【摘要】 目的 探討胸腰椎椎弓根釘內固定并發癥原因及預防措施。 方法 回顧性分析2006年12月-2010年12月行胸腰椎經椎弓根釘內固定治療失敗的21例患者臨床資料。手術均采用經椎弓根釘內固定。誤入椎管或穿出椎弓根外壁4例，螺釘斷裂4例，定位失誤3例；術后1~23個月內固定松動9例，其中術后1~2個月第1次X線片檢查發現松動3例，術后1~3個月內固定松動并感染2例；誤診1例（腰椎腫瘤、病理性骨折診斷為骨質疏松骨折）。19例再次手術。 結果 21例均獲隨訪，隨訪時間3~34個月，平均18.5個月。12例重新固定、植骨融合患者內固定位置良好，未發現內固定松動、斷裂或脫出，植骨獲得骨性愈合。8例內固定物取出，5例無腰、背部疼痛，腰部活動正常，3例述偶感腰、背部不適，腰部活動尚好，1例感腰、背部疼痛，影響日常活動。1例死亡。 結論 椎弓根螺釘內固定并發癥多方面因素引起的，應充分認識，有效的骨折節段融合、術中仔細操作、預防感染、正確的康復鍛煉等，可有效減少胸腰椎椎弓根內固定失敗。【Abstract】 Objective To discuss the reasons and preventive measures for complications of thoracolumbar pedicle screw fixation. Methods Retrospective analysis of thoracolumbar pedicle screw fixation failure in 21 cases between December 2006 and December 2010 was carried out in this study. The pedicle screw fixation was used in all operations. Straying into the spinal canal or piercing the outer wall of the pedicle during operations happened in 4 cases, screw breakage in 4 cases, and positioning error in 3 cases. Internal fixation was loosened 1 to 23 months after operation in 9 cases, among which 3 were detected at the first X-ray examination 1 to 2 months after operation, 2 were found with infections 1 to 3 months after operation, and 1 was misdiagnosed (spinal tumor with pathological fracture misdiagnosed as osteoporotic fractures). Reoperation was performed for 19 cases. Results All the patients were followed up for 3 to 34 months with an average time of 18.5 months. In the 12 patients who had undergone refixation, the location of the internal fixation was good without loosening, breakage or extrusion, and the grafts obtained bone healing. Internal fixation was removed in 8 patients, among whom 5 had no pain in the waist or back with normal waist activity, and 3 described waist and back discomfort occasionally with fair lumbar activity. One patient felt waist and back pain affecting daily activities. And one patient died. Conclusions Pedicle screw fixation complications are caused by various factors. Fully understanding of the effective integration of the fracture segments, careful intraoperative management, infection prevention, and proper rehabilitation exercises can effectively reduce the thoracic and lumbar pedicle screw failure.
Objective To discuss the safety and effectiveness of removing esophageal foreign bodies in children by using Foley catheter. Method Retrospective analysis on the effect, operation method, complication and the types of foreign bodies of 138 cases of removing esophageal foreign bodies in children by using Foley catheter, which happened from January 1998 to January 2008 in Department of Otorhinolaryngology, the Third People’s Hospital of Chengdu. Result Among these 138 cases with esophageal foreign bodies, 126 cases (91.3%) were successfully taken out by using Foley catheter without anaesthesia, 7 cases were applied esophagoscopy under general anaesthesia, and 5 cases were cured owing to the slipping of foreign body into stomach. The operating time for Foley catheter was 5.1 minutes in average, and there’s no complicating disease in any case. The hard esophagoscope operation lasted for 15 minutes in average and one case was accompanied by dyspnea. The foreign bodies in 138 cases were coin (98 cases), button (14 cases), chess and I-go piece (13 cases), key-ring (4 cases), plastic bottle cap (3 cases), oblate battery (3 cases) and ring (3 cases), respectively. Conclusion Foley catheter is safe and effective for removing esophageal obtuse-rounded foreign bodies in children.
The treatment of patients suffering from both severe coronary artery disease (CAD) and malignancy is different from those who have isolated CAD or tumor, because their body condition is poorer and the lesions of coronary artery are severer, which poses severe challenges to doctors. At present, the surgical treatment for these patients mainly includes staged operation and simultaneous surgery. Staged operation, which separates coronary artery revascularization surgery from tumor resection, has a lower incidence of postoperative complications, but tumor progression may occur during the waiting period. Simultaneous surgery combines heart procedure with tumor resection at the same time, shortens the treatment period of patients, overcomes the defect of tumor progression that may occur during the waiting period of the staged surgery, but the incidence of postoperative complications is higher. The progress of surgical treatment in patients with CAD combined with malignant tumor is summarized.
The large force applied by laparoscopic grasper during clamping operation can cause tissue damage and induce various complications. In this research, the security of graspers with different radii of curvature and teeth were evaluated by using experimental investigation, finite element simulation and tissue damage assessment method based on in vivo compression tests with rabbit large intestines models. Results showed that the most serious tissue damages appeared in areas that were in contact with the jaw edges, which were the regions of stress concentration. The increase in radii of curvature of the edges or teeth could alleviate the tissue damages. The results could provide basic data for choosing and designing noninvasive graspers.
ObjectiveTo analyze and evaluate the effect of the pharmacist-participated standardized drug management measures on improving the quality of drug management in day surgery center.MethodsDay surgery center carried out the pharmacist-participated standardized drug management since January 2019, including establishing a drug management group, strengthening the drug management specification, enhancing the training for standardized drug management, carrying out periodic inspection by pharmacist, etc. The Drug Management Quality Assessment Table was used to evaluate and compare the quality of drug management in day surgery center before standardized management (October 2018) and after standardized management (October 2019).ResultsThrough the standardized management, the quality of drug management in day surgery center was effectively improved, and the total score of drug quality management increased from 88.0 points before standardized management to 95.0 points after standardized management.ConclusionThe participation of pharmacists in the standardized drug management can effectively improve the quality of drug management in day surgery center, and ensure the safety of patients.
OBJECTIVE To investigate clinical effects and possible mechanisms of various growth factors on impaired healing ulcers of patients with diabetic disease. METHODS Seventy-eight patients were divided into three groups; saline control, epidermal growth factor(EGF) experimental group, and platelet-derived wound healing factor (PDWHF) experimental group. General healing conditions, wound closing index, healing rates and histological changes of the patient’s ulcer wound were observed during 1-8 weeks after treatment. RESULTS The wound closing index and healing rate of ulcers were significantly increased in the EGF and PDWHF experimental groups compared with the control group, while the angiogenesis, fibroblast hyperplasia, and collagen deposit were more obvious in EGF and PDWHF experimental groups than that of control group. The promoting effects on wound healing in PDWHF experimental group were better than in EGF group. CONCLUSION It suggests that local application of certain growth factor alone or various growth factors together is an effective method to improve the condition of impaired healing of diabetic ulcers.
目的:了解成都市3~6歲學齡前兒童超重、單純性肥胖發展趨勢和干預效果,以尋求更有效的干預措施。方法:自2000~2007年對成都市五城區所有一類托幼園所3~6歲兒童進行調查,對其超重、肥胖發生、發展動態趨勢進行分析研究,并設重點干預點進行連續干預監測。參照WHO標準,應用身高別體重法評價兒童超重和肥胖。結果:2000~2005年中,成都市學齡前兒童超重、單純性肥胖發生率顯著升高(2000年為6.50%、2.14%;2005年為9.57%,4.39%,Plt;0.001);通過對托幼園所實施肥胖干預后,2005~2007年兒童超重、單純性肥胖檢出率處于穩定控制狀態(2007年為9.13%,4.17%,Pgt;0.05)。2005~2007年對本市15所托幼機構實施重點干預后,兒童超重、肥胖檢出率為8.51%,3.26%,明顯降低(Plt;0.05),而一般干預點,超重、肥胖發生率明顯升高(10.42%,5.12%,Plt;0.05)。結論:學齡前兒童超重、單純性肥胖呈上升趨勢,有效的干預措施能控制超重和肥胖發生率。
Objective The risk factors of noninvasive positive pressure ventilation (NPPV) in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with failure of respiratory failure were identified by meta-analysis, so as to provide a basis for early clinical prevention and treatment failure and early intervention. Methods PubMed, The Cochrane Library, EMbase, China National Knowledge Infrastructure, Wanfang, VIP and CBM Data were searched to collect studies about risk factors about failure of noninvasive positive pressure ventilation in AECOPD and respiratory failure published from January 2000 to January 2021. Two researchers independently conducted literature screening, literature data extraction and quality assessment. Meta-analysis was performed on the final literature obtained using RevMan 5.3 software. Results Totally 19 studies involving 3418 patients were recruited. The statistically significant risk factors included Acute Physiology and Chronic Health Evaluation (APACHEⅡ) score, pre-treatment PCO2, pre-treatment pH, Glasgow Coma Scale (GCS), respiratory rate (RR) before treatment, body mass index (BMI), age, C-reactive protein (CRP), renal insufficiency, sputum disturbance, aspiration of vomit. Conclusions High APACHE-Ⅱ score, high PCO2 before treatment, low pH value before treatment, low GCS score, high RR before treatment, low BMI, advanced age, low albumin, high CRP, renal insufficiency, sputum disturbance, and vomit aspiration were the risk factors for failure of respiratory failure in patients with COPD treated by NIPPV. Failure of non-invasive positive pressure ventilation in COPD patients with respiratory failure is affected by a variety of risk factors, and early identification and control of risk factors is particularly important to reduce the rate of treatment failure.
Objective To explore the effect of multimodal pain management in the perioperative period of ambulatory laparoscopic cholecystectomy. Methods Non-randomized historical control method was adopted. Patients who underwent laparoscopic cholecystectomy in the Day Surgery Center of West China Hospital, Sichuan University were included. The patients who received single modal pain management between January and May 2020 were taken as the control group, and the patients who received multimodal pain management between January and May 2021 were taken as the trial group. The postoperative pain and pain-related indicators of the two groups were compared. Results A total of 731 patients were included, including 496 in the trial group and 235 in the control group. There was no significant difference in gender, age, body mass index, nationality, education level, diagnosis, marriage and occupation between the two groups (P>0.05). There were 41 patients with moderate or above pain after surgery in the trial group, of which 3 patients were accompanied by severe nausea and vomiting. There were 41 patients with moderate or above pain after surgery in the control group, of which 4 patients were accompanied by severe nausea and vomiting. The incidence of moderate or above postoperative pain (8.3% vs. 17.4%) and post-discharge pain (0.0% vs. 1.3%) in the trial group were lower than those in the control group (P<0.05). There was no significant difference in the incidence of postoperative severe nausea and vomiting and delayed discharge due to postoperative pain between the two groups (P>0.05). There was no statistically significant difference between the two groups patients with moderate or above pain in gender, age, body mass index, education level, diagnosis, time from the onset of pain to the end of surgery, pain location, pain nature, use rate of antiemetic drugs, and score after treatment (P>0.05). The majority of pain sites were surgical incision pain, and the nature of pain was mostly swelling pain. The pain score of patients with moderate or above pain in the trial group was lower than that of the control group (4.4±0.6 vs. 4.9±1.1, P<0.05). Conclusion Multimodal pain management reduces postoperative pain of patients undergoing ambulatory laparoscopic cholecystectomy by means of assessment, medication, procedure improvement, health education, which can provide guarantee for perioperative quality management of ambulatory laparoscopic cholecystectomy.
ObjectiveTo evaluate the predictive value of critical illness scores for hospital mortality of severe respiratory diseases in respiratory intensive care unit (ICU).MethodsThe clinical data of the patients who needed intensive care and primary diagnosed with respiratory diseases from June, 2001 to Octomber, 2012 were extracted from MIMIC-Ⅲ database. The Acute Physiology Score (APS) Ⅲ, Simplified Acute Physiology Score (SAPS) Ⅱ, Oxford Acute Severity of Illness Score (OASIS), Logistic Organ Dysfunction System (LODS), Systemic Inflammatory Response Syndrome (SIRS) and Sequential Organ Failure Assessment (SOFA) were calculated according to the requirements of each scoring system. ICU mortality was set up as primary outcome and receiver operating characteristic (ROC) analysis was performed to evaluate the predictive performances by comparing the areas under ROC curve (AUC). According to whether they received invasive mechanical ventilation during ICU, the patients were divided into two groups (group A: without invasive mechanical ventilation group; group B: with invasive mechanical ventilation group). The AUCs of six scoring systems were calculated for groups A and B, and the ROC curves were compared independently.ResultsA total of 2988 patients were recruited, male accounted for 49.4%, median age was 67 (55, 79), and ICU mortality was 13.2%. The AUCs of SAPSⅡ, LODS, APSⅢ, OASIS, SOFA and SIRS were 0.73 (0.70, 0.75), 0.71 (0.68, 0.73), 0.69 (0.67, 0.72), 0.69 (0.67, 0.72), 0.67 (0.64, 0.70) and 0.58 (0.56, 0.62). Subgroup analysis showed that in group A, the AUCs of OASIS, SAPSⅡ, LODS, APSⅢ, SOFA and SIRS were 0.81 (0.76, 0.85), 0.80 (0.75, 0.85), 0.77 (0.72, 0.83), 0.75 (0.70, 0.80), 0.73 (0.68, 0.78) and 0.63 (0.56, 0.69) in the prediction of ICU mortality; in group B, the AUCs of SAPSⅡ, APSⅢ, LODS, SOFA, OASIS and SIRS were 0.68 (0.64, 0.71), 0.67 (0.63, 0.70), 0.65 (0.62, 0.69), 0.62 (0.59, 0.66), 0.62 (0.58, 0.65) and 0.57 (0.54, 0.61) in the prediction of ICU mortality. The results of independent ROC curve showed that the AUC differences between groups A and B were statistically significant in terms of OASIS, SAPSⅡ, LODS, APSⅢ and SOFA, but there were no significant differences in SIRS.ConclusionsThe predictive values of six critical illness scores for ICU mortality in respiratory intensive care are low. Lack of ability to predict ICU mortality of patients with invasive mechanical ventilation should hold primary responsibility.