昏迷患者院前转诊气道管理的方案比较

目的 探讨对昏迷患者院前急救转运最佳气道管理方案.方法 选取2005~2010年院前昏迷患者127例(格拉斯评分8以下),分别给于口咽通气管(A组)、普通喉罩(B组)及气管插管(C组),根据病情常规治疗,观察一次性置管时间、院前重复置管及安全转运.结果 口咽通气管组和普通喉罩组一次性置管时间明显少于气管插管组(P<0.01),然而安全转运成功率气管插管组较口咽通气管组和普通喉罩组有明显优势(P<0.05).结论 气管插管组对院前昏迷患者安全转诊提供较安全的气道保护.     

Friedrich Trendelenburg: Historical background and significant medical contributions

Friedrich Trendelenburg's name is widely known today because it is associated with the Trendelenburg position. However, Trendelenburg made many other valuable contributions to the field of medicine, including a test, a gait, and a sign. A historical review of his life helps to elucidate the factors that contributed to his innovative approaches and techniques. Both Trendelenburg's mentors in his early years and the influences upon him throughout his professional career contributed to his development as a pioneer of surgery, anesthesia, and clinical diagnostics. Clin. Anat. 27:815–820, 2014. © 2014 Wiley Periodicals, Inc.     

Effectiveness of high-flow nasal cannula on pulmonary rehabilitation in subjects with chronic respiratory failure

BackgroundThe effects of exercise training using both high fraction of inspired oxygen (F_IO₂) and high flow oxygen delivered through a high-flow nasal cannula (HFNC) on exercise capacity in patients with chronic respiratory failure (CRF) receiving long-term oxygen therapy (LTOT) are unknown.MethodsIn this randomized study, 32 patients with CRF receiving LTOT were assigned to undergo 4 weeks of exercise training on a cycle ergometer using an HFNC (flow: 50 L/min) with a F_IO₂ of 1.0 (HFNC group; n = 16) or ordinary supplemental oxygen via a nasal cannula (flow: 6 L/min) (oxygen group; n = 16). A 6-min walking test and a constant-load test were performed before and after 4 weeks of exercise training.ResultsFollowing 4 weeks of exercise training, change in the 6-min walking distance was significantly greater in the HFNC than in the oxygen group (55.2 ± 69.6 m vs. −0.5 ± 87.3 m; p = 0.04). However, there was no significant difference between the two groups in the degree of improvement in the duration of the constant-load exercise test after exercise training.ConclusionsConsidering the effect on daily activities (e.g., walking), exercise training using both high F_IO₂ and high flow through an HFNC is a potentially superior exercise training modality for patients with CRF receiving LTOT.Clinical Trial Registration — http://www.clinicaltrials.gov. Unique identifier: NCT02804243     

孕期尼古丁暴露致成年子代大鼠中枢对血管紧张素II的高反应性

目的 探讨孕期尼古丁暴露后,子代大鼠中枢对血管紧张素II（AngII）的反应性。方法 对孕期尼古丁暴露的子代大鼠（n =7）脑室内注射AngII、洛沙坦(Los)和PD123319（PD）后,观察尼古丁子代（尼古丁组）平均动脉压（MAP）、血气与正常大鼠子代（对照组,n =7）之间的差异,并检测下丘脑前区（AHA）c-Fos表达,AngII受体1a（AT1aR）、AT1bR和AT2R mRNA的变化,以及AHA区AT1R、AT2R蛋白表达水平。结果 尼古丁组基础MAP与对照组无差异,但脑室内注射 AngII后,尼古丁组大鼠MAP高于对照组［（120.36±6.23） mmHg （109.87±6.86）mmHg,P <0.05］,AHA区的c-Fos表达也明显强于对照组（25.8±2.91 比6.42±1.52,P <0.05）,而Los预处理后,两组MAP无明显变化,但PD预处理后,尼古丁组MAP仍高于对照组。并且尼古丁组AHA区的AT1aR mRNA高于对照组（1.23±0.05 比 1.00, P <0.05）,AT1R蛋白表达也高于对照组（0.581±0.06 比 0.353±0.05,P <0.05）。结论 孕期尼古丁暴露可导致子代大鼠AHA区AT1aR mRNA及AT1R蛋白高于对照组,可能导致中枢对AngII的反应性增强。     

Endonasal Skull Base Tumor Removal Using Concentric Tube Continuum Robots: A Phantom Study

Objectives The purpose of this study is to experimentally evaluate the use of concentric tube continuum robots in endonasal skull base tumor removal. This new type of surgical robot offers many advantages over existing straight and rigid surgical tools including added dexterity, the ability to scale movements, and the ability to rotate the end effector while leaving the robot fixed in space. In this study, a concentric tube continuum robot was used to remove simulated pituitary tumors from a skull phantom. Design The robot was teleoperated by experienced skull base surgeons to remove a phantom pituitary tumor within a skull. Percentage resection was measured by weight. Resection duration was timed. Setting Academic research laboratory. Main Outcome Measures Percentage removal of tumor material and procedure duration. Results Average removal percentage of 79.8 ± 5.9% and average time to complete procedure of 12.5 ± 4.1 minutes (n = 20). Conclusions The robotic system presented here for use in endonasal skull base surgery shows promise in improving the dexterity, tool motion, and end effector capabilities currently available with straight and rigid tools while remaining an effective tool for resecting the tumor.     

高流量呼吸湿化治疗仪在食管癌术后并发急性呼吸衰竭患者治疗中的效果观察及护理

目的 研究高流量呼吸湿化治疗仪（HFNC）在食管癌术后并发急性呼吸衰竭患者治疗中的临床效果。方法 选取复旦大学附属中山医院2017 年1 月～2018 年6 月45 例食管癌术后并发急性呼吸衰竭的患者作为研究对象,分为观察组和对照组。对照组22 例患者采用传统方法氧疗,观察组23 例患者采用高流量呼吸湿化治疗仪治疗。比较两组患者在睡眠时间、动脉血氧分压、心率、呼吸率、SpO2、气管插管率等在治疗后的上述指标差异。结果 治疗后,与对照组相比,观察组患者睡眠时间延长,动脉血氧分压显著提高,心率趋于平稳,呼吸率下降,SpO2 有明显改善（P＜0.05,P＜0.001）。治疗后,观察组患者的气管插管率为13.0%（3/23）,低于对照组的27.3%（6/22）,但差异无统计学意义（P＞0.05）。结论 高流量呼吸湿化治疗仪（HFNC）的使用可显著提高食管癌术后并发急性呼吸衰竭患者的氧疗效果、给氧舒适度及睡眠时间,患者易于接受,可以改善患者的呼吸功能。     

Pediatric Single‐Lumen Cannula Venovenous Extracorporeal Membrane Oxygenation: A French Center Experience

Single‐lumen cannula venovenous (VV) extracorporeal membrane oxygenation (ECMO) is a special extracorporeal life support (ECLS) technique used for neonatal and pediatric refractory hypoxemia. This is an alternative flow rate ECLS that consists of successive clamping on the drainage and the injection lines. Currently, the Armand‐Trousseau's pediatric intensive care unit remains the only pediatric ECMO center proposing this partial assistance. This article details a technical note and a retrospective analysis of our experience in refractory hypoxemia. The retrospective study, from 2007 to 2011, included all pediatric and neonatal patients treated by single‐lumen cannula VV ECMO. The study was focused on pre‐ECMO patient characteristics and complications during ECMO course. During the last 5 years, 67 pediatric patients were assisted by this single‐lumen cannula VV ECMO. Sixty‐one patients (91%) were newborns. Thirty‐nine patients presented with meconium aspiration syndrome (58%), which was the most frequent etiology. Before cannulation, mean oxygenation index (OI) was 32 ± 11, alveolar‐arterial oxygen difference was 604 ± 47 mm Hg, and partial pressure arterial oxygen/fraction inspired oxygen ratio was 59.2 ± 35.8. Forty‐eight patients (72%) presented pulmonary hypertension, and 66 patients were treated by nitric oxide (98%). Fifty patients (75%) were treated by vasopressors or inotropic drugs. Average duration of ECMO was 13.2 ± 7.8 days. There were forty‐six survivors (69%). The worst prognosis was for respiratory syncytial virus pneumonia. Complications like acute renal injury and hematologic and transfusion acts were not so different than those observed in classical ECMO techniques. Nevertheless, 19 patients presented a stroke (28% of the overall population), but this high rate did not seem to be due to the ECLS technique used. Single‐lumen cannula VV ECMO is a partial and efficient ECMO support. Our experience shows that this technique is as efficient and less invasive than two cannulas ECMO. The single‐lumen cannula VV ECMO is a simple and safe ECLS support used for neonatal or pediatric refractory hypoxemia. Because this is a partial assistance, it is a promising ECLS support.