巧做新生儿蓝光治疗一次性眼罩

黄疸新生儿在进行蓝光照射治疗时需使用眼罩遮光以避免损伤视网膜。我科使用自制的一次性新生儿眼罩,无1例新生儿发生视网膜损伤。     

内镜诊疗患者护理安全风险关键因素分析与对策

目的：对内镜诊疗患者常见的护理安全隐患进行原因分析和流程改进,减少护理安全风险事件发生,保障患者诊疗安全。方法：根据质量管理讨论会的记录,采用鱼骨图分析法,归纳并总结存在的安全隐患,分析关键因素和根本原因,并制定可行的护理防范措施。结果 ：分析出了内镜诊疗发生护理安全隐患的原因,落实了护理评估,采取了有效的护理防范措施,优化改进了信息系统自动识别功能,强化了安全核查。结论：紧抓安全风险防范关键环节,强化安全防范意识,优化流程并制定有效措施,有效地杜绝了护理安全风险的发生,保障了患者检查期间的安全。     

Efficacy and safety of upper endoscopy procedures during pregnancy

The risks of performing endoscopy become more complex when the patient is pregnant. The endoscopist has to consider all the factors that affect the health of both the patient and the fetus. Although pregnant patients are generally healthy, they may have changes in blood pressure and volume status as well as alterations in tolerance of anesthesia and luminal distention. Maternal complications will impact the health of the fetus. In addition, the fetus can be directly affected by procedural medications, mechanical factors, and therapeutic interventions. The endoscopist must be able to minimize the risks to the fetus and provide the pregnant patient with a safe and comfortable procedure. This review focuses on the risks of upper endoscopy as they relate to the health of a pregnant woman and the fetus.     

内镜中心工作流程和安全管理探讨

随着国民经济的增长和人们健康意识的不断增加,内镜检查作为疾病诊疗技术之一,已很普遍,胃肠镜检查越来越多地被人们列入健康体检的内容.因此,我院内镜中心也最大限度地为病人提供便捷、方便的服务.在此过程中为确保病人安全,实施有效的护理安全管理尤为重要.     

瑞马唑仑用于老年患者无痛消化道内镜检查的安全性与可行性的Meta分析

目的 系统评价瑞马唑仑用于老年患者无痛消化道内镜检查的镇静效果和麻醉安全性。方法根据Meta分析的原则,全面检索PubMed、The Cochrane Library、Embase、中国生物医学文献数据库、中国知网和万方数据中有关瑞马唑仑用于老年患者无痛消化道内镜检查的随机对照试验（RCT）,检索时间截止至2022年5月。筛选和提取所需资料,并使用Cochrane协作网偏倚风险评价工具,对纳入研究的质量进行评估,使用RevMan 5.4.1软件对结局指标进行Meta分析。结果 共12篇RCT(1 296例患者)纳入分析。其中,瑞马唑仑组（R组） 647例,丙泊酚组（P组） 649例。瑞马唑仑组患者心率（HR）(WMD=0.40,95%CI:-0.49～1.28,P=0.380)和平均动脉压（MAP）(WMD=5.05,95%CI:-3.83～13.93,P=0.260)的变化幅度与丙泊酚组比较,差异无统计学意义。麻醉期间,瑞马唑仑组低血压发生率（■=0.24,95%CI:0.15～0.39,P=0.000）、呼吸抑制发生率（■=0.28,95%CI:0.18～0.44,P=0.000）...     

Emergency gastrointestinal endoscopy and endoscopy for the emergency department

Endoscopic procedures usually are not performed in the Emergency Department. However, on some occasions, it is essential that trained emergency physicians be able to perform endoscopic examinations. All physicians working in the Emergency Department should have an understanding of the role of endoscopy in the evaluation and treatment of gastrointestinal disorders, since in some cases, for example, those of massive upper and lower gastrointestinal hemorrhage, foreign body extraction, or functional and obstructive disorders of the colon, endoscopic procedures may be required on an emergency basis.     

Effectiveness and safety of sedation in gastrointestinal endoscopy: An opinion review

Although endoscopy is a less invasive procedure than surgery, patients can experience pain without sedation. Patients expect reduced pain during endoscopies from effective and safe sedatives. Midazolam and propofol are used for endoscopic sedation in many countries and regions. Midazolam is a widely available benzodiazepine, and many clinical trials have shown it to be an effective sedative. However, patients who are sedated with midazolam require rest in the recovery room due to its relatively long half-life, and an antagonist such as flumazenil may need to be administered in cases of deep or prolonged sedation. Propofol is a short-acting sedative with a short half-life and a quick recovery time. Therefore, the use of propofol has been increasing. However, propofol has a narrow margin of safety and often induces adverse effects such as respiratory depression. Also, propofol has no specific antagonist, and should be administered by an anesthesiologist or an endoscopist familiar with anesthesia. Remimazolam, which is a novel ultra-short-acting benzodiazepine, has recently gained attention. Remimazolam has a short half-life and an antagonist. Both effective and safe sedation is desired in accordance with the increasing need for sedative endoscopies. Therefore, in this review each sedative is summarized.     

Artificial intelligence for endoscopy

In recent times, there has been progressive development in artificial intelligence (AI) following the introduction of deep learning in the medical field including gastroenterology and endoscopy. Most of the reported studies were based on retrospective data. Several prospective studies of real-time diagnosis of moving images using the AI system are expected to match the real clinical situation and to aid the endoscopists in the detection and diagnosis of neoplasms without missing any lesion. AI can read a large number of endoscopic images in a few minutes and make a diagnosis; therefore, it is expected to cover the lack of support for the screening esophagogastroduodenoscopy in the health check-up and a large number of capsule images, thereby freeing the endoscopists from this burden. AI can help make the diagnosis during the endoscopic procedure and thereby prevent an unnecessary biopsy for patients taking antithrombotic drugs. AI can also be useful for education and training in endoscopy. Trainees can learn to perform endoscopy and the detection and diagnosis of lesions by the support of AI. In the near future, real-time endoscopic diagnosis using AI is expected to lessen the burden of endoscopists, to enhance the quality level of endoscopists, to overcome the miss of lesions and to make optimal diagnosis.     

援鄂抗疫一线护目镜防起雾对策分析

新型冠状病毒肺炎疫情爆发以来,医护人员在临床诊疗及护理操作过程中需要佩戴护目镜进行防护,护目镜易起水雾而影响正常的诊疗操作。本文分析了起雾原因及干预措施,并对比了专用防雾剂、沐浴露、洗洁精、二型安尔碘防护目镜起雾的优缺点。推荐临床采用专用防雾剂、洗洁精进行防雾处理,沐浴露和二型安尔碘相对效果欠佳,但防疫的特殊时期,考虑到物资供应紧缺,没有条件使用专业泳镜防起雾喷剂的医务人员可以用洗洁精在护目镜内侧轻薄涂抹后晾干进行替代。     

新型冠状病毒肺炎疫情下医用护目镜的防雾技巧

新型冠状病毒具有很强的传染性,护目镜可有效防护职业暴露,但在使用护目镜过程中容易出现雾气,增加了操作的难度和污染风险.通过涂抹泳镜防雾剂、洗涤剂类用品、碘伏、洗手液等,能有效防止和延长起雾现象,提高工作效率.     

The Need for Enchantment

No abstract available for this article.     

The Need for Administrators

No abstract available for this article.     

Evaluation of a virtual endoscopy simulator for training in gastrointestinal endoscopy

BACKGROUND AND STUDY AIMS: Skills in gastrointestinal endoscopy mainly depend on experience and practice. Training on endoscopy simulators may decrease the time needed to reach competency in endoscopy. The purpose of the study was to determine whether the GI-Mentor, a virtual reality endoscopy simulator, can distinguish between beginners and experts in endoscopy and to assess whether training improves the performance of beginners. METHODS: A total of 13 beginners and 11 experts (more than 1,000 procedures) in gastrointestinal endoscopy were included. The baseline assessment consisted of virtual endoscopies and skill tests. The beginners were randomly allocated to receive training (n = 7) or no training (n = 6). The training group was allowed to practice using the simulator for 2 hours per day. After 3 weeks participants were re-evaluated with two new virtual endoscopy cases and one virtual skill test. Insertion time, correctly identified pathologies, adverse events and skill test performance were recorded. RESULTS: The baseline assessment revealed significant differences favoring the experts for virtual endoscopies and skill tests. Significant differences in favor of experts were found for successful retroflection during esophagogastroduodenoscopy (EGD) (P < 0.005); adverse events during colonoscopy (P < 0.02); insertion time (P < 0.001); correctly identified pathologies in gastroscopy and colonoscopy (P < 0.02); and skill test performance (P < 0.01). The final evaluation showed significant differences between training and no-training groups, in favor of the training group, for the number of adverse events during virtual endoscopy (P < 0.04), for the insertion time during colonoscopy (P < 0.03); and for skill test performance (P < 0.01). The training group improved its abilities on the simulator significantly. Differences between experts and the training group were no longer seen. CONCLUSION: This virtual endoscopy simulator is capable of identifying differences between beginners and experts in gastrointestinal endoscopy. A 3-week training improves the performance of beginners significantly. This quite fast improvement in endoscopic skills certainly cannot be seen in clinical practice; no conclusions can be made about the impact of virtual simulator training on real-life endoscopy, and this must be evaluated.     

Efficacy and safety of nurse-administered propofol sedation during emergency upper endoscopy for gastrointestinal bleeding: a prospective study

BACKGROUND AND STUDY AIMS: Recent studies have documented the safety of propofol sedation for endoscopic procedures, but many endoscopists are reluctant to use propofol for high-risk patients because of adverse effects. The aim of this study was to demonstrate the safety and efficacy of nurse-administered propofol sedation during emergency upper endoscopy for patients with gastrointestinal bleeding. PATIENTS AND METHODS: Over a period of 18 months, 120 patients suffering from acute upper gastrointestinal bleeding received propofol sedation administered by a registered nurse. Among these, 15 patients were classified into American Society of Anesthesiologists (ASA) class IV, 84 were ASA class III, and 21 were ASA class II. Patients without gastrointestinal bleeding, who also received propofol during the same period and were matched for age, gender, and ASA class, served as controls. RESULTS: Endoscopic hemostasis was achieved in 98.3 % of patients, and 97.5 % were satisfied with the procedure. In patients with gastrointestinal bleeding, the rates of hypotension (systolic blood pressure < 90 mmHg) and hypoxemia (peripheral oxygen saturation < 90 %) were 8.3 % and 6.7 % respectively, values higher than those in the control group. However, neither mask ventilation nor endotracheal intubation was necessary. Although two patients with gastrointestinal bleeding developed pneumonia, most likely due to aspiration during the procedure, they recovered within 5 days of treatment. There were no sedation-associated severe complications or mortalities. CONCLUSION: Using a strict protocol designed to protect the patient's airway and cardiovascular function, nurse-administered propofol sedation during emergency upper gastrointestinal endoscopy is safe and appropriate in cases of acute gastrointestinal bleeding.     

Narcan use in the endoscopy lab: an important component of patient safety.

This article uses a case study to demonstrate the proper use of Narcan (naloxone hydrochloride injection, USP) for the reversal of the effects of opiates which can occur during moderate or "conscious" sedation for procedures in the endoscopy setting. Alternative treatments for the sedation, hypotension, and respiratory depression are discussed, as are instructions and rationale for partial reversal. Guidelines to ensure patient safety are also presented.