Zhonghua yi xue za zhi
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Zhonghua yi xue za zhi · Nov 2017
Randomized Controlled Trial[Study of sevoflurane/remifentanil coadministration on improving emergence and recovery characteristics of patients following general anaesthesia with sevoflurane].
Objective: To investigate the effects of remifentanil infusion on emergence and recovery characteristics of patients with thoracoscopic lobectomy following general anaesthesia with sevoflurane. Methods: One hundred patients, who were aged 37 to 65 years with American Society of Anesthesiologists (ASA) physical status 1-2, and scheduled for elective thoracoscopic lobectomy under general anaesthesia in National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, from February 2016 to August 2016, were allocated to receive sevoflurane maintenance regimen(group S, n=50)or sevoflurane/remifentanil maintenance regimen(group SR, n=50)by random digital table. After routine induction and intubation, anaesthesia was maintained with 2% sevoflurane in group S and 1.5% sevoflurane/remifentanil(continuous intravenous injection at rate of 4 μg·kg(-1)·h(-1))coadministration in group SR respectively, with intermittent intravenous infusion of sulfentanil. ⋯ The difference were statistically significant(χ(2)=20.294, 23.574, all P<0.05). The NRS and incidence of complaining CRBD were similar in both groups(all P>0.05). Conclusion: Compared with sevoflurane maintenence, coadministration of remifentanil and sevoflurane maintenance regimen provides better emergence and recovery which are characterized by faster awakening and extubation with a lower incidence of emergence coughing and agitation.
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Zhonghua yi xue za zhi · Nov 2017
[Relationship between frailty and depression in elderly patients].
Objective: To investigate the relationship between frailty and depression by analyzing the clinical data, frailty and depression in the elderly outpatients. Methods: This study included outpatients who visited the Geriatric Section of West China Hospital from July 1, 2016 to December 31, 2016. Clinical characteristics and complications in patients were evaluated comprehensively. ⋯ The depression was assessed by the 30-Item Geriatric Depression. Results: Regression analysis showed that pre-frail (OR 3.286, 95%CI 1.59-3.98) and frail (OR 4.139, 95%CI 1.52-14.40) elder adults had a higher risk of depression than other elders. Conclusion: Pre-frail and frail elders are at high risk of depression.
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Zhonghua yi xue za zhi · Nov 2017
Randomized Controlled Trial[A concentration-response observation of hydromorphone combined with ropivacaine in labor analgesia].
Objective: To investigate the median effective dose (ED(50)) of hydromorphone and the appropriate concentration of ropivacaine combined with hydromorphone in epidural labor analgesia. Methods: One hundred and forty nulliparous women undergoing labor selected for delivery with epidural analgesia were enrolled in our hospital from January to June 2016. The first of top 50 women received 0.12% ropivacaine plus 20 μg/ml hydromorphone complex solution, then sequential women were used the modified sequential method to determine the ED(50) and ED(95) of hydromorphone. ⋯ VAS scores at the fourth, fifth, sixth contractions after analgesia in H1 group were significantly higher than those in H2 and H3 groups (all P<0.05). The incidence of motor nerve block in group H3 was higher than that in group H1 and group H2 (26.67%, 6.66%, 3.33%, respectively), the difference was statistically significant (χ(2)=6.413, 4.320, all P<0.05). Conclusions: 0.10% ropivacaine combined with 15 μg/ml hydromorphone has a good analgesic effect, slight motor block, high safety and worthy clinical application for labor analgesia.
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Zhonghua yi xue za zhi · Nov 2017
[Relationship between the severity of reflux esophagitis and the esophageal motility features on high resolution manometry].
Objective: To analyze esophageal motility dysfunction in gastroesophageal reflux disease (GERD) with different severity of esophagitis, and the relationship between the esophageal motility dysfunction and the severity of esophagitis. Methods: GERD patients simultaneously undergone endoscopy and high-resolution manometry were divided into four groups: Non-esophagitis (Non-erosive gastroesophageal reflux disease, NERD) group, mild esophagitis group, moderate esophagitis group and severe esophagitis group. The gender and age were matched for each group, and every group consisted of 80 cases. ⋯ When comparing the differences between each two of the groups, there were significant differences (P<0.001, P=0.012, P<0.001, P<0.001) between NERD group and severe esophagitis group in the HRM parameters of the lower esophageal sphincter pressure, the LES length, the LES-CD separation distance, and the percentage of ineffective swallowing in the NERD and severe esophagitis group. The detection rate of HH was significantly increased from NERD to severe esophagitis, the detection rate of HH was 6.3% to 82.5% in gastoracopy and 16.3% to 45.0% in HRM, and the diagnostic consistency was fair (Kappa Value: 0.31). Conclusions: Hypo-dynamic state of esophageal and HH are the main motility characteristics of erosive gastroesophageal reflux disease, Esophageal motility abnormalities increase in parallel with the severity of GERD from NERD to severe esophagitis, these motility disorders may also play important roles in causing esophagitis.
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Zhonghua yi xue za zhi · Nov 2017
[Effect of different tourniquet releasing strategy on blood loss in total knee arthroplasty].
Objective: To explore the influences on peri-operative blood loss and postoperative blood transfusion in primary total knee arthroplasty when using different methods to release the pneumatic tourniquet. Methods: From January 2015 to December 2016, 484 patients with osteoarthritis were enrolled, undergoing primary unilateral total knee arthroplasty in the Orthopedics Department of Peking University Third Hospital. Retrospective data was used, and all the patients had been operated on by three independent working groups. ⋯ A total of 29 patients received blood transfusion(Group A 10/165, 6.1%; Group B 11/177, 6.2%; Group C 8/142, 5.6%). There was no significant differences among the three groups in output of drain(P=0.496), decrease of hemoglobin level(P=0.242), total measured blood loss(P=0.390), hidden blood loss(P=0.204), or postoperative blood transfusion rate(P=0.976). Conclusions: Under the routine application of the multimodal blood-loss prevention approach, including tranexamic acid, drain under atmospheric pressure, compression and cryotherapy after operation, the different choices of tourniquet releasing strategies have no significant effect on peri-operative blood loss or postoperative blood transfusion rate in total knee arthroplasty.