Endovascular treatment of traumatic aortic rupture using iliac extension stent-grafts in patients with small aortic diameters

Open in a separate window OBJECTIVESTo evaluate outcomes after thoracic endovascular aortic repair in young patients sustaining traumatic blunt aortic injury (BAI) using iliac extension stent-grafts because of small aortic diameters measuring <24 mm.METHODSRetrospective analysis regarding clinical presentation, trauma management, endovascular techniques and outcome of patients with a small descending aorta involving an iliac extension stent-graft to treat traumatic BAI.RESULTSAmong 48 patients who suffered a BAI and underwent thoracic endovascular aortic repair, 7 received iliac extension stent-grafts. They were 27.4/[standard deviation (SD): −13.1] years old and 6 out of 7 were male. The iliac extension stent-graft was used as distal stent-graft, and a thoracic stent-graft was used in most patients as proximal extension. We achieved overall technical success in all patients during a procedure lasting 92.6 (SD: 54.9) min. One patient died 2 days after the endovascular procedure of hypoxic brain injury, and another died after 17 days of liver failure. That patient had also suffered a spinal cord injury following the procedure, as the stent-graft had been deployed in Ishimaru Zone 2, and the carotid to subclavian bypass had to be omitted because of his critical condition. Control computed tomographic angiographs was available in 6 patients after 7.7 (SD: 5.1) days and showed no endoleak. The surviving patients were discharged after 18.4 (SD: 13.4) days.CONCLUSIONSTreating traumatic BAI using iliac extension stent-grafts in young patients with small aortic diameters is feasible. We observed no mortality caused by the BAI or related to endovascular therapy within this small patient cohort.     

中西医结合治疗冠心病心绞痛临床疗效观察

目的：探讨中西医结合治疗冠心病心绞痛临床疗效,为治疗冠心病心绞痛提供了依据。方法：回顾性分析2009年6月-2012年9月我院收治的60例冠心病心绞痛患者的诊断和治疗情况,对照组给予西医疗法,治疗组在对照组基础上还给予益气活血通脉汤。结果：治疗组总有效率（93.3%）要明显高于对照组的总有效率（66.7%）。结论：中西结合治疗冠心病以及控制心绞痛的发作的临床疗效要比单纯西医疗法显著。     

自拟骨伤复元汤对胸腰椎骨折术后早期白介素-2、纤维蛋白原表达及疼痛的影响

目的：观察自拟骨伤复元汤对胸腰椎骨折术后早期白介素-2、纤维蛋白原表达及患者疼痛的影响。方法：将符合要求的80例胸腰椎骨折患者随机分为2组。对照组40例,术后给予补充血容量、抗感染等常规治疗;观察组40例,术后给予常规治疗联合口服自拟骨伤复原汤治疗。分别于术后第1天、第7天及第14天,比较2组患者血浆中白介素-2、纤维蛋白原含量的变化情况及疼痛视觉模拟评分变化情况。结果：1血浆白介素-2含量。不同时间点间血浆白介素-2的差异有统计学意义（F=98.792,P=0.000）。2组血浆白介素-2的组间差异总体上有统计学意义（F=18.916,P=0.000）。进一步比较显示,术后第1天2组患者血浆白介素-2含量的差异无统计学意义[（6.20±1.03）ng·L-1,（6.50±0.85）ng·L-1,t=-0.714,P=0.475];术后第7天、第14天2组患者血浆白介素-2含量比较,组间差异有统计学意义[（8.30±0.95）ng·L-1,（9.70±0.67）ng·L-1,t=-2.950,P=0.030;（10.20±1.32）ng·L-1,（11.90±1.29）ng·L-1,t=-2.431,P=0.015];时间因素与分组因素存在交互效应（F=12.417,P=0.011）。2血浆纤维蛋白原含量。不同时间点间血浆纤维蛋白原含量的差异有统计学意义（F=118.439,P=0.000）。2组患者血浆纤维蛋白原含量的组间差异总体上有统计学意义（F=0.896,P=0.049）。进一步比较显示,术后第1天2组血浆纤维蛋白原含量比较,差异无统计学意义[（3.29±0.31）mg·dL-1,（3.34±0.23）mg·dL-1,t=0.277,P=0.741）];术后第7天、术后第14天,2组血浆纤维蛋白原含量比较,组间差异有统计学意义[（2.98±0.16）mg·dL-1,（2.39±0.18）mg·dL-1,t=1.487,P=0.042;（2.77±0.13）mg·dL-1,（2.11±0.12）mg·dL-1,t=8.952,P=0.039];时间因素与分组因素存在交互效应（F=22.248,P=0.000）。3术后疼痛视觉模拟评分。不同时间点间术后疼痛视觉模拟评分的差异有统计学意义（F=264.972,P=0.000）。2组术后疼痛视觉模?     

外伤性血气胸中心静脉导管置管引流术的护理

目的 探讨中心静脉导管胸腔闭式引流术在外伤性血气胸患者的临床疗效及护理体会.方法 对62例外伤性血气胸的患者采用中心静脉导管胸腔闭式引流法治疗血气胸,护理并观察患者疗效及并发症.结果 本组病例患者疼痛少,引流口创伤小、愈合佳,血气胸吸收满意.结论 中心静脉导管胸腔闭式引流术对外伤性血气胸的治疗有积极的作用,可减轻患者的痛苦,利于血气胸吸收,缩短住院时间,值得临床推广.     

老年胸外伤机械通气患者营养支持的临床研究

目的 探讨营养支持在老年胸外伤机械通气患者中的应用.方法 将48例老年胸外伤机械通气患者随机分为两组,治疗组24例,给予早期肠内加肠外营养支持,对照组24例,给予全肠外营养支持,观察两组营养指标、机械通气时间及并发症(腹胀、肠麻痹、胃肠道出血、二重感染、肝功能异常以及高血糖)发生率.结果 两组均达到营养支持效果,但对照组机械通气时间和并发症发生率明显高于治疗组(P<0.01).结论 对老年胸外伤机械通气患者实施早期肠内加肠外营养支持,可改善患者营养状况,减少并发症发生,促进患者康复.     

无创兔颈椎间盘退变动物模型的建立及MRI观察

目的:设计一种新型用于颈椎间盘退变研究的动物模型。方法:30只日本大耳白兔随机分为实验组和对照组,每组各15只。实验组采用特制的固定套将兔颈部固定于屈曲60°位4h/天;对照组兔戴上布套,允许其颈椎自由活动。分别在造模开始后第4、6、8月,每组随机取5只大耳白兔处死后行MR I检查,比较各组间存在的差异性。结果:实验组出现颈椎间盘退变的典型征象:T2信号明显降低;对照组无特异性改变:仅有T2信号轻度改变。结论:本造模法符合人椎间盘退变的客观规律,操作简便易行,造模效果确切,而且对所观察椎间盘无直接干扰,有利于对椎间盘退变的防治进行深入研究。     

不同牵引重量对颈椎髓核内压力影响的研究

目的:通过测试不同牵引力量对颈椎标本髓核内压力的影响,探讨牵引对颈椎影响的机制。方法:利用生物力学材料实验机使用150N、200N、300N3种牵引力对6例新鲜人体颈椎标本进行力学加载,同时利用微型压力传感器测试加载过程中各节段髓核内压力的变化。结果:模拟头部重量及加载牵引力后均出现C5,6,C6,7髓核内压力高于C3,4,C4,5髓核内压力(P0.05),加载牵引力后所有标本髓核内压力均出现降低(P0.05)。结论:牵引通过增大颈椎椎间隙,降低外力对椎间盘髓核内的压力;同时在进行旋转手法时应配合适当的牵引力以增加旋转手法的安全性。     

胸段硬膜外阻滞复合全麻对非体外循环冠状动脉搭桥术患者应激反应的影响

目的 比较单纯全麻和胸段硬膜外阻滞复合全麻对非体外循环冠状动脉搭桥术患者应激反应的的影响。方法 选择非体外循环冠状动脉搭桥手术的患者作为研究对象,观察组15例,对照组15例。观察组于手术前一天行T4-5硬膜外穿刺置管,用0．8％利多卡因,确认硬膜外阻滞有效后再行全麻诱导插管。对照组不做硬膜外阻滞。分别于手术开始前、结束后1h、结束后24h及结束后48h各抽取动脉血5ml,分离出血浆冷藏,用放射免疫分析法检测血浆标本中内皮素（ET）、白介素-6、白介素-8、白介素-10及肿瘤坏死因子（TNF-α）值。结果 两组血浆中ET,TNF-α,IL-6,IL-8和IL-10水平在术前差异无显著性（P〉0．05）,对照组术后ET,TNF-α,IL-6,IL-8和IL-10水平明显升高,与麻醉诱导后相比,差异有显著性（P〈0．05）,术后24h时后开始下降。观察组术后TNF-α,IL-6,IL-8,IL-10水平也较术前显著升高（P〈0．05）,与对照组相比,差异有显著性（P〈0．05）。结论 高胸段硬膜外阻滞复合全麻相对于单纯全麻能明显降低非体外循环冠状动脉搭桥手术患者的应激反应。     

Regional anesthesia and acute perioperative pain management in thoracic surgery: a narrative review

Background and ObjectiveThoracic surgery causes significant pain which can negatively affect pulmonary function and increase risk of postoperative complications. Effective analgesia is important to reduce splinting and atelectasis. Systemic opioids and thoracic epidural analgesia (TEA) have been used for decades and are effective at treating acute post-thoracotomy pain, although both have risks and adverse effects. The advancement of thoracoscopic surgery, a focus on multimodal and opioid-sparing analgesics, and the development of ultrasound-guided regional anesthesia techniques have greatly expanded the options for acute pain management after thoracic surgery. Despite the expansion of surgical techniques and analgesic approaches, there is no clear optimal approach to pain management. This review aims to summarize the body of literature regarding systemic and regional anesthetic techniques for thoracic surgery in both thoracotomy and minimally invasive approaches, with a goal of providing a foundation for providers to make individualized decisions for patients depending on surgical approach and patient factors, and to discuss avenues for future research.MethodsWe searched PubMed and Google Scholar databases from inception to May 2021 using the terms “thoracic surgery”, “thoracic surgery AND pain management”, “thoracic surgery AND analgesia”, “thoracic surgery AND regional anesthesia”, “thoracic surgery AND epidural”. We considered articles written in English and available to the reader.Key Content and FindingsThere is a wide variety of strategies for treating acute pain after thoracic surgery, including multimodal opioid and non-opioid systemic analgesics, regional anesthesia including TEA and paravertebral blocks (PVB), and a recent expansion in the use of novel fascial plane blocks especially for thoracoscopy. The body of literature on the effectiveness of different approaches for thoracotomy and thoracoscopy is a rapidly expanding field and area of active debate.ConclusionsThe optimal analgesic approach for thoracic surgery may depend on patient factors, surgical factors, and institutional factors. Although TEA may provide optimal analgesia after thoracotomy, PVB and emerging fascial plane blocks may offer effective alternatives. A tailored approach using multimodal systemic therapies and regional anesthesia is important, and future studies comparing techniques are necessary to further investigate the optimal approach to improve patient outcomes.     

General thoracic surgery in Finland,a perspective from the Helsinki University Hospital

The field of thoracic surgery is a rapidly developing field due to exciting developments in technology and oncologic treatments as well as continuous innovation in surgical technique. Although the population of Finland is relatively small, general thoracic surgery is represented at a high level in five centralized university centers, Helsinki University Hospital, Tampere University Hospital, Turku University Hospital, Kuopio University Hospital and Oulu University Hospital. Thus, high case volume and good results are achieved in these centers. Here, we describe a short history, current state and future prospects of the field of cardiothoracic surgery in Finland, with a focus on general thoracic surgery and the perspective of Helsinki University Hospital. From the field’s birth in Finland, marked by the first lobectomy, in the late 1930’s, it has grown and adapted more and more modern techniques such as totally minimally invasive esophagectomy and robotic lung cancer surgery. Nowadays, most of general thoracic surgery in Helsinki University Hospital is either minimally invasive or robotic and open surgery is the exception to the norm. Helsinki University Hospital has a strong presence in the European general thoracic surgery community and aims to do so in the future by investing on training & education, research and surgical innovation.