ObjectivesTo systematically review the efficacy and safety of fast track surgery in perioperative patients with adrenalectomy.MethodsPubMed, EMbase, Web of Science, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy and safety of fast track surgery in perioperative patients with adrenalectomy from inception to January 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 11 RCTs involving 1 034 patients were included. The results of meta-analysis showed that: fast track surgery in perioperative patients with adrenalectomy could shorten first exhaust time (MD=−17.16, 95%CI −21.86 to −12.46, P<0.000 01), postoperative catheter indwelling time (MD=−43.44, 95%CI −46.65 to −40.23, P<0.000 01) and drainage tube indwelling time (MD=−39.91, 95%CI −57.58 to −22.23, P<0.000 01), and reduce the incidence of complications after adrenalectomy (OR=0.26, 95%CI 0.1 to 0.39, P<0.000 01). There were no statistically differences in operation time (MD=−1.18, 95%CI −3.22 to 0.86, P=0.26) and blood loss (MD=0.25, 95%CI −2.84 to 3.34, P=0.88) between two groups.ConclusionsCurrent evidence shows that, compared with the conventional rehabilitation group, fast track surgery can promote postoperative recovery of patients with adrenalectomy more safely and effectively, which has clinical promotion value. Due to limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusion.
摘要:目的: 评价机械通气对胸腔内脉搏氧饱和度的影响。 方法 :以食道、气管和降主动脉作为胸腔内脉搏氧饱和度的监测位点,将改制后的氧饱和度探头分别固定于上述部位,并连接于同一监护仪上。纯氧通气,待上述氧饱和度容积波波形和读数稳定,停止机械通气30s。以录像的方式记录机械通气停止前后30 s内食道、气管和降主动脉SpO2容积波和读数的变化。同时记录舌SpO2。 结果 :机械通气时,食道、气管和降主动脉三个监测位点均可获得异常高大的SpO2容积波;停止通气时,异常高大的氧饱和度波形消失。食道、气管和降主动脉脉搏容积波变异率分别为112%,74%,302%。降主动脉脉搏容积波的变异率明显高于食道和气管( 〖WTBX〗P ＜005)。机械通气停止前后30s内食道、气管和降主动脉的SpO2读数变化无显著差异(〖WTBX〗P ＞005)。 结论 :机械通气对胸腔内食道、气管和降主动脉氧饱和度读数无影响,主要影响是脉搏容积波。且各位点间脉搏氧容积波受呼吸的影响不同。Abstract: Objective: To investigate the impact of mechanical ventilation on pulse oximetry in thoracic cavity. Methods : After dogs anesthesia induction and thoracotomy, pulse oximeters were simultaneously placed at esophagus, trachea, and descending aorta, and connected with the same monitor for SpO2 monitoring. During ventilation with 100% oxygen, the mechanical ventilator was temporarily switched off for 30 seconds after high quality PPG waveforms and SpO2 readings were obtained. SpO2 signals and readings from esophagus (SeO2), trachea (StraO2), descending aorta (SDAO2) shown on the monitoring screen were recorded by the SONY video before and after stopventilation. And StonO2 were also recorded. Results : Abnormally largeamplitude PPG waves were found in normal waves at monitoring sites of esophagus, trachea, and descending aorta in all animals during ventilation; however, they disappeared without ventilator. The variation rate in ventilationinduced PPG amplitude were 112%, 74%, 302% at esophagus, trachea and descending aorta respectively. The PPG amplitude variation rate from SDAO2 was higher than that from SeO2 and StraO2 (〖WTBX〗P ＜005). However, the SpO2 readings obtained from pulse oximetries in all sites were no significantly statistical difference within 30s before and after temporarily stopventilation (〖WTBX〗P ＞005). Conclusion : Abnormally amplitude PPG waveforms from oximetry probe placed at esophagus, trachea, and descending aorta were induced by ventilation. The Variation rate in ventilationinduced PPG amplitude was various at different monitoring sites. The SpO2 readings from esophagus, trachea, and descending aorta were not significantly contaminated by ventilation.
Objective To explore the effect of extended nursing intervention on patients with enucleation day surgery. Methods Patients who underwent monocular enucleation in the day ward of the Ophthalmology Center, Beijing Tongren Hospital, Capital Medical University between July 2020 and June 2021 were selected. They were randomly divided into control group and trial group by random number table method. The control group was given routine day-to-day nursing care, while the trial group added the extended nursing intervention measures of “forward and extended” on the basis of routine day-to-day overall nursing. The preoperative and postoperative anxiety levels, health knowledge awareness, operation shutdown rate, and nursing satisfaction were compared between the two groups of patients, and the application effect of extended nursing interventions in such patients was evaluated. Results Finally, 106 patients were included, 106 questionnaires were distributed, 106 were recovered, and the recovery rate was 100.0%. There were 53 cases in both the control group and the trial group. There was no significant difference in gender, age and education level between the two groups (P>0.05). The operation shutdown rate in the trial group was lower than that in the control group (0.0% vs. 11.3%). The preoperative and postoperative anxiety scores of the trial group were lower than those of the control group (preoperative: 50.06±5.27 vs. 58.25±5.21, postoperatively: 49.43±5.45 vs. 58.53±5.55). The score of the health knowledge awareness questionnaire in the trial group was higher than that in the control group (89.96±2.88 vs. 75.00±3.16). The degree of satisfaction in the trial group was better than that in the control group. In the trial group, 38 cases were very satisfied, 14 cases were satisfied, and 1 case was dissatisfied. In the control group, 19 cases were very satisfied, 27 cases were satisfied, and 7 cases were dissatisfied. The above differences were statistically significant (P<0.05). Conclusions Nursing intervention of “forward and extended” for patients with enucleation day surgery can effectively relieve patients’ anxiety before and after surgery, improve health knowledge awareness and nursing satisfaction, and reduce the operation shutdown rate.
ObjectiveTo explore the value of ultrasonic score, blood vessels and vascular resistance index in predicting and diagnosing benign and malignant ovarian tumor. MethodsA total of 157 patients with ovarian tumors (77 benign and 80 malignant) aged from 19 to 68 years old (average 56 years) between January 2008 and June 2012 were enrolled in the research. The ultrasonic score, blood vessels and vascular resistance index were recorded, and the differences between benign and malignant tumor were compared according to the pathological diagnosis; Their sensitivities and specificities were analyzed with the preoperative prediction. ResultsIn benign ovarian tumor, ultrasound scores and blood vessels index were obviously lower than that in the malignant tumor (P<0.05); the vascular resistance index was much higher than that in the malignant tumor (P<0.05). The sensitivities and specificities in diagnosing malignant tumor were high when the ultrasonic score was ≥ 2, vascular index was>0.02/cm3, and blood flow resistance index was ≤ 0.6. The sensitivities were 92.5%, 90.0%, 87.5%, respectively; while the specificities were 90.9%, 89.6%, 84.4%, respectively. ConclusionUltrasonic score, blood vessels and vascular resistance index have significance for identifying benign and malignant ovarian tumors; ultrasonic score is more accurate which has high value of clinical application and popularization.
Objective To evaluate the relationship between body mass index (BMI) and malignant lymphoma by means of Meta-analysis. Methods Such databases as Web of Science, PubMed, EBbase, CNKI, Wanfang, VIP and CBM were searched from the date of their establishment to April 2011 to collect the case control studies on the relationship between BMI and malignant lymphoma. Two researchers independently selected studies, extracted data and assessed the quality according to the inclusive and exclusive criteria, and then conducted Meta-analyses by using RevMan5.0 software for heterogeneity test and pooled OR calculation. Results Seven case control studies involving 8416 malignant lymphoma patients and 14760 other patients were included. The quality of all studies scored 4, indicating reliable quality. Meta-analyses of the low BMI, overweight and obesity population were OR=0.8, 95%CI 0.79 to 0.95, P=0.003; OR=1.04, 95%CI 0.98 to 1.11, P=0.16; and OR=1.22 95%CI 1.04 to 1.43, P=0.01, respectively. The stratified Meta-analysis on histological subtypes showed that obesity was associated with a significantly increased risk of diffuse large B cell lymphoma (OR=1.33 95%CI 1.18 to 1.50, Plt;0.000 01), but was not associated with the follicular lymphoma or small lymphocytic lymphoma/chronic lymphocytic leukemia. Conclusion These findings demonstrate that low BMI is associated with the decrease of malignant lymphoma, and obesity is an increasing risk of malignant lymphoma, especially, the diffuse large B cell lymphoma.
Objective To investigate the effective dose of remimazolam benzenesulfonate to suppress cardiovascular responses to laryngeal mask placement in elderly patients. Methods Elderly patients undergoing laryngeal mask anesthesia between March and June 2023 were selected. Combined with sulfentanil 0.2 μg/kg, remimazolam was used as induction hypnotic. The first patient was given remizolam benzenesulfonate 0.16 mg/kg infused by pump for 1 min. The dose of remimazolam for the next patient was determined by the biased coin up-and-down method based on the patient’s response to the laryngeal mask placement. The score of Modified Observer’s Assessment of Alert/Sedation, vital signs and anesthesia depth index (AI) were recorded during induction. Probit analysis was used to calculate the half effective dose (ED50), 95% effective dose (ED95) and half effective AI (AI50). According to the statistical requirements, at least 45 negative patients were required. Results A total of 53 elderly patients were enrolled in the study until the end of the trial. The ED50 and ED95 of remimazolam benzenesulfonate for inhibiting cardiovascular responses to laryngeal mask insertion were 0.154 mg/kg [95% confidence interval (CI) (0.034, 0.170) mg/kg] and 0.207 mg/kg [95%CI (0.190, 0.614) mg/kg], respectively. AI decreased during induction, with an AI50 of 64.119 [95%CI (60.609, 69.984)]. Conclusion When combined with 0.2 μg/kg sufentanil, infusing 0.2 mg/kg remimazolam benzenesulfonate for 1 min is effective and safe for laryngeal mask anesthesia induction in elderly patients.
Objective To explore the application effect of " dual-channel teaching” of the rain classroom platform in airway obstruction teaching. Methods A total of 228 nursing undergraduate students in Grade 2015 were selected as the research subjects by the method of cluster random sampling. Class B (n=115) was randomly selected as the control group and Class A (n=113) was selected as the experimental group. Class B adopted the traditional practical teaching mode, and Class A was integrated with the rain classroom platform on this basis. After the end of the course, the learning situation of the experimental group students were understood through the rain classroom background data, the teaching effects of the two groups were evaluated by the students’ theoretical scores and applied case test scores, and the experimental group student’s evaluation of the rain class was understood by questionnaire survey. Results There were 105 nursing students (92.92%) completing pre-school preparation tasks, 103 (91.15%) participating in the class answering, and 113 (100.00%) completing the after-school exercises. The theoretical scores and applied case assessment scores of the experimental group students were 79.44±6.25 and 83.24±3.64, respectively, and those of the control group students were 68.50±7.96 and 70.59±5.51, respectively, the differences between the two groups were statistically significant (P<0.05). In the experimental group, 92 nursing students (81.42%) liked the rain classroom platform teaching. Conclusion The rain classroom platform teaching can bring about the ecological transformation of the open speech in classroom, and comprehensively improve the overall quality and comprehensive ability of students, which is worthy of promotion and application in teaching.