ABSTRACT
Objective:To compare the efficacy of left parapharyngeal pressure (PLP) combined with cricoid pressure in preventing gastric insufflation during positive pressure ventilation by facemask.Methods:Two hundred and forty patients of both sexes, aged 18-75 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing surgery under general anesthesia requiring endotracheal intubation, were selected and randomly divided into 4 groups ( n=60 each) using a random number table method: cricoid pressure group (group CP), left PLP group (group LP), cricoid pressure combined with left PLP7 group (group CP+ LP), and control group (group C). The gastric antrum cross-sectional area (CSA) was measured by ultrasound in all the patients before induction of anesthesia, and facemask ventilation in pressure-controlled mode with suction pressure of 25 cmH 2O was applied, the patients in 4 groups were treated with different manipulations, and 3 min later the CSA of gastric antrum was measured again.The gastric antrum CSA before and after ventilation and the difference were recorded.The occurrence of gastric insufflation was examined by ultrasound after ventilation. Results:Compared with the baseline before ventilation, the CSA of gastric antrum was increased after ventilation in C, CP and LP groups ( P<0.01), and no significant change was found in the CSA after ventilation in CP+ LP group ( P>0.05). The difference of gastric antrum CSA was decreased in turn in C, CP, LP and CP+ LP groups ( P<0.05 or 0.01). The incidence of gastric insufflation were 53%, 30%, 12% and 0 in C, CP, LP and CP+ LP groups, respectively.Compared with group C, the incidence of gastric insufflation was significantly decreased in LP and CP+ LP groups ( P<0.05), and no significant change was found in group CP ( P>0.05). Compared with group CP, the incidence of gastric insufflation was significantly decreased in group CP+ LP ( P<0.05), and no significant change was found in group LP ( P>0.05). Conclusion:The combination of left PLP and cricoid pressure can effectively prevent gastric insufflation during positive pressure ventilation by facemask.
ABSTRACT
Objective To compare hemostatic effect of bilateral uterine artery superior branch ligation and gauze intrauterine filling two methods for the placenta previa cesarean section bleeding.Methods 100 patients with bleeding in cesarean section were randomly divided into observation group (50 cases) and control group (50 cases).The patients in the observation group were treated with bilateral uterine artery ascending branch,and the control group was treated with gauze.The number of blood transfusion,the time of operation,the amount of bleeding,the time of hemostasis,the number of hysterectomy and the occurrence of complications were compared between the two groups.Results The success rate of hemostasis in the observation group (98.0％) was higher than that in the control group (86.0％),the difference was statistically significant (x2 =4.891,P ＜ 0.05).The bleeding volume and hemostasis time were (577.8 ± 55.9) mL,(19.2 ± 10.2)min,the differences between the two groups were statistically significant (t =2.50,3.25,all P ＜ 0.05).The operation time between the two groups had no significant difference (P ＜ 0.05).The transfusion rate and incidence rate of complications in the observation group were 8.0％ and 6.0％,which were significantly lower than those in the control group (22.0％,20.0％),and the differences were statistically significant (x2 =3.843,4.332,all P ＜ 0.05).Conclusion The use of bilateral uterine artery esophageal branching in the placenta previa is effective in controlling bleeding,it has rapid bleeding and low incidence of complications,and is worthy of clinical application.
ABSTRACT
Objective To determine the efficiency and safety of Phloroglucinol and Misoprostol for cervix pretreat-ment before diagnostic hysteroscopy. Methods Trials were located through electronic searches of the PubMed, MED-LINE, Springer, CNKI, VIP, CBM, WanFang Data (from the date of establishment of the databases to June 2015). Bibliographies of the retrieved articles were also checked. Result A total of 18 trials involving 2 341 patients were included. The Meta-analysis showed: application of Phloroglucinol lenovo better open and dilate the cervix [O? =2.95, 95 % CI (1.96, 4.45), = 0.000]; To better clarity of the operative field [ O? = 9.50, 95 % CI (6.46, 13.98), = 0.000]; To better shorten the operation time [O? =-4.12, 95 % CI (-5.75,-2.49), =0.000];To bet-ter able to reduce the amount of intraoperative leakage [ O? =0.22, 95%CI (0.10, 0.49), = 0.0002]; and postop-erative adverse reactions should be significantly lower than Misoprostol [ O? = 0.01, 95 % CI (0.00, 0.04), =0.000]. The difference was statistically significant. Conclusions Phloroglucinol is more effective and safer than Miso-prostol in inducing proper cervical priming and may be the optimal choice for cervical pretreatment before diagnostic hysteroscopy.