Objective To systematically review the effectiveness of forced air warming for the maintenance of perioperative core temperature, so as to provide clinical evidence for an appropriate warming plan during the perioperative period. Methods We electronically searched PubMed, The Cochrane Library, EMbase, Web of Science, CBM and CNKI from 2000 to 2012, so as to comprehensively collect randomized controlled trials (RCTs) about the effectiveness of different warming methods for the maintenance of perioperative core temperature (including forced air warming, resistive-heating blanket/electric heating pad, circulating water mattress, and infrared ray radiant heating system) for maintenance of perioperative core temperature. References of the included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results Eleven RCTs involving 577 patients were included. The results of meta-analysis indicated that, in the maintenance of core temperature during the perioperative period, forced air warming was superior to resistive-heating blanket/electric heating pad (SMD= –0.40, 95%CI –0.73 to –0.06), circulating water mattress (SMD= –1.10, 95%CI –1.55 to –0.66), and infrared ray radiant heating system (SMD= –0.69, 95%CI –1.06 to –0.32). In the incidence of hypothermia during the perioperative period, the group of forced air warming was lower than the group of blanket/electric heating pad (RR=1.76, 95%CI 1.15 to 2.69), but it was the same as the group of infrared ray radiant heating system (RR=1.37, 95%CI 0.83 to 2.27). In the incidence of shivering during the perioperative period, the group of forced air warming was the same as the group of blanket/electric heating pad (RR=0.75, 95%CI 0.18 to 3.21) and the group of infrared ray radiant heating system (RR=0.8, 95%CI 0.19 to 3.36). Conclusion Compared with resistive-heating blanket/electric heating pad, circulating water mattress, and infrared ray radiant heating system, forced air warming maintains patients’ core temperature better during the perioperative period, with a lower incidences of hypothermia. Due to the limited quantity and quality of the included studies, more high quality RCTs with large sample size are needed to verify the above conclusion.
Objective To explore the effect and mechanism of ultrashort wave (USW) for prevention and treatment of vascular crisis after rat tail replantation. Methods Eighty 3-month old female Sprague Dawley rats (weighing 232.8-289.6 g) were randomly divided into 5 groups. In each group, based on the caudal vein and the coccyx was retained, the tail was cut off. The tail artery was ligated in group A; the tail artery was anastomosed in groups B, C, D, and E to establish the tail replantation model. After surgery, the rats of group B were given normal management; the rats of group C were immediately given intraperitoneal injection (3.125 mL/kg) of diluted papaverine hydrochloride injection (1 mg/mL); the rats of groups D and E were immediately given the local USW treatment (once a day) at anastomotic site for 5 days at the dosage of 3 files and 50 mA for 20 minutes (group D) and 2 files and 28 mA for 20 minutes (group E). The survival rate of the rat tails was observed for 10 days after the tail replantation. The tail skin temperature difference between proximal and distal anastomosis was measured at pre- and post-operation; the change between postoperative and preoperative temperature difference was calculated. The blood plasma specimens were collected from the inner canthus before operation and from the tip of the tail at 8 hours after operation to measure the content of nitric oxide (NO). Results The survival rates of the rat tails were 0 (0/14), 36.4% (8/22), 57.1% (8/14), 22.2% (4/18), and 75.0% (9/12) in groups A, B, C, D, and E, respectively, showing significant overall differences among 5 groups (χ2=19.935, P=0.001); the survival rate of group E was significantly higher than that of group B at 7 days (P lt; 0.05), but no significant difference was found between the other groups by pairwise comparison (P gt; 0.05). At preoperation, there was no significant difference in tail skin temperature difference among 5 groups (P gt; 0.05); at 8 hours, 5 days, 6 days, and 7 days after operation, significant overall difference was found in the change of the skin temperature difference among groups (P lt; 0.05); pairwise comparison showed significant differences after operation (P lt; 0.05): group B gt; group D at 8 hours, group C gt; group D at 5 days, groups A, B, and C gt; group D at 6 days, groups B and C gt; groups A and E, and group B gt; group D at 7 days; but no significant difference was found between the other groups at the other time points (P gt; 0.05). Preoperative plasma NO content between each group had no significant difference (P gt; 0.05). The overall differences had significance in the NO content at postopoerative 8 hours and in the change of the NO content at pre- and post-operation among groups (P lt; 0.05). Significant differences were found by pairwise comparison (P lt; 0.05): group D gt; groups A, B, and C in the plasma NO content, group D gt; groups A and B in the change of the NO content at pre- and post-operation; but no significant difference was found between the other groups by pairwise comparison (P gt; 0.05). Conclusion Rat tail replantation model in this experiment is feasible. USW therapy can increase the survival rate of replanted rat tails, reduce skin temperature at 7 days, improve blood supply, increase the content of nitric oxide at the early period and prevent vascular crisis.
Objective To observe the long-term effectiveness of tendon allograft to repair tendon defect. Methods Between October 1996 and September 1999, 24 patients with tendon defect were treated with tendon allograft which was cultured with deoxyguanosine and preserved at low-temperature or ultra-deep-low-temperature. There were 19 males and 5 females, aged from 12 to 46 years with an average of 25.9 years. These patients included 7 cases of total extensor tendon defect of 2nd-5th fingers, 7 cases of index finger extensor tendon defect, 3 cases of deep flexor tendon defect of 2nd- 5th fingers, 1 case of ring finger deep flexor tendon defect, 3 cases of long extensor tendon defect of 2nd-5th toes, 2 cases of long extensor hallucis tendon defect, and 1 case of shoulder adduction missing. The sizes of tendon defect ranged from 5 to 15 cm. The mean time from injury to operation was 1.3 months (range, 2 hours to 3 months). Results Incisions healed by first intention. No deep infection, infectious diseases, and obvious immune rejection occurred. All patients were followed up from 10 to 12 years with an average of 10.8 years. When compared with contralateral sides, at 10 years of follow-up, 1 patient lost 6-10° flexion function; after 10.6 years, flexion tendon releasing was performed; allografted tendon had normal color and elasticity with decreased diameter and with mild and moderate adherence; and after releasing, function was improved. According to Hand Surgery Association assessment standard, the results were excellent in 12 cases, good in 6, and poor in 6; the excellent and good rate was 75%. Conclusion Tendon allograft which is cultured with deoxyguanosine and preserved at low-temperature or ultra-deep-low-temperature is safe to use in cl inical, which has good long-term effectiveness in treating tendon defect.
Objective To study the preventive measure of the subambient temperature burn by analysing the pathogenesis feature. Methods The cl inical data were analysed from 351 cases of subambient temperature burn between February 2004 and February 2009, including age, sex, burn season, burn factors, burn position, burn area, burn degree, treatment way, and wound heal ing. Results Subambient temperature burn occurred in every age stage. The susceptible age stages included infant, children, and the elderly. Female patients were more than male patients. The common burn reasons werehot-water bottle burn, honey warm keeper burn, and heating device burn. The peak season was winter. Lower l imb was the most common site of the subambient temperature burn. The deep II degree to III degree were the most common level, and the burn area was always small, often 1% of total body surface area. Most of patients were treated with changing dressings at cl inic and few patients needed hospital ization. Though the surface of wound could heal finally, and the wound healed well with no obvious scar in patients who received operation. Conclusion Subambient temperature burn is the frequently encountered disease in winter. Use of the warming articles should be cautious, at the same time safety awareness should be strengthened so as to decrease the incidence rate of subambient temperature burn and the injury degree.
Objective To investigate the effect of perioperative body temperature on the survival of skin flap grafting. Methods From July 2005 to November 2006, 50 cases of Ⅰ-Ⅱ grade patients undergoing elective skin flap grafting were randomly divided 2 groups. Pharyngeal temperature (PT) and skin temperature(ST) were monitored and recorded every 15 minutes. Operativetime, anesthetic time, time from the end of operation to extubation, the volume of blood transfusion, the volume of fluid transfusion and the flap survival 7 days after operation were recorded. In the experimental group, the body temperature was maintained in normal range with water market and forced air heater. In the control group， the body temperature was only monitored without any treatment. Results There were no significant differences in operating room temperature, operative time, anesthetic time, the volume of blood transfusion and fluid transfusion between 2 groups(Pgt;0.05). After induction, PT decreased gradually inboth groups during the first 45 minutes, compared with the time point of intubation(Plt;0.05),but there were no significant differences between the 2 groups(Pgt;0.05); and ST rose in both groups during the first45 minutes, compared with the time point of intubation (Plt;0.05). After 45 minutes of induction, in the experimental group, PT was in the normal range(36℃), and ST didn’t change compared with that of the timepoint of induction(Pgt;0.05). In the control group, both PT and ST decreasedgradually and timedependently compared with the time point of intubation (Plt;0.05). In the experimental group, PT and ST at each time point were higher than those in the control group (Plt;0.05). All the skin flap grafts survived in the experimental group, and skin flap grafts necrosed in 2 cases in the control group.Conclusion Keeping normal body temperature can improve the survival ofskin flap grafting. Therefore, the body temperature should be monitored and maintained in a normal range.
Objective To evaluate which is better method zymogen or low temperature frozen in removing vascular endothelial cell so as to lay a foundation for creating a kind of brace which is not to be rejected and the same as own blood vessel. Methods Fresh and not damaged umbilical blood vessel was collected from natural labour women, human umbilical blood vessel was remove carefully from normal foetus, then was put into disinfectant at 37℃ for 24 hours. They were divided into 3 groups:normal group(NG),zymogen group(ZG) and low temperature frozen group(LG). ZG: 0.1% collagenⅡ enzyme was addedin umbilical blood vessel and closed the both sides and the vascular endothelialcell was removed in 37℃ water. LG:Umbilical blood vessel was put into liquidnitrogen for 24 hours after frozened step by step, and then it was put into 37℃ water for 30-60 s and the vascular endothelial cells were washed away by normal saline. NG:Umbilical blood vessel was kept into 4℃ Kerb’s liquid. The bacteria were culturedin each group. The samples were stained by HE,elastic fiber and collagen fiberwere observed by light and scanning electron microscope. The difference of compliance was compared. Human leukocyte antigen ABC(HLA-ABC) and HLA-DR were observed by immunohistochemical method and the expression of antigen of umbilical blood vessel was analysed. Results In LG, umbilical vascular endothelial cells were removed completely; artery showed vertical smooth muscle and vein showed elastic membrane. InZG, umbilical vascular endothelial cells were removed completely after 20 minutes;artery showed vertical smooth muscle cells and vein showed lower endothelial layer. The vascular compliance in LG was higher than that in NG, and the latter was also higher than that in ZG,but showing no significant differences (Pgt;0.05). The compliance of umbilical vein was 2-3 times as much asthat of umbilical artery.The expression of HLA-ABC and HLA-DR in LG andZG were lower than that in NG, showing significant differences (Plt;0.01). Conclusion Low temperature frozen methodand zymogen method(0.1% collagen Ⅱ enzyme for 20 min) can remove vascular endothelial cells of human umbilical blood vessel completely.Low temperature frozenmethod was better than zymogen method.
Objective To conduct a systematic review on the Electrocardiogram (ECG) changes in the workers exposed to high temperatures by means of meta-analysis.Methods The retrospective cohort studies on the relationship between high temperature and ECG abnormalities published from 1990 to May 2009 were searched in CNKI, VIP, WanFang database and CBM database. The literatures meeting the inclusive criteria were selected, the quality was assessed, the data were extracted, and the meta-analyses were conducted with RevMan 4.2.2 software. Results A total of 20 studies were included. The results of meta-analyses showed: the ECG abnormality rate of the high-temperature group was obviously superior to that of the control group with significant difference (OR=2.76, 95%CI 2.37 to 3.20, Plt;0.000 01). The high-temperature severely affected left ventricular hypertrophy (OR=3.49, 95%CI 2.83 to 4.31, Plt;0.000 01), sinus bradycardia (OR=2.83, 95%CI 2.33 to 3.43, Plt;0.000 01), and changes in ST-T segment (OR=2.63, 95%CI 1.48 to 4.68, P=0.000 10), which indicated that the abnormal changes of ECG, such as left ventricular hypertrophy, sinus tachycardia, sinus bradycardia, and changes in ST-T segment could be the sensitive indexes to monitor cardiovascular disease of workers exposed to high-temperature. Conclusion The incidence of ECG abnormalities caused by high-temperature operation is obviously superior to that of the control group, so it is required to strengthen the health monitoring and labor protection for the workers exposed to high temperature.
Objective To investigate the clinical efficacy and safety of coblation-assisted adenotonsillectomy for treatment of children with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods From June 2007 to May 2008, after monitoring polysomnography (PSG) confirmed 82 cases of OSAHS in children aged 3 to 14 years, with an average age of 6.2 years old, the ENT CoblatorII surgical instrument made by Arthrocare in the US and one-time EVac 70 T amp; A segment was used under complete anesthesia to remove tonsils and(or)adenoid ablation. Polysomnography monitoring was used preoperatively and 6 months postoperatively to determine the therapeutic effect. Results No significant complications occurred among the children both during the operation and postoperatively. Patients were followed for 6 months, and a satisfactory effect was achieved. The lowest oxygen saturation (LSaO2) improved significantly (Plt;0.001); the apnea-hypopnea index (AHI) decreased significantly after the operation (Plt;0.001). In accordance with OSAHS diagnosis and efficacy evaluation standards, 45 patients were cured after 6 months, 21 patients showed an excellent effect, 10 patients showed a good effect, six patients had no effect, and the total effective rate was 92.6%. Conclusion Low-temperature coblation-assisted adenotonsillectomy has good clinical efficacy with a shortened surgical time, less intraoperative and postoperative blood loss, less postoperative pain, few complications, and a simple operation procedure. It can effectively expand the nasopharynx, oropharynx ventilation cross-sectional area, lift the upper airway obstruction, and can be especially suitable for surgical treatment of children with OSAHS.
【Abstract】Objective To investigate the effects of preservative temperature on pancreatic function and determine the optimal preservative temperature for pancreatic transplantation. MethodsCold pancreatic preservation was performed and a homologous male Wistar rat model of heterotopic total pancreaticoduodenal transplantation was established. The pancreas was preserved for 6 h in UW solution at specific temperatures(0 ℃, 4 ℃, 8 ℃ and 12 ℃). After preservation, pancreatic tissue was taken for histologic examination in every group. ATP and total adenine nucleotides (TAN) were determined by using high performance liquid chromatography (HPLC). Blood glucose(BG), serum amylase and lipase were measured 24 h after transplantation. And the activity of myeloperoxidase (MPO) in the pancreatic grafts was also measured at the same time. Besides, histological observation was performed. Results Microscopic studies showed that the histomorphological changes of pancreas in 4 ℃ group were less obvious than those in other groups. Tissual concentrations of ATP and TAN decreased gradually in 4 ℃ group, 0 ℃ group, 8 ℃ group, and 12 ℃ group after 6 h of preservation(PH＜0.05). The levels of BG, serum lipase and MPO increased gradually in 4 ℃ group, 0 ℃ group, 8 ℃ group, and 12 ℃ group(PH＜0.05). The activity of MPO in 4 ℃ group （1.19±0.16 U/g ）was significantly lower than that of the control group（0.26±0.09 U/g，PH＜0.05). Conclusion The temperature of 4 ℃ is most appropriate for hypothermic pancreatic preservation and can considerably alleviate cold ischemic injury of rat pancreas.
ObjectiveTo investigate the influence of different temperatures of distilled water on the general sensation of patients during endoscopic ultrasonography (EUS) examination. MethodsSixty patients who received EUS examination were randomly assigned to trial group and control group. The trial group used (40±1) ℃ distilled water, while the control group accepted 26-28℃ distilled water. The operating time and the grade of discomfort symptoms such as general discomfort, abdominal pain, nausea, vomiting and terror were observed. ResultsSignificant differences in general discomfort, nausea, vomiting and terror were found between the two groups (P ＜ 0.001) . Abdominal pain was not found in either group. The examination time in each group did not show any significant difference (P ＞ 0.05) . ConclusionDifferent distilled water temperatures significantly influence the sensation of patients during the EUS examination, and distilled water with a temperature of (40±1) ℃ is able to relieve the discomfort of patients.