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Objective:To investigate the occurrence of deglutition disorders after extubation in neurosurgery patients, to explore the recovery time and influencing factors, and to provide reference for the development of nursing intervention plan for dysphagia after extubation.Methods:This was a prospective study. A total of 250 patients who underwent oral catheterization under general anesthesia in neurosurgery department and were admitted to the Tenth People′s Hospital of Tongji University from June to December 2022 were selected as the study objects by convenience sampling method. The general demographic and clinical data of the patients were collected to evaluate the occurrence of deglutition disorders after extubation. The outcome and recovery time of deglutition disorders were used as dependent variables. Kaplan-Meier method and Cox proportional hazard regression analysis were used to analyze the recovery time and influencing factors of deglutition disorders after extubation in neurosurgery patients.Results:The incidence of deglutition disorders after extubation was 35.6%(89/250) among 250 cases of neurosurgery patients under general anesthesia by endotracheal intubation, the recovery time of Deglutition Disorders after postoperative extubation was 1 - 16 (5.17 ± 0.43)days. ICU stay days, duration of endotracheal intubation and the first standardized swallowing assessment after extubation were the main influencing factors for the recovery of deglutition disorders in patients with dysphagia after extubation.Conclusions:For patients with deglutition disorders after extubation after neurosurgery, ICU stay days, duration of endotracheal intubation and the first standardized swallowing assessment after extubation affect the process of swallowing function recovery. Medical staff should focus on the risk groups and develop targeted nursing interventions to improve the outcome of patients.
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Objective To compare the effectiveness and feasibility of oral tracheal intubation with Clarus video stylet,HPHJ-A video laryngoscope and Airtraq laryngoscope and in snoring pa-tients.Methods Ninety patients undergoing elective snoring surgery with general anesthesia,3 9 males and 51 females,aged 22-55 years,BMI 25-29 kg/m2,ASA physical status Ⅰ-Ⅲ,were ran-domly divided into three equal-sized groups (n=30):Clarus Video Stylet group (group C),HPHJ-A video laryngoscope group (group H)and Airtraq laryngoscope group (group A).The time of success-ful endotracheal intubation and the success rate of initial intubation of all groups were observed.The mean arterial pressure (MAP),heart rate(HR)and Rate-pressure product(RPP)were also monitored before induction of anesthesia(T0),before tracheal intubation(T1),at 0 min(T2),1 min (T3),and 3 min (T4)after intubation,as well as the throat injury and hemorrhage were noted. Results Patients in group C were successful intubated.Two patients in group H and one patient in group A with failed intubation were successfully intubated by using Clarus video stylet.The time re-quired for successful intubation in group C was longer than groups H and A (P<0.05).Compared with T0,the increasing of hemodynamic parameters (MAP,HR,RPP)after induction of all groups were significant(P<0.05).Compared with T1,the HR,MAP and RPP were increased significantly at T2in all groups (P<0.05).Compared with T1,the MAP and RPP were increased significantly at T3in all groups,and the HR were increased significantly at T3in groups H and A (P<0.05).There was no significant difference in the HR between T1and T3in group C.The increase in the HR and RPP at T2 was lower in group C than that in both the groups H and A (P <0.05).The changes of hemodynamic parameters were no significant among the three groups at other time.The differences of sore throat score and hemorrhage were no significant.Conclusion Compared with HPHJ-A video laryngoscope and Airtraq laryngoscope,Clarus video stylet for guiding oral tracheal intubation in snoring patients have less influence on hemodynamic parameters,and have no limited mouth opening. But Clarus Video Stylet spends longer intubating times,and has no obvious advantages on preventing throat injury.
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Objective To investigate the effects of different depths of anesthesia on incidence of postopera-tive cognitive dysfunction (POCD). Methods We systematically retrievedPubmed,OVID,CNKI,CBM and Wanfang database and VIP database for randomized controlled trials(RCTs)from inceptionto December 312016, comparing different depths of anesthesia for their impacts on incidence of early POCD. After data extraction and quality evaluation,Revman 5.3 software was used for statistical data analysis. Results A total of 714 patients in 8 eligible RCTs were identified. Results of meta-analysis were as follows.(1)Incidence of POCD of depth anesthesia (NTS=E0-E1)was lower than general anesthesia(NTS=D0-D1)1 d after surgery(OR=0.21,95%CI 0.13~0.35,P < 0.00001).(2)Incidence of POCD of depth anesthesia(NTS = E1)was lower than general anesthesia (NTS=D0)7 d after surgery(OR=0.45,95%CI 0.23~0.91,P=0.03).(3)Incidence of POCD of NTS=E1 was lower than NTS=D07d after surgery(OR=0.42,95%CI 0.24~0.71,P=0.001). Conclusion Comparedwith general anesthesia,depth anesthesia is associated with a lower incidence of early POCD.
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Objective To investigate the effects of different depths of anesthesia on incidence of postopera-tive cognitive dysfunction (POCD). Methods We systematically retrievedPubmed,OVID,CNKI,CBM and Wanfang database and VIP database for randomized controlled trials(RCTs)from inceptionto December 312016, comparing different depths of anesthesia for their impacts on incidence of early POCD. After data extraction and quality evaluation,Revman 5.3 software was used for statistical data analysis. Results A total of 714 patients in 8 eligible RCTs were identified. Results of meta-analysis were as follows.(1)Incidence of POCD of depth anesthesia (NTS=E0-E1)was lower than general anesthesia(NTS=D0-D1)1 d after surgery(OR=0.21,95%CI 0.13~0.35,P < 0.00001).(2)Incidence of POCD of depth anesthesia(NTS = E1)was lower than general anesthesia (NTS=D0)7 d after surgery(OR=0.45,95%CI 0.23~0.91,P=0.03).(3)Incidence of POCD of NTS=E1 was lower than NTS=D07d after surgery(OR=0.42,95%CI 0.24~0.71,P=0.001). Conclusion Comparedwith general anesthesia,depth anesthesia is associated with a lower incidence of early POCD.
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Objective To evaluate the effect of dexmedetomidine on gastric mucosal injury induced by intestinal ischemia-reperfusion (I/R) in rats.Methods Thirty-six healthy male Sprague-Dawley rats,aged 4-5 months,weighing 200-250 g,were randomly divided into 4 groups (n =9 each) using a random number table:sham operation group (group S),intestinal I/R group (group I/R),low-dose dexmedetomidine group (group LD),and high-dose dexmedetomidine group (group HD).Intestinal I/R was produced by occlusion of the superior mesenteric artery for 1 h followed by 2 h reperfusion in anesthetized rats.Dexmedetomidine 2.5 and 5.0 μg · kg-1 · h-1 were infused via the caudal vein for 1 h starting from 1 h before ischemia in LD and HD groups,respectively.The rats were sacrificed at 2 h of reperfusion,and the gastric mucosa was obtained for examination of the pathological changes (with light microscope) and for determination of the expression of serine/threonine kinase (Akt),phosphorylated Akt (p-Akt),activated caspase-3 and caspase-3 (by Western blot).The ratio of p-Akt to Akt (p-Akt/Akt)was calculated to reflect the phosphorylation of Akt.The ratio of activated caspase-3 to easpase-3 (activated caspase-3/caspase-3) was calculated to reflect the activation of caspase-3.Results Compared with group S,the expression of Akt was significantly up-regulated,the expression of p-Akt was significantly downregulated,the phosphorylation of Akt was significantly decreased,and the activation of caspase-3 was significantly increased in group I/R,and the expression of p-Akt was significantly up-regulated,and the phosphorylation of Akt and activation of caspase-3 were significantly increased in LD and HD groups (P＜0.05).Compared with group I/R,the expression of Akt was significantly down-regulated,the expression of p-Akt was significantly up-regulated,the phosphorylation of Akt was significantly increased,and the activation of caspase-3 was significantly decreased in LD and HD groups (P＜0.05).The degree of gastric mucosal injury was significantly lower in LD and HD groups than in group I/R,and there was no significant difference in the degree of gastric mucosal injury between group LD and group HD.Conclusion Dexmedetomidine can attenuate gastric mucosal injury induced by intestinal I/R,and the mechanism may be related to activation of PI3K/Akt signaling pathways and inhibition of cell apoptosis in rats.
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<p><b>OBJECTIVE</b>To evaluate efficacy of dexmedetomidine in preventing shivering after general anesthesia in women undergoing laparoscopic surgery.</p><p><b>METHODS</b>Eighty patients scheduled for laparoscopic gynecological surgery were randomized into dexmedetomidine group (n=40) and control group (n=40) to receive 1.0 µg/kg dexmedetomidine or an equal volume of saline slowly injected (for over 10 min) at 30 min before the anticipated completion of surgery. The postoperative incidences of shivering and the side effects were recorded.</p><p><b>RESULTS</b>The patients in the control group showed a significantly higher postoperative incidence of shivering (37.5%) than those in dexmedetomidine group (P<0.05). Heart rate and mean arterial pressure showed significant variations postoperatively in dexmedetomidine group (P<0.05), which had a significantly greater sedation score (P<0.05), a higher incidence of dry mouth (P=0.000), but a significantly lower incidence of nausea and vomiting than the control group (P<0.05).</p><p><b>CONCLUSION</b>Dexmedetomidine can lower the incidence of shivering after general anesthesia for laparoscopic gynecological surgery.</p>
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Adult , Female , Humans , Anesthesia, General , Dexmedetomidine , Therapeutic Uses , Gynecologic Surgical Procedures , Methods , Laparoscopy , Methods , Prospective Studies , Shivering , Single-Blind MethodABSTRACT
Objective To investigate the influence of proprioceptive training of hemiplegic stroke patients on their visually compensatory dependence.Methods Twenty stroke patients without vestibular abnormalities were recruited.They were able to walk for 10 meters.All the patients underwent 4 weeks of rehabilitation training including proprioceptive training,treadmill exercises and isometric muscle strengthening.Static standing balance test was performed before and after 4 weeks of treatment.The parameters such as the anteroposterior and mediolateral sway of the center of gravity,center of gravity distribution were analyzed before and after the treatment,taking into consideration of visual feedback (eyes open or closed) by using t-test and multiple linear regression analysis.Results Visual feedback had significant no influence on the anteroposterior sway of center of gravity before and after training (P ＞ 0.05) ; Visual feedback had significant influence on mediolateral sway of center of gravity.Rehabilitation training significantly improved the mediolateral sway in opened-eye standing (P ＜ 0.05) but not closedeye standing (P ＞ 0.05).Visual feedback played significant role in center of gravity distribution after training (P ＜ 0.05).Conclusions Visual compensation is of significant influence on the mediolateral sway.Proprioceptive training can help decrease the patient's dependence on visual feedback and enhance the patient's balance ability.
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Objective To investigate the effects of a new sling exercise treatment combined with injections of sodium hyaluronate on the radiographic findings and clinical variables of patients with patellofemoral pain.Methods Seventy patients with patellofemoral pain syndrome were divided into a group which was treated using a new sling exercise therapy combined with injections of sodium hyaluronate (the combined therapy group,n=34) and another which received only sodium hyaluronate injections (the control group,n=36).The patients of both groups were assessed pre-and post-treatment.The clinical assessment modalities were pain scores (using a visual analogue scale,VAS),quadriceps and hamstring strength and range of motion in the active flexion and extension of the knee.Q angles were measured supine and standing.Patellofemor tilt angle and congruence and sulcus angle were determined by CT scanning.Results After 5 weeks the average VAS pain score of the combined therapy group was significantly lower than that of the control group.Muscle strength and range of motion in the combined therapy group were both significantly higher than pro-treatment,the Q angles were significantly smaller,and the congruence and sulcus angles were significantly better.Conclusion Five weeks of practicing the new sling exercise therapy combined with injections of sodium hyaluronate can yield satisfactory clinical and radiologic outcomes in patients with patellofemoral pain syndrome.
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Objective To investigate the effects of sensorimotor therapy on patients with knee osteoarthritis.Methods Ninety-two patients with knee osteoarthritis were divided into a treatment group and a control group by using random digits table. Both groups received conventional rehabilitation therapy, including knee isometric and isotonic contraction training, ultrashort wave diathermy as well as aerobic exercise. The treatment group was also administered with sensorimotor training, in addition to the conventional training,including the muscle strengthening and control training of quadriceps and hamstring muscle using sling exercise therapy system and on the Thera-band mattress. The visual analogue scale (VAS) for pain, manual muscle testing and knee range of motion as well as the Japanese Orthopedic Association knee function evaluation form were used to evaluate the patients. Results There was no statistic difference between the 2 groups before treatment, with regard to the evaluation parameters used in this study. After 2 months of treatment, both groups improved significantly (P ＜0.05),with the treatment group improved to a significantly greater extent (P ＜0.05). Conclusions Sensorimotor training in addition to the conventional rehabilitation treatment can further relieve the pain of patients with knee osteoarthritis joints arthritis and improve the function of patients with knee osteoarthritis.
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Objective To investigate the association between the C609T polymorphism of NAD (P)H:quinoneoxidoreductase (NQO1) gene and post operative cognitive dysfunction (POCD).Methods 90 ASA Ⅰ-Ⅱ patients of 59 to 78 years old, undergoing elective hip replacement with epidural anesthesia were enrolled.All patients were given a battery of 5 neuropsychological tests before operation and seven days after operation.Patients were divided into POCD group and control group according to test results (45 patients in each group).The single nucleotide polymorphism C609T of NQO1 gene was detected using real-time PCR by Taqman probes and subjected to odd ratio assessment.Results 5 samples in control group couldn' t be used in the real-time PCR analysis due to quality control.The frequency of C/C genotype in POCD control was lower than that of control group ( 30.0% vs 11.1% ) with statistical significance ( OR = 0.292,95 % CI 0.092 ～ 0.92 1, P ＜ 0.05 ).The C/T +T/T genotype frequency was significantly higher in group POCD than in the control group(88.8% vs 70% ).Patients presented with C/T + T/T genotype showed an evidently increased risk of POCD ( OR =3.42,95% CI 1.08 ～ 10.82,P ＜ 0.05 ).The frequency of C allele of NQO1 gene in group control was 56.2%, as compared with 40% in group POCD with significance ( OR = 0.519,95% CI 0.282 ～ 0.955, P ＜ 0.05 ).The frequency of T allele of NQOI gene in control group was 43.7% ,as compared with 60.0% in POCD group( OR = 1.93,95% CI 1.047 ～3.552,P＜O.05).Conclusion The NQO1 gene single nucleotide polymorphism C609T is evidently associated with the increased risk of POCD.
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Objective To explore the effects of exercise on the levels of neurotrophin-3 (NT-3) in the skeletal muscles of streptozotocin-induced diabetic rats. Methods The rats were divided into an 8-week exercise group (A), a 4-week exercise group (B), a diabetes control group (C), an exercise group (D) in which no dia-betes was induced, and a control group (E). The rat model of diabetes was induced in the rats of groups A, B and C by intra-abdominal injection of streptozotocin (STZ) at 55 mg/kg. The exercising rats were forced to swim for 60 minutes once daily, 5 days a week. The levels of NT-3 in skeletal muscles were measured with an enzyme-linked immunosorbent assay. Cadual nerve conduction velocity (CNCV) in all of the rats was evaluated at the beginning, and after 4 and 8 weeks of swimming exercise. Results NT-3 levels in the skeletal muscles in group C were sig-nificantly lower than in groups A, D and E. There was no statistically significant difference in NT-3 levels between groups B and C. The NT-3 levels showed a significant positive correlation with CNCV at the 8th week. Conclu-sions The increase in NT-3 levels of skeletal muscles induced by exercise could contribute partially to the im-provement of diabetic neuropathy.