Impact of the supine position versus left horizontal position on colonoscopy insertion: a 2-center,randomized controlled trial

1. Download : Download high-res image (308KB)
2. Download : Download full-size image

     

老年尿毒症吞咽障碍患者改良插胃管法的效果观察

目的探讨并评价改良插胃管法在老年尿毒症吞咽障碍患者中应用的效果。方法将41例肾内科老年尿毒症吞咽障碍需要鼻饲患者作为研究对象,按照入院的先后顺序分为对照组20例和改良组21例。对照组采用传统插胃管法,改良组采用改良插胃管法。观察比较两组患者置管成功率、置管时间、恶心呕吐和呛咳发生率。结果改良组1次置管成功率、2次置管成功率明显高于对照组,差异有统计学意义(χ2=4.111,χ2=4.221,均P<0.05);改良组置管时间明显少于对照组(t=2.271,P<0.05),置管时呛咳发生率低于对照组(χ2=4.667,P<0.05),差异有统计学意义。而两组患者恶心呕吐发生率比较差异无统计学意义(χ2=0.006,P>0.05),置管费用无差异。结论改良插胃管法能显著提高置管成功率,缩短置管时间,减轻患者痛苦。     

单用依托咪酯或丙泊酚诱导插管在急诊危重患者中的临床观察

目的:探讨单用依托咪酯或丙泊酚诱导气管插管在急诊危重患者中的可行性和安全性。方法:回顾性分析单用依托咪酯或丙泊酚诱导气管插管的首次成功率、反流误吸发生率、诱导后低血压和心律失常发生率、气管插管后药物的使用情况。结果:所有患者在诱导插管过程中都无反流误吸发生。与丙泊酚诱导比较,依托咪酯诱导低血压与心律失常发生率更低,插管后升压药物使用率更低(P<0.05)。首次成功率和降压药使用率差异无统计学意义。结论:急诊危重病患者单用依托咪酯或丙泊酚诱导气管插管都具有良好可行性,但用依托咪酯诱导插管更安全。     

Parapharangeal edema: an uncommon complication of TMJ arthroscopy

Ohnishi in 1975 first described temporomandibular joint (TMJ) arthroscopy. Along with its extensive use, a range of complications has emerged. We describe a patient who experienced parapharyngeal swelling after undergoing arthroscopy. Prolonged intubation up to 1 hour postoperatively was required. The swelling resolved completely over 6 h without further intervention.     

A prolonged observational study of tracheal tube displacements: Benchmarking an incidence <0.5-1% in a medical-surgical adult intensive care unit

Background and Aims:

Tracheal tubes are commonly used in intensive care unit (ICU) and lead to complications like displacements. The primary aim of the study was to evaluate if the rate of tracheal tube displacement benchmarked at <1% per patient and <0.5% per tracheal tube day, could be sustained over a prolonged period. The secondary aim was to document the patterns of all forms airway accident and to evaluate their consequences.

Subjects and Methods:

This was a prospective observational study of Intubated and ventilated patients in a General Medical-Surgical Adult ICU. The incidence of accidental extubation, self extubation, partial displacement and blockages of tracheal tubes were recorded.

Results:

The overall tracheal tube displacement rate was 61/10,112 (0.6%) per patient and 61/28,464 (0.22%) per tracheal tube day. There were 30 additional incidents of blockage, kinking or biting of the tracheal tube. Physiological consequences-69 were mild, 10 moderate, 12 major and one death. Of the 91 accidents, 30 were partly and 30 were completely preventable. 76 incidents involved an endotracheal tube (54 displaced, 12 blocked and 10 bitten-kinked) and 15 a tracheostomy tube (seven displaced and eight blocked). Accidents were more common in medical than surgical patients (medical = 48, cardiac surgical = 17 and other surgical/trauma = 26).

Conclusion:

Tracheal tube displacement rate in a mixed medical-surgical adult ICU was maintained below the pre-set benchmark of <1% per patient and <0.5% per intubated day over nearly a decade.     

Conservative management of post-intubation tracheal tears—report of three cases

Iatrogenic tracheal rupture is a rare complication after intubation. We present three patients with tracheal tears. In all of these patients, a common finding was a lesion of the posterior tracheal wall with postoperative subcutaneous and emphysema as the first clinical sign of the rupture. Diagnosis and follow-up were based on clinical and endoscopic findings and chest computed tomography (CT) scans. In our cases with progressive subcutaneous and mediastinal emphysema or dyspnea, we performed a tracheotomy and bypassed the lesion with a tracheostomy tube to avoid an increase in air leakage into the mediastinum. Under broad-spectrum antibiotic therapy, no mediastinitis occurred and all patients survived without sequelae. Closure of tracheostomy was scheduled for 1-2 months after tracheal injury. Analysis of surgical and anesthesiological procedures revealed no abnormalities and the accumulation of tracheal injuries was considered as accidental. We found that in clinically stable patients with spontaneous breathing and with no mediastinitis, a conservative management of tracheal tears is a safe procedure.     

NIPPV和NCPAP作为早产儿拔管后无创呼吸支持模式的临床应用疗效对比

目的 探讨经鼻间歇正压通气(NIPPV)和经鼻持续气道正压通气(NCPAP)作为早产儿气管插管拔管后无创呼吸支持模式的临床应用疗效对比。方法 选取2016年1月～2017年6月在我院治疗的新生儿呼吸窘迫综合征65例,采用随机数字表法将患儿随机分为NIPPV组(n=32)和NCPAP组(n=33),观察两组撤机失败率、无创呼吸支持时间、无创后吸氧时间及总用氧时间,同时检测治疗前后二氧化碳分压(PaCO_2)、氧分压(PaO_2)和氧合指数(OI),两组并发症的发生情况。结果 NIPPV组和NCPAP组撤机失败率、无创后吸氧时间和总用氧时间比较,差异无统计学意义(P0.05);NIPPV组无创呼吸支持时间为2(1,3)d,明显短于NCPAP组(P0.05);NIPPV组和NCPAP组治疗前后PaO_2、PaCO_2比较,差异无统计学意义(P0.05);NIPPV组治疗后12 h、24 h OI分别为(240.100±31.140)%和(260.040±38.890)%,明显高于NCPAP组(P0.05);NIPPV组和NCPAP组支气管肺发育不良、早产儿视网膜病、新生儿坏死性小肠结肠炎和总发生率的比较,差异无统计学意义(P0.05)。结论 相比较NCPAP,早产儿气管插管拔管后应用NIPPV可缩短无创呼吸支持时间,值得临床使用。     

小儿颞下颌关节强直手术的麻醉处理

目的: 探讨小儿颞下颌关节强直手术的麻醉和困难气道管理。方法: 回顾性分析43例小儿颞下颌关节强直开口受限,困难气道病例资料,在保留自主呼吸的情况下,分为氯胺酮组（K1组）和氯胺酮复合右美托咪定组（K2组）。K1组和K2组均静脉给予氯胺酮1~2 mg/kg,K2组则追加静注右美托咪定1 μg/kg。患者意识消失后,辅以气管内和咽喉区表面麻醉。采用纤维支气管镜经鼻腔气管插管。插管过程中,根据患者反应小剂量滴定氯胺酮,维持麻醉深度。采用GraphPad Prism 6.0软件对数据进行统计学分析。结果: 所有患儿均在纤维支气管镜下经鼻腔成功气管插管。插管过程中,氧饱和度<95%发生率K2组略低于K1组,差异无统计学意义（P>0.05）。插管过程中追加氯胺酮次数和氯胺酮总剂量K2组显著低于K1组（P<0.05）,插管时心率变化和插管用时K2组显著低于K1组（P<0.05）。结论: 氯胺酮麻醉辅以良好的气管内和咽喉区表面麻醉,可完成小儿颞下颌关节强直开口受限的困难气道纤维支气管镜插管,氯胺酮复合右美托咪定可使小儿困难气道的插管过程更短、更平稳。