Zhonghua yi xue za zhi
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Zhonghua yi xue za zhi · Dec 2018
Randomized Controlled Trial Comparative Study[The comparison of preemptive analgesic efficacy between short-acting ketamine and long-acting parecoxib].
Objective: To compare the analgesic efficacy between preoperative single-dose ketamine, a short-acting medicine and parecoxib, a long-acting medicine for reducing analgesic consumption in the first 24 h after-operation. Methods: Eighty-one patients from Beijing Chaoyang Hospital undergoing laparoscopic uterus surgery between April and December 2015 were randomly divided into three groups: control group (group C), ketamine group (group K) and parecoxib sodium group (group P). All patients were anesthetized with general anesthesia and received sufentanil-based patient-controlled intravenous analgesia (PCIA). ⋯ There were no differences between groups in the incidence of any adverse effects(all P>0.05). Conclusion: A single injection of short-acting ketamine before laparoscopic uterus surgery, has the same efficacy as long-acting parecoxib for opioid-sparing effect in the first 24 h after-operation. However, parecoxib has better analgesic effect in the early postoperative period.
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Zhonghua yi xue za zhi · Dec 2018
[Predictive value of Wells Score, Revised Geneva Score combined with D-dimer for Pulmonary Embolism in patients with acute exacerbation of chronic obstructive pulmonary disease].
Objective: To evaluate the predictive value of Wells score, revised Geneva score combined with D-dimer for the risk of pulmonary embolism in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods: In this study, 234 AECOPD patients underwent CT pulmonary angiography from March 1, 2013 to December 31, 2015 in the First Affiliated Hospital of Zhengzhou University. The basic data of the patients were collected and the patients were classified into AECOPD combined with pulmonary embolism group(pulmonary embolism group) and AECOPD group according to CT pulmonary angiography results. ⋯ The AUC by Wells score, revised Geneva score, D-dimer, Wells score + D-dimer, revised Geneva score + D-dimer were 0.869 (95% CI: 0.789-0.949), 0.710 (95% CI: 0.588-0.832), 0.866 (95% CI: 0.790-0.941), 0.926 (95% CI: 0.874-0.977), 0.855 (95% CI: 0.751-0.959). The AUC of Wells score and D-dimer were significantly greater than that of revised Geneva score (Z=2.14, 2.12, both P<0.05); the AUC of Wells score + D-dimer was significantly greater than revised Geneva score + D-dimer (Z=2.73, P<0.05). Conclusion: The predictive value of Wells score + D-dimer for pulmonary embolism in AECOPD patients is higher than revised Geneva score + D-dimer.
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Zhonghua yi xue za zhi · Dec 2018
Randomized Controlled Trial[Effect of dexmedetomidine on perioperative stress and postoperative pain in patients with radical resection of esophageal cancer under combined thoracoscope and laparoscope].
Objective: To investigate the effects of dexmedetomidine on perioperative stress and postoperative pain in patients with radical resection of esophageal cancer under combined thoracoscope and laparoscope. Methods: In this prospective study, one hundred patients undergoing radical resection of esophageal cancer in Affiliated Cancer Hospital of Zhengzhou University from January 2016 to October 2017, were randomly divided into control group (group C) and dexmedetomidine group (group D), n=50. All patients were anaesthetized (induced and maintained) with intravenous target-controlled infusion(TCl) of propofol and remifentanil, and intermittent intravenous injection of cisatracuriumbesylate. ⋯ Serum corticosterone in group D were sharply less than them in group C at T(2), T(3), T(4), T(5) (t=16.364, 15.306, 12.153, 12.592, respectively; all P<0.05), but at T(0), T(1), T(6), T(7), T(8), there were no difference between these two groups (all P>0.05). Compared with group C, the number of patients with postoperative pain(VAS score≥4) in group D was obviously less at T(6), T(7), T(8)(10 vs 20, 4 vs 12, 3 vs 10; χ(2)=4.762, 4.762, 4.332, respectively; all P<0.05). Conclusion: Perioperative application of dexmedetomidine can effectively decrease the perioperative stress response, obviously cut down the perioperative opioid consumption, and prevent the transition from postoperative acute pain to chronic pain in patients with radical resection of esophageal cancer under combined thoracoscope and laparoscope.
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Zhonghua yi xue za zhi · Dec 2018
[Application of modified brain protection double-lumen drainage tube in external drainage of chronic subdural hematoma].
Objective: To compare the clinical effects of modified double-lumen drainage tube and traditional silicone tube in external drainage of chronic subdural hematoma. Methods: Selected 49 patients suffering from chronic subdural hematoma hospitalized in the Department of Neurosurgery, the First Affiliated Hospital of Bengbu Medical College between July 2016 and June 2018 who underwent external drainage, and divided them randomly into experimental groups (using modified brain protection double lumen drainage tube in 23 cases) and control group (using traditional silicone drainage tube in 26 cases). Comparison of postoperative hematoma residual volume, the tube indwelling time, the numbers of drainage tube contact with brain tissue and arachnoid membrane, the numbers of infections, the numbers of postoperative epilepsy cases, and changes in Modified Rankin Scale scores between the two groups. ⋯ There were significantly statistical differences in each of the two groups in the modified Rankin scale before and after surgery (P<0.001), there was no significant difference in postoperative Modified Rankin Scale scores between the two groups. Conclusion: The modified brain protection double-lumen drainage tube has good drainage effect in the external drainage of chronic subdural hematoma, and the short tube retention time, causing fewer complications. It is a safe and effective tool for treating chronic subdural hematoma, and it is worthy of clinical promotion.