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Nowadays, PDCA circle is a widely used theory of quality management system. Through the PDCA approach, the management reform was conducted in 17 anesthesia teachers of the Anesthesiology department. After 18 months of training and promotion, the problems such as lack of enthusiasm for teaching, uneven level of teachers, and boring single teaching method were basically solved, which improved their teaching skills. Certain effectiveness has been achieved in teacher training management including continuity of quality management, timely feedback and emphatically improvement, student-center teaching philosophy, and mutual promotion of teaching and learning.
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Objective To esplore the effecf and the practical utility of the postoperative nausea and vomiting intensity scale for Chinese patients with laparoscopic operation .Methods Ninety patients with ASA I-II,Apfel≥2 were enrolled .Interviews were carried out at 6 and 24 hours postoperatively .Measurements included the PONV Inten-sity Scale,nausea and pain visual analogue scale .Quality of Recovery Score and antiemetic were used .The patients whose PONV intensity score ≥50 were assessed by PONV intensity scale and PONV VAS .Results There was signif-icant difference of the occurrence of clinical PONV between the patients with Apfel ≥3 and those with Apfel=2(P<0.05).The PONV Intensity Scale had a stronger correlation with PONV VAS ,r=0.946(P<0.01).The PONV In-tensity Scale had a stronger correlation with QOR,r=-0.937(P<0.01).Patients with clinically important PONV at 24 hours required more antiemetic therapy (P=0.024).PONV rate of the patients with a clinically significant score VS those without a clinically significant score was 80%VS 18%(P<0.05).Conclusion PONV intensity scale can distinguish trivial from clinically important PONV availably in Chinese Laparoscopic operation .It is more reliable than PONV VAS.Patients with clinically important PONV required more antiemetic therapy .Clinically important PONV ,as determined by the PONV Intensity Scale ,was associated with a poor quality of recovery .
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ObjectiveTo explore the expression of Smad2 in cervical carcinoma and analyze the clinical significance of Smad2.MethodsThe expression of Smad2 in normal uterus group( NE group,n =61 ) and cervical carcinoma group( CC group,n =53 ) were detected by immunohistochemistry to analyze the significance of Smad2 in the cervical carcinoma.ResultsPositive rate of expression of Smad2 protein in NE group was 39.3％,positive rate was 77.4％ in CC group,statistical difference was found between the two groups(P ＜ 0.01 ).The degree of differentiation of cervical cancer was lower,and the Smad2 positive rate was higher,well-differentiated and poorly differentiated were 52.6％ and 91.2％,respectively,and the difference was statistically significante ( P ＜ 0.01 ) ; The invasion of cancer was higher,and the Smad2-positive rate was higher ≤ 1/2 and ＞ 1/2 were 66.7％ and 91.3％,respectively,and the difference was statistically significante ( P ＜ 0.05 ).ConclusionThe expression of Smad2 was less; Smad2 was related to depth of invasion and degree of differentiation of cervical carcinoma,which could be used as clinical diagnosis and prognostic markers.
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ObjectiveTo investigate the clinical effect of three-dimensional conformal radiotherapy simultaneously combined with XELOX program(oxaliplatin +capecitabine) for local recurrence of esophageal carcinoma after radiotherapy.MethodsSixty patients with local recurrence of esophageal carcinoma after radiotherapy were divided by random digits table method into treatment group and control group with 30 cases each.The patients in treatment group were treated with three-dimensional conformal radiotherapy simultaneously combined with XELOX program chemotherapy.While control group received three-dimensional conformal radiotherapy.The efficacy between two groups were compared.ResultsThe complete remission rate and efficiency rate in treatment group were significantly higher than those in control group [ 53.3％ (16/30) vs.23.3％ ( 7/30 ),86.7％ ( 26/30 ) vs.63.3％ (19/30) ] ( P ＜ 0.05 ).The 1,2,3-year survival rate and median survival time in treatment group were 65.5％,44.8％,34.5％ and 24.8 months,which were significantly higher than those in control group (48.3％,41.4％,6.9％ and 12.1 months)(P ＜0.01 ).The incidences of radioactive esophagitis,radioactive pneumonia and thrombocytopenia in treatment group were higher than those in control group,but there were no statistical differences between two groups (P ＞0.05).The incidences of nausea,vomiting,leukocyte decrease and anemia in treatment group were significantly higher than those in control group [36.7％(11/30) vs.13.3％(4/30),40.0％(12/30) vs.16.7％(5/30),43.3％( 13/30 ) vs.13.3％(4/30),P ＜ 0.05 ].ConclusionsThree-dimensional conformal radiotherapy simultaneously combined with XELOX program can improve short-term efficacy and long-term survival rate of local recurrence of esophageal carcinoma after radiotherapy.
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Objective To observe the influence of hands-washing and non-hands-washing on clinical disinfection effect before surgical hands antisepsis.Methods Totally 40 surgcal staff wee divided into the handa-washing group and the non-hands-washing group.The sterilizing effect of handa at diggerent time points during operations and kinds of bacteria colony were compared between two groups.Results Bacteria colony of hands at different time points during operations showed no significant difference between two groups.Both groups were detected bacteris colony on their hands,mainly made up of coagulase negative staphylococcus,corynebacterium and eaterococcus and no difference was seen between two groups.Conchusions The non-hands-washing method can acquire the same disinfection effect as traditional hands-washing method.Its disinfection effect lasts three hours,easy to operate,little stimulation on the skin,and was worthy of clinical application.
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Objective To explore the security of spinal anesthesia by observing the pefioperation serum troponin T in the elderly patients with coronary heart disease who underwent spinal anesthesia.Methods 40 case8 were divided into two groups according to the elderly patients with or without the history of coronary heart disease.Group Ⅰ 0f 20 cases were the patients with the history of coronary heart disease.Group Ⅱ of 20 cases were the patients without the history of coronary heart disease.Both groups were undertaken single spinal anesthesia combined with epidural anesthesia.The blood samples were collected at the time of perioperation,the end of the operation and 24 hours after surgery.The serum troponin T Was tested by Roche fully automated ehemiluminescent analyzer E170.The symptoms and signs of the coronary heart disease in the patient were observed.And the age,operation time,anesthesia lever,the amount of bleeding and transfusion were recorded,and at the same time,electrocardiogram,heart rate,pulse,cerebral oxygen saturation were monitored.Results There was no significant difference between two groups in age,operation time,anesthesia lever,the amount of bleeding and transfusion,heart rate,pulse,cerebral oxygen saturation.There was no significant difference between two groups in seram troponin T.No symptoms and signs of the coronary heart disease were observed in two groups.There Was no significant difference between two groups in constituent ratio of positive rate of serum troponin T.There was one case in each group that serum lroponin T was more than reference value (0.010μg/L)during the perioperation while the patient was no discomfort.Conclusion Spinal anesthesia has no impact on the change of perioperative 8ertlm troponin T in the elderly patients with coronary heart disease.
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OBJECTIVE To explore the relationship between intubation of general anesthesia and lower respiratory tract infection.METHODS Totally 947 cases were divided into bronchial intubation group(groupⅠ,541 cases) and(tracheal) intubation group(groupⅡ,406 cases) for a retrospective analysis about lower respiratory tract(infection).The(sputum) samples of(infected) patients were took germiculture and antibiotic susceptibility.RESULTS There were 26 cases arisen lower respiratory tract infection in group Ⅰ and there were 18 in group Ⅱ.The(incidence) was 4.81% and 4.43%,respectively.86.36% pathogens of sputum samples were non-zymophytes,it was a direct proportion between high(antimicrobial) resistance rate and lower respiratory tract infection rate.The infection rate of 60-70 years old and under 49 years patients was 9.56% and 2.04%,respectively.The infection rate of(patients) undergoing anesthesia less 3h and over 3h was 3.26% and 6.14%,respectively,with significant(differences)(P
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Objective To observe the therapeutic effect of tramadol combined with fentanyl in patient controlled intravenous analgesia after nucleotomy of intervertebral disc.Methods 60 patients under general anesthesia,scheduled for nucleotomy of intervertebral disc,were randomly divided into three group(n=20):group tramadol(group T),group fentanyl(group F) and group tramadol+fentanyl(group TF).All patients were received patient controlled intravenous analgesia by loading dose+background dose+PCA bolus dose.The BP,HR,RR,VAS at 6,12,24,48h of postoperation were observed.The sedation score in 24h,average effective-press times and drug dose in 48h of postoperation were recorded.The incidence of nausea and vomiting during 24h of postoperation were observed.Results It had no significantly difference of BP,HR,RR,VAS among three groups.The average effective-press times of group TF (8?2) were significantly less than those of group T (14?3) and group F (12?3).The drug dose of 48h was tramadol (17.9?1.5)mg/kg(group T),fentanyl (16.8?1.5)?g/kg(group F) and tramadol (11.5?0.7)mg/kg+fentanyl (9.1?0.7)?g/kg(group TF).The drug dose of group TF showed significant difference compared with others.The sedation score in group F was the highest,it had significant difference compared with the other two group.The frequency of nausea and vomiting in group T was significantly more than that in others.Conclusion Tramadol or fentanyl gived alone can afford the same satisfied analgesic effect on nucleotomy of intervertebral disc.But there is high nausea-vomiting frequency in tramadol and strong sedation frequency in fentanyl.Tramadol combined with a little opioid fentanyl can afford more satisfying analgesic effect,and is provided with advantage in less drug and side-effect.
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Objective To study the effect of different dose of propofol compounding with epidural anesthesia on oxygenation and shunt fraction during one-lung ventilation(OVL).Methods Forty patients with esophageal carcinoma undergoing thoracotomy were randomly divided into group Ⅰ and Ⅱ.After placing epidural tube at T_(6～7) for epidural anesthesia,the patients group Ⅰ were received propofol 5mg?kg~(-1)?h~(-1) and 10mg?kg~(-1)?h~(-1) in group Ⅱ.Taking the blood sample from arter for blood-gases measurement at beginning of operation,30min after OVL and 60min after OVL.Results At 30min after OVL,the shunt fraction(Qs/Qt) value of group Ⅰ and Ⅱ was(11.35?3.6) and(15.6?5.41);PaO_2 was (36.12?10.23) and(31.05?9.36).At 60min,the Qs/Qt was(13.9?3.7) and(18.5?2.1);PaO_2 was(34.87?15.42) and(26.97?11.35).There was significantly difference between two groups(P
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Objective To observe the treatment effect of nicardipine for the presence of hypertension responses during thyroidectomy under cervical plexus nerve block.Methods Patient without hypertension before the operation was brought into if he received thyroidectomy under cervical plexus nerve block,and with the presence of hypertension responses during the operation,and without effect after injected innovar one dose or dolantin 50mg by vein when the blood pressure was over 160/90mmHg.20 patients according to the criterion mention above were dripped nicardipine 20?g/kg by vein.The SBP,DBP,MAP,HR,SpO_2 and ECG were recorded at 3min,5min,15min,30min,45min after injection and the side effects were also recorded.Results The SBP,DBP,MAP of all patients were fallen distinctly at 3min after injection,and reached lowest at 5min.The blood pressures were steady at other points.There was significantly difference between the point before and after injection(P