右美托咪定联合综合体温保护对腔镜手术治疗老年恶性肿瘤患者苏醒期质量及免疫功能的影响

目的 探讨右美托咪定联合综合体温保护对腔镜手术治疗老年恶性肿瘤患者苏醒期质量及免疫功能的影响。方法 选择择期行腔镜手术治疗的老年恶性肿瘤患者90例，随机均分为3组：对照组（C组）、体温保护组（T组）和体温保护联合右美托咪定组（T-D组），每组30例。C组常规体温保护，T组和T-D组综合体温保护；T-D组麻醉诱导前10 min泵注右美托咪定0.5 μg/kg。记录3组患者麻醉诱导开始时（T₀）、手术开始30 min（T₁）、60 min（T₂）、90 min（T₃）、120 min（T₄）以及手术结束时（T₅）的鼻咽温度；于T₀、术后2 h（T₆）、24 h（T₇）和48 h（T₈）时抽取静脉血标本，测定T淋巴细胞亚群（CD3⁺、CD4⁺和CD8⁺）和自然杀伤细胞（NK cell）水平；记录患者术中麻醉药物用量及苏醒期质量指标。结果 与T₀比较，C组T₂～T₅时点鼻咽温度均明显降低（P < 0.05）；与C组比较，T组和T-D组T₂～T₅时点鼻咽温度明显升高（P < 0.05）。与T₀时点比较，C组、T组和T-D组T₆、T₇和T₈时点CD3⁺和NK cell活性均明显降低（P < 0.05）；C组在T₆、T₇和T₈时点，T组和T-D组在T₆和T₇时点，CD4⁺活性均明显降低（P < 0.05）。与C组比较，T组和T-D组T₆和T₇时点CD3⁺细胞活性均明显升高（P < 0.05）；T组在T₇时点，T-D组在T₆和T₇时点，CD4⁺细胞活性均明显升高（P < 0.05）；T组在T₇时点，T-D组在T₆、T₇和T₈时点，NK cell活性均明显升高（P < 0.05）。结论 采用体温保护措施联合右美托咪定能够维持老年恶性肿瘤患者的体温稳定，减少围手术期意外低体温（IPH）的发生，并有效提高患者苏醒期质量，减轻免疫抑制程度，加速患者早期恢复。     

活血化瘀方联合针灸治疗对脑梗后遗症患者脑血管血液流变动力学及神经功能的影响

目的:探讨血化瘀方联合针灸治疗对脑梗后遗症患者脑血管血液流变动力学及神经功能的影响。方法:选取2016年1月至2017年1月沈阳市第二中医医院收治脑梗后遗症患者120例作为研究对象,对照组61例患者接受针灸治疗;观察组59例患者接受活血化瘀方联合针灸治疗。2组连续治疗30 d。比较2组患者脑血流流变学指标、神经功能评分、中医证候积分、临床疗效。结果:治疗前2组患者脑部平均血流速度、左侧椎动脉血流量、右侧椎动脉血流量、基底动脉血流量比较,差异无统计学意义(P 0. 05)。治疗后观察组患者脑部平均血流速度、左侧椎动脉血流量、右侧椎动脉血流量、基底动脉血流量大于对照组(P 0. 05)。治疗前2组患者NIHSS评分、MMSE评分比较,差异无统计学意义(P 0. 05)。治疗后观察组患者NIHSS评分显著低于对照组,MMSE评分高于对照组(P 0. 05)。治疗前2组患者头晕目眩、语言謇涩、半身不遂、患侧麻木、舌苔白腻证候评分比较,差异无统计学意义(P 0. 05)。治疗后研究患者头晕目眩、语言謇涩、半身不遂、患侧麻木、舌苔白腻证候评分显著低于对照组(P 0. 05)。2组患者临床疗效比较,差异有统计学意义(Z=-5. 626,P=0. 000)。结论:活血化瘀方联合针灸能改善脑梗后遗症患者脑血管血液流变动力学指标,保护神经功能。     

Pyramidal and posterior osseous release for maxillary superior/posterior mobilization using an ultrasonic bone-cutting device after Le Fort I osteotomy

AimThe purpose of this study was to evaluate the efficiency of pyramidal and posterior osseous release (PPOR) for maxillary impaction using an ultrasonic bone-cutting device after Le Fort I (LFI) osteotomy.Materials and methodsIn total, 31 Japanese adults with jaw deformities, diagnosed as having maxillary excess with mandibular prognathism or deficiency, underwent LFI osteotomy and bilateral sagittal split osteotomy. The patients were divided into two groups: a trimming group (15 patients, four men and 11 women; mean age 24.8 years) and a PPOR group (16 patients, seven men and nine women; mean age 22.8 years). In the trimming group, osseous interference around the descending palatine artery (DPA) was removed using forceps, rounding bur, and reciprocating rasp. The PPOR technique was used to remove osseous fragments created by V-shaped osteotomy around the DPA following vertical osteotomy behind the DPA using an ultrasonic bone-cutting device (Variosurg 3; NSK, Tochigi, Japan). The operative times for maxillary osteotomy, total operative times (including bilateral sagittal split osteotomy), and total blood loss were assessed.ResultsThe mean planned amounts of maxillary impaction were 4.37 ± 1.27 mm in the trimming group and 4.38 ± 1.36 mm in the PPOR group (p = 0.98). The mean maxillary operative time for the PPOR group was significantly shorter, by 25.5% (p < 0.001). Total operative time for the PPOR group was also significantly shorter, by 24.3% (p < 0.001). Mean blood loss was significantly lower in the PPOR group than in the trimming group (p = 0.003).ConclusionThe PPOR technique for maxillary impaction after LFI osteotomy shortened the operative time and enabled secure reduction of the maxilla in patients who required the treatment of maxillary impaction with preservation of the DPA bundle.     

Utilization and Complications of Central Venous Access Devices in Oncology Patients

Purpose: To describe how central venous access devices (CVADs) are utilized for ambulatory oncology patients and to evaluate the rate of complications. Method: Single institution retrospective study of oncology patients with CVADs who received systemic treatment at the Walker Family Cancer Centre (WFCC) between 1 January and 31 December 2018. Results: A total of 480 CVADS were placed in 305 patients, of which 408 (85%) were peripherally inserted central catheters (PICCs) and 72 (15%) were implanted vascular access devices (PORTs). The incidence of early and late complications was 9% and 24%, respectively. For the entire cohort, the rate of venous thromboembolism (VTE) was 16%, of which 9% were CVAD-related thrombosis (CRTs) and 7% were distant VTE. The CRT rates were similar for PICCs and PORTs (9% vs. 7%). A total of 6% of CVADs were complicated by infection (i.e., localized infections and bacteremia), with a total infection rate of 0.43 and 0.26 per 1000 indwelling days for PICCs and PORTs, respectively. The incidence of central line associated bloodstream infections (CLABSI) was greater for PICCs than PORTs, at a rate of 0.22 compared with 0.08 per 1000 indwelling days, respectively. The premature catheter removal rate was 26% for PICCs and 18% for PORTs. PORTs required more additional hospital visits. Conclusions: PICCs were utilized more frequently than PORTs and had a higher rate of premature removal. The rates of VTE and CRT were similar for both CVAD types. PORTs had a lower rate of infection per 1000 indwelling days. However, the management of PORT related complications required more visits to the hospital and oncology clinic.     

Endoscopic ultrasonography and small‐bowel endoscopy: Present and future

Over the last decade, impressive technological advances have occurred in ultrasonography and small‐bowel endoscopy. Nowadays, endoscopic ultrasonography is an essential diagnostic tool and a therapeutic weapon for pancreatobiliary disorders. Capsule endoscopy and device‐assisted enteroscopy have quickly become the reference standard for the diagnosis of small‐bowel luminal diseases, thereby leading to radical changes in diagnostic and therapeutic pathways. We herein provide an up‐to‐date overview of the latest advances in endoscopic ultrasonography and small‐bowel endoscopy, focusing on the emerging paradigms and technological innovations that might improve clinical practice in the near future.     

前列地尔联合长春西汀治疗急性脑梗死的疗效观察

目的探讨前列地尔联合长春西汀治疗急性脑梗死的疗效。方法选取2015年3-12月在我科接受治疗的90例急性脑梗死患者,随机分为治疗组(45例)和对照组(45例)。两组患者均给予抗血小板、降血脂等常规对症治疗,11 d为1个疗程。对照组给予长春西汀静脉输液治疗,治疗组在对照组基础上加以前列地尔治疗。比较两组临床治疗效果,治疗前后神经功能恢复情况、日常生活能力恢复情况、并发症发生率及安全性。结果治疗组总有效率为93.3%,对照组为71.1%,治疗组明显高于对照组,差异有统计学意义(P<0.05)。两组患者用药11 d后,神经功能缺损评分均高于治疗前,且治疗组明显高于对照组,差异均有统计学意义(P<0.05)。治疗组患者用药11d及90 d后日常生活能力恢复情况优于对照组,差异有统计学意义(P<0.05)。两组均无严重药物不良反应。结论前列地尔联合长春西汀治疗急性脑梗死疗效显著,值得临床推广应用。