颅内动脉瘤夹闭术中早期未成熟破裂的急救

颅内动脉瘤夹闭术中未成熟破裂是指载瘤动脉近端或动脉瘤颈得到充分暴露前发生的破裂,处理不当可以直接导致患者重残或者死亡[1～3].未成熟破裂多数发生在牵抬脑叶或解剖动脉瘤时,在硬脑膜剪开之前或刚剪开时即发生破裂者非常少见[2].     

颅内动脉瘤破裂夹闭手术的护理

总结了9例颅内动脉瘤破裂晚期夹闭手术的护理经验.术前护理的重点是加强病情观察,做好心理护理,避免一切诱因,预防再出血,积极防治脑血管痉挛;术后配合“三高”治疗的护理,加强并发症的观察及护理,早期行高压氧治疗.认为加强责任心,积极关注整个围手术期和实施专业化的全面护理,可以有效地减少并发症,降低致残率,提高患者生存质量.     

颅内动脉瘤夹闭术的麻醉处理

颅内动脉瘤手术是神经外科中的一个重要领域。近年来由于在手术技术 ,神经麻醉和监测技术上的进展 ,围术期病死率已有所下降[1]。现对在本院行颅内动脉瘤手术病人的麻醉处理报告如下。1资料与方法1.1一般资料作者收集了2000年1月～2001年12月在本院确诊并行动脉瘤夹闭术的病人32例。其中男14例 ,女18例。年龄28～79岁。动脉瘤分别起源于前交通动脉12例 ,大脑前动脉7例 ,大脑中动脉3例 ,基底动脉3例及后交通动脉4例 ,其它部位3例。根据Hunt/Hess法对病人神经分级为 :I级4例 ;II级15例 ;III级11例和IV级2例。1.2采用气管插管全身麻醉方法…     

颅内动脉瘤夹闭术46例的麻醉处理

颅内动脉瘤并非真正的肿瘤,实际是因各种原因促使脑血管壁变薄,形成囊性突出而压迫脑神经,由此产生一系列症状,严重时可发生颅内出血。据统计,80％的颅内出血是由颅内动脉瘤引起。治疗颅内动脉瘤的方法有两类,即开颅夹闭动脉瘤和介入治疗。颅内动脉瘤开颅夹闭手术的病人于麻醉诱导气管插管期,存在血压骤升或呛咳而并发脑动脉瘤破裂出血的危险,为防止血压增高导致动脉瘤破裂出血意外,术中常需实施控制性降压,以使瘤壁松弛,减少破裂机会,保证手术安全。我院自2005年至2009年8月共实施颅内动脉瘤手术46例;现就其麻醉处理进行总结,并分析讨论。     

老年颅内动脉瘤行夹闭术的护理

总结55例老年颅内动脉瘤行夹闭术的护理。护理重点是术前做好心理护理、控制血压、用药护理,并完善各项术前准备;术后严密监测生命体征及瞳孔变化,重视呼吸道护理及创口引流护理,加强脑血管痉挛及出血等并发症的观察与护理。55例手术后54例治愈,1例死亡。     

颅内破裂动脉瘤术前再出血风险预测模型研究

目的:探讨颅内破裂动脉瘤术前再出血的风险概率预测模型。方法:纳入颅内破裂动脉瘤患者465例,采用多因素非条件Logistic回归法来构建概率预测模型,使用ROC曲线法来评价预测模型效果;对概率预测模型进行封装,设计Excel应用小软件。结果:构建了多因素Logistic回归概率预测模型,该模型有11个独立危险因素;ROC曲线下面积为0.907,明显大于机会线下的面积0.5(P0.01)。结论:所构建的Logistic回归概率预测模型预测颅内破裂动脉瘤术前再出血较好;Excel应用软件方便医护人员使用。     

亚低温下3例颅内动脉瘤夹闭术病人的护理配合

亚低温技术用于颅内巨大动脉瘤夹闭手术,可降低脑组织氧耗,减少脑组织乳酸堆积,保护血脑屏障的完整性,减轻脑水肿。本院自2010年8月至2011年4月为3例颅内动脉瘤病人实行亚低温下颅内动脉瘤夹闭术,取得满意效果。现将手术配合要点及体会介绍如下。     

预见性护理干预在颅内动脉瘤破裂早期行夹闭术患者中的应用

目的:探讨预见性护理干预在颅内动脉瘤破裂早期行夹闭术患者中的应用。方法:对32例颅内动脉瘤破裂早期手术患者实行围手术期预见性护理干预,包括心理护理干预、再出血干预、脑血管痉挛干预、消化道出血干预、电解质紊乱干预及肺部感染干预,预防并发症,出院时按格拉斯哥(GCS)标准评价患者的疗效。结果:出院时按GCS评定标准,恢复良好26例,中度残疾4例,重度残疾1例,植物生存1例。结论:预见性护理干预对颅内动脉瘤破裂早期手术患者的预后及并发症的预防有明显的协同作用,降低了死亡率和致残率,患者预后更好。     

前移护理干预对颅内动脉瘤破裂早期行夹闭术患者预后的影响

目的探讨前移护理干预对颅内动脉瘤破裂早期行夹闭术患者预后的影响。方法随机将32例颅内动脉瘤破裂早期手术患者分为干预组和对照组各16例,干预组患者实行围手术期预见性护理干预,对照组实行神经外科常规护理。观察2组患者术后再次出血、脑血管痉挛、消化道出血、电解质紊乱及肺部感染的例数。出院时按格拉斯哥(GCS)标准评价疗效。结果干预组患者再次出血、脑血管痉挛、消化道出血、电解质紊乱及肺部感染发生率明显低于对照组;干预组患者GCS评分与对照组相比明显升高。结论预见性护理干预对颅内动脉瘤破裂早期手术患者的预后及并发症的预防有明显的协同作用,降低了死亡率和致残率,患者预后更好。     

Corticosteroid treatment in critically ill patients with severe influenza pneumonia: a propensity score matching study

Purpose

To determine clinical predictors associated with corticosteroid administration and its association with ICU mortality in critically ill patients with severe influenza pneumonia.

Methods

Secondary analysis of a prospective cohort study of critically ill patients with confirmed influenza pneumonia admitted to 148 ICUs in Spain between June 2009 and April 2014. Patients who received corticosteroid treatment for causes other than viral pneumonia (e.g., refractory septic shock and asthma or chronic obstructive pulmonary disease [COPD] exacerbation) were excluded. Patients with corticosteroid therapy were compared with those without corticosteroid therapy. We use a propensity score (PS) matching analysis to reduce confounding factors. The primary outcome was ICU mortality. Cox proportional hazards and competing risks analysis was performed to assess the impact of corticosteroids on ICU mortality.

Results

A total of 1846 patients with primary influenza pneumonia were enrolled. Corticosteroids were administered in 604 (32.7%) patients, with methylprednisolone the most frequently used corticosteroid (578/604 [95.7%]). The median daily dose was equivalent to 80 mg of methylprednisolone (IQR 60–120) for a median duration of 7 days (IQR 5–10). Asthma, COPD, hematological disease, and the need for mechanical ventilation were independently associated with corticosteroid use. Crude ICU mortality was higher in patients who received corticosteroids (27.5%) than in patients who did not receive corticosteroids (18.8%, p?<?0.001). After PS matching, corticosteroid use was associated with ICU mortality in the Cox (HR?=?1.32 [95% CI 1.08–1.60], p?<?0.006) and competing risks analysis (SHR?=?1.37 [95% CI 1.12–1.68], p?=?0.001).

Conclusion

Administration of corticosteroids in patients with severe influenza pneumonia is associated with increased ICU mortality, and these agents should not be used as co-adjuvant therapy.

     

Association of cystatin C levels with metabolic syndrome incidence: a nested case-control study with propensity score matching

ObjectiveMetabolic syndrome (MetS) involves multiple metabolic disorders and seriously affects human health. Identification of key biological factors associated with MetS incidence is therefore important. We explored the association between MetS and the biochemical profiles of Chinese adults in Shenyang City in a nested case-control study.MethodsWe included adult participants who underwent physical examination at our hospital for 2 consecutive years. Participants’ biochemical profiles and other MetS components were tested and monitored continuously. Propensity score matching was used to adjust confounding factors between participants with and without MetS. We analyzed the association between incidence of MetS and the biochemical profiles of participants.ResultsOf 5702 participants who underwent physical examination between 1 January 2017 and 1 December 2018, 538 had confirmed newly developed MetS. After successfully matching 436 pairs of participants, mean cystatin C (Cys-C) level was significantly higher in the MetS group than in the non-MetS group. Logistic regression analysis indicated that age (years) and γ-glutamate transpeptidase, creatinine, uric acid, and Cys-C levels were significantly associated with MetS incidence; among these, the odds ratio of Cys-C was highest (3.03; 95% confidence interval, 1.02–9.00).ConclusionsCys-C levels were significantly associated with the incidence of MetS among Chinese adults.     

Performance of a quick sofa-65 score as a rapid sepsis screening tool during initial emergency department assessment: A propensity score matching study

PurposeWe sought to elucidate the performance of a Quick Sequential Organ Function Assessment-65 (qSOFA-65) score in recognizing sepsis and to compare the qSOFA-65 score to systemic inflammatory response syndrome (SIRS) and qSOFA scores.MethodsWe performed a matched case-control study using propensity score matching. The number of patients meeting qSOFA-65, qSOFA, and SIRS positive criteria were calculated between the sepsis and non-sepsis groups. We compared the diagnostic performance of the three scoring systems in predicting sepsis.ResultsA total of 2441 patients were included in the study. In propensity matched cohorts, the percentage of patients who met qSOFA-65, qSOFA, and SIRS positive criteria were 46.7%, 14.3%, and 55.6%, respectively. The sensitivity and specificity scores for the qSOFA-65, qSOFA, and SIRS positive criteria for sepsis were 0.66 and 0.73, 0.28 and 0.97, and 0.66 and 0.55, respectively. The AUC value of qSOFA-65 positive criteria in predicting sepsis was significantly higher than that of qSOFA and SIRS positive criteria (adjusted AUC 0.688 vs. 0.630 vs. 0.596, respectively).ConclusionsWe found that qSOFA-65 was more likely to identify patients with sepsis on the initial ED visit relative to qSOFA or SIRS. This may have quality improvement implications in predicting sepsis.     

Bicyclol for the treatment of drug-induced liver injury: a propensity score matching analysis using a nationwide inpatient database

ObjectiveTo evaluate the efficacy and safety of bicyclol in patients with drug-induced liver injury (DILI) using a nationwide database.MethodsWe retrospectively analyzed the clinical data of DILI patients in the DILI-R database. Propensity score matching was performed to balance the bicyclol and control groups, and alanine aminotransferase (ALT) recovery was compared between the two groups. Factors associated with ALT recovery and safety were identified.ResultsThe analysis included the data of 25,927 patients. Eighty-seven cases were included in the bicyclol group, with 932 cases in the control group. One-to-one propensity score matching created 86 matched pairs. The ALT normalization rate in the bicyclol group was significantly higher than that in the control group (50.00% vs. 24.42%), and statistical significance was found in the superiority test. After adjustment of baseline ALT levels, baseline total bilirubin levels, sex, age, acute or chronic liver diseases, and suspected drugs in the multivariate logic regression analysis, the major influencing factors for ALT recovery included the time interval between ALT tests (days) and the group factor (bicyclol treatment). There were no differences in the proportion of renal function impairment or blood abnormalities between the two groups.ConclusionsBicyclol is a potential candidate for DILI.     

尼卡地平与硝酸甘油控制性降压对颅内动脉瘤夹闭术患者脑氧代谢的影响

目的对比尼卡地平与硝酸甘油控制性降压对颅内动脉瘤夹闭术患者脑氧代谢的影响。方法采取随机、对照、双盲的方法将40例行颅内动脉瘤夹闭术的患者分成尼卡地平(Ⅰ)组和硝酸甘油(Ⅱ)组,每组20人。打开硬脑膜行控制性降压,并于打开硬脑膜即刻(T0)、瘤体分离结束(T1)、夹闭完毕(T2)、停止控制性降压20min(T3)四个时点行桡动脉及颈内静脉球血气分析,记录PaO2、PjvO2、SaO2、SjvO2、Hab、Hjvb值,并计算Da-jvO2、COER值。结果两组患者在控制性降压效果上无明显统计学差异(P>0.05),降压期间心率均增快(P<0.01);Ⅰ组患者在T1、T2时点SjvO2值较T0、T3时点明显升高(P<0.05或P<0.01),而Da-jvO2、COER值明显降低(P<0.01);Ⅱ组患者T1、T2时点SjvO2、Da-jvO2、COER值与T0、T3时点比较无明显统计学差异(P>0.05);Ⅰ组患者在T1、T2时点SjvO2值对应Ⅱ组明显升高(P<0.05),而Da-jvO2、COER值明显降低(P<0.05)。结论硝酸甘油与尼卡地平均可安全用于颅内动脉瘤夹闭术的控制性降压,但后者能有效降低脑氧代谢,改善脑氧合,脑保护作用更优越。     

How to prepare a hospital for an earthquake

Practical earthquake preparedness guidance for hospitals is provided, including information on the following: areas of the United States subject to earthquakes, estimated casualties in future earthquakes, structural weaknesses in buildings, nonstructural vulnerabilities and retrofit solutions, emergency planning suggestions, experiences of hospitals in past earthquakes. Sources for further information are included.     

Cautionary findings for motor evoked potential monitoring in intracranial aneurysm surgery after a single administration of rocuronium to facilitate tracheal intubation

Journal of Clinical Monitoring and Computing - Administration of rocuronium to facilitate intubation has traditionally been regarded as acceptable for intraoperative motor evoked potential (MEP)...     

生物类似物益赛普治疗晚期强直性脊柱炎患者报告结局分析——一项基于倾向性评分匹配的分析研究

目的 应用患者报告结局量表(PROs)分析生物类似物益赛普治疗晚期强直性脊柱炎(AS)的临床疗效.方法 回顾性分析145例确诊为晚期AS患者的临床资料,根据是否使用益赛普分为益赛普治疗组(Bg组,n=43)、非生物制剂治疗组(nBg组,n=102).对2组患者资料进行1∶1倾向性评分匹配(PSM)后,Bg组和nBg组分...     

Using propensity score matching with doses in observational studies: An example from a child physical abuse and sleep quality study

Both physical abuse and poor sleep quality are public health concerns among adolescents, particularly in mainland China, but examining any causal effect of physical abuse on adolescents’ sleep quality using a randomized controlled trial is not possible for obvious ethical reasons. Researchers have proposed the use of propensity score matching with doses to minimize overt bias and estimate the effect of multidose treatments or varying degrees of risk exposure in observational studies. In this paper, we demonstrate the propensity score methods with a focus on matching with doses in an examination of the relationship between physical abuse levels (frequency and number of perpetrators) and self‐reported sleep quality among adolescents. Secondary analyses were conducted using data from the China Jintan Child Cohort. The sample comprised 707 adolescents (13.16 ± 0.90 years old) who had complete data on physical abuse, sleep, and covariates. Propensity scores were computed from eight covariates and used to carry out pair matching, matching with the frequency of abusive experience, and matching with the number of perpetrators. The standardized differences of covariates suggested an acceptable balance between groups after matching. The results derived from matching sets consistently indicated that adolescents being physically abused by parent(s) have worse sleep quality. Despite its inherent limitations, propensity score matching with doses provides a useful tool for nurse researchers analyzing observational data.