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991.
根据循证医学的基本原则,美国血管外科学会(SVS)在系统性回顾的基础上,于2018年1月发布了腹主动脉瘤(AAA)治疗指南,针对AAA的诊断评估、治疗方式、麻醉及围术期处理、术后管理及随访、经济效益学分析5个方面做了重点阐述,并给出111条具体的推荐建议,并按GRADE法给出了推荐强度及证据级别。笔者对该指南中涉及的新观点或推荐意见、以及与临床诊疗过程中的密切相关点作一解读,以期读者更好的理解该指南。 相似文献
992.
Johan Ljungberg Bengt Johansson Ingvar A. Bergdahl Anders Holmgren Ulf Näslund Johan Hultdin 《Scandinavian journal of clinical and laboratory investigation》2013,73(7):524-530
AbstractRecently, a new approach was proposed to detect mild impairment in renal function: a reduced ratio between estimated glomerular filtration rate (eGFR) calculated by cystatin C and eGFR calculated by creatinine. We aimed to evaluate if this ratio is associated with aortic stenosis (AS) requiring surgery. We identified 336 patients that first participated in population surveys and later underwent surgery for AS (median age [interquartile range] 59.8 [10.3] years at survey and 68.3 [12.7] at surgery, 48% females). For each patient, two matched referents were allocated. Cystatin C and creatinine were determined in stored plasma. eGFRcystatin C and eGFRcreatinine and their ratio were estimated. Conditional logistic regression analyses were used to estimate the risk (odds ratio (OR) with [95% confidence interval (CI)]) related to one (ln) standard deviation increase in the ratio between eGFRcystatin C and eGFRcreatinine. A high ratio was associated with lower risk for AS requiring surgery (OR [95% CI]) (OR 0.84 [0.73–0.97]), especially in women (0.74 [0.60–0.92] vs. 0.93 [0.76–1.13] in men). After further stratification for coronary artery disease (CAD), the association remained in women with CAD but not in women without CAD (0.60 [0.44–0.83] and 0.89 [0.65–1.23], respectively). In conclusion, a high ratio between eGFRcystatin C and eGFRcreatinine was associated with lower risk for surgery for AS, especially in women. Mild impairment of renal function is thus associated with future risk for AS requiring surgery. 相似文献
993.
目的探讨喉罩通气全麻下经纤支镜介入治疗严重气道狭窄的疗效及安全性。方法分析8例严重气管狭窄患者临床资料。比较喉罩通气全麻下经纤支镜介入治疗前后患者气促评分、气管狭窄程度、血气分析指标变化及介入术中收缩压、心率、SPO2变化。结果 8例患者喉罩通气全麻术中血压、心率、SPO2平稳;经介入治疗后气管狭窄程度、气促评分较术前显著降低(P0.01),p(O2)显著升高(P0.01)。结论喉罩通气全麻下经纤支镜介入治疗严重气道狭窄安全有效。 相似文献
994.
《Journal of the American Society of Echocardiography》2022,35(7):692-702.e8
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995.
996.
The ideal range for tracheal tube cuff pressures is usually taken to be between 20 to 30 cm H2 O. This is easily measured with a cuff pressure manometer and should be measured in each instance. The importanceof tracheal tube cuff pressures is highlighted by the spectrum of airway complications that can occur with incorrect cuff pressures. High cuff pressures can result in complications ranging from sore throat and hoarseness to tracheal stenosis, necrosis, and even rupture. In such cases, the postulated causative factor is diminished blood flow to tracheal mucosa due to excessive cuff pressure on the tracheal wall. This hypothesized ischemic injury then produces healing fibrosis months or even years later. On the other hand, cuff pressures that are too low place the patient at risk for aspiration of gastric contents and consequently, aspiration pneumonitis and pneumonia. This is why the authors recommend that cuff pressures be measured following all intubations. 相似文献
997.
Amy Hammerich Julie Whitman Paul Mintken Thomas Denninger Venu Akuthota Eric E. Sawyer Melissa Hofmann John D. Childs Joshua Cleland 《Archives of physical medicine and rehabilitation》2019,100(5):797-810
Objective
To examine the effectiveness of epidural steroid injection (ESI) and back education with and without physical therapy (PT) in individuals with lumbar spinal stenosis (LSS).Design
Randomized clinical trial.Setting
Orthopedic spine clinics.Participants
A total of 390 individuals were screened with 60 eligible and randomly selected to receive ESI and education with or without PT (N=54).Interventions
A total of 54 individuals received 1-3 injections and education in a 10-week intervention period, with 31 receiving injections and education only (ESI) and 23 additionally receiving 8-10 sessions of multimodal PT (ESI+PT).Main Outcome Measures
Disability, pain, quality of life, and global rating of change were collected at 10 weeks, 6 months, and 1 year and analyzed using linear mixed model analysis.Results
No significant difference was found between ESI and ESI+PT in the Oswestry Disability Index at any time point, although the sample had significant improvements at 10 weeks (P<.001; 95% confidence interval [CI], ?18.01 to ?5.51) and 1 year (P=.01; 95% CI, ?14.57 to ?2.03) above minimal clinically important difference. Significant differences in the RAND 36-Item Short Form Health Survey 1.0 were found for ESI+PT at 10 weeks with higher emotional role function (P=.03; 95% CI, ?49.05 to ?8.01), emotional well-being (P=.02; 95% CI, ?19.52 to -2.99), and general health perception (P=.05; 95% CI, ?17.20 to ?.78).Conclusions
Epidural steroid injection plus PT was not superior to ESI alone for reducing disability in individuals with LSS. Significant benefit was found for the addition of PT related to quality of life factors of emotional function, emotional well-being, and perception of general health. 相似文献998.
目的:评价神经根沉降征与腰椎管狭窄症患者手术意愿相关性,探讨神经根沉降征判断腰椎管狭窄症严重程度及其作为腰椎管狭窄症手术治疗标准之一的可行性。方法:选取2017年6月—2018年6月在江门市五邑中医院住院治疗且明确诊断为腰椎管狭窄症(腰3/4、腰4/5)的患者120例,分别分析神经根沉降征阳性患者与神经根沉降征阴性患者手术意愿的相关性,且对2组患者的入院当天及建议手术时的VAS,JOA,ODI评分分析,组间比较采用t检验。结果:神经根沉降征阳性患者更意愿接受手术治疗,且2组患者的入院当天及建议手术时的VAS,JOA,ODI评分无差异。结论:神经根沉降征阳性患者的腰椎管狭窄症自我感觉程度较重,其可作为腰椎管狭窄症手术治疗的标准之一。 相似文献
999.
目的探讨经内镜下放射状切开术在治疗结直肠吻合口良性狭窄中的有效性和安全性。方法选取2015年1月-2016年12月该院结直肠术后并吻合口良性狭窄的患者46例,均采用内镜下放射状切开术解除肠道狭窄,操作为同一内镜医生完成,对患者治疗效果及术中、术后并发症进行总结,并随访1年,评估梗阻症状及吻合口狭窄复发情况。结果①入组46例患者中,45例(97.8%)治疗成功,操作时间12~36 min(平均18 min),住院天数2~6 d(平均3 d);②完成治疗的45例(100.0%)患者肠道梗阻症状均得到明显改善;③术中、术后均未出现穿孔、感染及严重的出血、腹痛等并发症;④41例(91.1%)患者完成随访,随访期间患者均未出现肠道梗阻症状及吻合口狭窄复发。结论经内镜下放射状切开术在治疗结直肠术后吻合口良性狭窄中安全、有效,值得临床推广应用。 相似文献
1000.
Ricardo A. Spampinato Cosima Jahnke Ingo Paetsch Sebastian Hilbert Franziska Busch Valerie Schloma Yaroslava Dmitrieva Fernanda Bonamigo Thome Susanne Löbe Elfriede Strotdrees Gerhard Hindricks Friedrich-Wilhelm Mohr Michael A. Borger 《Journal of the American Society of Echocardiography》2018,31(1):42-51