内镜下高频电凝、电切治疗消化道息肉及并发出血的护理

目的：：探讨高频电凝、电切治疗息肉及并发出血后,止血的护理配合,总结护理在止血前、后的重要性。方法：对42例患者经病理排除恶性消化道息肉患者行息肉治疗并发出血者,均在内镜下行止血术。护士在术前做好患者和物品准备,术中密切配合内镜操作医生及术后密切观察病情变化及护理;对18例患者在内镜直视下对出血灶使用冰盐水100 mL+去甲肾上腺素80~20g喷洒止血。9例患者在内镜下使用0.9%NCI5 u+肾上腺素1 mL注射3~5点止血;15例患者在内镜下使用金属钛夹夹闭止血。结果：治疗成功率和根治率达100%,无术后并发症发生,无1例转外科手术治疗,具有效果好,创伤小、费用低等优点。结论：护理工作在内镜下治疗消化道息肉并发出血,治疗中起到了非常重要的作用,是内镜下治疗消化道息肉并发出血治疗成功的必要条件。     

Tranexamic acid in the prehospital setting: Israel Defense Forces’ initial experience

Background

The leading cause of preventable death in the military setting is haemorrhage. Accumulating evidence has established the benefit of tranexamic acid (TXA), an antifibrinolytic, for treating traumatic haemorrhage in the hospital setting. The use of TXA in the prehospital setting, however, has not been previously described. The present study details our initial experience with a field protocol that advances TXA administration to (or as close as possible to) the point of injury.

Methods

We present a series of all casualties treated with TXA by Israel Defense Forces’ (IDF) prehospital advanced life support providers between December 2011 and February 2013. Data were abstracted from the IDF Trauma Registry at the Research Section of the Trauma and Combat Medicine Branch, Surgeon General's Headquarters.

Results

Forty casualties who received TXA in the prehospital setting were identified. Most casualties were male (n = 35; 88%) and young adults (median 28 years). The mechanism of injury was penetrating in 22 cases (55%). TXA was administered earlier than it could have been in the hospital setting without delaying evacuation. There were no reports of adverse outcomes that could be reasonably attributed to TXA. Casualties who received TXA per protocol were sicker than those who received it not per protocol.

Conclusions

We have shown that TXA may be successfully given in the prehospital setting without any apparent delays in evacuation. In light of recent evidence, the ability to give TXA closer to the time of wounding represents an important step towards improving the survival of trauma victims with haemorrhage, even before definitive care is available. While this may be especially relevant in austere combat environments, there is likely benefit in the civilian sector as well. The safety profile of TXA is an important consideration as prehospital personnel tended to overtreat casualties without indications for TXA per protocol. We suggest that TXA be considered a viable option for use by advanced life support providers at or near the point of injury.     

球囊扩张支架术在预防和治疗电烧伤腋动脉出血中的应用

目的 探讨球囊扩张支架术在预防和治疗电烧伤腋动脉出血中的临床效果.方法 11例上肢电击伤患者,通过行锁骨下动脉造影,显示出血部位或者截肢部位以上的血管,根据管径,选择合适的球囊扩张支架,进行预防和治疗腋动脉出血,观察其对手术安全性、手术时间、出血量的影响.结果 11例患者中,应用球囊扩张支架术治疗腋动脉出血的患者5例,预防腋动脉出血的患者6例,其中1例患者因电击伤非常严重死亡,1例患者术后1月因血管结扎段破裂,再次应用球囊扩张支架术治疗腋动脉出血,其余患者均治愈.平均手术时间（2.0±0.5）h,平均出血量（300±100） ml.结论 球囊扩张支架术在电烧伤腋动脉出血的预防和治疗中有很好的疗效.     

Lack of response to corticosteroids and pulse cyclophosphamide therapy in Cogan's syndrome

Summary A 17-year-old girl with Cogan's syndrome is described. Total and irreversible hearing loss occurred which was unresponsive to corticosteroids and immunosuppressive therapy. The girl died a year later from subarachnoid haemorrhage. The lethal prognosis in Cogan's syndrome despite the available treatment is emphasized.     

Early mobilisation is associated with lower subacute blood pressure and variability in ICH: A retrospective cohort study✰

BackgroundVery early rehabilitation after stroke appears to worsen outcome, particularly in intracerebral haemorrhage (ICH). Plausible mechanisms include increased mean blood pressure (BP) and BP variability.AimsTo test associations between early mobilisation, subacute BP and survival, in observational data of ICH patients during routine clinical care.MethodsWe collected demographic, clinical and imaging data from 1372 consecutive spontaneous ICH patients admitted between 2 June 2013 and 28 September 2018. Time to first mobilisation (defined as walking, standing, or sitting out-of-bed) was extracted from electronic records. We evaluated associations between early mobilisation (within 24 h of onset) and both subacute BP and death by 30 days using multifactorial linear and logistic regression analyses respectively.ResultsMobilisation at 24 h was not associated with increased odds of death by 30 days when adjusting for key prognostic factors (OR 0.4, 95% CI 0.2 to 1.1, p = 0.07). Mobilisation at 24 h was independently associated with both lower mean systolic BP (−4.5 mmHg, 95% CI −7.5 to −1.5 mmHg, p = 0.003) and lower diastolic BP variability (−1.3 mmHg, 95% CI −2.4 to −0.2 mg, p = 0.02) during the first 72 h after admission.ConclusionsAdjusted analysis in this observational dataset did not find an association between early mobilisation and death by 30 days. We found early mobilisation at 24 h to be independently associated with lower mean systolic BP and lower diastolic BP variability over 72 h. Further work is needed to establish mechanisms for the possible detrimental effect of early mobilisation in ICH.