喉罩通气全身麻醉下经纤维支气管镜辅助置入Montgomery T型硅酮支架治疗气管狭窄的临床研究

目的探讨喉罩通气全身麻醉下经纤维支气管镜辅助置入Montgomery T型硅酮支架治疗气管狭窄的疗效及安全性。方法回顾性分析10例气管切开术后良性气道狭窄拔管困难经喉罩通气全麻下经纤支镜辅助置入Montgomery T型硅酮支架治疗的患者的临床资料。比较患者T管置入前后生活质量评分、动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)、呼吸困难评分、嗓音综合质量评分的变化及患者并发症发生情况。结果患者术后1周生活质量评分、PaO_2较术前均明显提高(P0.05),嗓音质量综合评分及呼吸困难评分较术前明显下降(P0.05),无严重并发症发生。结论喉罩通气全麻下经纤支镜辅助置入Montgomery T型硅酮支架治疗气管狭窄安全有效,可作为气管插管后气道狭窄致拔管困难患者的一种选择。     

喉罩通气全身麻醉在纤维支气管镜氩气刀 治疗中心气道疾病中的临床应用

目的 评价喉罩通气（LMA）全身麻醉在纤维支气管镜（纤支镜）氩气刀治疗中心气道疾病中的应用效果和可行性。 方法 回顾分析2009年1月~2013年7月,LMA下纤支镜氩气刀治疗的21例中心气道疾病患者的临床和手术资料,从入室起持续监测收缩压（SP）、舒张压（DP）、心率（HR）和脉搏氧饱和度（SPO2）,记录麻醉前（T1）、手术中（T2）和术毕（T3）时的SP、DP、HR和SPO2,记录置入喉罩后（P1）、经喉罩置入纤支镜即刻（P2）、拔出纤支镜即刻（P3）的气道压力峰值,统计手术时间、通气时间、呼吸恢复时间、清醒时间、拔管时间和并发症情况。 结果 21例患者共实施了32例次LMA下纤支镜氩气刀手术。一次性成功置入喉罩30例次,另外2例次更换型号后成功置入。该组麻醉效果满意,术程顺利,手术时间为15～50（23.5±10.6） min,通气时间25～60（32.5±12.8）min,术中血压、心率等生命指征平稳,吸气气道压力峰值波动小,未发生气道并发症。 结论 喉罩通气全身麻醉下行纤维支气管镜氩气刀治疗中心气道疾病安全可行,血流动力学平稳,吸气气道压力峰值波动小,苏醒时间快,气道并发症少。     

经三通喉罩行全身麻醉下球囊扩张治疗气道狭窄60例临床分析

目的探讨三通喉罩用于全身麻醉下球囊扩张治疗气道狭窄的优越性。方法分析该院2011年2月~2011年5月经三通喉罩行全麻下球囊扩张治疗气道狭窄患者60例,其中男性17例,女性43例;年龄16~68岁,体重38~82 kg,ASA 1~2级。入室后快速诱导,插入三通喉罩,接麻醉机行机械通气,丙泊酚和维库溴铵维持麻醉。从三通喉罩操作孔置入纤支镜进行球囊扩张治疗气道狭窄。分别记录入室后(T0,基础值)、置入喉罩即刻(T1)、扩张开始前(T2)、扩张时(T3)、扩张结束后(T4)、术毕(T5)各时点的HR、SBP、DBP和SPO2。T1~T5时记录潮气量(VT)、气道峰压(Ppeak)和呼气末二氧化碳分压(PETCO2)。结果 置入喉罩过程中患者SBP、DBP、HR较T0有小幅降低(P<0.05)。喉罩控制通气后,各时点SPO2较T0均有显著改善(P<0.05)。在扩张进行时,Ppeak轻微升高,均维持在25 cmH2O以下。全部患者均于术后8 min内清醒拔除喉罩;操作时间21~40 min。结论经三通喉罩行全麻下球囊扩张治疗气道狭窄,麻醉效果良好,术后并发症少。     

机械控制通气下经纤支镜氩气刀切除中心气道器质性病变

目的评价全身麻醉机械控制通气下经纤支镜氩气刀切除中心气道器质性病变的效果及可行性。方法 34例中心气道器质性病变患者,在快速诱导全身麻醉下插入三通喉罩气道(TLMA),在机械控制通气下经纤支镜氩气刀切除中心气道器质性病变。术中连续监测收缩压(SP)、舒张压(DP)、心率(HR)和脉搏氧饱和度(SPO2),记录麻醉前5min(T0)、手术开始(T1)、手术5min(T2)、10min(T3)和术毕(T4)时的SP、DP、HR和SPO2。于T0、T2、T3和T4时采集桡动脉血行血气分析。记录手术时间,通气时间和手术结果。结果 34例患者共接受经纤支镜中心气道器质性病变切除术45例次,全部手术均顺利完成。手术时间15～52(24±8)min,通气时间35～65(41±10)min。术中血压、心率平稳。TLMA通气后PCO2、PO2、O2sat明显改善(P<0.05)。术后无明显并发症。结论全身麻醉机械控制通气下经纤支镜氩气刀切除中心气道器质性病变的效果好,并发症少。     

纤维支气管镜微波介入治疗中心气道狭窄17例临床分析

目的探讨纤维支气管镜(纤支镜)微波介入治疗中心气道狭窄的临床应用价值。方法对17例确诊为中心气道狭窄患者,应用纤支镜微波介入治疗,观察治疗前后气道直径和气促的变化情况。结果17例中心气道狭窄患者经纤支镜微波介入治疗后,气道直径、气促均得到明显改善,气道直径由治疗前(2.8±2.1)mm扩大为治疗后(8.4±2.1)mm(P<0.01),气促评分由治疗前(3.4±0.6)级改善为治疗后(1.2±0.8)级(P<0.01)。结论纤支镜微波介入治疗是中心气道狭窄患者的有效治疗手段,其安全可靠,并发症少。     

喉罩通气全麻下经纤支镜支架置入重度气道狭窄治疗中应用及护理

近年来，随着支气管腔内介入治疗的不断发展，以往需要手术治疗或根本无法治疗的一些气道腔内病变，可以借助支气管镜下的介入治疗而获得临床治愈。气道狭窄可谓是长期困扰肺内科和胸外科医生的一大临床难题，传统治疗常由于其创伤程度大，围手术期并发症多及术后功能恢复时间长等原因，使其临床应用受到很大限制。近年来，我们采用喉罩通气全麻下经纤支镜支架置入技术对16例重度气道狭窄的患者进行治疗，收到了良好的效果，将治疗经过及护理体会报道如下。     

喉罩通气全麻下经气管镜冷冻治疗支气管结核56例的护理体会

本文报告了喉罩通气全麻下经气管镜冷冻治疗支气管结核的临床资料和护理操作配合。56例患者经过术前准备,采用静脉全身麻醉后,在喉罩通气下行气管镜下冷冻局部治疗。56例患者护理配合好,经过平均(4±3)次的气管镜下冷冻治疗,总有效率为100％,无严重的并发症,取得了较好的疗效。喉罩通气全麻下经气管镜冷冻治疗支气管结核的疗效好,而护理配合则是保证患者完成喉罩通气全麻和支气管下检查的重要保证。     

喉罩通气全麻下经纤维支气管镜支架置入治疗重度气道狭窄

目的探讨喉罩通气全麻下经纤维支气管镜支架置入技术在重度气道狭窄中的应用。方法采用喉罩通气下全身麻醉后行纤维支气管镜支架置入术,观察治疗前后患者气道直径、气促症状的改善情况。结果喉罩均一次放置成功,16例患者治疗后完全有效11例(68.6%),部分有效5例(31.3%),近期有效率100%。气促指数由(3.63±0.57)下降为(1.53±0.72),气道直径由(3.33±2.12)mm扩大为(11.78±4.8)mm(P<0.05)。结论喉罩通气全麻下经纤维支气管镜支架置入是一种治疗重度气道狭窄安全、有效的新方法。     

一次性喉罩在介入颅内动脉狭窄支架成形术治疗中的应用

目的 探讨喉罩在介入治疗中的安全可行性.方法 60例患者随机分为气管插管组(30例)和一次性喉罩组(30例).记录操作一次成功率、操作时间、气道密封压;麻醉前、气管插管或喉罩置入前、置入后、拔出气管导管或喉罩后BP、HR、SpO2;记录气道压(Paw)及术中血气PaCO2值,喉罩拔除后测试通气罩远端分泌物的pH值.结果 两组患者术中及术后SpO2均维持98%以上,插管后气道压及术中血气PaCO2都在正常范围内,两组比较无统计学差异(P>0.05),喉罩组在置罩、拔罩过程中,血流动力学参数稳定,插管组插管、拔管中血流动力学参数改变明显(P<0.05),喉罩组在苏醒期并发症(呛咳、咽痛)明显少于气管插管组(P<0.05).结论 一次性喉罩全麻正压通气可安全有效地用于介入颅内动脉狭窄支架成形术.     

纤维支气管镜在抢救危重呼吸衰竭患者中的应用

目的 评价纤维支气管镜在临床上应用于危重呼吸衰竭患者的抢救作用。方法 1997年8月－1998年10月应用纤维支气管镜抢救危重的呼吸衰竭患者。第一部分：经纤支镜引导经鼻气管插管;第二部分：行纤支镜吸痰灌洗术。结果 纤支镜引导经鼻气管插管操作时间约2－5min,病人无不适,患者的心率无明显增高,血氧饱和度无明显降低,且局部损伤小,无明显出血。经纤支镜行气管或支气管吸痰、灌洗后1h、4h,气道压力、血氧饱和度明显改善,心率无明显变化。结论 熟练使用纤支镜经鼻气管插管可很快地建立人工气道,吸除口咽部及大气道内潴留的痰液,极大地减少气管插管对鼻、咽、喉及声带的损伤作用。纤支镜应用于气管、支气管吸痰灌洗对于危重患者能改善痰液引流、改善肺部通气、降低气道压力、减少肺损伤,且无任何并发症,临床上值得推广和应用。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.