气管插管全麻术中预防气道感染的临床研究

目的观察一次性病毒/细菌过滤器在气管插管全麻术中预防气道感染的应用价值,为临床预防策略的制定提供参考。方法选择2011年3月-2013年3月接受气管插管全麻手术的患者76例,按照随机数字表法将其分为观察组和对照组各38例;观察组应用一次性病毒/细菌过滤器,而对照组则未用,分别在麻醉前和手术结束时用无菌棉签采集麻醉机呼气端、吸气端表面标本行细菌学检测;在手术结束时收集钠石灰罐底部10g钠石灰行细菌学检测,对比两组患者的检测结果和术后24h内气道感染发生率。结果两组患者在麻醉开始前麻醉机呼气端、吸气端细菌学培养结果均为阴性;手术结束时,麻醉机吸气端、呼气端和钠石灰的细菌学培养阳性率均为0,对照组分别为5.26%、42.11%和15.79%,观察组细菌培养阳性率均显著低于对照组,差异有统计学意义(P<0.05);术后24h内气道感染发生率观察组为2.63%,显著低于对照组的18.62%,差异有统计学意义(P<0.05)。结论麻醉机气管插管全麻可增加患者气道感染的机会,通过一次性病毒/细菌过滤器、及时更换钠石灰等措施,可有效预防气道感染的发生。     

Understanding and improving airway management in companion animals - part 1

Airway Management, briefly taught within the veterinary nursing curriculum, is performed many times a day and a vital part of the anaesthesia process. Students are shown how to place an endotracheal tube, taught little about dead-space and airway resistance but, although there are many publications on the pitfalls of intubation, it is often sub-optimally managed in a busy clinic. To provide excellent, safe airway management for our patients, we must understand the history, mechanics and pitfalls about the process: It is only then can we truly apply better techniques in order to improve both care and safety to our patients.     

Major complications of airway management: a prospective multicentre observational study

We conducted an observational study of serious airway complications, using similar methods to the fourth UK National Audit Project (NAP4) over a period of 1 year across four hospitals in one region in the UK. We also conducted an activity survey over a week, using NAP4 methods to yield an estimate for relevant denominators to help interpret the primary data. There were 17 serious airway complications, defined as: failed airway management leading to cancellation of surgery (eight); airway management in recovery (five); unplanned intensive care admission (three); and unplanned emergency front of neck access (one). There were no reports of death or brain damage. This was an estimate of 0.028% (1 in 3600) complications using the denominator of 61,000 general anaesthetics per year in the region. Complications in patients with ‘predicted easy’ airways were rare (approximately 1 in 14,200), but 45 times more common in those with ‘predicted difficult’ airways (approximately 1 in 315). Airway management in both groups was similar (induction of anaesthesia followed by supraglottic airway or tracheal tube). Use of awake/sedation intubation, videolaryngoscopy and high-flow nasal oxygenation were uncommon even in the predicted difficult airway patients (in 2.7%, 32.4% and 9.5% of patients, respectively). We conclude that the incidence of serious airway complications is at least as high as it was during NAP4. Despite airway prediction being used, this is not informing subsequent management.     

Prospective randomized controlled trial evaluating cap-assisted colonoscopy vs standard colonoscopy

AIM: To study the significance of cap-fitted colonoscopy in improving cecal intubation time and polyp detection rate. METHODS: This study was a prospective randomized controlled trial conducted from March 2008 to February 2009 in a tertiary referral hospital at Sydney. The primary end point was cecal intubation time and the secondary endpoint was polyp detection rate. Consecutive cases of total colonoscopy over a 1-year period were recruited. Randomization into either standard colonoscopy (SC) or cap-assist...     

可视喉镜联合纤维支气管镜在声门显露困难患者双腔支气管插管中的应用

目的探讨GlideScope可视喉镜联合纤维支气管镜引导在声门显露困难患者双腔支气管插管中的应用。方法选择择期行胸科手术患者40例,男24例,女16例,年龄24~78岁,ASAⅠ或Ⅱ级,MallampatiⅢ或Ⅳ级,随机分为GlideScope可视喉镜组(GF组)和Macintosh喉镜组(M组),每组20例。GF组运用可视喉镜联合纤维支气管镜引导进行支气管插管及对位;M组运用传统方法(先用Macintosh喉镜插管,再使用纤维支气管镜对位)。记录患者喉镜下声门显露程度Cormack-Lehane分级、插管时间、插管一次成功率、需喉部按压的患者例数以及术后48h内的声音嘶哑及咽痛情况。结果GF组Cormack-Lehane分级明显低于M组(P0.01)。GF组插管时间明显短于M组[(104.3±11.1)s vs.(138.6±33.0)s](P0.01),一次插管成功率明显高于M组(90%vs.55%)(P0.05),需要喉部按压患者比例明显低于M组(20%vs.90%)(P0.01),术后声音嘶哑和咽痛的发生率明显低于M组(5%vs.35%,25%vs.75%)(P0.05)。结论与传统方法比较,可视喉镜联合纤维支气管镜引导用于声门显露困难患者可以提高插管的成功率,减少插管时的应激反应,降低声嘶和咽痛的发生率。     

泪道激光探通联合泪道植管术治疗泪道阻塞的疗效观察

目的：探讨泪道激光探通联合泪道植管术治疗泪道阻塞的治疗效果。方法选择2012年3月至2014年3月期间我院眼科收治的泪道阻塞患者80例(140眼)作为研究对象,根据手术方法将其分为研究组(行泪道激光探通联合泪道植管术治疗)40例(70眼)与对照组(行单纯行泪道激光探通术治疗)40例(70眼)。随访6个月,观察两组患者的临床治疗效果,以及术后并发症情况。结果研究组治疗的总有效率为95.71%,显著高于对照组的82.86%, P<0.05。两组并发症发生率对比差异无统计学意义(P>0.05)。结论泪道激光探通联合泪道植管术治疗泪道阻塞疗效确切,操作简单,并发症少,适于临床推广与应用。     

经股动脉插管超选择肾动脉栓塞治疗顽固性血尿（附13例报告）

目的：探讨经股动脉超选择插管动脉栓塞术治疗各种原因引起的顽固性血尿临床疗效。方法回顾性分析13例经内科药物治疗无效的顽固性血尿患者经股动脉超选择插管肾动脉或髂内动脉栓塞（或同时化疗药灌注）的临床资料。结果13例患者中5例晚期未手术膀胱癌,2例膀胱癌术后,2例经皮肾镜取石,2例晚期肾癌（后证实为1例肾结核）,1例移植肾出血,1例阴茎海绵体血管瘤伴动脉畸形出血;术后1～3 d完全或基本止血,2例无效（1例通过抗结核4d止血1例膀胱全切双肾造瘘尿道残端出血未能止血）。结论经股动脉插管行动脉栓塞术治疗各种顽固性血尿有显著疗效。     

心脏手术术后气管插管带管时间对声音嘶哑的影响

目的 分析在气管插管全身麻醉下接受心脏手术的患者术后发生声音嘶哑的情况及其影响因素.方法 回顾性分析2014年1月至2014年12月间在北京协和医院接受心脏手术患者的围术期资料,按照是否出现术后声音嘶哑分为声嘶组与对照组,分别统计两组患者的一般情况、手术麻醉信息、术后带管时间并作统计学分析;根据患者的带管时间分组,分别统计其声音嘶哑发病率并进行相关性分析.结果 在218例纳入研究的患者中,共有12例出现声音嘶哑,其平均术后带管时间显著长于对照组(P＜0.01);且声音嘶哑的发生率随术后带管时间延长而增加(P＜0.05).结论 在行心脏手术的患者中,发生声音嘶哑患者的术后带管时间较长,且声音嘶哑发生率随带管时间延长而升高.