序贯HFNC对中老年患者全麻胆囊切除术后低氧血症与再插管率的影响

目的探讨拔除气管插管后序贯经鼻高流量氧疗（HFNC）对中老年患者全麻胆囊切除术后低氧血症和再插管率的影响。 方法采用前瞻性随机对照研究，选取2019年1月至12月新疆维吾尔自治区第三人民医院重症医学科收治的全麻下行胆囊切除术患者90例，将其随机分为HFNC组（30例）、鼻导管组（30例）、面罩组（30例）。比较拔除气管插管前后各组间心率（HR）、血压和血气分析指标［动脉血氧分压（PaO₂）、动脉血二氧化碳分压（PaCO₂）、氧合指数］，以及拔管后患者不适感和再插管率情况。 结果拔除气管插管前，3组患者间HR、收缩压（SBP）、PaO₂、PaCO₂、氧合指数比较，差异无统计学意义（P＞0.05）。拔管后1 h，3组患者间HR和SBP比较，差异无统计学意义（P＞0.05）；HFNC组患者的PaO₂与氧合指数均高于面罩组，PaCO₂低于面罩组，差异均有统计学意义（P=0.013，P=0.009，P=0.031），但与鼻导管组比较，差异均无统计学意义（P=0.106，P=0.101，P=0.545）；面罩组与鼻导管组相比，PaO₂和氧合指数差异均无统计学意义（P=0.363，P=0.314）。鼻导管组黏膜干燥抱怨所占比例最高，面罩组的幽闭恐惧和恶心呕吐所占比例最高，差异均有统计学意义（P＜0.05）。3组患者再插管率比较，差异无统计学意义（P=0.484）。 结论对于中老年全麻下行胆囊切除术后低氧血症的患者而言，相比面罩氧疗，拔除气管插管后采用序贯HFNC可以更好地改善患者的PaO₂、PaCO₂、氧合指数和不适感，但不能降低再插管率。     

唇裂Ⅱ期鼻畸形修复术后患者佩戴硅胶鼻模初始时间的探讨

目的探索唇裂Ⅱ期鼻畸形修复术后患者佩戴硅胶鼻模适宜的初始时间。方法选取我科唇部整形门诊2016年3月-2018年1月收治的鼻修复手术的47例唇裂Ⅱ期鼻畸形患者,根据患者门诊号的奇偶数分为观察组(25例)和对照组(22例),观察组于术后拆线日起佩戴硅胶鼻模,对照组于术后即刻佩戴硅胶鼻模。比较两组术后即刻、术后6个月患者和手术医生对鼻部外型满意度;比较两组术后拆线日切口愈合恢复情况及患者自我清洁能力和舒适度。结果术后即刻、术后6个月患者和手术医生对鼻部外型满意度比较两组差异无统计学意义(P>0.05)。伤口愈合率、患者自我清洁能力和舒适度观察组明显优于对照组,差异有统计学意义(P<0.05)。结论术后拆线日开始佩戴硅胶鼻模,既不影响术后鼻部外型的巩固与维持,又有利于患者的自我护理和观察,改善术后早期舒适度的体验,有利于伤口愈合,增加手术成功率。     

Anesthetic management of traumatic septal hematoma in a 9 month old infant

Septal hematoma is treated by incision and drainage followed by nasal packing. This presents a problem in infants who being obligate nasal breathers do not tolerate nasal packing. We describe the use of a nasal airway as tubular pack to maintain the patency of nostril while providing pressure hemostasis.     

Nasal Foreign Body,an Unanticipated Complication of COVID-19 Care: A Case Report

BackgroundCoronavirus disease 2019 (COVID-19) has changed the way we practice medicine. Standards of care are evolving in an effort to diagnose, manage, and treat the cause of this global pandemic, as well as to protect the health care workforce. These practices can have unexpected and potentially dangerous consequences, particularly for patient populations with confounding factors that put them at increased risk for complications and poor outcomes.Case ReportA 52-year-old previously healthy woman presented with 4 days of nasal pain and discharge after using a home collection kit in an attempt to obtain a nasopharyngeal viral sample for COVID-19 testing.Why Should an Emergency Physician Be Aware of This?With treatments, policies, and procedures that are rapidly evolving and often deviating from established, evidence-based, usual care in response to the COVID-19 pandemic, emergency physicians must be cognizant of and monitor for poor outcomes and potential downstream complications, especially in underserved patient populations.