目的:探讨同哌替啶和曲马多比较,格拉斯琼预防全麻后寒战的临床效果。方法:120例ASA I～II级,在全麻下拟行择期手术患者,随机分为四组,每组30例:T组(曲马多1 mg/kg),G组(格拉斯琼40 μg/kg),M组(哌替啶0.4 mg/kg)和P组(0.9%生理盐水)。各组药物在手术结束时通过静脉给予。记录术后寒战评分和麻醉恢复时间及镇静程度。结果:同对照组比较,格拉斯琼明显减少麻醉后寒战的发生(P＜0.01),但同哌替啶和曲马多组比较无统计学差异(P ＞0.05)。哌替啶组和曲马多组的麻醉恢复时间(20.58±3.56和16.45 ±4.13 min)较对照组(12.61 ± 3.31 min)和格拉斯琼组(13.58 ± 3.41 min)明显延长(P＜0.05)。结论:使用40 μg/kg格拉司琼同使用曲马多1 mg/kg和哌替啶0.4 mg/kg一样可有效地预防麻醉后寒战。
ObjectiveTo review the research progress of intramedullary lengthening nail technology.MethodsThe foreign literature on the development history, types, advantages and disadvantages, indications and contraindications, complications, and effectiveness of intramedullary lengthening nail were reviewed and analyzed.ResultsThe intramedullary lengthening nail system mainly includes mechanical type, electric motor drive type, and magnetic drive type. Compared with traditional external fixation and lengthening technology, the intramedullary lengthening nail technology has certain advantages in incidence of complications, bone healing, postoperative functional rehabilitation, incision aesthetics, convenience, and patient satisfaction. However, there are also shortcomings, such as pain, uncontrollable distraction rate, device failure, etc. In the clinical application of intramedullary lengthening nails for limb lengthening, the indications should be grasped reasonably, and the related complications should be prevented and treated.ConclusionIntramedullary lengthening nails provide a new option for limb lengthening, and the initial effectiveness is good. It is one of the development direction of limb lengthening technology.
ObjectiveTo study the effectiveness of tibial transverse transport combined with the antibiotics embedded bone cement in the treatment of chronic infection of foot and ankle with lower extremity ischemic diseases.MethodsA retrospective analysis was performed on 28 patients with ischemic diseases of lower extremities associated with chronic foot and ankle infection who were treated with tibial transverse transport combined with antibiotic bone cement between August 2015 and October 2019. There were 22 males and 6 females, with an average age of 65.6 years (range, 41-86 years). There were 25 cases of diabetic foot, 2 cases of arteriosclerosis obliterans, and 1 case of thromboangiitis obliterans. The course of infection ranged from 1 to 27 years, with an average of 14.9 years. The healing condition and time of foot and ankle in all patients were recorded and compared, and the Wagner grading and WIFi (W: lower extremity wound classification; I: ischemic classification; Fi: foot infection classification) grading were compared before and at last follow-up.ResultsThe wound surface of 1 diabetic foot patient improved at 111 days after operation, without purulent secretion, and lost follow-up. The remaining 27 cases were followed up 5 to 21 months (mean, 8.4 months). There was no necrosis in the tibial osteotomy incision and the local flap. After operation, 21 cases showed needle reaction of external fixator, but the needle infection gradually improved after the corresponding treatment. Among the 24 patients with diabetic foot, 1 died of multiple organ failure due to pulmonary infection. Acute lower extremity vascular embolism occurred in 1 case, and the foot was amputated due to acute gangrene. In the remaining 22 cases, the wound healing time of foot and ankle was 2.5-11.0 months (mean, 4.6 months). At last follow-up, Wagner grading and WIFi grading of the patients were significantly improved when compared with those before operation (P<0.05). One patient with thromboangiitis obliterans had foot and ankle healing at 6 months after operation. Two patients with lower extremity arteriosclerosis obliterans had foot and ankle healing at 16 and 18 months after operation, respectively.ConclusionTibial transverse transport combined with the antibiotics embedded bone cement is effective in treating chronic infection of foot and ankle with lower extremity ischemic diseases.
目的 评价喉罩联合T型密封接头通气在新生儿无痛纤维支气管镜（纤支镜）诊治中的临床效果。 方法 对2010年3月－2012年10月收治的33例拟行纤支镜诊治的新生患儿，分为喉罩组（Ⅰ组）和常规组（Ⅱ组），两组患儿在术前半小时均静脉注射咪唑安定0.2～0.3 mg/kg基础上，Ⅰ组静脉注射枸橼酸芬太尼3～5 μg/kg，置入喉罩联合T型密封接头通气下行纤支镜诊治；Ⅱ组常规表面麻醉下行纤支镜诊治。分析术前（T1）、通过声门（T2）、诊治中（T3）、检查后（T4），脉搏血氧饱和度（SpO2）、心率（HR）的变化情况、纤支镜从T型密封接头入口或鼻孔到通过声门的时间、镜检时间、支气管肺泡灌洗次数、镜检期间不良反应（呛咳、憋气、肢体运动、呼吸道损伤）及麻醉满意度（由内镜医师评价）。 结果 Ⅰ组与Ⅱ组比较，T1、T4时间点SpO2、HR差异无统计学意义，T2、T3时间点SpO2＜85%、HR＜100次/min的发生率Ⅰ组与Ⅱ组比较差异有统计学意义（P＜0.01）；纤支镜从T型密封接头入口或鼻孔到通过声门时间差异无统计学意义（P＞0.05）；Ⅱ组镜检时间短于Ⅰ组，支气管肺泡灌洗次数少于Ⅰ组；Ⅰ组不良反应低于Ⅱ组，麻醉满意度高于Ⅱ组（P＜0.05）。 结论 喉罩联合T型密封接头通气在新生儿无痛纤支镜诊治气道管理安全有效可行，医师能从容操作。
【摘要】 目的 比较喉罩和气管内插管吸入七氟烷全麻用于小儿无痛苦纤支镜检查的麻醉效果、苏醒时间、苏醒质量。 方法 将2008年3月-2009年3月40例行纤支镜检查的患儿随机分为喉罩组（L组，21例）和气管内插管组（T组，19例）。两组均采用逐渐诱导法吸入七氟烷，静脉给予芬太尼1 μg/kg；L组置入喉罩，T组气管插管后控制呼吸。手术中，两组均吸入2%～5%七氟烷维持麻醉。分别记录麻醉前（T0）、麻醉后纤支镜进入前（T1）、进镜至咽部（T2）、声门部（T3）、气管内（T4）及第15 min（T5）时的血压（BP）、心率（HR）、MAP和动脉血氧饱和度（SPO2）。观察纤支镜检查期间有无呛咳、气道痉挛或体动；记录停药至拔管的时间，苏醒后是否再入睡及麻醉满意度。 结果 两组HR在T1、T3、T4时升高，与T0时比较，有统计学意义（Plt;0.05）；其中HR在T1时T组高于L组，组间比较有统计学意义（Plt;0.05）；MAP在T1、T2、T3、T4时，T组低于L组，组间比较有统计学意义（Plt;0.05）。两组患儿镜检期间均无呛咳、气道痉挛或体动；L组苏醒时间短于T组（Plt;0.05），苏醒后再入睡率低于T组（Plt;0.05），麻醉满意度高于T组（Plt;0.05）。 结论 喉罩吸入七氟烷全麻用于小儿无痛苦纤支镜检查，能保证稳定的血流动力学状态，苏醒快速，效果满意。【Abstract】 Objective To assess the feasibility and safety of Laryngeal mask combined with sevoflurane in painless fiberoptic bronchoscopy anesthesia in children. Methods Forty children from March 2008 to March 2009 were randomized divided into laryngeal mask airway group (group L) and endotracheal intubation group (group T). Anaesthesia was induced and maintenanced with 2%-5% sevoflurane and fentanyl 1 μg/kg. The blood pressure (BR), heart rate (HR) and oxygen saturation by pulse oximeter (SPO2)were recorded before anaesthesia (T0), immediately after anaesthesia induction (T1), when FOB at the level of pharynx(T2), vocal cords (T3), trachea (T4) and in 15 min of the FOB (T5). Extubation time, recovery quality and anesthesia effects were also analyzed. Results Compared with T0, there were significant increases in HR at T1、T3 and T4 (Plt;0.05), and HR was significantly higher in the group T than that in the group L at T1 (Plt;0.05). MAP was significantly lower in group T than that in group L at T1、T2、T3 and T4, respectively(Plt;0.05). Recovery time was significantly shorter in group L than that in group T. Incidence of sleep after recovery was lower in group L than that in group T. Anesthesia satisfaction was higher in the group L than that in the group T. Conclusions Laryngeal mask combined with Sevoflurane provide satisfactory anesthesia for painless fiberoptic bronchoscopy in children.
ObjectiveTo determine the effectiveness of continuous intercostal nerve block for pain relief after thoracotomy.MethodsFrom November 2017 to October 2018, 120 patients who received thoracotomy procedure in our hospital were collected, including 60 males and 60 females aged 40-77 (58.10±7.00) years. The patients were randomly allocated into three groups by digital table including a continuous intercostal nerve block group (group A, n=40), a single intercostal nerve block group (group B, n=40), and an epidural analgesia group (group C, n=40). All the groups received the same basic analgesia. The pain scores and rescue analgesic doses were compared.ResultsOn postoperative day (POD) 0, all groups achieved effective pain control, and the visual analogue score was 2.02±0.39 points in the group A, 2.13±0.75 points in the group B and 2.03±0.69 points in the group C (P>0.05). On POD 0-2 and POD 3-4 (without basement analgesia), there was no significant difference between the group A and group C in the pain scores (2.08±0.28 points vs. 1.93±0.53 points, 3.20±0.53 points vs. 3.46±0.47 points, P>0.05), however, the difference between POD 0-2 and POD 3-4 in each group was stastically different (group A, 2.08±0.28 points vs. 3.20±0.53 points; group B, 2.42±0.73 points vs. 5.45±0.99 points; group C 1.93±0.53 points vs. 3.46±0.47 points, P<0.05). In terms of the rescue analgesic doses, there was no significant difference between the group A and group C (220.00±64.08 mg vs. 225.38±78.85 mg, P>0.05); it was larger in the group B than that in the group A and group C (343.33±119.56 mg vs. 220.00±64.08 mg; 343.33±119.56 mg vs. 225.38±78.85 mg, P<0.05).ConclusionMultimodal analgesia is an optimal choice in the initial stage after thoracotomy surgery. Continuous intercostal nerve block is an effective way to pain management in patients with thoracotomy.
ObjectiveTo explore the risk factors for death within 7 days after admission in trauma patients undergoing surgery under general anesthesia, and provide evidence for predicting the outcomes of those patients and guidance for clinical practices.MethodsThe basic information and perioperative data of trauma patients who underwent surgery under general anesthesia between January 1st 2019 and December 31st 2020 were collected from the Hospital Information System and the Anesthesia Information Management System. Patients who died within 7 days after admission were assigned into the case group and the others were assigned into the control group, and then propensity-score matching method was used based on age, sex, and injury types. Univariate analyses and multivariate binary logistic regression analysis were used to identify the risk factors for death within 7 days after admission in these patients.ResultsThere were 2 532 patients who met the inclusion criteria, of whom 96 patients with missing follow-up information were excluded, and 2 436 patients remained for the study. After propensity-score matching, there were 19 patients in the case group and 95 patients in the control group. The result of multivariate logistic regression analysis showed that the coma state at admission [odds ratio (OR)=9.961, 95% confidence interval (CI) (1.352, 73.363), P=0.024], perioperative body temperature<36℃ [OR=23.052, 95%CI (1.523, 348.897), P=0.024], intraoperative mean arterial pressure<60 mm Hg (1 mm Hg=0.133 kPa) [OR=12.158, 95%CI (1.764, 83.813), P=0.011], serum calcium concentraion<2.0 mmol/L [OR=33.853, 95%CI (2.530, 452.963), P=0.008], and prothrombin time [OR=1.048, 95%CI (1.002, 1.096), P=0.042] increased the risk of death within 7 days after admission.ConclusionThe coma state, coagulopathy, perioperative hypothermia, intraoperative hypotension, and hypocalcemia are 5 independent risk factors for death in trauma patients after surgery under general anesthesia.