designed by ourselves.ResultsUsing the modified electrode fixation method, compared with the traditional fixation method, the electrode displacement, shedding rate and pain score of the children were significantly lower (P<0.05). The incidence of skin pressure sore by traditional fixation method was 7.03%. The rate of improvement after release was 3.37%. Although it was not statistically significant, the incidence of pressure ulcers were reduced.ConclusionsEffectively reduce the adverse reactions such as electrode displacement, shedding, pain and skin pressure sore caused by wearing the electrode for a long time. It has the advantages of being simple, fast, safe, stable and humanized, and it is worthy of clinical promotion.
There is a close relationship between inflammation and coagulation response. Inflammation and coagulation are activated simultaneously during cardiopulmonary bypass, which induce postperfusion syndrome. Leukocyte depletion filter can inhibit inflammation by reducing neutrophils in circulation. But, its effects on blood conservation are limited. Aprotinin is a serine protease inhibitor, and can prevent postoperative bleeding by anti-fibrinolysis and protection of platelet function. But its effects on anti-inflammation and protection of organs are subjected to be doubted. The combination of leukocyte depletion filter and aprotinin can inhibit inflammation as well as regulate coagulation, and may exert a good protective action during cardiopulmonary bypass.
ObjectiveTo recognize the intraoperative recognition of parathyroid gland optical technology and explore its application value in thyroid surgery to protect the parathyroid gland.MethodsLiterature review was conducted on the principle and application status of intraoperative recognition of parathyroid gland optical technology by using " thyroidectomy” " parathyroid gland” " Near-Infrared imaging” " laser speckle contrast imaging”, and " optical coherence tomography” as retrieval terms to retrieve literatures.ResultsIntraoperative optical technique alone or in combination with contrast agent could improve the recognition rate of parathyroid gland, reduce the damage of feeding vessels, and thus reduce the incidence of postoperative hypocalcemia.ConclusionsTraditional intraoperative parathyroid gland recognition methods needs to be improved in real-time protection effectiveness and accuracy, and the combination of new optical technology and contrast agent can largely make up for these shortcomings, but there are still obstacles in the promotion.
Objective To investigate clinical effects of modified Xiaozhiling injection with anal cushion suspensory fixation in treatment of prolapsed hemorrhoids. Methods From January 2012 to June 2013, 150 hospitalized patients with Ⅱ and Ⅲ degrees internal hemorrhoids and mixed hemorrhoid, with prolapsing as the main clinical manifestations, were included prospectively, then subsequently randomly divided into a modified Xiaozhiling injection with anal cushion suspensory fixation group (observation group), a procedure for prolapse and hemorrhoids (PPH) group, and a classic Milligan-Morgan surgery (M-M) group. The Xiaozhiling injection with saline by 1:1 mixture was injected into the rectum submucosa and perirectal gap and the anal cushion suspensory fixation were performed for the treatment of prolapsed hemorrhoids in the observation group. The operations of the PPH group and M-M group were same as the convention. The treatment effect, hospitalization time, hospital expenses, postoperative complications, and recurrence were compared among these 3 groups. Results ① Fourty-nine cases were cured and 1 case was improved in the observation group, 48 cases were cured and 2 cases were improved in the PPH group, 48 cases were cured and 2 cases were improved in the M-M group, the treatment effects had no significant differences among these 3 groups (χ2=0.411, P=0.814). ② The hospitalization time and hospitalization expenses of the observation group were significantly less than those of the PPH group (P<0.001) and the M-M group (P<0.001). ③ No prolapse of hemorrhoids and infection happened on day 1, 2, 3, 7, and 14 among these 3 groups. The pains of the observation group were slighter on day 1, 2, 3, 7, and 14 as compared with the PPH group (except on day 14,P<0.05) and the M-M group (P<0.05). The anus bulges had no significant difference between the observation group and the PPH group (except on day 1,P>0.05), which of the observation group were significantly slighter than those of the M-M group (P<0.05). The bleeding on day 2 and 3 and the perianal edema on day 3 had no significant difference between the observation group and the PPH group (P>0.05), which of the observation group were significantly slighter than those of the M-M group (P<0.05). The urinary retention had no significant difference on day 1–3 among these 3 groups (P>0.05). ④ The anal stenosis, anal continence, and hemorrhoids recurrence on month 1, 6, and 12 had no significant differences among these 3 groups (P>0.05). Conclusions Modified Xiaozhiling injection with anal cushion suspensory fixation in treatment of prolapsed hemorrhoids could effectively make anal cushion fixation, eliminate main symptoms of bleeding and prolapse, preserve anal function well. It’s clinical efficacy is same as PPH and M-M methods, with a shorter hospitalization time, less hospitalization expenses, milder postoperative complications, and lower recurrence rate.