艰难梭菌腹泻及实验室诊断

目的探讨艰难梭菌A&B毒素测定在临床应用价值,分析艰难梭菌毒素感染的临床特点。方法对四川大学华西医院2011-02/08收集的155份住院腹泻患者大便标本,采用VIDAS艰难梭菌A&B毒素检测试剂盒进行毒素检测。根据A&B毒素检测结果,将研究对象分为3组:艰难梭菌毒素检测阳性(CDAB阳性)组、艰难梭菌毒素检测灰区组和艰难梭菌毒素检测阴性组。对3组的实验室检测数据和临床资料进行分析比较,实验数据包括大便常规、血常规、生化检测以及粪便镜下微生物学检查,临床资料包括患者的年龄性别、使用抗生素与预后情况等。结果共检测了155例腹泻患者的大便标本,其中艰难梭菌A&B毒素阳性17例(10.97%),可疑6例(3.87%)。155例腹泻患者分为艰难梭菌毒素阳性、可疑和阴性3组进行实验室检测结果比较分析,大便隐血试验在阳性组和阴性组间有统计学差异(P=0.027)。3组病患的临床资料分析显示,抗真菌药物和质子泵抑制剂的使用可能是引起艰难梭菌感染的危险因素。结论艰难梭菌A&B毒素检测技术成熟并已商品化,该方法快速、简单、特异性高,可以作为艰难梭菌临床感染的辅助诊断指标。大便隐血试验可提示艰难梭菌感染,但不具有特异性。     

Extubation difficile imprévue

Complications at extubation remain an important risk factor in anaesthesia. Airway related complications at extubation are relatively frequent but are usually dealt with by simple basic measures. We report a new case of respiratory complications associated with tracheal extubation in a 59-year-old woman. Her medical history included obesity, no criteria difficult intubation and no adverse events during her previous anesthetic procedures. At the end of surgery, immediately after extubation, the patient developed respiratory distress requiring reintubation. A second extubation performed in postoperative recovery room was complicated by a new respiratory distress with reintubation. The patient was then admitted to the ICU. The examination on admission was unremarkable. Chest X-ray and a chest CT scan were performed in search of an etiology. Both tests showed a large thyroid “goitre plongeant” (plunging goiter) and compressive. In the suites, a thyroidectomy was performed with excision of a large cervical plunging goiter para- and retropharyngeal bilateral chest, allowing extubation successfully. The postoperative course was uneventful.     

Intubation au vidéolaryngoscope sous-sédation

We report a video laryngoscopic tracheal intubation under sedation in a patient with a hip fracture. Preoperative assessment revealed signs of difficult airway management linked to a cervical spine immobilization. Here we describe an alternative method to awake fiber optic flexible intubation.     

Comparaison de l’Airtraq™ et du laryngoscope Macintosh pour l’intubation trachéale chez l’adulte avec stabilisation manuelle en ligne du rachis cervical

Introduction

Airtraq laryngoscope is a new and single use device for endotracheal intubation. Few studies showed the superiority of the Airtraq comparing to Macintosh laryngoscope in the setting of difficult intubation.

Study design

To compare the performance of these two laryngoscopes by simulating a situation of reduced mobility of the cervical spine by applying the Manual in-line stablization (MILS) maneuver.

Patients and methods

After obtaining the approval of the ethic committee, we realized a prospective single blind randomized study. During a 6-month period, 120 consenting patients scheduled for ORL or ophthalmologic surgery were included. They all had general anesthesia and orotracheal intubation. These patients were randomly and equally divided in two groups (n = 60), depending on the type of the laryngoscope used (Airtraq or Macintosh). Were excluded from the study the patients with history or criteria predicting difficult intubation. Each patient was intubated by one of the five experimented anesthetists selected for this work. The principle judgment criteria were: i) the time taken for the orotracheal intubation and ii) the intubation difficulty score (IDS). The secondary judgment criterion was the hemodynamic modifications after the endotracheal intubation.

Results

Demographic and upper airway track variables were comparable between the two groups. There was no case of failure of intubation in this serie. Nonetheless, all the patients of the Airtaq group were intubated from the first attempt, whereas half of the patients of the Macintosh group were intubated after the third attempt. Comparing to the Macintosh, the Airtraq reduces the time taken for the orotracheal intubation (14 ± 1 s vs 19 ± 3 s, P = 0.01), the necessity of additional maneuver to facilitate the intubation, and the intubation difficulty score (0.7 ± 0.3 vs 3.8 ± 1, P < 0.001). Orotracheal intubation using the Airtraq laryngoscope caused less hemodynamic stimulation than using the Macintosh.

Conclusion

Our study showed the usefulness of the Airtraq laryngoscope for endotracheal intubation for patients presenting conditions of difficult intubation such as reduced mobility of the cervical spine.     

Intubation difficile : il faut suivre les recommandations

Intubation and ventilation impossible mask is a dramatic situation with potentially serious consequences. We report the case of a patient of 43 years, followed for a goiter, which was scheduled for a total thyroidectomy under general anesthesia. Preoperative evaluation is not noted signs of compression or tracheal deviation, and there were no criteria predictive of intubation or difficult mask ventilation. The induction of anesthesia was standard. Mask ventilation was effective allowing paralysis. The standard laryngoscopy showed a score of Cormack and Lehane grade IV. Several attempts at intubation were made leading to a situation of intubation and ventilation impossible mask with deep desaturation. A tracheostomy was done urgently. The patient was operated on, six months later, with a fiber optic intubation. Through this case, the authors draw attention to the difficulty of achieving an emergency tracheotomy in the presence of goiter and emphasize the need for integration of different modes of learning and retention of management skills of the upper airway.     

抗艰难梭菌rakicidin B1新衍生物的设计、合成及生物学活性评价

目的 以rakicidin B1为起始原料,经2步反应合成得到4个全新结构的rakicidin B1衍生物,并对其进行生物学活性研究,以期获得低细胞毒、高效抗艰难梭菌活性的化合物。方法 课题组前期首次发现rakicidin B1具有较强的抗艰难梭菌活性,在其结构基础上进行修饰和优化,通过氨基甲酸酯连接基团引入含氮杂环,设计合成得到4个全新目标化合物。所有化合物结构经高分辩质谱和核磁确证,并经抗艰难梭菌活性测试和细胞毒性活性测试。结果 在合成的4个化合物中,有3个化合物具有与先导化合物更强或相当的抗艰难梭菌活性;同时,MTT测试结果表明,3个化合物的细胞毒性降低,以3b的细胞毒性降低最多。结论 通过对rakicidin B1母核结构进行修饰和优化,获得全新结构的rakicidin B1衍生物并对其进行抗菌和细胞毒活性筛选。其中,化合物3b保留潜在抗艰难梭菌活性且细胞毒性降低最多,作为全新结构类型的抗艰难梭菌活性化合物,有潜在的开发价值。