可视喉镜及气管导管塑形角度在急救中的应用

目的观察可视喉镜下加强型气管导管“J”形塑形角度在急救气管插管中的应用情况。方法40例急救患者在气管插管前将导管前端套囊根部处塑形成120度,在可视喉镜下观察声门可视程度、导管尖端对准声门例数、平均插管时间、一次插管成功率。结果40例患者声门可视率100％,导管尖端对准声率95％、平均插管时间（15±1．49）秒,一次插管成功率97．5％。结论可视喉镜下气管导管塑形为120度“J”形,适用于急救气管插管。     

VL300L便携式可视喉镜在急诊困难气道插管中的应用研究

目的探讨VL300L便携式可视喉镜在急诊困难气道经口气管插管时的临床价值。方法收集2012年9月~2016年5月我院Mallampati分级Ⅲ~Ⅳ级的92例患者,其中48例使用VL300L便携式可视喉镜(V组),44例使用Macintosh直视喉镜(M组),两组均联合使用硬质管芯;比较两组声门显露时间、气管导管置入时间、一次性插管成功率、插管前后3 min平均动脉压(MAP)、插管前后3 min心率(HR)、咽喉部并发症等。结果在急诊困难气道经口气管插管时,VL300L便携式可视喉镜组较Macintosh直视喉镜组的声门显露时间明显缩短(P0.05),气管导管置入时间较M组短(P=0.01),一次性插管成功率较M组明显提高(P0.05),两组咽喉部并发症情况比较,差异无统计学意义(P0.05);两组插管后3 min平均动脉压、心率较插管前均有明显上升(P均0.05),但VL300L便携式可视喉镜组较Macintosh直视喉镜组升高程度小(P均0.05);两组咽喉部并发症比较差异无统计学意义(χ~2=2.381,P0.05)。结论 VL300L便携式可视喉镜用于急诊困难气道经口气管插管时能有效避免职业暴露,减少血流动力学影响,便于临床教学,较Macintosh直视喉镜有优势,值得推广应用。     

Truview-EVO2喉镜与Macintosh喉镜在经口气管插管中的对比研究

目的比较使用Truview-EVO2喉镜与Macintosh喉镜的全麻患者经口气管插管时间、声门暴露等的差异。方法选取2009年4～12月择期腹部手术的全麻患者60例,随机分成两组,Macintosh喉镜(M组),Truview-EVO2喉镜(T组),每组30例。采用静脉麻醉诱导,待患者意识丧失、肌肉松弛后插入气管导管。观察并记录两种喉镜插管所需的时间、插管次数、声门暴露情况(Cormack&Lehane分级)以及插管相关并发症。结果 T组插管时间明显长于M组(P<0.05)。两组声门暴露情况有差异(P<0.05)而患者气管插管相关并发症无差异(P>0.05)。结论与Macintosh喉镜相比,Truview-EVO2喉镜气管插管的时间较长,但能提供更好的声门暴露。     

GlideScope视频喉镜在Mallampati Ⅲ级及以上患者气管插管中的应用

目的 探讨GlideScope视频喉镜在Mallampati Ⅲ级及以上患者气管插管中应用的安全性与可行性.方法 选择需在经口气管插管全麻下行择期手术的患者80例,随机分入G组或M组,每组40例.麻醉诱导后G组使用GlideScope视频喉镜,M组用 Macintosh型直接喉镜进行经口气管插管.比较两组的声门显露程度[Cormack-Lehane(C/L)分级]、声门显露时间、气管导管置入时间、咽部并发症、平均动脉压(MAP)、心率(HR)、外周血管阻力(SVR)、心输出量(CO)等.结果 G组C/L分级≤Ⅱ级例数多于M组,差异有统计学意义.术后咽部并发症发生率两组比较,差异无统计学意义.两组显露声门时间,差异无统计学意义;G组气管导管置入时间是(30.2±10.4)s,M组是(17.2±8.1)s,差异有统计学意义.两组间CO、HR、SVR变化差异无统计学意义,组内变化差异有统计学意义;MAP组内、组间变化均差异有统计学意义.结论 在MallampatiⅢ级及以上患者经口气管插管时,使用GildeScope视频喉镜引起的血流动力学改变、应激反应、咽部并发症发生率与Macintosh型喉镜比较差异无显著性,声门显露程度优于Macintosh型喉镜,表明GildeScope视频喉镜可安全地应用于此类患者,而且是解决此类困难气管插管更合适的工具.     

Airtraq可视喉镜和Macintosh喉镜在困难气管插管中的对比应用

目的 探讨Airtraq可视喉镜和Macintosh喉镜在困难气管插管中的临床应用和对血流动力学的影响.方法 选择ASA Ⅰ～Ⅱ级,年龄20～62岁的Mallampatis Ⅲ~Ⅳ级的困难气道患者68例,随机均分为M组和A组.M组使用Macintosh喉镜传统方法直视下插管,A组使用Airtraq可视喉镜,全部患者采用相同的快速诱导方法进行气管插管,显露声门后在明视下气管插管;连续2次插管失败后采用Macintosh喉镜联合纤维支气管镜完成气管插管.从开口置入喉镜到气管插管成功并监测呼气末二氧化碳(ETCO2)确认插管正确无误为止进行秒表计时,记录完成气管插管的全部时间、插管次数、插管前后血流动力学变化、牙齿和口咽部有无损伤.结果 M组34例患者中16例一次插管成功,12例2次插管成功,另外6例经过两次插管失败后在Macintosh喉镜配合纤维支气管镜下插管成功;A组34患者中29例不需要导丝一次插管成功,另外5例声门显露清楚,但导管远端接近声门后联合而偏离声门中央,在特制的导丝引导下顺利完成插管.M组插管时间(82±38) s较A组(35±16) s显著延长(P＜0.01);M组较A组插管开始0.5、1、3和5 min多个时点心率明显增快、血压显著升高(P＜0.05或P＜0.01);M组插管后10例出现咽喉部少量渗血、2例门齿松动,A组1例咽喉部出血,无门齿损伤情况发生.结论 使用Airtraq可视喉镜在困难气管插管时具有快速、成功率高、应激反应小等优点,为困难气道处理提供了一种非常好的方法.     

GlideScope视频喉镜和Macintosh直接喉镜在经口气管插管应用中的对比研究

目的:比较GlideScope视频喉镜和Macintosh直接喉镜在经口气管插管应用中的优缺点.方法:对20例择期妇科或普外科病人,予术前行常规气管插管困难程度评估.全麻诱导后先后采用Macintosh直接喉镜和GlideScope视频喉镜行喉部显露,评估声门的Cormack分级,再行气管插管.结果:采用GlideScope视频喉镜后20例病人均在显示器上清晰显示声门,Cormack分级:Ⅰ级为18例,Ⅱ级为2例;采用Macintosh直接喉镜组Cormack分级Ⅰ级为6例,Ⅱ级为12例,Ⅲ级为2例.与Macintosh直接喉镜组比较,GlideScope视频喉镜组的Cormack分级显著低(P＜0.01),Cormack分级Ⅰ级显露率(90%vs 30%)显著高(P＜0.01).GlideScope视频喉镜组和Macintosh直接喉镜组显露声门的时间分别为(25±14)s和(27±19)s,组间比较无显著意义.GlideScope视频喉镜组经口气管插管成功率为100%,但各有1例病人分别重复插管2次和3次才取得成功,原因为气管导管置入口腔变形,无法将气管导管对准声门.结论:GlideScope视频喉镜用于临床经口气管插管具有操作简单、改善Cormack分级、声门显露清晰等优点,但气管导管通过口咽拐角处困难是其缺点.     

两种视频喉镜与传统喉镜用于全麻气管插管的比较

目的 比较2种便携式视频喉镜与传统Macintosh喉镜在全身麻醉诱导后气管插管时声门显露的情况、插管成功率及插管并发症等方面的差异。方法90例ASAⅠ～Ⅱ级行择期气管插管全麻成年手术患者知情同意后随机分为2组,McGrath喉镜组和易安视频喉镜组,每组45例。手术患者全身麻醉诱导后按照经典的气管插管方法,先用Macintosh喉镜观察声门显露,再用McGrath（McGrath喉镜组）或易安视频喉镜（易安视频喉镜组）观察声门显露并完成气管插管。记录不同喉镜下声门显露分级、插管次数、气管插管时间及插管相关并发症的发生率。结果与传统Macintosh喉镜相比,易安视频及McGrath喉镜组声门显露分级显著提高（P〈O.05）。而易安视频与McGrath喉镜相比,声门显露改善效果、插管时间及一次插管成功率等方面差异均没有统计学意义（P〉0.05）。结论McGrath和易安视频喉镜与传统Macintosh喉镜相比,均能改善声门显露,提高气管插管成功率,但并不能减少气管插管相关并发症。     

可视喉镜在高原急救中的临床应用

目的:探讨Truview EVO2可视喉镜在高原地区急救中心的临床应用经验。方法:对我院花土沟急救中心重症监护室中有创呼吸支持的危重39例病人,通过可视喉镜进行气管插管,观察插管过程中暴露声门的有效程度、插管时间、气管插管的成功率及有无误入食道、咽喉壁粘膜损伤、牙齿脱落等插管并发症。结果:我院花土沟急救中心39例病人,插管视野喉镜显露分级(Cormack&Lehane分级法)为Ⅰ~Ⅱ,插管平均时间为(25.07±7.92)s,插管成功率100%,一次插管成功37例(94.9%),失败2例(5.1%)。讨论:可视喉镜是一种新型的视频插管系统,它能够直观清晰地暴露咽喉部结构,减少气管插管的损伤、降低气管插管的难度,利用视频喉镜其独特结构更容易暴露声门的特点,通过缩短暴露患者声门的时间、降低暴露声门的难度来减少插管所需时间,提高插管成功率,于非麻醉专业的医护人员进行气管插管操作其优点更加突出,值得推广。     

可视喉镜与传统喉镜的临床应用比较

目的：比较可视喉镜与传统喉镜在临床中的应用。方法选取实施气管插管全麻的腹部及四肢择期手术患者71例,随机分为观察组（n=36）和对照组（n=35）。观察组使用可视喉镜进行气管插管,对照组使用传统喉镜进行气管插管,比较2组患者喉镜片气管插管时间、一次完成气管插管的成功率、Cormack-Lehane声门显露分级及气管插管期间血压（BP）和心率(HR)的变化、咽部损伤和术后咽痛的发生率。结果观察组气管插管时间为（28.1±5.6）s,一次完成气管插管成功率为33例（91.7%）,对照组气管插管时间为（37.2±7.8）s,一次完成气管插管成功率为25（71.4%）例,组间比较差异有统计学意义（P＜0.05）;观察组声门显露分级、气管插管期间BP和HR的变化及咽部损伤和术后咽痛的发生率均明显优于对照组,差异有统计学意义（P＜0.05）。结论可视喉镜在临床中的应用价值高,能明显提高一次气管插管成功率,且喉部暴露完全,操作过程中患者血压心率变化小,对咽部损伤小,值得临床推广应用。     

一次性可视喉镜在院前急救中的临床应用

目的：探讨一次性可视喉镜在院前急救中的应用及其临床价值。方法：选择2012年6月至2014年6月间,院前急救的呼吸、心跳骤停,需紧急气管插管患者90例,将其按时间分为A组（2013年6月至2014年6月）、B组（2012年6月至2013年6月）,每组45例。A组Airtra一次性可视喉镜插管,B组用普通喉镜插管。观察两组患者的插管时间、一次插管成功率、一次插管时间、声门显露程度及急救效果。结果：A组插管成功的时间明显短于B组,声门显露好,一次成功率高,急救效果优于B组。结论：一次性可视喉镜用于院前急救气管插管术,可明显改善声门的显露,缩短插管时间,提高插管成功率,提高复苏成功率,有很好的急救效果,可推广应用于院前急救。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.