舒适化浅镇静策略对ICU机械通气病人的影响

目的:观察舒适化浅镇静(eCASH)策略对重症监护室(ICU)机械通气病人的影响。方法:将医院2018年1月—2021年10月收治的在ICU行机械通气治疗的150例病人纳入研究,以随机数字表法分为观察组、对照组各75例,入住ICU后对照组给予常规镇静镇痛护理,观察组在此基础上给予eCASH策略护理干预,干预后观察两组治疗效果、不良事件发生率、镇痛镇静药物用量、氧化应激反应及转归情况。结果:观察组病人机械通气时间及ICU住院时间均短于对照组,唤醒时间早于对照组(P<0.05);观察组病人谵妄发生率为4.00%,低于对照组的13.33%(P<0.05),呼吸机相关肺炎发生率为6.67%,低于对照组的17.33%(P<0.05),意外拔管发生率为4.00%,低于对照组的14.67%(P<0.05);观察组镇痛镇静药物用量少于对照组(P<0.05);干预后观察组病人超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-PX)水平高于对照组,血清丙二醛(MDA)水平低于对照组(P<0.05);观察组转科率为98.67%,高于对照组的90.67%(P<0.05),病死率为1.33%,低于对照组的9.33%(P<0.05)。结论:对ICU机械通气病人实施eCASH策略可有效提高病人治疗效果,缩短机械通气时间、唤醒时间及ICU住院时间,降低谵妄、呼吸机相关肺炎、意外拔管等不良事件发生率,减少镇痛镇静药物用量,改善病人氧化应激反应,降低病死率,促进疾病康复。     

镜下前交叉韧带重建术中止血带应用的探讨

随着人们运动意识水平的增强和社会交通的快速发展,关节损伤患者的数量也大幅增加,而前交叉韧带(ACL)损伤是关节损伤中最常见的韧带损伤。目前治疗ACL损伤的标准手术方式是在关节镜下使用止血带进行前交叉韧带重建手术(ACLR),在ACLR中使用止血带可以减少患者出血,为术者提供一个清晰的手术视野,可为手术提供极大的便利,但止血带的使用并非没有弊端,在骨科快速康复趋势以及患者对术后康复要求提高的情况下,止血带使用所带来的并发症引起了越来越多的关注,为降低止血带并发症的发生,提高患者术后舒适度,加速康复进程,学者们不断探讨如何精准安全的使用止血带。本文为止血带在关节镜下ACLR术中的应用现状、利弊以及应用趋势等作一综述。     

泮托拉唑、阿莫西林和甲硝唑联合治疗幽门螺杆菌阳性消化性溃疡的疗效观察

目的观察并分析泮托拉唑、阿莫西林和甲硝唑联合治疗幽门螺杆菌阳性消化性溃疡的临床疗效,为临床治疗方案提供参考依据。方法将120例患者根据入选先后顺序进行随机分组,随机分为观察组(给予泮托拉唑、阿莫西林和甲硝唑联合治疗,n=60例)和对照组(给予泮托拉唑,60例),对比两组的疗效及并发症,以及随访3,6,12个月后对比其复发率情况。结果两组患者年龄、性别、病程等临床资料比较,差异无统计学意义(P>0.05),观察组的总有效率明显高于对照组(P<0.05),观察组随访3个月和12个月的复发率明显低于对照组(P<0.05)。结论泮托拉唑、阿莫西林和甲硝唑联合治疗幽门螺杆菌阳性消化性溃疡疗效确切、并发症少,复发率低,值得临床推广应用。     

Patient characteristics associated with venous thromboembolic events: a cohort study using pooled electronic health record data

Objective

To demonstrate the potential of de-identified clinical data from multiple healthcare systems using different electronic health records (EHR) to be efficiently used for very large retrospective cohort studies.

Materials and methods

Data of 959 030 patients, pooled from multiple different healthcare systems with distinct EHR, were obtained. Data were standardized and normalized using common ontologies, searchable through a HIPAA-compliant, patient de-identified web application (Explore; Explorys Inc). Patients were 26 years or older seen in multiple healthcare systems from 1999 to 2011 with data from EHR.

Results

Comparing obese, tall subjects with normal body mass index, short subjects, the venous thromboembolic events (VTE) OR was 1.83 (95% CI 1.76 to 1.91) for women and 1.21 (1.10 to 1.32) for men. Weight had more effect then height on VTE. Compared with Caucasian, Hispanic/Latino subjects had a much lower risk of VTE (female OR 0.47, 0.41 to 0.55; male OR 0.24, 0.20 to 0.28) and African-Americans a substantially higher risk (female OR 1.83, 1.76 to 1.91; male OR 1.58, 1.50 to 1.66). This 13-year retrospective study of almost one million patients was performed over approximately 125 h in 11 weeks, part time by the five authors.

Discussion

As research informatics tools develop and more clinical data become available in EHR, it is important to study and understand unique opportunities for clinical research informatics to transform the scale and resources needed to perform certain types of clinical research.

Conclusions

With the right clinical research informatics tools and EHR data, some types of very large cohort studies can be completed with minimal resources.     

医院药房面临的退药问题不容忽视

目的：介绍目前有关医院药房退药的政策和实际情况,并就规范这一问题提出合理化建议。方法：根据退药产生的实际原因区别对待,妥善处理。结果和结论：在保证用药安全的前提下,充分考虑人性化的服务理念。新时代的药剂师应承担更大的责任。     

COA：止血带对于全膝关节置换术失血量的临床影响

Background To study perioperative blood loss and its clinical relevance in total knee replacement surgery after applying a tourniquet. Methods From June 2009 to October 2009, 60 consecutive patients who underwent routine total knee arthroplasty were randomly divided into two groups and were treated with or without a tourniquet (30 patients/group). There were no differences in patient characteristics between the two groups. We compared the two groups of patients in terms of intra- and postoperative bleeding, invisible or visible bleeding, and total blood loss. Results None of the patients showed poor wound healing, lower extremity deep venous thrombosis or other complications. The amount of blood loss during surgery was lower in the tourniquet group than in the control group (P < 0.01). However, postoperative visible bleeding (P < 0.05) and occult bleeding (P < 0.05) were significantly greater in the tourniquet group than in the control group. There was no difference in the total amount of blood loss between the two groups (P > 0.05).     

止血带捆绑下子宫下段环形蝶式缝扎术在凶险性前置胎盘伴胎盘植入中的应用效果研究

目的探讨分析止血带捆绑下子宫下段环形蝶式缝扎术在凶险性前置胎盘伴胎盘植入患者中的临床应用效果。方法选取2016年12月至2018年12月深圳市龙华区人民医院妇产科收治分娩的72例凶险性前置胎盘伴胎盘植入患者作为研究对象。根据随机数字表法将其分为试验组(n=36)和常规组(n=36)。试验组采用止血带捆绑下子宫下段环形蝶式缝扎术进行胎盘处理,常规组采用常规胎盘处理和子宫内压迫止血。统计两组的手术时间、术中出血量、术后24h累计出血量、修正血红蛋白(Hb)值、住院时间等情况,并比较两组的子宫切除率、红细胞输注、输注量以及术后并发症发生情况。结果试验组术中出血量、产后24h累计出血量以及修正Hb值均低于常规组,住院时间短于常规组,差异具有统计学意义(P<0.05)。试验组的子宫切除率为5.56%,低于常规组的22.22%,差异具有统计学意义(P<0.05)。试验组红细胞输注率为88.89%,与常规组的97.22%比较,差异无统计学意义(P>0.05);试验组的平均红细胞输注量为(645.2±56.1)mL,低于常规组的(794.7±75.3)mL,差异具有统计学意义(P<0.05)。试验组的术后并发症发生率为11.11%,与常规组的19.44%比较,差异无统计学意义(P>0.05)。结论对于凶险性前置胎盘伴胎盘植入患者,采用止血带捆绑下子宫下段环形蝶式缝扎术进行处理,能起到较好的止血效果,降低出血量,从而更好地保留患者的子宫和生育能力,具有一定的临床推广应用的价值。     

杨志旭治疗新型冠状病毒肺炎用药规律

目的：探析杨志旭教授治疗新型冠状病毒肺炎（新冠肺炎）的用药规律。方法：收集2020年2月1日至3月21日杨教授在武汉市金银潭医院救治新冠肺炎患者的50张处方,采用频数法分析用药规律。结果：50张处方涉及57味中药,合计用药频次646次,使用频次>30次的分别为黄芪、贯众、金银花、苦杏仁、百合、麻黄、茯苓、瓜蒌;四气中以寒性多见;五味位居前3位的是甘、苦、辛;归经位居前3位的是肺经、胃经、脾经;功效位居前3位的是清热药、化痰止咳药、补虚药。结论：杨志旭教授治疗新冠肺炎寒温并用、甘苦兼施,以治肺为主,注重固护脾胃,将清热药、化痰止咳药、补虚药协同配伍,以扶正解毒贯穿治疗始终,并根据疾病特点随症加减。     

Endolymphatische Metastasentherapie mit Radioisotopen bei malignem Melanom

Zusammenfassung Wegen der frühzeitigen und häufigen lympgogenen Metastasierung des malignen Melanoms erfordert eine erfolgversprechende Therapie nicht nur eine lokale Tumorbehandlung sondern auch eine Blockierung der Metastasenwege mit Vernichtung bereits vorhandener Lymphknotenmetastasen. Die endolymphatische Therapie mit³²P ermöglicht eine interne Bestrahlung der Lymphknoten und peripheren Lymphgefäße mit mittleren Strahlendosen von 100 000 rad. Die Strahlenbelastung der Lunge liegt im Toleranzbereich.

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