目的:探討同哌替啶和曲馬多比較,格拉斯瓊預防全麻后寒戰的臨床效果。方法:120例ASA I～II級,在全麻下擬行擇期手術患者,隨機分為四組,每組30例:T組(曲馬多1 mg/kg),G組(格拉斯瓊40 μg/kg),M組(哌替啶0.4 mg/kg)和P組(0.9%生理鹽水)。各組藥物在手術結束時通過靜脈給予。記錄術后寒戰評分和麻醉恢復時間及鎮靜程度。結果:同對照組比較,格拉斯瓊明顯減少麻醉后寒戰的發生(P＜0.01),但同哌替啶和曲馬多組比較無統計學差異(P ＞0.05)。哌替啶組和曲馬多組的麻醉恢復時間(20.58±3.56和16.45 ±4.13 min)較對照組(12.61 ± 3.31 min)和格拉斯瓊組(13.58 ± 3.41 min)明顯延長(P＜0.05)。結論:使用40 μg/kg格拉司瓊同使用曲馬多1 mg/kg和哌替啶0.4 mg/kg一樣可有效地預防麻醉后寒戰。
ObjectiveTo review the research progress of intramedullary lengthening nail technology.MethodsThe foreign literature on the development history, types, advantages and disadvantages, indications and contraindications, complications, and effectiveness of intramedullary lengthening nail were reviewed and analyzed.ResultsThe intramedullary lengthening nail system mainly includes mechanical type, electric motor drive type, and magnetic drive type. Compared with traditional external fixation and lengthening technology, the intramedullary lengthening nail technology has certain advantages in incidence of complications, bone healing, postoperative functional rehabilitation, incision aesthetics, convenience, and patient satisfaction. However, there are also shortcomings, such as pain, uncontrollable distraction rate, device failure, etc. In the clinical application of intramedullary lengthening nails for limb lengthening, the indications should be grasped reasonably, and the related complications should be prevented and treated.ConclusionIntramedullary lengthening nails provide a new option for limb lengthening, and the initial effectiveness is good. It is one of the development direction of limb lengthening technology.
ObjectiveTo study the effectiveness of tibial transverse transport combined with the antibiotics embedded bone cement in the treatment of chronic infection of foot and ankle with lower extremity ischemic diseases.MethodsA retrospective analysis was performed on 28 patients with ischemic diseases of lower extremities associated with chronic foot and ankle infection who were treated with tibial transverse transport combined with antibiotic bone cement between August 2015 and October 2019. There were 22 males and 6 females, with an average age of 65.6 years (range, 41-86 years). There were 25 cases of diabetic foot, 2 cases of arteriosclerosis obliterans, and 1 case of thromboangiitis obliterans. The course of infection ranged from 1 to 27 years, with an average of 14.9 years. The healing condition and time of foot and ankle in all patients were recorded and compared, and the Wagner grading and WIFi (W: lower extremity wound classification; I: ischemic classification; Fi: foot infection classification) grading were compared before and at last follow-up.ResultsThe wound surface of 1 diabetic foot patient improved at 111 days after operation, without purulent secretion, and lost follow-up. The remaining 27 cases were followed up 5 to 21 months (mean, 8.4 months). There was no necrosis in the tibial osteotomy incision and the local flap. After operation, 21 cases showed needle reaction of external fixator, but the needle infection gradually improved after the corresponding treatment. Among the 24 patients with diabetic foot, 1 died of multiple organ failure due to pulmonary infection. Acute lower extremity vascular embolism occurred in 1 case, and the foot was amputated due to acute gangrene. In the remaining 22 cases, the wound healing time of foot and ankle was 2.5-11.0 months (mean, 4.6 months). At last follow-up, Wagner grading and WIFi grading of the patients were significantly improved when compared with those before operation (P<0.05). One patient with thromboangiitis obliterans had foot and ankle healing at 6 months after operation. Two patients with lower extremity arteriosclerosis obliterans had foot and ankle healing at 16 and 18 months after operation, respectively.ConclusionTibial transverse transport combined with the antibiotics embedded bone cement is effective in treating chronic infection of foot and ankle with lower extremity ischemic diseases.
【摘要】 目的 比較喉罩和氣管內插管吸入七氟烷全麻用于小兒無痛苦纖支鏡檢查的麻醉效果、蘇醒時間、蘇醒質量。 方法 將2008年3月-2009年3月40例行纖支鏡檢查的患兒隨機分為喉罩組（L組，21例）和氣管內插管組（T組，19例）。兩組均采用逐漸誘導法吸入七氟烷，靜脈給予芬太尼1 μg/kg；L組置入喉罩，T組氣管插管后控制呼吸。手術中，兩組均吸入2%～5%七氟烷維持麻醉。分別記錄麻醉前（T0）、麻醉后纖支鏡進入前（T1）、進鏡至咽部（T2）、聲門部（T3）、氣管內（T4）及第15 min（T5）時的血壓（BP）、心率（HR）、MAP和動脈血氧飽和度（SPO2）。觀察纖支鏡檢查期間有無嗆咳、氣道痙攣或體動；記錄停藥至拔管的時間，蘇醒后是否再入睡及麻醉滿意度。 結果 兩組HR在T1、T3、T4時升高，與T0時比較，有統計學意義（Plt;0.05）；其中HR在T1時T組高于L組，組間比較有統計學意義（Plt;0.05）；MAP在T1、T2、T3、T4時，T組低于L組，組間比較有統計學意義（Plt;0.05）。兩組患兒鏡檢期間均無嗆咳、氣道痙攣或體動；L組蘇醒時間短于T組（Plt;0.05），蘇醒后再入睡率低于T組（Plt;0.05），麻醉滿意度高于T組（Plt;0.05）。 結論 喉罩吸入七氟烷全麻用于小兒無痛苦纖支鏡檢查，能保證穩定的血流動力學狀態，蘇醒快速，效果滿意。【Abstract】 Objective To assess the feasibility and safety of Laryngeal mask combined with sevoflurane in painless fiberoptic bronchoscopy anesthesia in children. Methods Forty children from March 2008 to March 2009 were randomized divided into laryngeal mask airway group (group L) and endotracheal intubation group (group T). Anaesthesia was induced and maintenanced with 2%-5% sevoflurane and fentanyl 1 μg/kg. The blood pressure (BR), heart rate (HR) and oxygen saturation by pulse oximeter (SPO2)were recorded before anaesthesia (T0), immediately after anaesthesia induction (T1), when FOB at the level of pharynx(T2), vocal cords (T3), trachea (T4) and in 15 min of the FOB (T5). Extubation time, recovery quality and anesthesia effects were also analyzed. Results Compared with T0, there were significant increases in HR at T1、T3 and T4 (Plt;0.05), and HR was significantly higher in the group T than that in the group L at T1 (Plt;0.05). MAP was significantly lower in group T than that in group L at T1、T2、T3 and T4, respectively(Plt;0.05). Recovery time was significantly shorter in group L than that in group T. Incidence of sleep after recovery was lower in group L than that in group T. Anesthesia satisfaction was higher in the group L than that in the group T. Conclusions Laryngeal mask combined with Sevoflurane provide satisfactory anesthesia for painless fiberoptic bronchoscopy in children.
目的 評價喉罩聯合T型密封接頭通氣在新生兒無痛纖維支氣管鏡（纖支鏡）診治中的臨床效果。 方法 對2010年3月－2012年10月收治的33例擬行纖支鏡診治的新生患兒，分為喉罩組（Ⅰ組）和常規組（Ⅱ組），兩組患兒在術前半小時均靜脈注射咪唑安定0.2～0.3 mg/kg基礎上，Ⅰ組靜脈注射枸櫞酸芬太尼3～5 μg/kg，置入喉罩聯合T型密封接頭通氣下行纖支鏡診治；Ⅱ組常規表面麻醉下行纖支鏡診治。分析術前（T1）、通過聲門（T2）、診治中（T3）、檢查后（T4），脈搏血氧飽和度（SpO2）、心率（HR）的變化情況、纖支鏡從T型密封接頭入口或鼻孔到通過聲門的時間、鏡檢時間、支氣管肺泡灌洗次數、鏡檢期間不良反應（嗆咳、憋氣、肢體運動、呼吸道損傷）及麻醉滿意度（由內鏡醫師評價）。 結果 Ⅰ組與Ⅱ組比較，T1、T4時間點SpO2、HR差異無統計學意義，T2、T3時間點SpO2＜85%、HR＜100次/min的發生率Ⅰ組與Ⅱ組比較差異有統計學意義（P＜0.01）；纖支鏡從T型密封接頭入口或鼻孔到通過聲門時間差異無統計學意義（P＞0.05）；Ⅱ組鏡檢時間短于Ⅰ組，支氣管肺泡灌洗次數少于Ⅰ組；Ⅰ組不良反應低于Ⅱ組，麻醉滿意度高于Ⅱ組（P＜0.05）。 結論 喉罩聯合T型密封接頭通氣在新生兒無痛纖支鏡診治氣道管理安全有效可行，醫師能從容操作。
ObjectiveTo determine the effectiveness of continuous intercostal nerve block for pain relief after thoracotomy.MethodsFrom November 2017 to October 2018, 120 patients who received thoracotomy procedure in our hospital were collected, including 60 males and 60 females aged 40-77 (58.10±7.00) years. The patients were randomly allocated into three groups by digital table including a continuous intercostal nerve block group (group A, n=40), a single intercostal nerve block group (group B, n=40), and an epidural analgesia group (group C, n=40). All the groups received the same basic analgesia. The pain scores and rescue analgesic doses were compared.ResultsOn postoperative day (POD) 0, all groups achieved effective pain control, and the visual analogue score was 2.02±0.39 points in the group A, 2.13±0.75 points in the group B and 2.03±0.69 points in the group C (P>0.05). On POD 0-2 and POD 3-4 (without basement analgesia), there was no significant difference between the group A and group C in the pain scores (2.08±0.28 points vs. 1.93±0.53 points, 3.20±0.53 points vs. 3.46±0.47 points, P>0.05), however, the difference between POD 0-2 and POD 3-4 in each group was stastically different (group A, 2.08±0.28 points vs. 3.20±0.53 points; group B, 2.42±0.73 points vs. 5.45±0.99 points; group C 1.93±0.53 points vs. 3.46±0.47 points, P<0.05). In terms of the rescue analgesic doses, there was no significant difference between the group A and group C (220.00±64.08 mg vs. 225.38±78.85 mg, P>0.05); it was larger in the group B than that in the group A and group C (343.33±119.56 mg vs. 220.00±64.08 mg; 343.33±119.56 mg vs. 225.38±78.85 mg, P<0.05).ConclusionMultimodal analgesia is an optimal choice in the initial stage after thoracotomy surgery. Continuous intercostal nerve block is an effective way to pain management in patients with thoracotomy.
ObjectiveTo explore the risk factors for death within 7 days after admission in trauma patients undergoing surgery under general anesthesia, and provide evidence for predicting the outcomes of those patients and guidance for clinical practices.MethodsThe basic information and perioperative data of trauma patients who underwent surgery under general anesthesia between January 1st 2019 and December 31st 2020 were collected from the Hospital Information System and the Anesthesia Information Management System. Patients who died within 7 days after admission were assigned into the case group and the others were assigned into the control group, and then propensity-score matching method was used based on age, sex, and injury types. Univariate analyses and multivariate binary logistic regression analysis were used to identify the risk factors for death within 7 days after admission in these patients.ResultsThere were 2 532 patients who met the inclusion criteria, of whom 96 patients with missing follow-up information were excluded, and 2 436 patients remained for the study. After propensity-score matching, there were 19 patients in the case group and 95 patients in the control group. The result of multivariate logistic regression analysis showed that the coma state at admission [odds ratio (OR)=9.961, 95% confidence interval (CI) (1.352, 73.363), P=0.024], perioperative body temperature<36℃ [OR=23.052, 95%CI (1.523, 348.897), P=0.024], intraoperative mean arterial pressure<60 mm Hg (1 mm Hg=0.133 kPa) [OR=12.158, 95%CI (1.764, 83.813), P=0.011], serum calcium concentraion<2.0 mmol/L [OR=33.853, 95%CI (2.530, 452.963), P=0.008], and prothrombin time [OR=1.048, 95%CI (1.002, 1.096), P=0.042] increased the risk of death within 7 days after admission.ConclusionThe coma state, coagulopathy, perioperative hypothermia, intraoperative hypotension, and hypocalcemia are 5 independent risk factors for death in trauma patients after surgery under general anesthesia.
Objective To explore the effectiveness of limb shortening/re-lengthening technique combined with in situ tissue regeneration technique in limb salvage for patients with complex lower limb fractures and soft tissue defects. Methods Between January 2021 and December 2024, 12 patients with complex lower limb fractures and soft tissue defects caused by trauma were admitted. There were 10 males and 2 females; the age ranged from 18 to 46 years, with an average of 36 years. Among them, 1 case of open comminuted tibiofibular fracture caused bone necrosis and soft tissue infection; 4 cases of open tibiofibular fractures developed bone and soft tissue infections after being fixed with a combined external fixator, resulting in defects; 7 cases of closed tibial fractures that underwent internal fixation developed soft tissue infections, leading to bone and soft tissue necrosis. The time from injury to the formation of bone and soft tissue defects was 2-9 weeks, with an average of 6 weeks. The length of bone defects was 5.0-10.2 cm, with an average of 6.8 cm; the area of soft tissue defects was 32-54 cm2, with an average of 43.9 cm2. After admission, all patients underwent thorough debridement. The limb shortening treatment was performed after the wound had filled with fresh granulation tissue, and an Ilizarov ring-shaped external fixator was placed or replaced. The limb was shortened at a rate of 1 mm/day to reduce bone defects. At the same time, the soft tissue defects were repaired using the in situ tissue regeneration technique. After the wound healed, osteotomy was performed, and limb lengthening was carried out at a rate of 1 mm/day. The lower limb full-length X-ray films were taken, and the lengthening was stopped when the lower limb alignment was restored. The healing condition of the wound was observed and the healing time was recorded. Results One patient died due to a traffic accident during limb lengthening. The remaining 11 patients completed limb shortening and re-lengthening treatment and were followed up 18-36 months, with an average of 20 months. All 11 patients successfully preserved their limbs. The wound healing time was 4-12 weeks, with an average of 8 weeks; the limb shortening time was 4-8 weeks, with an average of 6 weeks; and the limb lengthening time was 4-12 weeks, with an average of 8 weeks. One patient experienced delayed bone mineralization during bone lengthening, and one had pin tract infection. Both were treated symptomatically. The lower limb mechanical axis of all 11 patients was restored, and they were able to walk independently. ConclusionThe application of limb shortening/re-lengthening technique combined with in situ tissue regeneration technique in the treatment of large bone and soft tissue defects not only effectively avoids the occurrence of nonunion at the apposition ends and increases the stability of the lower limb, but also significantly shortens the wound healing time, avoids the risk of soft tissue infection and increases the limb salvage rate. It can be used as a treatment technique for patients with complex lower limb fractures combined with soft tissue defects.