剖宫产与阴道分娩对产妇近期并发症的影响

目的：探讨剖宫产和阴道分娩对产妇近期并发症的影响。方法选取2010年7月~2012年6月在本院分娩的1878例产妇,根据产妇的要求按分娩方式将产妇分成阴道分娩组（782例）和剖宫产组（1096例）,比较两组的并发症发生率。结果两组的子宫破裂发生率差异无统计学意义（P>0.05）,阴道分娩组的产褥感染、产后出血、产后尿潴留发生率明显低于剖宫产组（P<0.05）。结论剖宫产方式会明显增高产后并发症发生率,阴道分娩的产后并发症发生率则明显较低,应提倡阴道分娩。     

全面护理在颈3以上颈椎骨折脱位患者中的应用效果

目的：探讨全面护理在颈3以上颈椎骨折脱位患者中的应用效果。方法选取2010年1月~2011年11月本院收治的60例颈3以上颈椎骨折脱位患者作为研究对象,随机分为观察组和对照组,各30例。所有患者均给予哈罗架治疗,其中对照组给予常规护理,观察组给予全面护理。比较两组的近期并发症发生率及预后情况。结果观察组的近期并发症发生率显著低于对照组,差异有统计学意义(P<0.05)。观察组经固定后均能坐起,脊髓损伤均得到不同程度改善,均骨性愈合,且无感染、吞咽困难、神经损伤等并发症;早期3例颅钉松动患者反复固定,2例背部压疮患者进行清洁换药、加强护理,2例腹胀患者改善饮食后,病情均得到改善。对照组经固定后能够坐起,骨性愈合良好;随访过程中2例出现吞咽困难,均由术后护理不当引起,给予地塞米松治疗后症状明显改善;早期5例颅钉松动、1例进钉点感染、4例背部压疮、3例腹胀、1例神经损伤均得到有效处理。结论全面护理在颈3以上颈椎骨折脱位患者中的应用效果显著,能够有效降低并发症发生率,值得临床推广应用。     

护理干预在肝脏穿刺活检患者中的临床价值

目的：探讨护理干预在肝脏穿刺活检患者中的临床价值。方法选取本院2010年1月~2014年1月收治的100例拟实施肝穿刺活检术患者作为研究对象,随机分为对照组和观察组,各50例。对照组采用常规护理,观察组在对照组的基础上给予护理干预。比较两组的焦虑和恐惧发生率、疼痛程度、治疗配合度、患者满意度。结果观察组的Ⅰ、Ⅱ、Ⅲ级焦虑、恐惧发生率显著低于对照组,差异有统计学意义(P<0.05)。观察组的Ⅰ、Ⅱ级疼痛发生率显著低于对照组,差异有统计学意义(P<0.05)。两组的治疗配合度比较,差异无统计学意义(P>0.05)。观察组的患者满意度为98.0%,显著高于对照组的80.0%,差异有统计学意义(P<0.05)。结论护理干预能显著降低患者的焦虑、恐惧、疼痛程度,提高患者满意度和治疗配合度,值得临床推广应用。     

护理安全质量目标管理在老年髋部骨折术后并发症预防中的应用效果

目的：探讨护理安全目标质量管理在老年髋部骨折术后并发症预防中的应用效果。方法选取2014年1~9月的109例老年髋部骨折术后患者作为实验组,选取2013年同期的95例老年髋部骨折术后患者作为对照组。实验组按照十大护理安全质量目标对患者实施护理,对照组在常规安全管理模式指导下实施护理干预。比较两组的并发症发生率。结果实验组的术后并发症发生率为3.7豫,显著低于对照组的14.7豫,差异有统计学意义(P<0.05)。结论护理安全质量目标管理能够有效降低老年髋部骨折术后的并发症发生率,值得临床推广应用。     

Renal Complications and Their Prognosis in Korean Patients with Middle East Respiratory Syndrome-Coronavirus from the Central MERS-CoV Designated Hospital

Some cases of Middle East Respiratory Syndrome-Coronavirus (MERS-CoV) infection presented renal function impairment after the first MERS-CoV patient died of progressive respiratory and renal failure. Thus, MERS-CoV may include kidney tropism. However, reports about the natural courses of MERS-CoV infection in terms of renal complications are scarce. We examined 30 MERS-CoV patients admitted to National Medical Center, Korea. We conducted a retrospective analysis of the serum creatinine (SCr), estimated glomerular filtration rate (eGFR), urine dipstick tests, urinary protein quantitation (ACR or PCR), and other clinical parameters in all patients. Two consecutive results of more than trace (or 1+) of albumin and blood on dipstick test occurred in 18 (60%) (12 [40%]) and 22 (73.3%) (19 [63.3%]) patients, respectively. Fifteen (50.0%) patients showed a random urine ACR or PCR more than 100 mg/g Cr. Eight (26.7%) patients showed acute kidney injury (AKI), and the mean and median durations to the occurrence of AKI from symptom onset were 18 and 16 days, respectively. Old age was associated with a higher occurrence of AKI in the univariate analysis (HR [95% CI]: 1.069 [1.013-1.128], P = 0.016) and remained a significant predictor of the occurrence of AKI after adjustment for comorbidities and the application of a mechanical ventilator. Diabetes, AKI, and the application of a continuous renal replacement therapy (CRRT) were risk factors for mortality in the univariate analysis (HR [95% CI]: diabetes; 10.133 [1.692-60.697], AKI; 12.744 [1.418-114.565], CRRT; 10.254 [1.626-64.666], respectively). Here, we report renal complications and their prognosis in 30 Korean patients with MERS-CoV.     

高龄食管癌和贲门癌患者手术治疗的临床分析

目的：探讨高龄食管癌和贲门癌患者手术的可行性及围手术期注意事项。方法总结分析2012年7月至2014年7月收治的37例高龄（＞75岁）食管和贲门癌患者（研究组）外科手术治疗的临床资料,并与同期手术治疗的61例（＜65岁）食管和贲门癌患者（对照组）的术后并发症进行对比研究。结果研究组患者均平稳度过围手术期,无一例死亡;研究组与对照组并发症中吻合口瘘差异无统计学意义（P＞0.05）,但肺不张与肺炎、呼吸衰竭和心律失常差异有统计学意义（P＜0.05）。结论高龄（＞75岁）食管癌和贲门癌患者外科手术治疗可行,但易出现并发症,选择手术治疗需谨慎,加强围手术期管理很重要。     

A Time Series Observation of Chinese Children Undergoing Rigid Bronchoscopy for an Inhaled Foreign Body: 3149 Cases in 1991–2010

Background:

In China, tracheobronchial foreign body (TFB) aspiration, a major cause of emergency episode and accident death in children, remains a challenge for anesthetic management. Here, we share our experience and discuss the anesthetic consideration and management of patients with TFB aspiration.

Methods:

This was a single-institution retrospective study in children with an inhaled foreign body between 1991 and 2010 that focused on the complications following rigid bronchoscopy (RB). Data including the clinical characteristics of patients and TFB, anesthetic method, and postoperative severe complications were analyzed by different periods.

Results:

During the 20-year study period, the charts of 3149 patients who underwent RB for suspected inhaled TFB were reviewed. There were 2079 male and 1070 female patients (1.94:1). A nut (84%) was the most commonly inhaled object. The study revealed a 9% (n = 284) overall rate of severe postoperative complications related to severe hypoxemia, laryngeal edema, complete laryngospasm, pneumothorax, total segmental atelectasis, and death with incidences of 3.2%, 0.9%, 1.3%, 0.3%, 0.3%, and 0.1%, respectively. The rates of preoperative airway impairment, negative findings of TFB, and adverse postoperative events have been on the rise in the past 5 years.

Conclusions:

The survey results confirmed that hypoxemia remains the most common postoperative complication in different periods. Both controlled ventilation and spontaneous ventilation were effective during the RB extraction of the foreign body at our hospital in the modern technique period. An active respiratory symptom was commonly seen in the groups with negative findings.     

An Interdisciplinary Nutrition Support Team Improves Clinical and Hospitalized Outcomes of Esophageal Cancer Patients with Concurrent Chemoradiotherapy

Background:

The prevalence of malnutrition is very high in patients with cancer. The purpose of this study was to investigate whether or not a nutrition support team (NST) could benefit esophageal cancer patients undergoing chemoradiotherapy (CRT).

Methods:

Between June 2012 and April 2014, 50 esophageal cancer patients undergoing concurrent CRT were randomly assigned into two groups: The NST group and the control group. The nutritional statuses of 25 patients in the NST group were managed by the NST. The other 25 patients in the control group underwent the supervision of radiotherapy practitioners. At the end of the CRT, nutritional status, the incidence of complications, and completion rate of radiotherapy were evaluated. Besides, the length of hospital stay (LOS) and the in-patient cost were also compared between these two groups.

Results:

At the completion of CRF, the nutritional status in the NST group were much better than those in the control group, as evidenced by prealbumin (ALB), transferrin, and ALB parameters (P = 0.001, 0.000, and 0.000, respectively). The complication incidences, including bone marrow suppression (20% vs. 48%, P = 0.037) and complications related infections (12% vs. 44%, P = 0.012), in the NST group were lower and significantly different from the control group. In addition, only one patient in the NST group did not complete the planned radiotherapy while 6 patients in the control group had interrupted or delayed radiotherapy (96% vs. 76%, P = 0.103). Furthermore, the average LOS was decreased by 4.5 days (P = 0.001) and in-patient cost was reduced to 1.26 ± 0.75 thousand US dollars person-times (P > 0.05) in the NST group.

Conclusions:

A NST could provide positive effects in esophageal cancer patients during concurrent CRT on maintaining their nutrition status and improving the compliance of CRF. Moreover, the NST could be helpful on reducing LOS and in-patient costs.     

散发性肌萎缩侧索硬化39例临床分析

目的了解散发性肌萎缩侧索硬化(sporadic amyotrophic lateral sclerosis,s ALS)的临床特点,以提高临床诊断率。方法回顾性分析2009年6月—2014年6月武警总医院收治的39例s ALS的临床资料。结果本组发病平均年龄(54.7±10.7)岁,男性多见,病程高峰在24个月左右。发病人群主要为既往体健人群,临床表现主要为肌无力、肌肉萎缩、肌束震颤、言语不清和饮水呛咳,5例(12.8%)伴随认知功能障碍,颈髓受累最多。结论 s ALS以中年发病为主,男性多见,s ALS伴认知功能障碍可能与阿尔茨海默病和额颞叶痴呆等其他神经系统变性病存在某种联系;详细问诊,仔细查体,及时行肌电图检查并注意鉴别诊断,有助于诊断。