Electro‐vectorcardiographic demonstration of bifascicular block associated with ventricular preexcitation

Down syndrome occurs more frequently in the offsprings of older pregnant women and may be associated with atrioventricular septal defect. This refers to a broad spectrum of malformations characterized by a deficiency of the atrioventricular septum and abnormalities of the atrioventricular valves caused by an abnormal fusion of the superior and inferior endocardial cushions with the midportion of the atrial septum and the muscular portion of the ventricular septum.     

The anesthetist as cardiologist: a case of heart block identified in the peripartum period

We describe a case of undiagnosed heart block which was detected during the postpartum surgical repair of a vaginal tear, and the subsequent investigations that confirmed diagnosis of atrio-ventricular heart block.     

颅脑外伤性癫痫发病的危险因素分析

目的探讨颅脑外伤性癫痫(PTE)发病的危险因素。方法选取我院神经外科2016年1月至2019年10月收治的120例颅脑外伤患者,既往均有癫痫史,分为PTE组和非PTE组各60例。分析两组的临床因素,采用Logistic回归分析PTE发病的危险因素。结果单因素分析结果显示,PTE发病与年龄、严重程度(GCS)、受伤部位、凹陷性颅骨骨折相关(P <0.05),与性别、蛛网膜下腔出血无相关性(P>0.05)。多因素Logistic回归分析结果显示,年龄(OR=0.652, 95%CI:1.246~2.419),严重程度(GCS)(OR=2.041, 95%CI:1.394~4.842)、受伤部位(OR=1.642, 95%CI:2.105~4.378)、凹陷性颅骨骨折(OR=6.548, 95%CI:1.541~3.547)为PTE发病的影响因素。结论年龄、严重程度(GCS)、受伤部位、凹陷性颅骨骨折为PTE发病的影响因素,临床中应针对PTE发病因素进行预防和及时治疗,以提高临床疗效和预后。     

超声引导下腹横肌平面阻滞在腹腔镜下胆囊切除术术后镇痛的疗效与评价

目的 探讨超声引导下腹横肌平面阻滞在腹腔镜下胆囊切除术术后镇痛的疗效与评价。方法 将2018年1月～2019年3月在我院肝胆外科行腹腔镜下胆囊切除术的60例患者随机分为两组,对照组使用气管插管全身麻醉,观察组使用气管插管全身麻醉联合超声引导下腹横肌平面阻滞,比较两组患者术后静息及咳嗽时的疼痛情况、术后镇静程度、不同时间点血压及心率变化、不良反应情况。结果 在静息及咳嗽状态下,观察组出PACU时、术后4 h、术后24 h的VAS疼痛评分均明显低于对照组(P0.05);观察组入PACU后5 min、10 min、15 min的镇静评分低于对照组(P0.05),而入PACU后30 min的镇静评分无明显差异(P0.05);两组在术中及入PACU后各时间点的MAP无明显差异(P0.05),观察组在入PACU 10 min的心率慢于对照组(P0.05),其他时间点无明显差异(P0.05);观察组术后头痛、头晕、嗜睡、恶心呕吐、皮肤瘙痒、颤抖等不良反应发生率与对照组相比无明显差异(P0.05)。结论 超声引导下腹横肌平面阻滞在腹腔镜下胆囊切除术术后镇痛的疗效显著,对血流动力学影响小,安全性高,具有积极的临床意义。     

“Triceps Brachii Muscle Response to Neurostimulation of the Radial Nerve during Axillary Plexus Blockade: Clinical,Anatomical and Histological Correlation”

Axillary plexus blockade is a common technique in clinical practice with a well-known pattern of structures around the brachial artery. Historically, the only proper response to radial nerve stimulation was considered to be extension of the hand and wrist. Twenty-five axillary blockades were assessed by ultrasound and neurostimulation; the principal objective was to correlate the needle position over the radial nerve with the anatomical and histological structure of that nerve. During the procedure, the needle was directed in two ways to reach the medial or lateral margin of the nerve: above the brachial artery or beneath it. Once the needle reached the nerve, the current was augmented gradually until a response was elicited. For the cadaveric anatomical study, eight axillae were dissected and histological samples were examined. The response of the triceps brachii muscle differed significantly between the two approaches to the radial nerve (P < 0.001), and the mean intensity of stimulation was significantly lower when the nerve was accessed above the artery (0.44 ± 0.15 mA) than below it (0.57 ± 0.17 mA) (P = 0.015). A triceps brachii motor response occurs at lower current intensity and lower needle-nerve distance when the radial nerve is accessed above the artery and over the latissimus dorsi tendon. These findings were correlated with the topography of the radial nerve in the axillary fossa. Clin. Anat. 33:578–584, 2020. © 2019 Wiley Periodicals, Inc.