经静脉自控镇痛治疗晚期癌性疼痛40例

目的观察经静脉自控镇痛治疗晚期癌性疼痛的临床疗效。方法选取我院于2016年1月~2017年1月收治的80例晚期癌性疼痛患者作为观察对象,均经病理、影像学及临床确诊,无手术、化疗、放疗指征,80例晚期癌性疼痛患者采用随机数字法分为对照组和观察组,每组40例,对照组应用地佐辛,观察组应用舒芬太尼,比较两组患者术前及术后不同时间点的VAS评分、镇痛满意率。结果观察组与对照组患者术前的VAS评分比较,差异无显著性(P0.05)。观察组患者术后12 h、术后24 h的VAS评分明显低于对照组,差异有显著性(P0.05)。观察组的镇痛满意率明显高于对照组,差异有显著性(P0.05)。观察组的不良反应发生率明显低于对照组,差异有显著性(P0.05)。结论经静脉自控镇痛治疗晚期癌性疼痛可以显著减轻患者的疼痛,提高镇痛满意率,具有一定的临床研究价值,为晚期癌性疼痛患者临床镇痛药物的选择提供了有利支持。     

早产两个临床热点问题探讨

<正>早产是多病因引起的一种综合征,是造成新生儿死亡和发病最主要的原因~([1])。据报道,世界范围内的早产率约为11%,也就是说,每年约有1500万早产儿出生,因此,早产一直是产科学界最关注的主题之一~([2])。但近几十年来,产科的一系列防治早产的干预措施并没有明显降低早产率,目前认为产前糖皮质激素促胎肺成熟的治疗以及硫酸镁保护脑神经的使用是改善围产儿结局的最重要的产科干预措施~([2])。     

Investigating the use of tie‐over dressing after skin grafting

Tie‐over bolster dressing after skin grafting can prolong operative time, and cause hematoma and seroma formation because of uneven pressure application. To describe the possibility of discontinuing the use of tie‐over dressing, we carried out a retrospective comparative study of patients who underwent skin grafting at an institution between January 2009 and December 2014. We investigated and compared the take rate, healing period, wound infection rate and hematoma formation rate for the tie‐over dressing group and the non‐tie‐over dressing group. Among 266 patients, 148 and 118 patients were included in the tie‐over dressing group and non‐tie‐over dressing group, respectively. There were no significant differences between the take rate, healing period, wound infection rate and hematoma formation rate for the two groups. Multivariate analysis showed that the complete graft take rate was not significantly influenced by tie‐over dressing, age, sex, graft site, graft procedure and skin graft diameter. Although the use of tie‐over dressing might remain necessary on sites with a free margin, including the eyelids, lips or nostrils, because of the difficulty in using tape fixation, the present study showed that alternative dressing with polyurethane foam is also useful in most cases of skin grafting.     

Oral health status of hospitalized amyotrophic lateral sclerosis patients: a single-centre observational study

Objective: To assess the intraoral conditions and oral function of patients with amyotrophic lateral sclerosis (ALS).

Material and methods: This single-centre, cross-sectional observational study included 50 ALS patients, who were treated with tracheostomy positive-pressure ventilation (TPPV) while hospitalized. The disease duration, TPPV duration, current number of teeth, number of occlusal units, number of decayed/missing/filled teeth, community periodontal index, bleeding on probing, dental calculus, maximum mouth opening, salivation rate, tongue anomalies (atrophy or hypertrophy) and tongue coating were determined for each patient. Differences in intraoral conditions according to disease duration or TPPV duration were statistically analysed.

Results: The maximum mouth opening was low in the included patients, with a mean distance of 13.7?±?7.4?mm. Furthermore, the maximum mouth opening showed a significant negative correlation with both disease duration and TPPV duration. No statistically significant differences were found between any other intraoral parameters and disease duration or TPPV duration.

Conclusions: Severe dental disease is uncommon among hospitalized ALS patients who receive oral care by nurses; however, mouth opening is very restricted in these patients. Early intervention for restricted mouth opening, directed by a dentist or dental hygienist, is essential in this population.     

20-MHz Ultrasound for Measurements of Flow-Mediated Dilation and Shear Rate in the Radial Artery

A high-frequency scanning system consisting of a 20-MHz linear array transducer combined with a 20-MHz pulsed Doppler probe was introduced to evaluate the degree of radial artery flow-mediated dilation (FMD [%]) in two groups of patients after 5?min of controlled forearm ischemia followed by reactive hyperemia. In group I, comprising 27 healthy volunteers, FMD (mean?±?standard deviation) was 15.26?±?4.90% (95% confidence interval [CI]: 13.32%–17.20%); in group II, comprising 17 patients with chronic coronary artery disease, FMD was significantly less at 4.53?±?4.11% (95% CI: 2.42%–6.64%). Specifically, the ratio FMD/SR (mean?±?standard deviation), was equal to 5.36?×?10^?4?±?4.64?×?10^?4 (95% CI: 3.54?×?10^?4 to 7.18?×?10^?4) in group I and 1.38?×?10^?4?±?0.89?×?10^?4 (95% CI: 0.70?×?10^?4 to 2.06?×?10^?4) in group II. Statistically significant differences between the two groups were confirmed by a Wilcoxon–Mann–Whitney test for both FMD and FMD/SR (p?<0.01). Areas under receiver operating characteristic curves for FMD and FMD/SR were greater than 0.9. The results confirm the usefulness of the proposed measurements of radial artery FMD and SR in differentiation of normal patients from those with chronic coronary artery disease.