共查询到13条相似文献,搜索用时 15 毫秒
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Hironori Ishizaki Hiroaki Murata Takuji Maekawa Taiga Ichinomiya Tetsuya Hara 《Medicine》2021,100(47)
Rationale:Congenital long QT syndrome (LQTS) can cause syncope or sudden death due to ventricular arrhythmia. Congenital LQTS has 3 major types, 1, 2, and 3. Life-threatening arrhythmias are triggered by emotion in patients with LQTS type 2. As patients with LQTS type 2 have a higher incidence of postnatal cardiac events, careful perinatal management especially during delivery is required. To the best of our knowledge, perinatal management of a patient with LQTS type 2 has not been properly described with consideration to its type-specific risk factors for ventricular tachyarrhythmia.Patient concerns:A 36-year-old pregnant woman, gravida 1, para 0, with LQTS type 2 was scheduled to undergo vaginal delivery under epidural labor analgesia in the 38th week of pregnancy. No fainting episodes were reported since she began to take 40 mg of propranolol once daily at the age of 25. Despite this, we instituted maximum preventive measures for the safety of both the parturient and the fetus to minimize the risk of maternal cardiac events throughout the perinatal period.Diagnoses:She was diagnosed with LQTS type 2 by genetic testing at the age of 25.Interventions:Two epidural catheters were placed at levels T11–T12 and L5–S1. Injection of 0.2% ropivacaine and subsequent infusion of ropivacaine 0.1% with fentanyl (2 μg/mL) was directed through each catheter according to the stage of labor. Concurrently, landiolol, a selective and short-acting β1 receptor antagonist, was infused intravenously at a dose of 1 to 7 μg/kg/min.Outcomes:The delivery proceeded uneventfully without pain. No adverse cardiac events were observed during the perinatal period.Lessons:Vaginal delivery under epidural labor analgesia using 2 catheters might be a viable option for maternal perinatal care and delivery of patients with LQTS type 2. 相似文献
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Background:Till date only a few studies have reported the clinical outcomes of intraoperative hidden blood loss of intertrochanteric fracture in the old people treated with various intramedullary immobilizations. The aim of the trial is to investigate the best choice for treating intertrochanteric fractures, as well as the hidden blood loss among different intramedullary fixations.Methods:This randomized, single-blind, superiority clinical trial was admitted by the Ethics Committee in our hospital (The 7th Medical Center of PLA, 20200602DM). The eligibility criteria were:
- (1)Over 60 years or older;
- (2)Fresh closed intertrochanteric fractures (AO 31-A2);
- (3)A low- intensity trauma;
- (4)With complete records of serial full blood count, including haematocrit value on admission and 72 hour after surgery.
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Gonzalez-Porras JR Graciani IF Alvarez M Pinto J Conde MP Nieto MJ Corral M 《Vox sanguinis》2008,95(1):52-56
Background and Objectives The greatest risk in transfusion medicine is actually human error, resulting in the use of the incorrect blood component. The aim of our study was to identify and evaluate the risk factors involved in the collection and labelling of pretransfusion blood samples.
Material and Methods We prospectively evaluated 6446 samples submitted to the blood bank for pretransfusion testing. Inappropriate samples were classified as 'mislabelled' or 'miscollected'. After 4 months of study, an educational approach was taken.
Results The frequency of inappropriately labelled samples was 6·45%. Such samples were associated with the use of addressograph labels (vs. hand-written labels) [23·4% vs. 1·4%, P < 0·0001], collection by clinical staff (vs. blood bank staff) [8·8% vs. 2·1%, P = 0·001] and emergency situations (vs. routine sampling) [10·1% vs. 6·1%, P = 0·005]. Following educational intervention, the percentage of inappropriately labelled samples decreased from 7·3% (pre-educational) to 5·8% (post-educational), P = 0·005.
Conclusion Ongoing monitoring and analysis of labelling and collection should be mandatory in order to improve the safety of transfusion. 相似文献
Material and Methods We prospectively evaluated 6446 samples submitted to the blood bank for pretransfusion testing. Inappropriate samples were classified as 'mislabelled' or 'miscollected'. After 4 months of study, an educational approach was taken.
Results The frequency of inappropriately labelled samples was 6·45%. Such samples were associated with the use of addressograph labels (vs. hand-written labels) [23·4% vs. 1·4%, P < 0·0001], collection by clinical staff (vs. blood bank staff) [8·8% vs. 2·1%, P = 0·001] and emergency situations (vs. routine sampling) [10·1% vs. 6·1%, P = 0·005]. Following educational intervention, the percentage of inappropriately labelled samples decreased from 7·3% (pre-educational) to 5·8% (post-educational), P = 0·005.
Conclusion Ongoing monitoring and analysis of labelling and collection should be mandatory in order to improve the safety of transfusion. 相似文献
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Kazuomi Kario Akihiro Nomura Ayaka Kato Noriko Harada Tomoyuki Tanigawa Ryuhei So Shin Suzuki Eisuke Hida Kohta Satake 《Journal of clinical hypertension (Greenwich, Conn.)》2021,23(5):923
Hypertension is the most considerable but treatable risk factor for cardiovascular disease. Although physicians prescribe multiple antihypertensive drugs and promote lifestyle modifications, the real‐world blood pressure (BP) control rate remains poor. To improve BP target achievement, we developed a novel digital therapeutic—the HERB software system —to manage hypertension. Here, we performed a randomized pilot study to assess the safety and efficacy of the HERB system for hypertension. We recruited 146 patients with essential hypertension from March 2018 to March 2019. We allocated eligible patients to the intervention group (HERB system + standard lifestyle modification) or control group (standard lifestyle modification alone). The primary outcome was the mean change from baseline to 24 weeks in 24‐hour systolic BP (SBP) measured by ambulatory blood pressure monitoring (ABPM). The baseline characteristics in each group were well balanced; the mean age was approx. 57 years, and 67% were male. In the primary end point at 24 weeks, HERB intervention did not lower the mean change of 24‐hour SBP by ABPM compared with the controls (adjusted difference: −0.66 mmHg; p = .78). In an exploratory analysis focusing on antihypertensive drug‐naïve patients aged <65, the effects of the HERB intervention were significantly greater than the control for reducing 24‐hour SBP by ABPM at 16 weeks (adjusted difference: −7.6 mmHg; p = .013; and morning home SBP at 24 weeks (adjusted difference − 6.0 mmHg; p = .012). Thus, the HERB intervention did not achieve a primary efficacy end point. However, we observed that antihypertensive drug‐naïve adult hypertensive patients aged <65 years could be a potential HERB system‐effective target for further investigations of the efficacy of the system. 相似文献
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Spinal anesthesia is the anesthetic technique of choice for patients undergoing cesarean delivery. In the present study, total spinal anesthesia failure was defined as a case when an absent blockade or inadequate surgery required general anesthesia administration with an endotracheal tube. This study aimed to investigate factors related to this condition and report its maternal and neonatal outcomes.This retrospective matched case–control study was conducted by recruiting 110 patients with failed spinal anesthesia and 330 control patients from September 1, 2016, to April 30, 2020, in the largest university hospital, Thailand.Of 12,914 cesarean deliveries, 12,001 patients received single-shot spinal anesthesia (92.9%) during the study period. Total spinal anesthesia failure was experienced by 110/12,001 patients, giving an incidence of 0.9%. Factors related to the failures were a patient body mass index (BMI) ≤29.5 kg/m2 (adjusted odds ratio 1.9; 95% confidence interval 1.2–3.1; P = .010) and a third-year resident (the most senior trainee) performing the spinal block (adjusted odds ratio 2.4; 95% confidence interval 1.5–3.7; P < .001). In the group with failed spinal anesthesia, neonatal Apgar scores at 1 and 5 minutes were lower than those of the control group (both P < .001). Two patients in the failed spinal anesthesia group (2/110; 1.8%) had difficult airways and desaturation.Independent factors associated with total spinal anesthesia failure were a BMI of ≤29.5 kg/m2 and a third-year resident performing the spinal block. Although the incidence of total failure was infrequent, there were negative consequences for the mothers and neonates. Adjusting the dose of bupivacaine according to the weight and height of a patient is recommended, with a higher dose appropriate for patients with a lower BMI. 相似文献
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Durán A Martín P Runkle I Pérez N Abad R Fernández M Del Valle L Sanz MF Calle-Pascual AL 《Journal of Diabetes》2010,2(3):203-211
Background: Intensive treatment of patients with Type 2 diabetes mellitus (T2DM) from the moment of diagnosis facilitates β‐cell recovery. Self‐monitoring of blood glucose (SMBG)‐based educational and pharmacological intervention may be better than conventional HbA1c algorithms in the treatment of newly diagnosed T2DM. Methods: Newly diagnosed T2DM patients were randomized to either an SMBG‐based intervention or an HbA1c‐based control group (n = 99 and 62, respectively) and were followed for 1 year. Results: Higher rates of diabetes regression (HbA1c < 6% on metformin alone) and remission (HbA1c between 6.0% and 6.4%) were achieved in the intervention compared with the control group (39% vs 5% (P < 0.001) and 37% vs 30% (P < 0.01), respectively). Furthermore, significantly greater reductions in median HbA1c (6.6% to 6.1%; P < 0.05) and body mass index (29.6–27.9 kg/m2; P < 0.001) were seen in the intervention over the 1 year of therapy. The percentage of patients achieving a lifestyle score >12 was significantly greater in the SMBG compared with the control group (38.4% vs 9.7% respectively; P < 0.001). An inverse correlation was observed between SMBG and HbA1c levels (P < 0.04). Conclusions: The results indicate that SMBG‐based structured educational and pharmacological programs empower patients to achieve nutritional and physical activity goals, and encourage physicians and patients to use SMBG to optimize therapy. We believe that the concept of intensive treatment of T2DM patients should be modified; instead of referring to the type of treatment (insulin use), the term should reflect the intensity with which we work to reach glucose objectives. 相似文献
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Tülay Dal Hilal Sazak Mehtap Tun? ?aziye ?ahin Ayd?n Y?lmaz 《Journal of thoracic disease》2014,6(6):742-751
Objective
We aimed to compare the effectiveness and safety of ketamine-midazolam and ketamine-propofol combinations for procedural sedation in endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA).Methods
Sixty patients who were undergoing EBUS-TBNA were included in this study. Patients were randomly divided into two groups. Group 1 was given 0.25 mg/kg intravenous (iv) ketamine, 2 min later than 0.05 mg/kg iv midazolam. Group 2 received 0.125 mg/kg ketamine-propofol mixture (ketofol), 2 min subsequent to injection of 0.25 mg/kg each. Sedation was maintained with additional doses of ketamine 0.25 mg/kg, and ketofol 0.125 mg/kg each in Group 1 and Group 2, respectively. Blood pressure, heart rate (HR), peripheral oxygen saturation, respiratory rate (RR), Ramsay Sedation Score (RSS), and severity of cough were recorded prior to and after administration of sedation agent in the beginning of fiberoptic bronchoscopy (FOB) and every 5 min of the procedure. The consumption of the agents, the satisfactions of the bronchoscopist and the patients, and the recovery time were also recorded.Results
HR in the 10th min and RSS value in the 35th min of induction in Group 1 were higher than the other group (P<0.05). The recovery time in Group 1 was statistically longer than Group 2 (P<0.05). There was no statistically significant difference between groups with respect to other parameters (P>0.05).Conclusions
It was concluded that both ketamine-midazolam and ketamine-propofol combinations for sedation during EBUS-TBNA were similarly effective and safe without remarkable side effects. 相似文献12.
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Kimihiro Okubo Eiji Uchida Takaaki Terahara Katsuhiko Akiyama Shigeo Kobayashi Yusuke Tanaka 《Allergology international》2018,67(3):371-379