ABSTRACT
OBJECTIVE@#To invstigate the influence of femoral neck area on larger anteversion angle of lag screw guide pin initial placement in proximal femoral intertrochanteric fracture treated with intramedullary nail.@*METHODS@#From June 2014 to June 2016, 60 patients with femoral intertrochanteric fractures were treated with intramedullary nail, including 27 males and 33 females with an average age of 75 years old ranging from 49 to 88 years old. The lateral images of femoral neck were divided into areas during operation. The anteversion angle of lag screw guide pin of proximal femoral nail was observed at the time of initial insertion. The incidence of normal and larger was counted and the angle index of influencing factors was recorded.@*RESULTS@#Among 60 patients, the screw guide pins of 23 cases were in the central region of the femoral neck and the anteversion angle was normal;screw guide pins of 37 cases were in the front area of the femoral neck, leading to larger anteversion angle. The single factor analysis showed that the independent variables influence factors of larger anteversion were internal collection of the affected limb, internal rotation of the affected limb, hip elevation and screw guide pin level(<0.05). The multi-factor regression analysis showed that the anteversion angle larger was significantly related to the internal rotation of the affected limb and screw guide pin level, and the screw guide pin level was the most relevant(=0.030).@*CONCLUSIONS@#The internal rotation of the affected limb and screw guide pin level may affect the anteversion angle of femoral neck when lag screw guide pin initial insertion, cause it to be too large and the screw guide pin level is the main influencing factor.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Bone Nails , Bone Screws , Femoral Fractures , General Surgery , Femur , Femur Neck , Fracture Fixation, Intramedullary , Treatment OutcomeABSTRACT
Objective To research the application of low tidal volume, apnea ventilation and low PEEP in soft ureteroscope surgery. Methods 80 patients with renal calculi who underwent ureteroscopic holmium laser lithotripsy were randomly divided into tow groups, 40 patients in each group. The observation group was treated with low tidal volume, apnea ventilation and Low PEEP, and the control group was treated with low tidal volume and apnea ventilation. Recorded the HR, MBP, PaCO2, PaO2, Ppeak, A-aDO2, and recorded A-aDO2at pre-anesthesia, preoperation, tracheal extubation, 30 min after tracheal extubation and 24 hours after surgery in tow groups. And observed the trend of RI and CLdyn in tow groups. Results There were no satistically significant differences of HR, MBP, Ppeak and Pmean after recovery and that before apnea in the observation group (P > 0.05); the HR, MBP, Ppeak and Pmean of the observation group was lower than that of the control group after recovery (P < 0.05); the PaO2 of the observation group was higher than that of the control group after recovery (P < 0.05); at tracheal extubation, 30min after tracheal extubation and 24 hours after surgery, the A-aDO2 of the observation group was lower than thatof the control group (P < 0.05); the CLdyn 20 in the observation group was better than that in the control group(P < 0.05). Conclusion In soft ureteroscope surgery, the application of Low tidal volume, apnea ventilation andlow PEEP can ensure the asfe of operation, and maintain the vital aspect, results of blood gas analysis smoothly; andprotect the lung function, promote the recovery of the patients.
ABSTRACT
<p><b>OBJECTIVE</b>To study the feasibility of using Narcotrend (NCT) in monitoring the anesthetic depth during endotracheal intubation in sevoflurane anesthesia.</p><p><b>METHODS</b>Thirty ASA I-II patients (aged 20-49 years) undergoing gynecologic surgery under general anesthesia with tracheal intubation were randomized into sevoflurane group (n=15) and sevoflurane plus rocuronium group (n=15). In the former group, anesthesia was induced with sevoflurane at the primary concentration of 8% till the final end expiratory concentration reaching 2 MAC(minimum alveolar concentration) for 3 min, followed then by tracheal intubation and further observation of the indicators for another 3 min. The patients in sevoflurane plus rocuronium group received identical anesthesia procedures except for the administration of intravenous injection of rocuronium (0.6 mg/kg) after the loss of eyelash reflex. The NCT, BIS and hemodynamics were recorded during the process.</p><p><b>RESULTS</b>No significant differences were noted in NCT, bispectral index (BIS), MAP and heart rate before tracheal intubation between the two groups (P>0.05). The NCT and BIS increased significantly after tracheal intubation in sevoflurane group (P<0.05), but remained below 60. No significant changes in NCT and BIS occurred during intubation in sevoflurane plus rocuronium group (P>0.05). The mean arterial pressure (MAP) and heart rate were significantly increased in both groups after tracheal intubation in comparison with those before tracheal intubation (P<0.05), but the increment in sevoflurane group was significantly greater (P<0.05).</p><p><b>CONCLUSION</b>NCT may reflect the changes of the anesthetic depth resulting from the nociceptive stimulus of tracheal intubation in sevoflurane- induced anesthesia. NCT and BIS can not serve such a purpose in combined anesthesia with sevoflurane and rocuronium.</p>