疼痛对创伤骨科术后患者生命体征的影响

目的探讨疼痛时测量患者生命体征的临床意义。方法采用视觉模拟评分法和文字描述式评分法对190例无基础疾病的创伤骨科术后患者定时或疼痛时测量体温、脉搏、呼吸、血压,并与其无疼痛时(安静时)的测量值比较。结果轻、中、重、极度疼痛时疼痛量分别为1.85±0.58、3.80±0.76、6.57±0.63、8.61±0.45;轻度疼痛时患者生命体征平稳(均P>0.05);中度疼痛时患者收缩压升高明显(t=3.65,P<0.01),体温、脉搏、呼吸、舒张压较平稳(均P>0.05);重、极度疼痛时患者呼吸、收缩压、舒张压均显著升高(t=4.46、5.20,t=4.46、4.56,t=2.74、2.81,均P<0.01),但体温、脉搏平稳(均P>0.05)。结论中度尤其是重、极度疼痛时患者血压、呼吸有所改变,手术后应定时或疼痛时测量患者生命体征,及时予以干预,以减轻患者治疗性痛苦。     

临终关怀对患儿生命体征的影响

为探讨临终关怀对患儿生命体征的影响 ,将 48例 (≤ 3岁 )住院的临终患儿进行分组 (对照组和观察组各 2 4例 )护理 ,对照组行常规护理 ,观察组行临终关怀护理。观察两组患儿生命体征变化、情绪状态及生存时间。结果两组患儿体温比较 ,差异无显著性意义 (P>0 .0 5 ) ;呼吸、脉搏、血压比较 ,差异有极显著性意义 (P<0 .0 1) ;观察组患儿较安静 ,且生存时间延长 ,与对照组比较 ,差异有显著性意义 (均 P<0 .0 5 )。提示临终关怀能减轻患儿的痛苦 ,使其安静地度过生命的临终阶段     

术后体位改变方式对贲门癌患者生命体征的影响

目的探讨术后体位改变方式对贲门癌患者生命体征的影响。方法通过计算机产生的随机序列将105例贲门癌根治术患者随机分为Ⅰ组、Ⅱ组、Ⅲ组各35例。在术后生命体征平稳的前提下,改变体位,Ⅰ组由仰卧位0°改为50°半卧位;Ⅱ组由仰卧位0°改为30°半卧位,10min后再将体位改为50°半卧位;Ⅲ组仰卧位0°改变为15°低坡卧位,10min后改为30°半卧位,再10min后改为50°半卧位。分别记录三组患者体位改变前后的体温、脉搏、呼吸、血压变化及恶心发生情况。结果体位改变后三组脉搏、呼吸、收缩压、舒张压测量值及恶心发生率比较,差异有统计学意义(P0.05,P0.01);Ⅰ组脉搏、呼吸、收缩压、舒张压及恶心发生率相对较高;组内比较,Ⅰ组除体温外,其余各项指标体位改变前后差异有统计学意义(均P0.01)。Ⅱ、Ⅲ组各项指标体位改变前后组内比较差异无统计学意义(均P0.05)。结论术后逐步改变体位方式(先由0°至30°,10min后再改变至50°)可避免由体位突然改变而引起的生命体征波动,减轻患者的不舒适感。     

不同体位对心脏术后气管插管患者生命体征的影响

目的研究体位交替更换对心脏术后气管插管患者生命体征的影响,了解其可行性,以确保体位护理在此类患者中的有效实施。方法对35例气管插管时间>24h的心脏手术后患者于清醒后实施半卧位,左、右侧卧位各1h交替及晨、晚间仰卧位各1h的体位护理,比较不同体位HR、SBP、SaO2值及不适情况。结果不同体位对HR、SBP无显著影响(均P>0.05);半卧位,左、右侧卧位即刻及30min时SaO2值均比仰卧位高(均P<0.05);半卧位和左、右侧卧位不同时间SaO2值比较,差异无显著性意义(均P>0.05)。不适症状除腰痛外,伤口胀痛、胸闷和紧张发生率仰卧位均显著高于其他卧位(均P<0.05)。结论体位改变对患者的生命体征无负面影响,可促进肺氧合功能,增加患者舒适度。     

腹腔镜直肠癌根治术中体位调整对患者生命体征的影响

目的:探讨腹腔镜直肠癌根治术中患者特殊体位对生命体征的影响。方法:回顾分析2022年3月至2022年4月接受腹腔镜直肠癌根治术(Dixon术式)患者的临床资料,统计并比较手术开始时改变体位前、改变体位后及手术结束时恢复体位前、恢复体位后4个时点患者的生命体征。结果:符合入组标准的患者共49例,40～83岁,其中男26例,女23例。术中体位调整对患者的血压影响较大,由平卧位调整至截石位时,患者血压尤其收缩压明显升高[(132.57±23.79)mmHg vs.(144.31±20.05)mmHg,P<0.001],手术结束恢复至平卧位时,收缩压明显下降[(127.51±16.73)mmHg vs.(118.49±16.78)mmHg,P<0.001];体位调整前后患者心率、呼吸频率及体温无明显变化。结论:腹腔镜直肠癌根治术体位的调整会引起患者生命体征的变化,尤其收缩压波动较大。术中需优化医护配合,对于高危患者应预先制定干预措施,以保证患者生命体征平稳,减少并发症的发生。     

膀胱冲洗速度对病人生命体征的影响

目的：探讨不同速度冲洗膀胱对病人生命体征的影响程度。方法：将102例留置导尿行膀胱冲洗的病人随机分成A、B、C三组（A组48例，B组32例，C组22例），冲洗液均为250ml，冲洗速度分别为250、140、100gtt/min，分别于20、35、50min滴完。比较冲洗前及冲洗后（未排液体前）生命体征的变化。结果：A组冲洗前后心率、呼吸、血压比较，差异均有显著性意义（均P＜0．05），体温的变化差异无显著性意义（P＞0．05）；B、C组冲洗前后生命体征比较，差异均无显著性意义（均P＞0．05）。结论：冲洗速度过快可引起病人心率、呼吸增快和血压升高，采用B组的速度进行膀胱冲洗，既可保证病人安全，又可减轻护士的劳动强度。     

翻身拍背对重症脑出血病人生命体征的影响

对 37例重症脑出血病人翻身拍背前后的生命体征等进行观察分析 ,结果 2 5例无明显意识障碍和浅度昏迷病人翻身拍背前后生命体征变化不显著 (均P >0 .0 5 ) ,而 12例中、深度昏迷病人翻身拍背前后生命体征变化显著 (均P <0 .0 5 )。提示对于中、深度昏迷病人不主张过早翻身拍背 ,而对无明显意识障碍和浅昏迷病人可积极进行 ,以防止并发症的发生。     

静脉穿刺所致疼痛对新生儿生命体征的影响

目的探讨静脉穿刺时疼痛程度对新生儿生命体征的影响。方法静脉穿刺时应用新生儿疼痛行为评分量表进行疼痛评分,对105例疼痛评分大于5分的患儿应用监护仪动态记录穿刺前和穿刺时的呼吸、心率、血压和经皮血氧饱和度的变化。结果 105例新生儿平均疼痛评分为5.8分,进行穿刺时新生儿呼吸、心率、收缩压和舒张压均有不同程度的上升,血氧饱和度下降(均P<0.05)。结论静脉穿刺所致疼痛对新生儿生命体征的变化有显著影响,应引起临床重视。     

腹腔热灌注化疗对患者生命体征的影响

目的探讨腹腔热灌注化疗对患者生命体征的影响,为评估该种治疗方法临床应用的安全性提供依据。方法对收治的20例恶性肿瘤患者进行腹腔热灌注化疗,治疗温度43℃,时间60 min,灌注速度500 mL/min。监测患者治疗前及治疗术中15,30,45,60 min各时点进水口、出水口及患者体表、直肠、鼓膜的温度;监测各相应时点的血压、心率、呼吸、血氧饱和度;分析该疗法对患者体生命体征的影响。结果腹腔热灌注化疗前至治疗60 min结束时患者的腋窝、鼓膜、直肠温度平均分别上升了0.9℃,0.7℃和0.9℃;治疗过程中各时点血压、心率、呼吸、血氧饱和度等数值均在正常范围内,治疗前及治疗过程中无明显变化。结论以43℃的治疗温度,500 mL/min的灌注速度进行腹腔热灌注化疗60 min,可引起体温轻微升高,但对各重要生命体征无明显影响。腹腔热灌注化疗对机体生理影响轻微,临床应用安全可靠。     

经尿道前列腺电切围手术期低温对患者生命体征的影响

目的　比较不同灌洗液温度在经尿道前列腺电切 (TURP)围手术期对患者生命体征的影响,探讨手术的有关安全因素。　方法　按使用不同温度灌洗液将患者分为室温组 ( 21℃,n=40)和等温组( 37℃,n=60)。两组年龄、体重、国际前列腺症状评分 (IPSS)、心脑肺并发症比例及术中麻醉方式、灌洗液时间、灌洗液量、切除腺体重量和输血量比较无明显差异。以灌洗时间为参数,动态观察患者在TURP过程中平均动脉压 (MAP),心率,体温,血氧饱和度 (SaO2 )及血渗透量浓度(Oms)的变化。　结果　室温组患者于手术灌洗 45min后,MAP平均降低 7. 6mmHg( 8~13mmHg, 1 mmHg=0. 133kPa,F=1. 334,P=0. 262 );心率平均减缓 21. 6次 /min,P<0. 001, 18例(36% )伴有以期前收缩为主的心律失常。以体温 36℃为临界值,平均降低 0. 75℃ (0. 9~0. 6℃),P<0. 01。等温组患者上述指标变化多出现于灌洗 60min后,两组比较差异无统计学意义。室温组高龄(≥75岁)患者 17例,其中 14例(82% )出现低温及生命体征变化,等温组高龄患者 24例,亦有 9例(38% )出现低体温。高龄作为单一因素与围手术期低温呈相关性 (r=-0.417,P=0. 002)。大腺体(切除腺体重量≥25g)亦与围手术期低温呈相关性 (r=-0. 633,P=0. 001)。　结论　TURP中灌洗液温度可致手术期低体     

Abnormal vital signs after laparoscopic colorectal surgery: More common than you think

BackgroundAnastomotic leak is a feared complication. The presence of abnormal vital signs is often cited as an important overlooked predictive clue in retrospective settings once the diagnosis of leak has already been established. We aimed to determine the prevalence of abnormal vital signs following colorectal resection and assess its predictive value.MethodsWe retrospectively studied patients undergoing colorectal resection. The performance of vital signs in predicting anastomotic leak was assessed using discrete-time survival analysis and receiver operator characteristic curve.Results1662 patients (841 laparoscopic, 821 open) were included. Clinical anastomotic leak was diagnosed in 50 patients (3.1%). 96.8% of patients of the entire cohort had at least one abnormal vital sign during their postoperative course. No individual vital sign was a strong predictor of anastomotic leak in either laparoscopic or open cohorts.ConclusionVital sign abnormalities are extremely common following open and laparoscopic colorectal surgery and alone are poor predictors of anastomotic leak.     

A comparison of base deficit and vital signs in the early assessment of patients with penetrating trauma in a high burden setting

Introduction: An assessment of physiological status is a key step in the early assessment of trauma patients with implications for triage, investigation and management. This has traditionally been done using vital signs. Previous work from large European trauma datasets has suggested that base deficit (BD) predicts clinically important outcomes better than vital signs (VS). A BD derived classification of haemorrhagic shock appeared superior to one based on VS derived from ATLS criteria in a population of predominantly blunt trauma patients. The initial aim of this study was to see if this observation would be reproduced in penetrating trauma patients. The power of each individual variable (BD, heart rate (HR), systolic blood pressure (SBP), shock index(SI) (HR/SBP) and Glasgow Coma Score (GCS)) to predict mortality was then also compared.Methods: A retrospective analysis of adult trauma patients presenting to the Pietermaritzburg Metropolitan Trauma Service was performed. Patients were classified into four “shock” groups using VS or BD and the outcomes compared.Receiver Operator Characteristic (ROC) curves were then generated to compare the predictive power for mortality of each individual variable.Results: 1863 patients were identified. The overall mortality rate was 2.1%. When classified by BD, HR rose and SBP fell as the “shock class” increased but not to the degree suggested by the ATLS classification. The BD classification of haemorrhagic shock appeared to predict mortality better than that based on the ATLS criteria. Mortality increased from 0.2% (Class 1) to 19.7% (Class 4) based on the 4 level BD classification. Mortality increased from 0.3% (Class 1) to 12.6% (Class 4) when classified based by VS.Area under the receiver operator characteristic (AUROC) curve analysis of the individual variables demonstrated that BD predicted mortality significantly better than HR, GCS, SBP and SI. AUROC curve (95% Confidence Interval (CI)) for BD was 0.90 (0.85-0.95) compared to HR 0.67(0.56-0.77), GCS 0.70(0.62-0.79), SBP 0.75(0.65-0.85) and SI 0.77(0.68–0.86).Conclusion: BD appears superior to vital signs in the immediate physiological assessment of penetrating trauma patients. The use of BD to assess physiological status may help refine their early triage, investigation and management.     

微创经皮肾穿刺取石术中不同冲洗液温度对患者生命体征的影响

目的探讨微创经皮肾穿刺取石术中冲洗液温度对患者生命体征的影响。方法87例经皮肾镜取石术患者随机分为两组，分别应用室温（21℃-24℃，A组）和等体温（37℃，B组）冲洗液，监测冲洗液温度对中心体温、血压和心率的影响。结果B组术中低体温发生率及心动过缓发生率均低于A组（10％：29．8％，12．5％：27．6％），差异有显著意义（P〈0．01）；B组血压异常发生率（20％）低于A组（23．4％），差异无统计学意义（P〉0．05）。结论应用等温冲洗液可有效维持患者术中中心体温及心率，提高微创经皮肾穿刺碎石取石术的安全性。     

目标导向液体治疗对脊柱手术老年患者预后的影响

目的观察以脉压变异率(PPV)为目标的液体导向治疗(goal-directed fluid therapy,GDFT)对脊柱手术的老年患者预后的影响。方法选择择期行全身麻醉下脊柱手术的老年患者520例,男250例,女270例,年龄65~93岁,BMI18.5~34.0kg/m2,ASAⅡ或Ⅲ级。采用随机数字法分为两组:目标导向液体治疗组(G组)和常规输液组(C组),每组260例。G组以PPV为目标,根据GDFT方案对患者进行容量管理,C组麻醉科医师根据经验进行液体管理。记录术前1d(T0)、麻醉诱导前(T1)、手术开始即刻(T2)、手术结束即刻(T3)的HR、MAP、脉压变异率(PPV)。记录手术时间、术中晶体液的输入量、胶体液输入量、输液总量、自体血回输量、出血量、尿量、麻黄碱使用例数和去甲肾上腺素使用例数。记录术后住院时间,恶心呕吐、头晕、伤口感染、肺部感染和发热等术后并发症情况。结果T3时G组PPV明显低于C组(P0.05)。两组不同时点HR和MAP差异无统计学意义。G组晶体液输入量明显少于C组(P0.05),术中去甲肾上腺素使用率明显低于C组(P0.05)。两组胶体液输入量、输液总量、自体血回输量、出血量、尿量和麻黄碱使用率差异无统计学意义。G组术后住院时间明显短于C组(P0.05)。G组发热病例明显少于C组(P0.05)。结论以PPV为目标导向的液体治疗可以减少脊柱手术老年患者术中晶体液的输入量,血流动力学稳定性好,减少术后并发症的发生,缩短术后住院时间。     

Buccal partial pressure of carbon dioxide outweighs traditional vital signs in predicting the severity of hemorrhagic shock in a rat model

Background

Hemorrhagic shock (HS) is a leading cause of death in both military and civilian settings. Researchers have investigated different parameters as predictors of HS, but reached inconsistent conclusions. We hypothesized that buccal partial pressure of carbon dioxide (PCO₂) was a better predictor of HS than traditional vital signs.

Materials and methods

Twenty-four anesthetized Wistar rats were randomly divided into four groups: one control group (no bleeding) and three surgical groups (25%, 35%, and 45% blood loss). Hemorrhage was induced by withdrawing blood from the left femoral artery over a period of 30 min. After that, resuscitation was performed on animals in surgical groups using the Ringer lactate solution. Buccal PCO₂ was continuously measured by a newly designed sensor holder during the experiments. Traditional vital signs, cardiac output, base excess, and microvascular perfusion (MPF) were also measured or calculated.

Results

Buccal PCO₂ differed significantly among four groups beginning at 20 min, approximately 10 min earlier than the shock index and more earlier than the heart rate, systolic blood pressure, and mean arterial pressure. Buccal PCO₂ correlated well with cardiac index and the changes in MPF. The correlation coefficients with cardiac index, chest MPF, and upper-limb MPF for buccal PCO₂ were 0.781, −0.879, and −0.946, respectively. Besides, buccal PCO₂ showed a good value for predicting mortality. Furthermore, an approximate critical threshold of buccal PCO₂ was also identified for predicting the severity of HS.

Conclusions

Buccal PCO₂ was a noninvasive, sensitive indicator of HS than traditional vital signs and may help on-scene rescuers administer early treatment of injured patients.     

The effect of isoflurane on cerebrospinal fluid pressure in patients undergoing neurosurgery

Ten patients with intracerebral tumours (TC) and 13 patients with subarachnoid haemorrhage (SAH) from a ruptured cerebral arterial aneurysm were studied before intracranial surgery, and during a 3-h postoperative period. Cerebrospinal fluid pressure (CSFP) determined by an intraventricular (TC group) or intraspinal (SAH group) catheter, and mean arterial blood pressure (MABP) were recorded under neurolept anaesthesia (control) followed by isoflurane inhalation. These two measurements were performed during normocapnia. A third measurement was made during hypocapnia, with unchanged isoflurane concentration. After the experimental period, isoflurane remained the main anaesthetic agent throughout the surgical procedure. After recovery from anaesthesia, the patients were monitored with CSFP and blood pressure during the first postoperative hours, and the quality of breathing was assessed by hourly blood-gas analyses. The results show that isoflurane causes a 10-14% reduction of MABP with no further changes during hyperventilation. Mean CSFP increased 27% in the TC group, and 12% in the SAH group after isoflurane induction and decreased from these levels by 29% during hyperventilation in both groups. Consequently, the impact on cerebral perfusion pressure (CPP) by isoflurane was a 19% and 21% mean decrease in the TC and SAH group, respectively. Controlled hyperventilation reduced this effect by partially restoring control CPP values, with 8% and 14% increase, respectively. In the postoperative follow-up, all patients had normal breathing and blood pressure with low values of CSFP. It is concluded that isoflurane can be used in intracranial surgery with adequate safety if combined with controlled hyperventilation.     

右美托咪定改善儿童腹股沟疝手术后苏醒质量效果观察

目的分析右美托咪定对改善儿童腹股沟疝手术后苏醒质量的应用效果。 方法选择2016年4月至2018年5月在新疆医科大学第一附属医院接受七氟醚麻醉下行腹股沟疝手术治疗的56例患儿。采用随机数字表法分为对照组与观察组,每组28例。观察组给予右美托咪定静脉泵注治疗,对照组给予生理盐水泵注治疗。分析2组患儿麻醉诱导前（T1）、泵入右美托咪定负荷量后（T2）、手术开始10 min时（T3）、手术结束后（T4）4个时间点的心率（HR）与平均动脉压（MAP）、临床指标、镇痛镇静效果以及不良反应情况。 结果在麻醉诱导前T1时间点,2组患儿的HR、MAP水平比较,差异无统计学意义（P>0.05）;在T2时间点,观察组患儿的HR低于对照组（P<0.05）,在T3、T4时间点,观察组患儿的HR、MAP明显低于对照组（P<0.05）;观察组患儿入睡时间明显短于对照组（P<0.05）;观察组患儿术毕苏醒期躁动评分、儿童疼痛行为（FLACC）评分明显低于对照组（P<0.05）,且Ramsay评分明显高于对照组（P<0.05）;观察组患儿不良反应发生率低于对照组（P<0.05）。 结论儿童腹股沟疝行腹腔镜疝修补术中应用右美托咪定可显著发挥镇痛镇静催眠的效果,稳定患儿生命体征,不良反应发生率低,苏醒质量良好。