暖风机在青少年特发性脊柱侧凸手术中的应用

目的探讨暖风机在青少年特发性脊柱侧凸手术中的应用价值。方法选取上海长征医院2015-2016年收治的147例青少年特发性脊柱侧凸手术患者,术前根据患者住院号奇偶性将患者分为观察组和对照组,观察组术中拟使用暖风机进行保暖,对照组术中无特殊保暖措施。比较两组患者术前、术中60 min、术中120 min及术后的体温,在患者送入苏醒室后30 min、60 min两次对患者进行寒战程度分级,并在60 min时进行复苏质量评分。分别比较两组患者术中保暖、术后寒战及复苏质量的差异。结果观察组术中60 min、术中120 min和术后的体温分别为(36.7±0.3)℃、(36.5±0.2)℃及(36.3±0.3)℃,明显高于对照组(36.5±0.5)℃(P0.05)、(36.4±0.2)℃(P0.05)及(36.2±0.3)℃(P0.05)。观察组患者术后30 min和60 min时寒战分级明显低于对照组(P0.05),且术后60 min复苏评分也显著高于对照组(P0.05)。结论暖风机能够减少青少年特发性脊柱侧凸患者术中热量丢失、减少低体温的发生,并可有效降低患者术后寒战及改善患者复苏质量。     

Pediatric resuscitation training—Instruction all at once or spaced over time?

AimHealthcare providers demonstrate limited retention of knowledge and skills in the months following completion of a resuscitation course. Resuscitation courses are typically taught in a massed format (over 1–2 days) however studies in education psychology have suggested that spacing training may result in improved learning and retention. Our study explored the impact of spaced instruction compared to traditional massed instruction on learner knowledge and pediatric resuscitation skills.MethodsMedical students completed a pediatric resuscitation course in either a spaced or massed format. Four weeks following course completion students completed a knowledge exam and blinded observers used expert-developed checklists to assess student performance of three skills (bag-valve mask ventilation (BVMV), intra-osseous insertion (IOI) and chest compressions (CC)).ResultsForty-five out of 48 students completed the study protocol. Students in both groups had similar scores on the knowledge exam spaced: (37.8 ± 6.1) vs. massed (34.3 ± 7.6)(p < 0.09) and overall global rating scale scores for IOI, BVMV and CC; however students in the spaced group also performed critical procedural elements more frequently than those in the massed training groupConclusionLearner knowledge and performance of procedural skills in pediatric resuscitation taught in a spaced format is at least as good as learning in a massed format. Procedures learned in a spaced format may result in better retention of skills when compared to massed training.     

Increased risk of hip fracture mortality associated with intraoperative hypotension in elderly hip fracture patients is related to under resuscitation

BackgroundAs the US and world population ages, hip fractures are increasingly more common. The mortality associated with these fractures remains high both in the immediate postoperative period and at one year. Perioperative resuscitation in this population is of key interest to prevent organ injury and mortality. Our objectives were to evaluate the effect of fluid resuscitation and hemodynamic status in the form of mean arterial pressure (MAP) on inpatient mortality of hip fracture patients.MethodsAn institutional database was queried to compare elderly hip fracture patients that sustained in-hospital mortality to a matched control cohort. Pre-, intra-, and post-operative intravenous fluid (IVF) administration and MAP were extracted from the electronic medical record. Time from hospital presentation to the OR was also recorded.Results1,114 total hip fractures were identified during the two-year study period, 16 of which suffered inpatient mortalities. The mortality cohort was then matched with a control of 394 hip fracture patients for the same period based on age, sex, and Charlson Comorbidity Index (CCI). Conditional logistical regression analysis found odds ratios (OR) indicating that longer time between presentation and surgery (OR per additional hour: 1.05; 95% CI: 1.01–1.08) and lower intraoperative minimum MAP (OR per 5 mmHg decrease: 0.77; 95% CI: 0.61–0.97) were associated with significantly increased odds of mortality. There was also a marginal relationship between greater intraoperative IVF administration and reduced odds of mortality (OR per 500 cc additional fluid: 0.61; 95% CI: 0.37–1.00).ConclusionExtended time from presentation to surgery and intraoperative hypotension were associated with increased likelihood of inpatient mortality in an elderly hip fracture cohort, with a possible additional effect of under-resuscitation. Further investigation into a safe intraoperative minimum MAP should be pursued.Level of evidenceLevel III.