The Role of Surgery in Neonatal Respiratory Distress

Compression of the newborn's lungs by one or another type of space-occupying lesion results in a crisis that can be dealt with only through immediate differential diagnosis followed by appropriate surgery. Most common among these space-occupying lesions are those caused by air trapped inside the pleural cavity or within the lung itself. Dr. Pickett outlines the steps in the essential differentiation and correction.     

The Cancer Series: An Introduction

A 77-year-old man presented to the emergency department with chest pain. Severe pain had occurred while he was walking, persisted for ten minutes, and was relieved when he took two nitroglycerine tablets. He had experienced intermittent chest pain for the past 11 days, mostly on exertion. The patient had hypertension, an elevated serum cholesterol level, and was a former smoker. His medications included aspirin, pravastatin, isosorbide dinitrate, metoprolol, and nitroglycerine.

The patient was in no apparent distress and without chest pain when he was examined. His blood pressure was 154/88 mm Hg; pulse, 70 bpm; respirations, 18 per min; temperature, 36.8° C; and oxygen saturation, 97% by pulse oximetry. The physical examination was unremarkable. The ECG is shown.     

Strategies for Preventing Distractions and Interruptions in the OR

Stakeholders in the automotive industry, airline industry, and anesthesia profession have identified critical periods of time in which distractions and interruptions of normal processes can have devastating effects. Just as reducing distractions improves safety in an automobile or airplane cockpit, limiting distractions and interruptions during critical times in the perioperative setting can increase patient safety. We assessed perioperative nurses and identified what they perceived as critical phases of nursing care. We also worked with our anesthesia partners to address their concerns about interruptions during the administration of nerve blocks. The perioperative nurses at our hospital initiated strategies to reduce distractions or interruptions to their practice at critical points, and, in collaboration with surgical committee members, we developed strategies to reduce or eliminate distractions for anesthesia professionals during the preoperative administration of nerve blocks and to eliminate distractions for the RN circulator and scrub person during the final counts.     

围生期产妇健康素养量表条目筛选

目的：对围生期产妇健康素养量表条目池进行条目筛选,形成条目更可靠、更准确的围生期产妇健康素 养量表。方法：运用Delphi法,请14名妇幼专家对研究者自行编写的56个条目的需要性和重要性进行两轮函询,保 留50个条目。用该条目池对350名产后1~3 d的产妇进行横断面调查,选取其中10%的调查对象1周后重测。在这些数 据基础上,运用χ2检验法、相关系数法(2种)、因子分析法、Cronbach’s α系数法、重测信度法6种方法进行条目筛 选,保留3种或3种以上方法均不需删除的条目,组成最终量表。结果：重测结果Person相关系数为0.507(P=0.004)。 通过6种筛选方法删除的条目数量分别为：1)χ2检验法删除9条;2)相关系数法1删除25条;3)相关系数法2删除1条;4) Cronbach’s α系数法删除19条;5)因子分析法删除8条;6)重测信度法删除37条。最终由33个条目组成围生期产妇健 康素养量表。结论：运用6种条目筛选方法获得了精简后的量表,但距离推广应用还有很大距离,需要在人群中进行 大样本调查,进行信效度检验。     

不同剂量丙泊酚预防小儿术后躁动的效果和安全性分析

目的：探讨不同剂量丙泊酚对预防小儿术后躁动的影响。方法选择2012年9月至2013年6月在泸州医学院附属中医院择期行斜疝修补术的小儿60例,分为Ⅰ、Ⅱ、Ⅲ3组,3组患儿均采用七氟醚进行全身麻醉,术后分别采用0．10 mL／kg 的0．90％氯化钠注射液静脉注射、1．00 mg／kg 丙泊酚静脉注射1次和1．00 mg／kg 丙泊酚静脉注射2次,比较 3组患儿术后30 min 内躁动的发生率,并对患儿进行麻醉苏醒烦躁评分、Aldrete 改良评分和苏醒时间及出室时间比较。结果Ⅰ、Ⅱ、Ⅲ组患儿30 min 内躁动发生率分别为65．00％、25．00％及15．00％,3组患儿比较差异有统计学意义（P ＜0．05）;3组患儿在麻醉苏醒烦躁评分、Aldrete 改良评分和苏醒时间比较,差异有统计学意义（P ＜0．05）,3组患儿出室时间比较,差异无统计学意义（P ＞0．05）。结论术后采用1．00 mg／kg 丙泊酚静脉注射2次,预防小儿术后躁动效果明显,安全性好,具有重要的临床参考价值。     

Child-Pugh与Rockall评分评估肝硬化失代偿期上消化道出血短期预后价值比较

【】目的：分析Child-Pugh分级与Rockall评分对评估肝硬化失代偿期上消化道出血患者短期预后价值并进行比较。方法：选取我院2015年2月～2016年8月收治的肝硬化失代偿期上消化道出血患者100例为对象进行前瞻性研究。所有患者随访4个月,根据患者存活与否分为死亡组33例,存活组67例。对比两组血清胆红素(TBIL)、白蛋白(Alb)、肌酐(Cr)水平以及患者Child-Pugh分级与Rockall评分情况。应用受试者工作特征(ROC)曲线下面积(AUC)分析两个评分系统对短期预后的预测价值。结果：死亡组患者血清TBIL及Cr水平分别为(94.5±11.3)μmol/L、(132.8±28.2)μmol/L,均高于存活组(89.6±12.8)μmol/L、(120.6±31.5)μmol/L,而Alb水平为(24.1±5.3)g/L,低于存活组的(26.3±6.4)g/L(均P>0.05)。与存活组相比,死亡组Child-Pugh分级C级的比例较高,为75.76%(25/33) vs 5.97%(4/67) (P<0.001),而A级及B级比例较低,为9.09%(3/33) vs 35.82%(24/67) (P<0.001)、15.15%(5/33) vs 58.21%(39/67) (P<0.001)。死亡组患者的Rockall评分显著高于存活组,为(8.4±2.4) vs (2.1±0.4)(P<0.001)。Child-Pugh分级及Rockall评分系统预测短期死亡的AUC分别为0.759(95%CI：0.702～0.818, P=0.018)、0.785(95%CI：0.735～0.836, P=0.011);两者联合预测短期死亡的AUC分别为0.879(95%CI：0.811～0.942, P=0.003)。结论：Child-Pugh分级与Rockall评分评估肝硬化失代偿期上消化道出血短期预后均有较高的价值,两种评分联合评价可显著提高评估的准确性。     

应对方式在围绝经期女性睡眠状况和生存质量之间的中介效应

目的 探讨应对方式在围绝经期女性睡眠状况与生存质量之间的中介效应。方法 采用便利抽样方法,选取2017年10月—2018年9月辽宁省丹东市40～60岁围绝经期女性600例,采用简易应对方式问卷（SCSQ）、匹兹堡睡眠质量指数量表（PSQI）、绝经生存质量量表（MENQOL）对绝经过渡期女性进行调查。结果 积极应对方式平均（1.615±0.577）分,消极应对方式平均（1.380±0.678）分,睡眠质量平均（6.820±3.575）分,绝经生存质量平均（57.470±38.790）分。睡眠质量得分与积极应对方式得分呈负相关（r?=-0.432,P?=0.000）,与消极应对方式得分呈正相关（r?=0.393,P?=0.000）;绝经生存质量得分与积极应对方式得分呈负相关（r?=-0.516,P?=0.000）,与消极应对方式得分呈正相关（r?=0.446,P?=0.000）;睡眠质量得分与绝经生存质量得分呈正相关（r?= 0.593,P?=0.000）;睡眠状况不仅可以直接影响围绝经期女性绝经期生存质量,还可以通过应对方式这一中介作用间接影响其绝经期生存质量,且中介效应占总效应的31.06%（0.250/0.805）。结论 应对方式在围绝经期女性睡眠状况与生存质量间起部分中介效应。