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Background:Thesenliewithfracturerestinbedforalongtime,andhaven'tsufficientfunctionexercise,allabovewillleadtoosteoporosis,badrepairofbonetissue,muscleatrophyandjointstiffnessoccurs,whichbringsufferingandenconomicburden.Objective:Tosummarizetheeffectofpostoperativefunctionexercisesonrecoveryoffractureofneckoffemur.Unit:OrthopedicsHospitalofShenyang.Subjects:Therewere86patientsoffractureofneckoffemur,including52males,34famles,aged60-84years,average72years.Accordingtopositionoffractureline:sub… 相似文献
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INTRODUCTIONSlippageoflumbarvertebraeisasecondcommondiseaseafterprotrusionofintervertebraldiscs.Althoughsomepatientswerecuredbyconservativetherapy,surgicaltreatmentisneededinsomecases犤1犦.FromMarch1994toMarch2001,weusedstealplateinternalfixationtotreat18casesofslippageandtheeffectwasobvious.Thefollowingisthereport.MATERIALSANDMETHODSMaterial18patientswereinvolvedincluding10malesand8femalesaged41-64(mean:46)years.Slippagelocus:L4-5,11cases;L5-S1,7cases.Clinicalmanifestation:all… 相似文献
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Background:Protrusionofintervertebraldiscwasaclinicalsyndromresultedfromintervertevraldiscdegeneration,fibrousringrupture,protrusionofpulpiformnucleusthatstimulateandcom-pressesnerveroot,andcomprehensiveconservativetherapywasoftenadopted.Inthisgroupofdata,196casesofprotrusionofinterverte-braldisctreatedbyseriesofspinalbalancetherapywerecollectedfromJanuary2000toDecember2001.Objective:Toinvestigateeffectofseriesofspinalbalancetherapyintreatmentofprotrusionofintervertebrald… 相似文献
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BACKGROUND: Application of Tenor system and is to decompress nerve root, reduction of olisthe, internal fixation and auto-grafts are to restore anatomic structure and stability of spinal column.OBJECTIVE: To observe therapeutic effects of Tenor system on fissural olisthe of isthmus of lumbar vertebra.UNIT: Department of Orthopaedics, General Hospital of Armed Police 相似文献
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INTRODUCTIONHowtopreventhanddeformitycausedbyburn,restoreappearanceandworkingabilityhasbeenalwaysthemainproblem,thefollow-ingisthereportaboutcausesofdeformityandexperienceofpre-ventionandtreatment.GENERALDATA2037casesofburntreatedfromJanuary1997toOctober2002amongincluding957casesofburnofhandsandtheincidencewas46.9%amongwhichwere229casesofdeepburnand195pa-tientsreceivedearlysurgicaltreatment.6patients(15fingers)un-derwentfingeramputation.38casesneededplasticsbecauseofscardeformityinlat… 相似文献
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BACKGROUND: Despite of treatment of operation or routine conservation, special psychological and physical characteristics, osteoporosis, recession of muscular strength and long braked time on bed often cause retrograde degeneration of muscle and skeleton and the complications of delayed recovery and other diseases. To above problems, a series of continuous ways of functional rehabilitation are applied and satisfactory effects are achieved. 相似文献
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Expanded abstract
Citation
Jakob SM, Ruokonen E, Grounds RM, Sarapohja T, Garratt C, Pocock SJ, Bratty JR, Takala J; Dexmedeto midine for Long-Term Sedation Investigators: Dexmedetomidine vesus midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. JAMA 2012, 307:1151-1160.Background
Long-term sedation with midazolam or propofol in intensive care units (ICUs) has serious adverse effects. Dexmedetomidine, an alpha-2 agonist available for ICU sedation, may reduce the duration of mechanical ventilation and enhance patient comfort.Methods
Objective
The objective was to determine the efficacy of dexmedetomidine versus midazolam or propofol (preferred usual care) in maintaining sedation, reducing duration of mechanical ventilation, and improving patients'' interaction with nursing care.Design
Two phase 3 multicenter, randomized, double-blind trials were conducted.Setting
The MIDEX (Midazolam vs. Dexmedetomidine) trial compared midazolam with dexmedetomidine in ICUs of 44 centers in nine European countries. The PRODEX (Propofol vs. Dexmedetomidine) trial compared propofol with dexmedetomidine in 31 centers in six European countries and two centers in Russia.Subjects
The subjects were adult ICU patients who were receiving mechanical ventilation and who needed light to moderate sedation for more than 24 hours.Intervention
After enrollment, 251 and 249 subjects were randomly assigned midazolam and dexmedetomidine, respectively, in the MIDEX trial, and 247 and 251 subjects were randomly assigned propofol and dexmedetomidine, respectively, in the PRODEX trial. Sedation with dexmedetomidine, midazolam, or propofol; daily sedation stops; and spontaneous breathing trials were employed.Outcomes
For each trial, investigators tested whether dexmedetomidine was noninferior to control with respect to proportion of time at target sedation level (measured by Richmond Agitation Sedation Scale) and superior to control with respect to duration of mechanical ventilation. Secondary end points were the ability of the patient to communicate pain (measured by using a visual analogue scale [VAS]) and length of ICU stay. Time at target sedation was analyzed in per-protocol (midazolam, n = 233, versus dexmedetomidine, n = 227; propofol, n = 214, versus dexmedetomidine, n = 223) population.Results
Dexmedetomidine/midazolam ratio in time at target sedation was 1.07 (95% confidence interval (CI) 0.97 to 1.18), and dexmedetomidine/propofol ratio in time at target sedation was 1.00 (95% CI 0.92 to 1.08). Median duration of mechanical ventilation appeared shorter with dexmedetomidine (123 hours, interquartile range (IQR) 67 to 337) versus midazolam (164 hours, IQR 92 to 380; P = 0.03) but not with dexmedetomidine (97 hours, IQR 45 to 257) versus propofol (118 hours, IQR 48 to 327; P = 0.24). Patient interaction (measured by using VAS) was improved with dexmedetomidine (estimated score difference versus midazolam 19.7, 95% CI 15.2 to 24.2; P <0.001; and versus propofol 11.2, 95% CI 6.4 to 15.9; P <0.001). Lengths of ICU and hospital stays and mortality rates were similar. Dexmedetomidine versus midazolam patients had more hypotension (51/247 [20.6%] versus 29/250 [11.6%]; P = 0.007) and bradycardia (35/247 [14.2%] versus 13/250 [5.2%]; P <0.001).Conclusions
Among ICU patients receiving prolonged mechanical ventilation, dexmedetomidine was not inferior to midazolam and propofol in maintaining light to moderate sedation. Dexmedetomidine reduced duration of mechanical ventilation compared with midazolam and improved the ability of patients to communicate pain compared with midazolam and propofol. Greater numbers of adverse effects were associated with dexmedetomidine. 相似文献12.
Citation
Jabre P, Combes X, Lapostolle F, et al. Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: a multicentre randomised controlled trial. Lancet 2009, 374:293-300. PMID: 19573904Background
Critically ill patients often require emergency intubation. The use of etomidate as the sedative agent in this context has been challenged because it may cause a reversible adrenal insufficiency, potentially associated with increased in-hospital morbidity. We compared early and 28-day morbidity after a single dose of etomidate or ketamine used for emergency endotracheal intubation of critically ill patients.Methods
In this randomized, controlled, single-blind trial, 655 patients who needed sedation for emergency intubation were prospectively enrolled from 12 emergency medical services or emergency departments and 65 intensive care units in France. Patients were randomly assigned by a computerized random-number generator list to receive 0-3 mg/kg of etomidate (n = 328) or 2 mg/kg of ketamine (n = 327) for intubation. Only the emergency physician enrolling patients was aware of group assignment. The primary endpoint was the maximum score of the sequential organ failure assessment during the first 3 days in the intensive care unit. We excluded from the analysis patients who died before reaching the hospital or those discharged from the intensive care unit before 3 days (modified intention to treat). This trial is registered with ClinicalTrials.gov, number NCT00440102.Findings
234 patients were analyzed in the etomidate group and 235 in the ketamine group. The mean maximum SOFA score between the two groups did not differ significantly (10.3 [SD 3.7] for etomidate vs. 9.6 [3.9] for ketamine; mean difference 0.7 [95% CI 0.0-1.4], p = 0.056). Intubation conditions did not differ significantly between the two groups (median intubation difficulty score 1 [IQR 0-3] in both groups; p = 0.70). The percentage of patients with adrenal insufficiency was significantly higher in the etomidate group than in the ketamine group (OR 6.7, 3.5-12.7). We recorded no serious adverse events with either study drug.Interpretation
Our results show that ketamine is a safe and valuable alternative to etomidate for endotracheal intubation in critically ill patients, and should be considered in those with sepsis. 相似文献13.
Background
For joint reductions, adequate sedation is often required. Propofol has increasingly been used for sedation in the emergency department (ED) in recent years. The benefits of propofol are the rapid onset of action and the short recovery time. However, whether these characteristics can shorten the duration of ED stay is not been proved.Objective
Our study retrospectively compared patients receiving propofol for sedation during joint reductions with those who received sedatives other than propofol. The primary objective was to compare the duration of ED stay between the 2 groups. The secondary outcomes were rate of adverse events and the success of the procedure.Methods
Patients were included if they had a dislocated joint requiring management in the ED. The following covariates were recorded on a standard form for each patient: age, sex, indication for procedural sedation, sedative used, pain medications used, physician levels, duration of ED stay, failed reduction, and adverse events. We further matched each patient in the propofol group to the patient in the nonpropofol group using a standard propensity score greedy-matching algorithm. The primary and secondary outcomes were compared accordingly.Results
A total of 241 patients met our inclusion criteria and were enrolled for further analysis. In the propensity score assignment, 56 patients (28 in each group) were further selected. The duration of ED stay in the propofol group is significantly shorter compared with the nonpropofol group (127 vs 192 minutes, P = .0019). The successful reduction rate is higher in the propofol group (96.4% vs 64.3%, P = .002). The complication rate is similar in both groups (3.6% vs 0%, P = .313).Conclusion
Propofol is a safe sedative with few complications and higher successful rates when applied in the joint reductions. It can also shorten the duration of ED stay. 相似文献14.
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James R. Miner Brian E. Driver Johanna C. Moore Erik Faegerstrom Lauren Klein Matthew Prekker Jon B. Cole 《The American journal of emergency medicine》2017,35(10):1451-1456
Study objective
To compare the frequency of airway and respiratory adverse events leading to an intervention between moderate sedation using alfentanil or propofol.Methods
We performed a randomized clinical trial in which adults undergoing moderate sedation in the ED received either alfentanil or propofol. Our primary outcome was the frequency of airway and respiratory adverse events leading to an intervention. Other outcomes included sedation depth, efficacy, sedation time, patient satisfaction, pain, and satisfaction.Results
108 subjects completed the trial: 52 receiving alfentanil and 56 receiving propofol. Airway or respiratory adverse events leading to an intervention were similar between the two groups: 23% for alfentanil and 20% for propofol (p = 0.657). There were no serious adverse events in any group. Secondary outcomes were notably different in the rate of reported pain (48% for alfentanil, 13% for propofol) and recall (75% for alfentanil, 23% for propofol) and similar in the rate of satisfaction with the procedure (87% for alfentanil, 84% for propofol).Conclusion
We found a similar frequency of airway and respiratory adverse events leading to intervention between alfentanil and propofol used for moderate procedural sedation. Both agents appear safe for moderate procedural sedation. 相似文献16.
Heleen Lameijer Ytje T. Sikkema Albert Pol Maike G.E. Bosch Femke Beije Rieneke Feenstra Bas W.J. Bens Ewoud ter Avest 《The American journal of emergency medicine》2017,35(5):692-696
Background
Procedural sedation for painful procedures in the emergency department (ED) can be accomplished with various pharmacological agents. The choice of the sedative used is highly dependent on procedure- and patient characteristics and on personal- or local preferences.Methods
We conducted a multicenter retrospective cohort study of procedural sedations performed in the EDs of 5 hospitals in the Netherlands over a 4 year period to evaluate the efficacy- (success rate of the intended procedure) and safety (incidence of sedation (adverse) events) of propofol sedations compared to midazolam sedations.Results
A total of 592 ED sedations were included in our study. Patients sedated with propofol (n = 284, median dose 75 mg) achieved a deeper level of sedation (45% vs. 25% deep sedation, p < 0.001), had a higher procedure success rate (92% vs. 81%, p < 0.001) and shorter median sedation duration (10 vs. 17 min, p < 0.001) compared to patients receiving midazolam (n = 308, median dose 4 mg). A total of 112 sedation events were registered for 99 patients. Transient apnea was the most prevalent event (n = 73), followed by oxygen desaturation (n = 18) airway obstruction responsive to simple maneuvers (n = 13) and hypotension (n = 6). Propofol sedations were more often associated with the occurrence of apnea's (20% vs. 10%, p = 0.004), whereas clinically relevant oxygen desaturations (< 90%) were found more often in patients sedated with midazolam (8% vs. 1%, p = 0.001). No sedation adverse events were registeredConclusion
Propofol is more effective and at least as safe as midazolam for procedural sedation in the ED. 相似文献17.
Yongfang Zhou Xiaodong Jin Yan Kang Guopeng Liang Tingting Liu Ni Deng 《Critical care (London, England)》2014,18(3):R122
Introduction
Midazolam and propofol used alone for long-term sedation are associated with adverse effects. Sequential use may reduce the adverse effects, and lead to faster recovery, earlier extubation and lower costs. This study evaluates the effects, safety, and cost of midazolam, propofol, and their sequential use for long-term sedation in critically ill mechanically ventilated patients.Methods
A total of 135 patients who required mechanical ventilation for >3 days were randomly assigned to receive midazolam (group M), propofol (group P), or sequential use of both (group M-P). In group M-P, midazolam was switched to propofol until the patients passed the spontaneous breathing trial (SBT) safety screen. The primary endpoints included recovery time, extubation time and mechanical ventilation time. The secondary endpoints were pharmaceutical cost, total cost of ICU stay, and recollection to mechanical ventilation-related events.Results
The incidence of agitation following cessation of sedation in group M-P was lower than group M (19.4% versus 48.7%, P = 0.01). The mean percentage of adequate sedation and duration of sedation were similar in the three groups. The recovery time, extubation time and mechanical ventilation time of group M were 58.0 (interquartile range (IQR), 39.0) hours, 45.0 (IQR, 24.5) hours, and 192.0 (IQR, 124.0) hours, respectively; these were significantly longer than the other groups, while they were similar between the other two groups. In the treatment-received analysis, ICU duration was longer in group M than group M-P (P = 0.016). Using an intention-to-treat analysis and a treatment-received analysis, respectively, the pharmaceutical cost of group M-P was lower than group P (P <0.01) and its ICU cost was lower than group M (P <0.01; P = 0.015). The proportion of group M-P with unbearable memory of the uncomfortable events was lower than in group M (11.7% versus 25.0%, P <0.01), while the proportion with no memory was similar (P >0.05). The incidence of hypotension in group M-P was lower than group (P = 0.01).Conclusion
Sequential use of midazolam and propofol was a safe and effective sedation protocol, with higher clinical effectiveness and better cost-benefit ratio than midazolam or propofol used alone, for long-term sedation of critically ill mechanically ventilated patients.Trial registration
Current Controlled Trials ISRCTN01173443. Registered 25 February 2014. 相似文献18.
Hamed Aminiahidashti Sajad Shafiee Seyed Mohammad Hosseininejad Abulfazl Firouzian Ayyub Barzegarnejad Alieh Zamani Kiasari Behzad Feizzadeh Kerigh Farzad Bozorgi Misagh Shafizad Ahmad Geraeeli 《The American journal of emergency medicine》2018,36(10):1766-1770
Objective
Many procedures performed in emergency department are stressful and painful, and creating proper and timely analgesia and early and effective assessment are the challenges in this department. This study has been conducted in order to compare the efficacy of propofol and fentanyl combination with propofol and ketamine combination for procedural sedation and analgesia (PSA) in trauma patients in the emergency department.Method
This is a randomized prospective double-blind clinical trial conducted in the emergency department of Imam Khomeini Hospital, a tertiary academic trauma center in northern Iran. Patients with trauma presenting to the emergency department who needed PSA were included in study. Patients were divided into two groups of propofol fentanyl (PF) and propofol ketamine (PK). Pain score and sedation depth were set as primary outcome measures and were recorded.Results
Out of about 379 patients with trauma, who needed PSA, 253 met the criteria to be included in the study, 117 of which were excluded. The remaining 136 patients were randomly allocated to either PF group (n?=?70) or PK group (n?=?66). Pain management after drug administration was significantly different between the groups and the analgesia caused by fentanyl was significantly higher than ketamine. The sedation score after 15?min of PSA in the group PF was significantly higher than the group PK.Conclusion
It seems that regarding PSA in the emergency department, PF caused better analgesia and deeper sedation and it is recommended to use PF for PSA in the emergency departments. 相似文献19.
Brian Price Annette O. Arthur Michael Brunko Pam Frantz Joshua O. Dickson Tom Judge Stephen H. Thomas 《The American journal of emergency medicine》2013
Objective
Recent drug shortages have required the occasional replacement of etomidate for endotracheal intubation (ETI) by helicopter emergency medical services (HEMS), with ketamine. The purpose of this study was to assess whether there was an association between ketamine vs etomidate use as the main ETI drug, with hemodynamic or clinical (airway) end points.Methods
This retrospective study used data entered into medical records at the time of HEMS transport. Subjects, 50 ketamine and 50 etomidate, were accrued from 3 US HEMS programs. The study period was from August 2011 through May 2012. Data collection included demographics, diagnostic category, ETI drugs use, ETI success, and complications. Hemodynamic parameters were assessed for up to 2 sets of vital signs before airway management and up to 5 sets of post-ETI vital signs. Significance was defined at the P < .05 level.Results
Patients on ketamine and etomidate were similar (P > .05) with respect to age, sex, scene/interfacility mission type, trauma vs nontrauma, neuromuscular blocking agent use, and rates of coadministration of fentanyl or midazolam. All patients had successful airway placement. Peri-ETI hypoxemia was seen in 10% of etomidate and 16% of ketamine cases (P = .55). The pre-ETI and post-ETI were similar between the ketamine and etomidate groups with respect to systolic blood pressure and heart rate at every vital signs assessment after ETI.Conclusion
Initial assessment of ETI success and complication rates, as well as peri-ETI hemodynamic changes, suggests no concerning complications associated with large-scale replacement of etomidate with ketamine as the major airway management drug for HEMS. 相似文献20.
Guilherme Loures Penna Fernanda M. Fialho Pedro Kurtz André M. Japiassú Marcelo Kalichsztein Gustavo Nobre Nivaldo Ribeiro Villela Eliete Bouskela 《Journal of critical care》2013