加强型鼻咽通气道应用于鼻腔手术后气道管理临床研究

目的研制加强型鼻咽通气道应用于五官科鼻腔手术后的气道管理。方法选取2014年1月至2015年3月行五官科鼻腔手术的患者60例,将其分为A组和B组,各30例。A组作为加强型鼻咽通气道组,术毕在膨胀止血海绵中放置加强型鼻咽通气道保留鼻腔通气;B组作为对照组,术毕采用传统单纯填塞膨胀止血海绵。通过术后24、48 h随访,对两组患者进行疼痛、睡眠质量、口干程度评分,并对其进行对比分析。结果加强型鼻咽通气道具有良好的抗压抗折性;A组患者24、48 h睡眠质量、口干程度评分均明显优于B组,差异均有统计学意义(P<0.05)。结论加强型鼻咽通气道用于五官科鼻腔手术后气道管理可增强气道管理安全性及患者舒适度。     

脊柱侧弯后路矫形内固定术的配合与护理

目的探讨脊柱侧弯后路矫形内固定术的配合及护理方法。方法对10例青少年患者行脊柱侧弯后路矫形内固定术,配合医生手术并严密观察病情变化。结果所有患者手术过程顺利,无一例脑脊液漏,脊髓损伤及切口感染等术后并发症发生,术后随访两年脊柱侧弯畸形均得到了明显矫正。结论手术护士熟悉手术步骤,全面掌握各种仪器及器械操作是手术配合成功的关键。完善的术前准备及密切的术中观察是减少脊柱侧弯病人术中并发症的重要因素。     

Unexpectedly high incidence of hypothermia before induction of anesthesia in elective surgical patients

Study objectivePerioperative hypothermia is a frequently observed phenomenon of general anesthesia and is associated with adverse patient outcome. Recently, a significant influence of core temperature before induction of anesthesia has been reported. However, there are still little existing data on core temperature before induction of anesthesia and no data regarding potential risk factors for developing preoperative hypothermia. The purpose of this investigation was to estimate the incidence of hypothermia before anesthesia and to determine if certain factors predict its incidence.Design/setting/patientsData from 7 prospective studies investigating core temperature previously initiated at our department were analyzed. Patients undergoing a variety of elective surgical procedures were included.Interventions/measurementsCore temperature was measured before induction of anesthesia with an oral (314 patients), infrared tympanic (143 patients), or tympanic contact thermometer (36 patients). Available potential predictors included American Society of Anesthesiologists status, sex, age, weight, height, body mass index, adipose ratio, and lean body weight. Association with preoperative hypothermia was assessed separately for each predictor using logistic regression. Independent predictors were identified using multivariable logistic regression.Main resultsA total of 493 patients were included in the study. Hypothermia was found in 105 patients (21.3%; 95% confidence interval, 17.8%-25.2%). The median core temperature was 36.3°C (25th-75th percentiles, 36.0°C-36.7°C). Two independent factors for preoperative hypothermia were identified: male sex and age (> 52 years).ConclusionsAs a consequence of the high incidence of hypothermia before anesthesia, measuring core temperature should be mandatory 60 to 120 minutes before induction to identify and provide adequate treatment to hypothermic patients.     

Comparison of anterior cervical discectomy and fusion with the zero-profile device versus plate and cage in treating cervical degenerative disc disease: A meta-analysis

Zero-profile device was applied to diminish the irritation of the esophagus in the treatment of cervical degenerative disc disease. However, the clinical application of the zero-profile device has not been testified with clinical evidence. The aim of the meta-analysis was to systematically compare the safety and effectiveness of anterior cervical discectomy and fusion with zero-profile device with plate and cage for the treatment of cervical degenerative disc disease. Electronic searches of PubMed and Embase were conducted up to May 2015. Relevant studies were included. Weighted mean difference (WMD) and 95% confidence intervals (CI) were assessed for continuous data. Risk ratio (RR) and 95% CI were assessed for dichotomous data. P value <0.05 was considered to be significant. Eleven studies were included in the meta-analysis. Compared with plate and cage, zero-p is associated with lower operation time of two-level surgery, less intraoperative blood loss, higher subsidence rate, higher JOA score, lower incidence of dysphagia in short-term (RR: 0.72, 95% CI [0.58, 0.90], P = 0.005, I² = 22%) and long-term (RR: 0.12, 95% CI [0.05, 0.30], P < 0.00001, I² = 0%) and lower Cobb angle of multilevel surgery (WMD: −3.16, 95% CI: [−4.35, −1.97], P < 0.00001, I² = 0%). No significant difference was found in one-level and two-level Cobb angle, fusion rate and operation time of one-level and three-level surgery. Both zero-p implantation and the plate and cage have respective advantages and disadvantages.     

The association between obesity and migraine in a population of Iranian adults: a case-control study

Aim

To assess the association between obesity and risk of migraine with aura and features of migraine attacks among a population of Iranian adults.

Watson人性照顾理论在手术室护士职业防护中的应用效果

目的探讨Watson人性照顾理论在手术室护士职业防护中的应用效果。方法采用便利抽样法选择2018年1月—2019年12月在树兰(杭州)医院手术室工作的24名护士为研究对象。本研究为前后对照研究,于2019年1月开始在常规管理的基础上实施基于Watson人性照顾理论的职业防护管理干预。采用自制的护士职业危险风险评估表、护士职业认同量表和护士工作满意度量表比较干预前后护士的职业风险认知能力、职业认同感和工作满意度。结果干预后护士的环境风险、事故风险、生物风险、化学风险、物理风险维度得分高于干预前[(21.7±2.8)vs(.17.5±3.0)、(21.8±3.2)vs.(16.0±2.7)、(16.7±2.6)vs(.14.4±2.5)、(22.0±2.3)vs(.17.8±2.8)、(16.1±2.2)vs(.13.8±2.7)分],差异均有统计学意义(P<0.01);干预后护士的一致感、把握感、患者影响感、自我决定感、自我效力感、有意义感及组织影响感维度得分均高于干预前[(81.5±5.6)vs(.77.8±6.4)、(77.9±4.8)vs(.74.4±5.2)、(81.2±5.0)vs.(76.7±5.5)、(82.2±6.1)vs(.77.2±5.7)、(83.5±5.1)vs(.79.3±4.7)、(84.7±4.5)vs(.80.2±4.9)、(80.1±5.6)vs.(75.7±6.2)分],差异均有统计学意义(P<0.01);干预后护士的工作满意度量表得分为(126.7±12.5)分,高于干预前的(113.2±11.3)分,差异有统计学意义(P<0.01)。结论将Watson人性照顾理论应用于手术室护士职业防护中,可提高手术室护士的职业风险认知能力、职业认同感和工作满意度,值得临床推广。     

Quadriceps strength in intensive care unit survivors: Variability and influence of preadmission physical activity

BackgroundMuscle weakness is common in patients who survive a stay in the intensive care unit (ICU). Quadriceps strength (QS) measurement allows evaluation of lower limb performances that are associated with mobility outcomes.ObjectivesThe objective of the study was to characterise the range of QS in ICU survivors (ICUS) during their short-term evolution, by comparing them with surgical patients without critical illness and with healthy participants. The secondary aim was to explore whether physical activity before ICU admission influenced QS during that trajectory.MethodsPatients with length of ICU stay ≥2 days, adults scheduled for elective colorectal surgery, and young healthy volunteers were included. Maximal isometric QS was assessed using a handheld dynamometer and a previously validated standardised protocol. The dominant leg was tested in the supine position. ICUSs were tested in the ICU and 1 month after ICU discharge, while surgical patients were tested before and on the day after surgery, as well as 1 month after discharge. Healthy patients were tested once only. Patients were classified as physically inactive or active before admission from the self-report.ResultsThirty-eight, 32, and 34 participants were included in the ICU, surgical, and healthy groups, respectively. Demographic data were similar in the ICUS and surgical groups. In the ICU, QS was lower in the ICU group than in the surgical and healthy groups (3.01 [1.88–3.48], 3.38 [2.84–4.37], and 5.5 [4.75–6.05] N/kg, respectively). QS did not significantly improve 1 month after ICU discharge, excepted in survivors who were previously physically active (22/38, 56%): the difference between the two time points was ?6.6 [?27.1 to ?1.7]% vs 20.4 [?3.4 to 43.3]%, respectively, in physically inactive and active patients (p = 0.002).ConclusionsPatients who survived an ICU stay were weaker than surgical patients. However, a huge QS heterogeneity was observed among them. Their QS did not improve during the month after ICU discharge. Physically inactive patients should be early identified as at risk of poorer recovery.     

搏动型心室辅助装置大动物模型的建立

目的 建立可用于搏动型心室辅助装置动物实验的大动物模型。 方法　选取实验动物小尾寒羊3只,麻醉后建立动静脉通路,左侧开胸建立体外循环,心脏诱颤,心尖部打孔缝合心尖插管,降主动脉缝合主动脉插管,连接NPVAD,启动驱动器,观察血泵运转情况和实验动物情况。结果 血泵运转良好,血泵随驱动器正压负压驱动血液单向流动。同时动物左心室负荷减轻,动脉血压升高。结论 建立搏动型心室辅助装置的大动物模型对于进行国产化心室辅助装置的研发具有重要意义。