镀银气管导管对呼吸机相关性肺炎影响的荟萃分析

目的 评价镀银气管导管,对预防机械通气患者呼吸机相关性肺炎(VAP)的效果.方法 电子检索Cochrane图书馆、PubMed、EMbase、ScienceDirect、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、万方数据库等,各数据库检索时间均从创建到2011年8月；纳入镀银气管导管对预防机械通气患者VAP效果的随机对照试验(RCT);采用RevMan5软件进行荟萃分析,对于无法转换合并的数据,采用描述性分析.结果 共纳入3个RCT、2127例患者,文献异质性较小；荟萃分析结果表明,镀银气管导管可显著降低VAP的发生率[固定效应模型,OR=0.59,95 ％CI(0.41,0.84),P=0.005]、死亡率和负面事件等方面两组差异无统计学意义;住院时间、住ICU时间、气管插管时间、临床肺感染指数及呼吸道细菌浓度等指标,由于数据难以转换及难以获取完整数据等原因未能做荟萃分析,只进行描述性分析,显示两组在上述指标方面差异无统计学意义.结论 与标准非镀银气管导管相比,镀银气管导管能显著降低机械通气患者VAP的发生率,而对患者死亡率及负面事件发生率等指标无明显改善；需要进行更多设计严格的、多中心、大样本随机对照试验,对镀银气管导管的综合效果进行验证.     

Diagnostic utilities of tracheal ultrasound and USB-endoscope for the confirmation of endotracheal tube placement: A cadaver study

Objectives

Confirmation of the endotracheal tube placement (CoETP) has the utmost importance in the management of an airway. Visualization of tracheal rings or carina with a fiber-optical bronchoscope (FOB) has considered to be a reliable method for the CoETP. However, FOB is expensive, time-consuming, and not always practical. Inexpensive endoscopic USB-cameras were shown to aid intubation successfully and reliably. On the other hand, there have been no studies investigating their use for the CoETP. Tracheal ultrasonography (TUS) is also a new, inexpensive and widely available alternative. A cadaver study has planned to evaluate the diagnostic utility of TUS and a USB-camera.

Comparison of the effect of gel used in two different serum separator tubes for thyroid function tests

Background

Selection and verification of blood collection tubes is an important preanalytical issue in clinical laboratories. Today, gel tubes are commonly used with many advantages, although they are known to cause interference in immunoassay methods. In this study, we aimed to compare SSTs of two different suppliers (Ayset clot activator & Gel and Becton Dickinson (BD) Vacutainer SST II advance) with reference tubes and evaluate the effect of storage time in terms of commonly used endocrine tests such as thyroid‐stimulating hormone (TSH), free thyroxine (fT4), and free triiodothyronine (fT3).

Methods

Fifty‐five volunteers were included in the study. Samples were taken into three different tubes and analyzed for serum TSH, fT4, and fT3 on Architect ci8200 Immunoassay System. Clinical decision levels were estimated using total allowable error (TEa).

Results

No difference was found between tubes in terms of TSH, fT3, and fT4 levels. From a statistical standpoint, TSH and fT4 levels were no longer stable during 24, 48, and 72 hours storage time periods. However, their variations were not clinically significant.

Conclusion

Ayset clot activator & Gel tubes and BD Vacutainer SST II advance tubes have comparable results with glass tube in terms of TSH, fT3, and fT4 levels on Architect ci8200 Immunoassay Systems. From a clinical standpoint, serum TSH, fT4, and fT3 concentrations may be considered as stable when storing these tubes over 72 hours.

     

Video laryngoscopy improves the first-attempt success in endotracheal intubation during cardiopulmonary resuscitation among novice physicians

AimTo compare the first-attempt success in endotracheal intubation (ETI) during cardiopulmonary resuscitation (CPR) using direct laryngoscopy (DL) and video laryngoscopy (VL) (GlideScope^®) among novice emergency physicians (EPs).MethodsThis study is a historically controlled clinical design. From May 2011 to April 2013 out-of-hospital cardiac arrest patients were intubated during CPR by novice EPs. CPR data was automatically recorded by pre-installed video and subsequently analysed. The primary outcome was the success rate of the first-attempt at ETI. In addition, time to successful ETI from first-attempt (T-complete), duration of chest compression interruptions, and incidence of oesophageal intubation were compared.ResultsOf 305 patients undergoing ETI, 83 were intubated by novice EPs. The success rate of first-attempt ETI in the VL group (n = 49) was higher than that in the DL group (n = 34, 91.8% vs. 55.9%; p < 0.001). The median T-complete was significantly shorter with VL than with DL (37 [29–55] vs. 62 [56–110] s; p < 0.001). Oesophageal intubation was observed only in the DL group (n = 6, 17.6%). The median duration of chest compression interruptions was greater with DL (7 [3–6] s) than with VL (0 [0–0] s). Improvements in ETI during CPR were observed in the VL group after the first 3 months, but not the DL group during regular use for 1 year.ConclusionsFor novice EPs, the VL could significantly improve the first-attempt success in ETI during CPR while the DL couldn’t improve it.     

The effect of orthodontic bands or tubes upon periodontal status during the initial phase of orthodontic treatment

Introduction

Orthodontic bands cause periodontal inflammation. In theory, the use of a buccal tube (bond) instead of a band should prevent or minimize periodontal changes because the bonds are positioned away from the gingival margins.

Objective

The primary aim of this study was to investigate the periodontal status of orthodontic bands compared with bonds in the first three months of orthodontic treatment.

Materials and methods

Twenty-four orthodontic patients (mean age = 12.6 years) were enrolled in this Randomized Controlled Trial (RCT). Using the cross-mouth technique, bands and bonds were used in opposite quadrants. Periodontal parameters including the presence or absence of Bleeding On Probing (BOP) and Probing Depths (PDs) were taken at the start and three months into treatment.

Results

Bands caused a statistically significant change in the Bleeding On Probing (BOP) (P = 0.001 and 0.021) and bonds displayed a statistically insignificant change in the Bleeding On Probing (BOP) (P = 0.125 and 1.00) for the upper and lower arch. The difference in Probing Depths (PDs) between bands and bonds was also statistically significant (P = 0.001).

Conclusion

Molar bands are associated with greater periodontal inflammation compared with molar bonds in the first three months of fixed orthodontic treatment.     

舒芬太尼用于高龄患者全麻诱导气管插管的临床研究

目的：观察舒芬太尼用于高龄患者全麻诱导气管插管的临床效果。方法选择ASAⅡ～Ⅲ级,需在气管插管全身麻醉下行四肢手术的高龄（年龄≥80岁）患者45例,随机分三组：舒芬太尼0.15μg/kg 组（ S1组）、舒芬太尼0.25μg/kg组（S2组）及芬太尼2μg/kg组（F组）,每组15例。所有患者均分别记录基础值（T0）、插管前1 min（T1）、插管后1 min（T2）和插管后5 min（T3）的收缩压（SP）、舒张压（DP）和心率（HR）,并计算各时间点 SP 与 HR 的乘积（ RPP）;记录不良反应的发生及药物使用情况。结果三组T1时间点BP和T3时间点SP、S2组T2时间点SP和F组T3时间点DP均显著低于同组T0时间点（P均<0.01）,F组T2时间点DP显著高于同组T0时间点（P<0.05）和S2组同时间点（ P<0.05）,S1组和S2组T1时间点SP、S2组T2时间点BP均显著低于F组同时间点（ P<0.01或0.05）。S1组和F组T2时间点HR均显著大于同组T0时间点（ P均<0.01）和S2组同时间点（ P<0.05）。三组T1、T3时间点RPP均显著小于同组T0时间点（ P<0.01或0.05）。F组T2时间点RPP显著大于同组T0时间点（ P<0.05）和S2组同时间点（P<0.05）。S2组声带活动发生率、丙泊酚和瑞芬太尼使用率小于S1组,罗库溴铵、新福林使用率均显著小于S1组和F组（P<0.05）。结论舒芬太尼0.25μg/kg用于高龄患者全麻诱导,不仅能抑制插管反应,减少不良反应,而且能保持插管前后心血管功能稳定和心肌氧供需平稳,安全可行。     

光棒联合新型喉罩与纤维支气管镜气管插管临床效果比较

目的：比较光棒联合新型喉罩气管插管与纤维支气管镜气管插管的临床效果。方法选择100例接受光棒联合新型喉罩气管插管全身麻醉的患者100例为观察组,同期接受纤维支气管镜气管插管患者100例为对照组。观察两组不同等级气道插管情况（ Mallampati分级Ⅰ～Ⅳ级）及置管成功前后血流动力学变化,包括平均动脉压、血氧饱和度、心率、呼气末二氧化碳分压。比较两组插管时间及并发症发生情况。结果观察组Ⅳ级气道插管成功率为80.0％,显著高于对照组的36.4％,气管插管时间短于对照组,差异均有统计学意义（ P＜0.05）。气管插管置入后,观察组平均动脉压、心率、咽喉疼痛及口腔损伤的比例均低于对照组,差异有统计学意义（ P＜0.05）。两组血氧饱和度、呼气末二氧化碳分压比较差异均无统计学意义（ P＞0.05）。结论光棒联合新型喉罩气管插管成功率高,对血流动力学影响小,并发症少,值得临床推广应用。