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BACKGROUND: At present, extrusion is widely used in total knee arthroplasty. Studies have shown that extrusion can aggravate early pain and increase the risk of complications after operation. Therefore, a safer and more effective method it is urgently needed in clinic. OBJECTIVE: To observe the effects of elevation and extrusion of blood-expelling method on clinical outcomes during total knee arthroplasty. METHODS: Sixty-four patients who were scheduled to undergo unilateral total knee arthroplasty for the first time were randomly divided into two groups. During total knee arthroplasty, the control group received extrusion method, while the experimental group received elevation method. The main outcomes of the two groups were compared: Visual analogue scale score, knee joint swelling, C-reactive protein, serum creatine kinase activity and postoperative complications; secondary outcomes: Tourniquet use time, Hospital for Special Surgery score, and SF-36 score. RESULTS AND CONCLUSION: (1) Visual analogue scale scores in the experimental group were significantly lower than those in the control group on the first day, the seventh day, the first month and the third month after operation (P 0.05). (5) Hospital for Special Surgery score and SF-36 score were assessed at 1, 3 and 6 months. The results showed that it was better than before, but there was no significant difference between the two groups (P > 0.05). (6) In conclusion, elevation of blood-expelling method could alleviate early pain response, reduce inflammation reaction and soft tissue injury, and decrease the incidence of skin tension blisters and thromboembolism. It is in line with the concept of rapid recovery. Therefore, during total knee arthroplasty, elevation of blood-expelling method is a safer and more effective method than extrusion.
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ABSTRACT OBJECTIVE：To study the association between CYP3A5，CYP3A4，ABCB1 and POR*28 genetic polymorphisms and drug dosage（D）and steady blood concentration/dosage（c0/D）of tacrolimus in lung transplant recipients after one year of tacrolimus administration. METHODS：By retrospective analysis，a total of 46 recipients who underwent lung transplantation in China-Japan Friendship Hospital during May 2017-May 2018 were selected. The c0 and D of tacrolimus were measured and collected after one year of tacrolimus administration，and c0/D was calculated. Recipients’genotypes of CYP3A5（rs776746）， CYP3A4（rs2242480，rs28371759），ABCB1（rs1045642，rs2032582，rs1128503）and POR*28（rs1057868）were collected. The relationship between genetic polymorphism and D，c0/D was analyzed statistically. RESULTS：The genotype frequency in this study were all in accordance with Hardy-Weinberg equilibrium （P＞0.05）. While maintaining tacrolimus c0 within therapeutic range， genetic polymorphism of CYP3A5（rs776746）and CYP3A4（rs2242480）influenced D and c0/D of tacrolimus significantly（P＜ 0.05）. There was no statistical significance in D or c0/D among different genotypes of other sites（P＞0.05）. There was statistical significance in D or c0/D among extensive metabolism type recipients with CYP3A5（rs776746）*1 and CYP3A4（rs2242480）*1G alleles，normal metabolism type recipients with only CYP3A5 （rs776746） *1 or CYP3A4 （rs2242480） *1G alleles and poor metabolism type recipients without CYP3A5（rs776746）*1 and CYP3A4（rs2242480）* 1G alleles（P＜0.05）. D of tacrolimus was the highest in extensive metabolism type recipient and the lowest in poor metabolism type recipient. CONCLUSIONS：The detection of genetic polymorphism of CYP3A5（rs776746）and CYP3A4（rs2242480）has guiding significance for individualized medication of tacrolimus after one year of tacrolimus administration.
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OBJECTIVE：To analyze the occurrence of acute kidney injury （AKI）after lung transplantation and its possible influential factors . METHODS ：Medical records of 64 patients who received lung transplantation in our hospital from April 2017 to June 2018 were included in this retrospective study. Patients were divided into AKI group （44 cases）and non-AKI group （20 cases），according to whether AKI occurred after operation. According to diagnostic criteria for lung transplantation in our hospital ， all patients were given Methylprednisolone sodium succinate for injection or Methylprednisolone sodium succinate for injection combined with Basiliximab for injection ，and triple immunosuppressive therapy of Tacrolimus capsules+Mycophenolate mofetil dispersible tablets or Mycophenolate mofetil capsules or Mycophenolate sodium enteric-coated tablets+Methylprednisolone tablets or Prednisone acetate tablets were given after operation. The occurrence of AKI in AKI group within a week after operation were recorded. Intraoperative influential factors （operation type ， operation duration ， ECMO support ， immune inhibitor use ， intraoperative blood loss ），postoperative influential factors [days of ICU ，mechanical ventilation and ECMO support ，median value of Scr within one week after operation ，median tacrolimus concentration and the use of potential nephrotoxic drugs （≥4 kinds）， hospitalization days] and survival rate one year after operation were observed in 2 groups. RESULTS ：Within one week after lung transplantation，44 patients（68.8％）had experienced at least one episode of AKI ，among which 19 cases（29.7％）were stage 1， 17 cases（26.5％）were stage 2 and 8 cases（12.5％）were stage 3. The incidence of AKI was the highest on post-operative day 4 （57.4％）. The incidence of AKI at stage 3 exhibited growth trend within the first week after operation ，and reached the highest on median post-operative day 5（8.7％）. Operation duration ，median value of Scr within one week after operation ，median tacrolimus concentration in non-AKI group were significantly shorter or lower than AKI group ；there was no significant difference in operation type， ECMO support ， use of immunosuppressive agents ， intraoperative blood loss ，ICU days ，mechanical ventilation days，ECMO support days ，the utilization rate of potential nephrotoxic drugs （ ≥4 kinds） and hospitalization days between 2 groups （P＞0.05）. There was no statistical significance in the survival rate at stage 1 and 2 one year after operation between AKI group and non-AKI group （P＞0.05）. One year after operation ，survival rate of AKI group at stage 3 was significantly lower than that of non-AKI group （P＜0.05）. CONCLUSIONS：The incidence of AKI is high after lung transplantation. Operation duration ，median value of Scr within one week after operation ，median tacrolimus concentration were possible factors for the occurrence of AKI after operation.
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Objective To investigate the effect of Shenfu Injection on acute renal injury (AKI) in children with congenital heart disease after operation. Methods Sixty-two children with atrial or ventricular septal defect, treated in Affiliated Hospital of Southwest Medical University from August 2016 to December 2018, were divided into two groups according to different treatment methods, such as conventional Western medicine treatment group and Shenfu Injection group, with 31 cases in each group. The children in Shenfu Injection group were given 20 mL Shenfu Injection from the beginning of anesthesia induction to the end of cardiopulmonary bypass, the children in Western medicine conventional treatment group were pumped with the same volume of normal saline. The anesthesia time, total operation time, cardiopalmonary bypass time, aortic clamping time, and the use of milrinone, dopamine, epinephrine, sodium nitroprusside and other drugs in the two groups were observed. The serum creatinine (SCr) level was measured by chemiluminescence method before operation (T0), at the beginning of operation (T1), at the beginning of cardiopulmonary bypass (T2), at the end of cardiopulmonary bypass (T3) and at the end of operation (T4), and the glomerular filtration rate (eGFR) was calculated. The mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), adrenaline (E) and noradrenaline (NE) in two groups were recorded at each time point. Results There was no significant difference in anesthesia time, total operation time, cardiopalmonary bypass time, aortic clamping time and the use of milrinone, dopamine, E and sodium nitroprusside between the Shenfu Injection group and Western medicine conventional treatment group (all P > 0.05). There was no significant difference in HR and CVP between the two groups at T0-T4 (all P > 0.05). There was no significant difference in MAP level between the two groups at T0 and T1( both P > 0.05), with the time prolonging, the MAP level of Western medicine conventional treatment group was significantly lower than that of T0, while MAP level of Shenfu Injection group was significantly higher than that of T0. At T2, the MAP level of Shenfu Injection group was significantly higher than that of the Western medicine conventional treatment group [mmHg (1 mmHg = 0.133 kPa): 66.6±6.5 vs. 53.1±6.7, P < 0.05]. There was no significant difference in E and NE between the two groups at T0 and T1 (P > 0.05), with the time prolonging, both E and NE decreased compared with those at T0 (both P < 0.05), but there was no significant difference at the same time point (all P > 0.05). At T0, there was no significant difference in SCr and eGFRs between the two groups (both P > 0.05), at T1, the SCr levels of two groups were significantly higher than those at T0, but the SCr level of Shenfu Injection group was significantly lower than that of Western medicine conventional treatment group (μmol/L: 42.43±15.91 vs. 56.58±16.80, all P < 0.05). From T2, the SCr levels of two groups began to gradually reduce, but it was still significantly higher than those at T0, the two groups reached the lowest level at T4, and the level of SCr in Shenfu Injection group was significantly lower than that of Western medicine conventional treatment group (μmol/L: 36.24±9.72 vs. 46.85±15.91, P < 0.05). Compared with T0, the eGFRs levels of the two groups were significantly lower at T1-T4, but gradually increased with time, reached the highest level at T4, and the eGFRs level of Shenfu Injection group was significantly higher than that of Western medicine conventional treatment group (mL·min-1·1.73 m-2: 113.7±12.1 vs. 79.6±12.5, P < 0.05). The incidence of AKI in Shenfu Injection group was significantly lower than that in Western medicine conventional treatment group [22.58% (7/31) vs. 64.52% (20/31), P < 0.05]. Conclusion Shenfu Injection can reduce the incidence of AKI in children with congenital heart disease after operation.
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Objective@#To explore the main risk factors of hospital infection in children with hypospadias after operation and to formulate targeted nursing measures so as to provide accurate nursing strategies for effective prevention and control of hospital infection after operation.@*Methods@#Totally 383 children who underwent hypospadias surgery in the hospital from January 2016 to December 2017 were selected as the research objects. The clinical data of all cases were reviewed and sorted out. The hospital infection rate, infection site and main risk factors of hospital infection after operation were analyzed to formulate prevention strategies.@*Results@#71 of 383 children suffered from hospital infection, and the incidence rate of hospital infection was 18.5%.The distribution of infection sites was: respiratory tract infection in 30 cases, accounting for 42.25%;Urinary tract infection was found in 25 cases (35.21%). Incision infection was found in 14 cases (19.72%).Gastrointestinal infection occurred in 2 cases (2.82%). Logistic multivariate analysis showed that age, length of hospital stay after operation were closely related to hospital infection.@*Conclusions@#The major risk factors for postoperative nosocomial infection in children with hypospadias are age and postoperative hospital stay.Nursing measures: The hospital stay of children after operation can be shortened as much as possible by reminding and standardizing the routine maintenance of urinary catheter and strengthening the cooperation between doctors and nurses through charts. Strict implementation of visiting and accompanying system, good environmental control, strengthening hand hygiene, standardization of preoperative skin preparation and other nursing measures are adopted to protect children to the greatest extent.
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Objective To observe the effect of combination use of tramadol and ketorolac tromethamine for patientcontrolled intravenous analgesia (PCIA) after gynecological laparoscopic surgery. Methods Ninety patients with American Society of Anesthesiologists (ASA) grade I or Ⅱ undergoing gynecological laparoscopic surgery under general anesthesia were randomly divided into three groups: group T (using tramadol for PCIA) , group TK (using tramadol and ketorolac tromethamine for PCIA) and group K (using ketorolac tromethamine for PCIA) . The visual analog scale (VAS) scores at rest and moving and Ramsay sedation scale(Ramsay) scores were recorded at 1 h (t1) ,4 h (t2) ,8 h (t3) , 12 h (t4) , 24 h (t5) , 36 h (t6) , 48 h (t7) after surgery.The total dosage of rescue analgesia drug and the times of needing rescue analgesia were recorded. Adverse reactions were also recorded. Results VAS scores at rest in t 1,t2,t3,t4,t5 and t6 after surgery were significantly lower in group T and group TK than in group K(P<0.05) . VAS scores at movement time was not significantly different. After surgery,incidence rate of nausea,vomiting,dizziness or sleepiness was significantly higher in group T than in group TK and group K(P<0.05) . The total dosage of rescue analgesia drug in group K was significantly higher than in group T and in group TK (P<0.05) . In 24 h after surgery,patients pressed the button of PCIA (2.89±0.597) times in group TK,(3.05±0.574) times in group T,(6.50±0.859) times in group K.Ramsay scores at each time points after surgery were significantly increased (P<0.05) . Total dosage amount of rescue drugs and number of patients using rescue drugs were significantly higher in group K than in group T and group TK (P< 0.05) . Conclusion Combination use of tramadol and ketorolac tromethamine for PCIA after gynecological laparoscopic surgery has better analgesia effect with reduced side effects.
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Objective To explore the main risk factors of hospital infection in children with hypospadias after operation and to formulate targeted nursing measures so as to provide accurate nursing strategies for effective prevention and control of hospital infection after operation. Methods Totally 383 children who underwent hypospadias surgery in the hospital from January 2016 to December 2017 were selected as the research objects. The clinical data of all cases were reviewed and sorted out. The hospital infection rate, infection site and main risk factors of hospital infection after operation were analyzed to formulate prevention strategies. Results 71 of 383 children suffered from hospital infection, and the incidence rate of hospital infection was 18.5% .The distribution of infection sites was: respiratory tract infection in 30 cases, accounting for 42.25% ;Urinary tract infection was found in 25 cases (35.21% ). Incision infection was found in 14 cases (19.72%).Gastrointestinal infection occurred in 2 cases (2.82%). Logistic multivariate analysis showed that age, length of hospital stay after operation were closely related to hospital infection. Conclusions The major risk factors for postoperative nosocomial infection in children with hypospadias are age and postoperative hospital stay.Nursing measures: The hospital stay of children after operation can be shortened as much as possible by reminding and standardizing the routine maintenance of urinary catheter and strengthening the cooperation between doctors and nurses through charts. Strict implementation of visiting and accompanying system, good environmental control, strengthening hand hygiene, standardization of preoperative skin preparation and other nursing measures are adopted to protect children to the greatest extent.
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OBJECTIVE:To investigate therapeutic efficacy and safety of the use of Kubai oil and Cuyu oil by stages on wound healing after perianal abscess operation.METHODS:A total of 125 observation objects selected from Chengdu Third People' s Hospital during Jan.2014-Jan.2016 were randomly divided into control group (60 cases) and observation group (65 cases).Both groups received perianal abscess incision drainage or thread-drawing drainage.Control group was additionally given gentamicin gauze for dressing and other treatments after surgery based on routine treatment.Observation group was given Kubai oil gauze for dreassing in wound inflammation period,Cuyu oil gauze for dressing in granulation growth period and epithelial growth period.After 4 weeks of treatment,therapeutic efficacy,wound healing,wound pain,wound secretion and the growth of granulation tissue were compared between 2 groups.The occurrence of ADR was also recorded.RESULTS:The cure rate of observation group reached 80.0％,which was significantly higher than 63.3％ of control group (P＜0.05);the reduction rate of wound area was significantly higher than control group,while the carrion shedding time and wound healing time were significantly lower than control group (P＜0.01 or P＜0.05).The wound pain score in 2nd,4th week,the wound secretion score and granulation tissue growth score in 1st,2nd,4th week after operation were significantly lower than control group (P＜0.01 or P＜0.05).No significant ADR was found in 2 groups.CONCLUSIONS:For the patients underwent perianal abscess operation,the use of Kubai oil and Cuyu oil by stages can effectively improve therapeutic efficacy and wound healing,and relieve postoperative pain with good safety.
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Objective:To study the prevention effect of specimen skin transplantation for skin flap necrosis after breast cancer surgery.Methods:A retrospective analysis of 116 patients with breast cancer treated by surgery from January 2015 to November 2015 was reviewed,with skin graft in 58 cases,recorded as the observation group;skin graft was not accepted in 58 cases,as the control group,compared skin flap necrosis rate between the two groups after the operation,the operation index (operation time,hospitalization time,follow-up time and two times the proportion of skin graft),and before and after the operation of the IL-1 β,IL-6 and TNF-α levels.Resultes:The observation group of full-thickness skin flap necrosis of skin flap necrosis ratio was 0,the total incidence rate was 8.62％,which were significantly lower than the control group of 8.62％ and 25.86％,the differences were statistically significant(P＜0.05).Hospitalization time of the observation group and two skin graft ratio were significantly less than the control group,the differences were statistically significant (P＜0.05).The two groups after the IL-1 β,IL-6 and TNF-α respectively was significantly lower than that before treatment,the difference was statistically significant (P＜0.05).The patients in the observation group of IL-1 β,IL-6 and TNF-α respectively was significantly lower than the control group,the difference was statistically significant (P＜0.05).Conclusions:For large masses of breast cancer patients,under the premise of clear skin edge there is no residual cancer,through specimen skin transplantation can better prevention of skin flap necrosis after,at the same time,can promote the rehabilitation of patients,the effect is good,it is worth to give recommendation.
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Objective: To share the anti-infection experience for the patients with complicated intra-abdominal infection after operation.Methods: The whole course of drug administration participated by clinical pharmacist in one patient with complicated intra-abdominal infection after pancreatoduodenectomy were retrospectively analyzed and discussed.Results: Enterococcus was found in the blood culture and ascites.According to the results of drug sensitive tests, clinical pharmacist provided medication suggestions and performed medication mornitoring.According to the blood concentration, clinical pharmacist adjusted the dose of vancomycin, and changed the therapy regimen according to the changes of conditions.As a result, adverse reactions were controlled timely, and satisfactory treatment effects were obtained.Conclusion: The aetiology of complicated intra-abdominal infection is complex with intractable treatment, and the participation of clinical pharmacists in the treatment can improve the efficiency and safety.
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Objective To investigate the effect of ultrasound-guided subcostal transverses ab-dominis plane block with dexmedetomidine mixed ropivacaine in related-living kidney transplantation donor.Methods Forty related living kidney transplantation donors (male 1 5 cases,female 25 cases, aged 20-60 years,ASA grade Ⅰ or Ⅱ)were randomized into dexmedetomidine group (group D,n =20)and control group (group C,n =20).All the patients received ultrasound-guided subcostal TAP block after operation,group D with dexmedetomidine 1 μg/kg and 0.375% ropivacaine to 20 ml,and group C with 0.375% ropivacaine 20 ml.All the patients were assessed with both Ramsay scores and Visual Analogue Scale (VAS)at rest or on moving at 2,4,8,24 and 48 hours after operation.The duration of sensory blockade,the first time and the times of pressing the analgesia pump in the first 24 hours after operation,the requirements of flurbiprofen axetil and midazolam were recorded.The u-rine on the first and the second day after operation and the first flatus time were compared.The plas-ma concentrations of urea nitrogen (BUN)and creatinine(Cr)before surgery and on the second and fifth day after operation were determined.Results Compared with group C,the scores of VAS were de-creased at 4 and 8 hours after operation in group D (P <0.05).There were no differences in Ramsay scores between the two groups.Compared with group C,less frequency of use of flurbiprofen axetil (15% vs 0%) and midazolam (10% vs 0%)in group D,longer time of sensory blockade,postponed time to firstly press the analgesia pump and the less frequency of pressing the analgesia pump in group D (P <0.05),the urine on the first day was increased and the first flatus time was earlier,the plasma concentrations of BUN and Cr were significantly lower on the second day after operation in group D (P < 0.05 ). Conclusion Dexmedetomidine mixed ropivacaine can promote the anaesthesia of ultrasound-guided subcostal TAP block with ropivacaine,prolong the time of sensory blockade and improve the recovery after nephrecto-my in living-related kidney donor.
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Objective To study the effects of previous analgesia of acupuncture on patients with the mixed hemorrhoid surgery pain.MethodsA total of 70 patients with mixed hemorrhoid treated with “Milligan-morgan hemorrhoids” were randomly divided into treatment group and control group, 35 patients in each group. The treatment group was treated 30 min prior to the surgery with needling and manipulating Baliao, Chengshan, Hegu every five minutes until the operation, while the control group was not treated before the operation. The patients were assessed by Visual Aualogue Scale and self-reporting Inventory.ResultsAfter the operation, the treatment group was significantly better than the control group in the outcome index of beginning time of pain (14.3 ± 4.9 hvs. 4.2 ± 2.3 h, Z=-5.666,P<0.01) and peak time of pain (17.3 ± 4.5 hvs. 6.0 ± 2.9 h,Z=-5.581,P<0.01). The treatment group was significantly better than the control group in decreasing the pain beginning VAS score (3.3 ± 1.7vs. 4.6 ± 1.7,Z=-2.820, P<0.01) and pain peak VAS score (4.5 ± 2.0vs. 6.5 ± 1.2,Z=-4.025,P<0.05). After surgery, the treatment group was significantly better than the control group in decreasing the score of Self-reporting Inventory scale at the 1stday (1.8 ± 1.3vs. 3.0 ± 1.3),Z=-3.472,P<0.01) and 2ndday (1.2 ± 0.9vs. 1.9 ± 1.2,Z=-2.464,P<0.05). And the treatment group was significantly better than the control group inreducing the quantities of compound aminopyrine phenacetin tablet (0.5 ± 0.9vs.1.5 ± 1.7,t=3.167,P=0.002).ConclusionAcupuncture analgesia 30 minutes prior to the mixed hemorrhoid surgery can significantly reduce the postoperative pain.
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Objective To observe the effect of heat-producing needling (Shao Shan Huo) and cool-inducing needling (Tou Tian Liang) on the gait cycle after operation for gluteus contracture. Method Sixty-six patients after operation for gluteus contracture were randomized into a treatment group and a control group, 33 in each group. The control group was intervened by rehabilitation, while the treatment group was by acupuncture in addition to the rehabilitation training. The topical points Zhibian (BL 54), Huantiao (GB 30), and Juliao (GB 29) were treated with reducing cool-inducing needling technique; Biguan (ST 31), Futu (ST 32), Zusanli (ST 36), Fenglong (ST 40), Xuehai (SP 10), Diji (SP 8), and Yanglingquan (GB 34) were treated with reinforcing heat-producing needling technique. The motor time parameters were observed before and after intervention.Result After intervention, the supporting phase of the affected side, supporting phase of the healthy side, gait cycle, swinging phase of the affected side, swinging phase of the healthy side, and bilateral supporting phase of the treatment group were significantly different from that of the control group (P<0.05).Conclusion Heat-producing and cool-inducing needling techniques can effectively shorten the gait cycle after operation for gluteus contracture, and can improve the walk function.
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Objective To explore the administration of Dexmedetomidine combined with remifentanil for sedation and analgesia of ICU patients with hypertensive cerebral hemorrhage after operation.Methods A total of 60 patients with hypertensive cerebral hemorrhage treated with hematoma removal under craniotomy were selected from May 2013 to June 2015.The patients were randomly (random number) divided into the Dexmedetomidine combined with remifentanil group (D + R, n =30), and Midazolam combined with remifentanil group (M + R, n =30).The blood pressure, respiration rate, oxygen saturation, heart rate, ICP (intracranial pressure), Ramsay sedation scores, and IL-1, and TNF-α levels were recorded after sedation and analgesia in ICU, and 6 h, 24 h, 48 h after operation (T0-T3).Results Compared with M +R group, the MAP, RR, HR, ICP, IL-1β, TNF-α, rate of reoperation for check bleeding, and mortality were significantly decreased in D + R group (P ＜ 0.05), and Ramsay sedation score was significantly increased at the same time (P ＜ 0.05) without excessive sedation and analgesia noticed.Conclusions Dexmedetomidine combined with remifentanil exhibits significant benefit in many respects including control of great fluctuations of blood pressure and intracranial pressure after craniotomy, reduce the production and release of inflammatory mediators, reduce the occurrence of rebleeding after operation.It shows good controllability and safety, it is an optimal method producing sedation and analgesia in ICU patients with hypertensive cerebral hemorrhage after operation.
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Objective To explore the efficacy and safety of compound azintamide enteric‐coated tablets in the treatment of patients with dyspepsia after gastrointestinal surgery .Methods Multicenter , randomized ,double blind ,placebo‐controlled ,parallel controlled method w as applied .From January 2011 to January 2013 , of 240 patients with dyspepsia after gastrointestinal surgery from 12 hospitals in Shanghai were enrolled and divided into medicine treatment group (n= 120) and placebo control group (n= 120 ) ,received compound azintamide enteric‐coated tablets or placebo , respectively . Compound azintamide enteric‐coated tablet (100 mg) or placebo was oral taken each time ,three times per day for four weeks .Total and respective score of dyspeptic symptoms (abdominal distension ,loss of appetite ,early satiety ,belching ,nausea ,abdominal pain or abdominal discomfort) were evaluated prior to study and on the 1st , 2nd , 3rd and 4th week after treatment . On the 4th week after treatment ,the efficacy of the improvement of dyspeptic symptoms was compared between the two groups ,and the safety was also evaluated .The score of the quality‐of‐life was compared between the two groups prior to study and on the 4thweek after treatment .The t‐test was performed for comparison between measurement data ,Chi‐square test was used for count data ,and rank sum test was used for rank data .Results At one week after treatment ,the scores of abdominal distension (4 .61 ± 0 .98 ) ,early satiety (2 .87 ± 0 .64 ) ,belching (3 .03 ± 0 .58) ,abdominal pain or abdominal discomfort (3 .13 ± 0 .79) and total score (18 .32 ± 3 .44) of patients in medicine treatment group were significantly lower than those of placebo control group (8 .83 ± 1 .28、4 .28 ± 0 .61、4 .87 ± 1 .07、5 .46 ± 0 .87、29 .63 ± 5 .50) ,and the differences were statistically significant (t=28 .524、17 .400、16 .453、21 .619 and 18 .983 ,all P 0 .05) .At 2nd ,3rd and 4th week after treatment ,respective score of dyspeptic symptoms and total score of medicine treatment group (2nd week:2.57±1.28,1.87±1.17,1.55±1.27,1.55±1.08,1.09±0.82,1.98±1.02,10.53±4.54,3rdweek:1 .42 ± 0 .60 ,1 .11 ± 0 .45 ,0 .94 ± 0 .37 ,0 .94 ± 0 .41 ,0 .79 ± 0 .31 ,1 .42 ± 0 .55 ,6 .52 ± 2 .41 ,4th w eek:1.13±0.51,0.46±0.12,0.58±0.13,0.38±0.16,0.30±0.07,0.81±0.33,3.65±1.06)wereall significantly lower than those of placebo control group (2nd week:8 .50 ± 2 .61 ,3 .78 ± 2 .01 ,4 .08 ± 2 .14 , 4.73±2.64,2.27±2.13,4.91±2.24,28.25±8.86,3rdweek:7.92±2.51,3.68±1.76,4.08±1.86, 4.71±1.77,2.14±0.83,5.01±1.31,27.54±8.09,4th week:7.63±2.37,3.67±1.63,3.92±2.08, 4 .66 ± 2 .95 ,2 .14 ± 1 .65 ,4 .67 ± 2 .34 ,and 26 .68 ± 7 .45) ,and the differences were statistically significant (all t=0 .000 ,all P<0 .01) .At 4th week after treatment ,the total efficacy of total score improvement of dyspepsia symptoms in medicine treatment group was 86 .21% (100/116) ,which was significantly better than that of placebo control group (39 .16% (47/120)) ,and the difference was statistically significant (Z=9 .464 ,P<0 .01) .The total score of quality of life in medicine treatment group was significantly lower than that of placebo control group (12 .24 ± 4 .30 and 22 .13 ± 6 .18) ,and the difference was statistically significant (t=14 .225 , P< 0 .01 ) .No adverse events was observed in both groups during treatment period . Conclusion Compound azintamide enteric‐coated tablets may effectively improve dyspeptic symptoms and quality of life in patients with dyspepsia after gastrointestinal surgery ,and with good safety .
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Objective To discuss the efficacy and safty of sodium β-aescin in the treatment of swelling after lower limb fracture operation.Methods From February 2011 to February 2014 in Minda Hospital Affiliated to Hubei Minzu University,patients with swelling limb after lower limb fracture operations were selected as research subjects.The patients were divided into experimental group and control group randomly.The experimental group were received sodiumβ-aescin,the control group were received mannitol.After 4 days treatment,limb circumference,swelling score and pain score in two groups were compared. Results Compared with control group,the limb circumference,swelling score and pain score in experimental group significantly reduced after 4 days treatment(P<0.05 );the therapeutic effect in experimental group was significantly better than that in control group(P<0.05).The incidence of adverse reaction in two groups had no significant difference.Conclusion Application of sodiumβ-aescin on lower limb fracture shows good therapeutic effect.
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Objective To investigate the effect of ultrasound-guided subcostal transverses abdominis plane (TAP) block with dexmedeto-midine after laparoscopic radical operation. Methods 40 patients underwent laparoscopic radical operation for colorectal cancer were ran-domized into dexmedetomidine group (group DEX) and control group (group CON). All the patients received ultrasound-guided subcostal TAP block after operation, Group DEX with dexmedetomidine 1μg/kg and 0.25%ropivacaine to 20 ml, and group CON with 0.25%ropiva-caine 20 ml. All the patients were assessed with Ramsay scores and the pain at rest and on coughing were assessed with Visual Analogue Scale (VAS), 2, 6, 12, 24 and 24 hours after operation. The highest level and the duration of sensory blockade, the first time and the total times of pressing the analgesia pump in the first day after operation, and the requirements of sufentanil were recorded. First flatus time, first diet time and the length of hospital stay were compared. Results The scores of VAS were significantly less (P<0.001), and the Ramsay scores were more in the group DEX than in the group CON (P<0.01) 2, 6 and 12 hours after operation; with the longer time of sensory blockade (P<0.001), the later to first press the analgesia pump (P<0.001), the less frequence of pressing the analgesia pump (P<0.001), and less dosage of sufentanil (P<0.001). The first flatus time, first diet time were significantly earlier in the group DEX than in the group CON (P<0.001), with the less length of total hospital stay (P<0.001). Conclusion Dexmedetomidine can promote the anaesthesia of ultra-sound-guided subcostal TAP block with ropivacaine and improve the recovery after laparoscopic radical operation.
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Objective To investigate the effects of fresh isolated platelets combined with hemocoagulase on treating and preventing rehaemorrhagia after operation in the patients with cerebral hemorrhage who treated with aspirin.Methods Forty-six patients with cerebral hemorrhage who treated with aspirin were divided into combined therapy group(n =23) and simple therapy group(n =23).Eighteen patients with no aspirin treated were as control group.All patients were received the same basic treatment of small bone flap craniotomy and hemocoagulase.Moreover,patients in combined therapy group were treated with fresh isolated platelets before and after operation.The remained haematoma volume,the volume of draining,platelect aggregation rate,platelet adhesion rate,prothrombin time and activated partial thromboplastin time were measured before and after treatment respectively.Results Before treatment,the haematoma volume were(53 ± 11) ml,(51 ± 13) ml,(50 ± 15) ml in combined therapy group,basic therapy group and control group respectively,and no significant difference was found among the three groups(F =0.29,P ＞0.05).The rate of platelet aggregation and the rate of platelet adhesion in combined treatnnet group were (43.6 ± 6.2) ％ and (41.6 ± 8.5) ％,and (43.1 ± 5.0) ％,(42.7 ± 8.9) ％ in simple group,significantly lower than that in control group ((65.2 ± 6.1) ％,64.3 ±9.1) ％.F =92.93,40.93,P ＜0.05)).At 1st day after treatment,the remained haematoma volume and the volume of draining in combined therapy group were(7 ±4) ml and (301 ±21) ml,significantly lower than that in simple therapy group ((19 ± 5) ml,(413 ± 26) ml,P ＜ 0.05).While the rate of platelet aggregation (64.8 ±5.7)％ and the rate of platelet adhesion(63.3 ±6.6)％ in combined therapy group were significantly higher than that in simple therapy group ((51.6 ± 3.7) ％,(50.3 ± 7.8) ％,P ＜ 0.05).And compared to control group ((68.1 ± 5.9) ％,(67.4 ± 9.5) ％),there were no significant difference between combined therapy group and control group (P ＞ 0.05).Conclusion Fresh isolated platelets combined with hemocoagulase can improve the function of blood clotting and reduce rehaemorrhagia after operation in the patients with cerebral hemorrhage who treated with aspirin.
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Objective To explore the relation and measures prevention between aspirin and relapsing haemorrhage after operation in cerebral haemorrhage patients. Method It' s a prospective control study. A total of 725 patients with hypertensive basal ganglia cerebral haemorrhage admitted to department of neurosurgery from January 2001 to May 2007 were enrolled. They were diagnosed according to the diagnostic criteria set by the fourth national cerebrovascular disease conference in 1995. Haematoma volume was ＞ 50 mL. All patients were treated with craniotomy. And those with respiration and circulation failure, neurologic function deficit before the onset of the disease,major organ dysfunction, haemorrhagic disease and bleeding tendency or applied medicines affecting coagulation function excepted aspirin were excluded. The patients without use of aspirin before the onset of the disease were operated as the control group(group A), and there were 389 patients in group A.The patients with use of aspirin before the onset of the disease were randomly assigned to group B and C group,and there were 168 patients in group B or group C.The patients in group C received the frozen apheresis platelets. We counted different haematoma volume of relapsing haemorrhage after operation,death rate,ADL scores grades by 6 months follow-up survey in three groups. Quantitative data were expressed as mean ± standard deviation (-x ± s). The data were analyzed by using Chi-square test and Student's t test and rank sum test with SPSS 13.0 statistical package. A P value less than 0.05 indicated statisticals significance. Results Haematoma volume of relapsing haemorrhage was (40.59 + 20. 061 )mL, (53.21 ± 21.260) mL, (40.68 ± 19.517) mL in groups A, B, C,respectively. There was significant difference between group A and group B ( P ＜ 0.01 ), between group B and group C ( P ＜ 0.05), but there was no significant difference between group A and group C(P ＞ 0.05). ADL scores grades at 6-month follow-up was (67.04 ± 26. 176), (54.47 ± 29.403 ), (68.21 ± 25.254) in groups A, B, C, respectively. There was more significant difference between group A and group B, in ADL scores grades and the death rate between group B and group C (P ＜ 0.01), but there was no significant difference between group A and group C (P ＞ 0.05). Conclusions Aspirin can increase the occurrence rate of haemorrhage after operation, disablement and death in cerebral haemorrhage patients, but frozen apheresis platelets can reduce the occurrence rate.
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OBJECTIVE To analyze the morbility of nosocomial pulmonary acquired infection and related factors after operation of head injury,and inquire into effective countermeasures. METHODS By methods of retrospective investigation,280 patients in hospital form Jan 2005 to Jan 2007 operated for craniocerebral trauma had investigated on mortality rates of pulmonary infection and related factorsRESULTS The rates of pulmonary infection was 18.2% in 280 patients,the death rate was 38.7% in infected group. and group 13.7% in uninfected. The risk factors of nosocomial pulmonary infection were lower immunity among elderly patients,long-time in hospital,general anesthesia intubation,trachea incision and the use of respiraters. CONCLUSIONS The mortality and morbidity rates of pulmonary infection are both higher for the head injury patients. It's important to prevent infection. According to the main risk factors,to take corresponding protection measures,comprehensive supervision,and emphasis enhencing prevention and control;meanwhile to improve the quality of treatment and nurse,and reduce morbility and death rates of pulmonary infection.