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Objective:To compare the effects of five different types of videolaryngoscopes in patients with a simulated difficult airway.Methods:575 patients who needed endotracheal intubation in Nanjing Hospital Affiliated to Nanjing Medical University from May 2021 to September 2021 were randomly divided into 5 groups [UE videolaryngoscope group (U group), GlideScope videolaryngoscope group (G group), C-MAC videolaryngoscope group (C group), Airtraq videolaryngoscope group (A group) and A. P.advance videolaryngoscope group (AP group)], with 115 patients in each group. They all wore cervical collar to simulate difficult airway. The main observation index was the success rate of first endotracheal intubation. Secondary observation indicators included overall success rate, laryngoscope exposure field, intubation time, operator′s subjective score, cause of failure, adverse events, and complications of intubation.Results:The patients′ mouth opening degree was reduced from (46±6)mm to (24±4)mm ( P<0.05) after wearing the cervical collar; The success rate of the first endotracheal intubation were 96%(UE), 92%(C-MAC), 86%(GlideScope), 85%(Airtraq), and 60%(AP.Advance) respectively, with statistically significant difference ( P<0.05); Compared with AP group and G group, the incidence of soft tissue injury or bleeding in U group and C group were lower ( P<0.05); There were significant difference in the overall success rate of videolaryngoscopes, laryngoscope visual field exposure, intubation time, the subjective score of the operator and adverse events ( P<0.05); There was no significant difference in the complications of intubation among the groups ( P>0.05). Conclusions:Among 575 patients with a simulated difficult airway with limited neck mobility and limited mouth opening, there were significant differences in the use of five videolaryngoscopes. Among them, UE video laryngoscope had the highest first intubation success rate and lowest tissue trauma rate, C-MAC video laryngoscope, GlideScope video laryngoscope and Airtraq video laryngoscope followed in performance, while A. P.Advance video laryngoscope performed the worst.
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OBJECTIVE@#To assess the effect of transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) on gastric insufflation during general anesthesia induction in obese patients.@*METHODS@#Ninety obese patients (BMI 30-39.9 kg/m@*RESULTS@#The incidence of gastric insufflation was significantly higher in Group M and Group M+T than in Group T (@*CONCLUSIONS@#Ultrasound monitoring of the comet tail sign and the changes of CSA-GA in the gastric antrum is feasible and reliable for detecting gastrointestinal airflow, and in obese patients, the application of THRIVE for induction of anesthesia can ensure the oxygenation level without further increasing gastric insufflation.
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Humans , Anesthesia, General , Insufflation , Intubation, Intratracheal , Masks , ObesityABSTRACT
Objective To investigate the current status of self-management in patients after mechanical heart valve replacement(MHVR) and the influential factors. Methods The convenience sampling method was used to obtain the sample in Chongqing Province, and 400 participants after MHVR at a month in 3 top three hospitals were recruited (Department of Cardiothoracic Surgery, the First Hospital of Chongqing Medical University. The Second Clinical Medical College of Third Military Medical University. The Third Clinical Medical College of Third Military Medical University). Self-Management Scale for patients after Mechanical Heart Valve Replacement edited by ourselves were used to collect the data. Results The score of patients were 79-119 (96.81 ± 7.86) points. The influential factors were sex, age, education level and the resident manner. Conclusions The self-management level of patients after MHVR is not so bad, the male, advanced age, live with distant relatives or housemaid, low education level's patients' self-management ability are low, the medical workers should strenghen health education in these patients.
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Objective To investigate the application value of the ratio of lactic acid(LAC)divided by central venous oxygen saturation (ScvO2 ) to judge the illness severity and prognosis in shock patients. Methods Sixty-four shock patients were divided into two groups:survival group (n=35) and death group (n=29) based on death in 28-d admission. The gender, age, LAC/ScvO2, LAC, 6 h-lactate clearance rate (6 h-LCR), ScvO2 and acute physiology and chronic health Ⅱ(APACHEⅡ) score were compared between two groups. The correlation of LAC/ScvO2 with APACHEⅡscore was analysised in two groups. The receiver operating characteristic (ROC) curve was used to analyse the values of LAC/ScvO 2, LAC, 6 h-LCR, ScvO2 and APACHEⅡscore in the treatment and prognosis of shock. Results There were significant differences in LAC, ScvO2, 6h-LCR and APACHEⅡbetween two groups. There was a lower LAC/ScvO2 in survival group compared with that of death group (P<0.01). LAC/ScvO2 was positively correlated with APACHEⅡscore (rs=0.706,P<0.01). The sensitivity and speciality of LAC/ScvO2 were the highest compared with those of LAC, ScvO2, 6 h-LCR and APACHEⅡ score, the best threshold was 13.92. Conclusion LAC/ScvO2 is a better indicator for shock patients to evaluate the severity degree and prognosis.
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@#Objective To observe the effect of comprehensive rehabilitation on the recovery of knee joint function in old patients severe burned in lower extremity. Methods 49 patients severe burned in lower extremity were randomly divided into observation group (n=25) and control group (n=24). The control group accepted routine rehabilitation, while the observation group accepted comprehensive rehabilitation. They were assessed with the range of motion (ROM) of knee flexion/extension, 45 m-walking, stair activity, Functional Independence Measure (FIM) and muscle strength 3 months after rehabilitation. Results The active and passive ROM of knee, stair activity, FIM score and muscle strength improved more in the observation group than in the control group (P<0.05). Conclusion Comprehensive rehabilitation promotes the recovery of knee function of old patients with severe burn in lower extremity.
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Objective To analyze the difference of the venous port access (VPA) and peripherally inserted central catheter (PICC) in cancer chemotherapy.Methods All eligible studies on VPA and PICC were searched in the databases of PubMed,China National Knowledge Internet (CNKI),Chinese Biomedical Database (CBM),WANFANG Database and VIP Database.Literatures screening,quality evaluation and data extraction were conducted according to Cochrane Handbook;Meta-analysis was calculated by using RevMan 5.2.Results Twenty-nine studies with a total of 4 449 cases of patients were included in this Meta-analysis,with 1 912 cases in experimental group which adopted VPA and 2 537 cases in controlled group which adopted PICC.Experimental group had advantages in the average catheter retention time (SMD=3.36,95％CI 2.51-4.21) and quality of life (RR=1.61,95％CI 1.15-2.24) compared with controlled group.The overall complication rate (RR=0.26,95％CI 0.20-0.34,P＜0.01),phlebitis incidence (RR=0.08,95％CI 0.04-0.16,P＜0.01),catheter infection incidence (RR=0.32,95％CI 0.23-0.44,P＜0.01),catheter obstruction incidence (RR=0.32,95％CI 0.22-0.48,P＜0.01),catheter dystopy incidence (RR=0.18,95％CI 0.09-0.37,P＜0.01) in experimental group were remarkably lower than that in controlled group.However,no significant difference was found between the two groups in the incidence of the puncture success rate for the first time,errhysis or hematoncus,thrombus and catheter leakage (P ＞0.05).Conclusions Compared with PICC,VPA had advantages in a long retention time,fewer complications and few influence on quality of life.Therefore,VPA should be widely used in cancer chemotherapy.
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Objective To evaluate the effect of evidence based nursing on the prevention of the complications of PICC .Meth‐ods The randomised controlled trials (RCT) on the evidence based nursing in reducing or preventing the complications of patients with PICC were collected using the databases of PubMed ,CNKI ,WanFang ,CBM and VIP;the data were analyzed by RevMan5 .0 software .Results 17 studies involving 3 092 patients were included in total .The results of Meta analyses showed that compared with the control group ,the complication (Phlebitis ,puncture point infection ,catheter prolapse or ectopic and catheter obstruction) rates of evidence based nursing group with PICC were lower (P<0 .05) than that of the control group .Conclusion Evidence based nursing can effectively prevent the complication of PICC ,improve the quality of nursing and worth of clinical application .
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Objective To observe the effect of comprehensive rehabilitation on the recovery of knee joint function in old patients severe burned in lower extremity. Methods 49 patients severe burned in lower extremity were randomly divided into observation group (n=25) and control group (n=24). The control group accepted routine rehabilitation, while the observation group accepted comprehensive rehabilitation. They were assessed with the range of motion (ROM) of knee flexion/extension, 45 m-walking, stair activity, Functional Independence Mea-sure (FIM) and muscle strength 3 months after rehabilitation. Results The active and passive ROM of knee, stair activity, FIM score and muscle strength improved more in the observation group than in the control group (P<0.05). Conclusion Comprehensive rehabilitation pro-motes the recovery of knee function of old patients with severe burn in lower extremity.
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Objective We used the method ot Meta analysis to evaluate the effect of the comfort care in Chinese patients with breast cancer in peri-operative period.Methods The randomized controlled trials on the comfort care in patients with breast cancer in peri-operative period were collected using the databases of China National Knowledge Infrastructure (CNKI),Wanfang Periodical Databases and Chinese Science Technology Periodical Databases which were analyzed by RevMan 5.3 software.Results Twelve randomized controlled trials were included in the study.The results of Meta-analysis revealed that the comfort care were effectively on anxiety condition,the degree of pain,the incidence rate of complicating diseases after surgery and degree of satisfaction on nursing than the conventional nursing,OR value and 95％CI were 0.26(0.13-0.50),9.98(6.00-16.61),0.24(0.13-0.42) and 4.74(2.84-7.90).Conclusions The comfort care can improve the state of anxiety,relieve the pain,reduce the postoperative complications and improve the degree of satisfaction of the patients.
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Aim To investigate whether ischemic postconditioning could induce ischemic tolerance to focal cerebral reperfusion injury and comparison with ischemic preconditioning. Methods A reversible middle cerebral artery occlusion (MCAO)was used in this study. Fifty male Sprague-dawley rats were randomized into five groups(n=10): sham-operated group,MCAO group,preconditioning group, postconditioning group and nimodipin group . The neurological function was scored and the infarct volume was measured after operation. The grouping,experimental methods and procedures of another fifty rats were as above except that ipsilateral brain of infarction was dissected and made into homogenate,then the contents of MDA,SOD,GSH and LA were quantitatively measured. Results The postconditioning and preconditioning improved the neurological function,reduced the cerebral infarction volumes and cerebral swelling significantly compared with those of the MCAO group. Contents of LA and MDA were lower, while the activity of SOD in the brain tissues were higher in preconditioning group and postconditioning group than those of the MCAO group. Conclusion Postconditioning could induce brain tolerance, and increase the antioxidant activity, which might be an important mechanism of induction of brain tolerance.