新型冠状病毒肺炎疫情期间外科患者围术期防控策略

目前新型冠状病毒肺炎疫情防控形势严峻,各级医疗机构在做好新型冠状病毒肺炎防控的同时,还需提供优质安全的常规医疗服务。笔者旨在通过严格患者分类管理以及围术期标准预防,为需行外科治疗的患者,尤其是需行急诊外科治疗的患者提供优质安全的医疗服务,减少院内感染,为新型冠状病毒肺炎防控贡献一份力量。     

侧卧手术体位对老年患者眼压变化的影响及护理观察要点

目的探讨使用有效的测量工具和在适合的测量时间段采集侧卧手术体位老年患者基础数据,找出患者眼压变化随体位变化的规律,旨在制订有效的护理预防措施。方法选取2019年3—6月在首都医科大学附属北京同仁医院中心手术室完成胸科胸腔镜手术的老年患者31例。使用icare回弹式眼压计分别于患者入手术室后、全身麻醉插管后、侧卧5 min、侧卧30 min、术中1 h、术中2 h、术中3 h、翻身拔管、出室前9个时间点测量双眼眼压,同时记录每个时间点患者的血压、心率数据,记录手术过程中液体出入量、特殊用药等。结果患者侧卧5 min、侧卧30 min、术中1 h、术中2 h、术中3 h的血压与入室后比较,差异有统计学意义(P<0.05);不同时间点的心率比较,差异无统计学意义(P>0.05)。麻醉插管后患者双眼眼压均低于入室时眼压,差异有统计学意义(P<0.05);侧卧30 min、术中1 h、术中2 h、术中3 h的双眼眼压与入室后眼压比较,差异有统计学意义(P<0.05);侧卧5 min、侧卧30 min、术中1 h、术中2 h、术中3 h的受压侧眼压与非受压侧眼压比较,差异有统计学意义(P<0.05)。Pearson相关分析显示,患者平均动脉压与受压侧眼及非受压侧眼的眼压均无相关性(r值分别为-0.1138、0.0179,P>0.05)。进入手术间时患者测试视力与术后6 h回病房后测试视力比较,差异无统计学意义(P>0.05)。结论胸腔镜手术老年患者的眼压随手术体位变化而波动,从侧卧5 min开始眼压出现变化,2 h内受压侧眼眼压达到高峰,体位恢复平卧位后,眼压随即恢复到入室时水平。本研究未发现血压与眼压变化的相关性。     

Dangerosité psychiatrique et responsabilité pénale atténuée : à propos de la condamnation à la réclusion à perpétuité d’un schizophrène auteur d’un homicide sexuel sadique

The second paragraph of article 122-1 of the French Criminal Code provides for a reduced penalty in criminal matters (Court of Assizes) when the offender is suffering at the time the act is committed from a mental disorder that reduces his liability. This legal provision is not always respected, as shown by the sentencing to life imprisonment of a chronic psychotic patient who committed a sexual homicide (sadistic rape). The Court of Assizes found that the great dangerousness of this schizophrenic, with a multiple criminal record and who had refused his treatment, justified his conviction, while the psychiatric expertise concluded that he should benefit from a reduction on his criminal liability. The sentence was passed without the level of severity of his mental state having been verified by a new expert. The author therefore questions the “ethical” nature of this court decision which, albeit legal, is contrary to the spirit of the law. There was no appeal against the sentence.     

臭茉莉叶总黄酮提取工艺优化及月周期变化研究

目的:采用超声辅助正交试验法优化臭茉莉叶总黄酮的提取工艺,并进一步研究臭茉莉叶中总黄酮1年内每月含量变化趋势,探讨臭茉莉叶最佳采收时间。方法:以提取液中总黄酮含量为指标,选择乙醇浓度(%)、超声时间(min)、料液比、提取温度(℃)等为考察因素,采用正交试验法L9(34)确定臭茉莉叶提取液中总黄酮的最优工艺。结果:臭茉莉叶所含总黄酮最优提取工艺条件:乙醇浓度70%、超声时间60min、料液比1∶25、提取温度50℃。3月份总黄酮/药材量是0.0235mg·g-1为最高。结论:该提取工艺快捷以及操作简便,适用于臭茉莉叶总黄酮的提取。结合总黄酮月周期变化规律,可以确定1年中5月份和7月份为最佳采摘期。     

Increased risk of hip fracture mortality associated with intraoperative hypotension in elderly hip fracture patients is related to under resuscitation

BackgroundAs the US and world population ages, hip fractures are increasingly more common. The mortality associated with these fractures remains high both in the immediate postoperative period and at one year. Perioperative resuscitation in this population is of key interest to prevent organ injury and mortality. Our objectives were to evaluate the effect of fluid resuscitation and hemodynamic status in the form of mean arterial pressure (MAP) on inpatient mortality of hip fracture patients.MethodsAn institutional database was queried to compare elderly hip fracture patients that sustained in-hospital mortality to a matched control cohort. Pre-, intra-, and post-operative intravenous fluid (IVF) administration and MAP were extracted from the electronic medical record. Time from hospital presentation to the OR was also recorded.Results1,114 total hip fractures were identified during the two-year study period, 16 of which suffered inpatient mortalities. The mortality cohort was then matched with a control of 394 hip fracture patients for the same period based on age, sex, and Charlson Comorbidity Index (CCI). Conditional logistical regression analysis found odds ratios (OR) indicating that longer time between presentation and surgery (OR per additional hour: 1.05; 95% CI: 1.01–1.08) and lower intraoperative minimum MAP (OR per 5 mmHg decrease: 0.77; 95% CI: 0.61–0.97) were associated with significantly increased odds of mortality. There was also a marginal relationship between greater intraoperative IVF administration and reduced odds of mortality (OR per 500 cc additional fluid: 0.61; 95% CI: 0.37–1.00).ConclusionExtended time from presentation to surgery and intraoperative hypotension were associated with increased likelihood of inpatient mortality in an elderly hip fracture cohort, with a possible additional effect of under-resuscitation. Further investigation into a safe intraoperative minimum MAP should be pursued.Level of evidenceLevel III.     

Effects of cinnamon on perineal pain and healing of episiotomy: a randomized placebo-controlled trial

BACKGROUND: Analgesic and wound-healing effects of cinnamon, a widely used spice, have been shown in laboratory rats. However, we found no human studies in this area.OBJECTIVE: The aim of this study was to assess the effect of cinnamon on perineal pain and healing of episiotomy incision.DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: In this double-blind, randomized, placebo-controlled trial, 144 postpartum women were allocated into two groups, using stratifi ed block randomization, 1 h after completion of episiotomy repair. They received cinnamon or placebo ointment, 2 mL every 12 h for 10 d.MAIN OUTCOME MEASURES: Perineal pain and wound healing were assessed using visual analogue scale(0-10) and Redness, Edema, Ecchymosis, Discharge, Approximation scale(0-15), respectively. General linear model was used to compare the groups on the outcomes adjusted for baseline values and stratifi ed factors.RESULTS: Follow-up rate was 100% up to the 8 h time point in both groups, and 86%(62 of 72) in the cinnamon group and 85%(61 of 72) in the placebo group at day 10-11 after delivery. Pain score in the cinnamon group was signifi cantly lower than that in the placebo group at(4±1) h(adjusted difference:-0.6, 95% confi dence interval:-1.0 to-0.2) and(8±1) h(-0.9,-1.4 to-0.3) after intervention, and on the 10-11 th day after delivery(-1.4,-2.0 to-0.7). Also the cinnamon group showed signifi cantly more improvement than the control group in healing score at(8±1) h(-0.2,-0.4 to-0.04) and the 10-11 th day after delivery(-1.6,-2.0 to-1.1). CONCLUSION: Cinnamon can be used for reducing perineal pain and improving healing of episiotomy incision.     

关节置换术患者血浆胆碱酯酶水平与术后认知功能障碍的相关性研究

目的：探讨关节置换术患者血浆胆碱酯酶（ChE）水平对发生术后认知功能障碍（POCD）的影响。方法选择2013年1~11月择期行膝关节、髋关节置换术患者82例，根据是否发生POCD分为POCD组32例（39.02%）和非POCD组50例（60.98%）。所有入选患者分别于术前1 d和术后1、3、5、7 d应用简易精神状态检查量表（MMSE）进行认知功能测定，并于术前1 d和术后1、3、5、7 d抽取患者空腹静脉血测定ChE水平。结果两组患者术后1、3、5、7 d血浆ChE水平均较术前降低，且POCD组较非POCD组降低更明显，差异有统计学意义（P〈0.05）；POCD组术前1 d血浆ChE水平明显低于非POCD组，差异有统计学意义（P=0.017）；血浆ChE水平与MMSE评分呈正相关（r=0.630，P〈0.01）。结论关节置换术患者血浆ChE水平降低与POCD的发生密切相关。     

优质护理在混合痔围手术期患者中的应用价值分析

目的：探讨分析优质的护理在混合痔围手术期患者中的应用价值。方法：选取2013年1月～2014年1月我院接受治疗的68例混合痔患者，随机分为试验组（优质护理组，试验例数为34）和对照组（常规护理组，试验例数为34），利用统计学方法对此两种护理方式下患者的术前精神状态和术后并发症发生率等进行比较分析。结果：试验组通过优质精心的护理，试验组混合痔患者的术前精神状态和并发症发生率明显优于对照组，且术后住院时间也低于对照组，两组对比具有显著差异性（P〈0．05），具有统计学意义。结论：通过优质精心的护理，可有效地促进手术创面的愈合，有利于患者的旱日康复，避免各种并发症的发生，值得在临床上应用和推广。